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The treatment of patients with isolated adrenal metastases remains controversial. Metastases from NSCLC suggest that these patients could have improved survival. The role of N2 status as independent predictor of poor survival is still unclear and under discussion. The aim of this study was to evaluate the role of mediastinal nodal status in patients with isolated adrenal metastases form Non Small Cell Lung Cancer (NSCLC) treated with surgery. A total of eight patients with NSCLC and isolated adrenal lesions were operated on for a period of ten years. They were divided into two groups depending on the morphology of the adrenal lesion. Group I includes 4 patients with adrenal metastases which underwent lobectomy and Retroperitoneal Endoscopic Adrenalectomy (REA). The loco regional stage was pI in 3 patients and pIIA in one. The mean size of the metastases was 24.5 mm, without capsular invasion and all of them were metachronous. The other four patients were proven to be with adenomas of the adrenal gland. All of the patients underwent lobectomy with locoregional stage pIIIA (3) and pIIA. One stage operation was performed in two cases – left lower lobectomy and adrenalectomy via frenotomy. REA was performed in two of the patients. No major postoperative complications were observed. The median survival is 34.75 months in Group I and 18.6 months in Group II. Two of the patients from Group I are still alive at the end of the study – 57 and 34 months after the initial surgery. The mediastinal nodal status is significant and independent prognostic factor for survival in surgical patients with NSCLC and isolated adrenal metastasis.

Various surgical approaches for pericardial fenestration are described in the medical literature and are used in practice. Each of them has its advantages and disadvantages depending on the cause suggesting the need of pericardial fenestration. The purpose of this study is to demonstrate whether the substernal approach after resection of the xiphoid process is a safe and effective approach to the surgical treatment of pericardial tamponade. From 2000 to 2017 in the Clinic of Thoracic Surgery at the University Hospital “Prof. Dr. St. Kirkovich” – Trakia University, Stara Zagora, Bulgaria, and in the Clinic of Thoracic Surgery at the University Hospital for Active Treatment of Pulmonary Diseases “St. Sophia”, Faculty of Medicine, Medical University – Sofia, Bulgaria, a total of seventy-one patients were diagnosed with pericardial effusion, respectively pericardial tamponade, and due to this underwent surgery. In thirty-two of them, the pericardial effusion was accompanied by a malignant pleural effusion (MPE). The VATS – Fenestratio pericardii procedure was performed on 29 patients while substernal pericardial fenestration was performed on the remaining 42 patients. Operative and perioperative mortality was not reported. Operative complications such as bleeding, damage to the coronary artery or myocardium did not occur. The average operating time was 38 min and the average length of hospital stay was 5 days. After resection and removal of the xiphoid process, the surgeon has sufficient and comfortable working space. The substernal approach after resection of the xiphoid process is a safe and effective approach to the surgical treatment of pericardial tamponade.

Surgical interventions for corrosive stricture of the esophagus are extremely difficult and technically challenging. In this manuscript, we present a patient with esophagectomy due to perforation of a corrosive stricture of the esophagus that underwent malignant transformation and subsequent perforation of a giant duodenal stress ulcus, which occurred 12 days after the intervention. We performed a total esophagectomy, pharyngo- and gastrostomy, suture of the duodenal perforation but the postoperative period was challenging and despite our efforts, the patient died on the 50th postoperative day due to respiratory and renal failure.

Stent migration is a rare event with potentially serious complications including cardiac arrhythmias and heart failure. We report a case of migration of arterial stent placed in the right iliac vein into the right pulmonary artery; it was diagnosed there and subsequently not removed for at least 3 years. Despite reports in the literature for the removal of migrated stents by minimally invasive interventional methods, in our case, that was not possible because of the long period during which the foreign body was in the right pulmonary artery and the proximal partial occlusion of organized mural thrombus.

Background: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options developed over the last five decades it remains a major surgical challenge. Materials and methods: A literature search in MEDLINE database was carried out (accessed through PubMed), by using a combination of the following key-words and MeSH terms: pneumonectomy, postoperative, complications, broncho-pleural fistula, empyema, prevention. The following areas of intervention were identified: epidemiology, etiology, prevention. Results: Pleural empyema in a post-pneumonectomy cavity occurs in up to 16% of patients with a mortality of more than 10%. It is associated with broncho-pleural fistula in up to 80% of them, usually in the early postoperative months. Operative mortality could reach 50% in case of broncho-pleural fistula. Unfavourable prognostic factors are: benign disease, COPD, right-sided surgery, neoadjuvant and adjuvant therapy, time of chest tube removal, long bronchial stump and mechanical ventilation. Bronchial stump protection with vascularised flaps is of utmost importance in the prevention of complications. Conclusion: Postpneumonectomy pleural empyema is a common complication with high mortality. The existing evidence confirms the role of bronchopleural fistula prevention in the prevention of life-threatening complications.

