[The value of the associated therapy of "ligation of the hepatic artery-systemic cytostatic chemotherapy" in the treatment of secondary hepatic heteroplasias].
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Adult↗
Biomedical subjects
S Sandrucci
Publications and source records attributed to S Sandrucci.
Prolactin and thyrotropin response to thyrotropin-releasing hormone in premenopausal women with fibrocystic disease of the breast.
Plasma PRL, TSH, total and free T4, total and free T3, and 17 beta-estradiol were evaluated in 29 premenopausal women with well-documented fibrocystic disease of the breast and in 29 healthy matched controls. Plasma PRL and TSH dynamics after acute TRH injection (200 micrograms i.v.) were also determined. All hormonal measurements were performed in the follicular phase of the menstrual cycle. Neither patients nor controls showed any thyroid function impairment. Basal plasma levels of the examined hormones were in the normal range in both groups. When considering data pertinent to PRL and TSH secretory patterns after TRH stimulation, no difference was recorded between patients and controls for TSH secretion, evaluated in terms of maximum peak, net (delta) and percent (delta %) increase above the baseline level and integrated area of response. On the contrary, the response of PRL was significantly higher in patients than controls (maximum peak at 20 min, mean +/- SE, 119.9 +/- 14.1 vs. 60.8 +/- 5.5 ng/ml, p less than 0.001; integrated area of response, 5,725 +/- 908 vs. 3,243 +/- 266 ng/ml/120 min, p less than 0.01). The results are compatible with the view that, in most patients with fibrocystic disease of the breast, there are abnormalities in the control of PRL secretion, which lead to enhanced release of the hormone after stimulation. In such cases the control of TSH appears to be operating normally.
Adult↗
[Retrosternal thyroid cancers. Considerations on 25 cases].
Intrathoracic thyroid cancer is an unusual finding, and few reports are available on this item. Literature data have been reviewed, and some considerations on epidemiologic characteristics of the disease and on its treatment were gained from an analysis of reports based on the files of I Surgical Clinic of the University of Turin, Surgical service of the Oncological Department of the S. Giovanni Battista Hospital and II Pathological Anatomy Service of the University of Turin. No correlation was found between previous thyroid disease, sex, histological findings, previous radiotherapy and incidence of the disease. Older age at the onset and recurrent laryngeal nerve lesions are frequently associated with intrathoracic thyroid cancer; papillary carcinoma is rarely found. Intrathoracic situation is not likely, in Author's opinion, to affect the long term prognosis more than usual risk factors.
Adult↗
[Initial immunologic evaluations in breast and thyroid cancer].
In evaluating pre- and post-operative immunological status of 15 patients with malignant breast and thyroid tumors and of 9 patients with benign breast and thyroid lesions, rosette E test, CEA, cortisol, immunocomplexes and determination of circulating leukocytes, B lymphocytes and immunoglobulins was employed. The obtained data were not significative to show a lack of immune response in tumor bearing patients. Among the reexamined parameters, CEA was the only one that apparently correlated with prognosis; its serum levels, being at a high rate in a high percentage of malignancies, tended to fall down after surgical treatment.
Antigen-Antibody Complex↗
[Antiprolactin therapy in the treatment of benign lesions of the breast. Comparison of bromocryptine and methergoline].
The Authors have treated 11 patients with benign breast diseases (fibroadenosis or fibrocystic disease) with two prolactin inhibitor drugs -- metergoline and bromocriptine -- at the dose of 8 mg/die and 7,5 mg/die respectively for sixty days with a 30 days interval from one to the other. All patients, except one, had normal serum prolactin levels before the trial; during the treatment with metergoline no long-term changes in serum prolactin levels were observed; on the contrary, bromocriptine reduced significantly prolactin values for the whole duration of the therapy. Negative clinical results were obtained with the first drug, while bromocriptine allowed to reach an 80% of positive results at the end of the trial. Coming from previous experience, the Authors conclude that the positive therapeutic effect of bromocriptine treatment is connected with the maintenance of prolactin reduction.
Adult↗
Sentinel lymph node and breast cancer staging: final results of the Turin Multicenter Study.
