bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraperitoneal Chemotherapy with Mitoxanthrone in Ovarian Cancer
Authors: Le Donne Maria , Messina Giovanna , Buda Concetta , Corrado Francesco , Pettineo Giuseppe , Salimbeni Vincenzino , Irato Stefano
Published: April 2018

Aims and background

Ovarian carcinoma remains confined to the peritoneal cavity for the greater part of its natural history, so intraperitoneal (IP) administration of chemotherapy could result in greater total drug exposure of the tumor and minimize systemic antiblastic drug side effects. The aim of this study was to evaluate the therapeutic efficacy and toxic effects of intraperitoneal mitoxanthrone in patients affected by ovarian carcinoma with macroscopic absence of disease or minimal residual disease.

Methods

Ten patients were enrolled (stage II and III) who had been previously treated with neoadjuvant systemic chemotherapy (CDDP or CBDCA + CTX) and radical surgery resulting in macroscopic absence of disease or minimal residual disease (<1 cm). Mitoxanthrone (25 mg/m2) was instilled in 2 liters of normal saline every four weeks for 2-4 cycles.

Results

A total of 26 courses was administered; two patients discontinued IP therapy, one for chemoperitonitis and another for bowel perforation requiring catheter removal. Of the 10 patients receiving IP chemotherapy, 7 are alive at 5 years from radical surgery, and 3 had relapses at 13, 14 and 57 months, respectively, from radical surgery.

Conclusions

Intraperitoneal mitoxanthrone appears to be an effective second-line therapy in ovarian cancer; it is well tolerated as far as toxic effects are concerned, allowing cost reduction and improved patient compliance. For those cases requiring a limited number of peritoneal accesses traditional percutaneous systems have a more favorable cost/benefit ratio.
HLA Binding Characteristics and Generation of Cytotoxic Lymphocytes against Peptides Derived from Oncogenic Proteins
Authors: Bertazzoni Carla , Marchesi Edoardo , Dermime Said , Ravagnani Fernando , Parmiani Giorgio , Gambacorti-Passerini Carlo
Published: April 2018

Aims and background

Structurally altered proteins (derived from chromosomal translocations or gene mutations) can be considered tumor specific antigens and represent an attractive target for a T-cell mediated response. T lymphocytes recognize antigens in the form of peptides bound to HLA-mole-cules.

Materials and methods

Peptides derived from oncogenic proteins were screened fro the presence of HLA binding motifs; actual binding were evaluated by HLA stabilization experiments using transfectants and specific anti-HLA antibodies. Specific lymphocytes were induced by in vitro peptide sensitization and screened by thymidine uptake or cellular cytotoxic assays.

Results

We identified peptides derived from EWS/FLI-1 fusion protein and from mutated K-RAS protein (encompassing respectively the fusion point and the mutation at position 12) that showed binding motif for HLA-Cw*0702 and HLA-A3 respectively. The actual binding of these peptides was analysed in a stabilization assay. We detected binding for the EWS/FLI-I peptide and for 5 RAS peptides (1 wild type and 4 mutated). The effect of temperature, β2-microglobulin (β2-m) and fetal calf serum (FCS) on the binding and the stability of the HLA/peptide complex was studied. A low temperature (26°C) increased the binding both in HLA-A3 and HLA-Cw*0702, while FCS reduced it. β2-m increased the binding to the HLA-A3 molecule but did not influence the binding to the HLA-Cw*0702. The stability of already formed complexed was somewhat different in the HLA-A3 and HLA-Cw*0702 system: both were more stable at 26°C than at 37°C but while the β2-m and FCS did not influence the stability of the HLA-A3/peptide complex, they seemed to cause opposite effects in the HLA-Cw*0702 system (β2-m stabilized and FCS destabilized the complex). Finally, we were able to generate a specific CD8+ CTL line against a K-RAS mutated peptide.

Conclusions

Although binding motifs and actual HLA binding can be detected in several cases, the generation of a cellular response is infrequent, confirming that HLA binding is necessary but not sufficient to obtain an in vitro response. Further optimization of culture conditions, type of Antigen Presenting Cells (APC), peptides, use of stabilizers like β2-m are still needed.
Role of Pamidronate Disodium in the Treatment of Metastatic Bone Disease
Authors: Ripamonti Carla , Fulfaro Fabio , Ticozzi Chiara , Casuccio Alessandra , De Conno Franco
Published: April 2018

Aims and Background

Bone metastases are a common feature of advanced neoplastic disease and are considered to be among the most frequent causes of pain and complications in oncologic patients. The main objective of the treatment of such patients is to control their symptoms and improve their quality of life. Pamidronate disodium is a second-generation bisphosphonate capable of inhibiting bone resorption (particularly osteoclast activity) without affecting bone reminerali-zation. After a brief introduction concerning the pathophysiology of bone metastases and neoplastic bone pain, we herein present data on the clinical pharmacology and toxicity of bisphosphonates in general, and pamidronate in particular. We conclude by reviewing the literature on the use of pamidronate in phase II and III trials involving patients with metastatic bone disease.

Methods

The paper is based on a review of articles published between 1984 and 1997 selected from the Cancerline and Medline databases.

Results

In the considered phase II and III studies involving patients with bone metastases (breast cancer and multiple myeloma in particular), pamidronate proved to be efficacious in reducing the incidence of pain and skeletal complications, decreasing the excretion of metabolic markers of bone resorption and improving the quality of life. Intravenous infusions of 60-90 mg over a period of 2 hr every 3-4 weeks did not cause any significant toxic effects and was easily managed.