The authors present a rare clinical case of a patient with Bardet-Biedl syndrome and chronic kidney disease, who reached end-stage renal disease (ESRD) and underwent a long-term hemodialysis treatment, during which infections with Hepatitis C Virus (HCV) infection and Cytomegalovirus (CMV) infection were established. Kidney transplantation from an alive unrelated donor was performed. Later, an adenocarcinoma of the esophagus was diagnosed at an early stage, treated surgically with resection of the esophagus and gastroesophagoplasty afterward. Seven months later, a rare complication of the immunosuppressive therapy with Cyclosporin A occurred, which consisted of spontaneous bilateral pleural hemorrhage. The same, as well as the postoperative ventral hernia, was successfully resolved. Concomitant HCV was also treated. Rare autosomal recessive syndrome with severe complications, adenocarcinoma of the esophagus, spontaneous bilateral pleural hemorrhage after the operation, and successful treatment were discussed.

Revision surgery following colon interposition is a challenging problem. We describe a case of successful surgery for neo-esophago-sternocutaneous fistula as a late complication following coloesophagoplasty for intractable benign stricture. The cutaneous part of the fistula was excised and the distal part of the sternum was resected. On the anterior wall of the colon graft, there was a large defect that communicated with the posterior wall of the osteomyelitis-transformed sternum with sinus track formation. After excising the edges of the neoesophagus defect, Roux-en-Y neo-esophagojejunostomy and gastrostomy were carried out.

Background: Isolated adrenal gland metastases are not frequently finding. The aim of the present retrospective study was to estimate clinical and pathological parameters that could be used to predict survival after adrenalectomy. Material and methods: A total of 34 patients with adrenal gland masses suspected to be metastases was included in this study. The group of patients with isolated metastases was19 (56%) and a group of patients with adrenal adenomas -15 (44%). Results: The sample of patients consisted of 18 (53%) men and 16 (47%) women from 40 to 81 years old with a mean (±SD) age of 61.6±10.3 years, presented with adrenal mass suspected to be metastases. Nineteen (56%) of them had demonstrated metastases and 16 (84%) metachronous with median overall survival (OS) 54.6 (range 43-66) months. Median OS in the group with metastases was 22.6 months. Lung carcinoma was the most common primary tumour metastasizing in the adrenal gland – 58% of all metastases with a disease-free interval (DFI) of 13 months. It was presented by shorter median survival than the rest primary tumour types (37.8 vs. 96.7months; log-rank test, p=0.028). In the multivariate Cox’s hazard analysis of the surgical technique was found to be an independent prognostic factor (p=0.047), together with lung carcinoma vs. renal cell carcinoma (p=0.045). Conclusion: Adrenalectomy due to isolated metastases in the adrenal glands showed the median overall survival of 22.6 months. Shorter survival periods were associated with lung carcinoma, DFI

Introduction: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Despite various therapeutic options developed during the last five decades it remains a major surgical challenge.Results: There is no widely accepted treatment for post-pneumonectomy pleural empyema (PPE) and the management depends mostly on the presence or absence of broncho-pleural fistula (BPF) and the patient’s general condition. In the absence of BPF, the role of surgery is still not clear because of its high morbidity and impossibility to prevent recurrences. In the earlier period, the definitive treatment consisted of open window thoracostomy followed by obliteration of the pleural cavity with antibiotic solution at the time of chest wall closure. Subsequently, the proposed different methods and modifications improved the outcome. There is an association between hospital volume and operative mortality after the lung resection. Hospital volume and the surgeon’s specialty have more influence on the outcome than the individual surgeon’s volume.Conclusions: Treatment management of PPE should be individualized. Definitive treatment options comprise aggressive surgery that is not possible in quite a high proportion of impaired patients. Hospital volume, surgeon’s volume and surgeon’s specialty may influence the prognosis.

