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Biomedical subjects

M Lise

Publications and source records attributed to M Lise.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Giant cavernous hemangiomas: diagnosis and surgical strategies.

From January, 1972 to June, 1989, 51 patients with liver hemangiomas (32 females and 19 males, mean age 35 years) were evaluated for surgical treatment. Diameters of the masses were 5 cm to 20 cm (median 8.5 cm). Nine of the patients had already been treated for cancer. Twenty-two (43.1%) of the 51 patients were symptomatic and 29 (56.9%) patients were asymptomatic. In 34 patients (66.7%) a definite diagnosis of hemangioma was made by scintiscan and/or ultrasound and/or computed tomography and/or angiography while in the remaining 17 (33.3%) patients the diagnosis was uncertain. The most common indications for resection were the presence of a symptomatic angioma, a symptomatic mass with an uncertain diagnosis, and/or lack of a definite pre-operative diagnosis. Surgery was performed on 25 patients. Ten anatomic and 15 atypical resections or enucleations were performed. There were no postoperative deaths. Two further patients, operated for probable hemangioma, were found to have primary hepatic malignancies. In the 26 unresected patients, no complications were observed during follow-up. In 3 patients, hemangioma enlargement was detected by ultrasound, but there were no symptoms. As cavernous liver hemangiomas are now more reliably diagnosed and their natural history is usually uneventful, surgery can be avoided in most cases. However, when a non-resection policy is adopted, an exact diagnosis is essential in order to rule out primary or metastatic cancer. Surgical exploration and treatment should be limited to symptomatic or complicated cases as well as to patients with an uncertain diagnosis.

Adult↗
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Preoperative combined radiotherapy and chemotherapy for middle and lower rectal cancer: preliminary results.

BACKGROUND: Adjuvant treatment for rectal cancer is still controversial. This study reports on overall survival and disease-free survival, toxicity, downstaging, and surgical morbidity in rectal cancer patients who received combined chemoradiation therapy followed by curative surgery. METHODS: Between 1993 and 1998, 51 patients (31 males and 20 females; median age, 60 years; range, 33-73 years) underwent chemoradiation therapy followed by radical surgery for middle and lower rectal adenocarcinoma. Criteria for giving preoperative radiotherapy (total 45 Gy in 25 fractions of 1.8 Gy/day for 5 weeks) and chemotherapy (5-fluorouracil 350 mg/m2/day and leucovorin 10 mg/m2/day, bolus on days 1-5 and 29-33) were an age younger than 75 years; an Eastern Cooperative Oncology Group performance status score of 0 to 2; and clinical preoperative stage II-III. Forty-three low anterior and eight abdominoperineal resections were performed. Median follow-up time was 29 (range, 3-63) months. RESULTS: Although grade 3 to 4 toxicity occurred in 14 cases (27.4%), all patients completed the planned adjuvant therapy. At pathology, a complete response was found in eight (15.7%) cases. Of the remaining 43 cases, 22 were stage I, 12 were stage II, and 9 were stage III. Five-year actuarial disease-free survival and overall survival rates were 86.4% and 85.5%, respectively. Whereas no local recurrences were found, 4 patients had distant metastases. Three patients died (1 of cancer-related causes), 45 are alive and disease free, and 3 are alive with disease. CONCLUSIONS: The combined preoperative chemoradiation approach used by us seems to improve the disease-free survival and overall survival of selected patients with rectal cancer. However, a longer follow-up time is required to confirm these preliminary results.

Adenocarcinoma↗
PubMedDate not supplied

Absence of the cell cycle inhibitor p27Kip1 protein predicts poor outcome in patients with stage I-III colorectal cancer.

