Association between Mortality and Lung Low Attenuation Areas in NSCLC Treated by Surgery

BACKGROUND

to test the association with overall survival (OS) of low attenuation areas (LAAs) quantified by staging computed tomography (CT) of patients who underwent radical surgery for nonsmall-cell lung cancer (NSCLC).

METHODS

patients who underwent radical surgery for NSCLC at our institution between 1 January 2017 and 30 November 2021 were retrospectively evaluated. Patients who performed staging or follow-up CTs in other institutions, who received lung radiotherapy or chemotherapy, and who underwent previous lung surgery were excluded. At staging and 12-months follow-up CT, LAAs defined as voxels <-950 Hounsfield units, were extracted by software. The percent of LAAs relative to whole-lung volume (%LAAs) and the ratio between LAAs in the lobe to resect and whole-lung LAAs (%LAAs lobe ratio) were calculated. Cox proportional hazards regression analysis was used to test the association between OS and LAAs.

RESULTS

the final sample included 75 patients (median age 70 years, IQR 63-75 years; females 29/75, 39%). It identified a significant association with OS for pathological stage III (HR, 6.50; 95%CI, 1.11-37.92; p = 0.038), staging CT %LAAs ≥ 5% (HR, 7.27; 95%CI, 1.60-32.96; p = 0.010), and staging CT %LAA lobe ratio > 10% (HR, 0.24; 95%CI 0.05-0.94; p = 0.046).

CONCLUSIONS

in patients with NSCLC who underwent radical surgery, a %LAAs ≥ 5% and a %LAA lobe ratio > 10% at staging CT are predictors, respectively, of shorter and longer OS. The LAA ratio to the whole lung at staging CT could be a critical factor to predict the overall survival of the NSCLC patients treated by surgery.

Advanced stage empyemas in community-acquired pneumonia: how hospital re-organization during the Covid-19 pandemic affected the increase in surgically treated cases

The cause of pleural empyema is bacterial pneumonia and three stages has been described in the evolution of this disease: exudative, fibrino-purulent and organizational phases. The first therapeutic intervention is the antibiotic therapy; where pharmacological therapy alone is not sufficient to eradicate the infection, it is also necessary a surgical treatment. Since the province of Piacenza having been in the epicenter area during the first Sars-Cov 2 pandemic wave in March 2020 and the number of patients with Covid-related pneumonia required invasive and non-invasive respiratory support, had a considerable organizational impact on pulmonology and respiratory unit, hindering an optimal treatment of the bacterial pneumonia both in community as well as in the hospital. Among the many "collateral" damages of the epidemiological wave of the infection with Sars Cov-2, we have been able to observe in our Hospital, also an increase of pulmonary empyemas diagnosed at an advanced stage for what we believe to be organizational and social causes directly related to the pandemic: in order to cope with the emergency the Unit of Pneumology has been since March nearly uninterruptedly dedicated to the exclusive treatment of covid patients so the pneumologist has been removed due to the need from outpatient and residential management of general pneumology.

Left diaphragmatic rupture in vehicle trauma: Report of surgical treatment and complications of two consecutive cases

BACKGROUND AND AIMS

Diaphragmatic ruptures are associated with blunt abdominal or thoracic trauma and often occur in car and motorbike accident with a high energy impact.

CASE PRESENTATION

We report two cases of patients victims of car and motorbike accidents that were referred to the Emergency Department of our Hospital in August and September 2017 for a politrauma. The patients were both diagnosed with a left diaphragmatic rupture with herniation of the stomach in the chest, and decomposed fractures of the ribs. One of the two patients reported a large abdominal wound with loss of substance in the site of the impact. Both patients underwent to open emergency surgery with primary repair of the phrenic rupture. The post-operative course was characterized by the occurrence of complications such as respiratory distress and emothorax for one of the patients.

CONCLUSION

Traumatic rupture of the diaphragm can be associated to blunt or penetrating abdominal trauma in car and motorbike accident with a prevalence of the left-sided lesions. In patients with politrauma an associate rupture of the diaphragm should be always suspected especially in motor accident where high energy impact can generate a traumatic laceration of the respiratory muscle. The treatment of associate thoracic wall fractures to prevent weaning and respiratory distress in intubated patient should be discussed.

