772 Surgery for Bullous Lung Disease

Aim The aim of this study to assess the surgical presentation and outcome for bullous lung disease in Sudanese patients. Method A cross sectional hospital based descriptive retrospective study. Procedures were conducted at Al-Shaab Teaching Hospital Sudan during the period from November 2009 to September 2012. Results 11 patients had lung bullae in the given period. Smoking does not play an important role in the development of bullae in healthy young adults in our patients. Vanishing Lung syndrome (VLS) was seen in 18% of patients without history of smoking. The patients presenting in the fifth decade of life constituted (36.3%) of total number. symptoms of presentation were chest pain and SOB and half of them (45.5%) had exertional dyspnoea. The duration of symptoms before presentation was more than 2 months. Asthma was the only respiratory disease associated seen in 45%. HBV and HTN were the most associated diseases seen in 27% and 18% respectively without significant findings in the history. The diagnosis was made by highresolution CT. Chest in all patients. Bullectomy was done to majority of patients. Muscle sparing thoracotomy is the standard approach (Posterolateral Thoracotomy). improved regarding symptoms and signs (90.9%) and) and no death reported. Conclusions Bullous lung disease with bilateral lung involvement is common in our patients. However, there was no association between lung bullae and smoking in our population. lt's associated with other respiratory disease. The outcome was excellent, and no death was reported. To prevent the miss diagnosis we need sensitive and noninvasive investigation tools.

Retrospective analysis of the clinical presentation and imaging of eight primary benign mediastinal schwannomas

Objective Mediastinal schwannomas are sometimes confused with other neoplasms during initial radiological studies, especially when there is a history of cancer in another area. In these cases, a more accurate analysis using computed tomography (CT) or even magnetic resonance (MRI) is required. Our study aimed to perform a retrospective analysis of the clinical and imaging features for a series of patients with mediastinal schwannomas that were confirmed by histology and immunohistochemistry. Results We found eight patients, five men and three women, with an average age of 51 years for this study. The main signs and symptoms at diagnosis were chest pain, dyspnea, cough, and dysphagia. CT showed that the tumor was located in the posterior compartment of the chest in 7/8 cases. Tumors > 10 cm were more heterogeneous and showed cystic changes. All patients underwent posterolateral thoracotomy, and radiological follow-up showed no evidence of recurrence. Histological analysis was considered the gold standard to confirm diagnosis, along with at least one neurogenic IHC marker. In conclusion, mediastinal schwannomas are benign encapsulated tumors. According to CT, schwannomas > 10 cm show cystic degeneration more frequently. Posterolateral thoracotomy allows complete resection and is considered the surgical approach of choice.

HEMOTHORAX FOLLOWING PENETRATING THORACIC INJURY (GUNSHOT WOUND) IN GERIATRIC PATIENT: A CASE REPORT AND EMERGENCY MANAGEMENT

Introduction: Penetrating chest trauma is highly lethal. Studies have reported up to 60% mortality depending on the mechanism of injury. While penetrating chest trauma is less common than blunt trauma, it can be more deadly. High-velocity gunshot injury resulting in penetrating thoracic trauma in geriatric patients poses a significant challenge for the traumatic surgeon. Hemothorax is usually a consequence of penetrating chest trauma. It can be caused by intercostal arterial bleeding, especially the posterior part. Initial treatment, including chest tube drainage insertion, is needed to avoid lung compression and to assess future treatment needed. Purpose: To report the patient survival from massive hemothorax caused by penetrating Thoracic injury caused by an air rifle, treated by chest tube insertion and posterolateral thoracotomy to take out the bullet several days after. Case Report: 70-year male patient came to the Emergency Room (ER) Adihusada Hospital Surabaya with a penetrating chest injury caused by an air rifle on the right side of the chest. The patient had chest pain, shortness of breath, and hypoxia. By inserting a chest tube, emergency management was done by a general surgeon due to the massive right hemothorax. An immediate chest tube insertion was needed to overcome the patient’s breathing problem to assess the future treatment needed. Chest X-ray and CT-Scan was done immediately after the patient’s hemodynamic were stable. Three days after hospitalizing, the Cardiothoracic and vascular surgeon performed posterolateral thoracotomy to take the bullet out of the chest. Conclusion: Seven days postoperatively, the patient was discharged from the hospital without any complications and stable hemodynamic. The patient went to the outpatient department for follow-up one week after.

