Surgical treatment of stage III non-small cell lung cancer.

The resectability of NSCLC is determined by its stage. The surgical treatment in stage I and II NSCLC remains a golden standard. Stage IIIA NSCLC constitutes a non-homogenous group, and many patients are potentially non-resectable. The patients in stage IIIA NSCLC also constitute a non-homogenous group. The patients in stage T3N1 usually undergo surgical resection, but many patients with N2 disease are disqualified from surgical treatment due to the negative prognostic factors. The negative prognostic factors comprise: (1) metastases to upper paratracheal (no 2), anterior paratracheal (no 3), and subcarinal (no 7) lymph nodes; (2) metastases to multiple mediastinal lymph nodes; (3) occurrence of the so called 'bulky disease'; (4) capsular lymph node invasion. The occurrence of one of these negative prognostic factors disqualifies the patient with N2 disease from radical surgical treatment. In more advanced cases, i.e. stage IIIB, and stage IV NSCLC, patients are rarely operated. It regards the patients in stage T4 N1, and in M1 disease with a single metastasis (mainly to CNS) accompanied by the stage I, or II, of the primary focus. In these cases N2 disease always constitutes the contraindication to the surgical treatment. Multidisciplinary approach in the treatment of NSCLC is supposed to improve the results of the treatment of NSCLC.

[Sarcoid reaction in patients with lung neoplasm--personal experiments]. / Odczyn sarkoidalny u chorych na raka pluca--doswiadczenia wlasne.

In two cases histological examination of the lymph nodes excised during mediastinoscopy showed non-caseous epithelioid granulomas. In one patient with hilar lymphadenopathy sarcoidosis was misdiagnosed. One-year later progression of lesions in lungs was found and adenocarcinoma was diagnosed. In second patient with tumour in chest x-ray examination after misdiagnosed sarcoidosis thoracotomy was done and histological examination of samples from tumour showed nonsmall cell lung cancer. In both carcinomatous cases sarcoid reaction was recognised.

[Pulmonary amyloidosis--own experience]. / Amyloidoza ukladu oddechowego--doswiadczenia wlasne.

Three cases of amyloidosis were described. In all diagnosis was confirmed by histological examination. There was amyloidosis limited to the lungs in 2 cases and in 1 generalised. In 1 patient lobectomia was performed. Next 2 pts were treated with prednisone and cytostatic drugs (melphalane and cyclophosphamide).

Experimental study of the effects of different stapling devices in healing of the mechanically sutured bronchial stump.

OBJECTIVE: The invention of the mechanical suture of the bronchial stump resulted in the significant decrease of the incidence of bronchial fistulas. Bronchial fistula constitutes the most dangerous complication of the pulmonary resection. In connection with some negative opinions in world literature regarding the safety of applying some types of mechanical suture, the multi-factor analysis of efficacy of bronchial stump closure following the total pneumonectomy by two different types of stapling devices was performed. METHODS: The experimental study was performed on 22 sheep. Each sheep underwent left pneumonectomy. In group I the bronchus was closed by the hinged-jaw stapling device (TA-Premium, Auto-Suture). In group II the bronchus was closed by the stapling device of parallel pattern (RLV 30 Ethicon). The macroscopic parameters (i.e. linear structure of staples, degree of staples closure, the symmetry of staples closure in the medial and lateral part of bronchial stump) as well as microscopic parameters (i.e. degree of inflammatory reaction, degree disorder in collagen fibers system, degree of disorders in cartilaginous system, degree of vascular proliferation and nervous regeneration) were evaluated. RESULTS: In three cases of group I the serious abnormalities in staples closure in the medial part of the bronchial stump were revealed. Abnormalities were found also in microscopic evaluation of the specimens. In the whole group the inflammatory reaction predominated in the medial part of bronchial stump near the hinge of the cartridge (P value <0.05). The disorder in the collagen fibers system as well as in the stratified structure of muscular fibers and cartilaginous system was proved. On the other hand, in group II all staples were properly closed in adequate linear structure, without any symmetry in both medial and lateral end of the bronchial stump. The microscopic findings were only the subtle inflammatory process and a slight disarrangement in muscular, collagen and cartilaginous systems. CONCLUSION: The listed abnormalities of mechanical, hinged-jaw suture of bronchial stump seem to be due to the inaccurate placement of staples, their incomplete closure, and excessive damage to the sutured tissues. We conclude that the application of the hinged-jaw mechanical suture of the bronchial stump might result in higher incidence of bronchial fistula after pneumonectomy.

