Results of surgical treatment of primary lung cancer with synchronous brain metastases.

INTRODUCTION: The surgical treatment of non-small cell lung cancer (NSCLC) with synchronous brain matastases is more effective than other therapeutic options, but this management is still controversial. THE AIM OF THE STUDY: The aim of the study was to evaluate the survival of patients after pulmonary resection NSCLC preceded by resection of brain metastases. MATERIAL AND METHODS: From 2007 to 2012, 645 patients underwent pulmonary resection for NSCLC at our department. In 25 of them (3.87%) thoracic surgery was preceded by resection of a single brain metastasis of NSCLC and a PET CT scan. No signs of nodal involvement or distant metastases were detected. RESULTS: The group consisted of 18 men (72%) and 7 women (28%). Average age was 57.62 years (46-70). In all cases, whole brain radiotherapy (5 × 4 Gy) was performed. The average interval between excision of brain metastasis and lung resection was 31.4 days (27-41). Pneumonectomy was performed in 1, lobectomy/bilobectomy in 17 and wedge resection in 7 cases. Pathological stage N0 was diagnosed in 17, N1 in 5 and N2 in 3 patients. Average survival was 18.68 months (4-74). Survival at 1, 2 and 5 years was 64%, 28% and 28% respectively. Average disease-free survival was 17.52 months. Histological type (p = 0.57) and G (p = 0.82) have no influence on survival. All the patients with hilar lymph node involvement died within 26 months and with mediastinal one within 12 months. CONCLUSIONS: Surgical treatment of patients with NSCLC with synchronous brain metastases may prove beneficial in selected patients after excluding other distant metastases and lymph node involvement.

Pneumonectomy due to lung cancer results in a more pronounced activation of coagulation system than lobectomy.

UNLABELLED: Surgical treatment of lung cancer is associated with an elevated risk of thrombo-embolic complications. The question is whether the extent of pulmonary resection influences the concentration of serum coagulation system proteins. OBJECTIVE: This study aims to compare the blood coagulation activation parameters among patients undergoing pneumonectomy and lobectomy due to primary lung cancer. METHODS: A prospective study was carried out in 40 patients. Of whom, 30 underwent lobectomy and 10 treated with pneumonectomy. Serum concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), tissue factor pathway inhibitor-activated factor X complex (TFPI/Xa), thrombin-antithrombin complex (TAT), L-selectin, E-selectin and P-selectin were measured on the first and seventh postoperative days. RESULTS: On the first postoperative day, the results of selected proteins concentrations were similar in both groups. However, on the seventh postoperative day, significantly higher concentrations of TF, TAT complex and E-selectin were found in patients who underwent pneumonectomy (median values: TF: 182.4 pg ml(-1) vs 116.6 pg ml(-1), P=0.031; TAT: 6.2 mg ml(-1) vs 3.9 mg ml(-1), P=0.048; E-selectin 40.24 ng ml(-1) vs 26.54 ng ml(-1), P=0.049). CONCLUSIONS: Pneumonectomy was associated with significantly higher activation of coagulation system on the seventh postoperative day than lobectomy. TAT complex, TF and E-selectin are promising markers of extensive postoperative activation of coagulation and efficacy of antithrombotic prophylaxis.

[Bronchial bacterial colonization in patients with lung cancer]. / Bakteryjna kolonizacja drzewa oskrzelowego u chorych na raka pluca.

INTRODUCTION: Infections are a part of the natural course of lung cancer but few studies have looked at the clinical and microbiological documentation of infections in these patients. The aim of this study is to analyze the profile of potentially pathogenic bacteria that colonize the bronchial tree in patients with primary lung cancer. MATERIAL AND METHODS: The study was conducted from January 2006 to August 2007. It included 44 consecutive patients (34 males and 10 females) with primary lung cancer aged from 38 to 77 (mean age of 57.9 years). In all patients, bronchoalveolar lavage (BAL) was performed during bronchofiberoscopy. Obtained BAL fluid was subjected to microbiological examination. The number of bacteria present in 1 ml of fluid was estimated by quantitative culture. A diagnostic level was set on >or= 104 cfu/ml. RESULTS: In 26 (59.1%) of 44 patients physiologic bacterial flora was found in the bronchial tree. In three cases (6.8%), potentially pathological bacteria were cultured but their number was < 104 cfu/ml. In 15 (34.1%) cases, the colonization of potentially pathogenic bacteria was >or= 104 cfu/ml. Both Gram-positive and Gram-negative bacteria were isolated. The most frequently isolated bacterium in the first group was Streptococcus pneumoniae (n = 7), and in the second group Haemophilus influenzae (n = 3). Multibacterial colonization was found in five patients (11.4%). In four cases (9.1%), the bronchial tree was colonized simultaneously by two and in one case [2.3%] by three types of micro-organism. Multi-drug-resistant strains were not found in the examined materials but among Streptococcus pneumoniae the constitutive MLSB phenotype was observed. CONCLUSIONS: 1. Approximately 30% of patients with lung cancer had a respiratory tract colonized by micro-organisms whose number was higher than the assumed diagnostic level. 2. Among micro-organisms colonizing the lower respiratory tract, Gram-positive cocci such as Streptococcus pneumoniae and Staphylococcus aureus were dominant. 3. The analysis of antibiotic-resistance did not detect multi-drug-resistant micro-organisms but some strains of Streptococcus pneumoniae exhibited resistance to macrolide, lincosamide and streptogramin B.

