The importance of postoperative analgesia after major thoracic surgery interventions, protocols, applications, and the following evaluation of the patient's quality of life.

OBJECTIVES: Major thoracic surgery procedures constitute a standard method of diagnosis and/or therapy against lung, mediastinal cancer and other non-malignant manifestations of the respiratory system. Such patients' recovery and rehabilitation depend directly from the applied postoperative analgesia, with purpose to determine an optimum and long-term quality of life. BACKGROUND: Our database consists of 300 individuals, submitted to major thoracic surgery procedure during a 2 - year period of time (between December 2016 and December 2018) at the "Thoracic Surgery Department" of "Theageneio" Cancer Hospital, Thessaloniki. METHODS: Every operative method is accompanied with three different types of postoperative analgesia, depending on the demands of the surgical approach: Each patient's postoperative management and evaluation is performed via usage of three "Quality of Life" (QoL) Questionnaires and the "VAS-Visual Analog Scale" for pain, leading to the determination of the "QoL Index". RESULTS: Each patient answers the Questionnaires in 4 specific time intervals. The differentiation in their answers is the key point to extract important information about their postoperative health evolution. A detailed questionnaire evaluation follows, both individually and in groups, according to the subgroup of each patient's pain treatment, a combined study which is applied in this form for the first time. CONCLUSIONS: The measure of a "QoL" index is widely taken into account as one of the most accurate indicators of a patient's health evolution. The results supply us with significant information which is added to the initial management strategy, mainly regarding pain symptomatology and eventual complications and discomforts, while they indicate us towards a thorough realization of each patient's "follow up" individually and the achievement of an optimal Quality of Life level.

Galactorrhea, mastodynia and gynecomastia as the first manifestation of lung adenocarcinoma. A case report.

Gynecomastia with mastodynia and galactorrhea as a paraneoplastic syndrome due to lung cancer with complete response after surgical excision is rare. A 62-year-old Caucasian male presented with mastodynia, galactorrhea and right breast enlargement. Chest x-ray revealed a left upper lobe tumor. The patient had high levels of serum beta-human chorionic gonadotropin (b-HCG) and prolactine. Complete staging was negative for metastases. A typical left upper lobectomy with radical mediastinal lymph node dissection was performed. Pathology report was consistent with a poorly differentiated adenocarcinoma (T2N1M0). Immunohistochemically, multinucleate cells and occasional mononucleate tumor cells showed positivity for human chorionic gonadotropin. The patient received adjuvant chemotherapy with cisplatin - navelbine. One year later physical examination showed regression of both gynecomastia and mastodynia and there was no nipple discharge, while he is free from local or distant metastatic disease and the b-HCG level is normal (1,59 mIU/ml). This case represents a very rare, first manifestation of lung cancer. Galactorrhea, mastodynia and gynecomastia were the initial symptoms, which totally resolved following the successful surgical resection and adjuvant chemotherapy. In this case, prolactin and b-HCG are useful biomarkers during follow up for checking local or distal recurrence of the disease.

Outcome of lung cancer patients admitted to the intensive care unit with acute respiratory failure.

BACKGROUND: Previous studies have shown that the outcome of lung cancer patients who were admitted to the Intensive Care Unit (ICU), especially those requiring mechanical ventilation, is extremely poor. The present study was conducted in order to assess the outcome of a recent cohort of lung cancer patients admitted to the ICU with acute respiratory failure. METHODS: A retrospective analysis of the medical records of 105 lung cancer patients who were admitted to the ICU between January 2008 and January 2011 was performed. Severity of illness on the first day of ICU admission was assessed using the acute physiology and chronic health evaluation (APACHE) II and the sequential organ failure assessment (SOFA) scoring systems. Associated organ failure was determined according to the Knaus criteria. RESULTS: Eighty four (80%) patients were diagnosed with non-small cell lung cancer, 14 (13.3%) with small cell lung cancer, one patient with mesothelioma, and in the remaining 6 patients, the type of lung cancer could not be determined. Significant factors on admission were APACHE II and SOFA scores, poor performance status and severe comorbidity. During ICU stay, the main risk factors for poor outcome were the long term mechanical ventilation duration, use of vasopressors, more than two organ system failures and septic condition. The overall ICU, hospital and 6-month mortality rates were 44.7% (47/105), 56.1% (59/105) and 77.1% (81/105) respectively. CONCLUSIONS: The present data show that the medical intensive care unit outcome of lung cancer patients is improving. Further studies of patients selected to ICU admission are needed to assess long-term mortality, quality of life, ability to continue chemotherapy and economic cost.

