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1. Burden of Disease in PWH Harboring a Multidrug-Resistant Virus: Data from the PRESTIGIO Registry

Author

Galli, L, Parisi, M, Poli, A, Menozzi, M, Fiscon, M, Garlassi, E, Francisci, D, DI Biagio, A, Sterrantino, G, Fornabaio, C, Degli Antoni, A, Angarano, G, Fusco, F, D'Arminio Monforte, A, Corbelli, G, Santoro, M, Zazzi, M, Castagna, A, Gianotti, N, Maggiolo, F, Calza, L, Foca, E, Cenderello, G, Rusconi, S, Mussini, C, Antinori, A, Gagliardini, R, Bonora, S, Ferrara, M, Galli, A, Carini, E, Bigoloni, A, Tavio, M, Butini, L, Giacometti, A, Vaccher, E, Martellotta, F, Da Ros, V, Saracino, A, Balena, F, Comi, L, DI Filippo, E, Valenti, D, Suardi, C, Mazzola, B, Viale, P, Del Turco, E, Ramirez, M, Castelli, F, Celotti, A, Brognoli, F, Bonoldi, G, Menzaghi, B, Abeli, C, Farinazzo, M, Ortu, F, Campus, M, Cacopardo, B, Celesia, M, Pan, A, Bartoloni, A, Rinaldi, F, Giache, S, Pierluigi, B, Vichi, F, Santantonio, T, Ferrara, S, Bruno, S, Cassola, G, Marcello, F, Calautti, F, Bassetti, M, Bruzzone, B, Artioli, S, Lazzarin, A, Canetti, D, Galli, M, Formenti, T, Morena, V, Gabrieli, A, Gazzola, L, Merlini, E, Minieri, V, Gori, A, Bandera, A, Pastore, V, Ferroni, V, Puoti, M, Moioli, C, Vassalli, S, Enrica, R, Giulia, N, Beghetto, B, Manzillo, E, Franco, A, Cattelan, A, Marinello, S, Cavinato, S, Macario, A, Cascio, A, Mazzola, G, Antoni, A, Ferrari, C, Laccabue, D, Filice, G, Gulminetti, R, Pagnucco, L, Asti, A, Schiaroli, E, Papalini, C, Italiani, F, DI Pietro, M, Magnani, G, Elisa, G, Barchi, E, Corsini, R, Vergori, A, Cicalini, S, Onnelli, G, Giannetti, A, Cauda, R, Ciccullo, A, La Monica, S, Vullo, V, Dettorre, G, Cavallari, E, Andreoni, M, Malagnino, V, Ceccarelli, L, Viviani, F, Sasset, L, Dentone, C, Rossetti, B, Modica, S, Borgo, V, DI Perri, G, Carcieri, C, Malena, M, Padovani, B, Luzzati, R, Centonze, S, Valentinotti, R, Galli L., Parisi M. R., Poli A., Menozzi M., Fiscon M., Garlassi E., Francisci D., DI Biagio A., Sterrantino G., Fornabaio C., Degli Antoni A., Angarano G., Fusco F. M., D'Arminio Monforte A., Corbelli G. M., Santoro M. M., Zazzi M., Castagna A., Gianotti N., Maggiolo F., Calza L., Foca E., Cenderello G., Rusconi S., Mussini C., Antinori A., Gagliardini R., Bonora S., Ferrara M., Santoro M., Galli A., Carini E., Bigoloni A., Tavio M., Butini L., Giacometti A., Vaccher E., Martellotta F., Da Ros V., Saracino A., Balena F., Comi L., DI Filippo E., Valenti D., Suardi C., Mazzola B., Viale P., Del Turco E. R., Ramirez M. V., Castelli F., Celotti A., Brognoli F., Bonoldi G., Menzaghi B., Abeli C., Farinazzo M., Ortu F., Campus M., Cacopardo B., Celesia M., Pan A., Bartoloni A., Rinaldi F., Giache S., Pierluigi B., Vichi F., Santantonio T., Ferrara S., Bruno S. R., Cassola G., Marcello F., Calautti F., Bassetti M., Bruzzone B., Artioli S., Lazzarin A., Canetti D., Galli M., Formenti T., Morena V., Gabrieli A., Gazzola L., Merlini E., Minieri V., Gori A., Bandera A., Pastore V., Ferroni V., Puoti M., Moioli C., Vassalli S., Enrica R., Giulia N., Beghetto B., Manzillo E., Franco A., Cattelan A. M., Marinello S., Cavinato S., MacArio A., Cascio A., Mazzola G., Antoni A. M. D., Ferrari C., Laccabue D., Filice G., Gulminetti R., Pagnucco L., Asti A., Schiaroli E., Papalini C., Italiani F., DI Pietro M., Magnani G., Elisa G., Barchi E., Corsini R., Vergori A., Cicalini S., Onnelli G., Giannetti A., Cauda R., Ciccullo A., La Monica S., Vullo V., Dettorre G., Cavallari E. N., Andreoni M., Malagnino V., Ceccarelli L., Viviani F., Sasset L., Dentone C., Rossetti B., Modica S., Borgo V., DI Perri