Swyer-James-MacLeod syndrome presenting as spontaneous pneumothorax in an adult: Case report and review of literature

Swyer-James-MacLeod Syndrome (SJMS) is an uncommon, emphysematous disease characterized by obliteration of the small bronchioles, hypoplasia/or absence of pulmonary artery and peripheral vascular bed. It is most commonly diagnosed in childhood. Patients are often asymptomatic or they could suffer from symptoms of recurrent pulmonary infections. Spontaneous pneumothorax is a rare presentation of this syndrome. We report a case of a 42-year old female patient presented at our Emergency Department with complaints of dyspnea and pleuritic chest pain with a diagnosis of spontaneous pneumothorax in emphysematous disease. The diagnosis of SJMS is usually based on imaging and clinical findings rather than on the results of pathologic examination; indeed, asymptomatic adult patients with SJMS are often diagnosed after a chest radiograph obtained for another reason. High-resolution computed tomography (HRCT) seems to be the most appropriate technique for the diagnosis. SJMS can be associated with spontaneous pneumothorax which represent an emergency condition due to the underlying pathological disease. The surgical treatment of the affected lung should be considered when conservative approach is ineffective.

Baseline radionuclide and heavy metal concentrations in sediments of Sabaki River estuary (Kenya, Indian Ocean)

Baseline study of natural (⁷Be, ²¹⁰Pb, ²²⁶Ra, ²³⁴Th, ²²⁸Ra, ⁴⁰K) and anthropogenic (¹³⁷Cs) radionuclides was carried out in two cores collected from Sabaki River estuary (Kenya, Indian Ocean). There was no exponential decrease of excess ²¹⁰Pb down the cores, which did not allow dating and determination of heavy metal pollution history. The use of ¹³⁷Cs as a time marker was not possible due to its low fallout rates in East Africa. The short-lived radioisotope ⁷Be, a tracer of river floods, confirmed 2018 flood in Sabaki River estuary. Heavy metal concentration in the two cores showed nonsystematic trends with depth. Only Pb concentration in Sabaki River estuary was higher than the background levels. Application of the "Environmental Risk from Ionising Contaminants Assessment and management" (ERICA) tool confirmed that the potential dose rates to biota from the sediment radioactivity concentrations are unlikely to pose appreciable ecological risks.

Edge Contrast of the FLAIR Hyperintense Region Predicts Survival in Patients with High-Grade Gliomas following Treatment with Bevacizumab

BACKGROUND AND PURPOSE

Treatment with bevacizumab is standard of care for recurrent high-grade gliomas; however, monitoring response to treatment following bevacizumab remains a challenge. The purpose of this study was to determine whether quantifying the sharpness of the fluid-attenuated inversion recovery hyperintense border using a measure derived from texture analysis-edge contrast-improves the evaluation of response to bevacizumab in patients with high-grade gliomas.

MATERIALS AND METHODS

MRIs were evaluated in 33 patients with high-grade gliomas before and after the initiation of bevacizumab. Volumes of interest within the FLAIR hyperintense region were segmented. Edge contrast magnitude for each VOI was extracted using gradients of the 3D FLAIR images. Cox proportional hazards models were generated to determine the relationship between edge contrast and progression-free survival/overall survival using age and the extent of surgical resection as covariates.

RESULTS

After bevacizumab, lower edge contrast of the FLAIR hyperintense region was associated with poorer progression-free survival (P = .009) and overall survival (P = .022) among patients with high-grade gliomas. Kaplan-Meier curves revealed that edge contrast cutoff significantly stratified patients for both progression-free survival (log-rank χ² = 8.3, P = .003) and overall survival (log-rank χ² = 5.5, P = .019).

CONCLUSIONS

Texture analysis using edge contrast of the FLAIR hyperintense region may be an important predictive indicator in patients with high-grade gliomas following treatment with bevacizumab. Specifically, low FLAIR edge contrast may partially reflect areas of early tumor infiltration. This study adds to a growing body of literature proposing that quantifying features may be important for determining outcomes in patients with high-grade gliomas.

