This article describes a case involving a poorly treated odontogenic infection, which was complic... more This article describes a case involving a poorly treated odontogenic infection, which was complicated by mediastinitis, thoracic empyema, pericarditis, and ascites. A posterolateral thoracotomy was necessary as incisional surgical drainage proved to be inadequate. A multidisciplinary approach of descending necrotizing mediastinitis and its complications is essential.
Background: The purpose of this study was to evaluate the effectiveness of an albumin-glutaraldeh... more Background: The purpose of this study was to evaluate the effectiveness of an albumin-glutaraldehyde tissue adhesive (BioGlue Surgical Adhesive) in preventing air leaks after bullectomy. Methods: Between January 1999 and June 2002, BioGlue was applied over the staple or suture lines of 21 consecutive patients who underwent resection of bullae for persistent or recurrent pneumothorax. An age- and sex-matched control group of 19 bullectomy patients from our center was used for comparison. Results: Air leak duration was significantly reduced in the BioGlue group (mean, 0.42 days; range, 0-2 days), compared with the control group (mean, 3.68 days; range, 2-11 days; P < .001). Chest tube drainage time was reduced to a mean of 2.33 days (range, 2-4 days) in the BioGlue group, compared with a mean of 5.42 days (range, 3-12 days) in the control group (P < .05). Morbidity and hospital stay length were slightly lower in the BioGlue group. There was no mortality or BioGlue-related complication in this patient cohort. Conclusions: The use of BioGlue as a surgical lung sealant significantly decreased the duration of postoperative air leaks and the time to chest tube removal. Use of BioGlue facilitates the postoperative course following bullectomy.
Background: The purpose of this study was to test the performance of an albumin-glutaraldehyde ti... more Background: The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive, BioGlue(r) Surgical Adhesive (BioGlue) in the sealing of air leaks from pulmonary parenchyma and bronchopleural fistulas. Material/methods: Between March 2000 and November 2001 BioGlue was applied in 38 randomly selected patients, who underwent 39 operations. The mean age was 51.4 years (range 19 to 75 years). A median of 5 cc of BioGlue was used per patient (range 5 to 20 cc). The operations included 36 thoracotomies, 2 video-assisted thoracoscopies and one rigid bronchoscopy. Results: The duration of air leak ranged from 0 to 2 days with a median of 1 day. The duration of total (air and fluid) chest tube drainage ranged from 1 to 12 days with a median of 3 days. Complications were observed in 3 patients (8%) and included atelectasis in one and residual space in 2. Three patients died because of preexisting respiratory failure unrelated to BioGlue application. Hospitalization ranged from 4 to 16 days with a median of 6 days and was prolonged in some patients because of their primary disease (empyema, bronchopleural fistula, etc.). Conclusions: The use of BioGlue proved to be safe and effective in the sealing of lung lacerations and in preventing air leakage from suture or staple lines in emphysematous lungs. It was also successful in sealing bronchopleural fistulas when applied either intra-bronchially through the rigid bronchoscope or during thoracotomy.
To evaluate the outcomes of video-thoracoscopic and open surgical management of patients with tho... more To evaluate the outcomes of video-thoracoscopic and open surgical management of patients with thoracic empyema. We studied 122 patients retrospectively who underwent surgery for thoracic empyema in our hospital between January, 1999 and January, 2005. Patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; medical records, surgical procedures, and outcomes were reviewed. The study identified 97 affected men and 25 affected women with a mean age of 54 years (range 16-78 years). The empyema was parapneumonic in 95 patients (78%). Forty-four patients who had stage II empyema underwent video-assisted thoracic surgery (VATS). The procedure was converted to thoracotomy in 13 patients (29.5%); the morbidity and mortality rates of VATS were 13% and 0, respectively. Seventy-eight patients had stage III empyema and, along with those 13 who were converted, underwent thoracotomy for decortication. The associated morbidity rate was 12%, and the mortality rate was 6.6%. Thoracotomy was considered successful in 90 of 91 patients (99%); one patient needed a reoperative thoracotomy for an organ space/surgical site infection with pus in the pleural cavity. Many treatment modalities are available for thoracic empyema, depending on the results of appropriate clinical and laboratory investigations. In fibrinopurulent empyema, VATS debridement is safe and effective, with minimal morbidity and no deaths. Lung decortication via thoracotomy is the only option for organized empyema and is associated with a substantial mortality rate.
