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Pubblicazioni - Dott. Torre Massimo
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Chemotherapy-induced myasthenic crisis in thymoma treated with primary chemotherapy with curative intent on mechanical ventilation: a case report and review of the literature.
J Med Case Rep2021 Feb;15(1):32. doi: 10.1186/s13256-020-02601-8.
Patelli Giorgio, Bencardino Katia, Tosi Federica, Pugliano Mariateresa, Lanzani Francesca, Innocenti Alessandro, Rinaldo Alessandro, Mauri Gianluca, Cerea Giulio, Sartore-Bianchi Andrea, Torre Massimo, Agostoni Elio Clemente, Siena Salvatore
Abstract
BACKGROUND:
Thymoma is an uncommon cancer often associated with myasthenia gravis, an autoimmune disorder of the neuromuscular junction characterized by muscular fatigability. In patients with advanced nonmetastatic thymoma, primary chemotherapy may be required to induce tumor shrinkage and to achieve radical resection. Cancer chemotherapy has been anecdotally reported as a trigger factor for worsening of myasthenia gravis in thymic epithelial cancers. The study of uncommon cases of chemotherapy-related myasthenic crisis is warranted to gain knowledge of clinical situations requiring intensive care support in the case of life-threatening respiratory failure.
CASE PRESENTATION:
We report a case of an 18-year-old Caucasian woman with advanced Masaoka-Koga stage III type B2 thymoma and myasthenia gravis on treatment with pyridostigmine, steroids and intravenous immunoglobulins, who developed a myasthenic crisis 2 hours after initiation of cyclophosphamide/doxorubicin/cisplatin primary chemotherapy. Because of severe acute respiratory failure, emergency tracheal intubation, mechanical ventilation, and temporary (2 hours) discontinuation of chemotherapy were needed. Considering the curative intent of the multimodal therapeutic program, we elected to resume primary chemotherapy administration while the patient remained on mechanical ventilation. After 24 hours, the recovery of adequate respiratory function allowed successful weaning from respiratory support, and no further adverse events occurred. After 3 weeks, upon plasma exchange initiation with amelioration of myasthenic symptoms, a second course of chemotherapy was given, and in week 6, having documented partial tumor remission, the patient underwent radical surgery (R0) and then consolidation radiation therapy with 50.4 Gy in 28 fractions in weeks 15-20.
CONCLUSIONS:
This case report, together with the only four available in a review of the literature, highlights that chemotherapy may carry the risk of myasthenic crisis in patients affected by thymoma and myasthenia gravis. To our knowledge, this is the first reported case of chemotherapy continuation on mechanical ventilation in a patient with chemotherapy-induced myasthenic crisis requiring tracheal intubation. The lesson learned from the present case is that, in selected cases of advanced thymoma, the paradoxical worsening of myasthenia gravis during chemotherapy should not be considered an absolute contraindication for the continuation of primary chemotherapy with curative intent.
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Hospital organization and thoracic oncological patient management during the coronavirus disease-2019 outbreak: a brief report from a nationwide survey of the Italian Society of Thoracic Surgery.
Interact Cardiovasc Thorac Surg2020 12;31(6):895-899. doi: 10.1093/icvts/ivaa204.
Viggiano Domenico, Lococo Filippo, Dell'Amore Andrea, Crisci Roberto, Torre Massimo, Rea Federico, Muriana Giovanni,
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic has made us aware of the weaknesses and often the inadequacies of our current technologies and practices and has presented us with a huge challenge: to reorganize the way we work and sometimes even think, in order to ensure the safety of our patients. The Italian Society of Thoracic Surgery has launched various initiatives in response to the COVID-19 pandemic, aimed at facilitating the exchange of information, strategies and personal experiences between institutions. This article presents the results of a survey amongst all Italian thoracic surgery units accredited to SICT, with the aim of providing a glimpse of the current working conditions in these units, and an understanding of the impact of COVID-19 on their daily activities and patient care.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Pulmonary Resection for Metastasis of Hepatocellular Carcinoma Recurring After Liver Transplant: An Italian Multicenter Experience.
