Objective: The co-incidence of lung cancer and heart disease is increasing. This can be caused by population ageing, which has more co-morbidities and most likely due to the common etiological causes of both entities, i.e. smoking, hypertension and obesity. The aim of this study was to analyze the outcomes of simultaneously performed heart surgery and pulmonary resection in a selected group of patients. Methods: From January 2002 to December 2011 we performed in our department 1115 pulmonary resections for lung tumor. Signifi cant heart disease requiring surgical treatment was diagnosed in 21 patients from the whole group. In 12 patients, group A; simultaneous heart surgery and lung resection procedure were performed. Results: Group A consisted of 8 men and 4 women with the median age of 67.8 ± 5.9 years. In this group, 10 lobectomy procedures and 2 wedge resections for pulmonary metastasis were done. Nine patients underwent coronary artery revascularization, 2 patients underwent mitral valve replacement and one patient underwent tumor removal from the left atrium. In 5 patients, extracorporeal circulation (ECC) was needed, the remaining 7 patients underwent myocardial revascularization using an off-pump technique. Group B consisted of 7 men and 5 women with the age of 68.5 ± 7.4 years. Ten lobectomy procedures and 2 wedge resections were performed. Conclusion: The risk of simultaneously performed lung resection and cardiac surgery is not high. Despite the certain differences in clinical indicators between group A and B, the safety of simultaneous procedure, in group A, was evident. Furthermore, earlier lung resection was enabled and the eventual complications from further surgical procedure were avoided (Tab. 5, Ref. 33). Text in PDF www.elis.sk. Acknowledgement: Supported by the programme PRVOUK P37/04. DyszkiewiczW, Jemielity M, Piwkowski C, Kasprzyk M, Perek B, Gasiorowski L, Kaczmarek E. The early and late results of combined off pump coronary artery bypass grafting and pulmonary resection in patients with concomitantlung cancer and unstable coronary heart disease. Eur J Cardiothorac Surg 2008; 34: 531-535. 32. Apostolakis E, Prokakis C, Koletsis E, Dougenis D. Median sternotomy for combined coronary artery bypass grafting and lung tumor resection: is it valid or not? Eur J Cardiothorac Surg 2009; 35: 1117-1119. 33. Habal P, Šimek J, Lonský V, Novotný J. Possibilities of combined surgical treatment of lung tumours and heart diseases Acta Medica (Hradec Králové) 2006; 49 (3): 175-181.

Surgical treatment is not commonly used in the management of chylothorax. We describe a complicated algorithm that we used in treating a 70-year-old lady with Bechterev disease, who suffered from a blunt chest injury with subsequent right-sided serial ribs fracture with hemothorax and thoracic vertebral body fracture. Because of Bechterev disease, hyperextension of the ossifi ed thoracic spine caused an injury of the thoracic lymphatic duct. Simultaneous thoracic spine stabilisation with surgical revision of the thoracic lymphatic duct from an anterior approach was indicated. Despite the urgency of thoracic spine stabilisation, the procedure was postponed due to an acute coronary syndrome, which implied drug eluting stent insertion with a subsequent need of dual anti platelet therapy. Thus, the procedure was done 16 days after stent insertion. The diagnosis of chylotorax must be considered in case of thoracic injury with continuing waste to the chest tube and the fi nding of well expanded pulmonary parenchyma. Biochemical investigation of the effusion is the cornerstone in establishing the diagnosis of chylothorax (Tab. 2, Fig. 1, Ref. 14). Text in PDF www.elis.sk. Fig. 1. MRI image comminutive fracture thoracic vertebra Th12.

INTRODUCTION: The authors present the results of a promising method to reduce peroperative bleeding in thoracic surgery within large thoracic surgical interventions. Usage of a resorbable haemostat on the basis of oxidized cellulose in the form of cotton wool may minimize the cause of bleeding, mainly in patients with postinfl ammatory thoracic complications. The strong point of this material is its easy application and malleability. Another advantage is the long-term antibacterial effect caused by lowering pH during its biodegradation. AIM: Retrospective evaluation of post-operative blood losses, time of thoracic drainage, length of hospitalisation, and development of infl ammatory indicators between groups using and not using haemostats. METHODOLOGY: A group consisted of 48 patients (group A), who underwent operation for post-infl ammatory thoracic complications and where haemostat was used. Using the pair selection method, 48 patients were selected to the control group B, where no haemostats were applied during operation. The selection depended on a similar demographic profi le, identical diagnosis, and a type of operations. Post-operational blood loss, dynamics of haematological profi le, time of thoracic drainage, blood parameters value, infl ammatory response of the organism, and length of hospitalisation. RESULTS: A key differentiation of dynamics in development was found between the groups in the concentration of haemoglobin and haematocrit in the post-operative period, in the time of thoracic drainage, and in total length of hospitalisation. A sudden rise of CRP serum values in the group A after 12 hours after application of haemostat was recorded, most probably as manifestation of the aseptic pleuritic (Tab. 4, Fig. 1, Ref. 16).