BACKGROUND: The p27Kip1 protein regulates the G1 to S phase transition of cell cycle by binding to and inhibiting the cyclin E/Cdk2 complex. This study explores the prognostic significance of the absence of the p27Kip1 protein in patients with colorectal cancer (CRC). METHODS: Formalin-fixed tumor sections from 124 patients who underwent curative resection for stage I-III CRC were analyzed by immunohistochemistry using MoAb anti-p27KiP1. RESULTS: Detectable levels of p27Kip1 protein were found in 86% of tumors. Median follow-up was 55 months. Actuarial 5-year disease-free survival (DFS) and overall survival (OS) were 76% and 85%, respectively, in patients with tumors with p27Kip1 protein expression and 34% and 40%, respectively, in those whose tumors lacked p27Kip1 protein expression (P < .001). At multivariate analysis, tumor stage (III vs. I-II) and p27Kip1 protein status (absence vs. presence) were found to be independent prognostic factors for DFS and OS. CONCLUSIONS: Lack of p27KiP1 protein expression in CRC is a negative prognostic marker and may therefore be useful in selecting early-stage patients more likely to benefit from adjuvant treatment.

Adenocarcinoma↗
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Percutaneous endoscopic gastrostomy for feeding. A comparison between neurologic and neoplastic indications.

The most common indications for percutaneous endoscopic gastrostomy (PEG) are neurologic deficits precluding adequate oral nutrition. The aim of this study was to ascertain whether PEG is as feasible, safe and effective in patients with advanced oropharyngeal, oesophageal and pulmonary carcinoma as it is in patients with neurologic deficit. PEG, attempted in 108 consecutive patients, was successful in 100 (overall success rate of 92%). On the basis of primary disease, the patients were subdivided into two groups: patients with neurologic diseases (group A, n = 50) and patients with oropharyngeal, oesophageal and lung carcinoma precluding adequate oral nutrition (group B, n = 50). No statistically significant difference was found between the PEG placement success rates of the two groups. Of the patients PEG placement 1 died and 2 had major complications. 15 out of 50 patients in group A and 11 out of 50 in group B had minor complications. No statistically significant differences were found between the mortality and morbidity rates of the two groups. Duration of nutrition was similar in both groups. In particular, 46% group A patients and 46% group B patients were PEG-fed for more than 3 months. A wider use of PEG is suggested in patients with advanced oropharyngeal, oesophageal and pulmonary carcinoma precluding adequate oral nutrition.

Adolescent↗
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Sentinel node biopsy in cutaneous melanoma patients: technical and clinical aspects.

The role of the patent blue dye (PBD) technique and intraoperative probe-guided lymphoscintigraphy (LS) in detecting the sentinel node (SN) was investigated in a group of 130 consecutive stage I cutaneous melanoma patients. The preoperative workup included high-resolution US scanning and LS performed 15-18 hours before surgery. On the basis of preoperative LS, in the group of examined patients a total of 143 lymphatic drainage basins were identified and surgically explored: 41.6% in the axilla, 52.8% in the groin, and 5.6% in the head/neck. A total of 228 SNs were intraoperatively detected and removed; 110 lymphatic basins contained histologically negative SNs, while 33 basins had metastatic SNs. The sensitivity for SN detection using PBD alone was 93%, while it was 100% when PBD was combined with intraoperative LS. Preoperative and intraoperative LS appears to be a highly sensitive technique for SN detection in cutaneous melanoma patients. Furthermore, in view of the limited skin incision when radioguided surgery is performed, SN biopsy could be feasible under local anesthesia.

Adolescent↗
PubMedDate not supplied

The value and present indications of staging laparotomy in Hodgkin's disease.

From December 1971 to December 1976 224 patients with Hodgkin's disease underwent diagnostic laparotomy and splenectomy under a multidisciplinary protocol of treatment. In 149/224 (66.5%) the clinical stage of the disease was confirmed, whereas in 75/224 (33.5%) it was modified after surgery. In 7.6% of the patients (17/224) there were postoperative complications. One patient died of myocardial infarction. The rate of complications in the last 100 cases was 5%. Preoperative patient selection, excluding those definitely in stage IV, is of relevance, and it can be done by iliac crest biopsy and laparoscopy. Although a better exploitation of some diagnostic procedures (lymphangiography, laparoscopy) and the expanding use of chemotherapy may reduce in the future the need for staging laparotomy and splenectomy, diagnostic laparotomy is still indicated for the selection and preparation of patients for radiation therapy in stages I, II and III.

