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Elderly patients represent the majority of lung cancer cases, but they are often under-represented in clinical cancer treatment trials or excluded from studies because of comorbidities. Due to lack of data, treatment options for this population must be carefully evaluated and preliminary assessment should aim to stratify patients into different risk subgroups. In early NSCLC stages, surgery remains the best therapeutic option in low-moderate risk patients. Conversely, in patients unfit for surgery or in advanced stages, chemotherapy and radiotherapy should be considered as they may offer benefits in terms of clinical outcomes. Recent developments in targeting driver genes mutations as well as immune checkpoints have opened novel horizon in lung cancer management and systematic investigation in elderly population is required. In this review, we examined the more recent results of the literature about the therapeutic scenario in limited and advanced lung cancer stages in elderly and very elderly population.

Il tumore fibroso solitario della pleura viscerale è una neoplasia rara che deriva dalle cellule mesenchimali adiacenti al tessuto mesoteliali di pleura. La resezione chirurgica è il trattamento di scelta nelle sia nelle lesione benigne che maligne. La recidiva locale può essere il risultato di una chirurgia incompleta o conservatrice, di una mancanza di identificazione dei lembi del tumore durante l’operazione o di crescita di una neoplasia sincrona indipendente da quello rimossa. La resezione chirurgica è anche gravata da qualche difficoltà come la dimensione del tumore, il rapporto con le strutture anatomiche viciniori e la identificazione del peduncolo vascolare. Riportiamo un caso di un uomo di 72 anni con un tumore fibroso solitario sessile della pleura viscerale. Il paziente è stato trattato mediante videotoracoscopia con approccio uniportale. Questo caso, rappresenta una resezione in VATS uniportale di un SFTP sessile con ampia base di impianto. In letteratura, solo due casi di SFTP sono stati trattati mediante approccio uniportale. In tutti i due casi, il tumore era piccolo (4x3 cm nel primo, nel secondo 33 x 22mm) e peduncolato. Nel nostro caso, si parla di un STFP di dimensioni maggiore, sessile e con larga base di impianto. I vantaggi dell’approccio uniportale rispetto alla tradizionale VATS triportale sono la riduzione del dolore post-operatorio, la minore durata di utilizzo dei tubi di drenaggio, la ridotta degenza ospedaliera ed un miglior risultato estetico. 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.

Asthma is a heterogeneous chronic inflammatory lung disease originating from a complex interaction between individual and environmental factors. As consequence of world population ageing an increase of chronic diseases prevalence, including asthma, has been documented. Late-onset asthma may have more complex pathogenic mechanisms other than Th2-mediated pattern. Diagnosis in older subjects is not straightforward as consequence of poor symptoms perception; in adults co-morbidities are associated with different asthma outcomes. A careful assessment and management of all potential concurrent disorders is essential to achieve a better disease control and an adequate response to treatment in elderly asthmatic patients.

Identification of risk factors for severe outcome of Sars-Cov-2 infection is an important issue in COVID-19 management. Much attention has been focused on comorbidities as well as drugs taken by patients. Usage of proton pump inhibitors (PPIs) appears to potentially influence disease course. These drugs are known to reduce stomach acid and also modulate the immune system. Their use, prior to and during COVID-19 infection, seems to predispose to the development of more severe pneumonia and therefore to a greater risk of mortality. Instead, the use of Histamine receptor 2 antagonists (H2RAs) seems to be associated with a better outcome in patients with COVID-19, in terms of symptoms, risk of intubation and death. As PPIs are essential for treatment of many disorders, usage of these drugs should be balanced considering the benefits and risk ratio, in order to guarantee their correct use for the necessary time. It remains to be clarified whether the detrimental effects, in terms of COVID19 severe outcome, are due to PPIs or to the underlying disease for which they are administered. New controlled-randomized trials are required to better understand their impact in SARS-COV-2 infections. *Vanvitelli/Monaldi COVID Group: Adriano Cristinziano, Carolina Delle Donne, Cecilia Calabrese, Fabio Perrotta, Filippo Scialò, Francesco Lassandro, Gennaro Mazzarella, Giorgio Paoli, Leonardo De Luca, Maria Galdo, Miriam Buonincontro, Roberta Cianci, Rosalba Donizzetti, Stefano Sanduzzi Zamparelli, Tullio Valente, Vito D’Agnano, Vittorio Bisogni

