[Phenotypic characteristics of coagulase-negative Staphylococci colonizing pleural drains in patients with lung cancer after thoracic surgery]. / Fenotypowa charakterystyka gronkowców koagulazo-ujemnych kolonizujacych dreny po zabiegach torakochirurgicznych u pacjentów z rakiem pluca.

Coagulase-negative staphylococci (CNS) represent an important group of etiologic agents of infections associated with plastic biomaterials, e.g. drains. In the present paper 33 strains of CNS were characterized. All of them were isolated from fluid of pleural drains in patients with lung cancer after pulmonary resection under conditions of antimicrobial prophylaxis. The most frequently isolated species were Staphylococcus epidermidis and S. warneri. The majority of CNS strains showed ability to produce slime and possessed hydrophobic properties of cell surface. Strains of CNS resistant to penicillin and oxacillin, but sensitive to amoxicillin/clavulanate were isolated most frequently. Only two methicillin-resistant strains, belonging to S. haemolyticus, were found. The obtained data indicate that CNS strains colonizing pleural drains had potential ability to adhere to smooth surfaces. Most of isolated strains were susceptible to antibiotics and chemotherapeutics routinely used in staphylococcal infections.

[Quality of life assessment in patients with non-small cell lung cancer treated surgically or with pre-operative chemotherapy followed by surgery]. / Ocena jakosci zycia chorych na niedrobnokomórkowego raka pluca (NDRP) leczonych chirurgicznie lub przedoperacy jna chemioterapia i nastepowa resekcja.

The aim of the study was assessment of quality of life (QL) in patients with non-small cell lung cancer treated surgically or treated with both: neoadjuvant chemotherapy and surgery. We evaluated 200 NSCLC patients in I-IIIa stages. They were divided into 2 groups. Group 1-136 surgical only patients, group 2-64 patients treated with pre-operative chemotherapy, followed by surgery. Some of the patients from both groups required postoperative chemotherapy or radiotherapy. We used QLQ-C30 and QLQ-LC13 questionnaires both made and used with permission of EORTC. Measurements were taken while patients were qualified for treatment, 10-15 days after surgery and 4 and 12 months after treatment. Additional measurements were taken after pre-operative chemotherapy in group 2. Global QL (noted during qualification for treatment) decreased significantly in early postoperative period, regardless the range of resection in both groups. There were also significant decrease in functioning, increase in disease symptoms and financial difficulties after operation. In course of time all parameters of QL were stabilised and after the year they were higher than before treatment. Pre-operative chemotherapy and post-operative radiotherapy had no significant influence on QL. This was observed among the patients treated with post-operative chemotherapy. The assessment of QL seems to be a more effective method of treatment evaluation, because it allows seeing the patient as a part of the society in which he is living.

[A rare case of gaseous gangrenous mediastinitis]. / Rzadki przypadek zgorzeli gazowej sródpiersia.

We report a case of a cervical phlegmone and mediastinitis descending from peridental abscess in 32-year old student. Emergency left thoracotomy was performed after CT evaluation in which multiple fluid levels and gas spaces were found. After 72 hours bacterial strains showed Clostridium perfringens in fluid taken from left pleural cavity and patient was sent to Hiberbaric Center in Gdynia, where he underwent hyperbaric oxygen therapy. After 10 days the patient was brought back in good condition to our Department. After 3 days he died because of sudden massive bleeding caused by necrosis of aorta wall.

[Microflora colonizing pleural drains after thoracic surgery]. / Mikroflora kolonizujaca dreny po zabiegach torakochirurgicznych.

The aim of this paper was to analyse aerobic and anaerobic bacterial flora colonizing pleural drains in 32 patients with lung tumor undergoing pulmonary resection and receiving antimicrobial prophylaxis. Fluid from pleural drains was taken up on the day of operation and on the 3-rd or 4-th day after the operation. Significant number of aerobic bacteria, mainly methicillin-resistant coagulase-negative staphylococci and multidrug resistant Gram-negative rods, were isolated from 30 (46.9%) specimens. Lower number of anaerobic bacteria were found in 24 (37.5%) specimens. Colonization of the pleural drains does not mean infection, (in only one patient isolated Pseudomonas aeruginosa could be the etiologic agent of infection) however knowledge about bacterial species found in drain fluid in a local population and drug susceptibility of isolated strains allows to propose effective antimicrobial prophylaxis.

[Evaluation of selected parameters of blood coagulation and the fibrinolysis system in patients undergoing total hip replacement]. / Ocena dynamiki wybranych parametrów krzepniecia i fibrynolizy u chorych poddanych zabiegowi wszczepienia cementowej protezy stawu biodrowego.

