Video-assisted thoracoscopic resection of a bronchogenic esophageal cyst.

Bronchogenic cysts are lesions of congenital origin derived from the primitive foregut. The usual presentation of bronchogenic cyst in the mediastinum is related to cyst infection or adjacent organs compression. A case of a bronchogenic esophageal cyst presenting with progressive dysphagia in a 46-year-old man is described. A video-assisted thoracoscopic excision was performed successfully. Details of the procedure are discussed.

Totally implantable central venous access ports. Analysis of 700 cases.

BACKGROUND AND OBJECTIVES: Vascular access has great importance in the treatment of patients submitted to prolonged chemotherapy. Purpose of this study is to assess the efficacy and safety of the percutaneous insertion and use of totally implantable central venous access ports (TICVAP). METHODS: During a 10-year period, 700 TICVAP were inserted into cancer patients for chemotherapy. Early and late complications and their management were recorded and analyzed. RESULTS: Of the 700 catheters implanted, 126 (18%) presented one or more types of early and late complication. Removal of 262 catheters was performed, of which 216 (82.4%) were elective indications due to the termination of the treatment and 46 (17.6%) resulted from complications that could not be controlled using clinical measures. In 280 patients (40%), the catheter remained functional until the patient's death, and 158 patients (22.5%) are still making use of their catheters for clinical treatment. CONCLUSIONS: The low rate of complications according to this study confirms the safety and convenience of the percutaneous insertion and use of TICVAP in patients undergoing prolonged chemotherapy regimens and explains the increasing use of these devices in current medical oncology practice.

Modified pleural tenting for prevention of anastomotic leak after Ivor Lewis esophagogastrectomy.

BACKGROUND: The most dangerous complication following esophagogastrectomy for esophageal cancer is anastomotic leakage. Surgical interventions described did not have a major impact in reducing the risk of occurrence. On the other hand, pleural tenting has been used for more than a decade by thoracic surgeons to prevent prolonged air leak after formal upper lobectomy with excellent results. METHODS: A retrospective analysis of 114 cases of esophagogastrectomy for cancer of esophagus or cardioesophageal junction is presented. Patients have been divided in 2 groups. In group B modified pleural tenting was used to prevent a potential anastomotic leak, while in group A, the control group, pleural tenting was not used. Evaluation of modified pleural tenting in preventing anastomotic leakage was the aim of the study. RESULTS: The pleural tenting group showed a significant decrease in anastomotic leak. In 1 patient versus 8 in group without pleural tenting the complication appeared (P = .032). The risk for an anastomotic leakage in group without pleural tenting was almost 9 times greater (odds ratio: 9.143, 95% confidence interval: lower bound 1.104, upper bound 75.708). The 30-day mortality, although lower in pleural tenting group, was not statistically significant. CONCLUSIONS: Pleural tenting is a safe, fast, and effective technique for prevention of anastomotic leakage after Ivor Lewis esophagogastrectomy. Subpleural blanketing of intrathoracic anastomosis could diminish the consequences of a possible anastomotic leak.

Renal Artery Thrombosis following Lobectomy for Lung Cancer.

Acute renal arterial thrombosis is a rare but very urgent situation demanding immediate treatment. It is characterized by unspecific symptomatology which often misleads the clinicians. As a result, precious time can be lost until the correct diagnosis is reached. The case of a 53-year-old female who underwent a left upper lobectomy for lung cancer is presented. On the third postoperative day, the patient began to complain of a flank pain located at the lower side of the left hemithorax and the nearby lumbar area. A renal arterial thrombosis was finally diagnosed and subcutaneous low molecular weight heparin was started immediately. The patient was discharged two weeks later and anticoagulation therapy with warfarin was given. Six months later, renal function remains satisfying and the patient is free of any symptoms. This is probably the first case in English literature of renal arterial thrombosis following lobectomy for lung cancer.

Pericardiectomy for radiation-induced constrictive pericarditis.

