Alfonso Fiorelli | Università della Campania Luigi Vanvitelli (original) (raw)

Papers by Alfonso Fiorelli

Clinical cancer research : an official journal of the American Association for Cancer Research, Jan 29, 2015

Resistance to tyrosine kinase inhibitors (TKIs) of epidermal growth factor receptor (EGFR) is oft... more Resistance to tyrosine kinase inhibitors (TKIs) of epidermal growth factor receptor (EGFR) is often related to activation of other signaling pathways and evolution through a mesenchymal phenotype. Since Hedgehog (Hh) pathway has emerged as an important mediator of epithelial-to-mesenchymal transition (EMT), we studied the activation of Hh signaling in models of EGFR TKIs intrinsic or acquired resistance from both EGFR mutated and wild-type (WT) non small cell lung cancer (NSCLC) cell lines. Activation of the Hh pathway was found in both models of EGFR-mutated and EGFR-WT NSCLC cell line resistant to EGFR-TKIs. In EGFR mutated HCC827-GR cells we found SMO (the Hh receptor) gene amplification, MET activation and the functional interaction of these two signaling pathways. In HCC827-GR cells inihibition of SMO or downregulation of GLI1 (the most important Hh-induced transcription factor) expression in combination with MET inhibition exerted significant antitumor activity. In EGFR-WT NSC...

Annali italiani di chirurgia

Thyroidectomy is considered a low-risk operation. The authors report a case of tracheal necrosis ... more Thyroidectomy is considered a low-risk operation. The authors report a case of tracheal necrosis after total thyroidectomy for multinodular goiter with bilateral adenomas, and a case of oesophageal fistula after total thyroidectomy for papillary cancer. The patient with tracheal perforation was treated by a non operative management after clinical stabilization. The patient with oesophageal perforation underwent surgical treatment consisting of neck drain placement. Both patients are alive after 12 months of follow-up, although the patient who had surgery for papillary cancer of the thyroid gland was found to have multiple diffuse liver and lung metastases. Thyroidectomy is a safe surgical procedure, but in some patients major complications may arise. In cases of iatrogenic tracheal or oesophageal perforation, conservative non-surgical or conservative surgical treatment, in specialized centers, results in a favourable outcome. The authors discuss the risk factors and management of th...

Annali italiani di chirurgia

Tracheal rupture is a rare condition, and its most common cause is head and neck injury. Nontraum... more Tracheal rupture is a rare condition, and its most common cause is head and neck injury. Nontraumatic disruption of the anterolateral fibrocartilaginous trachea is an exceptional complication following thyroidectomy with few cases reported in literature. We report a case of upper tracheal necrosis arising 15 days after uneventful total thyroidectomy and resulted in pneumomediastinum and subcutaneous emphysema. The patient felt a sudden pop in his neck following an episode of vigorous coughing and experienced rapid swelling in his neck. The presence of pneumomediastinum was diagnosed on chest Computed Tomography scan and bronchoscopy visualized a small perforation on the right side of the anterolateral tracheal wall. The first interesting aspect is that several factors (female gender, thyrotoxic goiter, wound infection or excessive use of diathermy) reported as possible cause of anterior tracheal necrosis in the previous reports are unlike for the present case. The second unusual poi...

Asian Cardiovascular and Thoracic Annals, 2015

We report tracheal-bronchial migration of a covered esophageal self-expanding metal stent used to... more We report tracheal-bronchial migration of a covered esophageal self-expanding metal stent used to relieve dysphagia in a patient with advanced esophageal cancer. The stent eroded the trachea and completely occluded the main left bronchus. Surgery was contraindicated due to her poor clinical condition, and insertion of another stent in the trachea, esophagus, or both was contraindicated due to extension of the fistula. Esophageal exclusion with a combination of cervical esophagostomy and an enteral feeding tube was the only feasible treatment to minimize spoilage by aspirated saliva and provide enteral nutrition.

