Catamenial pneumothorax: Not only VATS diagnosis.

Background: Catamenial pneumothorax (CP) is a rare type of spontaneous, recurring pneumothorax occurring in women, from the day before menstruation until 72 hours after its beginning. Conservative treatment is generally associated with recurrence of CP. Video-assisted thoracic surgery (VATS) approach allows not only to obtain diagnosis but also to guide definitive treatment of causing lesions, such as ectopic endometrial implants or diaphragmatic defects and fenestrations. We report our experience in VATS management of CP to focus on its role in CP. Materials and methods: In this retrospective observational study, we collected data from women referred to our center for CP, from January 2019 to April 2022. All patients underwent VATS approach, with muscle-sparing thoracotomy when diaphragmatic fenestrations were detected, to perform selective diaphragmatic plication and/or partial diaphragmatic resection. Results were analyzed in terms of pneumothorax recurrence after surgical treatment. All patients were referred to gynecologists for medical therapy. Results: Eight women (median age 36 years, range: 21-45), all with right side CP, were included; three already had pelvic endometriosis and two had already undergone lung apicectomy at other institutions. VATS allowed us to detect diaphragmatic fenestrations in seven patients (87.5%) and apical bullae in five (62.5%). Apicectomy was performed in five cases (62.5%), selective diaphragmatic plication in two (25%), and partial diaphragmatic resection in five (62.5%). Chemical pleurodesis with talc was performed in all to minimize the risk of recurrence. Pathological diagnosis of endometriosis on the resected diaphragm was achieved in five patients (62.5%). No recurrence occurred, except for one woman who stopped medical treatment for endometriosis. Conclusions: In the management of patients with CP, VATS should be recommended not only to obtain an explorative diagnosis of ectopic endometrial implants or diaphragmatic fenestrations but also to allow the most appropriate surgical treatment and obtain pathological specimens for confirmation and definitive diagnosis of thoracic endometriosis. Medical therapy to achieve ovarian rest is mandatory in the postoperative period and should not be discontinued.

Neuroblastoma Cells Depend on CSB for Faithful Execution of Cytokinesis and Survival.

Neuroblastoma, the most common extra-cranial solid tumor of early childhood, is one of the major therapeutic challenges in child oncology: it is highly heterogenic at a genetic, biological, and clinical level. The high-risk cases have one of the least favorable outcomes amongst pediatric tumors, and the mortality rate is still high, regardless of the use of intensive multimodality therapies. Here, we observed that neuroblastoma cells display an increased expression of Cockayne Syndrome group B (CSB), a pleiotropic protein involved in multiple functions such as DNA repair, transcription, mitochondrial homeostasis, and cell division, and were recently found to confer cell robustness when they are up-regulated. In this study, we demonstrated that RNAi-mediated suppression of CSB drastically impairs tumorigenicity of neuroblastoma cells by hampering their proliferative, clonogenic, and invasive capabilities. In particular, we observed that CSB ablation induces cytokinesis failure, leading to caspases 9 and 3 activation and, subsequently, to massive apoptotic cell death. Worthy of note, a new frontier in cancer treatment, already proved to be successful, is cytokinesis-failure-induced cell death. In this context, CSB ablation seems to be a new and promising anticancer strategy for neuroblastoma therapy.

Endoscopic removal of tracheobronchial foreign bodies: results on a series of 51 pediatric patients.

PURPOSE: Rigid bronchoscopy (RB) is still considered the gold standard approach for the removal of airway foreign bodies (FBs) in children; however, flexible bronchoscopy (FOB) has recently been proposed both as diagnostic and therapeutic means. Our purpose was to evaluate the outcomes of FOB, associated with the Dormia basket, for the removal of FBs. METHODS: Retrospective data about 124 children who underwent bronchoscopy for the suspicion of a FB aspiration between January 2008 and January 2019 in our department were collected. RESULTS: In a total of 51 cases, FBs were removed through FOB or RB associated with forceps or Dormia basket. Male to female ratio was 1.8:1, mean age 30 ± 26.1 months. Thirty-four (67%) FBs were directly removed through FOB, in most of the cases using Dormia basket and twelve (23%) patients underwent RB. The overall left-versus-right distribution was 57% vs. 43%. The mean retrieval procedural time was 36.29 ± 24.99 min for FOB and 52.5 ± 29.74 min for RB; the success rate of the procedures was 97% vs. 67%. CONCLUSION: FOB can be used not only as a diagnostic procedure, but also as the first method for the removal of airway FBs. The Dormia basket is a useful tool, especially to remove peripherally located FBs.