An effect of Nuss Procedure on lung function among patients with pectus excavatum.

UNLABELLED: The aim of the study was to evaluate lung function among patients who underwent Nuss Procedure. The analysis included spirometric evaluation of the lung function before Nuss Procedure, during perioperative period and after removing steel bars from behind the sternum. MATERIAL AND METHODS: The study group involved patients operated on the pectus excavatum in the Department of Thoracic Surgery in Poznan in years 2002-2004. The study group consisted of 44 patients (5 females and 39 males). Aged between 10 to 32 years old, the mean age was 16. The following spirometric parameters were analysed: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV1/VC ratio, peak expiratory flow (PEF), forced expiratory flow for 25% (FEF25), 50% (FEF50) and 75% FVC (FEF75). RESULTS: The values of the FVC, FEV1, FEF25, and FEV1/VC ratio in the study group were significantly higher in the postoperative period in comparison with the preoperative period. There was a statistically significant correlation between the improvement in spirometric parameters after Nuss Procedure and the impairment of spirometric values in preoperative period. There were no statistical differences between the value of initial chest deformation and spirometric parameters improvement. There were also no statistically significant correlations between age, height and weight of the patient in the study group and spirometric values improvement. CONCLUSION: There is a statistical improvement in lung function in patients who underwent Nuss Procedure. The improvement in spirometric parameters correlates with the impairment of spirometric values in the preoperative period.

[The assessment of acute phase proteins as prognostic factors in patients surgically treated for non-small cell lung cancer]. / Ocena wybranych bialek ostrej fazy jako czynników rokowniczych u chorych leczonych chirurgicznie z powodu niedrobnokomórkowego raka pluca.

INTRODUCTION: The aim of the study was to assess quantitative changes of the acute phase protein (APP) serum level in patients with non-small cell lung cancer (NSCLC) who underwent a radical resection. We analysed the correlation between quantitative APP changes and: the survival rate, the histological type of the cancer, TNM stage and grading. MATERIAL AND METHODS: We analysed a group of 46 patients surgically treated for NSCLC from 2003 to 2004. The average age of patients was 61 (45 to 77 years). The most frequent histological types of cancer were: squamous cell lung cancer (24 patients) and adenocarcinoma (17 patients). The majority of them were in stage II B (15 patients) and III A (14 patients). We analysed serum levels of: C-reactive protein (CRP), alpha1-acid glycoprotein (AGP), alpha1-antichymotrypsin (ACT), alpha1-antitrypsin (AT), alpha2-macroglobulin (M), ceruloplasmin (Cp), haptoglobin (Hp), and transferrin (Tf) by means of rocket immunoelectrophoresis by Laurell. RESULTS: The level of AT was significantly higher in patients with adenocarcinoma, as compared to other histological types of cancer. In the case of patients with squamous cell lung cancer, significantly higher M and Cp. We did not find any correlation between the APP level and grading. The levels of five APP: CRP, AGP, ACT, M and Cp were significantly higher in the group of patients with T3 or T4 category, while N1 or N2 status had significantly higher concentrations of AT, CRP and Hp. The multivariate analysis confirmed the influence of the following factors on long-term survival: N stage, histological type of cancer and preoperative serum levels of AGP and Hp. CONCLUSIONS: The serum concentration of some APP may correlate with the more aggressive clinical behavior of lung cancer. The patients with N1 or N2 stage of adenocarcinoma have significantly higher serum level of AT and the preoperative concentration of AGP and Hp correlates with the overall survival. These proteins could serve as prognostic factors in the risk assessment of the cancer recurrence after the surgical management.

[The quantitative evaluation of the serum acute phase proteins (APP) of patients undergoing a curative resection for non-small cell lung cancer (NSCLC)]. / Ocena zmian ilosciowych bialek ostrej fazy w surowicy krwi chorych poddanych radykalnej resekcji niedrobnokomórkowego raka pluca.

The aim of this study was to quantitatively evaluate serum APP in patients undergoing the radical resection for NSCLC. The quantitative changes in APP were correlated with the cancer type, clinical staging and grading and the procedure type. Also, the impact of selected post-operative complications on the APP serum concentrations was evaluated. 46 patients undergoing surgery secondary to NSCLC in the years 2003-2004 were analyzed. The patients' age varied from 45 to 77 years with an average of 61.1. The most common pathological cancer type was the squamous cell cancer (24 patients) and adenocarcinoma (17 patients). The majority of the patients were stage IIB (15 patients) and IIIA (14 patients). The following APPs were evaluated in the patients' serum by Laurell rocket immunoelectrophoresis: C-reactive Protein (CRP), alfa-1 antichymotrypsine (alfa-1 ACT), alfa-1 antitrypsine (AT), alfa-2 macroglobuline (alfa2 M), ceruloplasmin (Cp), haptoglobine (Hp) and transferrin (Tf). Significantly higher serum AT level were found in patients with adenocarcinoma as compared to other pathology types. Patients with the squamous cell cancer had a significantly higher level of alfa-2 M and Cp. There was no significant difference in APP levels between the cancer grading types. In the group of patients with T3 or T4 stage the following five APPs were significantly elevated: CRP, AGP, alfa-1 ACT, alfa-2 M and Cp. Patients with regional lymph nodes metastasis (N2 or N2) had significantly higher level of AT, CRP and Hp. Patients undergoing more significant procedures (pneumonectomy, prolonged procedure time) and those with morbidities (rethoracotomy, blood transfusions) showed significantly higher levels of alfa-1 ACT, AGP and Cp. The most common post-operative complications were prolonged air-leak requiring probronchoscopy. In both complications a significantly higher level of AGP was observed. Patients with adenocarcinoma of the lung and regional lymph node metastasis have significantly higher serum levels of AT. This protein could be considered as one of the indicators of cancer involvement and could be a marker of the cancer recurrence. AGP is a protein that correlates positively with a more advanced clinical stage, and the extent of the surgical procedure as well as with the higher risk of morbidity. This could serve as a marker of higher post-operative complication rate.