The Influence of Asthma Exacerbations on Health-Related Quality of Life.

The purpose of this study was to determine the influence of asthma on the quality of life (QoL) of patients hospitalized for an exacerbation of the disease and those with controlled asthma receiving outpatient treatment, and to establish the patients' somatic status and the level of health care utilization. This study involved 239 adults with asthma (123 hospitalized patients and 116 outpatients of family physicians). The authors used: WHOQOL-BREF questionnaire and a questionnaire measuring health care utilization. There were no differences in QoL levels between the patients with severe and controlled asthma. The psychological domain was assessed higher by hospitalized patients (p = 0.02). QoL levels correlated negatively with age, place of residence, and marital status, and positively with education. The general QoL level was most strongly influenced by gender, age, education, the number of home visits and interventions of a district nurse, and the somatic index (p < 0.05). Somatic symptoms were more severe in hospitalized patients. The QoL assessment of asthma patients in relation to somatic symptoms, health care services and socio-demographic variables allows better understanding of the complex health situation of patients at various stages of the disease, and tailoring the therapy to individual needs. Patients receiving outpatient treatment require professional psychotherapeutic support.

Lung cancer in situs inversus totalis (SIT)--literature review.

We present 21 studies of cases of lung cancer in patients with situs inversus totalis (SIT) published worldwide. The first case was described in 1952. Thirteen patients were from Japan, 4 from Eastern Europe, including 2 Polish cases from the authors` center (Department of Thoracic Surgery, Pomeranian Medical University in Szczecin, Poland), 2 from Western Asia, 1 from the U.S. and 1 from Australia. Male patients (20/21) as well as left-sided lung cancer cases (14/21) and squamous cell carcinoma cases (8/21) dominated in the entire group. Thirteen patients underwent surgical treatment. There were 10 left-sided and 3 right-sided surgical interventions with uneventful intra- and postoperative course. Explorative thoracotomy was performed in one case only on the right side. Upper lobectomy was performed in 5 cases, pneumonectomy in 3 cases, lower bilobectomy and middle lobectomy in one case and lower lobectomy in two cases. Surgery was performed through thoracotomy in 10 cases, VATS-assisted approach in two cases and sternotomy in one case. Descriptions of the surgical anatomy confirmed mirror image of the anatomy in all cases and were consistent with the preoperative CT images. Preoperative diagnosis was discussed including the role of 3-D reconstruction of CT for improving perioperative safety in this group of patients. In conclusion, lung cancer/SIT cases despite inversed but regular anatomy can be operated on radically as cases with normal anatomy with preservation of intraoperative security level.

The impact of the sequence of pulmonary vessel ligation during anatomic resection for lung cancer on long-term survival--a prospective randomized trial.

PURPOSE: The aim of this prospective randomized trial was to assess the influence of the sequence of pulmonary vessel ligation, during anatomic resection, on long term survival in patients with NSCLC. MATERIAL/METHODS: This prospective randomized study included 385 patients treated surgically with lobectomy or pneumonectomy and standard lymphadenectomy between 1999 and 2003. Patients were randomly assigned to either primary ligation of the pulmonary artery or arteries (group A - 215 patients) or of the pulmonary vein or veins (group V - 170 patients). Patients were excluded if the sequence of vessel ligation was affected by technical difficulties or anatomic limitations. Univariate and multivariate analyses included: the sequence of vessel ligation, age, gender, tumor histology, stage (TNM), and cause of death (cancer related or non-cancer related). RESULTS: Median follow-up was 63 months. The groups were comparable regarding gender, histology, type of resection, and T, N, and overall stage. Overall, 5-year survival reached 50% in group A and 54% in group V (p = 0.82) and did not differ significantly in cancer related and non-cancer related deaths (p = 0.67 and p = 0.26, respectively). Univariate analysis identified higher T and N factors, advanced stage, pneumonectomy, male sex, and older age as negative prognostic factors. Multivariate analysis demonstrated that age, T3-4 disease, and nodal involvement were associated with inferior survival. CONCLUSIONS: The sequence of pulmonary vessel ligation during anatomic resection for non-small cell lung cancer does not significantly affect long-term survival.

Accelerated treatment of postpneumonectomy empyema - report of 12-year experience.

