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1.
J Cardiothorac Vasc Anesth ; 35(8): 2297-2302, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33039288

RESUMO

OBJECTIVES: Video-assisted thoracoscopy surgery-lobectomy is less invasive than conventional thoracotomy and is associated with fewer complications. However, the pain related is classified as moderate and requires adequate treatment. Ultrasound-guided serratus anterior plane block (SAPB) provides analgesia by blocking the lateral branches of the intercostal nerves, avoiding the complications of epidural analgesia and paravertebral block. The aim of the present study was to evaluate the efficacy and safety of the SAPB compared with the intercostal nerve block (ICNB). DESIGN: This was a non-randomized prospective study, in which surgery-lobectomy pain after video-assisted thoracoscopy was treated with the following multimodal approach: SAPB or ICNB, morphine-patient controlled analgesia, and paracetamol. SETTING: The study was undertaken in a single community hospital. PARTICIPANTS: The study comprised 40 patients. INTERVENTIONS: Execution of ultrasound-guided SAPB. MEASUREMENTS AND MAIN RESULTS: Nineteen (47.5%) men and 21 (52.5%) women were enrolled, and the mean age was 67.22 ± 11 years. Both groups showed any visual analog scale values >4, which was significantly lower in the SAPB group at the 6th hour and at the 12th and 24th hours only during coughing (p < 0.05). The sedation score was significantly lower in the ICNB group at 0 and at the 2nd and 4th hours; it was lower in the SAPB group at the 6th hour. All patients had a sedation score <1, and they all were awake and oriented. After 24 hours, the total morphine requirement was 19.3 ± 14.4 mg and 11.3 ± 8.5 mg (p = 0.038); after 48 hours, it was 12.2 ± 7.9 mg and 8.2 ± 5.8 mg in the ICNB and SAPB groups, respectively. CONCLUSIONS: The multimodal approach of SAPB, morphine-patient controlled analgesia, and paracetamol is effective, safe, and time efficient.


Assuntos
Nervos Intercostais , Parede Torácica , Idoso , Feminino , Humanos , Nervos Intercostais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Toracoscopia
2.
Semin Thorac Cardiovasc Surg ; 33(2): 581-592, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32853737

RESUMO

Validation of predictive risk models for prolonged air leak (PAL) is essential to understand if they can help to reduce its incidence and complications. This study aimed to evaluate both the clinical and statistical performances of 4 existing models. We selected 4 predictive PAL risk models based on their scientific relevance. We referred to these models as Chicago, Bordeaux, Leeds and Pittsburgh model, respectively, according to the affiliation place of the first author. These predicting risk models were retrospectively applied to patients recorded on the second edition of the Italian Video-Assisted Thoracoscopic Surgery Group registry. Predictions for each patient were calculated based on the logistic regression coefficient values provided in the original manuscripts. All models were tested for their overall performance, discrimination, and calibration. We recalibrated the original models with the re-estimation of the model intercept and slope. We used curve decision analysis to describe and compare the clinical effects of the studied risk models. Better statistical metrics characterize the models developed on larger populations (Chicago and Bordeaux models). However, no model has a valid benefit for threshold probability greater than 0.30. The Net benefit of the most performing model (Bordeaux model) at the threshold probability of 0.11 is 23 of 1000 patients, burdened by 333 false positive cases. One of 1000 is the Net benefit at the threshold probability of 0.3. The use of PAL scores based on preoperative predictive factors cannot be currently used in a clinical setting because of a high false positive rate and low positive predictive value.


Assuntos
Pneumonectomia , Cirurgia Torácica Vídeoassistida , Chicago , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos
3.
Chir Ital ; 59(1): 83-9, 2007.
Artigo em Italiano | MEDLINE | ID: mdl-17361935

RESUMO

Intestinal ischemia in antiphospholipid antibody syndrome (PAPS) could be due to arterial thrombosis from hypercoagulability. A male patient, 45 years old, was admitted to the hospital with symptoms of acute abdomen and after laparotomy he developed sepsis, right kidney infarction, jejunal ischemia, aortic thrombosis, wide necrosis of both gluteus muscles, left subclavian vein thrombosis. Our therapeutic and diagnostic strategy was delineated after demonstration of antiphospholipid antibodies. The patient was treated with total parenteral nutrition in the presence of 5 enteric fistulas with very high outflow, arterial stent insertion and daily changes of medicated dressings. Outcome was excellent with small residual deficit in walking. Continuous nutritional status monitoring and very high nitrogen supply allowed excellent healing of huge wounds and closure of enteral fistulas.


