[Recent concepts regarding the treatment of traumatic hemopneumothorax]. / Recenti acquisuzioni sul trattamento dell'emopneumotorace traumatico.

BACKGROUND: The aim of the study was to examine the different therapeutic options for traumatic hemopneumothorax and in particular the latest concepts (videothoracoscopy). METHODS: A retrospective study was performed on a group of 20 patients with post-traumatic hemothorax and/or pneumothorax attending the emergency department at Ospedale Vittorio Emanuele in Catania over the past 10 years where 2500 patients with abdominal and/or thoracic trauma were treated during the same period. The patients included 18 males and 2 females with a mean age of 35 years (range 13-70). The cause of injury was a gunshot wound in 8 patients, a blunt trauma following a road accident in 9 and a stab wound in 3 patients. A drainage tube was inserted in 15 patients (a videothoracoscopic approach was used in 2 cases); 3 patients required a diaphragmatic suture and 2 thoracotomy (inferior lobectomy and repair of the main left bronchus). RESULTS: Three out of 20 patients died with an overall mortality rate of 15%. Two patients died respectively from severe brain and abdominal injuries associated with thoracic trauma, while the third patient died from septic complications. CONCLUSIONS: In the past few years videothoracoscopy has allowed a different approach to be used in patients affected by hemo-pneumothorax since it allows a more accurate diagnosis (extent and origin of bleeding, identification of associated diaphragmatic lesion) and the possibility of treating pleuro-pulmonary injuries without performing extensive thoracotomies.

[An update in the diagnosis and treatment of tumors of the hepatic portal]. / Attualità nella diagnosi e nel trattamento dei tumori della placca ilare.

BACKGROUND: Cholangiocarcinoma affecting the cross of the bile ducts is a tumour which has, although treatments, a high rate of mortality. METHODS: Between January 1986 and January 1996 six patients affected by Klatskin's tumor were studied; three of them underwent operation and were treated with insertion of a T tube (Kerr), whereas the other three were managed endoscopically with trans-tumoral stenting. RESULTS: The survival rate was about seven months for patients who underwent operation and fifteen months for patients managed with endoscopic stenting. CONCLUSIONS: After a review of the literature and according to personal experience, it is underlined that only an early diagnosis can achieve best results, since the latest knowledge about hepatic anatomy derived from transplants allows more extensive resections.