Cervico-mediastinal thyroid masses - our experience.

INTRODUCTION: Over the last decades, several definitions and classifications of cervico-mediastinal goiters and thyroid masses have been proposed. We analyze and discuss the clinical presentation, the diagnostic procedures and the surgical technique in relation to post-operative complications and results in cervico-mediastinal thyroid masses admitted in our Clinic of Thoracic Surgery over a period of 22 years (1991-2012). METHODS: We reviewed 130 patients who underwent surgery for retrosternal thyroid masses, 77 (59.23%) women and 53(40.77%) men. Mean age was of 53 years. Shortness of breath was observed in 71 (54.61%) patients as the most frequent preoperative symptom. Cervico-thoracic CT scan reveales the existence of a cervico-mediastinal mass and can appreciate the degree of intrathoracic progression, tracheal compression and dislocation, as well as the relations with other anatomical structures of the visceral mediastinum. All 130 patients were prepared for a thoracic approach, majority of the cases were operated by Prof. T. Horvat. The surgical procedure was performed by cervical approach only in most of the cases (106 cases) (Kocher type cervicotomy in 63 cases and Horvat type "en-Y" cervicotomy in 43 cases). We used a bipolar approach for large cervico-thoracic masses: cervicotomy and partial upper sternotomy in 20 cases, cervicotomy and full sternotomy in 3 cases, cervicotomy and right axillary thoracotomy in one case. RESULTS: The removal of the thyroid mass and decompression of the trachea have been achieved in all cases. Post operative results were very satisfactory, with absence of respiratory distress and with normal function of the vocal cords. No post operative mortality was encountered. CONCLUSION: The presence of a cervico-mediastinal thyroid mass with or without respiratory distress requires a surgical excision as the only treatment option. The surgical procedure represented a milestone for both anesthesiologist (difficult intubation in some cases of large goiters) and thoracic surgeon.Thyroid masses extending to the mediastinum can be excised successfully by cervical incision. Bipolar approach has an excellent outcome, achieving a safe resection, especially in large thyroid masses extending to the mediastinum with close relations to mediastinal structures.

[Neurogenic tumors of the posterior mediastinum]. / Tmorile neurogene ale mediastinului posterior.

The posterior mediastinum is the potential space along each side of the vertebral column and adjacent proximal portions of the ribs--the paravertebral sulci. From the posterior mediastinal tumors, the most commonly encountered are the neurogenic tumors (75%), the remaining 25% are represented by a heterogenous group of rare tumors including teratoma, lymphoma, sarcoma and other lesions arising outside the mediastinum and projecting into the posterior compartment. Surgical excision, by thoracotomy or miniinvasive techniques, is the first line of treatment in the posterior mediastinal tumors. Tumors with extension into the spinal canal (dumbbell tumors), accounting for nearly 10% of the posterior mediastinal tumors, require a multidisciplinary approach: thoracic surgeon and neurosurgeon. We present the experience of the "Carol Davila" University of Medicine and Pharmacy Thoracic Surgery Clinic in the surgery of neurogenic posterior mediastinal tumors throughout a 9 year period (2001 - 2010). 42 cases admitted and operated in this period are being analysed.

[Solitary pulmonary nodule--150 resected cases]. / Nodulul pulmonar solitar--150 de cazuri operate.

Solitary pulmonary nodule represents a radiological entity with unknown prevalence in general population. As definition, solitary pulmonary nodule has 3 cm diameter or less and is surrounded by lung parenchyma, with no other abnormalities on the same chest X-ray or CT scan film. The differential diagnosis of the solitary pulmonary nodule includes over 100 conditions and the most frequent is lung cancer. Identification and correct management of the solitary pulmonary nodule opposes early detection and treatment of the lung cancer and the uselessness of a surgical procedure on a benign disease which needs no treatment. After analyzing 150 solitary pulmonary nodules resected and after comparing the results with the literature, given the fact that 48.66% of the nodules are malignant and 52.66% of the nodules have the maximum accepted dimensions (3 cm), the authors proposed an algorithm for solitary pulmonary nodule management adapted to Romania's accessibility to diagnostic procedures. As conclusion, the surgical resection of an indeterminate solitary pulmonary nodule (not certified as benign at CT scan or by biopsy) has an absolute indication and curative intention.

[Minimally invasive surgical techniques for the treatment of pulmonary metastases]. / Tratamentul miniinvaziv al metastazelor pulmonare.

OBJECTIVE: Raising surgeons' awareness and sensitivity about the use of minimally invasive surgical techniques for the treatment of patients with pulmonary metastases. PATIENTS AND METHODS: The study was based on the data collected from 10 consecutive patients who underwent surgery for lung metastases in our department between 2003 and 2008. RESULTS: The most frequently encountered metastases to the lung were from breast and lung carcinoma; the disease free interval was between 6 months and 20 years. Most patients were symptomatic at presentation. Solitary metastases were the most commonly found ones in imagistic studies. We performed mainly atypical resections, postoperative course was uneventful in all cases, without intra- or postoperative complications. CONCLUSIONS: The advantages of minimally invasive surgical techniques are: shorter hospital stay with lower hospital expenses as well as improving the quality of life of patients with pulmonary metastases.