HLA haplotype and familial polyposis coli.
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Adenomatous Polyposis Coli↗
Biomedical subjects
R Doci
Publications and source records attributed to R Doci.
The occurrence of cholangitis after percutaneous biliary drainage: evaluation of some risk factors.
Sepsis of the biliary tract is often reported after percutaneous transhepatic biliary drainage (PTBD) and is considered a life-threatening condition. The authors studied 39 patients with biliary stenosis (35 with neoplastic stricture and four with benign disease) with the purpose of identifying some factors possibly associated with a higher risk of cholangitis. None of the patients complained of biliary sepsis at the first clinical examination. Several factors were taken into account and were statistically tested according to Miettinen rate ratios to differentiate patients in whom cholangitis would consequently develop: nature, site and extent of basic disease, type and functioning of PTBD, skin contamination at puncture site of PTBD, and bile contamination at PTBD and at follow-up. The presence of bacteria in the first bile (31.5%) was not related to a higher risk. All subjects showed bile contamination after PTBD, but cholangitis developed in only 15 patients, and it was always supported by enteric microorganisms. When we compared patients with cholangitis and subjects without infection, it was possible to demonstrate a statistically significant association of cholangitis and the following: nature of the stricture, presence of multiple intrahepatic biliary obstruction, neoplastic invasion or compression on the duodenum, and presence of Staphylococcus aureus on the skin at puncture site at drainage.
Adult↗
A new set for transhepatic insertion of large caliber catheters for biliary drainage: technical and clinical report.
An original set for percutaneous insertion of large caliber (12-16 French) biliary drainages is described. The results obtained in the 70 patients submitted to biliary drainage with late complications due to malfunction of the standard 8.3 or 10 F catheters show the advantage of the set described. The correction of unsatisfactory levels of bilirubinemia was obtained in 100% of cases, the resolution of recurrent cholangitis in 84.2% and of bile leakage on the skin in 46.7%. The large caliber and the large side holes of the catheter, together with its length and its easy handling, allow resolution of many different problems of insufficient drainage present in patients with neoplastic involvement of bile ducts.
Bile↗
Spontaneous massive necrosis of a hepatocellular carcinoma.
A case of hepatocellular carcinoma that underwent total necrosis without previous chemotherapy is described. Histologic examination of the neoplasm revealed massive thrombosis of numerous peritumoral venous vessels in the adjacent normal liver. Although the importance of a newly formed arterial blood supply for the maintenance of the viability of hepatocellular carcinoma is unquestionable, this case suggests a similar importance of the venous drainage of the surrounding liver.
Aged↗
Patterns of failure following surgical resection of colorectal cancer liver metastases. Rationale for a multimodal approach.
A total of 45 patients, after surgical resection of colorectal liver cancer metastases, were retrospectively analyzed to define areas of failure, to identify some possible prognostic factors (site of primary, stage, site, number of metastases, preoperative carcinoembryonic antigen, differentiation of the primary, type of surgery), and to seek a new rationale for a multimodal approach. The median postoperative follow-up was 18 months (range: 4-45 months). Survival rate was calculated by the actuarial method, and statistical significance was tested by the Mantel-Haenszel test. Twenty-eight patients had a relapse. These recurrences were hepatic in 11 patients, extrahepatic (intra- and extra-abdominal) in 12 patients, and intra- and extrahepatic in five patients: The stage (classification of the Istituto Nazionale Tumori of Milan) was the most important parameter related to the overall recurrence rate (47% in stage I, 62% in stage II, and 81% in stage III) and to the overall and disease-free survival. Stage was significantly related to hepatic relapse but not to extrahepatic relapse. In stage I the failure rate of 18 months was similar in hepatic and extrahepatic relapses (one third to one fourth of the patients); in stages II and III the hepatic failure rate was always higher than the extrahepatic rate. These data indicate that surgery alone is an inadequate form of therapy in cases of colorectal cancer metastases of the liver, and an adjuvant therapy, including alternate regimens of intraperitoneal and systemic chemotherapy, should be considered.
Actuarial Analysis↗
Prognosis of patients after palliative surgical procedures for carcinoma of the stomach.
