Endobronchial valve for secondary pneumothorax in a severe emphysema patient.

Secondary pneumothorax represents a challenging problem in patients with chronic obstructive pulmonary disease, due to their compromised health status. In this case, an endobronchial one-way valve was inserted in the left lower lobe by flexible bronchoscopy, resulting in a complete resolution of air leak and lung reexpansion. Endobronchial valve could represent a new option for the management of persistent air leak in patients not suitable for surgical procedures.

The surgeon and the oncologist in non-small cell lung cancer (NSCLC).

A strict collaboration is necessary between the oncologist and the surgeon, both must know the respective problematic and competences and must contribute together to all phases of clinical management of patients affected by NSCLC.

Expression of protease activated receptor-2 (PAR-2) in central airways of smokers and non-smokers.

BACKGROUND: Protease activated receptor-2 (PAR-2) is a transmembrane G protein coupled receptor preferentially activated by trypsin and tryptase. The protease activated receptors play an important role in most components of injury responses including cell proliferation, migration, matrix remodelling, and inflammation. Cigarette smoking causes an inflammatory process in the central airways, peripheral airways, lung parenchyma, and adventitia of pulmonary arteries. METHODS: To quantify the expression of PAR-2 in the central airways of smokers and non-smokers, surgical specimens obtained from 30 subjects undergoing lung resection for localised pulmonary lesions (24 with a history of cigarette smoking and six non-smoking control subjects) were examined. Central airways were immunostained with an antiserum specific for PAR-2 and PAR-2 expression was quantified using light microscopy and image analysis. RESULTS: PAR-2 expression was found in bronchial smooth muscle, epithelium, glands, and in the endothelium and smooth muscle of bronchial vessels. PAR-2 expression was similar in the central airways of smokers and non-smokers. When smokers were divided according to the presence of symptoms of chronic bronchitis and chronic airflow limitation, PAR-2 expression was increased in smooth muscle (median 3.8 (interquartile range 2.9-5.8) and 1.4 (1.07-3.4) respectively); glands (33.3 (18.2-43.8) and 16.2 (11.5-22.2), respectively); and bronchial vessels (54.2 (48.7-56.8) and 40.0 (36-40.4), respectively) of smokers with symptoms of chronic bronchitis with normal lung function compared with smokers with chronic airflow limitation (COPD), but the increase was statistically significant (p<0.005) only for bronchial vessels. CONCLUSIONS: PAR-2 is present in bronchial smooth muscle, glands, and bronchial vessels of both smokers and non-smokers. An increased expression of PAR-2 was found in bronchial vessels of patients with bronchitis compared with those with COPD.

Surgical results for multiple primary lung cancers.

OBJECTIVE: The development of a multiple primary lung cancer (MPLC) is not rare in long-term survivors after curative resections. We analysed our experience in order to verify surgical results and long-term survival in our patients. METHODS: From 1971 to 1999, 80 patients with MPLC (two tumours each, total 160) were treated at the Division of Thoracic Surgery of the University of Padua. Our criteria for the definition of a synchronous or metachronous cancer are those proposed by Martini and Melamed. We had 19 patients with a synchronous tumour and 61 patients with a metachronous tumour. We performed 95 lobectomies, 5 completion pneumonectomies and 53 segmentectomies. Of 160 MPLCs, 60 were squamous carcinomas, 78 adenocarcinomas, 8 small cell lung cancers, 9 large cell lung cancers and 5 other tumours. Of 160 MPLCs, 140 were N0 disease (87.5%) and 20 were N1 or N2 disease (12.5%). RESULTS: The overall 30-day mortality was 2.5% (2 patients). Eighteen patients (22.5%) had postoperative complications. Survival at 5 and 10 years for all patients was 72% and 58%, respectively. Five-year survival for patients with metachronous and synchronous disease from the time of initial diagnosis of cancer was 85% and 20% (P=0.001), and 10-year survival was 58% and 0% (P=0.001), respectively. Survival after the development of a metachronous lesion was 51% at 5 years and 20% at 10 years. The 5-year survival of patients with metachronous tumours undergoing standard surgical procedures of the second tumour was 52%; the 5-year survival of patients undergoing atypical or segmental resections was 55%. CONCLUSIONS: Careful follow-up is recommended in all patients surviving curative resection. More accurate selection criteria for MPLC is required. An aggressive surgical approach is justified in patients with MPLC and offers the greatest chance for long-term survival even in the case of limited resection.

A field survey of Escherichia coli O157 ecology on a cattle farm in Italy.

