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L Spaggiari

Publications and source records attributed to L Spaggiari.

At least 37 records · Page 2Linked to original sources
PubMed2001

Life-threatening giant mediastinal goiter: a surgical challenge.

Mediastinal goiter is a well known benign disease, usually resectable through a cervical approach with minimal morbidity and mortality. Only occasionally a median sternotomy or a lateral thoracotomy may be required. The present case is worthy of presentation because of the exceptional dimension of the disease and the surgical challenge that it presented. In a 72-year-old woman a large intrathoracic goiter of the right thorax caused a severe dyspnoea due to an important contralateral mediastinal shift with compression of the lung, superior vena cava system and trachea. At surgical exploration, through a cervico-sternotomic approach, the mediastinal structures dislocation and the strong adherences between the anomalous neovascularized capsula of the mass and the surrounding structures, complicated the surgical dissection. An accidental lesion of the innominate artery required its reimplantation on the ascending aorta. An immense mass, was finally removed and pathological examination revealed a rare case of neovascularized, pseudosarcomatoid capsula among a benign hyperplastic proliferation. In spite of its benign nature, a giant goiter caused a life-threatening compression of the respiratory tract and lung parenchyma in this patient. The dimension of the lesions, the mediastinal anatomy alterations and the severe intraoperative haemorrhage represented major technical difficulties during surgical resection.

Aged↗
PubMed2000

Combined tracheal sleeve and superior vena cava resections for non-small cell lung cancer.

BACKGROUND: Combined superior vena cava and tracheal sleeve resections are occasionally indicated in the treatment of non-small cell lung cancer. However, more effective induction therapy may potentially expand the benefit of locally extended resections. METHODS: From January 1998 to December 1999, 6 consecutive patients had combined tracheal sleeve and superior vena cava resections for non-small cell lung cancer after induction treatment. Surgical approach was muscle-sparing lateral thoracotomy in 4 patients and hemiclam-shell approach in 2 patients. There were four tracheal sleeve pneumonectomies, one tracheal sleeve bilobectomy, and one tracheal sleeve lobectomy. Three patients (50%) had complete superior vena cava resection with graft replacement, whereas the other patients had partial superior vena cava resection using vascular staplers. RESULTS: There were no perioperative complications. Three patients (50%) had major postoperative complications, but there were no postoperative deaths. Four patients are still alive, 2 without evidence of disease. The median survival was 14.5 months (range, 3 to 17 months). CONCLUSIONS: These combined resections are technically feasible with no postoperative mortality but high morbidity (50%). This aggressive surgery may be useful in highly selected patients where adequate local control can achieve long-term survival.

Aged↗
PubMed2000

Extended resections for bronchogenic carcinoma invading the superior vena cava system.

BACKGROUND: Extended resection of non-small-cell lung cancer (NSCLC) involving the superior vena cava (SVC) system is infrequently performed and oncologic benefits are still uncertain. METHODS: From 1983 to 1996, 25 patients underwent resection of the SVC system for T4, NSCLC. RESULTS: A total of 12 pneumonectomies (48%), ten lobectomies (40%), and three wedge resections (12%) were performed. Seven patients had complete resection of the SVC with graft interposition, 12 patients underwent tangential resection of the SVC, and 1 patient had a pericardial patch; 5 patients underwent resection of right innominate and subclavian veins without vessel reconstruction. The lymph node status was N0 in 8 patients (32%), N1 in 3 (12%) and N2 in 14 patients (56%). Five patients (20%) underwent incomplete resection. Nine patients (36%) developed postoperative complications (36%) that were fatal in 3 patients (12%). At the completion of the study, 10 patients were still alive. The median survival was 11.5 months and the 5-year actuarial survival rate was 29%, with 4 patients alive at 5 years. CONCLUSIONS: The resection of the SVC system for direct involvement by T4, NSCLC can be performed in selected patients with an acceptable postoperative mortality. Even though no significant prognostic factors were observed, the patients who required a lobectomy with limited lymph node involvement seemed to benefit the most from surgery.

Actuarial Analysis↗
PubMed2000

Detection by denaturant gradient gel electrophoresis of tumor-specific mutations in biopsies and relative bronchoalveolar lavage fluid from resectable non-small cell lung cancer.