Malignant triton tumor of the chest wall invading the lung. A case report and literature review.

BACKGROUND: Malignant triton tumor (MTT) is an histological deviation of malignant peripheral nerve sheath tumor with additional rhabdomyosarcomatous elements. It is very rare, profoundly aggressive, with a tendency to recur locally and metastasize early. If manifests itself more often in individuals with neurofibromatosis type I (NF-1) disease but also sporadically or post radiotherapy. Description of case: A 57-year-old male was admitted with a history of malignant triton tumor of the chest wall. Despite prior aggressive locoregional treatment including wide excision and adjuvant consolidating radiotherapy, the tumor recurred. The patient underwent a new operation and systemic chemotherapy, but expired a few months later due to disease progression. CONCLUSION: MTT is exceedingly malignant requiring multimodality treatment. The cornerstone of management is radical surgical resection with clear margins. Nevertheless, the overall prognosis remains dismal.

Brugada-like ECG pattern due to giant mediastinal lipoma.

A case of a 33-year-old female who presented with mild dyspnea and palpitations is presented. Diagnostic investigation was consistent with a giant intrathoracic mass filling the right thoracic cavity and an abnormal electrocardiogram (Brugada-like pattern). The patient underwent surgical removal of the mass (benign lipoma) with a normal postoperative ECG pattern.

A rare cause of mediastinal mass: Primary liposarcoma.

Liposarcoma is the most commonly diagnosed soft tissue sarcoma in adults and occurs predominantly in the lower limbs and retroperitoneum. Primary mediastinal liposarcomas are rare. Herein we report a case of a 68-year-old man with primary mediastinal liposarcoma involving the diaphragm and pericardium, which was successfully managed by complete surgical excision. The patient's postoperative course was uneventful with no evidence of recurrence 9 months after the operation. Surgical removal is the optimal treatment for a mediastinal liposarcoma, as it is in other sites. If the entire tumor can not be resected, surgical debulking often results in symptomatic relief. International literature suggests that recurrent disease occurs and therefore a long-term careful follow up is required.

Non-thromboembolic pulmonary hypertension in multiple myeloma, after thalidomide treatment: a pilot study.

BACKGROUND: Multiple myeloma (MM) is thrombogenic as a consequence of multiple hemostatic effects and endothelial damage. Thalidomide has been associated with an increased risk of thromboembolic pulmonary hypertension (PH). PH in the absence of venous thromboembolism has also been described in MM patients during thalidomide treatment. AIM: Detection of clinical and subclinical nonthromboembolic PH in MM patients after thalidomide treatment. PATIENTS AND METHODS: Eighty-two patients, 46-82 years (median age 61 years), 42 males, were studied. They underwent echocardiographic study at baseline, 1 month thereafter, 6 months later and whenever symptoms indicating deterioration of cardiac function appeared. Echocardiographic signs of PH were especially identified. RESULTS: Clinical and echocardiographic evaluation revealed four patients (out of 82 patients, 4.87%) with PH. Nonimaging and imaging diagnostic methods excluded thromboembolic PH. Statistical analysis demonstrated significant correlation between structural heart disease and PH (r = 14.078; P = 0.008). No significant correlation between age (r = 0.770; P = 0.724), gender (r = 1.157; P = 0.285), International Staging System (ISS) (r = 0.316; P = 0.716) and PH was found. CONCLUSIONS: Preexisted endothelial dysfunction due to structural cardiac disease enhances the vasoactive substances release causing increased pulmonary vascular resistance. Thalidomide possibly causes a vasodilator and vasoconstriction imbalance, which may cause abnormal pulmonary vascular response interfering to a vicious circle perpetuating PH.

Primary mediastinal hemangiopericytoma.

