Rupture of the spleen is a common event associated with trauma, infectious diseases, neoplasia and many systemic disorders affecting the reticuloendothelial system. A rare subtype of rupture occurring spontaneously and arising from a normal spleen was recognized as a distinct clinicopathologic entity. It has been reported in association with trivial insults such as vomiting and coughing. We report a case of a patient with spontaneous rupture of a normal spleen observed after severe coughing on the 3rd postoperative day following bronchoplastic left lung lower lobectomy combined with S4, S5 segmentectomy.

Background Chest ultrasound (US) is well documented as a valuable tool for pleural diseases. US helps to clarify the cause of pleural opacities, estin? ate the volume of pleural effusion an identify minimal or loculated pleural effusion. US characteristics of effusion provide helpful information regarding the nature of the effusion. Pleural diseases, such as pleural fibrosis, tumours and pneumothorax all display display diagnostic US features. Safe thoracentesis and drainage of effusion can be carried out under US guidance with a high success rate. The technique of US, which is safe and cost-effective compared to CT scanning, may be learned relatively easily by the pulmonologist and thoracic or general surgeons. Conclusions US guidance is recommended for every chest tube insertion, especially in the ICU patients. Appropriate US machine should be readily available in every trauma, ICU, pulmonology and thoracic surgery unit.

BACKGROUND Intrapleural application of streptokinase (SK) is an old and somewhat forgotten method oftreatment of complicated pleural effusions. In a selected group of cases, SK can successfullyreplace more aggressive surgical procedures. METHODS A retrospective analysis of all intrapleural SK applications at our department between2004 and 2007 was performed. RESULTS 14 patients met the study inclusion criteria: 7 parapneumonic effusions, 5 residual hemothoracesand 2 loculated malignant effusions.Significant increase of the drained volume with notable radiological and clinical improvementfollowed the applications of 500,000 IU of SK in all patients and 9 patients (64 %)were spared the painful thoracotomy. CONCLUSIONS Our data supports the evidence on high efficiency of the intrapleural fibrinolysis with SK ina selected population of complicated pleural effusions

BACKGROUND Tracheostomy is one of the most commonly performed procedures in ICU patients. Fourdifferent techniques of percutaneous tracheostomy (PT): Ciaglia Blue Rhino, Griggs GuideWire Dilating Forceps, PercuTwistTM and Translaryngeal Tracheostomy are now considered an excellent alternative to the surgical tracheostomy (ST). The most commonly citedadvantages of the PT are the ease of the technique, the ability to perform the procedure atthe bedside and consequently lowered costs. CONCLUSIONS Regardless of the PT technique, there is a learning curve and meticulous attention to technique and education is necessary to maintain the excellent safety record of PT – comparable to ST

Background Fine-needle aspiration biopsy can very reliably discriminate between benign and mali- gnant thyroid tumors. The role of additional intraoperative frozen section to guide intra- operative management was questioned.

Background: Hamartomas are the most common benign neoplasms of the lung. The population incidence is 2.5/1000. In most cases the diagnosis is based on computed tomography (CT) and fine needle aspiration biopsy (FNAB). In this report we reviewed cases of pulmonary hamartoma seen at Golnik Hospital and studied the diagnostic and therapeutic procedures used in each case.Methods: 35 cases diagnosed as pulmonary hamartoma at Golnik Hospital in the last eight years were studied. We reviewed medical records of 30 patients who were hospitalized. We also reviewed the cytologic smears of 31 patients.Results: There were 21 females and 14 males, the average age was 60.5 years, the average size of hamartoma was 21.7 mm. For diagnosing hamartoma we used CT and FNAB in 16 (45.7 %) patients, only FNAB in 15 (42.9 %) and only CT in 4 (11.4 %) patients. Cytologic smears of all 31patients contained chondroid substance or mature cartilage, fibromyxoid material was present in 29 (93.5 %), adipose cells or tissue in 24 (77.4 %) and cuboidal cells in 28 (90.3 %) specimens. Over this period 6 (17.1 %) patients underwent surgery, the definitive histologic diagnosis in all cases was hamartoma.Conclusions: In some cases of pulmonary hamartoma the definitive diagnosis can be made only by CT without invasive diagnostic procedures. Many times CT does not yield a definitive diagnosis and in these cases we recommend transthoracic FNAB.

