A surgical series on endometriosis-related diaphragmatic hernia.

BACKGROUND: Thoracic endometriosis syndrome gives rise to various clinical and radiological manifestations. We reviewed the records of patients operated for intrathoracic migration of abdominal viscera through a diaphragmatic hernia secondary to thoracic endometriosis. METHODS: We retrospectively reviewed the single-center prospective collected database of all patients operated for thoracic endometriosis during the twenty years. All cases in which an abdominal organ was found to be herniated into the thoracic cavity were retrieved. Clinical and pathological data are presented and analyzed. RESULTS: Twenty women of median age 36 (range 25-58) years were operated for endometriosis-related diaphragmatic hernia. The hernia was diagnosed concomitantly with endometriosis-related pneumothorax in 13 cases and during the exploration of catamenial thoracic pain in seven cases. There were 18 cases on the right side and two cases on the left side. The median diameter of the hernia was 8 cm (2.5-20 cm). In seventeen cases, the hernia was repaired by direct suture, and in three cases a heterologous prosthesis was positioned. At follow-up, two patients had an episode of recurrent pneumothorax. CONCLUSIONS: Diaphragmatic hernia should be ruled out in the presence of endometriosis-related pneumothorax or catamenial thoracic pain. Surgery is indicated to make a pathological diagnosis, restore anatomy, and prevent recurrence in patients presenting with pneumothorax.

Telemedicine for management of patients with lung cancer during COVID-19 in an Italian cancer institute: SmartDoc Project.

BACKGROUND: Telemedicine, and particularly video-consulting, has rapidly accelerated since the coronavirus disease 2019 (COVID-19) pandemic outbreak. The role of e-healthcare for the management of patients with lung diseases is evolving. We report the results of the initial experience of the SmartDoc Project, a telemedicine program activated in a cancer center (Istituto Nazionale Tumori) at the epicenter of the COVID-19 pandemic onset in Italy. METHOD: The SmartDoc project was established to guarantee continuity of healthcare services for patients with lung cancer during the COVID-19 pandemic crisis. The project was promoted within the National Health System to create a regulatory framework to authorize and reimburse telemedicine in its care delivery for all patients. At the end of the virtual meeting, patients were asked to answer an online survey. RESULTS: From June 19 to December 1, 2020, 83 patients participated in the SmartDoc project and received a teleconsultation. The majority of patients were older than 65 years. Among the 83 televisits, 14 (16.9%) were new visits, 2 (2.4%) second opinions, 4 (4.8%) 30-day postsurgery controls, and 63 (75.9%) long-term follow-up visits. A "complete satisfaction" score (5 out of 5 points) was reported in 70.59% of all the respondents; most patients (76.5%) preferred video-consulting and defined it as better than or comparable to an in-person visit. CONCLUSION: The favorable initial results of this study suggest that telemedicine should continue beyond the pandemic crisis and should be embedded in a more efficient and accessible healthcare system.

Usefulness of autofluorescence bronchoscopy in early diagnosis of airway complications after lung transplantation.

Despite the promising results achieved so far in long-term survival after lung transplantation (LuTx), airway complications (ACs) still arise in the post-operative period. Early diagnosis and prompt treatment of ACs play a critical role in preventing their onset. Specifically, large bronchi ischemia has been recognized as a triggering factor for ACs. Autofluorescence bronchoscopy, which was first introduced for early cancer diagnosis, displays ischemic mucosae as red spots, while normal vascularized mucosae appear in green. The aim of this study is to investigate whether a significant correlation exists between ACs and the red/green (RG) ratio detected on scheduled autofluorescence bronchoscopy up to 1 year after LuTx. This prospective, observational, single-center cohort study initially considered patients who underwent LuTx between July 2014 and February 2016. All patients underwent concomitant white-light and autofluorescence bronchoscopy at baseline (immediately after LuTx), on POD7, POD14, POD21, POD28, POD45, 3 months, 6 months, and 1 year after LuTx. An autofluorescence image of the first bronchial carina distal to the anastomosis was captured and analyzed using histograms for red and green pixels; the R/G ratio was then recorded. Potential ACs were classified according according to the presence of a white-light following the MDS (macroscopic aspect, diameter and suture) criteria. The authors assessed the association between the R/G ratio and the ACs occurrence using a generalized estimating equations model. Thirty-one patients met the inclusion criteria and were therefore selected. Out of a total of 53 bronchial anastomoses, 8 developed complications (late bronchial stenosis), with an average onset time of 201 days after LuTx. ACs showed a similar baseline covariate value when compared to anastomoses that involved no complication. Generalized estimating equations regression indicated a clear association over time between the R/G ratio and the rise of complications (p = 0.023). The authors observed a significant correlation between post-anastomotic stenosis and the delayed decrease of the R/G ratio. Preliminary outcomes suggest that autofluorescence bronchoscopy may be an effective and manageable diagnostic tool, proving complementary to other instruments for early diagnosis of ACs after LuTx. Further research is needed to confirm and detail preliminary findings.

