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ULIANO MORANDI

CULTORE DELLA MATERIA
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2022 - Cancer Stem Cells and Cell Cycle Genes as Independent Predictors of Relapse in Non-small Cell Lung Cancer: Secondary Analysis of a Prospective Study [Articolo su rivista]
Masciale, V.; Banchelli, F.; Grisendi, G.; D'Amico, R.; Maiorana, A.; Stefani, A.; Morandi, U.; Stella, F.; Dominici, M.; Aramini, B.
abstract

PURPOSE: Cancer stem cells (CSCs) are described as resistant to chemotherapy and radiotherapy. It has been shown that CSCs influence disease-free survival in patients undergoing surgery for lung cancer (NCT04634630). We recently described an overexpression of CSCs recurrence-related genes (RG) in lung cancer. This study aims to investigate CSC frequency and RG expression as predictors of disease-free survival in lung cancer. EXPERIMENTAL DESIGN: This secondary analysis of a prospective cohort study involved 22 surgical tumor specimens from 22 patients harboring early (I-II) and locally advanced (IIIA) stages ACL and SCCL. Cell population frequency analysis of ALDHhigh (CSCs) and ALDHlow (cancer cells) was performed on each tumor specimen. In addition, RG expression was assessed for 31 target genes separately in ALDHhigh and ALDHlow populations. CSCs frequency and RG expression were assessed as predictors of disease-free survival by Cox analysis. RESULTS: CSCs frequency and RG expression were independent predictors of disease-free survival. CSC frequency was not related to disease-free survival in early-stage patients (HR = 0.84, 95%CI = 0.53-1.33, P = .454), whereas it was a risk factor for locally advanced-stage patients (HR = 1.22, 95%CI = 1.09-1.35, P = .000). RG expression-if measured in CSCs-was related to a higher risk of recurrence (HR = 1.19, 95%CI = 1.03-1.39, P = .021). The effect of RG expression measured in cancer cells on disease-free survival was lower and was not statistically significant (HR = 1.12, 95%CI = 0.94-1.33, P = .196). CONCLUSIONS: CSCs frequency and RG expression are independent predictors of relapse in lung cancer. Considering these results, CSCs and RG may be considered for both target therapy and prognosis.

2022 - Dissecting Tumor Growth: The Role of Cancer Stem Cells in Drug Resistance and Recurrence [Articolo su rivista]
Aramini, B.; Masciale, V.; Grisendi, G.; Bertolini, F.; Mauer, M.; Guaitoli, G.; Chrystel, I.; Morandi, U.; Stella, F.; Dominici, M.; Haider, K. H.
abstract

Emerging evidence suggests that a small subpopulation of cancer stem cells (CSCs) is responsible for initiation, progression, and metastasis cascade in tumors. CSCs share characteristics with normal stem cells, i.e., self-renewal and differentiation potential, suggesting that they can drive cancer progression. Consequently, targeting CSCs to prevent tumor growth or regrowth might offer a chance to lead the fight against cancer. CSCs create their niche, a specific area within tissue with a unique microenvironment that sustains their vital functions. Interactions between CSCs and their niches play a critical role in regulating CSCs’ self-renewal and tumorigenesis. Differences observed in the frequency of CSCs, due to the phenotypic plasticity of many cancer cells, remain a challenge in cancer therapeutics, since CSCs can modulate their transcriptional activities into a more stem-like state to protect themselves from destruction. This plasticity represents an essential step for future therapeutic approaches. Regarding self-renewal, CSCs are modulated by the same molecular pathways found in normal stem cells, such as Wnt/β-catenin signaling, Notch signaling, and Hedgehog signaling. Another key characteristic of CSCs is their resistance to standard chemotherapy and radiotherapy treatments, due to their capacity to rest in a quiescent state. This review will analyze the primary mechanisms involved in CSC tumorigenesis, with particular attention to the roles of CSCs in tumor progression in benign and malignant diseases; and will examine future perspectives on the identification of new markers to better control tumorigenesis, as well as dissecting the metastasis process.

2022 - Phenotypic, functional, and metabolic heterogeneity of immune cells infiltrating non–small cell lung cancer [Articolo su rivista]
Aramini, B.; Masciale, V.; Samarelli, A. V.; Dubini, A.; Gaudio, M.; Stella, F.; Morandi, U.; Dominici, M.; De Biasi, S.; Gibellini, L.; Cossarizza, A.
abstract

Lung cancer is the leading cancer in the world, accounting for 1.2 million of new cases annually, being responsible for 17.8% of all cancer deaths. In particular, non-small cell lung cancer (NSCLC) is involved in approximately 85% of all lung cancers with a high lethality probably due to the asymptomatic evolution, leading patients to be diagnosed when the tumor has already spread to other organs. Despite the introduction of new therapies, which have improved the long-term survival of these patients, this disease is still not well cured and under controlled. Over the past two decades, single-cell technologies allowed to deeply profile both the phenotypic and metabolic aspects of the immune cells infiltrating the TME, thus fostering the identification of predictive biomarkers of prognosis and supporting the development of new therapeutic strategies. In this review, we discuss phenotypic and functional characteristics of the main subsets of tumor-infiltrating lymphocytes (TILs) and tumor-infiltrating myeloid cells (TIMs) that contribute to promote or suppress NSCLC development and progression. We also address two emerging aspects of TIL and TIM biology, i.e., their metabolism, which affects their effector functions, proliferation, and differentiation, and their capacity to interact with cancer stem cells.

2021 - A case of cervico-mediastinal paraganglioma mimicking an ectopic goiter [Articolo su rivista]
Bianchi, D.; Scamporlino, A.; Costantini, M.; Cavallesco, G.; Morandi, U.; Stefani, A.
abstract

Introduction and importance: Mediastinal paragangliomas are rare neuroendocrine tumors that originate from extra-adrenal paraganglia, occasionally secreting catecholamines. Nonfunctional mediastinal paragangliomas present nonspecific clinical and radiological features and represent a diagnostic challenge. Case presentation: A 53-year old woman presented with cough and dyspnea increasing over time. CT-scan and ultrasonography showed a large vascularized cervico-mediastinal mass, consistent with an intrathoracic ectopic goiter. Preoperative angiography showed a blood supply from neck vessels. The lesion was completely removed through a cervical approach. The diagnosis of paraganglioma was a histological surprise. The patient is alive without recurrence 30 months after surgery. Clinical discussion: When preoperatively diagnosed, the treatment of choice of a mediastinal paraganglioma is surgical excision. However, a preoperative diagnosis of mediastinal paraganglioma is difficult to obtain, especially in cases of nonfunctional lesions. Distinction between an intrathoracic goiter and a nonfunctional paraganglioma can be extremely difficult and, given the rarity of the latter, an ectopic goiter is suspected in first instance. CT-scan and ultrasonography are of little use in the differential diagnosis. However, scintigraphy with 123I-metaiodobenzylguanidine can be an useful diagnostic tool when a paraganglioma is suspected. In case of vascularized cervico-mediastinal mass, such as paragangliomas or intrathoracic goiter, preoperative angiography should be performed to study the blood supply and orient the surgical approach. Conclusion: Although uncommon, paragangliomas should be considered in the differential diagnosis of mediastinal masses, especially when an ectopic goiter is suspected.

2021 - Cancer stem cells and macrophages: molecular connections and future perspectives against cancer. [Articolo su rivista]
Aramini, Beatrice; Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Morandi, Uliano; Dominici, Massimo; Husnain Haider, Khawaja
abstract

Cancer stem cells (CSCs) have been considered the key drivers of cancer initiation and progression due to their unlimited self-renewal capacity and their ability to induce tumor formation. Macrophages, particularly tumor-associated macrophages (TAMs), establish a tumor microenvironment to protect and induce CSCs development and dissemination. Many studies in the past decade have been performed to understand the molecular mediators of CSCs and TAMs, and several studies have elucidated the complex crosstalk that occurs between these two cell types. The aim of this review is to define the complex crosstalk between these two cell types and to highlight potential future anti-cancer strategies.

2021 - Le malattie della pleura e del mediastino [Capitolo/Saggio]
Stefani, A; Aramini, B; Morandi, U
abstract

2021 - New Perspectives in Different Gene Expression Profiles for Early and Locally Advanced Non-Small Cell Lung Cancer Stem Cells. [Articolo su rivista]
Masciale, Valentina; Banchelli, Federico; Grisendi, Giulia; D'Amico, Roberto; Maiorana, Antonino; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Introduction: Lung cancer is one of the most common cancers in the world, causing over 1.7 million deaths in 2018. Thus far, no effective treatments against lung cancer for advanced stages have been found. For early stages, although surgery is considered the gold standard treatment, 30–55% of patients develop recurrence within the first 5 years of surgery. Our aim is to assess whether cancer stem cells (CSC) display overexpression of a pool of genes that were previously identified for adenocarcinoma recurrence in patients with early and locally advanced stages of non-small cell lung cancer (NSCLC). Methods: This cross-sectional study was carried out by harvesting surgical tumor specimens obtained from patients harboring early (I-II) and locally advanced (IIIA) stages of NSCLC. For each patient, cell sorting was performed to identify and isolate the ALDHhigh (CSC) and ALDHlow (cancer cells) populations. The mRNA expressions of 31 recurrence-related genes (target genes) in both ALDHhigh and ALDHlow populations were then assessed and compared. Results: Surgical specimens were obtained from 22 patients harboring NSCLC. Sixteen (51.6%) out of 31 recurrence-related genes were significantly overexpressed in ALDHhigh cells in the early stages and 9 (29.0%) were overexpressed in the locally advanced stages of NSCLC. Overall, the relative mRNA expressions for these recurrence-related genes were higher in early-stage patients. The average fold change, considering all 31 recurrence-related genes together, was 4.5 (95% CI = 3.1-6.3) in early-stage patients and 1.6 (95% CI = 1.2-2.2) in locally advanced-stage patients. Conclusions: Our study represents the first attempt toward identifying genes associated with recurrence that are overexpressed in cancer stem cells in patients with early and ocally advanced stages of NSCLC. This finding may contribute to the identification of new target therapies tailored for NSCLC stages.

2021 - Surgical stabilization of severe flail chest with Judet and Sanchez-Lloret plates. A case report [Articolo su rivista]
Stefani, A; Tormen, F; Scamporlino, A; Natali, P; Cavallesco, G; Morandi, U
abstract

INTRODUCTION: Flail chest is now usually treated by conservative methods and surgical fixation remainsindicated in selected cases. Different techniques can be used for fixation. The aim of this paper is topresent a case in which Judet and Sanchez-Loret plates were employed and to discuss the usefulness ofthis traditional technique.PRESENTATION OF CASE: A 79-year-old woman was admitted for left thoracic trauma with severe antero-lateral flail chest. She was affected by COPD with chronic respiratory failure, ischemic heart disease,autoimmune thrombocytopenia treated on chronic steroid therapy and severe osteoporosis. CT-scandetected multiple rib fractures, left hemothorax and lung contusions. An initial conservative treatmentof flail chest involved compressive bandage and then internal pneumatic stabilization in ICU, but it failed.The patient underwent successful surgical treatment of the flail chest by fixation of the anterior fracturesfrom the second to the eight rib. Judet and Sanchez-Lloret plates were used. A bilateral pneumoniadeveloped during the rehabilitation period and the patient died two months after operation.DISCUSSION: Judet and Sanchez-Lloret plates represent a traditional technique for fixation of flail chest.This technique is less and less used and progressively replaced by newer materials, especially titaniumplates with screws or intramedullary struts. Our patient had multiple comorbidities and a very fragilebones that advised against use of screws or intramedullary struts.CONCLUSION: Judet and Sanchez-Lloret plates can be still considered a useful tool for the fixation of flailchest in cases of thin and fragile bones.

2021 - The importance of medical treatment before surgery in pleomorphic carcinoma of the lung: A case series study [Articolo su rivista]
Tormen, F.; Banchelli, F.; Masciale, V.; Maiorana, A.; Morandi, U.; Aramini, B.
abstract

Introduction and importance: Pleomorphic carcinoma of the lung is a rare malignant epithelial tumor. Due to its rarity, its clinicopathological characteristics are not clear, and there is no defined therapeutic path for this type of tumor. Case presentation: We retrospectively analyzed the medical and pathological reports of 8 patients who underwent surgical resection for pleomorphic carcinoma between 2007 and 2010. Clinical discussion: Eight patients were analyzed (7 males and 1 female, mean age 60). All patients underwent CT scans, and the average diameter of the nodules was 56 mm. Four patients were also investigated with FDG-PET with hypermetabolic activity in all four cases. In four patients, the carcinomatous component was adenocarcinoma (all with sarcomatoid component of spindle cell and giant cell carcinoma), although in two patients, it was squamous cell carcinoma (one with spindle cell and one with giant cell). In the two remaining patients, one showed a non-small cell carcinoma with giant cell carcinoma, and the other was a non-small cell carcinoma and squamous cell carcinoma with spindle and giant cell carcinoma. All cases were treated with surgical resection. Only two patients underwent neoadjuvant chemotherapy. At the time of data analysis, only one patient treated with neoadjuvant chemotherapy was alive. Conclusion: The prognosis for these patients with a diagnosis of pleomorphic carcinoma undergoing surgery is generally better than those not treated with surgical resection, however the survival remains poor. Although with low number of patients, our research would suggest to consider neoadjuvant chemotherapy an appropriate approach for improving the outcomes before surgery.

2021 - Use of Octreotide in association with talc poudrage for the management of a severe chylothorax: A case report [Articolo su rivista]
Lovati, Eleonora; Ruggiero, Ciro; Masciale, Valentina; Stefani, Alessandro; Morandi, Uliano; Aramini, Beatrice
abstract

Chylothorax is an uncommon form of pleural effusion characterized by the presence of chylomicrons, triglycerides and cholesterol in the physical and chemical examination of the pleural fluid. It may have poor prognosis if not properly treated. Currently, conservative measures are the first line of treatment for managing chylothorax. The aim of our study is to show and suggest the use of octreotide in association with talc poudrage as good option to manage post-operative a severe chylothorax.

2020 - ALDH Expression in Angiosarcoma of the Lung: A Potential Marker of Aggressiveness? [Articolo su rivista]
Aramini, Beatrice; Masciale, Valentina; Bianchi, Daniel; Manfredini, Beatrice; Banchelli, Federico; D'Amico, Roberto; Bertolini, Federica; Dominici, Massimo; Morandi, Uliano; Maiorana, Antonino
abstract

Background: Primary angiosarcoma of the lung is a very aggressive rare malignant disease resulting in a severe prognosis (1). This type of cancer represents about 2% of all soft tissue sarcomas and has a high rate of metastasis through the hematogenous route. For the rarity of this malignant vascular tumor it is still challenging to set a diagnosis (1). The diagnostic features that have thus far been considered include primarily clinical and radiological findings. In some cases, immunohistochemical characteristics based on the most common markers used in pathology have been described. The aim of this report is to present two cases of angiosarcoma of the lung in which the aldehyde dehydrogenase (ALDH) marker was analyzed by immunohistochemistry. Methods: We report two cases of angiosarcoma of the lung in patients underwent lung surgery at our Unit. In addition to the standard histopathological analysis for this disease, immunohistochemistry using an ALDH1A1 antibody was performed in both of the cases. For ALDH quantification, a semi-quantitative method based on the positivity of the tumor cells was used: 0 (<5%), 1 (5–25%), 2 (>25–50%), 3 (>50–75%), 4 (>75%). Results: One patient with recurrent lung disease survived, achieving complete remission after chemo- and radiotherapy. The second patient died of recurrent disease within 5 years of diagnosis. ALDH1A1 was evaluated in both of these cases using an immunohistochemistry scoring system based on the positivity for this marker. The scores were consistent with the patients’ clinical outcomes, as the lower (score 1) was observed in the patient with the better clinical outcome, while the higher (score 3) was seen in the patient with the worse outcome. Conclusion: Our data suggest that ALDH may be an important clinical marker in angiosarcoma of the lung. Although further studies need to be performed in a larger cohort of patients, we believe that, if the results will be confirmed, ALDH1A1 may be used to stratify patients in terms of prognosis and for targeted therapy.

2020 - Cancer Stem-Like Cells in a Case of an Inflammatory Myofibroblastic Tumor of the Lung. [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Sighinolfi, Pamela; Brugioni, Lucio; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Background: Inflammatory myofibroblast tumor (IMT) is a rare tumor with obscure etiopathogenesis in which different inflammatory cells and myofibroblastic spindle cells are seen histologically. Although the majority of these neoplasms have a benign clinical course, the malignant form has also been reported. The gold standard is surgical treatment for complete removal. Our report describes a 50-year-old woman who underwent surgery for IMT of the lung. The aim is to determine whether cancer stem cells may be present in IMT of the lung. Methods: In April 2018, the patient underwent surgery for tumor mass asportation through lateral thoracotomy. The histology of the tumor was consistent with IMT of the lung. The ALDEFLUOR assay, after tissue digestion, was used to identify and sort human lung cancer cells expressing high and low aldehyde dehydrogenase (ALDH) activity. SOX2, NANOG, OCT-4, and c-MYC positivity were additionally determined by immunohistochemistry. Results: The specimen contained 1.10% ALDHhigh cells among all viable lung cancer cells, which indicates the population of cancer stem cells is not negligible. Immunohistochemically assessed cell positivity for ALDH1A1, SOX2, NANOG, OCT-4, and c-MYC, which are considered as lung cancer stem-like cells markers. Conclusion: For the first time, we demonstrated the presence of cancer stem cells in a case of IMT of the lung. This finding may provide a base for considering new pathological and molecular aspects of this tumor. This perspective suggests further studies to understand the possibility of developing recurrence depending on the presence of cancer stem cells.

2020 - CD44+/EPCAM+ cells detect a subpopulation of ALDHhigh cells in human non-small cell lung cancer: A chance for targeting cancer stem cells? [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Sighinolfi, Pamela; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Objectives: Several studies demonstrated that aldehyde dehydrogenase (ALDH) and CD44 are the most considered cancer stem cells (CSC) markers. However, a comparison between ALDH high cells and CD44+ cells have been previously described with no significant correlation. Indeed, the aim of the present research is to identify a superficial marker able to match with ALDH high cells population in freshly isolated human lung cancer cells. Materials and Methods: This cross-sectional study analyzed the expression of ALDHhigh/low cells and the positivity for CD44 and epithelium cell adhesion molecule (EPCAM) antigens in surgical lung cancer tissues. The main approach was a cytofluorimetric analysis of ALDH expression and positivity for CD44/EPCAM on primary cell population obtained from 23 patients harboring NSCLC. Results: There was a highly positive correlation between the expressions of ALDHhigh and CD44+/EPCAM+ cells, with a Pearson’s correlation coefficient equal to 0.69 (95% CI 0.39–0.86; P = 0.0002), and Spearman’s correlation coefficient equal to 0.52 (P = 0.0124). The average paired difference between the expression of ALDHhigh and CD44+/EPCAM+ cells was very close to 0, being 0.1% (SD 2.5%); there was no difference between these subpopulations in terms of means (95% CI = –1.0; 1.2%, P = 0.8464). These results highlight a strong similarity between ALDHhigh and CD44+/EPCAM+ cells. Conclusions: Our study is the first attempt which identifies a high correlation between the ALDHhigh and the CD44+/EPCAM+ cells, thus suggesting the possibility to use this superficial marker for future target treatments against lung cancer stem cells.

2020 - Expression of ALDH and SOX-2 in Pulmonary Sclerosing Pnemocytoma (PSP) of the Lung: Is There a Meaning Behind? [Articolo su rivista]
Aramini, Beatrice; Masciale, Valentina; Manfredini, Beatrice; Bianchi, Daniel; Banchelli, Federico; D'Amico, Roberto; Bertolini, Federica; Dominici, Massimo; Morandi, Uliano; Maiorana, Antonino
abstract

Background: Pulmonary sclerosing pneumocytoma (PSP) is a rare benign pulmonary tumor that derives from primitive respiratory epithelium of the pulmonary alveolus. The etiology and pathogenesis are still unclear. Histopathological diagnosis focuses on cells that are positive for TTF1, EMA, cytokeratin-7, and CAM 5.2. The aim of our study is to highlight the elevated expression of ALDH and the presence of SOX-2 in pulmonary sclerosing pneumocytoma. Methods: We report five cases of pulmonary sclerosing pneumocytoma undergone surgery at our Division of Thoracic Surgery, during a period between 1994 and 2011. ALDH and SOX-2 markers were also tested for positivity in all the patients. Results: Patients showed elevated expression of ALDH during immunohistochemistry and mild expression of SOX-2, although in two cases in which SOX-2 was highly expressed. Among these two patients, one presented with lymph node recurrence while the other had no recurrence with a PET-positive nodule. In particular, the patient who had developed recurrence had an ALDH score of 4 and a SOX-2 score of 3, whereas the patient with the PET-positive nodule showed an ALDH score of 4 with a mild SOX-2expression of score 1. Conclusions: This is the first attempt demonstrating the elevated expression of ALDH in this disease. SOX-2 expression was noted in both the patient who developed recurrence and the patient with a PET-positive nodule. We believe that further investigation may be highly useful to better characterize these two markers as well as understandtheir function.

