Bone marrow characterization in COPD: a multi-level network analysis.

BACKGROUND: Bone marrow (BM) produces hematopoietic and progenitor cells that contribute to distant organ inflammation and repair. Chronic obstructive pulmonary disease (COPD) is characterized by defective lung repair. Yet, BM composition has not been previously characterized in COPD patients. METHODS: In this prospective and controlled study, BM was obtained by sternum fine-needle aspiration in 35 COPD patients and 25 healthy controls (10 smokers and 15 never-smokers). BM cell count and immunophenotype were determined by microscopy and flow cytometry, respectively. Circulating inflammatory (C-reactive protein, IL-6, IL-8) and repair markers (HGF, IGF, TGF-ß, VEGF) were quantified by ELISA. Results were integrated by multi-level network correlation analysis. RESULTS: We found that: (1) there were no major significant pair wise differences between COPD patients and controls in the BM structural characteristics; (2) multi-level network analysis including patients and controls identifies a relation between immunity, repair and lung function not previously described, that remains in the COPD network but is absent in controls; and (3) this novel network identifies eosinophils as a potential mediator relating immunity and repair, particularly in patients with emphysema. CONCLUSIONS: Overall, these results suggest that BM is activated in COPD with impaired repair capacity in patients with more emphysema and/or higher circulating eosinophils.

Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port: a feasible and safe procedure.

BACKGROUND: Recent authors have pioneered the use of single-incision laparoscopic surgery (SILS) for umbilical cholecystectomy. The SILS approach has the potential of reducing the trauma of the surgical access and postoperative pain. Video-assisted thoracic surgery (VATS) greatly reduces patient postoperative pain compared with traditional thoracotomy incisions. The current trend is to use fewer working ports to reduce even more postoperative pain, chest wall paresthesia, and hospital stay. No reports have described using a SILS port in VATS. METHODS: From September 2009 to March 2010, 13 patients had surgery for primary spontaneous pneumothorax. The patients underwent single-lung ventilation. A 2.5-cm-long incision was made at the sixth intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a single flexible port. A 5-mm 0° videothoracoscope, a roticulating grasper, and an endoGIA stapler were introduced through port channels. Apical lung blebs were stapled, and pleurodesis by pleural abrasion with Marlex mesh was performed. RESULTS: The study enrolled nine men (69.2%) and four women with a median age of 26.3 years. No complications were recorded. The postoperative pain was mild for 10 patients (76.9%) and moderate for 3 patients. Mild chest wall paresthesia (numbness) was observed in three patients (23.07%). The postoperative hospital stay was 2.15 days. CONCLUSIONS: Although the SILS port is for laparoscopic use, it allowed an adequate lineup of the instruments along the intercostal space and adequate instrument maneuverability for stapling and resecting of apical lung bullae or blebs. The procedure was accomplished successfully for 92.3% of the patients. This is the first report on the use of a SILS port in VATS. Further work and development of a proper thoracic single port are needed to define the uses and advantages of this uniportal technique.

Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study.

OBJECTIVES: A prospective, randomized study was carried out on patients undergoing lung cancer surgery, with the aim of determining if uniportal video-assisted lobectomy has more favourable postoperative outcomes than other video-assisted thoracoscopic lobectomy techniques (Duke approach and Copenhagen approach). METHODS: Patients were randomly assigned to two groups; uniportal video-assisted lobectomy (Group A; n = 51) and other video-assisted thoracoscopic lobectomy techniques (Group B; n = 55). The primary outcome measures were: postoperative pain (analogue visual scale) and supplementary doses of analgesics (morphine, milligrams); the secondary outcome measures were: the delay in removing the paravertebral catheter and the chest drain, the duration of the postoperative hospital stay, postoperative complications and the operative or 30-day mortality. We assessed postoperative pain during the first 3 days to identify possible differences coinciding with paravertebral catheter removal and with the start of mobilization, and we evaluated the type of resection, R0/R1 (a very important factor in assessing postoperative pain). All continuous data were evaluated for normality, and analysed with the Mann-Whitney U-tests or t-tests. Categorical data were analysed by Fisher's exact test. RESULTS: One hundred and six lobectomies were completed. Both groups were comparable with respect to different clinical parameters (age, clinical stage and comorbidity), preoperative and pathological variables. The median visual analogue pain score in the first 3 days did not show statistically significant differences (respectively, P = 0.58, P = 0.64, P = 0.85). Likewise, the median morphine use in the first 3 days did not show statistically significant differences (respectively, P = 0.72, P = 0.81, P = 0.64). There was no difference in timing to remove the paravertebral catheter (P = 0.82) and the chest drain (P = 0.65) and the duration of the postoperative hospital stay (P = 0.62). There was no difference in postoperative complications (one reoperation for bleeding in Group B, P = 0.24). There was no operative or 30-day mortality in either group. CONCLUSIONS: Uniportal video-assisted thoracoscopic lobectomy does not present better postoperative outcomes than other video-assisted thoracoscopic lobectomy techniques.

Uniportal right upper video-assisted thoracoscopic surgery lobectomy: safe and feasible.

Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy is now well established and performed all around the world. We are going to share the surgical technique for uniportal VATS right upper lobectomy based on our experience. A 62-year-old patient underwent Uniportal VATS right upper lobectomy for a primary non-small cell lung cancer (NSCLC). Our patient had no perioperative complications and was then discharged to his home on postoperative day 4. The patient's pain was managed with a paravertebral catheter during the first 48 hours and then with oral analgesics. Pathology report: well-differentiated adenocarcinoma; the size of the tumour was 1 cm × 0.8 cm × 1 cm; all margins were negative for residual tumour. The patient did not require adjuvant radiation or chemotherapy. Uniportal VATS lobectomy is a safe and effective procedure providing a favourable clinical outcome in the patient.