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Objectives: This study aimed to explore the effect of suturing upper mediastinum pleura on postoperative complications, surgery-related mortality, and hospital stay., Methods: Four hundred and thirty-eight patients with esophageal cancer who underwent esophagectomy were identified. Patients were divided into two groups: those in the test group who received reconstruction of upper mediastinal pleura, those in the conventional group who did not. The incidence of postoperative complications, surgery-related mortality, and hospital stay were compared. To reduce the impact of confounding factors, a propensity score matching (PSM) method was performed., Results: A total of 273 patients were treated with suturing upper mediastinal pleura and 165 were not. After PSM, compared with the conventional group, the incidence of atelectasis (7.2% vs. 1.4%, p = 0.035), anastomotic leakage (5.8% vs. 0.7%, p = 0.036), and delayed gastric emptying (10.8% vs. 3.6%, p = 0.034) were significantly lower in the test group. And suturing the upper mediastinal pleura could reduce the severity of leakage (p = 0.045), consistent with the results before PSM. Moreover, there were no significant differences in the incidence of other complications, postoperative hospital stay, and 30-day mortality (all p > 0.05)., Conclusions: In this study, suturing the upper mediastinal pleura can reduce the incidence of atelectasis, anastomotic leakage, and delayed gastric emptying, and the severity of leakage, without increasing the incidence of other complications, surgery-related death, and postoperative hospital stay., (© 2021 Wiley Periodicals LLC.)

Background: Pleural complications after lung transplant may restrict allograft expansion, requiring decortication. However, its extent, indications, risk factors, and effect on allograft function and survival are unclear., Methods: From January 2006 to January 2017, 1,039 patients underwent primary lung transplant and 468 had pleural complications, 77 (16%) of whom underwent 84 surgical decortications for pleural space management. Multivariable time-related analysis was performed to identify risk factors for decortication. Mixed-effect longitudinal modeling was used to assess allograft function before and after decortication., Results: Cumulative number of decortications per 100 transplants was 1.8, 7.8, and 8.8 at 1 month, 1 year, and 3 years after transplant, respectively. Indications for the 84 decortications were complex effusion in 47 (56%), fibrothorax in 17 (20%), empyema in 11 (13%), and hemothorax in 9 (11%). Thoracoscopic operations were performed in 52 (62%) and full lung re-expansion was achieved in 76 (90%). Complications occurred after 30 (36%) decortications, with 15 pulmonary complications (18%), including 2 patients requiring extracorporeal support due to worsening function. Ten reinterventions occurred via thoracentesis (2), tube thoracostomy (1), and reoperation (7). In-hospital and 30-day mortality was 5.2% (n = 4/77). Forced expiratory volume in 1 second increased from 50% to 60% within the first year after decortication, followed by a slow decline to 55% at 5 years. Postdecortication survival was 87%, 68%, and 48% at 1, 3, and 5 years, respectively., Conclusions: Despite high risk of reoperative surgery, decortication after lung transplant allows salvage of pleural space and graft function with a reasonable morbidity profile., Competing Interests: Conflicts of interest The authors of this manuscript have no conflicts of interest to disclose., (Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the clinical impact of pleurotomy during skeletonized internal thoracic artery (ITA) harvesting in patients undergoing on-pump coronary artery bypass grafting (CABG)., Methods: Consecutive patients (n = 758) who underwent CABG with skeletonized ITA were divided into 2 groups according to pleural integrity: open pleura (OP) and closed pleura (CP). Propensity score matching was performed after retrospective data extraction. The measured outcomes were postoperative pulmonary and hemorrhagic complications, 30-day mortality, and duration of hospital stay., Results: Among 236 propensity score-matched pairs, there was no statistically significant difference between the 2 groups in terms of first 30-day mortality (OP, n = 7 [3%]; CP, n = 5 [2.5%]), blood product use (OP, 0.90 ± 0.71; CP, 0.74 ± 0.7), or median duration of hospital stay. The incidence of postoperative pleural effusion, thoracentesis, prolonged mechanical ventilation, respiratory failure, excessive drainage, cardiac tamponade, and reexploration and the number of patients requiring transfusion were similar in both groups., Conclusion: The clinical effect of pleural protection or pleurotomy on postoperative outcomes is limited in patients undergoing on-pump CABG with skeletonized ITA.

Background: Primary Spontaneous Pneumothorax (PSP) is considered an absolute and definitive contraindication for scuba diving and professional flying, unless bilateral surgical pleurectomy is performed. Only then is there a sufficiently low risk of recurrence to allow a waiver for flying and/or diving., Case Presentation: A young fit male patient who suffered a PSP 6 years ago, and underwent an uncomplicated videoscopic surgical pleurectomy, presented with a complete collapse of the lung on the initial PSP side. Microscopic examination of biopsies showed a slightly inflamed tissue but otherwise normal mesothelial cells, compatible with newly formed pleura., Conclusions: Even with pleurectomy, in this patient, residual mesothelial cells seem to have had the capacity to create a completely new pleura and pleural space. The most appropriate surgical technique for prevention of PSP may still be debated.

Background: The present study aimed to use an ex-vivo model to investigate whether a new method involving the use of fibrin glue and a polyglycolic acid (PGA) sheet under ventilation enhances the sealing effect after repair of the pleural defect., Methods: Ex-vivo pig lungs were used in this study. We investigated the maximum pressure tolerance of pleural defects repaired using three methods: 1, directly spraying fibrin glue over a PGA sheet; 2, spreading fibrinogen on the site then sealing with a PGA sheet and spraying with fibrin glue; and 3, spreading fibrinogen while maintaining ventilation then sealing with a PGA sheet and spraying with fibrin glue., Results: The maximum tolerable pressures were as follows (mean ± standard deviation, cmH 2 O): Method 1, 37.1 ± 13.6, Method 2, 71.4 ± 27.7, Method 3, 111.5 ± 8.8. Histological findings explained the difference in tolerable pressure at the repaired site between methods. Microscopic findings of lungs repaired using Method 3 indicated that the fibrinogen penetrated into deeper tissues to act as an anchor., Conclusions: Fibrin glue sealing under ventilation increases the anchoring effect of repairing air leakages due to pleural defect in an ex-vivo model. This method may have clinical application. For example, it may be useful to reduce severe air leakage in patients who undergo lung-sparing surgery for a pleural tumor.

