bluuebunny/crossref_metadata_2025 huggingface dataset:
Treated knitted fabric for hip-protective pads for elderly women, part I: force attenuation capacity
Authors: Wardiningsih Wiah , Troynikov Olga
Published: April 2018

This paper describes a study of hip-protective pads made from warp-knitted spacer fabric treated with shear thickening fluid (STF). Hip fractures, mostly caused by falls, are a substantial contributor to morbidity and mortality in the elderly, and incidence is rising worldwide. Hip-protective pads reduce fractures, but wearing adherence is poor. Protective pads made from breathable and comfortable fabrics can improve adherence and prevent more hip fractures. In this research, warp-knitted spacer fabrics were treated with STF using different methods. Treatment 1 involved STF and room-temperature vulcanizing silicone, while treatment 2 applied STF and tetraisopropyl titanate. The effects on force attenuation capacity of each treatment method, the amount of STF used, and fabric layering were measured using drop impact tests. Treated knitted spacer fabric had significantly higher force attenuation capacity than untreated knitted spacer fabric. Impact forces decreased as the number of layers increased and as STF concentrations rose. Treatments 1 and 2 produced fabrics with force attenuation capacity similar to that of closed-cell foam.
Feeling Interpersonally Controlled While Pursuing Materialistic Goals: A Problematic Combination for Moral Behavior
Authors: Sheldon Kennon M. , Sommet Nicolas , Corcoran Mike , Elliot Andrew J.
Published: April 2018

We created a life-goal assessment drawing from self-determination theory and achievement goal literature, examining its predictive power regarding immoral behavior and subjective well-being. Our source items assessed direction and energization of motivation, via the distinction between intrinsic and extrinsic aims and between intrinsic and extrinsic reasons for acting, respectively. Fused source items assessed four goal complexes representing a combination of direction and energization. Across three studies ( Ns = 109, 121, and 398), the extrinsic aim/extrinsic reason complex was consistently associated with immoral and/or unethical behavior beyond four source and three other goal complex variables. This was consistent with the triangle model of responsibility’s claim that immoral behaviors may result when individuals disengage the self from moral prescriptions. The extrinsic/extrinsic complex also predicted lower subjective well-being, albeit less consistently. Our goal complex approach sheds light on how self-determination theory’s goal contents and organismic integration mini-theories interact, particularly with respect to unethical behavior.
Diagnostic Accuracy of Tuning Fork Tests for Hearing Loss: A Systematic Review
Authors: Kelly Elizabeth A. , Li Bin , Adams Meredith E.
Published: April 2018

Objective

(1) To determine the diagnostic accuracy of tuning fork tests (TFTs; Weber and Rinne) for assessment of hearing loss as compared with standard audiometry. (2) To identify the audiometric threshold at which TFTs transition from normal to abnormal, thus indicating the presence of hearing loss.

Data Sources

PubMed, Ovid Medline, EMBASE, Web of Science, Cochrane, and Scopus and manual bibliographic searches.

Review Methods

A systematic review of studies reporting TFT accuracy was performed according to a standardized protocol. Two independent evaluators corroborated the extracted data and assessed risk of bias.

Results

Seventeen studies with 3158 participants, including adults and children, met inclusion criteria. The sensitivity and specificity of the Rinne test for detecting conductive hearing loss ranged from 43% to 91% and 50% to 100%, respectively, for a 256‐Hz fork and from 16% to 87% and 55% to 100% for a 512‐Hz fork. The audiometric thresholds at which tests transition from normal to abnormal ranged from 13 to 40 dB of conductive hearing loss for the Rinne test and from 2.5 to 4 dB of asymmetry for the Weber test. Significant heterogeneity in TFT methods and audiometric thresholds to define hearing loss precluded meta‐analysis. There is high risk of bias in patient selection for a majority of the studies.

Conclusion

Variability exists in the reported test accuracy measurements of TFTs for clinical screening, surgical candidacy assessments, and estimation of hearing loss severity. Clinicians should remain mindful of these differences and optimize these techniques in specific clinical applications to improve TFT accuracy.
Diversity in Otolaryngology Residency Programs: A Survey of Otolaryngology Program Directors
Authors: Newsome Hillary , Faucett Erynne A. , Chelius Thomas , Flanary Valerie
Published: April 2018

Objective

As the population of the United States becomes increasingly racially and ethnically diverse, it is important that the medical profession reflect these changes. Otolaryngology has previously been identified as one of the surgical subspecialties with the smallest presence of those underrepresented in medicine. In the context of this study, the term underrepresented in medicine is defined as blacks, Latinos, Native American, and Native Hawaiians. The purpose of this study was to describe the current state of otolaryngology residency programs in terms of diversity of resident and faculty cohort, explore general interviewing practices, and investigate recruitment of underrepresented in medicine applicants.

Study Design

Survey via electronic questionnaire.

Setting

Academic otolaryngology residency programs.

Subjects and Methods

A 14‐item survey was distributed to 105 program directors asking them to consider their program's past 15 years of existence.

Results

With a response rate of roughly 30%, we found that over one‐third of responding programs had matriculated 1 or fewer underrepresented in medicine residents. There was a statistically significant association between the number of underrepresented in medicine faculty and the number of underrepresented in medicine residents matriculated (P =. 02).

