bluuebunny/crossref_metadata_2025 huggingface dataset:
Overview of Available Data on Diet and Cancer Mortality in France
Authors: Hill Catherine
Published: April 2018

We are reasonably sure today that diet plays an important role in the etiology of many common types of cancer, although the mechanisms and the relevant components of the diet have not yet been clearly identified. Data on the temporal and geographical variations of diet, and of cancer mortality, are presented here for France. There were important modifications in the dietary habits of the French population between 1950 and 1985. The consumption of bread and potatoes went down by a factor 2, and alcohol consumption decreased by 20%. Simultaneously, increases varying between 50% and 100% were observed for butter, fish, fruits and vegetables; the consumptions of pork meat, oil, and margarine were more than doubled; and lastly the consumption of poultry went up by a factor 3.5, and cheese or yogurt by a factor 4.5. The variations between regions for France are also very large. The largest increases in cancer mortality between 1950 and 1985 were observed for mouth and pharynx, both in males and females, and for lung cancer in males. The largest geographical variations were observed for mouth and pharynx, for esophagus, and for stomach. For these sites, the highest rates were observed in Brittany. In our present state of knowledge on the relation between diet and the risk of cancer, we cannot reliably attribute the variations in cancer mortality to specific dietary habits.
The Management of Inoperable Gastrointestinal Obstruction in Terminal Cancer Patients
Authors: Ventafridda Vittorio , Ripamonti Carla , Caraceni Augusto , Spoldi Elio , Messina Lina , De Conno Franco
Published: April 2018

The aim of the study was to assess vomit and pain control in terminal cancer patients with inoperable gastrointestinal obstruction, using a pharmacologic symptomatic treatment which prevents recourse to nasogastric tube placement and intravenous hydration, in hospital and home care settings. Twenty-two symptomatic patients, who were judged as inoperable, were treated with a pharmacologic association of morphine hydrochloride and scopolamine butylbromide as analgesics and haloperidol as an antiemetic. The drugs were administered by continuous subcutaneous infusion via a syringe driver or intravenously only when a central venous catheter had been inserted previously. Daily recordings included assessment of pain, number of vomiting episodes, dry mouth, drowsiness, and thirst sensation. Data were examined before starting the treatment (T0), 2 days after (T2) and 2 days before death (T-2). They showed that there was a significant decrease in the pain score (p < 0.001) on T2 and a further decrease on T-2 (p < 0.05). Vomiting was controlled in all patients, with the exception of three patients with upper abdomen obstruction who required nasogastric tube placement. Dry mouth showed an upward trend throughout the observation period (p < 0.05) but was successfully treated by administering liquids by mouth or ice-cubes to suck. Drowsiness too presented an upward trend from TO to T-2 (p < 0.001). Only one patient out of 16 who reported to be thirsty required intravenous hydration. We believe that in terminal cancer patients, vomit and pain resulting from inoperable intestinal obstruction, with the exception of obstruction of the upper abdomen, can be controlled through administration of analgesic and antiemetic drugs, in the hospital and at home, without recourse to nasogastric tube placement or intravenous hydration.
Soybean and Ascorbate Feeding in Experimental Carcinogenesis: Immunological Studies
Authors: Medhat Amina Mohamed , Abdelwahab Kouka Saad El-Din , El-Aaser Abdelbaset Anwer , Al-Nagdy Sohair Ali , El-Dardiri Zeinab Zaki
Published: April 2018

Soybean and/or sodium ascorbate have been demonstrated to have protective effects against carcinogenicity of the nitrosamine precursors dibutylamine and sodium nitrite in rats. Some immunological aspects of the cellular and humoral compartments of the immune system were investigated in this experimental model. The parameters chosen for the study were the lymphocyte transformation test, migration inhibition test, the demonstration of Fc and Fc plus complement receptors on the lymphocyte surface (EA and EAC rosette-forming test), and the determination of total serum proteins and their fractions. The results indicated that dibutylnitrosamine can be formed in vivo from its precursors dibutylamine and sodium nitrite, and that it affects the immune system of rats which showed an immunosuppressed state present as depressed cellular and humoral immunity. The protective role of soybean and/or ascorbate against carcinogenicity of dibutylamine and sodium nitrite was demonstrated by the absence of tumor formation. These agents were found to be capable of increasing the defense mechanism of rats by enhancing both cellular and humoral immunity in the presence of the carcinogenic nitrosamine precursors dibutylamine and sodium nitrite.
Studying Survival of Cancer Patients in Different Populations: Its Potential and Role
Authors: Micheli Andrea , Gatta Gemma , Verdecchia Arduino
Published: April 2018

Rationale

Survival figures from a population-based study incorporate the overall practice in diagnosis, cure and clinical follow-up for a specific disease within a given health care system. Being the outcome of a number of individual, social and economical aspects, population-based survival may be thought as index for measuring the level of a country's development.

Data

The EUROCARE project, a European Cancer Registries (CR) concerted action, provided reliable information on survival for more than 800,000 cancer patients from 11 European countries. A great deal of epidemiologic information has derived from EUROCARE. Women had a longer survival than men for all studied tumour sites, except for the colon. European survival variability was fairly high for several cancers, but it was lower for cancers with a relatively good prognosis and those sensitive to treatment. The ranking of populations of cancer survival tended to be fairly stable for many cancers: CR of Switzerland and Finland ranked high and Polish CR low. Denmark, Italian and France CR did not substantially differ from the European survival average. For most cancers, prognosis improved during the studied period (years of diagnosis: 1978–1985). Survival figures for colon (r = 0.74, males; r = 0.73, women) and female breast cancer (r = 0.57) well correlated with the national health expenditure of different participating countries. The ITACARE study, a new Italian Cancer Registries collaborative project involving more than 100,000 cancer patients, was set up to study survival differences within the country. Survival of cancer patients was not homogeneous in 7 studied Italian regions (the estimated 5-year relative survival for all malignant neoplasms combined ranked from 37.8% in CR of Sicily to 42.1% in those of Emilia-Romagna). The lowest levels of regional health expenditures were accompanied by the lowest levels of prognosis for overall cancers. However, a relatively low correlation among patient cancer survival and the regional health expenditure (r = 0.21) was found, suggesting that other factors such as different efficiency in managing cancer may play a role in explaining the intracountry differences.

