In-vivo isolation of circulating tumor cells in non-small cell lung cancer patients by CellCollector.

In non-small cell lung cancer (NSCLC) circulating tumor cells (CTCs) can provide information on patient prognosis and treatment efficacy. Currently CTCs are mostly isolated in vitro from small volumes of patient blood samples. The aim of the study was to assess a medical device for in vivo isolation of CTCs directly from the blood of NSCLC patients. The device was inserted in a cubital vein through a standard cannula for thirty minutes. The interaction of target CTCs with the CellCollector was mediated by an antibody directed against the epithelial cell adhesion molecule. There were 60 applications of the wire in 48 stage I-IIIB NSCLC patients and 12 non-cancer patients. The device was well tolerated in all applications without side effects. We obtained in vivo isolation of CTCs in 32 of 34 NSCLC patients (94.1%) with a median (range) of 13 (0-300) CTCs. In the non-cancer patients, no CTCs were detected. The safety and efficacy of an in vivo CTC detection method directly from the bloodstream of patients with NSCLC has been demonstrated. This proof of concept study may have important clinical implications, as the implementation of the device into clinical practice may improve early detection, prognosis and therapy monitoring of NSCLC patients.

Sleeve lobectomy as an alternative to pneumonectomy in patients with operable lung cancer.

In many patients with non-small cell lung cancer (NSCLC), pneumonectomy is still the only choice of surgical treatment. Pneumonectomy is associated with the increased risk of postoperative complications and higher mortality. Late results are affected by progressive deterioration of the quality of life. In some patients, especially with central location of the tumor the sleeve lobectomy can be an alternative to pneumonectomy. However, there are some doubts about the higher risk of local recurrence. The aim of the study was to assess the early and late results of sleeve lobectomy in patients with NSCLC treated surgically. The study group consisted of 107 patients subjected to surgery due to NSCLC between 2001 and 2009. There were 89 male and 18 female patients, aged between 35 and 78 years (mean age: 65 years). Surgery was preceded by routine diagnostic and staging procedures. Statistical analysis was based on the Statistica 6.0 software.The following sleeve lobectomies were performed: 71 right upper, 29 left upper, 5 left lower lobectomies, one inferior bilobectomy and one upper bilobectomy. Twelve patients were subjected to left upper sleeve lobectomy with partial resection and reconstruction of the pulmonary artery. Squamous cell carcinoma (SCC) was the most common type of histology. Most patients were classified as stage IB and IIB. Perioperative mortality in the entire study population was 1.8%. The most frequent complications were as follows: supraventricular arrhythmias (11.2%) and atelectasis of the operated lung (10.3%). The five-year survival after surgery was 56.1%. Local recurrence was observed in 10 patients (9.3%). Statistical analysis demonstrated that T stage and postoperative chemotherapy were significant factors influencing long-term survival. Multivariate analysis showed that T stage was the only factor influencing the long-term survival. Sleeve lobectomy is a good alternative to pneumonectomy in selected patients with NSCLC. Although it is considered as technically difficult, it is characterized by lower risk of death during the perioperative period, lower percentage of significant postoperative complications and better quality of life after the operation.

An unusual case of giant primary mediastinal liposarcoma.

Primary liposarcomas of the mediastinum are extremely rare. They have a dramatic clinical course. An unusual case of a giant primary liposarcoma of the mediastinum in a 49-year-old female is described. In spite of the tumor size the patient's only symptom was dry cough. Chest X-ray and CT showed a huge mass in the left pleural cavity. A radical procedure was performed with removal of a giant 25 x 31 cm soft fatty tumor. Pathology showed liposarcoma. The postoperative course was uneventful and follow-up examination after 12 months showed no recurrence of the disease.

Nonrandom DNA copy number changes related to lymph node metastases in squamous cell carcinoma of the lung.

