Unique presentation of a giant mediastinal tumor as kyphosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although posture distortion is a common problem in elderly patients, spinal deformity caused by a thymoma has not been previously reported. Thymomas are slowly growing tumors that predominantly cause respiratory symptoms.</p> <p>Case presentation</p> <p>We report the case of an 83-year-old woman who was admitted with a giant mediastinal mass that had caused progressive spinal distortion and weight loss to our department. The clinical and laboratory investigations that followed revealed one of the largest thymomas ever reported in the medical literature, presenting as a mass lesion placed at the left hemithorax. She underwent complete surgical excision of the tumor via a median sternotomy. Two years after the operation, she showed significant improvement in her posture, no pulmonary discomfort, and a gain of 20 kg; she remains disease free based on radiographic investigations.</p> <p>Conclusions</p> <p>In this case, a chronic asymmetric load on the spine resulted in an abnormal vertebral curvature deformity that presented as kyphosis.</p

Σύνδρομο διαταραχής αιματώσεως στο διαχωρισμό αορτής τύπου Α. Ο ρόλος των ενδαγγειακών τεχνικών.

Σκοποί και Υποθέσεις: Το σύνδρομο διαταραχής αιματώσεως αποτελεί καταστροφική επιπλοκή του οξέως διαχωρισμού της αορτής, η οποία σχετίζεται με υψηλή θνητότητα. Σκοπός της παρούσας μελέτης είναι ο προσδιορισμός της ιδανικότερης θεραπείας για τον οξύ διαχωρισμό αορτής τύπου Α με διαταραχή αιματώσεως και η διερεύνηση του αναδυόμενου ρόλου των ενδαγγειακών τεχνικών ως τμήμα μίας υβριδικής θεραπευτικής στρατηγικής. Υλικό και Μέθοδος: Πραγματοποιήσαμε μία ηλεκτρονική βιβλιογραφική έρευνα στις βάσεις δεδομένων PubMed, EMBASE και Cochrane Library για άρθρα στην αγγλική γλώσσα χρησιμοποιώντας επιλεγμένες λέξεις κλειδιά. Περιγραφικά Αποτελέσματα: Όλες οι σχετικές μελέτες υποστηρίζουν ότι η συνδυασμένη ενδαγγειακή επαναιμάτωση και παραδοσιακή χειρουργική θεραπεία σχετίζονται με ευνοϊκότερα αποτελέσματα. Σε περιπτώσεις σοβαρών ισχαιμικών επιπλοκών η διαδερμική ενδαγγειακή αναστροφή της διαταραχής αιματώσεως πριν την ανοικτή αποκατάσταση της ανιούσας θωρακικής αορτής συμβάλλει στη μείωση της πρώιμης θνητότητας. Τυχαιοποιημένες προοπτικές μελέτες, που να συγκρίνουν χειρουργική μόνο και συνδυασμένες προσεγγίσεις στην αντιμετώπιση του επιπλεγμένου με σύνδρομο διαταραχής αιματώσεως οξύ διαχωρισμού αορτής τύπου Α, δεν ανευρέθηκαν. Συζήτηση αποτελεσμάτων – Συμπεράσματα – Προτάσεις: Τα διαθέσιμα βιβλιογραφικά δεδομένα στηρίζουν την υπόθεση ότι η υιοθέτηση μίας συνδυασμένης χειρουργικής και ενδαγγειακής προσέγγισης στην αντιμετώπιση του διαχωρισμού αορτής τύπου Α με σύνδρομο διαταραχής αιματώσεως αποτελεί μία υποσχόμενη εναλλακτική, που σχετίζεται με αποτελεσματική επαναιμάτωση και βελτιωμένα κλινικά αποτελέσματα.Objective: Malperfusion is a devastating complication of acute aortic dissection that is associated with high mortality rates. The objective of this study is to assess the optimal therapy in acute type A aortic dissection with malperfusion along with the arising role of endovascular techniques as part of an hybrid management strategy. Materials and Methods: We performed electronic literature search of PubMed, EMBASE and Cochrane Library for articles in English using a number of key words. Results: All identified studies support that combined endovascular reperfusion and traditional surgical therapy is associated with favorable results. In cases of severe ischemic complications, percutaneous endovascular reversal of malperfusion prior to open ascending aortic repair contributes to lower early mortality rates. We found no prospective randomized trials comparing surgical and combined approaches in the management of type A acute aortic dissection complicated with malperfusion syndrome. Conclusions: Available evidence supports the presumption that implementation of a combined surgical and endovascular approach in the management of type A aortic dissection with malperfusion is a promising treatment option associated with effective reperfusion and improved patient outcomes

