Surgical risk models : how they contribute to improvement of our treatments?

Adverse events are common among surgical patients. The question of how to predict risk associated with invasive procedures and how to select an optimal procedure for particular patients is as old as surgery itself. Accurate calculation of complication risk and mortality risk has three important aspects: (I) Risk assessment and its discussion with a patient is essential for their informed consent to undergo surgery; (II) Determination of risk allows for implementation of specific measures, aimed at reduction of this risk; (III) Awareness of the adverse event that is likely to happen enables one to get prepared for it, to provide optimal setting for the procedure and to use appropriate treatment without delay

Double stenting for malignant oesophago-respiratory fistula

Introduction : The close anatomical relationship between the oesophagus and bronchial tree results in formation of an oesophago-respiratory fistula in a subset of patients with advanced oesophageal or lung cancer. In those patients stenting of both the oesophagus and tracheobronchial tree is a valid option of palliative treatment. Aim : To determine the effectiveness, tolerance, quality of life, safety and survival after double stenting procedures. Material and methods: Retrospective analysis of a prospectively collected database was performed, concerning consecutive patients with oesophago-respiratory fistulas treated with double stenting. In all patients the degree of dysphagia, respiratory function before and after the procedure, and quality of life were evaluated. Partially covered oesophageal self-expanding metallic stents (PCESEMS) were used for oesophageal stenting, and silicone Y-type or partially covered self-expanding bronchial and tracheal stents (PCASEMS) were used to restore airway patency. Results: Between 2003 and 2015, 31 patients underwent double stenting due to oesophago-respiratory fistulas. Twenty-nine patients were diagnosed with oesophageal squamous cell carcinoma and 2 with bronchial carcinoma. In all patients, improvement in the general condition and quality of life was observed after airway patency restoration. Two patients required mechanical ventilation due to respiratory failure immediately after the procedure. Seven patients with oesophageal fistulas died because of bleeding in the long-term follow-up. Four patients required endoscopic re-intervention. Mean survival time was 67.1 days. Conclusions : Double stenting is an effective procedure improving patients’ quality of life. However, life-threatening complications can occur

Safety and efficacy of airway stenting in patients with malignant oesophago-airway fistula

Background: Close anatomical relationships between the oesophagus and the bronchial tree can lead to the formation of oesophageal fistula particularly in patients with advanced lung or oesophageal carcinoma. Stenting is a most often used treatment in such patients, but data regarding the relative value of unilateral (US) vs. double stenting (DS) are scarce. Methods: Retrospective analysis of hospital records of patients with oesophageal fistula who underwent stenting between 2008 and 2016. In those in whom airway stenosis was >30%, double stenting (oesophagus and bronchial tree) was performed, whereas in those with lesser airway stenosis unilateral stenting (i.e., oesophagus only) was performed. In all patients, the degree of dysphagia, the degree of dyspnoea and the quality of life were assessed before and after the stenting. Results: There were 46 patients, analysed, including 26 who underwent DS and 20 patients who underwent US. Both, DS and US resulted in significant improvement of dysphagia (2.72 vs. 1.2, P=0.0001 and 2.65 vs. 1.0, P=0.0001), dyspnoea (2.89 vs. 0.34, P=0.0001 and 1.71 vs. 0.09, P=0.0001) and performance score (53.2 vs. 66.3, P=0.0001 and 54.3 vs. 62.38, P=0.0001). Neither fistula type, nor stenting method, weight loss and gain, and BMI, had an effect on survival (P=0.34). Disease progression and recurrence of fistula requiring re-intervention occurred in 9 patients (19.5%). Conclusions: Double and unilateral stenting is an effective measure to alleviate dysphagia and dyspnoea in patients treated with malignant oesophageal fistula. In those with airway stenosis of ≤30%, stenting of the oesophagus only, instead of DS, is a safe method of treatment

Composite metrics in response assessment-new hope in oesophageal cancer?

Oesophageal cancer is still associated with poor prognosis. The progress in systemic treatment, radiation therapy and surgery over the last decades has resulted in only moderate improvement of survival. Neoadjuvant chemoradiotherapy (CRT) has been shown to be associated with tumour response in 60–70% of patients (1), and with complete pathological response (CPR) in 25–30% of patients (2,3). Although it reportedly improves survival, there are several concerns about its routine use. Besides the treatment-related toxicity, the most important issue is lack of reliable predictive factors for pathological tumour and nodal response. In fact, in non-responders the neoadjuvant therapy is harmful, as it delays alternative, potentially effective treatment. Progression during the neoadjuvant therapy is not rare in this subset of patients

Hey boys, it’s no fun! or polish architecture’s games and play

What, if any, are the relationships between architecture and games and fun? Are games and fun identical values? Are these phenomena, when they come together, different depending on the specific cultural centres and the passage of time? I n this essay the author tries to answer this question

Finansowe aspekty stabilności makroekonomicznej. Przykład Polski

The purpose of the article was to determine whether there is a long-term relationship between the variables of the financial market and the variables characterizing Poland's macroeconomic stability. In the first stage of the research, the stationarity analysis of the variables was carried out using the ADF test, then, for the further stage of research, variables characterized by non-stationarity were selected and an Engle–Granger cointegration analysis was used. The research used data published by the National Bank of Poland, the Polish Financial Supervision Authority and the Central Statistical Offie for the years 2006–2017. The results of the research confirm the existence of cointegration in some variables.Celem artykułu było określenie, czy między zmiennymi rynku fiansowego a zmiennymi charakteryzującymi stabilność makroekonomiczną Polski występuje długookresowa zależność. W pierwszym etapie badań przeprowadzono analizę stacjonarności zmiennych testem ADF, następnie do dalszych badań wybrano zmienne charakteryzujące się niestacjonarnością i zastosowano analizę kointegracji metodą Engle’a–Grangera. W badaniach wykorzystano dane publikowane przez Narodowy Bank Polski, Komisję Nadzoru Finansowego oraz Główny Urząd Statystyczny dla lat 2006–2017. Wyniki badań potwierdziły istnienie kointegracji w przypadku niektórych zmiennych

Iatrogenic injuries to the trachea and main bronchi

INTRODUCTION: Iatrogenic tracheobronchial injuries are rare. AIM: To analyse the mechanism of injury, symptoms and treatment of these patients. MATERIAL AND METHODS: Retrospective analysis of hospital records of all patients treated for main airway injuries between 1990 and 2012 was performed. RESULTS: There were 24 patients, including 21 women and 3 men. Mean time between injury and initiation of treatment was 12 hours (range: 2-48). In 16 patients the injury occurred during tracheal intubation, in 1 during rigid bronchoscopy, in 1 during rigid oesophagoscopy, in 1 during mediastinoscopy and in 5 during open surgery. Mean length of airway tear was 3.8 cm (range: 1.5-8). In 1 patient there was an injury to the cervical trachea and in the remaining 23 in the thoracic part of the airway. The treatment included repair of the membranous part of the trachea performed via right thoracotomy in 10 patients (in 1 patient additionally coverage with a pedicled intercostal muscle flap was used), a self-expanding metallic stent in 1 patient, suture of the right main bronchus and the oesophagus in 1, left upper sleeve lobectomy in 1, right upper lobectomy in 1, implantation of a silicone Y stent in 3, mini-tracheostomy in 1, and conservative treatment in 5 patients. CONCLUSIONS: Intubation is the most frequent cause of iatrogenic main airway injuries. Patients with these life-threatening complications require an individualised approach and treatment in a reference centre