Francesco Zaraca

Immunohistochemical study of fatty acid synthase, Ki67, proliferating cell nuclear antigen, and p53 expression in hyperplastic parathyroids

Patients with secondary hyperparathyroidism following chronic renal disease frequently develop hyperplastic parathyroids. Hyperplastic parathyroids have an increased number of chief cells, a decreased amount of stromal fat, and a nodular or diffuse histologic pattern. Hyperplastic parathyroids may also express higher proliferative activity compared with controls. We evaluated the morphologic features and immunohistochemical expression of fatty acid synthase (FAS), Ki67, proliferating cell nuclear antigen, and p53 protein in 78 hyperplastic parathyroids from 20 patients with secondary hyperparathyroidism. Twenty normal parathyroids incidentally removed during nonneoplastic thyroid surgery were used as controls. Our results showed that hyperplastic glands overexpress FAS (P =.06). Statistical analysis also revealed a significant association between FAS and p53 protein (P =.006) and between FAS and hyperplastic glands with a predominant nodular pattern (P =.02). Hyperplastic parathyroids from patients with chronic renal failure strongly express FAS. Fatty acid synthase may therefore be a potential biological indicator of highly proliferating parathyroid cells.

Prospective randomized evaluation of preoperative endoscopic vital staining using CH-40 for lymph node dissection in gastric cancer

AbstractBackground: CH-40 is a suspension of activated carbon particles that was developed in Japan to carry anticancer drugs to regional nodes and peritoneal seedings of gastric cancer. Methods: Forty-five consecutive patients who had surgical resection and D2 lymph node dissection for gastric cancer over a 2-year period were randomly assigned to preoperative endoscopic submucosal injection of CH-40 (group A) or no staining (group B). A total of 21 patients in group A and 24 in group B were available for analysis. Results: The number of resected nodes per patient was significantly higher (t=6.06; 40df; P<.0001) in group A (mean±S.E.=35.3±1.24) than in group B (mean±S.E.=25.5±1.02). The rate of metastatic nodes resected was significantly higher (χ2=6.903 ; 1df; P=.009) in stained (22.5%) than in non-stained (14.7%) nodes of group A and also (χ2=6.906 ; 1df; P=.009) in stained nodes of group A than in group B (15.8%). Conclusions: Preoperative endoscopic vital staining with CH-40 proved to be rapid, safe, and effective in all cases in this series. Its use allowed surgeons to resect a higher number of lymph nodes, and to identify and examine more metastatic nodes. It also permitted identification of nodal micrometastases on routine histopathologic examination.

Surgery for T4 lung cancer invading the thoracic aorta: Do we push the limits?

Few investigators have described en bloc resection of non‐small cell lung cancer (NSCLC) invading the aorta.

VATS and RATS lobectomy up to date: clinical and experimental evidences

VATS lobectomy has been representing the gold standard treatment in early stage “non-small cell lung cancer” (NSCLC) for the last 15 years. Never before has technology influenced so much the diagnostic and therapeutic strategies in thoracic surgery.

Intraoperative complications during VATS lobectomies from conversion to minimally-invasive “trouble-shooting”

The aim of this study was to explore intraoperative complications during video-assisted thoracoscopic surgery (VATS) lobectomy. Vascular and bronchial injuries, after a robust learning curve, can be sometimes successfully managed by VATS. During a VATS lobectomy, it is necessary: to be prepared in potentially dangerous situations; to think about strategies to handle intraoperative complications and to share these strategies with your own staff. Herein we present some videos showing cases where vascular injuries led to conversion and others where a minimally-invasive trouble shooting of intraoperative complications was achieved.