Sleeve, Semi-sleeve Lobectomy, Segment Pyramidobasalectomy in Patients with Preoperative Contraindications for Pneumonectomy

Background: Sleeve and semisleeve lobectomy and segment pyramydobasalectomy is a parenchyma-sparing procedure that is particularly valuable in patients with cardiac or pulmonary contraindications to pneumonectomy. The purpose of this study is to report our experience with sleeve lobectomy for bronchogenic cancer and carcinoid , and to investigate factors associated with long-term survival. Methods: Retrospective descriptive study among January 2006 to November 2014,in the Service of Thoracic Surgery in the University Hospital”Shefqet Ndroqi” in patients treated for lung cancer. Results: Patients underwent sleeve lobectomy for non-small-cell lung cancer (n = 3) one patient underwent double sleeve lobectomy or carcinoid tumor (n = 15), including 5 patients underwent sleeve lobectomy (atipic carcinoid) and 10 patients underwent semisleeve lobectomy (tipic carcinoid) with a preoperative contraindication to pneumonectomy. Mean age was 52 ± 14 years (range, 19 to 79 years). Vascular sleeve resection was performed in 1 patient and segmentbasalectomy on the right lung. Major bronchial anastomotic complications occurred in 2 (13%) patient: One was fatal postoperatively (double sleeve bronchial and vasculare) two weeks after intervent ,because was massive hemoptisia , and one after pyramidbazalectomy 6-th day after intervent, because nosocomial difusse pneumonia in the rest lung (shock septic) was installed. In the non-small-cell lung cancer group, operative mortality was 13% (2 of 15), and overall 5-year and 10-year survival rates were 60% . By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0 or N1 versus N2; p = 0.01) and microscopic invasion of the bronchial stump (p = 0.02). In the carcinoid tumor group, there were no operative deaths, and overall 5-year and 10-year survival rates were 100% (Typic carcinoid) and 95% (atipic carcinoid). Conclusions: Sleeve lobectomy was performed for the first time in Albania, in April 2006. Long-term survival is excellent for carcinoid tumors. For patients with non-small-cell lung cancer, N2 disease or incomplete resection is associated with a worse prognosis; outcome is not affected by presence of a preoperative contraindication to pneumonectomy.Sleeve lobectomy facilitated the maintenance of residual lung function without serious perioperative complications.Keywords: sleeve lobectomy, semisleve, carcinoid, pyramid basal segmentectomy

Limited Axillary Thoracotomy or Posterolateral Thoracotomy vs. Video-Assisted Thoracoscopic Surgery for Recidivant Spontaneous Pneumothorax Our Experience

Video-assisted thoracoscopic surgery (VATS) has been reported to have a higher pneumothorax recurrence rate than limited axillary thoracotomy (LAT) or postero-lateral thoracothomy (PLT) . We investigated the cause of pneumothorax recurrence after VATS by comparing surgical results for VATS and LAT or PLT.Keywords: thoracoscopic surgery, PNX, VATS surgery, PSP, LAT/PLT cases, etc

Physiotherapy Treatment of Obstetrics Brachial Plexus Palsy (OBPP) Erb - Duchenne by age group

Presentation: Obstetric Brachial Plexus Palsy is a damage of Brachial Plexus. The aim of Study: The importance of treatment Obstetric Brachial Plexus Palsy divided by age groups , Erb - Duchenne with the techniques of Bobath and Vojta. Material and methods:In the study were 30 cases in an 8-year timeframe. Wich 15 of these children have come within 3 months of birth. These entities are applied treatment techniques according to Bobath and Vojta. Result:Of the 30 cases in the study, 15 came within 3 months of their birth. Were treated with Bobath and Vojta techniques and have achieved 100%functional results and 90% aesthetic. 15 children come after this age, 8 arrivals within the first year of birth have reached 90% function and 80% aesthetic. 7 arrivals after 18 months have received 80% function and 70% aesthetics. In measuring the results have participated doctors orthopedic and neuro-pediatric of Q.S.U. "Mother Teresa" and Trauma. Conclusion:Determinant in the results:1. The degree of damage2. Time of arrival in treatment3. Treatment by age.Keywords: Obstetric Brachial Plexus Palsy, Erb-Duchenne, 30 cases, techniques Bobath and Vojta, Function, Aesthetics

Physiotherapy Treatment of Obstetrics Brachial Plexus Palsy (OBPP) Erb - Duchenne by age group

