Biomedical subjects

Romaldas Rubikas

Publications and source records attributed to Romaldas Rubikas.

12 recordsLinked to original sources

PubMed2006

Changes in quality of life after esophageal resections for carcinoma.

OBJECTIVE: To evaluate the changes of the quality of life after the surgery for esophageal carcinoma and to find out whether these changes are influenced by the extent of the resection and lymphadenectomy. PATIENTS AND METHODS: A total of 49 patients in whom esophageal carcinoma had been resected with curative intent and who stayed disease-free for at least twelve months after the surgery were studied. Twenty-four patients (48.9%) underwent two-field lymphadenectomy and intrathoracic esophagogastric anastomosis (group T), while in another twenty-five patients three-field lymphadenectomy and cervical esophagogastric anastomosis were performed (group C). To determine the impact of surgery quality of life was assessed in each patient just before the surgery, on the day of the discharge and at three-month intervals until the end of the first postoperative year. The quality of life was measured by means of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0. RESULTS: Compared with the preoperative assessment quality of life had decreased at discharge but was restored within 3-12 months. The emotional functioning had increased just after the surgery. Significant differences between groups C and T were found in global health, physical, and role functioning scales. CONCLUSIONS: Majority of the aspects of quality of life deteriorated after the radical surgery for esophageal carcinoma and regained the preoperative level before the end of the first postoperative year. Major surgical procedure (three-field lymphadenectomy and cervical esophagogastric anastomosis) gives some disadvantages in physical, social and role functioning during the first six postoperative months.

Adenocarcinoma↗

PubMed2004

Pharyngeal and oesophageal injuries.

OBJECTIVES: (1) To determine the actual incidence of transmural pharyngeal and oesophageal injuries (POI); (2) to reveal the main causes and character of infectious complications following transmural POI; (3) to evaluate the effectiveness of different types of urgent surgical intervention for complicated transmural POI. METHODS: A detailed retrospective analysis was completed on 15 years (1987-2001) of clinical experience, involving 84 cases of POI, caused by neck or chest injuries, foreign bodies, tracheal intubation, oesophagogastroscopy and oesophageal dilation (bougienage). RESULTS: Transmural (perforating) and superficial (non-perforating) POI were revealed in 58 and 26 cases, respectively. Transmural POI was diagnosed within 24h in 38 of the 58 patients. Fourteen patients with uncomplicated transmural POI were treated conservatively; all recovered uneventfully. Forty-two patients with complicated transmural POI underwent urgent surgical intervention. Hospital stay was shorter in patients who underwent primary repair of the perforated pharyngeal or oesophageal wall than in those who had only irrigational drainage ( 22.4 +/- 5.3 days versus 31.7 +/- 8.4 days). Overall post-operative morbidity and mortality were 42.8 and 19.0%, respectively. CONCLUSIONS: (1) Transmural injuries occurred in approximately two-third of the total number of POI; (2) underlying pathology, location of injury, time to accurate diagnosis and, eventually, urgent surgical intervention constituted statistically significant influences ( P < 0.05) relevant to development of complications following transmural POI; (3) urgent surgical intervention is the main part of the combined treatment of complicated transmural POI.

Abscess↗

PubMed2004

[Plastic reconstruction of chest wall defects and residual pleural cavities].

AIM: To compare the results of plastic reconstructions of the infected chest wall defects using either muscular, or omental flaps. MATERIAL AND METHODS: There were 29 thoracic reconstructions performed in the Clinic of Thoracic Surgery, Kaunas University of Medicine Hospital, due to infected chest wall defects in the last 30 months. In 14 cases (48.3%) pedicled omental flaps and in 15 cases (51.7%) muscular flaps were used. The groups of patients were comparable according to gender, age, underlying pathology, and perioperative risk. The retrospective analysis of case reports was carried out; the duration of the surgery and of postoperative stay, as well as morbidity were analyzed. RESULTS: Only duration of the surgery differed statistically significantly (255+/-21 min in the first and 172+/-34 min in the second group), but there was a tendency the morbidity to be lower in the group of pedicled omental flaps. CONCLUSION: The pedicled omental flaps could be used safely and successfully for reconstruction of infected chest wall defects.

Adult↗

PubMed2004

[Video-assisted thoracoscopic surgery as an alternative to urgent thoracotomy following open chest trauma in selected cases].

