ABSTRACT
The authors present two cases of atraumatic (spontaneous) thoracic lung hernias, which are extreme rarities in the international literature, too. Risk factors and clinical pictures discussed and operative treatments are demonstrated. The spontaneous thoracic (intercostal) hernias were provoked by intractable cough caused by chronic obstructive pulmonary disease (COPD) in both cases. Multi-slice spiral CT (MSCT) scan as well as the secondary 3D 'volume rendering' (VRT) reconstructions unequivocally suggested this rare condition. Provided with the exact diagnosis, the surgical correction of the thoracic wall resulted in full recovery of the two patients. Finally, the authors briefly discuss data of thoracic hernias published in the Hungarian and the international literature. They conclude that the awareness of this extremely rare condition is important due to the high prevalence of COPD as a risk factor. Diagnostic imaging demonstrated can provide significant help in the correct diagnosis of similar cases.
Subject(s)
Hernia/diagnosis , Herniorrhaphy , Lung Diseases/diagnosis , Lung Diseases/surgery , Aged , Cough/complications , Hernia/etiology , Humans , Image Processing, Computer-Assisted , Lung Diseases/etiology , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/complications , Tomography, X-Ray ComputedABSTRACT
Thoracoscopic sympathectomy (VATS) is routinely used to treat severe palmar and axillary hyperhydrosis. The authors present a novel method: one-stage bilateral VATS-sympathectomy. Special considerations also discussed regarding the anaesthesia and operative technique of the procedure. The history of surgical therapy of hyperhidrosis is reviewed briefly, too. The authors conclude that one-stage bilateral VATS-sympathectomy for palmar and axillary severe hyperhidrosis is a safe and effective method, patient satisfaction improves and cost is significantly decreased due to shorter hospital stay.
Subject(s)
Hyperhidrosis/surgery , Sympathectomy/methods , Thoracic Surgery, Video-Assisted , Adult , Axilla , Face , Female , Hand , Humans , Thoracic Surgery, Video-Assisted/methods , Thoracic Vertebrae , Treatment OutcomeABSTRACT
The authors summarize their therapeutic methods of palmar and axillary hyperhidrosis in this article. They discuss the characteristics, frequency of upper limb and patho-anatomical features of chronic sweating. Authors summarized their almost 40 years experience in treatment methods, technological improvements as well as they review recent knowledge and relevant literature. The open thoracotomic desympathization applied in the beginnings was gradually replaced by a minimally invasive VATS-sympathectomy (Video Assisted Thoracoscopic Surgery). The possibilities of conservative treatments, local excision methods will also be discussed, as well as the application and efficiency of Botox-treatments that are used in plastic surgery. The mean frequency of 0.1-1.0% described in scientific literature is indicative of a significant number of unresolved cases, which thus requires more efficient diagnostic and patient orientation practices. Based on their experiences, the most efficient treatment of upper limb hyperhidrosis is the thoracic sympathectomy (ramicotomy and the relevant T(2) -T(3) ganglia) according to Smithwick-procedure and modified by others. If necessary, one-stage bilateral VATS-surgery may be applied. Another effective conservative possibility is the Botox-therapy, which they had applied individually at the plastic surgery clinic. Significant complications or compensatory hyperhidrosis were not detected.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Hyperhidrosis/drug therapy , Hyperhidrosis/surgery , Neuromuscular Agents/therapeutic use , Thoracic Surgery, Video-Assisted , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Retrospective Studies , Thoracoscopy/methods , Treatment Outcome , Young AdultABSTRACT
A case of spontaneous thoracic (intercostal) lung herniation originating from a chronic obstructive pulmonary syndrome (COPD) is presented. The authors present the classification, the clinical aspects and the patho-anatomic features of hernia along with the steps of diagnostic procedures. They discuss the potential pathomechanism of intercostal muscle disruption and the attached literature of this disease. The thoracic wall herniation was detected via a chest radiograph and confirmed by CT-imaging with the help of a special "3D" reconstruction-method. The knowledge of rare lung herniation is important because of the huge increase in the number of COPD-cases in our country recently.
