Multifocal Endobronchial Fibromas Presenting as Unilobar Emphysema.

Tracheobronchial fibromas are very rare, locally-invasive tumors of the airways. Fewer than 30 cases have been reported within the English-speaking literature. Historically, these neoplasms have been diagnosed as isolated endobronchial masses, with affected patients presenting with wheezing, cough, stridor, hemoptysis, dyspnea, or pneumonia. We report the case of 39-year-old man with multiple, synchronous endobronchial fibromas causing unilobar emphysema. A computed tomographic scan and bronchoscopy with biopsy were performed preoperatively to diagnose these lesions in the orifices of the anterior segment and the lingula within the left upper lobe. The patient underwent successful video-assisted left upper lobectomy, without recurrence at 3 years. This is the first report of a synchronous presentation of multiple pulmonary endobronchial fibromas within the same patient and the first report of endobronchial fibroma presenting as unilobar air trapping. Recognition of the unusual presentation of this uncommon pathology can lead to timely intervention.

Anastomotic complications associated with stapled versus hand-sewn anastomosis.

OBJECTIVE: To compare anastomotic complications of stapled versus hand-sewn cervical esophago-gastric anastomosis. METHODS: All patients undergoing esophageal resection are entered into a prospectively maintained database. The database was queried to identify patients who had near total esophagectomy with cervical esophago-gastric anastomosis. The effect of anastomotic technique and surgeon experience on anastomotic complications, leak, and stricture were analyzed. RESULTS: Eighty-one patients underwent open or minimally invasive esophagectomy and gastric pull-up with or without thoracic mobilization. Eighteen patients had hand-sewn anastomosis and 63 had a partially stapled anastomosis. There was no significant difference between leak rate (22% (4/18) versus 7% (5/63) P = 0.09) and anastomotic stricture rate (38% (7/18) versus 26% (17/63), P = 0.34) between the two groups. Dividing the experience chronologically into three groups of 27 reveals a trend towards decreased leak rate with experience. The leak rate was only 3.7 % (1/27) in the most recent group compared with 14.8% (4/27) in the first group (P = 0.17). CONCLUSIONS: In our experience, there was no significant difference in anastomotic complications between hand-sewn and stapled anastomosis. However, there is a decreasing trend in anastomotic complications with increasing surgeon experience.

Preoperative diagnosis of xanthogranulomatous pyelonephritis.

INTRODUCTION: The aim of this study was to evaluate the possibility of differentiating xanthogranulomatous pyelonephritis (XGPN) preoperatively from chronic pyelonephritis on the basis of demographic data, clinical parameters, and biochemical, microbiological, and radiological workups. MATERIALS AND METHODS: Between 1995 and 2005, a total of 239 patients were diagnosed to have pyelonephritis at our center, of which, 56 underwent nephrectomy. Forty-five (80.4%) of the nephrectomy specimens showed diagnosis of chronic pyelonephritis and 11 (19.6%) showed XGPN. RESULTS: Compared to chronic pyelonephritis, XGPN was more likely to occur in the middle-aged women (90.9%) with diabetes mellitus (63.6%). A positive history of UTI was more frequent in these patients, too. The disease was likely to present with flank pain and tenderness in 100.0% and 90.9% of the patients with XGPN, respectively. Anemia (81.8%), hematuria (81.8%), and bacteriuria (90.9%) were more frequent in these patients than in those with chronic pyelonephritis. The mean blood hemoglobin was 7.0 g/dL in the patients with XGPN. Proteus mirabilis was detected in 6 patients (54.5%) of the XGPN group and only 2 of the chronic pyelonephritis group (P < .001). Renomegaly and kidney calculus were more frequently noted in the patients with XGPN. Finally, XGPN led to a higher rate of postoperative complications. CONCLUSION: Demographic data, comorbidities, predisposing factors, and biochemical as well as roentgenological features are significant but nonspecific indicators of preoperative diagnosis of XGPN.