The Thoracic and Cardiovascular Surgeon

Our medical research library holds 18 studies published in The Thoracic and Cardiovascular Surgeon (1985–2021). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 18 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Thieme
• Published: 1979 to the present, Germany
• Language: English
• ISSN: 0171-6425 (print), 1439-1902 (electronic)
• Continues: Thoraxchirurgie, Vaskuläre Chirurgie
• Its record in the NLM Catalog

2020s

• ECLS for Life-Threatening Complications in Mesothelioma Surgery: Is It Worthwhile?. A. Bellini, A. Dell'Amore, P. Ferrigno, et al. 2021;69(6):548-550. Case report PubMed · Publisher

  Abstract

  Extracorporeal life support (ECLS) is an effective method for bridging patients to recovery in cases of respiratory and/or cardiac failure that are potentially reversible and unresponsive to conventional management. Nevertheless, there have been only few reports about the use of ECLS in oncological patients with complications due to their neoplasm or its treatment. We report the use of veno-arterial extracorporeal membrane oxygenation in three cases of severe perioperative complications following surgery for mesothelioma after induction chemotherapy at our Institution.

  Thieme. All rights reserved.

2010s

• Video-Thoracoscopic Management of Postpneumonectomy Empyema. D. Galetta, L. Spaggiari. 2018;66(8):701-706. PubMed · Publisher

  Abstract

  Background: Postpneumonectomy empyema (PPE) is a serious complication even when it is not associated with bronchopleural fistula (BPF). Besides irrigation, an aggressive treatment is usually applied for removing infected material. However, a minimally invasive approach might achieve satisfactory results in selected patients.

  Methods: We retrospectively identified 18 patients presenting with PPE receiving video-thoracoscopic approach. Of these 18 patients, pneumonectomy was performed for nonsmall cell lung cancer in 15 cases, for mesothelioma in 2, and for trauma in 1 case. There were 14 males and 4 females, (mean age, 62 years; range, 44-73 days). Empyema was confirmed by thoracentesis and bacteriological examination. All patients had immediate chest tube drainage and underwent thoracoscopic debridement of the empyema. Fifteen patients had no proven BPF; two had suspicious BPF, and one had a minor (<3 mm) BPF.

  Results: Median time from pneumonectomy to empyema diagnosis was 129 days (range, 7-6205 days). Median time from drain position to video-assisted thoracoscopic surgery (VATS) procedure was 10 days (range, 2-78 days). A bacterium was isolated in 13 cases (72.2%). There was no mortality and no morbidity related to the procedure. The average duration of thoracoscopic debridement was 56 minutes (range, 40-90 minutes). Median postoperative stay was 7 days (range, 6-18 days). Only in one patient an open-window thoracostomy was performed. Median follow-up of the 18 patients receiving thoracoscopy was 41.5 months (range, 1-78 months). None had recurrent empyema. The patient with a minor BPF remained asymptomatic and is doing well at 48 months follow-up.

  Conclusions: Thoracoscopy might be a valid approach for patients presenting with PPE with or without minimal BPF. Video-thoracoscopic debridement of postpneumonectomy space is an efficient method to treat PPE.

  Georg Thieme Verlag KG Stuttgart · New York.

• Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy. J. Turtiainen, J.V. Räsänen, S. Hiippala, et al. 2016;64(6):540-2. Case report PubMed · Publisher

  Abstract

  Endoscopically superimposed Amplatzer (St. Jude Medical, St. Paul, Minnesota, United States) septal occluder plug was successfully used in the treatment of septic right main bronchus fistula having developed after extrapleural pneumonectomy and heated chemotherapy in two patients with malignant pleural mesothelioma. In the first case the method was curative and in the other Amplatzer served as temporary bridging allowing rehabilitation from empyema and sepsis. After 4.5 and 4.2 years both patients are alive with no sign of relapse of mesothelioma or infection.

  Georg Thieme Verlag KG Stuttgart · New York.

• Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases. S.T. Liman, A. Elicora, S. Topcu, et al. 2013;61(4):350-6. PubMed · Publisher

  Abstract

  Background: Autofluorescence (AF) examination in thoracoscopy has not been used frequently. Here, our aim was to determine whether AF examination contributes additional information to white-light (WL) examination when attempting to detect malignant pleural lesions. We also liked to know whether the effectiveness of WL and AF-mode combination would be different for various pathologies or lesions of the pleura.

  Methods: It is a retrospective study. Thirty-three patients with unexplained exudative pleural effusions underwent AF-assisted video-assisted thoracic surgery (VATS). Patients' data from the files were evaluated. In each case, the pleural cavity was thoroughly examined under WL alone and then in AF mode.