Lung cancer is one of the most common malignancies and cancer-related death worldwide. Lymph node metastasis is the main cause of treatment failure. Although many studies were performed to evaluate genetic events associated with development and progression of lung cancer, molecular mechanism still remains poorly defined. In the present study, using comparative genomic hybridization (CGH) technique, we described the pattern of DNA copy number changes in a cohort of 42 primary squamous cell carcinomas (SCC) of the lung. A direct comparison of nonmetastatic (TxN0M0) and metastatic (TxN1-2M0) tumors was performed to define chromosomal imbalances related to lymph node metastases. Some genetic alterations were observed more frequently in metastatic than in non-metastatic tumors, including losses at 11q, 16p, 16q, 19p and gains at 4q, 7q, 12p, 13q, 18p. The gain at 7q with the smallest common altered region 7q31.2-q32, was found to be directly associated with lymph node involvement (p=0.0407). We suggest that the established chromosomal region harbors two putative tumor suppressor genes WNT2 and c-Met. An overexpresion of these genes seems to be involved in inducing the invasive growth and metastatic potential of SCC of the lung.

The prognostic value of DNA content analysis in patients with squamous cell lung cancer treated surgically.

The aims of the study were to assess the degree of ploidy and determine whether it had any influence on the remission time and survival of surgically treated patients with squamous cell lung cancer. The results were then related to the clinical staging, grading, size and location of the tumor. Tissue samples of squamous cell lung carcinoma (n=80) resected between 1995 and 1996 in the Department of Thoracic Surgery at University of Medical Sciences in Poznan were prepared using the modified Hedley's method. The measurements were made by means of a Cytoron Absolute flow cytometer. Abnormal (aneuploid) DNA was found in 45% of the tumors. In the 2-year observation period significantly more patients with aneuploid tumors died (75%) than those with diploid tumors (43.2%), P<0.05. No significant correlation was found between the ploidy and frequency of metastasis to regional lymph nodes, tumor size, location or grading. Estimation of the DNA content in cancer cells appears to be a significant prognostic factor. Furthermore measurement of the DNA content can be useful after surgery to estimate the risk of recurrence.

Prognostic significance of DNA ploidy in squamous cell lung carcinoma: is it really worth it?

BACKGROUND: Many previous studies attempted to associate DNA quantification with prognosis for lung cancer, but there is a divergence of opinion about its value. The purpose of the study was to evaluate the frequency of abnormal DNA content in squamous cell cancer (SCC) and analyze its correlation with late survival rates after surgical treatment. METHODS: A group of 110 patients surgically treated because of SCC was analyzed. Paraffin-embedded pathologic material underwent cytometric analysis. Postoperative follow-up was performed with standard follow-up visits. The statistical analysis was carried out using Mann-Whitney's U and chi2 tests to compare various variables in both groups. The survival curves were drawn using the Kaplan-Meier method. Clinical staging, regional metastasis, and ploidy, were analyzed with multivariate analysis for having a great impact on survival rates. RESULTS: Fifty (45%) tumors were DNA aneuploid. The survival rate in patients with aneuploid cancers was worse than in those with diploid tumors and the most frequent cause of death was local recurrence (p < 0.05). CONCLUSIONS: DNA content abnormalities were found to be an important prognostic factor in patients with SCC. The DNA quantification can select a group of high risk of recurrence even after a radical procedure and set new guidelines for adjuvant therapy.

Mitral valvuloplasty with sutures used for aortic prosthesis implantation.

BACKGROUND: The purpose of this study was to analyze surgical treatment for aortic valve lesions with coexisting mitral regurgitation (MR). METHODS: Seventy-five patients were divided into two groups according to intensity of MR (group 1, MR less than or equal to II; group 2, MR greater than or equal to II/III). There were two control groups (control 1, only patients with implantation of aortic valve; control 2, patients with implantation of both aortic and mitral prostheses). During implantation of a mechanical aortic prosthesis, the same suture for fixation of a mechanical prosthesis and for suspension of mitral commissural regions and lifting the base of anterior mitral cusp was used. RESULTS: In all patients, no early death occurred. There were two late deaths, one due to endocarditis, and the other to heart failure. All patients from both groups had decreased MR. Selected echocardiographic parameters improved: end diastolic and end systolic diameter and ejection fraction in group 2 improved in proportion to patients in whom mitral valves were implanted (control 2). CONCLUSIONS: Simultaneous suspension of the mitral commissure area during mechanical aortic prosthesis implantation reduces associated MR. This technique seems to be efficient during implantation of aortic prostheses in patients with coexisting MR.

