To evaluate factors that are predictive of outcome for patients with chest wall soft-tissue sarco... more To evaluate factors that are predictive of outcome for patients with chest wall soft-tissue sarcomas. A retrospective review of 55 surgically treated patients, from March 1964 to October 1996. The median age of the patients was 47.5 years (age range, 15 to 76.3 years), and 56.4% were men. The most common presenting symptom was chest wall mass in 29 patients (52.7%). The median symptom duration was 12 months. Tumor size ranged from 1 to 26 cm (median size, 9.7 cm). The most common histologic type of tumor was fibrosarcoma (52.7%). Twenty-three sarcomas (41.8%) were high-grade, and 32 sarcomas (52.8%) were low-grade. Of the 55 patients, 27 (49.1%) had previously been treated elsewhere (surgical resection, 23 patients; radiation therapy and surgery, 3 patients; chemoradiation therapy, 1 patient). Previously treated patients presented either with residual disease (10 cases) or recurrence of disease (17 cases). All 55 patients underwent surgical resection, 15 patients (27.3%) were treated by neoadjuvant chemoradiation therapy, and 2 patients were treated by adjuvant radiotherapy. Wide surgical resection was performed in 45 patients (81.8%), and marginal resection was performed in 10 patients (18.2%). The median follow-up time was 51.9 months. Local recurrence of disease developed in 6 patients, and metastases developed in 10 patients. The overall survival rates at 5 and 10 years were 87.3% and 79.3%, respectively. Tumor size < 5 cm and low histologic grade were determinants of better survival at univariate analyses. Multivariate analyses disclosed only histologic grade as an independent predictor for the risk of death. Disease-free survival rates at 5 and 10 years were 75.3% and 64.2%, respectively. Tumor size < 5 cm, performance of wide surgical resection, and low histologic grade were determinants of a better disease-free survival rate. Independent prognostic factors for disease-free survival were histologic grade and type of surgical resection. The clinical behavior of chest wall soft-tissue sarcomas is similar to that of extremity sarcomas. Thoracic wall soft-tissue sarcomas are best controlled by wide surgical resection.
We present a rare situation in which two mediastinal tumors of different topology and histology w... more We present a rare situation in which two mediastinal tumors of different topology and histology were found during the resection of an extensive mediastinal tumor in an asymptomatic patient. Different histologies within the same mass have been reported, although, to our knowledge, there have been no reports of different tumors at distinct locations. Thymomas and intrathoracic goiters account for a large proportion of the tumors found in the mediastinum. When feasible, surgical resection plays a fundamental role in effecting a cure. In order to identify concomitant lesions and perform a complete resection, detailed surgical exploration is required.
RESUMO -OBJETIVO. O presente estudo visa avaliar os resultados do tratamento cirúrgico de metásta... more RESUMO -OBJETIVO. O presente estudo visa avaliar os resultados do tratamento cirúrgico de metástases pulmonares, além de tentar identificar mais precisamente os subgrupos de pacientes que se beneficiariam mais da operação. CASAUÍSTICA E MÉTODO. O estudo é uma análise prospectiva de pacientes com história de tumores primários, submetidos à ressecção de nódulos pulmonares com suspeita ou diagnóstico de metástases, para determinar os resultados desta abordagem, e investigar a influência de fatores prognósticos potenciais sobre a probabilidade de sobrevida global ou livre de doença. Foram incluídos neste estudo todos os pacientes (n=182) com neoplasias malignas prévias, e submetidos a toracotomia.