Muscle-sparing thoracotomy: Anatomy and technique

The thoracotomy incision is essential for many thoracic surgery procedures. A number of different variations exist, and different techniques can be used, depending both on the patient and on the technical factors. The muscle-sparing technique was first described by Noirclerc et al. in 1973. [1] Initially, it was thought that preservation of the muscular structures compared with the results of a traditional posterolateral thoracotomy, in which the latissimus dorsi and sometimes the serratus anterior are often divided, would benefit long-term outcomes. However, subsequent study results have not demonstrated any difference in postoperative outcomes. The unequivocal benefit of a muscle-sparing approach is to preserve the latissimus dorsi for any future intervention, such as a procedure involving the chest wall and the intrathoracic flaps. In this video tutorial, we describe our approach to this commonly used incision, including the anatomy and the technical aspects used to provide optimal operative exposure and minimal postoperative complications while preserving the underlying musculature.

Retrospective Analysis of the Clinical and Image Presentation of Eight Primary Benign Mediastinal Schwannomas

Objective: Mediastinal schwannomas sometimes can be confused with other neoplasms in the initial radiological studies, especially when there is a history of cancer in another site and that require a more accurate analysis by computed tomography (CT) or even magnetic resonance (MRI). Our study was aimed to perform a retrospective analysis of the clinical and imaging features in a series of patients with mediastinal schwannomas that were confirmed by histology and immunohistochemistry.Results: We found eight patients, five man and three women with an average age of 51 years. The main signs and symptoms at time of diagnosis were chest pain, dyspnea, cough and dysphagia. CT showed that the tumor was located in the posterior compartment of the chest in 7/8 cases. Tumors >10 cm were more heterogeneous and showed cystic changes. All cases underwent posterolateral thoracotomy and radiological follow-up showed no evidence of recurrence. Histological analysis was the gold standard to confirm diagnosis in addition to at least one neurogenic IHC marker. In conclusion, mediastinal schwannomas are benign encapsulated tumors. By CT, schwannomas >10 cm showed cystic degeneration more frequently. Posterolateral thoracotomy allows complete resection and is considered the surgical approach of choice.

The Endobronchial Inflammatory Myofibroblastic Tumor

The inflammatory myofibroblastic tumor is a rare tumor described in the literature as a type of inflammatory pseudotumor. It mainly has a pulmonary location but can appear at endobronchial or mediastinal sites on rarely. While it is a benign tumor, it can sometimes be unpredictable due to its invasive characteristic as well as its resurgence after complete excision. We report the case of a patient presenting hemoptysis. The bronchoscopy revealed a bud in the left upper lobe bronchus, and the biopsy pointed to a myofibroblastic tumor. In one month, interval, the bud extended to the left main bronchus, hence the indication of a left pneumonectomy, performed by posterolateral thoracotomy. The study of the operative specimen confirmed the biopsy diagnosis. The particularity of our case is the endobronchial presentation and the fast evolution of this inflammatory myofibroblastic tumor, which requires a pneumonectomy.

Application of Left Axillary Incision in Patent Ductus Arteriosus Ligation

Background: Left posterolateral incision has been a conventional incision for patent ductus arteriosus ligation. This study aimed to evaluate the efficacy and safety of left axillary thoracotomy for patent ductus arteriosus ligation. Methods: Between January 2013 and December 2019, the clinical data of 76 patients who underwent left axillary thoracotomy for patent ductus arteriosus ligation were compared with the data of a paired group of 101 patients who underwent left posterolateral thoracotomy. Results: Compared with the left posterolateral group, the left axillary group showed less drainage (P < 0.05). Operation time, postoperative mechanical ventilation time, and postoperative hospitalization duration were similar between the groups. Complications were rare in both groups with no mortality during follow up. In total, 72 patient families (95%) in the left axillary group and 81 patient families (80%) in the left posterolateral group were satisfied with their cosmetic results (P < 0.01). Conclusions: A left axillary thoracotomy is as safe and effective as a left posterolateral thoracotomy for patent ductus arteriosus ligation. With lower trauma and better cosmetic results, this procedure provides a good alternative to the standard left posterolateral thoracotomy.

Successful Surgical Strategy for Graft-esophageal Fistula After Total Arch Replacement : A Case Report.

BackgroundGraft infection is one of the catastrophic complications in the aortic surgical area. Case presentationA 62-year-old man was diagnosed graft-esophageal fistula after total arch replacement. We have experienced aggressive debridement, that includes the infected previous graft and unhealthy esophagus under the same operative field, and staged esophageal reconstruction was performed 4 months later. ConclusionsWe believe that this successful surgical strategy, which involves aggressive debridement using re-median incision plus a left posterolateral thoracotomy under the same operative field, is useful and safe and achieved a favorable result.