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Abstract. Background Stage IV disease at initial presentation accounts for approximately 41% of newly-diagnosed cases with non-small cell lung cancer (NSCLC) (1). Prognosis for metastatic lung cancer remains dismal, despite continuously emerging treatment options. Although the majority of patients have disseminated metastatic disease at diagnosis, a small percentage are found to have a solitary metastasis. In addition any patients with NSCLC who previously received definitive treatment may experience metachronous solitary distant recurrence during the course of their disease. This poorly understood state of limited metastatic load has been described as oligometastatic disease and it seems to run a more indolent course (2, 3). Retrospective clinical studies focused on the surgical management of solitary extrapulmonary metastases, have reported favorable results (4).The aim of this retrospective study was to review our experience with patients who underwent resection of primary NSCLC and solitary extrapulmonary metastasis, and to analyze prognostic factors affecting survival. Patients and MethodsWe reviewed the medical records of thoracic surgical Departments at Laikon General Hospital of Athens and Sotiria Hospital for Chest Diseases (former Second Department of Thoracic Surgery) from January 2004 to December 2012 for patients with NSCLC having undergone combined resections (including stereotactic radiosurgery) of primary lung tumor and solitary hematogenous metastasis.

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Background: Any type of radical thymectomy, open or thoracoscopic, always results in a skeletonized left innominate vein (LIV), which is highly expected to form adhesions to the posterior surface of the sternum. Therefore, in case of future sternotomy, the LIV remains highly exposed to trauma. Methods:We describe a surgical technique that is expected to protect the innominate vein in case of future sternotomy.Results: Our technique is not technically demanding, is easily reproducible, can be applied in both open and thoracoscopic procedures and does not significantly prolong the overall duration or cost of the procedure.Conclusions: Our alternative is the only protective measure for the left innominate vein that can be applied in the first operation and in our opinion should be a standard part of the procedure.

Congenital Coronary Artery Fistulae (CAF) originating from Right Coronary Artery (RCA) and draining into Coronary Sinus (CS) demonstrate high gradients and high flows, which result in ectasia of the entire artery. The anatomic margin between the ectatic RCA and the fistula are not clear and most cardiologists and cardiac surgeons tend to misname the entire vessel as "fistula". We presented a 60-year-old female with multiple CAF draining into CS. The fistula originating from the RCA was huge and caused severe ectasia of the entire artery. The patient had progressive breathlessness due to high left to right shunt. Both fistulae were ligated under cardiopulmonary bypass. Our introduced term "ectatic-fistulous lesion" comes to address the confusion with nomenclature. It not only offers the theoretical advantage of precise description of the above complex pathology, but also allows the cardiac team to identify the anatomical margins between the ectasia and the fistula and, thus, to proceed to closure of the coronary fistula with safety.