[Organ injuries due to thoracic trauma : Diagnostics, clinical importance and treatment principles]. / Organverletzungen im Rahmen des Thoraxtraumas : Diagnostik, klinischer Stellenwert und therapeutische Prinzipien.

Thoracic trauma can be a life-threatening condition due to the involvement of vital organs, such as the heart, lungs, tracheobronchial tree and the great vessels. A coordinated interdisciplinary management is vital for the survival of the injured person. Modern diagnostic procedures provide an essential basis for the surgical treatment of patients. Surgical treatment principles include insertion of chest drainage, emergency thoracotomy, complex bronchoplastic and vascular reconstructive techniques and cardiac surgical maneuvers. For this reason highly complex surgical procedures are available, which can be effectively and specifically integrated into an interdisciplinary concept. In this review, the most frequent and prognostically relevant conditions, the indicated diagnostics and their significance as well as the surgical treatment principles, are comprehensively presented under consideration of the clinical situation.

[Surgery of colorectal lung metastases : Results of a survey in Germany]. / Chirurgie pulmonaler Metastasen des kolorektalen Karzinoms : Ergebnisse einer Umfrage in Deutschland.

BACKGROUND: There is no evidence from randomized trials on the prognostic significance of pulmonary metastasectomy of colorectal cancer. The objective of this study was to assess the current criteria for indications, preoperative diagnostics and preferred operative techniques of pulmonary metastasectomy in Germany. METHODS: An anonymous survey was carried out in 239 German centers performing thoracic surgery in October 2015. RESULTS: Chest computed tomography (CT, 98%), liver CT (62%), pelvis CT (39%) and fluorodeoxyglucose positron emission tomography (FDG-PET, 37%) were used by the respondents (65% of participants) for preoperative staging. Pulmonary metastasectomy was most commonly performed for solitary lung metastasis without extrathoracic disease (96%), >1 ipsilateral lung metastases without extrathoracic disease (94.8%), solitary lung metastasis with resectable hepatic metastases (92%) and resectable bilateral lung metastases without extrathoracic disease (91%). Of the respondents 95% performed open lung metastasectomy, 82% video-assisted thoracic surgery, 18% radiofrequency ablation, 53% used laser-assisted open resection and 46% indicated that there was no scientific consensus on pulmonary metastasectomy. CONCLUSION: The majority of respondents performed pulmonary metastasectomy for solitary and multiple, unilateral and bilateral lung metastases without extrathoracic disease and/or local recurrence of primary tumors. The coexistence of resectable liver metastases was not an absolute contraindication for surgery. Of the respondents 46% expressed the need for prospective randomized studies to improve the evidence on pulmonary metastasectomy for colorectal cancer.

[Neoadjuvant Radiochemotherapy Followed by Curative Resection in Patients with Advanced Non-Small Cell Lung Cancer in Stage IIIA/IIIB: Prognostic Factors and Results]. / Neoadjuvante Radiochemotherapie gefolgt von kurativer Resektion im fortgeschrittenen Stadium IIIA/IIIB eines nicht kleinzelligen Lungenkarzinoms: prognostische Faktoren und Ergebnisse.

The role of surgical lung resection following neo-adjuvant radio-chemotherapy (RCT) in patients with locally advanced non-small cell lung cancer (NSCLC) is yet not clearly defined. The aim of our study was to analyze the postoperative survival and to identify relevant prognostic factors. 46 patients underwent curative resections after neo-adjuvant RCT for locally advanced NSCLC (IIIA/IIIB) between February 2008 and February 2015. A retrospective data analysis regarding preoperative regression status, perioperative mortality, postoperative survival, patho-histological remission, relapse pattern and other prognostic factors was performed. A neo-adjuvant RCT with a median radiation dose of 50.4 [range, 45-60] Gy was performed in 44 (96 %) patients. Partial and/or complete regression was observed in 32 (70 %) patients. R0-resection was achieved in 44 (96 %) patients. The 30-day mortality was 4 % and the perioperative morbidity was 37 %. The overall and progression free 5-year survival rate was 47 % and respectively 45 % [in median 58 months]. The 5-year survival rate of 64 % in the "responder"-group was significantly better when compared with 24 % in the "non-responder"-group (p = 0.038). The tri-modality therapy improved the prognosis in patients with locally advanced NSCLC (stage IIIA/IIIB). The complete patho-histological remission is an important prognostic factor for better long term survival. Dividing the patients in "responder" and "non-responder" after neo-adjuvant RCT may have large therapeutically consequences in the future.

Chlorhexidine--still an underestimated allergic hazard for health care professionals.

