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Biomedical subjects

A Carli

Publications and source records attributed to A Carli.

At least 19 recordsLinked to original sources
PubMed2001

Prediction of lymph node status by analysis of prognostic factors and possible indications for elective axillary dissection in T1 breast cancers.

OBJECTIVE: To identify those patients with T1 breast cancers with lower risk of nodal metastases who can safely be spared axillary dissection. DESIGN: Retrospective study. SETTING: University hospital, Italy. SUBJECTS: Review of clinical records and histopathological slides of 547 patients with T1 breast cancer, operated on between 1984 and 1997. MAIN OUTCOME MEASURES: Incidence of axillary metastases in relation to age, menopausal status, diameter and grade of tumour, vascular invasion, DNA ploidy, S-phase fraction and hormone receptor state, by univariate and multivariate analysis. RESULTS: Axillary metastases were present in 159 patients (29%). On univariate analysis, diameter of tumour 10 mm or less (pT1a/pT1b cancers), no vascular invasion, and grade 1 tumour were significantly correlated with a lower risk of nodal metastases, but only vascular invasion (p = 0.0001, odds ratio = 3.1) and diameter of tumour (p = 0.04, odds ratio = 1.6) were independent predictors on multivariate analysis. Among 34 pT1a/pT1b cancers, with low grade of tumour and no vascular invasion, only 2 (6%) had axillary metastases. When only one favourable predictive factor was associated with diameter of tumour of 10 mm or less, the incidence of axillary metastases ranged from 12% for 43 patients with grade 1 cancers to 13% for 76 patients with no vascular invasion. CONCLUSIONS: Axillary dissection may be avoided in pT1a and pT1b breast cancers (< or = 10 mm), with low grade of tumour or no vascular invasion. T1 breast cancers 10 mm or less in diameter should be treated by a two-step approach, first wide excision of the tumour and then axillary dissection or not depending on pathological examination of the primary tumour.

Adult↗
PubMed2001

Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC).

BACKGROUND: Lymph node metastases are present in only about 15% of patients with early gastric cancer (EGC) and for this reason, the majority of these patients do not require lymphadenectomy. In Japan, EGC patients undergo less invasive treatment (endoscopic mucosal resection, wedge resection, laparoscopy). However, the indications for and results of these types of treatment are still uncertain. METHODS: In a multicentre retrospective study, we analysed the clinicopathological data referring to 584 early gastric cancer patients who underwent D2 gastrectomy. A comparison was made between patients with and without lymph node metastases in relation to numerous pre- and postoperative variables. Long-term survival and risk factors for lymph node metastases were analysed. The primary aim was to compare our results with those of Western and Japanese authors; we also evaluated the possibility of identifying a subset of patients at low risk of lymph node metastases who may be candidates for endoscopic treatment. RESULTS: The incidence of lymph node metastasis was 14.4%. Univariate and multivariate analyses showed that submucosal infiltration, diffuse histotype, tumour size and Kodama Pen A type were all related to the presence of lymph node metastases. Patients with types I, IIa and IIb mucosal tumours did not present lymph node metastases. Postoperative mortality was 2.2%. Five-year survival in relation to lymph node groups was 95% in N0 patients, 77% in N1 patients and 60% in N2 patients (p = 0.0001, Japanese N-stage). The number of positive lymph nodes also had a prognostic value. Patients with three or fewer positive lymph nodes presented a better 5-year prognosis (83%) than those with more than three positive lymph nodes (48%) (p = 0.0001). CONCLUSIONS: Our study confirms that lymph node involvement is an extremely important prognostic factor. For this reason, the therapeutic strategy of our surgical units is as follows: 1) D2 gastrectomy is the standard treatment even in early gastric cancer (EGC); 2) endoscopic mucosal resection (EMR) could be considered first in types I, IIa and IIb tumours that are diagnosed as limited to the mucosal layer.

Aged↗
PubMed1999

Cosmetic results in 242 patients treated by conservative surgery for breast cancer.

The surgery of breast cancer has changed lately in favour of breast conserving treatment, the main purpose of which is to provide good cosmetic results together with radical resection of the tumour. In this paper we describe the cosmetic results obtained in 242 patients treated by conservative surgery (226 quadrantectomies, 93%, and 16 lumpectomies, 7%) for low risk breast cancer. Several of these resections were combined with plastic surgical techniques for residual breast reshaping. The technique chosen depended on the site of tumour, width of resection, and breast volume. The cosmetic assessment was made by the patient and the physician. Our data suggest that better cosmetic results may be obtained when plastic surgical procedures are combined with conservative surgery for breast cancer.

Adult↗
PubMed1998

Complications after surgery for gastric cancer in patients aged 80 years and over.

