ABSTRACT
Postintubation tracheobronchial laceration is a rare complication of endotracheal intubation. It requires early serial treatment in cases of pneumomediastinum with difficulty in ventilation to prevent mediastinitis and stricture. The surgical access to the posterior tracheal wall depends on the site of the laceration. A right posterolateral thoracotomy is performed for lacerations of the middle-distal trachea and a transcervical approach for the upper third. Either of them is associated with specific postoperative morbidities. We describe a novel technique of exclusively intraluminal repair of postintubation tracheobronchial laceration using conventional endoscopic instrumentation through a 14.1-mm rigid bronchoscope.
Subject(s)
Bronchoscopy/instrumentation , Endoscopy/instrumentation , Intubation, Intratracheal/adverse effects , Lacerations/surgery , Trachea/surgery , Equipment Design , Female , Humans , Lacerations/diagnosis , Lacerations/etiology , Middle Aged , Tomography, X-Ray Computed , Trachea/diagnostic imagingABSTRACT
Platypnoea-orthodeoxia syndrome (POS) is a rare clinical entity. It is characterized by position-dependent dyspnoea and oxygen desaturation in the upright position with orthodeoxia resolving in the supine position, and is mainly associated with cardiac defects. Only 9 cases of post-lobectomy POS have been reported in the literature. We describe a case of POS in a woman who underwent a lobectomy and in whom POS was diagnosed and treated.
Subject(s)
Adenocarcinoma of Lung/surgery , Computed Tomography Angiography/methods , Dyspnea/diagnosis , Hypoxia/diagnosis , Lung Neoplasms/surgery , Pneumonectomy/adverse effects , Postoperative Complications , Aged , Diagnosis, Differential , Dyspnea/etiology , Female , Humans , Hypoxia/etiology , Rare Diseases , SyndromeABSTRACT
We describe a rare case of primitive neuroectodermal tumor arising from the thoracic wall in a 48-year-old man. He underwent extensive resection of the tumor en bloc with the diaphragm and the thoracic wall, followed by adjuvant chemoradiotherapy. Primitive neuroectodermal tumor may be included in a multidisciplinary protocol incorporating neoadjuvant chemotherapy, surgery, and adjuvant chemoradiotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Diaphragm/surgery , Neuroectodermal Tumors, Primitive, Peripheral/therapy , Thoracic Neoplasms/therapy , Thoracic Surgical Procedures , Thoracic Wall/surgery , Biopsy , Chemotherapy, Adjuvant , Humans , Immunohistochemistry , Male , Middle Aged , Neuroectodermal Tumors, Primitive, Peripheral/diagnosis , Radiotherapy, Adjuvant , Thoracic Neoplasms/diagnosis , Thoracic Wall/diagnostic imaging , Thoracic Wall/pathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The laparoscopic adjustable gastric banding (LAGB) is a popular therapeutic option for morbid obesity. It is a minimally invasive procedure. The reported early morbidity is low and there are only few reports of respiratory complications. We report a case of empyema and lung abscess due to diaphragm perforation by a LAGB.
Subject(s)
Empyema, Pleural/etiology , Gastroplasty/adverse effects , Adult , Cerebral Decortication , Empyema, Pleural/surgery , Female , Foreign-Body Migration/complications , Humans , Laparoscopy , Lung Abscess/etiology , Pleural Effusion/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Does lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients?' Altogether 225 papers were found using the reported search, of which nineteen represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A meta-analysis published in 2005 showed a 0.7% (P=0.3659) survival difference at one year, 1.9% (P=0.5088) at three years and 3.6% (P=0.3603) at five years. The largest study prior to the meta-analysis was a randomized controlled study of 247 patients with T1N0 tumors that showed eight locoregional recurrences in the lobectomy group compared to 21 in the sublobar group, which was statistically significant. Since the meta-analysis we identified three studies, two of which showed no difference in survival and recurrence between wedge resection and lobectomy for T1N0 tumors and one that showed improved survival after lobectomy compared to wedge resection for T1N0 tumors. We conclude that wedge resection is not comparable to lobectomy for stage IA NSCLC. The increased long-term mortality associated with wedge resection is mainly due to non-cancer deaths, reflecting a higher risk patient group with many comorbid conditions. Segmental resection is comparable to lobectomy for small peripheral tumors. Sublobar resection is associated with shorter hospital stay. For bronchioalveolar carcinoma sublobar resection is recommended provided intra-operative pathologic consultation confirms pure bronchioalveolar histology without evidence of invasion, and surgical margins are free of disease.
Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Pneumonectomy , Pulmonary Surgical Procedures , Benchmarking , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Evidence-Based Medicine , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Patient Selection , Pneumonectomy/adverse effects , Pneumonectomy/mortality , Pulmonary Surgical Procedures/adverse effects , Pulmonary Surgical Procedures/mortality , Recurrence , Risk Assessment , Survival Analysis , Time Factors , Treatment OutcomeABSTRACT
A 39-year-old woman, who was addicted to drugs, was admitted because of referred chest pain and dysphagia after deliberate ingestion of a thermometer in a suicide attempt 6 hours earlier. Rigid esophagoscopy was unrevealing. On awakening, the patient confessed that the thermometer had been swallowed more than a month be operated on and get narcotic pain medications. Her history disclosed multiple admissions and laparotomies after suicide attempts with swallowed thermometers in the last 3 years.
