RESUMO
An association between climatic conditions and asthma incidence has been widely assumed. However, it is unclear whether climatic variations have a fingerprint on asthma dynamics over long time intervals. The aim of this study is to detect a possible correlation of the Summer North Atlantic Oscillation (S-NAO) index and the self-calibrated palmer drought severity index (scPDSI) with asthma incidence over the period from 1957 to 2006 in Italy. To this aim, an analysis of non-stationary and non-linear signals was performed on the time series of the Italian databases on respiratory health (ISAYA and GEIRD) including 36,255 individuals overall, S-NAO, and scPDSI indices to search for characteristic periodicities. The ISAYA (Italian Study on Asthma in Young Adults) and GEIRD (Gene Environment Interactions in Respiratory Diseases) studies collected information on respiratory health in general population samples, born between 1925 and 1989 and aged 20-84 years at the time of the interview, from 13 Italian centres. We found that annual asthma total incidence shared the same periodicity throughout the 1957-2006 time interval. Asthma incidence turned out to be correlated with the dynamics of the scPDSI, modulated by the S-NAO, sharing the same averaged 6 year-periodicity. Since climate patterns appear to influence asthma incidence, future studies aimed at elucidating the complex relationships between climate and asthma incidence are warranted.
Assuntos
Asma , Mudança Climática , Feminino , Adulto Jovem , Humanos , Incidência , Asma/epidemiologia , Estações do Ano , Itália/epidemiologiaRESUMO
The current Covid-19 pandemic poses an unprecedented global challenge in the field of education and training. As we have seen, the lack of proper information about the virus and its transmission has forced the general population and healthcare workers to rapidly acquire knowledge and learn new practices. Clearly, a well-informed population is more likely to adopt the correct precautionary measures, thus reducing the transmission of the infection; likewise, properly educated healthcare workers are better equipped to manage the emergency. However, the need to maintain physical distancing has made it impossible to provide in-presence information and training. In this regard, new technologies have proved to be an invaluable resource by facilitating distance learning. Indeed, e-learning offers significant advantages because it does not require the physical presence of learners and teachers. This innovative method applied to serious games has been considered potentially effective in enabling rapid and large-scale dissemination of information and learning through content interactivity. We will review studies that have observed the development and use of serious games to foster information and practices about Covid-19 aimed at promoting behavioral changes in the population and the healthcare personnel involved on the front line.
RESUMO
There is a pathophysiological and clinical link between atherosclerosis and skeletal fragility. Abdominal aortic calcifications (AACs) can be considered as a marker of coexistent atherosclerotic disease and osteoporosis. Indeed, AACs have been associated with alterations in bone strength and severe AACs predicted vertebral fractures in post-menopausal women and older men, independent of densitometric diagnosis of osteoporosis. Although quantitative computed tomography is the gold standard for evaluation of AACs, dual-energy x-ray absorptiometry can be considered as a cost-effective tool to identify and quantify AACs in clinical practice. This article provides an update on diagnostic aspects and clinical relevance of AACs as predictor of fractures in patients at high cardiovascular risk.
Assuntos
Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Osteoporose/diagnóstico , Calcificação Vascular/diagnóstico por imagem , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Osso e Ossos/diagnóstico por imagem , Compostos de Boro , Feminino , Humanos , Masculino , Metacrilatos , Metilmetacrilatos , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
PURPOSE: Vertebral fractures (VFs) were described in elderly patients with heart failure (HF) whereas their prevalence and determinants in younger HF patients are still unknown. This study aimed at assessing whether secondary hyperparathyroidism (SHPT) may influence the risk of VFs in middle-aged patients with HF. METHODS: 84 patients (44 males, median age 48.5 years, range 43-65) with HF were prospectively evaluated at the baseline and after 36-month follow-up for bone mineral density (BMD) and VFs by quantitative morphometry on chest X-rays. Serum PTH, calcium, 25-hydroxyvitamin D and 24-h-urinary calcium were evaluated at the baseline and every 6-12 months during the study period. RESULTS: At baseline, SHPT, hypovitaminosis D and VFs were found in 43 patients (51.2%), 73 patients (86.9%) and 29 patients (34.5%), respectively. SHPT was associated with VFs at baseline [inverse probability-weighted (ipw) odds ratio (OR) 12.2, p < 0.001]. Patients were treated with vitamin D3 alone (56%), vitamin D3 plus calcium carbonate (21.4%), calcitriol alone (4.8%), bisphosphonates plus vitamin D3 (8.3%) or a combination of bisphosphonates, vitamin D3 and calcium carbonate (9.5%). At the end of follow-up, hypovitaminosis D was corrected in all patients, whereas 19/84 patients (22.6%) had persistent SHPT. During the follow-up, 16 patients developed incident VFs which resulted to be associated with baseline SHPT (ipw OR 55.7, p < 0.001), even after adjusting from BMD change from baseline to follow-up (ipw OR 46.4, p < 0.001). CONCLUSIONS: This study provides a first evidence that SHPT may be a risk factor for VFs in middle-aged patients with HF.
