Lung ultrasound (LUS) is highly portable and has excellent diagnostic accuracy for pneumonia compared with conventional radiography, but the literature on its use in pulmonary tuberculosis (PTB) is limited. This study characterized lesions using LUS in patients with PTB and compared them with chest X-ray (CXR). Adult patients in Lima, Peru, with PTB were recruited within 1 week of starting antituberculosis treatment. Comprehensive LUS was performed in all patients at enrollment and assessed for consolidation, small subpleural consolidation (SPC, hypothesized to be a marker of CXR consolidation), cavity, pleural effusion, pathologic B-lines, and miliary pattern. Patient CXRs were digitized and interpreted by a board-certified radiologist. Fifty-one patients were included in the final analysis. Lung ultrasound detected either consolidation or SPC in 96.1% of participants. No significant difference was found between the LUS detection of a composite of consolidation or SPC, and CXR detection of consolidation (96.1% versus 98%, P = 1.00). The proportion of patients with cavity detected by LUS was significantly lower than that detected by CXR (5.9% versus 51%, P < 0.001). Overall, LUS detection of consolidation or SPC may be a sensitive marker for diagnosis of PTB. Lung ultrasound demonstrated poor ability to detect radiographically identified cavity, although previous studies suggest SPC could add specificity for the diagnosis of PTB. Based on its portability and evidence base for diagnosing other pulmonary diseases, LUS may have a role in screening and diagnosis of PTB in areas without ready access to CXR. Further studies should evaluate its diagnostic accuracy in patients with and without PTB.

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The acceptance of uniportal video-assisted thoracoscopic surgery (VATS) for minor and major thoracic procedures is growing in South America. This study presents the experience with uniportal VATS in Buenos Aires, Argentina. In a retrospective study, 181 patients were operated with uniportal VATS technique between December 2013 and October 2016. Uniportal procedures included minor and major procedures.Uniportal VATS were analyzed en terms of morbidity, mortality, conversion rate, hospital stay. A total of 181 patients were analyzed. 59% were males and 41% females. The mean age was 58.

Background Early studies have illustrated the robotic lobectomy to be safe, oncologically effective, and economically feasible as a therapeutic modality in the treatment of thoracic malignancies. The ‘challenging’ learning curve seemingly associated with the robotic approach, however, continues to be an often-cited factor to its ongoing uptake, with the overwhelming volume of these surgeries being performed in centers of excellence where extensive experience with minimal access surgery is the norm. An exact quantification of this learning curve challenge, however, has not been made, begging the question of whether this is an outdated assumption, versus fact. This systematic review and meta-analysis sort to clarify the learning curve for robotic-assisted lobectomy based on the existing literature. Methods An electronic search of four databases was performed to identify relevant studies outlining the learning curve of robotic lobectomy. The primary endpoint was a clear definition of operator learning (e.g., cumulative sum chart, linear regression, outcome-specific analysis, etc.) which could be subsequently aggregated or reported. Secondary endpoints of interest included post-operative outcomes and complication rates. A meta-analysis using a random effects model of proportions or means was applied, as appropriate. Results The search strategy identified twenty-two studies relevant for inclusion. A total of 3,246 patients (30% male) receiving robotic-assisted thoracic surgery (RATS) were identified. The mean age of the cohort was 65.3±5.0 years. Mean operative, console and dock time was 190.5±53.8, 125.8±33.9 and 10.2±4.0 minutes, respectively. Length of hospital stay was 6.1±4.6 days. Technical proficiency with the robotic-assisted lobectomy was achieved at a mean of 25.3±12.6 cases. Conclusions The robotic-assisted lobectomy has been illustrated to have a reasonable learning curve profile based on the existing literature. Current evidence on the oncologic efficacy and purported benefits of the robotic approach will be bolstered by the results of upcoming randomized trials, which will be critical in supporting RATS uptake.

A213accurate incidence and prevalence data, but incidence estimates were found to be 5-12 people/million/year in US. AL amyloidosis is associated with early mortality (median survival < 3 years in many series) and a 42-64% rate of non-response or progression. Costly complications of AL amyloidosis include disease-related organ failure. For example, kidney involvement is present in about 70% of patients, and rates of dialysis in patients with AL amyloidosis range from 5-18% with mean total 12-month healthcare costs (inpatient, outpatient and indirect costs) for patients receiving dialysis being $99,776. There are no disease specific patient-reported outcome (PROs) tools developed for AL amyloidosis, but patients report severe psychological distress, anxiety and also experience unintentional weight loss. There are no consistent clinical guidelines for treatment of AL amyloidosis especially after relapse as no drug has received FDA or EMA approval for this indication. Overall, limited efficacy and significant toxicity are still major concerns with current therapy. CONCLUSIONS: Limited epidemiologic and health outcomes data exist in the literature for relapsed or refractory AL amyloidosis. Treatment options are insufficient. New therapies which offer better clinical outcomes with less toxicity are needed to improve patient care.

Traditional approach of bilateral lesions usually involves bilateral approaches instead of classical thoracotomy or video-assisted thoracoscopic surgery (VATS) surgery, and often at two different times. During visit of Dr. Gonzalez Rivas at Master Class to Málaga, we performed right upper lobectomy and S3 wedge resection left upper lobe of a two synchronous bilateral lung lesions case with subxiphoid single incision approach. We are reporting the first case of a lobectomy combined with a wedge resection performed through an uniportal subxiphoid bilateral VATS in Spain.

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