Asian Cardiovascular and Thoracic Annals, Feb 1, 2008
Complete rupture of the main bronchus after blunt thoracic trauma is rare. Most patients with blu... more Complete rupture of the main bronchus after blunt thoracic trauma is rare. Most patients with blunt traumatic injury to the trachea or bronchus die before arriving at hospital. A 26-year-old man with complete right main bronchus rupture was successfully treated by urgent surgical intervention and postoperative fiberoptic bronchoscopy for bronchial toilet.
Asian Cardiovascular and Thoracic Annals, Oct 24, 2013
Primary pleomorphic adenomas of the lung are very rare tumors that have peculiar clinical and onc... more Primary pleomorphic adenomas of the lung are very rare tumors that have peculiar clinical and oncologic features. We report here on the diagnostic and therapeutic approach for a patient with a large neglected pulmonary pleomorphic adenoma that presented initially as pneumonia.
Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and m... more Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental- odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our Department during the period of general lockdown in Greece, between March 2020 and June 2020, because of the Covid19. Patients and Methods: During the period of general lockdown in Greece, 4 patients, mean age 46, 25 years (range 39-59), with DNM treated to our Department of General Thoracic Surgery. Primary odontogenic abscess occurred to 2 patients and peritonsillar abscess to other 2 of them. Diagnosis was confirmed by computed tomography (CT) of the neck and chest. All patients underwent surgical drainage of abscesses of the involved cervical region and mediastinum by lateral cervicotomy and left thoracotomy in three of them and cervicotomy, and bilateral thoracotomy in one pa...
Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by pur... more Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by purulent fluid or the presence of bacterial organisms. The aim of this study is to highlight the importance of early diagnosis and management of empyema in an attempt to avoid needless procedures and dreaded complications while shining a light into the warrant of a multidisciplinary approach that would had a paramount significance during the lockdown period in Greece, between March-June of 2020 due to COVID-19, in ameliorating those issues. Patients and Methods: During the aforementioned period 12 patients were treated at our Department, 11 of them were male, ages ranging from 22-71 years old. The cause of empyema was parapneumonic effusion from a bacterial pneumonia in 10 patients and the other 2 were tuberculous empyema and extension of an intraabdominal process (Diffuse large B-cell lymphoma of the stomach). Predominately the patients were admitted to our Department with stage III empyem...
BackgroundEpidermal growth factor receptor (EGFR) overexpression is observed in significant propo... more BackgroundEpidermal growth factor receptor (EGFR) overexpression is observed in significant proportions of non-small cell lung carcinomas (NSCLC). Furthermore, overactivation of vascular endothelial growth factor (VEGF) leads to increased angiogenesis implicated as an important factor in vascularization of those tumors.Patients and MethodsUsing tissue microarray technology, forty-paraffin ( n = 40) embedded, histologically confirmed primary NSCLCs were cored and re-embedded into a recipient block. Immunohistochemistry was performed for the determination of EGFR and VEGF protein levels which were evaluated by the performance of computerized image analysis. EGFR gene amplification was studied by chromogenic in situ hybridization based on the use of EGFR gene and chromosome 7 centromeric probes.ResultsEGFR overexpression was observed in 23/40 (57.5%) cases and was correlated to the stage of the tumors ( p = 0.001), whereas VEGF was overexpressed in 35/40 (87.5%) cases and was correlate...
Interactive cardiovascular and thoracic surgery, 2005
The aim of this study was to evaluate the experience of our institution with the use of video-ass... more The aim of this study was to evaluate the experience of our institution with the use of video-assisted thoracic surgery (VATS) in chest trauma. Between January 1999 and September 2004, 25,213 patients presented with chest trauma to the emergency room, and 2304 were admitted to our service. Twenty-three hemodynamically stable patients (1%) underwent VATS. They were 19 men and 4 women with an average age of 42 years (range, 19-67 years). Indications included post-traumatic hemothorax in 11 patients, and post-traumatic empyema in 3, treated after 24 h of trauma. Indications for exploratory VATS in the acute phase included suspected diaphragmatic injury in 3 patients, persistent pneumothorax in 2, continued hemorrhage in 2 and removal of intrathoracic foreign body in 2. There was no mortality and complications occurred in 3 patients (13%). Management of hemodynamically stable thoracic injuries by using VATS provides diagnostic accuracy and therapeutic efficacy. It can be successfully ap...