Assuntos
Insuficiência Cardíaca/epidemiologia , Hiperparatireoidismo Secundário/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Vértebras Torácicas/lesões , Adulto , Fatores Etários , Idade de Início , Idoso , Densidade Óssea , Feminino , Insuficiência Cardíaca/complicações , Humanos , Hiperparatireoidismo Secundário/complicações , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/etiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVES: The effect of intranasal corticosteroids and oral antihistamines on acoustic rhinometry parameters has not been directly compared. The primary objective was to compare the effect of a 21-day course of treatment with nasal beclomethasone dipropionate (nBDP) with that of cetirizine (CTZ) on nasal patency measured using acoustic rhinometry in children with perennial allergic rhinitis (PAR). The secondary objective was to compare the effect of both drugs on nasal cytology, symptom severity, sleep quality, and quality of life. METHODS: In this 21-day, open-label, randomized controlled study, 34 children with PAR (age 6-14 years) with a Total 5-Symptom Score (T5SS) ≥5 received nBDP 100 µg per nostril twice daily or CTZ 10 mg tablets once daily. The measures of effect were the least square mean change (LSmc) in nasal volume, minimal cross-sectional area (MCA), and nasal cytology, as well as the scores on the T5SS, Pittsburgh Sleep Quality Index (PSQI), and Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ). RESULTS: After 21 days, nBDP improved nasal volume and MCA more than CTZ (LSmc, 2.21 cm3 vs 0.20 cm3 [P=.013]; and LSmc 0.63 cm2 vs 0.13 cm2 [P=.002], respectively). Compared with the CTZ group, a more marked improvement was found in the nBDP group with respect to eosinophil classes (LSmc, -1.10 vs -0.40; P=.031) and neutrophil classes (LSmc, -0.97 vs -0.17; P=.010), T5SS (LSmc, -5.63 vs -3.54; P=.008), PSQI (LSmc, -1.30 vs -0.19; P=.025), and PRQLQ total scores (LSmc, -1.15 vs -0.69; P=.031). CONCLUSIONS: In children with PAR, nBDP is more effective than CTZ in improving nasal patency measured by acoustic rhinometry, with associated beneficial effects on nasal cytology, symptoms, sleep quality, and quality of life.
Assuntos
Anti-Inflamatórios/uso terapêutico , Beclometasona/uso terapêutico , Cetirizina/uso terapêutico , Rinite Alérgica Perene/tratamento farmacológico , Administração Intranasal/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Qualidade de Vida , Rinometria Acústica/métodos , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND PURPOSE: Only a few studies have considered the role of comorbidities in the prognosis of amyotrophic lateral sclerosis (ALS) and have provided conflicting results. METHODS: Our multicentre, retrospective study included patients diagnosed from 1 January 2009 to 31 December 2013 in 13 referral centres for ALS located in 10 Italian regions. Neurologists at these centres collected a detailed phenotypic profile and follow-up data until death in an electronic database. Comorbidities at diagnosis were recorded by main categories and single medical diagnosis, with the aim of investigating their role in ALS prognosis. RESULTS: A total of 2354 incident cases were collected, with a median survival time from onset to death/tracheostomy of 43 months. According to univariate analysis, together with well-known clinical prognostic factors (age at onset, diagnostic delay, site of onset, phenotype, Revised El Escorial Criteria and body mass index at diagnosis), the presence of dementia, hypertension, heart disease, chronic obstructive pulmonary disease, haematological and psychiatric diseases was associated with worse survival. In multivariate analysis, age at onset, diagnostic delay, phenotypes, body mass index at diagnosis, Revised El Escorial Criteria, dementia, hypertension, heart diseases (atrial fibrillation and heart failure) and haematological diseases (disorders of thrombosis and haemostasis) were independent prognostic factors of survival in ALS. CONCLUSIONS: Our large, multicentre study demonstrated that, together with the known clinical factors that are known to be prognostic for ALS survival, hypertension and heart diseases (i.e. atrial fibrillation and heart failure) as well as haematological diseases are independently associated with a shorter survival. Our findings suggest some mechanisms that are possibly involved in disease progression, giving new interesting clues that may be of value for clinical practice and ALS comorbidity management.
