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Altorki NK, Walsh ZH, Melms JC, Port JL, Lee BE, Nasar A, Spinelli C, Caprio L, Rogava M, Ho P, Christos PJ, Saxena A, Elemento O, Bhinder B, Ager C, Amin AD, Sanfilippo NJ, Mittal V, Borczuk AC, Formenti SC, Izar B, McGraw TE. Author Correction: Neoadjuvant durvalumab plus radiation versus durvalumab alone in stages I-III non-small cell lung cancer: survival outcomes and molecular correlates of a randomized phase II trial. Nat Commun 2024; 15:225. [PMID: 38172131 PMCID: PMC10764801 DOI: 10.1038/s41467-023-44575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Nasser K Altorki
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA.
| | - Zachary H Walsh
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Johannes C Melms
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Jeffery L Port
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Benjamin E Lee
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Abu Nasar
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Cathy Spinelli
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Lindsay Caprio
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Meri Rogava
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Patricia Ho
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Paul J Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Ashish Saxena
- Weill Cornell Medicine, Division of Hematology and Oncology, New York, New York, USA
| | - Olivier Elemento
- Weill Cornell Medicine, Caryl and Israel Englander Institute for Precision Medicine, Institute for Computational Biomedicine, Department of Physiology and Biophysics, New York, New York, USA
| | - Bhavneet Bhinder
- Weill Cornell Medicine, Caryl and Israel Englander Institute for Precision Medicine, Institute for Computational Biomedicine, Department of Physiology and Biophysics, New York, New York, USA
| | - Casey Ager
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Amit Dipak Amin
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | | | - Vivek Mittal
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Alain C Borczuk
- Department of Pathology, Northwell Health, Greenvale, New York, New York, USA
| | - Silvia C Formenti
- Weill Cornell Medicine, Department of Radiation Oncology, New York, New York, USA
| | - Benjamin Izar
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA.
- Department of Systems Biology, Program for Mathematical Genomics, Columbia University, New York, New York, USA.
- Columbia Center for Translational Immunology, New York, New York, USA.
| | - Timothy E McGraw
- Weill Cornell Medicine, Department of Biochemistry, New York, New York, USA.
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Altorki NK, Walsh ZH, Melms JC, Port JL, Lee BE, Nasar A, Spinelli C, Caprio L, Rogava M, Ho P, Christos PJ, Saxena A, Elemento O, Bhinder B, Ager C, Amin AD, Sanfilippo NJ, Mittal V, Borczuk AC, Formenti SC, Izar B, McGraw TE. Neoadjuvant durvalumab plus radiation versus durvalumab alone in stages I-III non-small cell lung cancer: survival outcomes and molecular correlates of a randomized phase II trial. Nat Commun 2023; 14:8435. [PMID: 38114518 PMCID: PMC10730562 DOI: 10.1038/s41467-023-44195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
We previously reported the results of a randomized phase II trial (NCT02904954) in patients with early-stage non-small cell lung cancer (NSCLC) who were treated with either two preoperative cycles of the anti-PD-L1 antibody durvalumab alone or combined with immunomodulatory doses of stereotactic radiation (DRT). The trial met its primary endpoint of major pathological response, which was significantly higher following DRT with no new safety signals. Here, we report on the prespecified secondary endpoint of disease-free survival (DFS) regardless of treatment assignment and the prespecified exploratory analysis of DFS in each arm of the trial. DFS at 2 and 3 years across patients in both arms of the trial were 73% (95% CI: 62.1-84.5) and 65% (95% CI: 52.5-76.9) respectively. For the exploratory endpoint of DFS in each arm of the trial, three-year DFS was 63% (95% CI: 46.0-80.4) in the durvalumab monotherapy arm compared to 67% (95% CI: 49.6-83.4) in the dual therapy arm. In addition, we report post hoc exploratory analysis of progression-free survival as well as molecular correlates of response and recurrence through high-plex immunophenotyping of sequentially collected peripheral blood and gene expression profiles from resected tumors in both treatment arms. Together, our results contribute to the evolving landscape of neoadjuvant treatment regimens for NSCLC and identify easily measurable potential biomarkers of response and recurrence.
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Affiliation(s)
- Nasser K Altorki
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA.
| | - Zachary H Walsh
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Johannes C Melms
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Jeffery L Port
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Benjamin E Lee
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Abu Nasar
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Cathy Spinelli
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Lindsay Caprio
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Meri Rogava
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Patricia Ho
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Paul J Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Ashish Saxena
- Weill Cornell Medicine, Division of Hematology and Oncology, New York, New York, USA
| | - Olivier Elemento
- Weill Cornell Medicine, Caryl and Israel Englander Institute for Precision Medicine, Institute for Computational Biomedicine, Department of Physiology and Biophysics, New York, New York, USA
| | - Bhavneet Bhinder
- Weill Cornell Medicine, Caryl and Israel Englander Institute for Precision Medicine, Institute for Computational Biomedicine, Department of Physiology and Biophysics, New York, New York, USA
| | - Casey Ager
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Amit Dipak Amin
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | | | - Vivek Mittal
- Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA
| | - Alain C Borczuk
- Department of Pathology, Northwell Health, Greenvale, New York, New York, USA
| | - Silvia C Formenti
- Weill Cornell Medicine, Department of Radiation Oncology, New York, New York, USA
| | - Benjamin Izar
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, New York, New York, USA.
- Deparmtent of Systems Biology, Program for Mathematical Genomics, Columbia University, New York, New York, USA.
- Columbia Center for Translational Immunology, New York, New York, USA.
| | - Timothy E McGraw
- Weill Cornell Medicine, Department of Biochemistry, New York, New York, USA.
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Altorki N, Mynard N, Nasar A, Spinelli C, Villena-Vargas J, Chow O, Lee B, Harrison S, Port J. Ten-Year Survival and Recurrence Patterns After Three-Field Lymph Node Dissection for Squamous Cell and Adenocarcinoma of the Esophagus. Ann Surg 2023; 278:e43-e50. [PMID: 35866662 DOI: 10.1097/sla.0000000000005627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to determine the prevalence of metastases to the cervical and recurrent laryngeal cervicothoracic (CT) nodes as well as survival and recurrence patterns after esophagectomy with three-field lymph node dissection (TFD) in patients with predominately adenocarcinoma (AC) of the esophagus. BACKGROUND Although esophagectomy with TFD is commonly practiced in Japan and Southeast Asia for squamous cell cancer (SCC) of the esophagus, there are only a handful of reports about its' utilization and survival benefit in North American patients. METHODS This is a retrospective case series of patients who had an esophagectomy with TFD. The primary outcomes of interest were the prevalence of nodal metastases to the CT nodes as well as overall survival (OS) and disease-free survival. Secondary outcomes included time to recurrence, recurrence patterns, operative morbidity as well as 30 and 90-day mortality. RESULTS Two hundred forty-two patients with esophageal cancer (AC: 67%) underwent esophagectomy with TFD. Metastases to the CT nodes were present in 56 patients (23%: AC 20% and SCC 30%). Positive CT nodes were present in 14% of pT1/T2 tumors and 30% of pT3 tumors. For the 56 patients with CT positive nodes, 5-year OS was 25% (AC:16%; SCC:39%). Fifteen of 56 (26.7%) patients with metastases to the CT nodes were alive and disease-free at a minimum of 5 years postoperatively. Ten-year OS was 43% for all patients with SCC and 28% for patients with AC. CONCLUSIONS Metastases to the CT nodes are common in both SCC and AC of the esophagus and may be present in at least 14% of early lesions. Five-year survival is encouraging particularly for patients with esophageal SCC cancer.
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Affiliation(s)
- Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Plessi C, Sica M, Molinaro F, Fusi G, Rossi F, Costantini M, Roviello F, Marano L, D'ignazio A, Spinelli C, Angotti R. Diagnosis and treatment of primary hypertrophic pyloric stenosis (HPS) in older children. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2021.101860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Shah MA, Almhanna K, Iqbal S, Thakkar P, Schneider BJ, Yantiss R, Wu Y, Futamura E, Port JL, Spinelli C, Sarkar S, Christos PJ, Brar G, Betel D, Sanfilippo NJ, Altorki NK. Multicenter, randomized phase II study of neoadjuvant pembrolizumab plus chemotherapy and chemoradiotherapy in esophageal adenocarcinoma (EAC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4005 Background: Recent transformative studies in the treatment of EAC support adjuvant nivolumab for patients with residual disease following neoadjuvant chemoradiotherapy (CRT) (Checkmate 577) and pembrolizumab (P) with chemotherapy in untreated metastatic disease (Keynote 590). We hypothesized that pre-operative P combined with CRT can further improve outcomes in patients with locally advanced EAC. Methods: Patients with cT3-4Nx or T2N1 M0 EAC or gastroesophageal junction (GEJ) adenocarcinoma eligible for curative surgery were randomized (1:1) to receive either full-dose paclitaxel (T)/ carboplatin (C) or T/C + P induction therapy. All patients then received CRT with weekly T/C, RT 41.4Gy in 23 fractions, and P every 3 weeks. Following resection, patients received P for one year. The primary endpoint is rate of major pathologic response (MPR), defined as pathologic complete response or near complete response ( < 10% residual cancer), with 80% power and 0.1 one-sided significance level to detect the difference between a MPR proportion of 30% (historical control) and an alternative hypothesis of 47% (with preoperative P). Tissue was collected for tumor immune microenvironment (TIME) analysis including bulk and single cell RNA(scRNA) expression analysis, DNA sequencing, and flow cytometry. Results: From 8/4/17 to 10/26/20, 40 patients were enrolled: median age 68 [38-81], male 32, esophagus/GEJ type I (n = 16), GEJ II/III (n = 24). CRT was well tolerated, with no grade 3-4 adverse events attributed to P. Notable toxicity included grade 3-4 pneumonitis (13%), anastomotic leak (13%), infection (35%). In 31 evaluable patients to date, the MPR rate was 50.0% (95% CI, 32.7%-67.3%). 1-yr disease free survival was 100% for patients with MPR vs. 31.8% without MPR, p = 0.002. Esophageal/GEJ type I cancers had a significantly higher MPR rate when compared with GEJ type II/III (76.9% vs 37.5%, p = 0.03). scRNA seq on > 100,000 tumor cells revealed EAC/GEJ type I had higher infiltration of activated dendritic cells (p = 0.12), whereas GEJ tumors have significantly higher infiltration of activated B cells (p = 0.02). Conclusions: The addition of P to preoperative CRT for EAC is safe and associated with a significantly higher MPR rate compared to historical data. We found MPR to be significantly enriched in EAC/GEJ type I tumors compared with GEJ II/III, associated with important differences in the baseline tumor immune microenvironment. Clinical trial information: NCT02998268.