RESUMO - OBJETIVO. O presente estudo visa ava- liar os resultados do tratamento cirúrgico de me- ... more RESUMO - OBJETIVO. O presente estudo visa ava- liar os resultados do tratamento cirúrgico de me- tástases pulmonares, além de tentar identificar mais precisamente os subgrupos de pacientes que se beneficiariam mais da operação. CASAUÍSTICA E MÉTODO. O estudo é uma análise prospectiva de pacientes com história de tumores primários, submetidos à ressecção de nódulos pulmonares com suspeita ou diagnóstico
To analyze surgical and pathological parameters and outcome and prognostic factors of patients wi... more To analyze surgical and pathological parameters and outcome and prognostic factors of patients with nonsmall cell lung cancer (NSCLC) who were admitted to a single institution, as well as to correlate these findings to the current staging system. Seven hundred and thirty seven patients were diagnosed with NSCLC and admitted to Hospital do Cancer A. C. Camargo from 1990 to 2000. All patients were included in a continuous prospective database, and their data was analyzed. Following staging, a multidisciplinary team decision on adequate management was established. Variables included in this analysis were age, gender, histology, Karnofsky index, weight loss, clinical stage, surgical stage, chemotherapy, radiotherapy, and survival rates. 75.5% of patients were males. The distribution of histologic type was squamous cell carcinoma 51.8%, adenocarcinoma 43.1%, and undifferentiated large cell carcinoma 5.1%. Most patients (73%) presented significant weight loss and a Karnofsky index of 80%....
Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2009
To identify preoperative characteristics associated with complete surgical resection of primary m... more To identify preoperative characteristics associated with complete surgical resection of primary malignant mediastinal tumors. Between 1996 and 2006, 42 patients with primary malignant mediastinal tumors were submitted to surgery with curative intent at a single facility. Patient charts were reviewed in order to collect data related to demographics, clinical manifestation, characteristics of mediastinal tumors and imaging aspects of invasiveness. The surgical resection was considered complete in 69.1% of the patients. Cases of incomplete resection were attributed to invasion of the following structures: large blood vessels (4 cases); the superior vena cava (3 cases); the heart (2 cases); the lung and chest wall (3 cases); and the trachea (1 case). Overall survival was significantly better among the patients submitted to complete surgical resection than among those submitted to incomplete resection. The frequency of incomplete resection was significantly higher in cases in which the t...
Cross JL, Younes RN, Barbuto IAM, Haddad Fj, Dehenzelin D elevated serum tumor markers (p< 0.0... more Cross JL, Younes RN, Barbuto IAM, Haddad Fj, Dehenzelin D elevated serum tumor markers (p< 0.001), and type of treatment (p< 0.001). The prognostic value ofanatomical tumor extension reached the limit of significance (p= 0.052); however, two or more ...
... Tumor de células granulares da traquéia* JEFFERSON LUIZ GROSS1, RIAD NAIM YOUNES2, FABIO JOSÉ... more ... Tumor de células granulares da traquéia* JEFFERSON LUIZ GROSS1, RIAD NAIM YOUNES2, FABIO JOSÉ HADDAD1, CLÓVIS ANTONIO LOPES PINTO3 ... A paciente evo-luiu com vários episódios de pneumonia e bronquiectasia em lobo médio, decorrentes da AIDS. ...
Isolated pulmonary metastases from soft tissue sarcomas occur in 20-50% of these(the issue is abo... more Isolated pulmonary metastases from soft tissue sarcomas occur in 20-50% of these(the issue is about metastases, not lung cancer )patients, and 70% of these patients will present disease limited only to the lungs. Surgical resection is well accepted as a standard approach to treat metastases from soft tissue sarcomas isolated in the lungs, and many studies investigating this technique have reported an overall 5-year survival ranging from 30-40%. The most consistent predictor of survival in these patients is complete resection. The aim of the present study was to determine the demographics and clinical treatment-related variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy from soft tissue sarcomas. We performed a retrospective review of patients admitted in the Thoracic Surgery Department with lung metastases who underwent thoracotomy for resection following treatment of the primary tumor. Data regarding primary tumor features, demographics, treatment, and outcome were collected. One hundred twenty-two thoracotomies and 273 nodules were resected from 77 patients with previously treated soft tissue sarcomas. The median follow-up time of all patients was 36.7 months (range: 10-138 months). The postoperative complication rate was 9.1%, and the 30-day mortality rate was 0%. The 90-month overall survival rate for all patients was 34.7%. Multivariate analysis identified the following independent prognostic factors for overall survival: the number of metastases resected, the disease-free interval, and the number of complete resections. These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after lung resection.
