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Bertani A, Schiavon M, Boffini M, Rosso L, Nosotti M, Luzzi L, Dolci G, Colledan M, Diso D, Meloni F, Parisi F, Masiero L, Peritore D, Cardillo M. Clinical Impact of the Lung Allocation Policy: A Nationwide Study. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1222] [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: 11/27/2022] Open
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2
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Schiavon M, Camagni S, Venuta F, Rosso L, Boffini M, Parisi F, Bertani A, Meloni F, Paladini P, Faccioli E, Colledan M, Diso D, Cattaneo M, Scalini F, Alfieri S, Morosini M, Luzzi L, Lorenzoni G, Dell'Amore A, Rea F. A Multicentric Evaluation of Pediatric Lung Transplantation in Italy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.997] [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: 11/25/2022] Open
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3
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Carillo C, Pecoraro Y, Anile M, Poggi C, Oliva A, Amore D, Bruschini P, Naldi G, Mantovani S, Francioni F, Pugliese F, De Giacomo T, Venuta F, Diso D. Colistin-based Treatment of Multidrug-resistant Gram-negative Bacterial Pulmonary Infections After Lung Transplantation. Transplant Proc 2018; 51:202-205. [PMID: 30661895 DOI: 10.1016/j.transproceed.2018.04.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lung transplantation (LT) is a viable option for a select group of patients with end-stage lung disease. However, infections are a major complication after LT, accounting for significant morbidity and mortality. Several germs may be responsible; multidrug-resistant Gram-negative (MDR-GN) bacteria are emerging. Colistin is widely used in the treatment of these infections and is administered by inhalation and/or parenterally. At our institution, in patients with tracheostomy, colistin is administered by direct instillation in the airway during bronchoscopy. We reviewed a series of patients who underwent LT complicated by postoperative MDR-GN bacterial pulmonary infection. METHODS From January 2015 to May 2017, 26 lung transplants were performed. In the postoperative course, 14 (54%) developed MDR-GN bacterial infection; respiratory specimen culture, blood tests, and chest X-ray were considered. Colistin was the only antibiotic usable. Thirteen patients received intravenous (IV) colistin; in the subgroup of patients with tracheostomy, colistin was instilled directly in the airway, and 6 patients received inhaled colistin. RESULTS Seven patients needed tracheostomy. Pseudomonas aeruginosa was the predominant infection (86%), with Acinetobacter baumanii seen in 2 cases (14%). An early clinical-laboratory response was observed in 9 patients (64%). White blood cell count and C-reactive protein values improved (P = .02 and P = .001, respectively). A significant reduction in bacterial load was observed on microbiologic bronchoalveolar lavage specimens. CONCLUSION Colistin instilled directly in the airway did not show side effects. The combination of IV and inhaled/instilled colistin could be a useful treatment option for MDR-GN infections after LT.
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Affiliation(s)
- C Carillo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Y Pecoraro
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - M Anile
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - C Poggi
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A Oliva
- Department of Public Health and Infectious Disease, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Amore
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - P Bruschini
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - G Naldi
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - S Mantovani
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - F Francioni
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - F Pugliese
- Division of Anesthesia and Transplant Intensive Care Unit, Department of General Surgery and Organ Transplant, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - T De Giacomo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - F Venuta
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Diso
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Pecoraro Y, Carillo C, Diso D, Mantovani S, Cimino G, De Giacomo T, Troiani P, Shafii M, Gherzi L, Amore D, Rendina EA, Venuta F, Anile M. Efficacy of Extracorporeal Photopheresis in Patients With Bronchiolitis Obliterans Syndrome After Lung Transplantation. Transplant Proc 2017; 49:695-698. [PMID: 28457374 DOI: 10.1016/j.transproceed.2017.02.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/18/2022]
Abstract
BACKGROUND Lung transplantation (LT) is only therapeutic option for patients affected by chronic respiratory failure. Chronic rejection, also known as bronchiolitis obliterans syndrome (BOS), is still the main cause of death and the most important factor that influences post-transplantation quality of life. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Extracorporeal photopheresis (ECP) seems to reduce the rate of lung function decline in transplant recipients with progressive BOS. METHODS From 1991 until now, 239 LTs were performed at our center. Fifty-four patients (22.5%) developed BOS; 15 of these (27.7%) were treated with ECP. At the beginning of the treatment, all patients showed a mean decline of forced expiratory volume in 1 second (FEV1) from baseline values of 45.8% ± 17.2%; 2 patients were in long-term oxygen therapy. RESULTS Mean follow-up from November 2013 to June 2016 was 11.6 ± 7 months. Twelve patients (80%) showed lung function stabilization with an FEV1 range after treatment between -6% to +8% from the pre-treatment values. We did not report any adverse effects or increase of infections incidence. DISCUSSION ECP seems to be an effective and well-tolerated therapeutic option for LT patients with BOS in terms of stabilization of lung function and increased survival.
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Affiliation(s)
- Y Pecoraro
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - C Carillo
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - D Diso
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - S Mantovani
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - G Cimino
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - T De Giacomo
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - P Troiani
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - M Shafii
- Department of Hematology, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - L Gherzi
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - D Amore
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - E A Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - F Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - M Anile
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
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Nosotti M, Dell'Amore A, Diso D, Oggionni T, Aliberti S. Selection of Candidates for Lung Transplantation: The First Italian Consensus Statement. Transplant Proc 2017; 49:702-706. [PMID: 28457376 DOI: 10.1016/j.transproceed.2017.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lung transplantation is a well-established treatment for selected patients with advanced chronic respiratory insufficiency. Recognizing those patients with end-stage lung disease who might benefit from lung transplantation is a crucial task. Considering the presence of inadequate evidence-based practice, international and national scientific societies provided consensus opinions regarding the appropriate timing of listing. The Study Group for Thoracic Organs Transplantation (branch of the Italian Society for Organs Transplantation) promoted and realized a Delphi conference among the Italian lung transplantation centers to provide guidance to clinical practice based on international recommendations. The experts from the nine Italian centers completed two rounds of standardized questionnaires (answer rate, 100%): 42 statements received a consensus ≥80%. The selected statements presented in this article are intended to assist Italian clinicians in selecting patients for lung transplantation.
