Aortocoronary bypass grafting in high-risk patients over 75 years. Propensity score analysis of on versus off-pump, early and midterm results.

AIM: Bypass surgery in high risk patients over the age of 75 results in increased mortality and morbidity, which may be also related to the cardiopulmonary bypass system. METHODS: Using the propensity score analysis, we have selected two homogeneous groups of high-risk elderly patients undergoing coronary surgery: 41 patients operated with cardiopulmonary bypass- coronary artery bypass graft (CPB-CABG), and 78 patients operated without cardiopulmonary bypass (off-pump coronary artery bypass graft, OPCABG). All preoperative and operative variables were similar and outcomes were compared. RESULTS: Perioperative mortality was higher in the patient group operated with CPB (12.2%) as compared to patients operated without CPB (1.3%, P = 0.01). Perioperative complications were more frequent in the CPB-CABG group. Logistic regression analysis showed that avoiding CPB was an independent protective factor for mortality and morbidity. Midterm survival, freedom from angina, freedom from reintervention, and Canadian Cardiovascular Society (CSS) class were comparable between the 2 groups. CONCLUSION: OPCABG is safe in the high risk elderly population and significantly reduces postoperative mortality and morbidity. There are no differences in midterm results between the 2 groups of patients in our study.

Fine needle aspiration of thoracic splenosis. A case report.

BACKGROUND: Thoracic splenosis is a rare event, and fine needle aspiration (FNA) of a pleural implant of splenic tissue can be a pitfall when previous anamnestic data are ignored. CASE: A 53-year-old male underwent FNA of a left thoracic subpleural nodule highly suggestive of a metastatic lesion. The presence of a population of small and medium-sized lymphocytes suggested the possibility of lymphoproliferative disease; frozen sections confirmed this possibility. The final diagnosis was normal splenic tissue. Twenty-five years earlier the patient sustained a gunshot wound in the left side of the upper abdomen followed by splenectomy and drainage of the left pleural cavity because of mild, concomitant hemothorax. CONCLUSION: A left pleural thoracic nodule in subjects with a previous history of traumatic rupture of the spleen must be considered highly suggestive of thoracic splenosis. Scintigraphy with Tc 99 m and magnetic resonance imaging are diagnostic, while FNA, especially in the absence of anamnestic data, can create a pitfall that can induce inappropriate removal of ectopic, normally functioning splenic tissue.

[The treatment of bronchopleural fistulae due to bronchial dehiscence by chest wall interventions. The authors' personal experience]. / Trattamento delle fistole bronco-pleuriche da deiscenza bronchiale mediante interventi sulla parete toracica. Esperienza personale.

The authors present their personal experience of three cases of bronchial fistulae post pneumonectomy or lobectomy. Surgical treatment was not done directly on the bronchial stump but by thoracoplasty. This approach to the thoracic chest gets good results on condition that stabilization in reexpansion of residual parenchyma and drainage of bronchial secretions is carried out.

Pneumomediastinum: physiopathological considerations and report of six cases treated in an emergency surgery division.

Pneumomediastinum indicates the presence of air in the mediastinal space. It may be classified in three categories, based on the main causes of air dissection into the mediastinal structures: spontaneous pneumomediastinum (pnm), the most frequently encountered, post traumatic pnm and pnm secondary to non-traumatic rupture of an abdominal hollow viscus. This paper reports the experience of a major regional emergency surgery division in the management of pnm during a five years period. Physiopathologic correlations are discussed together with diagnostic and therapeutic options.

[Anatomo-pathologic study of parenchymal segments with bullous pneumopathy. Mini-invasive surgical technic]. / Studio anatomo-patologico di segmenti di parenchima affetti da pneumopatia bollosa. Tecnica chirurgica mini-invasiva.

