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Preoperative examination in lung surgery enable to determine the extent and severity of lung disease with an assessment of the patient's ability to undergo an operation under general anesthesia, with the determination of the maximum range of the lung resection. This review article presents the multidisciplinary view of the particular examinations, A comprehensive preoperative preparation is a set of psychological techniques, education, rehabilitation training and elimination of smoking. Indications for surgery and the assessment of a definitive treatment procedure arises from the multidisciplinary team decision and the attitude and choice of each patient. [ABSTRACT FROM AUTHOR]

Authors present a historical review of treatment for lung tuberculosis. They describe indications of modern surgical treatment for lung tuberculosis, and focus on single surgical procedures, surgical techniques and complications. An absence of specialized centre for treatment of tuberculosis and lung mycobacteriosis is pointed out in conclusion. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 is considered a respiratory virosis in its classic form, although it may present with heterogeneous symptoms. Thoracic complications occur in a small percentage of patients. Our objective was to evaluate existing experience with this disease and its thoracic manifestations and to determine the real-world status of care of these patients., Methods: This study is a retrospective, single-institution analysis of a group of patients hospitalized with acute and post-acute COVID-19 pneumonia at Thomayer Hospital in Prague in the period from December 2020 to March 2022 and indicated for a thoracic surgical procedure., Results: During the peak of COVID-19 pandemic, a thoracic intervention was performed in 46 admitted patients. Thoracic drainage (due to pneumothorax in 18 cases, fluidothorax in 3 cases, CT-guided lung abscess drainage in 2 cases, and CT-guided pneumatocele drainage in 2 cases) were the most common thoracic surgical procedures. Pleurectomy/decortication surgery was done in 10 cases. Additionally, 12 lung parenchyma-sparing resections were performed, while lobectomy was required in 2 cases. Resection of postintubation tracheal stenosis due to a severe course of COVID-19 pneumonia was indicated in 2 patients., Conclusion: Even mild COVID-19 may cause a considerable morphological a functional alteration of the respiratory system. The most common complications of COVID-19 pneumonia that require a thoracic surgical intervention include pathologies associated with an air leak and accumulation of air (pneumothorax, pneumomediastinum and subcutaneous emphysema). The development of pulmonary necrosis, symptomatic bronchiectasis, pneumatocele, and bullous-fibrotic formations may result in pneumothorax, hemothorax or thoracic empyema in sporadic cases. An early thoracic surgical intervention to treat thoracic complications of COVID-19 pneumonia can improve the survival of COVID-19 patients.

Background: Complex networks of chemokines are part of the immune reaction targeted against tumor cells. Chemokines influence cancer growth. It is unclear whether the concentrations of chemokines at the time of NSCLC (non-small cell lung cancer) diagnosis differ from healthy controls and reflect the extent of NSCLC., Aims: To compare chemokine concentrations (CCL2, CCL8, CXCL12) in the plasma of patients with resectable NSCLC to those without cancer. To determine whether the chemokine concentrations differ relative to the stage of disease., Methods: Sixty-nine patients undergoing surgery for proven/suspected NSCLC were enrolled. They underwent standard diagnostic and staging procedures to determine resectability, surgery was performed. Forty-two patients were diagnosed with NSCLC, while 27patients had benign lung lesions and functioned as the control group. Chemokine concentrations in peripheral blood were assessed using ELISA. Parametric statistics were used for the analysis of results., Results: There were no differences in plasma chemokine concentrations in NSCLC patients compared to controls. CXCL12 concentrations correlated positively with tumor extent expressed as clinical stage, (mean values: stage I 5.08 ng/mL, SEM 0.59; stage II and IIIA 7.82 ng/mL; SEM 1.06; P=0.022). Patients with NSCLC stages II+IIIA had significantly higher CXCL12 concentrations than controls (mean values: stage II+IIIA 7.82 ng/mL; SEM 1.06; controls 5.3 ng/mL; SEM 0.46; P=0.017)., Conclusion: CXCL12 was related to tumor growth and could potentially be used as a biomarker of advanced disease., Competing Interests: The authors report no conflicts of interest in this work.