G., Carcieri C., Malena M., Padovani B., Luzzati R., Centonze S., Valentinotti R., Galli, L, Parisi, M, Poli, A, Menozzi, M, Fiscon, M, Garlassi, E, Francisci, D, DI Biagio, A, Sterrantino, G, Fornabaio, C, Degli Antoni, A, Angarano, G, Fusco, F, D'Arminio Monforte, A, Corbelli, G, Santoro, M, Zazzi, M, Castagna, A, Gianotti, N, Maggiolo, F, Calza, L, Foca, E, Cenderello, G, Rusconi, S, Mussini, C, Antinori, A, Gagliardini, R, Bonora, S, Ferrara, M, Galli, A, Carini, E, Bigoloni, A, Tavio, M, Butini, L, Giacometti, A, Vaccher, E, Martellotta, F, Da Ros, V, Saracino, A, Balena, F, Comi, L, DI Filippo, E, Valenti, D, Suardi, C, Mazzola, B, Viale, P, Del Turco, E, Ramirez, M, Castelli, F, Celotti, A, Brognoli, F, Bonoldi, G, Menzaghi, B, Abeli, C, Farinazzo, M, Ortu, F, Campus, M, Cacopardo, B, Celesia, M, Pan, A, Bartoloni, A, Rinaldi, F, Giache, S, Pierluigi, B, Vichi, F, Santantonio, T, Ferrara, S, Bruno, S, Cassola, G, Marcello, F, Calautti, F, Bassetti, M, Bruzzone, B, Artioli, S, Lazzarin, A, Canetti, D, Galli, M, Formenti, T, Morena, V, Gabrieli, A, Gazzola, L, Merlini, E, Minieri, V, Gori, A, Bandera, A, Pastore, V, Ferroni, V, Puoti, M, Moioli, C, Vassalli, S, Enrica, R, Giulia, N, Beghetto, B, Manzillo, E, Franco, A, Cattelan, A, Marinello, S, Cavinato, S, Macario, A, Cascio, A, Mazzola, G, Antoni, A, Ferrari, C, Laccabue, D, Filice, G, Gulminetti, R, Pagnucco, L, Asti, A, Schiaroli, E, Papalini, C, Italiani, F, DI Pietro, M, Magnani, G, Elisa, G, Barchi, E, Corsini, R, Vergori, A, Cicalini, S, Onnelli, G, Giannetti, A, Cauda, R, Ciccullo, A, La Monica, S, Vullo, V, Dettorre, G, Cavallari, E, Andreoni, M, Malagnino, V, Ceccarelli, L, Viviani, F, Sasset, L, Dentone, C, Rossetti, B, Modica, S, Borgo, V, DI Perri, G, Carcieri, C, Malena, M, Padovani, B, Luzzati, R, Centonze, S, Valentinotti, R, Galli L., Parisi M. R., Poli A., Menozzi M., Fiscon M., Garlassi E., Francisci D., DI Biagio A., Sterrantino G., Fornabaio C., Degli Antoni A., Angarano G., Fusco F. M., D'Arminio Monforte A., Corbelli G. M., Santoro M. M., Zazzi M., Castagna A., Gianotti N., Maggiolo F., Calza L., Foca E., Cenderello G., Rusconi S., Mussini C., Antinori A., Gagliardini R., Bonora S., Ferrara M., Santoro M., Galli A., Carini E., Bigoloni A., Tavio M., Butini L., Giacometti A., Vaccher E., Martellotta F., Da Ros V., Saracino A., Balena F., Comi L., DI Filippo E., Valenti D., Suardi C., Mazzola B., Viale P., Del Turco E. R., Ramirez M. V., Castelli F., Celotti A., Brognoli F., Bonoldi G., Menzaghi B., Abeli C., Farinazzo M., Ortu F., Campus M., Cacopardo B., Celesia M., Pan A., Bartoloni A., Rinaldi F., Giache S., Pierluigi B., Vichi F., Santantonio T., Ferrara S., Bruno S. R., Cassola G., Marcello F., Calautti F., Bassetti M., Bruzzone B., Artioli S., Lazzarin A., Canetti D., Galli M., Formenti T., Morena V., Gabrieli A., Gazzola L., Merlini E., Minieri V., Gori A., Bandera A., Pastore V., Ferroni V., Puoti M., Moioli C., Vassalli S., Enrica R., Giulia N., Beghetto B., Manzillo E., Franco A., Cattelan A. M., Marinello S., Cavinato S., MacArio A., Cascio A., Mazzola G., Antoni A. M. D., Ferrari C., Laccabue D., Filice G., Gulminetti R., Pagnucco L., Asti A., Schiaroli E., Papalini C., Italiani F., DI Pietro M., Magnani G., Elisa G., Barchi E., Corsini R., Vergori A., Cicalini S., Onnelli G., Giannetti A., Cauda R., Ciccullo A., La Monica S., Vullo V., Dettorre G., Cavallari E. N., Andreoni M., Malagnino V., Ceccarelli L., Viviani F., Sasset L., Dentone C., Rossetti B., Modica S., Borgo V., DI Perri G., Carcieri C., Malena M., Padovani B., Luzzati R., Centonze S., and Valentinotti R.

