An alternative technique of dealing special cases of bronchopleural fistulas

The closure of a bronchopleural fistula (BPF) complicating pneumonectomy remains a serious challenge for the surgeon. Although several endoscopic, surgical and combined (surgical + endoscopic) techniques have been proposed to manage this complication, serious technical challenges appear when the bronchial stump is too rigid and/or is in very close proximity to the carina. In such cases the use of common staplers can be proved ineffective or even hazardous. In the present we describe a tension-free technique for buttressing the bronchial stump with intercostal muscle flap. Although we have not applied this technique neither in humans nor in animals yet, its theoretic advantages are obvious and we believe that it can be applied to specific cases of BPF’s with very short and rigid bronchial stump

Debatable results of surgery for lung cancer in a patient with long existing pulmonary metastases from differentiated thyroid carcinoma

Introduction: The appropriate following treatment in a patient with a new presented non-small cell lung cancer (NSCLC) and history of chronic lung metastases of thyroid origin has never been reported. In such cases, the presence of long­standing thyroid metastatic disease with proven “limited malignant potential” could be considered as a minor treatment problem justifying one’s the decision to focus on the primary lung carcinoma as the only serious threat for the patient’s life.Case report: We report the surgical treatment of a new presented NSCLC in a patient with chronic lung metastases of thyroid origin and we present all the diagnostic, staging and treatment problems.Conclusion: The therapeutic results of our surgical approach were not encouraging. This could be owed to our staging prob­lems of NSCLC and the well documented limited immunological response of such patients with multiple neoplasms

A huge posteromedial mediastinal cyst complicated with vertebral dislodgment

BACKGROUND: Mediastinal cysts compromise almost 20% of all mediastinal masses with bronchogenic subtype accounting for 60% of all cystic lesions. Although compression of adjoining soft tissues is usual, spinal complications and neurological symptoms are outmost rare and tend to characterize almost exclusively the neuroenteric cysts. CASE PRESENTATION: A young patient with intermittent, dull pain in his back and free medical history presented in the orthopaedic department of our hospital. There, the initial clinical and radiologic evaluation revealed a mediastinal mass and the patient was referred to the thoracic surgery department for further exploration. The following computed tomography (CT) and magnetic resonance imaging (MRI) shown a huge mediastinal cyst compressing the T4-T6 vertebral bodies. The neurological symptoms of the patient were attributed to this specific pathology due to the complete agreement between the location of the cyst and the nervous rule area of the compressed thoracic vertebrae. Despite our strongly suggestions for surgery the patient denied any treatment. CONCLUSION: In controversy with the common faith that the spine plays the role of the natural barrier to the further expansion of cystic lesions, our case clearly indicates that, exceptionally, mediastinal cysts may cause severe vertebral complications. Therefore, early excision should be considered especially in young patients or where close follow up is uncertain

Sigmoid schwannoma: A rare case

Schwannomas are rare tumors derived from the cells of Schwann that form the neural sheath. When located in the gastrointestinal tract, they constitute together with leiomyoma, leiomyoblastoma, and leiomyosarcoma, the gastrointestinal stromal tumors (GIST). Peripheral nerve sheath tumors represent 2-6% GIST with most common location, the stomach and the small intestine. Schwannomas of the colon and rectum are extremely rare and radical excision with wide margins is mandatory, due to their tendency to recur locally and become malignant, if left untreated. In the present study, we report a rare case of a sigmoid schwannoma, which was successfully treated in our department and reviewed the literature. (c) 2005 The WJG Press and Elsevier Inc. All rights reserved

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