Chest wall reconstruction using biomaterials.

Background: Skeletal chest wall reconstruction can be a challenge, depending on the indication, location, and health of the patient; various materials are available. Recently, biomaterials that are remodelable (bovine pericardium patch; Veritas, Synovis Life Technologies Inc, St Paul, MN) or absorbable (polylactic acid [PLA] bar; BioBridge, Acute Innovations, Hillsboro, OR) have been introduced for reconstruction procedures.

Methods: We performed a retrospective review of all patients who underwent chest wall stabilization or reconstruction between July 1, 2009, and March 31, 2011.

Pneumonectomy for benign disease: analysis of the early and late outcomes.

Objectives: To analyse the indications, operative techniques, postoperative morbidity, mortality and long-term outcomes of patients who underwent pneumonectomy for benign lung disease.

Methods: We retrospectively reviewed our institutional database for patients who underwent a pneumonectomy for benign lung disease from January 1991 to June 2010. The data were queried for the indications for surgery, details of operative technique, development of perioperative complications, mortality and long-term survival.

Esophageal Cancer: Recent advances.

Esophageal carcinoma has, over the past decade, undergone a sea of change, not only in its pathological distribution, but also in the diagnosis, staging and subsequent management. Although the advent of better imaging techniques has helped in diagnosing patients at an earlier period, the majority of them have unresectable disease at the time of presentation. Despite aggressive treatment protocols involving either one or a combination of the options of surgery, radiation, and chemotherapy, the five-year survival remains dismal in the order of 10 to 15%.

Cervical tracheal resection: new lessons learned.

Background: Cervical tracheal stenosis can be a difficult condition to manage. Depending on the etiology, location, and extent of the stenosis, tracheal or cricotracheal resection may be required. Intraoperative decisions may predict outcome.

Low mortality after treatment for esophageal perforation: a single-center experience.

Background: Historically, esophageal perforation has been associated with significant mortality. Improvements in diagnosis, critical care, and surgical and endoscopic techniques may lead to lower mortality rates in the modern era. We reviewed our experience with the management of esophageal perforation to determine whether outcomes have improved.

Surgery for recurrent pectus deformities.

Background: Pectus repair in adults can be challenging. Standard repair has been the modified Ravitch procedure. More recently the minimally invasive Nuss procedure, used exclusively in children, has been introduced for correction of pectus deformities in adults.

Primary yolk sac tumor of the lung.

Yolk-sac tumor mimics the yolk sac of the embryo, and the presence of alpha fetoprotein in the tumor cells is highly characteristic. We present an 18-year-old boy with primary pulmonary yolk-sac tumor diagnosed postoperatively. A computed tomographic scan revealed a huge intrathoracic soft tissue mass 20 x 25 cm occupying most of the left hemithorax.

The risk of esophageal resection after esophagomyotomy for achalasia.

Background: Esophagomyotomy is the mainstay of treatment for achalasia with proven long-term success. However, in patients with a significantly dilated esophagus, many advocate esophageal resection thus forgoing an esophagomyotomy. The purpose of this study is to determine the esophagomyotomy failure rate in patients with achalasia.

Prevalence and pattern of lymph node metastasis in malignant pleural mesothelioma.

Background: The incidence and pattern of nodal metastases in mesothelioma are not well understood. This study was conducted to evaluate the prevalence and pattern of nodal metastasis in mesothelioma patients.

Methods: The study included 53 patients with mesothelioma.

Neoadjuvant chemoradiation versus chemotherapy for patients undergoing esophagectomy for esophageal cancer.

Background: Neoadjuvant chemoradiation followed by esophagectomy is currently the standard of care for locally advanced esophageal cancer. This intense preoperative regimen delays definitive resection and increases perioperative risks. With the improvement of chemotherapy agents, chemotherapy alone may be better suited for patients awaiting esophagectomy because of shorter preoperative treatment time and less associated perioperative complications.

Blunt traumatic lung injuries.

Approximately one third of patients admitted to major trauma centers in the United States sustain serious injuries to the chest. The lungs, which occupy a large portion of the chest cavity and lie in close proximity to the bony thorax, are injured in the majority of these patients directly or indirectly. A significant number of lung injuries are also associated with trauma to other critical thoracic structures.

