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Eugenio Solima

Publications and source records attributed to Eugenio Solima.

11 recordsLinked to original sources
PubMed2006

Clinical and pathological prognostic factors in squamous cell carcinoma of the vulva.

OBJECTIVE: The objective of this study was the prognostic analysis of clinicopathologic variables related to primary tumor and to lymph node metastases. METHODS: We retrospectively analyzed 389 cases of squamous cell carcinoma of the vulva. The following variables were studied: patients' age, diameter and location of the tumor, clinical tumor characteristics, depth of invasion, grade, lymphovascular space involvement (LVSI) and lymph node status. In the subset of 110 node positive patients, we evaluated number of positive nodes, laterality, extension of node dissection, lymph node chains involved, presence of extracapsular spread and rate of lymph node replacement. All variables with P value < 0.2 by the univariate analysis were successively subjected to multivariate analysis (Cox proportional hazard model). RESULTS: Among all the tumor-related variables age, clinical tumor characteristics, LVSI and lymph node status were found to be statistically significant predictors of survival for the log-rank test. On the basis of multivariate analysis, the nodal status was the most significant independent prognostic factor (hazard rate [HR]: 2.06; confidence interval [CI] 95%: 1.57-12.07) followed by LVSI (HR: 3.47; CI95%: 1.85-7.85). The independent prognostic factors among the variables relative to positive nodes were the percentage of nodal replacement (HR: 6.99; CI95%: 3.51-16.14) and the extracapsular spread (HR: 4.88; CI95%: 2.96-10.14). CONCLUSIONS: Lymph node status and nodal features, such as extracapsular spread and nodal replacement rate, were shown to be independent factors. These factors should be considered to identify high risk patients and in planning further adjuvant therapy.

Adult↗
PubMed2006

Type II versus Type III nerve-sparing radical hysterectomy: comparison of lower urinary tract dysfunctions.

OBJECTIVES: According to our previous experience, Type III Nerve-sparing Radical hysterectomy (NSRH) for cervical cancer presented an acceptable urologic morbidity, without compromising radicality. The aim of this study was to compare Type NSRH with other types of RH in terms of incidence of early bladder dysfunctions and perioperative complications. METHODS: One hundred and ten patients with cervical cancer were submitted to Type II RH (group 1), Type III NSRH (group 2) and Type III RH (group 3). We assessed the postoperative early bladder function and complications. The follow-up period was 3 months. RESULTS: Group 1 had a significantly shorter duration of the surgery, minor mean blood loss and shorter mean length of postoperative stay when compared to groups 2 and 3. No intraoperative complications were reported in either of the groups. The groups did not differ significantly in terms of GIII/IV morbidity (group 1 = 10%, group 2 = 10% and group 3 = 15%, chi(2), P value: 0.65). Not even they differed in terms of urologic GI-IV morbidity (group 1 = 13%, group 2 = 15% and group 3 = 10%, chi(2), P value = 0.88). Groups 1 and 2 presented a prompt recover of bladder function, significantly different from that of group 3. There was a significant difference between the groups regarding the number of patients discharged with self-catheterism (group 1 = 0; group 2 and group 3 = 11; chi(2), P value << 0.05). CONCLUSIONS: The Type III NSRH seems to be comparable to Type II RH and superior to Type III RH in terms of early bladder dysfunctions.

Adult↗
PubMed2004

Sentinel lymph node detection following the hysteroscopic peritumoural injection of 99mTc-labelled albumin nanocolloid in endometrial cancer.

PURPOSE: The purpose of this study was to assess the feasibility of sentinel lymph node (SLN) detection in endometrial cancer patients with a dual-tracer procedure after hysteroscopic peritumoural injection. METHODS: Twenty-six women with previously untreated endometrial adenocarcinoma underwent the hysteroscopic injection of 111 MBq 99mTc-Nanocoll and blue dye administered subendometrially around the lesion. On the same day, all 26 patients underwent lymphoscintigraphy, followed 3-4 h later by hysterotomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Para-aortic lymphadenectomy was also performed in cases of either serous or papillary carcinoma (n=7/26). All SLNs were removed and examined with haematoxylin and eosin staining and immunohistochemical techniques. RESULTS: The procedure was well tolerated by patients, only two experiencing transient vagal symptoms. The sensitivity of this technique for correct identification of SLNs was 100%. Lymph node metastases were found in 4 out of the 26 patients (15%), bilaterally in the external iliac region (n=1), unilaterally in the external iliac region (n=1), unilaterally in the common iliac region (n=1) and unilaterally in the para-aortic region (n=1). In all four cases, nodal metastases were located within SLNs detected by lymphoscintigraphy. Only 10 of the 26 patients (38%) had significant blue dye staining. All blue-stained SLNs were radioactive. CONCLUSION: In patients with endometrial cancer, it is feasible to use lymphatic mapping and SLN biopsy to define the topographic distribution of the lymphatic network and also to accurately detect lumbo-aortic and pelvic metastases within SLNs. In the majority of patients with early stage endometrial cancer, this procedure may avoid unnecessary radical pelvic lymphadenectomy. It may also guide para-aortic lymph node dissection on the basis of the SLN status.