Diagnostic cytopathology, Jan 21, 2015

Lung adenocarcinoma and papillary thyroid carcinoma (PTC) share a number of microscopic and immun... more Lung adenocarcinoma and papillary thyroid carcinoma (PTC) share a number of microscopic and immunophenotypical features. Thus, patients presenting with thyroid and lung synchronous neoplasms may be difficult on fine-needle aspiration (FNA) samples to define the site of origin of the malignancy. In the case reported here, inherent to a 57-years-old man presenting with a right lung mass and a large (44 mm) thyroid nodule, an integrated cytological, immunocytochemical and molecular approach enabled to clarify the primary nature of the neoplasm. FNA cytology showed in both sites papillary structures and nuclear changes reminiscent of PTC. The lung origin of the neoplasm was suggested on cell-block immunocytochemistry showing thyroid transcription factor-1 positive and PAX8 and TGB negative neoplastic cells. Next generation sequencing performed on the Ion Torrent platforms by the Ion Ampliseq Colon and Lung Cancer panel showed a similar genomic profile in both neoplastic sites with a con...

Translational lung cancer research, 2013

Resection of lung cancer associated with pneumoconiosis may be difficult since fibrosis limits th... more Resection of lung cancer associated with pneumoconiosis may be difficult since fibrosis limits the exposure of hilum, and the use of stapler; yet, surgery may be complicated by persistent air leaks due to the underlying disease. In this setting, LigaSure was used to perform the tumor resection, and the postoperative treatment of air leaks in the same patient was treated with placement of endobronchial valves.

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 11, 2015

Continuous wound infusion of local anaesthetics has been successfully applied for postoperative p... more Continuous wound infusion of local anaesthetics has been successfully applied for postoperative pain control in several procedures but, surprisingly, it is underused in thoracic surgery. We aimed to investigate the effects of wound analgesia associated with systemic patient-controlled analgesia in patients undergoing lung cancer resection with muscle-sparing thoracotomy. Sixty consecutive patients undergoing lung cancer resection via standard muscle-sparing thoracotomy were randomized into two groups (wound analgesia and placebo groups). Bupivacaine in the wound group and free-saline solution in the placebo group were injected using a multiholed catheter connected to an elastomeric pump inserted at the end of operation between the pericostal sutures and the serratus muscle and removed 48 h after. The inter-group differences were assessed by the following criteria: (i) level of cytokines [IL-6, IL-10 and tumour necrosis factor-alpha (TNF-alpha)]; (ii) pain on a visual analogue scale ...

The Annals of thoracic surgery, 2015

We report a case of a 35-year-old woman affected by costal exostosis, originating from the poster... more We report a case of a 35-year-old woman affected by costal exostosis, originating from the posterior arc of the left fifth rib, who complained of a persistent intractable neuralgia in the left T5 dermatome. Both pain and the risk of visceral injury led us to resect exostosis. The procedure was performed using a uniportal videothoracoscopic approach without additional incisions. For bone resection, we used Piezosurgery, a soft tissue-sparing system based on ultrasound vibrations. Piezosurgery allowed the complete resection of exostosis without injuring the intercostal nerve and vessels. The histologic analysis confirmed the diagnosis of osteochondroma and showed no sign of malignancy. The patient was discharged 2 days after the operation. Considering the lack of symptoms, the low risk of degeneration, and the absence of recurrence at 12-month follow-up, the simple resection of exostosis without performing a more extensive rib resection was judged to be optimal.

Interactive cardiovascular and thoracic surgery, 2015

As airway management specialists, thoracic surgeons should be familiar with percutaneous dilatati... more As airway management specialists, thoracic surgeons should be familiar with percutaneous dilatational tracheostomy. To optimize the learning curve, we propose a home-made pig model obtained from a slaughterhouse for training residents in the technical aspects of performing percutaneous dilatational tracheostomy. The satisfaction of the residents' training experience using this model was compared with that using a standard manikin model. Fifty residents participated in the present study. At the end of the session, each participant completed a questionnaire assessing the pig model and the manikin by assigning a score (ranging from 1 to 4) to five specific characteristics including (i) reality of skin turgor; (ii) landmark recognition; (iii) feasibility of the procedure; (iv) reality of the model and (v) preference of each model. The differences between models were statistically analysed. Forty-five participants completed the study. The pig model, compared with the manikin model, p...

General thoracic and cardiovascular surgery, Jan 16, 2014

We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clav... more We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival.

