Delayed iatrogenic diaphragmatic hernia after thoracoscopic lobectomy.

Postoperative iatrogenic diaphragmatic hernia after thoracoscopic lobectomy is extremely rare. We present a 55-year-old female patient who developed an iatrogenic diaphragmatic hernia with gastric perforation several months after VATS (video-assisted thoracic surgery) left upper lobectomy with systematic lymphadenectomy. During the readmission, urgent laparotomy was performed. Intraoperatively, the choledochoscopy was introduced into left thoracic cavity through the diaphragmatic defect for dissecting the secondary inflammatory adhesions and achieving satisfactory hemostasis. It appears to be an efficient and feasible approach for the patients who have been diagnosed as delayed diaphragmatic hernia concomitant with remarkable intra-abdominal findings and have a history of thoracic surgery. We consider that delayed-onset diaphragmatic hernia should be suspected in patients complaining of nausea or vomiting after VATS procedure, although it is very rare.

Left lower sleeve lobectomy and systematic lymph node dissection by complete video-assisted thoracic surgery.

Sleeve lobectomy for selected cases of central lung cancer has better functional outcomes comparing to pneumonectomy. With improved technology and increased experiences in complete video-assisted thoracic surgery (VATS) lobectomy, complete VATS sleeve lobectomy has been applied in major medical centers recently. A 64-year-old male patient with left lower central lung cancer underwent thoracoscopic sleeve lobectomy and systemic mediastinal lymph node dissection. The major incision, of four incisions in total, was a 4 cm mini-incision in the 4th intercostal space of anterior axillary line. The patient had recovered uneventfully after the surgery.

Successful resection of a giant subpericardial lipoma with recurrent ventricular arrhythmias.

We report a case of a giant subpericardial lipoma with ventricular arrhythmias. It was resected through a median sternotomy without cardiopulmonary bypass. The tumour was about 21x23x5 cm and weighed 2100 g. After resection the heart rhythm returned to sinus rhythm.

[Diagnosis and surgical treatment of giant intrathoracic solid tumors].

OBJECTIVE: To summarize the experience in diagnosis and surgical treatment of giant intrathoracic solid tumors. METHODS: The data of surgically treated 36 patients with giant intrathoracic solid tumors were analyzed, including 19 males and 17 females. Complete resection was achieved in 34 cases with superior vena cava angioplasty in 3 cases and ligation of the left anonymous vein in 2 cases. Six patients received postoperative radiotherapy. RESULTS: The symptoms in 32 cases were significantly improved. Two patients (5.6%) died of postoperative respiratory infection and failure. The mean postoperative hospital stay was 14.2 days. Pulmonary edema occurred in 6 cases due to rapid decompression of the lung. Pathological results showed that 25 cases had benign tumors and 11 had malignancy. During the follow-up of 1 to 22 years, all patients with benign tumors were still alive, but the patients with malignant tumors had a mean survival time of only 2.1 years. CONCLUSION: Surgical treatment for giant intrathoracic solid tumors is suggested whenever technically possible. Even though a tumor can not be completely resected, satisfied results could still be achieved if combined with postoperative radiotherapy. Proper anesthesia, satisfied exposure with a suitable incision, appropriate resection pattern and hemostatic method are the keys for successful surgical treatment.

Coronary artery bypass grafting after pneumonectomy.

When open-heart operations are necessary in patients who have undergone pneumonectomy, the unavoidable shift of mediastinal structures should be carefully considered. Surgical access, revascularization procedures, and the institution of cardiopulmonary bypass can all require approaches that differ from the usual. In particular, no general recommendations exist regarding the management of patients who undergo coronary artery bypass grafting after pneumonectomy. We successfully performed coronary artery bypass grafting in a 57-year-old man who had undergone a left pneumonectomy 7 years previously. Because the patient's heart was completely displaced into the left posterior hemithorax, access via a left posterolateral thoracotomy was chosen. Saphenous vein grafts were chosen over the internal mammary artery. The distal anastomoses were performed with use of the off-pump technique; for the proximal anastomosis, 2 venous grafts were implanted into the descending aorta. The patient's postoperative course was uneventful, and postoperative angiography revealed patent grafts. Herein, we discuss the case of this patient, and we present some considerations that can influence surgical approaches in similar circumstances.

[Effect on synthesis of nitric oxide in myocardium by local cryoablation].

OBJECTIVE: To study the effect on synthesis of nitric oxide in myocardium by local cryoablation and to investigate its mechanism. METHODS: Myocardium was cryoablated locally by a probe cooled to -60 degrees C and rewarmed by normal salt solution, nitric oxide and its synthesis enzyme were measured before and after cryoablation. L-arginine or methylene blue was added before and during cryoablation and the effect of these drugs on synthesis of nitric oxide was studied. RESULTS: Nitric oxide and its synthesis enzyme decreased after cryoablation; L-arginine preserved the synthesis of nitric oxide and methylene blue inhibited the synthesis of nitric oxide. However, nitric oxide in serum did not change. CONCLUSION: Nitric oxide and its synthesis enzyme in myocardium decrease after cryoablation.