Effect Of α2-Adrenergic Agonists And Antagonists On Cytokine Release From Human Lung Macrophages Cultured In Vitro.

The most trusted hypothesis to explain how α2-adrenergic agonists may preserve pulmonary functions in critically ill patients is that they directly act on macrophages by interfering with an autocrine/paracrine adrenergic system that controls cytokine release through locally synthetized noradrenaline and α1- and α2-adrenoreceptors. We tested this hypothesis in primary cultures of resident macrophages from human lung (HLMs). HLMs were isolated by centrifugation on percoll gradients from macroscopically healthy human lung tissue obtained from four different patients at the time of lung resection for cancer. HLMs from these patients showed a significant expression of α2A, α2B and α2C adrenoreceptors both at the mRNA and at the protein level. To evaluate whether α2 adrenoreceptors controlled cytokine release from HMLs, we measured IL-6, IL-8 and TNF-α concentrations in the culture medium in basal conditions and after preincubation with several α2-adrenergic agonists or antagonists. Neither the pretreatment with the α2-adrenergic agonists clonidine, medetomidine or dexdemetomidine or with the α2-adrenergic antagonist yohimbine caused significant changes in the response of any of these cytokines to LPS. These results show that, different from what reported in rodents, clonidine and dexdemetomidine do not directly suppress cytokine release from human pulmonary macrophages. This suggests that alternative mechanisms such as effects on immune cells activation or the modulation of autonomic neurotransmission could be responsible for the beneficial effects of these drugs on lung function in critical patients.

Surgical management of cervico-mediastinal goiters: Our experience and review of the literature.

AIM: We analyze and discuss the clinical presentation, the diagnostic procedures and the surgical technique in relation to post-operative complications and results in cervico-mediastinal thyroid masses admitted in Thoracic Surgery Unit of AOU Second University of Naples from 1991 to 2006 and in Thoracic Surgery Unit of AOU "S. Giovanni di Dio & Ruggi D'Aragona" of Salerno over a period of 3 years (2011-2014). METHODS: We reviewed 97 patients who underwent surgical treatment for cervico-mediastinal goiters. 47 patients (49.2%) had cervico-mediastinal goiter, 40 patients (40%) had mediastino-cervical goiter and 10 patients (10.8%) had mediastinal goiter. 73 cases were prevascular goiters and 24 were retrovascular goiters. We performed total thyroidectomy in 40 patients, subtotal thyroidectomy in 46 patients and in 11 cases the resection of residual goiter. In 75 patients we used only a cervical approach, in 21 patients the cervical incision was combined with median sternotomy and in 1 patient with transverse sternotomy. RESULTS: Three patients (3.1%) died in the postoperative period (2 cardio-respiratory failure and 1 pulmonary embolism). The histologic study revelead 8 (7.7%) carcinomas. Postoperative complications were: dyspnea in 9 cases (10.7%), transient vocal cord paralysis in 6 patients (9.2%), temporary hypoparathyroidism in 9 patients (9.2%) and kidney failure in 1 case (0.9%). CONCLUSIONS: The presence of a cervico-mediastinal thyroid mass with or without respiratory distress requires a surgical excision as the only treatment option. Thyroid masses extending to the mediastinum can be excised successfully by cervical incision. Bipolar approach (cervical incision and sternotomy) has an excellent outcome, achieving a safe resection, especially in large thyroid masses extending to the mediastinum with close relations to mediastinal structures and in some limited cases (carcinoma, thyroiditis, retrovascular goiter, ectopic goiter). Postoperative mortality and morbidity is very low, independent of surgical techniques. Other surgical approaches for excision of a Posterior Mediastinal Thyroid Goiter reported in literature are: VATS techniques to remove an ectopic intrathoracic goiter, robot-assisted technique for the removal of a substernal thyroid goiter, with extension into the posterior mediastinum.

Role of diffusing capacity in predicting complications after lung resection for cancer.

BACKGROUND: The purpose of our study was to determine whether the assessment of the diffusing capacity of the lung for carbon monoxide (DL (CO)), together with the forced expiratory volume in 1 second (FEV (1)), could improve the selection of surgical patients. METHODS: The data of 76 patients undergoing major lung resection (pnemonectomy, bilobectomy or lobectomy) for non-small cell lung cancer were retrospectively studied. All patients were reviewed for age, sex, preexisting medical conditions, operative, and pathological findings and postoperative outcome. RESULTS: Univariate and multivariable logistic regression analysis showed that ppoFEV (1) and ppoDL (CO) were the only statistically significant predictors of pulmonary complications. In the group of patients with marginal ppoFEV (1) (between 30 - 40 %), ppoDL (CO) predicted pulmonary morbidity with a better accuracy ( P < 0.005) than ppoFEV (1) ( P > 0.05). Multiple regression analysis showed that pneumonectomy was the only statistical factor correlated with mortality ( P < 0.05). CONCLUSION: Our experience seems to suggest that ppoDL (CO) is a strong predictor of pulmonary complications after major lung resection, allowing a better surgical selection of the patients with compromised respiratory function.