This article describes a case involving a poorly treated odontogenic infection, which was complic... more This article describes a case involving a poorly treated odontogenic infection, which was complicated by mediastinitis, thoracic empyema, pericarditis, and ascites. A posterolateral thoracotomy was necessary as incisional surgical drainage proved to be inadequate. A multidisciplinary approach of descending necrotizing mediastinitis and its complications is essential.
Background: The purpose of this study was to evaluate the effectiveness of an albumin-glutaraldeh... more Background: The purpose of this study was to evaluate the effectiveness of an albumin-glutaraldehyde tissue adhesive (BioGlue Surgical Adhesive) in preventing air leaks after bullectomy. Methods: Between January 1999 and June 2002, BioGlue was applied over the staple or suture lines of 21 consecutive patients who underwent resection of bullae for persistent or recurrent pneumothorax. An age- and sex-matched control group of 19 bullectomy patients from our center was used for comparison. Results: Air leak duration was significantly reduced in the BioGlue group (mean, 0.42 days; range, 0-2 days), compared with the control group (mean, 3.68 days; range, 2-11 days; P < .001). Chest tube drainage time was reduced to a mean of 2.33 days (range, 2-4 days) in the BioGlue group, compared with a mean of 5.42 days (range, 3-12 days) in the control group (P < .05). Morbidity and hospital stay length were slightly lower in the BioGlue group. There was no mortality or BioGlue-related complication in this patient cohort. Conclusions: The use of BioGlue as a surgical lung sealant significantly decreased the duration of postoperative air leaks and the time to chest tube removal. Use of BioGlue facilitates the postoperative course following bullectomy.
Background: The purpose of this study was to test the performance of an albumin-glutaraldehyde ti... more Background: The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive, BioGlue(r) Surgical Adhesive (BioGlue) in the sealing of air leaks from pulmonary parenchyma and bronchopleural fistulas. Material/methods: Between March 2000 and November 2001 BioGlue was applied in 38 randomly selected patients, who underwent 39 operations. The mean age was 51.4 years (range 19 to 75 years). A median of 5 cc of BioGlue was used per patient (range 5 to 20 cc). The operations included 36 thoracotomies, 2 video-assisted thoracoscopies and one rigid bronchoscopy. Results: The duration of air leak ranged from 0 to 2 days with a median of 1 day. The duration of total (air and fluid) chest tube drainage ranged from 1 to 12 days with a median of 3 days. Complications were observed in 3 patients (8%) and included atelectasis in one and residual space in 2. Three patients died because of preexisting respiratory failure unrelated to BioGlue application. Hospitalization ranged from 4 to 16 days with a median of 6 days and was prolonged in some patients because of their primary disease (empyema, bronchopleural fistula, etc.). Conclusions: The use of BioGlue proved to be safe and effective in the sealing of lung lacerations and in preventing air leakage from suture or staple lines in emphysematous lungs. It was also successful in sealing bronchopleural fistulas when applied either intra-bronchially through the rigid bronchoscope or during thoracotomy.
To evaluate the outcomes of video-thoracoscopic and open surgical management of patients with tho... more To evaluate the outcomes of video-thoracoscopic and open surgical management of patients with thoracic empyema. We studied 122 patients retrospectively who underwent surgery for thoracic empyema in our hospital between January, 1999 and January, 2005. Patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; medical records, surgical procedures, and outcomes were reviewed. The study identified 97 affected men and 25 affected women with a mean age of 54 years (range 16-78 years). The empyema was parapneumonic in 95 patients (78%). Forty-four patients who had stage II empyema underwent video-assisted thoracic surgery (VATS). The procedure was converted to thoracotomy in 13 patients (29.5%); the morbidity and mortality rates of VATS were 13% and 0, respectively. Seventy-eight patients had stage III empyema and, along with those 13 who were converted, underwent thoracotomy for decortication. The associated morbidity rate was 12%, and the mortality rate was 6.6%. Thoracotomy was considered successful in 90 of 91 patients (99%); one patient needed a reoperative thoracotomy for an organ space/surgical site infection with pus in the pleural cavity. Many treatment modalities are available for thoracic empyema, depending on the results of appropriate clinical and laboratory investigations. In fibrinopurulent empyema, VATS debridement is safe and effective, with minimal morbidity and no deaths. Lung decortication via thoracotomy is the only option for organized empyema and is associated with a substantial mortality rate.
