The effect of Nd:YAG laser resection on symptom control, time to progression and survival in lung cancer patients.

PURPOSE: The aim of this study was to determine the effect of Nd:YAG laser resection of centrally located tumors on the control of various symptoms and signs, time to progression and survival in lung cancer patients. PATIENTS AND METHODS: We evaluated the effects of Nd: YAG laser resection in combination with high-dose rate (HDR) brachytherapy and external beam radiotherapy (EBRT) vs. combination of HDR brachytherapy and EBRT alone on lung cancer symptoms and signs, ECOG performance status, time to progression and overall survival in lung cancer patients. Patients in group I (n=81) were treated with combination of HDR brachytherapy and EBRT, while patients in group II (n=97) were treated with Nd:YAG laser in combination with HDR brachytherapy and EBRT. Patients were evaluated before and after treatment, and were followed-up regularly every 3 months until the end of life. After RT +/- laser treatment all patients received standard chemotherapy (cisplatin plus etoposide) during the course of disease. RESULTS: After treatment in both groups significant improvement in all investigated parameters was seen. Improvement in dyspnoea, thoracic pain, body weight loss and ECOG performance status was significantly better in group II (p <0.05), as were time to progression and overall survival (p <0.05). CONCLUSION: Laser resection improves symptom control in lung cancer patients with central airway obstruction (CAO). Longer time to progression and survival of lung cancer patients could be the result of imminent airway desobstruction accomplished with Nd:YAG laser.

Interventional pulmonology techniques for immediate desobstruction of malignant central airway obstruction.

In recent years interventional pulmonology techniques have found their place in the palliative treatment of lung cancer invading central airways (trachea and principal bronchi). The curative effect of interventional techniques is reported in a number of studies with very different success ratios, but with excellent potential and perspective. Increase in number and variety of these techniques led to the development of internationally accepted guidelines for their use. The choice of a specific interventional technique in the treatment of lung cancer patients with central airway obstruction (CAO) depends on several factors: patient's general condition and comorbidities, type and characteristics of airway stenosis, availability of techniques and trained personnel. The aim of this review was to introduce interventional pulmonology procedures aimed at urgent desobstruction of central airways obstruction to medical oncologists who are dealing with the problem of malignant CAO. We tried to emphasize indications, contraindications, technique procedure and possible complications in the treatment of malignant CAO. At the Institute for Pulmonary Diseases of Vojvodina Nd: YAG laser resection, electrocautery, argon plasma coagulation and metallic and silicone stent insertions for immediate treatment of malignant CAO are practised.

Combination of interventional pulmonology techniques (Nd:YAG laser resection and brachytherapy) with external beam radiotherapy in the treatment of lung cancer patients with Karnofsky Index < or =50.

PURPOSE: To compare Nd: YAG laser resection with Nd: YAG laser plus brachytherapy and external beam radiotherapy (EBRT) in the palliation of malignant central airway obstruction symptoms due to lung cancer. PATIENTS AND METHODS: In this prospective non-randomized study we evaluated the effects of Nd:YAG laser photoresection alone vs. Nd:YAG laser resection in combination with brachytherapy and EBRT on cough, dyspnoea, thoracic pain, haemoptysis, body weight loss, atelectasis, postobstructive pneumonia, endoscopic findings, disease-free period and survival rate in lung cancer patients. Only patients with Karnofsky index (KI) < or =50 were included. Sixty-four patients were divided into 2 groups: group I patients ( = 20) were treated only with Nd: YAG laser, and group II patients (n = 44) were treated with Nd: YAG laser followed by brachytherapy and EBRT. RESULTS: Group I patients showed statistically significant improvement in all investigated parameters but cough. Group II patients achieved significant improvement in all investigated parameters. Comparative statistical analysis between the 2 groups revealed statistically significant improvement in group II with regard to dyspnoea, haemoptysis, KI and atelectasis. No significant improvement in group II was seen when other investigated parameters were considered. Disease-free period and survival rate were significantly longer in group II (p< or =0.0005). CONCLUSION: The combination of interventional pulmonology procedures with standard modalities is the best option for the treatment of selected lung cancer patients.

Bronchodilatation test response predictors in lung function assessment of patients with resectable lung cancer and concomitant chronic obstructive pulmonary disease.

PURPOSE: The goal of this pilot study was to determine factors influencing the bronchodilatation test (BDT) response during preoperative lung function assessment in patients with resectable non-small cell lung cancer (NSCLC) and concomitant chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: The analysis included 34 patients who met the following entry criteria: preoperative lung function assessment including a BDT, presence of operable, histologically confirmed stage IA-IIIA NSCLC established by computerized tomography (CT) and endoscopical findings, no more than one cardiovascular risk factor present, no interstitial pulmonary diseases (restriction exclusively due to the tumor), and patient's age up to 70 years. The study was partially retrospective and partially prospective. BDT was performed by forced expiratory volume in the first second (FEV1) measurement prior to and 30 min after two Berodual(R) inhalations (0.005 mg of fenoterol + 0.002 mg of ipratropium bromide per inhalation). RESULTS: Possible predictors of BDT response may include history of COPD longer than 15 years, N2 lymph nodes involvement, total lung restriction, and presence of a visible tumor in the main and intermediate bronchus. CONCLUSION: These possible predictors remain hypothetical as the study cohort is rather small, so a large scale research should follow to provide reliable data necessary to make definite conclusions.

[Successful treatment of acquired F:VIII C inhibitor after delivery using plasmapheresis and high doses of immunoglobulins]. / Uspesno lecenje stecenog inhibitora F:VIII C nakon porodaja primenom plazmafereze i visokih doza imunoglobulina.

Three months after delivery a patient 34 years of age was admitted to the Clinic of haematology in Novi Sad because of sudden massive bleeding from the left ankle, left lower leg as well as for having small haematomas visible at forearms. Examining the mechanism of haemostasis, a diagnosis was made: acquired inhibitor VIII:C coagulation factor. Concentrate of VIII coagulation factor was used in treatment, as well as plasmaphaeresis, high doses of immunoglobulins and immunosuppressive drugs: prednisone and azathioprime. The result was a very quick recovery of the clinical state with loss of inhibitor to VIII: C coagulation factor. Three years after the treatment the patient has no difficulties and no antibodies to VIII:C coagulation factor.

Intensity of thrombin activity and surgical trauma.

Increased level of in vivo thrombin activity represents the essential mark of prethrombotic state. In order to assess the influence of surgical trauma on the constitution of prethrombotic state immediately after the surgical intervention, dynamic estimations of fibrinopeptide A (FPA) have been done in a group of 18 patients who had undergone abdominal surgery and in the group of 25 patients who underwent the replacement of artificial hip, and who were on preventive treatment with subcutaneous heparin. At the same time the presence of soluble fibrinmonomer complex and, in the group of patients on heparin treatment, the concentration of plasma heparin were examined. The investigations were done before the surgical intervention and on the first, third and seventh postoperative day. Our dynamic study showed the existence of certain relation between the surgical trauma and values of FPA which were the expression of intensity of in vivo thrombin activity. The mean values of FPA increased markedly on the first postoperative day in comparison with the preoperative levels. On the third postoperative day significant reduction of FPA was observed and on the seventh day marked increase was found only in patients who were not on heparin prevention. Although preventive application of subcutaneous heparin did not affect the whole blood coagulability it showed a suppressive impact on the thrombin activity level in examined surgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)