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OBJECTIVE: To develop a new score (CATH-score) for predicting intra-procedural risk in patients undergoing CT-guided percutaneous needle pulmonary biopsy. PATIENTS AND METHODS: 100 CT-guided lung biopsies performed with a 18 Gauge (G) needle (Pilot Group) were reviewed to analyse patient-, lesion- and procedure-related variables to identify risk factors for procedural complications (pneumothorax and parenchymal bleeding) and diagnosis failure. A scoring system for predicting complications and choosing the right needle (16 G, 18 G, 21 G) was developed using risk factors weighting and prospectively applied to 153 consecutive biopsies (CATH-score Group); complications and diagnostic rates obtained were compared with a group of patients (Control Group) that underwent lung biopsy; in this group of patients the choice of the calliper of the needle was based on the operator experience. RESULTS: lesion diameter (p=0.03), central location of lesion (p=0.02), centrilobular emphysema (p=0.04) and trans-pulmonary needle route (p=0.002) were associated with a higher complications rate in Pilot Group and were selected as risk factors to include in the CATH-score definition. Risk factors "cut-off" values were identified (Receiver Operating Characteristics curves) and risk-stratification groups were classified as follows: low (16 G, score 1), intermediate (18 G, score 2), and high procedural risk score (21 G, score 3). CATH-score usage limited complications rate despite a higher number of 16 G needle employed, with a diagnostic performance rising respect to Control Group. CONCLUSIONS: CATH-score seems to be a valuable tool for predicting the risk of complications and choosing the right needle, in order to increase diagnostic performance in patients undergoing TTNA.
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Biopsia Guiada por Imagen/métodos , Pulmón/patología , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/efectos adversos , Biopsia con Aguja/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Neumotórax/etiología , Curva ROC , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: The aim of this research was to study the epidemiology, microbiology, prophylaxis, and antibiotic therapy of surgical site infections (SSIs), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), and identify the risk factors for these infections. In Italy SSIs occur in about 5 % of all surgical procedures. They are predominantly caused by staphylococci, and 30 % of them are diagnosed after discharge. In every surgical specialty there are specific procedures more associated with SSIs. METHODS: The authors conducted a systematic review of the literature on SSIs, especially MRSA infections, and used the Delphi method to identify risk factors for these resistant infections. RESULTS: Risk factors associated with MRSA SSIs identified by the Delphi method were: patients from long-term care facilities, recent hospitalization (within the preceding 30 days), Charlson score > 5 points, chronic obstructive pulmonary disease and thoracic surgery, antibiotic therapy with beta-lactams (especially cephalosporins and carbapenem) and/or quinolones in the preceding 30 days, age 75 years or older, current duration of hospitalization >16 days, and surgery with prothesis implantation. Protective factors were adequate antibiotic prophylaxis, laparoscopic surgery and the presence of an active, in-hospital surveillance program for the control of infections. MRSA therapy, especially with agents that enable the patient's rapid discharge from hospital is described. CONCLUSION: The prevention, identification and treatment of SSIs, especially those caused by MRSA, should be implemented in surgical units in order to improve clinical and economic outcomes.
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OBJECTIVE: Despite the World Health Organization (WHO) and Masaoka classifications have been widely accepted as the main describers of prognosis determinants in thymic malignancies, so far, these have been considered independently from one another. We have reviewed our single-centre 40-year results after surgical treatment of thymic malignancies evaluating the inter-relationships between the clinical, surgical and pathological variables and investigating their prognostic impact in completely resected patients. PATIENTS AND METHODS: A surgical series of 347 patients was reviewed and, of these, 305 with complete resection enrolled. Long-term and disease-free survival (LTS, DFS) analyses were performed. Kaplan-Meir curves for WHO histotypes and Masaoka-stages were inspected and matched with the log-rank test; the Cox regression analysis was adopted in a multivariable approach. RESULTS: Considered independently, the WHO-histotypes did not differentiate clearly from one to another in terms of LTS and DFS; however, types A-AB-B1-B2 and B3-C clustered in 2, statistically different, malignancy groups (LTS, DFS: Cox-p < 0.001). Masaoka staging was confirmed to be a relevant prognostic determinant, even if no evident difference between stages I vs II and stages III vs IV emerged when the Masaoka-classification was factored in. Thus, when investigating 13 surgical and pathological factors of invasiveness, these showed a clustering in 2 groups according to the presence/absence of pathological proven infiltration in the peri-thymic structures (LTS, DFS: Cox-p < 0.001). By matching the WHO-malignancy clusters and infiltration clusters, 4 classes may be identified, which proved to have a distinct prognostic significance: (LTS-Cox: stage-I vs stage-II, p = 0.003; III: p < 0.001, IV: p < 0.001; DFS-Cox: stage-I vs stage-II, p < 0.001; III: p < 0.001; IV: p < 0.001). CONCLUSIONS: When analyzing the long-term outcome of patients underwent complete resection for thymic malignancies, the combination between pathological and surgical variables showed accurate prognosis predictability.