2020 - Is laser-assisted resection preferable to lobectomy for pulmonary metastasectomy? [Articolo su rivista]
Stefani, A; Oricchio, Francesco; Cinquepalmi, A; Aramini, B; Morandi, U
abstract

Purposes. The aim of this study was to investigate if laser-assisted resection is appropriate for large and/or central lung metastases, when stapler wedge resection is not feasible, to determine whether this technique can be an alternative to lobectomy. Methods. All patients who underwent laser-assisted resection for large and/or central metastases were selected for the study. For comparison, patients who underwent lobectomy for metastases between 2005 and 2017 were reviewed. All resections were performed with a 1318-nm Nd:YAG laser. Perioperative features and long-term oncological outcomes were investigated. Some aspects and drawbacks of laser resection were also investigated. Results. Among 89 patients, 42 (47%) underwent laser resection and 47 underwent lobectomy. Complete resection was achieved in 91% of laser resections and in 98% of lobectomies. The operative time, postoperative drainage time and length of stay were significantly shorter in patients who underwent laser resection than in those who underwent lobectomy. Severe postoperative complications tended to be more frequent after lobectomy. The 5-year survival was 66% and 54% after laser resection and lobectomy respectively, the 5-year disease-free survival was 35% and 32% after laser resection and lobectomy respectively. No differences were found in long-term outcomes between the two techniques. Conclusions. Our experience showed that laser resection, when performed for large/central metastases, resulted in comparable survival and obtained better perioperative outcomes with respect to lobectomy. We believe that laser resection can be proposed as a reliable and advantageous lung-sparing technique, as an alternative to lobectomy for metastasectomy, when stapler wedge resection is not feasible.

2020 - Overall survival in patients with lung adenocarcinoma harboring "niche" mutations: an observational study [Articolo su rivista]
Aramini, Beatrice; Banchelli, Federico; Bettelli, Stefania Raffaella; Manfredini, Samantha; D'Amico, Roberto; Masciale, Valentina; Pinelli, Massimo; MORETTI FANTERA, Margherita; Stefani, Alessandro; Bertolini, Federica; Dominici, Massimo; Morandi, Uliano; Maiorana, Antonino
abstract

Objective: In addition to the most common somatic lung cancer mutations (i. e., KRAS and EGFR mutations), other genes may harbor mutations that could be relevant for lung cancer. We defined BRAF, c-MET, DDR2, HER2, MAP2K1, NRAS, PIK3CA, and RET mutations as “niche” mutations and analyzed. The aim of this retrospective cohort study was to assess the differences in the overall survival (OS) of patients with lung adenocarcinoma harboring niche somatic mutations. Results: Data were gathered for 252 patients. Mutations were observed in all genes studied, except c-MET, DDR2, MAP2K1, and RET. The multivariable analysis showed that 1) niche mutations had a higher mortality than EGFR mutations (HR = 2.3; 95% CI = 1.2–4.4; p = 0.009); 2) KRAS mutations had a higher mortality than EGFR mutations (HR = 2.5; 95% CI = 1.4–4.5; p = 0.003); 3) niche mutations presented a similar mortality to KRAS mutations (HR = 0.9; 95% CI = 0.6–1.5; p = 0.797). Methods: Three cohorts of mutations were selected from patients with lung adenocarcinoma and their OS was compared. Mutations that were searched for, were 1) BRAF, c-MET, DDR2, HER2, MAP2K1, NRAS, PIK3CA, and RET; 2) K-RAS; and 3) EGFR. Differences in OS between these three cohorts were assessed by means of a multivariable Cox model that adjusted for age, sex, smoking habits, clinical stages, and treatments. Conclusions: Niche mutations exhibited an increased risk of death when compared with EGFR mutations and a similar risk of death when compared with KRAS mutations.

2020 - Pectus excavatum correction enhanced by pectoralis muscletransposition: A new approach. [Articolo su rivista]
Aramini, Beatrice; Morandi, Uliano; DE SANTIS, Giorgio; Baccarani, Alessio
abstract

BACKGROUND: Indications for the surgical correction of pectus excavatum include func-tional/physiological, cosmetic, and psychosocial reasons. The most popular open technique forpectus excavatum repair was proposed by Ravitch in 1949 as an open approach that requires partialresection of the costal cartilage, xiphoid excision, and osteotomy of the sternum. The goal is to removeabnormal rib cartilage while preserving the perichondrium, allowing regrowth of the rib cartilage tothe sternum in a more anatomic manner. Operative technique. We present a case of bilateral pectoralismuscle flap transposition during a modified Ravitch procedure is presented herein. Conclusion: Thisapproach allows for a significant reduction in late complications and improves both functional andaesthetic outcomes.

2020 - Secondary spontaneous pneumothorax and bullous lung disease in cannabis and tobacco smokers. A case-control study. [Articolo su rivista]
Stefani, A; Aramini, B; Baraldi, C; Pellesi, L; Della Casa, G; Morandi, U; Guerzoni, S.
abstract

Background The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. Methods and findings We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. Conclusions Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous pneumothorax. A history of cannabis abuse should always be taken in patients with pneumothorax. There may be need for a specific treatment for pneumothorax in cannabis smokers.

2020 - Surgery for elastofibroma dorsi: optimizing the management of a benign tumor – an analysis of 70 cases [Articolo su rivista]
Scamporlino, A; Ruggiero, C; Aramini, B; Morandi, U; Stefani, A
abstract

Background: Elastofibroma dorsi (ED) is a benign soft-tissue tumor of the chest wall located near the tip of the scapula. Clinical presentation includes swelling, pain and impairment of shoulder movements. The present literature relies only on few small case series. The aim of this study was to analyze the surgical management of ED, focusing on the debated topics regarding preoperative evaluation, operative technique, post-operative outcome and follow-up. Methods: We conducted a single-center retrospective cohort analysis of patients operated for ED between 2003 and 2018. Diagnostic techniques were ultrasonography (US), computed tomography (CT-scan) and magnetic resonance imaging (MRI). CT-scan represented our preferred imaging study for preoperative assessment. Surgery was proposed for symptomatic and/or large lesions. Marginal excision through a musclesparing approach was performed. An open-door follow-up policy was adopted. All clinical, radiological, perioperative and pathological variables were matched in a univariate analysis. A multivariate analysis was performed to investigate risk factors for postoperative complications. Correlations analysis between radiological and pathological measurements of elastofibroma was conducted. Results: Seventy elastofibromas were excised in 59 patients. Mean age was 59 years and female prevalence was 59%. All elastofibromas were completely resected with no recurrence. Postoperative complications rate was 17%. Complications were mild in most cases. At the univariate analysis, patients with body mass index (BMI) >25 had a longer operative time (P=0.048), patients on antiplatelet medications experienced a prolonged drainage time (P=0.006) and a higher rate of complications (P=0.038); the occurrence of complications resulted in prolonged drainage time (P=0.047) and length of stay (P=0.023). A BMI ≤25 was the only independent risk factor for postoperative morbidity (OR 8.71, P=0.024). CT-scan showed the highest correlation with pathological size (r=0.819), US the lowest (r=0.421). Conclusions: Marginal resection through a muscle-sparing approach is safe and effective for the treatment of ED. CT-scan can be adequate for preoperative assessment. Giving the benign nature of the lesion and the absence of recurrence after complete resection, an open-door follow-up may be appropriate.

2020 - Wound complication after modified Ravitch for pectus excavatum: A case of conservative treatment enhanced by pectoralis muscle transposition [Articolo su rivista]
Aramini, B; Morandi, U; De Santis, G; Brugioni, L; Stefani, A; Ruggiero, C; Baccarani, A
abstract

Ravitcha b s t r a c tINTRODUCTION: Multiple surgical debridement sessions are mandatory before wound closure in cases ofinfection after a modified Ravitch procedure for pectus excavatum. Vacuum-assisted closure (VAC) is awell-established technical resource for treating complicated wounds; however, in cases of suspicion ofbone infection, this approach is not enough to prevent bar removal.PRESENTATION OF THE CASE: We present a case of surgical wound dehiscence with hardware exposure in apatient who had undergone chondrosternoplasty for pectus excavatum. Several sessions of debridement(three) and VAC were applied every time. The final result was achieved without the necessity to removethe hardware; however, to avoid the risk of infection, a bilateral pectoralis muscle flap mobilization wasperformed as the final step after the surgical wound revisions, although this approach is suggested tobe used during the modified Ravitch procedure. This approach allows for a significant reduction in latecomplications and improves morphological outcomes.DISCUSSION: In summary, the pectoralis muscle flap transposition is very useful not only for aestheticalresults but also in combination with multiple surgical revisions for conservative management in caseof wound infection during a modified Ravitch procedure. In our case, this technique was adopted afteraccurate care of the wound and before the final closure, which helps to maintain good vascularizationand a very satisfying result.CONCLUSION: It is important to consider this approach during the modified Ravitch procedure, not onlyfor better aesthetical results but also to prevent infections or wound dehiscence at the level of the bar

2019 - A case of mixed-pattern calcifications in multinodular goiter associated with a benign diagnosis [Articolo su rivista]
Bianchi, D; Morandi, Uliano; Stefani, A; Aramini, B.
abstract

BACKGROUND: Calcified nodules are often found in a goiter when performing an ultrasound of the neck. An analysis of different calcification patterns could contribute to discriminating between nodules with a lower malignancy risk and those with a higher malignancy risk. In certain cases, the results of a simple cytological analysis of a nodule are not specific enough to be completely trusted. CASE PRESENTATION: We present the case of a goiter with a mixed calcification pattern, including a type of calcification that is strongly associated with a malignant diagnosis, for which a completely benign diagnosis was determined. CONCLUSION: We believe that further studies examining a combination of ultrasound (US) and computed tomography (CT) scan presentations of thyroid nodules need to be performed.

2019 - Can surgery relieve pain and act as first-line treatment for a large metastasis of the sternum? [Articolo su rivista]
Manfredini, Beatrice; Morandi, U.; De Santis, G.; Catani, F.; Stefani, A.; Pinelli, M.; Baccarani, A.; Starnoni, M.; BELLINI ARTIOLI, Francesco; Aramini, B.
abstract

BACKGROUND: There are few papers published on sternal metastasis from renal cell carcinoma. The unifying element is the operability of the sternal metastasis if it is the only site of metastasis, on the operability of the primary site of the tumor and on the patient's health conditions. PRESENTATION OF THE CASE: We present a case of a 66-years-old man undergone sternal resection for a large painful metastasis. He was previously undergone left nephrectomy for clear cells carcinoma. En bloc resection of the sternal manubrium and right clavicle was performed, a Gore-Tex mesh was placed. Histology confirmed metastasis of kidney clear cells carcinoma. Patient was discharged with no complications and no pain. Chest CT at six months follow up was negative for recurrence. DISCUSSION AND CONCLUSION: We highlighted the importance of surgery as possible first-line treatment in symptomatic large sternum metastasis. Therefore, prospective studies should be considered to confirm our strategy.

2019 - Cancer stem-neuroendocrine cells in an atypical carcinoid case report. [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Lung neuroendocrine cells tumor (NET) classification and diagnosis, particularly for typical and atypical carcinoids, are complicated by a variable natural history and nonspecific symptoms. Mechanisms for the development and progression of well-differentiated lung NETs are still unclear. An accurate and timely diagnosis can ensure the implementation of appropriate treatment and impact on prognosis. One of the main unclear point is the definition of these cells’ composition. In fact, it is known that carcinoids are mainly constituted by neuroendocrine cells. Aim of our report is to show for the first time the presence of a high percentage of cancer stem cells (CSCs) in an atypical carcinoid. The ALDEFLUOR assay was used to identify and sort ALDHhigh and ALDHlow human lung cancer cells following tissue digestion. SOX2 was additionally determined by immunohistochemistry. All specimens contained the 53.10% of ALDHhigh cells among all viable lung cancer cells, which indicates that more than half of the entire tumor cell population was composed by CSCs. As expected also in immunohistochemistry, about a half of the nuclei of the cells were positive for SOX2. We strongly support the hypothesis of the presence of cancer stem-neuroendocrine cells (CSCs-NETs) as subpopulation in these types of tumors.

2019 - Cannonball-like lung nodules in a patients with a colorectal tumor. [Articolo su rivista]
Scamporlino, A; Mengoli, Mc; Calabrese, Olga; Della Casa, G; Aramini, B; Spallanzani, A; Morandi, U; Stefani, A
abstract

N.D.

2019 - Correlating tumor-infiltrating lymphocytes and lung cancer stem cells: a cross-sectional study. [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Sighinolfi, Pamela; Pinelli, Massimo; Lovati, Eleonora; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Background: Lung cancer stem cells (LCSCs) are endowed with high aldehyde dehydrogenase (ALDH) expression and play roles in tumor proliferation, metastasis, and drug resistance. Their elusive nature may allow them to escape the immune response by tumor-infiltrating lymphocytes (TILs), which can positively affect the outcome in non-small cell lung cancer (NSCLC) patients. Despite independent investigations on both LCSCs and TILs, the relationship between the two has been very marginally considered. We analyzed whether these two cell types may be related as a prerequisite for novel diagnostic and therapeutic approaches. Methods: In this cross-sectional study, NSCLC human surgical specimens from 12 patients were tested by ALDEFLUOR assay to identify ALDHhigh cells. Fluorescence-activated cell sorting (FACS) analyses for CD3+, CD4+, and CD8+ TILs were performed in combination with immunohistochemistry evaluation. Results: Statistically positive correlations were found between ALDH+ and CD8+, and between ALDH+ and CD3+ cells populations; no correlation was found between ALDH+ and CD4+ cells. The expression of CD3+ and CD8+ by cells accounted for 40.1% and 58.7%, respectively, of the variability of ALDH+ cell expression by an R-squared index, which highlights the strong correlation between TILs and LCSCs. Immunohistochemistry revealed 6–25% positive cells. Conclusions: We report a correlation between cytotoxic TILs and LCSCs, which may contribute to the future development of targeted therapies focusing on the different roles of lymphocytes against lung cancer.

2019 - Correlazione tra fumo di cannabis e pneumotorace spontaneo. [Poster]
Aramini, B; Stefani, A; Guerzoni, S; Dellacasa, G; Pellesi, L; Baraldi, C; Morandi, U
abstract

Scopo del lavoro. Lo scopo dello studio è di investigare le associazioni esistenti tra il fumo di cannabis e il pneumotorace spontaneo, analizzando una popolazione di pazienti giovani operati, prendendo in considerazione anche le interazioni con il fumo di tabacco. Materiali e metodi. Studio retrospettivo sui pazienti operati in videotoracoscopia per pneumotorace spontaneo recidivante o cronico tra il 2009 e il 2018, di età inferiore ai 40 anni e che abbiano eseguito una TC-torace prima dell’intervento. Sono state considerate variabili cliniche (età, sesso, sintomi respiratori cronici), tossicologiche (consumo di cannabis in dose/years, 1d/y=5mg di cannabis/settimana; consumo di tabacco in pack/years), radiologiche (gravità del pneumotorace sul radiogramma, grado di enfisema alla TC), perioperatorie (aspetto del polmone secondo Vanderschueren, durata intervento, numero cariche di suturatrice utilizzate per la bullectomia, complicanze postoperatorie, durata drenaggio e durata degenza, recidiva postoperatoria). Il consumo di cannabis è stato correlato con ciascuna delle variabili. Un confronto è stato inoltre eseguito tra 3 gruppi: fumatori di cannabis (più eventualmente tabacco), fumatori soltanto di tabacco, non fumatori. Risultati. 112 pazienti: 39 fumatori di cannabis (media 9.8d/y, 37 fumavano anche tabacco), 23 fumatori di solo tabacco (media 7.5p/y), 50 non fumatori. Il consumo di cannabis è risultato significativamente correlato con sesso maschile, presenza di sintomi respiratori cronici, severità dell’enfisema, gravità del pneumotorace, classe di Vanderschueren, numero di cariche utilizzate e recidiva del pneumotorace. I fumatori di cannabis hanno presentato sintomi respiratori e un grado di enfisema più severi, un pneumotorace di entità più grave e un maggior rischio di recidiva postoperatoria rispetto ai non fumatori e ai fumatori di solo tabacco. Conclusioni. Lo studio evidenzia l’associazione tra fumo di cannabis e pneumotorace, argomento poco studiato in letteratura. L’aggiunta di tabacco funge probabilmente da moltiplicatore degli effetti della cannabis. E’ auspicabile una maggiore consapevolezza da parte della popolazione dei danni polmonari indotti dal fumo di cannabis, ormai chiaramente dimostrati.

2019 - Giant bulla or pneumothorax: How to distinguish. [Articolo su rivista]
Aramini, Beatrice; Ruggiero, Ciro; Stefani, Alessandro; Morandi, Uliano
abstract

BACKGROUND: The differential diagnosis between pneumothorax and giant bullae is thought to be straightforward but sometimes poses a challenge. CASE PRESENTATION: We present a case of a 54-year-old Caucasian man with a giant emphysematous bulla who underwent surgical resection. He had no smoking history and had previous pneumonia episodes. The surgery was free of complications, without air leaks, and he showed good ventilation of the lung. DISCUSSION: The main complications of bullae are pneumothorax, infection and hemorrhage. Pneumothorax is a serious complication in patients with compromised lung function. Therefore, it is very important to carefully distinguish bullae from pneumothorax to avoid iatrogenic pneumothorax in patients with bullous disease. CONCLUSION: We emphasize how to differentiate between giant bullae and pneumothorax utilizing history, physical examination, and radiological studies, including computed tomography (CT) scan.

2019 - Isolation and Identification of Cancer Stem-Like Cells in Adenocarcinoma and Squamous Cell Carcinoma of the Lung: A Pilot Study [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Sighinolfi, Pamela; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Background: Lung cancer stem cells (CSCs) share many characteristics with normal stem cells, such as self-renewal and multipotentiality. High expression of aldehyde dehydrogenase (ALDH) has been detected in many tumors, particularly in the CSC compartment, and it plays an important role in tumor proliferation, metastasis, and drug resistance. CD44 is commonly used as a cell surface marker of cancer stem-like cells in epithelial tumors. The aim of this study was to isolate and analyze cancer stem-like cells from surgically removed specimens to compare lung adenocarcinoma (ADENO) and squamous (SQUAMO) cell carcinoma. Methods: The ALDEFLUOR assay was used to identify and sort ALDHhigh and ALDHlow human lung cancer cells following tissue digestion. Fluorescence-activated cell sorting analysis for CD44 was performed with tumor cells. Quantitative real-time PCR was performed to assess the expression of SOX2 and NANOG as stemness markers. ALDH1A1 expression was additionally determined by immunohistochemistry. Anchorage-independent ALDHhigh cell growth was also evaluated. ALDHhigh ADENO and SQUAMO cells were cultured to analyze spheroid formation. Results: All specimens contained 0.5–12.5% ALDHhigh cells with 3.8–18.9% CD44-positive cells. SOX2 and NANOG relative expression in ALDHhigh compared to ALDHlow cells in ADENO and SQUAMO was analyzed and compared between the histotypes. Immunohistochemistry confirmed the presence of ALDH1A1 in the sections. SOX2 and NANOG were expressed at higher levels in the ALDHhigh subpopulation than in the ALDHlow subpopulation only in ADENO cells, and the opposite result was seen in SQUAMO cells. In vitro functional assays demonstrated that ALDHhigh cells exhibited migration capacity with distinct behaviors between ALDHhigh spheres in ADENO vs. SQUAMO samples. Conclusions: Our results highlight the importance of a better characterization of cancer stem-like cells in ADENO and SQUAMO histotypes. This may suggest new differential approaches for prognostic and therapeutic purposes in patients with non-small-cell lung cancer.

