Prognostic factors in survival of patients with cerebral metastases.

e12505 Background: The problem of cerebral metastases is a great one and seems to become more and more important thanks to earlier diagnosis and the possibilities of effective treatment. In this analysis 330 patients with cerebral metastases, treated at the Clinic of Oncology, School of Medicine, Zagreb, Croatia, over 13 years, from 1995 - 2007 are dealt with. The most common primary tumor was bronchus carcinoma in 201/330 patients (60.91%), then breast carcinoma in 48/330 patients (14.54%), melanoma in 16/330 patients (4.85%), gastrointestinal tumors in 17/330 patients (5.15%), hypernephroma in 9/330 patients (2.73%), ovarian carcinoma in 10/330 patients (3.03%), cervical small cell carcinoma in 4/330 patients (1.21%), testicular tumors in 5/330 patients (1.52%) and in 20/330 patients (6.06%) the primary was not found. Methods: The patients were treated by surgery, radiotherapy and chemotherapy in various combinations. Results: There is a significantly better survival in female patients with cerebral metastases from breast carcinoma in comparison to other primary tumors (p<0.001). The patients with longer symptom-free period up to the diagnosis of the secondaries in the brain had significantly better survival (p<0.001). Better survival was achieved in younger patients (p<0.05). Conclusions: Considering the applied therapy methods, the best survival results were obtained in patients treated by a combination of surgery, radiotherapy and chemotherapy.

Pneumonectomy due to bronchus carcinoma after pleural empyema

Pneumonectomy is a lung resection that is associated with significantly higher operative mortality and morbidity than lobectomy. Beside classical causes of operative morbidity, such as respiratory and cardiovascular, the most important cause of postoperative complications is bronchopleural fistula. This complication occurs in 5 to 10 percents of patients with pneumonectomy, in some series up to 15 percents before introducing mechanical bronchial suture. The risk of the occurrence of this complication is increased in patients undergoing pneumonectomy after previous infection in the pleural space. Not so frequently, surgeons are faced with the necessity of performing pneumonectomy after pleural empyema as the first manifestation of the bronchus carcinoma. Over the last 5 years, in the the Institute of Lung Diseases, 4 patients underwent pneumonectomy after pleural empyema. The preoperative assessment, operative procedure and postoperative problems are the subject of this paper. Unlike the last three patients, in the first patient, pleural empyema was not recognized preoperatively. Based on the outcome of the treatment of the presented patients, we can conclude that pleural empyema, as the first manifestation of the bronchus carcinoma does not necessarily exclude surgical treatment. Such a statement is based on the fact that, even in these patients, it is possible to achieve postoperative course without significant morbidity and with a possibility to perform various forms of adjuvant therapy.

Inhalationsszintigraphie der Lunge mit dem neuen ultrafeinen Aerosol »Technegas«

Evaporation of 99mTc-pertechnetate at about 2500° C on a carbon surface generates an ultrafine aerosol of labelled carbon clusters. Its particle size of about 2-5 nm enables the aerosol to behave similarly to a gas regarding the ability of penetration. After inhalation, the radioactive particles adhere to the walls of the respiratory bronchioli and alveoli. The high concentration of the radioactivity in the argon carrier gas makes it possible to record a scintigram after a single deep breath. We studied four healthy volunteers and 79 patients including 34 with a tentative diagnosis of pulmonary embolism, 20 with bronchus carcinoma, and 15 with various other lung diseases. Ten of these patients were infants, the youngest being nine months old. All patients also had a perfusion scintigraphy.