1
|
Bosso G, Sansone G, Papillo M, Giaquinto A, Orefice S, Allegorico E, Serra C, Minerva V, Mercurio V, Cannavacciuolo F, Dello Vicario F, Porta G, Pagano A, Numis FG. Lung ultrasound-guided PEEP titration in COVID-19 patients treated with CPAP. J Basic Clin Physiol Pharmacol 2023; 34:677-682. [PMID: 37463298 DOI: 10.1515/jbcpp-2023-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES An increasing number of COVID-19 patients were treated with continuous positive airways pressure (CPAP). To evaluate the clinical effects of personalized positive end-expiratory pressure (PEEP) compared to standard fixed PEEP in COVID-19 patients requiring CPAP. METHODS This is a single center, prospective, randomized clinical study. Sixty-three COVID-19 patients with hypoxemic respiratory failure and bilateral pneumonia were randomized in two Groups: Group A received CPAP with fixed PEEP of 10 cm H2O, Group B performed the "PEEP trial", that consists in the evaluation of best PEEP defined as the PEEP value that precedes the echographic appearance of "lung pulse" determining a PaO2/FiO2 increase. Primary outcome was composite in-hospital mortality + intubation, secondary outcome was the percentage increase of PaO2/FiO2. As safety indicator, the incidence of pneumothorax was collected. RESULTS Thirty-two patients were enrolled in Group A and 31 in Group B. The two groups were comparable for clinical characteristics and laboratory parameters. The primary outcome occurred in 36 (57.1 %) patients: 23 (71.8 %) in Group A and 13 (41.9 %) in Group B (p<0.01). Mortality was higher in Group A (53.1 vs. 19.3 %, p<0.01), while intubation rate was comparable between groups. Group B showed a higher PaO2/FiO2 increase than Group A (34.9 vs. 13.1 %, p<0.01). Five cases of pneumothorax were reported in Group A, none in Group B. CONCLUSIONS Lung ultrasound-guided PEEP trial is associated with lower mortality in COVID-19 patients treated with CPAP. Identifying the best PEEP is useful to increase oxygenation and reduce the incidence of complications.
Collapse
Affiliation(s)
- Giorgio Bosso
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Gennaro Sansone
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Martina Papillo
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Alessandro Giaquinto
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Silvia Orefice
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Enrico Allegorico
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Claudia Serra
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Valentina Minerva
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Ferdinando Dello Vicario
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Giovanni Porta
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Antonio Pagano
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Fabio Giuliano Numis
- Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| |
Collapse
|
2
|
Pagano A, Porta G, Bosso G, Allegorico E, Serra C, Mercurio V, Sansone G, Orefice S, Numis FG. Blood lactate in mild and moderate ARDS secondary to SARS COV 2. Am J Emerg Med 2023; 66:73-75. [PMID: 36731159 PMCID: PMC9869639 DOI: 10.1016/j.ajem.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Elevated blood lactate levels are associated with poor outcome in several critical conditions. Patients with SARS-CoV-2 rarely develop hyperlactatemia. The purpose of this study is to evaluate the trend of lactatemia in patients affected by mild/moderate SARS-Co V-2-ARDS and if it affected prognosis. METHODS We analyzed blood lactate levels in thirty-eight patients with severe SARS-CoV-2 infection admitted to COVID Care Unit of Santa Maria delle Grazie Hospital, Pozzuoli. RESULTS Twenty patients survived and were discharged at home and 18 patients died. Despite severe hypoxia that affected all patients enrolled, T0 lactate was within normal values. All survivors showed a significant increase in lactate concentration the day prior to clinical improvement. In not-survivors levels of lactate did not increase significantly. CONCLUSION In our study, patients who survive SARS CoV-2 ARDS have a fleeting increase in lactate, which precedes clinical improvement by one day.
Collapse
Affiliation(s)
- A Pagano
- Emergency Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Via Domitiana località La Schiana Pozzuoli, Naples, Italy.
| | - G Porta
- Emergency Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Via Domitiana località La Schiana Pozzuoli, Naples, Italy
| | - G Bosso
- Emergency Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Via Domitiana località La Schiana Pozzuoli, Naples, Italy
| | - E Allegorico
- Emergency Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Via Domitiana località La Schiana Pozzuoli, Naples, Italy
| | - C Serra
- Emergency Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Via Domitiana località La Schiana Pozzuoli, Naples, Italy
| | - V Mercurio
- University of Naples, Federico II, Via Pansini 5, 80131 Naples, Italy
| | - G Sansone
- Emergency Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Via Domitiana località La Schiana Pozzuoli, Naples, Italy
| | - S Orefice
- Emergency Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Via Domitiana località La Schiana Pozzuoli, Naples, Italy
| | - F G Numis
- Emergency Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Via Domitiana località La Schiana Pozzuoli, Naples, Italy
| |
Collapse
|
3
|
Esposito R, Fedele T, Orefice S, Cuomo V, Prastaro M, Canonico ME, Ilardi F, De Stefano F, Fiorillo L, Santoro C, Esposito G. An Emergent Form of Cardiotoxicity: Acute Myocarditis Induced by Immune Checkpoint Inhibitors. Biomolecules 2021; 11:biom11060785. [PMID: 34067474 PMCID: PMC8224544 DOI: 10.3390/biom11060785] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 01/22/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. ICIs have shown great promise in the treatment of several advanced malignancies. However, therapy with these immunomodulatory antibodies may lead to a wide spectrum of immune-related adverse events in any organ and any tissue. Cardiologic immune-related events include pericarditis, pericardial effusion, various types of arrhythmias including the occurrence of complete atrioventricular block, myocardial infarction, heart failure, and myocarditis. Although relatively rare, myocarditis is associated with a very high reported mortality in comparison to other adverse events. Myocarditis often presents significant diagnostic complexity and may be under-recognized. When confronted with an unexpected change in the clinical picture, the physician must differentiate between immune-related adverse events, cancer worsening, or other causes unrelated to the cancer or its therapy. However, this is not always easy. Therefore, with the increasing use of checkpoint inhibitors in cancer, all providers who care for patients with cancer should be made aware of this rare, but potentially fatal, cardiologic immune-related adverse event, and able to recognize when prompt consultation with a cardiologist specialist is indicated. In this review, we evaluate currently available scientific evidence and discuss clinical manifestations and new potential approaches to the diagnosis and therapy of acute myocarditis induced by ICIs. Temporary or permanent discontinuation of the ICIs and high-dose steroids have been administered to treat myocarditis, but symptoms may worsen in some patients despite therapy.