Tuberculosis (TB) is still a major public health concern, mostly affecting resource-constrained settings and marginalized populations. The fight against the disease is hindered by the growing emergence of drug-resistant forms whose management can be rather challenging. Surgery may play an important role to support diagnosis and treatment of the most complex cases and improve their therapeutic outcome. We conducted a non-systematic review of the literature based on relevant keywords through PubMed database. Papers in English and Russian were included. The search was focused on five main areas of intervention as follows: (I) diagnosis of complicated cases; (II) elimination of contagious persisting cavities, despite appropriate chemotherapy; (III) treatment of destroyed lung; (V) resection of tuberculomas; (VI) treatment of tuberculous pleural empyema. Although specific practical guidelines concerning surgical indications and approaches are currently unavailable, a summary of the evidence emerged from the scientific literature was elaborated to help the clinician in the management of severely compromised TB patients. The decision to proceed to surgery is usually individualized and a careful assessment of the patient’s risk profile is always recommended before performing any procedure in addition to appropriate chemotherapy.

Background Ultrasound-guided transthoracic core needle biopsy (US-TCNB) is a promising method for establishing the correct diagnosis of mediastinal masses. However, the existing studies in this area are scant and with small samples. Purpose To evaluate the diagnostic value and the complication rate of US-TCNB, particularly large bore cutting biopsy in patients with mediastinal lesions. Material and methods This retrospective study includes 566 patients with mediastinal lesions suspicious of malignancy evaluated between March 2004 and December 2018. Inclusion criteria: 1. Patients with mediastinal lesions detected on thoracic CT scan; 2. Lesions more than 15 mm; 3. Negative histological diagnosis after bronchoscopic biopsy; 4. Normal coagulation status; 5. Cooperative patient; 6. Written informed consent. US visualization of the mediastinal lesions was successful in 308 (54.4%). In all of them, US-TCNB was performed. All patients with mediastinal lesions unsuitable for US visualization were evaluated for a CT-guided transthoracic needle biopsy (CT-TTNB), which was done if the presence of a safe trajectory was available (n = 41, 7.2%). All patients inappropriate for image-guided TTNB were referred to primary surgical diagnostic procedures (n = 217, 38.3%). Results The US-TCNB is a highly effective (accuracy 96%, sensitivity 95%) and safe tool (2.6% complications) in the diagnosis of all subgroups mediastinal lesions. It is non-inferior to CT-TTNB (90%) and comes close to the effectiveness of surgical biopsy techniques (98.4%), but is less invasive and with a lower complication rate. Conclusion US-TCNB of mediastinal lesions is highly effective and safe tool which is particularly helpful in critically ill patients.

Aim: Evaluation of the different surgical techniques for the treatment of post-pneumonectomy empyema(PPE). Materials and Methods: A total of 500 patients underwent pneumonectomy between Jan 1995-Dec 2017.PPE was detected in 21(4,2%)-19 male, 2 female with an average age of 57 years. Right pneumonectomy for lung cancer(14);tuberculosis(1) and pulmonary abscess (1) was done in 16(76,19%). One(4,77%) right extra-pleural pneumonectomy for MDR tuberculosis. Four(19,04%) had left pneumonectomy for lung cancer (3) and thoracic trauma(1). Four(19,04%) received neo-adjuvant chemotherapy and seven (33,33%) adjuvant chemotherapy. Bronchial stump insufficiency(BSI) was found in 15(71,42%). Results: Palliative tube thoracostomy was applied in 2(9.5%) with late PPE and advanced malignancy. In 1(4.7%) PPE was definitively cured by tube drainage and additional irrigation. In cases of BSI were performed: accelerated treatment (Weder) with omentoplasty in 5(23.8%); open window thoracostomy(OWT) with omentoplasty(3), intercostal flap and omentoplasty(1), m.pectoralis major(1) and m.rectus abdominis(1), closed definitively (Clagett closure) within 3 months. In 1(4.7%) OWT closed spontaneously after 4 months. In 6(28.6%) recurrent VATS and our VATS modification of Weder procedure in 3 patients were carried out. The accelerated approaches and VATS provide the earliest recovery and the shortest stay. Only one of the patients had recurrent BSI and died with PPE relapse- unsuccessful application of the m. rectus abdominis. Conclusion: The treatment should be tailored for each case depending on empyema stage, presence of BSI and general condition.