Results of surgical repair of ostium primum atrial septal defect in adult patients.

BACKGROUND AND AIM OF THE STUDY: Ostium primum atrial septal defect (ASD I) is very rarely observed in the adults. Although ASD I was first corrected surgically almost 50 years ago, the efficacy of surgical treatment in adults has not been well documented. Thus, the long-term outcome of patients aged over 20 years and having surgical repair of ASD I was examined. METHODS: Fifteen patients (10 males, five females; mean age 31.4+/-13.1 years; range: 20 to 56 years) who had surgical repair of ASD I between 1982 and 2000 were followed. All patients were examined physically and underwent chest radiography, ECG and echocardiography (cross-sectional and Doppler) before and after surgery. Autologous pericardium was used to close the defect in 14 patients, and a direct suture was used in one patient. Mitral valvuloplasty (repair of the cleft) was performed in 12 patients, and De Vega annuloplasty in eight. RESULTS: There were no hospital deaths. In one case a pacemaker was implanted five days after surgery because of complete heart block. Preoperatively, nine patients (60%) were in NYHA classes III and IV; at the end of follow up, 14 (93.3%) were in classes I and II. Preoperatively, 13 patients had sinus rhythm, and one each had atrial fibrillation (AF) and rhythm from the atrioventricular sinus. During follow up, three patients developed AF which was treated successfully with electrical cardioversion. The preoperative mean cardiac volume index of 695 +/- 216 ml/m(2) was reduced significantly after repair to 523 +/- 108 ml/m(2) (p < 0.05). Before surgery, mitral regurgitation was observed (severe in five cases, moderate in seven, mild in three). Postoperatively, a residual intracardiac shunt was identified in one case. Postoperative mitral regurgitation was noted in six patients (moderate in two, mild in four). The right ventricular dimension was decreased significantly, from 5.0 +/- 1.5 mm before surgery to 3.2 +/- 0.6 mm after repair (p < 0.001). CONCLUSION: Patients aged over 20 years with ASD I benefit from surgical repair of the defect.

Atrial fibrillation after surgery of the lung: clinical analysis of risk factors.

OBJECTIVE: The aim of this study was to determine which of the clinical parameters are the most valuable in predicting postoperative atrial fibrillation after lung surgery. MATERIALS AND METHODS: Retrospective analysis was carried out on 298 patients after pulmonary resection necessitated mainly by lung cancer. The following parameters were investigated: age and sex, disturbances of cardiac rhythm, history of ischemic heart disease, diabetes and atherosclerosis, NYHA classification and type of surgical procedure. In addition, the duration of surgery, variations in oxygen saturation, changes in systemic blood pressure and heart-rate were noted intraoperatively. Statistical analysis was performed using Fisher's exact test. RESULTS AND CONCLUSIONS: Atrial fibrillation occurred in 25 cases (8.4%) and more frequently after pneumonectomy (24%). Other factors contributing to atrial fibrillation after lung surgery were: history of ischemic heart disease, congestive heart failure, intraoperative cardiac arrest and the need for rethoracotomy.

Energy state of the myocardium during long-term cold storage and subsequent reperfusion.