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Affiliation(s)
- M Nosotti
- Department of Phato-physiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - A Dell'Amore
- Department of Cardiac-Thoracic and Vascular Diseases, Thoracic Surgery, University Hospital St. Orsola-Malpighi, Bologna, Italy
| | - D Diso
- Department of Thoracic Surgery, University of Rome La Sapienza, Umberto I Hospital, Rome, Italy
| | - T Oggionni
- Pulmonology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - S Aliberti
- Department of Phato-physiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Carillo C, Pecoraro Y, Anile M, Mantovani S, Oliva A, D'Abramo A, Amore D, Pagini A, De Giacomo T, Pugliese F, Rendina EA, Venuta F, Diso D. Evaluation of Renal Function in Patients Undergoing Lung Transplantation. Transplant Proc 2017; 49:699-701. [PMID: 28457375 DOI: 10.1016/j.transproceed.2017.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute kidney injury and chronic kidney failure are serious complications after lung transplantation. Glomerular filtration rate (GFR) is the primary indicator of renal function. Several equations have been proposed to evaluate the estimated GFR (eGFR). We compared three different equations to determine which has the better correlation with the development of acute and chronic renal failure in lung recipients. METHODS Twenty-two patients with a mean age of 54.4 ± 8.5 years underwent lung transplantation from 2010 to 2015. Thirteen (59%) had pulmonary fibrosis, 7 (32%) emphysema, 1 (4.5%) bronchiectasis, and 1 (4.5%) lymphangioleiomyomatosis. In all patients, eGFR was measured preoperatively using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Levey's Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. In 20 patients (90%) eGFR was calculated at 1, 3, and 6 months. RESULTS According to CKD-EPI and MDRD, eight patients (36.3%) had preoperative reduction in eGFR, whereas 6 patients (27.2%) had preoperative reduction according to the CG (P = .04). The mean values were higher for the CG (103.2 vs. 102 vs. 94.4). Five patients (22.7%) developed perioperative acute renal failure requesting a dialysis treatment; four of these showed a preoperative eGFR to the highest CG (P = .05). At 1 and 6 months after lung transplantation, the CG, MDRD and CKD-EPI eGFR values were, respectively, 86.6, 84.1 and 76.6 mL/min/1.73m2 and 75.8, 72.7, and 72.3 mL/min/1.73m2. CKD-EPI eGFR values are more predictable than the other equations of AKI. CONCLUSIONS Preoperative assessment of eGFR using the MDRD and CKD-EPI seems to correlate better than the CG to the prediction of acute renal failure, whereas for the chronic form the three equations seem equivalent.
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Affiliation(s)
- C Carillo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Y Pecoraro
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - M Anile
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - S Mantovani
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A Oliva
- Department of Public Health and Infectious Disease, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A D'Abramo
- Department of Public Health and Infectious Disease, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Amore
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A Pagini
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - T De Giacomo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - F Pugliese
- Division of Anesthesia and Transplant Intensive Care Unit, Department of General Surgery and Organ Transplant, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - E A Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza Univeristy of Rome, Rome, Italy
| | - F Venuta
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Diso
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Fiorelli A, D’Andrilli A, Anile M, Cascone R, Occhiati L, Diso D, Cassiano F, Poggi C, Ibrahim M, Cusumano G, Terminella A, Failla G, La Sala A, Bezzi M, Innocenti M, Torricelli E, Venuta F, Rendina EA, Santini M, Andreetti C. F-075THE COST/BENEFIT OF UNIDIRECTIONAL ENDOBRONCHIAL VALVES IMPLANT FOR MANAGEMENT OF PERSISTENT AIR-LEAKS: RESULTS OF A MULTICENTRE STUDY. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.087] [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: 11/13/2022] Open
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8
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Ruberto Franco F, Zullino V, Congi P, Magnanimi E, Bernardinetti M, Paglialunga G, Maldarelli F, Diso D, Venuta F, Pugliese F. Independent lung ventilation in the postoperative management of single lung transplantation: case report. Transplant Proc 2015; 46:2357-9. [PMID: 25242787 DOI: 10.1016/j.transproceed.2014.07.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Independent lung ventilation (ILV) is a ventilation strategy used in patients with significant differences in respiratory mechanics between the 2 lungs owing to asymmetric or unilateral lung diseases. We report the case of a 66-year-old patient treated with ILV for a primary graft dysfunction occurred early after single lung transplantation. On intensive care unit admission, the patient was ventilated with pressure-controlled mechanical ventilation. Despite efforts to optimize ventilation and medical therapy, his clinical condition progressively worsened, manifesting hypoxemia, hypercapnia, and radiologic evidence of hyperinflation of the native lung, collapse of the graft, and mediastinal shift. The ventilation was therefore switched to ILV. A constant improvement in clinical conditions, arterial blood gas parameters, and radiologic findings was then obtained. The patients was weaned from mechanical ventilation and finally successfully extubated.
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Affiliation(s)
- F Ruberto Franco
- Dipartimento di Anestesia e Rianimazione, UOD Anestesia e Terapia Intensiva Trapianti d'Organo, Policlinico Umberto I, "Sapienza", Rome, Italy
| | - V Zullino
- Dipartimento di Anestesia e Rianimazione, UOD Anestesia e Terapia Intensiva Trapianti d'Organo, Policlinico Umberto I, "Sapienza", Rome, Italy.
