[Esophageal perforation during nasogastric tube insertion in a patient with right-sided aortic arch and thoracic aorta. Pathophysiology and surgical implications]. / Perforation oesophagienne par sonde nasogastrique avec arc aortique droit et aorte descendante à droite. Physiopathologie et particularités chirurgicales.

Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.

[Esophageal perforation during nasogastric tube insertion in a patient with right-sided aortic arch and thoracic aorta. Pathophysiology and surgical implications]. / Perforation oesophagienne par sonde nasogastrique avec arc aortique droit et aorte descendante à droite. Physiopathologie et particularités chirurgicales.

Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.

[Experimental left orthotopic mono-pulmonary transplantation swine model]. / Model experimental porcin de transplant mono-pulmonar stâng ortotopic.

UNLABELLED: The swine model is an orthotopic pulmonary transplantation model often uses in the transplantation experiments. The purpose of this study is to control the transplantation technique on swine model and perform the learning curve of this procedure, as much from surgical than anaesthetic point of view. METHODS: 20 orthotopic left pulmonary transplantations were performed on 20 pairs of domestic female pigs, weighting 30-35 kg. Tracheal intubation's time, monitoring time, bronchial, arterial and venous anastomosis time, warm ischemia time, were recorded. The causes of morbidity and mortality were also analyzed. RESULTS: Bronchial anastomosis was a running mattress suture. All bronchial anastomoses were airtight. Arterial anastomosis was a running mattress end-to-end anastomosis. The venous return was carried out by a left atrium-venous running mattress suture anastomosis. Satisfied blood flows in all arterial and venous anastomoses were obtained. CONCLUSIONS: We established an experimental swine model of pulmonary transplantation. The anaesthetic and surgical team performed their learning curve. Various anastomoses times and consequently, the total time of the intervention, were shortened.

[Minimally invasive combined surgical treatment in a case of bilateral pulmonary hydatidosis]. / Tratament chirurgical mini-invaziv combinat într-un caz de hidatidoza pulmonara bilaterala.

The minimally invasive surgical techniques had an explosive development in the last 15 years. In thoracic surgery, these techniques were rapidly adopted, especially because of medical advantages, but also for aesthetic reasons. We present the case of a 33 years old patient, with bilateral pulmonary hydatidosis, treated in one-stage surgery, by VATS (video-assisted thoracic surgery) and thoracoscopic approach. The post-operative course was uneventful and the patient was discharged in five days. In selected cases, of patients with uncomplicated hydatid cysts, the minimally invasive surgical approach is not only possible, but probably also indicated.

[Single-stage operation in simultaneous pulmonary and liver hydatic disease]. / Tratamentul chirurgical într-o singura sedinta operatorie al maladiei hidatice hepato-pulmonare.

The most frequent association of hydatic disease lesions is hepatic and pulmonary localisations. It is generally admitted that surgical treatment is the only effectiveness treatment in hydatidosis. The classic approach is the two-stage surgical interventions of pulmonary and liver localisation or one-stage extensive thoraco-phrenic-laparotomy, exclusively reserved to right pulmonary hydatic cysts associated with hepatic dome localisations. The study presents single-stage operation by thoracotomy or mini-invasive thoracic surgery and laparotomy or laparoscopy, or single-stage thoracic approach, as alternative of classic attitude and evaluates the results in 10 patients with synchronous pulmonary and liver hydatic cysts. Overall observations are-encouraging.

[Thoracoscopic splanchnicectomy--a method of pain palliation in non-resectable pancreatic cancer and chronic pancreatitis]. / Splanhnicectomia toracoscopica--metoda de paliatie a durerii în cancerul pancreatic nerezecabil si pancreatita cronica.

