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BACKGROUND Children malnutrition involves simultaneous deficiency of nutrients, leading to cardiac morphological and functional alterations. In this complex condition repolarization abnormalities can evolve. Also sexual dimorphism is a well-established phenomenon, but its influence on ventricular repolarization varies tremendously among races. No data are available about African children, so the aim of our work was to study the correlation between malnourishment and electrocardiographic repolarization parameters, and evaluating the sex influence. METHODS 307 children (mean age 7,6±3 years old) were consecutively enrolled in the north of Madagascar. The QT interval was measured and corrected (QTc) following the Bazett formula (QT/√RR). QT dispersion (QTcd) was defined as the difference between maximum and minimum QTc. Malnutrition was defined in relation to age and sex specific BMI values. Grade mild, moderate and severe were defined as the value to pass through BMI of 16, 17 and 18,5 at the age of 18. RESULTS 126 children (41%) were malnourished, 42 (13%) with mild, 61 (20%) moderate and 23 (7%) with a severe grade. No differences were found between normal weight and malnourished regarding the gender, age, height or heart rate. They had similar QT and QTc intervals (respectively 362,4±36 msec vs 365,1±47 msec for QT, p=0.59 and 476,9±43 msec vs 470±53 msec for QTc, p=0.70). QTcd was statistically higher in malnourished children (53,2±16 msec vs 44,4±15 msec, p

Neuroendocrine tumors (NETs) are epithelial neoplasms with predominant neuroendocrine differentiation that arise in most organs of the body. Mediastinal NETs are very rare, and account for no more than 5% of all mediastinal tumors. R0 surgery represents the milestone of treatment. Here, we describe a case of a locally advanced primary atypical carcinoid of the mediastinum. This was initially considered inoperable due to infiltration of a great vessel and was successfully resected after neoadjuvant treatment as a result of very extensive surgery. Only through an accurate preoperative diagnosis and good radiological planning is it possible to obtain satisfactory oncological results., Locally advanced primary mediastinal atypical carcinoid.

Objectives: We examined a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent surgery in our institution during the last 20 years. Across this period, we changed our surgical approach to MPM, adopting extended pleurectomy and decortication (eP/D) instead of extrapleural pneumonectomy (EPP). In this study, we compare the perioperative outcomes and long-term survival of patients who underwent EPP vs. eP/D. Methods: A retrospective analysis was carried out of all the MPM patients identified from our departmental database who underwent EPP or P/D from 2000 to 2021. Clavien–Dindo criteria was adopted to score postoperative complications, while Kaplan–Meier methods and a Cox multivariable analysis were used to perform the survival analysis. Results: Of 163 patients, 78 (48%) underwent EPP and 85 (52%) eP/D. Induction chemotherapy was significantly administrated more often in the eP/D group (88% vs. 51%). Complete trimodality treatment including induction chemotherapy, radical surgery, and adjuvant radiotherapy was administered in 74% of the eP/D group versus 32% of the EPP group (p < 0.001). The postoperative morbidity rate was higher in the eP/D group (54%) compared to the EPP group (36%) (p = 0.02); no statistically significant differences were identified concerning major complications (EPP 43% vs. eP/D 24%, p = 0.08). No statistical differences were identified in 30-day mortality, 90-day mortality, median disease-free, and overall survival statistics between the two groups. The Cox multivariable analysis confirmed no induction chemotherapy (HR, 0.5; p = 0.002), RDW (HR, 1.08; p = 0.02), and the presence of pathological nodal disease (HR, 1.99; p = 0.001) as factors associated with worse survival in the entire series. Conclusions: Our data support that eP/D is a well-tolerated procedure allowing the implementation of a trimodality strategy (induction chemotherapy, surgery, and radiotherapy) in most MPM patients. When eP/D is offered in this setting, the oncological results are comparable to EPP. To obtain the best oncological results, the goal of surgical resection should be macroscopic complete resection (R0) in carefully selected patients (clinical N0).