| | - P Congi
- Dipartimento di Anestesia e Rianimazione, UOD Anestesia e Terapia Intensiva Trapianti d'Organo, Policlinico Umberto I, "Sapienza", Rome, Italy
| | - E Magnanimi
- Dipartimento di Anestesia e Rianimazione, UOD Anestesia e Terapia Intensiva Trapianti d'Organo, Policlinico Umberto I, "Sapienza", Rome, Italy
| | - M Bernardinetti
- Dipartimento di Anestesia e Rianimazione, UOD Anestesia e Terapia Intensiva Trapianti d'Organo, Policlinico Umberto I, "Sapienza", Rome, Italy
| | - G Paglialunga
- Dipartimento di Anestesia e Rianimazione, UOD Anestesia e Terapia Intensiva Trapianti d'Organo, Policlinico Umberto I, "Sapienza", Rome, Italy
| | - F Maldarelli
- Dipartimento di Anestesia e Rianimazione, UOD Anestesia e Terapia Intensiva Trapianti d'Organo, Policlinico Umberto I, "Sapienza", Rome, Italy
| | - D Diso
- Dipartimento di Chirurgia Toracica, Policlinico Umberto I, "Sapienza", Rome, Italy
| | - F Venuta
- Dipartimento di Chirurgia Toracica, Policlinico Umberto I, "Sapienza", Rome, Italy
| | - F Pugliese
- Dipartimento di Anestesia e Rianimazione, UOD Anestesia e Terapia Intensiva Trapianti d'Organo, Policlinico Umberto I, "Sapienza", Rome, Italy
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9
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Fiorelli A, D'Andrilli A, Poggi C, Diso D, Anile M, Polverino M, Failla G, Venuta F, Rendina E, Santini M. O-018SEQUENTIAL BILATERAL BRONCHOSCOPIC LUNG VOLUME REDUCTION WITH ONE-WAY VALVES FOR HETEROGENEOUS EMPHYSEMA. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.18] [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: 11/14/2022] Open
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10
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Carillo C, Anile M, Diso D, Onorati I, Mantovani S, Russo E, Pecoraro Y, De Giacomo T, Ciccone A, Longo F, Vitolo D, Rendina E, Venuta F. F-035MULTIMODALITY TREATMENT OF STAGE II THYMIC TUMOURS. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.35] [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: 11/12/2022] Open
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11
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Paone G, Sebastiani A, Ialleni E, Diso D, Rose D, Quagliarini F, Ialongo P, Peruzzi M, Venuta F, Frati G. A Combined Therapeutic Approach in Progressive Idiopathic Pulmonary Fibrosis—Pirfenidone as Bridge Therapy for Ex Vivo Lung Transplantation: A Case Report. Transplant Proc 2015; 47:855-7. [DOI: 10.1016/j.transproceed.2015.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
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Ruberto F, Bergantino B, Testa MC, D'Arena C, Zullino V, Congi P, Paglialunga SG, Diso D, Venuta F, Pugliese F. Low-flow venovenous CO₂ removal in association with lung protective ventilation strategy in patients who develop severe progressive respiratory acidosis after lung transplantation. Transplant Proc 2014; 45:2741-5. [PMID: 24034037 DOI: 10.1016/j.transproceed.2013.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Primary graft dysfunction (PGD) might occur after lung transplantation. In some severe cases, conventional therapies like ventilatory support, administration of inhaled nitric oxide (iNO), and intravenous prostacyclins are not sufficient to provide an adequate gas exchange. The aim of our study was to evaluate the use of a lung protective ventilation strategy associated with a low-flow venovenous CO2 removal treatment to reduce ventilator-associated injury in patients that develop severe PGD after lung transplantation. METHODS From January 2009 to January 2011, 3 patients developed PGD within 24 hours after lung transplantation. In addition to conventional medical treatment, including hemodynamic support, iNO and prostaglandin E1 (PGE1), we initiated a ventilatory protective strategy associated with low-flow venovenous CO2 removal treatment (LFVVECCO2R). Hemodynamic and respiratory parameters were assessed at baseline as well as after 3, 12, 24, and 48 hours. RESULTS No adverse events were registered. Despite decreased baseline elevated pulmonary positive pressures, application of a protective ventilation strategy with LFVVECCO2R reduced PaCO2 and pulmonary infiltrates as well as increased pH values and PaO2/FiO2 ratios. Every patient showed simultaneous improvement of clinical and hemodynamic conditions. They were weaned from mechanical ventilation and extubated after 24 hours after the use of the low-flow venovenous CO2 removal device. CONCLUSION The use of LFVVECCO2R together with a protective lung ventilation strategy during the perioperative period of lung transplantation may be a valid clinical strategy for patients with PGD and severe respiratory acidosis occured despite adequate mechanical ventilation.
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Affiliation(s)
- F Ruberto
- Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, "Sapienza" University of Rome, Policilinico Umberto I, Rome, Italy.
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Patella M, Anile M, Diso D, Porto PD, Pecoraro Y, Onorati I, Mantovani S, Giacomo TD, Ascenzioni F, Venuta F. F-020 * ROLE OF CYTOKINE PROFILE IN THE DIFFERENTIAL DIAGNOSIS BETWEEN CLINICAL ACUTE LUNG REJECTION AND PULMONARY INFECTIONS AFTER LUNG TRANSPLANTATION. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.20] [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: 11/13/2022] Open
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14
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Anile M, Diso D, Russo E, Patella M, Carillo C, Pecoraro Y, Onorati I, Pugliese F, Ruberto F, De Giacomo T, Angioletti D, Mantovani S, Mazzesi G, Frati G, Rendina E, Venuta F. Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation. Transplant Proc 2013; 45:2621-3. [DOI: 10.1016/j.transproceed.2013.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Diso D, Anile M, Patella M, Pecoraro Y, Rendina EA, Carillo C, Russo E, Onorati I, Angioletti D, Ruberto F, Mazzesi G, Marullo AGM, Frati G, Venuta F. Lung transplantation for cystic fibrosis: outcome of 101 single-center consecutive patients. Transplant Proc 2013; 45:346-8. [PMID: 23375321 DOI: 10.1016/j.transproceed.2012.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
Bilateral sequential lung transplantation (BSLT) is nowadays considered a valid therapeutic option for patients with end stage cystic fibrosis. We report our experience with 104 BSLTs in 101 patients. The overall survivals at 1, 3, 5, 10 years were 79%, 65%, 58%, and 42%, respectively. Perioperative mortality was 14.8% (n = 15). The leading causes of perioperative mortality were primary graft dysfunction and sepsis. Three patients were retransplanted owing to obliterative bronchiolitis. In 70 cases (69%), patients displayed ≥ 1 additional risk factors: previous lung resections, colonization by Burkholderia cepacia, diabetes, pneumothorax, or noninvasive ventilatory support. The mean preoperative 1-second forced expiratory volume of 0.69 ± 0.2 L (22%) increased to 85% at 1 year after the operation. The mean time on the waiting list was 12 ± 5 months. The 5 patients treated with extracorporeal membrane oxygenation before urgent transplantation were operated after 3, 5, 6, 30, and 3 days respectively. During the procedure, cardiopulmonary bypass was required in 33 patients (32%). Lung transplantation represents a unique opportunity to ameliorate the quality and improve the survival of patients affected by cystic fibrosis. Timing of referral and patient selection remain crucial for success.
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Affiliation(s)
- D Diso
- University of Rome Sapienza, Rome, Italy.
