Prognosis of stage pIIIA non small cell lung cancer after mediastinal lymph node dissection or sampling.

Purpose: The aim of this study was to define the impact of systematic mediastinal lymph node dissection (MLD) and mediastinal lymph node sampling (MLS) on the long-term results of patients suffering from non-small cell lung cancer (NSCLC) with N2 disease (pIIIA/N2).

Patients And Methods: From 1999 to 2002, patients with NSCLC in stage pIIIA/N2 were retrospectively classified according to MLD or MLS procedure. Several clinical and pathological factors such as overall survival, disease-free interval, and complications were recorded and analyzed.

The significance of one-station N2 disease in the prognosis of patients with nonsmall-cell lung cancer.

Background: A retrospective study was conducted to define the characteristics and the prognosis of N2 disease subgroups according to their patterns of spread.

Methods: From January 1993 to December 2004, 1,329 patients underwent lung resection for bronchogenic carcinoma The records of all patients with positive mediastinal lymph nodes at the surgical specimen (pIIIA/N2) after radical resection were analyzed, and the pattern of mediastinal lymphatic spread was classified according to regional spread, to skip metastasis, and to one or two or more lymph node stations, in relation to primary tumor location. Age, sex, type of resection, right or left lesion, T status, primary tumor location, tumor size, tumor central or peripheral location, histology, and survival were recorded and analyzed.

Biweekly administration of docetaxel and gemcitabine as adjuvant therapy for stage II and IIIA non-small cell lung cancer: a phase II study.

Background: The aim of this study was to determine the overall survival, progression-free survival, and toxicity associated with adjuvant administration of docetaxel and gemcitabine for completely resected patients with stage II and IIIA non-small cell lung cancer (NSCLC).

Patients And Methods: Thirty-nine eligible patients had surgical resection for pathological stage II or IIIA disease and received postoperative gemcitabine 1000 mg/m2 followed by docetaxel 80 mg/m2 on days 1 and 14. Cycles were repeated every 28 days.

Omental transposition: the final solution for major sternal wound infection.

Sternal osteomyelitis after median sternotomy for cardiac surgery is associated with considerable morbidity and mortality. The ideal reconstruction after sternal debridement is still debated. From 2000 to 2004, we treated 15 patients for sternal osteomyelitis (type IIIB, IVA, IVB) after median sternotomy for cardiac surgery.

Descending necrotizing anterior mediastinitis: analysis of survival and surgical treatment modalities.

Purpose: Descending necrotizing anterior mediastinitis (DNAM) is a severe infectious disease with a very high mortality rate. The aim of this study was to define the impact of several clinical factors on survival.

Patients And Methods: Between 1985 and 2002, 27 patients were managed for DNAM, 11 with combined transthoracic mediastinal and cervical drainage (group A) and 16 with a less aggressive surgical approach, such as cervical drainage and transcervical mediastinal drainage (group B).

Postoperative residual pleural spaces: characteristics and natural history.

This study was conducted in order to re-define the incidence and natural history of postresectional residual pleural spaces (PRS). From 1997 to 2005, 966 patients who were subjected to less than entire lung resections, were followed and any cases of PRS were recorded. The records of these patients were retrospectively analyzed for age, gender, type of resection, side, apical or basal location, size, PRS wall thickness, empyema as well as for bronchopleural fistula occurence, management, and outcome.

Muscle-sparing versus posterolateral thoracotomy: a prospective study.

Objective: Although the thoracotomy incision is guided in part by the exposure required, both cosmesis and the potential for improved recovery are important factors to be taken into account. We conducted a prospective randomized study in order to compare muscle sparing thoracotomy (MST) and standard posterolateral thoracotomy (PLT) for postoperative pain and physical function during and after hospitalization.

Material And Method: One hundred patients operated from June through December 2004 were recruited in this study.

Asymptomatic solitary mediastinal cystic lymphangioma: a rare entity.

Solitary mediastinal cystic lymphangioma is an extremely rare tumor-like abnormality of the lymphatic system, of congenital origin. From 1996 to 2003, 4 cases of solitary mediastinal cystic lymphangioma were managed in our department. The clinicopathologic characteristics were recorded and analyzed.

Surgical management of late postpneumonectomy bronchopleural fistula: the transsternal, transpericardial route.

