Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

Introduction: Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. Methodology: During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. Results: We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008). Conclusion: The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

mg] compared to sham group [112.00 (79.97-173.35) mg, p = 0.043, Cohen's d = 0.42]. On postoperative day 5, maximum visual analog scale (VAS) pain score with cough was significantly lower in the tDCS group [29.

We present our first experience with endovascular treatment of 6 subclavian artery aneurysms (SAA) occurring in five male and one female patient. All patients, in our studies, according to ASA classification were high risk for open repair of SAA. The etiology of the all aneurysms was atherosclerosis degeneration of the artery. Two aneurysms were of intrathoracic location, then the other were extrathoracic. Symptoms related to subclavian artery aneurysms were present in two patients, compression and chest pain in one, and hemorrhage shock in second, while the remaining patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with ruptured of subclavian artery aneurysm who was high-risk for open repair we made combined endovascular procedure. First at all, we covered the origin of left subclavian artery with thoracic stent graft and after that we put two coils in proximal part of subclavian artery. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and one patient required endovascular reoperation due to endoleak type I. Endovascular treatment is recommended for all patients with subclavian artery aneurysm whenever this is possible due to anatomical reasons especially in high-risk patient with intrathoracic localization of aneurysm, to prevent potential complications.

Introduction/Objective The aim of the study is to analyze the treatment of spontaneous pneumothorax (PSP) through our 10-year experience. Methods The study included 67 patients with PSP treated with video-assisted thoracoscopic surgery (VATS) or with thoracic drainage (TD) in the Clinic for Chest Surgery at the Military Medical Academy in Belgrade, Serbia in the 2008-2017 period. Results PSP patients with VATS were younger (33.2 ± 16.4 vs. 45.5 ± 21.5 years, p = 0.010), and both groups consisted mainly of males (69.2% vs. 78%). VATS-treated patients were hospitalized shorter and wore drains (p < 0.001, p < 0.002). Recurrence after treatment was more common after TD (61% vs. 3.8%) and in most cases it was treated with VATS (92%). The incidence of intraoperative complications is similar between groups (p = 0.599, p = 0.636, p = 0.311, p = 0.388, p = 0.388, respectively). Pain was more common in TD (p < 0.001). The early complications in the group of patients treated with TD occurred more often (p < 0.001, p < 0.001), without significant difference in the incidence of pleura infections and intercostal blockade between groups (p = 0.388, p = 0.388, respectively). Patients treated for PSP with the VATS method came to the control follow-up later, compared to patients treated with TD (p < 0.001). Conclusion VATS proved to be efficient, which was reflected in the optimal duration of surgery, length of hospitalization, tolerable postoperative pain and satisfactory cosmetic effect, and postsurgical relapse in only one case.

Aggressive surgical treatment, regardless the localization and the extent of changes is the key to success in the treatment of patients with necrotizing mediastinitis.

Unicentric form of Castleman's disease is expressed with enlarged lymph nodes on predilected places, usually in mediastinum. Surgical treatment is best method for the management of the disease and brings a full recovery of patient.

Background/Aim. Lung cancer is one of the most common malignant tumors. About 80% of all lung cancers are non-small cell lung cancer (NSCLC). According to histopathological characteristics, the most common types of NSCLC are squamous cell carcinoma and adenocarcinoma. The aim of this study was to evaluate the overall survival rate in the NSCLC patients initially received surgery according to its histopathological type and T-primary tumor, N-regional lymph nodes, M-distant metastasis (TNM) stages which were treated with surgical treatment, and after that, according to the TNM stage, chemotherapy protocols and/or radiation therapy. Methods. This retrospective case series study included all patients with NSCLC admitted to the Military Medical Academy in Belgrade in the period 2010-2015. A total number of selected patients was 85 (27 females and 58 males). Results. Out of 41 patients with squamous cell carcinoma, 19.5% deceased. On the other hand, in the group of patients with adenocarcinoma, 43.2% Ključne reči: pluća, nesitnoćelijski karcinom; adenokarcinom; karcinom skvamoznih ćelija; preživljavanje; recidiv.