Assuntos
Esclerose Lateral Amiotrófica/diagnóstico , Esclerose Lateral Amiotrófica/epidemiologia , Doenças Cardiovasculares/epidemiologia , Idoso , Índice de Massa Corporal , Comorbidade , Diagnóstico Tardio , Progressão da Doença , Feminino , Humanos , Incidência , Itália , Masculino , Pessoa de Meia-Idade , Fenótipo , Prognóstico , Estudos RetrospectivosRESUMO
Smoking still represents a huge public health problem. Millions of children suffer the detrimental effects of passive smoking. An increasing number of countries have recently issued laws to regulate smoking in public places. Instead, homes remain a site where children are dangerously exposed to environmental tobacco smoke (ETS). The combination of tobacco smoke pollutants which remain in an indoor environment, the so-called 'third-hand smoke' (THS), represent a new concept in the field of tobacco control. THS consists of pollutants that remain on surfaces and in dust after tobacco has been smoked, are re-emitted into the gas-phase, or react with other compounds in the environment to form secondary pollutants. Indoor surfaces can represent a hidden reservoir of THS constituents that could be re-emitted long after the cessation of active smoking. Human exposure to THS pollutants has not yet been thoroughly studied. Infants and children are more prone to the risks related to THS exposure than adults because they typically spend more time indoors and have age-specific behaviours that may expose them to potential health hazards from THS. Further investigations are warranted to study the health effects of THS relevant to different exposure pathways and profiles. It would also be very important to evaluate how THS may affect the lung development through the in utero exposure during the pre-natal life. We aimed at reviewing recent findings published about THS, with special reference to the effects on children's health.
Assuntos
Substâncias Perigosas/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Criança , HumanosRESUMO
BACKGROUND: Expected benefits of gluten-free diet (GFD) in coeliac patients include healing of small intestinal mucosa, but it remains unclear to what extent this benefit is achieved in adults. AIM: To assess factors affecting histological outcome of GFD in a large cohort of adult coeliac patients. METHODS: We extracted information on 465 consecutive coeliac patients studied before and during GFD. RESULTS: Duodenal biopsies at diagnosis were classified as Marsh I in 11, II in 25 and III in 429 cases. After a median 16 months GFD, 38 (8%) patients had histological 'normalization', 300 (65%) had 'remission' with persistent intraepithelial lymphocytosis, 121(26%) had 'no change' and 6 (1%) had 'deterioration'. Coeliac disease related serology was negative in 83% of patients with Marsh III lesion during GFD. Male gender and adherence to GFD were independently associated with histological 'normalization' and 'remission'. Persistence of intraepithelial lymphocytosis was not associated with human lymphocyte antigen gene dose or with Helicobacter pylori infection. CONCLUSIONS: Complete normalization of duodenal lesions is exceptionally rare in adult coeliac patients despite adherence to GFD, symptoms disappearance and negative CD related serology. Control biopsies are mandatory to identify lack of response to gluten-free diet.