2019 - Pectoralis Muscle Transposition in Association with the Ravitch Procedure in the Management of Severe Pectus Excavatum. [Articolo su rivista]
BACCARANI, ALESSIO; Aramini, Beatrice; DELLA CASA, GIOVANNI; BANCHELLI, FEDERICO; D'AMICO, Roberto; RUGGIERO, Ciro; Starnoni, Marta; Pedone, Antonio; STEFANI, Alessandro; MORANDI, Uliano; DE SANTIS, Giorgio
abstract

Background: Pectus excavatum (PE) is the most common congenital chest wall deformity. PE is sometimes associated with cardiorespiratory impairment, but is often associated with psychological distress, especially for patients in their teenage years. Surgical repair of pectus deformities has been shown to improve both physical limitations and psychosocial well-being in children. The most common surgical approaches for PE treatment are the modified Ravitch technique and the minimally invasive Nuss technique. A technical modification of the Ravitch procedure, which includes bilateral mobilization and midline transposition of the pectoralis muscle flap, is presented here. Methods: From 2010 to 2016, 12 patients were treated by a modified Ravitch procedure with bilateral mobilization and midline transposition of the pectoralis muscle flap for severe PE. Outcomes, morphological results, and complications were analyzed with respect to this new combined surgical approach. Results: There was a statistically significant difference between pre- and postoperative values (P = 0.0025) of the Haller index at the 18-month follow-up, showing a significant morphological improvement for all treated patients. After surgery, no morbidity and mortality were noted. The mean hospital stay was 7 days, and all patients were discharged without major complications. Conclusion: This technique significantly improved patients’ postoperative morphological outcomes and significantly reduced long-term complications, such as wound dehiscence, skin thinning, and hardware exposure.

2019 - Stem cells and lung cancer : between advanced diagnostics and new therapeutics. [Capitolo/Saggio]
Masciale, V; Grisendi, G; Morandi, U; Dominici, M; Aramini, B.
abstract

Lung cancers (LCs) remain a significant and devastating cause of morbidity and mortality worldwide. Despite the very recent success of immunotherapy, the diagnosis and treatment of LC remain one of the greatest challenges in chest surgery, clinical oncology, and molecular medicine. A growing number of investigations on normal/cancer stem cells and cellular therapies are offering exciting new avenues to advance knowledge on LC. Here, we will be focusing on the multiple relationships between LC and stem cells accounting for cancer stem cell (CSC) diagnostics and progenitor-based therapeutics for LC. Cancer cell repopulation after chemotherapy and/or radiotherapy still represents a major factor limiting the efficacy of treatment since CSCs play critical roles during this process by reciprocal connections between CSCs and tumor microenvironment. This calls for new opportunities to integrate advanced CSC diagnostics and targeted approaches also based on immunotherapy. In addition, recent discoveries on malignant pleural and other LC highlight that mesenchymal stromal/stem cells may be a novel platform for drug delivery within still unexplored gene therapy strategies. This chapter will dissect these two apparently distant technologies within a unified stem-cell-based vision aimed at providing better diagnostics and therapeutics for LC at the forefront of modern clinical oncology.

2019 - Total thyroidectomy in HIV positive patient with buffalo hump and taurine neck [Articolo su rivista]
Carrese, Elena; Morandi, Uliano; Stefani, Alessandro; Aramini, Beatrice.
abstract

BACKGROUND: The authors present a case of multinodular goiter in an HIV-positive patient affected by lipodystrophy with particular accumulation of adipose tissue in the region of the neck and trunk. CASE PRESENTATION: The patient, a 53-year-old man, presented with multinodular struma with partial retrosternal engagement, as well as multiple thyroid nodules increasing in size; some of the nodules had suspicious characteristics on ultrasound. Needle aspiration biopsy was difficult to use to determine the presence of lipodystrophy; however, even in the absence of cytology, surgical treatment was necessary due to the presence of dyspnea during exercise, the dimension of the goiter with retrosternal engagement, and the ovalization of the tracheal lumen. The patient underwent total thyroidectomy by anterior cervicotomy with particular attention to patient positioning because of the buffalo hump and taurine neck. Histological examination was positive for adenomatous hyperplasia with outbreaks of papillary microcarcinoma. CONCLUSIONS: The aim of this case report was to highlight the importance of the perioperative teamwork, with particular attention to patient positioning before surgery, as well as professional collaboration and experience among the operators.

2018 - Cancer stem cells and their microenvironment. [Capitolo/Saggio]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Morandi, Uliano; Dominici, Massimo; Husnain Haider, Khawaja; Aramini, Beatrice
abstract

2018 - Congenital cystic adenomatoid malformation in adults presenting as a single cyst [Articolo su rivista]
Scamporlino, Adriana; Ambrosini, A; Turrini, E; Morandi, U; Stefani, A
abstract

Congenital cystic adenomatoid malformations are lung anomalies usually detected prenatally or in newborns and infants. Type 1 congenital cystic adenomatoid malformations appears as a multicystic lesion, with cysts up to 2 cm in diameter, or as a single large cyst. In the latter case, when detected in adults, the preoperative diagnosis is challenging because congenital cystic adenomatoid malformations can be confused with other more common lesions.We describe two cases of uniloculated type 1 congenital cystic adenomatoid malformation in adults. In both cases, the preoperative clinical diagnosis was missed and the patients were surgically treated with lung-sparing cyst resections.

2018 - La malformazione congenita adenomatoido-cistica del polmone nell’adulto: difficoltà diagnostiche e approccio chirurgico [Abstract in Atti di Convegno]
Scamporlino, A; Ambrosini Spaltro, A; Turrini, E; Morandi, U; Stefani, A.
abstract

ND

2018 - Salvage procedure after sternochondroplasty for pectus excavatum. [Articolo su rivista]
Aramini, Beatrice; Morandi, Uliano; DE SANTIS, Giorgio; Baccarani, Alessio
abstract

Vacuum-Assisted Closure in association to flap reconstruction is a well-established approach for treating complicated wounds. Case presentation: The authors present a case of soft-tissue breakdown with hardware exposure in a patient treated with strenochondroplasty for pectus excavatum. VAC therapy was applied in association to multiple debridement procedures and final flap closure. This was achieved without the need for hardware removal, thus maintaining adequate skeletal fixation. To our knowledge this approach has not yet been described into the literature after sternochondroplasty procedure. Conclusion Aggressive debridement and VAC therapy before final closure may represent a new, conservative method for managing surgical complications after sternochondroplasty procedures.

2018 - Un raro caso di PECOMA maligno all’interno di un sequestro polmonare extralobare. [Abstract in Atti di Convegno]
Cinquepalmi, Alessandro; Stefani, A; Aramini, B; Morandi, U
abstract

N.D.

2018 - Vacuum Assisted Closure in the Management of exposed hardware for skeletal fixation: a challenging case [Articolo su rivista]
Baccarani, Alessio; Aramini, Beatrice; Morandi, Uliano; DE SANTIS, Giorgio
abstract

No abstract available

2017 - Pathologic findings and long-term results after surgical treatment for pulmonary sarcomatoid tumors: a multicenter analysis [Articolo su rivista]
56) Lococo, F; Rapicetta, C; Cardillo, G; Stefani, A; Margaritora, S; Leuzzi, G; Rossi, G; Ciavarella, L; Morandi, U; Facciolo, F; Ricchetti, T; Cesario, A; Paci, M.
abstract

Background Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small cell lung cancer (NSCLC). The aim of this study was to clarify the pathologic characteristics and long-term survival after surgical treatment in patients with PSC. Methods From January 2003 to December 2013, we retrospectively reviewed the clinical findings, surgical notes, and pathologic and follow-up data from 148 consecutive patients who underwent curative resection for PSC in 5 institutions. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used. Results Mean age and male to female ratio were 66.6 ± 9.9 years and 120:28, respectively. Surgical resection (pneumonectomy in 8 patients, bilobectomy in 132 patients, and sublobar resection in 8 patients) was complete in 142 cases (96%). At pathologic evaluation, 36 patients (24%) had stage I, 69 patients (47%) had stage II, 33 patients (22%) had stage III, and 10 patients (7%) had stage IV disease. A “biphasic tumor” (PSC with an NSCLC component) was observed in 77 patients (52%). We detected a high rate of vascular emboli in the surgical specimens (overall, 68%; 57% in pathologic stage I tumors), whereas lymphatic emboli were found in 30% of cases (5% of pathologic stage I tumors). Overall median and 5-year long-term survival (LTS) was 19 months and 12.6% (LTS, 16.3% in pathologic stage I), respectively. Distant recurrences frequently occurred after surgical treatment (81%), even in pathologic stage I tumors that underwent R0 resection (62%). Multivariable survival analysis identified R+ resection (hazard ratio [HR],12.3; 95% confidence interval [CI], 3.67–41.28; p < 0.0001), advanced pathologic stage (HR, 5.75; 95% CI, 2.55–12.98; p < 0.0001), and the presence of vascular emboli (HR, 1.67; 95% CI, 1.05–2.67; p = 0.0327) as independent negative prognostic factors. Conclusions PSCs have very aggressive behavior and high metastatic potential even in early stages. R+ resection, pathologic TNM status, and the presence of vascular emboli are independent prognostic factors

2017 - Thoracic surgery [Capitolo/Saggio]
Morandi, U; Stefani, A; Aramini, B
abstract

Vengono descritti brevemente gli aspetti di diagnosi e stadiazione delle neoplasie polmonari. Gli autori descrivono poi dettagliatamente gli aspetti dello studio funzionale cardiorespiratorio preoperatorio e la valutazione del rischio perioperatorio. Più brevemente si soffermano sulle principali procedure chirurgiche e infine si descrivono gli aspetti relativi al trattamenti riabilitativo e generale postoperatorio. Il tutto focalizzato ai pazienti anziani,.

2016 - Malignant Pigmented Mass “Sequestrated” in the Lung: A Unique Case Report [Articolo su rivista]
Mengoli, M. C.; Lococo, F.; Depenni, R.; Morandi, U.; Rossi, G.
abstract

Primary lung tumors arising in pulmonary sequestration is an exceptional event, usually consisting of common histologic types. On the other hand, malignant perivascular epithelioid cell (PEComatous) tumors with deposition of melanin pigment have never been reported in the lung so far. In this study, we report a challenging case of a 34-year-old man presented with recurrent hemoptysis and CT scan detection of a pulmonary mass at the left lower lobe, vascularized by aberrant communication with the left diaphragmatic artery. After surgical resection, we documented a malignant PEComatous tumor (characterized by TFE3 expression and high mitotic rate) that had arisen in the context of an extralobar sequestration.

2016 - Mucorales-specific T cells in patients with hematologic malignancies [Articolo su rivista]
Potenza, Leonardo; Vallerini, Daniela; Barozzi, Patrizia; Riva, Giovanni; Gilioli, Andrea; Forghieri, Fabio; Candoni, Anna; Cesaro, Simone; Quadrelli, Chiara; Maertens, Johan; Rossi, Giulio; Morselli, Monica; Codeluppi, Mauro; Mussini, Cristina; Colaci, Elisabetta; Messerotti, Andrea; Paolini, Ambra; Maccaferri, Monica; Fantuzzi, Valeria; DEL GIOVANE, Cinzia; Stefani, Alessandro; Morandi, Uliano; Maffei, Rossana; Marasca, Roberto; Narni, Franco; Fanin, Renato; Comoli, Patrizia; Romani, Luigina; Beauvais, Anne; Viale, Pier Luigi; Latgè, Jean Paul; Lewis, Russell E.; Luppi, Mario
abstract

Background: Invasive mucormycosis (IM) is an emerging life-threatening fungal infection. It is difficult to obtain a definite diagnosis and to initiate timely intervention. Mucorales-specific T cells occur during the course of IM and are involved in the clearance of the infection. We have evaluated the feasibility of detecting Mucorales-specific T cells in hematological patients at risk for IM, and have correlated the detection of such cells with the clinical conditions of the patients. Methods and Findings: By using an enzyme linked immunospot assay, the presence of Mucorales-specific T cells in peripheral blood (PB) samples has been investigated at three time points during highdose chemotherapy for hematologic malignancies. Mucorales-specific T cells producing interferon-γ, interleukin-10 and interleukin-4 were analysed in order to detect a correlation between the immune response and the clinical picture. Twenty-one (10.3%) of 204 patients, accounting for 32 (5.3%) of 598 PB samples, tested positive for Mucorales-specific T cells. Two groups could be identified. Group 1, including 15 patients without signs or symptoms of invasive fungal diseases (IFD), showed a predominance of Mucorales-specific T cells producing interferon-gamma. Group 2 included 6 patients with a clinical picture consistent with invasive fungal disease (IFD):2 cases of proven IM and 4 cases of possible IFD. The proven patients had significantly higher number of Mucorales-specific T cells producing interleukin-10 and interleukin-4 and higher rates of positive samples by using derived diagnostic cut-offs when compared with the 15 patients without IFD. Conclusions: Mucorales-specific T cells can be detected and monitored in patients with hematologic malignancies at risk for IM. Mucorales-specific T cells polarized to the production of T helper type 2 cytokines are associated with proven IM and may be evaluated as a surrogate diagnostic marker for IM.

2016 - Prediction of distant recurrence in resected stage I and II lung adenocarcinoma [Articolo su rivista]
Aramini, Beatrice; Casali, Christian; Stefani, Alessandro; Bettelli, Stefania; Wagner, Susanne; Sangale, Zaina; Hughes, Elisha; Lanchbury, Jerry S.; Maiorana, Antonino; Morandi, Uliano
abstract

Objectives Optimal procedures for adjuvant treatment and post-surgical surveillance of resected non-small-cell lung cancer remain under discussion. Pathological features are the main determinant of follow-up therapy but have limited ability to identify patients at risk of recurrence. Increasingly, molecular markers are incorporated into clinical decision-making, including measures of tumor growth. The CCP score is a quantitative, molecular measure of proliferation derived from the RNA expression of 31 cell cycle genes and a component of the molecular prognostic score (mPS). The mPS score is a linear combination of CCP score and pathological stage. CCP score and mPS are independent predictors of survival in resected lung adenocarcinoma. Materials and methods CCP scores were determined by RT-qPCR for 318 patients diagnosed with stage I–II lung adenocarcinoma. Association of mPS and CCP score with distant recurrence and lung-cancer specific survival was assessed in Cox proportional hazards regression models adjusted for age, gender, tumor size, pathological stage and pleural invasion. Distant recurrence-free survival and lung-cancer specific survival by mPS risk group were calculated by Kaplan-Meier survival analysis. Results CCP scores were obtained for 205 stage I and 84 stage II patients. CCP score and mPS were independent markers of distant recurrence (CCP: HR 1.62, 95%CI 1.15-2.29, p = 0.0055; mPS: HR 2.22, 95%CI 1.11-4.44, p = 0.023). Patients with low mPS tumors were at significantly reduced risk of distant recurrence (log-rank p = 4.2 × 10−5). Among stage I patients, stratification by mPS identified a patient group with increased risk of distant recurrence (36%, 95%CI 28–46%, log-rank p = 0.0011) Conclusions The molecular prognostic score stratifies early-stage, resected lung cancer patients for risk of distant recurrence and could be useful to inform treatment and surveillance decisions.

2016 - Prediction of Distant Recurrence-Free Survival in Resectable Lung Adenocarcinoma. [Abstract in Atti di Convegno]
Aramini, B; Casali, C; Stefani, A; Bettelli, S; Wagner, ; Sangale, Z; Hughes, E; S., Lanchbury J; Maiorana, A; Morandi, U.
abstract

OBJECTIVES: Optimal procedures for adjuvant treatment and post-surgical surveillance of resected non-small-cell lung cancer remain under discussion. Pathological features are the main determinant of follow-up therapy but have limited ability to identify patients at risk of recurrence. Increasingly, molecular markers are incorporated into clinical decision-making, including measures of tumor growth. The CCP score is a quantitative, molecular measure of proliferation derived from the RNA expression of 31 cell cycle genes and a component of the molecular prognostic score (mPS). The mPS score is a linear combination of CCP score and pathological stage. CCP score and mPS are independent predictors of survival in resected lung adenocarcinoma. MATERIALS AND METHODS: CCP scores were determined by RT-qPCR for 318 patients diagnosed with stage I-II lung adenocarcinoma. Association of mPS and CCP score with distant recurrence and lung-cancer specific survival was assessed in Cox proportional hazards regression models adjusted for age, gender, tumor size, pathological stage and pleural invasion. Distant recurrence-free survival and lung-cancer specific survival by mPS risk group were calculated by Kaplan-Meier survival analysis. RESULTS: CCP scores were obtained for 205 stage I and 84 stage II patients. CCP score and mPS were independent markers of distant recurrence (CCP: HR 1.62, 95%CI 1.15-2.29, p=0.0055; mPS: HR 2.22, 95%CI 1.11-4.44, p=0.023). Patients with low mPS tumors were at significantly reduced risk of distant recurrence (log-rank p=4.2×10-5). Among stage I patients, stratification by mPS identified a patient group with increased risk of distant recurrence (36%, 95%CI 28-46%, log-rank p=0.0011) CONCLUSIONS: The molecular prognostic score stratifies early-stage, resected lung cancer patients for risk of distant recurrence and could be useful to inform treatment and surveillance decisions.

2015 - Malattie della pleura e del mediastino [Capitolo/Saggio]
Stefani, Alessandro; Morandi, Uliano
abstract

Gli autori descrivono le principali malattie della pleura e del mediastino di interesse chirurgico

2015 - Malattie della pleura e del mediastino e trapianto di polmoni. [Capitolo/Saggio]
Aramini, Beatrice; Morandi, Uliano; Federico, Rea; Alessandro, Stefani; Vitulo, Patrizio
abstract

Malattie della pleura e del mediastino e trapianto di polmoni.

2015 - Morbidity and Mortality in Patients with Idiopathic Pulmonary Fibrosis Undergoing Diagnostic Surgical Lung Biopsy [Abstract in Atti di Convegno]
Zelent, Gabriele; Cerri, Stefania; Sghedoni, Enrico; Montanari, Gloria; Taddei, Sofia; Aramini, Beatrice; Rossi, Giulio; Stefani, Alessandro; Torricelli, Pietro; Morandi, Uliano; Luppi, Fabrizio
abstract

Morbidity and Mortality In Patients With Idiopathic Pulmonary Fibrosis Undergoing Diagnostic Surgical Lung Biopsy.

2014 - A standardized technique for lung biopsy in idiopathic interstitial pneumonias [Articolo su rivista]
Stefani, Alessandro; Aramini, Beatrice; Morandi, Uliano
abstract

Objective. In cases of suspected idiopathic interstitial pneumonia, a surgical lung biopsy can be necessary to obtain a definitive diagnosis. The optimal site, size and specimen number to ensure adequate sampling remain controversial. We developed a standardized technique to perform surgical lung biopsy. Methods. Patients with preoperative suspicion of IIP were evaluated for this kind of operation. When diffuse, bilateral and uniformly distributed abnormalities were seen at high-resolution computed-tomography the patient underwent this operation. Three pulmonary segments of the left lung (lingula, lateral/posterior basal and apical segment of the lower lobe) were biopsied using a three-ports videothoracoscopic approach. The operation was conducted under general anaesthesia and double-lumen endotracheal intubation for single-lung ventilation. No frozen examination nor microbiological examination were routinely requested. Results. Fifty-nine patients were operated using this technique. No conversions from VATS to thoracotomy were necessary. The mean operative time was 38 minutes. Mortality was 3.3%. A firm clinicopathological diagnosis was achieved in all patients. Conclusions. The proposed technique has been proved to have a high diagnostic yield and to be safe, simple and fast in the various form of idiopathic interstitial pneumonias. Conversely, the technique is not indicated in diffuse parenchymal lung diseases in which the distribution of the lesions at HRCT is non-uniform and inhomogeneous. In these cases the various distribution of pathological changes requires a case-by-case evaluation of the optimal site, size and number of biopsies.

2014 - An unusual case of giant benign metastasizing leiomyoma mimicking solitary fibrous tumor of the pleura [Articolo su rivista]
Stefani, Alessandro; Rossi, Giulio; Longo, Lucia; Morandi, Uliano
abstract

Benign metastasizing leiomyoma is a rare entity usually manifesting with asymptomatic multiple pulmonary nodules in women with history of uterine leiomyoma. Surgical resection is the treatment of choice when feasible, alternatively hormonal therapy can be proposed. We describe a case of a 72-year-old woman with a giant and symptomatic benign metastasizing leiomyoma of the left lung, developed 22 years after hysterectomy. Complete surgical excision of the mass was performed. The patient is alive without recurrence 20 months after the operation.