OBJECTIVES: To prove that video-assisted thoracoscopic surgery in selected cases is an alternative to urgent thoracotomy following open chest trauma. MATERIALS AND METHODS: Retrospective analysis of case reports of patients operated for open chest trauma during 1997-2002. Comparison of two methods of surgical treatment: urgent video-assisted thoracoscopy and urgent thoracotomy. Duration of drain presence in the pleural cavity, duration of postoperative treatment, pain intensity and cosmetic effect were evaluated. Data analysis was performed using SPSS statistical software. Statistical evaluation of differences between groups was performed using Mann-Whitney U test. The differences between groups were considered to be statistically significant when the probability of deviation was p<0.05. RESULTS: During 1997-2002, 121 patients with open chest trauma were operated. Thirty three patients underwent urgent video-assisted thoracoscopy, 88 patients were operated through thoracotomy incision: 69 due to isolated open chest trauma, 17 due to thoracoabdominal injury and 2 due to abdominothoracic injury. Almost thirteen percent (12.5%) of patients after urgent thoracotomy underwent urgent laparotomy due to damaged diaphragm and other organs of peritoneal cavity. Duration of drain presence in the pleural cavity after video-assisted thoracoscopy was 4.57 days and after urgent thoracotomy - 6.88 days (p<0.05). Duration of post-operative treatment after video-assisted thoracoscopy was 8.21 days and after urgent thoracotomy - 14.89 days (p<0.05). Amount of consumed non-narcotic analgesics after video-assisted thoracoscopy was 1056.98 mg and after urgent thoracotomy - 1966.70 mg (p<0.05). CONCLUSIONS: Video-assisted thoracoscopy is minimally invasive method of thoracic surgery allowing for the evaluation of the pathological changes in the lung, pericardium, diaphragm, mediastinum, thoracic wall and pleura, including the localization of these changes, and the type and severity of the injury. The number of early post-operative complications following video-assisted thoracoscopy is lower. Compared to operations through thoracotomy incision, video assisted thoracoscopies entail the shortening of the duration of drain presence in the pleural cavity and the duration of post-operative treatment. Video-assisted thoracoscopy should be performed on all patients with open chest trauma and stable hemodynamics and the respiration function. Video-assisted thoracoscopy is an informative diagnostic and treatment method allowing for the selection of patients for urgent thoracotomy.

Abdominal Injuries↗

PubMed2003

[Emergency thoracotomy].

OBJECTIVE: To determine indications for emergency (immediate and urgent) thoracotomies in cases of penetrating and blunt chest traumas. METHODS: We performed retrospective analysis of treatment methods and results, achieved in 2927 patients treated for chest traumas in 1987-2000. RESULTS: Algorithms for decision making in surgical management of chest traumas are drawn. Indications for emergency (immediate and urgent) thoracotomies are determined. Immediate thoracotomy was performed in 17.2% and 0.2% of patients, suffering from penetrating and blunt chest trauma respectively. Urgent thoracotomy underwent 7.6% due to penetrating and 2.7% due to blunt chest trauma. Postoperative mortality rate was much higher after immediate (20.0%) and urgent (10.9%) thoracotomy performed due to blunt chest traumas. In cases of penetrating chest traumas postoperative mortality rate was 3.3% and 3.0% after immediate and urgent thoracotomies respectively. CONCLUSIONS: The effectiveness of surgical treatment of chest traumas depends on logical determination of indications for immediate or urgent thoracotomies. They should be undertaken in cases of severe damage of chest wall and/or internal organs and dangerous pathological syndromes.

Algorithms↗

PubMed2002

[Foreign bodies in the heart].

During 1987-2000, in Clinic of Thoracic Surgery, Kaunas Medical University Hospital 30 patients with cardiac injuries and foreign bodies in the heart were treated. Average age of patients--37 years. Eighteen patients were extra operated with symptoms of acute pericardial tamponade and shock. We found right ventricular involvement for 5 patients; 9 patients had left ventricular injury, 2 had right atrium injury and 1 patient had left atrium injury. Two patients had foreign bodies in the heart (one--needles, one--bullet). We present two rare cases of foreign bodies in the heart.

Adult↗

PubMed2002

[Surgical treatment of pulmonary emphysema].

Lung volume reduction has become an accepted option for surgical treatment of pulmonary emphysema. Lately this method was introduced in Lithuania.The first 14 of 19 patients, who underwent lung volume reduction surgery, where admitted due to spontaneous pneumothorax, that is a common complication of pulmonary emphysema. Lung volume reduction using wedge resection or plication was performed in 13 and 6 patients respectively. Rethoracotomy was required for postoperative bleeding (2 cases) and prolonged air leakage (1 case). Two patients died. Pulmonary insufficiency decreased significantly in 2/3 of operated on patients. There were no recurrent spontaneous pneumothorax.