Assuntos
Doença Celíaca/dietoterapia , Dieta Livre de Glúten/métodos , Duodeno/patologia , Glutens/administração & dosagem , Mucosa Intestinal/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença Celíaca/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estatística como Assunto , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Obesity in Prader-Willi Syndrome (PWS) is progressive, severe, and resistant to dietary, pharmacological, and behavioral treatment. A body weight reduction is mandatory to reduce the risk of cardio-respiratory and metabolic complications. The aim of the study was to assess risks and benefits of BioEnterics Intragastric Balloon (BIB) for treatment of morbid obesity in PWS patients. METHODS: Twenty-one BIB were positioned in 12 PWS patients (4 M, 8 F), aged from 8.1 to 30.1 years, and removed after 8 +/- 1.4 months (range: 5-10 months). Auxological, clinical, and nutritional evaluations were performed every 2 months. Variations in body composition were analysed by dual energy X-ray absorbiometry (DXA). RESULTS: One patient (28.5 years, BMI: 59.3 kg/m(2)) died 22 days after BIB positioning because of gastric perforation. In another case (26.2 years, BMI: 57.6 kg/m(2)), BIB was surgically removed after 25 days because of symptoms suggesting gastric perforation (not confirmed). The remaining ten patients showed a significant decrease of BMI (p = 0.005) and of fat tissue as measured by DXA (p = 0.012). No significant modifications in bone mineral density (BMD) occurred, but a slight loss in lean body mass (p = 0.036) was documented. In five patients, BIB treatment was repeated more than once. CONCLUSION: This study shows that when noninvasive pharmacological therapies fail, BIB may be effective to control body weight in PWS patients with morbid obesity, particularly when treatment is started in early childhood. However, careful clinical follow-up and close collaboration with parents are crucial to avoid severe complications, which can be caused by persisting unrestrained food intake.
Assuntos
Balão Gástrico , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/terapia , Síndrome de Prader-Willi/epidemiologia , Adolescente , Adulto , Criança , Comorbidade , Endoscopia Gastrointestinal , Feminino , Balão Gástrico/efeitos adversos , Humanos , Masculino , Cuidados Pós-Operatórios , Implantação de Prótese/métodos , Medição de Risco , Redução de Peso , Adulto JovemRESUMO
THE AIM OF THE WORK.: The mandibular canal, if it is affected by different illnesses, often shows typical radiological changes, made up of widespread hypodensity, an increase in its diameter and disappearing walls. This study aims to verify the reliability of such radiological signs in the cases of later post-operative lesions of the mandiblular canal. MATERIALS AND METHOD.: The study includes 16 patients, 9 males and 7 females, with an average age of 54 years, who underwent an operation to rehabilitate the mandible with a prosthetic implant for a total of 37 implants. All the subjects underwent an Orthopantograph due to the appearance of painful radicular symptoms some time after the operation. RESULTS.: In 36 cases out of 37 we found, with the Orthopantograph, a slight increase in the calibre of the mandibular canal compared to the controlateral. In 10 subjects we observed hypodensity of the canal itself, while in 6 subjects the canal passages were no longer recognisable. CONCLUSION.: The radiological indications of damage of the inferior alveolar nerve (IAN) are reliable even in the case of indirect post-implant lesions.
RESUMO
Several NMR protocols are presented for assigning peaks in complex T1-T2 spectra, including the effects of varying the spectrometer frequency and the CPMG pulsing rate. Extensions into a third dimension based on chemical-shift; diffusion- and field-cycled weighted T1-T2 cross-correlation methods are also explored as a means of peak assignment. We illustrate the power of these novel techniques with reference to simple aqueous sucrose solutions, but the methodology should be generally applicable.