Since the beginning of 2020, the new pandemic caused by SARS-CoV-2 and named coronavirus disease 19 (COVID 19) has changed our socio-economic life. In just a few months, SARS-CoV-2 was able to spread worldwide at an unprecedented speed, causing hundreds of thousands of deaths, especially among the weakest part of the population. Indeed, especially at the beginning of this pandemic, many reports highlighted how people, suffering from other pathologies, such as hypertension, cardiovascular diseases, and diabetes, are more at risk of severe outcomes if infected. Although this pandemic has put the entire academic world to the test, it has also been a year of intense research and many important contributions have advanced our understanding of SARS-CoV-2 origin, its molecular structure and its mechanism of infection. Unfortunately, despite this great effort, we are still a long way from fully understanding how SARS-CoV-2 dysregulates organismal physiology and whether the current vaccines will be able to protect us from possible future pandemics. Here, we discuss the knowledge we have gained during this year and which questions future research should address.

Viral infections are frequent among patients with thoracic malignancies prompted by dysregulation of innate and adaptative immune response. Clinical symptoms and radiological findings of both viral pneumonia and lung adenocarcinoma may overlap resulting in diagnostic and clinical challenges.We present the case of a women admitted to our department presenting with an acute manifestation of coronavirus OC43 pneumonia with underlying undiagnosed lung adenocarcinoma.

Intercostal artery pseudoaneurysms (IAP) are extremely rare but its sudden rupture represents a life-threatening complication. We report an unusual case of a late intercostal artery pseudoaneurysm, after a video-assisted thoracoscopic surgery, presenting as a large intra-parenchymal lung mass. Diagnosis was made by biphasic computed tomography angiography and contrast-enhanced pulsed-wave doppler ultrasound. To minimize the risk of aneurysm bleeding immediate angiographic embolization was planned and successfully performed.IAP should be considered in presence of lung mass in patients who have previously undergone an intervention with intercostal approach to prevent life-threatening complications.

Objective: Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. Methods: We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. Results: There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). Conclusions: Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results. RESUMO Objetivos: A avaliação funcional pré-operatória é fundamental para otimizar a seleção dos pacientes para cirurgia torácica para tratamento do CPCNP. Uma alta inclinação VE/VCO2 se mostrou um preditor de complicações cirúrgicas e de aumento da mortalidade. Programas de reabilitação pulmonar (PRP) demonstraram aumentar os parâmetros funcionais e os desfechos de curto prazo em pacientes com DPOC submetidos à ressecção pulmonar. O impacto dos PRP na inclinação VE/VCO2 não foi totalmente investigado. Métodos: Avaliamos retrospectivamente 25 pacientes com DPOC consecutivos submetidos aos efeitos de um programa de reabilitação pulmonar de alta intensidade (PRP) na inclinação VE/VCO2. Resultados: Não foram observadas variações significativas nos principais parâmetros espirométricos após o programa de reabilitação de três semanas (pré-reabilitação VEF1 versus pós-reabilitação VEF1 %prev: 61,5 ± 22,0% para 62,0 ± 21,1%, ns; pré-reabilitação DLCO para pós-reabilitação DLCO %prev: 67,2 ± 18,1% para 67,5 ± 13,2%, ns). Por outro lado, o pico de VO2 e a inclinação VE/VCO2 melhoraram significativamente após PRP (pico de VO2 pré-reabilitação para pico de VO2 pós-reabilitação: 14,7 ± 2,5 para 18,2 ± 2,7 mL/kg/min, p < 0,0000001; inclinação pré-reabilitação VE/VCO2 para pós-reabilitação inclinação VE/VCO2: 32,0 ± 2,8 para 30,1 ± 4,0, p

Highlights • We report a case of 17 years-old male suffering from bronchogenic cysts of the mediastinum. • A complete surgical resection was performed by using bilateral simultaneous VATS with three-port access. • No intra and post-operative complications occurred., 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.