The Series on "How to Deal with Early Stage Lung Cancer: Sublobar Resections as A Possible Choice (Report of the 2019 Spring Meeting of Italian Society of Thoracic Surgery)?"

This series is the result of the work of different specialists from all around Italy and from Fudan University in Shanghai, who gathered in Milan on April 2019, to attend the Spring Meeting of Italian Society of Thoracic Surgery (SICT). The meeting discussed new evidences suggesting sublobar resection as the elective surgical treatment of early stage lung cancer

Selection of Candidates for Lung Transplantation: The First Italian Consensus Statement

Lung transplantation is a well-established treatment for selected patients with advanced chronic respiratory insufficiency. Recognizing those patients with end-stage lung disease who might benefit from lung transplantation is a crucial task. Considering the presence of inadequate evidence-based practice, international and national scientific societies provided consensus opinions regarding the appropriate timing of listing. The Study Group for Thoracic Organs Transplantation (branch of the Italian Society for Organs Transplantation) promoted and realized a Delphi conference among the Italian lung transplantation centers to provide guidance to clinical practice based on international recommendations. The experts from the nine Italian centers completed two rounds of standardized questionnaires (answer rate, 100%): 42 statements received a consensus >= 80%. The selected statements presented in this article are intended to assist Italian clinicians in selecting patients for lung transplantation

A valid academic path to promote respiratory physiotherapy

A one- year post- graduate Master in Physiotherapy and Pulmonary Rehabilitation has been offered within the University of Milan Medical School in collaboration with Associaz ione Italiana Riabilitatori dell\u2019Insufficienz a Respiratoria (ARIR). The aim is to cover a gap in Italian Physiotherapy academic curricula offering a course with theoretical and practical teaching that make students capable of using different techniques and procedures in respiratory physiotherapy. After the recognition by the International Education Recognition System (IERS), ARIR wanted to investigate if and how this course has affected students'attitude and their profession. METHODS A structured questionnaire made up of 15 multiple- choices items (8 on perceived quality of education and 7 on professional change) was sent by email to all physiotherapists who graduated in the previous four editions of the Master. One month was given for completion. Age, gender, year of degree and year of Master where considered as background variables. RESULTS We had a 78% response rate with 57 out of 73 physiotherapists sending the questionnaire back. Mean age was 37 years (23- 60) and women were the majority (78%). Forty- two students (74%) worked in the respiratory field at the time of application but only 15 (36%) dealt with respiratory patients only. Expectations were completely met at the end of Master for 71% of physiotherapists. 96% reported greater professional and clinical skills after the master with a 67% saying working team relationship has improved. 28% improved their job position thanks to the master degree and physiotherapy working in the respiratory field increased by 22%. CONCLUSIONS This course seems to meet students expectations and offer a solid knowledge to better work within the field of respiratory physiotherapy. It is also a way to promote the profession of respiratory physiotherapy in Italy

Role of autofluorescence bronchoscopy in evaluation of bronchial mucosa after lung transplantation

Airway complications are a significant and persistent source of morbidity and mortality after lung transplantation; the incidence of these complications is around 15% with a mortality rate of 2- 3%. Airway complications arise, typically, the first two years post-transplant, and of these almost half are identified prior to discharge; their pathogenesis, as well as to opportunistic infections, appear to be related to the difficult revascularization of the bronchi resulting in chronic ischemia

Stenosis of bronchus intermedius: an unusual complication after transplantation and its treatment

Complications related to ischemia are the most important cause of morbidity and mortality after lung transplantation. Ischemia suffered by large bronchi during topical cooling and transplantation of the graft is considered the possible pathogenic noxa for late stenosis as well as a possible cause of anastomotic leak or ulceration of the mucosa. It seems to emerge from the literature that the bronchus intermedius may be particularly prone to ischemia and may undergo stenosis late after transplantation

La toracotomia con risparmio muscolare : quali vantaggi?

OBIETTIVI: Paragonare il dolore post-operatorio, la ripresa della forza muscolare e la funzione polmonare dopo toracotomia con risparmio muscolare e toracotomia postero-laterale tradizionale. MATERIALI E METODI: Nel periodo compreso tra marzo e dicembre 2005 i pazienti candidati a lobectomia per carcinoma polmonare I stadio sono stati randomizzati e sottoposti a toracotomia con risparmio muscolare o a toracotomia postero-laterale tradizionale. I criteri di esclusione sono stati: pregressa toracotomia, diabete mellito, malattie psichiatriche o assistenza post-operatoria > 24 ore. In tutti i pazienti \ue8 stato eseguito il blocco intraoperatorio dei nervi intercostali ed \ue8 stata somministrata analgesia post-operatoria con morfina per via endovenosa e ketoralac. I dati relativi al dolore, alla funzione post-operatoria e alla ripresa della forza muscolare del cingolo scapolare sono stati raccolti in maniera prospettica prima e 1, 7, 30 e 90 giorni dopo l\u2019intervento da un ricercatore non informato del tipo di toracotomia eseguita. \uc8 stata registrata la quantit\ue0 totale di analgesia richiesta. Lo studio \ue8 stato approvato dal comitato etico del nostro ospedale. RISULTATI: Quarantotto pazienti sono stati arruolati nello studio. Nei due gruppi vi \ue8 stato lo stesso numero di pazienti, senza differenze anagrafiche significative. La lunghezza dell\u2019incisione, l\u2019entit\ue0 dell\u2019apertura del divaricatore, il tempo operatorio, la durata della degenza post-operatoria sono state sovrapponibili nei due gruppi. Non abbiamo osservato la comparsa di sieromi. Il dolore, la funzione respiratoria post-operatoria e la ripresa della forza muscolare del cingolo scapolare non hanno dimostrato differenze statisticamente significative tra i due gruppi. L\u2019analisi multivariata dei dati ha dimostrato solamente correlazioni tra la lunghezza dell\u2019incisione e il body mass index, e tra il dolore post-operatorio e la durata dell\u2019intervento. CONCLUSIONI: Entrambe le toracotomie permettono un ottimo accesso alla cavit\ue0 toracica, e hanno sequele paragonabili in termini di dolore e di diminuita funzione muscolare. La scelta tra le due toracotomie \ue8 quindi basata sulla preferenza personale del chirurgo