Conclusions

Pamidronate is a bisphosphonate that is efficacious in the treatment of symptomatic bone metastases and can be considered an important therapeutic option in association with systemic treatments, radiotherapy and normal supportive care, especially in patients with breast cancer and multiple myeloma. Further randomized studies are necessary to confirm the positive preliminary results in other neoplasms, analyze the cost/benefit ratio of the treatment, and verify the possibility that, in addition to being used for palliative purposes, pamidronate may also prevent or delay the appearance of bone metastases.
Cancer Mortality by Urbanization and Proximity to the Sea Coast in Campania Region, Southern Italy
Authors: Bidoli Ettore , Franceschi Silvia , Montella Maurizio
Published: April 2018

Aims and background

The risk for several cancers is higher in urban than in rural areas. The gradient has seldom been studied in southern Europe.

Patients and methods

The geographical pattern of mortality for different cancers and all causes was studied in the Campania Region (about 5.6 million inhabitants), whose largest town is Naples. The key variables were residence in urban/rural and coastal/inland municipalities. Relative risks of death and corresponding 95% confidence intervals by residence were evaluated by means of Poisson log-linear regression models.

Results

Significantly increased mortality rates in urban compared to rural municipalities were found for several cancer causes of death. In particular, in both sexes, excesses in the order of 30-50% were observed for tobacco-related neoplasms (i.e., larynx, lung, and bladder) and cancers of the intestine, liver, brain, multiple myeloma and non-Hodgkin's lymphoma, in addition to all-cancer, and all-cause mortality. In females, specific excesses were also noticed for cancer of the gallbladder, pancreas, breast and uterus (corpus and cervix). Conversely, significantly decreased mortality rates in urban with respect to rural municipalities were observed for cancer of the oral cavity and pharynx in males. Coastal location and degree of urbanization were strongly correlated, thus showing similar associations with most causes of death. However, a significant excess of cancer of the pleura in males was restricted to coastal municipalities.

Conclusions

Anti-smoking campaigns, sanitation improvements, hepatitis B vaccination, and a decrease in obesity emerge as high priorities with respect to cancer control strategies in the Campania Region, particularly in overpopu-lated, underprivileged urban areas.
Does Long-Term Exposure to Gel-Filled Silicone Implants Increase the Risk of Relapse after Breast Cancer?
Authors: Petit Jean-Yves , Lê Monique , Rietjens Mario , Contesso Geneviève , Lehmann Andrée , Mouriesse Hélène
Published: April 2018

Background

An increased risk of cancer and autoimmune diseases associated with gel-filled silicone implants, debated by FDA experts since 1991, has given rise to a profusion of literature on the subject. However, such effects have not been adequately investigated in patients with breast cancer. In a previous report we compared 146 breast cancer patients with gel-filled silicone implants for breast reconstruction to 146 control patients in whom no reconstruction had been performed. The observed results were reassuring, as the evolution of the disease after 10 years was better in the reconstruction group than in the control group. We now report the end results of this study with a median follow-up of 13 years after the breast reconstruction (range, 10-20 years).

Method

The relative risks of detrimental events were estimated with Cox's Proportional Hazards Model, with stratification according to age at diagnosis.

Results

The risks of locoregional recurrences and distant metastasis were significantly lower in the BR group than in the control group. The risks of death, of a second breast cancer and of a second primary cancer at a site other than the breast were not significantly different between the two groups of patients.

Conclusion

Long-term follow-up of patients exposed to gel-filled silicone implants confirms the absence of detrimental effects after breast cancer. The power of our study is, however, below that required to detect a very slight increase in the risks studied.
Interleukin-2, Interferon-α and Interleukin-2 plus Interferon-α in Renal Cell Carcinoma. A Randomized Phase Ii Trial
Authors: Boccardo Francesco , Rubagotti Alessandra , Canobbio Luciano , Galligioni Enzo , Sorio Roberto , Lucenti Antonio , Cognetti Francesco , Ruggeri Enrico , Landonio Giuseppe , Baiocchi Claudia , Besana Carlo , Citterio Giovanni , De Rosa Marisa , Calabresi Federico
Published: April 2018

Background

The purpose of the present study was to investigate the therapeutic effectiveness of interleukin-2 (IL-2) and interferon (IFN), either alone or in combination, in comparable groups of patients affected by advanced renal cell carcinoma (RCC).

Patients and methods

In order to limit selection biases, treatment was allocated on a random basis. Patients randomized to IL-2 alone were scheduled to receive eight rIL-2 24-hour i.v. infusion cycles, days 1 to 4, at a daily dose of 18 x 106 IU/m2 for a total of 25 weeks. Patients randomized to IFN alone were scheduled to receive rIFN-α at a daily dose of 6 x 106 IU/m2, days 1, 3 and 5, every week for a total of 52 weeks. Patients randomized to the combination of IFN and IL-2 were given the same drugs at the same daily doses for a total of 24 weeks. Drug dose was modified according to toxicity.

