Husten, Giemen, Atemnot, aber auch rezidivierende Infekte oder Pneumonie können Hinweise auf eine stattgehabte Aspiration sein. Circa 80% der Fremdkörperaspirationen ereignen sich bei Kindern. Am häufigsten sind Kleinkinder im Alter von 1–3 Jahren betroffen. Meist sitzen die Fremdkörper im Bronchialsystem, seltener, dann aber besonders gefährlich, im Kehlkopf oder der Trachea. Bei Erwachsenen sind Fremdkörperaspirationen selten, bei etwa 1–2‰ aller Erwachsenenbronchoskopien ergeben sich Fremdkörper. Bei aspirierten Fremdkörpern dominieren Nahrungspartikel. Methode der Wahl zur Entfernung der Aspirate stellt die Bronchoskopie dar.

minimally invasive, accurate evaluations of the tracheobronchial tree and to perform an ever-increasing array of diagnostic, therapeutic, and palliative interventions. The role of both ‘‘old’’ and ‘‘new’’ diagnostic bronchoscopy will continue to evolve as further improvements are made in bronchoscopes, accessory equipment, and imagin gt echnologies. The major challenge in the adoption of the many new bronchoscopi ct echniques into routine clinical practice is the need for well-designed studies to delineate the appropriate use of these interventions and to better define their limitations.

In naher Zukunft werden bereits über 40% der an Bronchialkarzinom Erkrankten über 75 Jahre alt sein. Älteren Patienten sollte jedoch ein Eingriff am Thorax nicht allein aufgrund des Alters verweigert werden. Es ist gezeigt worden, dass ältere Patienten (über 70 Jahre) als auch über 80-Jährige eine Lob- oder Pneumonektomie tolerieren. Die meisten Patienten mit Bronchialkarzinom befinden sich in höherem Alter und haben als Folge langjährigen Tabakkonsums oftmals noch eine begleitende obstruktive Lungenerkrankung und atherosklerotisch bedingte kardiovaskuläre Risiken. Voraussetzung für die Indikationsstellung zu einem thorakalen Eingriff ist eine zuverlässige präoperative Stadienzuordnung und funktionelle Abklärung — unter besonderer Berücksichtigung des kardiopulmonalen Status — durch ein interdisziplinäres Team, sodass unter Einbeziehung des ASA-Index das Operationsrisiko und die Langzeitprognose adäquat dargestellt werden können. Da lediglich im Frühstadium des nichtkleinzelligen Bronchialkarzinoms nach kurativer Resektion eine 5-Jahres-Überlebensrate von über 50% erwartet werden kann, kommt der Patientenselektion eine hohe Verantwortung zu.

Various techniques are used for diagnosing mesothelioma including clinical investigation, transthoracic ultrasound, X-ray, computed tomography (CT), sonographic support puncture and thorascoscopy with biopsy. Whereas ultrasound examination of a normal lung is of limited value, it can be very useful in identifying pleural pathological processes. The presence of pleural effusion can substantially enhance the usefulness of ultrasound investigations: the liquid of the pleural effusion acts as an acoustic window and can enable the detection of intrapleural and intrapulmonal processes. Highly soluble transducers can be used to visualise pathological findings at the chest wall, enabling the recognition of pleural effusions and the diagnosis of pleural thickening, tumour tissue and abscesses.