Objective: The aim of this study was to assess the incidence of thoracic tuberculosis (TB) in patients who underwent surgery for indeterminate lung nodules, mass and pleural effusions., Methods: A monocentric retrospective study was carried out from 2012 to 2018 in a high-volume thoracic surgery centre. All patients with finding of thoracic TB within surgery and/or confirmed post-surgery were studied. Demography, origin, TB related symptoms, immunosuppression, type of surgery, and complication of surgery were analyzed., Results: During the seven-year period TB was diagnosed in 71 cases, 58% were men. The mean age was 50 years. 21% of the cases had family history of TB or were successfully treated for TB in the past. 14% of patients had prior history of treatment for malignancy. Five patients (7%) received immunosuppressive therapy. The indication for surgery was indeterminate lung nodules and mass in 55 patients (77.5%) and indeterminate recurrent or persistent pleural effusions in 21 patients (22.5%). In five patients (7%) a lung carcinoma and a concomitant TB infection was detected. 63 of the cases (88.7%) had positive real-time PCR TBC test. Direct microscopic detection of Mycobacterium tuberculosis detected TB in five cases (7%). The microbiological diagnosis by culture was achieved in 19 patients (26.8%). Two patients (2.8%) were diagnosed with multidrug-resistant TB. Surgical procedure complications occurred in nine cases (12.7%)., Conclusions: Although the overall incidence of TB in the Czech Republic is low and constantly continues to decrease, the number of TB detected by surgical procedures is increasing. Surgery still remains an important tool in diagnostics of nonobvious cases of TB, especially in patients with a potential risk of malignancy.

Introduction: The individual patient prognosis after radical surgery for Non-small cell lung cancer (NSCLC) of left upper lobe remains still unclear. The purpose of this study is to evaluate the predictive value of elevated white blood cell count in peripheral blood as early indicator of postoperative NSCLC prognosis., Methods: A retrospective statistical analysis was performed studying patients subject to radical treatment of left upper lobe NSCLC in period of five years with subsequent one to three-year monitoring of morbidity and mortality of the patient population. The statistical ROC (Receiver Operating Characteristic) analysis of the WBC count in peripheral blood third day after the operation was used to evaluate the relationship with overall survival, with respect to patients surviving for at least 24 months., Results: Based on the results of the ROC analysis with a total area under the curve (AUC) of 0.67, it is possible to confirm that the WBC count established third day after the operation allows us to classify patients into groups according to the 24-month overall survival., Conclusion: Our findings confirm the potential of using WBC count to improve current protocols to establish postoperative prognosis for NSCLC of the upper left lobe (Tab. 2, Fig. 1, Ref. 11).

Introduction: Human Alveolar Echinococcosis - Alveolar Hydatid disease (AE) is an omitted zoonotic infection presenting with focal liver lesions. Cause of AE is a larval stage of Echinococcus multilocularis tapeworms., Case Presentation: In this report an extraordinary case of a 38 year-old female examined due to 2 liver tumors and 2 pulmonary nodules is described. The patient underwent pulmonary and liver surgery for suspected advanced cholangiocellular carcinoma and surprisingly AE was found., Discussion: Distinguishing intrahepatic AE from other focal liver lesion can be complicated and in many cases is diagnosed incorrectly as intrahepatic cholangiocarcinoma or other liver malignancy., Conclusion: AE is a rare but potentially fatal parasitic infection primarily affecting liver, although it can metastasise to lung, brain and other organs. The diagnosis and treatment can be difficult and clinical misinterpretation as malignancy is not rare. The principal treatment of AE is surgery accompanied with chemotherapy., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Studies focused on arbovirus diseases transmitted by invasive species of mosquitoes have become increasingly significant in recent years, due to the fact that these vectors have successfully migrated to Europe and become established in the region. Mosquitoes, represented by more than 3 200 species, occur naturally worldwide, except in Antarctica. They feed on the blood of warm-blooded animals and by this route, they are capable of transmitting dangerous diseases. Some species can travel a distance of 10 km per night and can fly continuously for up to 4 hours at a speed of 1-2 km/h. Most species are active at night, in the evening or morning. It usually takes a mosquito female about 50 seconds to penetrate the skin of mammals and the subsequent blood meal usually takes about 2.5 minutes. Mosquitoes live for several weeks or months, depending on the environmental conditions. The VectorNet project is a European network of information exchange and sharing of data relating to the geographical distribution of arthropod vectors and transmission of infectious agents between human populations and animals. It aims at the development of strategic plans and vaccination policies which are the main tasks of this time, as well as the development and application of new disinfectants to control vector populations.

