Results Of Radiological Evaluation Research Articles

Can locally applied risedronate be an effective agent when combined with xenografts? An animal study

BackgroundTo examine the effects of local risedronate application with xenografts on healing of rabbit skull defects using histological, histomorphometric, immunohistochemical, and three-dimensional radiological methods.MethodsTwo critical-sized defects with a diameter of 10 mm were created in 16 rabbits and filled with xenogenic bone graft and xenogenic bone graft + 5 mg risedronate in the control I and risedronate (RIS) groups, respectively. Residual graft, new bone, soft tissue areas, and bone volume were evaluated in the 4- and 8-week study groups.ResultsIn both the 4- and 8-week samples, the RIS group samples had significantly higher mean new bone area values than the C group (p < 0.05). In both groups, the values for the new bone area were significantly higher in the 8-week-old samples than in the 4-week-old samples (p < 0.05). The h scores obtained for sialoprotein and osteopontin did not differ significantly between the groups at either time point (p > 0.05). The results of radiological evaluation showed that the bone density value was significantly higher in the C group than in the RIS group at either time point (p < 0.05).ConclusionsAlthough this study aimed to demonstrate the effect of risedronate on the osteoconductive properties of xenografts when applied locally, targeted results could not be achieved.

Hearing Loss Related to Gene Mutations in Distal Renal Tubular Acidosis

Introduction: Distal renal tubular acidosis (dRTA) is a disease that may develop either primarily or secondarily, resulting from urinary acidification defects in distal tubules. Hearing loss may accompany primary forms of dRTA. This study aims to determine the characteristics of hearing loss due to different gene mutations in patients with dRTA. Methods: Behavioral and electrophysiological audiological evaluations were performed after otolaryngology examination in 21 patients with clinically diagnosed dRTA. Radiological imaging of the inner ear (n = 9) was conducted and results of genetic analyses using next-generation sequencing method (n = 16) were included. Results: Twenty-one patients with dRTA from 20 unrelated families, aged between 8 months and 33 years (median = 12, interquartile range = 20), participated. All patients with ATP6V1B1 mutations (n = 9) had different degrees of hearing loss. There was one patient with hearing loss in patients with ATP6V0A4 mutations (n = 6). One patient with the WDR72 mutation had normal hearing. Large vestibular aqueduct syndrome (LVAS) was detected in 6 (67%) of 9 patients whose radiological evaluation results were available. Conclusions: LVAS is common in patients with dRTA and may influence the type and severity of hearing loss in these patients. The possibility of both congenital and late-onset and progressive hearing loss should be considered in dRTA patients. A regular audiological follow-up is essential for the early detection of a possible late-onset or progressive hearing loss in these patients.

Radiological evaluation results of minimally invasive unicompartmental knee arthroplasty (MİUCA) in Oxford group