Interactive cardiovascular and thoracic surgery, 2014

The aim of the present paper was to conduct a comparative analysis of outcomes after thoracoscopi... more The aim of the present paper was to conduct a comparative analysis of outcomes after thoracoscopic resection versus standard thoracotomy approach in the treatment of Pancoast tumours. All consecutive patients with Pancoast tumours undergoing surgical treatment from March 2000 to November 2012 were enrolled. Patients were divided into 2 groups according to whether a thoracoscopic or standard thoracotomy approach was adopted. In addition to morbidity and mortality, (i) intensity of pain; (ii) respiratory function focusing on the postoperative value and its variation with respect to the predicted value (Delta); (iii) analgesic consumption at different times during the postoperative course; and (iiii) survival rate were recorded in both groups and the inter-group differences were statistically compared. Of the 45 enrolled patients, 34 (75%) were included in the final analysis (18 in the thoracoscopic group and 16 in the standard group). Eleven (25%) patients were excluded because they (...

Interactive cardiovascular and thoracic surgery, 2014

Surgery is the treatment of choice for management of pulmonary hydatid cysts. Total pericystectom... more Surgery is the treatment of choice for management of pulmonary hydatid cysts. Total pericystectomy provided the best results concerning the recurrence of the disease, but haemorrhagia and air leak during dissection of the pericystic space are the main disadvantages of such a method. To avoid these complications, we proposed the use of an electrothermal bipolar tissue sealing system. After the extraction of the hydatid cyst, a small space is created between the pericyst and normal lung, and the separation between the two zones is joined using the electrothermal bipolar tissue sealing system. This procedure reduces the risk of bleeding and of air leaks because the bronchi and the vessels encountered during dissection are sealed by the electrothermal bipolar tissue sealing system. When the pericystic membrane (inflammatory host reaction) is intimately adherent to the lung, total pericystectomy demands greater technical training because the bronchovascular axes of the healthy segments a...

Interactive cardiovascular and thoracic surgery, 2014

To investigate the role of volume quantitative assessment using multidetector-row computed tomogr... more To investigate the role of volume quantitative assessment using multidetector-row computed tomography to select patients scheduled for endobronchial one-way valves treatment. Twenty-five consecutive patients (15 with heterogeneous emphysema and 10 with giant emphysematous bulla) undergoing endobronchial valves treatment were enrolled. All patients were studied pre- and postoperatively with standard pulmonary functional tests and quantitative volume assessment of target lobe and entire lung. Emphysematous parenchyma was obtained applying density thresholds of -1.024/-950 Hounsfield units. Among different subtype of patients, we evaluated: (i) the differences between preoperative versus postoperative data; (ii) the correlation between functional and volumetric quantification changes and (iii) the critical threshold value of volumetric quantification of the target lobe in close association with clinical effects. Among heterogeneous emphysematous and giant emphysematous bulla patients, ...

Interactive cardiovascular and thoracic surgery, 2013

A best evidence topic in thoracic surgery was written according to a structured protocol. The que... more A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether surgery could ever be justified in non-small cell lung cancer patients with an unexpected malignant pleural effusion at surgery. Eight papers were chosen to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Study limitations included a lack of retrospective studies, the heterogeneous patient population and various treatments applied. Three papers found that surgery--compared to exploratory thoracotomy--was associated with a survival advantage in cases of minimal pleural disease. One paper showed that the median survival time of 58.8 months in patients with pleural effusion was better than that of patients with more extensive pleural dissemination as pleural nodule (10 months; P=0.0001) or pleural nodule with effusion (19.3 months; P=0.019)...

Annali italiani di chirurgia

We report a clinic case of patient in whom angiosarcoma of the heart presents as bilateral pulmon... more We report a clinic case of patient in whom angiosarcoma of the heart presents as bilateral pulmonary nodular infiltrates. The cardiac tumor was clinically silent, the electrocardiogram was normal and the cough was the only symptom. Chest CT scan (Fig. 1) showed bilateral diffuse nodular infiltrates ranging. Clinical clues, the results of laboratory tests and all of the cultures obtained excluded an infectious etiologies; the findings of CT-guided needle biopsy was inconclusive for a definitive diagnosis. Thus, the patient was scheduled for a thoracoscopic biopsy. Surprisingly, the pre-operatory echocardiogram showed a soft tissue mass fixed to the posterior wall of the right atrium. On retrospective reviewing of chest CT scan, a tumor was evident in the right atrium, but it was missed initially. In theory, the lung lesions attract the attention of the observer who had not taken into account anything else as to say: "the brain knows what the eyes want". The diagnosis ofpulm...

