Inter-rater reliability of classification systems of scapular dyskinesis

Prevalence of scapular dyskinesis varies across records, with overhead athletes being more frequently affected than non-overhead athletes A number of methods have been described to evaluate scapular kinematics and scapular dyskinesis. The "yes/no" and the "4-type" classification systems are widely accepted and diffusely used among orthopaedics and physical therapists. The inter-rater reliability for both the "yes/no" and the "4-type" classification systems may be different. Moreover, differences between physical therapists and orthopaedic surgeons may exist. Seven examiners (2 orthopaedic surgeons and 5 physical therapists) were asked to evaluate a mixed sequence of video recordings of healthy subjects and patients affected by shoulder, scapular or clavicular disorders and to assess scapular dyskinesis using the "yes/no" and the "4-type" classification systems. Cohen's kappa coefficient (κ) and weighted kappa were used to measure inter-rater reliability. Twenty-four subjects were enrolled. In general, the "4- type" system has higher κ values than ''yes/no'' classification system and orthopaedic surgeons achieve higher reliability than physical therapists for both systems. The clinical evaluation of active shoulder movements permits reproducible assessment and classification of scapular dyskinesis, in particular for the "4-type" classification system. The "4-type" classification system can be used to assess and classify scapular dyskinesis, especially among orthopaedic surgeons.

Transthoracic cholecystectomy following biliary pancreatitis arising from a thoracic herniated gallbladder

Asymptomatic right diaphragmatic rupture with liver and gallbladder herniation and secondary Budd-Chiari syndrome is a rare complication of abdominal trauma. In this setting, the management of gallbladder stones remains poorly described and may require a thoracic approach.

The impact of drugs on male fertility: a review

Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed.

Conformational Change in the Mechanism of Inclusion of Ketoprofen in β-Cyclodextrin: NMR Spectroscopy, Ab Initio Calculations, Molecular Dynamics Simulations, and Photoreactivity

Inclusion of drugs in cyclodextrins (CDs) is a recognized tool for modifying several properties such as solubility, stability, bioavailability, and so on. The photoreactive behavior of the β-CD/ketoprofen (KP) complex upon UV exposure showed a significant increase in photodecarboxylation, whereas the secondary degradation products by hydroxylation of the benzophenone moiety were inhibited. The results may account for an improvement of KP photophysical properties upon inclusion, thus better fostering its topical use. To correlate the structural details of the inclusion with these results, an NMR spectroscopic study of KP upon inclusion in β-CD was performed. Effects of the magnetically anisotropic centers of KP, changing their orientations upon inclusion and giving chemical shift variations, were specifically correlated with the results of the molecular dynamic simulations and ab initio calculations. In the large variety of papers focusing on the structural analysis of β-CD complexes, this work represents one of the few examples in which a detailed analysis of these simultaneous upfield-downfield NMR shifts of the same aromatic molecule upon inclusion is reported. Interestingly, the results demonstrate that the observed upfield and downfield shifts upon inclusion are not related to any direct magnetic role of β-CD. The conformational change of KP upon the inclusion process consists of a slight reduction in the angle between the two phenyl rings and in a remarkable reduction in the mobility of the carboxyl group, the latter being one of the main contributions to the NMR resonance shifts. These structural details help in understanding the features of the inclusion complex and, eventually, the driving force for its formation.

Case Studies of Physical and Chemical Gels Based on Microbial Polysaccharides

Microbial anionic polysaccharides, although structurally closely related, exhibit strikingly different gelling properties in aqueous media (physical gels formation). Experimental observations are traced to differences, minor differences in some instances, in primary structures. Chemical gels have been prepared using deacylated gellan by means of an interchain partial esterification procedure, and a sample subjected to preliminary characterization in terms of swelling properties. NMR water proton relaxation data show that such amples display a remarkable water retention capability.

