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Biomedical subjects

F Lumachi

Publications and source records attributed to F Lumachi.

At least 55 records · Page 3Linked to original sources
PubMed1998

Extraadrenal and multiple pheochromocytomas. Are there really any differences in pathophysiology and outcome?

In 15-20% of the cases pheochromocytoma (pheo) localizes in extraadrenal sites and in about 15% of all cases it seems to be multiple. We analyze our 20-year experience in surgical treatment of pheos, studying the differences between typical and extraadrenal or multiple tumors. From 1977 to 1996 we operated 55 patients (patients) with pheos, 28 (50.9%) males and 27 females (mean age 41 years, range 10-63). Two groups have been distinguished: classic pheos (Group 1, 45 patients) and extraadrenal or multiple pheos (Group 2, 10 patients). Hypertensive crises were present in 37/45 (82.2%) patients of Group 1 and in 7/10 patients of Group 2. Five (11.1%) masses were nonfunctioning and incidentally discovered (4 in Group 1 and one in Group 2). In 4 cases association with familial syndromes was observed (3 MEN IIb, 1 von Recklinghausen syndrome); no further significant differences in clinical features and laboratory data were found between the two Groups. At immunohistochemical analysis 26/26 patients resulted positive for chromogranin A and NSE and 17/26 (11/20 in Group 1 and 4/6 in Group 2) resulted positive for S 100 protein. Five (11.1%) malignant pheos were discovered and removed (Group 1); average survival of these patients was 54.4 months, two patients underwent radioactive iodine (131-I-MIBG) therapy after surgery and only one patient is still alive at 24-month follow-up. Recurrence for benign sporadic pheo (Group 1) occurred in one patient 183 months after adrenalectomy. Ectopic, associated with familial syndromes and multiple pheos are not uncommon and although recovery in surgically treated patients is excellent, lifelong follow-up is necessary also in benign tumors.

Adolescent↗
PubMed1995

Adrenocortical carcinoma. Our experience.

Adrenocortical carcinoma represents only 0.2% of the causes of deaths from cancer and this extremely low incidence rate implies that few medical centers have sufficient experiences to permit logical conclusions to be drawn regarding its treatment. From 1979 to 1993 we operated on 215 patients for adrenal diseases. The male/female ratio was 1:2.5 and the median age was 47 years (range 13-70). Eighty patients presented a clinical picture of hypercortisolism, 66 had a Conn's syndrome and 38 a pheochromocytoma; 30 had a nonfunctioning cortical or medullary tumor and one a metastatic adrenal mass. Of 141 patients with cortical tumors, 19 (13.5%) had malignancy of which 9 (7 males and one female, mean age 62 years) were nonfunctioning and 10 (3 males and 7 females, mean age 43 years, range 15-65) associated with a Cushing's syndrome. Seventeen patients underwent surgery, and two had multiple CT-FNAB-confirmed liver metastases and received o,p'DDD and chemotherapy treatment only. Tumor staging was the following: 3 (16%) stage I patients (tumor size varying from 4 to 5 cm), 7 (37%) stage II patients (tumor size 6-20 cm, mean 12 cm) and 9 (47%) stage III or IV. In 14 of the 17 operated patients the surgical approach was a lateral extraperitoneal incision with 12th rib partial resection. One patient had postoperative hemorrhage and reoperation was necessary. Operative mortality related to adrenalectomy was 0% although in three cases a nephrectomy was necessary because the mass completely surrounded the kidney. Three patients had a second operation 21-48 months after adrenalectomy for local recurrence of the disease. Overall survival time ranged from 2 to 42 months, the one-year survival rate was less than 40% and only six patients are still alive, 2-18 months after surgery. Tumor size and its endocrine functionality did not seem to correlate with prognosis in our experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Radical interventions in the treatment of thyroid carcinoma].

From 1970 to 1993, 196 patients with thyroid cancer were treated surgically. In 26 (13.2%) an invasion of local and regional structures was observed. Eighteen patients had papillary or follicular carcinoma and 9 anaplastic carcinoma. Tracheal invasion occurred in 11 cases and 7 patients underwent total thyroidectomy, segmental resection of the trachea (1-5 rings) and reanastomosis, associated preoperatively in 2 cases with Nd:YAG laser photocoagulation. Six of thirteen patients with muscle invasion are alive at 2-16 years follow-up; 3 patients with tracheal invasion died in less than 6 months and the others seem to be free of disease 6-14 years after operation.

Adenocarcinoma, Follicular↗
PubMed1989

[Hürthle cell tumor of the thyroid: which surgical approach?].

