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Biomedical subjects

S Di Pietro

Publications and source records attributed to S Di Pietro.

At least 37 records · Page 2Linked to original sources
PubMed1985

Benign breast disease and consumption of beverages containing methylxanthines.

The relationship between methylxanthine (Mx) consumption and benign breast disease was evaluated in a case-control study of 288 women with histologically confirmed benign breast lumps (203 dysplastic lesions and 85 benign tumors) and 2 groups of control women--285 patients in the hospital for acute conditions apparently unrelated to the consumption of Mx-containing beverages and 291 outpatients. The relative risk estimates of dysplastic breast lesions (fibrocystic disease), with allowance for all identified potential distorting factors, for women who drank 1-2 or 3 or more cups of coffee per day were 4.1 and 6.4, respectively, when the hospital controls were the comparison group and 2.0 and 3.7, respectively, when the outpatient controls were the comparison group. The relationship was even stronger when the total consumption of Mx-containing beverages (coffee plus tea) was considered and increased with increasing duration of use. The association was not explained by any of the major risk factors for fibrocystic breast diseases or by differences in general characteristics or other lifestyle habits between cases and controls. Mx consumption was not related to the risk of benign breast tumors (fibroadenomas). These findings support the hypothesis that Mx consumption is related to the risk of dysplastic lesions of the breast.

Adult↗
PubMed1985

Outpatient biopsy of breast cancer. Influence on survival.

From 1948 to 1975, at the Istituto Nazionale Tumori of Milan, 209 patients underwent extended radical mastectomy (ERM) for breast cancer classified as T1 NO-1 MO. In 57 patients (27.3%), the ERM was preceded by an excisional biopsy performed in the outpatient clinic (Group A), of which 75% were performed within 30 days of admission and 25% after 30 days (average, 25 days; range 5-99). The remaining 152 patients (Group B) underwent an extemporaneous frozen biopsy. There was no difference in the distribution of the histologic types in the two groups. The axillary lymph nodes (N) and the internal mammary chain (MI) were free of neoplastic invasion (N-, MI-) in 156 patients (74.6%), 44 in Group A (77.2%) and 112 in Group B (73.7%). Actuarial 10-year survival of the patients was 79.9% in Group A and 77.7% in Group B (p = NS). It was 90% in N- MI- patients of Group A and 81.9% in those of Group B (p = NS). Instead, for N+ patients, actuarial survival at 10 years was 50% in Group A and 67% in Group B (p = NS), and for MI+ patients it was 50% and 49.8%, respectively. These present data do not support the hypothesis that a delay between biopsy and radical surgery of breast cancer is an important prognostic factor.

Actuarial Analysis↗
PubMed1984

Circulating levels and breast cyst fluid concentrations of human chorionic gonadotropin, progesterone and testosterone in women with gross cystic breast disease.

Circulating levels and cyst fluid concentrations of human chorionic gonadotropin, progesterone and testosterone were measured in 30 premenopausal women with gross cystic breast disease. Specific radioimmunoassay procedures were used. Amounts of human chorionic gonadotropin exceeding 5.0 mIU/ml were found in cyst fluid of many patients, but not in serum. Progesterone and testosterone concentrations in breast cyst fluid were significantly higher than in serum (p less than 0.01 and p less than 0.001, respectively).

Adult↗
PubMed1984

Increased androgenic activity and breast cancer risk in premenopausal women.

Blood and urine specimens from 27 premenopausal breast cancer patients and 62 healthy controls have been compared with respect to concentration of testosterone and progesterone in blood and of testosterone and androstanediol in urine, measured in the luteal phase of the menstrual cycle. There was a strong positive association between the concentration of the two androgens, either in blood or urine, and breast cancer risk. A strong association was also observed with decreasing levels of progesterone. The association was statistically significant (p for trend less than 0.01) for each hormone; the rate ratios were 10.2 for serum testosterone (highest category), 5.6 for serum progesterone (lowest category), 8.4 for urinary testosterone (highest category), and 5.2 for androstanediol (highest category). The rate ratio for women presenting both high serum testosterone and low progesterone was 21.8 (4.1 to 116.1). Considering the exposure to at least one of three androgens at the highest level and low progesterone, the rate ratio was as high as 90.2 (8.2 to 989.7). This study provides evidence for the hypothesis that increased androgenic activity is an important risk indicator for breast cancer, particularly when associated with anovulation, as indicated by low serum progesterone level.