INTRODUCTION: Of oncological patients who have undergone chest radiation therapy, 20% develop radiation-induced constrictive pericarditis. The purpose of this study was to review our clinic's experience of such cases, focusing on survival and the functional outcome. METHODS: Six patients with a history of previous radiation therapy, aged 33-61 years, most of whom had symptoms of heart failure, underwent radical (2 patients) or partial (4 patients) pericardiectomy. RESULTS: All patients were completely free of cardiovascular events during the 8 years covered by the study. Among the postoperative complications the most serious was low cardiac output syndrome in 4 patients, which was treated successfully. CONCLUSIONS: Radiation-induced constrictive pericarditis is a clinical entity that should be taken into account in the differential diagnosis of oncological patients who show signs of heart failure. Surgery is the only effective treatment. The results are satisfactory, but always depend on associated damage to the myocardium as a result of radiation and on the underlying cancer.

Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases.

BACKGROUND: Malignant pleural effusion is a common sequelae in patients with certain malignancies. It represents a terminal condition with short median survival (in terms of months) and the goal is palliation. Aim of our study is to analyze morbidity, mortality and life expectancy following videothoracoscopic talc poudrage. MATERIALS AND METHODS: From September 2004 to October 2009, 400 patients underwent video-assisted thoracic surgery (VATS) for malignant pleural effusion. The conditions of patients were assessed and graded before and after treatment concerning morbidity, mortality, success rate of pleurodesis and median survival. RESULTS: The median duration of follow up was 40 months (range 4-61 months). All patients demonstrated notable improvement in dyspnea. Intraoperative mortality was zero. The procedure was well tolerated and no significant adverse effects were observed. In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. The best survival was seen in breast cancer, followed by ovarian cancer, lymphoma and pleural mesothelioma. CONCLUSIONS: Video-assisted thoracoscopic talc poudrage is an effective and safe procedure that yields a high rate of successful pleurodesis and achieves long-term control with marked dyspnea decrease.

Spontaneous chylous cardiac tamponade: a case report.

BACKGROUND: Chylous cardiac tamponade is a rare condition with little known cause. CASE PRESENTATION: A case of an otherwise healthy woman who admitted with dyspnea and palpitations is presented. She had a history of a painful flexion-hyperextension of the spine. Diagnostic evaluation proved a chylous pericardial effusion with a disruption of the anterior longitudinal spinal ligament. Video-assisted thoracic surgery with mass supradiaphragmatic ligation of the thoracic duct and pericardial window formation was carried out successfully and resulted in the complete cure of the patient's condition. CONCLUSION: Chylous pericardial effusion and subsequent tamponade is a rare entity. Endoscopic surgery is offering a safe and effective treatment.

Cutaneous skull metastasis from uterine leiomyosarcoma: a case report.

BACKGROUND: Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer. CASE PRESENTATION: A 52-year-old woman who admitted with a lung and a skull skin nodule is presented. She had a known diagnosis of uterine leiomyosarcoma following an extended total hysterectomy two years ago. Excision biopsy of both nodules revealed metastatic disease. CONCLUSION: The appearance of a cutaneous nodule in a patient with a history of uterine leiomyosarcoma might indicate a metastatic tumor lesion. Biopsy and immunohistochemistry are essential for correct diagnosis.

Tension pneumocephalus complicating Pancoast tumor resection.

A case of tension pneumocephalus following Pancoast tumor resection is presented. Conservative management was successful. The presenting symptoms and signs, diagnostic methods and options for treatment are discussed and reviewed.

Facial skin metastasis due to small-cell lung cancer: a case report.

INTRODUCTION: Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer. They are an important finding and are not often the first sign leading to diagnosis. CASE PRESENTATION: We describe the case of a 64-year-old male patient who presented with dyspnea, pleuritic pain, loss of weight and a nodule on his left cheek. A chest X-ray revealed a left upper lobe mass with mediastinal lymphadenopathy. Excision biopsy of the facial nodule revealed small-cell lung carcinoma. Palliative chemo-radiotherapy was administered and the patient survived for 12 months. CONCLUSION: A high index of suspicion is necessary for the early detection of facial cutaneous metastases. Appropriate treatment may prolong patient survival.

Synchronous left ventricular myxoma and malignant fibrous histiocytoma: simultaneous surgical management.

The occurrence of synchronous but unrelated cardiac and soft tissue tumours is extremely rare. Here we describe the case of a 62-year-old man who had a left ventricular myxoma and an unrelated synchronous malignant fibrous histiocytoma. The patient first underwent successful resection of the soft tissue tumour and in the same session emergency resection of the cardiac mass under cardiopulmonary bypass. One year after this combined operation, the patient is well, with no recurrence of either tumour.