Results

Twenty-three percent (95% CI: ± 17.5) of patients treated with IL-2 alone showed an objective response to treatment (9% CR). The corresponding figures in patients treated with IFN alone or IFN plus IL-2 were 9% (95% CI: ± 11.9) and 9% (95% CI: ± 11.9), respectively. Complete responses were observed only in patients treated with IL-2. The median duration of response in the IL-2 arm was 18 months (range, 9.5-24). The duration of the two responses achieved by IFN alone was seven and nine, months, respectively. The corresponding figures in the two patients responding to the combination of IFN with IL-2 were 19 and 27 months, respectively. Total IL-2 dose appeared to be a major predictor of response. Only a minority of patients experienced grade 3-4 toxicity, the incidence being higher in those treated with IL-2 or IL-2 plus IFN.

Conclusions

Neither IFN nor IL-2 or the combination of the two appear to be very active in patients with advanced RCC, even when trial entry was restricted to patients with relatively indolent disease. This stresses the need for the development of new approaches.
Early Gastric Cancer: Diagnosis, Surgical Treatment and Follow-Up of 45 Cases
Authors: Sigon Roberto , Canzonieri Vincenzo , Cannizzaro Renato , Pasquotti Bruno , Cattelan Alessandro , Rossi Carlo , Carbone Antonino
Published: April 2018

Aims and background

The 5-year survival rate of early gastric cancer (EGC) is 85%-100% after “curative” resection, as compared to 20%-30% in advanced gastric cancer (AGC). Because of this relatively high cure rate, the interest in the diagnosis and therapy of EGC has been steadily increasing. The present study, based on 45 EGCs, is aimed at a critical evaluation of the diagnostic procedures and surgical options.

Methods and results

Forty-five patients with early gastric cancer (27 men and 18 women; median age, 62 years; range, 28-84) were diagnosed and operated on. They represented 22.5% of all patients with gastric cancer (200) treated in the period July 1987 to January 1998. Forty-one patients were from the northeastern part of Italy. The most frequent symptom was epigastric pain (84%). Barium upper gastrointestinal radiography findings were strongly suggestive of malignancy in 41 cases (91%). Preoperative histopathological diagnosis of adenocarcinoma was performed in 43 cases (95.5%). In two cases (4.5%) severe epithelial dysplasia (associated with ulcer) was the first diagnosis, but the final diagnosis on the basis of the resected specimens was a well differentiated adenocarcinoma. The primary surgical procedure included i) subtotal distal resection (37 cases) with Billroth II (33) and Billroth I (4) reconstructions; ii) total gastrectomy (3) for proximal neoplastic extension; iii) proximal gastric resection (2) for cardial cancer; iv) degastro-total gastrectomy (3) for cancer of the stump. Two patients, previously treated with conservative surgery, underwent degastro-total gastrectomy for neoplastic microfocal extension to the margin of resection and for early anastomotic recurrence, respectively. Mural infiltration was limited to the mucosa and submucosa in 27 and 18 cases, respectively. Lymph node metastases were found in three mucosal and five submucosal tumor cases, involving either the first or the second echelon. No operative deaths or postsurgical complications occurred in this series. In the follow-up period (median, 36 months; range, 3-120) four patients died due to other causes; one developed liver metastases, another developed oropharyngeal cancer and two died of biopsy-proven lung cancer without evidence of gastric cancer recurrence.

Conclusions

The clinical presentation of EGC is aspecific. Preoperative endoscopy with biopsy remains the most sensitive diagnostic procedure. For treatment, subtotal distal gastric resection with lymphadenectomy is the “gold standard” but in some instances total gastrectomy may be indicated. Accurate pathological examination establishes the depth of infiltration, as well as the superficial extension of tumors and the lymph node status. Although the prognosis of EGC is favorable, a medium-term follow-up should be planned.
Measurement of the Cost of Screening for Cervical Cancer in the District of Florence, Italy
Authors: Zappa Marco , Cecchini Silvia , Ciatto Stefano , Iossa Anna , Falini Patrizia , Mancini Maria , Paci Eugenio
Published: April 2018

Aims and background

To estimate the cost per woman examined and per CIN II or more severe lesion detected in a population-based cytologic screening program for cervical cancer prevention. An organized cytologic screening program has been ongoing in the Florence District since 1973, and a call-recall system using mail invitation has been ongoing since 1980. Smear reading and assessment of screening positives is centralized at the screening unit.

Methods and study design

All relevant resources (costs) consumed by the program were listed and measured. The unit cost per examined woman and per each CIN II or more severe lesion detected was estimated for each screening phase (recruitment, screening, assessment).

Results

The cost per examined woman was $24.60, whereas that per CIN II or more severe lesion detected was $13,600. Staff accounted for 80% of total amount.

Conclusions

Although the cost for a single procedure is low, the cost per detected lesion is quite remarkable due to the low detection rate in a population screened for a long time. Different approaches and longer interval screening tests are discussed.
Quality Control by Portal Film Analysis in Radiotherapy for Prostate Cancer: A Comparison between Two Different Institutions and Treatment Techniques
Authors: Italia Corrado , Fiorino Claudio , Ciocca Mario , Cattaneo Giovanni Mauro , Montanaro Paolo , Bolognesi Angelo , Lanceni Angelo , Reni Michele , Bonini Antonio , Modugno Antonio , Calandrino Riccardo , Valdagni Riccardo
Published: April 2018

Aims and background

Accuracy and reproducibility of patient setup during radiotherapy for prostate cancer were investigated in two different Institutions (A and B), within their Quality Assurance programs. The purpose of the study was to evaluate and compare setup accuracy and reproducibility in Institutions A and B, which adopt different patient positioning and treatment techniques for prostate irradiation.

