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S Morassut

Publications and source records attributed to S Morassut.

At least 19 recordsLinked to original sources
PubMed2002

Prognostic factors in soft tissue sarcomas: a study of 395 patients.

AIMS: The aim of this study was to report prognostic factors, end-points of local recurrence, distant recurrence, post-metastasis survival, and overall survival in a cohort of patients with soft tissue sarcomas. METHODS: We analysed a database of 395 patients affected by primary soft tissue sarcomas of various primary sites, treated and followed up at the Centro di Riferimento Oncologico, Aviano, Italy from January 1985 to January 1997. RESULTS: Grade, size, stage, surgical margins, distant metastasis, age, sex, performance status, and haemoglobin value were significant for overall survival. Histology, grade, stage, and surgical margins were significant for local recurrence. Grade, size, and stage, were significant for distant recurrence; and surgical margin was significant variable for post-metastasis survival. CONCLUSIONS: Grade, size, and TNM stage (UICC/AJCC) have stronger prognostic significance for overall survival and distant recurrence than for local relapse. Positive surgical margins are the main predictors for local relapse. Age was the most consistent adverse independent prognostic factor for survival.

Adolescent↗
PubMed2002

The Italian multi-centre project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk.

This report presents the preliminary results of the first phase (21 months) of a multi-centre, non-randomised, prospective study, aimed at evaluating the effectiveness of contrast-enhanced magnetic resonance imaging (MRI), X-ray mammography (XM) and ultrasound (US) in early diagnosis of breast cancer (BC) in subjects at high genetic risk. This Italian national trial (coordinated by the Istituto Superiore di Sanità, Rome) so far recruited 105 women (mean age 46.0 years; median age 51.0; age range 25-77 years), who were either proven BRCA1 or BRCA2 mutation carriers or had a 1 in 2 probability of being carriers (40/105 with a previous personal history of BC). Eight cases of breast carcinomas were detected in the trial (mean age 55.3 years, median age 52.5; age range 35-70 years; five with previous personal history of BC). All trial-detected BC cases (8/8) were identified by MRI, while XM and US correctly classified only one. MRI had one false positive case, XM and US none. Seven "MRI-only" detected cancers (4 invasive, 3 in situ) occurred in both pre- (n = 2) and post-menopausal (n = 5) women. With respect to the current XM screening programmes addressed to women in the age range 50-69 years, the global incidence of BC in the trial (7.6%) was over ten-fold higher. The cost per "MRI-only" detected cancer in this particular category of subjects at high genetic risk was substantially lower than that of an XM-detected cancer in the general women population. These preliminary results confirmed that MRI is a very useful tool to screen subjects at high genetic risk for breast carcinoma, not only in pre-, but also in post-menopausal age, with a low probability of false positive cases.

Adult↗
PubMed2000

Raysum reconstruction algorithm in MR cholangiopancreatography.

Magnetic resonance cholangiopancreatography (MRCP) is a new, non-invasive imaging technique for the visualization of the biliary ducts. The presence of stones within the choledocus is easily detectable in source images. However, three-dimensional reconstructions using the maximum intensity pixel (or projection) algorithm (MIP) fail to reproduce accurately the eventual presence of filling defects or parietal irregularities due to biliary stones. We used the Raysum algorithm in addition to the MIP in evaluating MRCPs of twelve patients with known choledocolithiasis. A visualization of the stones was obtained in nine (75%) patients by using the Raysum while visualization was obtained in one patient by using MIP. No additional sequences are required, and the post-processing time takes only a few seconds. The Raysum reconstruction can be successfully associated to the MIP in the three-dimensional evaluation of biliary stones in MRCP.

Adult↗
PubMed1997

Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study.