Conclusion

The authors stress the importance of underrepresented in medicine faculty mentorship. Although not statistically significant in this study, increasing the number of underrepresented in medicine applicants interviewed, as well as recommending outreach programs, may help to improve underrepresented minority matriculation into residency programs as demonstrated in the literature.
U.S. Feminism, 1968 and Mediated Collective Intellectuality
Authors: Bratich Jack Z.
Published: April 2018

In response to the editorial call to examine the legacy of 1968 and critical intellectual formations, this short paper maps some of the feminist intellectual practices in and out of the university system around that era. The paper focuses on intellectuality defined via three features: publication, pedagogy, and peer development; in sum, peer transmission of analysis and know-how.  Along the way, we find parallel educational institutions, small scale media production, biopolitical information transmission, and underground support networks. 1968 was a pivotal year for the development of collective intelligence within movements, forged through media ecologies, using academia as a site and resource while not being contained in it. This feminist intellectual production illuminates contemporary feminist mediated intellectuality as part of the “Long ’68.”
“He Is Just the Nowhere Man of British Politics”: Personal Attacks in Prime Minister’s Questions
Authors: Waddle Maurice , Bull Peter , Böhnke Jan R.
Published: April 2018

Views from the media, the public, and from inside Parliament have expressed discontent with, reportedly, recent high levels of personally antagonistic behavior in Prime Minister’s Questions. The focus of this study is a fine-grained analysis of language classified as a personal attack. A personal attack coding system was devised, and significant individual differences between Prime Ministers and increases across individual premierships were observed. Of the five Prime Ministers between 1979 and 2016, David Cameron was the most personally aggressive, though a significant decrease followed Jeremy Corbyn’s appointment as Leader of the Opposition. Potential explanations for recent highs include heightened TV and social media attention coupled with sports-like reporting and party expectation, and not discounting individual personalities or intergroup theories. Suggestions for the functions of personal attacks include highlighting differences, disarming or deconstructing adversaries, and equivocation. Further explanations are offered for the relative politeness of Cameron versus Corbyn.
Clinical Management of a Case of Recurrent Apocrine Gland Carcinoma of the Scalp: Efficacy of a Chemotherapy Schedule with Methotrexate and Bleomycin
Authors: Morabito Alessandro , Bevilacqua Pierantonio , Vitale Stefano , Fanelli Massimo , Gattuso Domenico , Gasparini Giampietro
Published: April 2018

Apocrine carcinoma of the skin is a rare tumor. Wide surgical excision with complete removal of the neoplasm is the standard therapy and this appears to offer the best chance of cure. Radiotherapy may be used in case of local relapse or regional lymph node involvement. Systemic chemotherapy has not proved to be effective in the treatment of this tumor. We report on a 46-year-old woman with a recurrent apocrine carcinoma of the scalp that had previously been treated with surgery, radiotherapy and chemotherapy (Al-Saraff schedule). The patient was responsive to a second-line systemic chemotherapy regimen consisting of a weekly combination of methotrexate and bleomycin, and achieved long-term progression-free survival.
A Young Female Patient with An Androgen-Secreting Tumor: A Rare Malignant Disease
Authors: Bozbora Alp , Erbil Yesim , Özbey Nese , Kapran Yersu , Özarmagan Selçuk , Berber Eren , Molvalilar Senay
Published: April 2018

A 23-year-old female patient presented with hirsutism and fatigue nine months after delivery. Endocrine assessment showed high testesterone, DHEA-S and androstenedione levels. Abdominal computed tomography and ultrasonography revealed the presence of a large tumor in the right renal region. Right adrenalectomy was performed resulting in a diagnosis of a functional adrenal tumor. Pathological examination showed a steroidogenically active tumor. Adjuvant chemothe-raphy was administered postoperatively. At three months following surgery all endocrinological tests normalized, but liver metastases were detected by abdominal CT. Eight months after the operation the patient died of hepatic and renal failure. Androgen-secreting adrenal tumors are seen very rarely, yet the prognosis is poor due to their agressive nature.
Concomitant Chemoradiotherapy Followed by Adjuvant Chemotherapy in Parotid Gland Undifferentiated Carcinoma
Authors: Airoldi Mario , Gabriele Anna Maria , Gabriele Pietro , Pedani Fulvia , Marchionatti Sara , Succo Giovanni , Beatrice Fabio , Bumma Cesare
Published: April 2018

Aims and background

Undifferentiated carcinoma of the parotid gland is a poor-prognosis lesion. Results in unresectable lesions, treated with radiotherapy alone, are very disappointing.

Methods

Six patients with T3-4 N0-1 inoperable lesions were treated with conventional radiotherapy (64-70 Gy, 2 Gy per fraction 5 times a week) and concomitant cisplatin (100 mg/m2, days 1, 22 and 43). Four weeks after radiotherapy, adjuvant chemotherapy (cisplatin, 80 mg/m2, day 1, + VP16, 100 mg/m2, days 1, 3 and 5, q = 3 weeks, for 3 cycles) was given.

Results

A median dose of 66 Gy (range, 64-70 Gy) was delivered, and all patients recived 3 courses of cisplatin during radiotherapy. Five of 6 patients recived all three chemotherapeutic adjuvant courses. Two months after the end of treatment, 3 CR (50%), 2 PR (33%) and 1 NC (16%) was observed. Median CR and PR duration was 26+ and 10 months, respectively. Median overall survival was 18 months. No severe acute or late toxicity was observed.

Conclusions

Concomitant chemoradiotherapy followed by adjuvant chemotherapy in advanced unresectable undifferentiated parotid carcinoma is feasibile and well tolerated. The high percentage of long-lasting CR is encouraging.
Fourteen-Day Infusion of Ifosfamide in the Management of Advanced Breast Cancer Refractory to Protracted Continuous Infusion of 5-Fluorouracil
Authors: Di Lauro Vincenzo , Spazzapan Simon , Lombardi Davide , Paolello Concetta , Scuderi Cristina , Crivellari Diana , Magri Maria Donatella , Veronesi Andrea
Published: April 2018

Aims and background

Ifosfamide is an active drug in advanced breast cancer. Short-term continuous infusion schedules have been evaluated with encouraging results. The aim of the study was to evaluate in patients with advanced breast cancer a 14-day infusion schedule previously tested at our center in soft tissue sarcomas.

