Post-pneumonectomy broncho-pleural fistula successfully closed by open-window thoracostomy associated with V.A.C. therapy

Broncho-pleural fistula (BPF), is a dramatic complication that may occur after lung resection. The treatment is challenging due to its high rate of morbidity and mortality. Herein, a case of BPF associated with empyema, occurred in an elderly patient who had undergone to left pneumonectomy for non-small cell lung cancer (NSCLC), is reported. After various treatments including chest drainage and endoscopic procedures, BPF was successfully closed by open-window thoracotomy associated with vacuum assisted closure (V.A.C.) device therapy. The authors conclude that V.A.C. is a convenient and safe measure in the management of empyema with BPF. Moreover, in similar clinical contexts, V.A.C. may be the only option available that may assure the survival of the patient and the avoiding any later-phases of residual cavity

On the Telegraph Process Driven by Geometric Counting Process with Poisson-Based Resetting

We investigate the effects of the resetting mechanism to the origin for a random motion on the real line characterized by two alternating velocities v1 and v2 . We assume that the sequences of random times concerning the motions along each velocity follow two independent geometric counting processes of intensity λ , and that the resetting times are Poissonian with rate ξ> 0 . Under these assumptions we obtain the probability laws of the modified telegraph process describing the position and the velocity of the running particle. Our approach is based on the Markov property of the resetting times and on the knowledge of the distribution of the intertimes between consecutive velocity changes. We obtain also the asymptotic distribution of the particle position when (i) λ tends to infinity, and (ii) the time goes to infinity. In the latter case the asymptotic distribution arises properly as an effect of the resetting mechanism. A quite different behavior is observed in the two cases when v2< 0 < v1 and 0 < v2< v1 . Furthermore, we focus on the determination of the moment-generating function and on the main moments of the process describing the particle position under reset. Finally, we analyse the mean-square distance between the process subject to resets and the same process in absence of resets. Quite surprisingly, the lowest mean-square distance can be found for ξ= 0 , for a positive ξ , or for ξ→ + ∞ depending on the choice of the other parameters

Age as a risk factor in the occurrence of pneumothorax after transthoracic fine needle biopsy: Our experience

Transthoracic needle biopsy (TTNB) of the lung is a well-established technique for diagnosing many thoracic lesions, and is an important alternative to more invasive surgical procedures. Complications of TTNB include pneumothorax, hemoptysis, hemothorax, infection, and air embolism, with the most common complication as pneumothorax. From June 2011 to June 2014 we performed a prospective study of 188 patients who underwent TTNB with CT guidance at University Hospital of Salerno, Italy. Pneumothorax occurred in 14 of 188 biopsies (7.45%). With the respect of age of patients pneumothorax occurred more frequently in patients aged 60-70 years, while it was less frequent in younger (70 years). In conclusion, data of our prospective study documented that CT-guided TTNB is a safe and reliable procedure in elderly patients with suspected chest malignancy and is well tolerated

Directionality preservation of nuclear recoils in an emulsion detector for directional dark matter search

Nuclear emulsion is a well-known detector type proposed also for the directional detection of dark matter. In this paper, we study one of the most important properties of direction-sensitive detectors: the preservation by nuclear recoils of the direction of impinging dark matter particles. For nuclear emulsion detectors, it is the first detailed study where a realistic nuclear recoil energy distribution with all possible recoil atom types is exploited. Moreover, for the first time we study the granularity effect on the emulsion detector directional performance. As well as we compare nuclear emulsion with other directional detectors: in terms of direction preservation nuclear emulsion outperforms the other detectors for WIMP masses above 100 GeV/c$^2$.Comment: Prepared for submission to JCA

Flood susceptibility assessment in a highly urbanized alluvial fan: the case study of Sala Consilina (southern Italy)

