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Blunt traumatic rupture of the diaphragm is a well known but uncommon event of thoracoabdominal traumatic injuries. It occurs in 1-5% of polytrauma patients and requires a high degree of suspicion for a rapid diagnosis. The frequency of delayed diagnosis is difficult to be estimated and up to 30% of blunt diaphragmatic ruptures present late. A case of herniated splenic colic flexure through a defect in the left hemidiaphragm and the subsequent development of colon cancer in this area are presented. We emphasize the importance of making a prompt diagnosis in order to avoid further morbidity and mortality in this rare clinical entity.

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Mediastinal exploration is a common procedure used for the diagnosis of the thoracic diseases and the staging of lung cancer. A retrospective review was performed to assess sensitivity, specificity, accuracy and morbidity of video-assisted cervical mediastinoscopy (VACM). From 1999 to 2006 a total of 139 VACMs were performed in 138 patients. Eighty-seven patients were evaluated for known or suspected lung cancer (CN2 or CT scan)--group 1. Fifty-one patients underwent VACM for the evaluation of adenopathies or masses having no indication of lung cancer--group 2. In group 1, the diagnosis of lymph node (LN) involvement was certified in 55 patients--sensitivity 80.8%. The remaining 27 patients (28.7%) were negative and underwent thoracotomy. In group 2, we obtained a definitive diagnosis in 57 patients--sensitivity 93.6%. In the negative patients the definitive histological diagnosis was obtained by means of thoracotomy or other procedure. The more frequent pathologies were lymphomas in 15 patients, sarcoidosis in 13 and reactive lymphadenitis in 14 patients. The mean operative time was 41.7 min. Mean number of sampled nodal stations was 1.9. There were two patients with complications (1.4%). The mortality rate was 0%.

Bronchopleural fistula after pneumonectomy is a life-threatening complication which is associated with the surgical technique and the experience of the surgeon. We evaluated the incidence of bronchopleural fistula using the posterior membranous flap technique, as originally described by G. Jack in 1965. The surgical technique of bronchial closure proximal to the carina is described and discussed. From 1999 to 2005, 45 consecutive patients underwent pneumonectomy in our hospital using the posterior membranous flap technique for bronchial closure. Twenty-nine patients (64.5%) underwent left pneumonectomy and 16 patients (35.5%) right pneumonectomy. Patients were operated on for non-small cell lung cancer (41 patients - 89%), small cell lung cancer (one patient - 2.2%), mixed and other types of cancer (two patients - 4.4%), and non-neoplastic etiology (one patient - 2.2%). In the follow up of the patients no bronchopleural fistula was identified after pneumonectomy, right or left. Thirty-day mortality was 6.6% (three patients), all because of cardiorespiratory insufficiency. Using the posterior membranous flap technique, we eliminated the two major factors of the occurrence of BPF: (a) the tension in the suture line; and (b) the remaining stump from the resected bronchus. This bronchial closure technique offers a safe method of prevention of bronchopleural fistula.