Hürthle cell tumors are a very particular thyroid disease. Controversies exist about the most adequate treatment. Radical surgery is sometimes advocated also for benign lesions, due to their malignant potential, but conservative surgery is thought to be adequate in most cases. The Authors' experience consists of 8 Hürthle cell tumors: 7 adenomas and 1 carcinoma. The latter has been treated by total thyroidectomy and the patient died after 6 months. Adenomas have been always treated by conservative procedures and there is no recurrence at a 2-6 year follow-up.

Adenoma↗
PubMed1984

Parathyroid localization in primary hyperparathyroidism: double-tracer scintigraphy and venous sampling techniques combined. A first evaluation.

The authors report their first experience with two techniques for preoperative localization of hyperfunctioning parathyroid glands: double-tracer (99mTc-201Tl) scintigraphy and venous sampling from thyroid veins. Nineteen patients affected by primary hyperparathyroidism were examined by both methods and subsequently submitted to surgery. Scintigraphy showed a sensitivity of 77.3% while the positivity of sampling was 63.6%; with the two techniques combined a correct localization was obtained in 90.9% of all cases. The authors emphasize the usefulness of both methods combined for locating enlarged hyperfunctioning parathyroids.

Adenoma↗
PubMedDate not supplied

Role of bilateral adrenalectomy in Cushing's disease.

Of 206 patients with Cushing's syndrome observed from 1975 through 1991, 144 (69.9%) had pituitary-dependent Cushing's disease. Of the 110 patients who underwent pituitary surgery, 31 (28%) developed an early recurrence and 23 patients (20%) had a late relapse 1 to 5 years after primary pituitary exploration. We performed a one- or two-step total bilateral adrenalectomy in 43 patients-9 men and 34 (79.4%) women, with an average age of 47.5 years (range 13-58 years). Thirty-three of these patients had already been treated by previous transsphenoidal surgery or alternatively by external pituitary irradiation over a period of 1 to 10 years prior to adrenal surgery. Thirty-one patients underwent adrenalectomy by a double lumbar access or left lumbar and right subcostal incisions. In our series of 55 operations, perioperative complications included two splenectomies and two hemorrhages (7.3%). The early mortality rate was 3.6% (two patients). Minor complications consisted of wound infection (13.5%), bronchopneumonia or pneumothorax (four cases) with a 7- to 12-day longer hospital stay. Nelson syndrome occurred in 6 of 41 patients (14.6%). We therefore believe that bilateral adrenalectomy does play a major role in the treatment of patients with pituitary-dependent Cushing's disease unsuccessfully managed by transphenoidal surgery. It represents the definitive therapy for those patients in whom hypophysectomy was not able to provide satisfactory control of the disease.

Adolescent↗
PubMedDate not supplied

Adrenalectomy in primary aldosteronism: a long-term follow-up study in 52 patients.

From 1975 to 1989, 52 patients with primary aldosteronism underwent adrenalectomy. There were 16 men and 36 women. The average age was 42.5 years, ranging from 28 years to 70 years. They were all hypertensive, with average pre-operative diastolic pressures varying from 105 to 140 mm Hg (median 117 mm Hg). The subjective symptoms most frequently reported were headache (71%) and asthenia (53%). In all patients except two, serum potassium concentration was 3.3 mEq/L (median 2.7 mEq/L) at the time of diagnosis. Plasma aldosterone concentration was elevated in all patients, 48 +/- 5.3 ng/mL in the recumbent position and 52.6 +/- 6.0 ng/mL in the upright position. The operations carried out were 50 unilateral and 2 bilateral adrenalectomies. In 4 patients a transperitoneal approach was employed and in the remaining 48 patients an extraperitoneal flank incision was used. The histological findings were 47 adenomas (with dimension ranging from 1 to 4.5 cm), unilateral macronodular hyperplasia in 2 patients, an adenoma plus controlateral hyperplasia in 1 patient, bilateral hyperplasia in 1 patient, and unilateral hyperplasia in 1 patient. After long-term follow-up (median 77 months, range 13 to 189 months), 15 patients remained hypertensive (diastolic blood pressure up to 100 mm Hg). In 9 of these patients the hypertensive illness had been present for more than 5 years prior to operation. In the remaining 37 (71%) patients, the arterial pressure returned to normal and in almost half of the patients this result was evident one or two days after operation.

Adrenalectomy↗
PubMedDate not supplied

[Primary hyperparathyroidism. Critical analysis of a 20-year experience].

