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Khirurgiia 2020Pneumomediastinum and subcutaneous emphysema are the main manifestations of gas syndrome in patients with tracheal injury. Traditional mediastinal decompression in case...
Pneumomediastinum and subcutaneous emphysema are the main manifestations of gas syndrome in patients with tracheal injury. Traditional mediastinal decompression in case of tension emphysema is carried out through different types of cervical or transpleural mediastinotomy and subsequent passive drainage. Clinical observation of the use of VAC-therapy in the patient with injury of the membranous part of trachea followed by tension pneumomediastinum is presented. Cervicotomy with dissection of anterior mediastinum and installation of vacuum-assisted dressing were performed. Fast regression of subcutaneous emphysema and relief of pneumomediastinum were noted. There were no complications. The patient was discharged in 6 days after admission. Effectiveness of VAC-therapy in patients with tension subcutaneous emphysema and pneumomediastinum was confirmed.
Topics: Humans; Mediastinal Emphysema; Neck; Negative-Pressure Wound Therapy; Pneumothorax; Subcutaneous Emphysema; Trachea; Vacuum
PubMed: 32352674
DOI: 10.17116/hirurgia202004177 -
Journal of Cardiac Surgery Mar 2020IgG4-related disease (IgG4-RD)is a multifactorial and systemic immune-mediated disease. Pulmonary vein stenosis related to IgG4 is a rare entity. We report a case of a...
IgG4-related disease (IgG4-RD)is a multifactorial and systemic immune-mediated disease. Pulmonary vein stenosis related to IgG4 is a rare entity. We report a case of a 57-year-old male who presented with vague symptoms of weakness, easy fatigue, shortness of breathing, chest tightness, and occasional palpitations. The patient was admitted, and investigations were arranged in the form of anterior mediastinotomy and pleural biopsies were taken to look for a possible diagnosis. The histopathology was reported as IgG4-related immunopathy. A transoesophageal echocardiogram was performed and this showed severe stenosis of left superior pulmonary vein. In patients with rare pathologies such as IgG4-RD, a transesophageal can be a useful diagnostic aid especially in patients with severely impaired renal functions which does not allow utilization of contrast computed tomography.
Topics: Humans; Male; Echocardiography, Transesophageal; Immunoglobulin G4-Related Disease; Severity of Illness Index; Stenosis, Pulmonary Vein; Middle Aged
PubMed: 31945218
DOI: 10.1111/jocs.14428 -
Evaluation of surgical procedures in primary mediastinal cysts and tumors: single-center experience.Kardiochirurgia I Torakochirurgia... Oct 2019In this study, we aimed to evaluate the results of our patients with a primary mediastinal mass and the surgical techniques applied in our clinic retrospectively.
AIM
In this study, we aimed to evaluate the results of our patients with a primary mediastinal mass and the surgical techniques applied in our clinic retrospectively.
MATERIAL AND METHODS
Between March 2015 and March 2019, the results and treatment protocols of 32 patients with a primary mediastinal mass or cysts who were followed up and treated in our clinic were evaluated retrospectively. Twenty-six patients who underwent surgery for biopsy or resection were included in the study.
RESULTS
Sixteen of our patients were male and 10 were female. The mean age was 39 years. 80.2% of our patients were symptomatic and 19.2% were asymptomatic and a mediastinal mass was incidentally detected in these asymptomatic patients. The most common symptom was dyspnea with frequency of 38.4%. In terms of localization, the mass was lateralized on the right side in 7 patients, on the left side in 5 patients. In 13 patients, the tumor was located in the posterior mediastinum. 8 patients underwent anterior mediastinotomy and 1 patient underwent biopsy with video-assisted thoracoscopic surgery (VATS). Most commonly a thymus-derived mass was seen. Fifteen patients underwent excision with VATS, 3 thoracotomy, 2 sternotomy and in 1 patient VATS assisted anterior minithoracotomy was performed.
CONCLUSIONS
Mediastinal tumors and cysts have different histopathological features. Robotic surgery and VATS-assisted surgery are increasingly used in surgical excision.
PubMed: 31708982
DOI: 10.5114/kitp.2019.88597 -
Journal of Bronchology & Interventional... Jan 2018Nonsmall cell lung cancer (NSCLC) treatment is based on an accurate staging. Mediastinal lymph nodes staging has a critical impact on treatment management.
BACKGROUND
Nonsmall cell lung cancer (NSCLC) treatment is based on an accurate staging. Mediastinal lymph nodes staging has a critical impact on treatment management.
METHODS
The objective was to assess the current accuracy of preoperative tools for predicting mediastinal and hilar lymph nodes staging with NSCLC. Retrospective analysis of 997 biopsy-proven NSCLC patients treated at a single academic medical center between January 2006 and April 2012. Mediastinal lymph nodes were evaluated with preoperatively with: computed tomography (CT), positron emission tomography (PET), endobronchial ultrasound-guided fine needle aspiration, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Results are compared with pathologic surgical biopsy.
