[Show abstract][Hide abstract] ABSTRACT: High thoracic epidural anesthesia (TEA) causes blockade of sympathetic fibers involved in innervation of the heart (segments T1-T4), which results in changes of cardiac electrophysiology. The anti-arrhythmic effects of TEA on supraventricular arrhythmias, mainly atrial fibrillation, are controversial.
The aim of the study was to assess the influence of epidural anesthesia on the electrical function of heart atria, including proven markers of increased risk of perioperative atrial fibrillation, such as P wave dispersion and P wave maximum duration.
The study involved 50 male patients, without a history of previous heart diseases, scheduled for elective surgical procedures. Patients received thoracic epidural anesthesia (group T, n = 25) or lumbar epidural anesthesia (group L, n = 25). The measurements were obtained from a continuous recording of ECG before epidural anesthesia and after the detection of blockade (T1 or T8 segment sensory block in groups T and L, respectively).
The statistical analysis of electrocardiographic parameters, including the maximum, minimum and mean P wave duration; P wave dispersion; the maximum, minimum and mean PR interval duration; and PR interval dispersion, did not show any inter- or intragroup differences at selected time points.
Regardless of its location, epidural anesthesia and sympathetic blockade associated with this procedure do not significantly affect the electrical functions of the cardiac atria reflected in superficial ECG, including the electrocardiographic parameters that are considered to be markers of increased risk of perioperative atrial fibrillation, such as P wave dispersion and its maximum duration.
Full-text · Article · Jun 2014 · Polish journal of cardio-thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Molecular features of non-small cell lung cancer (NSCLC) in never-smokers are not well recognized. We assessed the expression of genes potentially related to lung cancer etiology in smoking vs. never-smoking NSCLC patients.
We assayed frozen tumor samples from surgically resected 31 never-smoking and 54 clinically pair-matched smoking NSCLC patients, and from corresponding normal lung tissue from 27 and 43 patients, respectively. Expression of 21 genes, including cell membrane kinases, sex hormone receptors, transcription factors, growth factors and others was assessed by reverse transcription - quantitative PCR.
Expression of 5 genes was significantly higher in tumors of non-smokers vs. smokers: CSF1R (p<0.0001), RRAD (p<0.0001), PR (p=0.0004), TGFBR2 (p=0.0027) and EPHB6 (p=0.0033). Expression of AKR1B10 (p<0.0001), CDKN2A (p<0.0001), CHRNA6 (p<0.0001), SOX9 (p<0.0001), survivin (p<0.0001) and ER2 (p=0.002) was significantly higher in tumors compared to normal lung tissue. Expression of AR (p<0.0001), EPHB6 (p<0.0001), PR (p<0.0001), TGFBR2 (p<0.0001), TGFBR3 (p<0.0001), ER1 (p=0.0006) and DLG1 (p=0.0016) was significantly lower in tumors than in normal lung tissue. Expression of IGF2 was higher in tumors than in healthy lung tissue in never-smokers (p=0.003), and expression of AHR (p<0.0001), CSF1R (p<0.0001) and RRAD (p<0.0001) was lower in tumors than in healthy lung tissue in smokers.
Expression of several genes in NSCLC is strongly related to smoking history. Lower expression of PR and higher expression of ER2 in tumors suggests a possibility of hormonal therapeutic intervention in selected NSCLC patients. Distinct molecular features of NSCLC in never-smokers, e.g. CHRNA6 upregulation, may prompt new treatment strategies.
Full-text · Article · Jan 2014 · Advances in Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Bronchial stump fistula (BSF) is a known complication after lobectomy, although its incidence after lobe resection for non-small cell lung cancer usually does not exceed 2%. We present the case of a patient in whom a late BSF developed that led to a fatal pulmonary hemorrhage 4 weeks after right upper lobectomy and 4 hours after emergency readmission. Such a pulmonary hemorrhage could have been prevented by pulmonary artery embolization and intrapericardial pneumonectomy. The decision to perform pneumonectomy as a preventative procedure without overt clinical symptoms was a difficult decision to reach, particularly given the likelihood of being unnecessarily aggressive.
No preview · Article · Oct 2013 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Low-dose computed tomography (LDCT) screening improves lung cancer prognosis but also results in diagnostic work-up and surgical treatment in many individuals without cancer. Therefore, we analysed the procedures that screening participants underwent to better understand the extent of overdiagnosis.
