Christos Lafaras

Neoplastic pericardial disease in lung cancer: Impact on outcomes of different treatment strategies. A multicenter study

BACKGROUND Local (intrapericardial) chemotherapy has been reported to be useful for the treatment of neoplastic pericardial disease, but it has never been compared to systemic chemotherapy, a combination of the two and simple pericardial drainage or sclerosis. METHODS We analyzed the clinical and echocardiographic data of 119 patients, suffering of neoplastic pericarditis due to lung cancer (97 with non-small-cell), comparing the outcomes of four different treatment strategies (extended catheter drainage/sclerosis, systemic chemotherapy, local chemotherapy, and combined - local plus systemic - chemotherapy) at the last available follow-up or at the change of therapy after a treatment failure. The outcomes (based on semiquantitative evaluation of pericardial disease) were classified as complete, partial, no response and progressing disease. RESULTS A complete response was achieved in 37/53 of patients with combined, in 12/22 with local, in 5/27 with systemic chemotherapy, respectively, and in 4/17 after drainage/sclerosis (p<0.001). Overall response was achieved in 51/53 with combined, 18/22 and 16/27 with local or systemic chemotherapy, respectively, and in 5/17 with drainage/sclerosis only (p<0.001). Survival was significantly better after combined chemotherapy (p<0.001) and 12/53 patients (23%) in this subgroup survived more than 1 year. The overall response rate was higher with intrapericardial cisplatinum than with other agents (98% vs 80%, χ(2)=7.69, p<0.01). CONCLUSIONS Local chemotherapy, alone or with systemic chemotherapy, is effective in treating pericardial metastases from lung carcinoma, leading to a good control of pericardial effusion in 92% of cases, and to complete disappearance of effusion and masses in 65%. Combined therapy is significantly better than any other treatment. Pericardiocentesis and intrapericardial chemotherapy should be used whenever possible in lung cancer neoplastic pericardial disease, not only in case of tamponade.

Non-thromboembolic pulmonary hypertension in multiple myeloma, after thalidomide treatment: A pilot study

BACKGROUND Multiple myeloma (MM) is thrombogenic as a consequence of multiple hemostatic effects and endothelial damage. Thalidomide has been associated with an increased risk of thromboembolic pulmonary hypertension (PH). PH in the absence of venous thromboembolism has also been described in MM patients during thalidomide treatment. AIM Detection of clinical and subclinical nonthromboembolic PH in MM patients after thalidomide treatment. PATIENTS AND METHODS Eighty-two patients, 46-82 years (median age 61 years), 42 males, were studied. They underwent echocardiographic study at baseline, 1 month thereafter, 6 months later and whenever symptoms indicating deterioration of cardiac function appeared. Echocardiographic signs of PH were especially identified. RESULTS Clinical and echocardiographic evaluation revealed four patients (out of 82 patients, 4.87%) with PH. Nonimaging and imaging diagnostic methods excluded thromboembolic PH. Statistical analysis demonstrated significant correlation between structural heart disease and PH (r = 14.078; P = 0.008). No significant correlation between age (r = 0.770; P = 0.724), gender (r = 1.157; P = 0.285), International Staging System (ISS) (r = 0.316; P = 0.716) and PH was found. CONCLUSIONS Preexisted endothelial dysfunction due to structural cardiac disease enhances the vasoactive substances release causing increased pulmonary vascular resistance. Thalidomide possibly causes a vasodilator and vasoconstriction imbalance, which may cause abnormal pulmonary vascular response interfering to a vicious circle perpetuating PH.

Intraoperative tracheal reconstruction with bovine pericardial patch following iatrogenic rupture.

IntroductionIatrogenic injuries of the membranous trachea have become increasingly common and may trigger a cascade of immediate life-threatening complications.Case presentationA case of a 48-year-old man with an iatrogenic membranous tracheal wall rupture after double-lumen intubation during Ivor Lewis esophagogastrectomy is presented. Tracheal injury was successfully managed surgically with the use of bovine pericardial patch and reinforcement with the gastric conduit which was moved toward the posterior wall of the membranous trachea sealing the wall laceration.ConclusionOur technique was proved to be safe, effective and not technically demanding. Early recognition with prompt surgery is the gold standard of managing such cases, although small tears can be managed conservatively.

Evaluation of Treatment with Bosentan in Patients with Carcinoid Heart Disease: Single Center Study

Background: The primary aim of this study was to evaluate a combined therapeutic intervention, including the dual endothelin receptor antagonist bosentan, in patients with carcinoid heart disease (CaHD). The efficacy of the treatment protocol was investigated using serological, echocardiographic, and clinical markers. Patients and Methods: Since 2003, 40 patients with neuroendocrine tumours were identified; 14 had echocardiographic findings consistent with CaHD. Six of the 14 patients with CaHD and a New York Heart Association (NYHA) functional class ≥ III received bosentan and were eligible for inclusion in this study. Results: N-terminal pro-brain natriuretic peptide (NT-pro-BNP) had decreased 6 months after treatment with bosentan (median: 646 pg/ml vs. 400.5 pg/ml; p = 0.02); the right ventricular systolic pressure had decreased after 3 and 6 months (median: 69 mmHg vs. 61 mmHg, p = 0.02; median: 69 mmHg vs. 48.5 mmHg, p = 0.02); the 6-minute walk distance (6MWD) had significantly improved after 3 and 6 months of treatment (median: 293.5 vs. 406.5 m; p = 0.02; median: 293.5 vs. 578.5 m; p = 0.02). The NYHA functional class improved in 5/6 patients receiving bosentan. Conclusions: Combined treatment with bosentan is effective in patients with CaHD, based on functional class, 6MWD, and NT-pro-BNP. Further clarification of the CaHD fibrosis pathogenesis is needed to facilitate development of targeted antifibrotic therapeutic agents.

