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11. Epidemiology and management of primary spontaneous pneumothorax: a systematic review

Author

Mendogni, P, Vannucci, J, Ghisalberti, M, Anile, M, Aramini, B, Congedo, Mt, Nosotti, M, Bertolaccini, L, Collaborators of the Pneumothorax Working Group, on behalf of the Italian Society for Thoracic Surgery (endorsed by the Italian Ministry of Health) Collaborators of the Pneumothorax Working Group, D'Ambrosio, Ae, De Vico, A, Guerrera, F, Imbriglio, G, Pardolesi, A, Schiavon, M, Russo, E., Mendogni P, Vannucci J, Ghisalberti M, Anile M, Aramini B, Congedo MT, Nosotti M, Bertolaccini L, Collaborators of the Pneumothorax Working Group, on behalf of the Italian Society for Thoracic Surgery (endorsed by the Italian Ministry of Health) Collaborators of the Pneumothorax Working Group, D'Ambrosio AE, De Vico A, Guerrera F, Imbriglio G, Pardolesi A, Schiavon M, and Russo E.

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Video-assisted, Guidelines, Global Health, Conservative treatment, Diagnostic imaging, Primary spontaneous pneumothorax, Systematic review, Thoracic surgery, Epidemiology, primary spontaneous pneumothorax, systematic review, Medicine, Humans, Lung emphysema, Thoracotomy, Intensive care medicine, Pleurodesis, First episode, Cannabis smoking, business.industry, Thoracic Surgery, Video-Assisted, Incidence, Pneumothorax, medicine.disease, eye diseases, Talc, Chest Tubes, Video-assisted thoracoscopic surgery, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

Primary spontaneous pneumothorax (PSP) is one of the most common thoracic diseases affecting adolescents and young adults. Despite the high incidence of PSP and the availability of several international guidelines for its diagnosis and treatment, a significant behavioural heterogeneity can be found among those management recommendations. A working group of the Italian Society of Thoracic Surgery summarized the best evidence available on PSP management with the methodological tool of a systematic review assessing the quality of previously published guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II. Concerning PSP physiopathology, the literature seems to be equally divided between those who support the hypothesis of a direct correlation between changes in atmospheric pressure and temperature and the incidence of PSP, so it is not currently possible to confirm or reject this theory with reasonable certainty. Regarding the choice between conservative treatment and chest drainage in the first episode, there is no evidence on whether one option is superior to the other. Video-assisted thoracic surgery represents the most common and preferred surgical approach. A primary surgical approach to patients with their first PSP seems to guarantee a lower recurrence rate than that of a primary approach consisting of a chest drainage positioning; conversely, the percentage of futile surgical interventions that would entail this aggressive attitude must be carefully evaluated. Surgical pleurodesis is recommended and frequently performed to limit recurrences; talc poudrage offers efficient pleurodesis, but a considerable number of surgeons are concerned about administering this inert material to young patients. Clinical trial registration number International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084247.

Published
2019

12. METTL3-dependent MALAT1 delocalization drives c-Myc induction in thymic epithelial tumors

Author

Iaiza, A., Tito, C., Ianniello, Z., Ganci, F., Laquintana, V., Gallo, E., Sacconi, A., Masciarelli, Silvia, De Angelis, L., Aversa, S., Diso, D., Anile, M., Petrozza, V., Facciolo, F., Melis, E., Pescarmona, E., Venuta, F., Marino, M., Blandino, G., Fontemaggi, G., Fatica, A., Fazi, F., Masciarelli S., Iaiza, A., Tito, C., Ianniello, Z., Ganci, F., Laquintana, V., Gallo, E., Sacconi, A., Masciarelli, Silvia, De Angelis, L., Aversa, S., Diso, D., Anile, M., Petrozza, V., Facciolo, F., Melis, E., Pescarmona, E., Venuta, F., Marino, M., Blandino, G., Fontemaggi, G., Fatica, A., Fazi, F., and Masciarelli S.

