In Silico Transcriptomic Analysis of Wound-Healing-Associated Genes in Malignant Pleural Mesothelioma.

Background and objectives: Malignant pleural mesothelioma (MPM) is a devastating malignancy with poor prognosis. Reliable biomarkers for MPM diagnosis, monitoring, and prognosis are needed. The aim of this study was to identify genes associated with wound healing processes whose expression could serve as a prognostic factor in MPM patients. Materials and Methods: We used data mining techniques and transcriptomic analysis so as to assess the differential transcriptional expression of wound-healing-associated genes in MPM. Moreover, we investigated the potential prognostic value as well as the functional enrichments of gene ontologies relative to microRNAs (miRNAs) of the significantly differentially expressed wound-healing-related genes in MPM. Results: Out of the 82 wound-healing-associated genes analyzed, 30 were found significantly deregulated in MPM. Kaplan-Meier analysis revealed that low ITGAV gene expression could serve as a prognostic factor favoring survival of MPM patients. Finally, gene ontology annotation enrichment analysis pointed to the members of the hsa-miR-143, hsa-miR-223, and the hsa-miR-29 miRNA family members as important regulators of the deregulated wound healing genes. Conclusions: 30 wound-healing-related genes were significantly deregulated in MPM, which are potential targets of hsa-miR-143, hsa-miR-223, and the hsa-miR-29 miRNA family members. Out of those genes, ITGAV gene expression was a prognostic factor of overall survival in MPM. Our results highlight the role of impaired tissue repair in MPM development and should be further validated experimentally.

A deep azygoesophageal recess may increase the risk of secondary spontaneous pneumothorax.

PURPOSE: The azygoesophageal recess (AER) is known as a possible cause of bulla formation in patients with spontaneous pneumothorax. However, there has been little focus on the depth of the AER. We evaluated the relationship between the depth of the AER and pneumothorax development. METHODS: We conducted a retrospective study of 80 spontaneous pneumothorax patients who underwent surgery at our institution. We evaluated the depth of the AER on preoperative computed tomography scans. RESULTS: Ruptured bullae at the AER were found in 12 patients (52.2%) with secondary spontaneous pneumothorax (SSP) and 8 patients (14.0%) with primary spontaneous pneumothorax (PSP) (p < 0.001). In patients with ruptured bullae at the AER, 10 SSP patients (83.3%) had a deep AER while only 2 PSP patients (25%) had a deep AER (p = 0.015). CONCLUSIONS: A deep AER was more frequently associated with SSP than with PSP. A deep AER may contributes to bulla formation and rupture in SSP patients.

A 44-year-old man with bilateral pneumothorax.

A 44-year-old man presented with a 3-day history of persistent upper-back pain, chest discomfort, and dyspnea. He denied any precipitating events such as trauma or vigorous activity before the presentation of symptoms. His exercise capacity had been excellent. He is a lifetime nonsmoker and never had significant lung problems apart from intermittent asthma for which he had several ED visits in the past. Chest CT scan performed during an asthma exacerbation 2 years earlier demonstrated two left-side lung blebs. He had no prior surgical procedures.

Lipoma pulmonar intraparenquimatoso con comportamiento clínico de neoplasia maligna / Intraparenchymal pulmonary lipoma clinically mimicking malignant neoplasm

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Simultaneous operation in a patient with coronary heart disease, abnormal orifice of coronary arteries, morgagni hernia, atrial septal defect, and pericardial and pleural agenesis.

A 68-year-old male patient with acute coronary syndrome was referred to our center. He also received a diagnosis of diaphragmatic hernia after a clinical examination. The patient underwent a simultaneous aorta coronary bypass operation and repair of the congenital diaphragm hernia. During the operation, the patient was observed to have an atrial septal defect. Our handling of the case is discussed in light of the literature.

Apical parietal pleural holes: what are they?

We report the incidental discovery of an apical pleural abnormality characterized by the presence of pleural holes during video-thoracoscopic surgery for upper limb hyperhidrosis. Patients were 4 males and one female with a median age of 24 years. These pleural anomalies were left sided in all cases with a maximum diameter of 5 mm. One of the defects was double. There was neither air leakage nor water leakage after irrigation. Our hypothesis is that the revealed pleural defect is a precursor of cervical lung hernia.

Relationship of parenchymal and pleural abnormalities with acute pulmonary embolism: CT findings in patients with and without embolism.

