Taskova, Alice*
Dotaz
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BACKGROUND: Biodegradable (BD) stents made from polydioxanone have been used only in human airways. These stents combine the advantages of classical tracheal stents, and fewer side effects are expected due to their biocompatibility and their time-limited presence in airways. However, new clinical consequences have arisen. Here, the authors share their experiences with BD stents for tracheal indications, focusing on their safety and efficacy. METHODS: This was a retrospective review of a collected database of adult patients who underwent implantation of biodegradable tracheal stents between September 2013 and December 2022 at the Department of Respiratory Medicine of the 1st Faculty of Medicine in Prague and Thomayer University Hospital. The indications included functionally significant nonmalignant tracheal stenosis and tracheomalacia. Self-expandable, biodegradable, polydioxanone tracheal stents manufactured by ELLA-CS Ltd. (Hradec Kralove, Czech Republic) were implanted during rigid bronchoscopy under general anaesthesia. All patients were followed up in the department and were provided with the necessary care. The main efficacy and safety parameters and relationships were analysed using descriptive statistics and Fisher ́s exact, Wilcoxon and Kruskal‒Wallis tests. RESULTS: A total of 65 stents were implanted in 47 adult patients. During the first two months after implantation, when adequate function was expected, the stent was found to be effective in 26 out of 39 patients who completed this period (66.7%). The clinical effectiveness reached 89.7%, as early restenoses were mostly mild and necessitated treatment in only 4 patients. The frequencies of significant mucostasis, migration and granulation tissue growth were 2.6%, 7.5% and 23.1%, respectively, during this period. Thirty-four participants completed the half-year follow-up period after the first or second stent insertion, and some were followed up beyond this period. Poor control of symptoms, the development of restenosis and the need for interventions were characteristic of this period as the stents degraded. Twenty-two patients who experienced remodelling or stabilization of the tracheal lumen achieved a stent-free state. Seven patients underwent subsequent surgical treatment. CONCLUSIONS: BD stents are safe and provide adequate tracheal support until they begin to degrade. The use of BD stents necessitates close monitoring of patients and accurate treatment of possible restenosis. TRIAL REGISTRATION: Based on project NT14146 - Biodegradable stents in the management of the large airways (2013-2015, MZ0/NT), registered on May 1, 2013, in the Research and Development and Innovation Information System of the Czech Republic and at ClinicalTrials.gov (reg. no. NCT02620319, December 2, 2015).
- MeSH
- bronchoskopie * MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- polydioxanon MeSH
- protézy - design MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stenóza průdušnice * chirurgie MeSH
- stenty * MeSH
- trachea chirurgie MeSH
- tracheomalacie chirurgie MeSH
- vstřebatelné implantáty * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Ventilatory efficiency (V˙e/V˙co2 slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙e/V˙co2 during exercise also exhibit an increased V˙e/V˙co2 ratio and a decreased end-tidal CO2 at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures. METHODS: Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p <0.05 is considered significant. RESULTS: Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56 (74%) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p = 0.03), lower rest end-tidal CO2 (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙e/V˙co2 ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p = 0.02), and higher V˙e/V˙co2 slope (34.9 ± 6.4 vs 31.2 ± 4.3; p = 0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO2 to be the best predictor of respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06 to 1.39; area under the curve: 0.77; p = 0.01). CONCLUSIONS: Resting end-tidal CO2 may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.
- MeSH
- časové faktory MeSH
- dechový objem fyziologie MeSH
- hrudní chirurgické výkony škodlivé účinky MeSH
- incidence MeSH
- lidé MeSH
- míra přežití trendy MeSH
- následné studie MeSH
- odpočinek fyziologie MeSH
- oxid uhličitý metabolismus MeSH
- plicní nemoci mortalita patofyziologie chirurgie MeSH
- pooperační komplikace diagnóza epidemiologie MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- senioři MeSH
- zátěžový test MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: Complex networks of chemokines are part of the immune reaction targeted against tumor cells. Chemokines influence cancer growth. It is unclear whether the concentrations of chemokines at the time of NSCLC (non-small cell lung cancer) diagnosis differ from healthy controls and reflect the extent of NSCLC. AIMS: To compare chemokine concentrations (CCL2, CCL8, CXCL12) in the plasma of patients with resectable NSCLC to those without cancer. To determine whether the chemokine concentrations differ relative to the stage of disease. METHODS: Sixty-nine patients undergoing surgery for proven/suspected NSCLC were enrolled. They underwent standard diagnostic and staging procedures to determine resectability, surgery was performed. Forty-two patients were diagnosed with NSCLC, while 27patients had benign lung lesions and functioned as the control group. Chemokine concentrations in peripheral blood were assessed using ELISA. Parametric statistics were used for the analysis of results. RESULTS: There were no differences in plasma chemokine concentrations in NSCLC patients compared to controls. CXCL12 concentrations correlated positively with tumor extent expressed as clinical stage, (mean values: stage I 5.08 ng/mL, SEM 0.59; stage II and IIIA 7.82 ng/mL; SEM 1.06; P=0.022). Patients with NSCLC stages II+IIIA had significantly higher CXCL12 concentrations than controls (mean values: stage II+IIIA 7.82 ng/mL; SEM 1.06; controls 5.3 ng/mL; SEM 0.46; P=0.017). CONCLUSION: CXCL12 was related to tumor growth and could potentially be used as a biomarker of advanced disease.
- MeSH
- biologické markery MeSH
- chemokin CCL2 MeSH
- chemokin CCL8 MeSH
- chemokin CXCL12 MeSH
- chemokiny MeSH
- lidé MeSH
- nádory plic * chirurgie patologie MeSH
- nemalobuněčný karcinom plic * chirurgie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory plic * chirurgie MeSH
- pneumektomie metody MeSH
- torakotomie metody MeSH
- transplantace srdce MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Tumory hrudníku tvoří různorodou skupinu onemocnění. Lokalizací se jedná o nádory plicního parenchymu, pleury, stěny hrudní a mediastina. Etiologie je benigní či maligní, může se jednat o vrozené či získané léze. Péče o pacienty s neověřenými tumory hrudníku je vždy komplexní a multidisciplinární a podílí se na ní celá řada specialistů. Dokud není jasně stanovena etiologie neověřeného tumoru, přistupujeme k tumoru vždy jako k potencionálně malignímu a je nutno jej dále vyšetřovat.
Tumours of the chest form a heterogenous group of diseases. By localization we distinguish tumours of lung parenchyma, pleura,chest wall and mediastinum. The etiology is benign or malignant, they could be congenital or acquired. Care for patients withthoracic tumours with unknown etiology should be always complex and multidisciplinary and involves a number of specialists.They should be considered malignant until proven otherwise and should be investigated further.
