Here, we describe two cases of lung metastasis of adamantinoma of long bones, a low-grade bone neoplasm that rarely metastasizes. In both cases, the clinical presentation of the metastases was characterized by spontaneous pneumothorax secondary to tumor cavitation, a phenomenon described in only three of the studies reviewed in the literature. Clinical, radiological, and anatomopathological findings, as well as the procedures adopted in the two cases, are described.

Keywords: Adamantinoma; Pneumothorax; Neoplasm metastasis; Medical records.

The aim of this study was to analyze the results of 17 patients with myasthenia gravis who, from 1985 to 1994, were submitted to thymectomy at the Medical School of Santa Casa de São Paulo. Nine patients (52.9%) were female and the mean age was approximately 30.3 years. The most usual symptoms were ptoses, weakness, and diplopia. Other symptoms included: dyspnea, dysphonia, thoracic pain and loss of weight. The average development period of the disease was 17.5 months (between 3 and 96 months). The diagnostic methods use were chest X-ray, response to edrophonium chloride (Tensilon), electrophysiologic study and thoracic CT. All patients were submitted to thymectomy through medium sternotomy. Patients were followed up from one month to ten years. Only one patient did not return to the clinic. Twelve patients (75%) achieved good results. The others four patients presented little or no response after thymectomy.

Keywords: Thymectomy. Myasthenia gravis.

Ten surgeries have been performed on 8 patients for the relief of symptoms due to bullous disease. Closed intubation drainage of the bullae was used in all patients under local anesthesia. The technique, initially devised by Monaldi for the treatment of intrapulmonary tuberculous abscesses was modified. Symptomatic improvement and total collapse of the bullae was reported by 9 of the 10 procedures. The technique described provides a simple method for decompressing bullae by means of a minimally invasive surgical procedure. It has proved a suitable approach for all but those with the poorest lung function and is now the author's treatment of choice. Techniques using intracavitary intubation have potential advantages: no lung tissue is removed, in addition, the limited incision and a local anesthesia needed for the procedure are better tolerated by patients with poor lung function.

Keywords: pulmonary emphysema; drainage; lung surgery

We present a protocol to test a new surgical procedure for the treatment of patients with diffuse lung emphysema who, after having received the golden standard treatment (pulmonary rehabilitation), continue to present respiratory failure with disabling dyspnea. Ten patients with severe lung hyperinflation will be evaluated. The method proposed is designed to create alternative expiratory passages for air trapped in the emphysematous lung by draining the lung parenchyma, thereby establishing communication between the alveoli and the external environment. The ten patients selected will be required to meet the inclusion criteria and to give written informed consent. Those ten patients will be included in the study pending the approval of the Ethics in Research Committee of the São Paulo Santa Casa School of Medicine, São Paulo, Brazil. The protocol we will employ in order to evaluate the proposed procedure is feasible and will show whether debilitated patients suffering from diffuse pulmonary emphysema can benefit from this procedure, which could represent an alternative to lung transplant or lung volume reduction surgery, the only options currently available.

Keywords: Pulmonary emphysema; Pulmonary disease, chronic obstructive; Lung, hyperlucent.

Objective: To report the results obtained in three patients with diffuse pulmonary emphysema during the pre- and post-operative periods following a new surgical technique: collateral ventilation with lung parenchyma drainage. Methods: Patients suffering from pulmonary failure and disabling dyspnea, despite having received the gold standard treatment, including pulmonary rehabilitation, were selected for the evaluation of pulmonary drainage. During the pre- and post-operative periods, patients were submitted to plethysmography and six-minute walk tests, as well as completing the following quality of life questionnaires: Medical Outcomes Study 36-item Short-Form Health Survey, Saint George's Respiratory Questionnaire, Eastern Cooperative Oncology Group Performance Status and Medical Research Council Scale. In all three cases, the post-operative follow-up period was at least 300 days. The tests were performed at the following time points: during the pre-operative period; between post-operative days 30 and 40; and on post-operative day 300. Data were analyzed using profile plots of the means. Results: When the results obtained in the pre-operative period were compared to those obtained at the two post-operative time points evaluated, improvements were observed in all parameters studied. Conclusions: The results suggest that the surgical technique proposed for the treatment of patients suffering from severe diffuse emphysema successfully reduces the debilitating symptoms of these patients, improving their quality of life considerably.

Keywords: Pulmonary emphysema; Lung diseases, obstructive; Lung, hyperlucent.