Abstract

Background: Currently, no data are available on the burden of morbidity and mortality in people with HIV-1 (PWH) harboring a 4-class drug-resistant (4DR) virus (nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase strand transfer inhibitors). The study aimed to assess the incidence of clinical events and death in this population. Methods: This was a cohort study on PWH from the PRESTIGIO Registry with a documented 4DR virus. Burden of disease was defined as the occurrence of any new event including an AIDS-defining event (ADE) or non-AIDS-defining event (NADE) or death from any cause after 4DR evidence (baseline). Cox regression models evaluated factors associated with the risk of new clinical events/death. Results: Among 148 PWH followed for a median (interquartile range) of 47 (32-84) months after 4DR evidence, 38 PWH had 62 new events or died from any cause (incidence rate, 9.12/100 person-years of follow-up; 95% CI = 6.85-11.39): 12 deaths (6 AIDS-related and 6 non-AIDS-related), 18 ADEs, 32 NADEs; 20 of the 38 NADEs (45%) of the incident clinical events were malignancies. The 4-year cumulative incidence of death was 6% (95% CI, 3%-13%), and that of ≥1 event or death was 22% (95% CI, 16%-31%). A higher risk of new clinical events/death was more likely in PWH with previous clinical events (adjusted hazard ratio [aHR], 2.67; 95% CI, 1.07-6.67) and marginally associated with lower baseline CD4+/CD8+ ratio (aHR, 0.82; 95% CI, 0.65-1.02). Conclusions: PWH harboring 4DR have a high burden of disease with a worrying incidence of malignancies, strongly advising for close prevention and monitoring interventions as well as access to innovative therapeutic strategies, especially in people with a history of clinical events and low CD4+/CD8+ ratio.

