Intraoperative Management of Hypercapnia With an Extracorporeal Carbon Dioxide Removal Device During Giant Bullectomy.

Extracorporeal CO2-removal devices have been introduced in clinical practice to provide protective and ultraprotective ventilation strategies in different settings to avoid retention of carbon dioxide. The need to facilitate lung-protective ventilation is required not only for the treatment of acute respiratory distress syndrome but also in thoracic surgery during complex operations, especially in respiratory compromised patients. This report describes a case of giant bullectomy for vanishing lung syndrome in which intraoperative hypercapnia secondary to protective ventilation was managed with a CO2-removal device (Decap-Hemodec s.

Pulmonary Metastases from NSCLC and MPLC (Multiple Primary Lung Cancers): Management and Outcome in a Single Centre Experience.

Background: This is an institutional review of surgical management of second pulmonary tumours in patients with history of Non-small Cell Lung Cancer (NSCLC) resection according to The American College of Chest Physicians' (ACCP) revision to the Martini and Melamed's criteria for the classification of multiple primary lung cancers (MPLC).

Methods: All patients who underwent iterative pulmonary resections for pulmonary metastasis (Group A) or MPLC (Group B) between 2006 and 2012 were reviewed and their survivals compared accordingly. The main criteria of insertion in Group B were different histology and the same histology with disease-free interval ≤ 4 years; we excluded loco-regional recurrence in nodes and/or on bronchial stump.

Tracheo-bronchoplastic procedures for NSCLC: single-centre experience.

Background: The purpose of this study was to assess operative mortality, morbidity, and long-term results of the totality of sleeve resections performed at our institutions over the last eight years, including sleeve lobectomies (SL), carinoplasties with total lung sparing (CP) and sleeve pneumonectomies (SP).

Methods: A retrospective review of all the patients who underwent a tracheo-bronchial resection for bronchial cancer between 2004 and 2012 was undertaken. Bronchial sleeve resections and combined bronchial and vascular sleeve resections were described.

Accuracy of transthoracic ultrasound for the prediction of chest wall infiltration by lung cancer and of lung infiltration by chest wall tumours.

Background: We wanted to determine the accuracy of transthoracic ultrasound in the prediction of chest wall infiltration by lung cancer or lung infiltration by chest wall tumours.

Methods: Patients having preoperative CT-scan suspect for lung/chest wall infiltration were prospectively enrolled. Inclusion criteria for lung cancer were: obliteration of extrapleural fat, obtuse angle between tumour and chest wall, associated pleural thickening.

Synchronous thymoma and lung adenocarcinoma treated with a single mini-invasive approach.

A 75 year-old man with a lesion in the middle lobe of the lung was discovered to also have, during the follow-up period, a mass in the mediastinum, diagnosed as a multi-thymic cyst. Both pathologies were successfully treated with a single surgical approach by video-assisted thoracoscopy. We performed a middle VATS lobectomy with complete lymphadenectomy followed by radical thymectomy without additional incision.

Surgery for non-small cell lung cancer in younger patients: what are the differences?

Background: Non-small cell lung cancer (NSCLC) in young adults is uncommon. The objective of this study was to evaluate the clinicopathological characteristics, outcomes and prognosis of people younger than 50 years old treated surgically for NSCLC.

Methods: A retrospective study was conducted using the institutional database of four thoracic surgery units to collect patients with NSCLC younger than 50 years who had undergone surgery.

Three-dimensional surgical simulation-guided navigation in thoracic surgery: a new approach to improve results in chest wall resection and reconstruction for malignant diseases.

Objectives: Oncological surgery of the chest wall should be performed to achieve free margins of at least 2 cm for metastasis or 4 cm for primary tumours. When the lesion is not visible or palpable, difficulty in identification may lead to a larger incision and a resection wider than is necessary.

Methods: We report three cases of non-palpable metastatic chest wall lesions in which the preoperative surgical planning and the intraoperative identification of the tumour, and thus the subsequent chest wall reconstruction, was supported using computer-based surgery.

