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Key words: chest tube; median sternotomy; pleurodesis; spontaneous pneumothorax; thoracoscopy; thoracotomy; tube thoracostomy Abbreviations: ELC = emphysema-like changes; PSP = primary spontaneous pneumothorax; SP = spontaneous pneumothorax; SSP = secondary [...]

Background. The purpose of this study was to assess the ability of administering to patients induction chemotherapy with carboplatin and etoposide (VP-16), followed by full-course radiation therapy and weekly carboplatin with tolerable toxicity as preoperative therapy to downstage disease thus allowing the resection of clinically staged IIIA non-small cell lung cancer. Methods. Twenty-eight eligible patients with good performance status and previously untreated, marginally resectable stage IIIA non-small cell lung cancer received induction chemotherapy with carboplatin (dosed per the Egorin formulation), and VP-16 (100 mg/[m.sup.2]) followed by 6000 cGy of chest radiotherapy over six weeks administered concurrently with weekly doses of 100 mg/[m.sup.2] of carboplatin. Patients who had either responsive or stable disease underwent thoracotomy, with attempted surgical resection of the primary lung lesion and the areas of abnormal adenopathy. Procedures involving less than a pneumonectomy were used whenever feasible. Results. Fifty-two cycles of induction chemotherapy were administered. The average initial dose of carboplatin was 407 mg/[m.sup.2]. Toxicity was tolerable with grade 3-4 neutropenia and/or thrombocytopenia in 48 and 27% of the patients. There were no septic deaths. Full-dose radiotherapy was administered to 82% of patients, with 73% receiving at least five weekly doses of carboplatin. The radiographically assessed response rate to the neoadjuvant treatment was 64% (partial response, 46%; minimal response, 18%). Sixteen patients underwent gross tumor resection with 12 (43%) having negative pathologic margins. Six patients had pneumonectomy. There were three perioperative deaths (19%); two were secondary to respiratory failure after the patients underwent a pneumonectomy. The median survival for all 28 patients was 15 months, and for the 16 patients undergoing thoracotomy was 23 months. Eight patients were alive and in remission, with follow-up ranging from 8 to 31 months. Conclusions. The authors conclude that (1) carboplatin and VP-16, followed by full-dose radiotherapy with weekly carboplatin administration, is a well tolerated and effective regimen in the treatment of patients with marginally resectable stage IIIA non-small cell lung cancer; and (2) full-course radiotherapy can be administered before surgical resection without additional surgical morbidity or mortality. Cancer 1994; 74:1243-52. Key words: lung cancer, neoadjuvant treatment, radiation therapy, carboplatin chemotherapy.

A 68-year-old white man with lung carcinoma underwent removal of the lower lobe of the left lung. Four months later, the patient developed a hemothorax requiring exploratory thoracotomy, evacuation of [...]

According to the authors of a study from Louvain, Belgium, 'A 37-year-old woman presented at casualty with a 1-day history of progressive spontaneous left iliac fossa pain. She was having [...]

Byline: Sunil. Yeshvanth, Veena. Shivamurthy, Channappa. Patil, Sandeep. Rai, Kishan Prasad. Lakshminarayana, Jagadish. Makannavar Sir, Mesenchymal hamartoma of the chest wall (MHCW) occurs as intraosseous expansile mass involving the ribs [...]

Byline: Arvind. Krishnamurthy, N. Vijayalakshmi, Urmila. Majhi Sir, Lung cancers are an extremely heterogeneous family of malignant neoplasms', with well over 50 different histological variants recognized under the 2004 revision [...]

Background. Off-pump coronary artery bypass (OPCAB) surgery is an established technique for the management of three-vessel coronary artery disease. This study compared the clinical results of two different surgical approaches: median sternotomy and left anterolateral thoracotomy in patients undergoing OPCAB surgery. Methods. The study included two groups of 50 patients each with multivessel coronary artery disease matched for age, gender, extent of coronary disease, diabetes, hypertension and ejection fraction. Results. Preoperative characteristics were similar in the two groups. There were no deaths, or stroke. Patients undergoing median sternotomy received more grafts than those undergoing left anterolateral thoracotomy (3.30+/-0.8 vs 2.48+/-0.8 p, Introduction Off-pump coronary artery bypass (OPCAB) surgery via a median sternotomy is an established surgical technique for patients undergoing coronary revascularization. Recently the left anterolateral thoracotomy has been proposed as [...]

Pulmonary arteriovenous malformation (PAVM) is an abnormal communication between the pulmonary artery and the pulmonary vein. PAVMs are usually congenital in origin. In this study we reported a 32-year-old woman that was referred to the clinic with the chief complain of frequently coughs and hemoptysis for three months. Also, her past medical history revealed that she had a thoracotomy and decortication of the right lung due to clotted hemothorax, about 12 years ago while she had a term pregnancy. CT angiography and spiral CT-scan demonstrated cystic-masses in the right hemithorax. These masses were enhanced like pulmonary vessels and had feeding artery and evacuator vein. So, three PAVMs were diagnosed in the right lung. The patient underwent right postrolateral thoracotomy. Two of the PAVMs were in the lower lobe which treated by resection but the one in the middle lobe was completely intraparenchymal and it could not be localized during the surgery so the lobectomy of the right middle lobe was performed. Keywords: Pulmonary Arterio-Venous Malformation | Pulmonary Arterio-Venous Fistulas | Thoracotomy | Lobectomy, Introduction First described in 1897, pulmonary arteriovenous malformation (PAVM) is an abnormal communication between the pulmonary artery and the pulmonary vein. PAVMs are usually congenital in origin; however, they may [...]

