[Thoracic endometriosis--the rare pathology in thoracic surgery]

Thoracic hematogenic endometriosis is a rare pathology. A clinical course hasn't pathognomic symptoms, because of it, the diagnosis is established due to histological study. The article presented two cases of female patients, who were suffering from thoracic endometriosis. They were hospitalized to the department of thoracic surgery of Municipal multifield hospital No 2 in Saint-Petersburg. The first patient had a posterior mediastinum tumor with asymptomatic disease course. The second patient was with recurrent catamenial pneumothorax.

[Optimization of surgical strategy in complications after thoracic operations demanding recurrent surgical interventions]

A frequency of postoperative complications varied from 1-2% after endoscopic thoracal operations to 4-12% after open operations using thoracotomic access. There isn't any common approach to indications and terms of the recurrent endoscopic intervention. An analysis of postoperative complications was made after 2795 thoracothomies and 3632 videothoracoscopies required the recurrent operation in 139 patients (2.2%). The rethoracoscopies were performed on 62 patients (44.6%), thoracoscopies were carried out after thoracotomies in 40 cases (28.8%) and rethoracotomies were in 37 cases (26.6%). The more frequent indication to recurrent operation was bleeding (26.6%), pleural empyema (20.9%), fragmented pleuritis (11.5%). It was shown that thoracoscopy was an alternative to rethoracotomy as the rethoracoscopy in case of nonmassive intrapleural bleeding, clotted hemothorax, postoperative fragmented pleuritis, non-sanitized empyema region, the presence of sequestrums in this area, limited postoperative pleuritis, chylothorax, bronchopleural fistula of the size of 1-2 mm, leakage of the lung, a foreign body in pleural cavity. The lethality consisted of 35.1% after rethoracotomies and it was 12.7% after recurrent endoscopic operations.

[Re-thoracotomy for intrathoracic complications after esophagectomy for esophageal cancer]

We reviewed the indications for re-thoracotomy after esophagectomy for esophageal cancer. Hemothorax, chylothorax, tracheobronchial injury (fistula), pneumothorax, and pyothorax were the main causes of re-thoracotomy. Indications for emergency thoracotomy were as follows. 1)Hemothorax:bleeding through the chest drain continuing at >100 ml/hour for ≥5 hour, or in cases when normal blood pressure cannot be maintained without blood transfusion. 2)Chylothorax:in cases with ≥1.5 l/day of chyle drainage for >5 days under conservative treatment. Healing is not seen for 14 days after conservative treatment. Nutritional status of the patient has worsened. 3)Tracheobronchial injury:at 1st respiration state should be understood. After we maintain the patient's airway, fistula is treated by closure and plombage with omentum or muscle flap. Appropriate diagnosis and timing are important for re-thoracotomy for complications after esophagectomy.

Surgical views: thoracoscopy: basic principles, anesthetic concerns, instrumentation, and thoracic access

Thoracoscopic surgery offers an exciting method for treating a variety of thoracic disease processes. To date, several thoracoscopic procedures have been described in veterinary patients. This article discusses the basic principles of thoracoscopic surgery and thoracic access, anesthetic concerns, and required instrumentation. A companion article discussing the surgical techniques of thoracoscopic pericardial window creation, subphrenic pericardectomy, thoracoscopic lung biopsy, lung lobectomy, thoracic duct ligation, and cranial mediastinal mass excision will be published in the February 2013 issue.

[Posterior thoracotomy in ventral decubitus]

The rigidity of the chest wall, thank to its bone framework, determines the variety of operative access in thoracic surgery, both thoracoscopic and open. The posterior thoracotomy on the bed of the resected rib in ventral decubitus is traditionally but gratuitously rarely used access. The method permits comfortable access to trachea, bifurcation, main bronchi and thoracic esophagus. It can also be used in cases of foregoing thoracothomy. Authors own the experience of 111 cases with the use of posterior thoracotomy in ventral decubitus. The access proved to be preferable for the operations on the membranous part of the trachea and main bronchi, some localizations of thoracic tracheoesophageal fistula. The access suggests fast mobilization of the root of the lung without foregoing pneumolisis, which is important in cases of pleural cavity obliteration after tuberculosis or pleural empyem.

