Multimodality Treatment of Thymic Tumors

Tumors of the thymus are rather infrequent compared with all the other thoracic neoplasms. They may display a variable clinical presentation and outcome. Although they may present as a capsulated lesion with an indolent course, in other cases they may be locally aggressive, invading the surrounding structures, or show the presence of distant metastases. At these advanced stages, cure and complete resection may be difficult, and only a multimodality approach integrating surgery with induction chemotherapy and adjuvant treatment can contribute to improve outcome. © 2009 Elsevier Inc. All rights reserved

replacement

Lung resections combined with vena cav

Successful treatment with one-way endobronchial valve of large air-leakage complicating narrow-bore enteral feeding tube malposition

Tracheopulmonary intubation is the most common misplacement site for narrow-bore feeding tube and it might be associated with severe pleuro-pulmonary complications. A 38-year-old female with a severe bilateral pneumonia and acute respiratory insufficiency was admitted in the ICU, intubated, and mechanically ventilated. Few hours after the insertion of a narrow-bore feeding tube the patient's oxygen saturation dropped with hypotension and tachycardia. A large left-side hydropneurnothorax developed requiring a chest tube. Air-leakage was important and bronchoscopic implant of one-way endobronchial valve was accomplished. Immediate and substantial decrease of air-leakage was observed, and it completely stopped after 5 days; as soon as the patient was extubated. Endobrochial one-way valve, specifically designed for bronchoscopic lung volume reduction, resulted in being safe and effective to control a significant and prolonged air-leakage due to a malposition of a narrow-bore feeding tube. (c) 2006 Elsevier B.V. All rights reserved

Extended operations for recurrent thymic carcinoma presenting with intracaval growth and intracardiac extension

Thymic carcinoma is a relatively uncommon tumor that represents less than 1% of thymic malignancies. The prognosis is often poor, with a 5-year survival for all patients of between 31% and 50%.1 At present, a multimodality approach including aggressive surgical resection, platinum-based combination chemotherapy, and radiotherapy seems the preferred therapeutic strategy. Overall recurrence rate is very high and vascular invasion is particularly associated with poor prognosis. [2] and [3] Only aggressive and complete resection yields long-term survival. We report the management of recurrent thymic carcinoma with extension into the right atrium, resulting from the progression of intracaval growth, 4 years after induction chemotherapy and successful total resection followed by chemoradiation treatment

Prevention of air leaks after lung surgery.

No abstract availabl

Bronchoscopic lung volume reduction

Emphysema is a debilitating lung disease continuing to be a major source of morbidity and mortality in the developed countries. Medical treatment is the mainstay of therapy and consists of smoking cessation, pulmonary rehabilitation, administration of bronchodilators and, when indicated, steroids and supplemental oxygen. Various surgical procedures have been promoted in the past to relieve dyspnoea and improve quality of life in patients with advanced emphysema; whilst early results were often encouraging, a sustained objective functional improvement was rarely achieved and most of those procedures were progressively abandoned. Despite controversies, LVRS has been shown to be beneficial to selected patients with end-stage emphysema when medical therapy has failed. There is no doubt that LVRS allows a significative functional improvement in a selected group of patients; however, it still carries a substantial morbidity, even if mortality is low at the centers with the larger experience. Patients with a most advanced functional deterioration show a higher surgical mortality and less impressive functional results, suggesting that LVRS should be considered more carefully in these situations. Bronchoscopic alternatives to the surgical approach have been recently proposed and some of them may play an important role in the future; in particular, the airway bypass and bronchoscopic lung volume reduction with one-way valves are certainly one step beyond on their way to clinical application. We hereby report the initial experimental and clinical experience with these new treatment options

Lung transplantation for emphysema

[No abstract available