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A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether adjuvant antifungal therapy is useful after pulmonary surgery for aspergilloma. One hundred and sixteen papers were identified using the search described below, of which 5 papers presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. No paper was greater than level-three evidence. One study compared the outcomes of 72 patients treated for pulmonary aspergilloma (PA) during a 23-year period. Despite no difference being found in outcomes, more complications were seen in the surgery-alone group. Another study included 14 patients treated with amphotericin B alone or with flucytocine. They found no benefit in the treatment of PA by systemic antifungal therapy. One retrospective study reported complete eradication of PA in patients treated with preoperative and postoperative oral itraconazole. One large cohort study reported their outcomes in 256 patients with PA, divided into two groups: Group A (simple aspergilloma, n = 96) and Group B (complex aspergilloma, n = 160) after aggressive surgical treatment and antifungal therapy. They found no difference in the postoperative morbidity between two groups (P = 0.27). A postoperative fungal relapse was found in 2 patients. One retrospective study reported the outcomes and mortality in 61 cases with PA. Thirty-five (60%) patients were treated with antifungal agents, and 15 (25%) patients were treated surgically. Many cases did not respond to antifungal therapy. Nineteen (31%) patients died. We did not find evidence to support the role of adjuvant antifungal therapy following definitive surgical removal of the fungus ball in immunocompetent patients; however, randomized control studies in multiple centres, with new antifungal therapy, are necessary to confirm these preliminary results., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

We report the case of a 77 year old man treated with a distal pancreatectomy for rectal metastatic cancer. Diagnosis was made based on increased CEA levels following excision of the rectal tumor discovered during treatment follow up of liver and pulmonary metastases. Eight months after pancreatectomy the patient was asymptomatic and CEA levels were normal. Pancreatic resection for metastatic colonic adenocarcinoma of the pancreas may be considered in selected patients without extrapancreatic disease. Long-term survival or good palliation may be achieved after surgery.

We report here a case of acute fever with pleuropericarditis and high levels of Coxiella burnetti antibodies (phase II), excluding other possible etiologies. Complete recovery occurred with the use of non-steroidal anti-inflammatory agents combined with tetracycline.

The diagnosis and technical aspects of revascularization are discussed in a series of 14 consecutive cases of intestinal arterial insufficiency. The typical clinical presentation of post-prandial pain and weight loss was found in 12 out of 14 cases. Gastroenterological investigations demonstrated associated lesions in 8 cases, including 5 cases of gastroduodenal ulcer disease where this was initially considered responsible for the symptomatology. No case of malabsorption was noted. Angiography demonstrated involvement of the three splanchnic vessels in 7 cases, two vessels in 6 cases and one vessel only in the remaining case. The revascularization techniques were as follows: reimplantation of the superior mesenteric (n = 1), bypass from the sub-renal aorta (n = 5), or a sub-renal aortic graft (n = 2) or supra-coeliac aorta (n = 6). Control angiography demonstrated permeability in 9 out of 10 cases where this examination was carried out. The early results included one post operative mortality. From a nutritional and functional point of view they were three failures and ten good results. Overall, follow up and survival ranged from 6 months to 9 years. In five cases death was due to secondary causes. Abdominal angina occurs in a population at high vascular risk. In view of this etiology the diagnosis should be considered at an early stage and this also explains the secondary mortality. Gastroduodenal ulcerative lesions may occur as part of the clinical presentation. The angiographic data confirmed the Mikkelsen rule, however the functional effects of stenosis could be better evaluated by pulsed echo-doppler.(ABSTRACT TRUNCATED AT 250 WORDS)

Fifty cases of epidermoid carcinoma of the thoracic oesophagus were examined by computed tomography (CT). The tumor was located in the lower third of the oesophagus in 15 cases, in the middle third in 24 cases and in the upper third in 11 cases. More than two-thirds of these patients underwent complete surgical exploration. CT provided valuable information on the size of the tumor, its extension to the mediastinum and the presence of distal metastases, but lymph node involvement often remained undetected. Nevertheless, the resectability of the lesions could be predicted in a fairly large number of cases. A new CT classification based on the TNM system is suggested. According to the criteria used, this new system significantly improves staging, with results that are close to the pTNM classification of the American Joint Committee on cancer.

Seventy-two cases of diffuse pulmonary contusion, 50 of which concerned multiple injury patients, are retrospectively described. The pleuro-parietal and associated lesions, the clinical, radiological and laboratory findings and the extent of the damage are analyzed. Treatment of shock (50 cases), mechanical ventilation (51 cases), thoracotomy (7 cases) and surgery of associated lesions are studied. Morbidity and mortality (34.7%) are detailed. The nosology of pulmonary contusion is discussed in relation to several factors, including shock, perfusions and associated lesions. The principles of treatment are restated. The most important complication is pulmonary superinfection. Diffuse pulmonary contusion is a serious condition. Associated lesions and their treatment contribute to its outcome.