Recent studies have shown a considerable increase in the number of aged patients with gastric cancer. In this retrospective study, we report our 18-year experience with 110 patients aged 80 years and over affected with this neoplasm. Postoperative morbidity and mortality rates and risk factors affecting their incidence were examined by univariate and multivariate analysis. Operability and resectability rates were 70.9% and 47.3% respectively. Of the resective procedures, 41 (78.8%) were subtotal gastrectomies. In five cases (9.6%), we performed combined resections. Twenty-five patients (32.1%) experienced postoperative complications; overall mortality rate was 12.8% (10 patients). In resective procedures, morbidity and mortality were 26.9% and 3.8% respectively, which are very low rates compared to other Western reports. Statistical analysis identified the number of preexisting medical illnesses as an independent predictor of morbidity and mortality. Crude five-year survival rate of curatively resected cases was 43%. Although multiple medical illnesses involved much higher operative mortality, neither the presence of postoperative complications nor the number of preexisting medical illnesses significantly influenced five-year survival rate of curatively resected patients. With careful evaluation and selection of patients, correct treatment of concomitant diseases and adequate peri- and postoperative care, gastric surgery provides good immediate and long-term results even in very old patients. Subtotal gastrectomy with limited lymphadenectomy should be the preferred procedure; total gastrectomy, combined resections and extended lymphadenectomy should be performed only when necessary, in patients with fewer than two illnesses. Surgery should be avoided in patients with highly advanced disease, if multiple medical illnesses are present.

Aged↗
PubMed1996

Toxicity of jellyfish and sea-anemone venoms on cultured V79 cells.

Cnidarian toxins exert an influence on human activities and public health. The cytotoxicity of crude toxins (nematocyst and surrounding tissue venom) of Aequorea aequorea, Rhizostoma pulmo and Anemonia sulcata was assessed on V79 cells. Rhizostoma pulmo and Anemonia sulcata crude venoms showed remarkable cytotoxicity and killed all treated cells at highest tested concentration within 2 and 3 hr, respectively. Aequorea aequorea crude venom greatly affected growth rate during long-term experiments. No genotoxic effect was observed.

Animals↗
PubMed1996

Attachment of Vibrio alginolyticus to chitin mediated by chitin-binding proteins.

Vibrio alginolyticus is the only culturable vibrio associated with the chitinaceous carapace of the copepod Tigriopus fulvus (Fisher 1860) living in Ligurian coastal rock pools (Tyrrhenian Sea). The characteristics of the interaction between chitin particles and V. alginolyticus were studied by analysing strains isolated both from the copepod surface and from rock-pool water. The highest degree of attachment to chitin was observed at 20 degrees C, in the presence of 3% NaCl. Bacterial treatment with N-acetylglucosamine and pronase E caused a reduction in attachment of 52-62% and 77-94%, respectively. Chitin pretreatment with either wheat germ agglutinin or membrane proteins (MPs) from V. alginolyticus caused a reduction in attachment, of 50-57% and 53-70%, respectively. No inhibition was observed when bacteria were pretreated with D-glucose, D-fucose or D-fructose, or when chitin was pretreated with concanavalin A and Escherichia coli DH5 alpha MPs. V. alginolyticus MPs able to bind chitin were isolated and analysed by SDS-PAGE. Four chitin-binding proteins were visualized in all tested strains (53, 35, 20 and 14 kDa); in vivo these peptides may efficiently mediate V. alginolyticus attachment to chitin-containing substrates.

Acetylglucosamine↗
PubMed1995

[Cervical esophageal perforation caused by a foreign body: a clinical case].

The Authors report a case of cervical esophageal perforation from foreign body. Comparing their experience with data from literature, they point out the diagnostic importance of both X-ray studies, in order to demonstrate the site of the lesion, and CT scans, to have accurate information on perilesional infective complications (abscesses). Early surgical treatment, with primary closure of perforation and adequate drainage, associated with antibiotics and enteral or total parenteral nutrition, allows good results in most cases.

Aged↗
PubMed1994

Lack of alteration in cardiac beta-adrenoceptor site concentration in rats treated with an adenylate cyclase-stimulating dose of endotoxin.

In previous experiments on male rats we showed that 2 mg kg-1, intravenously, lipopolysaccharide from Escherichia coli, a sublethal nonhypotensive dose, induced circulating cardiodepressant activity, maximal alterations in steroid hormonal response, and myocardial adenylate cyclase hyperactivity 4 h later. The purpose of the present study was to investigate a possible relation between this adenylate cyclase hyperactivity and alterations in total ventricular beta-adrenoceptors. To this end, ventricular beta-adrenoceptor concentration and affinity were measured under the same conditions. Binding assays were performed using [3H]dihydroalprenolol. No significant change was observed in both parameters.

Adenylyl Cyclases↗
PubMed1994

Effect of estradiol on endotoxin-induced changes in steroid hormone levels and lethality in male rats.