Methods

From July 1998 to February 2000, 26 consecutive patients with heavily pretreated breast cancer, progressing during protracted continuous infusion of fluorouracil, were treated with ifosfamide at the dose of 800 mg/m2/day for 14 consecutive days by means of an eiastomeric pump via an indwelling Groshong catheter. The median age of the patients was 52 years (range, 32-67) and median PS was 1 (range, 1-3). All patients were pretreated with anthracyclines or taxanes; the median number of chemotherapy lines in the metastatic phase was 2 (range, 1-4). Predominant metastatic sites were soft tissues in 5 patients, lung in 6, liver in 7 and serosal cavities in 3.

Results

Twenty-four patients were assessable for response. Two complete responses and 2 partial remissions were noted, for an overall 16.6% response rate. The duration of responses was 3+, 5, 8 and 10 months, respectively. Stabilization or minor response was observed in 2 more patients. The main toxic effect was myelosuppression (grade 1-2 in 15 patients, grade 3-4 in 4). Other toxicities included nausea in 14 patients (grade 3 in 2) and grade 1-2 vomiting in 2 patients. Hair loss or alopecia was universal.

Conclusions

The regimen yielded some clinically useful responses with acceptable toxicity. Its evaluation in less advanced cases appears to be warranted.
Predictive Value of Thyroglobulin Changes for the Efficacy of Thyroid Remnant Ablation
Authors: Savelli Giordano , Chiti Arturo , Rodari Marcello , Schreiner Frodo , Maccauro Marco , Aliberti Gianluca , Gerali Alberto , Bombardieri Emilio
Published: April 2018

The aim of this case-control study was to determine the utility of the evaluation of changes in serum thyroglobulin (Tg) levels before and after 131I diagnostic total body scan (TBS) in patients with thyroid cancer to predict the efficacy of radioiodine ablation. Among 134 consecutive patients with differentiated thyroid carcinoma (DTC) who had undergone a thyroidectomy and TBS prior to radioiodine ablation, we selected those subjects with no evidence of distant metastases and with two consecutive assessments of Tg before TBS and radioiodine ablation within a period of four weeks. With this selection procedure 27 patients (22 with papillary and five with follicular carcinomas) were included in our evaluation. The ablation therapy was considered successful when the TBS performed one year after treatment did not show any or less than 1% cervical 131I uptake, Tg levels remained below 3 ng/mL, and clinical and instrumental examinations were negative for the presence of relapses. These criteria divided the selected patients into two subsets: patients with successful radioiodine ablation and patients with residual thyroid tissue. The majority of patients with unsuccessful ablation showed an increase in serum Tg levels, while most of the patients with successful ablation showed a steady decrease in Tg concentrations. Statistical analysis evidenced that the increase in Tg levels after TBS was related to unsuccessful ablation (P ≥0.01). By contrast, the rate of thyroid remnants with 131l uptake did not show any relationship with the outcome of ablation therapy. The group of patients with increasing Tg levels after TBS had a relative risk of 3.3 of unsuccessful ablative therapy compared to the group with stable or decreasing Tg levels. This study supports the concept that by monitoring Tg levels in patients who undergo diagnostic TBS before radioiodine ablation it is possible to obtain useful information about the efficacy of 131l therapy.
Bcl-2 Expression in Primary Uveal Melanoma
Authors: Sulkowska Mariola , Famulski Waldemar , Bakunowicz-Lazarczyk Alina , Chyczewski Lech , Sulkowski Stanislaw
Published: April 2018

Aims

Uveal malignant melanoma is the most common intraocular tumor. The aim of this study was the analysis of bcl-2 oncoprotein expression in this tumor type. The melanomas were evaluated according to tumor location and patient age and sex. The relationship between bcl-2 expression and histological type, clinicopathologic stage and the presence of a set of predetermined morphological parameters was analyzed.

Methods

The study involved 39 patients with ocular melanomas treated with surgery alone between 1983 and 1997. Formalin-fixed, paraffin-embedded tissues were treated with anti-bcl-2 antibody (Dako No M0887). Immunolocalization of the bcl-2 oncoprotein was performed using the labeled streptavidin biotin (LSAB) method. bcl-2 expression in neoplastic cells was evaluated in a semiquantitative manner: lack of reactivity was defined as bcl-2 negative, reactivity present in less than 30% of cells as low bcl-2, and reactivity in more than 30% of cells as high bcl-2. The percentage of cells with a positive reaction was assessed independently by two pathologists, and the results were subjected to statistical analysis using Fischer's exact test.

Results and conclusion

No statistically significant correlation was found between the expression of bcl-2 oncoprotein and the clinicopathologic features analyzed. However, the high percentage of tumors with positive expression of this oncoprotein suggests that it plays a significant role in the biology of uveal melanoma.
Cervical Cancer Epidemiology in Friuli Venezia Giulia
Authors: Vicario Gianni , French Susan , Little D'Anna , Forgiarini Ornella , Bidoli Ettore , Zanier Loris , Franceschi Silvia
Published: April 2018

Aims and background

Until 1998 there was opportunistic screening in Friuli Venezia Giulia (FVG). Beginning in 1999, formal screening efforts were organized. The regional cancer registry was established in 1998, and data on incidence was collected for the period 1995–98. The scope of this study is to provide baseline data on the incidence of invasive cervical cancer in FVG for further examination of trends in incidence and of the effectiveness of screening efforts.