Collapse
Affiliation(s)
- Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
- Mediterranea Cardiocentro, 80122 Naples, Italy;
- Correspondence: ; Tel.: +39-817-464-749
| | - Teresa Fedele
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Silvia Orefice
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Vittoria Cuomo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Federica Ilardi
- Mediterranea Cardiocentro, 80122 Naples, Italy;
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | | | - Ludovica Fiorillo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| |
Collapse
|
4
|
Luciano F, Santoro C, Capone V, Casciano O, Canonico ME, Fedele T, Orefice S, Fiorillo L, Esposito R. Usefulness of myocardial work assessment for the understanding of mechanisms underlying sacubitril/valsartan efficacy in patients with heart failure and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sacubitril/valsartan has shown the ability in reducing the risk of death and of hospitalization in patients with HF (heart failure) and is recommended in patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite conventional therapies. Strain imaging derived myocardial work (MW) is an emerging tool for the evaluation of left ventricular (LV) mechanics by incorporating both systolic deformation and afterload burden in the analysis.
Aim of the study
To evaluate in a prospective fashion the impact of sacubitril/valsartan therapy in HF patients on MW derived parameters in relation with standard echocardiographic indices.
Methods
We recruited thirteen HF patients with indication to sacubitril/valsartan therapy according to current guidelines. Sacubitril/valsartan therapy titrated at the maximum tolerated dose. A comprehensive echo-Doppler exam, including speckle tracking derived assessment of global longitudinal strain (GLS) (in absolute value), was performed before and after a three months therapy with sacubitril/valsartan. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were calculated according to standardized procedures. Patients with more than mild aortic and mitral stenosis and/or regurgitation were excluded. Other exclusion criteria included permanent and/or persistent atrial fibrillation and inadequate echo images.
Results
The 13 patients (M/F = 11/2, age: 57 ± 8.2 years, aetiology: idiopathic in 3 patients, ischaemic in 7 patients and chemotherapy related cardiotoxicity in 3 patients, NYHA Class: II in 7 and III in 6 patients). All patients tolerated sacubitril/valsartan therapy. After the three months therapy an improvement of LVEF (from 32.3 ± 2% to 36.2± 6%, p = 0.015), GLS (from 9.8 ± 1% to 11.6 ± 2%, p = 0.019), GWI (from 845.0 ± 175.0 mmHg% to 1091.6 ± 336.8 mmHg%, p = 0.003), GCW (from 993.4± 211.6 mmHg% to 1262.7 ± 404 mmHg%, p = 0.002) and GWE (from 77 ± 11% to 81 ± 10%, p = 0.002) was observed, without significant changes in GWW (from 190 ± 121 mmHg% to 211 ± 145 mmHg%, p = 0.307). We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.66, p = 0.014). This relation remained significant even after adjusting for the extent of systolic blood pressure reduction (r = 0.54, p = 0.033).
Conclusion
Three months sacubitril/valsartan therapy significantly improves standard and advanced indices of LV systolic function. This improvement is due to the increase of constructive work more than to the reduction of wasted work and the increase of LVEF can be predicted by the global constructive work levels at baseline. MW assessment may help to understand the mechanisms underlying the sacubitril/valsartan therapy efficacy in HF patients.
Abstract Figure.
Collapse
Affiliation(s)
- F Luciano
- Federico II University of Naples, Naples, Italy
| | - C Santoro
- Federico II University of Naples, Naples, Italy
| | - V Capone
- Federico II University of Naples, Naples, Italy
| | - O Casciano
- Federico II University of Naples, Naples, Italy
| | - ME Canonico
- Federico II University of Naples, Naples, Italy
| | - T Fedele
- Federico II University of Naples, Naples, Italy
| | - S Orefice
- Federico II University of Naples, Naples, Italy
| | - L Fiorillo
- Federico II University of Naples, Naples, Italy
| | - R Esposito
- Federico II University of Naples, Naples, Italy
| |
Collapse
|
5
|
Fedele T, Orefice S, Fiorillo L, Cuomo V, Capone V, Casciano O, Luciano F, Canonico ME, Santoro C, Esposito R. 77 Routine outpatients visits during SARS-CoV2 global pandemic. Eur Heart J Suppl 2020; 22:N135-N137. [PMID: 38626258 PMCID: PMC7799053 DOI: 10.1093/eurheartj/suaa208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aims The inability to carry office visits was collateral damage caused by the Coronavirus (COVID-19) pandemic. Tele-health is a relatively new, and yet fundamental amid the current crisis, resource to bridge the gap between phisicians and patients. Methods and results We report our experience with telemedicine and describe the major events occured in our patients. 121 consecutive adult patients with arterial hypertension (F/M: 56/65; mean age: 66.8 years) were enrolled. 33 patients (27%) had also diabetes, 94 (78%) were also affected from dyslipidemia and 11 (9%) had CAD. They all referred to our ambulatory of hypertension, in most of case for several years. Given the impossibility to continue routine outpatient visits during lockdown, they were all phone called by three residents in order to detect their state of health or any events they could have experienced over this period. They were all asked about their own blood pressure values, the occurrence of new symptoms and of new-onset both cardiovascular and non cardiovascular events. We also followed a self-made preset form. 31 of them (26%) experienced cardiovascular symptoms/events during this period: 11 had hypertensive peaks, in one case associated with nausea and vomiting while 2 of them had hypotensive episodes; 10 had typical angina and/or dyspnoea while 4 had atypical angina; 6 had palpitations; 1 of them developed new onset atrial fibrillation resolved with pharmacologic cardioversion during hospitalization; 1 had syncope; 1 patient reported new onset peripheral oedema; 2 patients died during lockdown for non cardiovascular causes. 17 of them also developed non cardiovascular symptoms, 7 of whom were severe anxiety and/or panic attacks. Almost all patients had important lifestyle changes, in 15 cases (12.3%) associated with weight increase. Conclusion The impossibility to access to routine outpatient visits during lockdown due to global pandemic of SARS-CoV2, has brought out the risk of underestimating consequences of chronic disease, in absence of appropriate Follow-up. Nevertheless, the two deaths we report were not related to cardiovascular disease. The risk is that both the missing of cardiovascular control visit and the extension of the waiting list, could provoke serious complications in patients suffering from chronic cardiovascular disease.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Roberta Esposito
- Departement of Clinical Medicine and Surgery, Federico II Univerisity, Naples, Italy
| |
Collapse
|
6
|
Scopsi L, Castellani MR, Gullo M, Cusumano F, Camerini E, Pasini B, Orefice S. Malignant Pheochromocytoma in Multiple Endocrine Neoplasia Type 2B Syndrome. Case Report and Review of the Literature. Tumori 2018; 82:480-4. [PMID: 9063528 DOI: 10.1177/030089169608200514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A malignant behavior (i.e., distant metastatic spread) has been recorded in 3-4% of pheochromocytomas occurring in the context of multiple endocrine neoplasia type 2A syndrome, but has never been documented in patients with the type 2B form. In this report we describe a case of malignant pheochromocytoma arising in the latter syndrome setting. The patient, a white young male, had the full-blown syndrome, including multicentric, bilateral medullary thyroid carcinoma metastatic to regional lymph nodes, mucosal neuromas, digestive ganglioneuromatosis, marfanoid habitus, and bumpy lips. Three and a half years after surgical resection of an apparently benign adrenal pheochromocytoma he developed widespread osseous metastases. The presence of hypertensive crises and high urinary catecholamine excretion rates, coupled to moderate hypercalcitoninemia, normal circulating carcinoembryonic antigen levels, negative whole-body 99mTc-(V) dimercaptosuccinic acid scan, and absence of neck or mediastinal disease by magnetic resonance imaging, proved that the metastases were from his previous adrenal and not thyroid tumor. Furthermore, since the bone metastases strongly accumulated 131I-metaiodobenzylguanidine, several courses of the radiocompound were given, which resulted in an objective, though partial, tumor regression.
