: Seven children aged 6 weeks to 9 months with anomalous left coronary artery originating from the pulmonary artery and a 46-year-old female patient with pronounced formation of collaterals in Bland-White-Garland syndrome and left-right shunt were operated between July 1976 and February 1984. All children had already experienced left ventricular anterior wall infarction. Angiocardiography in 6 cases established the diagnosis, in one case echocardiography had proved sufficient. In the children, close-to-origin ligation of the left coronary artery was done after median sternotomy. One child succumbed postoperatively whereas in all others preoperative cardiac insufficiency regressed satisfactorily. In the adult female close-to-origin cutting of the left coronary artery was followed by aorto-coronary venous bypass.

Purpose: The aim of this prospective study was to assess the prognostic impact of serum tumor markers (Cyfra21-1, carcinoembryonic antigen, neuron-specific enolase, squamous cell carcinoma-antigen and TPAcyk) in patients with non-small cell lung cancer (NSCLC) receiving complete resection. Methods: Sixty-seven patients with histologically proven NSCLC and complete resection of stage I-IIIA disease were included. The scrum levels of all markers were measured using commercially available immunoassays. Results: With a median follow-up of 86 months for surviving patients, those with initial Cyfra21-1 serum levels higher than 3.57 ng/ml had a significantly worse prognosis (P=0.014). The remaining serum tumor markers showed no prognostic impact. In a Cox regression model, Cyfra21-1 proved to be an independent prognostic factor for both overall survival and disease-free interval. In addition, Cyfra21-1 sustained as an independent prognostic factor in completely resected stage I/II disease. Conclusions: With a cut-off value of 3.57 ng/ml, Cyfra 21-1 was an independent prognostic factor for survival in NSCLC-patients with complete resection. Further evaluation is needed, particularly in stage I/II disease. When the prognostic impact is confirmed with larger patient numbers this may contribute to the identification of stratification variables for future treatment approaches of NSCLC. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

We present a 26 year old patient with a primary malignant synovial sarcoma of the lung that was observed for more than one year by a general practitioner and a pulmologist. Finally, because of recurrent hemoptysis a central tumor of mesenchymal origin of the left lower lobe was diagnosed by bronchoscopy. The invasion of the left atrium as far as to the mitral valve was diagnosed by MRT. The patient was operated on by extended pneumonectomy with extracorporeal circulation. The partial excision of the left atrium required plastic reconstruction. In the postoperative course the patient underwent chemo-therapy, 6 cycles adriablastine/ifosfamid. 8 months after the first operation an extensive tumor recurrency occurred with infiltration of the chest wall. The patient refused further radio- or chemotherapy and died 14 months after the operation. Because of the small number of cases therapeutic strategy conceptions do not exist. The resection of the tumor is generally recommended. Chemo- and radiotherapy are accepted as an option for advanced tumor stage.

The aim of this study was to assess the prognostic value of deoxyribonucleic acid analysis, expression oferbB1, erbB2 and P53, and amplification levels of erbB1, erbB2 and erbB3 in non-small cell lung cancer (NSCLC). Consecutive patients with NSCLC who underwent treatment with curative intention (118) were included. In 108 cases, the cell cycle was analysed using flow cytometry and double-staining with propidium iodide and anticytokeratin. In another 108 cases, expression of erbB1, erbB2 and P53 was assessed immunhistochemically. Amplification of the erbB family was determined in the tumours of 53 patients using double-differential polymerase chain reaction. Of the tumours, 81% were aneuploid and 14% showed positive staining for erbB1, 18% for erbB2 and 41% for P53. There were normal mean gene copy numbers in 86% for erbB1, 94% for erbB2 and in 96% for erbB3. No significant correlations were noted between erbB1, erbB2 and P53 expression, ploidy status and tumour stage. In a Cox regression model, only tumour stage was shown to be prognostically significant. It seems that ploidy and expression status of erbB1, erbB2 and P53 are not prognostic parameters in non-small cell lung cancer. Amplification of the erbB family does not seem to be a frequent event in non-small cell lung cancer.

DNA flow cytometry;was used to study ploidy and cell cycle phase in patients with non - small cell lung carcinoma. A total number of 80 tumor samples were investigated. Cell cycle analysys was possible in 42 tumors. 79% of the tumors were aneuploid and 21% had diploid tumors. There was a correlation between high S-phase fraction in aneuploid tumors and lower S-phase fraction in diploid tumors. Patients with a lower S-phase fraction had a tendency to better survival, both diploid and aneuploid tumors.