Conclusions

Population-based survival figures may be used to study epidemiologic aspects, comparing different health systems, and may be interpreted as indexes for discussing inequalities in health in different populations.
Does Concomitant Chemoradiotherapy Influence Cosmetic Outcome in Conservative Treatment of Breast Cancer?
Authors: Moro Gregorio , Stasi Michele , Borca Valeria Casanova
Published: April 2018

Purpose

To evaluate retrospectively factors influencing the cosmetic outcome after conservative treatment for breast cancer.

Material and methods

From 1988 until 1992, 164 patients were treated with conservative surgery (quadrantectomy) and radiotherapy with 60Co (50 Gy on the whole breast) plus 10 Gy on the surgical bed (300 kV photons) for T1–T2 breast cancers; 46 patients (28%) received concomitant adjuvant chemotherapy (CMF schedule). Cosmesis evaluation was carried out after 24 to 108 months (median, 38 months). A logistic regression analysis was performed to identify independent variables influencing the aesthetic outcome. P values of 0.05 or less were considered significant.

Results

Univariate analysis showed that T2 versus T1 (P = 0.0102), lower quadrants site (P = 0.0002) and concomitant adjuvant chemotherapy (P = 0.0009) produced a worse aesthetic outcome. Multivariate analysis confirmed the same factors: tumor size (P = 0.0020), tumor site (P = 0.0150) and concomitant chemotherapy (P = 0.0024).

Conclusions

The significant negative influence on the cosmetic outcome of concomitant adjuvant chemotherapy implies questions about the timing of radiotherapy and chemotherapy in breast cancer conservative treatment.
The Influence of Blood Glucose Levels on [18F]Fluorodeoxyglucose (Fdg) Uptake in Cancer: A Pet Study in Liver Metastases from Colorectal Carcinomas
Authors: Crippa Flavio , Gavazzi Cecilia , Bozzetti Federico , Chiesa Carlo , Pascali Claudio , Bogni Anna , De Sanctis Vinicio , Decise Donatella , Schiavini Mauro , Cucchetti Gianenrico , Bombardieri Emilio
Published: April 2018

Aims and background

To study the influence of blood glucose levels on the clinical reliability of positron emission tomography (PET) with [18F]-2-fluoro-2-deoxy-D-glucose (FDG) in the detection of liver metastases from colorectal carcinomas and in the analysis of tumor uptake of FDG.

Methods

After having given their informed consent, 8 patients with 20 liver metastases (mean size, 31.5 mm; range, 10–75 mm) detected by means of CT were submitted to a first FDG-PET examination under fasting conditions and, 2 days later, to a second FDG-PET examination performed after iv infusion of a glucose solution (4 mg/kg/min for 2 hrs). The results of the two studies were compared in each patient, considering both the localization of the metastases and the FDG uptake in the lesions. A non-kinetic method was used, calculating the Standardized Uptake Value (SUV).

Results

All 20 metastases were clearly visible on FDG-PET under fasting conditions. Moreover, in 2 patients FDG-PET detected a number of unknown liver metastases. The blood glucose levels after glucose infusion were significantly higher than the levels under fasting conditions, 158 ± 13.8 mg/100 ml (mean ± sd) and 92.4 ± 10.2, respectively (P « 0.001), and the quality of the FDG-PET images showed a marked deterioration. FDG-PET was unable to detect 6 of the 20 lesions and another 10 lesions were localized less clearly. Moreover, 80% of the unknown liver metastases were not detected after glucose loading. The SUVs of metastases decreased from 9.4 ± 5.7 (mean ± sd) under fasting conditions to 4.3 ± 8.3 after glucose loading (P « 0.001).

Conclusions

FDG-PET studies may be particularly unreliable under conditions of high levels of blood glucose. Therefore, patients entering FDG-PET studies should fast, and blood glucose concentration needs to be taken into account when evaluating FDG uptakes in follow-up studies.
Angiotropic (Intravascular) Large Cell Lymphoma: Case Report and Short Discussion of the Literature
Authors: Sanna Piero , Bertoni Francesco , Roggero Enrico , Quattropani Cristiana , Rusca Tiziana , Pedrinis Ennio , Monotti Rita , Mombelli Giorgio , Cavalli Franco , Zucca Emanuele
Published: April 2018

We report a case of angiotropic (intravascular) large B-cell lymphoma in an 84-year-old woman who underwent diagnostic procedures for progressive, painful induration of the legs. Physical examination and imaging studies revealed only widespread telangiectasias and significant panniculitis-like lymphedema of the legs, with no masses or lymphadenopathies. The patient achieved a complete clinical remission after the first three cycles of polychemotherapy. Although angiotropic lymphoma is a rare entity with polymorphic clinical presentations, its early diagnosis appears very important since it may be curable with appropriate chemotherapy regimens.
Splenomegaly as the First Manifestation of Thyroid Cancer Metastases
Authors: Paolini Rossella , Toffoli Sandra , Poletti Alessandro , Casara Dario , Moschino Paolo , Fabris Fabrizio , Girolami Antonio
Published: April 2018