Collapse
Affiliation(s)
- L Scopsi
- Endocrinology Unit, Istituto Nazionale Tumori, Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
7
|
Beretta G, Bajetta E, Bonadonna G, Tancini G, Orefice S, Veronesi U. Combination Chemiotherapy with 5-(3,3 dimethyl-1-triazeno) imidazole-4-carboxamide (DTIC; NSC-45388), 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU; NSC-409962) and Vincristine (VCR; NSC - 67574) in Metastatic Malignant Melanoma. Tumori 2018; 59:239-48. [PMID: 4729646 DOI: 10.1177/030089167305900305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The toxic and therapeutic effects obtained with a triple drug combination (BCNU, DTIC and VCR) administered in a cyclic fashion to 41 unselected evaluable patients with metastatic malignant melanoma are reported. Side effects were moderate and reversible. The overall regression rate was 44% without difference between males and females. Partial remission (> 50%) plus complete remission was 19.5% with an average duration of 5.1 months (1–20+). With the exclusion of bone lesions, all types of metastases showed regression especially those located in the soft tissues (lymph nodes and skin). The actuarial analysis of survival shows that responders live twice as long as non responders (median survival 12 months versus 6 months). However, the superior therapeutic efficacy of BCNU + DTIC + VCR over DTIC alone in metastatic melanoma remains to be demonstrated. A controlled study with different triple combinations is now in progress.
Collapse
|
8
|
Abstract
Of 174 patients previously resected for gastric, colon or rectal adenocarcinoma, 75 had distant metastases at the time of the first examination and provided information on the specific characters of different types of tumors as regards CEA sensitivity. The remaining 99 cases, all without clinical evidence of disease, showed positive CEA levels in 26 and negative CEA levels in 73. Of the 26 CEA-positive cases, 24 showed clinical signs of metastases in a period of time varying from 1 to 11 months. The remaining 2 cases, although CEA positive at subsequent tests, did not develop clinical metastases and have been disease-free for 5 years after the first test. Of 73 CEA-negative patients, 30 developed metastases: in 17 the clinical appearance of recurrences was preceded by a positive CEA test, while in 13 the CEA test remained negative even with the presence of disease. The remaining 43 cases are still CEA negative and without metastases from 44 to 51 months from the first examination. Altoghether, in 22 cases CEA was negative, but the clinical evidence of recurrences was positive, and in these cases 63.6 % were undifferentiated carcinomas; 2 patients were CEA positive but without signs of evident metastases.
Collapse
|
9
|
Abstract
Lympho-venous anastomoses (LVA) were performed in 30 patients, immediately after the completion of ilio-inguinal dissection for metastatic nodal involvement. This surgical procedure, originally devised to treat post-mastectomy lymphedema from radical mastectomy, was intended in this series of cases to prevent complications from ilio-inguinal nodal dissection. Actually, when compared to another group of 84 patients previously operated on by ilioinguinal nodal dissection without lympho-venous anastomoses, the series showed a lower rate of local-regional complications (38% vs 65.9%). The mean duration of hospital stay was also reduced (18.5 vs 34.7 days). Distant lymphedema of the lower limb was observed in 7 of 23 patients who had received LVA, whereas in the control group, lymphedema was recorded in 39 of 52 patients who were regularly followed-up (30% vs 75%). LVA should be routinely used, as a useful surgical procedure, to prevent or reduce the occurrence of local-regional complications following ilio-inguinal nodal dissections.
Collapse
Affiliation(s)
- S Orefice
- Divisione di Oncologia Chirurgica C, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italia
| | | | | | | |
Collapse
|
10
|
Abstract
The delayed cutaneous hypersensitivity reaction to carcinoembryonic antigen (CEA) was tested in 84 patients with different diseases including large bowel adenocarcinoma and breast carcinoma, with or without metastasis, liver cirrhosis and inflammatory or degenerative diseases. Positive skin test to CEA was observed in a small proportion (11 %) of the patients tested. No difference in positive skin test reactions was observed in the 6 different groups of patients. Similar delayed cutaneous hypersensitivity reactions were found to various amount of CEA ranging from 0.5 to 25 μg. No correlation was seen between the results of skin test and blood CEA levels.
Collapse
|
11
|
Abstract
The use and limitations of lymphography in malignant melanoma are evaluated on the basis of 116 cases, nearly all of the lower limbs, and the possibilities of use both preoperatively and during follow-up are discussed. In 53.5% of the cases lymphography revealed lymph node metastases in the inguino-iliac-lumboaortic chains, a datum that justifies the use of lymphography. Histologic examination of the lymph nodes removed at operation proved to be just as important. The two investigations agreed in 89.1% of the cases, taking the material as a whole, and in 90.5%, taking the individual lymph chains (157).