Adolescent↗

PubMed2002

[Possibility of computed tomography in evaluation of locoregional invasion of non-small cell lung cancer].

UNLABELLED: Clinical prognosis and treatment schedules of non-small cell lung cancer are dependent on tumor stage. The objective of the study was to assess the diagnostic value of computed tomography scans in preoperative staging of non-small cell lung cancer. METHODS: One hundred thirty seven case reports were analyzed retrospectively and 72 cases were found eligible for the analysis. RESULTS: The sensitivity, specificity, positive and negative prognostic values of computed tomography in assessing metastases in mediastinal lymphnodes were 0.79; 0.45; 0.34; 0.85 respectively. The overall accuracy was 0.51. When evaluating the direct invasion of the tumor to chest wall, pericardium and mediastinum the values were as follows: 0.56; 0.87; 0.59; 0.86; 0.76. The conclusion is made that the accuracy of computed tomography in evaluating mediastinal lymphnode status is not sufficient due to increased sensitivity and decreased specificity. The accuracy of computed tomography in evaluating direct invasion of the non-small cell lung cancer is tolerable.

Aged↗

PubMed2002

[Thoracoscopy in management of spontaneous pneumothorax].

OBJECTIVES: To estimate possibilities of video-assisted thoracoscopy in surgical treatment of spontaneous pneumothorax. PATIENTS AND METHODS: A retrospective analysis of 209 clinical cases of spontaneous pneumothorax, which underwent urgent thoracoscopy, is presented. RESULTS: Eighty eight patients underwent coagulation of small bullos, twenty six - parietal pleura electroscarification, 12 - mechanical pleurodesis. Four patients underwent thoracoscopic parietal pleurectomy and wedge resection. The postoperative drainage time for spontaneous pneumothorax was 3-4 days. Hospital stay - 7 days. CONCLUSIONS: Modern video-assisted thoracoscopy diagnostics and surgical treatment are inseparable parts of management of spontaneous pneumothorax. Video-assisted thoracoscopy is a safe, simple, less traumatic and effective diagnostic and treatment procedure of patients with spontaneous pneumothorax.

Data Interpretation, Statistical↗

PubMed2002

[Early results of esophageal resections, performed due to carcinoma].

UNLABELLED: The objective was to compare early results of two different techniques of esophagectomies performed due to cancer. METHODS: All 42 patients were examined according to the protocol preoperatively; 19 of them underwent esophagectomy with two-field lymphadenectomy and intrathoracic anastomosis, while 23 patients underwent esophagectomy with three-field lymphadenectomy and cervical anastomosis. The morbidity and mortality was studied in the intrahospital period. RESULTS: Morbidity and mortality rates were 26.3 and 5.2 percent in the first and 56.5 and 21.7 percent in the second group respectively. The conclusion is made that esophagectomy with three-field lymphadenectomy and anastomosis in the neck gives higher morbidity and mortality rates in the early postoperative periods. Late results, quality of life and survival should be investigated.

Aged↗

PubMed2002

[Descending necrotizing mediastinitis].

We estimated reliability of computed tomography scan for early detection of mediastinal infectious inflammation, influence of descending necrotizing mediastinitis type and extent of urgent surgical intervention on final treatment results. A retrospective analysis was completed with clinical experience, involving 19 patients (11 male, 8 female), 38-78 years of age, operated on due to descending necrotizing mediastinitis in 1992-2002. Early diagnosis, using computed tomography scan, and more aggressive surgical management allowed to decrease mortality rate from 85.7 % ( in 1992-1998) to 50.0 % (in 1999-2002). We suggest an algorythm for well-timed diagnosis and complex surgical treatment of descending necrotizing mediastinitis based on results of this study and medical literature review.

Abscess↗

PubMed2002

[Penetrating neck injury].

Penetrating injury of neck is a complicated pathology, and there is more than one opinion of its treatment tactic in nowadays. Our recomendation is to refuse mandatory surgical exploration. There are found some recomendations to refuse routinely performed mandatory explorations, with suggestions of active observation of patients. The results of scientific studies showed, that there is no difference between those two models of treatment and observation. In cases with possibilities of full investigation of patients (panendoscopy, X-ray investigations, ultrasound investigations, angiography), we suggest the model of active observation. If there are no possibilities of full investigation, we prefer mandatory surgical exploration.

Adult↗