Surgical approaches for invasive tumors of the anterior mediastinum.

Malignant tumors of the anterior mediastinum frequently appear locally advanced at the time of diagnosis, with invasion of the surrounding organs including major blood vessels, lungs, and pericardium. Surgery can be indicated either with diagnostic intent or for radical resection, usually as a part of a multimodality treatment. Extended operations with complex vascular reconstructions may be required for the complete removal of the mediastinal mass.

Successful treatment of infected residual pleural space after pulmonary resection with autologous platelet-leukocyte gel.

Complications of the residual pleural space after pulmonary resection have been reported to be between 5% and 40% depending on the type of resection, and they increase morbidity, mortality, hospital stays, and costs. The therapeutic use of autologous prepared platelet leukocyte-enriched gel is a relatively new technology for the stimulation and acceleration of soft tissue and bone healing. This gel can be applied to a diversity of tissue.

Reconstruction of the pulmonary artery for lung cancer: long-term results.

Objective: Reconstruction of the pulmonary artery in association with lung resection is technically feasible with low morbidity and mortality. To assess long-term outcome, we report our 20-year experience.

Methods: Between 1989 and 2008, we performed pulmonary artery reconstruction in 105 patients with non-small cell lung cancer (tangential resections not included).

Submucosal injection of the silver-human albumin complex for the treatment of bronchopleural fistula.

Objective: Postoperative bronchopleural fistula (BPF) is a serious complication and a therapeutic challenge in thoracic surgery. The purpose of this study is to assess the efficacy of the use of the silver-human albumin (SHA) complex injected in the bronchial submucosa for the treatment of BPF.

Methods: From January 2005 to March 2008, we treated 11 patients with BPF (seven post-pneumonectomy and four post-lobectomy) by endoscopic injection of the SHA complex into the bronchial submucosa.

Endobronchial treatment of emphysema with one-way valves.

Numerous endoscopic procedures have recently been studied and progressively introduced in clinical practice to improve mechanics and function in patients who have emphysema. Bronchoscopic lung volume reduction with one-way endobronchial valves facilitates deflation of the most overinflated emphysematous parts of the lung. These valves have been designed to control and redirect airflow by preventing air from entering the target parenchymal area but allowing air and mucus to exit.

Thymoma and thymic carcinoma.

Thymoma and thymic carcinoma are an extremely heterogeneous group of neoplastic lesions with an exceedingly wide spectrum of morphologic appearances. They show different presentations with a variable and unpredictable evolution ranging from an indolent non-invasive attitude to a highly infiltrative and metastasising one. Prognosis can be predicted on the basis of a number of variables, mainly staging, the WHO histological pattern and diameter of the tumour.

Transdiaphragmatic harvesting of the omentum through thoracotomy for bronchial stump reinforcement.

Background: We present our technique of omental flap transposition performed through a thoracotomy for bronchial stump protection, and employed over 11 years.

Methods: Between February 1997 and January 2008, the transdiaphragmatic harvesting of the omentum was performed, using an original technique through a thoracotomy approach, in 45 patients. Forty-three patients (29 male, 14 female), considered at high risk for bronchial dehiscence, simultaneously underwent pneumonectomy and 2 patients (1 male, 1 female) were treated for an early postpneumonectomy bronchopleural fistula by the standard thoracotomy route.

Surgical treatment of redundancy after retrosternal esophagocoloplasty.

Redundancy is a well-recognized complication of esophageal replacement with colonic interposition, occurring several years after surgery. In a small number of patients, symptoms are disabling and might require reoperation. This article describes the surgical treatment of a 54-year-old male presenting with severe dysphagia, malnutrition and recurrent aspiration pneumonia, progressively developed 30 years after esophageal replacement with retrosternal ileocolonic interposition for caustic strictures.

Extracorporeal removal CO2 using a venovenous, low-flow system (Decapsmart) in a lung transplanted patient: a case report.