(137)Cs vertical distribution at the deep basins of the North and Central Aegean Sea, Greece

Large volume seawater samples were collected for the determination of (137)Cs concentration along with depth in the deep basins of North and Central Aegean Sea. The vertical (137)Cs distribution showed maximum concentration at the bottom of the basins, while the minimum values corresponded to the intermediate layer, where Levantine water exists. The surface (137)Cs activity is found to lie between the two limits and is originated from the Black Sea waters. The typical oceanographic advection-diffusion balance model is modified to a diffusion-settling-decay balance model to better understand the vertical distribution and variation of the (137)Cs concentration in the deep basins. In addition, the diffusivity of each basin, as well as the settling speed of particulate (137)Cs is also estimated. The results are compared with theoretical approach as well as with previous data.

Solitary fibrous tumors of the pleura: a case report and review of the literature

BACKGROUND

Solitary fibrous tumors of the pleura are rare and slow-growing neoplasms originating from the mesenchymal tissue underlying the mesothelial layer of the pleura. These tumors may have an unpredictable clinical course. Most cases occur in the sixth or seventh decades of life with no gender predilection, and more than 80% of cases are benign. The predominant clinical symptoms and signs are dyspnea, cough, chest pain, finger clubbing and hypoglycemia. However, because many patients are asymptomatic, the incidence rates are affected by the likelihood of its incidental detection, often through medical imaging of the chest. Surgical resection is the treatment of choice and is usually curative, even though local recurrence can occur many years after an adequate resection.

METHODS

We reviewed the literature by performing a computerized search of MEDLINE, CANCERLIT and Embase with the terms fibrous tumor, pleura, surgery, immunohistochemical analysis. Articles and s were also identified by back-referencing from other relevant papers.

RESULTS

The clinical, radiological and pathological features of a 48-year-old woman with a primary solitary fibrous tumor of the pleura are reviewed and a literature search for other reported cases has been performed.

CONCLUSIONS

Although localized fibrous tumors of the pleura are considered histologically benign, there is a risk of recurrence and malignant transformation. Complete surgical resection is mandatory and long-term clinical and radiological follow-up is indicated in all patients. For malignant cases complete surgical resection may not be adequate and studies are needed to define the role of preoperative and postoperative systemic treatment. Diagnosis is very difficult in limited samples such as fine-needle aspiration or needle-core tissue biopsy, and immunohistochemical analysis may be useful to differentiate solitary fibrous tumor of the pleura from mesothelioma and other similar tumors.

Solitary Fibrous Tumors of the Pleura: A Case Report and Review of the Literature

Background

Solitary fibrous tumors of the pleura are rare and slow-growing neoplasms originating from the mesenchymal tissue underlying the mesothelial layer of the pleura. These tumors may have an unpredictable clinical course. Most cases occur in the sixth or seventh decades of life with no gender predilection, and more than 80% of cases are benign. The predominant clinical symptoms and signs are dyspnea, cough, chest pain, finger clubbing and hypoglycemia. However, because many patients are asymptomatic, the incidence rates are affected by the likelihood of its incidental detection, often through medical imaging of the chest. Surgical resection is the treatment of choice and is usually curative, even though local recurrence can occur many years after an adequate resection.

Methods

We reviewed the literature by performing a computerized search of MEDLINE, CANCERLIT and Embase with the terms fibrous tumor, pleura, surgery, immunohistochemical analysis. Articles and abstracts were also identified by back-referencing from other relevant papers.

Results

The clinical, radiological and pathological features of a 48-year-old woman with a primary solitary fibrous tumor of the pleura are reviewed and a literature search for other reported cases has been performed.

Conclusions

Although localized fibrous tumors of the pleura are considered histologically benign, there is a risk of recurrence and malignant transformation. Complete surgical resection is mandatory and long-term clinical and radiological follow-up is indicated in all patients. For malignant cases complete surgical resection may not be adequate and studies are needed to define the role of preoperative and postoperative systemic treatment. Diagnosis is very difficult in limited samples such as fine-needle aspiration or needle-core tissue biopsy, and immunohistochemical analysis may be useful to differentiate solitary fibrous tumor of the pleura from mesothelioma and other similar tumors.