Long-term preservation of dog hearts was performed over 24 h using Bretschneider-HTK cardioplegia and cold storage. Preservation was assessed in terms of conservation of myocardial tissue levels of high-energy phosphates (HEP) and functional outcome after cardiac transplantation. Serial left ventricular biopsies were taken and analysed for ATP, ADP, AMP, adenosine, inosine, hypoxanthine, xanthine and creatine phosphate. Myocardial structure was studied by electron microscopical examination of a similar biopsy specimen. Cardiac performance was measured before and after cardiac transplantation. Several techniques of cardioplegic arrest were studied: single dose cardioplegia, multidose cardioplegia and continuous perfusion with the cardioplegic solution. In all groups, the hearts were stored at 0.5 degree C for 24 h. In the group of single dose Bretschneider-HTK cardioplegia, myocardial ATP content after 24 h of cold storage was only 25% of control. The total sum of nucleotides at that time interval was however 65% of the control value. Reperfusion of these hearts using a support dog (whole blood reperfusion) did not result in any recovery of ATP. Creatinine phosphate however showed an overshoot. Accumulated nucleosides were washed out. The hearts showed electrical activity but were severely arrhythmic. Contractility was poor. In the group of multidose Bretschneider-HTK cardioplegia, HEP preservation was better than after single dose cardioplegia. ATP content was about 50% of control. The total sum of nucleotides was 85% of control. Ultrastructural assessment of the myocytes revealed only slight ischaemic damage to the mitochondria. Reperfusion on cardiopulmonary bypass after cardiac transplantation did not show any restoration of ATP, but a steady catabolism of HEP. The nucleosides adenosine and inosine were not washed out upon reperfusion. After cardiac transplantation, none of these hearts could be weaned from cardiopulmonary bypass due to irreversible low cardiac output. Histological examination demonstrated irreversible myocardial tissue damage. In the group of continuous cold Bretschneider cardioplegia, HEP content was completely preserved throughout the 24 h of perfusion. Ultrastructure of the myocytes was normal. Reperfusion of the transplanted hearts showed a mild breakdown of ATP to 70% of control values accompanied by a slight accumulation of nucleosides. Haemodynamic recovery however was perfect and none of the hearts needed positive inotropic support. Myocytes after reperfusion had a normal subcellular appearance.(ABSTRACT TRUNCATED AT 400 WORDS)

Early post-pneumonectomy complications in the elderly.

OBJECTIVE: The surgical treatment of non-small cell lung cancer (NSCLC) in elderly patients presents a serious challenge to thoracic surgeons. As there is considerable divergence of opinion about both the mortality and morbidity rates, it is important to set guidelines for proper patient selection. METHODS: Early post-operative complications in 42 patients aged over 70 years who had undergone pneumonectomy because of NSCLC (Group I) were analyzed. The control group (Group II) consisted of 48 patients, also aged over 70 years, but who had undergone lobectomy or wedge resections. In both groups, the pre-operative conditions and 30-day morbidity and mortality were evaluated. RESULTS: Postoperative complications occurred significantly more frequently in pneumonectomy patients (78.5%) than in Group II (58%). Transient or long-standing arrhythmias were noted in 20 patients (47.6%) from Group I and in 17 (35.4%) from Group II. Pulmonary complications occurred in 17 patients (40.4%) from Group I and 16 (33.3%) from Group II. The most important factors contributing to post-operative complications in pneumonectomy patients were performance status (WHO), chronic obstructive pulmonary disease (COPD) and elevated level of blood urea nitrogen (BUN). The highest impact on early mortality in pneumonectomy patients was exerted by COPD, arterial hypertension, formation of broncho-pleural fistula (BPF), the need for re-thoracotomy and high level of BUN. CONCLUSIONS: (1) Pneumonectomy in patients over the age of 70 carries a considerable risk of severe post-operative complications and death, when compared to patients with less extensive pulmonary resections. (2) Elderly patients with impaired Performance Status (WHO 2 or more) and co-existing arterial hypertension, COPD and elevated level of BUN should be considered for pneumonectomy very carefully and cautiously.

Myocardial perfusion correlates with improvement of systolic function of the left ventricle after CABG. Dobutamine echocardiography and Tc-99m-MIBI SPECT study.

