Value of wedge resection for lung cancer in poor cardiopulmonary status patients.

The strategic management of primary lung cancer in patients with poor cardiopulmonary status is still controversial. The aim of this study was to ascertain the early and late results of wide-margin wedge resection with curative intent in this group of patients. Between January 1995 and January 2002, 24 patients (13 males; mean age, 69.

Pheasant rearer's lung.

A 47-year-old gamekeeper presented with an 8 month history of variable breathlessness, cough and clinical features of severe interstitial lung disease. Open lung biopsy showed an extrinsic allergic alveolitis, which we believe related to his work rearing pheasants. Initially he was resistant, despite advice, to changing his occupation but subsequently, although ceasing exposure to pheasants and beginning treatment with corticosteroids, his disease progressed to the point where he developed respiratory failure and was referred for lung transplantation.

Value of wide-margin wedge resection for solitary pulmonary nodule: a single center experience.

Objective: Despite refinements of the diagnostic procedures, often surgery remains the only option to ascertain the histopathological nature of solitary pulmonary nodules (SPN). Aim of the present study was to ascertain the value of wide-margin wedge resection (WMWR) with curative intent in a consecutive cohort of patients afflicted by SPN.

Methods: From January 1995 to January 2002, 129 patients (74 male, mean age 60.

Pulmonary sclerosing hemangiomas: new approach in patients with low cancer risk.

Three cases of sclerosing hemangioma managed differently are described. Thoracic surgeons should raise their awareness of this benign slow-growing tumor in the differential diagnosis of solitary pulmonary nodule. Radiographic evidence of expansion of such a lesion is not conclusive for malignancy, and should not affect its biological behavior.

Surgical resection of a solitary plasmacytoma originating in a rib of a patient with Castleman's disease.

Castleman's disease is a rare disorder characterized by lymphoid hyperplasia. It may present as asymptomatic involvement of one lymph node group or as a multicentric disease with systemic features. We report a patient with Castleman's disease who presented with axillary lymphadenopathy associated with a solitary plasmacytoma originating from a rib.

Accessory spleniculi in the right hemithorax.

Accessory spleniculi are present in the thoracic cavity without a history of trauma due to anomalies in the development of spleen. We report the case of a 62-year-old woman with hereditary spherocytosis and previous splenectomy with an incidental mass on a chest radiograph and an indeterminate diagnosis on needle biopsy. The probable sequence of embryological events that may explain the anatomic presence of splenic tissue in the thorax is discussed.

Gastropleural fistula originating from the lesser curve: a recognised complication, an uncommon pathway of communication.

Fistulous communications between the abdominal and the pleural cavity are rare; they implicate intra-abdominal sepsis. We present a rare case of subphrenic abscess following gastric perforation, which resulted in thoracic empyema. This report emphasises that gastropleural fistulas, although uncommon, should be considered in differential diagnoses of thoracic empyema, especially when there is a longstanding history of peptic ulceration.

Lung carcinoid related Cushing's syndrome: report of three cases and review of the literature.

Three patients with lung carcinoid related Cushing's syndrome (LCRCS) treated at Frenchay Hospital, Bristol between 1984 and 1994 are described. The first patient presented with hyperpigmentation 13 years after bilateral adrenalectomy. The second patient had no recurrence or metastases 14 years after removal of a typical carcinoid tumour.

Adult congenital lobar emphysema in pregnancy.

A young woman presented with left sided chest pain. Chest radiography revealed a hyperexpanded left upper lobe and the rare diagnosis of congenital lobar emphysema was made. She was then found to be pregnant.

Strangulated iatrogenic diaphragmatic hernia: a late diagnosed complication.

Three cases of iatrogenic diaphragmatic herniation are reported following thoracic and high abdominal surgery. Each case presented at least 6 months after the original surgery with symptoms of acute upper gastrointestinal obstruction. Diaphragmatic herniation was not considered in the initial differential diagnosis which lead to a delay in their referral.

Spontaneous rupture of a congenital diaphragmatic eventration.

A 51-year-old man presented as an emergency with acute intestinal obstruction following herniation of abdominal contents into the left hemithorax through a spontaneous rupture of his eventrated left hemidiaphragm. He underwent a left thoracotomy with reduction of the herniated abdominal contents, repair of the diaphragmatic rupture and plication of the diaphragm. He made an uneventful recovery and remains asymptomatic.

Thoracoscopy in the diagnosis and management of recurrent pleural effusions.

Between April 1984 and July 1988, 102 patients with persistent or recurrent pleural effusions investigated by conventional methods in whom a diagnosis had not been achieved were submitted to thoracoscopy under general anesthesia. A positive diagnosis was obtained in 80.3% of the patients.

Randomized trial of one-dose versus six-dose cefazolin prophylaxis in elective general thoracic surgery.

The objective of this study was to compare the efficacy of one to six doses of cefazolin as prophylaxis in general thoracic surgery using a randomized, double-blind design. Two-hundred eight consecutive patients admitted to a regional thoracic surgery unit for elective thoracotomy and lung resection were eligible for the trial. There were no wound infections in the one-dose group and two in the six-dose group (95% confidence intervals [CI]: -0.

Reflex sympathetic dystrophy associated with squamous cell carcinoma of the lung.

Reflex sympathetic dystrophy was the presenting feature in an otherwise occult case of non-metastatic squamous cell carcinoma of the lung which improved on surgical removal of the primary tumour. Reflex sympathetic dystrophy, therefore, should be considered an occasional manifestation of a paraneoplastic syndrome warranting a thorough search for underlying malignancy.

Leiomyomas of the lower respiratory tract.

Leiomyomas account for about 2% of benign tumours of the lower respiratory tract. From the relatively few cases reported in the literature, it appears that these tumours most commonly occur in the fourth decade, although one third of patients are under the age of 20 years. The distribution of leiomyomas favours the distal part of the tracheobronchial tree and the most common site for tracheal lesions is the membranous portion of the lower third.

Early decortication for the disorganized pleural space.

Early decortication is advocated for the disorganized pleural space. This series reviews 85 patients operated on for haemothorax and empyema as a result of penetrating chest trauma (61 cases), blunt chest trauma (2), post-pneumonic empyema (15), tuberculous empyema (4) and chronic pneumothorax (2). The aetiology, surgical technique and results are discussed.

Bronchopleural fistula following pneumonectomy for carcinoma of the bronchus: mechanical stapling versus hand suturing.

Four hundred fifty cases of pneumonectomy for carcinoma of the bronchus are reviewed. The incidence of bronchopleural fistula is compared in two separate groups differentiated according to whether the bronchus was closed with interrupted sutures or with the auto-suture stapling clamp. The incidence of fistula was 11.