Published
2020

2. Burden of Disease in PWH Harboring a Multidrug-Resistant Virus: Data from the PRESTIGIO Registry

Author

Galli, L., Parisi, M. R., Poli, A., Menozzi, M., Fiscon, M., Garlassi, E., Francisci, D., DI Biagio, A., Sterrantino, G., Fornabaio, C., Degli Antoni, A., Angarano, G., Fusco, F. M., D'Arminio Monforte, A., Corbelli, G. M., Santoro, M. M., Zazzi, M., Castagna, A., Gianotti, N., Maggiolo, F., Calza, L., Foca, E., Cenderello, G., Rusconi, S., Mussini, C., Antinori, A., Gagliardini, R., Bonora, S., Ferrara, M., Santoro, M., Galli, A., Carini, E., Bigoloni, A., Tavio, M., Butini, L., Giacometti, A., Vaccher, E., Martellotta, F., Da Ros, V., Saracino, A., Balena, F., Comi, L., DI Filippo, E., Valenti, D., Suardi, C., Mazzola, B., Viale, P., Del Turco, E. R., Ramirez, M. V., Castelli, F., Celotti, A., Brognoli, F., Bonoldi, G., Menzaghi, B., Abeli, C., Farinazzo, M., Ortu, F., Campus, M., Cacopardo, B., Celesia, M., Pan, A., Bartoloni, A., Rinaldi, F., Giache, S., Pierluigi, B., Vichi, F., Santantonio, T., Ferrara, S., Bruno, S. R., Cassola, G., Marcello, F., Calautti, F., Bassetti, M., Bruzzone, B., Artioli, S., Lazzarin, A., Canetti, D., Galli, M., Formenti, T., Morena, V., Gabrieli, A., Gazzola, L., Merlini, E., Minieri, V., Gori, A., Bandera, A., Pastore, V., Ferroni, V., Puoti, M., Moioli, C., Vassalli, S., Enrica, R., Giulia, N., Beghetto, B., Manzillo, E., Franco, A., Cattelan, A. M., Marinello, S., Cavinato, S., Macario, A., Cascio, A., Mazzola, G., Antoni, A. M. D., Ferrari, C., Laccabue, D., Filice, G., Gulminetti, R., Pagnucco, L., Asti, A., Schiaroli, E., Papalini, C., Italiani, F., DI Pietro, M., Magnani, G., Elisa, G., Barchi, E., Corsini, R., Vergori, A., Cicalini, S., Onnelli, G., Giannetti, A., Cauda, R., Ciccullo, A., La Monica, S., Vullo, V., Dettorre, G., Cavallari, E. N., Andreoni, M., Malagnino, V., Ceccarelli, L., Viviani, F., Sasset, L., Dentone, C., Rossetti, B., Modica, S., Borgo, V., DI Perri, G., Carcieri, C., Malena, M., Padovani, B., Luzzati, R., Centonze, S., Valentinotti, R., Galli L., Parisi M.R., Poli A., Menozzi M., Fiscon M., Garlassi E., Francisci D., DI Biagio A., Sterrantino G., Fornabaio C., Degli Antoni A., Angarano G., Fusco F.M., D'Arminio Monforte A., Corbelli G.M., Santoro M.M., Zazzi M., Castagna A., Gianotti N., Maggiolo F., Calza L., Foca E., Cenderello G., Rusconi S., Mussini C., Antinori A., Gagliardini R., Bonora S., Ferrara M., Santoro M., Galli A., Carini E., Bigoloni A., Tavio M., Butini L., Giacometti A., Vaccher E., Martellotta F., Da Ros V., Saracino A., Balena F., Comi L., DI Filippo E., Valenti D., Suardi C., Mazzola B., Viale P., Del Turco E.R., Ramirez M.V., Castelli F., Celotti A., Brognoli F., Bonoldi G., Menzaghi B., Abeli C., Farinazzo M., Ortu F., Campus M., Cacopardo B., Celesia M., Pan A., Bartoloni A., Rinaldi F., Giache S., Pierluigi B., Vichi F., Santantonio T., Ferrara S., Bruno S.R., Cassola G., Marcello F., Calautti F., Bassetti M., Bruzzone