Chlorhexidine is a low molecular weight occupational sensitizer that can cause different delayed and immediate-type allergic reactions including anaphylaxis. It is widely used as an antiseptic and disinfectant and not only in the occupational environment as it is present in toothpaste, mouthwash, nose and eye drops and ointments. We present three cases of occupationally exposed workers with airway allergy to chlorhexidine. The role of chlorhexidine as an occupational allergen was confirmed by placebo-controlled specific inhalative challenge tests monitored by spirometry and analysis of induced sputum (influx of eosinophils after provocation has been observed). One of these patients presented with a systemic reaction with ordinary environment exposure. These findings are a reminder to clinicians of chlorhexidine's ability to cause various hypersensitivity reactions and the potential risk of this widely used antiseptic.

Occupational asthma due to spruce wood.

Workers exposed to a variety of wood dusts are known to experience work-related respiratory symptoms, including occupational asthma. There are, however, few reports of occupational asthma due to spruce wood. We present the case of a 31-year-old sawmill owner with severe asthma caused by exposure to spruce wood dust, who developed asthmatic symptoms after 2 years of working. Investigations included clinical examination, routine laboratory tests, spirometry, chest X-ray, total serum immunoglobulin E (IgE) and specific serum IgEs against various woods and other occupational allergens. Additionally, we monitored the peak expiratory flow rate (PEFR) and symptom score both at work and when off work. Specific serum IgE for spruce wood was detected (7.8 IU/ml). The results of PEFR and workplace symptom-score monitoring, coupled with an elevated eosinophil count in induced sputum, supported the diagnosis of occupational asthma. To our knowledge, this is the first well-documented case of occupational asthma induced by spruce wood dust. A type I immunological mechanism seems to be responsible.

Human adipose tissue stromal vascular fraction cells differentiate depending on distinct types of media.

OBJECTIVES: Angiogenesis, the process of formation of blood vessels, is essential for many physiological as well as pathological processes. It has been shown that human adipose tissue contains a population of non-characterized cells, called stromal-vascular fraction (SVF) cells, which are able to differentiate into several lineages. The aim of this study was to determine conditions for promoting differentiation of human adipose tissue progenitors towards endothelial cells, as well as to show that SVF cells cooperate with differentiated endothelium in capillary network formation. MATERIALS AND METHODS: Stromal vascular fraction cells were isolated according to modified Hauner's method and after adaptation they were cultured in pro-angiogenic or pro-adipogenic medium. Cells were characterized by presence of surface antigens by flow cytometry, and by expression of genes characteristic for endothelial cells or for adipocytes, quantitative real-time polymerase chain reaction. A number of tests were performed to verify their differentiation. RESULTS: Differentiation of human SVF cells towards endothelium was stimulated by the presence of serum and absence of adipogenic factors, documented by the pattern of gene expression as well as different functional in vitro assays. SVF cells were found to work together with human umbilical vein endothelial cells to form capillary networks. CONCLUSIONS: Here, we show that differentiation of SVF cells to endothelial cells or adipocyte-like cells depended on the medium used. Our work provides a clear model for analysing the differentiation capacity of SVF cells.

Allergy to animal fur and feathers among zoo workers.

OBJECTIVES: This study determined the prevalence of respiratory symptoms and immediate hypersensitivity to feather and fur allergens and pulmonary function among zoological garden workers. METHODS: Skin-prick test (SPT) reactivity to common and epithelium (hair) animal fur and feather allergens were examined in 68 zoological garden workers. All subjects responded to a questionnaire and underwent spirometry. Total and antigen-specific IgE were estimated among subjects claiming respiratory symptoms. RESULTS: Forty-five subjects revealed positive SPTs with any inhalant allergen. Twelve reacted to feather extracts and 18 reacted to animal fur extracts. IgE specific for occupational allergens was seen in the serum of five subjects with SPTs positive to feather allergens and in the serum of 12 subjects with SPTs positive to fur allergens. Nose or eye symptoms were reported most frequently. Rhinitis and asthma were reported by atopic subjects more often than by non-atopic subjects. Occupational asthma due to feathers was diagnosed in 2% of zoo workers, and to fur in 10% of subjects working in contact with birds and furred animals. DISCUSSION: The results suggest that occupational asthma caused by feathers is very rare in contrast to asthma caused by animal fur. Atopy predisposes to the development of allergic diseases caused by animal fur and feathers.

[Beryllium--underestimated occupational health hazard in Poland]. / Beryl--niedocenione zagrozenie zdrowia pracujacych w Polsce.

Beryllium is a metal used in different branches of industry. Inhalation is the most common way of exposure. Beryllium shows a high affinity to the lung tissue. It may act as toxic, carcinogenic and immunological agent. Chronic beryllium disease (CDB) is very difficult to diagnose because of its similarity to sarcoidosis. The lymphocyte proliferation assay is a very helpful test in CBD diagnosis. It seems reasonable to include this test into the body of the standard diagnostic procedures in workers exposed to beryllium. Early detection of hypersensitivity to beryllium, before CBD symptoms occur will allow to minimize adverse health effects.