  Results: The sensitivity and specificity of AF-assisted VATS for detecting malignant pleural lesions were 78.7 and 85%, respectively, and there were 21.3% false negatives. In the group with metastatic pleural disease, AF VATS correctly identified all lesions as AF positive, whereas sensitivity was lower for the group with malignant mesothelioma. Seven lesions, which were not diagnosed under WL, were detected in AF mode.

  Conclusion: The overall sensitivity of AF-assisted VATS for detecting pleural malignancies was not satisfactory because of diagnostic errors in malignant mesothelioma. But it would be useful in detecting small malignant pleural lesions, which are not diagnosed under WL.

  Georg Thieme Verlag KG Stuttgart · New York.

• Benign localized fibrous tumor of the pleura: report of 25 new cases. S. Enon, D. Kilic, C. Yuksel, et al. 2012;60(7):468-73. Review PubMed · Publisher

  Abstract

  Objective: Benign localized fibrous tumors (BLFT) of the pleura are very rare slow-growing neoplasms that generally have a favorable prognosis. The aim of this manuscript is to evaluate the predictors of outcome with the review of the literature in a series of 25 patients with BLFT.

  Methods: Between January 1985 and November 2009, 25 patients underwent an operation due to BLFT. Of these patients, 14 (56%) were male; mean age was 41.1 (25 to 64) years. All patients underwent thoracotomy. Left thoracotomy approach was used in 16 patients. The mass lesions were totally excised. The histopathological examinations were performed with hematoxylin-eosin and immunohistochemical staining methods.

  Results: Of the patients, 18 (72%) were symptomatic. Symptoms were cough in 36%, shortness of breath in 32%, and chest pain in 20% of the patients. One patient (4%) appeared to have some symptoms (pain and swelling of the joints) associated with pulmonary osteoarthropathy. Seven patients (28%) underwent an operation due to mass lesion detected at routine control visits. None of the patients had a history of exposure to asbestos. Radiological investigations revealed 16 (64%) mass lesions in the left. Of the lesions found on exploration, 5 (20%) were intrapulmonary localized lesion without pedicle and 20 were pedicled. Of the pedicled masses, 5 were connected to parietal pleura and 15 to visceral pleura and all were intrathoracic extrapulmonary localized lesions. Eight (32%) lesions connected to left lower lobe. Additionally, three pedicled lesions were located in the lung fissure. Pedicled lesions were totally excised together with their pedicles. Intraparenchymal mass lesions were resected using wedge resection. The diameter of the resected masses was ranging between 3 and 22 cm (mean: 8.7). Macroscopically, all were encapsulated with a homogeneous cut surface. Intraoperative mortality and morbidity was not observed. The average hospitalization duration for all patients was 8.6 days (5 to 12). The mean follow-up was 33.6 (9 to 142) months with no recurrence.

  Conclusions: Benign localized fibrous tumors are uncommon and treated by surgical means. According to our data obtained from literature review, clinicians should be aware of recurrence possibility even after complete resection of benign localized fibrous tumor and the risk of malign transformation.

  Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

• Biological materials for diaphragmatic repair: initial experiences with the PeriGuard Repair Patch®. P. Zardo, R. Zhang, B. Wiegmann, et al. 2011;59(1):40-4. PubMed · Publisher

  Abstract

  Background: We sought to analyze the efficacy of a bovine pericardial patch (PeriGuard®) for diaphragmatic repair.

  Methods: Seven consecutive patients (6 males, median age 56 years) scheduled for diaphragmatic resection and/or repair were enrolled in this study. In all cases diaphragmatic repair was performed with a PeriGuard Repair Patch® (Synovis, St. Paul, MN, USA). At follow-up (median: 12 months; range: 6-18 months), quality of life, signs of reherniation and incorporation of mesh were assessed through clinical examination, blood samples and CT or MRT scan.

  Results: Diagnosis on admission included sarcoma (n = 2), mesothelioma (n = 1), squamous cell carcinoma (n = 1), parachordoma (n = 1) and large congenital or posttraumatic herniation (n = 2). At follow-up successful diaphragmatic repair with no signs of reherniation, graft dehiscence or seroma formation was confirmed for all patients. Recorded inflammatory markers [C-reactive protein (CRP), white blood cell count (WBC) and procalcitonin (PCT)] reached their peak values between postoperative day (POD) 4 and POD 7. Values ranged from 122-282 mg/L for CRP, 0.4-4.6 µg/L for PCT and 6.2-15.6 Tsd/µL for WBC. Overall oncological results were good and 5 out of 6 survivors reported a fully reestablished quality of life.

