Background Benign esophageal anastomotic strictures often require repeat dilation to relieve dysphagia. Little is known about the factors that affect their remediation. The purpose of this article was to retrospectively evaluate the long-term clinical results of endoscopic dilation in the treatment of benign anastomotic strictures after esophagectomy, and to identify factors associated with stricture recurrence. Methods A single-center retrospective analysis (using electronic records) was performed on patients who underwent endoscopic dilation for esophageal anastomotic strictures. Long-term clinical effectiveness, including technical and clinical success, and complication rate were assessed. Factors independently related to recurrence were evaluated. Results Between January 2014 and December 2017, a total of 35 patients who had benign anastomotic strictures after esophagectomy underwent 182 endoscopic dilation procedures. Technical success was 100%. Thirty-two patients (91%) had initial relief of dysphagia. The clinical success, defined as resolution of dysphagia and achieving luminal patency of 13 mm or more, was achieved in 24 patients (69%). Strictures recurred in 43% of patients, and refractory strictures were identified in 10/35 (29%). Proximal anastomosis and the presence of anastomotic foreign bodies were found to be risk factors for refractory strictures. The complication rate was low (4%) and adverse events were mild. No major complications (perforations, severe bleeding) or treatment-related deaths occurred in this series. Conclusions Endoscopic dilation has a high technical and a good clinical success rate. However, anastomotic strictures are often refractory and frequently recur.

Nocardiosis is a rare infectious disease caused by bacteria of the genus nocardia, which causes considerable morbidity and mortality. We report two unusual cases of nocardiosis in young, immunocompetent patients; the first case involved a nocardia farcinica pulmonary and chest-wall infection, while the second was an anterior mediastinal nocardia asiaticum infection mimicking a mediastinal tumor. These cases reflect the need for a broad differential diagnosis during exploration of thoracic findings, white the potentially ambiguous presentation of nocardiosis must be considered.

BACKGROUND:Pediatric empyema necessitates prompt resolution and early hospital discharge with minimal morbidity. However, the most effective treatment approach is not yet established.OBJECTIVES:To assess the efficacy of an intrapleural streptokinase washing protocol as a non-operative treatment for stage II pediatric empyema as compared to operative decortications, by the number of pediatric intensive care unit (PICU) admissions, length of PICU stay, and hospitalization duration.METHODS:We retrospectively evaluated 75 consecutive pediatric empyema cases for the period January 2006 to December 2009. Since July 2007 we have used repeated streptokinase-based pleural washing for stage II patients whose condition did not improve with chest drainageRESULTS:Before July 2007, 17 of 23 stage II empyema patients underwent decortication, compared to only 1 of 21 after July 2007. Non-operated children were admitted to the PICU less frequently than those who were operated (83% vs. 31%, p = 0.0006) and spent less time in the PICU (2.56 +/- 1.92 vs. 1.04 +/- 1.9 days, P= 0.0148); there was no significant statistical difference in overall hospitalization (13.33 +/- 3.69 vs.11.70 +/- 5.74 days, P= 0.301).CONCLUSIONS:Using intrapleural streptokinase washing as a non-operative treatment for stage II pediatric empyema yielded comparable success rates to the operative approach, with less morbidity.

BACKGROUNDEsophageal diseases vary in relation to geographic and behavioral factors. Whether benign or malignant, these diseases interfere with food swallowing. Surgical treatment is variable and aims at restoring the alimentary tract continuity. In this research the authors retrospectively studied esophageal pathologies and their surgical treatment in their department over a 6 year period.PATIENTS AND METHODSThe records of all patients who underwent surgery for esophageal pathology in a single surgical department at a referral center between January 2002 and December 2007 were reviewed. Data that was collected included patient age, gender, type of pathology, staging, type and length of surgery, length of hospital stay, post-operative morbidity and mortality.RESULTSDuring the study period, 186 patients were operated for esophageal pathology, 154 (83%) had malignant disease and 32 (17%) had benign disease. The distribution of malignancy types was: adenocarcinoma 57%, squamous cell carcinoma 27%, signet ring cell carcinoma 8%, and other 8%. Median length of post-operative hospital stay was 27 days. Thirty two percent of the patients experienced complications, including anastomotic leak (10%), respiratory (9.5%) or cardiac (2%) complications, and infection (7.5%), while 3% required re-operation. Postoperative mortality rate in the hospital was 6.5%.CONCLUSIONSThe majority of patients undergoing esophageal surgery suffer malignancy, mainly adenocarcinoma. The surgery is extensive and is followed by a long recovery period, during which the patient is subject to a variety of complications. Mortality rate is significant yet comparable to centers around the world with high volume of esophageal operations.

