[Pneumosurgery in the management of colorectal carcinomas]. / Pneumochirurgie v resení karcinomu kolorekta.

OBJECTIVE: Surgically solved lung involvement in patients after surgery of colorectal cancer. MATERIALS AND METHODS: Altogether 15 patients, 9 men (median age in the time of lung diagnosis 67 years) and 6 women (median age 59 years) underwent classical open pulmonary surgery during 2003-2008 years from the follow-up cohort of 836 persons after operation due to colorectal cancer in the time period of 1996-2008 years. The indication for lung surgery: solitary pulmonary lesion. Procedures distribution: pulmonary lobectomy 7, bilobectomy 2, segmentectomy 4, wedge resection 2. The requirement of the European Society of Thoracic Surgeons (ESTS) guidelines of complete pulmonary resection has been met by 10 operations (66.7%) with lobe specific lymphadenectomy. Histopathology investigation: Formalin fixed, paraffin embedded samples were investigated after hematoxylin-and-eosin staining, supplemented in case of need by immunohistochemistry of CK7, CK20 and TTF1. RESULTS: Eleven pulmonary metastases were found, in two cases with interlobar lymfatics involvement. Two metachronous primary adenocarcinomas of the lung (ADL) were diagnosed, one of them with metastases into hilar lymphatics. In remaining two patients pulmonary chondrohamartoma was discovered. CONCLUSION: Solitary pulmonary opacity in patient after colorectal surgery might not represent simple metastasis explicitly. Complete resection is needed.

[Complications in patients undergoing pulmonary oncological surgery]. / Komplikace u pacientu po operaci pro plicní malignitu.

AIM: A survey evaluating incidence and risk factors of complications in persons underwent complete open lung resection because of primary or secondary lung malignancy. MATERIAL AND METHODS: Retrospective study of 189 open surgery procedures in 128 males and 61 females, mean age males 61 years (range 21-78), females 64 years (range 33-80) during a five-years period (2003-2007). Data processing and analysis were performed with the statistical software system Statistica and compared by parametres odds ratio a chi2 test. RESULTS: Complications were divided into five groups. First group was defined as complications in perioperative period and was composed of three events 1.5%: endotracheal tube dysfunction (i.e. 0.5%), heavy cardiac arrhytmia 0.5% and serious haemorrhage, that occurred immediately after operation 0.5%. Second group includes complications within period of 7 days after surgery: prolonged air leak (PAL > 7 days) 7.4%, bronchopneumonia 6.9%, cardiac arrhythmia 6.9%, postoperative delirium 4.2%, atelectasis 2.6%, wound infection 1.1%, bleeding 1.1% and chylothorax 0.5%. Third group contains events between 8th and 30th postoperative days: thoracic empyema 2.1%, dysphonia 2.1%, painfull shoulder 1.1%, alimentary tract infection 0.5% and bronchial closure insufficiency 0.5%. Fourth group contains patients with severe complications, that led to death during 30 days after operation: ischemic stroke 0.5% and pulmonary embolism 0.5%. Patients without any complication formed the fifth group of 60.5%. CONCLUSION: Main risk factors for complications in postoperative period after lung resection due to primary or secondary lung malignancy in our group of patients are COPD, corticotherapy, time of operation over 3 hours, BMI over 25, left side tumor localization and bronchoplastic procedure. For cardiac arrhytmia seems to be risk factor pneumonectomy and previous neoadjuvant radiochemotherapy.

[Pulmonary segmentectomy for tumour]. / Plicní segmentektomie pro nádor.

BACKGROUND: An analysis of outcome data of pulmonary segmentectomy focused on local efficacy in primary non small cell lung cancer and true or seeming lung metastasis. PATIENTS AND METHODS: Miscellaneous series of twenty patients treated with classical open procedure involving individuals with primary or metachronous non small cell lung cancer, solitary pulmonary metastasis of extrapulmonary cancer and/or benign pulmonary lesions, lung metastasis mimicing. Thirteen patients after segmentectomy because of malignancy are separated into a group of 7 cases with NSCLC up to 20 mm in diameter, and a group of 6 persons with solitary pulmonary opacity up to 38 mm treated previously surgically for extrapulmonary cancer. Both without enlargement of hilar and/or mediastinal lymphatics proven on preoperative CT imaging. Third part of the group collects benign pulmonary lesions: chondrohamartoma, pneumonitis and pulmonary infarct. Persons involved through a ten years period are followed up at 3 (4)-months intervals. RESULTS: No perioperative and thirty day mortality was registered. Six cases of distant recurrence were recorded, three in NSCLC and three in extrapulmonary cancer patients. Five patients died within the follow-up period, three of them through the general progression of the oncological disease. Two deaths were non-cancer related. One R1 disease was discovered in a patient with primary lung adenocarcinoma. No local recurrence was recorded in both cancer series with median age of 63 yrs (range 45-79 yrs) and median duration of follow up 35 months. CONCLUSION: Lung segmentectomy seems to accomplish local control of early stage non small cell lung cancer and pulmonary metastasis of extrapulmonary cancer in selected patients.

[Our experience with treatment of postoperative pain in Crohn's disease]. / Nase zkusenosti s lécbou pooperacní bolesti u Crohnovy nemoci.

When conservative options for the treatment of Crohn's disease are exhausted, surgical treatment of complications is indicated. Based on our experience, it appears that the pain thershold is reduced in these patients and, compared to other patients undergoing comparable procedures, they poorly tolerate postoperative algesia. In the report, the authors concentrated on postoperative analgesia, considering the altered pain perception of the subjects, with the aim to define the best analgesic procedure.

[Utilization of continuous elimination methods at the surgical ICU]. / Vyuzití kontinuálních eliminacních metod na chirurgické JIP.

The authors inform about the causes of introduction and use of continuous veno-venous hemofiltration at theirs intensive care unit. They describe in details this technique. They present theirs experience in this field and give the overview of the development of its indication in the last years. Based on group of 46 patient results, they recommend implementation of this technique to intensive care units, where surgical patients with organ insufficiency are treated as highly positive and essential.

[Hemodynamic changes during laparoscopic cholecystectomy]. / Hemodynamické zmeny behem laparoskopických cholecystektomií.

The authors investigated in 24 patients with ASA I or II who were subjected to elective laparoscopic cholecystectomy haemodynamic parameters (CI, SI, HR, MAP, SVRI, EF and LCWI), assessed by transthoracic electric bioimpendance. They used a BoMED NCCOM3 apparatus and evaluated data from the period before induction of anaesthesia (considered as control data), after induction of anaesthesia, immediately after insufflation of CO2 into the peritoneum, 30 minutes after insufflation and after desufflation. Insufflation of CO2 into the peritoneum caused a statistically significant drop of CI (p < 0.05), reduction of HR (p < 0.05), a drop of EF (p < 0.05), reduction of LCWI (p < 0.05) and a statistically significant rise of SVRI (p < 0.001). Thirty minutes after insufflation another significant drop of CI occurred and also for the first time of SI (p < 0.05 and p < 0.05 resp.); the mean values of HR and MAP did not differ significantly from control values, SVRI remained elevated (p < 0.05) and EF was permanently reduced (p < 0.05). After desufflation all haemodynamic values with the exception of EF did not differ significantly from control values. The reduced EF (p < 0.05), however, reached as to its absolute value the lower borderline of the physiological range. Based on these results, the authors assume that in patients with a compromised cardiovascular apparatus circulatory complications could develop. In these patients laparoscopic cholecystectomy should be indicated after due consideration.