PubMed Health⌕ Search

Biomedical subjects

M Lucchi

Publications and source records attributed to M Lucchi.

At least 55 records · Page 3Linked to original sources
PubMed1995

Microvessel count predicts metastatic disease and survival in non-small cell lung cancer.

The growth of newly formed vessels, or neoangiogenesis, represents an important step in both physiological and pathological situations: in particular, tumour growth and metastasis require angiogenesis. Microvessel count (MC), which represents a measure of tumour angiogenesis, has been associated with metastatic spread in cutaneous, mammary, prostatic, head and neck, and early-stage lung cancer. In this study, the role of tumour angiogenesis as a prognostic indicator was examined in 253 primary non-small lung cancer (NSCLC) patients. Microvessels were counted by highlighting endothelial cells with anti-Factor VIII monoclonal antibody (Mab) in methacarn-fixed tumour samples. In univariat analysis, MC (P< 0.000001), sex (P=0.0036), histotype (P < 0.014), tumour status (P <0.007), and vessel invasion (P < 0.019) were significantly related to hilar and/or mediastinal nodal involvement. However, in the stepwise logistic regression analysis, MC (P<0.000003) retained the most important influence on nodal metastasis. The overall survival analysis calculated by the Kaplan-Meier method revealed that tumours with high MC ( > 25 vessels/field) were significantly associated with increased death risk (log-rank test P = 0.00067; Cox's test P = 0.00046; Gehan's Wilcoxon test P = 0.00108). In 94 patients, the development of metastatic disease during follow-up was significantly related to MC. Indeed, patients who developed metastasis during follow-up showed a higher MC, either as a dichotomous (P = 0.01) or as a continuous (P = 0.003) variable, than patients who had developed no metastasis at the time of the analysis. Moreover, in the stepwise logistic regression analysis, MC retained the most important influence on distant metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Pre-operative chemotherapy for stage IIIa (N2) non-small cell lung cancer.

From June 1990 to December 1993, 36 patients were enrolled in a phase II study, aimed at determining the feasibility of surgery, patterns of disease recurrence and survival after neoajuvant chemotherapy in non-small cell lung cancer (NSCLC) stage IIIA-N2. Twenty-seven patients underwent invasive staging procedures (i.e. mediastinoscopy or needle biopsy). Two CHT schedules were used. Cisplatin (P) 90 mg/mq, day 1, mitomycin (M) 6 mg/mq, day 1, and vindesine (V) 5 mg/mq, days 1, 8, 15, were administered every 3 weeks for 3 cycles in the first 20 patients. The last 16 patients were treated with cisplatin (P) 90 mg/mq, day 1, mitomycin (M) 6 mg/mq, day 1, and vinorelbina 20 mg/mq, days 1, 8, 15. Thoracotomy was performed 15-20 days after haematological recovery in the objective-responders. Thirty-two patients were evaluable for response to CHT. The overall objective response (OR) rate was 78.1%. There were three complete (CR) (9.4%) and 22 partial responses (PR) (68.7%). The 25 patients with OR underwent radical surgery (16 pneumonectomies, one bilobectomy, seven lobectomies and one wedge resection). The only morbidity reported was a late broncho-pleural fistula (on post-operative day 37). There were three post-operative deaths in patients who underwent pneumonectomy: two due to an empyema following a broncho-pleural in fistula and one by pulmonary embolism. Histology was negative for the three CRs. Six patients with residual nodal involvement at surgery underwent radiotherapy. Relapse occurred in seven resected patients. Presently 14 patients are alive, all but one being disease-free, with a median follow-up of 30.5 months (15-47). Median survival was 31 months (5-47). Actuarial 3-year survival rate is 49%. Our results confirm the high response rate of CHT, as well as the feasibility and the overall low complication rate of both treatments (CHT and surgery).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Second primary lung cancer and relapse: treatment and follow-up.

