Induction chemotherapy with the TIP regimen (paclitaxel/ifosfamide/cisplatin) in stage III non-small cell lung cancer.

Induction chemotherapy may improve clinical outcome of locally advanced non-small cell lung cancer (NSCLC). To further pursue this, the Austrian Association for the Study of Lung Cancer (AASLC) performed a multi-center phase II trial with TIP induction chemotherapy (Taxol 175 mg/m2 over 3h on day 1, ifosfamide 1000 mg/m2 daily on days 1-3, cisplatin 60 mg/m2 on day 1, and prophylactic filgrastim 5 microg/kg daily on days 4-13). Treatment cycles were repeated every 3 weeks for 3 cycles.

Prognosis of patients with non-small cell lung cancer with isolated brain metastases undergoing combined surgical treatment.

Objective: To compare survival of patients with isolated synchronous and metachronous brain metastases from non-small cell lung cancer (NSCLC) after combined surgical treatment.

Methods: A total of 991 patients underwent surgical resection of primary NSCLC between January 1994 and November 1999. Out of these, 32 patients (21 males and 11 females) were further treated for isolated brain metastases.

Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax.

Background: To evaluate the role of apical lung wedge resection in patients with recurrent primary spontaneous pneumothorax with no endoscopic abnormalities at surgery as compared with simple apical pleurectomy.

Methods: We performed a retrospective analysis on 126 consecutive video-assisted thoracoscopic surgery (VATS) procedures in 113 patients treated for stage I recurrent PSP between January 1994 and December 2001. Two surgical strategies were applied: simple apical pleurectomy (57 procedures, 45.

Using a dedicated lung-marker system for localization of pulmonary nodules before thoracoscopic surgery.

Objective: Our aim was to evaluate the effectiveness of a commercially available dedicated lung-marker system for localization of pulmonary nodules before video-assisted thoracoscopic surgery.

Subjects And Methods: Guidewires were positioned under CT fluoroscopy guidance in 16 patients (11 men, five women; age range, 39-79 years; mean age, 60.4 years).

Evidence for a role of FGF-2 and FGF receptors in the proliferation of non-small cell lung cancer cells.

Basic fibroblast growth factor (FGF-2) has been implicated in the progression of human tumours via both autocrine and paracrine (angiogenic) activities. We investigated the expression of FGF-2 and FGF receptors (FGFR-1 to -4) in NSCLC cell lines (N = 16), NSCLC surgical specimens (N = 21) and 2 control cell lines. Our data show that almost all NSCLC cells produce elevated levels of FGF-2 and FGFR in vitro and in vivo.

The TP53 genotype but not immunohistochemical result is predictive of response to cisplatin-based neoadjuvant therapy in stage III non-small cell lung cancer.

Background: The cytotoxic effects of cisplatin and anthracyclins have been attributed to apoptosis induction, which has been recognized as a major function of the TP53 gene. The TP53 gene appears to be mutated in about 50% of cases of non-small cell lung cancer. A possible dependence of chemotherapy response on TP53 genotype was evaluated retrospectively in a group of patients with advanced non-small cell lung cancer and induction treatment.

Long-term results after repeated surgical removal of pulmonary metastases.

Background: Although surgical resection is accepted widely as first-line therapy for pulmonary metastases, few data exist on the surgical treatment of recurrent pulmonary metastatic disease. In a retrospective study, we analyzed patients who were operated on repeatedly for recurrent metastatic disease of the lung with curative intent over a 20-year period.

Methods: From 1973 to 1993, 396 metastasectomies were performed in 330 patients.

Survival after surgical treatment of recurrent pulmonary metastases.

Objective: Resection of lung metastases is a generally accepted therapeutic strategy today. This retrospective study was performed in order to estimate the value of an aggressive surgical approach in recurrent metastatic disease of the lung.

Methods: The survival rates of 42 patients undergoing repeated resectional treatment for recurrent lung metastases (group A) were compared to the outcome of a total of 288 patients after a single surgical intervention for lung metastases (group B).

Video-assisted thoracic surgery in patients with spontaneous pneumothorax.

