We evaluated an optimized patient care program for patients undergoing lung resections in a prospective randomized pilot study. Using this fast track clinical pathway the rate of pulmonary complications could be significantly decreased as compared to a conservative treatment regimen; our results support the implementation of an optimized perioperative treatment in lung surgery in order to reduce pulmonary complications after major lung surgery.

Venous spurs are found among about half of patients with left-sided iliac venous thrombosis. As long as the underlying venous pathologic process is left untreated, thrombectomy will not restore patency. Stent implantation is a simple and safe means to correct central venous strictures and provides excellent long-term results.

Purpose: To investigate the extent to which clinical status is affected by covering the left subclavian artery (LSA) with stent-grafts in the thoracic aorta. Methods: Stent-graft reconstruction of the thoracic aorta was performed in 23 patients (20 men; mean age 50.8 years, range 17–77) for management of rupture (n = 11), type B dissection (n = 9), or aneurysm (n = 3). All patients had bilaterally equal systolic and diastolic blood pressures (141.3 ± 19.8 and 78.9 ± 11.0 mmHg, respectively). Twenty Gore TAG and 1 Talent thoracic endografts were used; 2 cases required a combination of prostheses. In all patients, the stent-graft was intentionally placed to cover the LSA. Follow-up included clinical examination with blood pressure measurements and computed tomography during the first postoperative week and at 3-month intervals thereafter. Results: After coverage of the LSA by the stent-graft, systolic pressure fell by a mean 48.3 ± 23.4 mmHg. In 4 cases of proximal endoleak, however, systolic pressure fell by only 25.0 ± 15.0 mmHg. Twenty (78.5%) patients reported no complaints during a mean follow-up of 12.1 ± 7.3 months. Postinterventional complaints reported by 3 patients included exercise-dependent paresthesias; nonexercise-dependent, intermittent, and completely reversible dizziness; and a temperature difference between the upper extremities with no decrease in strength. Conclusions: Covering the LSA is generally well tolerated by patients and increases the landing zone for the placement of thoracic stent-grafts. Long-term studies, however, must investigate the hemodynamic effects of this procedure on the vertebrobasilar circulation.

Background. It is known that cytokeratin 19 is particularly abundant in carcinoma of the lung. Methods. A sandwich enzyme‐linked immunosorbent assay called CYFRA 21‐1 was, therefore, developed to detect soluble cytokeratin 19 fragments in serum using two specific monoclonal antibodies (Ks 19.1 and BM 19.21). The authors investigated the clinical significance of this new marker compared with the established markers carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), neuron‐specific enolase (NSE), carbohydrate antigen (CA) 19–9, CA 125, CA 15–3, CA 72–4, alpha‐fetoprotein, and prostate‐specific antigen in a pilot study on 1741 serum samples from patients with various benign and malignant diseases. Results. Postulating a specificity of 95% versus benign diseases of the lung, the diagnostic sensitivity of CYFRA 21‐1 in lung cancer (independent of histologic type) at primary diagnosis was superior (47%) to CEA (27%), SCC (15%), and NSE (16%). Especially in squamous cell carcinomas of the lung, the true‐positive test results were much higher for CYFRA 21‐1 (60%) than for CEA (18%) or SCC (31%). Conclusions. In small cell lung carcinomas, NSE was confirmed as the marker of first choice. For all of the other solid tumors investigated, CYFRA 21‐1 showed no better profile of specificity and sensitivity than the established markers.

Endoluminal treatment in diseases of the thoracic descending aorta is feasible and may offer results as good as the open method.