[What can thoracic surgery accomplish in recurrent/second carcinoma of non-small-cell bronchial carcinoma?]. / Was kann die Thoraxchirurgie beim Rezidiv-/Zweitcarcinom des nicht kleinzelligen Bronchialcarcinoms leisten?

From 1990 to 2000, 2268 (29.9%) of 9600 lung cancer patients underwent resection for stage I to IIIA non-small cell lung cancer. Reinterventions were done in one hundred (3.5%) patients, for locoregional recurrence in 27, metachronous cancer in 42, metastasis or a third tumor in 31. A third intervention was performed in 23 patients and a fourth in two. The in-hospital mortality rate was 9%. The overall survival was 31.9% at five and 17.9% at ten years. The 5-year survival after the first intervention (reintervention) was 26% (11%) for local recurrence, 80.3% (27%) for metachronous cancer, 7% (0%) for recurrence of synchronous cancers and 0% (0%) for lung metastasis after a solitary primary lung cancer.

[Placentoid malformation of the lung as differential diagnosis of localized emphysema]. / Plazentoide Malformation der Lunge als Differentialdiagnose eines lokalisierten Emphysems.

In a 50-year old patient with a long history of chronic obstructive airway disease and pulmonary emphysema, unusual solid spongious areas adjacent to bullous tissue were detected by bullectomia because of mediastinal displacement and dyspnoea on exertion. Pathological anatomical diagnosis showed villous framework in the marginal regions of bullous transformed parenchyma. According to pathognomonic histological finding the lesion is known as placentoid malformation or placentoid bullous transmogrification, respectively. This disease must be differentiated against rare cystic tumours such as alveolar adenoma or sclerosing haemangioma as well as congenital lesions e.g. adenomatoid cystic malformation. The lesion presented here includes hamartomatous features, such as the presence of leiomyomatoid proliferations of smooth muscle cells and fatty tissue embedded in the villous stroma. The clinically predominant emphysematous transformation of the adjacent lung tissue is pathogenetically the result of a valve formation in combination with unphysiological traction forces. The ectatic lymphatic vessels in peripheral tissue may perhaps be of etiological importance. According to former studies this may be an congenital malformation with progressive development. Resection of affected lung parenchyma seems to be curative: so far, no recurrences have been noticed.

[Bronchiolitis obliterans after mycoplasma pneumonia]. / Bronchiolitis obliterans nach Mykoplasmenpneumonie.

Mycoplasmal pneumonias belong to the class of atypical pneumonias. Generally, the histomorphological findings are non-specific; occasionally there are fibrotic pulmonary changes in consequence of partial recovery. In the case under report we present a 27-year old male patient who developed an almost total atelectasis of the right lung subsequent to an unspecific respiratory infection. Serologically his findings were characterised by an extremely elevated mycoplasmal titre so that we had to assume he was suffering from mycoplasmal pneumonia taking an unusual course. Since it was not possible to restitute the lung despite intensive therapeutic efforts, right-sided pneumonectomy had to be performed. Histological examination of the resectate resulted in diagnosing a bronchiolitis obliterans with partially complete obliteration of the bronchi down to subsegmental size. The case presented here must therefore be interpreted as a rare course of mycoplasmal pneumonia associated with the development of a massive atelectasis on an underlying bronchiolitis obliterans.

Surgical treatment of pulmonary and pleuro-pulmonary Aspergillus disease.

Between 6/87 and 3/92 22 out of 24 patients were treated (22 by surgery) for pulmonary and pleural Aspergillus disease. The most frequent lung disorder was tuberculosis (9 x), followed by bronchiectasis (5 x), congenital lung cysts (2 x), pneumonia with abscess formation (2 x), sarcoidosis (2 x), and bronchial cancer (4 x). More than half the patients had further severe secondary diseases. 4 patients with "simple aspergilloma" and 5 patients with "complex aspergilloma" underwent lobectomy or segmentectomy without complications or recurrence. Special surgical problems occurred in 13 patients with inflammation involving pleura and chest wall (pleuro-pulmonary aspergillosis, pleural aspergillosis) and invasive lung changes (invasive pulmonary aspergillosis). 7 patients developed an empyema after lung resection, on 4 occasions with bronchopleural fistula. In 4 cases myoplasty, in 2 cases thoracomyoplasty, on 2 occasions completion pneumonectomy with omentoplasty, in one case omentoplasty alone, and on 2 occasions decortication with pleurectomy and lung resection lead to a complete cure. 2 open window thoracostomies were constructed. In 15 cases a single operation was adequate. In 7 patients up to 3 further operations were necessary. 17 patients had haemoptysis, in 10 of these cases it was recurrent. On 7 occasions life-threatening haemorrhage took place, causing death in 2 cases. These were the only deaths resulting from the lung disease. Our results show that aggressive surgical action can be successful. Myoplasty, thoracomyoplasty, and omentoplasty are, in our view, the most suitable measures for healing pleura empyemas and bronchopleural fistulae coincident with pleuro-pulmonary aspergillosis.(ABSTRACT TRUNCATED AT 250 WORDS)

The mechanism of angioplasty--endoscopic and morphometric investigations in an experimental model.

