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Biomedical subjects

G di Paola

Publications and source records attributed to G di Paola.

16 recordsLinked to original sources
PubMed1999

Laparoscopically assisted Schauta operation: learning experience at the Gynecologic Oncology Unit, Buenos Aires University Hospital.

OBJECTIVES: The aim of this study was to show the learning experience of the employment of laparoscopic lymphadenectomy followed by a Schauta operation to treat patients with cervical carcinoma at a university hospital and to evaluate the feasibility, complications, hospital stay, delay in return to work, and overall survival of this procedure. METHODS: Between June 1, 1993, and December 30, 1997, 56 patients were selected. Surgical treatment began with a pelvic laparoscopic lymphadenectomy followed by a Schauta operation. Patients were staged according to FIGO criteria (Ia2, 10 cases; Ib1, 33 patients; Ib2, 8 cases; IIa, 3 cases; and IIb, 2 patients). Patients had a follow-up of 47 months. Overall survival was calculated with Kaplan-Meier tables. RESULTS: The procedure was not completed in 9 pts, in 5 cases among the first 20 pts that were entered on the trial due to technical problems and in 4 due to extracervical spread of disease (2 with gross laparoscopically unresectable lymph node metastases, 1 with parametrial infiltration, and 1 with rectovaginal septum involvement). In the 47 pts in which the procedure could be completed, the laparoscopic approach was done in 102 min and the vaginal part in 165 min. There were 4 complications: 1 ureteral injury, 1 abscess of the ischiorectal fossa, 1 hematoma of the Schuchardt incision, and 1 case of leg edema. The mean number of resected nodes was 17. Among the 47 cases in which the surgical procedure was completed, overall survival was 100% for Stage Ia, 88% for Ib1, and 85% for Ib2 after a mean follow-up of 4 years. Four pts have relapsed and died; 3 were stage Ib1 and the other was stage Ib2. They had pelvic recurrences. CONCLUSIONS: This surgery is secure and has an excellent outcome, so it can be considered a valid approach for the treatment of patients with cervical carcinoma, but in our hands, 20 cases were needed to obtain the minimum skill needed to perform it.

Adult↗
PubMed1999

Laparoscopic staging in locally advanced cervical carcinoma: A new possible philosophy?

OBJECTIVES: The aim of this study was to evaluate the feasibility and efficacy of designing the therapeutic management of each patient, morbidity, and mortality using laparoscopic staging in locally advanced cervical carcinoma and to establish the standard procedure for a "complete" staging. METHODS: From July 10, 1995, to June 30, 1998, 98 pts were included. Clinical staging was performed according to FIGO's criteria (22 Ib2; 38 IIb; 25 IIIb; and 6 IV). The Quetelet index was calculated for each patient. Forty-nine pts were submitted to a previous CT scan. Surgical steps for a complete staging were: (1) peritoneal washings for cytology; (2) whole abdominal cavity exploration, with a biopsy of all suspicious lesions; (3) exploration of the vesicocervical and rectovaginal septums with a biopsy of suspicious areas; (4) bilateral pelvic lymphadenectomy and, when macroscopically positive, paraaortic lymphadenectomy. RESULTS: Eighty-four of 91 pts were evaluable. The average duration for the procedure was 108 min, and blood loss was less than 200 cc. Hospitalization time ranged from 24 to 48 h. The average number of resected pelvic nodes was 18.5 (9-31). Positive nodes were found in 38 cases; 19 pts had unresectable positive nodes. Paraaortic dissection was performed in 26 cases and 11 cases were positive. When tumor was <5 cm, 8/32 (25%) lymphadenectomies were positive; when it was >5 cm, 30/52 (58%) were positive. Thirty-eight of 49 pelvic CT scans were reported to be normal (18/38 had positive nodes) and 11/49 suspicious (6/11 had positive nodes). Tumor invasion of the vesicocervical space or of the anterior parametrium was found in 23/84 patients. The rectovaginal septum was positive in 10 cases. Four of 84 patients (4.7%) presented with intraperitoneal spread. Only one trauma to the vena cava occurred at the time of the Verres needle insertion and two postoperative lymphoceles were observed. All patients began curative treatment within 3 to 7 days. CONCLUSIONS: This method is feasible, complications are infrequent, and subsequent treatment is not delayed.

Adult↗
PubMed1998

Neoadjuvant chemotherapy followed by radical hysterectomy and postoperative adjuvant chemotherapy in the treatment of carcinoma of the cervix uteri: long-term follow-up of a pilot study.

