Merkel cell carcinoma of the skin. Treatment of primary, recurrent, and metastatic disease: review of clinical cases.

The clinical features of 10 cases with the adjunct of a literature review of primary neuroendocrine carcinoma of the skin (Merkel cell tumor) are reported. This cancer arises in the dermis and subcutaneous tissue of elderly individuals. Natural history is characterized by local recurrences (40%), regional lymph-nodes metastases (50%), and distant metastases (60%). Surgery is the elective treatment of primary and locoregional disease and subsequent radiotherapy prevents local recurrences and prolong disease-free survival in literature reports. Chemotherapy and radiotherary resulted in only a short-term palliative response in the metastatic setting.

Simulation of soft-tissue tumor excisions: a multimodal interactive approach.

Total 3-D reconstruction of the tumor size, shape, and relations with surrounding structures using CT, MRI, sonography, and angiography images can make simulated radical resection of soft-tissue sarcomas possible, thus sparing normal tissues. With our approach, starting from three MR images for a given patient, a new single image representation of all three parameters is generated by using two different techniques on a workstation in a standard UNIX and X-11 environment. The first one is a transformation linking together the MR parameters and the RGB (red, green, blue) color components. The second one is an unsupervised segmentation method based on a number of neural and fuzzy models. We can dinamically render and update a stereo display using field sequential presentation of left and right eye views on the monitor, with Cristal Eyes LCD shutter eyewear (StereoGraphics Inc., San Rafael, CA) to view it. As 3D locating tool, a 3D locating control system based on low-frequency magnetic fields (Polhemus Fastrak) has been chosen. Simulations of soft-tissues excisions may be performed in this interactive environment with augmented-reality modalities. All this, in our experience, has greatly facilitated the simulation of soft-tissue sarcoma excisions.

An "augmented-reality" aid for plastic and reconstructive surgeons.

Starting from MR and CT images for a given patient, a new single image representation of all parameters has been generated by using false-color techniques in a standard UNIX and X-11 environment. A transformation linking together the MR, CT parameters and the RGB (red, green, blue) color components has been used. Moreover an unsupervised segmentation method based on a number of neural and fuzzy models may directly produce segmented image volumes. Each image of the various sequences has been interactively displayed by using a specifically designed application. The resulting images have been displayed on a stereo monitor allowing the three-dimensional rendering of visual data through LCD shuttered glasses. Moreover, a 3-D control system based on low frequency magnetic fields has been used, while a bandheld Polhemus stylus could be used as an electronic knife for dissecting the 3-D data set and for defining flaps and grafts. Bone or soft-tissue contour can be analyzed, and sections can be removed from the model to allow a view of the underlying structures. Flaps and grafts obtained utilizing the above-reported techniques can be fitted exactly, without repeated removal and recarving. Nuances of depth, tapering, and arc are carved directly into the bone, while chances of asymmetry are markedly diminished. In this way, moreover, anesthetic times are reduced by more efficient utilization of operative time, which usually offsets the increased cost of imaging.

[Long-term central venous access in oncology. Review of a caseload of 750 cases]. / Accessi venosi centrali a lungo termine in oncologia. Revisione di una casistica relativa a 750 casi.

Totally implantable central venous accesses systems are presently widely used in cancer patients. Perioperative and long-term morbidity of 750 consecutive implants performed from 1985 to 1994 were retrospectively reviewed. Our Series consisted in 616 (82.1%). Ports and 134 (17.9%) external tunnelled catheters with subcutaneous Dacron cuff (Hickmann or similar catheters) implanted by percutaneous access route in local anesthesia. Subclavian vein was the elective access route in 700 (93.3%) patients while in the remaining 50 (6.7%) the access was performed in the femoral vein, due to peculiar clinical conditions. One-day surgery was only required for 19 (2.6%) patients while outpatient surgery was the routine in 731 (97.4%) patients. Perioperative morbidity was at all similar both for Port and external catheters Series (p > 0.07). Late morbidity requiring the removal of the device occurred in 27/134 patients (18.7%) and in 40/616 (6.5%) for external catheters and Port Series, respectively (p < 0.002). The rate of infection, 2.3% for ports (p < 0.002). Patient's compliance was higher for Ports compared to external catheters. Apart from peculiar clinical conditions such as hematologic cancers, bone marrow transplantation or short life expectancy, Ports seem to guarantee for a lower morbidity coupled with better long-term results.

Long-term femoral vein central venous access in cancer patients.

Subclavian percutaneous access with reservoir placement has been shown to be difficult or contraindicated in some patients. Of 465 cancer patients who required a port placement between January 1992 to January 1995, 41 (8.8%) had alternative percutaneous femoral access with a totally implantable port reservoir located in the abdomen because of the inaccessibility to subclavian or jugular veins and/or the presence of massive cutaneous metastases or severe radiodermitis in the upper part of the torso. Overall implant days was 9880, with an average of 241 days (range: 65-445). Ports were alternatively used for chemotherapy and nutritional purposes in 11 of 41 patients. Late morbidity causing the removal of the implanted ports was observed in two of 41 (4.9%) and 25 of 424 (5.9%) patients in the femoral and subclavian series, respectively (P = 0.86). The femoral percutaneous access for totally implantable port devices appears to be a safe alternative for cancer patients when subclavian and/or jugular vein catheterization and reservoir in the upper part of the torso is contraindicated.

Clinical application of a computerized diagnostic aid in the initial evaluation of 250 outpatients with gastrointestinal complaints.

The results of a prospective controlled study designed to evaluate the performance of a computerized diagnostic aid in the clinical setting are reported herein. Two hundred and fifty patients referred to an outpatient clinic for gastrointestinal complaints were entered into the study. The diagnostic aid program was used routinely and the findings elicited from patients' medical histories and physical examinations were entered into the computer at the time of initial evaluation. The accuracy of the program's diagnoses was measured and compared with the accuracy of diagnoses made by a control group of physicians. The overall diagnostic accuracy of the program was found to be 69.2% (P much less than .0000001), a value significantly greater (P = .0005) than the overall accuracy of the control group of physicians, which was found to be 52%. A high agreement rate between program and physicians was also observed. These preliminary results seem to indicate a practical use for the program as a support in the initial screening of patients presenting with gastrointestinal complaints.

Effects of pinaverium bromide on Oddi's sphincter.

Twelve to 15 days after cholecystectomy, endocholedochal pressure was measured in ten patients before and one hour after oral administration of 15 mg of pinaverium bromide (six patients) or placebo. The mean endocholedochal pressure was 7.1 +/- 0.25 mmHg before and 3.1 +/- 0.2 mmHg after pinaverium (P less than 0.01), and 7.0 +/- 0.2 and 6.8 +/- 1.2 mmHg in the placebo-treated patients. The results suggest that pinaverium bromide has a specific effect on the common bile duct and probably on Oddi's sphincter.