Biomedical subjects
Publications and source records attributed to A Cunsolo.
On the basis of more than 10 years' clinical experience of 122 patients operated on for cancer of the right colon, stress is laid on intestinal occlusion which is one of the most frequent complications of this pathology. The factors that make the event to be avoided and that lead to the poor short and long-term results are analysed.
The long-term urogenital dysfunctions in 46 of 104 surviving patients submitted to abdominoperineal resection for rectal carcinoma between 1972 and 1986 were collected and assessed. Urinary retention was present in 41 percent of the men and 35 percent of women, while incontinence was present in 10 percent of men and 29 percent of women. Impotence was reported by 59 percent of the males, all sexually active before surgery. Dyspareunia was present in 50 percent of the women in the study. The possibility of treating prostatic hypertrophy concurrently with abdominoperineal resection in selected cases to avoid urinary retention is discussed. The limited number of responders to the survey may interfere with the global statistical significance.
Paykel's Clinical Interview for Depression (CID), an observer-rated scale, and Kellner's Symptom Questionnaire (SQ), a self-rating inventory, were administered to twenty-six patients with breast cancer: 1) the day prior to discharge after mastectomy or lumpectomy, 2) after six months, during a follow-up outpatient visit. There were no significant changes in depression and anxiety (except for self-rated anxiety) and, indeed, there were very high test-retest correlations. Observer and self-rated assessments were significantly related, and these correlations improved on outpatient follow-up. DSM-III-R diagnoses of affective illness (mood and anxiety disorders) based on pre-established cut-offs of the CID, showed considerable stability, particularly as to major depressive illness.
To establish the effectiveness of adjuvant chemotherapy in patients with colon cancer after radical surgery, from 1980 to December 1983, 263 patients were randomized in a multicentric study to no further treatment (131 patients) or to a combination of fluorouracil (5-FU) (400 mg/m2 i.v., days 1-5) and lomustine (CCNU) (100 mg/m2 per os on day 5) every 6 weeks for 9 cycles (132 patients). The two groups were well balanced for age, sex, histology, tumor and nodal extent. Chemotherapy was not given to 30 of the 132 randomized patients, and of 98 treated patients only 38 completed the entire protocol. Analysis, as intention to treat, at 54 months did not show any significant difference between the two treatment groups in terms of relapse-free survival (surgery alone, 74.5%; surgery + adjuvant chemotherapy, 70.9%; p = 0.91). In contrast, a significant difference was observed in overall survival (surgery alone, 78.8%; surgery + adjuvant chemotherapy, 60.8%; p = 0.04). The sites of relapse were identical in the two treatment arms. In conclusion, from this study it appears that adjuvant chemotherapy with 5-FU and CCNU seems to have no efficacy in the cure rate of colon cancer patients.
Personal experience in seven cases of ischaemic colitis that required surgery is reported. The aetiological, pathological and clinical features of the disease are then considered.
The results of 164 abdominoperineal resections and 87 anterior resections carried out between 1972 and 1985 for cancer of the rectum were reviewed, assessed, and compared. The problems with anterior resection included a 1.1% hospital mortality and a 5.4% anastomotic failure rate in the 73 manual sutures and 28.5% in the 14 mechanical sutures; recurrence rate was 15.4% and the global 5-year-survival was 62%. There was no mortality in the Miles series; the recurrence rate was 4.8% and the 5-year-survival rate was 53.5%. Urogenital complications after Miles were found in 86.9%: urinary alone 10.8%, sexual alone 19.5%, both 56.5%.
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Two cases of angiosarcoma of the breast observed in 1981 and 1982 are reported; one of these is still living, but with local recurrence. The pathogenesis, classification, prognosis and therapy of this malignant tumor are analysed. The review of the literature and personal experience seem to suggest that the treatment of choice should be surgical with complementary radiotherapy.
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An immunoperoxidase method which reveals saturated ER and PgR receptors is reported. With this method it is possible to assess nuclear and cytoplasmic positivity as well as the percentage of the positive cells present in the tumour.
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In situ carcinomas of the breast represent a clinical reality of recent decades that oncologists have to face today. Their observation is rendered increasingly frequent thanks to the improvements made in radiological techniques for early diagnosis and mass screening, and better health education. Reference is made to cases of lobular and ductal in situ cancer observed at the Bologna Surgical Clinic. Recommendations are made with respect to the drawing up of a rational treatment plan.