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OBJECTIVES Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the segmental resections with the corresponding anatomical lobes. METHODS We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry. RESULTS The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality. CONCLUSIONS Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.

Adult, benign, non-iatrogenic bronchoesophageal fistula (BEF) is a rare condition, which is occasionally described in single case reports. Therefore, little is known about its possible causes, presentation and management. A systematic search of the literature in MEDLINE, PubMed Central and EMBASE databases between 1990 and 2020 was carried out to identify all cases of BEF. The initial database search identified 19,452 articles, of which 183 (251 individual patient cases) were included in the final analysis. Main causes of BEF were congenital malformations (97/251, 38.7%) and infections (82/251, 32.7%), while 33/251 (13.1%) fistulae were regarded as idiopathic and 39/251 (15.5%) attributed to other causes. Esophagograpy was the most sensitive method of diagnosis (97.4%) compared with esophagoscopy (78.9%), computed tomography (49.6%) and bronchoscopy (46.0%). Definitive treatment was surgical for 176 patients (70%), endoscopic for 25 (10%) and medical for 37 (14.7%). Compared with congenital BEFs, infective BEFs had shorter median symptom duration and were distributed more proximally over the bronchial tree. Definitive treatment was almost only surgical for congenital BEFs, while infective BEFs were treated also endoscopically (12%) and by medical therapy (38%). Morbidity, treatment failure and recurrence rates were higher for infective BEFs. BEFs are rare. Symptoms are non-specific and a high index of suspicion is necessary for diagnosis. Patients with infective BEF tend to have a more severe clinical picture than those with congenital BEF. Surgery is the main treatment for patients affected by congenital BEF, while infective BEFs may heal conservatively.

The use of extracorporeal membrane oxygenation (ECMO) in the field of lung transplantation has rapidly expanded over the past 30 years. It has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative setting. ECMO is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the recipient. For example, patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous (VV) ECMO or peripheral veno-arterial (VA) ECMO in the case of hemodynamic instability. Moreover, in an intra-operative setting, VV ECMO can be maintained or switched to a VA ECMO. The routine use of intra-operative ECMO and its eventual prolongation in the post-operative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion injury. This review will assess the current evidence on the role of ECMO in the different phases of lung transplantation, while analyzing different studies on pre, intra- and post-operative utilization of this extracorporeal support.

Thermosensitive bioadhesive formulations can display increased retention time, skin permeation, and improve the topical therapy of many drugs. Acne is an inflammatory process triggered by several factors like the proliferation of the bacteria Propionibacterium acnes. Aiming for a new alternative treatment with a natural source, propolis displays great potential due to its antibiotic, anti-inflammatory, and healing properties. This study describes the development of bioadhesive thermoresponsive platform with cellulose derivatives and poloxamer 407 for propolis skin delivery. Propolis ethanolic extract (PES) was added to the formulations with sodium carboxymethylcellulose (CMC) or hydroxypropyl methylcellulose (HPMC) and poloxamer 407 (Polox). The formulations were characterized as rheology, bioadhesion, and mechanical analysis. The selected formulations were investigated as in vitro propolis release, cytotoxicity, ex vivo skin permeation by Fourier Transform Infrared Photoacoustic Spectroscopy, and the activity against P. acnes. Formulations showed suitable sol-gel transition temperature, shear-thinning behavior, and texture profile. CMC presence decreased the cohesiveness and adhesiveness of formulations. Polox/HPMC/PES system displayed less cytotoxicity, modified propolis release governed by anomalous transport, skin permeation, and activity against P. acnes. These results indicate important advantages in the topical treatment of acne and suggest a potential formulation for clinical evaluation.