Methods

Data from the regional cancer registry database was examined and linked with data from the regional pap smear screening database.

Results

The incidence of cervical cancer in FVG was 8.6 per 100,000. Most women were diagnosed in stages I and II. Most cervical cancers (80%) were squamous cell. Opportunistic screening in FVG reached 39.8% of the total female population. Analysis by local health unit showed heterogeneous data.

Conclusions

FVG has one of the highest incidence rates of cervical cancer in italy. Approximately 1/3 of the diagnoses were in women over the age of 65. Pap smear screening prior to the formal program covered a low percentage of the female population. Screening efforts in the future should focus on screening coverage in the older female population.
Locally Advanced Breast Cancer in the Elderly: A Major Challenge Requiring Effective and Appropriate Treatment
Authors: Brancato Giovanna , Gandolfo Luigi , Privitera Antonio , Donati Marcello , Amodeo Corrado
Published: April 2018

Aims and background

Breast cancer is the most common tumor in women. As the population above 65 years increases, breast cancer will be a more substantial problem for elderly patients. This work reports our experience in the management of stage III and IV locally advanced breast cancer.

Methods

Nineteen patients over 65 years of age (mean, 70.3 years) with stage III and IV breast cancers, treated between 1990 and 2000, are considered. The management and outcome are evaluated.

Results

Nine patients had stage IIIA breast cancer, 7 stage IIIB and 3 stage IV. Sixteen underwent Madden mastectomy and 3 simple mastectomy. Patients at stage HIB and 1 patient at stage IV with T4 tumor received neo-adjuvant chemotherapy. There were no significant postoperative complications. Sixteen patients were given tamoxifen and 10 patients adjuvant chemotherapy. Patients were followed for a median of 36.7 months (range, 6–72 months). In 8 patients with stage III disease, metastasis developed. Two patients had local recurrence of disease. Of the patients at stage IIIA, 6 were free from disease (one died from unrelated causes) and 3 had recurrent disease (2 died). Of the patients at stage IIIB, 2 are disease free and 5 had recurrent disease and died. Of the patients at stage IV, only one is alive.

Conclusions

Stage and individual characteristics of elderly women influence management. Patients should be managed adequately since most of them are fit enough to undergo treatment.
Recurrence after Treatment by Loop Electrosurgical Excision Procedure (LEEP) of High-Grade Cervical Intraepithelial Neoplasia
Authors: Cecchini Silvia , Visioli Carmen Beatriz , Zappa Marco , Ciatto Stefano
Published: April 2018

Purpose

To evaluate the recurrence rate of high-grade CIN treated by loop electrosurgical excision procedure (LEEP) and the optimal follow-up schedule.

Method

622 cases of CIN2/3 consecutively treated by LEEP in the Florence screening program, with 66.5 months average follow-up (range, 6–195 months), were evaluated. Recurrence was defined as histological evidence of high-grade CIN.

Results

The average recurrence rate was 9.1% (52 cases). Recurrence was significantly associated to increasing age (χ2 = 12.73, df = 3, P < 001), CIN grade (10.5 vs 6.1%, χ2 = 3.37, df = 1, P = 0.067), and time interval, with the risk of developing a recurrence highest in the first year (7.4%, 95% confidence interval, 5.3–9.5%.), and rare beyond the third year. Multivariate analysis confirmed a significant independent association of age (particularly over age 40) and CIN grade to the risk of recurrence.

Conclusions

LEEP is an effective procedure for the treatment of high-grade CIN. Most recurrences after LEEP occur in the first 3 years, and non-recurrent cases at that date may stop intensive follow-up and return to current cytological screening every 3 years.
Postoperative Irradiation in Localized Renal Cell Carcinoma: The Rambam Medical Center Experience
Authors: Gez Eliahu , Libes Michael , Bar-Deroma Raquel , Rubinov Rafael , Stein Moshe , Kuten Abraham
Published: April 2018

Objective

This study evaluated the results of postoperative adjuvant radiotherapy in patients with localized renal cell carcinoma (RCC).

Patients

Eighty-six patients (median age, 60 years) with RCC treated by radical nephrectomy were evaluated for the efficacy of postoperative radiotherapy. Twenty-four percent of patients had stage T2, 35% T3a, 36% T3b and 5% T4 disease. Seventy-seven percent had clear cell carcinomas and 23% granular cell or spindle and mixed cell carcinomas. Radiotherapy was given to the renal bed and adjacent lymphatic basin at a median dose of 46 Gy.

Results

Thirty-two (37%) patients relapsed: 27 (84%) had systemic relapse only and five (16%) had local and systemic relapse; all patients of the latter group had stage T3b disease. The 10-year disease-free and overall survival was 40% and 42%, respectively. Tumor invasion of the renal vessels and stage of disease were correlated with survival. Side effects of radiotherapy were mainly gastrointestinal, but one patient who received right abdominal irradiation died because of liver failure.

Conclusion

The results of our study are comparable with those reported in the literature. Since postoperative irradiation did not improve the survival of patients with RCC and showed toxicity, it is not recommended.
Are International Guidelines for the Prescription of Adjuvant Treatment for Early Breast Cancer Followed in Clinical Practice? Results of a Population-Based Study on 1547 Patients
Authors: Palazzi Mauro , De Tomasi Dolores , D'Affronto Caterina , Richetti Antonella , Valli Maria Carla , Meregalli Sofia , Asnaghi Diego , Arienti Virginia , Cavallini Dario , Pradella Renato , Cafaro Ines , Baroncelli Gianni , Di Lorenzo Innocenzo , De Agostini Antonio , Parrinello Giovanni , Bertoni Filippo
Published: April 2018

Aims and background

The results of several randomized trials and meta-analyses have been reported on adjuvant treatment for early breast cancer and treatment guidelines have been defined accordingly, but detailed data are lacking on the appropriateness of treatment prescription in clinical practice.

