[A case of retroperitoneal fibrosis with spontaneous regression]

Retroperitoneal fibrosis has an unknown pathogenesis. Medical treatment should be preferred to surgery. However, surgical treatment is required when an ureteral involvement is present. A case of retroperitoneal fibrosis with spontaneous regression is reported. Current knowledge on pathogenesis, diagnosis and preferred treatment is outlined.

Popliteal artery entrapment syndrome: the role of early diagnosis and treatment

BACKGROUND

The purpose of this study was to evaluate whether certain factors could influence arterial impairment at presentation for treatment of popliteal artery entrapment syndrome (PAES) and whether its early diagnosis could optimize long-term results.

METHODS

Between 1979 and 1995, 30 patients were treated for PAES at our institution. Patients were characterized by age, risk factors, associated diseases, preoperative symptoms, affected side, dominant limb, duration of symptoms, musculotendinous structure causing the compression, arteriographic findings, arterial status at presentation, type of operation, postoperative complications, and long-term follow-up.

RESULTS

Twenty-nine (65%) limbs underwent musculotendinous section (MTS), 15 (33%) limbs underwent vascular reconstruction, and 1 (2%) was surgically explored. Patients submitted to MTS were younger (mean, 31 +/- 3 years) than patients who underwent vascular reconstruction (mean, 41 +/- 4 years; p < 0.05). MTS limbs had a greater number of minor symptoms compared with those that underwent vascular reconstruction (62% versus 20%; p < 0.02). Arteriogram showed that MTS limbs had a greater number of normal findings at rest when compared with limbs that underwent conventional reconstruction (85% versus 0%; p < 0.001). No specific factors influenced the arterial status at presentation. During follow-up, treadmill examination revealed that MTS limbs had a better response (96%) than limbs that had undergone vascular procedures (67%; p < 0.02). MTS limbs had a better long-term patency rate (mean, 87 +/- 7 months) compared with limbs that were submitted to vascular reconstruction (mean, 107 +/- 8 months) (95% versus 65%; p < 0.02).

CONCLUSIONS

Because PAES is a progressive disease that can create serious vascular obstructive disease and no specific factors seem to influence the degree of vascular impairment, the detection and treatment of PAES at an early stage permit better long-term results.

Mechanical and morphological properties of living 3T6 cells probed via scanning force microscopy

Scanning Force Microscopy (SFM) is utilized to study living confluent 3T6 cells. Images based on mechanical contrast are obtained and related morphological details, mostly regarding the cell cytoskeleton, are analyzed. Moreover, numerical estimates of the local mechanical properties of the living cells are given, by extensive use of the "force-vs.-distance" operation mode. On the basis of the results obtained, the potentialities of SFM as an optimal new technique available for probing the cell cytoskeleton of unstained living cells, and assessing related models, are shortly discussed.

[Nodular fasciitis: a case arising from the splenius cervicis muscle]

An unusual case of nodular fasciitis, arising from the splenius muscle, is presented. This uncommon lesion is always benign, but a local spread in the surrounding muscular tissue is possible. Through a Literature review, the main pathological, clinical and therapeutic features are discussed.

An unusual case of spontaneous rupture of a clinically "silent" phaeochromocytoma

A case of an adrenal mass which presented as spontaneous rupture contained by its own capsule is described. Clinical symptoms were aspecific and endocrinological examinations were within normal range. CT scan missed the presence of the adrenal tumor and interpreted the mass as a large haematoma arising from the left kidney. The pathological diagnosis was phaeochromocytoma. The management of "silent" phaeochromocytoma and its atypical presentation are discussed. A review of the international literature was also made collecting 29 cases of spontaneous rupture of an adrenal phaeochromocytoma.