A field survey was performed in a heifer raising operation in Northern Italy to study the introduction, maintenance and dissemination of Escherichia coli O157 in the herd and to identify possible control measures at the farm level. Rectal swabs from two different groups of animals (surveys 1 and 2) were tested for E. coli O157 by an immunomagnetic separation technique. In survey 1, a group of female calves (341 animals initially) introduced from 30 dairy herds during April 1996 to March 1997 were tested for E. coli O157 on arrival from the original herd when housed in individual hutches, 2-3 days after completion of weaning (which was associated with grouping) and 2 months after weaning. No statistically significant difference between excretion rates (3.8%, 4.2%, 4.4%, respectively) was found. Calves from which E. coli O157 was isolated on arrival came from 6 of the 30 dairy herds. Strains isolated during survey 1 belonged to seven different pulsed field gel electrophoresis (PFGE) profiles. In survey 2, a group of young animals aged, at the beginning of the study, between 2 1/2 and 7 1/2 months (median = 124 days) was tested monthly for E. coli O157 for 11-15 months from May 1996 to July 1997. The group included 92 animals for 11 months and then gradually decreased to 59 animals. Overall, E. coli O157, belonging to six different PFGE profiles, were isolated from 138 (10.7%) of 1293 rectal swabs. Monthly excretion rates ranged from 2.7% to 23.7%, with summer peaks in both years. Fifty-nine (64.1%) of the 92 heifers were positive at least once: of these 59 animals, 22 (37.3%) were positive on only one occasion, 23 (39%) were positive on two occasions and 14 (23.7%) were positive on three or more occasions. From two heifers positive on 9 out of the 15 sampling visits, strains with the same PFGE profile were isolated, respectively, on seven and eight occasions while strains with only one band difference were isolated on the remaining occasions. E. coli O157 was also isolated from 6 of 16 samples of bedding, two of two samples of slurry and one of five samples from water troughs collected during survey 2.

Detection of equine arteritis virus in semen by reverse transcriptase polymerase chain reaction-ELISA.

The reverse transcriptase polymerase chain reaction (RT-PCR) assay was used to detect Equine Arteritis Virus (EAV) in the semen of 88 horses and 2 donkeys, with neutralising antibodies against EAV, on the basis of the amplification of a 279 bp long fragment located in the viral polymerase gene. The RT-PCR assay revealed the virus at 4 TCID50/ml in cell culture and showed a greater sensitivity (54.4%) than cell culture isolation (33.3%). Moreover, the two samples of donkey semen were found positive. The cDNAs obtained from 14 samples of horse and 2 of donkey semen were sequenced. Comparing the sequence of reference strain Bucyrus, the analysed samples were 78-100% identical and showed a 84-97% nucleotide identity with Bucyrus isolate. The results demonstrate high levels of genomic heterogeneity among the extracted RNAs, but inside the fragment amplified a well-preserved region of 24 bp was found with only three mismatches in some samples, suggesting that this could be ideal as a probe for RT-PCR-ELISA. The RT-PCR-ELISA assay using the EAV 7 and 8 primer set, has proved to be sensitive, specific and above all directly applicable to semen. Additionally, the short time needed for the overall procedure makes this method suitable for diagnostic purposes.

Isolation and characterization of Aujeszky's disease virus in captive brown bears from Italy.

An epizootic of Aujeszky's disease (pseudorabies) in four captive European brown bears (Ursus arctos) in November 1994, in the Val di Non, Trentino Region, Italy, was linked to consumption of raw pork. Affected animals had severe pruritus resulting in self-mutilation, and all four died within 24 hr after onset of clinical signs. Aujeszky's disease virus was isolated on first passage from the brain and was characterized by means of restriction endonuclease analysis. Based on these data, we believe that bears are extremely susceptible to the disease, and that wildlife managers should consider pseudorabies as a potential risk for the captive and wild bear populations.

Atypical strains of verocytotoxin-producing Escherichia coli O157 in beef cattle at slaughter in Veneto region, Italy.

Cattle arriving for slaughter at abattoirs in the Veneto region of N. Italy were examined for intestinal carriage of Escherichia coli O157. Rectal swabs were cultured in modified buffered peptone water and E. coli O157 was concentrated by an immunomagnetic separation technique; the magnetic beads were cultured onto cefixime tellurite sorbitol MacConkey agar. Sorbitol non-fermenting E. coli O157 was isolated from 15 (3.6%) of 419 feedlot cattle but not from 437 veal calves or 65 culled cows. All strains of E. coli O157 hybridized with DNA probes specific for the VT1 or VT2 genes, but two strains did not produce toxin detectable by Vero cell assay. Six different plasmid profiles were observed with all strains harbouring the large 93 kb plasmid characteristic of VTEC. Six strains produced urease but otherwise strains were biochemically typical of E. coli O157. One strain was resistant to streptomycin, tetracycline and sulphonamides but the remainder were sensitive to all antimicrobials tested. This is the first description of the isolation of verocytotoxin-producing E. coli O157 from cattle in Italy. As the contamination of bovine carcasses with E. coli O157 during slaughter and processing has been demonstrated, the risk of transmission of this organism from beef cattle to the human population in the Veneto region, through foods of bovine origin or by other routes, should not be overlooked.