Journal of thoracic disease, 2011

Spontaneous pneumothorax is a rare complication of chemotherapy for lung neoplasm. Herein, we rep... more Spontaneous pneumothorax is a rare complication of chemotherapy for lung neoplasm. Herein, we report a case of right spontaneous pneumothorax occurring in a patient in whom lung metastases from synovial cell sarcoma were treated with combination chemotherapy. Chest tube alone was unable to attempt the resolution of air leaks. Thus, it was connected to gentle suction set at minus 15 cm of water which achieved complete re-expansion of the lung with reduction of air leaks. In closure, chemical pleurodesis was attempted using 5 gram of talc diluted in 50 ml normal saline solution instilled into the right pleural cavity via chest tube. The connecting tube was suspended at 30 cm above the level of the patient's chest for one hour and the patient's position was changed at 15 minutes intervals to ensure uniform distribution. At three months of follow-up, the patient had no-recurrence of pneumothorax.

Journal of thoracic disease, 2011

Pulmonary metastases from transitional cell carcinoma usually present as multiple nodules, solita... more Pulmonary metastases from transitional cell carcinoma usually present as multiple nodules, solitary mass, or interstitial micronodules but rarely manifested as cystic pulmonary lesions. We report an atypical case of multiple cavitating pulmonary metastases from transitional cell carcinoma of urinary bladder. Infectious disease is ruled out by sputum examination, laboratory exams and failure of response to antibiotic therapy. In closure, the need to exclude a second primary tumor led us to perform a fine-needle aspiration biopsy by which metastatic transitional cell carcinoma was diagnosed. Inadequacy of blood supply with necrosis may be advocated as possible mechanism of cavitations of the lesion.

Interactive cardiovascular and thoracic surgery, 2011

Negative-pressure pulmonary edema is an unusual complication mainly associated with general anest... more Negative-pressure pulmonary edema is an unusual complication mainly associated with general anesthesia. It is caused by excessive negative intrathoracic pressure following a deep inspiration against an acute airway obstruction. The resultant decreased intrathoracic pressure amplifies venous return to the right heart and increases pulmonary capillary wedge pressure that can be further amplified by massive sympathetic discharge due to hypoxia. The combination of increased venous return and pulmonary capillary wedge pressure favours the shift of fluid into the pulmonary interstitium with resultant pulmonary edema. Conversely, spontaneous pneumomediastinum (SP) results from alveolar rupture following an excessive positive intrathoracic pressure. The air leaks out of the alveoli and along the perivascular space toward the mediastinum. We experienced a case of negative pulmonary edema which presented in association with SP. Pneumomediastinum is probably caused by an excessive positive int...

Asian Cardiovascular and Thoracic Annals, 2015

We describe a bronchoscopic technique for closing small postoperative bronchopleural fistulas, us... more We describe a bronchoscopic technique for closing small postoperative bronchopleural fistulas, using an oxidized regenerated cellulose patch and fibrin glue. The patch is mounted on the end of endoscopic forceps and introduced into the fistula to cover it. Intracavitary and submucosal injections of fibrin glue fill the bronchial stump and achieve apposition of the fistula edges. Closure was obtained in 3 of 4 patients; the 4th had complete bronchial dehiscence and empyema.

Interactive CardioVascular and Thoracic Surgery, 2010

Our goal was to determine the role of vascular endothelial growth factor (VEGF) in diagnosing of ... more Our goal was to determine the role of vascular endothelial growth factor (VEGF) in diagnosing of pleural effusion (PE) in order to select patients deserving of more aggressive procedures. Seventy-nine consecutive patients with undiagnosed unilateral PE were enrolled. Pleural VEGF levels, measured using enzyme-linked immunosorbent assay (ELISA), were correlated to etiology of PEs and other markers (protein, lactic dehydrogenase, amylase, glucose). The median level of VEGF in exudates (ns65) was significantly higher than that in transudates (Ps0.0001) and among exudates, it was significantly higher in malignant (ns49) than that in benign exudates (Ps0.005). No significant differences were observed between malignant effusions due to lung cancer (ns11) and other malignant effusions wmesothelioma (ns13) andyor extra-thoracic cancerx. Among all variables evaluated, logistic regression found that only VEGF was significantly correlated with the presence of malignant disease (Ps0.002). Analysis of the receiver operating characterists (ROC) curves showed that the areas under the curve of VEGF were significantly larger than that of amylase (Ps0.02), glucose (Ps0.01), lactic dehydrogenase (Ps0.001) and protein (Ps0.01). VEGF increased the diagnostic rate of cytological examination by 24%. VEGF may represent a helpful adjunct to conventional diagnostic tools in ruling out malignancy as a probable diagnosis, thus guiding the selection of patients who might benefit from further invasive procedures.