Correlation between tumor-associated glycoprotein 72 mucin levels in tumor and serum of colorectal patients as measured by the quantitative CA 72-4 immunoassay

Colorectal tissue biopsies were obtained from 110 patients diagnosed with primary colorectal carcinoma (tumor and normal colonic mucosa samples), 20 patients diagnosed with benign colorectal disease, and 31 healthy donors. The level of expression of tumor-associated glycoprotein 72 (TAG-72) was quantitatively measured in each sample using a double-determinant RIA with monoclonal antibodies B72.3 and CC49 and detecting the sialyl-Tn epitope; this assay was termed CA 72-4. Statistical analysis revealed a significant (approximately 10-fold) increase of TAG-72 expression in the colon tumor biopsies when compared with the expression in normal colonic mucosa from the same patients. A regression analysis revealed a significant correlation (r = 0.459; P < 0.001) between TAG-72 levels measured in biopsies from the tumor lesions and those found in the corresponding normal colonic mucosa. Furthermore, regression analysis showed a significant positive correlation between TAG-72 levels in the tumors and sera of the same patients (r = 0.491; P < 0.001). TAG-72 levels in normal colonic mucosa from healthy donors and patients diagnosed with colorectal cancer were compared. TAG-72 expression was 5-fold higher in the normal mucosa from the colorectal carcinoma patients. No relationship between TAG-72 tumor tissue content and stage of disease was found. Moreover, the correlation between TAG-72 distribution and degree of tumor differentiation observed (P < 0.05) was not any more evident when mucinous carcinomas were excluded. Finally, the results provide further evidence that TAG-72 may be considered an important early marker for colorectal cancer and/or other dysplastic colonic diseases. The statistical correlation between TAG-72 levels in tumors and circulating TAG-72 indicates that patients with elevated levels of serum TAG-72, as measured by the CA 72-4 assay, would be most suited for diagnostic and/or therapeutic intervention with the anti-TAG-72 monoclonal antibodies B72.3 or CC49 or vaccine trials using the sialyl-Tn epitope.

Clinical utility of CA 72-4 serum marker in the staging and immediate post-surgical management of gastric cancer patients

CA 72-4 is a high molecular weight, pancarcinoma human tumor mucin which may play an important role in the identification (i.e., staging) and clinical management of patients with gastric carcinoma. In the present study of 242 patients with primary or recurrent gastric cancer, a higher percentage of these patients had measurable serum CA 72-4 levels when compared with either CA 19.9 or CEA. Moreover, the presence of positive serum CA 72-4 levels correlated with the presence of lymph node involvement and with the identification of patients with a poor prognosis due to the presence of an advanced stage of gastric cancer. Post-operative monitoring of serum CA 72-4 revealed that the disappearance of CA 72-4 often indicated curative surgery which correlated with a longer disease-free interval. Additional clinical studies are needed to better evaluate the role of CA 72-4 as a serum marker for human gastric carcinoma. Concomitant studies should also focus on what role CA 72-4 may play in the initiation and/or progression of the gastric carcinoma phenotype.

Energetics of underwater swimming with SCUBA

Underwater swimming has unique features of breathing apparatus (SCUBA), thermal protective gear, and fins. The energy cost of underwater swimming is determined by the drag while swimming and the net mechanical efficiency. These are influenced by the cross-sectional area of the diver and gear and the frequency of the leg kick. The speeds that divers can achieve are relatively low, thus the VO(2) increases linearly with values of VO(2)*d(-1) of 30-50 l*km(-1)for women and men, respectively. Diving experience had little effect on VO(2) for women; however, male divers with experience had lower VO(2) than beginners. The location and density of the gear can alter the diver's attitude in the water and increase the energy cost of swimming by 30 percent at slow speeds. The type of fin used has an effect on the depth and frequency of the kick, thus on drag and efficiency, with a range of VO(2) from 25 to 50 l*km(-1). A large flexible fin had the lowest energy cost and a large rigid fin the highest. Adding extra air tanks or a dry suit increased the cost of swimming by 25 percent. The energy cost of underwater swimming is influenced by gender, gear and its placement, fin type, and experience of the diver.

[Preoperative blood storage and intraoperative blood recovery in elective treatment of abdominal aorta aneurysm]

We evaluated the efficiency and costs-effectiveness of blood predonation and intraoperative salvage in elective abdominal aortic aneurysm surgery. Between January 1992 and January 1994, 66 patients (59 male and 7 female, aged 69.9 +/- 0.8 years) who underwent elective surgical repair of an AAA were selected for the study. Thirty-six (54.5%) patients (Group 1) intra- and/or postoperatively received homologous blood whereas 30 (45.5%) patients (Group 2) received autologous blood predonation and intraoperative blood aspiration and reinfusion. The two groups were similar for demographic data, aneurysmal diameter and associated diseases and/or risk factors (p = NS). Operative mortality was comparable between the two groups (p = NS). The mean intraoperative blood loss was 803.4 +/- 104.5 ml in group 1 and 812.8 +/- 44.8 ml in group 2 (p = NS). Group 2 patients received intra- or postoperatively a mean of 0.8 +/- 0.2 units of homologous blood (p < 0.001). Aneurysmal diameter did not influence the transfusion requirement between the two groups (p = NS). The cost per unit of homologous banked blood was significantly higher (p < 0.01). Cumulative costs of the procedures did not show statistical differences between the two groups (p = NS). Aortic surgery is the ideal target for predonation and intraoperative blood salvage.

