Parathyroid Carcinoma in Patients that Have Undergone Surgery for Primary Hyperparathyroidism.

BACKGROUND/AIM: Parathyroid carcinoma is a rare clinical entity, which represents one of the main reasons, why surgery should be performed in specialized centres. Preoperatively, it is very difficult to distinguish between benign and malignant hyperparathyroidism. PATIENTS AND METHODS: During the years 1996-2016, we performed 2,220 operations in 2,075 patients with a diagnosis of primary hyperparathyroidism. RESULTS: Among these 2,220 operations, there were 16 operations for parathyroid carcinoma. These 16 operations, including reoperations, were performed in four patients. Two patients had no reoperation, but another 2 patients required 14 reoperations in total. Parathyroid carcinoma was described in 0.2% of all patients with a diagnosis of primary hyperparathyroidism. The number of operations was 0.73% of all operations of primary hyperparathyroidism in years 1996-2016. CONCLUSION: Prognosis of parathyroid carcinoma is quite favourable, patients evidence a long-term survival rate after the primary operation. However, every reoperation increases the number of possible complications, including recurrent laryngeal nerve injury.

[Surgeons not interested in smoking?] / Kourení chirurgy nezajímá?

Smoking worsens surgical treatment outcomes: Smokers have more complications, spent longer time at postoperative wards / intensive care units, have longer overall hospitalization time after surgery, healing process is slower. In addition to the deterioration of patient comfort, it is also an economic burden for the health care unit. The surgery results are significantly better especially if the patient stops smoking at least 3-6 weeks before the surgery - but every day without cigarettes is a benefit.Except of acute cases, the preoperative preparation should include recommendation to quit smoking as long as possible before elective surgery and to offer treatment of tobacco dependence to the patient.

Continued Smoking in Lung Transplant Patients: A Cross Sectional Survey.

INTRODUCTION: Smoking is associated with a higher incidence of post-lung transplantation complications and mortality. Prior to inclusion on the lung transplant waiting list in the Czech Republic, patients are supposed to be tobacco free for at least 6 months. Our aim was to determine the prevalence of smoking, validated by urinary cotinine, among patients post lung transplantation and prior to inclusion on the transplant waiting list. METHODS: Between 2009 and 2012, we conducted a cross-sectional survey of urinary cotinine to assess tobacco exposure in 203 patients in the Lung Transplant Program in the Czech Republic. We measured urinary cotinine in 163 patients prior to inclusion on the transplantation waiting list, and 53 patients post bilateral lung transplantation. RESULTS: 15.1% (95% CI 0.078 to 0.269) of all lung transplant recipients had urinary cotinine levels corresponding to active smoking; and a further 3.8% (95% CI 0.007 to 0.116) had borderline results. Compared to patients with other diagnoses, patients with COPD were 35 times more likely to resume smoking post- transplantation (95% CI 1.92 to 637.37, p-value 0.016). All patients who tested positive for urinary cotinine levels were offered smoking cessation support. Only one Tx patient sought treatment for tobacco dependence, but was unsuccessful. CONCLUSION: Smoking resumption may be an underrecognized risk for lung transplantation recipients, particularly among patients with chronic obstructive pulmonary disease. More rigorous screening, as well as support and treatment to stop smoking among these patients are needed.

[Transplantations of lungs in the Czech Republic - from the perspective of the pathologist]. / Transplantace plic v Ceské republice - z pohledu patologa.

Lung transplantation has become a standard therapeutic procedure for patients with end-stage pulmonary diseases in the Czech Republic. There were 246 lung transplantations performed from December 1997 to the end of November 2014 at the 3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague and Motol University Hospital. The most common indications for transplantation were chronic obstructive pulmonary disease in 39.4 % of patients, idiopathic pulmonary fibrosis in 28.9 % of patients and cystic fibrosis in 19.1 % of patients. The trans-bronchial biopsy is important for monitoring patients after lung transplantation. The biopsy helps to detect acute cellular rejection, which was found within 63 % of our patients. Patients with the mild and moderate grade of acute cellular rejection got better after the anti-rejection therapy. The severe rejection in three patients led to the shock change in lung and to respiratory failure. Humoral rejection cannot be determined based on biopsy only - the capillaritis and the linear binding of C4d fraction of the complement to the capillaries are inconsistent findings and are not pathognomonic. The classification of chronic rejection, which corresponds to the bronchiolitis obliterans, is limited for the common absence of bronchioli in the biopsy. Therefore, bronchiolitis obliterans in our study group was detected in only 3.7 % of patients.Since the first transplantation, 109 of our patients have survived (44.3 %). After transplantation about 90 % of patients live one year, about 70.9 % of patients live 3 years and 69.1 % live 5 years. An autopsy at our department was performed in 79 cases. The most common causes of death were mycotic infections (aspergillosis, candidiasis), bacterial infections (Klebsiela, Pseudomonas aeruginosa, Burkholderia cepacia) followed by sepsis and viral infection (CMV, varicella zoster). At the autopsy, chronic rejection was found in 13 patients and it led to chronic respiratory failure, which was often complicated by an infection. The tumors as the cause of death were mostly generalized carcinomas.

Predictors of atelectasis after pulmonary lobectomy.

