Biomedical subjects
Publications and source records attributed to A Lanza.
In literature there have been only 8 cases of unavoidable laparotomy due to uterine leiomyomas performed in patients with breast cancer on Tamoxifen (TAM). Our article describes two cases of rapidly growing leiomyomas in patients treated with TAM: one of these underwent abdominal hysterectomy while the second stopped taking TAM and began therapy with Triptorelin. This therapeutical alternative could be a useful choice.
DNA topoisomerase-targeting antitumor drugs are potent inducers of protein-concealed strand breaks in mammalian cells and act by trapping DNA topoisomerases on chromosomal DNA in the form of drug-enzyme-DNA cleavable complexes. It has been proposed that the cleavable complex is an unusual form of DNA damage that elicits cellular responses analogous to those caused by DNA damaging agents. The relationship between topoisomerase-targeting drug-induced damage and radiation-induced damage has been investigated by analyzing the properties of DNA topoisomerases in mouse L5178Y lymphoma strains that are cross-sensitive to topoisomerase I-II inhibitors and to UV light or X-ray irradiation. The strains are LY-R, isolated from L5178Y cells on the basis of increased resistance to ionizing radiation, and strain LY-S, isolated from LY-R cells following a spontaneous increase in the sensitivity to ionizing radiation. LY-S cells, deficient in the rejoining of DNA double-strand breaks, show enhanced sensitivity to topoisomerase II-targeting inhibitors, whereas LY-R cells have an increased sensitivity to UV radiation and to the topoisomerase I inhibitor, camptothecin. The cellular availability of DNA topoisomerase I and II and the sensitivity of the enzymes to their specific inhibitors have been measured in the two related strains. In the LY-R strain, we found a 30% decrease in topoisomerase I content but no difference in camptothecin sensitivity, while no quantitative or qualitative differences were observed for the topoisomerase II. The results indicate that variations in sensitivity of the L5178Y strains to topoisomerase inhibitors are unlikely to be related to primary defects of the target enzymes, and thus it is possible that common pathways exist for processing of topoisomerase- and radiation-induced damage.
In the course of a chromosome fragility investigation on the cancer prone hereditary disorder xeroderma pigmentosum, a low proportion of cells with a 47,XY,+21 karyotype was found in lymphocyte cultures of a patient not showing any Down syndrome symptom. The presence of trisomy 21 mosaicism was demonstrated also in peripheral blood of the healthy father and confirmed by "chromosome painting" that allowed a rapid detection of chromosomes 21 on metaphase cells and interphase nuclei. The trisomic cell line was not detected in fibroblast cultures. The analysis of chromosome 21 heteromorphism indicated that in both subjects the mosaic could result from either a diploid or an aneuploid zygote. Since in the trisomic cell line of the father and the son the extra chromosome 21 seems to be the same, a predisposition toward mitotic errors (non-disjunction or anaphase lagging) may be postulated, leading to the recurrent gain or loss of a specific chromosome 21. In order to test the hypothesis of an abnormal mitotic behaviour of the chromosome 21, we investigated the centromere separation index and the DNA restriction pattern in Southern blots probed with satellite DNA sequences specific for chromosome 21 centromere. Both the approaches did not reveal any peculiar feature that may account for the genetically determined proneness to mitotic error observed in the family.
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This paper reports an investigation of the mechanism involved in the response of endometrial adenocarcinoma to MPA. The following protocol was used for a period of 8 years: 1 g/day MPA per os for 30 days and 60 days after surgery, following by 500 mg/day for 1 year. Adenocarcinoma glycolytic activity, G-6-P cycle, polyamine concentration, and the activity of ornithine decarboxylase (ODC), i.e. the first enzyme in polyamine synthesis, were compared before and after the 30/day treatment. The modifications induced by MPA are discussed and related to the pathological picture in an attempt to determine the characteristics of responding tumors.
Actuarial survival in 178 patients treated with radical surgery and lymphadenectomy from 1977 to 1987 have been evaluated. The survival rate at 60 months in the 124p N0 patients was 95%; in the 57 p N1 patients was 20.2%. The survival in patients with only 1 or 2 metastatic lymph nodes was 39.7%, while it was 13.1% with 3 or more lymph nodes involved. Survival rate related to lymph nodal metastatic level was 36%, 32%, 17% respectively when the first, second and third levels were involved. We demonstrated a statistically significant relation between survival and external thirds, CLS, vaginal, parametrial invasion. A multifactorial analysis also showed the remarkable significance of the simultaneous negativity of vaginal, CLS, external third invasion (survival rate 98.4%). When the positivity of the external invasion was associated with simultaneous negativity of vaginal and CLS invasion the survival rate was 79.4%. The survival rate in patients with positive vaginal and external third invasion was 26%. This showed the decisive importance of vaginal invasion in cervical cancer survival.
We analyzed 8 pathological factors in order to recognize which of them are statistically significant in worsening the stage of cervical cancer. Three factors (external third invasion, CLS, parametrial invasion) are highly significant (p less than 0.001) as regards lymphatic metastases, while no one statistical relation has been found among grading or histotype and cervical canal invasion. Comparing the 8 pathologic factors among themselves, we have observed that parametrium, corpus and CLS are highly related to external third (p less than 0.001); in the same way corpus is related to cervical canal and parametrium to CLS (p less than 0.001).
