Spontaneous pneumomediastinum: experience in 18 adult patients.

Spontaneous pneumomediastinum (SPM) is defined as the presence of air in the mediastinum, developing in the absence of traumatic, iatrogenic, or preceding pulmonary pathologies (emphysema, chronic bronchitis, and lung cancer). The aim of this study was to review our experiences with SPM, underlining its symptomatology, diagnosis, treatment, and followup, and defining a reasonable course of assessment and management. A retrospective case series was conducted to identify adult patients with SPM who were diagnosed and treated in our institution between 1998 and 2005. Eighteen patients (10 males) were identified (average age = 25 +/- 4.8 years). Acute onset of chest pain was the predominant symptom at presentation. All patients developed clinically evident subcutaneous emphysema and underwent chest computerized tomography. Fiber bronchoscopy and echocardiogram were used selectively (8 patients). The average hospital stay was 6 (+/-1.4) days. Sixteen patients were conservatively treated, and only two patients were treated with thoracic drainage due to a related pneumothorax. The disease followed a benign evolution in all patients and, as of today, no relapse has been reported. SPM is an uncommon pathology with a usually benign course. The authors discuss SPM. A diagnostic algorithmic approach is necessary to rule out severe secondary entities and consequences that need urgent treatment.

Role of artificial nutrition in patients undergoing surgery for esophageal cancer.

Malnourished cancer patients undergoing major surgical treatments are at a high risk of morbidity and mortality. As compared to patients affected by other tumors, the highest rate of malnutrition (78.9%) was found in those with esophageal cancer due to postoperative complications. The impact of perioperative nutritional support on outcome in esophageal cancer patients undergoing surgery is analyzed. Strategies that can be used to preserve or restore the nutritional condition in patients throughout treatment are illustrated. Oral supplementation, and enteral or parenteral nutrition are among several methods of support. Enteral option is to be preferred because the intestinal integrity is preserved, the risk of complications is reduced and costs are lower. Prevention or correction of nutrient depletion in severely malnourished esophageal cancer patients remarkably reduces or eliminates malnutrition-related morbidity and mortality. Therefore to identify and treat malnutrition is of the utmost importance.

[Treatment of the esophageal cancer: the impact of peri-operative parenteral nutrition]. / Terapia del cancro esofageo: ruolo del supporto nutrizionale.

The malnourished cancer patients are at a higher risk of morbidity and mortality, when undergoing major surgical treatments. In comparison with patients affected with other cancers, the highest occurrence of malnutrition (78.9%) was found in those with esophageal cancer and is related with post-operative complications. The Authors review the impact of peri-operative nutritional support on outcomes in esophageal cancer patients undergoing surgery, and produce strategies that can be used to preserve or restore the nutritional condition in patients throughout treatment. Several methods may be used to provide nutritional care, such as oral supplementation, and enteral or parenteral nutrition. The enteral option is to be preferred, due to preservation of intestinal integrity, reduced risk of complications, and lesser expenses. The prevention or correction of nutrient depletion in several malnourished esophageal cancer patients remarkably reduce or eliminate malnutrition-related morbidity and mortality, therefore the level of malnutrition must be identified and treated.

Vitamins A, E, microelements and membrane lipid peroxidation in patients with neoplastic disease treated with calcium antagonists and antagonists of receptors H2.

We studied the serum levels of vitamins A, E, zinc and copper in two hundred and twenty-five subjects of both sexes. They were divided into two groups: 87 healthy subjects who served as controls and 138 patients with neoplastic disease. The patients were subdivided according to the absence (n = 79) or the presence of metastatic disease (n =59). In 59 patients with cancer, who were in therapy with scavenger drugs of free radical such as calcium antagonists and the antagonists of receptors H2, we also studied the possible effect of the same therapy on the serum levels of vitamins, on the concentrations of the microelements and on membrane lipid peroxidation. We found that membrane lipid peroxidation, evaluated from the time of in vitro formation in the blood of so-called "Heinz bodies," decreased in all patients treated with scavenger drugs. In these patients the permeability of the erythrocyte membrane was similar to the controls and the serum levels of the vitamins were equal to the levels in patients who did not receive these therapies. Zinc concentration increased while copper remained unchanged. We also studied the levels of vitamins in some organs. The results are discussed considering the role of free radicals. We underline the importance of vitamins A and E in the protection from membranous peroxidation and from free radicals and the need to consider cancer as a systemic morbid event, apart from the contingent actual location.

Chest wall reconstruction after resection in lung cancer: personal experience.

Chest wall reconstruction after resection, for locally advanced lung cancer but also for some selected secondary tumors, is a demanding challenge to surgeons, anesthetists and experts in respiratory function rehabilitation who must guarantee a regular natural ventilation, adequate protection of intrathoracic organs and acceptable cosmetic outcome. To this aim, many procedures using autologous, heterologous, or prosthetic materials, are available. A study conducted on 13 lung cancer patients who after resection underwent reconstruction with heterologous prosthetic material is presented. No intraoperative mortality or septic complications were observed. There was prompt wall stabilization in 10 patients; it occurred 3 weeks later in another patient (polytetrafluoridethylene patch). Only in one patient (prolene mesh) a seroma developed, treated with US-guided drainage. In the authors' experience, even for fairly small defects reconstruction with prosthetic material is suitable, to prevent, in case of the presence of risk factors, pulmonary hernia-induced major respiratory symptoms. Prosthetic materials are also preferred for benign lesions characterized by a long-term survival.