RESULTS
A total of 217 cervical mediastinoscopies, 15 anterior mediastinotomies, and 952 surgical lymphadenectomies were performed. The sensitivity of CT scan for mediastinal lymph nodes detection was 18.9% and PET-CT scan was 33.8%. Specificities were 94.9% and 93.8%, respectively. For hilar lymph nodes detection, CT was less sensitive (17.0% vs. 39.7%); however, more specific (94.7% vs. 80.3%) than PET-CT. Endobronchial ultrasound-guided fine needle aspiration (72.7% sensitivity and 100% specificity) and endoscopic ultrasound-guided fine needle aspiration (51.9% sensitivity and 100% specificity) both demonstrated superior results.
CONCLUSIONS
The majority of biopsy-proven mediastinal lymph nodes metastases are not associated with positive results on preoperative CT or PET. CT and PET have low positive predictive value for mediastinal lymph node. This study supports the routine utilization of invasive mediastinal lymph nodes staging in NSCLC, especially for patients with tumors of >4 cm diameter, regardless of CT or PET-CT results.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Endoscopic Ultrasound-Guided Fine Needle Aspiration; False Negative Reactions; Female; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Mediastinum; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Predictive Value of Tests; Preoperative Period; Tomography, X-Ray Computed; Ultrasonography, Interventional; Young Adult
PubMed: 29261576
DOI: 10.1097/LBR.0000000000000425 -
Indian Journal of Otolaryngology and... Sep 2017This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age...
This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age 67.4 ± 10.9 years) with retrosternal goitre (mainly right-sided in 9, left-sided in 14 and bilateral in 12) underwent surgery. A palpable neck mass was found in 11 (31.4%), stridor in 10 (28.6%) and thyrotoxicosis in 4 (11.4%) cases. 4 (11.4%) patients were asymptomatic. Tracheal compression was detected radiologically in 27 (77.2%) patients with deviation in 18 (51.4%). A collar incision was performed in 34 patients, 6 (17.1%) of whom required additional sternotomy, 1 (2.9%) was assisted by an anterior mediastinotomy. 1 (2.9%) had a right lateral thoracotomy. There was no operative mortality. Transient vocal changes occurred in 3 (8.6%) patients, recurrent laryngeal nerve palsy in 3, atrial fibrillation in 2, and wound complications in 2 (5.7%). Hospital stay ranged from 2 to 12 days (5.5 ± 2.0). Multinodular goitre was found in 33 patients, diffuse goitre in 1 and ectopic thyroid in 1. The average vertical length of goitres in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. The average weight of specimens was 156.3 g in patients with collar incisions and 307.5 g in the sternotomy group. Removal of retrosternal goitre is more commonly performed via a cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the risk of sternotomy. Surgical outcomes are not affected by surgical approach.
PubMed: 28929066
DOI: 10.1007/s12070-017-1151-0 -
Journal of Medical Case Reports Jun 2017Neuroendocrine tumors are a large group of tumors with a wide spectrum of behavior, affecting mainly the digestive system and the lung. The thymus is very rarely...
BACKGROUND
Neuroendocrine tumors are a large group of tumors with a wide spectrum of behavior, affecting mainly the digestive system and the lung. The thymus is very rarely affected.
CASE PRESENTATION
A 28-year-old Arab woman presented with chronic chest pain and dyspnea. A computed tomography scan showed a huge anterior mediastinal mass invading neighboring structures. A mediastinotomy was performed with biopsies of the mass. Pathological findings were consistent with a thymic large cell neuroendocrine carcinoma.
CONCLUSIONS
The occurrence of a large cell neuroendocrine carcinoma in the thymus, especially in young people, is extremely rare. In this current report, we discuss the clinicopathological issues of this rare tumor according to recent literature data.
Topics: Adult; Antineoplastic Agents; Carcinoma, Neuroendocrine; Chest Pain; Disease Progression; Dyspnea; Female; Humans; Thoracic Surgical Procedures; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28602157
DOI: 10.1186/s13256-017-1331-2 -
The Pan African Medical Journal 2017Thymic neuroendocrine tumors (TNET) are rare, with little-known prognosis. This study aims to report a case of TNET and to highlight the diagnostic and therapeutic... (Review)
Review
Thymic neuroendocrine tumors (TNET) are rare, with little-known prognosis. This study aims to report a case of TNET and to highlight the diagnostic and therapeutic difficulties in low-resource settings. A 60-year-old man presented with chest pain, greasy cough and recent weight loss. Chest CT scan showed anterior mediastinal tissue mass. Histologic evaluation of a 4 months-biopsy specimen obtained from anterior mediastinotomy showed a well differentiated TNET, labeled intensely positive for chromogranin and synaptophysin. The search for other neuroendocrine tumors and the extent of extension were negative. The tumor was immediately inextricable and radiation therapy was unavailable. The patient underwent two lines of first line chemotherapy. At 16 months follow-up, the patient was asymptomatic but showed tumor progression. The diagnosis of TNET may be delayed when immunohistochemistry is not routinely performed. Chemotherapy is associated with symptoms improvement in palliative care situation.