Studies on catheter-related central venous thrombosis (CRCVT) have been focused mainly on clinically evident CRCVT due to occlusive thrombi, underestimating therefore the actual thrombosis prevalence. This prospective study was aimed at evaluating prevalence, timing and evolution of thrombosis, and identifying involved veins and risk factors in cancer patients (pts) undergoing percutaneous subclavian central venous catheterization (CVC) for chemotherapy, parenteral nutrition or both. We enrolled 127 consecutive pts requiring partially or totally implanted central venous silastic catheters. The study protocol included peripheral phlebography (P) at day 8, 30 and every two months following CVC and/or when clinically indicated, along with peripheral and pullout P on catheter withdrawal. A quantitative scale was developed to evaluate thrombus grading in subclavian, innominate and cava veins. Age, sex, coagulation profile tumor histotype, metastases, therapy, catheter type, and catheter insertion side were also investigated. Only pts who underwent at least two P were evaluated, and chi 2 test was adopted for statistical analysis. Altogether, 95 pts were evaluable. CRCVT was observed in 63/95 (66%) pts. At day 8, 30 and 105 (representing the median days in which first, second and last P were performed) CRCVT was evidenced in 64%, 65% and 66% of the pts, respectively. Thrombus grading did not differ among first, second and last P. CRCVT was symptomatic in 4/63 (6%) pts. Thrombosis prevalence was higher in subclavian (97%) with respect to innominate (60%) or cava (13%) veins (p < 0.001). Thrombosis was higher in left subclavian catheters (14/16; 87.5%) than in right ones (49/79; 62%), p < 0.01. No associations were established between CRCVT and other investigated parameters. Our data show a very high actual frequency of CRCVT in cancer pts, and emphasize that first days following CVC are at the highest risk for CRCVT development. Based on our results, a study on short-term antithrombotic prophylaxis in cancer pts requiring CVC is warranted. Finally, our data indicate that left subclavian vein catheterization represents a risk factor for CRCVT.

Adolescent↗
PubMed1997

Single-needle celiac plexus block: is needle tip position critical in patients with no regional anatomic distortions?

BACKGROUND: The "single-needle" celiac plexus block is becoming a popular technique. Despite different approaches and methods used to place the needle, the success of the block depends on adequate spread of the injectate in the celiac area. In the present retrospective study, the influence of needle tip position in relation to the celiac artery on injectate spread was evaluated. METHODS: Among 138 cancer patients subjected, via an anterior approach, to computed tomography (CT)-guided single-needle neurolytic celiac plexus block, a radiologist, blinded to the aim of the study, retrospectively selected 53 cases with normal anatomy of the celiac area as judged by CT. The decision was based on images obtained before the block. Patients were then classified into either group A (29 patients), in whom the needle tip was caudad to the celiac artery, and group B (24 patients), in whom it was cephalad. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: upper right and left and lower right and left, as related to the celiac artery. Patient assessments by visual analog scale were reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was judged as long-lasting. The patterns of contrast spread in relation to the needle position and pain relief according to the number of quadrants with contrast were analyzed. RESULTS: The percentage of cases with four quadrants with contrast was higher when the needle tip was cephalad (58%, group B) than when it was caudad (14%, group A) to the celiac artery (P < 0.01). The percentage of patients with four and three quadrants with contrast was also higher in group B at 79% than in group A at 38% (P < 0.01). A significant difference in long-lasting pain relief was observed between patients with four quadrants with contrast (18 of 18, 100%; 95% confidence interval [CI], 81-100%) and patients with three quadrants with contrast (5 of 12, 42%; 95% CI, 15-72%) (P < 0.01). No patients showing two or one quadrant with contrast had long-lasting pain relief. CONCLUSIONS: These findings suggest that, when the celiac area is free from anatomic distortions, and the single-needle neurolytic celiac plexus block technique is used, the needle tip should be positioned cephalad to the celiac artery to achieve a wider neurolytic spread. It also appears that only a complete (four quadrants) neurolytic spread in the celiac area can guarantee long-lasting analgesia.

Adult↗
PubMed1997

HIV-associated human herpesvirus 8-positive primary lymphomatous effusions: radiologic findings in six patients.