Subject(s)
Hernia/etiology , Lung Diseases/etiology , Pulmonary Disease, Chronic Obstructive/complications , Thoracic Wall , Hernia/diagnostic imaging , Humans , Lung Diseases/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
UNLABELLED: INTRODUCTION, OBJECTIVES: Authors of two thoracic surgical departments from the above named hospitals discuss their practices of pulmonary metastasectomy after pneumonectomy for malignant disease. MATERIAL AND METHODS: Six patients were operated after pneumonectomy for metastatic spread in the residual lung. The average age of the three male and three female patients was 52.5 years. The applied preoperative diagnostical methods were the following: chest-x-ray, CT scan, MRI, PET-CT scan, perfusion lung scintigraphy, bronchological examinations, functional respiratory tests, ECG, cardiac echo, arterial blood gases (ABGs) and other laboratory analyses. Patient selection for operation was based on strict oncological and cardiorespiratory criteria. Finally, the authors describe the applied operative technique; atypical mechanical resection with stapler. RESULTS: Mean length of postoperative intensive care was between 3 to 7 days, while that of hospitalization altogether was 13 to 18 days (average 15.2 days). Ventilation needed for one patient for 5 days approximately. Two of the six patients' survival was 18 and 25 months after pulmonary metastasectomy. Four patients are still alive, their average postoperative survival is 33.5 months. They are followed up regularly and their quality of life is satisfactory. CONCLUSIONS: The key factors that determine the successful outcome of metastasectomies are careful and personalized evaluation of the patients, their condition and fitness for thoracotomy, stabile cardiopulmonary functions and the capacity of the residual lung. Multidisciplinary teamwork involving anaesthetists and intensive care specialists along with surgeons using the quick atypical resection technique are the key elements to improved survival of these patients.
Subject(s)
Lung Neoplasms/secondary , Lung Neoplasms/surgery , Pneumonectomy , Critical Care , Female , Humans , Hungary , Intensive Care Units , Length of Stay , Lung Neoplasms/diagnosis , Lung Neoplasms/physiopathology , Male , Middle Aged , Patient Care Team , Quality of Life , Reoperation , Respiration, Artificial , Retrospective Studies , Survival Analysis , Sutures , Treatment OutcomeABSTRACT
More than thousand plastic operations were performed in our departments with ROMICRO-set during the last ten years. First we applied it for reconstructive and aesthetic augmentation of the breast. Thereafter, we developed new technique for gynecomastia and reconstruction of diastasis of the m. rectus abdominis sheath. According to our experience, the ROMICRO-set is a useful tool in plastic surgery. The ROMICRO-set can be used through a small incision to achieve three dimensional views with excellent exposure and lighting.
Subject(s)
Plastic Surgery Procedures/instrumentation , Female , Humans , Male , Mammaplasty/instrumentation , Minimally Invasive Surgical Procedures/instrumentation , Rectus Abdominis/surgery , Reoperation , Retrospective Studies , Treatment Outcome , Video RecordingABSTRACT
We describe the results of an operative method applied in patients suffering from refractory ascites. Instead of the well-known shunt-implants we started to re-use Ruotte's method, which was published 100 years ago. According to our observations the anastomosis formed by the long saphenous vein and the peritoneal surface eliminates not only the known complications of the traditional shunt-operations but also provides an effective early and a late ascites inflow. The flow of the ascites was convincingly proven by regularly performed colour Doppler UH tests. This old/new method is applicable in patients with therapy-resistant ascites to eliminate the traditional shunt-models.
Subject(s)
Ascites/surgery , Peritoneovenous Shunt/methods , Saphenous Vein/surgery , Ascites/diagnostic imaging , Ascites/etiology , Drainage , Humans , Liver Cirrhosis/complications , Polytetrafluoroethylene , Silicones , Treatment Failure , Treatment Outcome , Ultrasonography, Doppler, ColorABSTRACT
Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are almost always situated under the left lobe of the liver between the IV and III segments or on the III segment to the left of the falciform ligament. One left positioned gallbladder was found in a consecutive series of 2536 patients undergoing microlaparotomy cholecystectomy for symptomatic gallstone disease in the "Moritz Kaposi" Teaching Hospital between 1990 and 2000, a prevalence of 0.04 per cent. Despite of the abnormal position of the gallbladder, the biliary pain experienced by the patient was on the right side. Preoperative diagnosis of this anomaly was not made in this patient despite preoperative sonography. The cystic duct may open in the common hepatic duct either side. In this anomaly safe microlaparotomy cholecystectomy or laparoscopic cholecystectomy can be performed.