[The influence of application of resorbable fibrinogen-collagen patches on the costs of selected procedures in thoracic surgery]. / Wplyw stosowania wchlanialnych opatrunków kolagenowo-fibrynowych na koszty wybranych operacji torakochirurgicznych.

UNLABELLED: The application of fibrinogen-collagen patch to air tight closure of the lung parenchyma after pulmonary surgery is profitable for the patients but relatively high price of this product may cause a surgeons' hesitation before using it. THE AIM OF THE STUDY: To compare the total costs of treatment of two subgroups of patients in whom, during the same surgical procedure, the fibrinogen-collagen patches were applicated or not to achieve air tight closure of the lung surface. MATERIAL AND METHODS: A total costs of treatment of 122 patients were analyzed. The operations performed were as follows: bullectomy in pulmonary emphysema (n=31), decortication and empyemectomy (n= 16), partial pulmonary resection with coexisting diffuse pleural adhesions (n=75). In 58 patients the surface of the lung was sutured manually or by staplers but in 64 cases fibrinogen-collagen patches were used additionally. RESULTS: The costs of the surgical procedure were higher in the sub-group of patients in whom fibrinogen-collagen patches were applicated. However, in these patients the hospital stay was shorter and the costs of laboratory tests and x-ray examinations performed after surgery were lower in comparison with patients operated on in traditional way. CONCLUSION: Application of a relatively expensive product - fibrinogen-collagen patch to seal the lung parenchyma does not cause the increase of the total cost of the treatment.

[Thoracic sympathectomy performed by videothoracoscopic technique]. / Zabiegi sympatektomii piersiowej wykonywane metoda wideotorakoskopowa.

UNLABELLED: Thoracic sympathectomy is a method for a segmental elimination of functions of the sympathetic system by the excision of its Th2-Th3 ganglia. The procedure can be performed both using open and videoscopic technique. OBJECTIVE: The purpose of the study was the evaluation of efficacy of videoscopic thoracic sympathectomy. MATERIAL AND METHOD: From 1993 to 2003 we performed 53 videoscopic thoracic sympathectomies in patients with Raynaud's syndrome and upper limb hyperhidrosis. RESULTS: In all patients that underwent thoracic sympathectomy we obtained a positive reaction to a segmental excision of the sympathetic trunk. Patients with Raynaud's showed a significant improvement in symptoms in 76% of cases after a 4-year observation while patients with hyperhidrosis in 100%. The time of hospitalisation was 3.5 days in average. Postoperative complications were observed in two patients (3.7%). Videoscopic thoracic sympathectomy provides good therapeutic and cosmetic results and deserves more common use compared with open technique.

[Thoracoscopic splanchnicectomy for control of epigastric pain of neoplastic origin]. / Zastosowanie torakoskopowej splanchnicektomii w zwalczaniu dolegliwosci bólowych pochodzenia nowotworowego w nadbrzuszu.

UNLABELLED: One of the methods for control of epigastric splanchnic pain is thoracoscopic transsection of splanchnic nerves. The purpose of the study is to evaluate the effect of thoracoscopic splanchnicectomy on pain intensity in patients with unresectable epigastric malignancies. MATERIAL AND METHODS: From 2001 to March 2004 we performed thoracoscopic splanchnicectomy in 26 patients (17 males and 9 females) aged from 42 to 76 years. Indications for the procedure were as follows: unresectable pancreatic cancer (17 cases), gastric cancer (7 cases), gallbladder cancer (2 cases). In all patients the intensity of pain was evaluated before the operation, two days and one month postoperatively by Prince Henry Hospital Pain Scale (PHHPS). RESULTS: 26 patients were evaluated during their hospitalisation and 24 of them one month postoperatively. The intensity of pain measured by PHHS before the procedure was 2.77 points in average and 1.26 point and 1.5 point in average two days and one month postoperatively respectively. All patients demanded lower doses of analgesics after an operation. CONCLUSION: Thoracoscopic splanchnicectomy is a safe and efficient method for control of pain caused by unresectable epigastric malignancies.