We report the case of a 65-year-old man who developed a symptomatic splenomegaly due to spleen metastasis from thyroid follicular carcinoma. In 1982, at the age of 53, the patient had undergone a thyroid lobectomy for a cold node, followed one year later by a second intervention for a microfollicular adenoma. He was subsequently administered thyroid suppressive therapy with no further follow-up. The diagnosis of spleen metastases from thyroid cancer was first suspected on the basis of history, high serum thyroglobulin (Tg) levels, and the presence of pulmonary 99Tc uptake. The patient underwent a splenectomy, during which vast infiltration involving the diaphragm, spleen, stomach, colon and pancreas, was found. Histological and immunohistochemical results showed that the spleen and diaphragm metastases derived from thyroid follicular carcinoma. Radioiodine uptake by the pulmonary metastases confirmed the thyroid source. Retrospective re-evaluation of the thyroid tissue removed in 1983 revealed a histological pattern consistent with follicular carcinoma, which could not be unequivocally attributed to the widely or minimally invasive form. To our knowledge this is the first report of splenomegaly as the first manifestation of thyroid cancer metastases. In this paper cases of splenomegaly due to metastatic spread are reviewed and the management of the present case is discussed.
Colposcopy as a Primary Screening test for Cervical Cancer
Authors: Cecchini Silvia , Bonardi Rita , lossa Anna , Zappa Marco , Ciatto Stefano
Published: April 2018

Aim and background

To evaluate the cost effectiveness of screening by colposcopy compared to conventional cytology.

Methods

A prospective study was performed in the Florence District screening center on 3,000 consecutive women, self referring, who were examined by cytology and colposcopy in a blind fashion. Further assessment was based on cytologic report or on colposcopy-directed punch biopsy. Actual costs of the whole screening process were known. The cost effectiveness of different possible simulated screening scenarios was then determined.

Results

Overall, 18 high-grade lesions (CIN3 = 9, CIN2 = 9) were detected. Four different screening scenarios were compared, namely a) cytology alone, b) cytology + repeat smear for ASCUS (atypical squamous cells of undeterminate significance) cases, c) colposcopy + cytology for cases of condyloma at punch biopsy, and d) colposcopy alone. Although they had a higher cost per examined woman (a) = 17.98, b) = 19.40, c) = 23.86, d)= 22.10 US$), scenarios c) and d) had a higher relative sensitivity (a = 44.4, b = 61.1, c = 100, d = 88.8%) and a lower cost per high-grade lesion detected (a = 6,743, b = 5,291, c = 3,977, d = 4,144 US$).

Conclusions

Screening by colposcopy is a feasible procedure which is more sensitive and more cost effective than conventional cytologic screening. At least in those settings where access to cytopathology may be difficult, screening by colposcopy should be considered as a possible alternative.
Lymph Node Merkel Cell Carcinoma with No Evidence of Cutaneous Tumor - Report of Two Cases
Authors: Ferrara Gerardo , lannielio Giovanni Pietro , Di Vizio Dolores , Nappi Oscar
Published: April 2018

We report two cases of Merkel cell carcinoma within inguinal and axillary lymph nodes, respectively, showing no clinicopathologic evidence of a primary (extranodal) tumor; one of our patients was alive with no evidence of disease five years and ten months after the surgical excision of the neoplasm with no postoperative chemotherapy.

The diagnosis of nodal Merkel cell carcinoma needs to be supported by a careful immunohistochemical study: in fact, cytokeratin- and neurofilament-positive paranuclear “dots”, as well as epithelial antigens and neuroendocrine markers may be variably expressed in tumor cells, thus requiring the application of a complete antibody panel.

In the presence of a nodal Merkel cell tumor, an exhaustive clinico-radiologic search for a primary tumor must be carried out. After the exclusion of any reasonable starting point of the neoplasm, a provisional diagnosis of “primary” nodal Merkel cell carcinoma may be acceptable; since a primary extracutaneous tumor is expected to follow a less aggressive course than a metastatic one, follow-up data may provide indications as to the truly extracutaneous origin of Merkel cell carcinoma.
Brachytherapy for Squamous Cell Carcinoma of the LIP. The Experience of the Institute of Radiology of the University of Rome “La Sapienza”
Authors: Tombolini Vincenzo , Bonanni Alessio , Valeriani Maurizio , Zurlo Alfredo , Vitturini Alessandro
Published: April 2018

Aims and background

Cancer of the lip is the most common malignancy occurring in the oral cavity. The aim of our retrospective study was to review the results of patients with lower lip squamous cell carcinoma who were treated with radiotherapy.

Methods & study design

From 1970 to 1992, 57 patients with squamous cell carcinoma of the lower lip were treated at the Institute of Radiology of the University of Rome “La Sapienza” with low-dose rate interstitial brachytherapy. According to the UICC 1992 TNM classification, the disease stage was T1 in 27 (47%) cases, T2 in 20 (35%) and T3 in 10 (18%); 8 patients (14%) were cN+. The median tumor dose was 62 Gy (range, 44-96): 10 patients (18%) received a total dose < 50 Gy, 28 (49%) between 50 and 70 Gy, and 19 (33%) > 70 Gy. The cN+ cases were irradiated to total doses of 65-70 Gy on the involved station. Ail patients obtained complete remission.

