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Biomedical subjects

M Di Fiore

Publications and source records attributed to M Di Fiore.

At least 19 recordsLinked to original sources
PubMed2000

Chondrosarcoma of the mobile spine: report on 22 cases.

STUDY DESIGN: A retrospective review of 22 cases of chondrosarcoma arising from the mobile spine. OBJECTIVE: To evaluate the role of oncologic and surgical staging in correlating management and outcome of chondrosarcoma involving the spine. SUMMARY OF BACKGROUND DATA: Approximately 10% of chondrosarcomas arise from the mobile spine, occurring mainly in adults, particularly elderly men. The course of the disease depends on the aggressiveness of the tumor, but also is influenced by the management. Intralesional surgery is followed almost constantly by local recurrence even with adjuvant therapy. METHODS: All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of the reviewed cases. According to Enneking criteria, the surgical procedures were defined as curettage (piecemeal excision) or en blocexcision. The margins were submitted to histologic study and reported as intralesional, marginal, or wide. - As primary management, 10 intralesional curettages (follow-up period, 2-119 months; average, 61 months) and 12 en bloc excisions (follow-up period, 39-207 months; average, 97 months) were performed. A total of 33 procedures were performed, including the management of the recurrences (18 curettages and 15 en bloc excisions: one for soft tissue recurrence). A clinical and radiographic follow-up period of of 2 to 236 months (average, 81 months; minimal follow-up period for survivors, 30 months; average follow-up period for survivors, 115 months) was available for all the patients. RESULTS: Three recurrences occurred in 14 patients treated by en bloc excision at onset or for recurrence, two in cases of histologically proven contaminated or intralesional margins. All but one patient were alive at final follow-up evaluation. Conversely, all the patients treated by one or more curettages (with or without adjuvant radiation therapy) had at least one recurrence, and 8 of 10 of these patients died of the disease. At final follow-up evaluation, nine patients had died of the disease; nine were continuously disease free (but one had died of another unrelated malignancy); and four were symptom free after management for recurrences (one was found alive 155 months after a soft-tissue metastasis en-bloc excision). CONCLUSIONS: En bloc excision, with wide or marginal histologic margins, is the suggested management for chondrosarcomas of the spine. Early diagnosis and careful surgical staging and planning are necessary for conducting adequate management. However, tumor contamination of the specimen margins, even in a small area, or spreading of the tumor myxoid content can worsen the prognosis.

Adult↗
PubMed1996

En bloc resections of bone tumors of the thoracolumbar spine. A preliminary report on 29 patients.

STUDY DESIGN: Twenty-nine patients with primary bone tumors and solitary metastases of the thoracolumbar spine treated with en bloc resection are reviewed retrospectively. OBJECTIVE: To demonstrate the possibility to apply in the spine the same principles of surgical oncology adopted for primary bone tumors of the limbs. SUMMARY OF BACKGROUND DATA: The surgical oncologic staging systems currently applied in limb tumor surgery are difficult to apply to spinal tumors. The anatomic conditions make extralesional surgery difficult or impossible, which has restrained a more common use of resection surgery in the spine. Focus is put on a new surgical staging system and en bloc vertebral resection. METHODS: Twenty-five primary malignant and aggressive benign bone tumors and four solitary metastases were treated. The patients were submitted to oncologic and surgical staging for surgical planning. The primary tumors were classified according to Enneking system: three Stage IA, six Stage IB, eight Stage IIB, eight Stage 3 benign. Staging according to the Weinstein-Boriani-Biagini system was also done. Thirteen lesions involved the vertebral body; nine lesions developed in the posterior arch, or part of it, and seven lesions occupied part of the body and part of the arch. A careful anesthesiologic evaluation was performed as well as a continuous intraoperative on-line monitoring of the vital parameters. The en bloc resections (multisegmental in five patients) were performed in 10 thoracic, in 16 lumbar, in two thoracolumbar lesions, and in one lumbosacral lesion. Reconstruction was performed, aiming to replace the resected columns. The specimens were submitted to histologic study of the margins. All the patients were followed, and their status was defined on clinical and imaging studies. RESULTS: In 20 patients, a wide margin was achieved, in eight a marginal margin, in one an intralesional margin. The margin was contaminated in seven patients. Surgical time was 3-21 hours (average, 12 hours). No patient died during surgery or from surgical complications. Three mechanical failures of the implants required additional surgery. One deep infection arose. The only neurologic problems observed were related to the nerve roots sectioned for oncologic purpose. No local recurrence was found at follow-up evaluation after 6-134 months (average, 30 months). CONCLUSIONS: En bloc resection can be performed in selected tumors of the spine; the indication to such major surgery must be based on the oncologic stage, and the procedure must be carefully planned. For this purpose, the Weinstein-Boriani-Biagini system could be a helpful tool. Long-term results must be weighed before a definitive statement of the indications can be made.

