[Development of an immuno-neutral lipid emulsion for optimal postoperative management of intensive care patients]. / Entwicklung einer immunneutralen Lipidemulsion zur optimalen postoperativen Therapie intensivmedizinischer Patienten.

Lipid emulsions prolong the rejection of allogeneic rat heart grafts in relation to their n-3 to n-6 fatty acid ratio. Because of the predominance of n-6 fatty acids soybean oil, which is clinically applied, shows an immunosuppressive effect. An n-3 to n-6 fatty acid ratio of 1 to 2 proved to be immunoneutral. Intravenous fat emulsions with an impaired n-3 to n-6 fatty acid ratio reduce cytokine release, infiltration and proliferation of immunocompetent cells. Lipids rich in n-3 fatty acids additionally reduce the release of the potent vasoconstrictor thromboxane A3 and increase the synthesis of leukotriene B5, which unlike leukotriene B4 does not activate polymorphonuclear neutrophils. Based on our results, the production of a clinically applicable lipid emulsion with a n-3 to n-6 fatty acid ratio of 1 to 2 can be recommended for the optimal parenteral nutrition of ICU patients with a markedly reduced immune system.

[Tumor dissemination after thoracoscopic resection of malignant pulmonary coin lesions]. / Tumordissemination nach thoracoskopischer Resektion von malignen Lungenrundherden.

We report about two cases of tumor dissemination after thoracoscopic wedge resection of malignant nodules of the lung. In the first case, a metastasis at the extraction site was observed after thoracoscopic resection of a metastasis of the lung. In the second case we diagnosed a pleural carcinosis after thoracoscopic wedge resection (and additional open lobectomy and lymph node dissection) of a pT2 N0 lung cancer. The patient died 12 months after the operation. The indication for thoracoscopic resection of malignant nodules of the lung should be restricted for peripheral tumors smaller than 2 centimetres.

[Is surgical therapy of bronchial carcinoma in advanced age justified?]. / Ist die chirurgische Therapie des Bronchialkarzinoms im höheren Lebensalter sinnvoll?

It was the aim of this study to evaluate the results of surgical therapy in patients with bronchial carcinoma aged younger and older than 70 years. From 1985 to 1995, 130 patients older than 70 years (group 1) and 572 patients younger than 70 years (group 2) underwent thoracotomy for bronchial carcinoma. The 5-year survival rate was significantly worse in the older group (25%) as compared to group 2 (39%). Postoperative complications such as atelectases, pulmonary insufficiency and cardiac problems were more frequent in group 1. Thirty-day mortality was almost double (9.2%) in the older group.