Aged↗
PubMed2004

Hysteroscopic injection of tracers in sentinel node detection of endometrial cancer: a feasibility study.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of sentinel lymph node (SLN) detection in endometrial cancer patients with hysteroscopic injection of tracers. Study design Eighteen patients with endometrial adenocarcinoma were submitted to hysteroscopic injection of technetium-99m-labeled colloids and blue-dye subendometrially around the lesion followed by lymphoscintigraphic scans. The SLN was detected by direct visualization of blue-dye marked nodes and by a radio-guided surgery (RGS). RESULTS: Seventeen hysteroscopic procedures were satisfactory regarding the visualization of the uterine cavity. The compliance to the procedure was acceptable in 15 cases, with no severe complication. A hysterectomy and bilateral salpingo-oophorectomy were performed in all cases, and pelvic lymphadenectomy in 14 cases. The RGS detected a total of 45 SLN with a mean of 3 SLN/patient (range 2 to 4). Blue-dye uptake was observed in 6 (33%) cases. No case presented blue-dye uptake and radioactive-colloid negativity. CONCLUSION: The results seem promising for further controlled studies.

Adenocarcinoma↗
PubMed2004

Nerve-sparing radical hysterectomy: a surgical technique for preserving the autonomic hypogastric nerve.

OBJECTIVES: Recently, a nerve-sparing radical hysterectomy has been proposed for cervical cancer to reduce morbidity. The aim of this study is (i) to describe the surgical anatomy of the autonomic nervous system, (ii) to describe a new nerve-sparing technique for Piver III radical hysterectomy (RH) using the CUSA, in which greater attention was paid to the autonomic nervous pathway, and (iii) to assess the feasibility and the impact of this nerve-sparing technique on the incidence of early bladder dysfunctions. METHODS: Twenty-three patients with cervical cancer were submitted to nerve-sparing Piver III RH with pelvic lymphadenectomy. Postoperative assessment of bladder function consisted draining the bladder for 3 days using Foley catheterization. Then, we started draining the bladder every 3 h with a no. 10 French catheter to register the onset of spontaneous voiding and to assess the postvoid residual urine volume (PVR). RESULTS: The nerve-sparing technique were performed satisfactorily in all cases. The mean operating time was 219 min (range: 150-270). The mean blood loss was 489 ml (range: 200-800). The average period of hospitalization was 10 days (range: 5-16). Two (9%) patients were discharged with self-catheterization, and one of them recovered the ability to void her bladder spontaneously by the time of her first visit to the outpatient clinic. CONCLUSIONS: This nerve-sparing RH technique using the CUSA proved feasible, with promising results in terms of preventing early bladder dysfunction. The average time between surgery and the onset of spontaneous voiding was acceptable. Further prospective controlled studies are needed to confirm our data.

Adult↗
PubMed2004

Gemcitabine combined with oxaliplatin (GEMOX) as second-line chemotherapy in patients with advanced ovarian cancer refractory or resistant to platinum and taxane.

OBJECTIVES: The aim of this multicenter feasibility study was to determine the toxicity profile and antitumor activity of the gemcitabine plus oxaliplatin combination as second-line treatment in platinum plus paclitaxel resistant/refractory advanced ovarian cancer. METHODS: Twenty patients received a 30-60-min infusion of gemcitabine a week for 2 weeks, followed by 120-180 min infusion of oxaliplatin every 3 weeks. The doses used were 1,000 and 130 mg/m(2), respectively. Seventeen cases (85% of the total) were platinum resistant and 3 (15%) were platinum refractory. RESULTS: Grade 3/4 thrombocytopenia occurred in 14/20 of cases (70%); there were no symptomatic cases. 2 patients required platelet transfusion and 8 patients received hydrocortisone. The dose- limiting toxicity was thrombocytopenia. Combined grade 3/4 neutropenia was observed in 8/20 (40%) of cases (no sepsis was registered). Five patients were treated with recombinant erythropoietin because of grade 3 anemia and 4 cases received G-CSF prophylactically from the first cycle. The overall response rate of the combination in terms of antitumor activity was 26% (95% CI = 9-51%). CONCLUSION: A combination of gemcitabine and oxaliplatin using this schedule gave rise to a moderate/severe toxicity profile and would be feasible only if growth factors were used and/or gemcitabine were administered at lower doses. The antitumor activity of the combination was insufficient reward for the resultant toxicity profile. However, equivalent to that of other drugs used in platinum refractory and resistant patients.