Background: Late postpneumonectomy bronchopleural fistula (LBPF) is a serious complication. Surgical repair of the bronchial stump through a lateral thoracotomy is a dangerous attempt due to mediastinal fibrothorax and the risk of pulmonary artery stump damage.

Objectives: The goal of this study was to estimate the effectiveness of the transsternal, transpericardial approach for bronchial stump repair in case of LBPF.

Early detection of occult bronchopleural fistula after routine standard pneumonectomy.

Objective: The aim of this study was to define symptoms and signs for early diagnosis of occult bronchopleural fistula (OBPF) after routine pneumonectomy.

Patients And Method: From 1999 to 2003, 301 pneumonectomies for malignancy were performed. The records of these patients were retrospectively analyzed for several clinicopathologic factors.

The degree of oxidative stress is associated with major adverse effects after lung resection: a prospective study.

Objective: This prospective randomized study was conducted in order to define the contribution of the generated oxygen and nitrogen reactive species on postlobectomy morbidity and mortality.

Patients And Methods: Between 2001 and 2003, 132 patients with non-small cell lung cancer (NSCLC) were prospectively studied. The patients were grouped according to one-lung ventilation (OLV) use or not and to the duration of lung's atelectasis.

Massive hemorrhage caused by major pulmonary vessel-cutaneous fistula in the late postoperative period: report of two cases.

Sudden life-threatening hemorrhage caused by erosion of the wall of a thoracic blood vessel such as the aorta, pulmonary artery, or pulmonary vein, in the late postoperative period is extremely rare and presents a challenging emergency. We report the cases of two patients whose only clinical manifestation was a hemorrhagic cutaneous chest wall fistula. Both patients were treated by emergency surgery.

Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study.

Objective: A prospective randomized study was conducted in order to analyze the role of fibrinolytics in the treatment of complicated parapneumonic effusion.

Methods: From 2001 to 2004, 127 consecutive patients were managed for thoracic empyema. In all cases the cause was bacterial pneumonia.

Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation.

Objective: The authors conducted a prospective analysis in order to investigate through lipid peroxidation metabolites the generation of oxygen free radicals after one-lung ventilation (OLV).

Methods: From 2001 to 2003, 212 patients were prospectively studied for lung reexpansion/reperfusion injury. They were classified in six groups.

Late postpneumonectomy bronchopleural fistula.

Objective: The incidence of late postpneumonectomy bronchopleural fistula (PBPF) is very small after the 3rd postoperative week due to the existence of fibrothorax providing an effective natural protection against fistula formation. However, the development of late PBPF is a serious complication characterized by high morbidity and mortality. We present our modest experience in treating 11 patients with late PBPF using the transsternal transpericardial approach.

A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma.

Objectives: A prospective analysis was conducted to define the incidence of occult pneumothorax (OPX), delayed pneumothorax (DPX) and delayed hemothorax (DHX) and to propose an algorithm for surveillance.

Methods: During the last 2 years 709 consecutive patients who did not fulfill the indications for intrahospital management were examined at our emergency department for blunt thoracic injury. All patients were subjected to expiration posteroanterior chest radiograph (eCXR) and were scheduled for reevaluation after 24, 48 h and at 7, 14 and 21 days.

Spontaneous hemopneumothorax: a rare but life-threatening entity.

Objectives: Spontaneous hemopneumothorax (SHP) is a rare disorder, complicating 1-12% of patients with spontaneous pneumothorax. We conducted a retrospective review in order to study this potentially life-threatening condition and compared our experience with reports in the international literature.

Methods: Between 1970 and 2000, 3489 patients were treated in our department with spontaneous pneumothorax.

Skip metastases: analysis of their clinical significance and prognosis in the IIIA stage of non-small cell lung cancer.

Objective: To determine the clinical significance of skip metastases (pN2/S) in patients with resected pIIIA/N2 NSCLC. The incidence of pN2/S after mediastinal lymph node dissection (MLD) and sampling (MLS) were compared.

Method: From 1997 to 2000, 580 lung resections for NSCLC performed at our department.

Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report.

Background: Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy has become the most popular method for performing a gastrostomy for long-term enteral feeding. It has been associated, however, with a lot of minor and major complications.

Case Presentation: A case of mediastinitis with concominant sepsis caused by a masked esophageal perforation after percutaneous endoscopic gastrostomy in a multi-traumatized, brain-injured patient is presented.