Search

We reported the feasibility of thoracoscopic anatomical resections for lung cancer in four consecutive patients undergoing previous cardiac surgeries as coronary artery by-pass graft (CABG) using left internal mammary artery (LIMA) graft (n=1), cardiac transplantation (n=2), and mitral valve replacement (n=1). A three-port approach was used in all patients but one where an uniportal approach was adopted. Lobectomy was carried out in two patients; left upper three-segmentectomy and upper bilobectomy in the other two. All procedures were successfully performed without needing conversion. No intra-operative, post-operative morbidity and mortality were recorded. At last follow-up, all patients were alive without recurrence but one who had cerebral metastasis. Thoracoscopic lung resection after cardiac surgery is a feasible but complex procedure that should be performed in centres having a cardiac surgery team ready to operate in case of cardiac complications., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Nowadays several studies have shown that, in the management of patients with early-stage lung cancer, video-assisted thoracoscopic surgery (VATS) lobectomy compared to open surgery is associated with many clinical short-term benefits, such as less post-operative pain and shorter hospital stay. Despite the advantages described earlier, some authors have expressed concern about the effectiveness of the procedure arguing that the lymph node harvest performed during VATS lobectomy is inferior to that performed through thoracotomy access. Experience from a multicentre database, with a more balanced number of VATS versus open patients, actually has shown that there is no difference in the efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. In expert hands the technique of VATS lymphadenectomy is the same as that performed by thoracotomy: instrumentation and tricks can change but not the oncologic principles. We believe that is necessary to follow a learning curve not only for VATS lobectomy but also for thoracoscopic lymph node dissection. However even experienced VATS surgeons should keep in mind that the metastatic lymphadenopathy with extracapsular lymph node spread requires great caution during dissection and that a preoperative plan for conversion to thoracotomy can be useful in this case., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

In recent decades, mediastinal surgery has undergone radical innovations. In fact, introduction of minimally invasive methods, such as video-assisted thoracoscopic surgery (VATS), showed several clinical benefits over median sternotomy. Recently the introduction of robotic-assisted thoracoscopic surgery (RATS) has added more technological advantages in mediastinal dissection such as 3-dimensional (3D) vision and multi-articulated instruments. We agree with many authors about the advantages of RATS for the treatment of patients with thymomas and patients with myasthenia gravis (MG) resistant to medical treatment, but actually we express concerns about the high costs of this procedure. Furthermore we are waiting for long term clinical and oncological outcomes compared with trans-sternal or VATS approach. Here we report our series experience., Competing Interests: Conflicts of Interests: The authors have no conflicts of interest to declare.

Video-assisted thoracoscopic surgery (VATS) lobectomy has been employed in recent decades for the treatment of non-small cell lung cancer (NSCLC). Although trials have shown this procedure to be safe and feasible a VATS approach for lobectomy has not been widely used yet. Surgeons can go beyond this limit by following a specific operative plan focused on learning the minimally invasive technique in centers of excellence and then including: a pre-operative phase based on the radioclinical assessments and an operating phase designed to develop a methodical approach to VATS technique. At the beginning it's recommended to follow a learning curve with careful selection of patients keeping in mind that intraoperative complications may occur even later, especially in presence of clinical nodal disease or significant calcification on preoperative CT scan, which represents the main reason for conversion from VATS to thoracotomy., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Introduction: Solitary fibrous tumors are uncommon soft tissue tumors initially reported only in the pleura but, in recent years, they have been described at many extra pleural sites, such as mediastinum. The treatment of choice is the extensive surgical resection that is curative for most benign lesions., Presentation of the Case: We present the case of solitary fibrous tumor of the anterior mediastinum in obese patient (BMI: 34.3) undergoing complete surgical resection by robotic-assisted thoracoscopic surgery with da Vinci ® Surgical System., Discussion/conclusion: Robotic-assisted thoracoscopic surgery with da Vinci ® Surgical System is an interesting option for obese patient, at higher risk for deep sternal wound infection., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Unlabelled: We report a case of 31 years-old female suffering from complicated giant bulla in the right upper pulmonary lobe. The patient was admitted to our hospital with a radiologic diagnosis of hydro - pneumothorax treated by chest tube in a first time, and later, for prolonged air leaks, by uniportal VATS with a single 4-cm skin incision. We have observed a giant ruptured bulla in right upper lobe, so we have performed bullectomy and mechanical pleurodesis. This case, in our knowledge, represents the first giant bulla resection performed by uniportal VATS., Key Words: Giant bulla, Giant bullous emphysema, Uniportal VATS.

