Left upper lobe pulmonary adenocarcinoma with partial anomalous pulmonary venous connection in the same lobe: Case report / Bal felso lebenyi adenocarcinoma és pulmonális vénás fejlodési rendellenesség együttes elofordulása

Authors present a case of a 60-year-old male patient with left upper lobe cancer in association with partial anomalous pulmonary venous connection (PAPVC) in the same lobe. The hemiazygous vein joined the left superior pulmonary vein above the aorta in the thorax cavity draining into the left brachiocephalic vein causing left to right shunt flow. PAPVC was clearly identified intraoperatively and left upper lobectomy was performed as definitive solution for both. PAPVC was closed by stapler. To our knowledge 32 operated cases of lung cancer with PAPVC has been described in the literature (PubMed), including our patient.

[Standardization of VATS lobectomies in our department between 2011-2017 in regard to results of their oncological follow-ups]. / A VATS lobectomia standardizálódása osztályunkon 2011­2017 között az onkológiai utánkövetés eredményeinek tükrében.

Introduction: Authors present their 7-year experience since the introduction of minimal-invasive (VATS) lobectomies for lung cancer in regard to their surgical technique, results and oncological follow-up. Method: 173 VATS lobectomies were performed between June 2011 and December 2017, 105 men and 68 women. The mean age of patients was 64.1 years. Duration of surgery was 130 minutes on average. Results: Conversion to thoracotomy was required in 8 cases (3 bleedings, 3 pulmonary vessel lymph node infiltrations, 2 bronchial suture insufficiencies). Twenty persistent air leaks developed postoperatively, requiring 10 re-drainages and 10 re-operations: 7 re-VATS and 3 thoracotomies. Two hematomas were evacuated by re-VATS, 1 postoperative atrial fibrillation required cardioversion. There were no perioperative deaths. The 164 malignant cases were: 110 adenocarcinomas, 32 squamous cell carcinomas, 6 small cell neuroendocrine carcinomas, 4 undifferentiated carcinomas, 4 carcinoid tumours, 1 synchronous adenocarcinoma and squamous cell carcinoma, 1 synchronous adenocarcinoma and small cell carcinoma, 1 carcinosarcoma and 5 metastasis from other primary tumours. 118 patients received adjuvant chemotherapy. Tumour staging distribution was: IA 40, IB 53, IIA 29, IIB 16 and IIIA 21 cases. During an average follow-up time of 19.5 months, 9 local tumour recurrence and 27 distant metastasis evaluated, of which 11 were pulmonary (3 multiplex), 10 bone, 6 cerebral, 3 hepatic (1 multiplex), and 3 suprarenal gland. Conclusion: Our results correlate with published literature. During the period of this review, VATS lobectomies became a routine surgical technique in our department. Our experience proved that axillary thoracotomy is an advantage to learn the anterior VATS lobectomy technique.

[Fulminant isolated necrotizing fasciitis of the chest wall, complicating thoracic empyema]. / Fulmináns lefolyású, mellkasi empyemát okozó izolált mellkasfali fasciitis necrotisans.

Authors introduce the case of a 64-year-old male patient with fulminant isolated necrotizing fasciitis of the chest wall, complicating empyema thoracis of unknown origin. The patient's co-morbidities were hypertension, ischaemic heart disease, atrial fibrillation with oral anticoagulation. The real etiology was revealed post mortem, due to the rapid progression. The autopsy demonstrated that the fasciitis was caused by a small blunt thoracic trauma (haematoma), not emerged from patient's history and was not visible during physical examination. Authors review diagnostic pitfalls, leading to delayed recognition in addition to this very case. After quick diagnosis surgical debridement, targeted wide spectrum antibiotics and maximal intensive care are the basic pillars of the management of necrotizing fasciitis.

[Digital drainage system in the postoperative treatment of thoracic surgical patients]. / Mellkassebészeti betegek posztoperatív kezelése digitális szívórendszer alkalmazásával.