Front Oncol2020 ;10():381. doi: 10.3389/fonc.2020.00381.
Invenizzi Federica, Iavarone Massimo, Donato Maria Francesca, Mazzucco Alessandra, Torre Massimo, Conforti Serena, Rimessi Arianna, Zavaglia Claudio, Schiavon Marco, Comacchio Giovanni, Rea Federico, Boetto Riccardo, Cillo Umberto, Dondossola Daniele, De Carlis Luciano, Lampertico Pietro, Nosotti Mario, Mendogni Paolo
Abstract
Liver transplantation (LT) is a validated treatment for hepatocellular carcinoma (HCC). HCC recurrence occurred between 8 and 20% of patients and lung is the most frequent site. Pulmonary metastases resection (PMR) prolongs survival, however in LT-setting the impact on survival is unclear. To give new lights on this issue, we report the experience of three Italian LT Centers. All consecutive HCC transplanted patients in three Italian LT Centers, who developed pulmonary metastasis from HCC (PM-HCC), as first metastasis, from 2008 to 2018, were included whenever treated with PMR. Twenty-five patients were enrolled (median age 58 yrs, 84% male, 3% cirrhotics). HCC recurred after 34 months (9-306) since LT and PMR was performed after 2.4 months (0-43.1). A total of 28 PMR (19 single resections; 9 multiple resections; 16 right; 2 left) have been performed on 24 patients while in one case percutaneous microwave ablation (MWA) was preferred. Four patients have been re-operated due to pulmonary HCC-recurrence after surgery. The majority of surgical resection type was wedge resection (26, 89%). Surgical access was: video-assisted thoracic surgery (VATS) in 17 cases (59%); thoracotomy in 11 (38%); MWA in 1 (3%). The 48% of nodule was in right lower lobe. Perioperative in-hospital mortality and 30 days mortality were nil; median surgical time 90 min (50-365); median post-operative overall stay 5 days (2-11). Post-operative ICU treatment was necessary in 1 case (3%) for 3 days; blood transfusions in 2 cases (7%). Overall, 5 complications (2 bleeding; 1 AKI; 1 major cardiac; 1 wound dehiscence) occurred, with an overall complications rate of 23%. Eight (32%) patients died during a follow-up after HCC recurrence of 32 months (7-213): 7 for HCC progression, 1 for severe liver failure due to chronic rejection. The 1 and 5 year cumulative probability of OS from recurrence were 100 and 43% (95%CI 12-74), respectively, with a median OS of 51 months (95%CI 24-78). Selected patients with isolated pulmonary HCC-recurrence after LT and with preserved hepatic function showed that a pulmonary metastasectomy could be efficacious in managing a PM-HCC and could give an opportunity for long-term survival.
Copyright © 2020 Invenizzi, Iavarone, Donato, Mazzucco, Torre, Conforti, Rimessi, Zavaglia, Schiavon, Comacchio, Rea, Boetto, Cillo, Dondossola, De Carlis, Lampertico, Nosotti and Mendogni.
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Complications related to endoscopic lung volume reduction for emphysema with endobronchial valves: results of a multicenter study.
J Thorac Dis2018 Oct;10(Suppl 27):S3315-S3325. doi: 10.21037/jtd.2018.06.69.
Fiorelli Alfonso, D'Andrilli Antonio, Bezzi Michela, Ibrahim Mohsen, Anile Marco, Diso Daniele, Cusumano Giacomo, Terminella Alberto, Luzzi Valentina, Innocenti Margherita, Novali Mauro, Carelli Emanuele, Freda Chiara, Natale Giovanni, Peritore Valentina, Poggi Camilla, Failla Giuseppe, Basile Marco, Mazzucca Emilia, Conforti Serena, Serra Nicola, Torre Massimo, Venuta Federico, Rendina Erino Angelo, Santini Mario, Andreetti Claudio
Abstract
Background:
Despite bronchoscopic lung volume reduction (BLVR) with valves is a minimally invasive treatment for emphysema, it can associate with some complications. We aimed at evaluating the rate and type of complications related to valve treatment and their impact on clinical outcomes.
