Biomedical subjects
Publications and source records attributed to A Giongo.
We report our indications and experience in the use of intraprostatic endoprosthesis. We report also our preliminary experience in the use of a new intraprostatic endoprosthesis which has been developed at our institute. This prosthesis can be easily positioned, shows little invasiveness and does not require ultrasonic, radiological or endoscopical guidance.
The Authors report their experience about surgical treatment of metastases from renal cell carcinoma. From January 1983 to December 1989, twenty eight patients, 19 males and 9 females, with a median age of 58 years (range 42-79), have been submitted to contemporary or subsequent metastasectomy. Metastases were synchronous in 10 cases, while they appeared after a free disease mean-time of 28 months after nephrectomy in 18 patients. Recovery period has always been normal and all the patients were controlled, every six months, with routine blood and urine examinations, Chest X-ray, abdominal CAT and bone scan. Among the 10 patients with synchronous metastases 5 died, 3 are in progression and 2 are NED after a mean-time follow up of 36 months. Among 18 patients who underwent surgery for metachronous metastases, 2 died, 4 are in progression and 12 NED (mean follow up of 36 months). In conclusion, while the presence of synchronous metastases is an unfavourable prognostic factor even after their surgical removal (8 out of 10 patients died or are in progression shortly after metastasectomy), results after metachronous metastases surgery are encouraging, but the real efficiency of this treatment is still to be confirmed.
We studied 151 patients aged from 49 to 85 years (mean 71) with a clinical suspect of prostatic cancer. 104 underwent a transrectal digitally directed prostatic biopsy, while 47 an ultrasonically perineal guided prostatic biopsy. Transrectal fine needle aspiration was performed in the whole group. Both techniques showed a high cyto-histologic concordance: 83.6% with transrectal digitally directed biopsy, 78.7% with perineal ultrasonically guided biopsy. The ultrasound guided biopsy has been able to downset the rate of cytologic false negatives in comparison to the digitally guided biopsy. In case of pathological rectal examination, digitally directed prostatic biopsy is still available and those who haven't an ultrasound apparatus, can equally perform a traditional biopsy with a limited possibility of mistake.
From July 1, 1979 to June 30, 1983, 136 consecutive patients from 5 centers in Lombardy entered a prospective randomized study to compare 500 mg. adjuvant medroxyprogesterone acetate 3 times a week for 1 year to no treatment following radical nephrectomy for category M0 renal cancer. After a median followup of 5 years (range 42 to 90 months) 40 of 120 evaluable patients (33.3 per cent) experienced relapse after a median interval free of disease of 17 months (range 2 to 74 months). Relapses occurred in 19 of 58 evaluable patients in the adjuvant treatment group (32.7 per cent) and in 21 of the 62 evaluable controls (33.9 per cent). Sex steroid hormone receptors were studied in 102 of the 120 evaluable patients with the dextran-coated charcoal technique. No significant correlation could be found among receptors, relapses and treatment. On the other hand, 33 (56.9 per cent) of the 58 treated patients experienced 39 complications related to the long-term hormonal therapy. Three patients had to discontinue medroxyprogesterone acetate for severe toxicity after 2 to 3 months. Medroxyprogesterone acetate cannot be recommended as adjuvant therapy to radical nephrectomy in patients with renal cell carcinoma.
One hundred sixty-five consecutive patients with resectable renal cancer entered a cooperative study to evaluate hormone treatment and steroid receptors. Twenty-nine patients with concomitant distant metastases (category M1) received intramuscular medroxyprogesterone acetate (MPA) 500 mg/day for at least two months after the operation. No measurable remission was observed, but 8 of 24 evaluable patients (33%) had disease stabilization for a median duration of 6 months. One hundred thirty-six cases with category M0 cancer were randomly allocated to a control group or to a treatment group with MPA 500 mg/3 times a week for one year. After a median follow-up period of over 3 years, 30 of 121 evaluable patients (24.8%) had a relapse, usually in distant sites. Relapses and survival were independent from postoperative treatment and sex. Only the extent of the disease and the presence of steroid receptors in the tumor were related with prognosis, but no relation could be found between receptors and response to hormone treatment. The presence of low concentrations of hormone receptors in a proportion of renal cancers remains unclear. However, MPA is confirmed to be only marginally active in metastatic renal cancer and the drug cannot be recommended as adjuvant to radically resected patients because of significant toxicity and lack of therapeutic activity.
Twenty-eight patients with metastatic renal cell carcinoma entered a multicentric prospective study to evaluate the response to high-dose medroxyprogesterone acetate (MPA) and testosterone in MPA failures in relation to sex steroid receptors. No objective remission was seen in the 24 evaluable patients, and only disease stabilizations of short duration were achieved in one-third of treated patients. Stabilizations achieved with second line testosterone were all seen in patients unresponsive to MPA. Receptor studies demonstrated that estrogen, progesterone, or androgen receptors were found in low concentrations and in only 6 of 23 tumors (26%) and 13 normal tissue samples (56%). Surprisingly, no disease stabilization was achieved in patients positive for receptors. It can be concluded that the occasional objective responses to hormone therapy reported in the literature may have been due to some cytotoxic effect of hormone therapy rather than to a true hormonal mechanism.
From July 1979 to December 1981, 83 patients from 6 centers in the Lombardy underwent radical nephrectomy for category M0 renal cell carcinoma. Postoperatively they were randomly allocated to adjunctive medroxyprogesterone acetate (MPA) or to a control group. After the first year of follow-up, the relapse rate was 13% in the controls (5 of 38 evaluable patients) versus 28% in the MPA treatment group (9 of 32). Sex steroid receptors were studied in both the tumor and in the surrounding healthy parenchyma by the dextran-coated charcoal technique in 52 of 70 clinically evaluable patients. There was no significant correlation between receptor studies and the relapse rate. Besides, receptors were more often detected in the healthy than in the neoplastic tissue, and values rarely exceeded 10 fmol/mg protein. Due to the negative trend in the MPA treatment group, the admittance of patients to this study was stopped after 120 patients had been accepted.
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