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Anile M, Diso D, Chiappetta C, Liparulo V, Russo E, Patella M, Rocca CD, Venuta F. F-048FREE CIRCULATING DNA IN PATIENTS WITH LUNG CANCER. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.48] [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: 11/14/2022] Open
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Venuta F, Tonelli AR, Anile M, Diso D, De Giacomo T, Ruberto F, Russo E, Rolla M, Quattrucci S, Rendina EA, Li Phd N, Coloni GF. Pulmonary hypertension is associated with higher mortality in cystic fibrosis patients awaiting lung transplantation. J Cardiovasc Surg (Torino) 2012:R37126834. [PMID: 22669100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM:Pulmonary hypertension (PH) is frequently found in patients with advanced parenchymal lung diseases. In advanced stages, cystic fibrosis (CF) patients can develop PH and eventually cor pulmonale. Little is known about the prevalence of PH in CF patients and its impact on outcome. METHODS: We retrospectively studied a large cohort of CF patients evaluated for lung transplantation between 1995 and 2010. All the patients underwent right heart catheterization as part of the evaluation. We included 179 unique consecutive adult CF patients. Age was 24±9 years and 45.8% were women. RESULTS:Eighty-seven patients were transplanted (48.6%) and 65 died (36.3%) while waiting for LT. By right heart catheterization, 38.5% of the patients had PH (mean ≥25 mm Hg). PaCO2 (P=0.045) and forced vital capacity (P=0.023) were independent predictors of PH in CF patients. The median survival (free of lung transplantation) was 13.4 months. After adjusting for several covariates, the presence of PH significantly increased mortality (hazard ratio, HR) (P<0.001). Pulmonary vascular resistance was associated with mortality (P=0.03). When both PH and PVR were included in the model, only PH predicted mortality. CONCLUSION: Pulmonary hypertension of mild degree is frequently found in CF patients with advanced lung disease and its presence significantly worsens survival.
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Affiliation(s)
- F Venuta
- Department of Thoracic Surgery, La Sapienza University of Rome, Rome, Italy -
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Anile M, Diso D, Frati G, Venuta F. Emergency lung transplantation contributes to knock down mortality on the waiting list. Eur J Cardiothorac Surg 2012; 41:1220-1; author reply 1221. [DOI: 10.1093/ejcts/ezr207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Anile M, Telha V, Diso D, De Giacomo T, Sciomer S, Rendina EA, Coloni GF, Venuta F. Left atrial size predicts the onset of atrial fibrillation after major pulmonary resections. Eur J Cardiothorac Surg 2011; 41:1094-7; discussion 1097. [DOI: 10.1093/ejcts/ezr174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Anile M, Diso D, Russo E, Venuta F. Post-intubation membranous trachitis after endotracheal intubation. Eur J Cardiothorac Surg 2011; 41:967; author reply 967-8. [DOI: 10.1093/ejcts/ezr096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rolla M, Anile M, Venuta F, Diso D, Quattrucci S, De Giacomo T, Russo E, Ruberto F, Rendina EA, Furio Coloni G. Lung transplantation for cystic fibrosis after thoracic surgical procedures. Transplant Proc 2011; 43:1162-3. [PMID: 21620078 DOI: 10.1016/j.transproceed.2011.01.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
During their life, cystic fibrosis (CF) patients may require thoracic surgical procedures for a number of reasons before undergoing lung transplantation. In the past, this has been considered to be a contraindication to lung transplantation. However, a meticulous surgical technique and careful intraoperative management allows one to perform the transplantation safely. Herein we have reported our experience with CF patients undergoing lung transplantation after previous surgical treatment for pneumothorax or bronchiectasis.
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Affiliation(s)
- M Rolla
- Department of Pediatric, University of Rome Sapienza, Rome, Italy
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Diso D, Venuta F, Anile M, De Giacomo T, Ruberto F, Pugliese F, Francioni F, Ricella C, Liparulo V, Rolla M, Russo E, Rendina EA, Coloni GF. Extracorporeal circulatory support for lung transplantation: institutional experience. Transplant Proc 2010; 42:1281-2. [PMID: 20534281 DOI: 10.1016/j.transproceed.2010.03.114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung transplantation (LT) represents the only available therapy for selected patients affected by end-stage pulmonary disease. Cardiopulmonary bypass (CPBP) is used, when required, during single and sequential double lung transplantation; however, it increases the risk of bleeding, early graft dysfunction, failure, and other potential side effects. We report our experience with 145 patients who underwent lung transplantations, among whom 34 required intraoperative CPBP. The indications for LT among these 34 patients were cystic fibrosis (n = 22), chronic obstructive pulmonary disease (n = 3), bronchiectasis (n = 2), primary pulmonary hypertension (n = 1), fibrosis (n = 2), pulmonary microlithiasis (n = 1), and retransplantation for obliterative bronchilitis (n = 3). CPBP was planned in 12 cases (group I) and unplanned in 22 (group II). The main reason for planning CPBP was primary and secondary pulmonary hypertension (mean pulmonary artery pressure >or=25 mm Hg). Acute right ventricular failure, hemodynamic instability, arterial desaturation, and increased pulmonary artery pressure were mandatory for unplanned CPBP. Among the 34 CPBP patients, the 30-day mortality rate was 35% (12/34) including 9 (70%) in group II (unplanned CPBP). The leading cause of death was multiorgan failure. The 1-year survival rates were 67% and 36%, and the 3-year survival rates were 47% and 18% for groups I and II, respectively. In conclusion, even if it represents a useful tool in the management of critical events, the use of unscheduled CPBP during LT procedures is associated with an increased postoperative morbidity and mortality.
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Affiliation(s)
- D Diso
- Department of Thoracic Surgery, University of Rome, La Sapienza, V le del Policlinico 155, 00161 Rome, Italy.