Androgens↗
PubMed1984

High testosterone and low progesterone circulating levels in premenopausal patients with hyperplasia and cancer of the breast.

Serum testosterone, progesterone, luteinizing hormone, prolactin, and sex hormone-binding globulin levels were measured in 55 normal controls, in 31 patients with hyperplastic alterations of breast epithelium, and in 23 patients with breast cancer. All patients and controls were premenopausal, and they were comparable for age, weight, and body surface. In the controls, the mean level of testosterone [0.47 +/- 0.16 (S.D.) ng/ml] was lower and the mean level of progesterone (17.63 +/- 8.11 ng/ml) was higher than in breast cancer patients [testosterone level, 0.62 +/- 0.22 ng/ml (p less than 0.005); progesterone level, 11.4 +/- 8.0 ng/ml (p less than 0.005)] and in patients with breast epithelial hyperplasia [testosterone level, 0.55 +/- 0.2 ng/ml (p less than or equal to 0.05); progesterone level, 13.9 +/- 8.6 ng/ml (p less than 0.05)]. No difference was found in the mean circulating levels of luteinizing hormone, prolactin, or sex hormone-binding globulin between controls and patients. These results confirm previous findings of increased urinary testosterone excretion in women with anovulatory menstrual cycles and epithelial hyperplasia or cancer of the breast and strongly support the hypothesis that androgens play an important role in both induction and development of breast cancer.

Breast↗
PubMed1983

Fine-needle aspiration biopsy in parotid masses.

Seventy-nine cases of parotid masses were punctured by fine needle for cytologic examination and subsequently operated on. Of the material obtained, conventional smears, as well as formalin-fixed, paraffin-embedded histologic sections were prepared. The two procedures detected 16 malignant tumors and 63 nonmalignant lesions, with a high sensitivity (86%) and absolute specificity (100%). These data confirm the validity of this combined method and favor the complementary use of the two procedures, which improves the accuracy (80%) of preoperative diagnosis and histologic typing of parotid tumors.

Biopsy, Needle↗
PubMed1983

Accuracy of breast cancer diagnosis by physical, radiologic and cytologic combined examinations.

Physical examination, mammography and fine-needle aspiration cytology were performed in 1498 consecutive cases with a solitary solid lump of the female breast. The intent was to verify the validity of this diagnostic triplet in the accuracy of the preoperative diagnosis of breast cancer. Clinically sure cancers were excluded from the study. The collected data were evaluated in terms of sensitivity, specificity and predictivity of any procedure alone or in combination. In 1138 cases confirmed by histology (514 carcinomas and 669 benign or non-neoplastic lesions), the physical examination and mammography were very sensitive (respectively 96% and 84%) but with a high rate of false-positive reports (respectively 20% and 18%). The cytologic diagnosis was less sensitive (65%), mostly due to many inadequate smears, but highly specific (93%) and predictive for malignancy (99%) when the cytologic report was frankly positive. Any single procedure improved the overall sensitivity, and taken together this triplet appears to be the most effective noninvasive diagnostic combination that provides in a short time with minimal cost and discomfort, a diagnosis of certain malignancy in about 50% of carcinomas with a predictivity close to 100%, when cytology detected malignancy.

Adult↗
PubMed1983

A rationale for surgical detection of cancer without hospitalization.

