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Biomedical subjects

A Azzarelli

Publications and source records attributed to A Azzarelli.

66 records · Page 4Linked to original sources
PubMed1983

A rationale for surgical detection of cancer without hospitalization.

During 1980, in strict accordance with indication schedules outlined for breast, skin, oral cavity, lymph node, and soft tissue lesions, 2,499 patients were selected and operated on in the outpatient department of our institution. The main purpose was early detection of unexpected cancer without hospitalization. Of 1,266 breast operations, 99 (7.8%) unexpected carcinomas and 67 (5.3%) borderline or precancerous lesions were detected, with a higher rate of T1 and N- cases than were found in hospitalized breast carcinoma patients: T1, 61% vs 38%; N-, 68% vs 54%. The specimens of 1,048 skin and oral cavity lesions revealed 261 (24.9%) squamous or basal cell carcinomas, and most of them were cured by the outpatient surgery itself. Removal of 149 suspicious nevi revealed 20 (13.4%) unexpected malignant melanomas; 185 operations on lymph node and soft tissues detected 44 lymphomas (31 unexpected), 36 metastatic lymph nodes (five unexpected), and six sarcomas (five unexpected). These data confirm the validity of and necessity for surgical outpatient operations in selected cases.

Adult↗
PubMed1983

The outpatient-procedure effectiveness of laser treatments in oncology.

The outpatient procedure of CO2 laser surgery has been recently integrated into the routine activity of the National Cancer Institute, Milan. Specific operative protocols that are codified for laser outpatient selection after adequate staging by pathology are presented. Specific indications for gynecologic disease (preneoplastic disorders, CIN, VAIN, and VIN), and general-surgery neoplastic disorders (soft tissue sarcomas, lip and oral cavity lesions, breast lesions) are described. Details of the safety procedures, rules of application, laser instrumentation accessories and wattages, both with vaporization and excisional technique, are reported. An overall rate of 30% out of the 4,000 cases treated yearly are selected for laser treatment procedures on the basis of the evaluation of real advantages. The general advantages of laser surgical applications such as reduction of bleeding and postoperative pain, early and late complications; no-touch method; and patient acceptability--have been emphasized in the routine outpatient procedures. Reduction of the total costs and of the waiting list for hospitalization by the new procedures are finally considered.

Ambulatory Surgical Procedures↗
PubMed1983

Intra-arterial adriamycin followed by surgery for limb sarcomas. Preliminary report.

A multimodal treatment schedule for operable soft tissue sarcomas is ongoing in our institution. The main purposes are to achieve an easier radical surgery with limb preservation and to lower the risk of local relapses. Patients with documented untreated soft tissue sarcoma of the lower limb are given continuous intra-arterial regional infusion with adriamycin consecutively for 8 days up to a dose of 100 mg/m2. Radical surgery is performed by the fourth day after infusion. Preliminary data on 13 cases are available: after infusion only 6 patients presented reduction of the tumor diameters, but almost all postoperative histological examinations revealed wide areas of necrosis (up to 100%) of tumor tissue (in 9 cases greater than 50%). In 4 patients surgical treatment was completed with radiotherapy. In 2 cases the preliminary indication to disarticulation could be modified in wide excision after the postinfusional tumor reduction. The toxicity of adriamycin was typical and acceptable. Further data will be available after adequate follow-up and when more patients enter the study. These data document the feasibility of this multimodal treatment and its validity in terms of specific tumor tissue toxicity and improved surgical approach.

Adolescent↗
PubMed1982

A case of pancreatoduodenectomy as resolutive treatment for a solitary metastasis of breast cancer.

A 49-year-old woman was hospitalized for obstructive jaundice 4 years after extended mastectomy for lobular infiltrating carcinoma. After routine investigations that detected a malignant lesion of the pancreas head, the patient underwent pancreatoduodenectomy. The surgical specimen revealed unexpected breast carcinoma metastatic to the pancreas and duodenum wall. The woman is alive and free of disease at 10 years from the mastectomy and 6 years from the pancreatoduodenectomy. This experience confirms the validity of a surgical radical treatment for metastatic lesions in selected cases.