Amai?½: Nisan 2010 ve Eylul 2019 tarihleri arasinda ayni cerrah tarafindan,ayni yontem ile Minimal Invaziv Unikompartmantal Diz Artroplastisi(MIUCA) uygulanmis 93 hastanin 104 dizi calismaya alindi. Bu calismada amacimiz: MIUCA’da uygulamaya bagli teknik hatalarin, Oxford gurubunun radyolojik degerlendirme kriterleri kullanilarak, sik yapilan implant uygulama kusurlarinin ortaya konmasidir. Hastalar ve Yi?½ntem: Bu calismaya Nisan 2010 ve Temmuz 2017 arasinda MIUCA uyguladigimiz ve takiplerini kayit altina alabildigimiz 94 hastanin 104 dizi calismaya alindi, 13 erkegin 14 dizi ve 80 kadinin 90 dizi. Ortalama kadin yasi; 56.38 (dagilim: 46-74) ve ortalama erkek yasi; 57.80 (dagilim: 48-66). Ortalama yas; 57.12 (dagilim:46-74). Ortalama takip suresi:58 ay (dagilim:3-104). 82 dize fix-bearing, 22 dize mobil-bearing MIUCA uygulandi. Preoperatif donemde: standart iki yonlu diz grafisi ile medial eklemdeki OA derecesi ve valgus stres testi ile varus deformitesinin esnekligi degerlendirildi. Postoperatif degerlendirmede; hastalara rutin iki yonlu diz grafisi cekilerek, Oxford diz grubunun onerdigi radyolojik olcumler yapildi(8). MIUCA uygulanan dizler bir butun olarak Oxford grubunun onerdigi 17 kriterin tamami ile degerlendirildi. Bulgular: Tibial komponent; Varus-Valgus:-4 (valgus) ve 8 (varus) derece araligi disinda iki hasta bulundu. Tibial posterior egim: Iki dizde (8 ve 10 derece) yuksek olculdu. Implantta tasma durumu: 11 diz posterior, 2 diz anterior ve 2 dizde medial platodan 2 mm ve ustu tasma goruldu. Tibial sement tasma durumu: 12 dizde vardi.rn Femoral komponenet;varus-valgus: 34 diz valgusta, ortalama: 5.41 (dagilim:3-10 derece), 19 diz varusta, ortalama: 4.58 (dagilim:4-8 derece) kabul edilebilir sinirlardaydi. Fleksiyon-Estensiyon durumu; 52 diz fleksiyonda,ortalama: 3.95 (dagilim:2-35 derece) olculdu, bunlardan 21 diz 5 dereceden fazla fleksiyonda olculdu. 16 diz ekstensiyonda ortalama: 3 (dagilim:1-10 derece) olculdu, bunlardan 4 diz 5 dereceden fazla ekstensiyonda olculdu. rn Sonui?½:Oxford diz gurubunun postoperatif MIUCA degerlendirmedsine gore sik uygulama hatalarimiz; Femoral komponentte protezin 5 derece ustunde fleksiyonda uygulanmasi(21 diz), femoral komponentin arka duvarinda 2 mm gap varligi(20 diz). Tibial komponentte protezin posteriore tasmasi(11 diz), tibial komponentteki sementin tasmasi(12 diz).

Risk factor analysis of axial symptoms after single-segment anterior cervical discectomy and fusion: A retrospective study of 113 patients.

ObjectiveThis retrospective study was performed to investigate the risk factors for axial symptoms (AS) after single-segment anterior cervical discectomy and fusion (ACDF).MethodsOne hundred thirteen patients with cervical spondylosis who had undergone single-segment ACDF from January 2012 to December 2015 were divided into those with and without AS (n = 34 and n = 79, respectively). Clinical data and radiological evaluation results were recorded.ResultsThe occurrence rate of AS was 30.1% (34/113), and the average visual analog scale score was 4.5 points. Bony fusion was achieved in all cases during follow-up. There were no differences in age, sex, disease duration, diagnostic categories, operative segment, Japanese Orthopaedic Association score, or adjacent segment degeneration. However, cervical range of motion (CROM), cervical curvature, and disc space enlargement significantly differed between the groups. Logistic regression analysis revealed that CROM, cervical curvature, and disc space enlargement were independently associated with AS.ConclusionsAS after single-segment ACDF is not rare. Disc space enlargement is a risk factor for AS, while higher CROM and lordotic cervical curvature are protective factors. Excessive or insufficient disc space enlargement could increase the incidence of AS. Maintaining CROM within the normal range and restoring cervical lordosis might help to prevent AS.

Wedge-shaped vertebrae is a risk factor for symptomatic upper lumbar disc herniation

BackgroundAt present, much is unknown about the etiology and pathogenesis of ULDH. However, it is interesting to note that many ULDH patients have a radiographic feature of adjacent vertebral wedge deformation. The purpose of this study is to investigate the relationship between symptomatic upper lumbar disc herniation (ULDH) and wedge-shaped vertebrae (WSV).MethodsThis was a retrospective study of 65 patients with single-level ULDH, who had undergone surgery at our medical center between January 2012 and December 2016. Clinical data including clinical and radiological evaluation results were performed.ResultsThe incidence of WSV in the ULDH group (44.6%, 29/65) was more than in the lower lumbar disc herniation group (21.5%, 14/65). And there were statistically significant differences in WSV (χ2 = 7.819, P = 0.005), wedging angle of the vertebrae (WAV) (t = 9.013, P < 0.001), and thoracolumbar kyphotic angle (TL) (t = 8.618, P < 0.001) between two groups. Based on multivariate logistic regression analysis, WAV (OR = 0.783, 95% CI = 0.687–0.893, P < 0.001) and TL (OR = 0.831, 95% CI = 0.746–0.925, P = 0.001) were independently associated with ULDH. The cutoff values of WAV and TL were 5.35° and 8.35°, which were significantly associated with ULDH (OR = 3.667, 95% CI = 1.588–8.466, P = 0.002).ConclusionThe WSV is an independent risk factor for ULDH. WAV > 5.35° and TL > 8.35° were the predictors for ULDH. It should be noted that the patients with vertebral wedge deformation combined with thoracolumbar kyphosis have a higher risk of ULDH.

Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures: PVP or PKP?

PurposeThe purpose of this study was to compare the clinical efficacy and safety of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of the elderly with very severe osteoporotic vertebral compression fractures (vsOVCFs).MethodsFrom September 2012 to September 2015, 57 patients with vsOVCFs who had undergone PVP and PKP surgeries at our medical center were reviewed retrospectively, at least 2 years follow-up. All patients were divided into PVP group (n=31) and PKP group (n=26). Clinical data including clinical and radiological evaluation results were performed pre- and postoperatively.ResultsThe operation time of PVP group (29.6±3.3 minutes) was less than that of PKP group (37.4±4.2 minutes), with significant differences (P<0.05). Compared with preoperative data, the VAS scores, Oswestry disability index (ODI) scores, and local kyphotic angle were improved with significant differences at 1 day after surgery and the last follow-up in two groups (P<0.05). However, there were no differences in VAS and ODI scores between the two groups (P>0.05). The local kyphotic angle of PVP group was more than that of PKP group after surgery, with significant differences (P<0.05). At 1 day after surgery and the last follow-up, the anterior height of vertebrae fractured was significantly improved compared with preoperative in PKP group (P<0.05), and there was no statistical difference compared with preoperative in PVP group (P>0.05). However, there were no significant differences between the two groups in the leakage rate of bone cement (P>0.05) and incidence of adjacent-level vertebra fracture (P>0.05).ConclusionBoth PVP and PKP can significantly relieve the pain of the patients with vsOVCFs. Restoring the vertebral height and local kyphotic angle corrections of PKP are comparatively better than those of PVP. However, the operation time of PKP is significantly longer than that of PVP and PKP is not superior in the leakage rate of bone cement and incidence of adjacent-level vertebra fracture compared to PVP.

Diagnostic Value of Ultrasound and Gastrointestinal Series Findings in Detection of Pediatric Intestinal Malrotation

Background: Clinical diagnosis of malrotation is difficult to achieve, especially in older children and adults as its nonspecific presentations at this stage are usually neglected leading to delayed diagnosis of these cases. Objectives: In this study, we aimed to evaluate the diagnostic values of ultrasound and upper gastrointestinal (GI) series in patients with suspected intestinal malrotation. Patients and Methods: This six-year cross-sectional, prospective study was conducted in Dr. Sheikh Children’s Hospital affiliated to Mashhad University of Medical Sciences, Mashhad, Iran from 2009 to 2015. Totally, 67 children (aged < 15 years) with clinical findings of intestinal malrotation who had evidence of malrotation in ultrasound or upper GI series were enrolled in the study. Results of radiological evaluation were compared to the final diagnosis of patients achieved from surgery. Data analysis was performed using SPSS software. Results: Of the 67 enrolled participants with clinical findings or suspected radiological signs of intestinal malrotation, about half (52.2) were male. Patients were 2 days to 16 years (mean, 2.5 years) old. Associated anomalies were observed in 47.7 of cases. Sensitivity and specificity were 82.5 and 85.7, respectively for GI series findings and 82.3 and 54.5, respectively for ultrasound compared with surgical findings as a gold standard. Conclusion: Ultrasound has a similar diagnostic value compared to upper GI series. They are complementary examinations and negative ultrasound or GI series results do not necessarily rule out intestinal malrotation. Mesenteric vessels ultrasound could be used as more specific diagnostic method for the detection of intestinal rotational disorders. © 2018, Iranian Journal of Radiology.

Incidence and risk factors of poor clinical outcomes in patients with cervical kyphosis after cervical surgery for spinal cord injury.