Results

The actuarial overall survival rates at 3, 5 and 10 years were 95%, 76% and 53%; actuarial disease-free survival at 3, 5 and 10 years was 84%, 81%, and 81%, respectively. Actuarial cause-specific survival was 98%, 88% and 84% at 3, 5 and 10 years, respectively. Actuarial local control rate was 90% at 3 and 5 years, rising to 94% with salvage surgery. Local-regional control was obtained in 90% and 86% of patients at 3 and 5 years, and in 93% and 89% of cases, respectively, following surgery. Five of 11 deaths were due to local-regional or distant disease recurrence.

Conclusions

Tumor stage and positivity of regional nodes were the only predictive factors of survival and disease control. Radiation-induced morbidity was very low, and all patients considered their cosmetic outcome at least satisfactory.
Intraperitoneal Hyperthermic Chemotherapy in Gastric Cancer: Rationale for a new Approach
Authors: Bozzetti Federico , Vaglini Maurizio , Deraco Marcello
Published: April 2018

There is preliminary evidence from experience in the treatment of various abdominal malignancies that intraperitoneal chemotherapy alone or combined with hyperthermia may attain a role in the therapeutic strategy. This paper considers the rationale for such an approach, as well as its current results and potential indications in patients with gastric cancer. The literature is critically reviewed, with special emphasis on specific topics such as patterns of tumor spread, mechanisms of local recurrence, the rationale for intraperitoneal chemotherapy and intraperitoneal hyperthermic chemotherapy, toxicity, and results from non-controlled as well as randomized clinical trials in patients with gastric cancer. There is some evidence that intraperitoneal hyperthermic chemotherapy has a favorable effect on clinical outcome in patients with limited peritoneal carcinomatosis or malignant ascitis and in those at risk of future peritoneal spread, such as patients with pT3-pT4 cancers or with positive cytology of the peritoneal fluid. Hyperthermic chemotherapy should be considered a promising approach in limited or impending peritoneal carcinomatosis, and should be included in the multidisciplinary approach to the treatment of locally advanced gastric cancer.
Retrospective Analysis of Ploidy in Primary Osseous and Extraosseous Ewing Family Tumors in Children
Authors: Perotti Daniela , Corletto Valentina , Giardini Roberto , Parafioriti Antonina , Fossati-Bellani Franca , Luksch Roberto
Published: April 2018

Aims

To restrospectively study the DNA content in a series of childhood Ewing Family Tumors (EFT), and to investigate its prognostic value.

Methods

The study was performed on a series of 27 EFTs (osseous Ewing's sarcoma, 18 cases; extraos-sous Ewing's sarcoma, 2; peripheral neuroepithelioma, 4; Askin Rosai tumors, 3). Ploidy was investigated using both flow cytometry (FCM) and image cytometry (ICM) on tumor cell suspensions from formalin-fixed paraffin-embedded specimens or fresh frozen tissue obtained from the primary tumor at diagnosis.

Results

Ploidy was evaluable by FCM in all cases, and by ICM in 23/27. When fresh frozen tissue and paraffin-embedded samples from the same tumor were available for analysis, they yielded equal results. The rate of agreement between FCM and ICM was 82%. The majority of cases were diploid, and in the present series aneuploidy seemed to be associated with a poor outcome.

Conclusions

These results suggest that aneuploidy could be an indicator of a bad prognosis in EFT; however, the small number of cases precludes any conclusion of statistical value. Larger restrospective studies on ploidy using archival material could be performed and their reliability is supported by the concordance of results from fresh and formalin-fixed tissue.
Neoplastic and Non-neoplastic Thyroid Lesions in Autopsy Material: Historical Review of Six Decades in São Paulo, Brazil
Authors: Bisi Hélio , Ruggeri Gláucia Berreta , Filho Adhemar Longatto , Asato de Camargo Rosalinda Y. , Fernandes Vilma S.O. , Abdo Anete H.
Published: April 2018

Aims and background

The aim of the study was to report and discuss a historical series of neoplastic and non-neoplastic lesions of the thyroid gland obtained at autopsy that were examined between 1931 and 1989 at the Pathology Department of the Medical School of the University of SaTo Paulo.

Methods

Records of 145,043 cases were reviewed to select those affecting the thyroid gland. The slides of these selected cases were analyzed and classified according to the current terminology.

Results

Non-neoplastic lesions comprised 91.62% of the cases (n=4647), and most of them were adenomatous goiter (n=3014). Neoplastic lesions were divided into two groups: primary and metastatic. Of the 282 primary tumors, 135 were benign and 147 were malignant. Among the malignant neoplasms, the most frequent types were follicular, papillary and undifferentiated (n=39, 36 and 29, respectively). The most frequent tumor types among the metastatic neoplasms were lymphoproliferative processes and carcinomas (n=67 and 34, respectively).

Conclusions

We conclude that, because of the high frequency of neoplastic lesions (8.38%), 68.24% of which were malignant, detailed examination of the thyroid by pathological methods should be carefully and systematically performed for the accurate detection of thyroid lesions, especially carcinomas.
Littoral Cell Angioma of the Spleen: An Additional Report of Four Cases with Emphasis on the Association with Visceral Organ Cancers
Authors: Bisceglia Michele , Sickel Joshua Z. , Giangaspero Felice , Gomes Vito , Amini Mostafà , Michal Michal
Published: April 2018

Aims and background

Littoral cell angioma (LCA) is an uncommon vascular tumor of the spleen recently described and interpreted as the tumoral counterpart of the normally present littoral cells lining the splenic sinus channels of red pulp. The diagnosis of LCA is suggested by a quite characteristic morphology and confirmed by the demonstration of a hybrid endothelial/histiocytic phenotype.

Methods

Four original and previously unreported cases of LCA are presented. All four splenic vascular tumors were investigated by light microscopy and immunohistochemistry for endothelial and histiocytic markers.