Methods:
It is a retrospective multicenter study including all consecutive patients with severe heterogeneous emphysema undergoing BLVR with endobronchial valve treatment and developed any complications related to this procedure. The type of complication, the time of onset, the treatment required and the out-come were evaluated. Response to treatment was assessed according to the minimal clinically important difference (MCID) as follows: an improvement of ?15% in forced expiratory volume in one second (FEV); of -8% in residual volume (RV); of ?26 m in 6-minnute walking distance (6MWD); and of ?4 points on the St. George's Respiratory Questionnaire (SGRQ). Target lobe volume reduction (TLVR) ?350 mL was considered significant.
Results:
One hundred and seven out of 423 (25.3%) treated patients had complications related to valve treatment including pneumothorax (17.3%); pneumonia (1.7%), chronic obstructive pulmonary disease (COPD) exacerbation (0.9%), respiratory failure (1.4%), valve migration (2.1%), and hemoptysis (1.9%). In all cases complications resolved with appropriate treatment including removal of valves in 21/107 cases (19.6%). Patients with TLVR ?350 mL (n=64) those <350 mL (n=43) had a statistically significant higher improvement in FEV (19.0%±3.9% 3.0%±0.9%; P=0.0003); in RV (-10.0%±4.8% -4.0%±2.9%; P=0.002); in 6MWD (33.0±19.0 12.0±6.3 metres; P=0.001); and in SGRQ (-15.0±2.9 -8.0±3.5 points; P=0.01). Only patients with TLVR ?350 mL met or exceeded the MCID cut-off criteria for FEV (19.0%±3.9%), RV (-10.0%±4.8%), 6MWT (33.0±19.0 metres), and SGQR (-15.0±2.9 points). Five patients (1.2%) died during follow-up for causes not related to valves treatment neither to any of the complications described.
Conclusions:
Valve treatment is a safe and reversible procedure. The presence of complications seems not to have a significant impact on clinical outcome in patients with lobar atelectasis. Due to poor clinical conditions and possible complications, BLVR should be performed in high volume centers with a multidisciplinary approach.
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Prophylactic continuous positive airway pressure after pulmonary lobectomy: a randomized controlled trial.
J Thorac Dis2018 May;10(5):2829-2836. doi: 10.21037/jtd.2018.05.46.
Palleschi Alessandro, Privitera Emilia, Lazzeri Marta, Mariani Sara, Rosso Lorenzo, Tosi Davide, Mendogni Paolo, Righi Ilaria, Carrinola Rosaria, Montoli Matteo, Reda Marco, Torre Massimo, Santambrogio Luigi, Nosotti Mario
Abstract
Background:
Despite advances in perioperative care and surgical techniques, patients undergoing pulmonary lobectomy are still at high risk for postoperative complications. Among interventions expected to reduce complications, continuous positive airway pressure (CPAP) is a discussed option. This trial aims to test the hypothesis whether prophylactic application of CPAP following pulmonary lobectomy can reduce postoperative complications.
Methods:
The study was designed as a prospective, randomized, controlled trial. Patients with clinical stage I non-small cell lung cancer scheduled for pulmonary lobectomy were eligible and were trained for the use of CPAP interface. The control group received standard postoperative pain management and physiotherapy; in addition, the study group received CPAP (PEEP 8-12 cmHO, 2 hours thrice daily for three days).
Results:
After the appropriate selection, 163 patients were considered for the analysis: 82 patients constituted the control group, 81 the study group. The two groups were substantially comparable for preoperative parameters. The rate of postoperative complications was lower in the study group (24.7% 43.9%; P=0.015) as well as the hospital stay (6 7 days; P=0.031). The stepwise logistic regression model identified: CPAP [odd ratio (OR): 0.3026, CI: 0.1389-0.6591], smoke habits [OR: 2.5835, confidence interval (CI): 1.0331-6.4610] and length of surgery in minutes (OR: 1.0102, CI: 1.0042-1.0163) as regressors on postoperative complications.
Conclusions:
The present trial demonstrated that prophylactic application of CPAP during the postoperative period after pulmonary lobectomy for stage I non-small cell lung cancer was effective in prevent postoperative complications.
