Background:Postoperative pneumonia (POP) remains a major cause of morbidity after lung cancer surgery. The role of perioperative antibiotic prophylaxis (PAP), particularly the choice of antibiotics and their adjustment to bronchial colonization, is still debated. Methods:We conducted a prospective, double-blind, comparative study including 200 patients with primary lung malignancy undergoing lung resection. Patients received either cefazolin or amoxicillin-clavulanic acid as PAP. Preoperative bronchial colonization was assessed before surgery. The primary outcomes were the incidence of POP according to the antibiotic regimen and colonization status. Results:The cohort comprised 200 patients (median age 68 years, range 44-83; 48.5% women). POP occurred in 47 patients (23.5%). Of these, 23 (21.5%) had received cefazolin and 24 (25.8%) amoxicillin-clavulanic acid, with no significant difference between regimens. Colonization was detected in 178 patients (89.0%), including 36 (20.2%) with potentially pathogenic microorganisms (PPMs). POP incidence was similar in non-colonized (22.7%), colonized (23.6%), and PPM-colonized patients (25.0%) (all P ≥ 0.51). Only one patient (0.5%) died within 30 days, unrelated to pneumonia. Conclusions:In this prospective comparative study, POP after lung cancer surgery did not significantly differ according to the prophylactic antibiotic regimen or colonization status. However, given the relatively small number of patients with PPM colonization and the single-center design, these findings should be interpreted cautiously. Standard perioperative prophylaxis with cefazolin appears appropriate, while routine preoperative colonization screening may not be necessary. Further studies are needed to better define risk-adapted preventive strategies.

BACKGROUND:Postoperative pneumonia (POP) remains a leading cause of mortality following lung surgery. Recent studies have confirmed that the respiratory tract below the vocal cords is not sterile and often harbours potentially pathogenic microorganisms (PPMs), putting patients with lung malignancies at an increased risk for pulmonary infections. PATIENTS AND METHODS:The study analysed 149 patients who underwent bronchoscopy for lung lesions suspected to be lung cancer. Protected specimen brush (PSB) samples were obtained during bronchoscopy prior to any specific treatment. Bacterial identification and antimicrobial susceptibility testing were conducted on the isolated strains. RESULTS:Bacterial colonization was detected in 88.6% of patients, with 21.5% carrying PPMs. Notably, patients with type 2 diabetes exhibited a higher rate of PPM colonization compared to others. Antibiotic susceptibility testing showed no significant differences in efficacy between amoxicillin with clavulanic acid and first-generation cephalosporin in both colonized patients and those with PPMs. Importantly, no multidrug-resistant bacteria were identified. CONCLUSIONS:Our findings indicate a slightly lower PPM colonization rate compared to previous studies, possibly due to the unique geographic characteristics of the study population. The absence of significant differences in bacterial susceptibility between the two tested antibiotics highlights the need for further research to refine perioperative infection management strategies.

In 2019, the Recommendations for the management of patients with lung cancer were published bringing much-needed standardisation of diagnosis and treatment to improve survival of patients with lung cancer. Three years after the original Recommendations were published, the update of the Recommendations brings the most innovations in the chapter on systemic treatment of patients with lung cancer. This reflects the remarkable progress made in the field of understanding the oncogenesis and biology of lung cancer and thus the development of new drugs. The burden of lung cancer remains high, as lung cancer is still the most common cause of cancer related death in our country and worldwide. Lung cancer is responsible for one of five cancer-related deaths. Almost one third of patients with lung cancer do not receive any oncological treatment, either because of poor performance status, comorbidities or the extent of the disease. Half of the patients have metastatic disease at diagnosis, resulting in only small improvements in survival despite advances in the treatment of lung cancer patients. These data remind us that if we are to make major shifts in the management of lung cancer patients, we will need to take different approaches. The most promising seems to be the detection of early stages of lung cancer which offers the best treatment results. The Recommendations written here are guidelines for the management of patients with lung cancer. Only with comprehensive multidisciplinary treatment approach, the best outcome from the prognostically unfavourable disease can be offered.