We examined the effect of exogenous estradiol on the changes in serum steroid hormone levels induced by a nonlethal dose of Escherichia coli endotoxin in male rats and the deaths due to nonlethal and lethal doses of endotoxin. Injection of estradiol 5 min before a nonlethal dose of endotoxin changed the serum sex steroid hormone response of male rats to endotoxin. The serum estrogen concentrations of estradiol + endotoxin-treated rats decreased by 50% (P < 0.001), while those of the endotoxin-treated rats increased (2- to 5-fold). The serum androgen concentrations of estradiol + endotoxin-treated rats did not change significantly, while those of endotoxin-treated rats dropped to 30-40%, P < 0.001. Exogenous estradiol also appeared to influence the percentage of endotoxin-induced deaths in a dose-dependent manner. It reduced the number of deaths induced by nonlethal (2 mg/kg) dose of endotoxin but increased the number of deaths induced by a highly lethal dose (8 mg/kg). These results, together with the known relationships between estrogen and the immune response, suggest that estrogens affect the course of septic shock in a complex fashion and may have either protective or deleterious effect.

Androgens↗
PubMed1994

[Surgical treatment of neoplasms in geriatric patients].

The Authors report their experience in the surgical management of cancer in the aged (over 65 year old patients), during the period 1988-1992 at the Istituto Policattedra di Scienze Chirurgiche, University of Siena. They consider colon and rectum, breast, stomach, pancreas and biliary tract neoplasms in relation to site, staging, emergency or delayed surgical treatment, and early postoperative results. Finally, they outline the frequently encountered problems in treating old patients and the most appropriate surgical approach.

Age Factors↗
PubMed1993

[Ischemic colitis localized in the right colon. A clinical case report].

Ischemic colitis shock-associated still is a not well-defined clinical entity. The authors describe symptoms, clinical course and treatment in a case recently observed. They outline the difficulties of preoperative diagnosis and the need of a not postponable surgical treatment due to shock and peritonitis.

Adenocarcinoma↗
PubMed1992

Effect of the aromatase inhibitor, 4 hydroxyandrostenedione, on the endotoxin-induced changes in steroid hormones in male rats.

The increase in circulating estrogen concentrations that follows injection of Escherichia coli endotoxin (Endo) may be due to increased aromatase activity. We have therefore analysed the effect of the aromatase inhibitor, 4 hydroxyandrostenedione (4OHA) on the steroid hormone response of male rats, particularly the dramatic increase in estrogens and decrease in androgens, induced by Endo. The concentrations of corticosterone (B), progesterone (P4), 17 alpha hydroxyprogesterone (17 alpha OHP4), androstenedione (delta 4), testosterone (T), estrone (E1) and estradiol (E2) were determined 2 hours after injection of increasing doses of 4OHA with and without Endo. The increase in serum estrogen concentrations and drop in serum androgen levels in response to Endo were blocked by a single dose of 4OHA. The effect of 4OHA appeared to be dose dependent. Low doses (30 mg/kg and 50 mg/kg) induced significant changes in the estrogen and androgen responses, but the high dose (100 mg/kg) blocked all changes in sex steroids induced by Endo. 4OHA did not alter the Endo-induced changes in other steroids.

Analysis of Variance↗
PubMed1992

[Postoperative morbidity and mortality after surgical intervention for gastric carcinoma in advanced stage].

The paper reports the authors' experience in a group of 546 patients who underwent surgical treatment for gastric cancer from 1981 to 1988. Of 437 patients (80%) with advanced gastric cancer, 121 (28%) received palliative treatment and 316 (72%) were treated for curative purposes. Postoperative care was normal in 331 patients with a mean hospital stay of 11 days; various complications occurred in 106 patients with a mean hospital stay of 26 days. Overall operative mortality was 6% (27 patients). This study aimed to assess the main factor responsible for postoperative morbidity and mortality. Findings were compared to previously reported data and were shown to be similar.

Adult↗
PubMed1992

Relationship between changes in serum estrone levels and outcome in human males with septic shock.

The effect of septic shock on the production of estrogens, other steroid hormones, and gonadotropins in men was investigated. Two groups of male patients in the early septic shock were studied over 3 days following their admission to the Intensive Care Unit. Group I (n = 9) patients recovered and group II (n = 6) patients died. The simplified acute physiological score was 13.5 +/- 1.5 for group I and 21.2 +/- 2.3 for group II (P less than .05). In group I patients, estrogen levels (particularly E1) were high on day 1 and decreased progressively (day 1: 3,515 +/- 884 pmol/L, day 2: 2,450 +/- 292 pmol/L, and day 3: 1,043 +/- 255 pmol/L). In group II patients, estrone levels were as high as in group I on day 1, but increased throughout the 3 days (day 1: 3,250 +/- 1,200 pmol/L, day 2: 4,495 +/- 930 pmol/L, and day 3: 6,123 +/- 966 pmol/L). There were few changes in gonadotropins and other steroid hormones, except that the testosterone levels were below normal in both patient groups, while cortisol was elevated in group II. The changes in serum E1 may provide an accurate marker of individual outcome.

Aged↗