Air leak syndrome (ALS) is a rare complication after bone marrow transplantation (BMT) and usually has a fatal outcome because of the high recurrence rate and treatment-refractory nature. A 32-year-old man with a history of BMT for acute lymphoblastic leukemia suffered from metachronous bilateral ALS. Bullectomy and the pleural covering procedure (PLC) were successfully performed for each side of the thorax. After surgery, no relapse of pneumothorax was seen for 2 years on the right side and for 1 year on the left side. A 38-year-old man with a history of BMT for acute myelogenous leukemia (AML) suffered from ALS at the thorax on the left side. Bullectomy and the PLC were successfully performed. After that no recurrence of left pneumothorax for 7 years. We experienced two cases of ALS after BMT successfully treated by the PLC. This technique may be a viable treatment option for future lung transplantation.

Objective: To review the complications associated with the minimally invasive retropleural approach used in the anterior approach to the thoraco-lumbar spine., Material and Method: We present the MIS surgical technique and the evaluation of data collected prospectively from the initial series of 31 patients undergoing surgery. Pleural opening during the approach, lung complications derived, other surgical complications, time of intervention, intraoperative bleeding, need for transfusion and hospital stay are evaluated., Discussion: The mean age of the patients was 58years, the surgical time 225min, and the bleeding 274ml, with a 13% postoperative transfusion. Intraoperatively, pleural opening was detected in 8 cases, of which none had major pulmonary complications during the postoperative period. There were 3 cases of mild pleural effusion, all patients without pleural opening, and one case of haemopneumothorax due to intercostal vessel bleeding that required reoperation. The percentage of intercostal neuralgia was 3%. The mean hospital stay was 6.7days, and 24 of 31 patients were able to initiate early mobilization on the first postoperative day., Conclusions: The retropleural approach allows the surgical treatment of pathologies requiring anterior access to the thoraco-lumbar spine, with a low profile of pulmonary complications, and with the advantages of minimally invasive techniques in terms of less bleeding, early recovery and shorter hospital stay. Nevertheless the learning curve is long., (Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Postoperative adhesion is one of major concerns at re-thoracotomy. Aspirin has both the anti-platelet and anti-inflammatory effects, and decreases several cytokines production., Objective: We investigated that aspirin could reduce postoperative adhesion formation in a rat model., Methods: We cauterised the lung visceral pleural to make postoperative adhesion in rats. The animals were allocated to a control group and an aspirin administration group (100 mg/kg/day for 14 days). We performed re-thoracotomy and evaluated the adhesion lengths on day 14. We also investigated the cytokine expression in the adhesion region and the peripheral tissue with platelet-derived growth factor (PDGF), platelet-derived growth factor receptor (PDGFR), alpha smooth muscle actin (α-SMA), transforming growth factor beta 1 (TGF-β1), and vascular endothelial growth factor-A (VEGF-A), sequentially., Results: The adhesion lengths were significantly shorter in the aspirin group than that in the control group (8.7±2.0 mm vs 11.2±1.1 mm, p =0.024). The expressions of PDGF and PDGFR were lower in the aspirin group than that in the control group on day 3. The expression of α-SMA on fibroblasts decreased in the aspirin group on day 3. There was no significant difference in the expressions of TGF-β1 and VEGF-A with administration of aspirin., Conclusions: Aspirin could reduce postoperative pleural adhesion by inhibiting the expression of PDGF., Competing Interests: Competing Interests: The authors have declared that no competing interest exists.

Background: Intrathoracic mesothelial cysts almost always arise in the mediastinum, and extramediastinal mesothelial cysts are extremely rare. Here we describe a case of mesothelial cyst derived from the chest wall pleura growing after thoracic surgery., Case Presentation: A 63-year-old Japanese woman was referred to our department. She had undergone total hysterectomy for cervical carcinoma and two lung wedge resections for metastatic lung cancer on the upper and lower lobes of her right lung and lower lobe of her left lung. After the thoracic surgery, an intrathoracic chest wall mass was found, which grew gradually. Computed tomography demonstrated a 2.0 × 1.8 cm low-density mass without contrast effect. Magnetic resonance imaging demonstrated a low-intensity mass in T1-weighted imaging and a high-intensity mass in T2-weighted imaging. Thoracoscopic excision of the mass was performed. The cystic mass was thought to be derived from her chest wall and was pathologically diagnosed as mesothelial cyst. Five years after the surgery, she has no evidence of recurrence of the cyst or cervical carcinoma., Conclusions: The genesis of extramediastinal mesothelial cysts may be related to inflammation. From this perspective, extramediastinal mesothelial cysts may have different characteristics from pericardial cysts and resemble peritoneal inclusion cysts. Although, extramediastinal mesothelial cysts are not established, their characteristics resemble peritoneal inclusion cysts; therefore, such interesting intrathoracic cysts should be carefully resected considering the risk.

Purpose: This study of a large, contemporary national database evaluated postoperative outcomes and overall survival (OS) for malignant pleural mesothelioma (MPM) by facility volume., Methods: The National Cancer Database was queried for newly-diagnosed non-metastatic MPM undergoing definitive surgery (extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D)). Patients were dichotomized into those receiving therapy at a high-volume facility (HVF), defined a priori at the 90th percentile of case volume, with all others categorized as lower-volume facilities (LVFs). Statistics included multivariable logistic regression, Kaplan-Meier analysis, propensity-matching, and multivariable Cox proportional hazards modeling. Sensitivity analysis varied the dichotomized HVF-LVF cutoff and evaluated effects on postoperative outcomes and OS., Results: Of 1307 patients, 621 (48%) were treated at LVFs and 686 (52%) at HVFs. HVFs were more often in the Middle/South Atlantic regions, and less likely in New England, South, and Midwest. Notably, 75% of procedures at HVFs were P/Ds, versus 84% at LVFs (p < 0.001). Patients treated at HVFs experienced shorter length of postoperative hospitalization (p = 0.035), lower 30-day readmission rates (4.6% vs. 6.1%, p = 0.021), and lower 90-day mortality rates (10.0% vs. 14.6%, p = 0.029). Median OS for respective groups were 18 versus 15 months (p = 0.010), which were not significant following propensity-matching (p = 0.540). On multivariable analysis, facility volume did not independently predict for OS. Sensitivity analyses confirmed the postoperative outcomes and OS findings., Conclusions: This is the largest investigation to date assessing facility volume and outcomes following surgery for MPM. Although no independent effects on OS were observed, postoperative outcomes were more favorable at HVFs. These findings have implications for postoperative management, patient counseling, referring providers, and cost-effectiveness., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Bronchial pleural fistula (BPF) is a common complication after thoracic surgery for lung resection. Clinical treatment is complex and the effect is poor. The treatment of BPF after lung resection has plagued thoracic surgeons. We reviewed retrospectively the clinical and follow-up data of 6 patients in our hospital who underwent the omentum transplantation in thorax to cover bronchial stump as treatment of BPF after pulmonary resection to analyze why BPF occurs and describe this treatment method. We intend to discuss and evaluate the feasibility, safety and small sample success rate ofthis treatment method., Methods: During August 2016 to February 2018, six patients in our hospital underwent remedial open thoracotomy and omentum transplantation in pleura space to cover bronchial stump as treatment of bronchopleural fistula after pulmonary resection. Four patients had undergone a prior pneumonectomy and two patients had undergone a prior lobectomy (the residual lungs were resected with the main bronchus cut by endoscopic stapler during the reoperation). The bronchial stumps were sutured by 4-0 string with needle and covered by omentums, which were transplanted in pleura space from the cardiophrenic angle. Postoperatively, the pleura space was irrigated and drained. Summarize the clinical effect and technique learning points., Results: The patients were all males, aged 61 to 73 years (median age: 66). BPF occurred from postoperative day 10 to 45 (median postoperative day 25). The reoperation was finished in 80 mins-150 mins (median 110 mins). Total blood loss was 200 mL-1,000 mL (median 450 mL). These patients were discharged on postoperative day 12-17 (median 14 days), and there was no more complications associated with bronchopleural fistula. All six patients' bronchial stumps were well closed (100%) and have recovered well during the follow-up period, which lasted 1 month-18 months., Conclusions: Remedial operation should be performed as soon as possible when BPF after pulmonary resection diagnosed. Excellent prognoses can be achieved by omentum which is easy to get transplanted in thorax to cover bronchial stump as treatment in patients with BPF after pulmonary resection those who can tolerate reoperation.