Collapse
|
12
|
Gennari L, Doci R, Podrecca S, Orefice S, Bozzetti F, Cataldo I. Immediate and Long-Term Results of Anterior Resection in Tumors of the Rectum and Sigmoid. Tumori 2018; 61:237-47. [PMID: 1162750 DOI: 10.1177/030089167506100302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
127 anterior resections for adenocarcinoma of the rectum and sigmoid were performed at the Istituto Nazionale Tumori from 1950 to 1972. In 48% of cases the site of tumor was upper rectum and recto-sigmoid. The surgical mortality rate was 4,7%. Complications were observed in about 40%, fecal fistula being the most frequent. It seems correlable with the anastomotic technique and is significantly reduced by colostomy. Local failure occurred in 8,3% of patients with maximum rate (28,5%) for tumors located under 12 cm from the anus. The 5-year over-all survival rate was 73,3% with substantial differences according to the extent of initial disease.
Collapse
|
13
|
Bonadonna G, De Lena M, Bartoli C, Monfardini S, Guzzon A, Molinari R, Bajetta E, Beretta G, Fossati-Bellani F, Orefice S. Preliminary Phase I Evaluation of Bleomycin, a New Antitumor Antibiotic. Tumori 2018; 57:21-53. [PMID: 4108879 DOI: 10.1177/030089167105700103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bleomycin (BLM), a new antitumor antibiotic isolated in Japan from cultures of Streptomyces Verticillus, was administered by single intravenous injections to patients with different types of lymphomas and miscellaneous solid tumors for phase I evaluation. 85 out of the 110 patients included in the study were suitable for the evaluation of acute and delayed toxicity, while 93 patients were evaluable to detect the therapeutic effects of the drug. The average age of the patients was 54 years (range 7–83). 16 patients were untreated and 77 had received one or more courses of radiotherapy and/or chemotherapy. During this trial different doses and schedules were employed (table 2): A) 30 mg/m2 × 2/week × 4 weeks; B) 30 mg/m2/day × 8 days; C) 15 mg/m2/day × 8 days. After a month interval all 3 courses were repeated; D) 15 mg/m2/day × 5 days to be repeated twice after 3 weeks interval. Maintenance therapy consisted of 15–30 mg/m2/week. To diminish the febrile reaction, a suppository of indometacin (100 mg) was given 30–60 minutes prior to drug administration. The incidence of toxic manifestations, irrespective of dose and schedule, was as follows (fig. 4): sclerotic changes of the skin of hands (80%), fever (67%), alopecia (61 %), skin hyperpigmentation (60 %), stomatitis (48 %), gastrointestinal disturbances (20%) and pulmonary symptoms (19%). No definite signs of marrow toxicity nor significant changes in the blood chemistry attributable to the drug were observed. Symptoms and signs of pulmonary toxicity, appearing 1–4 weeks after the last dose were: rhonchi, rales and pleural friction rubs, in some cases associated with fever and dyspnea. The chest X-ray showed evidence of interstitial lesions (in early phases most marked at the costophrenic angle) which may become widespread with a bronchopneumonia-like appearance (fig. 5 and 6). No clearcut radiological signs of pulmonary fibrosis were observed (patients were not followed for a period longer than 5 months). If BLM is stopped in time and carticosteroids are given in association to antibiotics, both clinical and radiological findings may disappear completely (fig. 7). Of the 7 patients studied post mortem, 6 revealed lesions attributable to drug toxicity (alveolar collapse with edema, histiocytic proliferation, hyaline membranes, alveolar and interstitial fibrosis (fig. 8–11). In 7 patients pulmonary toxicity was suspected only on clinical grounds, in 2 cases the radiological aspect of the lungs was suggestive of interstitial lesions without concomitant physical findings, in 9 cases a good correlation between clinical and radiological diagnosis was observed and, finally, in 6 patients the pulmonary fibrosis was detected on histological examination (table 3). In the 17 patients in whom the diagnosis of pulmonary toxicity was documented either radiologically or histologically, the average age was 56,5 years (7–78 years) and the mean total dose, producing toxicity was 230 mg/m2 (range 60–480). Practically, all these patients prior to the treatment had different grades of chronic pulmonary lesions (emphysema, fibrosis post RT or tuberculosis, silicosis in 1 case). It is difficult to estimate in what proportion BLM could have contributed to the cause of death, since most patients dying during treatment had also lung metastases. However, at least in 1 case in whom postmortem examination did not disclose lymphosarcoma cells (complete remission), the cause of death could be related to drug administration (total 225 mg/m2) since extensive pulmonary fibrosis was seen on histological examination (table 4). Table 5 shows the incidence of side-effects after the first course of BLM. No significant differences were observed among cases treated with 4 different schedules, and the first sign of toxicity appeared in all groups after the 4th–6th dose irrespective of the dose and schedule. Regressions in different types of tumors were observed during this phase I study (table 6). The overall regression rate was 69 % (24 % greater than 50 % and 5% complete). The therapeutic response was prompt but usually short-lived (average 4–6 weeks). No cross-resistance with radiotherapy nor with some of the conventional agents was observed. The most responsive tumors were carcinomas of head and neck, carcinomas of esophagus (fig. 17) and malignant lymphomas (fig. 16). One 7-year-old boy with acute lymphosarcoma cell leukemia had a complete remission and autopsy revealed no signs of neoplastic disease. In 2/3 patients with CLL a moderate decrease in the volume of hepato-splenomegaly was observed without significant fall in the WBC. The minimal toxic dose was 45–60 mg/m2 in malignant lymphomas and 60–120 mg/m2 in the other solid tumors. BLM appears to be a potent new growth-inhibiting compound specific for epidermoid carcinomas and devoid of bone marrow toxicity. The optimal dose schedule as well as the real incidence and course of pulmonary toxicity should be more clearly defined in future studies.