Materials and methods

A retrospective analysis of portal localization films taken during the treatment course was performed: 30 and 21 patients in Institutes A and B, respectively, entered the study. In Institute A, patients were treated in a prone position, utilizing an individualized immobilization cast (either an alpha cradle or a heat and vacuum-formed cellulose acetate cast) with an open table top and individual abdominal wall compressor to minimize small bowel irradiation; a 5-field conformal technique was used. In Institute B, patients were treated in a supine position without any immobilization device; a 6-field BEV-based technique (conformal only for patients treated with a radical aim) was adopted. A total of 598 portal films (420 from Institute A and 178 from Institute B) were analyzed. The mean number of films per patient was 12 (range, 4-29). Systematic and random setup errors were estimated utilizing the statistical method suggested by Bijhold et al. (1992).

Results

When patients with a mean (systematic) error larger than 5, 8 and 10 mm in craniocaudal, lateral and posterior-anterior directions, respectively, were compared, no statistically significant difference between the two groups was observed. Similarly, when comparing portal films, a significant difference ( P <0.01) appeared only in the craniocaudal direction (errors > 5 mm: Institute A = 24%; Institute B = 11%). In both Institutes, the SD of random and systematic error distribution ranged from 1.8 to 4.2 mm, with a small prevalence of systematic errors. Only for craniocaudal shifts in Institute A was the random error larger than the systematic error, and it was significantly worse than in Institute B (1 SD, 4.2 mm in Institute A vs 1.8 mm in Institute B).

Conclusions

Setup errors observed in Institutes A and B were similar and in accord with data reported in the literature. In Institute B, satisfactory geometrical treatment quality was achieved without patient immobilization. In Institute A, the goal of minimizing small bowel irradiation and prostate motion through the aforementioned technique, which makes patient position less comfortable, did not seem to considerably increase daily setup uncertainty.
La Risonanza Magnetica Del Carcinoma Pancreatico
Authors: Pavone Paolo , Laghi Andrea , Catalano Carlo , Panebianco Valeria , Pediconi Federica , Fabiano Sebastiano , Passariello Roberto
Published: April 2018

The role of MR imaging in the assessment of pancreatic adenocarcinoma is in identification, characterization and staging of the neoplastic lesion. Technique optimization is required in order to obtain high qualities images competitive with spiral CT. The choice of imaging protocol is strictly related to the available equipment as well as fast imaging capabilities. Contrast-enhanced study using breath-hold sequences is required if working at high field strength with high gradient performance; on mid-low field strength nonbreath-hold acquisition techniques, using respiratory compensation techniques, can be implemented. The use of fat saturation pulses may increase the sensitivity of MR in detecting pancreatic lesions. Other advantages of MR imaging are represented by the availability of additional noninvasive techniques for the evaluation of the biliary tree (MR-cholangiopancreatography) and splanchnic vessels (MR-angiography).

Lesion identification is based on Tlw sequences where the lesion appears hypointense compared with the surrounding pancreas; increased lesion-pancreas contrast is obtained when fat suppression is used. On dynamic studies following gadolinium injection, pancreatic tumors are hypovascular compared with surrounding normal pancreatic gland. Problems in correctly defining the size of the lesions may be encountered in patients presenting with inflammatory changes of the pancreatic parenchyma surrounding the carcinoma (epineoplastic pancreatitis).

For lesion characterization MRI is not able to characterize focal pancreatic lesions, allowing a differential diagnosis between pancreatic cancer and focal hypertrophic chronic pancreatitis. Even the use of MR-cholangiopancreatography is not helpful for characterizing focal pancreatic masses. MR imaging is accurate in local staging (assessment of peripan-creatic fat infiltration) thanks to the higher contrast resolution, but in vascular staging and in the evaluation of lymphn-odal involvement it suffers the same limitations as computed tomography. Future perspectives are represented by the use of magnetic resonance angiography for the evaluation of vascular encasement and the use of specific contrast agents for lymphadenopathy.

Identification of hepatic metastases with MRI has been proven to be high, with sensitivity and specificity comparable to CT. The use of liver-specific contrast agents (either positive or negative) is becoming almost routine and it is proving to further improve the diagnostic value of MRI.
I Marcatori Tumorali Nella Diagnosi Del Carcinoma Pancreatico
Authors: Cappelli Gino , Paladini Sergio , D'Agata Alberino
Published: April 2018

The difficulty in an early diagnosis of pancreatic cancer is in the absence of early symptoms due to lower limit of detection of the actual imaging techniques.

Clinical symptoms like weight loss, abdominal pain and jaundice indicate an advanced cancer stage. Today 50% of pancreatic tumors are diagnosed in advanced metastatic stage and only 20-30% show resectable cancer. Ultrasound and determination of a mucine like antigen as CA 19-9, CA 50 and CA 195 seem to allow an earlier diagnosis with a higher rate of resective surgery and a prolonged survival for these patients.

The mucines are high molecular weight glycoproteins consistent of a backbone protein to which oligosaccarides are attached. The linkage of carbohydrate to the peptide is termed O-glycosidic and involves the hydroxylic groups of serine or threonine with N-acetylglucosamine. Only the backbone proteins are genetically determined (genes MUC). The ganglio-sides are the same or derivative of Lewis antigen.

CA 19-9, CA 50 and CA 195 are assays directed to different epitopes probably present on the same mucinous antigen. These epitopes are not present in different mucines as CA 15-3, CA 125 and TAG 72.

Recently other two mucines are emploied CA 242 and CAM 17.1 but they are not better than CA 19-9.

