Sources of pathogens causing pleuropulmonary infections after lung cancer resection.

OBJECTIVE: The source of pathogens responsible for pleuropulmonary complications after lung resection is not yet completely understood, yet knowing this source is very important for proper perioperative use of antibiotics in lung surgery. We studied prospectively the value of sputum samples -- collected 3 days before and 3 days after surgery -- and of intraoperative bronchial swabs in the diagnosis of infective pulmonary complications following lung cancer resection. METHODS: In a prospective trial, we studied 194 patients (18 women and 176 men, age range 34-79 years, mean 57 years) who were operated on for lung cancer. The infection screen consisted of intraoperative bronchial swabs, and sputum samples obtained prior to and 3 days after surgery. Before the operation, all patients were free of clinical signs of respiratory infection. In patients with postoperative infection, causative pathogens were identified from sputum, tracheal aspirate, thoracic puncture and thoracic drainage fluids. RESULTS: Thirty-four patients suffered from 32 pleuropulmonary infections, and two from wound infection. Pathogenic organisms were isolated from preoperative and postoperative sputum samples and from intraoperative bronchial swabs in 50, 64 and 27% of patients, respectively. Postoperative infective complications were caused by gram-negative bacteria and Candida albicans in 75% of patients. These potential pathogens were recovered from preoperative sputum samples and from intraoperative bronchial swabs in only 18 and 13% of cases, but from postoperative sputum samples in 63% of cases. A strong correlation in identified pathogens was found between the postoperative sputum samples and the samples collected for microbiological diagnosis of subsequent postoperative infective complications (P<0.01). CONCLUSIONS: Our results indicate that pathogens that cause pleuropulmonary infective complications are probably acquired postoperatively from the patient's oral cavity, pharynx and hypopharynx. Appropriate antibiotic prophylaxis is discussed.

Onset of spontaneous pneumothorax and the synodic lunar cycle.

The relation between spontaneous pneumothorax events and synodic lunar cycle was studied in a retrospective analysis of patients with a first or recurrent spontaneous pneumothorax. The study included a total of 244 patients, 203 males and 41 females. The data were arranged along the first (new moon) to 28th day (one day before another new moon) of the synodic lunar cycle. Periodogram analysis revealed a 14-day rhythm, significant for the male and pooled sample. Cosinor analysis found the whole synodic lunar cycle and its 2nd, 4th and 5th harmonics as significant. Maximal accumulation of cases happened 1 week before and 1 week after the new moon. Mechanisms of a putative moon influence are not clear.

Surgery for cure followed by combined modality treatment for small cell bronchial carcinoma. ISC Lung Cancer Study Group.

For patients with small cell lung cancer (SCLC) at early stages (TNM I, II) surgery for cure is used to eliminate the primary tumour and its regional lymph-nodes followed by intermittent chemotherapy and radiotherapy within the first six postoperative months. After the pathohistological examination of the operation-specimen a two-arm-randomization is performed: standard chemotherapy compared with sequential chemotherapy using three different drug-combinations. Thereafter tumour-free patients only receive prophylactic cranial irradiation. In preliminary evaluations of March 1988, of 121 patients from 20 cooperating departments it was found that the projected life-table survival rate, three years postoperatively, of 47 patients with SCLC at stages pT1-3 N0 M0 was 65%, of 46 patients at stages pT1-3 N1 M0, 56% and of 28 patients at stages pT1-3 N2 M0, 34%. The indication for surgery were emphasized for pTNM-stages I+II. For N2-lesions surgery would not be recommended in general, but the survival rate seemed to indicate that this treatment was not detrimental, but rather more favourable compared with chemotherapy or radiotherapy only. The continuation and enlargement of these studies seem not only justified but emphatically indicated. Multicentre cooperation has to be organized to collect within a reasonable period of time a sufficient number of patients to enable subdivisions to be made according to various prognostic factors.

[Late results of esophageal and cardial resection for cancer during the past 15 years]. / Pozni rezultati resekcije poziralnika in kardije zaradi karcinoma v zadnijih 15 letih.

Out of 196 patients--that we performed recestion on for cancerous esophagus and cardia, 30 are still alive by June 1977. 18,7% patients lived more than 5 years, and today 15 patients have been alive for more than 5 years. The majority of operated patients died due to advanced cancerous illness and metastasis, and less than half in number due to local recidive. By for largest percentage of them had soon after operation started to live normal lives, had no problems with taking in food, had improved physically and psychologically and started their jobs anew. All but one of alive patients are mobile, four of them partially. Two thirds do same or lighter jobs, eat normally and are in good condition. The most frequent problems are pain which are mostly temporary, and pyrosis due to reflux. We can conclude that the quality of life of operated patients is in major cases good, and cure by operation the only way for permanent recovery or fast and best method to palliate patients troubles.