B., Artioli S., Lazzarin A., Canetti D., Galli M., Formenti T., Morena V., Gabrieli A., Gazzola L., Merlini E., Minieri V., Gori A., Bandera A., Pastore V., Ferroni V., Puoti M., Moioli C., Vassalli S., Enrica R., Giulia N., Beghetto B., Manzillo E., Franco A., Cattelan A.M., Marinello S., Cavinato S., MacArio A., Cascio A., Mazzola G., Antoni A.M.D., Ferrari C., Laccabue D., Filice G., Gulminetti R., Pagnucco L., Asti A., Frsdi E., Schiaroli E., Papalini C., Italiani F., DI Pietro M., Magnani G., Elisa G., Barchi E., Corsini R., Vergori A., Cicalini S., Onnelli G., Giannetti A., Cauda R., Ciccullo A., La Monica S., Vullo V., Dettorre G., Cavallari E.N., Andreoni M., Malagnino V., Ceccarelli L., Viviani F., Sasset L., Dentone C., Rossetti B., Modica S., Borgo V., DI Perri G., Carcieri C., Malena M., Padovani B., Luzzati R., Centonze S., Valentinotti R., Galli, L, Parisi, M, Poli, A, Menozzi, M, Fiscon, M, Garlassi, E, Francisci, D, DI Biagio, A, Sterrantino, G, Fornabaio, C, Degli Antoni, A, Angarano, G, Fusco, F, D'Arminio Monforte, A, Corbelli, G, Santoro, M, Zazzi, M, Castagna, A, Gianotti, N, Maggiolo, F, Calza, L, Foca, E, Cenderello, G, Rusconi, S, Mussini, C, Antinori, A, Gagliardini, R, Bonora, S, Ferrara, M, Galli, A, Carini, E, Bigoloni, A, Tavio, M, Butini, L, Giacometti, A, Vaccher, E, Martellotta, F, Da Ros, V, Saracino, A, Balena, F, Comi, L, DI Filippo, E, Valenti, D, Suardi, C, Mazzola, B, Viale, P, Del Turco, E, Ramirez, M, Castelli, F, Celotti, A, Brognoli, F, Bonoldi, G, Menzaghi, B, Abeli, C, Farinazzo, M, Ortu, F, Campus, M, Cacopardo, B, Celesia, M, Pan, A, Bartoloni, A, Rinaldi, F, Giache, S, Pierluigi, B, Vichi, F, Santantonio, T, Ferrara, S, Bruno, S, Cassola, G, Marcello, F, Calautti, F, Bassetti, M, Bruzzone, B, Artioli, S, Lazzarin, A, Canetti, D, Galli, M, Formenti, T, Morena, V, Gabrieli, A, Gazzola, L, Merlini, E, Minieri, V, Gori, A, Bandera, A, Pastore, V, Ferroni, V, Puoti, M, Moioli, C, Vassalli, S, Enrica, R, Giulia, N, Beghetto, B, Manzillo, E, Franco, A, Cattelan, A, Marinello, S, Cavinato, S, Macario, A, Cascio, A, Mazzola, G, Antoni, A, Ferrari, C, Laccabue, D, Filice, G, Gulminetti, R, Pagnucco, L, Asti, A, Schiaroli, E, Papalini, C, Italiani, F, DI Pietro, M, Magnani, G, Elisa, G, Barchi, E, Corsini, R, Vergori, A, Cicalini, S, Onnelli, G, Giannetti, A, Cauda, R, Ciccullo, A, La Monica, S, Vullo, V, Dettorre, G, Cavallari, E, Andreoni, M, Malagnino, V, Ceccarelli, L, Viviani, F, Sasset, L, Dentone, C, Rossetti, B, Modica, S, Borgo, V, DI Perri, G, Carcieri, C, Malena, M, Padovani, B, Luzzati, R, Centonze, S, Valentinotti, R, Galli, Laura, Parisi, Maria Rita, Poli, Andrea, Menozzi, Marianna, Fiscon, Marta, Garlassi, Elisa, Francisci, Daniela, Di Biagio, Antonio, Sterrantino, Gaetana, Fornabaio, Chiara, Degli Antoni, Anna, Angarano, Gioacchino, Fusco, Francesco Maria, D'Arminio Monforte, Antonella, Corbelli, Giulio Maria, Santoro, Maria Mercede, Zazzi, Maurizio, and Castagna, Antonella