OBJECTIVE: The aim of the study was to assess the effect of surgical revascularization [coronary artery bypass grafting (CABG)] on systolic function and perfusion of the left ventricle using dobutamine echocardiography (DE) and Tc-99m-MIBI SPECT (SPECT). METHODS: There were 32 patients mean age 52.2+/-7.2 years in whom DE and SPECT were performed before and 3-4 months after CABG using standard protocols. Wall motion score index (WMSI) and perfusion index (PI) were calculated. RESULTS: Significant improvement of WMSI at rest (1.44+/-0.46 vs 1.33+/-0.41; P=0.03) as well as after maximal dose of dobutamine (1.49+/-0.42 vs 1.39+/-0.44; P=0.02) was observed after CABG as compared to preoperative examination. Similar relation was observed during SPECT study. Perfusion index diminished significantly after revascularization during rest acquisition (2.19+/-0.71 vs 1.93+/-0.70; P=0.0008) and after Dipirydamole administration (2.73+/-0.73 vs 2.20+/-0.69; P=0.0001) as compared to preoperative examination. We found correlation between PI and WMSI at rest before CABG (R=0.46; P=0.01), PI after Dipirydamole and WMSI after maximal dose of Dobutamine before CABG (R=0.37; P=0.04), PI and WMSI at rest after CABG (R=0.39; P=0.03), PI after Dipirydamole and WMSI after dobutamine after CABG (R=0.38; P=0.03). CONCLUSIONS: Surgical revascularization significantly improves both perfusion and contractility. Increased perfusion after CABG correlates with improvement of systolic function of the left ventricle.

Significance of cell adhesion molecules, CD56/NCAM in particular, in human tumor growth and spreading.

Cell adhesion molecules (CAM) represent a large group of cell surface protein moieties with distinctive biological functions. In physiological terms they ascertain cell to cell contact such as cell cohesion of epithelia, condition cell migration and transmigration via biological membranes such as blood vessel walls, provide means for homing cells in a new microenvironment etc. These features of CAM are exploited by tumor cells to grow and spread in a tumor bearing host. CD56/N-CAM antigen is 140 kD isoform of neural cell adhesion molecule. N-CAM belongs to the large Ig superfamily of CAMs. CD56 can be traced at various sites, including nervous tissue, neuro-muscular junctions, neuroendocrine and endocrine organs. It is well known as a differentiation antigen of natural killer (NK) cells. Its role and function are far from clear, but its adhesion properties are evident in cell-cell (homophilic) interactions. CD56 has been, however, demonstrated the cells various human malignancies. Tumors of the nervous system such as neuroblastoma, are well known to express this marker. Malignant lymphomas of T-NK cell origin bear CD56, as well as multiple myeloma, melanoma and some cancers of epithelial origin. These data suggest that CD56/N-CAM antigen is, in some unknown manner involved in tumor biology.

Extended pneumonectomy for non small cell lung cancer--should we still do it?

The aim of the study was to assess the early and late results of extended pneumonectomies in lung cancer patients with T3 and T4 disease. Between Jan. 1995 and Dec. 1999--445 pneumonectomies were performed in patients with lung cancer. In 37 patients without preoperative N2 involvement a standard pneumonectomy was extended to include the following additional resections: chest wall (10), pericardium (9), diaphragm (5), VCS (3), descending aorta (2), left atrium (5), esophagus (1) and tracheal bifurcation (2). The effect of various factors on general mortality and morbidity was analyzed with the use of binary logistic regression. There were two early postoperative deaths (6.8%). Major complications occurred in 10 patients (29%). Overall survival rates at 1, 2, and 3 years were 43, 30 and 24%, respectively. The survival rates for the subgroup with chest involvement only were 50, 42 and 30%, respectively. Eight patients survived beyond the 36 month follow-up. The only factor significantly affecting mortality was incomplete resection, as revealed by postoperative microscopic examination (R1, p<0.05). Extended operations are justified by a relatively low mortality rate and low number of severe postoperative complications, specially in patients with chest wall involvement only. The result of this treatment predominantly depends upon the completeness of the resection.