Prolonged and high dose recombinant interferon alpha-2b alone or after prednisone priming accelerates termination of active viral replication in children with chronic hepatitis B infection

BACKGROUND

There is no generally accepted treatment for chronic hepatitis B (HB) infection in children.

OBJECTIVES

To evaluate the efficacy of a prolonged course of high dose interferon alone or after prednisone priming in children with chronic HB infection.

METHODS

The outcome of 31 children with HB e antigen (HBeAg)-positive chronic hepatitis who randomly received either no treatment (n = 9) or 10 million units of interferon alpha-2b/m2, alone (n = 13) or after prednisone priming (n = 9), three times weekly for 1 year was studied.

RESULTS

One patient withdrew from treatment. By the end of the first year treatment induced a loss of HB virus DNA and HBeAg from serum in 10 of 21 patients (48%), and a loss of HB surface antigen (HBsAg) in 4 (19%). Alanine aminotransferase values became normal in one patient (4.8%). Response rates in the two groups of treated patients were similar. In controls only one patient lost HBeAg and HBV DNA (11%; P = 0.05), and none lost HBsAg or showed alanine aminotransferase normalization (P = 0.21 and 0.70, respectively). After a posttreatment 2-year follow-up there were still no differences in the response rates of the two treatments; of the 21 pooled treated patients, 61% lost HBeAg and DNA and 67% normalized alanine aminotransferase (vs. 33 and 44% of controls, respectively; P = 0.32 and 0.40). Reversion to HBeAg and HBV DNA negativity in treated patients occurred significantly earlier (P = 0.02 and 0.006, respectively) than in controls. No further patient lost HBsAg, but one reacquired HBsAg. Treated patients had posttreatment histologic scores better than controls (P = 0.03).

CONCLUSIONS

Our medium term follow-up results indicate that a prolonged course of high dose interferon in children with chronic HB infection, regardless of prednisone priming, poorly affects response rates but significantly speeds termination of active viral replication.

[Adrenocortical carcinoma. Current approaches in diagnosis and treatment]

Adrenocortical carcinoma is a rare malignant tumor. The survival rate is related to a radical tumor resection. However, adrenocortical carcinomas are usually diagnosed in advanced stage. Although some cases of long-term regressions of metastases under op'-DDD (Mitotane) therapy have been sometimes reported the overall efficiency of mitotane in prolonging life remains controversial. Between May 1975 and January 1994, 9 patients were surgically treated for adrenocortical carcinoma at our institution. There were 6 females and 3 males, mean age 40.8 years (median 40 years). Five (55.6%) patients presented with abdominal pain, whereas 4 (44.4%) patients had symptoms of hormone secretion (cortisol). One patient was lost at follow-up. Overall survival rate was 16.8 +/- 5.9 months, the survival rates according to tumor stage were: stage I. 58 months (1 case), stage II. 6 and 16 (2 cases; mean 11 months), stage III. 7, 15.17 and 22 (4 cases, mean 15 months) and stage IV. 9 months (1 case). The progression of the disease is not controlled by the administration of op'-DDD and the best treatment is represented by surgery.

[Total thyroidectomy in the treatment of multinodular toxic goiter]

The Authors report their experience in the management of 201 patients with multinodular toxic goiter (MTG): 122 (60.7%) underwent subtotal thyroidectomy (STT), while 79 (39.3%) underwent total thyroidectomy (TT). Through a retrospective study the patients were stratified into two groups according to the type of operation (TT or STT). Overall, neither operative mortality nor recurrent nerve damage were encountered. Permanent hypocalcemia was observed in 7 patients (5.7%) who underwent STT and in 6 patients (7.5%) who underwent TT (p=N.S.), while transitory hypocalcemia was observed in 12 cases (9.8%) in group I and 11 cases (13.9%) in group II (p=N.S.). All patients were followed every 4 months for the first year and every 6 months thereafter. Average and median follow-up period were, respectively, 72 and 74 months. The Authors conclude that total thyroidectomy is the surgical treatment of choice in multinodular toxic goiter (MTG). A thorough anatomical-surgical evaluation is essential in order to prevent the complications characteristic of this type of surgery (inferior laryngeal nerve injury and hypoparathyroidism).

