Evlp for lung transplant. Initial experience

Background Il trapianto polmonare rappresenta l'unica soluzione percorribile per l'insufficienza respiratoria end-stage. La principale limitante ad un suo impiego è rappresentata dalla scarsità di polmoni idonei. In questo contesto si colloca il progetto di ricondizionamento ex-vivo. L'implementazione risulta possibile attraverso il ricondizionamento di organi cosiddetti “marginali” o giudicati inizialmente non idonei al trapianto e da donatori a cuore fermo (Donor after Cardiac Death – DCD). Scopo Lo scopo principale del progetto è quello di analizzare i risultati a breve e medio termine del trapianto polmonare effettuato impiegando polmoni sottoposti a procedura di ricondizionamento ex-vivo in due centri trapianti di polmone a basso volume. Materiali e Metodi I dati sono stati raccolti retrospettivamente (da Giugno 2013 per quanto riguarda l’ISMETT e dal 2014 quelli dell’ Ospedale S. Orsola-Malpighi) e in maniera prospettica dal 2019. Risultati Sommando i dati relativi ad entrambi i centri, dal 2013 sono stati eseguiti un totale di 26 procedure di riperfusione. Sei volte i polmoni sono stati giudicati idonei al trapianto al termine con 5 trapianti doppi e un trapianto singolo sinistro. I risultati in termine di sopravvivenza a medio termine sono risultati sovrapponibili a quelli disponibili in letteratura, tuttavia è stato registrato un alto tasso di PGD (Primary Graft Disfunction) di grado 3, da imputare alla patologia di base del ricevente (ipertensione polmonare), che per protocollo di istituto rimane con supporto cardio-respiratorio (ECMO) dopo il trapianto. Conclusioni L’EVLP si conferma in centri di piccolo e medio volume un metodo sicuro ed efficace per implementare in numero di polmoni idonei al trapianto.Background Lung transplant is a life-saving treatment for patients with end stage lung disease. The shortage of suitable lung graft still a major limiting factor. Ex-vivo lung perfusion has emerged as a solution to increase transplantable graft. Methods We collected data about lung transplant in two different lung transplant center in Palermo and Bologna, retrospectively respectively since 2013 and 2014, and since 2019 in a prospective way. Results A total of 26 reperfusion procedures have been performed since 2013. Six times the lungs were judged suitable for transplant after 4 hours, leading to 5 double transplants and a single left transplant. The results in terms of medium-term survival were comparable to those available in the literature, however a high rate of grade 3 PGD (Primary Graft Disfunction) was recorded, attributable to the underlying disease of the recipient (pulmonary hypertension). Conclusion The EVLP is confirmed in small and medium volume centers as a safe and effective method to implement the number of lungs suitable for transplantation

Responsabilidad social universitaria en Maracaibo, Venezuela

This article aims to analyze university social responsibility in Maracaibo, Venezuela. The work is based on the postulates of Rodriguez (2010), De la Cuesta (2011) and the Ministry of Education in Spain (2011), among others. It is a descriptive, field study. The population consisted of authorities from five universities, one (1) public and four (4) private, located in Maracaibo, who were accessed through a questionnaire composed of thirty-two (32) closed items. The instrument was validated by experts in the university management field. To determine the questionnaire’s reliability, the test-retest method was applied, obtaining a 0.94 coefficient. To analyze data, the arithmetic mean or average was used. Results indicate that the universities under study exhibit a social responsibility model with an instrumental, entrepreneurial tendency, where knowledge is seen as the main asset available for society’s use. However, a greater integration of these higher education institutions with their stakeholders is required.  El presente artículo tiene como objetivo analizar la responsabilidad social universitaria en Maracaibo, Venezuela. El trabajo se sustenta en los postulados de Rodríguez (2010), De la Cuesta (2011), el Ministerio de Educación de España (2011), entre otros. El estudio fue descriptivo, de campo. La población estuvo conformada por autoridades de cinco (5) universidades, una (1) pública y cuatro (4) privadas ubicadas en Maracaibo, a las cuales se accedió mediante un cuestionario compuesto por treinta y dos (32) ítems cerrados. El instrumento fue validado por expertos en el ámbito de la gerencia universitaria. Para determinar la confiabilidad del cuestionario se aplicó el método test-retest, obteniéndose un coeficiente de 0,94. Para analizar los datos se utilizó el promedio aritmético o media. Los resultados indican que las universidades estudiadas exhiben un modelo de responsabilidad social de tendencia empresarial instrumental, donde el conocimiento se perfila como el principal activo disponible para su uso por la sociedad, pero se requiere una mayor integración de las instituciones de educación superior con sus stakeholders. &nbsp

