bluuebunny/crossref_metadata_2025 huggingface dataset:
AWOL: Canada’s defence policy and presence in the Asia Pacific
Authors: Dewitt David , Young Mary , Brouse Alex , Piereder Jinelle
Published: April 2018

Our focus is on Canadian defence and security activities in the Asia Pacific arena between 1990 and 2015. While governments have asserted the growing primacy of the Asia Pacific, we ask the following: What does Canada’s recent military and security record tell us about the policies and operational aspects of Canadian engagement? How might we assess these in comparison with Ottawa’s declared importance of the Asia Pacific? What might this tell us about the near-term future of Canada’s role and pursuit of interests and opportunities in this complex region? We present and analyze empirical materials drawn from primary sources that inform an assessment of Canada’s presence in the defence and security agenda of the Asia Pacific, during the period that saw Canadian governments declare a deep interest in relations with the Asia Pacific, yet fail to make Canada a full partner with sustained commitments.
The International Relations of Police Power in Settler Colonialism: The “civilizing” mission of Canada's Mounties
Authors: Bell Colleen , Schreiner Kendra
Published: April 2018

In contrast to narratives by the Royal Canadian Mounted Police, the United Nations, and some scholars that international police assistance is a relatively recent phenomenon, we argue that Canada's Mounties have always been international. To develop this argument, we examine three dimensions of police power in international relations historically and with respect to the role of the Mounties specifically. First, we discuss the concept of police power and its central role in giving rise to another concept: civilization. The concept of civilization gained considerable traction as a rationale for police power in Britain's colonies, including Canada. Second, we turn to a discussion of imperial policing in the colonial settlement of Canada involving an elaborate array of “civilizing” techniques, some of which are still in operation today. Since Confederation, the Mounties have been involved in wide-ranging state-building missions with the purpose of securing Canadian sovereignty, in part through land and resource acquisition, and the denial of Indigenous sovereignties. Third, we show that the Mounties' contributions to settler colonialism played a role in shaping international relations from the twentieth century. In particular, the Mounties were central in constituting Canada as a member of the globally dominant Anglo-Saxon community of states. In conclusion, we suggest that current international policing practices in the global periphery are not novel phenomena, but are rooted in international police powers that made possible the colonial settlement of Canada.
Why Canada needs a global education strategy
Authors: Paris Roland , Biggs Margaret
Published: April 2018

Based on the report of the Study Group on Global Education, this article explains why Canada needs a national strategy aimed at significantly increasing the number of Canadian post-secondary students going abroad for study and work-integrated learning experiences. International education may once have been viewed as an optional luxury. Now it must be seen as a vital tool to equip young Canadians – and Canada – to succeed in a more complex and competitive world.
A method for estimating localised space-use pattern and its applications in integrated land-use transport modelling
Authors: Zhong Ming , Yu Bilin , Liu Shaobo , Hunt John Douglas , Wang Huini
Published: April 2018

Contemporary integrated land-use transport models (ILUTMs) explicitly consider interactions between floorspace demand/supply and rent at fine spatial scales, which requires a good understanding between floorspace use pattern and competition of locations among socioeconomic activities. Floorspace use patterns are usually represented by space use coefficients (SUCs) by activity type by zone, which are then used to develop theoretical space-use-rent curves (SURCs), in order to reflect the elasticity between rent and floorspace consumption rates. Literature review indicates that existing studies mostly use borrowed SUCs or subjective judgement methods for synthesising base-year floorspace and developing SURCs. In general, their accuracy is largely unknown and synthesised floorspace could be highly inaccurate. In this study, a linear programming method is proposed to estimate localised SUCs by assuming that zonal population, employment and floorspace total data are available. Study results show that the method can provide localised SUCs and better SURCs than traditional methods. It is found that, as the size of the homogeneous optimisation areas (HOAs) decreases, the accuracy of zonal space totals estimated increases considerably. For example, the estimation error between the observed and estimated zonal space totals reduces from 76.2% under the most aggregate case to 24.7% under the most disaggregate case. The sum of square errors (SSEs) between the optimised SUCs and the SURCs also reduces to about one-quarter of their original values. The method proposed contributes to a procedural process to estimate localised SUCs with known accuracy, which is proved to be a better alternative to traditional synthesis methods.
Learning Clinical Integration: A Case Study Approach
Authors: Strawn Brad D. , Bland Earl D. , Flores Paul S.
Published: April 2018

The present article identifies three waves in the integration of psychology and theology literature including apologetic, model building, and empirical validation, bringing the discussion to a fourth wave, clinical integration. Rather than a model or destination, clinical integration is an emergent phenomenon of the dynamic complexity of the particular therapeutic configuration and therefore is best learned through supervisory experience, which includes observing, hearing, and reading cases. Subsequently, the articles that make up this special volume are case studies. In addition, the article notes the lack of cultural and theological diversity in the integration literature so invited authors were selected not only for their scholarship, but also for being newer voices in the field and for their personal diversity. The rewards, challenges, and ethics of writing about clinical cases are also explored.
Climate Change Is Not a Problem: Speculative Realism at the End of Organization
Authors: Campbell Norah , McHugh Gerard , Dylan-Ennis Paul
Published: April 2018