[The rectus abdominis free flap in reconstructive surgery of the head and neck]

The Authors describe their preliminary experience with rectus abdominis free flap in reconstructive surgery of the head and neck. Out of the 29 cases of microsurgery in treating head and neck tumours, four inferior rectus abdominis free tissue transfers were used: two for complex intraoral reconstruction and two for composite facial defects. There was one flap loss due to late infection in the region of anastomosis, while there were two complications in the remaining three cases. The morphological and functional results have proved to be highly satisfactory. The flap, based on the deep inferior epigastric vessels, appears to be versatile in terms of skin island design, thickness and length of the pedicle. As with the forearm free flap, the inferior rectus abdominis has the advantage of offering the possibility of simultaneous demolition and reconstruction in one surgical session. The Authors conclude that the low morbidity concerned with this microvascular flap, also reported in international literature, confirm its validity as a soft tissue transfer in the in the treatment of advanced head and neck cancer.

[Carotid thromboendarterectomy: personal experience and review of the literature]

Carotid endoarterectomy (CEA) is known to prevent cerebrovascular accidents. Between February 1987 and December 1993 we performed 97 CEA on 82 patients (62 male and 20 female, median age 66 +/- 7.6 years) 95.1% reported previous hemispheric neurological accidents; 4.9% were asymptomatic. Operative indications for asymptomatic patients were high degree stenosis (> 70%) of the internal carotid artery and ulcerated plaques with a moderate degree (50%) of stenosis. Major events (transient ischemic attack and stroke) were recorded in 73.2% cases. Preoperative investigations consisted of Duplex scan, arteriography, and cerebral CT scan or NMR. Operative mortality was 2.06% (2 cases) and perioperative stroke was 5.1% (5 cases). The sensibility, sensitivity and accuracy of Duplex scan to detect ulcerated plaques was 88.7%, 85.2% and 87.5% respectively. At a median follow-up of 33 months (range 6-81 months) 74 (92.5%) patients are free of strokes whereas 1 patient died for stroke. In our series the annual incidence of stroke was 0.5%. Our results suggest that Duplex scan is a reliable exam to investigate the carotid axis and CEA is a safe operation that prevents future cerebrovascular accidents.

Persistent hyperaminotransferasemia resolving after weight reduction in obese children

Nine obese children were referred to our liver disease unit because of asymptomatic, long-standing (range, 4 to 49 months) hyperaminotransferasemia of unknown origin. Ultrasonography showed a "bright" liver in most patients. A hypocaloric diet was prescribed, and the hepatic abnormalities of the complaint patients showed a prompt and persistent improvement that paralleled the loss of excess weight.

TAG-72 (CA 72-4 assay) as a complementary serum tumor antigen to carcinoembryonic antigen in monitoring patients with colorectal cancer

BACKGROUND

Serum carcinoembryonic antigen (CEA) is the most frequently chosen tumor marker in the clinical diagnosis of colorectal carcinoma and in the long-term monitoring of patients after tumor resection. In recent years, monoclonal antibody technology has identified several new markers of neoplasia, two of which, TAG-72 and CA 19-9, are found in the sera of patients with adenocarcinoma. Serum CEA, TAG-72, and CA 19-9 were evaluated in 300 patients with either malignant (n = 200) or benign (n = 100) colorectal disease.

METHODS

Serum CEA, TAG-72 (CA 72-4), and CA 19-9 antigen levels were determined with a double-determinant radioimmunometric assay kit. Samples and appropriate standards were assayed in duplicate. The cutoff limits used for each assay were indicated by the manufacturer. All of the results of the CA 72-4, CEA, and CA 19-9 serum assays were separated from the clinical information until the study was completed.