AIM OF THE STUDY: Validation of the sentinel node (SN) technique in breast cancer by means of lymphoscintigraphy. MATERIALS AND METHODS: From December 1996 to January 1999 102 T1-T2 breast carcinoma cases were recruited in Turin. 99mTc-human serum albumin colloids were injected subdermally the day before surgery (mean activity, 5.2 +/- 2.5 MBq). Scintigraphic imaging was performed after injection. After identification of the SN during surgery by a hand-held gamma probe, the SN was excised and sent for histologic examination. SN histology was compared with that of other axillary nodes. RESULTS: The SN detection rate was 86.3%; among 88 cases with an identified SN, 37 (42%) had axillary metastases; the SN was metastatic in 35 cases (sensitivity, 94.6%); in 51.3% of pN+ cases (19/37) the SN was the only metastatic site. In two of the 53 negative SNs, SN histology did not match with that of the remaining axilla (negative predictive value, 96.2%; staging accuracy, 97.7%). CONCLUSIONS: Our results agree with those reported in the literature; however, except in clinical trials and experienced structures axillary lymph node dissection should not be abandoned when mandatory for prognostic purposes, considering that at present SN biopsy alone is not completely accurate for axillary staging, especially in the absence of an adequate learning period.
Adult↗
Radiolabeled localization of the sentinel lymph node: dosimetric evaluation in personnel involved in the procedure.
AIMS AND BACKGROUND: Peritumoral injection of 99mTc-labeled colloids for lymphoscintigraphy and radioguided surgery does not entail any relevant radiation burden to the patients. The real issue about radiation protection concerns the personnel involved in the procedure besides the nuclear medicine personnel. The aim of our study was to evaluate the cumulative doses to personnel involved during the injection of radiolabeled compounds, under ultrasound or stereotactic guidance and the radiation burden to the personnel involved in the surgical incision of the tumor 24 hours after the administration of 99mTc-labeled colloids. METHODS AND STUDY DESIGN: We performed environmental contamination tests (SMEAR TEST) and exposure evaluation in the operating room. RESULTS: In the operating room the removed activity in the analyzed samples was less than 0.5 Bq/g and exposure to the personnel was less than 6 micro Sv/h. The evaluations made during ultrasound guidance demonstrated an equivalent and effective dose less than 20 microSv. CONCLUSIONS: Our results show that during ultrasound or stereotactic administration of radiolabeled compounds the radiation burden to the personnel involved in the procedure is virtually negligible. The surgeons too are exposed to a negligible radiation dose.
Adult↗
The sentinel node in anal carcinoma.
AIMS AND BACKGROUND: Anal cancer is a rare condition. The inguinal lymph nodes are the most common site of metastasis in this neoplasm. The inguinal lymph node status is an important prognostic indicator and the presence of metastases is an independent prognostic factor for local failure and overall mortality. Depending on the primary tumor size and histological differentiation, metastasis to superficial inguinal lymph nodes occurs in 15-25% of cases. METHODS AND STUDY DESIGN: To evaluate the inguinal lymph node status we performed a search for the sentinel node in a female patient affected by squamous and carcinoma. RESULTS: Identification and examination of the sentinel node was positive and postoperative histology showed the presence of bilateral lymph node metastases. CONCLUSIONS: We suggest that examination of the sentinel node in anal cancer could be an efficient way to establish the inguinal lymph node status, which would help the clinician to plan and perform adequate treatment.
Anus Neoplasms↗
Sentinel lymph node mapping and biopsy for breast cancer: a review of the literature relative to 4791 procedures.
The status of axillary nodes is the most important prognostic factor in breast cancer to select patient subgroups for adjuvant chemotherapy; the current standard of care for surgical management of invasive breast cancer is complete removal of the tumor by either mastectomy or lumpectomy followed by axillary lymph node dissection (ALND). The recent introduction of intraoperative lymphatic mapping and sentinel lymph node biopsy (SLND) represents a major new opportunity for appropriate and less invasive surgical management of many tumors. There is an almost uniformly enthusiasm concerning the potential of this technique in breast carcinoma management, shown by published data. A peculiar attention to the so-called "sentinel node debate" in breast cancer surgery is a constant in the last years issues of the major medical journals. Even patients have become more aware about medical enthusiasm and their request of concise information on the topic and the possibilities of this approach is an increasing reality in medical practice. The aim of this paper is to review recent literature to offer an overview about the main controversial methodological aspects and a wide analysis of reported results. The most significative international literature papers from Medline were retrieved from 1993 to September 1999, and 4782 procedures were analysed. This extensive review of the literature has confirmed accuracy, feasibility and reliability of the SN detecting technique in axillary mapping. Provided a good proficiency in SN localisation and pathological evaluation, human resources and efforts should be mainly focused on its clinical validation as an alternative to ALND instead of on further phase I-lI clinical studies.
