Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry.

Objectives: Obesity in Europe, and worldwide, has been an increasing epidemic during the past decades. Moreover, obesity has important implications regarding technical issues and the risks associated with surgical interventions. Nevertheless, there is a lack of evidence assessing the influence of obesity on video-assisted thoracic surgery (VATS) lobectomy results.

Digital versus traditional air leak evaluation after elective pulmonary resection: a prospective and comparative mono-institutional study.

Background: The increased demand to reduce costs and hospitalization in general pushed several institution worldwide to develop fast-tracking protocols after pulmonary resections. One of the commonest causes of protracted hospital stay remains prolonged air leaks (ALs). We reviewed our clinical practice with the aim to compare traditional vs.

Cryopreservation of orchid mycorrhizal fungi: a tool for the conservation of endangered species.

The effectiveness of cryopreservation at --80 °C on orchid mycorrhizal fungi was assessed by testing the symbiotic ability of ten fungal isolates following cryo-storage for 10-24 months. The results obtained prove the efficacy of the method, thus providing a valuable tool for ex situ conservation.

Digital air leak monitoring after lobectomy for primary lung cancer in patients with moderate COPD: can a fast-tracking algorithm reduce postoperative costs and complications?

Aim: Prolonged air leaks remain one of the most important complication after pulmonary resection. The aim of this study was to test a new fast-track chest tube removal protocol using a new drainage system, which digitally records postoperative air leaks, compared to the traditional one, with subjective visual air leak assessment.

Methods: Patients with moderate COPD undergoing lobectomy for primary lung cancer at the Department of Thoracic Surgery of the University of Torino were randomised in two groups with different chest drainage systems and different removal protocols: in Group A the drainage was removed after digitally recordered measurement of air leaks; in Group B the tube was removed according to the air leaks visualization by bubbling in the water column.

Management of patients on long-term oral anticoagulant therapy undergoing elective surgery: survey of the clinical practice in the Italian anticoagulation clinics.

In the perioperative management of patients on long-term oral anticoagulant (OAC) therapy the problem is balancing the thromboembolic (TER) and the haemorrhagic risk (HR) in the perioperative period. The Federazione Centri per la diagnosi della trombosi e la Sorveglianza delle terapie Antitrombotiche (FCSA) activated an online registry from November 2001 to August 2003 in order to collect information on the management of these patients in Italy. Four hundred and eleven patients, undergoing elective major (18%) and minor surgery (82%), from 7 centres, were registered.

Low-intensity oral anticoagulant plus low-dose aspirin during the first six months versus standard-intensity oral anticoagulant therapy after mechanical heart valve replacement: a pilot study of low-intensity warfarin and aspirin in cardiac prostheses (LIWACAP).

The objective of this study was to evaluate the safety and efficacy of low-intensity warfarin treatment plus aspirin during the first 6 months after surgery in patients undergoing heart valve substitution with mechanical prostheses. Vitamin K antagonists (VKA) are able to reduce but not eliminate thrombosis and systemic embolism in patients with mechanical heart valves. The intensity of treatment and additional use of aspirin in these patients is still controversial.

The significance of associated pre-invasive lesions in patients resected for primary lung neoplasms.

Objective: To evaluate the prevalence and clinico/prognostic significance of the presence of pre-invasive lesions in patients resected for primary lung neoplasm.

Methods: From 1993 to 2002, 1090 patients received resection for primary lung carcinomas. Of these, 73 presented an associated pre-invasive lesion in the surgical specimen distant from the primary tumour.

The significance of intraoperative pleural effusion during surgery for bronchogenic carcinoma.

Objectives: To analyze patients submitted to thoracotomy for lung carcinoma presenting with an intraoperative pleural effusion (PE).

Methods: From 1993 to 1999, 1279 patients received thoracotomy with curative intent for primary lung carcinoma. Intraoperatively, 52 patients (4%) presented a PE >100ml which was not diagnosed preoperatively.

Solitary fibrous tumour of the pleura: surgical treatment.

