ABSTRACT
BACKGROUND: The present article reports the updated survival outcome of the 200 patients enrolled in the Southern Italy Cooperative Oncology Group 9908 trial, which compared 12 weekly cycles of cisplatin-epirubicin-paclitaxel (PET) with 4 triweekly (once every 3 weeks) cycles of epirubicin-paclitaxel (ET) in patients with locally advanced breast cancer (LABC). METHODS: The effects of treatment, pathologically documented response (pathological response), pre- and post-treatment biomarkers on relapse-free survival (RFS), distant metastasis-free survival (DMFS), and overall survival (OS) are analysed. RESULTS: At a median follow-up of 74 (range 48-105 months) months, the 5-year RFS, DMFS, and OS were 64 % versus 53% (P = 0.11), 73% versus 55% (P = 0.04), and 82% versus 69% (P = 0.07) in PET and ET, respectively. At multivariate analysis, after adjusting treatment effect for pretreatment biomarkers, PET independently predicted better DMFS (P = 0.018) and OS (P = 0.03), whereas the impact on RFS was of borderline significance (0.057). PET treatment was significantly better than ET treatment only in high-grade or highly proliferating tumours. The better outcome in PET arm was the results of both the higher rate of patients with optimal pathological response and the lower rate of patients with biologically aggressive residual tumour. CONCLUSIONS: The PET weekly regimen significantly improves both DMFS and OS in LABC patients, compared with the triweekly ET combination. The therapeutic advantage is limited to patients with highly aggressive tumours.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , Carcinoma/diagnosis , Carcinoma/drug therapy , Adult , Aged , Algorithms , Breast Neoplasms/mortality , Breast Neoplasms/surgery , Carcinoma/mortality , Carcinoma/surgery , Cisplatin/administration & dosage , Combined Modality Therapy , Disease Progression , Drug Administration Schedule , Epirubicin/administration & dosage , Etoposide/administration & dosage , Female , Follow-Up Studies , Humans , Italy , Middle Aged , Paclitaxel/administration & dosage , Preoperative Care , Taxoids/administration & dosageABSTRACT
BACKGROUND: Mean platelet volume (MPV) is arousing increasing interest as a new independent cardiovascular risk factor. AIM: To provide a comprehensive review on the biological significance, the main determinants and the prognostic implications of MPV. METHODS: A literature search was performed using key terms, such as 'MPV' or 'mean platelet volume', together with 'stroke', 'myocardial infarction' and 'diabetes and 'obesity'. RESULTS: Large platelets are likely more reactive: elevated MPV values are associated with a shortened bleeding time and increased thromboxane B2 plasma levels. Thus, MPV could be considered an indicator of platelet function. Platelet size is mainly determined in the bone marrow during megakaryocytopoiesis, and subsequently does not substantially change. MPV is only partially regulated by thrombopoietin: in fact, growth factors and cytokines may also elicit the production of larger and more reactive platelets in the bone marrow, in the presence of conditions capable of increasing their concentrations, such as obesity, endothelial dysfunction and possibly myocardial and cerebral ischaemia. This phenomenon could play an important role in vascular diseases. In fact MPV is predictive of stroke, acute myocardial infarction (AMI) and restenosis of coronary angioplasty, is increased in the presence of obesity, diabetes mellitus, metabolic syndrome, AMI and stroke and has been shown to have a prognostic significance in patients with stroke and AMI. CONCLUSION: In assessing whole blood count, MPV should not be undervalued, as its increase should suggest a careful assessment of cardiovascular risk.
Subject(s)
Blood Platelet Disorders/complications , Blood Platelets/pathology , Cardiovascular Diseases/etiology , Arteriosclerosis/etiology , Arteriosclerosis/pathology , Blood Platelet Disorders/pathology , Cardiovascular Diseases/pathology , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/pathology , Diabetic Angiopathies/etiology , Diabetic Angiopathies/pathology , Humans , Obesity/etiology , Obesity/pathology , Platelet Aggregation Inhibitors/adverse effects , Risk FactorsABSTRACT
Osteoporosis is the most common cause of vertebral collapse, which significantly impairs mobility and quality of life. Primary management consists of conservative therapeutic measures such as analgesics, bed rest, external bracing and rehabilitation. Percutaneous vertebroplasty for the treatment of osteoporotic compressive fractures has gained popularity during the last decade. The limited invasiveness and encouraging results of vertebroplasty obtained in the treatment of patients with symptomatic osteoporotic compression fractures have favored an extensive use of the procedure for the management of patients with disabling pain refractory to conservative therapy. In the present paper, the authors provide procedure results and functional outcomes in a series of 175 consecutive patients with 242 symptomatic osteoporotic vertebral compression fractures treated by means of percutaneous polymethylmethacrylate vertebroplasty.