[A case of recurrent breast cancer with pneumothorax treated by chest wall reconstruction]

We report a case of a 41-year-old woman who underwent mastectomy and axillary lymph node dissection for right breast cancer(T3N3cM0) in 2004. She was treated with chemotherapy for multiple bone metastases and recurrence in the iliopsoas from January 2008. Right chest wall recurrence was observed in May 2010 and it progressed to ulcer. She was admitted to our hospital complaining of dyspnea on December 2, 2011. We diagnosed open pneumothorax and inserted a chest tube, and then packed the ulcer. No recurrence was observed in the liver and lungs. After stabilization of her general condition, we performed chest wall resection and reconstruction with a latissimus dorsi flap. She was discharged 2 weeks after surgery without severe complications. Although there were distant metastases, this surgical procedure may be effective for patients with open pneumothorax from recurrent breast cancer in order to maintain quality of life.

Retrocardiac herniation of atelectatic lung into the opposite chest

A 64-year-old man with a history of esophageal adenocarcinoma status postneoadjuvant therapy underwent esophagogastrectomy. Postoperatively he was found with increasing dyspnea and oxygen requirements. Computed tomography of the chest showed retrocardiac herniation of atelectatic lung into the contralateral hemithorax.

Thoracic endometriosis: a case report

BACKGROUND

Endometriosis is a benign gynecologic disorder that affects women of reproductive age. It can be asymptomatic or can cause pelvic pain or subfertility. On rare occasions it may manifest outside of the pelvis, leading to a multitude of symptoms that can be life-threatening if proper diagnosis is delayed.

CASE

A 35-year-old, nulliparous female presented with dyspnea and pleuritic chest pain. She was diagnosed with a rare case of thoracic endometriosis. Her symptoms improved with combined surgical and medical management.

CONCLUSION

The diagnosis of this rare entity often goes unrecognized unless physicians have a high clinical suspicion and make a temporal association between patients' pulmonary symptoms and menstruation. Diagnosis can be confirmed only by pathological examination and immunohistochemical staining. Management should be guided by symptom severity and the patient's desire to conserve future fertility.

[The mechanoreceptor tactile diagnostics of thoracic diseases]

The novel system of tactile analysis was used in the mechanoreceptor device. The local pressure measurement is carried out in in cameras, divided by the elastic membrane from the analyzed organ. The devise allows fast and adequate real-time measurement of tissue density and elasticity. The results, acquired with the use of the mechanoreceptor device were checked microscopically. The study showed high compatibility and adequacy of the novel mechanoreceptor.

[Early rethoracotomies for diseases and chest traumas]

Rethoracotomies were performed on 34 patients operated for diseases and traumas of the chest, diseases of the esophagus which made up 1.3%. Emergency and reoperations were performed on 14 (46%) patients for ongoing intrapleural bleeding, clotted hemothorax and pulmonary bleeding. Emergency and delayed rethoracotomies were performed on 7 patients for non-hermeticity of the lung and incompetence of the bronchus suture, on 5 patients for incompetence of esophagogastroanastomosis, necrosis of the transplant and gastric wall, 3 patients for chylothorax not-arrested conservatively, 2 patients for gangrene of the residual lung lobe due to disturbed venous outflow. Postoperative complications resulted in death of 12 (37.5%) patients. Causes of lethal outcomes were purulent complications (pleural empyema, mediastinitis, sepsis, polyorganic insufficiency--in 5), massive blood loss with the development of coagulopathy (in 4), pneumonia of the only lung after pulmonectomy (in 2), pulmonary embolism (in 1). In addition, torsion of the residual lung lobe, foreign body in the pleural cavity can be considered as indications for rethoracotomy.

[Video-assisted thoracoscopic surgeries for thoracic diseases and trauma]

The experience of videothoracoscopic operations, performed for various diseases of the thoracic organs, was summarized. The reduction of the operation traumaticity, the complications rate, lethality, the patients rehabilitation duration permits to consider videothoracoscopic operations as the method of choice in many thoracic diseases and trauma.