Background: Biodegradable stents that disintegrate after a period of time are expected to be well tolerated and have advantages over other stents that are more commonly used in practice today. Polydioxanone is a biodegradable polymer that is widely used during surgery with absorbable sutures., Methods: We present cases from the first four patients to undergo a tracheal polydioxanone stent insertion. Indications included significant non-malignant tracheal stenosis in cases where primary surgical treatment was not possible. The stents were implanted using rigid bronchoscopy and patients received regular follow-ups as needed. This use of biodegradable stents in adult patients was a novel, previously untested approach. The study was approved by the Institutional Ethics Committee and was based on a project entitled; "Biodegradable stents in the management of stenoses of large airways" (project NT 14146-3/2013)., Results: Six biodegradable stents were implanted in four patients with benign stenoses. No technical difficulties occurred and no serious or life-threatening events were recorded. All patients reported some benefit from treatment., Conclusion: Polydioxanone tracheal stents can be considered when a need for temporary support is expected, and as an alternative to other stents if the latter could compromise the patient. Owing to limited experience and observed disadvantages, further research is needed to fully assess this treatment., Trial Registration: This work is based on project NT14146 - Biodegradable stents in the management of stenoses of the large airways (2013-2015, MZ0/NT), registered from May 1, 2013 in The Research and Development and Innovation Information System of the Czech Republic and in ClinicalTrials.gov, reg. no. NCT02620319, December 2, 2015.

VATS lobectomy is a respected modality of anatomic lung resections nowadays. Video-assisted lobectomies without rib extractor fulfil all current requirements for minimally invasive lung resections. This type of an anatomic pulmonary resection with a targeted treatment of hilar structures doesn't traumatize the intercostal space by using rib retractor. Videothoracoscope serves to visualize the surgical field on the screen. Assisted VATS (aVATS) lobectomy is a procedure using 3-5 cm working incision. Fully endoscopic resection (VTS) or complete VATS lobectomy (cVATS) are operations performed only through ports, without working incision. The authors supplement the article with a videorecord of VATS lobectomy general technique (Fig. 4, Ref. 11).

The authors present their own unique original method of fixation polydioxan biodegradable stents in the treatment of tracheal stenosis documented by pictures and video (Fig. 3, Ref. 12).

Background: Diagnostics and treatment of bronchogenic non-small cell lung carcinoma is a severe clinical problem. Radical surgery is the major treatment modality with the highest chance for a long-time survival. The aim of the study was to map metastasizing of bronchogenic non-small cell lung carcinoma into homolateral mediastinal lymph nodes and to assess the importance of histological verification of mediastinal lymphadenectomy for exact staging and treatment., Methods: Study of 29 patients with non-small cell lung carcinoma in stage IIIa, IIIb and IV (TNM classification) diagnosed from September 2006 to March 2007, with mediastinal lymph nodes invasion according to CT, and with subsequent mediastinal lymph node dissection during autopsy., Results: 50% of the right upper lobe tumors metastasized into group 1 nodes (N1-N4) and 50% into group 3 (N7). 66% of the right lower lobe tumors metastasized into group 3 nodes (N7) and 33.3% into group 1 (N1-4). 20.0% of the left upper lobe tumors metastasized into group 1 nodes (N1-4), 33.0% into group 2 (N5-6), 25.0% into group 3 (N7) and 16.7% into group 4 (N8-9). 23.5% of the left lower lobe tumors metastasized into group 1 nodes (N1-4), 23.5% into group 2 (N5-6), 23.5 % into group 4 (N8-9) and 29.5% into group 3 (N7). 27.6% of examined patients had false positivity of lymph node metastasis according to CT., Conclusion: Histological verification of suspect mediastinal lymph nodes via Endobronchial Ultrasound Biopsy (EBUS) or mediastinoscopy or thoracoscopy is crucial for determining the stage of the disease according to the TNM classification. False positivity of imaging methods in diagnostics of non-small cell brochogenic carcinoma can contraindicate up to quarter of potentially operable patients (Tab. 3, Ref. 11).