Subject(s)
Orthopedic Procedures/methods , Osteoporosis/complications , Spinal Fractures/etiology , Spinal Fractures/surgery , Aged , Aged, 80 and over , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/injuries , Female , Fractures, Compression/diagnostic imaging , Fractures, Compression/surgery , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/injuries , Male , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Orthopedic Procedures/adverse effects , Polymethyl Methacrylate , Retrospective Studies , Spinal Fractures/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/injuries , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Carpal tunnel syndrome is the most common peripheral neuropathy. Conventional carpal tunnel surgery has been performed as a primary procedure for the decompression of the median nerve at the wrist in patients who have idiopathic carpal tunnel syndrome. While the results have been excellent, this surgical procedure has been reported to be related to high postoperative morbidity and extended length of recovery time. Over the past decade, endoscopic release of the transverse carpal ligament has been developed as a new, alternative method to the open procedures. Endoscopic carpal tunnel release has been reported to ensure less postoperative morbidity, more rapid recovery of strength, with earlier return to work, reduced disability time and a better cosmetic result. The authors present a surgical series of 200 hands in 164 patients (36 bilaterals) with idiopathic carpal tunnel syndrome, who underwent a single-portal endoscopic carpal tunnel release (Agee technique), with regards to the clinical outcome and complications occurred after 4-months follow-up.
Subject(s)
Carpal Tunnel Syndrome/pathology , Carpal Tunnel Syndrome/surgery , Endoscopy/adverse effects , Intraoperative Complications , Postoperative Complications , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Reproducibility of Results , Retrospective Studies , Time FactorsABSTRACT
AIM: The authors report their experience on the paravertebral retropleuric microsurgery approach to the treatment of thoracic disc herniation. The paper describes both the approach and its result and it further expands on the reason behind the few cases of unsatisfactory results. METHODS: Twenty-three patients were operated upon for thoracic disc herniation between 1994 and 2000. The paravertebral retropleuric microsurgery approach was used in each. RESULTS: The results were very satisfactory in 20 cases, with all symptoms completely disappearing. In only 3 cases we had unsatisfactory results. CONCLUSION: We think that the postero-lateral retropleuric approach is a correct method for the treatment of thoracic disc herniation because it did not cause any significant bone intervention.
Subject(s)
Intervertebral Disc Displacement/surgery , Microsurgery , Thoracic Vertebrae/surgery , Adolescent , Adult , Aged , Female , Humans , Intervertebral Disc Displacement/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Radiography , Thoracic Vertebrae/diagnostic imaging , Treatment OutcomeABSTRACT
In the present review we report a case of a 53-year-old woman affected with a cyst solitary cerebral hemispheric lesion causing acute generalized seizure. Clinical and neuroradiologic diagnosis of cystic astrocytoma was performed and the patient was operated. Microscopic analysis of the surgical specimen led to a diagnosis of parasitic infection, consistent with neurocysticercosis (NCC). NCC is the most frequent parasitosis of the central nervous system (CNS) in the world. The infective agent is taenia solium larvae. It is endemic in Latin America, Africa and some Asiatic countries, such as India. In Europe, many cases have been reported in Portugal, Spain, Poland and Romania. In Italy NCC is a rare disease. In recent years no cases have been described, but with high rate of immigration from endemic areas (Africa and East Europe) this parasitosis will be found in our country too, particularly affecting communities where hygienic conditions are poor. In conclusion we briefly analyze the relationship between pathogenesis of this parasitosis and its clinical symptoms.
Subject(s)
Cerebral Cortex/pathology , Cerebral Cortex/parasitology , Neurocysticercosis/pathology , Female , Humans , Italy , Magnetic Resonance Imaging , Middle Aged , Seizures/parasitology , Seizures/pathology , Tomography, X-Ray ComputedABSTRACT
A 16-year-old boy presented with a four-month history of polyuria-polydipsia and a diplopia which had reverted after treatment. The neuroimaging studies performed had been strongly suggestive of an optic nerve glioma, while endocrinological investigation (beta-hCG 420 IU/L) has lead to the correct diagnosis later confirmed at the immunohystochemical analysis performed at biopsy. The high serum level of hCG was unaffected by bromocriptine nor octreotide, while the PRL level (80.0 microg/L) was reduced only by bromocriptine. Among the several tumor markers which may be secreted by such lesions, ours is the first reported case of an elevation of serum LDH for a primary intracranial germinoma. Moreover, the elevated value of serum leptin reported by us might be due to the insensitivity of the hypothalamic structures to endogenous leptin.