Abstract Background A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study aims to critically assess the continuous ultrasound-guided erector spinae plane block (ESPB) at our institution and compare it to a standard regional anesthetic technique, the intercostal nerve block (ICNB). Patients and methods A prospective randomized-control study was performed to compare outcomes of patients, scheduled for video-assisted thoracoscopic (VATS) lung cancer resection, allocated to the ESPB or ICNB group. Primary outcomes were total opioid consumption and subjective pain scores at rest and cough each hour in 48 h after surgery. The secondary outcome was respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP/MEP) after 24 h and 48 h. Results 60 patients met the inclusion criteria, half ESPB. Total opioid consumption in the first 48 h was 21. 64 ± 14.22 mg in the ESPB group and 38.34 ± 29.91 mg in the ICNB group (p = 0.035). The patients in the ESPB group had lower numerical rating scores at rest than in the ICNB group (1.19 ± 0.73 vs. 1.77 ± 1.01, p = 0.039). There were no significant differences in MIP/MEP decrease from baseline after 24 h (MIP p = 0.088, MEP p = 0.182) or 48 h (MIP p = 0.110, MEP p = 0.645), time to chest tube removal or hospital discharge between the two groups. Conclusions In the first 48 h after surgery, patients with continuous ESPB required fewer opioids and reported less pain than patients with ICNB. There were no differences regarding respiratory muscle strength, postoperative complications, and time to hospital discharge. In addition, continuous ESPB demanded more surveillance than ICNB.

Background Treatment of early-stage non-small cell lung cancer (NSCLC) is rapidly evolving. When introducing novelties, real-life data on effectiveness of currently used treatment strategies are needed. The present study evaluated outcomes of stage I-IIIA NSCLC patients treated with upfront radical surgery in everyday clinical practice, between 2010-2017. Patients and methods Data of 539 consecutive patients were retrieved from a prospective hospital-based registry. All diagnostic, treatment and follow-up procedures were performed at the same thoracic oncology centre according to the valid guidelines. The primary outcome was overall survival (OS) analysed by clinical(c) and pathological(p) TNM (tumour, node, metastases) stage. The impact of clinicopathological characteristics on OS was evaluated using univariable (UVA) and multivariable regression analysis (MVA). Results With a median follow-up of 53.9 months, median OS and 5-year OS rate in the overall population were 90.4 months and 64.4%. Five-year OS rates by pTNM stage I, II and IIIA were 70.2%, 60.21%, and 49.9%, respectively. Both cTNM and pTNM stages were associated with OS; but only pTNM retained its independent prognostic value (p = 0.003) in MVA. Agreement between cTNM and pTNM was 69.0%. Next to pTNM, age (p = 0.001) and gender (p = 0.004) retained their independent prognostic value for OS. Conclusions The study showed favourable outcomes of resectable stage I-IIIA NSCLC treated with upfront surgery in real-life. Relatively low agreement between cTNM and pTNM stages and independent prognostic value of only pTNM, observed in real-life data, suggest that surgery remains the most accurate provider of the anatomical stage of disease and important upfront therapy.