Following the development of video-assisted technologies and the principle of minimally-invasive surgery thoracoscopy has finally established itself as an integral part of the surgeon's armamentarium in the treatment of spontaneous pneumothorax. This procedure was performed on 18 patients at the Department of Cardio-Thoracic Surgery of the Medical University in Vienna from October 1995 to April 1996 and on 5 patients at the Department of Thoraco-Abdominal Surgery of the Medical University in Plovdiv from October 1996 to January 1997, all of which had been diagnosed as having complicated spontaneous pneumothorax. The main indications were: recurrent spontaneous pneumothorax or persistent pneumothorax following a five-day unsuccessful drainage of the pleural cavity.

[Guidelines in minimal invasive surgery in oncologic thoracic surgery].

Due to the development of video-assisted thoracoscopic surgery (VATS) over the past 7 years, many procedures are now technically feasible. A side from indication in benign disease, VATS became important for the presectional staging of lung cancer, the biopsy of pulmonary lesions and extrapulmonary intrathoracic tumors, wedge resections of isolated pulmonary nodules and the treatment of pleural or pericardial effusions, as pleurodesis and pericardial window. The current status of VATS metastasectomy, lobectomy and pneumonectomy is controversial and there are no clear indications for VATS lobectomy or pneumonectomy.

Tracheobronchial ruptures in children.

Tracheobronchial ruptures in children after blunt trauma are rare, with an incidence at our clinic of 0.17% of juvenile thoracic injuries in the years 1985 to 1994. The symptoms are variable, and these injuries frequently occur in conjunction with other thoracic injuries, leading to delays in diagnosis.

Molecular genetic differentiation between primary lung cancers and lung metastases of other tumors.

When solitary pulmonary tumors are observed in patients with a history of cancer, differentiation between metastasis and primary lung cancer is crucial for appropriate therapy. Assuming that p53 mutations are conserved in metastases, mutation analysis of the p53 gene would be a valuable tool in differentiating metastases from primary carcinomas of the lung. In nine of 267 resected lung tumors, the origin of the lung tumor could not be defined histologically.

[Diagnostic and therapeutic video thoracoscopy: conversion rate and costs].

With the further development of new surgical techniques, that allow for the performance of a variety of standard diagnostic and therapeutic procedures in a less invasive fashion, it is instructive to look at the complications of these new techniques, in order to define their role for general thoracic surgery. 372 patients have been treated by means of video-assisted thoracic surgery (VATS) between 1/1992 and 12/1994. A total of 934 open thoracic procedures were performed in the same time frame, 399 out of them for the same chest disorders as treated by VATS alternatively.

Evaluation of solitary pulmonary nodules with dynamic contrast-enhanced MR imaging--a promising technique.

The evaluation of a solitary pulmonary nodule (SPN) is one of the most frequently encountered challenges in thoracic radiology. In addition to a "state-of-the-art" evaluation of SPNs with CT and biopsy techniques, recently the assessment of the enhancement characteristics with iodinized contrast agents has shown its potential to improve the characterization of SPNs. We investigated whether dynamic contrast-enhanced MRI is suitable to assess the degree and kinetics of MR contrast enhancement and whether this technique could help in the noninvasive specification of SPNs.

[Video-assisted thoracic surgery].

Over the past two to three years video-assisted thoracic surgery has opened up new possibilities in diagnostic and therapeutic procedures. It is viewed as a sparing and quick alternative to thoracotomy and open operation for a number of indications including the treatment of pneumothorax, obtaining biopsies of undiagnosed diffuse or nodulary lung disease, as well as extirpation of peripheral pulmonary lesions. In oncological thoracic surgery it still remains to be verified whether the criteria of radicality are fulfilled by this new technique.

[Bronchiolitis obliterans organizing pneumonia with acute respiratory insufficiency].

A 22-year-old woman was hospitalized because of fever of 39 degrees C and increasing dyspnoea. The chest radiograph demonstrated coarse confluent opacities bilaterally. Despite antibiotic treatment the condition deteriorated acutely after 2 days.

