Sławomir Jabłoński

Biochemical and functional indices of malnutrition in patients with operable, non-microcelullar lung cancer

INTRODUCTION The aim of this study was to assess non-microcellular lung cancer patients´ nutritional status impact on psychomotor performance, muscle strength and functional activity. MATERIAL AND METHODS The study involved 60 consecutive patients admitted to the clinic for surgical treatment due to histologically verified non-microcellular lung cancer. The patients were divided, depending on the stage of weight loss, into two groups: relatively well-nourished--29 patients and those with malnutrition--31 patients. History, physical examination, anthropometric data, biochemical parameters as well as functional tests were carefully noted. RESULTS Patients qualified for particular groups differed significantly in age, p<0.002. Mean values of albumin, transferrin and total protein for the well nourished patients ranged within proper values. In the malnourished patients they were respectively: 34.05±0.27 g/l, 1.764±0.27 g/l, 68.90±6.39 g/l and the differences were statistically significant. Total loss of urea nitrogen was significantly higher in malnourished patients 13.32±2.92 g/l (p<0.005). The average percentage weight loss in both groups differed significantly 0.111±0.044 vs. 0.031±0.028 at p<0.0005. In the group of malnourished patients the right hand average strength was 26.52±8.06 kg and the left one amounted to 25.35±6.04 kg, The values were significantly lower than the results recorded in well nourished patients: 34.93±11.27 kg, 32,37±11.72 kg, p<0.001. The tapping test average time of the right hand was 19.24±4.04 vs. 16.72±3.06 and of the left one 19.69±3.59 kg vs. 17.48±2.79 kg and were significantly longer in patients suffering from malnutrition (p<0.01). Simple reaction times for dominating hand were longer in the group of patients with malnutrition, for the visual stimulus 0.50±0.08 s vs. 0.45±0.087 s, (p<0.05) and for auditory one 0.43±0.08 vs. 0.39±0.08 s (non significant). CONCLUSIONS Malnutrition in the course of non-microcellular lung cancer significantly reduces psychomotor function assessed by reaction time to visual and acoustic stimuli as well as efficiency of the functional tests evaluated by tapping test and muscle strength measurement.

Efficacy assessment of the drainage with permanent airflow measurement in the treatment of pneumothorax with air leak.

AIM The aim of this study was to compare the efficacy of the treatment of patients with spontaneous pneumothorax with air leak (AL) using two different chest drainage systems. METHODS Patients were randomized into two groups: group A included 30 patients (23 males and 7 females, mean age 41.1 ± 16.29 y, range 17-71 y) in which digital drainage system was used, group B with 30 patients (22 males and 8 females, mean age 40.3 ± 15.74 y, range 18-72 y) in which traditional suction drainage system was applied.The following variables were evaluated: intensity of AL, duration of the chest tube drainage, delay in surgery, length of stay, and the overall hospitalization costs. RESULTS In group A the mean drainage duration was 47.63 hours, the hospitalization time was about 5.10 days, and the cost of hospitalization was €1,495. In group B the mean drainage duration was 84.93 hours, the hospitalization time was 6.97 days, and the hospitalization cost was €1,925. CONCLUSION The digital drainage system applied in the treatment of AL in patients with pneumothoraces reduced the duration of the drainage, the length of hospital stay, and overall hospitalization costs.

The estimation of metaloproteinases and their inhibitors blood levels in patients with pancreatic tumors

BackgroundThe aim of the study was to evaluate the concentration of proteolytic enzymes, MMP-2 and MMP-9, and their tissue inhibitors, TIMP-1 and TIMP-2, in the blood of patients with benign and malignant pancreatic tumors.MethodsMMP-2, MMP-9, TIMP-1, and TIMP-2 were evaluated in the patients with benign and malignant pancreatic tumors before surgery and in the 30-day follow-up. The study covered 134 patients aged 54 to 76 years, who were divided into groups by TNM staging.ResultsBefore the operation, the highest mean concentration of MMP-2 was found in patients with unresectable cancer, whereas the highest level of MMP-9 was in patients with resectable cancer. The highest level of TIMP-1 was noted in patients with inflammatory tumors. In 1 month following the operation, the highest level of MMP-2 was also in patients with unresectable cancer and the highest level of TIMP-2 in patients with inflammatory tumors.ConclusionsThe evaluation of the level of the studied cytokines in the pancreatic tumor patients can be diagnostically significant in the differentiation of benign and malignant changes. The changes in the levels of the studied enzymes and their inhibitors can have a prognostic value in the clinical severity of pancreatic cancer.

Evaluation of prognostic value of selected biochemical markers in surgically treated patients with acute mediastinitis

Summary Background Monitoring of biochemical markers of inflammation in acute mediastinitis (AM) can be useful in the modification of treatment. This study was a retrospective evaluation of selected biochemical parameters with negative impact on the prognosis in surgically treated patients. Material/Methods There were 44 consecutive patients treated surgically due to AM of differentiated etiology. Selected biochemical markers (WBC, RBC, HGB, HCT, PLT, CRP, PCT, ionogram, protein and albumins) were assessed before surgery and on the 3rd day after surgery. ANOVA was applied to find factors influencing observations. Numerical data [laboratory parameters] were compared by means of medians. Results The overall hospital mortality rate was 31.82%. In the group of dead patients, there were observed statistically significant lower mean preoperative values of RBC [p=0.0090], HGB [p=0.0286], HCT [p=0.0354], protein [p= 0.0037], albumins [p=0.0003] and sodium [p<0.0001] and elevated values of CRP [P=0.0107] and PCT p<0.0001]. High level of inflammatory markers on day 3 after surgery was found to increase the risk of death – for WBC (by 67%), for CRP (by 88%) and for PCT (by 100%). Conclusions Poor prognosis was more frequent in patients with preoperative high levels of CRP, PCT, anemia, hypoproteinemia and hyponatremia. The risk of death increases significantly if in the immediate postoperative period no distinct decrease in WBC count and of the CRP and PCT level is observed. In such a situation the patients should be qualified earlier for broadened diagnostic workup and for reoperation.

