Segmental bronchial sleeve resection: preserving all lung parenchyma for benign/low-grade neoplasms.

BACKGROUND: Bronchoplastic techniques are used commonly for the surgical treatment of benign or low-grade malignant neoplasms as a means of sparing healthy lung parenchyma. Because of technical difficulties, however, standard lobectomy or segmentectomy procedures are performed for the neoplasms localized in distally located tumors. We present the clinical and surgical data of 12 patients who underwent a unique surgical procedure, called by the authors of this article "segmental bronchial sleeve resection," without any pulmonary resection. METHODS: Twelve patients with benign or low-grade malignant neoplasms who underwent segmental bronchial sleeve resection to totally preserve lung parenchyma between the years 1979 and 2008 were included in the study. Data were gathered from patient records retrospectively. RESULTS: The postoperative course was uneventful for 10 patients. One of the remaining 2 patients underwent rethoracotomy because of hemorrhage, and tracheostomy was performed for the other patient because of persistent atelectasis. There was no mortality for any of the patients. CONCLUSIONS: Segmental bronchial sleeve resection is complex in technique and may have an increased risk of complications compared to a standard sleeve resection, but it is an effective and safe bronchoplastic technique for selected patients with benign or low-grade malignant bronchial tumors when performed carefully by an experienced surgeon.

Comparison of mersilene mesh-methyl metacrylate sandwich and polytetrafluoroethylene grafts for chest wall reconstruction.

We report the outcomes of patients who underwent reconstruction with Mersilene mesh-methyl methacrylate (MM-MM) sandwich and polytetrafluoroethylene (PTFE) grafts after a large chest wall resection. Between June 1990 and September 2001, 59 consecutive patients (37 men, 22 women; mean age, 48.1 +/- 11.8 years; range 22-74 years) underwent large chest wall resection (greater than 5 cm diameter) and reconstruction with prosthetic material in our department. Twenty-one patients (33%) underwent reconstruction with a PTFE graft (group 2) between 1990 and 1994, and 38 patients (67%) underwent reconstruction with an MM-MM sandwich graft (group 1) between 1994 and 2001. Operative morbidity ratios were 5.2% (2/38) in group 1 and 24% (5/21) in group 2 (p = .036). The paradoxical respiration ratio was significantly higher (p = .018) in group 2 (5/21: 24%) than it was in group 1 (1/38: 2.6%). The operative mortality ratio was 4.5% (1/21) in group 2 and 0% in group 1. Mean hospital stay was 10.6 days (range 5-21 days) in group 1 and 13.3 days (range 7-36 days) in group 2 (p = .015). The MM-MM graft is inexpensive and easy to apply, provides better cosmetic options, and offers minimal morbidity. We therefore recommend that the MM-MM sandwich graft be used rather than the PTFE graft for large defects of the anterolateral chest wall and sternum where successful prevention of paradoxical respiration is required.

Detection and typing of human papillomavirus in non-small cell lung cancer.

BACKGROUND: Lung cancer is the most frequent cause of death in both men and women. Smoking is the greatest risk factor for lung cancer and the relation of human papillomavirus (HPV) infection with lung cancer has been reported. HPV can be detected in small cell lung cancer samples with the methods like in situ hybridization, polymerase chain reaction (PCR), Southern blotting, dot blotting. OBJECTIVE: We aimed to detect and type HPV infection in non-small cell lung carcinoma tissue samples. METHODS: Tumor samples from 40 patients were collected during surgery and PCR and restriction fragment length polymorphism (RFLP) were used in order to detect HPV infection in the samples. RESULTS: Two HPV DNA were detected among 40 of the patients, revealing a low frequency of HPV in the samples. CONCLUSIONS: HPV can be regarded as an environmental factor in tumor development. There might be a relationship between HPV infection and some non-small cell lung cancers, especially in the smoking group.

Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach.

OBJECTIVES: Although the transaxillary route appears to be the optimal approach in patients with thoracic outlet syndrome (TOS), the effect of clinical features on surgical outcome remains unclear. We conducted a study to determine the clinical predictors of surgical outcome in patients with TOS. METHODS: We examined the data charts of patients with TOS who underwent operation via transaxillary approach. We investigated the possible correlations between the clinical features and surgical outcomes, and analyzed the data with logistic regression model to clarify the effect of clinical features on surgical outcome. RESULTS: A total of 127 patients with a mean age of 32.1+/-10.0 years (range 14-62 years) were analyzed. The rates of favorable and poor surgical outcomes were 82.7 and 17.3%, respectively. The subgroups of symptom duration (P=0.023), the subgroups of ulnar nerve conduction velocity (P=0.033) and the presence of cervical rib (P=0.003) showed a significant correlation with surgical outcome. Multivariate analysis revealed that the shorter duration of symptoms (P=0.017) and the presence of a cervical rib (P=0.026) had a significantly unfavorable effect on surgical outcome. CONCLUSIONS: The shorter duration of symptoms and the presence of a cervical rib may imply an unfavorable surgical outcome in patients with TOS.

Anterior transmediastinal contralateral access.

Transmediastinal approach for resection of bilaterally metastatic lung tumors, bullectomy and apical pleurectomy is a technically feasible and safe method. We report herein a 40-year-old male with a 20-year history of progressive dyspnea who underwent bilateral bullae excision through a left posterolateral thoracotomy. We tried to emphasize that a transmediastinal contralateral approach may prevent a secondary operation in patients with bilateral bullous lesions.

