1,721,059 research outputs found
Role of surgery in lung emphysema
No full textLung emphysema is associated with high morbidity and morality rates. During the last decades, different surgical procedures have been performed in the management of the bullous (bullectomy) and diffuse emphysema (lung transplantation or lung volume reduction surgery). Bullectomy is applied in those patients affected by large or giants bullae causing functional impairment or secondary pleural or pulmonary pathologies such as empyema, hemoptysis or pulmonary infections. During the '80s lung transplantation became a reality in the treatment of end-stage pulmonary emphysema in selected patients. After lung transplantation, single or bilateral, significant improvement of the functional status and quality of life are referred, even if the residual life is limited by chronic rejection and infections. Lung volume reduction surgery, performed the first time in 1957 by Brantigan and Mueller, has been re-discovered by Cooper et al. in the '90s. The most affected areas of the lung, previously detected by high resolution computed tomography and perfusion scintigraphy, are excised by multiple wedge resections. This procedure allows reduction of the lung volumes, improvements in the thoracic mechanic stich as the pulmonary function and exercise tolerance with significant reduction of dyspnoea and disease-related symptoms. Unfortunately, these results are limited and the progression of the underlying disease restores the preoperative conditions in 12-24 months even in selected patients
[Neuroendocrine tumors of the lung]
No full textBACKGROUND: To review the patients treated at our Institute over the past 22 years and to evaluate the behaviour of 14 atypical carcinoids on the basis of Capella's classification (1994), defining the most suitable surgical approach. METHODS: A total of 118 patients undergoing surgery for lung neuroendocrine tumours were reanalyzed on the basis of their anatomic and pathological characteristics, surgical treatment and survival. RESULTS: The 5-year survival rate was 96.5% for typical forms and 74.5% for atypical forms; the 10-year survival rate was 92.4% for typical forms and 49.8% for atypical forms (p < 0.001). Lymph node metastatic involvement was also an important contributing factor for survival (p < 0.05). A review of the series of 19 patients treated over the past 6 years, diagnosed with so-called atypical carcinoid based on Capella's anatomic and pathological classification, showed that 5 were well differentiated neuroendocrine tumours (WDNT), 8 well differentiated neuroendocrine carcinomas (WDNC) and 1 small-cell lung neuroendocrine carcinoma (SLCL). From a surgical point of view, 10 cases underwent demolitive surgery and 9 conservative surgery. The overall actuarial survival rate in this series was 78% at 5 years, 100% for WDNT and 75% for WDNC. The only case of SCLC died after a few months. CONCLUSIONS: The authors conclude that the 5 and 10-year probability of survival are closely linked to the histological type of the lung neuroendocrine tumour and the presence of lymph node metastasis. Capella's new anatomic and pathological classification helps to establish a more precise prognosis for so-called atypical carcinoids. Lastly, given the malignant potential of these tumours, preference should be given to radical exeresis
[Bronchopulmonary carcinoid tumours]
No full text: Carcinoids are neuroendocrine neoplasms. Bronchial carcinoids are unusual, malignant primary neoplasms that characteristically involve the central airways and typically exhibit well-defined margins and bronchial-related growth. Bronchial carcinoids include low-grade typical carcinoids and the more aggressive atypical ones. They usually affect patients in the 3rd through the 7th decade of life who are often symptomatic with cough, hemoptysis or obstructive pneumonia. Rarely, the initial symptoms are related to the secretion of hormones causing carcinoid or other endocrine syndromes. Bronchial carcinoids radiologically manifest as hilar or perihilar masses, with or without associated atelectasis, pneumonia or bronchiectasis. At CT-scan the relationship of these tumors with the bronchial tree is usually seen, and they show contrast enhancement or calcification. Even if the radiological signs may be suggestive for bronchial carcinoid, the definitive diagnosis is reached only by the tissue sampling. Bronchoscopic biopsy is the more effective way to identify the nature of carcinoid tumors because of their frequent central location. The treatment of choice is the surgical resection which should be carried out with maximum respect for the residual lung and bronchial tissues. Endoscopic ablations in well defined cases, bronchotomy and lung resections with or without bronchoplastic procedures have been described. Hilar and mediastinal lymph node sampling and examination should be ever performed during open procedures. Positivity of the nodal tissues could influence the resection procedure and is related with the prognosis, specially for the atypical carcinoids. Chemo- and radiation therapy are not effective in improving the long-term outcome in those patients with advanced disease. The long-term outcome is strictly related with the histological subtype and the lymph node status. Local recurrences and distant metastases are more frequent in the atypical carcinoids which manifest a more aggressive behavior. During the last decade, the importance of the use of somatostatine analogues (octreotide) in the staging, early detection of the recurrent disease and its management such as that of the associated carcinoid syndrome became clear
[Bronchopulmonary carcinoid tumours]
No full textCarcinoids are neuroendocrine neoplasms. Bronchial carcinoids are unusual, malignant primary neoplasms that characteristically involve the central airways and typically exhibit well-defined margins and bronchial-related growth. Bronchial carcinoids include low-grade typical carcinoids and the more aggressive atypical ones. They usually affect patients in the 3rd through the 7th decade of life who are often symptomatic with cough, hemoptysis or obstructive pneumonia. Rarely, the initial symptoms are related to the secretion of hormones causing carcinoid or other endocrine syndromes. Bronchial carcinoids radiologically manifest as hilar or perihilar masses, with or without associated atelectasis, pneumonia or bronchiectasis. At CT-scan the relationship of these tumors with the bronchial tree is usually seen, and they show contrast enhancement or calcification. Even if the radiological signs may be suggestive for bronchial carcinoid, the definitive diagnosis is reached only by the tissue sampling. Bronchoscopic biopsy is the more effective way to identify the nature of carcinoid tumors because of their frequent central location. The treatment of choice is the surgical resection which should be carried out with maximum respect for the residual lung and bronchial tissues. Endoscopic ablations in well defined cases, bronchotomy and lung resections with or without bronchoplastic procedures have been described. Hilar and mediastinal lymph node sampling and examination should be ever performed during open procedures. Positivity of the nodal tissues could influence the resection procedure and is related with the prognosis, specially for the atypical carcinoids. Chemo- and radiation therapy are not effective in improving the long-term outcome in those patients with advanced disease. The long-term outcome is strictly related with the histological subtype and the lymph node status. Local recurrences and distant metastases are more frequent in the atypical carcinoids which manifest a more aggressive behavior. During the last decade, the importance of the use of somatostatine analogues (octreotide) in the staging, early detection of the recurrent disease and its management such as that of the associated carcinoid syndrome became clear
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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