Perioperative management of a post heart transplantation patient with renal failure qualified to lung resection.

Since the first heart transplantation (1967, Christian Bernard), hundreds of similar procedures have been performed all over the world. Considerable advance made in immunosuppressive treatment improved survival rate and long-term efficiency of treatment improved survival rate and long-term efficiency of treatment. Many of these patients suffer from ailments requiring operations which are not connected with the transplanted organ. The present study describes a case of a post heart transplantation patient qualified to lung resection, in whom renal insufficiency occurred in the course of immunosuppressive therapy.

[Early and late results of surgical treatment for bronchial carcinoids]. / Wczesne i odlegle wyniki leczenia chirurgicznego rakowiaków oskrzeli.

UNLABELLED: The aim of the study was to evaluate the efficacy and safety of surgical treatment of the bronchial carcinoids. Between 1983 and 1996 52 patients (pts) with typical carcinoid were operated. The group consisted of 23 males and 29 females aged from 20 to 68 years (mean 41.3 years). In the chest X-ray and CT scan round shadow were found in 21 (40.4%) cases, lung tissue atelectasis in 23 (44.1%) cases. The bronchial tree was normal in fiberoptic bronchoscopy in 8 cases. We performed 4 pneumonectomies, 3 wedge resection and 45 lobectomies (including 5 "sleeve" lobectomies). We haven't recorded any early post-op deaths. Only two pts (3.8%) developed post-op complications--cardiac arrhythmias. In two cases the surgical treatment was followed by radiotherapy for metastases in regional lymph nodes. The period of follow-up ranged from 3 to 166 months (mean 62.2 months). During that time we noticed the recurrence of tumor in 2 pts (3.8%). One patient died from cardiac reason. The 5-year survival among patients operated in the period 1983-1992 was 91.2%. The 10-year survival in the group of pts operated on between 1983 and 1987 was 90%. CONCLUSION: The surgical treatment of bronchial carcinoid is method of choice, very efficient and safe.

The management of tracheal obstruction.

The stenting of the tracheobronchial tree has become common method of palliative treatment in inoperable cases. The patients with malignant tracheal stenosis constitute the most numerous group. The airway patency should be restored prior to inserting the stent. The stent protects both trachea and bronchi from narrowing their lumen with malignant tissue. When malignant infiltration is accompanied by airway compression the stenting is the method of choice. The own model of tracheobronchial prosthesis has been invented. It enables the protection of both trachea and the bronchi. The stent is inserted endoscopically on rigid bronchoscope. It is the method of stenting, which allows the visual control during the whole procedure.

Palliative intubation of the tracheobronchial tree.

Sixteen patients with far-advanced neoplastic lesions in the trachea and main-stem bronchi were studied. Ten of them were admitted to the ward in extremely poor general condition with marked cyanosis and dyspnea at rest. Palliative intubation was undertaken with two types of tubes: a Neville tracheal prosthesis and a Tracheoflex tracheostomy tube. Both types of tubes had to be specially prepared, as they had originally been designed for other purposes. The tubes were placed in the stenotic sections of the trachea and, depending on anatomical relations, within the right or left main bronchus as well. Intubation of the bronchus in the case of changes involving only the trachea was necessary to properly position and fasten the tube in the bronchial tree and to prevent displacement of the prosthesis inside the trachea. In two patients the esophagus was intubated as well. An improvement in the general condition of all patients was observed. Intubation resulted in reexpansion of a completely collapsed lung in two patients. The longest time of intubation was 9 months. The method is simple, and every physician experienced in endoscopy can use it. The results obtained encourage its further and wider application.

Leiomyoma of the lung.

A case of asymptomatic pulmonary leiomyoma diagnosed by routine chest radiography and treated by lobectomy is reported. There is no particular clinical pattern that distinguishes this lesion, and diagnostic maneuvers to identify its nature are generally unrewarding except for biopsy. Resection is the recommended treatment.