Clinical cancer research : an official journal of the American Association for Cancer Research, Jan 29, 2015

Resistance to tyrosine kinase inhibitors (TKIs) of epidermal growth factor receptor (EGFR) is oft... more Resistance to tyrosine kinase inhibitors (TKIs) of epidermal growth factor receptor (EGFR) is often related to activation of other signaling pathways and evolution through a mesenchymal phenotype. Since Hedgehog (Hh) pathway has emerged as an important mediator of epithelial-to-mesenchymal transition (EMT), we studied the activation of Hh signaling in models of EGFR TKIs intrinsic or acquired resistance from both EGFR mutated and wild-type (WT) non small cell lung cancer (NSCLC) cell lines. Activation of the Hh pathway was found in both models of EGFR-mutated and EGFR-WT NSCLC cell line resistant to EGFR-TKIs. In EGFR mutated HCC827-GR cells we found SMO (the Hh receptor) gene amplification, MET activation and the functional interaction of these two signaling pathways. In HCC827-GR cells inihibition of SMO or downregulation of GLI1 (the most important Hh-induced transcription factor) expression in combination with MET inhibition exerted significant antitumor activity. In EGFR-WT NSC...

Annali italiani di chirurgia

Thyroidectomy is considered a low-risk operation. The authors report a case of tracheal necrosis ... more Thyroidectomy is considered a low-risk operation. The authors report a case of tracheal necrosis after total thyroidectomy for multinodular goiter with bilateral adenomas, and a case of oesophageal fistula after total thyroidectomy for papillary cancer. The patient with tracheal perforation was treated by a non operative management after clinical stabilization. The patient with oesophageal perforation underwent surgical treatment consisting of neck drain placement. Both patients are alive after 12 months of follow-up, although the patient who had surgery for papillary cancer of the thyroid gland was found to have multiple diffuse liver and lung metastases. Thyroidectomy is a safe surgical procedure, but in some patients major complications may arise. In cases of iatrogenic tracheal or oesophageal perforation, conservative non-surgical or conservative surgical treatment, in specialized centers, results in a favourable outcome. The authors discuss the risk factors and management of th...

Annali italiani di chirurgia

Tracheal rupture is a rare condition, and its most common cause is head and neck injury. Nontraum... more Tracheal rupture is a rare condition, and its most common cause is head and neck injury. Nontraumatic disruption of the anterolateral fibrocartilaginous trachea is an exceptional complication following thyroidectomy with few cases reported in literature. We report a case of upper tracheal necrosis arising 15 days after uneventful total thyroidectomy and resulted in pneumomediastinum and subcutaneous emphysema. The patient felt a sudden pop in his neck following an episode of vigorous coughing and experienced rapid swelling in his neck. The presence of pneumomediastinum was diagnosed on chest Computed Tomography scan and bronchoscopy visualized a small perforation on the right side of the anterolateral tracheal wall. The first interesting aspect is that several factors (female gender, thyrotoxic goiter, wound infection or excessive use of diathermy) reported as possible cause of anterior tracheal necrosis in the previous reports are unlike for the present case. The second unusual poi...

Asian Cardiovascular and Thoracic Annals, 2015

We report tracheal-bronchial migration of a covered esophageal self-expanding metal stent used to... more We report tracheal-bronchial migration of a covered esophageal self-expanding metal stent used to relieve dysphagia in a patient with advanced esophageal cancer. The stent eroded the trachea and completely occluded the main left bronchus. Surgery was contraindicated due to her poor clinical condition, and insertion of another stent in the trachea, esophagus, or both was contraindicated due to extension of the fistula. Esophageal exclusion with a combination of cervical esophagostomy and an enteral feeding tube was the only feasible treatment to minimize spoilage by aspirated saliva and provide enteral nutrition.

Diagnostic cytopathology, Jan 21, 2015

Lung adenocarcinoma and papillary thyroid carcinoma (PTC) share a number of microscopic and immun... more Lung adenocarcinoma and papillary thyroid carcinoma (PTC) share a number of microscopic and immunophenotypical features. Thus, patients presenting with thyroid and lung synchronous neoplasms may be difficult on fine-needle aspiration (FNA) samples to define the site of origin of the malignancy. In the case reported here, inherent to a 57-years-old man presenting with a right lung mass and a large (44 mm) thyroid nodule, an integrated cytological, immunocytochemical and molecular approach enabled to clarify the primary nature of the neoplasm. FNA cytology showed in both sites papillary structures and nuclear changes reminiscent of PTC. The lung origin of the neoplasm was suggested on cell-block immunocytochemistry showing thyroid transcription factor-1 positive and PAX8 and TGB negative neoplastic cells. Next generation sequencing performed on the Ion Torrent platforms by the Ion Ampliseq Colon and Lung Cancer panel showed a similar genomic profile in both neoplastic sites with a con...