In this paper, we trace the compounding and escalation of frames to try and encompass the reality of climate change. These frames capture significant aspects, revealing new contours and extreme organizational challenges. However, what if climate change is unframeable? We locate three ontological dimensions of climate change – its unboundedness, incalculability and unthinkability – that make this case. This means that climate change is not a problem that organizations can encompass, divide or draw lines around – some ‘thing’ that can be recuperated into existing institutional, infrastructural and interpersonal frameworks. Instead, it is calling forth forms of organization without any precedent. We argue that the philosophy of speculative realism, specifically the work of Quentin Meillassoux, reveals climate change as a new World for which we do not have categories. We deploy Meillassoux’s concepts which are non-human and rational to think through what climate change is ontologically. Meillassoux’s work is characterized as the reintroduction of the old philosophical idea of the absolute, and we use it as a possible way to overcome the equivocal status of climate change without succumbing to despondency and passivity. Rather than a negative, overwhelming threat, climate change gives us what we call a bleak optimism: the realization that climate change has already happened, and that human civilization must learn how to die in a way that is a creative and just foreclosure of the Earth’s organizational forms.
Becoming part of the city: Influences on the career choice of an urban music educator
Authors: Eros John
Published: April 2018

The purpose of this case study was to examine and describe the life experiences that influenced one music teacher’s career choice to teach music in an urban school. The primary research question is: What experiences influenced the participant to pursue urban music education as a career? Calling upon research into urban music education and career choice, the article used a “secondary analysis” of survey, journal, and interview data collected in a larger investigation of the teacher career cycle, as viewed through the lens of narrative research. Findings are presented in four categories, and indicate that the teacher’s career choice was influenced by three primary elements: (a) feeling a need to be of service to others; (b) experiencing cultural differences; and (c) curiosity about the city; all of which led to (d) being a part of the city. These elements combined to form not just a career choice, but a strong sense of commitment to teaching music in a specific city. Implications for both urban music education and music teacher education are discussed, as are suggestions for further research.
Transarterial chemoembolization plus multi-imaging–guided radiofrequency ablation for elimination of hepatocellular carcinoma nodules measuring 3.1 to 5.0 cm: a single-center study
Authors: Haochen Wang , Jian Wang , Li Song , Tianshi Lv , Xiaoqiang Tong , Yinghua Zou
Published: April 2018

Objective

This study was performed to determine whether transarterial chemoembolization (TACE) plus multi-imaging–guided radiofrequency ablation (MIG-RFA) can completely eliminate 3.1- to 5.0-cm hepatocellular carcinoma (HCC) nodules and identify factors that may influence the complete elimination rate (CER) of this therapy.

Methods

Patients who underwent TACE+MIG-RFA for initial treatment of HCC from January 2008 to January 2016 were retrospectively reviewed. In total, 162 patients with 216 HCC nodules (3.1–5.0 cm) were enrolled. TACE was performed first; MIG-RFA was performed 2 to 4 weeks later. Contrast-enhanced computed tomography was performed 1, 3, 6, and 12 months after TACE+MIG-RFA. If tumor enhancement was not detected by the end of the 12-month follow-up, the lesion was considered completely eliminated. Additional TACE+MIG-RFA was performed for residual lesions. The CER was calculated 12 months after the last therapy. Factors that may influence the CER were analyzed.

Results

In total, 207 (95.8%) nodules showed no residual lesions and were completely eliminated after one or more TACE+MIG-RFA sessions. Nine (4.2%) nodules were incompletely eliminated even with repeated TACE+MIG-RFA. Tumor location was the only significant prognostic factor influencing the CER.

Conclusions

TACE+MIG-RFA can eliminate 3.1- to 5.0-cm HCC nodules; the tumor location may affect the treatment outcome.
Epithelioid Angiomyolipoma: A Case Report
Authors: Lebe Banu , Koyuncuoğrlu Meral , Tuna Burçin , Tuncer Canten
Published: April 2018

Epithelioid angiomyolipoma is a recently recognized tumor entity. We report a case of epithelioid angiomyolipoma of the kidney that occurred in a 70-year-old female. The patient presented with massive abdominal hemorrhage and shock. There was no history of tuberous sclerosis complex. The tumor consisted of smooth muscle, adipocytes, small-to-medium-sized hyalinized blood vessels and numerous pleomorphic epithelioid cells with clear to eosinophilic cytoplasm. Mitosis was exceptional and no glandular pattern was recognizable. Immunohistochemically the epithelioid cells were strongly positive for HMB45 and CD68, focally positive for S-100, actin and vimentin, and negative for epithelial markers including epithelial membrane antigen and cytokeratins. Previous reports in the English literature suggest that epithelioid angiomyolipoma may have malignant potential. In our case, at six months from surgery the patient is alive and well without evidence of relapse or metastasis.
Acute Cardiotoxicity during Capecitabine Treatment: A Case Report
Authors: Bertolini Alessandro , Fiumanò Mario , Fusco Ornella , Muffatti Albino , Scarinci Antonio , Pontiggia Gigliola , Scopelliti Massimo
Published: April 2018

Capecitabine (Xeloda®, Roche, Monza), a fluoropyrimidine carbamate, is an orally administered drug that delivers fluorouracil (5-FU) selectively to the tumor. The drug has demonstrated activity in metastatic breast cancer, pancreatic cancer and colorectal cancer.