During a 14-year period (1980-1993) second primary lung cancer or relapse was treated in 44 consecutive patients. Thirty-seven patients had synchronous (n = 18) or metachronous (n = 19) second primary lung cancer. Ten synchronous tumors were ipsilateral and treated contemporarily with five pneumonectomies, three lobectomies and two double wedge resections. The bilateral synchronous lesions (8 patients) were treated by staged bilateral thoracotomy (mean interval; 2 months). The first resection consisted of a lobectomy in six patients and wedge resection in two. The second one was a wedge resection in six patients and a lobectomy in two. In the metachronous presentation 15 patients (79%) were asymptomatic and detected by follow-up chest X-ray. In this group the first operation was a lobectomy in 12 patients, a wedge resection or segmentectomy in 6 and a pneumonectomy in 1. The second one was a wedge resection in nine patients, a lobectomy in six and completion pneumonectomy in four. Seven patients, all of them asymptomatic, had local recurrence from their primary lung cancer. The first lung resection was a lobectomy in five patients and a wedge resection in two. The second one was completion pneumonectomy in five patients and completion lobectomy in two. We had no operative death. The actuarial over-all 5-year survival rate after the second pulmonary resection for second primary lung cancer was 38.3% with a median survival time of 13.5 months. The synchronous presentation had a better survival than the metachronous one (46.2% and 25.9%), respectively). The actuarial overall 5-year survival rate for patients with relapse was 38.1% with a median survival time of 37 months. We may conclude that an aggressive surgical approach is safe, effective and warranted in patients with either a second primary lung cancer or relapse from their primary lung cancer. Moreover, for early detection of the second lesions, follow-up at a maximum of 6-monthly intervals should be continued for more than 5 years after the first resection.

Actuarial Analysis↗
PubMed1995

Bcl-2 protein: a prognostic factor inversely correlated to p53 in non-small-cell lung cancer.

Non-small-cell lung cancer (NSCLC) prognosis is strictly related to well-established clinicopathological parameters which have unfortunately become insufficient in the prognostic evaluation of this type of cancer. As p53 and bcl-2 gene deregulations are frequently involved in several types of epithelial malignancies, we investigated the Bcl-2 and p53 protein expression in 91 and 101 cases of NSCLC respectively. The expression was then compared with established indicators of prognosis and biological behaviour of the tumours. No relationship was observed between Bcl-2 and either clinicopathological or biological parameters such as histology, grading, tumour status, nodal metastasis and proliferative activity evaluated by scoring proliferating cell nuclear antigen expression and Ki-67 immunoreactivity. However, the mean Bcl-2 expression was significantly lower in patients who developed metastasis during follow-up or died of metastatic disease (P = 0.006 and P = 0.01 respectively). Moreover, survival probability was higher in patients who expressed the Bcl-2 protein (P = 0.0002). In contrast with this, p53 protein accumulation was observed in tumours with metastatic nodal involvement (P = 0.02) or in patients who developed metastasis during follow-up (P = 0.01), although no correlation was found between p53 expression and overall survival. An inverse relationship was also found between Bcl-2 and the anti-oncogene protein product p53 (P = 0.01). Thus, a high proportion of NSCLCs express p53 and Bcl-2 proteins and their expression may have prognostic importance.

Aged↗
PubMed1995

Functional lymphatic alterations in patients suffering from lipedema.

Lipedema is a chronic vascular disease almost exclusively of female sex, characterized by the deposit of fat on the legs, with an "Egyptian column" shape, orthostatic edema, hypothermia of the skin, alteration of the plantar support, and negativity of Stemmer's sign. The etiology and pathogenesis of this disease are still the object of study, and therapy is very difficult. Various authors have described morphologic and functional alterations of prelymphatic structures and of lymphatic vessels. The big veins remain untouched in the phlebograms and an alteration of the skin elasticity is demonstrated. The present authors have studied by dynamic lymphoscintigraphy 12 women patients suffering from lipedema, and compared the results with those of 5 normal subjects and 5 patients suffering from idiopathic lymphedema who were sex and age matched with the patients suffering from lipedema. The patients suffering from lipedema showed an abnormal lymphoscintigraphic pattern with a slowing of the lymphatic flow that presented some analogies to the alterations found in the patients suffering from lymphedema. A frequent asymmetry was also noticed in the lymphoscintigraphic findings that is in contrast to the symmetry of the clinical profile.

