Pleural tent after upper lobectomy: a prospective randomized study.

BACKGROUND: The aim of the present study was to assess the cost/efficacy of the pleural tent procedure after upper lobectomy. METHODS: A prospective randomized analysis was performed on 50 patients submitted to upper lobectomy and divided into two groups: group 1 (25 patients) with pleural tent; group 2 (25 patients) without pleural tent. RESULTS: The univariate comparison between the two groups did not show any significant difference in terms of age, gender, spirometry, smoking history, chronic obstructive pulmonary disease index, side of tumor, arterial oxygen tension, arterial carbon dioxide tension, size and location of tumor, presence of pleural adhesions, length of the stapled parenchyma, and operative time. Pleural tent significantly reduced the days of postoperative air leak (1.2 versus 5.8, p = 0.01), chest tubes (5.4 versus 10.4, p = 0.01), and hospital stay (6.9 versus 10.8, p = 0.01). Moreover, no difference was noted between the two groups in terms of pleural effusion in the first postoperative 48 hours, need of postoperative blood transfusion, and occurrence of other complications. CONCLUSIONS: Pleural tenting after upper lobectomy is a safe and effective procedure and its routine use is warranted.

Stair-climbing test to evaluate maximum aerobic capacity early after lung resection.

BACKGROUND: The aim of this study was to investigate the extent of reduction in maximum oxygen consumption in the early postoperative period after lung resection for lung carcinoma. METHODS: A total of 115 patients who underwent lung resection (95 lobectomies, 20 pneumonectomies) performed a maximal stair-climbing test the day before operation and the day of discharge from the hospital (8 +/- 3.3 days after the operation). RESULTS: The postoperative test showed a 15% reduction in maximum oxygen consumption (VO2max) with respect to the preoperative test (Student's t test, p < 0.0001). This reduction was greater after pneumonectomy (21.4%) than after lobectomy (14%) (Student's t test, p < 0.05). A multiple regression analysis showed that the only significant independent predictors of both preoperative and postoperative VO2max were the age of the patient and the level of arterial oxygen content. CONCLUSIONS: The early postoperative reduction in VO2max was greater after pneumonectomy than after lobectomy and the exercise performance was significantly influenced by the level of arterial oxygen content both before and early after the operation.

Internal comparative audit in a thoracic surgery unit using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM).

OBJECTIVE: The aim of the study was to use the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) to assess the performance of our thoracic surgery unit during two successive periods of activity. METHODS: From 1992 through 1997, 801 candidates for thoracic procedures at our institution were considered for the study. After validation of the logistic regression model, including the POSSUM score, observed and POSSUM-predicted morbidities were compared within two groups of patients divided by year of operation (group 1: 1992-1994, n=362; group 2: 1995-1997, n=439) by means of the z-test for the comparison of a proportion with an expected value. RESULTS: The POSSUM-predicted morbidity was significantly lower than the observed one in the first period of activity of our unit (19.6 vs. 24.3%, respectively; z-test for the comparison of a proportion with an expected value, 2.25; P=0.01), whereas no difference was found in the second period (20.5 vs. 19.1%, respectively; z-test for the comparison of a proportion with an expected value, -0.71; P=0.76). CONCLUSIONS: The result suggests a worse-than-expected performance of our unit in the first period of activity, showing that POSSUM can be reliably applied as an instrument of internal comparative audit in a thoracic surgery unit.

Paraneoplastic syndromes in 68 cases of resectable non-small cell lung carcinoma: can they help in early detection?

The aim of this study was to assess the importance of paraneoplastic syndromes as an early sign of non-small cell lung cancer (NSCLC). A procedure for searching paraneoplastic syndromes, based on 40 years of reports in the literature, was established and the prevalence of paraneoplastic syndromes estimated in 68 patients with resectable NSCLC. Stages I and II were considered eligible for surgery straight away. Patients in Stage IIIA underwent surgery if partially or completely responsive to three courses of neo-adjuvant chemotherapy. Paraneoplastic syndromes were assessed and confirmed in nine patients (13%). Motor-sensory neuropathy, arthritis and arthralgias to the knees, periarthritis to the shoulder, hypertrophic osteopathy, clubbing, pruritus were observed. Only three patients with painful osteoarthropathies were diagnosed with NSCLC by tracing their paraneoplastic syndrome, whereas most of them (36/68) were diagnosed incidentally through a chest radiograph taken for tumour-unrelated symptoms. A careful research of paraneoplastic syndromes in high risk patients may guide the doctor to a resectable NSCLC diagnosis. Recent onset arthritis and arthralgias, which cannot be explained otherwise, should be considered to be early clues of lung cancer.

Bromoanaindolone, a novel antimicrobial exometabolite from the cyanobacterium Anabaena constricta.

A new brominated indole alkaloid, designated as bromoanaindolone, was isolated from culture media of the cyanobacterium Anabaena constricta and was identified as 6-bromo-3-hydroxy-3-methyl-indol-2-one with a slight excess of the (3R) enantiomer. The molecular structure was elucidated on the basis of IR, MS and NMR data. This extracellular metabolite of A. constricta possessed antimicrobial (anticyanobacterial and antibacterial) activity in different test systems, such as suspension and porous matrix tests.

Functional recovery after near complete traumatic deficit of the cervical cord lasting more than 24 h.

Two young men presented with a complete cervical cord deficit associated with bilateral C4-C5 dislocation and 11 mm encroachment (sagittal narrowing) of the spinal canal in one case and near complete cervical cord deficit due to a crush fracture of the C7 vertebral body with 9 mm axial compression and 50% antero-posterior encroachment of the canal in the other case. There was no improvement within the first 24 h. Both patients left the hospital walking after open surgical realignment and complete cord decompression.