Background: Pulmonary circulation typically shows flow divided between the right and left lungs, with a marked predominance of the right lung. Pneumonectomy reduces pulmonary circulation by ~50%, irreversibly changing the pulmonary perfusion characteristics. Here we assessed pulmonary flow after pneumonectomy and investigated how selected factors influenced pulmonary perfusion in this patient group. Methods: This study included 31 patients who underwent pneumonectomy complicated by postpneumonectomy pleural empyema, which was successfully treated, with long-term survival. Testing was conducted at a median of 1100 days after pneumonectomy, after flow stabilization. The control group comprised 31 subjects without pulmonary pathology. Pulmonary flow was assessed by scintigraphy using Technetium (99m-Tc). Results: The average single lung perfusion after pneumonectomy corresponded to the total perfusion in both lungs in the control group without statistic difference between comparable parameters (upper field, 21.35 vs. 22.129, p = 0.4; middle field, 47.15 vs. 49.62, p = 0.099; lower field 30.71 vs. 28.29, p = 0.14). Compared to those with left-sided pneumonectomy, patients with right-sided pneumonectomy exhibited increased upper field perfusion (22.61 vs. 19.82, p = 0.049) and decreased perfusion in the lower field (30.81 vs. 26.22, p = 0.049) and the combined middle and lower field (79.63 vs. 76.49, p = 0.046). Pulmonary flow was not significantly related to age, side of surgery, or empyema duration. Conclusions: Flow rate in the remaining lung after pneumonectomy corresponded to the total flow in both lungs in healthy controls. The perfusion ratio differed after right-sided versus left-sided pneumonectomy, which may be related to the initial anatomical differences of the right and left lung.

Background/Objectives: After pneumonectomy, the right ventricular stroke volume is pumped into pulmonary vessels whose volume has been reduced by approximately 50%. To sustain conditions for pulmonary flow, the flow reserve is increased in the remaining lung, which is conducive to the development of pulmonary hypertension symptoms. This study sought to examine pulmonary flow in one lung and the size of the right atrium (RA), right ventricle (RV) and pulmonary artery (PA) in patients who had undergone pneumonectomy and to establish the influence of time since pneumonectomy on these parameters, as well as their potential mutual dependencies. Methods: The retrospective analysis included 34 patients who had undergone pneumonectomy. Pulmonary flow was measured by means of perfusion scintigraphy. The diameters of the RA, RV and PA were evaluated based on computed tomography with contrast. Results: We observed complete or near-complete utilization of flow reserve in 38.2% (13/34) of patients, enlarged transversal and longitudinal dimensions of the RA in 17.6% (6/34) and 32.3% (11/34) of patients, respectively, and enlarged transversal and longitudinal dimension of the RV in 67.6% (23/34) and 44.1% (15/34) of patients, respectively. Dilatation of the PA was discovered in 23.5% (8/34) to 26.5% (9/34) of patients, as well as the presence of an extensive complex of radiographic features of pulmonary hypertension (PH) syndrome in 23.5% (8/34) of cases. Conclusions: Radiological features of PH were present in a significant number of patients. These features developed at varying rates but were present in all patients followed >10 years after the procedure.

Objectives: This study assesses vancomycin concentrations in allogenic transplanted rat lung tissue in acute and hyperacute rejection models of the lung. Methods: Left lung allotransplantation was performed from a male Brown Norway donor to a male Fisher F344 recipient in the case of an acute rejection model (the animals were sacrificed 5 days after transplantation) as well as a male Brown Norway donor to a male Wistar recipient in the case of hyperacute rejection (the animals were sacrificed 2 days after transplantation). Control rats were sham-operated and sacrificed on day 2 or 5, respectively, of the experimental model. Rejection was confirmed by blood gas assessment and lung histological examination. A single intraperitoneal dose of vancomycin 30 mg kg⁻¹ body weight was administered on the day of autopsy (day 2 or 5 from transplantation, respectively, of the experimental model), and then the blood and lung specimens were sampled at 0, 5, 1, 2, 4 and 6 h from the time of drug injection. Results: Arterial blood gas assessment (Wistar rats – pO₂: 44.33 ± 21.73 mmHg (mean ± standard deviation (SD)); Fisher rats – pO_2: 50.67 ± 14.30 mmHg (mean ± SD)) as well as histopathologic examinations of lung grafts confirmed rejection. Vancomycin lung/plasma concentration ratio was significantly higher in transplanted rats than in sham-operated animals. Conclusions: Both acute and hyperacute lung rejection affect the lung/serum of vancomycin in the transplanted lung resulting in higher drug accumulation, especially in late post-dosage time.

