Erratum to nodal management and upstaging of disease. Initial results from the Italian VATS Lobectomy Registry

[This corrects the article DOI: 10.21037/jtd.2017.06.12.]

Tracking occult pN2 disease after mediastinal dissection in early stage lung cancer.

Lobectomy with mediastinal lymph node dissection represents the standard treatment approach for patients with resectable non-small cell lung cancer (NSCLC). Defining the stage of a malignant disease is crucial for planning therapy, estimating prognosis and for studies compariso

Reti in Alta tensione a neutro isolato: Metodi per la rilevazione della distanza di guasto monofase

Circa 1.940 chilometri della rete di sub-trasmissione italiana a 50-60 kV, in parte posseduta e gestita da Terna, sono tuttora eserciti a neutro isolato, differentemente da tutta la rete di trasmissione che \ue8 sempre esercita con neutro a terra. Tale sistema di potenza ha struttura radiale e consta principalmente di linee aeree dissimmetriche ed eterogenee con tratti in doppia terna, nonch\ue9 in diversi casi con sezioni derivate dalla linea principale. Attualmente, al verificarsi di un guasto monofase permanente, il guasto \ue8 localizzato off-line a seguito dell\u2019apertura permanente degli interruttori di linea. Questa operazione \ue8 compiuta da Terna utilizzando o elicotteri o mezzi terrestri, a seconda delle condizioni metereologiche e orografiche. Tuttavia, dal momento che l\u2019incidenza di guasti monofase \ue8 spesso legata a condizioni meteo avverse, tale procedura pu\uf2 richiedere molto tempo. Per di pi\uf9 essa pu\uf2 essere pi\uf9 complessa e richiedere pi\uf9 tempo se la corrente di guasto monofase \ue8 tale da non lasciare tracce evidenti del guasto stesso, come nel caso di fessurazione interna dell\u2019isolatore. Il prolungato tempo richiesto per individuare il punto di guasto pu\uf2 rappresentare un problema nel caso in cui la porzione di rete coinvolta nel guasto alimenta in antenna strutturale un cliente AT, un produttore o una cabina primaria (specialmente se la capacit\ue0 di contro-alimentazione lato MT non \ue8 sufficiente ad alimentare tutti i carichi sottesi). Da un punto di vista generale, il processo di localizzazione \ue8 consecutivo a quello di rilevazione e consta di due stadi. Primariamente viene identificata la fase guasta, e successivamente si procede con la stima della distanza del punto di guasto dai terminali di linea. Il primo requisito pu\uf2 essere semplicemente soddisfatto determinando quale fase presenta la minore tensione stellata in modulo in concomitanza al guasto monofase. Per quanto riguarda il secondo passo, in [1] e [2] \ue8 riconosciuto che la configurazione a neutro isolato comporta due limitazioni primarie in condizioni di guasto: la corrente di cortocircuito \ue8 piccola in confronto ad altri tipi di guasto (es. bifase e trifase) e l\u2019influenza delle capacit\ue0 distribuite della linea \ue8 maggiore. Questo implica che i metodi convenzionali di localizzazione di guasto monofase non sono adatti a tale configurazione [1]. Il termine \u201cconvenzionale\u201d si riferisce in questo caso specificamente agli algoritmi basati sul metodo voltamperometrico, recensiti in [3] e [4] e sviluppati principalmente per sistemi di potenza AT o AAT eserciti con neutro francamente a terra. Per superare queste limitazioni ad oggi non si \ue8 imposta una procedura preferenziale, ma al contrario esiste nella letteratura tecnica una grande variet\ue0 di metodologie. L\u2019obiettivo di questo contributo \ue8 dunque selezionare, classificare e confrontare quei metodi di localizzazione di guasto monofase applicabili ad un sistema di potenza esercito a neutro isolato. Dato che questa configurazione non \ue8 comune per un sistema AT, molti algoritmi non sono direttamente applicabili essendo pensati per altre topologie di rete. Ne deriva la necessit\ue0 di specificare per ciascun metodo di rilevazione i requisiti di applicazione e le eventuali modifiche da apportare al fine di garantirne il corretto funzionamento