PURPOSE: To define the imaging features of body cavity-based lymphoma (BCBL) related to the acquired immunodeficiency syndrome. This is a peculiar type of non-Hodgkin lymphoma harboring infection by human herpesvirus 8 (HHV-8) and displaying a peculiar tropism for the serous body cavities. MATERIALS AND METHODS: At diagnosis of BCBL, six consecutive patients were investigated with radiography of the chest and conventional computed tomography (CT) of the chest and abdomen. For all patients, clinical features and results of biologic characterization of the lymphoma were also available. RESULTS: In all patients, chest radiographs displayed bilateral or unilateral pleural effusion in the absence of parenchymal opacities or mediastinal enlargement. CT scans confirmed chest radiographic findings and revealed a slight thickening of the parietal pleura in all patients and a pericardial thickening in four patients. CT also depicted pericardial and abdominal effusions in five and two patients, respectively, in the absence of solid tumor masses or parenchymal abnormalities. CONCLUSION: BCBL must be included among the differential diagnoses of serous effusions detected radiologically in individuals infected with the human immunodeficiency virus (HIV). Since the combination of serous effusion, slight serosal thickening, and absence of solid masses is compatible with, though not specific for, BCBL in the context of HIV infection, radiologic findings need to be complemented by a detailed biologic and virologic characterization of tumor cells.

Adult↗
PubMed1997

Surgical second look in ovarian cancer: a randomized study in patients with laparoscopic complete remission--a Northeastern Oncology Cooperative Group-Ovarian Cancer Cooperative Group Study.

PURPOSE: The usefulness of extensive and repetitive surgery for patients with ovarian cancer still remains unproven (at least for some conditions). We planned an accurate prospective test of the hypothesis that patients with advanced-stage disease, after they had reached a clinical complete remission (CR), may benefit from surgical second look (SSL). PATIENTS AND METHODS: One hundred two patients in CR (as assessed by clinical findings, markers, and visualization by computed tomographic [CT] scan and laparoscopy), after initial debulking and first-line chemotherapy, were randomized to two arms, which were well balanced for predictive criteria such as age, stage at presentation, histology, grading, date of randomization, and residua after first surgery. Forty-eight patients were randomly assigned to receive follow-up evaluation only, while 54 were assigned to receive second surgery (eight of them refused). Of 46 surgical patients, 35 had negative and 11 positive surgical findings (24% clinically false-negative). RESULTS: Despite the microscopic residua found at open surgery, and the fact that the patients were then treated with second-line chemotherapy, SSL did not increase the probability of survival in this setting. In an analysis of the results according to the intention-to-treat criteria, after a 60-month follow-up period, the overall survival rates in the two groups of patients (SSL v no SSL) were 65% and 78%, respectively (P = .14). Multivariate analysis according to predictive criteria confirmed there was no significant difference between the two groups (P = .39). CONCLUSION: Our study shows the following: (1) our second-line treatment is scarcely effective; (2) SSL accurately defines complete responders to first-line chemotherapy; (3) SSL per se does not prolong survival; and (4) if confirmed, a less invasive procedure could replace SSL as a valuable method in new first-line regimens in ovarian cancer patients with clinical CR confirmed by laparoscopy.

Female↗
PubMed1997

[The presentation of a picture archiving and communication system (PACS) and the initial experiences with its use].

INTRODUCTION: The use of computers has yielded new diagnostic techniques (US, CT, MRI and computed radiography) that can successfully replace conventional film in data acquisition, image display and image interpretation. Thanks to the Picture Archiving and Communication System (PACS), we can now manage the whole of diagnostic data because the images are acquired, coupled to the patient data stored in the Radiology Information System (RIS), sent to display workstations and finally sent to the archives. PURPOSE: To present the configuration and functions of a new PACS used in radiology and nuclear medicine departments and to evaluate its efficacy one year after implementation. Particular attention is paid to the objective difficulties radiologists found in approaching the system. RESULTS: Secretarial work reduction and a more rational archiving organization are two of the advantages of automation. PACS permits rapid image display, retrieval nd archiving for both scientific and statistical purposes; however, its correct use is hindered by a series of problems, namely: a) reluctance to use PACS by many members of the medical staff, due to the complexity of its procedures; b) lack of panoramicity on the display monitor in multi-image examinations and c) underuse of viewing workstations in several wards of our institution due to lack of know-how. CONCLUSIONS: Although the use of PACS has improved the workload management in our departments, the system still needs to be customized to the radiologist to optimize its use. Workstations must be user-friendly, with simultaneous display of more images. On the other hand, radiologists need to expand their knowledge of new techniques, thus modifying obsolete working procedures.

