Efficacy and safety of fibrin sealant patch in the treatment of air leakage in thoracic surgery.

AIM: Air leakage represents a major problem in lung surgery. Absorbable fibrin sealant patch (AFSP), a collagen sponge coated with human fibrinogen and thrombin, can be used as an adjunct to primary stapling or suturing. This study compared the efficacy of AFSP with manual suturing after primary stapling. METHODS: This was a prospective, multicenter, randomized study. Patients undergoing lobectomy, bilobectomy, anatomical segmentectomy for lung cancer or wedge resection for pulmonary metastasis with air leakage grade 1 or 2 according to Macchiarini scale after stapler suture were randomized to receive AFSP or standard surgical treatment (ST). The primary endpoint was the reduction of intraoperative air leakage intensity. Duration of postoperative air leakage and number of days until removal of last chest drain were secondary endpoints. Safety was recorded for all patients. RESULTS: A total of 346 patients were enrolled in 14 centres, 179 of whom received AFSP and 167 ST. Intraoperative air leak intensity was reduced in 90.5% of AFSP patients and 82% of ST patients (P=0.03). A significant reduction in postoperative air leakage duration was observed in the AFSP group (P=0.0437). The median number of days until removal of last drainage was 6 (3-37) in the AFSP group and 7 (2-27) in the ST (P=0.38). Occurrence of adverse events was comparable in both groups. CONCLUSION: AFSP was more efficacious than standard ST as an adjunct to primary stapling in reducing intraoperative air leakage intensity and duration of postoperative air leakage in patients undergoing pulmonary surgery. AFSP was well tolerated.

Purification and amino acid sequence of basic protein I, a lysine-49-phospholipase A2 with low activity, from the venom of Trimeresurus flavoviridis (Habu snake).

A basic protein (pI 10.2), named basic protein I, was purified to homogeneity from the venom of Trimeresurus flavoviridis (Habu snake) after four chromatographic steps. The amino acid sequence of this protein was determined by sequencing the S-pyridylethylated derivative of the protein and its peptides produced by chemical (cyanogen bromide and formic acid) and enzymatic (chymotrypsin, Achromobacter protease I, and Staphylococcus aureus V8 protease) cleavages. The protein consisted of 122 amino acid residues and was similar in sequence to phospholipases A2 from the venoms of crotalid and viperid snakes. A most striking feature of this protein is that aspartic acid at the 49th position common in phospholipases A2 is replaced by lysine. When the protein acted on 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphorylcholine, oleic acid was preferentially released, indicating that the protein has phospholipase A2 activity. Its molar activity toward 1,2-dilauroyl-sn-glycero-3-phosphorylcholine, however, was 1.5% that of T. flavoviridis phospholipase A2 isolated previously. The fact that both affinity to Ca2+ and reactivity to p-bromophenacyl bromide of basic protein I are approximately one order of magnitude lower than those of T. flavoviridis phospholipase A2 might explain the low activity of basic protein I.

The kinetics of growth of semiconductor nanocrystals in a hot amphiphile matrix.

The first comprehensive study on the kinetics of nanocrystal growth in a hot amphiphile medium is presented. An example is given with CdSe semiconductor nanocrystals grown after the injection of precursor (a mixture of Cd- and Se-reagents) in concentrated tri-octylphosphine oxide matrix (heated to more than 300 degrees C). The particle size distribution is reconstructed as a function of time from the absorption and photoluminescence spectra collected during the synthesis process. For this purpose a new expression is used relating the exciton energy due to quantum confinement with the nanocrystal radius. The growth kinetics is considered as a two-stage process in order to describe the time variation of nanoparticle size. During the first stage, called reaction-limited growth, the size of initial nucleus rapidly increases due to a sort of surface reaction exhausting the precursor in the nanoparticle vicinity. The growth in such conditions favors also a remarkable narrowing of the size distribution. The nanocrystal develops further on account of a slow precursor transfer from a distant space driven by the concentration gradient--classical diffusion-limited growth. The width of size distribution also increases proportional to the average particle size. Any growth will stop after the precursor concentration reaches a minimum value defining the limit for the final nanocrystal size in a batch. Solving the kinetic equations for the growth rate in each case of kinetics derives analytical expressions for the mean radius and variance of size distribution. Then the respective expressions are matched in a uniform solution valid during the entire synthesis. The theoretical model is in a good quantitative agreement with the experimental data for independent syntheses. Important characteristic scales of the processes (time-constant and length) and microscopic parameters of the reacting system (interfacial energy and reaction rate constant) are estimated from the data. It turns out that the fast reaction-limited growth is important to obtain well-defined nanocrystals of high optical quality by using less energy, time and consumable. However, to make them reproducibly uniform one should control also the ultra-fast nucleation process preceding the nanocrystal growth, which is still unknown. Nevertheless, our current findings allow the conceptual design of a new continuos-flow reactor for the manufacturing of a large amount of uniform nanocrystals.