Pancreatic cancer and retroperitoneal neural tissue invasion. Its implication for survival following radical surgery.

To analyze the implication of retroperitoneal perineural lymphatic infiltration (rpli) for the survival of patients affected by exocrine pancreatic cancer, we considered 17 cases which underwent radical resection at our Institute from 1980 to 1993. Histology of specimens showed an rpli in 15 cases, without any correlation between this anatomopathologic aspect and the neoplasm size or the presence of lymph node metastases. The 2 patients without rpli are both alive and have been free from disease during a follow-up period of more than 5 years. In the group of 15 patients with positive rpli, 3 (21.4%) have remained free from disease (2 alive and 1 dead for other reason). Eleven remained with disease (1 is alive and 10 have died). One died in the postoperative period and could not be included in the evaluation. These observations have led the surgeon to consider the necessity, during resection, of an accurate dissection not only of the regional lymph nodes but also of the retropancreatic tissue and the neural structures present in this area. This approach may lead to a more correct staging of the neoplasia, a better radical surgery and perhaps a longer survival. Moreover it may represent an important marker for an adjuvant protocol of chemotherapy and/or radiotherapy.

Implication of laparoscopy and peritoneal cytology in the staging of early pancreatic cancer.

Staging of pancreatic cancer still represents a challenge for surgeons involved in this field. Diagnostic methods of radiological imaging used routinely (CT, NMR, angiography) may understage this neoplasm. In fact, the presence of peritoneal or subglissonian hepatic micrometastases (< 2 cm) is a frequent surprise at laparotomy and forces the surgeon to use a palliative procedure. Actually this policy has not to be followed because the possibility to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and celiac alcoholization. In this viewpoint, preoperative staging has acquired an important role for a correct treatment, be it surgical or medical. Laparoscopy allows it to overcome the understaging produced by the more common diagnostic means, with the possibility to view directly the celomatic space and the surface of the abdominal viscera; moreover, during this procedure it is possible to perform a peritoneal washing to obtain other information about the cancer stage. In our experience, 56 patients were judged as resectable by radiologic methods; 31 were excluded from surgery by laparoscopy; 10 of the remaining 25 cases were submitted to radical resection. The operative resectability rate resulted in 40%, against 18% in cases where we submitted to surgery all the patients. Seven patients underwent peritoneal washing, always with a negative result; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal washing represent useful tools in the staging of patients affected by pancreatic cancer.

[The role of laparoscopy and peritoneal cytology in the preoperative staging of pancreatic carcinoma]. / Il ruolo della laparoscopia e della citologia peritoneale nella stadiazione pre-operatoria del carcinoma pancreatico.

The staging of pancreatic cancer still represents a challenge for surgeons involved in this field; radiological diagnostic methods used routinely (CT, NMR, angiography) may under-estimate this neoplasm; in fact, the presence of peritoneal or subglissonian hepatic micrometastasis (< 2 cm) is a frequent surprise at laparotomy and force the surgeon to undertake a palliative procedure. This policy need not be followed because it is possible to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and coeliac alcoholisation. Pre-operative staging thus acquires an important role in the correct treatment, surgical or medical. Laparoscopy allows us to overcome the understaging of the more common diagnostic methods and view directly the coelomatic space and the surface of the abdominal viscera; moreover during this procedure it is possible to perform a peritoneal wash to obtain other information on the cancer stage. We judged 56 patients by radiological diagnosis; 31 were excluded from surgery by laparoscopy; 10 of the other 25 cases were submitted to radical resection. The resectability operative rate was 40%, compared with 18% if we had submitted patients to surgery. Several patients underwent peritoneal wash, always with negative results; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal wash represent useful tools in the staging of patients affected with pancreatic cancer.

Research on the presence of porcine enterovirus serotype 1 in north-eastern Italy.

The liquid-phase blocking sandwich ELISA, already developed for foot-and-mouth disease and swine vesicular disease serology, has been employed in pig sera for the antibody detection against porcine enterovirus serotype 1. ELISA-titers correlate positively with virus neutralization and their distribution show a high prevalence among the sampled pigs. The serological findings are confirmed by the isolation of a field strain of porcine enterovirus belonging to the serotype 1.