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Biomedical subjects

V Beltrami

Publications and source records attributed to V Beltrami.

71 records · Page 4Linked to original sources
PubMedDate not supplied

Surgical treatment of T3 lung cancer invading the chest wall.

Lung tumors invading the chest wall are classed as belonging to the T3 group and are considered potentially resectable. Their management, however, is controversial, and extrapleural resection, when possible, is preferred to en bloc resection which is regarded as a far more invasive and dangerous operation. Five year survival rates for completely resected cases range in the literature from 25 to 35%, but survival rates are much worse if lymph node metastases are present. These poor outcomes have prompted the development of combined surgical approaches: preoperative radiation therapy, with or without chemotherapy, has been used with an improvement in resectability rates, but only modest results in terms of median survival; in a number of case series, increased operative morbidity and mortality have been reported with this approach. The present report relates to 122 patients treated by en bloc (20 cases) or extrapleural (102 cases) resection, 31 of whom also received neoadjuvant treatment. The operative mortality was 4.6%. Median survival was 17 months after en bloc resection and 19 months after extrapleural resection. Though no statistically significant difference was found, extrapleural resection would appear to yield better results than the en bloc procedure.

Adult↗
PubMedDate not supplied

Second primary lung cancer: possible prediction, treatment and prognosis.

The incidence of second primary lung cancer (SPLC) seems to have increased in recent years. In our series that included more than 4000 patients with lung cancer and 1600 operations, we observed 26 cases of SPLC up until June 1999. We considered the standard criteria accepted by most authors for the selection. Characteristics of patients and tumors at the time of the first operation were compared with the statistical data of our general series. Age, sex, performance status and smoking were all considered, as well as cancer site, histology, stage and type of first surgical operation. No significant independent factor could be identified for the prediction of a new tumor at that time. A second operation was possible in 16 cases: two patients died in the postoperative period, two survived for 12 and 24 months, respectively, 12 are still alive 8-87 months after the new resection. The high rate of surgical cases (16/26 = 62%) and a good survival rate is clearly correlated with an early diagnosis of SPLC.

Adult↗
PubMedDate not supplied

[Current indications for sublobar resection in non-small-cell bronchogenic carcinoma].

Over the past 30 years, there has been considerable controversy regarding the role of segmental and wedge resections in the management of stage I (T1-T2N0M0) non-small-cell lung cancer. Recently, a prospective randomized trial (Lung Cancer Study Group, 1995) revealed unfavorable results after limited resection, which, in early stage lung cancer, remains a reasonable option for patients with compromised pulmonary reserve, especially those in whom a previous contralateral resection has been performed. The following report describes the role of limited resection in the management of patients with T1-T2N0 non-small-cell lung cancer and presents a retrospective review of our series of 125 limited resections out of 1356 resections performed for lung cancer. In particular, long term survival and the frequency of local/regional recurrence were noted in 92 cases operated on with a curative intent. 26.6% vs 12.5% local/regional recurrence rates were observed among patients undergoing limited resections for T2 and T1 lung cancer, respectively. The five year survival in the limited resection group was 13.5% for T1 and 60% for T2 vs 51% and 72% in the standard procedure group, respectively. The lobectomy results were superior to those of sublobar resection. The latter should be reserved for patients in poor general condition contraindicating a standard lobectomy.

Adult↗
PubMedDate not supplied

[Major surgery in thoracic injuries].

Chest injuries have a high and steadily increasing incidence in western countries, but only some of the most common problems they create require an emergency thoracotomy or surgical video thoracoscopy. Flail chest, persistent pneumothorax, massive haemothorax, mediastinal emphysema, cardiac tamponade and intrathoracic foreign bodies can be identified as major surgical problems. Some of such patients (i.e. those with flail chest or foreign bodies) would be immediately candidates for major intervention. Other require fast but diagnostic procedures, because the choice of a therapy is dependent upon a precise identification of the damage. Injuries of trachea and primary bronchi, oesophagus, diaphragma, vena cava, great lung vessels, heart and aorta may represent important surgical emergencies; some leading rapidly to death. Fortunately, major surgical procedures are not really frequent in the management of thoracic traumas. Only 42 (3.5%) of nearly 2,000 patients with non-penetrating thoracic injuries had a thoracotomy or an surgical video thoracoscopy. The figure is far different for penetrating wounds; in fact 12 patients (41%) of 29 underwent mayor surgery.