Translational lung cancer research, 2013

Resection of lung cancer associated with pneumoconiosis may be difficult since fibrosis limits th... more Resection of lung cancer associated with pneumoconiosis may be difficult since fibrosis limits the exposure of hilum, and the use of stapler; yet, surgery may be complicated by persistent air leaks due to the underlying disease. In this setting, LigaSure was used to perform the tumor resection, and the postoperative treatment of air leaks in the same patient was treated with placement of endobronchial valves.

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 11, 2015

Continuous wound infusion of local anaesthetics has been successfully applied for postoperative p... more Continuous wound infusion of local anaesthetics has been successfully applied for postoperative pain control in several procedures but, surprisingly, it is underused in thoracic surgery. We aimed to investigate the effects of wound analgesia associated with systemic patient-controlled analgesia in patients undergoing lung cancer resection with muscle-sparing thoracotomy. Sixty consecutive patients undergoing lung cancer resection via standard muscle-sparing thoracotomy were randomized into two groups (wound analgesia and placebo groups). Bupivacaine in the wound group and free-saline solution in the placebo group were injected using a multiholed catheter connected to an elastomeric pump inserted at the end of operation between the pericostal sutures and the serratus muscle and removed 48 h after. The inter-group differences were assessed by the following criteria: (i) level of cytokines [IL-6, IL-10 and tumour necrosis factor-alpha (TNF-alpha)]; (ii) pain on a visual analogue scale ...

The Annals of thoracic surgery, 2015

We report a case of a 35-year-old woman affected by costal exostosis, originating from the poster... more We report a case of a 35-year-old woman affected by costal exostosis, originating from the posterior arc of the left fifth rib, who complained of a persistent intractable neuralgia in the left T5 dermatome. Both pain and the risk of visceral injury led us to resect exostosis. The procedure was performed using a uniportal videothoracoscopic approach without additional incisions. For bone resection, we used Piezosurgery, a soft tissue-sparing system based on ultrasound vibrations. Piezosurgery allowed the complete resection of exostosis without injuring the intercostal nerve and vessels. The histologic analysis confirmed the diagnosis of osteochondroma and showed no sign of malignancy. The patient was discharged 2 days after the operation. Considering the lack of symptoms, the low risk of degeneration, and the absence of recurrence at 12-month follow-up, the simple resection of exostosis without performing a more extensive rib resection was judged to be optimal.

Interactive cardiovascular and thoracic surgery, 2015

As airway management specialists, thoracic surgeons should be familiar with percutaneous dilatati... more As airway management specialists, thoracic surgeons should be familiar with percutaneous dilatational tracheostomy. To optimize the learning curve, we propose a home-made pig model obtained from a slaughterhouse for training residents in the technical aspects of performing percutaneous dilatational tracheostomy. The satisfaction of the residents' training experience using this model was compared with that using a standard manikin model. Fifty residents participated in the present study. At the end of the session, each participant completed a questionnaire assessing the pig model and the manikin by assigning a score (ranging from 1 to 4) to five specific characteristics including (i) reality of skin turgor; (ii) landmark recognition; (iii) feasibility of the procedure; (iv) reality of the model and (v) preference of each model. The differences between models were statistically analysed. Forty-five participants completed the study. The pig model, compared with the manikin model, p...

General thoracic and cardiovascular surgery, Jan 16, 2014

We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clav... more We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival.

Interactive cardiovascular and thoracic surgery, 2014

The aim of the present paper was to conduct a comparative analysis of outcomes after thoracoscopi... more The aim of the present paper was to conduct a comparative analysis of outcomes after thoracoscopic resection versus standard thoracotomy approach in the treatment of Pancoast tumours. All consecutive patients with Pancoast tumours undergoing surgical treatment from March 2000 to November 2012 were enrolled. Patients were divided into 2 groups according to whether a thoracoscopic or standard thoracotomy approach was adopted. In addition to morbidity and mortality, (i) intensity of pain; (ii) respiratory function focusing on the postoperative value and its variation with respect to the predicted value (Delta); (iii) analgesic consumption at different times during the postoperative course; and (iiii) survival rate were recorded in both groups and the inter-group differences were statistically compared. Of the 45 enrolled patients, 34 (75%) were included in the final analysis (18 in the thoracoscopic group and 16 in the standard group). Eleven (25%) patients were excluded because they (...