Subject(s)
Brain Neoplasms/diagnosis , Diabetes Insipidus/etiology , Germinoma/diagnosis , L-Lactate Dehydrogenase/blood , Proteins/metabolism , Adolescent , Brain Neoplasms/blood , Brain Neoplasms/complications , Bromocriptine/therapeutic use , Chorionic Gonadotropin, beta Subunit, Human/blood , Germinoma/blood , Germinoma/complications , Gonadotropin-Releasing Hormone , Humans , Leptin , Male , Prolactin/blood , Thyrotropin-Releasing HormoneABSTRACT
A case of encapsulated intracerebral hematoma is described in the light of the relevant literature. The etiopathogenesis, diagnostic problems and treatment of this rare entity are also discussed.
Subject(s)
Cerebral Hemorrhage , Hematoma , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/surgery , Female , Hematoma/diagnosis , Hematoma/surgery , Humans , Middle Aged , Tomography, X-Ray ComputedABSTRACT
An atypical case of post-traumatic syringomyelia is reported. Clinical presentation, electrophysiological and MR findings, as well as therapeutic efforts adopted for this case are discussed in the light of pertinent literature.
Subject(s)
Cervical Vertebrae/injuries , Spinal Cord Injuries/complications , Spinal Fractures/complications , Syringomyelia/etiology , Humans , Male , Middle Aged , Syringomyelia/diagnosis , Syringomyelia/surgery , Time FactorsABSTRACT
METHODS: During the period from January 1986 to December 1994, 187 consecutive patients (102 males and 85 females, between the ages of 24 and 63 years) with soft disc herniations of the cervical spine were operated on by anterior approach. RESULTS: One hundred and twenty-seven (67.9%) patients presented pure radicular syndrome, 17 (9.1%) with pure medullary syndrome, and 43 (23%) with myeloradiculopathy. Disc herniation was at the C3/4 level in 8 (4.3%) cases, at the C4/5 level in 17 (9.1%) cases, at the C5/6 level in 101 (54%) cases, and at the C6/7 level in 87 (46.6%) cases. In 18 (30%) patients suffering from myelopathy (with or without radiculopathy) an area of high MR signal intensity was observed within the cervical cord on T2-weighted images; such area corresponded at the level of cord compression by the herniated disc and was not demonstrated on T1-weighted images. All patients underwent microdiscectomy without bone grafting. Complete or almost complete relief of preoperative symptomatology was observed in 95.6% of patients with radiculopathy and in 83.3% of those with myelopathy.
Subject(s)
Cervical Vertebrae/surgery , Diskectomy , Intervertebral Disc Displacement/surgery , Adult , Female , Humans , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/diagnosis , Magnetic Resonance Imaging , Male , Microsurgery , Middle Aged , Nerve Compression Syndromes/etiology , Postoperative Complications , Spinal Cord Compression/etiology , Spinal Nerve Roots , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A 65-year-old man experienced an ictal episode. CT revealed a left capsulo-thalamic mass, and SPET showed hypoperfusion of the left cerebral emisphere. The lesion was subtotally removed, and postoperative radiotherapy was given. Pathological examination demonstrated an "atypical" pleomorphic xanthoastrocytoma. The patient died of massive regrowth of the tumor 22 months after surgery. This case is discussed in light of the pertinent literature.
Subject(s)
Astrocytoma/surgery , Brain Neoplasms/surgery , Aged , Astrocytoma/diagnosis , Astrocytoma/pathology , Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Humans , Male , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The literature on pure traumatic disc herniation is now voluminous but diversity of opinion exists regarding frequency, pathogenesis and management of this type of lesion. As a further contribution to the solution of the question it is thus justified to report our series of cervical traumatic disc herniation. METHODS: During the period from January 1986 to December 1994, 41 patients (25 males and 16 females, between the ages of 24 and 51 years) with traumatic cervical disc herniations were operated on by anterior approach. Twenty-six (63.4%) patients presented with radicular syndrome, 3 (7.3%) with medullary symptoms and signs, and 12 (29.3%) with myeloradiculopathy. Disc herniation was at the C3/4 level in 4 (9.7%) cases, at the C4/5 level in 7 (17.1%) cases, at the C5/6 level in 24 (58.5%) cases, and at the C6/7 level in 8 (19.5%) cases. In 6 (40%) patients suffering from myelopathy (with or without radiculopathy) an area of high MR signal intensity was observed within the cervical cord on T2-weighted images; such area corresponded at the level of cord compression by disc and was not demonstrated on T1-weighted images. All patients underwent discectomy without bone grafting. RESULTS: Among patients with radiculopathy, 27 (71%) experienced complete relief of preoperative symptomatology, and 11 (29%) minor pain and/or neurological deficits without interference with work activities. The myelopathy completely disappeared in 11 (73.3%) cases whereas remained unchanged in 3 (20%); 1 patient with myelopathy experienced amelioration of preoperative specific symptoms and signs. CONCLUSIONS: The results of surgery for cervical radiculopathy due to traumatic disc herniation are satisfactory since 92 to 100% of the patients postoperatively regain prior activities, an observation we have confirmed with our own series. The results in cases of myelopathy are less satisfactory: although approximately 73% of our patients with myelopathy reported total relief of preoperative symptomatology, published reports indicate that a significant postoperative improvement is seen in 33 to 56% of patients.
