Lavinia De Monte

Peri-operative complications of video-assisted thoracoscopic surgery (VATS)

Video-assisted thoracoscopic surgery (VATS) has multiple indications for diagnosis and treatment of many different thoracic diseases; the commonest are lung wedge resection, pleural and mediastinal biopsy, treatment of pneumothorax, and pleurectomy. Moreover, in recent years a few surgeons have performed routinely major lung anatomic resections by VATS approach, including segmentectomy, lobectomy and pneumonectomy. In our experience VATS constitutes about one-third of all thoracic surgical procedures. In the reviewed literature as in the most frequent complications after VATS procedures are: prolonged air leak, bleeding, infection, postoperative pain, port site recurrence and the need to convert the access in thoracotomy. The complication and mortality rates are generally very low and VATS procedures are considered safe and effective. It is recommended that all thoracic surgery departments audit their VATS procedures for peri-operative morbidity and mortality to compare results and outcomes.

Metastasis at a tracheostomy site as the presenting sign of late recurrent breast cancer

Metastasis in a tracheostomy site occurs rarely, usually from head and neck primary tumors. Breast cancer relapse to a tracheostomy has not been described to date.

Hypertension and Intrapericardial Paraganglioma: An Exceptional Presentation of Multiple Endocrine Neoplasia Type IIA Syndrome

To the Editor: Paracardiac paragangliomas are very rare. A catecholamine-producing intrapericardial paraganglioma has never been described previously in the context of multiple endocrine neoplasia (MEN) IIA syndrome.1,2 We report the case of a patient with MEN IIA syndrome and secondary hypertension caused by functioning paraganglioma exceptionally located intrapericardially. A 34-year–old woman presented with recent episodes of headache, palpitation, and flushing. For several months she had arterial hypertension controlled by ramipril; however, she reported high blood pressure spikes (180/90 mm Hg). Moreover, her sister was diagnosed with medullary thyroid cancer. Examination of the patients neck demonstrated a small lump in the left thyroid lobe. Aspiration cytology of the nodule (1 cm) revealed a medullary thyroid carcinoma cell pattern. Thyrocalcitonin serum level was high (217.6 pg/mL; normal: <18 pg/mL), whereas calcium, thyroid-stimulating hormone, T3, and T4 levels were normal. A MEN syndrome was suspected, and additional exams were …

Should Pectus Excavatum Alter Aortic Root Surgery in Patients With Marfan Syndrome? A Computed Tomography Scan–Guided Surgical Strategy Through Left Anterior Thoracotomy

Uncorrected pectus excavatum does not impair aortic root surgery through left anterior thoracotomy in Marfan patients. INTRODUCTION The optimal management of patients with Marfan syndrome (MFS), affected with pectus excavatum (PE), and requiring aortic surgery is an underreported and debated issue because of the considerable technical difficulties. Aortic root dilatation is found in 80% of MFS, and up to 66% of patients with MFS present with PE. Combined or staged aortic root and PE repair have been shown to be safe and effective, though data are available mainly in case reports or case series. We report 2 cases of computed tomography (CT) scan–guided aortic root repair in MFS with extreme PE through a left anterior thoracotomy (LAT).

Chronic tracheoesophageal fistula successfully treated using Amplatzer septal occluder

Tracheoesophageal fistula (TEF) is a serious life-threatening condition that appears in critically ill patients with a prolonged history of mechanical ventilation. Enteral feeding and dietary support combinedwith surgery is the gold standard. In selected patients, TEF healing can be ensured by a mini-invasive approach using an Amplatzer septal occluder (AGA Medical Corporation), intended for cardiac septal defect closure [1]. The Amplatzer septal occluder, which is composed of a nitinol mesh, has two self-expandable disks connected by a thin diameter waist (▶Fig. 1) and ensures mechanical closure of the two sides of the fistula, making a potential platform for subsequent tissue ingrowth [2]. This technique was used in a 44-year-old man with tracheostomy and a history of protracted invasive lung support. He had been diagnosed as having a TEF after numerous episodes of aspiration pneumonitis and had subsequently undergone anterior cervicotomy with surgical closure of the fistula. After 7 months, his dysphagia relapsed. Endoscopy confirmed recurrence of the TEF (▶Fig. 2), which was initially treated unsuccessfully by submucosal injection of acrylic glue. Given the poor clinical condition of the patient and the failure of both surgical and endoscopic therapy, it was decided to try positioning of an Amplatzer septal occluder (▶Video1). The procedure was performed using a gastroscope (GIF-1TH190; Olympus Europe) and a bronchoscope (BF-1T180; Olympus Europe). The TEF was cannulated using a papillotome (TRUETome; Boston Scientific) and a 0.025-inch guidewire (Jagwire; Boston Scientific) was inserted into the bronchial segment. The wire was then grasped with a biopsy forceps (Endo-Jaw; Olympus Europe) passed through the bronchoscope, providing countertraction by maintaining a straightened position. The septal occluder catheter was introduced and the two ends were released into the trachea and esophagus, respectively (▶Fig. 3). Successful closure of the TEF was confirmed by contrast medium injection (▶Fig. 4). The procedure was uneventful. E-Videos

Erratum to nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry

[This corrects the article DOI: 10.21037/jtd.2017.06.12.].

Metastasis at a tracheostomy site as the presenting sign of late recurrent breast cancer: Tracheostomy Site Metastasis of Breast Cancer

Metastasis in a tracheostomy site occurs rarely, usually from head and neck primary tumors. Breast cancer relapse to a tracheostomy has not been described to date.