[Initial experiences with VATS lobectomy]. / VATS-lobectomiák kezdeti tapasztalatai.

OBJECTIVE: The authors analyse the experience of videothoracoscopic (VATS) lung lobectomies performed since December 2010 at the Thoracic Surgery Department of Markusovszky University Teaching Hospital. PATIENTS AND METHOD: 78 patients (44 men and 34 women) underwent VATS lobectomy. The average age was 61.2 years ranging from 30 to 80. The indications were peripheral malignancy (35 cases) or the suspicion of that (43 cases), presence of curable distant metastasis was not considered as contraindication. RESULTS: In the initial period the operation time was quite long, but shortly after the duration of surgery became almost similar to lobectomies via thoracotomy. Late reoperation was performed in two cases, one for chronic pneumothorax and one for port-site metastasis. 10 vessel and two bronchial injuries occurred, eight of them needed conversion into axillary thoracotomy (conversion rate 10.26%). The postoperative pain was significantly less than after thoracotomy. CONCLUSION: VATS lobectomy is a safe procedure with less surgical stress and without oncological compromise.

Egyre gyakoribbá váló megbetegedés: pulmonalis dirofilariasis.

Due to the climate change zoonoses, dirofilariasis in particular is spreading. Hence, it is likely that we will encounter with this problem more frequently in the future Our intention with this case presentation is to draw attention to the increasing number of nematodes that cause differential diagnostic problems. The patient underwent surgery with suspicion of pulmonary malignancy suggested by a peripheral rounded opacity in imaging, but histological examination revealed dirofilariasis.

Vizuális analóg skála felhasználásával végzett postoperativ fájdalom vizsgálatának klinikai vonatkozásai thoracotomizált betegeken a Markusovszky Egyetemi Oktatókórház Mellkassebészeti Osztályán.

OBJECTIVE: The authors examined pain after thoracotomies in the Department of Thoracic Surgery, University Teaching Hospital Markusovszky and compared two analgetic methods. PATIENTS AND METHOD: The study was conducted for a period of 10 months, they have processed 268 patients details whose chest were open. The patients were divided in 2 groups: one of them got fentanyl containing plaster which absorbs transdermal as well as intraoperatively applied intercostal bupivacain blockade. The other group got anaesthetic to their epidural space (EDA). On the day of surgery and for two postoperative days they measured the pain with VAS. Time between premedication and surgery, the medications given before and after the surgery, doses and time of administration were all noted. Cases with rib fractures occurring during surgery were followed separately, and the number of broken ribs and the name of the operating surgeon were noted, too. RESULTS: The authors used linear regression and analysis of variance for the collected data. The results showed significant and close to significance relations. The dependent variables were the daily pain on day 0, 1, and 2. These data will be detailed later. CONCLUSIONS: The authors concluded that skin patch containing fentanyl applied around the same time of surgery with intercostal bupivacain injection were effective for pain relief, which was practical for the patient and the nursing staff too. It can be an alternative for the EDA.

[Long-term survival after lung-sparing central bronchoplastic procedures [CBPs] for malignant tumors]. / Hosszú túléléssel járó malignus tumor miatti tüdomegtartó centrális fohörgoplasztikáink.