Adipose Tissue↗
PubMed1995

[Pulmonary carcinoma and solitary intracranial metastasis: results of the combined surgical treatment].

Previous reports have shown the utility of combined lung and brain surgery in patients with a primary non small cell lung cancer (-NSCLC) and solitary brain metastasis. This paper reports our recent data with the aim to rationalize the indication of this surgical approach. Over a period of eighteen years (1975-1992), 50 patients with NSCLC and solitary brain metastasis underwent combined lung and brain surgery. Fifteen of these patients had a synchronous presentation while the remaining 35 had a metachronous presentation of lung cancer and single brain metastasis. There were no operative deaths and complete remission of neurological symptoms was obtained in 46 patients (92%). Actuarial overall five year survival was 16% with a median survival of 21 months. Age, gender, histology, T status, size and site of NSCLC, site and location of brain metastasis and the association with adjuvant therapy did not significantly affect survival. The variables that were associated with a significantly prolonged survival were type of lung surgery, N status and interval between the two operations. Patients with synchronous presentation had a five-year survival of 6.6%. By contrast the actuarial five-year survival of those patients with the diagnosis of brain metastasis after the removal of NSCLC was 19%. In this subset of patients those with N0 status and a median interval between lung and brain surgery longer than 14.5 months had a significantly longer survival. We may conclude that combined lung and brain surgery is recommended both for relieving neurological symptoms and for prolonging survival. This is particularly true in those patients with limited loco-regional involvement and a late single brain metastasis.

Adult↗
PubMed1995

[The role of adjuvant therapy in the management of pN2 non-small-cell carcinoma of the lung].

Over a period of eleven years (1983-1993), the role of adjuvant chemo and/or radiotherapy was evaluated on 222 resected patients (pts) with NSCLC at atage IIIA(N2). All the patients underwent an attentive mediastinal limphoadenectomy. Fifty-five patients had a clinical mediastinal node involvement. 174 pts had a single mediastinal node station involved while 48 had two or more stations involved. One hundred and seventy-one pts (77%) underwent adjuvant therapies, consisting of citotoxic chemotherapy in 40 pts, radioterhapy in 97 pts and chemoradioterhapy in 34 pts. Follow-up lasted until September 1994. Overall 5-yr survival was 17.5%, the median being 17 months. Forty-two pts were, at that moment, still living (median 43.5 months, min 11-max 120) with 37 disease free. We verified a significant difference concerning survival among the three histologic types (p = 0.03), with the squamous achieving the best result (21.3% at 5-yrs). Surgical N2 had a better survival (20/5% at 5-yrs) than the clinical one (9%), (p = 0.01). In particular, if only one nodal station was involved, survival was 21.3% compared to 4.5% when metastases were present at two or more nodal station (p = 0.0001). Considering the level of mediastinal node involvement, the worst prognosis was linked to the carina node metastases (p = 0.02). Survival benefits were obtained by means of adjuvant therapies (20/2% vs 8.1%), (p = 0.0002). Analyzing all the pts, the best survival was achieved in those treated by surgery plus chemo-radiotherapy (32.4%), (p = 0.0001). As regards the squamous cell tumors, pts who underwent surgery plus radiotherapy had the best prognosis (24.2%), (p = 0.0026). Further, in non-squamous cell tumor, chemo-radiotherapy increased survival (45%), (p = 0.0001). At multivariate analysis, only the level of nodal involvement and the adjuvant therapy maintained their statistical significance. Our results prompt us to conclude that: 1) Squamous cell tumors and single nodal station involvement are linked to the best prognosis; 2) Squamous cell carcinoma should be treated by adjuvant radiotherapy; 3) Non-squamous tumors should undergo to chemo-radiotherapy; 4) Clinical N2 (according to our recent experience) may benefit from neoadjuvant chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

[The diagnosis of primary lesions of the anterior mediastinum].

