Is transanal endoscopic microsurgery (TEM) a valid treatment for rectal tumors?

BACKGROUND: In 1983 G. Buess, in Germany, developed transanal endoscopic microsurgery (TEM), a new minimally invasive technique for the treatment of rectal tumors. METHODS: Rectal lesions are excised through a modified rectoscope of 40 mm in diameter under stereoscopic control in the gas-dilated rectal cavity. Full-thickness excision, partial-wall excision, or mucosectomy can be performed. Seventy-one patients were treated with the TEM technique in our department. Major complications were observed in one patient (1.4%). No mortality was reported. RESULTS: Histological examination revealed 40 (56.3%) villous adenomas, 6 (8.4%) pT1; 17 (23.9%) pT2; 5 (7%) pT3 carcinomas; and 3 ((4.2%) other lesions. The recurrence rate was 2.8% for adenomas and 2.8% for carcinomas. The overall survival at mean follow-up of 17 months was 96.4%. CONCLUSIONS: The advantages of TEM are less or no postoperative pain, unrestricted mobility, short hospitalization, quick rehabilitation, and absence of skin scars.

[Surgical and radiologic treatment of cancer of the uterine body. Results of 12 years]. / Il trattamento radiochirurgico del cancro del corpo dell'utero. Risultati di 12 anni.

Findings were reviewed of 518 female patients with carcinoma of the body of the uterus treated and followed up during the 12 year period 1970-1982. For the patients treated with total hysterectomy and bilateral salpingo-oophorectomy followed by postoperative radiation therapy, the five-year overall survival was 88% for stage I histologic grade G1, as compared with 73% for stage I grade G2 + G3 and 48% for stages II + III. The survival rates were also analyzed in terms of myometrial infiltration. The rates of pelvic and paraaortic nodal metastases were analyzed; these observations suggested that routine postoperative radiotherapy should be considered.

[Radiation-surgical treatment of cancer of the female breast]. / Il trattamento radio-chirurgico del cancro della mammella femminile.

Findings were reviewed of 1566 female patients with primary breast carcinoma treated with radical or total mastectomy followed by postoperative radiation therapy during the 22 year period 1960-82. The five-year overall survival for the axillary node-positive breast cancer group was 58.3 percent, as compared with 79.9 percent for the node-negative group. The survival rates were also analyzed in terms of age of the patients and number of the axillary positive nodes present. The ratios of observed deaths to expected deaths were turned from many times greater than unity into nearly the expected number, after ten year follow-up period. These findings showed that host factors are capable of destroying tumor cells both in node-negative and in node-positive patients. The significance of axillary negative nodes was emphasized. The rates of locoregional recurrences and distant metastases for node-negative patients were analyzed; these observations suggested that routine postoperative radiotherapy should be considered also in node-negative breast cancer patients.

[Biologic effects of total body irradiation with single dose administered with various dose-rate]. / Effetti biologici della irradiazione corporea totale in dose unica somministrata con diverso dose-rate.

Total body irradiation (TBI) is used in conditioning regimens prior to bone marrow transplantation (BMT) in haematologic diseases to achieve the objective of eradicating bone marrow stem cells. The dose deliverable to the whole body is limited by the radiation tolerance of the normal tissues, especially of the lung, which is the major dose limiting organ because of the high incidence of interstitial pneumonia. The dose rate is important to successfully affect the therapeutic ratio of TBI and BMT; two different dose-rate schedules have been compared to define radiation damages in all tissues. Twenty mini-pigs were lethally irradiated, TBI was performed with 750 cGy total dose, but with two different midplane dose rates: a low dose rate (LDR) of 5 cGy/min and a quite high dose rate (HDR) of 25 cGy/min. In mini-pigs lethally irradiated with HDR, microscopic examination showed severe hemorrhagic changes in bone marrow, lymphonodes, lung parenchyma and other tissues, more prominent than in LDR mini-pigs. Hystologic pictures showed moderate changes in kidney and liver parenchyma, in thyroid and brain tissue both in HDR and in LDR group. Tissue radiation damages are related not only to TBI total dose, but to the dose-rate; the selection of a low dose-rate is useful to reduce radiation cell killing by accumulation of lethal injury to normal tissues, especially to the lung.

[Cancer of the bladder. Results of radiotherapy after partial cystectomy]. / Il cancro della vescica. Risultati del trattamento radiante dopo cistectomia parziale.

The authors evaluate 374 patients treated by adjuvant radiotherapy after conservative surgery or radiotherapy alone for bladder carcinoma, from 1974 to 1982. The five year survival rate was 61, 39, 8 and 43 percent, respectively, for stages A (84 pts), B (154 pts), C (65 pts) and NOS (71 pts). Two homogeneous groups of patients staged B, treated by conservative surgery and adjuvant radiotherapy were evaluated: group I by "high" dose radiotherapy (TDF greater than 95), group II by "low" dose (TDF between 50 and 95); the five years survival rates were, respectively, 59% and 28% (P less than 0.05). It is discussed the value of treatment of the bladder carcinoma by high dose radiotherapy after conservative surgery.

[Whole-body irradiation for bone marrow transplantation]. / La irradiazione corporea totale per il trapianto di midollo osseo.

High dose total body irradiation is widely used in conditioning regimens to treat patients undergoing bone marrow transplantation. Radiation-related complications observed in 67 patients who received total body irradiation and their correlation with physiopathological mechanism of clinical manifestations are discussed. Interstitial pneumonitis occurred in 9 patients in our study (14%); the relationship between the incidence of interstitial pneumonitis and many factors such as irradiation treatment techniques, pre-graft chemotherapy, bone marrow malignant as well hereditary diseases, are discussed and related to a detailed literature review. Radiation techniques are different in leukemic and thalassemic patients.

[The survival curves of 153 cases of thyroid cancer]. / Studio delle curve di sopravvivenza di 153 casi di carcinoma della tiroide.

A study is presented on the stage by stage survival curves in 153 cases of thyroid carcinoma observed over 15 years in Ancona Regional Hospital's General Surgery Division. The study reveals that prognosis is good in the first stage, but that neither surgery nor medical or radiological treatments is effective in preventing the deaths of incurable patients at later stages. It is therefore concluded that early surgery is more useful than any operations conducted at later stages.

[Mercury dichloride in lung pathology. Study of 241 patients]. / Il bicloruro di mercurio nella patologia del polmone. Studio su 241 pazienti.

In 241 patients suffering from various of lung pathology and subjected to lung scanning with mercury bichloride (Hg 197), it was found that 90% of the neoplastic masses pick up the isotope in significant fashion; 40% of the masses of other nature also pick up the compound. This results means that scanning with radioactive mercury bichloride is of little diagnostic usefulness.

[Normal values of T3-index and of thyroxine (T4) (author's transl)]. / Valori normali del T3-indice e della tiroxina (T4).

The normal values of T3-index and of thyroxine (T4) have been evaluated comparing a binomial distribution to frequential curve of all the values obtained. The findings are: T3-index = 89 divided by 112; T4 = 3.7 divided by 15.3 microgram/100 cm3 of serum.