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Biomedical subjects

U M Reali

Publications and source records attributed to U M Reali.

At least 19 recordsLinked to original sources
PubMed1998

Malignant melanoma associated with human immunodeficiency virus infection: a case report and review of the literature.

A case of malignant melanoma arising in a young patient suffering from human immunodeficiency virus (HIV) infection is reported, along with a review of the literature. The neoplasm was characterized by aggressive clinical behaviour and, histopathologically, by a peculiar retiform pattern of growth with neoplastic cells interspersed among collagen bundles in the dermis without evident fibroplastic stromal reaction. In addition, a complete absence of host inflammatory cell infiltrate was noted. We hypothesize that this unusual histopathological pattern of growth, which has never been reported in this clinical setting, might be associated to HIV disease, immunosuppression and poor clinical outcome.

Adult↗
PubMed1998

Infusion of in vitro expanded tumour-infiltrating lymphocytes and recombinant interleukin-2 in patients with surgically resected lymph node metastases of malignant melanoma: a pilot study.

A pilot study was set up in order to evaluate the feasibility and safety of infusing in vitro expanded tumour-infiltrating lymphocytes (TILs) and recombinant interleukin-2 (rIL-2) in a group of patients with advanced melanoma after radical resection of lymph node metastases. Twenty-four patients were eligible for the study and proliferating TILs were collected in 16. These patients were infused with TILs and then treated with rIL-2 and alpha-interferon. Short-term toxic effects (such as fever) were in general controlled by symptomatic drugs, whereas chronic toxicities were absent. The median follow-up period was 19 months; at present, 13 patients are alive and disease free, one patient is in progression and two patients have died. The approach was feasible and safe and the clinical results observed are comparable to those obtained by long-term treatment with other biological response modifiers.

Adult↗
PubMed1997

Vessel-wall recovery after diode laser-assisted microvascular anastomosis: clinical and histologic analysis on long-term follow-up.

The authors recently reported an experimental study on diode laser-assisted microvascular anastomosis (LAMA) in the femoral arteries and veins of rats. Good success rates and very promising histologic results obtained in this preliminary phase suggested an extension of the investigation with a larger number of rats and for longer follow-up periods. In the present work, they describe an experimental study with two main goals: 1) improvements of the laser-assisted surgical procedure for reduction in the number of permanent stay sutures, with minimization of bleeding at the end of the intervention, compared with conventional microvascular sutured anastomosis (CMSA); and 2) providing more information on the repair mechanism(s) induced by laser treatment, obtained from clinical and histologic analyses extended up to 3 months of follow-up. In a total of 64 Wistar rats, 46 arterial and 22 venous LAMAs were performed, and 15 arterial and 11 venous CMSAs. The recorded success rates of LAMA in both arteries and veins were fairly high (67/68 at the time of surgery, and 54/55 in the follow-up), and substantially comparable with those of CMSA. Clear evidence of a superior healing process in the LAMAs was provided by histologic examinations. In particular, specific stains and immunohistochemistry analysis indicated that laser irradiation can induce wide proliferation of smooth muscle cells and negligible scar tissue which, together with diminished foreign-body reaction consequent to the reduction of suture material, result in a better restoration of vessel structures.

Anastomosis, Surgical↗
PubMed1997

In situ expression of transforming growth factor beta is associated with melanoma progression and correlates with Ki67, HLA-DR and beta 3 integrin expression.

Transforming growth factor-beta (TGF beta), which is secreted by cultured melanoma cells constitutively, inhibits the proliferation of normal melanocytes and of most melanoma cells in vitro, but some melanoma cells from advanced stages of the disease develop resistance to TGF beta-dependent growth inhibition, without developing any change in TGF beta cell surface binding. In vitro TGF beta also downregulates the expression of HLA-DR molecules on melanoma cells, and upregulates the expression of the beta 3 integrin subunit on some cell lines. Immunohistochemical analysis of 53 melanocytic lesions (12 naevi, 30 primary melanomas and 11 metastases) revealed a trend of increasing expression of TGF beta and TGF beta receptor type III with tumour progression, and a significantly higher expression of both TGF beta (P < 0.0001) and the receptor (P < 0.05) in metastatic and thick (> 1 mm) primary melanomas compared with thin (< 1 mm) primary melanomas. The expression of TGF beta correlated with expression of a marker of proliferation, Ki67, and with HLA-DR and beta 3 integrin subunit expression. Coexpression of the four molecules was observed in all metastases and in most thick primary melanomas. These findings argue against an inhibitory effect of TGF beta on cell proliferation or HLA-DR antigen expression in melanoma, and suggest the upregulation of the beta 3 subunit. TGF beta protein appears to be a biological marker of melanoma progression in situ.