During 1980, in strict accordance with indication schedules outlined for breast, skin, oral cavity, lymph node, and soft tissue lesions, 2,499 patients were selected and operated on in the outpatient department of our institution. The main purpose was early detection of unexpected cancer without hospitalization. Of 1,266 breast operations, 99 (7.8%) unexpected carcinomas and 67 (5.3%) borderline or precancerous lesions were detected, with a higher rate of T1 and N- cases than were found in hospitalized breast carcinoma patients: T1, 61% vs 38%; N-, 68% vs 54%. The specimens of 1,048 skin and oral cavity lesions revealed 261 (24.9%) squamous or basal cell carcinomas, and most of them were cured by the outpatient surgery itself. Removal of 149 suspicious nevi revealed 20 (13.4%) unexpected malignant melanomas; 185 operations on lymph node and soft tissues detected 44 lymphomas (31 unexpected), 36 metastatic lymph nodes (five unexpected), and six sarcomas (five unexpected). These data confirm the validity of and necessity for surgical outpatient operations in selected cases.

Adult↗
PubMed1983

The outpatient-procedure effectiveness of laser treatments in oncology.

The outpatient procedure of CO2 laser surgery has been recently integrated into the routine activity of the National Cancer Institute, Milan. Specific operative protocols that are codified for laser outpatient selection after adequate staging by pathology are presented. Specific indications for gynecologic disease (preneoplastic disorders, CIN, VAIN, and VIN), and general-surgery neoplastic disorders (soft tissue sarcomas, lip and oral cavity lesions, breast lesions) are described. Details of the safety procedures, rules of application, laser instrumentation accessories and wattages, both with vaporization and excisional technique, are reported. An overall rate of 30% out of the 4,000 cases treated yearly are selected for laser treatment procedures on the basis of the evaluation of real advantages. The general advantages of laser surgical applications such as reduction of bleeding and postoperative pain, early and late complications; no-touch method; and patient acceptability--have been emphasized in the routine outpatient procedures. Reduction of the total costs and of the waiting list for hospitalization by the new procedures are finally considered.

Ambulatory Surgical Procedures↗
PubMed1983

Androgen excretion in women with a family history of breast cancer or with epithelial hyperplasia or cancer of the breast.

Urinary testosterone and androstanediol were measured by gas chromatography in four groups of premenopausal subjects: 22 healthy women (control group), 21 healthy women with a family history of breast cancer (familiality group), 39 patients with breast lumps which consisted of ductal or lobular hyperplasia (hyperplasia group) and 18 patients with infiltrating breast carcinoma (carcinoma group). On the basis of normal values found in our laboratory, steroid levels were above normal in 4.5% of the controls, 4.7% of the familiality group, 38.5% of the hyperplasia group (P less than 0.01 vs controls) and 61.1% of the carcinoma group (P less than 0.001 vs control group). The mean testosterone level in the carcinoma group (11.3 +/- 6.78 S.D.) and the mean androstanediol level in the hyperplasia group (47.25 +/- 31.0 S.D.) were significantly higher than those of the control group (testosterone 6.25 +/- 3.48 S.D., androstanediol 32.55 +/- 20.0 S.D.). No significant difference was found in mean testosterone or androstanediol levels between the control group and the familiality group (testerone 5.41 +/- 3.6 S.D., androstanediol 29.38 +/- 15.89 S.D.). We conclude that increased excretion of androgenic steroids is a hormonal abnormality common to breast cancer patients and to patients with breast epithelial hyperplasia, but not to subjects with a family history of carcinoma of the breast.

Adult↗
PubMed1982

Problems in fine-needle aspiration biopsy cytology of clinically or mammographically uncertain breast tumors.

