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The optimal surgical reconstruction of chest wall defects especially in the context of posttraumatic, oncological and congenital etiologies has a large impact on the recovery of the patients. Regardless of the etiology, various complications, such as a generally impaired respiratory physiology in an unstable thorax or decreased pulmonary clearance associated with acute and chronic pulmonary infections, may impair the recovery of affected patients. The postoperative occurrence of an intrathoracic dead space may lead to a difficult to treat empyema. Each thoracic wall defect must be accurately assessed and treated according to size, depth and location on the chest. The complexity of this condition and the resulting complications require the highest degree of surgical care which should be interdisciplinary both preoperatively and postoperatively.

Objectives This review presents laser resection as treatment option in pulmonary metastasectomy and summarizes the current evidence. Moreover, it includes the comparison of laser resection and common techniques used in lung metastasectomy. Methods We performed a systematic literature research in Medline and the Cochrane library to detect case series and even randomized trials. All included studies underwent qualitative analysis. Results Laser metastasectomy is a safe procedure. Data regarding relevant clinical end points as hospitalization, duration of chest tube drainage and long-term survival are heterogeneous and still controversial. Laser enucleation decreases the resection volume. Therefore, it leads to a significant reduction of parenchymal loss. Survival rates after laser metastasectomy are equal to the outcome after resection using other techniques. Conclusions Laser resection is a parenchyma-sparing method. Hence, it offers radical metastasectomy even in case of multiple pulmonary lesions or impaired lung capacity.

In patients with isolated meta- or synchronous pulmonary metastases from renal cell cancer, lung metastasectomy could be an appropriate treatment option after successful treatment of primary cancer. Presentation of lung metastasectomy as a treatment option in patients with pulmonary metastatic renal cell cancer and the postoperative outcome. Description of alternative treatment modalities focusing on targeted therapies. Systematical literature research and qualitative analysis of studies on patients undergoing lung metastasectomy after primary nephrectomy published since 01 January 2000. We assessed operative findings, survival data, and prognostic factors. Pulmonary metastasectomy results in a median postmetastasectomy survival of 26-94 months. The 5aEuroyear survival rates vary between 33 and 58%. The patients' prognosis depends on a prolonged disease-free interval and complete resection of all suspected metastases. In particular, number and location of lung metastases should play a minor role for the indication for lung metastasectomy. Pulmonary metastasectomy should be considered the treatment of choice in selected patients with successfully resected primary cancer showing no evidence of extrapulmonary metastases and having guaranteed operability and complete resection.

Background. Scoring systems are part of the daily routine in intensive care units (ICU). Various aspects lead to a special position of cardiac surgery patients; therefore, some established systems, such as the acute physiology and chronic health evaluation (APACHE), multiple organ dysfunction score (MODS), simplified acute physiology score (SAPS) and sequential organ failure assessment (SOFA) can only be applied with reservation in this population. In recent years specific models were developed, including the cardiac surgery score (CASUS) that are tailored to the cardiac surgery patient population. Aim. This article gives an overview of conventional scoring systems in intensive care medicine and describes the advantages and disadvantages in comparison to specialized models for cardiac surgery. Material and methods. A total of seven scoring systems are presented and discussed based on a randomly selected patient of a prospective, cardiac surgery database, cardiac surgery database with over 5200 patients. Results. The two new versions of CASUS capture the severity of organ dysfunction in a time based context. Both models allow an accurate prediction of mortality as a percentage; however, the severity of a disease cannot be precisely represented by the established scoring systems. Conclusion. Besides the evaluation of the postoperative period in the ICU, the severity of a disease can be measured by scoring systems. In addition, decision-making at the bedside, prognosis for survival, resource management and quality assurance can be facilitated.

Pulmonary metastasectomy is an established procedure in oncological therapeutic concepts. A systematic literature search and an analysis of all studies published since 01.01.2000 should evaluate the advantage of pulmonary metastasectomy for patients with primary head and neck cancer. Lung metastases develop in 1.9-13 % of head and neck cancer patients. Following metastasectomy, patients reach a median survival of 9.5-78 months and 5-year survival rates of up to 58 % are achieved. Intrathoracic recurrence occurs in 18.4-81.8 % of patients, selected instances of which can be successfully treated by remetastasectomy. Patients with squamous cell carcinoma have the worst prognosis, but could also become long-term survivors (a parts per thousand yenaEuro parts per thousand 60 months). Pulmonary metastasectomy is frequently the only potentially curative therapeutic approach and offers a better long-term survival than nonsurgical therapies. Lung metastasectomy is thus the treatment of choice in selected patients with pulmonary metastases from primary head and neck cancer.

Background: We aimed to validate the usefulness of CASUS derivatives for cardiac surgery patients and their reliability for daily decision making. Methods: We included, prospectively, the data of all adult cardiac surgery patients who had an ICU stay of at least 12 hours between 20 January 2003 and 14 October 2005 in the Department of Cardiothoracic Surgery of the University of Cologne, Germany. Data were collected until ICU discharge and included initial, maximum, mean, and total CASUS values. delta CASUS (difference from initial value) was calculated at 48 and 96 hours postoperatively. The predictive efficacy of the derivatives was tested with calibration and discrimination statistics. Results: 2372 patients were included with a mean age of 66.2 +/- 11.2 years. ICU mortality was 3.6% (n = 85). Mean ICU stay was 3.0 +/- 6.1 days. The discrimination was very good for all derivatives (area under the curve ranged between 0.988 and 0.926). The calibration was also good except for the total CASUS, which showed a significant difference between the expected and observed mortality. Increased d CASUS at 48 hours (1038 patients) and 96 hours (435 patients) correlated with an increase in mortality (23.1% and 42.9%, respectively), and conversely a decreased mortality rate was observed with decreasing values (1.9% and 3.8%, respectively). Conclusion: CASUS derivatives including d CASUS have a good prognostic value for cardiac surgery patients with regard to the prediction of mortality and survival during ICU stay, with the exception of total CASUS which was not informative.