[Analysis of complications after laparoscopic cholecystectomy on the basis of our thirteen-years experience]. / Analiza powiklan cholecystektomii laparoskopowej na podstawie trzynastoletnich doswiadczen wlasnych.

UNLABELLED: The objective of study is to present and discuss complications observed in our patients after laparoscopic cholecystectomy throughout nine years of using this technique. MATERIAL AND METHODS: Between 1992 and 2003, 3146 laparoscopic cholecystectomies were performed in our clinic for symptomatic or complicated cholecystolithiasis. The number of laparoscopic cholecystectomies (LC) increases constantly compared to open cholecystectomies (OC). At the beginning the ratio of LC to OC was 1:20, then 1:1, for a short time, and it is 10:1 presently. Approximately 280 LC and merely 30 OC are carried out in our clinic annually. RESULTS: The most common complications of LC in our material were suppuration of a infraumbilical wound (23) and umbilica hernia (14). A common bile duct injury was observed in nine cases and intraoperative haemorrhage in 11 patients. Infrahepatic abscess (2), bile peritonitis (2), digestive tract injury (1) and abdominal wall haemorrhage (1) appeared rarely. Conversion into an open technique had to be done in 91 cases (2.89%) but only in 34 cases due to intraoperative complications. No deaths connected with LC were observed. CONCLUSIONS: The number of complications after laparoscopic cholecystectomy is not higher than after open cholecystectomy. Laparoscopic cholecystectomy is a save operative technique in the hands of an experienced surgeon.

[CD11b and CD62L receptors expression on neutrophils after laparoscopic versus open cholecystectomy]. / Ekspresja receptorów CD11b i CD62L na powierzchni neutrofilów obojetnochlonnych po cholecystektomii laparoskopowej w porównaniu z cholecystektomia klasyczna.

UNLABELLED: The development of immunology correlated with surgery enables close recognition of multiple mechanisms responsible for more frequent complications observed after open surgical procedures than after minimally invasive operations. OBJECTIVE: Evaluation of selected elements of non-specific immunity in patients undergoing open cholecystectomy (OC) versus laparoscopic cholecystectomy (LC). MATERIAL AND METHODS: 30 postmenopausal females with non-complicated cholecystolithiasis were analysed. Both OC and LC was performed in 15 cases. Blood samples for an analysis were collected 24 hours before surgery and 24 and 72 hours postoperatively. Qualitative changes of neutrophils measured by the expression of CD11b and CD62L receptors on their surface without or with formyl-methionyl-leucyl-phenylalanine (fMLP) stimulation were evaluated. RESULTS: The expression of CD11b and CD62L receptors show no significant changes in patients that underwent LC while patients that underwent OC had significant changes 24 hours postoperatively compared both with their preoperative values and values observed in patients after LC. CONCLUSION: The activation of neutrophils measured by changes of the expression of CD11b and CD62L receptors on their surface is connected with the magnitude of trauma and is only observed in patients after OC.

[The assessment of hepatic portal flow using Doppler's technique in patients after laparoscopic cholecystectomy]. / Ocena watrobowego przeplywu wrotnego metoda Dopplera u chorych po cholecystektomii laparoskopowej.

UNLABELLED: A decrease in hepatic portal flow was observed within two days after open cholecystectomy but such an analysis was not done for laparoscopic cholecystectomy. OBJECTIVE: To answer the following problems: 1. Is there any difference between the volume of hepatic portal flow in patients with cholecystolithiasis and without it. 2. Does hepatic portal flow change within two days after laparoscopic cholecystectomy compared with its preoperative value. MATERIAL AND METHODS: 30 patients without hepatic parenchyma diseases were qualified for the study (21 cases of cholecystolithiasis and 9 cases without cholecystolithiasis). In the group of patients with cholecystolithiasis a maximal portal velocity (Vmax) was measured by Doppler's technique and the diameter of the portal vein (D) before laparoscopic cholecystectomy and 1 and 2 days postoperatively. In the group without cholecystolithiasis these values were measured once. On the basis of Vmax a mean velocity (Vmean = 0.57 x Vmax) of portal flow was calculated. Using Vmean and D values a volume of portal flow was calculated. RESULTS: A mean hepatic portal flow volume in patients with cholecystolithiasis was 725+/-187 ml/min and without it 792+/-229 ml/min. The difference between these values was not statistically significant. No statistically significant differences were also found between values of preoperative and postoperative hepatic portal flow volume. CONCLUSIONS: No statistically significant difference was found between hepatic portal flow volume in patients with and without cholecystolithiasis. Hepatic portal flow does not change significantly within 2 days after laparoscopic cholecystectomy.