Biomedical subjects

T F Molnár

Publications and source records attributed to T F Molnár.

8 recordsLinked to original sources

PubMed2003

Continuous epidural or intercostal analgesia following thoracotomy: a prospective randomized double-blind clinical trial.

BACKGROUND: Pain following thoracotomy is frequently associated with clinically important abnormalities of pulmonary function. The aim of the current study was to compare the efficacy of continuous thoracic epidural analgesia (EDA) to continuous intercostal (IC) block for postoperative pain and pulmonary function in a prospective, randomized, double-blinded clinical trial. METHODS: Fifty patients undergoing lung lobectomy for malignancies were randomized into two groups (25/group). Respiratory function (forced vital capacity, forced expiratory volume per 1 s/forced vital capacity, maximum midexpiratory flow rate, peak expiratory flow rate) were evaluated preoperatively, within 4 h after the operation and on the first postoperative day. Visual analog scale (VAS: 0-10) scores were evaluated four-hourly for 20 h. RESULTS: The VAS scores were significantly lower in the EDA versus IC group at the 4th, 8th, and 12th h of observation (mean +/- SD) 5.5 +/- 2.9 vs. 7.3 +/- 2.2 P = 0.04; 4.1 +/- 2.1 vs. 5.1 +/- 2.9 P = 0.02; 3.6 +/- 1.9 vs. 5.2 +/- 2.4 P = 0.01, respectively. Respiratory function parameters deteriorated significantly in both groups (P < 0.001) with no significant difference between the groups. Only one major adverse effect was detected: one patient suffered from rib osteomyelitis after intercostal cannulation and healed following surgical repair. CONCLUSIONS: The results of the present study show that following thoracotomy in the early postoperative period continuous EDA is a better pain relieving method than continuous IC block, as indicated by the VAS scores.

Adult↗

PubMed2000

Non-malignant tracheo-gastric fistula following esophagectomy for cancer.

Two cases of neoesophago-tracheal fistula are described. After esophagectomy for cancer a fistula developed between the trachea and the pulled-up stomach probably because of the ischaemic effect of the tracheostomy tube. At single stage repairs, the fistulae were divided and the gastric defects were closed directly. In one case, tracheal resection and anastomosis was necessary. The defect on the membranous trachea in both cases was patched with an autologous fascia lata graft. A left pectoralis major muscle flap was interposed between the suture lines to prevent recurrence of the fistula. Treatment of this potentially life-threatening and rare condition yielded excellent results.

Esophageal Neoplasms↗

PubMed1999

Predictive value of MRI in lung cancer.

Pathologic results of 543 lymph nodes removed during 164 radical surgery for lung cancer is compared with the expected findings based on preoperative MRI imaging. Specificity of T2 weighted MRI images were 95.5% for individual lymph nodes and 88.1% for TNM staging, respectively. Sensitivity was found to be 89.4% for lymph nodes and 94.6% for TNM staging of the patient. The accuracy of the MRI imaging was 84.7%. Properly chose MRI imaging and interpretation sounds to be no inferior to more invasive methods as collar mediastinoscopy, Chamberlain procedure or VATS exploration.

Adult↗

PubMed1999

Palliative treatment of malignant pleural effusions by video-assisted thoracoscopic surgery.

Malignant pleural effusion (MPE) are associated with significant morbidity. Prompt clinical evaluation followed by aggressive treatment often results in successful palliation. Video-assisted Thoracic Surgery (VATS) today can be employed in the diagnosis and treatment of idiopatic and known MPE. Between January 1994 and December 1998 233 MPE patients were treated with pleurodesis. 206 of them underwent tube thoracostomy and drainage alone followed by chemical pleurodesis. In 27 out of the 233 cases VATS management was applied. These patients had undiagnosed pleural effusions or recurrent MPE following failed previous drainage and pleurodesis. The cause of the effusion was breast cancer in 11 patients, lung cancer in 9, urogenital cancer in 3, mesothelioma in 2 and other in 2. VATS intervention was thoracoscopic exploration with biopsy and directed chemical sclerosis in undiagnosed MPE (19/27) and lysis of pleural adhesions with partial decortication and pleurodesis in recurrent effusions (8/27). VATS managements were successful 26/27 after mean follow up of 6 months. Had not mortality postoperatively and severe morbidity. Chest tubes were removed 1.5 +/- 0.5 days postoperatively and hospital stay were averaged 4 +/- 1 days. We concluded that VATS is a safety and effective way of managing selected patients with pleural effusions.

Adult↗

PubMed1999

Two cases of benign tracheo-gastric fistula following esophagectomy for cancer.

Two successfully managed cases of esophageal replacement for cancer complicated by neoesophagotracheal fistula are described. In both cases radical esophagectomy with a gastric pull-up was performed. In the postoperative period different complications necessitated prolonged ventilatory support and tracheostomy. In both cases a tracheo-gastric fistula developed probably because of the ischaemic effort of the tracheostomy tube and the nasogastric tube. At single stage repairs, the fistulae were divided and the gastric defects were closed directly. In the first case resection of four strictured tracheal rings and tracheal anastomosis had to be performed. In the second case the fistula was recognized earlier and stricture did not develop. The defect on the membranous trachea was patched with autologous fascia lata graft. A left pectoralis major muscle flap was interposed between the trachea and the pulled up stomach in both cases to prevent recurrence of the fistula. Treatment of this potentially life-threatening and rare condition yielded excellent results.

Esophageal Neoplasms↗

PubMed1997

A case of fibrin sealant application for closing benign trachea-esophageal fistula (TEF).

Surgical treatment of upper airway-esophageal communications are frequently lead to failure. Having previous experience of thoracic administration of Tissucol fibrin glue authors attempted the local application in a case of TEF. A young lady suffering from myasthenia gravis required longstanding artificial ventilation. Not surprisingly a TEP developed in the area of the tracheostomy. There was no room for surgical repair of the TEF. Two administrations of rapid acting form of Tissucol was needed following local astringent therapy and enzymatic debridement to achieve a complete and permanent closure of a tracheobronchial sinus in a diameter of 5 mm. In addition of meticulous technique and of general supporting therapy special attention was paid to the followings: 1/healthy wound edges 2/ local infection control 3/dry environment 4/patient building up strategy.

Adult↗

PubMed1993

[Pericardial-peritoneal shunt].

A new shunt procedure is reported for persistent pericardial effusions. Abdominal approach to pericardial sac via transphrenic window is described. The technique proved to be useful in cases when the standard pericardiopleural procedure was not the proper solution. A decision-making algorithm is suggested when one faces different types of pericardial tamponade.

Aged↗

PubMedDate not supplied

Multimodality treatment resulting in long-term survival in hepatocellular carcinoma.

The early detection and complex therapy of the hepatocellular carcinoma (HCC) is one of the most seasonable questions of the gastroenterology-oncology, because of the increasing prevalence of the primary liver cancer. The course of the hepatocellular carcinoma is rapid, untreated patients rarely live over 5-6 months. Combination of different treatment modalities in HCC can offer the best chances for survival. If possible, a surgical resection should be the primary procedure, followed by adjuvant cytostatic treatment and chemoembolisation. The authors report three cases with HCC with extremely long survival. The long-term survival achieved by multimodality therapy, as presented in these cases, seems to justify aggressive therapeutical approaches in HCC. It has been concluded, that early detection and complex, aggressive multimodality treatment--even repeated liver resections and surgical elimination of duplex distant metastases--can result in long-term survival with a good quality of life.

Aged↗