The treatment of bullous pneumopathy using minimally invasive surgery gets available "new" specimens for the pathologist. The change of the specimen's features is related to the peculiarity of the analyzed elements and the systematicity of the treatment. Observing 41 cases, we have noticed modifications in 26 cases of the vascular wall 25 cases of the elastic and 23 of the muscular tissues and 21 cases inflammatory features.

[The minimally invasive treatment of bullous pneumopathy. The anatomicopathological and pneumological findings in 18 months of experience]. / Trattamento mininvasivo della pneumopatia bollosa. Considerazioni anatomopatologische e pneumologische in 18 mesi di esperienza.

The authors present 18-month experience in the minimally invasive treatment of bullous pneumopathy and review of the relative literature. Results of pneumologic and pathologic studies are correlated with the advantages of the technique. Tobacco smoking, positive family history, associated disease and long standing treatments have been considered. Special attention is drawn to macro and microscopic findings. The authors concluded that: (a) There is a positive correlation between surgical technique of pleural cavity exploration and recidival pneumopathy. (b) There is no correlation between family history and pneumological and pathological findings. (c) A wider experience on bullous pneumopathy may offer new interesting pneumological knowledge.

[Middle lobe syndrome]. / Sindrome del lobo medio.

The authors, based on their actual experience with four cases and using previously published articles, state the pathological and clinical features of the middle lobe syndrome. Considering the physio-pathological processes, the authors determine the therapeutic program: the first approach would be pharmacological, second, if necessary, surgical-seeking to be as conservative as possible.

[Drainage of the pleural cavity]. / Il drenaggio della cavità pleurica.

The authors, from their personal experience, demonstrate the goals, the indications, the techniques and complications of performing a drain of the pleural cavity (DCP). DCP has an important role as a single operation or at the end of every thoracic operation. For this reason it is mandatory to respect the principles and the concepts reported by the authors.

[Risk factors in the surgical patient over 80]. / I fattori di rischio nel paziente chirurgico ultraottantenne.

Authors present the experience about 266 elderly patients treated by surgery since 1985 to 1990. The range of the patient's age is comprised between 74 and 89. 113 patients (42%) have been treated in emergency, with 12% mortality. Authors report the different experiences in relation to various kinds of operations: thorax, vascular, digestive surgery, and to their level of trauma to the patients; "major surgery" distinguished from "little surgery". Elderly age is not considered as an inhibiting limit to major surgery. Only the emergency treatment leads to different situations with more risks. Absolutely necessary in the knowledge of the physiopathological modification of the elderly, and his nutritional and performance status.

[Prognostic value of postoperative determination of CEA in carcinoma of the large intestine]. / Valore prognostico del dosaggio postoperatorio del C.E.A. nel carcinoma del grosso intestino.

The C.E.A. level was routinely determined in the follow up of 133 patients who underwent surgery because of colorectal cancer. Preoperative levels of C.E.A. appear to be related to Dukes staging of the disease. Postoperative values of the marker were higher than normal in 36 patients, 91% of whom had recurrences; normal postoperative values were observed in 90 patients and only 21% of these eventually showed recurrences.

[384 papillosphincterostomy operations. Indications, technic, results and long-term control]. / 384 interventi di papillosfinterostomia. Indicazioni, tecnica, risultati e controlli a distanza.

The immediate and long-term results of 384 papillosphincterostomy operations carried out between 1969 and 1979 are presented and discussed. After defining the operation exactly, indications for it are illustrated, i.e.: VP lithiasis, fibrosclerotic odditis, Oddian functional pathology and other pathologies. Special attention is paid to diagnostic techniques. After commenting on surgical techniques, the results obtained in the immediate postoperative course are examined and it is pointed out that complications specific to the type of operation occurred in 1.5% of cases, with a mortality of 1.3% and an incidence of acute pancreatitis of 0.3% (3 cases of which 1 fatal). 162 patients (42%) were followed up between 10 years and 3 months after operation. Follow-up showed the absence of late after-effects and as well as the advantages of effecting an extensive incisura at the Oddian sphincter.