1. Release of growth factors after mechanical and chemical pleurodesis for treatment of malignant pleural effusion : a randomized control studyAljaž Hojski, Maja Leitgeb, Anton Crnjac, 2015, original scientific article Abstract: Growth factors are key inducers of fibrosis but can also mediate inflammatory responses resulting in increasing pleural effusion and acute respiratory distress syndrome. The primary aim of the study was to analyse growth factors release after performing chemical and mechanical pleurodesis in the first 48 hours at the patients with malignant pleural effusion. The secondary endpoints were to evaluate the effectiveness of the both pleurodeses, symptoms release and the quality of life of patients after the treatment. Patients and methods. A prospective randomized study included 36 consecutive female patients with breast carcinoma and malignant pleural effusion in an intention-to-treat analysis. We treated 18 patients by means of thoracoscopic mechanical pleurodesis and 18 patients by chemical pleurodesis with talcum applied over a chest tube. We gathered the pleural fluid and serum samples in the following 48 hours under a dedicated protocol and tested them for growth factors levels. A quality of life and visual analogue pain score surveys were also performed. Results. Median measured serum vascular endothelial growth factor (VEGF) level after chemical pleurodesis was 930.68 pg/ml (95% CI: 388.22-4656.65) and after mechanical pleurodesis 808.54 pg/ml. (95% CI: 463.20-1235.13) (p = 0.103). Median pleural levels of transforming growth factor (TGF) ß1 were higher after performing mechanical pleurodesis (4814.00 pg/ml [95% CI: 2726.51-7292.94]) when compared to those after performing chemical pleurodesis (1976.50 pg/ml [95% CI: 1659.82-5136.26]) (p = 0.078). We observed similar results for fibroblast growth factor (FGF) ß; the serum level was higher after mechanical pleurodesis (30.45 pg/ml [95% CI: 20.40-59.42]), compared to those after chemical pleurodesis (13.39 pg/ml [95% CI: 5.04-74.60]) (p = 0.076). Mechanical pleurodesis was equally effective as chemical pleurodesis in terms of hospital stay, pleural effusion re-accumulation, requiring of additional thoracentesis, median overall survival, but, it shortened the mean thoracic drainage duration (p = 0.030) and resulted in a higher symptoms release and in a better quality of life (p = 0.047). Conclusions. We recorded an increase in serum VEGF levels after chemical pleurodesis, however on the contrary, an increase in the pleural fluid level of TGF%1 and FGF%] after mechanical pleurodesis with respect to compared group. Although the differences did not reach statistical significance, VEGF, TGFß1 and FGFß remain the most interesting parameters for future research. Considering the mechanisms of growth factors action, we conclude that in our study group mechanical pleurodesis might be more efficient in terms of growth factors release, thoracic drainage duration and resulted in a higher symptoms release and in a better quality of life than chemical pleurodesis.
Keywords: malignant pleural effusion, pleurodesis, growth factors, quality of life
Published in DiRROS: 23.04.2024; Views: 4; Downloads: 1
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2. Giant solitary fibrous tumour of the pleura : case report and review of the literatureAnton Crnjac, Bojan Veingerl, Damjan Vidovič, Rajko Kavalar, Aljaž Hojski, 2015, review article Abstract: Background. Solitary fibrous tumours of the pleura (SFTP) are rare tumours. They are mostly benign. Only around 12% of them are malignant. In the initial stage they are mostly asymptomatic and by growing they cause chest pain, irritating cough and dyspnoea on account of the pressure created on the surrounding structures. Rare giant tumours have compression symptoms on the mediastinal structures. The condition requires tiered diagnostic radiology. Preoperative biopsy is not successful in most cases. The therapy of choice is radical surgical tumour removal. Malignant or nonradically removed benign solitary fibrous tumours of the pleura additionally require neoadjuvant therapy. Case report. A 68-year old patient was hospitalized for giant solitary fibrous tumour of the pleura in the right pleural cavity. With its expansive growth the tumour caused the shift of the mediastinum by compressing the lower vena cava, right cardiac auricle as well as the intermediate and lower lobe bronchus. Due to cardiac inflow obstruction and right lung collapse, the patient's life was endangered with signs of cardio-respiratory failure. After preoperative diagnostic radiology, the tumour was surgically removed. Postoperatively, the patient's condition improved. No disease recurrence was diagnosed after a year. Conclusions. Giant solitary fibrous tumour of the pleura may cause serious and life-threatening conditions by causing compression of the pleural cavity with its expansive growth. Early diagnosis of the condition enables less aggressive as well as video-assisted thoracic surgery in patients with significantly better state of health. Large tumour surgeries in cardio-respiratory affected patients are highly risk-associated procedures.
Published in DiRROS: 23.04.2024; Views: 2; Downloads: 0
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4. Vloga endoluminalnih opornic med neoadjuvantnim zdravljenjem karcinomov požiralnikaAnton Crnjac, Boris Greif, Aljaž Hojski, 2014, published professional conference contribution Abstract: Prvi cilji zdravljenja simptomatskih malignomov požiralnika vključujejo vzdrževanje prehranske poti, preprečevanje krvavitev in bolečin. Vsi bolniki potrebujejo multidisciplinarno oceno, da jim zagotovimo primerno, običajno več-modalno terapijo. Opredelitev najbolj ustreznega načina prehranske podpore bolnika z rakom požiralnika mora biti individualna. Zdravljenje je odvisno od stadija bolezni, simptomov, razpoložljive tehnologije in izkušenj lečečega zdravnika. Predstavljamo naš način reševanja disfagije s pomočjo znotraj- -lumenskih opornic požiralnika. V naši praksi se je znotraj- -lumenska opornica požiralnika pokazala za zelo učinkovit in bolniku najprijaznejši način zagotavljanja optimalnega vnosa hranil pred ter med neoadjuvantno terapijo. Zapletov je malo, vstavitve pa nimajo negativnega vpliva na perioperativne izide.
Keywords: rak požiralnika, prehranska podpora, zdravljenje, endoluminalne opornice
Published in DiRROS: 31.08.2018; Views: 2823; Downloads: 780
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