Lung Carcinoma

Metastasis to bone is the most frequent extra-pulmonary site of recurrence in patients with non-small cell lung carcinoma, accounting for as many as 43% of all distant recurrences. Of these, metastases to the spine are the most significant and potentially debilitating. Lung carcinoma may invade the spinal column, through direct extension or via hematogenous routes. Most frequently, metastases produce osteolytic lesions, which result from a variety of acid phosphatases, acid hydrolases and alkaline phos-phatases. Lung carcinoma follows the typical pattern of spread, with the thoracic spine being most commonly involved, followed by the lumbar spine and finally the cervical spine.

The ultimate biologic activity of the subtypes of lung carcinoma is directly linked to their presumed cell of origin. Squamous cell carcinoma is thought to arise from the basal cell of the bronchial epithelium; adenocarcinoma from the CLARA cell of the bronchiole; bronchoalve-olar carcinoma from the type II pneumocytes; and for small (oat) cell carcinoma, the neuroendocrine cells of the bronchoalveolar system are felt to be responsible. The cell of origin for large cell carcinoma is yet to be clearly defined. Of these, however, the spine surgeon rarely encounters those patients with disease other than non-small cell adenocarcinoma. This is due to the rarity of some lesions, such as large cell carcinoma, and to the exquisite sensitivity to radiation for small cell tumors. Patients with squamous cell disease typically have very aggressive disease that is widely disseminated in the lungs and liver, with overall survival looked at in terms of months.

Overall, the prognosis of patients with vertebral metastasis from lung carcinoma remains poor. With the exception of some patients with small cell carcinoma, in which significant responses or even remissions may be seen after chemotherapy and radiation, for the majority of patients with non-small cell disease, the goal of therapy is palliation and prevention of neurological deficits. Due to the relative radio-insen-sitivity of non-small cell carcinoma compared to breast or prostate cancer, patients may more frequently require surgical intervention to attain these goals [2,14,15,17-19,22].

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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