In this case report the authors describe an unusually and reversible cardiac side effect which occurs to 39-year-old patient treated with capecitabine 2000 mg/m2/day for advanced gastric cancer.

It is important to note that the safety data from clinical trials indicate that capecitabine has a toxicity profile typical of infused fluoropyrimidines. However, none of the studies described cardiac side effects.
Parachordoma: A Case Report
Authors: Šeparović Robert , Glumbić Ivana , Pigac Biserka , Šeparović Viktor , Krušlin Božo
Published: April 2018

Parachordoma is a very rare soft tissue tumor with histological features similar to chordoma and chondrosarcoma. It should be distinguished from metastatic chordoma and extraskeletal myxoid chondrosarcoma because of its different treatment and prognosis. In this paper we report one case of parachordoma in a 20-year-old female patient. The tumor occurred in the subcutaneous tissue of the left hand as a painless, fixed, slow-growing mass. Pathologic analysis revealed a tumor composed of lobules of cells with variably vacuolated cytoplasm (physaliphorous cells) separated by fibrous septa, predominantly arranged in peculiar small or large alveolar structures. Immunohistochemistry showed positive staining of the tumor cells with cytokeratin 8/18, S-100 protein and vimentin. The patient is well and without recurrence 20 months after surgery.
Chemotherapy with Cisplatin and 5-fluorouracil Chronomodulated Infusion in Locally Advanced or Metastatic/Recurrent Carcinoma of the Cervix
Authors: Miglietta Loredana , Bruzzone Milena , Ghione Gloria , Pepe Alessio , Marenghi Cristina , Ragni Nicola , Boccardo Francesco
Published: April 2018

Aims and Background

The purpose of this study was to review our experience with the combination of circadian chronomodulated 5-fluorouracil infusion in association with cisplatin in patients with locally advanced or metastatic cancer of the cervix in order to assess the activity and tolerability of the combination.

Methods

Twenty patients with locally advanced disease and 21 patients with metastatic or recurrent disease were treated from January 1995 to May 1999. 5-fluorouracil (600 mg/m2, days 1 to 5) was administered by a continuous circadian-shaped infusion employing an external programmable portable pump; cisplatinum (20 mg/m2) was infused days 1 through 5 iv over a 2-hr period. Response to treatment was evaluated after 3 and 6 cycles of therapy. Patients with locally advanced disease who achieved a clinical shrinkage of their tumor or were at least stable were submitted to surgery; pelvic radiotherapy was administered to patients with disease progression.

Results

Seven patients with locally advanced disease achieved a partial clinical response (overall response, 35%; 95% Cl, 15.4-59.2), and 12 of 20 patients were submitted to surgery. Median progression-free and overall survival were 17 months and 36 months, respectively. Objective responses were observed in 9 of 21 patients with metastatic/recurrent disease (7 partial plus 2 minor responses: overall response 43%; 95% Cl, 21.8-65.9). Median time to progression and overall survival were 5 and 17 months, respectively.

Conclusions

Cisplatinum plus 5-fluorouracil chronomodulated infusion showed a moderate but definite activity and was well tolerated in both groups of patients. In consideration of clinical results comparable to more toxic and expensive regimens reported in the literature, the combination appears to be a reasonable option especially for women with metastatic/recurrent cervical carcinoma and a promising treatment in combination with definitive radiotherapy in patients with locally advanced disease.
Reliability and Accuracy of Sentinel Node Biopsy in Cutaneous Malignant Melanoma
Authors: Carcoforo P , Soliani G , Bergossi L , Basaglia E , Virgili AR , Pagani W , Pozza E , Feggi LM
Published: April 2018

Aims and Background

The aims of this study were 1) to investigate whether sentinel lymph node (SLN) biopsy could become the method of choice for the early detection of metastatic disease in patients with malignant melanoma and 2) to identify those patients with lymph node metastases who could benefit from regional lymphadenectomy.

Methods and Study Design

Our study started in March 1998 and involved 110 patients with primary cutaneous malignant melanoma stage I or II (AJCC) in whom the primary lesion had been surgically removed no more than 90 days previously. On the day of lymph node dissection patients were given an intradermal injection of colloid particles of human serum albumin labeled with technetium-99m and an injection of isosulfan blue. The surgical procedure was usually performed with local anesthesia but in some cases locoregional or general anesthesia was preferred. Contralateral and ipsilateral lymphatic areas were scanned with a hand-held gamma camera (Scintiprobe MR 100) to measure the background and identify the hot point indicating the location of the sentinel node to direct the incision.