The purpose of this study was to evaluate the efficacy, safety, and cost of bedside pleurodesis f... more The purpose of this study was to evaluate the efficacy, safety, and cost of bedside pleurodesis for malignant pleural effusions using talc slurry (TS) or bleomycin (BL) in a prospective randomized trial, and to determine prognosticators for procedure failure. From June 1997 to June 1999 a series of 71 patients entered this trial. They underwent 37 procedures with TS (4 g) and 34 with BL (60 units) via tube thoracostomy. Success was defined as no recurrence of pleural effusion or asymptomatic recurrence of a small amount of effusion. Pleural effusion-free survival curves were used to analyze the success rates and the prognosticators of failure. Follow-up ranged from 3 days to 26 months (median 2.5 months). No difference in success rates was detected between TS or BL (log-rank test: p = 0.724). There were no major complications related to the procedure. The independent prognosticators of failed pleurodesis were the use of steroids (p = 0.004) and the volume of pleural fluid drained during the first thoracentesis when it was more than 900 ml (p = 0.029). The average cost of intervention per patient was significantly lower for TS (p < 0.001). There was no significant difference between the success rates for TS and BL as agents of bedside pleurodesis for malignant pleural effusions. Because of its significantly lower cost, TS should be considered the agent of choice. The use of steroids and the volume drained during the first thoracentesis (if more than 900 ml) were independent prognosticators of pleurodesis failure. The role of this latter finding as a marker of pleurodesis failure awaits more data.
BALF from tumor segments provides access to immune system cells in contact with lung tumors. We a... more BALF from tumor segments provides access to immune system cells in contact with lung tumors. We analyzed BALF cells as to their production of H2O2 and NO, comparing tumor-affected to non-affected lung segments. Twelve patients were studied (4 NSCLC, 3 SCC, 5 Adenocarcinoma). The cell numbers recovered from BALF varied, and, in adenocarcinoma patients, smaller numbers were recovered from tumor-affected segments. H2O2 production (up to 6.3 nmoles/2x10(5)cells) was obtained in 7/12 patients and, in these, it was more frequent in non-affected segments (7/7) than in affected segments (2/7). After culture, NO production was observed in three patients (6 to 314 microM) that also produced H2O2. These functional characteristics of cells in contact with neoplasia may have a role in determining the fate of the interactions between the immune system and lung cancer.
The Journal of Thoracic and Cardiovascular Surgery, 2006
There are few data in the literature regarding the utility of open lung biopsy for the assessment... more There are few data in the literature regarding the utility of open lung biopsy for the assessment of graft dysfunction after pediatric lung transplantation. The aim of this study is to review our experience with diagnostic open lung biopsy in lung transplant recipients in a children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hospital. Records of lung transplant recipients from January 1990 through December 2002 were reviewed to identify the indications, outcomes, and complications of open lung biopsy. Two hundred twenty-four patients (mean age, 9.9 +/- 6.2 years; median age, 11 years; age range, 0.01-19.6 years) underwent 249 lung transplantations: 231 bilateral, 8 single, and 10 heart-lung transplantations. Mean follow-up was 3.4 years. One hundred three open lung biopsies were performed in 89 (40% of all recipients) patients. Thirteen recipients underwent open lung biopsy twice, and 1 recipient had 3 open lung biopsies. The indications for open lung biopsy were suspicion of bronchiolitis obliterans (n = 70), posttransplantation lymphoproliferative disorder (n = 15), infection (n = 8), and unexplained respiratory failure (n = 10). A new diagnosis was made in 49 biopsies (48%), 50 biopsies (49%) confirmed the preoperative clinical diagnosis, and 4 biopsies (3%) were nondiagnostic. Bronchiolitis obliterans was confirmed in 40 (57%) of 70 open lung biopsies, posttransplantation lymphoproliferative disorder was confirmed in 4 (27%) of 15 open lung biopsies, and infection was confirmed in 6 (75%) of 8 open lung biopsies. A change in therapy occurred in 69% of the cases as a result of the diagnosis made from open lung biopsy. There was no mortality as a direct result of open lung biopsy. Eleven major complications and 22 minor complications occurred in 103 procedures. Open lung biopsy can be performed safely, and established or confirmed a diagnosis in 97% of the cases. A change in therapy occurred in 69% of the cases as a result of the diagnosis made from open lung biopsy. In our experience open lung biopsy appears to be a useful tool.