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Anile M, Venuta F, Diso D, Liparulo V, Ricella C, De Giacomo T, Pugliese F, Rolla M, Quattrucci S, Pecoraro Y, Rendina EA, Coloni GF. Treatment of complex airway lesions after lung transplantation with self-expandable nitinol stents: early experience. Transplant Proc 2010; 42:1279-80. [PMID: 20534280 DOI: 10.1016/j.transproceed.2010.03.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Airway complications (AC) are considered a serious cause of morbidity after lung transplantation (LT). Mechanical dilatation, laser vaporization, and silicone stent placement usually solve it. However, the use of self-expandable metallic stents (SENS) may be indicated in selected cases. Ten lung transplant recipients with AC were treated with SENS. Six patients underwent LT for cystic fibrosis, 2 for idiopathic pulmonary fibrosis, 1 for bronchiectasis, and 1 for emphysema. All patients received at least 1 treatment attempt with dilatation and silicone stent placement. The indications for SENS placement were the presence of a tortuous airway axis with stenosis and malacia of the right main bronchus in 5 patients; a long stenosis of the main and intermediate right bronchus involving the upper lobe orifice in 3 patients; or malacia that could not be stabilized with silicone stents in 3 cases. In 1 patient the procedure was bilateral. Functional improvement was immediate with a mean forced expiratory volume at 1 second (FEV(1)) gain of 35%. No stent dislocation was observed. Symptoms did not occur again in 5 patients with previous recurrent episodes of pneumonia. One stenosis, which was due to the ingrowth of granulation tissue occurred at 6 months after the procedure, was successfully treated with mechanical dilatation and laser vaporization. The deployment of SENS in a selected group of patients with AC after LT was easy, safe, and effective.
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Affiliation(s)
- M Anile
- Department of Thoracic Surgery, University of Rome Sapienza, Sapienza, Italy.
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De Giacomo T, Di Stasio M, Diso D, Anile M, Venuta F, Furio Coloni G. Sub-lobar lung resection of peripheral T1N0M0 NSCLC does not affect local recurrence rate. Scand J Surg 2010; 98:225-8. [PMID: 20218419 DOI: 10.1177/145749690909800406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The use of sub-lobar resection versus lobectomy for stage I non small cell lung cancer is still controversial. This study was undertaken to compare the results of limited resection in terms of survival and local recurrence rate to lobectomy in patients with peripheral stage I non small cell lung cancer. MATERIAL AND METHODS During the 8 year period from 1999 to 2007, 152 consecutive patients with stage I non-small cell lung cancer underwent lung resection at our thoracic surgery unit. In 116 cases we performed a standard lobectomy while in the remaining 36 cases we did sub lobar resection through mini-thoracotomy or video-assisted thoracoscopy. The survival, local recurrence rate and the clinical outcome were analyzed and compared. RESULTS Fifty-one patients were staged as T1 N0 M0, 22 in the sub-lobar resection group (61,1%) and 29 (25%) in the lobectomy group. The remaining were staged as T2 N0 M0. Although the patient population undergone to sub-lobar resection was older, with poorer lung function and more co-morbidities, the Kaplan-Meier survival proportion at 5 year did not differ significantly between the two groups: 64% for lobectomy group vs 66,7% for sub-lobar resection group. Overall local recurrence did approach significance in favour of lobectomy group but analyzing only T1 patients, no differences in terms of survival and local recurrence rate were observed. CONCLUSIONS The results of this study indicate that in patients with peripheral T1N0M0 non small cell lung cancer the outcome of limited resection is comparable with that of pulmonary lobectomy.
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Affiliation(s)
- T De Giacomo
- University of Rome "Sapienza", Department of Thoracic Surgery, Policlinico Umberto I, Rome, Italy.
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Francioni F, De Giacomo T, Jo Filice M, Anile M, Diso D, Venuta F, Coloni GF. Surgical treatment of redundancy after retrosternal esophagocoloplasty. MINERVA CHIR 2009; 64:317-319. [PMID: 19536059] [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: 05/27/2023]
Abstract
Redundancy is a well-recognized complication of esophageal replacement with colonic interposition, occurring several years after surgery. In a small number of patients, symptoms are disabling and might require reoperation. This article describes the surgical treatment of a 54-year-old male presenting with severe dysphagia, malnutrition and recurrent aspiration pneumonia, progressively developed 30 years after esophageal replacement with retrosternal ileocolonic interposition for caustic strictures.
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Affiliation(s)
- F Francioni
- Department of Thoracic Surgery, La Sapienza University, Rome, Italy
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Aratari M, Venuta F, De Giacomo T, Rendina E, Anile M, Diso D, Francioni F, Quattrucci S, Rolla M, Pugliese F, Liparulo V, Di Stasio M, Ricella C, Tsagkaropoulos S, Ferretti G, Coloni G. Lung Transplantation for Cystic Fibrosis: Ten Years of Experience. Transplant Proc 2008; 40:2001-2. [DOI: 10.1016/j.transproceed.2008.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anile M, Venuta F, Diso D, Vitolo D, Longo F, De Giacomo T, Francioni F, Liparulo V, Ricella C, Ruberto F, Coloni GF. Preoperative anaemia does not affect the early postoperative outcome in patients with lung cancer. MINERVA CHIR 2007; 62:431-435. [PMID: 18091652] [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: 05/25/2023]
Abstract
AIM Several prognostic factors like age, gender, histology, stage, type of operation, associated disorders and administration of induction therapy have been evaluated to assess the risk of postoperative complications and outcome in patients with resectable lung cancer. Anemia is a frequent condition in this subset of patients being estimated up to 50%. The aim of this retrospective study was to evaluate the effect of preoperative anemia on early outcome after lung cancer resection. METHODS One-hundred thirty nine consecutive patients undergoing surgery for non small cell lung cancer were retrospectively considered. The mean age was 64.8+/-11.6 years. No patient received blood transfusions or administration of erythropoetin preoperatively. Overall, we performed 96 lobectomies, 14 pneumonectomies, 2 bilobectomies and 27 atypical resections. A subset of 27 patients (19.4%) (group I) had a preoperative value of Hb less than 12 g/dl (10.4+/-1.9 g/dL). Seven patients of them were stage IA (26%), 9 stage IB (33.3%), 2 stage IIA (7.4%), 6 stage IIB (22.2%), 2 stage IIIA (7.4%) and 1 stage IIIB (3.7%). Age, gender, stage, type of operation, induction chemotherapy, comorbidities were evaluated by univariate analysis comparing patients with and without preoperative anaemia. The two groups were homogenous regarding demographic characteristics. RESULTS Three patients (11.1%) in group I and 2 (1.8%) in group II required blood transfusions after surgery (P=0.01); 4 of them received pneumonectomy (P<0.0001). The overall morbidity was 17.9% (25/139); the most frequent complication was persistent air leakage, followed by retention of secretions. No statistically significant difference was observed between the 2 groups about early mortality (1 patient-3.7% in group I and 2 patients-1.8% in group II) and postoperative complications (5 patients-18.5% in group I and 20 patients-17.9% in group II). CONCLUSION Preoperative anaemia is not a risk factor for an increased rate of postoperative complications and should not be considered a contraindication to surgery.