OBJECTIVES Minimally invasive surgery simulation is an integral part of surgical education and skills acquisition. Our goal was to present a new video-assisted thoracic surgery simulation model based on the human corpse as an alternative to animal models. METHODS Selective cannulation of the cadaver heart was used to fill the pulmonary vessels with a gel to improve the visibility and tactile feedback of the vessels and to simulate any bleeding complications. During surgical simulation, the tutor fills out a questionnaire designed to evaluate the duration of the procedure, the correct completion of the surgical steps and the occurrence of complications. At the end of the simulation session, in order to compare the simulation to clinical practice, all the participants were asked to answer 5 questions using a scale from 1 to 10. RESULTS We have performed 2 hands-on sessions using 2 human corpses for each session. Each surgeon performed 1 lobectomy using video-assisted thoracoscopic surgery (VATS) first as the operator and at least 1 lobectomy as an assistant. The median operative time was 83 min in favour of surgeons who had previously performed more than 30 video-assisted lobectomies (P = 0.03). All the surgeons were able to complete all the steps of the procedure; surgeons who had performed fewer than 10 lobectomies required more support by the tutors than the other surgeons. The median total score was 40.5 (interquartile range 39–44.8). CONCLUSIONS We believe that this model includes most of the features necessary to validate a surgical simulator and allows realistic training for performing a VATS lobectomy. This model could be an effective alternative to anaesthetized animals for VATS lobectomy training and simulation.

Hypericin (Hyp), a natural hydrophobic and photoactive pigment, and methylene blue (MB), a hydrophilic cationic dye, are utilized as photosensitizer (PS) for photodynamic therapy of cancer. Bioadhesive and thermoresponsive polymeric systems can improve the drug availability by increasing the contact time between the system and the mucosa and also controlling the drug release. In this work, an accelerated physicochemical stability study of binary polymeric systems composed of poloxamer 407 (Polox) and Carbopol 934 P (Carb) for MB or Hyp release was performed. Formulations were prepared containing Polox (20%, w/w), Carb (0.15%, w/w) and MB (0.25%, w/w) or Hyp (0.01%, W/W) and submitted to different stress conditions (5 ± 3 °C, 25 ± 2 °C and 40 ± 2 °C with relative humidity of 75 ± 5%) during 180 days. The samples were analyzed as macroscopic characteristics, photosensitizer content and mechanical properties by texture profile analysis. Both systems displayed decrease of photosensitizer content less than 5% during 180 days. MB-system showed an undefined reaction model, while Hyp-system displayed PS decay following a pseudo first-order reaction. Systems also displayed stable mechanical characteristics. The pharmaceutical analyses showed the good physicochemical stability of the bioadhesive platform for delivery Hyp and MB in photodynamic therapy.

A lung transplant is an effective therapeutic option for selected patients with end-stage lung diseases. The shortage of donors is a major limitation for this life-saving therapy, especially in patients with small body sizes or with reduced thoracic cavities, who usually wait longer for grafts with adequate dimensions. Nonanatomic or sublobar graft resections can be sufficient in cases of a small size discrepancy between the donor and the recipient; however, in cases of a greater size mismatch, lobar reduction is mandatory but, because of the associated technical difficulties, only a few centers have adopted this procedure as part of their routine clinical practice. We describe a left upper lobectomy performed at the back table and the subsequent implantation of the left lower lobe in the recipient’s chest cavity.

