Background: We planned to investigate the effect of preoperative short period intensive physical therapy on lung functions, gas-exchange, and capacity of diffusion, and ventilation-perfusion distribution of patients with non-small cell lung cancer. Methods: Sixty patients with lung cancer, who were deemed operable, were randomly allocated into two groups. Intensive physical therapy was performed in patients in the study group before operation. Both groups received routine physical therapy after operation. Results: There was no difference in pulmonary function tests between the two groups. Intensive physical therapy statistically significantly increased peripheral blood oxygen saturation. At least one complication was noted in 5 patients (16.7%) in the control group, and 2 (6.7%), in the study group. However, there was no statistically significant difference (p = 0,4). The hospital stay has been found to be statistically significantly shortened by intensive physical therapy (p <0.001). Ventilation-perfusion distribution was found to be significantly effected by intensive physical therapy. The change was prominent in the the contralateral lung (p <0.001). Conclusions: Intensive physical therapy appeared to increase oxygen saturation, reduce hospital stay, and change the ventilation/perfusion distribution. It had a significant, positive effect on the exercise capacity of patients.

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare condition, mainly seen in patients with underlying lung disease. Up to now, there are 65 patients who have been published. Twelve consecutive patients who presented with SBSP as definitive diagnosis were recruited for this study. They represented 1 % of all patients with spontaneous pneumothorax. All patients had immediate bilateral chest tubes on admission. Five of the 12 patients (42%) had no underlying lung disease. In 7 patients, SBSP was secondary to pulmonary metastases, histiocytosis X, undefined interstitial pulmonary disease, tuberculosis, pneumonia and chronic obstructive pulmonary disease. None of the patients died during hospitalization. Eleven patients were treated with chemical pleurodesis, whereas thoracotomy and pleurectomy were necessary in 7 patients. Reexpansion of the lungs was achieved in all patients. Immediate bilateral chest tube insertion and pleurodesis are of major importance in the treatment of SBSP although a subset of patients needed surgical pleurectomy. Combination of these treatments provides successful and uneventful treatment of the disease.

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.

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Construction of cTNM stage remains a crude evaluation, preoperative mediastinoscopy in every patient must be performed. Preoperative limited T4 disease is not to deny surgery to patients since a considerable number of patients with cT4 are to be understaged following surgery.