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Affiliation(s)
| | | | - Syma Iqbal
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Prashant Thakkar
- Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | | | | | - Yiru Wu
- Lifespan Cancer Institute, Providence, RI
| | | | | | | | | | - Paul J. Christos
- Department of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY
| | | | - Doron Betel
- Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
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Altorki NK, McGraw TE, Borczuk AC, Saxena A, Port JL, Stiles BM, Lee BE, Sanfilippo NJ, Scheff RJ, Pua BB, Gruden JF, Christos PJ, Spinelli C, Gakuria J, Uppal M, Binder B, Elemento O, Ballman KV, Formenti SC. Neoadjuvant durvalumab with or without stereotactic body radiotherapy in patients with early-stage non-small-cell lung cancer: a single-centre, randomised phase 2 trial. Lancet Oncol 2021; 22:824-835. [PMID: 34015311 DOI: 10.1016/s1470-2045(21)00149-2] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous phase 2 trials of neoadjuvant anti-PD-1 or anti-PD-L1 monotherapy in patients with early-stage non-small-cell lung cancer have reported major pathological response rates in the range of 15-45%. Evidence suggests that stereotactic body radiotherapy might be a potent immunomodulator in advanced non-small-cell lung cancer (NSCLC). In this trial, we aimed to evaluate the use of stereotactic body radiotherapy in patients with early-stage NSCLC as an immunomodulator to enhance the anti-tumour immune response associated with the anti-PD-L1 antibody durvalumab. METHODS We did a single-centre, open-label, randomised, controlled, phase 2 trial, comparing neoadjuvant durvalumab alone with neoadjuvant durvalumab plus stereotactic radiotherapy in patients with early-stage NSCLC, at NewYork-Presbyterian and Weill Cornell Medical Center (New York, NY, USA). We enrolled patients with potentially resectable early-stage NSCLC (clinical stages I-IIIA as per the 7th edition of the American Joint Committee on Cancer) who were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1. Eligible patients were randomly assigned (1:1) to either neoadjuvant durvalumab monotherapy or neoadjuvant durvalumab plus stereotactic body radiotherapy (8 Gy × 3 fractions), using permuted blocks with varied sizes and no stratification for clinical or molecular variables. Patients, treating physicians, and all study personnel were unmasked to treatment assignment after all patients were randomly assigned. All patients received two cycles of durvalumab 3 weeks apart at a dose of 1·12 g by intravenous infusion over 60 min. Those in the durvalumab plus radiotherapy group also received three consecutive daily fractions of 8 Gy stereotactic body radiotherapy delivered to the primary tumour immediately before the first cycle of durvalumab. Patients without systemic disease progression proceeded to surgical resection. The primary endpoint was major pathological response in the primary tumour. All analyses were done on an intention-to-treat basis. This trial is registered with ClinicalTrial.gov, NCT02904954, and is ongoing but closed to accrual. FINDINGS Between Jan 25, 2017, and Sept 15, 2020, 96 patients were screened and 60 were enrolled and randomly assigned to either the durvalumab monotherapy group (n=30) or the durvalumab plus radiotherapy group (n=30). 26 (87%) of 30 patients in each group had their tumours surgically resected. Major pathological response was observed in two (6·7% [95% CI 0·8-22·1]) of 30 patients in the durvalumab monotherapy group and 16 (53·3% [34·3-71·7]) of 30 patients in the durvalumab plus radiotherapy group. The difference in the major pathological response rates between both groups was significant (crude odds ratio 16·0 [95% CI 3·2-79·6]; p<0·0001). In the 16 patients in the dual therapy group with a major pathological response, eight (50%) had a complete pathological response. The second cycle of durvalumab was withheld in three (10%) of 30 patients in the dual therapy group due to immune-related adverse events (grade 3 hepatitis, grade 2 pancreatitis, and grade 3 fatigue and thrombocytopaenia). Grade 3-4 adverse events occurred in five (17%) of 30 patients in the durvalumab monotherapy group and six (20%) of 30 patients in the durvalumab plus radiotherapy group. The most frequent grade 3-4 events were hyponatraemia (three [10%] patients in the durvalumab monotherapy group) and hyperlipasaemia (three [10%] patients in the durvalumab plus radiotherapy group). Two patients in each group had serious adverse events (pulmonary embolism [n=1] and stroke [n=1] in the durvalumab monotherapy group, and pancreatitis [n=1] and fatigue [n=1] in the durvalumab plus radiotherapy group). No treatment-related deaths or deaths within 30 days of surgery were reported. INTERPRETATION Neoadjuvant durvalumab combined with stereotactic body radiotherapy is well tolerated, safe, and associated with a high major pathological response rate. This neoadjuvant strategy should be validated in a larger trial. FUNDING AstraZeneca.
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Affiliation(s)
- Nasser K Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA.
| | - Timothy E McGraw
- Department of Biochemistry, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Alain C Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Ashish Saxena
- Division of Hematology Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Brendon M Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Benjamin E Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Nicholas J Sanfilippo
- Department of Radiation Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Ronald J Scheff
- Division of Hematology Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Bradley B Pua
- Department of Radiology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - James F Gruden
- Department of Radiology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Paul J Christos
- Department of Population Health Sciences, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Cathy Spinelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Joyce Gakuria
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Manik Uppal
- Department of Physiology and Biophysics, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Bhavneet Binder
- Department of Physiology and Biophysics, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Olivier Elemento
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Karla V Ballman
- Department of Population Health Sciences, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
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Affiliation(s)
- A. Mussi
- Service of Thoracic Surgery - Cardio and Thoracic Department, University of Pisa, Pisa, Italy
| | - M. C. Ambrogi
- Service of Thoracic Surgery - Cardio and Thoracic Department, University of Pisa, Pisa, Italy
| | - P. Iacconi
- Service of Endocrine Surgery - Department of Surgery, University of Pisa, Pisa, Italy
| | - C. Spinelli
- Service of Endocrine Surgery - Department of Surgery, University of Pisa, Pisa, Italy
| | - P. Miccoli
- Service of Endocrine Surgery - Department of Surgery, University of Pisa, Pisa, Italy
| | - C. A. Angeletti
- Service of Thoracic Surgery - Cardio and Thoracic Department, University of Pisa, Pisa, Italy
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Altorki N, Borczuk A, Saxena A, Port J, Stiles B, Lee B, Sanfilippo N, Ko E, Scheff R, Pua B, Gruden J, Christos P, Spinelli C, Gakuria J, Mittal V, Mcgraw T, Formenti S. P2.04-92 Neoadjuvant Durvalumab With or Without Sub-Ablative Stereotactic Radiotherapy (SBRT) in Patients with Resectable NSCLC (NCT02904954). J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Spinelli C, Montermini L, Meehan B, Brisson AR, Tan S, Choi D, Nakano I, Rak J. Molecular subtypes and differentiation programmes of glioma stem cells as determinants of extracellular vesicle profiles and endothelial cell-stimulating activities. J Extracell Vesicles 2018; 7:1490144. [PMID: 30034643 PMCID: PMC6052423 DOI: 10.1080/20013078.2018.1490144] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/07/2018] [Indexed: 02/08/2023] Open
Abstract
We have previously uncovered the impact of oncogenic and differentiation processes on extracellular vesicles (EVs) in cancer. This is of interested in the context of glioma stem cells (GSC) that are responsible for recurrent nature of glioblastoma multiforme (GBM), while retaining the potential to undergo differentiation and self renewal. GSCs reside in vascular niches where they interact with endothelial cells through a number of mediators including bioactive cargo of EVs. GSCs can be classified as proneural (PN) or mesenchymal (MES) subtypes on the basis of their gene expression profiles and distinct biological characteristics. In the present study we investigated how GSC diversity and differentiation programmes influence their EV-mediated communication potentials. Indeed, molecular subtypes of GBMs and GSCs differ with respect to their expression of EV-related genes (vesiculome) and GSCs with PN or MES phenotypes produce EVs with markedly different characteristics, marker profiles, proteomes and endothelial stimulating activities. For example, while EVs of PN GSC are largely devoid of exosomal markers their counterparts from MES GSCs express ample CD9, CD63 and CD81 tetraspanins. In both GSC subtypes serum-induced differentiation results in profound, but distinct changes of cellular phenotypes including the enhanced EV production, reconfiguration of their proteomes and the related functional pathways. Notably, the EV uptake was a function of both subtype and differentiation state of donor cells. Thus, while, EVs produced by differentiated MES GSCs were internalized less efficiently than those from undifferentiated cells they exhibited an increased stimulatory potential for human brain endothelial cells. Such stimulating activity was also observed for EVs derived from differentiated PN GSCs, despite their even weaker uptake by endothelial cells. These findings suggest that the role of EVs as biological mediators and biomarkers in GBM may depend on the molecular subtype and functional state of donor cancer cells, including cancer stem cells. Abbreviations: CryoTEM: cryo-transmission electron microscopy; DIFF: differentiated GSCs; EGF: epidermal growth factor; DUC: differential ultracentrifugation; EV: extracellular vesicle; FGF: fibroblast growth factor; GBM: glioblastoma multiforme; GFAP: glial fibrillary acidic protein; GO: gene ontology; GSC: glioma stem cells; HBEC-5i: human brain endothelial cells; MES: mesenchymal cells; MTS - [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt; PMT1: proneural-to-mesenchyman transition cell line 1; PN: proneural cells; TEM: transmission electron microscopy; WB: western blotting
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Affiliation(s)
- C Spinelli
- Department of Pediatrics, McGill University, The Research Institute of the McGill University Health Centre, Montreal, Canada
| | - L Montermini
- Department of Pediatrics, McGill University, The Research Institute of the McGill University Health Centre, Montreal, Canada
