ABSTRACT
INTRODUCTION: Pectus excavatum is a wall deformity that often warrants medical evaluation. In most cases, it's a purely visual aesthetic alteration, while in others, it comes with symptoms. Several surgical techniques have been described, but their outcomes are difficult to assess due to the heterogeneity of presentations and the lack of long-term follow-up. We present our experience as thoracic surgeons, assessing correction as either structural (remodeling of the thoracic cage through open surgery) or aesthetic (design and implantation of a customized 3D prosthesis). MATERIAL AND METHODS: Retrospective observational study of the indication for surgical treatment of pectus excavatum carried out by a team of thoracic surgeons and the short- to mid-term results. RESULTS: Between 2021 and 2023, we treated 36 cases surgically, either through thoracic cage remodeling techniques or with 3D prostheses. There were few minor complications, and the short- to mid-term results were positive: alleviation of symptoms or compression of structures when present, or aesthetic correction of the defect in other cases. CONCLUSIONS: Surgery for pectus excavatum should be evaluated for structural correction of the wall or aesthetics. In the former, thoracic cage remodeling requiring cartilage excision and possibly osteotomies is necessary. In the latter, the defect is corrected with a customized 3D prosthesis.
Subject(s)
Esthetics , Funnel Chest , Funnel Chest/surgery , Humans , Retrospective Studies , Male , Female , Adult , Adolescent , Young Adult , Treatment Outcome , Prosthesis Design , Child , Prostheses and ImplantsABSTRACT
Lung cancer patients are diagnosed at late stages when curative treatments are no longer possible; thus, molecular biomarkers for noninvasive detection are urgently needed. In this sense, we previously identified and validated an epigenetic 4-gene signature that yielded a high diagnostic performance in tissue and invasive pulmonary fluids. We analyzed DNA methylation levels using the ultrasensitive digital droplet PCR in noninvasive samples in a cohort of 83 patients. We demonstrated that BCAT1 is the candidate that achieves high diagnostic efficacy in circulating DNA derived from plasma (area under the curve: 0.85). Impact of potentially confounding variables was also explored.
Subject(s)
Cell-Free Nucleic Acids , Lung Neoplasms , Biomarkers, Tumor/genetics , Cell-Free Nucleic Acids/genetics , DNA , DNA Methylation , Epigenesis, Genetic , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/genetics , Transaminases/geneticsABSTRACT
The ideal tracheal substitute must have biomechanical properties comparable to the native trachea, but currently there is no standardised approach to evaluating these properties. Here we propose a novel method for evaluating and comparing the properties of tracheal substitutes, thus systematising both measurement and data curation. This system was tested by comparing native rabbit tracheas to frozen and decellularised specimens and determining the histological characteristics of those specimens. We performed radial compression tests on the anteroposterior tracheal axis and longitudinal axial tensile tests with the specimens anastomosed to the jaw connected to a measuring system. All calculations and results were adjusted according to tracheal size, always using variables relative to the tracheal dimensions, thus permitting comparison of different sized organs. The biomechanical properties of the decellularised specimens were only slightly reduced compared to controls and significant in regard to the maximum stress withstood in the longitudinal axis (-0.246 MPa CI [-0.248, -0.145] MPa) and the energy stored per volume unit (-0.124 mJ·mm-3 CI [-0.195, -0.055] mJ·mm-3). The proposed method is suitable for the systematic characterisation of the biomechanical properties of different tracheal substitutes, regardless of the size or nature of the substitute, thus allowing for direct comparisons.