Die epidemische Ausbreitung der Tuberkulose nach Beendigung des 2. Weltkrieges und der anfängliche Mangel an wirksamen Antituberkulotica führte zu einer Renaissance chirurgischer Maßnahmen, darunter auch der von Tuffier 1891 inaugurierten Pneumolyse. Der damit angestrebte Kollaps tuberkulöser Oberlappenkavernen wurde vornehmlich in Deutschland mit der Einbringung von Paraffin (Ölplombe) oder Polyäthylen (Perlonplombe) in den extrapleuralen bzw. extrafascialen Raum erzielt. Frühe Komplikationen und die unterstellte Cancerogenität des Füllmaterials führten in vielen Fällen bald zu dessen Entfernung. In Einzelfällen verblieben die Plomben und konfrontieren uns 30–40 Jahre danach mit einer Infektion und/oder Neoplasien. Von 1985 bis 1996 behandelten wir in beiden thoraxchirurgischen Zentren 13 Patienten mit der Beseitigung der „Plomben“; in 11 Fällen wegen einer Infektion, in einem Fall wegen der Pneumolyseninfektion in Verbindung mit einem malignen Lymphom der plombennahen Brustwand und in einem Fall wegen eines homolateralen Bronchialcarcinoms. Methodisch kamen eine Thoracoplastik nach Schede (n = 9), ihre Kombination mit einer Muskellappenplastik (n = 1) und einer Brustwandteilresektion (n = 1), die Empyemektomie (n = 1) und eine Pleuropneumonektomie als En-bloc-Resektion mit dem Pneumolysenschwartensack (n = 1) zur Anwendung. Alle Patienten waren polymorbide (COPD, CIHK, Diabetes mellitus). Dennoch gab es neben 2 tödlichen Komplikationen (Lungenembolie, Pneumonie mit Multiorganversagen) keine weiteren Komplikationen im Zusammenhang mit der Operation. Im Falle des Non-Hodgkin-Lymphoms kann eine Cancerogenität des Plombenmaterials in Abhängigkeit von der Expositionszeit unterstellt werden. Damit muß man die Entfernung solcher Materialien auch ohne manifeste Komplikationen empfehlen.

The epidemic spread of tuberculosis after World War II and the deficiency of appropriate antituberculotic drugs led to a renaissance of surgical procedure such as plombage thoracoplasty, initiated in 1891 by Tuffier. Especially in Germany the insertion of paraffin and polyethylene was used in order to achieve an extrapleural pneumothorax in order to collapse the tuberculous cavities in the upper lobes. Due to a high rate of early complications and the assumed cancerogenicity, in a considerable number of cases the material was removed soon after its deployment. In some cases with the filling remaining in place, 30-40 years later infections and/or neoplasms occurred. From 1985 to 1996 in two centers of thoracic surgery 13 patients underwent procedures for removal of filling material. The patients suffered from infections (n = 11), malignant lymphoma associated with infection of the plombage (n = 1) and bronchial carcinoma (n = 1). Technically, we performed the thoracoplasty described by Schede (n = 9). Schede's thoracoplasty in combination with a muscle flap repair (n = 1) or partial resection of the thoracic wall (n = 1), an empyemectomy (n = 1), and an en-bloc pleuropneumonectomy (n = 1). All patients suffered from multiple underlying diseases (COPD, coronary heart disease, diabetes mellitus). However, apart from beside two procedure related deaths (pulmonary embolism n = 1, pneumonia complicated by multi-organ failure n = 1) no other major complications were observed. The plombage material in the case of malignant lymphoma is probably carcinogenic in relation to the time of exposure and should be removed in all cases.

From 1985 to 1994, we performed 4568 thoracic operations, 234 of these patients (176 males, 58 females) were older than 70 years of age; the oldest patient was 82 years. Of these 234 patients, 144 suffered from bronchial carcinornas, 25 from lung metastases, 21 from recurrent pneumothoraces, 12 from thymomas, 21 from tuberculomas, hamartomas, an intrathoracic goiter or mesothelioma; in 11 patients, diagnostic thoracotomias or biopsies had been done. We did 146 anatomical resections, 59 atypical wedge resections, 14 decortications, pleurectomies, thymectomies or exstirpations of mediastinal tumors; in addition, three resections of an intrathoracic goiter were done. The hospital lethality was 3.8%, the total rate of complications 56%, mostly cardiac arrhythmias. The survival rate of the patients suffering from a bronchial carcinoma was the same as in younger patients.

