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1.
Eur J Surg Oncol ; 27(2): 125-34, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11289746

ABSTRACT

Peritoneal carcinomatosis and sarcomatosis (PCS) are short-term fatal conditions amenable only to palliative treatment. They are generally considered as a systemic disease at clinical presentation, and are resistant to standard treatments. However, there may be in the natural history a phase of loco-regional tumour spread during which the tumour may still be curable. Surgical treatment alone, or in combination with systemic chemotherapy, has yielded poor results in terms of survival and quality of life. One approach is cytoreductive surgery (CS) combined with the intraperitoneal administration of antiblastic agents. This may diminish any residual tumour following macroscopic excision and may overcome the pharmacokinetic limits of systemic chemotherapy. A further improvement in this multimodal approach may be achieved by the use of hyperthermic intraperitoneal intraoperative chemotherapy (HIIC). Results so far have been encouraging. However, series reported in the literature are relatively small and heterogeneous, and clinical and technical factors which include the selection of patients, optimal drugs dosage and temperature, evaluation of outcome and costs are still under discussion.


Subject(s)
Carcinoma/therapy , Peritoneal Neoplasms/therapy , Sarcoma/therapy , Antineoplastic Agents/adverse effects , Antineoplastic Agents/therapeutic use , Carcinoma/diagnostic imaging , Carcinoma/mortality , Humans , Hyperthermia, Induced , Neoadjuvant Therapy , Peritoneal Neoplasms/diagnostic imaging , Peritoneal Neoplasms/mortality , Quality of Life , Radiography , Sarcoma/diagnostic imaging , Sarcoma/mortality , Survival Rate
2.
Tumori ; 86(4): 339-40, 2000.
Article in English | MEDLINE | ID: mdl-11016722

ABSTRACT

The role of the patent blue dye (PBD) technique and intraoperative probe-guided lymphoscintigraphy (LS) in detecting the sentinel node (SN) was investigated in a group of 130 consecutive stage I cutaneous melanoma patients. The preoperative workup included high-resolution US scanning and LS performed 15-18 hours before surgery. On the basis of preoperative LS, in the group of examined patients a total of 143 lymphatic drainage basins were identified and surgically explored: 41.6% in the axilla, 52.8% in the groin, and 5.6% in the head/neck. A total of 228 SNs were intraoperatively detected and removed; 110 lymphatic basins contained histologically negative SNs, while 33 basins had metastatic SNs. The sensitivity for SN detection using PBD alone was 93%, while it was 100% when PBD was combined with intraoperative LS. Preoperative and intraoperative LS appears to be a highly sensitive technique for SN detection in cutaneous melanoma patients. Furthermore, in view of the limited skin incision when radioguided surgery is performed, SN biopsy could be feasible under local anesthesia.


Subject(s)
Lymph Nodes/pathology , Lymph Nodes/surgery , Melanoma/pathology , Melanoma/surgery , Sentinel Lymph Node Biopsy/methods , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Adolescent , Adult , Aged , Coloring Agents , Female , Humans , Lymph Node Excision , Lymphatic Metastasis , Male , Middle Aged , Rosaniline Dyes , Sensitivity and Specificity
3.
Eur J Cancer ; 36(7): 895-900, 2000 May.
Article in English | MEDLINE | ID: mdl-10785595

ABSTRACT

1.5 mm and in all cases with two metastatic SNs, further positive additional nodes were found. The mean counts per 10 s (CP10S) ratio for SN and non-SN values was 5.62 (1.29-23.51) and 3.09 (1.03-10.99) in the intra-operative and extra-operative phases, respectively. US scanning and preoperative lymphoscintigraphy associated with PBD allows preoperative patient selection and accurate SN(s) identification. Breslow thickness and the number of metastatic SN(s), but not their type, are correlated with disease spread; CP10S contributed to the differentiation amongst the nodes and the determining of procedure's completion.


Subject(s)
Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Melanoma/diagnostic imaging , Melanoma/pathology , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/pathology , Adolescent , Adult , Aged , Biopsy , Follow-Up Studies , Humans , Middle Aged , Preoperative Care/methods , Survival Rate , Ultrasonography, Interventional/methods
4.
World J Surg ; 23(2): 197-201, 1999 Feb.
Article in English | MEDLINE | ID: mdl-9880432

ABSTRACT

Based on the premise that optimal drug delivery might improve the efficacy of locoregional treatment for solid tumors, the authors set up an experimental model for isolation perfusion in surgical specimens from patients resected for carcinoma of the colon. Ten surgical specimens were cannulated, washed internally and externally with saline solution, promptly cooled to 4 degreesC, connected to a circuit, and perfused with Krebs-Henselait modified solution, concentrated red blood cells, albumin, desamethasone, glucose, and heparin for 60 minutes at a target temperature of 37 degreesC. Organ temperature, flow rate, perfusion pressure, and metabolic and functional parameters were checked at 5, 20, and 60 minutes of perfusion. A paraphysiologic perfusion procedure was achieved. Mean values (and ranges) were as follows: temperature 37 degreesC (35. 1-39.6 degreesC); flow rate 10.2 (5.6-17.9) ml/min/100 g; arterial pressure 96 (42-154) mmHg; arterial pH 7.3 (7.1-7.5); arterial PO2 183 (78-304) mmHg; arterial PCO2 36 (31-46) mmHg. No important signs of tissue damage were found at histology. Autonomous or stimulated peristalsis (or both) was present throughout the experiment. Mean O2 extraction was 7.9 ml/min/100 g (range 3.1-11.0). Mean glucose consumption was 229 mg/100 g (range 174-252). The model worked well and appears promising, particularly for future use in various pharmacokinetic and pharmacodynamic studies of antiblastic agents.


Subject(s)
Adenocarcinoma/pathology , Colonic Neoplasms/pathology , Adenocarcinoma/metabolism , Adenocarcinoma/physiopathology , Albumins/administration & dosage , Anticoagulants/administration & dosage , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/pharmacokinetics , Antineoplastic Agents/pharmacology , Blood Pressure/physiology , Chemotherapy, Cancer, Regional Perfusion , Colonic Neoplasms/metabolism , Colonic Neoplasms/physiopathology , Cryopreservation , Culture Techniques , Dexamethasone/administration & dosage , Drug Delivery Systems , Erythrocyte Transfusion , Feasibility Studies , Glucocorticoids/administration & dosage , Glucose/administration & dosage , Glucose/metabolism , Heparin/administration & dosage , Humans , Organ Preservation Solutions/administration & dosage , Oxygen/blood , Oxygen Consumption/physiology , Perfusion , Peristalsis/physiology , Regional Blood Flow/physiology , Temperature , Time Factors , Tromethamine/administration & dosage
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