Surgical strategies in cervico-mediastinal goiters.

AIM: We retrospectively studied clinical picture, diagnosis, treatment and complications of patients with cervico-mediastinal goiter who underwent surgery. METHODS: Sixty-three patients underwent surgical treatment for cervico-mediastinal goiter in the last 10 years. Thirty-two patients (50.8%) had cervico-mediastinal goiter, 24 patients (33.3%) had mediastino-cervical goiter and 7 patients (11.1%) had mediastinal goiter. Forty-seven cases were prevascular goiters and 16 were retrovascular goiters. We performed total thyroidectomy in 25 patients, subtotal thyroidectomy in 31 patients and in 7 cases the resection of residual goiter. In 50 patients we used a cervical approach, in 12 patients the cervical incision was combined with median sternotomy (6 in total) and in 1 patient with transverse sternotomy. RESULTS: Three patients (4.7%) died in the postoperative period (2 cardio-respiratory failure and 1 pulmonary embolism). The histologic study revelead 5 (7.9%) carcinomas. Postoperative complications were: dyspnea in 7 cases (11.1%), transient vocal cord paralysis in 5 patients (7.9%), temporary hypoparathyroidism in 6 patients (9.5%) and kidney failure in 1 case (1.6%). CONCLUSIONS: Cervicotomy is the approach of choice but in some limited cases (carcinoma, thyroiditis, retrovascular goiter, ectopic goiter) the sternotomy should be performed. Postoperative mortality and morbidity is very low, independent of surgical techniques.

[Role of radio-guided surgery with 111In-octreotide in the treatment of thoracic neoplasms]. / Ruolo della chirurgia radio-guidata con in-octreotide nel trattamento delle neoplasie toraciche.

The study evaluates the role of radio-guided surgery (RGS) with 111In-octreotide in the treatment of lung neoplasms. RGS with octreotide appears to be useful in surgery, above all during the intraoperative staging of the tumour; it can define with greater precision the extent of the resections extended towards the lung wall and ensure a radical approach in minimal lung resections.

[Pleural mesothelioma. A case report]. / Mesotelioma pleurico. Descrizione di un caso.

Malignant mesothelioma can be considered a rare neoplasm, very aggressive, chemo- and radio-resistant, characterized by high percentage of mortality and precarious quality of life. Surgery, radio- and chemo-therapy must be administered with articulate strategy and with realistic objective of palliation. Our experience can represent a model in this direction: we treated a patient with palliative surgery and following loco-regional and "maintenance" systemic chemotherapy with taxol at minimal efficacious dosage (135 mg/m2 every 3 weeks). After 27 months the patient is alive and with a good quality of life.

[Postoperative septic complications in patients operated on for thoracic neoplasms]. / Le complicanze settiche postoperatorie nei pazienti operati per neoplasie del torace.

The authors executed a prospective clinic study evaluating, whether at the admittance or after surgery, the immunity status of 30 patients with a thoracic neoplasm, admitted to Department of Thoracic Surgery, I School of Medicine, Naples. Only 21 of them, immunodepressed at the admittance, were accepted to trial and assigned respectively to A Group destined to surgery (10 patients) and to B check Group (11 patients). In the A Group the effectiveness of the immunotherapy was valued in the prophylaxis and in the postoperative septic complications' therapy. The global incidence of those complications was of 6 cases, of which 10% only in A Group and 45% in B Group. In the operated patients the septic complications had few repercussions on general status and were rapidly and totally dominated in strict correlation with an adequate immunoreconstitution.

[Endoscopic sclerosing therapy in esophageal varices. Indications and personal technics]. / Sclerosi endoscopica delle varici esofagee.

Variceal bleeding in cirrhotic patients with poor liver function is associated with a high mortality. A non-operative treatment, endoscopic sclerotherapy, was employed in 16 patients. The preliminary results have been encouraging. It has been possible to eradicate esophageal varices in the cronic injection group. A longer follow-up period will be required to assess both the quantitative and the qualitative aspects of survival and to determine how long esophageal varices will remain eradicated as well as how frequently repeated injections will be required.