Thoracoscopic debridement and/or decortication for thoracic empyema: a comparative study with open decortication

To compare between thoracoscopic debridement and/or decortication versus open decortication in the management of thoracic empyema. This retrospective study was conducted out at King Hussein Medical Center, during the period of December 2006 and November 2011. Fifty-five patients with the diagnoses of stage two or three thoracic empyema were included in this study. The patients were divided in two groups. Group A included patients who underwent thoracoscopic debridement and/or decortication and group B included patients who underwent open decortication. Efficacy of the procedure, operative time, and postoperative blood loss, the need for ventilator support, postoperative complications, postoperative hospital stay and mortality were compared in both groups. Males constituted 61.8% [n=34] of the studied patients. Twenty-nine patients [52.7%]; underwent thoracoscopic debridement and /or decortication while 26 patients [47.3%] underwent open decortication. Mean age [range] was 36.55 +/- 16.47 [16-70] years for group A, and 37.70 +/- 14.28 [17-67] years for group B. There was no statistical significant difference between both groups regarding postoperative hospital stay [P=0.1012] and duration of air leak [P=0.1515]. Duration of the procedure was 209.29 +/- 20.93 minutes for group A patients, while it was 97.86 +/- 38.06 minutes for group B patients [P<0.001]. Three out of the 26 patients [11.5%] who underwent open decortication died in the postoperative period though the fatality was zero in group A patients. Thoracoscopic debridement and/or decortication should be considered as the first surgical option in the management of stage two and three thoracic empyema.

Post major lung resection cardiac arrhythmias

To describe the possible postoperative cardiac arrhythmias after major lung resection surgery performed for lung malignancies. This descriptive study was conducted from January 2007 to October 2009 at the Thoracic Surgery Division of the Royal Medical Services in Amman-Jordan. Forty-eight patients were included in this study. Patients with pre existing cardiac diseases were excluded. All the patients underwent different types of major lung resection surgery for primary and secondary lung malignancies. Postoperative cardiac arrhythmias after different types of lung resection surgery were documented and described. Simple descriptive statistics were used. The sample included 35 males [72.9%] and 13 females [27.1%]. Age ranged between 21 to 82 years [mean 56.6 +/- 14.9]. Left sided surgery was performed in 21 patients [43.7%], while right sided resections were performed in 27 patients [56.3%]. Lobectomy was the most commonly performed operation which was carried out in 27 patients [56.3%], followed by pneumonectomy which was performed in 14 patients [29.2%]. Post operative cardiac arrhythmias occurred among 19 patients [39.6%]. Atrial fibrillation was the most common reported arrhythmia which occurred in 15 patients [31.2%], followed by supra ventricular tachycardia in 2 patients [4.2%], and 2 patients developed atrial flutter [4.2%]. Cardiac arrhythmias were observed to be more common after lobectomy or pneumonectomy, in old male patients, and during the first 48 hours post lung resection. Post major lung resection cardiac arrhythmias are common. Preoperative evaluation and postoperative cardiac monitoring are mandatory in these patients even among those without pre existing cardiac diseases

Cardiac complications in the first week post transhiatal esophagectomy for esophageal cancer

To determine cardiac complications and associated risk factors in the first week post transhiatal esophagectomy for esophageal cancer patients without detectable cardiac diseases. This descriptive study was conducted during the period from January 2000 through October 2007. Sixty-eight patients were included in this study. Patients with pre existing cardiac diseases were excluded. All the patients underwent transhiatal esophagectomy for a malignant lesion. All the cardiac complications were documented and analysed in the first week post operatively. There were 50 males [73.5%] and 18 females [26.5%], age ranged from 35 to 83 years [mean 62.7 +/- 10.3]. Post operative cardiac complications occurred in 25 patients [36.8%] during the first post operative week. Atrial fibrillation was the most commonly reported cardiac complication which occurred in 14 patients [20.6%], followed by supra ventricular tachycardia in six patients [8.8%], two patients developed atrial flutter [2.9%], fatal myocardial infarction in two patients [2.9%] and nonfatal myocardial infarction in one [1.5%]. Male gender, older age, longer procedure and first 48 hours post transhiatal esophagectomy were risk factors. Cardiac complications, mainly arrhythmias, are common after transhiatal esophagectomy. Preoperative evaluation, intraoperative and postoperative cardiac monitoring are mandatory in all patients even in those who have no cardiac illnesses

Complications of video assisted thoracoscopic sympathectomy for primary hyperhidrosis

To document the possible complications of video-assisted thoracoscopic sympathectomy procedure and their frequency of occurrence. This retrospective study was conducted at King Hussein Medical Center, Amman, Jordan, between April 2001 and January 2006. Two hundred and seven patients underwent thoracoscopic sympathectomy for the treatment of facial, axillary, and/or palmar hyperhidrosis. Follow up was completed for one year. All possible early and late complications were documented and analyzed. Males constituted 59.4% of the studied patients. Mean age range was 25.2 +/- 4.6 13-34 years. One hundred and fifty-three patients 73.9% had palmar hyperhidrosis as the main indication for sympathectomy, 4 patients 1.9% had axillary hyperhidrosis, and facial sweating or blushing in 7 patients 3.4%. Palmar hyperhidrosis combined with axillary and/or facial sweating were found in 43 patients 20.8%. The most common recorded complication was compensatory hyperhidrosis, which occurred in 142 patients 68.6%. Compensatory sweating remains the most common, and most disabling complication of video-assisted thoracoscopic sympathectomy. Other alternative more selective methods, rather than cutting the main trunk should be studied thoroughly to assess their efficacy in reducing the complication of compensatory sweating