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A Smooth Esophageal Stricture Causing Dysphagia.
Dysphagia2018 Jun;33(3):399-402. doi: 10.1007/s00455-018-9891-x.
Forti Edoardo, Bonato Giulia, Dioscoridi Lorenzo, Cintolo Marcello, Pugliese Francesco, Cristoferi Laura, Tringali Alberto, Caputo Valentina, Motta Valentina, Torre Massimo Domenico, Conforti Serena, Mutignani Massimiliano
Abstract
Dysphagia in patients with lung cancer is usually due to direct invasion from bronchogenic carcinomas or nodal localizations, while metastases from distant lung neoplasms are considered rare. We report a case of a smooth esophageal narrowing secondary to intramural metastasis from pulmonary adenocarcinoma in a patient with no previous history of neoplasia. Since standard linear echoendoscope could not overpass the malignant stricture, we obtained a histological diagnosis by fine-needle aspiration biopsy using an echobronchoscope (EBUS), due to its lower diameter. The EBUS scope represents a valuable tool to obtain cytological specimens in patients with esophageal strictures.
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Self-expanding y stent for the treatment of malignant tracheobronchial stenosis. Retrospective study.
Arch Bronconeumol2016 Nov;52(11):e5-e7. doi: S0300-2896(16)30026-6.
Conforti Serena, Durkovic Sava, Rinaldo Alessandro, Gagliardone Maria Pia, Montorsi Emanuela, Torre Massimo
Abstract
Palliation of malignant tracheobronchial stenosis is challenging. Published experience with self-expanding Y-shaped stents is limited and it seems necessary to evaluate whether they improve clinical results with respect to alternative prostheses. We present a retrospective case series of 20 consecutive patients with malignant tracheobronchial stenosis that underwent placement of a single-unit, Y-shaped covered metallic stent. Outcomes were: safety of the procedure, palliation of dyspnea, complications, and survival. All stents were safely and easily placed using a rigid tracheoscope within 24hours of admission. Dyspnea was effectively palliated in all patients, and no early or late adverse stent-related events were observed. Thirty-day mortality was 40%. Median survival was 12.2 weeks. Placement of Y-shaped self-expanding stents is a safe and effective procedure for the palliation of malignant tracheobronchial stenosis, and is currently our stent of choice for this subgroup of patients.
Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.
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Cardiac metastatic melanoma: Imaging diagnostic clues.
J Cardiol Cases2015 Aug;12(2):33-36. doi: 10.1016/j.jccase.2015.03.001.
Pedrotti Patrizia, Musca Francesco, Torre Massimo, Pirola Roberto, De Biase Anna Maria, Fieschi Stefano, Quattrocchi Giuseppina, Roghi Alberto, Giannattasio Cristina
Abstract
A 47-year-old male was admitted to hospital for severe pericardial effusion; he had undergone surgical removal of cutaneous melanoma 10 years before. Echocardiography-guided pericardiocentesis revealed the presence of intramyocardial masses, which were better defined and characterized, together with pericardial involvement, by cardiac magnetic resonance. Pericardial fluid drained was negative for malignant cells, so video-assisted thoracoscopy was performed and pathologic tissue was biopsied, leading to the diagnosis of metastatic melanoma. Multidisciplinary approach and multimodality imaging played a key role in allowing the diagnostic workup in this complex case. < The diagnosis of cardiac metastases is challenging and histologic characterization is necessary to guide therapy. Multimodality imaging and minimally invasive thoracoscopy are key tools to achieve these goals.>.
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Diarrhea as sole presentation of Good's syndrome mimicking Crohn's disease.
Clin Immunol2013 Apr;147(1):9-10. doi: S1521-6616(13)00025-9.
Mancuso Andrea, Gentiluomo Maria, Vangeli Marcello, Torre Massimo Domenico, Belli Luca Saverio
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High expression of dopamine receptor subtype 2 in a large series of neuroendocrine tumors.
Cancer Biol Ther2008 Dec;7(12):1970-8.
