Use of vacuum-assisted closure in the treatment of complex intrapleural infections

Background: Debilitated patients with chronic empyema, who are not fit enough to undergo thoracotomy and decortication due to lung entrapment, may be offered a lower-risk alternative – an open-window thoracostomy. Vacuum-assisted closure (VAC) may accelerate empyema drainage and wound closure. Methods: In this study, we compared two cohorts of patients receiving open-window thoracostomy (OWT) with or without VAC dressing. We included patients with chronic or postresectional empyema with multiple comorbidities or in poor general condition or on immunosuppression. Results: Delayed wound closure by thoracoplasty was performed in 8 (28%) patients in the OWT group and 8 (53%) patients in the OWT-VAC group (OR 2.54; 95% CI: 0.704-9.168). Time until DWC was significantly shorter (p<0.001) in the OWT-VAC group (48.5 ± 27.5 days) compared to the OWT group (316.5 ± 102.5 days). Regarding complications, we found no significant differences between the two groups, except for air leak, which was found in 0 (0%) patients in the OWT group and 6 (40%) patients in the OWT-VAC group (OR 1.67; 95% CI: 1.10-2.52; p<0.001). The percentage of patients who required re-do surgery did not differ significantly between the groups - 1 (3%) patient in the OWT group vs. 2 (13%) patients in the OWT-VAC group (OR 7.0; 95% CI: 0.66 – 74.29; p=0.07). Conclusion: Our experience shows that using VAC therapy in OWT can significantly shorten the overall treatment time. It can be safely used at home and in an outpatient setting

Haemodynamic changes after induction of anaesthesia with sevoflurane vs. propofol

Inhalation induction with sevoflurane would appear to offer several objective advantages compared to induction with propofol. In our study, the hemodynamic results of sevoflurane vs. propofol induction in patients undergoing thoracotomy were studied. In a prospective, randomized, blinded study 24 patients were randomly allocated to one of 2 groups: sevoflurane (S) and propofol (P) (n=12 each). For hemodynamic monitoring the LIDCO plus system was used. Patients in group S were induced into anaesthesia with sevofluran, remifentanil and vecuronium, whereas patients in group P with propofol, remifentanil and vecuronium. The anaesthesia was maintained with the same agents. Hemodynamic stability was guided using a special algorithm. The goal was oxygen delivery index (DO2I) > 500 mL min-1 m-2. According to the algorithm, patients received colloids or vasoactive drugs. Hemodynamic parameters were recorded before induction, 3 minutes after induction and 3 minutes after intubation and commencement of one lung ventilation. The consumption of vasoactive drugs and colloids and the time from the beginning of induction to intubation were documented. No statistically significant differences in measured hemodynamic parameters, remifentanil and colloid consumption between the S and P group were found. In group P, statistically more ephedrine was used (S: 4.2, P:20.8, p<0.05). Patients undergoing thoracotomy induced with sevoflurane are circulatory more stable than those induced with propofol