Lung cancer is a serious health problem, since it is one of the leading causes for death worldwide. Molecular–cytogenetic studies could provide reliable data about genetic alterations which could be related to disease pathogenesis and be used for better prognosis and treatment strategies. We performed whole genome oligonucleotide microarray-based comparative genomic hybridization in 10 samples of non-small cell lung cancer. Trisomies were discovered for chromosomes 1, 13, 18 and 20. Chromosome arms 5p, 7p, 11q, 20q and Хq were affected by genetic gains, and 1p, 5q, 10q and 15q, by genetic losses. Microstructural (

Background: Cushing’s syndrome (CS) is characterized by the overproduction of cortisol. Common causes include pituitary adenomas and excess produceduction from adrenal pathologies. Rarely pulmonaryneuroendocrine tumors can produce ACTH and cause CS. It is controversial if such tumors are more aggressive. Case Report: A 45years old male hospitalized due to weakness, dyspnea, swelling of ankles, disorientation and raised levels of Cortisol (>60.0 mcg/dL), Parathormone (168 ng/L), low level of Aldosterone (0.4 mcg/24H) and severe hypokalemia (1.8 mEg/L). MRI of the pituitary gland and brain with contrast did not show any abnormalities. CT- scan of the thorax and abdomen showed a lesion in the right lower lobe with size 1.7 cm. After potassium substitution and improvement the patient was discharged and redirected to Endocrinology, where additional findings were raised levels of ACTH (155.7 pg/ml), Chromogranin A (116 ng/ml) and urinary free Cortisol (1750 nmol/24h). SPECT-CT with99mTc-Tektrotyd showed high tracer accumulation in the lung lesion and the adrenal glands. The fibrobronchoscopy showed normal endoscopic finding. The patient was admitted underwent right pyramid resection and mediastinal lymph node dissection. The histology was typical carcinoid - T1bN0M0- st. After the removal of the tumor all hormonal levels normalized. In the next 6 months of follow up the patient is in very good condition with normal hormonal levels. Conclusion: Ectopic ACTH- secreting tumours are some of the most challenging differential diagnoses and require multidisciplinary approach with close collaboration between endocrinologist, surgeon, pathologist, and radiologist.

Background: Superior vena cava (SVC) obstruction is a medical emergency and most often manifests in patients with a thoracic malignancy. A patient with SVC syndrome (SVCS) requires immediate diagnostic evaluation. Aim: To evaluate the diagnostic value and the complication rate of ultrasound (US) guided transthoracic core needle biopsy (US-TCNB) in patients with mediastinal lesions (ML) and SVCS. Patients and Methods: 566 patients with CT visualized ML >20 mm were included; 113 of them were with SVCS. US visualization of the ML in SVCS patients was successful in 75.2% (n=85) where US-TCNB was performed; in 36 we additionally applied transthoracic fine needle aspiration (22G) (TTFNA). TCNB biopsy was performed in 22 critically ill patients in sitting or semi-sitting position. CT guided transthoracic needle biopsy (CT-TTNB) was done in the presence of safe trajectory and no US visualization (n=14). Excluded patients were referred for surgical diagnostic procedures (n=14). Results: The US-TCNB was a highly effective: accuracy (ACC) 94%, sensitivity 94 % and safe tool in diagnosis of ML in patients with SVCS. Complications were 3.5% (2 chest wall hematoma; 1 hemoptysis). It is noninferior to surgical biopsy (ACC 98.5%) and CT-TTNB (ACC 90%), but was less invasive and with lower complication rate. US-TTFNA had 93% ACC in epithelial metastatic disease (14/15), 60% in malignant lymphoma (9/15) and 60% in thymoma (3/5). US-ТТFNA ACC was significantly lower compared to US-TCNB (75% vs 94%, р Conclusion: US-TCNB of mediastinal lesions in SVCS patients is highly effective and safe tool, particularly helpful in critically ill patients.