We report 12-year experience in the accelerated treatment (AT) of postpneumonectomy empyema (PPE). There were 38 patients (7 females, 31 males) in age 19-80 years. 34 patients underwent pneumonectomy due to non-small cell lung cancer (NSCLC), 2 for other malignancies, and 2 for lung abscess. 19 right and 19 left pneumonectomies were performed. PPE was caused by bronchopleural fistula in 16 cases (42.1%) and by pleural infection in 22 patients (57.9%). The interval between first symptoms of PPE and AT ranged 1-47 months. The technique described by Schneiter et al. is based on repeated debridement/lavage of the postpneumonectomy cavity every second day performed a total of three times. 35 patients (92.1%) were free from empyema definitively. 4 of them required additional thoracomyoplasty and another 2 of them thoracostomy due to PPE recurrence. 1 patient (2.6%) during hospitalisation and 2 (5.2%) didn't complete treatment and remained drain carriers. AT alone without additional procedures healed 29 patients (76.3%). Follow up time for the NSCLC group was 8-148 months (median 67). Cancer recurrence or second malignancy rate was 8/36 (22%). Accelerated treatment of PPE is safe and effective. It provides cure for the vast majority of patients without thoracoplasty. Patients with cancer and PPE tend to live longer than similar patients without PPE.

Global Lung Oncology Branch trial 3 (GLOB3): final results of a randomised multinational phase III study alternating oral and i.v. vinorelbine plus cisplatin versus docetaxel plus cisplatin as first-line treatment of advanced non-small-cell lung cancer.

BACKGROUND: The study compared the efficacy of a first-line treatment with day 1 i.v. vinorelbine (NVBiv) and day 8 oral vinorelbine (NVBo) versus docetaxel (DCT) in a cisplatin-based combination in advanced non-small-cell lung cancer, in terms of time to treatment failure (TTF), overall response, progression-free survival (PFS), overall survival (OS), tolerance and quality of life (QoL). METHODS: Patients were randomly assigned to receive cisplatin 80 mg/m2 with NVBiv 30 mg/m2 on day 1 and NVBo 80 mg/m2 on day 8 every 3 weeks, after a first cycle of NVBiv 25 mg/m2 on day 1 and NVBo 60 mg/m2 on day 8 (arm A) or cisplatin 75 mg/m2 and DCT 75 mg/m2 on day 1 every 3 weeks (arm B), for a maximum of six cycles in both arms. RESULTS: From 2 February 2004 to 1 January 2006, 390 patients were entered in a randomised study and 381 were treated. The patient characteristics are as follows (arms A/B): metastatic (%) 80.5/84.8; patients with three or more organs involved (%) 45.3/40.8; median age 59.4/62.1 years; male 139/146; squamous (%) 34.2/33.5; adenocarcinoma (%) 41.6/39.3; median TTF (arms A/B in months) [95% confidence interval (CI)]: 3.2 (3.0-4.2), 4.1 (3.4-4.5) (P = 0.19); overall response (arms A/B) (95% CI): 27.4% (21.2% to 34.2%), 27.2% (21.0% to 34.2%); median PFS (arms A/B in months) (95% CI): 4.9 (4.4-5.9), 5.1 (4.3-6.1) (P = 0.99) and median OS (arms A/B in months) (95% CI): 9.9 (8.4-11.6), 9.8 (8.8-11.5) (P = 0.58). The median survival for squamous histology was 8.87/9.82 months and for adenocarcinoma 11.73/11.60 months for arms A and B, respectively. Main haematological toxicity was grade 3-4 neutropenia: 24.4% (arm A) and 28.8% (arm B). QoL as measured by the Lung Cancer Symptom Scale was similar in both arms. CONCLUSIONS: Both arms provided similar efficacy in terms of response, time-related parameters and QoL, with an acceptable tolerance profile. In the current Global Lung Oncology Branch trial 3, NVBo was shown to be effective as a substitute for the i.v. formulation. This can relieve the burden of the i.v. injection on day 8 and can optimise the hospital's resources and improve patient convenience.

Model of single left rat lung transplantation. Relation between surgical experience and outcomes.