Operacije v področju prsnega koša spadajo med najbolj boleče operacije, kjer prepletanje operacijskega polja in dihalne poti še dodatno prispeva k nastanku in vzdrževanju bolečine po posegu. T. i. pooperativno bolečino je potrebno lajšati, ker povečuje tveganje za zaplete, kot so pljučne atelektaze, pljučnica, daljša hospitalizacija, kasneje pa tudi razvoj kroničnega bolečinskega sindroma. Pristop k lajšanju bolečine po operacijah v prsnem košu je tri stopenjski. Vključuje seznanitev z možnostmi za lajšanje bolečine med in po operaciji v sklopu priprave na poseg, čim pogostejšo uporabo področnih tehnik za lajšanje bolečine med operacijo ter multimodalni pristop za lajšanje bolečine v obdobju po posegu za zmanjšanje celokupne porabe opioidov. V sklopu tega so se tradicionalno uveljavljeni torakalni epiduralni analgeziji v zadnjem desetletju pridružile manj invazivne področne analgetične tehnike, kot so paravertebralni blok, blok pod mišico erector spinae, retrolaminarni blok, blok serratus anterior in interkostalni blok. K razvoju teh tehnik je prispevala predvsem uporaba ultrazvoka, vedno večja uporaba zdravil proti strjevanju krvi ter uvajanje manj invazivnih kirurških tehnik, ki zahtevajo prilagoditev vodenja anestezije v smislu uporabe čim manj invazivnih področnih analgetičnih tehnik. Učinkovito lajšanje bolečine med in po operaciji je ključno za preprečitev kroničnega bolečinskega sindroma, ki bolnikom močno poslabša kakovost življenja, zdravstvenemu sistemu pa naloži dodatne stroške zdravljenja. Pregledni članek bo prikazal trenutne možnosti za lajšanje bolečine med in po operacijah v prsnem košu s poudarkom na vrsti in mehanizmu delovanja novejših področnih analgetičnih tehnik.

1. Introduction COVID-19 pandemic has a profound impact on surgical healthcare because of suspension of surgeries due to re-location of staff to COVID-19 wards and outbreaks of infections in surgical wards. Testing upon admission was introduced to limit the spread of new coronavirus. However, the reliability of testing is limited by the fact that some patients with negative test may be in the incubation period and may start spreading the virus just after admission. We observed two peaks of COVID-19 epidemic in Slovenia. In the first wave the maximal positivity rate in population was 2,2/100.000 (7-day average). All elective surgeries were suspended for one month with the exemption of cancer surgery. The second wave was much stronger. It peaked at 96,6/100.000 (7-day average) and elective surgeries were performed in limited capacity, mostly with preoperative testing. In this correspondence we describe a successful approach to control the entry of COVID-19 in a specialized surgical hospital throughout the pandemic. 2. Methods Strict COVID-19 protocol was followed in each patient before, during and after surgery. All surgeries were scheduled maximum of 10 days in advance. Patients were told to take maximum precautions against COVID-19. Each patient was called the day before surgery by a registered nurse and interviewed about COVID-19-related symptoms and recent risky contact according to our standardized questionnaire. The same questionnaire was repeated on the admission day together with body temperature measurement. All asymptomatic patients without a history of recent contact with COVID-19 were admitted and surgery was performed. Afterwards all patients were transferred to the surgical department where masks were mandatory and visits were forbidden. When infection with COVID-19 was suspected, PCR test was performed. Patient with positive result was transferred to a COVID-19 ward. All medical staff and patients who had been in contact with positive patients were tested and sent to isolation. If negative, testing was then repeated in 3–5 days or at the onset of any cold-like symptoms. 