RESULTS

Of the 200 patients with colorectal carcinoma, the percentage of patients whose serum samples were positive for CEA, TAG-72, or CA 19-9 was 43%, 43%, and 27%, respectively. The measurement of TAG-72 with CEA for patients with primary or recurrent colorectal carcinoma increased substantially (to 60%) the percentage of positive serum samples when compared with measuring each serum tumor marker alone. Moreover, the apparent advantage gained by measuring the two tumor markers was achieved with little increase in the number of false-positive results.

CONCLUSIONS

The findings support previous observations of complementary expression of TAG-72 and CEA and indicate that a significant advantage could be gained in the detection of primary and, perhaps, recurrent colorectal carcinoma by incorporating the measurement of serum TAG-72 with that of CEA.

TAG-72 (CA 72-4 assay) as a complementary serum tumor antigen to carcinoembryonic antigen in monitoring patients with colorectal cancer

BACKGROUND

Serum carcinoembryonic antigen (CEA) is the most frequently chosen tumor marker in the clinical diagnosis of colorectal carcinoma and in the long-term monitoring of patients after tumor resection. In recent years, monoclonal antibody technology has identified several new markers of neoplasia, two of which, TAG-72 and CA 19-9, are found in the sera of patients with adenocarcinoma. Serum CEA, TAG-72, and CA 19-9 were evaluated in 300 patients with either malignant (n = 200) or benign (n = 100) colorectal disease.

METHODS

Serum CEA, TAG-72 (CA 72-4), and CA 19-9 antigen levels were determined with a double-determinant radioimmunometric assay kit. Samples and appropriate standards were assayed in duplicate. The cutoff limits used for each assay were indicated by the manufacturer. All of the results of the CA 72-4, CEA, and CA 19-9 serum assays were separated from the clinical information until the study was completed.

RESULTS

Of the 200 patients with colorectal carcinoma, the percentage of patients whose serum samples were positive for CEA, TAG-72, or CA 19-9 was 43%, 43%, and 27%, respectively. The measurement of TAG-72 with CEA for patients with primary or recurrent colorectal carcinoma increased substantially (to 60%) the percentage of positive serum samples when compared with measuring each serum tumor marker alone. Moreover, the apparent advantage gained by measuring the two tumor markers was achieved with little increase in the number of false-positive results.

CONCLUSIONS

The findings support previous observations of complementary expression of TAG-72 and CEA and indicate that a significant advantage could be gained in the detection of primary and, perhaps, recurrent colorectal carcinoma by incorporating the measurement of serum TAG-72 with that of CEA.

The role of the administration time of prophylactic antibiotic therapy in colorectal cancer surgery: a review of 6,069 patients from 36 randomized clinical trials

The aim of the present report was to establish the effectiveness of different prophylactic antibiotic regimens and administration times in colorectal cancer surgery. Six thousand and sixty nine patients from 36 selected randomized clinical trials, published between 1980 and 1989, were reviewed. The occurrence of septic events, isolated bacterial strains, fever and postoperative hospitalization times were also analyzed. The therapeutic schedules that included the perioperative administration of antibiotics provided better results that those that did not (p. less than .0001 for infections both specifically related and unrelated to colorectal surgery). The number of postoperative administrations did not affect the clinical results, even if the predominant choice was to give more than one administration of antibiotics. A factorial design demonstrated that prolonging the perioperative administrations up to the postoperative period provided statistically significant benefits (p less than .0001) only with regard to the risk of infections that were not specifically related to colorectal surgery.

Long-term evolution of chronic delta hepatitis in children

Twenty-three children, aged 3 to 15 years, with chronic delta hepatitis have been followed for 5 to 12 years to evaluate long-term outcome. Although 83% of patients had chronic active hepatitis when first seen, with cirrhosis in 26%, the clinical and biochemical features of the disease remained reasonably stable during observation; liver histologic findings, obtained in 14 patients, worsened in only two.

Images of cultured neurons: Morphological and functional information

The in vitro culture of neuronal cells is a useful tool for studying, in a controlled way, neurobiological and neuropharmacological phenomena. A first step towards the understanding of these phenomena is described. Effects of simulated excitatory/inhibitory synapses, artificially positioned along the digitized image of neural arborizations, are presented.