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Affiliation(s)
- M Anile
- Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy.
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De Giacomo T, Venuta F, Anile M, Diso D, Rolla M, Coloni G. Non-Hodgkin’s Lymphoma, Presenting as an Isolated Endobronchial Mass After Bilateral Lung Transplantation: A Case Report. Transplant Proc 2007; 39:3541-4. [DOI: 10.1016/j.transproceed.2007.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
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Anile M, Venuta F, Diso D, De Giacomo T, Rendina EA, Rolla M, Ruberto F, Liparulo V, Aratari MT, Di Stasio M, Ricella C, Vitolo D, Longo F, Coloni GF. Malignancies following lung transplantation. Transplant Proc 2007; 39:1983-4. [PMID: 17692672 DOI: 10.1016/j.transproceed.2007.05.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 01/22/2023]
Abstract
During the last 2 decades, long-term survival after lung transplantation has significantly improved. However, among the complications related to the continuous administration of immunosuppressive drugs, malignancy plays an important role. We retrospectively revisited our series of patients to report our experience. From January 1991 we performed 134 lung transplantations in 128 recipients (mean age, 33.4 +/- 13.5 years). In all patients the first-line immunosuppressive regimen was based on a calcineurin inhibitor (cyclosporine or tacrolimus), an antimetabolic agent (azathioprine), and steroids. Five patients (4.2%) developed malignancy and the mean time of occurrence after the transplantation was 46.4+/-23 months. The mean age was 41 +/- 16 years (P = not significant [ns]). The tumors were as follows: laryngeal cancer (radiotherapy), colon cancer (surgery plus adjuvant chemotherapy), gastric cancer (surgery plus adjuvant chemotherapy), endobronchial non-Hodgkin lymphoma (NHL) (endoscopic resection plus chemoradiotherapy), and cutaneous and visceral Kaposi's sarcoma (KS) (chemotherapy). All patients have reduced the dose of immunosuppressive drugs; in 1 of them, tacrolimus was changed to rapamycin. Two patients died because of neoplastic dissemination, another 1 due to obliterans bronchiolitis. The 2 patients with NHL and KS are alive at 6 and 9 months, respectively, without signs of recurrence. Malignancies after lung transplantation represent an important problem. A multidisciplinary approach is mandatory to obtain satisfactory results in terms of improved quality of life and long-term survival.
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Affiliation(s)
- M Anile
- Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy.
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Pugliese F, Ruberto F, Cappannoli A, Perrella SM, Bruno K, Martelli S, Marcellino V, D'Alio A, Diso D, Rossi M, Corradini SG, Morabito V, Rolla M, Ferretti G, Venuta F, Berloco PB, Coloni GF, Pietropaoli P. Incidence of fungal infections in a solid organ recipients dedicated intensive care unit. Transplant Proc 2007; 39:2005-7. [PMID: 17692677 DOI: 10.1016/j.transproceed.2007.05.060] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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: 11/19/2022]
Abstract
UNLABELLED Invasive fungal infections are a significant cause of morbidity and mortality for patients undergoing solid organ transplantation. Our aim was to evaluate the incidence of invasive fungal infections in solid organ recipients within a dedicated intensive care unit (ICU). MATERIALS AND METHODS From May 2002 to May 2005, 278 patients undergoing solid organ transplantation (105 liver, 142 kidney, 20 lung, 2 combined liver-kidney, 9 combined pancreas-kidney) were admitted to our posttransplant intensive care unit. We retrospectively analyzed data obtained from the ICU stay. Fungal infection was defined by positivity of normally sterile biological samples and by elevated positivity of normally non sterile biological samples. We did not consider superficial fungal infections and asymptomatic colonizations. RESULTS Forty-six patients (16.5%) developed a fungal infection; at least one mycotic agent was isolated from each patient. Candida albicans was the most common pathogen, isolated from 71 % of infected patients (33 of 46). Infected patients showed a mortality rate of 35%, while that for non infected recipients was 3.5%. Total length of ICU stay was the most significant risk factor among infected patients (30.26 days vs 5.04 days P < .0001). Mean time between transplantation and first positive samples was 6.17 days (SD 8.88). CONCLUSION Fungal infections in solid organ transplant patients are a major issue because of their associated morbidity and mortality. Candida albicans was the most common pathogen and total length of ICU stay was the most important risk factor.
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Affiliation(s)
- F Pugliese
- Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Universita' Degli Studi di Roma La Sapienza, Roma, Italy.
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De Giacomo T, Martelli M, Venuta F, Anile M, Diso D, Di Stasio M, Rendina EA, Coloni GF. Lung cancer after treatment for non-Hodgkin lymphoma. MINERVA CHIR 2006; 61:467-71. [PMID: 17211351] [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: 05/13/2023]
Abstract
AIM Because of the improvement in treatment and survival of patients with lymphoma, late sequelae, including secondary cancers have been extensively studied. Lung cancer is one of the two most common solid tumors after Hodgkin's disease but fewer studies have been published about lung cancer after non-Hodgkin lymphoma (NHL). METHODS Over the last five years at our Institution we have observed 16 patients, 13 male and 3 female, with a mean age of 61 years, previously treated for NHL and lung cancer. Median latency between NHL and lung cancer was 7 years. In 6 patients (37.5%) the latency period was shorter than 5 years and 3 of them developed lung cancer within 2 years after the end of NHL therapy. RESULTS Ten patients underwent lung complete resection. Two, 3 and 5 year survival rate was respectively 52.7%, 26.3% and 13%. In contrast, the median survival of non surgical patients was 9 months. Comparison of survival between surgical and non-surgical group demonstrated a statistically significant better survival for surgically treated patients (P<0.04). CONCLUSIONS Surgery can improve survival in patients with history of NHL and lung cancer. Early diagnosis and treatment is crucial. NHL survivors should undergo careful follow-up and surveillance for secondary malignancy.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Aged
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lung/pathology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/surgery
- Lymphoma, Non-Hodgkin/therapy
- Male
- Mediastinoscopy
- Middle Aged
- Neoplasm Staging
- Neoplasms, Second Primary
- Neuroendocrine Tumors/mortality
- Neuroendocrine Tumors/pathology
- Neuroendocrine Tumors/surgery
- Pneumonectomy
- Prognosis
- Radiography, Thoracic
- Survival Analysis
- Time Factors
- Tomography, X-Ray Computed
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Affiliation(s)
- T De Giacomo
- Department of Thoracic Surgery, University of Rome, La Sapienza, Rome, Italy.