Introduction: Benign subglottic/tracheal stenosis (SG/TS) is a life-threatening condition commonly caused by prolonged endotracheal intubation or tracheostomy. Invasive mechanical ventilation was frequently used to manage severe COVID-19, resulting in an increased number of patients with various degrees of residual stenosis following respiratory weaning. The aim of this study was to compare demographics, radiological characteristics, and surgical outcomes between COVID-19 and non-COVID patients treated for tracheal stenosis and investigate the potential differences between the groups. Materials and methods: We retrospectively retrieved electronical medical records of patients managed at two referral centers for airways diseases (IRCCS Humanitas Research Hospital and Avicenne Hospital) with tracheal stenosis between March 2020 and May 2022 and grouped according to SAR-CoV-2 infection status. All patients underwent a radiological and endoscopic evaluation followed by multidisciplinary team consultation. Follow-up was performed through quarterly outpatient consultation. Clinical findings and outcomes were analyzed by using SPPS software. A significance level of 5% (p < 0.05) was adopted for comparisons. Results: A total of 59 patients with a mean age of 56.4 (±13.4) years were surgically managed. Tracheal stenosis was COVID related in 36 (61%) patients. Obesity was frequent in the COVID-19 group (29.7 ± 5.4 vs. 26.9 ± 3, p = 0.043) while no difference was found regarding age, sex, number, and types of comorbidities between the two groups. In the COVID-19 group, orotracheal intubation lasted longer (17.7 ± 14.5 vs. 9.7 ± 5.8 days, p = 0.001), tracheotomy (80%, p = 0.003) as well as re-tracheotomy (6% of cases, p = 0.025) were more frequent and tracheotomy maintenance was longer (21.5 ± 11.9 days, p = 0.006) when compared to the non-COVID group. COVID-19 stenosis was located more distal from vocal folds (3.0 ± 1.86 vs. 1.8 ± 2.03 cm) yet without evidence of a difference (p = 0.07). The number of tracheal rings involved was lower in the non-COVID group (1.7 ± 1 vs. 2.6 ± 0.8 p = 0.001) and stenosis were more frequently managed by rigid bronchoscopy (74% vs. 47%, p = 0.04) when compared to the COVID-19 group. Finally, no difference in recurrence rate was detected between the groups (35% vs. 15%, p = 0.18). Conclusions: Obesity, a longer time of intubation, tracheostomy, re-tracheostomy, and longer decannulation time occurred more frequently in COVID-related tracheal stenosis. These events may explain the higher number of tracheal rings involved, although we cannot exclude the direct role of SARS-CoV-2 infection in the genesis of tracheal stenosis. Further studies with in vitro/in vivo models will be helpful to better understand the role of inflammatory status caused by SARS-CoV-2 in upper airways.

Donor to recipient (D-R) matching in lung transplantation (LTx) is firstly directed by blood group (identity or compatibility), immunological status and morphological criteria. Sex matching is ignored and impact on outcome less investigated.Systematic review of English literature using PubMed (1990-2019) was performed to evaluate the potential role of D-R matching in determining long-term outcome in patients after LTx. Search terms included (LTx) AND (sex) OR (gender) OR (matching) OR (mismatch) OR (donor characteristics) and were restricted to articles' title. Only articles directly reporting LTx survival outcome according to gender match/mismatch and D-R gender combination in LTx were included. Two authors independently extracted articles using predefined data fields, including study quality indicators. MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies applied.Nine articles were analyzed and included into this study. All studies analyzed the effect of the different D-R gender combinations on survival while seven of them investigated exclusively the role of sex matching on LTx outcome. In this latter group two out of seven showed a trend towards an overall survival advantage for sex matching LTx combination. The worst survival results were reported for F to M gender combination in 3 studies and for M to F gender combination by 1 study. No differences were reported in remaining 4 studies.This systematic review suggests that sex matching and several gender combinations could play a role in determining overall survival rate after LTx. Data deriving from unbiased studies supported that matching female-female (F-F) and male-male (M-M) could improve LTx outcome while FD-MR combination should be avoided. Unfortunately, a good part of the analyzed data are affected by bias due to confounding factors. Up-to-date immunological, hormonal and morphological factors could explain the gender-based difference in LTx outcome. Further investigations should clarify their role and importance to define the effects of gender combinations on survival.