PURPOSE: To compare the frequency of pleural and parenchymal abnormalities detected on computed tomography (CT) in patients with and without acute pulmonary embolism (PE), and to investigate whether the pleuroparenchymal findings correlate with the severity of PE. MATERIALS AND METHODS: We retrospectively reviewed contrast-enhanced CT scans acquired in 128 patients suspected of having acute PE. The presence of filling defects consistent with PE was recorded, and the clot burden was quantified. The presence and the severity of parenchymal abnormalities, and the presence, size, and location of pleural effusions were recorded. RESULTS: Forty-nine patients (38%) had CT evidence of PE with a mean degree of obstruction of 27 +/- 21%. Parenchymal abnormalities were seen in 45 patients with PE (92%) and in 66 patients without PE (84%) (P = 0.28). Atelectasis, the most common finding, was present in 27 patients with PE (55%) and 42 patients without PE (53%) (P = 0.86). Wedge-shaped opacity was observed in 15 patients (31%) and consolidation was observed in 19 patients (39%) with PE (P = 0.001). Pleural effusions were present in 27 patients with PE (55%) and 42 patients without PE (53%) (P = 0.86). With regard to the severity of ancillary parenchymal findings, only the number of wedge shaped opacities showed mild correlation with the severity of PE (r = 0.34, P = 0.04). CONCLUSION: The majority of patients with and without PE demonstrate parenchymal and pleural findings on CT. Wedge-shaped opacities and consolidation are significantly associated with PE. Other parenchymal and pleural findings on CT do not correlate with the presence and severity of PE.

Simultaneous bilateral spontaneous pneumothorax with pleural window communicating with bilateral pleural spaces.

A pleural window communicating between bilateral pleural cavities is a serious condition in patients with pneumothorax, allowing air to leak from the affected lung into the contralateral pleural cavity and resulting in bilateral spontaneous pneumothorax. We treated a patient with a history of right-sided bullectomy for simultaneous bilateral spontaneous pneumothorax that subsequently recurred. A pleural window (1 cm long) was detected in the mid-mediastinum, and direct suture closure with localized pleural abrasion using argon beam coagulation on the circumference of the lesion was performed at video-assisted thoracoscopic surgery.

Lóbulo ácigos. Presentación de un caso en pediatría / Azygous lobe. Presentation of a case in pediatrics

El lóbulo ácigos es una rara anomalía del pulmón pero su apariencia radiológica ha sido bien definida. La combinación de la pleura a lo largo de la fisura junto con la vena ácigos da lugar a una imagen parecida a una coma en posición invertida. Clínicamente el lóbulo ácigos se ha aceptado como una variación normal que puede simular varias enfermedades así que la detección de esta anomalía y la clasificación de sus características anatómicas son importantes no solo para diferenciarla de otras condiciones patológicas, sino también para alertar al cirujano de problemas potenciales durante la cirugía. Presentamos el caso de una lactante con diagnóstico inicial de neumonía de lóbulo superior derecho, que posteriormente se diagnostica la presencia de un lóbulo accesorio lóbulo ácigos(AU)

The azygous lobe is a strange anomaly of the lung but its radiological appearance has been well defined. The combination of the pleura along the fissure together with the azygous vein gives rise to an image similar to a comma in inverted position. Clinically, the azygous lobe has been accepted as a normal variation that can simulate several illnesses, so detecting this anomaly and classifying its anatomical characteristics are important not only to differentiate it from other pathological conditions, but also to warn the surgeon of potential problems during surgery. We present the case of a female nursling with an initial diagnosis of pneumonia of the upper right lobe, but later on the presence of an accessory lobe is diagnosed azygous lobe(AU)

Case of the month: Buffalo chest: a case of bilateral pneumothoraces due to pleuropleural communication.

Simultaneous spontaneous bilateral pneumothoraces, the presentation of separate right and left pneumothoraces together, is a rare event. The pleural cavities in humans are separated completely and the only previous reports of pleuropleural communication have been associated with major invasive thoracic procedures, specifically mediastinal surgery. The term "buffalo chest" has been coined for the condition on the basis that the buffalo or bison has a single pleural cavity, one of the few mammals to do so. We present the case of a woman with a past history of a single right sided spontaneous pneumothorax but no major thoracic surgery, who presented to the emergency department with a second spontaneous right pneumothorax that was under tension. After thoracostomy, she was found to have bilateral pneumothoraces which resolved with a unilateral chest drain demonstrating pleuropleural communication. We believe this to be the first reported case of such a presentation in the literature. The case demonstrates an unusual emergency presentation of a rare anatomical anomaly.

