The prognostic impact of the international association for the study of lung cancer (IASLC) definitions on completeness of surgical resection for non-small cell lung cancer (NSCLC)

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Solitary Fibrous Tumours of the Pleura

Solitary fibrous tumours of the pleura (SFTP) are rare neoplasms originating from one of the components of the sub-mesothelial connective layer underlying the pleura. They are the most common non-mesothelial primary pleural neoplasms but still remain relatively rare. Their behaviour is mostly indolent; however, some may de-differentiate into malignant and aggressive tumours. Surgical resection is the mainstay treatment for SFTP, even more so in case of voluminous masses, due to compression onto lung, mediastinum and great vessels. In this chapter, we discuss the disease characteristics reported in the literature with respect to clinical presentation, diagnosis and treatment; also, we will discuss the results of patients treated for SFTP who underwent a surgical treatment in our unit of thoracic surgery

Diagnostic and Therapeutic Challenges of Malignant Pleural Mesothelioma

Malignant pleural mesothelioma is a rare cancer characterized by a very poor prognosis. Exposure to asbestos is the leading cause of malignant pleural mesothelioma. The preinvasive lesions, the mesothelial hyperplasia and its possible evolution are the focus of the majority of the studies aiming to identify the treatable phase of the disease. The role of BAP-1 and MTAP in the diagnosis of mesothelioma in situ and in the prognosis of malignant pleural mesothelioma is the main topic of recent studies. The management of preinvasive lesions in mesothelioma is still unclear and many aspects are the subject of debate. The diagnosis, the disease staging and the accurate, comprehensive assessment of patients are three key instants for an appropriate management of patients/the disease

Secondary Pneumothorax from a Surgical Perspective

Although less frequent than the primary spontaneous pneumothorax (PSP), secondary pneumothoraces (SP) are a common clinical problem with a wide range of severity, depending on the triggering cause(s) and patient clinical condition. By definition, an SP occurs in those patients with an underlying condition that alters the normal lung parenchyma and/or the visceral pleura and determines air entry in the pleural space (e.g., COPD) or, eventually, following trauma or invasive procedures (i.e., iatrogenic pneumothorax). Less frequent, yet described, is SP occurring in neoplastic patients or infectious ones. The gravity of an SP is directly correlated to the underlying cause and patients’ clinical conditions. For example, it may be a life-threatening condition in an end-stage COPD but less severe in a catamenial related syndrome. In this chapter, we are providing a surgical overview of the most relevant and updated information on etiology, incidence, pathophysiology, and management of secondary pneumothoraces

Time required to start multicentre clinical trials within the Italian Medicine Agency programme of support for independent research

Time allowed for independent ethics committees (IECs) and administrative offices to assess and activate clinical trials is regulated by law. This study aims to describe time spent activating two multicentre non-profit trials supported by the Italian Medicines Agency (AIFA). Five non-AIFA supported (NAS) trials were used as a benchmark

Blood pressure circadian rhythm alterations in alpha-synucleinopathies

Introduction: We sought to analyze the blood pressure (BP) circadian rhythm in Parkinson's disease (PD), multiple system atrophy (MSA), and pure autonomic failure (PAF) and to evaluate the effect of vasoactive and dopaminergic medications on BP fluctuations during activities of daily living.Methods: We analyzed data from patients with PD (n=72), MSA (n=18), and PAF (n=17) evaluated with 24-h ambulatory BP monitoring (ABPM) at our Center between 1996 and 2015. Comparisons between groups were performed according to (a) clinical diagnosis and (b) pharmacological treatment. ABPM parameters included 24-h BP variability, BP load, nocturnal dipping, and awakening hypotension.Results: The average BP was 12114/72 +/- 8 mmHg during daytime and 133 +/- 20/76 +/- 13 mmHg during nighttime (p<0.01), with BP load of 24 +/- 22/15 +/- 16% (daytime) vs. 61 +/- 36/52 +/- 36% (nighttime) (p<0.01). In-office BP measurements were consistent with OH in 95 patients (89%) and SH in 63 (59%). ABPM demonstrated increased BP variability in 67 patients (63%), awakening hypotension in 63 (59%), "reverse dipping" in 85 (79.4%), "reduced dipping" in 13 (12.1%), and "normal dipping" in 9 (8.4%). No differences were observed between PD, MSA, and PAF, but a sub-analysis of PD patients revealed two distinct patterns of BP alterations. No significant differences were observed in relation to the use of vasoactive or dopaminergic medications.Conclusion: Regardless of the neurological diagnosis and pharmacological treatment, patients with alpha-synucleinopathies showed a BP circadian rhythm characterized by increased BP variability, reverse dipping, increased BP load, and awakening hypotension

Detection of orthostatic hypotension with ambulatory blood pressure monitoring in parkinson's disease

We sought to test the accuracy of 24-hours ambulatory blood pressure (BP) monitoring (ABPM) for the detection of orthostatic hypotension (OH) in Parkinson's disease (PD). A total of 113 patients referred for autonomic testing between January 2015 and June 2017 underwent ABPM and office BP measurements in supine and standing positions. The study population consisted of 81 males and 32 females with PD duration of 6.5 +/- 4.1 years and Hoehn and Yahr staging of 1 (13.3%), 1.5 (20.4%), 2 (27.4%), 2.5 (23.9%), 3 (13.3%), and 4 (1.8%). Motor fluctuations were present in 44% of patients. The data from office BP recordings were compared to selected ABPM parameters, and the results showed an association between OH and (a) ABPM-detected hypotensive episodes (Hypo-ep) and (b) ABPM-detected awakening hypotension (Hypo-aw). Having 2 or more Hypo-ep episodes <= 15 mmHg (systolic) compared to average 24-h systolic BP (Hypo-ep(Delta 15/24h)) yielded 75% diagnostic accuracy for OH, while the presence of at least one Hypo-ep(Delta 15/24h) within 90 min after getting up (Hypo-aw(Delta 15/24h)) yielded 93% specificity for OH. A diagnostic accuracy of 87.6% was achieved when including daytime and nighttime ABPM values, weighted BP variability, systolic and diastolic BP loads, nocturnal dipping, and postprandial hypotension in a computerized prediction algorithm. In conclusion, our findings suggest that selected ABPM parameters, such as the number of hypotensive episodes and the presence of awakening hypotension, may be used to screen patients for OH, while using a computerized prediction algorithm that includes all ABPM parameters provides the greatest diagnostic accuracy