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Biomedical subjects

L Gennari

Publications and source records attributed to L Gennari.

At least 109 records · Page 6Linked to original sources
PubMed1988

Primary lymphoma of the liver showing immunohistochemical evidence of T-cell origin. Successful management by right trisegmentectomy.

Primary malignant lymphomas of the liver are extremely rare. Thus far, 28 cases (1-13) of this entity have been described, but after careful clinical and histological staging, no other sites of extrahepatic involvement were demonstrated in 17 of these cases (2,3,5-13). We recently had the opportunity to investigate and manage a case of true primary malignant peripheral T-cell lymphoma of the liver in a 22-year-old man. To our knowledge this is the first reported case of a primary T-cell lymphoma of the liver. The patient was successfully treated with a right trisegmentectomy and no tumor recurrence has appeared after five years.

Adult↗
PubMed1988

Sensitivity of Hemoccult test for large bowel cancer in high-risk subjects.

From 1979 to 1982, 1233 symptom-free subjects at high risk for colon cancer because of family history and/or personal history of bowel neoplasia (cancer or adenomatous polyp) were examined with a guaiac test (Hemoccult II) for occult blood in stools. The test was positive (H+) in 98 subjects (7.9%). Endoscopy was subsequently performed on 86% of the H+ and on 64% of the H- subjects. Of 20 in invasive cancers found, 15 had been H+ [75.0%; 95% confidence interval (CI), 54.3-91.0%]. Of 96 patients with adenoma(s), 23 were H+ (24%; 95% CI, 16.0-33.0%). However, the sensitivity for adenomas was higher in patients with multiple adenomas or with a single adenoma measuring 2 cm or more in its largest diameter (37.5%; 95% CI, 21.8-54.7%). Of 699 subjects free of neoplastic lesions at endoscopy, 47 had been H+, ie, false positive (6.7%; 95% CI, 5.0-8.7%). Adjusting for differential compliance of H+ and H- subjects to endoscopy, a corrected estimate for sensitivity would be 69% for cancer and 19% for adenomas; the corrected estimate for the false-positive rate would be 5%.

Adenoma↗
PubMed1988

Kaposi's sarcoma: malignant tumor or proliferative disorder?

UNLABELLED: In order to provide information on the response to treatments and clinico-pathological pattern, the clinical course of 41 patients with classic Kaposi's sarcoma (KS) was reconsidered. Twenty-six cases presented a single nodular lesion, and 15 multiple, pluricentric lesions. Surgery was the first treatment for patients with single lesions, 14 of 26 (54%) patients had recurrences: the disease-free interval ranged from a few months to 11 years. Five cases had disseminated disease, three of these were preceded by local recurrence. Cases with multiple lesions were treated by a combination of surgery, chemo- and radiation therapy (RT). In three cases spontaneous regression of disease was observed and two of these are presently disease-free. After chemotherapy and RT, many patients had complete remission of disseminated disease for up to 40 months. The drugs of first choice were vinblastine and bleomycin. Over all, only one patient died of KS, 10 years after diagnosis, nevertheless the cure rate was very poor and the final overall disease-free rate was around 30%. Proper treatment for nodular or disseminated lesions provides a fair disease-free period. FINAL CONSIDERATIONS: mortality of disease is exceptional despite the 80% risk of recurrence or dissemination. Data from our series do not provide proof that adequate control of the primary single lesion could screen against recurrence: the interval between treatment of the first lesion and recurrence is sometimes exceptionally long, up to more than 10 years, and for that it is not easy to state when disease is really cured. These considerations and other analogies between KS and lymphoproliferative disorders in immunodepressed people strongly suggests the possibility of a non-malignant or even non-tumoral pattern to this disease, with implications for therapeutic strategies.

Adult↗
PubMed1988

The occurrence of cholangitis after percutaneous biliary drainage: evaluation of some risk factors.

Sepsis of the biliary tract is often reported after percutaneous transhepatic biliary drainage (PTBD) and is considered a life-threatening condition. The authors studied 39 patients with biliary stenosis (35 with neoplastic stricture and four with benign disease) with the purpose of identifying some factors possibly associated with a higher risk of cholangitis. None of the patients complained of biliary sepsis at the first clinical examination. Several factors were taken into account and were statistically tested according to Miettinen rate ratios to differentiate patients in whom cholangitis would consequently develop: nature, site and extent of basic disease, type and functioning of PTBD, skin contamination at puncture site of PTBD, and bile contamination at PTBD and at follow-up. The presence of bacteria in the first bile (31.5%) was not related to a higher risk. All subjects showed bile contamination after PTBD, but cholangitis developed in only 15 patients, and it was always supported by enteric microorganisms. When we compared patients with cholangitis and subjects without infection, it was possible to demonstrate a statistically significant association of cholangitis and the following: nature of the stricture, presence of multiple intrahepatic biliary obstruction, neoplastic invasion or compression on the duodenum, and presence of Staphylococcus aureus on the skin at puncture site at drainage.

