Metastatizzazione al colon discendente da carcinoma lobulare della mammella misconosciuto condizionante occlusione intestinale

Distant spread from lobular breast cancer is common, but metastatic bowel involvement is unusual. We report a case of a 83 year old woman admitted with abdominal pain, ascites and fiver. Her history present only a right breast nodule yet biopsied with negative result for malignancy. Blood samples showed leucocitosis and radiological study with abdominal CT revealed only ascites. The paracentesis with cultural and cytological exam were negative. Support and antimicrobal therapy were started. After ten days the patient get worst, so explorative laparoscopy was performed. The retro-peritoneum and the left colon were find involved in a neopalstic mass. Laparotomical resection of involved bowel and definitive colostomy was performed in order to allow canalisation. Intraoperative histological examination revealed retroperitoneal and bowel involvement from lobular breast cancer. Than a surgical biopsy of r the right breast lesion was performed in operating theatre. To our knowledge this is one of few cases reported in literature of colon metastasis from lobular breast cancer. As like as others, metastatic involvement began in parastromal tissue and than infiltration gained sub-mucosal and mucosal tissue. So patient didn’t deveplops signs or symptoms of endoluminal masses or bowel occlusion. No therapy could be started for severe pronstration and the patient died after 39 days from hospital admittance

La qualità in chirurgia oncologica colorettale

ognostic value of good oncological colorectal surgery is now evaluated by the number of lymphnode dissected, particularly the stadiation of the patients is in strong relation between the number of nodes dissected and the overall survival, especially in stage II. The aim of the study is to provide an adequate oncological resection for all patients by stimulating surgeons to perform a more extensive bowel resection with finest nodal dissection. In a two years period since 2007 to 2008, to achieve a more extensive lymphectomy and also minimize local recurrence, a minimum of 5 cm in distance of resection margin was arbitrary fixed for colonic cancer. As reported in literature the distal margin for medium rectal cancer was fixed in 4 cm and 2 cm for lowest rectum. The data collected showed an improvement in the number of patients with more than 5 cm resection margin for colonic cancer raising from 81% in 2006 (before the beginning of the study) to 92,2% in 2007 and 92,4% in 2008. Also the number of patient with more than 12 nodes raised from 94% in 2006, to 98% in 2007 and 100% in 2008. In rectal cancer the results were similar with 81% in 2006, 96% in 2007 and 100% in 2008. These data suggest that interesting surgeon to perform an extensive and finest surgical dissection permit to join a correct oncological surgery in most patients

Software-Based Assessment of Well-Aerated Lung at CT for Quantification of Predicted Pulmonary Function in Resected NSCLC

Background: To test the agreement between postoperative pulmonary function tests 12 months after surgery (mpo-PFTs) for non-small cell lung cancer (NSCLC) and predicted lung function based on the quantification of well-aerated lung (WAL) at staging CT (sCT). Methods: We included patients with NSCLC who underwent lobectomy or segmentectomy without a history of thoracic radiotherapy or chemotherapy treatment with the availability of PFTs at 12 months follow-up. Postoperative predictive (ppo) lung function was calculated using the resected lobe WAL (the lung volume between −950 and −750 HU) at sCT. The Spearman correlation coefficient (rho) and intraclass correlation coefficient (ICC) were used to the test the agreement between WAL ppo-PFTs and mpo-PFTs. Results: the study included 40 patients (68 years-old, IQR 62–74 years-old; 26/40, 65% males). The WAL ppo-forced expiratory volume in 1 s (FEV1) and the ppo-diffusing capacity of the lung for carbon monoxide (%DLCO) were significantly correlated with corresponding mpo-PFTs (rho = 0.842 and 0.717 respectively; p < 0.001). The agreement with the corresponding mpo-PFTs of WAL ppo-FEV1 was excellent (ICC 0.904), while it was good (ICC 0.770) for WAL ppo-%DLCO. Conclusions: WAL ppo-FEV1 and WAL ppo-%DLCO at sCT showed, respectively, excellent and good agreement with corresponding mpo-PFTs measured 12 months after surgery for NSCLC. WAL is an easy parameter obtained by staging CT that can be used to estimate post-resection lung function for patients with borderline pulmonary function undergoing lung surgery

Association between Mortality and Lung Low Attenuation Areas in NSCLC Treated by Surgery

Background: to test the association with overall survival (OS) of low attenuation areas (LAAs) quantified by staging computed tomography (CT) of patients who underwent radical surgery for nonsmall-cell lung cancer (NSCLC). Methods: patients who underwent radical surgery for NSCLC at our institution between 1 January 2017 and 30 November 2021 were retrospectively evaluated. Patients who performed staging or follow-up CTs in other institutions, who received lung radiotherapy or chemotherapy, and who underwent previous lung surgery were excluded. At staging and 12-months follow-up CT, LAAs defined as voxels p = 0.038), staging CT %LAAs ≥ 5% (HR, 7.27; 95%CI, 1.60–32.96; p = 0.010), and staging CT %LAA lobe ratio > 10% (HR, 0.24; 95%CI 0.05–0.94; p = 0.046). Conclusions: in patients with NSCLC who underwent radical surgery, a %LAAs ≥ 5% and a %LAA lobe ratio > 10% at staging CT are predictors, respectively, of shorter and longer OS. The LAA ratio to the whole lung at staging CT could be a critical factor to predict the overall survival of the NSCLC patients treated by surgery

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P&lt;0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)