Aim: To compare postoperative results after surgery for pulmonary metastases from colorectal carcinoma with them from other extrapulmonary origin. Methods: From Jan 2001 to Dec 2015 were operated on 67 patients, 22 for metastases from colorectal carcinoma. One-stage operations were performed via median sternotomy (7) and bilateral thoracotomies (3), 1 of them with colorectal origin. Two-stage strategy was applied in 6 patients, 3 of them with colorectal origin. Unilateral operation were carried out: metastasectomy in 38 (56.7%), lobectomy in 9 (13.4%), extended lobectomy in 2 (3.0%), sleeve lobectomy in 1 (1.5%) and polysegmental resection in 1 (1.5%). By the patients with colorectal origin were carried out: metastasectomy in 12 (54.5%), lobectomy in 4 (18.2%), extended lobectomy in 1 (4.5%) and polysegmental resection in 1 (4.5%). VATS was applied in 9 (13.4%) patients, 3 (13.6%) of them with colorectal carcinoma. Results: No 30-day postoperative mortality was faced. The mean number of resected metastases was 2.13 per patient, in the group with colorectal origin 1.86. Metastatic mediastinal lymph nodes involvement was found in 9 (13.6%) patients, 3 (13.6%) of them with metastases from colorectal carcinoma. There was no significant difference in long-term results and in prognostic factors between two groups of patients (p=0.578).Survival in months in patients with colorectal cancer and patients with other primary origin. Conclusion: Disease free intervaland number of metastases are the main prognostic factors. Mediastinal lymph nodes involvement is an unfavorable prognostic factor.

Background Isolated adrenal metastasis from non-small cell lung cancer(NSCLC) is a rare event with poor survival following nonsurgical treatment. The role of adrenalectomy is unclear and suprarenal adenoma can be misdiagnosed as a metastatic lesion. Aim To evaluate the outcome after resection of solitary adrenal metastases and to compare its survival with that after adrenalectomy of adenoma in operable NSCLC patients. Material and Methods A total of 8 patients underwent curative resection for suspected metastatic NSCLC of the adrenal gland. In all the primary NSCLC had been treated by complete lobectomy. Results The patients were divided into 2 groups according to the pathomorphology of resected adrenal gland:metastasis(4) or adenoma(4). The metastases in Group 1 were metachronous(2 ipsilateral, 1 contralateral). In 1 patient there was a synchronous lesion in the contralateral lung. The mean Disease Free Interval was 36.8 months. Retroperitoneal endoscopic adrenalectomy(REA) was performed in all patients followed by sublobar resection for synchronous lung lesion in one. Adjuvant chemotherapy was administered in all patients. The adenomas in Group 2 were synchronous and ipsilateral. One stage operation was performed in 2 patients with left sided localization:lower lobectomy and adrenalectomy via transdiaphragmatic approach. Right upper lobectomy was performed followed by REA within a month in 1 patient. In the last patient REA was first followed by left upper lobectomy(pSt. IIIA). Median 5-year survival in Group 1 was significantly greater than in Group 2(34.75vs 18.6 months,p=0.03). Conclusion Long-term survival is possible after resection of isolated adrenal metastases from operable NSCLC patients.

Aims and backgroundAngiogenesis is a key process in the early stages of tumor development. In this study we aimed to evaluate the expression of a panel of angiogenesis-related genes in a group of Bulgarian patients with early-stage non-small cell lung cancer (NSCLC).Methods and study designWe analyzed the expression of 84 genes associated with the angiogenic process in 12 NSCLCs of two histological subtypes: 7 adenocarcinomas and 5 squamous cell carcinomas. Eight peripheral nontumorous tissues were used as controls. We performed real-time PCR on pathway-specific gene arrays (SABiosciences).ResultsOur pilot study identified upregulated genes in early-stage NSCLC including growth factors (TGFA and EFNA3), the adhesion molecule THBS2, cytokines and chemokines (MDK, CXCL9, CXCL10), and the serine protease PLAU. Several genes showed downregulation including one growth factor (FIGF), the receptors for growth factors TEK and S1PR1 as well as adhesion molecules (COL4A3 and CDH5), the cytokine IL6, the matrix protein LEP and the transcription factor NOTCH4. The study demonstrated deregulated genes specific for the two histological subtypes including the transcription factor HAND2, which was overexpressed in squamous cell carcinomas but not adenocarcinomas.ConclusionsDespite the limited number of patients, our results demonstrated the potential of angiogenesis-related genes as biomarkers in the early stages of NSCLC development. Free full text available at www.tumorionline.it