Subject(s)
Tissue Engineering , Tissue Scaffolds/chemistry , Trachea/growth & development , Animals , Biomechanical Phenomena , Humans , Rabbits , Trachea/drug effectsABSTRACT
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Subject(s)
Humans , Male , Aged , Carcinoma/surgery , Lung Neoplasms/surgery , Postoperative Complications/pathology , Pyoderma Gangrenosum/pathology , Surgical Wound/complications , Surgical Wound/pathologyABSTRACT
Although EGFR mutant-selective tyrosine kinase inhibitors (TKI) are clinically effective, acquired resistance can occur by reactivating ERK. We show using in vitro models of acquired EGFR TKI resistance with a mesenchymal phenotype that CXCR7, an atypical G protein-coupled receptor, activates the MAPK-ERK pathway via ß-arrestin. Depletion of CXCR7 inhibited the MAPK pathway, significantly attenuated EGFR TKI resistance, and resulted in mesenchymal-to-epithelial transition. CXCR7 overexpression was essential in reactivation of ERK1/2 for the generation of EGFR TKI-resistant persister cells. Many patients with non-small cell lung cancer (NSCLC) harboring an EGFR kinase domain mutation, who progressed on EGFR inhibitors, demonstrated increased CXCR7 expression. These data suggest that CXCR7 inhibition could considerably delay and prevent the emergence of acquired EGFR TKI resistance in EGFR-mutant NSCLC. SIGNIFICANCE: Increased expression of the chemokine receptor CXCR7 constitutes a mechanism of resistance to EGFR TKI in patients with non-small cell lung cancer through reactivation of ERK signaling.
Subject(s)
Carcinoma, Non-Small-Cell Lung/drug therapy , Drug Resistance, Neoplasm , Lung Neoplasms/drug therapy , Protein Kinase Inhibitors/pharmacology , Receptors, CXCR/metabolism , Animals , Carcinoma, Non-Small-Cell Lung/metabolism , Carcinoma, Non-Small-Cell Lung/mortality , Cell Line, Tumor , Drug Resistance, Neoplasm/genetics , Epithelial-Mesenchymal Transition/genetics , ErbB Receptors/antagonists & inhibitors , Humans , Lung Neoplasms/metabolism , Lung Neoplasms/mortality , MAP Kinase Signaling System/drug effects , MAP Kinase Signaling System/genetics , Mice, Transgenic , Mutation , Neoplasms, Experimental/drug therapy , Neoplasms, Experimental/genetics , Receptors, CXCR/genetics , beta-Arrestins/metabolismABSTRACT
We communicate the first reported application of video-assisted thoracic surgery for early repair of a postintubation tracheal laceration. The patient was a 60-year-old man. After an initial unsuccessful approach with conservative measures, surgical repair was indicated. The patient underwent 2-port video-assisted thoracic surgery for direct tracheal repair using a 3-0 resorbable monofilament running suture and two reinforcing X-stitches. Bronchoscopic control after 2 and 4 weeks showed complete restoration of the airway, with no complication.
Subject(s)
Intubation, Intratracheal/adverse effects , Thoracic Surgery, Video-Assisted/methods , Trachea/surgery , Humans , Male , Middle Aged , Trachea/injuriesABSTRACT
OBJECTIVES: Metastatic affectation of lymph node is the main prognostic factor in localized lung cancer. A pathologic study of the obtained samples, even after adequate lymphadenectomy, showed tumor relapses for 20% of stage I patients after oncological curative surgery. We evaluated the prognostic value of molecular micrometastasis in the sentinel lymph node of patients with early-stage lung cancer. PATIENTS AND METHODS: The sentinel node was marked immediately after performing thoracotomy by peritumorally injecting 0.25 mCi of nanocoloid of albumin (Nanocol1) labeled with Tc-99m in 0.3 mL. Guided by a Navigator1 gammagraphic sensor, we proceeded to its resection. The RNA of the tissue was extracted, and the presence of genes CEACAM5, BPIFA1, and CK7 in mRNA was studied. The significant association between the presence of micrometastasis, clinicopathologic characteristics, and patients' outcome was assessed. RESULTS: Eighty-nine stage I-II non-small cell lung cancer patients were included in the study. Of the 89 analyzed sentinel lymph nodes, 44 (49.4%) were positive for CK7, 24 (26.9%) for CEACAM5, and 17 (19.1%) for BPIFA1, whereas 10 (11.2%) were positive for the 3 analyzed genes. A survival analysis showed no significant relation between the presence of molecular micrometastasis in the sentinel node and patients' progression. CONCLUSIONS: The molecular analysis of the sentinel node in patients with early-stage lung cancer shows node affectation in cases staged as stage I/II by hematoxylin-eosin or an immunohistochemical analysis. However, this nodal affectation was not apparently related to patients' outcome.
