A pleura óriás fibrosus tumora légzési elégtelenséggel szövodve.

Surgery of mostly benign giant tumours involving large part of the chest is a special surgical challenge. The problems comprise difficulties of surgical technique, management of the narcosis and postoperative intensive care. An additional peculiarity of our case is the extreme confliction of the otherwise presumably evident indication for surgery. Our 64-years-old male patient has been suffering from increasing dyspnoea on exercise for one and a half years. A chest X-ray performed for other reasons demonstrated a large, expansive structural change in the right thoracic cavity. Lung biopsy performed as part of respiratory investigations, which showed a solitaire fibrous tumour of the pleura. Oncological consultation suggested consideration of surgery. The general condition of the patient worsened rapidly in the course of preassessment; he had to be admitted to ICU due to dyspnoea and atrial fibrillation, where respiratory insufficiency developed and required respiratory therapy. Surgery was performed in this high anaesthetic risk patient, since removal of the tumour was the only chance for surviving. The patient left the hospital healthy after successful surgery and cumbersome postoperative period. He returned to his original job and no recurrence was detected one year after surgery.

[Hemorrhagic complications of chronic anticoagulant treatment in a single intensive care unit]. / A krónikus antikoaguláns kezelés intenzív osztályos ellátást igénylo vérzéses szövodményei osztályunkon.

INTRODUCTION: There are well defined indications in which chronic anticoagulant treatment has been widely applied. However, complications of this therapy are less discussed, although these complications may lead to serious or even fatal consequences. AIM: The aim of the authors was to analyze data of patients admitted to their multidisciplinary intensive care unit for complications of chronic anticoagulant therapy between January 1, 2006 and December 31, 2011. METHOD: Data of 73 patients admitted for serious hemorrhagic complications of chronic anticoagulant therapy were retrospectively analysed. RESULTS: Of the 73 patients, 63 patients had intracranial bleeding, most of them with traumatic origin. A few patients with other hemorrhagic complications such as spinal hematoma, gastrointestinal bleeding, hemorrhagic cystitis, hemothorax and intraabdominal bleeding were also noted. The INR values were out of therapeutic range in 43 patients. The mortality of patients was very high in spite of complex intensive care; 49 of the 73 patients (75.5%) died due to hemorrhagic complications. CONCLUSIONS: Due to the high proportion of traumatic origin, the large number of out-of-range INR, and the high mortality, the authors strongly believe that regular patient follow-up, transmission of detailed information, and time-to-time reevaluation of the indications and contraindications of chronic anticoagulant therapy could help to decrease the number of serious and fatal complications of chronic anticoagulant therapy.

Analysis of the 8.1 ancestral MHC haplotype in severe, pneumonia-related sepsis.

The most frequent Caucasian MHC haplotype, AH8.1 - associated with numerous immunopathological differences and certain autoimmune diseases - was recently linked to the delayed onset of bacterial colonization in cystic fibrosis. Based on this observation, we hypothesized that the carriers of AH8.1 have lower risk for a worse outcome in sepsis. AH8.1 carrier state was determined in 207 Caucasian patients with severe, pneumonia-related sepsis. Our data showed that in patients without chronic obstructive pulmonary disease (COPD), septic shock - a serious consequence of the bacterial infection - occurred significantly less frequently (OR=0.3383; 95% CI=0.1141-0.995; p=0.043) in carriers of AH8.1, than in non-carriers. According to the multivariate logistic regression analysis, this haplotype had an independent protective role against septic shock in all patients (OR=0.315; 95% CI=0.100-0.992; p=0.048), particularly in COPD-free patients (OR=0.117; 95% CI=0.025-0.554; p=0.007). These results indicate that AH8.1 may confer protection against the progression of bacterial infection, and this could explain, at least partially, its high frequency in the Caucasian population.

[Management of malignant and benign airway stenosis by stent implantation]. / Malignus és benignus légúti szukületek megoldása légúti protézis (stent) beültetésével.

INTRODUCTION: In the last few decades the different bronchoscopic procedures have gained an important role in the treatment of airway stenosis, and the number of implanted airway stents has also greatly increased. PATIENTS: Between 1998 and 2004 the authors implanted altogether 108 airway prosthesis in 90 patients at the Institute of Pulmonology of Pest County. 58% of the patients were males, 42% females, the average age was 57.5 years, the average follow-up time was 7 months. RESULTS: On the basis of different etiology the patients were separated into two main groups. In 57% the airway stenosis was caused by malignant illnesses, in these cases stents can be used only with palliative purpose. However, in case of benign lesions they can offer a long-term solution and require an adequate follow-up of the patients. The authors' main aim was to get an overall picture of the interventions they had done by processing the data, with the help of the measurable characteristics that make possible to follow the airways' permeability and its changes. Analysing the results of the respiratory function and blood gas examinations they didn't find a significant difference inspite of the subjective improvement.

