Surgical Management of Pleural Space Infection

Pleural space infections are a common clinical entity affecting a large number of patients. These are associated with considerable morbidity and mortality rate and they require significant healthcare resources. In this chapter, we discuss the disease characteristics with regards to the etiology (primary and secondary), clinical presentation, radiological findings, different stages of the condition and treatment options according to stage at presentation. Conservative management (medical treatment, pleural drainage, with or without intrapleural fibrinolytic) may be effective in management of simple pleural space infections, but surgical management may be required in loculated complex empyema to prevent acute sepsis, deterioration and trapped lung. Surgical treatment of complicated pleural infections either by VATS or thoracotomy will be discussed in order to understand when to perform debridement/decortication of the pleural cavity or less frequently a thoracostomy

WITHDRAWN: Lung metastases of adenoid cystic carcinoma mimicking broncho alveolar carcinoma growth pattern

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Does Myasthenia Gravis Affect Long-Term Survival in Thymic Carcinomas? An ESTS Database Analysis

Background: Thymic carcinoma is a rare and highly malignant tumor with a dismal prognosis, which occasionally coexists with myasthenia gravis (MG). This study aims to investigate the MG incidence on a surgical cohort of patients with thymic carcinoma and to explore its influence on long-term survival. Methods: the prospectively collected data from the ESTS database on thymic epithelial tumors were reviewed. Clinical, pathological, and survival information on thymic carcinoma were analyzed. Results: the analysis was conducted on 203 patients, with an equal gender distribution (96 males and 107 females). MG was detected in 22 (10.8%) patients, more frequently elderly (>60 years, p = 0.048) and male (p = 0.003). Induction therapy was performed in 22 (10.8%) cases. After surgery, 120 (59.1%) patients had a Masaoka stage II-III while complete resection (R0) was achieved in 158 (77.8%). Adjuvant therapy was performed in 68 cases. Mean follow-up was 60 (SD = 14) months. The 3-year, 5-year and 10-year survival rates were 79%, 75% and 63%, respectively. MG did not seem to influence long-term survival (5-year survival in non-MG-TCs 78% vs. 50% in MG-TCs, p = ns) as age < 60 years, female gender, early Masaoka stage, and postoperative radiotherapy did, conversely. Conclusions: myasthenia occurred in about 10% of thymic carcinomas and it did not seem to affect significantly the long-term prognosis in surgically treated thymic carcinoma-patients

Tracheal rupture post-emergency intubation

Tracheal rupture is an uncommon and potentially lifethreatening complication of endotracheal intubation. We present a case of intrathoracic tracheal rupture in a female patient who required emergent endotracheal intubation for acute respiratory distress related to chronic obstructive pulmonary disease exacerbation. Possible contributing factors to tracheal injury included overinflation of the tube cuff, chronic obstructive pulmonary disease, and chronic steroid use. The patient underwent surgical repair without complication. Postoperatively, the tube cuff was placed far distally, close to the carina, and mechanical ventilation was performed using low tidal volume and PEEP in order to avoid high ventilatory pressures

Surgery for Lung Herniation: A New Approach for an Old Problem

Lung herniation is frequently related to previous chest surgery or thoracic trauma. It can be symptomatic. Surgery with new titanium rib prosthesis is an interesting device to repair the chest wall in order to obtain better cosmetic and physiological results

Traumatic Ribs Fracture: How to Treat Them?

Flail chest complicates about 10% of patients with chest trauma and is associated with a mortality rate of 10–20% in older series, while a recent one reports no mortality. The majority of the cases are treated conservatively with internal pneumatic stabilization and pain control. In recent years, nevertheless, we assisted in the resurgence of chest wall fixation due to the availability of new devices. We report our experience in the use of mouldable titanium clips (STRACOS, Strasbourg Thoracic Osteosyntheses System; MedXpert, Heitersheim, Germany) to fix traumatic rib fracture. This device presents an advantage over previous strategies, as it is easy to apply and doesn’t require drilling and screwing of the ribs

WITHDRAWN: Lung metastases of adenoid cystic carcinoma mimicking broncho alveolar carcinoma growth pattern

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