Midazolam and dexmedetomidine sedation impair systolic heart function.

BACKGROUND: Sedation is an essential part of clinical practice. Despite this fact, we still lack data describing the exact impact of sedation on heart function. PURPOSE: To compare the changes in heart function, induced after sedation with either midazolam or dexmedetomidine, using cardiac magnetic resonance imaging (MRI). METHODS: A total number of 30 volunteers were randomized into two groups: 15 participants in the midazolam group (MID) and 15 participants in the dexmedetomidine group (DEX). Every participant underwent a one-session cardiac MRI before and after sedation onset. The following parameters were recorded: left and right ventricle stroke volume (Ao-vol and Pul-vol resp.) and maximum flow velocity through the mitral valve during early (E-diast) and late diastole (L-diast). A monitor recorded values of mean blood pressure (MAP), pulse (P) and blood oxygen saturation (SpO2) in 5-minute intervals. RESULTS: Dexmedetomidine led to a statistically significant decrease in Ao-vol (p = 0.006) and Pul-vol (p = 0.003), while midazolam decreased E-diast (p = 0.019) Ao-vol (p = 0.001) and Pul-vol (p = 0.01). The late diastolic filling was not influenced by the sedation technique. CONCLUSION: Both sedation regimens worsened the systolic function of both ventricles. Midazolam moreover attenuated early diastolic filling of the left ventricle (Tab. 3, Fig. 4, Ref. 19).

New haemostat in thoracic surgery.

INTRODUCTION: The authors present the results of a promising method to reduce peroperative bleeding in thoracic surgery within large thoracic surgical interventions. Usage of a resorbable haemostat on the basis of oxidized cellulose in the form of cotton wool may minimize the cause of bleeding, mainly in patients with post-inflammatory thoracic complications. The strong point of this material is its easy application and malleability. Another advantage is the long-term antibacterial effect caused by lowering pH during its biodegradation. AIM: Retrospective evaluation of post-operative blood losses, time of thoracic drainage, length of hospitalisation, and development of inflammatory indicators between groups using and not using haemostats. METHODOLOGY: A group consisted of 48 patients (group A), who underwent operation for post-inflammatory thoracic complications and where haemostat was used. Using the pair selection method, 48 patients were selected to the control group B, where no haemostats were applied during operation. The selection depended on a similar demographic profile, identical diagnosis, and a type of operations. Post-operational blood loss, dynamics of haematological profile, time of thoracic drainage, blood parameters value, inflammatory response of the organism, and length of hospitalisation. RESULTS: A key differentiation of dynamics in development was found between the groups in the concentration of haemoglobin and haematocrit in the post-operative period, in the time of thoracic drainage, and in total length of hospitalisation. A sudden rise of CRP serum values in the group A after 12 hours after application of haemostat was recorded, most probably as manifestation of the aseptic pleuritic (Tab. 4, Fig. 1, Ref. 16).

Perspective in predicting the effect of pleurodesis in the treatment of malignant pleural effusions.

BACKGROUND: Pleurodesis with talc has been used for many years. No objective criteria of inflammatory symptoms are known in order to use them to predict the effect of therapy and selection of patients. PURPOSE OF THE STUDY: To objectify the course of local inflammatory changes in the pleural cavity, quantify their dynamics in a clinically used procedure, and to determine specific predictors of inflammation as perspective markers of selection of patients suitable for talcage. MATERIAL AND METHOD: A total of 114 patients were retrospectively divided into Group A (n1 = 98) of patients without relapse and Group B (n2 = 16) of patients with relapse of exudate. The need for repeated thoracic punctures or drainages over the course of a 12-month monitoring period was the criterion of treatment failure. RESULTS: The groups were not different as for the baseline values of sTLR-2 (p0 = 0.638). Group A showed a marked growth during the monitoring period in 2 hours following talcage (p2= 0.002) and in 24 hours (p24 = 0.016). Group B showed higher sCD-163 levels (p0 < 0.001). The initial sTREM-1 values and those after two hours were similar in both groups (p0 = 0.146; p2 < 0.0641). In 24 hours, Group A had markedly higher values (p24 < 0.001). CONCLUSION: The sTLR-2, sCD-163 and sTREM-1 values can be prospectively determined. High sCD-163 values predict unsuitable selection of a candidate for talcage. The degree of inflammatory response can be evaluated using sTLR-2 or sTREM-1. Talcage using an inserted thoracic drain can be repeated at low levels. The cost of ELISA examination is approximately 18 euros (Tab. 1, Fig. 4, Ref. 20).

