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Federico Rea

Publications and source records attributed to Federico Rea.

At least 19 recordsLinked to original sources
PubMed2006

Extended tracheal resection for chondroma.

We report a case of a 43-year-old man who underwent an extended resection of the lower trachea for primary chondroma. Tracheal chondroma is a rare benign disease, arising from the cartilaginous rings, that grows intra-luminally or extends through the tracheal wall determining an obstructing syndrome. The endoscopy may be useful for diagnosis and palliative treatment, but the tracheal resection is recommended because the risk of recurrence or malignant transformation.

Adult↗
PubMed2006

Outcome and surgical strategy in bronchial carcinoid tumors: single institution experience with 252 patients.

OBJECTIVE: To evaluate type of surgery, long-term survival and factors influencing outcome in pulmonary carcinoid tumors. PATIENTS AND METHODS: We reviewed data of 252 patients who underwent surgery for carcinoid tumor in 1968-1989 (Group A) and in 1990-2005 (Group B). All cases were reviewed and classified as typical (TC) or atypical carcinoid (AC) according to WHO criteria (1999). RESULTS: There were 174 (69%) patients with TC (167 N0, 6 N1 and 1 N2) and 78 (31%) with AC (56 N0, 13 N1, 9 N2). Surgery consisted of 163 (64.7%) formal lung resections (121 lobectomies, 18 bilobectomies, 14 segmentectomies, 10 pneumonectomies), 76 (30.1%) sleeve or bronchoplastic resections and 13 (5.2%) wedge resections. No perioperative mortality occurred, 17 (6.7%) patients experienced complications. Overall 5, 10 and 15-year survival rate was 90%, 83% and 77%. TC showed a more favourable prognosis than AC (10-year survival rate 93% and 64%; p=0.00001) as well as N0 patients in comparison with N1-2 patients (10-year survival rate 87% and 50%; p=0.00005). Group A received lymph-node sampling, Group B received a systematic lymphadenectomy. No difference was found between Group A and B in detection of nodal metastases (10.9% versus 11.9%; p=0.79), but in Group A we observed 2 lymph-node relapses. In Group B number of sleeve resections significantly increased (2.7% versus 20.4%; p=0.0001) and number of pneumonectomies showed a significant reduction (7.2% versus 1.4%; p=0.01). CONCLUSIONS: Typical histology and N0 status were important prognostic factors in carcinoid tumors. Parenchyma-sparing procedures must be considered the treatment of choice with systematic lymphadenectomy.

Adolescent↗
PubMed2006

Metachronous bronchial carcinoid tumor.

We report a rare case of bilateral metachronous bronchial typical carcinoid tumor surgically treated. At the age of 33 years, the patient underwent, in another hospital, a left upper lobectomy for a typical carcinoid tumor. After 4 years, the patient manifested the symptoms of a new central typical carcinoid tumor located at the origin of the middle lobe bronchus and infiltrating the intermedius one. This tumor was first treated by laser therapy, but long-term follow-up evaluation with bronchoscopy revealed a local recurrence of disease. So we performed a middle sleeve lobectomy with radical node dissection.

Adult↗
PubMed2006

Large cell neuroendocrine carcinoma of the lung: a retrospective analysis of 144 surgical cases.

OBJECTIVE: Large cell neuroendocrine carcinoma of the lung are considered aggressive. However, reported prognoses are heterogeneous and the optimum treatment remains undefined. We retrospectively evaluated outcomes in a series of patients with a pathological diagnosis of large cell neuroendocrine lung carcinoma, who underwent lung resection. We also assessed the utility of chemotherapy in a small subgroup. PATIENTS AND METHODS: The clinical records of 144 consecutive patients were reviewed in a multicenter study. Survival times, assessed from the day of surgery until death or most recent follow-up, were estimated by the Kaplan-Meier method, and compared by the log rank test. RESULTS: There were 117 men and 27 women of median age 63 years. Twelve wedge resections, 3 segmentectomies, 95 lobectomies, 7 bilobectomies and 24 pneumonectomies were performed. Induction chemotherapy was given in 21 and postoperative chemotherapy in 24. Pathologically, 73 (50%) were stage I, 29 (20%) stage II, 40 (28%) stage III and 2 stage IV. Postoperative mortality was 2.8% and morbidity 26%. Overall 5-year survival was 42.5%: 52% for stage I, 59% for stage II and 20% for stage III (p=0.001 log-rank test on Kaplan-Meier curves). A trend to better outcome was associated with preoperative or postoperative chemotherapy in stage I disease (p=0.077) compared to no chemotherapy. The response rate to induction chemotherapy was 80% in the 15 patients with data available. CONCLUSION: large cell neuroendocrine carcinoma of the lung are confirmed as aggressive but are also chemosensitive. Our experience suggests that chemotherapy may improve prognosis in stage I disease.