Uniportal video-assisted removal of a right paratracheal pericardial cyst: an unusual location

Cystic lesions of the pericardium are a rare entity. Generally, they are congenital and located in the cardiophrenic angle. The right paratracheal location is unusual and differential diagnosis in particular with bronchogenic cyst is difficult even when using magnetic resonance imaging (MRI). The surgical indication exists in case of symptomatic patients or huge mass with compression of nearby structures. Different surgical approaches have been reported in literature to treat mediastinal cysts. We report a case of uniportal thoracoscopic removal of an unusual located right paratracheal pericardial cyst

Unilateral pulmonary vein atresia without anomalous connection in adult patient with recurrent severe hemoptysis

Isolated unilateral pulmonary vein atresia (UPVA) is a rare congenital malformation and the management remains controversial. In adults, pneumonectomy is the treatment of choice when significant hemoptysis becomes life-threatening. We report a case of a 28-year-old male with isolated unilateral right atresia of the pulmonary vein who had life-threatening hemoptysis treated with bronchial arteries embolization followed by successful right pneumonectomy

Micro-incision thoracoscopic treatment of primary spontaneous pneumothorax: the "loop" technique

Primary spontaneous pneumothorax has been defined as the disease of the 'young and healthy'. There are multiple possible therapies and in recent years, surgery has evolved towards the use of the uniportal thoracoscopic approach. The objective of our study is to describe and present an innovative approach to access to the thoracic cavity in patients with spontaneous pneumothorax. The surgery was performed using a single access of 20 mm at the level of the 8th intercostal space. For the isolation and suspension of any dystrophic area, we use a 'loop' of non-absorbable braided suture inserted through the IV intercostal space and successive wedge resection using an endoscopic 10 mm mechanical stapler. Using this access, we were able to visualize and dissect the pulmonary ligament and perform complete pleural abrasion. We had no complications. The operative time was 60 min, the chest tube was removed the 2th postoperative day and the patient was discharged the day after. The operation we propose permits the reduction of the dimension of the access to the thoracic cavity. We were able to resect blebs without problems, the recovery was excellent and no complications related to the procedure were reported

Metabolic and clinical effect of alpha-lipoic acid administration in schizophrenic subjects stabilized with atypical antipsychotics: A 12-week, open-label, uncontrolled study

Background: Many of the atypical antipsychotics induce metabolic side effects, limiting their use in clinical practice. Alpha-lipoic acid (ALA) was proposed as a new approach in schizophrenia to improve metabolic effects of atypical antipsychotics. The aim of the study is to evaluate the effect of ALA on metabolic and clinical parameters among schizophrenic subjects. Methods: 15 schizophrenic subjects, in stable atypical antipsychotic monotherapy were included in the study. ALA was administrated at the oral daily dose of 600 ​mg/d in addition to antipsychotic therapy. Metabolic, clinical, and psychopathological parameters were measured at typical antipsychotics. e initial screening, and after 12 weeks. Results: ALA produced a statistically significant reduction in QTc (p ​= ​0.012), blood glucose (p ​= 0.005), AST (p ​= ​0.021), γGT (p ​= ​0.035), CPK (p ​= ​0.005) and prolactinaemia (p ​= ​0.026). In contrast, there was a significant increase in HbA1c (p ​= ​0.026). No effects on body weight and blood lipid levels (triglycerides, total cholesterol, HDL, LDL) emerged. Conclusions: ALA treatment appeared to be effective for reducing diabetes risk, liver functionality parameters, hyperprolactinaemia and QTC interval. ALA appears to be safe as adjunctive components in schizophrenia

Video-assisted thoracoscopic surgery lobectomy using "the caudal approach": results and evolution