Adolescent↗
PubMed1994

Two-level thoracic disc herniation.

STUDY DESIGN: A double, contiguous disc herniation in the thoracic spine (T7-T8, T8-T9) in a 44-year-old man is reported. The patient complained of intermittent episodes of weakness and numbness in the lower extremities, paraesthesias radiating to the anterior and medial surfaces of the thigh and the leg (mostly on the left side), and mild sexual and urinary dysfunction. OBJECTIVE: The treatment must achieve complete spinal cord decompression, prevent further herniation, and prevent iatrogenic vascular damage to the cord. A transthoracic approach seems to offer the largest surgical view. SUMMARY OF BACKGROUND DATA: Twenty-six other cases of two-level thoracic disc herniation were found in the literature, only five of which were treated with a transthoracic approach. METHODS: Treatment consisted of complete disc excision (T7-T8 and T8-T9) with a right anterior transthoracic approach. Complete and safe removal of the discs required hemicorporectomy of T8 and subsequent grafting and plating. Spinal cord angiography, showing the Adamkiewicz artery originating from the left T10, was performed before surgery. Computed tomography-guided methylene blue injection in the retropleural interspace of T7-T8 was done for intraoperative level localization. RESULTS: At 1 year follow-up, complete relief of neurologic symptoms was observed, as was solid interbody fusion. CONCLUSION: In this case, a transthoracic approach was safe and effective for disc excision and cord decompression via hemicorporectomy.

Adolescent↗
PubMed1992

[Normovolemic induced hemodilution. Behavior of various hemodynamic indices].

Changes in mixed venous oxygen saturation of hemoglobin (SvO2), heart rate (HR), cardiac index, (SI) were measured in 20 patients undergoing major orthopedic surgery (rachis and pelvis bone resections for tumours: mean-lasting 8 hours), to estimate the safety limits during isovolemic hemodilution. Up to Hb 8 g%, in all patients, a cardiac index improvement (+41%) was found, and this was mainly caused by an increase in stroke index (+31%). For 16 patients at Hb 6 g%, this improvement was present only in 44% and declined during further hemodilution. In all cases, CI was moderately lower than baseline value (-18%) this was caused by an important increase in HR (= 55%) partially compensating for by the fall in SI (-57%). The Authors conclude that, in patients under general anaesthesia, isovolemic hemodilution is safe up to Hb 8 g%. Below this value the left ventricular performance rapidly declines.

Adult↗
PubMed1990

An ELISA method in the diagnosis of typhoid fever.

Anti-S. typhi IgG and IgM antibodies were detected by an ELISA test using whole S. typhi as antigen. Among sera of patients suffering from typhus, 100% were positive for IgG and 78.9% for IgM. In the control group (blood donors and patients with various diseases) positivities were 1.01% for IgG and 1.01% for IgM.

Antibodies, Bacterial↗
PubMed1989

[Antibodies against Toxocara canis in human serum from western Sicily].

335 human sera of western Sicily were examined with an ELISA method for the prevalence of antibodies anti-Toxocara canis. The results (13% pos. in psychiatric patients,9.4% in farmers, 1.9% in children and 1.2% in blood donors) seem to indicate a strong correlation between style of life and infestation risk.

Adult↗
PubMedDate not supplied

Neoadjuvant chemotherapy for osteosarcoma of the extremity in patients in the fourth and fifth decade of life.

From January 1986 to March 1993, 29 patients aged between 40 and 60 years with primary high grade osteosarcoma of the extremity were treated at Rizzoli Institute with neoadjuvant chemotherapy. Before surgery patients received cisplatin and adriamycin. Postoperatively, patients with a good histologic response received the same two drugs preoperatively used, while in case of poor response ifosfamide and etoposide were added to cisplatin and adriamycin. Twenty-five patients (86%) were surgically treated with a limb salvage, whereas 4 patients (14%) were amputated. With a median follow-up of 8 years (5-12), the 8-year event-free survival was 57% and the 8-year overall survival was 62%. No chemotherapy-related deaths were recorded and toxicity was manageable. These results are significantly better than those achieved in 24 patients of the same age, treated at Rizzoli Institute between 1975 and 1985 only with surgery (87% of amputation and 17% of 8-year event-free and overall survival) and indicate an advantage for the use of neo-adjuvant chemotherapy also in patients with high grade osteosarcoma of the extremity older than 40 years.

Adult↗
PubMedDate not supplied

Delayed diagnosis and tumor stage in Ewing's sarcoma.