2014 - Identification of malignant pleural effusion by tumor markers: a National multicenter trial. [Abstract in Atti di Convegno]
Griffo, Salvatore; Elia, Stefano; Vetrani, A; Morandi, Uliano; Pacelli, F; Stefani, Alessandro
abstract

All examined concetnrations of tumor markers examined in pleural effusions were significantly higher in malignant effusions than in benign

2014 - Osteomielite ed osteonecrosi della parete toracica anteriore con radiodermite consensuale: risultati di due casi trattati con parietectomia toracica anteriore e ricostruzione della parete con lembo peduncolato di grande omento. [Abstract in Atti di Convegno]
Nesci, Jessica; Pignatti, Marco; Stefani, Alessandro; Loschi, Pietro; Deruvo, Nicola; DE SANTIS, Giorgio; Morandi, Uliano
abstract

Una complicanza relativamente rara, ma debilitante descritta nelle pazienti che hanno subito una mastectomia con successiva radioterapia per neoplasia della mammella può essere la formazione di ulcere radionecrotiche infette della parete toracica. In questi casi, in assenza di recidiva neoplastica l’indicazione terapeutica di scelta è l’asportazione chirurgica di tutti i tessuti infetti con successiva ricostruzione del difetto creato con tessuti altamente vascolarizzati. Presenteremo due casi di pazienti donne, entrambe sottoposte da più di 20 anni a mastectomia radicale destra, successivamente radiotrattate e che hanno entrambe sviluppato un’ ulcera radionecrotica infetta della parete toracica anteriore destra. Le pazienti sono state trattate chirurgicamente dopo il fallimento di medicazioni ripetute e della terapia antibiotica mirata. In entrambi i casi abbiamo eseguito un ampio debridement parietale con rimozione di tutti i tessuti macroscopicamente infetti o necrotici, mantenendo adeguati margini di resezione. In entrambi i casi è stato necessario asportare dalla terza alla sesta cartilagine costale insieme ai relativi spazi inetrcostali e l’emisterno destro nella porzione di corpo compresa tra il secondo e il quinto spazio intercostale. Nel primo caso l’area totale del difetto era di 108 cm2, mentre nel secondo caso era più ampia e misurava 160 cm2. La ricostruzione della parete toracica è stata fatta in tutti e due i casi con un lembo peduncolato di grande omento e il lembo è stato successivamente coperto con un innesto cutaneo prelevato dalla coscia sinistra. Nella prima paziente abbiamo osservato una necrosi post operatoria parziale del lembo che è stata trattata con successo grazie a VAAC (vacuum-assisted closure) therapy e con un successivo nuovo innesto cutaneo. Il decorso post operatorio della seconda paziente è stato privo di complicanze. Le possibilità ricostruttive dei difetti di parete della prete toracica anteriore prevedono l’utilizzo del muscolo grande dorsale, del muscolo retto dell’addome o del grande omento. In questi casi il muscolo grande pettorale e il retto dell’addome non erano utilizzabili a causa del pregresso irradiamento, mentre il gran dorsale non era sufficientemente trofico. Lembi liberi non peduncolati non rappresentano una buona alternativa a causa della insufficiente vascolarizzazione. In letteratura sono presenti pochi casi di ulcere radionecrotiche infette trattate con questa tecnica. La nostra esperienza conferma che l’ampia resezione dell’area di parete toracica patologica, la successiva ricostruzione con un lembo peduncolato di grande omento e la copertura del lembo con un innesto cutaneo rappresenta un trattamento valido delle ulcere radionecrotiche infette della parte toracica anteriore in pazienti precedentemente radiotrattati.

2014 - Un caso inusuale di interstiziopatia polmonare cistica [Abstract in Atti di Convegno]
Aramini, Beatrice; Stefani, Alessandro; Rossi, Giulio; Pecchi, Annarita; Bertolini, Federica; Falasca, Angelo; Morandi, Uliano
abstract

Nel marzo 2011, una donna di 27 anni è stata ricoverata per cefalea persistente. La RMN dell’encefalo mostrava una neoformazione parasagittale destra, eterogenea, con aree emorragiche e compressione del tessuto circostante, compatibile con meningioma. Il radiogramma del torace mostrava una interstiziopatia diffusa reticolonodulare e pneumotorace sinistro. La HRCT evidenziava la presenza di lesioni cistiche bilaterali, diffuse prevalentemente ai lobi inferiori e sottopleuriche, micronoduli peribronchiali e centrolobulari e confermava il pneumotorace, completo a sinistra, soltanto apicale a destra. Le cisti, da pochi millimetri a un centimetro, presentavano pareti sottili e tendenza a confluire. La paziente non riferiva sintomatologia respiratoria. La diagnosi radiologica è stata di interstiziopatia polmonare a componente cistica. Gli esami di laboratorio (compresi test-HIV, ANAtest, immunoelettroforesi) e una TC addome-pelvi sono risultati negativi. La paziente è stata sottoposta ad intervento neurochirurgico di rimozione completa della neoplasia cerebrale in craniotomia. La diagnosi istologica è stata di meningioma benigno (grado I). Dopo tre settimane sono state eseguite biopsie polmonari multiple in videotoracoscopia. L'esame istologico ha mostrato una proliferazione di tipo nodulare e cistico di cellule fusate, con rare mitosi, senza necrosi. All’immunoistochimica queste cellule si presentavano diffusamente positive per vimentina, EMA, CD56 e recettori per estrogeni/progesterone, focalmente positive per S100. In considerazione dell’analogo quadro morfologico e immunoistochimico con la neoplasia cerebrale, è stata posta diagnosi di metastasi polmonari da meningioma. Questa diagnosi è stata ulteriormente avvalorata dai test molecolari. La paziente ha iniziato chemioterapia con idrossiurea, interrotta dopo 12 mesi a causa di progressione della malattia polmonare. Da Giugno 29012 è in terapia con everolimus e da allora la malattia rimane stabile. Le metastasi da meningioma sono rare (0,1 % dei meningiomi) e il polmone è l’organo più colpito. Metastatizzano principalmente i meningiomi maligni (grado II-III), eccezionalmente le forme benigne (circa 20 casi riportati in letteratura). Le metastasi polmonari sono descritte in genere come masse o noduli, più spesso isolate, raramente come lesioni multiple o bilaterali. Questo è il primo caso riportato di presentazione con aspetto microcistico. L’aspetto radiologico poneva la diagnosi differenziale con altre forme di interstiziopatia cistica (linfoangioleiomiomatosi, istiocitosi a cellule di Langherans, neurofibromatosi-1, LIP, collagenopatie), per cui è stata obbligatoria la biopsia polmonare. All’esame istologico l’aspetto morfologico non poteva escludere altre proliferazioni a cellule fusate riscontrabili a livello polmonare, (linfoangioleiomiomatosi, meningoteliomatosi) ma le caratteristiche immunoistochimiche nel contesto clinico di un meningioma cerebrale hanno supportato la diagnosi di metastasi. E’ stata decisiva l’analisi molecolare per la diagnosi di certezza.

2014 - Utilità della FDG-PET/TC nella diagnosi dei carcinoidi polmonari [Abstract in Atti di Convegno]
Stefani, Alessandro; Franceschetto, Antonella; Nesci, Jessica; Aramini, Beatrice; Proli, Chiara; Kaleci, Shaniko; Casolo, Lucia; Massi, Lucia; Casali, Christian; Morandi, Uliano
abstract

Scopo del lavoro I carcinoidi polmonari entrano nella diagnosi differenziale dei noduli polmonari solitari (NPS). I carcinoidi sono tradizionalmente considerati come tumori PET negativi, anche se studi più recenti hanno evidenziato una certa sensibilità della FDG-PET/TC per la diagnosi di queste neoplasie. Lo scopo di questo studio è di determinare l’utilità della PET/TC nella valutazione dei NPS sospetti per carcinoide. Materiali e metodi Si tratta di uno studio retrospettivo eseguito su tutti i pazienti sottoposti ad exeresi chirurgica di carcinoide e precedente FDG-PET/TC dal 2006 al 2012. L’esame PET/TC è stato eseguito con la stessa macchina e la stessa tecnica in tutti i casi. Sono state analizzate le seguenti variabili: età, sesso, aspetti TC (lato, sede, dimensioni, forma, margini), SUVmax, tipo di intervento, aspetti patologici (dimensioni, numero di mitosi). Riguardo alla valutazione PET, è stato considerato soltanto il SUVmax e non la valutazione qualitativa. I carcinoidi sono stati classificati come tipici o atipici e periferici o centrali. E’ stato registrato anche il follow-up a distanza. Il SUVmax è stato confrontato con tutte le altre variabili cliniche, radiologiche e patologiche, al fine di evidenziare eventuali associazioni o differenze. Risultati Sono stati recuperati 25 pazienti. Si è trattato di 24 forme tipiche e un carcinoide atipico, 21 periferici e 4 centrali. Il diametro medio alla TC è stato di 25.3mm e il dato correlava con le dimensioni patologiche. 60% dei tumori avevano forma ovalare e il 68% margini lisci. Il SUVmax medio è stato 3.6 (range 1.4-12.9). Tutte le lesioni sono state asportate in modo radicale. L’analisi di regressione lineare ha evidenziato una associazione diretta tra il SUVmax e le dimensioni (p=0.004), mentre nessun’altra correlazione è stata ritrovata tra il SUVmax e le altre variabili. Nessun paziente ha presentato recidiva o è morto durante il follow-up. Conclusioni Questo studio dimostra che la FDG-PET/TC è utile nella valutazione del NPS sospetto per carcinoide. E’ necessario utilizzare il SUVmax e non la valutazione qualitativa e il confronto deve essere eseguito con il resto del polmone e non con la captazione mediastinica, come usualmente nell’interpretazione della captazione FDG. Quando un NPS si presenta con forma ovoidale/rotonda e margini lisci alla TC e mostra una captazione alla FDG-PET superiore a quella del polmone circostante, con un SUVmax>1-1.5, in questo caso è elevato il sospetto di carcinoide. Pertanto, se si può ragionevolmente escludere una lesione benigna, si raccomanda la resezione chirurgica o almeno una biopsia della lesione.

2013 - A standardized technique for lung biopsy in idiopathic interstitial pneumonia. [Abstract in Atti di Convegno]
Aramini, B; Stefani, A; Morandi, U.
abstract

A standardized technique for lung biopsy in idiopathic interstitial pneumonia.

2013 - An unusual case of cystic interstitial lung disease [Articolo su rivista]
Stefani, A.; Rossi, G.; Pecchi, A.; Bertolini, F.; Falasca, A.; Aramini, B.; Morandi, U.
abstract

NON DISPONIBILE

2013 - Characterization of Specific Immune Responses to Different Aspergillus Antigens during the Course of Invasive Aspergillosis in Hematologic Patients [Articolo su rivista]
Potenza, Leonardo; Vallerini, Daniela; Barozzi, Patrizia; Riva, Giovanni; Forghieri, Fabio; Beauvais, Anne; Beau, Remi; Candoni, Anna; Maertens, Johan; Rossi, Giulio; Morselli, Monica; Zanetti, Eleonora; Quadrelli, Chiara; Codeluppi, Mauro; Guaraldi, Giovanni; Pagano, Livio; Caira, Morena; DEL GIOVANE, Cinzia; Maccaferri, Monica; Stefani, Alessandro; Morandi, Uliano; Tazzioli, Giovanni; Girardis, Massimo; Delia, Mario; Specchia, Giorgina; Longo, Giuseppe; Marasca, Roberto; Narni, Franco; Merli, Francesco; Imovilli, Annalisa; Apolone, Giovanni; Carvalho, Agostinho; Comoli, Patrizia; Romani, Luigina; Latgè, Jean Paul; Luppi, Mario
abstract

Several studies in mouse model of invasive aspergillosis (IA) and in healthy donors have shown that different Aspergillus antigens may stimulate different adaptive immune responses. However, the occurrence of Aspergillus-specific T cells have not yet been reported in patients with the disease. In patients with IA, we have investigated during the infection: a) whether and how specific T-cell responses to different Aspergillus antigens occur and develop; b) which antigens elicit the highest frequencies of protective immune responses and, c) whether such protective T cells could be expanded ex-vivo. Forty hematologic patients have been studied, including 22 patients with IA and 18 controls. Specific T cells producing IL-10, IFN-γ, IL-4 and IL-17A have been characterized through enzyme linked immunospot and cytokine secretion assays on 88 peripheral blood (PB) samples, by using the following recombinant antigens: GEL1p, CRF1p, PEP1p, SOD1p, α1-3glucan, β1-3glucan, galactomannan. Specific T cells were expanded through short term culture. Aspergillus-specific T cells producing non-protective interleukin-10 (IL-10) and protective interferon-gamma (IFN-γ) have been detected to all the antigens only in IA patients. Lower numbers of specific T cells producing IL-4 and IL-17A have also been shown. Protective T cells targeted predominantly Aspergillus cell wall antigens, tended to increase during the IA course and to be associated with a better clinical outcome. Aspergillus-specific T cells could be successfully generated from the PB of 8 out of 8 patients with IA and included cytotoxic subsets able to lyse Aspergillus hyphae. Aspergillus specific T-cell responses contribute to the clearance of the pathogen in immunosuppressed patients with IA and Aspergillus cell wall antigens are those mainly targeted by protective immune responses. Cytotoxic specific T cells can be expanded from immunosuppressed patients even during the infection by using the above mentioned antigens. These findings may be exploited for immunotherapeutic purposes in patients with IA. © 2013 Potenza et al.

2013 - Identification of malignant pleural effusions (mpes) by tumor markers: a national multi-center trial. [Abstract in Rivista]
S., Elia; Morandi, Uliano; A., Vetrani; S., Griffo; R., Massoud; S., Iona; Stefani, Alessandro; A., Pierantozzi; F., Pacelli; A., Destefano; G., Petrella
abstract

l'abstract descrive i risultati definitivi del progetto PRIN 20083YAR35, in cui gli autori hanno studiato la presenza di markers all'interno del liquido pleurico predittivi di versamento pleurico neoplastico.

2013 - Integrated FDG-PET/CT imaging is useful in the apporach to carcinoid tumors of the lung [Articolo su rivista]
Stefani, Alessandro; Franceschetto, Antonella; Nesci, Jessica; Aramini, Beatrice; Proli, Chiara; Kaleci, Shaniko; Casolo, Alessandra; Massi, Lucia; Casali, Christian; Morandi, Uliano
abstract

Background. Carcinoids enter the differential diagnosis of the solitary pulmonary nodule. Bronchial carcinoids have been traditionally considered as FDG-PET negative but recent studies have found an higher sensitivity of integrated FDG-PET/CT for the detection of these neoplasms. The purpose of this study was to investigate the value of integrated FDG-PET/CT for the evaluation of SPN suspected to be carcinoids. Methods. All patients with pathologically proven bronchial carcinoids who had FDG-PET/CT scans between 2006 and 2012 have been retrospectively reviewed. PET/CT was performed with the same scanner and the same technique for all patients. The following data were retrieved: age, sex CT findings (side, location, size, shape, margins), SUVmax, type of operation, pathological findings (size and number of mitoses). Regarding PET findings, only SUVmax was considered, whereas the visual assessment was not undertaken. Carcinoids were defined as typical and atypical and as central and peripheral. The long-term follow-up was also recorded. The SUVmax was compared with the other clinical, radiological and pathological variables to find any significant difference or correlation. Results. Twenty-five patients were retrieved, 24 typical and one atypical carcinoid, 21 peripheral and 4 central lesions. The mean diameter on CT-scan was 25.3mm and the clinical size correlated well with the pathological size. Fifty-six percent of the tumors were ovoid and 68% had smooth margins. The mean SUVmax was 3.6 (range 1.4-12.9). All the lesions were completely resected. The regression analysis showed a direct correlation between the SUVmax and the tumor size (p=0.004). No further correlations were found between the SUVmax and the other variables. None of the patients had recurrent disease or died during the follow-up. Conclusions. Our study showed that FDG-PET/CT might be a useful tool in the evaluation of SPNs suspected to be bronchial carcinoids. When a solitary pulmonary nodule shows an ovoid/round shape and smooth margins on the CT scan and demonstrates an FDG uptake higher than that of the normal lung and with a SUVmax value >1-1.5, a carcinoid should be suspected. If benign lesions can be presumably excluded, surgical resection or at least a biopsy of the lesion is recommended.

2013 - La metodica STRATOS nella correzione del pectus excavatum: esperienza in due casi trattati. [Abstract in Atti di Convegno]
Nesci, J.; Stefani, Alessandro; B., Aramini; Morandi, Uliano
abstract

Gli autori riportano la loro esperienza su due casi di pectus excavatum trattati con la nuova metodica con barre metalliche fissate alle coste e allo sterno proposta dalla STRATOS.

2013 - Preoperative predictors of a successful surgical treatment in the management of parapneumonic empyema [Articolo su rivista]
Stefani, Alessandro; Aramini, B.; Dellacasa, G.; Ligabue, Guido; Kaleci, Shaniko; Casali, C.; Morandi, Uliano
abstract

Background: Video-assisted thoracoscopic surgery (VATS) and thoracotomy are the main surgical options for treating parapneumonic empyema. The choice of either operation depends on many preoperative features, including the patient's condition, clinical and radiologic findings, and pleural fluid characteristics. The identification of the combination of those preoperative findings that will allow surgeons to select the appropriate approach for a successful operation (VATS or thoracotomy) could be of great interest in clinical settings. Methods: We retrospectively reviewed a series of 97 patients who had undergone successful VATS or thoracotomy for parapneumonic empyema; in all cases, the operation had begun through VATS and was changed to a thoracotomy if a complete decortication was needed. Preoperative clinical, radiologic, and laboratory features were compared between the two groups to search for differences that might serve as predictive factors for either operation. Perioperative findings were also analyzed. Results: The operation was accomplished by VATS in 40 patients (41%), and conversion to thoracotomy was necessary in 57 (59%). Significant predictive factors for conversion were a prolonged delay from diagnosis to operation, the presence of fever and of pleural thickness on computed tomography (CT) images. The 25 patients who presented with these three features were cured by thoracotomy. The operative time and postoperative complication rate were significantly higher for the thoracotomy patients. Conclusions: Some preoperative features can help the surgeon to better select patients for the appropriate operation. Delayed operation, fever, and pleural thickness can be used to predict the likelihood of conversion to thoracotomy. © 2013 The Society of Thoracic Surgeons.

2013 - Prognostic role of clusterin in resected adenocarcinomas of the lung. [Articolo su rivista]
Panico, Francesca; Casali, C; Rossi, Giulio; Rizzi, F; Morandi, Uliano; Bettuzzi, Sara; Davalli, Pierpaola; Corbetta, Lorenzo; Storelli, Es; Corti, Arnaldo; Fabbri, Leonardo; Astancolle, Serenella; Luppi, Fabrizio
abstract

Rationale Clusterin expression may change in various human malignancies, including lung cancer. Patients with resectable non-small cell lung cancer (NSCLC), including adenocarcinoma, have a poor prognosis, with a relapse rate of 30–50% within 5 years. Nuclear factor kB (Nf-kB) is an intracellular protein involved in the initiation and progression of several human cancers, including the lung. Objectives We investigate the role of clusterin and Nf-kB expression in predicting the prognosis of patients with early-stage surgically resected adenocarcinoma of the lung. Findings The level of clusterin gradually decreased from well-differentiated to poorly differentiated adenocarcinomas. Clusterin expression was significantly higher in patients with low-grade adenocarcinoma, in early-stage disease and in women. Clusterin expression was inversely related to relapse and survival in both univariate and multivariate analyses. Finally, we observed an inverse correlation between Nf-kB and clusterin. Conclusions Clusterin expression represents an independent prognostic factor in surgically resected lung adenocarcinoma and was proven to be a useful biomarker for fewer relapses and longer survival in patients in the early stage of disease. The inverse correlation between Nf-kB and clusterin expression confirm the previously reported role of clusterin as potent down regulator of Nf-kB.

2013 - Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax. [Articolo su rivista]
Casali, C.; Stefani, Alessandro; Ligabue, Guido; P., Natali; B., Aramini; Torricelli, Pietro; Morandi, Uliano
abstract

Background: The prevention of recurrence after a first episode of primary spontaneous pneumothorax (PSP) remains a debated issue. The likelihood of recurrence based on the presence of blebs and bullae detected on high-resolution computed tomography (HRCT) imaging is controversial. Methods: We evaluated patients conservatively treated for PSP who underwent chest HRCT scan in a single-institution retrospective longitudinal study. Absolute risk values and positive and negative predictive values of recurrence based on HRCT findings were the primary end points. Results: We analyzed 176 patients. Ipsilateral and contralateral recurrence developed in 44.8% and 12% of patients, respectively. The risk of recurrence was significantly related to the presence of blebs or bullae, or both, at HRCT. The risk of ipsilateral recurrence for patients with or without blebs and bullae was 68.1% and 6,1%, respectively (positive predictive value, 68.1%; negative predictive value, 93,9%). The risk of contralateral pneumothorax for patients with or without blebs and bullae was 19% and 0%, respectively (positive predictive value, 19%; negative predictive value, 100%). The risk of ipsilateral recurrence was directly related to the dystrophic severity score: recurrence risk increased by up to 75% in patients with bilateral multiple lesions. Multivariate analysis showed that a positive HRCT was significantly related to ipsilateral recurrence. Conclusions: The presence of blebs and bullae at HRCT after a first episode of PSP is significantly related to the development of an ipsilateral recurrence or a contralateral episode of pneumothorax. Further studies are needed to validate the dystrophic severity score in the selection of patients for early surgical referral. © 2013 The Society of Thoracic Surgeons.

