Outcomes and Risk Factors for Morbidity after Lung Hydatidosis Surgery in Children.

OBJECTIVES: To examine outcomes and associated risk factors for children who undergo surgery for lung hydatidosis (LH). STUDY DESIGN: Through a retrospective and analytical-aim-study, over a period of 35 years in two surgical departments, we reported all operative cases for LH in children, regardless of cyst number, location, and aspect. Univariate and multivariable analyses were used to assess variables potentially predictive of postoperative morbidity. RESULTS: In total, 456 children with a mean age of 10.3 years were included. We performed 544 surgical procedures for 704 cysts with a median size of 60 mm (range 10-200 mm). Thirty-six percent of cysts were complicated. Conservative surgery was performed in 98.5% of cases and anatomical lung resection was required for 1.47% of children. Postoperative complications occurred in 24.4% of children and one death was recorded (0.2%). After multivariable analysis, the independent associated morbidity risk factors for post-operative morbidity were anatomical lung resection, intensive care unit stay, complicated cyst, a cyst size ≥60mm, ≥3 bronchial fistulas, associated liver hydatidosis, and the presence or occurence of empyema during surgery. CONCLUSIONS: Conservative surgery sparing the lung parenchyma is the treatment of choice for lung hydatidosis and is associated with a low mortality rate. Knowledge of independent risk factors for morbidity may help clinicians to manage children with LH more adequately and improve postoperative outcomes.

Enhanced recovery after thoracic surgery in low- and middle-income countries: Feasibility and outcomes.

BACKGROUND: Enhanced Recovery After Surgery (ERAS) applies multimodal, perioperative, and evidence-based practices to decrease postoperative morbi-mortality, the length of hospital stay, and hospitalization costs. Implementing enhanced recovery after thoracic surgery (ERATS) in low- and middle-income countries (LMIC) is problematic. This randomized controlled trial evaluated the feasibility and effectiveness of an ERATS protocol adapted to LMIC conditions in Tunisia. MATERIALS AND METHODS: We conducted this randomized controlled trial between December 2015 and August 2017 in the Thoracic and Cardiovascular Surgery Department at Habib Bourguiba University Hospital of Sfax, Tunisia. RESULTS: One hundred patients undergoing thoracic surgery were randomly allocated to the ERATS group or Control group. During the postoperative phase, 13 patients (13%) were excluded secondary. These complication rates were lower in the ERATS group: lack of reexpansion (14.63% vs 16.10%: p = 0.72), pleural effusion (0% vs 10.86%, p = 0.05), and prolonged air leak (17.07% vs 30.43%, p = 0.14). The pain level decreased significantly in the ERATS group from postoperative H3 (p = 0.006). This difference was significant at H6 (p = 0.001), H24 (p = 0.05), H48 (p = 0.01), discharge (p = 0.002), and after 15 days (p = 0.01), with a decreased analgesic consumption. The length of hospital stay was shorter in the ERAS group (median six days vs seven days, p = 0.17). CONCLUSION: This study provides an adapted ERATS protocol, applicable regardless of the surgical approach or the type of resection and suitable for LMIC hospital's conditions. This protocol can improve the postoperative outcomes of thoracic surgery.

Sternal tail: A new entity; A case report.

INTRODUCTION AND IMPORTANCE: Supernumerary ribs are very rare. They may occur at any level of the spine. We present here a case of an unusual localization of an extra rib that has not been previously described in the literature. CASE PRESENTATION: A 4-year-old girl, with no medical history, presented with a congenital deformity in the sternal region mimicking a tail. The tail-like structure had a bony axis and was covered by normal skin and hairs. A computed tomography of the chest demonstrated that this structure was an abnormal bone articulated with the the sternum. For cosmetic purposes, we have decided to resect the malformation. On histopathological examination, it was a supernumerary rib. CLINICAL DISCUSSION: A review of the literature reveals a global incidence of cervical ribs ranging from 0.04 % up to 4.5 %, intrathoracic ribs in about 50 cases to date and very few reports on supernumerary ribs in the lumbar and sacral region. We were unable to find any similar cases of supernumerary ribs in the sternum. CONCLUSION: Supernumerary ribs are rare and benign congenital anomalies. This case report describes an unusual localization of an extra rib in the sternum mimicking a tail.

Effectiveness and safety of povidone iodine for prolonged lung air-leak after lung surgery.

BACKGROUND: Pulmonary surgery is often associated with postoperative prolonged parenchymal air-leak. The purpose of this study was to determine efficacy and safety of povidone iodine as treatment of prolonged parenchymal air-leak following all-types of lung surgery. METHODS: This prospective trial was conducted from June 2019 to December 2020, and designed under PanAfrican Clinical Trials Registry requirements. Patients having prolonged parenchymal air-leak were randomly allocated to povidone iodine protocol (Group A) or surveillance without povidone iodine (Group B). We collected the number of povidone iodine injections required before bubbling stopped, total drainage period, tolerance after injection, complications and side-effects. Comparative study was performed to evaluate povidone iodine efficacy. RESULTS: Following randomization, Group A included 19 patients, and Group B 21. Both groups were comparable. The mean drainage period was 9.21 days in Group A (6-14 days) and 15.62 days in Group B (7-31 days) (p = 0.001). The mean hospitalization period was 11.05 days in Group A (7-16 days) and 18.9 days in Group B (9-38 days) (p < 0.0001). The mean follow-up period was 6.8 months (3-18 months). No deaths were noted in either groups. Four side-effects were reported in Group A (21%) and four serious complications were noticed in Group B (19%). No recurrences were reported in Group A versus one recurrence of homolateral pneumothorax in Group B (4.76%). CONCLUSIONS: Povidone iodine is an effective and safe solution for pleurodesis. It is associated with a low complication rate that remains acceptable, and could be proposed as treatment of prolonged parenchymal air-leak after lung resections.