2.1. Results Between March 16th and May 31st, 2020 and between October 19th, 2020 and February 28th, 2021, 1049 patients were scheduled for surgery among which 18 (1.7%) were cancelled due to symptoms or recent risky contact (Table 1). During the first period one patient (0.3%) developed cough and fever, however the PCR test turned out negative. During the second period 21 (2.9%) patients developed symptoms or signs of COVID-19 among which 1 (0.14%), who had fever and sudden low oxygen saturation, tested positive and was immediately transferred to COVID-19 ward. Out of 6 nurses that had been in contact with positive patient no one developed symptoms of the disease. However, all of them were sent to isolation and in 3 days two of them tested positive.Table 1: Overview of surgeries performed during covid-19 pandemic.3. Next steps At the beginning of COVID-19 pandemic, several surgical societies across the world recommended postponement of elective surgery [1]. In our hospital we continued to perform elective surgeries during both epidemiological waves on patients who were not preoperatively tested for SARS-CoV-2, using very strict COVID-19 protocols before, during and after the surgery. The infection was not recognized by the protocol in only one patient who was admitted during the very heavy second wave of epidemic in the country. The approach allowed us to maintain a full programme of elective surgery during the pandemic and some other institution reached similar results as well [2]. PCR testing is the generally accepted tool in preoperative screening of patients. However, viral transmission may occur up to three days before patients may become symptomatic [3]. Therefore, it should be considered that PCR test provides only the information about the infectious status at a certain point of time and that a negatively tested patient might test positive a few days after the initial testing. It has been demonstrated that elective surgical programs could, based on epidemiological questionnaire in combination with a strict COVID-19 surgical protocol, safely be performed during the ongoing pandemic. Based on our results we certainly do not want to discourage the use of preoperative testing for COVID-19, since it could identify some asymptomatic patients, as described by other authors [4]. However, we would like to underline the high negative predictive value of COVID-19 risk screening questionnaires [5] and that they could help us identify patients who would benefit the most from PCR testing, enabling us to save resources. To develop clearer guidelines on resuming different elective procedures and determine the extent of preoperative screening in times of ongoing COVID-19 pandemic, further studies are necessary. Provenance and peer review Not commissioned, editor reviewed. Ethical approval No Ethical Approval was needed due to the type of study. Please state any sources of funding for your research This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author contribution Petrovic Sabrina: Conceptualisation, Investigation, Methodology, Data Analysis, Writing – original draft. Miklavcic Martina: Conceptualisation, Methodology, Data Analysis, Writing – original draft. Beovic Bojana: Conceptualisation, Methodology, Writing – review & editing. Bitenc Marko: Supervising, Writing – review & editing. Consent No patient consent was needed due to the type of study. Registration of research studies 1. Name of the registry:/ 2. Unique Identifying number or registration ID:/ 3. Hyperlink to your specific registration (must be publicly accessible and will be checked):/ Guarantor Bitenc Marko, MD, FECTS. Declaration of competing interest All Declarations of interest: none.

Pandemija virusa SARS-CoV-2 je popolnoma presenetila celotni svet. V zelo kratkem času je bilo potrebno reorganizirati zdravstveni sistem v celoti. Bolnišnice, ki sprejemajo bolnike s covidom-19, je bilo treba čez noč prestrukturirati v del bolnišnice za bolnike s covidom-19 in v del bolnišnice z ostalimi bolniki, ki nimajo covida-19. Pri delu s kirurškim bolnikom s covidom-19 je potrebna predvsem popolna in dosledna uporaba zaščitnih sredstev, da ne pride do okužbe zdravstvenega osebja. Prav tako je potrebna posebna klinična pot znotraj bolnišnic, da ne pride do kontaminacije v delu bolnišnice, ki je brez bolnikov s covidom-19. Začasno so bile odpovedane vse elektivne kirurške obravnave. Zdaj se pod posebnimi pogoji za zaščito zdravstvenih delavcev in bolnikov ponovno sproščajo. Pred elektivnimi kirurškimi posegi se priporoča jemanje brisov na covid-19, vendar to ni nujno. Brisi so namreč v 30 % negativni oz. nezanesljivi in se nanje ne moremo popolnoma zanesti. Predvsem je pomembno, da bolnik v zadnjih 14 dneh ni imel znakov prehladne bolezni in prav tako ne člani njegove družine. Znotraj ustanove se moramo vesti do vsakega sprejetega bolnika, kot da je lahko okužen z virusom SARS-CoV-2. Enako velja za osebje. Ravnati se je potrebno glede zaščitnih ukrepov tako, kot da je vsak od zaposlenih okužen z virusom SARS-CoV-2.