Between 2009 and 2011, 8649 healthy volunteers aged 50-75 years with a 20 pack-year smoking history underwent LDCT screening, of whom individuals with detected lung nodules had 2-years control. Participants with a nodule >10 mm in diameter or with suspected tumour morphology underwent diagnostic work-up: 283 (6%)/4694 (54%) screened participants had detected lung nodules. One hundred and four individuals underwent surgery, 27 underwent oncological treatment and 152 without a cancer diagnosis underwent further follow-up with LDCT.
In 75% of participants accepted for diagnostic work-up and 25% of surgical patients, the procedures were unnecessary. In 70 (24.7%) participants, a specific diagnosis was obtained mainly due to the low efficacy of fine needle aspiration biopsy [sensitivity, 65.2%; negative predictive value (NPV), 95.9%] and bronchofiberoscopy (sensitivity, 71.4%; NPV, 50%) caused by overinterpretation of LDCT [positive predictive value (PPV), 2%]. Of 104 (36.7%) surgical patients, 43 (41.4%) had a preoperative cancer diagnosis, and 61 (58.6%) underwent surgery without pathological examination. In the latter group, intervention was justified in 35 (57.3%) patients. Complications occurred in 49 (17.3%) participants subjected to diagnostic work-up. In surgical patients, 67 (64.4%) malignant and 37 (35.6%) benign lesions were resected. In the latter group, intervention was justified in only 11 (29.7%) patients. No patient died because of diagnostic or treatment procedures during the study. The complication rate was 14.5% in the malignant and 10.8% in the benign groups. A neoplasm was found in 94 screening participants, of whom 67 (71.3%) underwent surgery; the remaining 27 (28.7%) patients were not surgical candidates. Adenocarcinoma accounted for 49/67 (73%) patients who underwent surgery for non-small-cell lung cancer (NSCLC); 56/67 (84%) patients had stage I NSCLC, and 26/67 (38%) underwent video-assisted thoracoscopic surgery lobectomy.
Futile diagnostic work-ups and operations must be reduced before LDCT screening can be broadly used. Stage I adenocarcinoma dominated in the NSCLC patients who underwent surgery.
Preview · Article · Sep 2013 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: There is increasing evidence that suggests that particular histopathologic types of non-small-cell lung cancer (NSCLC) display distinct molecular characteristics. We analyzed, in lung squamous cell carcinoma (SCC) and adenocarcinoma (AC), the expression of 8 genes that constitute 2 previously reported prognostic expression signatures in NSCLC.
Fresh-frozen tumor and normal lung samples were obtained at surgery from 135 patients with stage I-III NSCLC (89 (65.9%) SCC, 46 (34.1%) AC). Expression of CSF1 (colony stimulating factor for macrophages), carbonic anhydrase 9 (CA9), epithelial growth factor receptor (EGFR), dual specificity phosphatase 6 (DUSP6), v-erb-b2 erythroblastic leukemia viral oncogene homolog 3 (ERBB3), monocyte to macrophage differentiation-associated (MMD), lymphocyte-specific protein tyrosine kinase (LCK) and signal transducer and activator of transcription 1 (STAT1) was assessed in SCC, AC, and in normal lung by quantitative reverse transcriptase - polymerase chain reaction (qRT-PCR). Metastasis-free survival was analyzed according to the median value of gene expression in the entire NSCLC cohort and separately in SCC and AC.
Expression of CA9, CSF1, DUSP6, STAT1, and MMD differed between NSCLC and normal lung. EGFR was more abundant in SCC compared with AC, whereas the reverse was true for DUSP6 and ERBB3. A high expression of CSF1 correlated with shorter metastasis-free survival in the entire NSCLC group (P = .016) and in SCC (P = .049) and AC (P = .034) cohorts.
Several genes considered prognostic in NSCLC showed significantly different expression in SCC and AC, and thus should be analyzed separately in these 2 subtypes for their prognostic significance. CSF1 is similarly expressed in SCC and AC, and portends a poor outcome in the entire group of patients with NSCLC, and in SCC and AC when considered separately.