We describe the case of a patient with metastatic renal cell carcinoma (mRCC) who developed a nontuberculous mycobacteria (NTM)-related pulmonary nodule during therapy with the mammalian target of rapamycin (mTOR) inhibitor temsirolimus. After discontinuation of temsirolimus treatment, a small pulmonary nodule with increased glucose uptake was detected on a positron emission tomography (PET) scan. A lung resection carried out to confirm and treat the suspected solitary metastasis of RCC yielded the surprising finding of a caseating granuloma containing NTM. A single PET-positive nodule presents a significant differential diagnostic dilemma in the setting of mRCC treated with mTOR inhibitors. Although the treatment of mRCC with temsirolimus can lead to immunosuppression and opportunistic infections, there is no report to our knowledge on the occurrence of NTM infections in mRCC patients treated with mTOR inhibitors. These infections should be included in the differential diagnosis of lung nodules. Interestingly, there is strong preclinical evidence pointing to direct and indirect antimycobacterial activity of mTOR inhibitors. We therefore hypothesize that while the seeding of NTM can occur during temsirolimus therapy due to T-lymphocyte suppression, the infection may only become active after the discontinuation of mTOR inhibitor treatment.

Background: Constituent part of radical lung resection for lung cancer is a dissection of mediastinal lymph nodes. Lymphadenectomy is a standard procedure in an assessment of clinical stage of the disease. The aim of the study was to map metastasizing of bronchogenic non-small cell lung carcinoma into homolateral mediastinal lymph nodes and to assess the importance of mediastinal lymphadenectomy for exact staging and survival., Methods: Study of 31patients with lung resection and systematic mediastinal lymphadenectomy operated from August 2004 to January 2007, with pre-operative stage Ia to IIb (TNM classification) - according to CT without mediastinal lymph nodes invasion and with positive histological finding after systematic mediastinal lymphadenectomy., Results: Tumors in right upper lobe metastasized in 45.5 % into group 1 nodes (stages N1-N4) and group 3 nodes (stages N7) and in 9 % into group 4 nodes (stages N8-N9). Tumors of the right middle lobe metastasized in 100 % into group 3 nodes (stage N7).Tumors of the right lower lobe metastasized in 87.5 % into group 3 nodes (N7) and in 12.5 % into group 4 nodes (stages N8-N9). Tumors of the left upper lobe metastasized in 9.0 % in group 1 nodes (stages N1-N4), in 82 % into group 2 nodes (stages N5-N6) and in 9.0 % were found skip metastases into group 4 nodes (stages N8-N9). Tumors of the left lower lobe metastasized in 26.7 % in group 4 nodes, 46.6 % into group 3 nodes, in 20,0 % into group 2 nodes and in 6,7 % into group 1 nodes., Conclusion: Systematic mediastinal lymphadenectomy is crucial for determining the stage of the disease according to the TNM classification. Systematic lymphadenectomy is essential for the diagnosis of stage IIIa disease and setting of additional therapy that prolongs survival (Ref. 17).

Authors present case-reviews of three patients, 33 years old, with finding of pulmonary sequestration and indicated for surgical therapy, it means lung resection. It was an accidental finding in all three case-reviews. Standard examination methods in pneumology as a X-ray of the chest, bronchoscopy with cytology, spirometry and chest CT, were used for diagnosis. If the suspicion of pulmonary sequestration was expressed from chest CT scans, then CT angiography was indicated. The patients underwent surgery revision, ligation of atypically leading artery followed by lung resection with pulmonary seqestration. In the postoperative course there were no complications.

The study was undertaken to test whether marginally resectable or unresectable stage IIIa-IIIb non-small cell lung cancer (NSCLC) patients could reach complete resectability after induction chemotherapy. Fifty six patients were included into the study and treated either by vinorelbine 35 mg/m2 day 1 and cisplatin 75 mg/m2 day 1 (n=28) or by vinorelbine 30 mg/m2 day 1 and 8 and cisplatin 80 mg/m2 day 1 (n=28). Cycles were repeated every 21 days. At the completion of induction therapy patients assessed to be resectable underwent thoracotomy. Radiation therapy was applicated in nonresected cases. The minimal follow up was 24 months. 32% of patients with marginally resectable or unresectable stage IIIa-IIIb NSCLC could reach a complete resectability after induction chemotherapy. Survival of patients stage IIIa was comparable to stage IIIb. Responders and resected patients survived significantly longer comparing to the patients with stable disease and progression, respectively to the incompletely resected plus nonresected patients. Perioperative complications were rare and there were no treatment-related deaths in our study. The main surgery-related complication was late bronchopleural fistula.

