Background: Debilitated patients with chronic empyema, who are not fit enough to undergo thoracotomy and decortication due to lung entrapment, may be offered a lower-risk alternative – an open-window ...thoracostomy. Vacuum-assisted closure (VAC) may accelerate empyema drainage and wound closure.
Methods: In this study, we compared two cohorts of patients receiving open-window thoracostomy (OWT) with or without VAC dressing. We included patients with chronic or postresectional empyema with multiple comorbidities or in poor general condition or on immunosuppression.
Results: Delayed wound closure by thoracoplasty was performed in 8 (28%) patients in the OWT group and 8 (53%) patients in the OWT-VAC group (OR 2.54; 95% CI: 0.704-9.168). Time until DWC was significantly shorter (p<0.001) in the OWT-VAC group (48.5 ± 27.5 days) compared to the OWT group (316.5 ± 102.5 days). Regarding complications, we found no significant differences between the two groups, except for air leak, which was found in 0 (0%) patients in the OWT group and 6 (40%) patients in the OWT-VAC group (OR 1.67; 95% CI: 1.10-2.52; p<0.001). The percentage of patients who required re-do surgery did not differ significantly between the groups - 1 (3%) patient in the OWT group vs. 2 (13%) patients in the OWT-VAC group (OR 7.0; 95% CI: 0.66 – 74.29; p=0.07).
Conclusion: Our experience shows that using VAC therapy in OWT can significantly shorten the overall treatment time. It can be safely used at home and in an outpatient setting.
First reported by Hattori in 2004, the mediastinal cyst with Mullerian differentiation is a rather new finding. We present a case of a 51-year-old woman with a cystic formation in the left ...paravertebral space at the level of 4th and 5th thoracic vertebrae, which was discovered on an MRI scan. We have performed a video-assisted thoracosopic (VATS) resection of the cyst. Histological and immunohistochemical staining showed a ciliated cyst with Mullerian differentiation (i.e. Hattori's cyst). To our knowledge, only 31 cases have been described in the literature so far. Data suggests their prevalence may be higher since they are often found incidentally and are typically asymptomatic.
Introduction
Lipoblastomas are benign tumors that arise from the proliferation of fetal adipose tissue. They are frequently found in the extremities, in the head, and in the neck. Dumbbell ...conformation (which refers to epidural tumors with extraspinal extension) has been described in only seven lipoblastoma cases so far.
Case report
We describe an 11-month-old patient with a large mediastinal dumbbell lipoblastoma. The mass was excised, but it recurred 1 year later when the MRI showed also multiple pleural lipoblastomatous lesions, thus establishing the diagnosis of lipoblastomatosis. The tumor has been removed with a second surgical procedure.
Conclusion
Radical excision of lipoblastomas is the gold standard but is not always possible to achieve. Residual lesions can be managed conservatively, on the basis of the benign nature of the tumor and of its potential maturation to normal fat. Recurrence of lipoblastoma appears in 15 % of non-radical excisions but has not yet been described in the form of lipoblastomatosis. A second surgery is indicated if the tumor mass reaches large dimensions, if it increases in size, and if it threatens the functionality of vital organs such as the spinal cord.
Videotorakoskopska kirurgija (angl. video assisted thoracoscopic surgery, VATS) je minimalno invaziven način izvajanja posegov v prsnem košu. Na tak način danes opravljamo sko-raj vse posege, ki smo ...jih nekdaj izvajali “odprto”. Prednosti VATS so manjša operacijska rana, manj bolečin, hitrejše okrevanje, krajša hospitalizacija ter dolgoročno boljši funkcionalni in kozmetični rezultat. V prispevku podajamo pregled značilnosti videotorakoskop-skih posegov v primerjavi z odprtimi posegi, predstavljamo posebnosti pri anesteziji in njihovi tehnični izvedbi ter opisujemo lastne izkušnje. Posege VATS najpogosteje opravljamo zaradi okužb plevralnega prostora in so danes zamenjali odprte posege. Pomemben del videotorakoskopskih posegov so odstranitve in biopsije pljučnega parenhima zaradi prirojenih anomalij, bolezni pljučnega intersticija, pnevmotoraksa ali malignih bolezni. Biopsija ali resekcija VATS je lahko potrebna zaradi cist ali tumorjev medpljučja. Operiramo tudi prirojene diafragmalne kile ali eventeracije. Operacije na požiralniku so redke, a torakoskopsko povsem izvedljive. Na KO za torakalno kirurgijo UKC Ljubljana izvajamo videotorakoskopske posege pri otrocih od leta 2009. Pri otrocih v starosti od enega dneva do 16 let smo opravili skupno 60 posegov. Operirali smo 8 bolnikov v prvem letu starosti in 36 bolnikov, mlajših od 6 let. Pri večino posegov je pristop VATS danes prva izbira. Otrokom prinaša očitne koristi, zato je v splošnem dobro sprejet. Z napredkom znanja in opremljenosti pričakujemo nadaljnji razvoj.
