Solitary fibrous tumor of the pleura.

BACKGROUND: The aim of this study was to evaluate the clinical behavior of solitary fibrous tumors of the pleura and consider the optimal surgical approach for these rare tumors. MATERIAL AND METHODS: We retrospectively reviewed the records of nine patients who underwent thoracotomy for tumor resection in our clinic between 1997 and 2006. RESULTS: Nine patients were operated in this period and their median age was 46 years. None of them had been exposed to asbestos. Symptoms were present in 8 patients. All patients underwent thoracotomy. The tumor originated from the visceral pleura in 7 patients and was parietal in 2. All tumors were totally excised. The median diameter of the tumors was 9 cm (range 4-24 cm). Pathological investigation reported the tumors to be a benign solitary fibrous tumor of the pleura in all 9 patients. Resection was complete in all patients. There was no postoperative mortality and no major complications. No recurrence was observed during a median follow-up of 74 months. CONCLUSIONS: Solitary fibrous tumors of the pleura are rare neoplasms and can have giant diameters. Complete surgical resection is the optimal treatment. The risk of malignant transformation of such large masses should be borne in mind.

Elective pneumonectomy for non-small cell lung cancer: factors affecting early operative mortality and morbidity.

BACKGROUND: The aim of this study was to investigate the factors influencing the morbidity and mortality of the non-small cell lung cancer (NSCLC) cases where pneumonectomy was performed. MATERIAL & METHODS: All 101 patients who had underwent a pneumonectomy for NSCLC between 1994-2001 in our hospital were included in the retrospective study. There were 97 males and 4 females with a mean age of 56+/-9.6. Factors affecting morbidity and mortality were analysed by univariate and multivariate analysis. RESULTS: The morbidity rate was 53% and the mortality rate was 9%. Morbidity was related to cardiopulmonary complications in 40% of the cases. The risk factors for cardiopulmonary morbidity with univariate analysis were age > 60 years (p = 0.004), FEV1 < 2 lt (p = 0.016), early bronchopleural fistula (p = 0.0001), tumour size > 4 cm (p = 0.033), vital capacity < 3.7 lt (p = 0.016), forced vital capacity < 3.5 lt (p = 0.033).. With multivariate analysis the risk factors cardiopulmonary morbidity were age (60 >) (p = 0.012) and tumour size > 4 cm (p = 0.043). The risk factors mortality with univariate analysis were right pneumonectomy (p = 0.025), respiratory morbidity (p = 0.0001), cardiac morbidity (p = 0.002), cell type (Epidermoid CA) (0.047), tumour size > 6 cm (p = 0.036), fluid infusion (p = 0.009), forced vital capacity < 78% (p = 0.039), forced expiratory volume in 1 second < 75% (p = 0.039), PO2 (p = 0.037), PCO2 > 42 mmHg (p = 0.023). CONCLUSION: Among the pneumonectomies performed for NSCLC, the causes of postoperative morbidity were multifactorial, however, multivariate analysis did not show any significant factor affecting the mortality, related to this procedure.

Autologous patch reconstruction to pulmonary artery for left upper lobe tumour.

A 47-year-old man presented with a cough, sweating and a 14 kg. weight loss. Chest radiography revealed a 5 x 5 cm mass at the left upper lobe. Transthoracic needle biopsy revealed a non-small cell lung cancer. There were no metastases. We performed left upper lobectomy and autologous patch reconstruction of the left pulmonary artery. The patient was discharged on the 4th postoperative day.

Spontaneous hemopneumothorax: is conservative treatment enough?

PURPOSE: Spontaneous hemopneumothorax is a rare disorder, occurring in 1% to 12% of patients with spontaneous pneumothorax. The present review was undertaken to emphasize the potential life-threatening condition of spontaneous hemopneumothorax and reassess the benefit of conservative treatment with chest tube drainage. MATERIAL AND METHODS: From 1997 to 2002, 291 cases of spontaneous pneumothorax were treated in our department. Of these, 9 (3.09%) developed hemopneumothorax (> 400 ml). The clinical features of these patients and the results of conservative and surgical management were retrospectively reviewed. RESULTS: Seven patients were treated conservatively and two required VATS and thoracotomy because of worsening clinical condition. The amount of aspirated blood ranged from 400 to 3700 ml (mean, 1533 ml). Six patients received a homologous blood transfusion. CONCLUSIONS: In conclusion, hemopneumothorax is a serious condition complicating spontaneous pneumothorax. Conservative treatment is adequate in most cases and should be performed if bleeding persists for less than 24 hours after chest tube placement.

Video-assisted repair of an eventrated left hemidiaphragm.

Video-assisted thoracoscopic surgery is emerging as a viable approach to increasingly complex intrathoracic therapeutic procedures. Here, we present a case of eventrated left hemidiaphragm caused by a blunt trauma in an elderly man. The diaphragm was repaired successfully using a video-assisted procedure, thus giving the patient the advantages of a minimally invasive operation.

Surgical treatment of pulmonary hydatid disease in children: report of 122 cases.

BACKGROUND/PURPOSE: The aim of this study was to review the authors' surgical experience in pediatric pulmonary hydatid disease focusing on clinical presentation, parenchyma saving operations, and long-term results. METHODS: One hundred twenty-two children with pulmonary hydatid cyst were treated surgically over the last 2 decades and were reviewed retrospectively. There were 66 boys and 56 girls with a mean age of 9 years. RESULTS: Pulmonary hydatid cyst was seen in 111 (91%) patients and pulmonary and hepatic cysts in 11 (9%). Lateral thoracotomy was performed in 106 (87%) patients, thoracotomy and laparotomy in 6 (5%), median sternotomy in 5 (4%), lateral thoracotomy with phrenotomy in 4 (3%), and median sternotomy with phrenotomy in 1 (0.8%). Parenchyma-saving procedures were performed in 114 patients (93%) and lung resection in 8 (7%). There was no mortality. Postoperative complication was seen in 5 patients (4%). CONCLUSIONS: Parenchyma-saving procedures without capitonnage are preferable. In patients with right or bilateral lung and coexisting cysts in the upper part of the liver, thoracotomy or median sternotomy and transdiaphragmatic approach allows the surgeon to remove the lung and liver cysts in a single operation. Median sternotomy is an alternative method for the bilateral lung hydatidosis compared with sequential thoracotomy.

Factors affecting postoperative morbidity and mortality in destroyed lung.

BACKGROUND: The presence of specific risk factors can increase the postoperative complication rate of pneumonectomy for destroyed lung. METHODS: Our experience in 118 consecutive patients who underwent pneumonectomy for destroyed lung over a 10-year period was retrospectively analyzed to evaluate the effect of specific risk factors on postoperative complications. The significance of tuberculosis, right pneumonectomy, preoperative empyema, and duration of illness longer than 36 months was examined by univariate analyses. RESULTS: The most common underlying diseases were nonspecific bronchiectasis (n = 52) and tuberculosis (n = 43). Sixty-day or in-hospital morbidity and mortality rates were 11.9% and 5.9%, respectively. The combined morbidity and mortality rate was significantly higher in patients with preoperative empyema (p < 0.003), tuberculosis (p < 0.03), and right pneumonectomy (p < 0.03). The prevalence of bronchopleural fistula was higher in patients with preoperative empyema (p < 0.02) and patients with tuberculosis (p < 0.03). CONCLUSIONS: The postoperative complication rate of pneumonectomy for destroyed lung is acceptably low. However, it is increased by preoperative empyema, tuberculosis, and right-sided resection.