Changing indications for thoracotomy in blunt chest trauma after the advent of videothoracoscopy.

BACKGROUND: The advent of videothoracoscopy may restrict the indications for thoracotomy in blunt chest trauma. METHODS: We retrospectively compared two groups of patients with blunt chest trauma observed in consecutive periods, before and after the advent of videothoracoscopy, 989 patients from 1989 to 1993 and 908 patients from 1994 to 1998. RESULTS: During the first period, 38 thoracotomies were performed; but in 8 instances (21%), no major injuries were found. In the second period, 36 videothoracoscopies were performed to repair the lung (n = 5) or diaphragm (n = 5), to evacuate clots (n = 4), pericardial effusion (n = 3), and empyema (n = 2). Six procedures were converted and 11 findings were negative for lesions. Only nine intentional thoracotomies were performed, and significant lesions were found in each case. CONCLUSION: Videothoracoscopy has reduced the number of thoracotomies performed. Thoracotomy can be limited to massive bleeding with hemodynamic instability, major air leak, radiologic evidence of mediastinal enlargement or diaphragmatic rupture, or major anterolateral flail chest.

Recurrent massive hyperplasia of the thymus.

Differentiation of massive thymic hyperplasia from malignant lesions requires early resection. We report a case in which thoracoscopic thymectomy was performed for massive hyperplasia recurring 16 years after steroid therapy. This case provides additional information on the natural history, surgical management and histology of the disease.

[Video-assisted extensive thymectomy in the treatment of autoimmune myasthenia]. / Timectomia estesa video-assistita nel trattamento della miastenia autoimmune.

In the surgical treatment of autoimmune myasthenia, complete thymectomy is considered indispensable to ensure maximum clinical results. From May 1995 through June 1997, we carried out video-assisted extended thymectomy via sole left access in 16 patients. There were no deaths and no major complications. At the intermediate-term follow-up, remission and improvement rates were 19% and 56% respectively. These results were similar to those achieved on the last 16 patients who had extended thymectomy via median sternotomy. We believe that the advantages of the video-assisted approach render it a reliable option for the surgical management of autoimmune myasthenia.

Benign vascular tumours of the Mediastinum: presentation of three cases and review of the literature.

Two patients with epithelioid haemangioendothelioma and one patient with multiple cavernous haemangiomas of the mediastinum, pharynx and larynx, are herein presented. Haemothorax as initial manifestation of the tumour was observed in one of them. Epithelioid haemangioendotheliomas were radically removed in both cases. Because of the absence of a well defined capsule and the huge extension, the cavernous mediastinal haemangioma was not resected. However the patient was successfully treated by administration of corticosteroids. Clinicopathologic characteristics of these benign forms of vascular tumours are discussed and treatment options are suggested.

Usefulness of the Nd:YAG laser in parenchyma-sparing resection of pulmonary nodular lesions.

AIMS AND BACKGROUND: The neodymium:yttrium-aluminium-garnet (Nd:YAG) laser has been successfully employed in parenchyma-sparing resection of pulmonary nodular lesions. We report our experience with limited resection using a noncontact Nd:YAG laser applied through a thoracotomic approach. METHODS: During the period March 1987-October 1993, we performed parenchyma-sparing resections of 66 pulmonary nodular lesions with a noncontact Nd:YAG laser in 47 patients. Nodules were approached through postero-lateral thoracotomy (n = 40), median sternotomy (n = 5) or staged bilateral thoracotomy (n = 2). Fifty-two lesions were located in a peripheral position and the others (n = 14) at various depths within the parenchyma. RESULTS: Fifteen lesions were benign: hamartoma (n = 5), chronic pneumonic infiltrate (n = 3), tuberculoma (n = 3), asbestosis (n = 2), Wegener's granuloma (n = 1). Twelve lesions were attributable to primary lung cancer and 33 were metastatic lesions. Another 6 lesions turned out to be necrotic metastases following chemotherapy. There were no perioperative deaths. Pulmonary re-expansion was shortly obtained: mean drainage time was 4.31 +/- 3.9 days. Only one patient presented a prolonged drainage time (11 days); in this case, the air leak was successfully treated by tissue glue sealant trans-drainage infiltration. Follow-up ranged from 2 to 96 months. No case of relapse on the resection site has been observed. CONCLUSIONS: The results suggest that Nd:YAG laser resection is safe and worthwhile in patients with multiple lesions and borderline pulmonary function.

[Study of mediastinal lymph nodes in lung cancer using transesophageal ultrasonography]. / Lo studio dei linfonodi mediastinici nel carcinoma polmonare con l'ultrasonografia endoesofagea.

Evaluation of mediastinal lymph nodes in patients with lung cancer is fundamental for their treatment and prognosis. Chest computed tomography (CT) is presently the most utilized diagnostic modality. In recent years endoscopic ultrasound (EUS) is being employed for this purpose. We retrospectively compared the results of CT and EUS staging of 35 selected patients with postsurgical stage. A total of 175 lymph node sites were examined. Results CT vs EUS were as follows: specificity 92% vs 98%, sensitivity 88% vs 84%, positive predicted accuracy 80% vs 96%, negative predicted accuracy 95% vs 94%, overall accuracy 92% vs 95%. The region most accessible by EUS evaluation were the paraesophageal lymph nodes; the most difficult were the right superior mediastinal nodes which cannot be imaged for anatomic reasons. EUS not only allows one to arrive at correct diagnosis with less false positive results, but also permits evaluation of lymph nodes which are not enlarged. We think that EUS, in combination with CT, is an appropriate modality for staging of mediastinal lymph nodes in patients with lung cancer.

[Short-term prophylaxis with erythromycin lactobionate in patients undergoing lung surgery]. / Short term prophylaxis con eritromicina lattobionato in pazienti sottoposti ad intervento di chirurgia polmonare.

The efficacy of short term prophylaxis with erythromycin lactobionate in the peri-operative treatment in patients undergoing pulmonary surgery is examined.