[Palliative therapy of central bronchial carcinoma].
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Airway Obstruction↗
Biomedical subjects
D Greschuchna
Publications and source records attributed to D Greschuchna.
[The current role of thoracoplasty in treatment of chronic pleural empyema].
To demonstrate the indication for surgery, the preoperative and postoperative course, and to assess the influence of thoracoplasty on respiratory physiology, the data of patients subjected to thoracoplasty during the past 30 years at our hospital were evaluated. Final assessment was performed separately for patients with and without preceding pulmonary resection. In 21 cases there was an unspecific empyema of the pleura and in 6 cases a specific one; in 14 cases there was also a concomitant bronchopleural fistula. After a washing-out period of 92 days (24-283) and after surgery had been unsuccessful in 9 patients, standard thoracoplasty was performed, complemented by a "jalousie" ("Venetian blind") plasty after Heller. Postoperative lethality was 11.1%. 5 patients developed pleuro-cutaneous fistulas that healed by local treatment; in one patient, a small residual cavity remained that required an additional plasty for correction. In 94% of the patients who had been operated upon, scoliosis occurred convex to the thoracoplasty; this was more marked in patients in whom lung resection had been performed than in patients without resection. Restrictive ventilatory disorders were seen in the lung function of 55% of the patients, whereas mixed restrictive-obstructive disorders occurred in 45%. Ergospirometry resulted under load besides in an increased respiratory minute volume (AMV), in a proportionate dead space of the AMV which was significantly higher than preoperatively. Despite the considerable functional and aesthetic consequences resulting therefrom, thoracoplasty still has its justification in refractory pleura empyemas as an ultimate means of cleaning up.
Adenocarcinoma↗
[Endobronchial prosthesis: experience report].
Between January 1988 and December 1990 a total of 84 endobronchial prosthesis were implanted in 55 patients at the Ruhrlandklinik, Essen. Bronchial carcinoma (33/55) was the leading indication for placing an endoluminal stent. Since the technique of implantation seldom leads to serious complications, non-malignant tracheobronchial stenosis and malacia play an increasing role in airway stenting. Implantation was usually performed under general anaesthesia and through rigid tube bronchoscopes with enlarged diameters. Most frequently a flexible silicone stent (Dumon) was used, Montgomery (5/84), Gianturco (5/84), Orlowski (4/84) and Strecker stents were also implanted. The respiratory gain was greatest in central stenosis, 79/84 stents were positioned into trachea or main stem bronchus. Permanent and temporary stenting were performed with success. Dislocation and hemoptysis seldom occur, mucus plugging and incrustation were more frequent complications.
Bronchi↗
The role of bronchoscopy in pulmonary complications due to mustard gas inhalation.
Over the last five years we have repetitively treated a group of 21 Iranian soldiers who developed pulmonary complications as a result of severe inhalation injury due to mustard gas during the Iran-Iraq war. Early respiratory manifestations included hemorrhagic inflammation of the tracheobronchial tree accompanied by severe erosions. Secondary complications consisted of chronic infections, suppurative bronchitis, and extensive stenotic process of the entire tracheobronchial tree with life-threatening sequelae. After a delay of up to 15 months, scars, ulcers, and strictures developed in the central airways. Progressive deterioration of gas exchange was common. At this point, bronchoscopy, both diagnostic and therapeutic, was invaluable in evaluating the conditions in these patients since many required multiple therapeutic bronchoscopies. Repeated bougienage of the stenotic tracheobronchial lesions and laser photoresection of scarring tissue was life-saving. The recurrence rate of stenosis was very high, with intervals of less than six months on the average. One pneumonectomy was necessary, with the excised lung showing bronchiectasis and chronic pneumonia. To this date we have performed 146 therapeutic bronchoscopies. In four patients, silicone stents had to be implanted. One patient received brachytherapy and external beam radiation therapy in an effort to prevent continued scarring and life-threatening stenoses of the tracheobronchial tree. Our experience demonstrates the extreme usefulness of bronchoscopy in the diagnosis and treatment of pulmonary complications due to inhalation of poisonous gases.
