PURPOSE:Pleurodesis can relieve dyspnea in patients with malignant pleural effusions. We retrospectively compared the success rate of talc slurry instillation pleurodesis with thoracoscopic talc powder insufflation pleurodesis. PATIENTS AND METHODS:From 2000 to 2005, two methods of talc pleurodesis were performed in 71 patients with symptomatic massive malignant pleural effusions: a) through the pleural drain (24F), 50 ml of a slurry containing 4-5 g of Luzenac talc in saline with 20 ml 1% lidocaine were instilled. The drain was clamped for 1 h; b) insufflation of 3-5 g of talc powder was performed via videothoracoscope using local anaesthesia. The drain was left in the pleural space until the daily secretion of pleural fluid was under 100 ml. Pleurodesis was considered successful when the patient was without dyspnea and did not need pleural fluid evacuation and the pleural fluid did not re-accumulate in the 1st month after pleurodesis. RESULTS:The success rate of talc slurry pleurodesis was 78%(38/49). Excluding 8 patients who died in the first month, the success rate increased to 93% (38/41). Thoracoscopic pleurodesis was successful in 77% (17/22) of patients. Excluding one patient who died in the first month, the success rate increased to 81%(17/21) (intergroup difference non significant). Complications were observed in 41% (20/49). vs. 73% (16/22) of patients in the talc slurry group and thoracoscopic group, respectively (p=0.013). CONCLUSION:Pleurodesis with instillation of talc slurry and with insufflation of talc during thoracoscopy were equally successful in patients with massive malignant pleural effusions. However, thoracoscopic pleurodesis is accompanied with considerably more complications, rather as a result of the thoracoscopy itself and not as a consequence of pleurodesis.

Background. The aim of the study was to establish characteristics of lung cancer patients diagnosed at the University Clinic of Respiratory and Allergic Diseases Golnik in 1996, their selected and realized therapy, and survival. Methods. The retrospective study comprises 345 patients aged from 37 to 90 years (mean 65), 285 males and 60 females. Performance status (Karnofsky): > 80 in 171 patients, 60-80 in 130 and <60 in 44 patients. Microscopically confirmed tumour in 97%: by bronchoscopy 281, transthoracic needle biopsy 23, peripheral lymph nodes biopsy 12, sputum cytology 7, pleural (effusion) cytology 4, distant metastases biopsy 2, mediastinoscopy 1, autopsy 4 patients. Histology and/or cytology: squamous 131, adenocarcinoma 86, large cell 63, small cell 51, non-small cell 1, unclassified 2. Clinical staging of non-small cell lung cancer (NSCLC): stage I 63, stage II 32, stage IIIA 48, stage IIIB 59, stage IV 77, undeterminable 2 patients. Staging in small cell lung cancer (SCLC): limited disease 24, extended disease 27 patients. Results. The selected primary oncological therapy was changed in 11%. Realized primary therapy: radiotherapy 102 (30%), surgery 77 (23%), chemotherapy 47 (14%), supportive treatment 111 (33%). In resected patients staging was correct in 46%, underestimated in 44%, overestimated in 10%. The overall five-year survival was 7.8% (median 6.2 months) and the five year survival of resected patients was 41.9% (median 33 months). The median survival of irradiated patients was 5.7 months, of supportively treated patients 2.5 months. The survival was significantly different according to the performance status and stage. Conclusions. The selected oncological therapy was actually realized in 89%. In our patients there was a low percentage of NSCLC treated by chemotherapy. Among five-year survivors there were 26 resected and one supportively treated patient, that confirms surgery as the most effective therapy in our lung cancer patients.