PURPOSE: To define the incidence of and factors predisposing to postlobectomy atelectasis (PLA). METHODS: The subjects were 412 patients who underwent pulmonary lobectomy at our hospital between January 2004 and April 2007. This study was performed as a retrospective analysis of our prospective database. Postlobectomy atelectasis was defined as ipsilateral opacification of the involved lobe or segment with an ipsilateral shift of the mediastinum on chest radiograph, requiring bronchoscopy. RESULTS: Postlobectomy atelectasis developed in 27 patients (6.6%), accounting for 29% of all postoperative pulmonary complications. There were no significant differences between the PLA and no-PLA groups in age, sex, American Society of Anesthesiology performance status, cardiovascular comorbidity, or operation time. Chronic obstructive pulmonary disease (COPD) was the only preoperative variable predictive of PLA (P<0.05). Right upper lobectomy (RUL), either alone or in combination with right middle lobectomy, was associated with a significantly higher incidence of PLA than any other type of resection (P<0.05). CONCLUSIONS: Postlobectomy atelectasis is an important postoperative complication. Patients with COPD and those undergoing RUL are at higher risk of this complication. Although often isolated, PLA is associated with longer hospital stay.

Surgical treatment of primary hyperparathyroidism in children: report of 10 cases.

Primary hyperparathyroidism in children is very rare. It is caused by overproduction of parathormone by a pathologically changed parathyroid gland. We carried out a retrospective study in 10 patients (age 10-17 years) who had surgical treatment between 1996 and 2007. The main signs of primary hyperparathyroidism were urolithiasis, nephrolithiasis, nephrocalcinosis and bone resorption, as well as non-specific signs such as fatigue, torpidness and muscle weakness. Patients were examined using sonography, MIBI-scintigraphy, CT and MRI. Calcium was measured before and after surgery; parathormone was monitored postoperatively. Surgery was curative in nine patients; reoperation was necessary in one patient because an ectopic parathyroid gland was not detected during the primary operation. Other major complications were not observed. Removal of pathologically changed parathyroid glands offers definitive and safe treatment of primary hyperparathyroidism in children. Special care should be taken if an ectopic parathyroid gland is suspected.

Extension of pulmonary adenocarcinoma into the left atrium.

A 62-year-old man presented with pulmonary adenocarcinoma that penetrated through the pulmonary vein into the left atrium. The tumor in the left atrium was removed via a right lower lobectomy under cardiopulmonary bypass. In selected cases, radical removal of a tumor in patients without mediastinal lymph node involvement may improve the prognosis. The use of cardiopulmonary bypass extends the possibilities of radical tumor removal.

Management of benign stenoses of the large airways in the university hospital in Prague, Czech Republic, in 1998-2003.

BACKGROUND: Clinically significant benign stenoses of the large airways develop in about 1% of patients after intubation. The management of benign stenoses is not unified around the world, nor are there any accepted methods for their screening. OBJECTIVES: The purpose of this study is to describe and compare results of interventional bronchoscopy and surgical therapy of benign stenoses as well as to propose an algorithm for the management of this airways disorder. METHODS: Prospective study on 80 consecutive patients with benign stenoses of the large airways admitted to the Pulmonary Department of the University Hospital of Prague-Motol. RESULTS: Sixty-two patients developed stenoses after endotracheal intubation or tracheostomy, in 18 patients the stenosis was caused by other diseases or pathological situations. Thirty-eight patients were sent for surgical resection of the stenotic part of the airways. 2 surgically treated patients developed recurrence of the stenosis and had to be reoperated on. Narrowing of the trachea at the site of end-to-end anastomosis developed in 6 other patients and was cured by interventional bronchoscopy. The remaining 42 patients were treated by interventional bronchoscopy (Nd-YAG laser, electrocautery, stent) which was curative in 35 patients. Sixty-five patients were alive at the time of evaluation, 15 patients died. Five of them died between 3 and 14 (median 4) months after surgery from a disease other than airway stenosis. Ten nonresected patients also died, with 1 exception, due to a disease other than airway stenosis; the median survival was 9 months. CONCLUSIONS: We recommend to assess the patient for surgery after the initial diagnosis and therapeutic bronchoscopy with dilatation of the stenosis. If the patient is not a suitable candidate for resection, interventional bronchoscopy is an appropriate alternative for the management of benign stenoses of the large airways.

Predictors of prolonged air leak following pulmonary lobectomy.

OBJECTIVE: To predict risk factors of a prolonged air leak following pulmonary lobectomy. METHODS: From January 2003 to March 2004, 134 patients (95 male, mean age 66+/-7.7 years) underwent pulmonary lobectomy for lung tumor. Prolonged air leak (PAL) was defined as an air leak lasting 7 days or more of postoperative chest tube drainage. Chronic obstructive pulmonary disease (COPD) was defined as an FEV1 of <70% predicted and an FEV1/FVC ratio <70% based on the results of a preoperative pulmonary function test. RESULTS: PAL occurred in 13 (9.7%) patients and it lasted 10.4+/-3.2 days. Eleven out of 13 patients with PAL were identified with this co-morbidity only. There was not reoperation for PAL. Differences in age, gender, exposure to neoadjuvant chemotherapy, body mass index (BMI) and type of lobectomy were not statistically significant. COPD remained the only variable predicted for PAL (P<0.05). CONCLUSIONS: Prolonged air leak is quite a common pulmonary complication after pulmonary lobectomy and can be treated conservatively. This complication significantly prolongs the length of hospitalization (P<0.01). We also conclude that COPD increases the risk of an air leak persisting for longer than 7 days.