Abstract

Background: Thymic epithelial tumors (TETs) are rare neoplasms, originating from epithelial thymic cells. The oncogenic potential of these rare neoplasms is still largely undefined, and a deeper molecular characterization could result in a relevant advance in their management, greatly improving diagnosis, prognosis and treatment choice. Deregulation of N6-methyladenosine (m6A) RNA modification, catalyzed by the METTL3/METTL14 methyltransferase complex, is emerging as a relevant event in cell differentiation and carcinogenesis. Various studies have reported that altered expression of METTL3 is associated with an aggressive malignant phenotype and favors migration and invasiveness, but its role in Thymic Tumors remains unknown. Results: In this study, we characterized that METTL3 contributes to Thymic Epithelial Tumor phenotype. We evidenced that METTL3 is overexpressed in tumor tissue compared to normal counterpart. Silencing of METTL3 expression in thymic carcinoma cells results in reduced cell proliferation and overall translation rate. Of note, METTL3 is responsible for the induction of c-MYC expression in TET cells. Specifically, high expression of c-MYC protein is enabled by lncRNA MALAT1, which is methylated and delocalized by METTL3. Interestingly, blocking of c-MYC by using JQ1 inhibitor cooperates with METTL3 depletion in the inhibition of proliferation and induction of cell death. Conclusion: This study highlighted METTL3 as a tumor promoter in Thymic tumors and c-MYC as a promising target to be exploited for the treatment of TET.

Published
2021

17. LINC00174 is a novel prognostic factor in thymic epithelial tumors involved in cell migration and lipid metabolism

Author

Tito, C., Ganci, F., Sacconi, A., Masciarelli, Silvia, Fontemaggi, G., Pulito, C., Gallo, E., Laquintana, V., Iaiza, A., De Angelis, L., Benedetti, A., Cacciotti, J., Miglietta, S., Bellenghi, M., Care, A., Fatica, A., Diso, D., Anile, M., Petrozza, V., Facciolo, F., Alessandrini, G., Pescarmona, E., Venuta, F., Marino, M., Blandino, G., Fazi, F., Masciarelli S., Tito, C., Ganci, F., Sacconi, A., Masciarelli, Silvia, Fontemaggi, G., Pulito, C., Gallo, E., Laquintana, V., Iaiza, A., De Angelis, L., Benedetti, A., Cacciotti, J., Miglietta, S., Bellenghi, M., Care, A., Fatica, A., Diso, D., Anile, M., Petrozza, V., Facciolo, F., Alessandrini, G., Pescarmona, E., Venuta, F., Marino, M., Blandino, G., Fazi, F., and Masciarelli S.

Abstract

Long non-coding RNAs are emerging as new molecular players involved in many biological processes, such as proliferation, apoptosis, cell cycle, migration, and differentiation. Their aberrant expression has been reported in variety of diseases. The aim of this study is the identification and functional characterization of clinically relevant lncRNAs responsible for the inhibition of miR-145-5p, a key tumor suppressor in thymic epithelial tumors (TETs). Starting from gene expression analysis by microarray in a cohort of fresh frozen thymic tumors and normal tissues, we identified LINC00174 as upregulated in TET. Interestingly, LINC00174 expression is positively correlated with a 5-genes signature in TETs. Survival analyses, performed on the TCGA dataset, showed that LINC00174 and its associated 5-genes signature are prognostic in TETs. Specifically, we show that LINC00174 favors the expression of SYBU, FEM1B, and SCD5 genes by sponging miR-145-5p, a well-known tumor suppressor microRNA downregulated in a variety of tumors, included TETs. Functionally, LINC00174 impacts on cell migration and lipid metabolism. Specifically, SCD5, one of the LINC00174-associated genes, is implicated in the control of lipid metabolism and promotes thymic cancer cells migration. Our study highlights that LINC00174 and its associated gene signature are relevant prognostic indicators in TETs. Of note, we here show that a key controller of lipid metabolism, SCD5, augments the migration ability of TET cells, creating a link between lipids and motility, and highlighting these pathways as relevant targets for the development of novel therapeutic approaches for TET.