Introduction: The mediastinal bronchogenic cysts represents 50%-60% of mediastinal cysts and rarely occurs in the posterior mediastinum. The final surgical resection is indicated for symptomatic patients and is recommended for some asymptomatic patients in order to establish the diagnosis and to avoid any subsequent complications., Case Presentation: We report a case of 17 years-old male suffering from bronchogenic cysts of the mediastinum. The patient was admitted to our hospital complaining with dry chough and dyspnea; CT scan showed a cystic mass in posterior mediastinum. To achieve a correct diagnosis and to prevent the risk of complications, a complete surgical resection was performed by using bilateral simultaneous VATS., Discussion: Bronchogenic cysts manifest as solitary or multiple lesions, majority of which are located in the mediastinum while sometimes can occur in the lung parenchyma. They are usually asymptomatic and casually discovered at chest X-ray or CT scan. The most common complications are infections, pneumothorax and hemoptysis. The complete surgical resection is the only radical and definitive treatment of the bronchogenic mediastinal cysts. VATS permits good exposure of the thoracic cavity including the mediastinum and better evaluation of the anatomic relationship. The absence of intra and postoperative complications, the reduction of pain in the early postoperative period demonstrate the security of this approach., Conclusion: Bilateral simultaneous VATS for resection of bilateral posterior mediastinal bronchogenic cyst may be a useful approach. In our case no intra and post-operative complications occurred and patient discharged home on 4 rd day., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Unlabelled: The solitary fibrous tumour of the visceral pleura is a rare neoplasm that derives from mesenchymal cells adjacent to the mesothelial tissue of pleura. Surgical resection is the treatment of choice in benign lesions and healing resulting in half of malignant. Local recurrence can occur in malignant cases, but it is very rare in solitary benign tumors. It may be a result of an incomplete or conservative surgery, lack of identification of a tumor during the operation or a growth of a synchronous neoplasm independent from that removed. Surgical resection is also burdened with some difficulty as the size of the tumor, the relationship with the adjacent structures and identification of the vascular peduncle. We report a case of 72 years-old male with a sessile left solitary fibrous tumour of the visceral pleura. The mass of 10 x 7 x 5 cm was attached, thanks to large planting base, to lateral basal segment of left lower lobe. The patient was treated by single port video assisted approach with a 4 cm skin incision. This case, in our knowledge, represents the first resection by single port VATS of a sessile SFTP with a large plating base and, more generally, the third SFTP resection treated by single portal access., Key Words: Solitary fibrous tumour, Uniportal VATS.

In the wet-dry tropics, animal species face the major challenges of acquiring food, water or shelter during an extended dry season. Although large and conspicuous animals such as ungulates and waterfowl migrate to wetter areas during this time, little is known of how smaller and more cryptic animal species with less mobility meet these challenges. We fenced off the entire entrance of a gorge in the Australian tropical savanna, offering the unique opportunity to determine the composition and seasonal movement patterns of the small vertebrate community. The 1.7 km-long fence was converted to a trapline that was deployed for 18-21 days during the early dry season in each of two years, and paired traps on both sides of the fence allowed us to detect the direction of animal movements. We predicted that semi-aquatic species (e.g., frogs and turtles) would move upstream into the wetter gorge during the dry season, while more terrestrial species (e.g., lizards, snakes, mammals) would not. The trapline captured 1590 individual vertebrates comprising 60 species. There was a significant bias for captures on the outside of the fence compared to the inside for all species combined (outside/inside = 5.2, CI = 3.7-7.2), for all vertebrate classes, and for specific taxonomic groups. The opposite bias (inside/outside = 7.3, N= 25) for turtles during the early wet season suggested return migration heading into the wet season. Our study revealed that the small vertebrate community uses the gorge as a dry season refuge. The generality of this unreplicated finding could be tested by extending this type of survey to tropical savannahs worldwide. A better understanding of how small animals use the landscape is needed to reveal the size of buffer zones around wetlands required to protect both semi-aquatic and terrestrial fauna in gorges in tropical savannah woodland, and thus in ecosystems in general.