Presaditev pljuč v Sloveniji – izkušnje prvih treh let

Izhodišča: Presaditev pljuč je zahtevna metoda zdravljenja za izbrane bolnike z napredovalo pljučno boleznijo. Naraščanje števila primernih kandidatov in standarizacija posega sta v letu 2018 omogočila vzpostavitev transplantacijskega centra v UKC Ljubljana. Prispevek poroča o prvih rezultatih. Metode: Opravili smo analizo lastnega registra bolnikov. Rezultate smo primerjali s skupino bolnikov, ki so jim pred tem opravili presaditev v AKH Dunaj. Rezultati: Med 15. 9. 2018 in 15. 9. 2021 smo opravili 37 presaditev pljuč (od tega pri 13 ženskah). Indikacije so bile KOPB (n = 13, 35 %), pljučne fibroze (n = 7, 19 %), cistična fibroza (n = 5, 14 %), kovidna pljučnica (n = 4, 11 %), bronhiektazije (n = 3, 8 %), pljučna hipertenzija (n = 2, 5 %), limfangioleiomiomatoza (n = 1, 3 %), pomanjkanje alfa-1-antitripsina (n = 1, 3 %) in bronhiolitis (n = 1, 3 %). V primerjavi s prejšnjo skupino bolnikov, napotenih v AKH Dunaj (71 bolnikov, od tega 35 žensk), je bil delež bolnikov s KOPB višji (35 % in 16 %, p = 0,019), bolniki pa so bili starejši (mediana [razpon], 59 [14–68] in 43 [4–58] let, p = 0,001). 76 % darovanih pljuč ni ustrezalo standardnim merilom (30 % darovalcev je bilo starejših od 55 let, 22 % jih je imelo infiltrate na rentgenogramu pljuč, 24 % pa ni izpolnjevalo enega od ostalih meril), v 43 % pa je bila potrebna redukcija velikosti, kar pa ni vplivalo na primarno odpoved presadka. Kratkoročno preživetje je bili podobno v obeh skupinah (1-letno preživetje v UKC Ljubljana 89 % [95 % CI 78–99 %] in v AKH Dunaj 83 % [95 % CI 74–92 %]). Zaključek: Prvi rezultati kažejo, da so zgodnji izidi po presaditvi pljuč primerljivi pri bolnikih, ki so imeli presaditev v UKC Ljubljana ali v AKH Dunaj

Priporočila za obravnavo bolnikov s pljučnim rakom

No abstract.Ni abstrakta

Endovascular embolization prior to surgical resection of symptomatic intralobar pulmonary sequestration in an adult

Intralobar pulmonary sequestration is a rare congenital malformation, conventionally managed by surgical resection. Recently, the endovascular embolization has been proposed for the definite treatment of this disease. Additionally, preoperative embolization of aberrant arteries to minimize the risk of serious intraoperative haemorrhage has also been described. We report the case of 43-year old female patient who presented with cough and haemoptysis, and was successfully treated with endovascular embolization followed by a Video-assisted thoracoscopic wedge resection. Keywords: Endovascular embolization, Intralobar pulmonary sequestratio

Primer bolnika s karcinomom požiralnika z vstavljeno samoraztezno kovinsko opornico

Regulation of nutritional status is one of the main goals in patients with esophageal carcinoma, as it has a significant impact on the course and success of treatment. Due to frequent occurrence of dysphagia and difficulty in oral food intake, it is often necessary to establish an alternative feeding route before starting treatment. Nasogastric- and percutaneous feeding tube have been shown to be superior to self-expandable metal stents in patients on curative treatment. Despite self-stretching metal stents enabling rapid improvement of dysphagia, they are suitable mainly as part of palliative treatment due to frequent, possibly even life-threatening complications. In this paper, a case of esophageal carcinoma patient with an inserted self-expandable metal stent, receiving neoadjuvant treatment, is reported.Ureditev prehranskega statusa je eden glavnih ciljev pri bolnikih z rakom požiralnika, saj ima pomemben vpliv na potek in uspeh zdravljenja. Zaradi pogostega pojava disfagije in oteženega uživanja hrane skozi usta je pogosto potrebno že pred pričetkom zdravljenja vzpostaviti prehransko pot. Izkazalo se je, da sta pri bolnikih na radikalnem zdravljenju, to je z namenom ozdravitve, NGS in perkutana hranilna stoma superiorni samorazteznim kovinskim opornicam. Kljub temu, da samoraztezne kovinske opornice omogočajo hitro izboljšanje disfagije, pa so zaradi pogostih, tudi življenje ogrožujočih zapletov, primerne predvsem v sklopu paliativnega zdravljenja. V prispevku je opisan primer bolnika z rakom požiralnika na predoperativnem zdravljenju in predhodno vstavljeno samoraztezno kovinsko opornico