Adolescent↗
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Pulmonary lymphangioleiomyomatosis: a case report in postmenopausal woman treated with pleurodesis and progesterone (medroxyprogesterone acetate).

The main problem in the treatment of pulmonary lymphangioleiomyomatosis, which frequently occurs in the reproductive age, is the control of chylothorax and disease progression. We herein report a case of a 62-year-old woman who underwent surgery for recurrent chylothorax. Histologic examination of lung and lymph node biopsies demonstrated lymphangioleiomyomatosis. Thirty-six months after tetracycline pleurodesis and high-dose medroxyprogesterone acetate therapy, the disease was stable and cyclothorax effectively controlled. It would therefore appear that hormonal treatment with medroxyprogesterone acetate may be beneficial in postmenopausal women.

Antineoplastic Agents, Hormonal↗
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Detection of circulating CEA-IgM complexes in early stage colorectal cancer.

We have recently shown that alpha fetoprotein (AFP) and squamous cell carcinoma antigen (SCCA), biomarkers associated with hepatocellular carcinoma, may be detected in patient sera as circulating immune complexes with IgM, and that assessment of serum levels of AFP-IgM and SCCA-IgM may be used for the detection of liver cancer. In this study we measured the levels of carcinoembryonic antigen (CEA) as free form (FCEA) and complexed to IgMs (CEA-IgM) in sera of patients affected by colorectal carcinoma (CRC) at different stages as well as in healthy subjects. FCEA levels were above the 5 ng/mL cutoff in 43% of CRC patients (31/72) and CEA-IgM levels were above the 200 AU/mL cutoff in 38% of CRC patients (27/72). Serum levels of CEA-IgM immune complexes (IC) and FCEA did not overlap and 64% of patients (46/72) were positive for at least one marker without compromising the detection specificity (94%). Early detection of CRC was significantly improved by CEA-IgM IC assay. CRC patients at an early stage (stage 1) had elevated CEA-IgM levels in 29% of cases (7/24), while FCEA levels were elevated in only 8% of cases (2/24). These results indicate that CEA-IgM is a complementary serological marker to FCEA which is much more sensitive for early stage CRC, and that the combination of these biomarkers may be useful in the early detection of colorectal cancer.

Adult↗
PubMedDate not supplied

Comparison between manual and automatic coding of medical record statistical cards at a university hospital.

The coding error rate of systems for medical record statistical cards (MRSCs) throughout health services is about 30%. A program using automatic coding has been developed at the Institute of Clinical Surgery II, Padua University Hospital, with a view to reducing this percentage. Out of an overall sample of 4776 MRSCs from all departments of the hospital, 54 were automatically coded at our institute. Categories of discrepancy between the discharge diagnosis codes of the 4722 manually coded MRSCs and the other 54 MRSCs were classified as follows: types I-III, diagnosis assigned to an erroneous under-class, class or heading (ICD-9) respectively; type IV, incorrect diagnosis formulation precluding code assignment; type V, two or more discrepancies on MRSC; and type VI, secondary diagnosis not coded. Discrepancy rates were as follows: 22.3% and 0.0% for type I; 21.3% and 0.0% for type II; 17.6% and 0.0% for type III; 1.9% and 0.0% for type IV; 5.8% and 0.0% for type V; 31% and 1.9% for type VI. Code discrepancy rates for surgical procedures, which were also compared, ranged from 7.0 to 12.5% for manual coding, while no discrepancy was observed in automatically-coded MRSCs. The results clearly demonstrate the utility of the system reported on, and it is suggested that it should be used in a modified form in other hospital departments.

Abstracting and Indexing↗
PubMedDate not supplied

Genetic heterogeneity of variable number tandem repeats in thymidylate synthase gene in colorectal cancer patients.