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A series of 28 exenterations for advanced pelvic tumours is presented. The operative mortality (within 90 days) was 17.8%. The actuarial survival (expressed as a two-year disease-free interval) was 35.7%, and better in cases with negative lymph nodes. The types of urinary and bowel diversions adopted are discussed in terms of longer survival.
From January 1st 1980 up to December 31st 1986, 93 endometrial adenocarcinomas were treated at the Chair B of the Institute of Gynecology and Obstetrics. Full anatomopathological and hormonal data are available for 81 cases on whom diagnostic and therapeutic protocols were applied. In this selected group, positive lymph nodes were shown in 10 cases. Lymph node positivity was compared with miometrial infiltration grade: there were only two cases of lymph nodal positivity among 49 adenocarcinomas in which the invasion was more than 10 mm from the serosa, 8 lymph nodes metastases out of 32 adenocarcinomas with a distance between 10 and 5 mm and with distance less than 5 mm.
Our study is based on 29 patients with ovarian carcinoma in early stage (IA-IIB) having undergone total abdominal hysterectomy, with bilateral salpingo-oophorectomy, omentectomy, appendectomy and pelvic and paraaortic lymphadenectomy selective and bioptic. Out of the 29 patients 11 were classified I stage and 18 II stage. Within 3 years, out of 10 patients with node metastases, 1 is alive and free of disease, 6 deceased from the tumor and 3 are alive with residual tumor at various stages of invasion. Out of the 19 patients without nodes metastases 14 are alive and free of disease, 4 deceased from the tumor and 1 is alive with residual carcinoma. Survival related to histological type shows no statistically significant differences. Grading III has a survival of 27.6%, while the other two grades have a survival of 70% without significant differences. We can affirm that lymph nodes metastases represent the most reliable marker of high risk patients among the 3 risk factors (grading, histotype and nodes metastases) even if considered on a limited number of patients on the basis of preliminary data so obtained.
We studied 39 patients with stromal invasion exceeding 1 mm. Among them 3 underwent emivulvectomy and 8 simple vulvectomy; all had selective inguinal lymphadenectomy of one side the first and bilaterally the others. 17 women underwent radical vulvectomy and inguinal lymphadenectomy while 11 had radical vulvectomy and inguino-pelvic lymphadenectomy. Out of 21 patients with lymph nodal metastases, 11 had one side inguinal metastases, 2 had a single metastasis, 2 had double metastases, 1 had three metastases and 2 multiple ones. Survival rate decreased from 54.5% to 20.0% when patients had more than 3 monolateral inguinal metastases or bilateral ones, with increase of pelvic lymph nodal metastases; therefore, in those cases, pelvic lymphadenectomy can be associated to inguinal lymphadenectomy or, when the carcinoma is situated in the clitoridis, Bartolino's gland or vagina (the same could be done for melanoma of the vulva). The usefulness of radiotherapy is limited by the small response of vulvar tissue. In a series of 45 patients with clinical diagnosis of inguinal metastases, who could not undergo operation, only therapy, with electron beam therapy (9 meV) associated to inguinal fields (15 meV), had positive influence in 27% of the cases.
402 radical hysterectomies (17 ultraradical) were performed with lymphadenectomy. Positive metastatic nodes (N+) rate was 23.6% with an arithmetic mean of 22 excised lymph nodes. Single N+ belonged mostly to the obturatory group, double N+ to obturatory and external iliac groups, while multiple N+ (24 cases) had no particular site. Neoplastic invasion, embolism and grading were studied in 122 cases. The parametrium, vagina and uterine corpus were interested more in N+ cases. The cervical stroma was divided into internal, middle and external parts and invasion rate was respectively 3.6%, 7.2%, 89.2% in N+ cases and 35.1%, 22.3%, 42.6% in N--cases.
Post-axillary lymphadenectomy complications have been checked in 1097 patients. Lymphedema occurred in 4.6% of cases, brachial injuries in 2% and necrosis with wound dehiscence in 0.44%. Pelvic lymphadenectomy complications have been studied in 139 patients who underwent Wertheim's operation and in 4 cases treated with Schauta-Mitra's operation for cervix or endometrium cancer. Para-aortic and pelvic lymphadenectomy complications have been considered in 92 patients who underwent Wertheim's operation, in 10 patients treated with anterior pelvic exenteration and in 1 patient who underwent posterior pelvic exenteration. The complications of para-aortic and pelvic selective lymphadenectomy have been checked in 101 patients. We had 3 peri-operatory deaths, 5 severe gastrointestinal complications (3 deceased for fistulae) and 2 intra-operatory iliac vessel injuries. Uretero-vaginal fistulae occurred in 6.2% of the cases also treated with radium-therapy and in 2.2% of the others. Intra/post-operatory bleeding was respectively 1500 +/- 450 ml and 450 +/- 300 ml. The complications of inguino-femoral and inguino-pelvic lymphadenectomy for vulvar cancer have been checked in 35 patients who had necrosis and wound dehiscence in all cases and lower limb thrombophlebitis in 2 cases.
We studied the survival period in two groups of patients with endometrial adenocarcinoma treated at the Chair B Institute of Gynecology and Obstetrics. The first series includes 30 of the 52 patients treated from 1976 to 1979. The second series includes 81 patients treated from 1980 to 1986. Lymph nodal positivity was present in 5 cases out of 30 patients belonging to Group I: all the interested lymph nodes were in the pelvic areas. Lymph nodal metastases were, instead, present in 10 cases as regard patients of Group II. Pelvic lymph nodes were involved in all the cases; in 5 of them also the paraaortic nodes were involved.
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