Objective: Alpha-B-crystallin, a small heat-shock protein, recently gained major interest because of its differential expression during tumourigenesis and metastasis in various epithelial tumours. The purpose of this study was to investigate the expression of alpha-B-crystallin and its biologic and prognostic significance in non-small-cell lung cancer (NSCLC). Methods: Immunohistochemical analysis was performed on a tissue microarray slide containing samples from 146 NSCLC patients who were operated on between 2004 and 2005. Results: Cytoplasmic and nuclear staining was detected. Squamous cell carcinomas and adenocarcinomas had a distinctive profile of expression. The cytoplasmic staining of the tumours, however, is related to the local invasion — T-factor (p = 0.044). Nuclear staining was more commonly detected in advanced stages, and was a biomarker of an aggressive tumour biology (p = 0.042). Kaplan-Meier analysis showed that patients with positive nuclear staining had shorter overall survival (log-rank p=0.002). Using Cox's proportional hazards model, we performed multivariate analyses to assess the independent prognostic value of nuclear staining. The variables used included age, histology, gender and stage. Alpha-B-crystallin was an independent negative prognostic factor of survival in addition to clinical stage. Conclusions: Alpha-B-crystallin plays an essential role in NSCLC biology and its nuclear staining is an independent factor of poor survival. Its clinical application in molecular biologic substaging of NSCLC patients needs further validation.

Apoptosis Gene Expression Profile in Early-Stage non Small Cell Lung CancerNon small cell lung cancer (NSCLC) is a highly aggressive malignancy with survival rates limited to some patients in early stages (I and II). Apoptosis resistance is a hallmark of solid tumors that is tightly concerned with their biology. We analyzed the expression of 84 apoptosis-related genes in a group of Bulgarian patients with early-stage NSCLC.RNA samples extracted from 12 early-stage NSCLC patients [five squamous cell carcinomas (SCC) and seven adenocarcinomas (AC)] and eight adjacent non neoplastic pulmonary tissues were used for gene expression analysis. We applied pathway-focused expression profiling of 84 apoptosis-related genes using real-time PCR.Apoptosis-related genes down regulated in NSCLC compared to non tumor lung tissue (p

The Pittsburgh group has suggested a perforation severity score (PSS) for better decision making in the management of esophageal perforation. Our study aim was to determine whether the PSS can be used to stratify patients with esophageal perforation into distinct subgroups with differential outcomes in an independent study population.In a retrospective study cases of esophageal perforation were collected (study-period, 1990-2014). The PSS was analyzed using logistic regression as a continuous variable and stratified into low, intermediate, and high score groups.Data for 288 patients (mean age, 59.9 years) presenting with esophageal perforation (during the period 1990-2014) were abstracted. Etiology was spontaneous (Boerhaave; n = 119), iatrogenic (instrumentation; n = 85), and traumatic perforation (n = 84). Forty-three patients had coexisting esophageal cancer. The mean PSS was 5.82, and was significantly higher in patients with fatal outcome (n = 57; 19.8%; mean PSS, 9.79 vs 4.84; P.001). Mean PSS was also significantly higher in patients receiving operative management (n = 200; 69%; mean PSS, 6.44 vs 4.40; P.001). Using the Pittsburgh strata, patients were assigned to low PSS (≤2; n = 63), intermediate PSS (3-5; n = 86), and high PSS (5; n = 120) groups. Perforation-related morbidity, length of stay, frequency of operative treatment, and mortality increased with increasing PSS strata. Patients with high PSS were 3.37 times more likely to have operative management compared with low PSS.The Pittsburgh PSS reliably reflects the seriousness of esophageal perforation and stratifies patients into low-, intermediate-, and high-risk groups with differential morbidity and mortality outcomes.

The importance of p53 mutations in the pathogenesis of lung cancer is well established, but it is still controversial whether the presence of p53 mutations or overexpression of P53 protein are of clinical significance. The aim of this study was to define the levels of expression of p53 mRNA in tumor, lymph nodes and peripheral blood of patients with non-small cell lung cancer, detected by relative quantification real-time PCR and to analyze the association with clinicopathological data. We applied real-time PCR to define the levels of expression of p53 mRNA in tumor, lymph nodes and blood of 25 patients with non-small cell lung cancer, which underwent an operation at the Department of Thoracic Surgery of the University Hospital for Pulmonary Diseases in Sofia. As a control group 25 healthy volunteers were used. The method of relative quantification was applied for the analysis. We detected a high expression of p53 mRNA in 90.9% of the tumors and in 73.7% of the lymph nodes. A trend for a correlati...

