Paul A. Thomas

Cancer recurrence after resection: T1 N0 non-small cell lung cancer

The Lung Cancer Study Group entered 907 eligible patients with T1 N0 non-small cell lung cancer in one of three successive clinical trials. At the time of analysis, 201 of these patients were free from malignancy 60 months after operation. Thirty percent of patients who died were free from malignancy at death. Death rates were comparable for the total group (907 patients) and the patients free from malignancy at 60 months (201 patients) (0.086 versus 0.079, respectively); therefore death was not a suitable therapeutic end point. Cancer recurrences were more frequent in patients with non-squamous carcinoma than those with squamous carcinoma (0.088 versus 0.042); however, this difference was not observed after a 60-month malignancy-free interval (0.035 versus 0.022, respectively). Select comparisons between the total group of 907 patients and the 201 patients free from malignancy at 60 months are noteworthy: (1) the rate of occurrence of new, nonpulmonary malignancies was constant (0.016 versus 0.018, respectively); (2) the rate of pulmonary recurrences decreased (0.043 versus 0.013, respectively); and (3) the rate of occurrence of new lung cancer increased (0.009 versus 0.016, respectively). Therefore, although cancer recurrences decreased with survival, new lung cancer occurrences increased, and the probability of malignant disease appearing more than 60 months after operation for T1 N0 non-small cell lung cancer dictates continued patient surveillance.

Binding of semiconductor quantum dots to cellular integrins

There is currently a major international effort aimed at integrating semiconductor nanostructures with biological structures. This paper reports the functionalization of cadmium sulfide quantum dots with peptides that facilitate the selective binding of these quantum-dot-peptide complexes to integrins in the membranes of cancer cells of the MDA-MB-435 cell line. In addition, this paper focuses on the roles that biological environments play in altering and determining the optical and vibrational properties of these nanostructures.

Combined Tracheal Transection and Innominate Artery Disruption from Blunt Chest Trauma

Both transection of the trachea and injury of the aorta and its arch vessels can occur after blunt chest trauma; however, the combination of these injuries in 1 patient is exceedingly rare. This report of a patient with distal trachea transection and proximal innominate artery disruption from blunt chest trauma reviews some of the important factors to be considered in managing these injuries. Management of the airway must be planned before the operative procedure is begun and can be facilitated by the use of a sterile anesthesia circuit passed on to the operative field. Exposure of tracheal injuries as low as the carina can be achieved through sternotomy incision if this approach is indicated for repair of the associated vascular injury. The use of prosthetic materials should be avoided in vascular injury repair due to contamination of the field from the associated airway disruption. Attention to postoperative bronchial hygiene is mandatory for successful outcome after tracheal anastomosis.

Canine Lung Allograft Lymphatic Alterations

Lymphatic obstruction has not been emphasized as a feature of lung allograft rejection. However, accumulation of fluid and cellular infiltrate, aggravated by lymph stasis, results in impaired lung function. In this study, lung specimens were recovered at varying times up to 133 days after either reimplantation (7 dogs) or allografting (29 dogs). Azathioprine and prednisone were administered to 17 allograft recipients. The presence of abnormally dilated perivascular, peribronchiolar, and subpleural lymphatic channels was a consistent histological finding, most striking in specimens recovered from untreated allograft recipient dogs. Attenuated lymphatic alterations were noted in immunosuppressed allograft recipients. In these animals the pulmonary lymphatics seemed to be ineffectual in clearing the allograft of the accumulating cellular infiltrates and fluid during rejection.

A thoracoscopic peek: what did Jacobaeus see?

More than 80 years ago, Jacobaeus inserted a cystoscope into the pleural space of patients with pleural diseases to visually examine the pathology. Subsequently, he courageously inserted a galvanocautery instrument into the pleural space through a separate entry site to divide adhesions between the lung and chest wall under direct vision. This was done to establish therapeutic pneumothorax for patients with pulmonary tuberculosis. The discovery of effective antituberculosis chemotherapy eliminated the need for lung collapse therapy, and thoracoscopy was discarded as no longer useful. Today, the enthusiasm for thoracoscopic surgical intervention, both diagnostic and therapeutic, is a result of applied technologic innovations. Rediscovery of thoracoscopy is exciting and expands the vision for both diagnostic and therapeutic applications predicted by Jacobaeus.

Preservation of Alveolar Cell Metabolism by Successful Immune Suppression After Canine Lung Transplantation

Mongrel dogs of both sexes, weighing from 13 to 20 kg., were used for these experiments. This report is based on histological examination and surface-tension measurements of lung extracts prepared from 28 experimental animals who survived left lung or left lower lobe transplantation. The total laboratory experience from which the definitive measurements were obtained included 115 canine lung allograft preparations. Excluded from this consideration of experimental data were animals prepared for other related studies and animals with allograft failure as a result of faulty technique, complicating infection, or other problems unrelated to immune rejection.

A Comparative Study of Lung Compliance and Pulmonary Surfactant Activity in Human Subjects

Abstract Twenty-seven patients were studied by measuring dynamic lung compliance and lung extract surface activity to investigate a theoretical correlation. Fifteen patients were without respiratory symptoms or diffuse pulmonary disease. They were classified Group I (9 patients) with normal ventilation, normal lung compliance, and normal pulmonary surfactant activity, or Group II (6 patients) with either obstructed or restricted ventilation, low lung compliance (2 of 6 patients), and normal pulmonary surfactant activity. The other 12 patients, who made up Group III, were studied because they had radiographically apparent diffuse pulmonary disease. Their ventilatory impairment was consistent with the histopathology; however, lung compliance was normal in all but 1 patient, whereas pulmonary surfactant activity was abnormal in 4 including the patient with low compliance. It is concluded that (1) dynamic lung compliance may be independently abnormal in patients with obstructive ventilation; (2) pulmonary surfactant activity may be independently abnormal in lungs with parenchymal pathology; and (3) the I case of dynamic lung compliance and pulmonary surfactant found in this investigation does not constitute sufficient evidence to establish a correlation between these entities.