Adult↗
PubMed2006

Giant localized fibrous tumours of the pleura: report of three subsequent cases.

Localized fibrous tumours of the pleura (LFTP) represent clinical entities rarely encountered, especially in giant forms. We report of three cases of giant localized fibrous tumours of the pleura found last year in a short time. The patients underwent surgery by thoracotomy. All tumours arose from visceral pleura and were radically excised by a wedge resection of the lung. The patients discharged from the hospital after a short postoperative period without complications. Two of three giant localized fibrous tumours were classified as benign forms; in one case a malignant characteristic was found.

Adult↗
PubMed2006

Experience with the "da Vinci" robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases.

BACKGROUND: Our initial experience in applying robotic-assisted technologies for the treatment of myasthenia gravis (MG) in patients without thymoma is reported. METHODS: from April 2002 to October 2004, 33 patients (24 females and 9 males; mean age, 41 years), with clinical nonthymomatous myasthenia gravis, underwent robotic thoracoscopic thymectomy using the "da Vinci" (Intuitive Surgical, Inc, Mountain View, CA) system and adopting a 3 port, left-sided approach. RESULTS: Mean operative time was 120 minutes. No intraoperative complications or surgical mortality is reported and postoperative complications occurred in two patients (6%). Mean hospital stay was 2.6 days (range, 2-14 days). Histologic analysis of surgical specimens revealed 23 hyperplasia, 4 normal thymus, 4 atrophy, and 2 thymomas; in 12 patients (36.3%) ectopic thymic tissue was found. Follow-up evaluation of the first 24 patients (mean, 23.8 months; range, 12-31 months) showed that 4 patients (16.7%) had complete remission and 18 (75%) had significant clinical improvement for a global benefit rate of 91.7%. CONCLUSIONS: In patients with MG, robot-assisted thymectomy can be performed safely and efficiently. The improved visualization and dexterity of this instrument and its advanced technology may facilitate the minimally invasive approach to the thymus. We prefer to use the left-sided approach because it provides an enhanced visualization of the aortic window and it reduces the probability of phrenic nerves injury. A longer follow-up is necessary to verify long-term clinical results.

Adolescent↗
PubMed2005

Marked alveolar apoptosis/proliferation imbalance in end-stage emphysema.

BACKGROUND: Apoptosis has recently been proposed to contribute to the pathogenesis of emphysema. METHODS: In order to establish if cell fate plays a role even in end-stage disease we studied 16 lungs (9 smoking-associated and 7 alpha1antitrypsin (AAT)-deficiency emphysema) from patients who had undergone lung transplantations. Six unused donor lungs served as controls. Apoptosis was evaluated by TUNEL analysis, single-stranded DNA laddering, electron microscopy and cell proliferation by an immunohistochemical method (MIB1). The role of the transforming growth factor (TGF)-beta1 pathway was also investigated and correlated with epithelial cell turnover and with the severity of inflammatory cell infiltrate. RESULTS: The apoptotic index (AI) was significantly higher in emphysematous lungs compared to the control group (p < or = 0.01), particularly if only lungs with AAT-deficiency emphysema were considered (p < or = 0.01 vs p = 0.09). The proliferation index was similar in patients and controls (1.9 +/- 2.2 vs 1.7 +/- 1.1). An increased number of T lymphocytes was observed in AAT-deficiency lungs than smoking-related cases (p < or = 0.05). TGF-beta1 expression in the alveolar wall was higher in patients with smoking-associated emphysema than in cases with AAT-deficiency emphysema (p < or = 0.05). A positive correlation between TGF-betaRII and AI was observed only in the control group (p < or = 0.005, r2 = 0.8). A negative correlation was found between the TGF-beta pathway (particularly TGF-betaRII) and T lymphocytes infiltrate in smoking-related cases (p < or = 0.05, r2 = 0.99) CONCLUSION: Our findings suggest that apoptosis of alveolar epithelial cells plays an important role even in end-stage emphysema particularly in AAT-deficiency disease. The TGFbeta-1 pathway does not seem to directly influence epithelial turnover in end-stage disease. Inflammatory cytokine different from TGF-beta1 may differently orchestrate cell fate in AAT and smoking-related emphysema types.