Results

All four cases were associated with visceral epithelial malignancies (colorectal adenocarcinoma in two cases, renal and pancreatic adenocarcinoma in one case each). One case was also associated with an intracranial tentorial meningioma.

Conclusions

We consider our findings as a novelty and signal the possible existence of a clinical syndrome. Five of a total of 21 previously reported cases in the literature were also described as being associated with other cancers (non-Hodgkin's lymphoma in two cases, two not further specified tumors of the liver and brain, an epithelial ovarian cancer, and a non-small cell lung cancer in one case each). Close follow-up and careful investigation in search of a second visceral neoplasm are strongly recommended in cases of LCA, but further clinical observations and more in-depth genetic and molecular studies are needed before any valid conclusions can be drawn.
Brachytherapy for Isolated Vaginal Recurrences from Endometrial Carcinoma
Authors: Colombo Alessandro , Cormio Gennaro , Placa Franco , Landoni Fabio , Ardizzoia Antonio , Gabriele Antonio , Lissoni Andrea
Published: April 2018

Aims and background

Isolated vaginal recurrences of endometrial carcinoma are rare, and prognostic factors that predict treatment outcome are still not well defined. The aim of the present study was to evaluate the results of brachytherapy in isolated vaginal recurrences from endometrial carcinoma.

Methods

Thirty-five patients with isolated vaginal recurrences were treated with brachytherapy with intravaginal ovoids or cylinders that were calculated to deliver 6000 to 7000 cGy at the surface. Patients were assessed for size and location of recurrence at presentation, response and complications from therapy.

Results

Treatment was well tolerated by most patients. Grade 2 toxicity occurred in 4 patients (3 cases of partial vaginal stenosis and one proctitis). Complete response to radiation was observed in all patients, and an overall 9 failures were observed (4 local, 4 distant and 1 local plus distant). Twenty patients (57%) were alive without evidence of disease at 3 to 11 years following treatment. Site of vaginal recurrence (upper third versus others) and long (more than 12 months versus less than 12 months) interval from hysterectomy were the only factors significantly related to local failures.

Conclusions

Isolated vaginal recurrences following hysterectomy for endometrial carcinoma can be treated with brachytherapy with a low rate of severe toxicity.
Activity and Tolerability of Courses of Intra-Arterial Chemotherapy Followed by Chemoembolization in Unresectable Hepatocellular Carcinoma
Authors: Colleoni Marco , Vicario Giovanni , Manente Paolo , De Braud Filippo , Fazio Nicola , Liessi Guido
Published: April 2018

Aims and Background

We previously reported encouraging response rates and survival with combined intraarterial (i.a.) chemotherapy and chemoembolization in unresectable hepatocellular carcinoma. We therefore evaluated a new program combining three courses of i.a. chemotherapy with chemoembolization administered every 28 days.

Patients and methods

The treatment regimen consisted of L-Ieucovorin (100 mg/m2 i.v.), fluorouracil (800 mg/m2 i.a.), and carboplatin (250 mg/m2 i.a.). Chemoembolization with mitoxantrone (10 mg/m2) plus ethiodized oil and gelatin sponge was performed immediately after. The same treatment was given every 28 days for 3 times.

Results

Twenty-eight patients entered the study and were assessable for response and side effects. There were 24 males and 4 females (median age, 68 yrs; range, 42-75). TNM stage was II-III in 20 and IVA in 8; 17 were Child's A and 11 Child's B. Baseline α-fetoprotein was elevated in 15, and there was cirrhosis in 23. Twelve patients had a partial response (43%; 95% confidence interval, 24-63%), 13 had stabilization, and 3 progressive disease. Median survival was 16.6 months (range, 2-24). Sixteen patients had grade I-II pain and 14 grade I-II fever.

Conclusions

Our results indicate that the regimen is safe and well tolerated. Despite 43% objective remissions, our results do not seem better than those obtained with less intensive regimens.
L'ecografia Del Carcinoma Pancreatico
Authors: Innocenti Paolo , Falchini Massimo , Stecco Alessandro
Published: April 2018

Pancreatic tumors are the fourth cause of death in Occident: the 5-year-survival rate is less than 5% because of diagnostic difficulties, low clinical expression at early stage, and complexity of the surgical treatment. The role of ultrasound (US) is in early diagnosis, because also in early cancer there could be lymphatic spread or peritoneal involvement.

There are multiple modalities to study the pancreas with US: abdominal US, “contact” US (endosonography and intra-op-erative or laparoscopic US). The first is not invasive, cheap but limited by extrinsic and intrinsic factors, the latter are respectively characterized by high cost, and need of endoscopic specialists for endosonography, the complementarity to laparoscopy or surgery for the laparoscopic/intraoperative US. Abdominal US is the first diagnostic step for the pancreas, but it is not affordable in 15-25% of patients, because of me-teorism. In all the other cases, it represents the pancreas with a good contrast between the normal parenchyma and tumoral tissues. Abdominal US, together with biopsy, can define the resectability.

Ecoendoscopy is actually dedicated to small tumors staging, but recent studies demonstrate the same results achieved by spiral TC.

Laparoscopic US is a second step imaging in patients already selected for surgery.

The first finality in US evaluation of tumor masses is early diagnosis of pancreatic cancer; it can give to some of these patients the opportunity of undergoing to surgical treatment. This could be achieved by a proper use of the moltitude of ultrasonic abdominal explorations that are requested in daily practice.

US, together with CT and MR, can define the resectability of the tumor, with further supplementar evaluation by mean of laparoscopic US.