Bronchial brushing and biopsy: a comparative evaluation in diagnosing visible bronchial lesions.

One hundred and forty patients underwent 142 brushings and conventional biopsies of suspected malignant lesions of the lung through a fibreoptic bronchoscope. Both samples were taken from the same area. One hundred and three patients showed positive results on brushing and 90 on biopsy. Thirty-nine diagnoses were negative on brushing and 52 on biopsy. A correct cell typing was obtained in 105 of 109 diagnoses of malignancy. Final diagnoses showed 118 malignant lesions and 22 benign conditions. False positives were respectively, 2 on brushing and 1 on biopsy, while false negatives were 17 on brushing and 30 on biopsy. Brushing showed higher sensitivity (85.5%) and accuracy (86.6%) than biopsy. A combination of the two techniques gives an accuracy rate of 94.3%.

[Intrathoracic goiter: experience with 61 surgically treated cases]. / Gozzi endotoracici: esperienza su 61 casi trattati chirurgicamente.

Sixty-one patients with substernal goiter--42 women and 9 men (female:male ratio 2.2:1), mean age 57.5 years--underwent surgical resection in the General and Thoracic Surgery Division of the Surgery Department of the University of Catania from January 1980 to March 1999. Six patients (9.8%) had previously undergone cervicotomy. Forty-nine patients (80.3%) had symptoms (2 with acute respiratory failure); 22.9% had metabolic symptoms. Fifty-one patients (83.6%) had cervicomediastinal goiter, 8 (13.1%) migrated mediastinal goiter and 2 (3.3%) ectopic goiter. Forty-one cases (69.5%) were prevascular and 18 (30.5%) retrovascular; of the latter 5 were pre-visceral and 13 retrovisceral. Fifty-one thyroidectomies (6 subtotal) were performed, as well as 5 mediastinal excisions to complete removal and 4 resections confined to the mediastinal component. The 51 patients with cervicomediastinal goiter underwent cervicotomy in 42 cases (82.4%), cervicosternotomy in 7 cases (13.7%) and cervicosternothoracotomy in 2 cases (3.9%). The 8 migrated mediastinal goiters were removed via sternotomy in 6 cases, cervico thoracotomy in 1 and thoracotomy in 1. This latter approach was also used for the 2 ectopic goiters. The goiter presented signs of neoplastic degeneration in 2 cases (3.2%). Postoperative complications were: recurrent nerve palsy in 5 cases (1 bilateral definitive, 1 monolateral definitive, 3 monolateral transient), respiratory failure in 2, mediastinal hematoma in 1 and hypocalcemia in 8 (transient in 6). There was one postoperative death due to cardiorespiratory failure after cervicosternotomy. Surgical excision of substernal goiters is the best choice of treatment in view of the very low postoperative mortality and morbidity.

[Pathogenetic and clinico-diagnostic considerations on a case of non-parasitic cyst of the spleen]. / Considerazioni patogenetiche e clinico-diagnostiche su un caso di cisti non parassitari della milza.

A rare case of non-parasitic cyst of endothelial type, recently observed in the spleen, is illustrated. The relevant literature is reviewed, Fowler's classification stressed, and the aetiopathogenetic and histopathological characteristics of such cysts are discussed in critical spirit. The diagnostic means are also fully described. With stress on the utility of the scintiscanning examination.

[Bochdalek's hernia with retroperitoneal contents in adults]. / L'ernia di Bochdalek a contenuto retroperitoneale nell'adulto.

The authors report a case they had the opportunity to observe, surgically treated (thoraco-phrenotomy, removal of the herniated mass, repair of the diaphragmatic breach). They illustrate the genesis of such abnormality, its incidence and symptomatology. The Authors, moreover, dwell upon the diagnostic problems caused by Bochdalek's hernia with retroperitoneal contents, and upon the advantages shown by the thoracic way of aggression in the light of their own experience.

[Heterotopic pancreas in a gastric site]. / Il pancreas eterotopico a sede gastrica.

The authors describe two cases of heterotopic pancreas tissue involving the stomach. After some general comments on the frequency and anatomopathological aspects of this disease, they discuss the clinical features and modern technics for the diagnosis of heterotopic pancreas tissue, with special emphasis on gastroscopic detection and execution of aimed biopsy specimen collection. Last, they discuss the indications for surgical treatment of the disease.

Tracheal reconstruction with jejunal loop autograft.

An experimental study on tracheal reconstruction using a jejunal loop autograft, is reported. Eight dogs divided into 2 groups have been used. In the first group the jejunal loop was prepared using a single vascular pedicle including both the artery and the vein and was revascularized with the superior thyroid artery and its collateral vein. In the second group the jejunal loop was prepared with two different vascular pedicles, revascularizing the artery with the superior thyroid artery and the vein with the jugular vein. In this group a sylastic T-tube was placed inside the loop. The procedure and preliminary results, are reported.