OBJECTIVE: The aim of the study was to determine if ACH given after NCH followed by RH could decrease the incidence of distant metastases in patients with locally advanced carcinoma of cervix uteri. MATERIAL: 56 pts (34 Ib, 18 IIb, 4 IIIb) with confirmed diagnosis of squamous cervical cancer were enrolled in this phase II trial. The methodology used was: 1) Figo clinical staging; 2) Ultrasonographic determination of tumor volume in < or > 4 cms; 3) V.B.P. scheme: cis-platinum 50 mg/m2/day 1; vincristine 1 mg/m2/day 1; bleomycin 25 mg/m2/days 1-2-3 (3 courses with 10 days interval); 4) Clinical and sonographic tumor response evaluation following U.I.C.C. response criteria; 5) Radical hysterectomy; 6) Pathological risk factor evaluation; 7) ACH with P.M.C. (cis-platinum 50 mg/m2, methotrexate 30 mg/m2, cyclophosphamide 500 mg/m2) 3 courses every 21 days; 8) Comparison and location of recurrences with a neoadjuvant group (NCH + RH + RT to whole pelvis), and with a control group treated with conventional radiotherapy were done. For statistical analysis the Chi-Square was used and D.F.S. and overall survival (O.S.) were calculated according to the Kaplan Meier and Log Rank Test. RESULTS: After a median follow-up of 75 months (range 42-108), O. S. for stage Ib was 88%, Stage IIb 78%, and 50% for IIIb. The recurrences were 12% (4/34) for Stage Ib (3 local and 1 distant); 28% for IIb (5/18) (4 pelvic and 1 distant); 50% (2/4) for IIIb (2 pelvic recurrences). When residual tumor volume was < 2 cm in the surgical specimen (n=39) there were 4 recurrences (3 pelvic and 1 distant), and 7 (6 pelvic and 1 distant) for tumors > 2 cm. (p<0.01 for pelvic recurrences). For the stage Ib with residual tumor <2 cm (n=14) there were no pelvic recurrences and only 1 distant. Comparing for Stage Ib with previous tumor volume >4 cm of the ACH Group (n=17) with a classical NCH (n=51) and control (n=51) groups, there were observed 2 (11.7%) pelvic and 1 (5,8%) distant relapses for the 1st Group, 3 (5.9%) pelvic and 3 (5.9%) distant relapses for the 2nd, and 11 (21.6%) pelvic and 5 (9.8%) distant relapses for the 3rd Group. From the comparison of locally advanced tumors (Stages IIb + IIIb) of ACH group (n=22), with a Stage IIIb surgically removed of classical NCH group (n=38) and with a control group of conventional RT (n=51), there were observed 6 (27%) pelvic and 1 (4.5%) distant relapses for the 1st Group, 4 (11%) pelvic and 7 (18.4%) distant relapses for the 2nd, and 31 (60.7%) pelvic and 5 (9.8%) distant for the 3rd one. CONCLUSION: ACH after NCH + RH could be used for stage Ib with tumor volume > 4 cm, with complete clinical response or residual tumor < 2 cm. The results of this group of tumors suggest the importance of going on phase III trials comparing NCH+RH alone vs. NCH+RH+ACH. ACH could also be used to try to obtain better control of distant metastases in Stages IIb and IIIb. In these cases radiotherapy to the whole pelvis must not be excluded.

Carcinoma↗
PubMed1997

Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results.

OBJECTIVE: To determine if three courses consisting of 50 mg/m2 cis-platinum, 1 mg/m2 vincristine, and 25 mg/m2 bleomycin (day 1-3) at 10-day intervals can improve survival before Wertheim-Meigs + radiotherapy. MATERIAL: Two hundred five unselected stage Ib patients (having tumors > 2 cm in diameter) were divided into two groups at random: (1) The group control consisted of 103 patients (56 bulky, > 4 cm diameter) treated with Wertheim-Meigs (if the tumor was resectable with free surgical margins) + adjuvant radiotherapy to whole pelvis (extended field radiation was used only in patients with paraaortic lymph node metastases). When the tumor was unresectable, a surgical staging was performed and radiotherapy was the chosen treatment. (2) Neoadjuvant (102 patients, 61 bulky) had neoadjuvant chemotherapy and then the same treatment as the control patients. RESULTS: After 67 (31-102) months of follow-up, no difference was seen in tumors > 2 and < 4 cm in both groups (C = 77% vs N = 82%), but statistically significant differences were seen in survival and disease-free survival, in bulky tumors, and between patients with neoadjuvant chemotherapy + Wertheim-Meigs + radiotherapy (80%) and the control (61%). This was due to an increased operability that was substantially improved in bulky tumors in the neoadjuvant chemotherapy group (61/61, 100%) vs control (48/56, 85%; P < 0.01). After 7 years of follow-up, the outcome of the unresectable bulky control group of patients is significantly worse (14%) than that of the resectable group (69%; P < 0.001). With regard to recurrences, a significant decrease in pelvic failures in the neoadjuvant chemotherapy group was observed (P < 0.001). Survival was improved in bulky resectable cases (N = 81% vs C = 69%, P < 0.05). Pathological findings for the surgical specimens revealed differences between both groups because all the risk factors such as parametrial and lymph node metastases, tumor bulk, and vascular embolism had been decreased (P < 0.001). CONCLUSION: Neoadjuvant chemotherapy can improve survival because of increased operability with free survival margins and a decrease in pathologic risk factors in unselected, bulky (> 4 cm diameter) stage Ib patients.

