[Surgical treatment for intralobar pulmonary sequestration in 50-years old woman with aberrant artery from a. gastrica sin].

A case of 50-years old female, operated on for intralobar sequestration with two 2 anomalous arteries in lig. pulmonale inf., one arising from thoracic aorta and the other--from truncus coeliacus of abdominal aorta. The diagnosis was confirmed by CT scan with i.v. and a left lower lobectomy was carried out with exellent long-term result.

[Surgical treatment of pulmonary sequestration--20 years experience].

AIM: To study our experience in the diagnostics and treatment of pulmonary sequestration and to evaluate the long-term postoperative results. MATERIAL AND METHODS: Between Jan 1989 and Jan 2009. 8 patients (3 men, 5 women, mean age of 23.9 years) were operated on for lung sequestration. Sequestration was intralobar in 6 cases and extralobar in 2 cases. The abnormality was discovered by chance in 2 patients. The most frequent clinical manifestation was those of recurrent bronchopneumonia. Chest X-rays showed an apparently benign, posterobasal image in 75% of the cases. Arteriography was performed in 2 patients and revealed an abnormal systemic artery. Computerized tomography imaging with i.v. contrast confirmed the diagnosis in 6 patients. The intralobar type of sequestration was treated by lobectomy, and the extralobar type by sequestrectomy. RESULTS: The operative mortality and the morbidity rates were nil. The mean in-hospital stay was 7.75 days. The long-term postoperative results (follow-up from 5 to 20 years) are considered excellent. CONCLUSION: The surgery is a method of choice in the treatment of pulmonary sequestration. with low rate of postoperative complications and excellent long-term results.

[Results of the operative treatment of primary pulmonary sarcomas].

OBJECTIVE: To study and evaluate clinic, diagnostics and operative treatment of patients with primary pulmonary sarcomas (PPS). MATERIAL AND METHODS: During 24 years period, a total of 49 patients underwent surgery for PPS. There were 29 male and 20 female with a mean age of 52.6 years. Main presenting complaints were shortness of breath, cough, chest pain, weight loss and haemoptysis. Correct preoperative diagnosis was obtained in 12 (24.48%) of the patients by bronchoscopy or percutaneous core biopsy. Carcinoma was diagnosed in 14 (28.6%) of them. Almost half of the cases were operated on without histological confirmation for suspected malignancy. The histological diagnoses were fibrosarcoma (16), fibroleiomyosarcoma (10), leiomyosarcoma (6), rhabdomyosarcoma (7), hemangiopericytoma (3), epitheloid hemangioendothelioma (3), undifferentiated sarcoma (2), malignant schwannoma (1) and liposarcoma (2). Only 2 of the tumors were scored in grade 1. The rest were classified in higher grades of malignancy. The following operations were carried out: lobectomy--30 (59.2%), including 2 sleeve lobectomies; pneumonectomy--10 (20.4%), polysegmental resections--3 (6.2%) and atypical resection--1 (2%). The resections were extended to the thoracic wall, diaphragm or pericardium in 4 patients. Endoscopic laser resection was applied in 1 (2%) case. Exploratory thoracotomy was performed on 3 (6.1%) patients. There were 2 (4.1%) stage I A; 26 (53.1%) stage I B; 11 (22.4) stage II B; 5 stage III A; 4 stage III B and 1 stage IV. RESULTS: No postoperative death occurred. Postoperative empyema was observed in 2 cases (4.1%) and 1 patient (2%) was reoperated on for local recurrence 18 months after surgery. Adjuvant therapy was administered to 20 of the patients. Follow-up (range, 6 to 160 months) was available for 41 patients. The actuarial 5-year postoperative survival was 51.8% with mean survival of 40.8 months. CONCLUSION: The correct preoperative diagnosis of PPS still presents a challenge. There are no specific clinical, imaging and other signs for this tumor evaluation. Surgery with systematic lymphnode dissection is a treatment of choice with an acceptable 5-year survival rate. Only the complete resection and the low stages of the tumor significantly influence survival.

[Anatomical pulmonary resections via median sternotomy].

During a 10-year period a total of 5 anatomical pulmonary resections (2 lobectomies, 2 pneumonectomies with mediastinal tumor extirpation and 1 polysegmental resection-S1-3) were carried out in 4 patients via median sternotomy. They were operated on for bilateral complicated pulmonary hydatidosis (2), mediastinal teratocarcinoma with right lung invasion and mediastinal Hodgkin's disease after chemotherapy failure. The mean operative time was 161 minutes, and the mean in-hospital stay was 12.75 days. The postoperative period was complicated in 1 patient by pulmonary edema, successfully treated by medication. Teratocarcinoma patient died on the 73th postoperative day with disease progression. The long-term postoperative results in the rest 3 cases (follow-up between 5 and 8 years) are considered very good. In conclusion, median sternotomy is acceptable approach for unilateral or bilateral pulmonary resections in carefully selected patients.