Von 1985 bis 1994 nahmen wir insgesamt 4568 Thoraxoperationen vor, davon waren 234 Kranke (176 Männer, 58 Frauen) älter als 70 Jahre (5,1%), der Älteste war 82. Von den 234 Patientinnen und Patienten hatten 144 ein Bronchialkarzinom, 25 Lungenmetastasen, 21 rezidivierende Pneumothoraces, 12 Thymome, 21 wurden wegen eines Chondromes, Tuberkulomes, einer intrathorakalen Struma oder eines Mesotheliomes operiert, bei 11 erfolgten diagnostische Thorakotomien mit Biopsien. Es wurden 146 anatomische Lungenresektionen, 59 atypische Keilresektionen, 14 Dekortikationen, Pleurektomien, Thymektomien oder Mediastinaltumorexstirpationen und 3 intrathorakale Strumaresektionen vorgenommen. Die 30-Tage-Letalität betrug 3,8%, die gesamte Komplikationsrate 56%. Dabei führend waren Herzrhythmusstörungen. Die Überlebensrate der Patientinnen und Patienten mit einem Bronchialkarzinom entsprach denen von Operierten jüngeren Alters.

A 48-year old patient complaining of immitigable coughing with purulent and sanguineous sputum and a loss of weight of 8 kg within the last three months was admitted to our hospital. Due to anamnesis and radiological findings (tumor of the right side upper lung field with infiltration of the chest wall and the mediastinum) we suspected a bronchogenic carcinoma. As bronchoscopy and histological examinations of biopsies revealed no hints to the underlying disease, we submitted the patient to a right side explorative thoracotomy. It showed a tumorous involvement of the right side upper lung field with infiltration and partial destruction of the chest wall and infiltration of the apical segment of the lower lobe of the lung and a phlegmonous infiltration of the paratracheal tissue. Histological examination confirmed chronical course of actinomycosis. Therapy consisted in resection of the affected tissue and long-term administration of antibiotics. Response to therapy was excellent concerning both radiological findings and subjective complaints.

Seit Anfang 1991 behandelten wir 16 Patienten — 9 Frauen, 7 Männer im Alter von 16 bis 40 Jahren — mit einem rezidivierenden Spontanpneumothorax minimal invasiv chirurgisch. In Seitenlagerung und „Ein-Lungen-Beatmung“ erfolgten der Leckverschluß thorakoskopisch über zwei Inzisionen mit Endoclips und eine Pleurodese mit einem Fibrinkleber, der operierte Hemithorax wurde für 4 bis 5 Tage drainiert. Bei einer durchschnittlichen Verweildauer von 8 Tagen war die perioperative Rate der Morbidität und Mortalität 0%, ein Rezidiv beobachteten wir bislang nicht.

In the treatment of malignant lung tumours in the older patient it is important to consider the effects of a higher morbidity and the prognostic influence of concomitant diseases. In competent hands, the risks of invasive procedures such as bronchoscopy and thoracoscopy are comparatively low. Although the mortality and the rate of diagnostic thoracotomies are acceptable, lung resections carry a complication rate of 50%. One third of patients over the age of 70 years cannot be treated for small cell lung tumours as the complications of chemotherapy are considerable higher than in patients under the age of 70 years. A median survival time of 9 months is achievable which in patients of this age is acceptable. The decision to treat the patient should be individualized and be related to the patient's biological condition.

Sixty patients with a potentially resectable non-oat-cell lung carcinoma were examined by computed tomography and cervical mediastinoscopy. The sensitivity of computed tomography as opposed to mediastinoscopy was 74% versus 58% and the specificity in 85% versus 100%. Considering the limitations of both methods and the varying prevalence of mediastinal lymph-node metastases associated with peripheral and central lesions, three different situations can be distinguished: 1. with peripheral lesions and a normal mediastinal CT, preoperative mediastinoscopy is unnecessary. 2. With an abnormal mediastinal CT, mediastinoscopy is always indicated irrespective of the location of the tumor. 3. With large central lesions, mediastinoscopy is necessary even when the CT is normal. Using these rules, 37 of 60 mediastinoscopies in our patient group could have been avoided without influencing the resection rate (98%).

Thirty years after bilateral pneumolysis followed by plombage with paraffin for bilateral upper lobe tuberculosis, a 58-year-old female patient suffered a thrombosis of the left jugular- subclavian vein junction. Compression of the vessel by the plombage in addition to chronic fibrous scar tissue reaction must be assumed as the main cause of thrombosis, since infection of the plombage space was excluded.