Objective: Solitary fibrous tumours (SFT) of the pleura are rare tumours originated from the mesenchimal tissue underlying the mesothelial layer of the pleura. This tumours present unpredictable clinical course probably related to their histological and morphological characteristics.

Methods: Twenty-one patients affected by SFT of the pleura were referred to us for surgical resection from September 1984 to April 2000.

Postoperative pain and superficial abdominal reflexes after posterolateral thoracotomy.

Background: Posterolateral thoracotomy can produce stretching of/or damage to the intercostal nerves and their branches. To assess intercostal nerve impairment after operation, we measured the superficial abdominal reflexes, which are mediated, at least in part, by the most inferior intercostal nerves.

Methods: Using electrophysiologic techniques, we made recordings from the left and right abdominal walls to study the responses evoked by mechanical stimulation of the skin after operation.

Recurrence of thymoma: analysis of clinicopathologic features, treatment, and outcome.

Objective And Methods: This study reports clinicopathologic features, treatment, and outcome of 30 recurrent thymomas out of 266 totally resected thymomas.

Results: The mean disease-free interval to recurrence was 86 months. Recurrence occurred less frequently and after a longer disease-free interval after resection of encapsulated versus invasive thymomas.

Right post pneumonectomy pleural empyema caused by an esophagopleural fistula due to an esophageal carcinoma.

A case report of a patient with pleural empyema resulting from esophagopleural fistula following perforation of squamous cell carcinoma of the esophagus is presented. The patient had previously received a right pneumonectomy for bronchogenic carcinoma with the adjunct of postoperative radiotherapy. Description of the case, differential diagnosis and therapy of esophagopleural fistulas (EPF) as well as a review of the Literature is described and discussed.

Bronchial carcinoid associated with Cushing's syndrome.

Bronchial carcinoid is the most frequent cause of Cushing's syndrome due to ectopic ACTH production. The authors report a case of bronchial carcinoid which diagnosis was difficult because of the presence of pulmonary mycosis, that determined a hypercorticosuprarenalism. Medical treatment with octreotide, ketoconazolo and mitotane was useless, and bilateral suprarenalectomy was performed.

Hemangioma of the rib. A case report.

A case of hemangioma of the left twelfth rib is presented. clinical presentation, radiologic appearance and differential diagnosis with other vascular tumors of the bone are discussed, along with a review of the literature.

[Askin's tumor in a young adult: a rare occurrence. Apropos one case observed].

Askin's tumour is a rare malignant small cell neoplasia of the thoracic wall; it most often effects females during childhood and is characterised by limited survival. The authors report a recent case of Askin's tumour in a young adult male. The case was characterised by multiple recidivation but a long survival.

[Benign fibrous mesothelioma of the pleura].

The authors report 4 cases of patients with benign fibrous mesothelioma of the pleura, an extremely rare pathology (not more than 500 cases reported to date in the literature), and discuss biological behaviour, diagnosis and surgical treatment. Benign fibrous mesothelioma is generally diagnosed by chance during chest x-ray given that it is paucisymptomatic; diagnostic procedures include thoracic CT (which may be supplemented by transthoracic needle biopsy) and bronchoscopy. Treatment is surgical and consists of exeresis of the neoplasia; prognosis is excellent and cases are reported in the literature of 24-year follow-up without recurrence.

Videothoracoscopy and video-assisted small thoracotomy for the treatment of pulmonary malignancies.

Video-assisted thoracic surgical procedures continue to be performed with increased frequency; the role of this new technique in the treatment of pulmonary malignancies or metastatic mediastinal adenopathies is not yet defined. Out of a series of 100 consecutive video-assisted thoracic operations, 22 patients resulted affected by a malignancy in the lung or in the subcarinal lymphnodes: six patients had a primary lung cancer and were operated with a video-assisted small thoracotomy of 5 cm (three lobectomy and three segmentectomy) because of a very poor respiratory reserve. Nine patients received a video-assisted wedge resection of a nodule resulted at the frozen section a metastasis of a carcinoma: a small thoracotomy of 8 cm was made and a hand entered the thoracic cage to obtain a careful palpation of the entire lung; five patients had enlarged lymphnodes only in posterior and inferior mediastinum, inaccessible by cervical mediastinoscopy or anterior mediastinotomy: thoracoscopic exploration obtained a useful mediastinal nodal sampling for these adenopathies.