| | - B Meehan
- Department of Pediatrics, McGill University, The Research Institute of the McGill University Health Centre, Montreal, Canada
| | - A R Brisson
- UMR-CBMN CNRS, University of Bordeaux, IPB, France
| | - S Tan
- UMR-CBMN CNRS, University of Bordeaux, IPB, France
| | - D Choi
- Department of Pediatrics, McGill University, The Research Institute of the McGill University Health Centre, Montreal, Canada
| | - I Nakano
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Rak
- Department of Pediatrics, McGill University, The Research Institute of the McGill University Health Centre, Montreal, Canada
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Nicolini A, Campani D, Miccoli P, Spinelli C, Carpi A, Menicagli M, Ferrari P, Gadducci G, Rossi G, Fini M, Giavaresi G, Bonazzi V, Giardino R. Vascular Endothelial Growth Factor (Vegf) and Other Common Tissue Prognostic Indicators in Breast Cancer: A Case-Control Study. Int J Biol Markers 2018; 19:275-81. [PMID: 15646833 DOI: 10.1177/172460080401900404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
VEGF is a specific mitogen and survival factor for endothelial cells and a key promoter of angiogenesis in physiological and pathological conditions. Nevertheless, VEGF tissue evaluation in cancer patients as a prognostic factor compared to the conventional histological and biological parameters is still controversial. In this case-control study, tissue VEGF was retrospectively determined by immunohistochemistry and related to T, N, ER, PgR, c-erbB-2, p53, MIB-1 and cyclin D1 in 129 breast cancer patients. Seventy-four of these patients had developed distant metastases postoperatively. The remaining 55 patients had remained disease-free >10 years after surgery. In 17 (13%) of the 129 patients (six with distant metastases and eleven disease-free) tissue and plasma VEGF were concomitantly evaluated. In univariate analysis no significant differences in VEGF and tumor size were found between metastatic and disease-free patients, whereas there were significant differences in N, ER, PgR, c-erbB-2, p53, MIB-1 and cyclin D1 (p ranging from 0.001 to 0.0001). In multivariate analysis VEGF showed less significance than N, ER, c-erbB-2, MIB-1 and cyclin D1 (p=0.012, p=0.007, p=0.005, p=0.005, p=0.002 and p=0.001, respectively). VEGF was a significant unfavorable prognostic indicator only in the N+ subset (p=0.015), while ER (p=0.05 and p=0.021) and MIB-1 (p=0.031 and p=0.022) were significant in both the N+ and N– subgroups. In multivariate analysis in the 74 metastatic cases VEGF did not show any significance in relation to disease-free interval and overall survival from the time of mastectomy and from the time of relapse, whereas N and PgR did (p ranging from 0.018 to 0.001). In conclusion, tissue VEGF does not seem a suitable candidate to replace conventional histological and other common biological prognostic factors in breast cancer.
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Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Italy.
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Spinelli C, Strambi S, Rossi L, Bakkar S, Massimino M, Ferrari A, Collini P, Cecchetto G, Bisogno G, Inserra A, Bianco F, Miccoli P. Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients. J Endocrinol Invest 2016; 39:1055-9. [PMID: 27129982 DOI: 10.1007/s40618-016-0474-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/18/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The extent of surgery for pediatric papillary thyroid carcinoma is debatable. The aim of this study was to evaluate the feasibility of offering pediatric patients a tailored surgical approach based on certain clinical features. METHODS A national multicenter retrospective review of 250 pediatric patients treated for papillary thyroid carcinoma in a 14-year period was performed. Outcomes of interest included tumor-related features, type of surgery, surgical morbidity, disease-free and overall survival rates. Recurrence was thoroughly analyzed with particular focus on how it correlated with certain patient- and tumor-related features. RESULTS The majority of patients (58.8 %) had tumors >2 cm in size. Nodal involvement occurred in 115/250 (46 %) patients and distant metastasis in 4 % (10/250). Total thyroidectomy and lobectomy were performed in 90.4 % (226/250) and 9.6 % (24/250) of patients, respectively. The overall rate of surgical complications was 20.8 % (52/250). These included transient and permanent hypoparathyroidism (13.6 and 4.4 %, respectively), and vocal fold palsy (2.8 %). All surgical complications occurred exclusively in the total thyroidectomy group. The rate of recurrent disease was 12 % (30/250) with the vast majority of recurrences (96.6 %) occurring in the total thyroidectomy group. The risk of recurrence correlated significantly with certain tumor-related features (size > 2 cm, multifocality, extrathyroidal invasion, nodal positivity, and distant metastasis). However, it did not correlate with the patient's age or sex. Overall survival was 100 %. CONCLUSION Pediatric patients are likely to benefit from a tailored surgical strategy. Uniformly offering patients total thyroidectomy seems to be an overly radical approach.
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Affiliation(s)
- C Spinelli
- Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - S Strambi
- Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - L Rossi
- Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Bakkar
- Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Massimino
- Pediatric Oncology Unit, Istituto Nazionale Tumori, University of Milan, Milan, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Istituto Nazionale Tumori, University of Milan, Milan, Italy
| | - P Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, University of Milan, Milan, Italy
| | - G Cecchetto
- Department of Women's and Children's Health, Pediatric Surgery Unit, University Hospital of Padua, Padua, Italy
| | - G Bisogno
- Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital of Padua, Padua, Italy
| | - A Inserra
- Division of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - F Bianco
- Faculty of Mathematical, Physical and Natural Sciences, University of Pisa, Pisa, Italy
| | - P Miccoli
- Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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Spinelli C, Rossi L, Strambi S, Piscioneri J, Natale G, Bertocchini A, Messineo A. Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases. J Endocrinol Invest 2016; 39:529-35. [PMID: 26403983 DOI: 10.1007/s40618-015-0390-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Branchial abnormalities occur when there is disturbance in the maturation of the branchial apparatus during fetal development. Branchial anomalies are congenital lesions usually present in childhood, even if they can be diagnosed later for enlargement or infection. A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice. The purpose of this article is to present clinical features, diagnostic methods and surgical treatment of branchial anomalies in childhood, based on a series of 50 patients. METHODS We conducted a retrospective analysis of a total of 50 pediatric patients operated from June 2005 to June 2014 for the presence of branchial cleft anomalies. RESULTS 27 cases (54 %) presented a second branchial cleft fistula and 11 cases (22 %) a second branchial cleft cyst and one case (2 %) presented both cyst and sinus of the second branchial cleft; four cases (8 %) presented first branchial cleft cyst whereas four cases (8 %) a first branchial cleft sinus and two cases (4 %) a first branchial cleft fistula; one case (2 %) presented a piriform sinus fistula (third branchial cleft). None of our patients presented anomalies of the fourth branchial cleft. All patients underwent surgical treatment and lesions have been removed by excision or fistulectomy. No post-surgical complication occurred. The rate of recurrence was 4 %. CONCLUSIONS Pre-operative diagnosis supplies important information to the surgeon for a proper therapy: a complete excision of the lesion without inflammatory signs is essential to avoid re-intervention and to achieve a good outcome.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Rossi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Strambi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - J Piscioneri
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - G Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - A Bertocchini
- Department of Pediatric Surgery, Children's Hospital A. Meyer, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy
| | - A Messineo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy
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13
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Spinelli C, Rossi L, Barbetta A, Ugolini C, Strambi S. Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review. J Endocrinol Invest 2015; 38:547-54. [PMID: 25501841 DOI: 10.1007/s40618-014-0226-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Ganglioneuromas are benign tumors which originate from the neural crest. This tumor affects mainly young patients rather than adult ones, and its most frequent localizations are mediastinum, retroperitoneum, adrenal glands and cervical region. Usually, ganglioneuromas are discovered as incidentalomas since they are often asymptomatic, even if they could present sympathetic or mass-related symptoms. To obtain a definitive diagnosis, histological exam is necessary since CT scan and MRI are not capable of distinguishing ganglioneuromas from other tumors, such as neuroblastomas or pheocromocytomas. The surgical excision is the chosen treatment and it offers an excellent prognosis. METHODS We conducted a retrospective analysis of our cases of ganglioneuroma from 2004 to 2014; this study aims to compare our experience with literature review (2000-2014). Data about patients' features, tumor localization, symptoms, treatment and follow-up were analyzed and reported in detailed tables. RESULTS Between 2004 and 2014 we treated 14 patients affected by ganglioneuroma. For all of them the diagnosis was incidental; 9 out of 12 (64.3 %) patients presented an adrenal mass; in 2 patients (14.3 %) the tumor was localized in cervical region; in other 2 patients (14.3 %) the tumor was in the retroperitoneum and one patient (7.1 %) presented a ganglioneuroma in the costo-vertebral space. All our patients underwent surgical removal and none of them present surgery-related complications or recurrences to date. CONCLUSIONS Our data widen the knowledge about ganglioneuroma and confirm that the surgical approach has an excellent prognosis with very low incidence of surgery-related complications and recurrences.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Rossi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - A Barbetta
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - C Ugolini
- Department of Laboratory Medicine and Integrated Diagnostics, Section of Experimental Pathology, University of Pisa, Pisa, Italy.
