Pre-operative caloric load (amino acids) reduces the level of insulin resistance and glucose in the presence of elevated cortisol levels.
Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery -decortications or thoracoplasty. Early recognition of the parapneumonic effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally invasive, is possible not to prograde the process and not to become empyema. aim: To analyze the results of the surgical treatment in patients with empyema treated at Clinic for thoracic surgery. Material and methods:In the retrospective study we analyzed 234 patients with empyema which were treated at the Clinic for Thoracic Surgery in 5 year period (2011)(2012)(2013)(2014)(2015). The mean age of the patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty. results: With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total of 108/234 (46.15%) were treated with decortications from which, primary decortications were indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty -3 of the patients with decortications and 2 with primary indicated thoracoplasty according to the local findings, long term untreated empyema and bad general condition. The Mean hospitalization was 17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and 2/5 (40%) in the group with thoracoplasty. conclusion: Early detection of the parapneumonic effusion and the adequate treatment will prevent the appearance of empyema. If the empyema is detected it is necessary as early as possible to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to use less invasive decortications, using VATS than the open thoracotomy decortication which is more extensive surgical intervention.
Aim: The aim of the study was to identify the impact of T stage, the presence of estrogen, progesterone, HER2neu receptors and the values of the Ki67 on the positivity for metastases of the axillary lymph nodes, from primary breast cancer. Material and methods: 290 surgically treated patients for breast cancer were included in the study. All cases have been analyzed by standard histological analysis including microscopic analysis on standard H&E staining. For determining the molecular receptors -HER2neu, ER, PR, p53 and Ki67, immunostaining by PT LINK immunoperoxidase has been done. Results: Patients age was ranged between 18-90 years, average of 57.6+11.9. The mean size of the primary tumor in the surgically treated patient was 30.27 + 18.3 mm. On dissection from the axillary pits 8 to 39 lymph nodes were taken out, an average of 13.81+5.56. Metastases have been found in 1 to 23 lymph nodes, an average 3.14+4.71. In 59% of the patients there have been found metastases in the axillary lymph nodes. The univariate regression analysis showed that the location, size of tumor, differentiation of the tumor, stage, the value of the Ki67 and presence of lymphovascular invasion influence on the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors and HER2neu receptors showed that they do not have influence on the positivity for metastatic deposits in axillary lymph nodes. The multivariate model and the logistic regression analysis as independent significant factors or predictors of positivity of the axillary lymph nodes are influenced by the tumor size and the positive lymphovascular invasion. Conclusion: Our study showed that the involving of the axillary lymph nodes is mainly influenced by the size of the tumor and the presence of lymphovascular invasion in the tumor. Ki67 determined proliferative index in the univariate analysis points the important influence of positivity in the axillary lymph nodes, but not in the multivariate regressive analysis.
A 48-year-old man with retrosternal chest pain and upper abdominal pain with propagation to the back, with clinical signs of nausea, dyspnea and dysphagia was referred to the Clinics of thoracic surgery. After esophagography, operative treatment was indicated. Left thoracotomy with mediastinothomy were performed. During the operation, a sample of pus was taken and sent for a microbiological examination at the Institute of Microbiology and Parasitology, Medical Faculty in Skopje. Standard microbiological procedures were used. The sample was cultured anaerobically on Schaedler agar and incubated for 48 hours at 37ºC. Oval, smooth colonies were observed. Gram stained smear revealed short branching Gram-positive filaments suspected for genus Actinomyces. For a definitive diagnosis and differentiation of the Actinomyces species, an automated VITEK system was used. Two weeks after treatment by ceftriaxon, metronidazol and analgetics, all clinical signs improved and patient was released in good physical condition.
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