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Background Factors influencing long-term outcome after surgical resection for duodenal adenocarcinoma are unclear. Methods A prospectively created database was reviewed for patients undergoing surgery for duodenal adenocarcinoma in six UK hepatopancreaticobiliary centres from 2000 to 2013. Factors influencing overall survival and disease-free survival (DFS) were identified by regression analysis. Results Resection with curative intent was performed in 150 (84·3 per cent) of 178 patients. The postoperative morbidity rate for these patients was 40·0 per cent and the in-hospital mortality rate was 3·3 per cent. Patients who underwent resection had a better median survival than those who had a palliative surgical procedure (84 versus 8 months; P < 0·001). The 1-, 3- and 5-year overall survival rates for patients who underwent resection were 83·9, 66·7 and 51·2 per cent respectively. Median DFS was 53 months, and 1- and 3-year DFS rates were 80·8 and 56·5 per cent respectively. Multivariable analysis revealed that node status (hazard ratio 1·73, 95 per cent c.i. 1·07 to 2·79; P = 0·006) and lymphovascular invasion (hazard ratio 3·49, 1·83 to 6·64; P = 0·003) were associated with overall survival. Conclusion Resection of duodenal adenocarcinoma in specialist centres is associated with good long-term survival. Lymphovascular invasion and nodal metastases are independent prognostic indicators.

To evaluate the possible role and the effectiveness of videothoracoscopy (VATS) in the treatment of pleural empyema.Personal experience on 40 cases of pleural empyema treated by (VATS) during 5 years is reported. The underlying diseases were: pneumonia (32), pneumothorax (3), tuberculosis (2), abdominal diseases (2) and lung cancer (1). Before VATS at least one thoracentesis was performed to evaluate the characteristic of the pleural fluid.Due to complications related to thick pleural adhesions, in one case (2.5%) the procedure was converted to open surgery, while in the remaining 39 cases VATS was able to achieve a complete cleaning of the pleural space with re-expansion of the pulmonary parenchyma. The improvement of the clinical symptoms were observed after a mean period of 3.5 days (range: 1-12 days). Chest tube was removed in a mean period of 4.8 days (range: 3-11 days); five patients had prolonged air leak from 6 to 10 days after surgery.In conclusion we are of the opinion that VATS has to be considered a very important mean for the treatment of pleural empyema; its use in the fibrinopurulent phase of the disease should give very good results, while in the following phase its indications are controversial.

The authors report their experience about 15 patients surgically treated for chronic large pericardial effusion; in 12 cases the etiology was malignant neoplasm, while in the other 3 cases was inflammatory disease. In 4 patients a simple subxiphoid pericardial drainage was carried out, while in the other cases a pericardial window was performed. These cases were managed using an anterior left thoracotomy in 8 patients and a videothoracoscopy in 3. The authors conclude that pericardial window with videothoracoscopic approach is the preferable procedure, but it cannot be used in every case because a lot of patients have seriously compromised conditions and the use of this technique can be hazardous.

Videothoracoscopic techniques were utilized in managing 88 consecutive patients. The series was composed of 36 patients with pneumothorax, 44 cases of single and 9 of multiple pulmonary nodules and 1 patient with diffuse lung disease. In 14 cases (15.9%) conversion to open thoracotomy was necessary while in the remaining 74 patients the procedure (30 blebectomies, 2 bullectomies, 37 wedge resections, 6 lobectomies and one multiple biopsies) were carried out as planned. In each lobectomy and in six wedge resections an accessory small incision was necessary; we consider only this video-assisted thoracic surgery (VATS). Benign disease, aside from the blebs and bullae, was found in 12 cases of solitary pulmonary nodules and in I case of multiple lesions, while malignant lesions were detected in 31 patients. Primary carcinoma was diagnosed in nine cases after a wedge resection had been performed on a suspicious solitary nodule. In two of these wedge resection had to suffice because of poor lung function, while in the remaining seven cases, a lobectomy was carried out through an open thoracotomy in two patients, and in five cases VATS was attempted successfully in four, while in one case a formal thoracotomy was necessary due to bleeding. Solitary metastases were found in 14 patients and were managed by 12 wedge resections and 2 lobectomies. Seventy-one patients (97.3%) had an uneventful postoperative course while 2 (2.7%) had only minor complications. No recurrences were observed, however follow-up is limited. Videothoracoscopy techniques are very useful and are good alternatives to conventional thoracotomy in managing cases of pneumothorax, benign pulmonary lesions and in taking biopsies. Further evaluation is necessary in cases of stage I primary lung cancer and in certain cases of solitary metastasis, however the initial results of videothoracoscopy seem to be favorable