Vascular Ehlers-Danlos syndrome is a hereditary disorder of the connective tissue characterized by a reduction in the production of type III collagen. Clinical evolution of the disease is unpredictable because vascular lesions can occur everywhere in the body. Bruising, arterial and bowel fragility, and uterine fragility during pregnancy are the most common symptoms. Thoracic surgeons should take with these patients because, in rare cases, thoracic complications may occur, such as recurrent pneumothorax or spontaneous hemothorax. We report an extra-pleural hematoma in a patient with vascular Ehlers-Danlos syndrome, an unusual complication treated successfully with conservative management.

Castleman’s disease is a benign lymphoproliferative disorder affecting both lymph nodes and extranodal loci. Castleman’s disease can occur in practically any part of the body, but it occurs mainly in the thorax (~70%) followed by the abdomen and pelvis, neck and axilla. Clinically, Castleman’s disease can be classified into a unicentric or multicentric form, depending on the number of lymph nodes involved, and histologically into a hyaline vascular variant, plasma cell, mixed cellular or plasmablastic variant. In this mini-review we briefly report and focus on all clinical thoracic manifestations of Castleman’s disease resuming for each of them the possible strategy of treatment.

Despite the adoption of enhanced recovery programs, the reported postoperative length of stay after robotic surgery is 4 days even in highly specialized centers. We report preliminary results of a pilot study for a new protocol of early discharge (on day 2) with telehealth home monitoring after robotic lobectomy for lung cancer. All patients with a caregiver were discharged on postoperative day 2 with a telemonitoring device if they satisfied specific discharge criteria. Teleconsultations were scheduled once in the afternoon of post-operative day 2, twice on postoperative day 3, and then once a day until the chest tube removal. Post-discharge vital signs were recorded by patients at least four times daily through the device and were available for consultation by two surgeons through phone application. In case of sudden variation of vital signs or occurrence of adverse events, a direct telephone line was available for patients as well as a protected re-hospitalization path. Primary outcome was the safety evaluated by the occurrence of post-discharge complications and readmissions. Secondary outcome was the evaluation of resources optimization (hospitalization days) maintaining the standard of care. During the study period, twelve patients satisfied all preoperative clinical criteria to be enrolled in our protocol. Two of twelve enrolled patients were successively excluded because they did not satisfy discharge criteria on postoperative day 2. During telehealth home monitoring a total of 27/427 vital-sign measurements violated the threshold in seven patients. Among the threshold violations, only 1 out of 27 was a critical violation and was managed at home. No postoperative complication occurred neither readmission was needed. A mean number of three hospitalization days was avoided and an estimated economic benefit of about EUR 500 for a single patient was obtained if compared with patients submitted to VATS lobectomy in the same period. These preliminary results confirm that adoption of telemonitoring allows, in selected patients, a safe discharge on postoperative day 2 after robotic surgery for early-stage NSCLC. A potential economic benefit could derive from this protocol if this data will be confirmed in larger sample.

