[Monstrous Solitary Fibrous Tumor of the Pleura - A Case Report and Review of the Literature]. / Monströser solitärer fibröser Tumor der Pleura.

Localized solitary fibrous tumors are a rare entity and are mostly found in the thorax, but can also occur in the liver, skin, meninges, peritoneum, and pericardium. Making the diagnosis is often difficult because of the various micromorphologic outlooks. The histopathological assessment with differentiated immunohistochemistry is decisive. Surgical resection of the localized solitary fibrous tumors is the therapy of choice. The recurrence and metastasis rates depend on the histological dignity and are in total very low. Therefore, continuous follow-up examinations are indicated. We report on a 76-year-old female patient with a monstrous solitary fibrous tumor of the pleura who complained of exertional dyspnea and sharp pain in the right thoracic region for several weeks. Computed tomography showed a massive, heterogeneous pulmonary mass 22 cm in diameter in the middle and lower field of the right lung with compression of the diaphragm and mediastinum. The tumor was completely resected through a double thoracotomy in the 5th and 8th ICR. Intraoperatively, the tumor was stalked to the middle lobe. In order to completely remove the tumor, a wedge resection was also performed from the middle lobe. The tumor weighed 2.4 kg. The diagnosis of a solitary fibrous tumor of the pleura was made histologically and immunohistochemically. Postoperatively, the lung has fully expanded. There was no evidence of a relapse at the 3-month follow-up examination. The clinical symptoms, diagnosis, treatment options, risk of recurrence and the prognosis of these tumors are shown and discussed in accordance with the literature.

[Health-Related Quality of Life in Patients with Non-Small Cell Lung Cancer before and after Surgery - a Comparison between Thoracotomy and Video-Assisted Thoracoscopic Surgery]. / Untersuchungen zum Verlauf der Lebensqualität vor und bis 2 Jahre nach anatomischer Resektion bei Patienten mit Lungenkarzinom ­ ein Vergleich zwischen anterolateraler Thorakotomie und videoassistierter Thorakoskopie.

BACKGROUND: Earlier studies have proven that in patients with non-small cell lung cancer video-assisted thoracoscopic surgery is functionally superior to thoracotomy in terms of perioperative and postoperative complications. The objective of this work was to determine whether there is a difference in health-related quality of life (HRQoL) of patients with non-small cell lung cancer - compared to the German normal population - before and after surgery. Moreover, HRQoL after thoracotomy was compared to HRQoL after video-assisted thoracoscopic surgery (VATS). MATERIAL AND METHODS: Based on retrospective data generated during a 7-year period (2010 - 2017), 327 patients with non-small cell lung cancer who underwent therapy were examined. Patients either underwent thoracotomy or video-assisted thoracoscopic surgery. 456 of short form 12 questionnaires were analysed. Via norm-based scoring, and physical and mental component summaries (PCS and MCS) were calculated before and 6, 12, and 24 months after treatment. Using t tests, potential differences in physical and mental component summaries were evaluated between patients and the German normal population as well as between patients after thoractomy and after VATS. RESULTS: Up to 24 months after surgery, the physical dimension of HRQoL is significantly reduced, while the mental component summary does not significantly differ from the German population. Moreover, thoracotomy and VATS gave equivalent values for health-related quality of life. CONCLUSION: With respect to health-related quality of life, thoracotomy and video-assisted thorascopic surgery are equivalent in the long term. But there was a trend to improvement with both summary scores that might indicate superiority of video-assisted thoracoscopic surgery.

[Pain Treatment After Thoracic Surgery]. / Schmerztherapie nach thoraxchirurgischen Eingriffen.

The treatment of pain after thoracic surgery is a challenge and takes place in the individual clinics mostly according to clinic internal standards. It exists no currently valid S3 guideline for the treatment of acute perioperative and posttraumatic pain. For an effective pain treatment as well individual pain experience as the pain intensity of the various thoracic surgical procedures must be considered. Regular pain assessment with appropriate methods and their documentation form the basis for adequate and adapted pain therapy.There are a number of different pain therapy methods, non-medicamentous and drug-based methods, whose effectiveness is described in the literature partially different. For the treatment of acute postoperative pain after thoracic surgery, mainly drug-related procedures are used, except for physiotherapy as a non-medicamentous method. Increasingly, alternative procedures for the peridural catheter as a therapeutic gold standard in the treatment of pain after thoracic surgery are used. Their application can be integrated into a therapeutic algorithm.