Hemothorax by Intercostal Varicose Veins in Alcoholic Liver Cirrhosis

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From "traction bronchiectasis" to honeycombing in idiopathic pulmonary fibrosis: A spectrum of bronchiolar remodeling also in radiology?

The diagnostic and prognostic impact of traction bronchiectasis on high resolution CT scan (HRCT) in patients suspected to have idiopathic pulmonary fibrosis (IPF) is increasing significantly

Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: The Pros-IT CNR study

Background: The National Research Council (CNR) prostate cancer monitoring project in Italy (Pros-IT CNR) is an observational, prospective, ongoing, multicentre study aiming to monitor a sample of Italian males diagnosed as new cases of prostate cancer. The present study aims to present data on the quality of life at time prostate cancer is diagnosed. Methods: One thousand seven hundred five patients were enrolled. Quality of life is evaluated at the time cancer was diagnosed and at subsequent assessments via the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and the Short Form Health Survey (SF-12). Results: At diagnosis, lower scores on the physical component of the SF-12 were associated to older ages, obesity and the presence of 3+ moderate/severe comorbidities. Lower scores on the mental component were associated to younger ages, the presence of 3+ moderate/severe comorbidities and a T-score higher than one. Urinary and bowel functions according to UCLA-PCI were generally good. Almost 5% of the sample reported using at least one safety pad daily to control urinary loss; less than 3% reported moderate/severe problems attributable to bowel functions, and sexual function was a moderate/severe problem for 26.7%. Diabetes, 3+ moderate/severe comorbidities, T2 or T3-T4 categories and a Gleason score of eight or more were significantly associated with lower sexual function scores at diagnosis. Conclusions: Data collected by the Pros-IT CNR study have clarified the baseline status of newly diagnosed prostate cancer patients. A comprehensive assessment of quality of life will allow to objectively evaluate outcomes of different profile of care

Transesophageal endoscopic ultrasound (EUS) in pulmonary medicine

Endoscopic ultrasound (EUS) is a safe and minimally invasive procedure, allowing ultrasound-guided needle aspirates in real-time, with high-sensitivity diagnostics. EUS is an instrument available to the pulmonologist for the diagnosis of mediastinal neo-plasms, benign and malignant, including the mediastinal lymph node staging of non-small cell lung cancer (NSCLC), with a specific sensitivity up to 90%. EUS allows to detect and to sample even small lesions with a diameter of 3 mm, which are not visible at usual imaging. The most recent guidelines on mediastinal nodal staging of lung cancer report endoscopic and trans-bronchial ultrasound (EUS and EBUS) as a viable and valid minimally invasive alternative to the “classical” surgical staging with mediastinoscopy, resulting in significant savings in diagnostic invasive surgical procedures, and unnecessary thoracotomy, with a consequent high economical impact. EUS-FNA, as EBUS-TBNA, has been shown to be able to give in one time the diagnosis, the typing, staging, and genotyping of lung cancer with a single diagnostic procedure. However, it must be highlighted that in the mediastinal nodal re-staging of NSCLC, the sensitivity of EUS-FNA significantly decreases, being <50%. Therefore, in all cases of negativity at the re-staging a surgical mediastinoscopy should be performed before therapeutical decisions. EUS should be performed in referral centres, so patients should be referred to centres of reference for a complete endoscopic staging with EBUS/ EUS. All patients, except those with a known pathologic esophageal stenosis, might be investigated by EUS, even on an outpatient basis, in mild sedation with midazolam, or deep sedation with anaesthesia care based on the internal structure organization, and complications are very rare

Diagnostic yield and safety of EUS-FNA biopsy in sub-aortic and para-aortic lymph node stations with the trans-aortic approach: a case series and literature review

Background: Sub-aortic (station 5) and para-aortic (station 6) lymph nodes are not easily accessible due to the interposition of the aorta and the left pulmonary artery. Taking a biopsy from those stations could be of value when there are no other mediastinal lymph node stations or when biopsy in other sites failed to reach a diagnosis. Surgery is the gold standard technique in the evaluation of those stations; endoscopic ultrasound-fine needle aspiration (EUS-FNA) has been proposed as a minimally invasive technique through the trans-aortic approach, with an acceptable diagnostic yield and safety profile. Objective: To evaluate diagnostic accuracy and safety of the trans-aortic EUS-FNA in lymph node stations 5 and 6. Methods: We reviewed all patients who underwent trans-aortic EUS-FNA from 2010 to 2017, for mediastinal lymph node enlargement or positron emission tomography/computed tomography (PET/CT) positivity (integrated 2-deoxy-2-fluoro-d-glucose). Demographic characteristics, lesion site and size, needle, final diagnosis, and complications were collected. Results: A total of 11 patients were included, 5 males, mean age 59 years. Samples were inadequate in two cases, a diagnosis of lung cancer was reached in four patients (two adenocarcinoma and two squamous cell carcinoma) and five cases were negative for malignancy (one confirmed by surgery, two were found to be cancer at percutaneous lung biopsy and transbronchial biopsy, one patient received a diagnosis of Langerhans cell histiocytosis by transbronchial lung cryobiopsy, and one patient was lost at follow-up). The sensitivity for malignancy was 57%, and the overall diagnostic accuracy was 45%. No complications occurred. Conclusions: Trans-aortic EUS-FNA could be proposed as a valuable and safe approach for taking biopsy from mediastinal lymph node stations 5 and 6