1,720,965 research outputs found
Multiple pleuropericardial implants of thymoma after videothoracoscopic resection
No full textThe case of a 49-year-old man with multiple pleuropericardial implants of B2 thymoma is reported. Two years earlier, the patient had undergone left videothoracoscopic (VATS) resection of a 6-cm thymoma in another hospital. The operative report describes a technically correct procedure with morcellation of the lesion within a retrieval thoracoscopic bag. Through a standard thoracotomy, 11 implants were resected with macroscopically complete tumor removal. The origin of cell spillage was ascribed to manipulation of the thymoma during VATS resectio
Therapeutic options in locally advanced thyroid carcinoma: our experience
No full textINTRODUCTIONS:
Thyroid cancer is the most common endocrine malignancy with an incidence equal to 1% of all malignant tumors. Prognostic factors affecting survival are manifold, including in several classifications (AMES, AGES, CORN and TNM). In this sense, the invasion of adjacent structures is one of the most important variables. The authors describe the experience of a single center in surgical treatment of advanced thyroid cancer.
MATERIALS AND METHODS:
Between 1986 and 2010 , 1565 patients were undergoing surgery with thyroid cancer. In particular, 1403 interventions were made for differentiated cancer, 97 for medullary carcinoma, 25 for insular carcinoma, 29 for anaplastic carcinoma, 2 for plasmacytoma, and 7 for lymphoma and 2 for angiosarcoma. Among these 896 showed invasion of adjacent structures and / or distant metastases.
RESULTS:
There were no perioperative deaths or major complications. Surgical procedures consisted of: 13 loboistmectomy, 519 total thyroidectomy (TT), 325 TT with lymphadenectomy of the central compartment, 7 TT with radical lymphectomy, 621 TT with functional lymphectomy, 6 TT with breast lumpectomy, 5 TT with with video-assisted lung metastasectomy, 16-TT with resection and tracheal anastomosis, 6 TT with laryngotracheal resection, 3 TT with laryngectomy, 4 TT with trachetomy, 28 TT with respiratory stent placement, 12 tracheotomy. At present, 1328 patients were free of disease, while 104 showed recurrence. Total of 133 deaths were recorded, all linked to disease relapse.
DISCUSSION:
The role of surgery in the treatment of advanced thyroid cancer is still undeniable. In the presence of extracapsular trespassing, in fact, the adoption of interventions demolition permits long-term survival, given the lack of aggressiveness of the tumor differentiated representing the majority of cases. The aim of surgical radicalization addition, even in the presence of distant metastases, it is justified by the possibilities offered by the therapeutic radioiodine treatment, which is not feasible in the presence of significant amounts of thyroid tissue which picks. In the presence of undifferentiated tumors, finally, endoscopic or surgical treatment may be indicated by simple purpose of palliation of respiratory symptoms
Impatto della microalbuminuria nel decorso post operatorio in chirurgia toracica
No full textIMPATTO DELLA MICROALBUMINURIA NEL DECORSO POSTOPERATORIO IN CHIRURGIA TORACICA
Topic: Le nuove tecnologie; Tipo di presentazione: Presentazione orale
Scopo del lavoro
La micro-albuminuria (MA) è manifestazione di un aumento generalizzato della permeabilità vascolare ed un marker precoce e sensibile di disfunzione endoteliale. Alcuni studi hanno attribuito un significato prognostico negativo al brusco aumento di MA dopo trauma, ustioni, pancreatiti, danno da rivascolarizzazione, chirurgia maggiore, ALI e ARDS. Le potenziali implicazioni dell’aumento della MA nel postoperatorio in chirurgia toracica non sono state ancora indagate.
Materiali e Metodi
Studio prospettico osservazionale, a breve termine, condotto su 171 pazienti consecutivi sottoposti in elezione ad intervento di chirurgia toracica. In aggiunta alle valutazioni eseguite di routine, i pazienti sono stati sottoposti pre-operatoriamente, in prima e quarta giornata postoperatoria a determinazione urinaria di microalbumina espressa in valore assoluto (mediante determinazione quantitativa immuno-istochimica) e come rapporto microalbuminuria/creatininuria.