ObjectiveThis retrospective study investigated the incidence and risk factors of poor clinical outcomes after cervical surgery for cervical spinal cord injury in a large population of patients with global or segmental cervical kyphosis.MethodsThe clinical and radiological evaluation results of 269 patients with cervical kyphosis who underwent either anterior or posterior surgery between 2008 and 2013 were collected, preoperatively and at each follow-up after surgery.ResultsAll patients were followed for an average of 2.5 years. Outcomes were classified as good or poor (n=156 and 113 patients, respectively), based on the Japanese Orthopedic Association (JOA) recovery ratios. The rates of patients with good or poor outcomes were statistically comparable with regard to gender ratio, type of injury, history of diabetes or cardiovascular disease, interval between injury and surgery, and follow-up time. The multivariate logistic regression analysis indicated that the following were independent predictors of poor improvement: patient age (P=0.016, odds ratio [OR] =1.0261); preoperative JOA scores (P=0.003, OR =0.1932); and cervical instability (P=0.004, OR =2.1562).ConclusionThis study showed that advanced age, low preoperative JOA score, and cervical instability are closely associated with a poor surgical outcome in patients with cervical kyphosis. However, these results do not suggest that the type of cervical kyphosis influences the clinical outcome of surgery.

The Immunomodulatory Effect of Trichophyton Rubrum Exoantigens in the Treatment of Experimental Septic Arthritis.

Background: Understanding the nature and function of fungal exoantigens might lead to novel approaches in the treatment and prophylaxis of some infectious diseases. Septic arthritis represents a serious problem for medicine due to the high incidence rate and severe complications.Objective: The present study aimed at assessing the immunomodulatory effects of Trichophyton rubrum culture filtrate as a novel compound in experimental septic arthritis.Method:The septic arthritis was haematogenously induced in Sprague-Dawley rats by a single intravenous injection of 109 colony forming units of the human clinical isolate Staphylococcus aureus producing toxic shock syndrome toxin-1. Trichophyton rubrum culture filtrate at two different doses 20 and 40 mg/kg was administered intraperituneally two days after bacterial inoculation in the treatment groups and concurrently with the appearance of clinical signs in the patient groups. The administration of Trichophyton rubrum solution was continued every other day for 10 injections.Results:The clinical evaluation showed that Trichophyton rubrum-treated rats were significantly protected from disease development compared with untreated controls. This finding was correlated with results of radiological evaluation of the involved joints. Although, the inflammatory cell infiltration, cartilage/bone destruction and synovial hypertrophy had been decreased in the treatment groups in comparison with arthritic controls however, the histological changes were not significant in these two groups.Conclusion:It is possible that Trichophyton rubrum antigens may play a role in modulating the immune responses and would be efficient in septic arthritis treatment.

Leptin Influences Healing in the Sprague Dawley Rat Fracture Model.

BackgroundLeptin plays a crucial role in bone metabolism, and its level is related to bone callus formation in the fracture repair process. The objective of this study was to evaluate the effect of recombinant leptin on the healing process of femoral fractures in rats.Material/MethodsForty-eight male Sprague Dawley (SD) rats with an average body weight of 389 g (range: 376–398 g) and an average age of 10 weeks were included in this animal research, and all rats were randomly divided into two major groups. Then standardized femur fracture models were implemented in all SD rats. Rats in the control group were treated with only 0.5 mL of physiological saline, and rats in the experimental group were treated with recombinant leptin 5 μg/kg/d along with the same 0.5 mL of physiological saline for 42 days intraperitoneally. At the same time, each major group was evenly divided into three parallel subgroups for each parallel bone evaluation separately at the second, fourth, and sixth weeks. Each subgroup included eight rats.ResultsThe total radiological evaluation results showed that the healing progress of femoral fracture in the experimental group was superior to that in the control group from the fourth week. At the sixth week, experimental group rats began to present significantly better femoral fracture healing progress than that of the control group rats. Results of biomechanics show the ultimate load (N) and deflection ultimate load (mm) of the experimental group rats was significantly increased compared with that of the control group rats from the fourth week.ConclusionsOur results suggest that leptin may have a positive effect on SD rat femur fracture healing.

The effect of NovaBone combined with autologous iliac in the acetabular osteotomy of children with developmental dislocation of the hip