ABSTRACT
El cáncer de pulmón (CP) constituye un problema de salud pública de primer orden. A pesar de los recientes avances en su tratamiento, la prevención primaria y el diagnóstico precoz son las claves para reducir su incidencia y mortalidad. Un ensayo clínico reciente demostró la eficacia del cribado selectivo con tomografía computarizada de baja dosis (TCBD) en la reducción del riesgo de muerte en personas de alto riesgo, tanto por CP como global. Este artículo recoge las reflexiones de un grupo de expertos designados por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Cirugía Torácica (SECT), la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Oncología Médica (SEOM) sobre el uso de la TCBD para el diagnóstico precoz del CP en personas con riesgo elevado de padecerlo y los pasos necesarios para evaluar su implementación en nuestro país
Lung cancer (LC) is a major public health issue. Despite recent advances in treatment, primary prevention and early diagnosis are key to reducing the incidence and mortality of this disease. A recent clinical trial demonstrated the efficacy of selective screening by low-dose computed tomography (LDCT) in reducing the risk of both lung cancer mortality and all-cause mortality in high-risk individuals. This article contains the reflections of an expert group on the use of LDCT for early diagnosis of LC in high-risk individuals, and how to evaluate its implementation in Spain. The expert group was set up by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM)
Subject(s)
Humans , Lung Neoplasms/diagnostic imaging , Tomography, X-Ray Computed/methods , Early Detection of Cancer/methods , Mass Screening/methods , Risk Factors , Survival Analysis , Smoking/adverse effects , Tobacco Use Cessation/methods , Cost-Benefit AnalysisABSTRACT
Lung cancer (LC) is a major public health issue. Despite recent advances in treatment, primary prevention and early diagnosis are key to reducing the incidence and mortality of this disease. A recent clinical trial demonstrated the efficacy of selective screening by low-dose computed tomography (LDCT) in reducing the risk of both lung cancer mortality and all-cause mortality in high-risk individuals. This article contains the reflections of an expert group on the use of LDCT for early diagnosis of LC in high-risk individuals, and how to evaluate its implementation in Spain. The expert group was set up by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM).
Subject(s)
Lung Neoplasms/diagnostic imaging , Mass Screening/methods , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Cost-Benefit Analysis , Early Detection of Cancer , Female , Humans , Lung Neoplasms/epidemiology , Male , Mass Screening/economics , Middle Aged , Practice Guidelines as Topic , Predictive Value of Tests , Quality-Adjusted Life Years , Risk , Sensitivity and Specificity , Solitary Pulmonary Nodule/diagnostic imaging , Spain/epidemiology , Tomography, X-Ray Computed/economicsABSTRACT
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Subject(s)
Humans , Female , Adult , Solitary Fibrous Tumor, Pleural/metabolism , Solitary Fibrous Tumor, Pleural/pathology , Mediastinum/pathology , Vena Cava, Superior/physiology , Pleura/metabolism , Solitary Fibrous Tumor, Pleural/complications , Solitary Fibrous Tumor, Pleural/diagnosis , Mediastinum/physiology , Vena Cava, Superior/metabolism , Pleura/pathologyABSTRACT
