[The technique of sleeve resection on the bronchial and pulmonary vascular tree]. / Technik der Manschettenresektion am Bronchial- und Lungengefäßbaum.

Sleeve resections of the lungs have affected the oncologic radicality, parenchyma and lung function-saving resections and extended the indications for operations in thoracic surgery. Whenever lung amputations can be avoided by bronchoplastic and/or angioplastic procedures with the same radicality, sleeve resection should be performed. In centrally located distinct malignomas, intraluminal tumor growth (T3) infiltrations of peribronchial or extrabronchial areas, the lobular ostia and the pulmonary artery (T2/T3) as well as lymph node involvement (N1/N2), these procedures give a better qualitative survival and lower morbidity and mortality rates. Broncoscope-guided localization of a double lumen tube and routine anesthesia monitoring are mandatory. Before performing sleeve resections a complete lymph node dissection should be done without denuding the area of the anastomosis and sparing the bronchial arteries. Preoperative endoscopic biopsies, knowledge of the topography and mobilization of the vascular and bronchial tree, subtile operation techniques, perioperative and postoperative videobronchoscopic guidance as well as intraoperative frozen sections and a tension-free and smooth anastomosis, avoid postoperative complications. Depending on the blood supply of the bronchial tree a vascularized flap is indicated. Operability can therefore be achieved in elderly patients with limited pulmonary function, particularly those under adjuvant or neoadjuvant therapy who are no longer suitable for pneumonectomy.

Key genes in lung cancer translational research: a meta-analysis.

In lung cancer, integrating translational data from various histologies obtained in different patients under different conditions can increase their robustness. This is a meta-analysis of cDNA array data obtained in 688 tumor patients (541 non-small cell lung cancer, 33 small cell lung cancer and 114 others) and 205 controls. 1,206 genes were found to be dysregulated in one of the 12 transcriptomics studies available. 748 results (62%) were obtained only once and might be questioned. 38% of observations could be reproduced twice or more. 346 genes were reported twice, 80 three times, 27 four and 5 five times. A common set of genes dysregulated in lung cancer was obtained, including BPA1, DUSP6, ASCL1, RNAS1 and S100P. p63 and CK 5/6 p63 are useful for differentiating adenocarcinoma and small cell lung cancer from squamous cell carcinoma. TFF-3 and MUC1 are over-expressed in adenocarcinoma. INSM1, SGNE1 and H2AFZ are typical for small cell lung cancer. Using a meta-analysis approach, it was possible to detect a robust set of genes differentially expressed in lung cancer and to determine a limited number of key genes linked to subtypes in lung cancer molecular pathology.

[The thoracoscopic talc pleurodesis with intraoperative pleural biopsy - a retrospective analysis in patients with malignant pleural effusion]. / Die thorakoskopische Talkumpleurodese mit Pleurabiopsie - eine retrospektive Analyse bei Patienten mit malignem Pleuraerguss.

BACKGROUND: The thoracoscopic pleurodesis with talc is an established therapy in case of malignant pleural effusion. With the instillation of talc a -localised inflammation is induced. However, some-times it turns into a severe systemic reaction. In this study of the postoperative course, the -question is examined whether a pleural biopsy is an additional risk factor for morbidity and mortality after talc pleurodesis. PATIENTS AND METHODS: Between January 2002 and December 2004, 77 patients with a malignant pleural effusion were enrolled in this retrospective trial. All patients received a thoracoscopic talc pleurodesis. The patients were divided retrospectively into two groups: 50 patients with an intra-operative pleural biopsy, 27 patients without a biopsy were the control group. C-reactive protein (CrP), leukocytes, and creatinine were -analysed. RESULTS: In both groups, CrP and leukocytes increased postoperatively with a peak on day 2 or 3. In general, the analysed data for creatinine -showed in the median standard values but with a high range up to at most 317 micromol / L on the 2 (nd) postoperative day, also in both groups. At no time was any significant difference in laboratory values seen among the two groups. Concerning morbidity and mortality also no significant difference could be determined. CONCLUSIONS: There were no significant differences for the examined laboratory values or for the morbidity / mortality between the two groups. That is why a disadvantage for patients with an intraoperative pleural biopsy is not to be expected.

Video thoracoscopic surgery used to manage tuberculosis in thoracic surgery.

BACKGROUND: The aim of this study was to evaluate the indications and results of video-assisted thoracic surgery (VATS) for the management of tuberculosis in 10 patients with unusual clinical and radiologic presentation for the disease. METHODS: From March 2000 to March 2002, 96 diagnostic VATS operations for unclear thoracic lesions were performed at the authors' institution. Their final diagnosis for 10 (10.4%) of these patients was tuberculosis. The suspected preoperative diagnoses were pancoast tumour (n = 1), pericardial effusion (n = 1), pleural mesothelioma (n = 1), pleural empyema (n = 2), mediastinal lymphoma (n = l), and lung cancer (n = 4). RESULTS: For all the patients, the diagnosis of tuberculosis was achieved by VATS. The duration of drainage was 2.5 days. There have been neither morbidity nor mortality since surgery. The hospital stay was 3 to 5 days. CONCLUSION: Thoracoscopy is a safe and effective procedure for the management of tuberculosis. Tuberculosis should be kept in mind during the differential diagnosis of unknown thoracic lesions, and also for patients who live in economically well developed countries and are not immune compromised.

[Pericardial empyema due to oropharyngeal infection -- a rare entity]. / Das Perikardempyem im Rahmen einer oropharyngealen Infektion -- Eine seltene Entität.

Both the descending necrotizing mediastinitis (DNM) and the pericardial empyema are rare but life threatening situations, in which rapid aggressive surgical approach is important for the outcome. A 37-year-old man presented with reduced general health and new establishment of thoracal pain after an infection in the oropharyngeal region. The dissemination of the infection into the mediastinum (mediastinitis) diagnosed by clinic and radiography required surgical intervention. A pericardial empyema was detected intraoperatively. The patient was discharged home on the 14 (th) hospital day.

[Differential diagnosis of pulmonary infiltration after insertion of a chest tube for pneumothorax]. / Differentialdiagnose des pulmonalen Infiltrates nach Pneumothorax-Drainage.

Reexpansion injury of the lung is rare and may occur after reexpansion of a collapsed lung such as after evacuation of a large amount of air or fluid from the pleural space. Its pathogenesis, however, is not clearly understood. Pulmonary edema should always be considered if the patient's respiratory condition worsens after lung reexpansion.

Rapid cycling patients: conceptual and etiological factors.

The concept of rapid cycling is confusing in terms of its definition, clinical features, course of illness and the outcome. To complicate the matter further, rapid cycling has been reported to be drug resistant. Currently this condition has been reported to be secondary to lithium, tricyclic antidepressants and other agents such as cyproheptadine, a serotonin antagonist, piribedil, propranolol and levodopa. The increase in rapid cycling has coincided with the rapid increase in cocaine use in the society even though such an association cannot prove a causal relationship. Clinical or subclinical hypothyroidism as well as hyperthyroidism have been implicated in rapid cycling. In addition to the lack of specific knowledge on the etiology, a number of heterogeneous disorders has been grouped under this entity. It is useful to attempt a classification to ascertain whether clinically distinguishable subgroups have a common or different pathophysiology and to tailor the treatment that is most desirable for each subgroup.