Published
2020

18. Prognostic factors of lung cancer in lymphoma survivors (the LuCiLyS study)

Author

Fiorelli, A., D'Andrilli, A., Carlucci, A., Vicidomini, G., Loizzi, D., Ardo, N. P., Marasco, R. D., Ventura, L., Ampollini, L., Carbognani, P., Bocchialini, G., Lococo, F., Paci, M., Di Stefano, T. S., Ardissone, F., Gagliasso, M., Mendogni, P., Rosso, L., Mazzucco, A., Vanni, C., Marinucci, B. T., Potenza, R., Matricardi, A., Ragusa, M., Tassi, V., Anile, M., Poggi, C., Serra, N., Sica, A., Nosotti, M., Sollitto, F., Venuta, F., Rendina, E. A., Puma, F., Santini, M., Lococo F. (ORCID:0000-0002-9383-5554), Fiorelli, A., D'Andrilli, A., Carlucci, A., Vicidomini, G., Loizzi, D., Ardo, N. P., Marasco, R. D., Ventura, L., Ampollini, L., Carbognani, P., Bocchialini, G., Lococo, F., Paci, M., Di Stefano, T. S., Ardissone, F., Gagliasso, M., Mendogni, P., Rosso, L., Mazzucco, A., Vanni, C., Marinucci, B. T., Potenza, R., Matricardi, A., Ragusa, M., Tassi, V., Anile, M., Poggi, C., Serra, N., Sica, A., Nosotti, M., Sollitto, F., Venuta, F., Rendina, E. A., Puma, F., Santini, M., and Lococo F. (ORCID:0000-0002-9383-5554)

Abstract

Background: Second cancer is the leading cause of death in lymphoma survivors, with lung cancer representing the most common solid tumor. Limited information exists about the treatment and prognosis of second lung cancer following lymphoma. Herein, we evaluated the outcome and prognostic factors of Lung Cancer in Lymphoma Survivors (the LuCiLyS study) to improve the patient selection for lung cancer treatment. Methods: This is a retrospective multicentre study including consecutive patients treated for lymphoma disease that subsequently developed non-small cell lung cancer (NSCLC). Data regarding lymphoma including age, symptoms, histology, disease stage, treatment received and lymphoma status at the time of lung cancer diagnosis, and data on lung carcinoma as age, smoking history, latency from lymphoma, symptoms, histology, disease stage, treatment received, and survival were evaluated to identify the significant prognostic factors for overall survival. Results: Our study population included 164 patients, 145 of which underwent lung cancer resection. The median overall survival was 63 (range, 58-85) months, and the 5-year survival rate 54%. At univariable analysis no-active lymphoma (HR: 2.19; P=0.0152); early lymphoma stage (HR: 1.95; P=0.01); adenocarcinoma histology (HR: 0.59; P=0.0421); early lung cancer stage (HR: 3.18; P<0.0001); incidental diagnosis of lung cancer (HR: 1.71; P<0.0001); and lung cancer resection (HR: 2.79; P<0.0001) were favorable prognostic factors. At multivariable analysis, no-active lymphoma (HR: 2.68; P=0.004); early lung cancer stage (HR: 2.37; P<0.0001); incidental diagnosis of lung cancer (HR: 2.00; P<0.0001); and lung cancer resection (HR: 2.07; P<0.0001) remained favorable prognostic factors. Patients with non-active lymphoma (n=146) versus those with active lymphoma (n=18) at lung cancer diagnosis presented better median survival (64 vs. 37 months; HR: 2.4; P=0.02), but median lung cancer specific survival showed

Published
2020

20. Inflammatory myofibroblastic tumor after lung transplant-A rare and aggressive complication. A case report

Author

Poggi, C., Pecoraro, Y., Carillo, C., Anile, M., Amore, D., Mantovani, S., Naldi, G., Pagini, A., Bassi, M., Cagnetti, S., Mottola, E., D&apos, Agostino, F., Vannucci, J., Pernazza, A., Cimino, G., Savi, D., Gomellini, S., Pugliese, F., De Giacomo, T., Rendina, E. A., Venuta, F., and Diso, D.