| | - S Strambi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Spinelli C, Strambi S, Tartaglia D, Di Franco G, Pucci V, Faviana P, Lencioni M. Primary retroperitoneal müllerian adenocarcinoma: a case report and literature review. Case Rep Oncol 2013; 6:616-21. [PMID: 24474926 PMCID: PMC3901585 DOI: 10.1159/000357424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary retroperitoneal müllerian adenocarcinoma (PRMA) is an extremely rare clinical entity. We report the case of a 54-year-old woman who presented with a mass in the right lower retroperitoneum, identified during an ultrasound exam. Computed tomography confirmed a retroperitoneal mass measuring 11 cm. The patient underwent laparotomy and the mass was completely excised. The histopathological exam revealed PRMA.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Clinical, Molecular Pathology and Critical Area, UO Chirurgia Generale 2, University of Pisa, Pisa, Italy
| | - S Strambi
- Department of Surgical, Clinical, Molecular Pathology and Critical Area, UO Chirurgia Generale 2, University of Pisa, Pisa, Italy
| | - D Tartaglia
- Department of Surgical, Clinical, Molecular Pathology and Critical Area, UO Chirurgia Generale 2, University of Pisa, Pisa, Italy
| | - G Di Franco
- Department of Surgical, Clinical, Molecular Pathology and Critical Area, UO Chirurgia Generale 2, University of Pisa, Pisa, Italy
| | - V Pucci
- Department of Surgical, Clinical, Molecular Pathology and Critical Area, UO Chirurgia Generale 2, University of Pisa, Pisa, Italy
| | - P Faviana
- Department of Surgical, Clinical, Molecular Pathology and Critical Area, UO Anatomia Patologica 3, University of Pisa, Pisa, Italy
| | - M Lencioni
- Department of Oncology, Transplants, and New Technologies, UO Oncologia 1, University of Pisa, Pisa, Italy
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15
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Cecchetto G, Riccipetitoni G, Inserra A, Esposito C, Michelazzi A, Ruggeri G, Spinelli C, Lima M. Minimally-invasive surgery in paediatric oncology: proposal of recommendations. Pediatr Med Chir 2010; 32:197-201. [PMID: 21171519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The Authors report a proposal of recommendations concerning Minimally Invasive Surgery (MIS) in Paediatric Oncology. Since the exact role of MIS in Paediatric Oncology is still not completely defined, a restrict panel of Italian Paediatric Surgeons, some interested in Oncologic Surgery, others in MIS, prepared a schematic document, mainly founded on literature data, to provide Paediatric Surgeons with recommendations useful to approach paediatric tumours with MIS. The final draft was approved by the Italian Group of Paediatric Oncologic Surgeons. The Authors summarize the feasibility of MIS, when performed with different purposes (biopsy / resection) and timing (initial / delayed surgery) for the most common solid tumours in children. The oncologic criteria must be always followed with MIS as well as with "open" surgery.
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Affiliation(s)
- G Cecchetto
- Department of Pediatrics, Division of Paediatric Surgery, University of Padua, Italy.
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16
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Port JL, Yankelevitz D, Lee PC, Spinelli C, Altorki NK. Preoperative erlotinib in clinical stage I and II non-small cell lung cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Spinelli C, Di Giacomo M, Mucci N, Massart F. Hemorrhagic corpus luteum cysts: an unusual problem for pediatric surgeons. J Pediatr Adolesc Gynecol 2009; 22:163-7. [PMID: 19539202 DOI: 10.1016/j.jpag.2008.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 07/06/2008] [Accepted: 07/08/2008] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE Hemorrhagic corpus luteum cysts (HCLC) constitute a common disorder in pediatric subjects undergoing surgical intervention. HCLCs especially develop in the early period after menarche, and they are commonly associated with dysfunctional ovulation. DESIGN Retrospective analysis of surgery outcome of HCLC patients. SETTING Pediatric Surgery Unit, S. Chiara University Hospital. PARTICIPANT 13 girls with HCLC diagnosis. INTERVENTIONS Surgical treatment of HCLCs. MAIN OUTCOME MEASURES We reviewed the clinical presentation and outcome of 13 post-menarcheal girls surgically treated for HCLCs in the Pediatric Surgical Unit from 2002 to 2006. RESULTS Primary presentation was persistent abdominal pain in 84.6% and acute abdominal pain in 15.4% of patients, respectively. Ultrasound examination showed complex ovarian masses in 77.23% cases and simple ovarian masses in 33.7% cases, respectively. Although laparoscopic excision of HCLC was performed in more than 45% cases, laparotomic approach was commonly required. After conservative surgery, ovarian size and viability were normal, as assessed by 6-month ultrasound scan. No recurrences of disease and regular menses were reported at 2 years follow-up. CONCLUSIONS In pediatric subjects with HCLC that required surgical intervention, no complications or disorder recurrence were reported. In order to preserve ovarian function, conservative surgery has to be performed whenever feasible.
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Affiliation(s)
- C Spinelli
- Department of Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy.
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Abstract
STUDY OBJECTIVE Functional ovarian lesions represent 45% of all pediatric adnexal abnormalities. Their surgical management, even if frequent, is not clear, especially in pediatric age. MATERIALS AND METHODS We retrospectively reviewed 22 pediatric patients surgically treated for functional ovarian lesions from 2000 to 2006. The following characteristics were analysed: age, size of the lesion, ultrasound (US) aspect and clinical presentation. RESULTS The average age was 16.1 years of age (range: 6 months-18 years). Of the 22 functional lesions, 12 (55%) were follicular cysts and 10 (45%) corpus luteum ones. The average size was 6.7 cm (range: 5.1-33 cm). US scan showed simple lesions in 10 cases (45%) and complex ones in 12 cases (55%). In 16 girls (72.8%) the presenting symptom was abdominal pain while 2 patients (9%) presented abdominal distention. In the other 4 patients (16.2%) the lesion was found accidentally during US examination. CONCLUSION In pediatric subjects, functional ovarian cysts rarely required surgical intervention, though no complications or disorder recurrence were reported. To preserve ovarian function, conservative surgery has to be performed whenever feasible.
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Affiliation(s)
- C Spinelli
- Chair of Pediatric and Infantile Surgery, Department of Surgery, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
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19
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Manno C, Virgilio M, Giangrande A, Stalteri A, Contu B, Quintaliani G, Spinelli C, Avella F, Cappelli G, Casino F, Cicchetti T, Di Giulio S, Di Luca M, Meneghel G, Milone F, Moriconi L, Panzetta GO, Procaccini AD, Triolo G, Zoccali C. [Update of the Italian Society of Nephrology Project No. 1 of the 2004-2006 SIN programme]. G Ital Nefrol 2006; 23:58-63. [PMID: 16521076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In the last few years the Italian Society of Nephrology has addressed many technical-scientific and management aspects to better patient satisfaction. Project No. 1 of the 2004-2006 programme on 'Quality and Accreditation of National Renal Units' focuses on four essential points. The first is the questionnaire mailed to all the Presidents and Regional Delegates on the relationship between Nephrology units, Local Government Health-System and the Regional Healthcare Agency. The results evidence that the 'political' decision-making power of nephrologists decreases in the absence of a national strategy. The second point, in collaboration with the National Census Group, includes the quality analysis and the standardization of resources (human and structural) and management of the Renal Units. The third point is based on 'Educational Courses for Quality and Accreditation' held in Rome (3-5 October 2005: L'Accreditamento all'Eccellenza dell'Unita' Operativa di Nefrologia, Dialisi e Trapianto; 17-19 October 2005: Il Manuale di Accreditamento della Specialità di Nefrologia). The courses aim at training members responsible for each region to hold courses in their specific region to create a network including each single Renal Unit to create an acceptable homogenous language on the models of analysis and on the correct use of 'The Guide for Excellence Accreditation'. The fourth point concerns both the on-line Guide for Excellence Accreditation and 'Peer Review Accreditation' and the NEQUASY (Nephrology Quality System) project. The manual must be 'user friendly' allowing each Centre to self-evaluate using national and regional standards.
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Affiliation(s)
- C Manno
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Università degli Studi di Bari-Policlinico, Bari.
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Nicolini A, Tartarelli G, Ferrari P, Carpi A, Conte M, Spinelli C, Anselmi L, Spisni R, Miccoli P. Intensive post-operative follow-up of breast cancer patients with tumour markers: Accuracy of serum MCA-CA15.3 and CEA-TPA-CA15.3 tumour marker panels for early detection of relapse. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Nicolini
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
| | - G. Tartarelli
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
| | - P. Ferrari
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
| | - A. Carpi
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
| | - M. Conte
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
| | - C. Spinelli
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
| | - L. Anselmi
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
| | - R. Spisni
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
| | - P. Miccoli
- University of Pisa, Department of Internal Medicine, Pisa, Italy; University of Pisa, Department of Reproduction, Pisa, Italy; University of Pisa, Department of Surgery, Pisa, Italy
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Bertelloni S, Navari S, Spinelli C, Bertacca L, Geraci S. [The child with ambiguous genitalia: differential diagnosis after the first month of life]. Minerva Pediatr 2003; 55:19-24. [PMID: 14992173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- S Bertelloni
- Centro di Riferimento Regionale di Endocrinologia Pediatrica, Dipartimento di Medicina della Procreazione e dell'Età Evolutiva, Università di Pisa, Ospedale Santa Chiara.
