Left upper lobe pulmonary adenocarcinoma with partial anomalous pulmonary venous connection in the same lobe: Case report / Bal felso lebenyi adenocarcinoma és pulmonális vénás fejlodési rendellenesség együttes elofordulása

Authors present a case of a 60-year-old male patient with left upper lobe cancer in association with partial anomalous pulmonary venous connection (PAPVC) in the same lobe. The hemiazygous vein joined the left superior pulmonary vein above the aorta in the thorax cavity draining into the left brachiocephalic vein causing left to right shunt flow. PAPVC was clearly identified intraoperatively and left upper lobectomy was performed as definitive solution for both. PAPVC was closed by stapler. To our knowledge 32 operated cases of lung cancer with PAPVC has been described in the literature (PubMed), including our patient.

[Standardization of VATS lobectomies in our department between 2011-2017 in regard to results of their oncological follow-ups]. / A VATS lobectomia standardizálódása osztályunkon 2011­2017 között az onkológiai utánkövetés eredményeinek tükrében.

Introduction: Authors present their 7-year experience since the introduction of minimal-invasive (VATS) lobectomies for lung cancer in regard to their surgical technique, results and oncological follow-up. Method: 173 VATS lobectomies were performed between June 2011 and December 2017, 105 men and 68 women. The mean age of patients was 64.1 years. Duration of surgery was 130 minutes on average. Results: Conversion to thoracotomy was required in 8 cases (3 bleedings, 3 pulmonary vessel lymph node infiltrations, 2 bronchial suture insufficiencies). Twenty persistent air leaks developed postoperatively, requiring 10 re-drainages and 10 re-operations: 7 re-VATS and 3 thoracotomies. Two hematomas were evacuated by re-VATS, 1 postoperative atrial fibrillation required cardioversion. There were no perioperative deaths. The 164 malignant cases were: 110 adenocarcinomas, 32 squamous cell carcinomas, 6 small cell neuroendocrine carcinomas, 4 undifferentiated carcinomas, 4 carcinoid tumours, 1 synchronous adenocarcinoma and squamous cell carcinoma, 1 synchronous adenocarcinoma and small cell carcinoma, 1 carcinosarcoma and 5 metastasis from other primary tumours. 118 patients received adjuvant chemotherapy. Tumour staging distribution was: IA 40, IB 53, IIA 29, IIB 16 and IIIA 21 cases. During an average follow-up time of 19.5 months, 9 local tumour recurrence and 27 distant metastasis evaluated, of which 11 were pulmonary (3 multiplex), 10 bone, 6 cerebral, 3 hepatic (1 multiplex), and 3 suprarenal gland. Conclusion: Our results correlate with published literature. During the period of this review, VATS lobectomies became a routine surgical technique in our department. Our experience proved that axillary thoracotomy is an advantage to learn the anterior VATS lobectomy technique.

Proton dissociation properties of arylphosphonates: Determination of accurate Hammett equation parameters.

Determination of the proton dissociation constants of several arylphosphonic acid derivatives was carried out to investigate the accuracy of the Hammett equations available for this family of compounds. For the measurement of the pKa values modern, accurate methods, such as the differential potentiometric titration and NMR-pH titration were used. We found our results significantly different from the pKa values reported before (pKa1: MAE = 0.16 pKa2: MAE=0.59). Based on our recently measured pKa values, refined Hammett equations were determined that might be used for predicting highly accurate ionization constants of newly synthesized compounds (pKa1=1.70-0.894σ, pKa2=6.92-0.934σ).

[The first use of iv. idarucizumab for dabigatran reversal in Hungary]. / A dabigatran-antidótum, az intravénás idarucizumab elso hazai alkalmazása.