Assuntos
Espectroscopia de Ressonância Magnética/métodos , Sacarose/química , Algoritmos , Método de Monte Carlo , Processamento de Sinais Assistido por Computador , SoluçõesRESUMO
ST-elevation myocardial infarction is due to the occlusion of a coronary artery, mainly due to a rupture of an atherosclerotic plaque with superimposed thrombosis. The main therapeutic goal is to restore the blood flow within the culprit artery as quickly as possible. In this review we discussed the several approaches which have been employed to reach this target. Primary percutaneous coronary intervention (PCI) is considered the best treatment option, as it is associated to lower in-hospital mortality, reduced risk of reinfarction and stroke, lower rate of intracranial bleeding and ventricular rupture from myocardial hemorrhage compared with fibrinolytic therapy. Also, it is superior to facilitated PCI, i.e. immediate planned PCI after i.v. thrombolytic therapy administration, because of lower mortality, reinfarction rate, strokes and bleedings. Rescue PCI after failed thrombolysis was associated with a reduction of early severe heart failure and improved survival at 1 year, in patients with moderate to large infarctions, compared to conservative medical therapy, in a pooled analysis of 9 randomized trials, carried out in the balloon era. Also in the stent era, a meta-analysis of 5 randomized trials found a significant 36% reduction in the risk of 30-day mortality, a trend to lower risk of heart failure, although a marginally increased risk of thromboembolic stroke, in the rescue PCI arm. However, rescue PCI is not associated with a better long-term clinical outcome. Laser thrombectomy before PCI could be a useful additional strategy which might be compared to standard stenting in future randomized studies.
Assuntos
Angioplastia Coronária com Balão/métodos , Angioplastia com Balão a Laser/métodos , Infarto do Miocárdio/terapia , Doença Aguda , Fibrinolíticos/uso terapêutico , Humanos , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/cirurgia , Stents , Resultado do TratamentoRESUMO
A secondary malignant pleural effusion is a common event in the evolution of some tumours. It is frequent in advanced phase, above all the breast cancer in the woman and the cancer of the lung in the man, but such pathology can interest also extra-thoracic cancers (ovary, colon, prostate, etc.) and the malignant lymphoma. In the majority of cases in order to obtain a good control of the effusion entity with reduction of the respiratory symptoms and improvement of the quality of life, palliative local therapy is indispensable. Numerous methods and substances have been proposed in the time for the treatment of the N.P.E. The talc pleurodesis executed in the old patients (> 70 years) by means of the V.A.T.S. "one trough" and "Monitored Anaesthesia Care" (MAC) has shown valid procedure for the control of the secondary neoplastic pleural effusion, with little uneasiness for the patients, reduced complications and a sure effectiveness.
Assuntos
Anestesia/métodos , Derrame Pleural Maligno/terapia , Pleurodese/métodos , Talco/administração & dosagem , Cirurgia Torácica Vídeoassistida , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Monitorização Intraoperatória , Estudos RetrospectivosRESUMO
The third-harmonic generation of a pump wave, resulting from the electron-ion collision frequency dependence on the electric field in the skin layer of a hot dense plasma is investigated. The relation of the current third harmonic with the high-frequency field in the skin layer is established for arbitrary ratios of the electron-ion collision frequency to the field frequency. For arbitrary ratios of these two frequencies, the field structure inside the skin layer is determined, and the field of the wave irradiated by the plasma at tripled frequency, too, is calculated. It has permitted us to find the explicit dependencies of the third-harmonic generation efficiency on the plasma and pump field parameters.
RESUMO
Broncho-oesophageal fistulae are rare lesions and may be benign or malignant. The articles in medical literature generally concern one case of BEF, and rarely more cases. The term "benign" is debatable, considering the severity of this disease in view of the aetiology and the bronchopulmonary complications. The aetiology in the past was connected to tuberculosis or toxoplasmosis, now to bacterial, viral or fungal infections. The Authors report three acquired cases and one congenital. They confirm the importance of anamnesis, symptomatology and oesophagography for diagnosis and CT scan for detection of pulmonary lesions. The treatment is surgical with resection of fistula and suture of the oesophagus and bronchus, interposing pleura or pericardium or intercostal muscle.
Assuntos
Fístula Brônquica/cirurgia , Fístula Esofágica/cirurgia , Fístula Brônquica/congênito , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Neoplasias Brônquicas/complicações , Cisto Broncogênico/complicações , Carcinoma de Células Escamosas/complicações , Criança , Fístula Esofágica/congênito , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Estenose Esofágica/complicações , Esôfago/lesões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/complicações , Ferimentos Penetrantes/complicações , Divertículo de Zenker/complicaçõesRESUMO
The formation of a highly anisotropic photoelectron velocity distribution as a result of the interaction of a powerful ultrashort laser pulse with a thin foil is found to yield a large skin-layer depth and an anomalous increase of the transmission coefficient. The physical reason for the effect is the influence of the incident wave magnetic field, through the Lorenz force, on the electron kinetics in the skin layer.
