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AbstractBackgroundThis study examined the effect of metastatic mediastinal lymph node involvement on the prognosis of patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy (EPP) or extended pleurectomy (E/P) and also to assess the effect of metastatic mediastinal lymph node involvement on the prognosis of patients with MPM in these group of patients.MethodsThis retrospective study included 84 patients with MPM (66 men [78.6%] and 18 women [21.4%]) who underwent EPP (n = 44) or E/P (n = 40) at our institution between January 2001 and July 2019. Survival analyses were performed according to histopathology, nodal status, and surgical approach.ResultsIn the EPP group, patients with T2-N2 status had a significantly better mean survival (17 ± 2.1 months) than patients with T3-N2 (7.3 ± 1.6 months) or T4-N2 (3.2 ± 1.1 months) status (p = .001). In the E/P group, patients with T2-N2 status had a mean survival of 18 ± 1.1 months, while patients with T3-N2 and T4-N2 status had mean survival durations of 6.6 ± 1.6 and 4.8 ± 1.2 months, respectively (p = .159). In both treatment groups, the survival rates of patients with epithelial tumors were better than those of patients with non-epithelial tumors, independent of N status. None of the patients with N2 disease survived until 5 years postoperatively.ConclusionIn summary, our results suggested that mediastinal lymph node metastasis negatively influenced the prognosis of patients with T3 MPM, regardless of treatment by EPP or E/P. Under these circumstances, preoperative cervical mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration may be considered for patients with high-stage MPM who are scheduled for surgery with curative intent. In our study, N2 status was spotted as a significant factor affecting survival, nevertheless its significance in survival of pleural mesothelioma patients should be analyzed in multi-centered studies.

Purpose Diaphragmatic rupture following trauma is often an associated and missed injury. This report documents our experience of treating traumatic diaphragmatic rupture (TDR). Methods We retrospectively analyzed 18 patients who presented between 1993 and 2000 with TDR, caused by blunt injuries in 14 and by penetrating injuries in 4. Results The average age of the patients was 32 years and the female to male ratio was 4?:?14. The TDR was right-sided in 5 patients and left-sided in 13. The diagnosis was made by chest X-ray, thorax and upper abdominal computed tomography, and upper gastrointestinal contrast studies. The most common herniated organs were the omentum ( n = 11), stomach ( n = 10), spleen and colon ( n = 9), and liver ( n = 2). Sixteen diaphragmatic injuries were repaired primarily, and two were repaired using a prolene mesh graft. The mortality rate was 5.5% ( n = 1). Conclusions A high index of suspicion and early surgical treatment determine the successful management of TDR, with or without the herniation of abdominal organs. The surgical approach to TDR is individualized. Acute left-sided injuries are best approached through the abdomen, although we prefer the chest approach, adding laparotomy when necessary. Acute right-sided injuries and chronic injuries should be approached through the chest.

We report the case of a 47-year-old woman who presented with the unique asymptomatic malformation of an extralobar pulmonary sequestration communicating with a bronchogenic cyst. Despite computed tomography and magnetic resonance imaging of the chest, the diagnosis could not be established before a left thoracotomy was performed. The sequestrated lobe and bronchogenic cyst were then successfully resected.

Many reports have been published describing different vascular lesions after lumbar disc surgery but the actual incidence is probably higher than has been published. Lesions of vascular structures (aorta, iliac arteries, and veins) close to the spine can arise as a consequence of the removal of disc fragments.In emergency cases, general surgeons are usually called upon to deal with these in the absence of more qualified vascular surgeons. But for an elective case, an experienced vascular surgeon's knowledge of the pathogenesis and ap propriate management of these lesions is mandatory for the proper care of the patients. Herein, 3 additional cases of late vascular complications of lumbar disc surgery, their diagnostic features, and correct treatments are presented.

Development of a fistula between the main renal vessels after nephrectomy has heretofore been a rare occurrence, but its increasing frequency would seem to result from increased interest in detection of this fistula. The authors present a rare case of arteriovenous fistula following partial nephrectomy. Renal hyper tension following nephrectomy, also quite rare, developed in this case.

An unusual case of pulmonary foreign body is reported. The foreign body, Kirschner wire, was used for clavicular fixation. It was found free in the middle part of mediastinum one and a half years after fixation in a control chest roent genogram. We discussed by which tract such a rigid substance had arrived in the pulmonary artery. We also reviewed the diagnostic techniques and surgical difficulties in removing foreign bodies from the pulmonary circulation.

A rare case of brachial pseudoaneurysm at puncture site in a patient with Behçet's disease is presented. The aneurysm developed at the level of the brach ial artery following an erroneous venipuncture. Aneurysmectomy and en doaneurysmorrhaphy were performed successfully. This kind of complication should always be kept in mind, and care must be taken during all invasive procedures in patients with Behçet'sdisease.