Background: Prolonged air leak after pleural decortication is one of the most frequent complications., Objective: The aim of this study is to compare the effects of prolonged air leak between the digital chest drainage (DCD) system and the classic drainage system in patients with empyema class IIB or III (American Thoracic Society classification) in pleural decortication patients., Material and Methods: A total of 37 patients were enrolled in a prospective randomized control trial over one year, consisting of 2blinded groups, comparing prolonged air leak as a main outcome, the number of days until removal of chest drain, length of hospital stay and complications as secondary outcomes., Results: The percentage of prolonged air leak was 11% in the DCD group and 5% in the classic group (P=0.581); the mean number of days of air leak was 2.5±1.8 and 2.4±2.2, respectively (P=0.966). The mean number of days until chest tube removal was 4.5±1.8 and 5.1±2.5 (P=0.41), the length of hospital stay was 7.8±3.7 and 8.9±4.0 (P=0.441) and the complication percentages were 4 (22%) and 7 (36%), respectively (P=0.227)., Discussion: In this study, no significant difference was observed when the DCD was compared with the classic system. This was the first randomized clinical trial for this indication; thus, future complementing studies are warranted., (Copyright © 2016 Academia Mexicana de Cirugía A.C. All rights reserved.)

Background: For primary lung cancer, anatomic pulmonary segmentectomy may have a functional advantage over lobectomy; however, persistent air leak or delayed pneumothorax after segmentectomy is prevalent and increases surgical morbidity. To prevent pulmonary complications after pulmonary segmentectomy, we used 2 methods for the involved intersegmental plane: coverage using polyglycolic acid mesh and fibrin glue (mesh cover) or closing it by suturing the pleural edge (pleural suture). We aimed to compare postoperative pulmonary function and complications between the 2 groups., Methods: A total of 133 patients who underwent pulmonary segmentectomy for stage IA non-small cell lung cancer were analyzed retrospectively. A pulmonary function test, including vital capacity and forced expiratory volume in 1 second, was performed preoperatively and at 1 and 6 months postoperatively. Propensity score analysis generated 2 matched pairs of 46 patients in the pleural suture and mesh cover groups., Results: In each group, there was no significant difference in the recovery rate of vital capacity and forced expiratory volume in 1 second at 1 and 6 months postoperatively. Compared with the pleural suture group, the mesh cover group had higher incidence of prolonged air leak (8.7% versus 0%; p = 0.042), delayed pneumothorax (10.9% versus 2.2%; p = 0.051). On logistic regression analysis, management of intersegmental plane by either mesh cover or pleural suture was the only independent factor related to pulmonary complications (prolonged air leak or delayed pneumothorax) after pulmonary segmentectomy (odds ratio: 5.26, p = 0.047; odds ratio: 13.39, p = 0.018, respectively)., Conclusions: Pleural suturing of the involved intersegmental plane during pulmonary segmentectomy appeared to be an acceptable method to reduce postoperative pulmonary complications., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: The objective of this retrospective study was to assess perioperative outcomes, overall survival and freedom from recurrence after induction chemotherapy followed by extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) in patients with mesothelioma in a propensity score matched analysis., Methods: Between September 1999 and August 2015, 167 patients received multimodality treatment (platinum-based chemotherapy followed by EPP [ n =  141] or P/D [ n =  26]). We performed 2:1 propensity score matching for gender, laterality, epithelioid histological subtype and International Mesothelioma Interest Group (iMig) stage (52 EPP and 26 P/D)., Results: Postoperative major morbidity (48% vs 58%, P =  0.5) was similar in both groups; however, the complication profile and severity were different and favoured P/D; the 90-day mortality (8% vs 0%, P =  0.3) rate was lower in P/D although not statistically significant. Prolonged air leak (≥10 days) occurred in 15 patients (58%) undergoing P/D. The intensive care unit stay was significantly longer after EPP ( P =  0.001). Freedom from recurrence was similar for both groups (EPP: median 15 months, 95% confidence interval [CI]: 10-21; P/D: 13 months, 95% CI: 11-17) ( P =  0.2). Overall survival was significantly longer for patients undergoing P/D (median 32 months, 95% CI: 29-35) compared to EPP (23 months, 95% CI: 21-25) ( P =  0.031), but in the P/D group many cases were censored (73%) and the follow-up time was relatively short., Conclusions: P/D and EPP seem to have similar rates of major morbidity, although the profile of complications is different and more severe after EPP. Freedom from recurrence is comparable in both groups whereas improved overall survival needs to be confirmed in a large patient group with longer follow-up., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: According to major difficulty for the giant omphalocele management in the visceral reintegration and the parietal closure, many teams use currently conservative treatment by topical application. These techniques are suppliers of a covered eventration and a scar sequela requiring a complementary treatment. We report the place of the tissue expansion as complementary treatment., Patients and Methods: Two patients with a giant omphalocele benefited from a protocol of cutaneous expansion for the correction of their abdominal scar±of their residual eventration., Results: An eventration closure was possible thanks to this protocol. The skin expansion allowed the complete excision of the abdominal scar and the defect cover. An additional skin graft was necessary in the first case., Conclusion: The cutaneous expansion in the parietal sequela management of the giant omphaloceles seems to be an interesting alternative. This technique should be realized remotely and except any septic context., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Pneumothorax is one of the most important complications after bronchoscopy. This study was conducted to determine the risk factors for post-bronchoscopy pneumothorax., Methods: We retrospectively reviewed the medical records of 23 consecutive subjects who were diagnosed with iatrogenic pneumothorax after bronchoscopy between August 2010 and February 2014. Forty-six control subjects who did not develop pneumothorax after bronchoscopy were randomly selected. The factors affecting the occurrence of pneumothorax were determined by univariate and multivariate analyses., Results: Among 991 patients who underwent bronchoscopy during the study period, 23 (2.3%) developed pneumothorax after bronchoscopy. Among these 23 subjects, 13 (57%) required chest tube drainage. Compared with the control group (46 randomly selected from 968 subjects who did not develop pneumothorax), the group that developed pneumothorax had a preponderance of women and had more target lesions located in the subpleural area (odds ratio [OR] 7.8, 95% CI 0.9-64), especially those that were close to the interlobular pleura (OR 5.1, 95% CI 1.6-16.1) and the left lung (OR 3.2, 95% CI 1.1-9.5). Multivariate analysis revealed that a subinterlobular pleural location of a lesion was a risk factor for pneumothorax (OR 4.8, 95% CI 1.1-20.4)., Conclusions: Pneumothorax occurred significantly more frequently when bronchoscopy was performed for subinterlobular pleural lesions. Close attention and care should be taken during bronchoscopy, especially when target lesions are abutting the interlobular pleura., (Copyright © 2016 by Daedalus Enterprises.)