BACKGROUND: Bronchial malignancies are leading tumour-related cause of death. Prolonged survival can only be expected after radical resections. Central bronchoplastic procedures, which save the whole lung parenchyma, however, may play a role. AIM: These bronchoplastic procedures can be good alternatives for pulmonectomies. The value of these operations can be evaluated by postoperative mortality complication, and the survival rate. MATERIAL AND METHODS: In the period of 1985-2012 we operated 7130 bronchial carcinomas. Of these, 7 cases of 80 central broncoplastics we preserved the whole lung (in one case as an alternative for inoperability, in 6 patients as an option instead of pulmonectomy). The indications were carcinoid in four cases, epidermoid carcinoma, mucoepidermoid carcinoma and main carina SCLC after induction chemo-radiotherapy. The average age of the 4 male and of the 3 female patients were 28.5 (14-58) years. In 5 cases the right main bronchus, while in one case the left main bronchus was resected and the bronchial tree was reconstructed. In one case (SCLC patient) we made a complete carina resection and end-to-end anastomosis between the trachea and the rebuilt neocarina to preserve both lungs. The anastomosis was made with 3-4/0 PDS interrupted sutures above a sterile tube (6 cases) and in one case due to a jet catheter which were positioned through the operation field into the distal part of the main healthy bronchus. RESULTS: There was no operative mortality nor bronchopleural fistula. In the early postoperative period we applied repeated bronchoscopic suctions. In the patient with carina SCLC anastomosis stenosis developed. The main bronchi were temporarily stented. This patient is fit 174 months after the intervention, the Karnofsky index mesures to 90%. Other 5 patients are alive without any consequences of recurrence nor metastasis. The patient with epidermoid carcinoma died 83 months later because of distant metastases of a SCLC, originating from the contralateral lung. The mean survival is 118 (7-233) months. CONCLUSION: In case of some properly selected localised mainstem bronchial malignancies, such as young age and low grade malignancy, radical surgical interventions can be performed with long term survival preserving the whole lung due to special CBPs. Some such successful series and case reports (under 200 cases) can be found in the literature but the long-term survival data was not demonstrated in most publications. In Hungary there has not been any publications yet on such a successful series with long term survival. These results are remarkable within international standards.

[Diagnosis and treatment of traumatic esophageal perforation.] / A traumás nyelocso-perforáció diagnosztikája, kezelési stratégiája egy konzervatívan sikeresen kezelt eset kapcsán.

Traumatic esophageal injuries are extremely rare and challenging both from a diagnostic and therapeutic point of view. As regards one of their patients, the authors review the etiology and the pathophysiology of esophageal perforations. They present the case of a 36-year-old patient with a penetrating chest trauma. During an acute surgery, the foreign body was removed from the mediastinum, but in the early postoperative period, an oesophageal rupture was recognized. After conservative management, the patient was discharged from the hospital without any complications 82 days after the injury. Considering that the traumatic esophageal rupture is rare and the mortality of these patients is very high, it is important to make a good decision in time. The authors would like to highlight that even in the case of severe penetrating esophageal injury, the right therapeutical decision can lead to complete recovery. Orv Hetil. 2023; 164(43): 1719-1724.

[Left pneumonectomy for intrapulmonary unicentric Castleman disease]. / Bal oldali teljes tüdoeltávolítás intrapulmonalisan elhelyezkedo Castleman betegség miatt.

Castleman disease is an uncommon lymphoproliferative disorder, located most commonly in the mediastinal lymph nodes. The intrapulmonary presentation is extremely rare, with 14 published cases in the English literature. The clinical presentation of the disorder is not specific and the diagnosis is often challenging. The main goal is to achieve an R0 surgical resection which gives the potential chance for a recurrence-free survival. We present the case of a symptomless, 15-year-old female patient with left-sided tumor mass. Transthoracal invasive tissue biopsy confirmed Castleman disease. The central mass involved the main structures in the left hilus and therefore left pulmonectomy was necessary to reach the complete, tumor-free resection margins. The patient had no local or distant relapse during the 7-year follow-up. Although Castleman disease treated by complete surgical resection provides excellent results, radical and extended lung resection is sometimes inevitable to reach tumor-free margins. Orv Hetil. 2023; 164(37): 1476-1483.

Chronic postoperative pain after non-intubated uniportal VATS lobectomy.