Bronchoscopy↗
Limited and radical resection for tracheal and bronchopulmonary carcinoid tumour. Report on 227 cases.
Bronchopulmonary carcinoid tumours occur at all levels from the trachea to the lung periphery. Over a 20-year period. 227 patients with carcinoid tumour underwent thoracotomy. The age at operation ranged from 14 to 79 years. Haemoptysis, chronic cough, recurrent infection and wheeze were the most common symptoms; 24% of patients were asymptomatic. The primary tumour was within the trachea or the main, lobar or segmental bronchi in 190 patients (83.7%). A variety of surgical procedures were employed: pneumonectomy in 32 patients; lobectomy and bilobectomy including bronchial sleeve resection in 144; segmentectomy in 18; wedge excision in 19; bronchial sleeve only in 5; carinal resection in 2; tracheal resection in 4 and bronchotomy in 3 cases. There was only 1 hospital death in the 227 patients (mortality: 0.44%). Survival at 5 and 10 years in patients with benign carcinoid was 97.5% and 95%, respectively. In patients with the atypical form it was 41.2%. The peripheral carcinoid was usually totally removed by an ample wedge excision or segmental resection and the central bronchial carcinoid by sleeve resection with lobectomy rather than pneumonectomy. The atypical variant, because of the frequency of lymphatic involvement, should be treated as a bronchial carcinoma by radical resection.
Adolescent↗
[Indications for surgery and results of 207 thoracotomies in children with diseases of the lung, pleura and mediastinum].
Between 1968 and 1988, 207 children with congenital, inflammatory, and neoplastic diseases of the lung, pleura, and mediastinum underwent thoracotomy. In 34 patients indication for operation was a therapy-resistent recurrent spontaneous pneumothorax, in 25 benign and malignant mediastinal tumors, in 26 pulmonary metastases of extrathoracic primary tumors, in 42 bronchiectasis and post-pneumonic empyema with callosity, in 21 bronchogenic and enterogenous cysts. 22 children had benign tumors of the trachea, bronchi, and lung, 5 malignant tumors of the lung and chest wall. In a smaller number of children congenital defects, parasitic cysts, and aspergillomas as well as foreign bodies, were present. The surgical procedure included anatomical and atypical resections, bronchoplastic interventions, exstirpation of tumors and cysts, decortications and partial resections of the parietal pleura. There was no perioperative mortality.
Child↗
[Interdisciplinary concepts and long-term results after surgery of pulmonary metastases].
From January 1976 to December 1988, 338 patients with pulmonary metastases underwent 376 resections. For 26 patients with recurrent disease a second or repeated thoracotomy was necessary. The operative mortality was for isolated lesions under 1%, for multiple bilateral nodules 3.8%. A parenchymal saving resection was performed, except for metastases from colorectal carcinoma, who often involved the bronchopulmonary lymphatic nodules. In these cases (30%) a segmentectomy or lobectomy was indicated. The five-year survival rates was significantly favorable for patients with isolated lesions, specially for late uterine metastases (57%), late mammary metastases (45%) and head and neck metastases (60%). The adjuvant hormones substitution and chemotherapy for multiple uterine and mammary metastases leaded to favorable results (prolonged median survival of 18 months). The indication for resection of multiple ipsilateral or bilateral lesions from testicular cancer, soft tissue and osteogenic sarcomas were recommended only when there was no response or partial response to the chemotherapy. The five-year survival was 46%, 27% and 17% approximately. The disease-free interval, location of the pulmonary lesions and the stage of primary cancer had not influenced on post-thoracotomy survival. The metastatic route of primary cancer, caval or portal route, size and number of metastases and the tumor doubling time was significantly associated with postoperative survival.
Adolescent↗
[Interdisciplinary treatment measures in pulmonary metastasis of uterine cancer: initial results in 61 patients].