Single-stage transthoracic approach for right lung and liver hydatid disease.

OBJECTIVE: Human echinococcosis remains a serious health problem for the Mediterranean countries. Synchronous pulmonary and hepatic hydatid disease may occur in 4% to 25% of cases. Our experience on simultaneous surgical treatment of right lung and liver hydatid disease in patients was reviewed. METHODS: Between 1990 and 2000, 48 patients (33 female patients and 15 male patients) with synchronous right lung and liver dome hydatid cysts were operated with a 1-stage procedure. RESULTS: Six patients had previous surgical treatment of hepatic (n = 2) or pulmonary (n = 4) hydatid cyst. The pulmonary cysts were diagnosed with radiography in 18 patients and thoracic computed tomography scan in 30. The pulmonary cysts of 9 patients were bilateral. Seventy-five pulmonary cysts were seen in radiological examinations. The diagnosis of hepatic cysts was established with ultrasonography in 18 patients and upper abdominal computed tomography in 30. The total number of hepatic cysts was 48. In cases with pulmonary cysts, cystotomy and capitonnage were performed in 32 patients, only cystotomy was done in 14 patients, and wedge resection was performed in 2. Liver cysts were approached to transdiaphragmatically after the lung cysts had been dealt with and were managed with evacuation of the cysts. In the remaining cases, marsupialization (n = 2), pericystectomy (n = 1), and enucleation (n = 1) were performed. Major postoperative complications were hemorrhage (n = 1) and biliocutaneous fistula (n = 1). Hepatic recurrence was seen in 3 patients (6.2%) and pulmonary recurrence in 1 (2.1%). CONCLUSION: Transthoracic approach is a useful and a safe surgical management of both pulmonary and upper surface of hepatic hydatid cysts.

Predictors of clinical outcome following extended thymectomy in myasthenia gravis.

OBJECTIVE: Thymectomy remains as the optimal treatment of choice in patients with myasthenia gravis (MG), however, the selection criteria for surgery remains controversial. METHODS: We examined the data charts of patients with MG underwent extended thymectomy. We investigated the possible correlations between the clinicopathologic features and clinical outcomes, and analyzed the data to clarify the effect of prognostic factors on clinical outcome. RESULTS: A total of 61 patients with a mean age of 35.8 +/- 12.2 years (range, 13-66 years) were analyzed. The overall improvement/remission and clinical worsening rates were 81.9 and 18.1%, respectively. Ossermann stage (P = 0.011) and presence of mediastinal ectopic thymic tissue (P = 0.007) showed a significant correlation with the clinical outcome. Multivariate analysis confirmed Ossermann stage (P = 0.0158), and presence of mediastinal ectopic thymic tissue (P = 0.0100) as independent predictors on clinical outcome. CONCLUSION: Ossermann stage and the presence of mediastinal ectopic thymic tissue are potential predictors on clinical outcome in patients with MG undergoing extended thymectomy.

Primary repair of a sternal cleft in an infant with autogenous tissues.

A cleft sternum is a rare congenital anomaly often diagnosed as asymptomatic at birth. Clinical outcome may be unfavorable when an associated anomaly, particularly an intracardiac anomaly coexists with the defect. Primary repair should be employed in the neonatal period because the flexibility of the chest wall is maximal and compression of underlying structures is minimal. However, patients with sternal cleft may even present late in the childhood or adolescence period. We herein report a case of a 4-year-old girl with sternal cleft who showed a favorable clinical outcome following successful primary surgical repair with the use of autogenous tissues.

Surgical treatment of peripheral lung cancer adherent to the parietal pleura.

OBJECTIVES: The objective of this paper is to assess the results of surgical treatment retrospectively in a consecutive series of 85 patients with peripheral non-small cell lung cancer (NSCLC) invading parietal pleura and chest wall. METHODS: From 1994 to 1998, of the 572 patients having pulmonary resection for NSCLC, 29 patients with neoplasm involving the parietal pleura (group I) and 56 with that invading the chest wall (group II) underwent resection. RESULTS: The operative mortality rate was 3.4% in group I and 1.8% in group II. In groups I and II, pathologic N status was N0 in 20 (69%) cases, N1 in five (17%), N2 in four (13.8%) and 44 (78.6%), seven (12.5%), five (8.9%), respectively. An incomplete resection (R1) was performed in two (6.9%) patients in group I and seven (12.5%) in group II. Postoperative radiotherapy was carried out in 18 patients in group I and 46 in group II. Systemic chemotherapy was also administered in seven patients in group I and eight in group II. There was a significant difference in adjuvant therapy between the groups (P<0.05). Two patients (R1) in group I (7.4%) and 12 patients (seven patients R1+5 R0) in group II (24%) had local recurrence. There was no significant difference in local recurrence between the groups (P=12). Follow-up was completed in 79 cases (28 in group I and 51 in group II). Median survival for groups I and II were 27+/-6 and 16+/-4.6 months, respectively. Five-year survival was longer in group I than in group II (33 vs. 14%), but there was no significant difference (P=13). CONCLUSIONS: We found similar survival rates for extrapleural resection in limited parietal pleura invasion and chest wall resection in exceeded-beyond-parietal pleura invasion. The completeness of resection is important in both groups.