Actualmente los pacientes que presentan cáncer de pulmón no microcítico (CPNM) portadores de mutaciones en el gen receptor del factor de crecimiento epidérmico (EGFR) pueden recibir un tratamiento específico a partir de la detección de dicha mutación en el tejido tumoral, pues estas mutaciones se consideran un factor predictivo de eficacia al tratamiento con inhibidores de la tirosina quinasa (ITK) de EGFR (ITK-EGFR). En el presente trabajo analizamos qué características clinicopatológicas presentan mayoritariamente los pacientes con CPNM EGFR mutado en el Área de Salud de La Ribera (Comunidad Valenciana) entre marzo de 2012 y noviembre de 2014. Nuestros datos muestran una predominancia del género femenino (70%), de pacientes no fumadores (60%), mayores de 65 años (65%) y en estadio avanzado de la enfermedad (75%). Las mutaciones predominantes son la deleción en el exón 19 y la mutación L858R en el exón 21 del gen EGFR (AU)
Currently, patients suffering from non-small cell lung cancer (NSCLC) with mutations in EGFR gene (epidermal growing factor receptor) can benefit from specific treatment based on the detection of these mutations in the tumour tissue. Mutated EGFR is considered as a positive predictor factor of efficacy for EGFR tyrosine kinase inhibitor (ITK) treatment. In the present study we analyzed the predominant clinicopathological characteristics from NSCLC patients with EGFR mutations in the Health Area of La Ribera (Comunidad Valenciana, Spain) between March 2012 and November 2014. Our data show a predominance of females (70%), non-smokers (60%), and patients older than 65 (65%) and in an advanced stage of the disease (75%). Predominant detected mutations are deletion in exon 19 and L858R mutation in exon 21 in EGFR gene (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/genetics , ErbB Receptors , Receptor Protein-Tyrosine Kinases/analysis , Receptor Protein-Tyrosine Kinases , Lung Neoplasms/diagnosis , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Adenocarcinoma/classification , Adenocarcinoma/pathologyABSTRACT
INTRODUCTION: Metastatic lymph node affectation is the main prognostic factor in localized lung cancer. Pathological study of the obtained samples even after an adequate lymphadenectomy, present tumoral relapses of 40% of stage I patients after oncological curative surgery. In this paper we have studied micrometastasis in the sentinel lymph node by molecular methods in patients with stage I lung cancer. MATERIAL AND METHODS: The sentinel node was marked by injecting peritumorally performed just after performing the thoracotomy with 2 mCi of nanocoloid of albumin (Nanocol®) marked with 99mTc in 0.3 ml. Guided with a Navigator® gammagraphic sensor, we proceeded to its resection. RNA of the tissue was extracted and the presence of genes CEACAM5, PLUNC and CK7 in mRNA was studied. RESULTS: Twenty nine 29 patients were included. Of the tested genes, CEACAM5 and PLUNC were the ones that showed a high expression in lung tissue. Of the 29 analyzed sentinel lymph nodes, 7 (24%) were positive in the molecular study. A positive sentinel lymph node was found in 4/7 adenocarcinomas and 3/12 squamous-cell tumors. Affected lymph nodes were: station 5 (1/3), station 7 (0/6), station 9 (0/1); station 10 (5/11); station 11 (1/1). CONCLUSIONS: Detection of sentinel node in patients with stage I lung cancer by marking with radioisotope is a feasible technique. The application of molecular techniques shows the tumoral affectation in cases staged as stage I.