Mechanism of Action of Thymosinα1: Does It Interact with Membrane by Recognition of Exposed Phosphatidylserine on Cell Surface? A Structural Approach

Thymosinα1 is a peptidic hormone with pleiotropic activity, which is used in the therapy of several diseases. It is unstructured in water solution and interacts with negative regions of micelles and vesicles assuming two tracts of helical conformation with a structural flexible break in between. The studies of the interaction of Thymosinα1 with micelles of mixed dipalmitoylphosphatidylcholine and sodium dodecylsulfate and vesicles with mixed dipalmitoylphosphatidylcholine/dipalmitoylphosphatidylserine, the latter the negative component of the membranes, by (1)H and natural abundance (15)N NMR are herewith reported, reviewed, and discussed. The results indicate that the preferred interactions are those where the surface is negatively charged due to sodium dodecylsulfate or due to the presence of dipalmitoylphosphatidylserine exposed on the surface. In fact the unbalance of dipalmitoylphosphatidylserine on the cellular surface is an important phenomenon present in pathological conditions of cells. Moreover, the direct interaction of Thymosinα1 with K562 cells presenting an overexposure of phosphatidylserine as a consequence of resveratrol-induced apoptosis was carried out.

Intra-Operative Contrast Cholangiography in Living Donor Liver Transplantation: The ISMETT Experience

BACKGROUND

We evaluated the clinical impact of donor biliary anatomy discrepancies (DBAD) achieved by comparing pre-operative evaluation obtained with magnetic resonance (MR)/magnetic resonance cholangiopancreatography (MRCP) imaging, with intra-operative cholangiography (IOC) on the living related liver donor (LDLT) and recipient.

METHODS

This single-center, retrospective study included 97 consecutive adult-to-adult (A2A) LDLT performed in our hospital in the last 12 years. Donor sex and age, living donors with biliary and/or vascular anomalies, recipient age, sex, primary etiology, re-transplantation, Model of End-Stage Liver Disease score, co-morbidities, arterial and biliary recipient complications assessed on the basis of clinical follow-up were collected and analyzed for significance through the use of a multivariate linear regression model.

RESULTS

Biliary complications in the donor (DBC) were detected in 8 (8.2%) cases. Biliary complications in the recipients (RBC) were detected in 38 (39%) cases. DBADs were found in 32 (33%) cases and resulted strictly related to RBC (P = .05).

CONCLUSIONS

After adjusting for co-variables, results of the linear regression analysis confirmed that DBAD is an independent predictor of RBC, but it is not significantly associated with vascular complications or patient survival. We showed that RBCs after LDLT were influenced by DBAD.

Human induced pluripotent stem cell-derived versus adult cardiomyocytes: an in silico electrophysiological study on effects of ionic current block

Background and Purpose

Two new technologies are likely to revolutionize cardiac safety and drug development: in vitro experiments on human‐induced pluripotent stem cell‐derived cardiomyocytes (hiPSC‐CMs) and in silico human adult ventricular cardiomyocyte (hAdultV‐CM) models. Their combination was recently proposed as a potential replacement for the present hERG‐based QT study for pharmacological safety assessments. Here, we systematically compared in silico the effects of selective ionic current block on hiPSC‐CM and hAdultV‐CM action potentials (APs), to identify similarities/differences and to illustrate the potential of computational models as supportive tools for evaluating new in vitro technologies.

Experimental Approach

In silico AP models of ventricular‐like and atrial‐like hiPSC‐CMs and hAdultV‐CM were used to simulate the main effects of four degrees of block of the main cardiac transmembrane currents.

Key Results

Qualitatively, hiPSC‐CM and hAdultV‐CM APs showed similar responses to current block, consistent with results from experiments. However, quantitatively, hiPSC‐CMs were more sensitive to block of (i) L‐type Ca²⁺ currents due to the overexpression of the Na⁺/Ca²⁺ exchanger (leading to shorter APs) and (ii) the inward rectifier K⁺ current due to reduced repolarization reserve (inducing diastolic potential depolarization and repolarization failure).

Conclusions and Implications

In silico hiPSC‐CMs and hAdultV‐CMs exhibit a similar response to selective current blocks. However, overall hiPSC‐CMs show greater sensitivity to block, which may facilitate in vitro identification of drug‐induced effects. Extrapolation of drug effects from hiPSC‐CM to hAdultV‐CM and pro‐arrhythmic risk assessment can be facilitated by in silico predictions using biophysically‐based computational models.