Prenatal diagnosis of thoracic kidney in the 2nd trimester with delayed manifestation of associated diaphragmatic hernia

Ectopic kidney is a rare congenital malformation, caused by renal malpositioning during embryogenesis. We report a rare case of ectopic kidney located in the left hemithorax of a male fetus. The unique features in this case were early sonographic prenatal diagnosis of thoracic kidney at 22 weeks' gestation, which was confirmed by fetal MRI, and delayed sonographic manifestation of the associated congenital diaphragmatic hernia at 27 weeks.

[Causes and results of repeated videothoracoscopy]

For 7 years videothoracoscopies for diseases and traumas of the chest were fulfilled in 2075 patients, abscessoscopy in 27 patients. Repeated videothoracoscopies were fulfilled in 41 (2%) patients operated for spontaneous pneumothorax, pleural empyema, exudative pleurisy and injuries to the chest due to recurrent hydropneumothorasx, prolonged abundant release by drainage, bleedings by drainage or formation of clotted hemothorax, not effectiveness of sanation, of the empyema cavity, reabscessoscopy - in 2 patients. Revideothoracoscopies were divided into groups with the presence of drainages or removed drainages according to the terms - into emergent (on the first day, immediately after the development of complications), urgent (from 2 to5 days), postponed (from 6 to 15 days), and late (more than 15 days). In 4 cases the conversion to minithoracotomy had to be done due to continuing bleeding, the absence of lung hermetism. All patients with spontaneous pneumothorax, pleuritis and chest trauma recovered. Lethal outcome was in 1 (2.4%) case from lung artery thromboembolism. It was concluded that revideothoracoscopy was an alternative thoracotomy of full value in reinterventions.

[Thoracoscopically removed thoracolithiasis]

Thoracolithiasis is a rare condition with only 16 cases of surgically removed nodules reported in the literature in Japan. We report an additional thoracoscopically removed case. A 62-year-old man was pointed out an abnormal shadow behind the left diaphragmatic dome on a routine health examination. Computed tomography (CT) revealed a round mass lesion with calcification, about 11 mm in diameter, in the left thorax. Video-assisted thoracic surgery (VATS) was performed and a white 11 mm completely free nodule in the left pleural cavity was removed. Pathological findings revealed necrotic fat tissue in the center surrounded by hyalinized fibrous tissue, being consistent with thoracolithiasis.

[Intrathoracic kidneys : review and case report]

Intrathoracic kidneys are rare and are often only diagnosed incidentally. The literature on intrathoracic kidneys in children and adults is reviewed and discussed, focusing on diagnostic procedures and surgical therapy. Additionally, the case of a 35-year-old woman with a relapse of a left-sided intrathoracic kidney after pregnancy is reported. Diagnostic procedures and the surgical management are discussed.

Presternal giant epidermal cyst: 2 cases

BACKGROUND

Epidermal cysts are a common benign lesion, occurring often above the shoulder and within the face and the scalp. Presternal site and huge volume are quite rare, especially in children.

AIM

The authors report on two paediatric cases, discuss etiopathogenesis and diagnostic difficulties.

CASES

A 2, 5 and 3-year-old boys were admitted for voluminous subcutaneous tumour of the chest. The lesions had appeared since neonatal period with rapid growth after a minimal trauma for the last year. The physical examination found a great presternal cystic mass of 70 mm in diameter which is painless round and mobile. Ultrasonography and magnetic resonance imaging, showed a subcutaneous cystic mass with no mediastinal involvement or other localization in both. Complete surgical excision including the overlying skin with direct cutaneous closure was performed in both cases. The histological examinations confirmed the diagnosis of epidermal cyst. Postoperative courses were uneventful with no recurrence during respectively 18 months and 5 years follow-up periods.

CONCLUSIONS

Giant presternal epidermal cyst is uncommon and can raise diagnostic problems. Imaging investigations facilitate accurate diagnosis. Because of malignant degeneration, surgical excision should be mandatory.