Uniportal video-assisted thoracoscopic lobectomies in lung cancer management

OBJECTIVE. The study summarized personal surgical experience of uniportal video-assisted thoracoscopic (VATS) lobectomies for patients with stage I-II non-small cell lung cancer. MATERIAL AND METHODS. The authors have performed 72 VATS lobectomies for patients with stage I-II non-small lung cancer using modified minimally invasive single incision above anterior part of musculus latissimus dorsi. RESULTS. During the implementation period, there were carried out 2 (2,8 %) conversions to open thoracotomy. There weren’t observed lethal postoperative complications of VATS lobectomies. Other complications had 5 (6,9 %) patients. Postoperative pneumonia was in 1 (1,4 %) patient. Arrhytmia was noted in 4 (5,6 %) patients. The average operation time consisted of 227,4 min (from 60 to 460 min). Learning curve demonstrated a significant decrease of operation time with every following VATS lobectomy from 227,4 to 90,3 min (p=0,03). The quantity of removed regional lymph nodes estimated 14,2 ± 0,7 during uniportal VATS lobectomy. The median blood loss was 98,3 ml (from 10 to 300 ml). The average duration of air leak was 2,3 ± 0,65 days after uniportal VATS lobectomy. The mean term of drainage was 4,6 ± 0,53 days. CONCLUSIONS. The data obtained justified the feasibility, efficacy and safety of VATS lobectomies in patients with I-II stage of lung cancer.

FIRST EXPERIENCE OF RECONSTRUCTIVE AND ONCOLOGY PLASTIC OPERATIONS ON THE MAMMARY GLAND

In Chernivtsi Regional Clinical Oncologic Dispensary organ-preserving operations constitute up to 50% all surgery performed in case of breast cancer. Organ-preserving and reconstructive operations for the last 5 years have been performed on 92 patients which are less than 10% of all operations. The majority of operations are subcutaneous mastectomies, and implantation grafting with musculus latissimus dorsi. The outcome of surgery was without complications.

Variation of the latissimus dorsi

ABSTRACTA typical muscle variation of latissimus dorsi - the axillary arch is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi passing over the axilla under the axillary fascia crossing the medial side of the brachial plexus to continue as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. The full extent of the muscle is rarely present. Slips of muscle extend from the latissimus dorsi at the inferior angle of scapula to insert into pectoralis major (Langer), coracobrachilis, biceps or coracoid process forming what is described as a common variant - the muscular axillary arch. We report three cases of variants of latissimus dorsi, one of which has not been reported in the literature before.

Aspergillus empyema kezelése nyitott thoracostomiával és izomplasztikával, a tüdő funkciójának megőrzésével – esetismertetés

Absztrakt Bevezetés: Az invazív aspergillosis életet veszélyeztető kórkép immunsupprimált betegeknél, mivel roncstüdő kialakulásához vezethet. Az Aspergillus empyema kezelése összetett. Eset: 18 éves férfi beteget kezeltünk, akinek anamnaesisében pancytopenia hátterében aplasticus anaemia, ciklosporin-A anti-thymocyta globulin (CA ATH) kezelés szerepel. Eredménytelen idegen donoros őssejtbeültetést követően gombás pleuropneumonia alakult ki nála, így empyema kialakulása miatt „open window thoracostomiát” (OWT), fenestratiót készítettünk. Ismételt mellkasi CT készült septicus állapot miatt, a korábbi műtét során készített stomából multidrog-rezisztens Pseudomonas tenyészett ki. Intézetünkbe történő áthelyezését követően az üreg debridementjének elvégezése után a musculus latissimus dorsi (MLD) és a musculus serratus anterior (MSA) izmok felhasználásával thoracomyoplasticát végeztünk. A műtétet követően parenchymaveszteség nélkül hazabocsátottuk a beteget. Következtetés: Az aspergillus okozta empyema kezelése nyitott thoracostomiával és halasztott izomlebeny-plasztikával szelektált esetekben sikerhez vezet, a tüdő funkciójának megtartásával. Ezen eset is példa arra, hogy társszakmák (jelen esetben mellkassebész és plasztikai sebész) együttműködése vezethet a sikeres gyógyuláshoz.

An adjustable shoulder abduction orthosis for the post-operative management of tendon transfers: A preliminary study

Transfer of Musculus Latissimus dorsi/M. Teres major to the rotator cuff with or without M. Subscapularis/M. Pectoralis release is a widely used procedure for restoring shoulder abduction and external rotation in squeal of obstetric brachial plexus palsy. After the operation a shoulder abduction orthosis in maximal external rotation and 90 – 100° abduction is utilized following six weeks of immobilization in a shoulder spica cast for protecting the newly transferred muscle from undue elongation. However this in turn may cause contracture of the external rotators. To overcome this problem, a modified shoulder abduction splint with adjustable internal-external rotation/abduction-adduction ranges was developed in the orthotics department of a rehabilitation center. The custom molded adjustable shoulder abduction orthosis is described and the preliminary results are compared with former applications.