2013 - STRATOS system for the repair of pectus excavatum [Articolo su rivista]
Stefani, Alessandro; J., Nesci; Morandi, Uliano
abstract

Open techniques represent a valid repair option for severe asymmetric pectus excavatum in adults. The use of metal supports is recommended to reduce the risk of recurrence. A wide variety of metal supports have been proposed, with pre-, trans- or retrosternal fixation. A novel open technique using titanium bars fixed to the ribs with clips has been recently introduced (STRATOS™ system) for chest wall reconstruction, rib fracture fixation and chest wall malformation repair. We employed this technique in two adult patients with severe asymmetric pectus excavatum: after sternal mobilization, one bar is passed below the body of the sternum and secured with clips bilaterally to two ribs. In the first case, the results remained excellent 5 years after surgery. In the second case, the initial results were satisfying but the bar ruptured after 30 months: removal of the bars and clips was performed and a subsequent recurrence of the deformity occurred. The experiences reported in literature are still too limited to draw firm conclusions about the use of the STRATOS™ system in pectus excavatum repair, but it seems that the use of two bars may reduce the risk of rupture. At present, we are the only ones who reported long-term results.

2013 - Una metodica standardizzata di biopsia polmonare per la diagnosi di polmonite interstiziale idiopatica. [Abstract in Atti di Convegno]
Aramini, B; Stefani, A; Nesci, J; Morandi, U.
abstract

Una metodica standardizzata di biopsia polmonare per la diagnosi di polmonite interstiziale idiopatica.

2013 - Una metodica standardizzata di biopsia polmonare (SLB) per la diagnosi di polmonite interstiziale idiopatica. [Abstract in Atti di Convegno]
Aramini, B.; Stefani, Alessandro; Nesci, J.; Pedrazzi, M.; Morandi, Uliano
abstract

Gli Autori descrivono una tecnica standardizzata, rapida, semplice ed efficace per eseguire la biopsia polmonare chirurgica in videotoracoscopia nei pazienti affetti da polmonite interstiziale idiopatica.

2012 - Malattie respiratorie ostruttive. Bronchiectasie [Capitolo/Saggio]
Beghe', Bianca; A., Boner; C., Braggion; F., Luppi; Morandi, Uliano
abstract

Non disponibile

2012 - Resezione atipica versus lobectomia nel trattamento chirurgico del NSCLC T1AN0. [Abstract in Atti di Convegno]
Stefani, Alessandro; Nesci, J; Casali, C; Morandi, Uliano
abstract

nd

2012 - Thoracoscopic pleural abrasion [Capitolo/Saggio]
Morandi, Uliano; Stefani, Alessandro; Casali, C.
abstract

Pleural abrasion represents a surgical technique to achieve pleural symphysis in order to prevent recurrence in spontaneous pneumothorax. It can be performed either by thoracotomy or VATS. Pleural abrasion is obtained by scrubbing the parietal pleura until a uniform aspect of bloody pleura is achieved. Various tools can be used for this purpose, such as meshes, gauzes, sponges, the electro-surgical tip cleaner or pleural abraders especially fit for VATS. The recurrence rate of pneumothorax after pleural abrasion vary from 0% to 10%, according the type of surgical approach, with thoracotomy having the lowest rate of recurrences but the drawbacks of a more invasive approach. Considering the balance between effectiveness and risks, pleural abrasion performed by VATS is considered today as the procedure of choice for the treatment of spontaneous pneumothorax.

2012 - Wedge resection versus lobectomy for T1aN0 non-small-cell lung cancer. [Articolo su rivista]
Stefani, Alessandro; Casali, C; Nesci, J; Morandi, Uliano
abstract

ABSTRACT Objective Advances in imaging techniques and screening protocols can detect more small lung cancers. Controversy exists regarding surgical management of these small tumors. Methods. Records and long-term outcome of all patients with T1N0 (≤ 2cm) non-small cell lung cancer undergoing wedge resection with curative intent from 1996 through 2010 were retrospectively reviewed. Those patients were compared with a group of patients treated with lobectomy during the same period and for a disease at the same stage. Sublobar resections were performed in compromised patients in all cases. Results. The study included 206 patients: 82 received wedge resection, 124 lobectomy. Morbidity and mortality were similar between the two groups. Locoregional recurrence rate was significantly higher for wedge resection compared with lobectomy (22% versus 8% respectively), cancer-specific survival and disease-free survival were significantly poorer for wedge resection with respect to lobectomy: 5-year survival of 74% versus 85% respectively, 5-year disease-free survival of 62% versus 77%. The type of operation resulted as an independent prognostic factor of cancer-specific survival. Conclusions. We found poorer outcome for wedge resection compared to lobectomy. We believe that caution should be used when suggesting the use of wedge resection as intentional limited resection for patients with small non-small cell lung cancer who may otherwise tolerate lobectomy. Two randomized trials comparing limited resection and lobectomy are ongoing in Japan and in United States: they will better clarify the role of limited resection, especially segmentectomy, in the treatment of T1aN0 tumors. Wedge resection may remain a valid option for compromised patients.

2011 - Enriched sera protein profiling for detection of non-small cell lung cancer biomarkers. [Articolo su rivista]
Monari, Emanuela; Casali, Christian; Cuoghi, Aurora; Nesci, Jessica; Bellei, Elisa; Bergamini, Stefania; Fantoni, Luca Isaia; Natali, Pamela; Morandi, Uliano; Tomasi, Aldo
abstract

BackgroundNon Small Cell Lung Cancer (NSCLC) is the major cause of cancer related-death. Many patients receive diagnosis at advanced stage leading to a poor prognosis. At present, no satisfactory screening tests are available in clinical practice and the discovery and validation of new biomarkers is mandatory. Surface Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-ToF-MS) is a recent high-throughput technique used to detect new tumour markers. In this study we performed SELDI-ToF-MS analysis on serum samples treated with the ProteoMinerTM kit, a combinatorial library of hexapeptide ligands coupled to beads, to reduce the wide dynamic range of protein concentration in the sample. Serum from 44 NSCLC patients and 19 healthy controls were analyzed with IMAC30-Cu and H50 ProteinChip Arrays.ResultsComparing SELDI-ToF-MS protein profiles of NSCLC patients and healthy controls, 28 protein peaks were found significantly different (p<0.05), and were used as predictors to build decision classification trees. This statistical analysis selected 10 protein peaks in the low-mass range (2-24 kDa) and 6 in the high-mass range (40-80 kDa). The classification models for the low-mass range had a sensitivity and specificity of 70.45% (31/44) and 68.42% (13/19) for IMAC30-Cu, and 72.73% (32/44) and 73.68% (14/19) for H50 ProteinChip Arrays.ConclusionsThese preliminary results suggest that SELDI-ToF-MS protein profiling of serum samples pretreated with ProteoMinerTM can improve the discovery of protein peaks differentially expressed from NSCLC patients and healthy subjects, useful to build classification algorithms with high sensitivity and specificity. However, identification of the significantly different protein peaks needs further study in order to provide a better understanding of the biological nature of these potential biomarkers and their role in the underlying disease process.

2011 - N1 non-small-cell lung cancer. A 20-year surgical experience. [Articolo su rivista]
C., Casali; Stefani, Alessandro; Morandi, Uliano
abstract

N1 non-small-cell lung cancer has heterogeneous prognosis in relation to node descriptors. There is no agreement on the ideal type of resection. A new classification of N1 descriptors was proposed in the 7(th) edition of the TNM staging system. A retrospective study was conducted on 384 patients with T1-T3N1 non-small-cell lung cancer who underwent complete pulmonary resection. The prognostic role of N1 descriptors according to the current and new staging systems and type of resection was investigated. The 5-year survival rate was 46\%. Involvement of hilar node stations, multiple stations, and multiple nodes were poor prognostic factors (5-year survival, 33\%, 21\%, and 30\%, respectively), as well as involvement of the hilar zone and multiple zones (5-year survival, 27\% and 23\%, respectively). Pneumonectomy showed significantly better survival rates compared to lobectomy or bilobectomy (5-year survival, 60\% vs. 29\%). Multivariate analysis showed that the number of N1 zones and type of resection were independent prognostic factors. Patients with hilar nodal, multiple-level, or multiple-zone involvement had poor prognosis. Standard lobectomy remains the procedure of choice, but in cases of fixed nodes in the hilar zone, sleeve resection or even pneumonectomy should be considered.

2010 - A single institution-based retrospective study of surgically treated bronchioloalveolar adenocarcinoma of the lung: clinicopathologic analysis, molecular features, and possible pitfalls in routine practice. [Articolo su rivista]
C., Casali; G., Rossi; A., Marchioni; G., Sartori; F., Maselli; L., Longo; E., Tallarico; Morandi, Uliano
abstract

Prognostic evaluation of bronchioloalveolar carcinoma (BAC) from a homogenous population of Caucasian patients.Retrospective analysis of resected BAC reclassified according to the 2004 World Health Organization classification of lung tumors. Analyzed variables are clinicoradiologic presentation, histologic subtypes, stage, epidermal growth factor receptor (EGFR) and HER2/neu immunohistochemical expression, EGFR exons 18, 19, and 21 mutations, K-RAS exon 2 mutation. Univariate and multivariate analyses of survival were performed.Of 40 patients analyzed, EGFR and HER2/neu expression were detected in 72\% and 20\%, respectively. HER2/neu expression significantly characterized mucinous BAC (46\% versus 7\%; p = 0.014). EGFR mutations were identified in 17\% (30\% in nonmucinous BAC and none in mucinous BAC; p = 0.083). K-RAS mutations were found in 42.5\% (92\% in mucinous BAC versus 18\% in other types; p 0.0001). Early stages (IA+IB) nonmucinous BAC had excellent prognosis: 5 years overall survival of 91\% (100\% for stage IA). Sixty six percent (4 of 6) of patients with multifocal disease died (two mucinous BAC and one nonmucinous BAC with recurrent disease). Seventy one percent (5 of 7) of patients with pneumonic-like tumor (all mucinous BAC) died of recurrent/progressive disease. Stage (p = 0.004) and histologic classifications (p = 0.035) resulted as independent prognostic factors at multivariate analysis.Early stage nonmucinous BAC has excellent prognosis, whereas mucinous BAC presents a poor prognosis. Locally advanced nonmucinous BAC has a poor prognosis: the diagnosis of nonmucinous BAC in large tumors should be interpreted with caution given the possible presence of invasive areas in incompletely sampled tumor. Coexpression of EGFR and HER2/neu in mucinous BAC could be considered for future trials on target therapies even in Caucasian population.

2010 - Adipose-derived mesenchymal stem cells as stable source of tumor necrosis factor-related apoptosis-inducing ligand delivery for cancer therapy [Articolo su rivista]
Grisendi, Giulia; Bussolari, Rita; Cafarelli, Luigi; Petak, I.; Rasini, Valeria; Veronesi, Elena; DE SANTIS, Giorgio; Spano, Maria Carlotta; Tagliazzucchi, M.; Barti Juhasz, H.; Scarabelli, Laura; Bambi, F.; Frassoldati, A.; Rossi, G.; Casali, Christian; Morandi, Uliano; Horwitz, E. M.; Paolucci, Paolo; Conte, P.; Dominici, Massimo
abstract

Adipose-derived mesenchymal stromal/stem cells (AD-MSC) may offer efficient tools for cell-based gene therapy approaches. In this study, we evaluated whether AD-MSC could deliver proapoptotic molecules for cancer treatment. Human AD-MSCs were isolated and transduced with a retroviral vector encoding full-length human tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), a proapoptotic ligand that induces apoptosis in a variety of human cancers but not normal tissues. Although several studies have documented the antitumor activity of recombinant human TRAIL, its use in vivo is limited by a short half-life in plasma due to a rapid clearance by the kidney. We found that these limitations can be overcome using stably transduced AD-MSC, which could serve as a constant source of TRAIL production. AD-MSC armed with TRAIL targeted a variety of tumor cell lines in vitro, including human cervical carcinoma, pancreatic cancer, colon cancer, and, in combination with bortezomib, TRAIL-resistant breast cancer cells. Killing activity was associated with activation of caspase-8 as expected. When injected i.v. or s.c. into mice, AD-MSC armed with TRAIL localized into tumors and mediated apoptosis without significant apparent toxicities to normal tissues. Collectively, our results provide preclinical support for a model of TRAIL-based cancer therapy relying on the use of adipose-derived mesenchymal progenitors as cellular vectors.

2010 - Analysis of prognostic factors in surgically resected N1 non small cell lung cancer [Abstract in Rivista]
Di Prima, E; Iacuzio, L; Casali, C; Stefani, Alessandro; Morandi, Uliano
abstract

nd

2010 - Crystal-storing histiocytosis presenting with pleural disease. [Articolo su rivista]
G., Rossi; Morandi, Uliano; N., Nannini; G., Fontana; M., Pifferi; C., Casali
abstract

Non disponibile

2010 - IL TRATTAMENTO CHIRURGICO DEL PETTO ESCAVATO E CARENATO [Relazione in Atti di Convegno]
Morandi, Uliano; Casali, C.
abstract

Non disponibile

2010 - The variation of prognostic significance of Maximum Standardized Uptake Value of [18F]-fluoro-2-deoxy-glucose positron emission tomography in different histological subtypes and pathological stages of surgically resected Non-Small Cell Lung Carcinoma. [Articolo su rivista]
C., Casali; M., Cucca; G., Rossi; F., Barbieri; L., Iacuzio; B., Bagni; Morandi, Uliano
abstract

Even if the prognostic role of SUVmax of 18-FDG-PET has been largely investigated, many issues regarding its relationship with pathologic staging and histological subtypes still remain controversial. This retrospective study investigated the prognostic significance of SUVmax in 119 completely resected, pathologically proven NSCLC. The SUVmax values resulted significantly related to histological subtypes (p<0.001), histological grading (p<0.001), and pathologic stage (p<0.001). The optimal cut-off value of SUVmax to predict prognosis in the whole series was 6.7 (p=0.029). 2-Year disease-specific survival (DSS) was 91\% for SUVmax < or =6.7 and 55\% for SUVmax >6.7 (p<0.001). SUVmax still remain a significant predictor of survival in Stage IB (2-year DSS of 100\% for SUVmax < or =6.7; 51\% for SUVmax >6.7, p=0.016). The optimal cut-off values of SUVmax to predict prognosis were 5 for adenocarcinoma (p=0.027) and 10.7 for other non-adenocarcinoma NSCLC subtypes (p=0.010). These histologic-specific cut-offs resulted significantly related to survival when stratified for stage: 2-year DSS for Stage IB adenocarcinoma were 100\% for SUV< or =5 and 40\% for SUVmax >5 (p=0.051); 2-year DSS for Stage IB non-adenocarcinoma were 83\% for SUVmax < or =10.7 and 26\% for SUVmax >10.7 (p=0.018). Adenocarcinomas showed significantly lower survival results respect to other NSCLC for intermediate SUVmax level (range 5.5-11.3) (p=0.021). High SUVmax resulted an independent negative prognostic factor at multivariate analysis (HR of 15.7, 95\% CI of 2.50-98.44, p=0.003). In conclusion, SUVmax represents a significant prognostic factor in surgically resected NSCLC but a great variability between different histological subtypes, even when adjusted for stage, is present and could be considered when planning future trials on prognostic role of FDG uptake.

2009 - Long-term functional results after surgical treatment of parapneumonic thoracic empyema. [Articolo su rivista]
C., Casali; E. S., Storelli; E. D., Prima; Morandi, Uliano
abstract

Retrospective evaluation of long-term functional results of surgical treatment of chronic pleural empyema. Two different surgical procedures (debridement vs. decortication) and approaches (VATS vs. thoracotomy) were analyzed. Three end-points were considered: short-term surgical results, short- and long-term radiological results, clinico-functional long-term results. Fifty-one debridement (52\% VATS, 48\% thoracotomy) and 68 decortication were performed. Postoperative mortality and morbidity were 1.5\% and 24\%, respectively. Older age (>70 years old) had worse postoperative morbidity (P=0.048). Video-assisted thoracic surgery (VATS) debridement had lower postoperative hospital stay (P=0.006) and shorter duration of chest drainage (P=0.006). The infectious process was resolved in all patients. All patients presented a postoperative radiological improvement, 63 patients (60\%) with a complete pulmonary re-expansion. Sixty patients (58\%) referred a complete respiratory recovery. VATS debridement had a greater improvement in subjective dyspnea degree (P=0.041). The long-term spirometric evaluation was normal in 58 patients (56\%). Age >70 years old resulted the only variable associated to poor long-term results (FEV(1)\% < 60\% and/or MRC grade > or = 2) at multivariate analysis. Surgical treatment of pleural empyema achieves excellent long-term respiratory outcomes. VATS is associated to less postoperative mortality and shorter postoperative hospital stay. In elderly patients, postoperative morbidity could be higher and long-term functional improvement less warranted.

2008 - Conventional techniques: Transthoracic approach [Capitolo/Saggio]
Morandi, U.; Casali, C.
abstract

Thymomas are the most frequent neoplasms of the anterior mediastinal compartment, accounting for approximately 20% of all mediastinal tumors in adults. They are, however, a rare neoplasm, with an incidence of approximately 0.15 cases in 100,000 habitants per year in the USA [1]. Thymomas are neoplasms of epithelial origin which, despite being considered tumors with an often indolent growth pattern, have a well-documented capability to invade adjacent structures and develop metastases in the pleura as well as, though more rarely, distant metastases. Although several histological classifications have been proposed over the last few years, today there is a wide consensus on the use of the classification proposed by the World Health Organization (WHO) in 1999, as reviewed and confirmed in 2003, which breaks down thymic neoplasms into 6 groups based on the presence of cellular atypias and based on the relationship between epithelial and lymphatic cells (Table 16.1) [2]. By now, a unanimous consensus has been reached on the staging system proposed by Masaoka in 1981 and reviewed in 1994 (Table 16.2) [3], which classifies neoplasms based on the presence or absence of a macroscopic or microscopic invasion of the capsule, of adjacent structures, and the presence of metastases. © 2008 Springer Milan.

2008 - Thymus gland pathology: Clinical, diagnostic, and therapeutic features [Monografia/Trattato scientifico]
Lavini, C; Moran, Ca; Morandi, Uliano; Schoenhuber, R.
abstract

Non disponibile

2007 - La chirurgia toracica a Modena. 30 anni di esperienze vissute e di risultati conseguiti [Articolo su rivista]
Morandi, U; Fontana, G; Lavini, C; Ruggiero, Ciro; Stefani, A; Casali, C; Natali, P; Brandi, L; Chiapponi, A; Lodi, R.
abstract

L'articolo riporta i risultati conseguiti in 30 anni di attività della clinica di chirurgia toracica di modena

2007 - Le metastasi polmonari: diagnosi e terapia [Monografia/Trattato scientifico]
Morandi, Uliano; Stefani, Alessandro
abstract

Non disponibile

2007 - Management of spontaneous pneumothorax: nationwide fact-finding survey among Italian thoracic surgery units [Articolo su rivista]
Ragusa, M; Martelli, M; Breda, C; Carbognani, P; Cardillo, G; Griffo, S; Lucchi, M; Monaco, G; Morandi, Uliano; Pecoriello, R; Puma, F; Sensi, B; Daddi, G.
abstract

non disponibile

2007 - Paraffinoma and carcinoid tumorlet: A hitherto unreported association mimicking lung cancer [Articolo su rivista]
Casali, C; Rossi, G; Siopis, E; Fontana, G; Morandi, Uliano
abstract

non disponibile

2007 - Reply to Margaritora et al [Articolo su rivista]
Stefani, Alessandro; Natali, P; Casali, C; Morandi, Uliano
abstract

nd

2007 - Reply to molnar and rami-porta [Articolo su rivista]
Stefani, Alessandro; P., Natali; C., Casali; Morandi, Uliano
abstract

nd

2007 - Toracotomia: quando e perché. [Capitolo/Saggio]
Stefani, Alessandro; Morandi, Uliano
abstract

nd

2007 - Unusual pathogenesis of spontaneous pneumothorax secondary to Wegener's granulomatosis. [Articolo su rivista]
E., Storelli; C., Casali; P., Natali; G., Rossi; Morandi, Uliano
abstract

Spontaneous pneumothorax represents a rare and potentially severe complication of Wegener's granulomatosis. A 31-year-old man with Wegener's granulomatosis on immunosuppressive therapy was admitted for a right massive spontaneous pneumothorax. After chest drainage he presented with a prolonged air leak that required a surgical treatment. Histologic findings did not reveal any necrotizing granulomatous vasculitis, but only subpleural fibrous tissue. We hypothesize that pneumothorax could be related to the subpleural fibrous retraction induced by immunosuppressive therapy.