Computer Systems↗
PubMed1995

Antithrombin III deficiency as a risk factor for catheter-related central vein thrombosis in cancer patients.

The fibrin sleeve of venous catheters (VC) and parietal thrombi represent frequent and dangerous side-effects of central venous catheterization (CVC), due to the risk of embolism. Reduced levels of coagulation clotting factors inhibitors (such as Antithrombin III) are known to be associated with increased thrombogenic risk. The aim of this study was to evaluate the role of Antithrombin III (AT III) deficiency as a risk factor for thrombosis in cancer patients undergoing CVC. The study groups included patients with a reduced AT III activity (< 70%, 20 consecutive patients) and with normal AT III values (> 70%, 20 randomly selected patients), requiring a VC for chemotherapy and/or total parenteral nutrition. The study protocol included evaluation of Hb, PLTs, PT (INR), aPTT, Fibrinogen and AT III at days 0, 1, 3 and 8 after CVC and upon VC removal. Peripheral and pullout phlebographies were performed in all patients on catheter withdrawal. A quantitative scale was developed to evaluate both VC and parietal thrombus degree in each catheter-containing venous segment (subclavian, innominate, superior vena cava); the sum of the mean values was defined as overall thrombus. The average VC dwelling time was similar in both groups. There were no significant differences in Hb, PLTs, PT (INR), aPTT, Fibrinogen and in the remaining parameters of the study between the two groups. The group with AT III deficiency presented a higher degree of both parietal (p < 0.05) and overall thrombus (p < 0.02). Data showed a higher severity of CVC-related thrombosis in patients with AT III deficiency than in the control group. Further studies are needed to evaluate whether the therapeutically-induced normalization of AT III levels can reduce the thrombosis degree.

Adult↗
PubMed1995

The use of thallium-201 in the preoperative detection of breast cancer: an adjunct to mammography and ultrasonography.

Thallium-201 breast scans were performed preoperatively in 72 female patients with breast abnormalities detected by mammography and/or ultrasonography (7.5-13 MHz), in order to differentiate benign from malignant breast disease. Informed consent was obtained from each patient. Scintigraphy consisted of anterior and oblique planar images of the affected breast and axilla at 10 min and 3 h following the injection of 201Tl chloride (110 MBq). All 201Tl scans were interpreted without prior knowledge of surgery data. Pathological features of breast malignancies, such as tumour size, axillary lymph node metastases, tumour grading, lymphatic vascular channel invasion and receptor status, were analysed for their association with 201Tl uptake by tumour cells. A total of 76 breast lesions were assessed in the study. On final histological diagnosis, there were 56 malignant tumours, 14 benign nodules (9 fibroadenomas, two cases of adenosis, two cases of focal fibrosis and one case of epitheliosis) and six atypical lesions (atypical ductal or lobular hyperplasia). Thallium scintigraphy was shown to have high accuracy (92%) in detecting breast cancer, better than mammography (74%) and ultrasonography (84%). Almost all (51/56) breast cancers showed greater 201Tl activity than surrounding normal breast tissue while there was no significant increase in 201Tl activity above background in all but one (19/20) case of non-malignant disease. 201Tl activity within breast tumours, calculated as tumour/background (T/B) ratio, ranged between 1.2 and 2.5 with a mean value of 1.45. In our experience the concentration of thallium in the breast cancer seems to be primarily dependent on vascularity and tumour size rather than tumour grading, lymphatic/vascular invasion or receptor status. 201Tl scan sensitivity was 97% for malignant lesions larger than 1.5 cm (n = 35) and 80% for lesions of 1.5 cm or less (n = 21); however, five of the eight breast cancers smaller than 1.0 cm were also detectable by 201Tl scintigraphy, compared with five out of seven by mammography. Thallium scintigraphy would not be useful in evaluating the axilla for lymph node metastases (sensitivity 27%, specificity 77%).