To evaluate factors that are predictive of outcome for patients with chest wall soft-tissue sarco... more To evaluate factors that are predictive of outcome for patients with chest wall soft-tissue sarcomas. A retrospective review of 55 surgically treated patients, from March 1964 to October 1996. The median age of the patients was 47.5 years (age range, 15 to 76.3 years), and 56.4% were men. The most common presenting symptom was chest wall mass in 29 patients (52.7%). The median symptom duration was 12 months. Tumor size ranged from 1 to 26 cm (median size, 9.7 cm). The most common histologic type of tumor was fibrosarcoma (52.7%). Twenty-three sarcomas (41.8%) were high-grade, and 32 sarcomas (52.8%) were low-grade. Of the 55 patients, 27 (49.1%) had previously been treated elsewhere (surgical resection, 23 patients; radiation therapy and surgery, 3 patients; chemoradiation therapy, 1 patient). Previously treated patients presented either with residual disease (10 cases) or recurrence of disease (17 cases). All 55 patients underwent surgical resection, 15 patients (27.3%) were treated by neoadjuvant chemoradiation therapy, and 2 patients were treated by adjuvant radiotherapy. Wide surgical resection was performed in 45 patients (81.8%), and marginal resection was performed in 10 patients (18.2%). The median follow-up time was 51.9 months. Local recurrence of disease developed in 6 patients, and metastases developed in 10 patients. The overall survival rates at 5 and 10 years were 87.3% and 79.3%, respectively. Tumor size &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 5 cm and low histologic grade were determinants of better survival at univariate analyses. Multivariate analyses disclosed only histologic grade as an independent predictor for the risk of death. Disease-free survival rates at 5 and 10 years were 75.3% and 64.2%, respectively. Tumor size &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 5 cm, performance of wide surgical resection, and low histologic grade were determinants of a better disease-free survival rate. Independent prognostic factors for disease-free survival were histologic grade and type of surgical resection. The clinical behavior of chest wall soft-tissue sarcomas is similar to that of extremity sarcomas. Thoracic wall soft-tissue sarcomas are best controlled by wide surgical resection.
We present a rare situation in which two mediastinal tumors of different topology and histology w... more We present a rare situation in which two mediastinal tumors of different topology and histology were found during the resection of an extensive mediastinal tumor in an asymptomatic patient. Different histologies within the same mass have been reported, although, to our knowledge, there have been no reports of different tumors at distinct locations. Thymomas and intrathoracic goiters account for a large proportion of the tumors found in the mediastinum. When feasible, surgical resection plays a fundamental role in effecting a cure. In order to identify concomitant lesions and perform a complete resection, detailed surgical exploration is required.
RESUMO -OBJETIVO. O presente estudo visa avaliar os resultados do tratamento cirúrgico de metásta... more RESUMO -OBJETIVO. O presente estudo visa avaliar os resultados do tratamento cirúrgico de metástases pulmonares, além de tentar identificar mais precisamente os subgrupos de pacientes que se beneficiariam mais da operação. CASAUÍSTICA E MÉTODO. O estudo é uma análise prospectiva de pacientes com história de tumores primários, submetidos à ressecção de nódulos pulmonares com suspeita ou diagnóstico de metástases, para determinar os resultados desta abordagem, e investigar a influência de fatores prognósticos potenciais sobre a probabilidade de sobrevida global ou livre de doença. Foram incluídos neste estudo todos os pacientes (n=182) com neoplasias malignas prévias, e submetidos a toracotomia.