Methods A total of 32 patients (11 males, 21 females, mean age 51.9 years) were operated on during a 7 years period in two institutions. There were 16 sarcomas (9 chondrosarcomas, 3 radiation-induced sarcomas, 2 Ewing sarcoma, 2 osteosarcoma), 1 recurrent desmoid tumor, 3 local breast cancer recurrences, 1 plasmocytoma, and 11 metastatic tumors (5 from breast cancer, 2 rabdomyosarcoma, 2 liposarcoma, 1 NSCLC, 1 prostate cancer). Four-five cm free margins on each side were achieved in all patients with total sternectomy (13), subtotal sternal resection (17), and partial resection (2). Concurrent en bloc resections included anterior ribs (7), clavicle (6), pericardium (2), brachiocephalic vein (2), and diaphragm (1). The chest was reconstructed with Gore-tex (5) or Marlex mesh (22) and myocutaneous flap in 18 (56.25%) patients or omentum in 6 (18.75%) patients. Only double layer Marlex mesh with breast mobilization was performed in 5 women (15.62%). Combination of prostetic material and metal bars or wires was needed in 6 patients after total sternectomy (18.75%). Multimodality treatment preor postoperatively was administered in most of the patients.

Methods ELISA was applied to determine the plasma levels of HspB5 in 45 patients, operated on for NSCLC, 38 high risk COPD patients and 45 age and sex-matched healthy volunteers. The pTNM of NSCLC patients was defined according to the 7th revision of TNM staging system. All operated on patients were followed up either their death or up to 5 years. ROC analysis was used to characterize the diagnostic role of HspB5. The one and fiveyear survival rates were defined by Kaplan-Maier.

B-crystallin is a major heat-inducible small heat shock protein, which is supposed to be implicated in tumour cell proliferation, differentiation, invasion, metastasis and apoptosis. Still the expression pattern of the phosphorylated on serin 59 form ofB-crystallin in lung cancer is not yet investigated. The aim of the present work is to study this pattern in different histological subtypes of pulmonary neuroendocrine tumours (pNETs). Surgically resected specimens from 143 patients with pNETs were studied. The histological subtype, pathological Tumour-Node-Metastasis stage and the immunohistochemical expression of phosphorylatedB-crystallin were evalu- ated. We demonstrated that the nucleus was the major localization site of the protein although there were some rare cases showing also diffuse cytoplasmic expression. High grade pNETs (small cell lung carcinoma and large cell neu- roendocrine carcinoma) showed nuclear expression in all cases but most fre- quently it was in less than 50% of the tumour cells; cytoplasmic expression was shown in single cases. Just the opposite was observed in low and intermediate grade pNETs (typical carcinoids and atypical carcinoids) - nuclear expression was not seen in all of the cases, but when it was present it was in almost all tumour cells; the cases expressing phosphorylatedB-crystallin also in the cy- toplasm were mainly typical carcinoids. We demonstrated that cytoplasmic This study was financially supported by the Council for Medical Science, Medical University of Sofia, Project Contract No 18-D/2010 and Project Contract No 1-D/2011.

Objective The early detection of NSCLC is of importance because it provides chances for better outcomes. The aim of the study was to explore the clinical utility of EGFR and hTERT mRNA expression as markers for diagnosis of NSCLC. Methods EGFR and hTERT mRNA were quantified by quantative reverse transcription real time polymerase chain reaction in plasma of 45 non-small cell lung cancer (NSCLC) and 40 chronic obstructive pulmonary disease (COPD) patients, selected by certain spirometric characteristics that made them at high risk of developing lung cancer in future. Results The gene expression level of each gene was calculated and given as a relative quantity–-RQ. EGFR gene expression was found in all lung cancer patients. The mean level of expression was RQ = 29.39. hTERT mRNA could be detected in 88% of patients. The mean expression ratio in them was RQ = 17.31. Only 50% of the high risk patients turned to be positive for EGFR. The level of their expression was RQ = 2.09. The plasma levels of hTERT could be detected in 17 (42.5%) patients of the high risk COPD group. Their mean level of expression was RQ = 1.02. A statistically significant difference in EGFR and hTERT mRNA expression could be observed between the two groups of patients–-p = 0.0001. Conclusion EGFR and hTERT mRNA are potential markers for lung cancer diagnosis, whose clinical importance should be replicated in a larger cohort of patients.