Introduction: Patients undergoing thoracic surgery are at increased risk of developing, long-lasting pain. Beyond the non-surgical factors, the type of operation, including the number of incisions, and the anesthetic assessment seemed to be important factors, although some studies are controversial. The aim of our study was to examine the presence of chronic postoperative pain after non-intubated uniportal VATS lobectomy. We examined the difference between the intubated, relaxed and non-intubated spontaneous ventilation surgical approaches in patients who underwent video-assisted thoracoscopic (VATS) uniportal lobectomy. Methods: Demographic and postoperative data were retrospectively collected and analyzed, focusing on the use of pain medications, in 67 patients of the 140 patients selected by propensity score matching who underwent intubated (iVATS) or non-intubated (NITS) uniportal VATS lobectomy. This study focused on the use of analgesic medications 3, 6, and 12 months after surgery. Results: Thirty-five intubated and 32 non-intubated patients were compared. Although the analgesic consumption was nearly 2% higher among the iVATS patients during the follow-up period, there were no statistically significant differences at 3 months (15.6 vs. 17.1%) (p = 0.868), at 6 months (9.4 vs. 12.4%) (p = 0.785), and at 12 months (3.3 vs. 5.9%) (p = 0.633) between the NITS and iVATS groups, respectively. More female than male patients reported chronic pain, but the difference was not statistically significant (p = 0.616). Diabetes mellitus was a statistically significant cofactor associated with chronic pain (p = 0.03), while cardiac disease (p = 0.6), perioperative morbidity (p = 0.228), prolonged air leak (p = 0.057), and repeat drainage (p = 0.626) were not. Conclusion: Our study suggests that after non-intubation VATS lobectomies, the postoperative pain was less at 3, 6, and 12 months in NITS patients compared to iVATS patients. The 2% difference was not significant, so it may not be appropriate to claim the advantages of NITS in terms of postoperative pain.

[Isolated pulmonary arteriovenous malformation (PAVM)--report of three cases]. / Izolált pulmonalis arteriovenosus malformatio (PAVM) - 3 eset kapcsán.

Isolated PAVM is rare condition and only a few cases of VATS (Video-Assisted Thoracoscopic Surgery) resection have been reported so far. Since the clinical course of PAVM is not entirely benign due to its possible progression and serious complications (paradoxical emboli, stroke, brain abscess, etc.), the most radical least invasive treatment should be chosen in all cases nowadays. Embolization may be incomplete and carries a risk of accidental systemic embolization, therefore surgical excision is the preferred method of choice. In cases of surgical resections, pulmonary parenchyma sparing techniques such as wedge resection and local excision by VATS is desirable, if possible. We present three patients who were admitted with asymptomatic pulmonary round shadow (umbra rotunda) for further investigation and treatment. We have performed two wedge resections by VATS and one segmentectomy via axillary thoracotomy. We wish to emphasize the importance of this disease to consider in differential diagnosis to avoid complications.

[Videothoracoscopic removal of ectopic liver]. / Ectopiás máj videothoracoscopos eltávolítása.

Authors present a case of an ectopic liver in the chest of a 14 year-old female patient. The lesion was discovered by screening chest X-ray and was consequently removed by videothoracoscopic surgery. A brief literature review was carried out, too.

[Pulmonary metastasectomy after pneumonectomy]. / Pneumonectomiát követoen végzett pulmonalis metastasectomiák.

UNLABELLED: INTRODUCTION, OBJECTIVES: Authors of two thoracic surgical departments from the above named hospitals discuss their practices of pulmonary metastasectomy after pneumonectomy for malignant disease. MATERIAL AND METHODS: Six patients were operated after pneumonectomy for metastatic spread in the residual lung. The average age of the three male and three female patients was 52.5 years. The applied preoperative diagnostical methods were the following: chest-x-ray, CT scan, MRI, PET-CT scan, perfusion lung scintigraphy, bronchological examinations, functional respiratory tests, ECG, cardiac echo, arterial blood gases (ABGs) and other laboratory analyses. Patient selection for operation was based on strict oncological and cardiorespiratory criteria. Finally, the authors describe the applied operative technique; atypical mechanical resection with stapler. RESULTS: Mean length of postoperative intensive care was between 3 to 7 days, while that of hospitalization altogether was 13 to 18 days (average 15.2 days). Ventilation needed for one patient for 5 days approximately. Two of the six patients' survival was 18 and 25 months after pulmonary metastasectomy. Four patients are still alive, their average postoperative survival is 33.5 months. They are followed up regularly and their quality of life is satisfactory. CONCLUSIONS: The key factors that determine the successful outcome of metastasectomies are careful and personalized evaluation of the patients, their condition and fitness for thoracotomy, stabile cardiopulmonary functions and the capacity of the residual lung. Multidisciplinary teamwork involving anaesthetists and intensive care specialists along with surgeons using the quick atypical resection technique are the key elements to improved survival of these patients.

Nano-sized Superlattice Clusters Created by Oxygen Ordering in Mechanically Alloyed Fe Alloys.