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Neoplasias del Timo/diagnóstico , Neoplasias del Timo/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor/tendencias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Neoplasias del Timo/mortalidad , Organización Mundial de la Salud , Adulto JovenRESUMEN
OBJECTIVE: To evaluate, in function of time, the modification of pulmonary function after radical esophagectomy with the aim of identifying clinical and/or surgical predictors of functional worsening. PATIENTS AND METHODS: Data of 57 patients operated from 01/06 to 06/11 were retrospectively reviewed. Thirty-eight patients (67%) underwent transhiatal cervico-laparotomic (CL-Group) and 19 (33%) a Mc-Keown cervico-thoraco-laparotomic esophagectomy (CTL-Group). The pulmonary function has been evaluated before and one month after surgery. The outcome has been benchmarked with demographic/clinical characteristics, the type of operation and the presence of post-operative pulmonary complications (POPCs). RESULTS: Mean age and male/female distribution were 66.6±10.6 yrs and 39/18, respectively. A total of 14 (24% of total sample) POPCs occurred with a significantly higher occurrence in the CTL-Group (71% vs 28%, p < 0.001) and in those patients with a pre-operative concurrent pathological condition (64% in COPD patients vs 36% in patients without COPD, p = 0.021). A global worsening of the spirometric parameters (expressed as the baseline percentage change, Δ) emerged, but this decrease was significantly higher in the CTL-Group in terms of Δ-FVC (p = 0.005) and Δ-FEV1 (p = 0.005). Similarly, those patients who have experienced a POPC, showed a higher reduction of the pulmonary function regardless of the surgical approach when compared with those who did not (Δ-FVC: p = 0.053 and Δ-FEV1%: p = 0.015). CONCLUSIONS: In the context of a global reduction of pulmonary function, patients who underwent trans-thoracic esophagectomy or experienced a POPC showed a significantly worse pattern. These patients could be the "best target" for therapeutic rehabilitative strategies in the pre-operative and/or post-operative setting. This assumption is to be proven through prospective clinical trials.
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Neoplasias Esofágicas/fisiopatología , Neoplasias Esofágicas/cirugía , Pulmón/fisiopatología , Anciano , Esofagectomía/métodos , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
Transesophageal EUS-FNA have become a useful tool in the evaluation of the mediastinum, especially during the staging work-up examination of patients with non-small-cell lung cancer (NSCLC) or other malignancies. We report a challenging case of a 53 years-old woman with an endometrial adenocarcinoma who subsequently presented with right pleural effusion, diffuse pleural thickening with few pleural lesions. The patient referred a long history of exposure to amiantum, this posing a differential diagnosis between primary pleural tumour (mesothelioma) and neoplastic pleural localization of the endometrial cancer. The cytological examination of the pleural effusion (sampled via thoracenthesis) was not adequate to reach a diagnosis. Although a right-video-assisted thoracoscopy was considered the gold standard in this clinical setting to achieve a tissue acquisition of the pleura, an EUS (as the least invasive procedure) was attempted to reach a definitive diagnosis. EUS-FNTA of the pleura was done using a 19-Gauge needle and the pathological and immunophenotypic features were diagnostic for a pleural metastasis of high-grade endometrial serous carcinoma. The patient received adjuvant chemotherapy with a complete regression of the pleural lesions. We take the opportunity of this challenging case to discuss the efficacy and safety of EUS-FNAT to sample the pleural lesions with the use of a large calibre needle if the lesion lies just under the EUS cursor. We may assume that, in selected patients, this technique could be presented as a viable option to the more invasive surgical procedure, which has been previously the gold standard for the pleural tissue acquisition.