Adult↗
PubMed1987

Patterns of failure following surgical resection of colorectal cancer liver metastases. Rationale for a multimodal approach.

A total of 45 patients, after surgical resection of colorectal liver cancer metastases, were retrospectively analyzed to define areas of failure, to identify some possible prognostic factors (site of primary, stage, site, number of metastases, preoperative carcinoembryonic antigen, differentiation of the primary, type of surgery), and to seek a new rationale for a multimodal approach. The median postoperative follow-up was 18 months (range: 4-45 months). Survival rate was calculated by the actuarial method, and statistical significance was tested by the Mantel-Haenszel test. Twenty-eight patients had a relapse. These recurrences were hepatic in 11 patients, extrahepatic (intra- and extra-abdominal) in 12 patients, and intra- and extrahepatic in five patients: The stage (classification of the Istituto Nazionale Tumori of Milan) was the most important parameter related to the overall recurrence rate (47% in stage I, 62% in stage II, and 81% in stage III) and to the overall and disease-free survival. Stage was significantly related to hepatic relapse but not to extrahepatic relapse. In stage I the failure rate of 18 months was similar in hepatic and extrahepatic relapses (one third to one fourth of the patients); in stages II and III the hepatic failure rate was always higher than the extrahepatic rate. These data indicate that surgery alone is an inadequate form of therapy in cases of colorectal cancer metastases of the liver, and an adjuvant therapy, including alternate regimens of intraperitoneal and systemic chemotherapy, should be considered.

Actuarial Analysis↗
PubMed1987

A posterior approach for the excision of sacral chordoma.

We report eight cases of sacrococcygeal chordoma treated by high sacral resection through S2 by a posterior approach, with the intention of achieving radical removal. The technique we describe is easier than the combined abdominosacral approach, and there have been no serious intra-operative or postoperative complications. The major technical problems were the margins of excision in the sacrum itself (one recurred) and in the perirectal soft tissues (four recurred), and the preservation of sacral nerve roots. When both S2 roots were preserved, sphincter problems were mild and reversible. One patient died from recurrence 32 months after operation and one was lost to follow-up at eight months. Six patients are alive with a median survival of three years; three of them are free of disease after 22, 36 and 80 months respectively. These results indicate the possibility of surgical cure of this malignant tumour.

Adult↗
PubMed1987

Prognosis of patients after palliative surgical procedures for carcinoma of the stomach.

From 1965 to 1980, 294 (33 per cent) of 885 patients admitted to the Istituto Nazionale Tumori of Milan with carcinoma of the stomach did not undergo a radical operation. Forty-eight patients were not considered suitable for operation due to their poor general status and spread of disease. One hundred and five patients underwent simple exploratory laparotomy, 80 underwent bypass procedure and 61, noncurative resection, and the operative mortality rate was 4.7, 10.0 and 11.5 per cent, respectively. Median survival time was 2.4 months for patients who did not undergo an operation, 2.8 months after exploratory laparotomy and 3.5 months after bypass procedures. Median survival time after nonradical resections was 8.0 months and 6 per cent of these patients survived for more than five years. To perform the analysis within relatively homogeneous groups, patients with different treatments were further stratified into three groups according to the spread of disease: local, distant and local plus distant spread. It is noteworthy that the benefit after bypass procedures in comparison to exploratory laparotomy was limited to those patients with local spread of disease; the advantage of nonradical resection was apparent in all groups. Survival time was finally analyzed with reference to the extent of liver involvement in patients with metastatic disease confined to the liver. The data suggest that a limited sporadic survival time is possible only after gastric resection in patients with liver involvement of less than 50 per cent.

Carcinoma↗
PubMed1987

Immunoscintigraphy of colorectal carcinoma with F (ab')2 fragments of anti-CEA monoclonal antibody.

A monoclonal antibody to carcinoembryonic antigen (CEA) (F023C5), belonging to IgG1 class, was obtained by cell fusion technique. Preliminary screening on different tissues was performed with immunoperoxidase staining, which showed good specificity of the antibody for gastric and colorectal carcinomas. F(ab')2 fragments were subsequently prepared and labeled with 131I and 111In. After immunoreactivity check the radiopharmaceuticals were injected intravenously. Sixteen patients with 22 primary or secondary localizations of colorectal carcinoma were studied following the recommendations of the ethical Committee of the Istituto Nazionale Tumori, Milan, Italy. Serial scans were performed after injection of the two radioactive reagents. In vivo pharmacokinetics of the compound was studied. Radioactivity level in surgical specimens was measured, and immunostaining was performed. All tumors were found to express the antigen. Eleven out of 12 tumor localizations of the gastrointestinal tract and three out of ten liver metastases were imaged. Specificity of tumor uptake was assessed by simultaneous injection of an irrelevant antibody.

