Minimally Invasive Thoracic Surgery - Video Assisted Thoracic Surgery: Technique and Indications.

Video-Assisted Thoracic Surgery (VATS) is already practised worldwide, in almost every condition addressed by open thoracic surgery. As part of minimally invasive thoracic surgery (MITS), VATS offers to patients and to healthcare providers excellent results and great satisfactions. Learning and performing VATS use different pathways in trainees and in experienced surgeons. This article presents VATS in its essence: classification, indications, contraindications, instruments and tools, incisions and access, troubleshooting, learning curve and training. We wish that the information helps our colleagues, both trainees and experienced thoracic surgeons, to start and continue performing VATS as standard care in thoracic surgery.

Immediate Postoperative Results in the Surgical Treatment of Neoplastic Pericarditis - 76 Consecutive Cases.

Introduction: Pericardial effusion, accumulation of fluid in the pericardial sac, may develop in any type of cancer. It was revealed in up to 20% of oncological patients. Method: We made a retrospective study of patients with pericardial efusion presented in our clinic between 2010 and 2015. We included 76 consecutive patients with indication for peri cardial drainage - we performed on them 80 surgical procedures: pericardocentesis, subxiphoid pericardial window, left paraxifoidian pericardial window, intercostal video-assisted thoracic surgery (VATS) pericardial fenestration, and classical thoracic surgery (fenestration or partial pericardiectomy). We had patients with ages between 28 and 83 years. 23 patients were admitted with cardiac tamponade. The immediate postoperatory survival is 97.3 % and the 30-days-postoperatory survival is 81.5 %. Results: The immediate postoperatory mortality is 2.7% and the 30-days-postoperatory mortality is 8.5%. Conclusions: The immediate prognosis of the patient with malignant pericardial effusion is influenced by the risk of postoperative Low-Cardiac-Output-Syndrome (LCOS), or pericardial decompression syndrome (PDS), which remains the main cause of mortality. The long-term prognosis is related to the type of malignant tumor. The most effective tehnique with the lowest rate of recurrence is pericardo-pleural window done thoracoscopically/ by VATS; pericardocentesis has the highest rate of recurrence - 90% and is associated with high rates of cardiac complications and mortality.

[Lung metastases secondary to bronchopulmonary cancer]. / Metastazele pulmonare ale cancerului bronhopulmonar.

OBJECTIVES: The goal of this study is to establish the surgical options in the management of patients with lung metastases secondary to lung cancer. MATERIAL AND METHOD: A retrospective study was performed on 34 patients admitted in our hospital between January 2000 and June 2009. RESULTS: Most of the patients were males over 45 years old. There are 2 groups: one (the most numerous) represents the patients in whom the metastases were discovered concomitantly with the symptomatic primary lung tumor and the other group consists in patients who previously underwent surgery and in whom the metastases were detected at imagistic postoperative follow-ups after a variable disease-free interval of time ranging from 5 months to 11 years. The therapeutic option most commonly used in the first-group patients was pneumonectomy and wedge resection in the second group. Post-operative evolution was favourable in 88% of the cases. CONCLUSIONS: The surgical treatment of lung metastases secondary to lung cancer is a valuable therapeutic option. When surgical treatment is indicated the most frequently used technique is wedge resection followed by pneumonectomy. The postoperative imaging follow-ups play an important role in the early detection of lung metastases developing after the surgical management of the primary lung tumour.

A rare case of unicentric plasma cell type Castleman's disease in the mediastinum.

Castleman's disease is a very rare (and thus little-known) lymphoproliferative disorder characterized by lymph node follicular hyperplasia with abnormal interfollicular vascular growth. It can be classified into unicentric and multicentric variants according to its localization, and into three histological types: hyaline-vascular, plasma cell and mixed. We describe the case of a 51 year-old woman who presented with precordial chest pain. Chest X-Ray and computed tomography (CT) raised the suspicion of an aortic aneurysm, and the patient was sent to the Interventional Cardiology Clinic at the Military Emergency Clinical Center for Cardiovascular Diseases (CCUBCVA), where the diagnosis of mediastinal tumor was made by ultrasonography, coronarography and CT. The patient was transferred to our clinic, where a diagnostic mediastinoscopy proved histolopathologically inconclusive. A lateral thoracotomy with ideal tumorectomy was decided upon and carried out, and the diagnosis of plasma cell type Castleman's disease was established. This paper discusses the pathogenic mechanisms, symptoms, diagnosis and treatment of Castleman's disease.

[Cervico-mediastinal lymphangioma]. / Limfangiomul cervico-mediastinal.

The authors are describing three cases of lymphangioma, one at a seven years old child with cervico-mediastinal localization; another at a 39 years old person, situated only in mediastinum, the third is a cervical lymphangioma at a 55 years old subject. The respiratory symptoms are present in the two cases with mediastinal involvement. The patient with cervical localization had no symptoms. The radiological exams: thoracic radiography, CT or the ultrasound test are revealing a cystic tumor in mediastinum or in cervical region. We performed a complete surgical tumor resection through median sternotomy, left thoracotomy and cervicotomy. The evolution was very good in all cases. The diagnosis had histopathological confirmation.