Subjects
Adult, Male, medicine.medical_specialty, lung transplantation, inflammatory myofibroblastic tumor, cystic fibrosis, medicine.medical_treatment, Bronchopleural fistula, Plasma Cell Granuloma, Pulmonary, Lesion, Immunocompromised Host, Pneumonectomy, Biopsy, medicine, Humans, Lung transplantation, Endobronchial Lesion, Cystic Fibrosis, Female, Lung Transplantation, Transplantation, medicine.diagnostic_test, business.industry, medicine.disease, Plasma cell granuloma, Empyema, Surgery, Radiology, medicine.symptom, business
Abstract

Introduction Malignant diseases are well-known complications after lung transplantation (LT). Among these, inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with a not well-known and often aggressive biological behavior. Material and Methods We hereby describe 2 cases of cystic fibrosis patients who underwent bilateral sequential LT (BSLT) complicated by IMT. Results A 26-year-old man presented a right endobronchial lesion 6 months after BSLT. Two consecutive fiber bronchoscopic biopsies showed granulation tissue. For the persistent lesion growth, the patient underwent a transthoracic biopsy showing histologic diagnosis of IMT. Therefore, he underwent to right pneumonectomy that was unfortunately complicated after 6 months with a late bronchopleural fistula and empyema with exitus 6 months later. A 31-year-old woman 1 year after BSLT presented with a left voluminous pleural-parenchymal lesion; the histologic examination after biopsy revealed an IMT. She underwent a removal of the lesion with a macroscopic R0 resection. Histologic, immunophenotypic, and cytogenetic examinations showed a strong overexpression of anaplastic lymphoma kinase requiring biological adjuvant therapies; however, the patient refused it. Four years later, she presented a recurrence treated with debulking procedure and adjuvant radiotherapy. At last follow-up, the patient was alive with stable disease and optimal graft function. Conclusions Although IMT is a rare complication after lung transplant, to obtain a careful diagnosis, an early and aggressive treatment is mandatory.

Published
2019

26. F-075THE COST/BENEFIT OF UNIDIRECTIONAL ENDOBRONCHIAL VALVES IMPLANT FOR MANAGEMENT OF PERSISTENT AIR-LEAKS: RESULTS OF A MULTICENTRE STUDY

Author

Fiorelli, Alfonso, primary, D’Andrilli, A, additional, Anile, M, additional, Cascone, R, additional, Occhiati, L, additional, Diso, D, additional, Cassiano, F, additional, Poggi, C, additional, Ibrahim, M, additional, Cusumano, G, additional, Terminella, A, additional, Failla, G, additional, La Sala, A, additional, Bezzi, M, additional, Innocenti, M, additional, Torricelli, E, additional, Venuta, F, additional, Rendina, E A, additional, Santini, M, additional, and Andreetti, C, additional

Published
2017
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28. Thymic Epithelial Tumors phenotype relies on miR-145-5p epigenetic regulation

Author

Bellissimo, T., Ganci, F., Gallo, E., Sacconi, A., Tito, C., De Angelis, L., Pulito, C., Masciarelli, Silvia, Diso, D., Anile, M., Petrozza, V., Giangaspero, F., Pescarmona, E., Facciolo, F., Venuta, F., Marino, M., Blandino, G., Fazi, F., Masciarelli S., Bellissimo, T., Ganci, F., Gallo, E., Sacconi, A., Tito, C., De Angelis, L., Pulito, C., Masciarelli, Silvia, Diso, D., Anile, M., Petrozza, V., Giangaspero, F., Pescarmona, E., Facciolo, F., Venuta, F., Marino, M., Blandino, G., Fazi, F., and Masciarelli S.

Abstract

Background: Thymoma and thymic carcinoma are the most frequent subtypes of thymic epithelial tumors (TETs). A relevant advance in TET management could derive from a deeper molecular characterization of these neoplasms. We previously identified a set of microRNA (miRNAs) differentially expressed in TETs and normal thymic tissues and among the most significantly deregulated we described the down-regulation of miR-145-5p in TET. Here we describe the mRNAs diversely regulated in TETs and analyze the correlation between these and the miRNAs previously identified, focusing in particular on miR-145-5p. Then, we examine the functional role of miR-145-5p in TETs and its epigenetic transcriptional regulation. Methods: mRNAs expression profiling of a cohort of fresh frozen TETs and normal tissues was performed by microarray analysis. MiR-145-5p role in TETs was evaluated in vitro, modulating its expression in a Thymic Carcinoma (TC1889) cell line. Epigenetic transcriptional regulation of miR-145-5p was examined by treating the TC1889 cell line with the HDAC inhibitor Valproic Acid (VPA). Results: Starting from the identification of a 69-gene signature of miR-145-5p putative target mRNAs, whose expression was inversely correlated to that of miR-145-5p, we followed the expression of some of them in vitro upon overexpression of miR-145-5p; we observed that this resulted in the down-regulation of the target genes, impacting on TETs cancerous phenotype. We also found that VPA treatment of TC1889 cells led to miR-145-5p up-regulation and concomitant down-regulation of miR-145-5p target genes and exhibited antitumor effects, as indicated by the induction of cell cycle arrest and by the reduction of cell viability, colony forming ability and migration capability. The importance of miR-145-5p up-regulation mediated by VPA is evidenced by the fact that hampering miR-145-5p activity by a LNA inhibitor reduced the impact of VPA treatment on cell viability and colony forming ability of TET