Adult↗
PubMed1995

Central venous catheter-related thrombosis in clinically asymptomatic oncologic patients: a phlebographic study.

Fifty-seven oncologic patients with short- or long-term central venous catheters (CVCs) and without clinical signs of axillary-subclavian thrombosis were evaluated phlebographically. Different degrees of incomplete thrombosis were found in 26 patients (45.5%) and complete thrombosis, clinically silent, was found in six patients (10.5%). A fibrin sleeve around the CVC was radiologically demonstrated in 45 (78%) patients, 21 of them (46%) with negative standard venogram. Only in four patients there was no evidence of fibrin sleeve or parietal thrombosis. There were no significant differences between patients with long-term and short-term CVCs. We conclude that parietal thrombosis of the axillary-subclavian veins is a frequent event, even if there is no clinical evidence of flow obstruction and we confirm in vivo that a fibrin coating of the CVCs is present in the majority of the cases.

Adolescent↗
PubMed1995

Can a specifically-aimed pathologic classification overcome the difficulties in defining HIV-associated lymphomas?

High grade B-cell systemic lymphomas in HIV-infected patients exhibit pleomorphic features as well as some overlap between established histologic subtypes thus highlighting the difficulties in defining them precisely by making use of the classifications for non-Hodgkin's lymphomas (NHL) proposed before the AIDS epidemic. A series of HIV-associated systemic lymphomas including 114 NHL and 25 Hodgkin's disease (HD) cases were morphologically and immunopheno-genotypically investigated at the Centro di Riferimento Oncologico, Aviano, Italy during a period of nine years. The International Working Formulation (WF) for NHL, the updated Kiel Classification and, later, morphologic variants of high grade B-cell NHL have been adopted in order to obtain a more detailed and specific histopathologic description of HIV-associated lymphomas. As a consequence of morphologic data, and considering also pathogenetic aspects as derived from literature, we have attempted a pathological categorization of HIV-associated systemic lymphomas based on the recognition of two main groups: the "blastic" cell group and the "anaplastic" one, both including specific cytomorphologic subtypes with, possibly, aggressive HD subtypes within one of them. This categorization uses the WF, the updated Kiel system, and the morphologic variants of high-grade lymphomas, and provides a provisional category for cases with intermediate morphologic features. Thus other histologic subtypes, such as small noncleaved cell (Burkitt) and immunoblastic lymphomas, can be defined in a more accurate way. The clear-cut placement of "anaplastic" cell lymphomas, including anaplastic large cell (CD30/Ki-1+) lymphomas, including anaplastic large cell (CD30/Ki-1+) lymphomas and possibly a proportion of HD cases, emphasizes the need for their diagnostic differentiation from polymorphic "blastic"' cell lymphomas, immunoblastic ones in particular.

Humans↗
PubMed1994

[Diagnostic imaging in immunosuppressed subjects: malignant tumors].

Each state of immunodeficiency is complicated by an increased incidence of certain types of cancer. The risk factors in the development of malignancies increase in a time-dependent relationship with the age of the defect in cell-mediated immunity and some tumors will develop at fairly distinct time intervals during immunodeficiency. Thus, Kaposi's sarcoma appears mostly when the degree of immunodeficiency is slight (average time: 23 months), non-Hodgkin's lymphoma is prevalent in an intermediate phase (average time: 37 months) and some carcinomas will appear only if immunodeficiency lasts many years. Many hypotheses have been suggested as to the biological mechanisms by which an immunity defect contributes to the development of malignancies: the most credible of them is the one suggesting the action of some oncogenic viruses which are not sufficiently controlled by the immune system. Kaposi's sarcomas and non-Hodgkin's lymphomas are the most common types of tumor in AIDS patients. Other tumors--except for Hodgkin's lymphoma--are seldom reported in HIV patients. However, the incidence of carcinomas is thought to be likely to increase in the next few years, because the longer survival of HIV patients, without strengthening their immune system, will unfortunately allow the tumors with longer onset time to develop. As for Kaposi's sarcomas and non-Hodgkin's lymphomas, the major epidemiological data are reported, together with some etiopathogenetic hypotheses and the main clinical and radiologic patterns. Other solid tumors in HIV patients and their clinical and radiologic features are reported too. Our series of cases was collected by the GICAT (Italian Cooperative Group on AIDS-related Tumors) which coordinates epidemiological studies, supports medical research and standardizes the treatment of patients suffering from HIV-related tumors.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Epirubicin and ifosfamide in advanced soft tissue sarcomas.

