[Use of Valtrac in digestive surgery. Initial clinical experience]. / L'uso del Valtrac in chirurgia digestiva. Iniziale esperienza clinica.

Stapling instruments are being currently used for digestive or colorectal anastomoses with definite advantages. The authors report their initial clinical experience about BAR utilization to restore intestinal continuity after upper digestive and colorectal resections. The authors have been carried out 20 anastomoses on 18 patients: 11 males and 7 females. Eleven (61.1%) of them were affected with malignant neoplasms and in 9 cases were performed an urgency procedure. The colorectal and jejunal-jejunal anastomoses were performed, respectively, in 8 cases; gastric-jejunal and ileo-colic anastomoses, respectively, in 2. The satisfactory results obtained seem to demonstrate that the biofragmentable anastomotic ring constitutes a "safe" method of bowel junction of the whole digestive apparatus.

Primary tumor receptorial status and axillary metastases: their prognostic significance.

Data on the prognostic value of receptorial status are controversial. On the basis of our results, receptorial status has no significance as an independent role; only the number of involved nodes and hormonal therapy have this prognostic role. Free of disease survival curves according Kaplan and Meier show that there are no statistically significant differences either in patients with low neoplastic recurrences (pN0) or in those patients with high risk (pN1) among women with tumor ER+ and ER-. Among 291 pN0 patients there was no relation between receptorial status (negative from 3 to 9 fmol/mg) and results of therapy on the follow-up. Among 248 pN1 patients therapy with tamoxifen had an influence on free interval both in the group with a low receptorial status and in particular in that with high receptorial level; no effects of therapy on the ER- patients. In the group of 248 pN1 patients with high receptorial status, the therapy was more successful in the group with a medium lymph nodal risk (from 1 to 3 positive nodes) and also in the group with G1 or G2. With regard to the study of the relation between lymph nodal metastases and receptorial status, we can state that lymph nodal levels data gives the main prognostic factor of risk. Therefore lymphadenectomy involving the three lymph nodal levels appears to be the crucial point in diagnostic and therapeutic surgical strategy of breast carcinoma.

The influence of hormone receptors and hormonal adjuvant therapy on disease-free survival in breast cancer: a multifactorial analysis.

The prognostic value of estrogen (ER) and progesterone (PgR) receptor status and the influence of hormonal adjuvant therapy on disease-free survival (DFS) in breast cancer were evaluated in 680 women after radical and modified radical mastectomy. The effect of 17 variables, including clinical data, TNM, hormone receptor status, histology and adjuvant therapy, on the DFS observed was analyzed, using a multivariate proportional hazard model. Multifactorial analysis revealed that DFS was strongly related to the number of positive axillary nodes (P less than 0.001) and the histological grade of the tumor (P = 0.05). Moreover, the DFS of ER-positive patients with node involvement was significantly improved by hormonal adjuvant therapy (tamoxifen). Combination of adjuvant chemotherapy with hormonal therapy did not enhance its effectiveness. Recurrence rates of either node-negative or ER-negative patients were not affected by either adjuvant therapy. When no systemic therapy was given, no significant relationship between ER or PgR content of the tumor and the DFS was observed. These findings suggest that hormone receptor status is not an independent prognostic factor but provides reliable information on responsiveness to adjuvant hormonal therapy which is very effective in patients selected on the basis of ER assay.

The correlation between estrogen and progesterone receptors and some clinical and pathological features in human breast cancer.

The correlation between estrogen (ER) and progesterone (PgR) receptor status and some clinical and pathological features was evaluated in a series of 680 breast carcinomas. ER status was significantly related to age, menopause, histological grade and vascular invasion. No relationship was found with tumor size, lymph node involvement, histotype and multicentricity. PgR status was significantly related to vascular invasion only. Despite the relationship between ER and favorable pathological features, ER-positive patients did not show a longer disease-free interval after surgery when no systemic adjuvant therapy was administered. ER status is thus of little prognostic value.

The correlation between estrogen receptor status, axillary-node metastases and disease-free interval after surgery in primary breast cancer.

The prognostic value of estrogen receptor (ER) status in primary breast cancer was evaluated in 208 women subjected to Halsted radical mastectomy. The correlation between ER status, node involvement and disease-free interval after surgery was analyzed in detail. Forty-seven out of 127 ER-positive patients received hormonal adjuvant therapy, whereas the 81 ER-negative patients did not. Similar recurrence rates were found in ER-negative and untreated ER-positive patients, suggesting that the natural course of disease was not related to ER status. ER-positive patients who received hormonal adjuvant therapy showed a significantly longer disease-free interval than both ER-negative and untreated ER-positive patients, even though a higher frequency of node involvement was found in ER-positive tumors. Since only hormone-treated ER-positive patients showed a significantly lower recurrence rate, it is felt that ER status cannot be used as an independent prognostic factor.

[Methods of treatment of tumors of the soft parts and bones of the limbs and extremities. Analysis of case records]. / Modalità di trattamento dei tumori delle parti molli e delle ossa, degli arti e delle estremità. Analisi di una casistica.

218 patients examined for localized cancer of the extremities (50% benign, 50% malignant) are reported. The incidence is considered by sex and age. Demolition surgery was carried out in 35 patients and 27 locoregional treatment with antiblastics and radioactive isotopes was employed. Conservative surgery was used in 158. Operative mortality was less than 1% (2 cases out of 218) and did not reach 6% if amputations and disarticulations alone are considered. There were no deaths in cases submitted to radiochemotherapy and inguinocrural hymphadenectomy. The series includes a 15-years survival for giant-cell tumour of the femur treated with radioactive microsphores, an 11-years survival for a popliteal melanoma submitted to radiocolloid infiltration, a 9-year survival for femoral osteosarcoma for which hip disarticulation was carried out and a 4-year survival for a recurrent rhabdomyosarcoma of the hip operated by hemipelvectomy.

[Arterial chemotherapy of tumors. Considerations on 159 cases]. / Chemioterapia arteriosa dei tumori. Considerazioni su una casistica di 159 casi.

The results obtained in 153 patients suffering from advanced primary, residual, recurrent and metastatic cancers localized mainly in the cervico-cephalic district and in other sites (skin, extremities and pelvis, liver, thoracic wall, breast) in whom locoregional intraarterial chemotherapy was employed from 1967, are reported. In order of frequency, the commonest antiblastics used were Methotrexate, 5 FU, Vincristin and DITC. Long-term results show an average remission of 52% and mean survival of 11.4 months; these values are liable to wild fluctuations in relation to various factors such as site, development, state of regional lymph nodes, and any previous surgical, radiation or antiblastic therapy. Intraarterial treatment is found to have the best effect in cases of cancer which have not previously been subjected to any therapy at all, and which involve the cervico-cephalic districts, the liver and melanomas.