Published
2017

30. The IASLC/ITMIG thymic malignancies staging project: development of a stage classification for thymic malignancies

Author

Detterbeck, Fc1, Asamura, H, Crowley, J, Falkson, C, Giaccone, G, Giroux, D, Huang, J, Kim, J, Kondo, K, Lucchi, M, Marino, M, Marom, Em, Nicholson, A, Okumura, M, Ruffini, E, van Schil, P, Stratton, K, Staging, Prognostic Factors Committee, Members of the Advisory Boards, Goldstraw P, Participating Institutions of the Thymic D. o. m. a. i. n., Rami Porta, R, Ball, D, Beer, D, Beyruti, R, Bolejack, V, Chansky, K, Detterbeck, F, Eberhardt, W, Edwards, J, Galateau Sallé, F, Gleeson, F, Groome, P, Kennedy, C, Kim, Y, Kingsbury, L, Kondo, H, Krasnik, M, Kubota, K, Lerut, A, Lyons, G, Marom, E, van Meerbeeck, J, Mitchell, A, Nakano, T, Newman, J, Nowak, A, Peake, M, Rice, T, Rosenzweig, K, Rusch, V, Sculier, Jp, Suzuki, K, Tachimori, Y, Thomas CF Jr, Travis, W, Tsao, M, Turrisi, A, Vansteenkiste, J, Watanabe, H, Wu, Yi, Zielinski, M, Filosso, L, Baas, P, Erasmus, J, Hasegawa, S, Inai, K, Kernstine, K, Kindler, H, Krug, L, Nackaerts, K, Pass, H, Rice, D, Blackstone, E, Call Caja, S, Ahmad, U, Girard, N, Haam, Sj, Bae, Mk, Gomez, Dr, Ströbel, P, Marx, A, Saita, S, Wakelee, H, Bertolaccini, L, Vallieres, E, Scott, W, Su, S, Park, B, Marks, J, Khella, S, Shen, R, Rosenberg, M, Aires, B, Tomulescu, V, Foroulis, C, Lang Lazdunski, L, Billè, A, Maessen, Jg, Keijzers, M, van Veer, H, Wright, C, Palmieri, G, Buonerba, C, Ferguson, M, Marulli, G, Loehrer, P, Kalkat, M, Rohrberg, K, Daugaard, G, Toker, A, Erus, S, Kimmich, M, Brunelli, A, Refai, M, Lim, E, Park, Ik, Wagner, J, Tieu, B, Fang, W, Zhang, J, Yu, Z, Han, Y, Li, Y, Chen, K, Chen, G, Fujii, Y, Nagai, K, Nakajima, J, Ikeda, N, Haraguchi, S, Onuki, T, Yoshino, I, Tsuchida, M, Takahashi, S, Yokoi, K, Hanyuda, M, Niwa, H, Date, H, Maniwa, Y, Miyoshi, S, Iwasaki, A, Okamoto, T, Nagayasu, T, Tanaka, F, Suzuki, M, Yoshida, K, Okuma, Y, Horio, H, Matsumura, A, Higashiyama, M, Suehisa, H, Sano, Y, Kattan, K, Cerfolio, R, Gebitekin, C, de Antonio, D, Kernstine, Kh, Altorki, N, Novoa, N, Filosso, Pl, Scarci, M, Voltolini, L, Weder, W, Zurek, W, Arame, A, Casadio, C, Toracica, C, Carbognani, P, Donati, G, Keshavjee, S, Klepetko, W, Moser, B, Lequaglie, C, Liberman, M, Mancuso, M, Nosotti, M, Spaggiari, L, Thomas, Pa, Rendina, Erino Angelo, Venuta, F, Anile, M, Schützner, J, Rocco, G., Staging Prognostic Factors Comm, University of Zurich, Detterbeck, Frank C, and Eberhardt, Wilfried (Beitragende*r)