Diagnosis, Differential↗
PubMedDate not supplied

[The surgery of tumors and "limited situations"].

The term "limit" applied to cancer surgery, denotes the ideological moment beyond which one cannot and should not propose any aggressive treatment. Such limits may concern the operability of a patient and may be represented by some general characteristics independent of the patient's current disease status (e.g. very old age, poor performance status, poor cardiac, respiratory, renal hepatic or mental conditions). They may concern the neoplastic involvement of the organ affected by the tumor: if undertaken, surgery should guarantee a reasonable duration of life, and a quality of life that makes it worth living. Other factors to be taken in consideration are the possibility the tumor spread to local or distant sites, as well as certain extreme conditions such as cancer, cachexia, liver/kidney failure, irreversible septic-toxic shock, ect. Moreover, there may be limits related to the structural conditions of the establishment where the operation is to be carried out (facilities, equipment, pharmacological supplies, medical and paramedical personnel) and to the social environment and the economic situation of the patient, in view of the assistance required following surgery. Lastly, a severe assessment of one's own fitness to perform any specific task should be part of the daily preparation of any surgeon.

Humans↗
PubMedDate not supplied

[Lymphadenectomy in the surgical treatment of bronchogenic carcinoma].

Bronchogenic carcinoma is one of the tumors with the statistically most markedly rising incidence, at least in western countries. For many years both the resectability and the long-term results have remained invariable due to the serious delay with which the disease is usually diagnosed. In addition, the success of treatment appears to be closely correlated with disease stage; in particular lymph node involvement has a major influence on the long-term survival following adequate treatment. As a consequence, a strong conviction has established itself in recent years, that radical removal of all mediastinal lymph node stations ipsilateral to the operated lung represents not only a necessary staging procedure, but also a useful measure to improve the prognosis of these patients. However, the real utility of radical lymphadenectomy is questioned by a number of groups: on the one hand the supporters of lymph node "sampling", inasmuch as the usefulness of radical lymphadenectomy has not been demonstrated by randomized clinical trials; on the other hand those workers, in particular from Japan, who on the basis of observations of the lymphatic flow in the mediastinum stress the necessity to extend lymph node clearance to the nodal station contralateral to the tumor. The current opinion is changing under the influence of recent developments, for instance the possible use of the sentinel technique also in lung cancer, and the possibility of "reasonable" or targeted lymphadenectomies, planned in relation to the lobar location of individual tumor. Whichever of these approaches is chosen--and this choice is still a matter of debate--many agree about the importance of neoadjuvant treatment not only to render patients eligible for surgery but also to improve the prognosis for patients at the most advanced stages of the disease.

Carcinoma, Bronchogenic↗
PubMedDate not supplied

[Reoperations in lung surgery].

A second thoracotomy in patients who have undergone previous chest surgery can be performed soon or immediately after the first operation and is usually aimed at resolving severe or even life-threatening postoperative complications. Late reoperations, on the other hand, are either performed to resolve complications of previous surgery or to remove second primary lung tumors (SPLCs) or metastases. The most exacting reoperation in this context is completion pneumonectomy, which is particularly indicated in the case of failure of the residual lobe to re-expand after primary surgery; it is also used for--rarely occurring--fistulas of the lobar bronchi and for new ipsilateral primary lung tumors. This type of surgery is technically complicated and has been associated, in our experience and that of others, with a certain mortality. Technically less difficult is a second ipsilateral thoracotomy for exploratory purposes or minor parenchymal resection, and the same is true of contralateral lobar or sublobar resections. Lastly, Abruzzini's operation, for fistulas of the primary bronchus, is relatively complicated but often leads to good results; we have performed 15 such operations with only one death occurring due to acute myocardial infarction.