Intraoperative US is now indicated for planning and guiding the surgeon in resection of the pancreatic cancer.
La Chemioterapia Adiuvante Concomitante Del Carcinoma Pancreatico
Authors: Turci Daniele , Cariello Anna , De Giorgi Ugo , Marangolo Maurizio
Published: April 2018

Pancreatic cancer is a leading cause of cancer death. Despite improvement in diagnosis and treatment in the last 15 years, mortality rates essentially equal the incidence of the disease. Combination treatment with chemoradiation yields up to now better results than chemotherapy or radiotherapy given alone in consideration of substantial radio and chemoresistance of the cancer cells. This study will review the most important literature data about combination adjuvant treatment and preoperative (primary) chemoradiation in pancreatic cancer. Some other reports will be given on locoregional chemotherapy and finally a brief view on a possible perspective for promising future treatments coming from data of molecular pathology.

Adjuvant chemoradiation after surgery has been shown to be superior to operation alone in potentially resectable pancreatic cancer in many studies, in terms both of local control and median overall survival. Unfortunately, a consistent percentage of patients cannot receive adjuvant treatment since late recovery after surgery or postoperative morbidity. Owing to this last reason, many authors prefer primary chemoradiation in potentially resectable pancreatic cancer; neoadjuvant treatment find out its background in other relevant biological and clinical evaluations.

Some studies report encouraging results with primary chemoradiation using 5-fluorouracil. Other experiences with relatively new drugs, with potent radiosensiting effect, such as gemcitabine or taxol are going on; many of these are phase I studies. Clinical research in the field of preoperative treatment is up to now emerging in some importants Oncological Institutions. The principal actual aim seems to be that of forsee periods of treatment which will be brief and use the dose of chemotherapy that is active, giving acceptable toxicity.

Ongoing trials will give, in the next years, the answer about the improvement of efficacy of treatments largely expected by all researchers.
Continuous Monitoring of Urea and Inorganic Phosphate during Hemodialysis: II. Clinical Trials
Authors: Klein E. , Montalvo J.G.
Published: April 2018

Ion-selective electrodes have been used to monitor urea and inorganic phosphate removal during dialysis. The dialysate outflow concentrations from a single pass bedside controller were used to compute instantaneous serum concentrations. The urea data are in agreement with a single pool reservoir model; the inorganic phosphate removal was not log-linear, indicating rate limiting intracompartmental transfer.

The procedure can be applied to the computation of urea generation rates and thus provide information on the protein catabolism rates of the patient; in addition, the monitor provides continuous checks on the dialyzer performance.
Gastric Acid Secretion, Calcitonin and Secondary Hyperparathyroidism in Uremic Patients Undergoing Regular Dialysis Therapy (RDT)
Authors: Antonucci F. , Vezzadini P. , Cecchettin M. , Bonora G. , Adami A. , Compiano U. , Feder G.
Published: April 2018

Fortyseven uremic patients on RDT underwent a gastric secretion study and a contemporary evaluation of serum levels of Calcium (Ca), Phosphate (iP), Magnesium (Mg), Alkaline Phosphatase (AP), immunoreactive gastrin (Gas), parathyroid hormone (PTH), calcitonin (CT). Secretory test (pentagastrin 6 μg/kg) was performed in the morning, after 12 hours of fasting, in the interdialytic interval. Female patients, male patients on RDT from less 1 year and hyposecretor patients were excluded from the study. On the basis of these criteria 25 normal or hyper-secretor males between 20 and 55 years old were selected. A significant positive correlation was found between PTH and CT, while a negative significant correlation was found between CT and BAO and CT and PAO. Similarly, a significant negative correlation was found between PTH and BAO and PTH and PAO. Multiple regression study showed that the negative influence of CT on BAO and PAO is more relevant than the positive influence of PTH. These data suggest that PTH and CT are involved in gastric acid secretion in uremia. Since the inhibitory effect of CT is prevailing on the stimulating effect of PTH, patients with higher levels of PTH and CT have a lower gastric acid secretion. CT might therefore be considered as a protective factor against hypersecretion in uremia.
Management of Hypertension in Dialysis
Authors: Zucchelli P. , Zuccalà A. , Santoro A. , Sturani A. , Esposti E. Degli , Ligabue A. , Chiarini C.
Published: April 2018

Arterial hypertension is a highly frequent symptom in end-stage renal failure. This study was designed to evaluate the importance of total exchangeable sodium (NaE), plasma renin activity (PRA) and the adrenergic nervous system in the pathogenesis of high blood pressure. 86 patients were studied (26 with end-stage kidney disease and under conservative treatment and 60 on maintenance haemodialysis).

Under conservative treatment a simple linear regression analysis gave a correlation coefficient of 0.794 for NaE × log. PRA against mean arterial pressure (MAP). This data suggests that before the start of the haemodialytic treatment NaE and PRA are important determinants of hypertension.

In patients undergoing chronic heamodialysis the correlation between MAP and the product of NaE × log. PRA was lost. In hypertensive patients we have found indication of an increased adrenergic activity. In fact resting heart rate and two hours walking plasma catecholamines were significantly higher in hypertensive compared with normotensive patients on dialysis. A significant positive correlation was found between basal plasma noradrenaline levels and MAP in 34 patients treated with periodic haemodialysis when hypothyroid patients were excluded.

Arterial hypertension is a highly frequent symptom in end-stage renal failure and occurs in over 80% of all case histories (1, 2, 3, 4, 5).