At present, the direct thrombin inhibitor dabigatran is the only one amongst the new direct anticoagulants which has an effective, specific reversal agent. The novel agent idarucizumab is a humanized, monoclonal antibody fragment binds to dabigatran within minutes thereby offers an opportunity to induce a safe, long-lasting reverse of the anticoagulant effects of dabigatran. The authors describe the first use of idarucizumab in Hungary (23. 05. 2016) in an old female patient with non-valvular paroxysmal atrial fibrillation of high stroke risk-score and renal dysfunction who was taking dabigatran (2 x 110 mg/day) when an acute abdomen developed requiring emergency cholecystectomy. Patient received the antidote (idarucizumab 2 x 2.5 g/50 ml iv.) two hours before the surgical intervention, and she did not have any uncontrollable, life-threatening bleeding during the surgery. The high activated partial thromboplastin time relating to anticoagulative influence before the surgery normalized completely after administration of the antidote. Antagonizing dabigatran with idarucizumab was feasible and safe without any side effects. The patient received dabigatran therapy again after her recovery. Orv. Hetil., 2017, 158(10), 387-392.

[Fulminant isolated necrotizing fasciitis of the chest wall, complicating thoracic empyema]. / Fulmináns lefolyású, mellkasi empyemát okozó izolált mellkasfali fasciitis necrotisans.

Authors introduce the case of a 64-year-old male patient with fulminant isolated necrotizing fasciitis of the chest wall, complicating empyema thoracis of unknown origin. The patient's co-morbidities were hypertension, ischaemic heart disease, atrial fibrillation with oral anticoagulation. The real etiology was revealed post mortem, due to the rapid progression. The autopsy demonstrated that the fasciitis was caused by a small blunt thoracic trauma (haematoma), not emerged from patient's history and was not visible during physical examination. Authors review diagnostic pitfalls, leading to delayed recognition in addition to this very case. After quick diagnosis surgical debridement, targeted wide spectrum antibiotics and maximal intensive care are the basic pillars of the management of necrotizing fasciitis.

[Digital drainage system in the postoperative treatment of thoracic surgical patients]. / Mellkassebészeti betegek posztoperatív kezelése digitális szívórendszer alkalmazásával.

INTRODUCTION: persistent air leak is one of the major complications following pulmonary resections and, in combination with immobilization, it increases the cost of treatment significantly. METHODS: Authors analyzed retrospectively data of 40 consecutive patients of a thoracic surgical unit between 01. March 2011 and 30. October 2011. The mean age of 22 men and 18 women was 61.6 years. They applied electronic chest drainage system for all patients after open or VATS wedge resections or lobectomies. Drains were removed according to the electronical drainage data. RESULTS: After open wedge resections the drainage time was 57 hours, and 6.2 days of hospital stay. Open lobectomies resulted in 59.8 hours drainage time and 6.8 days of hospital stay. VATS wedge resections were followed by 75.2 hours drainage and 5 days of hospital stay, while VATS lobectomies needed 48 hours duration of chest tubing and 4.5 days of in-patient stay. CONCLUSIONS: Electronic chest drainage systems are easy-to-use, portable and safe, offering objective data of the amount of postoperative air leak, and visualize the trends in graphical format, too. Importantly, early mobilization contributes to cost reduction. In combination with VATS technique surgical stress is significantly reduced as well as postoperative recovery is shortened.

Comparing bipolar electrothermal device and endostapler in endoscopic lung wedge resection.

Video-assisted thoracoscopy (VATS) is gaining on thoracic surgery, having newly developed devices next to endostaplers for haemostatic and airtight sealing of lung parenchyma. Though the bipolar electrothermal Ligasure has good results for pulmonary wedge resection, its literature is small in numbers. Authors compared Ligasure and endostapler for pulmonary wedge resection of solitary pulmonary nodules (SPN). Authors performed a retrospective analysis of 44 consecutive patients. The indication of operation was non-verified SPN in all cases. They carried out pulmonary wedge resection for 22 patients with Ligasure-Atlas and 22 patients with ETS Flex endostapler via VATS. Authors examined the gender, average age (62 vs. 49 years), mean hospital stay (6.6 vs. 6.8 days), average operation time (55 vs. 50 min), number of complications (2 vs. 1), average drainage time (2.8 vs. 2.7 days), average fluid loss (190 vs. 160 ml), and instrumental costs (367 euro vs. 756 euro) of both groups. They accomplished the histological analysis of the coagulated lung parenchyma as well. According to the results, the Ligasure-Atlas is eligible for pulmonary wedge resection. The method is safe, easy to use, having minimal rate of complications. It can moderate costs of operation, compared to endostaplers.

