Thoracic surgery for malignancy and emergency irrespective of COVID-19

until March 24, 2020, a COVID-19 test by nasopharyngeal swab was offered to the patients presenting with symptoms of COVID-19. However, from April 2, 2020, we changed that policy, offering 2 COVID-19 tests by nasopharyngeal swab to everyone undergoing thoracic surgery for malignancies before admission to our general university hospital, even if asymptomatic

Bronchovascular reconstruction in the era of mini-invasiveness

bronchovascular reconstruction in the era of mininvasivenes

A high-volume thoracic surgery division into the storm of the COVID-19 pandemic

Since the coronavirus 2019 (COVID-19) crisis broke out in Italy at the end of February 2020, days before the World Health Organization declared the pandemic,1,2 two crucial issues urgently emerged and needed to be addressed by our institution. First was the containment of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic together with the restructuring of national public and private health care to face the spread of the new viral disease among the population. Second, central as well, was to maintain the offer of medical and surgical treatments to the patients who still presented with other severe diseases—of these in particular, oncologic patients

Stenting treatment is a minimally traumatic and effective alternative to surgical repair for iatrogenic tracheobronchial lesion

Iatrogenic tracheobronchial injuries are rare but lifethreatening events, most frequently due to complication of endotracheal intubation or percutaneous tracheostomy. Their incidence is low (0.005–0.2% after double lumen or emergency single lumen intubation and up to 0.7% after percutaneous tracheostomy), but related mortality can be high and has been generally reported between 11% and 42% (1-5). Surgical repair has been considered the treatment of choice for a long time. More recently, along with the progressive evolution of interventional bronchoscopy, minimally invasive endoscopic treatment has gained diffusion as an effective alternative

The advantage of sleeve lobectomy over pneumonectomy

Answer to Dr. Ludwig about lower sleeve lobectomy, the so-called “Y” sleeve

Managing benign tracheal stenosis during COVID-19 outbreak

If elective surgery has been recommended to be postponed some diseases could potentially become life-threatening and cannot be delayed. Among these conditions, tracheal idiopathic stenosis, primary caused by endotracheal intubation or tracheostomy, usually become symptomatic when reach 50% obstruction. Endoscopic procedures could be considered as frst treatment in selected patients after stenosis evaluation, such as non-complex stenosis with low grade of cartilage involvement or tracheomalaci

Relevance of pharmacogenomics and multidisciplinary management in a young-elderly patient with KRAS mutant colorectal cancer treated with first-line aflibercept-containing chemotherapy

Introduction: Intensive oncological treatment integrated with resection of metastases raised the clinical outcome of metastatic colorectal cancer (MCRC). In clinical practice, complex evaluation of clinical (age, performance status, comorbidities), and biological (tumoral genotype, pharmacogenomic) parameters addresses tailored, personalized multidisciplinary treatment strategies. Patients with MCRC unsuitable for first-line intensive medical treatments are prevalent and showed worse clinical outcome. After progression to oxaliplatin-based chemotherapy, aflibercept/FOLFIRI significantly improved clinical outcome, even if no survival benefit was reported in adjuvant fast relapsers by aflibercept addition. The case reported a young-elderly (yE) patient with KRAS mutant colorectal cancer rapidly progressing to adjuvant chemotherapy, unfit owing to comorbidities, with multiple pharmacogenomic alterations, who gained long-term survival in clinical practice by multidisciplinary treatment strategy consisting of first-line and re-introduction of aflibercept-containing chemotherapy and two-stage lung metastasectomies. Case presentation: A 71-years-old yE patient, unfit for intensive oncological treatments owing to Cumulative Illness Rating Scale (CIRS) stage secondary, affected by KRAS c.35 G>T mutant colorectal cancer, rapidly progressing with lung metastases after adjuvant XelOx chemotherapy, reached long-term survival 66 months with no evidence of disease after first-line and re-introduction of tailored, modulated aflibercept (4 mg/kg) d1,15-irinotecan (120 mg/m2) d1,15-5-fluorouracil (750 mg/m2 /day) dd1–4, 15–18; and secondary radical bilateral two-stage lung metastasectomies. Safety profile was characterized by limiting toxicity syndrome at multiple sites (LTS-ms), requiring 5-fluorouracil discontinuation and aflibercept reduction (2 mg/kg), because of G2 hand-foot syndrome (HFS) for >2 weeks, and G3 hypertension. Pharmacogenomic analyses revealed multiple alterations of fluoropyrimidine and irinotecan metabolism: severe deficiency of fluorouracil degradation rate (FUDR), single nucleotide polymorphisms of UGT1A1* 28 variable number of tandem repeats (VNTR) 7R/7R homozygote, ABCB1 c.C3435T, c.C1236T, MTHFR c.C667T homozygote, DPYD c.A166G, TSER 28bp VNTR 2R/3R heterozygote. Conclusions: In clinical practice, a complex management evaluating clinical parameters and RAS/BRAF genotype characterizing an individual patient with MCRC, particularly elderly and/or unfit owing to comorbidities, is required to properly address tailored, multidisciplinary medical and surgical treatment strategies, integrated with careful monitoring of superimposing toxicity syndromes, also related to pharmacogenomic alterations, to gain optimal activity, and long-term efficacy

Report of a Case of Video-Assisted Thoracoscopic Resection of Bronchogenic Cyst Developed in the Aorto-Pulmonary Window

We report the case of a 28-years-old male with a bronchogenic cyst developed in the aorto-pulmonary window. Left video-assisted thoracoscopy was performed and the cyst was removed intact and completely. Operative time was 48 minutes. The postoperative course was uneventful and the patient was discharged on the third postoperative day. We believe that an uncomplicated mediastinal bronchogenic cyst can be successfully approached by video-assisted thoracoscopy. In the case of an intraparenchymal or complicated cyst, thoracoscopic resection can be technically difficult and hazardous, and open approach is preferable

In Vitro Efficacy of Essential Oils from Melaleuca Alternifolia and Rosmarinus Officinalis, Manuka Honey-based Gel, and Propolis as Antibacterial Agents Against Canine Staphylococcus Pseudintermedius Strains

Abstract: Essential oils (EOs) and honeybee products (e.g., honey and propolis) are natural mixtures of dierent volatile compounds that are frequently used in traditional medicine and for pathogen eradication. The aim of this study was to evaluate the antibacterial properties of tea tree (Melaleuca alternifolia) EO (TTEO), Rosmarinus ocinalis EO (ROEO), manuka-based gel, and propolis against 23 strains of Staphylococcus pseudintermedius (SP) isolated from canine pyoderma. Antimicrobial resistance screening was assessed using a panel of nine antimicrobial agents coupled with a PCR approach. An aromatogram was done for both EOs, using the disk diusion method. The minimum inhibitory concentration (MIC) was determined for all the compounds. Among the 23 SP strains, 14 (60.9%) were multidrug-resistant (MDR), 11 strains (47.8%) were methicillin-resistant (MRSP), and 9 (39.1%) were non-MDR. The mean diameter of the inhibition zone for Melaleuca and Rosmarinus were 24.5 8.8 mm and 15.2 8.9 mm, respectively, resulting as statistically dierent (p = 0.0006). MIC values of TTEO and ROEO were similar (7.6 3.2% and 8.9 2.1%, respectively) and no statistical significances were found. Honeybee products showed lower MIC compared to those of EOs, 0.22 0.1% for Manuka and 0.8 0.5% for propolis. These findings reveal a significant antibacterial eect for all the tested products

Volumetric rheology of polymers

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