Intrathoracic muscular transposition in chronic tuberculous empyema.

BACKGROUND: The effective management of chronic tuberculous empyema requires an evacuation of pus and a re-expansion of the lung or an obliteration of the empyema space such as closed thoracostomy, decortication, or open window thoracostomy (OWT) followed by intrathoracic muscular transposition (IMT). However, the most effective management of chronic tuberculous empyema is still debatable. METHODS: From June 1999 to July 2010, 18 patients with chronic tuberculous empyema who underwent OWT and/or IMT were enrolled in this study. The causes of empyema, and methods and outcomes of treatment were retrospectively reviewed. The success rate of IMT was investigated to evaluate the efficacy. RESULTS: Mean patient age was 54.3 ± 14.9 years and 16 patients were male. Depending on operative methods, three groups were divided: OWT only (n = 4); two-stage operation as OWT followed by IMT (n = 7); and one-stage operation as OWT with IMT simultaneously (n = 7). Of 14 patients who underwent IMT, 13 patients successfully recovered from empyema and bronchopleural fistula (BPF) (success rate, 92.86%), but one patient developed a secondary bacterial infection. There was no operative mortality. CONCLUSION: This study suggests that IMT may be an effective option to control infection or BPF in chronic tuberculous empyema.

Pulmonary mass diagnosed as extrauterine epithelioid trophoblastic tumor.

Pulmonary extrauterine epithelioid trophoblastic tumors (ETTs) are extremely rare. A 26-year-old nonsmoking woman with a history of a suspected subclinical miscarriage presented with a large mass in the right lower lobe that was confirmed to be a pulmonary extrauterine ETT using immunohistochemical stains. When a nonsmoking fertile woman presents with a pulmonary mass and an elevated serum ß-human chorionic gonadotrophin in the absence of gynecologic disease, pulmonary extrauterine ETT should be considered.

Real-Time Fluorescence Imaging in Thoracic Surgery.

Near-infrared (NIR) fluorescence imaging provides a safe and cost-efficient method for immediate data acquisition and visualization of tissues, with technical advantages including minimal autofluorescence, reduced photon absorption, and low scattering in tissue. In this review, we introduce recent advances in NIR fluorescence imaging systems for thoracic surgery that improve the identification of vital tissues and facilitate the resection of tumorous tissues. When coupled with appropriate NIR fluorophores, NIR fluorescence imaging may transform current intraoperative thoracic surgery methods by enhancing the precision of surgical procedures and augmenting postoperative outcomes through improvements in diagnostic accuracy and reductions in the remission rate.

Aberrant methylation of Fragile Histidine Triad gene is associated with poor prognosis in early stage esophageal squamous cell carcinoma.

The aim of this study was to understand the clinicopathological and prognostic significance of promoter methylation of Fragile Histidine Triad (FHIT) gene in esophageal cancer. FHIT methylation in 257 primary esophageal squamous cell carcinomas was retrospectively analyzed by methylation-specific polymerase chain reaction. Aberrant methylation of FHIT was found in 85 (33%) of 257 esophageal cancer patients. The FHIT methylation was found to be significantly associated with exposure to tobacco smoke (P = 0.007) and with a poor prognosis in cases of stage 1-2 cancer irrespective of recurrence. The hazard of failure after esophagectomy for stage 1-2 cancers with FHIT methylation was about 5.81 (95% CI = 1.15-14.07; P = 0.009) times higher than in those without. Recurrence occurred in 116 (45%) of the 257 patients studied. The survival after recurrence in stage 1-2 cancers was also poorer for patients with FHIT methylation than in those without (HR = 2.31; 95% CI = 1.18-7.92; P = 0.03). In conclusion, aberrant methylation of the FHIT promoter was found to be significantly associated with exposure to tobacco smoke and with a poor prognosis for stage 1-2 cases, but not with recurrence rate. Our study suggests that FHIT promoter methylation may be an independent prognostic biomarker in early stage esophageal squamous cell carcinoma.

Surgical Outcomes of Pneumatic Compression Using Carbon Dioxide Gas in Thoracoscopic Diaphragmatic Plication.

BACKGROUND: Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide (CO2) gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy. METHODS: Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using CO2 gas and group without using CO2 gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence. RESULTS: The improvement of forced expiratory volume at 1 second in the group using CO2 gas and the group not using CO2 gas was 22.46±11.27 and 21.08±5.39 (p=0.84). The improvement of forced vital capacity 3 months after surgery was 16.74±10.18 (with CO2) and 15.6±0.89 (without CO2) (p=0.03). During follow-up (17±17 months), there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred. CONCLUSION: Thoracoscopic plication under single lung ventilation using CO2 insufflation could be an effective, safe option to flatten the diaphragm.

Pharyngo-colostomy with supraglottic partial laryngectomy in caustic oropharyngeal stricture.

We present two cases of chronic caustic stricture from the oropharynx to the entire esophagus combined with laryngeal stricture in which the piriform sinuses were stenosed. The restoration of digestive continuity was accomplished by end-to-end pharyngo-colostomy at the level of the cricoid cartilage through the posterior mediastinal route. Supraglottic partial laryngectomy and pharyngoplasty were done simultaneously for the laryngeal and oropharyngeal stricture. The patients were able to swallow a soft blend diet to regular diet with negligible penetration.

Complete surgical resection of inflammatory myofibroblastic tumor with carinal reconstruction in a 4-year-old boy.

Inflammatory myofibroblastic tumor of the carina and the main bronchus is a rare tumor. The authors report here on a case of a 4-year-old boy with an inflammatory myofibroblastic tumor at the carina and extending to the left main bronchus. He presented with fever and a cough of 2 months' duration. Preoperative assessment of the tumor revealed an intraluminal round mass arising from the carina and extending into the left main bronchus, and this caused near-total obstruction of the left main bronchus and the subsequent total collapse of the entire left lung. The complete resection of the mass with carinal reconstruction was successful. The tumor was a round mass measuring 1.5 x 1 cm. It had characteristic features of an inflammatory myofibroblastic tumor, namely, the proliferation of spindle-shaped fibroblasts and myofibroblasts.