Pulmonary resections performed after pneumonectomy due to NSCLC are rare procedures but with an acceptable perioperative risk. The second procedure should be limited to wedge resection. The prognosis is poor for patients with N2 status and for those treated by second surgery earlier than 12 months after the first procedure.

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The effects of heavy metals on cancer risk have been widely studied in recent decades, but there is limited data on the effects of these elements on cancer survival. In this research, we examined whether blood concentrations of the heavy metals arsenic, cadmium, mercury and lead were associated with the overall survival of lung cancer patients. The study group consisted of 336 patients with lung cancer who were prospectively observed. Blood concentrations of heavy metals were measured to study the relationship between their levels and overall survival using Cox proportional hazards analysis. The hazard ratio of death from all causes was 0.99 (p = 0.94) for arsenic, 1.37 (p = 0.15) for cadmium, 1.55 (p = 0.04) for mercury, and 1.18 (p = 0.47) for lead in patients from the lowest concentration quartile, compared with those in the highest quartile. Among the patients with stage IA disease, this relationship was statistically significant (HR = 7.36; p < 0.01) for cadmium levels in the highest quartile (>1.97–7.77 µg/L) compared to quartile I (0.23–0.57 µg/L, reference). This study revealed that low blood cadmium levels <1.47 µg/L are probably associated with improved overall survival in treated patients with stage IA disease.

The aim of the study was to review the clinical characteristics of operated patients with respect to pulmonary sequestration and analyze diagnostic and therapeutic problems connected with this anomaly. Material and methods. We performed a retrospective analysis of 23 patients operated on because of pulmonary sequestration between 1963 and 2004 in the Departments of Thoracic Surgery in Zakopane (10 patients) and Szczecin-Zdunowo (13 patients). Results. The study group comprised 8 men and 15 women and the mean age was 28 years. 15 patients (65.2%) presented with clinical symptoms such as coughing, fever and chest pain. Preoperatively, pulmonary sequestration was suspected in 5 patients. Amongst the remaining patients, the preoperative diagnosis was lung cancer (9 patients), metastasis from testicular neoplasms (n=1), emphysematous bullae (n=2), pulmonary cyst (n=4), bronchiectasis (n=1) and lung abscess (n=1). None of the patients were subjected to arteriography and 6 patients underwent contrast-enhanced computer tomography examination, although it did not lead to a proper diagnosis. We found 20 intralobar sequestrations and 3 extralobar sequestrations, which were situated above the diaphragm. There were 11 sequestrations on the right side and 12 on the left side. The operations performed included: lobectomy (14 patients), segmentectomy 1+2 (n=1), wedge resection (n=3), sequestrectomy (n=3), lower bilobectomy (n=1), and middle lobectomy (n=1). Blood supply from the thoracic aorta was found in 17 patients and the abdominal aorta in the remaining 6 patients. In 5 patients, the pulmonary sequestration was supplied by more than one artery. Complications included hemorrhage from supplying arteries in 8 patients and phrenic nerve palsy in one patient. One patient required mechanical ventilation after the operation. There was no further morbidity and mortality. Distant surgical results were good. Conclusions. 1. Pulmonary sequestration in adults is difficult to diagnose before the operation, even with a detailed computer tomography examination. 2. Intralobar sequestration is much more common (87%) than extralobar and is often situated in the basal segments with comparable incidence on the right and left sides. 3. The greatest danger during the operation is major bleeding from the supplying artery. 4. Prognosis after the operation is favorable.

BackgroundLung cancer diagnosis in tissue material with commonly used histological techniques is sometimes inconvenient and in a number of cases leads to ambiguous conclusions. Frequently advanced immunostaining techniques have to be employed, yet they are both time consuming and limited. In this study a proteomic approach is presented which may help provide unambiguous pathologic diagnosis of tissue material.MethodsLung tissue material found to be pathologically changed was prepared to isolate proteome with fast and non selective procedure. Isolated peptides and proteins in ranging from 3.5 to 20 kDa were analysed directly using high resolution mass spectrometer (MALDI-TOF/TOF) with sinapic acid as a matrix. Recorded complex spectra of a single run were then analyzed with multivariate statistical analysis algorithms (principle component analysis, classification methods). In the applied protocol we focused on obtaining the spectra richest in protein signals constituting a pattern of change within the sample containing detailed information about its protein composition. Advanced statistical methods were to indicate differences between examined groups.ResultsObtained results indicate changes in proteome profiles of changed tissues in comparison to physiologically unchanged material (control group) which were reflected in the result of principle component analysis (PCA). Points representing spectra of control group were located in different areas of multidimensional space and were less diffused in comparison to cancer tissues. Three different classification algorithms showed recognition capability of 100% regarding classification of examined material into an appropriate group.ConclusionThe application of the presented protocol and method enabled finding pathological changes in tissue material regardless of localization and size of abnormalities in the sample volume. Proteomic profile as a complex, rich in signals spectrum of proteins can be expressed as a single point in multidimensional space and than analysed using advanced statistical methods. This approach seems to provide more precise information about a pathology and may be considered in futer evaluation of biomarkers for clinical applications in different pathology. Multiparameter statistical methods may be helpful in elucidation of newly expressed sensitive biomarkers defined as many factors "in one point".