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Adenocarcinoma/patología , Neoplasias Endometriales/patología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Neoplasias Pleurales/secundario , Adenocarcinoma/química , Adenocarcinoma/complicaciones , Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/análisis , Carboplatino/administración & dosificación , Doxorrubicina/administración & dosificación , Doxorrubicina/análogos & derivados , Neoplasias Endometriales/química , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Clasificación del Tumor , Derrame Pleural Maligno/etiología , Neoplasias Pleurales/química , Neoplasias Pleurales/complicaciones , Neoplasias Pleurales/tratamiento farmacológico , Polietilenglicoles/administración & dosificación , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Lung neuroendocrine tumors are catalogued in four categories by the World Health Organization (WHO 2004) classification. Its reproducibility and prognostic efficacy was disputed. The WHO 2010 classification of digestive neuroendocrine neoplasms is based on Ki67 proliferation assessment and proved prognostically effective. This study aims at comparing these two classifications and at defining a prognostic grading system for lung neuroendocrine tumors. The study included 399 patients who underwent surgery and with at least 1 year follow-up between 1989 and 2011. Data on 21 variables were collected, and performance of grading systems and their components was compared by Cox regression and multivariable analyses. All statistical tests were two-sided. At Cox analysis, WHO 2004 stratified patients into three major groups with statistically significant survival difference (typical carcinoid vs atypical carcinoid (AC), P=0.021; AC vs large-cell/small-cell lung neuroendocrine carcinomas, P<0.001). Optimal discrimination in three groups was observed by Ki67% (Ki67% cutoffs: G1 <4, G2 4-<25, G3 ≥25; G1 vs G2, P=0.021; and G2 vs G3, P≤0.001), mitotic count (G1 ≤2, G2 >2-47, G3 >47; G1 vs G2, P≤0.001; and G2 vs G3, P≤0.001), and presence of necrosis (G1 absent, G2 <10% of sample, G3 >10% of sample; G1 vs G2, P≤0.001; and G2 vs G3, P≤0.001) at uni and multivariable analyses. The combination of these three variables resulted in a simple and effective grading system. A three-tiers grading system based on Ki67 index, mitotic count, and necrosis with cutoffs specifically generated for lung neuroendocrine tumors is prognostically effective and accurate.
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Carcinoma Neuroendocrino/patología , Neoplasias Pulmonares/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Carcinoma Neuroendocrino/clasificación , Carcinoma Neuroendocrino/mortalidad , Niño , Estudios de Cohortes , Estudios Transversales , Medicina Basada en la Evidencia , Femenino , Humanos , Italia/epidemiología , Estimación de Kaplan-Meier , Antígeno Ki-67/análisis , Estudios Longitudinales , Neoplasias Pulmonares/clasificación , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Organización Mundial de la Salud , Adulto JovenRESUMEN
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.
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Fuga Anastomótica/terapia , Adhesivo de Tejido de Fibrina , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Anciano , Aire , Femenino , Adhesivo de Tejido de Fibrina/efectos adversos , Humanos , Masculino , Estudios Prospectivos , Procedimientos Quirúrgicos TorácicosRESUMEN
INTRODUCTION: To investigate the performance of combined (18)F-FDG-PET/CT as a predictor of the WHO-classification based malignancy grade in thymic epithelial tumors. METHODS: From 05/06 to 02/12, the data of 47 patients with thymic epithelial tumors assessed by (18)F-FDG-PET/CT before being surgically treated were collected in 3 centers and retrospectively reviewed for the purposes of this study. The SUVmax and the SUVmax/T index (the ratio tumor-SUVmax to tumor-size) have been matched with specific subgroups of the WHO-classification: low-risk thymomas (types A-AB-B1), high-risk thymomas (types B2-B3) and thymic carcinomas (type C). RESULTS: There were 22 men and 25 women (age range: 31-84 yrs). Mean tumor size was 44.7 ± 19.0 mm. The WHO-classification was: type-A #2, type-AB #11, type-B1 #9, type-B2 #9, type-B3 #9 and type-C #7. The SUVmax and the SUVmax/T were found to be predictive factors useful to distinguish thymomas from thymic carcinomas (SUVmax: area under ROC-curve: 0.955, p = 0.0045; SUVmax/T-size: area under ROC-curve: 0.927, p = 0.0022). Moreover, both parameters were found to be correlated with the WHO malignancy grade (low-risk thymomas; high-risk thymomas; thymic carcinoma), Spearman correlation coefficients being 0.56 (p < 0.0001) and 0.76 (p < 0.0001), respectively for the SUVmax and for the SUVmax/T index. In addition, the SUVmax is also significantly correlated with Masaoka stage (Spearman correlation coefficient: 0.30, p = 0.0436) CONCLUSIONS: A significant relationship was observed between (18)F-FDG-PET/CT findings and histologic WHO-classification for this cohort of thymic epithelial tumors. Thus, on the basis of these evidences, we infer that (18)F-FDG-PET/CT may be useful to predict histology and the WHO classes of risk.