Pro-Brain Natriuretic Peptide is a Sensitive Marker for Detecting Cardiac Metastases in Patients with Non-Small Cell Lung Cancer

Background: B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP) are important diagnostic tools for patients with suspected cardiac disorders. The aim of this study was to evaluate the predictive value of plasma NT-pro-BNP in identifying cardiac metastases in patients with non-small cell lung cancer (NSCLC) and dyspnoea. Patients and Methods: A total of 120 patients, median age 62 years (range 46–83), with NSCLC and dyspnoea were studied. Patients with heart failure or documented coronary artery disease were excluded. Echocardiographic imaging was used to detect cardiac metastases and estimate global left ventricular function. Ejection fraction and E/A ratio from transmitral inflow pattern were calculated. Plasma NT-pro-BNP was also measured. 72 patients (72/120, 60%) with cardiac metastases were identified. Results: NT-pro-BNP was significantly higher in patients with metastases (1347.5 ± 1004.30 pg/ml vs. 159.02 ± 93.29 pg/ml; p = 0.001). No differences between groups, regarding s-creatinine (p = 0.45), haemoglobin (p = 0.71), left ventricular hypertrophy (p = 0.91), and diastolic dysfunction (p = 0.79), were observed. Conclusion: Plasma NT-pro-BNP is remarkably elevated in patients with NSCLC and myocardial/pericardial infiltrations and may be used as a sensitive marker for detecting cardiac metastases in these patients.

Cardiac tamponade as primary manifestation of angioimmunoblastic T-cell lymphoma (AILT). Coexistence with malignant mesothelioma.

Background: Cardiac tamponade (CT) as the primary clinical manifestation of lymphomas is extremely rare. Angioimmunoblastic T-cell lymphoma (AILT) is characterised by systemic disease usually presenting with generalised peripheral lymphadenopathy, hepatosplenomegaly, and bone marrow infiltration. Case Report: We report on a 59-year-old male patient with CT as initial clinical manifestation of AILT. Coexistence with malignant pleural mesothelioma was additionally revealed. Cytologic examination of pericardial fluid presented diffuse lymphoid cells and sporadic malignant mesothelial cells. AILT diagnosis was confirmed by thoracoscopic mediastinal lymph node and bone marrow biopsy. Despite the presence of pleural effusion, the diagnosis of mesothelioma was initially established by cytologic ex-amination of pericardial fluid, due to the patient’s critical cardiac condition requiring prompt subxiphoid pericardiocentesis. Conclusion: CT as primary clinical manifestation of AILT is very rare. This case reflects the differences in the underlying biology of AILT and consequently the vast spectrum of its clinical presentations. Coexistence of AILT with malignant pleural mesothelioma is also extremely rare.

Deutsche Osteoonkologische Gesellschaft gegründet

zudem Dr. Holger Uhthoff, Speyer (Schatzmeister) und Prof. Dr. M. Heinrich Seegenschmiedt, Hamburg (Schriftführer) an. Zu Beisitzern wurden PD Dr. Christian Eberhardt, Hanau, Prof. Dr. Tanja Fehm, Tübingen, Prof. Dr. Franz Jakob, Würzburg, und PD Dr. Florian Schütz, Heidelberg berufen. Die Gesellschaft umfasst derzeit 45 Gründungsmitglieder. Mitglied werden kann jeder, der sich wissenschaftlich mit dem Gebiet der Osteoonkologie beschäftigt. Die Gesellschaft wird als Verein eingetragen und die Gemeinnützigkeit wird beantragt.

eComment: Pericardial sclerosis with cisplatin following pericardiocentesis. A simple and effective technique for the management of refractory malignant pericardial effusions

Severe pericardial effusion in patients with concurrent malignancy: a retrospective analysis of prognostic factors influencing survival. factors for malignant pericardial effusion treated by pericardial drainage in solid-malignancy patients. and prognostic outcomes of double-balloon pericardiotomy for large malignancy-related pericardial effusions. Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. of pericardial fluid cytology in cardiac tamponade associated with non-small cell lung cancer. We read with great interest the article by A ´ podaca-Cruz et al. concerning the effectiveness and prognosis of initial pericardiocentesis in the primary management of malignant pericardial effusions w1x. The aim of our brief comment is to highlight the advantages of pericardi-ocentesis followed by intrapericardial cisplatin administration in patients with neoplastic pericarditis. In our center, we favor pericardiocentesis and subsequent cisplatin instillation as the method for preventing recurrence of malignant pericardial effusion, especially in patients with lung cancer. Our results were documented during a 5-year period study w2, 3x. Pericardiocentesis followed by intrapericardial administration of cisplatin is safe and effective in preventing the re-accumulation of malignant peri-cardial effusion in the majority of oncology patients. In case of recurrence, the creation of a pleuropericardial window through a mini thoracotomy or a VATS procedure is the last alternative and is absolutely indicated. Effectiveness and prognosis of initial pericardiocentesis in the primary management of malignant pericardial effusion. Intrapericardial cisplatin administration after pericardiocen-tesis in patients with lung adenocarcinoma and malignant cardiac tamponade.

Post-pericardiotomy syndrome following lung cancer surgery

DOI:€10.1510/icvts.2010.248948A Interact CardioVasc Thorac Surg 2010;11:871- Nikolaos Barbetakis, Christos Asteriou, Athanassios Kleontas and Christos Lafaras Post-pericardiotomy syndrome following lung cancer surgery http://icvts.ctsnetjournals.org/cgi/content/full/11/6/871 located on the World Wide Web at: The online version of this article, along with updated information and services, is