Pulmonary sequestration (PS) is a rare congenital broncho-pulmonary malformation. The main feature of this disease is that partial lung tissues separate from the main lung during the embryonic period, receiving blood supply from systemic circulation arteries. Pathogenesis of PS is not clear, and categorized into congenital and acquired PS. We report a case of a 38 year old woman smoker with medical history characterized by difficult to treat asthma with frequent exacerbations and infections since childhood. CT scan showed a partial PS of left lower lobe, supplied by an abnormal artery arising from supradiaphragmatic aortic diverticulum. Surgical treatment through a lung sequestrectomy and laterobasal segment resection was performed., (Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

The alveolar adenoma of the lung is a rare benign tumor characterized by a proliferation of both the alveolar epithelial cells and the mesenchymal septal cells. Immunohistochemically, the epithelial cells stain for cytokeratin (CK) AE1AE3, CK7, thyroid transcription factor 1 (TTF1), and surfactant apoprotein confirming the derivation by the type 2 pneumocytes. The stromal cells are negative for these markers but they show focally smooth muscle and muscle-specific actin positivity. We describe two cases that showed immunohistochemically a CD34 positivity of the mesenchymal septal cells. This aspect has been previously described in a two cases report, but not emphasized by the authors as a distinctive feature of the lesion. We consider this CD34 positivity as a marker of immaturity or stemness of the lesional septal spindle cells, that could be responsible of the different phenotypic and morphological profile of the interstitial cells, that could be, therefore, considered neoplastic and not reactive.

A dysregulated interaction between intestinal epithelial cells (IEC) and components of innate immunity is a hallmark of inflammatory bowel diseases. Rifaximin is a poorly absorbed oral antimicrobial agent increasingly used in the treatment of inflammatory bowel diseases that has been demonstrated to act as a gut-specific ligand for the human nuclear receptor pregnane-X receptor (PXR). In the present study we investigated, whether activation of PXR in IEC by rifaximin, emanates counter-regulatory signals and modulates the expression of cytokines or chemokines mechanistically involved in dysregulated intestinal immune homeostasis documented in inflammatory bowel diseases. Our results demonstrate that primary IEC express PXR that regulate the pattern of cytokines and chemokines expressed. PXR silencing decreases TGF-β and IP-10 while increases the expression of TNF-α, IL-8, Rantes and increase the production of PGE2. This pattern is further exacerbated by treating anti-PXR siRNA cells with bacterial endotoxin (LPS). Exposure to rifaximin caused a robust attenuation of generation of inflammatory mediators caused by LPS and increased the generation of TGF-β. PXR silencing completely abrogated these anti-inflammatory effects of rifaximin. By Western blot analysis we found that rifaximin abrogates the binding of NF-κB caused by LPS. Finally, exposure of human colon biopsies from inflammatory bowel diseases patients to rifaximin reduced mRNA levels of IL-8, Rantes, MIP-3α and TNFα induced by LPS. Collectively, these data establish that rifaximin exerts counter-regulatory activities at the interface between enteric bacteria and intestinal epithelial cells. The ability of rifaximin to activate PXR contributes to the maintenance of the intestinal immune homeostasis., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Riverine organic matter supports of the order of one-fifth of estuarine metabolism. Coastal ecosystems are therefore sensitive to alteration of both the quantity and lability of terrigenous dissolved organic matter (DOM) delivered by rivers. The lability of DOM is thought to vary with age, with younger, relatively unaltered organic matter being more easily metabolized by aquatic heterotrophs than older, heavily modified material. This view is developed exclusively from work in watersheds where terrestrial plant and soil sources dominate streamwater DOM. Here we characterize streamwater DOM from 11 coastal watersheds on the Gulf of Alaska that vary widely in glacier coverage (0-64 per cent). In contrast to non-glacial rivers, we find that the bioavailability of DOM to marine microorganisms is significantly correlated with increasing (14)C age. Moreover, the most heavily glaciated watersheds are the source of the oldest ( approximately 4 kyr (14)C age) and most labile (66 per cent bioavailable) DOM. These glacial watersheds have extreme runoff rates, in part because they are subject to some of the highest rates of glacier volume loss on Earth. We estimate the cumulative flux of dissolved organic carbon derived from glaciers contributing runoff to the Gulf of Alaska at 0.13 +/- 0.01 Tg yr(-1) (1 Tg = 10(12) g), of which approximately 0.10 Tg is highly labile. This indicates that glacial runoff is a quantitatively important source of labile reduced carbon to marine ecosystems. Moreover, because glaciers and ice sheets represent the second largest reservoir of water in the global hydrologic system, our findings indicate that climatically driven changes in glacier volume could alter the age, quantity and reactivity of DOM entering coastal oceans.