Presentation: Obstetric Brachial Plexus Palsy is a damage of Brachial Plexus. The aim of Study: The importance of treatment Obstetric Brachial Plexus Palsy divided by age groups, Erb - Duchenne with the techniques of Bobath and Vojta. Material and methods: In the study were 30 cases in an 8-year timeframe. Wich 15 of these children have come within 3 months of birth. These entities are applied treatment techniques according to Bobath and Vojta. Result: Of the 30 cases in the study, 15 came within 3 months of their birth. Were treated with Bobath and Vojta techniques and have achieved 100%functional results and 90% aesthetic. 15 children come after this age, 8 arrivals within the first year of birth have reached 90% function and 80% aesthetic. 7 arrivals after 18 months have received 80% function and 70% aesthetics. In measuring the results have participated doctors orthopedic and neuro pediatric of Q.S.U. "Mother Teresa" and Trauma. Conclusion: Determinant in the results: 1. The degree of damage2. Time of arrival in treatment3. Treatment by age

Atelectasis is Common Pulmonary Complication in Patients Following Thoracic Surgery

Continued advances in anesthesia, surgery, and perioperative medicine have improved postoperative outcome. Despite these advances postoperative pulmonary complications (PPCs) remain a significant problem. Pain and surgical trauma after thoracic operations lead to abnormal diaphragm function, lessened intercostals muscle tone and pulmonary dysfunction. Our duty is how to grade the risk, prepare and manage patients to minimize the risk of PPCs.Keywords: PPCs, Atelectasis, Anaesthesia, bronchospasm, treatment, patients, etc.

Acute Respiratory Distress Syndrome (ARDS) and the Use of Positive End-Expiratory Pressure (PEEP)

Qëllimi dhe objektivat e studimit: Të përcaktojë nivelin optimal të PEEP-it me qëllim që të arrihet një rekrutim alveolar maksimal nëpërmjet niveleve të oksigjenimeve të përshtatshme. Materiali dhe metoda: Nga 120 pacientë në studim u inkluduan 63 prej tyre me moshë 18-70 vjeç të shtruar në Shërbimin e Reanimacionit Pulmonar dhe të Reanimacionit polivalent të Qendrës Spitalore Universitare, Tiranë. Rezultatet: Paraqitja e vlerave të PaO2 dhe të numrit të pacientëve. Në tabelën PaO2 dhe Mbijetesa paraqiten vlerat e PaO2 fillestar, vlerat e PaO2 më të ulët dhe PaO2 më të lartë. Përpunimi statistikor i studimit të ketyre vlerave pra të PaO2 dhe PEEP-it është paraqitur në tabelën në vazhdim ku jepen mesatarja, devijacioni standart dhe gabimi i mesatares së devijacionit standart. Paraqitja e vlerave të t statistike, sinjifikanca dhe intervalit të konfidencës 95% jepet në tabelën në vazhdim. Konkluzion: Përdorimi i manovrave rekrutuese dhe PEEP-it të lartë është një mënyrë mjaft e mirë ventiluese në pacientët me ARDS . Kurba presion/volum (p/v) në sistemin respirator luan një rol qëndror në zhvillimin e konceptit të mbrojtjes pulmonare.Ky informacion mund të jetë i vlefshëm për të bërë identifikimin e regjimit optimal me PEEP në ventilator .Identifikimi i një niveli të përshtatshëm te PEEP-it përbën një prioritet themelor dhe mjaft të vlefshëm në pacientët me ARDS.

Desmoid tumors of the pleura: a clinicopathologic mimic of localized fibrous tumor

Introduction: Desmoid tumor is an aggressive form of fibromatosis of musculoaponeurotic origin. It is a histologically benign, slow growing tumor commonly presenting in the age group of 15-60 years. Desmoid tumor is a rare, benign soft tissue tumor having the potential for local invasion. It commonly arises in the abdominal wall, presenting as a palpable mass. We describe a case of thoracic desmoid tumor in a middle-aged male arising from the chest wall.Objective: Intrathoracic desmoid tumors of the pleura are unusual tumors that are often clinically and histologically confused with localized fibrous tumor of the pleura or benign neurogenic tumors. Material and Methods: We studied three cases of intrathoracic desmoid tumor of the pleura and reviewed the clinical, histopathologic, and immunohistochemical features of the patients. Three women, ranging in age from 30 to 40 years (mean, 35 yr) comprised the study group. Treatment included complete resection (two cases)by anterolateral thoracotomy in one case and by VATS in another one, subtotal resection (one case), followed by radiation therapy.Results: Follow-up to date shows stable residual disease at 12 months (one case) was done reinvent also expected again local receive and recommendation radiotherapy treatment and two patients with no evidence of disease at 12 and 36 months, respectively. Conclusions: Desmoid tumor should be considered in the differential of localized fibrous tumor of the pleura.Keywords: Desmoidal tumor , complete resection, Intrathoracic.