The effect of angioplasty using two different sizes of balloon catheter were examined by angiography and angioscopy before and after dilatation. A significant increase in the outer and inner diameters was seen accompanied by a decrease in the cross sectional area of the stenoses as well as the thickness of the vascular wall. Angioscopy revealed typical longitudinal tears of the plaque edges which are pressed during flow against the vessel wall. Turbidity of saline could be seen after dilatation indicating possible rupture of the atheromatous plaque. These findings are discussed in the light of the mechanisms of angioplasty and the possible reasons for the good early and long-term results.

Selection and preoperative treatment of over-seventy-year-old patients undergoing thoracotomy.

The thoracic surgeon is confronted with the question of the operability of patients over 70 years old more and more frequently. Not only the advanced age, but also probable functional impairments are decisive for the outcome of an operation in this often polymorbid age group. Fifty-three patients over 70 years old underwent 58 thoracotomies. The hospital lethality was 7.5%, the complication rate 17%. These results could be obtained by a specific selection of patients, based on functional parameters, intensive preoperative medical and physiotherapeutic treatment in terms of improvement of possible functional deficits and the usual postoperative intensive care. In our long-term observations we could record a 5-year survival rate of 100% in patients with benign diseases and of 46% in cases of bronchial carcinoma. These results confirm our attitude that the age 70 years and older should not be considered as contraindication for thoracic surgery.

Functional surgery of bullous emphysema.

Multiple large and small emphysematous bullae were resected in 27 patients with chronic obstructive lung disease (COLD). Twenty-two patients were operated on one side, and 5 patients underwent bilateral consecutive operations. Twenty-five patients were male, 2 female, and they were between 22 and 67 years old (mean 49.5 years). All patients had a follow-up examination between 3 and 48 months postoperatively. As operative techniques, resection by means of a clamp, plication of cysts according to Nissen, resection with homologous dura plasty (7 patients) and pericardial plasty (7 patients) were used. In 19 patients preoperative and postoperative pulmonary function was compared. Functional improvement occurred in 17 patients - including all of the 5 bilateral procedures. Postoperative improvement was more pronounced with decreasing preoperative pulmonary function, measured as VC, RV, IGV and Raw. Partial pulmonary insufficiency could be improved in 9 patients and global pulmonary insufficiency was improved in 5. In 16 cases physical work capacity was increased. The hemodynamics of the pulmonary circulation were improved in all patients with increased preoperative pulmonary artery pressure (latent pulmonary hypertension in 7 patients, overt pulmonary hypertension in 5). FEV1 was least influenced by surgery, especially in patients more than 50 years old. The long-term prognosis, thus has to be judged cautiously. One patient died postoperatively (mortality 4%). The technique of dura and pericardial plasty, aiming at functional adaptation, is described. Sutures inverting or folding pulmonary tissue are avoided. The aspect of at least temporary (up to 3 years) functional improvement leads us to advocate the use of extended criteria of operability.

[Inflammatory and tumorous metastases of the thoracic spine: operative management and results (author's transl)]. / Entzündliche und tumoröse Metastasen der Brustwirbelsäule: Operative Behandlung und Ergebnisse.

133 patients with inflammatory or tumorous metastases of the thoracic spine were operated upon within the last 11 years. Radical removal of inflammatory lesions with consecutive corticalis-spongiosa-plasty, taken from the christa pelvis, and chemotherapy are a therapeutical unit. Excision of the tumor with supplement bone grafting or "Pallacosplombe" and stabilization according to the principals of osteosynthesis are rewarding in individual cases. Four out of nine tumor patients survived two years after surgery.

[Aetiology and treatment of spontaneous pneumothorax (author's transl)]. / Spontanpneumothorax--Atiologie--Behandlungsplan und Ergebnisse.

During the past 24 years 571 cases of spontaneous pneumothorax were observed in 408 persons. The aetiology of spontaneous pneumothorax is reviewed. Diagnostic thoracoscopy followed by suction drainage is recommended. Bilateral tension pneumothorax and recurrent pneumothorax were treated by surgery. The preferential method was local or partial parietal pleurectomy. In some cases the pneumothorax was sealed by a dura graft. There was no substantial functional impairment and no post-thoracotomy death. The average lenght of treatment was 20 days.