[Pulmonary resections for cancer in the octogenarian]. / Résections pulmonaires pour cancer chez l'octogénaire.

UNLABELLED: More and more elderly subjects are offered for pulmonary resection. The object of this study was to review the results of excision for cancer in octogenarians. PATIENTS: 51 consecutive patients (44 men, 7 women) with a mean age of 82 years (80-91) were operated on. 31 lobectomies, 2 bilobectomies, 13 pneumonectomies, 1 segmental resection and 4 exploratory thoracotomies were carried out. 17 tumours were classed as stage I, 15 as stage II and 15 as stage III. RESULTS: 38 patients (75%) had uncomplicated post-operative periods; the predicted factors for complication were the existence of weight loss and alteration of respiratory function. 2 patients (4%) died in the post-operative phase. Neither the type of operation, the staging or the existence of cardiovascular dysfunction had any influence on the post-operative phase. The level of the survival at 3 and 5 years was 39% and 16% respectively. 30% of the late deaths were related to intercurrent events. CONCLUSIONS: Pulmonary excision may be envisaged in an octogenarian who is in good physical and intellectual state with a limited tumour. This surgery in general is applied to a population which probably only marginally consists of octogenarians but the results here justify their inclusion in the indications for selection.

[Pulmonary sequestration. Surgical aspects based on 61 cases]. / Les séquestrations pulmonaires. Aspects chirurgicaux à propos de 61 observations.

Between 1955 and 1989, 61 patients (33 men, 28 women; mean age: 20 years) were operated upon for lung sequestration. Sequestration was intralobar in 49 cases and extralobar in 10 cases; both types were present in 2 cases. The abnormality was discovered by chance in 15 patients (24%). The most frequent clinical manifestations were those of recurrent bronchopneumonia (54%). X-ray films of the chest showed an apparently benign, posterobasal image in 88% of the cases. Arteriography was performed in 40 patients and revealed an abnormal systemic artery in 28. An abnormal artery was found by the surgeons and the pathologists in all cases. The intralobar type of sequestration was treated, by preference, by lobectomy, and the extralobar type by sequestrectomy. Problems were encountered in 5 cases: 2 wounds of an unrecognized artery and 3 difficult bleeding controls which required aortic clamping. The operative mortality was nil, and the morbidity rate was 5%. Computerized tomography and magnetic resonance imaging can confirm the diagnosis of pulmonary sequestration, but arteriography seems to be the best method to ascertain the diagnosis and guide the surgical procedure. Surgery is the rule in case of doubtful diagnosis or to treat symptomatic sequestration.

[Cutaneous ascites as complication of the placement of a totally implantable arterial system]. / Filtrazione ascitica cutanea come complicanza del posizionamento di un sistema totalmente impiantabile arterioso.

The Authors report the case of a patient with intrahepatic colangiocarcinoma, operated on for totally implantable arterial device (TIAD) implant in view of hepatic chemotherapy. The postoperative course was characterized by cutaneous drainage of ascites fluid from the wound of the TIAD implant. Its aetiology and therapy are discussed.

[Malignant mesothelioma located in the pleura: its radical surgical treatment]. / Il mesotelioma maligno localizzato della pleura: trattamento chirurgico radicale.

The authors report a rare case of localized malignant pleural mesothelioma infiltrating the thoracic wall. The absence of widespread pleural involvement allowed for a radical operation with removal of a large portion of the thoracic wall. However, due to rarity of such tumor, an hypothesis on long term prognosis is difficult to formulate.

[Pleuroscopy and talc pleurodesis in recurrent pleural effusions: experience with 51 cases]. / Pleuroscopia e talcaggio nei versamenti pleuric recidivanti: esperizena su 51 casi.

From January '92 up to January '94 thoracoscopy was performed in 51 patients with recurrent pleural effusion: 49 of these patients underwent talc pleurodesis. 10 pleural mesotheliomas, 29 diffuse metastasic pleural involvement and 12 benign effusions were diagnosed. Intrapleural talc therapy allowed a definitive pleurodesis in 43 patients with a success rate of 87%.

[Leiomyosarcoma of the inferior vena cava: description of a new case and review of the literature]. / Leiomiosarcoma della vena cava inferiore: descrizione di un nuovo caso e revisione della letteratura.

A case of primary leiomyosarcoma of the inter-renal vena cava is reported. This tumor is rare and up to date no more than 100 cases have been reported. Surgical treatment consisted in the removal of vena cava from the iliac veins to the suprahepatic veins with right nephrectomy. Restoration of vena cava and left renal vein continuity was not necessary because of the presence of collateral venous circulation at the time of operation. Venous ligation was haemodynamically well tolerated and the patient is disease-free at one year from operation. However, despite surgical radicality, prognosis remains poor given the frequency of metastases reported in more than 35% of cases.

[Tracheal resection-anastomosis in carcinoma of the thyroid infiltrating the airways. A case report]. / Resezione--anastomosi tracheale per carcinoma della tiroide infiltrante la via aerea. Caso clinico.

The Authors report a case of thyroid carcinoma with tracheal involvement. Since the neoplastic invasion of the trachea was 3 cm long total thyroidectomy with sleeve tracheal resection and immediate reconstruction with end-to-end anastomosis were performed. The diagnostic and therapeutic approach is discussed and the Literature data reviewed.

[Surgical treatment of spontaneous pneumothorax: comparison of thoracotomy and thoracoscopy]. / Trattamento chirurgico del pneumotorace spontaneo: toracotomia e toracoscopia a confronto.

The video-thoracoscopic treatment of spontaneous pneumothorax currently has the same role of laparoscopic cholecystectomy in abdominal surgery. The Authors consider thoracoscopic approach and traditional thoracotomy examining advantages versus disadvantages, comparing 50 patients with spontaneous pneumothorax treated by thoracoscopy, from February 1992 up to February 1995, and 50 patients, previously treated by open surgery. Video-thoracoscopy has the same percentage of recurrences of thoracotomic approach but assures a quicker functional recovery and, above all, a remarkable reduction of pain.