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D'Adamo G, Di Napoli A, Amoroso F, De Martino A, Della Grotta F, Filippini A, Mauro M, Rosa M, Santoboni A, Scaccia F, Di Lallo D, Miceli M, Spinelli C. [Collaborative study on peritoneal dialysis (PD) as first dialysis treatment in an Italian region: 1994-2000]. G Ital Nefrol 2003; 20:381-7. [PMID: 14523899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND In Lazio, only about 5% of uremic patients are on peritoneal dialysis (PD). The present study focuses on the parameters of PD selection, the treatment schedules, and the clinical outcomes of PD patients in the nine public facilities offering a PD program. A cohort of 249 first-time PD patients, from July 1, 1994 to December 31, 2000, was retrospectively considered. METHODS For the enrollment of the patients, the Regional Dialysis Registry databank was consulted. On December 31, 2000, a systematic review of patient charts was performed to extract the reasons for the PD choice, details of PD schedule, peritonitis episodes, reasons for drop-out, and patient survival rates. In regard to technique success-defined as the probability of having a patient alive on PD-change of modality and death were considered as final events. In regard to patient survival, only death, even in the first 2 months after a shift to hemodialysis, was considered the end point. RESULT The main PD selection reasons were patient and/or nephrologist preference in 90% of cases. One-hundred eighty-nine patients (76%) had been started on CAPD. During the follow-up, 38.2% dialysis schedules had been modified at least once. At the end of follow-up, 41.2% patients were on APD. The peritonitis rate was one episode per 30 patient-months (1 per 27 patient-months in CAPD; 1 per 37 patient-months in APD; p = 0.08). The technique success rate was 66.3% after 2 years and 49.8% after 3 years. The patient survival rate was 81.1% after 2 years and 68.7% after 3 years. CONCLUSIONS Patients chose PD as a first dialysis treatment mainly because of reasons unrelated to their clinical status. The technique's success, patient mortality rates, and the peritonitis rate do not explain the low PD diffusion in the region. The peritonitis rate meets the target criteria for excellence recommended by the Italian Society of Nephrology. The observed outcomes may have been favored by the selection of motivated patients and by the increased use of APD.
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Affiliation(s)
- G D'Adamo
- U.O.C. Nefrologia e Dialisi, Ospedale S. Spirito, Roma.
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23
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Calbo L, Spinelli C, Melita G. [Thyroid carcinoma in childhood]. Chir Ital 2003; 49:29-32. [PMID: 12743872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Thyroid carcinoma in childhood is very rare. The Authors report the features of this neoplasm versus other period of the life. There were no undifferentiated type of neoplasm in 69 cases. Almost all the tumors were well differentiated epithelial types especially papillary and only few cases were non epithelial differentiated tumors. Prognosis, that is better on childhood than other ages, depends, besides surgical indications (total thyroidectomy with lymphadenectomy for epithelial types of neoplasm to metabolic radiotherapy even if metastatized. Medullary carcinoma that as after associated to other endocrinopaties has the worst prognosis; total thyroidectomy with bilateral lymphadenectomy as not enough to avoid recurrence that does not responds to complementary treatment. Thyroid surgery in the child exposes to a major risk of iatrogenic lesions than the adult because of anatomical characteristics.
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Affiliation(s)
- L Calbo
- Cattedra di Endocrinochirurgia, Università degli Studi di Messina
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Spinelli C, Bertocchini A, Massimetti M, Ughi C. Muscle thickness in infants hypertrophic pyloric stenosis. Pediatr Med Chir 2003; 25:148-50. [PMID: 12916445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Hypertrophic pyloric stenosis (IHPS) is the most common abdominal abnormality requiring surgery in infants. It occurs due to the hypertrophic and hyperplasia of the muscular layers of the pyloric. The usual age of clinical presentation is about three weeks of life. The most important symptom is non bilious emesis, intermittent or after each feeding. From march 1996 to June 2001, 21 infants, 20 males and 1 female, were subjected to ultrasonographic, radiographic exams and after diagnosis to the pyloromyotomy extramucosa. Ultrasonography was the study of choice used to identify hypertrophic pyloric stenosis; the markers to analyse were the length and the overall diameter of the pyloric canal and the muscle thickness of the wall. The results showed that a length of the pyloric canal 20 +/- 6 mm, a diameter 13.6 +/- 2.5 mm and a muscle thickness 4.1 +/- 1 mm are diagnostics for hypertrophic pyloric stenosis.
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Affiliation(s)
- C Spinelli
- Cattedra di Chirurgia Pediatrica, Università di Pisa, Via Roma, 67.
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25
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Spinelli C, Bertocchini A, Lima M, Miccoli P. Graves-Basedow's disease in children and adolescents: total vs subtotal thyroidectomy. Pediatr Med Chir 2002; 24:383-6. [PMID: 12494541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
"Graves' disease" is an autoimmune pathology and is the most important cause of hyperthyroidism in children and adolescents. The treatment for this disease is controversial; there are three different options: synthetic antithyroid drugs, ablation of the thyroid gland with I 131 or surgery. Our study reports the clinical and therapeutic aspects and long-term results of 27 patients (< = 18 years old) treated with total thyroidectomy or "near-total" thyroidectomy from 1975 to August 2001. Antithyroid drugs represent the preliminary treatment of choice. For a long time in the past therapy with radioactive iodine was not recommended; now it represents an efficiently therapy with low morbility. Surgical treatment is suitable when a young patient presents a considerable enlargement of the thyroid gland or when antithyroid medical treatment does not achieve a good control of the disease, or when rapid control of hyperthyroidism is necessary. The surgical treatment can be a total thyroidectomy or a "near-total" thyroidectomy. The first is the best choice for us, because it has a low risk of relapse and a major efficacy in the ophthalmopathy.
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Affiliation(s)
- C Spinelli
- Cattedra di Chirurgia Pediatrica, Università di Pisa, Via Roma 67.
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26
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Nicolini A, Carpi A, Ferrari P, Tartarelli G, Anselmi L, Metelli MR, Gorini I, Spinelli C, Miccoli P, Giardino R. Long-term monitoring of cell-mediated immunity in disease-free breast cancer patients: a preliminary retrospective study. Biomed Pharmacother 2002; 56:339-44. [PMID: 12418581 DOI: 10.1016/s0753-3322(02)00243-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In 102 N- and 44 N+ disease-free breast cancer patients, lymphocytic populations and skin reaction of delayed hypersensitivity (SRDH) were monitored up to 266 months after mastectomy to find out whether they were similar or different from control values. In two selected groups of 34 N- and 11 N+ breast cancer patients, the whole 10 year follow-up was divided into three subintervals, each of them lasting 40 months and the time course of lymphocytic populations was evaluated. In the 102 N- patients, mean CD4+, CD8+, CD3+ values were lower (P < 0.01, P < 0.001, P < 0.01, respectively) while CD4+/CD8+ ratio was higher (P < 0.05) than in controls. Fifteen N- breast cancer patients (16%) were anergic compared to 30(32%) of controls (P < 0.05). In the 34 selected N- breast cancer patients soon after mastectomy the mean value of CD4+, CD8+, CD3+ T subpopulations was lower (P < 0.01, P < 0.001, P < 0.01, respectively) than in controls. Successively their mean value increased so that in the last subinterval they were not or were only slightly lower (P n.s., P < 0.05, P < 0.05, respectively) than in controls. In the 44 N+ patients, mean CD4+, CD8+, CD3+ values were lower (P < 0.001, v < 0.05, P < 0.01, respectively) and CD19+ lymphocytes higher (P < 0.001) than in controls. Five N+ breast cancer patients (13%) were anergic compared to 32% of controls (P < 0.05). In the 11 selected N+ breast cancer patients soon after mastectomy, the mean value of CD4+, CD8+ T subpopulations and CD16+56+ cells was significantly lower (P < 0.001, P < 0.001, P < 0.01, respectively) than in controls. Successively their mean value constantly increased so that in the last subinterval, no or slight (P n.s., P < 0.05, P n.s., respectively) significant difference compared to controls occurred. The mean CD4+/CD8+ ratio value of N- patients was significantly higher than in controls. However in the last subinterval, the significance was lower than in the first one (P < 0.05 and P < 0.01, respectively). In the N+ patients, the mean value of CD4+/CD8+ ratio was constant, although not significantly, lower than in controls; however it progressively increased from the first to the last subinterval. Therefore the significance of the difference of the mean CD4+/CD8+ ratio between N- and N+ patients strongly decreased from the first to the last subinterval (P < 0.001 and P < 0.05, respectively). These data indicate that in breast cancer patients, following mastectomy, a significant activation of memory and CD4+ T cells and long-term decrease of the circulating immunocompetent CD4+, CD8+ and CD16+56+ cells occurs. The prolonged disease-free interval observed in the 34 N- and 11 N+ breast cancer patients can be correlated with the restoration of the normal state of cell-mediated immunity.
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Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Italy.
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27
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Ghirri P, Ciulli C, Vuerich M, Cuttano A, Faraoni M, Guerrini L, Spinelli C, Tognetti S, Boldrini A. Incidence at birth and natural history of cryptorchidism: a study of 10,730 consecutive male infants. J Endocrinol Invest 2002; 25:709-15. [PMID: 12240903 DOI: 10.1007/bf03345105] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Of the 10,730 neonates born in the period 1978-1997 and examined for cryptorchidism (C) at birth, 1387 were pre-term (gestational age <37 wk), and 9343 were full-term. At birth, a total of 737 neonates (6.9%) were cryptorchid, 487 had bilateral C and 250 unilateral C. The C rate of pre-terms was 10 times higher than that of the full-terms (30.1 and 3.4%, respectively). Comparing the two studied decades, a significant decrease of C rate was found in the second decade in full-term neonates. The rates of C at birth were significantly elevated for low birth weight, babies born from mothers with an age <20 or >35 yr, newborns from mothers with A Rh positive and B Rh positive blood group. Of the 737 cryptorchid newborns at birth, 613 (83%) were re-examined after 12 months from the expected date of delivery, and those born in the period 1988-1997 were also re-evaluated at 6 months of life. Late spontaneous descent occurred in 464 cases (75.7%), while 149 (24.3%) were still cryptorchid. The incidence of C at 12 months from the expected date of delivery, after survival curve calculation, in term and pre-term infants, was 1.53 and 7.31%, respectively, in the period 1978-1987, and 1.22 and 3.13% respectively, in the 2nd decade (1988-1997). In the groups also examined at 6 months of life, spontaneous descent occurred almost completely within the first 6 months of life in term infants, but not in pre-terms. No evidence of seasonal cyclicity was found. Medical and/or surgical treatment was generally started within 2-4 yr of age earlier in the second decade of the study. In conclusion, the main risk factor for C at birth and at 12 months of life seems to be pre-term birth and low birth weight. If this is associated itself to a higher risk of infertility too, it remains to be defined.
