Therapy of empyema. Retrospective review of 77 patients Background: Empyema can cause significant medical problems, despite the advances in antimicrobial and surgical treatments. Aim: To compare the results of different therapeutic approaches to empyema. Material and Methods: Retrospective review of medical records of 77 patients with empyema (aged 53 ± 20 years, 48 males) treated in a clinical hospital between 1994 and 2007. Results: In 74% of patients the cause of empyema was pneumonia. Thirty two were initially managed with percutaneous pleurostomy. Seven of these required and additional intervention due to residual empyema. Eleven patients were managed with open thoracotomy and 34 with video assisted thoracoscopy. Complications for percutaneous pleurostomy, open thoracotomy and video assisted thoracoscopy were 34, 36 and 12% respectively. The figures for mortality were 25, 0 and 0% respectively. Patients subjected to video assisted thoracoscopy required less days with a pleural tube than those subjected to percutaneous pleurostomy or open thoracotomy (5,5-14,3 and 12,4 days respectively). Conclusions: Video assisted thoracoscopy had the best therapeutic results for empyema in this series of patients.

Lung sclerosing hemangioma is an uncommon tumor that presents as a solitary asymptomatic nodule and that affects middle age women. It derives from type II pneumocytes. We report a 52 years old female with a solitary lung nodule detected in a chest X ray requested for the diagnosis of an acute respiratory disease. The nodule was excised by video thoracoscopy and the frozen section biopsy was informed as a non small cell undifferentiated carcinoma. Therefore an inferior right lobectomy with lymph node resection was performed. The definitive biopsy was informed as a lung sclerosing hemangioma.

Resection of lung metastasesIntroduction: Surgical treatment of lung metastases (LM) is a therapy used for several types of metastatic cancers. However, the type of surgery and its outcome is controversial. Aim: To describe a series of patients with LM undergoing surgical treatment, their results and long-term follow up. Material and Methods: We retrospectively reviewed all the medical records of patients with the diagnosis of LM, of whatever origin, operated at our hospital between the years 2002 and 2008. We analyzed their clinical characteristics, treatment, morbidity, mortality and results. Results: During this period 24 patients with LM were operated. The mean age was 52.8 ± 16.6 years. Most patients had kidney cancer as primary tumour. The usual clinical presentation was multiple bilateral nodules. The surgical approach was in general a video-thoracoscopy (40.9%) associated with a wedge resection of the lesions (81.8%). In 83.4% of cases, there were no post-operative complications. Seventy six percent of the patients relapse, in an average of 16.7 ± 12 months and 68.7% were reoperated for a new resection. The probability of surviving more than 3 and 5 years post metastasectomy was 57% and 36% respectively. Conclusions: In this series the LM were mostly secondary to renal cancer. The video-thoracoscopy is an emergent and safe technique in the treatment of LM, being the main type of surgical approach in our patients. Despite the high percentage of reoperations, the survival rate is comparable to the rest of the published series.

Inhaled foreign body: a video-thoracoscopic resection. A case report We report an 18 years old male who reported a history of 2 years of recurrent episodes of hemoptysis with no other symptoms. A chest X-ray and chest CT scan, showed an image suggestive of a metallic foreign body in the posterior segments of the right lower lobe. Since fibro-bronchoscopy failed to extract it, a video-thoracoscopy with wedge resection of the affected lung parenchyma was performed, finding a capsular lesion of inflammatory tissue which contained a map pin in its interior. The clinical outcome was favorable, with a chest X-ray showing proper lung re-expansion. The patient was discharged 48 hours after surgery.