Subject(s)
Cervical Vertebrae/injuries , Intervertebral Disc Displacement/pathology , Peripheral Nervous System Diseases/etiology , Spinal Cord Diseases/etiology , Spinal Nerve Roots/pathology , Adult , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/pathology , Cervical Vertebrae/surgery , Female , Humans , Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/surgery , Magnetic Resonance Imaging , Male , Middle Aged , Orthotic Devices , Radiography , Spinal Cord Diseases/pathology , Treatment Outcome , Wounds and Injuries/complicationsABSTRACT
The authors present their series of intracranial epidermoid and dermoid cysts. Clinical, radiological and anatomopathological features of these tumors are analyzed. Appropriate surgical treatment and results are discussed in light of the pertinent literature.
Subject(s)
Brain Diseases/surgery , Brain Neoplasms/surgery , Dermoid Cyst/surgery , Epidermal Cyst/surgery , Frontal Lobe , Temporal Lobe , Adolescent , Adult , Brain Diseases/diagnosis , Brain Neoplasms/diagnosis , Dermoid Cyst/diagnosis , Epidermal Cyst/diagnosis , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Time FactorsABSTRACT
The authors analyze possibilities and limitations of surgery in the treatment of frontal lobe tumors. They also stress the importance of microtechnique and propose notes of operative management.
Subject(s)
Brain Neoplasms/surgery , Frontal Lobe/surgery , Brain Neoplasms/blood supply , Brain Neoplasms/physiopathology , Frontal Lobe/anatomy & histology , Frontal Lobe/physiology , Humans , Microsurgery , Postoperative ComplicationsABSTRACT
Between 1988 and 1994, 101 patients with carpal tunnel syndrome underwent microsurgical treatment. In 69 (68.3%) patients, simple incision of the transverse carpal ligament was performed. The remaining 32 (31.7%) patients also required neurolysis: external neurolysis in 17 (16.8%) patients, both external and internal neurolysis in 15 (14.9%) patients. There were no intra- and postoperative complications. After surgery, preoperative symptoms completely disappeared in 98 (97.1%) patients and improved in 3 (2.9%).
Subject(s)
Carpal Tunnel Syndrome/surgery , Microsurgery/methods , Adult , Aged , Chronic Disease , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Male , Middle AgedABSTRACT
Four cases of pleomorphic xanthoastrocytoma (PXA) were collected from among 688 glioma patients who underwent operation at the Institute of Neurosurgery, University of Naples "Federico II" between January 1973 and December 1994. Three were females and one male, ranging in age from 10 months to 65 years. Three tumors were superficial in location, appearing as a meningo-cerebral mass in the temporo-parietal region. In one case, the tumor was situated deep within the brain (capsulo-thalamic region), without contact with leptomeninges. Three patients had experienced epileptic seizures, whereas one patient presented with an ictal episode. Tumor excision was grossly total in two cases, and subtotal in the remaining two. In three cases, histological examination demonstrated a "typical" PXA; conversely one tumor (subtotal excised) was an "atypical" PXA. The two patients with incomplete surgical resection were postoperatively treated with fractionated brain radiation therapy. Of the two patients who had grossly total removals, one showed tumor recurrence 6 years after surgery, and underwent operation (the recurrent neoplasm did not exhibit malignant transformation); the second patient was free of tumor at 14 months following craniotomy. Of the two patients who had undergone subtotal removals, one died because of massive regrowth of the lesion 22 months after surgery, whereas the second patient was asymptomatic at 1 year follow up.