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Andreetti C, Anile M, Diso D, Francioni F, Venuta F, De Giacomo T, Di Stasio M, Rendina EA, Coloni GF. [Surgical treatment of iatrogenic perforations of the distal third of the esophagus. Personal experience]. MINERVA CHIR 2006; 61:367-71. [PMID: 17159743] [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: 05/12/2023]
Abstract
AIM The esophageal perforations are associated with a high mortality and morbidity when they are not diagnosed and treated quickly. The aim of our study is to analyze the treatment and prognosis of the distal iatrogenic esophageal perforations on the basis of time of onset, concomitant disease and size of perforations. METHODS The retrospective review was performed on 10 patients treated for distal iatrogenic esophageal perforations at our Institution from 1994 to 2003. The cause of perforations was: pneumatic dilation (7 patients) and esophageal endoprosthesis placing (3 patients). Seven patients presented within 24 h (Group A), and 3 patients presented after 24 h (Group B). In Group A, 4 patients underwent primary repair, 2 patients required esophagectomy and 1 patient was treated conservatively. In Group B, 2 patients were treated conservatively and 1 patient required an esophagectomy. RESULTS Hospital morbidity was 20% and mortality was 30%. In Group A no patients died. In Group B hospital mortality was 100%. The most common cause of death was multiorgan failure resulting from sepsis. CONCLUSIONS The prognosis for esophageal perforations is influenced by the time elapsed between diagnosis and treatment. Esophagectomy is indicated for patients with extensive perforation and necrosis of the esophagus when primary repair cannot be carried out. It is indicated also as treatment for the concomitant disease.
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Affiliation(s)
- C Andreetti
- Divisione di Chirurgia Toracica, Dipartimento Paride Stefanini, Università degli Studi di Roma La Sapienza, Rome, Italy.
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Pugliese F, Ruberto F, Ferrazza V, Bruno K, Martelli S, Celli P, Perrella S, Aimi G, Diso D, Anile M, Venuta F, Coloni GF, Pietropaoli P. Extracorporeal Circulation With Low Systemic Heparinization During Lung Transplantation. Transplant Proc 2006; 38:1167-8. [PMID: 16757296 DOI: 10.1016/j.transproceed.2006.02.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/24/2022]
Abstract
BACKGROUND Some lung transplantation (LT) recipients suffer from pulmonary hypertension and right ventricular dysfunction or failure requiring extracorporeal circulation (ECC) to avoid catastrophic complications during surgery. The extracorporeal support usually requires systemic heparinization which is potentially associated with important side effects. We performed eight LT using preheparinized ECC circuits and an oxygenator associated with a lower level of systemic heparinization without evidence of perioperative complications. PATIENTS AND METHODS From May 2002 to May 2005, 8 patients (5 men and 3 women) of mean age 22.5 +/- 9.5 years underwent bilateral sequential lung transplantation (BSLT) for cystic fibrosis (n = 6) or idiopathic pulmonary fibrosis (n = 2). All procedures were performed with ECC through a femoro-femoral veno-arterial bypass with preheparinized circuits and an oxygenator. RESULTS No intraoperative mortality occurred. The mean ECC time was 147.8 +/- 31.3 minutes and the mean heparin administered was 3525 +/- 969.16 UI. No coagulopathy or thrombotic events were observed perioperatively. CONCLUSIONS Our study confirmed the efficacy and safety of prehepanized circuits and oxygenator for femoro-femoral veno-arterial bypass during LT for patients with severe pulmonary hypertension requiring ECC.
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Affiliation(s)
- F Pugliese
- Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Italia.
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Francioni F, Anile M, Venuta F, De Giacomo T, Andreetti C, Diso D, Di Stasio M, D'Ecclesia G, Liparulo V, Coloni GF. [Mechanical cervical esophagogastric anastomosis after esophagectomy for cancer]. MINERVA CHIR 2006; 61:79-83. [PMID: 16871138] [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: 05/11/2023]
Abstract
AIM Fibrous stenosis of the esophagogastric cervical anastomosis remains a significant complication occurring in up to one third of cases. Trying to reduce the incidence of this complication, we describe our technique of cervical esophago-gastric anastomosis using endoscopic linear stapler which seems to reduce the incidence of fibrous stricture formation after resection of esophageal cancer. METHODS Between March 2000 and December 2004, 34 patients (20 males and 14 females) underwent esophagectomy using tubulized stomach for reconstruction. Mean age was 57 years. Eight patients with advanced stage (5 T3 and 3 T4) underwent induction chemotherapy. The most of patients was affected by squamous cell carcinoma. In all cases we performed cervical esophagogastric anastomosis using linear endoscopic stapler. The occurrence of postoperative anastomotic leak and development of anastomotic stricture were recorded and analyzed. RESULTS All patients survived esophagectomy and 30 of them (88%) were available for postoperative follow-up at 6 months. Anastomotic leak developed in 1 case. No patient developed fibrous stenosis that required dilatation therapy. CONCLUSIONS Complete mechanical esophago-gastric anastomosis, using endoscopic linear stapler is effective and safe, even when a narrow gastric tube is used as esophageal substitute. These technique seems superior to other techniques to reduce the incidence of postoperative anastomotic complications.
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Affiliation(s)
- F Francioni
- Dipartimento di Chirurgia Generale, Specialità Chirurgiche e Trapianti di Organo, Paride Stefanini, Cattedra di Chirurgia Toracica, Università degli Studi di Roma, La Sapienza, Roma, Italy
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Abstract
Lung transplantation is currently a suitable option for patients with end-stage lung disease. Since the early 1980s the surgical technique and immunosuppressive protocols have been progressively modified to improve results and favor long-term survival. The original heart-lung transplantation under cardiopulmonary bypass is now rarely performed and single or bilateral lung transplantation is the procedure of choice. Bilateral transplantation is performed with two single lung transplants performed in sequence. Extracorporeal support is rarely employed and in most cases it is instituted through the femoral approach. Also, the surgical approach has been modified and the original clam shell incision has been replaced by two small anterior thoracotomies. The use of marginal donors has been increasingly proposed to enlarge the number of organs potentially available for transplantation. Immunosuppressive protocols have evolved to patient-specific regimens that can be quickly modified if required by the clinical status. Induction is now more aggressive and also rescue protocols for obliterative bronchiolitis can contribute to improved outcomes. Overall, lung transplantation is now performed with encouraging long-term results.