Subject(s)
Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Radiopharmaceuticals , Sentinel Lymph Node Biopsy/methods , Technetium Tc 99m Aggregated Albumin , Aged , Female , Humans , Lung Neoplasms/genetics , Male , Middle Aged , Molecular Diagnostic Techniques , Radionuclide ImagingABSTRACT
INTRODUCCIÓN: La afectación metastásica a nivel ganglionar es el principal factor pronóstico en el carcinoma pulmonar localizado. Pese al estudio anatomopatológico de las piezas obtenidas tras una adecuada linfadenectomía mediastínica, la recidiva tumoral alcanza el 40% en pacientes estadio I tras la cirugía oncológica curativa. En este trabajo hemos realizado el estudio de micrometástasis por métodos moleculares en el ganglio centinela de pacientes con carcinoma pulmonar estadio i. MATERIAL Y MÉTODOS: Marcaje del ganglio centinela mediante la inyección peritumoral de 2 mCi de nanocoloide de albúmina (Nanocol®) marcado con 99mTc en un volumen de 0,3 ml tras la toracotomía. Guiados mediante la sonda gammagráfica Navigator® se procedió a su localización y exéresis. Se extrajo ARN de los tejidos y se analizó la presencia de ARNm de los genes CEACAM5, PLUNC y CK7. RESULTADOS: Se incluyó a 29 pacientes. De los genes testados, el CEACAM5 y el PLUNC fueron los que mostraron una alta expresión en tejido pulmonar. De los 29 ganglios centinela analizados, 7 (24%) fueron positivos para estudio molecular. Se encontró ganglio centinela positivo en: 4/7 adenocarcinomas y 3/12 escamosos. Los ganglios afectos fueron: nivel 5 (1/3), nivel 7 (0/6), nivel 9 (0/1), nivel 10 (5/11), nivel 11 (1/1). CONCLUSIONES: La detección del ganglio centinela en pacientes con carcinoma pulmonar estadio I mediante marcaje con radioisótopo es factible. La aplicación de técnicas moleculares pone de manifiesto la afectación tumoral en casos estadificados como estadio I
INTRODUCTION: Metastatic lymph node affectation is the main prognostic factor in localized lung cancer. Pathological study of the obtained samples even after an adequate lymphadenectomy, present tumoral relapses of 40% of stage I patients after oncological curative surgery. In this paper we have studied micrometastasis in the sentinel lymph node by molecular methods in patients with stage I lung cancer. Material and methods The sentinel node was marked by injecting peritumorally performed just after performing the thoracotomy with 2 mCi of nanocoloid of albumin (Nanocol®) marked with 99 mTc in 0.3 ml. Guided with a Navigator® gammagraphic sensor, we proceeded to its resection. RNA of the tissue was extracted and the presence of genes CEACAM5, PLUNC and CK7 in mRNA was studied. RESULTS: Twenty-nine 29 patients were included. Of the tested genes, CEACAM5 and PLUNC were the ones that showed a high expression in lung tissue. Of the 29 analyzed sentinel lymph nodes, 7 (24%) were positive in the molecular study. A positive sentinel lymph node was found in 4/7 adenocarcinomas and 3/12 squamous-cell tumors. Affected lymph nodes were: station 5 (1/3), station 7 (0/6), station 9 (0/1); station 10 (5/11); station 11 (1/1). CONCLUSIONS: Detection of sentinel node in patients with stage I lung cancer by marking with radioisotope is a feasible technique. The application of molecular techniques shows the tumoral affectation in cases staged as stage I
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/pathology , Lung Neoplasms/pathology , Sentinel Lymph Node Biopsy , Lymphatic Metastasis/pathology , Molecular Diagnostic Techniques , RadioisotopesABSTRACT
No disponible
No disponible
Subject(s)
Humans , Female , Aged , Pneumothorax/complications , Pneumothorax/diagnosis , Pneumothorax/pathology , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/pathology , Lung Diseases/complications , Lung Diseases/diagnosis , Lung Diseases/therapySubject(s)
Mucormycosis/diagnosis , Tracheal Diseases/diagnosis , Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Bronchoscopy , Combined Modality Therapy , Diabetes Mellitus, Type 1/complications , Drainage , Female , Humans , Intraoperative Complications/etiology , Intraoperative Complications/surgery , Mucormycosis/drug therapy , Mucormycosis/surgery , Pneumonia/diagnosis , Pneumonia/drug therapy , Pneumothorax/etiology , Pneumothorax/surgery , Tracheal Diseases/drug therapy , Tracheal Diseases/surgeryABSTRACT
Endotracheal metastases (ETM) from non-lung cancer are seldom seen. Their main clinical symptoms are cough, haemoptysis and dyspnoea, although occasionally an incidental finding is made during a bronchoscopy. Breast, colon and kidney adenocarcinoma might be associated with ETM, lung cancer being the most frequent cause. Its finding is associated with advanced disease but survival will depend on the primary origin, patient status and comorbidity. Therefore, treatment should be individual for each patient. In our centre we recommend pre-surgery bronchoscopy to exclude metastatic endotracheal lesions in patients with metastatic colon adenocarcinoma disease, as this might affect the final outcome and therefore management of the disease.