OBJECTIVES Thymomectomy is gaining consensus over complete thymectomy in early-stage thymoma without myasthenia gravis. This is due both to the difficulty of establishing prospective and randomized controlled studies and to the lack of well-defined selection criteria. This bicentric, retrospective propensity score-matched study aims at comparing oncological outcomes, measured in terms of overall survival and thymoma-related survival, in patients undergoing either thymomectomy or complete thymectomy. METHODS We retrospectively analysed medical records of patients with clinical early-stage (I and II) thymoma undergoing thymomectomy or complete thymectomy. Exclusion criteria were the presence of myasthenia gravis, clinical advanced tumours and thymic carcinoma. A propensity score-matching analysis was applied to reduce potential preoperative selection biases such as comorbidity (Charlson score), tumour maximal diameter and surgical approach (open versus minimal). All variables were dichotomized. RESULTS A total of 255 patients were enrolled from 2 different Hospitals, 126 underwent complete thymectomy and 129 a thymomectomy. Disease-free and thymoma-related survivals showed a 5-year rate of 87.7% and 96.0% and a 10-year rate of 82.2% and 91.9%, respectively. Propensity score-matching analysis selected a total of 176 patients equally divided between the 2 groups. No difference was found for both disease-free (P = 0.11) and thymoma-related (P = 0.37) survival in the 2 groups of resection. Multivariable Cox regression analysis showed that histology (P CONCLUSIONS Thymomectomy is an adequate surgical resection for non-myasthenic thymoma, achieving disease-free and thymoma-related survivals comparable to those after complete thymectomy.

Background: We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. Methods: A retrospective analysis was performed on MPM patients underwent eP/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien–Dindo criteria. Survival analysis was performed by the Kaplan–Meier methods and Cox multivariable analysis. Results: Eighty-five patients underwent extended pleurectomy decortication (eP/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien–Dindo ≥ 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien–Dindo ≥ 3), operative time, pT3–T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. Conclusions: In our experience, eP/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0).

Simple Summary Lung cancer is by far the main cause of cancer-related deaths among both men and women. Early detection of malignant nodules and non-invasive monitoring of disease status is essential to increase the chance of cure. In this study, we analyzed the frequency and the biological features of circulating tumor cells, i.e., cells released from the tumor and in transit in the bloodstream, in patients with a diagnosis of non-small cell lung cancer undergoing surgical resection, with the aim to develop a blood-based diagnostic test and to promptly identify patients at risk of post-operative disease recurrence. Abstract Background: Non-small cell lung cancer (NSCLC) frequently presents when surgical intervention is no longer feasible. Despite local treatment with curative intent, patients might experience disease recurrence. In this context, accurate non-invasive biomarkers are urgently needed. We report the results of a pilot study on the diagnostic and prognostic role of circulating tumor cells (CTCs) in operable NSCLC. Methods: Blood samples collected from healthy volunteers (n = 10), nodule-negative high-risk individuals enrolled in a screening program (n = 7), and NSCLC patients (n = 74) before surgery were analyzed (4 mL) for the presence of cells with morphological features of malignancy enriched through the ISET® technology. Results: CTC detection was 60% in patients, while no target cells were found in lung cancer-free donors. We identified single CTCs (sCTC, 46%) and clusters of CTCs and leukocytes (heterotypic clusters, hetCLU, 31%). The prevalence of sCTC (sCTC/4 mL ≥ 2) or the presence of hetCLU predicted the risk of disease recurrence within the cohort of early-stage (I–II, n = 52) or advanced stage cases (III–IVA, n = 22), respectively, while other tumor-related factors did not inform prognosis. Conclusions: Cancer cell hematogenous dissemination occurs frequently in patients with NSCLC without clinical evidence of distant metastases, laying the foundation for the application of cell-based tests in screening programs. CTC subpopulations are fine prognostic classifiers whose clinical validity should be further investigated in larger studies.

Thyrolipoma and thymolipoma are rare neoplasms of the thyroid gland and thymus, respectively. Their simultaneous occurrence is exceptional. Up to now, only 2 cases have been reported in literature in 1966 and in 1997. For the first time, we report the occurrence of both neoplasms associated with myasthenia gravis in a 64-year-old woman. The value of this case report lies not only in the fact that it allows us to speculate on the presence of a syndrome but also because a complete radiological work-up (computed tomography scanner, magnetic resonance imaging, Positron emission tomography (PET) with fluorodeoxyglucose (FDG)) is reported.

