Biomedical subjects
Publications and source records attributed to M Covizzi.
Two cases of infected aneurysms of the subrenal abdominal aorta observed in the last year are reported. In this study some specific aspects of this unusual pathology are analyzed: the high mortality rate, the difficulties involved in the diagnosis and the surgical solutions.
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Diagnostic imaging and mediastinoscopy have reduced but not eliminated the exploratory thoracotomy in the management of lung cancer patients. Considering all the limits of such diagnostic techniques, an aggressive approach to lung neoplasm imply an increase both in explorative thoracotomies and in radical or palliative intraoperative procedures. Our study includes 55 explorative thoracotomies performed on 206 surgical operations for lung cancer. The patients of E.T.'s group couldn't undergo surgical resection in 28 cases because of direct tumoral mediastinal diffusion, involving cardio-pericardial wall and/or great vessels; in 20 for extensive nodal mediastinal diffusion, in 3 patients for pleural dissemination, and 4 had unresectable chest wall involvement. Postoperative mortality rate was 3.6% vs. 5.5% recorded in resected patients; postoperative morbidity rate was 9%. During explorative operations became possible to define more exactly diagnosis and, through palliative procedures, to improve life quality: in fact we performed tumor histology correction or settlement (12/55 P.ts), pericardiotomy for pericardial effusion (5/55 P.ts), pleurodesis or pleurectomy when pleural effusion was present (16/55 p.ts), intercostal neurolysis in involved chest wall areas (4/55 p.ts).
Sixty-four patients with advanced colorectal cancer were randomized to receive 5-fluorouracil (5-FU) at the dose of 600 mg/sm weekly or the same regimen of 5-FU administered halfway through a 1 hour i.v. infusion of folinic acid (FA) at the dose of 200 mg/sm. A partial remission (PR) was obtained in 1/30 patients (3%) treated with 5-FU and in 9/34 patients (26%) treated with 5-FU + FA (P = 0.028). The objective response was accompanied by an improvement in subjective status and general conditions. The median duration of PR in 5-FU + FA arm was 10 months (range: 6-17). The median time to progression was 5 and 6 months in patients treated with 5FU and 5FU + FA, respectively (not a statistically significant difference). There were no cases of grade 4 toxicity. A higher, but not statistically significant, incidence and intensity of diarrhoea was observed in the 5-FU + FA arm. However, 14 patients on 5-FU + FA as opposed to 3 on 5-FU had to stop the treatment temporarily because of side-effects (P = 0.011). Median survival was higher with 5-FU + FA treatment (10 vs 7 months), but the difference is not statistically significant. This study confirms that the addition of an intermediate dose of FA enhances the cytotoxicity of 5-FU. Although its clinical advantage was limited, this weekly 5-FU + FA regimen appears useful in the treatment of advanced colo-rectal cancer on a outpatient basis.
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The authors take the opportunity, on the basis of a clinical case examined, to revise an uncommon disease: neutropenic colitis. In the presence of an acute abdominal pain and tenderness localized at right lower quadrant, in a patient affected by hematologic neoplasm or by a solid tumor, at the end of a chemotherapeutic treatment with absolute residual neutropenia, we would be strongly oriented to neutropenic colitis. The treatment according to the primary disease and to the patient's poor conditions, will be where possible conservative, reserving the surgical approach only for those cases of absolute necessity.