[Acute quadriplegia after diabetic ketoacidosis]. / Diabeteses ketoacidózis után kialakuló akut tetraplégia.

A 36-year-old female was admitted to the intensive care unit after resuscitation diagnosed with diabetic ketoacidotic coma, which was the first manifestation of her diabetes mellitus. It may have been provoked by pulmonary or gastrointestinal coinfection. Five days following admission the patient regained consciousness and homeostasis returned to normal. One week after the stabilization of her cardiopulmonary state, weaning from the respirator turned out to be unsuccessful: flaccid tetraparesis developed with rapid muscle atrophy and absence of deep tendon reflexes. The sensory system and cranial nerves remained intact. Electrophysiological studies and muscle biopsy showed serious acute illness myopathy with mild demyelination owing probably to the latent diabetes. The course of acute quadriplegia was fluctuating and correlated mainly with the activity of the systemic inflammatory response syndrome mechanisms. Myopathy might have been aggravated by using high-dose glucocorticoid therapy. The patient's general condition improved quickly as a result of full recovery from sepsis, discontinuation of glucocorticoids and normoglicaemia maintained by subcutan insulin substitution. Eight months after admission almost full neuromuscular restitution was achieved showing the reversibility of this grave illness.

Comparison of nasal and oral inhalation during exhaled breath condensate collection.

Analysis of exhaled breath condensate is a method for noninvasive assessment of the lung. Condensate can be collected with a nose clip (subjects inhale and exhale via the mouth) or without it (subjects inhale via the nose and exhale via the mouth), but the mode of inhalation may influence condensate volume and mediator levels. We compared condensate volume and adenosine, ammonia, and thromboxane B2 levels in young healthy volunteers (n = 25) in samples collected for 10 minutes from subjects with or without a nose clip. Patients with allergic rhinitis (n = 8) were also studied to assess the effect of upper airway inflammation on mediator levels. Adenosine, ammonia, and thromboxane B2 levels were determined by HPLC, spectrophotometry, and radioimmunoassay, respectively. Volume of condensate was significantly higher without nose clip than that with nose clip (mean +/- SD, 2321 +/- 736 microl and 1746 +/- 400 microl, respectively; p = 0.0001). We found no significant difference in any mediator levels between these two collection modes in healthy volunteers, but adenosine showed a tendency to differ between oral and nasal inhalation in patients with allergic rhinitis. Our data indicate that whereas a greater volume of condensate can be obtained when subjects inhale through their noses, the mode of inhalation does not influence mediator levels in young healthy volunteers, but may affect these levels in patients with allergic rhinitis.

[Surgical treatment of pulmonary embolism]. / Tüdóembólia sebészi kezelésének lehetóségei.

The authors describe the pathology and the symptoms of pulmonary embolism with possible therapies, including thrombolysis and suction extraction. We performed two successful operations and after the examination of the data of the literature we think that in most patients the conditions for immediate surgery are not present. After the acute period, when the cardio-respiratory status is stabile, pulmonary embolectomy can result in complete recovery. Extracorporeal circulation and cardiac surgical background are necessary for the intervention. The seven Hungarian adult cardiac surgical centers could save the life of many patients.

[Continuous postoperative epidural analgesia in abdominal surgery using ropivacain]. / Posztoperatív folyamatos epidurális fájdalomcsillapítás hasi sebészeti betegeknél ropivacain alkalmazásával.

We studied the selective block on patients receiving epidural Ropivacain (R) infusion for postoperative analgesia after major abdominal surgery. Twenty patients received R and twenty patients received Bupivacain (B) via peridural catheter during and after surgery. The patients' age ranged between 40 and 80 and they belonged to ASA I, II and III risk group. The epidural catheter was inserted one day before surgery and the proper position was tested by 80 mg Lidocaine. The epidural needle was inserted via T10-L1 interspaces in upper abdominal surgery and through L1-L3 interspaces in lower abdominal surgery. After the operation continuous epidural infusion of 2 mg/ml solution of R or 2.5 mg/ml solution of B was started. The infusion rate was changed according to the grade of sensory and motor block. The following parameters were observed during the postoperative 72 hours: blood pressure, heart rate, arterial blood O2 saturation, modified Bromage (BMG) score, verbal analogue scale (VAS), the spread of sensory block. Satisfactory sensory blockade was achieved with both local anaesthetics. The required daily dose of R and B increased during 72 hours. VAS scores reached their maximum level within 24 hours and were lower in the R group than in the B group but the difference was not significant. We experienced that 0.25% B causes more intense motor block than 0.2% R in equianalgetic dose but the difference did not reach a significant level. The infusion rate was often decreased because of the unwanted motor block caused by 0.25% B leading to insufficient postoperative analgesia. Because of this fact patients receiving B required opioid addition more often. Our conclusion is that R/B relative dose ratio is 1.2 suggesting that these local anaesthetics have different analgesic potency.