Antonio Marrosu

Single access videothoracoscopic biopsy and talc pleurodesis in patients with malignant pleural effusion

Aim-BackgroundRecurrent pleural effusion is frequently observed in clinical experience and malignancy is one of the most frequent causes. Although it is generally necessary to prevent the recurrence of effusion in patients with disseminated neoplastic disease, in others, a diagnosis is required. The aim of this study was to determine the efficacy and safety of biopsy and pleurodesis by a single access videothoracoscopic approach.MethodsWe report a consecutive series of 20 patients (12 men, 8 women, aged 39 to 83 years) who underwent single access videothoracoscopy with pleural biopsy and talc pleurodesis for recurrent pleural effusion. In all cases, indication for the procedure was a recurrent pleural effusion, suspicious for malignancy. Videothoracoscopy was performed under general anaesthesia. For pleurodesis, an average of 8g of sterile talc powder was used. A six-month follow-up was completed for all patients, and efficacy was judged by clinical examination and chest X-ray.ResultsDiagnosis was obtained in all cases. In five cases, the diagnosis was a pleural involvement by breast cancer metastasis, and in four cases, a primary lung cancer was detected. Eight were mesotheliomas and one a parapneumonic collection. In two cases, an unknown-malignancy recurrent pleural effusion was observed. No deaths, talc-induced ARDS or malignant invasion of the scar occurred, but only a postoperative empyema and two subcutaneous emphysemas treated successfully without further operation.ConclusionsSingle access videothoracoscopic pleural biopsy and talc pleurodesis is a safe and effective method for the diagnosis and treatment of malignant pleural effusions.

An unusual case of excessive sweating affecting the right upper limb after bilateral endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: recurrence or compensatory hyperhidrosis?

SummaryIntroductionHyperhidrosis is excessive perspiration beyond physiological needs and can be primary (essential, idiopathic) or secondary to drugs, toxins, substance abuse, and several medical conditions. Primary hyperhidrosis generally involves the palms, axillae, and face. Herein, we report an unusual case of excessive sweating after endoscopic thoracic sympathectomy, which was misinterpreted as recurrence due to improper surgery.MethodsA 31-year-old male patient underwent bilateral T3-T4 videothoracoscopic sympathicotomy for primary palmar hyperhidrosis.ResultsAfter the surgery, the patient complained about sweating of the right axillae and palm, and underwent reoperation at the right side, which revealed correct division of the sympathetic chain and absence of visible communicating nerves between the stubs. Subsequently, the patient presented with excessive sweating, greater than that prior to surgery, in the right upper limb. This condition was difficult to contextualise as either recurrence, given the correctness of the surgical procedure and higher amount of sweating compared with the preoperative state, or as compensatory hyperhidrosis, given the involvement of body areas affected by surgery.ConclusionsCompensatory hyperhidrosis may involve areas affected by endoscopic thoracic sympathectomy and thus may be confused with recurrence due to incomplete surgery, leading to unnecessary surgical re-interventions.

Hybrid transanal endoscopic microsurgery: a novel approach to rectal neoplasm excision.

Rectal neoplasm excision is a challenging issue in gastrointestinal endoscopy and surgery. This technical note describes a hybrid method for the excision of challenging rectal neoplasms.