Topics: Animals; Antineoplastic Agents; Biopsy; Chest Pain; Cough; Disease Progression; Follow-Up Studies; Humans; Male; Middle Aged; Neuroendocrine Tumors; Thymus Neoplasms; Tomography, X-Ray Computed; Weight Loss
PubMed: 28451004
DOI: 10.11604/pamj.2017.26.25.11500 -
Annals of Surgical Oncology Jan 2018The treatment of non-small cell lung cancer is largely dependent on accurate staging in order to determine appropriate therapy. Despite advances in imaging, such as...
The treatment of non-small cell lung cancer is largely dependent on accurate staging in order to determine appropriate therapy. Despite advances in imaging, such as computed tomography and positron emission tomography, invasive mediastinal staging is frequently needed to rule out mediastinal involvement prior to curative-intent stereotactic ablative radiotherapy or surgical resection. Surgical mediastinal staging with mediastinoscopy, or anterior mediastinotomy, were traditionally considered the gold standard for invasive mediastinal staging. Endobronchial and endoscopic ultrasound have emerged as modern techniques that are being used as first-line options instead of surgical staging. As experience is gained with these newer techniques, the need for confirmatory surgical staging continues to diminish. This article addresses the situations in which negative results should be confirmed by a more invasive procedure.
Topics: Bronchi; Carcinoma, Non-Small-Cell Lung; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; False Negative Reactions; Humans; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Mediastinoscopy; Mediastinum; Neoplasm Staging; Positron-Emission Tomography; Predictive Value of Tests; Tomography, X-Ray Computed
PubMed: 28074327
DOI: 10.1245/s10434-016-5674-5 -
The Annals of Thoracic Surgery Feb 2016The objective was to evaluate whether endobronchial ultrasonography (EBUS) or endoscopic ultrasonography (EUS) staging techniques of the mediastinum for lung cancer can...
BACKGROUND
The objective was to evaluate whether endobronchial ultrasonography (EBUS) or endoscopic ultrasonography (EUS) staging techniques of the mediastinum for lung cancer can change the treatment plan compared with the "gold standard" of surgical staging.
METHODS
Patients were retrospectively identified from a prospectively collected database. Endoscopic staging was compared with the "gold standard" cervical mediastinoscopy (CM). In cases where mediastinoscopy was not performed, EBUS/EUS was compared with "ideal" CM, a virtual procedure, which was assumed to have 100% rates of sensitivity and specificity.
RESULTS
EBUS was performed in 324 patients (99%), EUS in 295 patients (90%), and CM in 101 patients (31%); 226 patients (69%) were assumed to have undergone a virtual ideal CM and a virtual surgical mediastinal staging; 108 positive biopsies (33.0%) with endosonography had sampling of targets that were out of the scope of CM. Distant metastatic disease was diagnosed by EBUS/EUS in 7 patients (2.1%); 22 patients (6.7%) had positive targets outside the reach of the CM or virtual CM. If the 14 patients who had positive stations 5, 6, 10, and 11 are excluded (accessible with anterior mediastinotomy or extended cervical mediastinoscopy), there were 6 patients (1.8%) in whom endosonography upstaged the patient over ideal surgical mediastinal staging. In 20 patients (6.1%), ultrasound-guided biopsy made the diagnoses, which changed the treatment plan over CM and ideal CM.
CONCLUSIONS
Combined EBUS- and EUS-guided biopsies can access more targets, including lung and distant metastasis, and thus have the potential to upstage patients compared with mediastinoscopy and change the treatment plan.
Topics: Biopsy, Fine-Needle; Carcinoma, Non-Small-Cell Lung; Female; Humans; Image-Guided Biopsy; Lung Neoplasms; Male; Mediastinoscopy; Middle Aged; Neoplasm Staging; Reproducibility of Results; Retrospective Studies; Ultrasonography, Interventional
PubMed: 26545625
DOI: 10.1016/j.athoracsur.2015.08.070 -
Asian Cardiovascular & Thoracic Annals Jan 2016There is sparse information concerning approaches to metachronous lung cancer in patients who had a previous pneumonectomy for lung carcinoma. We describe the case of a...
There is sparse information concerning approaches to metachronous lung cancer in patients who had a previous pneumonectomy for lung carcinoma. We describe the case of a 55-year-old woman who underwent a left pneumonectomy for lung carcinoma. Four years later, a radiological examination revealed a hypermetabolic nodule in the right upper lobe, which was located in the left hemithorax because of right lung hyperinflation and a mediastinal shift to the left. Wedge resection was carried out through a left anterior mediastinotomy. We believe that an anterior mediastinotomy represents a valuable option for the management of recurrent lung cancer after previous surgery.
Topics: Adenocarcinoma; Adenocarcinoma of Lung; Female; Humans; Lung Neoplasms; Mediastinum; Middle Aged; Multimodal Imaging; Neoplasms, Second Primary; Pneumonectomy; Positron-Emission Tomography; Reoperation; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26124429
DOI: 10.1177/0218492315593696