Is there a role for prophylaxis against atrial fibrillation for patients undergoing lung surgery?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether prophylactic anti-arrhythmic drugs may prevent atrial fibrillation (AF) following lung resection. Altogether 457 papers were found using the reported search, of which 14 presented the best evidence to answer the clinical question.

Pectoral myoplasty for recurrent pneumothorax: an extrathoracic solution to an intrathoracic problem.

The recurrence rate of spontaneous pneumothorax in patients with underlying lung disease can be as high as 50%. We present a novel method of treatment for recurrent pneumothorax based on the intrathoracic transfer of an extrathoracic muscle flap.

Anesthetic management of laser surgery for central airway obstruction: a 12-year case series.

The retrospective 12-year experience of anesthetizing patients with central airway obstructions for laser treatment with a CO2 and two types of Nd:YAG laser has been reviewed and evaluated. More than 300 patients have been treated, many on several occasions. The beneficial effects of treatment to the majority of patients have been significant.

Evaluation of routine postoperative chest X-rays in the management of the cardiac surgical patient.

Objectives: To evaluate the role of routine chest X-rays in the management of patients post cardiac surgery.

Methods: 340 adult patients undergoing cardiac surgery were studied in three consecutive groups (A, B, C) of 100 patients each. Forty patients were excluded due to the intensive care stay greater than 36 h (n = 35), or early mortality within 36 h (n = 5).

"LIMA fissure" for a tension-free IMA graft in emphysema.

Tension on the mammary artery pedicle is a major concern during coronary artery bypass in asthmatic patients with emphysematous lungs. We are sharing here a simple and effective solution to this problem.

Video-assisted thoracoscopy in the evaluation of penetrating thoracic trauma.

The management of patients who present with penetrating thoracic trauma but are haemodynamically stable may be subjective and imprecise. We report our initial experience with the use of video-assisted thoracoscopy in a series of five patients in whom accurate assessment was achieved and unnecessary thoracotomy avoided.

Primary malignant melanoma of the bronchus.

A rare case of primary malignant melanoma of the bronchus is described. Before considering this diagnosis, metastasis from an occult primary must be convincingly excluded and the tumour should conform to certain guidelines. This patient presented with a solitary lung tumour for which she underwent left lower lobectomy and continues to be tumour free 54 months after surgery.

Cholelithoptysis and empyema formation after laparoscopic cholecystectomy.

Thoracic complications of laparoscopic operations are rare. We describe a case of cholelithoptysis due to a gallstone sequestered in the middle lobe after laparoscopic cholecystectomy.

Video-assisted thoracoscopic pleurectomy in the management of malignant pleural effusion.

Study Objective: To evaluate the outcome of pleurectomy using video-assisted thoracic surgery (VATS) for pleurodesis in patients with malignant pleural effusion.

Design: Cohort prospective study. Follow-up of patients from referral for thoracoscopy to death.

Carbon dioxide laser bronchoscopy--a review of its use in the treatment of malignant tracheobronchial tumours in 142 patients.

We report our experience over an 8-yr period, 1984-1991, of the use of the carbon dioxide (CO2) laser in the treatment of otherwise inoperable malignant tracheobronchial lesions. In that period 142 patients (84 male, 58 female; median age 63 years) underwent 278 procedures. The trachea was the site of treatment in 44 patients, the carina in nine, a main bronchus in 80 and a lobar bronchus in nine.

Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax.

In a prospective comparison, 60 patients suffering from complicated spontaneous pneumothorax were randomly allocated to receive treatment by a video-assisted thoracoscopic surgery (VATS) technique or by thoracotomy. Thirty patients underwent bullectomy and apical pleurectomy by VATS performed through three 2-cm incisions (group V) and 30 patients underwent a similar surgical procedure through a posterolateral thoracotomy (group T). The median operating time was significantly longer in group V (45 versus 37.

Videothoracoscopic operation for secondary spontaneous pneumothorax.

Thoracotomy for the management of a secondary spontaneous pneumothorax is associated with a high perioperative risk related to the presence of underlying lung disease. Videothoracoscopy offers the potential therapeutic benefits of a minimally invasive approach. We report on a series of 22 patients (19 men and 3 women) with a mean age of 70 years (range, 46 to 92 years) who underwent videothoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax.