A five year clinical audit was conducted between January 1, 2000 and January 1, 2005 to evaluate the management of patients with spontaneous pneumothoraces at three tertiary referral centres across Kingston, the capital city of Jamaica. Secondary pneumothoraces (SSP) were considered present if there was underlying lung pathology, otherwise patients were considered to have primary pneumothoraces (PSP). Data retrospectively extracted from hospital records, including patient demographics, clinical details and therapeutic outcomes, were analyzed using SPSS Version 12.0. Of the 81 cases identified, 58 patients with a mean age of 41.3 +/-18.2 years (SD) had PSP. The remaining 23 patients at a mean age of 51.8 +/-17.7 years were diagnosed with SSP from COPD (11), tuberculosis (6), asthma (3), PCP (1), endometriosis (1) and sarcoidosis (1). Recurrent SSP was present in 13/81 (16.1%) cases. One patient had a clinically diagnosed tension pneumothorax while the remaining cases were diagnosed on chest radiographs. Most cases were unilateral: 52 right sided (64.2%); 28 left sided (34.6%); 1 bilateral (1.2%). Of this, 80 patients had tube thoracostomy and 1 had aspiration as the definitive therapeutic maneouvre. Prophylactic second procedures (chemical pleurodesis in 3; open gauze pleurodeses in 5) were offered to 8/81 (9.9%) patients, all with recurrent SSP. The remaining patients had ongoing surveillance. There were no recurrences recorded during the study period. Needle aspiration and prophylactic procedures were under-utilized in this setting in contravention of evidence-based guidelines. Educational programmes and early referral to thoracic surgeons may increase the compliance with the standardized guidelines. Keywords: Pneumothorax | Spontaneous pneumothorax | Primary spontaneous pneumothorax | Secondary spontaneous pneumothorax | Idiopathic pneumothorax | Pleurodesis | Tube thoracosotmy, Introduction A spontaneous pneumothorax is an abnormal collection of air within the pleural space that occurs in an individual without a clinically apparent predisposition. (1) They are distinguished from pneumothoraces [...]

A five year clinical audit was conducted between January 1, 2000 and January 1, 2005 to evaluate the management of patients with spontaneous pneumothoraces at three tertiary referral centres across Kingston, the capital city of Jamaica. Secondary pneumothoraces (SSP) were considered present if there was underlying lung pathology, otherwise patients were considered to have primary pneumothoraces (PSP). Data retrospectively extracted from hospital records, including patient demographics, clinical details and therapeutic outcomes, were analyzed using SPSS Version 12.0. Of the 81 cases identified, 58 patients with a mean age of 41.3 18.2 years (SD) had PSP. The remaining 23 patients at a mean age of 51.8 17.7 years were diagnosed with SSP from COPD (11), tuberculosis (6), asthma (3), PCP (1), endometriosis (1) and sarcoidosis (1). Recurrent SSP was present in 13/81 (16.1%) cases. One patient had a clinically diagnosed tension pneumothorax while the remaining cases were diagnosed on chest radiographs. Most cases were unilateral: 52 right sided (64.2%); 28 left sided (34.6%); 1 bilateral (1.2%). Of this, 80 patients had tube thoracostomy and 1 had aspiration as the definitive therapeutic maneouvre. Prophylactic second procedures (chemical pleurodesis in 3; open gauze pleurodeses in 5) were offered to 8/81 (9.9%) patients, all with recurrent SSP. The remaining patients had ongoing surveillance. There were no recurrences recorded during the study period. Needle aspiration and prophylactic procedures were under-utilized in this setting in contravention of evidence-based guidelines. Educational programmes and early referral to thoracic surgeons may increase the compliance with the standardized guidelines. Keywords: Pneumothorax, Spontaneous pneumothorax, Primary spontaneous pneumothorax, Secondary spontaneous pneumothorax, Idiopathic pneumothorax, Pleurodesis, Tube thoracosotmy, Table of Contents Abstract Introduction Methods Results Discussion Conclusion References Introduction A spontaneous pneumothorax is an abnormal collection of air within the pleural space that occurs in an individual without [...]

Injuries to the subclavian artery are rare and associated with high morbidity and mortality rate regardless of the mechanism (1,2,3). Techniques for repair of the subclavian vessels and innominate artery vary and depend on type of injury. Several authors have reported success in treating such injuries with endovascular stents, but the long-term stability of the stents is yet unknown. (4). We are reporting a case of injury to the first segment of subclavian artery in trauma patient and the appropriate surgical management without opening the chest cavity. Keywords: Subclavian Artery Injury, Trauma, Surgical Management Without Thoracotomy, Table of Contents Abstract Case History Physical Examination Discussion References Case History A 20 year old white male that apparently was involved in a motorcycle accident and developed sustained injury [...]