Preoperative concurrent radiation therapy and cisplatinum continuous infusion in IIIa (N2) non small cell lung cancer. A pilot study.

From April 1991 to September 1993, 18 patients affected by a presumed operable IIIa (N2) non small cell lung cancer (NSCLC) with histologically confirmed bulky mediastinal metastases, received preoperative concurrent radiation therapy and continuous infusion of cisplatinum (CDDP). The radiotherapy consisted of 2 Gy given 5 days a week for a total dose of 50 Gy; CDDP was administered by means of a central catheter and a portable pump at the daily dose of 6 mg/m2 given on the same days as the radiation therapy (total dose: 150 mg/m2). Two weeks after the end of the treatment, the patients were reevaluated: 5 patients had either local or distant disease progression, the other 13 were submitted to thoracotomy: 12 received a complete resection and 1 patient underwent only a mediastinal lymphadenectomy, because pneumonectomy was impossible due to lack of respiratory function.

Successful management of hemorrhage from the pulmonary artery stump after lobectomy for bronchogenic carcinoma.

Pulmonary bleeding from the arterial stump following lung resection is a life-threatening complication requiring immediate surgical correction. Predisposing conditions are almost always represented by bronchopleural fistula and empyema. The operation often represents a major challenge to the thoracic surgeon, because of the choice of the most appropriate surgical access, the optimal technique to control the bleeding, as well as to treat the associated bronchopleural fistula.

[PT (INR) in extractive dental surgery in patients treated with oral anticoagulants].

The authors report their actual behaviour in dental extractive surgery with regard to patients subjected to oral anticoagulant therapy. They analyze the hospital ambulatory casistry treated, formulate some considerations and conclude confirming their behaviour supported by the results obtained.

Combined radiosurgical treatment of Pancoast tumor.

Operative technique and long-term results of 60 consecutive patients with Pancoast tumor treated with combined radiosurgical treatment were evaluated. External radiation therapy was administered preoperatively in a dose of 30 Gy in 50 patients. Operation was considered radical (R0) in 36 patients (60%).

[Post-traumatic right diaphragmatic hernia. Description of a clinical case].

The paper reports a case of chronic right posttraumatic diaphragmatic hernia which was brought to the authors' attention due to onset of intestinal subocclusion. Surgery was performed using thoracotomy with reduction of the ilial loops in the abdomen and suture of the diaphragmatic breech; a laparotomic route was used to resect a tract of ischemic small intestine using a termino-terminal anastomosis. The authors discuss the etiopathogenetic, diagnostic and therapeutic problems in the light of data reported in the literature.

Results of surgical resection of stage IIIa (N2) non small cell lung cancer, according to the site of the mediastinal metastases.

Out of a series of 1563 consecutive patients submitted to thoracotomy for lung cancer between 1980 and 1990, 278 patients underwent a resection for a non small cell lung cancer (NSCLC) with mediastinal node metastases (N2). Selection of cases for surgery was carried out using CT from 1983 and mediastinoscopy for the patients with mediastinal lymph nodes larger than 1.5 cm from 1985: all patients with positive mediastinoscopy were excluded from thoracotomy, but 10 cases underwent a resection after neoadjuvant radio-chemotherapy.

[Post-traumatic hernia of the diaphragm].

The paper reports the series of post-traumatic hernias of the diaphragm observed during the period between 1954 and June 1992. This group of 77 patients (59 males and 18 females) were aged between 6 and 75 years old. Both acute and chronic hernias were reported; in 60 cases the diaphragmatic lesion was on the left, in 9 cases on the right, and there were 8 cases of laceration to both hemidiaphragms.

[Clinical case of alloimmunization with a rare anti-Cartwright antibody associated with anti-Kidd antibody].

A patient with a rare IgG anti-Cartwright (anti-Yt(a)) is reported. An association with anti-Kidd(a) was also found. The behavior of this antibody "in vivo" is discussed.