Made available in DSpace on 2022-04-29T08:30:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-01 National Health and Medical Research Council Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation. Discipline of Anesthesiology Pain and Intensive Care Universidade Federal de São Paulo, Rua Napoleão de Barros, 737, 6ºandar Critical Care and Trauma Division George Institute for Global Health Hospital Sírio-Libanês Hospital das Clínicas Faculdade de Medicina Universidade de São Paulo Instituto de Pesquisa HCor - Hospital do Coração Instituto de Pesquisa Clínica Evandro Chagas Fundação Oswaldo Cruz Hospital de Clínicas Mário Lioni Hospital do Rim e Hipertensão Fundação Oswaldo Ramos Hospital Samaritano Hospital Paulistano Hospital São José Instituto D’Or de Ensino e Pesquisa Hospital Municipal São José Hospital Israelita Albert Einstein Hospital Santa Rita Hospital de Base Faculdade de Medicina de São Jose do Rio Preto Hospital Unimed de Belo Horizonte Hospital Santa Lúcia Hospital Evangélico de Sorocaba Hospital PIO XII Hospital São Camilo Pompéia Hospital Alvorada Brasília Hospital Ecoville Hospital do Trabalhador Hospital Vita Batel Hospital das Clínicas Faculdade de Medicina de Botucatu Universidade Estadual “Júlio de Mesquita Filho” Hospital Geral Dr. César Cals Hospital Copa D’Or Associação Beneficente Hospital Unimar Hospital Casa de Saúde de Santos Hospital Estadual Getúlio Vargas Hospital e Maternidade Otaviano Neves Instituto Estadual do Cérebro Paulo Niemeyer Hospital Universitário Universidade Federal de Juiz de Fora Lifecenter Hospital Geral de Fortaleza Hospital Municipal Dr. Moysés Deutsch (M’Boi Mirim) Santa Casa de Misericórdia de Presidente Prudente Hospital 9 de julho Hospital Estadual Rocha Faria Hospital Municipal Santa Isabel Hospital e Maternidade Municipal Dr. Odelmo Leão Carneiro Hospital Evangélico de Londrina Universidade Estadual de Londrina Hospital Samaritano João Pessoa Hospital de Caridade Astrogildo de Azevedo Vitória Apart Hospital Instituto de Ortopedia e Traumatologia Hospital do Subúrbio Hospital Renascentista Hospital Felício Rocho Hospital Municipal Irmã Dulce Hospital Universitário Júlio Müller Universidade Federal do Mato Grosso Hospital de Urgência Hospital Geral de Goiânia Fundação Doutor Amaral Carvalho Hospital Adventista de Belém Hospital Santa Juliana Hospital Dom Vicente Scherer Hospital Primavera Hospital Carlos da Silva Lacaz Hospital Escola Faculdade de Medicina de Jundiaí Hospital Sepaco Hospital Professor Edmundo Vasconcelos Hospital Paulo Sacramento Clínica Dom Rodrigo Complexo Hospitalar Ortotrauma de Mangabeira Hospital Nossa Senhora da Conceição Hospital Regional de Samambaia Hospital São Camilo Ipiranga Hospital da Restauração Instituto do Coração Hospital das Clínicas Faculdade de Medicina Universidade de São Paulo Hospital Estadual Jayme Santos Neves Hospital SOS Cárdio Hospital da Luz Vila Mariana Hospital Maternidade e Pronto-Socorro Santa Luci Santa Casa de Misericórdia de Vitória da Conquista Santa Casa de Misericórdia de Porto Alegre Hospital São Francisco de Assis Hospital Memorial São José Hospital Regional de Jundiaí Hospital Universitário Faculdade de Medicina de Jundiaí Hospital Regional de Presidente Prudente Santa Casa de Misericórdia de Assis Hospital de Clínicas Gaspar Vianna Hospital do Coração do Brasil Hospital Hélio Anjos Ortiz Hospital Vila da Serra Hospital Nereu Ramos Hospital Santa Maria Intensibarra Santa Casa de Misericórdia de Santo Amaro Santa Casa de Caridade de Don Pedrito Santa Casa de Misericórdia de Santana do Livramento Hospital Unimed de Macaé Hospital Municipal Pedro II Hospital Federal dos Servidores do Estado Hospital São Mateus Hospital IBR Hospital Uniclinic Santa Casa de Misericórdia de Paraguaçu Paulista Associação Hospitalar Beneficente São Vicente de Paulo Hospital do Servidor Público Municipal de São Paulo Hospital Santa Isabel Hospital Municipal Dr Jose Soares Hungria Hospital Fernandes Távora Hospital Distrital Evandro Ayres de Moura Hospital Saúde da Mulher Hospital Estadual de Urgência e Emergência de Vitória Samur Hospital e Pronto-Socorro 28 de Agosto Hospital Assunção Hospital Universitário de Santa Maria Hospital Universitário Cajuru Instituto do Câncer do Estado de São Paulo Hospital Unimed de Limeira Hospital Amecor Santa Casa de Caridade de Diamantina Hospital das Clínicas Faculdade Ribeirão Preto Universidade de São Paulo HCor - Hospital do Coração Hospital Goiânia Leste Hospital Ortopédico Hospital Santa Maria Hospital Municipal Dr. Munir Rafful Hospital Jardim Amália Hospital Madre Regina Prottman Hospital Universitário São Francisco de Paula Universidade Católica de Pelotas Hospital São Joao de Deus Hospital Nossa Senhora Monte Serrat Hospital Unimed Salto Hospital Moinhos de Vento Hospital Geral de Vitória da Conquista Hospital Marcelino Champagnat Hospital São Lucas Pontifícia Universidade Católica do Rio Grande do Sul Hospital Universitário Universidade Federal da Grande Dourados Hospital Português Hospital Brigadeiro Hospital Regional de Sousa Hospital das Clínicas Universidade Federal do Espírito Santo Santa Casa de Misericórdia de Ribeirão Preto Hospital Universitário Lauro Wanderley Santa Casa de Belo Horizonte Hospital Adventista de Manaus Santa Casa Maringá Universidade Estadual Maringá Hospital Total Cor Hospital Universitário Universidade de Santa Cruz do Sul Hospital Dom Hélder Hospital das Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Hospital Anis Rassi Instituto de Infectologia Emílio Ribas II Hospital Unimed Rio de Janeiro Hospital Alemão Oswaldo Cruz Hospital Samaritano Rio de Janeiro São Bernardo Apart Hospital Hospital Nossa Senhora dos Prazeres Hospital Unimed ABC Hospital Municipal de Paracatu Hospital Municipal Padre Germano Lauck Hospital Santa Helena Hospital Santa Izabel Santa Casa de Misericórdia de São Paulo Hospital Tereza Ramos Hospital Alvorada Taguatinga Hospital Maternidade São José Hospital Universitário Ciências Médicas Fundação Educacional Lucas Machado Santa Casa de Belém do Pará Instituto Nacional de Cardiologia Hospital Novo Atibaia BP - A Beneficência Portuguesa de São Paulo Hospital Universitário Maria Aparecida Pedrossian Universidade Federal de Mato Grosso do Sul Hospital do Servidor Público Estadual “Francisco Morato de Oliveira” Hospital Norte D’Or Hospital Estadual Ipiranga Hospital Universitário de Maringá Universidade Estadual de Maringá Albert Sabin Hospital e Maternidade Casa de Caridade de Carangola Irmandade de Misericórdia de Guaxupé Disciplina de Emergências Clínicas Universidade Estadual de Campinas Hospital São Lucas Fundação Pio XII- Hospital de Câncer de Barretos Clínica Campo Grande Hospital das Clínicas Universidade Federal de Minas Gerais Casa de Saúde Santa Lúcia Hospital Regional de Itapetininga São Camilo Santa Casa de Angra dos Reis Grupo Hospitalar Nossa Senhora da Conceição Irmandade Misericórdia Hospital Santa Casa de Monte Alto Hospital São Marcos Hospital Unimed de Manaus Hospital Universitário Getúlio Vargas Universidade Federal do Amazonas Casa de Saúde Campinas Hospital e Maternidade Galileo Hospital das Clínicas Faculdade de Medicina de Botucatu Universidade Estadual “Júlio de Mesquita Filho” National Health and Medical Research Council: APP1039312