Objective To compare the effect of application of autologous iliac alone and NovaBone combined with autologous iliac in the acetabular osteotomy of children with developmental dislocation of the hip (DDH). Methods Data of 113 cases of children with DDH who had undergone open reduction and acetabular osteotomy surgery from 2007 to 2011 were retrospectively analyzed. According to bone material using after acetabular osteotomy, the patients were divided into autogenous iliac bone graft group (52 cases, 60 hips) and NovaBone combined with autologous iliac bone graft group (61 cases, 67 hips). There were no statistical differences in gender, age, side, dislocation type, osteotomy and acetabular index between the two groups. The patients were evaluated by Lane's scoring criteria, Severin standards and McKay standards at 6 weeks, 3 months, 6 months, 1-year and 2-year post-operation follow-up. The bone healing of acetabular osteotomy zone, radiography and function of hip were compared. Results 6 weeks and 3 months after operation, Lane bone healing score in NovaBone combined with autologous iliac bone graft group (6.4± 1.3 points and 9.6±1.7 points respectively) was obviously superior to autogenous iliac bone graft group (4.7±1.5 points and 7.8±1.2 points respectively). And 6 months and 1 year after operation, the two groups were basically reached bone healing. The Severin standard results showed that the rate (94%, 63/67) of Excellent and Good in NovaBone combined with autologous iliac bone graft group (excellent: 41 hips, good: 22 hips, Fair: 4 hips) was significantly higher than the rate (83.3%, 50/60) in autogenous iliac bone graft group (excellent: 28 hips, good: 22 hips, Fair: 10 hips). The rate (16.7%, 10/60) of Fair in autogenous iliac bone graft group was significantly higher than the rate (6.0%, 4/67) in NovaBone combined with autologous iliac bone graft group. McKay standard results were consistent with the results of radiological evaluation. Conclusion As a novel bone defect repair material, NovaBone can promote early bone healing process of acetabular osteotomy areas. It also can improve the resistance of osteotomy area. NovaBone can get a satisfied result in acetabular osteotomy in children with DDH. Key words: Hip dislocation, congenital; Child; Osteotomy

Radiological Assessment of an Experimental Model of Human Osteomyelitis in Rabbits

Abstract The purpose of this paper is to present a radiological assessment of the treatment performed on a model of human osteomyelitis induced in rabbits. In order to induce osteomyelitis in rabbits, a human strain of Staphylococcus aureus was injected in bone defects created in the rabbit tibia, a quantity of 0.2 ml being administered in each defect. We have created five groups of animals (positive control, negative control and treatment - 3 groups), the treatment groups receiving treatment in different phases of the disease (acute and chronic). The treatment consisted of copper and silver sub-millimeter-particles introduced in the same place with the Staphylococcus solution. Evaluation of installation and evolution of the disease was made by clinical, hematological, microbiological, radiological and histological monitoring. A separate study of radiological data is presented here. Radiological monitoring was done dynamically using a computerized radiology unit. Analyses were performed and scored individually and independently by three radiologists and specialists by evaluating the following parameters: periosteal relieves, bone architecture deformation, widening of bone shaft, neo-formation tissue and soft tissue deformation. The results of radiological evaluation show a mitigation of osteomyelitis as a result of the treatment and confirm that radiological analysis is a powerful tool in experimental models of this disease. The study was conducted in compliance with the welfare standards for animals used for scientific purposes.

Is cervical lordosis relevant in laminoplasty?

Background contextLaminoplasty aims to decompress the spinal cord and stabilize the cervical spine in patients with multilevel cervical lesions. Not every patient with cervical compressive myelopathy is a good candidate for laminoplasty. Most studies recommend that neutral or kyphotic alignments are contraindications for laminoplasty. However, cervical sagittal alignment does not have a strong and consistent effect on the clinical outcomes of laminoplasty. Moreover, many reports on the effect of cervical sagittal alignment did not designate the ideal definition of alignment and used different definitions of lordosis. PurposeTo identify the effect of preoperative cervical alignment according to two different definitions after midline splitting double-door laminoplasty. Study designRetrospective cohort study. Patient sampleFrom August 2008 to September 2010, 58 patients were diagnosed with cervical myelopathy and treated with midline splitting double-door laminoplasty. Outcome measuresThe clinical results were assessed with the modified Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) and were compared to analyze the rate of change between preoperative and postoperative values. Postoperative radiological results at the final follow-up examinations were compared between groups to obtain the change in range of motion and sagittal alignment. MethodThe effect of cervical alignment on JOA, NDI, and VAS scales and also on change of alignment and change of range of motion (ROM) at the final follow-up examinations was analyzed statistically between two groups according to two different definitions such as Toyama classification and Cobb angle. ResultsNo difference was found between the two groups according to Toyama classification in terms of the postoperative improvement rate of the modified JOA score (p=.086), decreasing rate of the VAS (p=.940) or NDI (p=.211), postoperatively. Additionally, no difference was found for the decreasing rate of ROM (p=.427) or sagittal alignment (p=.864) based on the radiological evaluation results. Also, there was no difference between two groups according to Cobb angle in terms of the modified JOA score (p=.743), VAS (p=.548), or NDI (p=.32), postoperatively. Additionally, no difference was found for the ROM (p=1.000) or sagittal alignment (p=.440) based on the radiological evaluation results. ConclusionsDespite nonlordosis cervical sagittal alignment, double-door laminoplasty would be effective for patients with cervical myelopathy because of cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Furthermore, sagittal alignment is not the absolute and sole factor that surgeons should consider when determining the optimal treatment strategy.