Reoperative pulmonary resection may be associated with a higher rate of postoperative complications secondary to postoperative adhesions. This review was designed to investigate the effect of a bioabsorbable material on postoperative intrapleural adhesions following thoracotomy. A search was performed in PubMed (United States National Library of Medicine) for original studies published in English and investigating a bioabsorbable material in preventing postoperative intrapleural adhesions, using the terms "pleural", "adhesion", and "surgery". Eight animal experimental studies (five rodents and three canines) were eligible for review. No human studies were identified. The type of bioabsorbable material was a sheet in five studies and a powder or spray in three studies. In five studies (62.5 %), a biomaterial included polymers. Six studies (75 %) suggested that a bioabsorbable material was effective in preventing intrapleural adhesions on the basis of statistical analysis. We conclude that a bioabsorbable material may prevent postoperative adhesions following thoracotomy and that available materials may reasonably be applied in clinical practice. Clinical trials on postoperative anti-adhesions are warranted in select patients.

Purpose: The purpose of the study was to determine whether intensity modulated radiation therapy delivered via helical tomotherapy improves local control (LC) after pleurectomy/decortication (P/D) for malignant pleural mesothelioma compared with 3-dimensional conformal radiation therapy (3D-CRT)., Methods and Materials: Forty-five consecutive patients were treated with adjuvant radiation to 45 Gy in 1.8 Gy fractions after P/D between 2006 and 2014; 23 received 3D-CRT, and 22 received tomotherapy. Kaplan-Meier analysis was used to calculate overall survival, time to in-field or local failure (LF), and time to out-of-field failure. The Student t test and Fisher exact test were used to detect between-group differences., Results: Median follow-up time was 19.4 months and 12.7 months for the 3D-CRT and tomotherapy groups, respectively. Eighty-two percent of patients had T3/T4 disease, and 64% had positive nodes; 17.4% and 41% of patients in the 3D-CRT and tomotherapy groups had nonepithelioid histology, respectively. Mean planning target volume dose, percentage of planning target volume receiving 100% of the prescription dose, and lung doses were significantly greater with tomotherapy (P < .05), but toxicity rates (including radiation pneumonitis rates) were equivalent. LC was significantly improved with tomotherapy on Kaplan-Meier analysis with outcomes censored at 2 years (P < .05); uncensored, this became a trend (P = .06). Median time to LF was 19 months with tomotherapy and 10.9 months in 3D-CRT (the latter interval being less than the median follow-up in the tomotherapy group). On univariate analysis, treatment modality was the only significant predictor of LC (P < .05). Isolated LF was significantly more frequent with 3D-CRT (P < .05). Conversely, isolated out-of-field failure was significantly more frequent with tomotherapy (P < .05). Overall survival and out-of-field control were not significantly different., Conclusion: Tomotherapy after P/D for malignant pleural mesothelioma is associated with improved target coverage that translates into improved LC compared with 3D-CRT. This is related to a change in failure patterns, with isolated LF being more common in the 3D-CRT group and isolated out-of-field failures predominating in the tomotherapy group., (Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Various methods of radiofrequency ablation, using FOTEK-150 apparatus, were applied in 74 patients for pulmonary and pleural malignancies. Immediate positive effect was achieved in 92% observations, complications have occurred in 13% patients. It is expedient to use the method in patients, suffering pulmonary and pleural malignancies, when radical surgery is impossible. Radiofrequency ablation may be applied as a palliative method of treatment of pulmonary and pleural malignancies.

Creation of a pleural tent is effective in reducing persistent air leaks after pulmonary resection. I report a case of a pleural-like tent being created out of extracellular matrix to treat a persistent air leak in child after upper lobectomy for a large congenital pulmonary airway malformation type II. Over the next year, ipsilateral lung expansion and growth occurred with near complete resolution of the apical air space., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether preservation of the pleura during internal mammary artery (IMA) harvesting improved clinical outcomes after coronary artery bypass graft surgery. More than 210 papers were found using the reported search, of which 18 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studies, relevant outcomes, results and study weakness of these papers are tabulated. Most studies dealt with investigating the radiographic changes, pulmonary function tests, ventilation time and also clinical consequences, such as bleeding, the need for blood transfusion, pain scores and the length of hospital stay. There is still no meta-analysis and systematic review regarding this surgical problem. Eighteen articles were found, of which 6 were prospective randomized, controlled trials and 12 were cohort studies. In these studies, some beneficial clinical outcomes were reported including: pleural effusion (15 studies), atelectasis (11 studies), pulmonary function tests (9 studies), arterial blood gases (5 studies), postoperative pain (6 studies), tamponade (2 studies), ventilation time (12 studies with), blood loss (9 studies), transfusion (4 studies), intensive care unit stay (5 studies) and hospital stay (12 studies). Based on our findings, preservation of pleural integrity seems to contribute to decreased pulmonary complications and improved clinical outcomes, such as bleeding, pain and length of hospital stay., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

A 45-year-old man experienced dyspnea on effort and was hospitalized due to severe mitral valve regurgitation and atrial fibrillation. He also had alcoholic cirrhosis. After he was stabilized, mitral valve plasty and Maze procedure were performed. The postoperative clinical course was satisfactory. During the follow-up period, he began to suffer from persistent left pleural effusion, which amounted to about 2,500 to 3,000 ml, and required intercostal tube drainage weekly. Therefore a pleuro-peritoneal shunt was implanted. The pleural effusion decreased, and he obtained significant relief from dyspnea. After one year, we confirmed that pleural effusion had not reoccurred, and removed the pleuro-peritoneal shunt.