Background. The aim of the study was to identify perioperative morbidity and mortality, the category and mode of adjuvant treatment, local recurrence and survival in patients treated by extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM). Methods. From 2000 to 2003, 18 patients with MPM were referred to the Department of Thoracic Surgery in Ljubljana, and 17 of them were operated on. Two patients underwent explorative thoracotomy, and 15 patients were evaluated. Five female and nine male patients (aged 52-68 years) were treated by EPP and one male patient by pleurectomy. Eight patients received both adjuvant chemotherapy (ChT) and radiotherapy (RT), with cisplatin 100 mg/m2 + mitomycin C 6-10 mg/m2 or gemcitabine 1000 mg/m2 and external beam radiation with 24 Gy - 58 Gy respectively, three patients received no adjuvant therapy, three patients were treated by adjuvant ChT, two of them were given cisplatin 100 mg/m2 + mitomycin C 6-10 mg/m2, and one patient cisplatin 100 mg/m2 on the first day and gemcitabine 250 mg/m2 in prolonged 6 hours infusion on the first and on the eighth day. One patient was treated only by adjuvant RT. Results. There were no perioperative deaths and the postoperative morbidity was 42%. Of the 15 evaluable patients, and in the median follow up of 40 months (28-64), we noticed nine (60.0%) recurrences, seven local and two abdominal. Eight (53.3%) patients died, all because of the local progress of disease. Of the 3/15 patients without adjuvant treatment, one patient (T1bN0M0) is well 46 months after the operation, one patient (T2N0M0) got recurrence in abdomen, was treated with ChT and reoperation, and is still alive 31 month after the first surgical treatment. One patient (T2N0M0) died two months after the surgery due to local recurrence. In ChT+RT group, 6/8 patients died: the patient at stage T1aN0M0 died after nine months, the patient at stage T1bN0M0 died after nine months, two patients at the stage T2N0M0 died after four and 23 months respectively, the patient at stage T3N0M0 after 11 months, and the patients at stage T3N2M0 died seven months after the operation. Two out of eight patients are alive: the patient at stage T1bN0M0 is alive 43 months, and the patient at stage T2N0M0 is alive 28 months after the operation. In the ChT group, 1/3 patient (T2N0M0) died 6 months after the operation, 2/3 patients (T2N0M0 and T3N0M0) are well after 43 and 20 months respectively. The patient treated with adjuvant RT only is well 50 months after the surgical treatment. The median survival time was 20 months for the whole group of patients operated on, the 1-year survival rate was 53.3% and 2-year survival rate was 46.7%. Conclusions. In selected patients with MPM, complete surgical resection is indicated, followed by chemotherapy and radiotherapy. The operation could be performed safely with acceptable mortality and morbidity. Our group of patients is too small, the adjuvant therapies were too different to favour any of the treatment mode applied. Further randomised studies and standardised protocols are needed to evaluate the best mode of treatment for each patient.

After a favorable experience with gemcitabine at a low dose in a prolonged infusion in combination with cisplatin for advanced non-small-cell lung cancer, here, we present the results from a phase II trial for patients with malignant pleural mesothelioma. Eligible patients had biopsy-proven malignant pleural mesothelioma, were chemo-naive, Eastern Cooperative Oncology Group performance status 0–2, had normal hematopoietic liver and renal function, and gave informed consent. Treatment consisted of gemcitabine 250 mg/m2 in a 6-h infusion on days 1 and 8 and cisplatin at 75 mg/m2 on day 2 of a 3-week cycle for four cycles, followed by two additional cycles without cisplatin. Seventy-eight patients (58 men, 20 women; age 33–82 years, median 58) were recruited into the trial. The histologic types were as follows: epitheloid 56 (71.8%); four sarcomatoid (5.1%); mixed 15 (19.2%); and mesothelioma, three not otherwise specified (3.8%). Grades 3–4 toxicity included two (2.6%) patients with anemia, 18 (23.1%) with neutropenia, and one with nausea/vomiting. Reversible thrombocytosis with platelets over 1000–109/l was recorded in 10 (12.8%) patients and grade 2 alopecia in 60 (76.9%). Four (5.1%) patients showed a complete response and 35 (44.9%) showed a partial response with a response rate of 39/78 (50%). Minimal response or stable disease was seen in 35 (44.9%), whereas only four (5.1%) patients progressed during treatment. Most patients reported symptomatic improvement with a higher or a stable quality of life score in 70 (89.7%) cases. The median progression-free survival was 8.0 months (confidence interval 6.9–9.0). The median overall survival was 17.0 months (confidence interval 14.7–19.2). One-year, two-year, and three-year survival rates were 67.3, 32.7, and 19.8%, respectively. Epitheloid histological type was the only statistically significant favorable prognostic factor for progression-free survival and overall survival. Because of the acceptable toxicity, remarkable activity, and reasonable cost, this treatment should be further explored.

