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L Cavanna

Publications and source records attributed to L Cavanna.

At least 55 records · Page 3Linked to original sources
PubMed1991

Diagnostic aspects and follow-up of 174 cases of hepatocellular carcinoma. Second report.

From June 1981 to June 1989 we diagnosed 174 cases of hepatocellular carcinoma (HCC) at our institution (Piacenza, Northern Italy). Average age was 65.6 years; male to female ratio 3.4. 149 patients were cirrhotic (85.6%); alcohol abuse was present in 88/169 (52.1%); in 53/145 patients all hepatitis B virus markers were negative. Alpha-fetoprotein showed a low diagnostic sensitivity (values above 500 ng only in 49/169 or 29.0%). We used ultrasound (US) examination with a very high identification rate in all cases; pathological diagnosis was achieved by US guided fine-needle aspiration biopsy in 135 patients; in 13, by laparoscopy-histology. Metastases were found in 24/169 cases (14.2%); a second malignancy was diagnosed in 13/169 (7.7%): the most common association was HCC-non-Hodgkin lymphoma. Only 14 patients could be referred to surgery, which significantly improved prognosis.

Adult↗
PubMed1991

ProMACE-cytaBOM versus MACOP-B in intermediate and high grade NHL. Preliminary results of a prospective randomized trial.

One hundred seventy-nine patients with intermediate or high-grade non-Hodgkin's lymphoma were randomized to receive either ProMACE-CytaBOM (P-C) or MACOP-B (M-B). At last follow-up 71 patients in the P-C arm and 78 in the M-B arm were assessable for response. Forty-one patients treated with P-C (58%) and 49 patients treated with M-B (63%) achieved a CR. Moreover 18 and 22 patients achieved PR with P-C and M-B, respectively. Twenty-five patients relapsed, 12 in the P-C arm and 13 in the M-B arm. Thirty-nine patients died, 32 from disease progression, 5 from treatment related causes, and 2 from other causes. No differences between the two treatment groups were observed as regard to relapse or death-rate. At 27 months the survival rate was of 71.9% for patients treated with P-C and 70.7% for those treated with M-B. At 2 years the RFD rate was 64% and 60% for patients in P-C and M-B arm, respectively. Patients treated with M-B experienced an high rate of methotrexate-related toxicity. ProMACE-CytaBOM and M-B seem provided with similar activity. However P-C seem less toxic and more manageable in an outpatient setting.

Adolescent↗
PubMed1990

Serum antibodies to hepatitis C virus in Italian patients with hepatocellular carcinoma.

Antibodies against hepatitis C virus (anti-HCV) were detected in 60.8% of 78 patients with hepatocellular carcinoma (HCC). Cirrhosis, present in most of the patients, as well as alcohol abuse, age, sex, and alpha-fetoprotein were equally distributed in the anti-HCV-positive and -negative groups. HBsAg positivity was significatively higher in negative anti-HCV group. By contrast, hepatitis B virus (HBV) antibodies were detected more frequently in positive anti-HCV patients than in the negative anti-HCV group. These data must be considered with caution because of the small number of HBsAg-positive patients. It is concluded that the high prevalence of anti-HCV in patients with HCC may suggest an etiological role of the hepatitis C virus, although in relationship to age, alcohol abuse and cirrhosis, the similarity in the two groups questions this hypothesis.

Aged↗
PubMed1990

Cirrhosis of the liver. A risk factor for development of cholelithiasis in males.

An ultrasonographic study about the prevalence of cholelithiasis was performed in 410 cirrhotic patients and in 414 controls matched for age and sex. Gallstone disease was found more often in cirrhotic patients (31.9%) than in controls (20.7%) (P less than 0.001). The female-to-male ratio of gallstones prevalence in cirrhotic patients approached to 1:1. Gallstone disease in cirrhotic patients vs controls was significantly higher (30.2% vs 16.5%) (P less than 0.001) in males only. No difference was found, for gallstone disease prevalence in cirrhosis of different etiology. The prevalence of cholelithiasis increased from Child's A to Child's C with a significant trend (P less than 0.001); this difference was significant in males (12.3% vs 40.5%) (P less than 0.001) but not in females. This study shows that cirrhosis represents a risk factor for the development of cholelithiasis in males. We suggest that high levels of estrogens could play a role in these patients, by an impairment of gallbladder emptying similar to that observed in pregnant women.

