Peritonectomy and hyperthermic chemotherapy in patients with advanced or recurrent ephitelial ovarian cancer: a single center cohort study.

AIM: The present study reports our experience concerning with the advanced cancer treatment (cytoreductive surgery and hyperthermic intraperitoneal chemotherapy) in patients with advanced ovarian cancer ephitelial (AEOS) or recurrent ovarian cancer ephitelial (REOC). METHODS: In a period from October 2006 to December 2009, we observed 25 patients affected by advanced ephitelial ovarian cancer or recurrent ephitelial ovarian cancer. All patients underwent CRS + HIPEC procedures. Peritoneal involvement was valued according to the Peritoneal Cancer Index (PCI) and the remaining postoperative disease according to the Completeness of Cytoreduction score (CC). HIPEC was always performed with closed technique for 60 min, with an average inflow temperature of 42.5 °C. The drugs were administered in combination according two schemes: 1) cisplatin 60 mg/m2/L and caelyx 20 mg/m2/L; 2) 60 mg/m2/L taxotere and caelyx 20 mg/m2/L. Morbidity and mortality were evaluated in accordance with the NCI CTCAE v. 3.0 (USA). Finally, the Disease Free Survival and Overall Survival by the Kaplan-Meier method was rated. RESULTS: The average age observed was 64 years (range 46-76). Fourteen patients (56%) were affected by AEOC. From this group, 12 (48%) were subjected to neoadjuvant therapy and 2 (8%) to surgery as a first; 11 (44%) patients had REOC and all of them had previously undergone to surgery and adjuvant CHT. The average PCI was 12.63 (range 2-27). In 22 patients (88%), cytoreduction was considered total or almost total (CC-0 in 14 patients, CC-1 in 8); in 3 patients (12%), it had not been optimal (CC-2 or CC-3). In all 18 patients with PCI less than 15, it was possible to achieve an optimal cytoreduction, and this was possible only in 3 of the 7 patients who had a PCI greater than 15. The average operative time, including HIPEC, was of 612 min (range 425 min-840 min). In 9 patients (36%), the postoperative course was uncomplicated, in 10 patients (40%) complications were minor (G1-G2) and in 4 patients (16%) morbidity was important (G4). Mortality rate was 8%. The average OS was 30.8 months and the median OS was 30.8 months (respectively 36.5 months for AEOC and 27 months for REOC). The median DFS total (calculated from the day of surgery or from the day of the beginning of the CHT) was 12months (respectively 12.9 months for AEOC, 11.9 months for REOC). CONCLUSION: Although the CRS and HIPEC procedure in the treatment of advanced or recurrent ovarian cancer represents now a reliable method with good results both in terms of morbidity and of distance results, there are still many controversial aspects that may in the future be better clarified only with a randomized phase III study, which is in progress, involving international working groups and experts on the procedure.

High resolution small animal single photon emission computed tomography: uptake of [99mTc]bombesin and [123I]ioflupane by rat brain.

AIM: The aims of this study were: 1) to perform brain single photon emission computed tomography (SPECT) in anesthetized rats with high resolution cameras (HRC) equipped with parallel hole collimation resolution of about 1 mm (HRC1) and 2 mm (HRC2); 2) to assess when and with which radio-tracer HRC1 SPECT shows advantages over HRC2. METHODS: We used two multicrystal HRCs with parallel square hole collimators, whose pure tungsten septa closely fit the crystals, in turn matched with a 4 inch2 position sensitive photomultiplier. HRC1 showed 1.1 mm and HCR2 2.1 mm resolution at collimator contact. HRCs performed 180 degrees semi-circular orbits around the head of rats: image reconstruction occurred with ordered subsets expectation maximization algorithms. Resolution of SPECT was measured with a Derenzo Phantom, resulting 1.4 mm for HRC1 and 2.3 mm for HRC2. Three rats were studied with [(99m)Tc]HMPAO, 3 rats with [(99m)Tc]bombesin (BN) and 48 h later with [(123)I]ioflupane (DaTSCAN). SPECT studies were reviewed by two experienced operators. RESULTS: Technetium-99m-HMPAO SPECT showed similar images with HRC1 and HRC2. The uptake of BN by amygdale, hippocampus and olfactory tract was detected by both cameras. DaTSCAN SPECT with HRC1 showed detailed image of the tail of the caudatus: this image was not obtained with HRC2. DaTSCAN and BN SPECT showed amygdale with both HRCs. However, only the central nucleus of amygdale takes up DaTSCAN, whereas central, lateral and basolateral amygdaloid nuclei express BN receptors. Only HRC1 SPECT showed amygdale larger with BN than with DaTSCAN. CONCLUSION: Spatial resolution of 1.4 mm is appropriate to detect selected subcerebral structures.

