Primary pulmonary sarcomas and carcinosarcomas--postoperative results and comparative survival analysis.

OBJECTIVE: To evaluate the early and long-term results after surgery for primary pulmonary sarcomas (PPS) and to compare them with those of patients with pulmonary carcinosarcomas (PCaSa). METHODS: During a 20-year period, 48 patients with PPS and 15 patients with PCaSa underwent surgery. There were 40 males and 23 females with a mean age of 52.1 years (range 13-78). The histologic diagnoses in PPS group were fibrosarcoma (15), fibroleiomyosarcoma (10), leiomyosarcoma (6), rhabdomyosarcoma (6), hemangiopericytoma (3), epitheloid hemangioendothelioma (3), malignant schwannoma (1), liposarcoma (1) and undifferentiated sarcoma (3). The following curative resections were carried out: lobectomy (36), including two sleeve lobectomies (in PPS group), pneumonectomy (15) and polysegmental resections (4). In four PPS cases, these procedures were extended to the thoracic wall, diaphragm or pericardium. An atypical resection was applied in one PPS patient (the tumor was falsely classified as benign on frozen section examination). Exploratory thoracotomy was performed in five of PPS patients (11%) and in two of those with PCaSa (13%). The majority of PPS patients were with low stages I and II (76%). The PCaSa patients were predominantly with stage IIIA (39%). RESULTS: No postoperative death was registered. Major complications included two localized empyemas (4.2%) in PPS and one reoperation for bronchial stump fistula (6.7%) in PCaSa groups. Local recurrences were operated on in one patient per group (2.1 and 6.7%, respectively). Follow-up was available on 57 patients and ranged from 4 to 148 months. The overall cumulative 5-year survival was 48.81% for PPS and 49.38% for PCaSa patients (P=0.9035). It was better in low vs. higher stage cases, statistically significant in PPS group (P=0.0005) and without significant difference in PCaSa cohort (P=0.11). CONCLUSIONS: Complete resection of PPS and PCaSa favors an acceptable survival, especially in low stages. There is no significant difference in the survival rates between PPS and PCaSa patients, despite the greater number of cases with higher stages in PCaSa group.

[Algorithms for procedures in thoracic trauma]. / Algoritum na povedenie pri travmi v toraksa.

The study includes 1127 injured with thoracic trauma, 23 percent of them with polytrauma. The worse thoracic trauma were these with formed flail chest with pleural and lung complications, accompanied by severe disfunction in circulation and biomechanics of breathing. The application of minimal surgical procedures like pleural punctures and drainage of pleural cavities with aspiration achieved good results. Thoracotomy was performed on clear indications (unstoppable bleeding, large ruptures of lung parenchyma, suppurative lung haematoma, cardiac tamponade, rupture of major airways, rupture of diaphragm, rupture of oesophagus and coagulated haemothorax). The achieved mortality of 5.9 percent is an excellent index suggesting a choice of treatment.

[Mediastinitis--diagnostics and surgical treament]. / Diagnostika i lechenie na ostrite mediastiniti.

During the last 10 years we have treated 23 patients with acute mediastinitis. The patients' age, sex, medical status, causes of the infection, bacteriology, chest X-ray and computed tomography scan findings, surgical intervention, complications, survival, and other clinical parameters were reviewed.

[Uncommon tracheal trauma. Diagnosis and treatment]. / Lechebnodiagnostichen podkhod pri riad vid travma na trakheiata.

The trauma of the trachea and bronchi are extremely rare, in 0.6 to 3 per cent of the patients with chest trauma. Most common are the longitudinal lesions localized in the membranous part. Following are the transversal lesions localized between two cartilaginous rings and in 20 per cent of the cases total circular lesions with dislocation of the two ends are found. A review of the clinical signs, the complications, the diagnosis and the successful operative treatment of a patient with the latter particularly rare traumatic injury of the trachea is presented.

[Spontaneous esophageal perforation--a case report and review]. / Spontanni perforatsii na khranoprovoda--s prinos ot edin sluchai i obzor.

The quick diagnosis is decisive for the outcome of the treatment of patients with esophageal perforation because of the serious complications--mediastinitis, empyema and sepsis. These are the main causes for the high mortality of up to 60 per cent of the patients with esophageal perforation. The difficulties for the particular operative tactics rise from the late diagnosis. These are the most problematic moments of the spontaneous esophageal perforation (Boerhaave's syndrome) management. A review of the clinical signs, the complications, the diagnostics and the successful operative treatment on a patient with Boerhaave's syndrome performed on the 10th day after the incident is presented.

[Surgical treatment of post-traumatic intrapulmonary haematomas]. / Khirurgichno lechenie na posttravmatichni intrapulmonalni khematomi.

In a 14-year period 18 patients with post-traumatic intrapulmonary haematomas (PIH) were diagnosed and treated in our departments. There were 14 men and 4 woman with mean age 42.1 year. The mean diameter of PIH was 7.5 cm and they were localized mainly in the left lower lobe. Three of the patients were successfully treated with conservative antibiotic and mucolytic therapy. The remaining 15 patients (83%) were operated on: lobectomy (7), segmental resection (2), extirpation with partial resection of the fibrous capsule and capitonnage (4) and total extirpation with fibrous capsule removal (2). Indications for surgery were as follows: infection, haemoptysis and suspicions of malignant lesion. The early and late results are excellent. We recommend the surgical approach to PIH as a safe and effective treatment.

[Major respiratory tract traumas]. / Travmi na magistralnite vuzdukhonosni putishta.

Between 1988 and 2000 a total of 33 patients with traumatic tracheobronchial lesions were diagnosed and treated. The trauma was penetrating in 7 (stab and gun-shot), blunt in 10 (car accidents, compression and falling from heights) and iatrogenic in 16 of them (postintubational--15, after foreign body extraction--1). The main clinical and radiological features were subcutaneous emphysema, hemoptysis, respiratory insufficiency, pneumomediastinum and pneumothorax. The diagnosis was confirmed in all patients by early fiberoptic bronchoscopy. "Watch and see" tactics with massive antibiotics therapy was followed in 4 (12%) patients. A surgical treatment was carried out in 29 (88%) patients as follows: simple repair--19 (58%), left pneumonectomy--2 (6%), tracheal resection and anastomosis "end to end"--2 (6%), tracheostomy--1 (3%), thoracocenthesis and drainage--3 (9%) and cervical mediastinotomy--2 (6%). The operative mortality was 9%. The cause of death in these 3 patients were associated brain and spinal cord injuries. In the rest of patients the early and long-term postoperative results were considered very good.

[Combined heart injuries]. / Kombinovaná poranení srdce.

Cardiac injuries associated with a penetrating thoracic injury are not frequently encountered. The usual course is characterized by massive haemorrhage, cardiac tamponade and an entering wound in the cardiac area. Diagnostic problems arise if these clinical syndromes are absent. In the course of two years at the authors' department two cases of tangential cardiac lesions in the posterior left ventricular wall without penetration into the heart without massive haemorrhage and tamponade were absent as haemorrhage of the pericardial lesion into the pleural space occurred. It is not without interest that the entry wound was far away from the heart and the cardiac lesions were detected during surgical intervention made on account of other symptoms.