[Indications for the surgical treatment in bronchiectasis and postoperative results]. / Indikatsii za khirurgichno lechenie pri bronkhiektazii i sledoperativni rezultati.

During Jan. 1990 and Dec. 2002 a total of 14 patients with bronchiectasis were operated on. They were 5 female and 9 male with mean age of 35.7 years. In two of them (14.3%) the disease was with bilateral localization. Patients were typically presented with cough and purulent sputum production 12(85.7%), recurrent pulmonary infections 8(57.1%), halitosis 6(42.9%) and hemoptysis 4(28.6%). The mean duration of clinical manifestations was 8.4 years. The indications for surgery were failure of medical treatment in 10(71.4%) patients, hemoptysis in 2(14.3%) and lung abscesus, as a complication in 2(14.3%) patients. The operative methods included 9(64.3%) lobectomies, 1(7.1%) pleuropneumonectomy, 1(7.1%) pneumonectomy, 1(7.1%) bilobectomy with broncho-esophageal fistula resection, 1(7.1%) middle lobectomy with polysegmental resection S7-10 and 1(7.1%) polysegmental resection S7-10. No 30-day postoperative death was faced. Major complications, followed by rethoracotomy, were found in 2(14.3%) of the cases. The postoperative results were excellent in 8(57.1%) of the patient, very good in 5(35.75) of them and in only 1 patient there was no clinical improvement. In conclusion, surgery for bronchiectasis is followed by acceptable postoperative complications and better long-term result after radical operation.

[Diagnosis and surgical treatment of pulmonary sequestration]. / Diagnostika i khirurgichno lechenie na belodrobnata sekvestratsiia.

Between Jan. 1988 and Jan. 2003 4 patients (3 male, 1 female, mean age of 20 years) were operated on for lung sequestration. Sequestration was intralobar in 3 cases and extralobar in 1 case. The abnormality was discovered by chance in 1 patient. The most frequent clinical manifestation was those of recurrent bronchopneumonia. X-ray films of the chest showed an apparently benign, posterobasal image in 80% of the cases. Arteriography was performed in 1 patient and revealed an abnormal systemic artery. Computerized tomography imaging with i.v. contrast confirmed the diagnosis in 3 patients. The intralobar type of sequestration was treated by lobectomy and polysegmental resection--S7-12, and the extralobar type--by sequestrectomy. The operative mortality and the morbidity rate were nil. The mean stay in hospital was 10 days. The long-term postoperative results are considered excellent.

[Video-assisted thoracoscopic surgery (VATS) for treatment of pleural empyema]. / Video-asistirana torakoskopska khirurgiia (VATS) za lechenie na plevralniia empiem.

During 1996-2003 a total of 359 patients were treated for empyema. Forty eight of them (with parapneumonic empyema) were prospectively randomized into 2 groups of 24 patients who underwent early decortication either by thoracotomy or VATS. Comparing to thoracotomy group, VATS group had a significantly shorter chest tube duration (5.8+/-1.1 vs 9+/-1.3 days; p=0.03) and postoperative in-hospital stay with parapneumonic empyema (8.7+/-0.9 vs 12.8+/-1.1 days; p=0.009). VATS has been found to be particularly useful for treating the fibrinopurulent phase of empyema, in which multiple loculations could be easily disrupted to allow adequate drainage of a "cleaned" pleural space. On the other hand, although VATS is highly effective, it is not indicated in every patient and it's indiscriminate use may lead to none required operative interventions.

[Surgical treatment of chronical pulmonary abscesses--contemporary treatment]. / Khirurgichno lechenie na khronichniia belodroben abstses--suvremenni postanovki.

Between Jan 1991 and Dec 2000 a total of 67 patients were operated on for chronic primary pulmonary abscesses. They were 57 men and 10 women with mean age of 46.2 (range, 12 to 72) years. The indications for surgery was mainly "delayed closure" following medical therapy and percutaneous tube drainage (3), as well as a massive hemoptysis in 4 cases. CT scanning and brochoscopy were performed in all patients. The majority of them had multiple isolates (51/67) of both aerobic and anaerobic (predominantly Bacteroides sp., Fusobacterium sp., and Peptococci) organisms. The following operations were carried out: lobectomy (52) including 8 decortications, bilobectomy (5), pneumonectomy (4) including two pleuro pneumonectomy, polysegmentectomy (4) and segmental resection (2). The 30-day hospital mortality rate was 1.49% (1 patient died following rethoracotomy for bronchial stump fistula with empyema and polyorganic insufficiency). Major postoperative complications were 6 (8.9%) and included 3 pleural empyema (additional drainage), two rethoracotomy for intrapleural bleeding and one residual pleural cavity, treated by thoracoplasty. Minor postoperative complications (atelectasis, wound infection and prolonged air-leakage) were observed in 9 patients (13.4%). The long-term results (following-up ranged from 6 to 112 weeks) are considered very good. In conclusion, surgery is indicated for patients with significant hemoptysis, suspected malignancy and those with "late healing" abscesses with acceptable postoperative results, although the rate of major postoperative complications remains relatively high.