Proposal for a recovery prediction method for patients affected by acute mediastinitis

BackgroundAn attempt to find a prediction method of death risk in patients affected by acute mediastinitis. There is not such a tool described in available literature for that serious disease.MethodsThe study comprised 44 consecutive cases of acute mediastinitis. General anamnesis and biochemical data were included. Factor analysis was used to extract the risk characteristic for the patients. The most valuable results were obtained for 8 parameters which were selected for further statistical analysis (all collected during few hours after admission). Three factors reached Eigenvalue >1. Clinical explanations of these combined statistical factors are: Factor1 - proteinic status (serum total protein, albumin, and hemoglobin level), Factor2 - inflammatory status (white blood cells, CRP, procalcitonin), and Factor3 - general risk (age, number of coexisting diseases). Threshold values of prediction factors were estimated by means of statistical analysis (factor analysis, Statgraphics Centurion XVI).ResultsThe final prediction result for the patients is constructed as simultaneous evaluation of all factor scores. High probability of death should be predicted if factor 1 value decreases with simultaneous increase of factors 2 and 3. The diagnostic power of the proposed method was revealed to be high [sensitivity =90%, specificity =64%], for Factor1 [SNC = 87%, SPC = 79%]; for Factor2 [SNC = 87%, SPC = 50%] and for Factor3 [SNC = 73%, SPC = 71%].ConclusionThe proposed prediction method seems a useful emergency signal during acute mediastinitis control in affected patients.

Giant mesentery fibromatosis presenting as acute abdomen - case report

Mesentery fibromatosis, also called abdominal desmoid, is a rare clinical entity. It is part of the clinical-pathologic spectrum of so-called deep fibromatoses. The deep fibromatoses encompass a group of benign fibroproliferative processes that are locally aggressive; they may infiltrate the adjacent organs or recur, but do not create distant metastatic lesions. The small bowel mesentery is the most common site of intraabdominal fibromatosis. However, the omentum, ileocolic mesentery, transverse or sigmoid mesocolon, or ligamentum teres may be the site of origin for intraabdominal fibromatosis. Mesenteric fibromatosis occurs in a wide age range of patients, and has no gender or race predilection. Most cases of abdominal fibromatosis occur sporadically. In this article we would like to present a case report of a patient who was admitted to the clinic due to severe abdominal pain with clinically advanced peritoneal signs. The intraoperative findings were astonishing; we found a giant desmoid which originated in the mesentery. The tumor oppressed the ileum, leading to its obstruction.

Acute mediastinitis: evaluation of clinical risk factors for death in surgically treated patients

Acute mediastinitis (AM) is the most lethal form of infection within the thorax. The authors of this study, using statistical tools, made an attempt to determine the most important clinical risk factors in retrospective material of patients treated surgically due to AM.

Gastric tube resection due to metachronic cancer and a recurrence in anastomosis after Ivor-Lewis esophagectomy – case report

Gastric tube after esophagectomy can be the site of local recurrence or the development of second primary tumor which implies poor prognosis. The study presents an extremely rare case of a patient after Ivor-Lewis esophagectomy for squamous cell carcinoma, in whom there was detected local recurrence in the anastomosis associated with metachronous primary tumor in gastric tube. Esophageal reresection with the upper part of the stomach was performed. Left colonic segment supplied by middle colic vessels transposed through retrosternal route was used as new esophageal substitute.

Chest reconstruction using a custom-designed polyethylene 3D implant after resection of the sternal manubrium

Introduction Resection of manubrium or body of the sternum is associated with a necessity of chest wall reconstruction. Large sternal defects require the use of different types of implants to ensure acceptable esthetic effect for the patient and chest stabilization. Aim The purpose of this case report is to present a novel method of reconstruction of manubrium removed due to renal cancer metastasis to the sternum. Case We present the case of a patient, who had underwent right nephrectomy for clear cell kidney cancer, diagnosed with a metastatic tumor in the sternum resulting in destruction of manubrium. The patient undergone tumor resection with primary reconstruction with an individual prosthesis. Sternal defect was filled with a personalized, computed tomography scan-based 3D-milled implant made of polyethylene. Results Sternal reconstruction was uneventful. The patient endured surgery well, and has been under surveillance in outpatient clinic, without any respiration disorders, implant movement or local recurrence. Conclusion Custom-designed sternal implants created by 3D technique constitute an interesting alternative for previous methods of filling defects after resection of a tumor in this location.

Repair of postpneumonectomy bronchopleural fistula using pedicled pericardial flap supported by fibrin glue

Effective closure of the postpneumonectomy bronchopleural fistula (PBF) with the use of different techniques still remains a challenge for thoracic surgeons. The aim of this study was to evaluate the efficacy of modified method of PBF closure using pedicled pericardial flap (PPF) supported by fibrin glue (FG). The efficacy of the late PBF closure with the use of two surgical methods was compared. In 10 patients, the edges of the PBF were covered with FG and PPF. In the second group of nine patients, myoplasty was used to close the bronchial fistula. Postsurgical follow‐up was for 1 year. In the first group, the healing of the fistula was achieved in 100% of the cases, whereas in the second, myoplasty group, healing was achieved in only 66·67% of the cases. The number of complications was similar in both groups. Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of PBF in selected patients.