Methods

We performed a prospective, observational, multicenter study to monitor the prescription, delivery and effectiveness of radiotherapy following conservative surgery for early breast cancer; 1610 patients treated with postoperative radiation to the breast in 1997 were entered by 12 centers in Lombardy, Italy. Here we report the results of a secondary analysis focused on the prescription of medical adjuvant treatment (1547 eligible patients).

Results

Chemotherapy only was prescribed to 526 patients (33%), hormonal therapy only to 539 (33%), and both treatments to 85 patients (5%); 460 women (29%) received no medical adjuvant treatment. We compared the collected data with guidelines defined in 1995 by the St Gallen Consensus Conference. Undertreatment was most frequent in node-negative patients at intermediate/high risk, no treatment (instead of tamoxifen or chemotherapy) being prescribed in 21–45% of cases. Node-negative patients at low risk, on the other hand, were overtreated with tamoxifen in 31% of cases. In node-positive, premenopausal women compliance with guidelines was far better, with a 91–96% rate of chemotherapy prescription. In node-positive, postmenopausal, estrogen receptor-positive patients chemotherapy was unduly prescribed in as many as 56% of cases. Comparison of clinical practice with the next version of the guidelines (1998) showed a somewhat better compliance.

Conclusions

Despite the availability of official and authoritative guidelines, adjuvant treatment prescription for early breast cancer in Lombardy in 1997 was suboptimal, especially in well-defined subgroups of patients.
Inhibition of Growth of Human Nasopharyngeal Cancer Xenografts in Scid Mice by Arsenic Trioxide
Authors: Li Derui , Du Caiwen , Lin Yingchen , Wu Mingyao
Published: April 2018

Aims and background

It is known that arsenic trioxide (As2O3) can induce clinical remission in patients suffering from acute promyelocytic leukemia. It has been suggested that the agent might also be effective against other malignancies. This study was done to explore the efficacy of As2O3 in the treatment of human nasopharyngeal cancer xenografts in SCID (severe combined immunodeficiency) mice.

Methods

Human nasopharyngeal cancer cells from the CSNE-1 cell line were implanted subcutaneously into SCID mice to produce tumors. The tumor inhibitory rate in vivo was assessed after intraperitoneal administration of As2O3. Histopathological changes in the tumor tissues and the toxicity of As2O3 to the liver, heart and kidneys of the host mice were also investigated.

Results

At doses of 1 mg/kg and 5 mg/kg As2O3 induced apoptosis in nasopharyngeal carcinoma cells. At 5 mg/kg As2O3 also induced cancer cell differentiation, it reduced the PCNA expression, and inhibited tumor growth. The tumor growth inhibitory rate in this experimental group was 76.02%. No nephrotoxicity was observed histologically at these dose levels but some pathological changes in liver and cardiac tissues were found. As2O3 proved lethal to the SCID mice at a dose of 10 mg/kg.

Conclusion

As2O3 has an inhibitory effect on human nasopharyngeal carcinoma xenografts in SCID mice. The mechanism of antitumor activity may be due, at least in part, to the induction of apoptosis and differentiation in cancer cells.
Primary Non-Hodgkin's Lymphoma OH the Lacrimal SAC: A Case Report
Authors: Cama Gustavo Canale , Vassallo Patrizia , Alberti Domingo , Cante Domenico , Solla Raffaele , Punzo Giorgio , Cella Laura , Pacelli Roberto
Published: April 2018

Primary non-Hodgkin's lymphoma of the lacrimal sac is an extremely rare presentation of orbital localization of lymphoma. We present a 45-year-old male patient with primary NHL of the lacrimal sac, stage IE, who was treated with surgery and radiotherapy. Fourteen months after the end of radiotherapy the patient is free of disease and does not show any treatment-related toxicity.
Renal Cancer Treatment: A Review of the Literature
Authors: Gattinoni Luca , Alù Massimiliano , Ferrari Leonardo , Nova Paola , Del Vecchio Michele , Procopio Giuseppe , Laudani Agata , Agostara Biagio , Bajetta Emilio
Published: April 2018

Renal carcinoma represents about 3% of all adult tumors, with an estimate of 31,900 new cases diagnosed in 2003 in the United States. In the early phase of its natural history, renal cancer is potentially curable by surgery, but if the disease presents any signs of metastasis, the chances of survival are remote, even though anecdotal cases characterized by long survival have been reported. In fact, the treatment of metastatic renal cancer remains unsatisfactory. Systemic treatment with single agents and with polychemotherapy, with or without cytokine-based immunotherapy, has not been successful, obtaining very low response rates without a significant benefit in overall survival. This review highlights the most interesting issues regarding conventional therapeutic strategies, in localized and in advanced disease. New approaches such as monoclonal antibodies, vaccines, gene therapy, angiogenesis inhibitors and allogeneic cell transplantation and their possible clinical applications are also discussed.
Clinical Application of Proton Beams in the Treatment of Uveal Melanoma: The First Therapies Carried Out in Italy and Preliminary Results (Catana Project)
Authors: Spatola Corrado , Privitera Giuseppe , Raffaele Luigi , Salamone Vincenzo , Cuttone Giacomo , Cirrone Pablo , Sabini Maria Gabriella , Lo Nigro Salvatore
Published: April 2018

Background

The first Italian proton therapy facility was realized in Catania, at the INFN-LNS. With its energy (62 MeV proton beam), it is ideal for the treatment of shallow tumors like those of the ocular region: uveal melanoma, first of all (the most common primary intraocular malignancy of adults) and other less frequent lesions like choroidal hemangioma, conjunctiva melanoma, and eyelid tumors.

