Rocco J Lafaro

New York Medical College, New York, New York, United States

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Publications (14)47.41 Total impact

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    ABSTRACT: Background: Advanced predictive analytical techniques are being increasingly applied to clinical risk assessment. This study compared a neural network model to several other models in predicting the length of stay (LOS) in the cardiac surgical intensive care unit (ICU) based on pre-incision patient characteristics. Methods: Thirty six variables collected from 185 cardiac surgical patients were analyzed for contribution to ICU LOS. The Automatic Linear Modeling (ALM) module of IBM-SPSS software identified 8 factors with statistically significant associations with ICU LOS; these factors were also analyzed with the Artificial Neural Network (ANN) module of the same software. The weighted contributions of each factor ("trained" data) were then applied to data for a "new" patient to predict ICU LOS for that individual. Results: Factors identified in the ALM model were: use of an intra-aortic balloon pump; O2 delivery index; age; use of positive cardiac inotropic agents; hematocrit; serum creatinine ≥ 1.3 mg/deciliter; gender; arterial pCO2. The r2 value for ALM prediction of ICU LOS in the initial (training) model was 0.356, p <0.0001. Cross validation in prediction of a "new" patient yielded r2 = 0.200, p <0.0001. The same 8 factors analyzed with ANN yielded a training prediction r2 of 0.535 (p <0.0001) and a cross validation prediction r2 of 0.410, p <0.0001. Two additional predictive algorithms were studied, but they had lower prediction accuracies. Our validated neural network model identified the upper quartile of ICU LOS with an odds ratio of 9.8(p <0.0001). Conclusions: ANN demonstrated a 2-fold greater accuracy than ALM in prediction of observed ICU LOS. This greater accuracy would be presumed to result from the capacity of ANN to capture nonlinear effects and higher order interactions. Predictive modeling may be of value in early anticipation of risks of post-operative morbidity and utilization of ICU facilities.
    Preview · Article · Dec 2015 · PLoS ONE
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    Preview · Article · Apr 2015 · Archives of Medical Science
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    ABSTRACT: Squamous cell carcinoma (SCC) can arise from different anatomical sites including the skin, head and neck, lung, esophagus, genital area, and so on. Despite the same histopathologic features and immunohistochemistry profile, the SCCs of different body sites can show tremendous differences in their presenting symptoms, risk factor associations, natural history, prognosis, and response to treatment. This may reflect the fact that SCCs are heterogenous and likely have unique molecular characteristics at different anatomical sites. Recurrent somatic mutations in the TERT promoter region were first reported in human melanomas. Subsequently, other tumors including cutaneous SCC were found to demonstrate high frequencies of the same mutations. However, the incidences of TERT promoter mutation in noncutaneous SCCs have not been systemically studied. We investigated the TERT promoter mutation status among SCCs from different sites. We collected 84 cases of SCC from the skin (27), head and neck (12), lung (25), and cervix (10), as well as 10 cases of urothelial carcinoma with squamous differentiation (UC-SqD). We found that the frequencies of TERT promoter mutation among SCC of different sits are quite heterogenous: ~70% in skin SCC and UC-SqD, 16.67% in head and neck SCC, and 0% in lung and cervix SCC. These results may support the hypothesis of different carcinogenesis mechanisms of SCC in different sites. It also indicates that TERT promoter mutation could be a biomarker for distinguishing skin SCC or UC-SqD vs pulmonary SCC. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Mar 2015 · Annals of diagnostic pathology

  • No preview · Article · Oct 2014 · Journal of Nuclear Cardiology
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    ABSTRACT: Background: Telomerase reverse transcriptase (TERT) is up-regulated in a variety of human neoplasms and contributes to carcinogenesis. TERT promoter mutations were recently discovered in melanoma by next generation sequencing. Studies have indicated that, these mutations are highly prevalent in melanoma, glioblastoma, and bladder cancers, and low frequency in non small cell lung cancer (NSCLC) cell lines. However, these fi ndings have not yet been illustrated TERT promoter mutation status in squamous cell carcinoma (SCC) of the lung as well as other primary SCC. Our aim was to investigate whether the aforementioned TERT promoter mutations were present in SCC of different origins. Design: Total 53 cases were selected from the archives of our pathology department. These include 24 lung SCC, 12 head and neck SCC, 9 cervical SCC and 8 skin SCC. All Hematoxylin and Eosin (HE) stained slides were reviewed to confi rm the diagnosis and make sure at least >20% tumor content. In addition, several cases of non neoplastic tissue from the matched SCC patient were also studied. Genomic DNA was isolated from FFPE tissue and PCR was used to amplify TERT promoter region which included the C228T and C250T mutations. The TERT promoter mutations are determined by