Introduction: Less than 15% of all patients survive five years after a diagnosis of lung cancer. This poor prognosis is attributed to a lack of early detection. Among the methods of early diagnosis of bronchial cancer, autofluorescence bronchoscopy allows for the early identification of preinvasive bronchial lesions. The goal of this prospective study is to evaluate the contribution of the autofluorescence bronchoscopy, on a hospital site, over a period of one year., Methods: All patients with an indication of autofluorescence bronchoscopy were included in the study. The following parameters were collected: age, sex, smoking status, FEV1, FVC, biopsy sites, histology, duration of examination., Results: Two hundred and seventy-four patients were included. The average age was 63.8 years (+/-12), the smoking status was 35 packs/year (+/-19). A fluorescence abnormality was detected in 131 patients and 165 sites were biopsied. An histological abnormality was found in 76% of the samples, with 34 hyperplasia (28%), 56 squamous metaplasia (46%), three mild dysplasia (3%), two moderate dysplasia (2%), one severe dysplasia (1%), two carcinomas in situ (2%) and 21 invasive carcinomas (18%)., Conclusion: Autofluorescence bronchoscopy is an effective examination for the detection of the preinvasive neoplasic lesions and may be proposed when lung cancer is suspected.

A set of peat column experiments was used to determine the transport potential of lead (Pb) and diesel range organics (DRO) in palustrine slope wetlands near Juneau, AK. This project is important to southeast Alaskan communities because limited land resources are forcing development of regional wetlands. This study was instigated by concerns that proposed modifications to a nearby rifle range using DRO-contaminated soil posed a potential risk to an anadromous fish-bearing stream 250 m from the site. Three pairs of peat columns were extracted from the rifle range for analysis, one pair along and two pairs across the natural bedding planes of the soil. One column in each pair was spiked with Pb and DRO and the other was used as a control. Approximately 1-year worth of water (171 cm) was passed through each column and leachate was collected at regular intervals. The results showed that substantial DRO transport only occurred along the bedding planes. Leads was surprisingly mobile, both along and across the bedding planes with estimated soil-water partition coefficients several orders of magnitude lower than commonly published values, probably because the peat was heavily Pb-loaded by lead from bullets and because the peat's acidic, organic-rich environment enhanced Pb mobility. The chemical outflow behavior agreed with a simple macropore transport model. These results underscore the need for caution when developing regional wetlands.

A method is described for measuring glutamine (GLN) and alpha-ketoglutarate (KG) concentration and specific activity (SA) using high-performance liquid chromatography (HPLC). Plasma GLN and KG are separated on miniature ion-exchange columns. KG is derivatized with O-phenylene diamine, the derivative is extracted in ethyl acetate, dried, and dissolved in pH 7 phosphate buffer. The isolated GLN is enzymatically converted to KG and analysed as such. Derivatized samples are stable for weeks at -20 degrees C. Samples are injected onto a reversed-phase HPLC column. Absolute standards are injected to determine the nmol content of unknown samples. alpha-Ketoadipate and [3H]-glutamine are used as internal standards to quantitate KG and GLN concentrations, respectively. Collection of the entire peak of interest permits determination of the radioactivity in the GLN and KG peaks; this together with the determination of the nanomoles injected permits the calculation of the SA. Typical precision is 3.5 and 4.6% for GLN and KG concentrations and 5.3 and 3.3% for GLN and KG SA, respectively. Analysis time is ca. 7 min. Using this method, the turnover rate of GLN carbon was determined during a 5-h infusion of L-[U-14C]glutamine in a human subject.