Is video-assisted thoracic surgery justified at first spontaneous pneumothorax?

OBJECTIVE: The fundamental role of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax is generally acknowledged today. This study intends to evaluate whether VATS is justified at the onset of a first spontaneous pneumothorax through analysis of parameters tested on two group of patients treated respectively with pleural drainage and VATS. PATIENTS/METHODS: The study includes 70 patients affected by first spontaneous pneumothorax divided into two groups of 35 patients for the purpose of therapeutic treatment. The first group underwent pleural drainage while the second underwent VATS. Parameters analyzed were as follows: (1) prolonged air leaks (more than 6 days); (2) time required for pleural drainage; (3) time of hospital stay; (4) management costs; (5) recurrences (follow-up at 12 months). RESULTS: Prolonged air leaks occurred in four patients (11.4%) in the first group and two patients (5.7%) in the second; recurrences occurred in eight patients in the first group (22.8%), and only one in the second group (2.8%). Mean time for drainage and hospitalization was, respectively, 9 and 12 days in patients with pleural drainage against 3.9 and 6 days of those using VATS. Average management costs per patients including hospitalization was calculated at $2,750.00 per patient for the first group compared with$1,925.00 for the second group. CONCLUSIONS: The use of VATS at first spontaneous pneumothorax is justified in the interest of both patients and health administrations as demonstrated by the number of recurrences in patients in the first group and economy savings resulting from use of VATS

Giant metastatic small bowel and mesentery localization and pleural secondary to breast cancer. Case report

The authors present a case of a patient with double metastatic abdominal and thoracic localization coming from breast cancer. Peculiarity of this case concerns both the considerable size of metastatic abdominal mass (11 centimetres of the major axis for a weight of almost half a kilogram) and the swift development of the relapses at distance, even in the presence of an original tumour at first stage. Both abdominal surgical operation of the removal of the mass and diagnostic video assisted thoracoscopy (VAT) are described

Attuale ruolo dell’open window thoracostomy

The Open Window Thoracostomy (OWT) surgical method find its origin in the treatment of chronic tuberculous empyemas, in the cases where the drainage alone not permitted a sufficient cleaning of pleural cavity. In the recent years the indications for the execution of this method are extended also to metapneumoniae and post-pneumonectomy empyemas (for benign and malignant pathology), with or without bronco-pleural fistula, when these pathologies produces a general severe decline in the patient (septic shock). This method permit to effect a daily cleaning of a pleural cavity, through the introduction of a sterile gauzes imbued of specific antibiotic, reducing at least the purulent infection effects's previously present and favouring the reduction of the same cavity, in prevision of other reconstructive operations (thoracoplasty). Generally not many beloved by surgeons and patients (for the difficult management, aesthetic outcomes, the long stay in hospital), the OWT can often reestablish a dangerous situation, especially in the patients with a risk of septic shock. This study aims to analyse present indications, problems and therapeutics outcomes of this method, through the evaluation of 27 cases of OWT treated in the Department of Thoracic Surgery University of L'Aquila between the 1984 and the 1998

Anestesia totalmente endovenosa nella toracotomia con ventilazione monopolmonare

BACKGROUND: The aim of this study was to evaluate the benefits of total intravenous anaesthesia (TIVA), with the administration of drugs intravenously and the maintenance of pulmonary ventilation with oxygen enriched air, with respect to inhalatory anaesthesia, in thoracotomies with single lung ventilation. METHODS: The study, devoloped in collaboration between the Service of Anaesthesia and Resuscitation and the Division of Thoracic Surgery of the Hospital of Teramo, was carried out in two groups of patients chosen at random; fifty patients divided into two groups of twenty-five were studied. Pre-medication and induction was similar in both groups; maintenance, however, varied: a total intravenous anaesthesia was given to patients in group A whereas patients in group B received an inhalatory anaesthesia. These parameters were considered: pressure values, heartbeat, PaO2 and PaCO2 levels, SatO2 and EtCO2. RESULTS: Both protocols respected anaesthetic guidelines in terms of controlling pressure values, heartbeat and levels of PaCO2 during bipulmonary ventilation. Significantly statistical differences were observed in the oxygenation during one lung ventilation: the mean values of PaO2 being significantly higher in group A. CONCLUSIONS: On the basis of this experience, it can be conclude that TIVA offers the following advantages: a better oxygenation during one lung ventilation, good recovery of post operative consciousness with no psychomotor disturbances, absence of pollution in the operating theatre

L’approccio terapeutico nell’empiema pleurico non post-chirurgico

The Authors carried out an retrospective analysis on 81 patients, 67 men and 14 women, suffering from non post-surgical thoracic empyema, to evaluate the different therapeutic procedures and respective indications. The unsuccessful response to the preserving approach (intercostal drainage and pleural lavage twice a day with specific antibiotics or antiseptics) in 56 cases, induced the Authors to carry out a video-thoracoscopy (VAT), that allowed them to define the infection stage and subsequent treatment (the carrying on of a pleural drainage-lavage in 32 cases, the transcurrent pleural irrigation in 10 cases, the open window thoracostomy followed by myoplasty in 6 cases with bronchopleural fistula, the decortication with associated pleural exeresis in 6 cases with bronchopleural fistula, the decortication with associated pleural exeresis in 6 cases, the streptokinase in pleural cavity in 2 cases). There were registered totally 3 deaths (3.7%). The Authors in conclusion assert that the VAT, carried out after the unsuccessful preserving treatment, allows the evaluation of the infection stage and consequently suggests therapy

Trattamento chirurgico combinato delle neoplasie polmonari con metastasi cerebrale unica

The combined surgical treatment of primitive lung cancer with single brain metastasis is a frequently debated but still controversial problem. Up to day several therapeutic approaches are generally integrated (surgery, radiotherapy, chemotherapy) according to the clinical patterns and the technical possibilities. In general, the combined surgical operation (thoracotomy + craniotomy) when it is possible to be done, followed or proceeded by chemo-radiotherapy, has allowed to achieve a prolonged survival in these patients, maintaining an acceptable quality of life. The authors analyze 10 cases treated by thoracotomy and craniotomy at the Chair of Thoracic Surgery of University of L'Aquila. Although consisting of a small number of cases, this experience allows to detect the particular problems concerning these patients. The indications to the combined surgical treatment are considered, evaluating the surgical operation which is to be performed as first on the basis of lung cancer staging and of the location and size of the brain metastases. Finally the patients survival and their quality of life are considered

Multimodal treatment for oesofageal primary cancer. A preliminary study

OBJECTIVE: This study examines the role of chemoradiotherapy, surgical reconstructive techniques of the esophagus and lymphadenectomy in relation to morbidity and mortality. METHODS. From January 2005 to January 2008 we observed 18 patients with esophagus cancer. Eleven patients manifested a lesion of the middle third, 4 patients had a lesion of the upper third and 3 patients had a lesion of the lower third. Preoperative histological evaluation revealed 3 adenocarcinomas and 15 squamous carcinomas. Four patients with a lesion of the upper third received neoadjuvant chemotherapy RESULTS: In 13 patients reconstruction used stomach and 5 patients underwent reconstruction with the colon. Complications ensued in 3 of the latter: dehiscence of the anastomosis, anastomotic stenosis and chylothorax. Three patients highlighted a moderate malabsorption syndrome. A T3N1M0 patient received postoperative cisplatin/5-fluorouracil and radiation therapy. CONCLUSIONS: The use of the stomach represents the therapeutic gold standard for minimized incidence of complications. Lymphadenectomy allows to establish a precise stage of cancer. Chemoradiotherapy is recommended in case of risk of relapse