Re-expansion pulmonary edema is a potentially life-threatening situation following thoracic surgery of a compromised lung. We report the case of a 24-year-old female scheduled for a resection of a large intrathoracic desmoid tumor that presented with re-expansion pulmonary edema at the conclusion of her surgery and discuss the clinical presentation, mechanism and predictors of this entity and review similar cases reported in the literature.

Introduction: Catamenial pneumothorax (CP) is defined as spontaneous pneumothorax occurring within 72 hours before or after the onset of menstruation. Its etiology is not well understood, and its management remains controversial. Methods: A retrospective review was carried out in all female patients with spontaneous pneumothorax who were treated at our department, the last 20 years. Result: Five patients were suffered of CP. The median age was 27.4 (21-33). The side of the pneumothorax was right in four patients and bilateral in one. None of them were diagnosed with endometriosis. Four were treated surgically, while the last one was managed conservatively. Small fenestrations on the central tendon of the diaphragm was found in one patient. The mean hospital stay was 6.2 days. The follow-up examination did not confirm any recurrence. Conclusion: In this study, we investigated the clinical features of CP. A menstrual history and its temporal relation to a pneumothorax should be assessed on every woman presenting with recurrent pneumothorax. Surgical treatment must be selected as definitive for CP and must be combined with hormone therapy, as it prevents recurrence.

Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental- odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our Department during the period of general lockdown in Greece, between March 2020 and June 2020, because of the Covid19. Patients and Methods: During the period of general lockdown in Greece, 4 patients, mean age 46, 25 years (range 39-59), with DNM treated to our Department of General Thoracic Surgery. Primary odontogenic abscess occurred to 2 patients and peritonsillar abscess to other 2 of them. Diagnosis was confirmed by computed tomography (CT) of the neck and chest. All patients underwent surgical drainage of abscesses of the involved cervical region and mediastinum by lateral cervicotomy and left thoracotomy in three of them and cervicotomy, and bilateral thoracotomy in one patient. Results: The delay between the occurrence of thoracic symptoms and mediastinal drainage varied from 1 to 3 days. The side of the thoracotomy depended on the involved mediastinal compartments and side of pleural effusion. The duration of mediastinal drainage varied from 12 to 20 days (mean: 17 days). One patient died of multiorgan failure related to post-op septic shock. Conclusion: Between January 2000 and January 2020, 21 patients with DNM were treated at our Department, whilst during the four - month of lockdown, four patients were treated. We concluded that the patients delay for dentistry recourse because of covid-19, result in the increased number of patients with DNM in the above period. Delayed diagnosis and inadequate drainage are the main causes of the high mortality rate of DNM. If one realistically hopes to avoid the high mortality rate, aggressive surgical drainage and debridement of the neck and drainage of the mediastinum via a posterolateral thoracotomy by a multidisciplinary team of surgeons is a must.

Background and Objectives: The aim of this retrospective study was to assess brachial plexus decompression throughout the sequential stages of the Roos procedure and to elucidate the role of first rib resection in the surgical management of Thoracic Outlet Syndrome (T.O.S). Materials and Methods: A total of 34 patients with a mean age of 34.6 years were included in this retrospective analysis. All patients underwent transaxillary first rib resection following anterior scalenotomy, consistent with the Roos procedure. Intraoperative brachial plexus functionality was assessed using recording electrodes for sensory and motor stimulation on the deltoid, biceps, triceps brachii, and abductor digiti minimi muscles. Mixed linear models with log-transformed data were used to assess changes in muscle measurements across surgical stages, with statistical significance at p less than 0.05. Results: The electromyographic values of the deltoid, biceps brachii, triceps brachii, and abductor digiti minimi muscles were significantly higher in the final post-operative neutral position compared to both the post-anterior scalenotomy and initial preoperative neutral positions. No significant differences were observed between the initial preoperative neutral position and the post-anterior scalenotomy values for these muscles. However, the abductor digiti minimi muscle exhibited a trend toward decreased values following anterior scalenotomy in comparison to the initial neutral position. Conclusions: Intraoperative outcomes of brachial plexus decompression during the Roos procedure demonstrate that first rib resection contributes to complete decompression of the relevant anatomical structures in Thoracic Outlet Syndrome.

Background and Objectives: This study aimed to evaluate postoperative outcomes following transaxillary first rib resection with concomitant anterior scalenotomy (Roos procedure) for Thoracic Outlet Syndrome, using an ambispective design with a standardized two-year multimodal follow-up in a prospectively observed subgroup. Materials and Methods: This ambispective observational cohort study included 32 patients (87.5% women; mean age, 33.8 years) who underwent transaxillary first rib resection with anterior scalenotomy for Thoracic Outlet Syndrome. Of these, seven patients comprised the retrospective cohort, having undergone surgery between 2017 and 2019, while the remaining 25 patients were enrolled prospectively and underwent surgery from 2020 onwards. Patients were classified as having neurogenic, vascular (arterial or venous), or mixed Thoracic Outlet Syndrome. Retrospective data were obtained from medical records, while prospectively treated patients were followed according to a predefined postoperative protocol. Longitudinal changes in clinical outcomes were analyzed using mixed linear and logistic regression models. Results: All analyzed symptoms improved after surgery (p < 0.05), with a significant reduction in upper limb edema over time (OR = 0.44, p = 0.002). The prevalence of positive provocative tests decreased notably across all maneuvers postoperatively. Pathological color duplex ultrasound findings of the upper limb vessels resolved almost completely during follow-up. Patient-reported outcome measures (CBSQ, DASH, and BPI) demonstrated meaningful postoperative improvement with sustained benefits over time. Electrophysiological evaluation revealed notable improvement in median sensory and motor nerve conduction parameters. Conclusions: Transaxillary first rib resection with anterior scalenotomy appears to improve clinical, functional, and objective outcomes in patients with Thoracic Outlet Syndrome; however, findings should be interpreted with caution due to the ambispective design, small sample size, and cohort heterogeneity, and require confirmation in larger prospective studies.