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Fluorodesoxiglucosa F18 , Neoplasias Glandulares y Epiteliales/diagnóstico , Tomografía de Emisión de Positrones , Neoplasias del Timo/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Neoplasias Glandulares y Epiteliales/patología , Neoplasias Glandulares y Epiteliales/cirugía , Pronóstico , Curva ROC , Estudios Retrospectivos , Neoplasias del Timo/patología , Neoplasias del Timo/cirugía , Carga TumoralAsunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Carcinoma de Células Escamosas/secundario , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Neoplasias Pulmonares/patología , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Anciano , Carcinoma de Células Escamosas/diagnóstico por imagen , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Radiografía , Venas CavasAsunto(s)
Neoplasias del Mediastino/cirugía , Grupo de Atención al Paciente , Sarcoma de Ewing/cirugía , Quimioradioterapia Adyuvante , Femenino , Humanos , Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/terapia , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/terapia , Toracotomía , Resultado del TratamientoRESUMEN
INTRODUCTION: Elastofibroma dorsi (ELD) is a rare soft tissue benign tumor of the chest wall. So far, only a few large series have been reported in the English literature and, to the best of our knowledge, radiological assessment and clinical management remain without consensus. The aim of this study is to provide, on the basis of a single-institutional, homogeneous and large experience, ample evidences to support etiological and "clinical-usefulness-grade" classification hypotheses. MATERIALS AND METHODS: We report observational information on 71 ELD cases and, on the basis of these, we discuss the clinical onset features, radiological and surgical characteristics, as well as pathological and immunohistochemical evidences. RESULTS: In the period between January 1994 and September 2009, 71 consecutive patients (23 male and 48 female; mean age: 60.2 years; standard deviation [SD] ± 8.3 years) with ELD diagnosis were surgically treated at our institution. ELD was right sided in 34 patients (47.9%), left in 25 (35.2%), and bilateral in 12 (16.9%). In nine patients, ELD were diagnosed synchronously and three metachronously. Thirty-eight patients (53.5%) had no significant symptoms; 33 (46.5%) reported a clunking sensation or a localized scapular swelling during the shoulder movements. Sixty-six (93%) patients underwent surgical excision with radical intent while in five patients, a biopsy-only procedure was undertaken. Mean hospital stay was 3.0 days (SD ± 1.2 days) with a morbidity of 10.6% (one case of major postoperative bleeding requested a surgical revision of the hemostasis). At the univariate analysis, the probability of occurrence of morbidity increases with tumor size. All operated patients are alive and well at follow-up with no sign of recurrence and complete resolution of the symptomatology. CONCLUSIONS: ELD is relatively uncommon, benign, and well controlled by radical surgery.
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Tejido Elástico/patología , Fibroma/diagnóstico , Neoplasias Torácicas/diagnóstico , Pared Torácica/patología , Biopsia , Diagnóstico Diferencial , Femenino , Fibroma/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Neoplasias Torácicas/cirugía , Procedimientos Quirúrgicos Torácicos/métodos , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: Pneumonectomy for non small cell lung cancer (NSCLC) after induction radio-chemotherapy (IT) has been associated with high peri-operative risk and its safety and efficacy is still debated. The aim of this retrospective study was to compare short and long-term results of pneumonectomy in patients treated with and without IT (radiotherapy plus chemotherapy) for NSCLC. MATERIALS AND METHODS: From 1995 to 2008, 85 consecutive patients underwent pneumonectomy: 49 received pre-operative radiotherapy and chemotherapy (IT group), and 36 patients did not (non-IT group). Peri-operative and long-term outcomes were compared. RESULTS: Major complications rate was 14.3% for IT group and 16.7% for non-IT group (p = n.s.). Mortality rate was 2% in IT group and 5.5% in non-IT group (p = n.s.). Post-operative hospital stay was significantly longer in the IT group (p < 0.0001) as the need for blood transfusion (p = 0.002). Indeed, the mortality rate was similar in the left- and right-sided operations. 5 years survival was 45.3% for IT group and 38.4% for non-IT group (p = n.s.) and 5 year disease free survival rates were 42.3% vs. 37.8% for the two groups, respectively (p = n.s.). Among the clinical, surgical and pathological features no differences on long term outcomes were found with regards to IT. DISCUSSION: Pneumonectomy is a feasible and safe procedure even after pre-operative IT. Our results showed a prolonged hospitalization and the need for blood transfusion in the IT group.