Assuntos
Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/terapia , Abdome Agudo/diagnóstico , Abdome Agudo/terapia , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/cirurgia , Bandagens , Nádegas/patologia , Humanos , Infarto/etiologia , Isquemia/etiologia , Jejuno/irrigação sanguínea , Rim/irrigação sanguínea , Laparotomia , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/terapia , Nutrição Parenteral/métodos , Sepse/etiologia , Sepse/terapia , Stents , Resultado do Tratamento
4.
J Vis Surg ; 3: 179, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29302455

RESUMO

We standardised a Ventilation Mechanical Test (VMT) after video-assisted thoracoscopic surgery (VATS) lobectomy that classifies intraoperative alveolar air leaks (IOAALs) in mild, moderate and severe. We assumed that mild IOAALs (<100 mL/min) are self-limiting, whereas severe IOAALs (>400 mL/min) must be treated. An IOAAL between 100 and 400 mL/min was defined moderate and constituted the study population of a prospective multicentre randomised trial on the use of a polymeric biodegradable sealant (ProgelTM Pleural Air Leak Sealant, Bard Davol, USA) in case of moderate IOAAL compared with no treatment. We assumed that the standardised VMT allows to accurately selected patients needing treatment, thus limiting unnecessary sealant use. We analysed data of the randomised trial to assess the cost-effectiveness of Progel treatment in VMT selected patients. This is a multicenter randomised controlled trial. Patients with moderate IOAAL were randomised to Progel (group A) or "no treatment" (group B).The primary efficacy endpoint of the study was the postoperative duration of air leakage. The secondary outcome measures included: mean time to chest drain removal, mean length of hospitalisation, the percentage of postoperative complications occurring within two months, and cost of treatment. Between January 2015 and January 2017, 255 VATS lobectomies were performed in 4 centres, 55 met the inclusion criteria, and they were randomly assigned to 2 different groups (28 in the Progel and 27 in the control group). The mean air leakage duration was statistically different between the two groups: in the group A was 1.60 vs. 5.04 days in group B (P<0.001). The average duration of chest drainage was statistically shorter in group A than in the control group (4.1 vs. 6.74 days; P=0.008). The mean time to hospital discharge was also statistically shorter in group A than in group B (5.75 vs. 7.85 days, P=0.026). In the Progel group, a statistically significant reduction of hospitalisation costs compared with the control group was observed (Progel group =12,905£, Control group =39,690£; P<0.001). Our standardised VMT helps in reducing the length of hospital stay after VATS lobectomy because in case of IOAALs between 100 and 400 mL/min the use of ProgelTM significantly reduces postoperative air leak, time to drain removal and length of hospitalisation compared with no treatment. This shorter hospital stays results in significant cost saving benefits. Selection of patients with standardised VMT is essential to limit unnecessary intraoperative sealant treatments, thus contributing to limit the costs.

5.
J Thorac Dis ; 9(12): 5230-5238, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29312730

RESUMO

BACKGROUND: Intraoperative alveolar air leak (IOAAL) is one of most common complications after video-assisted thoracoscopic surgery (VATS) lobectomy. The study aimed to evaluate if, in moderate IOAAL, intraoperative polymeric biodegradable sealant (ProgelTM) reduced postoperative air leak (PAL) and consequently was cost-effective. METHODS: Patients with moderate IOAAL were randomised in a multicentre trial to intraoperative use of a sealant (Sealant group) or standard management of air leaks (Control group). Primary endpoint was the postoperative duration of air leakage. Secondary outcomes included: time to drainage removal, length of hospital stay, postoperative complications within 2 months, and cost analysis. RESULTS: Between January 2015 and January 2017, 255 VATS lobectomies were performed in four centres. Fifty-five met inclusion criteria and were randomly assigned to Sealant group [28] and Control group [27]. The mean air leakage duration was statistically different between groups (Sealant group =1.60 days, Control group =5.04 days; P<0.001). The average length of drainage was significantly (P=0.008) shorter in Sealant group (4.1 days) than in Controls (6.74 days). The mean time of hospital stay was statistically shorter in sealant group (Sealant =5.75 days, Control =7.85 days; P=0.026). Sealant group observed a statistically significant reduction of costs. CONCLUSIONS: In moderate IOAAL after VATS lobectomy, polymeric biodegradable sealants are safe and efficient. Compared with standard treatments, sealant significantly reduces PAL, time to drain removal and length of hospital stay resulting in significant costs benefits.

