Primary diffuse B-cell lymphoma presenting as a solitary chest-wall lesion.

Primary lymphoma presenting as a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumours arise from metastasis. We demonstrate a case report of a 67-year-old male who underwent investigations for a chronic left-sided pleural effusion. A computed tomography scan demonstrated a large chest-wall lesion, without rib destruction. He subsequently underwent fine needle aspirations and excisional biopsy for a histological diagnosis.

Bucket-handle repair of a tear in the bronchus intermedius with an intercostal muscle flap.

As previously well described in the literature, the intercostal muscle (ICM) flap can be used to buttress bronchial stumps following lung resection. We describe a harvesting technique of ICM flap which enabled a bi-lobectomy to be avoided in a patient with poor pulmonary function. The Key to this technique is the preservation of the neurovascular bundle. Therefore the flap is not divided anteriorly thereby differentiating it from any previous technique described.We have called it the 'bucket handle' technique, which was used to repair an intra-operative tear in bronchus intermedius. Its efficacy was tested to the full when the patient developed severe adult respiratory distress syndrome (ARDS) secondary to pseudomonas pneumonia and required high-pressure mechanical ventilation. This case demonstrates that ICM flap is an effective buttress to bronchial stumps or repairs and offers reassurance for optimal outcome due to its intact vascular pedicle.

Comparative analysis and outcomes of sleeve resection versus pneumonectomy.

To compare the outcome of sleeve resection or complex sleeve resection versus (Vs) pneumonectomy for lung cancer in a single unit. Between 1998 and 2006, 664 lung resections were carried out. There were 129 (19.4%) pneumonectomies and 79 (11.9%) sleeve resections; Twenty one patients (26.5%) underwent a complex sleeve resection. Operative mortality for the sleeve resections (SR) was 2.5% and for the pneumonectomies 8.53%. Overall 5-year survival after SR was 46.8% and after pneumonectomy 37.1%. The survival curves for the 2 procedures after adjusting for risk factors are different. The area under the curve is higher for the SR (Hazard ratio 1.78 C.I.: 0.92-3.46). The 5-year survival for early stages favors SR. The survival for the complex SR was not influenced by the complexity of the procedure but from the TNM stage of each individual case. Multivariate analysis of risk factors affecting survival after surgery showed: male sex Hazard ratio (HR) 1.19, 0.63-2.27(95%CI), Age >63 1.38(HR), 0.78-2.48, Pneumonectomy 1.78(HR), 0.92-3.46 and stage III 4.44(HR), 1.94-10.16(95% CI). For comparative stages survival appears to be better after sleeves, moreover male sex, sleeve resection, age younger that 63 and early TNM stage are positive predictors for survival.