bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Consumption in Hospitals of the Friuli-Venezia Giulia Region: A Four-Year Retrospective Study
Authors: Bortolussi Roberto , Spazzapan Simon , Lombardi Davide , Colussi Anna Maria , Veronesi Andrea , Matovic Mira , De Cicco Marcello 
Published: April 2018

Aims and background Opioid consumption for analgesic purposes is considered an important indicator of the quality of cancer pain treatment. Italy's consumption ranks among the lowest in economically developed countries. A lack of systematic education of health care professionals regarding pain control and a sort of “opiophobia” induced by measures designed to control the improper use of drugs have been indicated as possible reasons for this trend. The aim of this study was firstly to evaluate the level of opioid consumption at inpatient institutions (where opioid prescription rules have never been subjected to any restriction) and secondly to survey the attitude of the physicians working in general hospitals and specialized oncology institutions (oncology centers and hospices) towards opioid administration. Methods The authors performed a four-year survey (1996–1999) on the consumption of major opioids (morphine, meperidine, buprenorphine, transdermal fentanyl) among all the inpatient institutions (six regional/provincial hospitals, eleven district hospitals, the Aviano Oncology Institute and two hospices) of the Friuli-Venezia Giulia region in North-Eastern Italy. To facilitate data interpretation, all the opioids were converted to milligrams equivalent of oral morphine (mg OME). Data on the number of days of hospitalization of oncological patients in every institution were also collected. Results The overall consumption of opioids was 9,299,177 mg OME (83.3%) and 1,845,060 mg OME (16.7%) in general hospitals and specialized oncology institutions, respectively. Overall, the number of days of hospitalization of oncological patients was 1,121,142 (87%) and 167,665 (13%) in general hospitals and specialized oncology institutions, respectively. The ratio between the total dosage of mg OME administered and the total number of hospitalization days in general hospitals and specialized oncology institutions was 8.29 mg OME/day and 11 mg OME/day, respectively. Conclusions Our data show that in specialized oncology institutions, opioid consumption was proportionally higher than in general hospitals. This result indicates the attitude of the physicians of these institutions towards opioid administration, probably due to the training received on cancer pain treatment, and emphasizes the need to educate all health care workers involved in the management of cancer patients.
Micro-Melanoma Detection. A Clinical Study on 22 Cases of Melanoma with a Diameter Equal to or Less than 3 MM
Authors: Bono Aldo , Bartoli Cesare , Baldi Marzia , Moglia Daniele , Tomatis Stefano , Tragni Gabrina , Cascinelli Natale , Santinami Mario 
Published: April 2018

Background and aims Very small pigmented lesions may represent an extreme diagnostic challenge to the clinician. Our aim was to describe the clinical and dermoscopic features in a series of cutaneous melanomas with a maximum clinical diameter of 3 mm. Methods We conducted a retrospective study of the 924 primary melanomas seen and treated during a period of five years at the Unit for Melanoma Detection of the Istituto Nazionale Tumori of Milan, Italy. The size characteristics of the considered lesions allowed the identification of 22 (2.4%) cases of micro-melanoma (clinical diameter of 3 mm or less). Sixteen of these cases were subjected to dermoscopy. The clinical and dermoscopic features as well as the corresponding diagnoses were recorded. Results The typical lesion presents as a small, dark, often black macule, generally evenly colored, with well-defined borders; it may be asymmetric or symmetric in shape. These features prompted a correct clinical diagnosis in nearly half of the cases. Dermoscopy lead to a correct diagnosis in all cases subjected to the technique. Conclusion Dermoscopy appears to be an efficient aid to the diagnosis of micro-melanomas, provided that clinicians are aware of this type of lesion and maintain the index of suspicion at a high level.
Non-Occupational Risk Factors for Bladder Cancer a Case-Control Study
Authors: Radosavljević Vladan , Janković Slavenka , Marinković Jelena , Dokić Milan 
Published: April 2018