Radiopharmaceutical uptake as a marker of sternal blood supply following internal mammary artery harvesting.

To evaluate the impact of internal mammary artery harvesting on sternal blood supply after open heart surgery, a conventional bone scan was performed 7 days after operation in 30 patients. After administration of 370 MBq of technetium 99 m-medronic acid complex, imaging was carried out at the level of the sternum and including the humerus as a reference. A quantitative analysis of uptake (sternum/humerus uptake index) was performed and compared in three different groups of patients: group A, ten patients who had only vein grafts or valve surgery; group B, ten patients with single internal mammary artery harvesting; and group C, ten patients with bilateral internal mammary artery harvesting.

Videothoracoscopy in the diagnosis of intrathoracic pathology: early experience.

We report our experience using the new technique of videothoracoscopy in the diagnosis of intrathoracic pathology. In the last 12 months, 40 patients (24 male; 16 female) have undergone investigation by this method. Lung biopsy has been performed in 17 patients, pleural biopsy in 20 patients and mediastinal biopsy in three patients.

Videothoracoscopy in the treatment of spontaneous pneumothorax: an initial experience.

We report an initial experience with the new and potentially advantageous technique of videothoracoscopy in the treatment of pneumothorax. A series of 18 consecutive patients (14 male, 4 female) presenting with spontaneous pneumothorax over a 4-month period underwent surgical treatment by this method. The indication for surgery was recurrent pneumothorax in nine patients and persistent air leak in the remainder (median duration 15 days, range 5-28 days).

Bronchial rupture secondary to blunt chest trauma.

Bronchial injury due to blunt chest trauma is rare, and its rarity and the fact that it has two distinct modes of presentation may considerably delay diagnosis. Two recent cases illustrate the two main types of injury and presentation. In the first the rupture is intrapleural and air escapes into the pleural space; insertion of a chest drain leads to a continuous air leak.

Upper gastrointestinal dysmotility in heart-lung transplant recipients.

Recipient pneumonectomy and the necessity for meticulous hemostasis in heart-lung transplantation can result in injury to the vagus nerves as they course through the posterior mediastinum, with consequent delay in gastric emptying. This has been reported to lead to chronic aspiration and associated pulmonary sequelae. To study the association between delayed gastric emptying, bronchiectasis, and bronchiolitis obliterans after heart-lung transplantation, we performed esophageal manometry, 24-hour pH monitoring, and radioisotopic gastric emptying in 10 patients who underwent heart-lung transplantation.

Nonsteroidal antiinflammatory drugs for postthoracotomy pain. A prospective controlled trial after lateral thoracotomy.

Diclofenac (Voltarol) as an adjunct to papaveretum for pain relief was examined by a prospective, randomized trial in 44 patients who had lateral thoracotomies. Patients given diclofenac, 75 mg intramuscularly twice daily, required less papaveretum in the first 3 days after operation (p less than 0.005) and had lower pain scores on a visual analog scale on all 5 postoperative days (p = 0.

Palliation of malignant tracheal strictures using silicone T tubes.

The use of silicone T tubes for intubation of malignant tracheobronchial strictures may provide some degree of palliation of this distressing condition. It was used in seven patients with malignant lesions and two with benign strictures (resulting from tracheal trauma and lung transplantation). Four patients (two with cancer) are still alive and well with the tube in position.

Use of a fenestrated silicone drain to stent a malignant tracheobronchial stenosis.

An innovative use of a fenestrated silicone drainage tube as an endobronchial stent is reported. The patient had respiratory obstruction due to a carinal tumour and laser photoresection had failed to restore airway patency.

EEA stapler in oesophagogastrectomies.

A retrospective study was conducted to evaluate the use of the EEA circular stapler in the construction of oesophagogastric anastomoses. Eighty five consecutive patients were subjected to oesophageal resections. There were 58 males and 27 females.

Subacute rupture of a pseudoaneurysm formed by late rupture of a true left ventricular aneurysm.

A man aged 34 in whom rupture of a true aneurysm at least four weeks after acute myocardial infarction led to the development of a pseudoaneurysm is described. Because the pseudoaneurysm ruptured subacutely and the haemodynamic, clinical, and echocardiographic signs were not consistent, diagnosis of the cardiac rupture was delayed. Operative repair was successful, but the patient died.