Background: Video-assisted thoracoscopic surgery (VATS) has become a common surgical approach in the diagnosis and treatment of lung and mediastinal diseases. In this study, we reported our current experience of thoracoscopic surgery using a new caudal position technique for anatomical lung resections and compared it with the standard anterior VATS technique.Methods: From January 2016 to October 2017, 92 consecutive patients with lung cancer underwent VATS lobectomy. Among these, 34 patients were treated by conventional anterior three portal VATS lobectomy, and 58 patients were treated using the caudal three port VATS lobectomy. The mean operative time, conversion rate, hospital stay, post-operative drainage, reoperation, post operative pain were compared between each group.Results: No differences between the two groups are showed in terms of surgical time, post-operative drainage, incidence of prolonged air leaks and post-operative pain.Conclusions: The caudal approach to major pulmonary resection of thoracoscopic lobectomy results in a reliable and comfortable procedure for the surgeon. Once demonstrated the reliability of the VATS lobectomy with three accesses using the caudal position, we are starting to standardize biportal and uniportal VATS with the surgeon in the caudal position

Pulmonary Metastases from NSCLC and MPLC (Multiple Primary Lung Cancers): Management and Outcome in a Single Centre Experience

Background: This is an institutional review of surgical management of second pulmonary tumours in patients with history of Non-small Cell Lung Cancer (NSCLC) resection according to The American College of Chest Physicians' (ACCP) revision to the Martini and Melamed's criteria for the classification of multiple primary lung cancers (MPLC). Methods: All patients who underwent iterative pulmonary resections for pulmonary metastasis (Group A) or MPLC (Group B) between 2006 and 2012 were reviewed and their survivals compared accordingly. The main criteria of insertion in Group B were different histology and the same histology with disease-free interval 64 4 years; we excluded loco-regional recurrence in nodes and/or on bronchial stump. Results: Group A: Twenty patients; Disease free time (DFT) after first operation was 15.2 months (range 2-44). One, two and three years overall survival after second resection was 74%, 29%, 14% respectively. Group B: Thirty-six patients. One, two and three years overall survival was 94%, 81%, and 69% respectively. No statistical differences on outcome were found between the two groups in spite of the apparent worse survival rate for Group A (p. = .197). Conclusions: A further resection for additional nodules, whether designated as intrapulmonary metastases or second primary NSCLC, can be an appropriate curative strategy in selected patients with unimpaired respiratory function and no evidence of distant metastatic disease. The site, the extent of the second resection, the histology and even the stage are unlikely to be related to survival

Surgical options to treat massive sternal defect after failed Robicsek procedure

Full median sternotomy is still the most commonly used surgical approach for exposing the heart in cardiac surgery. However, early sternotomy wound complications represent a major cause of morbidity in heart surgery with an incidence from 0.5% to 10% in most surgical studies. Different classifications of sternal wound complications were reported. Mainly we consider three principal categories: mechanical uninfected sternal instability/dehiscence; sternal instability/dehiscence with superficial wound sternal infection (SWSI); and deep sternal wound infection (DSWI or mediastinitis) with sternal instability/dehiscence (1,5). In particular mediastinitis with sternal dehiscence is a life-threatening condition with reported mortality between 14% to 47%. The loss of sternal bone and adjacent ribs due to osteomyelitis and previous surgical debridement causes large defects of the anterior chest wall that increase the risk of heart and lung damage and in particular impairs respiratory function due to pain and paradox movement of the thorax, often necessitating prolonged mechanical ventilation and increasing the postoperative mortality. Sometimes DSWI and massive sternal loss is the result of previous attempts to fix mechanical sternal dehiscence with or without SWSI in patients with multiple risk factor for sternal instability and infection. In cardiac surgery the most common technique to repair a sternal instability/dehiscence is the Robicsek technique. Generally this is a very effective procedure, but in case of its failure the subsequent repair of the anterior chest wall could become very complex due to massive bone loss. We report our experience with two different surgical approaches to treat a massive sternal loss after a failed Robicsek repair

Uniportal thoracoscopic resection of intralobar and extralobar pulmonary sequestration

Pulmonary sequestration (PS) is a rare congenital malformation of the respiratory tract. Two main variants are described, the intralobar and the extralobar PS. Clinical manifestations vary from accidental findings to life threatening complications. Surgical resection is the definitive and indicated treatment of PS. The operation could be performed through an open thoracotomy or video-assisted thoracic surgery approach. We report the management of two patients with diagnosis of extralobar PS in the first case and intralobar PS in the second case. Both patients underwent uniportal video-assisted thoracic surgery resection of PS with success. In our experience, we confirm that uniportal video-assisted thoracic surgery is a safe and feasible approach for extralobar and intralobar PS