Piergiorgio Solli

Pulmonary endothelial cell modifications after storage in solid-organ preservation solutions.

During lung preservation, the vascular endothelium is probably the first site of damage and these lesions are considered the main limiting factor in solid-organ preservation. In the present study, the ultrastructural changes in the endothelial cells of human pulmonary artery hypothermically stored (at 4 °C) for 6 and 12 h in Euro-Collins, University of Wisconsin and Ringer-lactate solutions were compared. The arteries obtained from three patients who underwent pneumonectomy were divided into 20 segments and preserved in the three solutions mentioned. The specimens, which were fixed in osmic acid, were examined using transmission electron microscopy. Transmission electron microscopy indicated that the cells stored in the University of Wisconsin solution either for 6 or 12 h were the best preserved, while the most severely damaged cells were those stored in Euro-Collins solution, even after just 6 h. The cells stored in Ringer-lactate showed an intermediate level of damage. The data from an ultrastructural grading scale, which quantified the damage to the cytoplasm, mitochondria and nucleus, were in broad agreement with the general transmission electron microscopy observations. Analysis of variance of the grading scale data showed that there were statistically significant differences between the groups after both 6 and 12 h storage (P < 0.05).

Giant Alveolar Adenoma Causing Severe Dyspnoea

A 38-year-old Caucasian woman was admitted to hospital complaining of recent-onset acute night dyspnoea. A chest radiograph disclosed a bulky cystic lesion in the middle-lower field of the left lung (Figure 1), and a computed tomography scan confirmed the presence of a 91 50 98-mm multiseptated giant cystic mass arising in the lingula and compressing the adjacent pulmonary parenchyma (Figure 2). The patient’s clinical history was unremarkable apart from autoimmune hyperthyroidism under medical treatment for 4 years. The patient underwent left muscle sparing thoracotomy with resection of the entire unopened lesion and no lung tissue sacrifice. Grossly, the tumor consisted of a multiseptated giant cystic mass with gaseous content and scant liquid material (Figure 3). Histologically, it featured a typical alveolar adenoma with dual cell composition of type II pneumocytes and elongated septal mesenchymal cells, but with unusual formation of giant cystic spaces (Figures 4A, B). The immunohistochemical profile—positivity for thyroid transcription factor-1 (Figure 4C), negativity for myogenin, surfactant and cytokeratins in pneumocytes, and negativity for desmin in mesenchymal cells—was consistent with alveolar adenoma. The proliferative activity as assessed by Ki-67 immunostaining was unremarkable in both cell types (Figure 4D). The nonrandom occurrence of specific genetic alterations in alveolar adenoma in relation to its neoplastic nature, albeit benign, inasmuch as recurrence has never been recorded.1–4 Most patients are middle aged to elderly and asymptomatic, with a slight female predominance. Most tumors are found by chance, whereas the occurrence of severe tumorrelated symptoms, as described in our case, is exceptional. Conservative surgery is the best treatment and no further therapy is required.2

VATS thymectomy: oncological results and comparison between minimally invasive strategies

In this article we analyze the evidence for minimally invasive thymectomy and explain in details our technique. We review all current evidence and present it in a clear and concise form. Our preferred surgical approach is also described in details including tips and tricks and how to avoid complications.

Biportal VATS approach in the treatment of penetrating thoracic trauma: a case report

We report a case of a penetrating thoracic trauma caused by a stab wound that determined a laceration of the middle lobe and a resulting right hemopneumothorax. The patient underwent a successful biportal video-assisted thoracic surgery (VATS) procedure consisting in the evacuation of all the blood collections from the pleural space associated with a wedge resection of the damaged lung tissue of the middle lobe. The patient had a complete recovery of the pulmonary function and was discharged on postoperative day five.

Uniportal video assisted thoracic surgery: hilar dissection

In recent years, the uniportal approach has become one of the most exciting and innovative developments in minimally invasive thoracic surgery. While the debate over its supposed advantages, learning curve and complexity continues, this manuscript explores the technical aspects of performing the hilar dissection for a lobectomy via the uniportal approach. Using a step-by-step narration, surgical details and key tips and tricks are laid out for the beginner hoping to clarify basic steps of the technique.

Right side lobectomies

Lobectomy remains the definitive resection because assures removal of the regional lymph nodes and thus provides the best information for staging and local control. Doing less than a lobectomy must be considered a compromise because a wedge excision does not include the lobar bronchus, impeding evaluation of lobar lymph nodes, but also usually it provides only a minimal parenchymal margin and, thus, is accompanied by a significant incidence of local recurrence. Before the operation, at a minimum, patients should have a recent chest CT scan and a Positron Emission Tomography scan. Preoperative spirometry should be performed including forced expiratory volume in 1 second (FEV 1 ), diffusive capacity, FEV 1 /forced vital capacity (FVC) ratio, and the ratio of the residual volume (RV) to total lung capacity (TLC). FEV 1 2 max) <15 mL/kg/min has been associated with significantly increased postoperative morbidity and mortality. Lobectomies are approached via standard lateral decubitus position. The pleural cavity is entered through the fifth intercostal space or the bed of the fifth rib using a muscle sparing thoracotomy if possible. The key to an orderly lobectomy is an accurate knowledge of the anatomy of the pulmonary artery, the variations of branching, and its proper dissection.

Resolution of a respiratory failure due to massive chronic pericardial effusion with a pericardial window: the simplest is the best

A sizable proportion of patients with pericardial effusion (PE) are asymptomatic, and PE constitutes an incidental and unexpected finding on roentgenogram or echocardiogram performed for other reasons. Here we report a patient where the increasingly severe chronic PE causes not hemodynamic problems rather than indirect accumulation space symptoms due to the accumulation of fluid and the gradual growth of the pericardial sac in the chest cavity. A pleuropericardial window completely released these symptoms. The needs of new guidelines on the management of chronic PE should be stressed.