[Modern Treatment Options for Postoperative Chylothorax: a Systematic Review]. / Systematische Übersichtsarbeit: moderne Behandlungsverfahren beim postoperativen Chylothorax.

BACKGROUND: Chylothorax is a multifactorial complication, usually caused by surgery or traumatic injury, and more rarely by malignant disease. Because of the lack of prospective, randomised trials, the evidence-based treatment rests upon personal experience, but ideally taking into account retrospective analysis. MATERIAL AND METHODS: The aim of this review is to provide a comprehensive overview of the currently available modern treatment options. Another aspect is to show their advantages and disadvantages. For this purpose, a literature search was performed using the "PubMed" database. Publications older than ten years were excluded from this review. The literature search employed the keyword "chylothorax". The priority was set on publications including a comparative assessment of treatment approaches. The authors relied on many years of clinical experience to critically analyse and evaluate the treatment options and the given recommendations. RESULTS: The success rate of the conservative treatment methods ranges widely, depending on the underlying cause of the disease (3-90 %). Non-invasive or semi-invasive procedures are successful in 50 to 100 % of the cases, also depending on the aetiology. After unsuccessful conservative treatment of operable patients, the standard surgical therapy consists of thoracic duct ligature, which is usually performed thoracoscopically. Alternatively, pleurodesis or the placement of a permanent chest drain (PleurX) or a pleuroperitoneal shunt may be performed. The success rate of these procedures is between 64 and 100 %. The morbidity and mortality rate can reach values up to 25 %. CONCLUSION: Treatment of a chylothorax should be started conservatively. Subsequently, a more aggressive therapy may be gradually considered, based on the patient's health and the amount of the secretion. Interventional radiological procedures are safe, successful, and have a legitimate place alongside conservative or surgical treatment. However, they are currently only available in some larger centres.

Experimental observation of a periodically oscillating plasma sphere in a gridded inertial electrostatic confinement device.

The periodically oscillating plasma sphere (POPS) [D. C. Barnes and R. A. Nebel, Phys. Plasmas 5, 2498 (1998).] oscillation has been observed in a gridded inertial electrostatic confinement device. In these experiments, ions in the virtual cathode exhibit resonant behavior when driven at the POPS frequency. Excellent agreement between the observed POPS resonance frequency and theoretical predictions has been observed for a wide range of potential well depths and for three different ion species. The results provide the first experimental validation of the POPS concept proposed by Barnes and Nebel [R. A. Nebel and D. C. Barnes, Fusion Technol. 34, 28 (1998).].

Detection of germ-cell-tumor-specific gene products in peripheral blood by immunomagnetic tumor cell enrichment followed by RT-PCR.

Therapeutic procedures in patients with testicular germ cell tumors (GCT) are determined by the histopathology of the primary tumor and the tumor extension. The aim of our study was to determine whether conventional staging could be supplemented by combining enrichment of disseminated testicular GCT cells from peripheral blood with subsequent detection of germ-cell-specific gene products. Blood samples from 46 patients with GCT of different clinical stages (CS) were examined by RT-PCR before therapy and >/=8 weeks thereafter for alpha-fetoprotein, beta-human chorionic gonadotropin and germ-cell-specific alkaline phosphatase mRNA. In addition, we performed titration experiments to evaluate whether the sensitivity can be improved by previous immunomagnetic tumor cell enrichment with anti-epithelial HEA-125 microbeads. No positive results were found in controls (n=15; specificity 100%). The overall ratio of positive PCR results in the group of patients with GCTs was 28.26%. The ratio was 35.7% for CS >IIb (n=5/14 patients), 20.0% for CS IIa-b (n=4/20) and 33.3% for CS I (n=4/12). FACS analysis in titration experiments with GCT cell lines showed that previous immunomagnetic tumor cell enrichment achieved a significant increase ranging up to 185.6 times the initial ratio and thus improved the measuring conditions for detection of tumor-specific transcripts. The sole qualitative RT-PCR of tumor-specific gene products in peripheral blood is not sensitive enough to improve staging in GCT patients. Immunomagnetic enrichment of GCT cells in peripheral blood seems a promising approach for increasing the sensitivity of RT-PCR.

[Evaluation of the effectiveness of high voltage irradiation of malignant gynecologic tumors in a nude mouse model]. / Effektivitätsbeurteilung der Hochvoltbestrahlung bei malignen gynäkologischen Tumoren am Modell der Nacktmaus.

Not only the effect of cytostatic drugs and hormones, but also that of ionizing radiation can be tested after transplantation of human tumoral tissue into nu/nu mice with thymic aplasia. In this study, the effects of high voltage irradiations dosed up to 60 Gy (fractionation 2 X 5 Gy per week) to three carcinomas of the endometrium, three carcinomas of the cervix, three ovarian carcinomas, and one mammary metastasis of an immunoblastic sarcoma were observed during a period of 120 days. This irradiation plan could be performed without problems in eight cases, in two cases it had to be stopped after 50 Gy. Nine tumors decreased significantly in size, reaching sizes which were below those measured before irradiation. In six among the nine cases, the tumors grew again after different periods of observation. In case of rather long periods of observation, those points within the curves of development can be taken as efficacy indices which are representing the lowest or the initial values of tumor sizes. In another study, the effects of high voltage irradiation to tumors of the nude mouse are correlated to those found in the corresponding patients.

[Treatment with misonidazole and high voltage irradiation of xenotransplanted human carcinomas in nu/nu mice with thymic aplasia]. / Misonidazol und Hochvoltbestrahlung an xenotransplantierten menschlichen Karzinomen auf thymusaplastischen nu/nu-Mäusen.

An investigation was conducted in order to determine the effect of combined high voltage irradiation and the sensitizing drug misonidazole (Ro-07-0582) on human gynecologic carcinomas transplanted into nu/nu mice with thymic aplasia. Two carcinomas of the endometrium, two carcinomas of the ovaries, and one carcinoma of the cervix were submitted to Co-60 irradiation with and without misonidazole. The tumor growth was compared to that of control groups. The dosage and fractionation of the high voltage irradiation (2 x 5 Gy/week, total dose 60 Gy) were adapted to clinical data. Misonidazole (1 mg/kg body weight) was administered by intraperitoneal injection 15 minutes before the irradiation. Compared with the control animals, the locally irradiated tumors showed a slower growth or even a regression. The administration of misonidazole, however, did not produce significant differences in our five cases. Some reasons for this absence of the radiosensitizing effect of misonidazole are briefly discussed.