[The mitral valve in mitral valve defect. Histological and clinical correlations]. / Zastawka dwudzielna w wadzie mitralnej. Korelacja histologczno-kliniczna.

The purpose of this study was to investigate the correlation between the histologic changes in the excised mitral valves and the clinical findings in patients with mitral stenosis (with or without regurgitation). The Study group consists of 26 men and 23 women ranged in age from 24 to 56 years. The mitral valves were removed in a uniform manner by one surgeon during mitral valve replacement. The controls were 13 mitral valves removed at necropsy from patients who died of extracardiac causes. Excised valves were fixed in 5% solution of formaline. The extent of calcification was determined by radiographs. Tissue from the center of the anterior and posterior leaflet were selected as the samples. The blocks were paraffin embedded and processed in the conventional manner. For histological examination 11.5 um thick sections were stained with haematoxylin and eosin, Alcian blue, Van Gieson and Von Koss stain. Then the sections were examined under light microscope. We estimated the degree of fibrotic disorganization of architecture, vascularization, acid mucopolysaccharide content, number of fibroblasts, and the presence of calcific deposits and lymphoid infiltrates. The control valves had normal architecture with thick "fibrosa". In all stenotic mitral valves we found complete or partial disorganization of architecture. The most common change was hyalinization present in 94% valves, vascularization in 84% and calcification present in 66% of valves. In 33% of stenotic valves were present infiltrations by lymphocytes. We found a significant correlation (p less than 0.05) between the presence of lymphoid infiltrates and the duration of disease prior to surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intensity of tone and opening snap, and morphology of the bicuspid valve in patients with mitral valve disease]. / Intensywnosc I tonu I stuku otwarcia, a morfologia zastawki dwudzielnej u chorych z wada mitralna.

The purpose of this study was to investigate the correlation between mitral valve morphology and amplitude of the first heart sound and the opening snap. The material consisted of 21 women and 19 men with mitral valve disease. They ranged in age from 24 to 56 years. 36 patients had pure or dominant mitral stenosis and 4 patients had combined mitral valve disease with dominant regurgitation. Phonocardiograms were recorded in all patients before mitral valve replacement. We analyzed the presence and the amplitude of opening snap and the amplitude of the first heart sound at the apex. The amplitude of the opening snap was expressed in mm and as a ratio to the maximal vibration of the second sound in the same cycle. The amplitude of the first sound was expressed in mm and as a ratio of the maximal vibration of the first sound to the maximal vibration of the first sound to the maximal vibration of the second sound in the same cycle. All amplitude measurements were made in 10 consecutive cardiac cycles and were then averaged. Then we studied all mitral valves removed in a uniform manner by one surgeon. Excised valves were fixed in 5% solution of formaline. The extent of calcification was determined by radiographs (fig. 1). The mitral valve area and calcification area were estimated by planimetry of radiographs. Then we analyzed the localization of calcification and we calculated the ratio of calcification area to valve area. Valves were divided into three groups according to the degree of the fusion of subvalvular structures ("a funnel") (fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)

[Elevation of the diaphragma after cardiac surgery]. / Uniesienie przepony po operacjach kardiochirurgicznych.

Phrenic nerve injury and diaphragmatic dysfunction can be induced by cardiac operation. We evaluated nonconsecutive 34 patients (pts) with elevation of the diaphragma after cardiac operation. 27 pts have coronary artery bypass grafting, 7 pts have prosthetic valve implantation. We have impression that ice/saline slush used along with cold cardioplegia for heart arrest can cause hypothermic damage of phrenic nerve. Palsy of that nerve results in raised hemidiaphragm and delayed recovery of the pts. In our pts normalisation of the diaphragm we observed 6 months after operation in 41% pts and 12 month after in 93% pts. We suggest that results depends on early and well rehabilitation.

[Anti-C. pneumoniae IgG, IgA and IgM antibodies in patients undergoing coronary artery bypass grafting]. / Przeciwciala IgG, IgA i IgM przeciwko C. pneumoniae u chorych kwalifikowanych do operacyjnego leczenia z powodu choroby wiencowej serca.