Adult↗
PubMed1994

First recurrence analysis of 840 cutaneous melanomas: a proposal for a follow-up schedule.

AIMS AND BACKGROUND: A correct follow-up schedule for patients who underwent an excision for stage I cutaneous melanoma might allow the early detection of local and distant metastases. At present, there is no general agreement on follow-up protocols. In order to work out a follow-up guide, we have retrospectively evaluated the records of 840 stage I cutaneous melanoma patients surgically treated and followed during the postoperative period in the Division of Plastic Surgery of the University of Florence from 1975 to 1992. METHODS: We evaluated the patients' records by analyzing time, pathway and site of any first recurrence in relation to the main prognostic factors such as patient sex, site, histological type and depth of invasion of each primary melanoma. A statistical analysis was performed. RESULTS: To summarize, the salient results were the following: 80% of relapses occurred in the first 3 years and they occurred significantly earlier when the primary melanoma was localized in the trunk and significantly later when the melanoma was localized in the lower limbs and for < 1.5 mm lesions. The first recurrence occurred earlier by the lymphatic than by the hematic pathway regarding the overall number of patients. The hematic pathway was the most frequent (with respect to the overall percentage of hematic metastases) for the melanomas localized in the head and neck region and for lentigo malignant melanomas, whereas the lymphatic pathway was most frequent for melanomas of the lower limbs and > 3 mm in thickness. CONCLUSIONS: We suggest a follow-up schedule taking into consideration the postoperative behavior of stage I cutaneous melanoma patients (in terms of time and pathway of the first recurrence) in relation to the site and depth of invasion of the tumor.

Female↗
PubMed1994

Sonographic evaluation of dermis and subcutaneous tissue during and after skin expansion.

Soft-tissue thickness modifications were evaluated by high-resolution ultrasound sonography in six patients undergoing skin expansion, with the aim of investigating the possible use of this noninvasive method in the routine monitoring of soft tissues during and after skin expansion. Both during expansion (decrease) and in the postoperative period (increases up to 100 percent or more of the baseline preoperative value), changes in fat thickness occurred faster and were greater in magnitude than those in dermal tissue, overall gradual and limited. In our series, the values of fat thickness ranged between 44 (at full-expansion time) and 140 percent (2 months after expander removal), with a highly significant difference (p = 0.0003), while dermis thickness values ranged between 83 and 114 percent, respectively, showing no significant difference (p = 0.71). Some echo-structural dermal modifications were found by the 20-MHz probe at full skin expansion only. High-resolution ultrasound sonography may be proposed as a noninvasive method in the routine monitoring of soft tissues during and after skin expansion.

Adipose Tissue↗
PubMed1994

Proliferative, phenotypic and functional and molecular characteristics of tumour-infiltrating lymphocytes obtained from unselected patients with malignant melanomas and expanded in vitro in the presence of recombinant interleukin-2.

Tumour-infiltrating lymphocytes (TIL) derived from several histotypes, including melanoma, can be expanded in vitro in the presence of recombinant interleukin-2 (rIL-2) and infused as part of experimental adoptive immunotherapy protocols. Several authors have described the isolation and the expansion of TIL, but little is known about the actual proportion of unselected melanoma biopsies that give rise to 'positive' TIL cultures. We evaluated the proliferative, phenotypic, functional and molecular characteristics of cultured TIL obtained from 26 patients with metastatic melanomas, eligible for inclusion in a protocol of adoptive immunotherapy. Sixteen proliferating cultures were obtained. All TIL belonged to the T cell lineage and were characterized by a wide range of cytolytic activity against autologous and, to a lesser extent, allogeneic melanoma cells. Molecular analysis of the constant region of T cell receptor-beta (TCR-beta) showed an oligoclonal population of TIL in the majority of expanded samples, indicating that a selected subset of lymphocytes present in the tumour site could be expanded in vitro. These features, together with the high number of proliferating samples, make these populations of TIL suitable for infusion into patients with advanced disease.