The use of a “triplet” of tumor markers as CA 19-9, CA 125 and CEA is the best diagnostic tool for cancer of pancreas in an “integrated” use with ultrasonographic evaluation of the lesion.

CA 19-9 permits differential diagnosis from neuroendocrine tumor or pancreatitis, the values of CA 125 and CEA are useful in the evaluation of the stage, resectability and prognosis of pancreatic cancer.

The recent use of CA19-9 for the evaluation of ra-diochemotherapy in preoperative management of the patient is a mode of a well known application of tumor markers in a kinetic evaluation of the tumor for the radicality of therapy, follow-up, recurrence and the effectiveness of the palliative therapy.
L'approccio Chirurgico Nella Palliazione Del Carcinoma Pancreatico
Authors: Delrio Paolo , Izzo Francesco , Cremona Francesco , Palaia Raffaele , Ruffolo Fulvio , Fumo Fabio , Parisi Valerio
Published: April 2018

Pancreatic carcinoma is an aggressive disease and its prognosis is dismal. Patients present with an advanced stage of disease and only a small number of patients undergo resection with a curative intent; thus the 5 years survival rate is very low.

Several Improvements have been made in the surgical approach with a decrease in perioperative morbidity and mortality. Results offered by chemotherapy and radiotherapy remain unsatisfactory despite a number of new drugs and considerable advancements in irradiation techniques. Jaundice, pain and gastrointestinal obstruction are the main clinical problems to be dealt with in advanced patients. Surgical palliation still represents a widely preferred option but non surgical approaches appear promising.

The Authors analyse the possible options in palliation for pancreatic carcinoma. The various surgical procedures for biliary bypass are described. Hepaticojejunostomy is the operation of choice and offers the best results in terms of quality of life and time of palliation. A possible role for resective operation also in advanced cases has been proposed by some groups and is gaining wide acceptance in referral centres where low morbidity and mortality are now routine. Percutaneous and endoscopic approaches to jaundice represent a valid alternative in some patients with a low life expectancy and in those centres with a high experience. Gastrointestinal bypass in symptom-free patients or advanced cases only is an unsolved dilemma. New approaches such as locoregional chemotherapy with curative or neoadjuvant intent are also described in this paper. Many chemotherapic agents have been tested in various settings and appear to offer promising results in palliation and also, in some cases, in downstaging tumors then amenable to resection. Pain control is a major aspect in management of advanced pancreatic carcinoma. Appropriate pain therapy has to be established in all patients in order to obtain a better quality of life. Various options are available such as intraoperative alcohol injection or CT guided percutaneous splanchnicectomy. Palliation in patients with pancreatic carcinoma is a major aspect of management because of the high percentage of non curable cases; multimodality approach is mandatory and all possible problems have to be dealt with in order to increase survival and, more importantly, quality of life.
La Radiologia Interventistica Nella Palliazione Del Carcinoma Pancreatico
Authors: Mazza Ernesto , Carmignani Luca , Stecco Alessandro , Lucibello e Paolo
Published: April 2018

Aims and background

Pancreatic carcinoma often involves the head of the pancreas and obstructive jaundice is its earliest sign. It sometimes extends to celiac plexus and duodenum causing pain and bowel obstruction respectively. Only 20% of cases are totally resectable (stage I) at the time of diagnosis. Palliative treatment is the only available therapeutic option when the tumor extends surrounding organs or has given lymphatic metastases (stage II, III, IV). The aim of this study is to evaluate effectiveness of interventional radiology procedures on unresectable cancer palliative treatment.

Methods

Between Jan 90 and Sep 98, 195 patients with unresectable pancreatic carcinoma received percutaneous treatments. They were 104 males and 91 females with mean age of 74 years (range, 48-95). One hundred eighty four patients underwent biliary drainage, six patients underwent celiac plexus block, two patients were treated by bowel stenting. Two patients received both biliary and bowel stents, one patient underwent biliary drainage and celiac plexus block.

Results

Jaundice treatment was performed by placement of drainage catheters in 48 patients, polymeric endoprostheses in 58 and metallic stents in 77 (67 Wallstents). Biliary drainage was successful in all cases obtaining appreciable bilirubin serum levels reduction and jaundice regression in 175 patients (95%). In 44 patients Wallstents were placed during a single PTC session time (“one step” technique). In 21 cases (11%) peri-procedural complications occurred. Follow-up related to 85 patients shows survival rate covered between 30 and 570 days (mean, 142). Best survival values occurred in patients who underwent “one step” technique. Celiac plexus block was successful in 5/7 cases (71%) with no complications, total pain relief and withdrawal of pharmacological treatment. Bowel stenting achieved complete recanalization of intestinal loop in 2 cases but showed troubles related to management of these patients.

Conclusions

In patients with unresectable pancreatic carcinoma palliation is the only therapeutic option and has the purpose to achieve biliary tree decompression and eliminate jaundice associated symptoms, improving quality of life and reducing hospitalization. Jaundice relief is reachable by surgical, endoscopic or percutaneous approach. Surgical palliation is characterized by disadvantageous cost-effectiveness rate. Endoscopic and percutaneous palliations are alternative, although, in selected patients, percutaneous Wallstents placement by one step technique is perhaps the most successful procedure, showing high rate of technical outcome with low complications and short time spent in hospital. Celiac plexus block under CT guidance constitutes a reliable method for management of pain. At present bowel stricture treatment is surgical.
Ruolo Dell'Endoscopia Nella Palliazione Del Carcinoma Pancreatico
Authors: Spinelli Pasquale , Schicchi Angelo Aldo , Schiavo Marcello
Published: April 2018

The incidence of pancreatic cancer continues to increase and, although improving of diagnostic techniques, the prognosis is very poor with 5-year survival less than 5% and high mortality cancer rate.