Duplication of the transverse colon in an adult: Case report and review

Tubular duplication of the colon is very rare especially in adulthood, because it is frequently symptomatic earlier in newborn life, so only few cases are reported in literature. Several theories are proposed to explain the onset and the evolution of gut malformations as the aberrant lumen recanalization or the diverticular theory, the alteration of the lateral closure of the embryonal disk or finally the dorsal protrusion of the yolk-sac for herniation or adhesion to the ectoderm for an abnormality of the longitudinal line, but none clarifies the exact genesis of duplication. We present a case of “Y-shaped” tubular duplication of the transverse colon in a 21-year-old adult, with a history of chronic pain and constipation, referred to our department for abdominal pain with retrosternal irradiation, treated with the resection of the aberrant bowel.

Environmental radioactivity analyses in Italy following the Fukushima Dai-ichi nuclear accident

Following the Fukushima power plants accident on the 11th March 2011, the radioactivity monitoring programme at the Italian ENEA research centres was activated in order to detect the possible new input of radionuclides through atmospheric transport and precipitation. Measurements of (131)I and (134,137)Cs were carried out on atmospheric particulate, atmospheric deposition, seawater and mussels and sheep milk. In the daily samples of air particulate, (131)I was detectable between March 28 and April 12, with extremely low concentrations (<1 mBq m(-3); the detection limit for (131)I was ~0.2 mBq m(-3)) while Cs isotopes were always below the detection limit (<0.2 mBq m(-3)). The two main episodes of (131)I atmospheric deposition were registered in La Spezia research centre, around March 28 and April 15, reaching values of 17.8 ± 1.1 and 8.0 ± 2.5 Bq m(-2) respectively; maximum values of (134)Cs and (137)Cs were 0.11 ± 0.03 and 0.17 ± 0.02 Bq m(-2), respectively, detected in Brasimone research centre in April (reference date April 15). Mussels and seawater were collected in the Gulf of La Spezia: only mussels after the main (131)I deposition, on March 28, contained a measurable, although very small, amount of (131)I (0.18 ± 0.05 Bq kg(-1), detection limit (131)I = 0.03 Bq kg(-1) wet weight - soft parts). The (131)I was also detected in sheep milk in Rome (Casaccia research centre) until May 5, showing a maximum concentration of 4.9 ± 0.4 Bq L(-1). As for other European Countries for which data are available, activity levels remain of no concern for public health.

Sediment reworking rates in deep sediments of the Mediterranean Sea

Different pelagic areas of the Mediterranean Sea have been investigated in order to quantify physical and biological mixing processes in deep sea sediments. Herein, results of eleven sediment cores sampled at different deep areas (> 2000 m) of the Western and Eastern Mediterranean Sea are presented. ²¹⁰Pb(xs) and ¹³⁷Cs vertical profiles, together with ¹⁴C dating, are used to identify the main processes characterising the different areas and, finally, controlling mixing depths (SML) and bioturbation coefficients (D(b)). Radionuclide vertical profiles and inventories indicate that bioturbation processes are the dominant processes responsible for sediment reworking in deep sea environments. Results show significant differences in sediment mixing depths and bioturbation coefficients among areas of the Mediterranean Sea characterised by different trophic regimes. In particular, in the Oran Rise area, where the Almeria-Oran Front induces frequent phytoplankton blooms, we calculate the highest values of sediment mixing layers (13 cm) and bioturbation coefficients (0.187 cm² yr⁻¹), and the highest values of ²¹⁰Pb(xs) and ¹³⁷Cs inventories. Intermediate values of SML and D(b) (~6 cm and ~0.040 cm² yr⁻¹, respectively) characterise the mesothrophic Algero-Balearic basin, while in the Southern Tyrrhenian Sea mixing parameters (SML of 3 cm and D(b) of 0.011 cm² yr⁻¹ are similar to those calculated for the oligotrophic Eastern Mediterranean (SML of 2 cm and D(b) of ~0.005 cm² yr⁻¹).

