Biomedical subjects
Publications and source records attributed to T Maggino.
1068 patients were examined using a unified diagnostic protocol. 618 patients at high risk were screened out, and underwent further instrumental and surgical investigation. 17 cases of breast cancer were detected, while the remaining patients were addressed to an appropriate, highly reliable and repeatable follow-up for breast care.
Therapeutical program in cervical cancer usually include surgical or radiotherapeutical interventions or a combination of the two, variously integrated with techniques and sequences of application. Treatment planning and evaluation of results are normally based on the classification into clinical stages codified by the FIGO. But this classification, though providing useful prognostic standards of judgement, has proved to be inadequate to identify specific therapeutical guidance. Within a single clinical stage different risk factors have been identified which influence prognosis thus determining the therapeutical treatment more than staging itself. Furthermore clinical staging has failed to predict the surgical stage correctly in a significant number of cases. The index of correction after surgical staging shows discrepancy in about 1/3 of cases. In these cases a therapeutical program based on clinical examination exclusively may prove to be inadequate. The results reported by Authors warrant a rational resort to operative staging in cervical cancer in order to establish the real topography of the original focus more correctly. This indication is further strengthened by the need to identify lymphatic involvement, notably of para-aortic nodes, in locally advanced cases since such an occurrence bears a significant influence on the patient's prognosis and possibility of treatment. On the bases of these considerations the Authors suggest surgery as primary treatment in the management of cervical cancer.
A comparison between plasma lipid-bound sialic acid (LBSA) and carcinoembryonic antigen (CEA) in gynaecologic cancer patients has been performed. The LBSA level appears more specific then the CEA, especially for ovarian cancer. This finding has promoted a longitudinal study to show if LBSA test may prove a reliable marker of disease in ovarian cancer patients.
The Authors refer their own experience on a planned prospective study of integrated chemosurgical treatment in advanced epithelial ovarian cancer. Repetitive surgery interspersed with non cross resistant schedules of chemotherapy can achieve more than 60% of complete responses with an expected five years survival rate dependent on the residual disease after primary and especially second operation. In particular residual neoplasia larger than five centimeters after the first laparotomy or larger than two centimeters left behind at second laparotomy constitutes the worst prognostic index.
The Authors evaluate the percentage of vaginal delivery after previous cesarean section, in a group of 57 patients. Results show that 34% of the patients delivered spontaneously, and when recurring causes are excluded the percentage rises to 39%. The Authors conclude that a careful monitoring of labour can prevent unnecessary cesarean section in patients who underwent previous surgical delivery.
The problem of progestin treatment for benign breast disease and mastodynia is still dividing Clinicians and Searchers: the traditional methods of clinical investigation and follow-up do not allow any further step in the debate. In this work we evaluated the role of E2/Progesterone R.I.A. and thermography in monitoring the effect of progestin on BBD and found that only the latter can give useful informations, insufficient, however, to direct the treatment. If we want to be able to select the patients suitable to be treated by progesterone, we must know the tissutal hormone receptivity and be able to reexamine it during the treatment to verify the effectiveness of the administered drug. These informations can be obtained through the assay of Estradiol and Progesterone Receptors in the most accessible hormone-dependent tissue: the endometrium. Our data point out a quite different behaviour of Estradiol and Progesterone cytoplasmic Receptors in the endometrium of women with mastodynia and controls. The knowledge of these informations in the single patient will let us come out from subjectivity when deciding about BBD therapy or when trying to correct unsatisfactory treatments.
The Authors report the preliminary results of a study performed on patients submitted to radical hysterectomy according to Wertheim-Meigs for cervical-carcinoma, in order to evidence possible changes of the intestinal functionality, by means of a manometric investigation of the anal sphyncteres and measurement of the intestinal transit times. The manometric survey showed that no essential parameter was uniformly altered whereas the transit time measurement proved in some cases the slowing-down of the intestinal progression at the level of the ascending and transverse colon, and a normal transit in the descending colon as well as in the rectum in all examined cases.
In pre-terminal and terminal gynaecological patients with persistent cancer pain, now it is possible to carry out some anthalgic methods associated or not to parenteral administration of non-narcotic or narcotic analgesic, i.e. intrathecal neurolytic injections and epidural narcotic administration. Many favourable results have been obtained by means of single or repeated 7% phenol in glycerine injections to patients with advanced but not terminal cancer affected by somatic and segmental pain or by perineal pain. In order to control more extensive pains, epidural injections of morphine in saline have been employed in preterminal patients. This method appears to be the best answer to many problems complained by the patients: pain, depression, malaise. As a matter of fact, low doses of epidural morphine induce both complete pain relief and sedation or slight drowsiness.
The association between post-climacteric LH-preferential release after GnRH-Test and the occurrence of benign or malignant estrogen dependent diseases makes the Authors evaluate the variations induced in such type of hypophyseal response by MPA, administered in the same doses as in the hormonal therapy of cancer. MPA lowered both the basal gonadotropin secretion and the amplitude of the response to the neurohormone, suggesting the hypothesis of a possible direct inhibitory action of the hormone on the hypophysis. The persistence of LH-preferential release after the ten day treatment with MPA 200 mg daily might be explained by the lack of modifications induced by the hormone on the levels of cytoplasmic E2-receptors, on which seems based LH-preferential release.
