Intrathoracic application of vacuum wound therapy following thoracic surgery.

OBJECTIVE: The VAC system (vacuum-assisted wound closure) is an established noninvasive active therapy to promote the healing of difficult wounds that fail to heal with conventional treatment after cardiac surgery. We report our initial experience of the intrathoracic application of the VAC system after extended thoracic surgery. METHODS: Thirteen patients (11 men, 2 women) with a median age of 60 years (range 41 to 82 years) with deep wound infections after thoracotomy (empyema = 3; lobectomy = 5; Pancoast = 1; pneumonectomy = 4) were treated primarily with the VAC system after initial surgical debridement. All patients had an increased risk for impaired wound healing (e.g., diabetes, obesity, empyema, steroids). The VAC system was removed when systemic signs of infection resolved and quantitative cultures were negative. RESULTS: After a mean period of 64 +/- 45 days (range 7 to 134 days) the VAC system was removed in all patients. It was used as a bridge to reconstructive surgery with a latissimus dorsi muscle flap in 2 patients (15 %), while surgical wound closure could be achieved in the remaining 11 patients (85 %). Complete healing without recurrence was achieved in 11/13 (85 %) patients to date. Hemodynamic or respiratory complications (e.g., air leakage) during VAC system application were not observed in any case. Survival was 100 % after 16 +/- 9 months. Duration of hospital stay varied from 16 to 110 days (mean 44 +/- 34 days). CONCLUSION: Intrathoracic vacuum therapy after extended thoracic surgery seems to be an effective and safe adjunct to conventional treatment modalities for the therapy of intrathoracic infections or deep wound infections.

[Malformation of a bronchial artery with shunt into the pulmonary vascular bed - a rare cause of massive haemoptysis]. / Malformation einer Bronchialarterie mit Shunt in das Pulmonalgefässbett - seltene Ursache der massiven Hämoptyse.

We present the case of an otherwise healthy 41-year-old woman, who was admitted after having expectorated bright red blood. While the chest roentgenogram was found to be normal, fiberoptic bronchoscopy revealed mild active bleeding originating from the apicoposterior segmental bronchus of the left upper lobe, which exacerbated during the examination. The bleeding was contained through blockade of the upper lobe bronchus by means of a double-lumen endotracheal tube. After the patient had been referred to our department, we performed a resection of the superior segmental group of the left upper lobe. The histopathological examination of the specimen revealed a malformation of the bronchial artery with an abnormal communication to a branch of the pulmonary artery. The malformation was located in close proximity to the apicoposterior segmental bronchus. Whereas arteriovenous malformations with a pulmonary artery branch as feeding vessel have been described in more than 500 cases and primarily affect patients with hereditary hemorrhagic teleangiectasia (HHT, Rendu-Osler-Weber disease), the 23 reported cases of malformations supplied by a branch of the bronchial artery show no evidence of heredity. Furthermore, clinical appearence and localisation show characteristical differences between arteriovenous malformations with pulmonary arterial supply and malformations arising from a bronchial arterial source. Therefore, it seems appropriate to make a clear-cut distinction between these two patterns of vascular malformation of the lung.

[Surgical therapy of pleural empyema with tauroline]. / Chirurgische Therapie des Pleuraempyems mit Taurolin.

Empyema continues to be a significant problem in spite of improved surgical techniques and the use of new, more potent antimicrobial agents. This report describes our experience in the treatment of empyema at the Clemens Hospital in Münster, Germany, from 1990 to 1996. Basic to conservative treatment are closed drainage with intensive irrigation and instillation of Taurolin, a chemotherapeutic agent against bacterias, yeasts and mycetes. This treatment has been employed since 1990 and given 86 patients with just empyema or in combination with decortication. The superiority of this method to other methods of treatment is discussed on the basis of our results.

[Treatment of small cell bronchial carcinoma with reference to stage classification]. / Die Behandlung des kleinzelligen Bronchialkarzinoms unter Berücksichtigung der Stadieneinteilung.

There are controversial views and discussions on surgical treatment of small cell lung cancer. A retrospective study covering the period from 1959 through 1983 has been conducted by the authors to analyse resective approaches to lung cancer. A total of 2,039 resections for lung cancer included operations on 354 small cell carcinomas according to the WHO nomenclature. Operations were performed on 265 cases of small cell lung cancer by the end of 1977. These were subdivided by stages, with survival rates being determined. An overall five-year survival rate was recorded from 22.8 per cent of the cases with 43.0 per cent in Stage Ia und 21.4 per cent in Stage Ib. Hence, resection of small cell lung cancer is fully supported by the authors for Stage Ia and is conditionally supported for Stage Ib, whereas complex radiotherapy and chemotherapy should be applied to small cell lung cancer in the advanced Stage II and III.

[Surgical treatment of small-cell bronchial carcinoma]. / Die chirurgische Behandlung des kleinzelligen Bronchialkarzinoms.

The analysis of 284 resected small-cell bronchial cancers from 4 Lung clinics has shown that these represent 11% of all resected lung cancers. The 5-year survival rate was 24%. The male-to-female ratio was 9.5: 1. Two-thirds were detected by X-ray mass screening. The majority of them (60%) were peripheral tumors. 50% of the patients had a stage Ia cancer and showed a 5-year survival of 40%! This result speaks for the primary surgical therapy even for stage I small-cell bronchial cancers, and for a 6-month screening interval of the respective risk groups. Patients with stage II or III cancers showed a 5-year survival rate of only 10%. In such cases postoperative adjuvant chemotherapy should be carried out. But such a therapy seems to be little effective in stage Ia patients.

[Lung resection for carcinoma in old age--effect of cardiopulmonary risk factors on surgical indications]. / Lungenresektion wegen Karzinom im höheren Lebensalter--Einfluss kardiopulmonaler Risikofaktoren auf die Operationsindikation.

Advanced age will only play a limited role in determining the indication for lung resection in elderly patients. Our results demonstrate that the overall state of health and the stage of the tumour are the decisive criteria whether a lung resection can still be performed successfully or not.

[Resection therapy of bronchogenic carcinoma in old age]. / Resektionsbehandlung des Bronchialkarzinoms bei Patienten im höheren Lebensalter.

In a 20 year period from 1959 to 1979, 218 resections were performed for primary cancer of the lung in patients aged 70 and more. The postoperative mortality was 5% (11 cases). Long-term results could be evaluated for 160 cases operated before 1975. A 5 years survival rate could be established after pneumonectomy for 10.7%, after lobectomy for 39.6% and after wedge lobe resection for 25%. Staging by TNM-system 5 years survival rate in St.I/T 1 was 45.1%, St.II/T1/T2 33.3% and St.III/T1-T3 15.5%. Before opening the chest, the histological diagnosis of bronchial carcinoma could be defined by bronchoscopic findings in 81.8%. In cases of primary cancer of the lung without clinical symptoms, resections were done successfully at an age of 70 years and more.