PURPOSE: To analyze the genetic variability in a variable number of tandem repeats (VNTR) in the thymidylate synthase (TS) enhancer promoter region and assess the influence of functional alterations in mismatch repair genes by analyzing constitutional and tumoral DNA from patients with colorectal adenocarcinoma with a high microsatellite instability (MSI-H) or microsatellite stability (MSS) status. PATIENTS AND METHODS: Patients who underwent surgery for colorectal adenocarcinoma were selected from the colorectal database of our institute and, on the basis of MSI status, assigned to a study group and a control group: group A, MSI-H; group B, MSS. Microsatellite status was investigated using the Bethesda recommended panel (BAT-26, BAT-25, D2S123, D5S346, D17S250). In MSI-H patients an additional analysis was made of the microsatellite loci D18S61 and D18S58, both mapping in the region containing the TS gene (18p11.2-11.32). Based on the number of altered microsatellites (> or = 2, 1, or 0), tumors were considered as having high (MSI-H) or low (MSI-L) instability or microsatellite stability (MSS), respectively. Genotyping for thymidylate synthase promoter polymorphism was carried out on constitutional and tumor DNA of each patient by PCR amplification of the polymorphic region. RESULTS: MSI-H was found in 55 patients (group A) and MSS in 50 patients (group B). In none of the MSI-H patients was microsatellite instability found in the additional D18S61 and D18S58 loci. In five group A and ten group B cases the analysis was not performed because constitutional DNA and/or tumoral DNA were not amplifiable. Homozygotes for the triple repeat variant (3R/3R) displayed only the large PCR product, homozygotes for the double repeat variant (2R/2R) displayed only the smaller PCR product, while heterozygotes (2R/3R) displayed both the larger and smaller PCR products. In 3/50 (6%) group A patients and 5/40 (12%) group B patients repeat variations were found in tumoral DNA. CONCLUSION: Our findings demonstrate that there is genetic homogeneity between constitutional and tumoral DNA but do not support the hypothesis that mismatch repair genes are involved in VNTR recombinant events in TS gene variability.

Adenocarcinoma↗
PubMedDate not supplied

Gastric non-Hodgkin's lymphoma: analysis of 252 patients from a multicenter study.

AIMS AND BACKGROUND: The stomach is the most common site of primary extranodal non-Hodgkin's lymphoma (NHL) and no agreement has been reached so far on the best therapeutic approach. The main objects of this study were to report the long-term results and to evaluate the importance of some possible prognostic factors in a large series of patients. NHL was considered primary gastric if the main symptoms at presentation were those of gastric disease. METHODS AND STUDY DESIGN: We analyzed 252 consecutive patients treated between 1980 and 1993 in five hospitals in north-east Italy. According to the Working Formulation, 98 patients had low grade lymphoma, 59 intermediate grade (D to F), 81 G or high grade and 14 were not classified. The patients were divided into two groups: one including patients with limited disease (localized to the stomach or perigastric lymph nodes: 165 patients) and one including those with advanced disease (87 patients). The treatment consisted of surgery, chemotherapy, radiotherapy or combinations of these. Sixteen patients received only supportive therapy. RESULTS: The five-year overall survival was 65.4%: 80.3% for patients with limited disease and 36.7% for those with advanced disease (P < 0.0001). Among the limited disease patients the five-year survival was 84.4% for those treated with gastrectomy alone and 88.7% for those who received also adjuvant chemotherapy (P = 0.11). However, while chemotherapy did not improve survival in low grade NHL, it seemed to produce a better survival in the intermediate and high grade groups (P = 0.06). Twelve patients were treated with primary chemotherapy and the five-year survival was 71.2%. In multivariate regression analysis the most important variable for overall survival was surgery for the whole group of 252 patients (P < 0.0001), while it was age for the group with limited disease (P = 0.0008). CONCLUSIONS: Surgery alone can be curative for most patients with gastric lymphoma limited to the stomach or to the perigastric lymph nodes; surgery followed by chemotherapy seems to produce better results than surgery alone in intermediate and high grade lymphomas. Also a non-surgical approach with first-line chemotherapy is associated with a high rate of complete remissions and five-year survival. In advanced disease the five-year survival is similar to that of nodal NHL.