Aims The aim of this study was to determine non-occupational risk factors for bladder cancer in Serbia. Methods and design A hospital-based, case-control study included 130 newly diagnosed bladder cancer patients and the same number of individually matched controls with respect to sex, age (± 2 years) and type of residence (rural or urban), from the Clinical Center of Serbia in Belgrade and from the Clinical Center in Kragujevac in central Serbia. The study took place from June 1997 to March 1999. Results According to multivariate logistic regression analysis, there was an association between: frequency of daily urination (OR = 0.18; 95% CI = 0.08-0.39); consumption of liver (OR = 13.81; 95% CI = 2.49-76.69), canned meat (OR = 8.38; 95% CI = 1.74-40.36), fruit juices (OR = 0.08; 95% CI = 0.01-0.56); the highest fertile of pork (OR = 4.55; 95% CI = 1.30-15.93), cabbage (OR = 0.25; 95% CI = 0.06-1.01) and vinegar (OR = 4.41; 95% CI = 1.18-16.50) intake and risk for bladder cancer. Conclusions Consumption of liver, canned meat, pork (h vs I tertile) and vinegar (m vs I tertile) was indicated as a risk factor for bladder cancer, whereas frequent daily urination, consumption of fruit juices and cabbage (h vs I fertile) were indicated as protective factors.
Lung Cancer Mortality in a District of La Spezia (Italy) Exposed to Air Pollution from Industrial Plants
Authors: Parodi Stefano , Baldi Roberta , Benco Claudia , Franchini Michela , Garrone Elsa , Vercelli Marina , Pensa Floriana , Puntoni Riccardo , Fontana Vincenzo 
Published: April 2018

Aims and background In the last decades, many epidemiological studies have implicated outdoor environmental carcinogens in the onset of lung cancer. The present investigation evaluated lung cancer mortality in two areas of the Province of La Spezia (Northern Italy) exposed to environmental pollution emitted by a coal-fired power station and other industrial sources, including a waste incinerator. Methods In the two exposed areas, lung cancer mortality risk for the 1988-1996 calendar period was evaluated using the whole Province population as referent. The corresponding relative risks (RR) were estimated after controlling for age structure, urban/rural gradient and deprivation factors (occupation, education, home ownership, housing conditions and family structure) by a Poisson regression modeling. The geographic pattern of risk for the whole province was evaluated via the Besag, York and Mollié (BYM) bayesian model. Results Persons living in urban areas showed the highest rates in both sexes. No statistically significant risk excess was found in the two exposed areas among males, after excluding rural and semi-rural zones from the analyses (RR = 1.03 and RR = 0.77). In contrast, a risk excess was observed for females in both exposed areas, which remained elevated and statistically significant (P <0.05) after restriction to urban/semi-urban municipalities and after controlling for deprivation factors (RR = 1.54 and RR = 2.14, respectively). Bayesian mapping confirmed the rural/urban gradient and the risk excess observed in females near the industrial sites. Conclusions The risk observed among females is consistent with pollution measurements and with other epidemiologic findings, whereas a strong confounding from occupational exposures and smoking habit could account for the lack of an excess risk in males. However, the ecologic nature of this investigation prevented drawing a causal inference. The pollution-related risk observed in the female gender is an important clue that deserves further epidemiologic attention.
Treatment of Metastatic Pancreatic Cancer with a Combination of Gemcitabine and 5-Fluorouracil: A Single Center Phase II Study
Authors: Kanat Ozkan , Evrensel Turkkan , Kurt Ender , Demiray Mutlu , Gonullu Guzin , Arslan Murat , Manavoglu Osman 
Published: April 2018

Aim To determine the activity and toxicity of a combination of weekly gemcitabine and 5-fluorouracil bolus intravenously in patients with metastatic pancreatic cancer. Patients and methods Twenty-one patients with previously untreated metastatic pancreatic cancer were included in this phase II study. The schedule was gemcitabine (1000 mg/m2 iv) and 5-fluorouracil (500 mg/m2 bolus iv) weekly for 3 weeks every month. Results Four patients (19%) achieved a partial response and three stable disease. A clinical benefit was obtained in 7 patients (33%). Median survival for all the patients was 6 months. The treatment was well tolerated and toxicity was mild. WHO grade 3 leukopenia occurred in 2 (9.5%) patients, grade 3 anemia in 4 (19%) patients, grade 3-4 thrombocytopenia in 4 (19%) patients, grade 1 diarrhea in 1 (4.7%) patient and grade 1 mucositis in 3 (14.2%) patients. Conclusion The weekly administration of gemcitabine combined with 5-fluorouracil bolus iv is an active and well-tolerated regimen in metastatic pancreatic cancer. However, its efficacy is relatively limited.
Serum Interleukin-6 Levels Correlate with Malnutrition and Survival in Patients with Advanced Non-Small Cell Lung Cancer
Authors: Songür Necla , Kuru Bekir , Kalkan Faruk , Özdilekcan Çiğdem , Çakmak Hüseyin , Hızel Nedret 
Published: April 2018