Grossrubatscher Erika, Veronese Silvio, Ciaramella Paolo Dalino, Pugliese Raffaele, Boniardi Marco, De Carlis Luciano, Torre Massimo, Ravini Mario, Gambacorta Marcello, Loli Paola
Abstract
AIM:
To evaluate by immumohistochemistry the presence of DR subtype 2 (D2R) in well differentiated NETs of different sites and in normal islet cells.
BACKGROUND:
Recent data in vitro and in vivo support that dopaminergic drugs might exert an inhibitory effect on hormone secretion and, possibly, on tumor growth in neuroendocrine tumors (NET)s. Their potential therapeutic role needs the demonstration of dopamine receptors (DR) in tumor cells. Little is known on the expression of DR in NETs.
RESULTS:
85% of samples (100% of bronchial carcinoids and 93% of islet cell tumors) showed positivity for D2R; intensity of immunoreaction in NETs was similar or higher than in pituitary (54% and respectively 31% of cases). D2R positivity in more than 70% of tumor cells was observed in 46% of samples. Same intensity of D2R-immunoreactivity was found in pituitary and normal islet cells. No differences in D2R expression were recorded on considering tumor grading, size, proliferative activity, presence of metastases, endocrine activity and gender. A significant difference (62.5% vs 96.4%, p = 0.039) was observed in the prevalence of D2R expression between patients with more aggressive tumors and patients without recurrence/progression of disease during follow-up.
METHODS:
46 NET samples from 44 patients and normal endocrine pancreatic tissue were studied. D2R-staining was performed on NETs and compared with six non-secreting pituitary adenomas and related to clinical-pathological data.
CONCLUSION:
The present data demonstrate a high expression of D2R in NETs; this finding is of clinical relevance in view of the potential role of dopaminergic drugs in inhibiting secretion and/or cell proliferation in NETs.
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Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases.
J Neurosurg Spine2008 Nov;9(5):466-82. doi: 10.3171/SPI.2008.9.11.466.
D'Aliberti Giuseppe, Talamonti Giuseppe, Villa Fabio, Debernardi Alberto, Sansalone Cosimo Vincenzo, LaMaida Andrea, Torre Massimo, Collice Massimo
Abstract
OBJECT:
The authors report on a series of 145 consecutive patients with different types of spine lesions surgically treated via an anterior approach (AA) at the thoracic and lumbar levels during the past 10 years. Indications, techniques, and surgical results are described.
METHODS:
This series included 92 patients with fractures, 30 with neoplasms, 13 with thoracic disc hernias, and 10 with spinal infections. Based on the lesion to be addressed, the AA was used for lesion excision, corpectomy, vertebral body reconstruction with cages, realignment, and/or plating or screwing. The approach was extracavitary in 55 patients and intracavitary in 90. In 126 patients (86.8%), neural decompression and spine stabilization were achieved via a stand-alone AA (SA-AA), whereas 19 patients (13.1%) were treated using a 2-stage anteroposterior approach. This circumferential approach was reserved for select cases of severe traumatic dislocation, particular types of tumors, or specific anatomical locations. The authors developed a simple neuronavigation-based method of identifying the severely injured patients who were eligible for the SA-AA by evaluating the angle of lateral dislocation.
RESULTS:
There were no deaths and no instances of major surgery-related morbidity. Minor morbidity was almost always transitory and was reported in 13 patients (8.9%). Neurological improvement was reported in 20% of injured patients with a preoperative incomplete lesion. Postoperatively, all patients were able to stand or at least sit without load pain. During the follow-up (mean +/- standard deviation 3.8 +/- 2.4 years), there were no cases of failure, fracture, dislocation, or bending of the anterior instrumentation, and the rate of pseudarthrosis was 0%.
CONCLUSION:
The anterior route provides direct access to most spine diseases and allows optimal neural decompression and the possibility of adequate realignment and strong reconstruction/fixation. Stability of the vertebral column is achieved, resolution of clinical pain is rapid and almost complete, and the rate of surgical complications is very low. The authors assert that the SA-AA offers so many advantages and has such good results that the 2-stage anteroposterior approach can be reserved for a minority of select cases and that the time for using the posterior approach alone is over.