The authors evaluate the reliability of GnRH-Test in menopause in detecting the substratum at risk for the development of endometrial cancer. The study was carried out on 30 women affected with endometrial cancer and 30 controls; the examination of the individual curves of gonadotropin values in each patient led to observe LH preferential release in 23 out of 30 cancer patients and in 10 out of 30 controls. The difference of response between the two groups in highly statistically significant (0.0005 less than p less than 0.001). However, the predictive-value of the Test in relation to the detection of the substratum at risk, is about 70%; this apparently unsatisfactory result may be corrected by the finding that about 30% of endometrial cancers seem to develop independently from estrogens. GnRH-Test in menopause might then prove to be highly reliable in predicting the occurrence of estrogen-dependent endometrial malignancies, and may be particularly useful in detecting the substratum at risk among those women presenting no risk-factors, who otherwise might escape careful medical controls.
Assays have been developed for the quantitation of androgen, estrogen and progesterone receptors in the cytosol of 45 vulvar dystrophic tissues. In 27 patients we assayed only cytoplasmatic receptors, while in 18 patients both cytoplasmatic and nuclear receptors. The workers verified the possibility to assay these carriers, finding significant correlations neither with patient's age nor between atrophic and hypertrophic dystrophies. The research concerning the cytoplasmatic depletion and nuclear accumulation allowed us to understand the action mechanism of the androgen in vulvar tissues in patients in menopause.
The Author analyses the rationale for operative staging in cervical carcinoma. First-instance surgery in the treatment of this neoplasia can be merely exploratory, when during the operation radical removal of the neoplasia appears to be technically impossible. It can nevertheless identify the surgical stage, make lymphnodal histological control possible and detect target volumes for subsequent radiotherapy. In technically operable cases thanks to primary surgery not only can the primitive focus be controlled but through the pathologic study of the surgical specimen factors of risk for local or loco-regional relapse can be detected thus directing the planning of metasurgical radiotreatment.
The Authors analyse the correlations between clinical staging (FIGO) and surgical staging in 152 patients affected by cervical cancer who underwent primary surgical therapy at the Gynecologic Institute of Padua University between 1974 and 1982. In the examined series clinical staging agrees with surgical staging in 2/3 of cases. The error percentage of clinical staging does not change significantly, from a statistical point of view, when staging varies. In those cases in which the two systems disagree the overstaging figure tends to decrease as staging becomes more severe while the clinical understaging figure tends to increase accordingly. On the basis of these results the Authors advocate a rational resort to operative staging in cervical cancer so as to evaluate the real topography of the original focus more accurately and plan the most adequate treatment.
Primary surgical treatment in cervical carcinoma offers an unrepeatable chance to assess the biologic characteristics of the neoplasia by surgical staging and pathologic examination of the surgical specimen. The detection of factors of risk for locoregional diffusion, clinical staging being equal, can guide a subsequent target radio-treatment by identifying a group of patients at higher risk for relapses. The analysis of 155 cases of cervical carcinoma treated with radical primary surgery and pelvic lymphadenectomy at the Gynecologic Institute of Padua University has stressed the statistically significant correlation (P less than 0.05) existing between lymphatic diffusion and presence of neoplastic cells in capillaro-like spaces, degree of neoplastic cervical infiltration and parametrial diffusion. According to the Authors the presence of these features is a reliable basis to select patients eligible for post-surgery radiotreatment.
Surgical re-examination after first line surgery followed by chemotherapy is an absolutely necessary step in the course of integrated treatment of advanced ovarian epithelial tumours. Our personal experience of surgical re-staging and reductive surgery in 48 patients affected by ovarian tumours stage III and IV (FIGO), by laparotomic second look is reported. Repeated surgery succeeds in further reducing the neoplastic deposits or radicalizing the first intervention in 33% of the overall series; in 52% of the cases, the second look was negative for neoplasia; in 16% only, despite tumour finding no reductive surgery was possible. If only the cases presenting residual neoplasia after primary surgery are taken into account, tumour debulking was possible in 44% of the patients. The analysis of this series fully confirms the preliminary statement that the smaller the residual neoplasia after surgery, the greater the chances of success for chemotherapy in ovarian cancer. It confirms as well that the laparotomic second look is the only currently available way to usefully assess the full remission of the disease.
This study evaluates the possible use of computed tomography not as an alternative diagnostic method but, rather, as a supplement to laparotomy in patients treated for ovarian cancer. The following conclusions can be drawn: in patients presenting no clinical evidence of persistent or relapsing disease C.T. Scan is not a mandatory but, rather, an optional test since it entails 25% false negatives, a 66.6% predictive value and because the involved patients will need, in any case, a further intervention. Conversely, C.T. Scan is clearly indicated in patients presenting clinical evidence of disease. It can prove helpful in detecting metastases in areas that prove difficult to be clinically examined; in assessing whether the retroperitoneal areas conceal neoplastic tissue or in planning the right operation for masses that have been palpated only before chemotherapy, and then in regression. When, despite chemotherapy, tumour progresses, surgery may became useless, and the C.T. Scan may therefore prove helpful in defining the condition and guiding non surgical treatment. Therefore, in the follow up of ovarian cancer the C.T. Scan may be performed on the basis of clinical course, instead than on a rigid aprioristic planning.
20 women, matched for age, site of primary tumor, histotype and stage, have been selected among patients affected with vulvar carcinoma for a study comparing classic radical vulvectomy vs "non mutilant" radical surgery. Detailed results actually available are discussed, showing that "non mutilant" technique gives results comparable to classic radical vulvectomy in terms of survival and recurrence rate; with minor functional and aesthetic damage, minor side effects and shorter post operative course.
Explore the source record for details and available documents.