Background Reconstruction of the anterior chest wall defect after sternectomy is a challenge for cardiothoracic surgeons. In 2010, the Padua group published the first case of cadaveric sternum transplantation after sternectomy. This multicenter study reports the clinical indications and early and long-term results of sternal chondral allograft transplantation. Methods This is a retrospective multicenter study from 7 academic centers. We collected demographic data, surgical indications, technical details, and early postoperative results. The complications, long-term stability, and tolerance of the allografts were also analyzed. Results Between January 2008 and December 2019, 58 patients underwent sternectomy followed by reconstruction using cadaveric-cryopreserved sternochondral allografts. Thirty-two patients were male, median age 63.5 years (interquartile range, 50-72 years). Indications for sternectomy were secondary sternal tumors (n = 13), primary sternal tumors (n = 15), and nonneoplastic disease (n = 30). Thirty patients underwent total sternectomy, 16 lower-body sternectomy, and 12 upper-body manubrium resection. The 30-day mortality was 5%; overall morbidity was 31%. Six early reoperations were necessary because of bleeding (n = 1), titanium plate dislocation (n = 1), and resuture of the skin in the lower part of the incision (n = 4). Overall, 5-year survival was 74%. In all the survived patients, the reconstructions were stable and free from mechanical or infective complications. Conclusions The main indications for sternal allograft implantation were complex poststernotomy dehiscence followed by primary or secondary tumor involvement of the sternum. The collected results demonstrate that sternochondral allograft transplantation is a safe and effective method in reconstructing the anterior chest wall after sternectomy. Further studies to demonstrate the integration of the bone grafts into the patients’ sternal wall will be made.

