Videomediastinoscopy: a ten year experience on lung cancer stadiation and non-diagnosed mediastinal lymphoadenopathy.

Cervical Mediastinoscopy (CM) is a surgical procedure in it's own right requiring an operating room and general anesthesia and, in the recent past, the absence of minimally invasive techniques had created the myth of mediastinoscopy as the "gold standard" for the pathological staging of the mediastinum. Nowadays, investigating the mediastinum is different and this calls for a review of the role of the "gold standard" CM. Between January 1999 and December 2012 a total of 303 CM were performed; 167 for pre-operative lung cancer stadiation and 136 for non-diagnosed enlargement of mediastinal nodes. The nodal stations investigated where those usually obtainable with CM. Out of 167 CM for lung cancer stadiation, 102 were positive for metastatic nodal disease, 65 were negative. Out of 136 VAMs performed for other reason (indications other than lung cancer) 15 were diagnostic for lymphoma (NLH LH 2 4), 8 revealed non metastatic lung disease, 55 were suggestive for sarcoidosis, 10 for tubercular adenitis and 48 for non-specific adenitis. The data presented in this paper refer to the activity of a single institution in the period between 1999 and 2012 and the results we have extrapolated correspond with our idea that, despite the progress of new methods, we cannot as yet, do without mediastinoscopy.

[Use of Tachosil in splenectomy in patients with clotting and blood composition disorders]. / Impiego di Tachosil nella splenectomia in pazienti con disordini della coagulazione e della crasi ematica.

UNLABELLED: Splenectomy in patients suffering from onco-haematological conditions presents clotting-related problems which make correct haemostasis more difficult. Using operative haemostasis during splenectomy for onco-haematological conditions as a starting point, the authors report their personal clinical experience of the use of Tachosil, comparing it with other similar products and drawing some personal CONCLUSIONS: To complete their reflexions on clotting problems during splenectomy in the course of onco-haematological diseases, the comparison with its use in oncological pathologies in other parenchymas, such as the kidney and liver, which also present operative haemostatic difficulties of a technical nature, is pointed out and the soundness of the results indicated. The cases of 3 patients suffering from severe clotting disturbances and treated with splenectomy and 1 patient suffering from clear cell renal carcinoma and subjected to nephrectomy in which Tachosil was used as an aid to haemostasis are reported. In the light of these cases, it can be stated that, albeit with the persistence of difficulties related to the changed clotting capacities resulting from the basic disease, the use of Tachosil has proved effective as an aid in haemostasis and suggests the validity of its use in elective and emergency splenectomy, in these types of patient.

[A surgical emergency: iatrogenic lesion of the spleen. Case report and review of the literature]. / Un'emergenza chirurgica: la lesione iatrogena della milza. Caso clinico e review della letteratura.

The spleen is an organ often injured during surgical procedures. Iatrogenic lesions belong frequently to a low grade and can be treated with a conservative therapy. The surgeon may avoid the splenectomy by using new haemostatic agents as the patch of fibrinogen and thrombin in fixed combination.