Biomedical subjects
Publications and source records attributed to S Altobelli.
Videothoracoscopy can be used for diagnostic purposes when the other non-invasive methods are not satisfactory for an accurate histological diagnosis in lung and pleural pathology. The role of VTS was confirmed in the cases, observed from 1993 and surgically treated, which are herein discussed.
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Pneumonectomy for benign disease of the lung is a rather infrequent intervention. A retrospective study based on 1900 pulmonary resections performed in our institute up to 1998, identified a total of 15 patients submitted to pneumonectomy for non-neoplastic disease. Indications were chronic infections in 11 cases, congenital malformations in 2 cases, left primary bronchial stenosis caused by closed thoracic trauma one in case and gunshot wound in one case. Access to the lung was obtained in all cases by a classic postero-lateral thoracotomy: intra-pericardial ligature was required in five cases and in one patient an extrapleural pneumonectomy was performed. The intra-operative mortality was 20% and the average time of hospitalization 27 days. One patient, operated for pulmonary tuberculosis, developed a broncopleural fistula requiring a second operation. In conclusion, the use of pneumonectomy for non-neoplastic diseases presents serious problems and may be associated with major complications.
Despite various treatment options, empyema thoracis remains associated with important morbility and mortality. Diffused or loculated empyema developed through exudative, purulent and organized phases. Clinically, these phases corresponding to the evolution of the disease: acute and chronic one. The treatment of empyema thoracis is also correlated with the general condition of the patient and even if the drainage is satisfactory in the exudative form, these surgical procedure may be not curative in the purulent and chronic phase. In these cases empyemectomy and pleural decortication are treatment of choice. Recently, Video Assisted Thoracic Surgery has assumed greater importance in the management of this pathology. In our Department of General and Thoracic Surgery, on 178 patients with chronic empyema thoracis, 26 were underwent VATS. During the follow-up there was no mortality or recurrence of empyema. The results indicate VATS because of higher efficacy, shorter hospital stay and less cost, is the primary surgical treatment of chronic empyema thoracis.