Lung Metastasectomy: Where Do We Stand? Results from an Italian Multicentric Prospective Database.

Background/Objectives: The surgical resection of pulmonary metastases is considered a therapeutic option in selected cases. In light of this, we present the results from a national multicenter prospective registry of lung metastasectomy. Methods: This retrospective analysis involves data collected prospectively and consecutively in a national multicentric Italian database, including patients who underwent lung metastasectomy. The primary endpoints were the analysis of morbidity and overall survival (OS), with secondary endpoints focusing on the analysis of potential risk factors affecting both morbidity and OS. Results: A total 470 lung procedures were performed (4 pneumonectomies, 46 lobectomies/bilobectomies, 13 segmentectomies and 407 wedge resections) on 461 patients (258 men and 203 women, mean age of 63.1 years). The majority of patients had metastases from colorectal cancer (45.8%). In most cases (63.6%), patients had only one lung metastasis. A minimally invasive approach was chosen in 143 cases (30.4%). The mean operative time was 118 min, with no reported deaths. Morbidity most frequently consisted of prolonged air leaking and bleeding, but no re-intervention was required. Statistical analysis revealed that morbidity was significantly affected by operative time and pulmonary comorbidities, while OS was significantly affected by disease-free interval (DFI) > 24 months (p = 0.005), epithelial histology (p = 0.001) and colorectal histology (p = 0.004) during univariate analysis. No significant correlation was found between OS and age, gender, surgical approach, surgical extent, surgical device, the number of resected metastases, lesion diameter, the site of lesions and nodal involvement. Multivariate analysis of OS confirmed that only epithelial histology and DFI were risk-factors, with p-values of 0.041 and 0.031, respectively. Conclusions: Lung metastasectomy appears to be a safe procedure, with acceptable morbidity, even with a minimally invasive approach. However, it remains a local treatment of a systemic disease. Therefore, careful attention should be paid to selecting patients who could truly benefit from surgical intervention.

Benign tumors of the chest wall.

Benign tumors of the chest wall are rare tumors that might arise from all the tissues of the chest: vessels, nerves, bones, cartilage, and soft tissues. Despite benign features, these tumors can have several histological characteristics and different behaviors. Even if they do not influence life expectancy, rarely they may have a potential risk of malignant transformation. They can cause several, oft, unspecific symptoms but more than 20% of affected patients are asymptomatic and are being diagnosed incidentally on chest radiograph or computed tomography scan. Pain is the most common described symptom. Together with a detailed medical history, a rigorous and meticulous clinical and radiological assessment is mandatory. If radiological features are unclear or in case surgery could not be performed, a biopsy should be indicated to establish a diagnosis. Radical surgical resection can often be offered to resect and cure these neoplasms, but this is might not be true for all types of tumors and, in some cases, their dimension or position might contra-indicate surgery. Given the rarity of these tumors, there is a lack of treatment's guidelines and prospective trials that include a significant number of patients. This review discusses, according to the latest evidence, the histological features and the best treatment of several chest wall benign tumors.

Giant lung bulla as a late-onset complication of mild SARS-CoV-2 pneumonia.

A 49-year-old Caucasian man was admitted to the Emergency Department for shortness of breath and cough. CT imaging showed bilateral a mild COVID-19 related pneumonia. He was hospitalized in the low-intensity COVID-19 unit where he received O2 therapy and oral corticosteroids (CS). Three weeks after discharge a high-resolution computed tomography (HRCT) find a giant bulla of the inferior lobe. The bulla was resected by video-assisted thoracoscopic surgery (VATS) and the patient recovered completely. In our patient, it is reasonable to suspect that the development of the bulla is a result of SARS-CoV-2 infection, since no bulla was observed in the first HRCT two months before. SARS-CoV-2 related pneumonia may be responsible for lung remodeling due to diffuse alveolar damage and later interstitial myofibroblastic proliferation. Corticosteroids might have played a role in increasing SARS-CoV-2 dystrophic action. COVID-19 leads to pulmonary damages, which are still partially unknown and might result in development of bullae. In fit patient surgical treatment can be carried out safely.

Desenvolvimento e validação da versão em português da friends and family interview / Developing and validation the portuguese version of the friends and family interview / Desarrollo y validación de la versión portuguesa de la friends and family interview

O objetivo deste estudo foi a adaptação e validação da entrevista Friends and Family Interview que avalia o estilo de apego e a função reflexiva de crianças e adolescentes. Para adaptação, foram avaliadas a equivalência semântica, idiomática, experiencial e conceitual entre a versão traduzida e o instrumento original. A versão final da entrevista foi aplicada a uma amostra clínica de jovens entre 9 e 17 anos (M=13,12; DP=2,72) do sul do Brasil. Constatou-se que a versão em português apresentou uma consistência interna alta (α=0,79), assim como uma boa concordância entre avaliadores (α=0,89). A análise fatorial exploratória revelou dois componentes principais que melhor explicaram os dados, denominados Segurança nos Relacionamentos e Funcionamento Reflexivo (α=0,95) e Insegurança do Apego (α=0,72). Os resultados apoiaram a validade de construto e de critério da FFI e forneceram evidências de sua utilidade na avaliação do apego e da função reflexiva na infância e adolescência. (AU)

The study aimed to adapt and validate the Friends and Family Interview that assesses the attachment style and the reflective function in children and adolescents. The semantic, idiomatic, experiential and conceptual equivalences between the original and the translated version were analyzed. Then the final version was applied in a clinic sample of young people ranging from 9 to 17 years of age (M=13.12 SD=2.72 years), of southern Brazil. The statistical tests showed a high internal consistency (α=.79), as well as a good inter-evaluators reliability (α=.89) in the Portuguese version of the FFI. Exploratory factor analysis yielded two main factors, Relationships Security and Reflective Functioning (α=.95) and Attachment Insecurity (α=.72). The data supported the construct and criterion validities of the Portuguese version of the interview protocol. The FFI is a useful tool for the evaluation of attachment and reflective function in children and adolescents. (AU)

El objetivo de este estudio fue la adaptación y la validación de la entrevista Friends and Family Interview (FFI) que evalúa el estilo de apego y la función reflexiva de niños y adolescentes. Para la adaptación se evaluó la equivalencia semántica, idiomática, experiencial y conceptual entre la versión traducida y el instrumento original. La versión final de la entrevista se aplicó a una muestra clínica de jóvenes entre 9 y 17 años (M=13,12; DS=2,72) del sur de Brasil. Se encontró que la versión portuguesa tenía una alta consistencia interna (α=0,79), así como una buena concordancia entre evaluadores (α=0,89). El análisis factorial exploratorio reveló dos componentes principales, denominados Seguridad en las Relaciones y Funcionamiento Reflexivo (α=0,95) e Inseguridad del Apego (α=0,72). Los resultados apoyaron la validez de criterio y constructo de la FFI y proporcionaron evidencias de su utilidad para evaluar el apego y la función reflexiva en la niñez y en la adolescencia. (AU)