bi-directional Sanger sequencing. Results: The TERT promoter mutations were absent in all of the lung SCC and cervical SCC. In head and neck SCC, only two out of twelve (2/12; 17%) cases had the C228T mutation. For skin SCC, four out of eight (4/8; 50%) cases had the mutations including 3 cases of C228T and 1 case of C250T. No mutations were detected in the matched non-neoplastic tissue. Conclusions: This is the fi rst study to compare TERT promoter mutations in SCC of different origins. In our study, the TERT promoter mutations were not present in any of the lung and cervical SCC. The frequency of TERT promoter mutation is 17% and 50% in head neck SCC and skin SCC, respectively. The fi ndings further illustrate molecular differences among SCC from different origins despite their shared morphologic and immunophenotypic features. The TERT promoter mutations
    No preview · Article · Mar 2014 · Modern Pathology
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    ABSTRACT: neoplasms and contributes to carcinogenesis. TERT promoter mutations were recently discovered in melanoma by next generation sequencing. Studies have indicated that, these mutations are highly prevalent in melanoma, glioblastoma, and bladder cancers, and low frequency in non small cell lung cancer (NSCLC) cell lines. However, these fi ndings have not yet been illustrated TERT promoter mutation status in squamous cell carcinoma (SCC) of the lung as well as other primary SCC. Our aim was to investigate whether the aforementioned TERT promoter mutations were present in SCC of different origins. Design: Total 53 cases were selected from the archives of our pathology department. These include 24 lung SCC, 12 head and neck SCC, 9 cervical SCC and 8 skin SCC. All Hematoxylin and Eosin (HE) stained slides were reviewed to confi rm the diagnosis and make sure at least >20% tumor content. In addition, several cases of non neoplastic tissue from the matched SCC patient were also studied. Genomic DNA was isolated from FFPE tissue and PCR was used to amplify TERT promoter region which included the C228T and C250T mutations. The TERT promoter mutations are determined by bi-directional Sanger sequencing. Results: The TERT promoter mutations were absent in all of the lung SCC and cervical SCC. In head and neck SCC, only two out of twelve (2/12; 17%) cases had the C228T mutation. For skin SCC, four out of eight (4/8; 50%) cases had the mutations including 3 cases of C228T and 1 case of C250T. No mutations were detected in the matched non-neoplastic tissue. Conclusions: This is the fi rst study to compare TERT promoter mutations in SCC of different origins. In our study, the TERT promoter mutations were not present in any of the lung and cervical SCC. The frequency of TERT promoter mutation is 17% and 50% in head neck SCC and skin SCC, respectively. The fi ndings further illustrate molecular differences among SCC from different origins despite their shared morphologic and immunophenotypic features. The TERT promoter mutations could be of utility as a molecular marker to distinguish SCC with different origin
    No preview · Article · Mar 2014 · Modern Pathology
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    ABSTRACT: Background: Telomerase reverse transcriptase (TERT) is up-regulated in a variety of human neoplasms and contributes to carcinogenesis. TERT promoter mutations were recently discovered in melanoma by next generation sequencing. Studies have indicated that, these mutations are highly prevalent in melanoma, glioblastoma, and bladder cancers, and low frequency in non small cell lung cancer (NSCLC) cell lines. However, these fi ndings have not yet been illustrated TERT promoter mutation status in squamous cell carcinoma (SCC) of the lung as well as other primary SCC. Our aim was to investigate whether the aforementioned TERT promoter mutations were present in SCC of different origins. Design: Total 53 cases were selected from the archives of our pathology department. These include 24 lung SCC, 12 head and neck SCC, 9 cervical SCC and 8 skin SCC. All Hematoxylin and Eosin (HE) stained slides were reviewed to confi rm the diagnosis and make sure at least >20% tumor content. In addition, several cases of non neoplastic tissue from the matched SCC patient were also studied. Genomic DNA was isolated from FFPE tissue and PCR was used to amplify TERT promoter region which included the C228T and C250T mutations. The TERT promoter mutations are determined by bi-directional Sanger sequencing. Results: The TERT promoter mutations were absent in all of the lung SCC and cervical SCC. In head and neck SCC, only two out of twelve (2/12; 17%) cases had the C228T mutation. For skin SCC, four out of eight (4/8; 50%) cases had the mutations including 3 cases of C228T and 1 case of C250T. No mutations were detected in the matched non-neoplastic tissue. Conclusions: This is the fi rst study to compare TERT promoter mutations in SCC of different origins. In our study, the TERT promoter mutations were not present in any of the lung and cervical SCC. The frequency of TERT promoter mutation is 17% and 50% in head neck SCC and skin SCC, respectively. The fi ndings further illustrate molecular differences among SCC from different origins despite their shared morphologic and immunophenotypic features. The TERT promoter mutations could be of utility as a molecular marker to distinguish SCC with different origins.