Adult↗
PubMed1990

Extramedullary plasmacytoma of the testicle. Sonographic appearance and ultrasonically guided biopsy.

Extramedullary plasmacytomas of the testis are extremely rare. This is a report of a patient with plasmacytoma of the testicle who also had an extramedullary plasmacytoma of the epipharynx 12 months earlier. Sonography (US) scans showed a heterogeneous mass of the right testicle with hypoechoic echo pattern; ultrasonically guided fine-needle aspiration biopsy (UGFNAB) allowed confirmation of the diagnosis. Immunoperoxidase studies, performed on histologic specimen after a radical right orchiectomy showed a monoclonal staining pattern of intracellular immunoglobulin for IgA-K type. Bone marrow biopsy, skeletal X-ray and immunoelectrophoresis were all within normal limits. The patient was successfully treated by surgery and is still alive with no evidence of disease.

Aged↗
PubMed1990

Ultrasonically guided percutaneous drainage of abdominal fluid collections: a long-term study of its therapeutic efficacy.

Fifty patients underwent ultrasonically guided percutaneous drainage (US-GPD) either with needle aspiration or catheter drainage. The procedures resulted in 70% complete recovery, 20% partial success and 10% of failures. The same patients were followed with clinical examination and sonography for a mean time of 36.3 months (minimum follow-up: 12 months). During the follow up period, 10 relapses occurred and one patient, considered for surgery after partial percutaneous treatment of a pyogenic liver abscess, recovered completely under conservative treatment. An analysis of the factors potentially related to the recurrence was made. It was found that one-step needle aspiration of abdominal abscesses and percutaneous treatment of chronic pancreatic pseudocysts are more prone to relapses. We conclude that US-GPD is an efficacious therapy for abdominal fluid collections, but an adequate drainage technique and a careful selection of the patients is crucial to avoid the possibility of relapse.

Adolescent↗
PubMed1990

Role of ultrasound guided fine needle aspiration biopsy in the diagnosis of hepatocellular carcinoma.

In 170 cases of hepatocellular carcinoma, ultrasound showed a high sensitivity in identifying focal liver lesions. Fine needle aspiration biopsy guided by ultrasound yielded a pathological diagnosis in the majority of cases. The advantages of this technique, its high diagnostic yield and low cost, render the older technique of blind percutaneous biopsy using a coarse needle obsolete. Laparoscopy retains its essential role in selected cases. Complementary use of fine needle aspiration biopsy under ultrasound guidance and laparoscopy assures the highest rate of diagnostic accuracy in hepatocellular carcinoma. We confirm the poor sensitivity of alpha fetoprotein.

Adult↗
PubMed1990

Association of non-Hodgkin's lymphoma and hepatocellular carcinoma.

Four patients with hepatocellular carcinoma (HCC) out of a group of 132 with non-Hodgkin's lymphoma (NHL) are described. HCC was the most common second neoplasm in this series; in contrast, only 2 cases of HCC associated with NHL have been reported in the English literature. The diagnosis of HCC was suggested by ultrasound (US) and confirmed by ultrasonically guided fine-needle biopsy (UG-FNB). The 4 cases of HCC arose from cirrhosis. In this series, 10 out of 132 patients (7.6%) presented cirrhosis. Some considerations concerning the possible role of NHL (and/or the related therapy) in promoting the development of HCC in cirrhotic patients are discussed. The usefulness of US and of UG-FNB in the management of the patient with NHL is emphasized.

Adolescent↗
PubMed1990

Ultrasonically guided fine-needle aspiration biopsy: a highly diagnostic procedure for hepatic tumors.

In 481 patients, with sonographically suspected neoplastic involvement of the liver, we performed an ultrasonically guided fine-needle aspiration biopsy with 22-gauge Chiba needle. In the 441 controlled cases, we obtained 68.5% true positive, 26.5% true negative, and 5% false negative, with a sensitivity of 93.2%, specificity of 100%, and overall accuracy of 95%. The true positive include 42.1% hepatocellular carcinomas, 28.1% metastases from known extrahepatic malignancy, 24.5% metastases from unknown primary site, 5% hepatic involvement by non-Hodgkin lymphomas, and 0.3% undetermined malignancy. Also, in a larger series, ultrasonically guided fine-needle biopsy confirms its high specificity and overall accuracy. The cytologic assessment of the obtained material is almost always adequate. The use of immediate cytologic staining reduces the number of passes in each lesion with absence of insufficient sampling. Biopsy with fine cutting needles should be reserved only for cases not diagnosed by cytology.

