The importance of postoperative analgesia after major thoracic surgery interventions, protocols, applications, and the following evaluation of the patient's quality of life.

OBJECTIVES: Major thoracic surgery procedures constitute a standard method of diagnosis and/or therapy against lung, mediastinal cancer and other non-malignant manifestations of the respiratory system. Such patients' recovery and rehabilitation depend directly from the applied postoperative analgesia, with purpose to determine an optimum and long-term quality of life. BACKGROUND: Our database consists of 300 individuals, submitted to major thoracic surgery procedure during a 2 - year period of time (between December 2016 and December 2018) at the "Thoracic Surgery Department" of "Theageneio" Cancer Hospital, Thessaloniki. METHODS: Every operative method is accompanied with three different types of postoperative analgesia, depending on the demands of the surgical approach: Each patient's postoperative management and evaluation is performed via usage of three "Quality of Life" (QoL) Questionnaires and the "VAS-Visual Analog Scale" for pain, leading to the determination of the "QoL Index". RESULTS: Each patient answers the Questionnaires in 4 specific time intervals. The differentiation in their answers is the key point to extract important information about their postoperative health evolution. A detailed questionnaire evaluation follows, both individually and in groups, according to the subgroup of each patient's pain treatment, a combined study which is applied in this form for the first time. CONCLUSIONS: The measure of a "QoL" index is widely taken into account as one of the most accurate indicators of a patient's health evolution. The results supply us with significant information which is added to the initial management strategy, mainly regarding pain symptomatology and eventual complications and discomforts, while they indicate us towards a thorough realization of each patient's "follow up" individually and the achievement of an optimal Quality of Life level.

Galactorrhea, mastodynia and gynecomastia as the first manifestation of lung adenocarcinoma. A case report.

Gynecomastia with mastodynia and galactorrhea as a paraneoplastic syndrome due to lung cancer with complete response after surgical excision is rare. A 62-year-old Caucasian male presented with mastodynia, galactorrhea and right breast enlargement. Chest x-ray revealed a left upper lobe tumor. The patient had high levels of serum beta-human chorionic gonadotropin (b-HCG) and prolactine. Complete staging was negative for metastases. A typical left upper lobectomy with radical mediastinal lymph node dissection was performed. Pathology report was consistent with a poorly differentiated adenocarcinoma (T2N1M0). Immunohistochemically, multinucleate cells and occasional mononucleate tumor cells showed positivity for human chorionic gonadotropin. The patient received adjuvant chemotherapy with cisplatin - navelbine. One year later physical examination showed regression of both gynecomastia and mastodynia and there was no nipple discharge, while he is free from local or distant metastatic disease and the b-HCG level is normal (1,59 mIU/ml). This case represents a very rare, first manifestation of lung cancer. Galactorrhea, mastodynia and gynecomastia were the initial symptoms, which totally resolved following the successful surgical resection and adjuvant chemotherapy. In this case, prolactin and b-HCG are useful biomarkers during follow up for checking local or distal recurrence of the disease.

Brugada-like ECG pattern due to giant mediastinal lipoma.

A case of a 33-year-old female who presented with mild dyspnea and palpitations is presented. Diagnostic investigation was consistent with a giant intrathoracic mass filling the right thoracic cavity and an abnormal electrocardiogram (Brugada-like pattern). The patient underwent surgical removal of the mass (benign lipoma) with a normal postoperative ECG pattern.