The meeting was held in Heidelberg in July, 2001 and provided the basis for a European cooperation in molecular research focused on translational research in lung cancer. During this meeting, molecular and immunological analysis was discussed as the basis for the development of successful future cancer treatment strategies.R. Rosell, M. Monzó and M. Taron reported on new biotechnological and molecular approaches in a European framework for lung cancer management.Novel methods for diagnosis and management of cancer are being developed today and the most rapidly evolving field is oncogenomics. Oncogenic transformation confers resistance to chemotherapy through a variety of mechanisms including suppression of apoptosis, increased drug metabolism and modification of target proteins. Extensive characterization of genetic alterations in lung cancer can provide rapidly assessable repertoires that can be used for clinical stratification in phase II–III studies. For the sake of simplicity, these repertoires can be classified in five categories: allelic imbalance, aberrant promoter methylation, gene RNA overexpression, microtubule alterations and polymorphisms. Interest at the meeting was centred on ERCC1 mRNA levels as a direct mechanism of cisplatin resistance that could be exploited in customised chemotherapy. European collaboration in molecular research will rely on two simple principles: serial measurements of serum/plasma tumour DNA burden at baseline and after three and six cycles of chemotherapy and very importantly, the isolation of RNA, not only from paraffin-embedded tissue, but also from serum and plasma. Some ongoing Spanish studies are looking at serum RNA. We have successfully met the first challenge of sending blood samples for RNA extraction from geographically distant institutions. Now, we are performing RNA assessment of potential key markers, such as ERCC1, SXR (steroid xenobiotic receptor), ribonucleotide reductase M2 subunit and α- and β-tubulin, which can provide some clues to the prediction of chemotherapy response in individual patients.J. Niklinski, L. Chyczewski, J. Laudanski and W. Niklinska presented the state of advancement of the ongoing projects in Bialystok, Poland.They first described the organisation of the multidisciplinary team, comprising surgeons, molecular biologists, pathologists, pneumonologists and oncologists. Dr Niklinski then presented the method of sample collection, basically from patients treated by surgery. The samples consisted of tissue specimens, serum and nucleated cells (lymphocytes) from the blood; the collection is performed in conditions allowing analyses at both DNA and RNA levels. He then presented a short review of their evaluation of critical genes involved in lung cancer; he also provided information about their different possibilities to analyse p53 consisting of immunohistochemistry, ELISA for p53 antibodies, indirect and direct sequencing of the gene and finally a yeast functional assay. Dr Niklinski commented that some approaches have a significant number of limitations; presently it seems that direct sequencing is the most adequate way to study p53, not only the region comprised between exons 5 and 8, but also exons 4 and 11, in which a significant number of mutations can be determined. A promising new approach seems to be the development of a functional yeast assay, since some preliminary reports mention a 70% sensitivity; however, more information and complete follow-up data are needed, especially in relation to prognosis. Dr Niklinski then spoke about the alteration, both genetic and epigenetic, of the p16 gene. Point mutations appear to be rather rare events, but LOH and methylation of the promoter region (determined by MS-PCR) are rather common in established lung cancer and during its premalignant stages. They should be taken into consideration for the multicenter evaluation. He then talked about ras evaluation, emphasising that its clinical significance is not clear today. Sensitive approaches based on the enriched PCR technique are available and by using this sensitive technique, it would be worth a multiple evaluation of the gene. Finally, Dr Niklinski gave a short presentation about molecular evaluations in premalignant conditions, in order to obtain a clear definition of premalignant changes prone to evolve to malignancy. It seems that laser microdissection techniques are the most correct to study molecular alterations in premalignant changes of the lung.H. Lahm and J.R. Fischer presented their program on immunological and molecular markers for the assessment of genetic and epigenetic alterations in lung cancer.Alterations of the DNA by mutations, deletions or epigenetic modification, as well as dysregulation of gene expression determine the biological behavior and the response of neoplastic lung cells significantly. The Immunology-Molecular Biology Laboratory (IML) at the Thoraxklinik Heidelberg gGmbH undertakes efforts to determine these effects both in the periphery and at the tumour site. Plasma/serum DNA serves as a source to detect mutations (K-RAS, β-tubulin, p53) and hypermethylated promoter regions (RARβ, p16INK4a, DAPK, MGMT, FHIT, RASSF1A). In addition, the immunological status of the patients will be assessed by determination of cytokine secretion (IL-2, IL-6, IL-10, TNFα) by peripheral blood lymphocytes via ELISA. Earlier investigations of this laboratory have established the predominant prognostic significance of impaired cytokine secretion for survival of patients with SCLC and NSCLC. Several lines of evidence suggest that this cytokine suppression is caused by immunosuppressive factors secreted by tumour cells. Furthermore, investigation of tumour material will include an analysis of mutations, the status of hypermethylation, a quantitative assessment of gene expression (IL-10, COX-2, ERCC1, TGFβ1, telomerase) by means of a real-time RT-PCR analysis. A careful comparison with the results obtained in the periphery will be performed. All results will be stored in a central database, which will enable a correlation with any relevant parameters of the patients (therapy, survival). A particular interest will be given to the combination of several factors with respect to the patients’ situation. The work is ultimately focussed on obtaining an individual pattern of molecular and immunological markers, which may serve as the basis to propose a customised and improved therapy for each patient.N. van Zandwijk, L. van't Veer, P. Baas and W.J. Mooi proposed a program for analysis of prognostic factors for non-small cell lung cancer by micro-array techniques in a joint project.For more than 30 years, lung cancers for therapeutic purposes have been subdivided into two groups: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). The majority (±80%) of lung cancers are of the NSCLC group, which comprises carcinomas with squamous, adeno- and some without a specific differentiation (large cell carcinomas). Although there is evidence that squamous cell lung cancers have a somewhat different metastatic pattern when compared with those lacking squamous differentiation, the histological subdivisions within the heterogenous group of non-small cell lung cancers bear no major prognostic significance. Taking also into account the inability to predict a successful outcome of surgery—only ≈50% of patients, who currently undergo surgery for NSCLC with curative intent will be alive after 5 years—there is an urgent need for prognostic factors that can reliably predict long term survival and/or the emergence of metastatic disease.