High resolution mini-gammacamera and 99mTc [HMPAO] - leukocytes for diagnosis of infection and radioguided surgery in diabetic foot.

Discovery of osteitis may be delayed because of late appearance of X-ray signs in patients with diabetic foot. Scintigraphy with labelled leukocytes is able to detect flogosis but often misses bone involvement, due to inadequate resolution of Anger camera, the commonest detector used in nuclear medicine. Radioguided surgery and biopsy with high resolution scintigraphy (HRS) started to be studied since 2000: although this method had never been tested for planning and guiding diabetic foot surgery, in our opinion it can help early diagnosis and surgical treatment of diabetic foot. Five patients with diabetic foot and suspected infection were studied with standard 99mTc [HMPAO]-leukocyte scan. In the same patients 2 mm spatial resolution HRS was performed 24 hours after administration of labelled WBC, using our inch2 field-of-view portable mini-gammacamera. Operations were done just after the 24h scan and were guided with the portable high resolution device in the four patients who showed positive scan. Scintigraphy with Anger camera and HRS were positive in four patients. HRS showed a bar-shaped radioactivity corresponding to small phalanges, close to the main inter-digital hot spot. The presence of osteitis on phalanges that had been shown by HRS was confirmed at surgery, that was successfully driven with the high resolution mini-camera. In conclusion HRS is able to diagnose early osteitis of diabetic foot and to guide diabetic foot surgery.

Fast cancer uptake of 99mTc-labelled bombesin (99mTc BN1).

In human blood, breakdown of gastrin-releasing peptide and other bombesin-related peptides occurs in less than 15 min. This quick enzymatic cleavage might impair the diagnostic use of labelled bombesin (BN). 99mTc-labelled bombesin (99mTc BN1) was injected intravenously and dynamic uptake data were acquired for diagnosing 26 cancers of different origin: 15 breast, 3 prostate, 5 colo-rectal, 1 pancreas, 2 small cell lung cancers and 1 gastrinoma. Background subtracted tumour uptake data were plotted against time and fitted with known mathematical functions. Twenty-three out of 26 cancers showed rapid increase of radioactivity followed by a radioactivity plateau, with some oscillations around the average plateau value. The time to 80% of max activity (T80) was the reference parameter to measure and to compare the uptake speeds. The slowest T80 was 7 min in one T1b breast cancer, gastrinoma reached T80 in 5 min and node-positive prostate cancers in 2 min. N+ breast cancers showed T80 at 3.62 +/- 0.75 min, N- breast cancers at 5.5 +/- 0.88 min (p < 0.02). When all the tumours were considered, N+ tumours showed T80 at 2.68 +/- 1.03 min and N- cancers at 5.5 +/- 0.82 min. In all the cancer types, the uptake of 99mTc BN was faster than 10 min. This result shows the ability of 99mTc BN to image tumours. The faster uptake by N+ versus N- cancers probably depends on the higher blood flow in N+ cancers.

[Rubber band ligation of hemorrhoids. A four-year experience]. / La legatura elastica delle emorroidi. Considerazioni su una casistica quadriennale.

The non-surgical approach to hemorrhoidal disease was considered, particularly in relation to the rubber band ligation technique. On the basis of a four-year experience collected on 60 treated patients among 75 observed, cases, indications, results and advantages of the method were outlined. Besides the classic method's applications, two cases were presented in which the technique was applied on the grounds of non typical indications. From the final results the rubber band method represents a good therapeutic option for early degrees of hemorrhoidal disease. Moreover, on the basis of the author's experience, this method is also suitable in appropriately selected cases of advanced hemorrhoidal disease intra-anal mucosal prolapse.