Adult↗
PubMed2003

Microinvasive squamous cell cervical carcinoma.

Several histologic tumor-related features are the key factors for further treatment planning in microinvasive cervical cancer (MIC) after conization. To better define the indications for conservative treatment of MIC we conducted a literature review for prognostic factors for MIC and we carried out a prospective observational study evaluating most important pathologic factors and the relationships between tumor and edges of the cone and incidence of recurrences. In our experience seven recurrences were observed. Two distinct groups of patients were identified with a clearance lower or higher of 10 and 8 mm for apical and lateral margin respectively. Depth of infiltration and even lymph-vascular involvement have been confirmed as the most important histologic parameters to be evaluated. Apical and lateral clearance of the tumor are significantly correlated with the recurrence rate. If an adequate lateral border of healthy tissue is present on the specimen, conization may be considered as definitive treatment of MIC.

Carcinoma, Squamous Cell↗
PubMed2003

Hysteroscopic endometrial resection versus laparoscopic supracervical hysterectomy for menorrhagia: a prospective randomized trial.

OBJECTIVE: This study was undertaken to compare the relative efficacy and safety of hysteroscopic endometrial resection and laparoscopic supracervical hysterectomy in the treatment of abnormal uterine bleeding. STUDY DESIGN: One hundred eighty-one patients affected by menometrorrhagia and unresponsive to medical treatment agreed to be randomized to either laparoscopic supracervical hysterectomy or hysteroscopic endometrial ablation. They were monitored for 2 years to evaluate perioperative and postoperative outcomes, resolution of symptoms, and patient satisfaction. RESULTS: Duration of hospitalization, period of convalescence, perioperative complications, and resumption of normal activity were similar between the two groups. Operative time was significantly shorter in the hysteroscopic group, but patient satisfaction was significantly higher in the laparoscopic group. CONCLUSION: For the treatment of menorrhagia, hysterectomy has the distinct advantage of being curative but the disadvantage of being more invasive than the hysteroscopic approach. However, laparoscopic supracervical hysterectomy preserves the curative effect of hysterectomy without its increased surgical invasiveness, as suggested by the current study.

Adult↗
PubMedDate not supplied

Gonadoblastoma in androgen insensitivity syndrome: a case report.

We report a case of androgen insensitivity syndrome (AIS) characterized by malignant degeneration of the testes consisting of gonadoblastoma and dysgerminoma. AIS is a rare inherited form of male pseudohermaphroditism that can manifest as a normal female phenotype without müllerian derivatives and absence of the upper third of the vagina. A 32-year-old white 46,XY female with AIS underwent removal of the dysgenetic gonads at the Gynecological Oncology Department of the Istituto Nazionale Tumori, Milan, Italy. We investigated cytogenetic alterations, hormonal levels and the presence of neoplasia in the dysgenetic gonads. Histological analysis revealed a gonadoblastoma mixed with dysgerminoma in the left gonad and a pure dysgerminoma in the right gonad. The patient's hormonal status matched that of a male. Second-look laparotomy after chemotherapy showed a complete pathological response. AIS should be suspected in phenotypically female patients with primary amenorrhea; surgical removal of the gonads is mandatory to avoid malignant degeneration.

Adult↗
PubMedDate not supplied

Nerve-sparing radical hysterectomy: a pilot study.

Nerve-sparing radical hysterectomy has increasingly been used for cervical cancer, with less morbidity. We aimed with this study: i) to describe an alternative technique of nerve-sparing radical Piver III hysterectomy, using the CUSA, in which attention was given to the uterosacral ligament and cardinal ligament; ii) to evaluate the feasibility of this new nerve-sparing technique; iii) to describe the surgical anatomy of the autonomic nervous system; iv) to assess the early incidence of bladder dysfunction. Twelve consecutive patients with local-regional advanced cervical cancer were enrolled in the study on nerve-sparing radical hysterectomy with extended pelvic lymphadenectomy. The mean age was 44 years (range, 30-59), mean body mass index was 24 kg/m2 (range, 18-30), mean operating time was 217 mins (range, 195-240), and mean blood loss was 437 cc (range, 200-750). The average hospitalization time was 9 days (range, 5-15 days). Two patients presented pathologically positive parametrium. Two of 12 (17%) patients were discharged with self-catheterism. In the first outpatient follow-up, 1 patient had recovered spontaneous voiding. The nerve-sparing technique with CUSA can be an option to reduce radical hysterectomy-related morbidity. The technique proved to be feasible, with promising results in terms of preventing bladder dysfunction. An elevated body mass index and large tumors can impair the performance of the technique. Further studies clarifying neuroanatomy and neurophysiology of autonomic nervous structures, as well as a prospective controlled trial on nerve-sparing radical hysterectomy should be carried out to confirm our data.

Adult↗