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Severe airway bleeding or massive hemoptysis is a rare condition that carries high mortality. Patients are at risk of life-thretening respiratory compromise due to the airways filling with blood. The main principles in the management of massive hemoptysis are: maintainance of airway patency, localization of the source of bleeding and control of the hemorrhage. Most cases of massive hemoptysis are caused by inflammatory lung diseases such as aspergiloma, tuberculosis and bronchiectasis while a severe bleeding from a malignant lung tumor is a rare find.We present a case of massive hemoptysis in a 60-year old woman, caused by the invasion of lung cancer into the left pulmonary trunk and aorta, which was successfully managed by an extended left pneumonectomy, with the resection of the proximal part of the descending thoracic aorta and interposition of a vascualar graft without extra corporeal circulation. A complete (R0) resection was also achieved.

BACKGROUND Esophageal achalasia (EA) is a primary esophageal motility disorder of unclear aetiology. Standard treatments of EA are: pneumatic balloon dilation (PBD) of the lower esophageal sphyncter (LES) and surgical cleaving of the muscle by Heller myotomy. Although the treatment effectively cures dysphagia, the symptoms recur in about a half of the patients. Our point of interest was long-term effectiveness of EA treatment at our department.METHODSWe made a retrospective analysis of EA patients treated at our department of thoracic surgery during the 2000–2010 period.RESULTSIn 11 years we performed 187 PBD and 22 laparoscopic myotomies (LM) in 148 patients. Three years after the procedure 65 % of patients after PBD and 90 % of patients after LM showed no signs of disease. The risk of recurrence was 3.56-times greater (p = 0.03) after PBD (in comparison to LM), whereas patients older than 50 years bear 0.51-times lower risk (p = 0.02). The most significant complicatios were esophageal perforation in 3 patients (1.6 %) after PBD and gastroesophageal reflux in 3 patients (15 %) after LM.CONCLUSIONSPBD is a fast, simple, inexpensive and very efficient method of EA treatment, which can be safely performed in almost every patient. LM is far more expensive and a more complicated method that is more suitable for younger patients, in whom PBD is less effective.

BACKGROUND Malignant tracheoesophageal fistula is difficult to treat, and the patients’ quality of life isgenerally very poor due to suffering from dysphagia, continuous aspiration and dyspnea.Case report A case of effective closure of the fistula by double stenting (14–10 mm Dumon Y-trachealstent and 28–23 × 120 mm UltraflexTM esophageal stent) is reported. CONCLUSIONS Stenting is an effective method to close the tracheoesophageal fistula and to improve thepatients’ quality of life, although its effects are mostly short lived

BACKGROUND Tracheostomy is one of the most commonly performed procedures in ICU patients. Fourdifferent techniques of percutaneous tracheostomy (PT): Ciaglia Blue Rhino, Griggs GuideWire Dilating Forceps, PercuTwistTM and Translaryngeal Tracheostomy are now considered an excellent alternative to the surgical tracheostomy (ST). The most commonly citedadvantages of the PT are the ease of the technique, the ability to perform the procedure atthe bedside and consequently lowered costs. CONCLUSIONS Regardless of the PT technique, there is a learning curve and meticulous attention to technique and education is necessary to maintain the excellent safety record of PT – comparable to ST

BACKGROUND Intrapleural application of streptokinase (SK) is an old and somewhat forgotten method oftreatment of complicated pleural effusions. In a selected group of cases, SK can successfullyreplace more aggressive surgical procedures. METHODS A retrospective analysis of all intrapleural SK applications at our department between2004 and 2007 was performed. RESULTS 14 patients met the study inclusion criteria: 7 parapneumonic effusions, 5 residual hemothoracesand 2 loculated malignant effusions.Significant increase of the drained volume with notable radiological and clinical improvementfollowed the applications of 500,000 IU of SK in all patients and 9 patients (64 %)were spared the painful thoracotomy. CONCLUSIONS Our data supports the evidence on high efficiency of the intrapleural fibrinolysis with SK ina selected population of complicated pleural effusions

BACKGROUND Chest ultrasound (US) is well documented as a valuable tool for pleural diseases. US helpsto clarify the cause of pleural opacities, estimate the volume of pleural effusion and identifyminimal or loculated pleural effusion. US characteristics of effusion provide helpful informationregarding the nature of the effusion. Pleural diseases, such as pleural fibrosis,tumours and pneumothorax all display different diagnostic US features. Safe thoracentesisand drainage of effusion can be carried out under US guidance with a high successrate. The technique of US, which is safe and cost-effective compared to CT scanning, may belearned relatively easily by the pulmonologist and thoracic or general surgeons. CONCLUSIONS US guidance is recommended for every chest tube insertion, especially in the ICU patients.Appropriate US machine should be readily available in every trauma, ICU, pulmonologyand thoracic surgery unit

Background: Fine-needle aspiration biopsy can very reliably discriminate between benign and malignant thyroid tumors. The role of additional intraoperative frozen section to guide intraoperative management was questioned.Methods: A retrospective analysis of all thyroid resections at our department between 2000 and 2004 was performed.Results: 420 patients with benign thyroid lesions underwent surgical resections. 169 lobectomies and 251 total thyroidectomies were performed and 57 (13.5 %) thyroid cancers discovered (mostly papillary carcinomas). 54 frozen sections were performed and sensitivity rate of 11.1 % and specificity rate of 97.8 % was estimated.Conclusions: Our data supports the fact that intraoperative frozen section is not sensitive enough to substantially add to preoperative fine-needle aspiration biopsy, even with more selective use. We conclude that routine use of frozen section is not cost-effective in surgery of the benign thyroid and can therefore be abandoned.