Surgical management of sternal tumours-a decade of experience from a tertiary care centre in India.

Tumours of the sternum can be either primary or secondary with malignancy being the most common etiology. Wide local excision of these tumours results in a midline defect which pose a unique challenge for reconstruction. As limited data on the management of these tumours exists in the literature, we hereby report 14 consecutive patients who were treated at our institute between January 2009 to December 2020. Most of them were malignant with majority of them, 11 (78%) patients, with manubrial involvement requiring partial sternectomy. Overall, the average defect size was 75 cm2. Reconstruction of the chest wall defect was done using a semi-rigid fixation: mesh and suture stabilization in 3 (21%) or suture stabilization in 7 (50%) and without mesh or suture stabilization in 3 (21%) patients. Rigid fixation with polymethyl methacrylate (PMMA) was done for one patient (7%). Pectoralis major advancement flap was most commonly used for soft tissue reconstruction with flap necrosis noted in one patient (7%). There was no peri-operative mortality and one patient required prolonged post-operative ventilation. On a median follow-up of 37.5 months, one patient (7%) had a recurrence. Sternal defects after surgical resection reconstructed with semi-rigid fixation and suture stabilization render acceptable post-operative outcomes.

Surgical management of pulmonary aspergilloma-12 years' experience from a tertiary care centre in India.

INTRODUCTION AND PURPOSE: Pulmonary aspergilloma is the formation of saprophytic colonies of fungus in pre-existing pulmonary cavities. They may cause life-threatening haemoptysis. As medical treatment often fails, surgery is the mainstay of treatment in symptomatic patients. Earlier studies had reported high levels of mortality and morbidity with surgery while more recent studies have shown better results. Hence, being in a large tertiary care centre in India, we decided to analyse the details of our own experience in the surgical management of pulmonary aspergilloma. METHODS: Details of all adult patients treated surgically for pulmonary aspergilloma, between the years 2009 and 2020, maintained in a live database in our institute, were retrieved and analysed. RESULTS: There were 102 patients in the study. The average age was 40 years. There was a male (M: F, 3:1) and right side preponderance. Pulmonary tuberculosis (TB) was the commonest cause for cavities in which aspergilloma developed as identified in 84 (82%) patients and diabetes mellitus, the commonest comorbidity present in 28 (27.5%) patients. Parenchyma-preserving lung resections (PPLRs) were feasible in 8 (44%) of the non-tubercular patients, but only in 14 (17%) of the TB patients. Post-operative complications (11.7%) were higher among the patients with TB. There were 2 (1.9%) post-operative mortalities. CONCLUSION: Though surgery is technically complex in the presence of pulmonary aspergilloma, it is yielding better results with improvements in treatment strategies. Surgery for aspergilloma in patients with prior or current pulmonary TB has more morbidity and mortality when compared to the non-TB patients.

Surgical management of empyema thoracis - experience of a decade in a tertiary care centre in India.

INTRODUCTION AND PURPOSE: Empyema thoracis (ET) is defined as the accumulation of pus in the pleural cavity. Early stages of ET are treated medically and the late stages surgically. Decortication, thoracoplasty, window procedure (Eloesser flap procedure) and rib resections are the open surgical procedures executed. There are no strict guidelines available in developing nations to guide surgical decision-making, as to which procedure is to be followed. METHODS: Details of all adult patients treated surgically for ET, between the years 2009 and 2019, and maintained in a live database in our institute, were retrieved and analysed. Medically managed patients were excluded. RESULTS: There were 437 patients in the study. The average age was 38 years. There was right side preponderance with a male:female ratio of 5:1. Tuberculosis was the commonest aetiology identified in 248 (57%) patients and diabetes was the commonest co-morbidity present in 97 (22%) patients. There was a higher incidence of a window procedure (WP) in tubercular patients 145 (59%). Only 26 (14%) of the non-tubercular patients underwent a WP. Post-operative complications were persistent air leak in 12 (6%) patients and premature closure of a window in 7 (4%) patients. There were 4 (0.9%) post-operative mortalities. CONCLUSION: Surgical management of late stages of ET provides good results with minimal morbidity and mortality. In developing nations like India, the high incidence of tuberculosis and late presentations make the surgical management difficult and the strategies different from those in developed nations. No clear guidelines exist for the surgical management of ET in developing nations. There is a need for a consensus on the surgical management of empyema in such countries.

Pulmonary embolism from cardiac hydatids.

Metastatic hydatid disease of the lung may happen when a hydatid cyst (HC) anywhere in the body ruptures into a systemic vein, a right heart chamber or a pulmonary artery (PA), resulting in the embolisation of the cyst's contents into the lungs. We submit herewith, the images of embolised hydatids within the PA, in a patient who had surgery for HC involving the right ventricular (RV) wall in 2014. Despite adequate surgical and medical management, investigations in 2017 revealed multiple embolised cysts within PA branches. Further continued medical therapy resulted only in partial resolution of the disease, indicating probably the inadequacy of the currently available treatment strategies.

Myositis ossificans-a rare tumor of the chest wall.

Myositis ossificans (MO) is the abnormal formation of benign heterotopic bone tissue in soft tissues or muscles, mostly in sites of trauma. Though it has been described in most parts of the body, less than a dozen cases involving the chest wall have been reported. It is known to resolve spontaneously and various medical treatments have been suggested to hasten its resolution. Large tumors, suspicion of malignancy, and presence of symptoms are indications for surgical intervention. The differential diagnoses include sarcomas, infections, callous, calcified hematomas, and cysts. We present the clinical, radiological, and pathological images of a post traumatic MO of the chest wall, arising from under the medial third of the clavicle and growing into the deeper surface of the pectoralis major muscle. The patient is doing well eight months after the excision of the same.