Achilleas Lioulias

The Significance of One-Station N2 Disease in the Prognosis of Patients With Nonsmall-Cell Lung Cancer

BACKGROUND A retrospective study was conducted to define the characteristics and the prognosis of N2 disease subgroups according to their patterns of spread. METHODS From January 1993 to December 2004, 1,329 patients underwent lung resection for bronchogenic carcinoma The records of all patients with positive mediastinal lymph nodes at the surgical specimen (pIIIA/N2) after radical resection were analyzed, and the pattern of mediastinal lymphatic spread was classified according to regional spread, to skip metastasis, and to one or two or more lymph node stations, in relation to primary tumor location. Age, sex, type of resection, right or left lesion, T status, primary tumor location, tumor size, tumor central or peripheral location, histology, and survival were recorded and analyzed. Survival was analyzed according to regional spread or not, number of mediastinal lymph node stations involved, and skip metastasis status. RESULTS Among 302 cases (22.7%) with positive mediastinal lymph nodes pIIIA/N2, 66 (22%) were skip metastases, 72 (24%) had a nonregional mode of spread, and 199 (66%) included two or more stations of mediastinal lymph node invasion. Cox regression analysis of all cases disclosed malignant invasion in only one mediastinal lymph node station as the only favorable factor of survival (p < 0.001, odds ratio 0.57, 95% confidence interval: 0.42 to 0.78). CONCLUSIONS The presence of one-station mediastinal lymph node metastasis in patients with nonsmall-cell lung cancer who underwent major lung resection with complete mediastinal lymph node dissection proved to be a good prognostic factor that should be taken into account in the future.

Chylothorax complicating thoracic surgery: conservative or early surgical management?

Postoperative chylothorax is a rare complication in thoracic surgery. There is considerable controversy concerning the management of chylothorax with some physicians favoring conservative treatment while others favor a surgical one. Considering the current surgical experience with VATS and by reviewing the problems and outcome of conservative management, the guidelines regarding timing of surgery in patients with chylous leak need to be revised.

Minimal Invasive Coronary Artery Fistula Ligation

A coronary artery fistula was surgically ligated in a 38-year-old woman via a left anterior mini-thoracotomy without the use of cardiopulmonary bypass. In selected cases, this surgical approach can provide an excellent surgical exposure for coronary artery fistula ligation. It also offers an excellent cosmetic result and shorter hospital stay.

Emergent Endovascular Repair as Damage Control Step of Aortic Injury After Posterior Spinal Instrumentation

atrogenic injury of the aorta is a rare, but serious complication of spine fixation surgery. A 59-year-old woman as transferred to our service in profound shock (ie, hypoensive with severe metabolic acidosis). The patient had ndergone posterior spine fixation surgery at the levels T3, 4, T6, and T7 just 1 month prior). Despite the artifact due o the metallic tip, which masquerades the aortic lesion, the omputed tomographic scan (CT) of the chest revealed masive left hemothorax with active extravasation of contrast edium in the pleural cavity (Fig 1) due to aortic perforation rom a pedicle screw at the level of the fourth thoracic vertera. Initial left chest tube output was 1,650 mL. Because the eneral condition of the patient precluded any major surgical ntervention due to high expected mortality, an emergent ndovascular aortic stent-graft was decided on as a damage ontrol step. A Valiant (32 150 mm) thoracic endovascular raft (Medtronic Vascular, Santa Rosa, CA) was introduced hrough the right common femoral artery into the descending horacic aorta at the region of the perforation under direct uoroscopic guidance. Chest tube output became minimal, ndicating cessation of bleeding. The patient was transferred n the intensive care unit where she was hemodynamically tabilized with blood transfusion and vasoactive drugs. As oon as the metabolic acidosis was reversed and her hematorit was more than 30%, the patient received complete ortho-

Thoracoabdominal aneurysm repair using a four-branched thoracoabdominal graft: a case series.

Revascularization of the visceral arteries during thoracoabdominal aneurysm repair is usually performed sequentially by an anastomosis between a prosthetic graft and an aortic patch. There are immediate operative risks such as bleeding and distortion. In the longer term, aneurysm, pseudo-aneurysm and rupture may occur. These require reoperation and are associated with significant morbidity and mortality.We present our experience with Crawford IV thoracoabdominal aneurysm repair in four patients, using a prefabricated four-branched graft (Coselli graft). At two years there were no deaths, no complications and no vessel abnormalities on computed tomography. We recommend its use as the graft of choice in young patients with an aortic tissue disorder requiring total resection of the aortic wall at the level of the visceral vessels.

Cor triatriatum presenting as heart failure with reduced ejection fraction: a case report

Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atrium. We report an unusual case of cor triatriatum in a 33 - year old woman presented with congestive heart failure caused by left ventricular systolic dysfunction.

Paroxysmal atrial fibrillation due to left atrial appendage herniation and review of the literature

The incidence of the isolated form of partial absence of the pericardium is a rare finding. The authors present a case of an isolated left sided pericardial defect with intrathoracic protrusion of the left atrial appendage found during a left upper lobectomy for lung cancer, unrecognized after serial echocardiographs and computed tomography scan of the thorax. The patient suffered from episodes of atrial fibrillation which disappeared after pericardial defect repair without antiarrhythmic medication.

Chest Wall Hydatidosis as the Unique Location of the Disease: Case Report and Review of the Literature

The chest wall is a rare location of secondary hydatidosis, but secondary hydatidosis may occur from the rupture of a lung cyst, from a liver cyst invading the diaphragm into the pleural cavity, following previous thoracic surgery for hydatidosis, or by hematogenous spread. This report describes a case of chest wall hydatidosis, which was the primary disease site in the patient, who had no previous history or current disease (hydatidosis) at other sites. The cyst invaded and partially destroyed the 9th and 10th ribs and the 10th thoracic vertebra, and protruded outside the pleural cavity through the 9th intercostal space. Preoperative albendazole administration for 10 days, surgical resection of the disease through a posterolateral thoracotomy incision, and postoperative albendazole treatment resulted in a cure with no evidence of local recurrence or disease at other sites in four years of follow-up.

Chylothorax Complicating Thoracic Aortic Surgery

Abstract  Objective: Chylothorax is a very rare complication of patients undergoing thoracic aortic aneurysm repair. Possible mechanisms of this condition during thoracic aorta operations and current therapeutic strategies are analyzed according to our experience and thorough search of the English literature. Methods: Current experience with chylothorax occurring during thoracic aortic surgery is analyzed in this review by collecting data retrieved from English literature research. Results: Significant risk factors for postoperative chylothorax development after thoracic aorta surgical procedures are thoracic aortic reoperations and descending thoracic repairs. Various treatment modalities from conservative to operative intervention have been proposed. Conclusion: Currently, the morbidity and mortality have improved due to prompt management. Surgical intervention is needed when response to conservative treatment has failed. (J Card Surg 2011;26:410‐414)

Recurrent Massive Hemoptysis due to Postbronchotomy Bronchial Artery Aneurysm: A Case Report

Bronchial artery aneurysm (BAA) is a rare clinical entity. A case of intrapulmonary BAA associated with previous bronchotomy at the same site is described. A 22-year-old woman, who had undergone bronchotomy of the intermediate bronchus for the removal of a foreign body four years previously, presented with recurrent hemoptysis. Because of an increased risk for spinal cord ischemia, she immediately underwent lung resection rather than therapeutic embolization. The incidental finding of a BAA of any cause cannot be assumed to be stable, and immediate management should be undertaken regardless of the presence or absence of symptoms.