Randomized comparison of awake nonresectional versus nonawake resectional lung volume reduction surgery

ObjectiveThe study objective was to assess in a randomized controlled study (NCT00566839) the comparative results of awake nonresectional or nonawake resectional lung volume reduction surgery.MethodSixty-three patients were randomly assigned by computer to receive unilateral video-assisted thoracic surgery lung volume reduction surgery by a nonresectional technique performed through epidural anesthesia in 32 awake patients (awake group) or the standard resectional technique performed through general anesthesia in 31 patients (control group). Primary outcomes were hospital stay and changes in forced expiratory volume in 1 second. During follow-up, the need of contralateral treatment because of loss of postoperative benefit was considered a failure event as death.ResultsIntergroup comparisons (awake vs control) showed no difference in gender, age, and body mass index. Hospital stay was shorter in the awake group (6 vs 7.5 days, P = .04) with 21 versus 10 patients discharged within 6 days (P = .01). At 6 months, forced expiratory volume in 1 second improved significantly in both study groups (0.28 vs 0.29 L) with no intergroup difference (P = .79). In both groups, forced expiratory volume in 1 second improvements lasted more than 24 months. At 36 months, freedom from contralateral treatment was 55% versus 50% (P = .5) and survival was 81% versus 87% (P = .5).ConclusionsIn this randomized study, awake nonresectional lung volume reduction surgery resulted in significantly shorter hospital stay than the nonawake procedure. There were no differences between study groups in physiologic improvements, freedom from contralateral treatment, and survival. We speculate that compared with the nonawake procedure, awake lung volume reduction surgery can offer similar clinical benefit but a faster postoperative recovery

Identification of genes down-regulated during lung cancer progression: A cDNA array study

<p>Abstract</p> <p>Background</p> <p>Lung cancer remains a major health challenge in the world. Survival for patients with stage I disease ranges between 40–70%. This suggests that a significant proportion of patients with stage I NSCLC may actually be under-staged.</p> <p>Methods</p> <p>In order to identify genes relevant for lung cancer development, we carried out cDNA array experiments employing 64 consecutive patients (58 men and 6 women) with a median age of 58 years and stage 1 or stage 2 non-small-cell lung cancer (NSCLC).</p> <p>Results</p> <p>Basic cDNA array data identified 14 genes as differentially regulated in the two groups. Quantitative RT-PCR analysis confirmed an effective different transcriptional regulation of 8 out of 14 genes analyzed. The products of these genes belong to different functional protein types, such as extra-cellular matrix proteins and proteases (<it>Decorin </it>and <it>MMP11</it>), genes involved in DNA repair (<it>XRCC1</it>), regulator of angiogenesis (<it>VEGF</it>), cell cycle regulators (<it>Cyclin D1</it>) and tumor-suppressor genes (<it>Semaphorin 3B</it>, <it>WNT-5A </it>and retinoblastoma-related <it>Rb2/p130</it>). Some previously described differences in expression patterns were confirmed by our array data. In addition, we identified and validated for the first time the reduced expression level of some genes during lung cancer progression.</p> <p>Conclusion</p> <p>Comparative hybridization by means of cDNA arrays assisted in identifying a series of novel progression-associated changes in gene expression, confirming, at the same time, a number of previously described results.</p

Endoesophageal ultrasonography in the staging of esophageal carcinoma

Staging of esophageal cancer is fundamental for treatment and prognosis of this tumour. At present, barium swallow and computed tomography (CT) are the most utilized diagnostic modalities. In recent years Endoscopic Ultrasonography (EUS) has been employed for this purpose. We retrospectively compared the results of EUS and CT staging of 33 selected patients with postsurgical stage. EUS allowed a correct diagnosis of parietal invasion in 82% of cases vs 67% obtained by CT. At the same time, EUS diagnosed correctly 85% of metastatic lymph nodes vs 64% reached by CT. We believe that EUS, in combination with CT, is an appropriate modality for the staging of esophageal cancer

Solitary secretory plasmacytoma of the lung in a 14-year-old boy

A case of solitary plasmacytoma of the lung in a 14-year-old boy is reported. The diagnosis was made after a lobectomy was performed for the presence of a mass in the right lung. Two aspects of this case are of particular interest: the young age of the patient and the disappearance after 2 months of the M-protein of of the IgG-k type which was present in the serum

Awake videothoracoscopic biopsy of diffuse lung disease. Effects on pulmonary function and oxygenation

Surgical biopsy of diffuse lung disease (DLD) performed through general anesthesia has been associated with relatively high rate of pulmonary complications. Having hypothesized that videothoracoscopic biopsy of DLD could be feasible in awake patients, we have investigated its effects on pulmonary function and oxygenation. Twenty-one patients with DLD were enrolled in a pilot investigation entailing videothoracoscopic biopsy performed in awake patients through sole epidural anesthesia . Spirometry was performed preoperatively in sitting position (T0) and in lateral decubitus position either immediately before the operation (T1) and intraoperatively, after creation of the surgical pneumothorax (T2). Main cardiorespiratory data including mean arterial pressure (MAP), heart rate (HR), the ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2) and carbon dioxide tension (PaCO2) were assessed at T1, T2, at the end of the operation (T3) and 1h after the operation (T4). Mean age was 58±11 years. At T0, FEV1, FVC and TLC were 2,2L (78%), 2,8L (75%) and 4,4L (74%), respectively. At T1, FEV1 and FVC decreased by 10±12% and 14±13%, respectively while at T2, by 48±5% and 45±6%, respectively. MAP and HR remained relatively stable throughout the procedure. PaO2/FiO2 decreased from 321±49 at T1 to 235±72 at T3 (P=0.0006) but improved up to 284±49 at T4. All patients tolerated satisfactorily the procedure. Histologic diagnosis was always obtained. There was no morbidity and mean hospital stay was 1.5±0.6 days. In our study cohort, changes in pulmonary function and oxygenation measures occurring during awake videothoracoscopic lung biopsy were satisfactorily tolerated by the patients and did not jeopardize its feasibility