The Case for Pulmonary Metastasectomy-Clinical Practice Narrative Review and Commentary.

Pulmonary metastasectomy has become a well-established procedure for patients with certain types of solid tumors. Patients are usually scheduled for staged lung metastasectomy in case of primary tumor control, the absence of distant non-lung metastases, and when complete resection is achievable. Nodules are removed with precision resection in order to ensure radical resection with minimal margins; this technique permits good oncological results, preserving the surrounding pulmonary parenchyma and causing minimal distortion compared to staplers. When possible, anatomical resections should be avoided since they are not justified by real oncological advantages and, in the majority of cases, sacrifice too much healthy tissue, possibly leading to inoperability in the case of metachronous relapses. Thus, preserving the maximum amount of pulmonary parenchyma is crucial because repeated metastasectomies are possible and frequent, with no theoretical limits to the number of reinterventions. In our multidisciplinary board team, we support the role of pulmonary metastasectomy as a useful curative therapy, with acceptable morbidity and mortality, with indications to be discussed case-by-case.

Diffuse alveolar hemorrhage due to valproic acid: Case report and review of the literature.

Valproic acid (VPA) is one of the most frequently used antiepileptic drugs for the treatment of focal and generalized epilepsies, absence seizures, and Lennox-Gastaut syndrome (LGS). VPA has been demonstrated to have a negative effect on both the intrinsic and extrinsic coagulation systems and controversy exists about the clinical relevance of such hematological abnormalities. We describe a case of reversible lung hemorrage due to VPA. In English-language literature only two other similar cases (one of which fatal) have been described so far.

Nerve-sparing schwannoma removal from two infrequent origins.

Schwannomas of nerve sheath origin (Schwann cell) are the most common neurogenic thoracic tumors and they usually originate from an intercostal nerve, especially in the paravertebral region. Tumors that originate from other nerves such as the phrenic nerve, vagus, or sympathetic nerves are uncommon. We report two cases of schwannomas in rare locations. A 62-year-old woman had a giant schwannoma arising from the right phrenic nerve, and a 57-year-old woman had one from the left sympathetic nerve. Both tumors were completely removed with preservation of the nerves.

Tuberculosis a disease that created and shaped thoracic surgery.

Today it is incredible to think that an infectious disease, Tuberculosis (TB) as the disease that shaped Thoracic Surgery. The history of TB has so far evolved similarities with that of the mythological Phoenix, where the resurgence of this never completely eradicated "Insidious Disease" has now re-emerged and brought new challenges to modern medicine that of multi drug resistance. The probability of success, in treating complicated multi-drug resistant (MDR) TB pushing us back to the pre-antibiotic era, now depends on several factors: (I) optimal antibiotic management; (II) patient compliance; (III) multi-disciplinary teamwork; (IV) experience in carrying out "not-routine" surgical procedures; and finally (V) ability to offer long term patient hospitalization, frequently months, without bureaucratic and economical problems. The probability of good patient outcome is higher when all of these criteria are satisfied.

"Roman Sandal" modified method for securing the chest drain to the skin.

Chest drain insertion is a simple procedure with very low morbidity and mortality. The correct procedure provides for a good fixation of the drainage to the skin. An alternative "Roman Sandal technique" for securing the chest drain to the skin is proposed compared to the classical methods. The main feature of the method is the fact that a single suture acts as "tube fixing" and "wound closure" by creating an alpha-cross-wires into and around the wound. The new method is presented as more elegant, effective, quicker application and removal of the drainage and excellent cosmetic results.