Bronchogenic cysts are generally detected in the mediastinum, along the tracheobronchial tree, or in the lung parenchyma. Subcutaneous presternal bronchogenic cysts have been rarely described, and they are usually of small size (

BACKGROUND: The assessment before surgical plication for unilateral hemidiaphragm (HD) eventration is not clearly defined and no precise criteria exist to really understand which patient is operated with which results depending on the technique used. The goal of this study was to evaluate the place of dynamic magnetic resonance imaging (dMRI) before and after plication by developing measurement criteria. METHODS: Between 2006 and 2017, 18 patients (group1: Gp1) were operated for eventrations, 15 left-sided (Gp1L) and 3 right-sided (Gp1R). All had preoperative and postoperative evaluations including dMRI and pulmonary function tests. Five healthy volunteer subjects (group2: Gp2) had the same imaging protocol. For each HD, we measured the respiratory excursion at three fixed points (S1, S2, S3) and the height of curvature on sagittal plane. We also searched for upward paradoxical diaphragm movements. RESULTS: Before surgery, no excursion (n=13) or extremely reduced excursion (n=5) was detected on the injured HD (IHD) in Gp1. Upward paradoxical movements were identified only in Gp1L (n=6). Compared with Gp2 subjects, the healthy HD for Gp1L patients had significantly reduced excursion values at three sites S1 (P=0.038), S2 (P=0.006), and S3 (P=0.004). After plication, the decreasing height of curvature confirmed a tightening of the IHD in all patients (median value from 100 to 39.5 mm in Gp1L and 92 to 74 mm in Gp1R, P=0.0001). All upward paradoxical movements disappeared. Healthy HD excursions in Gp1L normalised their values. All those imaging improvements were correlated with postoperative improvements of dyspnoea score (P

Small cell lung cancer (SCLC) is an aggressive malignancy with a poor prognosis that accounts for 10% of all cases of clinical lung cancer. Due to its high growth fraction and rapid doubling time it is usually diagnosed as extensive local or metastatic disease in 60%–70% of cases. Combined small cell lung cancer (C‐SCLC) is a relatively rare subtype of SCLC and is defined as SCLC combined with any elements of non‐small cell lung cancer (NSCLC). Clinical presentation of SCLC as an isolated pedunculated endotracheal lesion is an especially rare occurrence. Here, we report for the first time the occurrence of a C‐SCLC as a polypoid tumor of the trachea diagnosed in an 80‐year‐old woman admitted to the emergency department with a principal complaint of cough and wheezing., Small cell lung cancer (SCLC) is an aggressive malignancy with a poor prognosis that accounts for 10% of all clinical lung cancer. Due to its high growth fraction and rapid doubling time it is usually diagnosed as extensive local or metastatic disease in 60%–70% of cases. Combined small cell lung cancer (C‐SCLC) is a relatively rare subtype of SCLC and is defined as SCLC combined with any elements of non‐small cell lung cancer (NSCLC). Clinical presentation of SCLC as an isolated pedunculated endotracheal lesion is a rare occurrence. Here, we report for the first time the occurrence of a C‐SCLC as a polypoid tumor of the trachea diagnosed in an 80‐year‐old woman admitted with a principal complaint of cough and wheezing.

