Search

Introduction Extracorporeal membrane oxygenation (ECMO) is used extensively in cardiothoracic surgery both for hemodynamic and respiratory support. It has proven to be a valuable tool to maintain adequate oxygenation during tracheal surgery. Airway lesion may be an indication for veno-venous ECMO both in case of conservative management and in case of surgical repair. Here we report the case of a patient with a iatrogenic tracheal injury, successfully operated with the support of veno-venous extracorporeal oxygenation. Presentation of case A 39-year-old female underwent an elective laparoscopic adhesiolysis. At the end of the procedure, the patient had developed subcutaneous emphysema. A CT-scan showed mediastinal and subcutaneous emphysema and left pneumothorax with a laceration of the membranous portion of the middle third of the trachea. A left pleural drain was inserted and a bronchoscopy showed a 2-cm long tear of the membranous portion in the middle third of the trachea. Veno-venous ECMO was established and surgical repair of the tracheal lesion was performed. Post-operative recovery was uneventful and the patient was discharged on 8th postoperative day. Discussion The use of Veno-venous ECMO allowed a safe intubation with optimal oxygenation. A selective intubation with a small tube was performed to prevent further tracheal injury and allow an adequate surgical space for tracheal repair. Conclusion The use of ECMO support represents a safe and effective way to manage patients with ITI when surgical repair with minimally invasive ventilation is needed. Since this is a case report larger studies are needed to validate the technique. [ABSTRACT FROM AUTHOR]

Study objectives: To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (VO[sub 2]max) as a criterion for operability and as a predictor of long-term disability. Design: Prospective study. Setting: Outpatients and inpatients of a university hospital. Participants: Sixty-two consecutive patients (mean ± SD age, 62 ± 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). Measurements: Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV[sub 1] (ppoFEV[sub 1]) was < 40%, patients underwent exercise testing; if VO[sub 2]max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. Results: All the patients with ppoFEV[sub 1] &Ge; 40%—even those patients (26%) with FEV[sub 1] < 80%— underwent thoracotomy without further tests. Seven patients with ppoFEV[sub 1] < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV[sub 1] ≥ 40%. ppoFEV[sub 1] significantly underestimated the actual postoperative FEV[sub 1] (poFEV[sub 1]; p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV[sub 1] after lobectomy. Two patients with predicted postoperative VO[sub 2]max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. Conclusions: ppoFEV[sub 1] ≥ 40% reliably identifies patients not requiting further tests and not at long-term risk of respiratory disability. VO[sub 2]max, effective for defining the immediate surgical risk, is not useful in... [ABSTRACT FROM AUTHOR]

The presence of activating mutations of the epidermal growth factor receptor ( EGFR )-gene identifies a distinct and clinically relevant molecular subset of non-small-cell lung cancer. It is now well demonstrated that EGFR tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib are superior to standard chemotherapy in this subset of tumors. Nevertheless, in many cases, responses are not durable and last for 6–12 months due to the occurrence of secondary or acquired resistance. Here we present three cases of EGFR -mutant lung adenocarcinomas (ADC), that showed an unexpected response to anti-EGFR small molecules. The first patient presented a continued 89 month-long response to erlotinib in a tumor recurred after surgery and conventional chemotherapy. In the other cases, subclinically persistent tumor in the lung tissue was documented histologically in lung resections performed after partial response to TKI treatment. The persistence of interstitial and endolymphatic tumor cells after TKI treatment might explain the common observation of tumor relapse after TKI discontinuation, and sustain the decision to continue treatment in responsive patients as in our first case. [ABSTRACT FROM AUTHOR]

A standard therapeutic approach for advanced malignant thymoma has yet to be defined given the rarity of this condition. We present a patient with advanced thymoma, evaluated as inoperable at diagnosis due to multiple serosal metastases. The strong constitution and determination of the patient allowed treatment with six distinct and subsequent chemotherapy regimens, all administered on an outpatient basis. A survival of 64 months from diagnosis was achieved. A favorable clinical response was obtained after the first three treatment lines, with the disappearance of all lesions on both computed tomography and positron emission tomography (PET) images. However, this result was not confirmed by surgical exploration of the thorax, undertaken with the aim of radical excision of possible residual disease. The presence of multiple pleural nodules, not evident on the imaging techniques, prevented even limited tumor debulking. The chemotherapy lines administered following detection of the lessions, stabilized the disease for a further 2 years, while a satisfactory quality of life was maintained. Only in the last months did the tumor progress and signs of cardiotoxicity appear, with the latter constituting the eventual cause of death. This case is important since the medical literature does not indicate non-cross-resistant regimens for advanced thymoma following second-line chemotherapy, and the sequence of regimens presented in this case study may serve as a feasible outline program. Moreover, we highlight the known possibility of false-negative PET studies, which can occur despite the claimed glucose avidity of thymoma tissue.