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A case of spontaneous intercostal pulmonary hernia as a result of vigorous coughing is reported in a 67-year-old man. The great majority of acquired pulmonary hernias are post-traumatic; rare cases are spontaneous, resulting from prolonged and/or repeated increased intrathoracic pressure. This hernia was successfully repaired with a polyglactin absorbable mesh and approximation of the ribs with heavy stitches. When required, surgical repair is the treatment of choice.

Background: Low-potassium (LP) solution with Dextran (Dx) improves lung preservation. Nevertheless, the role of Dx in simple cold storage is not established yet. This study was designed to investigate the relationship between molecular weight and concentration of Dx in LP solutions and its effects on cell viability after prolonged hypothermic preservation., Methods: Human fetal lung fibroblasts (WI-38) were preserved at 10 degrees C for 16 hrs in five solutions containing respectively Dx11, Dx17, Dx39.2, Dx71, Dx178 at 2% and at 5% concentrations and in LP solution without Dx. Cell viability was assessed by means of both the analysis of the total protein content (cytotoxicity index) and the rate of protein synthesis (index of cellular functioning)., Results: No differences were recorded in total protein content among the solutions tested. By contrast, the index of cellular functioning was significantly higher using LPDx178 at both concentrations. However, LPDx178 exerted a more significant cytotoxic effect than did LP alone., Conclusions: These effects were not mediated by the variation of osmolarity; two factors probably influenced this protection: the low oncotic pressure of the LPDx178 solution and an effect chemically specific due to the increased molecular weight of Dx still unknown. Nevertheless, during 10 degrees C preservation, WI-38 cells were better preserved with LP solution without Dx confirming, thus, that during simple cold storage the presence of an oncotic pressure might be harmful.

Background: The research on lung preservation for transplantation is directed to synthesize a solution, in order to prolong the preservation period, thus avoiding the damage to lung tissues caused by ischemia. In recent years some in vivo experimental papers have been published, in which good results were obtained by adding trehalose, a non-reducing disaccharide able to stabilize the cell membrane, to the storage solutions., Materials and Methods: In this study we have evaluated the effects on human lung fibroblasts of commonly used storage solutions like Euro-Collins (EC) and Low Potassium Dextran (LPD), in which trehalose has respectively replaced glucose (T-EC) or was added (LPD-T). The cultures were incubated for 8 hours at 10 degrees C in standard and modified solutions., Results: The data relative to EC compared to EC-T showed that the total protein content and the rate of protein synthesis, that is in other words cell viability, are drastically compromised. Concerning LPD-T, compared to standard LPD, a slightly decrease of the total protein content and of the rate of protein synthesis in the cells incubated in the modified solution were observed. The reasons for these unexpected data are related to the hypothesis that during the ischemic period membrane stabilization is neither the main nor the only factor responsible for the cellular damage. Moreover the role of trehalose in preservation solutions, is still not clear and should be further investigated., Conclusions: With the limits of the study of single cells in vitro, the advantages of trehalose containing solutions proved ineffective and toxic especially as for as EC-T is concerned.

The lack of an ideal heart-lung preservation solution is one of the principal factor that limits the wide spread of transplantation. The aim of this work was to investigate the efficacy of Haemaccel (HM) on isolated human pulmonary artery endothelial cells comparing its effects with those of University of Wisconsin (UWS). Subcultures of HPAEC were inoculated at the density of 5,000 cells per cm2 in 9 cm2 well-plates. Cells were incubated with HM and UWS for 6 hrs at 10 degrees C. Cellular viability was analysed by the total protein content (cytotoxicity index) and by the rate of protein synthesis (metabolic index). The results showed that HM and UWS did no show a significant differences in the toxicity when compared with the control; on the contrary, HM seems to determine a less inhibitory effect on cellular metabolism permitting a more rapid cellular metabolic recovery than UWS. Thus, HM appears to be more suitable for the preservation of isolated HPAEC than UWS.

Primary pulmonary lymphomas are uncommon tumours arising from mucosa associated lymphoid tissue (MALT). The authors report a case diagnosed by transbronchial biopsy and treated by surgery only. They discuss the distinct clinicalpathological features and debate the different ways of treating this condition.

