Perioperative analysis of biopsies issued from mediastinoscopy

BACKGROUND

The objective of this study was to evaluate frozen sections of samples obtained at mediastinoscopy for their clinical usefulness.

METHODS

This study retrospectively reviewed the records of all patients who underwent mediastinoscopy with perioperative frozen sections in a 1-year period.

RESULTS

A total of 123 consecutive patients underwent the procedure. There were no false-positive results. Of the 71 malignant proliferations, 67 were diagnosed from frozen sections. The technique never failed to establish the absence of mediastinal nodal involvement in patients with suspected or proven lung tumors and enlarged nodes (n = 18) who underwent immediate thoracotomy. Frozen sections allowed recognition (n = 36) or strong suspicion (n = 4) of N2 disease in patients subsequently treated by induction chemotherapy. The technique never failed to establish the nonresectability of lung cancer in patients for whom this condition was suspected perioperatively (clinical stage IIIb; n = 10).

CONCLUSIONS

Mediastinoscopy with frozen sections remains an extremely useful tool for the management of paratracheal or subcarinal mediastinal disease.

Blood vessel and lymphatic vessel invasion in resected nonsmall cell lung carcinoma. Correlation with TNM stage and disease free and overall survival

BACKGROUND

The objective of this prospective study was to assess in 96 patients with resected nonsmall cell lung carcinoma (NSCLC) the prevalence of both blood and lymphatic vessel invasion (BVI and LVI) according to stage, as well as their prognostic value for disease free and overall survival.

METHODS

BVI and LVI were evaluated by hematoxylin and eosin stains on surgical specimens after resection. Associations among variables were tested by Fisher's exact test or the chi-square test; prognostic values on time-failure data were analyzed by the log rank test and the multivariate Cox model.

RESULTS

BVI was present in 52% of NSCLC cases and LVI in 59%. Venous but not arterial vascular invasion correlated with the T factor and pTNM, whereas LVI correlated with the N factor and pTNM. In univariate analysis, LVI but not BVI was associated with a short disease free interval (P = 0.0007) and poor survival (P = 0.0001). The estimated relative risk of death in patients with LVI was 3.2 compared with patients without LVI. In multivariate analysis, LVI and pTNM were additional predictors for poor disease free and overall survival. In this series, BVI had no prognostic value.

CONCLUSIONS

The prevalence of BVI and LVI appeared high in patients with NSCLC, especially those with advanced pTNM stages. LVI was predictive of poor outcome, both time to recurrence and death.

[Importance of flow cytometry in the detection of anti-erythrocyte autoantibodies]

Coombs test and flow cytometry have been compared in terms of specificity and sensibility in a population of hospitalized patients, for whom a Coombs test had been required. The Coombs test seems more sensible than flow cytometry to detect red cell-bound IgG. For a given patient and over the time, flow cytometry seems better correlated with the severity of haemolysis if erythrocytes are strongly sensitized by IgG. The results of flow cytometric analysis, in percentage of sensitized erythrocytes, do not allow to define a sensibilization threshold for haemolysis prediction. Flow cytometric analysis would be more sensible than Coombs test in the detection of red cell-bound C3d, but these cases are not associated with autoimmune haemolytic anemia. Direct Coombs test should remain the diagnostic test of autoimmune haemolytic anemia.

[Drug-induced thrombopenias and neutropenias. An in vitro study by the indirect immunofluorescence test]

The sera from 38 patients with suspected drug-induced thrombocytopenia (22) or neutropenia (16) were tested with the indirect immunofluorescence test on platelets or granulocytes for the presence of drug-dependent antibodies. Three drug-induced antibodies with reactivity against platelets and 5 with reactivity against granulocytes were detected. In 3 sera antibodies were found which reacted already with target cells without adding the drug to the test system. These data show that drug-induced blood dyscrasias often have an immunological cause and that in vitro tests can be helpful in detecting the responsible drug. Different mechanisms can be involved. In many sera circulating antibodies were not found, but an immunological mechanism is likely to be involved in some of these cytopenias: the antibody could be entirely absorbed by the target cells, a metabolite of the drug could be the immunogen and finally the test may not be sensitive enough.

[Trial treatment of severe Raynaud's phenomenon with prostacyclin (PGI2)]

Severe forms of Raynaud's phenomenon are very disabling. In a randomized, single-blind trial, we have evaluated the effects of PGI2, a natural compound with strong vasodilator and anti-platelet activities, in 14 patients presenting with Raynaud's phenomenon. The patients received a 24-hour infusion of either PGI2 in doses of 10 mg/kg.min, or only the solvent (glycine buffer). All patients recorded the frequency and severity of the attacks before and after treatment, and 7 of the 8 patients who received the solvent benefited from a PGI2 infusion 30 to 60 days later. Among the 14 patients (6 men, 8 women), 10 had underlying collagen disease. The number of attacks per week was initially 15.9 +/- 5.3 (mean +/- s.e.). The resulting impairment was pronounced (+ + on a + to + + + scale). Radioimmunoassays of prostaglandins showed a strong increase in 6-keto PGF1 alpha levels during the infusion, without changes in thromboxane levels. A significant (p less than 0.05) reduction was observed in the number of attacks (2.6 +/- 2.5 per week) and in impairment (+ on average after PGI2 but not after the buffer). Improvement after PGI2 lasted from 0.5 to 12 months, and all but one patient regarded the treatment as effective in long-term, despite undesirable side-effects (flush, hypotension) which occurred regularly during PGI2 infusion. In all patients with ulcerations of the finger tips, these healed more rapidly after PGI2. It is concluded that in spite of immediate discomfort, PGI2 in 24-hour infusions seems to be of value in the treatment of severe Raynaud's phenomenon.