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104. 18-FDG positron emission tomography in the evaluation of malignant pleural diseases - A pilot study

Author

Carretta, A, Landoni, C, Melloni, G, Ceresoli, G, Compierchio, A, Fazio, F, Zannini, P, Ceresoli, GL, Zannini, P., LANDONI, CLAUDIO, FAZIO, FERRUCCIO, Carretta, A, Landoni, C, Melloni, G, Ceresoli, G, Compierchio, A, Fazio, F, Zannini, P, Ceresoli, GL, Zannini, P., LANDONI, CLAUDIO, and FAZIO, FERRUCCIO

Abstract

Objective: The diagnostic approach to pleural diseases may be difficult. The CT scan, which is the current diagnostic technique, has limited accuracy both in the differentiation between benign and malignant pleural diseases and in the diagnosis of primary and metastatic pleural neoplasms. Invasive procedures, such as thoracoscopy, are therefore frequently required to complete the diagnostic approach. The increasing incidence of malignant pleural mesothelioma has led to the development of new treatment strategies, which still need to be fully validated. There is, therefore, a need for new diagnostic techniques that can lead to a definite diagnosis and a satisfactory evaluation of the response to treatment. Encouraging results have been reported with the F-18-labeled analogue of a-deoxyglucose (18-FDG) positron emission tomography (PET) in the evaluation of chest tumors such as lung cancer. The aim of this study was to evaluate the role of 18-FDG PET in the diagnostic assessment of pleural diseases. Methods: Patients with CT scan evidence of pleural thickening, or fluid, entered a study to evaluate the accuracy of 18-FDG PET in diagnosing pleural diseases. Image analysis was performed both with visual interpretation and using a semiquantitative method, standardized uptake values (SUV), on coronal, sagittal and axial reconstructions. The results of PET imaging were compared to histological data. PET was also performed before and after treatment in patients who underwent chemotherapy to evaluate the accuracy of this technique in the assessment of the response. Results: Fourteen patients entered the study. Histology demonstrated a malignant pleural disease in 13 patients; malignant pleural mesothelioma in ten patients, adenocarcinoma in two and liposarcoma in one. Benign pleural disease was diagnosed in the remaining patient. PET assessment demonstrated significant 18-FDG uptake in 12 of the 13 patients with a malignant disease, also revealing distant metastases in two o, Objective: The diagnostic approach to pleural diseases may be difficult. The CT scan, which is the current diagnostic technique, has limited accuracy both in the differentiation between benign and malignant pleural diseases and in the diagnosis of primary and metastatic pleural neoplasms. Invasive procedures, such as thoracoscopy, are therefore frequently required to complete the diagnostic approach. The increasing incidence of malignant pleural mesothelioma has led to the development of new treatment strategies, which still need to be fully validated. There is, therefore, a need for new diagnostic techniques that can lead to a definite diagnosis and a satisfactory evaluation of the response to treatment. Encouraging results have been reported with the F-18-labeled analogue of 2-deoxyglucose (18-FDG) positron emission tomography (PET) in the evaluation of chest tumors such as lung cancer. The aim of this study was to evaluate the role of 18-FDG PET in the diagnostic assessment of pleural diseases. Methods: Patients with CT scan evidence of pleural thickening, or fluid, entered a study to evaluate the accuracy of 18-FDG PET in diagnosing pleural diseases. Image analysis was performed both with visual interpretation and using a semiquantitative method, standardized uptake values (SUV), on coronal, sagittal and axial reconstructions. The results of PET imaging were compared to histological data. PET was also performed before and after treatment in patients who underwent chemotherapy to evaluate the accuracy of this technique in the assessment of the response. Results: Fourteen patients entered the study. Histology demonstrated a malignant pleural disease in 13 patients; malignant pleural mesothelioma in ten patients, adenocarcinoma in two and liposarcoma in one. Benign pleural disease was diagnosed in the remaining patient. PET assessment demonstrated significant 18-FDG uptake in 12 of the 13 patients with a malignant disease, also revealing distant metastases in two o