Apoptosis↗
PubMed2005

Somatostatin analogs in vitro effects in a growth hormone-releasing hormone-secreting bronchial carcinoid.

A 29-yr-old woman presented with acromegaly, pituitary gland enlargement, and an isolated pulmonary mass of 3.3 cm in diameter, which displayed a very high tracer uptake after OctreoScan. Plasma GHRH levels were markedly elevated. The patient underwent left lung upper lobectomy, and histopathology disclosed a bronchial atypical carcinoid. The tissue was examined for somatostatin (SRIH) receptor subtypes (SSTRs) 1-5 expression by RT-PCR. Cultured tumor cells were treated with SRIH, lanreotide (BIM-23014), or SRIH analogs selective for SSTR2 (BIM-23120), SSTR5 (BIM-23206), or SSTR1 (BIM-23926). GHRH was measured in the medium after 6 h, and cell viability was assessed after 48 h. RT-PCR analysis showed expression of SSTR1, -2, and -5. GHRH secretion was significantly reduced by SRIH (-50%), Lan (-35%), as well as by the SSTR2, SSTR5, and SSTR1 selective agonists (-55, -75, and -20%, respectively), whereas cell viability was not affected. Our data show SSTR expression in a GHRH-secreting bronchial carcinoid and provide evidence that, in vitro, selective SSTR activation differently inhibit ectopic GHRH secretion. These findings suggest that SSTR-specific SRIH analogs may be useful in the medical therapy of GHRH-secreting bronchial carcinoids.

Adult↗
PubMed2005

Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study.

OBJECTIVE: The purpose of this study was to evaluate the effect of lobectomy on pulmonary function in patients with chronic obstructive pulmonary disease. METHODS: One hundred thirty-seven patients were analyzed; 49 had normal pulmonary function tests, and 88 had chronic obstructive pulmonary disease. Different functional parameter groups were identified: obstructive (forced expiratory volume in 1 second [FEV1], forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC], and chronic obstructive pulmonary disease index), hyperinflation (residual volume and functional residual capacity), and diffusion (transfer factor of the lung for carbon monoxide). Also, the ratio between observed and predicted postoperative FEV(1) was calculated. RESULTS: In patients with preoperative FEV1 greater than 80% of predicted, postoperative FEV1/FVC slightly but not significantly decreased, and postoperative FEV1 significantly decreased. In patients with preoperative FEV1 less than 65%, postoperative FEV1 and FEV1/FVC significantly increased. In patients with preoperative FEV1/FVC greater than 70%, postoperative FEV1 and FEV1/FVC significantly decreased. In patients with preoperative FEV1/FVC less than 70%, postoperative FEV1/FVC increased, and FEV1 remained unchanged. In patients with a chronic obstructive pulmonary disease index greater than 1.5, postoperative FEV1 and FEV1/FVC significantly decreased, whereas in patients with a chronic obstructive pulmonary disease index less than 1.5, postoperative FEV1/FVC significantly increased and FEV1 remained unchanged. In patients with residual volume and functional residual capacity greater than 115% and transfer factor of the lung for carbon monoxide less than 80% of predicted, postoperative FEV1 diminished less (not significant) compared with patients who had residual volume and functional residual capacity less than 115% (P = .0001). Observed postoperative/predicted postoperative FEV1 was higher if FEV1/FVC was less than 55% (1.46), if FEV1 was less than 80% of predicted (1.21), or if the chronic obstructive pulmonary disease index was less than 1.5 (1.17). CONCLUSIONS: Patients with mild to severe chronic obstructive pulmonary disease could have a better late preservation of pulmonary function after lobectomy than healthy patients.