Material and methods

The first patient was enrolled in February 2002, and to date 30 patients have been treated. All patients had a localized uveal melanoma, with no systemic metastases, and had specific indications for proton beam radiation therapy: lesions between 5–25 mm basal diameter, not exceeding 15 mm thickness, absence of total retinal detachment or glaucoma. According to the tumor dimensions, 2 patients had a small lesion or T1 (6%), 3 had a medium-sized lesion or T2 (10%), 14 had a large lesion or T3 (47%), and 11 had an extra-large lesion or T3 (37%); no patient had extrascleral invasion or T4 of the TNM-AJCC Staging System. In most cases, the tumor infiltrated only the choroid (14 patients, 47%) or the choroid plus the ciliary body (14 patients, 47%). We also treated a primitive iris melanoma, without diffusion to the ciliary body. The target volume was defined as the tumor plus a safety margin of 2.5 mm, laterally and antero-posteriorly; this margin was increased to 3 mm if ciliary body involvement was present. The treatment was carried out in 4 fractions on 4 consecutive days to a total dose of 54.5 Gy (single fraction 13.6 Gy), which corresponds to 60 CGE (Cobalt Gray Equivalent; single fraction 15 CGE), because the relative biological effectiveness is 1.1.

Results

The first follow-up is planned at 6–8 months after the end of the treatment, and our clinical end points are local control (defined as cessation of growth or tumor shrinkage), eye retention, and maintenance of a good visual function. At the time of this writing, we had preliminary results from 13 patients. Nine patients showed tumor shrinkage (69%), 3 a substantially stable dimension (23%), but almost all patients presented an increased ultrasound reflectivity (a surrogate for tumor control).

Discussion and conclusions

The literature data show that charged particle therapy has allowed an optimal local control in the treatment of uveal melanomas (about 96% in the different series, superior to that obtained with plaquetherapy [between 83% and 92%]), a metastatic rate slightly better than enucleation reports, and a survival rate of almost 90% at 5 years. Our preliminary results show a tumor response in almost all cases, with no major acute or subacute side effects. We thus plan to continue with our treatment procedures and our dose prescription.
Critical Aspects of Immunoradiometric Thyroglobulin Assays
Authors: Ferrari Leonardo , Biancolini Donatella , Seregni Ettore , Aliberti Gianluca , Martinetti Antonia , Villano Carlo , Pallotti Federica , Chiesa Carlo , Bombardieri Emilio
Published: April 2018

Background and aim of the study

Thyroglobulin (Tg) evaluation is currently used in the follow-up of patients with differentiated thyroid carcinoma (DTC), but the measurement methods are flawed by analytical inaccuracy. In this paper we describe the results of a comparison between seven different immunoradiometric assays (IRMAs) for Tg determination.

Material and methods

Tg was measured in 50 patients with DTC by means of the following commercially available IRMA kits: HTGK-2 (DiaSorin), Tg IRMA (Schering-CIS bio international), ELSA-hTG (Schering-CIS bio international), Tg IRMA C.T. (ICN Pharmaceuticals), SELco Tg (Medipan Diagnostica), Tg Bridge IRMA (Adaltis) and IRMA-mat Tg (BYK-Sangtec Diagnostica). The distribution of the Tg values measured by the different IRMAs was compared and a correlation analysis was performed.

Results

The Tg values were widely dispersed and the classification of patients according to Tg concentrations of clinical relevance varied depending on the IRMA used.

Conclusion

Despite efforts to develop standardized Tg assays, the measurement of this biomarker is still affected by a considerable degree of analytical inaccuracy. Tg values vary widely between assays and the classification of patients according to Tg values with clinical relevance is still dependent on the assay used.
Diagnostic and Therapeutic Aspects of Iatrogenic Hypoparathyroidism
Authors: Pallotti Federica , Seregni Ettore , Ferrari Leonardo , Martinetti Antonia , Biancolini Donatella , Bombardieri Emilio
Published: April 2018

Postsurgical hypoparathyroidism is the most common cause of chronic hypocalcemia. This condition may occur after removal of all parathyroid glands or after interruption of the blood supply to the parathyroid glands during thyroidectomy and radical neck dissection. The severity of the clinical presentation of hypocalcemia may vary from an asymptomatic laboratory finding to a severe life-threatening condition. Persistent hypoparathyroidism requires treatment that must be maintained throughout the patient's lifetime, and for this reason care is required to avoid complications. In this review the most relevant aspects of calcium homeostasis and its alteration in hypoparathyroidism are briefly discussed. In addition, the main approaches to treatment of the hypocalcemic state are presented.
Gemcitabine and Cisplatin following Surgical Treatment of Urinary Bladder Carcinosarcoma
Authors: Damiano Rocco , D'Armiento Massimo , Cantiello Francesco , Amorosi Andrea , Tagliaferri Pierosandro , Sacco Rosario , Venuta Salvatore
Published: April 2018