  Conclusion: We consider the PeriGuard Repair Patch® a viable alternative to synthetic materials for diaphragm replacement. Moreover, we advise carrying out cautious follow-up in patients undergoing extensive oncological resection to learn more about the biological behavior of the bovine PeriGuard Repair Patch® after diaphragmatic repair.

  © Georg Thieme Verlag KG Stuttgart · New York.

• Integrated positron emission tomography-computed tomography does not accurately stage intrathoracic disease of patients undergoing trimodality therapy for malignant pleural mesothelioma. J. Pilling, J.A. Dartnell, L. Lang-Lazdunski. 2010;58(4):215-9. PubMed · Publisher

  Abstract

  Introduction: The results of trimodality therapy for malignant pleural mesothelioma (MPM) are related to stage. Staging can be carried out by computed tomography (CT), magnetic resonance imaging and fluorodeoxyglucose positron emission tomography (FDG-PET), but all modalities suffer from limitations. We investigated whether integrated PET-CT improved the intrathoracic staging of patients undergoing trimodality therapy for MPM.

  Methods: Twenty consecutive patients [18 male, median age 62 years (range 52-68)] who underwent 24 PET-CT scans prior to extrapleural pneumonectomy (EPP) as part of trimodality therapy for MPM were reviewed. The intrathoracic stage of MPM on PET-CT was compared with the pathological stage following examination of the resected specimen. Patients excluded from radical surgery due to metastatic disease were not studied here.

  Results: PET-CT was performed a median of 119 days (range 2-229) prior to EPP. 16 scans were performed after talc pleurodesis. Nine scans were performed following chemotherapy. PET-CT correctly identified the T stage in 3 patients, overstaged 4 and understaged 17. Six scans failed to identify disease that later proved to be pT4. Nine patients were found to have pN2 disease; PET-CT identified N2 disease with a sensitivity of 11.1 %, specificity of 93 % and accuracy of 66 %. Previous talc pleurodesis did not alter the accuracy of PET-CT staging.

  Conclusions: In one of the few studies of integrated PET-CT in MPM that has complete pathological correlation we have shown that PET-CT does not accurately identify advanced tumor stage (T4) or mediastinal nodal disease (N2). The role of PET-CT staging prior to EPP lies outside the affected hemithorax.

2000s

• Solitary fibrous tumor of the pleura. A. Orki, A. Kosar, O. Akin, et al. 2008;56(5):287-90. PubMed · Publisher

  Abstract

  Background: The aim of this study was to evaluate the clinical behavior of solitary fibrous tumors of the pleura and consider the optimal surgical approach for these rare tumors.

  Material And Methods: We retrospectively reviewed the records of nine patients who underwent thoracotomy for tumor resection in our clinic between 1997 and 2006.

  Results: Nine patients were operated in this period and their median age was 46 years. None of them had been exposed to asbestos. Symptoms were present in 8 patients. All patients underwent thoracotomy. The tumor originated from the visceral pleura in 7 patients and was parietal in 2. All tumors were totally excised. The median diameter of the tumors was 9 cm (range 4-24 cm). Pathological investigation reported the tumors to be a benign solitary fibrous tumor of the pleura in all 9 patients. Resection was complete in all patients. There was no postoperative mortality and no major complications. No recurrence was observed during a median follow-up of 74 months.

  Conclusions: Solitary fibrous tumors of the pleura are rare neoplasms and can have giant diameters. Complete surgical resection is the optimal treatment. The risk of malignant transformation of such large masses should be borne in mind.

• Primary myxoid sarcoma of the pleura: 5 years follow-up. R. Tosson, M. Krismann. 2000;48(4):238-40. Case report PubMed · Publisher

  Abstract

  Primary sarcomas of the pleura are rare intrathoracic tumours. We describe a case of a recurring myxoid pleural sarcoma in a 51-year-old male patient with coronary heart disease, who initially was admitted for coronary revascularization surgery. Tumour diagnosis was based on pathological examination of a biopsy after radiological detection of a nodule in the right upper lobe. The nodule was excised. The first recurrence was diagnosed after 15 months. Pleuropneumonectomy was done. Four years after the first excision further tumour masses appeared above the diaphragm and were surgically removed and adjuvant irradiation carried out. A year later the patient is doing well.