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Affiliation(s)
- F Venuta
- Cattedra di Chirurgia Toracica, Policlinico Umberto I, Dipartimento di Chirurgia Paride Stefanini, Università di Roma, Rome, Italy.
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Torsello G, Lomascolo M, Licciulli A, Diso D, Tundo S, Mazzer M. The origin of highly efficient selective emission in rare-earth oxides for thermophotovoltaic applications. Nat Mater 2004; 3:632-637. [PMID: 15322534 DOI: 10.1038/nmat1197] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Accepted: 06/30/2004] [Indexed: 05/24/2023]
Abstract
Rare-earth oxide materials emit thermal radiation in a narrow spectral region, and can be used for a variety of different high-temperature applications, such as the generation of electricity by thermophotovoltaic conversion of thermal radiation. However, because a detailed understanding of the mechanism of selective emission from rare-earth atoms has so far been missing, attempts to engineer selective emitters have relied mainly on empirical approaches. In this work, we present a new quantum thermodynamic model to describe the mechanisms of thermal pumping and radiative de-excitation in rare-earth oxide materials. By evaluating the effects of the local crystal-field symmetry around a rare-earth ion, this model clearly explains how and why only some of the room-temperature absorption peaks give rise to highly efficient emission bands at high temperature (1,000-1,500 degrees C). High-temperature emissivity measurements along with photoluminescence and cathodoluminescence results confirm the predictions of the theory.
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Affiliation(s)
- G Torsello
- Department of Physics, University of Lecce, Campus Universitario, Via Arnesano, 73100 Lecce, Italy
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Coloni GF, Venuta F, Ciccone AM, Rendina EA, De Giacomo T, Filice MJ, Diso D, Anile M, Andreetti C, Aratari MT, Mercadante E, Moretti M, Ibrahim M. Lung transplantation for cystic fibrosis. Transplant Proc 2004; 36:648-50. [PMID: 15110621 DOI: 10.1016/j.transproceed.2004.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 11/25/2022]
Abstract
BACKGROUND Lung transplantation is a robust therapeutic option to treat patients with cystic fibrosis. PATIENTS AND METHODS Since 1996, 109 patients with cystic fibrosis were accepted onto our waiting list with 58 bilateral sequential lung transplants performed in 56 patients and two patients retransplanted for obliterative bronchiolitis syndrome. RESULTS Preoperative mean FEV(1) was 0.64 L/s, mean PaO(2) with supplemental oxygen was 56 mm Hg, and the mean 6-minute walking test was 320 m. Transplantation was performed through a "clam shell incision" in the first 29 patients and via bilateral anterolateral thoracotomies without sternal division in the remaining patients. Cardiopulmonary bypass was required in 14 patients. In 21 patients the donor lungs had to be trimmed by wedge resections with mechanical staplers and bovine pericardium buttressing to fit the recipient chest size. Eleven patients were extubated in the operating room immediately after the procedure. Hospital mortality of 13.8% was related to infection (n = 5), primary graft failure (n = 2), and myocardial infarction (n = 1). Acute rejection episodes occurred 1.6 times per patient/year; lower respiratory tract infections occurred 1.4 times per patient in the first year after transplantation. The mean FEV(1) increased to 82% at 1 year after operation. The 5-year survival rate was 61%. A cyclosporine-based immunosuppressive regimen was initially employed in all patients; 24 were subsequently switched to tacrolimus because of central nervous system toxicity, cyclosporine-related myopathy, or renal failure, obliterative bronchiolitis syndrome, gingival hyperplasia, or hypertrichosis. Ten patients were subsequently switched to sirolimus. Freedom from bronchiolitis obliterans at 5 years was 60%. CONCLUSIONS Our results confirm that bilateral sequential lung transplantation is a robust therapeutic option for patients with cystic fibrosis.
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Affiliation(s)
- G F Coloni
- UO Chirurgia Toracica, II Clinica Chirurgica, Università La Sapienza, Rome, Italy
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Anile M, De Giacomo T, Venuta F, Angelo Rendina E, Andreetti C, Diso D, Coloni GF. [Mini-invasive treatment of pectus excavatum in adolescence. Initial experience]. MINERVA CHIR 2004; 59:31-5. [PMID: 15111830] [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: 04/29/2023]
Abstract
BACKGROUND Personal preliminary experience with Minimally Invasive Repair of Pectus Excavatum (MIRPE), "Nuss" procedure, using VATS is reported. METHODS From January 2001 to February 2002, MIRPE has been performed on 5 patients (age range 13-18 y; mean 14.8 y). Under general anesthesia, a curved steel bar is inserted into the retrosternal tunnel between 2 bilateral midaxillary line incisions. The tunnel passes initially under the pectoral muscles and enters the pleural space at level of the mammilary line. Under thoracoscopic vision, the bar is passed through the tunnel with the concavity facing the front and then is turned over thereby correcting deformity. An epidural catheter relieved perioperative pain successfully. RESULTS In all patients the repair has been good. Mean hospital length of stay has been 6.8 d. Pneumothorax occurred in 1 patient requiring tube thoracostomy. After 45 d 1 patient had a bar displacement requiring a reoperation. All patients have a normal life. CONCLUSIONS The Minimally Invasive Repair of Pectus Excavatum is an effective procedure even in adolescence. Thoracoscopic vision makes safer the creation of the retrosternal tunnel and the passage of the bar. Short-term results have been good. Further follow-up is necessary to determine long-term results.
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Affiliation(s)
- M Anile
- Cattedra di Chirurgia Toracica Università di Roma La Sapienza, Roma.
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Venuta F, Quattrucci S, De Giacomo T, Cimmino G, Anile M, Andreetti C, Diso D, Ruberto F, Rendina E, Coloni G. Pulmonary hemodynamics can predict mortality on the waiting list for lung transplantation in patients with cystic fibrosis. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.306] [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: 10/26/2022] Open
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