Molecular monitoring of minimal residual disease in patients in long-term complete remission after allogeneic stem cell transplantation for multiple myeloma.

In the present study, we used a polymerase chain reaction-based (PCR-based) strategy to retrospectively analyze the presence of residual myeloma cells in serial posttransplant bone marrow samples obtained from 13 patients in remission after allogeneic hemopoietic stem cell transplantation (allo SCT). For this purpose, patient-specific primers were generated from complementarity determining regions 2 and 3 of the rearranged IgH gene. The level of sensitivity of the PCR-based assay ranged from 1 in 10(5) to 1 in 10(6) normal marrow cells. Following transplantation, 9 of 12 patients who attained stringently defined complete remission (CR) remained persistently PCR(-) for a median of 36 months, and 4 of the patients remained PCR(-) up to the latest analysis, which was performed at 48, 72, 72, and 120 months, respectively, after allo SCT. None of the patients in the PCR(-) subgroup experienced a disease relapse, and only 1 of 4 PCR(+) patients experienced a relapse. It is concluded that allo SCT has the potential ability to induce sustained serological and molecular CR in selected patients with multiple myeloma.

Primary intestinal lymphoma: clinical and therapeutic features of 32 patients.

BACKGROUND AND OBJECTIVE: Lymphomas of the gastrointestinal tract are the most common type of primary extranodal lymphomas, accounting for 5 to 10% of all non-Hodgkin's lymphomas. In particular, primary intestinal lymphomas represent about 15-20% of gastrointestinal lymphomas. New multimodal therapeutic approaches have improved the prognosis of this once deadly disease: we report a retrospective analysis of our experience with 32 cases of primary western intestinal lymphomas, presenting clinical, therapeutical and prognostic data. PATIENTS AND METHODS: From March 1989 to November 1995, 32 patients with untreated primary western intestinal lymphomas were submitted to radical surgery plus polychemotherapy (early stages, I and II; 22 patients), or polychemotherapy alone (advanced stage, III and IV; 10 patients). The most frequent symptoms were abdominal pain, nausea, vomiting and weight loss. The tumor was located in the jejunum in 2 cases (6.2%), in the proximal small bowel in 15 cases (46.9%), in the distal and terminal ileum in 8 cases (25%), in the colon and rectum in 4 cases (12.5%), and multiple sites were found in 3 cases (9.4%). According to histology, 26 patients had high-grade and 6 low-grade non-Hodgkin's lymphoma. RESULTS: Stage I-II patients underwent radical resection of the tumor and chemotherapy; advanced (III-IV) stage patients were treated with chemotherapy alone as first-line approach. Of the 32 patients, 24 (75%) achieved a complete response (CR); according to stage, all stage I-II patients had CR, while only 2 of the 10 stage III-IV patients reached CR. The risk of a lower response rate was significantly correlated with the presence of advanced stage (III-IV) (p = 0.000001). The overall 5-year survival rate was 59%, with a relapse-free survival rate of 72% among the 24 complete responders. INTERPRETATION AND CONCLUSIONS: Intestinal lymphomas differ significantly from their gastric counterpart, not only in pathology, but also with regard to clinical features, management and prognosis. Our experience confirm the efficacy of the surgery-chemotherapy combination in obtaining a good remission rate for localized early primary intestinal lymphoma and indicates that this combination represents the only means for managing complications.

[Role of microvascular free flaps in the treatment of amputation stumps]. / Ruolo dei lembi liberi microvascolari nel trattamento dei monconi di amputazione degli arti.

The authors report the importance of plastic surgery in rehabilitation of the amputated stump. After having referred the tight dependence between amputated stump and prosthesis, they underline the importance of a trophic and painless stump characterized by a satisfactory "useful length". They report two cases in which these priorities have been satisfied by using latissimus dorsi free flap. The authors believe that better rehabilitative results can be achieved by applying the most recent techniques utilized in plastic surgery and particularly microvascular free flaps.

[Skin tumors. Localization of basal cell carcinoma in 162 patients]. / Tumori cutanei. Localizzazione di carcinoma baso-cellulare in 162 pazienti.

The authors present a study on the incidence of skin tumors of the face. Benign tumors are important both from an aesthetic point of view and also because some precancerous lesions may degenerate. Major emphasis is placed on the various aspects of malignant lesions: basal cell carcinomas prevail in the more exposed areas of the face. The various surgical techniques in managing facial tumors are presented and discussed, underlining the importance of both oncological radicality and functional and aesthetic aspects.

[Neoplastic occlusion of the right colon]. / Occlusione neoplastica del colon destro.

On the basis of more than 10 years' clinical experience of 122 patients operated on for cancer of the right colon, stress is laid on intestinal occlusion which is one of the most frequent complications of this pathology. The factors that make the event to be avoided and that lead to the poor short and long-term results are analysed.

[Neoplasms of the sigmoid incarcerated in inguinal hernia (case report and review of the literature)]. / Neoplasia del sigma incarcerata in ernia inguinale (contributo casistico - revisione della letteratura).

The authors consider the association of colonic neoplasia and hernia of abdominal wall. Such association, although not so frequent, was formerly remarked in literature 23 times; with the personal casuistic contribution of the authors, who recently observed a case thereof in an old patient woman, such remarks amount to 24. The authors describe the case they have the opportunity to observe, and report the experience of the other authors thereabout, through a careful reviewing of the literature starting from 1930 up to our time.