Interactive cardiovascular and thoracic surgery, 2014

Surgery is the treatment of choice for management of pulmonary hydatid cysts. Total pericystectom... more Surgery is the treatment of choice for management of pulmonary hydatid cysts. Total pericystectomy provided the best results concerning the recurrence of the disease, but haemorrhagia and air leak during dissection of the pericystic space are the main disadvantages of such a method. To avoid these complications, we proposed the use of an electrothermal bipolar tissue sealing system. After the extraction of the hydatid cyst, a small space is created between the pericyst and normal lung, and the separation between the two zones is joined using the electrothermal bipolar tissue sealing system. This procedure reduces the risk of bleeding and of air leaks because the bronchi and the vessels encountered during dissection are sealed by the electrothermal bipolar tissue sealing system. When the pericystic membrane (inflammatory host reaction) is intimately adherent to the lung, total pericystectomy demands greater technical training because the bronchovascular axes of the healthy segments a...

Interactive cardiovascular and thoracic surgery, 2014

To investigate the role of volume quantitative assessment using multidetector-row computed tomogr... more To investigate the role of volume quantitative assessment using multidetector-row computed tomography to select patients scheduled for endobronchial one-way valves treatment. Twenty-five consecutive patients (15 with heterogeneous emphysema and 10 with giant emphysematous bulla) undergoing endobronchial valves treatment were enrolled. All patients were studied pre- and postoperatively with standard pulmonary functional tests and quantitative volume assessment of target lobe and entire lung. Emphysematous parenchyma was obtained applying density thresholds of -1.024/-950 Hounsfield units. Among different subtype of patients, we evaluated: (i) the differences between preoperative versus postoperative data; (ii) the correlation between functional and volumetric quantification changes and (iii) the critical threshold value of volumetric quantification of the target lobe in close association with clinical effects. Among heterogeneous emphysematous and giant emphysematous bulla patients, ...

Interactive cardiovascular and thoracic surgery, 2013

A best evidence topic in thoracic surgery was written according to a structured protocol. The que... more A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether surgery could ever be justified in non-small cell lung cancer patients with an unexpected malignant pleural effusion at surgery. Eight papers were chosen to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Study limitations included a lack of retrospective studies, the heterogeneous patient population and various treatments applied. Three papers found that surgery--compared to exploratory thoracotomy--was associated with a survival advantage in cases of minimal pleural disease. One paper showed that the median survival time of 58.8 months in patients with pleural effusion was better than that of patients with more extensive pleural dissemination as pleural nodule (10 months; P=0.0001) or pleural nodule with effusion (19.3 months; P=0.019)...

Annali italiani di chirurgia

We report a clinic case of patient in whom angiosarcoma of the heart presents as bilateral pulmon... more We report a clinic case of patient in whom angiosarcoma of the heart presents as bilateral pulmonary nodular infiltrates. The cardiac tumor was clinically silent, the electrocardiogram was normal and the cough was the only symptom. Chest CT scan (Fig. 1) showed bilateral diffuse nodular infiltrates ranging. Clinical clues, the results of laboratory tests and all of the cultures obtained excluded an infectious etiologies; the findings of CT-guided needle biopsy was inconclusive for a definitive diagnosis. Thus, the patient was scheduled for a thoracoscopic biopsy. Surprisingly, the pre-operatory echocardiogram showed a soft tissue mass fixed to the posterior wall of the right atrium. On retrospective reviewing of chest CT scan, a tumor was evident in the right atrium, but it was missed initially. In theory, the lung lesions attract the attention of the observer who had not taken into account anything else as to say: "the brain knows what the eyes want". The diagnosis ofpulm...

