Nutritional status and lung transplantation: an intriguing problem

In lung cancer accurate assessment of the mediastinal lymph node status is of paramount importance for the stage assignment as well as crucial for the therapeutic plan. TAC and positron emission tomography (PET) are valuable tools to achieve a preliminary picture of the mediastinal staging but Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is considered the first choice for investigating mediastinal lymph nodes as recommended by updated guide-lines. Despite the EBUS-TBNA sensitivity is satisfactory, it is not high enough to exclude mediastinal lymph node metastases; therefore devices and technologies were implemented to increase its sensitivity. The purpose of this narrative review is to describe the tools aimed at correctly interpreting sonographic patterns during EBUS and maximizing the diagnostic accuracy of TBNA. The bibliographic research identified 354 articles potentially related to the purpose of the current review and after accurate reading we selected 21 articles. Eight articles focused on the sonographic features of lymph nodes found during EBUS, 2 papers considered the Doppler patterns and, finally, 18 studies analyzed the advantages of ultrasound elastography. Sonographic features, vascular patterns and ultrasound elastography have proved to be helpful in directing the operator to biopsy the most suspect lymph node, especially in patients with CT-negative and/or PET-negative mediastinum.

The malignant pleural effusion is a common clinical issue, connected with metastatic tumors or with primary tumor of the pleura. This narrative review focuses on the video-assisted thoracic surgery (VATS) diagnostic approach and treatment modalities for management of malignant pleural effusion. We conducted searches for clinical studies and guidelines through Medline, Embase and Cochrane Library. Limiting the search to the last decade, we selected 29 papers: 5 randomized controlled trials, 9 prospective cohort studies, 11 retrospective studies, 3 guidelines and 1 survey. Malignant pleural effusion frequently affects the clinical evolution of patients with metastatic cancer and proper diagnosis in low risk patients is mandatory in the era of target therapy. Pleural biopsy, performed through pleuroscopy or VATS remains the gold standard for the diagnosis of malignant pleural effusion. The non-intubated VATS is a good combination of surgical skills and anaesthesiological management that could avoid risks of general anesthesia. The type and number of surgical access seems have no relevant impact on the short-term outcome. The best treatment to prevent the accumulation of pleural fluid remains the talc poudrage, possibly followed by talc slurry in case of recurrence.

Background: Phosphaturic mesenchymal tumors are rare neoplasms, frequently presenting with osteomalacia. These neoplasms usually grow at a slow rate and are associated with unspecific symptoms.Case: In this study, we present the case of a 70‐year‐old woman who had been suffering from musculoskeletal pain, hypophosphatemia, and spontaneous fractures. Positron emission tomography with Gallium showed increase uptake in a subpleural lesion.Conclusion: The patient underwent surgical excision of the subpleural lesion with a non‐intubated uniportal video‐assisted thoracoscopic surgery approach.