The authors present 2 cases of pulmonary lower lobectomy (right and left) using video-assisted modality. The I patient had a stage I NSCLC and the II had a metastasis from rectal carcinoma. The operation was performed using the modern videoendoscopic means introduced into the thoracic cavity thorough three ports and an anterior 4 cm mini-thoracotomy. The patients had an uneventful postoperative course and no pain or trouble breathing were observed. In conclusion the authors are of the opinion that performing lower pulmonary lobectomy, video-assisted technique is feasible and reliable; in very selected cases it should become the modality of choice.

The authors report their experience of 14 cases of hepatic trauma that underwent surgical treatment. During the period 1987-1990, 42 patients were admitted with diagnosis of hepatic injuries to the surgical department of Ravenna Hospital. 28 of the 42 patients were subjected to repeated abdominal echography and didn't undergo surgical treatment. The authors consider the importance of the abdominal echography whether of the surgical treatment or nonoperative management. Prognosis is always serious, and it is influenced by three factors: the kind of trauma, the concomitant lesions and the general conditions of the patient. The authors, in conclusion, report the per cent of survive and of complications that they have found.

The authors report their experience of transthoracic needle biopsy of the lung based on 68 consecutive cases from 1984 to 1990. In 55 cases significant data has been found: in 44 cases the diagnosis was exact, instead in other 11 cases it was only indicative. The overall complications were 11.7% and in particular were as follow: pneumothorax in 5 cases, hemoptysis in 2 cases and a temporary Horner syndrome in one case. The authors conclude by confirming the utility of transthoracic needle biopsy of intrathoracic tumors in which there is not other way to obtain a diagnosis. This technique is reliable and its complications can be disregarded.

Following an analysis of current treatment strategies for spontaneous pneumothorax and their surrounding controversies, the paper reports the Authors' personal experience. From 1 January 1984 to 31 December 1989 a total of 76 cases of spontaneous pneumothorax were treated, of which 3 were bilateral. The M:F ratio was 9:1 and the age of patients ranged between 16 and 77 years (mean age 39.2); 22 cases were relapses (27.8%). Conservative therapy was used in 12 cases (15.1%); pleural drainage was introduced in 54 cases (68.3%) for a mean of 7.5 days. Fourteen thoracotomies were performed in 13 patients (10.4%): bullectomy was performed 10 times with stapler, whereas pleurodesis was obtained in 9 cases using pleural abrasion and in 5 cases using apical pleurectomy plus pleural abrasion. Axillary thoracotomy at the 5th space was most commonly used. No major complications were observed during the postoperative period and, in spite of the minimum follow-up of 3 months, no cases of relapse were observed in operated patients.

The authors report their experience about splenic breakages in the blunt abdominal traumatology. Through the analysis of different parameters (type of accident, other associated lesions, heart frequency, hematocrit, paracentesis, direct radiological inspection of abdomen, gap of time between hospitalization and operation) they try to frame the blunt traumata of abdomen in four differential and orientative classes. As a conclusion; they assert the diagnosis of splenic breakage can be placed in any hospitals, with no need for sophisticated investigations, but following clinico-laboratorial criteria.

Personal experience with 75 consecutive cases of terminolaterale oesophagojejunal anastomosis by EEA Stapler is reported. A total of 6 intraoperative technical problems were encountered (8%) and consisted either of incomplete suturing of the anastomosis or stapling of the jejunal wall. Postoperative radiology revealed 5 dehiscences (6.6%) and 1 stenosis (1.33%). One patient with dehiscence died (1.33%) of septic complications. One dehiscence of the afferent jejunal stump and minor pleuropulmonary complications were observed in 3 cases. After a brief review of the literature, it is concluded that oesophagojejunal anastomosis by EEA Stapler produces a low incidence of postoperative complications such as the dehiscence, stenosis or bleeding.