Resume Introduction La maladie hydatique cardiaque est rare et touche 0,5 a 2 % des patients atteints d’hydatidose. L’hydatidose intrapericardique isolee est quant a elle extremement rare. Observation Nous rapportons le cas d’une jeune femme souffrant de compression cardiaque due a de multiples kystes hydatiques primaires intrapericardiques. Depuis un an, elle presentait une alteration progressive de l’etat general, une dyspnee, des sueurs et une perte de poids de 8 kg. Un elargissement du mediastin etait visible sur la radiographie du thorax. La tomodensitometrie, l’echocardiographie et l’IRM dynamique montraient des kystes mediastinaux multiples avec un effet de masse sur le cœur et le tronc de l’artere pulmonaire. La taille de l’artere pulmonaire principale etait reduite a 5 mm de diametre et la veine pulmonaire superieure droite etait presque obliteree par des kystes posterieurs. Les fractions d’ejection ventriculaire droite et gauche etaient estimees a 34 %. Une resection complete par sternotomie des kystes a ete effectuee. L’intervention chirurgicale fut difficile techniquement, en raison d’un processus inflammatoire local majeur. Les resultats postoperatoires apres un episode initial d’embolie pulmonaire localisee etaient finalement satisfaisants. Conclusion L’hydatidose peut entrainer une atteinte cardiaque severe. Ces formes rares de maladie hydatique doivent etre connues, meme dans les regions non endemiques, par les chirurgiens en raison de l’importance des flux migratoires actuels.

N1 disease represents a heterogeneous group of non-small cell lung carcinoma (NSCLC). Pathologic N1 disease may involve one or more lymph node (LN) in the lung classified by Mountain and Dressler (1) in five stations corresponding to their anatomical locations: the hilar LNs, the Interlobar LNs, the lobar LNs, the segmental LNs and the subsegmental LNs being termed station 10, 11, 12, 13 and 14, respectively. In the seventh edition of the TNM classification for lung cancer (2), N1 disease was classified in two zones, hilar/interlobar zone regrouping stations 10 and 11 and peripheral zone regrouping stations 12, 13 and 14.

Occult pN2 disease is the discovery of non-small-cell lung cancer (NSCLC) metastases in mediastinal lymph nodes (LNs) considered clinically disease free (cN0) after clinical staging (cTNM) established by increasingly precise work procedures, such as current imaging studies [computed tomography (CT) and positron emission tomography (PET)] and bronchoscopy or esophagoscopy with ultrasound directed biopsies (EBUS, EUS).

The patterns and prevalence of early repolarization pattern (ER) in pediatric populations from ethnic backgrounds other than Caucasian have not been determined. Black African children (ages 4–12) from north-west Madagascar were prospectively recruited and their ECGs compared with those of age- and sex-matched Caucasian ethnicity individuals. ER was defined by ≥ 0.1 mV J-point elevation in at least two contiguous inferior and/or lateral ECG leads. A total of 616 children were included. There was a trend toward a higher frequency of ER in the Africans compared to the Caucasians (23.3% vs. 17.1%, respectively, p = 0.053). The subtype (slurred vs. notched) and location of ER (lateral, inferior, or inferior-lateral) were significantly different in the two groups (p

We report for the first time in literature an exceptional case of a third-time lung transplantations (LTx) done on a single lung because of previous pneumonectomy in a cystic fibrosis 22-year-old female. Several hypotheses were advocate to explain the need of persistent continuous noninvasive ventilation occurred after left pneumectomy. Finally, chronic lung allograft dysfunction (CLAD) associated with near- diaphragmatic palsy secondary to lung distension was the retained diagnosis. Twenty-three months after third-time single lung retransplantation she is still alive, in good condition, with a Forced Expiratory Volume in 1 second (FEV1) measured at 47%, justifying the accepted risk and the technical difficulties of an exceptional procedure.

Adequate intra-operative lymph node sampling (LNS) is a fundamental part of non-small cell lung cancer (NSCLC) surgery but adherence to standards is still far from being commonly obtained. Edwards and coworkers (1) reviewed 1,301 surgical resections performed from 2011 to 2014 to identify factors that may be the cause of the LNS inadequacy.