INTRODUCTION: persistent air leak is one of the major complications following pulmonary resections and, in combination with immobilization, it increases the cost of treatment significantly. METHODS: Authors analyzed retrospectively data of 40 consecutive patients of a thoracic surgical unit between 01. March 2011 and 30. October 2011. The mean age of 22 men and 18 women was 61.6 years. They applied electronic chest drainage system for all patients after open or VATS wedge resections or lobectomies. Drains were removed according to the electronical drainage data. RESULTS: After open wedge resections the drainage time was 57 hours, and 6.2 days of hospital stay. Open lobectomies resulted in 59.8 hours drainage time and 6.8 days of hospital stay. VATS wedge resections were followed by 75.2 hours drainage and 5 days of hospital stay, while VATS lobectomies needed 48 hours duration of chest tubing and 4.5 days of in-patient stay. CONCLUSIONS: Electronic chest drainage systems are easy-to-use, portable and safe, offering objective data of the amount of postoperative air leak, and visualize the trends in graphical format, too. Importantly, early mobilization contributes to cost reduction. In combination with VATS technique surgical stress is significantly reduced as well as postoperative recovery is shortened.

Comparing bipolar electrothermal device and endostapler in endoscopic lung wedge resection.

Video-assisted thoracoscopy (VATS) is gaining on thoracic surgery, having newly developed devices next to endostaplers for haemostatic and airtight sealing of lung parenchyma. Though the bipolar electrothermal Ligasure has good results for pulmonary wedge resection, its literature is small in numbers. Authors compared Ligasure and endostapler for pulmonary wedge resection of solitary pulmonary nodules (SPN). Authors performed a retrospective analysis of 44 consecutive patients. The indication of operation was non-verified SPN in all cases. They carried out pulmonary wedge resection for 22 patients with Ligasure-Atlas and 22 patients with ETS Flex endostapler via VATS. Authors examined the gender, average age (62 vs. 49 years), mean hospital stay (6.6 vs. 6.8 days), average operation time (55 vs. 50 min), number of complications (2 vs. 1), average drainage time (2.8 vs. 2.7 days), average fluid loss (190 vs. 160 ml), and instrumental costs (367 euro vs. 756 euro) of both groups. They accomplished the histological analysis of the coagulated lung parenchyma as well. According to the results, the Ligasure-Atlas is eligible for pulmonary wedge resection. The method is safe, easy to use, having minimal rate of complications. It can moderate costs of operation, compared to endostaplers.

[Solitary oesophageal metastasis of breast cancer after 17 years latency]. / Mamma carcinoma solitaer nyelocso-metastasisa 17 éves remissio után.

The authors discuss a case of a 63-year-old woman, who presented with dysphagia, 17 years after radical mastectomy for breast cancer. CT scan showed a juxta esophageal mediastinal tumour. A biopsy via right thoracotomy revealed a metastatic adenocarcinoma of the oesophageal wall from the previous breast carcinoma. Minimally invasive oesophageal intubation was used for palliation. Hormonal manipulation and radiotherapy was commenced postoperatively. The patient was well after eight months follow-up. A combination of high clinical suspicion with EUS and deep oesophageal biopsy can lead to the correct diagnosis of this very rare clinical entity. The biology of metastatic breast cancer may demand palliation by oesophageal intubation or stenting combined with adjuvant chemo, radio or hormonal therapy in such instances.

[Emergency video-assisted thoracoscopic surgery for intrathoracic foreign bodies]. / Sürgos videothoracoscopos mutéttel eltávolitott melluri idegentestek.

The aim of this retrospective study is to highlight the advantages of video-assisted thoracic surgery (VATS) in the assessment of thoracic trauma. In the past 4 years 3 patients had intrapleural or intrapulmonary Kirschner needles which penetrated from the site of a previous humeroscapular osteosynthesis and one patient with a gunshot projectile and haemothorax in the left thorax. They were treated by VATS removal of intrathoracic foreign bodies. No complications developed postoperatively, the chest wall pain was minimal, the duration of hospital stay (3-5 days) and recovery was short. The widespread use of minimal invasive VATS procedure is an alternative approach that provides safe and less invasive operation for acute chest trauma patients. We believe that its extended use for both diagnostic and therapeutic purposes even in some special circumstances is justified today.