Patients undergoing orthopedic surgery, particularly total hip replacement procedure belong to a group of patients with a high risk of thromboembolic complications. Postoperative deep vein thrombosis may occur in 40-80% of these patients. 4-19% of patients develop clinically evident pulmonary embolism and approximately 7% of cases in this group result in death. A thorough evaluation of coagulation disorders in the perioperative period could lead to detecting risk factors of thromboembolic complications development and could facilitate more effective prophylaxis management. The aim of the study was to evaluate the dynamics of selected blood coagulation and fibrinolysis parameters in patients undergoing total hip replacement surgery. The study included 66 patients undergoing total hip replacement surgery. The group consisted of 51 women and 15 men, within the age range of 47-78, the mean age was 64. In 32 (group A) patients surgery was performed with the use of normovolemic hemodilution, in 34 (group B) the hemodilution procedure was not applied. The patients received low molecular heparin as prophylaxis started 12 hours prior surgery and continued for 5 weeks after. The examination of the coagulation system was performed: in the morning on the day of the operation--examination 1, on the day of the operation in the evening--examination 2, and on the first day after operation--examination 3. We determined the concentrations of thrombin-antithrombin complexes (TAT), prothrombin fragments 1 + 2 (F1 + 2), D-dimers (DD) and plasminantiplasmin complexes (PAP). In all the patients an ultrasound examination of the lower limbs by Doppler method was performed before the surgery and 10-12 days after the procedure. Significant activation of coagulation and fibrinolysis was found in all patients before surgery. 12 hour after the procedure a progressive increase of coagulation disorders was observed. After 24 hours marked decrease of coagulation parameters was noted. In group A significantly less thromboembolic complications was observed. On the basis of the performed examinations the following conclusions were drawn. (1) during total hip replacement surgery and particularly during the period of the first 12 hours after procedure, marked activation of coagulation and fibrinolysis occurred. (2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period.

[Soft tissue sarcoma as a result of uterine cervix cancer radiotherapy]. / Miesak tkanek miekkich jako nowotwór popromienny powstaly w wyniku radioterapii raka szyjki macicy.

The secondary neoplasms due to previous radiotherapy occur rarely. They develop within the radiation field or on its border. In this paper we present the case of soft tissue sarcoma that evolved 11 years after uterine cervix cancer radiotherapy. The long-term survival of patients subjected to radiotherapy is linked with the risk of secondary neoplasms appearance. That is why the repeated regular observation after radical treatment is recommended.

[Late results of the combined treatment with the use of preoperative chemotherapy and surgery of locally advanced non-small cell lung cancer]. / Odlegle wyniki leczenia skojarzonego z udzialem przedoperacyjnej chemioterapii i resekcji u chorych na miejscowo zaawansowanego niedrobnokomórkowego raka pluca.

The aim of the study is the assessment of efficacy of combined treatment (preoperative chemotherapy and surgery) of locally advanced non-small cell lung cancer. Material included sixty-two NSCLC patients treated in the Department of Thoracic Surgery of Medical School of Lublin between February 1993 and October 1997. Treatment was started with 2 or 3 courses of chemotherapy. In 51 cases chemotherapy was based on Cisplatin. Response (CR + PR) to chemotherapy was observed in 30 cases (48.8%). 21-25 days after last course of chemotherapy resections were carried out. In 1 case it was lobectomy, in 25 cases--pneumonectomy and in 36--extended pneumonectomy. In 56 cases resection was radical, in 6 cases non-radical. No perioperative deaths or bronchial fistulas were observed. Median survival was 21.4 months and 5-years survival--35.25%. The results confirm the usefulness of preoperative chemotherapy in locally advanced NSCLC.

Long-term survival after bronchial sleeve resections.

Between February 1990 and February 2000, 53 anatomical pulmonary tissue resections with sleeve bronchial resections have been performed in the Department of Thoracic Surgery of Medical University of Lublin. The aim of the present study was the evaluation of long-term results of operative treatment. Most of the cases (86.8%) were patients with non-small cell lung cancer. Three perioperative deaths (5.7%) were recorded. The mean time of survival for all patients was 45.6 months and for NSCLC patients was 41.2 months. The cumulative 5 years' survival rate in cancer patients was 38.6%. Preoperative performance status, presence of N2 and non-radical resection have been recognised as significant prognostic factors in cancer patients. In our opinion, in view of comparable efficacy, low morbidity, mortality and functional benefits pulmonary sleeve resections should be considered in every patient with favourable anatomical and functional conditions.