Collapse
|
14
|
Abstract
From June 1975 to August 1977, 19 patients with distant metastases of malignant melanoma of the skin that were no longer responsive to chemotherapy were treated with BCG given intravenously. A single dose of lyophilized Pasteur BCG ranging from 2×107 to to 3×108 viable units was given in 500 ml of saline infused in 5 to 6 h. Seven of the 16 evaluable patients benefited from treatment; 3 showed an objective regression of more than 50% of the original tumor volume, and 4 an arrest of tumor growth. The objective regressions lasted from 2 to 5 months, and 1 case had an arrest of tumor growth for 29 months. The regression rate was related to the BCG dosage: 2×108 viable units appears to be the dosage that gives severe but reversible toxicity and is able to induce objective regression. The most responsive lesions were skin and subcutaneous deposits (5 of 7) and lung metastases (1 of 4). Toxic effects seem to be related to the number of bacilli injected. In the group of 10 cases treated with less than 108 units, toxicity was modest: 4 patients had fever (up to 38.5 °C) that lasted a few days, and in 3 cases it was associated with shivering during the infusion period and weakness. One case only had vomiting and jaundice. Toxicity was severe in the 9 patients that were treated with a dosage higher than 108: patients had fever and weakness for at least 4 days and shivering during the infusion. Two had adrenal insufficiency and 7 had liver enlargement and jaundice with return to normality by day 21. In the whole series 8 patients had leucopenia and 5 thrombocytopenia for 2 to 3 days: only 1 patient required blood and platelet transfusion. No significant variations in immunoglobulin levels were observed. No variations of PPD or BCG skin tests were observed after treatment. Three patients expired; the first, treated with 6×107 units, had an intercurrent disease (autopsy showed a heart infarction); the second, treated with 1.8×108, showed a rapid growth of lung metastases and died 15 days after treatment; the death of the third patient was probably due to anaphylactic shock. All 3 patients had been previously treated with BCG, given by scarification or intranodular injection.
Collapse
|
15
|
Abstract
The outcome of surgical treatment of malignant melanoma has been evaluated on the basis of 157 limbs patients observed at the National Cancer Institute of Milan from January 1950 to December 1973. It was found that sex, site of origin and excisional biopsy do not affect the prognosis. The presence of regional nodes metastases is the factor that weight most heavily on long term results: 57.6% of patients without regional node metastases and only 15.2% of patients with positive bodes are free of disease 10 years after treatment. The depth of invasion and histological type of melanoma were found to be useful because they reveal the potential aggressiveness of the tumor: 2 out of 11 cases of lentigo maligna, 4 out of 55 cases of superficial spreading melanoma, 23 out of 91 cases of nodular melanoma and 12 out of 79 cases of Clark's level III, 8 out of 44 level IV and 8 out of 14 level V had regional nodes metastases. These two parameters were found to be correlated: lentigo maligna and superficial spreading melanoma infiltrate little as a rule whereas about half of nodular melanoma were classified as levels IV or V. Since there is not at present a definite evidence that an « elective » node dissection achieves better risults than excision only of primary melanoma followed by a possible « curative » dissection the so called « prophilactic » node dissection is considered mainly as a « staging » procedure and indicated only for level V melanoma where the incidence of nodes metastases is higher than 50%.
Collapse
|
16
|
Torrisi R, Garcia-Etienne CA, Losurdo A, Morenghi E, Di Tommaso L, Gatzemeier W, Sagona A, Fernandes B, Rossetti C, Eboli M, Rubino A, Barbieri E, Andreoli C, Orefice S, Gandini C, Rota S, Zuradelli M, Masci G, Santoro A, Tinterri C. Potential impact of the 70-gene signature in the choice of adjuvant systemic treatment for ER positive, HER2 negative tumors: a single institution experience. Breast 2013; 22:419-24. [PMID: 23643803 DOI: 10.1016/j.breast.2013.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 02/03/2013] [Accepted: 03/03/2013] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We investigated in a single institution series of 124 women with operable breast cancer whether tumor clinicopathological features could predict the 70-gene signature (Mammaprint, MP) results, and whether MP results could help to make decisions for the use of chemotherapy (CT) in patients (pts) with ER positive breast cancer beyond recommendations of international guidelines. RESULTS Among the 68 ER/PgR positive, HER2 negative tumors, Ki-67 ≥ 20% was the only significant predictor of a high risk-MP among standard clinicopathological features. In candidates for endocrine therapy with undetermined benefit from CT according to international guidelines, MP results would have led to different treatment decisions in 13/46 (28%) and in 20/68 (29%) pts according to NCCN and St. Gallen recommendations, respectively. CONCLUSIONS Ki-67 independently predicted high risk-MP in ER/PgR positive, HER2 negative tumors. MP results would have led to discordant treatment recommendations in about 30% of cases, generally increasing indication rate for CT. The results of large randomized trials are warranted in order to understand whether we should rely on multigene assays rather than on standard clinicopathological features for treatment decisions.
Collapse
Affiliation(s)
- R Torrisi
- Division of Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, 20089 Milano, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Masci G, Di Tommaso L, Del Prato I, Orefice S, Rubino A, Gullo G, Zuradelli M, Sacco R, Alloisio M, Eboli M, Incarbone M, Giordano L, Roncalli M, Santoro A. Sinusal localization of nodal micrometastases is a prognostic factor in breast cancer. Ann Oncol 2010; 21:1228-1232. [DOI: 10.1093/annonc/mdp453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
18
|
Orefice S, Rubino A. [Sentinel lymphnode: surgical standard in breast cancer]. Tumori 2000; 86:S14-6. [PMID: 11195287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Evaluation of the sentinel lymph node (SLN) is capable of avoiding dissection in a high percentage of node negative patients (> 90). It is essential that "useless" treatment not be performed as the negative collateral effects are not justifiable and furthermore present financial laws do not reimburse dissections carried out in the absence of node disease. The intraoperative evaluation of the SL is an extremely expensive procedure, due both to the personnel required and to the time necessary for the patient to remain in the operating room awaiting histology results. In fact, it is far easier to retrieve the SLN in day hospital and to examine the specimen on fixed material and not frozen. Twenty three cases of deferred SLN were evaluated, the results of which were highly reliable because of these, only 3 dissections were performed after an average of 4 days from biopsy. As SL evaluation does not increase the "curability" of the disease but only reduces any eventual complications, we believe it should be restricted to extremely selected and specialistic institutions due to the great economical and organizational cost involved.