The aim of the study was to analyse the prevalence of anti-C. pneumoniae specific IgG, IgA and IgM antibodies in patients undergoing coronary artery bypass engraftment. Sera of forty-six patients aged from 40 to 74 years (mean 57.3) were examined just before the time of operation. Serum samples taken from 21 young healthy blood donors aged from 19 to 28 years (mean 22.4) and 23 sera taken from older blood donors aged 44-60 years (mean 54.7), were used as controls. Specific IgG, IgA and IgM serum antibodies were tested by the enzyme immunoassay kits (Lab-systems, Helsinki). The prevalence of anti-C. pneumoniae IgG was determined within the studied groups, to be independent of their age. On the contrary, the level and seropositivity rate of specific IgA (63.0%), as well as a co-existence of IgA and IgG (60.9%) were significantly higher in coronary patients when compared to healthy blood donors. The presence of specific IgM (positive or borderline values) were detected in 23.9% of patients, whereas they were rarer found in healthy population. In the majority of coronary patients immunological markers of C. pneumoniae infection were found.

[Results of coronary artery bypass grafting in patients with impaired left ventricular systolic function]. / Wyniki chirurgicznego leczenia choroby wiencowej u chorych z uposledzona funkcja skurczowa lewej komory.

The purpose of this study was to examine the early and late results of CABG in patients with left ventricular ejection fraction (LVEF) lower than 40%. This study comprised 128 patients (114 male and 14 female) at age from 41 to 75 years (mean 58.3 +/- 7.9). Before operation 115 patients (89.8%) were in CCS class III or IV. Before operation in all patients coronary arteriography with left-sided ventriculography were performed. In 12 patients myocardial perfusion in SPECT with Tc-99m-MIBI was assessed. Perioperative mortality in whole group was 12.5% (16 patients). The lowest (9.2%) was in subgroup with LVEF from 0.31 to 0.4 and the highest (27.3%) in patients with LVEF below 0.2. In 8 patients death was caused by low cardiac output, in 4 by ventricular fibrillation, in the others by renal failure or cerebral stroke (2 patients in each). In 45 patients (35.2%) postoperative low cardiac output was observed. In 41 patients was treated with the use of intraaortic balloon pumping (IABP). Twenty seven (65.9%) patients with IABP survived. During follow-up died 5 pts. 24-months probability of survival calculated from Kaplan-Meier method was 82.4%. In follow-up 80.9% of patients were in CCS class I and II. In SPECT, four months after CABG significantly more segments of left ventricle with normal perfusion (45% vs 53%; p < 0.05) were observed. Patients with LVEF < 40% are at higher operative risk because of often postoperative low output syndrome. Low output syndrome can by successfully treated with IABP. CABG significantly improves circulatory sufficiency in patients with LVEF < 40%.

[Prognostic significance of DNA analysis in neoplastic cells of patients with squamous cell lung neoplasms treated surgically]. / Prognostyczne znaczenie zawartosci DNA w komórkach nowotworowych u chorych na raka plaskonablonkowego pluca leczonych chirurgicznie.

The aim of our study was the assessment of the ploidia and its influence on the remission time and the survival of surgically treated patients with squamous cell lung cancer. The results were then related to the clinical staging, grading, size and localization of the tumor. The tissue samples (n = 60) of squamous cell lung carcinoma resected between 1995-1996 at the Department of Thoracic Surgery at University of Medical Sciences in Poznan were prepared using modified Hedley's method. The measurement was done in Cytoron Absolute flow cytometer. The abnormal DNA (aneuploid) was found in 40% of tumors. In two-year observation period more patients died with aneuploid tumors (54.6% deaths) than with diploid tumors (35.2% deaths). No significant correlation was found between the ploidy and frequency of metastasis to regional lymph nodes, tumor size, localization and grading. The estimation of the DNA content in the cancer cells seems to be a significant and valuable prognostic factor. The measurement of the DNA content can be useful in patients to estimate risk of recurrence after surgery.