Large cell carcinoma of the lung: clinically oriented classification integrating immunohistochemistry and molecular biology

This study aimed at challenging pulmonary large cell carcinoma (LLC) as tumor entity and defining different subgroups according to immunohistochemical and molecular features. Expression of markers specific for glandular (TTF-1, napsin A, cytokeratin 7), squamous cell (p40, p63, cytokeratins 5/6, desmocollin-3), and neuroendocrine (chromogranin, synaptophysin, CD56) differentiation was studied in 121 LCC across their entire histological spectrum also using direct sequencing for epidermal growth factor receptor (EGFR) and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations and FISH analysis for ALK gene translocation. Survival was not investigated. All 47 large cell neuroendocrine carcinomas demonstrated a true neuroendocrine cell lineage, whereas all 24 basaloid and both 2 lymphoepithelioma-like carcinomas showed squamous cell markers. Eighteen out of 22 clear cell carcinomas had glandular differentiation, with KRAS mutations being present in 39 % of cases, whereas squamous cell differentiation was present in four cases. Eighteen out of 20 large cell carcinomas, not otherwise specified, had glandular differentiation upon immunohistochemistry, with an exon 21 L858R EGFR mutation in one (5 %) tumor, an exon 2 KRAS mutation in eight (40 %) tumors, and an ALK translocation in one (5 %) tumor, whereas two tumors positive for CK7 and CK5/6 and negative for all other markers were considered adenocarcinoma. All six LCC of rhabdoid type expressed TTF-1 and/or CK7, three of which also harbored KRAS mutations. When positive and negative immunohistochemical staining for these markers was combined, three subsets of LCC emerged exhibiting glandular, squamous, and neuroendocrine differentiation. Molecular alterations were restricted to tumors classified as adenocarcinoma. Stratifying LCC into specific categories using immunohistochemistry and molecular analysis may significantly impact on the choice of therapy.

Diagnostic pitfalls in the preoperative 18F-FDG PET/CT evaluation of a case of giant malignant solitary fibrous tumor of the pleura

Solitary fibrous tumor of the pleura (SFTP) is an uncommon entity, generally with an indolent behavior. Nevertheless, some malignant forms have been rarely reported. These, often have an aggressive biological behavior with pathological findings of invasiveness. The preoperative diagnosis and evaluation of the grade of malignancy are extremely challenging. Herein we report a case of a 64-year-old man who presented with a left giant intra-thoracic mass imaged with fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG/PET-CT) and sampled via fine-needle aspiration biopsy (FNAB). Imaging and FNAB findings showed suspicion of a benign form of SFTP. Surgical radical resection of the giant mass was performed. The definitive histological diagnosis showed a malignant SFTP. Based on this report, we take the opportunity to briefly discuss the insidious pitfalls concerning the radiological and (18)F-FDG/PET-CT features as well as cyto/histological findings in the pre-operative diagnostic work-up examination of this rare entity.

Processing and Properties of Polycarbonate/Liquid Crystal Polymer Blends

Rheological and mechanical properties, structural characteristics, extrusion and injection molding behavior of blends of polycarbonate (PC) with a thermotropic, wholly aromatic copolyesteramide have been investigated. The processability of polycarbonate is remarkably improved by addition of small contents of liquid crystal polymer. All the flow curves of the blends lie between those of the pure components. In the processing conditions adopted, the LCP particles are easily elongated in the flow direction. In this direction the elastic modulus rises remarkably with LCP content. The modulus-composition curve is, however, lower than that expected on the basis of an additive rule due to the incompatibility and poor adhesion between the two phases. Finally, injection molding of this extrusion grade PC has been easily performed by adding small contents of LCP. The impact strength values of the injection molding samples of these blends are only slightly lower than that of the pure PC.

Bovine rod rhodopsin. 1. Bleaching by luminescence in vitro by recombination of radicals from polyunsaturated fatty acids

Rod outer segments of photoreceptors are characterized by rhodopsin, a membrane protein surrounded by phospholipids containing a very high concentration of polyunsaturated fatty acids. These fatty acids can propagate free radicals, initiated by peroxidation, whose recombination is eventually associated with light emission as chemiluminescence. The results reported here indicate that this effect produces an isomerization of the retinal (bleaching effect) of the rhodopsin, similar to that induced by light in normal vision. In vitro experiments on detergent-suspended rod outer segments (RdOS) from bovine eyes, using an enzymatic source of radicals, xanthine/xanthine oxidase, were carried out. The results indicate that the proposed mechanism is likely, because they can show the bleaching of rhodopsin in RdOS, owing to its extraordinary sensitivity. Thus this mechanism is, also, a possible explanation for anomalous visual effects such as light flashes (phosphene-like) perceived by humans. The functionality of the rhodopsin in the RdOS was first tested by visible light. Rhodopsin reactivation after bleaching was obtained by adding cis-retinal to the suspension, demonstrating the reversibility of the bleaching process. A special experimental system was developed to observe the bleaching from luminescence by radical recombination, avoiding physical contact between the rod outer segment suspension and the radicals to prevent radical-induced damage and modifications of the delicate structure of the rod outer segment.