6.
Chir Ital ; 57(2): 177-82, 2005.
Artigo em Italiano | MEDLINE | ID: mdl-15916143

RESUMO

The main indications for cervical mediastinoscopy are preoperative staging of lung cancer and diagnostic biopsy of mediastinal mass (lymphoma, sarcoidosis, tuberculosis etc.). We undertook a retrospective review of our experience of mediastinal exploration by cervical media-stinoscopy: 253 mediastinoscopies were performed on 252 patients (195 male and 57 female; mean age 53 years, range 14-88 years) between 1995 and June 2003. Four extended mediastinoscopies were performed and 1 patient had a re-mediastinoscopy following a non-diagnostic procedure. 319 lymph nodal stations were investigated in 253 procedures. We observed no mortality, while 2 patients had major bleeding (0.7%), with the need for open surgical treatment in order to achieve haemostasis. The median length of hospital-stay was one day, with discharge in the first postoperative day. 69 out of 170 patients, who eventually resulted to be affected by a histologically proven lung cancer, had a negative mediastinoscopy. Fifteen of them resulted N2 at the time of surgery: 8 patients with a false negativity in a biopsied station (4 in station 4R and 4 in station 7), while 7 cases showed infiltration in stations which were not sampled (5 in station 5, 1 in station 8 and 1 in station 7, the latter being the only one in which a standard cervical mediastincoscopy could have been able to stage it correctly). So, having observed 61 true negatives and 8 false-negatives in the sampled stations, in our experience the negative predictive value of cervical mediastinoscopy was 88.4%, with 78.2% of patients correctly staged without using other diagnostic tools. In conclusion, mediastinoscopy is an important procedure for the diagnostic biopsy of mediastinal mass and a useful tool in preoperative staging of lung cancer, especially if associated with chest CT-scan and Positron Emission Tomography (PET). In our experience, the spreading of PET does not lead to a reduction of cervical mediastinoscopies, both for the contemporary introduction of new chemotherapeutic preoperative protocols and, above all, for the not negligible incidence of false-positive results using PET, suggesting that media-stinoscopy should always be performed in patients affected by a PET-positive mediastinal growth.


Assuntos
Neoplasias Pulmonares/patologia , Mediastinoscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Mediastinoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Eur J Cardiothorac Surg ; 26(6): 1196-9, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15541984

RESUMO

OBJECTIVE: To evaluate the short-term and the long-term results of bronchoplastic resections (BR) performed for central carcinoid tumors (CCT). METHODS: Retrospective study of patients who underwent BR for a CCT between 1966 and 2003. RESULTS: BRs were performed in 25 patients out of 92 (27%) who were resected for CCT. Median age was 37 years. All patients were symptomatic. Preoperative bronchoscopy was diagnostic in 15 patients. The bronchoplasties performed were: 11 sleeve lobectomies, 1 sleeve segmentectomy, 8 wedge lobectomies, 4 flap lobectomies and 1 wedge segmentectomy. There were 22 typical and 3 atypical carcinoids without nodal metastasis. No major complications or mortality occurred. One patient with a typical carcinoid developed pretracheal metastatic adenopathy 19 years after resection. No recurrence or stenosis has occurred at the sites of bronchoplasty so far. Three patients died of unrelated disease. Overall the 10-, 15- and 20-year survival rates were 100, 100 and 71%. CONCLUSIONS: Bronchoplastic resections are the treatment of choice for CCT. Short- and long-term results are excellent. Life-long follow-up is necessary, however, due to the possibility of late recurrence.


