The effect of Nd:YAG laser resection on symptom control, time to progression and survival in lung cancer patients.

PURPOSE: The aim of this study was to determine the effect of Nd:YAG laser resection of centrally located tumors on the control of various symptoms and signs, time to progression and survival in lung cancer patients. PATIENTS AND METHODS: We evaluated the effects of Nd: YAG laser resection in combination with high-dose rate (HDR) brachytherapy and external beam radiotherapy (EBRT) vs. combination of HDR brachytherapy and EBRT alone on lung cancer symptoms and signs, ECOG performance status, time to progression and overall survival in lung cancer patients. Patients in group I (n=81) were treated with combination of HDR brachytherapy and EBRT, while patients in group II (n=97) were treated with Nd:YAG laser in combination with HDR brachytherapy and EBRT. Patients were evaluated before and after treatment, and were followed-up regularly every 3 months until the end of life. After RT +/- laser treatment all patients received standard chemotherapy (cisplatin plus etoposide) during the course of disease. RESULTS: After treatment in both groups significant improvement in all investigated parameters was seen. Improvement in dyspnoea, thoracic pain, body weight loss and ECOG performance status was significantly better in group II (p <0.05), as were time to progression and overall survival (p <0.05). CONCLUSION: Laser resection improves symptom control in lung cancer patients with central airway obstruction (CAO). Longer time to progression and survival of lung cancer patients could be the result of imminent airway desobstruction accomplished with Nd:YAG laser.

Combination of interventional pulmonology techniques (Nd:YAG laser resection and brachytherapy) with external beam radiotherapy in the treatment of lung cancer patients with Karnofsky Index < or =50.

PURPOSE: To compare Nd: YAG laser resection with Nd: YAG laser plus brachytherapy and external beam radiotherapy (EBRT) in the palliation of malignant central airway obstruction symptoms due to lung cancer. PATIENTS AND METHODS: In this prospective non-randomized study we evaluated the effects of Nd:YAG laser photoresection alone vs. Nd:YAG laser resection in combination with brachytherapy and EBRT on cough, dyspnoea, thoracic pain, haemoptysis, body weight loss, atelectasis, postobstructive pneumonia, endoscopic findings, disease-free period and survival rate in lung cancer patients. Only patients with Karnofsky index (KI) < or =50 were included. Sixty-four patients were divided into 2 groups: group I patients ( = 20) were treated only with Nd: YAG laser, and group II patients (n = 44) were treated with Nd: YAG laser followed by brachytherapy and EBRT. RESULTS: Group I patients showed statistically significant improvement in all investigated parameters but cough. Group II patients achieved significant improvement in all investigated parameters. Comparative statistical analysis between the 2 groups revealed statistically significant improvement in group II with regard to dyspnoea, haemoptysis, KI and atelectasis. No significant improvement in group II was seen when other investigated parameters were considered. Disease-free period and survival rate were significantly longer in group II (p< or =0.0005). CONCLUSION: The combination of interventional pulmonology procedures with standard modalities is the best option for the treatment of selected lung cancer patients.

[Anesthesia for thymectomy in patients with myasthenia gravis]. / Anestezioloski pristup za timektomiju kod bolesnika sa miastenijom gravis.

INTRODUCTION: Anesthetic approach to patients with myasthenia gravis requires preoperative treatment with anticholinesterase drugs, corticosteroids, plasmapheresis and mechanical ventilation support, either before or immediately after the surgical procedure. MATERIAL AND METHODS: During the period of 10 years, 41 patients with myasthenia gravis (71.42% female and 28.57% male, aged between 9 and 69 years) underwent surgical procedures. All the patients were preoperatively treated with anticholinesterase drugs and corticosteroids and were in remission. Considering the fact that barbiturates and succinylcholine should be avoided during induction of anesthesia, halothane was used. The induction into the surgical stage of anesthesia was pronged. RESULTS: Intubation, as well as the surgical procedure, were successfully completed in all patients. All, except three patients, started breathing spontaneously. Two patients required respiratory support during the immediate postoperative period and one patient died. After the surgical procedure one patient had manifested gastrointestinal bleeding and three patients had pneumothorax (one iatrogenic and two during mechanical ventilation). Mechanical ventilation in postoperative period indicates inadequate respiratory function in patients with myasthenia gravis, whereas thymectomy is a therapy of choice. Volatile inhalation anesthetic with pre and postoperative anticholinesterase drugs and corticosteroids resulted in complete remission.