2006 - A therapeutical protocol for postoperative pain relief in thoracic surgery. [Abstract in Rivista]
Stefani, Alessandro; Casali, C; Morandi, Uliano
abstract

nd

2006 - Attivazione di un percorso diagnostico-stadiativo accelerato per neoplasia polmonare al Policlinico di Modena. [Articolo su rivista]
Callegaro, A; Campagna, A; Pieroni, G; Morandi, Uliano; Casali, C; Stefani, Alessandro; Bortolotti, M.
abstract

Dal Novembre 2001 la DS dell'AO Policlinico di Modena, in collaborazione con la struttura complessa di Chirurgia Toracica e il DH della SC di Malattie dell'apparato Respiratorio, ha iniziato la sperimentazione di un percorso diagnostico finalizzato a accelerare i tempi di stadiazione delle neoplasie polmonari, al fine di trattare chirurgicamente i pazienti operabili entro 30 giorni dalla diagnosi, riducendo il periodo di degenza pre-operatoria. L'attivazione di tale percorso parte dal presupposto che un adeguato studio diagnostico-stadiativo della neoplasia e una scrupolosa valutazione funzionale del paziente sono le condizioni indispensabili per una corretta indicazione chirurgica e per una buona riuscita dell'intervento chirurgico, sia in termini di risultati a breve che a lungo termine. Il paziente che giungeva all'attenzione degli specialisti del Policlinico inviato dai medici del territorio in modo differenziato e con una certa disomogeneità anche nell'invio da parte dei medici interni, ora viene preso in carico dalla SC di Pneumologia mediante un percorso diagnostico pre-operatorio per neoplasia polmonare. L'introduzione del nuovo percorso diagnostico preoperatorio per pazienti candidabili ad exeresi chirurgica per cancro polmonare , anche attraverso l'importante contributo fornito dall'approccio multidisciplinare, ha portato ad un miglioramento sia in termini gestionali (degenze medie e tempi di attesa) che qulitativi dell'attività chirurgica (diminuzione toracotomie esplorative). Attraverso tale iter al paziente viene garantito un trattamento chirurgico in linea con gli standard internazionali nel quadro di un'ottimizzazione della gestione aziendale.

2006 - Bronchial typical carcinoid tumors. [Articolo su rivista]
Morandi, Uliano; C., Casali; G., Rossi
abstract

The current WHO classification of lung tumors recognizes bronchial typical carcinoid as low-grade neuroendocrine tumors. These tumors grow slowly but can metastasize to regional nodes (4 to 20\%) and more rarely to extrathoracic sites. Symptoms are usually related to local compression and obstruction of the bronchial tree. Paraneoplastic syndrome can be present (carcinoid syndrome, Cushing's syndrome, acromegaly). Preoperative diagnosis is usually obtained with bronchoscopic biopsy. Computed tomography and somatostatin receptor scintigraphy are useful in the preoperative staging. Only selected cases can be treated endoscopically with laser resection. The complete surgical resection remains the only therapy with curative intent in the majority of patients. Parenchyma-sparing resections are indicated whenever possible. Overall survival after surgery is excellent (5-year rate, 87 to 100\%) with low recurrence rate (2 to 11\%). N-status and type of resection seem not to affect prognosis. Local relapse can be treated successfully with surgery, whereas distant metastases have a poor prognosis even after chemotherapy.

2006 - Chirurgia Toracica Videoassistita [Monografia/Trattato scientifico]
Lavini, C; Ruggiero, C; Morandi, Uliano
abstract

Non disponibile

2006 - Exclusive intrapulmonary lepidic growth of a malignant pleural mesothelioma presenting with pneumothorax and involving the peritoneum. [Articolo su rivista]
G., Rossi; A., Cavazza; E., Turrini; M., Costantini; C., Casali; Morandi, Uliano; R., Dallari
abstract

We report a rare case of malignant pleural mesothelioma presenting clinically with pneumothorax and histologically with an exclusive intrapulmonary lepidic growth. Neither intrathoracic nodules nor pleural thickening were found. The patient subsequently experienced acute abdominal pain with peritonitis and intestinal occlusion by peritoneal mesothelioma. The morphologic clues leading to the correct diagnosis of mesothelioma with prominent intrapulmonary growth are briefly discussed.

2006 - Invited commentary. [Articolo su rivista]
Morandi, Uliano; C., Casali
abstract

Non disponibile

2006 - Large cell neuroendocrine carcinoma of the lung: A retrospective analysis of 144 surgical cases [Articolo su rivista]
Veronesi, G; Morandi, Uliano; Alloisio, M; Terzi, A; Cardillo, G; Filosso, P; Rea, F; Facciolo, F; Pelosi, G; Gandini, S; Calabro, F; Casali, C; Marulli, G; Spaggiari, L.
abstract

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

2006 - Prognostic factors and survival after resection of lung metastases from epithelial tumours. [Articolo su rivista]
C., Casali; Stefani, Alessandro; E., Storelli; Morandi, Uliano
abstract

Lung metastasectomy is an accepted treatment for selected patients with pulmonary metastases. Resectability, disease-free interval and number of metastases are well characterised prognostic indicators after lung metastasectomy. Patients treated with lung metastasectomy for epithelial tumours were retrospectively reviewed. One hundred and forty-two patients were reviewed. The rate of mediastinal node metastases was 12\%. Overall 5-year survival rate was 36\% with a median survival time of 47 months. Recurrence rate after lung metastasectomy was 50\%. Five-year disease-free survival was 26\% with a median of 29 months. Mediastinal nodal status negatively affected survival at univariate analysis (5-years 32\% for N+ and 40\% for N-, P=0.013). Disease-free survival was significantly different according to nodal status: 5-year disease-free survival 17 and 28\% for N+ and N-, respectively (P=0.053). Systemic recurrences were more frequent in patients with nodal involvement (P=0.058). Mediastinal nodal involvement resulted in a significant prognostic factor at multivariate analysis (N+: RRD=3.0; 95\% CI 1.3-6.7). Patients with pulmonary metastases and nodal involvement had a poor prognosis and relapsed early after pulmonary metastasectomy. Nodal status should be considered in the selection of patients for lung metastasectomy.

2006 - Résultats du talcage pleural au cours des pleurésies néoplasiques. [Poster]
Stefani, Alessandro; Natali, P; Casali, C; Morandi, Uliano
abstract

nd

2006 - Simpaticectomia toracoscopica [Capitolo/Saggio]
Stefani, Alessandro; Morandi, Uliano
abstract

nd

2006 - Talc poudrage versus talc slurry in the treatment of malignant pleural effusion. A prospective comparative study [Articolo su rivista]
Stefani, Alessandro; Natali, P; Casali, C; Morandi, Uliano
abstract

Objective: The aim of this study was to investigate the effectiveness, safety and appropriate mode of administration of intrapleural talc for pleurodesis, in the treatment of malignant pleural. effusion (MPE). Methods: Prospective not randomized trial was conducted to compare thoracoscopic talc poudrage (TP) with tube thoracostomy and talc slurry (TS) for the local control of malignant pleural. effusion. Both procedures were previously standardized; 6 g of talc was administered for each procedure. Only the patients with lung re-expansion after drainage entered the study. Patients at high risk for general anaesthesia, poor general conditions and short life-expectancy received talc slurry through a chest tube, at the bedside. All. the other patients underwent videothoracoscopic talc poudrage, with a pneumatic atomizer, under general anaesthesia. Morbidity, 30-day freedom from recurrence and long-term results were assessed and the two groups were compared. Results: One hundred and nine patients entered the study (72 TP, 37 TS). Sixty-three patients in the TP group (87.5%) and 27 in the TS group (73%) had an immediate successful pleurodesis (p = 0.049); 53 patients (88.3%) and 16 patients (69.6%) had a successful pleurodesis 90 days after the procedure; 59 patients (81.9%) and 23 patients (62.2%), respectively, had a life-long pleural symphysis (p = 0.023). Adverse effects were generally mild: chest pain (36.1% in TP patients, 48.6% in TS patients) and fever (38.8% and 35.1%, respectively) were the more common but the difference was not significant between the two groups. We observed neither acute respiratory failure nor mortality due to the procedure. Conclusions: Our study confirms that intrapleural talc carries good results in the treatment of malignant pleural effusion. TP was significantly more effective than TS; both methods were safe but TS had a higher incidence of thoracic pain during the procedure. Talc pleurodesis should be offered to every patient with MPE, apart from terminally ill. ones, provided that a satisfying lung re-expansion has been achieved. TP should be performed whenever possible; otherwise, a slurry bedside procedure will be worthwhile, even in patients with low performance status (PS), though poorer results have to be expected. A careful selection is essential to define the proper technique. (c) 2006 Elsevier B.V. All. rights reserved.

2006 - Talc poudrage versus talc slurry in the treatment of malignant pleural effusion: a prospective trial [Abstract in Rivista]
Natali, P; Stefani, Alessandro; Casali, C; Morandi, Uliano
abstract

nd

2006 - The prognostic impact of tumor size in resected stage I non-small cell lung cancer: evidence for a two thresholds tumor diameters classification. [Articolo su rivista]
C., Casali; E., Storelli; Morandi, Uliano
abstract

The current TNM staging system for non-small cell lung cancer subdivides stage IA and IB according to a tumor size threshold of 3 cm. Some authors have suggested that tumor size behaves as a continuous, but the optimal diameter thresholds to be adopted remain debated.We conducted a retrospective study on 548 patients who underwent a complete surgical resection at our institute for stage IA and IB non-small cell lung cancer according to the current TNM staging system. Univariate and multiaviate analysis of overall and disease-specific survival were performed.Stage IA had an overall 5 years survival of 67\% and a 5 years disease-specific survival of 85\%. Stage IB had an overall 5 years of 49\% and 5 years disease-specific survival of 53\%. Tumors <2 cm had a significantly better survival than tumors > or =2 cm (overall survival: p=0.007; disease-specific survival: p=0.026), as well as tumors ranging from 2 to 5 cm in comparison with larger ones (overall survival: p=0.031; disease-specific survival: p=0.013). No significant difference was found between groups ranging from 2 to 5 cm. Tumors of 2-5 cm had 57\% higher probability of death in comparison with tumors <2 cm and tumors >5 cm had a probability of death 60\% higher than tumor of 2-5 cm. Age and tumor size (two thresholds diameter classification) resulted independent variables at multivariate analysis.the definition of T factor in the staging system of non-small cell lung cancer should consider two cutoffs according to tumor size. Two and 5 cm represent appropriate thresholds diameters that define subgroups with significant different prognosis.

2006 - Tuberous sclerosis complex presenting as a pulmonary solitary nodule. [Articolo su rivista]
G., Rossi; A., Cavazza; C., Casali; A. M., Cesinaro; F., Cinquantini; Morandi, Uliano
abstract

Non disponibile

2005 - Descending necrotizing mediastinitis following lingual tonsillectomy and elective tracheotomy. [Articolo su rivista]
S., Dallari; Morandi, Uliano; G., Bergamini; C., Lavini; G., Fontana
abstract

Non disponibile

2005 - Il pneumotorace spontaneo dalla genetica al trattamento chirurgico [Monografia/Trattato scientifico]
Morandi, Uliano; Stefani, Alessandro
abstract

Non disponibile

2005 - Il trattamento chirurgico del cancro del polmone non a piccole cellule infiltrante la parete toracica [Abstract in Atti di Convegno]
Stefani, Alessandro; Casali, C; Morandi, Uliano
abstract

nd

2005 - Il trattamento dell'empiema pleurico metapneumonico in videotoracoscopia [Abstract in Rivista]
Stefani, Alessandro; Casali, C; Natali, P; Ruggiero, C; Lavini, C; Morandi, Uliano
abstract

nd

2005 - Le indicazioni al trattamento chirurgico del pneumotorace spontaneo. [Capitolo/Saggio]
Stefani, Alessandro; Morandi, Uliano
abstract

nd

2005 - L'importanza della diagnosi precoce nel trattamento chirurgico delle neoplasie polmonari primitive metacrone [Abstract in Rivista]
Pirondini, E; Casali, C; Stefani, Alessandro; Morandi, Uliano
abstract

nd

2005 - Prognostic factors in surgically resected N2 non-small cell lung cancer: the importance of patterns of mediastinal lymph nodes metastases. [Articolo su rivista]
C., Casali; Stefani, Alessandro; P., Natali; G., Rossi; Morandi, Uliano
abstract

Patients with non-small cell lung cancer (NSCLC) with metastases to ipsilateral mediastinal lymph nodes (N2) are an heterogeneous group of patients as regard to prognosis and treatment. Indication and timing of surgery remain controversial. The present study investigates the prognostic factors, in order to identify homogenous subgroups of patients.Histologically proven N2-NSCLC patients, who underwent a complete surgical resection were retrospectively reviewed. Clinical and pathological features were reported and analyzed, and survival study was performed.One hundred eighty-three patients were analyzed. Overall 1.3 and 5 years survival rates were, respectively, 70, 35 and 20\%, with a median survival time of 24 months. Univariate analysis showed a significant better prognosis for: incidental N2 respect to clinical N2 (5-years 35.4 vs 17.4\%); single level lymph node involvement respect to multiple levels (5-years 23.8 vs 14.7\%); metastases to superior mediastinal or aortic nodes respect to lower mediastinal nodes (5-years 32 and 24.3 vs 16.3\%); right upper lobe tumors with superior mediastinal nodes and left upper lobe tumors with aortic nodes respect to lower lobes tumors with lower mediastinal nodes (5-years 31.8 and 26.9 vs 15.7\%). Skip metastases had not a significant survival advantage respect to continuous lymphatic spread. N2 clinical status, the number of levels involved and the two specific patterns of lymphatic spread resulted significant prognostic factors at multivariate analysis.Clinical N2 status, number of lymph nodes levels involved and specific patterns of lymphatic spread identify homogenous subgroups of patients that can be proposed for different therapeutic strategies.

2005 - Role of chemotherapy and the receptor tyrosine kinases KIT, PDGFR alpha, PDGFR beta, and met in large-cell neuroendocrine carcinoma of the lung [Articolo su rivista]
Rossi, Giulio; A., Cavazza; A., Marchioni; L., Longo; Migaldi, Mario; G., Sartori; N., Bigiani; L., Schirosi; C., Casali; Morandi, Uliano; N., Facciolongo; Maiorana, Antonino; M., Bavieri; Fabbri, Leonardo; E., Brambilla
abstract

Purpose Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a relatively uncommon, high-grade neuroendocrine tumor sharing several features with small-cell lung carcinoma (SCLC) but currently considered as a variant of non-SCLC and accordingly treated with poor results. Little is known about the optimal therapy of LCNEC and the possible therapeutic molecular targets. Patients and Methods We reviewed 83 patients with pure pulmonary LCNEC. to investigate their clinicopathologic features, therapeutic strategy, and immunohistorchemical expression and the mutational status of the receptor tyrosine kinases (RTKs) KIT, PDGFR alpha, PDGFR beta, and Met. Results LCNEC histology predicted a dismal outcome (overall median survival, 17 months) even in stage I patients (5-year survival rate, 33%). LCNEC strongly expressed RTKs (KIT in 62.7% of patients, PDGFRa in 60.2%, PDGFR beta in 81.9%, and Met in 47%), but no mutations were detected in the exons encoding for the relevant juxtamembrane domains. Tumor stage and size (>= 3 cm) and Met expression were significantly correlated with survival. At univariate and multivariate analysis, SCLC-based chemotherapy (platinum-etoposide) was the most important variable correlating with survival, both in the adjuvant and metastatic settings (P < .0001). Conclusion Pulmonary LCNEC represents an aggressive tumor requiring multimodal treatment even for resectable stage I disease, and LCNEC seems to respond to adjuvant platinum-etoposide-based chemotherapy, Patients who received this therapy had the best survival rate. Despite our failure in finding mutational events in the tested RTKs, the strong expression of KIT, PDGFR alpha, PDGFR beta, and Met in tumor cells suggests an important role of these RTKs in LCNEC, and these RTKs seem to be attractive therapeutic targets.

2004 - Il ruolo prognostico dell'espressione recettoriale estrogenica nella metastasectomia polmonare da carcinoma mammario [Abstract in Rivista]
Casali, C; Stefani, Alessandro; Natali, P; Pirondini, E; Parise, A; Morandi, Uliano
abstract

nd

2004 - La simpaticectomia toracica in videotoracoscopia: una tecnica efficace e mini-invasiva per il trattamento dell'iperidrosi palmare [Abstract in Rivista]
Natali, P; Stefani, Alessandro; Casali, C; Parise, A; Pirondini, E; Morandi, Uliano
abstract

nd

2004 - Manuale di Chirurgia toracica [Monografia/Trattato scientifico]
Morandi, Uliano; Lavini, C.
abstract

Non disponibile

2004 - Mediastinoscopy: past, present and future [Relazione in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Casali, C.
abstract

nd

2004 - Metodiche mini-invasive nella stadiazione linfonodale del cancro del polmone. Il punto di vista del chirurgo [Capitolo/Saggio]
Morandi, Uliano; Stefani, Alessandro; Lavini, C; Casali, C.
abstract

nd

2004 - Risultati nel trattamento delle metastasi polmonari da neoplasia della mammella. [Capitolo/Saggio]
Stefani, Alessandro; Casali, C; Pirondini, E; Morandi, Uliano
abstract

nd

2004 - The prognostic role of c-kit protein expression in resected large cell neuroendocrine carcinoma of the lung. [Articolo su rivista]
C., Casali; Stefani, Alessandro; G., Rossi; Migaldi, Mario; S., Bettelli; A., Parise; Morandi, Uliano
abstract

Large cell neuroendocrine carcinoma (LCNEC) is a high-grade neuroendocrine tumor of the lung that shares some clinicopathologic and molecular features with small cell lung carcinoma (SCLC). Optimal treatment has not yet been standardized and significant prognostic factors are lacking. Because c-kit protein overexpression has been recently reported as a negative prognostic factor in SCLC we investigated its expression and prognostic value in a series of LCNEC.Resected LCNEC fulfilling the morphologic criteria of the 1999 World Health Organization classification of lung tumors and showing neuroendocrine differentiation by appropriate immunohistochemical markers were retrospectively reviewed. Immunostaining for c-kit protein expression was performed using the polyclonal antibody CD117. Clinical and pathologic characteristic were reported and analyzed and a survival study was performed.Thirty-three patients underwent radical resection. Thirty-one were male (94\%) and 32 were smokers (97\%). Ten (30.3\%), 11 (33.3\%), 5 (15.2\%), and 7 (21.2\%) were at stage IA, IB, IIB, and IIIA respectively. Overall 1-, 3-, and 5-year survival rates were respectively 79\%, 58\%, and 51\%. Survival analysis showed no differences for any of the clinicopathological features except for CD117 immunostaining: 1-year and 3-year survival rates were respectively 91\% and 82\% for CD117-negative LCNEC, and 72\% and 44\% for CD117-positive ones (p = 0.046). Positivity of CD117 was significantly related to recurrence rate: 60\% versus 23\% for CD117 positive and negative LCNEC respectively (p = 0.037).Radical resection of large cell neuroendocrine carcinoma achieves poor outcomes. The c-kit protein is frequently expressed in this neoplasia and its expression represents a negative prognostic factor. This immunohistochemical marker may represent the basic rationale to select LCNEC for novel targeted therapy.