Subject(s)
Astrocytoma/surgery , Brain Neoplasms/surgery , Adolescent , Aged , Astrocytoma/diagnosis , Astrocytoma/pathology , Astrocytoma/radiotherapy , Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Brain Neoplasms/radiotherapy , Cerebral Cortex/pathology , Cerebral Cortex/surgery , Child, Preschool , Combined Modality Therapy , Cranial Irradiation , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/radiotherapy , Neoplasm Recurrence, Local/surgery , Prognosis , Radiotherapy, Adjuvant , Thalamic Diseases/diagnosis , Thalamic Diseases/pathology , Thalamic Diseases/radiotherapy , Thalamic Diseases/surgery , Thalamus/pathology , Thalamus/surgeryABSTRACT
Twenty-one right-handed patients with cerebral expanding space-occupying lesion underwent neuropsychological evaluation before surgery. Testing included the Bender Motor Gestalt Test (BMGT), the Benton Visual Retention Test (BVRT), and four subtests of the Wechsler Adult Intelligence Scale (WAIS), namely Digit span, Digit symbol, Picture completion, and Block design. Statistical analysis showed significant differences in cognitive efficiency between the groups defined by the side and biological behaviour of the lesions.
Subject(s)
Brain Neoplasms/complications , Brain Neoplasms/pathology , Brain/pathology , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Neuropsychological Tests , Adolescent , Adult , Brain/physiopathology , Cognition Disorders/physiopathology , Female , Functional Laterality , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Two cases of the rare cellular variant of the solitary capillary haemangioblastoma are reported. On MR study both tumors appeared as cerebellar contrast-enhancing masses, without evidence of intra- or perilesional blood vessels. Histologically, they showed compact groups of polygonal or rectangular cells separated by compressed small capillaries. There were no reticulin fibres among cell clusters. The stromal cells were found to be immunopositive for neuron-specific enolase (NSE), factor VIII-related antigen (von Wille-brand factor), Ulex europaeus lectin, and glial frillary acidic protein (GFAP). The findings are discussed in light of the pertinent literature.
Subject(s)
Biomarkers, Tumor/analysis , Cerebellar Neoplasms/pathology , Hemangioblastoma/pathology , Magnetic Resonance Imaging , Neoplasm Proteins/analysis , Receptors, Cell Surface , Aged , Cerebellar Neoplasms/chemistry , Cerebellar Neoplasms/diagnosis , Contrast Media , Gadolinium DTPA , Glial Fibrillary Acidic Protein/analysis , Hemangioblastoma/chemistry , Hemangioblastoma/diagnosis , Humans , Male , Middle Aged , Nerve Tissue Proteins/analysis , Organometallic Compounds , Pentetic Acid/analogs & derivatives , Phosphopyruvate Hydratase/analysis , Receptors, Mitogen/analysis , von Willebrand Factor/analysisABSTRACT
A clinical study on functions of the cerebral cortex is reported. In this regard, 107 patients with a supratentorial expanding mass have been investigated before and after surgical removal of the lesion. The results obtained are discussed in the light of what is available in the literature.
Subject(s)
Brain Neoplasms/physiopathology , Cerebellar Neoplasms/diagnosis , Cerebral Cortex/physiopathology , Dominance, Cerebral , Adult , Aged , Astrocytoma/diagnosis , Astrocytoma/surgery , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Cerebellar Neoplasms/physiopathology , Cerebellar Neoplasms/surgery , Cerebral Cortex/pathology , Cerebral Cortex/surgery , Dura Mater/physiopathology , Dura Mater/surgery , Female , Follow-Up Studies , Glioma/diagnosis , Glioma/surgery , Humans , Male , Meningioma/diagnosis , Meningioma/surgery , Middle Aged , Oligodendroglioma/diagnosis , Oligodendroglioma/surgery , Postoperative PeriodABSTRACT
Five patients with supratentorial dermoid cysts who were surgically treated are presented. There were three males and two females, between the ages of 17 and 35 years (mean 26.6 years). The tumor location was frontobasal and/or temporobasal. The duration of illness before the diagnosis ranged from 1 to 14 months (mean 7.4 months). Clinical presentation included seizures, intracranial hypertension syndrome, aseptic meningitis, homonimous lateral hemianopsia, and memory defect. Preoperatively, all patients were investigated by computerized tomography (CT); in two cases, magnetic resonance (MR) imaging was also obtained. Tumor removal was performed by microsurgical procedures; it was total in 3 cases and subtotal in the remaining 2 cases. Histologically, all of the tumors exhibited the typical dermoid cyst pattern. There were no operative deaths. Two patients experienced postoperative language dysfunction and/or hemiparesis. No patient developed clinicoradiological evidence of tumor recurrence at 1 to 10 years (mean 5 years) following surgery. These results are discussed in light of the data previously reported by the literature.