In the period between January, 1976 and December, 1987, 61 patients with a carcinoma of the uterus that had metastasized to the lungs were treated at the Ruhrlandklinik in Essen-Heidhausen, in a cooperative effort with the West German Tumour Center in Essen. The metastases were asynchronous and the pulmonary lesions manifested up to 18 years after surgical treatment of the primary tumour. No 30-day mortality was observed. In the case of solitary metastasis, no post-operative adjuvant therapy was, as a rule, applied; in the case of multiple metastases, even after they had been radically removed, hormone therapy alone or in combination with a four- to six-fold repeated adjuvant chemotherapy was applied in individual cases. The five-year survival rate for patients with solitary metastases was 57%, in those with multiple metastases receiving adjuvant chemotherapy 27%. None of the patients who received a pleurectomy for carcinoma-induced pleuritis survived for five years.
Adenocarcinoma↗
[Detection of the activation of alveolar lymphocytes in alveolar proteinosis].
In 7 patients with pulmonary alveolar proteinosis, differential cytology and lymphocyte subsets in BAL fluid were investigated. The study showed that pulmonary alveolar proteinosis is another disorder characterized by a lymphocytic alveolitis and activation of T-lymphocytes (expression of HLA-DR antigens and IL-2 receptors). Our data indicate that immunological mechanisms involving T-cell activation may contribute to be pathogenesis of pulmonary alveolar proteinosis.
Adult↗
[Portal and caval metastatic path of pulmonary metastases of extrathoracic primary tumors: prognosis and results in 303 surgically treated patients].
In the period between 1.1.1976 and 31.12.1987, a total of 336 surgical procedures were performed in 303 patients with pulmonary metastases from extrathoracic primary tumours. In 42 patients, metastatic spread had taken place via the portal vein, in 72 patients via the superior vena cava, and in the remaining 189 patients via the inferior vena cava. Irrespective of the primary tumour, the 30-day mortality rate for all three groups was less than one per cent; 3 patients died of respiratory complications. In the "portal" group, the five-year survival rate was 16% overall, although at the time of thoracotomy, metastastatic spread to other organs had been excluded. In the superior vena cava group, 36% of the patients survived for five years. Here, the favourable prognosis following resection of pulmonary metastases from carcinoma of the floor of the mouth and larynx, as also the late metastases from cancer of the breast, must be emphasized. In the third group (the inferior vena cava group) the five-year survival rate was 29%. In this group, the late metastases from cancer of the uterus has the better prognosis (57%).
Female↗
[Echinococcus cysticus costalis: report of 2 cases and review of the literature].
Since 1976, 14 patients with hydatic disease of the lung and chest wall underwent surgery at the Ruhrlandklinik Essen-Heidhausen. In two of them primary intra- and extra-osseous echinococcosis of the rib was seen. The patients came from Mediterranean countries, and the clinical symptoms were not very marked. The diagnosis is usually based on a routine chest film, chest tomography, and computerized axial tomography. The specific parasitological laboratory tests are seldom positive. The "gold standard" for therapy is radical removal of the ribs or chest wall involved.
Adult↗
[Thoracoscopy in thoracic wall processes].
Main emphasis in the diagnosis of diseases in the chest wall region is on modern imaging methods, perthoracic puncture, and surgery. It is only rarely that diagnostic thoracoscopy appears to be indicated, especially in patients with enhanced operative risk.
Biopsy↗
Recommendations on diagnosis, staging, and surgical therapy of lung cancer.
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Humans↗
Surgery for pulmonary aspergilloma and pleural aspergillosis.
Pulmonary aspergilloma and pleural aspergillosis are a potentially lifethreatening disease resulting from the colonization of lung or pleural cavities by the ubiquitous fungus Aspergillus fumigatus. Twenty four patients with pulmonary aspergilloma and five with pleural aspergillosis underwent major thoracic procedures at our hospital between 1976 and 1986. Fourteen of the patients had haemoptysis, in 9 it was recurrent, and in 5 life-threatening. Tuberculosis, pneumonia, and sarcoidosis were the most common preexisting lung lesions. Surgical procedures included 7 pleuropneumonectomies, 18 lobectomies and 4 wedge resections. The postoperative mortality rate was approximately 7% (2 pat.). Based on the pathological examination 4 patients had unexpectedly a bronchial carcinoma in addition to the aspergilloma. Bronchopleural fistula with persistent air space was a serious complication only for patients after pleuropneumonectomy. 23 patients including those with complex aspergilloma and pleural infection had no postoperative complications; in none of the 27 operative survivors were there any recurrent symptoms over a follow-up between one and ten years. Good-risk patients with documented aspergilloma, even asymptomatic, should be resected, because of the danger of exsanginating haemorrhage. For patients with pleural aspergillosis only the aggressive resection can provide effective long term palliation.