Assuntos
Broncoscopia/métodos , Tumor Carcinoide/cirurgia , Neoplasias Pulmonares/cirurgia , Adulto , Idoso , Brônquios/patologia , Brônquios/cirurgia , Tumor Carcinoide/patologia , Feminino , Humanos , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Chir Ital ; 56(1): 63-70, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15038649

RESUMO

Bronchopulmonary carcinoids are one of the most common cause of ectopic secretion of corticotropin (ACTH) and account for approximately 1% of all the patients in whom Cushing's syndrome develops. We reviewed 98 cases described in the World Literature and we report on two new cases. A 60-year old woman affected by Cushing's syndrome underwent to surgical wedge resection of a peripheral pulmonary nodule and a 30-year old woman with similar clinical features underwent to middle lobectomy for a small hilar neoplasm. Histopathologic examination of the tumours defined them as typical bronchopulmonary carcinoids. The patients are asymptomatic and with no sign of recurrence 72 and 30 months after surgery. According to our review we found no clear evidence that bronchial carcinoids associated with Cushing's syndrome should be considered a more aggressive variant or subtype of the typical carcinoid. If Cushing's syndrome does not disappear after surgery, the presence of residual disease (often a nodal involvement) should be investigated. A long-term relapse of the syndrome requires a careful search for local or distant neoplastic recurrence.


Assuntos
Neoplasias Brônquicas/complicações , Tumor Carcinoide/complicações , Síndrome de Cushing/etiologia , Neoplasias Pulmonares/complicações , Neoplasias Primárias Múltiplas/complicações , Adulto , Feminino , Humanos , Pessoa de Meia-Idade
9.
Chir Ital ; 55(3): 351-5, 2003.
Artigo em Italiano | MEDLINE | ID: mdl-12872569

RESUMO

A mammographic screening program was started in 1999 in the Province of Verona and was offered to women aged 50-69. The purpose of this study was to analyse and compare our data, particularly the type of surgery and histotype, with the literature data where no screening program was implemented. During the first three years of the screening, 113 patients underwent surgical treatment in our Institute. The histology of the mammary lesions was benign neoplasia in 28 (24.7%) and breast cancer in 85 (75.3%) patients. Seventy-three women (85.9%) with malignant neoplasms were submitted to conservative treatment. Mastectomy was performed in 12 (14.1%) patients, 8 of whom with immediate breast reconstruction. Patients coming from screening programs benefit in a high percentage of cases from conservative treatment, which, together with the reduced aggressiveness of the cancers, permits alternative treatments for the axillary lymph nodes and a reduction in adjuvant chemotherapy.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Mamografia , Programas de Rastreamento , Idoso , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Fatores de Tempo
10.
Pathol Res Pract ; 210(1): 40-6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24211161

RESUMO

The aim of this study was: (1) to compare the new pathological findings as detected by the IASLC/ATS/ERS classification with the traditional radiological features in pulmonary pN0 adenocarcinomas, (2) to evaluate their prognostic significance on overall survival (OS). A total of 42 surgically resected pN0 pulmonary adenocarcinomas were analyzed. On CT scans, the following radiological data were recorded: sphericity, predominant margins, cavitation and bronchogram, attenuation and percentage of ground glass opacity (GGO). On pathological examination, tumors were categorized according to the IASLC/ATS/ERS classification; Sica score and grade, pathological stage, tumor major axis, pleural invasion, vascular and lymphatic invasion, peritumoral lymphoid infiltration, and cytological features were also determined. Clinical follow up was available in 37 cases (range 1-117 months). Radiologically, 31 solid and 11 semisolid tumors were found. Morphologically, 2 minimally invasive and 40 invasive adenocarcinomas were diagnosed. In radiological-pathological comparisons, (1) the acinar pattern was higher in tumors with solid attenuation and low GGO (p=0.018); (2) the lepidic pattern was more elevated in tumors with high GGO (p=0.012). In multivariate survival analyses with stage, predominant margins on CT scans (p=0.036) and Sica score (p=0.028) significantly affected OS. This study confirms the validity of the new classification of pulmonary adenocarcinomas in radiological-pathological comparisons and underlines the importance of both radiological and pathological findings in correctly identifying their prognostic features.


Assuntos
Adenocarcinoma/classificação , Adenocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/classificação , Neoplasias Pulmonares/diagnóstico por imagem , Adenocarcinoma/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Análise de Sobrevida , Tomografia Computadorizada por Raios X
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