Tak-Wai Lee

Multidisciplinary Management of Life-Threatening Massive Hemoptysis: A 10-Year Experience

BACKGROUND Life-threatening massive hemoptysis requires prompt action and thoracic surgical input. Although there are a number of reports regarding each therapeutic modality for medical or surgical treatment, the significance of a multidisciplinary strategy remains undetermined. METHODS From January 1995 to December 2005, 120 patients were referred to our cardiothoracic center with massive hemoptysis. We retrospectively reviewed and compared the outcomes of a recent 5-year period (2000 to 2005) with those from the previous 5 years (1995 to 1999), as we made major changes in our practice in 2000. We currently try to avoid surgery within 48 hours after onset of active hemoptysis and adopt bronchial artery embolization as a first-line therapy. Treatment decisions are made after discussions among intensive care unit physicians, thoracic surgeons, and interventional radiologists. RESULTS The former group had 49 patients (57.9 +/- 14.1 years old, 41 males), and the recent group, 71 (62.2 +/- 23.5 years old, 52 males). There were no significant differences for any characteristics studied between the groups. In analyses of short-term complications after surgery, the former had a higher in-hospital mortality rate than the recent group (15% versus 0%). Furthermore, postoperative complications were seen in 8 patients (30%) in the former, whereas those occurred in 3 patients (18%) in the recent group. CONCLUSION Bronchial artery embolization is an effective therapeutic tool and plays a pivotal role in management of life-threatening massive hemoptysis. Surgery is indicated when bronchial artery embolization is not suitable and can be safely performed in combination with a rigid bronchoscopy or bronchial artery embolization procedure. Our results indicate that a multidisciplinary approach should be adopted for management of life-threatening massive hemoptysis.

Follicular dendritic cell sarcoma of the neck

Follicular dendritic cell (FDC) sarcoma is an uncommon neoplasm occurring primarily in lymph nodes but also in extranodal sites. A correct diagnosis can be difficult to make, especially in the latter sites.

Shoulder function after thoracic surgery

Thoracic procedures are considered to be among the most painful surgical incisions and are associated with considerable postoperative pain and shoulder dysfunction, severely affecting mobility and activities of daily living. Improper patient positioning, muscle division, perioperative nerve injury, rib spreading, and consequent postoperative pain influence the patients postoperative shoulder function and quality of life. To reduce access trauma and postoperative morbidity, various alternative modalities have been proposed to replace the standard PLT, including muscle-sparing techniques and VATS. Initial evaluations suggest that these alternatives are associated with significantly better postoperative shoulder function. Proper comparative studies using standardized questionnaires, objective evaluations, or quality-of-life assessments are scarce, however. Proper postoperative care, including early mobilization and effective physiotherapy, is a cornerstone in successful patient rehabilitation and rapid return to normal daily activities. Whether upper extremity exercises can contribute to improvement in postoperative shoulder function and the ability to perform activities of daily living needs to be studied further.

Quality of life after lung cancer resection

Lung cancer continues to be the most common cancer in the world, with the highest cancer mortality rate by far. Although resection remains the treatment of choice in early-stage NSCLC, the prognosis remains grim even after surgical treatment. In a patient population with such a high mortality rate, evaluation and preservation of QOL after treatment is imperative. Early-stage lung cancer patients already have significantly lower QOL when compared with the normal population before surgical treatment, with significant impairment in physical and emotional functioning. Lung cancer resection causes further deterioration of QOL, especially in the first 3 to 6 months after surgery. While some studies suggest that QOL returns to baseline levels at 6 to 9 months postoperatively, others report that QOL is still significantly impaired at 6 months and 1 year after surgery. Although prospective studies analyzing long-term postoperative QOL are not available, retrospective data suggest that long-term survivors after lung cancer surgery enjoy good QOL despite impaired physical functioning. QOL studies on VATS lung cancer resection are extremely limited. More prospective, longitudinal studies with larger study populations and longer follow-up periods are needed to portray the course of QOL in lung cancer patients more accurately and to improve postoperative care. Furthermore, comparative studies between VATS and the standard thoracic incisions (including QOL assessments) must be performed to guide clinical decision making regarding selection of optimal access modality for performing lung cancer resection.

Video-assisted thoracic surgery: A renaissance in surgical therapy

Within a few years, video‐assisted thoracic surgery (VATS) has become the accepted or preferred approach over a wide range of thoracic procedures. The authors review the development of this technique, the basic operative strategies and the current surgical indications. Technical pitfalls and future developments are also discussed.

Cystic pulmonary metastases from epithelioid cell sarcoma

A patient with cystic pulmonary metastases, from epithelioid sarcoma of the thigh, resulting in bilateral pneumothoraces is presented. The pulmonary metastases superficially resembled pneumomatoceles and were not visible on radiography. Computed tomography examinations over a 10-month period showed no change in the size or number of the cystic metastases, though air fluid levels and pericystic nodular consolidation (probably due to pulmonary hemorrhage) did occur and regress. This case report serves to emphasize that bullous type lesions on thoracic computed tomography in patients with a known sarcoma should be interpreted with particular caution.

Alveolar Capillary Dysplasia with Congenital Misalignment of Pulmonary Vessels

Alveolar capillary dysplasia with misalignment of pulmonary vessels is an uncommon congenital cause of persistent pulmonary hypertension of the newborn. It is universally fatal, and diagnosis is entirely dependent upon surgical lung biopsy. We present a case of alveolar capillary dysplasia with misalignment of pulmonary vessels occurring in a full-term neonate, emphasizing that early involvement of the thoracic surgeon for a histological diagnosis allows expensive and ineffective treatments to be avoided.

Mediastinal Synovial Sarcoma: A Case Report and Literature Review

Synovial sarcomas are uncommon soft tissue tumours. Immunohistochemistry and cytogenetic techniques are essential for proper diagnosis and differentiation from other spindle cell neoplasms. A case of mediastinal synovial sarcoma is described, of which the unusual location, diagnosis and treatment form the basis of this report.