This paper is a review of our experience concerned with the pathogenesis and management of hypertension in patients with chronic renal failure.
Composite Materials for Biomedical Applications
Authors: Migliaresi C. , Nicolais L.
Published: April 2018

The concepts of composite mechanics have been used to design two materials for potential prosthesis of biomedical interest. They attain specific physical properties and use polymers which show a high degree of biocompatibility.

The materials used were a poly (2-hydroxyethyl-methacrylate) as matrix and polyesther resin as reinforcing fibers.

The mechanical performance of a uniaxially oriented composite has been adjusted to match the behaviour of a human tendon. A laminate composite has been modelled for use in plastic surgery.
Restoration of Ultrafiltration Capacity of Peritoneal Membrane in Patients on CAPD
Authors: Bazzato G. , Coli U. , Landini S. , Lucatello S. , Fracasso A. , Righetto F. , Scanferla F. , Morachiello P.
Published: April 2018

Among 55 uremic patients who entered our CAPD program, 7 of them showed a reduction or loss of the ultrafiltration capacity (UF) of the peritoneal membrane (PM). They have been treated with high dose of Furosemide (F) to force residual urine output. Four appeared «responders» to drug administration with a significant increase in urine volume, Na excretion and, within a week period gained their dry body weight (BW).

In the remaining 3 patients drug therapy resulted ineffective, and fluid removal was obtained by hemofiltration (HF).

In both groups we noted an increase in the UF capacity of PM when their dry BW was obtained either by pharmacological or technical approach.

These results support the assumption that the overhydration status of the PM plays a major role in maintaining the UF process.
Serum Aluminum Levels and Peritoneal Dialysis
Authors: Gilli P. , Fagioli F. , Malacarne F. , Bedani P.L. , Buoncristiani U. , Carobi C. , Locatelli F. , Farinelli A.
Published: April 2018

Serum aluminum levels, significantly higher in dialysis patients than in normal subjects, were also found to be significantly higher in patients on PD than in those on HD. This could be related to a higher Al transport rate across membrane during PD than during HD. The easier contamination of PD dialysates and their acidic pH could account for this trend to a positive Al balance in PD.

On the basis of our observations, however, the significance of the serum aluminum level could be very low, since aluminemia does not seem to reflect the cumulative amount of Al ingested and might not readily help predict the risk of Al intoxication.
Modelling of Plasma-Separation through Microporous Membranes
Authors: Gupta B.B. , Jaffrin M.Y. , Ding L.H.
Published: April 2018

Available mathematical models of ultrafiltration have been used to predict changes in maximum plasma filtration rate with wall shear rate for given filters and blood properties. We have done many plasmapheresis experiments in vitro, using hollow-fiber filters (500–1000 cm2) and fresh bovine blood collected on ACD or heparin. The comparison between predicted and experimentally obtained filtration rates was good for models based on the concentration polarization theory and lift velocity theory. In other experiments with pulsatile inlet flow we found that plasma filtration rate increased by 20 to 50% compared to nonpulsatile conditions. These results are in good agreement with the modified model of ultrafiltration incorporating pulsating flow.

This paper presents relationships between plasma filtration velocity (steady and pulsating flow) and hemolysis limit as a function of wall shear rate and filter size.
A First Screening for Hemocompatibility of a Universal Support for Selective and Specific Hemoperfusion
Authors: Verhoeven M.L.P.M. , Böucher M. , Everaerts F.M. , Sluyterman L.A.AE. , Ernst B. , Klinkmann H.
Published: April 2018

A modified filmadsorber is presented, intended to be used for selective and specific hemoperfusion. It consists of a spirally wound cellulose nitrate film, onto which — after chemical activation with sodium periodate — albumin is bound, stabilized, sterilized and activated with glutaraldehyde. Various bioactive ligands containing amino groups can be coupled to this support. A subsequent treatment with dimethylamino borane stabilizes the bonds between cellulose nitrate, albumin, glutaraldehyde and ligand. Columns in which a second layer of albumin is bound to the support as a model for a bioactive ligand were first screened for hemocompatibility using rabbits. Leukocyte, thrombocyte and hematocrit behaviour during hemoperfusion showed that hemocompatibility of the support was good.
The Contribution of Hemofiltration among the Treatment Modalities of Chronic Uremia
Authors: Vidi E. , Bianco F. , Panzetta G.
Published: April 2018

To assess the role of hemofiltration (HF) among different treatment modalities, we reviewed our clinical material from 37 patients that consecutively underwent the treatment from 1981 on. A number of 12 patients on HF for at least 1 year deliberately switched to hemodialysis (HD) or hemodiafiltration (HDF) were studied retrospectively. Biochemical and nutritional parameters, cardiovascular aspects and morbidity data were collected during one year before and after the treatment change. A sodium balance study was perfomed in 9 patients during HF as well. No significant differences in plasma urea, creatinine, phosphate, body weight, serum albumin, transferrin, hemoglobin and PCR were found. BUN tended to be lower during HD-HDF because of the more efficient removal of urea with these treatments. Indeed, the Kt/V index was 0.91 during HF and it was 1.15 with HD-HDF. There were no differences in hypotensive episodes and morbidity. Sodium loss was strictly related to body fluid removal during HF session with a net sodium loss (NSL) of 128 mEq per liter of fluid removal (FR) (NSL = 6.44 + 122 FR; r:0.83; p<0.01). Adapting sodium concentration of substitution fluid to patients weight gain, cardiovascular stability improved in those subjects more prone to collapse. With equivalence in PCR during the 2 periods, although Kt/V was 20% lower during HF, it seems reasonable to assume that the lower urea clearance might be compensated by the more efficient removal of higher molecular weight substances and/or by the improved biocompatibility of HF.
A New Treatment for Dialysis-Related Amyloidosis with β 2-Microglobulin Adsorbent Column
Authors: Nakazawa R. , Azuma N. , Suzuki M. , Nakatani M. , Nankou T. , Furuyoshi S. , Yasuda A. , Takata S. , Tani N. , Kobayashi F.
Published: April 2018

