Efficacy of videothoracoscopic talc pleurodesis and intrapleural administration of Vibramicin in palliative treatment of neoplasmatic pleural effusion - a comparative study

Wstęp. U wielu pacjentów z pierwotnym rakiem płuca lub przerzutami innych nowotworów do płuc występuje nawracający wysięk opłucnowy, który znacznie zaburza komfort życia w schyłkowej fazie choroby. Celem niniejszej pracy było porównanie skuteczności 2 metod leczenia paliatywnego prowadzących do zamierzonej sklerotyzacji obu listków opłucnej, zapobiegającej nawrotowi wysięku. Materiał i metody. W grupie I (n = 45) zastosowano sproszkowany talk, który podawano doopłucnowo w czasie wideotorakoskopii. W grupie II (n = 30) wprowadzano doopłucnowy dren i po opróżnieniu opłucnej oraz rozprężeniu płuca kilkakrotnie podawano przez niego Vibramycynę. Wyniki i wniosek. Obie metody postępowania były bardzo skuteczne. Ograniczyły gromadzenie się wysięku u 65% chorych w 3-miesięcznym okresie obserwacji. W grupie I odsetek nawrotów był jednak wyraźnie mniejszy (22% vs. 33%), wskazując na większą trwałość pleurodezy uzyskanej za pomocą wideotorakoskopowego talkowania opłucnej.Background. Recurrent pleural effusion is a common finding in patients with primary or metastatic pulmonary neoplasm which worsen their quality of life at the end-stage disease. The aim of our study was the assessment of two comparable methods of pleurodesis.Material and methods. In group I (n = 45) videothoracoscopic approach was used for evacuation of the fluid and talc poudrage. In group II (n = 30) pleural effusion was evacuated with chest tubing. When the lung was fully expanded chest tubes were used for rinsing of pleural space with Vibramycin. Results and conclusion. Both methods showed comparable efficacy and 65% of patients at the third month of follow-up were free from pleural effusion. However, in group I (videothoracoscopic talc poudrage) recurrence rate of effusion was markedly lower than in group II (Vibramycin in pleural rinsing) (22% vs. 33%). We conclude that the use of videothoracoscopic talc poudrage provides longer and better results of pleurodesis than administration of Vibramycin to the pleural space

Detrimental effect of cardiopulmonary bypass(CPB) on malignant disease

Patients with coronary artery disease associated with malignancy are a difficult group of patients to treat. The ideal approach to manage them is still controversial. Both problems can be manage by either a combined or staged operation. The use of CPB during revascularization of the myocardium among patients with malignant disease, may have an effect on dissimination of malignant cells. This was observed among two of our patients. We believe that the use of off-pump technique to revascularize the myocardium is a safe approach and can be performed either in combined or staged surgery to resect malignant disease

Do patients over 40 years of age benefit from surgical closure of atrial septal defects?

OBJECTIVE—To determine the value of surgical closure of atrial septal defects in patients over 40 years of age.
METHODS—Retrospective analysis of 76 patients (63 women, 13 men), age range 40-62 years (mean (SD) 45.8 (5.1) years), who underwent surgical repair of atrial septal defect. Pre- and postoperative clinical status (New York Heart Association (NYHA) functional class) was assessed, and ECG, x ray, and echocardiographic investigations performed. Follow up was between 1 and 17 years.
RESULTS—One operative and one late death occurred during the study period. Before operation, 47 patients (61.8%) were in NYHA functional classes III and IV. After operation, 61 patients (82.4%) were in classes I and II. Four patients had atrial fibrillation before surgery versus nine after surgery. Before operation, 52 patients had intensified pulmonary vascularity compared with only seven after operation. Echocardiographic examination showed a significant reduction in right ventricular dimension (4.10 (0.91) v 2.95 (0.36) cm, p < 0.001). No residual intracardiac shunts were identified on echocardiographic follow up.
CONCLUSIONS—Surgical closure of atrial septal defects in patients over 40 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency.


Keywords: atrial septal defect; cardiac surger