RESUMO - OBJETIVO. O presente estudo visa ava- liar os resultados do tratamento cirúrgico de me- ... more RESUMO - OBJETIVO. O presente estudo visa ava- liar os resultados do tratamento cirúrgico de me- tástases pulmonares, além de tentar identificar mais precisamente os subgrupos de pacientes que se beneficiariam mais da operação. CASAUÍSTICA E MÉTODO. O estudo é uma análise prospectiva de pacientes com história de tumores primários, submetidos à ressecção de nódulos pulmonares com suspeita ou diagnóstico
To analyze surgical and pathological parameters and outcome and prognostic factors of patients wi... more To analyze surgical and pathological parameters and outcome and prognostic factors of patients with nonsmall cell lung cancer (NSCLC) who were admitted to a single institution, as well as to correlate these findings to the current staging system. Seven hundred and thirty seven patients were diagnosed with NSCLC and admitted to Hospital do Cancer A. C. Camargo from 1990 to 2000. All patients were included in a continuous prospective database, and their data was analyzed. Following staging, a multidisciplinary team decision on adequate management was established. Variables included in this analysis were age, gender, histology, Karnofsky index, weight loss, clinical stage, surgical stage, chemotherapy, radiotherapy, and survival rates. 75.5% of patients were males. The distribution of histologic type was squamous cell carcinoma 51.8%, adenocarcinoma 43.1%, and undifferentiated large cell carcinoma 5.1%. Most patients (73%) presented significant weight loss and a Karnofsky index of 80%....
Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2009
To identify preoperative characteristics associated with complete surgical resection of primary m... more To identify preoperative characteristics associated with complete surgical resection of primary malignant mediastinal tumors. Between 1996 and 2006, 42 patients with primary malignant mediastinal tumors were submitted to surgery with curative intent at a single facility. Patient charts were reviewed in order to collect data related to demographics, clinical manifestation, characteristics of mediastinal tumors and imaging aspects of invasiveness. The surgical resection was considered complete in 69.1% of the patients. Cases of incomplete resection were attributed to invasion of the following structures: large blood vessels (4 cases); the superior vena cava (3 cases); the heart (2 cases); the lung and chest wall (3 cases); and the trachea (1 case). Overall survival was significantly better among the patients submitted to complete surgical resection than among those submitted to incomplete resection. The frequency of incomplete resection was significantly higher in cases in which the t...
Cross JL, Younes RN, Barbuto IAM, Haddad Fj, Dehenzelin D elevated serum tumor markers (p< 0.0... more Cross JL, Younes RN, Barbuto IAM, Haddad Fj, Dehenzelin D elevated serum tumor markers (p< 0.001), and type of treatment (p< 0.001). The prognostic value ofanatomical tumor extension reached the limit of significance (p= 0.052); however, two or more ...
... Tumor de células granulares da traquéia* JEFFERSON LUIZ GROSS1, RIAD NAIM YOUNES2, FABIO JOSÉ... more ... Tumor de células granulares da traquéia* JEFFERSON LUIZ GROSS1, RIAD NAIM YOUNES2, FABIO JOSÉ HADDAD1, CLÓVIS ANTONIO LOPES PINTO3 ... A paciente evo-luiu com vários episódios de pneumonia e bronquiectasia em lobo médio, decorrentes da AIDS. ...
Isolated pulmonary metastases from soft tissue sarcomas occur in 20-50% of these(the issue is abo... more Isolated pulmonary metastases from soft tissue sarcomas occur in 20-50% of these(the issue is about metastases, not lung cancer )patients, and 70% of these patients will present disease limited only to the lungs. Surgical resection is well accepted as a standard approach to treat metastases from soft tissue sarcomas isolated in the lungs, and many studies investigating this technique have reported an overall 5-year survival ranging from 30-40%. The most consistent predictor of survival in these patients is complete resection. The aim of the present study was to determine the demographics and clinical treatment-related variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy from soft tissue sarcomas. We performed a retrospective review of patients admitted in the Thoracic Surgery Department with lung metastases who underwent thoracotomy for resection following treatment of the primary tumor. Data regarding primary tumor features, demographics, treatment, and outcome were collected. One hundred twenty-two thoracotomies and 273 nodules were resected from 77 patients with previously treated soft tissue sarcomas. The median follow-up time of all patients was 36.7 months (range: 10-138 months). The postoperative complication rate was 9.1%, and the 30-day mortality rate was 0%. The 90-month overall survival rate for all patients was 34.7%. Multivariate analysis identified the following independent prognostic factors for overall survival: the number of metastases resected, the disease-free interval, and the number of complete resections. These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after lung resection.