NETS of the lung (non SC): Experience of lung cancer working group E. Morelli Hospital Sondalo

18191

Background: pulmonary NETS are typical carcinoid (TC), atypical carcinoid (AC), large-cell neuroendocrine carcinoma (LCNC), and SCLC. Purpose: to evalue prognosis of pulmonary NET (non SC) according by histotype, treatment and serum CgA. Methods: From 1996 to 2006 our lung cancer working group followed 42 pulmonary NETs, none carcinoid syndrome and 1 metastatic (CgA 100xN) at diagnosis. 39/42 underwent radical surgical resection with adenectomy. 2/42 TC had endobronchial laser, the metastatic any treatment. 31/42 (73.8%) are TC. 10/42 (23.8 %) are AC, 1/42 (2%) undetermined. Results: In dec 06 we reviewed 37/42 cases (20 clinical examination and 17 by phone). 2/5 missing were dead: 1 AC 7 years later with liver metastasis, high CgA without syndrome and 3 years of octreotide. 2 TC, 1 AC drop-out. Of 20 pts seen, 3 had high CgA, but Octreoscan negative. 32 pts (86.5%) had only surgery: 15 with more than 5 years DFS. 7 had preoperating CgA: 4 normal, 2 high (1 had hepatic metastasis, in 1 normalized and 36 months DFS), 1 ongoing. 2 pts without surgery are alive after 17 and 8 months. The metastatic pt has PR with octreotide. 1 TC had gastric carcinoma at 7 years. 3 TC had progressive disease. 1 TC (IA and high pre-lobectomy CgA), had persistent high CgA and positive octreoscan hepatic lesion 4 months later: PR after 6 months of octreotide. Another with normal pre-lobectomy CgA (TC IB) had carcinoid syndrome with high CgA and octreoscan positivity, 4 months later: negative restaging at 22 months with one-year of octreotide. A sixteen girl - TC IB - with high CgA (normal after pneumonectomy) developed octreoscan positive thoracic lesions, 18 months later. PR after 44 months with radiometabolic therapy. Conclusion: NETS are heterogeneous and with better prognosis (except SC) than other lung cancers. AC radically resected had good prognosis (1/10 metastasis ), sometimes TC gave metastasis and progression (2/31). For the 2 subtypes OS is high. Octreotide- and radiometabolic therapy can control the metastatic disease. CgA is not indicative of relapse but well correlates with the extension of metastatic disease. High CgA values are not predictive of carcinoid syndrome. It is important to evalue CgA before and 2–3 months after surgery. Carcinoid syndrome is rare in lung NET. We don’t have any LCNL.

No significant financial relationships to disclose.

Variation of the activity concentrations and fluxes of natural (210Po, 210Pb) and anthropogenic (239,240Pu, 137Cs) radionuclides in the Strait of Gibraltar (Spain)

The activity concentrations and fluxes of natural (210Pb, 210Po) and anthropogenic (239,240Pu, 137Cs) radionuclides have been determined in the different water masses crossing the Strait of Gibraltar. New data have been gathered during four multidisciplinary and multinational sampling campaigns, performed between 1997 and 1999 within the framework of the CANIGO-FLUGIST Project. Mean activity concentrations of 210Po (1.53+/-0.34 Bq m(-3), n = 30) and 210Pb (1.16+/-0.50 Bq m(-3), n = 31) in the Atlantic water entering the Mediterranean basin are about double those measured in the Mediterranean outflow, namely 0.84+/-0.34 Bq m(-3) (n = 22) for 210Po and 0.66+/-0.34 Bq m(-3) (n = 22) for 210Pb. The opposite trend is observed for 231,240Pu, with average concentrations of 9.9+/-3.0 mBq m(-3) (n = 29) in the incoming Atlantic flow and 22.0+/-3.0 mBq m(-3) (n = 22) in the outpouring Mediterranean water. In the case of 137Cs, the same concentrations were quantified in the waters moving inwards (2.52+/-0.28 Bq m(-3), n = 27) and outwards (2.14+/-0.52 Bq m(-3), n = 21) from the Mediterranean Sea. On this basis, the Mediterranean basin experiences a net annual input flux of 14 TBq of 210Pb and 19 TBq of 210Po, and a net annual loss of 0.34 TBq of 239,240Pu, while--at present--137Cs input and output fluxes appear to be balanced.