Obiettivo primario: documentare se l’escrezione di MA implichi un rischio aumentato di complicanze a breve periodo. Obiettivo secondario: relazione tra MA e una serie di parametri fisiopatologici peri-operatori quali ritenzione idrica post-operatoria, BNP, rapporto pa02/Fi02.
Risultati
Sono stati arruolati 59 donne e 112 uomini, età media 63 anni; 19 diabetici, 63 ipertesi e 75 affetti da BPCO. Abbiamo eseguito 80 lobectomie, 8 pneumonectomie, 6 timectomie, e 87 resezioni polmonari sublobari; 122 in toracotomia e 49 VATS. Mortalità postoperatoria: 2 (ARDS); Complicanze maggiori: 9 (chilotorace: 3, insufficienza respiratoria: 3, fistola bronchiale minima: 1, IMA: 1, IRA: 1). Complicanze minori: 16 (FA: 14, perdite aeree > 7 giorni: 2). La MA preoperatoria era normale, valore medio: 0.61 mg/dl (0.48 - 0.79). In prima giornata abbiamo documentato un marcato aumento, valore medio: 4.45 (3.50 - 5.65), p<0.001. Un aumento ancora più spiccato si è osservato nei pazienti diabetici ed ipertesi valore medio rispettivamente: 8.95 (1.54 - 52.09), p<0.001 e 5.852 (4.04 - 8.46), p<0.001. In prima giornata postoperatoria abbiamo trovato differenze statisticamente non significative in relazione all’approccio chirurgico. Le complicanze postoperatorie non sono risultate statisticamente correlate con l’escrezione di MA.
Conclusioni
Il nostro studio conferma che MA è espressione della reazione dell’organismo allo stress chirurgico e costituisce un indice precoce di aumentata permeabilità vascolare in parte rapportato all’entità dello stress. Come atteso, nel post-operatorio, è stato riscontrato incremento maggiore di MA nei pazienti diabetici, ipertesi e sottoposti ad intervento toracotomico, quest’ultimo dato, peraltro, statisticamente non significativo. Non viene confermato il valore prognostico negativo a breve periodo espresso da altri autori
Short term prospective evaluation of microalbuminuria after thoracic surgery
No full textOBJECTIVE
Micro-albuminuria (MA) is associated with a generalized increase in systemic vascular permeability and a sensitive marker of endothelial dysfunction. Several studies documented its rapid increase and its adverse prognostic significance after trauma, pancreatitis, ischemia reperfusion injury, and surgery. However, little is known about MA and its potential implication after thoracic surgery. We performed a prospective study to serially assess MA after thoracic surgery.
METHODS
Design: short-term prospective observational pathophysiology driven study. Setting: thoracic surgery unit. Patients: 80 consecutive patients. Outcome measures: MA in first-void urine samples before thoracic surgery and in postoperative day 1, 3 and 7.
RESULTS
Mean age was 63 years [60 to 65], 67% were male, and the most common comorbidities were COPD (55), hypertension (38), and diabetes (9). Sixty-four patients underwent standard thoracic surgery (55 lobectomies, 4 pneumonectomies and 5 thymectomies) and 16 VATS resections. Preoperative MAU level was normal, mean 0.61 mg/dl ([0.48 to 0.79]) while on postoperative day 1 we observed a seven fold increase (4.45 mg/dl [3.50 to 5.65] p<0.001). An even larger increase was observed in patients with diabetes and hypertension (8.95 mg/dl [1.54 to 52.09]; p<0.001 and 5.852 mg/dl [4.04 to 8.46]; p<0.001 respectively). On postoperative day 1 we did not find significant MAU differences between categories defined by type of surgery. Average MAU was normal and close to baseline level on postoperative day 7, however 45% of patients submitted to open procedures still had MAU greater than baseline level.
