BipoJet Scissors as an Alternative to Laser in Lung Wedge Resection.

INTRODUCTION: An important goal in every lung resection is airtight closure of the resected lung surface. This can be achieved with several techniques, including clamp resection, stapler, laser, and various high-frequency methods. By quantitatively measuring the air fistula across the resection surface of porcine lungs, two resection techniques were compared in our study: BipoJet dissecting scissors (Aesculap, Inc., Tuttlingen, Germany) and laser (Ceralas HPD®, Biolitec Inc., Jena, Germany). METHODS: Following a stencil, wedge resections were performed in porcine lungs using water-irrigated bipolar scissors and laser (1350 nm, 40 watts, non-contact mode). The volume of the air fistula was then measured. The irrigation technique involved the attachment of an irrigation channel to a pair of standard surgical scissors. A sodium chloride (NaCl) solution was fed at a defined flow rate, along the blades of the scissors onto the parenchyma. This technique was used on a total of 10 specimens each. RESULTS: Somewhat better pneumostasis was achieved with laser resection, though the difference was small and not statistically significant. The flow rate was 124 mL/min/cm² after laser resection and 145 mL/min/cm² after using the BipoJet scissors. The difference was not statistically significant. Water irrigation during resection with the BipoJet scissors prevents the temperature in the tissue from exceeding 100°C thus avoiding tissue carbonization. These scissors offer the following advantages: ease of use, no need to change instruments, no need for staff training, no protective measures, all-in-one incision/coagulation/dissection, low cost, and a clear surgical field due to the irrigation effect. CONCLUSIONS: Resection of lung parenchyma, e.g., during resection of metastases, is easier with BipoJet scissors and comparable to laser resection. This was established both experimentally and by resecting lung metastases.

Positron emission tomography - Computed tomography for staging of mediastinal lymph nodes in patients with non-small cell lung cancer.

Background: The tumor involvement of lymph nodes (LN) in N2 station is a very important factor for the further therapy decision and the prognosis of lung cancer patients. Today, integrated positron emission tomography-computed tomography (PET-CT) is considered to be the new standard in the staging of bronchial carcinoma. The aim of this study is to investigate the correctness of the clinical staging of the mediastinal LNs in operated patients and to investigate the sensitivity and specificity of the PET-CT examination for mediastinal LNs. Subjects and Methods: In the years 2010-2014, 359 patients underwent surgery for bronchial carcinoma. The histological examination of all mediastinal and hilar LNs was used as a reference to the data from the PET-CT examinations. The correctness of the PET staging, overestimation, and underestimation for the N stage was analyzed. In addition, the "sensitivity," "specificity," and "overall accuracy" of the PET-CT examination with regard to the N2 LNs were calculated. Results: It was found that in 8.9% the staging of the mediastinal N2/N3 LN stations was rated too high by the PET and in 11.2% too low. The study showed a sensitivity of 47.37%, a specificity of 90.07%, and an accuracy of 81.01% for the mediastinal LNs. Conclusion: Our study confirms the limited ability of integrated PET-CT in staging the mediastinal LNs. We, therefore, recommend a histological examination of the LNs in patients with PET-positive N2 LNs to avoid false-positive results and to initiate correct therapy.

Résumé Contexte: L'implication tumorale des ganglions lymphatiques (LN) au stade N2 est un facteur très important pour la décision thérapeutique ultérieure et le pronostic des patients atteints de cancer du poumon. Aujourd'hui, la tomographie par émission de positons intégrée (TEP-CT) est considérée comme être la nouvelle norme dans la stadification du carcinome bronchique. Le but de cette étude est d'étudier l'exactitude de la stadification clinique des ganglions lymphatiques médiastinaux chez les patients opérés et d'étudier la sensibilité et la spécificité de l'examen TEP-TDM pour les ganglions lymphatiques médiastinaux. Sujets et méthodes: Dans les années 2010 à 2014, 359 patients ont été opérés d'un carcinome bronchique. L'examen histologique de tous les LN médiastinaux et hilaires a servi de référence aux données des examens PET-CT. La justesse de la mise en scène PET, la surestimation et la sous-estimation pour le stade N ont été analysées. De plus, la " sensibilité ", la " spécificité " et la " précision globale " de l'examen PET-CT en ce qui concerne les N2 LNs ont été calculés. Résultats: Il a été constaté que dans 8,9 % des cas, la mise en scène du médiastin N2/ Les stages N3 LN ont été jugées trop élevées par le PET et dans 11,2 % trop faibles. L'étude a montré une sensibilité de 47,37%, une spécificité de 90,07%, et une précision de 81,01 % pour les LN médiastinaux. Conclusion: Notre étude confirme la capacité limitée de la TEP-TDM intégrée dans la stadification les LN médiastinaux. Nous recommandons donc un examen histologique des ganglions lymphatiques chez les patients avec des ganglions lymphatiques N2 positifs à la TEP pour éviter résultats faussement positifs et d'initier un traitement correct Mots-clés: Cancer du poumon, tomographie par émission de positrons/tomodensitométrie, stadification.