Creating and maintaining precipitates coherent with the host matrix, under service conditions is one of the most effective approaches for successful development of alloys for high temperature applications; prominent examples include Ni- and Co-based superalloys and Al alloys. While ferritic alloys are among the most important structural engineering alloys in our society, no reliable coherent precipitates stable at high temperatures have been found for these alloys. Here we report discovery of a new, nano-sized superlattice (NSS) phase in ball-milled Fe alloys, which maintains coherency with the BCC matrix up to at least 913 °C. Different from other precipitates in ferritic alloys, this NSS phase is created by oxygen-ordering in the BCC Fe matrix. It is proposed that this phase has a chemistry of Fe3O and a D03 crystal structure and becomes more stable with the addition of Zr. These nano-sized coherent precipitates effectively double the strength of the BCC matrix above that provided by grain size reduction alone. This discovery provides a new opportunity for developing high-strength ferritic alloys for high temperature applications.

[Role of surgical lung volume reduction in the treatment of patients with severe emphysema]. / A tüdovolumen-redukciós mutét helye a súlyos emphysemás betegek gyógykezelésében.

OBJECTIVE: Based on literature data and own experience (unique in Hungary) we like to present the indications, contraindications, risks as well as medium and long term follow ups of the lung volume reduction surgery (LVRS) applicable in cases of therapeutic resistant end-stage emphysema (COPD). MATERIAL: In Szombathely between 1997 and 2003, 69 LVRS--by multiple wedge resections of most functionless parts of the lungs--were made on 56 patients (44 males and 12 females with a mean age of 52.5 years) via median sternotomy for both sides (12 pts), axillary thoracotomy on one (30 pts) or both sides in two sessions (13 pts) and VATS (one side, 1 pt). Selection criteria based on radiographic, spirometric and cardiac function tests. Indications were: diffuse homogenous emphysema: 17 pts, heterogenous emphysema 39 pts. Combined surgery for severe COPD and pulmonary malignancy was applied too (7/56 pts - 12.5%). RESULTS: Thirty-day operative mortality was 4.3% (3/69) similar to international results. We noticed high incidence of early complications: air leak (37.6%), serious arrhythmia (13%), respiratory insufficiency (8.7%), longer drainage time (5.7 days). Reoperations were 2/69 interventions (2.9%) because of air leak and bleeding. Late recurrent pneumothorax was observed in 1 case (1.3%). The mean follow up time was: 31.8 months. FEV1, RV, paO2, paCO2 and the quality of life improve as seen in follow-up, and patients regain apart of the former activity. There were no differences in the outcome in patients undergoing unilateral or bilateral LVRS. On the basis of literature and own data the long-term significant positive improvements last about 12-24 months. Thereafter one can observe a slow decrease of the cardiopulmonary functions, however, the quality of life remains adequate for longer. SUMMARY: The LVRS has a certain risk, but perioperative mortality is acceptable. LVRS is a realistic alternative of lung transplantation in case of severe COPD first of all in patients presenting with heterogenous emphysema (particularly upper lobe) and low exercise capacity. The expense of LVRS is maximum 10% of lung transplantation. Patients having undergone an LVRS and patients unacceptable for LVRS can be suitable for lung transplantation.

[Thymic neuroendocrine tumor: three cases in our practice]. / A thymus neuroendokrin daganata: három esetünk ismertetése.

Authors present 3 cases of the thymic neuroendocrine tumor. They describe the diagnosis, the TNM classification, histology, therapy, and prognosis of the disease. In their opinion the TNM and histology classification have adequate prognostic value.

Mechanical behavior of bulk amorphous alloys reinforced by ductile particles at cryogenic temperatures.

The mechanical behavior of Zr-based bulk amorphous alloy composites (BAACs) was investigated at 77 K. The 5 vol. % Ta-BAAC maintained large plastic strains of approximately 13% with a 16% strength increase, when compared with that at 298 K. The interaction between shear bands and particles shows that shear extension in particles has limited penetration, and shear bands build up around particles. In addition to on the failure surface of the amorphous matrix, molten characteristics were also found on the surface of sheared particles. Pair distribution function studies were performed to understand the mechanical behavior.