Hyperthermic antiblastic perfusion for the treatment of soft tissue limb sarcoma

Eighty patients with locally advanced, high grade soft tissue sarcoma of the extremities were studied prospectively in order to determine the efficacy of hyperthermic antiblastic perfusion (H.A.P.) as the first step of a combined multimodality therapy. All of the patients have been evaluated in terms of functional results, loco-regional control and survival according to the different treatment schedules adopted. The first clinical trial employed H.A.P., followed by surgery alone. Because the results obtained were unsatisfactory, the protocol was modified to include a continuous intra-arterial (i.a.) infusion of doxorubicin (dx) or radiotherapy before surgery. The best results have been obtained with the radiotherapy-including protocol showing a conservative surgery rate of 100% and a 94% rate of loco-regional control. The disease-free, distant disease-free and overall survival rates were 68%, 75% and 70%, respectively. The importance of the treatment protocol has been confirmed in a multivariate analysis which demonstrated that the treatment protocol adopted is one of the prognostic factors with an independent value (p = 0.06).

[Adenocarcinoma of the cardia: results of resection with nic interposition]

The incidence of cancer of the cardia is increasing. Surgical treatment, in a small percentage of patients in early stage, consists in esophagectomy and total gastrectomy, followed by colon interposition. The operation can be performed through the thorax or by an abdominal and cervical approach. From 1982 to 1989 twenty-five patients were operated on. Between 1980 and 1982 the cancer was resected opening the thorax in 9 patients (group A), while from 1983 to 1989 the esophagus was removed through diaphragmatic hiatus in 16 patients (group B). All cases were analyzed as for histology, staging and resection margin. Average clinical follow-up was 22 +/- 32.7 months (range 1-102). Morbidity was 77.7% in group A and 68% in group B. Mortality dropped to 14% in the last 7 patients. Mean survival time was 23 +/- 34 months in group A and 11.2 +/- 13.7 months in group B (p = N.S.). Follow-up controls showed that all patients, in whom the esophagus was replaced with colon, were able to feed adequately.

Cell metabolism measurements in culture via microelectronic biosensors

Silicon-based H(+)-sensitive biosensors in proximity to a cell population detect variations in cell metabolism via local measurements of changes in pH. The feasibility of this approach is shown in the case of ISFET devices.

Clinical evaluation of serum tumor-associated glycoprotein-72 as a novel tumor marker for colorectal cancer patients

A novel tumor marker, tumor-associated glycoprotein-72 (TAG-72), has been identified using monoclonal antibody (MAb) B72.3. Using immunohistochemical techniques, TAG-72 has been found in carcinomas of various origin including colon, stomach, breast, lung, prostate, and ovary, as well as in body fluids. The presence of TAG-72 in serum samples from 260 patients with colorectal disease (malignant or benign) has been evaluated using the CA72-4 assay. Approximately 40% of patients with colorectal cancer exhibit elevated levels of this marker; moreover, the presence of positive levels of TAG-72 significantly correlates with advanced stages of disease, suggesting that TAG-72 may be a good marker of advanced colorectal cancer. Only 2% of the patients diagnosed with colorectal disease had elevated TAG-72 serum levels indicating the high specificity of this marker. A comparative study with carcinoembryonic antigen (CEA) serum levels showed a complementarity of the two tumor markers; in fact, 49.6% of CEA negative cases scored positive for TAG-72. A longitudinal evaluation of TAG-72 serum levels in 31 patients with malignant disease was performed. The results indicate that patients with increasing TAG-72 serum levels postoperatively may be indicative of recurrent disease. In 60% of patients in which significant changes of CEA levels could not be detected, TAG-72 showed rising positive levels prior to clinical evidence of recurrent disease. These results suggest that the simultaneous use of TAG-72 and CEA serum markers may be useful in the diagnosis of recurrent disease and therefore play an important role in the clinical management of cancer patients.

Cell adhesion to silicon substrata: characterization by means of optical and acoustic cytometric techniques

The adhesion and growth of cells on silicon dioxide substrata are analysed. The adhesion of human red blood cells to silicon dioxide layers of different depth and doping compares well with that to glass. Rat pheochromocytoma cells also grow on the same substrata. The adhesion of these two biological systems is characterized at the microscopic level by using the quite new technique of scanning reflection acoustic microscopy. Possible future developments towards the functional coupling of living cells to microelectronic integrated circuits are briefly discussed.