Bilateral congenital diaphragmatic hernia with absent pleura and pericardium.

BACKGROUND: Bilateral congenital diaphragmatic hernia is a rare form of diaphragmatic hernia. Independently, pericardial defects are an extremely rare phenomenon. In the case presented, we provide the first complete description of an infant with bilateral congenital diaphragmatic hernia with complete agenesis of the pericardium and inferior parietal pleura. CASE: A male infant was born at 38 weeks of gestation with a prenatal diagnosis of left-sided congenital diaphragmatic hernia. After 1 week of aggressive management, the patient was taken to the operating room for repair. Intraoperatively, the patient was found to have absence of the diaphragm bilaterally, no pleura inferiorly, and no pericardium. A biological mesh was used to construct a diaphragm. At 6 months of age, the patient is growing normally, requiring only supplemental oxygen without pressure support. CONCLUSIONS: Embryologically, this anomaly represents complete lack of development of the pleurocardial folds, pleuroperitoneal folds, and transverse septum, which is previously unreported.

Common pleural cavity in combination with pectus excavatum.

A very rare case is being described; common pleural cavity was accidentally diagnosed in a 3-year-old boy operated for funnel chest (pectus excavatum). During 36 years 516 patients were operated in our department and we often notice pectus excavatum associated with other types of congenital pathology but only one had the common pleural space. In normal human beings pleural space is divided into left and right chambers separated by the mediastinum with no communication in between. In some mammals such as pigs, cows etc. a congenital communication is found between the pleural cavities, but this type of communication is very rare in humans and most often is of acquired origin. Pleural communication may also develop after major cardiothoracic surgery. In this case a 3-year-old male patient was admitted for the elective surgery on pectus excavatum. Clinical examination showed a very deep funnel chest. Both the heart and the mediastinum are left-shifted by the deformed breastbone; it is clearly demonstrated on a plain and lateral X-ray. On the left, beside the main vessels, an indistinct patch is noted. Typical M. Ravitch procedure was performed, by accident the pleural space was opened. Both pleural cavities had an evident communication along the anterior mediastinum. The torn pleura was sutured, the excess air removed by a puncture. Postoperative period was uneventful, additional treatment was not needed; currently the boy is feeling well. The postoperative X-ray showed the heart and the mediastinum to return to normal position.

Laparoscopic treatment of Bochdalek hernia without the use of a mesh.

Bochdalek hernia is a rare pathology. The preoperative diagnosis is difficult, and few reports are available regarding its treatment. Herein we report the case of a 25-year-old woman referred for symptoms of dyspepsia, dysphagia, and thoracic pain exacerbated by pregnancy. Preoperative radiography, EGD, and CT scan revealed a paraesophageal hiatal hernia. Laparoscopic exploration showed the complete thoracic migration of the stomach through a left posterolateral diaphragmatic foramen. The diagnosis of a Bochdalek hernia was then made. The diaphragmatic defect was repaired without inserting a prosthesis, using five separate non-reabsorbable stitches (Rieder technique). The procedure was completed with a Nissen-Rossetti fundoplication. The duration of the procedure was 150 min. Hospital stay was 12 days. There were no complications. Postoperative Gastrografin radiography of the esophagus and stomach showed a normal-shaped fundoplication and confirmed the subdiaphragmatic location of the stomach. We conclude that the laparoscopic approach represents the gold standard for the diagnosis and treatment of Bochdalek hernia and any associated complications.

Accessory fissures of the lung: evaluation by high-resolution computed tomography.

This study was performed to classify and assess the frequency of accessory fissures of the lung by high-resolution CT (HRCT) scans. The HRCT scans of 443 patients were retrospectively reviewed. After exclusion of patients with pulmonary parenchymal distortion, pleural disease or those who had had lobectomy, 186 patients were included in the study. The HRCT scans consisted of 1.5-mm sections obtained at 10-mm intervals and reconstructed with a high-spatial-resolution algorithm. In 59 of 186 patients (32%), a total of 69 accessory fissures were detected. The most common fissure was the inferior accessory fissure ( n=40; 21%, 38 on the right, 2 on the left) followed by the left minor fissure ( n=17; 9%). Other accessory fissures observed were the right superior accessory fissure ( n=2; 1%), the azygos fissure ( n=1; 0.5%) and intersegmental fissures between the medial and lateral segments of the right middle lobe ( n=3; 2%), the superior and inferior segments of the lingula ( n=2; 1%), the anterobasal and laterobasal segments of both the right ( n=1; 0.5%) and the left ( n=3; 2%) lower lobe. In conclusion, the inferior accessory fissure and the left minor fissure were the most common accessory fissures seen on HRCT examinations.

