Tension pneumomediastinum in patients with COVID-19

open5nonot presentopenCampisi A.; Poletti V.; Ciarrocchi A.P.; Salvi M.; Stella F.Campisi A.; Poletti V.; Ciarrocchi A.P.; Salvi M.; Stella F

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

Giant Intrathoracic Schwannoma of the left vagus nerve presenting as atrial fibrillation

Posterior mediastinal tumors are not infrequent, and among them neurogenic masses and schwannomas are the most common histological variety. They are benign, initially asymptomatic tumors and later become symptomatic due to the mass effect. Surgical excision is the preferred therapy and the approach can be evaluated according to the dimensions of the lesion. We report the case of a giant schwannoma, originating from the left vagus nerve, in a middle-aged woman whose symptoms were exertion-induced dyspnoea and atrial fibrillation

The role of Ivor Lewis esophagectomy in the treatment of achalasia with megaesophagus: A case report.

none6noIntroduction Achalasia with megaesophagus is a pathology characterized by widespread and irregular dilation of the esophageal lumen. In most cases, this dilation is caused by contraction and subsequent failed relaxation of the lower esophageal sphincter (LES). It may be associated with a partial or complete slowing of the esophageal peristalsis. Case overview We present the case of a 58-year-old woman who developed dysphagia, regurgitation, and substantial weight loss (11 kg) over a span of 1 year. Symptomatic achalasia with megaesophagus was diagnosed following chest and abdominal computed tomography (CT) with contrast and transit RX with gastrografin and esophageal manometry. The patient refuse all minimally endoscopic treatments and opted straightly for the treatment with esophagectomy sec. Ivor–Lewis. At the 6-month follow-up, the patient appeared in excellent general clinical condition and oral gastrografin radiography (OGR) showed good channeling. Discussion Patients require medical attention when presenting with achalasia that has eroded the esophageal wall enough to form a megaesophagus. Early and minimally invasive treatments (i.e., medical therapy, endoscopic dilation, and myotomy) are insufficient at this stage, and thus esophageal surgery is required. Among the most common surgical approaches, we must mention esophagectomy sec. McKeown and esophagectomy with interposition of a colic loop sec. Wilkins; however, based on our experience, esophagectomy sec. Ivor–Lewis with intrathoracic anastomosis leads to excellent results and can therefore be considered a valid alternative for treating complex cases. Conclusions Subtotal esophagectomy sec. Ivor–Lewis with intrathoracic anastomosis is effective in treating achalasia with megaesophagus.openLorenzo Federico Zini Radaelli, Beatrice Aramini, Angelo Paolo Ciarrocchi, Stefano Sanna, Desideria Argnani, Franco StellaLorenzo Federico Zini Radaelli, Beatrice Aramini, Angelo Paolo Ciarrocchi, Stefano Sanna, Desideria Argnani, Franco Stell

Lung sparing left secondary carina resection for low-grade tumors: a single-center study

Left-side secondary carina resection and reconstruction is a rare, complex procedure, performed just in a few specialized centers in a restricted group of patients. Few studies describe this technique and report its short and long-term results. We reviewed our experience to evaluate the perioperative and short-term outcomes of a very demanding surgery. We retrospectively collected the information of all the patients who underwent secondary carina resection and reconstruction for low-grade malignant bronchial tumors at our center. Between January 2012 and September 2018, 23 patients received surgery for low-grade malignant bronchial tumors. In all patients, a secondary carina resection and reconstruction with total lung parenchymal preservation was performed. The mean age was 44.5\u2009\ub1\u200912.2\ua0years. Pathologies included adenoid cystic carcinoma in ten patients, carcinoid in 7 (6 typical and 1 atypical), mucoepidermoid carcinoma in 4, myoepithelioma in 1 and inflammatory myofibroblastic tumor in 1. The median length of the resected bronchus was 25\ua0mm (range 15-50\ua0mm). Three patients (13%) had, at least, one postoperative complication with no deaths. Two patients had lymph node metastases and eight had positive margins. Nine patients received adjuvant therapy. Follow-up ranged from 13 to 96\ua0months, all patients are currently alive and free of recurrence. Resection and reconstruction of the left secondary carina with preservation of the lung parenchyma can be performed safely in anatomically and oncologically appropriate patients, providing good short-term results when combined with adjuvant therapies

Evaluation of dynamic image progression of minimally invasive and preinvasive lung adenocarcinomas

The target of our study was to investigate if the size (greater than and less than 1 cm) of ground-glass opacities (GGOs) of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) of the lung influences the rate of their evolution

Long-term metabolic assessment of cryopreserved sternal allograft: a case series

BACKGROUND: Sternal resection and reconstruction with cryopreserved allografts provides a safe alternative to traditional methods of anterior chest wall reconstruction. Despite favorable results, successful integration of the graft sternum has never been demonstrated due to the invasiveness of bone biopsy. We describe our experience of using 18F-sodium fluoride PET/CT scans as a non-invasive method of evaluating graft integration.METHODS: Seven patients underwent surgery and radiological follow-up. Surgical indications were sternal metastases (n=5) and sternal dehiscence (n=2). Sternal reconstruction was performed using a cryopreserved cadaveric sternal allograft fixed in place with titanium plates and screws. Follow-up with 18F-NaF PET/CT scans was performed at 1 and 2 years after surgery.RESULTS: Three patients underwent total sternectomy; 2 partial upper sternectomy involving the manubrium, clavicle (only 1 patient) and upper sternal body; and 2 partial sternectomy of the sternal body and xiphoid process. Focal tracer accumulation occurred at the junctions between native bone and graft bone. The median SUVmax at 1 year was 16.8 (range: 11.2-37.9; P25-P75 13.6-19.4) while at 2 years it was 10.8 (range: 6.1-30.2; P25-P75 8.9-15.1). In 6 cases accumulation was lower at the second scan while in one patient the accumulation was higher at the second scan.CONCLUSIONS: Sternal reconstruction with cryopreserved allograft is safe and well-tolerated. 18F-NaF PET/CT scans are a useful and promising non-invasive method of demonstrating the metabolic activity of the graft and its incorporation into the host skeleton during follow-up