[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.

Nurses' knowledge of care of chest drain: A survey in a Nigerian semiurban university hospital.

BACKGROUND/OBJECTIVE: Inefficient nursing care of chest drains may associated with unacceptable and sometimes life-threatening complications. This report aims to ascertain the level of knowledge of care of chest drains among nurses working in wards in a teaching hospital in Nigeria. METHODS: A cross-sectional study among nurses at teaching hospital using pretested self-administered questionnaires. RESULTS: The majority were respondents aged between 31 and 40 years (45.4%) and those who have nursing experience between 6 and 10 years. Only 37 respondents (26.2%) had a good knowledge of nursing care of chest drains. Knowledge was relatively higher among nurses who cared for chest drains daily, nurses who have a work experience of <10 years, low-rank nurses and those working in the female medical ward; however, the relationship were not statistically significant (P > 0.05). Performance was poor on the questions on position of drainage system were not statistically significant with relationship to waist level while mobilizing the patient, application of suction to chest drains, daily changing of dressing over chest drain insertion site, milking of tubes and drainage system with dependent loop. CONCLUSION: The knowledge of care of chest drains among nurses is poor, especially in the key post procedural care. There is an urgent need to train them so as to improve the nursing care of patients managed with chest drains.

Postcoital haemoptysis: a case report and a review of the literature.

Haemoptysis is rarely reported following coitus, and cardiac decompensation has been mostly implicated in the aetiology. We present a 53-year-old Nigerian, known hypertensive diabetic woman with background ischaemic heart disease who presented with postcoital haemoptysis of one-year duration. Echocardiography revealed combined ischaemic and mitral valvular heart disease, probably of rheumatic aetiology. There has been no previous report in an African population. This case illustrates the need to rule out coitus as a rare but potential cause of haemoptysis in middle aged patients with underlying cardiac pathologies and the need for an extensive cardiac workup in a population with predominantly pulmonary causes of haemoptysis.

Late presentation of giant intrathoracic neurofibroma with significant mediastinal shift: a case report and review of the literature.

Intrathoracic tumours in patients with Von Recklinghausen's disease have been widely reported, but there are very few cases of reported intrathoracic giant benign neurofibroma with marked mediastinal shift and superior vena cava syndrome. Patients that present with this pathology should be adequately investigated. Surgical resection has been considered curative.

Size of tumour as a risk factor for malignancy in patients with peripheral pulmonary nodules.

UNLABELLED: Peripheral pulmonary tumours are often quite difficult to diagnose and treat. Their detection brings immediately the problem of whether clinicians should just wait and observe or operate the patients. The aim of this study was to determine if there is a direct correlation between tumour size and the risk for malignancy and whether the tumor size should be considered a risk factor for malignancy. PATIENTS AND METHODS: Between 1997 and 2009, 145 patients with peripheral pulmonary tumours of less than 3 cm in diameter underwent video-assisted thoracoscopic (VATS) resection for the purpose of histologic examination of the tumor. RESULTS: The mean age of the patients was 62.60 +/- 0.95 years. The youngest patient was 17 years old and the oldest--82. The study sample included 61 women and 84 men; the men were statistically significantly more than the women (57.3% and 42.07%, respectively) (t = 2.74, P < 0.01). The total number of patients we operated were 145 with 198 resected tumours. The diameter of the lesions ranged between 0.30 cm and 3 cm (mean 1.41 +/- 0.06 cm). We found that 108 (54.55%) of the tumours were malignant, and 90 (45.45%) were benign, the difference between them failing to reach statistical significance (t = 1.82, P > 0.05). The mean size of malignant lesions was statistically significantly greater than that of benign tumours (1.62 +/- 0.08 cm vs 1.15 +/- 0.06 cm). CONCLUSION: The results of this study suggest that the bigger the diameter of the nodule, the greater the percentage share of malignant tumours, which means that the size of the tumour is an important risk factor for malignancy.