The authors publish their initial experience with wedge-shaped pulmonary biopsy by the endoscopic route. The group is formed by 18 patients who were indicated for the operation on account of a disseminated pulmonary process in order to assess the micromorphological appearance of the affected lung tissue. Two patients developed a complication during operation which therefore was completed by minor thoracotomy. In who patients the authors observed after operation slow expansion of the pulmonary parenchyma. No death after the operation was recorded. The authors assume, based on their initial experience, that this operation will soon be included among common diagnostic operations and will help to facilitate the diagnosis and selection of treatment in patients with disseminated lung disease.

In 1970-1990 in the Institute of Lung Diseases in Prague a total of 180 mediastinoscopies were performed. In the submitted paper the authors discuss 169 of these examinations. In this group 20 examinations were associated with a peroperative or postoperative complications, i.e. a total of 12% of the examinations. However, only in three patients, i.e. cca 1.8% from the total number serious complications were involved which were unequivocally specific for mediastinoscopy. In two instances massive haemorrhage occurred from lacerated mediastinal vessels associated with superior vena cava syndrome and in one case pneumothorax developed. All these complications were controlled by surgical intervention made in time. The most frequent complication after mediastinoscopic examination was retention of a serohaematoma in the wound--this was recorded 11 times. The cause of its development is the method of preparation and anatomical conditions in the pre- and paratracheal space. The percentage of this complication can be reduced by using active drainage of the mediastinum.

The authors give an account of their experience with extensive pulmonary resections on account of an extensive non-small-cell carcinoma of the lungs. During a 13-year period (1976-1988) they made 140 extensive resections of the lungs. As to histological characteristics, the epidermoid type of tumour predominated. The tumour spread most frequently to mediastinal nodes and the thoracic wall. The mean age of the patients was 54.9 years, the mortality within 30 days after operation 5.7%. The five-year survival of patients after operation was evaluated in patients operated between 1976 and 1988 when 90 operations were performed. The majority of patients (32.5%) survived combined surgery. Two patients survive after 10 years. Due to the small number of patients and their difficult comparability it is not possible to evaluate the effectiveness of different types of treatment statistically. In the literature views on combined postoperative treatment differ, a randomized study would be useful. In the conclusion the authors advocate continuation of the hitherto used trend of therapy, they recommend introduction of new chemotherapeutic agents in close collaboration with oncologists and concentration of patients in specialized departments.

In 1969 to 1989 in the Research Institute of Tuberculosis and Respiratory Diseases in Prague a total of 3583 thoracotomies were performed. Of these during the postoperative period 29 patients were re-operated on account of continuing haemorrhage into the pleural cavity. This is approximately 0.8% of all thoracotomies. Sixteen patients had to be re-operated within 12 hours after operation, 12 patients were re-operated later than 12 hours after operation but within 24 hours, one patient was re-operated later than 24 hours after operation. The cause of haemothorax was in the first place capillary haemorrhage from a lacerated pleura, in the second place haemorrhage from a severe intercostal artery at the very site of the thoracotomy. Other causes of haemorrhage such as haemorrhage from the bronchial artery and its branches are not frequent. None of the patients had to be re-operated on account of haemorrhage from the major arteries of the pulmonary hilus. Administration of small doses of heparin before and after operation did not influence the number of re-operations on account of haemothorax.

During a 15-year period, when in the department for thoracic surgery in the Research Institute for Tuberculosis and Respiratory Diseases 1612 resections of the lungs were performed, the authors recorded 18 patients with bronchopleural fistulae. After pneumonectomies and lobectomies the incidence of this complication was recorded in 1.4%. The majority of fistulae was observed after resection on the lungs on account of bronchogenic carcinoma, in two patients after resection on account of a pulmonary aspergilloma. After resection on account of TB and bronchiectas is the authors did not observe bronchopleural fistulae. Treatment of the fistula was in two thirds of the patients of the investigated group conservative with a 33% lethality. In six patients on account of the fistula rethoracotomy was performed with a lethality of 66.6%. The total lethality during treatment of bronchopleural fistulae was 44.4%. The purpose of the present work is to draw attention to the serious character of this post-resection complication and to its possible prevention by preoperative preparation and surgical technique.