OBJECTIVES: Lung transplantation (LTx) is an accepted therapy for selected infants, children and adolescents with end-stage lung and pulmonary vascular disease. It remains a challenge for a selected group of patients. In 2011, the number of paediatric lung transplantations (PLTxs) worldwide was 107. In France, a total of 131 PLTxs have been performed since 2000 (data from ABM: Agence de biomedecine), 65 of which were conducted at our institution. METHODS: All patients under 18 (4.8–17.11) years of age matching inclusion and exclusion criteria, who underwent LTx at our institution were included in this study (n= 58). We analysed the outcomes of these patients in terms of survival rates, controlling for indications for transplantations and surgical procedures. Secondary outcomes were analysis of surgical and medical complications and identification of prognostic factors in the field of LTx in these categories of ages. RESULTS: The 30-day mortality rate was 10%. Kaplan–Meier survival rates at 1 month, 1, 3, 5 and 10 years were 90, 81, 66, 60 and 57%, respectively; the median survival was 91 months. Reduced-size transplantation was performed in 33% of double-lung transplantation (DLTx) patients without negatively impacting survival. In our series, female sex, the presence of a sex mismatching and, in particular, the occurrence of a male donor to a female recipient (F/M group) have been poor prognostic factors after PLTx. CONCLUSIONS: The overall survival after PLTx was encouraging (57% at 10 years). A PLTx should be offered to the small number of patients with end-stage pulmonary disease. The limited number of paediatric donor organs can be overcome by using reduced-size organs without a survival disadvantage to the patients. In our series, male sex and sex matching seemed to be positive predictive prognostic factors after PLTx but further studies are required to confirm these results and to also clarify the role of age of donor, time of cold ischaemia and body mass index in PLTx.

Resume Objectif Chez les transplantes d’organes, l’incidence des tumeurs broncho-pulmonaires est reputee plus elevee et le pronostic plus mauvais que dans la population generale. Notre propos a ete d’etudier les resultats du traitement chirurgical sur ce terrain. Methodes Nous avons revu les dossiers de 49 hommes et 6 femmes, d’âge moyen 60,6 ans (extremes 38–85). Il s’agissait de greffes cardiaques ( n = 37), renales ( n = 12), hepatiques ( n = 5) et bipulmonaire ( n = 1). Quarante-huit patients etaient tabagiques ; 42 presentaient de lourdes pathologies associees (76,4 %). Les tumeurs etaient decouvertes dans le cadre d’une surveillance (78,2 % des cas, 43 patients), ou devant des symptomes (21,8 % des cas, 12 patients). Nous avons revu les caracteristiques de ces patients (epidermoides n = 23, adenocarcinomes n = 24, autres n = 8). Resultats Il y a eu 2 thoracotomies exploratrices, des resections atypiques chez 6 patients, 1 segmentectomie, 42 lobectomies et 4 pneumonectomies avec 34,5 % de complications postoperatoires ( n = 19 patients) et 7,4 % de mortalite ( n = 4). La survie de la population a ete de 46,4 % a 5 ans (65,4 % au stade I, n = 25) ; 35 patients sont decedes a distance dont 14 de leur cancer (40 %). Parmi eux, 2 avaient ete reoperes d’un autre cancer du poumon : l’un 3 et 8 ans apres (survie 16 ans) et l’autre 2 ans apres (survie 70 mois). Conclusions Les resultats observes apres chirurgie chez ces patients sont bons et les suites acceptables malgre des risques, a priori, majores. Ils demontrent l’interet d’un suivi rapproche chez les transplantes anciens fumeurs permettant de depister le cancer a un stade precoce.

Owing to the advances in imaging techniques such as thin-section computed tomography (CT) and 3D imaging, lung cancer can now be diagnosed at an early stage. The detection of small-sized lung cancer, including the 1 cm in diameter or less, is remarkably increasing. As a consequence, in 2015 the International Association for the Study of Lung Cancer (IASLC) proposed the new TNM staging system of lung and pleural tumours, in which T1 (≤3 cm) non-small-cell lung cancer (NSCLC) tumors were divided based on tumour size into T1a (≤1 cm), T1b (>1 and ≤2 cm) and T1c (>2 and ≤3 cm) (1). In this scenario several studies have investigated the role of limited resections, such as wedge and segmentectomy, in the treatment of small size lung cancer (