We examined 38 patients with malignant pleural mesothelioma who underwent medical thoracoscopy from 1989 to 2000. Local anaesthesia with lidocaine and fentanyl was used. Rigid thoracoscope Storz and videothoracoscope Olympus were applied. Macroscopic appearance revealed malignant nodules in 76% (29) and in 24% (9) non-malignant (inflammatory) changes of pleura. Parietal pleura was usually affected. Histopathologic types of mesothelioma were epitheloid (n=16), biphasic (n=12), sarcomatoid (n=5) and unclassified (n=5). Sensitivity of histopathologic examination was 92% (35/38). Pleurodesis with talc insufflation was successful in 83% (15/18) patients. The chest tube was left in place for 3 days. The most serious complication was bronchopleural fistula (n=3). Medical thoracoscopy is the most useful non-surgical examination for the confirmation of malignant pleural mesothelioma.

The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult. Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974-1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies. Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket. Foreign bodies in the tracheobronchial system are rare in adults. They can be successfully removed in the majority of patients under either flexible or rigid bronchoscopy.

The success rate of cytological examination of the bronchoalveolar lavage fluid (BALF) in patients with primary or metastatic lung tumors varies considerably according to different authors. In a prospective study, we have tried to establish the sensitivity of BAL in comparison with both transbronchial lung biopsy (TBB) and brushing. BAL was performed in 61 patients with lung malignancies and in 56 patients with nonmalignant lung disease: 39 patients had primary lung cancer, 22 had metastatic spread into the lungs. First the part of the lung involved was washed out with 100 ml physiological saline solution during bronchoscopy. Following BAL, 5 TBB and brushing were performed. The smears were stained by the May-Grünwald-Giemsa method. Malignant cells were found in BALF from 17 patients, in TBB specimens from 43 and in brushing smears from 26. TBB was significantly the most successful method applied. Malignant cells were never found in BALF only, nor were they ever found in patients with non-malignant lung disease. The sensitivity of the three methods was equal for primary as compared to metastatic tumors and for interstitial infiltrates as compared to coin lesions. Malignant cells were most frequently found in centrifuged specimens. BAL may be used in suspected malignant interstitial or rounded pulmonary infiltrates when it cannot be reached by forceps or brush, or when TBB and brushing are contra-indicated.

Cytological patterns of bronchoalveolar lavage (BAL) in pulmonary alveolar proteinosis (PAP) and amiodarone pulmonary toxicity (APT) are presented together with light and electron microscopy (EM). the differential cell count of BAL in both diseases is similar in that alveolar macrophages predominate. However, the cytology of PAP is characterized by scanty macrophages and alveolar epithelial cells in abundant periodic acid‐Schiff (PAS)‐positive extracellular material. the gross appearance of the BAL fluid is therefore opaque. In contrast, the cytology of APT is characterized by foamy alveolar macrophages with numerous lamellar bodies in their cytoplasm, and the BAL fluid is clear.

In the period from 1978 to 1987 3035 primary pulmonary carcinoma were diagnozed at the Institute of Diseases of the Chest, Golnik. Pleural effusion was cytologically examined in 351 patients with pulmonary carcinoma. Malignant or suspicous cells were found in 152 patients. Carcinosis of the pleura proved to be most frequently caused by adenocarcinoma. According to the cytological findings pulmonary adenocarcinoma cannot be differentiated from adenocarcinoma metastasizing from other organs. In one group of 39 patients pleural effusion was cytologically examined, and material obtained by blind needle biopsy of the parietal pleura was histologically examined. Histologic examinations were successful in 69.2% of cases and the cytologic ones in 53.9%. Carcinosis of the pleura was proved by both methods in 71.2% of patients with effusion. Since both methods are supplementary, it is advisable that in cases were carcinosis of the pleura is suspected and cytologic examinations of effusion are negative, the needle biopsy of pleura should be performed. When the operability of pulmonary carcinoma associated with effusion is questionable and both a forementioned examinations are negative, thoracoscopy should be performed.

During 6 yrs' period the malignant or suspicious cells were found in 219 patients. The male to female ratio was 1.2:1. The youngest patient was 21 yrs old, the oldest 92. Most patients were from the age group 55-64 yrs. The most frequent primary localisation of cancer with cytologically positive or suspicious pleural effusion was lung, on the second place was breast cancer in females and pleura in males. In 11.4% of patients the cytologic finding was suspicious. Most frequently the cells of mesothelioma could not be classified with certainty. In 94 patients the malignant cells were found in pleural effusion and also in any other kinds of material. In 125 patients the other materials were not examined or they were negative. In 76 patients apart from cytological examination of pleural effusion the histological examination of the material obtained by blind needle biopsy or by thoracoscopy was examined. Cytology was positive in 67.1% of cases and histology in 89.5%.