Lung cancer is the first cause of death for men in most countries. In women, its incidence is rising, displacing the gynecologic cancers as the first cause of death. An increase in tobacco abuse among women accounts for this epidemiological change [ 1 Häussinger K. Pichler J. Markus A. et al. Autofluorescence bronchoscopy: D-light system. in: Bolliger C.T. Mathur P.N. Interventional Bronchoscopy Prog. Respire Res. 30. Karger, Basel2000: 243-251 Google Scholar , 2 Lam S. Becker H.D. Future diagnostic procedures. Chest Surg. Clin. N. Am. 1996; 6: 363-380 PubMed Google Scholar , 3 Nakhosteen J.A. Khanavkar B. Autofluorescence bronchoscopy; the laser imaging fluorescence endoscope. in: Bolliger C.T. Mathur P.N. Interventional Bronchoscopy Prog Respire Res. 30. Karger, Basel2000: 236-242 Google Scholar ].

Endobronchial ultrasound (EBUS) is a new diagnostic tool, which has expanded the view of the bronchoscopist beyond the confinements of the airways. It has great potential for diagnosis of mediastinal processes and staging of lung cancer. These will be discussed and illustrated. EBUS will become a superior tool for staging of lung cancer, and several comparative studies on EBUS as compared with standard techniques in order to assess its role in the staging procedure are just on their way or already completed.

We measured changes in airway pressure (Paw) caused by microsurgical instruments introduced into a rigid bronchoscope during high frequency jet ventilation (HFJV). With approval of the institutional Ethics Committee, 10 adults undergoing elective tracheobronchial endoscopy and endosonography during general anaesthesia were investigated. Inflation of an endosonography probe balloon in the left main stem bronchus caused airway obstruction. Pressure measurements proximal and distal to the obstruction were compared after three degrees of obstruction (0%, 50% and 90%) and with two different driving pressure settings. Airway obstruction increased the mean (SD) peak inspiratory pressure (PIP) from 7.5 (2.6) to 9.5 (3.5) mm Hg for 2 atm (P = 0.0008) and from 9.7 (3.7) to 13.0 (5.1) mm Hg for 3 atm (P = 0.0001). Airway obstruction did not alter peripheral PIP (7.2 (4.1) to 7.1 (3.7) mm Hg for 2 atm and 8.8 (4.3) to 9.4 (5.2) mm for 3 atm), but resulted in an end-expiratory pressure (EEP) beyond the narrowing being significantly greater than in the unobstructed airway (2.5 (3.4) to 5.5 (3.7) mm Hg for 2 atm; P = 0.0005) and 3.2 (3.6) to 8.0 (4.3) mm for 3 atm; P < 0.0001). Severe airway narrowing increases inspiratory pressure proximal and expiratory pressure distal to the obstruction in relation to the applied driving pressure. Since the distal EEP never exceeded PIP, even near-total airway obstruction should not cause severe lung distension or barotrauma in subjects with normal lungs.