Results

The combined use of lymphoscintigraphy, isosulfan blue and gamma probe allowed us to identify sentinel nodes in 108 of 110 patients (98.18%) while the SLN was blue in only 90 cases (81.81%). The SLN was positive for metastases in 13 of the 108 patients (12.03%) and regional and distal lymphadenectomy was performed in all of them. The distribution of positive SLNs by primary lesion thickness was as follows: 0.76-1.5 mm: one positive SLN/44 patients (2.27%); 1.51-4 mm: six positive SLNs/51 patients (11.7%); >4 mm: six positive SLNs/15 patients (40%). Only four of 12 patients with ulcerated cutaneous melanoma had positive SLNs. The patients in our study underwent follow-up visits every four months. The median follow-up was 481 days (range, 97-1271 days).

Conclusions

In patients with primary cutaneous melanoma the histological status of the SLN accurately reflects the presence or absence of metastatic disease in the relevant regional lymph node basin. Complete lymph node dissection should only be performed in patients with positive SLNs. Patients with lesions >4 mm are likely to develop recurrences and to die of systemic disease, so in these patients the usefulness of SLN biopsy is questionable. In conclusion, sentinel node mapping is a rational approach for the selection of patients who might benefit from early lymph node dissection of the affected basin.
Clinical Application and Dosimetric Calibration Procedure of the Superficial and Orthovoltage Therapy Unit Therapax Dxt300
Authors: Malinverni Giuseppe , Stasi Michele , Baiotto Barbara , Giordana Carla , Scielzo Giuseppe , Gabriele Pietro
Published: April 2018

Aims and Background

The aim of this study was to configure a new superficial and orthovoltage therapy unit for clinical use and discuss the clinical indications for this kind of energy. There is renewed interest in radiotherapy using photon beams in the range from 40 to 300 kVp, in particular for the treatment of non-neoplastic diseases and superficial lesions. This is due to the fact that the latest units are of good quality, relatively cheap and reliable in comparison with alternative equipment. It is therefore necessary to document the steps involved in the clinical application of this therapeutic equipment.

Methods

The calibration procedure for a new superficial/orthovoltage therapy unit, Therapax DXT300 (Pantak, USA), installed at the Radiotherapy Department of the Mauriziano Hospital in Turin, was carried out by measurement of beam quality (half-value layer, HVL), percentage depth dose (PDD), profiles, internal dosimetry system, dose rate calibration and output factors. The Therapax DXT300 can be programmed to stop treatment either by time or dose, like a linear accelerator. It is equipped with one adjustable collimator (2 × 2 ÷ 20 × 20 cm2) for orthovoltage therapy (focus skin distance, FSD = 50 cm) and six fixed applicators for superficial and orthovoltage therapy (FSD = 30 and 50 cm, respectively). Up to eight combinations of generating potential, tube current and added beam filter can be set.

Results

In the range of accelerating potentials from 40 to 300 kVp the Therapax provides beams with HVL ranging from 1.48 mm Al to 3.68 mm Cu. As regards the PDD curves, a slight difference between PDD values has been observed with potentials ranging from 200 to 300 kVp. The beam symmetry and flatness are almost the same in Y and X plane directions for accelerating potentials of less than 200 kVp. At higher kVp values these parameters are significantly worse in the anode-cathode axis direction, because the useful X-ray beam is extracted perpendicular to the anode-cathode axis direction: as the energy increases, the bremsstrahlung becomes more forward directed, resulting in a higher dose rate on the anode side.

Conclusion

The present paper suggests a methodological approach for the clinical application of an orthovoltage/superficial therapy unit and discusses its current indications. It is necessary to maintain the performance of the equipment within predefined limits in order to meet the requirements of an efficient quality assurance program. This unit is particularly useful in the treatment of superficial lesions and non-neoplastic diseases and in palliative care (eg for bone metastases).
Cisplatin Treatment Triggers Familial Mediterranean Fever Attacks
Authors: Toubi Elias , Gershoni-Baruch Ruth , Kuten Abraham
Published: April 2018

A 42-year-old familial Mediterranean fever (FMF) patient who was treated with cisplatin-based chemotherapy for adenocarcinoma of the lung developed severe and frequent attacks of FMF during treatment. Abdominal pain, arthralgia and fever occurred for a few days following each cisplatin cycle. His FMF worsened, the abdominal pain and fever lasted longer and treatment with colchicine was ineffective. It has been hypothesized that the link between cisplatin treatment and FMF attacks lies in an increased production of serotonin, IL-6, IL-1, IL-8 and TNF-alpha. These inflammatory cytokines have been reported to be overproduced during cisplatin treatment and are known to play an important role in FMF relapse. The oncologist should be made aware of the possibility of disease aggravation in FMF patients during cisplatin-based chemotherapy.
Breast MRI Screening in Patients with Increased Familial and/or Genetic Risk for Breast Cancer: A Preliminary Experience
Authors: Trecate Giovanna , Vergnaghi Daniele , Bergonzi Silvana , De Simone Tiziana , Fengoni Elena , Costa Claudia , Spatti Gianbattista , Pasini Barbara , Manoukian Siranoush , Podo Franca , Musumeci Renato
Published: April 2018

Aims and background

Breast cancer is the most common cancer affecting women, and it is associated with or due to a genetic predisposition in 5%-10% of the cases. Owing to the higher risk of developing breast cancer and the early onset of the disease in women proved or suspected to be carriers of a breast cancer susceptibility gene, a dedicated screening should be offered as a less invasive approach with the otherwise suggested prophylactic mastectomy. This should be optimized in order to overcome the limitations of conventional breast imaging with the application of new technologies such as breast magnetic resonance imaging.