    No preview · Article · Jan 2014 · Modern Pathology
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    ABSTRACT: Myxomas arising from the eustachian valve are exceedingly rare. A 72-year-old Jamaican-Chinese woman was evaluated for worsening dyspnea. The 2-dimensional and real time 3-dimensional transesophageal echocardiogram showed a 75 mm length × 44 mm width, multilobulated, mobile mass arising from the eustachian valve occupying the entire right atrial and right ventricular cavities extending into the coronary sinus, right ventricular outflow tract, and proximal inferior vena cava. The patient underwent successful resection of the mass and replacement of the tricuspid valve. Histopathologic examination confirmed the diagnosis of atrial myxoma. This is the largest myxoma found on a Eustachian valve.
    Full-text · Article · Mar 2012 · American Journal of Case Reports
  • Arlen G Fleisher · Rocco J Lafaro · Richard A Moggio
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    ABSTRACT: We describe two cases of immediate structural valve deterioration of the 27-mm Carpentier-Edwards pericardial valve. Tissue characteristics of bovine pericardium and the possible mechanism of failure are discussed.
    No preview · Article · May 2004 · The Annals of Thoracic Surgery
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    ABSTRACT: Inadequate data exist regarding the management of acute major pulmonary embolism. Various modalities that are used, including thrombolytics and embolectomy, have not been shown to conclusively improve mortality when compared to heparin. In the past, open pulmonary embolectomy was reserved for patients with severe hemodynamic instability because of its high mortality rate. Our objective was to analyze our experience with early embolectomy as an alternative for the treatment of major pulmonary embolism. A retrospective review of charts of all patients undergoing pulmonary embolectomy at our institution over the last two years was performed. Patients were followed until their discharge from hospital. There were 13 patients (7 women and 6 men). Four had massive and 9 had submassive pulmonary embolism. There was one mortality. Postoperative echocardiography showed no evidence of pulmonary hypertension in 7. Open pulmonary embolectomy can be performed in patients with major pulmonary embolism with minimal mortality and morbidity. It may prevent the development of chronic thromboembolic pulmonary hypertension and should be a part of the algorithm in the treatment of major pulmonary embolism.
    Preview · Article · Apr 2004 · The Annals of Thoracic Surgery
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    ABSTRACT: Pseudoaneurysms in the ascending aorta most commonly occur as a complication of surgical procedures at this site. They have also been reported in association with trauma, infection, aortitis, and other disorders. Pseudoaneurysm formation in the descending aorta or arch may occur as a result of penetrating ulcers in the presence of severe atherosclerotic plaque. Pseudoaneurysm as a result of atherosclerotic disease has only rarely been noted in the ascending aorta, where complex plaque is less common. We report here the finding with transesophageal echocardiography of a pseudoaneurysm in the ascending aorta as a result of atherosclerotic disease and penetrating ulcer.
    No preview · Article · May 2003 · Journal of the American Society of Echocardiography
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    ABSTRACT: A 70-year-old man, who had undergone a radical nephrectomy for localized renal cell carcinoma (RCC) three years ago, was recently evaluated for shortness of breath. During his work-up, a transesophageal echocardiogram and magnetic resonance imaging indicated an extensive vena caval thrombus originating from the renal vein stump. Successful vena caval thrombectomy with cardiopulmonary bypass confirmed that the thrombus was comprised of RCC. This is a rare type of RCC recurrence with an unusual timing (3 years after a nephrectomy), alerting the importance of strict follow-up on all patients even after complete surgical excision of all suspected tumors.
    No preview · Article · Feb 2002 · Urologia Internationalis
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    ABSTRACT: Management of malignant renal tumors involving the inferior vena cava (IVC) depends on tumor extension within the cava. Of 295 patients treated for renal cancer, propagation of tumor mass through the renal vein to IVC was seen in 22 (7%) patients. Cephalad extension of the tumor was suprarenal: infrahepatic in 12, retrohepatic in 6, and within the right atrium in 4 patients. All patients had radical nephrectomy, cavotomy, and complete resection of tumors except 1 with diffuse peritoneal metastasis. Twenty-one patients had curative resections. No operative deaths and no instances of pulmonary embolism or exsanguination occurred. Seventeen patients were alive at 2 years and 12 at 5 years, resulting in 77% and 55% survival rates, respectively. An aggressive approach for vena cava involvement from malignant renal neoplasms resulted in prevention of tumor embolus, minimization of blood loss, and maintenance of venous return to the heart.
    No preview · Article · Sep 1998 · The American Journal of Surgery
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    ABSTRACT: Cavernous hemangioma is a rare tumor with infrequent cardiac involvement. Preoperative or antemortem diagnosis may be difficult. Several prior case reports have described echocardiographic findings of cavernous hemangioma. We report here a 50-year-old white female patient with this tumor. Transesophageal echocardiography detected a mass with an echocardiographic appearance not previously described for cavernous hemangioma. The tumor appeared as a large echolucent unilocular cystic mass, leading to an erroneous preoperative diagnosis of pericardial cyst. This previously unreported finding should be recognized by echocardiographers in the evaluation of cardiac masses.
    Preview · Article · Jul 1997 · Journal of the American Society of Echocardiography