I ntroduction: Isolated thoracic injuries are relatively common and they are on the second place as a cause of death overall trauma. Most patients with isolated thoracic injuries are treated on an outpatient basis while only serious cases are hospitalized. The basis of the treatment of thoracic trauma is efficient cardiopulmonary reanimation followed by an early detection and treatment of life threatening injuries. Less than 15% of patients with thoracic trauma require thoracotomy. Patients: Only the patients with exclusively isolated thoracic trauma were analyzed. Results: Based on initial diagnostic procedures initial conservative treatment was indicated and sufficient for 63,75% (204/320) cases while initial surgery treatment was necessary in 36,25% (116/320) of the injured. In relation to the type of surgery the thoracic drainage was performed in 81,03% (94/116) while thoracotomy and VATS procedure was necessary for 7,75% (9/116) of the injured. After the secondary examination or shorter monitoring of the status of the injured, the additional diagnostic procedure was suggested and performed in only 5% (16/320) of the injured. The average period of the hospitalization for all injured with isolated thoracic trauma was 5,9±4,0 days (from 6 hours to 16 days). In cases of patients with blunt injuries the average period of hospitalization was 6,07±4,26 days, while for the patients with penetrating trauma it was 5,4±3,36 days. The calculated value of t-student test (0,2766 > 0,05) indicates that there is no statistically significant difference in the period of the hospitalization in relation to the type of trauma (blunt vs. penetrating). The average period of thoracic drainage was 5,58 ±3,3 days (from 3 to 17 days). The average duration of thoracic drainage in the patients with blunt trauma was 5,81±2,67 days, while in the patients with penetrating trauma it was 5,08±1,99 days. The calculated value of the probability of t -test (0,1478 > 0,05) shows that there is no significant difference in the period of drainage in cases of blunt and penetrating trauma. Out of total number of patients, 98,0% (315/320) of the injured were successfully treated. The complications were found in 1,25% (4/320) cases. Death was the outcome in 1,5% (5/320) of injured. Conclusion: Based on the results of the initial diagnostic treatment, in majority of injured with isolated thoracic trauma, it was possible to conduct the relevant and appropriate therapeutic procedures. On the basis of relatively short period of thoracic drainage, hospitalization and low rates of morbidity and mortality, it may be confirmed that the application of initial diagnostic and therapeutic protocols of the Clinic for thoracic surgery resulted in the achievement of the successful treatments in majority of the injured for this type of the trauma.

Background: Video-Assisted Thoracoscopic Surgery (VATS) has recently occupied a significant place in the surgical treatment of primary pleural empyema (PPE). Patients with anamnesis shorter than 4 weeks have a good chance of being cured only by VATS. As it is not easy to define precisely the beginning of the disease, it is difficult to say strictly to which period VATS method will be successful in PPE treatment. Objective: The aim of this study was to determine the efficacy of the VATS method in the surgical treatment of primary pleural empyema. Methods: The study included 50 patients with findings appropriate for PPE over a period of three years, in whom the VATS method was applied in the surgical treatment of pleural empyema. Results: The established total length of treatment was 13.56 ± 7.98 days and the length of hospital treatment after surgery was 9.90 ± 3.315. The duration of thoracic drainage was 8.06 ± 3.005. Treatment was completed by the primary procedure without additional interventions in 94% of patients. Based on the final outcome, all patients from the clinic were discharged as cured Conclusion: The best time to indicate surgical treatment by using VATS method is history of disease in duration of four weeks Debridement or VATS decortication method is safe and efficient surgical procedure, especially in the first two stages. It is recommended to use this method as the first surgical option for patients in early stages of the disease.

Background:Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions.Aim:Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy.Methods:From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed. Studied patients underwent VATS pleurodesis (G1) and standard thoracostomy pleurodesis (G2), with 60 in each group, respecting defined inclusion and exclusion criteria. Pleurodesis success was examined radiologically over the next three months.Results:Average age of all patients was 63.97±8.75 years. Gender related, 45% were men and 55% were women (F/M=1.47:1). Average hospitalization was 7.22±1.37 (G1: 6.68±1.16; G2: 7.44±1.40; Mann-Whitney U-test: p=0.0016) days. Average thoracic drainage duration was 5.45±1.69, (G1: 4.28±1.15,G2: 6.05±1.58; Mann-Whitney U-test p<0.0001) days. Pleurodesis success after first month was 98.30% in G1, 91.60% in G2 (G1 vs. G2; p=0.2089); after second month was 98.30% in G1, 78.30% in G2 (G1 vs. G2; p=0.0011) and after three months was 91.60% in G1, 63.30% in G2(G1 vs. G2; p=0.0006). Average dyspnea degree (0-5) after the pleurodesis was 0.050±0.22 in G1 and 0.62±0.76 in G2 (Mann-Whitney U-test; p=0.0001). Complication were noticed in 9.2% patients, in G1 3.3%, 15.0% in G2.Conclusion:Difference in pleurodesis efficiency between the G1 and G2 was established after second month and was even more evident after third month in favor of G1. Results show the significant statistical improvement of the degree of dyspnea in G1 as opposite to the G2.

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