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Zakopane, Poland

Zielinski M.,Pulmonary Hospital
Thoracic Surgery Clinics | Year: 2012

This article describes in detail the operative technique of the new surgical methods, video-assisted mediastinoscopic lymphadenectomy (VAMLA) and transcervical extended mediastinal lymphadenectomy (TEMLA). Both techniques enable the removal of the mediastinal nodes with the surrounding fatty tissue. VAMLA and TEMLA have very high diagnostic yield and can be combined with minimally invasive video-assisted lobectomy. © 2012 Elsevier Inc. Source

Zielinski M.,Pulmonary Hospital
Thoracic Surgery Clinics | Year: 2010

Operative technique of a new surgical method, transcervical extended mediastinal lymphadenectomy (TEMLA), is described in detail. TEMLA enables almost complete en bloc removal of the mediastinal nodes in semiopen fashion. Sensitivity and negative predictive value of TEMLA for staging were 95.6% and 98.4%, respectively, and for restaging, 95.7% and 98.4%, respectively. Other uses of TEMLA include resection of the mediastinal tumors and resection of the metastatic nodes to the mediastinum, esophagectomy with 3-field dissection (combined with laparoscopy or laparotomy), closure of postpneumonectomy fistula, and right upper pulmonary lobectomy. © 2010 Elsevier Inc. All rights reserved. Source

Kosinski S.,Pulmonary Hospital | Darocha T.,Jagiellonian University | Galazkowski R.,Medical University of Warsaw | Drwila R.,Jagiellonian University
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2015

Background: The incidence of hypothermia is difficult to evaluate, and the data concerning the morbidity and mortality rates do not seem to fully represent the problem. The aim of the study was to estimate the actual prevalence of accidental hypothermia in Poland, as well as the methods of diagnosis and management procedures used in emergency rooms (ERs). Methods: A specially designed questionnaire, consisting of 14 questions, was mailed to all the 223 emergency rooms (ER) in Poland. The questions concerned the incidence, methods of diagnosis and risk factors, as well as the rewarming methods used and available measurement instruments. Results: The analysis involved data from 42 ERs providing emergency healthcare for the population of 5 305 000. The prevalence of accidental hypothermia may have been 5.05 cases per 100.000 residents per year. Among the 268 cases listed 25% were diagnosed with codes T68, T69 or X31, and in 75% hypothermia was neither included nor assigned a code in the final diagnosis. The most frequent cause of hypothermia was exposure to cold air alongside ethanol abuse (68%). Peripheral temperature was measured in 57%, core temperature measurement was taken in 29% of the patients. Peripheral temperature was measured most often at the axilla, while core temperature measurement was predominantly taken rectally. Mild hypothermia was diagnosed in 75.5% of the patients, moderate (32-28 ° C) in 16.5%, while severe hypothermia (less than 28 ° C) in 8% of the cases. Cardiopulmonary resuscitation was carried out in 7.5% of the patients. The treatment involved mainly warmed intravenous fluids (83.5%) and active external rewarming measures (70%). In no case was extracorporeal rewarming put to use. Conclusions: The actual incidence of accidental hypothermia in Polish emergency departments may exceed up to four times the official data. Core temperature is taken only in one third of the patients, the treatment of hypothermic patients is rarely conducted in intensive care wards and extracorporeal rewarming techniques are not used. It may be expected that personnel education and the development of management procedures will brighten the prognosis and increase the survival rate in accidental hypothermia. © Kosiński et al.; licensee BioMed Central. Source

Zielinski M.,Pulmonary Hospital
Thoracic Surgery Clinics | Year: 2011

Myasthenia gravis (MG) associated with thymomas differs from nonthymomatous MG, and thymomas associated with MG are also different from non-MG thymomas. According to the World Health Organization classification, the incidence of MG in thymomas was the highest in the subtypes B2, B1, and AB. Transsternal approach is still regarded as the gold standard for surgical treatment of thymomas. Less-invasive techniques of thymectomy are promising, but it is too early to estimate their real oncological value. In the series including more than 100 patients, the prognosis for survival is better in patients with thymomas associated with MG than in those with non-MG thymomas, and the prognosis for patients with MG associated with thymoma is worse than that for patients with nonthymomatous MG. © 2011 Elsevier Inc. Source

Zielinski M.,Pulmonary Hospital
Seminars in Thoracic and Cardiovascular Surgery | Year: 2010

Transcervical extended mediastinal lymphadenectomy (TEMLA), introduced by our team in 2004, is a new technique for the preoperative staging of non-small cell lung cancer (NSCLC). The aim of TEMLA is to maximally accurately stage and possibly to improve late results of treatment of NSCLC. Operative techniques include a collar incision in the neck, elevation of the sternal manubrium with a special retractor, bilateral visualization of the laryngeal recurrent and vagus nerves, and dissection of all mediastinal nodal stations except for the pulmonary ligaments nodes (station 9, according to the Mountain-Dresler map). Generally, the mediastinal pleura are not violated, and no drain is left in the mediastinum. In this article, some important steps the facilitating safe and straightforward performance of TEMLA are presented, and methods of managing intraoperative complications is discussed. © 2010 Elsevier Inc. Source

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