Methods

A diagnostic protocol for routine control in patients at high risk of developing breast cancer has been prepared. Within a 7-month period, 23 patients suspected or proved to carry a breast cancer susceptibility gene underwent breast magnetic resonance imaging.

Results

Four breast cancers were identified with breast magnetic resonance imaging. In these cases, mammography was negative because of the density of the parenchyma or for its fibroglandular pattern. Ultrasound was negative in 2 cases, not specific for malignancy in 1 case, and considered as only possibly malignant but with biopsy recommendation on the basis of magnetic resonance findings in the last one. Clinical analysis was positive for a mass in 2 cases.

Conclusions

The accuracy of breast magnetic resonance imaging is known to be higher than that of conventional imaging in the study of breast parenchyma. High spatial resolution, no breast density influence and multiplanarity can give more detailed information about the smaller lesions and the right extension of the disease. Preliminary studies where breast magnetic resonance imaging is performed in addition to mammography within this group of patients are encouraging. We also believe that the application of breast magnetic resonance imaging can be very useful in the detection of cancer as early as possible with the aim to obtain the highest chance of survival after treatment.
Clinical Experience on Eight Cases of Merkel Cell Carcinoma
Authors: Cirillo Fernando , Buononato Massimo , Lima Gianfranco , Cafaro Ines , Alquati Palmiro
Published: April 2018

Merkel cell carcinoma is a rare neuroendocrine neoplasm of the skin. The tumor most frequently affects elderly patients, with a preference for the head and neck. Eight patients affected by Merkel cell carcinoma have been observed at the General Surgery Unit II of the “Istituti Ospitalieri” hospital in Cremona, each in different stages of the disease; 75% of the cases involved the extremities, and in nearly all of the cases the tumor was nodular in appearance, with an average diameter of 2.2 cm. In 2 cases, the tumor was associated with rheumatoid arthritis, suggesting a dependency on the part of the neoplasm on the immune disorder and on steroid treatment. The available data confirm that in stage I of the disease, surgical treatment should be associated with radiotherapy in order to control the development of local relapses or metastases over time. In this stage, we observed a survival of 34 months (range, 24-48). In stages II and III, survival time falls, with very short duration of responses and poor quality of life as a result of the administration of cytotoxic molecules. Bearing in mind that any local relapse tends to appear within 12 months of the removal of the primitive tumor, that lymph node metastases appear in almost half of the patients, and that metastases over time are manifested in over a third of patients, it is essential to adopt a treatment capable of balancing the demand for longer remissions with a better quality of life. In this situation, we observed that treatment with somatostatin analogues achieves interesting responses without side effects, which suggests a close biological relationship between the tumor and somatostatin and that making a careful assessment of the prognostic factors of the disease can guarantee a correct therapeutic choice.
Preoperative Concomitant Radiotherapy and Chemotherapy in Ultrasound-Staged T3 and T4 Rectal Cancer
Authors: Luppi Gabriele , Santantonio Mario , Bertolini Federica , Fiorica Francesco , Zanelli Francesca , Gavioli Margherita , Balli Mario , Silingardi Vittorio
Published: April 2018

Background

To analyze early results of a single institution's experience using neoadjuvant chemoradiotherapy in locally advanced, ultrasound-staged rectal cancer.

Patients and methods

Since 1998, 67 consecutive patients (36 males and 31 females; mean age, 59.5) have received preoperative combined treatment for T3 or T4 rectal cancer. All patients were staged by endorectal ultrasound and computed tomography, and all had a pathology-demonstrated invasive adenocarcinoma of the rectum. Patients were treated preoper-atively with concomitant radiochemotherapy: pelvic irradiation (50 Gy in 25 fractions) and protracted-venous-infusion 5-fluorouracil (225 mg/m2/d, 7 days per week). Patients were restaged within 4 weeks, then submitted to surgery within 6-7 weeks after the end of therapy. Adjuvant postoperative chemotherapy with 5-fluorouracil plus folinic acid - the “de Gramont” schedule – for 24 weeks was purposed to all patients.

Results

Radiotherapy was completed in all cases; only one patient required suspension of the treatment for grade 4 toxicity (diarrhea). Instead, chemotherapy was interrupted in 3 cases (2 for central venous catheter thrombosis and 1 for grade IV diarrhea). Sixty-six patients underwent surgical resection (1 patient died before surgical treatment). Radical surgery was performed in 94%, and 46% of the 26 patients with distal rectal cancer had a conservative sphincter-sparing surgery. A complete pathologic response (defined as no evidence of viable tumor cells) was obtained in 22%. At a median follow-up of 17 months, distant metastases have been observed in 10 patients, and 3 of them developed a local recurrence. The actuarial estimations of 4-year overall survival, disease-free survival, local and distant control are 79%, 61%, 94% and 61%, respectively.