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Long-term results of lung cancer after heart transplantation: single center 20-year experience.
Lung Cancer2009 Jan;63(1):146-50. doi: 10.1016/j.lungcan.2008.04.018.
Bruschi Giuseppe, Conforti Serena, Torre Massimo, Colombo Tiziano, Russo Claudio F, Pedrazzini Giovanna, Frigerio Maria, Ravini Mario
Abstract
OBJECTIVE:
The present study analyses, long-term lung cancer survival rate in the Niguarda heart transplant population and the results of surgical treatments.
METHODS:
From November 1985 to December 2006, 786 heart transplants were performed in our Center; we underwent a retrospective review of patients developing primary lung cancer.
RESULTS:
Among 660 heart transplant recipients valuable in this study, 22 (3.3%) developed a primary lung cancer (20 male, 91%), their mean age at time of heart transplant was 54.5+/-5.2 years (range, 42-65). The mean time from transplantation to lung cancer diagnosis was 73.7+/-30 months. Eleven patients (50%) were in stage IIIB or higher at the time of presentation. The 5-year survival rate of the entire study population was 21.4%, with a median survival time (MST) of 10.1 months. Ten patients underwent surgical resection (9 lobectomies and 1 wedge resection) and demonstrated improved long-term survival with 5-year survival of 56% and MST 70.4 months, compared to patients who did not undergo any surgical procedure, all of whom died during follow-up, with 1-year survival of 33%.
CONCLUSIONS:
Long-term results following lung cancer surgery in heart transplant recipients are satisfactory when performed at the early stage of the disease. Preventive computed tomography screen should be considered as a routine method for early diagnosis in this group of high-risk patients.
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A case of fibrous histiocytoma of the trachea in an infant treated by endobronchial ND:YAG laser.
Lung Cancer2007 Jul;57(1):112-4.
Conforti Serena, Bonacina E, Ravini M, Torre Massimo
Abstract
Fibrous histiocytomas are uncommon tracheal tumors. They generally involve only the lung parenchyma; endobronchial involvement is extremely rare. At present, surgical resection is considered the therapy of choice for definitive diagnosis and cure. Endoscopical treatment is uncommon in pediatric patients because of the technical endoscopical difficulties and the high recurrence rate of treatment by endoscopy alone. We report the first case of fibrous histiocytoma in an infant successfully treated by endoscopy and yttrium alluminum garnet (YAG)-laser.
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A new safe and stable spiral wire needle for thoracoscopic resection of lung nodules.
Chest2004 Jun;125(6):2289-93.
Torre Massimo, Ferraroli Giorgio M, Vanzulli Angelo, Fieschi Stefano
Abstract
BACKGROUND:
To show the safety and stability of a spiral wire needle (Somatex; Rietzneuendorf, Germany) in the detection and subsequent thoracoscopic resection of subpleural and/or small nodules of the lung.
METHODS:
Under local anesthesia and CT control, 13 patients underwent the positioning of a spiral wire needle into the lung, with the spiral located close to or inside the nodule to be resected. Then the patients underwent video-assisted thoracoscopic surgery resection of the nodules with only two thoracoscopic accesses.
RESULTS:
All the nodules were identified due to the precise location of the spiral wire needle. The presence of a stable spiral wire inside the parenchyma has allowed us to put under tension the overlying parenchyma, which had previously been excluded from ventilation. The external traction on the needle facilitates the detection of the nodule and simplifies thoracoscopic resection with a stapler. With this new tool, we have always reached an adequate diagnosis and observed no cases of dislodgment of the needle during the traction maneuvers, nor cases of conversion from thoracoscopy to thoracotomy.
CONCLUSIONS:
Although our initial experience is limited, the use of this spiral wire needle has been shown to be extremely advantageous in identifying subpleural and/or small nodules of the lung, even sparing the classic third thoracoscopic access for their resection. The presence of a wire needle with a spiral terminal portion (which is placed firmly inside the lung parenchyma) is very useful for the thoracoscopic resection of pulmonary nodules.
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