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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

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Problems of Thoracic Surgery Residency in Slovenia

The introduction of minimally invasive technique in the surgical practice has significantly changed the image of thoracic surgery in our country. In the recent decade most of thoracic surgeons adopted a technique of different minimally invasive approaches for the treatment of wide spectrum of intrathoracic diseases. In our institution the greatest advancement in recent years has been made in the field of major lung resections with around 80% of resections being performed using video-assisted thoracic surgery.

Keywords: minimally invasive surgery, training programme, surgical skills.

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Comparison of the Rate of Preoperative and Post-Operative Pain in VATS and Open Surgery of the Lungs

Backgrounds

Our presentation includes a brief definition of videothoracoscopy and thoracotomy and brief comparison of both with focus on rib spacing in thoracotomy. Mention is also made of study that compared a number of parameters (time of drainage, time of hospitalization, total number and number of pulmonary complications) between VATS and thoracotomy. Following a key question, how is with the pain in both cases.

Keywords: videothoracoscopy, thoracotomy, pain rate.

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Rare Case of Thoracic Endometriosis Syndrome: Catamenial Hemothorax

Background

Thoracic endometriosis syndrome (TES) is uncommon disease presented as catamenial pneumothorax, hemothorax, lung nodules and hemoptysis occurring within first 48-72 hours of menstruation. Endometriosis affects about 10% of women in reproductive age; incidence of extrapelvic endometriosis in these women is approximately 12%. The most frequent presentation of TES is pneumothorax (about 74%) while hemothorax is rare TES presentation (14%). The diagnosis is almost always established on clinical grounds.

Keywords: hemothorax, endometriosis, VATS.

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The Role of Video Thoracoscopic Surgery in Treatment of Pleural Infections

Background

Pleural infections have high morbidity and mortality, and their incidence in all age groups is growing worldwide. Pleural effusion develops in 40% of pneumonia patients, but only 15% of patients develop thoracic empyema after antibiotic treatment. Pleural empyema can be differentiated into three phases, exudative (Stage I), fibrinopurulent (Stage II) and organizing (Stage III). It is important to emphases that it is representing as a continuously evolving process that can be stop by therapeutic intervention. The initial exudative stage can be often managed by antibiotics and placement of chest tube. However, it is not effective in the fibrinopurulent or organizing stages, due to fibrin deposits over the parietal pleura and loculation of fluid, that restricts the expansion of the lung. The variety of strategies in the treatment of parapneumonic pleural empyema demonstrates the ambiguity for the method of choice. Many publications demonstrated that an early and aggressive minimally invasive approach for empyema in stage II provides rapid relief from infection and guarantees lower morbidity rate, shorter hospital stay, lower costs and clinical resolution. Though, the role of video assisted thoracic surgery in organizing stage III of pleural empyema is still controversial. The objective of surgical treatment of pleural empyema is to drain infected collections from pleural cavity and to achieve a complete lung re-expansion which is usually trapped due to adhesion’s or thickening of the visceral pleura. Fibrinolysis has been shown to be superior to chest tube drainage alone. There are some trials who documented lower charges with fibrinolysis comparing to VATS procedures. However, a fibrinolitic therapy may make the subsequent operation more difficult. VATS provides higher diagnostic value as good visualization and magnification, direct visualization of all surgical regions, facilitates the evacuation of multilocular effusions, the division of a fibrin septa’s, debridement and decortication, as well as fluid sampling and pleural biopsy.

Keywords: Video-assisted surgery, pleural empyema, fibrinolysis, decortication.

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Dexmedetomidine in abdominal and thoracic anesthesia

Background

The Bispectral Index (BIS) is a processed electroencephalographic parameter that correlates with the sedative-hypnotic actions of anaesthetic drugs. Dexmedetomidine and lidocaine have both opioid sparing effects. Their influence in laparoscopic surgery has not been studied yet. We investigated their effect on perioperative opioid consumption, cognitive function and incidence of neuropathic pain.

Keywords: bispectral index, dexmedetomidine, lidocaine

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