PURPOSE: The aim of this study was to review our 20-year experience in the treatment of primary hyperparathyroidism (HPT) and to analyze clinical and biochemical findings in patients surgically treated in the nineties and before. MATERIAL AND METHODS: From 1978 to 1997, 302 patients with proved HPT underwent primary surgery. There were 95 (31.5%) males and 207 (68.5%) females with a median age of 53 years (range 11-82 years). Two groups of patients were considered: Group 1 (156 patients undergoing surgery between 1978 and 1989) and Group 2 (146 patients undergoing surgery from 1990 to 1997). RESULTS: No differences (p = NS) were found regarding age at operation and preoperative serum creatinine values. The most frequent symptoms in both groups were of rheumatological nature (54.5% and 42.5% in Groups 1 and 2 respectively). Renal stones were described in 60.3% and 42.5% of Group 1 and 2 patients, while peptic ulcerations or gastritis were present in 25.0% and 15.1%. No differences (p = NS) in the number of patients with neurological and neuropsychiatric rate and in the median size of the removed parathyroid glands were observed between the two groups. Asymptomatic HPT was more frequent (20.5% vs 7.7%) in patients who underwent parathyroidectomy from 1990. Average serum calcium preoperative levels and delayed diagnosis were greater (p < 0.01) in Group 1 (3.10 vs 2.90 mmol/L and 72 vs 24 months respectively). CONCLUSION: Increase of asymptomatic patients with HPT allowing an earlier surgical treatment may reduce the time of the of neck exploration and morbidity rate.

Adolescent↗
PubMedDate not supplied

Long-term follow-up study in breast cancer patients using serum tumor markers CEA and CA 15-3.

The aim of this study was to evaluate CEA and CA 15-3 changes in patients surgically treated for breast cancer. One hundred and three women (median age 59 years, range 31-83 years) with pT1-2, pN0-1, M0 breast cancer were followed up for at least 5 years. CEA and CA 15-3 serum levels were measured before operation and every 6 months during follow-up. The diagnostic sensitivity of CEA and CA 15-3 was 22.3% and 33.3% respectively. There was a significant difference (p < 0.01) between pre- and post-operative (6 months and 5 years after surgery) mean CEA serum levels independent of TNM staging. During follow-up, 21 (20.4%) patients showed recurrence of cancer and overall CEA and CA 15-3 sensitivity was 38.1% and 61.1%, with 98.8% and 91.2% specificity, respectively. Tumor marker measurement may be useful in post-surgical follow-up, but at present they are neither sensitive nor specific enough for early diagnosis of malignancy.

Adult↗
PubMedDate not supplied

Sensitivity of serum tumor markers CEA and CA 15-3 in breast cancer recurrences and correlation with different prognostic factors.

The aim of this study was to evaluate the correlation between serum tumor markers CEA and CA 15-3 in breast cancer (BC) patients with disease relapse and different prognostic parameters at first operation. Sixty-two women (median age 55 years, range 35-83 years) who had undergone curative surgery for pT1-2 pN0-1 M0 breast cancer developed local recurrences, distant metastases or contralateral BC during a median relapse time of 53 months (range 25-149 months). Sensitivity of CEA, CA 15-3, and CEA + CA 15-3 together was 40.3%, 41.9% and 59.7%, respectively. No correlation (p = NS) was found between tumor markers sensitivity and type of recurrence, surgical procedure, histologic subtypes and hormone receptors rate. CEA significantly (p < 0.01) correlated with the size of the tumor and axillary node status and CA 15-3 with the age of the patients. In conclusion, CEA and CA 15-3 should be considered complementary in detecting BC recurrences but their sensitivity is low and independent of the majority of the prognostic parameters that may be considered before relapse.

Adult↗
PubMedDate not supplied

Sestamibi scintimammography in pT1 breast cancer: alternative or complementary to X-ray mammography?

The aim of this study was to compare the results obtained using X-ray mammography (MG) and 99mTc-sestamibi scintimammography (SSM) in patients with breast lesions < or = 2 cm. One hundred and thirty-four women (median age 52 years, range 32-78), who had already been selected for open breast biopsy, underwent both MG and SSM prior to surgery. Final pathology showed 27 (20.1%) benign breast lesions and 107 (79.9%) breast cancers (pT1a=5 [4.7%], pT1b=50 [46.7%], pT1c=52 [48.6%]). The sensitivity, positive predictive value, negative predictive value and accuracy were 81.3%, 97.6%, 55.6% and 83.6% for SSM and 83.2%, 89.9%, 48.6% and 79.1% for MG, respectively. The results were similar (p=NS), but patients with breast cancer (BC) undetected by MG were significantly (p<0.05) younger than those in which the tumor was correctly diagnosed, while the age did not affect SSM sensitivity. SSM was more (p<0.05) specific than MG in BC detection both in the overall group of patients (92.6% vs 63.0%) and in those with < or = 10 mm breast lesions (94.7% vs 63.2%). In conclusion, in patients with suspected BC sized < or = 2 cm, SSM may help in surgical planning because of its high specificity, and should be considered complementary to MG, especially in younger women.

Adult↗