Outcomes from ischemic stroke subtypes classified by the Oxfordshire Community Stroke Project: a systematic review

BACKGROUND

Stroke is a highly heterogeneous disorder with distinct subtypes, each presenting specific clinical aspects. Information on prognosis of ischemic stroke subtypes help to improve clinical management and rehabilitation treatments.

AIM

Summarize findings of studies on outcome in stroke subtypes categorized by use of the Oxfordshire Community Stroke Project (OCSP) classification.

DESIGN

Systematic review.

SETTING

Not applicable.

POPULATION

Adult post-stroke patients.

METHODS

Systematic literature research of five databases was undertaken to identify relevant studies. Outcomes were examined in terms of impairment, activity restriction and participation restriction. Quality of Life and mortality was also examined for each study.

RESULTS

Sixteen studies met inclusion criteria. Most studies measure outcome in terms of activity limitations and participation restriction. Only one study measures impairment. TACI group have poor outcomes in comparison with other groups. Outcomes of LACI, PACI and POCI groups are controversial.

CONCLUSION

Stroke subtype is a factor influencing outcome. However, differences among groups, overall in terms of impairment, should be further investigated.

CLINICAL REHABILITATION IMPACT

Different prognosis of stroke subtypes may imply different rehabilitation managements.

Recognition of p63 by the E3 ligase ITCH: Effect of an ectodermal dysplasia mutant

The E3 ubiquitin ligase Itch mediates the degradation of the p63 protein. Itch contains four WW domains which are pivotal for the substrate recognition process. Indeed, this domain is implicated in several signalling complexes crucially involved in human diseases including Muscular Dystrophy, Alzheimer's Disease and Huntington Disease. WW domains are highly compact protein-protein binding modules that interact with short proline-rich sequences. The four WW domains present in Itch belong to the Group I type, which binds polypeptides with a PY motif characterized by a PP xY consensus sequence, where x can be any residue. Accordingly, the Itch-p63 interaction results from a direct binding of Itch-WW2 domain with the PY motif of p63. Here, we report a structural analysis of the Itch-p63 interaction by fluorescence, CD and NMR spectroscopy. Indeed, we studied the in vitro interaction between Itch-WW2 domain and p63(534-551), an 18-mer peptide encompassing a fragment of the p63 protein including the PY motif. In addition, we evaluated the conformation and the interaction with Itch-WW2 of a site specific mutant of p63, I549T, that has been reported in both Hay-Wells syndrome and Rapp-Hodgkin syndrome. Based on our results, we propose an extended PP xY motif for the Itch recognition motif (P-P-P-Y-x(4)-[ST]-[ILV]), which includes these C-terminal residues to the PP xY motif.

Acetylation of RTN-1C regulates the induction of ER stress by the inhibition of HDAC activity in neuroectodermal tumors

Reticulons are a family of highly conserved proteins, localized in the endoplasmic reticulum (ER) and involved in different cellular functions, such as intracellular membrane trafficking, apoptosis and nuclear envelope formation. The reticulon protein family consists of four members, but their specific functions are presently poorly understood. RTN-1C overexpression triggers apoptosis, regulating ER stress versus DNA damage-induced cell death in a mutually exclusive way. The different RTN isoforms share a C-terminal reticulon homology domain containing two hydrophobic segments and a 66-amino acid hydrophilic loop. In the C-terminal region of RTN-1C, a unique consensus sequence (GAKRH) has recently been identified, showing 100% identity with the DNA-binding domain of histone H4. In this study, we show that this sequence is essential for RTN-1C-mediated apoptosis. It is noteworthy that the lysine 204 present in this region is post-translationally modified by acetylation and that this event is associated with a significant decrease in histone deacetylase activity and contributes to RTN-1C binding to DNA. These data demonstrate a molecular mechanism by which RTN-1C controls apoptosis and indicate this protein to be a novel potential target for cancer therapy.