The effective incidence of cutaneous squamous cell carcinoma of the skin (cSCC) is unknown, in general cSCC is the second most common skin cancer, accounting for 20% of all cutaneous malignancies, with a continuous increase in its frequency (1). The skin of the thorax is a very rare localization for this kind of tumor (1-4). Despite cSCC is a malignant proliferation of keratinizing cells of the epidermis, generally, when the diagnosis is made, early surgical resection with adequate surgical margins is curative in more than 95% of the cases (5). Here we present a very rare case of local recurrence of a huge cSCC involving the anterior chest wall that underwent extensive chest wall resection associated to complex reconstruction by using a combination of synthetic materials and autologous flaps.

Background Total lung-sparing tracheobronchial sleeve resections are a step forward in the treatment of low-grade bronchial tumors in which minimal resection margins are required to achieve complete control of the disease. Methods This study retrospectively collected data on patients who underwent total lung-sparing procedures for low-grade tracheobronchial tumors at 2 thoracic surgical centers from January 1984 to October 2019. Results The study included 98 patients, 46 –female (47%) and 52 –male (53%), with a median age of 39 years (range, 7 to 70 years). Thirty-four patients underwent operative endoscopy before surgery (32 had laser treatment, and 2 had endobronchial stenting). The surgical resections were as follows: 9 (9%), tracheal carina; 18 (18%), second carina; 31 (32%), left main bronchi; 25 (26%), right main bronchi; and 15 (15%), intermediate bronchus. The median length of the resected bronchus was 2.2 cm. The median postoperative in-hospital stay was 8 days, and no perioperative mortality was observed. Postoperative complications were recorded in 26-patients (27%). The final histologic classification was as follows: 37 typical carcinoids (38%); 10 atypical carcinoids (10%); 29 adenoid cystic carcinomas (30%); 15 mucoepidermoid carcinomas (15%); 6 inflammatory myofibroblastic tumors (6%); and 1 glomic tumor (1%). Twenty-two patients had positive resection margins and underwent adjuvant radiotherapy. Three patients with adenoid cystic carcinoma had recurrences (1 local and 2 systemic). After a median follow-up time of 54.5 months (range, 4 to 360 months), the overall actuarial 5-year survival was 97%. Conclusions Total lung-sparing tracheobronchial sleeve resection for low-grade malignant disease requires advanced surgical skills, but the hospital morbidity and mortality are very low. This technique is adequate and safe for highly selected patients with low-grade endobronchial malignant diseases, and its use should be encouraged in experienced centers.

Vanishing lung syndrome is a rare disease that could be treated successfully in selected cases with bullectomy. Protective ventilation is very important during surgery to achieve optimal post-operative results and to prevent complications. Hypercapnia and respiratory acidosis are the main disadvantages of this ventilator strategy. The use of extracorporeal CO2 removal device has been introduced to support protective and ultra-protective ventilation during respiratory failure in complex cases. In thoracic surgery the intraoperative use of this device is still not widespread. We report a successful case of a giant left lung bullectomy with intraoperative support with Pro-Lung CO2 removal device for the management of hypercapnia during single lung ventilation.

The thoracoscopic approach to lobectomy is now the gold standard in cases of pulmonary malignancies because it is associated with a significant reduction in both postoperative hospital stay and pain. Even in cases of complex resection, as in the case reported here, the procedure can be performed safely after careful pre-operative planning. This video tutorial describes our technique for the intrapericardial isolation of the left inferior pulmonary vein in a patient affected by a left lower lobe metastasis from a colonic carcinoma. The lesion was retracting the inferior vein to such an extent that an intrapericardial approach was required in order to obtain a radical resection. The operation was carried out using a 3-port technique to allow for safe and unhindered manipulation of the hilar structures and the parenchyma. The pericardial sac was easily opened and the feasibility of the procedure was readily confirmed. The patient made an uneventful recovery; specifically, we did not record any arrhythmia or hemodynamic instability. She was discharged home on the 4th postoperative day.