CONCLUSIONS
Our study showed that MAU might be and early marker of increased vascular permeability in thoracic surgery patients. As expected a larger increase was observed in diabetics and hypertensives. A wider proportion of patients undergoing VATS compared to open thoracic surgery recovered baseline MAU within 7 days. Persistence of MAU seems associated with the severity of surgical stress
Experimental left pneumonectomy in pigs. Procedure and management
Full text linkBackground Because there is no detailed description of procedures and perioperative management of major pulmonary resections in swine, we reviewed our experience to delineate the most effective practice in performing left pneumonectomy. Materials and methods Analysis of 11 consecutive left pneumonectomies. Animal data, operative reports, anesthesia records, and perioperative facts were evaluated. Follow-up information until postoperative day 60, methods of care-taking, therapy administration, and all the stabling aspects were systematically assessed. The investigation was aimed at highlighting those procedural steps or details which make the difference in optimizing the available resources (animals, instruments, and personnel). No statistical analysis was performed considering data characteristics and the descriptive nature of information. Results Surgery requires a median time of 2 h and 16 min; two operators and one anesthesiologist represent the basic team. Circulators' number depends on goals to accomplish. The most straightforward procedure requires careful dissection of the pulmonary ligament (limited view), pulmonary veins (low variability), pulmonary artery (delicate), and finally bronchus (no variability observed). The key factors for good anesthesia management have been identified: sedation by caregivers, preoxygenation before induction of general anesthesia, high respiratory rates with low tidal volume after pneumonectomy, and noninvasive ventilation after extubation. Antibiotic prophylaxis has been performed. Postoperative care must be continuous until animals are able to stand up, afterward "preventive noncurative," and always animal friendly. Ideas for minimally stressful therapy administration are helpful. Conclusions After the delineation of this methodology, the compliance to a routine practice allowed us to reduce time, stress, and cost; quality and quantity of possible research increased
Uterine Leiomyoma Metastatic to the Lung
No full textPresented at the 20th National Congress of
the Italian Polyspecialist Society of Young Surgeons
(IPSYS) November 8–10, 2007, Naples
Published Online http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=109878&Ausgabe=234114&ProduktNr=223841&filename=109878.pd
Baseline and post-surgery endothelial progenitor cell levels in patients with early-stage non-small-cell lung carcinoma: impact on cancer recurrence and survival.
No full textOBJECTIVES:
Endothelial progenitor cells (EPCs) are believed to play a role in promoting abnormal vascularization in neoplastic sites. We measured the number of circulating EPCs in treatment-naïve patients with early non-small-cell lung cancer (NSCLC) and healthy controls. The prospective influence of baseline and post-surgery EPC levels on cancer recurrence and survival was investigated.
METHODS:
Circulating EPCs were quantified by FACS analysis in 34 patients with Stage I-II NSCLC and 68 healthy age- and sex-matched controls. Measurement of EPCs was repeated 48 h after thoracic surgery and at the hospital discharge. Cancer recurrence and survival was evaluated after 446 ± 106 days of follow-up (range 182-580 days).
RESULTS:
The base 10 logarithmic [log] number of circulating EPCs was comparable between patients with NSCLC and controls [mean ± standard deviation (SD): 2.3 ± 0.32 vs 2.3 ± 0.26 n/ml, P = 0.776]. In regression analysis, smoking status [standardized coefficient beta (β) = -0.26, 95% confidence interval (CI) for B -0.29/-0.03, P = 0.014] and systolic blood pressure [β = -0.23, 95% CI for B -0.011/-0.001, P = 0.018] were independent predictors of the number of EPCs, irrespective of the NSCLC status. The mean number of EPCs did not change after surgical treatment. However, a post-surgery EPC increase was observed in 44% patients. Patients with a 48 h post-surgery EPC increase had a higher rate of cancer recurrence/death than patients with either stable or decreased post-surgery EPC levels [hazard ratio (HR) 4.4, 95% CI 1.1-17.3; P = 0.032], irrespective of confounders.
CONCLUSIONS:
Circulating EPC levels are comparable between patients with early-stage NSCLC and healthy controls. Overall, surgical cancer resection was not associated with a significant early EPC change. However, an early post-surgery EPC increase is able to predict an increased risk of cancer recurrence and death
Surgical Treatment of Non Malignant Tracheal Lesions: A Single Center Experience
No full textPublished Online October 30, 200
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