RESUMO
BACKGROUND: Incidence and risk factors for delirium during clozapine treatment require further clarification. METHODS: We used computerized pharmacy records to identify all adult psychiatric inpatients treated with clozapine (1995-96), reviewed their medical records to score incidence and severity of delirium, and tested associations with potential risk factors. RESULTS: Subjects (n = 139) were 72 women and 67 men, aged 40.8 +/- 12.1 years, hospitalized for 24.9 +/- 23.3 days, and given clozapine, gradually increased to an average daily dose of 282 +/- 203 mg (3.45 +/- 2.45 mg/kg) for 18.9 +/- 16.4 days. Delirium was diagnosed in 14 (10.1 % incidence, or 1.48 cases/person-years of exposure); 71.4 % of cases were moderate or severe. Associated factors were co-treatment with other centrally antimuscarinic agents, poor clinical outcome, older age, and longer hospitalization (by 17.5 days, increasing cost); sex, diagnosis or medical co-morbidity, and daily clozapine dose, which fell with age, were unrelated. CONCLUSIONS: Delirium was found in 10 % of clozapine-treated inpatients, particularly in older patients exposed to other central anticholinergics. Delirium was inconsistently recognized clinically in milder cases and was associated with increased length-of-stay and higher costs, and inferior clinical outcome.
Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Delírio/induzido quimicamente , Adulto , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Análise Multivariada , Transtornos Psicóticos/tratamento farmacológico , Estudos RetrospectivosRESUMO
We describe the linear stage of Weibel instability in a plasma heated via inverse bremsstrahlung absorption of a high-frequency, moderate intensity radiation field under conditions in which the plasma electron velocity distribution function is weakly anisotropic. We report on the possibility of a significant amplification of spontaneous magnetic fields both in the case of an electron distribution function slightly departing from a Maxwellian in the region of subthermal velocities, and in the case where the Langdon nonequilibrium distribution is formed. We show that the direct influence of collisions on the Weibel instability growth rate may be traced back to subthermal electrons, for which the effective collision frequency is large.
RESUMO
OBJECTIVE: To retrospectively assess the results of surgical treatment in a consecutive series of 110 patients with Stage IIb and IIIa non small cell lung cancer (NSCLC) invading chest wall. METHODS: A series of 110 patients underwent surgery for Stage IIb and IIIa NSCLC with involvement of chest wall. There were 101 male and 9 female patients, mean age was 61.4 (range 32--74), 52 (47.3%) of them complaining for chest pain. Surgical procedures were pneumonectomy in seven patients (6.4%), lobectomy in 73 (66.4%), bi-lobectomy in six (5.4%) and wedge resection in 24 (21.8%). In 63 patients (57.3%) an extrapleural resection was performed while in the other 47 (42.7%) an 'en bloc' resection of tumor with chest wall was required. In 22 patients (76.3%) repair was achieved by muscle flap while in 8 (26.7%) a prosthesis was required. Five-year survival was computed using the Kaplan--Meier method; P values correspond to the log-rank test. RESULTS: There were neither intraoperative nor postoperative deaths. Postoperative staging revealed 83 T3N0M0, 17 T3N1M0 and 10 T3N2M0. Mean postoperative hospital stay was 17.7 days (range 5--40). For N0 patients 5 year survival was 47% (39/83) and no significant difference was noted when extrapleural and 'en bloc' resection groups were compared (P = 0.08). In N1/N2 patients no survival was observed (0/27) and comparison between surgical procedures was not statistically significant (P = 0.41). Moreover when N0 patients were compared with N1 patients the difference in survival was significant for both extrapleural (P = 0.02) and 'en bloc' (P = 0.04) groups. No difference was noted when the two surgical procedures were compared independently form N status (P = 0.94). Within the group of patients undergone 'en bloc' resection survival was significantly better for N0 patients as in the group of extrapleural resection. CONCLUSION: Surgical treatment of Stage IIb and IIIa NSCLC invading chest wall by extrapleural or 'en bloc' resection is widely adopted and justified by the good results in terms of morbidity and relief of pain. Survival is always depending on the N status.