Dialysis-related amyloidosis (DRA) is characterized by the presence of β 2-microglobulin (β 2-m) in the plasma. In order to eliminate β 2-m from the circulating blood, the β 2-m selective adsorbent for direct hemoperfusion (DHP) was developed. A DHP column (BM-01), containing 350 ml of the adsorbent, was subjected to clinical trials. The column was connected with a PAN (AN69) membrane dialyzer in series and used 3 times a week for 1 week (11 patients), 4 weeks (5 patients), 6 months (1 patient) and 12 months (2 patients). The percent reduction (%) of β 2-m was for 16 patients (for 1 or 4 weeks), more than 65, and for 3 patients (for more than 6 months), 76.5 ± 4.9, 73.5 ± 5.7, 72.2 ± 6.2. At the end of each session, β 2-m plasma levels were found to be below 10 mg/L, with 3.4 mg/L being the lowest. The total amounts of β 2-m removed were 172.5 ± 22.3, 257.0 ± 75.6, 157.6 ± 32.2 and 429.8 mg/session at max. Two out of these three patients had a favorable effect on joint symptoms and ocular fundus. It can be concluded that this selective adsorption therapy may delay the progression of DRA, and is worth considering for wide application.
Hepatocyte Aggregate Culture Technique for Bioreactors in Hybrid Liver Support Systems
Authors: Gerlach J.C. , Klöppel K. , MÜller C. , Schnoy N. , Smith M.D. , Neuhaus P.
Published: April 2018

Utilizing a modified culture technique for hepatocytes, a high performance suspension culture is possible in which hepatocytes spontaneously form cell aggregates. The aggregates of 20-100 cells have been histologically confirmed to hold a three-dimensional structure, they show a long-term external metabolism and a survival time comparable with standard adhesion cultures. This technique has several advantages in the construction of large scale bioreactors for hybrid liver support systems.
Concentration of Human Hematopoietic Stem Cells in Bone Marrow Transplantation: Results of a Multicenter Study Using Baxter CS 3000 plus Cell Separator
Authors: Angelini A. , Accorsi P. , Iacone A. , Bonfini T. , Refè C. , Olivieri A. , Bodini U. , Bergonzi C. , Incarbone E. , Adorno G. , Bertola F. , Fattori G. , Torlontano G.
Published: April 2018

Preliminary BM processing to produce an enriched MNC fraction from large BM volumes improves subsequent pharmacological and/or immunological “ex vivo” treatment and cryopreservation. We detail on a multicenter study (6 Transplant Centers) performed to establish an effective and reliable protocol using a CS 3000 continuous flow separator on a large series of BM processed for autologous (96) and allogeneic (12) transplantation. The reduction in volume was 78.6+7.2% while 28.9+12.4% of the original nucleated cells were found in the final product. A mean of 84.3+13.2% of the starting MNC was yielded in a fraction containing over 81% MNC. Cloning efficiency indicated than the final graft was highly enriched in progenitor cells committed to the granulocyte/macrophage pathway (> 100%) as assessed in vitro (CFU-GM). Removal of RBC and PLT was 98.3+1.1 and 37.7+14.6%, respectively. The mean dose of MNC and CFU-GM was 0.6+0.37 x 108 and 0.96+1 x 108 recipient weight. The entire process was accomplished in 87.5+20 min. We concluded that this automated device is a simple and reproducible method for BM processing suitable as first step for further “ex vivo” automated negative and/or positive cell selections.
Treatment of Multiple Myeloma with Autologous Blood Stem Cell Transplantation. Preliminary Results of an Italian Multicentric Pilot Study
Authors: Tribalto M. , Papa G. , Coppetelli U. , Adorno G. , Caravita T. , Dentamaro T. , Rainone A. , Avvisati G. , La Verde G. , Leone G. , Menichella G. , Martelli M. , Tabilio A. , Iacone A. , Fioritoni G. , Majolino I. , Scimè R. , Mandelli F.
Published: April 2018

Starting from May, 1991, 35 untreated myeloma patients entered a multicentric pilot study to evaluate the feasibility of a program of PBSC transplantation for previously untreated myeloma patients. The schedule was as follows: 2 cycles of VAD followed by CY, 7 g/mq + G-CSF (Granulokine, Roche) for 14 days, to increase and collect PBSC. The subsequent conditioning regimen was Melphalan + Busulfan followed by G-CSF. As maintenance R alpha-2 IFN was given, until relapse. The median follow-up is 14 months (4-22). On April 1993, 34 patients received at least 2 cycles of VAD, 27 were submitted to PBSC collection, 22 received conditioning regimen plus PBSC and 16 of them are in the maintenance treatment with IFN. Considering 28 patients for an intention to treat evaluation (35 -7 in treatment), responding patients are 71% with 46% who achieved CR. White cells and platelets raised to > 1000/mmc and >50,000/mmc after a median period of 10 and 13 days, from CY, and 11 and 14 days from transplant, respectively. Two patients relapsed, 2 others died while in PR because of CMV epatitis and candida pneumonia. The median number of CD34+ cells and CFU-GM was 24.75 x 106/kg b.w. and 28.1 x 104/kg b.w. respectively. In conclusion this treatment seems to be feasible and with low toxicity, but a longer follow-up is needed to evaluate the progression free survival of the high proportion of responding patients that we observed.