Neural and lymphatic micrometastases appear in early stages and curative resection is possible in few selected cases; in these patients there is a high local recurrence rate and a low median survival.

Most patients with pancreatic cancer need palliative care of the obstructive jaundice (90%), duodenal stenosis and abdominal pain; endoscopic procedures have an important role in the treatment of these patients.

Endoscopic placement of plastic biliary stents is a safe and efficient technique to perfom a biliary drainage with a short hospital stay. The use of metal stent, instead of plastic prosthesis, improve median patency of the prosthesis with a low incidence of cholangitis, but they should be used only in patients with a life expectancy of more than six months, because of their high costs.

Laparoscopic gastro-entero-anastomosis is a valide alternative to laparotomic procedure in the treatment of the duodenal stenosis, with a shorter hospital stay and a lower morbidity rate. The endoscopic treatment of abdominal pain with pancreatic endoprosthesis placement or with endosonography-guided celiac plexus neurolysis is an alternative approach to radiotherapy and analgesic drugs.
The geo-constitution: Understanding the intersection of geography and political institutions
Authors: Wills Jane
Published: April 2018

This paper draws on existing work in the discipline of human geography and cognate fields in order to develop the concept of the ‘geo-constitution’. This concept aims to: (1) highlight the importance of intersections between geography and political institutions in the constitution of government; (2) consider the path-dependent development of political institutions and their impact on statecraft and citizenship; (3) explore the implications of this for political reform. The paper provides an overview of current thinking in political geography and applies the concept of the geo-constitution to the example of devolution and localism in the United Kingdom.
A New Combined Enzyme-Charcoal System formed by Enzyme Adsorption on Charcoal followed by Polymer Coating
Authors: Pişkin K. , Chang T.M.S.
Published: April 2018

A method is described for a new combined enzyme-charcoal system. A model enzyme, urease, was adsorbed on activated charcoal granules which was then coated with ultrathin cellulose nitrate. The assayed activity of this immobilized enzyme was 28.1% ± 3.12% (mean ± S.D.) of the activity of urease in solution. The enzyme did not leak out after immobilization and worked efficiently. The assayed urease activity increased with greater amounts of urease/gm immobilized enzyme, but reached a plateau after 40 sumner units/gm. Immobilized urease has good storage and operational stabilities at refrigerator, room and body temperatures. In-vivo studies show that about 90% conversion urea in one single pass is possible.
Results of Valve Replacement Surgery with Mechanical Prostheses
Authors: Pellegrini A. , Peronace B. , Marcazzan E. , Rossi C. , Colombo T.
Published: April 2018

The clinical study is reported of the results of heart valve replacement surgery with a new pyrolytic carbon tilting disc prosthesis manufactured in Italy.

From March 1977 to January 1981, at the «De Gasperis» Cardiosurgery Center, this prosthesis has been implanted in 644 patients: 283 for mitral valve replacement, 240 for aortic valve replacement, and 121 for the replacement of both mitral and aortic valves.

To have a sufficiently long period of post-surgery follow-up, we considered the results of 207 patients (124 cases of isolated mitral valve replacement and 83 cases of isolated aortic valve replacement), who underwent surgery consecutively from March 1977 to December 1979.

The hospital mortality was 10.5% for mitral valve replacement and 4.8% for aortic valve replacement. All patients who were discharged from hospital, except 2, were subjected to clinical, electrocardiographic, phonocardiographic, ecocardiographic and radiological checks.

The average follow-up period was approximately 20 months: clinical results were satisfactory. The probability of survival, expressed by actuarial curve, was, three years after surgery, 94% for patients who underwent mitral valve replacement and 97.5% for those who underwent aortic valve replacement. The probability of embolism was, three years after surgery, 8.5% for patients with mitral replaced and 5% for aortic.

Even if further confirmations are needed the mortality rate and the probability of embolism related to this new prosthesis, are lower, over the same period of follow-up, than that found in the groups of patients who underwent valve replacement surgery, at the same Center, with Starr-Edwards and Björk-Shiley prostheses.

The phonocardiographic and ecocardiographic characteristics of this new prosthesis were also investigated.
Thyroidal Status in Uremia - Effects of Hemodialysis and CAPD
Authors: Giordano C. , De Santo N.G. , Carella C. , Mioli V. , Bazzato G. , Di Leo V.A. , Amato G. , Tarchini A. , Coli U. , Landini S.
Published: April 2018

Thyroid function was explored in 27 CAPD patients and 25 HD patients. Dialysis was associated with low T3 and T4 levels, increased rT3 concentrations, normal T4: T3 and reduced T4: rT3 ratios, normal FT3 and Thyroglobulin concentrations. TSH levels increased during dialysis but still fell within normal limits. The data rule out a condition of primary hypothyroidism and point out to increased thyroidal dismission associated with the block T4-T3 in peripheral cells. Also the increased FT4 levels in CAPD patients could be due to de novo dismission of thyroidal T4.
Anatomical Bases of Peritoneal Permeability: A Reappraisal. Anatomy of Peritoneum
Authors: Feriani M. , Biasioli S. , Chiaramonte S. , Fabris A. , Pisani E. , Ronco C. , La Greca G.
Published: April 2018

The peritoneal membrane consists of flat mesothelial cells linked together with digitations and containing vesiculae with pinocytic capacity, of endothelial cells (containing Weibel-Palade's bodies and vesiculae) and of an interstitial tissue consisting of a network of watery channels.