Percutaneous nephrolithotomy (PCNL) is presently the treatment of choice for large or multiple kidney stones or stones in the calyx. PCNL is generally safe and associated with low but indisputable complication rate. Pleural injury in PCNL is a rare but severe complication which can occur during or immediately after operation. Pleural injury may lead to chronic empyema thoracis. Until now no such case has been reported in literature., (2014 BMJ Publishing Group Ltd.)

Pneumonia, recurrent nerve injury and anastomotic leakage are common complications occurring after esophagectomy. However, there have so far been few reports on tracheal compression by the gastric tube. The patient was a 66-year-old female with a history of ankylosing spondylitis and esophageal superficial squamous carcinoma treated with endoscopic mucosal resection. The new lesion was located just next to the last treated lesion. Therefore, it was difficult to treat this lesion endoscopically because of severe stenosis and scarring due to the previous treatment. Transhiatal esophagectomy was therefore performed. However, severe tracheal obstruction occurred following extubation after the surgery due to compression caused by the gastric tube. This case was successfully treated with a mediastinal pleural incision through a right thoracotomy. The distance between the sternum and the vertebra in this case was narrower than normal, thereby inducing this rare condition.

Objectives: Progress in medical technology and improvements in prognosis have led to an increase in polysurgery. However, postoperative pleural adhesion leads to poor visualization, bleeding, and lung and vascular trauma during subsequent surgeries. To date, there have been no appropriate anti-adhesive agents to prevent pleural adhesion. The aim of this study was to investigate the anti-adhesive effects of commercially available anti-adhesive agents and a newly developed powder-type anti-adhesive agent., Methods: In 48 male rats, we performed thoracotomy at the fifth intercostal space. We randomized animals into four groups: normal saline, Seprafilm, Interceed, and aldehyde dextran and ε-poly(L-lysine) powder (D-L powder). W killed animals on Day 7 or 28 to evaluate the severity, length, gross appearance, and pathological appearance of adhesion formation., Results: Adhesion length in the D-L powder group was significantly shorter than in the control group (P < 0.05) on both Days 7 and 28. Pathologically, all anti-adhesive materials remained on the lung surface on Day 7. On Day 28, only Interceed remained on the lung surface, in which small vessels were present. We also demonstrated the usage of D-L powder during video-assisted thoracic surgery in pigs, and found it easy to administer via the trocar sleeve., Conclusions: We found D-L powder to be effective for preventing postoperative pleural adhesion, although Seprafilm and Interceed are also somewhat effective. However, D-L powder is easier to administer during video-assisted thoracic surgery., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The aim of the study was to assess the effectiveness of videothoracoscopic (VATS) costal pleurectomy in patients with primary and secondary spontaneous pneumothorax (SP). 136 patients were selected for the retrospective study. Among them 114 were men, the rest 22 - women with a mean age of 29.3 years (range 16 to 37 years). 123 patients had primary SP; 13 patients were diagnosed with interstitial lung disease and secondary SP. The follow-up time after surgery was minimally 3 years. The duration of the postoperative thoracic draining was 2.1 days for patients with primary SP and 3.4 days for those with the secondary SP. The length of the ICU stay was 1.1 and 1.2 days respectively. The overall complication rate was 9% for patients with primary SP and 47% for patients with secondary SP; the recurrence rate was 1 and 23%, respectively. Thus, marked satisfactory immediate and long-term outcomes among patients with primary SP, the VATS pleurectomy can not be considered the method of choice for patients with secondary SP, cause by interstitial lung disease.

Background: The most dangerous complication following esophagogastrectomy for esophageal cancer is anastomotic leakage. Surgical interventions described did not have a major impact in reducing the risk of occurrence. On the other hand, pleural tenting has been used for more than a decade by thoracic surgeons to prevent prolonged air leak after formal upper lobectomy with excellent results., Methods: A retrospective analysis of 114 cases of esophagogastrectomy for cancer of esophagus or cardioesophageal junction is presented. Patients have been divided in 2 groups. In group B modified pleural tenting was used to prevent a potential anastomotic leak, while in group A, the control group, pleural tenting was not used. Evaluation of modified pleural tenting in preventing anastomotic leakage was the aim of the study., Results: The pleural tenting group showed a significant decrease in anastomotic leak. In 1 patient versus 8 in group without pleural tenting the complication appeared (P = .032). The risk for an anastomotic leakage in group without pleural tenting was almost 9 times greater (odds ratio: 9.143, 95% confidence interval: lower bound 1.104, upper bound 75.708). The 30-day mortality, although lower in pleural tenting group, was not statistically significant., Conclusions: Pleural tenting is a safe, fast, and effective technique for prevention of anastomotic leakage after Ivor Lewis esophagogastrectomy. Subpleural blanketing of intrathoracic anastomosis could diminish the consequences of a possible anastomotic leak.

Study Design: To compare the preoperative and postoperative relative position of the thoracic aorta to the vertebrae in patients with idiopathic scoliosis (IS) after anterior corrective surgery without parietal pleura closure., Objective: To investigate the impact of unrepaired parietal pleura on thoracic aorta migration after anterior correction of right thoracic IS., Summary of Background Data: Vascular injuries caused by vertebral screws have been reported in several studies. Recent studies showed an anteromedial shift of thoracic aorta after anterior curve correction with closure of the parietal pleura in thoracic IS. Migration of the aorta in patients with nonclosed parietal pleura has not been studied before, although it has been speculated in benefiting the transposition of the aorta and thus reduces the risk of vascular injury., Methods: Fifteen IS patients with predominant right thoracic scoliosis who underwent anterior instrumentation without parietal pleura closure were recruited for the study. There were 10 female and 5 male patients with an average age of 15.9 years. The following parameters were measured on preoperative and postoperative computed tomographic scans: angle α: aorta-vertebral angle; distance a: distance between the aorta and the left rib head; distance b: distance from aorta to vertebral body cortex., Results: From computed tomographic measurements, the angle α from T5 to T12 ranged from 28.9 to 68.3 degrees before surgery and 18.8 to 63.2 degrees after surgery. The distance a ranged from 5.6 mm to 28.1 mm before surgery and 2.3 mm to 24.3 mm after surgery. The distance b ranged from 1.7 mm to 4.3 mm before surgery and 2.3 mm to 8.0 mm after surgery. These changes in all the parameters reached statistically significant difference at all the levels except in upper and lower end vertebrae (P<0.05)., Conclusions: The thoracic aorta in patients with predominant right thoracic IS migrated posterolaterally relative to the vertebral body after anterior surgery without parietal pleura closure.