Subjects
Pulmonary and Respiratory Medicine, Oncology, Stage classification, medicine.medical_specialty, Pathology, Lung Neoplasms, Thymoma, 10255 Clinic for Thoracic Surgery, Medizin, 610 Medicine & health, Thymic carcinoma, Internal medicine, medicine, Humans, Project management, Program Development, Lung cancer, Neoplasm Staging, business.industry, International Agencies, Thymus Neoplasms, Staging of stage classification, medicine.disease, 2740 Pulmonary and Respiratory Medicine, Interest group, 2730 Oncology, Program development, Human medicine, business
Abstract

The lack of an official-stage classification system for thymic malignancies is an issue that hampers progress in this rare disease. A collaborative effort by the International Association for the Study of Lung Cancer and the International Thymic Malignancies Interest Group is underway to develop proposals for such a system. A database of more than 10,000 cases worldwide has been assembled to provide a solid basis for analysis. This report outlines the structure of the effort and the process that has been designed.

Published
2014

33. F-035MULTIMODALITY TREATMENT OF STAGE II THYMIC TUMOURS

Author

Carillo, Carolina, primary, Anile, M., additional, Diso, D., additional, Onorati, I., additional, Mantovani, S., additional, Russo, E., additional, Pecoraro, Y., additional, De Giacomo, T., additional, Ciccone, A.M., additional, Longo, F., additional, Vitolo, D., additional, Rendina, E., additional, and Venuta, F., additional

Published
2015
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35. Preoperative anaemia does not affect the early postoperative outcome in patients with lung cancer

Author

Anile, M., Federico Venuta, Diso, D., Vitolo, D., Longo, F., Giacomo, T., Francioni, F., Liparulo, V., Ricella, C., Ruberto, F., and Coloni, G. F.

Subjects
Adult, Aged, 80 and over, Male, Lung Neoplasms, Anemia, Middle Aged, Postoperative Complications, Risk Factors, Carcinoma, Non-Small-Cell Lung, Data Interpretation, Statistical, Humans, Female, Pneumonectomy, Lung, Aged, Neoplasm Staging, Retrospective Studies
Abstract

Several prognostic factors like age, gender, histology, stage, type of operation, associated disorders and administration of induction therapy have been evaluated to assess the risk of postoperative complications and outcome in patients with resectable lung cancer. Anemia is a frequent condition in this subset of patients being estimated up to 50%. The aim of this retrospective study was to evaluate the effect of preoperative anemia on early outcome after lung cancer resection.One-hundred thirty nine consecutive patients undergoing surgery for non small cell lung cancer were retrospectively considered. The mean age was 64.8+/-11.6 years. No patient received blood transfusions or administration of erythropoetin preoperatively. Overall, we performed 96 lobectomies, 14 pneumonectomies, 2 bilobectomies and 27 atypical resections. A subset of 27 patients (19.4%) (group I) had a preoperative value of Hb less than 12 g/dl (10.4+/-1.9 g/dL). Seven patients of them were stage IA (26%), 9 stage IB (33.3%), 2 stage IIA (7.4%), 6 stage IIB (22.2%), 2 stage IIIA (7.4%) and 1 stage IIIB (3.7%). Age, gender, stage, type of operation, induction chemotherapy, comorbidities were evaluated by univariate analysis comparing patients with and without preoperative anaemia. The two groups were homogenous regarding demographic characteristics.Three patients (11.1%) in group I and 2 (1.8%) in group II required blood transfusions after surgery (P=0.01); 4 of them received pneumonectomy (P0.0001). The overall morbidity was 17.9% (25/139); the most frequent complication was persistent air leakage, followed by retention of secretions. No statistically significant difference was observed between the 2 groups about early mortality (1 patient-3.7% in group I and 2 patients-1.8% in group II) and postoperative complications (5 patients-18.5% in group I and 20 patients-17.9% in group II).Preoperative anaemia is not a risk factor for an increased rate of postoperative complications and should not be considered a contraindication to surgery.

Published
2007

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