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Carcinoma de Pulmón de Células no Pequeñas/terapia , Quimioradioterapia , Neoplasias Pulmonares/terapia , Neumonectomía , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Femenino , Humanos , Tiempo de Internación , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Biopsia del Ganglio Linfático Centinela/métodos , Neoplasias de la Mama/patología , Femenino , Humanos , Metástasis Linfática , Mediastino , Tomografía de Emisión de PositronesRESUMEN
Cigarette smoking is one of the major risk factors for COPD and COPD severity. In turn COPD is a major independent risk factor for lung cancer. Genome-wide association (GWA) studies both in lung cancer and COPD highlighted the same variants (SNPs) on chromosome 15q25 marking the gene cluster CHRNA3-CHRNB4-CHRNA5 for these smoking related diseases, showing a stimulating connection between this common genetic region and smoking behavior and smoking related illnesses. Different authors identified two candidate regions associated with age at smoking initiation in patients with COPD. The nicotinic acetylcholine receptor polymorphism (rs1051730) on chromosome 15q25 is associated with major tobacco-related diseases in the general population with additional increased risk of COPD as well as lung cancer. Moreover variants on the gene cluster CHRNA3-CHRNB4-CHRNA5 are associated with nicotine addiction antismoking therapy and antismoking therapy side-effects. These findings not only support the notion that variants can influence any therapy for smoking cessation, but offer rational bases to develop new drugs and new therapeutic strategies. Scope of Proposed Topic (50 words): Genome-wide association (GWA) studies both in lung cancer and COPD highlighted the same variants (SNPs) on the gene cluster CHRNA3-CHRNB4-CHRNA5. These data not only support the notion that variants can influence any therapy for smoking cessation, but offer rational bases to develop new drugs and new therapeutic strategies.
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Sitios Genéticos , Proteínas del Tejido Nervioso/genética , Enfermedad Pulmonar Obstructiva Crónica/genética , Receptores Nicotínicos/genética , Benzazepinas/uso terapéutico , Bupropión/uso terapéutico , Cromosomas Humanos Par 15 , Estudio de Asociación del Genoma Completo , Humanos , Familia de Multigenes , Proteínas del Tejido Nervioso/antagonistas & inhibidores , Proteínas del Tejido Nervioso/metabolismo , Polimorfismo de Nucleótido Simple , Enfermedad Pulmonar Obstructiva Crónica/etiología , Quinoxalinas/uso terapéutico , Receptores Nicotínicos/química , Receptores Nicotínicos/metabolismo , Factores de Riesgo , Fumar/efectos adversos , Fumar/tratamiento farmacológico , Cese del Hábito de Fumar , Dispositivos para Dejar de Fumar Tabaco , VareniclinaRESUMEN
BACKGROUND: Primary tracheal tumors are rare, accounting for only 0.2% of all thoracic cancers. Adenoid cystic carcinoma (ACC) diagnosed in the trachea is very uncommon and its coexistence with second histologically distinct malignant tumors of he neck region has never been reported. SUMMARY: We now report a case of multiple primary laryngotracheal ACC and thyroid follicular carcinoma surgically successful treated with an incidental 8 years follow-up. CONCLUSIONS: The laringotracheal resection with en-bloc thyroidectomy can be adopted for treating multiple primary tumor of tracheal and thyroid carcinoma with good long-term prognosis.
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Carcinoma Adenoide Quístico/cirugía , Neoplasias Laríngeas/cirugía , Neoplasias Primarias Múltiples/cirugía , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tráquea/cirugía , Parálisis de los Pliegues Vocales/etiología , Adulto , Femenino , HumanosRESUMEN
Solitary fibrous tumors are very rare neoplasms that seldomly appear in extra-serosal soft tissues. In such cases, an accurate preoperative diagnosis is often difficult and challenging, especially in extrapleural ones. Traditionally, extrapleural solitary fibrous tumours have been regarded as indolent neoplasms similar to their intra-thoracic counterparts, although there has been some evidence that this subgroup could be a subset of more aggressive malignant tumours. For these reasons, surgical excision is mandatory and represents, to date, the best therapeutic option. In this article we report a case of a malignant solitary fibrous tumor of the chest wall in a 58-year-old man. Problems related to differential diagnosis and the possible pitfalls that can be encountered in the diagnostic process of such rare tumors are discussed.
