Introduction: Malignant Pleural Mesothelioma (MPM) is characterized by an aggressive behavior and an inevitably fatal prognosis, whose treatment is still far from being standardized. The role of surgery is questionable since a radical resection is unattainable in most cases. Hyperthermic IntraTHOracic Chemotherapy (HITHOC) combines the advantages of antitumoral effects together with those of high temperature on the exposed tissues with the aim to improve surgical radicality. Material and Methods: this is a narrative review on the role of HITHOC in the management of MPM patients. To provide data on the beginnings and the historical evolution of this technique, we searched the available literature by selecting the more exhaustive papers on this topic. Results: from 1994 to date different authors experimented HITHOC following a cytoreductive surgery in MPM, obtaining in most cases a good local control and a better overall survival associated to very low complication rate. Conclusions: HITHOC may be considered as a safe, feasible and effective procedure although there is a high heterogeneity between different protocols adopted worldwide. More structured studies are needed to reach a unanimous consensus on this technique.
SARS-CoV2 outbreak led to several healthcare system challenges, especially concerning respiratory support to Covid-19 patients. In the first 2 years of pandemic (2020–2021), we assisted to a marked increase of post-invasive mechanical ventilation (IMV) tracheal stenosis incidence, many of them requiring surgical treatment, namely resection and primary end-to-end anastomosis. Our aim is to describe our experience during the abovementioned biennium, focusing on postoperative outcomes of patients who have had Covid-19 (“post-Covid”). We retrospectively collected pre-, intra- and postoperative data on all patients who underwent tracheal surgery for benign stenosis in our Unit from May 2020 to October 2021, including previous Covid-19. Comparison between “post-Covid-19” and “non-Covid-19” groups’ outcomes was then performed. Patients were 9 males and 6 females, and mean age was 57.4 ± 13.21 years. Nine patients had previous Covid-19 (60%). All patients underwent multidisciplinary preoperative evaluation. Almost every operation was conducted by cervicotomy, and the mean length of the resected specimen was 23.9 ± 6.5 mm. Postoperative complications were: dysphonia (3 cases), wound infection (1), bleeding (1), ab-ingestis pneumonia (1), anastomosis dehiscence (2), and stenosis recurrence (1). Thirty-day mortality rate was 6.7% (1 patient). No significant differences between “post-Covid-19” and “non-Covid-19” groups were identified. Pathology revealed, in 5 “post-Covid-19” patients, signs of vasculitis or perivascular inflammatory infiltrate. Tracheal stenosis’ surgical treatment has always been known as a challenging procedure because of high perioperative morbidity and mortality rates. Our experience shows that previous Covid-19 and ongoing pandemic did not significantly affect perioperative outcomes of patients who underwent tracheal resection and primary end-to-end anastomosis in a high-volume Center and after multidisciplinary workup. Graphical abstract
Primary focal hyperhidrosis is an idiopathic condition characterized by excessive sweating, predominantly localized in the hands and armpits. This condition affects about 1% of the general population and it is often associated with a deterioration of the Quality of Life (QoL), especially in younger patients. Medical therapy, usually prescribed as a first approach, is associated with good results, but only in the short term. Surgery, on the other hand, is associated with a definitive resolution of the disease in most patients. Currently, there is no consensus on the timing of treatment and the final decision is often at the discretion of the physician and the patient. The aim of this study is to analyze the post-operative, age-related QoL in patients affected by primary hyperhidrosis treated by surgery by analyzing data of 56 patients who underwent biportal thoracoscopic sympathectomy between January 2016 and October 2019, dividing the patients into two groups: under and over the age of 25. The QoL was studied by administering the IIRS questionnaire pre-operatively and then six months after surgery. Data analysis demonstrated a lower complication rate in younger patients and equal post-operative outcomes in the two age groups.
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