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Background: The clinical significance of lymph-node metastases, multicentric forms, and tumorlets in bronchial carcinoids is still a matter of debate. Aim of this study was to analyze their prevalence and clinical significance in a series of 123 bronchial carcinoids. Patients and Methods: Nodal dissection and serial sections of resected lung parenchima for research of multicentric forms and tumorlets were performed in most patients. Survival curve was produced using the Kaplan-Meyer method and multivariate analysis by the Cox proportional hazard model. Results: Lymph-node involvement was present in 14% of typical (14 of 100) and 13.04% of atypical carcinoids (3 of 23). Multicentric forms (syncronous carcinoids or tumorlets) were found in 11.3% of the total with a negative impact on survival (p = 0.021). Multiple tumorlets were found in 7.3% of all cases at the standard pathologic examination, but whenever accurate palpation and serial sections of the surgical specimen were performed, the percentage reached 24% of the cases. Overall survival was 98.2%, 95.8%, and 83.9% for typical and 71.6%, 57.3%, and 24% for atypical carcinoid respectively at 5, 10, and 15 years. Time from surgery was significantly directly correlated with recurrences (p < 0.0001) and disease related death (p = 0.0002). Conclusions: A high prevalence of tumorlets, multiple carcinoids, and lymph-nodal involvement was found in our series. On the basis of these observations bronchial carcinoids always require major surgical procedures with systematic nodal dissection, and a careful search for multifocal lesions should always be performed. Follow-up should always be accurate and protracted, due to the frequency of very long-term relapses (often more than 10 years after surgery). © 2009 by the International Association for the Study of Lung Cancer

Introduction: Uterine leiomyomas belong to a heterogeneous family of tumors with peculiar biological behaviour. Pulmonary metastases may originate from frankly malignant leiomyomas (sarcomas) as well as from so called benign metastasizing leiomyomas. Latency between hysterectomy and metastatic disease may vary from few months to several years. We report two cases with an exceptionally long latent period. Methods: Two cases of apparently primary giant lung tumor were observed. Both presenting clinical history of fever and malaise. Chest x-ray showed in both cases a left pulmonary opacity. Preoperative work-up yielded the diagnosis respectively of epithelial and mesenchymal tumor without extrapulmonary localization (CT and PET-CT). Results: Case N 1: 68 year-old (Z.A.), the giant lobulated tumor, invading the hilar structures, required a left pneumonectomy. Histology revealed a metastatic uterine leiomyoma. She had under- gone hysterectomy for multiple leiomyomas 21 years previously. Case N 2: 66 year-old (M.M), was submitted to left pneumonectomy for a giant tumor extended to both lobes. Also in this case metastasis from uterine leiomyoma was diagnosed and confirmed by comparison with histology from hysterectomy (performed 16 years previously). There was no peri-operative mortality. Both the patients are alive without evidence of disease 6 and 3 months after surgery. Discussion: These cases suggest that the diagnosis of primary pulmonary sarcoma needs careful pathological assessment and follow-up of the patients submitted to hysterectomy for leiomyoma should be protracted.

Introduction: Different etiologies are responsible for a wide spectrum of tracheal injuries. Some of these, such as cicatricial laryngo-tracheal stenosis and tracheoesophageal fistula (T-E) not rarely represent a challenge in tracheal surgery. Aim of this study is to retrospectively review the pattern of post-intubation lesions, extension of surgery and long term results in 49 patients. Methods: From December 1987 to February 2007, 49 patients (23 males and 26 females), mean age 50 (range 15–78), were submit- ted to surgical treatment: cicatricial tracheal stenosis (Group A), T-E fistula (Group B), and tracheal tear (Group C). All patients were symptomatic. Results: No post-operative deaths. In Group A (n = 34) the stricture was considered moderate (residual lumen:30–50%) in 27 patients, and severe (