Spiral CT of acute pulmonary thromboembolism: evaluation of pleuroparenchymal abnormalities.

PURPOSE: The goal of this work was to identify and categorize the spectrum of pulmonary parenchymal and pleural abnormalities identified by CT in patients with acute pulmonary thromboembolism (PE). METHOD: A review of interpretations from 4,715 consecutive contrast-enhanced thoracic CT studies identified 41 examinations in which the diagnosis of PE was reported. Thirty-four studies were available for review, and two radiologists confirmed intraluminal defects in 31 patients. The number of emboli were counted and localized using bronchopulmonary nomenclature. Associated parenchymal and pleural abnormalities were tabulated. RESULTS: Of the 31 patients, 13 underwent confirmatory or correlative studies including angiography, radionuclide study, or autopsy. In addition, deep venous thrombosis was confirmed by ultrasound or MRI in 13 patients. An average of 7.5 emboli per patient was detected. Pleuroparenchymal findings were as follows: Nine patients (29%) had no acute pulmonary parenchymal or pleural abnormality. In the remaining 22 patients, pleural effusion was the most common abnormality, found in 14 of 31 (45%). Ten patients (32%) had peripheral wedge-shaped parenchymal opacities suggestive of pulmonary infarction. Normally enhancing lobar atelectasis was seen in nine patients (29%). Six patients (19%) demonstrated heterogeneous parenchymal enhancement within nonaerated lung, two of whom had pathologically proven pulmonary infarct. Thirteen of 31 patients underwent high resolution CT; a typical mosaic perfusion pattern was seen in only 1 patient. CONCLUSION: Twenty-nine percent of patients with acute PE had no acute lung parenchymal abnormality on CT; thus, the absence of parenchymal abnormality on CT does not exclude PE. High resolution CT mosaic perfusion was not a common feature of acute pulmonary embolism. Regions of decreased enhancement within nonaerated lung, seen in 19%, may prove to be an indicator of pulmonary infarction; however, this is a nonspecific finding.

One-stage pedicled omentum majus transplantation into thoracic cavity for treatment of chronic persistent empyema with or without bronchopleural fistula.

OBJECTIVE: Assessment of the present results of surgical treatment for chronic persistent empyema with or without bronchopleural fistula (BPF) using one-stage pedicled omentum majus transplantation into the thoracic cavity. METHODS: From November 1979 to December 1996, 50 patients with chronic persistent empyema were treated by pedicled omentum majus transplanted into the thoracic cavity. There were 35 men and 15 women, and the age range was 15-58 years. Empyema had been present for 0.5-18 years. Twenty-six of 35 cases with chronic tuberculous empyema and six of 15 cases with chronic bacterial empyema suffered from concomitant BPF (n = 32). In the latter, the most common organisms were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. RESULTS: There were no perioperative deaths. Two cases had a significant air leak on the first postoperative day. One of them underwent rethoractomy 30 h after the initial operation to stop the fistula using intrathoracic omentum. Thoracic dead space disappeared in most of the operated cases and a sterilized dry cavity remained in some cases. CONCLUSIONS: One-stage pedicled omentum majus transposition is a safe and easy procedure for chronic persistent empyema and BPF, it breaks down residual or recurrent inflammatory foci mechanically and closes the BPF effectively with minimal deformity of the chest wall.

[An elderly case of pneumothorax treated with omentopexy].

A 74-year-old male was admitted to our hospital because of left pneumothorax with persistent air leakage. He had undergone negative pressure drainage, chemical pleurodesis and transbronchial embolization in another hospital. Chest X-ray and CT scan showed collapse of the left lung and a defect of the pleura in the left lung S9. Patch closure was performed for the round pleurobronchial fistula (35 x 35 mm in size) using polyglycol acid felt and fibrin glue. But as severe air leakage was observed again about 24 hours after surgery, omentopexy was performed. The postoperative course was uneventful, and he was discharged 17 days after the second surgery.