INTRODUCTION Acute postoperative pain management for patients undergoing thoracic surgery has always been on a lever between good pain coverage and major opioid side effects. As nonopioid drugs do not suffice to cover the pain after thoracic surgery and the epidural catheter seems to be losing its supremacy due to its severe possible complications,[1] the erector spinae (ES) plane block opts as a promising new method in multimodal analgesia. A continuous ES plane block administered for postoperative analgesia following video-assisted thoracic surgery (VATS) with minimal thoracotomy surgical approach has not been described thus far. CASE REPORTS We performed the blocks in awake state in prone position prior to surgery under ultrasound guidance at the T4 level. We moved the probe ~3 cm ipsilaterally to the operated side and found the transverse process by moving the probe sideways. The transverse process was noted by the oval shape of the rib changing into the rectangular shape of the process. We inserted an 18G hypodermic needle under aseptic conditions craniocaudally in-plane after subcutaneous injection of 2 ml lidocaine 2%. When the needle tip was correctly positioned, just above the vertebral lamina, we dissected the overlying ES muscle with 10mL of 0.9% NaCl. We inserted a perineural catheter and confirmed its position with ultrasound [Figure 1].Figure 1: Ultrasound confirmation of the ES catheter positioning. We can see the catheter coming in from the right side of the picture (arrow), lying above the hypoechogenic transverse process. The injected physiological solution dissects the ES muscle from the underlying thoracic vertebral lamina. 1- thoracic lamina, 2 – m. erector spinae, 3 – m. romboideus major, 4 – m. trapeziusWe induced anesthesia with a bolus of remifentanil 1 μg/kg, propofol 2 mg/kg and rocuronium 0.7 mg/kg. Total intravenous anesthesia proceeded with remifentanil and propofol with intermittent boluses of rocuronium. 20 min prior to end of the surgery we injected a bolus of 20 ml 0.5% levobupivacaine. Continuous infusion 5ml/h of 0.2% ropivacaine with boluses of 15 ml every 4 h was set using a programmable pump. Total consumption of local anesthetic ropivacaine 0.2% varied from 175ml to 367.5ml, depending on time to catheter removal. Multimodal analgesia included metamizole 2.5g/12h intravenously on the first day and 500 mg/8h orally on the second day, diclofenac 100mg orally on the second day and paracetamol 1000 mg/8h intravenously if needed. The patients assessed the pain subjectively according to the Visual Analogue Scale (VAS) from 0 being no pain and 10 being the worst pain imaginable [Figure 2]. When the pain was higher than 3/10, the nurse applied a bolus of 3-5mg piritramide. We obtained an approval of the Slovenian National Committee for Medical Ethics number 0120-372/2019/7.Figure 2: Postoperative pain in resting state according to VAS until the ES catheter removalCase 1 A 74-year-old man with carcinoma of the left superior lobe of the lung, hypertension, post cerebro-vascular insult, with right hemiblock and prostate enlargement, presented for VATS lobectomy. In the time after surgery he did not use any rescue analgesia. He marked pain scores up to 3/10 in the first 3 h after surgery in resting position. The pain fell to 0 in resting with increases solely during respiratory physiotherapy. We removed the catheter prior to 48 h postoperatively. Case 2 A 71-year-old man with a tumor of the right inferior pulmonary lobe, hypertension and candidiasis of the esophagus, presented for VATS marginal resection of the right inferior lobe of the lung. He marked pain scores up to 3 postoperatively and only received one rescue bolus of 3mg piritramide. We removed the catheter after 20 h, when he was transferred to another department. Case 3 A 66-year-old woman with adenocarcinoma of the right upper lobe of the lung, hypertension, moderate aortic stenosis with diastolic dysfunction of the left ventricle, chronic gastritis, diaphragmatic hernia, osteoporosis, uric arthritis, and sideropenic anemia presented for VATS lobectomy. The patient reported pain immediately after waking up from anesthesia. We administered a rescue bolus of 4 mg piritramide, after which the pain settled down. After 6 h she did not report any pain at rest, and after 12 h she did not report any pain at activity. We removed the catheter after her pain scores were negative for 21 consecutive h. Case 4 A 79-year-old woman with myasthenia gravis with thymoma, hypertension, diabetes mellitus 2, diverticulosis, fecal incontinence, on glucocorticoid drugs, presented for VATS thymoma resection. She did not require any piritramide therapy; her pain scale was 0 at rest with only one exception scaling 1 on the first postoperative day (POD). We removed the catheter on the second POD. DISCUSSION The ES plane block is a recently advanced method of regional anesthesia, where the local anesthetic is injected deep into the fascial plane between the erector spinae muscle and the lamina of thoracic vertebrae. The local anesthetic spreads in craniocaudal fashion over several levels of the spine.