No preview · Article · Jul 2013 · Clinical Lung Cancer
[Show abstract][Hide abstract] ABSTRACT: Aim of the study: The aim of the study was to evaluate the impact of implementing a digital chest drainage device with regulated suction during postoperative care following a pulmonary lobectomy. Material and methods: Sixty-four patients who underwent a lobectomy at the Department of Thoracic Surgery of the Medical University of Gdansk between June 2011 and January 2012 were included in this study. The patients were randomly divided into two groups. During the postoperative period, the patients in the study group received thoracic drainage using digital chest drainage or a conventional glass bottle. The drain was withdrawn when the daily volume did not exceed 350 ml and there was no air leakage for at least 6 hours. Results: The patients from the study and the control groups did not significantly differ with regard to the following parameters: mean age, physiological test results, presence of concomitant diseases, and surgical access to the chest. During the postoperative period, no significant differences in the drainage duration were found (Thopaz: 4 days, controls: 4 days, p = 0.919). Similarly, the period of hospitalization did not differ significantly. The general complication rate was 37%, with common complications including: atrial fibrillation (19%), atelectasis requiring bronchial aspiration (9%), and prolonged air leak (8%). The complication rate in the Thopaz group was significantly lower (25%) than in the control group (50%) (p = 0.039). There was no mortality in either group during the postoperative period. Conclusions: Withdrawing the drainage device at the daily volume of 350 ml together with the implementation of a light and compact digital chest drainage kit significantly reduces the complication rates after lobectomy.
No preview · Article · Jun 2013 · Polish journal of cardio-thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Background. Standard physiologic qualification for radical pulmonary resection due to primary malignancy consists of measuring FEV1 anddiffusing capacity of the lung for carbon monoxide. Abnormalities in performed tests are indication for exercise testing. Cardiopulmonary exercise test allows calculation of maximal oxygen consumption and reliably stratify risk of postoperative complications and death. There is lack of evidence for routine implementation of simple physiologic tests in preoperative evaluation. Material and methods. Between April 2009 and October 2011, 253 patients who underwent lobectomy entered this study. All the patients were qualified for resection on the basis of standard evaluation protocol. Additionally on the day before the surgery patients performed 6-minute walk test (6MWT). Patients were categorized depending on the result of 6MWT in order to stratify their operative risk. Results. There were 148 men and 105 women in the mean age of 63 years. All the patients underwent lobectomies due to primary lung cancer. The patients were divided to groups considering 3 cut off lines of 6MWT: 500 meters, 100% of the predicted 6MWT, and together 500 meters and 100% of the predicted 6MWT. Patients in the groups: below 500 meters, below 100% of predicted 6MWT, and below together 500 meters and 100% of predicted 6MWT had higher risk of postoperative complications. The cut off line of 500 meters occurred to separate groups with increased risk of postoperative complications (60,6% vs. 36,8% p=0,001 OR 2,631 95%CI 1,423-4,880) and median hospitalization time (7 vs. 6 days p=0,010). Incidence of atrial fibrillation (21,2% vs. 11,7% p=0,059 OR 2,019 0,904-4,484) andrequirement for blood transfusion (18,1% vs. 9,0% p=0,046 OR 2,222 95%CI 0,928-5,289) fairly reached the level of statistical significance. There were no postoperative deaths in the analyzed groups.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Hypoxia and hypoperfusion of the non-ventilated lung results in increased levels of reactive oxygen species, which may take part in the pathomechanism of complications after lung resection. The aim of the study was to evaluate the risk factors of increased oxidative stress during pulmonary resection. The influence of oxidative stress on the postoperative complications was recorded. Material and methods: Forty patients entered this prospective study. Patients were distributed into one of the two arms of the trial undergoing one or two lung ventilation during the resection. Blood was collected at the determined time points. The levels of carbonyl and sulfhydryl remnants were assessed. Results: Multivariate analyses showed that one lung ventilation was an independent risk factor of increased oxidative stress as measured by the decreased level of sulfhydryl remnants. The complication rates in both arms did not significantly differ. Conclusions: One lung ventilation is an independent risk factor for increased oxidative stress. This study did not show an influence of oxidative stress on the complication rate after lung resection.
[Show abstract][Hide abstract] ABSTRACT: Pacemaker implantation resulting in lymph leakage to the pleural cavity is exceptionally rarely reported in the medical literature. We report a case of a 87-year-old patient who developed left brachiocephalic vein thrombosis on pacemaker electrodes 12 years after implantation. Due to lack of flow from the thoracic duct to the left venous angle, the thoracic duct cracked and lymph leaked to the right pleural cavity. Supradiaphragmatic ligation of the thoracic duct in right thoracotomy efficiently ceased lymph leakage.