Abstract:Background: Pleurodesis with talc has been used for many years. No objective criteria of infl ammatory symptoms are known in order to use them to predict the effect of therapy and selection of patients. Purpose of the study: To objectify the course of local infl ammatory changes in the pleural cavity, quantify their dynamics in a clinically used procedure, and to determine specifi c predictors of infl ammation as perspective markers of selection of patients suitable for talcage. Material and method: A total of 114 patients were retrospectively divided into Group A (n 1 = 98) of patients without relapse and Group B (n 2 = 16) of patients with relapse of exudate. The need for repeated thoracic punctures or drainages over the course of a 12-month monitoring period was the criterion of treatment failure. Results: The groups were not different as for the baseline values of sTLR-2 (p 0 = 0.638). Group A showed a marked growth during the monitoring period in 2 hours following talcage (p 2 = 0.002) and in 24 hours (p 24 = 0.016). Group B showed higher sCD-163 levels (p 0 < 0.001). The initial sTREM-1 values and those after two hours were similar in both groups (p 0 = 0.146; p 2 < 0.0641). In 24 hours, Group A had markedly higher values (p 24 < 0.001). Conclusion:The sTLR-2, sCD-163 and sTREM-1 values can be prospectively determined. High sCD-163 values predict unsuitable selection of a candidate for talcage. The degree of infl ammatory response can be evaluated using sTLR-2 or sTREM-1. Talcage using an inserted thoracic drain can be repeated at low levels. The cost of ELISA examination is approximately 18 euros (Tab. 1, Fig. 4

Úvod: Bylo prokázáno, že chirurgické ablační procedury zajišťují účinnou léčbu fi brilace síní (FS), ovšem stále chybějí přesvědčivé důkazy o spojitosti mezi klinickými proměnnými, chirurgickou technikou a střednědobými až dlouhodobými výsledky. Provedli jsme tedy v našem centru retrospektivní databázovou studii s cílem identifi kovat prediktory udržení sinusového rytmu (SR) po 12 měsících od zákroku, a to s přihlédnutím ke standardní lékařské péči poskytované praktickými lékaři a/nebo ambulantními kardiology ve vztahu k této nově zavedené metodě. Metody: Byly shromážděny údaje o 376 konsekutivních pacientech, kteří v rozmezí od července 2006 do prosince 2010 podstoupili operaci srdce zahrnující chirurgickou ablaci levé síně (LS) pro FS. Primárním sledovaným ukazatelem bylo udržení SR po 12 měsících. K identifi kaci prediktorů dosažení primárního sledovaného ukazatele byla použita kroková zpětná víceproměnná logistická regresní analýza. Výsledky: U 210 pacientů byla provedena radiofrekvenční (RF) ablace a 166 pacientů podstoupilo kryoablaci. Údaje z kontroly po 12 měsících byly k dispozici u 273 osob. Úspěšnost udržení sinového rytmu po jednom roce od zákroku činila 48,9 % (63,1 % u kryoablace a 37,8 % u RF [p < 0,0001]). Během 12 měsíců sledování nebyla u žádného pacienta ablace opakována. Spojitost s primárním sledovaným ukazatelem byla prokázána u paroxysmální FS, u operace mitrální chlopně a u menšího průměru LS; kryoablace zajišťovala lepší výsledky než RF ablace. Četnost předepisování amiodaronu/propafenonu u pacientů, u nichž byl po 12 měsících doložen sinusový rytmus, ovšem dosáhla hodnoty 36,0 %. Závěry: Pomocí víceproměnné analýzy retrospektivních dat jsme identifi kovali klinické proměnné a technické aspekty spojené s lepšími výsledky chirurgické ablace FS.