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.

Electronic chest drainage systems are easy-to-use, portable and safe, offering objective data of the amount of postoperative air leak, and visualize the trends in graphical format, too. Importantly, early mobilization contributes to cost reduction. In combination with VATS technique surgical stress is significantly reduced as well as postoperative recovery is shortened.

The indication circle of enteral nutrition is continuously enlarging. Looking after this increasing group of patients, is now an everyday practice. Enteral nutrition has more advantages than intravenous. Amongst this, jejunal feeding is most widely applied, but it requires nasojejunal tube. Positioning the tube is possible by the guide of X-ray, endoscope, ultrasound, or simply "blind". Authors present the fluoroscopic technique, as their everyday practice. It does not demand special expertise, skilled endoscopist, or premedication, and can be performed in any hospital. It is fast, cheap, and tolerable. It's disadvantages are that only conscious, cooperating, spontaneously breathing patients can be treated such, and it involves irradiation. Authors have used this method 34 times in the past 3 years and had no major complications. Every patient suffered acute necrotising pancreatitis. Considering cost-benefit principles, they recommend this procedure as safe for all levels of in-patient departments.

Authors introduce the case of a 64-year-old male patient with fulminant isolated necrotizing fasciitis of the chest wall, complicating empyema thoracis of unknown origin. The patient's co-morbidities were hypertension, ischaemic heart disease, atrial fibrillation with oral anticoagulation. The real etiology was revealed post mortem, due to the rapid progression. The autopsy demonstrated that the fasciitis was caused by a small blunt thoracic trauma (haematoma), not emerged from patient's history and was not visible during physical examination. Authors review diagnostic pitfalls, leading to delayed recognition in addition to this very case. After quick diagnosis surgical debridement, targeted wide spectrum antibiotics and maximal intensive care are the basic pillars of the management of necrotizing fasciitis.

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.