Bratisl Med J
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Surgical treatment is not commonly used in the management of chylothorax. We describe a complicated algorithm that we used in treating a 70-year-old lady with Bechterev disease, who suffered from a blunt chest injury with subsequent right-sided serial ribs fracture with hemothorax and thoracic vertebral body fracture. Because of Bechterev disease, hyperextension of the ossified thoracic spine caused an injury of the thoracic lymphatic duct. ⋯ Thus, the procedure was done 16 days after stent insertion. The diagnosis of chylotorax must be considered in case of thoracic injury with continuing waste to the chest tube and the finding of well expanded pulmonary parenchyma. Biochemical investigation of the effusion is the cornerstone in establishing the diagnosis of chylothorax (Tab. 2, Fig. 1, Ref. 14).
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Malignant mesothelioma of tunica vaginalis testis is an extremely rare tumour. It is often caused by exposition to asbestos, however, more often its occurrence is sporadic. The diagnosis is usually set secondarily during hydrocele surgery. This type of tumour should be considered in cases with with atypical hydrocele, especially haematocele or atypical shape of seminal covering. ⋯ A case of an asbestos-exposed patient with described disease and long-term hydrocele is presented. The number of patients is so small that the guidelines are limited due to low statistical power (Fig. 2, Ref. 14).
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Perspective in predicting the effect of pleurodesis in the treatment of malignant pleural effusions.
Pleurodesis with talc has been used for many years. No objective criteria of inflammatory symptoms are known in order to use them to predict the effect of therapy and selection of patients. ⋯ The sTLR-2, sCD-163 and sTREM-1 values can be prospectively determined. High sCD-163 values predict unsuitable selection of a candidate for talcage. The degree of inflammatory response can be evaluated using sTLR-2 or sTREM-1. Talcage using an inserted thoracic drain can be repeated at low levels. The cost of ELISA examination is approximately 18 euros (Tab. 1, Fig. 4, Ref. 20).
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Our clinical experience with high - frequency SCS for FBSS in patients with predominant low back pain is presented. ⋯ Our group of 21 patients with implanted high - frequency SCS systems reported significant low back pain and leg pain relief within the period of 12 months as well as significant improvement in their performance status. We had a special subgroup of 5 patients with regular change of frequencies between high frequency and conventional frequency (with paresthesia) also with significant leg and low back pain relief (Tab. 2, Fig. 1, Ref. 8). Text in PDF www.elis.sk.
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The popularity of continuous caudal epidural block in post-operative analgesia in very young children has been growing. This method of analgesia is used in major abdominal and urological surgeries. A local anaesthetic, usually levobupivacaine, is administered through an epidural catheter introduced via hiatus canalis sacralis. ⋯ This catheter allows for the administration of caudal epidural analgesia even in premature children of approximately 500 g of body weight. This solution eliminates adverse effects of systemic opioid analgesia, accelerates surgical wound healing and disconnection from ventilation system, and improves the potential of enteral nutrition. Depth and quality of analgesia in very young children are monitored using a complex scheme called Comfort Neo Scale (Tab. 1, Fig. 2, Ref. 7).