Sampling versus systematic full lymphatic dissection in surgical treatment of non-small cell lung cancer

The extent of mediastinal lymph node assessment during surgery for non-small cell cancer remains controversial. Different techniques are used, ranging from simple visual inspection of the unopened mediastinum to an extended bilateral lymph node dissection. Furthermore, different terms are used to define these techniques. Sampling is the removal of one or more lymph nodes under the guidance of pre-operative findings. Systematic (full) nodal dissection is the removal of all mediastinal tissue containing the lymph nodes systematically within anatomical landmarks. A Medline search was conducted to identify articles in the English language that addressed the role of mediastinal lymph node resection in the treatment of non-small cell lung cancer. Opinions as to the reasons for favoring full lymphatic dissection include complete resection, improved nodal staging and better local control due to resection of undetected micrometastasis. Arguments against routine full lymphatic dissection are increased morbidity, increase in operative time, and lack of evidence of improved survival. For complete resection of non-small cell lung cancer, many authors recommend a systematic nodal dissection as the standard approach during surgery, and suggest that this provides both adequate nodal staging and guarantees complete resection. Whether extending the lymph node dissection influences survival or recurrence rate is still not known. There are valid arguments in favor in terms not only of an improved local control but also of an improved long-term survival. However, the impact of lymph node dissection on long-term survival should be further assessed by large-scale multicenter randomized trials

An Alternative Technique for Surgical Management of Poststernotomy Osteomyelitis and Reconstruction of the Sternal Defect

Introduction. Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy. In this paper, an alternative technique for the reconstruction of sternal defects with the use of bilateral pectoralis major pedicled muscle flaps is presented. Case presentation. A 70-year-old man with the diagnosis of poststernotomy osteomyelitis underwent reconstruction of his sternal defect with the use of bilateral pectoralis major muscle flaps. The patient had an uneventful recovery, and the physical examination revealed a normal range of motion for both upper limbs and sternal stability. Conclusion. The proposed technique incorporates a simple mobilization of the two pectoralis major muscles to be used as flaps to fill the sternal defect without the need for humeral detachment or a second cutaneous incision. Using this technique, a muscular implant is made that seals the dead space, which has no tension due to the presence of a second layer. Postoperative results are excellent, not only regarding infection and functionality but also from an aesthetic point of view

Surgical Management of Non-small Cell Lung Cancer with Solitary Hematogenous Metastases

Background/Aim: The treatment of patients with solitary hematogenous metastases from non-small cell lung cancer (NSCLC) remains controversial, although numerous retrospective studies have reported favorable results for patients offered combined surgical therapy. Our aim was to determine the role of surgical resection in the management of NSCLC with solitary extrapulmonary metastases and to investigate for possible prognostic factors. Patients and Methods: Between January 2004 and December 2012, 12 patients with NSCLC, from two Institutions, underwent metastasectomy for their solitary metastatic lesion. Sites of metastases included brain (n=3), adrenal gland (n=6), thoracic wall (n=2) and diaphragm (n=1). All patients had undergone pulmonary resections for their primary NSCLC. Results: Median survival for the entire cohort was 24.1 months, whereas 1- and 5-year survival rates were 73% and 39%, respectively. Patients with stage III intrathoracic disease had significantly worse survival than those with lower tumor stage. A tendency for adenocarcinomatous histology to positively affect survival was recognized, although it was proven not to be statistically significant. Conclusion: Despite the retrospective nature of our study surgical resection might offer patients with NSCLC with solitary hematogenous metastases a survival benefit. Limited intrathoracic disease and adenocarcinomatous histology might be associated with better outcomes