[Early chest tube removal after video-assisted thoracoscopic surgery. Results of a prospective randomized study].

Background: Chest tubes frequently cause postoperative patient discomfort after video-assisted thoracoscopic surgery (VATS). Therefore, a prospective randomized study was conducted to analyze whether early chest tube removal within 2 h postoperatively is justified in VATS.

Methods: Ninety-three patients fulfilled the inclusion criteria (VATS including wedge resection, complete lung extension on postoperative chest roentgenogram) and showed no exclusion criteria (lung volume reduction surgery, extensive pulmonary fibrosis, pneumothorax, pleural effusion, air fistula).

[Pulmonary lymphangioleiomyomatosis as a rare cause of recurrent spontaneous pneumothorax].

Background: Pulmonary lymphangioleiomyomatosis is a rare disease that occurs mainly in women of reproductive age. The clinical characteristics include recurrent spontaneous pneumothorax and progressive dyspnea. The features of chest computed tomography are nearly pathognomonic with the detection of bilateral thin-walled cysts.

Cost and quality of life in thoracic surgery--a health economic analysis in a German center.

Background: A critical look at the effectiveness of medical procedures and therapies is important with the increasing limitations on resources in health care.

Method: The costs for treatment and the quality of life according to the SF-36 were analyzed in a retrospective health economic study on 65 patients who had undergone surgery for primary non-small-cell lung cancer.

Results: The mean cost for all patients was 7,169 euro per patient.

[Simultaneous immunocytochemical detection of tumor cells in lymph nodes and in bone marrow of patients with resectable bronchial carcinomas].

Despite an apparently curative resection more than 50% of patients with non-small cell carcinomas (NSCLC) will relapse after surgery. Therefore, it has to be assumed that in a substantial number of patients a tumor cell dissemination has occurred already at the time of surgery. In a prospective study we analyzed the extend of an early regional tumor cell dissemination into lymph nodes and/or a systemic tumor cell dissemination into the bone marrow in 91 patients with completely resected NSCLC by using sensitive immunocytochemical techniques.

[Choristoma of the diaphragm. Case report of a rare tumor and approach through lateral thoracotomy].

Tumors of the diaphragm are rare and caused by there special localisation difficult to diagnose. We describe the case of a 31 year old man with a choristoma of the left diaphragmal crux where the localisation and genesis could only be cleared through lateral thoracotomy. Nor the CT guided puncture or the laparoscopy-although sufficient samples for the pathology could be gained-allowed the right diagnose.

Mediastinal lymphadenectomy in non-small cell lung cancer: effectiveness in patients with or without nodal micrometastases - results of a preliminary study.

Objectives: So far it has not clearly been demonstrated that systematic mediastinal lymphadenectomy improves survival in patients with non-small cell lung cancer. One explanation might be that in some patients an early spread of tumor cells has occurred which might not be curable by surgical means. To test this hypothesis lymph nodes of patients which were treated either by lymph node sampling or systematic lymphadenectomy were screened for micrometastatic spread of tumor cells and the influence of nodal micrometastases on the efficacy of lymphadenectomy was analyzed.

[Chronic diarrhea as a first manifestation of small cell lung cancer. A case report].

We report the case of a 57-year-old man presenting with chronic diarrhea for more than three months and a solitary pulmonary nodule of the right upper lobe. After atypical resection, showing a clinical stage I small cell lung cancer (SCLC), a lobectomy combined with a systematic mediastinal lymphadenectomy were performed. The histopathological examination revealed a pT1, pN0, SCLC.

Significance of lymphangiosis carcinomatosa at the bronchial resection margin in patients with non-small cell lung cancer.

Background: Treatment options for patients with microscopic residual disease at the bronchial margin (R1-resection) after resection for non-small cell lung cancer include observation, radiotherapy, reoperation, or even systemic therapy. The present study was performed to identify a parameter that would estimate the prognosis of these patients more precisely to permit a well-founded treatment recommendation for the individual patient.

Methods: A total of 1,162 patients with resected non-small cell lung cancer were analyzed in this retrospective study.

[Long-term complaints after minimal invasive thoracic surgery operations and thoracotomy].

Background: Minimally invasive techniques are now frequently used in general thoracic surgery. More than 30% of all minimally invasive procedures are operations in patients with spontaneous pneumothorax. Recently, it has been shown that the video-assisted approach compared to the standard anterolateral thoracotomy results in a significant reduction of the early postoperative pain.

Incidence of chronic pain after minimal-invasive surgery for spontaneous pneumothorax.

Objective: Recently, it has been shown that minimal-invasive surgical procedures like operations for spontaneous pneumothorax result in a reduction of pain in the immediate postoperative course. However, little is known on the influence of minimal-invasive thoracic surgery on long term disability. Therefore, we analyzed the incidence of chronic pain in patients after minimal-invasive operation for primary (PSP) or secondary (SSP) spontaneous pneumothorax.

Overexpression of matrix metalloproteinase 2 predicts unfavorable outcome in early-stage non-small cell lung cancer.

This prospective study was performed to assess the impact of matrix metalloproteinase (MMP) 2 expression on the clinical course of patients with operable non-small cell lung cancer (NSCLC). Specimens of 193 consecutive patients with completely resected NSCLC were examined for MMP-2 expression by immunohistochemical staining with a polyclonal antibody. Homogeneous immunostaining of cancer cells was considered positive and heterogeneous, or no staining was considered negative concerning overexpression of MMP-2.

[Isolated tumor cells in bone marrow predicts reduced survival in lymph node-negative non-small-cell lung cancer].