From June 1978 to December 1980 at the Istituto Nazionale Tumori of Milano, a fine-needle aspiration biopsy was performed on each of 4834 cases of palpable mammary nodules, the large majority of which were clinically and mammographically suspicious for cancer and only a small part clinically definitely positive. Of these, 1173 underwent surgery at this institution, and 534 (45.5%) had a histologically proven carcinoma. The aspirations were performed by individuals different from those who read the cytologic smears. The aspirations were never repeated, and methods for the retrieval of cells were never applied. Under the circumstances, sensitivity was 0.67, specificity 0.98, and the predictive value for positive results 0.97. The high percentage of inadequate samples (25.5%) influenced the low sensitivity. The few false-positive results occurred exclusively during the first year. Frozen sections can be avoided in those cases (about 50%) with definitely positive cytologic diagnosis by the application of strict criteria. The intrinsic incapability of cytology to yield any information on the extent and the invasiveness of a malignant lesion does not seem to effect its preoperatory conclusiveness.

Biopsy, Needle↗
PubMed1982

Parity and breast cancer: confirmed evidence of an effect on age at diagnosis.

An evaluation is made of the hypothesis of Woods et al. (1) that the number of full-term pregnancies constitutes a factor of growth acceleration in breast cancer. Our results confirm, at least in part, the effect of parity on age at diagnosis of breast cancer. Patients with two or more children were significantly younger at the time of diagnosis than were those with none or one child. Age at first birth and duration of lactation do not seem to be, in this analysis, confounding factors for the observed association.

Adult↗
PubMed1981

Unexpected breast cancer detection after outpatient biopsy for benign lesion.

At the Istituto Nazionale Tumori of Milan, in its Outpatient Department, 1302 breast surgical biopsies were carried out in 1978. Fibroadenomas occurred in 44.2% and benign dysplasias in 39.3%. Sixty-two cancers (4.8%) and 23 atypical hyperplasias (1.8%) were unexpected findings, with an increasing incidence in women over 50. Seventy-nine duct resections were performed for significant nipple discharge and revealed 5 unexpected carcinomas and 28 papillomas or papillomatosis. In our opinion and experience, this procedure of performing breast biopsy in the presence of a solid lump in women over 30 without hospitalization improves early detection of cancer, lowers costs, cuts down admission waiting lists and increases the number of women who better accept a surgical diagnosis and treatment.

Adenocarcinoma↗
PubMed1981

[Correlation between blood insulin response and blood potassium changes during oral glucose load (preliminary note)].

Glucose, insulin, K+ and Na+ serum levels were measured at fixed intervals during OGTT. Na+ showed no significant changes, while K+ progressively decreased from 0 to 240 min. A good correlation was found between kaliaemic lowest levels and insulin peak (p less than 0,01): the former followed the latter by 60-120 min. No correlation seemed to exist between nadir K+/basal K+ ratio and insulin peak. The results and their clinical implications are discussed.

Adult↗
PubMed1981

[Influence of blood potassium variations on changes in electrocardiographic patterns during oral glucose tolerance test].

In 45 apparently healthy subjects an OGTT was performed and glucose, insulin, potassium and sodium were measured at fixed intervals. A standard EKG was recorded at the beginning and at the end of the trial. K+ levels steadily decreased reaching their lowest value 60 to 120 min after insulin peak. Na+ levels did not change. In those subjects whose final EKG showed some worsening, the ratio final to initial K+ levels, unlike glucose levels, significantly decreased (p less than 0,01). The hypothesis is given that many clinical pictures of coronary heart disease, so often encountered during OGTTs, may depend on K+, rather than glucose, unbalance.

Adolescent↗
PubMed1981

[Relation between the blood potassium and blood glucose responses and electrocardiographic changes, specifically the T wave, during the oral glucose tolerance test].

As previously showed by the Authors, serum K+ levels significantly decrease during OGTT. Moreover, two possible patterns were separated: a) monophasic decrease ("M" type curve) causing a mild but continuous down-slope, possibly physiologically more relevant, and b) polyphasic decrease ("O" type curve) causing a sharp down-slope followed by a rebound to normal K+ levels. In 10 of 12 M type subjects (83%) electrocardiographic changes were shown after OGTT, comparative to only 9 out of 16 O type subjects. The Authors believe this to be suggestive of a heavier impact of kaliemic changes on to myocardial function in M type curves. The hypothesis needs further analysis.

Adult↗