Leiomyoma of the extrapleural chest wall: an atypical location

Tumours of the thoracic wall constitute a wide histological spectrum. However, the literature includes very few reports of a leiomyoma occurring at the extrapleural chest wall. In this report we present our experience together with a review of the literature. Our patient was a 33-year-old woman who was diagnosed with leiomyoma of the chest wall and treated accordingly and successfully. To the best of our knowledge, this is the seventh report in the literature defining the clinical entity

Management of Sternal Segment Dislocation in a Child with Closed Reduction

Trauma may lead to sternal fracture or dislocation. Dislocation of a sternal segment in the childhood period is very rare as for sternal fractures in children. There are only six case reports regarding the issue in the literature. Additionally, there is not an established consensus for the treatment of the pathology. In this paper we present traumatic dislocation of a sternal body segment in a 10-year-old child who was successfully managed conservatively by closed reduction together with the review of the literature. Surgical treatment is not necessary especially in acute cases. Pathology may be treated with closed reduction. Callus formation usually supports the dislocated part of the sternum in time

Clinical Study Parameters That May Be Used for Predicting Failure during Endoscopic Retrograde Cholangiopancreatography

Aim. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used for the diagnosis and treatment of hepatic, biliary tract, and pancreatic disorders. However, failure during cannulation necessitates other interventions. The aim of this study was to establish parameters that can be used to predict failure during ERCP. Methods. A total of 5884 ERCP procedures performed on 5079 patients, between 1991 and 2006, were retrospectively evaluated. Results. Cannulation was possible in 4482 (88.2%) patients. For each one-year increase in age, the cannulation failure rate increased by 1.01-fold ( = 0.002). A history of previous hepatic biliary tract surgery caused the cannulation failure rate to decrease by 0.487-fold ( < 0.001). A tumor infiltrating the ampulla, the presence of pathology obstructing the gastrointestinal passage, and peptic ulcer increased the failure rate by 78-, 28-, and 3.47-fold, respectively ( < 0.001). Conclusions.Patient gender and duodenal diverticula do not influence the success of cannulation during ERCP. Billroth II and Roux-en-Y gastrojejunostomy surgeries, a benign or malignant obstruction of the gastrointestinal system, and duodenal ulcers decrease the cannulation success rate, whereas a history of previous hepatic biliary tract surgery increases it. Although all endoscopists had equal levels of experience, statistically significant differences were detected among them

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery

Background: Mediastinal lymph node dissection is an essential component of lung cancer surgery. Literature lacks established information regarding the number and size of the healthy lymph nodes. In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. To implement the data for the clinical practice, we analyzed the possible number of nodes to be dissected in a systematic mediastinal lymph node dissection from the right and left sides during lung cancer surgery

Does a relationship exist between the number of thoracoscopic thymectomies performed and the learning curve for thoracoscopic resection of thymoma in patients with myasthenia gravis?

This study aimed to analyze surgeons' learning curve for thymoma resection with video-assisted thoracoscopic surgery (VATS). Two hundred and eleven myasthenia gravis patients had VATS thymic resections, including 25 patients with a thymoma. Three groups of surgeries, according to the order of operations, were analyzed: Group A comprised the first 70 thymectomies, Group B comprised the second 70 thymectomies, and Group C comprised the final 71 thymectomies. We compared the groups on a set of preoperative (age, gender, body mass index, and Osserman stage), operative (number in each group, size, and Masaoka stage), and postoperative (complications and length of stay) variables. A significant difference was observed in the number of thymoma operations (Group A: four patients, Group B: seven patients, and Group C: 14 patients; P: 0.031) and the duration of operation (Group A: 66 min, Group B: 52 min, and Group C: 48 min; P: 0.024). A strong correlation was found between the duration of operation and order of patients (Pearson r: -0.554, P: 0.000). We recommend the start of a program for the resection of thymoma with VATS after surgical staff have performed 70 VATS thymectomy operations. (C) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved

Learning curve in videothoracoscopic thymectomy: how many operations and in which situations?

Objective: Videothoracoscopic learning curve is known to vary among different surgeons, and may be influenced by patients and various situations. We aimed to analyze the learning curve of a surgeon in videothoracoscopic thymic surgery for myasthenia gravis. Methods: This is a descriptive single-center study using collected clinical data from 90 patients undergoing videothoracoscopic thymic surgery between June 2002 and September 2006. Cumulative summation (CUSUM) model was used to evaluate the [earning curve for videothoracoscopic thymectomy operations. Unsuccessful situations were accepted as longer operation time, surgeon-related open conversions, readmissions and postoperative complications. Factors affecting Longer operation time (patients with operation time longer than the average) and longer postoperative stay (patients with postoperative hospital stay longer than average) were analyzed. Results: Body mass index (BMI) was the only predictor of longer operation time (23.04 +/- 2.93 vs 25.61 +/- 2.70 (p = 0.001) independent samples test). The amount of prescribed pyridostigmine was the only factor for longer hospital stay (213.3 +/- 101.5 mg vs 270.0 +/- 122.6 mg (p = 0.044) Mann-Whitney U-test). CUSUM analysis demonstrated a Learning curve with success rates of 80%, 90% and 98%, respectively in the first 30 patients, the next 31-60 patients and after 60 patients. Median operative time declined with surgeons' experience (p < 0.001). Conclusions: A chest surgeon can have a high success rate in videothoracoscopic thymectomy (98%) after 60 operations. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

It is feasible to operate on pathological Masaoka stage I and II thymoma patients with video-assisted thoracoscopy: analysis of factors for a successful resection

The objectives of this study were to evaluate the feasibility of video-assisted thoracoscopic (VATS) thymoma resection and to analyze the factors contributing to a successful perioperative period

Extended Resection: Is It Feasible for Pulmonary Metastases?

Extended resections may be necessary to achieve tumor-free borders for secondary pulmonary malignancies. This study was performed to analyze the outcomes that result from extended resections of pulmonary metastases