Objective: Video-assisted thoracic surgery (VATS) is a less-invasive alternative to open thoracotomy. According to evidence-based medicine methodology, VATS is associated with better outcomes and the same complication rate as open thoracotomy., Case Description: Two women (19 and 21 years old) underwent VATS for treatment of pneumothorax. In an attempt to perform hemostasis, the subclavian arteries had to be occluded. Total sensorimotor deficit in both patients on the side where surgery was performed was noticed postoperatively. After 3½ months in patient 1, nerve roots C5 and C6 were neurolyzed. Neuromas of middle and lower trunks and posterior and medial cords were resected and graft repair with sural nerves was performed. In the second patient, 1 month after VATS the entire plexus was neurolyzed because of severe fibrosis. Following neurolysis, positive nerve action potentials (NAPs) were recorded. Patient 1 after the 6-year follow-up has full range of motion of the shoulder and elbow. Extension and flexion in the wrist and fingers recovered to M4/5. Pain sensation and two-point discrimination recovered. Patient 2 after 2½-year follow-up recovered full range of motion of the shoulder, elbow, and forearm. Pain sensation recovered in dermatomes C5 and C6., Conclusions: The two presented cases show that VATS is not without severe complications, as evidence-based medicine methodology suggests. Surgical findings in our patients imply that if this type of complication happens, early surgical exploration could be the best option for the patients., (Copyright © 2011 Elsevier Inc. All rights reserved.)

A 44-year-old man underwent radical thymectomy for malignant thymoma 5 years ago. He subsequently underwent right extrapleural pneumonectomy because a right pleural metastatic lesion had developed. The operation was completed uneventfully. Immediately after arrival at the intensive care unit, the patient appeared restless and in pain. His heart rate increased to 140 bpm and then abruptly decreased to 20-30 bpm concomitant with profound systolic hypotension of 30-40 mmHg. Chest X-ray showed that the heart was shifted into the right thorax. Emergent re-thoracotomy was performed and the heart was found to be malrotated and herniated from an upper defect of the pericardial patch in the right thoracic cavity. The heart was returned to the pericardium and the defect was covered with a pericardial patch. The blood pressure and heart rate became stable. He was transferred to the surgical ward from the intensive care unit on the first postoperative day. The rest of the course was uneventful and the patient was discharged on the seventh postoperative day. The incidence of cardiac herniation after extrapleural pneumonectomy following chemotherapy for malignant pleural mesothelioma has been reported to be around 3%. The risk of cardiac herniation should always be considered, especially after extrapleural pneumonectomy.

Objectives: Prolonged postoperative air leaks (AL) are a major cause of morbidity. Aim of this work was evaluating use of a Lung Sealant System (Pleuraseal, Covidien, Mansfield, MA, U.S.A.) in pleural decortications for empyema thoracis., Methods: From January 2008 to December 2008, 46 consecutive patients received pleural decortications for empyema thoracis. Post-procedural and malignancy-related empyemas were excluded. After hydro-pneumatic test and surgical correction of AL (until satisfaction), patients were assigned (23 per group) to Control or Sealant group. Control group underwent no additional interventions. In Sealant group, lung sealant was applied over AL areas. Following variables were measured daily: patients with AL; time to chest drainage (CD) removal; CD drainage volume at removal, postoperative length of hospital stay, postoperative C-reactive protein (CRP), and leukocyte counts. Personnel recording parameters were blinded to intervention. Two-tailed t-tests (normally distributed data) or Mann - Whitney U-test (not-normally distributed data) were used for evaluating significance of differences between group means or medians. Significance of any proportional differences in attributes were evaluated using Fisher's Exact Test. Statistical analysis was carried out using R-software (version 2.8.1)., Results: Groups were similar regarding demographic and baseline characteristics. No patients were withdrawn from study; no adverse effects were recorded. There were no significative differences on CRP and leukocyte levels between two groups. Compared with the Control group, in Sealant group significantly fewer patients had AL (30 versus 78%, p = 0.012), and drains were inserted for a shorter time (medians, 3 versus 5 days, p = 0.05). Postoperative hospitalization time was shorter in Sealant group than in control group, but difference was not significant (0.7 days, p = 0.121)., Conclusions: Pleuraseal Lung Sealant System significantly reduces AL following pleural decortications for empyema and, despite of not-increased infectious indexes, is suitable for routinely use, even in procedures with contaminated pleura.

Background: Persistent air leak after pulmonary resection is a difficult complication for thoracic surgeons to manage., Objectives: To show the results of our experience treating persistent pleuropulmonary air leak with autologous blood and review the literature on this specific method of treatment., Methods: Retrospective study of patients with persistent aerial pleuropulmonary fistula treated with autologous blood. The patient's own blood was collected from a peripheral vein and directly introduced through the pleural drain. An inverted siphon was located in the drainage system to avoid prolonged clamping of the drain. This siphon impeded blood return but not air escape., Results: Between January 2001 and August 2008, 27 patients were treated by the above method. Patient age ranged from 2 to 74 years, and 78% were male. Each procedure used a mean quantity of 92 ml blood. Mean persistent air leak time before pleurodesis was 10.6 days and mean time to fistula resolution after pleurodesis was 1.5 days. Twenty-three (85%) patients had persistent pleuropulmonary air leak closed with the above procedure., Conclusion: Treating persistent pleuropulmonary air leak with autologous blood is promising, but further studies are required to quantify its real effectiveness., (Copyright 2009 S. Karger AG, Basel.)