1990s

• Changes during the last decade in clinical parameters of operated lung carcinoma patients of a center for thoracic surgery and the prognostic significance of TNM, morphometric, cytometric, and glycohistochemical properties. K. Kayser, M. Altiner, H. Dienemann, et al. 1997;45(4):196-9. PubMed · Publisher

  Abstract

  Two sets of patients with potentially curative resection of primary carcinomas operated in the Department of Thoracic Surgery, Thoraxklinik, Heidelberg during the period 1983-1984 (cohort I), and in 1994 (cohort II) were analyzed. The survival of patients, postsurgical TNM-stages, cell types, and exposure to potentially harmful substances were evaluated. In addition, cytometric and morphometric techniques, and various biotinylated markers have been applied to the tissue sections of the 1994 cohort. Cohort I comprised 282 patients (253 men and 29 women), cohort II all in all 171 patients (121 men and 49 women). In cohort I there were 262 heavy smokers, and 28 patients had a history of exposure to harmful environmental substances (asbestos, polycyclic aromates, etc.) compared to 145 smokers and 68 patients who inhaled potentially harmful substances in cohort II. Major changes were also seen in early lung cancer stages (pT1, pN0) which increased in cohort II, and in a decrease in the relative frequency of epidermoid carcinomas in both men and women with corresponding increase in the frequency of adenocarcinoma in both sexes. The median survival of patients operated with advanced tumor stages had remained unchanged, that of early stages (pT1, pN0, pN1) seems to have improved. Within the cytometric features syntactic structure analysis revealed that the current of structural entropy is closely associated with the survival of patients. Of prognostic significance are, in addition, the expression of binding capacities to histoblood group trisaccharides A and H, the presence and the binding of macrophage migration inhibitory factor, and the presence of ligands for the chicken liver galectin CL-16 and the LewisY antigen. Multivariant statistical analysis gave preferential prognostic importance to the glycohistochemical and morphometric parameters relative to the clinical pT and pN stages in survival analysis.

• Videothoracoscopy in the diagnosis and treatment of malignant pleural mesothelioma with associated pleural effusions. A. Cantó, R. Guijarro, A. Arnau, et al. 1997;45(1):16-9. PubMed · Publisher

  Abstract

  Between 1985 and 1994 46 of 662 patients examined by thoracoscopy for secondary malignant pleural effusion were diagnosed to have diffuse malignant pleural mesothelioma. Mean patient age was 59 years, with a male: female ratio of 5:1. The right hemithorax was more frequently involved than the left (55% versus 45%). Pleural fluid cytology revealed malignancy in 61.5% of cases. All patients were treated thoracoscopically by talc pleurodesis. Mean patients survival was 9.4 months. Survival after one, two, and 5 years was 37.5%, 12.5%, and 5%, respectively. The characteristics of mesothelioma and pleural effusion evident in thoracoscopy and their diagnostic relevance are discussed. We suggest talc instillation as the sole therapeutic maneuver in evolutioned cases, since the literature and our own experience indicate that survival is not significantly prolonged by more aggressive surgical approaches.

• Angiosarcoma of the chest wall. T. Suzuki, S. Suzuki, A. Kitami, et al. 1996;44(4):213-5. Case report PubMed · Publisher

  Abstract

  Angiosarcoma is a rare but highly malignant disease. This report presents a 22-year-old male who has survived a primary angiosarcoma arising from the chest wall. The patient had been complaining of anterior chest pain for 3 years. CT and MRI revealed a tumor protruding into the right thoracic cavity from the anterior chest wall but no further findings. First, the tumor was resected using video-assisted thoracoscopy. The pathological diagnosis established from a frozen section was of a benign mesothelioma, but this was changed to angiosarcoma based on findings from a paraffin-embedded specimen. As a consequence, the third rib and intercostal muscles were resected in a second operation. Three years following surgery there was no evidence of tumor recurrence or metastasis. This case supports a suggestion that not all patients with angiosarcomas experience the same level of malignancy.

• Primary cardiac tumors: experience at the University of Minnesota. J.E. Molina, J.E. Edwards, H.B. Ward. 1990;38 Suppl 2:183-91. PubMed · Publisher

