Flow-volume curve analysis for predicting recurrence after endoscopic dilation of airway stenosis

The flow-volume curve is a simple test for diagnosing upper airway obstruction. We evaluated its use to predict recurrence in patients undergoing endoscopic dilation for treatment of benign upper airway stenosis

Harmonic technology versus neodymium-doped yttrium aluminium garnet laser and electrocautery for lung metastasectomy: An experimental study

We compared the efficacy of non-anatomical lung resections with that of three other techniques: monopolar electrocautery; neodymium-doped yttrium aluminium garnet laser and harmonic technology. We hypothesized that the thermal damage with harmonic technology could be reduced because of the lower temperatures generated by harmonic technology compared with that of other devices.OBJECTIVES We compared the efficacy of non-anatomical lung resections with that of three other techniques: monopolar electrocautery; neodymium-doped yttrium aluminium garnet laser and harmonic technology. We hypothesized that the thermal damage with harmonic technology could be reduced because of the lower temperatures generated by harmonic technology compared with that of other devices. METHODS Initial studies were performed in 13 isolated pig lungs for each group. A 1.5-cm capsule was inserted within the lung to mimic a tumour and a total of 25 non-anatomical resections were performed with each device. The damage of the resected lung surface and of the tumour border were evaluated according to the colour (ranging from 0 - pink colour to 4 - black colour), histological (ranging from Score 0 - no changes to Score 3 - presence of necrotic tissue) and radiological (ranging from Score 0 - isointense T2 signal at magnetic resonance imaging to Score 3 - hyperintense T2 signal) criteria. A total of seven non-anatomical resections with harmonic technology were also performed in two live pigs to assess if ex vivo results could be reproducible in live pigs with particular attention to haemostatic and air-tightness properties. RESULTS In the ex vivo lung, there was a statistical significant difference between depth of thermal damage (P < 0.0001) in electrocautery (1.3 [1.2-1.4]), laser (0.9 [0.6-0.9]) and harmonic (0.4 [0.3-0.5]) groups. Electrocautery had a higher depth of thermal damage compared with that of the laser (P = 0.01) and harmonic groups (P = 0.0005). The harmonic group had a less depth of thermal damage than that of the laser group (P = 0.01). Also, histological damages of tumour borders (P < 0.001) and resected lung surface (P < 0.001), radiological damage of tumour borders (P < 0.001) and resected lung surface (P < 0.001) and colour changes (P < 0.001) were statistically different between three study groups. Resections of in vivo pig lungs showed no bleeding; 2 of 7 cases of low air leaks were found; however, they ceased by sealing lung parenchyma with harmonic technology. CONCLUSIONS Our experimental data support the resections performed with the use of harmonic technology. The lack of severe tissue alterations could favour healing of parenchyma, assure air tightness and preserve functional lung parenchyma. However, randomized controlled studies are needed in an in vivo model to corroborate our findings

Minimally Invasive Surgery for the Management of Lung Cancer

Lung cancer is the leading cause of cancer-related death and the most diagnosed cancer. The treatment of Non-Small Cell Lung Cancer (NSCLC) depends on clinical staging. Surgical radical resection is recommended for patients with stage 1 or 2 of disease and represents the treatment of choice. In the last decades, the surgical approach for lung cancer changed moving from an open approach to a minimally invasive approach, represented by Video Assisted Thoracic Surgery (VATS) and Robot-Assisted Thoracic Surgery (RATS). In this chapter, we illustrate the characteristics of lung cancer, the diagnosis, the classification, the staging and the preoperative evaluation. Then we focus on the surgical treatment of lung cancer and on how it has changed during the years. We explain the open approach represented by the traditional posterolateral thoracotomy and by the muscle-sparing thoracotomy. We illustrate VATS approach and evolution: from the hybrid approach to the pure VATS that can be triportal, biportal or even uniportal. Then, we focus on RATS approach, characterized by the use of multiple ports in the same intercostal space and how it evolved toward the uniportal approach. The objective is to combine the advantage of uniportal VATS (lower postoperative pain, enhanced recovery) and RATS (better visualization, more degrees of movements)

Recurrent spontaneous pneumomediastinum: a rare but possible event!