Background. The aim of the study was to identify perioperative morbidity and mortality, the category and mode of adjuvant treatment, local recurrence and survival in patients treated by extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM). Methods. From 2000 to 2003, 18 patients with MPM were referred to the Department of Thoracic Surgery in Ljubljana, and 17 of them were operated on. Two patients underwent explorative thoracotomy, and 15 patients were evaluated. Five female and nine male patients (aged 52-68 years) were treated by EPP and one male patient by pleurectomy. Eight patients received both adjuvant chemotherapy (ChT) and radiotherapy (RT), with cisplatin 100 mg/m2 + mitomycin C 6-10 mg/m2 or gemcitabine 1000 mg/m2 and external beam radiation with 24 Gy - 58 Gy respectively, three patients received no adjuvant therapy, three patients were treated by adjuvant ChT, two of them were given cisplatin 100 mg/m2 + mitomycin C 6-10 mg/m2, and one patient cisplatin 100 mg/m2 on the first day and gemcitabine 250 mg/m2 in prolonged 6 hours infusion on the first and on the eighth day. One patient was treated only by adjuvant RT. Results. There were no perioperative deaths and the postoperative morbidity was 42%. Of the 15 evaluable patients, and in the median follow up of 40 months (28-64), we noticed nine (60.0%) recurrences, seven local and two abdominal. Eight (53.3%) patients died, all because of the local progress of disease. Of the 3/15 patients without adjuvant treatment, one patient (T1bN0M0) is well 46 months after the operation, one patient (T2N0M0) got recurrence in abdomen, was treated with ChT and reoperation, and is still alive 31 month after the first surgical treatment. One patient (T2N0M0) died two months after the surgery due to local recurrence. In ChT+RT group, 6/8 patients died: the patient at stage T1aN0M0 died after nine months, the patient at stage T1bN0M0 died after nine months, two patients at the stage T2N0M0 died after four and 23 months respectively, the patient at stage T3N0M0 after 11 months, and the patients at stage T3N2M0 died seven months after the operation. Two out of eight patients are alive: the patient at stage T1bN0M0 is alive 43 months, and the patient at stage T2N0M0 is alive 28 months after the operation. In the ChT group, 1/3 patient (T2N0M0) died 6 months after the operation, 2/3 patients (T2N0M0 and T3N0M0) are well after 43 and 20 months respectively. The patient treated with adjuvant RT only is well 50 months after the surgical treatment. The median survival time was 20 months for the whole group of patients operated on, the 1-year survival rate was 53.3% and 2-year survival rate was 46.7%. Conclusions. In selected patients with MPM, complete surgical resection is indicated, followed by chemotherapy and radiotherapy. The operation could be performed safely with acceptable mortality and morbidity. Our group of patients is too small, the adjuvant therapies were too different to favour any of the treatment mode applied. Further randomised studies and standardised protocols are needed to evaluate the best mode of treatment for each patient.

In a retrospective study we analysed our experience with palliative intubation of the esophagus in nonresectable carcinoma. During the 20-year period from 1969 to 1988, 159 palliative intubations were performed on 156 patients. Nine patients presented with malignant esophagobronchial fistulas. In all patients the Hdring pull-through prosthesis was inserted by an upper laparatomy and gastrotomy. The operative complication rate was 40%. Pneumonia, dehiscence of the laparatomy, perforation of the esophagus or stomach and cardiorespiratory failure were the most common complications. In 47% of patients the laparotomy wound healed with suppuration. The hospital mortality of the whole series was 30%. The most common causes of postoperative death were cardiorespiratory failure, perforation of the esophagus or stomach and pneumonia. The quality of life of the surviving patients was as follows: 97% could eat minced and/or liquid food, but 59% of them vomited occasionally or frequently, 50% had signs of occasional aspirations and 71 % had pain. The mean survival was 3.2 months. The palliative esophageal intubation saves the patient from death by starvation and improves the quality of the rest of his life, but does not prolong the survival. Because of the significant postoperative morbidity and mortality a strict selection of patients is mandatory.

Izvleček Izhodišča Traheostomija je eden najpogostejših posegov pri kritično bolnih. Štiri različne tehnike perkutane traheostomije (PT): metoda z dilatatorji po Ciaglii (Ciaglia Blue Rhino, CBR), metoda s kleščami po Griggsu (Griggs Guide Wire Dilating Forceps, GWDF), metoda z vijakom (PercuTwistTM) in translaringealna traheostomija (TLT) so odlična zamenjava za kirurško traheostomijo (KT). PT je hitra, enostavna, zlahka izvedljiva kar na bolnikovi postelji in morda tudi cenejša. V izkušenih rokah ima enako ali celo manj zapletov od KT. Zaključki PT je postala metoda izbire, ki bo v prihodnosti najbrž v večini primerov zamenjala odpr- to traheostomijo. Ker imajo vse tehnike PT tudi svojo učno krivuljo in ker so zapleti najbolj odvisni od izkušenj, bomo morali temu ustrezno prilagoditi tudi izobraževanje. Ključne besede Ciaglia; Griggs; PercuTwist; translaringealna traheostomija; bronhoskopija Abstract Background Tracheostomy is one of the most commonly performed procedures in ICU patients. Four different techniques of percutaneous tracheostomy (PT): Ciaglia Blue Rhino, Griggs Guide Wire Dilating Forceps, PercuTwistTM and Translaryngeal Tracheostomy are now conside- red an excellent alternative to the surgical tracheostomy (ST). The most commonly cited advantages of the PT are the ease of the technique, the ability to perform the procedure at the bedside and consequently lowered costs. Conclusions Regardless of the PT technique, there is a learning curve and meticulous attention to tech- nique and education is necessary to maintain the excellent safety record of PT - compar- able to ST.