Axilla↗
[A case of presacral myelolipoma].
Myelolipoma is a rare benign pathology whose pathogenesis is still unclear. It is most frequently localised in the adrenal gland, followed by the presacral region, mediastinum, and perirenal and hepatic region. It varies in size from a few millimetres to several centimetres. The lesion is usually capsulated, detachable from the surrounding tissues and hypovascularised. In histological terms, it is composed of lipomatous and hematopoietic tissues. A 65-year-old female patient was referred to our unit after the finding of a nonbiopsied, pelvic mass during earlier surgery. The patient was in considerable pain owing to the extrinsic compression of the mass on abdominal and pelvic organs. Preoperative tests confirmed the presence of a voluminous presacral neoformation that appeared to have a possible medullary origin (chordoma or schwannoma). During surgery, the lesion was found to be capsulated and mainly adherent to the rectum. Histological analysis confirmed the myelolipomatous nature of the lesion. A review of 21 cases reported in the literature is presented.
Aged↗
Intraoperative chemohyperthermia for advanced gastric cancer: a new procedure with closed abdomen and previously constructed anastomosis.
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Antineoplastic Combined Chemotherapy Protocols↗
[Lymphoscintigraphic localization of sentinel lymph nodes in colorectal carcinoma in early stage: results of a single center study and proposal of a multicenter protocol].
In colorectal cancer the sentinel node dissection may help to identify any unusual mesenteric lymphatic drainage pattern from the primary tumor site (ex/skip metastases); assuming that accurate pathological staging is critical for therapeutic decisions we are conducing a study to evaluate the feasibility of the sentinel node technique in colorectal neoplasms and its overall accuracy in predicting regional lymph nodes metastases for appropriate staging. From February 2001 to September 2004 we included in this study 30 patients with rectal lesions or degenerate colonic polyps not radically excised by endoscopy. Lymphatic mapping was performed with low molecular weight albumin colloid labelled with 500Mci of 99mTc in a 2 ml volume and injected submucosally by an endoscopic route at the four cardinal points around the tumor, the afternoon before the surgical procedure, both in case of colonic or rectal lesions. Scintigraphic images were obtained with a gamma camera fitted with a general purpose collimator. The day of the intervention, a hand held gamma detecting probe (Scintiprobe m100, Pol-Hi-Tech, Italy) was employed to detect the "hot" nodes, in vivo and ex vivo. These lymph nodes were tagged with a stitch in vivo; the specimen was removed by a standard resection and SLN were dissected ex vivo and sent separately for pathological examination. In case of rectal lesions, the sentinel nodes were searched ex vivo into mesorectal fat in case. All lymph nodes, including blue or hot ones, were embedded separately for preparation of paraffin sections and haematoxylin and eosin staining. Sentinel lymph node were submitted to multi-seriate sections in order to look for micrometastases. Using the radioactive tracer, sentinel lymph nodes were successfully identified in 27 out of 30 patients. Concordance between SLNs and nodal status was observed in 23 out of 27 cases (85%); two patients (7.4%) were upstaged, as SLN was the only site of metastases. In another two cases we observed no concordance between negative sentinel node and non sentinel nodes (false negative rate, 7.4%). Starting from this experience we are proposing a multicentric trial concerning the value of sentinel node technique in rectal cancer and in early colorectal cancers detected by screening programs.
Clinical Protocols↗
[Lymph node sentinel in gastric carcinoma: proposal of a multicenter GISCRIS (Gruppo Italiano per lo Studio della Chirurgia Radioguidata e dell'immunoscintigrafia) protocol].
Sentinel node biopsy has been widely adopted in the treatment of cutaneous melanoma and breast cancer. The ongoing controversy concerning the extension of lymphatic dissection in gastric cancer demonstrate that the optimal extent of lymphadenectomy has yet to be established, and underlines that the research in this area is needed to refine our knowledge and consequently our treatment of gastric tumors. In this paper the authors describe a multicentric protocol concerning the sentinel node research in early and advanced T1-T2 gastric cancer employing the blue dye method and lymphoscintigraphy by means of the endoscopic injection of Tc99m labeled nanocolloids. The aim of this protocol is to assess the clinical relevance of the sentinel node biopsy in selecting N+ patients in early gastric cancer, and the role of the same technique in detecting N2 positive patients in case of advanced gastric cancer. Assuming a confidence interval of +/- 5%, a sample of 100 recruited cases over three years is previewed.