[Monitoring the effectiveness of surgical treatment of malignant pleural effusions]. / Monitorace efektivity chirurgické lécby maligních pleurálních výpotku.

BACKGROUNDS: Recurrent pleural effusion occured in 10% of cancer patients. Repeated thoracocentesis or drainage may be complicated by pneumothorax, haemothorax or pleural cavity infection. Thoracoscopic talc poudrage is one of the most effective pleurodesis technique in patients with malignant pleural effusions. The effectiveness of such pleurodesis is reaching the 70 to 90%. This surgical approach also allows to take a biopsy for histological verification of the process. An effort to predict the success rate of chemical pleurodesis on the basis of the body's general inflammatory reaction rate, which is determined by the dynamics of values of humoral and cellular inflammatory parameters in both serum and in pleural effusion. PATIENTS: In the period 6/2008-12/2009 we applied biotalcum to 14 patients with malignant pleural effusions. The group of patients consisted of 10 male patients and 4 female patients of average age 71 years. Indication to include patients in the group was a second or further thoracic puncture, shortening of the interval between interventions, estimated time of survival > 3 months and the possibility of operation under selective pulmonary ventilation. METHOD: We performed the collection of pleural effusion and blood serum at 12-hour intervals. The first collection was performed preoperatively before biotalcum application, and then during the time of losses from thoracic drainage bigger than 150 ml in 24 hours. The duration of thoracic drainage was 4 days +/- 1 day. The success of the treatment was observed by ultrasound scan before drainage removal; during the first three months always at intervals of 1 month and then after 3 and 6 months, depending on the progression of a disease. RESULTS: No reccurence occured when the P-CRP (pleural) and S-CRP (serum) ratio exceeded 60% during the first 48 hours after pleurodesis. On the other hand, when the ratio fall bellow 30-35%, the effusion relapsed frequently. CONCLUSION: The P-CRP/S-CRP ratio as a promising marker of talc pleurodesis effectiveness and monitoring both P-CRP and S-CRP levels is inexpensive and acceptable method for clinical practice. The pleural effusion caused by malignant mesothelioma appeares to be resistant to talc pleurodesis.

[Improving of treatment safety in emergency thoracic surgery]. / Zvýsení bezpecnosti lécby v emergentní hrudní chirurgii.

Authors point out a possibility of improving operative results in thoracic surgery with acute state. They prove it with two groups of patients, where preoperative complications are anticipated. The first group consists of the patients with thorax injury and the second group consists of the patients with relapsing pneumothorax. With a blunt thorax injury is the surgical treatment often performed on blood-soaked pulmonary tissue or on parenchyma affected by ARDS. A necessary stapler suture during an atypical reaction is accompanied by bleeding or air-leak from the resected area. To reinforce the suture, there are used various materials for staplers to utilize a padding effect. Sometimes is necessary to use tissue sealants to prevent the air-leak. Traumacel Stapler Seam Protection meets requirements on the stapler suture reinforcement and, moreover, due to its bactericidal and haemostatic effects helps the tissue healing.

Ischemic affection of the spinal cord as a result of the blunt thoracic trauma--a case report.

Authors present the case of a patient who suffered the blunt thoracic trauma. In the clinical picture there dominated the paraplegia of both the lower extremities. Due to the weakened breathing on the right side the urgent thoracic drainage was performed. For circulation instability and amount of blood passing out of the drain an urgent thoracotomy was indicated even prior to the CT or MRI. During the operation bleeding from the Adamkiewicz's artery was spotted and sanated. After the postoperative stabilization the CT and MRI investigations proved the spinal cord ischemia as a cause of the local damage.

[Videothoracoscopy, standard and uncommon indications]. / Videotorakoskopie, standardní a méne casté indikace.

The authors' communication deals with standard cases of the application of thoracoscopy in the diagnostics and treatment. On the Cardiological Clinic of the Medical School of the Charles University and University Hospital in Hradec Králové they performed in the period 2000-2004 153 out of 837 operations using thoracoscopy (18.3%) and 22 using video assisted thoracoscopy (2.6%). Apart from the standard indications the authors mention two rare thoracoscopies when extracting a foreign body from the thorax and lungs.

