Iatrogenic tracheal rupture during intubation with a double-lumen tube.

Iatrogenic tracheal rupture after intubation with a double-lumen endotracheal tube is rare. An endobronchial tube positioning guide stylet, which is generally used during intubations with a double-lumen tube, may tear the trachea. A 76-year-old patient with right upper lobe carcinoma was scheduled for videothoracoscopic lobectomy. Mediastinal lymph node dissection was performed after a right upper lobectomy. When the mediastinal pleura in the right paratracheal region were opened, a tracheal cuff was noticed in the mediastinum. The tear in the membranous part of the trachea was repaired. Use of stylets during intubation may cause tracheal injury. To prevent such an injury, the stylet should be withdrawn after the tip of the tube has passed through the vocal cords.

Lingual inferior segmentectomy for a 7-cm pulmonary arteriovenous malformation.

Pulmonary arteriovenous malformation (PAVM) is a relatively rare abnormal pulmonary vascular connection that is mostly congenital. We report on a patient who was treated by lingual inferior segmentectomy for a 7-cm PAVM. This particular case emphasized the feasibility of resection of the PAVM by pulmonary segmentectomy regardless of the size of the lesion.

Prophylactic intraoperative pneumoperitoneum decreases pleural space problems after lower lobectomy or bilobectomy of the lung.

BACKGROUND: Following lower lung lobe resection, prolonged air leaks and residual pleural space are common. We investigated whether an artificially induced prophylactic intraoperative pneumoperitoneum would prevent these complications. METHOD: Sixty patients who underwent lower lobectomy or bilobectomy were prospectively randomized into 2 groups according to the use of intraoperative pneumoperitoneum. Air was delivered via a catheter placed under the diaphragm in the pneumoperitoneum group. Parameters related to pleural drainage, complications, and hospital stay were compared. RESULTS: No difference between the preoperative characteristics of both groups was present. The mean duration of chest tube drainage was shorter (3.47 +/- 1.04 days vs. 4.87 +/- 1.43 days, P < 0.001) and the mean amount of chest drainage was lower (305.0 +/- 76.9 ml vs. 488.3 +/- 215.2 ml, P < 0.001) in the pneumoperitoneum group. Residual pleural space was observed in 1 pneumoperitoneum patient (3.3 %) and in 8 controls (26.7 %). Pneumoperitoneum patients were discharged 1.1 days earlier on average than the controls. CONCLUSION: Artificial prophylactic intraoperative pneumoperitoneum is a simple and safe procedure that decreases the postoperative amount of fluid drainage, residual pleural space, duration of chest tube drainage, and hospital stay.

Correlation between sizes and intracystic pressures of hydatid cysts.

BACKGROUND: A bicentral prospective study was performed to assess the relationship between sizes and intracystic pressures (ICP) of pulmonary hydatid cysts as well as to compare these measurements in different age groups. METHODS: A total of 20 patients with 22 unperforated pulmonary hydatid cysts underwent surgery between April 1994 and September 1995. There were 12 males and 8 females with a mean age of 25.7 (7-62). Intraoperatively, ICP's were measured in cmH2O by direct cannulation. RESULTS: Out of a total of 22 cysts, 12 were located in the lower lobes. Mean diameter, volume and ICP of cysts were 9.6 cm (S.D. 4.2), 728.8 cm3 (S.D. 1014.9) and 36.6 cmH2O (S.D. 9.3), respectively. There was no significant correlation between various measurements of hydatid cysts, namely their short and long diameters, volumes and intracystic pressures (P > 0.05). There was no difference regarding the volume, ICP and age of patients, either among pulmonary lobes or between sexes. Patients who were 20 years old and less, presented a mean cystic diameter of 7.2 cm and mean ICP of 35.1 cmH2O, whereas the over 20 age group showed results of 11.9 cm and 38.1 cmH2O, respectively (P values were < 0.0083 for diameter and > 0.05 for ICP). CONCLUSIONS: Due to the small sample size and a few extreme measurements, the correlation between the sizes and the pressures of hydatid cysts turned out to be insignificant, but it is believed that a positive correlation is most probable with larger sample sizes. On the other hand, while the difference between the mean cystic diameters in age groups of below and over 20 was significant, the pressure difference between them was insignificant. This is why young patients carry the same risk of perforation as adults, although they present with relatively smaller cysts. Therefore, due to the well-known anaphylactic, obstructive and infectious risks of hydatid cyst perforation, urgent surgical removal is always necessary.