Adult↗
PubMed1995

Development of an alternative method for testing the immunogenicity of diphtheria vaccines.

The immunogenicity of the diphtheria component of 73 commercial vaccines from five different manufacturers was tested by the toxin neutralization test (TNT) and the enzyme-linked immunosorbent assay (ELISA) developed in our laboratory. A comparison of the antibody levels measured by both assays showed a very good correlation (r = 0.95, p < 0.001). The results suggest that the proposed ELISA is a reliable, simple and economical alternative to the TNT in guinea pigs. Also, the ELISA was found to measure IgG antibody levels as low as 5.5 x 10(-5) IU ml-1. To evaluate the possibility of accelerating the active immunization during the activity test of vaccines, an alternative schedule using one single human dose was assayed. A very good correlation was observed between the IgG antibody response obtained with this schedule and with the traditional programme. Therefore, the cost and the time required to perform the activity test may be considerably reduced when both the rapid immunization schedule and the ELISA are used.

Animals↗
PubMed1994

Development of an ELISA for measuring the activity of tetanus toxoid in vaccines and comparison with the toxin neutralization test in mice.

An enzyme-linked immunosorbent assay (ELISA) has been developed to measure anti-tetanus toxoid antibody levels in immunized guinea-pig sera as a useful alternative to the currently used toxin neutralization test (TNT) in determining the activity of the tetanus toxoid in vaccines. The ELISA was found to measure antibody levels as low as 5.8 x 10(-5) IU/ml. Furthermore, a comparison of the results from ELISA and TNT involving 132 different commercial vaccines showed a very good correlation (r = 0.94, p < 0.001) between antibody levels measured by both methods. The results suggest that the proposed ELISA is a reliable, simple and economical alternative to the TNT in mice for assessing the activity of tetanus toxoids in vaccines.

Animals↗
PubMed1994

Epithelial alterations adjacent to invasive squamous carcinoma of the vulva.

The slides of 64 vulvectomy specimens from vulvar squamous carcinoma were reviewed in order to study the histopathologic changes adjacent to the neoplasia. Normal epithelium was found in 7 cases (11%) and epithelial alterations adjacent to carcinoma in 59 (89%). The epithelial alterations found were: nonneoplastic epithelial disorder (NNDV) in 38 cases (59%) and vulvar intraepithelial neoplasia (VIN) in 19 (30%). The distribution of NNDV was: 20 cases of epithelial hyperplasia (EH) (31%), 6 of lichen sclerosus (9%) and 12 of the mixed type (19%). Sixteen cases of VIN 3 (25%) were undifferentiated, and three cases were differentiated VIN. Eighteen of 19 VIN cases were associated with NNDV, and 8 cases of undifferentiated VIN were associated with human papillomavirus infection. There was no apparent relationship between the associated lesions and tumor size, depth of invasion, lymph node metastases and clinical stage. Nevertheless, we found a significantly higher frequency of associated lesions in poorly differentiated tumors (P > .01). The most important finding was a high association between EH (50%) and VIN (30%) with carcinoma. VIN cases were almost always (95%) associated with EH.

Biopsy↗
PubMed1994

Histologic predictive factors. Therapeutic impact in vulvar cancer.