[Long-term results of surgical treatment in lung cancer]. / Dlouhodobé výsledky chirurgické lécby plicní rakoviny.

The surgical treatment of lung cancer has got a long tradition at our department. The aim of this work is to evaluate the group of 3,857 patients from the years 1948-1997. The special analysis has been performed of the group of 1572 patients from the years 1974-1997 undergoing lung resection. Evaluating our operation policy a strong trend from pneumonectomy to less extensive operations can be found. The introduction of bronchoplastic operations and modern diagnostic methods has substantially improved the possibility of surgical treatment. The utilization of TNM system enabled to compare the different groups of patients according to the unified classification. The long term survival was directly related to the stage and histological type of disease. The five years period survived 33% of patients in whom the lung resection was performed during the period 1974-1997. The operative hospital mortality has been substantially reduced to 1.7%. Even though it is our duty to provided the surgical treatment to all the patients if the resection is still possible the best results are to be expected in patients in the first stage of disease. Therefore the early diagnosis followed by adequately sized resection without delay offers the best chance for the patients long term survival.

[Early surgical stabilization of the thorax]. / Casná chirurgická stabilizace hrudníku.

Patients with non-penetrating chest trauma are encountered with increasing frequency. Car crash is the main cause of blunt chest trauma. Despite their nature these lesions may be life-threatening. The mortality rate of chest injuries varies from 20 to 50%. In the last 3 years 86 patients with blunt chest injuries were treated in our institution. 24 patients underwent surgical repair. We compared the outcome of surgical and conservative treatment. Early diagnosis and proper treatment reduce morbidity and mortality.

[Successful indirect cardiac massage as a cause of thoracic wall instability and respiratory insufficiency]. / Ucinná neprímá srdecní masáz jako prícina nestability hrudní steny a dechové nedostatecnosti.

The authors in their two cases describe unusual complication after successful indirect cardiac massage which was carried out in terrain. Both patients were then transferred to Dept. of gerontology and metabolic care. However the resuscitation was in both cases successful it caused in these two cachectic oseoporotic patients sternal and costal en block fractures. This iatrogenic trauma of thoracic wall showed up in further cause as a major problem. The patients could not have been disconnected from artificial support of ventilation and therefore their thoracic cage had to be surgically stabilized.

[Control of blood loss with topical administration of aprotinin after pulmonary tissue decortication and pleurectomy]. / Ovlivnení krevních ztrát po dekortikaci plicní tkáne a pleurektomii lokální aplikací aprotininu.

The authors were prospectively monitoring postoperative blood loss in 23 patients, in which decortication of the lung tissue and pleurectomy was performed and in which 500,000 KIU of aprotinin was applicated locally to the operating field before closing chest. The study was performed between the years 1998 and 2001. The amount of blood loss was compared to that of a group of 23 patients who underwent the same type of surgery between 1991 and 1998 without use of aprotinin. The postoperative blood loss was monitored 6, 12 and 24 hours after completing the surgery. Postoperative blood loss was lower in the group of patients in which aprotinin was used which was found to be statistically significant compared to the group of nonaprotinin patients.

[Surgical treatment of lung cancer]. / Chirurgická lécba plicní rakoviny.

The surgical treatment of lung cancer has got a long tradition at our department. The aim of this work is to evaluate the group of 3,727 patients from the years 1948-1995. The special analysis has been performed of the group of 1,456 patients from the years 1974-1995 undergoing lung resection. Evaluating our operation policy a strong trend from pneumonectomy to less extensive operations can be found. The introduction of bronchoplastic operations and modern diagnostic methods has substantially improved the possibility of surgical treatment. The utilization of TNM system enabled to compare the different groups of patients according to the unified classification. The long term survival was directly related to the stage and histological type of disease. The five years period survived 32% of patients in whom the lung resection was performed during the period 1974-1995. The operative hospital mortality has been substantially reduced to 2%. Even though it is our duty to provide the surgical treatment to all the patients if the resection is still possible the best results are to be expected in patients in the first stage of disease. Therefore the early diagnosis followed by adequately sized resection without delay offers the best chance for the patients long term survival.

Congenital absence of the left pericardium in combination with left pulmonary artery hypoplasia, right aortic arch, and secundum atrial septal defect.

The authors describe a rare congenital anomaly--absence of the left pericardium--in one patient who was operated on for a secundum atrial septal defect. The symptomatology, diagnostic, and therapeutic possibilities are discussed.