Adolescent↗
PubMedDate not supplied

[Neurogenic tumors of the mediastinum].

Neurogenic neoplasms represent approximately 20% of the space-occupying lesions in the mediastinum. They are primary tumors originating from structures belonging to the peripheral or sympathetic nervous system, they are most commonly diagnosed in subjects in the age range between 10 and 30 years. Benign forms are significantly more frequent than malignant forms, an observation that was confirmed by our own experience; whether these tumors have a predilection for the male or female sex cannot be concluded from the various case series studied to date. Surgical resection can be considered the treatment of choice on the basis of the long-term results, which are greatly satisfactory in benign tumors and encouraging in the malignant variants.

Adolescent↗
PubMedDate not supplied

[Prognostic markers of the epithelial tumors of the large intestine].

The surgical treatment of large bowel malignant tumors is now the most important therapeutic approach. The aim of our study was to evaluate a possible prognostic implication of ploidy and NM23 expression. The study includes 120 non selected patients who underwent surgery for colorectal cancer. The analysis of ploidy was obtained with cytometric test. The cases with only one gaff G0/G1 were considered as diploid. Patteras with more than one aneuploidic population were classified as multiploidic or poliploidic. While NM23 expression was evaluated with a double blind retrospective study by two separate equipe of authors in different centres. NM23 positivity degree was classified in 3 classes: absent or weak if < 10%; moderate if 10-50%; strong if > 50%. Forty-two patients (35%) were classified as diploidic; 30 patients (25%) as aneuploidic; 40 patients (33.2%) as multiploidic; in 8 cases (6.7%) the material was inadequate. Among the two groups who evaluated NM23 expression the group I a positivity: absent or weak in 32 cases (26.7%); moderate in 62 cases (51.7%); strong in 26 cases (21.6%); while the group II shows positivity: absent or weak in 30 cases (25%); moderate in 52 cases (43.3%); strong in 38 cases (31.7%). We cannot consider ploidy and the NM23 research as independent prognostic factor.

Carcinoma↗
PubMedDate not supplied

[Pericardial and pulmonary vascular involvement].

Over five hundred lung resections were considered, out of a series of 1570 cases of lung cancer. Histology of resected patients resulted squamous (348), adenocarcinoma (107), large cells (21) and small cells carcinoma (37). According to Mountain staging, 41% of patients were related to stage Ist, 12% to the IInd, 40.9% to the IIInd A: in such a group, a special class T3N0M0 was considered, due to the better follow-up observed in such cases. Lobectomies and minor resections were performed in 321 cases, pneumonectomies in 192. An analysis was done of differences in Histology, staging, early mortality, complications and late results after pneumonectomy which was traditional in 117 patients and required an intrapericardial section of great vessels in 68 cases: 16 patients had some pericardial resection, specific ECG disturbances, early mortality and recurrence within five years proved to be higher in the patients who had some pericardial operation: also as far as no connection was recognized with histology, the responsibility of such results can be attributed to the stage, that in those patients required a more aggressive operation.

Adenocarcinoma↗
PubMedDate not supplied

[Occupational asthma caused by inhalation of cuttlefish bone dust].

This report describes a new case of occupational asthma in a goldsmith. A 25-year-old female suffered attacks of urticaria and asthma at each exposure to the dust of cuttle-fish bone used to polish gold jewellery. A specific occupational bronchial provocation challenge showed a dual asthmatic response with a maximum fall in FEV1 of 26% of the baseline value after 6 hours. A prick-test with crude cuttle-fish bone dust in glycerin 10% also gave a positive response.

Adult↗
PubMedDate not supplied

Hypersensitivity to pets in Italy.