DEGREE OF SATISFACTION WITH THE ENDOSCOPIC TREATMENT OF LUMBAR DISC HERNIATION

ABSTRACT Objective: To evaluate the degree of patient satisfaction and complications after endoscopic surgery for the treatment of lumbar disc herniation. Methods: We retrospectively evaluated 94 patients with lumbar disc herniation undergoing endoscopic lumbar discectomy through the MacNab questionnaire and four subjective questions related to the procedure. Results: Approximately 82% of the patients had good and excellent results, and 91.4% reported being satisfied with the surgical result obtained with endoscopy. The rate of complications with the method was 9.5%, with recurrent disc herniation being the most common complication (5.4% of cases). Conclusions: Endoscopic surgery proved to be an effective and safe method, and an alternative to conventional open surgery. Level of evidence; III. Therapeutic studies - Investigation of treatment results

Trans-thoracic versus retropleural approach for symptomatic thoracic disc herniations: comparative analysis of 94 consecutive cases

Purpose: The authors illustrate their results in the surgical treatment of symptomatic thoracic disc herniations (TDHs) by comparing the traditional open to the less invasive retropleural lateral approaches.Methods: Retrospective review of 94 consecutive cases treated at a single Institution between 1988 and 2014. Fifty-two patients were males, 42 females, mean age was 53.9 years. Mean follow-up was 46.9 months (12-79 months). 33 patients were diagnosed with a giant thoracic disc herniation (GTDH). Upon admission, the most common symptoms were: motor impairment (91.4%, n\u2009=\u200986), neuropathic radicular pain with VAS > 4 (50%), bladder and bowel dysfunction (57.4% and 41.4% respectively) and sensory disturbances (29.7%). The surgical approach was based upon level, laterality and presence or absence of calcified lesions.Results: Decompression was performed in 7 cases via a thoraco-laparo-phrenotomy and in 87 cases via an antero-lateral thoracotomy. Out of the latter cases, 49 (56%) were trans-thoracic trans-pleural approaches (TTA) and 38 (44%) were less invasive retropleural approaches (MIRA). At follow-up, there were 59.5% neurologically intact patients according to the McCormick Scale, while 64.8% and 67% had no bladder or bowel dysfunction respectively. Complications occurred in 24 patients (25.5%). Pulmonary complications were the commonest (12.7%) with pleural effusion being significantly more common in patients treated with TTA compared to MIRA (20% vs 5.2%: X2 4.13 P:0.042). Severe post-operative neuralgia (VAS 7-10) was also significantly more frequent in the TTA group (22.4% vs 2.6% X2 7.07 p 0.0078).Conclusions: MIRA is a safe and effective technique to obtain adequate TDH decompression and is associated with lower morbidity compared to TTA

The Overweight Paradox: Impact of Body Mass Index on Patients Undergoing VATS Lobectomy or Segmentectomy

The aim of this study was to assess the impact of BMI on perioperative outcomes in patients undergoing VATS lobectomy or segmentectomy. Data from 5088 patients undergoing VATS lobectomy or segmentectomy, included in the VATS Group Italian Registry, were collected. BMI (kg/m2) was categorized according to the WHO classes: underweight, normal, overweight, obese. The effects of BMI on outcomes (complications, 30-days mortality, DFS and OS) were evaluated with a linear regression model, and with a logistic regression model for binary endpoints. In overweight and obese patients, operative time increased with BMI value. Operating room time increased by 5.54 minutes (S.E. = 1.57) in overweight patients, and 33.12 minutes (S.E. = 10.26) in obese patients (P < 0.001). Compared to the other BMI classes, overweight patients were at the lowest risk of pulmonary, acute cardiac, surgical, major, and overall postoperative complications. In the overweight range, a BMI increase from 25 to 29.9 did not significantly affect the length of stay, nor the risk of any complications, except for renal complications (OR: 1.55; 95% CI: 1.07-2.24; P = 0.03), and it reduced the risk of prolonged air leak (OR: 0.8; 95% CI: 0.71-0.90; P < 0.001). 30-days mortality is higher in the underweight group compared to the others. We did not find any significant difference in DFS and OS. According to our results, obesity increases operating room time for VATS major lung resection. Overweight patients are at the lowest risk of pulmonary, acute cardiac, surgical, major, and overall postoperative complications following VATS resections. The risk of most postoperative complications progressively increases as the BMI deviates from the point at the lowest risk, towards both extremes of BMI values. Thirty days mortality is higher in the underweight group, with no differences in DFS and OS