The treatment of anterior mediastinal tumours is often subordinated to histological diagnosis. Sometimes topographic, radiographic and clinical criteria are sufficient to indicate surgical therapy. From January 1988 to June 1992, 31 patients (40.7%) underwent immediate surgery, while 47 patients (59.3%) underwent fine needle aspiration and Trucut biopsy under ultrasonographic or computed tomographic guidance. Thirteen of these patients had also an anterior mediastinotomy according to McNeill-Chamberlain technique. In 36 patients it was possible to verify accuracy of diagnostic procedures comparing these specimens with surgical histological reports. Only 3 patients had minimal complications. No patients undergone anterior mediastinotomy had morbidity or mortality. Our reports show that transthoracic fine needle aspiration and Trucut biopsy have a diagnostic accuracy of 72% and 83% respectively in identifying malignant from benign lesions. These procedures are not adequate to detail diagnosis for tumours with pleomorphic pathologic characteristics (diagnostic accuracy of 39% and 75% respectively). This disagreement is due to false-positive results (one for fine needle aspiration and four for tru-cut biopsies), this discordance occurred in lymphomas and thymomas groups. Such correct diagnosis is very important either for frequency of these tumours either for different therapeutic approach: chemo-radiotherapy in lymphomas and surgery in thymomas.

Adolescent↗
PubMed1993

[Is clinical diagnosis of deep venous thrombosis really unreliable?].

The clinical diagnosis of deep venous thrombosis (DVT) is traditionally regarded as lacking of sensitivity and specificity. As we were not fully convinced by this statement, we assessed the value of two associated clinical signs in outpatients, namely the flapping of the calf and the modified Lowemberg's sign. The examiner has first put forth a diagnosis based on the data of history and/or the presence of clinical signs specific for another kind of disease. Then an objective test of the diagnosis was carried out with a duplex scanner performed by an expert. DVT was observed in 39 subjects out of 102 (38.2%) who where all referred by general practitioners (GP), which confirms the poor diagnostic value of clinics at GP level. Associated positiveness of these two signs yielded 87.2% sensitivity and 88.8% specificity with a positive predictive value of 82.9% and a negative predictive value of 91.8%. The addition of an overall clinical assessment later improved results to 87.2% sensitivity and 96.8% specificity, a positive predictive value of 94.4% and a negative predictive value of 92.4%. In this study, the performance of clinics, if assessed by an angiologist qualified for the diagnosis of DVT, proved to be better than in the common data of the literature. Clinical data, if perfect, should be included in the diagnostic management of DVT.

Adolescent↗
PubMed1992

Microangiopathy of ethylic polyneuropathy.

The authors have studied, by biopsy of the tip of the big toe, the histologic changes in microvessels of patients affected by ethylic polyneuropathy. Patients affected by diabetes, hypertension, peripheral arterial or venous diseases, or dermatologic diseases or vasculitides were excluded. The mean of daily drinks was 310 +/- 105 g of alcohol, chiefly wine. Important pathologic modifications were noted; complete narrowing of the arteriovenous anastomosis, regressive changes of the Vater-Pacini corpuscles, and dilatation of the small veins and the capillaries. The findings were compared with those of a patient affected by ulcerans and mutilans acropathy of Bureau and Barriere, a typical disease of alcoholics. The same characteristics appeared: profound changes of the structure of the smallest vessels, with sclerosis, extended to the interstitium. In a previous study of the authors, 3 other patients affected by Bureau-Barriere disease showed the same pattern. These alterations can be explained as the effect of alcohol on the microvessels.

Adult↗
PubMed1990

[Danazol and antithrombin III deficiency].

