Objectives:Thoracic empyema is characterized by the collection of infected fluid/pus in the pleural space. A multitude of etiologies and surgical approaches exist. The current study aims to assess outcomes in elderly ...Objectives:Thoracic empyema is characterized by the collection of infected fluid/pus in the pleural space. A multitude of etiologies and surgical approaches exist. The current study aims to assess outcomes in elderly and young patients undergoing surgery for thoracic empyema. Methods: A retrospective comparative analysis was undertaken comparing outcomes in elderly and young patients undergoing surgery with an established diagnosis of empyema. Two groups were generated for comparison 1) patients older than 65 and 2) patients younger than 65. Demographics, comorbidities, post-operative complications, surgical approach and mortalities were compared between groups. Results: 526 patients underwent surgery for empyema during the study period (1993-2016). Group A (65) comprised 108 patients. With respect to group A, the median age at surgery was 45.30 years. Median post-operative stay was 10.50 days (9.10 vs. 11.90 in VATS and open respectively). 30-day mortality in group A was 1.90% (3.30% vs. 0.47% in VATS and open respectively). Group B comprised 108 patients (median age 72.70 years). Median post-operative stay was 14.40 days (11.20 vs. 17.8, VATS vs. open, p = 0.001). Overall 30-day mortality was 8.30 % (7.5% vs. 9% in VATS and open respectively, p = 0.03). Conclusions: The associated mortality and in-patient stay was significantly greater in elderly cohorts when compared to younger. Minimal access approaches confer a number of advantages in elderly patients including shorter hospital stay and reduced mortality.展开更多
Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax(PSP). However, the conventional belief amongst most clinicians is that surgery should not be routine...Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax(PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracicsurgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.展开更多
BACKGROUND Fewer than 200 cases of diaphragmatic tumors have been reported in the past century. Diaphragmatic hemangiomas are extremely rare. Only nine cases have been reported in English literature to date. We report...BACKGROUND Fewer than 200 cases of diaphragmatic tumors have been reported in the past century. Diaphragmatic hemangiomas are extremely rare. Only nine cases have been reported in English literature to date. We report a case of cavernous hemangioma arising from the diaphragm. Pre-operative three-dimensional(3D)simulation and minimal invasive thoracoscopic excision were performed successfully, and we describe the radiologic findings and the surgical procedure in the following article.CASE SUMMARY A 40-year-old man was referred for further examination of a mass over the right basal lung without specific symptoms. Contrast-enhanced computed tomography revealed a poorly-enhanced lesion in the right basal lung, abutting to the diaphragm, measuring 3.1 cm × 1.5 cm in size. The mediastinum showed a clear appearance without evidence of abnormal mass or lymphadenopathy. A preoperative 3D image was reconstructed, which revealed a diaphragmatic lesion. Video-assisted thoracic surgery was performed, and a red papillary tumor was found, originating from the right diaphragm. The tumor was resected, and the pathological diagnosis was cavernous hemangioma.CONCLUSION In this rare case of diaphragmatic hemangioma, 3D image simulation was helpful for the preoperative evaluation and surgical decision making.展开更多
文摘Objectives:Thoracic empyema is characterized by the collection of infected fluid/pus in the pleural space. A multitude of etiologies and surgical approaches exist. The current study aims to assess outcomes in elderly and young patients undergoing surgery for thoracic empyema. Methods: A retrospective comparative analysis was undertaken comparing outcomes in elderly and young patients undergoing surgery with an established diagnosis of empyema. Two groups were generated for comparison 1) patients older than 65 and 2) patients younger than 65. Demographics, comorbidities, post-operative complications, surgical approach and mortalities were compared between groups. Results: 526 patients underwent surgery for empyema during the study period (1993-2016). Group A (65) comprised 108 patients. With respect to group A, the median age at surgery was 45.30 years. Median post-operative stay was 10.50 days (9.10 vs. 11.90 in VATS and open respectively). 30-day mortality in group A was 1.90% (3.30% vs. 0.47% in VATS and open respectively). Group B comprised 108 patients (median age 72.70 years). Median post-operative stay was 14.40 days (11.20 vs. 17.8, VATS vs. open, p = 0.001). Overall 30-day mortality was 8.30 % (7.5% vs. 9% in VATS and open respectively, p = 0.03). Conclusions: The associated mortality and in-patient stay was significantly greater in elderly cohorts when compared to younger. Minimal access approaches confer a number of advantages in elderly patients including shorter hospital stay and reduced mortality.
文摘Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax(PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracicsurgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.
文摘BACKGROUND Fewer than 200 cases of diaphragmatic tumors have been reported in the past century. Diaphragmatic hemangiomas are extremely rare. Only nine cases have been reported in English literature to date. We report a case of cavernous hemangioma arising from the diaphragm. Pre-operative three-dimensional(3D)simulation and minimal invasive thoracoscopic excision were performed successfully, and we describe the radiologic findings and the surgical procedure in the following article.CASE SUMMARY A 40-year-old man was referred for further examination of a mass over the right basal lung without specific symptoms. Contrast-enhanced computed tomography revealed a poorly-enhanced lesion in the right basal lung, abutting to the diaphragm, measuring 3.1 cm × 1.5 cm in size. The mediastinum showed a clear appearance without evidence of abnormal mass or lymphadenopathy. A preoperative 3D image was reconstructed, which revealed a diaphragmatic lesion. Video-assisted thoracic surgery was performed, and a red papillary tumor was found, originating from the right diaphragm. The tumor was resected, and the pathological diagnosis was cavernous hemangioma.CONCLUSION In this rare case of diaphragmatic hemangioma, 3D image simulation was helpful for the preoperative evaluation and surgical decision making.