The non-invasive approach of finding biomarkers in peripheral blood of cancer patients makes it useful for clinical application and cancer screening. The aim of the study was to explore the clinical utility of alpha-crystallin antibodies as markers for diagnosis of non-small cell lung cancer (NSCLC) and screening among high-risk groups. Alpha-crystallin antibodies were detected with enzyme-linked immunosorbent assay (ELISA) in 51 NSCLC patients, 38 high-risk chronic obstructive pulmonary disease (COPD) patients and 52 age and sex matched healthy volunteers. Alpha-crystallin IgG antibodies differed significantly between the groups of cancer patients and the healthy volunteers (P

The aim of the study was to evaluate the incidence of anaerobic bacteria in 198 patients with pleural empyema and the susceptibility of isolates to eight antibacterial agents. Isolates were identified by the Crystal anaerobes identification system, API System rapid ID 32 A and/or routine methods. Susceptibility was tested by Sceptor MIC system for anaerobic bacteria and limited agar dilution method. Anaerobic bacteria were found in 74.2% of the patients and included 247 strains within 21 genera. The predominant anaerobes were Gram-positive anaerobic cocci (52 isolates), Fusobacterium (51), microaerophilic streptococci (24), Prevotella (19) and Bacteroides species (11). Common species/groups were Fusobacterium nucleatum (in 27.2% of specimens yielding anaerobes), Micromonas micros (8.2%), Finegoldia magna (7.5%), Bacteroides fragilis group (6.8%), Peptostreptococcus anaerobius (6.1%) and F. necrophorum (5.4%). No resistance to chloramphenicol and ampicillin/sulbactam was detected. The susceptibility rates of Gram-negative anaerobic isolates to penicillin, cefoxitin, clindamycin, clarithromycin, metronidazole and tetracycline were 63.8%, 90.2%, 87.8%, 58.6%, 98.8% and 71%, and those of Gram-positive anaerobes were 79.2%, 100%, 84.3%, 68.4%, 41.9% and 75%, respectively. The wide diversity of isolated anaerobic genera and species and the susceptibility patterns of the isolates emphasize the role of the anaerobic microbiology in cases of pleural empyema.

A thorough review of all the methods for postpneumonectomy empyema treatment is presented. Surgical principles of treatment include evacuation of pus and debridement of the infected tissue combined with obliteration, marsupialization, or opening of the infected cavity. The indications, advantages and disadvantages of the different surgical procedures are analyzed. Special attention is paid to the accelerated methods and video-assisted thoracoscopic debridement in the management in this severe complication associated with bronchopleural fistula. Postpneumonectomy empyema treatment as a combination of several methods should be individually tailored. Accelerated Weder procedure is an effective method in postpneumonectomy empyema with or without bronchopleural fistula. Scripta Scientifica Medica 2013; 45(3): 16-22. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";}

Methods Surgically resected specimen (men n = 59; women n = 72, age 48 ± 15) from 111 TC (84.7%) and 20 AtC (15.3%) patients were studied. The histological type, T-status, N-status (TC 94 N0, 17 N1/2; AtC 16 N0, 4 N1), pTNM stage (TC-I n = 81, II n = 17, III+IV = 13; AtC-I n = 12, II-IV n = 8), surgery (55 simple lobectomies, 16 bilobectomies, 24 pneumonectomies (4 extended), 15 segmentectomies, 16 sleeve lobectomy (in 2 of them combined with sleeve resection of pulmonary artery), 5 sleeve resection of main bronchus), and immunohistochemical expression (on 64 TCs and 13 AtCs) of p-HspB5, Hsp27 and mTOR were evaluated. Kaplan-Meier, Wilcoxon, Cox regression analyses were the statistical methods used.

Objective The early detection of NSCLC is of importance because it provides chances for better outcomes. The aim of the study was to explore the clinical utility of EGFR and hTERT mRNA expression as markers for diagnosis of NSCLC. Methods EGFR and hTERT mRNA were quantified by quantative reverse transcription real time polymerase chain reaction in plasma of 45 non-small cell lung cancer (NSCLC) and 40 chronic obstructive pulmonary disease (COPD) patients, selected by certain spirometric characteristics that made them at high risk of developing lung cancer in future. Results The gene expression level of each gene was calculated and given as a relative quantity–-RQ. EGFR gene expression was found in all lung cancer patients. The mean level of expression was RQ = 29.39. hTERT mRNA could be detected in 88% of patients. The mean expression ratio in them was RQ = 17.31. Only 50% of the high risk patients turned to be positive for EGFR. The level of their expression was RQ = 2.09. The plasma levels of hTERT could be detected in 17 (42.5%) patients of the high risk COPD group. Their mean level of expression was RQ = 1.02. A statistically significant difference in EGFR and hTERT mRNA expression could be observed between the two groups of patients–-p = 0.0001. Conclusion EGFR and hTERT mRNA are potential markers for lung cancer diagnosis, whose clinical importance should be replicated in a larger cohort of patients.