[Pneumotorax and cannabis]. / Pneumotorace e cannabis.

AIM: After having read the articles by Treasure and Beshay about the particular incidence of spontaneous pneumothorax (SP) in patients with daily consumption of Cannabis the authors took a strictly control of these subjects reviewing their personal experience in the treatment of this condition. In particular, the prevalence of SP has been evaluated through genomic assay of monocorial twins. The strong impact of the inflammatory phenomena that have always supported the emphysema burning is 10 time higher among worldwide population and patients with SP. METHODS: In order to determine the real incidence of spontaneous pneumothorax in patients with proved daily assumption of Cannabis a retrospective analysis of patients with history of Cannabis drug abuse has been performed. In the period from January 2002 and June 2007,12 consecutive patients with SP and history of Cannabis abuse were enrolled. Selection criteria were: 1) age <16 years; 2) single-sided spontaneous pneumothorax; 3) history of daily Cannabis assumption. Patients with previous thoracic surgery/trauma and positive anamnesis for other drug assumption (ODA), snorkelling or work exposition to pollutions were excluded. In order to avoid the clinical overlapping of pathology and clinical symptoms due to other factors, patients with pleural effusion and documented similar episodes were excluded. This series focused on particular on twins. In all the patients an endopleuric drainage tube was inserted, and 3 patients underwent toracostomy. RESULTS: No operatory mortality and/or complications were observed. CONCLUSIONS: The role of the thoracic surgeon is important to sensitize on the problem of the circulation of light drugs among young people and their effects on the lung activity.

Chronic transverse sternal fracture. Role of CT scan and repair by an alternative use of the Synthes-Titanium Sternal Fixation System.

Chest wall fractures, including injuries of the sternum, usually heal spontaneously without specific treatment. However sometimes, they need surgical treatment. To treat these patients the selection criteria often are subjective in spite of many surgical devices for sternal osteosynthesis are available nowadays. One of the most recent device is the Synthes-Titanium Sternal Fixing System, usually used to treat post-sternotomy dehiscence. We describe the case of a 67-year-old man with previous history of chest trauma presenting to our institution with chronic transverse sternal fracture. We describe the pre-operative study, stressing the particular role of the CT scan and a surgical approach by an alternative use of the Synthes.

Misunderstood cardiac involvement with heart impairment in traumatic sternal fracture: an enzyme-guided evaluation.

BACKGROUND: Isolated sternal fractures occur more and more frequently in traffic road accidents in particular after the introduction of the seat-belt law. This study sets out to assess by laboratory parameters the incidence and consequences of pericardial and myocardial involvement in sternal injury. PATIENTS AND METHODS: Between June 1997 and March 2007, 50 consecutive patients were admitted to our Thoracic Surgical Unit with acute traumatic sternal fractures. X-ray, CT scan, standard 12-lead electrocardiogram (ECG) and echocardiographic evaluation were obtained in all patients. (28 males, 22 females), with displaced and undisplaced fractures. The patients were hospitalised for cardiorespiratory monitoring, pain control and physiotherapy. Oxygen implementation was performed to obtain an arterial saturation above 96%. Supplementary investigations or therapeutic interventions were assessed if clinically indicated. RESULTS: Our data, according to literature, show that sternal trauma must be careful evaluated by monitoring of vital parameters. In our collection we have no mortality with complex comorbidity. The interparametric relation between laboratory values and cardiac involvement was not significant anyway . The prolonged CK-MB peak level in a large number of patients is related with cardiac impairment. CONCLUSIONS: Our results suggest that in traumatic sternal fractures enzymatic activity of CK-MB, echocardiographic investigation and careful monitoring for the first 96 hours are necessary. The cardiac compliance is inadequate in polytrauma patients and can lead to cardiac impairment.

["Intentionally" limited pulmonary resection versus lobectomy for the treatment of peripheral stage IA non-small cell lung cancers]. / Resezioni polmonari limitate "intenzionali" versus lobectomie nel trattamento dei tumori polmonari periferici non microcitomi allo stadio IA.

BACKGROUND: The purpose of this study is to assess, through the retrospective analysis of our experience and the literature review, whether the limited pulmonary resection is comparable to lobectomy for treatment of the peripheral stage IA (T1N0M0) non-small cell lung cancers (NSCLC), in terms of oncologic radicality, survival and rate of local, regional and systemic recurrences. Moreover it has been considered the impact of the limited resections in comparison with the lobar resections on the postoperative pulmonary function. PATIENTS AND METHODS: We have analyzed a consecutive series of 36 patients, 28 men and 8 women, of inclusive age among the 61 to 81 years (average 73 years), who underwent surgical resection from January 2000 to December 2003 for T1N0M0 peripheral NSCLC; 11 limited resections and 25 lobectomies have been performed. Comparatively survival and recurrences (follow-up period of 3-5 years) are been analyzed, as well as the pulmonary function tests at 1 year after surgery. RESULTS: The 3-year and 5-year survivals were 88% and 82% in the patient's group underwent to limited resection , 93% and 88% in the patient's group underwent to lobectomy. Postoperative local recurrence was noted in 1 patient (9%) of the first group and in 1 patient (4%) of the second group. One year after surgery was noted a moderate decline in the forced expiratory volume in 1 second (FEV1) and in the diffusing capacity for carbon monoxide (DLCO) in the patients who underwent to lobar resection, whereas in the patient's group submitted to limited resection was observed a substantial maintenance, except for the DLCO, of the preoperative pulmonary function tests. CONCLUSIONS: Our limited experience, according to the actual tendencies of the literature, show that the limited pulmonary resections, in selected patients with peripheral stage IA NSCLC, represents a valid alternative to lobectomy in terms of survival and recurrence's rate, also determining a lower decrement of the postoperative pulmonary function. Therefore the segmentectomy can be considered, in such cases, the gold-standard procedure even if the patient is able to bear a wider resection.