Conclusions

Preoperative chemoradiotherapy seems to be an effective and well-tolerated treatment with a low complication rate. The high percentage of downstaging and sphincter sparing, also in distal rectal cancer, shows the efficacy of the treatment, which could significantly influence the incidence of relapses and quality of life.
Non Clinical Factors as Determinants of the Use of Breast Conservative Surgery in Italy
Authors:   The Italian Group for the Evaluation of Outcomes in Oncology (IGEO), Porzio Giampiero
Published: April 2018

The aims of the study were to evaluate the trend of breast conservative surgery (BCS) in Italian breast cancer patients and to identify its nonclinical determinants. Data of 2062 patients surgically treated patients for primary breast cancer were evaluated; 788 (38.0%) had been submitted to breast conservative surgery. A different percentage of breast conservative surgery was found with respect to geographic patient's residence (North, 41.1%; Central, 37.6%; South, 33.0%). Multifactorial analysis showed that time since diagnosis, age at diagnosis and nonclinical factors, such as geographic area of residence and level of education, were significantly associated with breast conservative surgery.
Italian General Practitioners and Smoking Cessation Strategies
Authors: Pizzo Anna Maria , Chellini Elisabetta , Grazzini Grazia , Cardone Antonella , Badellino Fausto
Published: April 2018

Aims and Background

General practitioners (GPs) are in a key position to intervene with patients who smoke. The cornerstone of a smoking cessation strategy should be the routine provision of brief advice and follow-up in primary care. However, it seems GPs do not often take action against smoking, at least in Italy as shown by previous reports. The survey was planned, in the context of the “GPs Empowerment Project”, a collaborative project involving Denmark, France, Greece, Italy and Portugal, under the ENSP contract with the European Commission (Health & Consumer protection Directorate-General), to evaluate the general attitude, knowledge and behavior of GPs regarding smoking cessation methods.

Methods

A total of 729 family doctors, 409 in Northern and 320 in Southern Italy, were interviewed by phone in the period July-October 2000 regarding their personal smoking habits and their approach with patients on the topic. Prevalence rates were computed using the Epi INFO 6.0 software and were presented as the unadjusted percentage prevalence.

Results

The percentage of current smokers among GPs included in the survey was 28.3%, with a higher prevalence in the south (33.3%). Most of the GPs believe that it is their duty to give information about smoking cessation (96.8%) and consider giving information about smoking cessation to their patients an important intervention (98.5%), but only about 49% think their patients will accept their advice. Most GPs (87.3%) declared having discussed about tobacco use with their patients during the month preceding the interview, and 83.5% would like to be trained on smoking cessation strategies.

Conclusions

The results show that, in order to implement primary prevention in clinical practice in Italy, it appears essential to reduce the number of GPs who smoke and to improve GP training on smoking cessation procedures.
Treatment of Desmoids and Mesenteric Fibromatosis in Familial Adenomatous Polyposis with Raloxifene
Authors: Tonelli Francesco , Ficari Ferdinando , Valanzano Rosa , Brandi Maria Luisa
Published: April 2018

Background

Among the great variety of extracolonic manifestations of familial adenomatous polyposis, the most serious are desmoids and fibromatosis of the abdominal cavity. These may be a danger to the patient and a concern to the clinician. Pharmacological management of this relentless problem is favored by surgical intervention. At present, however, beneficial actions of medical therapy are not separable from undesirable side effects.

Methods

We studied the effects of 120 mg daily of raloxifene, a non-steroidal benzothiophene, on progressive desmoid tumors and mesenteric fibromatosis by evaluation of lesion size and symptoms in 13 patients with familial adenomatous polyposis, selected on the basis of intra-abdominal localization of the lesion, on refractoriness to other medical treatments, and on estrogen receptor-α expression.

Results

The patients had a significant response to raloxifene therapy, with complete remission in 8 cases and partial response in 5 cases, evaluated by regression of symptoms and tumor size. Serum biochemical parameters did not show any significant changes. Side effects were never observed.

Conclusions

Although the number of patients included in the study is limited and in spite of some limitations, the available results support that, in the evaluation of response, daily therapy with raloxifene decreases desmoid tumor and mesenteric fibromatosis size and symptoms and does not cause side effects. These findings offer a novel option in the pharmacological treatment of desmoids, leading to medical therapy of these neoplastic lesions in familial adenomatous polyposis patients.
Pulmonary and Peribronchial Lymph Node Tumorlets: Report of a Case and Review of the Literature
Authors: Demirağ Funda , Altınok Tamer
Published: April 2018

A 38-year-old man underwent a left lower lobectomy and lingulectomy for bronchiectasis. On macroscopic examination the lungs were bronchiectatic. Microscopically, multiple tumorlets were detected in the lung parenchyma. One peribronchial lymph node contained a tumorlet. We discuss the case and review the literature on this rare entity.
Epic-Italy Cohorts and Multipurpose National Surveys. A Comparison of Some Socio-Demographic and Life-Style Characteristics
Authors: Calza Stefano , Specchia Claudia , Frasca Graziella , Tumino Rosario , Sacerdote Carlotta , Fiorini Laura , Galasso Rocco , Ciardullo Anna Vittoria , Palli Domenico , Salvini Simonetta , Krogh Vittorio , Sieri Sabina , Decarli Adriano
Published: April 2018

Background

EPIC-Italy cohort study recruited subjects who voluntarily accepted to participate in the project. From the self-selected bases of the population sample, some bias could derive in the data interpretation when risk estimation for cancer disease related to life-style factors is the principal concern. Knowledge of the bias related to self-selected sampling is important for better directing the interpretation of the EPIC-Italy study results.