Situs inversus totalis (SIT) is a congenital anomaly that involves the mirror rearrangement of the thoracic and abdominal internal organs. In this paper, we report a 56-year-old male patient with previously confirmed SIT, who was admitted to the hospital for the diagnosis and surgical treatment of non-small-cell lung cancer, located in the sixth right pulmonary segment. The patient underwent segmentectomy with mediastinal and hilar lymphadenectomy. Furthermore, we screened the PubMed and Embase databases for reports of the surgical treatment of patients with SIT and lung cancer. Articles describing inoperable and disseminated disease, as well as patients qualified for palliative treatment, were not included. Ultimately, we compared 21 articles (including the one described here). Data about the clinical condition, tumor characteristics, treatment, and histopathological examination were extracted and summarized.

Aim: The aim of this study was to compare the metabolic response in the early postoperative period after radical resection of stage I and II oesophageal cancer applying a minimally invasive procedure and an open procedure involving classical laparotomy and thoracotomy. Material and methods: Serum concentrations of interleukin 6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-alpha), and total serum protein (TP) and leukocyte count (WBC) in blood collected on the day of surgery prior to the procedure (day 0) and on days 1, 2 and 7 after the surgery were measured in two groups of patients undergoing oesophageal resection due to cancer: applying a minimally invasive procedure involving laparoscopy and videothoracoscopy (group A) and applying a classical procedure involving full opening of the chest and abdominal cavity (group B). The study involved a total of 24 patients divided into two groups of 12 patients each. Results: Tumour necrosis factor-a concentration was lower in group A compared to group B on day 0, PCT concentration was lower in group A compared to group B on day 2 after surgery, and on the remaining days TNF-alpha and PCT concentrations were not statistically different between groups. Conclusions: Lower concentration of PCT on post-surgery day 2 in the group of patients undergoing minimally invasive oesophageal resection seems to be associated with a smaller perioperative injury. Lower TNF-alpha concentration in serum collected on day 0 in the group of patients undergoing minimally invasive resection is associated with a lower stage of oesophageal cancer in this group.

Background/Objectives: The physiological ventilation–perfusion ratio (V/Q) in the upper pulmonary field is >3 and in the lower pulmonary field it is <1 due to the effect of gravity when the body is in an upright position. Pneumonectomy leads to significant changes in ventilation and perfusion conditions. The aim of this study was to evaluate perfusion and ventilation after pneumonectomy complicated by pleural empyema, including the relationship between surgical outcomes, sex, and time from pneumonectomy. Methods: The study group included 30 patients (25 men, 5 women) who underwent pneumonectomy complicated by pleural empyema. Lung function was assessed using ventilation–perfusion scintigraphy. Twenty-one patients were assessed within 5 years after pneumonectomy and nine patients >5 years after pneumonectomy. Results: Average flow was 21.1% in the upper field, 47.8% in the middle field, and 30.35% in the lower field. The mean perfusion value was significantly higher in the lower field of the right lung than in the lower field of the left lung (33.35 vs. 28.05, p = 0.001). Average ventilation was 17.21% in the upper field, 46.73% in the middle field, and 34.28% in the lower field. The mean V/Q in the upper field was in the range of 0.81–0.87, but it reached approximately 1 (0.96–1) in the middle field and exceeded 1 (1.05–1.25) in the lower field. Conclusions: Pneumonectomy led to increased perfusion in the upper pulmonary field and increased ventilation in the lower pulmonary field compared to the literature for patients with the two lungs (the two-lung system), with a reversal of the V/Q between the upper and lower field.