A PCR-denaturant gradient gel electrophoresis (DGGE) method was developed for the detection of p53 and K-ras mutations in primary operable tumors and paired BAL samples of non-small cell lung cancer. Among 36 patients, 9 showed p53 exon V mutations in biopsies and in three paired bronchoalveolar lavage (BAL) specimens with a 33% concordance. Five patients presented p53 exon VI mutations in biopsies and in two paired BALs with a 40% concordance. No mutations were found in p53 exon VII either in biopsies or in paired BAL samples with 100% concordance. Exon VIII mutations were found in six primary tumors and in two BALs with a 33% concordance. Of 36 patients, we detected 7 (19.4%) with K-ras exon I mutations on tumor samples. DGGE analysis of DNA from BAL samples revealed three mutations distributed on K-ras exon I with a 42% overall concordance with respect to tumor tissue. Molecular screening by DGGE of p53-amplified DNA from BAL had cumulative 46.6% sensitivity, 100% specificity, and 77.7% accuracy. DGGE K-ras detection showed 43% sensitivity, 100% specificity, and 88.8% test accuracy. The method proposed demonstrated to be specific, accurate, and at relatively low cost but limited by low sensitivity in detecting the presence of neoplastic cells in patients with resectable non-small cell lung cancer.

Adenocarcinoma↗
PubMed2000

Huge malignant localized fibrous tumor of the pleura.

Localized fibrous tumor is an unfrequent mesenchymal neoplasm. The malignant variant of the pleura is exceptional and differential diagnosis with the more frequent benign type or with other neoplasms such as soft tissue sarcoma and mesothelioma is rarely possible in a preoperative setting. The best treatment of this disease is radical surgical resection. No definitive data exist about the role of chemotherapy. We report a case of a giant right intrathoracic mass whose preoperative diagnosis, from an open biopsy, was consistent with sarcoma and, in a second review, with fibrous tumor of the pleura without any indication about malignancy. A right pleuropneumonectomy and pericardial resection was performed through a right hemiclam-shell approach. Histology demonstrated an aggressive behaviour: high mitosis rate, Ki 67 of 34% and diffuse necrosis were present. In consideration of the apparent local radicality we did not perform any adjuvant treatment. Six months after the operation a wide local recurrence was evident and a systemic treatment with Ifosfamide and Adriamicina is still in progress. So far a good response has been documented. Preoperative diagnosis of malignancy has an important role as a therapeutic strategy in management of fibrous tumours of the pleura. When there is suspicion of a malignant form neoadjuvant chemotherapy can represent a further tool to control poorly differentiated and large tumors, and a wide surgical resection of the lesion must be performed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Video-assisted Abruzzini technique for bronchopleural fistula repair. A pathology study.

Trans-sternal closure of the bronchial stump is an effective procedure to treat bronchopleural fistula after pneumonectomy. The paper reports a modified video-assisted Abruzzini technique that, maintaining the same results, should determine a lower surgical risk. Three simultaneous approaches are used: cervical video-mediastinoscopy, right anterior parasternal mediastinotomy, left parasternal thoracoscopic access. The dissection of the bronchial stump is performed entirely through the mediastinotomy approach after having controlled mediastinal vessels. The bronchial stump reamputation is achieved by a roticulator endoGIA introduced through the cervicotomy either for the right or left fistulae. The technique proposed might reach the same result as the classic approach with lower surgical risks.

Adult↗
PubMed1999

Transmanubrial approach with antero-lateral thoracotomy for apical chest tumor.

Transmanubrial osteomuscular sparing approach (TMA) has been recently proposed for the treatment of apical chest tumor to allow a safer subclavian artery control with a less invasive procedure for the patient. The present technique combines the antero-lateral muscle-sparing thoracotomy with TMA for lung cancer patients in whom extended resection of cervico-thoracic structures as well as anatomic lung resection and radical lymph nodes dissection are required.

Adult↗
PubMed1999

Cervico-thoracic tumors resection through transmanubrial osteomuscular sparing approach.

Twelve patients with cervico-thoracic tumors underwent transmanubrial approach during a 1-year period. All but two patients with NSCLC (n = 8), had double approaches. Three cases with cervical esophageal cancer underwent TMA and laparotomy. The last patient underwent TMA for cervical fibrosarcoma. One patient underwent subclavian artery resection, while another one resection of the left brachicephalic vein with graft replacement. Two cases, in the esophageal cancer group, had laryngeal nerve palsy requiring temporary tracheostomy. TMA affords an excellent exposure of the thoracic in/outlet allowing extended resection. Sparing the main osteo-muscular structures, it respects shoulder mobility of the scapular girdle, thus avoiding deformities due to clavicle resection.

Adult↗
PubMed1999

Experimental tracheal transplantation using a cryopreserved aortic allograft.