Aim To investigate the level of interleukin-6 in advanced non-small cell lung cancer and to analyze the relationship with malnutrition and survival. Methods and study design Seventy-one newly diagnosed advanced non-small cell lung cancer patients were enrolled in this prospective study. Malnutrition was defined by using subjective global assessment. Performance status was assessed by the Karnofsky scale. Serum levels of albumin, transferrin, C-reactive protein, lymphocytes/mm3, lactate dehydrogenase and growth hormone were determined before treatment. The patients were followed, and the factors affecting survival were analyzed. Results The mean follow-up after diagnosis was 180 days. IL-6 levels increased in 48 (68%) of 71 patients. According to the subjective global assessment, 28 (39%) patients were well nourished and 43 (61%) were malnourished. Of the 43 malnourished patients, 29 (41%) were moderately malnourished or suspected of being malnourished and 14 (20%) were severely malnourished. The IL-6 level was related to impaired performance status (P = 0.0001), severe malnutrition (P = 0.004), increased C-reactive protein (P = 0.013), higher growth hormone (P = 0.025) and transferrin (P = 0.03) levels. On univariate analysis, impaired performance status, moderate and severe malnutrition, decreased serum albumin and transferrin, a raised IL-6 and lactate dehydrogenase levels were the significant prognostic factors for survival. Multivariate analysis indicated that a raised IL-6, severe malnutrition and a low serum level of albumin were independent prognostic factors for survival in patients with advanced non-small cell lung cancer. Conclusions IL-6 secretion may play a role in the pathophysiology of malnutrition in advanced lung cancer. Results show a relation between elevated IL-6 serum levels and malnutrition, poor performance status, acute phase response and shorter survival in patients affected by advanced non-small cell lung cancer.
Postoperative Adjuvant Radio(Chemo)Therapy for Rectal Cancer: An Appraisal
Authors: Scandolaro Luciano , Cazzaniga Luigi Franco , Bianchi Ernestina , Cagna Emanuela , Prina Morena , Valli Maria Carla , Barsacchi Lucia , Frigerio Milena 
Published: April 2018

Aims and background Rectal cancer can be considered a broad-spectrum disease, where the surgeon, radiation oncologist and medical oncologist have a peculiar and specific place in order to work harmoniously as a good orchestra. The reality in common general hospitals is far from that of comprehensive cancer centers, particularly for postoperative approaches. The adjuvant therapy of rectal cancer is not codified worldwide, and it is strongly dependent on preoperative staging procedures, surgeon's acts and pathologist's decisions. Starting from our 10-year experience, we analyzed the various steps of postoperative approaches, defining possible decision errors, the incongruity of some attitudes, and the lack of knowledge of recent achievements of science in this disease. Methods A total of 194 patients with advanced surgically removed rectal cancer (pT3-4 pNO - any pT pN+) treated with postoperative radio(chemo)therapy was reviewed retrospectively. Anterior resection was performed in 126, abdominoperineal resection in 48, and other surgical procedures in 20 patients. Irradiation was conducted with a single daily fraction of 1.8 Gy until 45 Gy, and chemotherapy consisted of the combination of 5-fluorouracil and folinic acid (Machover schedule): 47% of patients with positive nodes did not receive chemotherapy. Results Five-year overall survival was 60.6% and relapse-free survival was 55.5%. The main prognostic factors were pathological T and N stages. The principal route of progression was distant metastases. Acute toxicity was severe in 1 case (drug toxic hepatitis) and very severe in 16 patients, and late severe sequelae appeared in 13 patients. Conclusions The outcome of rectal cancer patients has not changed during the last decade, and this was confirmed in our study. The improvement of radiotherapy techniques has reduced the adverse acute and late toxicity. The best postsurgical approach for pT3pN0 cancer remains unsolved, as the good chemotherapy combination and the real solution could be the application of a new Consensus Conference.
Postoperative Radiochemotherapy in Rectal Cancer Comparison of two Combination Schemes: Alternating versus Concomitant
Authors: Valencia Javier , Escó Ricardo , Polo Sofía , Bascón Natividad , Escudero Pilar , Alonso Vicente 
Published: April 2018

