First description of a mortality event in adult Pacific oysters in Italy associated with infection by a Tenacibaculum soleae strain.

Summer mortality episodes in adult Pacific oysters have been described since the 1950s in various farming areas. Starting in 2012, a recrudescence of mortalities in commercial-sized oysters was first observed in France and then in Italy, with seasonality extension and translation later in the year. Moribund individuals collected during an event in Italy in December 2014 showed yellowish lesions of the mantle and adductor muscle. Histological examination revealed filamentous bacteria associated with necrotic areas. Quantitative PCRs targeting OsHV-1 and Vibrio aestuarianus detected only high loads of the pathogenic bacteria in tissues of symptomatic individuals. A lower diversity of the hemolymph microbiota was also evidenced in moribund individuals, with a predominance of Vibrio and Arcobacter species. A strain of Flavobacteriaceae was isolated from all the symptomatic individuals. Sequence analysis of the 16S rRNA gene identified the strain as Tenacibaculum soleae. When strain pathogenicity was tested by injection in adult individuals, it induced mortality rates of up to 45%, even in the absence of V. aestuarianus. As mortality occurred only 11 days post-infection, further investigation is needed to determine its effective virulence in natural conditions. This is the first description of a Tenacibaculum strain associated with bivalve mortalities.

Adrenal tuberculosis masquerading as disseminated malignancy: A pitfall of (18)F-FDG PET/CT Imaging.

Non-invasive characterization of adrenal lesions is a commonly encountered diagnostic challenge. Characteristic clinical and correlative imaging findings may assist in only arriving at a probable diagnosis. Currently, (18)F-FDG PET/CT is considered to provide the most comprehensive imaging information. We here present a case of bilateral adrenal tuberculosis that highlights the need for caution during the interpretation of (18)F-FDG PET/CT and also the need to suggest histopathological correlation.

Home-management of malignant pleural effusion with an indwelling pleural catheter: ten years experience.

BACKGROUND: More than one half of patients with cancer have a malignant pleural effusion (MPE) at some time during their life span. Recurrent malignant pleural effusions impair respiratory functions and worsen the quality of life. Once a patient develops MPE, only fluid drainage relieves pulmonary compression and dyspnea. Optimal treatment is however, still controversial. In patients not suitable for pleurodesis, or with recurrent MPE after pleurodesis, or with trapped lung, the outpatient intermittent drainage through a subcutaneous tunneled indwelling pleural catheter (IPC) is a possible choice. METHODS: In ten years, we treated 90 patients by outpatient insertion of IPC. Eligibility for IPC required previous thoracentesis with histological confirmation of malignancy and chest roentgenogram evidence of effusion. All patients treated were made aware of their malignancy and positive cytology in the pleural effusion. RESULTS: Mean survival was 197 days (range 23-296 days). Median time of draining interval was 7.0 days with maximum amount of effusion drained off being 1000 ml. Pleurodesis occurred in 37 (41.1%) patients with a mean time of pleurodesis of 51 days (range 34-78 days). No major complication was recorded. CONCLUSIONS: The IPC is a useful device in the management of recurrent MPE. Treatment can be entirely accomplished at home and the complication rate is low.

[Lung resection after pneumonectomy for bronchogenic carcinoma]. / Resezioni polmonari dopo pneumonectomia per carcinoma broncogeno.

METHODS: Four patients who previously underwent pneumonectomy for lung cancer, underwent a new contralateral resection for a metachronous cancer. Functional evaluation of these patients was not different from the standard one and included ECG, spirometry, blood gas analysis and a careful clinical evaluation. A femoro-femoral bypass was used in 2 patients to work on a collapsed lung, High Frequency Jet Ventilation was used in 1 while the last patient was hyperoxygenated and then ventilation was discontinued for the time required for the resections. RESULTS: Each method was free of complications. Operative mortality was nil. Two patients are alive free of disease at 66 and 14 months, two died for metastatic disease at 4 (N2 paratracheal nodes) and 12 months. CONCLUSIONS: Patients with a single lung should not be denied a further resection on contralateral lung. A routine evaluation of cardiopulmonary function may be sufficient but a more sophisticated evaluation including exercise oxygen consumption test, cardiac catheterization, lung perfusion scan, should be used when there is some doubt on the possibility of the patients to sustain the resection. Due to the high operative risk of this kind of patients mediastinoscopy should be performed even if preoperative CT scan of the chest shows minimally enlarged mediastinal nodes.