[Peritoneojugular shunt in the treatment of idiopathic ascites in the hemodialyzed patient: a clinical case]. / Validità dello shunt peritoneo-giugulare nel trattamento dell'ascite idiopatica nel paziente emodializzato: descrizione di un caso.

The case of an uremic patient receiving dialytic treatment, who also had an hydiopatic ascites, probably due to peritoneal hyper-waterproofing, is described. Peritoneo-venous shunt was positioned with good result. Generally, similar clinical situations such a therapy is as valid as other commonly used methods.

[Surgical treatment of refractory ascites with peritoneovenous shunt]. / Trattamento chirurgico dell'ascite refrattaria con shunt peritoneovenoso.

Leveen and associates described a peritoneo-venous shunt which proved to be useful in patients with intractable ascites. Medical therapy, paracentesis and peritoneovenous shunt have been compared, but there is uncertainty about their relative merits. Therefore, the leveen device has be placed in last years in an increasing number of patients: it has not been shown by prospective trials to prolong survival significantly, although it may shorten hospitalization and improve the quality of life. A number of early and late complications were described but they do not influence the general results: origin and features of such complications are discussed as well as their prevention and treatment and personal cases are presented. Selection of patients and careful surgical procedure seems to be mandatory for better results.

[Intraoperative ultrasonic evaluation of the residual thyroid weight in thyroidectomy in diffuse toxic goiter]. / Valutazione ecografica intra-operatoria del peso tiroideo residuo nelle tiroidectomie per gozzo tossico diffuso.

The amount of thyroid tissue to be ablated in unresponsive Basedow disease has mainly, until now, been empirically evaluated. An attempt has been made, using intraoperative ultrasonography, to evaluate the residual tissue. This method allows weight calculation of the thyroid lobe to be ablated through two sonographic measurements of the superior pole axes. This technique provides a precise codification of the intervention and reduces the incidence of recurrence. The results six months after operation prove just two cases of latent hypothyroidism (10%).

[Complications in a patient with a jejuno-peritoneal shunt by the Le Veen technique]. / Complicanza in un paziente portatore di shunt peritoneo-giugulare secondo Le Veen.

The case of a patient, who, 3 months after application of a Le Veen shunt for a refractory ascites, underwent the pleural effusion of ascitic fluid is reported. The adoption of a scintigraphic diagnostic technique allowed the demonstration of a direct ascitic fluid passage from the peritoneal to the pleural cavity and the subsequent successful pleurodesis, performed using an application of local tetracycline.

[Peripheral pulmonary neoplasms: combined imaging (computerized tomography, ultrasonography, magnetic resonance) in the evaluation of chest wall involvement]. / Neoplasie polmonari periferiche: imaging integrato (tomografia computerizzata, ecografia, risonanza magnetica) nella valutazione del coinvolgimento parietale.

Chest wall involvement by a peripheral lung neoplasm, found in 4-8% of the cases, makes a difference in both staging and surgical approach. In the evaluation of the regional extent of the tumor, the radiologist must give the surgeon as much information as possible about relationships between lung neoplasm and chest wall structures, to correctly evaluate stage-T2 cancers and differentiate them from stage-T3 cancers. The authors report the results of a study made to assess the value of Computed Tomography (CT), ultrasonography (US) and Magnetic Resonance Imaging (MRI) to define chest wall invasion by a peripheral bronchogenic carcinoma. To this purpose 25 patients with primary peripheral lung neoplasm were studied with CT, US and MRI and the results were compared with surgical findings by means of TNM classification. Overall sensitivity and specificity were 68% and 74% for CT, 74% and 72% for US and 88% and 86% for MRI, respectively. CT, which still plays the major role in staging lung cancer, seems to get the worst results because of its impossibility to differentiate the cancers adjoining the chest wall from those showing signs of initial invasion. In these cases the use of the other imaging techniques (US, MRI) depends on their availability and on the specific experience of the radiologist.

