Search

Lung cancer is usually diagnosed at an advanced stage and metastases are present in 50% of patients. Small bowel metastases from lung cancer are rare, being more frequent in patients with melanoma, uterine, ovarian, kidney or gastrointestinal cancer, or osteosarcoma. From November 1998 to August 2003, 740 cases of lung cancer (641 non-small-cell lung cancer and 99 neuroendocrine tumours) were diagnosed. We also observed 64 patients with malignant pleural mesothelioma and performed 23 pleuropneumonectomies. Over the same period we admitted 4 patients (one recurrent) with small bowel metastases, three from lung cancer and one from malignant mesothelioma. The clinical symptoms were bowel occlusion and intestinal bleeding. Radiological techniques such as small bowel enema and CT enteroclysis were used with positive results. In one patient with intestinal bleeding capsular endoscopy revealed a bleeding metastasis. All patients were operated on. Neither mortality nor morbidity were observed. All patients were discharged after a median stay of 10 days. One patient is still alive and disease-free 39 months after the first intestinal surgery for metastases. Intestinal metastases from lung cancer are rare and the diagnosis is often late. In some cases the clinical manifestations of the metastases are observed before those of the primitive tumour. However, in the presence of small bowel occlusion and intestinal bleeding of uncertain origin, clinical history-taking is very important and diagnostic procedures must be performed to exclude a secondary pathology.

Despite various treatment options, empyema thoracis remains associated with important morbility and mortality. Diffused or loculated empyema developed through exudative, purulent and organized phases. Clinically, these phases corresponding to the evolution of the disease: acute and chronic one. The treatment of empyema thoracis is also correlated with the general condition of the patient and even if the drainage is satisfactory in the exudative form, these surgical procedure may be not curative in the purulent and chronic phase. In these cases empyemectomy and pleural decortication are treatment of choice. Recently, Video Assisted Thoracic Surgery has assumed greater importance in the management of this pathology. In our Department of General and Thoracic Surgery, on 178 patients with chronic empyema thoracis, 26 were underwent VATS. During the follow-up there was no mortality or recurrence of empyema. The results indicate VATS because of higher efficacy, shorter hospital stay and less cost, is the primary surgical treatment of chronic empyema thoracis.

In a 20 year period (1974-1995), 3451 patients with bronchogenic carcinoma were observed. Retrospective analysis of these cases allowed to study the relationship between primary pulmonary malignancies and laryngeal tumours. In 32 patients synchronous or metachronous carcinoma of the larynx and lung were found. All laryngeal tumours were curable but only fifteen of these second primary lung tumours were successfully treated. None of unresected patients survived beyond 2 years.

Videothoracoscopy can be used for diagnostic purposes when the other non-invasive methods are not satisfactory for an accurate histological diagnosis in lung and pleural pathology. The role of VTS was confirmed in the cases, observed from 1993 and surgically treated, which are herein discussed.

The non-surgical approach to hemorrhoidal disease was considered, particularly in relation to the rubber band ligation technique. On the basis of a four-year experience collected on 60 treated patients among 75 observed, cases, indications, results and advantages of the method were outlined. Besides the classic method's applications, two cases were presented in which the technique was applied on the grounds of non typical indications. From the final results the rubber band method represents a good therapeutic option for early degrees of hemorrhoidal disease. Moreover, on the basis of the author's experience, this method is also suitable in appropriately selected cases of advanced hemorrhoidal disease intra-anal mucosal prolapse.