Published
2000

119. Acupuncture for diagnostic fiberoptic bronchoscopy: a prospective, randomized, placebo-controlled study.

Author

Cabrini L, Gioia L, Gemma M, Melloni G, Carretta A, Ciriaco P, and Puglisi A

Abstract

Patients usually fear fiberoptic bronchoscopy (FBS) and they report a low level of satisfaction after this examination. We evaluated the efficacy of acupuncture in decreasing patient anxiety before diagnostic FBS and in improving tolerance to the examination. In a prospective double-blind study, we enrolled 48 patients scheduled to undergo diagnostic FBS. Patients were randomly assigned to one of three groups. Group A (16 patients): standard FBS, with airway topic anesthesia; Group B (16 patients): standard FBS, with airway topic anesthesia and acupuncture treatment; Group C (16 patients): standard FBS, with airway topic anesthesia and sham acupuncture. EKG, non-invasive arterial pressure, and pulse oximetry were monitored on a routine basis. We evaluated patient anxiety before and after acupuncture and, at the end of FBS, the discomfort suffered during the examination by a 100-mm Visual Analog Scale (VAS). Patient satisfaction in Group A was 50% worse than in Group B (p = 0.04). We observed a strong, even if not statistically significant, tendency toward a lower pre-FBS anxiety in Group B. Patients in group C had values very close to those recorded in group A. We observed no adverse event and no differences in cardio-respiratory parameters in these three groups; in particular, we did not observe a respiratory depression in Group B. Acupuncture seems an effective resource for a Thoracic Endoscopic Room to improve patient tolerance to FBS. [ABSTRACT FROM AUTHOR]

Published
2006
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130. Single lung transplantation for emphysema. Lessons learned on the field

Author

Zannini, P., Baisi, A., Melloni, G., Cavagnoli, R., Mancini, S., Galmarini, D., Damia, G., Iapichino, G., Langer, M., Solca, M., Bauer, D., Pezzuoli, G., Gerosa, C., Fassati, L. R., Giorgio Rossi, Colledan, M., Melada, E., Romito, R., Ruberti, U., Zannini, P, Baisi, A, Melloni, G, Cavagnoli, R, Mancini, S, Galmarini, D, Damia, G, Iapichino, G, Langer, M, Solca, M, Bauer, D, Pezzuoli, G, Gerosa, C, Fassati, L, Rossi, G, Colledan, M, Melada, E, Romito, R, and Ruberti, U

Subjects
emphysema, female, male, adult, article, lung transplantation, case report, human
Abstract

Emphysematous patients that were once treated with double lung transplantation can now also be treated with single lung transplantation. However, single lung transplantation in emphysematous patients presents problems in lung size matching, choice of side to transplant and post-operative assistance. Analysing their own experience of three single lung transplants performed on emphysematous patients, the Authors evaluate the effectiveness of the operation, the results and the difficulties encountered. Single lung transplantation is a good therapeutic option for end-stage emphysematous patients. In these patients right lung transplantation is preferable and the donor organ should be oversized. Positive end expiratory pressure in the native emphysematous lung should be applied with extreme caution.

131. Combined treatment of non-small cell lung cancer with synchronous brain metastases: A single center experience

Author

Melloni, G., Bandiera, A., Gregorc, V., Carretta, A., Ciriaco, P., Vigano, M. G., Franzin, A., Bolognesi, A., Piero Picozzi, Zannini, P., Melloni, G, Bandiera, A, Gregorc, V, Carretta, A, Ciriaco, P, Viganò, Mg, Franzin, A, Bolognesi, A, Picozzi, P, and Zannini, P

Subjects
Adult, Male, Lung Neoplasms, Time Factors, Kaplan-Meier Estimate, Risk Assessment, Neurosurgical Procedures, Fluorodeoxyglucose F18, Risk Factors, Carcinoma, Non-Small-Cell Lung, Odds Ratio, Humans, Pneumonectomy, Aged, Proportional Hazards Models, Retrospective Studies, Brain Neoplasms, Middle Aged, Survival Rate, Treatment Outcome, Italy, Chemotherapy, Adjuvant, Positron-Emission Tomography, Female, Radiotherapy, Adjuvant, Radiopharmaceuticals, Tomography, X-Ray Computed
Abstract

