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Biomedical subjects

G Furio Coloni

Publications and source records attributed to G Furio Coloni.

7 recordsLinked to original sources

Glutaraldehyde preserved autologous pericardium for patch reconstruction of the pulmonary artery and superior vena cava.

We describe a new employment of glutaraldehyde preserved autologous pericardium for patch reconstruction of the pulmonary artery (PA) and superior vena cava (SVC). This technique was devised to minimize technical problems related to the use of fresh pericardium such as excessive elasticity and tendency to curl. We have successfully employed this procedure in three cases of reconstruction of the PA and in two cases of reconstruction of the SVC.

Fixatives↗

Sleeve resection after induction therapy.

Preoperative chemoradiotherapy seems to improve the overall survival in locally advanced lung cancer but may also expose patients to an increased risk of postoperative complications. In particular, extended procedures, such as pneumonectomy, and especially right pneumonectomy, are associated with increased morbidity and mortality. Therefore, the extent of the procedure should be carefully weighed against the oncologic completeness of the resection. Among the potential sources of complications, special concern is given to bronchial healing, because of the impairment in bronchial blood flow caused by chemotherapy and radiation therapy. Accordingly, bronchial sleeve lobectomy after induction therapy was not widely accepted as an alternative to pneumonectomy, until the current authors showed that even complex bronchial and vascular procedures can be done safely and effectively in this setting. Many controversial issues still exist, and this article provides an updated summary of the different views and experiences.

Antineoplastic Combined Chemotherapy Protocols↗

Feasibility and safety of the airway bypass procedure for patients with emphysema.

OBJECTIVE: We have proposed that direct passages created between pulmonary parenchyma and large airways (airway bypass) could take advantage of the extensive collateral ventilation present in emphysematous lungs to provide improvement in expiratory flow and respiratory mechanics. A critical step in the safe performance of these procedures is to create passages through the airway wall into lung parenchyma while avoiding injury to adjacent blood vessels. METHODS: The procedure consists of selection of a target site bronchoscopically, use of a Doppler catheter to detect and avoid peribronchial blood vessels, and creation of a passage through the airway wall with a cautery probe. To evaluate the safety of airway bypass, 10 patients were treated during prescheduled lobectomies for neoplasm. The procedure was done after thoracotomy and immediately before resection and was confined to airways in the lung identified for removal. Airway bypass was subsequently performed in 5 patients undergoing lung transplantation for emphysema just before lung excision to evaluate the procedure in emphysematous patients. RESULTS: Twenty-nine passages (1-5 per subject) were created in the patients undergoing lobectomy. Eighteen passages were created (3-4 per subject) in the patients undergoing transplantation. There were 2 instances of mild bleeding in the patients undergoing lobectomy and no bleeding in the patients undergoing transplantation. Both instances were treated with suction and topical application of epinephrine and resolved without incident. CONCLUSION: The results of this study confirm that passages can be made safely through the airways of human subjects. These clinical results support further investigation of the efficacy of the airway bypass procedure in patients with emphysema.

Adult↗

Biopsy of anterior mediastinal masses under local anesthesia.

Treatment of most primary mediastinal tumors is based on positive histological diagnosis; we describe a variation of anterior mediastinoscopy under local anesthesia. After infiltration with local anesthetic, a transverse skin incision is made in the second, third, or fourth interspace. The endothoracic fascia is incised vertically adjacent to the periosteum and a mediastinoscope is inserted in the mediastinum. Between 1995 and 2001, we have employed this technique in 46 patients with anterior mediastinal tumors. Histological diagnosis was obtained in all patients. Pneumothorax (2 patients) was drained by a tube removed at the end of the procedures. No other complications occurred and all patients were discharged from hospital within 24 hours. Mediastinoscopy under local anesthesia proved safe and effective for diagnosing anterior mediastinal tumors.

Adolescent↗

Parenchymal sparing operations for bronchogenic carcinoma.

By the end of the 1950s, the principles of tracheobronchial and pulmonary artery (PA) reconstruction had been established, and their successful clinical application had taken place. It was not until very recently, however, that these techniques aroused widespread interest among thoracic surgeons as a means to achieve complete cancer resection while preserving functioning lung parenchyma. At the present time, sleeve resection of the bronchus and/or PA has a definite role in the surgical management of lung cancer. Growing interest in this field is evidenced by an increasing number of technical variations intended to adapt the basic technique to the different anatomical settings. Also pitfalls, complications, and their prevention and treatment are being extensively described. Last but not least, functional and oncological long-term results, comparing favorably with those of more extended resections, are being reported by many groups. This demonstrates that sleeve lobectomy is no longer reserved only for particularly skillful surgeons. Sleeve lobectomy has achieved its rightful position among the techniques commonly used in thoracic surgery after 40 years of improving understanding and alternating enthusiasm and legitimate doubts.

Carcinoma, Bronchogenic↗

Stage IIIB non-small-cell lung cancer.

Highly selected patients with locally advanced non-small-cell lung cancer achieving cure do not contribute meaningfully to the overall prognosis of stage III. This finding is true particularly if clinicians rely on currently available therapeutic modalities (chemotherapy, radiation therapy, surgery) or refinements thereof. Understanding of the molecular biology continues to improve; it is more likely that in the new millenium, the real breakthroughs in staging and therapy for this high-risk, poor-prognosis group will come from the integration of molecular modalities in the clinical application.

Carcinoma, Non-Small-Cell Lung↗

[Diagnostic delay in post-traumatic diaphragmatic ruptures].

Traumatic ruptures of the diaphragm are associated with closed chest and abdominal traumas, often the outcome of road accidents, with an incidence varying from 1 to 5% depending on the series. Diagnosis is frequently late if the possibility of breakages in two stages is also considered. This delay in diagnosis is encountered in a variable percentage of cases, between 9.5 and 60%. The clinical case of a post-traumatic ruptures of the diaphragm diagnosed 26 years after a car accident is described.

Aged↗