The clinical case of a 73-year-old man with a history of transitional cell carcinoma of the bladder, an ulcerated mass on the left hemitrigone and left hydronephrosis who underwent radical cystoprostatectomy and urinary diversion followed by cisplatin-gemcitabine chemotherapy is presented. Pathological examination revealed a biphasic mixed tumor characterized by an epithelial and a mesenchymal component. At 24 months of follow-up the patient is alive and free from recurrent disease, with good quality of life and preserved renal function. Carcinosarcoma is highly aggressive and often has a dismal outcome regardless of treatment. Among all the studied prognostic factors, pathological stage is the main predictor of survival. The outcome of our patient suggests that the relatively well tolerated gemcitabine-cisplatin regimen after surgical treatment of invasive carcinosarcoma of the bladder might improve the currently dismal prognosis of selected elderly patients.
Gastric Cancer: Extent of Lymph Node Dissection and Requirements for a Correct Staging
Authors: Cozzaglio Luca , Doci Roberto , Celotti Simone , Roncalli Massimo , Gennari Leandro
Published: April 2018

Aims and Background

Lymphatic spread is an important prognostic factor in gastric cancer. The TNM classification requires at least 15 lymph nodes to stage and identify three prognostic groups according to the number of metastatic lymph nodes: N1 (1-6), N2 (7-15), N3 (>15). The aim of this study was to investigate which type of lymph node dissection allows an accurate staging.

Methods

From 1996 to 2001, we treated 140 gastric cancer patients, 27 with D1 and 113 with D2 dissection. We evaluated lymph node count, status and ratio between metastatic and total number of excised lymph nodes, keeping 20% as the cutoff value.

Results

The mean number of lymph nodes was 18 and 33 respectively for D1 and D2 (P <0.001), 41% of patients in D1 and 5% in D2 had less than 15 lymph nodes (P <0.001). 59% in D1 and 73% in D2 (P = 0.145) had lymph node metastases, but this incidence decreased to 36% (P = 0.045) and 16% (P <0.001) respectively for D, and D2 when less than 15 lymph nodes were available. Considering the ratio between metastatic and total number of lymph nodes, 45% of D1 versus 3% of D2 (P <0.001) in the N1 group exceeded 20%.

Conclusions

D2 lymph node dissection is better than D1 in providing at least 15 lymph nodes required for a correct staging. We confirm the risk of a downstage when less than 15 lymph nodes are available.
Outcome after Conization for Cervical Intraepithelial Neoplasia Grade III: Relation with Surgical Margins, Extension to the Crypts and Mitoses
Authors: Maluf Paulo José , Adad Sheila Jorge , Murta Eddie Fernando Candido
Published: April 2018

Aims and Background

Factors linked to residual neoplasia and recurrence following conization of the uterine cervix for treating cervical intraepithelial neoplasia grade III (CIN III), such as the surgical margins, extension of CIN into the crypts and the number of mitoses, have been studied with contradictory results. We evaluated patients submitted to conization for CIN III and analyzed the aforementioned factors, relating them to recurrence and residual neoplasia in hysterectomy specimens.

Methods

The surgical specimen of cold-knife conization for CIN III performed in 63 patients (average age, 37.3 ± 9.3 years) was fixed in 4% formaldehyde. The ectocervical and endocervical margins were removed and the cone was cut into fragments perpendicular to the surface of the endocervical mucosa (1 mm thick). One histological section (5 μm thick) was cut from each block and stained with hematoxylin-eosin. We studied the total number of fragments from each cone and affected by CIN, endocervical and ectocervical margins, extension to the crypts, number of mitoses and tripolar mitoses in 100 microscope fields using a 100x objective.

Results

The endocervical margin was involved in 34.9% vs 9.5% (P = 0.001) of ectocervical margins. Recurrence affected 53.8% of cases presenting involved margins versus 12.9% in the cases without involved margins (P = 0.0078). The average interval to recurrence was 3.2 years. CIN was present in 2.5 to 100% (median, 28%) of the cone fragments (median no., 28; range, 7-95). A median of 44.4% and 25% of cone fragments presented CIN with and without recurrence, respectively. Correlation of the number of mitoses with tripolar mitoses and the percentage of fragments involved by CIN with the number of mitoses and tripolar mitoses showed, respectively, P = 0.02, 0.05 and 0.005. A median of 142 mitosis and 4 tripolar mitosis were observed per case with disease recurrence versus 104 and 3 (P = 0.02, 0.6), respectively, when recurrence did not occur. Of 14 patients who underwent hysterectomy after conization (mean, 3.6 ± 3 months afterwards) for endocervical or both margins involved by CIN in the cone specimen, 8 (57.1%) presented CIN III and one (7.1%) microinvasive carcinoma. In 96.8% of the conizations, the CIN extended to the crypts.

Conclusions

Involved margins and mitoses are associated with a greater recurrence rate for CIN. Residual neoplasia in the hysterectomy specimen after an involved margin with conization is frequent.
Correlation between Postoperative Infections and Long-term Survival after Colorectal Resection for Cancer
Authors: Nespoli Angelo , Gianotti Luca , Totis Mauro , Bovo Giorgio , Nespoli Luca , Chiodini Paolo , Brivio Ferdinando
Published: April 2018

Introduction

Predicting long-term survival and cancer recurrence in patients with colorectal cancer is difficult because of the many factors that may affect the prognosis. This study investigated the prognostic significance of postoperative infections for patient outcome.

Methods

From an electronic database we selected 192 patients undergoing elective radical surgery for Dukes’ stage B and C colorectal adenocarcinoma. The five-year survival rates were analyzed by the Kaplan-Meier method. Univariate and multivariate analyses were carried out to evaluate the potential prognostic variables using the Cox proportional hazard model.