Collapse
Affiliation(s)
- S Orefice
- Divisione di Chirurgia Generale 1, Senologia, Istituto Clinico Humanitas, Rozzano, Mi
| | | |
Collapse
|
19
|
Gianni AM, Siena S, Bregni M, Di Nicola M, Orefice S, Cusumano F, Salvadori B, Luini A, Greco M, Zucali R, Rilke F, Zambetti M, Valagussa P, Bonadonna G. Efficacy, toxicity, and applicability of high-dose sequential chemotherapy as adjuvant treatment in operable breast cancer with 10 or more involved axillary nodes: five-year results. J Clin Oncol 1997; 15:2312-21. [PMID: 9196145 DOI: 10.1200/jco.1997.15.6.2312] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To assess the efficacy, toxicity, and applicability of high-dose therapy administered as adjuvant initial treatment to women with breast cancer with extensive nodal involvement. PATIENTS AND METHODS Sixty-seven patients with stage II to III breast cancer involving > or = 10 axillary nodes received a novel high-dose sequential (HDS) regimen, including the high-dose administration of three non-cross-resistant drugs (cyclophosphamide, methotrexate, and melphalan) given within the shortest interval of time as possible with hematologic and nonhematologic toxicity. RESULTS Sixty-three patients completed the program as planned, one patient died of acute toxicity, and three patients were switched to standard-dose adjuvant therapy. After a median follow-up duration of 48.5 months and a lead follow-up of 78 months, actuarial relapse-free survival for all 67 registered patients is 57% and overall survival is 70%, respectively. Comparison with a historical control group of 58 consecutive patients showed a significantly superior rate of freedom from relapse for the HDS-treated group (57% v 41%, respectively), in particular when two subgroups of patients, more homogeneous for their number of involved nodes, were compared (65% v 42%). Overall, treatment was of short duration (median, 70 days), required a median of 32 days of hospital stay, and was associated with only a few severe side effects (the most distressing being oral mucositis after melphalan therapy). CONCLUSION HDS therapy emerges as an effective and applicable regimen, whose major toxicity was occasional. Final assessment of its value in a randomized, multicenter trial is presently underway.
Collapse
Affiliation(s)
- A M Gianni
- Department of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Zilembo N, Noberasco C, Martinetti A, Mariani L, Rimassa L, Del Vecchio M, Laffranchi A, Orefice S, Galante E, Sguotti C, Bajetta E. 963 Exemestane in postmenopausal patients with advanced breast cancer: A dose-finding study. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96212-v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Zilembo N, Noberasco C, Bajetta E, Martinetti A, Mariani L, Orefice S, Buzzoni R, Di Bartolomeo M, Di Leo A, Laffranchi A. Endocrinological and clinical evaluation of exemestane, a new steroidal aromatase inhibitor. Br J Cancer 1995; 72:1007-12. [PMID: 7547212 PMCID: PMC2034036 DOI: 10.1038/bjc.1995.451] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The androstenedione derivative, exemestane (FCE 24304), is a new orally active irreversible aromatase inhibitor. Fifty-six post-menopausal advanced breast cancer patients entered this study to evaluate the activity of four low exemestane doses in reducing oestrogen levels. The drug's tolerability and clinical efficacy were also assessed. Exemestane was orally administered to four consecutive groups at daily doses of 25, 12.5, 5 and 2.5 mg, and the changes in oestrogen, gonadotrophins, sex-hormone binding globulin and dehydroepiandrosterone sulphate levels were evaluated. Drug selectivity was studied by measuring 17-hydroxycorticosteroid urinary levels. After 7 days of treatment, mean oestrone and oestradiol levels had decreased by respectively 64% and 65% (a decrease which was maintained over time); in the 2.5 mg group, oestrone sulphate levels also decreased by 74%. Gonadotrophin levels were significantly higher, whereas no changes in the other serum hormone levels or any interference with adrenal synthesis were detected. Treatment tolerability was satisfactory: nausea and dyspepsia were reported in 16% of patients. The overall objective response rate was 18%. In conclusion, exemestane is effective in reducing oestrogen levels at all of the tested doses and shows interesting clinical activity.
Collapse
Affiliation(s)
- N Zilembo
- Division of Medical Oncology B, Istituto Nazional per lo Studio e la Cura dei Tumori, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Ferrari L, Zilembo N, Bajetta E, Buzzoni R, Noberasco C, Martinetti A, Celio L, Galante E, Orefice S, Cerrotta AM. Effect of two-4-hydroxyandrostenedione doses on serum insulin-like growth factor I levels in advanced breast cancer. Breast Cancer Res Treat 1994; 30:127-32. [PMID: 7949210 DOI: 10.1007/bf00666055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A number of endocrine treatments for advanced breast cancer seem to affect serum insulin-like growth factor I (IGF-I). The aim of our study was to investigate IGF-I levels in 33 postmenopausal patients with metastatic disease receiving the selective aromatase inhibitor 4-hydroxyandrostenedione: 250 mg (16 patients) or 500 mg (17 patients) i.m. fortnightly. Blood samples were collected before, and at one month and 3 months after the beginning of treatment for radioimmunoassay determinations. The median patient age was 56 and 60 years in the 250 and 500 mg groups respectively. Most patients had a disease free interval > or = 2 years and were oestrogen receptor positive. Objective responses were obtained in 3 patients (complete response, 1) in the 250 mg group, and in 7 patients (complete response, 3) in the 500 mg group. No significant IGF-I variations were seen in the 250 mg group, whereas a significant increase after 3 months (181.57 +/- 84.78 ng/ml versus 272.47 +/- 213.22 ng/ml, p = 0.0032) was observed in the 500 mg group. No IGF-I variations were seen between responsive and unresponsive patients in either treatment group. Our results in the 500 mg group are close to those obtained with aminoglutethimide and seem to agree with the hypothesis of an oestrogen-induced suppression of IGF-I circulating levels.
Collapse
Affiliation(s)
- L Ferrari
- Division of Medical Oncology B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Daidone MG, Orefice S, Mastore M, Santoro G, Salvadori B, Silvestrini R. Comparing core needle to surgical biopsies in breast cancer for cell kinetic and ploidy studies. Breast Cancer Res Treat 1991; 19:33-7. [PMID: 1756265 DOI: 10.1007/bf01975202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The evaluability and reliability of proliferative activity (expressed as 3H-thymidine labeling index, 3H-TdR LI) and ploidy determinations on core needle biopsies were compared with those obtained on surgical material from the same breast cancers. The evaluability of 3H-TdR LI on core needle biopsies was markedly lower than that on surgical material (53% vs 100%), and the association between 3H-TdR LI values in the 16 cases with both evaluable determinations was poor (rs = 0.45). Conversely, determinations of ploidy on core needle biopsy and surgical material provided superimposable results, in terms of evaluability (91% vs 100%) and reliability (rs = 0.99). Further efforts are needed to improve sampling procedures for a reliable assessment of biological markers.