OBJECTIVES: Pneumonectomy for benign disease is rare but is thought to have a higher more postoperative morbidity and mortality than when performed for lung cancer. We questioned this by assessing and analysing indications and postoperative outcomes of patients who underwent this type of resection. METHODS: We used Epithor, the French national thoracic database including 91 public and private institutions with more than 220 000 procedures. We prospectively collected data of 5975 patients who underwent pneumonectomy between January 2003 and June 2013. The 321 patients (5.4%) who underwent pneumonectomy (n= 201) or completion pneumonectomy (n= 120) for benign disease were compared with those treated for malignant disease. RESULTS: The patients’ mean age was 55.2 years (53.5; 56.8) for benign indications vs 61.6 years (61.4; 61.9) for malignant disease; the sex ratio was 1.8 (207 males) and 4 (4543 males), respectively; 53% of patients (n= 169) had an American Society of Anesthesiologist (ASA) score of ≥3 vs 29% (n= 1598) for malignant disease. For benign disease, most frequent indications were infection or abscess (n= 114, 37.1%), post-tuberculosis destroyed lung (n= 47, 15.3%), aspergillosis or aspergilloma (n= 33, 10.7%), bronchiectasis (n= 41, 13.3%), haemorrhage (n= 26, 8.5%) and benign tumour (n= 20, 6.5%). Complications occurred in 53% (n= 170) of patients and the postoperative in-hospital mortality rate was 22.1% (n= 71). These results were significantly worse than those for malignant indications: 38.9% (n= 2198) of morbidity (P< 0.0001) and 5.1% (n= 288) of in-hospital mortality (P< 0.0001). For benign disease, there was no difference in fistula formation regarding side (P= 0.07) or type of resection (P= 0.6). Morbidity was higher for completion pneumonectomy: 62.5 vs 47.3% (P= 0.008). Mortality was significantly higher in case of resection for infection or abscess (P= 0.01) and for haemorrhage (P= 0.002). Emergency procedures were associated with worse postoperative outcomes (P< 0.0001). CONCLUSIONS: Pneumonectomy for benign disease achieves cure with very high levels of morbidity and mortality. This type of surgical treatment should be considered as a salvage procedure.

Introduction Il n’existe pas de recommandation concernant l’evaluation preoperatoire des eventrations diaphragmatiques. L’objectif de cette etude a ete d’evaluer l’interet de l’IRM dynamique du diaphragme faite avant et apres plicature de coupole, en developpant des criteres standardises d’analyse. Methodes De 2006 a 2017, 18 patients (Gp1) operes d’une eventration diaphragmatique unilaterale gauche (Gp1L, n = 15) ou droite (Gp1R, n = 3) ont eu une evaluation pre- et post-operatoire incluant une IRM dynamique. Cinq volontaires sains ont aussi eu cet examen. La course diaphragmatique au niveau de 3 points fixes (S1-S2-S3) et l’evolution perioperatoire de la fleche de chaque coupole (n = 41) en vue sagittale ont ete les 2 criteres principaux d’analyse. Resultats Sur l’IRM preoperatoire, toutes les coupoles avec une eventration (Gp1) avaient une course significativement reduite voire nulle en comparaison avec leur cote sain (p Figure 1 ). Conclusion L’IRM dynamique est un examen non invasif qui parait utile pour ameliorer nos connaissances en eventrations unilaterales du diaphragme et evaluer nos resultats chirurgicaux. Bien qu’il s’agisse d’une petite serie de patients, cet examen nous permet de valider l’existence d’un impact negatif significatif de l’eventration unilaterale sur la coupole saine controlaterale. Il met en lumiere le benefice local et controlateral de la plicature diaphragmatique. La grille standardisee que nous avons developpee peut aider les cliniciens dans leur approche chirurgicale et leurs futures evaluations.