Adult↗
PubMed1994

Incidence of cutaneous melanoma in the centre of Italy: anatomic site distribution, histologic types and thickness of tumour invasion in a registry-based study.

The majority of epidemiological data on cutaneous melanoma (CM) derives from studies carried out in a predominantly fair-skinned population. On the contrary, little is known of the epidemiological figures (including incidence data) in mediterranean populations. The aim of this study was to investigate the incidence rates of CM in a geographically-defined area of the centre of Italy, with particular attention to anatomic site distribution, histologic types and thickness of tumour invasion. After revision of the data base of the Tuscany Cancer Registry concerning the period 1985 to 1987, 282 incident cases of invasive CM (135 males, 147 females) were found in a resident population of 1,174,121 inhabitants. The mean annual age-standardized rates were 6.7/100,000 for males and 7.0/100,000 for females. Site-specific incidence rates showed an almost three-fold higher incidence of CM of the trunk in males than females (3.7/100,000 vs 1.4/100,000). Conversely, a four-fold higher incidence in females than in males was observed for the lesions of lower limb (2.1/100,000 vs 0.5/100,000). A statistically significant difference of incidence rates was also observed for the thigh (females 1.1/100,000, males 0.2/100,000), a normally sun-exposed area. Concerning histologic types of CM, the incidence of the nodular type was higher in males than in females (1.8/100,000 vs 1.3/100,000), even if the difference was not statistically significant in any class of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Experimental diode laser-assisted microvascular anastomosis.

An experimental study to evaluate a diode-laser approach to microvascular end-to-end anastomoses is reported. Studies were carried out on the femoral arteries and veins of Wistar rats, and effective welding of vessel tissue was obtained at low laser power, by enhancing laser absorption with indocyanine green (Cardio-green) solution. The histologic and surgical effects of this laser technique were examined and compared with those of conventional microvascular sutured anastomoses.

Anastomosis, Surgical↗
PubMed1993

Reconstruction of a medial canthus defect with a myocutaneous flap.

Defects in the inner canthal area are generally repaired by full-thickness skin grafts, V-Y advancement flap, or frontal flap. Each of these techniques may give some problems in restoring the functional or aesthetic features of that region, or both. To avoid these inconveniences, we performed the reconstruction of the medial canthal area after tumor excision by using a myocutaneous rotation flap from the upper lid joined to a rotation flap from the lower lid and cheek. No scar resulted inside the aesthetic unit and a fine result was achieved from both the functional and the aesthetic point of view.

Aged↗
PubMed1992

The prognostic significance of histologic regression in cutaneous melanoma.

A retrospective evaluation of 201 stage I cutaneous melanomas was performed to investigate the prognostic significance of histological regression (present in 67 cases). Thin melanomas showed regression more frequently than thick lesions (48% less than or equal to 0.75 mm vs 12% greater than 3 mm). The mean disease-free interval was 33.53 months in regressing tumours and 19.9 in non-regressing tumours (p = 0.07): differences between the survival curves were not significant (p = 0.61). Metastases developed in 13 (19.40%) patients with regressing tumours and by 40 (29.85%) patients with non-regressing tumours. Although we observed a higher frequency of regression in thin melanomas we could not demonstrate an influence of regression on disease-free interval and survival.

Female↗
PubMed1992

BANS: a discussion of the problem.

The significance of the BANS location (upper Back, posterior Arm, Neck and Scalp) as a prognostic factor in patients with stage I melanoma is controversial. A meta-analysis performed by Weinstock et al. on their own and five comparable studies corroborated the hypothesis that this location is influential in the prognosis of intermediate thickness (0.76-1.69 mm) melanomas. Our study investigated the relationship between BANS subsites, thickness and prognosis in 1,082 stage I melanoma patients from two major Italian centres, Turin and Florence. A BANS primary was observed in 212 (19.5%) patients: recurrences occurred in 85 of them (40.1%) vs 309/870 non-BANS patients (35.5%). Overall survival probabilities were significantly shorter (p less than 0.01) in the BANS group (69.1% vs 76.7% at 5 years; 59% vs 68.5% at 10 years). The prognostic value of the BANS location was confirmed by a multivariate analysis using the Cox proportional hazards model. Stratification of BANS and non-BANS groups by thickness clusters showed a significant difference in both survival (p less than 0.001) and disease-free interval (p less than 0.05) in the 3.01-4.00 mm thickness subset, due to the greater incidence of distant and visceral metastases. In the 0.76-1.69 mm thickness range the significance was p = 0.06.

