NEUROENDOCRINE TUMORS OF THE LUNG WITH SURGICAL RESECTION AND LYMPH NODE DISSECTION IN A TERTIARY THORACIC SURGERY CENTER.

CONTEXT: Management of neuroendocrine tumors is highly dynamic, in both diagnosis and treatment. OBJECTIVE: Surgical resection with lymph node approach offers excellent 5-years survival. DESIGN: Between 2008 and 2011 we operated with radical intent 326 lung cancers. PATIENTS AND METHODS: Cases without lymph node approach were excluded. We found 38 neuroendocrine malignancies: 12 typical carcinoids, 3 atypical carcinoids, 4 large cell neuroendocrine carcinomas (LCNEC) and 10 small-cell lung cancers (SCLC). Limits of the study are: variable lymphadenectomy technique; absence of PET - CT and EBUS-TBNA (EndoBronchial UltraSound - TransBronchial Needle Aspiration) for staging; incomplete data for disease-free survival. RESULTS: We performed 13 pneumonectomies, 22 lobectomies and 3 non-anatomical resections. There were 5 bronchoplasties. The 5-year survival difference between NSCLC (non-small-cell lung cancer - 42.9%) and SCLC (40.53% - one of the best from the literature) is not statistically significant (p=0.4780). Five-years survival was 100% for typical and atypical carcinoids - the best published. We found lymph node metastasis in 2 typical carcinoids, in 2 atypical carcinoids and in 6 SCLCs. CONCLUSIONS: For typical and atypical carcinoids, radical resection with lymphadenectomy offers 100% 5-years survival. Early-stage SCLC may benefit from radical resection; lymph node dissection is mandatory because of the well-known precocious lymphatic dissemination.

Microbiologic Safety of the Transareolar Approach in Breast Augmentation.

BACKGROUND: In aesthetic breast augmentation, especially by the transareolar approach, there is increasing concern regarding the occurrence of capsular contracture and its potential correlation with intraoperative implant contamination from putative endogenous breast flora of the nipple and lactiferous ducts. However, detectable bacteria cannot be considered synonymous with established resident microflora. OBJECTIVES: The authors sought to elucidate the existence of endogenous breast flora and assess the microbiologic safety of transareolar breast augmentation. METHODS: In this prospective study (BREAST-MF), the authors collected microbiologic samples from the breast skin, ductal tissue, and parenchyma of 39 consecutive female patients who underwent breast procedures in a plastic surgery clinic. Swabs collected pre-, intra-, and postoperatively were processed for bacterial and fungal growth. Positive cultures underwent identification through VITEK and MALDI-TOF, as well as antimicrobial susceptibility testing. RESULTS: Staphylococcus species accounted for 95 of 106 (89.6%) positive results from native breast skin, 15 of 18 (83.3%) positive results from decontaminated breast skin, and 4 of 4 (100%) positive results from the breast parenchyma. Methicillin resistance was present in 26.4% of S. epidermidis, 25.3% of S. hominis, and 71.4% of S. haemolyticus strains. CONCLUSIONS: During transareolar breast augmentation, in the nipple-areola region it is more likely to find bacteria populating the skin, rather than endogenous breast flora, as previously considered. Appropriate preoperative decontamination is essential for minimizing the risk of postoperative infections. LEVEL OF EVIDENCE 3: Risk.

Are HMGB1 protein expression and secretion markers of upper airways inflammatory diseases?

Taking into account the mechanisms at the origin of the airways inflammatory pathologies, our attention has been recently addressed to the study of HMGB1, a protein belonging to the group of alarmins. Alarmins are those molecules which in homeostatic conditions carry out specific metabolic and/or structural functions; furthermore, after a direct trauma or an infection, these molecules are released in the extracellular milieu becoming there activators of the innate immunity and powerful inflammatory factors. In a previous research we found in patients affected with chronic rhinosinusitis with/without nasal polyposis (CRSwNP) an increased expression of this protein in the nucleus of nasal mucosa epithelial cells. HMGB1 was overexpressed also as focal subepithelial infiltration and in the inflammatory cells of patients in comparison with controls. These results suggested a possible pathogenetic role of HMGB1 in CRSwNP. The aim of the present study was to investigate if the expression and localization (nuclear, cytoplasmic and extracellular) of the HMGB1 protein-cytokine is somehow related to the severity and complexity of the histological and clinical picture. We noticed values which have around statistical significance between nuclear HMGB1 and eosinophils infiltrate (p=0.0607) and between nuclear HMGB1 and inflammatory infiltrate (P=0.0524). Even more significant was the correlation between extra-cellular HMGB1 expression and the presence of allergic-hyper reactive conditions such as asthma, allergic rhinitis, NSADs intolerance, antibiotic allergy. HMGB1 was significantly more expressed in the nucleus (p=0.0499) and in the intercellular space (p=0.0380) in allergic patients than in non-allergic subjects and as extra-cellular infiltrate in patients with NSADs intolerance (p=0.0022). These results confirm the role of HMGB1 in the pathogenesis of chronic rhinosinusitis with/without nasal polyposis; besides the higher extra-cellular expression in patients with a more severe clinical and inflammatory picture and the presence of associated co-morbidities suggests to seek for new compounds: these compounds, decreasing the extra-cellular release of this alarmin through a scavenger mechanism, could keep under control the inflammatory process without interfering with the nuclear transcriptional messengers.