Thymolipoma of the anterior mediastinum: videothoracoscopic removal using a bilateral approach

Thymolipoma, a rare benign neoplasm of the anterior mediastinum, is often asymptomatic and as a result it can become quite large before it is diagnosed. CT is the most accurate diagnostic technique to identify the adipose tissue, but it often cannot make a differential diagnosis differentiating it from other anterior mediastinal masses; transthoracic biopsy also reveals the presence of fatty tissue, but a definitive diagnosis can only be achieved by means of surgical excision, which is also curative. We describe the case of a young woman who presented with a fatty neoplasm of the anterior mediastinum. The mass was removed using single-stage bilateral sequential videothoracoscopy. The histopathological diagnosis was thymolipoma.

[Effects of two types of treatment for shoulder subluxation in hemiplegics: a pilot study]

PURPOSE

The aim of this pilot study is to compare the effects of a new sling, a special type of strapping and their association to treat shoulder subluxation.

MATERIALS AND METHODS

The effectiveness of a modified version of a sling, a special type of strapping and their association to treat shoulder subluxation has been compared in three hemiplegic patients. Shoulder subluxation has been diagnosed by palpation, then assessed by radiographic measurements in sitting position with the plane of the scapula method (at 30 degrees to the coronal plane). The distance between the inferior acromial surface and the horizontal line crossing through the central point of the humeral head (in millimeters) has been taken as measurement of subluxation.

RESULTS

All the patients showed a reduction of the acromial-humeral distance when the sling was applied with strapping. When sling or strapping alone was applied, a slight difference was measured in each patient.

CONCLUSIONS

The association of sling and strapping seems to be an effective strategy to treat shoulder subluxation in hemiplegic patients in sub-acute stage. The tools described in the paper give a better cost/benefit ratio in comparison with others described in literature and widely used in clinical practice. Hawever, further investigations are necessary to confirm these results.

Identification of a conserved N-capping box important for the structural autonomy of the prion alpha 3-helix: the disease associated D202N mutation destabilizes the helical conformation

Peptides corresponding to three alpha helices present in the C-terminal region of the human prion protein have been synthesized and their structural autonomy analyzed by circular dichroism (CD) and NMR spectroscopy. The results obtained indicate that the protein fragment corresponding to the alpha 3-helix, in contrast to alpha 1 and alpha 2 peptides, shows a complete structural autonomy. The chemical shifts values found for NH and CHalpha resonance of the isolated alpha 3 peptide, formed by 30 aminoacid residues, were markedly and surprisingly similar to the corresponding values of the alpha 3-helix in the protein. The structural autonomy of the alpha 3-helix is profoundly determined by the presence of the conserved capping box and, in part, by the ionic bond formed between Glu200 and Lys204. On the basis of these observations a novel PrP consensus pattern, centered on the alpha 3-helix region, has been defined. The data indicate that this autonomous and highly conserved region of the PrPc likely plays a critical role in folding and stability. This gives an explanation of why many of pathogenic mutations occur in this part of the molecule, sharing relevant effects on the overall protein conformation. In particular the D202N capping mutation almost completely destabilizes the isolated alpha 3 peptide. While it is well known that the D202N substitution is associated with a GSS disease, the possible structural basis of this fatal pathology has never been investigated. We propose that a lower alpha 3-helical propensity leading to a major destabilization of the PrPc molecule initiates the pathogenic process associated with D202N capping mutation.

Evaluation of N parameter in the staging of non-small cell lung cancer: role of CT and PET

PURPOSE

To determine diagnostic accuracy of CT and FDG-PET for the evaluation of N status in non-small cell lung cancer.

MATERIALS AND METHODS

Thirty-eight CT scans and PET scans of patients with non small-cell lung cancer were retrospectively reviewed. The data of the noninvasive techniques about N status were compared with the pathology findings obtained by standard lymphadenectomy.

RESULTS

The CT results were concordant with surgery in 24 out of 38 cases (63%); in discordant cases CT understaged 8 patients and overstaged 6. The PET images were concordant with surgery in 29 cases (76%); of the remaining 9, PET understaged 5 cases and overstaged 4. Concerning the N parameter, CT had a sensitivity of 42.8% and a specificity of 83.3%, while PET had a sensitivity of 71.4% and a specificity of 91.6%.

CONCLUSIONS

In our experience the diagnostic accuracy of PET is superior to that of CT, in agreement with the most important studies in the literature. On only one occasion did PET fail to differentiate between hilar uptake (N1) and the central primary tumour, an area in which CT provided more precise anatomic details. Nonetheless, we believe that PET should be performed in all patients affected by lung cancer, with the only exception of patients shown to be not suitable for surgery after CT examination.

