Stenting treatment is a minimally traumatic and effective alternative to surgical repair for iatrogenic tracheobronchial lesion

Iatrogenic tracheobronchial injuries are rare but lifethreatening events, most frequently due to complication of endotracheal intubation or percutaneous tracheostomy. Their incidence is low (0.005–0.2% after double lumen or emergency single lumen intubation and up to 0.7% after percutaneous tracheostomy), but related mortality can be high and has been generally reported between 11% and 42% (1-5). Surgical repair has been considered the treatment of choice for a long time. More recently, along with the progressive evolution of interventional bronchoscopy, minimally invasive endoscopic treatment has gained diffusion as an effective alternative

Thoracic surgery for malignancy and emergency irrespective of COVID-19

until March 24, 2020, a COVID-19 test by nasopharyngeal swab was offered to the patients presenting with symptoms of COVID-19. However, from April 2, 2020, we changed that policy, offering 2 COVID-19 tests by nasopharyngeal swab to everyone undergoing thoracic surgery for malignancies before admission to our general university hospital, even if asymptomatic

Bronchovascular reconstruction in the era of mini-invasiveness

bronchovascular reconstruction in the era of mininvasivenes

A high-volume thoracic surgery division into the storm of the COVID-19 pandemic

Since the coronavirus 2019 (COVID-19) crisis broke out in Italy at the end of February 2020, days before the World Health Organization declared the pandemic,1,2 two crucial issues urgently emerged and needed to be addressed by our institution. First was the containment of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic together with the restructuring of national public and private health care to face the spread of the new viral disease among the population. Second, central as well, was to maintain the offer of medical and surgical treatments to the patients who still presented with other severe diseases—of these in particular, oncologic patients

The advantage of sleeve lobectomy over pneumonectomy

Answer to Dr. Ludwig about lower sleeve lobectomy, the so-called “Y” sleeve

Managing benign tracheal stenosis during COVID-19 outbreak

If elective surgery has been recommended to be postponed some diseases could potentially become life-threatening and cannot be delayed. Among these conditions, tracheal idiopathic stenosis, primary caused by endotracheal intubation or tracheostomy, usually become symptomatic when reach 50% obstruction. Endoscopic procedures could be considered as frst treatment in selected patients after stenosis evaluation, such as non-complex stenosis with low grade of cartilage involvement or tracheomalaci

Relevance of pharmacogenomics and multidisciplinary management in a young-elderly patient with KRAS mutant colorectal cancer treated with first-line aflibercept-containing chemotherapy

Introduction: Intensive oncological treatment integrated with resection of metastases raised the clinical outcome of metastatic colorectal cancer (MCRC). In clinical practice, complex evaluation of clinical (age, performance status, comorbidities), and biological (tumoral genotype, pharmacogenomic) parameters addresses tailored, personalized multidisciplinary treatment strategies. Patients with MCRC unsuitable for first-line intensive medical treatments are prevalent and showed worse clinical outcome. After progression to oxaliplatin-based chemotherapy, aflibercept/FOLFIRI significantly improved clinical outcome, even if no survival benefit was reported in adjuvant fast relapsers by aflibercept addition. The case reported a young-elderly (yE) patient with KRAS mutant colorectal cancer rapidly progressing to adjuvant chemotherapy, unfit owing to comorbidities, with multiple pharmacogenomic alterations, who gained long-term survival in clinical practice by multidisciplinary treatment strategy consisting of first-line and re-introduction of aflibercept-containing chemotherapy and two-stage lung metastasectomies. Case presentation: A 71-years-old yE patient, unfit for intensive oncological treatments owing to Cumulative Illness Rating Scale (CIRS) stage secondary, affected by KRAS c.35 G>T mutant colorectal cancer, rapidly progressing with lung metastases after adjuvant XelOx chemotherapy, reached long-term survival 66 months with no evidence of disease after first-line and re-introduction of tailored, modulated aflibercept (4 mg/kg) d1,15-irinotecan (120 mg/m2) d1,15-5-fluorouracil (750 mg/m2 /day) dd1–4, 15–18; and secondary radical bilateral two-stage lung metastasectomies. Safety profile was characterized by limiting toxicity syndrome at multiple sites (LTS-ms), requiring 5-fluorouracil discontinuation and aflibercept reduction (2 mg/kg), because of G2 hand-foot syndrome (HFS) for >2 weeks, and G3 hypertension. Pharmacogenomic analyses revealed multiple alterations of fluoropyrimidine and irinotecan metabolism: severe deficiency of fluorouracil degradation rate (FUDR), single nucleotide polymorphisms of UGT1A1* 28 variable number of tandem repeats (VNTR) 7R/7R homozygote, ABCB1 c.C3435T, c.C1236T, MTHFR c.C667T homozygote, DPYD c.A166G, TSER 28bp VNTR 2R/3R heterozygote. Conclusions: In clinical practice, a complex management evaluating clinical parameters and RAS/BRAF genotype characterizing an individual patient with MCRC, particularly elderly and/or unfit owing to comorbidities, is required to properly address tailored, multidisciplinary medical and surgical treatment strategies, integrated with careful monitoring of superimposing toxicity syndromes, also related to pharmacogenomic alterations, to gain optimal activity, and long-term efficacy

