Video-assisted thoracoscopy (VATS) is gaining on thoracic surgery, having newly developed devices next to endostaplers for haemostatic and airtight sealing of lung parenchyma. Though the bipolar electrothermal Ligasure has good results for pulmonary wedge resection, its literature is small in numbers. Authors compared Ligasure and endostapler for pulmonary wedge resection of solitary pulmonary nodules (SPN). Authors performed a retrospective analysis of 44 consecutive patients. The indication of operation was non-verified SPN in all cases. They carried out pulmonary wedge resection for 22 patients with Ligasure-Atlas and 22 patients with ETS Flex endostapler via VATS. Authors examined the gender, average age (62 vs. 49 years), mean hospital stay (6.6 vs. 6.8 days), average operation time (55 vs. 50 min), number of complications (2 vs. 1), average drainage time (2.8 vs. 2.7 days), average fluid loss (190 vs. 160 ml), and instrumental costs (367 euro vs. 756 euro) of both groups. They accomplished the histological analysis of the coagulated lung parenchyma as well. According to the results, the Ligasure-Atlas is eligible for pulmonary wedge resection. The method is safe, easy to use, having minimal rate of complications. It can moderate costs of operation, compared to endostaplers.
Introduction: The successful combination of osteoinductive factors with current materials used in both endoprosthetics and implantology improves bony ingrowth and long-term stability of the chosen implants. The aim of the present experimental animal study was to clarify in what way faster bony integration can be achieved through additional BMP-3-coating of titanium test implants of different surface textures (hydroxy-apatite-coated or corundum-blasted). Methods: Thirty of 60 cylindrical titanium test implants with a hydroxy-apatite or corundum-blasted surface were coated with 230 mg porcine, high-purified BMP-3-precipitate per implant to check their osteoinductive potential in a bioassay. In each case a BMP-3-coated and an uncoated control-device were implanted with a gap formation of 1 mm into the femoral part of the patellofemoral joint of the right and left leg of 30 adult giant rabbits. Serial saw slices of all explanted specimens were prepared, and the osseous integration of the implant and time-dependent bone neoformation were analyzed microscopically and histomorphometrically 14, 35, and 56 days after implantation. Results: Coating of TiAl 4 V 6 -test devices with BMP-3 led in both groups after gap implantation to an improved osseointegration, that was histomorphological and histomorphometrical verifiable. Statistical evaluation using the t-test for matched samples showed 5 weeks after surgery a significant higher volume of new formed bone of the BMP-3-coated corundum-blasted or hydroxy-apatite-coated TiAl 4 V 6 test devices compared to the non-coated controls of the same type (P < 0.01). Light microscopy demonstrated osseointegration without connective tissue membrane around the surface of the implants after 2, 5, and 8 weeks. Better osseointegration was achieved in the hydroxy-apatitecoated implants than in the corundum-blasted implants. Conclusions: Our results indicate that composite metal implants, as used in endoprosthetics and implantology, are suitable carriers for BMP-3 and improved fixation of the implants can be achieved.
Lymphangioleiomyomatosis with tuberous sclerosis complex is a rare disease. One of the most frequent complications of lymphangioleiomyomatosis is pleural effusion (chylothorax) wich can be treated with the use of VATS. Authors report a case of pulmonary lymphangioleiomyomatosis in a 56-year-old female patient with tuberous sclerosis complex with an 8-week history of recurrent chylothorax, dyspnea and debilitating weakness. By CT scan a flat tissue proliferation was seen in the site of the thoracic duct and it was supposed to be the reason for the pleural effusion. A VATS resection of this laesion and ligation of the thoracic duct was performed successfully. Chylothorax is often associated with pulmonary lymphangioleiomyomatosis. Lymphangioleiomyomatosis combined with tuberous sclerosis complex is extremely rare. In case of chylothorax VATS treatment is successful and may be the first choice.
Az új típusú, direkt orális antikoagulánsok közül jelenleg egyedül a direkt trombingátló dabigatran rendelkezik haté kony antidótummal. Az idarucizumab egy humanizált, monoklonális dabigatrant megkötő antitestfragmentum, amely a gyógyszer szelektív véralvadásgátló hatását azonnal, tartósan, biztonságosan felfüggeszti. A szerzők a da bigatran iv. antidótuma, az idarucizumab első hazai alkalmazását (2016. május 23.) ismertetik egy nonvalvularis paroxysmalis pitvarfibrilláció miatt dabigatrant (2 × 110 mg/nap) szedő, akut cholecystectomiára szoruló, magas strokerizikójú, csökkent vesefunkciós idős nőbetegen. A beteg a műtét előtt két órával antidótumot (idarucizumab 2 × 2,5 g/50 ml iv.) kapott, a sebészeti beavatkozás kapcsán kontrollálhatatlan vérzés nem volt. Az antikoaguláns hatásra utaló műtét előtti megnyúlt aktivált parciális tromboplasztinidő az antidótum beadása után normalizálódott. Az idarucizumab iv. beadása kapcsán mellékhatás, szövődmény nem volt. A beteg felgyógyulása után ismét dabigat rankezelést alkalmaztak. Orv. Hetil., 2017, 158(10), 387-392. Kulcsszavak: direkt orális antikoagulánsok, dabigatran, antidótum, idarucizumabThe first use of iv. idarucizumab for dabigatran reversal in Hungary At present, the direct thrombin inhibitor dabigatran is the only one amongst the new direct anticoagulants which has an effective, specific reversal agent. The novel agent idarucizumab is a humanized, monoclonal antibody fragment binds to dabigatran within minutes thereby offers an opportunity to induce a safe, longlasting reverse of the antico agulant effects of dabigatran. The authors describe the first use of idarucizumab in Hungary (23. 05. 2016) in an old female patient with nonvalvular paroxysmal atrial fibrillation of high stroke riskscore and renal dysfunction who was taking dabigatran (2 x 110 mg/day) when an acute abdomen developed requiring emergency cholecystectomy. Pa tient received the antidote (idarucizumab 2 x 2.5 g/50 ml iv.) two hours before the surgical intervention, and she did not have any uncontrollable, lifethreatening bleeding during the surgery. The high activated partial thrombo plastin time relating to anticoagulative influence before the surgery normalized completely after administration of the antidote. Antagonizing dabigatran with idarucizumab was feasible and safe without any side effects. The patient re ceived dabigatran therapy again after her recovery.
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