[Resection of bronchial carcinoma combined with lung volume reduction]. / Die Resektion von Bronchialkarzinomen mit simultaner Lungenvolumenreduktion bei terminalem Lungenemphysem.

Lung volume reduction (LVRO) combined with simultaneous resection of bronchial carcinoma ignores the well known principles of functional operability. In case of 6 patients with LVRO and resection of the lung because of a non-small-cell lung cancer (NSCLC) stage I (4 x), stage II (1 x) and stage IIIa (1 x) located in the emphysematous lung parenchyma lobectomy was done four times and extraanatomical resection twice. Because of a gangrene the resection of middle lobe was necessary in case of one patient. There were no other perioperative complications. 6 months after the operation 5 patients noticed decreased dyspnea. The survival rate after 2 years was 66 %, after 3 years 34 %. 1 patient is still alive after 56 months. Cause of death was in every case progress of tumour. Due to the principles of oncologic surgery lung resection will be functional tolerated if the cancer is located in the area of bullous lung destruction; in singular cases lung resection will improve the cardiorespiratory status at least temporary. In case of extraanatomic or segmental resections there is a low rate of morbidity and lethality but a high incidence of recurrence of carcinoma. The short- and medium- term functional results seem to be encouraging. Limiting factor for carrying out extensive resections is the tumour infiltration of non emphysematous lung parenchyma. There is no doubt that simultaneous resection will be reserved for a group of highly selected patients.

[Diagnosis and treatment of primary mediastinal liposarcoma]. / Diagnostik und Therapie primärer mediastinaler Liposarkome.

Mediastinal liposarcoma are of rare entity; there are less than one hundred cases published worldwide. Because of the equivocal and inapparent symptomatology clinical signs often are falsely estimated, and in time of surgery there is generally seen a wide spread tumor growth, so that a radical resection often is impossible. Radiotherapy and chemotherapy are of limited value and mean no chance for curative therapy. The case of a 46 years old patient with an extensive primary liposarcoma of the mediastinum and the results of the review of the literature will be discussed.

[Endobronchial chondroma--bronchoscopic resection or thoracic surgery intervention?]. / Endobronchiale Chondrome--Bronchoskopische Resektion oder thoraxchirurgische Intervention?

Endobronchial chondromas as a rare form of benign tumors of the bronchial tree lead not only to diagnostic problems because of the unspecific often latent pattern of symptoms, but also to therapeutic difficulties because of the macroscopic findings and the poststenotic changes of the bronchial tree and the lung parenchyma. In case of a 75-year old female patient the various therapeutic possibilities are discussed. The therapy must be individual and consider the extent of simultaneous lung changes and the general criteria of operability in thoracic surgery.

Tracheal resection--state of the art.

Sleeve resection of the trachea and reconstruction by end-to-end anastomosis is seen as the method of choice in the treatment of short and long stenoses of the trachea following long-term artificial respiration and tumors. The experience with tracheal resection in 73 patients operated upon at 2 different thoracic units is analyzed. Postintubation was the main indication for operation in 63% of the patient population. The 30-day postoperative mortality rate was 8% with a total mortality of 19%. A satisfactory functional result was attained in 73% of the patients operated upon including those with malignant tumors. Restenoses occurred in 6 of the 73 patients who underwent surgery. Different approaches to tracheal resection were chosen in the 2 clinics and the possibility of mobilizing the larynx was used in a different way. A preference for resorbable material was noted regardless of the operative technique and has prevented restenosis. The diagnostic procedures considered mandatory, the indications for surgery and the various operative techniques are discussed.

[Pre-operative staging of bronchial carcinomas: a comparison of computed tomography and conventional radiography (author's transl)]. / Präoperatives Staging des Bronchialkarzinoms: Wertigkeit der Computertomographie im Vergleich zur konventionellen Radiologie.

Pre-operative staging was carried out in 52 out of 112 patients suspected of having bronchial carcinomas, using computed tomography and conventional radiology. CT was superior in demonstrating tumour infiltration of the mediastinum, of the thoracic wall and of metastases in mediastinal lymph nodes. Conventional radiology was better for demonstrating intrabronchial tumour and metastases of bronchopulmonary lymph nodes. By extending CT to the upper abdomen, it was possible to show metastases in 18% of patients.

[Surgical position and possibilities in bronchial carcinoma]. / Operativer Stand und Möglichkeiten beim Bronchialkarzinom.

In accordance with international statistics 25% of all patients with bronchogenic carcinoma can be treated by resection at the moment the diagnosis is established. The 5 year survival rate is in most series 25%. Important prognostic factors are: TNM-stage, histological classification, biological nature of the tumour and involvement of lymph nodes; discussed are further localisation of the primary tumour and immunological status. The summarizing statistics show that the carcinoma of squamous cell type has the best chance of a 5 year survival with a rate of more than 50%. In small-cell carcinoma extremely different 5 year survival rates between 0 and 20% are reported. In the surgical treatment it is obvious that the number of lobectomies are increasing in comparison to pneumonectomies. The postoperative mortality rate differs for "radical" pneumonectomy between 20% and 35%, for simple pneumonectomy between 7% and 10% and for lobectomy below 2%. Determinant for the postoperative course is the preoperative estimation of the risk factors. The 5 year survival rate after broncho- or angioplastic procedures varies in different series between 9,8% and 36%. In segmentectomies and wedge resections the 5 year survival rate was up to 56%. Primary palliative resections are indicated for pain reduction and improvement of the quality of life.

[Open and closed chest trauma (author's transl)]. / Das offene und das geschlossene Thoraxtrauma.

The observations made in 1,023 cases of chest trauma during 1947-1976 inclusive are analysed. According to the extent of the injuries they were classified as mild (group 1), moderate (group 2) and severe (group 3). The clinical picture was dominated by other than chest injuries in 45% of patients in group 1, in 66% in group 2 and in 51% in group 3. Injuries to the intrathoracic organs were seen in only 34 patients. Total mortality of all chest injuries was 12%; in group 3 it was 62%. Severe respiratory insufficiency was the direct cause of death in 25% of persons in group 3.

[Haemochron--a simple method of monitoring heparin level during extracorporeal circulation]. / Hämochron - einfache Methode zur Kontrolle des Heparinspiegels während des extracorporalen Kreislaufes.

Tow forms of heparin management during cardiopulmonary bypass were compared in order to analyze the role of the heparin level in relation to postoperative blood loss. The study was divided in three groups: In group I, the control group, 3 mg/kg body weight heparin was given as an initial dose and maintained at a dose of 1.0 mg/kg every 60 min during cardiopulmonary bypass; group II received the same initial dose, but additional doses were based upon the activated clotting time measured with a Haemochron; in group III, the Haemochron time was measured at 10-min intervals to establish a base value. In group II we found a significant decrease in postoperative blood loss as well as a decrease in the amount of heparin administered during cardiopulmonary bypass. In addition, fewer transfusions were required in the immediately postoperative period. In group III, wide variations in the activated clotting time curve were observed. No patients was underheparinized, but some had markedly prolonged Haemochron times.