Aspergillosis↗
Small cell carcinoma of the lung--to operate or not? Surgical experience and results.
From 1962 to 1979, out of 549 patients with small cell bronchial carcinoma (= 15% of all bronchial carcinomas) treated in our clinic, 109 (20%) underwent thoracotomy and 94 (17%) resection. The recurrence free 3-year survival rate for resected patients was 22%, and after 5 years 14 of the 94 (15%) were still alive, using absolute numbers including postoperative deaths. From 1962 to 1975 only patients in stages T1 N0 M0 or T2 N0 M0 survived, with one survivor in stage T1 N2 M0. In the period from 1976 to 1979 patients with tumors in more advanced stages were resected: now those with T1 N1 M0, T1 N2 M0 and predominantly with T2 N1 M0 survived, which can be attributed to the effect of more intensive chemotherapy. Sixty-eight percent of the operations were pneumonectomies; the exploratory thoracotomy rate was 14%. Surgical therapy was seen as an integral part of an oncological regime applied in suitable types of tumor. When the tumor was identified only after resection, 3 courses of a combined chemotherapy including cranial radiation were performed, with additional topical radiation in cases of N2 or T3 forms. When the diagnosis was ascertained preoperatively, 2 (to 3) courses of chemotherapy were followed by resection of the entire area affected, and then by a further 2 (to 3) courses of combined chemotherapy with cranial radiation. A prerequisite for resection in these cases was that the tumor had regressed as a result of the first courses of chemotherapy. In cases of initially inoperable tumors, "residual surgery" appears justified if adequate regression occurs as a result of chemotherapy in view of the large number of local recurrences following chemo(/radio-)therapy alone. Palliative resection is not indicated in small cell bronchial carcinomas, nor is surgery indicated in cases of primarily inoperable tumors which do not react to chemotherapy.
Carcinoma, Small Cell↗
[The so-called decapitated form of Wegener's granulomatosis. Value of diagnostic thoracotomy].
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Biopsy↗
The role of surgery in the treatment of small cell carcinoma of the lung.
The role of surgical treatment of non-small-cell carcinoma of the lung is controversial. Surgical therapy of small cell carcinoma of the lung has been the subject of criticism for two decades - in contrast to our opinion about the important role of initial surgical therapy in limited disease of this type of lung carcinoma. In a review of the results of surgical therapy in 109 patients with undifferentiated small cell carcinoma of the lung in the period from 1962 to 1979 and an attempt to define the role of the curative effect, we report on 109 thoracotomies after negative preoperative mediastinoscopy and exclusion of hematogenous spread of the cancer. The resection rate (94/109) was considerably lower than in differentiated lung carcinoma. Pneumonectomy (40%) and extended pneumonectomy (27%) were more frequently performed for small cell carcinoma than for differentiated tumors; thus, the rate of lobectomy and segmental resection (28/94 = 30%, and 3/94 = 3%, respectively) was low. When we included the postoperative lethality in the calculation rather than using the life-table method, we found in a follow-up study of 99% of the patients who had undergone resection, in absolute numbers, 3-year survival in 21/93 patients (23%). In the different stages I, II, and III, we noted 3-year survival rates of 32%, 25%, and 14%. Correlation to the N and T stages was N0 (10/29) 35%; N1 (6/34) 18%; N2 (5/30), 17%; N1 + 2 (11/64) 17%; T1 (11/28) 39%; T2 (8/35) 23%; T3 (2/30) 7%; and T2 + 3 (9/34) 14%.(ABSTRACT TRUNCATED AT 250 WORDS)
Carcinoma, Small Cell↗