Slide tracheoplasty applied to acquired subglottic and upper tracheal stenosis: an experimental study in a canine model.

Objective: To assess the applicability and complications of slide tracheoplasty in the management of subglottic and upper tracheal stenosis in experimental animals.

Design: Subglottic stenosis was induced in 10 dogs by cauterizing the subglottic area and the upper 3 to 4 cm of the trachea. After 21 days, the severity of stenosis ranged from 30% to 60%.

Primary malignant melanoma of the lung: review of literature and report of a case.

Less than 25 cases of primary malignant melanoma of the lung have been reported in the literature, with limited mention in the surgical literature. When published criteria are strictly applied, the actual number of cases is even fewer. We report the case of a 74-year-old man who underwent a left lower pulmonary lobectomy for a large left lower lobe mass consistent with malignancy.

Partial sleeve right pneumonectomy with carinal flap closure.

We describe a technique used in 2 patients for resection of carcinoid tumor arising from the right main bronchus and extending along the lateral wall of the lower trachea. A flap was mobilized from the non-involved membranous posterior wall of the right main bronchus, which was left attached to the carina. This was used to close the defect in the lower trachea.

Incidence of deep sternal wound infections after tracheostomy in cardiac surgery patients.

Background: Tracheostomy after median sternotomy is associated with an increased risk of deep sternal wound infection (DSWI). However, associated comorbidities in these patients make the exact risk of tracheostomy difficult to discern. Therefore, we performed a retrospective review to determine the risk of DSWI in our cardiac surgery patients who underwent postoperative tracheostomy.

Primary solitary endobronchial plasmacytoma.

Twenty-two cases of pulmonary plasmacytoma have been reported in the literature and verified by immunohistochemistry or other diagnostic tests. The treatment for this rare tumor has included various combinations of surgical resection, chemotherapy, and radiation therapy. We report a case of a middle-age man who underwent endoscopic debulking followed by laser ablation for a pulmonary plasmacytoma, which showed a prominent endobronchial location with clinical and histopathologic verification.

Twenty-six years of experience with the modified eloesser flap.

Background: Empyema thoracis is a common thoracic problem with a multitude of therapeutic options. The modified Eloesser flap (MEF) is one means of dealing with this problem in selected complicated patients. The purpose of this study is to report our 26-year experience with the MEF.

Thirty-year experience with repair of pectus deformities in adults.

Background: A plethora of studies have described repair of pectus deformities in children, but only few reports have described this repair in adults. The purpose of this study was to review our 30-year experience with surgical repair of pectus deformities in adults.

Methods: A retrospective review of all adult patients (> 16 years old) who underwent repair of congenital pectus deformities from 1971 through 2001.

Delayed intrathoracic rupture of herniated Nissen fundoplication: report of two cases.

We report 2 patients who presented with rupture of a laparoscopic Nissen fundoplication in the left chest. These were successfully managed by closure of the perforation over a tube drainage that was brought under the diaphragm as a controlled fistula.

Granulomatous Pneumocystis carinii pneumonia complicating hematopoietic cell transplantation.

Pneumocystis carinii pneunonia (PCP) is associated with a wide spectrum of clinical and histopathological presentations. While granulomatous PCP uncommonly occurs in AIDS patients, it is extremely rare in other non-AIDS immunocompromised patients. We identified three patients who developed granulomatous PCP after bone marrow or blood stem cell transplantation.

Giant mediastinal chordoma.

A chordoma is a slow-growing tumor representing about 5% of all malignant bone tumors. Mediastinal chordoma is very rare. We report a giant thoracic chordoma in a 32-year-old woman who presented with chest pain, progressive dyspnea, and cough.

Chest wall resections and reconstruction: a 25-year experience.

Background: Chest wall defects continue to present a complicated treatment scenario for thoracic and reconstructive surgeons. The purpose of this study is to report our 25-year experience with chest wall resections and reconstructions.

Methods: A retrospective review of 200 patients who had chest wall resections from 1975 to 2000 was performed.