Methods

We investigated the characteristics of volunteer subjects recruited in the EPIC-Italy cohorts and compared them with those of the randomly selected subjects recruited in the Multipurpose ISTAT Surveys realized in the same period (1993-1998) in which the Epic-cohorts were recruited.

Results

We found some differences, and in particular a different attitude towards cigarettes smoking and wine consumption, between the EPIC cohort and the Multipurpose ISTAT Surveys, as well as among geographical areas within the EPIC cohort.

Conclusions

The uneven distribution of some characteristics suggests that the self-selected subjects were characterized by an overall lower consumption of wine and cigarette smoking even when the educational level was considered. This could suggest a generally more healthy life-style among subjects recruited on a volountary bases.
Association between Social Class and Food Consumption in the Italian Epic Population
Authors: Vannoni Francesca , Spadea Teresa , Frasca Graziella , Tumino Rosario , Demaria Moreno , Sacerdote Carlotta , Panico Salvatore , Celentano Egidio , Palli Domenico , Saieva Calogero , Pala Valeria , Sieri Sabina , Costa Giuseppe
Published: April 2018

Aims and background

The objectives of the present study were to validate the social stratification variables adopted by the European Prospective Investigation into Cancer and Nutrition (EPIC) by comparing them with data from another independent source and to evaluate the geographic and social distribution of eating habits in the Italian EPIC population.

Methods

The validation of the socioeconomic data collected by the EPIC study was performed with the Turin Longitudinal Study as gold standard and using Cohen's kappa statistics to evaluate the concordance between the studies. We then analyzed food groups based on the consumption of meat and fats, carbohydrates, sweets and alcohol, and on an index of the Mediterranean diet. The standardized scores for each food group were subdivided into quartiles, which were used to compare persons in the extreme quartiles. Analysis of the differences in eating habits by center and by educational level was conducted separately for men and women, calculating the prevalence rate ratios and controlling for age, area of birth and body mass index.

Results

Concordance between the two data sources was high for educational level and low for the social-class index based on occupation. Most of the eating habits considered to be potentially harmful (high consumption of meat or fats and alcohol and low consumption of olive oil and fish) were more frequent in Northern than in Southern Italy. These habits were inversely correlated with educational level, especially in the South.

Conclusions

A significant improvement in health could be obtained in the Italian population if culturally and socioeconomically disadvantaged individuals were to abandon their diet rich in meat and fats, as done by more advantaged persons. In the absence of preventive interventions specifically addressed to disadvantaged groups, it is likely that social inequalities in mortality and morbidity will increase.
Outcome of Surgical Treatment of Carcinoma of the Pancreas
Authors: Freda Fulvio , Nunziata Luigi , Antropoli Massimo , D'Amodio Amodio Salvatore , Manganiello Amelia , Petronella Pasquale
Published: April 2018

Aims and background

Pancreatic resections for neoplastic diseases have a high risk of severe intra- and postoperative complications and are associated with high mortality rates. They should be performed as a rule in centers specializing in this type of surgery. However, it is becoming increasingly likely that such tumors may have to be treated in surgery units which are not specifically dedicated to pancreatic surgery. The aim of this study was to assess the improvements in clinical results in a non-specialized general surgery setting in the light of the most recent progress in surgical techniques, drug treatments and nutritional support.

Methods and study design

We analyzed 48 patients with pancreatic cancer treated in our institution over the period from 1980 to 1998: 36 had cancer of the head of the pancreas, 5 of the ampulla, 1 in the second duodenal portion, and 6 of the body-tail. The operations performed consisted of 13 Whipple pancreaticoduodenectomies with cutting and stapling of the distal pancreatic stump at the level of the isthmus, 4 left pancreasectomies, 2 local resections of the ampulla, 21 palliative operations, and 2 exploratory laparotomies.

Results and conclusions

The patients were submitted to follow-up including clinical examinations, blood-chemistry tests, and instrumental investigations. The mean survival was 18 months in the cases where radical surgery was performed, compared to 11 months after palliative surgery. We conclude that an improved prognosis can obtain after pancreatic resection. This is attributable to a more accurate preoperative staging and to the aid of the various forms of nutritional support and pharmacological prophylaxis currently available.
Early Results after Radiofrequency-Assisted Liver Resection
Authors: Navarra Giuseppe , Lorenzini Cesare , Currò Giuseppe , Basaglia Ernesto , Habib Nagy H
Published: April 2018

Aims and background

Intraoperative blood loss during liver resection remains a major concern due to its association with higher postoperative complications and shorter long-term survival. The aim of this study was to assess the feasibility and safety of a novel concept for liver resection using a radiofrequency energy-assisted technique.

