Optimal identification of the intersegmental plane can be challenging during thoracoscopic anatomical segmentectomy for lung cancer. We describe a simple new method of infrared-fluorescence-enhanced thoracoscopy with selected injection of indocyanine green into the bronchi not targeted for resection, which allows us to clearly identify the intersegmental plane in thoracoscopic segmentectomy.
Two patients with epithelioid haemangioendothelioma and one patient with multiple cavernous haemangiomas of the mediastinum, pharynx and larynx, are herein presented. Haemothorax as initial manifestation of the tumour was observed in one of them. Epithelioid haemangioendotheliomas were radically removed in both cases. Because of the absence of a well defined capsule and the huge extension, the cavernous mediastinal haemangioma was not resected. However the patient was successfully treated by administration of corticosteroids. Clinicopathologic characteristics of these benign forms of vascular tumours are discussed and treatment options are suggested.
Videothoracoscopy has reduced the number of thoracotomies performed. Thoracotomy can be limited to massive bleeding with hemodynamic instability, major air leak, radiologic evidence of mediastinal enlargement or diaphragmatic rupture, or major anterolateral flail chest.
Paraplegia after thoracic surgery is an uncommon complication, [1][2][3][4] and it is even more uncommon after surgery of the thoracic esophagus. Herein we describe 2 cases that occurred in our experience.Clinical summaries CASE 1. A 72-year-old man was admitted for the treatment of worsening dysphagia. Barium swallow and esophagogastroscopy revealed a mass 31 cm from the incisors, and the biopsy results showed squamous carcinoma. There was no evidence of locoregional spread or metastases at endosonography and computed tomographic scan. The examination revealed a 3.5-cm abdominal aortic aneurysm and diffuse signs of atherosclerosis. The patient underwent an intrathoracic esophagogastroplasty through a left thoracophrenolaparotomy. Tumor dissection necessitated the interruption of some vessels. No perigastric or mediastinal lymph nodes appeared to be involved. The early postoperative period was uneventful apart from a mild paresthesia of the lower limbs. After 24 hours he suddenly became unable to move his legs. Reflexes were totally absent below the T10-11 level. Multiorgan failure progressively developed and he died 7 days later. Postmortem examination showed a normal appearance of the anastomosis and of the tubulized stomach. An ischemic trait of the spinal cord at the T12-L1 level was also evident.CASE 2. A 58-year-old man was referred for treatment of a 5mm vegetating lesion that resulted in an infiltrating squamous cell carcinoma situated 27 cm from the upper incisors. Endosonography and computed tomographic scan did not show local infiltration or metastases. Esophagectomy was accomplished by blunt dissection, and tubulized stomach was anastomosed at the cervical level. No difficulties were found in gastric preparation and esophageal dissection. The early postoperative period was normal. After 38 hours, the patient began exhibiting a progressive sensory and motor deficit of the lower limbs originating at T6-T7. Magnetic resonance imaging showed an ischemic lesion of the spinal cord and excluded external compression. Apart from neurologic conditions, recovery was rapid. Despite continued medical and rehabilitative treatment, neurologic status was unchanged at 2 years.
Tumor M2-PK marker is useful in differentiating malignant from benign pleural effusions. Moreover, its sensitivity and NPV in pleural fluid are significantly higher compared to plasma. The usefulness of such a test is not strictly diagnostic but aims at excluding poorly performing patients from further invasive procedures. Thus, the inclusion of M2-PK within a panel of well-known tumor markers such as CEA, MCA, Ca 125 and Ca 19-9, may help in increasing the overall sensitivity and specificity.
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