Severe upper abdominal pain is a dominant and distressing feature in advanced pancreatic cancer and in chronic pancreatitis. A way of palliation needs to be practiced in the non-resectable pancreatic cancer in order to control the pain. Between the many methods of palliation the thoracoscopic splanchnicectomy seems to be the best due its simplicity, no risk to the patient and the good results. In the Center of General Surgery and Liver Transplantation from Fundeni Clinical Institute we have practiced 50 thoracoscopic splanchnicectomies in a number of 49 patients during a period of 3 years. The morbidity was 2% and the mortality 0. We noticed a significant improvement in the pain score, the quality of sleep and the overall quality of life and consecutively a quick social reintegration of these patients. The quality of life is greatly improved (with a significant reduction of the pain score in 92% of the cases) after this minimally invasive procedure, a fact the qualifies this procedure as the technique of choice in these patients.

[Results of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer: importance of the lymph node involvement prevalence]. / Résultats des ponctions ganglionnaires transbronchiques sous contrôle d'une écho-endoscopie bronchique: importance de la prévalence.

OBJECTIVE: We studied the non-surgical invasive staging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and we detailed the differences of our series, in order to understand the criteria allowing to achieve a better performance. METHODS: Retrospective observational study conducted between 2007 and 2011, including all patients with proven NSCLC who underwent EBUS-TBNA. RESULTS: For the 92 EBUS-TBNA performed, we found a sensitivity of 78%, a specificity of 93%, a positive predictive value (PPV) of 98%, a negative predictive value (NPV) of 45%, an accuracy of 80% and a prevalence of lymph node involvement at 84%. A learning curve has been demonstrated and a significant difference was found based on the number of punctures by procedure (P=0.02) or on histological type (P=0.02). By analyzing the data of the literature, we have been able to demonstrate that the accuracy and the negative predictive value are correlated with the prevalence. If we take into account this correlation, we can consider the results of our study close to those of the literature. CONCLUSION: We highlighted a number of criteria that will influence the diagnostic yield of EBUS-TBNA. While some have already been described, other criteria such as histological type or patient selection criteria are less discussed. The key point is the correlation between the prevalence and EBUS-TBNA results. Results of the assessment of lymph node involvement techniques should be interpreted according to the prevalence of lymph node involvement.

[Surgery for bronchiectasis]. / Chirurgie de la dilatation des bronches.

The incidence of bronchiectasis has declined significantly in industrialized countries and its management has also changed because of the progress of antibiotic therapy. However, for some patients, medical treatment is not sufficient to control the disease and the quality of life is affected. Surgical treatment is then a very good alternative, when a gesture of complete resection of the affected areas is feasible in terms of lung function and it allows, with a low morbidity and mortality, for very satisfactory long-term results and slows down the progression of the disease. In cases of diffuse and inhomogeneous bronchiectasis, a gesture of incomplete resection of cystic, non-perfused and suppurative areas improves symptoms and reduces recurrent infections. When the bronchiectasis is diffuse, but homogeneous, associated with severe respiratory failure, lung transplantation should be considered. Therefore, surgery remains important in the management of bronchiectasis. Its indications and the lung resection gesture to achieve should be discussed based on the symptoms, imaging examinations and the lung function of the patient.

[Schwannoma of the vagus nerve: diagnostic strategy and therapeutic approach]. / Schwannome médiastinal bénin du nerf vague: stratégies diagnostique et thérapeutique.

INTRODUCTION: Scwhannomas are uncommon neurogenic tumors of the mediastinum. Most of them are located in the posterior mediastinum usually in the paralateral gutters. We report the case of an uncommon localisation of such a tumour appended to the right vagus nerve in the middle mediastinum. CASE REPORT: The patient was 50 years old and complained of thoracic pain, shortness of breath and dysphagia. CT scanning of thorax and abdomen revealed a heterogeneous mass in the middle mediastinum, which was not visible on plain radiography. Further investigation included transoesophageal ultrasound and PET scan. The diagnosis was confirmed by histopathology after mini video-assisted thoracotomy. The schwannoma was entirely removed without any post-surgical complications. CONCLUSION: We report a novel case of schwannoma arising from the vagus nerve and review the diagnostic strategies. PET scanning has poor sensitivity and specificity and does not therefore contribute to confirm the diagnosis which depends on exploring the mediastimun surgically.