Perioperative in-stent thrombosis after lung resection performed within 3 months of coronary stenting

Background: Incidence of perioperative in-stent thrombosis associated with myocardial infarction in patients undergoing major lung resection within 3 months of coronary stenting. Methods: Retrospective multi-institutional trial including all patients undergoing major lung resection (lobectomy or pneumonectomy) within 3 months of coronary stenting with non-drug-eluting stents between 1999 and 2004. Results: There were 32 patients (29 men and 3 women), with age ranging from 46 to 82 years. One, two or four coronary stents were deployed in 72%, 22% and 6% of the patients, respectively. The time intervals between stenting and lung surgery were ≪30 days, 30-60 days and 61-90 days in 22%, 53% and 25% of the patients, respectively. All patients had dual antiplatelet therapy after stenting. Perioperative medication consisted of heparin alone or heparin plus aspirin in 34% and 66% of the patients, respectively. Perioperative in-stent thrombosis with myocardial infarction occurred in three patients (9%) with fatal outcome in one (3%). Twenty patients underwent lung resection after 4 weeks of dual antiplatelet therapy as recommended by the ACC/AHA Guideline Update; however, two out of three perioperative in-stent thrombosis occurred in this group of patients. Conclusions: Major lung resection performed within 3 months of coronary stenting may be complicated by perioperative in-stent thrombosis despite 4 weeks of dual antiplatelet therapy after stenting as recommended by the ACC/AHA Guideline Updat

Esophageal emergencies : WSES guidelines

The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.Peer reviewe

La thoracoplastie ostéoplastique de Björk est-elle encore d'actualité? (à propos de 34 patients opérés entre 1979 et 1999)

GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Traitement chirurgical du pneumothorax spontané sur poumon unique (fonctionnel ou après pneumonectomie) (à propos de 14 cas)

Titre. Traitement chirurgical du pneumothorax spontané sur poumon unique (fonctionnel ou après pneumonectomie) : à propos de 14 cas. Auteurs. C Ducos, A Aubert, E Cochet, P Chaffanjon, H Blaise, M Claudel, S Guigard, A De Lambert, C Veran, PY Brichon. Institution. Service de chirurgie vasculaire, thoracique et endocrinienne, CHU Michallon, Grenoble, France. Objectifs. Evaluer les résultats du traitement chirurgical du pneumothorax spontané sur poumon unique (fonctionnel ou après pneumonectomie). Méthodes. De 1985 à 2007, 14 patients (13 hommes, âge moy : 61,3 ans) étaient opérés d un pneumothorax survenant sur poumon unique. Dans le groupe 1 (8 pts), le pneumothorax survenait en moyenne 22 mois (extr. 0 à 57 mois) après pneumonectomie pour cancer (2 droites, 6 gauches). Dans le groupe 2 (6 pts), le poumon controlatéral au pneumothorax était jugé non fonctionnel en raison des antécédents (3 lobectomies pour cancer suivies de radiothérapie, 2 poumons détruits par lésions bénignes, 1 lobectomie pour DDB). Dans tous les cas, l indication de symphyse était décidée d emblée, dès le premier épisode (terrain ou mauvaise tolérance), réalisée dans un délai moyen de 10,9 jours. La symphyse était réalisée sous anesthésie générale, 3 fois par talcage isolé par pleuroscopie, 11 fois par thoracotomie axillaire : 6 résections de bulles de l apex, 9 pleurectomies subtotales associées à 4 talcages et 2 abrasions mécaniques isolées. Cinq patients (groupe 2) ont eu une sonde d intubation différentielle. Résultats. Deux patients ont eu une trachéotomie post-op dont 1 définitive. Cinq patients sont décédés en postopératoire (50 jours) de défaillance multi-viscérale (3), pneumopathie (1) et suites néoplasiques (1). Un patient a récidivé et a été traité médicalement. La survie à distance est en moyenne de 53,3 mois. Sept patients sont décédés à 4, 27, 30, 48, 72, 84 et 108 mois. Deux patients sont vivants (47 mois et 15 ans). Il n y a pas de différence entre les groupes. Conclusion. Le traitement chirurgical du pneumothorax sur poumon unique est efficace, malgré une morbi-mortalité importante. Des cas sporadiques sont rapportés dans la littérature, dont certains opérés sous ECMO.Title. Surgical treatment of spontaneous pneumothorax occurring on a single lung (functional or after pneumonectomy) : about 14 cases. Authors. C Ducos, A Aubert, E Cochet, P Chaffanjon, H Blaise, M Claudel, S Guigard, A De Lambert, C Veran, PY Brichon. Institution. Service de chirurgie vasculaire, thoracique et endocrinienne, CHU Michallon, Grenoble, France. Objectives. To assess the results of surgical treatment of spontaneous pneumothorax occurring on a single lung (functional or after pneumonectomy). Methods. From 1985 to 2007, 14 patients (13 males, mean age of 61,3 years) were operated on for a pneumothorax occurring on a single lung. In group 1 (8 pts), the pneumothorax occurred after a mean period of 22 months (range, 0 to 57 months) after pneumonectomy for cancer(2 right, 6 left). In group 2 (6 pts), the contralateral lung to the pneumothorax was evaluated as non-functional : lobectomy for cancer followed by radiotherapy (3 cases), destroyed lungs by benign lesions (2 cases), lobectomy for bronchiectasis (1case). In all cases, pleurodesis was indicated immediately, from the first episode (due to the patient s general condition or low tolerance), was performed in a mean period of 10,9 days. Pleurodesis was performed under general anaesthesia, 3 times by isolated talcage by pleuroscopy , 11 times by axial thoracotomy : 6 apical bullectomies, 9 subtotal pleurectomies associated with 4 talcages and 2 isolated mechanical abrasions. Five patients (group 2) got a double lumen tracheal tube. Results. Two patients got a tracheostomy , one of which permanent. Five patients died in the postoperative period (50 days), from multivisceral failure(3), pneumonia (1) and as a result of neoplastic illness (1). One patient had a relapse and was medically treated. The mean survival period is 53,3 months. Seven patients died after 4, 27, 30, 48, 72, 84 and 108 months. Two patients are still alive (47 months and 15 years). There is no difference between the groups. Conclusion. Surgical treatment of pneumothorax occurring on a single lung is effective, despite a high morbidy-mortality rate. Sporadic cases have been published, some of which were operated with ECMO.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[Postoperative complications after thoracic surgery]