Collapse
Affiliation(s)
- M G Daidone
- Division of Oncologia Sperimentale C, Istituto Nazionale Tumori, Milan, Italy
| | | | | | | | | | | |
Collapse
|
24
|
Daidone MG, Silvestrini R, Valentinis B, Persici P, Mezzanotte G, Squicciarini P, Orefice S, Salvadori B. Proliferative activity of primary breast cancer and of synchronous lymph node metastases evaluated by [3H]-thymidine labelling index. Cell Tissue Kinet 1990; 23:401-8. [PMID: 2245439 DOI: 10.1111/j.1365-2184.1990.tb01133.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The [3H]-thymidine labelling index ([3H]TdR LI) has been used to evaluate and comparatively analyse the proliferative activity of different tumour lesions from the same patient. The analysis was performed on the primary tumour and its synchronous lymph node metastasis from 210 patients operated on for breast cancer. A direct relation was observed between the proliferative activity of the two different lesions (Spearman correlation coefficient = 0.46, P less than 0.0001), but there was considerable scatter amongst the data. The [3H]TdR LI of primary and of metastatic lesions belonged to the same proliferation classes in only 47% of the cases. Higher or lower [3H]TdR LI values, categorized on the basis of the tertiles of the frequency distribution, occurred in the node metastasis than in the primary tumour in an almost similar percentage of the remaining cases. Menopause, receptor status and pathological features did not affect interlesion kinetic patterns. The prognostic role of the proliferative activity of the two different lesions was investigated on 107 patients with stage II tumours homogeneously treated with surgery and systemic adjuvant therapy. Relapse-free survival at 3 years was significantly affected by the proliferative activity of the primary tumour but not by that of the lymph node metastasis.
Collapse
|
25
|
Salvadori B, Squicciarini P, Rovini D, Orefice S, Andreola S, Rilke F, Barletta L, Menard S, Colnaghi MI. Use of monoclonal antibody MBr1 to detect micrometastases in bone marrow specimens of breast cancer patients. Eur J Cancer 1990; 26:865-7. [PMID: 2145925 DOI: 10.1016/0277-5379(90)90185-v] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Bone marrow specimens obtained from 121 breast cancer patients immediately after surgery were examined by an immunofluorescence method with monoclonal antibody MBr1 to detect tumour cells undetectable by other diagnostic procedures. 80 women were node-negative and 41 node-positive. In no case could conventional histology demonstrate tumour cells, whereas MBr1 was positive in 20 (16.5%) of the 121 cases. No difference was observed in MBr1 positivity between node-negative and node-positive cases (17% vs. 15%). With regard to clinical outcome (median follow-up 48 months) 27 women relapsed, including 6 of 20 MBr1-positive and 24 of 101 MBr1-negative patients. First distant metastases or death from progression of disease were taken as end-points. Multivariate analysis showed that the additional contribution of MBr1 positivity, after making allowance for other prognostic factors, was negligible.
Collapse
Affiliation(s)
- B Salvadori
- Division of Surgical Oncology C, National Cancer Institute, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Porro G, Ménard S, Tagliabue E, Orefice S, Salvadori B, Squicciarini P, Andreola S, Rilke F, Colnaghi MI. Monoclonal antibody detection of carcinoma cells in bone marrow biopsy specimens from breast cancer patients. Cancer 1988; 61:2407-11. [PMID: 3284635 DOI: 10.1002/1097-0142(19880615)61:12<2407::aid-cncr2820611202>3.0.co;2-g] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The possibility of using immunologic methods for detecting metastatic cells in bone marrow samples from breast cancer patients was investigated. The MBr1 monoclonal antibody, which recognizes a membrane antigen on breast carcinoma cells and is unreactive on normal bone marrow cells, seemed to be an adequate reagent for this kind of approach. When human leukocyte suspensions artificially contaminated with mammary tumor cells were tested by MBr1 immunofluorescence, it was demonstrated that the added tumor cells could be specifically discriminated from normal cells and that as little as one tumor cell in 200,000 could be detected. With the same methodology we screened bone marrow biopsies from breast cancer patients with apparently uninvolved lymph nodes at the moment of surgery. Immunoreactive tumor cells were detected by the MBr1 antibody in 17% of N- patients. None of the bone marrow samples showed any evidence of tumor involvement by conventional histologic analysis.
Collapse
Affiliation(s)
- G Porro
- Department of Experimental Oncology E, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Tommasini M, Colombo M, Sangiovanni A, Orefice S, Bignami P, Doci R, Gennari L. Intrahepatic doxorubicin in unresectable hepatocellular carcinoma. The unfavorable role of cirrhosis. Am J Clin Oncol 1986; 9:8-11. [PMID: 3006474 DOI: 10.1097/00000421-198602000-00002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To investigate the relationship between the presence of cirrhosis and the antitumor effects of locoregional chemotherapy with doxorubicin, 16 patients with nonresectable hepatocellular carcinoma (HCC) and satisfactory baseline clinical conditions (Child class A or B, Karnofsky index greater than 70%) were studied. Eight patients had post-necrotic cirrhosis, five had serum HBsAg. The dose of doxorubicin was 0.3 mg/kg body weight/day, given by continuous intracoeliac infusion for 8 consecutive days. Eight patients (six with cirrhosis) died prematurely after the first course of chemotherapy. Six (2 with cirrhosis) responded to therapy; they survived 3-33 months (median: 10). In these patients, the type and severity of drug-related side effects were comparable to those reported for patients treated by intravenous chemotherapy. The implication that in many patients with cirrhosis intrahepatic chemotherapy with doxorubicin may hasten death, lessens our interest in its use for nonresectable HCC. In fact, in Italy these cancers frequently occur in association with cirrhosis.