Here, we report the case of a patient with a slowly-progressing anterior mediastinal teratoma submitted to surgical resection. The anatomopathological examination of the sample revealed malignant degeneration to carcinoid tumor. Such evolution is very rare, and we have found only three related studies in the literature. We describe the clinicopathological features of the tumor and discuss the treatment administered. The evolution was satisfactory, and the patient was submitted to oncological treatment.

Keywords: Mediastinal neoplasms; Teratoma; Carcinoid tumor; Mediastinum/surgery.

Here, we describe the case of a 51-year-old female with mediastinal liposarcoma. Liposarcoma is the most common malignant mesenchymal neoplasm in adults, although a mediastinal location is extremely rare. It has a large volume and varied histologic subtypes. It is characterized by the compression of neighboring structures. Computed tomography and magnetic resonance imaging provide useful data for diagnosis. Tissue biopsy and histological typing are very important in determining the treatment and are needed for the final diagnosis. Radiotherapy and chemotherapy are ineffective treatment modalities. According to the literature, surgical resection is the treatment of choice. Long-term follow-up evaluation is indicated since there is a high rate of recurrence.

Keywords: Liposarcoma; Mediastinal neoplasms; Case reports [publication type].

Objetivo: Descrever a técnica operatória da drenagem pulmonar através do estudo anatômico em cadáveres, determinar se o local definido para a drenagem pulmonar é adequado e seguro, e determinar a relação anatômica do tubo de drenagem com a parede torácica, pulmões, grandes vasos e mediastino. Métodos: Foram dissecados 30 cadáveres de ambos os sexos, fornecidos pelo Necrotério do Hospital Central da Santa Casa de São Paulo, em São Paulo (SP) no período entre maio e novembro de 2011. Foi inserido um dreno de aço de 7,5 cm com 24 F de diâmetro no segundo espaço intercostal, na linha médio-clavicular, bilateralmente, e foi medida a distância do dreno com as seguintes estruturas: brônquios principais, brônquios dos lobos superiores, vasos subclávios, artérias pulmonares, artérias pulmonares do lobo superior, veia pulmonar superior, veia ázigos e aorta. Foram realizadas medições de peso, altura, diâmetro laterolateral do tórax, diâmetro posteroanterior do tórax e espessura da parede torácica de cada cadáver. Resultados: Dos 30 cadáveres dissecados, 20 e 10 eram do sexo masculino e feminino, respectivamente. A média da extremidade distal do dreno com os brônquios principais direito e esquerdo foi de 7,2 cm. Conclusões: A utilização de um dreno torácico de tamanho fixo na posição preconizada é factível e segura, independentemente das características antropométricas do paciente.

Keywords: Enfisema; Procedimentos cirúrgicos operatórios; Cirurgia torácica; Cadáver.

Case report of a 49-year-old man, presenting chest pain and bloody sputum for six months. Chest X-ray and computed tomography scan showed opacification on the left upper lobe. The bronchoscopy showed bronchial hemorrhage in the lingular bronchial segment. Due to diagnostic and therapeutic needs, this patient underwent a left inframammilary thoracotomy. The anatomopathological analysis of the surgical sample revealed an intrapulmonary teratoma. The patient presented favorable evolution and is now under outpatient follow-up treatment.

Keywords: Teratoma; Lung; Neoplasms.

Tumors of the anterior mediastinum include several entities with different radiological and clinical manifestations, constituting a heterogeneous group of congenital, inflammatory, and neoplastic conditions. Among these lesions, the most common primary tumor of the mediastinum is thymoma, nearly followed by germ cell tumors and lymphomas. Tuberculosis of the thymus, an extremely rare condition, typically involves the mediastinal lymph nodes. We present, in this study, pathological, radiological, and clinical findings of one case of tuberculosis of the thymus in an 18-year-old patient who presented thoracic pain, dyspnea upon minimal effort, and progressive worsening of the symptoms in one week. The chest X-ray showed a large mass in the mediastinum, and computed tomography scans indicated that it was located anteriorly. The patient was submitted to surgery in order to excise the mass. Microscopy revealed a massive inflammatory response and granulomas in the thymic tissue. Ziehl-Neelsen staining for acid-fast bacilli yielded positive results, and a diagnosis of tuberculosis was made. Surgeons and pathologists should remain alert for this condition and should include it in the differential diagnosis of mediastinal masses.

Keywords: Thymus; Tuberculosis; Thoracic surgery; Pathology.