[Evaluation of selected parameters of blood coagulation and fibrinolysis system in patients undergoing total hip replacement surgery with normovolemic hemodilution procedure and standard enoxaparine prophylaxis]. / Ocena wplywu skojarzenia hemodylucji ze standardowym podawaniem heparyny na wybrane parametry ukladu krzepniecia i fibrynolizy u chorych po endoprotezoplastyce stawu biodrowego.

UNLABELLED: The aim of the study was to evaluate selected blood coagulation and fibrinolysis parameters in patients undergoing total hip replacement surgery with normovolemic hemodilution and standard enoksaparine profilaxis. The study included 66 patients undergoing hip replacement surgery. The group consisted of 51 women and 15 men, within the age range of 47-78, the mean age was 64. In 32 (subgroup II) patients the surgery was performed with the use of normovolemic hemodilution, in 34 (subgroup I) the hemodilution procedure was not applied. The enoksaparine as prophylaxis started 12 hours prior to surgery and continued during hospitalisation. The examination of the coagulation system was performed: on the day of the operation in the morning, on the day of the operation in the evening and on the first day after operation. We determined the concentrations of TAT and PAP complexes, prothrombin fragments 1 + 2 (F1 + 2) and d-dimers (DD). CONCLUSIONS: 1) during total hip replacement surgery and particularly in the period of the first 12 hours after the procedure marked activation of coagulation and fibrinolysis occurRed; 2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period, but could reduced incidence of thromboembolic complications in the postoperative period.

Surgical treatment of severe emphysema--analysis of own material.

UNLABELLED: The aim of the study was a retrospective analysis of effectiveness of surgical treatment of severe diffuse emphysema, including urgent cases with symptomatic pneumothorax. We analyzed 99 patients with severe diffuse emphysema who underwent surgical treatment in Department of Thoracic Surgery in Lublin between 1995 and 2001. The evaluated group consisted of 86 men and 13 women aged from 27 to 83 (mean age 56.6). Among them 54 were operated on due to sudden pneumothorax, which was a result of bursted emphysematous parenchyma. Those patients were not evaluated with spirometry and CT of the chest. All the other patients were carefully examined and qualified for surgical treatment according to precise criteria: presence of clinical and radiological symptoms of diffuse severe emphysema (DSE), FEV1<35%, pCO2>50mmHg. Those 43 patients eligible for Lung Volume Reduction Surgery iLVRS) also did not have any main contraindications for lung surgery. In the whole analyzed population 89 resections were unilateral, limited to 20-25% of the most destroyed tissue. In 10 cases operation was bilateral, among them four were simultaneous and the remaining six were not. In our study we evaluated the frequency and degree of complications, early results of treatment, influence of surgery on selected parameters: FEV1, pCO2, subjective dyspnea according to Medical Research Council Dyspnea Scale. We observed three perioperative deaths. The most common complications were air leak> five days, cardiopulmonary insufficiency, pneumonia. Early results showed subjective decrease of dyspnea and in most cases improvement of the analyzed parameters. CONCLUSIONS: The early results are optimistic and correspond to the observations of other authors. Further analysis of the collected data and long term results will allow establishing the role of LVRS in treatment of Diffuse Severe Emphysema.

Preoperative chemotherapy as a predisposing factor for colonization of upper respiratory tract with Candida spp. in patients with non-small cell lung cancer.

In the present study 48 patients with non-small cell lung cancer (NSCLC) were included--20 patients from control group and 28 patients after at least one course of preoperative chemotherapy. The analysis of nasopharyngeal microflora in these patients suggests that preoperative chemotherapy can be regarded as a predisposing factor for colonization of mucous membrane of throat with yeast-like fungi--Candida spp.

The preliminary estimation of bcl-2, bcl-X(L) and p53 genes expression in locally advanced non-small cell lung cancer.

Cell neoplastic transformation results from disturbances in expression of genes regulating its basic functions like cell cycle and apoptosis. Our paper presents preliminary estimation of expression of protooncogenes: bcl-2 and bcl-X(L) as well as of p53 suppressor gene in (NSCLC) non-small-cell lung cancer patients. The study comprised 16 NSCLC patients subjected to chemotherapy before operative procedure. Gene expression was evaluated on paraffin embedded specimens using in situ hybridization assay and immunohistochemical method. In the majority of examined patients, high expression of bcl-X(L) gene both at mRNA and protein level was ascertained. In the case of 10 patients (62.5%), higher p53 gene expression at mRNA level was observed, whereas higher level of P53 protein was determined only in four subjects (25%). In two of 16 cases (12.5%), protein product of bcl-2 gene was found, while in eight subjects (50%)--mRNA expression of the gene.