[The role of clivarin in the preventive therapy of thromboembolism]. / Rolul Clivarinului în terapia preventiva a bolii tromboembolice.

UNLABELLED: Our paper represents a synopsis of the main mechanisms by which low-molecular-weight heparins act as pharmacodynamic stabilizing factors of the liquid coagulation balance, in the postoperative period. Today we note three main phases in the coagulation mechanism: 1. partial thrombin activation; 2. positive thrombin-mediated feedback; 3. explosive thrombin formation. Low-molecular-weight heparins (Clivarine-mean molecular weight = 3900 D) act as selective inhibitors an factor X a (anti-thrombotic action), and as weak inhibitors on factor II a. The authors' experience includes 321 patients, who received Clivarin as preventive therapy for thromboembolic disease. Most of the selected patients are included in groups 2 and 3 for thromboembolic risk--and have undergone general surgery and oncological surgery. The dosage and duration of the treatment have been the usual ones. The main clinical observations we noted are: 1. excellent tolerability of Clivarine; 2. no modifications of usual biological values; 3. no adverse reactions were noted. There were no deleterious interferences between Clivarine and the usual postoperative medication of the surgical patient, 4. among the incidents, we note 12 postinjection haematomas, which were spontaneously cured. CONCLUSIONS: Low-molecular-weight heparins are considered today drugs of election in the medical and surgical thrombosis prophylaxis.

[Intra-anesthetic hypothermia]. / Hipotermia intraanestezica.

Oesophageal temperature was recorded after induction of anesthesia, and further, at one, two and three hours. Temperature in the operation hall was continuously monitored. In relation to the temperature in the operating hall the effects on the patient were of three kinds: 1. operating halls with low temperatures (under 21 degrees C) where all the patients become hypothermic; 2. operating halls with an intermediate temperature (21-24 degrees C), where 67% of the patients remain normothermic; 3. operating halls with high temperatures (above 24 degrees C) where all the patients remain normothermic, although these temperatures are uncomfortable for the medical personnel, and increase the septic risk of the patient. When the oesophageal temperature of the patients falls by 0.5 degrees C chills will occur in 40% of the patients. Thermal falls of less than 0.5 degrees C will also determine chills but in only 10.5% of the cases. Immediate postanesthesia chills are also recorded in normothermic patients, but there is a direct relationship between the temperature in the operating hall, the degree of hypothermia and the frequency of chills, while the site of the surgery or the duration of the operation have but an unsignificant influence on intra-anesthetic temperature.

[The efficacy of Macronil in treating acute respiratory infections in children 0 to 5 years old]. / Eficienta produsului Macronil în tratarea infectiilor respiratorii acute, la copii de 0-5 ani.

The authors followed the efficiency of product Macronil in association with the usual (antibiotic and symptomatic) treatments in acute, viral respiratory infections in 62 children, 0-5 years old, admitted into hospital. Besides the usual treatment (25 cases--control group) Macronil was administered in 37 cases (experimental group). A significant improvement was found in clinical evolution (duration of disease evolution, improvement of general state, good appetite, fever duration, increase in weight) of the experimental group versus the control group. An important reduction (twice) of the pharyngeal viral population appeared in the experimental group treated with Macronil. In the control group, the viral flora, remained, practically, the same after treatment.

[Anesthesiologic aspects of surgical interventions in patients with liver diseases]. / Aspecte anesteziologice în interventii chirurgicale la bolnavul hepatic.