From 1965 to 1980, 294 (33 per cent) of 885 patients admitted to the Istituto Nazionale Tumori of Milan with carcinoma of the stomach did not undergo a radical operation. Forty-eight patients were not considered suitable for operation due to their poor general status and spread of disease. One hundred and five patients underwent simple exploratory laparotomy, 80 underwent bypass procedure and 61, noncurative resection, and the operative mortality rate was 4.7, 10.0 and 11.5 per cent, respectively. Median survival time was 2.4 months for patients who did not undergo an operation, 2.8 months after exploratory laparotomy and 3.5 months after bypass procedures. Median survival time after nonradical resections was 8.0 months and 6 per cent of these patients survived for more than five years. To perform the analysis within relatively homogeneous groups, patients with different treatments were further stratified into three groups according to the spread of disease: local, distant and local plus distant spread. It is noteworthy that the benefit after bypass procedures in comparison to exploratory laparotomy was limited to those patients with local spread of disease; the advantage of nonradical resection was apparent in all groups. Survival time was finally analyzed with reference to the extent of liver involvement in patients with metastatic disease confined to the liver. The data suggest that a limited sporadic survival time is possible only after gastric resection in patients with liver involvement of less than 50 per cent.
Carcinoma↗
Human leukocyte antigens (HLA) and haplotypes in familial polyposis coli (FPC).
Close correlation between HLA antigens and haplotypes and familial polyposis coli, an infrequent inherited condition which results in an early onset of colonic adenomas and carcinoma is reported. Similarity between the patients' group and their healthy relatives is recorded, both groups differing from a healthy control group (HLA B35, DR5). This haplotype cannot be considered as a marker of the disease but provides a statistical indication of a high risk of adenomas in each family affected by FPC.
Adenomatous Polyposis Coli↗
[Regional arterial chemotherapy of hepatic metastases secondary to colorectal carcinoma].
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Colonic Neoplasms↗
Immunoscintigraphy of colorectal carcinoma with F (ab')2 fragments of anti-CEA monoclonal antibody.
A monoclonal antibody to carcinoembryonic antigen (CEA) (F023C5), belonging to IgG1 class, was obtained by cell fusion technique. Preliminary screening on different tissues was performed with immunoperoxidase staining, which showed good specificity of the antibody for gastric and colorectal carcinomas. F(ab')2 fragments were subsequently prepared and labeled with 131I and 111In. After immunoreactivity check the radiopharmaceuticals were injected intravenously. Sixteen patients with 22 primary or secondary localizations of colorectal carcinoma were studied following the recommendations of the ethical Committee of the Istituto Nazionale Tumori, Milan, Italy. Serial scans were performed after injection of the two radioactive reagents. In vivo pharmacokinetics of the compound was studied. Radioactivity level in surgical specimens was measured, and immunostaining was performed. All tumors were found to express the antigen. Eleven out of 12 tumor localizations of the gastrointestinal tract and three out of ten liver metastases were imaged. Specificity of tumor uptake was assessed by simultaneous injection of an irrelevant antibody.
Antibodies, Monoclonal↗
Growth characteristics of human colorectal and non-small cell lung tumors xenografted into nude mice: possible correlation with prognosis.
Specimens from human colorectal tumors and from non-small-cell lung tumors obtained at surgery were subcutaneously implanted as xenografts in athymic Swiss mice of both sexes to investigate to what extent the properties of the original tumors were maintained. A successful take was obtained in 5 of 9 colorectal tumor and 6 of 11 non-small-cell lung tumor xenografts. Moreover, 44% and 45% of the respective tumors could be established as tumor lines. Neither metastases nor local tumor invasion was observed in tumor-bearing mice. Seven of 9 serially transplantable tumors had a short latency period (14-30.5 days) when first xenografted. No significant changes in tumor histopathology were noted after growth into nude mice. Tumor take was partially related to clinical stage and prognosis of patients. In fact, 8 of 12 specimens from N0 patients failed to grow, whereas 7 of 8 tumors from patients with nodal invasion and/or metastasis grew in nude mice. Moreover, for the group of patients whose tumor was "take - ", the one-year survival was 85%, compared to 40% for the "take + " group (p less than 0.05).
Adult↗
Evaluation of toxic effects following administration of monoclonal antibody MBr1 in patients with breast cancer.