Clinical Protocols↗
[A retrospective study on the use of preoperative percutaneous drainage in uncomplicated obstructive jaundice].
This study concerns a retrospective analysis of the use of preoperative percutaneous biliary drainage in the treatment of obstructive jaundice complicated or not by cholangitis. From 1980 to 1987, 87 patients were selected; among these, only those with bilirubin greater than 5 mg% and an overt indication to surgery were included in the study. It was so possible to match two relatively homogeneous populations, e.g. patients submitted to preoperative drainage vs patients not drained. According to our experience, a preoperative percutaneous biliary drainage does not affect postoperative mortality, incidence of immediate postoperative complications and length of hospitalisation. These results are probably linked to a predominant use of the drainage in absence of infectious complications.
Cholestasis↗
[Villous adenoma of the rectum. Review of the literature and personal experience].
Potential malignancy of rectal villous adenomas is referred as varying from 20 to 30%; an appropriate surgical excision is required in order to insure an effective cancer prophylaxis and to improve the accuracy of the pathologic assessment. The Authors review their series concerning 15 patients with one or more polyps of villous type, located at the lower third of the rectum and with precise indications for transanal excision. In 13 cases histology demonstrated the presence of an adenoma with different grade of dysplasia, which simply entered a follow-up together with a case of an adenoma with carcinoma in situ. The latter, because of the presence of invasive carcinoma, underwent radical surgery. No postoperative morbidity was observed. Recurrence rate was 8%. After an accurate review of the Literature, a radical management of the rectal villous tumour performed on routine basis seems unjustified. The Authors suggest the indication for a modern proceeding.
Adenoma↗
[Anatomo-clinical correlations in the polycystic ovary syndrome].
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Female↗
[Cytostatic therapy of metastatic breast cancer].
As complete as possible a picture of the current state of cytostatic chemotherapy in the treatment of metastatic breast carcinoma is offered. Attention is therefore mainly concentrated on application modalities of this form of therapy in relation to the clinical stage of the disease and to the use of other treatment possibilities. Methods and results of cytostatic therapy are then considered. The present situation is reviewed and the pharmacological and toxic aspects of prolonged antiblastic treatment are assessed. After outlining a number of special problems relating to the treatment of CNS and pleural metastases, the personal series is presented and results, which do not differ from other reported series, reported. In conclusion, stress is laid on the importance and effectiveness of cytostatic therapy in the treatment of metastatic breast carcinoma, but extended, controlled studies are also recommended.
Adrenal Cortex Hormones↗
[Advances in the treatment of gastroesophageal reflux. Intraoperative calibration of posterior fundoplication].
Posterior partial fundoplication can be as effective as total fundoplication in the long-term control of gastroesophageal reflux if the gastric fundus valve is encircled around the distal esophagus for no less than 270 degrees to obtain effective pressures in the newly built sphincter. In order to minimize the adverse effects, to reach constant results and to guarantee the reproducibility of the technique we have modified the 270 degrees posterior fundoplicatio (formerly described by Lind) according to the following principles: 1) the length of the gastric valve must be limited to 3 cm for each side of the esophagus; 2) the gastric valve must be fixed to the right and left side of the hiatal orifice by a single stitch; 3) the gastric valve must be calibrated with an intraoperative manometry, this allowing the standardization of the valve pressure to an average value of 35 mmHg by varying its wrapping angle; 4) the hiatal orifice must not be closed unless it is large enough for thoracic migration of the gastroplasty. Since 1984 to 1991 43 patients with proven gastroesophageal reflux not controlled by medical treatment were submitted to surgery. Twelve Nissen procedures (NP) and 31 posterior calibrated fundoplications (PCF) were performed; PCF seemed to be superior to NP in terms of postoperative mobility. After two years 20 patients treated with PCF were evaluated clinically, manometrically and by 24-hour pH monitoring. No dysphagia was reported; in two patients a pH-metric, asymptomatic relapse was observed, while one patient complained mild and occasional heartburn.(ABSTRACT TRUNCATED AT 250 WORDS)
Calibration↗