Fluorescence Bronchoscopic Surveillance in Patients With a History of Non-Small Cell Lung Cancer

Background Second lung primaries occur at a rate of 2% per patient per year after curative resection for non-small cell lung carcinoma (NSCLC). The aim of this study was to evaluate the role of fluorescence bronchoscopy using the Xillix® LIFE-Lung Fluorescent Endoscopy SystemTM (LIFE-Lung system) in the surveillance of patients for second NSCLC primaries after resection or curative photodynamic therapy (PDT)

Распространенность болезни Помпе у пациентов с идиопатической гиперкреатинкиназемией и слабостью поясно-конечностных мышц (анализ 3076 случаев)*

.Проведен проспективный скрининг дефицита фермента кислой α-глюкозидазы (GAA) европейской когорты пациентов с гиперкреатинкиназемией (гиперКК) и / или слабостью поясно-конечностных мышц (СПКМ) неустановленной этиологии с помощью метода сухого пятна крови (dry blood spot, DBS).Материалы и методы. Образцы DBS были собраны у 3076 взрослых пациентов, проходивших обследование в 7 немецких и британских нервно-мышечных центрах. Все образцы были исследованы на дефицит GAA методом флуорометрии. При выявлении пониженной ферментативной активности определяли наличие мутации гена GAA.Результаты. Из 3076 образцов DBS в 232 (7,6 %) случаях обнаружена низкая ферментативная активность GAA. У 55 (24 %) из 232 пациентов наблюдали изолированную гиперКК, а у 176 (76 %) – гиперКК и СПКМ. При комбинации 2 признаков у 94 % больных активность GAA была снижена. Мутационный анализ выявил мутации гена GAA у 74 (2,4 %) пациентов, при этом 70 больных были гетерозиготными по распространенной мутации сайта сплайсинга гена GAA c.-32-13T>G. У пациентов с подтвержденной болезнью Помпе основной симптомокомплекс состоял из СПКМ (85,3 %) в сочетании с дыхательной недостаточностью (61 %). У 12,0 % больных наблюдали изолированную гиперКК, а у 2,7 % – гиперКК и дыхательную недостаточность.Заключение. В большой когорте пациентов с гиперКК и / или СПКМ  распространенность болезни Помпе с поздним началом составляет 2,4 %, что требует проведения целевого скрининга активности GAA у пациентов с гиперКК и / или СПКМнеустановленной этиологии

Management of Air Leaks Post-Surgical Lung Resection

Airleaks are one of the most common complications associated with elective lung resection. There have been many techniques and modern advancements in thoracic surgery, however airleaks persist. This review article will discuss several interventions ranging from conservative noninvasive to surgical management of the persistent airleak. These techniques include stopping of suction on the plueravac, fibrin patches, pleurodesis, use of endobronchial valves (EBVs), return to OR for operative intervention, and lastly to send patients home with mini pleuravacs

Thoracoscopic lobectomy is associated with acceptable morbidity and mortality in patients with predicted postoperative forced expiratory volume in 1 second or diffusing capacity for carbon monoxide less than 40% of normal.

OBJECTIVE: A predicted postoperative (ppo) forced expiratory volume in 1 second (FEV1%) or diffusing capacity of the lung for carbon monoxide (DLCO%) of METHODS: PpoFEV1% and ppoDLCO% were calculated for patients undergoing open or VATS lobectomy for lung cancer in the Society of Thoracic Surgeons General Thoracic database from 2009 to 2011. Univariate comparisons, multivariate analyses, and 1:1 propensity matching were performed. RESULTS: A total of 13,376 patients underwent lobectomy (50.9% open, 49.1% VATS). A decreased ppoFEV1% and ppoDLCO% were each independent predictors for both cardiopulmonary complications and mortality in the open group (all P ≤ .008). In the VATS group, ppoFEV1% was an independent predictor of complications (P = .001) but not mortality (P = .77), and ppoDLCO% was an independent predictor of complications (P = .046) and mortality (P = .008). With decreasing ppoFEV1% or ppoDLCO%, complications and mortality increased at a greater rate in the open lobectomy than in a propensity-matched VATS group (n = 4215 each). For patients with ppoFEV1% \u3c 40%, mortality was greater in the open (4.8%) than in the matched VATS group (0.7%, P = .003). Similar results were seen for ppoDLCO% \u3c 40% (5.2% open, 2.0% VATS, P = .003). The rate of complications was significantly greater at ppoFEV1% \u3c 40% in the open (21.9%) than in the matched VATS (12.8%, P = .005) group and similar results were seen with ppoDLCO% \u3c 40% (14.9% open, 10.4% VATS, P = .016). CONCLUSIONS: VATS lobectomy can be performed with acceptable rates of morbidity and mortality in patients with reduced ppoFEV1% or ppoDLCO%

Primary Lung Cribriform Adenocarcinoma With Squamoid Morules Harboring Somatic CTNNB1 Mutation in a Never-Smoked Healthy Adolescent

Primary lung adenocarcinomas are rare in pediatric patients, and even rarer in patients without precedent malignancy or congenital malformation. Here we present the first reported case of primary lung cribriform adenocarcinoma with squamoid morules in a previously healthy adolescent female. Molecular testing identified CTNNB1 mutation in the tumor and excluded other common mutations in lung adenocarcinoma. Our case suggests molecular alterations to the same signaling pathway can lead to similar histomorphology regardless of the tissue of origin