Adolescent↗
PubMed1990

[Cultured epidermis in the treatment of leg ulcer: "edge effect" and correlation with keratinocyte proliferation index].

Cultured keratinocyte grafting (KG) of chronic leg ulcers produces an impressive stimulation of host epithelization by an effect on the edge of the ulcer, which starts to grow in rapidly ("edge effect"). In 5 patients with chronic leg ulcers treated by KG, we have studied the proliferation index of the epidermis of the edge and of the graft area and that of secondary culture keratinocytes. The aim of the study was to correlate this parameter with the clinical evolution of the treated lesions. We found a significant correlation between the proliferation index of the edge epidermis and the clinical evidence of "edge effect".

Aged↗
PubMed1990

[An unusual case of dermatofibrosarcoma protuberans].

A case of Dermatofibrosarcoma Protuberans (DFSP) with unusual cystic features is described. It is difficult to evaluate the actual incidence of this feature on the basis of literature; on the other hand we observed it only once in a series of 27 patients studied from 1975-1989.

Fibrosarcoma↗
PubMed1989

The use of high resolution ultrasound in preoperative evaluation of cutaneous malignant melanoma thickness.

High resolution ultrasound (HRUS) was tested in 58 cutaneous malignant melanomas to check its validity in evaluating tumor thickness in vivo before surgery. The values obtained with this method were compared with histologic values (measured according to Breslow); a highly significant correlation was found (r = 0.895, p less than 0.001). The accuracy of HRUS in distinguishing between low- and high-risk cutaneous malignant melanoma was also found to be quite high. Our data therefore justify the use of such a technique in the preoperative staging procedure.

Adult↗
PubMed1988

Multiple marker studies on a malignant fibrous histiocytoma with primary cutaneous localization.

Continuing controversy exists concerning a possible relation between neoplastic cells of malignant fibrous histiocytoma (MFH) and the mononuclear phagocyte system. The aim of this study was to investigate the membrane and cytoenzymatic phenotype of a primary cutaneous MFH, storiform pleomorphic type, and to compare these data with ultrastructural observations. Cytoplasmic proteins (acid phosphatase, non specific esterase, alpha-1 antitrypsin, and lysozyme) suggestive of a mononuclear phagocyte origin were demonstrated in varying amounts in neoplastic cells infiltrating the dermis. Consistent with these data, two (LeuM3 and OKM5) out of four (OKM1 and LeuM1) monoclonal antibodies directed against mononuclear phagocyte antigens stained most of the neoplastic cells. Class II MCH antigens (DR and DQ) were variably expressed on distinct groups of neoplastic cells, suggesting different activation/differentiation states. The results favor the view that the present case of primary cutaneous MFH was of mononuclear phagocyte origin. However, the observed phenotypic profile was expressed on neoplastic cells irrespective of their ultrastructural morphology (histiocytic or fibroblastic). Together with previous data in the literature, the latter finding corroborates the view that distinction between these two cell types in MFH is likely to reflect divergent growth and differentiation patterns rather than histogenesis.

Aged↗
PubMed1988

Antigenic phenotype of radial growth phase melanomas with or without a vertical growth phase portion.

The expression of 4 melanoma-associated antigens and of class I and II HLA antigens was investigated in 12 superficial spreading melanomas (SSM) and in 8 SSM with a vertical growth pattern portion (SS + NM) by the use of monoclonal antibodies and an indirect immunoperoxidase procedure. Monoclonal antibodies 225.28, 763.74, CL.203, VF19-LL217, Q5-13, W6-32 and anti-HLA-DR, were used. Each antigen was more frequently expressed by SS + NM on the whole than by SSM and also by the radial growth pattern portions of SS + NM than by SSM. Vertical growth pattern portions of SS + NM were not antigenically similar to radial growth pattern portions in the same tumors. The high frequency of antigen expression in radial growth pattern melanomas seems to be associated with the appearance of a more invasive cell population.

Antibodies, Monoclonal↗