Eight hundred and two consecutive symptomatic outpatients (with asthma and rhinitis) were studied to evaluate the incidence of prick test positivity to cat and dog danders and the association of exposure to these animals in the home, as revealed by a standard questionnaire. 14.3% were found to be skin positive to cat and/or dog danders. The incidence of cutaneous hypersensitivity to cat and/or dog danders was 25% in the 216 subjects who kept animals, significantly higher (p less than 0.0005) than the 10.4% of 586 subjects who did not keep animals. In the 57 subjects who owned both dogs and cats, a significantly higher incidence of skin hypersensitivity was found compared to the other subjects. Our data does not demonstrate a greater incidence in sensitivity to cat danders compared to dog danders, or increased sensitization to dermatophagoides pteronyssinus, nor a different incidence of clinical manifestations (asthma and rhinitis) between those with animals in the house and those without.

Adolescent↗
PubMedDate not supplied

Detection of specific antibodies in immune complexes of farmer's lung patients.

The authors examined 23 precipitin-positive symptomatic patients with Farmer's Lung(FL) and compared them to different groups of exposed asymptomatic precipitin-positive(EAPP) and precipitin- negative(EAPN) farmers. The sera were tested using several techniques (i.e., immunodiffusion and ELISA for specific antibodies; polyethylene glycol [PEG] for circulating immune complexes [CIC]) in an attempt to find an in vitro test correlated with the disease which could also provide an insight into the pathogenic mechanisms of Farmer's Lung. Circulating immune complexes formed by IgG were significantly higher in Farmer's Lung patients than in EAPP subjects. In polyethlyene glycol precipitates from Farmer's Lung patients, specific antibodies found by ELISA correlated well with serum positivity, but they were not found in EAPP subjects. The possibility that the circulating immune complexes found were Ig aggregates was ruled out, as was the possibility that the antibodies found in the polyethylene glycol precipitate were also due to an unspecific link. The authors suggest that the circulating immune complexes of Farmer's Lung patients contain specific specific antibodies and that since their composition is different in EAPP subjects, these circulating immune complexes may play a role in the pathogenesis of the disease.

Antibody Specificity↗
PubMedDate not supplied

Cardiac herniation following intrapericardial pneumonectomy.

Cardiac herniation is a rare, highly lethal complication of intrapericardial pneumonectomy, demanding urgent treatment. The condition presents in the immediate or early postoperative period. Cardiovascular collapse is invariably present. Elevation of the jugular venous pressure and cyanosis in the drainage area of the superior vena cava are frequently noted. ECG may demonstrate the abnormal position and some ischemia of the heart. The effects of cardiac herniation are due to a combination of cardiac malposition, with subsequent torsion of the great vessels, obstruction to the outflow of blood from the heart and strangulation of the prolapsed ventricles by the borders of the pericardial defect. The diagnosis rests on an awareness of this condition, its clinical manifestations and radiological examination. Urgent reduction of the herniated heart gives the only possibility of survival. Prevention of possible recurrence must be considered.

Adenocarcinoma↗
PubMedDate not supplied

A phase II study of neoadjuvant chemotherapy with cisplatin epirubicin and VP-16 for stage III unresectable non-small cell lung cancer.

BACKGROUND: The survival rate for surgically resected stage III N2 non-small cell lung cancer (NSCLC) patients is less than 10%. METHODS: A phase II study of cisplatin, epirubicin, and VP-16 (PEV) was undertaken in an attempt to improve the curative potential of surgery. Forty-one patients with stage III N2 NSCLC received 3 cycles of pEV. Patients with either complete response (CR) or partial response (PR) underwent surgery and 3 additional courses of PEV. RESULTS: The response rate in the whole patient population was 58%. Eighteen patients were resected; twelve resections were complete and 6 were incomplete. Toxicity was mild and consisted mainly of myelosuppression. Twenty-six patients have died, and the median survival of all 41 patients was 18.1 months, with a 3-year survival of 23%. The median survival for those patients who were resected was 27 months with a 3-year survival of 42%. CONCLUSIONS: PEV is an effective low toxic drug combination for limited NSCLC.

Adenocarcinoma↗