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Biomedical subjects

F Lumachi

Publications and source records attributed to F Lumachi.

62 records · Page 4Linked to original sources
PubMedDate not supplied

Predictive value of different prognostic factors in breast cancer recurrences: multivariate analysis using a logistic regression model.

BACKGROUND: The aim of this study was to compare the sensitivity of different pre-operative parameters in patients with breast cancer (BC) recurrence using univariate and multivariate analysis. MATERIALS AND METHODS: We retrospectively analyzed a series of 387 women (median age 60 years, range 35-83 years) who underwent curative surgery for pT1-2 BC. The patients were divided into two groups: Group 1: 325 (84.0%) patients with no evidence of disease during a median follow-up of 53 months (range 25-149 months) and Group 2: 62 (16.0%) patients who developed local or distant recurrences. RESULTS: Univariate analysis showed significant (p<0.01) differences between the two Groups in age, size and grading of the tumor and hormone receptor rate. MIB1 proliferation rate, serum markers CEA and CA 15-3, and lymph node status were not useful in predicting relapse. Multivariate analysis using a logistic regression model showed that only age, size of the tumor and hormone receptor rate independently correlate with the onset of recurrences. CONCLUSION: There is no clear correlation between BC recurrence and the majority of the prognostic factors available. Multivariate analysis of several pre-operative parameters may help to correctly select the high risk population.

Adult↗
PubMedDate not supplied

Noninvasive parathyroid imaging in primary hyperparathyroidism.

Several studies suggested that preoperative localization of abnormal parathyroid (PT) glands may be useful in reducing operative time facilitating parathyroidectomy, especially in patients with ectopic PT glands. At present, noninvasive techniques used to evaluate patients with primary HPT include (1) 99mTc-sestamibi scintigraphy, (2) high-resolution neck ultrasonography, (3) CT scanning, and (4) magnetic resonance imaging (MRI). The sensitivity and positive predictive value of each technique range from 70% to 90%, and a combination of two of more tests may significantly improve the results. In the minimally-invasive era both radioguided and video-assisted parathyroidectomy require an accurate preoperative localization of the abnormal PT glands, and PT imaging should be obtained before surgery in all patients with primary hyperparathyroidism, with the aim of reducing operative time and hospital stay.

Humans↗
PubMedDate not supplied

Minimally invasive radioguided parathyroidectomy.

In the last years, with the aim of reducing operative time and having better cosmetic results, minimally-invasive parathyroidectomy (MIP) has become to be extensively performed. Several techniques are available, including video-endoscopic techniques, and radioguided parathyroidectomy. In patients undergoing radio-guided parathyroidectomy receive an intravenous injection of 99mTc-sestamibi 60-90 minutes before the operation was scheduled to start. Four early images are obtained 5 minutes after radiopharmaeutical administration, with the aim of confirming the side and site of the enlarged PT gland. Intraoperative nuclear mapping using a hand-held gamma probe and quantitative gamma camera counting in the four quadrants is obtained. A 2-3 cm incision is made, and the enlarged PT gland excision is guided by the probe, resulting in a decline in radioactivity in the corresponding quadrant. Intraoperative quick PTH is routinely assayed. When the PTH levels at 10 min fail to fall to less than 50% of the preoperative levels, a multiglandular disease should be suspected and a bilateral neck exploration is usually required. MIP is a safe, cost-effective alternative to bilateral exploration, and should be considered the procedure of choice in patients with primary HPT, when preoperative imaging tests have suggested the presence of a PT adenoma. Radioguided MIP may improve the success rate of surgery in patients with primary hyperparathyroidism.

Humans↗
PubMedDate not supplied

Congenital anomalies of the spleen mimicking hematological disorders and solid tumors: a single-center experience of 2650 consecutive diagnostic laparoscopies.

Congenital anomalies of the spleen range from splenic lobulation, to accessory spleen to polysplenia. Though most of these anatomical variants have no clinical significance, an accessory spleen may simulate a tumor in the adrenal gland, pancreas, stomach or intestine. Alternatively, a missed accessory spleen may be the site of the relapse of a hematological disorder. We, therefore, assessed retrospectively: (i) the frequency of congenital anomalies of the spleen observed during 2650 consecutive laparoscopies and (ii) looked for possible misdiagnoses of the accessory spleen as hematological disorders or solid tumors located in the left upper quadrant of the abdomen. Congenital anomalies of the spleen were detected in 55 cases, accounting for 2.07%. Accessory spleens were observed in 44 patients (1.6%) and spleen lobulation in 11 (0.47%). An accessory spleen was the most common of the splenic anomalies. Among the 44 patients in whom an accessory spleen was discovered laparoscopically, the recognition of this anomaly prevented a relapse of a hematological disease in one case and avoided a useless exploratory laparotomy in the second, where the radiologist had interpreted this malformation as a space-occupying lesion. In the third case, the accessory spleen was initially misdiagnosed as a solid tumor of the pancreas, but was eventually recognized as a congenital anomaly by a second laparoscopy.

Abdominal Neoplasms↗
PubMedDate not supplied

[Lipolytic and lipoprotein lipase activity of subcutaneous and visceral adipose tissue in Cushing's syndrome].