Aims and background To compare the results on disease control and toxicity of two different schedules of adjuvant combined treatment in advanced rectal cancer. Methods From January 1995 to September 1998, 127 patients with stage B2-C rectal cancer were treated with postoperative chemotherapy and radiotherapy with two different schemes: three cycles of 5-fluorouracil and leucovorin followed by pelvic radiotherapy and three weeks after radiation therapy was completed, another three cycles of chemotherapy were administered (alternating arm), or two cycles of 5-fluorouracil and leucovorin followed by concurrent radiochemotherapy and three weeks after ending another two cycles of 5-fluorouracil and leucovorin were administered (concomitant arm). Results Grade 3 acute toxicity was more frequent in the concomitant schedule group (33% vs 13%, P = 0.014). In the alternating schedule group, the acute adverse effects were observed after an average radiation dose of 28.4 Gy and in the concomitant schedule group after an average dose of 22.7 Gy (P = 0.012). In the arm of concomitant treatment, 37.8% of patients had to interrupt the irradiation for severe toxicity compared to 10.4% in the arm of alternating treatment (P = 0.001). There was no difference in the rate of late toxicity. The actuarial overall survival rates at 3 and 5 years were, respectively, 68.8% and 56.6% in the alternating arm and 75.5% and 61.8% in the concomitant arm (P = 0.4599). There were no differences between the two arms in the 5-year actuarial rates of overall recurrence (47% vs 51.3%, P= 0.722), local recurrence (34.6% vs 35.7%, P = 0.935) or distant recurrence (32.7% vs 31.8%, P = 0.983). Conclusions For patients with B2-C rectal cancer, postoperative treatment with an alternating scheme of chemoradiotherapy is as effective as a concomitant scheme in control of the disease. The concomitant scheme had a higher incidence, earlier appearance and higher severity of intestinal acute toxicity than the alternating scheme, with a lower completion rate of chemoradiotherapy but without any influence on late toxicity incidence.
Feasibility and Results of a Multimodality Approach in Elderly Patients with Localized Intermediate to High-Grade Non-Hodgkin's Lymphomas
Authors: De Sanctis Vitaliana , Martelli Maurizio , Osti Mattia F , Donato Vittorio , Grapulin Lavinia , Monello Stefania , De Renzi Filippo , Mandelli Franco , Enrici Riccardo Maurizi 
Published: April 2018

Aims and background A prospective clinical study to determine efficacy and feasibility of a brief course or standard course of anthracycline-based chemotherapy and consolidation radiation therapy in non-Hodgkin's lymphoma patients over 60 years of age. Methods Twenty-five consecutive patients with stage I-IE intermediate to high-grade non-Hodgkin's lymphoma aged 60 and older were treated in an outpatient setting in the Radiotherapy Oncology and Hematology units. All patients had a performance status of 0-1 according to WHO criteria. The survival end points, ie, overall survival, disease-free survival and event-free survival, were considered. Lactate dehydrogenase value, nodal versus extranodal localization and dose intensity were assessed as risk factors for disease-free and overall survival. A comparison using logrank analysis with a wellmatched group of stage I-IE non-Hodgkin's lymphoma patients aged less than 60 years was performed. Results The 5-year overall and disease-free survival rates were 90% and 86%, respectively. There was no statistical difference with respect to the younger population regarding these survival end points. Finally, the 5-year event-free survival was 85% and 86% for elderly and younger patients, respectively, without statistical difference (P = 0.41). Neither acute nor late toxicity (G3-G4) was observed during chemotherapy and radiotherapy treatment and the follow-up in the elderly group. Conclusions We confirm the efficacy and feasibility of a full-dose combined chemoradiotherapy in elderly patients with a good performance status with localized I-IE intermediate to high-grade non-Hodgkin's lymphoma.
Hyperfractionated Radiotherapy for T2N0 Glottic Carcinoma: A Retrospective Analysis at 10 Years Follow-up in a Series of 60 Consecutive Patients
Authors: Bignardi Mario , Antognoni Paolo , Sanguineti Giuseppe , Magli Alessandro , Molteni Marinella , Merlotti Anna , Richetti Antonella , Tordiglione Michele , Conte Leopoldo , Magno Lorenzo 
Published: April 2018