In 59 cases of vulvar invasive squamous cell carcinoma treated with radical vulvectomy and inguino-femoral lymphadenectomy, seven histologic parameters were evaluated to establish their predictive value in the development of lymph node metastasis. The most significant was vascular involvement, observed in 86% of cases with lymph node metastases (P < .000004). Depth of stromal invasion and tumor thickness were highly significant, with P < .008 and < .007, respectively, with 0% lymph node metastases in tumors thinner than 1 mm and 62% and 60%, respectively, in those thicker than 5 mm. The growth pattern correlated with lymph node metastases but was not statistically significant. The histologic grade correlated with positive lymph nodes, with P < .04. The amount of keratin (P < .91) was not related. These histologic factors allow the identification of patients with a lower risk of developing lymph node metastases and in whom conservative surgery on the vulva and inguino-femoral lymph nodes is feasible.

Adult↗
PubMed1992

Density and distribution of Langerhans cells in the human uterine cervix.

Using a combination of immunohistochemistry and planimetric observation we report the density and distribution of Langerhans cells (LCs) in epithelium from the normal ectocervix and from the normal transformation zone (TZ). The density of LCs increased towards the basement membrane. Dendritic LCs aspect was more prominent in the superficial layers.

Adult↗
PubMed1992

Pertussis whole cell vaccine: relation between intracerebral protection in mice and antibody response to pertussis toxin, filamentous hemagglutinin and adenylate cyclase.

N:NIH mice were vaccinated according to the WHO recommendations for the potency test with the Second International Standard for Pertussis Vaccine (ISPV). Blood for serological investigation was taken from the animals on day 14 post immunization before intracerebral challenge with Bordetella pertussis 18323 was done. The relationship between anti-pertussis toxin, anti-filamentous hemagglutinin and anti-adenylate cyclase antibody levels as measured by ELISA and protection from intracerebral challenge was studied. The proportion of surviving mice increased in correlation with increasing anti-PT titres; a protective level of 4 ELISA units/ml was found. Such relationship between protection against intracerebral challenge and antibody titres was not found for anti-FHA nor for anti-AC antibodies, thus suggesting that these antibodies do not play an important role in protection in this model. The excellent correlation between anti-PT antibody titres and protection suggests that the measure of anti-PT response could be a useful tool for estimating the potency of whole-cell vaccines. The development of an alternative method for testing the potency of pertussis whole-cell vaccines based on the anti-PT response should be considered.

Adenylate Cyclase Toxin↗
PubMed1990

Neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri.

One hundred fifty-one patients (107 stage IIB and 44 stage IIIB) who had completed 2 years of follow-up after treatment with neoadjuvant chemotherapy ("Quick" VBP scheme), prior to standard therapy, are presented. Four groups of patients with different prognosis and operability status, according to tumor response, were identified. In the first group (excellent responders) 96% of the patients had no evidence of disease (NED), whereas in the fourth group (no response), only 33% had NED after 2 years of follow-up. In the first group, no pelvic failure was observed. On the other hand, of 21 patients in group 4, 11 (52%) had pelvic recurrences. The response to neoadjuvant therapy is strongly associated with the initial tumor volume ecographically evaluated. The critical pretreatment volume for response was 84 cm3 (4.85 cm in diameter). Surgery and radiotherapy were equally effective in those patients with initial tumor volume of 84 cm3 or less. But surgery appears to have a better outcome in those patients with tumors larger than the critical pretreatment tumor volume. Radiotherapy in this controversial group was ineffective in avoiding pelvic recurrences, especially when the tumor volume was not sufficiently reduced. The advantage of neoadjuvant chemotherapy is evident in stage IIB, with 79% (85/107) of patients showing no evidence of disease as compared with 47% (24/51) in a nonrandomized control group (P less than 0.01). Statistically significant differences were also obtained in stage IIIB (50% vs 26% in the control group).

Adult↗
PubMed1985

ACNUC--a portable retrieval system for nucleic acid sequence databases: logical and physical designs and usage.

ACNUC is a database structure and retrieval software for use with either the GenBank or EMBL nucleic acid sequence data collections. The nucleotide and textual data furnished by both collections are each restructured into a database that allows sequence retrieval on a multi-criterion basis. The main selection criteria are: species (or higher order taxon), keyword, reference, journal, author, and organelle; all logical combinations of these criteria can be used. Direct access to sequence regions that code for a specific product (protein, tRNA or rRNA) is provided. A versatile extraction procedure copies selected sequences, or fragments of them, from the database to user files suitable to be analysed by user-supplied application programs. A detailed help mechanism is provided to aid the user at any time during the retrieval session. All software has been written in FORTRAN 77 which guarantees a high degree of transportability to minicomputers or mainframes.

Base Sequence↗