[Initial experiences with VATS lobectomy]. / VATS-lobectomiák kezdeti tapasztalatai.

OBJECTIVE: The authors analyse the experience of videothoracoscopic (VATS) lung lobectomies performed since December 2010 at the Thoracic Surgery Department of Markusovszky University Teaching Hospital. PATIENTS AND METHOD: 78 patients (44 men and 34 women) underwent VATS lobectomy. The average age was 61.2 years ranging from 30 to 80. The indications were peripheral malignancy (35 cases) or the suspicion of that (43 cases), presence of curable distant metastasis was not considered as contraindication. RESULTS: In the initial period the operation time was quite long, but shortly after the duration of surgery became almost similar to lobectomies via thoracotomy. Late reoperation was performed in two cases, one for chronic pneumothorax and one for port-site metastasis. 10 vessel and two bronchial injuries occurred, eight of them needed conversion into axillary thoracotomy (conversion rate 10.26%). The postoperative pain was significantly less than after thoracotomy. CONCLUSION: VATS lobectomy is a safe procedure with less surgical stress and without oncological compromise.

Egyre gyakoribbá váló megbetegedés: pulmonalis dirofilariasis.

Due to the climate change zoonoses, dirofilariasis in particular is spreading. Hence, it is likely that we will encounter with this problem more frequently in the future Our intention with this case presentation is to draw attention to the increasing number of nematodes that cause differential diagnostic problems. The patient underwent surgery with suspicion of pulmonary malignancy suggested by a peripheral rounded opacity in imaging, but histological examination revealed dirofilariasis.

[Long-term survival after lung-sparing central bronchoplastic procedures [CBPs] for malignant tumors]. / Hosszú túléléssel járó malignus tumor miatti tüdomegtartó centrális fohörgoplasztikáink.

BACKGROUND: Bronchial malignancies are leading tumour-related cause of death. Prolonged survival can only be expected after radical resections. Central bronchoplastic procedures, which save the whole lung parenchyma, however, may play a role. AIM: These bronchoplastic procedures can be good alternatives for pulmonectomies. The value of these operations can be evaluated by postoperative mortality complication, and the survival rate. MATERIAL AND METHODS: In the period of 1985-2012 we operated 7130 bronchial carcinomas. Of these, 7 cases of 80 central broncoplastics we preserved the whole lung (in one case as an alternative for inoperability, in 6 patients as an option instead of pulmonectomy). The indications were carcinoid in four cases, epidermoid carcinoma, mucoepidermoid carcinoma and main carina SCLC after induction chemo-radiotherapy. The average age of the 4 male and of the 3 female patients were 28.5 (14-58) years. In 5 cases the right main bronchus, while in one case the left main bronchus was resected and the bronchial tree was reconstructed. In one case (SCLC patient) we made a complete carina resection and end-to-end anastomosis between the trachea and the rebuilt neocarina to preserve both lungs. The anastomosis was made with 3-4/0 PDS interrupted sutures above a sterile tube (6 cases) and in one case due to a jet catheter which were positioned through the operation field into the distal part of the main healthy bronchus. RESULTS: There was no operative mortality nor bronchopleural fistula. In the early postoperative period we applied repeated bronchoscopic suctions. In the patient with carina SCLC anastomosis stenosis developed. The main bronchi were temporarily stented. This patient is fit 174 months after the intervention, the Karnofsky index mesures to 90%. Other 5 patients are alive without any consequences of recurrence nor metastasis. The patient with epidermoid carcinoma died 83 months later because of distant metastases of a SCLC, originating from the contralateral lung. The mean survival is 118 (7-233) months. CONCLUSION: In case of some properly selected localised mainstem bronchial malignancies, such as young age and low grade malignancy, radical surgical interventions can be performed with long term survival preserving the whole lung due to special CBPs. Some such successful series and case reports (under 200 cases) can be found in the literature but the long-term survival data was not demonstrated in most publications. In Hungary there has not been any publications yet on such a successful series with long term survival. These results are remarkable within international standards.

[Isolated pulmonary arteriovenous malformation (PAVM)--report of three cases]. / Izolált pulmonalis arteriovenosus malformatio (PAVM) - 3 eset kapcsán.

Isolated PAVM is rare condition and only a few cases of VATS (Video-Assisted Thoracoscopic Surgery) resection have been reported so far. Since the clinical course of PAVM is not entirely benign due to its possible progression and serious complications (paradoxical emboli, stroke, brain abscess, etc.), the most radical least invasive treatment should be chosen in all cases nowadays. Embolization may be incomplete and carries a risk of accidental systemic embolization, therefore surgical excision is the preferred method of choice. In cases of surgical resections, pulmonary parenchyma sparing techniques such as wedge resection and local excision by VATS is desirable, if possible. We present three patients who were admitted with asymptomatic pulmonary round shadow (umbra rotunda) for further investigation and treatment. We have performed two wedge resections by VATS and one segmentectomy via axillary thoracotomy. We wish to emphasize the importance of this disease to consider in differential diagnosis to avoid complications.

[Videothoracoscopic removal of ectopic liver]. / Ectopiás máj videothoracoscopos eltávolítása.

Authors present a case of an ectopic liver in the chest of a 14 year-old female patient. The lesion was discovered by screening chest X-ray and was consequently removed by videothoracoscopic surgery. A brief literature review was carried out, too.