TLR2 in Pleural Fluid Is Modulated by Talc Particles during Pleurodesis

The aim of this study was to examine the role of TLR2 molecule in pleural space during thoracoscopic talc pleurodesis period in patients with malignant pleural effusion. We analyzed TLR2 molecule in soluble form as well as on membrane of granulocytes in pleural fluid. Pleural fluid examination was done at three intervals during pleurodesis procedure: 1st—before the thoracoscopic procedure, 2nd—2 hours after the terminating thoracoscopic procedure with talc insufflation, 3rd—24 hours after the thoracoscopic procedure. We reported significant increase of soluble TLR2 molecule in pleural fluid effusion during talc pleurodesis from preoperative value. This increase was approximately 8-fold in the interval of 24 hours. The changes on granulocyte population were quite different. The mean fluorescent intensity of membrane TLR2 molecule examined by flow cytometry on granulocyte population significantly decreased after talc exposure with comparison to prethoracoscopic density. To estimate the prognostic value of TLR2 expression in pleural fluid patients were retrospectively classified into either prognostically favourable or unfavourable groups. Our results proved that patients with favourable prognosis had more than 3-fold higher soluble TLR2 level in pleural fluid early, 2 hours after talc pleurodesis intervention

Thoracoscopic chemically induced pleurodesis in the treatment of malignant pleural effusion as a model of general and local inflammatory reaction

Thoracoscopic chemically induced pleurodesis in the treatment of malignant pleural effusion as a model of general and local inflammatory reaction Petr Habal Summary Continuous formation of malignant pleural effusions causes metabolic and mineral disruption. Large effusions gradually compress the lung parenchyma. The result is an increasing shortness of breath. Prolonged compression of pulmonary parenchyma also causes atelaktasis which may then cause an inflammatory process of the lung parenchyma. An effective method of palliative treatment is a chemical pleurodesis, which is used in selected patients as a second line of palliative cancer treatment. The principle is to eliminate the space between the visceral and parietal sheets of pleura by inducing aseptic inflammation. The most effective way of application of chemicals is via videothoracoscopy. The advantage is the possibility of drainage of pleural cavity and application of talc powder. Pleurodesis has been used for many years, but there is a lack of objective assessment of the overall and local inflammatory reactions, by which the body responds to foreign substances. In a group of 47 patients who were treated at our department in the period between January 2009 and December 2010, 29 (61.7%) were men and 18 (38.3%) were women with a cytologically proven..

BLUNT CHEST INJURY WITH CHYLOTHORAX AND THORACIC VERTEBRAL FRACTURE - MULTIDISCIPLINARY MANAGEMENT

Introduction. Chylothorax is the result of traumatic as well as nontraumatic events. The conservative approach is usually applied in the management of chylothorax. Surgical treatment is not commonly used and is considered only in specific patients. Case presentation. We describe a complicated algorithm that was used in treating a 70-year-old woman with Bechterew's disease. Admitted for healthcare after a fall, she suffered from a blunt chest injury with subsequent right-sided serial rib fracture with hemothorax and thoracic vertebral body fracture. The hyperextension of the ossified thoracic spine associated with Bechterew's disease caused the injury of the thoracic lymphatic duct.   Simultaneous thoracic spine stabilization and surgical revision of the thoracic lymphatic duct from an anterior approach were indicated. Despite the urgency of thoracic spine stabilization, the procedure was postponed due to acute coronary syndrome, which was treated with drug-eluting stent insertion with a subsequent need for dual antiplatelet therapy. Thus, the procedure was performed 16 days after stent insertion.  Conclusion. The diagnosis of chylothorax must be considered in case of thoracic injury with continuing waste to the chest tube and detection of well-expanded pulmonary parenchyma. Biochemical investigation of the effusion is the cornerstone in establishing the diagnosis of chylothorax

Comparison of Efficacy and Safety of Non-Regenerated and Regenerated Oxidized Cellulose Based Fibrous Haemostats

Purpose: Various forms of local haemostats are increasingly used routinely in surgical procedures. Our work is the first comparison of the efficacy and safety of non-regenerated and regenerated oxidized cellulose based fibrous haemostats. Methods: The haemostatic efficacy and safety of fibrous haemostats based on ONRC and ORC were compared in a randomized multicenter study. The primary endpoint was successful haemostasis within 3 minutes of application and no need for surgical revision within 12 hours after the procedure for recurrent bleeding. Results: There was a significant difference in the rate of successful haemostasis in 3 minutes that was achieved in 82% and 55% in the ONRC and ORC groups, respectively (confidence interval 99%; p = 0.009). Mean time to haemostasis was 133.9 ± 53.95 seconds and 178.0 ± 82.33 seconds, in the ONRC, and ORC group, respectively (p = 0.002). Revision surgery for re-bleeding was necessary in 0 (0%), and 1 (2%) of patients in the ONRC, and ORC group, respectively. No adverse events were reported. Conclusion: Fibrous haemostat based on ONRC was non-inferior compared to fibrous haemostat based on ORC when used in accordance with its intended purpose, and was safe and efficient

Case: Unusual Migration of Osteosynthetic Material

The authors present a rare and unusual case of complication, migration of osteosynthetic material for stabilization, titanium rod, which was used for stabilization of comminutive fracture of the first lumbar vertebra. This rod migrated from the retroperitoneal space to the pleural cavity. The removal of this rod was carried out by videothoracoscopy

Possibilities of Combined Surgical Treatment of Lung Tumours and Heart Diseases

The purpose of the study was a retrospective evaluation of the outcome of surgical therapy of lung cancer in patients where there was concomitant cardiac disease and who underwent a cardiac operation either because of ischemic heart disease or because of valvular disease. These patients were operated on at various time intervals (two to ten months) after their cardiac operation. Some patients had their lung cancer surgery after the cardiac operation because of the high risk of possible cardiac postoperative complications; in one patient the lung operation preceded the cardiac one

Chylothorax – a Rare Complication after Cardiac Surgery (a Case Report)

Chylothorax is a rare but severe complication of cardiac surgery. The authors present the case of a 76-year-old woman suffering from ischemic heart disease, after coronary artery bypass grafting that included a left internal mammary artery pedicle graft. On the ninth postoperative day the left-sided fluidothorax developed. The results of biochemical analysis were consistent with the chyle. Combined treatment with pleural drainage and total parenteral nutrition was effective

Controlled Hemostasis in Thoracic Surgery Using Drugs with Oxidized Cellulose

The authors demonstrate the possibility of improving surgical results by the reduction of perioperative bleeding in thoracic surgery associated with extended resection procedures. We focused on patients in whom the expected perioperative blood loss was greater than 500 ml. The first group consisted of patients with lung cancer stage III A after neoadjuvant chemotherapy had been indicated to extend the resection procedure. The second group consisted of patients with chest wall and mediastinum tumors of various etiologies. The third group consisted of patients with post-inflammatory thoracic complications in whom combined decortication and pleurectomy was necessary. By the using the local hemostyptic Traumastem TAF on the basis of oxidized cellulose, it is possible to minimize the perioperative blood loss, thus sparing the blood derivative requirement and enabling surgeons to provide the desired treatment even to high-risk patients