Treatment of pancoast tumors from the surgeons prospective: re-appraisal of the anterior-manubrial sternal approach

Pancoast tumours are now amenable to multimodality treatment with an acceptable survival. This is because trimodality treatment improves tumor sterilization and hence outcome. Moreover the development of an anterior approach to access the tumor, further improved the technical challenges for a sound resection

Carinal surgery: experience of a single center and review of the current literature

<p>Abstract</p> <p>Background</p> <p>To report our experience for the treatment of lung tumors of the right main bronchus (RMB) invading the carina.</p> <p>Methods</p> <p>From February 2000 till January 2007 we have identified 8 cases (1.09%) requiring carinal surgery.</p> <p>Plan of action: Close cooperation with anaesthetics, long flexible ET tube, Right posterolateral thoracotomy, no irrevocable steps until resection guaranteed, mobilization of trachea and main bronchus, division of the trachea & Left main bronchus. Intubate across surgical field. Tailoring for airway size discrepancies, appropriately. Construction of the tracheobronchial anastomosis around the ventilatory tube. Skillfull reintubation, over a long boogie.</p> <p>Results</p> <p>Mortality: 12.5% due to ARDS (one patient)</p> <p>Morbidity: anastomotic stenosis requiring stent (one patient). Follow-up 52 ± 11 months.</p> <p>Recurrences: 2 patients (both with pathological N2 disease on histology).</p> <p>Conclusions</p> <p>Success of carinal surgery depends on careful patient selection, team approach and attention to detail. Patients with N2 disease carry the worst prognosis.</p

Intra-aortic balloon pump (ΙΑΒΡ): from the old trends and studies to the current “extended” indications of its use

This report outlines the well defined indications of using IABP and also favours extending the indications of IABP use, to include not only “therapeutically” the aging unstable patients but also “prophylactically” patients with low EF or high Euroscore

Traumatic Bilateral Pneumothoraces due to Sternal Wire Migration

Sternal wound complications after cardiac surgery are associated with increased morbidity and mortality. Wire migrations associated with sternal dehiscence can lead to catastrophic haemorrhage unless intervened in time. We present a case of sternal wire migration causing bilateral pneumothoraces

Cardiac surgery: What the future holds?

Cardiac surgery has been scrutinized and challenged as no other specialty has. That has brought new ideas and structural frameworks but has also brought uncertainty and scepticism

Single stage repair of a complex pathology: end stage ischaemic cardiomyopathy, ascending aortic aneurysm and thoracic coarctation

The not uncommon combination of ascending aortic pathology with late presenting coarctation is a difficult surgical challenge. The two stage approach is usually adopted. The necessity for cardiac transplantation adds to the complexity: a trans-sternal approach and single stage repair become mandatory