The authors review the anesthesiology problems in hepatic patients on the one hand, and on the other hand they present their personal experience in anesthesia of patients with jaundice, upper digestive haemorrhage and hepatic coma. The conclusions of the study are the following: 1. The major hepatic functions which can interfere with anesthetic drugs and techniques are related to changes in the hepatic blood flow, the synthesis of proteins, homeostasis of carbohydrates, and especially the metabolization of medicinal drugs. 2. Hepatic patients presenting with jaundice, upper digestive haemorrhage, and hepatic coma raise special problems concerning preoperative preparations and anesthetic technique. Considering the risk factors which occur in the patient with jaundice denutrition, hypoalbuminemia and partially angiocholitis can be corrected by medical means. Hemostasis on hepatic patients with upper digestive haemorrhage is the most difficult problem, and also very controversial. There are not, at present, either infallible solutions or arguments in favor of hemostatic techniques (by compression, endoscopic haemostasis, or surgical hemostasis). The comatose patient is usually the final evolutive stage of the hepatic disease, and the mortality in this category of patients, indifferent of the therapy, is higher than 80%.

[Effects of treatment with Macronil on the viral population of the pharynx in 0- to 5-year-old children with acute respiratory infections]. / Etude des effets du traitement au Macronil sur la population virale pharyngienne chez des enfants âgés de 0 à 5 ans, souffrant d'infections respiratoires aiguës.

Macronil (a concentrated proteic extract from mackerel) associated to usual therapeutics (antibiotics, antipyretics, vitamins) in children aged 0-5 years, with acute respiratory infections led to a reduction of the viral pharyngeal population as detected by immunofluorescence (IF) technics. The IF positivity rate in children receiving Macronil was half as high as in controls receiving only the usual therapeutics. At the same time, the number of virus species detected in the pharynx of Macronil treated children was lower than in controls in which the viral pharyngeal population was not influenced in any way by the administered therapeutics without Macronil.

Ultrarapid induction.

We report 250 rapid induction anesthesias performed for the purpose of preventing regurgitation and vomiting in patients with full stomach. The anesthetic technique includes administration of morphine 20 mg and droperidol 5 mg intravenously 10-15 minutes before induction, a voluntary air hyperventilation at the anesthetist's command, during which induction drugs are introduced and an induction with a mixture containing suxamethonium 2 mg/kg and thiopentone 1.4 mg/kg, administered within 1-2 seconds. Eighteen seconds after the onset of injection the loss of lid reflex is observed followed 7 seconds later by masseter muscle relaxation. Within the following 5-10 seconds intubation is carried out in full fasciculation process, before cardia relaxation. With this technique, a mean intubation time of 35 seconds is achieved. The interval of maximum regurgitation risk is lowered to 15 seconds, so that ventilation by mask and cricoid pressure are no more necessary. The technique is indicated in the young and vigorous adult and contraindicated in the old and tainted patient, in coronary patients, in those with low heart output and slowing of circulation.

Stress ulcers in intensive care (etiology, symptomatology and therapy).

The authors present a group of 48 patients with stress ulcers (36 men, 13 women) average age 56.2 years. The analysis of the cases allowed to establish, for the first time in medical literature, a correlation between the etiology, the symptomatology and the moment of onset of the haemorrhage, with important practical implications in the adoption of a treatment regime. These considerations permitted us to delineate four categories of stress ulcers: The first category included stress ulcers caused by a cerebral lesion and manifested through cerebral hypertension. The upper digestive haemorrhage occurred within 24-48 h after the aggression and required the correction of the cerebral hypertension and of the anaemia. The second category comprised stress ulcers brought about by a hypovolaemic shock through myocardial infarction, burns, frost-bite and multiple traumas. Haemorrhage in the upper digestive tract appeared within 3-6 days after the moment of aggression and required surgical control unless it was caused by myocardial infarction. The third category was represented by post-operative stress ulcers. These forms occurred usually late, between the eighth and the thirty-seventh day after the aggression, and were due to the super-imposition of the septicaemia on the post-aggressive systemic reaction. The chief aim of treatment here was the surgical control of infection. The fourth category encompassed the stress ulcers occurring after protracted coma, especially in patients with ventilatory assistance. In these conditions, the ulcers of the digestive tract and the consequent haemorrhage represented terminal elements of irreversible diseases, in which no treatment was effective.

[Electronographic changes in general anesthesia]. / Modificari electronografice în anestezia generala.

Using the electronograph, a special device which is capable to record luminous effects of the Corona and Kirlian types, the authors investigated 9 patients (6 males and 3 females) both before and during anesthetic sleep, and after arousal from anesthesia. In all the patients the studies were made on black-and-white, as well as on colour films.