International audiencePostoperative complications after pneumonectomy, lobectomy, or wedge resection are relatively frequent and potentially significant. Chest radiographs and CT have a crucial role in the early detection and prompt management of these complications. The purpose of this paper is to illustrate the most frequent or severe complications, based on the timing of occurrence. Early complications include bronchopleural fistula, empyema, atelectasis, pneumonia, hemothorax, chylothorax, pulmonary edema, lobar torsion, cardiac hernia, gossypiboma and esophagopleural fistula. Late complications include bronchopleural fistula, esophagopleural fistula, postpneumonectomy syndrome, chest wall arteriovenous fistula and local tumor recurrence

[Postoperative complications after thoracic surgery]

International audiencePostoperative complications after pneumonectomy, lobectomy, or wedge resection are relatively frequent and potentially significant. Chest radiographs and CT have a crucial role in the early detection and prompt management of these complications. The purpose of this paper is to illustrate the most frequent or severe complications, based on the timing of occurrence. Early complications include bronchopleural fistula, empyema, atelectasis, pneumonia, hemothorax, chylothorax, pulmonary edema, lobar torsion, cardiac hernia, gossypiboma and esophagopleural fistula. Late complications include bronchopleural fistula, esophagopleural fistula, postpneumonectomy syndrome, chest wall arteriovenous fistula and local tumor recurrence

Malignant non-Hodgkin's lymphoma developing late after pneumonectomy.

A 64-year-old man underwent a left pneumonectomy for a benign bronchial stenosis in 1968. In 1997, a left parietal thoracic tumour: T-type malignant non-Hodgkin's lymphoma (MNHL) was detected. It was treated by chemotherapy and radiation therapy. After 6 years follow-up, the patient is alive and in remission. We have found only one case of such a lymphoma in the literature. It could be classified as pyothorax-associated lymphoma from which there are several published cases especially in Japanese literature

Extraction of substernal goitre using an innovative vacuum device.

International audienceThe extraction by cervicotomy of substernal goitres may be impossible and sometimes requires the enlargement of the thoracic inlet with at least a sternal-split. We present the extraction of a posterior mediastinal substernal goitre with the application of an innovative vacuum-based suction device, previously used for the control of bleeding from the heart and great vessels in clinical and experimental conditions

CT-guided biopsy of nonresolving focal air space consolidation.

International audienceOBJECTIVES: To evaluate the diagnostic accuracy of percutaneous computed tomography (CT)-guided coaxial core needle biopsy in patients with nonresolving pulmonary focal air space consolidations and negative fiberoptic bronchoscopy results. METHODS: From 1997 to 2005, 23 patients (11 woman, 12 men; age range, 45 to 81 y; mean age, 66 y) presenting with nonresolving pneumonia persisting more than 8 weeks (mean, 22 wk; range, 8 to 40 wk) with negative fiberscopic results, underwent coaxial percutaneous biopsy using an automated core needle (18-gauge) under CT guidance. Histologic and bacteriologic evaluations were obtained. The final diagnosis was confirmed by surgical pathology, culture results, or clinical follow-up. RESULTS: Specimens adequate for histopathologic evaluations were obtained in 20 (87%) cases. Final diagnoses were lung cancer (n=15) and benign diseases (infectious pneumonia, 3; lipoid pneumonia, 1; Erdheim Chester disease: 1; and nonspecific chronic pneumonia, 3). Diagnostic yield of core needle biopsy was 78% (18 of 23). The sensitivity and specificity for malignancy were 87% and 100%, respectively. Immediate pneumothorax was present in 11 patients of cases, but only 2 patients required pleural drainage. DISCUSSION: CT-guided lung biopsy using a core needle biopsy provides a high degree of diagnostic accuracy and allows specific characterization of nonresolving pulmonary focal air space consolidation