Aim. The aim of this study was to analyze our experience with combined treatment of non-small cell lung cancer with synchronous brain metastases. Methods. Between 1992 and 2008, 31 patients were treated by performing neurosurgery (or stereotactic radiosurgery) and lung surgery. Patients were divided into two groups according to their preoperative mediastinal work-up: group A (CT scan) and group B (FDG-PET scan). Results. Twenty-six patients had one brain metastasis and five had two. Neurosurgery was performed in 10 patients, stereotactic radiosurgery in 20 and both approaches in 1. Seven patients underwent chemotherapy after cerebral procedure. Pulmonary resection was complete in 27 cases and incomplete in 4. Histological findings showed: adenocarcinoma in 19 cases, squamous cell carcinoma in 8 and large cell carcinoma in 4. All patients underwent adjuvant chemotherapy. Overall 1, 2 and 5-year survival rates were 83%, 47% and 21%, respectively. The median survival was 22 months. Univariate analysis showed a better prognosis for complete resection (P=0.008), adenocarcinomas (P=0.015), N0 disease (P=0.038), and Group B (P=0.045). Multivariate analysis showed that only the radicality of the resection (P=0.027) and Group B (P=0.047) were independent prognostic factors. Conclusion. Our experience confirms that selected patients with non-small cell lung cancer and synchronous brain metastases may be effectively treated by combined therapy. Complete resection, adenocarcinoma histology and NO disease were prognostic factors. The incorporation of FDG-PET scan into the preoperative work-up may translate into a survival benefit.

132. Efficacy of Ketorolac Tromethamine and Extrapleural Intercostal Nerve Block on Post-Thoracotomy Pain: A Prospective, Randomized Study

Author

angelo carretta, Zannini, P., Chiesa, G., Altese, R., Melloni, G., Grossi, A., Zannini, Piero, Chiesa, G, Altese, R, Melloni, G, Grossi, A., and Carretta, Angelo

Subjects
Male, Pain, Postoperative, Dose-Response Relationship, Drug, Meperidine, Anti-Inflammatory Agents, Non-Steroidal, Nerve Block, Middle Aged, Bupivacaine, Drug Administration Schedule, Ketorolac Tromethamine, Analgesics, Opioid, Thoracotomy, Humans, Intercostal Nerves, Prospective Studies, Tolmetin, Tromethamine, Lung Volume Measurements, Pneumonectomy, Aged, Pain Measurement
Abstract

Background. Post-thoracotomy pain causes severe impairment of the respiratory function, Epidural analgesia is effective in the treatment of post-thoracotomy pain but may give rise to significant side-effects, Other low-risk and cost-effective analgesic treatments are therefore required. Methods. Thirty male patients who had undergone pulmonary Iobectomy entered a prospective, randomized trial to evaluate the efficacy of ketorolac tromethamine (Group 2) and extrapleural intercostal nerve block (Group 3) with intermittent low-dose bupivacaine, Objective and subjective assessment was carried out at 8, 16, 24 and 48 hours postoperatively. Results. There were no significant differences between Groups 1 (control group) and 2, Vital capacity was significantly lower in Group 3 (p

133. [The use of high resolution computerized tomography (HRCT) for the diagnosis of rejection and for monitoring air-way anastomosis in patients who have undergone lung transplantation. Preliminary study]

Author

Melloni G, Zannini P, Solca M, Baisi A, Nastri G, Angelo Vanzulli, Del Maschio A, Melloni, G, Zannini, P, Solca, M, Baisi, A, Nastri, G, Vanzulli, A, and DEL MASCHIO, Alessandro

Subjects
Adult, Graft Rejection, Male, Anastomosis, Surgical, Bronchi, Bronchography, Middle Aged, Humans, Female, Tomography, X-Ray Computed, Bronchiolitis Obliterans, Follow-Up Studies, Lung Transplantation, Monitoring, Physiologic
Abstract

