Iatrogenic vascular injuries following lumbar disc surgery. Case report and review of the literature.

Iatrogenic vascular injuries are unusual complications of lumbar disc surgery. The incidence of such injuries is very low but probably underestimated because clinical manifestations may be extremely variable depending on the extension of trauma whether artery or vein are injured or both. Diagnosis is suspected when early signs of retroperitoneal hemorrhage appear, but may often be delayed for weeks or years because formation of a pseudoaneurysm or an arteriovenous fistula which may be of gradual onset and produce only a few symptoms at the onset. Prompt diagnosis and aggressive treatment can hope to improve current mortality of more than 50%. A case of venous and arterial injury is reported, successfully operated on with an original technique of ilio-caval patching to avoid caval ligation. A review of the literature shows the predisposing factors and complex anatomy of such injuries, the clinical picture and the management of the emergency.

[New diagnostic and therapeutic prospects in peripheral nodules of the lung: surgical video thoracoscopy]. / Nuove prospettive diagnostiche e terapeutiche dei noduli periferici del polmone: la videotoracoscopia operativa.

The new findings and results of laparoscopic surgery lead us to apply this technique in thoracic surgery. Thoracoscopy is an old diagnostic procedure, but advanced imaging techniques, improved optics and new classes of instrument have paved the way for many diagnostic and therapeutic approaches, before not feasible. Now it is possible to treat spontaneous pneumothorax, removal of mediastinal and peripheral tumors, with minimally invasive surgery. It is our belief that thoracoscopic surgery will be a valuable tool in the near future for a variety of chest disorders.