[2] The use of a single shot ES block has been described for surgeries in different areas of the body, such as breast surgery[34] or even total hip arthroplasty.[5] Its use after VATS procedures was described in case reports[6] and proven useful in a prospective, randomised study from 2019.[7] To lengthen the duration of regional anesthesia, a block can be administered continually with the help of a catheter. However, the use of an ES catheter for prolonged analgesia in other fields of surgery was only described in case reports.[8] In our experience, the use of ES continuous block brought a dramatic decrease of opioid analgesics consumption. Before regional anesthesia, patients in our department going through VATS procedures, received continuous intravenous infusions of 1-3 mg/h piritramide for 36-42 hours postoperatively. With the ES continuous block, our patients did not receive a continuous infusion of opioid analgesics and required at most one bolus of 3-4 mg of piritramide. We continued with multimodal analgesia consisting of metamizole 500 mg/8h orally, diclofenac 100 mg/24 h orally and paracetamol 1g/8h intravenously if needed. Two of the patients did not receive any opioid interventions. The patients did not mark any sickness or vomiting in the first 48 h postoperatively. The most concerning factor of the ES catheter block for now is its cost, which might be several times higher than the cost of opioid analgesia. We decided for a combination of continuous infusion of local anesthetic with intermittent boluses. The supremacy of each of the administration regimes is yet unclear.[9] A pooled review of all publications, concerning ES blocks until 2018, reported 80% single shot techniques, followed by intermittent boluses (12%) and continuous infusions (8%).[10] Further investigations are needed before a perfect administration regime is determined. CONCLUSION As noted in our previously described cases, the continuous ES plane block is an efficient method of postoperative analgesia and goes with accordance to Enhanced Recovery After Surgery Guidelines for recovery after lung surgery.[11] Further studies are needed to scientifically confirm efficiency and cost-benefit of the method. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The SARS-CoV-2 pandemic caught the world by complete surprise The whole healthcare system had to be reorganised in a very short time COVID-19 admitting hospitals had to be restructured overnight into parts with COVID-19 patients and parts with non-COVID-19 patients When working with surgical COVID-19 patients, a complete and consistent use of protective equipment is especially necessary to prevent infection of healthcare workers It is also important to organise special clinical pathways within hospitals to prevent contamination of non-COVID-19 parts of the hospital All elective surgeries have been temporarily cancelled We are beginning to rele-ase restrictions on elective surgery under special conditions to protect healthcare workers and patients COVID-19 swabs are recommended, but not strictly necessary, before elective surgery Swabs can be either negative or inconclusive in 30% of cases, and therefore cannot be comple-tely relied upon It is especially important that patients or their families did not have signs of a respiratory infection in the previous 14 days We must consider each patient as potentially infected with SARS-CoV-2 in the hospital The same is true for healthcare workers – when using protective equipment we must act as if each worker is potentially infected with SARS-CoV-2

Transfuzija krvi po kirurškem posegu poveča tveganje za pooperativne zaplete, podaljša bolnišnično zdravljenje in poslabša izhod kirurškega zdravljenja. Neopredeljena in nezdravljena slabokrvnost pred operacijo predstavlja neodvisni napovedni dejavnik za perioperativne zaplete in transfuzijo v perioperativnem obdobju. Pred operacijo moramo odkriti bolnike, pri katerih je tveganje za slabokrvnost večje, ter jim prilagoditi predoperativno pripravo, kirurško tehniko in pooperativno zdravljenje. Program »Skrb za bolnikovo kri« (angl. Patient Blood Management PBM), ki je že uveljavljen v mnogih evropskih državah in podprt s strani direktorata Evropske komisije, je usmerjen v zdravljenje anemije, optimiziranje hemostaze in zmanjšanje potrebe po transfuziji krvi. Trije osnovni stebri so (1) optimalna hematopoeza, (2) zmanjšana iatrogena izguba krvi in (3) izboljšana bolnikova toleranca za anemijo. Analizirali smo potrebe po transfuziji krvi pri bolnikih, operiranih zaradi pljučnega ali urološkega obolenja v kirurškem centru Bitenc, d.o.o, med oktobrom 2016 in oktobrom 2018. Od bolnikov, ki so transfuzijo eritrocitov prejeli med operacijo, so bili predoperativno anemični 4 (57%) bolniki. Od bolnikov, ki so transfuzijo dobili pooperativno na oddelku, je bilo predoperativno anemičnih 12 (50%) bolnikov. V članku opišemo elemente programa PBM ter načrt za uvedbo programa v vsakodnevno klinično prakso.