Adolescent↗
PubMedDate not supplied

Metastatic colorectal cancer stimulates collagen synthesis by fibroblasts.

BACKGROUND: We ascertained in vitro whether there were any differences in the growth of fibroblasts and the production of collagen (PIIIP), in relation to the presence of conditioning sera or tumor tissues from colorectal cancer (CRC) patients with disease progression or regression after surgery. PATIENTS AND METHODS: Fibroblasts were conditioned with: 1) 10% of control (n=20) or CRC patients' (n=57) sera; 2) 10% of tumor tissue homogenates obtained from CRC patients without (group A, n=6) or with (group B, n=5) liver metastases. After surgery, 29/57 patients (group 1) developed while 28/57 (group 2) did not develop a recurrent disease. RESULTS: The ratio between cell growth and PIIIP production increases when fibroblasts were conditioned by group I (p<0.05), but not by controls or group 2 sera. Tumor homogenates from group B inhibited cell growth (p<0.001), while they induced PIIIP production (p<0.001) in comparison with results from group A. CONCLUSION: CRC non-metastatic cancer cells induce mainly fibroblasts growth, while metastatic cells mainly induce collagen synthesis. This effect is probably caused by soluble mediators, which partly pass into the systemic circulation.

Adult↗
PubMedDate not supplied

Adjuvant FAM2 in resectable gastric cancer.

In spite of the improvements in surgical techniques and intensive care, no important benefit in the prognosis of patients with gastric carcinoma has been attained in the last twenty years. Different adjuvant treatment protocols have been proposed in an attempt to improve upon the results obtained with surgery only. In western countries, the FAM chemotherapeutic regimen is one on the most widely used for the treatment of advanced gastric carcinoma. In 1982 the G.I. GROUP of the EORTC proposed a modification (FAM2) to the original FAM as an adjuvant treatment in a controlled clinical study for gastric carcinoma. It is still too early to determine any therapeutic advantages of FAM2 in this protocol. Although the FAM2 regimen is fairly well tolerated, there is some toxicity which, however, seems to be slightly higher than in the regular FAM. It remains to be seen if this is a reasonable price to pay for still unknown therapeutic advantages. In view of the scarcity of available data in this field and the conflicting results which have emerged so far, the results of our study are awaited with great interest.

Adenocarcinoma↗
PubMedDate not supplied

Regional intra-vascular and intra-lymphatic therapy of neoplastic diseases: a review.

The aims of regional therapy are to increase the exposure of regional confined cancers to drugs and to decrease their systemic levels. Two main approaches are available: intra-vascular and intra-lymphatic (I.L.) therapy. The former is comprised of different methods of delivering chemo-radio therapeutic agents directly to the tumor, i.e. intra-arterial infusion (I.A.I.), isolation perfusion (I.P.), tourniquet infusion (T.I.), trans-catheter embolization (T.C.E.) and intra-portal infusion (I.P.I.). The main aim of the latter is the prevention or cure of lymphatic metastases. So far none of the reported methods have been universally accepted. Pharmacokinetic studies have recently made I.A.I. a more rational method: the increase in regional exposure achieved is a direct function of the total body clearance of a drug and an inverse function of the regional arterial blood flow. I.A.I. is most effective in the treatment of hepatic metastases from carcinoid and colo-rectal cancer. I.P. gives objective response in 50% of recurrent melanomas. T.I., T.C.E., I.P.I. and I.L. therapy are still experimental methods. However, the future for regional therapy appears exciting, since pharmacological and technological developments seem to have greatly improved its potential effectiveness as a cancer treatment.

Brachytherapy↗