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Tumores Fibrosos Solitarios/patología , Pared Torácica/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Wernicke's encephalopathy is a neurological disorder caused by thiamine (vitamin B1) deficiency characterized by vertigo, ataxia, and mental confusion. Wernicke's encephalopathy has a causative association with alcoholism but recently there has been an increased prevalence also in other clinical conditions. In literature potentially fatal Wernicke's encephalopathy onset in an advanced achalasia has been previously reported only once. We describe for the first time an improvement of achalasic symptoms in a young patient affected by end-stage achalasia and anorexia nervosa (coming from ineffective Heller-Dor myotomy) after vitamin B1 supplementation. This case report suggest a potential positive impact of B1 supplementation on end-stage achalasic patients and requires systematic studies to confirm this observation.
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Anorexia Nerviosa/complicaciones , Acalasia del Esófago/complicaciones , Vómitos/etiología , Encefalopatía de Wernicke/complicaciones , Adulto , Acalasia del Esófago/tratamiento farmacológico , Femenino , Humanos , Tiamina/administración & dosificación , Encefalopatía de Wernicke/diagnósticoRESUMEN
Complications directly associated with the use of prosthetic materials in large hiatal hernia repair are rarely cited events in the literature. We herein report a case of a 47 year-old woman who came to our attention for a subacute onset of severe dysphagia and weight loss. She previously underwent laparotomic Nissen fundoplication with PTFE dual-mesh cruroplasty for a large recurrent hiatal hernia. With the clinical suspicious of "Tight Nissen", an endoscopy was performed and revealed a circular stenosis in the lower esophagus, a rotation of the stomach and, surprisingly, the presence of PTFE mesh free-moving in the gastric lumen With the use of rattooth forceps, the foreign body was removed and, after few days, the patient underwent a surgical debridement of hiatal scar tissue and a gastropexy procedure. In conclusion, dysphagia may manifest during the early postoperative period after mesh repair antireflux surgery, but such dysphagia usually resolves; if it doesn't or if it worsens, mesh migration must be excluded.
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Trastornos de Deglución/etiología , Migración de Cuerpo Extraño/complicaciones , Hernia Hiatal/cirugía , Mallas Quirúrgicas/efectos adversos , Anciano , Femenino , Fundoplicación/efectos adversos , Humanos , Politetrafluoroetileno , Recurrencia , EstómagoAsunto(s)
Carcinoma de Pulmón de Células no Pequeñas/rehabilitación , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/rehabilitación , Neoplasias Pulmonares/terapia , Anciano , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Ejercicio Físico/fisiología , Femenino , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , MasculinoRESUMEN
AIM: Postoperative air leaks and in particular persistent air leaks (>5 days) after pulmonary resection still represent a common complication and the first cause of hospital stay delay. Aim of this experimental trial was to investigate the efficacy of the use of bovine pericardium strips (in terms of reduction of postoperative leakage and hospital stay) in "critical" patients (COPD, emphysema etc.) who underwent pulmonary resection. METHODS: From October 2010 to February 2011, eight patients (experimental group, Group A) were preoperative selected and underwent pulmonary resection with bovine pericardium strips (Peri-Strips Dry; Synovis ). The inclusion criteria of a "frail patient" were established by a dedicate pneumologist according with clinical and functional data (predicted postoperative FEV1 ranging from 35% and 80% of the theorical predicted value). For comparison, from January 2010 to September 2010, we retrospectively reviewed the data of 28 patients who satisfied the same inclusion criteria and underwent pulmonary resection with standard surgical procedures. This group of patients represents our control group (Group B). RESULTS: There were no significant differences between the two groups in age, gender, preoperative risk factors for developing a postoperative air leak, preop FEV1 and type of resection. No technical deficiencies in the use of bovine pericardium strips were observed in Group A. Postoperative leakage was significant different in the two groups being persistent air leak detected in 0% in Group A versus 17.8% of Group B (P=0.046). Consequently, chest tube duration (6.75±0.84 days [Group A] vs. 9.70±1.26 days (Group B), P=0.019) and hospital stay (10.13±0.83 days [Group A] vs. 12.95±1.37 days [Group B], P=0.013) were lower in the experimental group. CONCLUSION: Bovine pericardium strips are safe and easy-to-do technique to reduce postoperative air leaks after pulmonary resection in "critical" patients.