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Video-Assisted Thoracoscopic Surgery (VATS) Vs Thoracotomy in the Surgical Treatment of Recurrent Spontaneous Pneumothorax

100%
Kasprzyk M., Dyszkiewicz W., Piwkowski C., Pawlak K., Adamczak J., Zieliński P., Zwaruń D.
Polish Journal of Surgery
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2008
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vol. 80
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issue 3
118-123
EN
The aim of the study was to compare surgical treatment results in cases of recurrent spontaneous pneumothorax following video-assisted thoracoscopic surgery (VATS) and thoracotomy. We assessed the recurrence rate after the procedures and postoperative complications, considering two patient groups.Material and methods. The study group was comprised of 127 patients subjected to surgical treatment due to recurrent spontaneous pneumothorax during the period between 1996 and 2005. The group of 43 women and 84 men was between 15 and 79 years of age (mean age: 37 years). Video-assisted thoracoscopic surgery was performed in 67 cases, while the remaining 60 patients underwent thoracotomy. We performed the excision of the emphysematous blebs or apex of the lungs in 96 patients, partial pleurectomy with mechanical pleurodesis in 73 patients, subtotal pleurectomy in 33 cases, decortication of the lung in 30 cases, and chemical pleurodesis in 13 patients.Results. Pneumothorax recurrence was significantly more frequent in the group of patients following the minimally-invasive approach (28% vs 8%). We observed no statistically significant differences considering patient gender in both groups. However, the VATS approach had a tendency to be performed in younger patients (average 33 yrs. in VATS vs 42 yrs. in the thoracotomy group). We performed partial pleurectomy and mechanical pleurodesis more often during VATS, while subtotal pleurectomy and lung decortication were performed more frequently during thoracotomy. The percentage of resections, considering emphysematous blebs or lung apexes was similar in both patient groups. We observed no differences considering the duration and amount of postoperative drainage, hospitalization period, or percentage of postoperative complications (pleural hematoma, prolonged air leak, residual pneumothorax) between both groups.Conclusions. Apart from the excision of emphysematous blebs, subtotal pleurectomy should be considered in cases of patients subjected to video-assisted thoracoscopy. Subtotal pleurectomy could decrease the risk of recurrent pneumothorax, while having comparable percentages of postoperative complications as those following mechanical pleurodesis.
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Evaluation of factors associated with the nutritional mixture leading to liver complications in patients treated by means of parenteral nutrition at home

84%
Matras P., Żuchowska K., Banakiewicz K., Bobak A., Jajko K., Szypowski R., Zalewski G., Zieliński P., Rudzki S.
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vol. 85
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issue 12
681-686
EN
The major problem of total parenteral treatment consists in the balancing of the source and dose of the nutritional mixture, so as to not deepen malnutrition with a positive impact on the patients’ organism. The aim of the study was to evaluate selected factors that induce hepato-billiary complications in patients treated by means of parenteral nutrition at home. Material and methods. The retrospective study comprised 70 patients with biochemistry performed every three months. Considering statistical analysis patients were allocated to four groups, depending on the period of treatment. Group A analysis results were based on the activity of aminotransferases, group B on the activity of bilirubin. Both groups A and B were additionally divided into group I where we assigned normal values of control lab results, and group II with improper results after treatment. Results. Differences between groups Ia vs IIa were presented on the basis of the daily supply of glucose: mean- 2.52 vs 3.49 g/kg (p=0.000003), glucose/lipids ratio: mean- 3.76 vs 4.90 g/kg (p=0.0001), daily non-protein energy: mean- 16.73 vs 21.06 kcal/kg (p=0.0001). Differences between groups Ib vs IIb were presented on the basis of the daily supply of glucose: mean- 2.76 vs 3.46 g/kg (p=0.0007), glucose/lipids ratio: mean- 3.98 vs 5.13 g/kg (p=0.01), daily non-protein energy: mean-17.96 vs 20.36 kcal/kg (p=0.04). Based on the above-mentioned analysis the main goal in the prevention of hepatic complications should lead to the reduction of the dose of glucose. Increased glucose supply leads to increased number of hepato-billiary complications. Conclusions. Based on obtained results we were able to conclude that in case of liver complications associated with parenteral nutrition, proper management consists in the modification of nutritional mixtures (reduction in the daily glucose supply and change in the proportions of extra-protein energy). Such management has the greatest clinical effect. When determining the composition of the nutritional mixture one should adjust the glucose supply, so as to offset both sources of extra-protein energy
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