Videothoracoscopic (Video-assisted thoracoscopic) surgery is a minimally invasive technique for performing procedures in the chest. All previously open procedures can be done in this manner. Its ...advantages include smaller incisions, less pain, faster rehabilitation, shorter hospitalisation, and long-term improved functional and aesthetic results. We aimed to review videothoracoscopic procedures, compare them with their open counterparts, review anaesthetic and technical requirements and report on our experience. VATS procedures for intrapleural infections are the most common, and they have completely supplanted open procedures. Further important VATS procedures include lung resections and biopsies for congenital anomalies, pneumothoraces, inter-stitial and malignant lung diseases. VATS biopsies or resections can be required for mediastinal cysts or tumours. Congenital diaphragmatic hernias and eventerations can also be oper-ated on videothoracoscopically. Oesophageal procedures are demanding and rare but can be performed thoracoscopically. Paediatric VATS procedures have been performed in the Department of Thoracic Surgery, UMC Ljubljana since 2009. Sixty procedures have been performed in patients aged from one day to 16 years. Eight patients were operated in their first year of life and 36 children under the age of six years. VATS has become the approach of choice for most procedures (pathologies). It offers obvious benefits to children and has been, therefore, well received. Further advances are expected with increased knowledge and experience and improved instrumentation.
Purpose
Performance status is an important factor in determining quality of life, the choice of treatment, and prognostic tool in patients. All scoring systems currently in use measure the patient’s ...performance subjectively. A new method of objective assessment of performance ECOG/WHO grades 2 and 3 was constructed and tested.
Methods
A performance meter—an adapted USB data logger with a mercury tilt switch—was constructed. The device was tested in a feasibility study on 33 residents of a retirement home. Parallel to the objective assessment, each resident gave their own estimate of their performance, and each resident was in turn assessed by the nursing staff.
Results
With the performance meter, 4 residents (12%) were assessed as PS ≥ 3 in comparison with 8 (24%) and 7 (21%) residents with an ECOG score ≥ 3 estimated by patients themselves and nursing staff respectively.
Conclusion
Subjective scoring—estimated by patients themselves and by nursing staff—showed underestimation of patients’ performance. In 12% of patients, a better performance score was observed with objective measurement in comparison with subjective assessment. Performance meter could be a useful tool for health care professionals for type of care decisions.
We report a case of human Dirofilaria repens infection in a woman in Slovenia who had concomitant pleural and subcutaneous manifestations of the infection. This case report illustrates the clinical ...course of a severe symptomatic parasitic infection that had multisystemic manifestations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary
Background
Catamenial pneumothorax is an uncommon form of spontaneous pneumothorax in women. The exact epidemiology and pathogenesis remain elusive. Video-assisted thoracoscopic surgery is ...used for diagnostic and therapeutic purposes.
Objective
The aim of this review was to analyze the demographic features, intraoperative findings, treatment methods and outcome in catamenial pneumothorax patients. In addition, we assessed the relationship between catamenial pneumothorax and pelvic endometriosis.
Search strategy
A PubMed search of medical literature, published from January 1993 (video-assisted thoracoscopic surgery first described in literature) to January 2015, using the keywords “catamenial pneumothorax” was performed. Our study complied with the preferred reporting of items for systematic reviews and meta-analysis principles. A total of 182 patients were included in the analysis, including 4 patients treated at our institution.
Selection criteria
The inclusion criteria of were recurrent (at least two) episodes of spontaneous pneumothorax in relation to onset of menses.
Data selection and analysis
Age at time of diagnosis, side affected, diagnosis of pulmonary endometriosis, intraoperative findings, histological confirmation of thoracic endometriosis, methods of treatment and outcome were recorded.
Main results
In 2.9% of the patients no pathological lesions were found; however, 59.3% had endometrial implants and 57.0% diaphragmatic perforations. Pelvic endometriosis was reported in 39.5% patients. Patients with diagnosed pelvic endometriosis showed a significantly higher rate of endometrial implants and histologically confirmed endometriosis lesions than patients without pelvic endometriosis. In 26.9% of patients, recurrence was observed after treatment.
Conclusion
Video-assisted thoracoscopic surgery provides good diagnostic and therapeutic results; however, 25% of patients experienced recurrence despite adequate treatment. A strong association exists between thoracic and pelvic endometriosis in catamenial pneumothorax patients.
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