Background: Factors associated with increased risk of major complications after extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma are not well characterized; in particular, the risks of induction chemotherapy and red blood cell (RBC) transfusion have not been well defined., Methods: We reviewed our experience with 62 consecutive EPP (28 right sided) performed in our institution for malignant pleural mesothelioma between January 1993 and May 2007. A total of 44 patients underwent induction chemotherapy with cisplatin-based therapy., Results: The majority of patients (88%) received RBC transfusions (median, 4 units; range, 0 to 18 units). Patients undergoing induction chemotherapy had lower preoperative hemoglobin (122 +/- 16 g/L versus 134 +/- 15 g/L in the remaining patients, p = 0.02) and received more RBC transfusions (5.1 +/- 3.5 units versus 2.1 +/- 2.3 units in the remaining patients, p = 0.007). Twenty-two patients (35%) experienced major postoperative complications and 4 of them died (6.5%). Patients experiencing major complications were older (60 +/- 8 years versus 56 +/- 12 years, respectively; p = 0.2) and received more RBC transfusions (5.8 +/- 4.3 units versus 3.7 +/- 2.7 units, respectively; p = 0.02). Major complications occurred more frequently after right-sided EPP than after left-sided EPP (54% versus 21%, p = 0.007). Induction chemotherapy had no impact on the risk of major complications (p = 0.5). Transfusion of more than 4 units of RBC (p = 0.01) and right-sided EPP (p = 0.01) were associated with increased risk of major complications after EPP in multivariate analysis., Conclusions: Right EPP and more than 4 units of RBC transfusion are associated with increased risk of major complications. Although patients undergoing induction chemotherapy received more RBC transfusions, induction chemotherapy did not directly impact the risk of major complications.

Chylous effusions are a well-described complication of lymphangioleiomyomatosis (LAM) in both pre- and post-transplant patients. Chylous effusions can cause significant morbidity among patients and most treatment modalities have limitations to complete success. We describe the use of a pleurovenous shunt to treat a refractory chylous effusion in a patient after lung transplant for LAM. After shunt placement, the patient had complete resolution of the chylous effusion and subsequent discharge home after a prolonged hospitalization. The use of a pleurovenous shunt for refractory chylous effusions is a viable option after conventional therapy fails.

The results of treatment are analyzed in 78 patients with brochopleural fistilas after lung surgery. A method for imaging the draining bronchus under endoscopic guidance, by using the foamed dye administered into the residual cavity, has been developed. A valvular bronchial blocker for abolishing the function of bronchopleural fistular inserted into the lobular and segmental bronchus at bronchoscopy was designed and clinically tested. This procedure allows resurgery to be avoided in 91.7% of cases.

Objective: The purpose of this study was to evaluate the influence of preserved integrity of pleura on postoperative bleeding and respiratory function in patients undergoing coronary artery bypass grafting (CABG)., Methods and Results: Seventy-two CABG patients who received pedunculated IMA graft without opening the pleura (group of intact pleura, group IP) between July 2002 and September 2004 were matched to 72 CABG patients who received pedunculated IMA graft with opened pleura (group of opened pleura, group OP). To match the patients with IP and unique patients with OP, logistic regression was used to develop a propensity score. The C statistic for this model was 0.79. Patients with IP were matched to unique patients with OP with an identical 5-digit propensity score. If this could not be done, we proceeded to a 4-, 3-, 2-, or 1-digit match. Patients characteristics were well matched. There were no differences in preoperative and peroperative variables between the groups. The incidence of postoperative pleural effusion and thoracentesis were significantly lower in group IP than group OP (pleural effusion in 15.2 versus 30.5%; p = 0.029, thoracentesis in 5.5 versus 18.5%; p = 0.036). Other pulmonary complications such as prolonged ventilation, reintubation, pneumothorax, atelectasis, diaphragmatic paralysis were similar in both groups. Patients with IP had significantly lower blood loss (520 versus 870 ml; p < 0.001) and whole blood unit transfusion (26.3 versus 41.6%, p = 0.036). Also, intensive care unit and hospital stay were similar in both groups., Conclusions: Meticulous internal mammary artery harvesting and preservation of the pleural integrity significantly reduces postoperative bleeding and pleural effusion.

Amnion allografts have been used in a number of clinical applications. However, no references of their use in thoracic surgery have been identified. Air leakage, is one of the most common complications in thoracic surgery, resulting from visceral pleura and lung injuries caused intraoperatively, in particular following rethoracotomy. Mechanical and manual sutures are also potential sites of air leakage. The aim of our study was to evaluate the usefulness of human amnion grafts in the treatment of air leakage following thoracic surgery. Deep-frozen, radiation-sterilized (35 kGy) human amnion grafts prepared in the Central Tissue Bank in Warsaw (Poland) were used. The amnion allografts were applied to 20 patients who had surgery: 11 thoracotomies and 9 rethoracotomies were performed (15 resections of 1-12 metastases, 3 lobectomies and 2 residual tumor resections). During lung ventilation the air leakage sites were covered by the amnion flap attached by moderate compression and stabilized by sutures. Air leakage and drainage were measured during the postoperative period. In 80% of the cases, no traces of air leakage was observed. The preliminary results suggest that the application of human amnion grafts may be a safe and effective method for preventing prolonged air leakage after thoracic surgery.

Pleural tears usually occur after pneumolysis for dense adhesion or after cone biopsy of lung parenchyma. Repair of the tears is sometimes very difficult. Herein we compared different methods on a pig lung air leak model. Twenty pigs with pleural tears by surgical manipulation through sternotomy were not treated (n = 5) or treated by simple electroablation (n = 5), pleural coverage (n = 5), or Surgecel coverage with surface electroablation (n = 5). We evaluated their immediate and delayed treatment effect by measuring the critical leak pressure, degree of air leakage, and air leakage period and histological examination. It was found that Surgecel coverage with surface electrocauterization had similar early and delayed effects in sealing air leakage to pleural coverage and was much better than the other two groups (P < 0.05). We conclude that coverage with Surgicel with local electroablation can significantly decrease immediate and late air leakage from pleural tears.

Background: The object of this study was to assess the efficay and maximum duration of effect of the pleural tent in reducing the incidence of air leak after upper lobectomy., Methods: Two hundred patients who underwent upper lobectomy were prospectively randomized into two groups: 100 patients who underwent an upper lobectomy and a pleural tent procedure (group 1; tented patients) and 100 patients who underwent only an upper lobectomy and not a pleural tent procedure (group 2; untented patients). The preoperative, operative, and postoperative characteristics of both groups were compared. Then multivariate analyses were used to identify factors predictive of prolonged air leaks and their duration. The reduction of incidences of air leak in the two groups was subsequently compared during successive postoperative periods., Results: No differences were detected between the two groups in terms of preoperative and operative characteristics. A significant reduction occurred in group 1 patients for the mean duration of air leak in days (2.5 vs 7.2 days; p < 0001), the number of days a chest tube was required (7.0 vs 11.2 days; p < 0.0001), the length of postoperative hospital stay in days (8.2 vs 11.6 days; p < 0.0001), and the hospital stay cost per patient (4,110 dollars vs 5,805 dollars; p < 0.0001). Logistic regression analyses showed that not having undergone a pleural tent procedure was the most significant predictive factor of the occurrence and duration of prolonged air leaks. A greater reduction in the duration of air leaks was observed before postoperative day 4 in group 1, and logistic regression analysis showed that having undergone a pleural tent procedure was the most significant predictive factor of air leaks that persisted for less than 4 days., Conclusions: Pleural tenting after upper lobectomy was a safe procedure that reduced the duration of air leaks and the hospital stay costs. The benefit from that procedure was achieved before postoperative day 4.