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.

[Pleural tent after high partial lung resection--prospective randomised research]. / Plevralna palatka sled gorni chastichni belodrobni rezektsii -- prospektivno randomizirano prouchvane.

OBJECTIVE: The aim of this study is to assess the role of the pleural tent in prophylactics of prolonged alveolar air leakage and apical residual pleural cavity formation after upper lobectomy/bilobectomy. METHODS: A total of 40 patients, who underwent upper lobectomy/bilobectomy were prospectively randomized into two homogeneous groups: (1) with pleural tent--20 pts and (2) control group without pleural tent--20 pts. The multivariate analyses were used to compare the chest tubes duration, the length of the hospital stay, the mean quantity of postoperative extravasation and the need of additional interventions to treat the persistent postoperative alveolar leak. RESULTS: No differences were detected between the two groups in terms of preoperative and operative characteristics. No 30-day operative death was faced. A significant reduction (p=0.001) of the number of days the chest tubes were required (7.7 days vs 12.38 days) and the length of the postoperative in-hospital stay (9.7 days vs 13.75 days) was found in pleural tent group compared to control group. The mean quantity of postoperative extravasation in pleural tent group was less compared to control group (1553 ml vs 1722 ml) without statistical significance (p=0.5485). Asymptomatic residual apical pleural cavities were found in 1 patient of pleural tent group and 2 patients of control group. In other 3 patients of the latter group an additional tube drainage was required to treat a residual apical cavity. CONCLUSIONS: Pleural tenting after upper lobectomy/bilobectomy reduces significantly the duration of the intrapleural drainages and the length of the in-hospital stay. It is simple, safe and effective additional method in the prophylactics of persistent alveolar air leakage and apical residual pleural cavity formation.

[Operative procedure for treatment of large and oversize cysts with interlobar location in pulmonary hydatid disease]. / Operativen metod za lechenie na golemi i ogromni kisti s interlobarna lokalizatsiia pri belodrobnata ekhinokokoza.

A procedure for treating large and oversize cysts with interlobar location, consisting in supplementary post-echinococcotomy draining of the respective interlobar groove using No. 18-20 catheter, is developed. It allows for maximal unfolding of the adjoining parenchyma, adherence of the fibrous capsule walls without any risk of a residual cavity formation. The procedure is successfully used in thirteen patients at average postoperative hospitalization 13.4 days. Both the early and long-term results are estimated as very good.

[The Echinococcus and complicated forms of hepatic echinococcosis--their surgical treatment]. / Ekhinokok, uslozhneni formi na chernodrobniia ekhinokok--operativno lechenie.

A series of 137 patients presenting Echinococcus of which 132 (96.3 per cent) with hepatic location, operated in the clinic of hepatobiliary and pancreatic surgery over the period 1984 to 1994, are analyzed. Right-side location is documented in 59.1 per cent, left-side--in 26.5 per cent, and bilateral--in 14.4 per cent of the patients operated on. In 18.2 per cent it is a matter of a multiple process, and in 27.3 per cent--complicated course. Conservative operative procedures are used in 56.1 per cent, mixed--in 18.9 per cent, and radical--in 25 per cent. Overall mortality in the series amounts to 3.03 per cent; in patients subjected to radical operation--0 per cent, and in cases with serious postoperative complications requiring relaparotomy--similarly 3.03 per cent. Biliary fistulas as postoperative complications are noted in 4.5 per cent, and recurrences in the late postoperative period--in 1.5 per cent. The clinical relevance of the diagnostic methods used, and the indications for performing various operative procedures are discussed. The early and long-term postoperative results are assayed against the background of current literature reports on the issue.

[Cholelithiasis, cholecystectomy and colorectal cancer--a retrospective analysis]. / Kholelitiaza, kholetsistektomiia i kolorektalen rak--retrospektiven analiz.

The authors analyzed a series of 421 patients with colorectal cancer after preliminary review of the current literature and the modern theories of the origin of the disease. The patients have been treated at the Department of Propedeutics of Surgical Diseases, Research Institute of Surgery, for the period 1984-1990, and special accent was placed on the study of the relation of colorectal cancer to cholelithiasis and cholecystectomy. It was shown that 1.19 per cent of all patients had been cholecystectomized at mean 10.6 years back and 6.65 per cent had pre-existing or accompanying biliary calculosis with mean duration of symptoms 16.4 years. A major relationship was found between morbidity from colorectal cancer, on the one hand, and patient sex and biliary calculosis, on the other. Eighty nine per cent of the patients with colorectal cancer and with biliary calculosis treated by cholecystectomy were women and 20.3 per cent of the women with colorectal cancer had biliary calculosis and had been cholecystectomized. Attention is focused on the current practical requirements of the prophylaxis of colorectal cancer--adequate attitude to biliary calculosis, feeding habits, specifying cases at risk and their observation.