Asian Cardiovascular and Thoracic Annals, Feb 1, 2008
Complete rupture of the main bronchus after blunt thoracic trauma is rare. Most patients with blu... more Complete rupture of the main bronchus after blunt thoracic trauma is rare. Most patients with blunt traumatic injury to the trachea or bronchus die before arriving at hospital. A 26-year-old man with complete right main bronchus rupture was successfully treated by urgent surgical intervention and postoperative fiberoptic bronchoscopy for bronchial toilet.
Asian Cardiovascular and Thoracic Annals, Oct 24, 2013
Primary pleomorphic adenomas of the lung are very rare tumors that have peculiar clinical and onc... more Primary pleomorphic adenomas of the lung are very rare tumors that have peculiar clinical and oncologic features. We report here on the diagnostic and therapeutic approach for a patient with a large neglected pulmonary pleomorphic adenoma that presented initially as pneumonia.
Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and m... more Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental- odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our Department during the period of general lockdown in Greece, between March 2020 and June 2020, because of the Covid19. Patients and Methods: During the period of general lockdown in Greece, 4 patients, mean age 46, 25 years (range 39-59), with DNM treated to our Department of General Thoracic Surgery. Primary odontogenic abscess occurred to 2 patients and peritonsillar abscess to other 2 of them. Diagnosis was confirmed by computed tomography (CT) of the neck and chest. All patients underwent surgical drainage of abscesses of the involved cervical region and mediastinum by lateral cervicotomy and left thoracotomy in three of them and cervicotomy, and bilateral thoracotomy in one pa...
Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by pur... more Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by purulent fluid or the presence of bacterial organisms. The aim of this study is to highlight the importance of early diagnosis and management of empyema in an attempt to avoid needless procedures and dreaded complications while shining a light into the warrant of a multidisciplinary approach that would had a paramount significance during the lockdown period in Greece, between March-June of 2020 due to COVID-19, in ameliorating those issues. Patients and Methods: During the aforementioned period 12 patients were treated at our Department, 11 of them were male, ages ranging from 22-71 years old. The cause of empyema was parapneumonic effusion from a bacterial pneumonia in 10 patients and the other 2 were tuberculous empyema and extension of an intraabdominal process (Diffuse large B-cell lymphoma of the stomach). Predominately the patients were admitted to our Department with stage III empyem...
BackgroundEpidermal growth factor receptor (EGFR) overexpression is observed in significant propo... more BackgroundEpidermal growth factor receptor (EGFR) overexpression is observed in significant proportions of non-small cell lung carcinomas (NSCLC). Furthermore, overactivation of vascular endothelial growth factor (VEGF) leads to increased angiogenesis implicated as an important factor in vascularization of those tumors.Patients and MethodsUsing tissue microarray technology, forty-paraffin ( n = 40) embedded, histologically confirmed primary NSCLCs were cored and re-embedded into a recipient block. Immunohistochemistry was performed for the determination of EGFR and VEGF protein levels which were evaluated by the performance of computerized image analysis. EGFR gene amplification was studied by chromogenic in situ hybridization based on the use of EGFR gene and chromosome 7 centromeric probes.ResultsEGFR overexpression was observed in 23/40 (57.5%) cases and was correlated to the stage of the tumors ( p = 0.001), whereas VEGF was overexpressed in 35/40 (87.5%) cases and was correlate...
Interactive cardiovascular and thoracic surgery, 2005
The aim of this study was to evaluate the experience of our institution with the use of video-ass... more The aim of this study was to evaluate the experience of our institution with the use of video-assisted thoracic surgery (VATS) in chest trauma. Between January 1999 and September 2004, 25,213 patients presented with chest trauma to the emergency room, and 2304 were admitted to our service. Twenty-three hemodynamically stable patients (1%) underwent VATS. They were 19 men and 4 women with an average age of 42 years (range, 19-67 years). Indications included post-traumatic hemothorax in 11 patients, and post-traumatic empyema in 3, treated after 24 h of trauma. Indications for exploratory VATS in the acute phase included suspected diaphragmatic injury in 3 patients, persistent pneumothorax in 2, continued hemorrhage in 2 and removal of intrathoracic foreign body in 2. There was no mortality and complications occurred in 3 patients (13%). Management of hemodynamically stable thoracic injuries by using VATS provides diagnostic accuracy and therapeutic efficacy. It can be successfully ap...
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