Twelve patients with disseminated breast cancer were injected with monoclonal antibody MBr1 at the National Cancer Institute of Milan, Italy, from January 1983 to March 1985. The first seven patients had advanced disease and the remaining five operable breast cancer. In the first seven patients the initial dosage of MBr1 was 0.5 mg and was doubled in the next patient up to 16 mg. The last five women received 10 mg of MBr1. No general side effects such as bronchospasm, hypotension, immediate or delayed allergic reactions were observed. Four patients who were injected with 10 mg or more experienced fever, shudder and vague abdominal and articular pain. The following tests were monitored: R.B.C., W.B.C., percentage of lymphocytes, blood glucose, urea nitrogen and creatinine, serum levels of Na+, K+, Cl-, total proteins levels, albumins and globulins, bilirubin, GOT, GPT, alkaline phosphatase, LDH, amylase, gamma GT and CPK. No major modifications were observed: a limited increase of the transaminases, LDH and gamma GT was evident at the last check. An early temporary alteration of CPK was observed in the four patients who had symptoms. Serum levels of MBr1 are detectable immediately after injection starting from 4 mg, and all sera were negative 48 hours later. It is concluded that the scanty toxicity allows to continue clinical investigations to verify the linkage between MBr1 and Ca-MBr1 "in vivo" after a single injection of no more than 16 mg of the MoAb. The increase of this dosage as well as multiple injections do not seem safe at present.
Alanine Transaminase↗
Subtotal versus total gastrectomy for cancer of the lower two-thirds of the stomach: a new approach to an old problem.
Many surgeons favour total gastrectomy (TG) 'de principe' in the treatment of gastric cancer, but final demonstration of its advantage over subtotal gastrectomy (SG) is still lacking. We analysed survival after curative TG or SG within groups of patients stratified according to the main prognostic variables as found in multivariate analysis, i.e., nodal status, degree of invasion of the gastric wall, patient age and sex. Our series consisted of 361 patients treated by curative SG and 41 by curative TG, admitted to the Istituto Nazionale Tumori of Milan between 1965 and 1979. In patients with lymph node involvement survival appeared to be significantly better (P = 0.0005) after SG. However, stratifying for age it was found that the benefit was limited to patients over 60 years old. No significant difference in survival was found in the group without nodal involvement (N -) and invasion of the wall to the serosa or beyond. No statistical comparison was possible in N - groups with invasion confined to mucosa, submucosa or muscularis propria because of the small number of such patients who underwent TG. We conclude that SG still represents the standard reference operation for gastric carcinoma provided that a safe proximal margin of resection is guaranteed.
Adult↗
Proposal for staging liver metastases.
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Follow-Up Studies↗
Intrahepatic doxorubicin in unresectable hepatocellular carcinoma. The unfavorable role of cirrhosis.
To investigate the relationship between the presence of cirrhosis and the antitumor effects of locoregional chemotherapy with doxorubicin, 16 patients with nonresectable hepatocellular carcinoma (HCC) and satisfactory baseline clinical conditions (Child class A or B, Karnofsky index greater than 70%) were studied. Eight patients had post-necrotic cirrhosis, five had serum HBsAg. The dose of doxorubicin was 0.3 mg/kg body weight/day, given by continuous intracoeliac infusion for 8 consecutive days. Eight patients (six with cirrhosis) died prematurely after the first course of chemotherapy. Six (2 with cirrhosis) responded to therapy; they survived 3-33 months (median: 10). In these patients, the type and severity of drug-related side effects were comparable to those reported for patients treated by intravenous chemotherapy. The implication that in many patients with cirrhosis intrahepatic chemotherapy with doxorubicin may hasten death, lessens our interest in its use for nonresectable HCC. In fact, in Italy these cancers frequently occur in association with cirrhosis.
Aged↗
Surgical treatment of hepatic metastases from colorectal cancer.