PURPOSE: The model of unilateral orthotropic left rat lung transplantation is well known and established experimental procedure. The author's personal learning curve of mastery process of this microsurgical procedure is presented. MATERIAL AND METHODS: During 18 months the author has performed 197 single left lung transplantations on the Thoracic Surgery Ward in University Hospital, Berne, Switzerland. There were 147 allogeneic and 50 isogeneic transplantations done. The allogeneic transplantations were carried out from Brown-Norway to Fischer F344 rats whereas isogeneic transplantations were done among Fischer F344 rats solely. Grafted lung was obtained from the intravenously anaesthetised, oxygen-ventilated donor. The implantation was carried out through left posterolateral thoracotomy on the gas anaesthetised, respirator ventilated recipient. The anastomoses of the vessels were done using the cuff technique, bronchi were sutured using continuous running over-and-over suture. Recipients were sacrificed on day 5 post-transplant. All recipients were divided into four consecutive groups. Warm ischaemia time and presence of perioperative pure technical complications were observed. RESULTS: We observed time dependent decline of complications number of consecutive recipient groups, respectively 20, 5, 4, 1. The warm ischaemia time in minutes decreased from 35.6 +/- 5.4 in group I through 26.7 +/- 4.4 in group II, 24.8 +/- 2.3 in group III to 22.0 +/- 3.1 in group IV. CONCLUSIONS: Continuous training of the procedure shortens the average warm ischaemia time and reduces the number of complications. This tedious microsurgical procedure is possible to master by the surgeon.

[Prospective randomized comparative study of early functional outcome of 2 knee joint endoprosthesis systems--rotation plateau versus fixed polyethylene inlay]. / Prospektiv randomisierte Vergleichsstudie frühfunktioneller Ergebnisse zweier Kniegelenksendoprothesensysteme--Rotationsplateau versus fixiertes Polyethyleninlay.

AIM: Different systems are used for total knee arthroplasty (TKA). Compared were a press-fit femur condyle replacement system with fixed tibial PE-inlay versus a rotating tibia component system with an emphasis on the early functional results. METHOD: Patient selection and the use of the Knee Society Score for this randomized and prospective study were based on the directives for TKA of the german Society for Orthopaedic and Trauma Surgery (DGOT). We examined the patients post-operatively after 1 week, 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. RESULTS: After 6 weeks an increase of the total knee score could be seen in both groups. The total knee score of the rotating tibia component increased from 93.96 pre-operatively to 113.57 after 6 weeks, to 139.82 after 3 months, to 154.32 after 6 months, and to 159.65 after one year. The total score with the fixed PE-inlay increased from 79.75 to 111.5 after 6 weeks, to 128.25 after 3 months, to 134.08 after 6 months, and to 130.08 after one year. CONCLUSION: After 6 weeks the implant with the rotating tibia component showed a lasting higher score as compared to the implant with a fixed PE-inlay component using the same early rehabilitation and mobilization techniques.

Serum p53 antibodies in small cell lung cancer: the lack of prognostic relevance.

Prognostic relevance of serum p53 antibodies was assessed in 96 patients with microscopically proven small cell lung cancer (SCLC). The study group included 67 males and 29 females; mean age 58 years; range 35--86 years; 60 with limited disease (LD), and 36 with extensive disease (ED). The control group consisted of 41 patients with non-malignant diseases. The presence of p53 antibodies was assayed by the immunoenzymatic method (P53 ELISA kit, PharmaCell, France). Antibodies were present in 26 SCLC cases (27%); 15 (25%) in LD and 11 (31%) in ED. Antibodies were also found in one out of 41 control subjects (2%). There was no correlation between the level of antibodies and clinical characteristics of SCLC patients including age, gender and extent of disease. The median follow-up for the entire group was 30 months (range: 11--39 months). By the time of analysis, 78 patients (82%) had deceased. Median survival in SCLC patients with and without antibodies was 42 and 39 weeks, respectively (log rank, P=0.81). These results indicate the lack of clinical relevance of serum p53 antibodies in SCLC.

[Use of perfusion lung scintigraphy for diagnosis of pleural empyema]. / Zastosowanie scyntygrafii perfuzyjnej pluc w diagnostyce ropniaka oplucnej.

Two cases of pleural empyema with the special reference to the value of perfusion scintigraphy in the diagnostics are presented. It's role in assessment of functional disorders caused by disease as well as in choosing way of treatment is emphasized.

[Mobility of the diaphragm and lung perfusion following decortication due to chronic pleural empyema]. / Ruchomosc przepony i przeplyw plucny po dekortykacji pluca z powodu przewleklego ropniaka oplucnej.

Mobility of the diaphragm and lung perfusion after decortication, due to chronic pleural empyema in the group of 31 patients is analysed. In our group amplitude of 8 cm diaphragm mobility at PA radiological examination was confirmed and it is accepted as normal range. Scintigraphic assessment of the lung perfusion with human macroalbumin-Technet complex was made. In 10 patients after left side decortication perfusion was lower than normal range. There was no statistical correlation between worsering of the mobility of the diaphragm and reduction of the lung perfusion in the examined group.