Breast Neoplasms↗
PubMed1981

Unexpected breast cancer detection after outpatient biopsy for benign lesion.

At the Istituto Nazionale Tumori of Milan, in its Outpatient Department, 1302 breast surgical biopsies were carried out in 1978. Fibroadenomas occurred in 44.2% and benign dysplasias in 39.3%. Sixty-two cancers (4.8%) and 23 atypical hyperplasias (1.8%) were unexpected findings, with an increasing incidence in women over 50. Seventy-nine duct resections were performed for significant nipple discharge and revealed 5 unexpected carcinomas and 28 papillomas or papillomatosis. In our opinion and experience, this procedure of performing breast biopsy in the presence of a solid lump in women over 30 without hospitalization improves early detection of cancer, lowers costs, cuts down admission waiting lists and increases the number of women who better accept a surgical diagnosis and treatment.

Adenocarcinoma↗
PubMed1976

Combination chemotherapy with DTIC (NSC-45388) in advanced malignant melanoma, soft tissue sarcomas, and Hodgkin's disease.

The results of three controlled studies with multiple-drug regimens which included DTIC are reported for advanced melanoma, soft tissue sarcomas, and Hodgkin's disease. In malignant melanoma, no statistical difference was observed between (a) DTIC, BCNU, and vincristine, and (b) DTIC, BCNU, and actinomycin D in terms of response rate, median duration of response, and survival. In sarcomas, the combination of adriamycin and DTIC produced a higher incidence of complete plus partial responders when compared to cyclophosphamide, vincristine, and methotrexate. However, no significant difference was seen in the median duration of response or survival. In Hodgkin's disease, a new four-drug combination including adriamycin, bleomycin, vinblastine, and DTIC (ABVD) produced an incidence of complete remissions and a median duration of response comparable to that achieved with mechlorethamine, vincristine (Oncovin), predinisone, and procarbazine (MOPP). Preliminary data indicate that ABVD is not cross resistant to MOPP. It is concluded that DTIC can be successfully and safely employed in combination with conventional agents in susceptible neoplastic diseases.

Antineoplastic Agents↗
PubMedDate not supplied

[Neurinoma of the abdominal vagus and replapsing peptic ulcer (author's transl)].

A singular association of neurinoma of the abdominal vagus with relapsing peptic ulcer is reported. The singularity lies in the exceptional finding of a neurinoma of the left abdominal vagus -- not previously recorded in the literature -- and in the concomitant severe relapsing peptic ulcer, for which the nerve lesion may have been partly responsible.

Gastrectomy↗
PubMedDate not supplied

[The action of chemotherapy on cicatrization processes].

The increasing use of chemotherapy in association with surgery has prompted the suggestion that cancer chemotherapeutic drugs may interfer with the healing process. To test this hypothesis 30 Wistar rats were subjected to laparotomy and colonic resection and treated with 5-Fluorouracil or Mitomycin C. The bursting strength of the abdominal scars and the colonic anastomotic bursting pressure revealed some interference in the rats treated with 5-Fluorouracil (Student's t test P less than 0.05) but none in the case of Mitomycin C. This preliminary study deserves to be followed up.

Abdominal Muscles↗
PubMedDate not supplied

Treatment of recurrent sarcoma of the extremities by isolated limb perfusion using tumor necrosis factor alpha and melphalan.