Lung resection on single residual lung after pneumonectomy for bronchogenic carcinoma.

Seven patients who had undergone a pneumonectomy for lung cancer developed a second tumor in the remaining lung after a mean time of 28.5 months and underwent a further resection. Preoperative evaluation was based on standard functional tests and on the "stair climbing test". Three patients were operated on using an extracorporeal oxygenator to work on a collapsed lung, three using standard anesthesiologic techniques, and one using high-frequency jet ventilation. There was no operative mortality. Complications occurred in two patients, requiring a temporary tracheostomy in one case. No patient required home oxygen supplementation. Four patients died of metastatic disease after 4, 8, 10, and 12 months, while two patients are alive and free of disease after 83 and 9 months, one is alive and free of symptoms but with a local recurrence after 29 months. Lung resection for bronchogenic carcinoma on a single lung can be safely performed provided that careful clinical judgment is used; long-term survival can be achieved with the resection of the new tumor.

Endobronchial extramedullary plasmacytoma. Report of one case.

A patient underwent a subtotal resection of the tracheobronchial carina for an obstructing endobronchial lesion. Preoperative biopsies of the lesion were not diagnostic. After resection, the histological examination of the specimen removed demonstrated an extramedullary plasmacytoma infiltrating the bronchial wall. Immunohistochemical studies showed monoclonality for kappa light chains. The postoperative course was uneventful and the screening for multiple myeloma was negative. No adjuvant treatment was given and the patient is currently alive and free of disease 63 months after the resection. Primary endobronchial plasmacytoma is a very rare disease: it is unclear which is the best treatment for endobronchial plasmacytoma. However, complete surgical resection has allowed a long-term survival, free of disease.

Left pneumonectomy for a second primary tumor after right upper lobectomy for superior sulcus tumor.

We report on a patient who underwent a left pneumonectomy for a second primary lung cancer after a right upper lobectomy and upper chest wall resection for a superior sulcus tumor. Although the postoperative course was complicated by sputum retention which required a temporary tracheostomy the outcome was good and the patient is now living without supplementary oxygen supply. Left pneumonectomy may be considered in patients with previous contralateral lobectomy when the preoperative evaluation of the patient shows an acceptable predicted postoperative pulmonary function. A long-term cure and a good quality of life must, however, be offered.

[Pulmonary carcinoid tumors]. / I tumori carcinoidi polmonari.

27 patients suffering from carcinoid of the lung (18 females and 9 males, middle age 52 years, range 26-68) underwent surgery in our department. The neoplasms were located at the pulmonary hilum in 21 cases. The diagnosis was occasional in 6 cases, cough (51.8%) and recurrent bronchitis (37%) were the most frequent symptoms. No instances of carcinoid syndrome were detected. Preoperative staging ruled out pathologic mediastinal lymph nodes or hematogenous metastases. 26 patients underwent complete excision of the neoplasm (11 lobectomies, 9 pneumonectomies, 4 bilobectomies, 1 segmental resection, 1 bronchial wedge resection). Histologically, 4 cases were categorized as atypical carcinoids. Two patients died within 1 year, one suffering from atypical carcinoid because of disease progression, and an other one (suffering from atypical carcinoid) who underwent only at exploratory thoracotomy followed by chemotherapy. A patient suffering from typical carcinoid died within 1.5 years because of gallbladder carcinoma. From our experience and from the literature review it appears that carcinoids has to be considered as malignant neoplasms and treated according to.

[Iatrogenic rupture of the esophagus: presentation of several cases]. / Le rotture iatrogeniche dell'esofago: presentazione di alcuni casi.

Four cases of iatrogenic rupture of the oesophagus are presented. The site of the lesion was in the cervical tract in 1 case and in the thoracic tract in the other 3 cases. Their etiology was pneumatic endoscopic dilatation for achalasia in 2 cases, endoscopic insertion of a Celestin tube for carcinoma of the thoracic tract of the oesophagus in 1 case, and diagnostic endoscopy in the last one. Instrumental findings were relevant in all cases. All patients underwent surgery. In the patients suffering from achalasia, the rupture was repaired by a patch of the gastric fundus. The patient suffering from carcinoma underwent an oesophageal resection, the one with cervical perforation underwent a mediastinal drainage. There were no deaths or considerable post operating complications. In a patient suffering from achalasia gastro-oesophageal reflux was demonstrated after some months following the operation.