Small cell osteosarcoma of the rib: An exceptional localization.

Small cell osteosarcoma is a rare sub-type of osteogenic malignant tumors. Rib localization is uncommon. Histological examination is an important step to make the difference with similar tumors like Ewing's sarcoma. Surgical resection is the unique curative treatment. The prognosis remains poor even with adjuvant treatment.

Alveolar Adenoma: A Rare Benign Tumour of the Lung with A Challenging Diagnosis.

Alveolar adenoma is a rare lung benign tumour originating from type II pneumocytes. It presents as a well-defined nodule. In some cases, it is difficult to differentiate from lung cancer. Few cases of this tumour have been reported. We describe here a case of alveolar adenoma in a 63-year-old man discovered incidentally on chest X-ray. The lesion was reported as lepidic adenocarcinoma in bronchoscopic biopsy. The patient underwent a thoracoscopic left lower lobectomy. The histopathological and immunohistochemical examinations resulted in a diagnosis of alveolar adenoma. We report this case to describe its morphological and immunohistochemical characteristics and to emphasize its diagnostic difficulties.

Morbidity and Mortality Risk Factors for Lung Hydatidosis Surgery: Over 30 Years' Experience Review.

BACKGROUND: Lung hydatidosis (LH) is still an endemic pathology. Different published surgical series have reported variable numbers of patients, but few have studied the morbidity- and mortality-associated risk factors. METHODS: Through a retrospective with a descriptive and analytical aim study, performed from January 1987 to December 2020, we reported all patients who underwent operations for LH, regardless of the cyst locations, numbers, and aspects. We excluded patients who were not operated on, patients with extrapulmonary hydatidosis, and those with a cystic pathology other than LH. RESULTS: Operations for LH were performed in 1169 patients, with a total of 1288 interventions and a median age of 20 years (semi-interquartile range [SIQR],11.5; 2-89 years). There were a total of 1951 cysts, with a median of 1 cyst (SIQR,0; 1-37 cysts) and a median size of 60 mm (SIQR,20; 10-250 mm). Forty percent were complicated. Conservative surgery was performed on most patients, and anatomical resection was required in 23 patients (1.8%). The median number of bronchial fistulas was 3 (SIQR,1; 0-16 fistulas). Decortication was necessary for 94 patients (7.3%). The morbidity rate was 25%, and mortality was 0.4%. Fever, pleural effusion, and associated decortication were correlated morbidity and mortality risk factors. Other morbidity factors were identified, including nonprotection of the surgical field, a cyst size ≥55 mm, and ≥3 bronchial fistulas. Mortality factors were determined, such as postoperative occurrence of septic shock, hemorrhage, and respiratory distress. CONCLUSIONS: The earlier we operate on LH patients (before complications set in) and identify the different associated risk factors, the better the prognosis of curative surgery is.

Cavitary lung opacity of unusual cause during Behçet disease.

Pulmonary artery aneurysm must be evoked in front of any hemoptysis in a patient with Behçet disease as it requires urgent immunosuppressive therapy and often surgery.

A diagnostic pitfall of a sternal mass.

Primary sternal lymphoma represents a rare entity which must be evoked in front of a sternal mass especially as its treatment is different from that of sarcomas, the principal etiology of sternal masses.

Left lung agenesis discovered by a spontaneous pneumothorax in a 20-year-old girl.

Lung agenesis is a rare condition which prognosis widely depends on associated malformations. Clinical presentation is so variable and diagnosis is often made in childhood. Here, we present a case of a 20-year-old girl who was admitted because of a spontaneous pneumothorax. Explorations concluded at a left lung agenesis, a hyperinflated right lung crossing the midline with a corresponding pneumothorax. There was no malformation else. This congenital condition and treatment for this rare presentation are discussed in detail.

Dendriform pulmonary ossification in a patient with mucoepidermoid carcinoma.

Dendriform pulmonary ossification is a chronic process characterized by the presence of heterotopic bone within the interstitium and alveolar walls. It usually occurs in the setting of chronic inflammation. We report an unusual case of a 54-year-old man with a history of relapsing Hodgkin lymphoma who was diagnosed with concomitant mucoepidermoid pulmonary carcinoma and dendriform ossifications. The radiological features were initially misinterpreted as post-radiation pulmonary fibrosis and bronchiectasis. The diagnosis was finally established after considering both the radiological and pathological findings. Dendriform pulmonary ossification is an under-recognized disease that should be considered in the differential diagnosis of lung chronic diseases.

Primary Burkitt lymphoma in the posterior mediastinum.

A 13-year-old boy was admitted to our hospital with complaints of posterior chest pain and dyspnea. Computed tomography and magnetic resonance imaging of the chest revealed a mass in the posterior mediastinum, extending from T8 to T11 with intraspinal involvement. A percutaneous core needle biopsy confirmed the diagnosis of Burkitt lymphoma. He was treated according to the Lymphoma Malignancy B protocol 2001 arm C3, but he presented with liver and brain relapses and died 7.5 months after admission. Although lymphoma is rarely localized in the posterior mediastinum, it should be considered in the differential diagnosis of posterior mediastinal masses in children.

Thoracoscopic partial thymectomy for untraceable mediastinal parathyroid adenomas.

Despite accurate preoperative imaging, ectopic mediastinal parathyroid adenomas can be difficult to find via a thoracic approach. Considering that - in most cases - these adenomas are intrathymic, it can be advisable to directly perform a partial thymectomy. We present the cases of three patients who were successfully cured using a thoracoscopic partial thymectomy.