There has been no report on the prevalence of spontaneous pneumothoraces in developing Caribbean nations. We performed a retrospective survey of all tertiary level hospitals serving Kingston, the capital of Jamaica over five years from January 1997 to December 2001. All patients treated for spontaneous pneumothoraces were identified and their records were retrospectively examined. There were 81 patients treated for spontaneous pneumothoraces over the study period. Spontaneous pneumothorax affects 1.96/100,000 persons yearly in Jamaica, with a 3:1 male preponderance. Secondary spontaneous pneumothorax (SSP) occurs in 0.56/100,000 persons yearly in this setting (0.36 in males and 0.19 in females). The commoner underlying disorders causing SSP were COPD (47.8%), Tuberculosis (26.1%), Asthma (13%), Pneumocysitis Carinii Pneumonia (4.4%), granulomatous lung disease (4.4%) and endometriosis (4.4%). The incidence of primary spontaneous pneumothorax (PSP) in Jamaica was 1.40/100,000 persons yearly (1.16 in males and 0.24 in females). The majority of patients (58/81, 72%) were current smokers of cigarettes and/or cannabis, and there was a significantly higher incidence of current smoking among males with PSP (83% vs 33%; [X.sup.2] = 16.67; p Spontaneous pneumothoraces are potentially dangerous conditions. The incidence in Jamaica is relatively low. Emergency room physicians must remain aware of this problem and maintain a high level of suspicion in order to optimize diagnosis and therapy. Keywords: Pneumothorax, Spontaneous pneumothorax, Primary spontaneous pneumothorax, Secondary spontaneous pneumothorax, Idiopathic pneumothorax, Pleurodesis, Tube thoracosotmy, Table of Contents Abstract Introduction Methods Results Discussion Conclusion References Introduction The term pneumothorax was first coined in 1803 by a medical student, Itard, while describing a collection of air [...]

Intrathoracic fracture dislocation of the humeral head due to a blunt trauma is very rare. In fact, there are only few cases in the medical literature documenting intrathoracic humeral fracture-dislocations. It is associated with high-energy trauma. Because a limited number of cases were reported, appropriate treatment modality remains unclear, and no guidelines exist. A case of intrathoracic humeral head fracture-dislocation caused by a high-impact fall down a ladder is presented herewith. Keywords: Fracture-dislocation of the humerus, humeral head fracture, shoulder dislocation, thoracotomy, multiple trauma surgery, Table of Contents Abstract Introduction Case Report Discussion References Introduction Among the gleno-humeral fracture-dislocations which have been reported in Literature, those ones, concerning an intrathoracic displacement of the humeral head, [...]

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a life-threatening condition very rarely documented. It usually results from the rupture of subpleural blebs/bullae and progresses to tension pneumothorax. Prompt and appropriate diagnosis and treatment are necessary in patients with such condition. Thoracoscopic surgery is considered as a standard approach for definitive treatment to SBSP. We report two cases of SBSP presenting sudden chest pain and acute dyspnea treated with bilateral tube thoracostomy and posterior bilateral bullectomy through thoracoscopy. Keywords: Simultaneous bilateral spontaneous pneumothorax, Thoracoscopic surgery, Table of Contents Abstract Introduction Case Reports Discussion References Introduction Simultaneous bilateral spontaneous pneumothorax (SBSP) is an extremely rare life-threatening condition, accounting for about 1.3% of spontaneous pneumothoraces (1), and [...]

Byline: C. Burlacu As the currently published research illustrates, the topic of epidural analgesia for major surgery continues to fascinate the anaesthetic and surgical community despite being one of the [...]

Table of Contents Abstract Introduction Discussion Conclusions References Abstract The incidence of trauma has been steadily increasing in many Caribbean countries over the past decade. This has led to an [...]

Table of Contents Abstract Introduction Patients And Methods Results Discussion Conclusion References Abstract Background: Empyema thoracis remains a common problem in the pediatric age group. We undertook the present study [...]

Table of Contents Abstract Case Report Discussion References Abstract Localized 'pneumothoracocele' formed due to air entrapment from a subsequent pneumothorax is termed as 'pneumothorax necessitans'. Only one other case of [...]

Table of Contents Abstract Introduction Case Report Discussion Summary References Abstract Thymoma is a neoplasm arising from the epithelial cells of the thymus. We report the case of a cystic [...]

Purpose: Cryoanalgesia has been advocated as a means of controlling post-thoracotomy pain. This technique has been hampered by inconsistent results. Cryoanalgesia has never been used in conjunction with video-assisted thoracic [...]

PURPOSE: A multifactorial score (FLAM score) was developed to standardize postoperative respiratory evaluation and to test the hypothesis that significant respiratory changes are evident at least 24 hours before the [...]

PURPOSE: This study analyses the outcome of patients with massive hemoptysis without response to conservative treatment and requiring emergency thoracotomy for hemostasis. METHODS: Between 1990 and 2005 we performed emergency [...]