[Show abstract][Hide abstract] ABSTRACT: 1. Prolongation of the QT interval is associated with a risk of life-threatening cardiac arrhythmias. In the present study, we examined whether reversible blockade of preganglionic sympathetic fibres of the heart, achieved by thoracic epidural anaesthesia, affects cardiac repolarization and thus confers an anti-arrhythmic effect. 2. Fifty-two men, aged between 28 and 65 years, were included in the study: 28 were patients scheduled for thoracic epidural anaesthesia (Group T) and 24 were patients scheduled for lumbar epidural anaesthesia (Group L). Epidural blockade was achieved with 0.5% isobaric bupivacaine solution. Measurements were taken from electrocardiogram fragments obtained before epidural anaesthesia and after detection of blockade (T1 or T8 segment sensory block in Groups T and L, respectively). Correction of the QT interval was calculated using Bazett's formula (QTcb), Fridericia's correction (QTcf) and the Framingham formula (QTcF). Transmural dispersion of repolarization (TDR) was determined using the Tpeak--Tend time, where Tpeak is the peak of the T wave and Tend is the end of the T wave. 3. Significant shortening of the QTcb interval and TDR was detected after blockade in Group T. However, there were no changes in the ECG parameters in Group L. 4. In conclusion, reversible blockade of preganglionic sympathetic fibres to the heart, achieved by thoracic epidural anaesthesia, results in a reduction in QTcb, as well as the TDR. These changes may explain the anti-arrhythmic action seen with central blockade.
Full-text · Article · Mar 2009 · Clinical and Experimental Pharmacology and Physiology
[Show abstract][Hide abstract] ABSTRACT: Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. Its appearance as a primary lung tumor is extremely rare. The cell origin of MFH remains controversial. The treatment of choice for MFH is surgical resection, while the role of chemo- and radiotherapy remains unclear.
A retrospective analysis of 5 patients operated on for primary MFH in the Department of Thoracic Surgery of the Medical University in Gdansk between 1990 and 2000 was performed.
Out of approximately 2000 patients operated on for primary malignant lung tumors, five (0.25 %) had MFH. The mean age of the 4 men and 1 woman was 62 years. In all cases radical resection was performed without adjuvant chemo- or radiotherapy. Four patients died within 2 - 7 months after the operation, three of them from distant metastases. The follow-up of one patient is not available. One patient is alive 11 years after the operation.
Although surgical resection of MFH is the treatment of choice in MFH, the results are unsatisfactory.
Full-text · Article · May 2007 · The Thoracic and Cardiovascular Surgeon
[Show abstract][Hide abstract] ABSTRACT: To evaluate the results of thymectomy in myasthenia gravis we performed retrospective analysis of 82 consecutive patients in the mean age of 39 +/- 15 treated between 1991 and 2001. All patients underwent extended thymectomy by median sternotomy. Follow-up was assessed in 74 of 81(91.4%) patients, in the mean age of 39 +/- 15, discharged from the Department.
Fifty three (71.6%) patients had symptoms of myasthenia gravis for less than 2 years. According to Osserman's classification 8 (10.8%) patients were assessed as class I, 32 (43.2%) as IIA 26 (35.2%) as IIB and 8 (10.8%) as IIC. In the postoperative period 8 (10.8%) patients had respiratory insufficiency, 5 (6.8%) were reoperated for bleeding. One patient died (1.4%) due to bilateral pneumonia and pulmonary insufficiency. After thymectomy the improvement of patient's clinical status was observed in 46 patients (86.4%) and complete remission was in 13 patients (17.6%). Prompt improvement after thymectomy (p = 0.008) and short duration of symptoms (p = 0.036) are positive predictive factors. Patients in class I had significantly better prognosis concerning complete remission (p = 0.036). Age, gender, histology of the thymus, and type of the thymoma had no influence on long time follow up.
Extended thymectomy is a safe procedure leading to the improvement in majority of patients treated for myasthenia gravis.
No preview · Article · Feb 2005 · Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
[Show abstract][Hide abstract] ABSTRACT: Myasthenia gravis is an autoimmunologic disease. Isolated symptoms of ocular myasthenia gravis (OMG) are ptosis and diplopia. Indications for surgical treatment of OMG remain controversial. The aim of the study was to evaluate results of surgical treatment of OMG. Between 1995 and 2002 in the Department of Thoracic Surgery Medical University's of Gdansk 7 patients were operated for OMG. All patients underwent extended thymectomy through median sternotomy. There were no deaths in the postoperative period. One patient was reoperated due to bleeding. In the early postoperative period none of the patients developed respiratory insufficiency. On the day of discharge 4 patients improved. In long term follow up 2 patients had complete remission and 2 patients had no changes in neurological state but nobody deteriorated. Extended thymectomy is safe and sufficient treatment of OMG. The risk of respiratory insufficiency in early postoperative period is low.
No preview · Article · Jan 2005 · Annales Academiae Medicae Gedanensis