Athanassios Kleontas

Totally implantable central venous access ports. Analysis of 700 cases

Vascular access has great importance in the treatment of patients submitted to prolonged chemotherapy. Purpose of this study is to assess the efficacy and safety of the percutaneous insertion and use of totally implantable central venous access ports (TICVAP).

Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases

BackgroundMalignant pleural effusion is a common sequelae in patients with certain malignancies. It represents a terminal condition with short median survival (in terms of months) and the goal is palliation. Aim of our study is to analyze morbidity, mortality and life expectancy following videothoracoscopic talc poudrage.Materials and methodsFrom September 2004 to October 2009, 400 patients underwent video-assisted thoracic surgery (VATS) for malignant pleural effusion. The conditions of patients were assessed and graded before and after treatment concerning morbidity, mortality, success rate of pleurodesis and median survival.ResultsThe median duration of follow up was 40 months (range 4-61 months). All patients demonstrated notable improvement in dyspnea. Intraoperative mortality was zero. The procedure was well tolerated and no significant adverse effects were observed. In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. The best survival was seen in breast cancer, followed by ovarian cancer, lymphoma and pleural mesothelioma.ConclusionsVideo-assisted thoracoscopic talc poudrage is an effective and safe procedure that yields a high rate of successful pleurodesis and achieves long-term control with marked dyspnea decrease.

Cutaneous skull metastasis from uterine leiomyosarcoma: a case report

BackgroundCutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer.Case presentationA 52-year-old woman who admitted with a lung and a skull skin nodule is presented. She had a known diagnosis of uterine leiomyosarcoma following an extended total hysterectomy two years ago. Excision biopsy of both nodules revealed metastatic disease.ConclusionThe appearance of a cutaneous nodule in a patient with a history of uterine leiomyosarcoma might indicate a metastatic tumor lesion. Biopsy and immunohistochemistry are essential for correct diagnosis.

Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: A case report

BackgroundReduction in visual acuity combined with blurred vision is rarely the first sign of lung cancer and very few cases have been announced globally.Case presentationA case of a 46-year-old man who admitted with blurred vision is presented. His medical history, apart from a mild gastritis under treatment was negative. Ocular examination revealed a decrease in visual acuity due to a choroidal tumor. Further image body scans demonstrated a right lung lesion with dissemination to other organs. Diagnosis of a non-small cell lung cancer established after a VATS biopsy carried out.ConclusionBlurred vision due to choroidal metastasis as the primary symptom of lung cancer is very uncommon. A great index of suspicion is essential when a choroidal lesion appears.

Giant mediastinal teratoma presenting with paroxysmal atrial fibrillation

Mediastinum is a common site where benign tumors, like teratomas, can develop. Usually, these lesions do not cause any symptoms and the diagnosis is reached accidentally. As they enlarge they may cause symptoms by compressing the nearby structures of the thorax, mostly the trachea and the bronchi. Extrinsic compression of the heart or the great vessels appears to be a very rare occurrence. Atrial fibrillation as the first clinical presentation of left atrial compression by a giant mediastinal teratoma is extremely uncommon and very few cases have been described in the English literature.

Nine years experience in surgical approach of leiomyomatosis of esophagus

BackgroundLeiomyomas of esophagus, although rare, are the most frequent benign tumors of esophagus. Aim of this study is the presentation of 7 patients with esophageal leiomyomas who underwent surgical treatment during a 9-year period.MethodsEpidemiological data (sex, age), the presenting symptoms, diagnostic examinations, tumor location, histopathological findings and the safety and efficacy of surgical resection are analyzed and assessed.Results5 men and 2 women with mean age of 56.9 years were operated. In 3 cases the tumor was located at the lower esophagus, while in the other 4 cases, the leiomyoma was found at the median third of esophagus. 4 patients had severe symptoms related to the leiomyoma, such as dysphagia and epigastric pain. All patients underwent a right postolateral thoracotomy with enucleation of the lesion. None of them received resection of part of the esophagus. The mean diameter of the resected tumors was 4.3 cm. The dimensions of leiomyomas were immediately associated with the symptoms. In no case was detected malignancy or recurrence. All patients were relieved from their symptoms, while postoperative morbidity and mortality did not occur.ConclusionsEsophageal leiomyoma is a benign tumor, which causes symptoms only if its size becomes large. Surgical enucleation is considered to be safe and effective, without complications.

Renal Artery Thrombosis following Lobectomy for Lung Cancer

Acute renal arterial thrombosis is a rare but very urgent situation demanding immediate treatment. It is characterized by unspecific symptomatology which often misleads the clinicians. As a result, precious time can be lost until the correct diagnosis is reached. The case of a 53-year-old female who underwent a left upper lobectomy for lung cancer is presented. On the third postoperative day, the patient began to complain of a flank pain located at the lower side of the left hemithorax and the nearby lumbar area. A renal arterial thrombosis was finally diagnosed and subcutaneous low molecular weight heparin was started immediately. The patient was discharged two weeks later and anticoagulation therapy with warfarin was given. Six months later, renal function remains satisfying and the patient is free of any symptoms. This is probably the first case in English literature of renal arterial thrombosis following lobectomy for lung cancer.

Primary glomangiosarcoma of the lung: A case report

BackgroundGlomus tumor is an uncommon neoplasm derived from cells of the neuromyoarterial glomus or glomus body. Most glomus tumours occur in the dermis and subcutaneous tissues. A case of a primary pulmonary glomus tumour originating in the right upper lobe is presented.Case presentationA 74-yr-old male was admitted with siccus cough, dyspnea and right-sided chest pain. Computed tomography of the thorax revealed a 4 cm growth of the right upper lobe. Fiberoptic bronchoscopy demonstrated an endobronchial hypervascular mass causing obstruction of the apical segmental bronchus. Pathology report was consistent with pulmonary glomus tumor. The patient underwent a typical right upper lobectomy with mediastinal lymph node dissection. Twelve months later he is free of disease.ConclusionOccasionally glomus tumors can occur in extracutaneous sites such as the gastrointestinal tract, bone, genitourinary system and respiratory tract. Primary pulmonary glomus tumors are very rare (our case is the 19th one presented in the international literature) and are often confused with other solid neoplasms such as carcinoids, hemangiopericytomas and tumors belonging to the family of Ewings sarcoma/primitive neuroectodermal tumours.

Post-Lobectomy Pulmonary Artery Stump Thrombosis: How Dangerous Is It?

A59-year-old man underwent a right lower lobe resection and mediastinal lymph node dissection for poorly differentiated adenocarcinoma of the lung (T3N0M0). Six months later during a routine follow-up, a chest computed tomographic scan revealed a filling defect in the right descending pulmonary artery stump (Fig 1). Low molecular weight heparin therapy was instituted. Doppler sonography of the patient’s lower extremities showed normal findings and a ventilation-perfusion scan obtained 2 days later was negative for pulmonary embolism. Oral anticoagulation therapy was discontinued 6 months later when a new computed tomographic scan revealed no change in the filling defect (arrow) (Fig 2). Distinguishing in situ vascular stump thrombosis from pulmonary emboli is important because the prognosis and treatment of these two conditions may differ. How-

Video-assisted thoracoscopic resection of a bronchogenic esophageal cyst

Bronchogenic cysts are lesions of congenital origin derived from the primitive foregut. The usual presentation of bronchogenic cyst in the mediastinum is related to cyst infection or adjacent organs compression. A case of a bronchogenic esophageal cyst presenting with progressive dysphagia in a 46-year-old man is described. A video-assisted thoracoscopic excision was performed successfully. Details of the procedure are discussed.