Video-assisted thoracoscopic lobectomy for non-small cell lung cancer: a morbidity limiting approach in a patient on chronic hemodialysis and double agent antiplatelet therapy.

Patients with end-stage renal disease on hemodialysis undergoing surgery for lung cancer represent a high-risk group because of electrolyte imbalance, anemia, hemodynamic instability, bleeding tendency, and immunocompromised state. We describe a patient on hemodialysis with three lung adenocarcinoma of the right lower lobe as an incidental finding during the clinical course of a myocardial infarction treated with drug-eluting stent implantation and double-agent antiplatelet therapy. Considering patient comorbidities, we decided to perform a right lower lobectomy and complete lymph node dissection by a minimally invasive technique.

Thoracoscopic resection of a giant mediastinal parathyroid cyst.

Parathyroid cysts are a rare situation, unusually in the mediastinum. The preoperative diagnosis could be more difficult in some atypical topographies and imaging characteristics in particular in case of huge mediastinal cyst. In the following years traditionally, in case of intrathoracic parathyroid cysts, sternotomy or thoracotomy have been the preferred approaches.

Recurrent primary cardiac osteosarcoma: a case report and literature review.

Primary malignant cardiac tumors are very rare. Among malignant tumors, sarcomas occupy first place. In particular, primary cardiac osteosarcoma is extremely rare.

A massive post-sternotomy sternal defect treated by allograft sternal transplantation.

We report a case of a patient with complete sternal destruction after cardiac surgery, who underwent total sternal replacement with sternal allograft, titanium bars, and screws.

Paraneoplastic dermatomyositis as presentation of thymic carcinoma.

Thymic carcinomas are very rare and heterogeneous groups of anterior mediastinum neoformations with an extremely aggressive behavior. Often, the diagnosis is made in the advanced stages. Paraneoplastic syndromes associated with thymic carcinoma are extremely rare.

Sternal resection and reconstruction for local recurrence of breast cancer using the sternal allograft transplantation technique.

Sternal involvement in patients with breast cancer is relatively rare and its treatment is still controversial. Surgery is usually indicated in cases of single metastases in a multimodality protocol. Partial or complete sternectomy associated or not with the resection of surrounding tissues is the technique of choice to obtain safety margins and radical treatment of the disease.

Can topical application of tranexamic acid reduce blood loss in thoracic surgery? A prospective randomised double blind investigation.

Objective: The systemic or topical use of antifibrinolytic agents is effective in reducing postoperative bleeding and blood product transfusion in cardiac surgery. We sought to study the effect of the topical application of tranexamic acid into the pleural space to reduce postoperative bleeding after lung surgery.

Methods: This was a prospective randomised double blind placebo controlled investigation.

Desmoid tumour of the thoracic outlet in a 70 year-old man successfully removed through cervico-thoracic Dartevelle approach.

Desmoid tumours have a strong tendency for local invasion and recurrence. A 70 year-old male presented with cervical and left shoulder pain associated with a supraclavicular mass. The computed-tomography showed an expansive lesion measuring 10 cm × 6 cm × 5.

Accuracy of transthoracic ultrasound for the detection of pleural adhesions.

Objectives: In the era of minimally invasive surgery, preoperative detection of pleural adhesions can be very useful for the assessment of surgical approach, because pleural adhesions are the main contraindication to video-assisted thoracoscopy. The aim of this study was to assess the sensitivity and specificity of transthoracic ultrasound in the detection of pleural adhesions prior to thoracic surgery.

Methods: From February 2010 to January 2011, 142 consecutive patients (male, 98; female, 44; age range, 36-83 years, mean age, 63.

Allogenic sternal transplant after sternectomy for metastasis of ovarian carcinoma.

Sternal metastasis from ovarian carcinoma is extremely rare. We report a case of a young woman in whom a single metastasis at the level of the upper portion of the sternum developed. Surgical excision of the sternum was performed with replacement by a sternal allograft stabilized by titanium plates and transosseous high-tension sutures.