Distributions of Pu, Am and Cs in margin sediments from the western Mediterranean (Spanish coast)

Continental margins are important areas to be considered when studying the distributions and depositions of pollutants, both conventional and radioactive. Coastal sediments accumulate most of those contaminants which can be introduced following atmospheric and/or fluvial pathways. Moreover, their residence times within the water column are usually shortened due to their affinity to associate with the downward falling particulate matter, more abundant at shallower depths. In this paper the distribution profiles and inventories of plutonium, americium and cesium are detailed, providing useful information about recent sedimentation phenomena such as sediment mixing, slumping processes and bioturbation. Unsupported 210Pb data are used as reliable indicators of enhanced/reduced deposition events. Also, the calculated inventories have enabled the estimation of the radiological contribution of the Spanish Mediterranean margin to the total radioactivity deposited onto the Mediterranean sea floor.

Vertical and horizontal fluxes of plutonium and americium in the western Mediterranean and the Strait of Gibraltar

New data on the vertical distributions of plutonium and americium in the waters of the western Mediterranean and the Strait of Gibraltar are examined in terms of the processes governing their delivery to, transport in and removal from the water column within the basin. Residence times for plutonium and americium in surface waters of approximately 15 and approximately 3 years, respectively, are deduced, and it is shown that by the mid 1990s only approximately 35% of the 239,240Pu and approximately 5% of the 241Am deposited as weapons fallout still resided in the water column. Present 239,240Pu inventories in the water column and the underlying sediments are estimated to be approximately 25 TBq and approximately 40 TBq, respectively, which reconcile well with the time-integrated fallout deposition in this zone, taken to be approximately 69 TBq. The data show that there are significant net outward fluxes of plutonium and americium from the basin through the Strait of Gibraltar at the present time. These appear to be compensated by net inward fluxes of similar magnitude through the Strait of Sicily. Thus, the time-integrated fallout deposition in the western basin can be accounted for satisfactorily in terms of present water column and sediment inventories. Enhanced scavenging on the continental shelves, as evidenced by the appreciably higher transuranic concentrations in shelf sediments, supports this contention.

137Caesium distribution in the eastern Mediterranean Sea: recent changes and future trends

A series of sampling campaigns were carried out in the eastern Mediterranean in the period 1995-1997, to examine the relationship between the distribution of 137Cs in the water column and water mass circulation. 137Cs concentration in the surface water ranges between 3.3 and 4.0 mBq/l all over the area, indicating that the input due to the Chernobyl accident has been transferred to deep water layers by convection processes. In fact, in the vertical profiles, relative maxima are observed in the intermediate (4 mBq/l) and deep waters (approximately 2.5 mBq/l) formed after the Chernobyl accident. A clear Chernobyl signal also traces the new deep waters formed in the Aegean Sea that, exiting from the Cretan Arc Straits, since 1991 are spreading in the bottom layer of the eastern Mediterranean. The changes in 137Cs vertical profiles related to the new thermohaline circulation of the intermediate and deep waters of the eastern Mediterranean are being monitored at a deep station in the western Ionian Sea. The 1997 profile shows a decrease in 137Cs concentration both in the Levantine intermediate water and in the eastern Mediterranean deep water with respect to 1996. The decrease in Levantine intermediate water is likely due to seasonal/interannual variability, while the changes in the deep layer are related to the spreading westward into the Ionian of the new Aegean dense water. Along the path towards the western Mediterranean, 137Cs content in the Levantine intermediate water decreases from approximately 4 mBq/l in the W-Ionian Sea to approximately 2 mBq/l at the western sill of the Sicily Straits, due to mixing with underlying water, with lower caesium content, near the Malta Sill. Time-series measurements at the western sill of the Sicily Straits show that, while 137Cs concentration in the surface water entering the eastern Mediterranean remained constant (approximately 3.5 mBq/l) in the period 1993-1997, its level in the Levantine intermediate water leaving the basin decreased from 3.5 to 2.0 mBq/l.