A microcomputer based system for the recording and automatic analysis of esophageal pH-studies has been developed. It consists of a microcomputer interfaced with a pH-meter, one video display, two ...disk-drives for five inch diskettes, one printer and a fully interactive program written in BASIC. Every second, the microcomputer records the values of pH measured by the pH-meter. The options available in the program are: 1) Creation of medical records; 2) pH probe calibration; 3) pH-basal value acquisition; 4) Standard Acid Reflux Test (SART); 5) Acid Clearing Test (ACT); 6) 24-hour pH-monitoring test; 7) Summary of patient's current results; 8) Printing and data file management. Each one of these options provides access to other related functions. This system and its software has the following advantages: 1) it achieves a high standard in the execution of esophageal pH-study tests; 2) it provides an objective real-time analysis of the results; 3) it reduces the total cost of the investigation.
To identify bronchoscopic findings that predict resectability of squamous cell carcinoma of the upper thoracic esophagus.
Tracheobronchoscopy was performed in patients with squamous cell carcinoma of ...the thoracic esophagus to assess the infiltration of the tracheobronchial tree by the tumor and predict the resectability. Bronchoscopic records were matched with clinical outcome and intraoperative findings.
University hospital, tertiary care referral center.
A total of 113 patients with supracarinal esophageal carcinoma underwent bronchoscopy as part of the preoperative staging. In 47 patients the bronchoscopy was repeated after a regimen of neoadjuvant chemotherapy.
A total of 160 bronchoscopies performed by the same operator.
Bronchoscopic records matched with clinical outcome and intraoperative findings.
Including patients before and after neoadjuvant chemotherapy, 27 of the 46 with no bronchoscopic abnormalities were operated on: in 24 (89%) of them radical surgical resection was possible. Among the 22 patients with a slight compression on the tracheobronchial tree admitted to surgery, a radical surgical resection was possible in 20 cases (91%). In none of the 5 patients with compression/deviation associated with fixation of the tracheobronchial tree but no mucosal infiltration who underwent surgery was a radical surgical resection possible because of tracheobronchial infiltration.
Compression of the tracheobronchial tree does not necessarily mean infiltration by esophageal carcinoma. If the compression is slight and the mobility of the tracheobronchial tree is normal, a radical esophagectomy is possible in 91% of patients.
To investigate modifications of phenotype in bronchoalveolar lavage (BAL) and venous blood lymphocytes as markers of acute organ rejection in lung transplant patients.
Five consecutive patients ...receiving successful single lung transplants between March 1991 and April 1992 were followed for two years; serial bronchoscopies with BAL and transbronchial biopsies (TBBs) were performed. BAL and venous blood lymphocyte cytofluorimetry was performed at every procedure, and an index, (blood T4/T8)/(BAL T4/T8), was computed.
The index was always > or = 3 in the two patients who did not have graft rejection and always < 3 in the two patients who had repeated episodes of acute rejection (even when no rejection was apparent). The index was frequently < 3 when cytomegalovirus infection was diagnosed.
Since BAL is far less invasive and carries lower risks than TBB, the index might be considered, if our results are confirmed, for screening patients at high risk of acute rejection. TBB could be used as a confirmatory tool for patients who have an index < 3.
March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent high-resolution CT ...(HRCT) of the lung in a complex follow-up program to identify specific abnormalities of acute and chronic rejection (bronchiolitis obliterans) and to monitor the resolution of the bronchial anastomosis. Twenty-two HRCT exams were performed. In patients with acute rejection HRCT failed to identify specific abnormalities of lung parenchyma. In contrast, in one patient with pathological evidence of early bronchiolitis obliterans HRCT showed decreased peripheral vascularization. In the study of the bronchial anastomosis, HRCT showed optimal anastomosis resolution in 4 patients, whereas in one patient with a granuloma demonstrated by fibrobronchoscopy it confirmed the lesion showing also a small pneumomediastinum. Even though the HRCT finding of decreased peripheral vascularization does not appear to be specific for bronchiolitis obliterans, it may be of value in suggesting the diagnosis of early bronchiolitis obliterans in lung transplant. HRCT should be used in all patients with bronchoscopic diagnosis of bronchial complication to study the lesion and its mediastinal spread.
To describe our experience with mediastinal cysts involving the oesophagus.
Retrospective study.
University hospital, Italy.
11 patients who presented to our department with a mediastinal cyst from ...1976-1994.
Excision of the mass through a posterolateral thoracotomy (n = 10) or by video-assisted thoracoscopy.
Morbidity and mortality.
8 patients presented with retrosternal or epigastric pain, three of whom had mild dysphagia. In the remaining 3 the tumour was asymptomatic and an incidental finding on a chest radiograph. Endoscopic ultrasonography and computed tomography (CT) allowed preoperative diagnosis of an extramucosal cyst in 5 of the 7 patients investigated by both tests. Masses were excised through a formal thoracotomy (n = 10) or by video-assisted thoracoscopy. Histological examination confirmed a benign cyst in all cases. There was no operative morbidity and nine patients are free of symptoms after a median follow-up of 2.3 years.
Excision, preferably by thoracoscopy, is the treatment of choice for mediastinal cysts that involve the oesophagus. Special attention should be paid to the vagal nerves, and as many as possible of the muscular layers of the oesophagus should be preserved.
Emphysematous patients that were once treated with double lung transplantation can now also be treated with single lung transplantation. However, single lung transplantation in emphysematous patients ...presents problems in lung size matching, choice of side to transplant and post-operative assistance. Analysing their own experience of three single lung transplants performed on emphysematous patients, the Authors evaluate the effectiveness of the operation, the results and the difficulties encountered. Single lung transplantation is a good therapeutic option for end-stage emphysematous patients. In these patients right lung transplantation is preferable and the donor organ should be oversized. Positive and expiratory pressure in the native emphysematous lung should be applied with extreme caution.
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