Aims and background To report results of hyperfractionated radiotherapy for T2N0 glottic carcinoma at a single institution after extended follow-up. Methods Between 1980 and 1988 at Varese University Hospital, 60 consecutive patients with T2N0 glottic carcinoma received exclusive radiotherapy consisting of 1.5 Gy/fraction twice a day. Treatment gaps during the radiotherapy course were allowed according to individual tolerance. This policy resulted in a wide range of elapsed treatment time: median, 5.7 weeks; range, 3.7-8.9. Median follow-up is 9.8 years. Results As a result of dose/time distribution, 16, 20 and 24 patients received an average weekly dose rate of <10 Gy/week, equal to 10 Gy/week or >10 Gy/week, respectively. Mean total dose for each group was 62.8 Gy, 63.7 Gy and 63.8 Gy, respectively. Five-year local-regional control was 69 ± 6% (95% Cl); ultimate local-regional control, including salvage surgery, was 78 ± 5%. All failures were at the primary site, and no patient developed neck recurrence as first site of failure. The actuarial incidence of grade 2-3 late reactions at 5 years was 42 ± 6%. Most late toxicity events were grade 2: only 2 patients developed grade 3 reactions and none grade 4. None of the several clinical and treatment-related variables showed any statistically significant impact on local-regional control or late toxicity at univariate and multivariate analysis. In particular, 3-year local-regional control rates were 73 ± 11%, 84 ± 8% and 69 ± 10% for an average weekly dose rate of <10 Gy/week, equal to 10 Gy/week and >10 Gy/week, respectively (not significantly different). Conclusions At a very long follow-up, the hyperfractionated regimen tested in the study was shown to be effective and devoid of major complications, provided individual patient acute tolerance is carefully taken into account. Also, time factor did not affect outcome in this series.
Free to Total Psa Ratio is not a Reliable Predictor of Prostate Biopsy Outcome
Authors: Ciatto Stefano , Rubeca Tiziana , Confortini Massimo , Pontenani Giovanni , Lombardi Claudio , Zendron Paola , Di Lollo Simonetta , Crocetti Emanuele 
Published: April 2018

Aims and background The aim of this study was to assess the validity of predictors of prostate biopsy outcome in order to improve their positive predictive value. Material and methods The study material consisted of a consecutive series of 410 prostate biopsies performed during 2003. The variables tested as possible predictors were age, findings at palpation (DRE) and ultrasonography (TRUS), total prostate-specific antigen (PSA), and free-to-total prostate-specific antigen (F/T) ratio. The association with biopsy outcome (cancer vs non-cancer) was investigated by univariate and multivariate analysis. Results All tested variables showed a statistically significant and independent association with biopsy outcome both in univariate and multivariate analysis. Nevertheless, no variable had good performance as a biopsy indicator: depending on the considered variable, three to nine cancer biopsies would be delayed in order to avoid ten benign biopsies. Using 0.12, 0.15 and 0.20 as the cutoff for F/T would avoid 77.3%, 64.4% and 43.1% of benign biopsies but would delay 54.0%, 35.6% and 21.0% of cancer biopsies, respectively. Conclusion Although it may contribute to diagnostic suspicion, F/T should never exclude a biopsy indicated because of suspicion arising from other diagnostic tests.
Adenomyoepithelioma of the Breast, Presenting as a Cancer
Authors: Gatti Giovanna , Viale Giuseppe , Simsek Serife , Zurrida Stefano , Intra Mattia , Caldarella Pietro , Luini Alberto 
Published: April 2018

Aims and background Adenomyoepithelioma is a rare lesion that can involve the breast tissue. The diagnostic appearance of the lesion can give raise to a difficult differential diagnosis with breast carcinoma. Patients and methods We report our experience with a case of adenomyoepithelioma whose differential diagnosis with a breast carcinoma was particularly difficult, leading to surgery for definitive histology. Discussion Few papers are available with evidence about adenomyoepithelioma. The difficult differential diagnosis and the potentiality of malignant evolution of this lesion could in principle justify a conservative surgical approach for final histology.