Abstract. This paper deals with the risk assessment to alluvial fan flooding at the piedmont zone of carbonate massifs of the southern Apennines chain (southern Italy). These areas are prime spots for urban development and are generally considered to be safer than the valley floors. As a result, villages and towns have been built on alluvial fans which, during intense storms, may be affected by flooding and/or debris flow processes. The study area is located at the foothills of the Maddalena mountains, an elongated NW-SE trending ridge which bounds to the east the wide intermontane basin of Vallo di Diano. The area comprises a wide detrital talus (bajada) made up by coalescent alluvial fans, ranging in age from the Middle Pleistocene to the Holocene. Historical analysis was carried out to ascertain the state of activity of the fans and to identify and map the zones most hit by past flooding. According to the information gathered, the Sala Consilina fans would appear prone to debris flows; in the past these processes have produced extensive damage and loss of life in the urban area. The watershed basins feeding the fans have very low response times and may produce debris flow events with high magnitudes. Taking into account the historical damage, the fan surface morphology, and the present urban development (street orientation and hydraulic network), the piedmont area was zoned and various susceptibility classes were detected. These results may represent a useful tool for studies aiming at territorial hazard mapping and civil protection interventions

A double-ended queue with catastrophes and repairs, and a jump-diffusion approximation

Consider a system performing a continuous-time random walk on the integers, subject to catastrophes occurring at constant rate, and followed by exponentially-distributed repair times. After any repair the system starts anew from state zero. We study both the transient and steady-state probability laws of the stochastic process that describes the state of the system. We then derive a heavy-traffic approximation to the model that yields a jump-diffusion process. The latter is equivalent to a Wiener process subject to randomly occurring jumps, whose probability law is obtained. The goodness of the approximation is finally discussed.Comment: 18 pages, 5 figures, paper accepted by "Methodology and Computing in Applied Probability", the final publication is available at http://www.springerlink.co

Role of FDG-PET scan in staging of pulmonary epithelioid hemangioendothelioma

In this report we describe a case of pulmonary epithelioid hemangioendothelioma (PEH) in a young woman. The neoplasm manifested with dry cough, chest pain, finger clubbing, and multiple bilateral pulmonary nodules on chest x-ray and computed tomographic (CT) scan. She underwent thoracoscopy, and the histological features of the lung biopsies were initially interpreted as consistent with a not-well-defined interstitial lung disease. Our patient was clinically and radiologically stable over a period of four years, after which the disease progressed to involve not only the lung but also mediastinal lymph nodes, liver and bone. Fiberoptic bronchoscopy showed subtotal occlusion of the right middle and lower lobe bronchi. The histologic examination of bronchial biopsies revealed a poorly differentiated neoplasm immunohistochemically positive for vimentin and vascular markers CD31, CD34 and Factor VIII. A diagnosis of malignant hemangioendothelioma was made. Positron emission tomography (PET) is more sensitive than CT scan and bone scintigraphy in detecting PEH metastases. Furthermore, 18-fluorodeoxyglucose (FDG) uptake seems to be related to the grade of malignancy of PEH lesions. Therefore, we suggest that FDG-PET should be included in the staging system and follow-up of PEH

Migration of surgical clips through a right lobectomy stump mimicking an asthmatic syndrome

The mechanical stapler is routinely used in thoracic surgery practice to attend resection of bronchus and vessels. Herein, we reported a very rare complication as the migration of a titanium surgical clip through a right lobectomy stump. One year after the procedure, the patient complained of persistent cough. A misdiagnosis of asthma was made and she treated for 6 months with bronchodilators, corticosteroid and antihistaminic without success. Thus, patient re-referred of our unit. No clinical signs of infection as fewer, productive cough, dyspnea were present. The laboratory exams were within normal value including white cells. CT scan revealed no abnormalities. Bronchoscopy demonstrated a healed upper bronchus stump without evidence of an actual, open bronchopleural fistula but with clips apparently working their way into the airway, with approximately half of the clip visible within the lumen. The side of the clips that would be open before closure by the surgeon formed the leading edge of the clips visible in the lumen. The clips were successfully removed during flexible bronchoscopy with a forceps usually used for biopsy. After the procedure, the cough disappeared. The endoscopy check after 3 months showed a normal bronchial stump without evidence of fistula