Pattern of thoracic surgical diseases at a Tertiary Care Hospital

Objective: to describe the pattern of thoracic surgical diseases at a tertiary care hospital

Study design: descriptive case series

Place and Duration of Study: department of Thoracic Surgery, Ojha Institute of Chest Diseases, Dow University of Health Sciences Karachi, from January 2013 to December 2014

Methodology: records of all the patients admitted, transferred to or referred from other departments / hospital during the study period was retrieved and analyzed. Variables studied included mode of admissions, diagnosis, surgical procedures performed and mortality. Descriptive statistics were used for data presentation

Results: a total of 669 patients were admitted during the study period. There were 382 [57%] males and 287 [43%] females. A total of 626 surgical procedures were performed. Out of these 254 [41%] were carried out under general anesthesia and 372 [59%] in local anesthesia. The most common procedure under general anesthesia was decortication [n=51, 20%]. Most common procedure under local anesthesia was tube thoracostomy [n=119, 32%]. The remaining 43 patients were managed conservatively. The overall mortality was 1.8%

Conclusion: empyema thoracis was the commonest thoracic surgical condition for which patients were admitted

Management challenge in chest wall neoplasms; a 2 year experience

Introduction: Chest wall neoplasms are rare and represent only about 5% of all thoracic neoplasm. We present our 2 years analysis of the clinical features, presentation, diagnosis and treatment of chest wall neoplasms

Study design: Case series study

Place and duration of study: Ojha Institute of Chest Diseases, Dow University of Health Sciences, Karachi, Pakistan from Nov 2012- Oct 2014

Methodology: Between 2012 and 2014, 39 patients with solid chest wall masses were enrolled in the study. Tumors were categorized as benign and malignant, including primary and secondary, after histopathological diagnosis with tissue biopsy. Data on patients' characteristics, symptoms, tumor type and management was recorded and analysed

Results: The study included 39 patients [20 males and 19 females] with age range 18-71years [mean 36.3]. 21[53.8%] patients had benign chest wall tumors while 18[46.1%] patients had malignant tumors. Among malignant tumors, 14[77%] patients had primary malignancy where as 4[22%] patients had chest wall tumor secondary to primary tumor elsewhere. Among these 4, the primary tumor remained unknown in 1 patient. The most common benign solid lesion was chest wal lesion lipoma in 8/21 patients [38%]. Among malignant tumors, chondrosarcoma [4/14, 29%] was the most common

Conclusion: Preoperative needs careful assessment of the patient, radiological imaging and histopathological examination for diagnosis of the tumor in the chest wall. Using a multidisciplinary team approach, excellent results can be available with complete surgical resection, reconstruction of the chest wall and appropriate or neo adjuvant treatment where necessary

Mediastinal synovial sarcoma

The mediastinum is an uncommon site of synovial sarcoma which is a rare soft tissue malignancy. An 18 year old boy was admitted for right sided chest pain since one year. Based on the CT scan chest findings, tru-cut biopsy of the mass was performed and histopathology initially reported as neurofibroma. The tumor was excised via posterolateral thoracotomy and excisional biopsy established the diagnosis of primary synovial sarcoma arising from the mediastinum. Patient was started on adjuvant chemotherapy at the oncologist tumor board's recommendation and he received 6 cycles of adriamycin and ifosfamide. At last follow up he is free of tumor recurrence