[Primary germinal tumors of the mediastinum: our experience in 9 cases]. / I tumori germinali primitivi del mediastino: nostra esperienza in nove casi.

9 patients (8 males 1 female, middle age 24.3 years, range 20-41) affected by primary mediastinal germ cell tumor were surgically treated in our department. They were 4 seminomas, 2 embryonal carcinomas, 1 malignant teratoma and 2 benign teratomas. Three patients were asymptomatic; cough, dyspnea and chest pain were the most frequently observed symptoms. The staging work-up did not show signs of metastatic disease in the malignant types. Benign teratomas underwent complete excision. In one patient suffering from seminoma radiotherapy and chemotherapy caused complete remission of the disease. In the others cases remission of the neoplasm was obtained by resection and adjuvant therapy in 3 cases, by neoadjuvant treatment and excision of the residual mass in 3 cases. Among the patients suffering from seminoma, 2 are dead at 60 months since initial treatment and 2 are alive at 132 and 120 months respectively. Among the patients with malignant nonseminomatous tumours, 2 are alive at 60 and 36 months and 1 patient is dead at 13 months. Two patients with benign teratoma are alive at 189 and 168 months respectively. At present a multimodality treatment including surgery, radiotherapy and cisplatin-based combination chemotherapy, give the most satisfactory results in the treatment of malignant mediastinal germ cell tumours.

[Thoracoplasty today. Review of a technique of the past]. / La toracoplastica oggi. Rivisitazione di una tecnica del passato.

Thoracoplastic operations had ruled the field in the past as treatment of choice in the surgical antituberculous collapse therapy; they have had a notable revival during the last years as an efficient therapeutic modality in the treatment of chronic empyemas of the most various etiologies. They are thoracoplasties done with particular modalities, imposing, setting out case by case to suppress the infected pleural space. It is usually joined with a thoracotomy and it permits also the execution of other surgical intrathoracic manoeuvres such as decortications, treatment of fistulas, myoplasties. Situations such as chronic empyemas, without any solution before, have found a brilliant solution by the use of this operation.

[Surgical resection for pancreatic neoplasms in the past 20 years]. / La chirurgia resettiva per neoplasie pancreatiche negli ultimi venti anni.

Over the last 20 years there has been substantial progress in histopathological and biological understanding of pancreatic tumours. This has allowed surgical removal to be planned according to the aggressiveness and natural history of the tumours with benign (cystoadenomas, insulinomas) or low grade tumours (borderline mucin producing tumours, cystic papillary tumours), the trend towards cost effective surgery (conservative pancreatectomy) may be linked to the neighbouring organs (spleen, stomach, duodenum) in an attempt to bring about more rapid functional recovery for the patient and an improvement in the quality of life. On the other hand, the drastic reduction in operative mortality, which is currently less than 5% of cases following duodeno-pancreatectomy, has encouraged a more aggressive surgical technique in order to increase radical resectability for malignant tumours. Moreover, for highly malignant tumours such as ductal adenocarcinoma, the role of pancreatic resection for palliative purposes, in order to improve the quality of life with an acceptable operative risk, has been confirmed. It is foreseeable that as a result of a more accurate selection and grading of patients for surgery, there may in the future be improvements in survival even in those patients operated on for ductal adenocarcinoma. Until now, these patients have received no significant benefit from the undoubted progress achieved in diagnostic and operative techniques.

[Thoracoscopy in the diagnosis of pleural mesothelioma]. / La toracoscopia nella diagnostica del mesotelioma pleurico.

The Authors assess the results of thoracoscopy in 21 cases of pleural mesothelioma observed over the period from 1982 to 1991. The procedure yielded a correct diagnosis in 18 cases (in 2 cases, CTM due to adenoma at cytology allowed histological definition of the tumour). In 3 cases, thoracoscopy failed to detect the tumour, which was confirmed at a later stage. This type of investigation is indicated for the diagnosis of all pleural diseases and, in particular, for diagnosing mesothelioma (reliability in our series: 85.7%).

[Thoracoscopy in the staging of tumors of the lung]. / La toracoscopia nella stadiazione dei tumori del polmone.

The Authors review the results of thoracoscopy in 15 cases of pleural effusions concomitant with tumours of the lungs. In addition to defining the aetiology of the pleural effusion, the investigation completes the staging of the malignancy and affords both the possibility of reducing the number of exploratory thoracotomies and of resolving a number of cases at exeresis.