March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent high-resolution CT (HRCT) of the lung in a complex follow-up program to identify specific abnormalities of acute and chronic rejection (bronchiolitis obliterans) and to monitor the resolution of the bronchial anastomosis. Twenty-two HRCT exams were performed. In patients with acute rejection HRCT failed to identify specific abnormalities of lung parenchyma. In contrast, in one patient with pathological evidence of early bronchiolitis obliterans HRCT showed decreased peripheral vascularization. In the study of the bronchial anastomosis, HRCT showed optimal anastomosis resolution in 4 patients, whereas in one patient with a granuloma demonstrated by fibrobronchoscopy it confirmed the lesion showing also a small pneumomediastinum. Even though the HRCT finding of decreased peripheral vascularization does not appear to be specific for bronchiolitis obliterans, it may be of value in suggesting the diagnosis of early bronchiolitis obliterans in lung transplant. HRCT should be used in all patients with bronchoscopic diagnosis of bronchial complication to study the lesion and its mediastinal spread.

136. MAPPING WHOLE-EXOME SEQUENCING DATA OF ACUTE MYELOID LEUKEMIA PATIENTS INTO KEGG PATHWAYS

Author

Padella, A., Simonetti, G., Iacobucci, I., Dovalle, I., Zago, E., Griggio, F., Garonzi, M., Manfrini, M., Guadagnuolo, V., Bernardi, S., CRISTINA PAPAYANNIDIS, Abbenante, M. C., Marconi, G., Melloni, G., Riva, L., Bruno, S., Fontana, M. C., Zuffa, E., Franchini, E., Baldazzi, C., Cavo, M., Testoni, N., Ottaviani, E., Pellicci, P. G., Sazzini, M., Ferrarini, A., Delledonne, M., Remondini, D., and Martinelli, G.

141. WHOLE EXOME SEQUENCING IDENTIFIES MUTATIONS OF ALDH2, IMPDH2, RETSAT, HSPG2, CHPF AND OTHER METABOLIC GENES AS A NOVEL FUNCTIONAL CATEGORY OF GENOMIC ALTERATIONS IN ACUTE MYELOID LEUKEMIA

Author

Simonetti, G., Padella, A., Iacobucci, I., Dovalle, I., Fontanarosa, G., Zago, E., Griggio, F., Garonzi, M., Bernardi, S., CRISTINA PAPAYANNIDIS, Abbenante, M. C., Marconi, G., Melloni, G., Riva, L., Guadagnuolo, V., Fontana, M. C., Bruno, S., Ferrari, A., Zuffa, E., Franchini, E., Astolfi, A., Baldazzi, C., Dan, E., Sinigaglia, B., Cavo, M., Testoni, N., Ottaviani, E., Pelicci, P. G., Sazzini, M., Ferrarini, A., Delledonne, M., Remondini, D., and Martinelli, G.

149. The use of high resolution computerized tomography (HRCT) for the diagnosis of rejection and for monitoring air-way anastomosis in patients who have undergone lung transplantation. Preliminary study,L'impiego della Tomografia Computerizzata ad alta risoluzione (HRCT) per la diagnosi di rigetto e per il monitoraggio dell'anastomosi sulla via aerea nei pazienti sottoposti a trapianto di polmone. Studio preliminare

Author

Melloni, G., Zannini, P., Solca, M., ALESSANDRO BAISI, Nastri, G., Vanzulli, A., and Del Maschio, A.

150. EUROPEAN NETWORK NGS-PTL PRELIMINARY DATA: WHOLE EXOME SEQUENCING IDENTIFIES MUTATIONS OF ALDH2, RETSAT, HSPG2, CHPF, AND OTHER METABOLIC GENES AS A NOVEL FUNCTIONAL CATEGORY IN ACUTE MYELOID LEUKEMIA

Author

Simonetti, G., Padella, A., Iacobucci, I., Dovalle, I., Fontanarosa, G., Zago, E., Griggio, F., Garonzi, M., Bernardi, S., CRISTINA PAPAYANNIDIS, Abbenante, M. C., Marconi, G., Melloni, G., Riva, L., Guadagnuolo, V., Fontana, M., Bruno, S., Zuffa, E., Franchini, E., Astolfi, A., Baldazzi, C., Dan, E., Sinigaglia, B., Cavo, M., Testoni, N., Ottaviani, E., Pelicci, P. G., Sazzini, M., Ferrarini, A., Delledonne, M., Remondini, D., and Martinelli, G.

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