Domenico Loizzi

A scale for decision making between whole lung transplantation or lobar transplantation

OBJECTIVE In lung transplantation, appropriate size matching is of crucial importance to achieve satisfactory outcomes. Tailoring of the lung has been repeatedly described as successful means of overcoming size disparities. The goal of this study was to define a parameter helping the surgeon in the decision whether a standard lung transplantation or a lobar transplantation should be anticipated. METHODS We retrospectively analysed the ratio between donor total lung capacity (TLC) and recipient TLC in all lung-transplant procedures performed in our institution from 1 January 2008 to 30 November 2008. The utility of this ratio using predicted recipient TLC (D/pR index) and real recipient TLC (D/rR index) in discriminating between whole lung transplantation and lobar transplantation was studied with the receiver operating characteristic (ROC) analysis. RESULTS The median D/pR index in whole lung transplantations was 1.01 (range: 0.69-1.26) and 1.19 in lobar transplantation (range: 1.09-1.54). In the range between 1.12 and 1.14, sensitivity and specificity are both above 90%. The area under the ROC curve for D/pR index was 0.96. The median D/rR index in whole lung transplantations was 0.95 (range: 0.56-2.74) and 1.58 in lobar transplantation (range: 0.85-2.56). The area under the ROC curve was 0.73. CONCLUSIONS We conclude that the D/pR index is more useful than D/rR index in discriminating between whole lung transplantation and lobar transplantation. With an area under the ROC curve of 0.96, this seems to be a suitable indicator in deciding between whole lung transplantation and lobar transplantation.

Surgical treatment of a rare case of tracheal inflammatory pseudotumor in pediatric age

Tracheal inflammatory pseudotumor (IPT) is a rare solid lesion with an unpredictable biological course. Treatment can vary and surgical resection may sometimes be necessary, even in pediatric age. We report the case of a 12-year-old male patient who presented to our institution with sudden dyspnoea after some months of wheezing and cough, wrongly considered and treated as asthma. Neck-chest CT-scan and fiberbronchoscopy showed an intraluminal tracheal mass, originating from the left antero-lateral wall at the level of the 5th cartilagineous tracheal ring, involving three rings, that was removed by rigid bronchoscopy. Histopathology revealed a tracheal IPT. Due to rapid tendency to recurrence of the lesion, two more endoscopic recanalizations were performed, but a new recurrence appeared, with CT evidence of transmural involvement of the tracheal wall. Resection of the three involved tracheal rings and termino-terminal tracheal anastomosis were successfully performed through cervicotomy and sternal split. CT-scan and fiberbronchoscopy at 17 months from surgery show a stable tracheal lumen without signs of recurrence. A tracheal IPT should be suspected in any pediatric patients with tracheal mass and asthmatic symptoms. After radical removal prognosis is generally excellent and recurrences after tracheal resection are rare.

Bladder Metastases from Lung Cancer: Clinical and Pathological Implications: A Systematic Review

Lung cancer is the tumor with the highest incidence in males worldwide and the most common cause of death from cancer overall; its high mortality is mostly due to its propensity to spread to other organs through lymphatic and blood vessels in spite of proper treatment. Bladder metastases from lung cancer are rare, with only 11 cases having been reported, all in recent years. This review aims to discuss some critical points regarding this uncommon condition, namely: (a) lung and bladder tumors share similar etiologic features; (b) almost all bladder metastases from lung cancer arise from lung adenocarcinomas; (c) cytology and superficial bladder biopsy may be falsely negative, since the neoplastic cells coming through the hematogenous route are typically located in the lamina propria and/or muscularis propria of the bladder wall; and (d) the differential diagnosis with primary bladder adenocarcinoma as well as primary and secondary small-cell carcinomas may be challenging. Though no definite conclusions can be drawn regarding treatment, we herein propose a practical algorithm to manage such patients based on available data.

Ambulation for enhanced recovery in thoracic surgery: how far can we walk?

Enhanced recovery after surgery (ERAS) is a multidisciplinary, goal-directed program aimed to decrease perioperative stress, improve pain management and mobilization and minimize post-operative complications. This can lead to hastened patient recovery and reduced time in hospital (1).

Spontaneous Pneumomediastinum After Electronic Cigarette Use

Spontaneous pneumomediastinum is an uncommon condition typically occurring in young men presenting with pleuritic pain, dyspnea, and subcutaneous emphysema. We report an exceptional case of spontaneous pneumomediastinum after electronic cigarette use in an otherwise healthy young man.

Enhanced recovery pathways in thoracic surgery from Italian VATS group: nursing care program

Enhanced recovery after surgery (ERAS) is an interprofessional program that can lead to hastened patient recovery and reduced time in hospital. Nursing staff play a key role in the implementation of enhanced recovery protocols. This issue focalizes the role of nurses in ERAS program for patients submitted to Thoracic Surgery, in particular for cases of major lung resection performed by a minimally invasive surgical approach (VATS, video assisted thoracic surgery).