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Affiliation(s)
- P Ghirri
- Division of Neonatology, University of Pisa, S. Chiara Hospital, Italy.
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Spinelli C, Lima M, Miccoli P. [Video-assistive minimally invasive surgical procedures in the treatment of thyroid in children and adolescents]. Pediatr Med Chir 2002; 24:217-9. [PMID: 12236036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Minimally invasive video-assisted (MIVA) surgery of the thyroid is now widely accepted by endocrinel surgeons, especially in adult age. This report describes indications, limits, technical aspects and results of MIVA in 10 young patients (mean age 16 years, range 11-18) enrolled in a study of 213 patients (mean age 45 years, range 11-81) operated with this technique, from October 1998 to August 2001, in the Department of Surgery at the University of Pisa. Young patients were submitted to surgery: 8 lobectomies (6 for microfollicular lesions and 2 for adenomas functionally autonomous) and 2 total thyroidectomies for papillary carcinoma. No case has been converted in "open" surgery and no post-operatory complications have been observed. Elective indications of MIVA are the volume of the nodule and the istological type. This technique cannot be performed in voluminous goiters, in medullary carcinomas and in scarcely differentiated carcinomas. Minimally invasive video-assisted surgery of the thyroid, in our experience, represents a reliable technique also in pediatric age.
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Affiliation(s)
- C Spinelli
- Dipartimento Chirurgia Generale, Università di Pisa, Via Roma, 67, Pisa, Italia
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Bertelloni S, Baroncelli GI, Ghirri P, Spinelli C, Saggese G. Hormonal treatment for unilateral inguinal testis: comparison of four different treatments. Horm Res 2002; 55:236-9. [PMID: 11740145 DOI: 10.1159/000050002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hormonal treatment of cryptorchidism has been used since the 30s, but controversies persist on its efficacy. It is also unclear whether there are differences with the use of different hormonal trials. AIMS To evaluate the efficacy of four hormonal treatments on testicular descent in a homogeneous group of cryptorchid boys. PATIENTS 155 patients (age 10-48 months) with unilateral inguinal palpable testis were studied. METHODS The patients were subdivided into four groups according to hormonal treatment: group 1 = hCG [500 IU/week (if the chronological age was <2 years) or 1,000 IU/week (if the chronological age was >2 years) for 6 weeks]; group 2 = hCG + hMG (hCG as in group 1 + hMG 75 IU/week for 6 weeks); group 3 = GnRH (1,200 microg/daily for 28 days); group 4 = GnRH + hCG (1,200 microg/daily for 28 days + 1,500 IU/week for 3 weeks, respectively). The results were evaluated at the end of the treatment period and 6 months later to exclude temporarily positive results. RESULTS At the end of the hormonal therapy, scrotal testicular descent was present in 30 of 155 boys (success rate 19.3%). Seven testes relapsed during follow-up (23.3%). The long-term success rate was 14.8% (23/155 testes). No significant differences were observed in success rates as well as in relapse rates among the four groups. CONCLUSIONS Hormonal therapy induced permanent testicular descent in a minority of young cryptorchid boys with inguinal palpable testis. Similar results were obtained with four different trials.
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Affiliation(s)
- S Bertelloni
- Endocrine Unit, Division of Paediatrics, Santa Chiara Hospital, University of Pisa, Italy.
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30
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Lima M, Ruggeri G, Dòmini M, Bertozzi M, Libri M, Federici S, Messina P, Spinelli C, Pigna A. The role of endoscopic surgery in paediatric oncological diseases. Pediatr Med Chir 2002; 24:41-4. [PMID: 11938681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Recent improvements in video imaging and instrumentation have encouraged a wider use of endoscopic surgery as a modality for diagnostic and operative procedures. To asses the utility and diagnostic accuracy of endoscopic surgery in children with oncological diseases, we reviewed our experience about thirty-eight patients affected by oncological diseases, referred to our Department since 1995. We performed laparoscopy in 22 cases, thoracoscopy in 14, 1 combinated procedure (laparoscopy + thoracoscopy) and retroperitoneoscopy in 1 case. Endoscopic surgery is indicated in cases of paediatric oncological diseases both for diagnosis and treatment.
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Affiliation(s)
- M Lima
- Chirurgia Pediatrica, Università degli Studi di Bologna, Via Massarenti, 11, 40138 Bologna, Italia
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31
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Spinelli C, Puccini M, Bertocchini A, Lima M, Pacini F, Miccoli P. [Prophylactic total thyroidectomy in children and adolescents with genetic mutations in the RET-protooncogene]. Pediatr Med Chir 2002; 24:53-7. [PMID: 11938683 DOI: pmid/11938683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Medullary thyroid cancer (C.M.T.) can be a sporadic form generally in adults or a heredofamilial form where the first symptom appears in pediatric and adolescent age. The hereditary form can be isolated or associated with others endocrine neoplasias of type 2: MEN2a (with or without cutaneous lichen amyloidosis) and MEN2b. The responsible gene of the transmission has been identified in proto-oncogene RET localized on chromosome 10. Point form mutations of this proto-oncogene have been found on exons 10 and 11 in MEN2a and on 16 in MEN2b. In our study on 64 subjects, who belong 11 familiar groups, affected by MEN2a, MEN2b and familiar C.M.T., underwent a genetic research to look for point form mutations of proto-oncogene RET with PCR followed by the analysis of restriction. A genetic mutation has been revealed in 25 subjects: 18 were already known affected by MEN2 and so surgical treated and 7 seemed healthy (mean age 17.4 years, range 10-25). These 7 patients has been undergone clinical research and surgical treatment: a total thyroidectomy associated a lymphectomy of the central compartment. In all cases the histological exam showed C.M.T. moreover a patient had metastasis in lymph nodes of the central compartment. Another had hyperparathyroidism and pheochromocytoma treated with total thyroidectomy, parathyroidectomy and bilateral laparoscopic adrenalectomy. The identification in a very early age of carrier subjects of hill's gene inside an affected family, permits the execution of a prophylactic total thyroidectomy to prevent the C.M.T.. The penetrance of this neoplasia in hereditary form is 100%.
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Affiliation(s)
- C Spinelli
- Dipartimento di Chirurgica Generale, Università di Pisa, Via Roma, 67, Pisa
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32
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Nicolini A, Carpi A, Ferrari P, Anselmi L, Spinelli C, Conte M, Miccoli P. The role of tumour markers in improving the accuracy of conventional chest X-ray and liver echography in the post-operative detection of thoracic and liver metastases from breast cancer. Br J Cancer 2000; 83:1412-7. [PMID: 11076646 PMCID: PMC2363419 DOI: 10.1054/bjoc.2000.1477] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The aim of this retrospective study was to assess the value of a serum tumour marker panel in selecting from among the patients with equivocal chest X-ray (CXR) or liver echography (LE) those with thoracic or liver metastases respectively. Between January 1984 and December 1999, 467 (341 non-relapsed and 126 metastatic) breast cancer patients were followed-up postoperatively. Among the 126 metastatic patients 36 showed thoracic (19 patients) or liver (17 patients) metastases, alone or in conjunction with other organs as the first evidence of distant spread. We focused on this series of 377 patients including 341 non-relapsed plus 36 with liver or thoracic metastases. The patients were followed-up after mastectomy with serial determinations of a panel of CEA-TPA-CA15.3 tumour markers, bone scintigraphy, CXR and LE. Up to December 1999, equivocal CXR occurred in 23 (6.1%) patients of whom 11 (47.8%) developed thoracic metastases; 14 (3.7%) patients showed an equivocal LE of whom 5 developed liver metastases. In the 37 patients with equivocal CXR or equivocal LE prolonged clinical and imaging follow-up over 41 +/- 36 months (mean +/- SD, range 3-163) was used to ascertain the presence or absence of thoracic or liver metastases. In the 23 patients with equivocal CXR the negative and positive predictive values of the tumour marker panel to predict thoracic metastases were 92% and 100% respectively. In the 14 patients with equivocal LE the negative and positive predictive values of the tumour marker panel for prediction of liver metastases were 90% and 100% respectively. This study shows that in breast cancer patients the CEA-TPA-CA15.3 tumour marker panel has a high value for selecting those patients at high risk of developing clinically evident pulmonary or liver metastases from amongst those subjects with equivocal CXR or equivocal LE.
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Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Pisa, Italy
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33
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Mussi A, Ambrogi MC, Iacconi P, Spinelli C, Miccoli P, Angeletti CA. Mediastinal goitres: when the transthoracic approach? Acta Chir Belg 2000; 100:259-63. [PMID: 11236179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The correct surgical approach to mediastinal goitre is not always well defined. We reviewed why and when our patients required a transthoracic approach. From 1979 to 1998, on 7.480 patients who underwent thyroid surgery in our hospital, 374 (5%) had a goitre whose greater bulk was inferior to the thoracic inlet; 43 patients of these last ones (11%) required a transthoracic approach. General anaesthesia was performed in all patients and orotracheal intubation was selective in 11 cases (double lumen tube of Carlens). In 34 cases, the first approach was a cervicotomy, followed by sternotomy in 23 cases or right posterolateral thoracotomy in 11 cases. Three patients underwent a sternotomy and 6 a thoracotomy only. We had neither perioperative mortality nor major complications. The mean hospital stay was 5 days. Mean goitre weight was 430 g and on average the greater diameter was 13 centimetres. The removal of a substernal goitre can be difficult and risky via the cervicotomy only. A transthoracic approach is often required in the case of greater secondary, primary and recurrent mediastinal goitres.