Subjects
0301 basic medicine, medicine.medical_specialty, 4-class drug resistance, AIDS-defining event, cancer, death, non-AIDS-defining event, Population, Major Articles, Settore MED/07, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, medicine, Cumulative incidence, 030212 general & internal medicine, education, Disease burden, education.field_of_study, Proportional hazards model, business.industry, Incidence (epidemiology), Hazard ratio, 030112 virology, AcademicSubjects/MED00290, Infectious Diseases, Oncology, business, Cohort study
Abstract

BackgroundCurrently, no data are available on the burden of morbidity and mortality in people with HIV-1 (PWH) harboring a 4-class drug-resistant (4DR) virus (nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase strand transfer inhibitors). The study aimed to assess the incidence of clinical events and death in this population.MethodsThis was a cohort study on PWH from the PRESTIGIO Registry with a documented 4DR virus. Burden of disease was defined as the occurrence of any new event including an AIDS-defining event (ADE) or non-AIDS-defining event (NADE) or death from any cause after 4DR evidence (baseline). Cox regression models evaluated factors associated with the risk of new clinical events/death.ResultsAmong 148 PWH followed for a median (interquartile range) of 47 (32–84) months after 4DR evidence, 38 PWH had 62 new events or died from any cause (incidence rate, 9.12/100 person-years of follow-up; 95% CI = 6.85–11.39): 12 deaths (6 AIDS-related and 6 non-AIDS-related), 18 ADEs, 32 NADEs; 20 of the 38 NADEs (45%) of the incident clinical events were malignancies. The 4-year cumulative incidence of death was 6% (95% CI, 3%–13%), and that of ≥1 event or death was 22% (95% CI, 16%–31%). A higher risk of new clinical events/death was more likely in PWH with previous clinical events (adjusted hazard ratio [aHR], 2.67; 95% CI, 1.07–6.67) and marginally associated with lower baseline CD4+/CD8+ ratio (aHR, 0.82; 95% CI, 0.65–1.02).ConclusionsPWH harboring 4DR have a high burden of disease with a worrying incidence of malignancies, strongly advising for close prevention and monitoring interventions as well as access to innovative therapeutic strategies, especially in people with a history of clinical events and low CD4+/CD8+ ratio.

Published
2020

4. Use of an electrothermal bipolar tissue sealing system in lung surgery.

Author

Santini M, Vicidomini G, Baldi A, Gallo G, Laperuta P, Busiello L, Di Marino MP, and Pastore V

Subjects
Adult, Aged, Animals, Biomechanical Phenomena, Electrocoagulation instrumentation, Female, Hemostasis, Surgical instrumentation, Humans, Male, Middle Aged, Models, Animal, Pulmonary Surgical Procedures instrumentation, Suture Techniques, Swine, Thoracic Surgery, Video-Assisted methods, Thoracotomy methods, Treatment Outcome, Wound Healing, Electrocoagulation methods, Hemostasis, Surgical methods, Lung Diseases surgery, Pulmonary Surgical Procedures methods
Abstract

Objective: We evaluated the validity of an electrothermal bipolar tissue sealing system (LigaSure, Valleylab Inc., USA) in lung surgery., Methods: Our study was divided into two phases., Experimental: We performed sutures of pulmonary vessels and bronchi and lung wedge resections by LigaSure in 28 lungs of adult pigs; subsequently, we quantitated the sealing capacity of the system detecting the burst pressure for each anatomical structure. Clinical: LigaSure was used in 36 patients undergoing lung surgery. We performed 23 thoracotomic procedures in 16 patients (19 wedge resections, 2 segmentectomies, and 2 fissure separations), and 20 thoracoscopic procedures (13 wedge resections, 5 bullectomies, and 2 adherence dissections)., Experimental: Bronchi and vessels were divided into seven groups (diameter: 1-7 mm); 10 burst pressure measurements for each group were performed. A total of 84 wedge resections were performed; lung specimens were divided into seven groups (weight: 0.2-1.4 g). The percentage of bronchial sutures resistant to the pneumatic critical pressure (60 mmHg) was 100% in the 1-mm and 2-mm groups. No bronchi with 6-mm or 7-mm diameter reached the critical pressure. All pulmonary vessel sutures were resistant to the critical hydrostatic pressure (150 mmHg). The average burst pressure of wedge resection margins was higher than the critical pressure, and the percentage of suture margins resistant to the critical pressure decreased from 95% (0.2-g group) to 68% (1.4-g group). Histology confirmed the sealing of vessels, with a mean depth of thermal injury limited to 1.1mm. Clinical: In all patients, hemostasis obtained by LigaSure was effective, with minimal perioperative bleeding. The mean operating time was 77.2 min (range: 60-97) for thoracotomies and 60.3 min (range: 46-80) for thoracoscopies. The mean drainage duration was 3.1 days (range: 1-8). Two patients had prolonged air leaks (>7 days). The mean postoperative stay was 7.3 days (range: 5-13) for thoracotomies and 4.6 days (range: 1-6) for thoracoscopies., Conclusions: Use of LigaSure in lung surgery appears feasible and easy. It provides satisfactory hemostasis and air-leak prevention; results are comparable to those of stapling devices, but this system seems to have a better benefit/cost ratio. Larger series are needed to confirm these data.