V prispevku predstavljamo primer 67-letnega bolnika z napredovalim karcinomom srednje tretjine požiralnika, s širjenjem v zgornjo in spodnjo tretjino, v stadiju T3 N2–3M0. Kljub obsežnosti bolezni je prejel optimalno zdravljenje s predoperativno radiokemoterapijo in operacijo. Uspešen potek zdravljenja je omogočil individualen pristop, tesno sodelovanje vseh strok onkologije in uporaba novih obsevalnih tehnik.

Background: Incidence of anaphylactic reactions occuring during anesthesia is not known. They occur most often in the induction phase and can present with different levels of severity, also as an anaphylactic shock. Neuromuscular blocking drugs are the most frequently involved substances.Case presentation: We report a case of a 77-year old female patient with granulomatous inflammation of unknown etiology. Surgical biopsy of a neck lymph node was indicated. During the induction of anesthesia using propofol and succinylcholine she developed severe anaphylactic reaction presented with bronchospasm and cardiac arrest. Despite 80 min continous cardiopulmonary resuscitation the patient died. Elevated tryptase level in the patient's blood sample taken before death confirmed anaphylactic reaction. On autopsy we confirmed the tuberculous etiology of generalized granulomatous inflammation.Conclusions: It is important to recognize anaphylactic reaction during anesthesia early and to take adequate measures in order to prevent unfavorable outcome. Tryptase assay of a blood sample taken during life or postmortem may help to identify anaphylactic reaction.

Background. The aim of the study was to establish eventual progress in routine management of lung cancer patients over a ten-year period at University Clinic for Respiratory and Allergic Diseases Golnik, Slovenia, comparing the results of analysis of 345 patients, diagnosed in 1996 (with analysis performed in 2002), and 405 patients, diagnosed in 2006 (with analysis performed in 2008).Patients and methods. The patients of both analysed groups were of comparable age and number of patients in stage I and II, but there were relatively more females, patients with better performance status, more precise clinical staging and tumour histology in the 2006 group. The parameters used for assessing the progress of management were as follows: time period from admittance to diagnosis and to surgery; precision of staging; accordance of clinical and pathological staging in resected patients; percentage of exploratory thoracotomy; and use of new treatment modalities. The proportion of patients in selected/actual primary treatment modality and survival rate could also be used for assessing the progress.Results. Although unessential longer time from admittance to microscopic confirmed diagnosis increased from a mean 7.4 to 8.6 days in 2006 progress was established by the following: more precise clinical staging ( stage I and II also A and B stage, TNM staging also in small-cell lung cancer patients); improved accordance with clinical and pathological staging in resected patients (46% against 58%); decreased percentage of exploratory thoracotomy (13% against 4%); increased use of multimodality therapy as primary treatment modality (radiotherapy/chemotherapy, neoadjuvant chemotherapy); newly performed radio frequency tumour ablation. The proportion in selected/actual surgery increased from 76% to 93% and median survival rate of all patients from 6.2 to 10.6 months. One-year survival increased from 33.6% to 45.8% and two-year survival from 17.4% to 23%.Conclusions. Progress in routine lung cancer management was proved by better staging, lower percentage of exploratory thoracotomy, use of new treatment modalities, minor discordance between selected and actual therapy, and improved short-term survival rate.