BACKGROUND: 24-60% of patients with soft tissue sarcoma shows local recurrences after treatment of the primary tumor. The event is associated with a high incidence of macroscopic or microscopic metastases and a poor survival. Our goal is to preserve a patient's functional limb by treating such cases with isolated limb perfusion (ILP) with recombinant human tumor necrosis factor alpha (rHu TNF-alpha) and melphalan, which have demonstrated a potent antitumor activity in vivo and in vitro studies. METHODS: During the period November 1991 to November 1995, 10 patients with unresectable recurrent soft tissue sarcoma of the limb were treated by ILP at intermediate hyperthermia (40-40.5 degrees C) with rHu TNF-alpha and melphalan. Two patients also received recombinant interferon gamma (rIFN-gamma) before and during ILP. We used a range of 2-4 mg for rHu TNF-alpha and 50-100 mg of melphalan. rIFN-gamma was administered on days -2 and -1 (15 x 10(6) IU) subcutaneously and the same dose was injected in the arterial line during ILP. RESULTS: No perioperative surgical complication was observed. Local toxicity was moderate (grade I or II); general toxicity was observed in 6 patients (2 grade I and 4 grade III). Complete response was obtained in 7 cases; 2 patients had a partial response and finally 1 was a nonresponder and showed local progression, which required surgical amputation. Tumor necrosis (observed in 5 cases) was maximal in 4 patients (80-100%) and absent in the patient who had local progression. CONCLUSIONS: The results we obtained with the treatment of soft tissue sarcoma confirm the efficacy of ILP as a limb-sparing methodology for unresectable recurrences. Furthermore, rHu TNF-alpha and melphalan confirmed their antitumor activity when associated with hyperthermia. Amputation or disarticulation may be reliable as a second-choice treatment for these patients.

Adult↗
PubMedDate not supplied

Limited role of TP53 and TP53-related genes in myxoid liposarcoma.

AIMS: Circumstantial evidence suggests that genetic changes may lead to tumor progression within the myxoid liposarcoma tumors (MLTs) carrying non-random chromosomal translocation t(12;16). METHODS: To address this subject an immunophenotypic analysis, applying antibodies against proteins encoded by TP53, MDM2 and CDK4 genes, complemented by molecular analysis of eight suitable cases, was performed on 104 consecutive cases. Chromosomal translocations were assessed either by cytogenetic analysis or by RT-PCR in 9 suitable cases and chimeric transcripts were found in all cases but two pleomorphic liposarcomas. RESULTS: Based on immunophenotyping and tumor site, the case material consisted of three groups. The first one was made up of 92 non-retroperitoneal cases carrying a null p53, mdm2, cdk4 immunophenotype, which remained unchanged over the time of recurrences and along the gamut of histologic subtypes. The second group was represented by five p53+, mdm2-, cdk4- non-retroperitoneal cases, 4 of which were further analysed by PCR-SSCP for p53 mutation. The immunophenotypic profile of these cases, complemented by the molecular findings, supported a role of TP53 in tumor progression in three high-grade MLTs. The third group, consisting of 7 retroperitoneal cases, showed a heterogeneous immunophenotype, sharing immunophenotypic and molecular features with the well-differentiated/evoluted (dedifferentiated) liposarcoma group. CONCLUSIONS: TP53 mutations seem to play a role in tumor progression in a few cases of MLTs (2.8%) showing more aggressive histologic characteristics. The unexpected finding that a number of retroperitoneal LMTs display the immunophenotypic profile of the well differentiated/evoluted (dedifferentiated) liposarcomas, deserves further investigation.

DNA Mutational Analysis↗
PubMedDate not supplied

Inclusion cytology by fine needle biopsy in mammary tumors.

In an attempt to reach a definite preoperative diagnosis of solitary, solid, breast lesions, data collected in our Institute during the last year was analyzed and confirmed the possibility of obtaining adequate cytologic and histologic specimens with fine-needle aspiration. When this is used in association with conventional cytologic examination the sensitivity of the procedure is increased from 73% to 78%. In 14% of cases, these combined aspiration techniques provided extra information concerning the histotype and infiltration of the tumor which was not obtainable with cytology alone.

Biopsy, Needle↗