Results

Forty-three patients developed deep incisional or organ/space surgical site infections, while the remaining 149 were complication free. The two groups were comparable for baseline, surgical and histopathological characteristics. At univariate analysis, Dukes’ stage and infections were negative prognostic factors, while peritumoral infiltration of lymphocytes and eosinophils and fibrotic tissue appeared as protective variables. However, multivariate analysis showed that only Dukes’ stage (P = 0.048) and occurrence of postoperative infectious complications (P = 0.011) were independently associated with outcome. In patients with infectious complications, the survival rate was significantly lower than in patients without infections (log-rank = 0.0004).

Conclusions

The present results suggest the importance of evaluating other variables besides tumor stage in the prediction of long-term outcome. In prognostic studies more attention should be paid to postoperative infections.
Invasive Ductal Carcinoma of the Breast with a Large Central Acellular Zone Associated with Matrix-producing Carcinoma
Authors: Hama Yukihiro , Tsuda Hitoshi , Sato Kazuhiko , Hiraide Hoshio , Mochizuki Hidetaka , Kusano Shoichi
Published: April 2018

Matrix-producing carcinoma is a variant of metaplastic carcinoma of the breast that consists of overt carcinoma with direct transition to a cartilagenous and osseous stromal matrix. A clinicopathological association between MPC and high-grade invasive ductal carcinoma with a large central acellular zone has been recently discussed. However, few reports have ever shown the radiological, pathological and immunohistochemical correlation of this unique tumor. We present a case of 27-year-old woman with matrix-producing carcinoma with a large central acellular zone, which was characterized by a large homogeneous hypodense center with well-marginated, ring-like enhancement on contrast enhanced computerized tomography.
An Ovarian Mucinous Adenocarcinoma Arising from Mature Cystic Teratoma Associated with Respiratory Type Tissue: A Case Report
Authors: Cobellis Luigi , Schürfeld Karin , Ignacchiti Erika , Santopietro Rosa , Petraglia Felice
Published: April 2018

Mature cystic teratoma (dermoid cyst) is the most common benign germ cell tumor of the ovary, accounting for approximately 30% of all ovarian tumors. Malignant transformation is rare; the most frequent transformation reported is to squamous-cell carcinoma in 80% of cases, whereas transformation to adenocarcinoma is described in about 7% of cases. We report a case of malignant transformation to mucinous adenocarcinoma arising from respiratory-like epithelium in a mature teratoma of the ovary.
Cystic Liver Metastases from Lung Adenocarcinoma: A Case Report
Authors: Romano Fabrizio , Porta Andrea , Caprotti Roberto , Uggeri Fabio , Conti Matteo , Uggeri Franco
Published: April 2018

Cystic hepatic metastases arising from lung cancer are rare. We herein describe a case of a 71-year-old women admitted to our hospital for abdominal pain 6 months after the resection of a lung adenocarcinoma. Two cystic lesions of the liver were discovered at abdominal ultrasonography and computerized tomography scan. An ERCP excluded a biliary adenoma or adenocarcinoma, and an ultrasound-guided liver biopsy was negative for malignant cells. For persistence of symptoms and lack of a diagnosis, the patient underwent an exploratory laparotomy, a surgical biopsy with a diagnosis of adenocarcinoma, and a consequent right hepatectomy. After 2 years of follow-up, the patient is well and disease free. Although cystic liver metastasis are rare and a differential diagnosis difficult, the malignant nature should always be considered in the differential diagnosis of hepatic cysts to offer the patient the best treatment.
Benign Breast Diseases in Breast Cancer Screening Programs in Italy (2000-2001)
Authors: Fabbri Sandra , Perfetti Elisa , Govoni Deanna , Bianchi Simonetta , Brancato Beniamino , Paci Eugenio ,   GISMa Working Group, Vettorazzi Marcello , Pellizzola Massimo , Tessali Maria , Zangirolami Antonella , Saccon Stefania , Tessaro Leonardo , Lovisatti Leonardo , Ferro Antonio , Fedato Chiara , Naldoni Carlo , Baraldi Gian Piero , Canuti Debora , Desiderio Franco , Serafini Monica , Bravetti Patrizia , Bonsanto Rosa , Marchesi Cristina , Mori Carlo Laberto , Baldazzi Paola , Collina Natalina , Salvadori Piero , Marovelli Debora , Piperno Giancarlo , Cristiano Giuseppe , Provincia Città e , Piccini Paola , Zappa Marco , De Masi Salvatore , Maffei Carlo , Scarfantoni Aurora , Coccioli Sergio , Giorgi Daniela , Segnan Nereo , Perfetti Elisa , Giordano Livia , Ponti Antonio , Petrella Marco
Published: April 2018

Aims and Background

Screening mammography has been shown to be effective in reducing breast cancer mortality in several randomized clinical trials. One major side effect of screening is the diagnosis of benign breast disease (BBD), which is considered as a nonprogressive lesion, except for a small percentage of lesions considered at high risk. We present data referring to service screening programs active in Italy in 2000 and 2001 and participating in the national survey carried out by the Italian Group for Mammography Screening (GISMa).

Methods

To all centers participating in the GISMa National Survey, we submitted a questionnaire regarding the service screening protocol and main indicators of performance of the local program in the years 2000 and 2001.

Results

A total of 657 detected BBD cases, registered by 23 Italian breast cancer screening centers in women 50 to 69 years of age, are included in this study. The BBD detection rate was 2.5 per 1000 at the first screening test and 1.05 per 1000 at repeated tests. The benign/malignant ratio was 0.34 at the first and 0.22 at the repeated test.

Conclusions

Detection of BBD occurred frequently in breast screening programs, and prognostic implications should be further investigated. Women should be individually informed at screening, and with greater detail at the moment of the recall for assessment, of the implications of BBD detection and receive the necessary, also psychological, counseling to avoid the possible harm related to breast cancer screening.