Broncho-pleural fistula: the real wound in the patient and the moral injury in the pride of Thoracic Surgeon

Each branch of surgery has its chronic complications that represent a disruption in the daily life of the patient and a wound in the pride of the Surgeon who failed to prevent the complication and often fails to remedy it. For Thoracic Surgeon one of the most feared chronic complication is broncho-pleural fistula (BPF). In Thoracic Surgery the problem of BPF is a very engaging experience because, despite the devices, expedients and tricks used during surgery, sometimes you can not prevent the unpleasant event, and mainly, the surgical and medical treatments necessary to close of the fistula are complicated and stressful

FATAL HEMORRHAGE DUE TO TRACHEAL-ESOPHAGEAL-AORTIC FISTULA IN A PATIENT WITH DOUBLE AORTIC ARCH

We report a case of a18-year-old male with double aortic arch who underwent surgery for bleeding from a left bulbar cavernous angioma of the medulla oblongata. A tracheostomy tube was positioned but after several days the patient died because of a tracheo-esophageal fistula with left aortic arch erosion due to the decubitus of the tube cuf

UNUSUAL FOREIGN BODY IN THE LEFT MAIN BRONCHUS

The paper present the images about a case of inusual foreign body in the left main bronchus that was removed with a very risky maneuver

Prognostic factors after surgical treatment of lung cancer invading the diaphragm

Background. Diaphragmatic invasion from lung cancer (T3-diaphragm) is a rare occurrence reported to portend a poor prognosis. Methods. Fifteen patients with T3-diaphragm (14 males, 1 female; median age, 64 years) were surgically treated over a twenty-year period by en bloc resection (14 patients). One patient was only explored. Pathologic stage IIB (T3N0) was found in 11 patients. A partial infiltration of the diaphragm was observed in 3 patients, whereas full-depth invasion was found in 12. Diaphragmatic reconstruction was done primarily in 9 patients, and, by prosthetic material in 5. Results. Two patients are still alive without evidence of disease at 88, and, 114 months from surgery. Overall median survival was 23 months (range, 3 to 168). The actuarial 5-year survival was 20%, when all patients were considered, and, 27%, for T3N0 patients. Univariate analysis showed that prosthetic replacement of the muscle (p = 0.018) was significantly related to survival. Conclusions. T3-diaphragm is best treated with en bloc resections with wide tumor-free margins and prosthetic replacement of the diaphragm. (C) 1999 by The Society of Thoracic Surgeons