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Affiliation(s)
- A Mussi
- Service of Thoracic Surgery, Cardio and Thoracic Department, University of Pisa, Pisa, Italy
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34
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Lippi F, Capezzone M, Miccoli P, Traino C, Di Martino F, Angelini F, Spinelli C, Iacconi P, Pinchera A, Pacini F. Use of surgical gamma probe for the detection of lymph node metastases in differentiated thyroid cancer. Tumori 2000; 86:367-9. [PMID: 11016732 DOI: 10.1177/030089160008600433] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with differentiated thyroid cancer (DTC) after total or near-total thyroidectomy require 131I therapy. After surgery the persistence of lymph node metastases in our series of patients was frequent (30%). Such patients are preferentially treated with radioiodine and shifted to surgical reintervention when the nodal lesions persist after two 131I treatments. AIM Use of an intraoperative radioactive probe (C-TraK) to allow a more radical surgical approach in thyroid cancer patients submitted to surgery for lymph node metastases. METHODS AND RESULTS After adequate withdrawal of L-thyroxine suppressive therapy six patients were given high 131I doses followed by post-therapy WBS which demonstrated cervical activity in 5 patients and peri-jugular activity in 1. Surgery with the help of a gamma probe allowed to detect and remove all metastatic nodes. After excision all surgical specimens showed higher radioactive counts with respect to the background. The post-surgical scan showed the disappearance of all areas of 131I uptake. Histology confirmed the presence of metastatic lesions from papillary thyroid cancer. CONCLUSIONS We conclude that the use of a gamma probe can be successful in patients with metastatic neck lesions resistant to 131I treatment, particularly in patients with nonpalpable lesions.
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Affiliation(s)
- F Lippi
- Dipartimento di Endocrinologia e Metabolismo, Pisa, Italy
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35
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Abstract
BACKGROUND Ultrasound-guided fine needle aspiration cytology (FNAC) of suspect parathyroid adenomas is sometimes used for the diagnosis of primary hyperparathyroidism (PHPT). FNAC complications are rare or mild. We describe the first case in literature of cutaneous spread of parathyroid carcinoma after FNAC. CASE A woman underwent a neck ultrasound which revealed a solid hypoechogenic nodule of 1.5 cm at the level of the inferior pole of the right thyroid. In the same time a FNAC of the nodule was performed. Cytology showed no atypical cells. Successively PHPT was diagnosed and a few weeks later the patient had a subcutaneous lump in the same area of FNAC. The patient underwent surgery and histology of the specimen showed a differentiated parathyroid carcinoma. The postoperative course was regular and calcium and parathormone resulted normal. CONCLUSION The use of FNAC should be carefully assessed in the presence of suspect parathyroid carcinoma, because this could cause a possible diffusion of a parathyroid carcinoma along the needle tract.
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Affiliation(s)
- C Spinelli
- Department of Surgery, Hospital S. Chiara, University of Pisa, Italy
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36
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Spinelli C, Gadducci A, Bonadio AG, Berti P, Miccoli P. Benign ovarian fibroma associated with free peritoneal fluid and elevated serum CA 125 levels. Minerva Ginecol 1999; 51:403-7. [PMID: 10638167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
This paper reports the clinical case of a patient with ovarian neoplasia, ascites effusion, and elevated serum CA 125 levels (411 U/ml). This condition simulated a malignant pathology on the grounds of preoperative diagnostic examinations. Surgical investigation diagnosed an ovarian fibroma and ascites. Ascites was resolved rapidly and the serum CA 125 levels decreased after surgical neoplasia removal. An ovarian neoplasia associated with ascites effusion and elevated serum CA 125 levels (also in the presence of suspect ecographic and tomographic features) do not necessarily imply a malignant neoplasia.
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Affiliation(s)
- C Spinelli
- Department of Surgery, University of Pisa
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37
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Antognoni F, Agostani S, Spinelli C, Koskinen M, Elo H, Bagni N. Effect of Bis(guanylhydrazones) on Growth and Polyamine Uptake in Plant Cells. J Plant Growth Regul 1999; 18:39-44. [PMID: 10467018 DOI: 10.1007/pl00007044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In the present work the effect of several bis(guanylhydrazones) on the growth of Helianthus tuberosus tuber explants was studied. Different aliphatic congeners of glyoxal bis(guanylhydrazone) were tested. Most of the compounds displayed an inhibitory effect on growth, and a correlation between the structure of the molecule and the inhibitory activity was observed. Experiments carried out with glyoxal bis(guanylhydrazone) and its congeners methyl-, ethylmethyl-, and methylpropylglyoxal bis(guanylhydrazones) show that as the total number of side chain carbon atoms in the molecule increases, the inhibitory potency also increases. A depletion of spermidine levels was also found in the explants treated with ethylmethylglyoxal bis(guanylhydrazone), which turned out to be one of the most potent growth inhibitors. The addition of spermidine caused a significant reversion of the antiproliferative action of glyoxal bis(guanylhydrazone). The effect of these compounds on spermidine uptake in protoplasts isolated from carrot phloem parenchyma was also investigated. Only a slight competition was found when antagonists were present at concentrations 20 times higher than the polyamine, thus suggesting that bis(guanylhydrazones) do not share, at least at low concentrations, the polyamine transport system in plant cells.Key Words. Bis(guanylhydrazones)-Carrot protoplasts-Growth-Helianthus tuberosus-Polyamines-Uptakehttp://link.springer-ny.com/link/service/journals/00344/bibs/18n1p39.html
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Affiliation(s)
- F Antognoni
- Dipartimento di Biologia evoluzionistica sperimentale, Università di Bologna, via Irnerio 42, 40126 Bologna, Italy
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38
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Calbo L, Spinelli C, Lazzara S, Melita P, Miccoli P. [Surgical management of hereditary medullary carcinoma of the thyroid in patients with "RET" proto-oncogene mutation]. CHIRURGIA ITALIANA 1999; 50:47-51. [PMID: 10392193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The authors report their results in 64 individuals belonging to 11 families with MEN 2 and familial medullary carcinoma of thyroid (CMT) syndromes. They show amplification and restriction techniques, type, site and incidence of genetic alteration in the observed cases; besides they illustrate the adopted surgical management related to the mutation. They stress the concept that genetic test allows to detect the population with altered gene before laboratory or clinical evidence, with the great advantage to indicate an early surgical approach. If it is shown a multi-organ disease, as in one patient with CMT associated with bilateral pheocromocytoma, the two diseases must be treated during the same operative time.
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Affiliation(s)
- L Calbo
- Cattedra di Chirurgia Generale, Scuola di Specializzazione in Chirurgia Generale 2a, Università degli Studi di Messina
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39
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Spinelli C, Galleri D, Calbo L, Palmeri R, Miccoli P, Melita P. [Medullary carcinoma of thyroid gland]. Chir Ital 1999; 49:21-5. [PMID: 10392179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The authors present the characteristic features of medullary carcinoma of thyroid (CMT) and underline the necessity to identify RET proto-oncogene that is the cause of hereditary transmission of CMT. Physiology of C cells and clinical syndromes are reported and the importance of a genetic screening in population at risk is emphasized; this test has shown to be reliable and easy to apply. They report their experience on techniques of amplification and restriction for RET proto-oncogene identification in relatives of patients with MEN or familial CMT syndromes. This study has allowed to recognize a population bearing the oncogene responsible of the disease and to achieve a correct prophylactic therapeutic management.
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Affiliation(s)
- C Spinelli
- Cattedra di Chirurgia Generale, Scuola di Specializzazione in Chirurgia Generale 2a, Università degli Studi di Messina
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Abstract
We report the first case of central precocious puberty in a patient with 48,XXYY Klinefelter syndrome variant. We also report clinical characteristics, growth pattern, endocrine data and pathological testicular findings. The patient did not receive medical care for his precocious pubertal development, because of adequate height prognosis, and reached normal height for both his target height and Klinefelter patients. Since precocious puberty seems to occur in Klinefelter syndrome and its variants, we advise karyotype analysis in boys with mental retardation, gynecomastia, small testes and precocious onset of puberty.
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Affiliation(s)
- S Bertelloni
- Department of Reproductive Medicine and Pediatrics, University of Pisa, Santa Chiara Hospital, Italy
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41
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Abstract
INTRODUCTION Most cases of intrathoracic goiter can be managed by cervical incision alone. A thoracic approach may be needed when adhesions or an anomalous blood supply are present or carcinoma is suspected. PATIENTS AND METHODS Only 44 patients out of 5263 operated on for goiter needed a thoracic incision. A sternotomy was performed in 29 cases and a thoracotomy in 15; a malignancy was present in 9 cases. Symptoms, surgical approach, histology, survival and pTN staging of these 9 patients were reviewed and discussed; no perioperative mortality was observed. DISCUSSION A thoracic approach is more frequently needed for treatment of intrathoracic thyroid carcinoma as it offers a greater chance of radical excision and better control of intraoperative bleeding. Histologically, thyroid carcinoma in intrathoracic goiter is often anaplastic or rare and has a poor long-term survival rate when compared to cervical forms.