From 1980 to 1984, 48 patients were subjected to liver resection for hepatic metastases from colorectal cancer. The disease was staged according to the original staging system proposed by the authors: stage I, single metastasis involving less than 25% of hepatic parenchyma (21 patients); stage II, multiple metastases involving less than 25% of hepatic parenchyma or single metastasis involving between 25-50% (9 patients); and stage III, multiple metastases involving between 25-50% or more than 50% of hepatic parenchyma, irrespective of the number of metastases (18 patients). The extent of hepatic resection was generally related to that of liver disease; a typical lobectomy was performed in 28 patients and segmentectomies in 20. One patient died after operation (mortality, 2.1%), and major complications occurred in seven patients (morbidity, 14.9%). Morbidity was related to operatory blood loss: 45% of patients with blood replacement of more than 2000 cc developed major complications versus 5.4% with blood replacement of less than 2000 cc (p less than 0.05). The actuarial 3-year survival for stages I, II, and III was 73%, 60%, and 29%, respectively (p less than 0.05). Twenty-two patients (45%) have had recurrences, all stage III patients within 2 years of resection versus 28% of stage I patients (30 months disease-free survival, 49%). The liver only was the site of recurrence in 10 patients, distant sites in seven, and both liver and distant in five. Analysis of the different features of the primary tumor, the interval between bowel resection and detection of hepatic metastases, and the number and extent of liver secondaries demonstrated that prognosis after surgery was mainly related to the latter; they are considered in the staging system adopted in this study. It is a simple system and shows a good prognostic correlation. The results reported here are in agreement with those of the literature; the low mortality and morbidity and the survival benefit support the growing acceptance of surgery in treatment of hepatic metastases from colorectal cancer, in particular stage I patients. For the other stages, surgery should represent, when applicable, only the first step of a multimodality treatment.
Adult↗
Human leukocyte antigens and sister chromatid exchanges in families with multiple adenomatosis coli.
To study human leukocyte antigens (HLA) and sister chromatid exchanges (SCE) in multiple adenomatosis coli (MAC), eight families were evaluated. Twenty-five subjects (14 affected members and 11 healthy relatives) were studied with HLA A, B, and C typing of peripheral lymphocytes and SCE count in cells that had replicated twice. The results of the present immunogenetic study, although limited to a small number of cases, suggest a correlation between HLA, SCE, and MAC. When the results of further investigations on larger series confirmed by clinical follow-up of these subjects are available, these methods might give useful information in predicting the risk of each family member to become affected by MAC and consequently develop a colorectal carcinoma.
Adenomatous Polyposis Coli↗
Actual role of Hartmann's resection in elective surgical treatment for carcinoma of rectum and sigmoid colon.
A consecutive series of 50 patients who underwent Hartmann's resection from 1967 to 1981 because of carcinoma of the rectum and sigmoid colon is reported upon herein. Indications for Hartmann's resection were palliation because of advanced disease (62 per cent of the patients), poor risk conditions and advanced age (24 per cent) and intraoperative complications or difficult primary anastomosis (14 per cent). The overall operative mortality and morbidity rates were 8 and 80 per cent, respectively--pelvic sepsis accounted for 37.5 per cent of the complications. The five year survival rate for patients with radical operations was 46 per cent. The choice of Hartmann's resection for patients with advanced disease was unfair because of the high postoperative morbidity and the discomfort of colostomy. The indications for intestinal resection without primary anastomosis because of general conditions or technical difficulties to perform the anastomosis are actually reduced by the improved perioperative care and by the confidence in using stapling guns. Hartmann's resection is still indicated in elderly patients, in instances of locally advanced tumors and when the primary anastomosis is judged to be unfeasible.
Adenocarcinoma↗
Regional arterial chemotherapy of liver tumours. I. Performance comparison between a totally implantable pump and a conventional access system.
Thirty-nine patients with liver tumours have been submitted to regional arterial chemotherapy by means of either totally implantable Infusaid-400 pumps (22 c.) or implantable ports (17 c.). The latter were subsequently perfused with external pumps. There was one single major operative complication and no operative deaths. Most patients underwent continuous Fudr infusion. Access related complications occurred in both groups. Treatment was stopped for access related complications in 18.4% and 29.4% of cases out of the pump and port groups respectively. In most of those cases, however, several cycles of chemotherapy had already been performed. The Infusaid-400 pumps showed a 12-month functional duration of 57% with a 13-month median, the 10-month duration of ports being 67%. The difference was not significant. The new implantable systems give better results in comparison with traditional regional access methods, the functional performances of the port systems appearing very similar to the totally implantable pumps, with an obvious advantage for the pumps as far as quality of life is concerned.
Antineoplastic Agents↗