Cerebral infarct complicating traumatic pneumatocele: a rare sequela following blunt chest trauma.

Systemic air embolism is known to rarely complicate blunt chest trauma. However, cerebral infarction caused by air emboli possibly originating from a traumatic pneumatocele has not been previously reported. We report a case of a 46-year-old woman who sustained blunt chest trauma with multiple rib and clavicular fractures, hemothorax and a huge, tense traumatic pneumatocele. She subsequently developed clinical and radiologic features of cerebral infarction. The cerebral infarct is likely to be secondary to cerebral air embolism originating from a traumatic pneumatocele.

Our experience in the diagnostics and therapy of patients with solitary peripheral lung tumours.

UNLABELLED: Patients presenting with a solitary pulmonary nodule are often a serious diagnostic-therapeutic problem. The AIM of the present report is to share our experience with VATS in the diagnostics and therapy of patients with solitary pulmonary nodules. PATIENTS AND METHODS: Between 2005 and 2009 we performed primary videothoracoscopic tumor resection in 125 patients with peripheral lung tumours. RESULTS: In 93 (74.4%) of the cases complete successful thoracoscopic resection of the tumor and subsequent intraoperative frozen section histology was accomplished. In the remaining 32 cases (25.6%) various reasons demanded conversion to thoracotomie with wedge resection of the nodule. 54.2% of the removed tumours were malignant and 45.8% - benign. In 18 of the patients the intraoperative frozen section histology diagnosis was primary bronchial carcinoma which required to do oncologic resection of the tumor. In 10 patients the intraoperative frozen section histology was unable to differentiate between pulmonary metastasis and primary bronchial carcinoma, and the oncologic resection was performed in another surgical session after the definitive pathomorphologic diagnosis had been available. In 28 of the cases pulmonary metastases of a primary extrapulmonary tumor were removed. CONCLUSIONS: Despite improvement in the diagnostic techniques, only the video-thoracoscopic removal of the lung nodule and its subsequent histological examination enables the definitive diagnosis, solving definitively the problem with benign lesions and indicating appropriate treatment of the malignant pulmonary lesions.

Thoracoscopic resection of solitary pulmonary nodules in patients with previous malignant tumors.

UNLABELLED: Round opacities in the lungs found in the course of a neoplastic disorder or during the initial tumor staging are most often regarded as metastases without histological studies to prove their nature. These presumed metastases are, however, very often diagnosed later as benign lesions or primary malignant pulmonary tumors. AIM: To investigate the histological substrate of solitary pulmonary nodules in patients with a history of neoplastic condition and study the role of video-assisted thoracoscopy in their diagnosing and treatment. METHOD: The study included 22 patients with solitary pulmonary nodules and history of previous malignant tumors who underwent video-assisted thoracoscopic surgery at the Clinic of Vascular and Thoracic Surgery, University Hospital Aschersleben, Germany between 01.01.2006 and 31.12.2009. Pulmonary wedge resection was performed and it was followed by histological verification. RESULTS: A diagnosis of pulmonary metastasis was confirmed in only 8 of the patients (36.4%). In another 8 of them (36.4%) the solitary pulmonary nodule proved to be a primary lung cancer, i.e. a second malignant tumor. The bronchial carcinoma was synchronous with the primary tumor in four of these patients, and metachronous in the rest. In the other 6 patients (27.2%) the lesions proved to be benign. CONCLUSIONS: Not all solitary pulmonary nodules in patients with preceding malignant formations are metastases. In order to define their nature more precisely they should be resected by video-assisted thoracoscopy, if possible. In benign lesions video-assisted thoracoscopic resection is the definitive medical procedure too.