Characterization of the conformational behavior of peptide Contryphan Vn: A theoretical study

In this work we report the study of a peptide, the Contryphan Vn produced by Conus ventricosus, a vermivorous cone snail living in the temperate Mediterranean sea. This cyclic peptide of nine residues is a ring closed by a Cys-Cys (Cys: cysteine) disulfide bond containing two proline (Pro) residues and two tryptophans (Trp), one of them being a D-Trp. We present a statistical mechanical characterization of the peptide, simulated in water for about 200 ns with classical molecular dynamics (MD). In recent years there has been a growing interest in the study of the mechanics and dynamics of biological molecules, and in particular for proteins and peptides, about the relationship between collective motions and the active conformations which exert the biological function. To this aim we used the essential dynamics analysis on the MD trajectory and extracted, from the total fluctuations of the molecule, the dominant dynamical modes responsible of the principal conformational transitions. The Contryphan Vn small size allowed us to investigate in details the all-atoms dynamics and the corresponding thermodynamics in conformational space defined by the most significant intramolecular motions.

Fungus colonisation of pulmonary rheumatoid nodule

This report describes a 69 year old woman, suffering from active rheumatoid arthritis since the age of 60 and presenting with severe dyspnoea and cough. A computed tomography scan of the chest showed multiple bilateral pulmonary nodules, sometimes cavitated, associated with reticular opacities and pleural effusion. A videothoracoscopic excision of a cavitated nodule was performed. Seven days after surgery, a right pneumothorax developed, and the patient died of septicaemia one month later. Microscopically, the excised nodule was composed of necrotic fibrinoid material with a peripheral rim of palisaded histiocytes, extending to the pleural surface and containing several fungal hyphae morphologically consistent with aspergillus. A diagnosis of pulmonary rheumatoid nodule with fungus colonisation was made. In the lung, fungus colonisation is a rare complication of rheumatoid nodules. The most important differential diagnostic considerations are briefly discussed.

[Primary leiomyoma of the lung, with clear-cell features and admixed alveolar spaces: description of a case presenting with pneumothorax]

OBJECTIVE

To report about a primary leiomyoma of the lung, with clear cell features and with admixed alveolar epithelium.

RESULTS AND CONCLUSIONS

The patient, a 18-year-old female, non smoker, presented with a well-delimited pleuro-pulmonary mass, 6,5 cm across, located in the right upper lobe. The mass was discovered 5 years previously, following an episode of spontaneous pneumothorax; initially interpreted as an intralobar pulmonary sequestration, it was subsequently removed due to a small dimensional increase. A gynaecological examination, a thoracic CT-scan obtained 2 years after operation, and a recent abdomino-pelvic echography were negative. The patient is alive and well 7 years after surgery. Microscopically, the lesion was well delimited and it was punctuated by multiple cysts of variable dimensions, covered by bland cubic cells. The solid part of the lesion was composed by oval, clear cells, merging with fusiform elements with densely eosinophilic cytoplasm. Significant atypia, mitoses and necrosis were absent. Immunohistochemically, both oval and spindle cells were strongly positive for vimentin, smooth muscle actin, desmin and h-caldesmon, negative for cytokeratin, EMA, CD-34, CD-10, CD-117, HMB-45, TTF-1, BCL-2, GFAP, calretinin, chromogranin, estrogen and progesterone receptors. Cells covering the cystic spaces were positive for cytokeratin, TTF-1 and EMA, negative for all the other antibodies tested. Smooth muscle proliferations of the lung are briefly discussed, together with the most important problems in differential diagnosis.

Preoperative localization of indeterminate pulmonary nodules before videothoracoscopic resection

BACKGROUND

The management of a solitary pulmonary nodule is the subject of debate and minimally invasive diagnostic approaches have low sensitivity for small peripheral nodules. We discuss the role of video-assisted thoracoscopic surgery (VATS) in the management of solitary pulmonary nodules (SPNs) < or = 1 cm performed with a preoperative computed tomography-guided wire localization.

METHODS

Thirty-five selected patients underwent VATS resection for SPN, with localization by guide wire before surgery.

RESULTS

Seven patients, after VATS exploration, underwent thoracotomy because of pleuropulmonary adhesions, depth or dimensions. Histological diagnosis was obtained in all procedures; there was no postoperative morbidity or morbidity.

CONCLUSION

Preoperative computed tomography hook-wire localization is a suitable strategy for peripheral nodules < or = 1 cm in diameter.