[Nasojejunal tube positioning with fluoroscopic guidance]. / Nasojejunalis tápszonda-levezetés röntgenkép-erosíto segítségével.

The indication circle of enteral nutrition is continuously enlarging. Looking after this increasing group of patients, is now an everyday practice. Enteral nutrition has more advantages than intravenous. Amongst this, jejunal feeding is most widely applied, but it requires nasojejunal tube. Positioning the tube is possible by the guide of X-ray, endoscope, ultrasound, or simply "blind". Authors present the fluoroscopic technique, as their everyday practice. It does not demand special expertise, skilled endoscopist, or premedication, and can be performed in any hospital. It is fast, cheap, and tolerable. It's disadvantages are that only conscious, cooperating, spontaneously breathing patients can be treated such, and it involves irradiation. Authors have used this method 34 times in the past 3 years and had no major complications. Every patient suffered acute necrotising pancreatitis. Considering cost-benefit principles, they recommend this procedure as safe for all levels of in-patient departments.

[Selective bowel decontamination]. / A szelektív béldekontamináció.

Infective complications play major role in mortality of high risk patients demanding intensive care. Selective Bowel Decontamination prevents endogenous infections by reducing the number of potentially pathogen microbes (aerobic bacteria, fungi) in the oropharynx and gastrointestinal tract, saving anaerobic bacteria. It had been used 20 years ago for the first time. Authors survey it's literature ever since. Selective Bowel Decontamination is performed by the mixture of antibiotics and antimycotic drug, administered orally in hydrogel, and suspension form in nasojejunal tube. The number of Gram negative optional aerobic bacteria and fungi decrease significantly in the gut, and the microbial translocation is following this tendency. Foreign authors achieved good results in acute necrotizing pancreatitis, after liver transplant, in polytrauma, in serious burn and in haematological malignancies. According to the literature Selective Bowel Decontamination shows advantages in selected groups of high risk surgical patients. In some studies the administration took few months, but the minimum time was one week. There was no report of increasing MRSA appearance. Regular bacteriological sampling is highly recommended in order to recognize any new antibiotic resistance in time.

Use of reversed-phase liquid chromatography for determining the lipophilicity of alpha-aryl-N-cyclopropylnitrones.

The relationship between a reversed-phase high-performance liquid chromatography (RP-HPLC) retention parameter and various calculated log P-values of our previously synthesized alpha-aryl-N-cyclopropyl-nitrone derivatives was investigated. The RP-HPLC experiments were carried out with acetonitrile-water and methanol-water mixtures as mobile phases and with two kinds of stationary phases of different polarity. The retention parameter, log k(w) was obtained by linear extrapolation of the log k retention to pure water as the mobile phase. The calculated log P-values were C log P, ACD/log P, R log P, A log P, LogKow, X log P and M log P. Statistically, highly significant correlations were found between log k(w) and the calculated log P-values with squared correlation coefficients ranging from 0.771 (with A log P) to 0.956 (with C log P). In addition, the comparative molecular similarity indices analysis (CoMSIA) method was also applied to correlate the log k(w) retention parameter of the compounds with their molecular fields. Statistically significant CoMSIA models were obtained between log k(w) and the hydrophobic and steric molecular fields of our compounds. The CoMSIA models describe how the structure of the nitrone derivatives influences (through hydrophobic and steric interactions with the stationary phase) the chromatographic retention of the compounds.