The cellular structures of mesothelium and endothelium are characterized by tight and gap junctions or perhaps by macular junctions. The visceral peritoneum shows a prevalence of gap junctions, the pericytic veins contain only tight junctions while both types can be found in the arterioles.

Two different ways for solute transport are theoretically possible: the vesicles of plasmalemma (via pinocytosis) and the junctions (via size-sieving effect). Studies with tracers did not furnish unequivocal data on this problem and did not clarify if these structures could be the equivalent of the pores of the Landis-Pappenheimer's theory. The studies of Karnowsky and Simionescu, using tracers, have in fact given opposite results.
Calculation of Combined Diffusive and Convective Mass Transfer
Authors: Sigdell J.E.
Published: April 2018

The clearance of a dialyzer is calculated under the most general conditions, allowing not only for a mixed diffusive and convective mass transfer, but also for a variation along the membrane of the local ultrafiltration, the membrane permeability and the sieving coefficient. The study is then carried on for the case in which these are all constant, to reach a relatively simple expression for the influence of a low ultrafiltration rate on the clearance. In this study, the permeabilities of the boundary layers on both sides are treated as included in the (equivalent) membrane. In an appendix, the stacking of membranes is studied, giving a general law for the calculation of overall permeabilities of a stack of individual membranes, regarded as one (equivalent) membrane (such as a physical membrane with two boundary layers). Permeability data for boundary layers are quoted from earlier works. In other appendices, the variation of the local ultrafiltration along the dialysis path is studied, as well as its effect on the effective permeability of the membrane.
Intraspinal Narcotic Tolerance: Preliminary Experience with Continuous Bupivicaine HCL Infusion via Implanted Infusion Device
Authors: Coombs D.W. , Pageau M.G. , Saunders R.L. , Mroz W.T.
Published: April 2018

Spinal opiate receptor tolerance is the major limitation of continuous intraspinal narcotic analgesia delivered by implanted reservoir pump. Six intractable pain patients receiving continuous epidural morphine were given trials of low dose bupivicaine HCL in order to assess the effects on implanted reservoir function, analgesia, and safety. Daily infusion of 2.6–18.8 mg bupivicaine HCL had no consistent effect on flow rates. Subjectively, three patients had at least partial relief of pain while their intraspinal morphine doses were weaned. No sympathectomy was appreciated at these doses. The future of continuous intraspinal analgesia might require further advances in implantable infusion pump technology to allow manipulation of both daily infusion doses and multiple intraspinal analgesics. Further study is needed to assess the safety and effectiveness of higher continuous intraspinal bupivicaine doses for chronic pain relief.
Cross-linked Stroma-free Polyhemoglobin as a Potential Blood Substitute
Authors: Keipert P. , Minkowitz J. , Chang T.M.S.
Published: April 2018

Stroma-free hemoglobin is prepared from human blood and then cross-linked with glutaraldehyde to produce soluble polyhemoglobin. Results from animal studies show that in the case of polyhemoglobin, its level in the circulation remained unchanged at 77% of the injected amount when followed for 3 hours; whereas stroma-free hemoglobin was removed rapidly with a half-life of 87 minutes. Thus, cross-linking stroma-free hemoglobin into the polyhemoglobin form has solved the major problem of rapid removal of stroma-free hemoglobin from the circulation.
CAPD and Bone Marrow Cell-Cell Interaction Abnormality in end Stage Renal Disease
Authors: Lamperi S. , Carozzi S.
Published: April 2018

In this research the early erythroid progenitor (BFU-E) growth has been observed in patients with chronic renal failure by studing in «in vitro» cultures the number of BFU-E developed per plate under various experimental conditions. Our results demonstrate that the BFU-E growth of uremic patients in the predialysis phase or on hemodialysis is suppressed both in basal conditions and with the addition of lympho-monocytes of normal subjects or CAPD patients to the «in vitro» cultures. In CAPD patients, on the contrary, the BFU-E growth appears near normal levels in basal conditions and is further more enhanced by adding the normal lympho-monocytes to the «in vitro» cultures. The above mentioned facts signify that in uremic patients both the abnormality of bone marrow and immunocompetent cells may be responsable for the suppressed BFU-E growth, while with CAPD the improvement of both systems allow a normalisation of erythropoiesis. Such a recovery with CAPD demonstrates the presence of an inhibitor material in uremia which is better depurated by this technique.
Lymphocyte Subsets Assayed by Numerical Tests in CAPD
Authors: Giacchino F. , Pozzato M. , Formica M. , Quattrocchio G. , Quarello F. , Belardi P. , Piccoli G.
Published: April 2018

Peripheral and peritoneal lumphocytes were assayed by numerical tests in adults on peritoneal dialysis. T lymphocytes were classified by monoclonal antibodies (OKT3, OKT4, OKT8) and B lymphocytes by the presence of surface immunoglobulins, using the immunofluorescence technique.

Peripheral T cells showed no significant change from the normal, except for T suppressor cells which increased in patients with 2 or more peritonitis episodes.