Aged↗
PubMed2005

Transdiaphragmatic-intrapericardiac approach to supradiaphragmatic vena cava invasion secondary to renal cell carcinoma: a novel surgical approach.

INTRODUCTION: A combined abdominal and thoracic surgical approach is the treatment of choice for renal cell carcinoma with secondary thrombus extending to the supradiaphragmatic vena cava and initially into the right atrium. This procedure usually requires a median sternotomy with cardiopulmonary bypass and deep hypothermic circulation arrest or, alternatively, venovenous bypass. In this report, we present a transdiaphragmatic-intrapericardiac approach to supradiaphragmatic thrombus extending to the atrium that avoids the disadvantages, mortality, and morbidity related to cardiopulmonary bypass and deep hypothermic circulatory arrest or venovenous bypass. TECHNIQUE: We describe a combined abdominal and transdiaphragmatic-intrapericardiac approach that was performed in 3 patients with renal cell carcinoma with secondary thrombus extending to the atrium. The estimated blood loss of the patients ranged from 1.1 to 2.8 L (mean 1.5). The total operative time ranged from 3 hours, 20 minutes to 4 hours. No postoperative complications were observed in any patient. CONCLUSIONS: This technique allows excellent exposure of the supradiaphragmatic inferior vena cava through a 10-cm incision and optimal control of the distal thrombus edge when it reaches the right atrium. This approach is safer, faster, easier, and minimally invasive and avoids cardiopulmonary bypass with deep hypothermic cardiac arrest or venovenous bypass.

Carcinoma, Renal Cell↗
PubMed2005

Idiopathic interstitial pneumonias: Primum movens: epithelial, endothelial or whatever.

The pathogenesis of idiopathic interstitial pneumonias (IIPs), particularly of idiopathic pulmonary fibrosis (IPF), is still unknown and the precise nature of the primum movens is strongly debated. Epithelial cells can be the first target of various environmental toxic agents. Both types of pneumocytes may be injured. Type I pneumocyte loss, however, is most conspicuous in fibroblastic foci, the principal sites where irreversible fibrogenesis starts. Epithelial regeneration is highly disturbed: cuboidal and bronchial cells are mainly involved in alveolar repair. These cells, unable to accomplish important functions of normal pneumocytes, secrete various factors inducing migration and proliferation of fibroblasts responsible for progressive extracellular matrix accumulation and lung remodelling. Endothelial cells may also be considered the major players in the initiation of fibrogenic events. Microvascular injury has been largely demonstrated as an early event in IPF lungs. Thrombin as well as other coagulation products has many biological effects such as the activation of different profibrotic factors, which in addition to other fibrogenetic molecules released by stimulated endothelium, are responsible for migration and proliferation of fibroblasts. The old pathogenesis of IPF: chronic inflammation can now be considered the principal event in other non IPF-IIPs. Among inflammatory cells, different cell types have been extensively suggested to play a key role in the pathogenesis of pulmonary fibrosis: granulocytes and eosinophils or mast cells. More recently novel mechanisms underlying the pathogenesis of pulmonary fibrosis have been proposed: bone marrow-derived stem cells may play a crucial role in the fibroproliferative response as well as in epithelial regeneration.

Animals↗
PubMed2004

Long-term survival and prognostic factors in thymic epithelial tumours.