[The use of magnetic tracers in hemodynamics. A proposed model study]. / L'uso dei tracciati magnetici in emodinamica. Proposta di un modello di studio.

Velocity of blood flow is critical in specific clinical situations. Available non invasive blood velocimeters gives only qualitative informations; quantitative estimates can be obtained invasively. We investigated the possibility of estimating the velocity of fluids using magnetic tracer. A model for the laminar blood flow inside a vessel was developed. A biomagnetometer was used to measure the fluid tracer velocity. The experimental setup was designed to mimic blood flow. A PVC tube simulated the vessel. The tube was connected to a bottle of normal saline. The tracer injection took place 25 cm distal to the saline bottle. The system was calibrated to a constant flow velocity of about 1 cm/s. A paramagnetic fluid (Magnevist, Schering, Berlin) was adopted as a tracer. In each session an amount of 2 cm3 was injected into the tube within 5 seconds. The recording equipment consisted of a second order gradiometer (baseline 7 cm, pick-up coil diameter 1.5 cm) coupled to a rfSQUID magnetometer. The recording bandwidth was dc-3 Hz, the sampling rate 32 Hz with 12 bit digitalization. The biomagnetic system was positioned immediately above the tube 55 cm away from the injection site. The total recording time for each session was 240 seconds. The injection of the tracer took place 60 seconds after the beginning of the data acquisition. Five measuring sessions in the earth magnetic field were performed at first and showed a low signal-to-noise ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of so-called Poland's syndrome]. / Su un caso di cosiddetta sindrome di Poland.

Pathogenesis, morphology and different associated abnormalities in the so-called Poland syndrome are considered. The surgical treatment adopted in the case recently observed is discussed. In most cases an isolated muscular and breast hypoplasia or aplasia is present so that surgery has the only intent to solve the esthetic problem.

Idiopathic biliary ductopenia in adults: a report of five cases.

The clinical and pathological findings of five adult cases of idiopathic nonsyndromatic paucity of interlobular bile ducts are reported. Patients were 18-32 years old at the onset of the disease; four presented with pruritus and/or jaundice and one with bleeding of the esophageal varices. Two patients were siblings. Serum alkaline phosphatase counts ranged from 1 to 16 times the upper normal value, and total bilirubin counts ranged from 0.6 to 8.8 mg/dL (10 to 150 mumol/L). Initial liver biopsy showed portal and periportal fibrosis with cholangiolar proliferation and reduction in the number of interlobular bile ducts. Antimitochondrial antibodies were absent, and bile ducts were normal after opacification. The patients were observed for 3-11 years. Repeated liver biopsies in the five patients showed progression of the lesions, with development of biliary type cirrhosis in four. Two of the four patients with cirrhosis died of hepatic failure 3 and 11 years after onset of the disease. In the two other cases, liver transplantation was performed successfully. These cases suggest that chronic cholestasis with marked ductopenia resembling the nonsyndromatic paucity described in infancy and childhood may reveal itself at an adult age. This disorder, possibly familial, may rapidly progress to severe and even fatal liver disease and could be a new indication for liver transplantation.

Dexamethasone inhibits alpha-fetoprotein gene transcription in neonatal rat liver and isolated nuclei.

The effect of dexamethasone on rat alpha-fetoprotein (AFP) expression has been further examined. Quantitation of serum AFP levels from newborns treated with dexamethasone showed a dose-response relationship between the quantity of dexamethasone administered and the reduction in AFP serum level. RNA blots, utilizing cloned AFP cDNA as probe, showed a marked reduction in AFP mRNA in dexamethasone treated livers. The extent of AFP mRNA depletion was correlated with dexamethasone dosage. The effect of dexamethasone on AFP mRNA concentration was relatively rapid; a substantial reduction occurred 12 hours after a single injection. The effect of dexamethasone appeared to be irreversible as hormone withdrawal did not cause AFP mRNA levels to rise. One putative AFP nuclear RNA precursor was identified which rapidly disappeared following dexamethasone treatment. AFP mRNA synthesis was also diminished in nuclei transcribed in vitro. The direct inhibitory effect of glucocorticoid hormone on AFP gene transcription was demonstrated in a reconstituted cell-free nuclear system.