The study concerned 7 subjects (3 men, 4 women) with nonfamilial antithrombin III deficit which, in the absence of known causes of acquired deficiency, was defined as "sporadic". Danazol (an attenuated synthetic androgen) already shown to be capable of compensating for a lack of certain antiproteases, was given in doses of 200 mg 3 times per day for 10 days, resulting in a rapid rise (mean 21.2%) in antithrombin III values. Unlike results reported in the literature in cases of familial antithrombin III deficit, the levels did not drop below their initial values despite discontinuance of the drug but unexpectedly remained high and even shows a slight subsequent rise. Although our study was limited to 11 cases, these data seem worthy of being reported, with the prospect of other confirmations concerning either this sort of "sporadic" antithrombin III deficit or the favorable effect of Danazol, even at long term.

Antithrombin III Deficiency↗
PubMedDate not supplied

Gamma probe-guided thoracoscopic surgery of small pulmonary nodules.

Video-assisted thoracic surgery (VATS) is an interesting and emerging procedure for the diagnosis and treatment of peripheral pulmonary nodules. We developed a new radioguided surgical technique for the detection during VATS of pulmonary nodules smaller than 2 cm, situated deep in the lung parenchyma and neither visible nor palpable with endoscopic instruments. The procedure is divided into two phases. Two hours before surgery 0.3 ml of a solution composed of 0.2 mL of 99mTc-labeled human serum albumin microspheres (5-10 MBq) and 0.1 mL of non-ionic contrast is injected into the lesion under CT guidance. Then the patient is submitted to VATS. During thoracoscopy a collimated probe of 11 mm diameter connected to a gamma ray detector is introduced via an 11.5 mm trocar and the pleural surface of the suspected area is scanned. A hot spot indicates the presence of the radiolabeled nodule and hence the area to be resected. We treated 39 patients with small pulmonary nodules (mean size, 8.3 mm; range, 4-19 mm). The patients were 27 men and 12 women (mean age, 60.8 years; range, 13-80 years). Nineteen patients had a history of synchronous or metachronous malignancy. In all cases the nodule was detected and resected and the resection margins were pathologically free of tumor. Histological examination showed 21 benign and 18 malignant lesions (7 metastases and 11 primary lung cancers). Nine patients with a frozen section-based histopathological diagnosis of lung cancer without functional contraindications underwent a completion lobectomy by open surgery in the same surgical session. In conclusion, the radiolocalization of small pulmonary nodules by gamma probe during VATS is a safe and easy procedure, with fewer complications and a lower failure rate than other localization techniques.

Adolescent↗
PubMedDate not supplied

Modulation of neoangiogenesis in bronchial preneoplastic lesions.

We have previously demonstrated that vascular count significantly increases in the preneoplastic lesions of the bronchial tree, starting from very low levels in the normal epithelium to a significantly higher number of microvessels in moderate dysplastic lesions and in situ carcinomas. Vascular endothelial growth factor (VEGF) protein expression has shown to be strictly associated with neovascularization both in human cancer and in various type of preinvasive lesions. A number of studies have demonstrated that mutant p53 is involved in the regulation of angiogenesis, and immunohistochemical detection of the p53 protein is associated with p53 gene mutations. In this study we looked for possible correlation between p53 protein detection, VEGF expression and vascular count in a series of preneoplastic and neoplastic lesions of the bronchial tree in order to investigate the angiogenic pattern and its genetic control in the early steps of bronchial cancer development. Twenty-four retrospective bronchial lesions with different grades of dysplasia and a case of normal bronchial epithelium were analysed. Surgical specimens removed from patients either confirmed, or suspect for lung carcinoma were stained immunohistochemically for CD34, VEGF, and p53. There were significant increases in microvascular density (MVD), VEGF, and p53 expression from normal bronchial epithelium through moderate dysplasia to in situ carcinoma to invasive cancer and these factors were significantly associated with moderate dysplastic lesions. A statistically significant difference was observed in MVD between hyperplastic-metaplastic, moderate dysplastic lesions and in situ carcinoma. A similar pattern was also observed for VEGF and p53 protein expression but no significant difference was observed between moderate dysplastic lesions and in situ carcinoma with regard to VEGF protein expression. The association between MVD, VEGF expression, p53 mutations and preinvasive lesions of the bronchial tree suggests that neoangiogenesis is early in non-small cell lung cancer (NSCLC) development and that p53 may have an important role in promoting angiogenesis in this human model of carcinogenesis.