OBJECTIVE: The aim of this study is to analyze long-term survival and the prognostic significance of some factors after surgical resection of thymic epithelial tumours. METHODS: We performed a retrospective analysis of clinical and histopathological data on 132 patients operated on for thymic tumours, from 1970 and 2001. Histologic diagnosis based on the new WHO classification system was made by a single pathologist. A univariate and multivariate analysis of prognostic factors predicting survival was carried out. RESULTS: There were: 108 complete resections (81.8%), 12 partial resections (9.1%) and 12 biopsies (9.1%). Overall 5, 10 and 15-year survival rate was 72, 61 and 52.5%, respectively. The Masaoka staging system showed 44 stage I, 18 stage II, 52 stage III and 18 stage IV. Histologic results were: 14 subtype A, 31 AB, 20 B1, 28 B2, 29 B3 and 10 C; the respective proportions of invasive tumour (stage II-IV) was 28.6, 58.1, 50, 75, 86.2 and 100%. There were 16 tumour recurrences (14.8%) of 108 radically resected thymomas, 10 were treated with radical re-resection. In univariate analysis, four prognostic factors were statistically significant: radical resection, Masaoka clinical staging, WHO histologic subtype and resectable tumour recurrence. In multivariate analysis, the independent factors predicting long-term survival were WHO histology and Masaoka stage. CONCLUSIONS: The WHO histologic classification seems to be the most significant prognostic factor reflecting the invasiveness of the thymic tumour. Completeness of resection and Masaoka stage I and II assure a better survival. Unresectable recurrence of thymic tumour predicted a worse prognosis.

Adolescent↗
PubMed2004

Prognostic significance of main bronchial lymph nodes involvement in non-small cell lung carcinoma: N1 or N2?

STUDY OBJECTIVES: Accurate TNM staging is the basis to evaluate prognosis and to plan treatment of patients with non-small cell lung cancer. Exact definition of N status is fundamental and the boundary line between N1 and N2 stations is one of the most controversial issue. Purpose of this study is to evaluate the prognostic significance of main bronchus nodes, that we classified as station number 10 (N1). METHODS: We reviewed retrospectively lymph node patterns and survival of 175 patients with N1 and 154 with N2 disease, that underwent surgical resection with hilar and mediastinal lymphadenectomy from January 1990 to December 2000. These two groups were subdivided in N1 without station number 10 involvement (N1-, n = 144), N1 with station number 10 involvement (N1+, n = 31), N2 single station (N2s, n = 107) and N2 multiple stations (N2m, n = 47), respectively. A univariate and multivariate analysis of prognostic factors predicting survival has been performed. RESULTS: Overall 5-year survival rate for 175 N1 patients and 154 N2 patients was 42 and 13%, respectively and the difference was statistically significant (P < 0.001). The prognosis between N1-, N1+, N2 was compared: 5-year survival rate was 44, 31 and 13%, respectively and the difference reached a statistical value between N1+ and N2 (P < 0.05), but not between N1- and N1+. When the comparison was made with N1-, N1+, N2s and N2m, the difference was significant between N1- and N2s (P = 0.0003), between N1+ and N2m (P = 0.0001), but not between N1+ and N2s. CONCLUSIONS: The aim of a uniform anatomical and clinical classification of nodal stations has not been thoroughly achieved, particularly regarding the boundary line between N1 and N2. Our study points out that the involvement of main bronchial nodes has a prognostic significance similar to that of N2 single station and should be considered as an early N2 disease.

Aged↗
PubMed2003

Gemcitabine combined with carboplatin in patients with malignant pleural mesothelioma: a multicentric phase II study.