BACKGROUND: The tracheal reconstruction after wide resections remains a critical surgical problem. Our aim was to replace trachea with a tissue easy to vascularize, which allows a simple reconstruction and does not require an immunosuppressive regimen. MATERIALS AND METHODS: A segment of cryopreserved aorta was used in order to verify its adequacy as tracheal substitute. In phase 1, the thoracic aorta of 10 rabbits was excised, obtaining 20 segments that were cryopreserved. Ten segments were implanted in the omentum of 10 rabbits that were sacrificed on postoperative days 7, 14 and 21, and the grafts were examined histologically. In phase 2, a segment of cryopreserved aorta arranged with a silicone prosthesis was transplanted in 10 rabbits and wrapped with omentum. The animals were sacrificed on postoperative days 7, 14 and 21. RESULTS: In phase 1, the neovascularization of the grafts was present after 7 days, and after 14 days the fibroblasts invaded the lumen of the aorta. In phase 2, 8 rabbits survived and the histologic examination after 7, 14 and 21 days showed neovascularization, the absence of rejection and the proliferation of fibroblasts inside the lumen of the aorta; this growth has been restrained by an endoluminal prosthesis. CONCLUSIONS: Our study demonstrated that replacing the trachea with cryopreserved aorta is technically feasible and does not evoke immunologic reactions. It requires, however, a silicone tube inside the allograft to limit the colonization of fibroblasts.

Animals↗
PubMed1999

A standard muscle-sparing utility thoracotomy for VATS procedures.

BACKGROUND: Improvements in surgical equipment have rendered video-assisted thoracic surgery (VATS) an effective device for thoracic surgeons and nowadays several intrathoracic diseases can benefit from this approach. This development has expanded potential use and recently the technical feasibility of major lung resections by VATS has been demonstrated. The authors present their experience with a standard muscle-sparing utility thoracotomy (UT) utilized for all VATS procedures, including major lung resections. METHODS: From November 1996 to October 1997, 30 patients were operated on. There were 22 males and 8 females (medium age 58 years; range 24-78). There were 13 anatomical lung resections (i.e.: 11 lobectomies, 1 left pneumonectomy, 1 segmental resection), 8 wedge resections, 3 lung biopsies, 2 debridements of pleural empyema, 2 mediastinal nodes biopsies, 1 esophageal resection for leiomyoma, 1 excision of benign mediastinal cyst. RESULTS: No mortality or major morbidity were recorded, as well as no rib fractures due to the rib spreader. Two patients suffered from prolonged air-leaks after respectively left upper lobectomy and lung biopsy and required prolonged chest drainage. Concerning anatomic major lung resections the medium hospital stay was 7.9 days and medium chest tube time was 5.6 days. The utility thoracotomy through the auscultatory triangle proved to be a safe approach and confirmed the technical feasibility of various type of surgical procedures with results comparable to standard open thoracotomy. Our data shows that VATS approach did not seriously affect the duration of hospital stay, chest tube time, the overall morbidity or lung function. CONCLUSIONS: As the real benefit of this approach remains controversial, the majority of the studies comparing the VATS approach to conventional muscle-sparing thoracotomy neither nor prospective nor randomized, and several parameters are difficult to evaluate in the literature further study are mandatory.

Adult↗
PubMed1999

Pulmonary abnormalities in Cowden's disease.

Cowden's disease is an inheritable multiple neoplastic syndrome represented by benign and malignant lesions of skin, digestive tract, mucosae, breast and thyroid. The syndrome, first described by Lloyd and Dennis in 1963, includes benign lung lesions, described in the literature only as hamartomas. The unusual condition of our case consists of multiple and bilateral lipomatous lesions of the lung and of adipose colonic polyps, diagnosed respectively by video assisted mini-thoracotomy and by endoscopic biopsies.

Biopsy↗
PubMed1999

Postoperative pneumoperitoneum for prolonged air leaks and residual spaces after pulmonary resections.

BACKGROUND: Postoperative air leaks and pleural residual spaces are often encountered during partial lung resections and may adversely affect the immediate outcome prolonging the hospital stay. At present the only treatment consists of maintenance of the chest drainage under suction until resolution of the leaks. METHODS: From January 1995 to December 1997 the authors have operated on and subsequently treated 12 patients presenting prolonged air leaks with residual pleural spaces after lobectomies for lung cancer. The patients underwent respectively: left or right lower lobectomies (n=7), left upper lobectomies (n=3), right upper lobectomies (n=2). In this study the air leak was considered prolonged if it continued and delayed the discharge after surgery beyond the postoperative day 8. The pneumoperitoneum was carried out under local anesthesia. The air was insufflated through a needle inserted just above the umbilical scar as for laparoscopic surgery access up to an amount of about 1200 cc-1300 cc. RESULTS: We have obtained in all cases and without complications an immediate reduction in the air leaks and a complete resolution of the residual pleural spaces. Chest drainages were removed from 3 to 4 days after the procedure. CONCLUSIONS: The good results achieved suggest that this procedure might be considered for selected cases, being a minor procedure, performed under local anesthesia and with minimum discomfort for the patient.

Chest Tubes↗