Collapse
|
28
|
Cascinelli N, Vaglini M, Rovini D, Orefice S, Marolda R, Veronesi U. [Immunological aspects in the treatment of malignant melanoma]. Minerva Med 1982; 73:1233-40. [PMID: 7078802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
29
|
Severini A, Bellomi M, Cozzi G, Strada M, Orefice S, Saccozzi R. [Percutaneous transhepatic biliary drainage in obstructive jaundice. Report of 19 cases (author's transl)]. Radiol Med 1981; 67:599-608. [PMID: 7313171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The development of percutaneous transhepatic techniques of access to biliary tree with the fine needle made possible the wide diffusion of percutaneous biliary drainage. Results of 19 attempts of biliary drainage are presented; success rate in positioning external or external-internal drainage was 79% (92.3% in the last year). The technique employed is described and discussed comparing it with the methods proposed by other authors. Early therapeutic effects and long-term benefits on bilirubin levels and survival were good. Only 2 major complications were observed (hepatic abscess and biliary subcapsular cyst) but they did not require surgery. Cholangiocarcinomas and ilar hepatic metastases appeared to be elective indications to definitive palliative drainage, but pre-surgical or palliative drainage is also recommended in all cases of obstructive jaundice. Careful follow-up and check of patients with the biliary drainage improves the drainage function and reduces the complications.
Collapse
|
30
|
Mor C, Orefice S, Rocco F, Accinni R, Bartorelli A. [Direct radioimmunological determination of plasma CEA in 1704 patients]. Minerva Med 1978; 69:553-63. [PMID: 634505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
An original technique for the direct radioimmunological measurement of plasma CEA has been prepared. Compared to the other in use, this has the advantage of a very low incidence of false positivity. 1704 patients make up the series: the percentage of positivity in 247 suffering from gastroenteric adenocarcinoma was 66.8%, in 60 with lung cancer 30%, in 243 with malignant tumours in various sites 7.4%, in 199 with chronic liver diseases 29.6% while in 598 cases of other non-neoplastic diseases it was only 2.5%. 212 patients who underwent radical surgery for gastroenteric adenocarcinoma were also followed up and the test provided early diagnosis of the clinical re-onset of the neoplastic lesion. It is considered that plasma CEA measurement represents a useful aid to the clinician althouth it cannot be employed at present to screen gastroenteric adenocarcinomas.
Collapse
|
31
|
Mor C, Orefice S, Rocco F, Accinni R, Bartorelli A. [Assay of carcinoembryonic antigen in breast cancers]. Nouv Presse Med 1976; 5:2166. [PMID: 980781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
32
|
Abstract
Foot lymphography was performed in a selected group of 250 patients with malignant melanoma, with different sites of origin and of various stages. The overall incidence of metastases was 40%. The case material was evaluated in detail; the tumors of the inferior limb and those on different sites, e.g., vulva and abdomen, were considered separately. In the group of 188 patients with melanoma of the inferior limb, the incidence of metastases was 42%. In 51%, histologic confirmation was obtained. In the group of 62 patients with melanoma of different sites of the body, the incidence of metastases was 34% and histologic confirmation was obtained in 21 patients. The values of accuracy, sensitivity, and specificity based on the histologic confirmation of the lymphographic reports ranged from 88% to 96%. These data justify the use of lymphography in the initial diagnostic work-up and in the follow-up of these patients.
Collapse
|
33
|
Corallini A, Barbanti-Brodano G, Portolani M, Balboni PG, Grossi MP, Possati L, Honorati C, La Placa M, Mazzoni A, Caputo A, Veronesi U, Orefice S, Cardinali G. Antibodies to BK virus structural and tumor antigens in human sera from normal persons and from patients with various diseases, including neoplasia. Infect Immun 1976; 13:1684-91. [PMID: 184044 PMCID: PMC420820 DOI: 10.1128/iai.13.6.1684-1691.1976] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sera from 1,279 patients with various diseases were examined for the presence of antibodies to BK virus (BKV) capsid antigens. The percentage of positive sera was comparable in all the diseases except rheumatoid arthritis and chronic nephropathies, where a slightly higher prevalence was found. Sera from 952 patients with tumors were examined for the presence of antibodies to BKV tumor and capsid antigens in comparison with a matched control group of 501 blood donors. Sera from 11 tumor patients (1.15%) and from 4 normal controls (0.80%) had antibodies to BKV tumor antigen. No higher prevalence of antibodies to BKV capsid antigens was found in any cancer type except in carcinomas of the urinary bladder, where the percentage of positive sera and of sera with high titers was higher than in other groups. BKV infection is discussed in relation to its possible connection with human non-neoplastic diseases as well as with human tumors and to its activation under conditions of immunosuppressive therapy.
Collapse
|
34
|
Bozzetti F, Doci R, Milani A, Orefice S, Rasponi A, Vaglini M. [Topical ampicilin and local infectious complications in oncological surgery]. Tumori 1975; 61:425-32. [PMID: 1209742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
420 consecutive patients having clean surgical operations were studied: 210 of them, selected at random, received 0.5-1 g of ampicillin into the wound before closure, the remainder being controls. Patients were examined for wound infection during the first postoperative week, in line with the opinion that topical antibiotic treatment can afford significant protection against wound infection caused by peroperative contamination. Wound infection has been defined as a local inflammation (redness and hyperthermia), usually with fever and/or discharge of pus. In some doubtful cases, a longer observation period was necessary to obtain a correct interpretation. Four out of 210 clean wounds (1.9%) became infected in the patients receiving ampicillin compared with 12 out of 210 (5.7%) in the control group. The difference could have arisen by chance less that one in a hundred times (p less than 0.01). It is our opinion therefore that after clean operations, the higher the risk of local infection, the more effective the topical use of antibiotics.
Collapse
|
35
|
Orefice S, Fontana V, Matè M. [Cytology of melanoma]. Minerva Ginecol 1975; 27:468-9. [PMID: 1097959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
36
|
Bartorelli A, Accinni R, Golferini A, Mistretta AP, Tassi GC, De Barbieri A, Mor C, Leonetti G, Orefice S, Rocco F. Direct radioimmunoassay of plasma CEA. Boll Ist Sieroter Milan 1973; 52:333-45. [PMID: 4777699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
37
|
Bartorelli A, Orefice S. Clinical and Radiological Study of Breast Metastatic Localization of Malignant Melanoma. Tumori 1972; 58:341-9. [PMID: 4651000 DOI: 10.1177/030089167205800505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Six cases of metastasis of malignant melanoma in the breast are described. Mammography did not differentiate these lesions from primary breast lesions.
Collapse
|
38
|
|