The purpose of this study was to evaluate the efficacy, safety, and cost of bedside pleurodesis f... more The purpose of this study was to evaluate the efficacy, safety, and cost of bedside pleurodesis for malignant pleural effusions using talc slurry (TS) or bleomycin (BL) in a prospective randomized trial, and to determine prognosticators for procedure failure. From June 1997 to June 1999 a series of 71 patients entered this trial. They underwent 37 procedures with TS (4 g) and 34 with BL (60 units) via tube thoracostomy. Success was defined as no recurrence of pleural effusion or asymptomatic recurrence of a small amount of effusion. Pleural effusion-free survival curves were used to analyze the success rates and the prognosticators of failure. Follow-up ranged from 3 days to 26 months (median 2.5 months). No difference in success rates was detected between TS or BL (log-rank test: p = 0.724). There were no major complications related to the procedure. The independent prognosticators of failed pleurodesis were the use of steroids (p = 0.004) and the volume of pleural fluid drained during the first thoracentesis when it was more than 900 ml (p = 0.029). The average cost of intervention per patient was significantly lower for TS (p < 0.001). There was no significant difference between the success rates for TS and BL as agents of bedside pleurodesis for malignant pleural effusions. Because of its significantly lower cost, TS should be considered the agent of choice. The use of steroids and the volume drained during the first thoracentesis (if more than 900 ml) were independent prognosticators of pleurodesis failure. The role of this latter finding as a marker of pleurodesis failure awaits more data.
BALF from tumor segments provides access to immune system cells in contact with lung tumors. We a... more BALF from tumor segments provides access to immune system cells in contact with lung tumors. We analyzed BALF cells as to their production of H2O2 and NO, comparing tumor-affected to non-affected lung segments. Twelve patients were studied (4 NSCLC, 3 SCC, 5 Adenocarcinoma). The cell numbers recovered from BALF varied, and, in adenocarcinoma patients, smaller numbers were recovered from tumor-affected segments. H2O2 production (up to 6.3 nmoles/2x10(5)cells) was obtained in 7/12 patients and, in these, it was more frequent in non-affected segments (7/7) than in affected segments (2/7). After culture, NO production was observed in three patients (6 to 314 microM) that also produced H2O2. These functional characteristics of cells in contact with neoplasia may have a role in determining the fate of the interactions between the immune system and lung cancer.
The Journal of Thoracic and Cardiovascular Surgery, 2006
There are few data in the literature regarding the utility of open lung biopsy for the assessment... more There are few data in the literature regarding the utility of open lung biopsy for the assessment of graft dysfunction after pediatric lung transplantation. The aim of this study is to review our experience with diagnostic open lung biopsy in lung transplant recipients in a children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hospital. Records of lung transplant recipients from January 1990 through December 2002 were reviewed to identify the indications, outcomes, and complications of open lung biopsy. Two hundred twenty-four patients (mean age, 9.9 +/- 6.2 years; median age, 11 years; age range, 0.01-19.6 years) underwent 249 lung transplantations: 231 bilateral, 8 single, and 10 heart-lung transplantations. Mean follow-up was 3.4 years. One hundred three open lung biopsies were performed in 89 (40% of all recipients) patients. Thirteen recipients underwent open lung biopsy twice, and 1 recipient had 3 open lung biopsies. The indications for open lung biopsy were suspicion of bronchiolitis obliterans (n = 70), posttransplantation lymphoproliferative disorder (n = 15), infection (n = 8), and unexplained respiratory failure (n = 10). A new diagnosis was made in 49 biopsies (48%), 50 biopsies (49%) confirmed the preoperative clinical diagnosis, and 4 biopsies (3%) were nondiagnostic. Bronchiolitis obliterans was confirmed in 40 (57%) of 70 open lung biopsies, posttransplantation lymphoproliferative disorder was confirmed in 4 (27%) of 15 open lung biopsies, and infection was confirmed in 6 (75%) of 8 open lung biopsies. A change in therapy occurred in 69% of the cases as a result of the diagnosis made from open lung biopsy. There was no mortality as a direct result of open lung biopsy. Eleven major complications and 22 minor complications occurred in 103 procedures. Open lung biopsy can be performed safely, and established or confirmed a diagnosis in 97% of the cases. A change in therapy occurred in 69% of the cases as a result of the diagnosis made from open lung biopsy. In our experience open lung biopsy appears to be a useful tool.
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Papers by Fabio Haddad