Methods

From January 2001 to July 2002, 42 patients were operated on using radiofrequency energy-assisted liver resection. Radiofrequency energy was applied along the resection edge to create a ‘zone of desiccation’ prior to resection with a scalpel.

Results

Median resection time was 50 mins (range, 30–110). The median blood loss during resection was 30 mL (range, 15–992). Mean preoperative and postoperative hemoglobin values were 13.7 g/dL (SD ± 1.6) and 11.8 g/dL (SD ± 1.4), respectively. No blood transfusion was registered, nor was any mortality observed. There were 3 postoperative complications, one subphrenic abscess, one chest infection and one biliary leak from a hepatico-jejunostomy. Median postoperative stay was 8 days (range, 5–86).

Conclusions

Liver resection assisted by radiofrequency energy is feasible, easy and safe. This novel technique offers a new method for ‘transfusion-free’ resection without the need for sutures, ties, staples, tissue glue or admission to an intensive care unit.
Pharmacoeconomic Comparison between Chronochemotherapy and Folfox Regimen in the Treatment of Patients with Metastatic Colorectal Cancer: A Cost-Minimization Study
Authors: Tampellini Marco , Bitossi Raffaella , Brizzi Maria Pia , Saini Andrea , Tucci Marcello , Alabiso Irene , Dogliotti Luigi
Published: April 2018

Aims and background

The addition of oxaliplatin to the widely employed De Gramont schedule (FOLFOX regimen) in patients with metastatic colorectal cancer improved their outcome with a moderate toxicity pattern. The adaptation of the delivery rate of 5-fluorouracil, leucovorin and oxaliplatin to circadian rhythms (chronotherapy) resulted in a very high drug tolerability with clinical results at least comparable to those achieved with the FOLFOX regimen. However, chronomodulated infusion seemed to be more expensive, requiring dedicated electronic pumps and several disposable materials. The present study aimed to compare the direct costs of the two regimens and to determine whether chronotherapy was effectively more expensive than the FOLFOX regimen.

Study design

The direct costs of drug delivery devices derived from various publicly available sources and of toxicity management as extrapolated from two published studies considering comparable patient subsets were added and compared.

Results

Pump, central venous system and disposable materials for a single chronotherapy cycle were € 193 or € 212 according to whether the pumps were bought or rented, compared to € 58 for the FOLFOX regimen. Toxicity management costs were € 144 vs € 288 for the two schemes, respectively. Globally, a single course of chronotherapy cost € 337 or € 356, whereas a single FOLFOX cycle cost € 346.

Conclusions

Direct costs for a single chronotherapy cycle appeared to be comparable to a single course of the FOLFOX regimen. In fact, the major material cost of chronochemotherapy devices was balanced by a better tolerability profile. The overall improvement in quality of life with chronochemotherapy affecting indirect costs, such as reduction of work, and intangible costs is worthy of further pharmacoeconomic attention.
Carboplatin and Gemcitabine in the Palliative Treatment of Stage IV Non-Small Cell Lung Cancer: Definitive Results of a Phase II Trial
Authors: Tassinari Davide , Fochessati Francesca , Arcangeli Valentina , Sartori Sergio , Agostini Vanessa , Fantini Manuela , Genestreti Giovenzio , Grassia Sergio , Ioli Giorgio , Imola Manuela , Iorio Domenico , Mianulli Anna Maria , Monticelli Giancarla , Oliverio Giovanni , Panzini Ilaria , Papi Maximilian , Poggi Barbara , Polselli Antonio , Pulini Stefano , Tamburini Emiliano , Fattori Pier Paolo , Ravaioli Alberto
Published: April 2018

Background

Cisplatin-containing regimens represent the gold standard in the treatment of advanced non-small cell lung cancer, but carboplatin is often preferred for its better toxic profile when palliation is the aim of the treatment. The synergistic effect and tolerability of carboplatin-gemcitabine combination are well known. In this phase II trial, we evaluated the activity and safety of a schedule with carboplatin and gemcitabine, defined in our previous phase I trial.

Methods

Thirty-seven patients with measurable stage IV non-small cell lung cancer were treated with carboplatin, AUC 4.5 mg/ml/min on day 1, and gemcitabine, 800 mg/m2 on days 1 and 8, every 21 days. All patients were treated until disease progression or intractable toxicity and were evaluated before each course of chemotherapy for toxicity and after every 3 courses for response.

Results

After a median follow-up of over 10 months, complete response, partial response, and stabilization of the disease were observed in 3 (8.1%), 9 (24.3%), and 15 patients (40.5%), respectively. Median time to progression was 7 months. At this writing, 27 patients have died, with a median survival of 10 months, and 29 (78.3%), 16 (43.2%), and 11 (29.7%) patients are alive after 6, 12, and 15 months of follow-up, respectively. Toxicity was mild, and mainly hematological, with a significant correlation with the number of courses of chemotherapy (P = 0.0003).

Conclusions

Our results are comparable with those reported in the literature and confirm the good activity and tolerability of the carboplatin-gemcitabine combination. Up to 4 courses of chemotherapy with carboplatin and gemcitabine may represent an interesting option in the palliative treatment of non-small cell lung cancer.