Thymoma and pure red cell aplasia with hypoplasia of megakaryocytopoiesis: A rare and life-treating condition.

Thymic tumors are rare diseases with an incidence of 0.15 cases per 100,000 person-years. They can be associated with a variety of other syndromes, such as Myasthenia Gravis or autoimmune disorders. Among them, pure red cell aplasia is a hemato-pathological condition characterized by anemia, reticulocytopenia and erythroid cell hypoplasia of bone marrow. Here, we reported a case of a 62-year-old female with a long history of neurologic symptoms due to Myasthenia Gravis. She was diagnosed with thymoma, with mediastinal mass and pleural thickening. After chemoradiotherapy treatment, she was surgically resected successfully, but she developed anemia and severe thrombocytopenia, worsening in respiratory failure requiring intubation. A bone marrow biopsy was performed resulting in a red-cell aplasia with marked hypoplasia of megakaryocytopoiesis compatible with pure red cell aplasia with acquired thrombocytopenia. Considering that there are no standard treatments, clinical condition improvement was achieved only after some lines of medical treatment. Our data, together with the few already published, help to raise the attention towards acquired cytopenias and the need to optimize the treatment for a potentially life-threatening condition.

Incidental diagnosis of pulmonary mycobacteriosis among patients scheduled for lung cancer surgery: results from a series of 3224 consecutive operations.

BACKGROUND: The relation between pulmonary mycobacteriosis and lung cancer has been scrutinized for many years but the current evidence is inconsistent as some studies found an association between the two, whereas others have reported an insignificant relation. MATERIALS AND METHODS: 3224 consecutive patients undergoing elective thoracic surgery at the Department of Thoracic Surgery of a comprehensive cancer center over a four-year period were considered. Patients diagnosed with pulmonary mycobacteriosis with microbiological confirmation on their surgical specimen were further analyzed. RESULTS: 30 patients were diagnosed with pulmonary mycobacteriosis: six of them had a history of cancer. 18 patients received wedge resection, four patients received anatomic segmentectomy, two were submitted to lobectomy, one underwent pneumonectomy and five patients received other types of lesser procedures. Pulmonary mycobacteriosis and synchronous lung cancer were observed in four patients. CONCLUSIONS: Although rare, the incidental diagnoses of pulmonary mycobacteriosis among patients scheduled for lung cancer resection is not negligible. Pulmonologists, anesthesiologists and thoracic surgeons should be aware of this possibility before planning pulmonary resections of histologically undiagnosed lung nodules.

Pulmonary metastasectomy in uterine malignancies: outcome and prognostic factors.

BACKGROUND: This retrospective study is designed to evaluate factors affecting survival in a population of patients receiving pulmonary metastasectomy after gynecologic cancers. METHODS: Nineteen patients with isolated lung metastases (one or two) were surgically treated with R0 resection. Four of them underwent lobectomies. RESULTS: Six patients (31.6%) received adjuvant therapy and 11 (58%) experienced recurrences after metastasectomy. Five- and ten-year survival were 40.9% and 31.4%, respectively. Five-year survival in patients receiving adjuvant therapy was 52.4%. At multivariate analysis factors negatively influencing survival were a disease-free interval (DFI) of less than 24 months and recurrence after pulmonary metastasectomy. CONCLUSIONS: Pulmonary resection for metastatic gynecologic cancer is feasible and effective; adequate selection of patients is mandatory to achieve satisfactory results and long-term survival.

Devastating fast-growing lung cancer after single lung transplantation.

Patients receiving lung transplantation are at increasing risk for the development of cancer due to the administration of immunosuppressive drugs. We hereby report the case of a patient with a devastating fast-growing lung cancer after single lung transplantation for pulmonary fibrosis.