Journal of thoracic disease, 2011

Spontaneous pneumothorax is a rare complication of chemotherapy for lung neoplasm. Herein, we rep... more Spontaneous pneumothorax is a rare complication of chemotherapy for lung neoplasm. Herein, we report a case of right spontaneous pneumothorax occurring in a patient in whom lung metastases from synovial cell sarcoma were treated with combination chemotherapy. Chest tube alone was unable to attempt the resolution of air leaks. Thus, it was connected to gentle suction set at minus 15 cm of water which achieved complete re-expansion of the lung with reduction of air leaks. In closure, chemical pleurodesis was attempted using 5 gram of talc diluted in 50 ml normal saline solution instilled into the right pleural cavity via chest tube. The connecting tube was suspended at 30 cm above the level of the patient's chest for one hour and the patient's position was changed at 15 minutes intervals to ensure uniform distribution. At three months of follow-up, the patient had no-recurrence of pneumothorax.

Journal of thoracic disease, 2011

Pulmonary metastases from transitional cell carcinoma usually present as multiple nodules, solita... more Pulmonary metastases from transitional cell carcinoma usually present as multiple nodules, solitary mass, or interstitial micronodules but rarely manifested as cystic pulmonary lesions. We report an atypical case of multiple cavitating pulmonary metastases from transitional cell carcinoma of urinary bladder. Infectious disease is ruled out by sputum examination, laboratory exams and failure of response to antibiotic therapy. In closure, the need to exclude a second primary tumor led us to perform a fine-needle aspiration biopsy by which metastatic transitional cell carcinoma was diagnosed. Inadequacy of blood supply with necrosis may be advocated as possible mechanism of cavitations of the lesion.

Interactive cardiovascular and thoracic surgery, 2011

Negative-pressure pulmonary edema is an unusual complication mainly associated with general anest... more Negative-pressure pulmonary edema is an unusual complication mainly associated with general anesthesia. It is caused by excessive negative intrathoracic pressure following a deep inspiration against an acute airway obstruction. The resultant decreased intrathoracic pressure amplifies venous return to the right heart and increases pulmonary capillary wedge pressure that can be further amplified by massive sympathetic discharge due to hypoxia. The combination of increased venous return and pulmonary capillary wedge pressure favours the shift of fluid into the pulmonary interstitium with resultant pulmonary edema. Conversely, spontaneous pneumomediastinum (SP) results from alveolar rupture following an excessive positive intrathoracic pressure. The air leaks out of the alveoli and along the perivascular space toward the mediastinum. We experienced a case of negative pulmonary edema which presented in association with SP. Pneumomediastinum is probably caused by an excessive positive int...

Asian Cardiovascular and Thoracic Annals, 2015

We describe a bronchoscopic technique for closing small postoperative bronchopleural fistulas, us... more We describe a bronchoscopic technique for closing small postoperative bronchopleural fistulas, using an oxidized regenerated cellulose patch and fibrin glue. The patch is mounted on the end of endoscopic forceps and introduced into the fistula to cover it. Intracavitary and submucosal injections of fibrin glue fill the bronchial stump and achieve apposition of the fistula edges. Closure was obtained in 3 of 4 patients; the 4th had complete bronchial dehiscence and empyema.

Interactive CardioVascular and Thoracic Surgery, 2010

Our goal was to determine the role of vascular endothelial growth factor (VEGF) in diagnosing of ... more Our goal was to determine the role of vascular endothelial growth factor (VEGF) in diagnosing of pleural effusion (PE) in order to select patients deserving of more aggressive procedures. Seventy-nine consecutive patients with undiagnosed unilateral PE were enrolled. Pleural VEGF levels, measured using enzyme-linked immunosorbent assay (ELISA), were correlated to etiology of PEs and other markers (protein, lactic dehydrogenase, amylase, glucose). The median level of VEGF in exudates (ns65) was significantly higher than that in transudates (Ps0.0001) and among exudates, it was significantly higher in malignant (ns49) than that in benign exudates (Ps0.005). No significant differences were observed between malignant effusions due to lung cancer (ns11) and other malignant effusions wmesothelioma (ns13) andyor extra-thoracic cancerx. Among all variables evaluated, logistic regression found that only VEGF was significantly correlated with the presence of malignant disease (Ps0.002). Analysis of the receiver operating characterists (ROC) curves showed that the areas under the curve of VEGF were significantly larger than that of amylase (Ps0.02), glucose (Ps0.01), lactic dehydrogenase (Ps0.001) and protein (Ps0.01). VEGF increased the diagnostic rate of cytological examination by 24%. VEGF may represent a helpful adjunct to conventional diagnostic tools in ruling out malignancy as a probable diagnosis, thus guiding the selection of patients who might benefit from further invasive procedures.