Abstracts 4. Gemeinsamer Jahreskongress der ... - SWISS KNIFE

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tion (SR) could be an option in order to reduce the postoperatory mortality. We retrospectively
evaluated the 30 days-morbidity and mortality after sleeve resection and pneumonectomy
in patients > 70 years.
Methods: The clinical records of patients with pneumonectomy or sleeve lobectomy performed
at our institution between 1999-2005 were reviewed. 140 patients were assessed. SR
were considered in 57 patients, and P in 83. Eleven patients > 70 years underwent pneumonectomy
and 16 sleeve resections. The median age in P and SR group was 73 years (range
70-79) and 74.5 years (range 70-81), respectively (p=0.23). NSCLC was the predominant
indication. The P and SR population revealed diabetes in 18% and 12.5%, COPD in 45% and
19%, and coronary artery disease in 9% and 31.5%, respectively (p=0.8).
Results: The 30 days mortality after P and SR was 18% and 0%, respectively. Minor complications
after P and SR was 19% (2 arythmia) and 50% (3 pneumonia, 5 arythmia), respectively.
Major complications were 19% (1 myocardial infarction, 1 acute pulmonary oedema) and
12.5% (2 myocardial infarction), respectively.
Conclusion: Sleeve resection in elderly patients > 70 years is associated with a lesser mortality
than with pneumonectomy and should be preferred over pneumonectomy if possible.
11.08
T.C. Roth 1 , T. Weber 1 , B. Hoksch 1 , F. Jungling 2 , M. Korner 3 , R.A. Schmid 1
1 Division of General Thoracic Surgery, University Hospital, 3010 Berne/CH, 2 Division of
Nuclear Medicine, University Hospital, 3010 Berne/CH, 3 Division of Pathology, University
Hospital, 3010 Berne/CH
Hoarseness caused by cancer metastasis to the vagus nerve
Objective: Intraneural metastase are rarely reported.
Methods: A 42-year-old woman complained of hoarseness and cough. Laryngoscopy revealed
paresis of the left vocal cord. 19 years earlier, a malignant melanoma of the left lower limb
had been excised, associated with inguinal lymph node dissection and local chemotherapy.
10 years later, an invasive ductal carcinoma (T1 N1 M0 G2) of the right breast was diagnosed.
Treatment included lumpectomy with axillary lymph node dissection and adjuvant radiochemotherapy.
4 years after this procedure, tumor relapse and necessitated a radical rightsided
mastectomy with adjuvant chemotherapy. Thereafter, no recurrence of both cancers
was observed. In order to clarify the origin of the isolated recurrent pharyngeal nerve palsy a
CT of the chest and abdomen was performed. The CT revealed only some paratracheal lymph
nodes. The suspicion of lymph nodes metastases was not confirmed in the mediastinoscopy.
6 month later, it was decided to perform a FDG-PET, which clearly depicted a solitary focal
uptake in the hilar region of the left lung. In view of discrepant CT and PET findings, a diagnostic
thoracoscopy was performed. During this procedure, a suspicious thickened-hardened
area of the vagus nerve at the aortic arch were excised. Histologic examination showed extensive
intraneural infiltration of the vagus nerve by a solid adenocarcinoma, compatible with a
metastasis of the invasive ductal carcinoma.
Results: The vast majority of malignant tumors metastasize to the brain, whereas metastases
to cerebral nerves outside the base of the skull or peripheral nerves are rare. If peripheral nerves
are affected by metastatic lesions, dysfunction is preferentially caused by direct nerve
compression or secondary infiltration of the nerve by extraneurally located metastases. Only
few cases of intraneurally located metastases have been described. Our case is exceptional,
because the only clinical symptom was a vocal cord paresis, no lymph node metastases or
evidence of any tumor manifestation were found and the solitary metastasis was strictly located
inside the nerve, which may implicate a hematogenous tumor spread.
Conclusion: Although rarely observed, solitary metastatic lesions of cerebral and peripheral
nerves should be considered as metastatic sites in patients with a history of malignancy. FDG-
PET may help to detect small lesions which are not visualized by CT-scan.
11.09
O. Pittet1, D. Michod 2 , T. Krueger 3 , H.B. Ris 4 , C. Widmann 2
1 Service De Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne/CH,
2 Department of Cellular Biology and Morphology, Univeristé de Lausanne, Lausanne/CH,
3 Service De Chirurgie Thoracique, Centre Hospitalier Universitaire Vaudois, Lausanne/CH,
4 Service De Chirurgie Thoracique et Vasculaire, CHUV, 1011 Lausanne/CH
TAT-RasGAP 317-326 peptide selectively enhances the photodynamic effect of m-THPC on
human malignant mesothelioma cells
Objective: Photodynamic therapy (PDT) has been tested as a new treatment modality for
pleural mesothelioma, however, tumor selectivity is still insufficient for its clinical application.
TAT-RasGAP 317-326 peptide has the potential to specifically sensitise tumour cells to the
cytotoxic action of several genotoxins. We hypothesised that the PDT effect on human mesothelioma
(H-Meso1) cells may be selectively enhanced in the presence of TAT-RasGAP 317-
326.
Methods: H-meso1 cells and human fibroblasts, respectively, were exposed to different treatment
modalities: light delivery, mTHPC + TAT-RasGAP 317-326, TAT-RasGAP 317-326 + light
delivery (control groups); mTHPC + light delivery, mTHPC + TAT-RasGAP 317-326 + light delivery.
mTHPC was added to the culture medium at a fixed concentration of 0.04 mg/ml for 24
hours. Non-thermal light delivery was performed at 652 nm with a fluence of 3J/cm2 and a
fluence rate of 40mW/cm2. TAT-RasGAP 317-326 was added to the culture medium at a concentration
of 20 mm. Apoptosis rate was determined by scoring the number of cells displaying
pycnotic nuclei.H-meso1 cells and human fibroblasts, respectively, were exposed to different
treatment modalities (control groups, PDT only and PDT + the peptide). mTHPC was
added to the culture medium at a fixed concentration for 24 hours. Light delivery was performed
with a fluence of 3J/cm2. TAT-RasGAP 317-326 was added to the culture medium at a
concentration of 20 mm. Apoptosis rate was determined by scoring the number of cells displaying
pycnotic nuclei.
Results: H-meso-1 cells revealed an apoptosis rate of 7.5% in control groups. After mTHPC-
PDT, the apoptosis rate was higher than in controls (14.9%, p