  Abstract

  A review of all primary cardiac tumors seen at the University of Minnesota or entered in the Registry of Cardiovascular Disease, affiliated with the University of Minnesota, between 1959 and 1989. Of a total of 124 primary cardiac tumors, 103 (83%) were benign and 21 (17%) were malignant. Atrial myxomas (51 cases) accounted for 42% of all tumors and 50% of benign neoplasias. The remaining 51 benign tumors were, in order of frequency: rhabdomyomas, 14 (13%), papillomas, 12 (11%), fibromas, 9 (9%), hamartomas, (4%), teratomas (2%), lipomas (2%), mesotheliomas (2%), fibroelastomas, hemangiomas, glomangiomas, and a few others. The 21 malignant tumors, all sarcomas, were, in order of frequency: rhabdomyosarcomas, 6 (29%), angiosarcomas, 4 (19%), myxosarcomas, 3 (14%), fibrosarcomas, 2 (10%), and one each leiomyosarcoma, reticulum cell sarcoma, and liposarcoma. There were 3 cases of spindle cell sarcoma (14%) originating in the great vessels: 1 in the pulmonary artery and 2 in the aorta. The prognosis of the resected benign tumors was good, with no complications of recurrences for up to 15 years of follow-up. Tumors that could not be excised included mostly rhabdomyomas, in newborns, and cavernous hemangiomas involving most of the heart, with poor prognosis. Malignant tumors of the heart had a very poor prognosis, even when operated on promptly after diagnosis. The mean survival time of these patients was 5 months after resection, even when followed with chemotherapy and/or radiation; 26% of the tumors had already metastasized at the time of operation. Extensive resections in malignant tumors did not render satisfactory results.

1980s

• Chest wall resection---alloplastic replacement. L.H. Lampl, H. Loeprecht. 1988;36(3):157-8. PubMed · Publisher

  Abstract

  In a retrospective study of 302 patients, who were operated on in our centre between 12/85 and 9/87, 25 patients required a chest wall resection. The most frequent indication (11 times) was an infiltration of the thoracic wall by bronchial carcinoma. 8 times we resected a primary rib tumour, in rarer cases a thoracic wall resection was required for mesothelioma, echinococcus alveolaris and tuberculoma. In 10 patients the defect was too small to require a patch. Initially we applied Marlex-mesh and Vicryl-mesh to cover the defects. In our last 10 cases GORE-TEX-2 mm-patch was used. The technical ease of the method, the mechanical stability and durability, the tightness for air and fluid and the positive tissue response speaks for the continued application of this material. Additional methods such as myocutaneous flaps are not necessary and should only be used in complex defects.

• Localized benign mesothelioma of the pleura: case report and review of the literature. H. Seggewiss, K. Minami, R. Körfer. 1986;34(5):330-2. Case report PubMed · Publisher

  Abstract

  Localized benign mesothelioma of the pleura is a rather uncommon disease with good prognosis after successful tumor extirpation. We present the history of a 66-year-old patient, in whom tumor growth could be observed retrospectively over a period of 6 years. The tumor was extirpated successfully. On the basis of this history and a review of the literature epidemiologic, clinical, radiologic, pathological and prognostic criteria of the tumor are described.

• Metastasis of cancer to cancer. A case of breast carcinoma metastasizing to a malignant mesothelioma. H.J. Andersen, L.G. Hansen, S.M. Paulsen. 1986;34(4):258-9. Case report PubMed · Publisher

  Abstract

  Metastasis of cancer to cancer is exceedingly rare, the most frequent being metastasis from bronchogenic carcinoma to renal carcinoma. A case of breast carcinoma metastasizing to a fibrosarcomatous malignant mesothelioma is presented. Breast carcinoma metastasizing to another carcinoma has been reported 4 times in the past. To our knowledge no case of breast carcinoma metastasizing to a malignant mesenchymal tumor has been published. It is unknown whether metastasis of cancer to cancer is a random occurrence or is due to selective lodging, survival and growth within another malignant neoplasm.

• Follow-up study of 100 malignant pleural mesotheliomas. D. Krumhaar, S. Lange, C. Hartmann, et al. 1985;33(5):272-5. PubMed · Publisher

  Abstract

  One hundred malignant pleural mesotheliomas have been treated in our hospital since 1955. Clinical and autopsy findings are analyzed and compared to X-ray changes. The most common symptoms were dyspnea (49%), pain (40%) and cough (36%). The main initial X-ray signs were pleural effusion (62%), pleural thickening (29%) and solitary nodules (6%). Prior to death a combination of effusion and pleural thickening was the usual finding. Histologically there were 49 biphasic, 32 mesenchymal and 18 epithelial malignant pleural mesotheliomas. At autopsy 82% of the cases had distant metastases, most of which had not been expected clinically. The median survival time was 7.3 months following the first clinical symptoms, and only 4 months after the first radiological signs.

• Pathology of pleural mesothelioma. H. Otto. 1985;33(6):332-4. PubMed · Publisher

  Abstract

  Macroscopic and microscopic details of benign and malignant mesotheliomas are discussed in connection with indications for localization and frequency. Of special significance are malignant mesotheliomas of the pleura and the peritoneum resulting from exposure to asbestos which had often taken place several decades earlier. It is especially important to objectify the exposure to asbestos by means of histological and pulmonary dust investigations in those cases where the occupational anamnesis is vague or questionable.

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