Postero-lateral thoracotomy is the standard access in thoracic surgery, and can be carried out dividing or preserving the serratus anterior muscle. This last method, besides its advantages, is still a matter of discussion, in fact traction has been claimed to cause severe muscular damage equal to section. We have studied 20 patients (16 males and 4 females, mean age 63 years), who underwent postero-lateral thoracotomy sparing the serratus anterior, after 6 months from surgery, both clinically and by means of electromyography (EMG), to evaluate the functional status of the spared muscles. In 4 cases (20%) there wasn't any neurogenic damage nor clinical evidence of winging scapula; 3 cases (15%) had medium neurogenic damage. The remaining 13 (65%) cases had a medium neurogenic damage and only one patient showed a winging scapula, neverthless being able to lift the arm to shoulder level. Our data confirmed that retraction during surgery does not damage the serratus anterior, leaving a functionally valid muscle.

In well selected cases, in which preoperative investigations allow us to plan a tracheal resection-anastomosis, surgery is the best current treatment also for secondary tumours involving the trachea. We report a case of a patient suffering from severe dyspnoea for tracheal stenosis due to recurrence of an epidermoid cancer of the tongue. Surgical treatment allowed us to obtain very good palliation.

Chylopericardium as an isolated complication after open heart surgery is a rare event. We present here a case of late postoperative chylopericardium and comment on the clinical course, the aetiopathology and treatment.

Unlabelled: The preservation of the lung for transplantation for a long period is still a problem not solved. Euro-Collins (EC) and Belzer (UW) solution are the most widely used. The aim of this work is to analyse the direct influence of both EC and UW solutions on endothelial cells of human pulmonary artery by means of an ultrastructural analysis. The arteries were obtained from 3 patients that underwent pneumonectomy and prepared with the no touch technique. The arteries were divided in 15 specimens and preserved in EC and UW solution at 4 degrees C for 6 and 10 hours. The specimens were fixed in osmic acid veronal buffer 1% and embedded in Durcupan. Ultrastructural examination was done with transmission electron microscopy (TEM) and the influence of the solutions was evaluated using a grading scale with scores ranging from 0 to 4 that express the damages of the cellular wall, mitochondria and nuclei. The data are expressed as mean +/- standard deviation (n = 5). Student's t-test was used for statistical comparison between the solutions., Results: after 6 hours of preservation in EC and UW the scores were 5.2 +/- 0.45 and 4.8 +/- 0.84 (p = 0.373) while after 10 hours were respectively 8.2 +/- 0.84 and 6.8 +/- 0.84 (p = 0.029). In conclusion our experimental model suggests that there are no significant differences between EC and UW after hypothermic 6 hours preservation while endothelial cells are better preserved after 10 hours in UW solution.

Currently, Eurocollins' (EC) solution (high-potassium concentration) is the most widely clinically used pulmonary perfusate. However, recently, experimental studies have reported an increase of the lung ischemic period using low-potassium solutions. The purpose of our study, is to investigate the influence of the EC ionic composition and the effect of hyperosmolarity due to the glucose concentration on isolated alveolar type II epithelial cells. Pneumocytes type II were isolated from pathogen free Wistar rats using the modified Dobbs' method. Cells were incubated for 6 hours at 4 degrees C in EC, Collins (CL) and Ringer Lactate (RL) solutions. After that, cellular viability was evaluated by analysis of the protein synthesis assay by measuring the 35 S methionine uptake during an incorporation period of one hour at 37 degrees C (picomol 35 S met/mg proteins/h). Mean +/- standard deviation and Student "t"-test were used for data presentation and results comparison. Cellular viability at time 0 (control) before cellular incubation was 3.93 +/- 0.38. After 6 hours at 4 degrees C the results were respectively as follows: EC = 2.16 +/- 0.13; CL = 2.63 +/- 0; RL = 3.21 +/- 0.04. Our results suggest that the low-potassium extracellular type solution (RL) shows a protection on isolated type II epithelial cells statistically significant (p < 0.05) if compared with EC solution. Moreover CL solution, that has the same ionic composition EC but without glucose, presents a less cytotoxic effects on incubated cells than EC, confirming a deleterious influence of solution hyperosmolarity.