Citato 156 volte in letteratura internazionale (Fonte: www.scopus.com). Citato 143 volte in letteratura internazionale (Fonte: apps.webofknowledge.com). Citato 212 volte in letteratura internazionale (Fonte: http://scholar.google.com/) Studio multicentrico. I membri dei vari centri sono indicati singolarmente in quota al proprio dipartimento universitario/centro di appartenenza nel paragrafo "Acknowledgment". Abstract Summary Background Data: The epidemiology of venous thromboembolism (VTE) after cancer surgery is based on clinical trials on VTE prophylaxis that used venography to screen deep vein thrombosis (DVT). However, the clinical relevance of asymptomatic venography-detected DVT is unclear, and the population of these clinical trials is not necessarily representative of the overall cancer surgery population. Objective: The aim of this study was to evaluate the incidence of clinically overt VTE in a wide spectrum of consecutive patients undergoing surgery for cancer and to identify risk factors for VTE. Methods: @RISTOS was a prospective observational study in patients undergoing general, urologic, or gynecologic surgery. Patients were assessed for clinically overt VTE occurring up to 30 ± 5 days after surgery or more if the hospital stay was longer than 35 days. All outcome events were evaluated by an independent Adjudication Committee. Results: A total of 2373 patients were included in the study: 1238 (52%) undergoing general, 685 (29%) urologic, and 450 (19%) gynecologic surgery. In-hospital prophylaxis was given in 81.6% and postdischarge prophylaxis in 30.7% of the patients. Fifty patients (2.1%) were adjudicated as affected by clinically overt VTE (DVT, 0.42%; nonfatal pulmonary embolism, 0.88%; death 0.80%). The incidence of VTE was 2.83% in general surgery, 2.0% in gynecologic surgery, and 0.87% in urologic surgery. Forty percent of the events occurred later than 21 days from surgery. The overall death rate was 1.72%; in 46.3% of the cases, death was caused by VTE. In a multivariable analysis, 5 risk factors were identified: age above 60 years (2.63, 95% confidence interval, 1.21-5.71), previous VTE (5.98, 2.13-16.80), advanced cancer (2.68, 1.37-5.24), anesthesia lasting more than 2 hours (4.50, 1.06-19.04), and bed rest longer than 3 days (4.37, 2.45-7.78). Conclusions: VTE remains a common complication of cancer surgery, with a remarkable proportion of events occurring late after surgery. In patients undergoing cancer surgery, VTE is the most common cause of death at 30 days after surgery. Copyright © 2005 by Lippincott Williams & Wilkins.

The main topic of the paper concerns multifunctional farms, their activities and motivations for starting up, and on the other hand visitor satisfaction. To this purpose, a preliminary sample survey was carried out addressed to 13 farms in 3 Sicilian provinces. The aim was to identify positive and negative aspects of the services offered. The most relevant findings of the survey are the variety of activities and services, a widespread use of internet services, efficient means of communications and a significant growth in labour force. On the other side, long time is generally needed in order to obtain administrative authorizations or to carry out farm plants, as well as excessive pay-back time.

The bronchial tree represents the most frequent site of origin of carcinoids (around 25% of the total). The spectrum of differentiation of lung neuroendocrine tumors ranges from low-malignancy (carcinoids) to highly aggressive forms (small cell lung carcinoma) Diagnostic and therapeutic strategies therefore vary greatly. In well differentiated tumors (carcinoids) signs and symptoms are related to the airways obstruction in central forms, while peripheral forms are mostly discovered accidentally if asymptomatic. Clinical or subclinical paraneoplastic syndromes are associated in a minority of cases. Diagnostic work-up includes CT multislice, bronchial endoscopy and Octreoscan with chest Single Photon Emission Computed Tomography (SPECT). Further contribute may be added by the (68), Ga-DOTA-D-Phe(1)-Tyr(3)-ocreotide (DOTATOC) and 5-hydroxytryptophan (5-HTP) PET-CT, at present available only in a few centres, and by endobronchial ultrasound (EBUS), fluorescence bronchoscopy and virtual bronchoscopy. Surgery is the treatment of choice, while medical therapy is useful to treat the hypersecretion in paraneoplastic syndromes and to control tumor proliferation in metastatic or/and inoperable disease.