Biopsy, Needle↗
PubMed1990

Vulvar intraepithelial neoplasia. A clinicopathologic study of 60 cases.

Sixty cases of vulvar intraepithelial neoplasia (VIN) were analyzed clinicopathologically (24 VIN I, 9 VIN II, 27 VIN III). The ages of the patients ranged from 21 to 83 years (mean, 53.7). Colposcopic examinations showed the presence of white areas in 29 cases, red areas in 9, acetowhite areas in 6 and other alterations in 13. One-third of the lesions were multifocal. Pruritus and burning were present in 65% of the cases. Fifty-one percent of the cases showed histologic changes suggestive of human papillomavirus (HPV) infection; the mean age of those patients was significantly lower than that of patients without HPV infection. In 15 cases of VIN, HPV DNA testing was performed with Southern blot hybridization; in three (20%) of those specimens HPV 16 episomal DNA was identified. Epithelial alterations surrounding the areas of VIN were found in 24 cases (40%)-23 squamous cellular hyperplasias and 1 lichen sclerosus. Different types of treatment were performed according to the different grades of VIN: medical therapy, diathermocoagulation, local excision, hemivulvectomy and total vulvectomy. Follow-up was possible in 52 cases, with a mean of 33 months (range, 3-98). Two cases of VIN I showed progression of disease over 12-24 months.

Adult↗
PubMed1990

Topographic distribution of groin lymph nodes. A study of 50 female cadavers.

There is a discrepancy between anatomy textbooks' description of groin node position and Way's technique of lymphadenectomy. On the one hand, anatomic studies have demonstrated that the deep femoral nodes are on the medial side of the femoral vein, lying on the deep portion of the fascia lata, and can be seen easily through the opening of the fossa ovalis. On the other hand, the standard technique of deep femoral lymphadenectomy consists of removing the fat lying lateral to the femoral artery through the incision and detachment of the fascia lata from the sartorius to adductor longus muscle. With the aim of demonstrating that a correct deep femoral lymphadenectomy does not require removal of the fascia lata, we dissected Scarpa's triangles in 50 female cadavers. The examination of 100 specimens demonstrated that the deep femoral nodes are always situated within the opening of the fossa ovalis, and no lymph nodes are distal to the lower margin of the fossa ovalis, under the fascia cribrosa. These findings suggest that deep femoral lymphadenectomy can be performed without removing the fascia lata.

Adult↗
PubMed1990

Deep femoral lymphadenectomy with preservation of the fascia lata. Preliminary report on 42 invasive vulvar carcinomas.

Forty-two patients with primary invasive vulvar carcinoma were treated with radical vulvectomy and deep femoral lymphadenectomy with preservation of the fascia lata and cribriform fascia. The rationale for using this technique was based on anatomic knowledge of the topographic distribution of groin lymph nodes, which was confirmed by the study of 50 cadavers. The preliminary data show that the number of superficial and deep femoral lymph nodes removed from the 42 patients (mean number of nodes, 20; range, 8-32) was similar to the number reported in anatomy books. In addition, the five-year actuarial survival rate, 70%, was comparable to that in the literature. These preliminary results suggest that the surgical technique used in this study is as radical an oncologic procedure as Way's classic groin lymphadenectomy, which consists of removing the fascia lata and cribriform fascia.

Aged↗
PubMed1989

Laparoscopic ultrasonography in the study of liver diseases. Preliminary results.

In this report we present our preliminary experience using a recently developed sonolaparoscope. The 7.5 MHz rotating transducer, fixed to the tip of the laparoscope, produces a sector scan display of 180 degrees. We have used this technique in nine patients: five with cirrhosis and four with focal lesions of the liver. Laparoscopic sonography (LS) visualized two small nodular lesions in two cases of cirrhosis that did not show up with conventional ultrasonography (US). In one case of small hepatocellular carcinoma (HCC) located in the seventh hepatic segment, the lesion was not revealed. The ultrasound patterns of cirrhosis, hepatic cyst, and hemangioma were typical. We also performed ultrasonically guided biopsies. We concluded that laparoscopic sonography may be useful in the study of cirrhosis and in oncological patients for the screening of small hepatic lesions and that it could, in future, represent a preoperative step for liver surgery.

Adult↗