Bronchi↗
PubMedDate not supplied

[Sclerotherapy of the internal saphenous vein: comparison between the trombovar protocol and the trombovar-iodine protocol].

Sclérosing injections of the long saphenous vein involve different protocols concerning technique as well as the sclerosing fluids and doses used. This retrospective study involved comparison of two groups of patients treated during successive periods on the basis of a protocol consisting of 3 per cent Trombovar at doses increasing progressively up to a maximum of 6 and another protocole as follows: 3 per cent Trombovar, 1 ml; 3 per cent Trombovar 2 ml; 8 per cent Variglobine 2 ml; 12% Variglobine 2 ml; 12 per cent Variglobine 3 ml; "Overdose" (12 per cent Variglobine 6 ml + 3 per cent Trombovar 6 ml, i.e. 2-4 ml as divided doses. Patients were seen for follow-up evaluation by continuous wave Doppler after six months and two years. The first protocole, with a mean follow-up of 11.5 months, was associated with a 40 per cent recurrence rate. The rate for the second, with a mean follow-up of 13.5 months, was 15.87 per cent. The difference between these figures was statistically very significant (p approximately 0.001). The largest amounts of sclerosing fluid provided lower percentage recurrence rates compared relatively small amounts.

Benzyl Alcohols↗
PubMedDate not supplied

[Postural physiotherapy: a possible conservative treatment of the thoracic outlet syndrome].

A physiotherapy treatment protocol of "thoracic outlet syndrome" is presented. This treatment is based on the correction positional and not on the reinforcement and developing of determinate muscular groups. Treatment includes 10 exercises, which have to be progressively practiced during each séance. Twenty patients were included into the assay, and they have no signs of their Syndrome by the end of the study. Authors conclude that positional physiotherapy treatment is effective on cases of "thoracic outlet syndrome" without neurovascular complications.

Adult↗
PubMedDate not supplied

[Lipedema: clinical and diagnostic criteria].

Lipedema is a common disease in the usual clinical practice. None organic description about the clinical symptoms and signs associated to this condition has been published. Fifty women with lipedema have been examined by the authors, and incidence rates of symptoms and signs have been emphasized. The following signs and symptoms were constantly reported: "Egyptian column", elastic edema, negative Stemmer's sign, alterated plantar support, cutaneous hypothermia. Some others were frequently found: ecchymosis, spontaneous pain, liposclerosis on the thigh, hypodermic hyperalgesia and pain on the internal face of the knee. Moreover, the two most relevant differential diagnosis as well as their two variant's clinical features (mixed lipedema and "thin women" lipedema) have been described.

Adipose Tissue↗
PubMedDate not supplied

[Pigmented livedo. Histologic design and pathogenetic hypothesis].

Pigmented livedo is a frequently encountered disease. It occurs as an ochre reticular membrane which does not disappear when the limb is raised. It is characteristic in persons who already have livido reticularis and who expose themselves for several hours every day to the heat from chimneys or foot-warmers. We wanted to study the histological context of this disease in a group of female patients that we kept under observation. The data that we compiled showed that it is due to lymphocytic vasculitis accompanied by atrophy of the epidermis, hyperpigmentation of the basal keratinocytes and telangiectasia. Our pathogenetic hypothesis is that it involves vasculitis "a calore", with atrophy of the epidermis, telangiectasia and melanoid pigmentation, which is the cause of the characteristic brown pigmentation.

Adult↗