Report of a Case of Video-Assisted Thoracoscopic Resection of Bronchogenic Cyst Developed in the Aorto-Pulmonary Window

We report the case of a 28-years-old male with a bronchogenic cyst developed in the aorto-pulmonary window. Left video-assisted thoracoscopy was performed and the cyst was removed intact and completely. Operative time was 48 minutes. The postoperative course was uneventful and the patient was discharged on the third postoperative day. We believe that an uncomplicated mediastinal bronchogenic cyst can be successfully approached by video-assisted thoracoscopy. In the case of an intraparenchymal or complicated cyst, thoracoscopic resection can be technically difficult and hazardous, and open approach is preferable

May antitransglutaminase levels predict severity of duodenal lesions in adults with celiac disease?

Background and Objective: Pediatric guidelines on celiac disease (CD) state that children with anti‐transglutaminase antibodies (TGAs) >×10 upper limit of normal (ULN) may avoid endos-copy and biopsy. We aimed to evaluate whether these criteria may be suitable for villous atrophy diagnosis in CD adults. Materials and Methods: We retrospectively enrolled patients with CD aged >18 years. TGAs were expressed as xULN. Duodenal lesions were classified as atrophic or non-atrophic according to Marsh‐Oberhuber. Fisher’s exact and t‐test were used for variables compari-son. Receiver operating characteristics (ROC) curve analysis was performed with estimation of area under the curve (AUC), sensitivity, specificity, and positive and negative predictive value (PPV/NPV). Results: One hundred and twenty‐one patients were recruited. Sixty patients (49.6%) had TGA >×10 ULN, and 93 (76.8%) had villous atrophy. The cut‐off of >×10 ULN had sensitivity = 53.7%, specificity = 64.3%, PPV = 83.3%, and NPV = 29.5% to predict atrophy. Therefore, considering pediatric criteria, in 50 (41.3%) patients, biopsy could have been avoided. Patient subgroup with atrophy had higher TGA levels despite being not significant (37.2 ± 15.3 vs. 8.0 ± 1.3 ULN, p = 0.06). In adults, a slightly better diagnostic performance was obtained using a cut‐off of TGA >×6.2 ULN (sensitivity = 57.1%, specificity = 65.6%, and AUC = 0.62). Conclusions: Despite our confirmation that villous atrophy is linked to high TGA levels, CD and atrophy diagnosis based only on serology is not reliable in adults

Long-term results of laryngotracheal resection for benign stenosis from a series of 109 consecutive patients

OBJECTIVES: Long-term results of patients undergoing laryngotracheal resection for benign stenosis are reported. This is the largest series ever published. METHODS: Between 1991 and March 2015, 109 consecutive patients (64 males, 45 females; mean age 39 ± 10.9 years) underwent laryngotracheal resection for subglottic postintubation (93) or idiopathic (16) stenosis. Preoperative procedures included tracheostomy in 35 patients, laser in 17 and laser plus stenting in 18. The upper limit of the stenosis ranged between actual involvement of the vocal cords and 1.5 cm from the glottis. Airway resection length ranged between 1.5 and 6 cm (mean 3.4 ± 0.8 cm) and it was over 4.5 cm in 14 patients. Laryngotracheal release was performed in 9 patients (suprahyoid in 7, pericardial in 1 and suprahyoid + pericardial in 1). RESULTS: There was no perioperative mortality. Ninety-nine patients (90.8%) had excellent or good early results. Ten patients (9.2%) experienced complications including restenosis in 8, dehiscence in 1 and glottic oedema requiring tracheostomy in 1. Restenosis was treated in all 8 patients with endoscopic procedures (5 laser, 2 laser + stent, 1 mechanical dilatation). The patient with anastomotic dehiscence required temporary tracheostomy closed after 1 year with no sequelae. One patient presenting postoperative glottic oedema underwent permanent tracheostomy. Minor complications occurred in 4 patients (3 wound infections, 1 atrial fibrillation). Definitive excellent or good results were achieved in 94.5% of patients. Twenty-eight post-coma patients with neuropsychiatric disorders showed no increased complication and failure rate. CONCLUSIONS: Laryngotracheal resection is the definitive curative treatment for subglottic stenosis allowing very high success rate at long term. Early complications can be managed by endoscopic procedures achieving excellent and stable results over time