Examination of peritoneal lymphocytes showed a significant reduction in S-IgA lymphocytes (B cells bearing IgA receptors) and an increase in T-suppressor cells (OKT8+) in patients who developed peritonitis in the follow-up study. The implications of these results are discussed with particular reference to susceptibility to peritonitis.
Branched Chain and Aromatic free Amino Acids in Plasma and Skeletal Muscle of uremic Patients Undergoing Hemodialysis and CAPD
Authors: Graziani G. , Cantaluppi A. , Casati S. , Citterio A. , Ponticelli C. , Trifirò A. , Borghi L. , Sani E. , Simoni I. , Montanari A. , Novarini A.
Published: April 2018

Plasma and skeletal muscle free amino acids were measured in patients submitted to Hemodialysis (HD) or Continuous Ambulatory Peritoneal Dialysis (CAPD) in order to evaluate the effects of these different dialysis modalities on amino acid pools; the data were compared with those obtained in control subjects and in patients with advanced Chronic Renal Failure (CRF) not submitted to Regular Dialysis Treatment (RDT).

Our findings show low intracellular concentrations of VAL, total Branched Chain Amino Acid (BCAA) and TYR in uremic patients treated with CAPD but not in those undergoing HD.

The observed differences in muscle amino acid pattern could be well explained by a changed amino acid metabolism regulation in CAPD, possibly related to the sustained hyperinsulinism and to an increased rate of hepatic protein synthesis.
Plasma Exchange and Concomitant Therapy in TTP
Authors: Stoffner D. , Banthien F.C.A. , Habersetzer R. , Samtleben W. , Clemm C. , Unterburger P. , Zähringer J. , Gurland H.J.
Published: April 2018

Since plasma exchange was introduced in the management of thrombotic thrombocytopenic purpura (TTP) in 1977, patient survival rate has increased from 10 to 80%. However, ∼50 subsequent case reports in the literature provide no consensus as to the optimal therapy. We review here 4 episodes of TTP in 3 patients. In all cases, treatment was started with intensive FFP plasma exchange combined with administration of antiplatelet agents and corticosteroids. Remission was achieved in 3 out of 4 episodes although all required individualization of the medication regimen. In the remaining patient, cytotoxic therapy (vincristine) and ultimately splenectomy were required to achieve stable remission. The variable clinical response to these therapeutic protocols indicates that TTP may not represent a single homogeneous disease entity but rather may involve various underlying pathologies. We conclude that the most effective present therapy for the management of TTP is daily plasma exchange with fresh frozen plasma infusions combined with antiplatelet agents and steroids. Vincristine and splenectomy should only be employed if this protocol proves ineffective.
Features of Residual Renal Function in End-Stage Renal Failure Associated with Spinal Cord Injury
Authors: Vaziri N.D. , Bruno A. , Mirahmadi M.K. , Golji H. , Gordon S. , Byrne C.
Published: April 2018

The characteristics of end-stage renal disease (ESRD) complicating spinal cord injury (SCI) were studied retrospectively in 43 male hemodialysis patients. A control group of male patients dialyzed in the same institution were studied for comparison. The SCI patients had significantly lower serum creatinine concentrations and daily urinary creatinine excretion than the control group, despite comparable creatinine clearances. Therefore, serum creatinine, when compared with the familiar values in non-SCI patients, may greatly underestimate the severity of the renal impairment. Urine optput was higher, urine specific gravity lower, and renal glucosuria more common in the SCI patients. 24-hour urinary protein excretion was higher and serum albumin was lower in the SCI patients, with 48% of the patients exhibiting nephrotic range proteinuria. Urine pH was markedly elevated, and pyuria and bacteruria were present in all SCI patients. Fractional excretion of potassium (159 ± 16%) exceeded its filtered load in most SCI patients.
Coagulation Abnormalities in Patients with End-Stage Renal Disease Treated with Hemodialysis
Authors: Vaziri N.D. , Toohey J. , Paule P. , Alikhani S. , Hung E.
Published: April 2018

Plasma levels of various blood coagulation factors, antithrombin III and plasminogen were measured in 18 patients with end-stage renal disease treated by long-term hemodialysis. The results were compared with those obtained in a group of normal volunteers. Factors XII, IX and II activities were significantly reduced; factors VIII, VII and X levels were increased; and factors XI and V activities and high molecular weight kininogen concentration were comparable to the control group. Antithrombin III activity and concentration were significantly reduced. The mean plasma fibrinogen concentration was normal although levels above and below normal limits were noted in a few patients. Similarly the mean platelet count was normal, although mild thrombocytopenia occurred in several patients and thrombocytosis in one. In conclusion, the present study confirms published results about factor VIII and AT-III, and provides new information on changes of other coagulation factors in uremia treated by long-term hemodialysis.
Membrane Plasma Fractionation: Effect of the Surface Area
Authors: Wojcicki J. , Piatkiewicz W. , Werynski A. , Waniewski J. , Goch H. , Hay M.
Published: April 2018

The influence of the surface area on the performance of plasma filters for dead-end mode of filtration is presented in this paper.

Theoretical analysis of the dead-end filtration was performed and verified experimentally (using ENKA cellulose-diacetate PF-100 membranes) in respect to β-lipoprotein. The theoretical model allows to optimize the course of the transmembrane pressure during plasma fractionation procedure in dependence of the surface area, initial concentration of macromolecules, total volume of the feed and membrane structure. The results indicate that the surface area effect is an important factor in the operation of membrane plasma fractionation and should be considered in the design of the plasma fractionation filter.