Carcinogen-specific mutations in the p53 tumor suppressor gene in lung cancer.

Mutations of the p53 tumor suppressor gene, whose encoded protein is one of the chief regulators of the cell cycle, are proving to be the most common genetic alteration in human cancer. Point mutations have been detected in numerous human solid tumors. The types of point mutations in the p53 gene vary considerably in different kinds of human cancers, suggesting that specific etiologic agents are responsible for typical kinds and sites of mutations in the p53 gene.

[Bronchial carcinoma].

Carcinoma of the lung constitutes 20% of all cancer in men and 11% of all cancer in women. It is the most common cause of death from malignancy in both sexes. The number of patients is increasing every year.

Clinical experience with minimally invasive thoracic surgery.

From October 1991 to June 1992 video-endoscopic lung surgery was applied in a total of 109 patients. In the first case a pulmonary cyst measuring 15 x 18 cm was resected. In 21 patients lung nodules were exstirpated by means of wedge resection.

Postoperative complication rate of thoracotomy in patients with normal and abnormal pulmonary function.

Recent advances in perioperative monitoring, anesthesia, and postoperative care have resulted in a more generous attitude towards performing thoracic surgery in patients with reduced pulmonary function. In our hospital 100 patients admitted for thoracotomy with or without pulmonary resection were classified on the basis of their pulmonary function: group I (n = 33) normal, group II (n = 40) moderate reduction, group III (n = 27) marked reduction. The mean and standard deviation in groups I, II, and III were: FEV 1 in % VC: 78 +/- 6, 72 +/- 7, and 58 +/- 10; RV in % TLC: 24 +/- 7, 35 +/- 8, and 43 +/- 9; Resistance, kPal/1/sec: 0.

[Isolated amyloidosis of hilar lymph nodes].

Pseudotumoral mediastinal and pulmonary amyloidosis occur infrequently and may be confused with other tumors that are found more commonly in this region. Enlargement of hilar lymph nodes in the absence of pulmonary involvement is extremely rare. We report a case of nodular amyloidosis of the hilar lymph nodes that was studied using different diagnostic and radiologic methods.

[Video-endoscopic interventions in thoracic surgery].

Between October and December 1991 we performed videoendoscopic procedures, including resection of lung tissue, on 9 patients in our thoracic surgery unit. A lung measuring 15 x 18 was extirpated in 1 patient and parietal pleurectomy was performed after complicated pneumothorax in 4 patients. In one of these cases it was necessary to close a parenchymal leak and in 3 cases bullae had to be removed.

Contrast-enhanced MRI for the staging of bronchogenic carcinoma: comparison with CT and histopathologic staging--preliminary results.

Nineteen patients with potentially operable bronchial carcinoma were included in a prospective study to assess the staging capabilities of plain and contrast-enhanced magnetic resonance imaging (MRI) in comparison with computed tomography (CT) and to compare the results to post-operative histopathological staging (HS). The evaluation focused on the following T-staging criteria: (i) direct invasion of the pleura; (ii) neoplastic invasion of the mediastinum; (iii) differentiation of the primary tumour from alterations of the surrounding lung parenchyma such as inflammation or atelectasis; and (iv) intrathoracic lymph node involvement by tumour. MRI and CT produced similar results for pleural invasion (sensitivity of 0.

[Results of transverse tracheal resection in post-intubation tracheal stenoses].

Tracheal problems in form of stenosis and malacia are a calculated risk of long-term tracheal intubation. Results with conservative treatment of such problems by bougienage, laser therapy, biopsy, cryotherapy, local steroids, tracheal stenting, and tracheostomy are not satisfactory in a higher percentage of cases. Resectional therapy of benign tracheal lesions has become an established technique, which combines excellent functional results with a low complication incidence.

CT and MRI in benign mediastinal haemangioma.

We report the findings of computed tomography and magnetic resonance imaging in two cases of surgically proven benign cavernous haemangiomas of the mediastinum. Both techniques produced similar results, although both were non-diagnostic for haemangioma as was percutaneous needle biopsy, which was performed in one patient.