Surgical results and long-term follow-up of T(4)-non-small cell lung cancer invading the left atrium or the intrapericardial base of the pulmonary veins.

Patients with locally advanced non-small cell lung cancer infiltrating the left atrium (LA) or the intrapericardial base of the pulmonary veins (PVs) are generally not considered good candidates for surgery because of the poor long-term survival. In the last 10 years, 31 consecutive patients with non-small cell lung cancer directly invading the LA or the intrapericardial base of the PVs underwent surgery. Pneumonectomy was the operation performed most frequently.

Pleuropneumonectomy for stage IVa thymoma: delayed metastatic spread after multimodality treatment.

We report a case of a caucasic woman aged 55, carrying a Masaoka stage IVa thymoma, initially not suitable to surgical treatment. After induction chemotheraphy, she underwent a radical resection of the mediastinal mass combined with left pleuro-pneumonectomy. After being disease-free for 5 years, the patient first developed a splenic recurrence, then an abdominal metastasis, both treated by surgery.

Right pneumonectomy for T4 non-small cell lung cancer invading intrapericardial pulmonary vein in a patient with a right aortic arch.

A 59 year-old man with a right-sided aortic arch who had a T4 right lung cancer invading the proximal superior pulmonary vein underwent an intrapericardial-pneumonectomy with partial left atrium resection and a radical lymphadenectomy. The presence of a right-sided aortic arch required particular attention during dissection of the lymph nodes. This is the first case of a right-pneumonectomy for T4-lung cancer in a patient with a right-sided aortic arch.

Unusual delayed presentation of post-traumatic intrapericardial hernia associated with intestinal occlusion.

Aim: We report a case of a 64-year-old man, admitted to our department following the onset a few months earlier of canalization disorders and a sensation of retrosternal tension.

Material Of Study: Patient's history revealed blunt thoraco-abdominal trauma with multiple costal fractures 15 years earlier as a result of a road accident and a cholecystectomy at the age of 57. A barium meal revealed an intrapericardial displacement of some intestinal loops; as the patient suffered acute intestinal occlusion with severe abdominal pain associated with nausea and vomiting, we performed an emergency median xipho-umbilical laparotomy, making it possible to identify both the site of the retrosternal diaphragmatic laceration with intrapericardial colonic herniation and the true cause of the occlusion: an adhesion, caused by the previous cholecistectomy, which was strangulating a jejunal loop.

Boerhaave's syndrome: long free interval before successful primary repair. Case report.

Aim: Report case of a 66-year-old man come to our observation for a bilateral pleural effusion, ten days after clinical manifestations of chest pain, initially misdiagnosed with a myocardial infarction.

Material Of Study: On the same day, the patient underwent an emergency chest CT scan with orally administered contrast medium that confirmed our suspicion of breakage of the esophageal wall. The patient underwent to a left thoracotomy: the visceral pleura and all the structures covered by the parietal pleura were affected by a widespread necrotic process.

Different patterns of fundus autofluorescence related to ABCA4 gene mutations in Stargardt disease.

Background And Objective: Stargardt disease is a type of juvenile-onset macular dystrophy. The clinical presentation is characterized by macular atrophy and the presence of lipofuscin storage. The aim of this study was to investigate a possible correlation between different ABCA4 gene mutations and the autofluorescence pattern.

Pulmonary artery leiomyosarcoma successfully treated by right pneumonectomy.

A 79-year-old woman had a primary tumor of the pulmonary artery, which was initially diagnosed as chronic pulmonary thromboembolism. Multislice angio-computed tomography showed a solid mass in the right pulmonary artery. Radical resection of the tumor was achieved by right pneumonectomy via a transsternal transpericardial approach.

Solitary fibrous tumor of the pleura: surgery and clinical course in 18 cases.

Solitary fibrous tumors of the pleura are very rare neoplasms that can sometimes present with malignant features. Between 1984 and 2007, 18 cases were treated in our institution. There were 7 men and 11 women, with a median age of 56 years (range, 33-77 years).