Reconstruction of chest wall using a two-layer prolene mesh and bone cement sandwich.

Wide surgical resection is the most effective treatment for the vast majority of chest wall tumors. This study evaluated the clinical success of chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich. The records of all patients undergoing chest wall resection and reconstruction were reviewed. Surgical indications, the location and size of the chest wall defect, diaphragm resection, pulmonary performance, postoperative complications, and survival of each patient were recorded. From 1998 to 2008, 43 patients (27 male, 16 female; mean age of 48 years) underwent surgery in our department to treat malignant chest wall tumors: chondrosarcoma (23), osteosarcoma (8), spindle cell sarcoma (6), Ewing's sarcoma (2), and others (4). Nine sternectomies and 34 antero-lateral and postero-lateral chest wall resections were performed. Postoperatively, nine patients experienced respiratory complications, and one patient died because of respiratory failure. The overall 4-year survival rate was 60 %. Chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich is a safe and effective surgical procedure for major chest wall defects.

Classification and Management of Subcutaneous Emphysema: a 10-Year Experience.

Subcutaneous emphysema (SE) is a condition often causing minimal symptoms, but sometimes it can be severe and even life-threatening. This study is the first great survey about SE. The aim of this study is to classify and evaluate the etiology, signs, symptoms, and management of SE. This retrospective study was performed by reviewing patients who had been diagnosed as having SE in Rasht, between January 2001 and January 2011. We classified the severity of SE in five grades including the (1) base of the neck, (2) all of the neck area, (3) subpectoralis major area, (4) chest wall and all of the neck area, and (5) chest wall, neck, orbit, scalp, abdominal wall, upper limbs, and scrotum. We excluded all patients in grades 1 and 2, because the symptoms and signs were not significant. Statistical analysis was carried out with SPSS 18. We collected 35 cases of SE with the mean age of 53 ± 14.83 (71 % men). The most common cause of SE was pneumothorax with background of COPD and surgery in grade 5, trauma due to rib fracture in grade 4, and iatrogenicity in grade 3. We performed two bilateral 2-cm infraclavicular incisions. In our patients with infraclavicular incisions, expansion of the lung was better, and the patients' appearance improved. Infraclavicular incisions as a simple method for the management of SE can decrease the severity of SE with no cosmetic problem.

Stiff man syndrome with invasive thymic carcinoma.

Stiff man syndrome is a rare disease characterized by painful chronic spasms in the muscle and skeletal system. This syndrome is an autoimmune neurologic disorder which is associated with thymoma. We treated a 32-year-old male patient with a type C thymoma (based on the World Health Organization classification) who had stiff man syndrome. The patient underwent an extended thymectomy which brought about alleviation of his symptoms.

One stage operation for five giant hydatid cysts of both lungs and liver in a 20-year-old female.

Echinococcosis remains a significant health hazard in endemic areas, including the Middle East, Mediterranean countries and Central Asia. Pulmonary disease appears more commonly in younger individuals but bilateral pulmonary involvement is relatively rare. Concomitant pulmonary and liver hydatid disease may occur in 4% to 25% of patients with hydatidosis. A previously healthy 20-year-old femal from north of Iran without any previous history of lung or liver disease presented with complaints of right upper quadrant and right side chest pain and a low grade fever for the past one month. In imaging studies, one cyst in the left lung, two cysts in the right lung and two cysts in the liver were found. Since the cysts were symptomatic, it was decided to treat these cysts surgically. The patient underwent bilateral antero-lateral thoracotomies and phrenotomy under general anesthesia and all cysts were evacuated. The patient was discharged in good condition.

Results of short- and long-segment cardioesophageal myotomy for achalasia.

BACKGROUND/AIM: We report the results of a short- and long-segment cardiomyotomy for relief of the symptoms of achalasia. PATIENTS AND METHODS: From 1997 to 2009, 41 patients (22 men, 19 women) with achalasia underwent cardiomyotomy. Patients were divided into 2 groups [short-segment group (SSG) and long-segment group (LSG)]. SSG include 22 patients with laparotomy and 8-cm short-segment myotomy and Dor fundoplication. LSG includes 19 patients with thoracotomy and 12-cm long-segment myotomy and Belsey partial fundoplication. results: Median follow up was 48 months (range: 12-70 months). Postoperative dysphagia improved in 20 patients in SSG and in 17 patients in LSG (P < 0.001). Slow emptying sensation improved in 19 patients in SSG and in 16 patients in LSG postoperatively (P < 0.001). Heartburn was present in 2 patients in SSG and 3 patients in LSG postoperatively (P = 0.179). Radiologically, barium stasis decreased significantly from 88% to 25% in SSG and from 85% to 30% in LSG. The lower esophageal sphincter (LES) gradient decreased from 32 to 10 mmHg in SSG and from 34 to 14 mmHg in LSG (P < 0.001). CONCLUSIONS: Short-segment cardiomyotomy reduces the LES gradient and relieves obstructive symptoms.

Giant mediastinal thymolipoma in 35-year-old women.

The patient was 35-year-old women with a six-month history of difficulty breathing and chest pain. An anterior-posterior chest radiograph revealed a widened mediastinum with small lung volumes. During his diagnostic evaluation, a computed tomographic scan was performed and with huge mass in the anterior mediastinum with extension to the left and right side of pleural space. With postero-lateral thoracotomy the huge mass was resected. The patient discharged with good condition.

Results of chest wall resection and reconstruction in 162 patients with benign and malignant chest wall disease.

BACKGROUND: Chest wall resection is a complicated treatment modality with significant morbidity. The purpose of this study is to report our experience with chest wall resections and reconstructions. METHODS: The records of all patients undergoing chest wall resection and reconstruction were reviewed. Diagnostic procedures, surgical indications, the location and size of the chest wall defect, performance of lung resection, the type of prosthesis, and postoperative complications were recorded. RESULTS: From 1997 to 2008, 162 patients underwent chest wall resection.113 (70%) of patients were male. Age of patients was 14 to 69 years. The most common indications for surgery were primary chest wall tumors. The most common localized chest wall mass has been seen in the anterior chest wall. Sternal resection was required in 22 patients, Lung resection in 15 patients, Rigid prosthetic reconstruction has been used in 20 patients and nonrigid prolene mesh and Marlex mesh in 40 patients. Mean intensive care unit stay was 8 days. In-hospital mortality was 3.7 % (six patients). CONCLUSIONS: Chest wall resection and reconstruction with Bone cement sandwich with mesh can be performed as a safe and effective surgical procedure for major chest wall defects and respiratory failure is lower in prosthetic reconstruction patients than previously reported (6).