2003 - Descending necrotizing mediastinitis - Diagnosis and surgical treatment [Articolo su rivista]
Lavini, C; Natali, P; Morandi, Uliano; Dallari, S; Bergamini, G.
abstract

Descending necrotizing mediastinitis (DNM) is an unusual and severe disease with a high mortality rate. Surgical management remains controversial. Our investigations reviews the most effective surgical treatment in the management of this rare pathology.Seven patients with DNM and treated over a 20-year period are reported. All patients were evaluated according to the classification suggested by Endo et al. of the degree of mediastinal diffusion, based on CT scan findings. Five patients underwent combined cervical drainage and thoracotomy, 2 patients were treated with cervical drainage alone.The outcome was favorable in 5 patients, 4 treated with a combined cervical and thoracic approach and 1 with a cervical approach alone. Two patients that underwent a combinated cervical and thoracic approach alone, died of septic shock. Overall mortality rate was 28.5\%.Early diagnosis and early, aggressive surgical treatment are required to improve the poor prognosis of DNM. Although a unique surgical management is still not completely accepted, we state, in agreement with other authors, a wide approach consisting of a cervical drainage and mediastinotomy in case of upper mediastinitis and a combined cervical and thoracic approach in case of lower mediastinitis. In the course of thoracotomy a wide excision of necrotic and particularly fat mediastinal tissue is needed, to avoid a recurrent infection. A continuous cervico-mediastinal irrigation system is suggested during the postoperative period.

2003 - Die prognostiche rolle der protein c-kit expression bei operierten grosszelligen neuroendokrin karzinomen [Relazione in Atti di Convegno]
Stefani, Alessandro; Casali, C; Parise, A; Lavini, C; Morandi, Uliano
abstract

nd

2003 - Il cancro del polmone con versamento pleurico consensuale. L’importanza della videotoracoscopia come indagine preliminare del tempo exeretico [Capitolo/Saggio]
Lavini, C; Ruggiero, C; Natali, P; Stefani, Alessandro; Morandi, Uliano
abstract

nd

2003 - Il nodulo polmonare solitario. Minitoracotomia o VATS? Contributo casistico. [Abstract in Atti di Convegno]
Lavini, C; Ruggiero, C; Stefani, Alessandro; Pirondini, E; Morandi, Uliano
abstract

nd

2003 - La biopsia polmonare in videotoracoscopia nelle polmoniti interstiziali idiopatiche: una tecnica semplice, sicura ed efficace [Abstract in Atti di Convegno]
Stefani, Alessandro; Fontana, G; Lavini, C; Ruggiero, C; Morandi, Uliano
abstract

nd

2003 - La biopsia polmonare in videotoracoscopia per "diffuse parenchimal lung disease": una tecnica standardizzata, semplice e sicura [Abstract in Rivista]
Stefani, Alessandro; Casali, C; Giovannetti, R; Natali, P; Parise, A; Morandi, Uliano
abstract

nd

2003 - Pectus carinatum [Capitolo/Saggio]
Lodi, R; Morandi, Uliano
abstract

Non disponibile

2003 - Thyroid abscess associated with a substernal goiter. Case report. [Articolo su rivista]
C., Lavini; P., Natali; G., Magni; R., Valli; Morandi, Uliano
abstract

An abscess associated with an intrathoracic goiter is an extremely rare condition. The authors report a case of a thyroid abscess complicated by acute dyspnea and asphyxia in a patient of geriatric age with a substernal goiter. Surgical therapy was necessary to obtain a correct diagnosis and an effective treatment.

2002 - Il pectus excavatum. Indicazioni chirurgiche e risultati. Analisi di una casistica. [Articolo su rivista]
C., Lavini; Stefani, Alessandro; C., Ruggiero; R., LODI R; Morandi, Uliano
abstract

Gli autori fanno il punto sullo stato dell'arte della chirurgia del pectus excavatum riportando la loro esperienza personale

2002 - Il trattamento chirurgico delle metastasi polmonari. Analisi di una casistica personale. [Abstract in Atti di Convegno]
Lavini, C.; Casali, C.; Natali, P.; Morandi, Uliano
abstract

Non disponibile

2002 - Risultati della chemioterapia neoadiuvante seguita da resezione chirurgica nel trattamento del NSCLC in stadio IIIA (N2). [Abstract in Atti di Convegno]
Stefani, Alessandro; Casali, C; Natali, P; Morandi, Uliano
abstract

nd

2002 - Risultati della chemioterapia neoadiuvante seguita da resezione chirurgica nel trattamento del NSCLC in stadio IIIA (N2) [Relazione in Atti di Convegno]
Stefani, Alessandro; Casali, C; Natali, P; Morandi, Uliano
abstract

nd

2002 - Significance of incidental N2 and other prognostic factors in N2 non small-cell lung cancer [Articolo su rivista]
Morandi, Uliano; Stefani, Alessandro; C., Casali; P., Natali; A., Parise
abstract

Background: patients with IIIA-N2 non-small cell lung cancer represent a large and heterogeneous group. Some N2-related factors affecting prognosis have been identified. The present study investigated the prognostic factors of a group of N2 patients and gave an overview of available literature on this issue, especially considering N clinical status. Methods: the study comprised 187 patients. All the patients had a postoperative histologic diagnosis of mediastinal lymph node involvement and underwent complete resection.The following N2-related factors were investigated: N clinical status, number of metastatic lymph node levels, topography of lymph node involvement. Results: univariate analysis showed a significantly better prognosis for incidental N2, single station involvement and right-sided metastatic nodes (5-year survival respectively 35.4%, 28.3% and 33.7%). Survival analysis for number of metastatic levels stratified for N clinical status demonstrated the best prognosis for the cN0-1/single level subgroup (5-ys 38%). In the multivariate analysis only N clinical status was found as significant prognostic factor. Conclusions: our study has confirmed the relevance of N clinical status as a prognostic factor. The overview of the literature has shown that number of metastatic levels and subcarinal involvement may also be relevant prognostic factors. For cN0-1 patients surgery is mandatory. For cN2 patients correlation with other variables should be considered: when good prognostic factors are associated, surgery may be indicated but in a mulimodality setting; when negative factors are associated, results of surgery are poor and exclusive administration of radiation therapy should be evaluated. The development of an optimal procedure for preoperative staging is needed, to better detect N2-related prognostic factors.

2001 - Il carcinoma bronchioloalveolare: caratteristiche cliniche e fattori di prognosi nella indicazione al trattamento chirurgico. [Abstract in Rivista]
Natali, P; Stefani, Alessandro; Morandi, Uliano
abstract

nd

2001 - Malattie della parete toracica [Capitolo/Saggio]
Ferrante, G; Morandi, Uliano; Griffo, S.
abstract

Non disponibile

2001 - Surgical management of solitary pulmonary nodules. An unexpected lucky case. [Articolo su rivista]
C., Casali; Stefani, Alessandro; M., Paci; Morandi, Uliano; R., Lodi
abstract

The case of a 63-year-old woman with a solitary pulmonary nodule (SPN) is reported. Surgical wedge resection revealed an hamartoma. Digital examination of the lung parenchyma showed an unexpected (not previously visualized by thoracic imaging) second nodule that intraoperative frozen examination revealed an adenocarcinoma. The operation was completed with a right upper lobectomy and complete lymphoadenectomy. The authors recommend an early open surgical procedure for any SPNs with risk factors for developing lung cancer.

2000 - Cardiac tamponade and pericardial window treatment. [Abstract in Rivista]
Ruggiero, C; Brandi, L; Urgese, Al; Paci, M; Casali, C; Stefani, Alessandro; Morandi, Uliano; Lodi, R.
abstract

nd

2000 - Plastica con infibulazione endomidollare secondo Lodi [Capitolo/Saggio]
Lodi, R; Morandi, Uliano
abstract

Non disponibile

2000 - Preoperative embolization in surgical treatment of mediastinal hemangiopericytoma [Abstract in Rivista]
Stefani, Alessandro; Morandi, Uliano; Desantis, M; Paci, M; Ruggiero, C; Urgese, Al; Casali, C; Lodi, R.
abstract

nd

2000 - Preoperative embolization in surgical treatment of mediastinal hemangiopericytoma. [Articolo su rivista]
Morandi, Uliano; Stefani, Alessandro; M., Desantis; M., Paci; R., Lodi
abstract

The case of a 47-year-old man with a tumor of the posterosuperior mediastinum is reported. Surgical biopsy sample revealed a hemangiopericytoma, but radical excision was impossible because of massive bleeding. Percutaneous embolization of mediastinal tumor was performed to reduce peroperative blood loss. It allowed uneventful complete removal of the lesion. We recommend preoperative embolization in cases of hypervascular mediastinal tumors.

2000 - Preoperative embolization in the treatment of mediastinal hemangiopericytoma. [Abstract in Atti di Convegno]
Stefani, Alessandro; Desantis, M; Morandi, Uliano
abstract

nd

2000 - Sindrome di Poland. Descrizione di un caso. [Articolo su rivista]
Ariosi, P; Torricelli, Pietro; Stefani, Alessandro; Morandi, Uliano
abstract

Gli Autori descrivono un raro caso di Sindrome di Poland in maschio di 16 anni. Non è stata necessaria correzione chirurgica.

2000 - Surgical management of pulmonary solitary nodules: an unexpected lucky case. [Abstract in Rivista]
Casali, C; Stefani, Alessandro; Paci, M; Ruggiero, C; Urgese, Al; Morandi, Uliano; Lodi, R.
abstract

nd

2000 - The surgical treatment of flail chest. [Abstract in Rivista]
Ruggiero, C; Paci, M; Stefani, Alessandro; Casali, C; Urgese, Al; Morandi, Uliano; Lodi, R.
abstract

nd

1999 - Carcinoid tumors of the lung: an analysis of 65 operated cases [Articolo su rivista]
Stefani, Alessandro; Morandi, Uliano; Urgese, Al; Rivasi, Francesco; Lodi, Renzo
abstract

Background The aim of this study was to analyse two groups of patients operated for bronchopulmonary neuroendocrine neoplasms (bronchial carcinoid and well-differentiated neuroendocrine carcinoma) and to investigate their clinico-pathological data and long-term survival. Methods. From January 1978 to June 1996, 65 patients with bronchial carcinoids underwent operation at our Institution. There were 33 males and 32 females, whose mean age was 49.8 years. Forty-four neoplasms (67.7%) were considered to be central. Histology revealed 54 typical bronchial carcinoids (83%) and 11 well-differentiated neuroendocrine carcinomas (17%), Surgical resection of tumor and complete lymph node dissection was performed in all cases, Results, All patients entered follow-up: 5-year survival was 91% for patients with bronchial carcinoid and 49% for those with well-differentiated neuroendocrine carcinoma (p<0.05). Univariate analysis found that there was a significant decrease in survival also for peripheral location of the tumor, advanced pathologic stage and histologically positive lymph nodes. Conclusions. These results point out that carcinoid tumors are malignant neoplasms, so they require a complete and radical surgical resection, Most tumors are only locally invasive and show a low aggressive behaviour; therefore, when possible, it is recommended to attempt a limited resection, Frozen sections of bronchial margins and complete lymphadenectomy should be routinely performed. The same criteria should apply to well differentiated neuroendoctine carcinomas, though their behaviour is more aggressive.

1999 - Carcinoma bronchioloalveolare: aspetti clinici e diagnostici e risultati della terapia chirurgica. [Articolo su rivista]
P., Natali; Stefani, Alessandro; Morandi, Uliano
abstract

Gli autori descrivono la loro casistica di 72 pazienti affetti da BAC operati tra il 1979 e il 1999.

1999 - Technical advances and results in surgical correction of pectus excavatum [Abstract in Rivista]
Stefani, Alessandro; Ruggiero, C; Paci, M; Casali, C; Urgese, Al; Morandi, Uliano; Lodi, R.
abstract

nd

1998 - Il trattamento chirurgico delle metastasi polmonari. [Abstract in Atti di Convegno]
Stefani, Alessandro; Morandi, Uliano; Urgese, Al; Paci, M; Brandi, L; Lodi, R.
abstract

nd

1998 - Indagine sui livelli ematici e tissutali di Se, Zn e Cu in pazienti con patologia neoplastica. [Poster]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Arigliano, V; Zanelli, F; Franchini, M; Zoboli, A; Fontana, I; Morandi, Uliano; Stefani, Alessandro
abstract

nd

1998 - Limiti della chirurgia exeretica del cancro del polmone [Relazione in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro
abstract

nd

1998 - Migration of pectus excavatum correction metal support into the abdomen. [Articolo su rivista]
Stefani, Alessandro; Morandi, Uliano; R., Lodi
abstract

The authors describe a case of migration of a metal support, used to fix a corrected pectus excavatum deformity, into the peritoneal cavity. The migrated wire caused abdominal pain. A video laparoscopic removal of the wire was undertaken and the patient made a full recovery. A review of the literature shows that this has not been reported before and that serious complications related to metal struts are very uncommon. We do not believe that a revision of this surgical technique is needed; anyway, foreign body migration should always be considered as a cause for unusual symptoms in patients undergoing this operation.

1998 - Migrazione di un supporto metallico nella cavità addominale dopo correzione chirurgica di un pectus excavatum [Abstract in Atti di Convegno]
Stefani, Alessandro; Morandi, Uliano; Urgese, Al; Santi, C; Lodi, R.
abstract

nd

1998 - Plasma, hair and tissue levels of trace elements in lung cancer [Relazione in Atti di Convegno]
Piccinini, Lino; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Stefani, Alessandro; V., Arigliano; Davalli, Pierpaola
abstract

The purpose of this study was to investigate the relationship between plasma, hair and tissue levels of Se, Zn and Cu, and cancer.

1998 - Progressi tecnici e risultati a distanza della correzione chirurgica del pectus excavatum. [Articolo su rivista]
Lodi, R; Morandi, Uliano; Stefani, Alessandro; Brandi, L.
abstract

ND

1998 - Results of surgical resection for lung metastases [Articolo su rivista]
Morandi, Uliano; Stefani, Alessandro; A. L., Urgese; C., Ruggiero; M., Paci; R., Lodi
abstract

Fifty-nine consecutive patients underwent thoracotomy with curative intent for lung metastases, with no operative deaths, between 1978 and 1996. Six patients could not be rendered free of disease; their long term survival was significantly lower respect to the 53 patients undergoing curative resection: 31% at one year versus 38% at five years respectively. By considering patients rendered free of disease, wedge excision was performed in 29 cases (55%) and it was the procedure of choice. Apart from resectability, the only significant factors influencing survival were morphology, with the best prognosis for carcinomas, intermediate for sarcomas and the worst one for melanoma and lymph node involvement, with a significant better survival for patients without nodal involvement. Survival was not influenced by primary site, disease-free interval, diameter and location of the pulmonary metastases, number of metastases resected and number of thoracotomies. We conclude that resection of lung metastases is safe and effective, that multiple lesions do not preclude resection but a known nodal involvement contraindicates it and that repeated thoracotomy is justified.

1998 - Selenium, Zinc and Copper il lung cancer: modifications in fluids and tissues [Abstract in Atti di Convegno]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Stefani, Alessandro; Arigliano, V; Davalli, P.
abstract

nd

1998 - The role of surgical resection in the management of limited small-cell lung cancer [Relazione in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro
abstract

nd

1997 - CORRECTION OF PECTUS EXCAVATUM: MODALITIES, TECHNIQUES AND RESULTS AT DISTANCE [Relazione in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Ruggiero, C; Paci, M; Cavozza, C; Lodi, R.
abstract

nd

1997 - Morphological researches on lung preservation with a modified University of Wisconsin solution containing gelatine polypeptides (Haemaccel) [Articolo su rivista]
G., Spagna; P., Bruzzone; I., Pecorella; R., Lorenzini; Stefani, Alessandro; Morandi, Uliano; R., Lodi
abstract

University of Wisconsin solution (U.W.S.) has prolonged hypotermic preservation of liver and kidney. This solution has been afterwards tested for heart and lung preservation. The high-potassium content and viscosity of the solution suggested to us to bring some modifications: addition of plasma expanders, aprotinin and an increased concentration of gluthatione. We studied the effect of this original solution using an animal model: 10 males adult Yuchatan micro-pig, undergoing excision of the heart-lung block. A morphological study of preserved lung was performed, then we compared the effect of standard UW solution and our modified solution. The cyto-histological findings, at different preservation times, showed that superior results have been obtained with the modified UW solution, such as better hematic wash-out from the pulmonary vessels and milder vasoconstriction in the pulmonary artery bed. Using our solution we observed a satisfactory preservation of pulmonary endothelium and bronchial epithelium respectively after 8 and 12 hours of hypotermic ischemia. This was the first step of our research; in a further study we shall perform the single-lung transplantation in a micro-pig model, to report a functional in vivo evaluation of the clinical applicability and quality of our solution for lung preservation

1997 - Results of surgical resection in patients over the age of 70 years with non small-cell lung cancer. [Articolo su rivista]
Morandi, Uliano; Stefani, Alessandro; M., Golinelli; C., Ruggiero; L., Brandi; A., Chiapponi; C., Santi; R., Lodi
abstract

From January 1989 to October 1993, at the Department of Cardio-Thoracic Surgery of the University of Modena, 806 patients underwent thoracotomy and curative pulmonary resection for non small-cell lung cancer. Eighty five patients were 70 years old or older (mean 73.4 years, range 70-88). There were 78 males (91.7\%) and 7 females (8.3\%). This population was compared to 130 younger patients (under 70 years old), treated during the same period and with similar features with respect to the type of resection, sex, histology, grading and staging. Lobectomy was the procedure of preference in both groups.As regards postoperative mortality and overall complications, no significant differences were noted between the two groups of patients (two younger patients died and 43.8\% had postoperative complications; one patient of the older group died and 55.2\% had postoperative complications), but in the older ones a higher incidence of cardiovascular complications was found (P < 0.01). With respect to the long-term survival (follow-up 12-70 months), no significant difference was found between the two groups.Such findings show that pulmonary resection for bronchogenic cancer is feasible and justified in patients more than 70 years old, even if a higher incidence of cardiovascular complications may occur: a careful preoperative selection ought to be performed and lobectomy should be preferred.

1997 - Selenium, Zinc and Copper levels in blood, hair and tissue of patients affected by lung and breast cancer [Abstract in Atti di Convegno]
Bargellini, Annalisa; Borella, Paola; Morandi, Uliano; Arigliano, V; Stefani, Alessandro; Fontana, I; Caselgrandi, E; Piccinini, L.
abstract

nd

1997 - Studio caso-controllo dei tassi di Selenio (Se) nel sangue e nei tessuti di soggetti sani o affetti da tumore [Poster]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Arigliano, V; Malavolta, L; Longo, L; Zoboli, A; Fontana, I; Morandi, Uliano; Stefani, Alessandro
abstract

nd

1997 - Trace element content of normal and cancerous lung and breast tissue [Abstract in Atti di Convegno]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Arigliano, V; Stefani, Alessandro; Fontana, I.
abstract

nd

1997 - VIDEO-ASSISTED THORACIC SURGERY. THE EXPERIENCE FROM THE CENTRE OF MODENA [Relazione in Atti di Convegno]
Urgese, Al; Paci, M; Cavozza, C; Guida, M; Ruggiero, C; Stefani, Alessandro; Pennetta, A; Morandi, Uliano
abstract

nd

1996 - Fattori di rischio, mortalità e morbidità della chirurgia di rivascolarizzazione miocardica nell’ottavo decennio di vita. [Abstract in Rivista]
Santi, C; Ruggiero, C; Golinelli, M; Stefani, Alessandro; Paci, M; Brandi, L; Morandi, Uliano; Lodi, R.
abstract

nd

1996 - Il trattamento chirurgico dei carcinoidi bronco-polmonari [Abstract in Rivista]
Morandi, Uliano; Stefani, Alessandro; Ruggiero, C; Lodi, R.
abstract

nd

1996 - Mesenchymal chondrosarcoma of the pleura. [Articolo su rivista]
G., Luppi; A. M., Cesinaro; A., Zoboli; Morandi, Uliano; Piccinini, Lino
abstract

A 52 year old man developed an extraskeletal mesenchymal chondrosarcoma (ESMC) arising from the pleura. Clinically, the tumour mimicked a mesothelioma. Fine needle biopsy was consistent with the diagnosis of sarcomatoid mesothelioma. Histological examination of multiple tumour samples, supported by immunohistochemical characterization, made it possible to correctly diagnose extraskeletal mesenchymal chondrosarcoma.