Cushing's syndrome has been recently compared to visceral-type obesity, since it is characterised by the accumulation of adipose tissue at a deep abdominal site, to the detriment of the subcutaneous adipose panniculus, and is associated with insulin-resistance and hyperlipemia. The aim of the present study was to evaluate the influence of glucocorticoid hormones on lipolytic activity (index of FFA mobilisation) and on lipoproteinlipase (LPL) activity (an index of the accumulation of triglycerides) in subcutaneous and perirenal adipose tissue in order to clarify the mechanisms involved in this type of accumulation in Cushing's syndrome. Five patients (4 F and 1 M) were included in the study, mean age 27.8 +/- 3.7 years and BMI 21.3 +/- 1.2 kg/m2; patients were hospitalised in the 2nd Surgical Clinic at the University of Padua and underwent surgery for secondary corticosurrenal hyperplasia with ACTH secreting hypophysial adenoma. Lipolytic activity in subcutaneous adipose tissue in these patients was significantly lower (p less than 0.05) than in control subjects, in particular after noradrenalin stimulation (p less than 0.01). No significant difference was observed when lipolytic activity in subcutaneous adipose tissue was compared to that one in perirenal tissue. LPL activity in subcutaneous adipose tissue did not reveal statistically significant differences compared to control subjects, although values were lower. A further decrease in LPL activity, which was not however significant, was observed in perirenal tissue in comparison to subcutaneous tissues in the same patients. The mean weight of adipocytes (ug) was slightly lower in subcutaneous adipose tissue compared to control subjects and even lower in perineal tissue in comparison to the subcutis in the same patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMedDate not supplied

[Surgical approach in the treatment of recurrent primary hyperparathyroidism].

Recurrent or persistent primary hyperparathyroidism (HPT) is a rare occurrence requiring generally a careful reoperation. From 1980 to 1992 a total of 192 patients underwent bilateral cervical exploration following a diagnosis of primary hyperparathyroidism. Persistent of recurrent HPT was found in 6 (3.04%) of our cases. In two patients a subtotal parathyroidectomy was performed (parathyroid hyperplasia) and hyperfunctioning parathyroid tissue was found at neck exploration. In one case an ectopic adenomatous fifth gland was found in mediastinum at reoperation. Three patients with recurrent HPT had a parathyroid carcinoma but in only two cases it was possible to identify and remove the pathologic tissue preoperatively localised in mediastinum by double-tracer scintigraphy and CT scan 6 and 15 months after first operation respectively. The third patient with parathyroid carcinoma was inoperable on account of multiple metastases both cervical and thoracic.

Follow-Up Studies↗
PubMedDate not supplied

[Adrenal incidentaloma: proposal for a correct treatment].

BACKGROUND: The incidence of unsuspected adrenal masses (incidentalomas) based on CT-scan results to be higher than in the past. The aim for our study was to establish some guidelines for an appropriate management. METHODS: From 1986 to 1995, 61 patients with no history or clinical findings suggestive of adrenal mass or adrenal hyperfunction were discovered by radiologic examination to have an incidentaloma larger than 1 cm. In each patient basal biochemical evaluations were obtained to exclude the presence of adrenal cortical or medullary dysfunction. There were 28 men and 33 (54.1%) women, with a mean age of 53 years (range 16-74). 19 patients underwent CT-guided fine-needle biopsy to exclude metastatic tumors. Furthermore in 29 patients 75-Se-selenomethyl-norcholesterol was performed and 17 were studied by MRI. RESULTS: At CT-scan mean lesion diameter was 5.48 +/- 3.76 cm (range 2-23); 32 adrenal masses were right sided and 3 (4.9%) were bilateral. 17 patients had concordant scintigraphic imaging pattern, 6 bilateral uptake and 6 had discordant imaging. CT-guided FNAB showed malignancy in 9. Adrenalectomy was performed in 45 patients according to a score calculated by 4 parameters: age of the patients, size of the mass, scintigraphic pattern, MR imaging. Twenty-four had a score greater than 9 and in the remaining 21 patients in spite of a score lower than 10 adrenalectomy was performed based on: 1) increased size at CT scan follow-up (15 pts); 2) either suspected primitive malignant neoplasm at CT-guided FNAB or history of malignancy (6 pts); 3) elevated 24-hour dopamine (4 pts). In 12 (26.7%) patients a malignant tumor was found. There were not any statistically significant differences (p > 0.05) between the age of the patients with malignant neoplasms and those with benign masses, and between the size of the masses, which were 7.58 +/- 5.93 cm (range 2-23) and 5.03 +/- 2.81 cm (range 3-17) respectively. The difference in scores between the patients with malignant masses (12.17 +/- 2.95) and those with benign ones (9.09 +/- 1.33) was statistically significant (p < 0.01). CONCLUSIONS: Since adrenal incidentaloma have a malignancy rate higher than the other adrenal tumors, it is crucial to outlinesome criteria to sort out the patients at risk for whom adrenalectomy is to be warranted. Based on our results we believe that patients with a score > 9 should undergo adrenalectomy.

Adolescent↗