Search

Author(s): Dario Amore [1]; Dino Casazza [1]; Umberto Caterino [2]; Danilo Rocco [3]; Carlo Bergaminelli [1] Sir, In the recent years, several studies have begun to evaluate the usefulness of [...]

Author(s): Dario Amore (corresponding author) [1]; Dino Casazza [1]; Umberto Caterino [2]; Carlo Bergaminelli [1] Sir, Acquired benign tracheoesophageal fistula (TEF) is a rare but serious condition and most often [...]

A 75-year-old man with hypertrophic obstructive cardiomyopathy underwent placement of a long-sensing vector implantable loop recorder (ILR) for unexplained syncope. One month later, ILR remote monitoring revealed unstable R-wave amplitudes ranging from very high (>1.9 mV) to very low (<0.2 mV) values. During an in-hospital clinic visit, the only site to establish communication with the ILR was the left posterior axillary area. Chest computed tomography confirmed ILR migration into the anterior costophrenic recess. The device was retrieved with forceps during video thoracoscopy without further complications. This is the first case report of migration of an implantable loop recorder diagnosed by remote monitoring. [ABSTRACT FROM AUTHOR]

Lung is the second most common locationof cystic echinococcosis (CE), after the liver. Diagnosis of lung CE is often incidental, and clinical manifestations depend on the location and size of the cyst, the most common being chest pain, shortness of breath, expectoration of fragments of endocyst, and haemoptysis. Surgery is the primary treatment, with a minor role for medical therapy. Delayed diagnosis and treatment may have important consequences. We present a case of lung CE in whichsurgical treatment was delayed due to the first wave of COVID-19. Since surgery could not be performed immediately, the patient was kept on albendazole and the cyst stage moved from CE1 to CE3a, to CE4, eventually requiring a more aggressive pericystectomy instead of the commonly performed endocystectomy. The clinical and imaging characteristics of a rare CE4 cyst of the lung are reported. [ABSTRACT FROM AUTHOR]

We report a case of anomalous course of the ascending posterior segmental artery (Asc. A2) to the right upper lobe detected by three-dimensional computed tomography image reconstruction. The knowledge of vascular anomalies is useful to avoid intraoperative complications during pulmonary lobectomy. [ABSTRACT FROM AUTHOR]

Leiomyoma is the most common benign tumor of the esophagus. Open thoracotomy, the traditional approach adopted for the enucleation of the esophageal leiomyoma, over the years, has been gradually replaced by video-assisted thoracoscopic surgery. However, this minimally invasive approach has limitations, such as two-dimensional vision and reduced range of motion, which have recently been overcome by technical advantages of robot-assisted surgery. In the surgical management of circumferential esophageal leiomyoma, a combined use of robotic surgery and intraoperative endoscopy may be helpful to facilitate tumor enucleation and to prevent esophageal mucosal injury during the surgical procedure. [ABSTRACT FROM AUTHOR]

Anatomical variations of pulmonary venous drainage have been widely described in the literature in order to perform safe thoracic surgical procedures. We report a case of anomalous vein from the superior segment of the right lower lobe running in the posterior mediastinum and draining into the superior pulmonary vein. As the patient showed a usual right inferior pulmonary vein, formed by the union of the superior segment right lower lobe vein (V6) and the common basal vein joining the left atrium, the uncommon segmental pulmonary vein described was named: additional V6. It was identified preoperatively and recognized intraoperatively during thoracoscopic right lower lobectomy and lymph node dissection performed for lung cancer treatment. Diagnostic imaging and careful surgical dissection are helpful tools to avoid intraoperative bleeding and other complications during thoracic surgical procedures due to unrecognized vascular anomalies. [ABSTRACT FROM AUTHOR]

Background Variations in pulmonary venous anatomy should not be undermined by thoracic surgeons during procedures which involve the pulmonary veins. Methods We have identified vascular anomalies in 25 of 346 patients undergoing video-assisted thoracoscopic surgery lobectomy at our Thoracic Surgery Unit, between December 2016 and November 2018. Results Some vascular anomalies described have not been reported in recent literature and include right V7 draining into the middle lobe pulmonary vein, accessory right V6 behind the bronchus intermedius, two V6 from the apical segment of left lower lobe, two V6 from the apical segment of right lower lobe, and one of them draining into the superior pulmonary vein. Conclusion Thoracic surgeons should be aware of this type of anomalies because failure in the preoperative or intraoperative identification of the pulmonary venous variations may lead to serious complications. [ABSTRACT FROM AUTHOR]

The identification of the accessory vein draining the superior segment of the right lower lobe (accessory V6), during the posterior mediastinal lymph node dissection, can help avoid operative complications. [ABSTRACT FROM AUTHOR]

OBJECTIVES Peak VO2, as measure of physical performance is central to a correct preoperative evaluation in patients with both non-small-cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) because it is closely related both to operability criteria and the rate of postoperative complications. Strategies to improve peak VO2, as a preoperative pulmonary rehabilitation programme (PRP), should be considered favourably in these patients. In order to clarify the role of pulmonary rehabilitation, we have evaluated the effects of 3-week preoperative high-intensity training on physical performance and respiratory function in a group of patients with both NSCLC and COPD who underwent lobectomy. METHODS We studied 40 patients with both NSCLC and COPD, age < 75 years, TNM stages I–II, who underwent lobectomy. Patients were randomly divided into two groups (R and S): Group R underwent an intensive preoperative PRP, while Group S underwent only lobectomy. We evaluated peak VO2 in all patients at Time 0 (T0), after PRP/before surgery in Group R/S (T1) and 60 days after surgery, respectively, in both groups (T2). RESULTS There was no difference between groups in peak VO2 at T0, while a significant difference was observed both at T1 and T2. In Group R, peak VO2 improves significantly from T0 to T1: 14.9 ± 2.3–17.8 ± 2.1 ml/kg/min ± standard deviation (SD), P < 0.001 (64.5 ± 16.5–76.1 ± 14.9% predicted ± SD, P < 0.05) and deteriorates from T1 to T2: 17.8 ± 2.1–15.1 ± 2.4, P < 0.001 (76.1 ± 14.9–64.6 ± 15.5, P < 0.05), reverting to a similar value to that at T0, while in Group S peak VO2 did not change from T0 to T1 and significantly deteriorates from T1 to T2: 14.5 ± 1.2–11.4 ± 1.2 ml/kg/min ± SD, P < 0.00001 (60.6 ± 8.4–47.4 ± 6.9% predicted ± SD, P < 0.00001). CONCLUSIONS PRP was a valid preoperative strategy to improve physical performance in patients with both NSCLC and COPD and this advantage was also maintained after surgery. [ABSTRACT FROM AUTHOR]