[A case of lipoid pneumonia]. / Przypadek tluszczowego zapalenia pluc.

The 58 years old woman with chronic cough, dyspnea and infiltrations in low area of left lung was described. Antibiotics were not effective. Cancer cells were not found during bronchoscopy. Explorative thoracotomy was made. Lipoid pneumonia was recognised. Just now the patient has completed history: she has taken lipoid nasal drops for many years.

Carcinosarcoma of the lung. Report of three cases.

This article presents three cases of carcinosarcoma of the lung which is considered to be a rare neoplasm. The authors describe supposed etiology, clinical symptoms, preoperative diagnostic difficulties, surgical interventions performed, postoperative course and follow-up. The role of modern histopathological techniques like use of monoclonal antibodies reaction against keratin, vimentin and neurofilaments in differential diagnosis is emphasized. Short review of other authors reports is presented.

Parietal pleurectomy as a method of treatment of recurrent pneumothorax: long-term functional results.

A retrospective study of 297 patients treated surgically due to recurrent pneumothorax between 1974 and 1990 was performed with special reference to long-term functional results, compared with preoperative values. Duration of follow-up was 5 years. 44 patients from this group were hospitalised twice at our department. The first incident of pneumothorax was treated by chest tube drainage, the next by parietal pleurectomy. Each time, with both lungs expanded VC, MVV and FEV1 were measured. It gave a unique occasion to compare real pre- and postoperative spirometric results in the same patient (in other publications postoperative results are usually compared to predicted values taken from different tables). There was no significant impairment of the mechanical efficiency of respiration. Surgical complications were rare and minor with no deaths. There were no postoperative recurrences of pneumothorax. This series indicates that pleurectomy is a safe and reliable method of protection against recurrence of pneumothorax.

[Evaluation of penetrating heart wounds by echocardiography]. / Ocena penetrujacych ran serca z wykorzystaniem echokardiografii.

The paper presents a rare case of a penetrating endocardial wound, managed conservatively, in which echocardiography was used in the serial monitoring. Heart injuries constitute about 6% of all chest injuries. Because of the possibility of cardiac tamponade and the massive bleeding into the pleural cavity, they are life-threatening. In such cases only surgical intervention gives a chance to save the patient (5). It turns out, however, that patients with normal echocardiogram and normal vital signs can be managed conservatively, with echocardiographic monitoring.

[Disruption of the middle bronchus]. / Oderwanie oskrzela plata srodkowego.

Disruption of the middle lobe broncus as a result of blunt chest trauma is described. Patient underwent emergency reconstructive operation. Follow-up examination revealed normal postoperative chest radiogram but bronchoscopy showed decreased patency of bronchial anastomosis. Perfusion lung scintigraphy showed severely decreased perfusion of the entire right lung. Concomitant fracture of right clavicle resulted in false joint which required surgical intervention 4 weeks after the chest trauma.

[A case of extrapulmonary hamartoma]. / Przypadek odpryskowiaka o umiejscowieniu pozaplucnym.

Rare case of hamartoma localised extrapulmonary in the chest cavity is described. Clinical evaluation as well as histopathological features were identical with typical intrapulmonary hamartomas.

[Evaluation of the effect of radical parietal pleurectomy on ventilatory function of the lungs in patients treated for recurrent spontaneous pneumothorax]. / Ocena wplywu calkowitego wyciecia oplucnej sciennej na czynnosc wentylacyjna pluc u chorych leczonych z powodu nawracajacej odmy samoistnej.

Pleurectomy as a method for treatment of recurrent pneumothorax and its influence on pulmonary ventilation are analyzed. Fifty-one patients were hospitalised twice at the Thoracic Surgery Department in Szczecin. The pneumothorax was treated by a chest tube drainage at the first time, and by pleurectomy in case of recurrent incident. Each time--with both lungs expanded--VC (vital capacity), MVV (maximal voluntary ventilation) and FEV1 (forced expiratory volume) were measured, thus it was possible to compare pre- and postoperative spirometric results. There was no statistically significant deficiency of ventilation after pleurectomy. The risk of different therapeutical methods and effectiveness in the protection against recurrence of pneumothorax were discussed. The results of own observations are compared with other authors' ones.