The minitracheotomy tube is a useful tool in the prevention and management of sputum retention in postoperative and trauma patients. It may also be employed for short-term ventilatory support. The minitracheotomy tube is often inserted in conscious patients without secure airway, so even a minor complication might cause major respiratory deterioration. Thus, the surgical team should be experienced with the procedure and technical steps must be followed with caution. The tube has no cuff and its diameter is small. Therefore, it does not impair speech and cough. It is well tolerated by patients and care by nursing personnel is simple and effective. The minitracheotomy tube is a useful tool in the prevention and management of sputum retention in postoperative and trauma patients. It may also be employed for short-term ventilatory support. The minitracheotomy tube is often inserted in conscious patients without secure airway, so even a minor complication might cause major respiratory deterioration. Thus, the surgical team should be experienced with the procedure and technical steps must be followed with caution. The tube has no cuff and its diameter is small. Therefore, it does not impair speech and cough. It is well tolerated by patients and care by nursing personnel is simple and effective.

BACKGROUND:Video-assisted thoracoscopic surgery (VATS) has gained an increasing importance as a diagnostic and therapeutic tool in chest trauma. Several studies have demonstrated its feasibility and safety, but only a few addressed the long-term benefit of VATS. The aim of this study was to evaluate the short-term and long-term benefits of VATS in chest trauma, with emphasis on the patient's point of view.METHODS:Medical records of patients with chest trauma during a 10-year period were reviewed. The study included 77 patients (37 patients in the VATS group and 40 in the thoracotomy group). Forty-four patients who underwent operative treatment during the study period were excluded from the study. Hospital charts and a telephone questionnaire were used to evaluate the outcome.RESULTS:No deaths occurred in either group. Clotted hemothorax was the most common finding. The incidence of wound and pulmonary complication were higher in the thoracotomy group. Patients in the thoracotomy group needed significantly higher doses of narcotic analgesia. Average time to resume normal activity was shorter in the VATS group. More than 2 years after discharge, the rate of return to a normal lifestyle was 81% in the VATS group and 60% of the thoracotomy group. Patients in the VATS group were generally more satisfied with their health status and surgical scars.CONCLUSIONS:The results of this study show that for stable patients with chest trauma, video assisted thoracic surgery is feasible and safe. Moreover, it is tolerated better than open thoracotomy, has a favorable postoperative course, a superior long-term outcome, and greater patient satisfaction.

BACKGROUND:Patients with primary malignant disease undergoing oncological surveillance, upon completion of their treatment, are a unique population that is gradually growing. Therefore, the number of patients with a pulmonary nodule and a previous malignant disease has increased over recent years. In order to select appropriate management for these patients, a few questions should be answered: Is it a malignant lesion? Secondly, is it primary or metastatic? Is it the only one? In the past, several imaging and invasive diagnostic procedures were used to clarify theses uncertainties. However, in many cases the results were equivocal and it was difficult to establish treatment policy. In recent years PET/CT-FDG was found to be specific, sensitive and accurate in the evaluation and staging of patients with primary malignant disease. In this study we analyzed the accuracy and value of PET/CT-FDG in patients with primary malignant disease and an indeterminate pulmonary nodule.METHODS:Patients with primary malignant disease in the past and undefined pulmonary nodule/s were recruited. Computerized retrospective screening was performed. The specificity, sensitivity, positive and negative predictive value of PET/CT-FDG were calculated. The influence of the PET results on the clinical policy was evaluated.RESULTS:Forty one patients with previous malignant disease entered the study. PET/CT-FDG was positive in 15 cases. In 13 patients (87%) the FDG positive nodule was found to be malignant. In 26 patients the PET/CT was negative. In 19 (73%) diagnosis of non-malignant nodule was confirmed. The positive and negative predictive value of PET/CT-FDG for metastatic disease was 87% and 91% respectively and the accuracy 86%.CONCLUSIONS:The results of the present study demonstrate that PET/CT-FDG is a very valuable tool in the evaluation of patients with previous primary malignant disease and a pulmonary nodule. This imaging technique was able to clarify most of the thoracic surgeon's uncertainties and provided enough data to choose the optimal treatment strategy.

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support.