BACKGROUND: To evaluate the feasibility, toxicity and efficacy of the combination of (IFO) ifosfamide and epirubicin (EPI) given at conventional doses for monochemotherapy, we started a phase II study in advanced/metastatic soft tissue sarcoma patients. PATIENTS AND METHODS: Treatment consisted of: epirubicin 75 mg/m2 i.v. day 1; IFO 1.8 g/m2 days 1 to 5; MESNA 20% of the IFO dose at 4-hour intervals three times a day during IFO administration. Cycles were given every 3-4 weeks for at least three cycles. RESULTS: The overall response rate for non-visceral sarcomas (51 pts) was 31% (95% confidence limits +/- 13%). Among the 13 visceral sarcomas no response was seen for the leiomyosarcomas of the gastrointestinal tract, whereas one complete and one partial remission were observed for the uterine sarcomas. The duration of response was 10 months (range 5-34+) for complete responses and 9 (range 4-42+) for partial responses. The median survival for responders is 18 months (range 2-60+) and for non-responders 10 months (range 1-33) (p < 0.004). CONCLUSIONS: This combination proved to be feasible and tolerable. The overall response rate does not appear to be superior to those with other standard treatments, but it should be pointed out that our patient population was totally unselected.

Adolescent↗
PubMed1993

[Urinary calculi in an intestinal loop used for ureteral substitution. A case report].

The authors report the case of large urinary calculi formed inside the ileal conduit diversion in a patient who underwent radical surgery for an ovarian carcinoma involving the right ureter. Two ureter stents were left to ensure drainage and were endoscopically removed after six months. Renal function and ureteral canalization were normal. However, because of a knot in the proximal end of stents, a piece 5 cm-long-was left inside the diversion. After six months the patient developed recurrent renal colics: plain abdomen X-ray and urography showed a large urinary stone around the stents fragment and several smaller stones nearby. They all were removed surgically. The pathogenesis of such complications was considered: even though the slow flux of urine in the diversion, the abnormal mucus production from the ileal mucosa and the excessive and chronic bicarbonate loss played an important role in the developing of urinary calculi, the authors believe that in this case the main responsible for the stone formation was the foreign body in the urinary diversion.

Adult↗
PubMed1992

[Radiologic characteristics of the thorax during therapy with interleukin-2].

Interleukin-2 is a glycoprotein physiologically produced by human lymphocytes which is capable of mediating some still unknown immunologic reactions. In vitro, interleukin-2 was seen to induce a lytic reaction against tumor cells through the activation of a cytolytic system of natural killer cells. If administered to man in heavy doses, it causes a clinical response in the treatment of metastases from melanoma and renal cell carcinoma in 20-40% of cases. However, the clinical use of the drug, in therapeutic doses, is prevented by the occurrence of several side-effects, the major one being increased permeability of alveolar vessels with capillary leak and interstitial pulmonary edema (Vascular Leak Syndrome in the English literature). Thus, this work was aimed at evaluating chest radiographs during interleukin-2 treatment to detect, in the pulmonary district, the early stages of the vascular leak syndrome--i.e., pulmonary edema, pleural and pericardial effusions. Forty-three patients had been treated for metastases from renal cell carcinoma and melanoma November 1989 through September 1991: standard chest radiographs demonstrated 26 cases (60%) of pulmonary edema, 14 cases (32%) of bilateral pleural effusions and 12 cases (27%) of pericardial effusions. Daily chest films of the patients undergoing interleukin-2 therapy allowed the early stage of the vascular leak syndrome to be depicted, thus enabling the physician to use the highest tolerated doses and eventually to stop infusion before marked respiratory distress develops.

Humans↗