BACKGROUND: Malignant pleural mesothelioma (MPM) is increasing rapidly worldwide. Currently, pemetrexed plus cisplatin chemotherapy showed a survival advantage versus cisplatin alone. No impact on patient survival of surgery, radiotherapy, or their combination has been demonstrated. METHODS: Eight centers in northeastern Italy participated in a Phase II multicenter study. Chemotherapy was comprised of carboplatin area under the concentration-time curve 5 on Day 1 and gemcitabine 1000 mg/m(2) on Days 1, 8, and 15. This cycle was repeated every 4 weeks. RESULTS: Between July 1996 and September 2000, 50 patients were treated. Of the sample, 68% were males, 88% had a Eastern Cooperative Oncology Group performance status score of 0-1, 56% had Stage I-II disease, 68% had epithelioid histology, and 62% had no previous treatments. The delivered dose intensity of gemcitabine was 617 mg/m(2) per week, which was 82% of the planned dose (750 mg/m(2) per week). For carboplatin, the delivered dose intensity was 80 mg/m(2) per week. Overall, 44% of 15th day doses were omitted or reduced. Twenty-six percent of the patients had partial responses (95% confidence interval: 15-40%) and 24% had disease progression. None of the patients had complete responses. The median response duration was 55 weeks (range, 13-113 weeks). Patients had good clinical benefit. For example, 46% had improved dyspnea, 40% improved in weight, and 26% experienced pain reduction. Patients developed Grade 3-4 leukopenia during 18 cycles (11%) of chemotherapy. Grade 3-4 thrombocytopenia occurred more frequently, i.e., there were 24 episodes (15%) among 17 patients. Grade 3 anemia developed among patients during eight cycles (5%). None of the patients developed Grade 3-4 nonhematologic toxicity. The median survival of this sample of patients was 66 weeks with 53%, 30%, and 20% of patients alive at 1, 2, and 3 years, respectively. The median progression-free survival period was 40 weeks. CONCLUSIONS: The gemcitabine/carboplatin combination is a valid option in the treatment of MPM due to its acceptable toxicity profile, the good response rate, and the clinical benefit to patients. Minor adjustments in schedule (3-week cycles instead of 4-week cycles) would permit a more optimal treatment administration.

Adult↗
PubMed2003

Increased proportion of CD8+ T-lymphocytes in the paratracheal lymph nodes of smokers with mild COPD.

Previous studies have shown an increased number of inflammatory cells and, in particular, of CD8+ T lymphocytes, in central airways, peripheral airways, lung parenchyma and pulmonary arteries of smokers with COPD. In this study we investigated whether this inflammatory process is restricted to the lung tissue or whether a similar process is also present in the lymph nodes of these subjects. We examined paratracheal lymph nodes obtained from 6 smokers with COPD (FEV1/VC < 88% predicted and FEV1/FVC < 70% both before and after 200 microg of inhaled salbutamol) and 6 smokers without COPD (FEV1/VC > 88% predicted and FEV1/FVC > 70%) undergoing lung resection for localised pulmonary lesions. By immunohistochemistry we quantified CD4+ and CD8+ T-lymphocytes in the lymph nodes. Smokers with COPD had a decreased ratio CD4/CD8 compared to smokers without COPD. When all subjects were considered together, the ratio CD4/CD8 showed a positive correlation with the values of FEV1/VC and a negative correlation with cigarette consumption. In conclusion, smokers with COPD have an increased proportion of CD8+ cells in the lymph nodes, indicating that a T-lymphocyte pattern similar to that present in the lung tissue is also present in the lymph nodes of these subjects. This finding suggests that, in COPD, the polarisation of the immune response may occur in the regional lymph nodes, possibly as a consequence of the presentation of an endogenous antigen that remains unknown.

Aged↗
PubMed2002

Recurrence of idiopathic pulmonary hemosiderosis in a young adult patient after bilateral single-lung transplantation.

BACKGROUND: Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology characterized by hemoptysis, diffuse pulmonary infiltration, and anemia. Diagnosis requires a detailed clinical history and transbronchial lung biopsy (TLB). METHODS AND RESULTS: A 19-year-old man developed progressive dyspnea, hemoptysis, and anemia. The chest x-rays showed bilateral opacities. IPH was diagnosed on the basis of clinical findings and TLB. The patient was treated with corticosteroidal therapy. His respiratory function worsened, and he underwent lung transplantation in 1997. The pathological examination on native lungs confirmed the previous histologic diagnosis. In 2000, the patient again developed hemoptysis, fever, and hypoxemia. A recurrence of the disease was established by TLB. CONCLUSIONS: This is the first report of recurring IPH. The possibility of recurrent IPH raises the question whether these patients should be disqualified from lung transplantation. This question is unanswerable because incidence of recurrence, time course, and impact on the graft function are presently unknown and unpredictable.

Adult↗