The relationship between tumor stage and time to diagnosis was investigated in a consecutive series of 618 patients with Ewing's sarcoma. This tumor is diagnosed late, with a mean interval between initial symptoms and biopsy of 4 months. The interval between the clinical onset and the final diagnosis was not associated with tumor stage. On the contrary, patients with metastatic Ewing's sarcoma were generally diagnosed at an earlier time than patients with localized disease, possibly reflecting inherent biological differences in aggressiveness among sub-groups of Ewing's sarcoma.

Biopsy↗
PubMedDate not supplied

[Sodium naproxen in postoperative pain in orthopedics. Comparison of 2 different doses].

In order to use etiopathogenetic criteria for the treatment of postsurgical pain, non-steroid anti-inflammatory drugs (NSAIDs) can be used rather than narcotic analgesics. These agents are often classified as peripherally acting analgesic drugs; nevertheless in the last years many pages have who showed a central supraspinal analgesic effect. Sodium naproxen is commonly used in the treatment of postoperative orthopedic pain because of its pharmacokinetic properties. The aim of this study was to evaluate the suitable dosage of sodium naproxen for post-surgical pain relief. Forty patients submitted to foot surgery were randomized into two groups of 20 patients each. At the end of surgery one group of patients (group I) received sodium naproxen 275 mg i.m.; the same dose was administered after 12 hours. A second group (group II) received sodium naproxen 550 mg i.m. at the same time intervals. Based on a Descriptive scale for algometric measurements, the results showed significant differences in analgesic activity for the two treatments. The best results (70% of patients with no pain or slight pain vs 20% of patients) were obtained in the group that received sodium naproxen at the higher dosage (p less than 0.001). No differences were observed in the incidence of side-effects in the two groups. These results are discussed.

Adolescent↗
PubMedDate not supplied

Autologous blood pre-deposit in cemented hip arthroplasty.

The authors examine one of the methods used to avoid homologous blood transfusion in patients submitted to cemented hip arthroplasty. Although the series is not a numerous one (25 cases) it does show that even the pre-deposit of single unit of autologous blood is capable of eliminating the need for homologous blood transfusion in 96% of all cases.

Aged↗
PubMedDate not supplied

Surgical technique: dorsal vertebral hemiresection for bone tumors.

The authors describe the technique of sagittal vertebral hemiresection used for the treatment of tumors of the thoracic spine involving one or more hemivertebrae. This type of treatment is not frequently indicated because of the rare asymmetrical distribution of vertebral tumors.

Anesthesia↗
PubMedDate not supplied

Lumbar vertebrectomy for the treatment of bone tumors: surgical technique.

The authors describe lumbar vertebral resection for the treatment of bone tumors by double approach (posterior longitudinal with the patient in prone position, and retroperitoneal lobotomy in lateral position), usually performed in one-stage surgery. The indication includes aggressive benign tumors (e.g., stage 3 giant cell tumor, osteoblastoma) and low-grade malignant tumors (e.g., chordoma, chondrosarcoma). In these cases an oncologically adequate surgical margin may be obtained, provided that the neoplasm is entirely or largely intracompartmental and at least one of the vertebral pedicles is uninvolved. The different stages of surgery and anesthesia-related problems are described, and possible complications are discussed.

Anesthesia↗
PubMedDate not supplied

Low back pain in tumors: diagnosis and treatment.

On the basis of the authors' experience in the treatment of 257 skeletal neoplasms of the lumbar spine, the features of back pain, which in 96% of the cases constitutes the first symptom of these diseases, are discussed. The overall clinical aspects firstly depend on the stage of the primary tumor: latent, active, aggressive for benign tumors; intra- and extra-compartmental for malignant tumors. Symptoms may include elements which suggest specific lesions, such as osteoid osteoma, eosinophilic granuloma, aneurysmal bone cyst, or high-grade malignant tumors such as Ewing's sarcoma, while lumbar metastasis from carcinoma do not seem to have distinctive features. Site and localization of the tumor are also important variables. The treatment of neoplastic back pain depends on diagnosis, and cannot be adequate if it is not planned on the basis of a complete preoperative study, taking into account not only surgery, but also adjuvant therapy.

Adolescent↗
PubMedDate not supplied

Anesthesia and perioperative treatment in large resections of the pelvic girdle.

The authors examine 24 patients submitted to resection of the pelvic girdle in neoplastic pathology, illustrating the perioperative anesthesiologic procedures used. Sudden variations in blood and plasma volume and increasing hypothermia constitute the main problems. The prevention of hypothermia and continuous invasive monitoring of hemodynamic parameters and of oxygen saturation in mixed venous blood (SvO2) are of primary importance.

Adolescent↗