Attila Vágvölgyi

Doege–Potter-szindróma a mellhártya óriás malignus szoliter fibrosus tumorával

Absztrakt: A mellhartya ritkanak szamito szoliter fibrosus tumora nehany szazalekban hypoglykaemiaval tarsul, amit első ket leirojukrol Doege–Potter-szindromanak neveztek el. Hatvanharom eves ferfi betegunk egy evvel korabban mar pulmonologiai kezeles alatt allt bal oldali melluregi folyadekgyulemmel, bal also lebenyi daganat CT-kepevel. Ismet fokozodo terhelesi dyspnoe miatt vegzett ujabb vizsgalatok soran a most mar oriasira nőtt tumor vastagtű-biopsziaja low grade sarkomat igazolt. Onkologiai konzilium műteti elbiralas merlegeleset javasolta. A beteg nyugalmi dyspnoe es ismetlődő hypoglykaemias rosszulletek miatt gyorsan romlo allapotban az intenziv osztalyrol kerult a műtőbe. A tumor eltavolitasa es bal oldali pneumonectomia tortent szovődmenymentes gyogyulassal. A szovettan szoliter fibrosus pleuratumort igazolt a Doege–Potter-szindromanak megfelelően. A műtet alatt eszlelt pleuralis szorodas miatt adjuvans kemoterapiaban reszesult. Egy evvel a műtet utan helyileg kiujult tumort tavolitottunk el. A f...Infrequent solitary fibrous tumours of the pleura are associated with hypoglycaemia only in a few percent of the cases; this condition is called Doege-Potter syndrome, named after its first descriptors. Our 63 years old male patient has previously undergone clinical treatment for intrathoracic fluid accumulation on the left side caused by a giant tumour-like mass in the lower left lobe detected by CT scan. In the course of further investigations performed due to increasing load-induced dyspnoea, lung core biopsy verified low grade sarcoma in the tumour. Tumour board suggested surgery. The patient was transferred from the intensive care unit into the operation theater due to increasing dyspnoea and repeated hypoglycaemic periods in rapidly worsening general condition. Pneumonectomy and removal of the tumour was performed on the left side. Histology showed solitary fibrous tumour of the pleura corresponding to Doege-Potter syndrome. The patient was discharged without complications and underwent adjuvant chemotherapy due to pleural dissemination of the tumour observed intraoperatively. One year after surgery the patient underwent surgical removal of a locally recurrent tumour. In spite of repeated chemotherapy local and multiplex contralateral pulmonary progression was observed. Three-year survival was noted from the time of the first surgery. Orv Hetil. 2018; 159(41): 149-153.

A mellkassebészeti műtéti teherbíró képesség megítélése, perioperatív légzésrehabilitáció

INTRODUCTION Besides the oncology and operative surgical technics, functional aspects influence the operability of lung cancer. Preoperative risk stratification, evaluation of postoperative complications needs to be considered. AIM To review international literature and experiences of our institute. METHOD We focused the literature of risk stratification of thoracic surgery. Lung function, lung mechanics, chest kinematics, exercise physiology were considered. Effectiveness of pulmonary rehabilitation for cardiovascular system, lung mechanics, muscles, exercise capacity and quality of life were evaluated. Laboratory parameters, comorbidities, obesity, cachexia, smoking cessation were considered. RESULTS Elevated blood sugar, kidney function, reduced albumin level increased the risk. COPD, sleep apnoea, heart failure, obesity and cachexia influences the outcome. Smoking cessation may reduce postoperative complications. Controlled breathing technics, chest wall mobilization, training have favourable effects. Psychosocial support and dietetics are important. CONCLUSIONS Risk stratification is supported by laboratory parameters, lung function, oxygen uptake and comorbidities. Pulmonary rehabilitation can improve functionality and quality of life. Orv Hetil. 2017; 158(50): 1989-1997.Absztrakt: Bevezetes: A mellkassebeszeti operabilitast onkologiai, sebesztechnikai szempontok mellett meghatarozzak a funkcionalis parameterek. Szukseges a mellkasi műteti teherbiro kepesseg es a lehetseges posztoperativ szovődmenyek megbecslese. Celkitűzes: A funkcionalis operabilitas megiteleseről szolo nemzetkozi irodalom es intezetunk gyakorlatanak attekintese. Modszer: A mellkassebeszeti műteti rizikobecsleshez szakirodalmi attekintest vegeztunk, előterbe helyezve a legzesfunkcios, legzesmechanikai, mellkasi kinematikai, terheles-elettani valtozokrol szolo kozlemenyeket. A legzesrehabilitacio sziv-er rendszeri, izmokra, legzesmechanikara, teljesitőkepessegre es eletminősegre kifejtett hatasat vizsgaltuk. Laborparameterek, tarsbetegsegek, az elhizas, a lesovanyodas es a dohanyzas rizikojat ertekeltuk. Eredmenyek: A magas vercukorszint, alacsony albuminszint es az emelkedett vesefunkcios ertekek novelik a műteti rizikot. A COPD, alvasi apnoe, szivelegtelenseg, ischaemias szivbetegseg, obesitas es lesov...

Videothoracoscopic treatment of a rare complication of nasojejunal tube insertion.

OBJECTIVE Intubation of the tracheobronchial tree is the most common type of malposition during the placement of narrow-bore enternal tubes. CASE REPORT In addition to other treatment components in a 65-year-old female, nasojejunal feeding was started to treat her for severe acute pancreatitis. After the placement of the narrow-bore feeding tube, she developed dyspnea and huskiness. On auscultation and X-ray investigation, the right pneumothorax was detected and the tube was found in the chest cavity. The diagnosis was confirmed by bronchoscopy. Videothoracoscopic resection and closure of the lacerated lung, using a tube thoracostomy, were performed. The patient recovered after postoperative conservative treatment for her pancreatitis. CONCLUSION Pneumothorax and laceration of the lung-caused by the malposition of narrow-bore enternal tube-can be successfully treated by applying videothoracoscopy.

Anterior Approach for Liver Resection in the Treatment of Large Liver Tumors

Background: We compared retrospectively the results of the patients who underwent hemihepatectomy through anterior approach (AHH) with those undergoing conventional hemihepatectomy (HH). Patients and Methods: In 119 patients hemihepatectomy was done, 52 of them were anterior approaches. We used this technique if the tumor size was large or if the tumor seemed to be fragile, and thus a liver mobilization would be very dangerous. We started the operation with dissecting parenchyma from the anterior surface toward hilus without preparation of the hilus. Resection of the liver was performed with the help of CUSA dissector. Results: No patient died following AHH. Two re-operations were performed in the HH group, and 2 patients died. The operation time was not significantly different in both groups. The need for blood transfusion was much less during AHH. The average nursing days were also similar in both groups. However, in those cases in which the operations were performed because of liver malignancies, there were no differences in the survival rate after 32-month follow-up between both groups. Conclusions: AHH can be performed safely. The blood consumption during AHH is significantly lower than during HH. The median survival rate was similar in both groups. Our team suggest the anterior approach for liver resection in those cases when the hilar structures and the hepatic veins cannot be isolated easily.