1996 - Trattamento chirurgico delle embolie polmonari fulminanti [Abstract in Rivista]
Morandi, Uliano; Minale, C; Tazzioli, Giovanni; Lodi, Renzo; Messmer, Bj
abstract

1995 - Il trattamento chirurgico dei carcinoidi bronco-polmonari. [Abstract in Atti di Convegno]
Morandi, Uliano; Rivasi, F; Campanini, A; Ruggiero, C; Stefani, Alessandro; Cavozza, C; Paci, M; Lodi, R.
abstract

nd

1995 - La correzione chirurgica del pectus excavatum. Modalità tecniche e risultati morfo-funzionali [Abstract in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Golinelli, M; Ruggiero, C; Cavozza, C; Brandi, L; Santi, C; Lodi, R.
abstract

nd

1995 - La correzione chirurgica del pectus excavatum. Modalità tecniche e risultati morfo-funzionali. [Abstract in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Golinelli, M; Ruggiero, C; Cavozza, C; Brandi, L; Santi, C; Lodi, R.
abstract

nd

1995 - Le exeresi polmonari per cancro negli ultrasettantenni [Abstract in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Golinelli, M; Ruggiero, C; Cavozza, C; Chiapponi, A; Brandi, L; Santi, C; Lodi, R.
abstract

nd

1995 - Pericardial window e pericardioscopia nel trattamento del tamponamento cardiaco [Abstract in Rivista]
Morandi, Uliano; Santi, C; Golinelli, M; Brandi, L; Ruggiero, C; Stefani, Alessandro; Cavozza, C; Lodi, R.
abstract

nd

1995 - Studio cardiologico preoperatorio polistrumentale per la valutazione del rischio toracochirurgico. [Abstract in Atti di Convegno]
Brandi, L; Morandi, Uliano; Ruggiero, C; Golinelli, M; Stefani, Alessandro; Cavozza, C; Tartoni, Pl; Stella, F; Santi, C; Lodi, R.
abstract

nd

1995 - Trattamento chirurgico del cancro bronco-polmonare (NSCLC): popolazioni a confronto (serie di ultrasettantenni-serie di età inferiore). [Abstract in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Golinelli, M; Ruggiero, C; Brandi, L; Chiapponi, A; Lodi, R.
abstract

nd

1995 - Valutazione cardiorespiratoria predittiva del rischio operatorio in chirurgia exeretica del cancro bronco-polmonare. [Abstract in Atti di Convegno]
Brandi, L; Morandi, Uliano; Pennetta, Ra; Ruggiero, C; Golinelli, M; Stefani, Alessandro; Cavozza, C; Chiapponi, A; Tartoni, Pl; Stella, F; Santi, C; Lodi, R.
abstract

nd

1995 - "Yellow nail syndrome" associated with chronic recurrent pericardial and pleural effusions. [Articolo su rivista]
Morandi, Uliano; M., Golinelli; L., Brandi; C., Ruggiero; Stefani, Alessandro; R., Lodi
abstract

The authors describe a case of yellow nail syndrome in a 44-year-old male patient, with a clinical picture characterized by hand and foot onychodystrophy, lymphedema in the legs and recurrent pleural and pericardial effusions. They indicate subxiphoid pericardiostomy and pleural drainage as the rational surgical procedure for the treatment of this particular associated pathology.

1994 - Pericardial window e pericardioscopia nel trattamento del tamponamento cardiaco [Relazione in Atti di Convegno]
Morandi, Uliano; Santi, C; Golinelli, M; Brandi, L; Ruggiero, C; Stefani, Alessandro; Cavozza, C; Lodi, R.
abstract

nd

1994 - Significato prognostico del contenuto di DNA e dell'attività proliferativa cellulare nel carcinoma polmonare non a piccole cellule operato [Articolo su rivista]
Morandi, Uliano; Sabbatini, R; Stefani, Alessandro; Piccinini, L; Golinelli, M; Bandieri, E; Frassoldati, A; Lodi, R.
abstract

Scopo dello studio è stato quello di ricercare una correlazione tra l'evoluzione clinica dei pazienti affetti da NSCLC, la ploidia e l'attività proliferativa del tumore. Campioni tumorali di 127 pazienti operati dal 1989 al 1991 sono stati studiati mediante citofluorimetria a flusso. Novanta casi sono risultati aneuploidi. il valore medio della SPF era 19.6%. DNA-index e SPF sono stati correlati con istotipo, grading e stadio ma non sono state trivate differenze significative. . A 2 anni dall'intervento è stato studiato l'intervello libero da malattia dei pazienti allo stadio I e II sottoposti a intervento radicale: 83/127, di cui soltanto 55 valutabili per la fase S. I pazienti con tumore aneuploide e con elevata SPF hanno presentato un maggior numero di recidive a 24 mesi, 50% contro 26%. Questa differenza, ancorchè non significativa (0.08)suggerische una possibile tendenza delle neoplasie aneuploidi ed altamente proliferanti ad avere una prognosi peggiore.

1994 - Valutazione ecocardiografica preoperatoria in pazienti toracochirurgici ad alto rischio cardiovascolare [Abstract in Atti di Convegno]
Brandi, L; Santi, C; Ruggiero, C; Golinelli, M; Stefani, Alessandro; Tartoni, Pl; Stella, F; Morandi, Uliano; Lodi, R.
abstract

nd

1989 - Surgical management of adrenal cortical carcinoma. [Articolo su rivista]
D., Borrelli; A., Ingenito; P., Cicchi; M., Rettori; G., Nicita; A., Mercatelli; E., Vanni; Morandi, Uliano
abstract

The experience with the surgical management of 14 patients with adrenal cortical carcinoma is presented. Four patients were males and 10 females (mean age: 37 years). Seven patients (50\%) has proven hormonal activity and 7 (50\%) had "non functioning" tumors. The location of carcinoma involved the left adrenal gland in 9 cases, the right in 3 and it was bilateral in 2. The mean diameter of the mass was 10 cm. The most helpful diagnostic tests were shown to be sonography and computed tomography. The surgical procedure was chosen according to the patients condition: this included resection of primary lesion and excision of local lymph nodes and all involved structures. Adjuvant treatment with either mitotane, 5-FU or local irradiation did not result in any benefit with respect to the expected survival. There was a slightly better survival for functioning versus non functioning tumors. Surgery remains the treatment of choice for these tumors. Prognosis is exceedingly poor: only 5 patients (36\%) have survived beyond two years after surgery.

1987 - [Dissecting aneurysms of the thoracic aorta. Analysis of 22 cases operated on]. [Articolo su rivista]
C., Minale; Tazzioli, Giovanni; C., Lavini; Morandi, Uliano; A., Smerieri; L., Zanotti; R., Lodi
abstract

Non disponibile

1987 - Il cancro broncopolmonare [Monografia/Trattato scientifico]
Lodi, R; Pisaneschi, M; Morandi, Uliano
abstract

Non disponibile

1987 - Le lesioni esofago-gastriche da caustici [Capitolo/Saggio]
Morandi, Uliano; Tazzioli, Giovanni; Lavini, C; Marchioni, Carlo Felice
abstract

no abstract

1986 - Correzione dalla TGA secondo la tecnica "originale" di Senning: risultati immediati ed a distanza di 47 casi [Abstract in Rivista]
Minale, C; Tazzioli, Giovanni; Morandi, Uliano; Lodi, Renzo; Messmer, Bj
abstract

1986 - I rischi della chirurgia plurivalvolare cardiaca [Abstract in Atti di Convegno]
Minale, C; Tazzioli, Giovanni; Morandi, Uliano; Smerieri, A; Fontana, G; Lavini, C; Zanotti, L; Lodi, Renzo
abstract

N/A

1986 - Il valore dell'endoarterectomia coronarica nel programma terapeutico delle coronaropatie diffuse: risultati di 312 casi [Abstract in Rivista]
Minale, C; Tazzioli, Giovanni; Morandi, Uliano; Lodi, Renzo; Messmer, Bj
abstract

1986 - La correzione chirurgica delle malformazioni congenite della parete toracica anteriore [Relazione in Atti di Convegno]
Lodi, Renzo; Morandi, Uliano; Tazzioli, Giovanni; Lavini, C; Marchioni, Carlo Felice
abstract

no abstract

1986 - La resezione del setto interventricolare nella cardiomiopatia ipertrofica ostruttiva: risultati a distanza di 33 pazienti [Abstract in Rivista]
Minale, C; Tazzioli, Giovanni; Morandi, Uliano; Lodi, Renzo; Messmer, Bj
abstract

1986 - La scelta del tipo di protesi nella chirurgia mitro-aortica [Abstract in Rivista]
Tazzioli, Giovanni; Minale, C; Morandi, Uliano; Lodi, Renzo; Messmer, Bj
abstract

1986 - Sostituzione valvolare e bypass aorto-coronarico combinati. Risultati immediati e tardivi di 194 casi operati [Articolo su rivista]
Lodi, Renzo; Minale, C; Tazzioli, Giovanni; Smerieri, A; Morandi, Uliano; Barozzi, M; Zanotti, L; Fontana, G; Lavini, C.
abstract

no abstract

1986 - Sostituzioni valvolari in 182 pazienti al disopra dei 60 anni [Abstract in Rivista]
Minale, C; Tazzioli, Giovanni; Morandi, Uliano; Lodi, Renzo; Messmer, Bj
abstract

1985 - [Diagnosis and treatment of traumatic rupture and dislocation of the diaphragm. Experience of 2 surgical centers (Modena and Bologna)]. [Articolo su rivista]
C., Lavini; Morandi, Uliano; C., Luppi; I., Ghidoni; R., Lodi; D., Salcito; L., Lancellotti; L., Sensi
abstract

Non disponibile

1985 - Gli aneurismi dell'aorta addominale. Diagnosi e trattamento [Aneurysms of the abdominal aorta. Diagnosis and treatment] [Articolo su rivista]
Smerieri, A; Salcito, D; Sensi, L; Zanotti, L; Tazzioli, Giovanni; Morandi, Uliano; Lodi, Renzo
abstract

Non disponibile

1985 - La mediastinoscopia e la biopsia mediastinica nella sarcoidosi polmonare [Relazione in Atti di Convegno]
Tazzioli, Giovanni; Morandi, Uliano; Smerieri, A; Fontana, G; Lavini, C; Lodi, Renzo
abstract

no abstract

1985 - La terapia chirurgica del cancro bronco-polmonare. Analisi al computer di una casistica selezionata del centro di Chirurgia Toracica di Modena (328 osservazioni) [Articolo su rivista]
Lodi, Renzo; Morandi, Uliano; Smerieri, A; Fontana, G; Lavini, C; Tazzioli, Giovanni; Luppi, G; De Grandi, F; Barozzi, M.
abstract

no abstract

1984 - Patologia timica e miastenia gravis [Articolo su rivista]
Lavini, C; Morandi, Uliano; Smerieri, A; Tazzioli, Giovanni; Fontana, G; Schoenhuber, R; Lodi, R.
abstract

no abstract

1983 - Adenolipoma della trachea [Articolo su rivista]
Lodi, Renzo; Maiorana, Antonino; Morandi, Uliano; Tazzioli, Giovanni; Fontana, Giovanni
abstract

Viene descritto un caso raro di adenolipoma insorto nella trachea ed asportato chirurgicamente.

1983 - Adenolipoma della trachea. Descrizione di un caso trattato mediante resezione-anastomosi tracheale. [Articolo su rivista]
Lodi, Renzo; Maiorana, Antonino; Morandi, Uliano; Tazzioli, Giovanni; Fontana, G.
abstract

no abstract

1983 - Adult respiratory distress syndrome (A.R.D.S.). Rilievi anatomofisiopatologici e terapeutici [Articolo su rivista]
Lodi, Renzo; Tazzioli, G; Lavini, C; Morandi, Uliano; Fontana, G.
abstract

no abstract

1983 - Curioso comportamento di un corpo estraneo (protesi dentaria) migrato dalle vie aeree nel tubo digerente [Articolo su rivista]
Morandi, Uliano; Tazzioli, Giovanni; Smerieri, A; Lavini, C; Rigo, Gp; Leonelli, V; Antonioli, A; Codeluppi, Pl
abstract

no abstract

1983 - [Epiphrenic megadiverticula: clinical and therapeutic considerations. Case contributions]. [Articolo su rivista]
C., Lavini; Morandi, Uliano; D., Salcito; A., Smerieri; G., Fontana; R., Lodi
abstract

Non disponibile

1983 - Istiocitoma fibroso maligno mediastino-polmonare. Aspetti clinici, istiopatologici, terapeutici. Contributo casistico [Articolo su rivista]
Lavini, C; Morandi, Uliano; Tazzioli, Giovanni; Fontana, G; Lodi, Renzo; Leonelli, V.
abstract

no abstract

1983 - Microcitoma quale "coin lesion" polmonare isolata: esperienza chirurgica e follow-up [Abstract in Atti di Convegno]
Morandi, Uliano; Piccinini, L; Tazzioli, Giovanni; Luppi, G.
abstract

1983 - Schwannoma del nervo vago intratoracico. Descrizione di un caso singolare. [Articolo su rivista]
Morandi, Uliano; Tazzioli, Giovanni; Pantusa, M; Lodi, Renzo; Lavini, C; Romani, F.
abstract

no abstract

1983 - Sindrome di Boerhaave. Considerazioni cliniche e terapeutiche su un caso di rottura spontanea dell'esofago [Articolo su rivista]
Tazzioli, Giovanni; Morandi, Uliano; Fontana, G; Olivetti, Gp; Lavini, C; Lodi, Renzo
abstract

no abstract

1983 - Sindrome di Boerhaave. Considerazioni sulla rottura spontanea dell'esofago. Contributo casistico [Articolo su rivista]
Smerieri, A; Tazzioli, Giovanni; Fontana, G; Morandi, Uliano; Lodi, Renzo
abstract

no abstract

1982 - Le emergenze toraciche nel nostro territorio. Studio sull'incidenza, osservazioni tecno-organizzative, necessità e proposte operative [Articolo su rivista]
Lodi, Renzo; Romano, A; Morandi, Uliano; Olivetti, Gp; Tazzioli, Giovanni; Fontana, G; Barozzi, M.
abstract

no abstract

1982 - Lipoma puro del bronco lobare medio. Considerazioni cliniche e terapeutiche. Contributo casistico [Articolo su rivista]
Lodi, Renzo; Fontana, G; Morandi, Uliano; Mazzera, E; Consigli, Gf; Tazzioli, Giovanni; Lavini, C; Olivetti, Gp
abstract

no abstract

1982 - Tomografia computerizzata e patologia del mediastino. Considerazioni in 60 casi. [Articolo su rivista]
Lodi, Renzo; Morandi, Uliano; Tazzioli, Giovanni; Fontana, G; Mazzera, E; Lavini, C; Calò, M.
abstract

no abstract

1981 - Biopsia in toracotomia minima per la diagnosi nella patologia del polmone profondo [Articolo su rivista]
Lodi, Renzo; Morandi, Uliano; Tazzioli, Giovanni; Fontana, G; De Grandi, F; Lavini, C.
abstract

no abstract

1981 - La toracotomia d'urgenza nelle emergenze cardiache e dei grossi vasi [Relazione in Atti di Convegno]
Tazzioli, Giovanni; Lodi, Renzo; Romano, A; Morandi, Uliano; Mazzera, E; Fontana, G; Pellegrino, M.
abstract

no abstract

1981 - Mediastinoscopy and mediastinal biopsy in lung sarcoidosis [Capitolo/Saggio]
Lodi, Renzo; Morandi, Uliano; Romano, A; Mazzera, E; Tazzioli, Giovanni; Fontana, G; Pellegrinoo, M.
abstract

no abstract

1980 - A modified method of correction for pectus excavatum [Articolo su rivista]
Mazzera, E; Morandi, Uliano; Romano, A; Tazzioli, Giovanni; Fontana, G; Bondioli, A; Lodi, Renzo
abstract

no abstract

1980 - Il linfangioma cistico del mediastino. Diagnostica e terapia [Articolo su rivista]
Lodi, Renzo; Morandi, Uliano; Tazzioli, Giovanni; Romano, A; Fontana, G; Lavini, C; Bruno, F; Franchini, G.
abstract

no abstract

1980 - Linfoma benigno di Castleman a localizzazione timica. Trattamento chirurgico [Articolo su rivista]
Lodi, R; Morandi, Uliano; Massolo, F; Romano, A; Pellegrino, M; Tazzioli, Giovanni; Fontana, G; Bruno, F.
abstract

abstract

1979 - Anatomo-surgical aspects and approaches fo the transposition of intercostal nerves to the brachial plexus in the treatment of traumatic radicular avulsions [Articolo su rivista]
Lodi, Renzo; Morandi, Uliano; Bondioli, A; Bonati, L; Tazzioli, Giovanni; Byrnes, Jj
abstract

no abstract

1979 - Gli adenomi bronchiali a sede periferica: analisi di una casistica e considerazioni clinico-terapeutiche [Articolo su rivista]
Lodi, Renzo; Bondioli, A; Morandi, Uliano; Lavini, C; Romano, A; Fontana, G; Tazzioli, Giovanni; Pellegrino, M.
abstract

no abstract

1979 - Problematica delle infezioni in chirurgia toracica [Capitolo/Saggio]
Lodi, Renzo; Morandi, Uliano; Romano, A; Fontana, G; Tazzioli, Giovanni; Bruno, F.
abstract

no abstract

1979 - Simultaneous penetrating wounds of the myocardium and aorta caused by firearms: surgical treatment. [Articolo su rivista]
R., Lodi; A., Bondioli; G., Domenichini; C., Mazzetti; Morandi, Uliano; L., Bonati; J. J., Byrnes
abstract

The frequency of trauma and penetrating wounds ofthe heart and the great intrathoracic vessels is continuouslyincreasing. In peacetime heart wounds constituteabout 3% of all penetrating wounds of thechest. About 40% of patients with penetrating woundsof the heart reach hospital alive. If these patientsundergo an immediate pericardiocentesis and operationthey have an 80-90% chance of survival. In astudy of cases of penetrating gunshot wounds of theheart and aorta 31 patients died immediately whilefive survived for at least 30 minutes (Parmley et al,1958).We present a case of simultaneous penetrating gunshotwounds of the myocardium and thoracic aortawhen the patient survived more than 30 minutes andwas successfully treated surgically. Repeated assessmentduring the four years since the injury has notshown any late complications.

1979 - Trombosi neoplastica dell'arteria polmonare sinistra in un caso di rabdomiosarcoma primitivo del polmone [Articolo su rivista]
Lodi, Renzo; Velluti, Giorgio; Morandi, Uliano; Tazzioli, Giovanni; Fontana, G; Lavini, C.
abstract

no abstract

1978 - Analisi dei parametri emogasanalitici e dell'equilibrio acido-base nell'operato toracico [Articolo su rivista]
Lodi, Renzo; Bondioli, A; Morandi, Uliano; Bonati, L; Pieralisi, F; Grana, G; Lavini, C; Fontana, G; Tazzioli, Giovanni
abstract

no abstract

1978 - BRONCHIOLITE MUCOIDE DIFFUSA IN CORSO DI ASMA BRONCHIALE [Articolo su rivista]
Tazzioli, Giovanni; Loschi, Giuseppe; Morandi, Uliano
abstract

BRONCHIOLITE MUCOIDE DIFFUSA IN CORSO DI ASMA BRONCHIALE.

1978 - CAUSA INCONSUETA DI COIN LESION [Articolo su rivista]
Tazzioli, Giovanni; Lodi, Renzo; Bondioli, A; Morandi, Uliano; Bonati, L.
abstract

no abstract

1978 - Contributo alla conoscenza del germinoma (seminoma) timico, presentazione di un caso. [Articolo su rivista]
Lodi, Renzo; Bondioli, A; Morandi, Uliano; Bonati, L; Tazzioli, Giovanni; Fontana, G.
abstract

no abstract

1978 - L'elettropneumografia per impedenza transtoracica (Z.P.G.) come indagine di esplorazione morfo-funzionale del polmine [Articolo su rivista]
Lodi, Renzo; Bondioli, A; Morandi, Uliano; Lvini, C; Bonati, L; Tazzioli, Giovanni
abstract

no abstract

1978 - L'embolia polmonare. Diagnosi e trattamento chirurgico. [Articolo su rivista]
Lodi, Renzo; Bondioli, A; Morandi, Uliano; Tazzioli, Giovanni; Bonati, L; Miglio, V.
abstract

no abstract

1978 - REPERTI MICROBIOLOGICI IN UNA CASISTICA DI CHIRURGIA TORACO-POLMONARE [Articolo su rivista]
Tazzioli, Giovanni; Lodi, Renzo; Bondioli, A; Morandi, Uliano; Bonati, L.
abstract

no abstract

1977 - FISTOLA BRONCO-BILIARE DA ECHINOCOCCOSI EPATICA E DIAFRAMMATICA [Articolo su rivista]
Lodi R, Bondioli A; Morandi, Uliano; G, Bonati L. Tazzioli; Loschi, G. C.
abstract

abstract:

1976 - [Leiomyoma of the intermediate bronchus with intra- and extra-bronchial development]. [Articolo su rivista]
R., Lodi; V., Gualtieri; A., Bondioli; Morandi, Uliano; L., Bonati
abstract

Non disponibile