Background: It became recently evident that isolated tumor cells undetectable by conventional tumor staging are frequently present in bone marrow of patients with apparently localized non-small cell lung cancer (NSCLC). The clinical relevance of this minimal hematogenous tumor cell dissemination is under vigorous debate.

Methods: For tumor cell detection in the bone marrow we used monoclonal antibody CK2 against the epithelial intermediate filament protein cytokeratin 18.

The 17-1A antigen is expressed on primary, metastatic and disseminated non-small cell lung carcinoma cells.

In view of the high incidence of early distant tumor relapses in apparently completely resected (R0, M0) non-small cell lung cancer (NSCLC), there is a need for an adjuvant therapy. Considering the low tumor burden in these patients, an adjuvant therapy with monoclonal antibodies (i.e.

Early detection of lymph node metastases by 7.5 MHz-ultrasound examination in a patient with primary malignant melanoma of the lung.

Primary malignant melanoma of the lung (PMML) is a rare neoplasm that may be misdiagnosed as one of the more common types of lung cancer. Most cases are characterized by a very poor prognosis, ultimately leading to the patient's death. Since an optimal systemic treatment schedule is not established so far, early detection of lymph node metastases may be important for surgical interventions.

Isolated tumor cells in bone marrow predict reduced survival in node-negative non-small cell lung cancer.

Background: It recently became evident that isolated tumor cells undetectable by conventional tumor staging are frequently present in bone marrow of patients with apparently localized non-small cell lung cancer (NSCLC). The clinical relevance of this minimal hematogenous tumor cell dissemination is under vigorous debate.

Methods: For tumor cell detection in the bone marrow, we used monoclonal antibody CK2 against the epithelial intermediate filament protein cytokeratin 18.

Disseminated tumor cells in lymph nodes as a determinant for survival in surgically resected non-small-cell lung cancer.

Purpose: In recent years, the detection of even a few tumor cells in lymph nodes of patients with surgically resected non-small-cell lung cancer (NSCLC) became possible with immunohistochemical staining procedures. Tumor cells in lymph nodes have been shown to be associated with an increased rate of early recurrence. However, the prognostic significance of this minimal tumor cell spread for overall survival remains unclear.

Imaging of lung cancer with fluorine-18 fluorodeoxyglucose: comparison of a dual-head gamma camera in coincidence mode with a full-ring positron emission tomography system.

Dual-head gamma cameras operated in coincidence mode are a new approach for tumour imaging using fluorine-18 fluorodeoxyglucose (FDG). The aim of this study was to assess the diagnostic accuracy of such a camera system in comparison with a full-ring positron emission tomography (PET) system in patients with lung cancer. Twenty-seven patients (1 female, 26 males, age 62+/-9 years) with lung cancer or indeterminate pulmonary nodules were studied on the same day with a full-ring PET scanner (Siemens ECAT EXACT) and a coincidence gamma camera system (ADAC Vertex MCD).

[Minimally invasive thoracic surgery--evaluation after 5 years].

A prospective study documented all minimally invasive operations performed in the department of thoracic surgery between 1992 and 1996. The most frequent indications were: lung biopsy (n = 181, 30.9%), coin lesions of unknown origin (n = 179; 30.

Reduced expression of plakoglobin indicates an unfavorable prognosis in subsets of patients with non-small-cell lung cancer.

Purpose: Plakoglobin is thought to play a key role in cadherin-mediated epithelial cell adhesion, because it is a common component of desmosomal and nondesmosomal adherens junctions. Because loss of homotypic cell adhesion is an important early step in invasion and metastasis of solid tumors, we evaluated the frequency and prognostic significance of a deficient expression of plakoglobin in human lung cancer.

Patients And Methods: At primary surgery, representative specimens of the primary tumor were obtained from 96 consecutive patients with completely resected non-small-cell lung carcinoma (NSCLC) without overt distant metastases.

[Results of minimally invasive surgery in patients with recurrent or persistent primary pneumothorax].

Background: The objective of the study was to analyse the efficiency of video-assisted thoracic surgery (VATS) in the treatment of primary spontaneous pneumothorax (PSP) in an initial series of 65 patients.

Methods: From April 1992 to December 1995 47 male and 18 female patients with a median age of 28 years (range 17-53) were treated for persistent (n = 20) or recurrent (n = 45) spontaneous pneumothorax by VATS. In most patients a stapling of bullae using an endostapler was performed followed by parietal pleurectomy or pleural abrasion.

Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax.

Background: The objective of the study was to analyze the efficiency of video-assisted thoracic surgery (VATS) for the treatment of primary (PSP) or secondary (SSP) spontaneous pneumothorax in an initial series of 99 patients.

Methods: From April 1992 to December 1995, 74 men and 25 women with a median age of 31 years (range, 17 to 85 years) were treated by VATS for persistent (n = 40) or recurrent (n = 59) PSP (n = 65) or SSP (n = 34). Postoperative parameters such as use of analgesics, length of hospital stay, and duration of drainage were compared with those of a control group of 100 patients treated by lateral thoracotomy between January 1988 and December 1991.

Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial.

Objective: To evaluate the effectiveness of lymphadenectomy in the treatment of non-small cell lung cancer (NSCLC).

Summary Background Data: The extent of lymphadenectomy in the treatment of NSCLC is still a matter of controversy. Although some centers perform mediastinal lymph node sampling (LS) with resection of only suspicious lymph nodes, others recommend a radical, systematic mediastinal lymphadenectomy (LA) to improve survival and to achieve a better staging.