A number of risk indices have been formulated in an attempt to predict risk of a major hemorrhage in an individual on warfarin therapy. No single index to date is able to reliably predict this risk in an individual patient. Although most warfarin related hemorrhages are gastrointestinal or intracranial in origin this case represents a particularly rare entity of a major hemorrhage presenting as an encysted empyema. To the best of our knowledge this has never before been described

Right isthmus ablation reduces supraventricular arrhythmias after surgery for chronic atrial fibrillation

Background. Clinical, electrocardiographic, and echocardiographic results of atrial fibrillation (AF) ablation by left mini-Maze, with or without concomitant cavotricuspid isthmus ablation, during cardiac surgery were analyzed.Methods. Eighty-seven patients undergoing radiofrequency left mini-Maze without (group A) or with (group B) concomitant cavotricuspid isthmus ablation underwent serial electrocardiography and echocardiography to assess sinus rhythm recovery and atrioventricular remodelling. Recurrence of AF, incidence of atrial flutter, hospital readmission, and episodes of congestive heart failure were recorded. Predictors of AF recurrence were evaluated.Results. Follow-up of 33.4 +/- 11.2 months demonstrated 88.5% had sinus rhythm recovery, with normalized E/A velocity in 90.9%. Freedom from AF recurrence, congestive heart failure, and hospital readmission was 72.6% +/- 7.8%, 93.3% +/- 5.5%, and 79.9% +/- 8.2%, respectively, without differences between the two groups. Atrial flutter developed in group A more frequently during hospitalization (19.5% versus 2.2%; p = 0.009) and follow-up (12.2% versus 0%; p = 0.02); freedom from atrial flutter was thus lower (79.6% +/- 7.8% versus 100%; p = 0.024). Although no differences were recorded in postoperative and follow-up New York Heart Association (NYHA) functional class or in postoperative or follow-up echocardiographic indicators between the two groups, AF patients displayed a worse NYHA than did sinus rhythm patients (discharge p = 0.009; follow-up p = 0.0002). Accordingly, only sinus rhythm patients showed reverse remodelling of longitudinal (discharge p = 0.002; follow-up p = 0.0001) and transverse diameter (discharge p = 0.0001; follow-up p = 0.001), and of follow-up left ventricular diastolic diameter (p = 0.0001). Mitral valve disease and high postoperative and follow-up echocardiographic pulmonary pressures were independent predictors of AF recurrence. Left + right ablation was the only protective factor against AF recurrence.Conclusions. Concomitant cavotricuspid isthmus ablation should be routinely considered in AF surgery, given the shorter hospitalization, low incidence of atrial flutter onset, and beneficial effect on AF recurrences

Geogenic versus anthropogenic geochemical influence on trace elements contents in soils from the Milazzo Peninsula

International audienc

The Prediction of Fissure Integrity by Quantitative Computed Tomography Analysis

Background Incomplete interlobar fissure may increase the difficulty of thoracoscopic lobectomy. Herein, we compared the accuracy of visual versus quantitative analysis to predict fissure integrity in lung cancer patients undergoing thoracoscopic lobectomy and evaluated the effects of fissure integrity on surgical outcome. Methods This was a single-center retrospective study including consecutive patients undergoing VATS (video-assisted thoracoscopic surgery) lobectomy for lung cancer. The target interlobar fissures were classified as complete or incomplete by visual and quantitative analysis. Using the intraoperative finding as the reference method, the diagnostic accuracy of the two methods to define fissure completeness (dependent variable) was calculated and statistically compared. Yet, we evaluated differences in postoperative outcomes between patients with complete and incomplete fissure integrity. Results A total of 93 patients were included in the study; 33/93 (36%) presented complete fissure. Visual and quantitative analyses correctly identified complete fissure in 19/33 (57%) and 29/33 (88%) patients, respectively, and incomplete fissure in 56/60 (93%) and 58/60 (96%) patients, respectively. Quantitative analysis had better diagnostic accuracy than visual analysis (81 vs. 93%; p = 0.01). Patients with incomplete fissure compared with those with complete fissure had a higher conversion rate (6 vs. 13%; p = 0.43), higher persistent air leak rate (0/33 vs. 14/60; p = 0.03), and longer hospitalization (12.6 +/- 3.8 vs. 7.1 +/- 2.4 days; p = 0.01). Conclusions Quantitative analysis accurately predicted the fissures' integrity; it may be useful for selecting suitable cases for thoracoscopic lobectomy especially for surgeons with limited minimally invasive experience