Published
2006
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5. Use of a modified endobronchial tube for mechanical ventilation of patients with bronchopleural fistula.

Author

Santini M, Vicidomini G, La Monica G, and Pastore V

Subjects
Aged, Bronchial Fistula diagnostic imaging, Equipment Design, Fistula diagnostic imaging, Humans, Male, Pleural Diseases diagnostic imaging, Radiography, Bronchial Fistula therapy, Fistula therapy, Intubation, Intratracheal methods, Pleural Diseases therapy, Respiration, Artificial methods
Abstract

Mechanical ventilation in patients with bronchopleural fistula after lung resection is a major problem, as it causes increase of the air-leak, complicates the healing process and makes residual lung tissue ventilation difficult. We present two cases in which the use of a modified double lumen endobronchial tube improved ventilation and eliminated the fistula air-leak. We used a right-sided double lumen sher-i-bronch tube (Sheridan Catheter Corp., USA). This method, by blocking the airflow through the fistula, may facilitate the expansion of the residual lung parenchyma. In both the patients treated with this technique, we obtained a good expansion of the residual parenchyma. Despite the procedure, the first patient died of septic shock; in the second patient, we achieved improvement of the respiratory function, the weaning from the mechanical ventilation, and thereafter, the healing of the fistula. The use of a modified double lumen sher-i-bronch tube in mechanically ventilated patients with post-resection bronchopleural fistula allows the anaesthesiologist to suction separately the two lungs and to ventilate adequately the remaining lung tissue, thus obtaining the lung reexpansion and the consequent reduction of the residual pleural space, and facilitating the healing of the fistula.

Published
2005
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6. Diagnosis and radioguided surgery with 111In-pentetreotide in a patient with paraneoplastic Cushing's syndrome due to a bronchial carcinoid.

Author

Mansi L, Rambaldi PF, Panza N, Esposito D, Esposito V, and Pastore V

Subjects
Adult, Bronchial Neoplasms surgery, Carcinoid Tumor surgery, Cushing Syndrome diagnostic imaging, Humans, Male, Radionuclide Imaging, Bronchial Neoplasms diagnostic imaging, Carcinoid Tumor diagnostic imaging, Cushing Syndrome surgery, Somatostatin analogs & derivatives
Abstract

In a 28-year-old man with Cushing's syndrome, studies investigating a hypophyseal and/or adrenal origin of the disease, including computed tomography and magnetic resonance imaging, were negative. In agreement with reports showing somatostatin receptors on the cell membrane of ectopically secreting ACTH tumours, scintigraphy was performed after intravenous injection of 111 MBq 111In-pentetreotide (OCT). The radiolabelled OCT scan showed a small focal area of intense uptake at the inferior lobe of the right lung. Subsequent radioguided surgery located and defined a small mass (1.8 x 1.4 x 1.6 cm). The probe pinpointed the mass to the right inferior chest lobe, with a tumour/normal tissue count ratio of 6:1 and tumour/hilar normal lymph node ratio of 12:1, thus permitting the complete excision of the tumour to exclude lymph node and/or parietal involvement. A lung carcinoid was diagnosed at histology. The patient is still alive and disease-free 24 months after surgery. 111In-OCT was found to be useful for localizing the ACTH-secreting tumour and also permitted rapid non-invasive differential diagnosis between an ACTH-secreting pituitary adenoma and malignancy causing ectopic ACTH syndrome. This study also showed the clinical usefulness of radioguided surgery in the treatment of bronchial carcinoid.

Published
1997
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