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Affiliation(s)
- M Nervi
- Department of Endocrine Surgery, University of Pisa, Italy
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Miccoli P, Antonelli A, Spinelli C, Ferdeghini M, Fallahi P, Baschieri L. Completion total thyroidectomy in children with thyroid cancer secondary to the Chernobyl accident. Arch Surg 1998; 133:89-93. [PMID: 9438766 DOI: 10.1001/archsurg.133.1.89] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the usefulness of submitting children with thyroid cancer secondary to nuclear accidents to a completion total thyroidectomy. DESIGN A case series consisting of patients living and operated on in Belarus whose parents had asked for a clinical evaluation in a western European center. SETTING A tertiary care referral center. PATIENTS The conditions of 47 children from Gomel, Belarus, with differentiated thyroid carcinoma following the nuclear accident at Chernobyl, Ukraine, were evaluated at the University of Pisa, Pisa, Italy. In approximately half of the cases, the treatment in Belarus consisted of a hemithyroidectomy. After a complete evaluation, the decision was made to reoperate on 19 of them by performing a completion total thyroidectomy. The preoperative evaluation revealed that 5 (26%) of the 19 patients who had undergone a hemithyroidectomy had unilateral recurrent nerve palsy and that 2 (10.5%) had hypoparathyroidism. INTERVENTIONS Neck ultrasonography was used for the preoperative localization of thyroid residuals, thyroid nodules, suspicious lymph nodes, and a guided fine-needle aspiration biopsy specimen. The circulating thyroglobulin measurement was obtained before reoperation. An iodine 131 whole-body scan (WBS) was performed and circulating thyroglobulin levels were obtained after completion of the thyroidectomy during withdrawal of levothyroxine sodium therapy. MAIN OUTCOME MEASURE The number of patients with a recurrence of thyroid cancer and lung or lymph node metastases after the completion total thyroidectomy. RESULTS The results of the histologic examination were positive for papillary thyroid cancer in 6 (28.6%) of 21 patients, 3 with residual cancer in the remaining thyroid lobe and 3 with metastatic lymph node disease. A posttherapy WBS demonstrated lung metastases in 5 (28%) of 18 patients and lymph node metastases in 6 (33%) of 18 patients; the results of a posttherapy WBS were negative for metastases in 7 (39%) of 18 patients. Hypoparathyroidism developed in 4 (21%) of 19 patients who underwent a completion total thyroidectomy; unilateral laryngeal nerve palsy developed in 1 (5.2%) of these 19 patients. Among 22 children who previously underwent total thyroidectomy in Belarus, a diagnostic WBS showed lung metastases in 10 (45%) of the children and lymph node metastases alone in 3 (14%) of the children; the results of a diagnostic WBS were negative for metastases in 9 (41%) of the children. Statistical analysis showed a nonsignificant (P>.05) difference in the prevalence of lung and lymph node metastases in patients who previously underwent total thyroidectomy compared with patients who underwent completion total thyroidectomy. CONCLUSION Completion total thyroidectomy allowed for the diagnosis and treatment of recurrent thyroid cancer and lung or lymph node metastases in 61% (11/18) of the patients in whom residual differentiated thyroid carcinoma was not previously recognized.
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Affiliation(s)
- P Miccoli
- Endocrine Surgery Unit, University of Pisa, Italy
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43
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Baldini E, Tibaldi C, Lencioni M, Giannessi P, Evangelista G, Roncella M, Spinelli C, Meucci C, da Prato M, Conte P. Filgrastim and lack of support of intensive adjuvant chemotherapy for high-risk breast cancer patients. Am J Clin Oncol 1997; 20:169-72. [PMID: 9124194 DOI: 10.1097/00000421-199704000-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The capacity of filgrastim to reduce the myelotoxicity of a 16-week intensive chemotherapy regimen has been investigated in 24 operable breast cancer patients with > or = 10 metastatic axillary nodes. Five patients were treated with chemotherapy alone (control group); 19 patients were treated with chemotherapy and filgrastim, 5 microg/kg/day s.c. Six patients in the latter group were treated from day 4 to day 7 (level 1), seven from day 10 to day 13 (level 2), and six from day 4 to day 7 and day 10 to day 13 (level 3). A total of 135 courses were administered: neutropenia was the most severe toxicity, and the prophylactic use of filgrastim does not reduce its severity. Moreover, the dose intensities of antiblastic drugs actually received by the patients were not significantly different in the four study groups. Among the patients treated at level 3, there were three toxic deaths: one patient died because of febrile neutropenia and sepsis, two patients because of ischemic colitis. At a median follow-up of 15 months, 17 patients were alive, and 15 patients were disease free. The use of filgrastim does not ameliorate myelotoxicity and does not allow the administration of the planned doses of antiblastic drugs of a 16-week intensive chemotherapy regimen.
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Affiliation(s)
- E Baldini
- U. O. Oncologia Medica, Ospedale S. Chiara, Pisa, Italy
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44
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Abstract
Omeprazole is a proton pump inhibitor widely used for the treatment of peptic ulcer disease. We report a patient presenting nonoliguric acute renal failure following omeprazole treatment. Both eosinophilia and eosinophiluria were observed, and the patient was diagnosed as having drug-induced acute interstitial nephritis. Renal failure spontaneously resolved when omeprazole was discontinued.
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Affiliation(s)
- G d'Adamo
- Nephrology and Dialysis Unit, Ospedale Santa Spirito, Rome, Italy
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45
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46
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Abstract
Four cases of symptomatic myelolipoma of the adrenal gland are presented. Three were treated at laparotomy and one with a laparoscopic approach. On the basis of these four cases we discuss the aetiology, pathogenesis, clinical manifestations, diagnosis and treatment of this rare disease. We also report the follow-up of a patient with bilateral myelolipoma, who underwent monolateral excision. We conclude that myelolipoma, if correctly diagnosed, can be treated conservatively with careful follow-up, limiting surgery to symptomatic cases.
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Affiliation(s)
- C Spinelli
- Dipartimento di Chirurgia, Università di Pisa, Italia
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47
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Spinelli C, Berti P, Miccoli P. [Identification of the recurrent nerve in thyroid surgery. Technical note]. MINERVA CHIR 1995; 50:93-6. [PMID: 7617269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors report an experience of 1800 surgical operations for thyroid diseases executed, with identification of the recurrent laryngeal nerve in all cases, from 1988 to 1992, and analyse the various causes of recurrent laryngeal nerve injury. This complication of thyroid surgery is not completely avoidable, in spite of an extremely accurate surgical technique. In most instances of injury to one of the recurrent laryngeal nerves during thyroidectomy, the surgeon can confirm that the recurrent laryngeal nerve was not sectioned during the operation. This fact demonstrates that often the recurrent laryngeal nerve injury is due not to a section but to a stretching, a compression, an ischemia of the nerve. The recurrent laryngeal nerve injury may be due to a mistake in surgical technique: the ligation of the inferior pole vessels before identifying the recurrent laryngeal nerve; a mistake in hemostasis maneuvers; excessive aspiration near to the nerve; an excessive traction of the recurrent laryngeal nerve during the medial traction of the thyroid lobe with a stretching of the nerve; an excessive dissection of the nerve with ischemia. Other causes that make easier the recurrent laryngeal nerve injury are, anatomic variations of the nerve; extension of the surgical operation; histologic findings.
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Affiliation(s)
- C Spinelli
- Instituto di Clinica Chirurgica, Università degli Studi di Pisa
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48
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Spinelli C, Berti P, Miccoli P. [The postoperative hemorrhagic complication in thyroid surgery]. MINERVA CHIR 1994; 49:1245-7. [PMID: 7746443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hemorrhage is a complication of thyroid surgery less important than recurrent laryngeal nerve injury or hypoparathyroidism, but extremely dangerous. Hemorrhage may be early or delayed. Early hemorrhage occurs generally in the operating theatre and is made easier by vomiting and coughing after removal of the tracheal tube. For this reason it is indispensable for the surgeon to remain until the patient is awake and carefully control the drainages. Delayed hemorrhage generally occurs some hours after the surgical operation with a swelling of the neck associated with difficulties in the breathing, due to tracheal compression. In our institution, from 1988 to 1992, we performed 1800 surgical operations for thyroid diseases and we observed 9 early hemorrhages and 10 delayed hemorrhages. In all cases we performed reoperation in general anaesthesia. In our series the hemorrhage was due to the vessels of the pre-thyroidal muscles and of the inferior pole, rarely of the superior pole. We had no complications after the reoperation. To prevent this complication, we have to respect some technical aspects: accuracy in the ligature of the blood vessels of the superior and inferior pole; partial section of the pre-thyroidal muscles; to bring the remaining thyroid (in case of subtotal thyroidectomy) near to the trachea with some stitches.
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Affiliation(s)
- C Spinelli
- Cattedra di Endocrinochirurgia, Università degli Studi, Pisa
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49
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Spinelli C, Berti P, Miccoli P. [Carcinoma of the parathyroids. Surgical experience in 3 cases]. MINERVA CHIR 1994; 49:1343-7. [PMID: 7746459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Parathyroid carcinoma is a rare cause of hyperparathyroidism (rate of occurrence of 0.5% of all parathyroid neoplasms). In this report we describe three cases of parathyroid carcinoma seen in our Institution and we analyse the clinical, diagnostic, therapeutic and pathological findings of this disease. The three patients were 14, 22 and 45 year old respectively. Familial history was negative for endocrine diseases. The laboratory and instrumental findings of thyroid and adrenal glands were negative. Predominant symptoms were in all cases weakness, lethargy, bone and muscular pain, nausea, vomiting. The two young patients presented fractures of the inferior limb and of the forearm respectively, five years and one year before the diagnosis. X-ray examination and MNR easily demonstrated the "brown tumors". In two cases a symptomatic nephrolithiasis was present. The 14 year old child presented polyuria and polydipsia. In all cases a mass was palpable in the neck (two in the right side and one in the left one). The elevated serum calcium concentration (15, 18, and 20.2 mg/dl respectively) and the elevated serum PTH (480, 651, and 680 pg/ml respectively) allowed the diagnosis of hyperparathyroidism. Ultrasound scan and thallium-technetium scanning identified in all cases a mass adjacent the thyroid. A radical resection of the malignant parathyroid gland and the ipsilateral thyroid lobe was performed in two cases, while only a resection of the involved parathyroid gland in one case. The diagnosis of parathyroid cancer was established using pathologic criteria.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Spinelli
- Cattedra di Endocrinochirurgia, Università degli Studi, Pisa
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50
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Spinelli C, Gori L, Berti P, Pierallini S, Durno M, Angeletti CA, Miccoli P. [Cardiac echinococcosis. Case report and review of the literature]. MINERVA CHIR 1993; 48:695-7. [PMID: 8414114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cardiac echinococcosis is a rare disease. We report the case of a patient affected by cardiac echinococcosis who underwent surgical treatment successfully. A forty year old woman was hospitalized referring palpitation and dyspnea. The patient had undergone surgical pericystectomy of the right lobe of the liver for echinococcosis 6 month before. Chest X-ray film showed a round opacity well delineated on the left side of the heart, Ghedini reaction was negative, ECG was normal. After a review of literature we analyze anatomo-clinic and therapeutic aspects of the disease.
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Affiliation(s)
- C Spinelli
- Istituto di Clinica Chirurgica, Università di Pisa
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