Thoracoscopic localization techniques for patients with solitary pulmonary nodule: radioguided surgery versus hookwire localization.

AIM: The aim of this study is to compare 2 different methods for localization of peripheral pulmonary lesions requiring thoracoscopic resection: radioguided surgery (still considered an innovative method) and computed tomography-guided hookwire localization. METHODS: Thirty randomized patients (21 males and 9 females), ranging from 21-74 years, average age 56.3 years) with solitary pulmonary nodule (SPN) were enrolled in this prospective study. Inclusion criteria was: a maximum nodule diameter of less than 3 cm and a maximum distance from the visceral pleura of 3 cm. The patients were subdivided into 2 equal groups and one of the 2 different methods for diagnosing SPN was applied. Group A received a thoracoscopy using the scinti-probe technique and group B received a thoracoscopy aided by a hooked needle. RESULTS: The frozen section revealed a primitive pulmonary tumor in 13 cases, intestinal adenocarcinoma metastasis in 3 cases and renal cancer metastasis in 1 case. The remaining 13 cases were pathologically benign: sarcoidosis in 6 cases, hamartochondroma in 3 cases, scleroanthracosis in 2 cases and tuberculoma in 2 cases. CONCLUSION: On the basis of our experience, the conclusion is drawn that this methods has been proven efficacious in the diagnosis of SPN, and video-assisted thoracoscopy allows for the removal of pulmonary nodules without complications.

[Surgical staging of pulmonary carcinoma. Probability of error]. / Stadiazione chirurgica del carcinoma polmonare. Probabilità di errore.

234 patients with lung cancer and operated in Thoracic and Cardiovascular Surgery Department of Careggi Hospital in Florence have been evaluated in order to examine surgical staging accuracy in comparison with pathological staging. There is a statistically significative difference between surgical and pathological staging as a datum point. Surgeon is inclined to over-estimate the lymph-nodes involvement and the primitive tumor extension. It is important to bear in mind this bent whenever decisions of surgical strategy have to be taken.

[Features and evolution of postoperative pain in patients undergoing thoracotomy]. / Caratteristiche ed evoluzione del dolore postoperatorio in pazienti sottoposti a toracotomia.

We examined in this perspective study 30 patients (15 males and 15 females) who undergone classic thoracotomy for lung or mediastinal diseases, without postoperative complications. Intensity and different qualitative components of postoperative pain have been evaluated in the 1st, 3rd, 5th, the day after last pleural drainage removal and 2 months after the operation. All patients answered a schedule adherent to Questionario Italiano del Dolore (QUID). Pain became less intense chiefly with drainage removal with the same time trend for both sex (parallel curves). Pain is probably stronger in women. From a qualitative point of view, the sensorial component is the same in both sexes. Affective and evaluative component is greater in women: in other words, women realize more than men the painful stimulus and are more troubled. A computerized analysis of answers to a questionnaire like QUID or, better, its evolution, may be helpful for a more effective pharmacological choice between pure analgesics, sedative analgesics and ataractic drugs.

["N2" carcinoma of the lung. Therapeutic considerations]. / Carcinoma del polmone "N2". Considerazioni terapeutiche.

The follow-up of 240 N2 lung cancer cases operated in Thoracic and Cardiovascular Surgery Department of Florence is examined. The analysis is performed in compliance with global survival, "T", histology, therapeutic choices. Global survival is 81% after 6 months, 60% after 1 year, 37% after 2 years, 26% after 3 years, 23% after 4 years, 23% after 5 years. Significative difference on survival does not exist between principal histologic types (squamous, adenocarcinoma, adenosquamous). Raising the "T" survival decreases, but only for adenocarcinoma. Different therapeutic options (only surgery, surgery+radiotherapy, surgery+chemotherapy, surgery+radio and chemotherapy) do not influence the survival in a way statistically significative. From the literature, any certainty about radiotherapy and chemotherapy associated to surgery for N2 lung cancer treatment does not exist at the moment. Thus radical surgery is essential.

[Iontophoresis of tenoxicam in the therapy of osteoarthrosis]. / Ionoforesi con tenoxicam nella terapia dell'osteoartrosi.

After a brief physiopathological research about iontophoresis applications, the authors examine this treatment by two drugs (Tenoxicam and acetylsalicylic acid) in a group of patients suffering from painful osteoarthritis. They came to the conclusion that the treatment is efficacious with both substances though realising a quicker analgesic result in the group treated with tenoxicam.

Broncho-alveolar lavage in lung transplantation.

Broncho-alveolar lavage was performed on normal and transplanted lungs of dogs that had received unilateral autografts or allografts without immuno-suppression. Differential cell counts were performed on the lavage fluid. Allografts showed a progressive rise in the proportion of neutrophils from the operated lung compared to the unoperated lung. Rejection in the operated lung was subsequently confirmed histologically. Autografted lungs showed no differences in differential cell counts from the unoperated side. Differential cell counts on broncho-alveolar lavage specimens may be useful as an indication of lung allograft rejection.