Commentary

Laminoplasty aims to decompress the spinal cord and stabilize the cervical spine in patients with multilevel cervical lesions. Not every patient with cervical compressive myelopathy is a good candidate for laminoplasty. Most studies recommend that neutral or kyphotic alignments are contraindications for laminoplasty. However, cervical sagittal alignment does not have a strong and consistent effect on the clinical outcomes of laminoplasty. Moreover, many reports on the effect of cervical sagittal alignment did not designate the ideal definition of alignment and used different definitions of lordosis.To identify the effect of preoperative cervical alignment according to two different definitions after midline splitting double-door laminoplasty.Retrospective cohort study.From August 2008 to September 2010, 58 patients were diagnosed with cervical myelopathy and treated with midline splitting double-door laminoplasty.The clinical results were assessed with the modified Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) and were compared to analyze the rate of change between preoperative and postoperative values. Postoperative radiological results at the final follow-up examinations were compared between groups to obtain the change in range of motion and sagittal alignment.The effect of cervical alignment on JOA, NDI, and VAS scales and also on change of alignment and change of range of motion (ROM) at the final follow-up examinations was analyzed statistically between two groups according to two different definitions such as Toyama classification and Cobb angle.No difference was found between the two groups according to Toyama classification in terms of the postoperative improvement rate of the modified JOA score (p=.086), decreasing rate of the VAS (p=.940) or NDI (p=.211), postoperatively. Additionally, no difference was found for the decreasing rate of ROM (p=.427) or sagittal alignment (p=.864) based on the radiological evaluation results. Also, there was no difference between two groups according to Cobb angle in terms of the modified JOA score (p=.743), VAS (p=.548), or NDI (p=.32), postoperatively. Additionally, no difference was found for the ROM (p=1.000) or sagittal alignment (p=.440) based on the radiological evaluation results.Despite nonlordosis cervical sagittal alignment, double-door laminoplasty would be effective for patients with cervical myelopathy because of cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Furthermore, sagittal alignment is not the absolute and sole factor that surgeons should consider when determining the optimal treatment strategy.

Pleural dissemination in non-small cell lung cancer: Results of radiological evaluation and surgical treatment: Akaogi E, Mitsui K, Onizuka M, Ishikawa S, Tsukada H, Mitsui T. Institute of Clinical Medicine, University of Tsukuba, Tsukuba 305. J Surg Oncol 1994;57:33–39

Pleural dissemination in non-small cell lung cancer: Results of radiological evaluation and surgical treatment: Akaogi E, Mitsui K, Onizuka M, Ishikawa S, Tsukada H, Mitsui T. Institute of Clinical Medicine, University of Tsukuba, Tsukuba 305. J Surg Oncol 1994;57:33–39

Pleural dissemination in non‐small cell lung cancer: Results of radiological evaluation and surgical treatment

The aims of this study are to evaluate the diagnostic ability of chest computed tomography (CT) in the early detection of pleural disease and to analyze the results of surgical treatment for lung cancer with pleural dissemination. Twenty-three non-small cell lung cancer patients with pleural dissemination, but without distant metastasis, underwent pleuropulmonary resection during the past 15 years. Chest CT scans were obtained preoperatively in 21 of those patients. In eight patients without pleural effusion, small pleural nodules, about 3-5 mm in size, were found in their chest CT. However, during surgery, small nodules were more frequently observed on the parietal pleura than on the visceral pleura in five of them. Therefore, early detection of the dissemination by chest CT seemed limited to only those of the visceral pleura. In the survival curve after resection, there was no difference among the patients with n2 disease, but there was a significant difference between the patients without n2 disease and those with it (P < 0.05). The presence of n2 disease appeared to be a poor prognostic sign in this form of advanced lung cancer.