Background: Primary graft dysfunction (PGD) is a syndrome that may occur after lung transplantation. In some cases of severe PGD, conventional therapies like ventilatory support, administration of inhaled nitric oxide (iNO), and surfactant and intravenous prostacyclins are inadequate to achieve adequate gas exchange. The only lifesaving option is to use an extracorporeal membrane oxygenator.

Thoracoscopic resection of mediastinal bronchogenic cysts in adults.

Objective: Bronchogenic cysts are uncommon congenital anomalies of foregut origin usually located within the mediastinum and the lung and rarely diagnosed in adults. Surgical excision is recommended to establish diagnosis based on histologic examination, alleviate symptoms if present, and prevent future complications. Thoracoscopic approach is becoming the primary therapeutic option.

Treatment of persistent pulmonary air leaks using endobronchial valves.

Background: Prolonged pulmonary air leaks are a significant source of frustration for patients and physicians. When conventional therapy fails, an alternative to prolonged chest tube drainage or surgery is needed. Bronchoscopic blockage of a bronchus can be performed with the hope of accelerating closure of the air leak by reducing the flow of air through the leak.

Multimodality treatment of thymic tumors.

Combined modality therapy is gaining acceptance for treating stage 3 and 4A thymic tumors. Also, specific subsets of stage 2 tumors deserve particular attention. Single-center experiences demonstrate that there are some advantages in selected groups of patients.

A prospective randomized study to assess the efficacy of a surgical sealant to treat air leaks in lung surgery.

Objective: A prospective, randomized study to evaluate the effectiveness and safety of a polymeric sealant (Coseal, Baxter Healthcare, Deerfield, IL) to reduce air leaks and to improve postoperative outcome in patients undergoing lung resection.

Methods: Between November 2005 and February 2008, 203 (128 M, 75 F) patients showing moderate/severe intraoperative air leaks after pulmonary lobectomy/bilobectomy/sleeve lobectomy (110) or minor resection (segmentectomy/wedge) (93) have been prospectively enrolled and randomly assigned to receive one of the two following management strategies: suture/stapling (101 patients--standard care group (SCG)) or suture/stapling plus Coseal sealant (102 patients--Coseal group (CG)). To assess the effectiveness of the sealant the following data were registered and compared in the two groups: number of patients with air leak cessation intraoperatively, number of patients without air leaks at 24h and 48h, duration of air leaks, length of hospital stay.

Sub-lobar lung resection of peripheral T1N0M0 NSCLC does not affect local recurrence rate.

Background And Aims: The use of sub-lobar resection versus lobectomy for stage I non small cell lung cancer is still controversial. This study was undertaken to compare the results of limited resection in terms of survival and local recurrence rate to lobectomy in patients with peripheral stage I non small cell lung cancer.

Material And Methods: During the 8 year period from 1999 to 2007, 152 consecutive patients with stage I non-small cell lung cancer underwent lung resection at our thoracic surgery unit.

Computed tomography with volume rendering for the evaluation of parenchymal hyperinflation after bronchoscopic lung volume reduction.

Objective: To assess computed tomography with volume rendering (CT-VR) as a tool to evaluate parenchymal hyperinflation before and after bronchoscopic lung volume reduction (BLVR) in patients with advanced stage emphysema.

Materials And Methods: Between March 2006 and October 2007, we have prospectively studied pre- and postoperatively by spiral multislice CT scan and functional tests seven patients (six male, one female; age range 51-77 years, mean 64) with advanced stage heterogeneous emphysema who underwent BLVR using the Emphasys one-way valves (Emphasys, Redwood City, CA, USA). CT parameters considered were: the volume of the 'target' lobe and of the entire treated lung, the diameters (antero-posterior and cranio-caudal) of the treated hemithorax and the emphysematous parenchyma rate with respect to the normal parenchyma rate of the treated lobe.

Lung transplantation for cystic fibrosis: ten years of experience.

Lung transplantation represents the only therapeutic option for patients affected by end-stage cystic fibrosis (CF). We performed 76 lung transplantations in 73 patients from 1996-2007. The mean time on the waiting list was 10+/-6 months.