BACKGROUND: Hemangiopericytoma is a rare mesenchymal neoplasm, accounting for about 1% of vascular tumors The tumor occurs most commonly in the skin, subcutaneous soft tissues, muscles of the extremities, retroperitoneum but rarely in the lung, trachea or mediastinum. CASE PRESENTATION: A rare case of primary mediastinal hemangiopericytoma is presented. A 72-year-old woman was treated by complete surgical resection of the tumor. Details of the clinical and radiographic feature are presented. The patient's postoperative course was uneventful with no evidence of recurrence 9 months after the operation. CONCLUSION: Hemangiopericytoma is an uncommon, potentially malignant tumor originating from pericytes in the small vessels and surgical radical excision is the treatment of choice, although the criteria for determining the area of resection have not been established. International literature has demonstrated that recurrent disease usually occurs within 2 years and therefore a long-term careful follow-up is required.

An unusual cause of haemoptysis in a young male.

Inflammatory myofibroblastic tumours are reported to occur in a variety of sites, including the head and neck, abdominal organs, central nervous system and urinary tract. They only rarely occur in the lung. We report a case of a 25-year-old male admitted with haemoptysis. His chest radiograph showed a peripheral right lung opacity and computed tomography revealed a right lower lobe soft tissue density mass. Bronchoscopy and fine needle aspiration were unhelpful. a diagnosis of pulmonary carcinoma was made, and the patient underwent a right lower lobectomy. On pathology, the tumor was found to be an inflammatory pseudotumor. These lesion are extremely rare, constituting less than 1% of pulmonary malignancies, but are known to occur in young patients. We believe clinicians need to retain an index of suspicion for the presence of this disease in young patients, which can masquerade as more common malignancies.

A long-term survivor of Bland-White-Garland syndrome with systemic collateral supply: a case report and review of the literature.

BACKGROUND: Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a rare disease which may result in myocardial infarction, congestive heart failure and sometimes death during the early infantile period. CASE PRESENTATION: A successfully treated case of a 45-year-old mother of 2 children with Bland-White-Garland syndrome and concomitant severe mitral regurgitation is presented. Subsequent therapy consisted of ligation of the anomalous origin of the left coronary artery, anastomosis of the left internal mammary artery to the left anterior descending branch and mitral valve replacement. Continuous blood flow from the left coronary artery ostium during extracorporeal circulation and aorta clamping suggested systemic collateral supply. CONCLUSIONS: Recognition and diagnosis of Bland-White-Garland syndrome is important due to its potentially life-threatening complications.

Operative evaluation of cardiac tamponade in a patient with multiple myeloma.

Multiple myeloma presents with various clinical manifestations depending on the mode and the extent of organ involvement. Pericardial involvement by myeloma and subsequent cardiac tamponade is extremely rare. We report on the case of a patient with multiple myeloma who presented with cardiac tamponade and was evaluated surgically with thoracotomy and minimal debulking pericardiectomy (fenestration).

Metastatic squamous cell vulvar carcinoma of the lung: a case report and review of the literature.

Recurrent squamous cell carcinoma of the vulva advances locally, spreads via the regional lymphatics and hematogenous spread is late and unusual. This is a rare case of a patient with a solitary pulmonary tumor originating from squamous cell carcinoma of the vulva. According to the literature this form of pulmonary involvement has not previously been described in cases of vulvar carcinoma in the last 20 years.

The efficacy of medication on tinnitus due to acute acoustic trauma.

Seventy-two young males suffering from acute acoustic trauma with tinnitus due to gunshots were included prospectively in the study. Forty of the subjects had the left ear affected, four the right ear and the remaining 28 sustained bilateral acoustic traumas. The mean time of admission after onset of symptoms was 28 days (5-88 days). The subjects were randomly categorized into three groups: group A received trimetazidine, prednisolone and complex B vitamins; group B were treated only with trimetazidine; and group C received prednisolone and complex B vitamins. At 3-month follow up, tinnitus had been completely eradicated in only eight subjects and had in 17. No statistically significant difference was found between the three groups concerning improvement of tinnitus. However, it was found that early admission predisposed towards better prognosis. The degree of hearing improvement after medication did not seem to correlate with the relief of tinnitus.