Introduction: Ventriculoatrial and ventriculopleural shunts (VPS) are alternatives to ventriculoperitoneal shunts for draining cerebrospinal fluid from patients with hydrocephalus. VPS has seldom been used because of the risk of respiratory insufficiency due to pneumothorax or pleural effusion. However, valves are currently available with anti-siphon devices for use with standard shunting systems to prevent the development of pleural effusion. The aim of this study was to analyze outcome after VPS in eight patients in whom we used the new valves for avoiding overdrainage of cerebrospinal fluid., Material and Method: Nine VPS procedures were performed in eight hydrocephalic patients between 1988 and 2000. We used differential pressure valves in eight procedures and a flow regulator valve in one. The externally adjustable Sophy valve was used in six cases. The indication for VPS was peritoneal adhesions in four cases, persistent ascites in two, ventriculoatrial valve obstruction in one, and infection of the peritoneal shunt (peritonitis) in one. The ninth case involved replacement of a previously obstructed valve., Results: After a follow-up period of 22 months all shunts were functioning well and the only patient with symptoms of hydrocephalus was the one who required valve replacement at six months. No surgical morbidity or mortality was observed, and only one patient developed transitory signs of excessive cerebrospinal fluid drainage, which was corrected by regulating the magnetic valve gradient. The death of one patient 36 months after surgery was unrelated to pleural drainage., Conclusions: Valves newly designed to prevent overdrainage of cerebrospinal fluid give satisfactory results, such that VPS should be considered as an alternative to peritoneal drainage.

Introduction: Fifty-eight patients (mean age 27 years, range 17-44) with primary spontaneous pneumothorax (PSP) underwent resection of apical bullae and partial apical pleurectomy via mini-thoracotomy or thoracoscopy, in 12 cases bilaterally, between 1982 and 1999., Method: After a mean follow-up period of 111 (16-212) months, 26 patients with 31 operated lungs were reassessed by high-resolution CT (HRCT) to demonstrate postoperative morphological changes., Results: Neither relevant clinical symptoms nor recurrence of a pneumothorax were found. However, HRCT revealed new apical bleb formations in 22 (71%) of 31 lungs. Neither the surgical approach, the technique of resection nor giving up smoking could be correlated to the tissue alterations. Surgical excision of the apex of the lung does not stop bleb formation., Conclusion: This study confirms earlier results from a different institution, when blebs recurred in 50% of the cases. The presence of these new apical formations neither influenced the clinical outcome nor predisposed to recurrence of PSP. Parietal (partial) pleurectomy seems mandatory to prevent PSP in the long-term.

Object: Anterior decompression and stabilization for thoracic spinal tumors often involves a thoracotomy and can be associated with surgical approach-related complications. An alternative to thoracotomy is surgery via a costotransversectomy exposure. To delineate the risks of surgery, the authors reviewed their prospective database for patients who had undergone surgery via either of these approaches for thoracic or thoracolumbar tumors. The complications were recorded and graded based on severity and risk of impact on patient outcome., Methods: Between September 1995 and April 2001, the authors performed 29 costotransversectomies (Group 1) and 18 thoracolumbar or combined (Group 2) approaches as initial operations for thoracic neoplasms. The age, sex, preoperative motor score, and preoperative Frankel grade did not significantly differ between the groups. In the costotransversectomy group there were greater numbers of metastases, upper thoracic procedures, and affected vertebral levels; additionally, the comorbidity rate based on Charlson score, was higher. The mean Frankel grades at discharge were not significantly different whereas the discharge motor and last follow-up motor scores were better in Group 2. There were 11 Group 1 and seven Group 2 patients who suffered at least one complication. The number or patients with complications, the mean number of complications, and severity of complications did not differ between the groups., Conclusions: Compared with anterior or combined approaches, the incidence and severity of perioperative complications in the surgical treatment of thoracic and thoracolumbar spinal tumors is similar in patients who undergo costotransversectomy. Costotransversectomy may be the preferred operation in patients with significant medical comorbidity or tumors involving more than one thoracic vertebra.

Objective: Over the last 15 years we have managed patients with malignant pleural effusion, using a single procedure with thoracoscopy and talc pleurodesis or shunt as appropriate. Talc pleurodesis remains our primary treatment option but in those patient shown to have the 'trapped lung syndrome', in whom pleurodesis would fail, we have been using a pleuroperitoneal shunt., Methods: This retrospective review was undertaken to evaluate the mortality and morbidity of pleuroperitoneal shunts in the management of malignant pleural effusions and to assess their long-term results. Three hundred and sixty patients were treated for malignant effusions during the period 1983-1998, 160 (44.4%) of whom had a pleuroperitoneal shunt inserted. There were no intraoperative deaths and the hospital mortality was three patients (1.87%). Follow up was available for 88.1% of patients. The median survival of all malignant cases was 7.7 months (range 1-72 months). Mesothelioma patients survived somewhat longer with a median survival of 10.1 months., Results: Shunt complication occurred in 21 patients (14.8%). Twelve patients developed shunt occlusion, requiring revision in five and replacement in seven. The shunt was removed in eight patients due to skin erosion in one patient and infection in seven patients. The distal limb of shunt was broken in one patient and the shunt was replaced. One patient developed malignant seeding along the chest wall at the site of shunt insertion but there were no incidences of peritoneal deposits. Effective palliation was achieved in 95% of patients., Conclusions: Pleuroperitoneal shunt insertion provides effective and safe palliation for malignant pleural effusion when associated with the 'trapped lung syndrome'. There are however complications which require revision or shunt removal. There is no evidence that peritoneal deposits result from pleuroperitoneal shunting.

Analyzed in the study are data from 153 patients with severe scoliosis who had undergone thoracic spine corrective surgery and developed posttraumatic exudative pleurisy. Transudate evacuation in pleurocentesis was consistent with a diagnosis of the above complication.

Insufficient intraopertive aerostasis is a serious, actual, and yet unsolved problem of pulmonary surgery. It is a frequent cause for the development of postoperative complications that compromise the results of surgery. The authors investigate the development and modification of the contemporary surgical methods for aerostasis--surgical techniques for suturing the lung parenchyma, additional methods for buttressing and hermetization of the suture line, parietal pleurectomy, tissue glues, and fibrine adhesives. The advantages and disadvantages of the different methods for aerostasis are analyzed and their rationality and efficacy in various surgical conditions are discussed.