Antibodies, Monoclonal↗
PubMed1986

Subtotal versus total gastrectomy for cancer of the lower two-thirds of the stomach: a new approach to an old problem.

Many surgeons favour total gastrectomy (TG) 'de principe' in the treatment of gastric cancer, but final demonstration of its advantage over subtotal gastrectomy (SG) is still lacking. We analysed survival after curative TG or SG within groups of patients stratified according to the main prognostic variables as found in multivariate analysis, i.e., nodal status, degree of invasion of the gastric wall, patient age and sex. Our series consisted of 361 patients treated by curative SG and 41 by curative TG, admitted to the Istituto Nazionale Tumori of Milan between 1965 and 1979. In patients with lymph node involvement survival appeared to be significantly better (P = 0.0005) after SG. However, stratifying for age it was found that the benefit was limited to patients over 60 years old. No significant difference in survival was found in the group without nodal involvement (N -) and invasion of the wall to the serosa or beyond. No statistical comparison was possible in N - groups with invasion confined to mucosa, submucosa or muscularis propria because of the small number of such patients who underwent TG. We conclude that SG still represents the standard reference operation for gastric carcinoma provided that a safe proximal margin of resection is guaranteed.

Adult↗
PubMed1986

Intrahepatic doxorubicin in unresectable hepatocellular carcinoma. The unfavorable role of cirrhosis.

To investigate the relationship between the presence of cirrhosis and the antitumor effects of locoregional chemotherapy with doxorubicin, 16 patients with nonresectable hepatocellular carcinoma (HCC) and satisfactory baseline clinical conditions (Child class A or B, Karnofsky index greater than 70%) were studied. Eight patients had post-necrotic cirrhosis, five had serum HBsAg. The dose of doxorubicin was 0.3 mg/kg body weight/day, given by continuous intracoeliac infusion for 8 consecutive days. Eight patients (six with cirrhosis) died prematurely after the first course of chemotherapy. Six (2 with cirrhosis) responded to therapy; they survived 3-33 months (median: 10). In these patients, the type and severity of drug-related side effects were comparable to those reported for patients treated by intravenous chemotherapy. The implication that in many patients with cirrhosis intrahepatic chemotherapy with doxorubicin may hasten death, lessens our interest in its use for nonresectable HCC. In fact, in Italy these cancers frequently occur in association with cirrhosis.

Aged↗
PubMed1986

Surgical treatment of hepatic metastases from colorectal cancer.

From 1980 to 1984, 48 patients were subjected to liver resection for hepatic metastases from colorectal cancer. The disease was staged according to the original staging system proposed by the authors: stage I, single metastasis involving less than 25% of hepatic parenchyma (21 patients); stage II, multiple metastases involving less than 25% of hepatic parenchyma or single metastasis involving between 25-50% (9 patients); and stage III, multiple metastases involving between 25-50% or more than 50% of hepatic parenchyma, irrespective of the number of metastases (18 patients). The extent of hepatic resection was generally related to that of liver disease; a typical lobectomy was performed in 28 patients and segmentectomies in 20. One patient died after operation (mortality, 2.1%), and major complications occurred in seven patients (morbidity, 14.9%). Morbidity was related to operatory blood loss: 45% of patients with blood replacement of more than 2000 cc developed major complications versus 5.4% with blood replacement of less than 2000 cc (p less than 0.05). The actuarial 3-year survival for stages I, II, and III was 73%, 60%, and 29%, respectively (p less than 0.05). Twenty-two patients (45%) have had recurrences, all stage III patients within 2 years of resection versus 28% of stage I patients (30 months disease-free survival, 49%). The liver only was the site of recurrence in 10 patients, distant sites in seven, and both liver and distant in five. Analysis of the different features of the primary tumor, the interval between bowel resection and detection of hepatic metastases, and the number and extent of liver secondaries demonstrated that prognosis after surgery was mainly related to the latter; they are considered in the staging system adopted in this study. It is a simple system and shows a good prognostic correlation. The results reported here are in agreement with those of the literature; the low mortality and morbidity and the survival benefit support the growing acceptance of surgery in treatment of hepatic metastases from colorectal cancer, in particular stage I patients. For the other stages, surgery should represent, when applicable, only the first step of a multimodality treatment.

Adult↗
PubMed1986

Chondrosarcoma--55 unreported cases: epidemiology, surgical treatment and prognostic factors.

Fifty-five cases of chondrosarcoma, seen at the Istituto Nazionale Tumori of Milan, were reviewed to collect epidemiological data in order to verify therapeutic effects and the validity of possible prognostic factors. Epidemiological data according to sex and age distribution and skeletal location were in accordance with the literature (male:female ratio, 1.8; mean age, 37 years, 62% of lesions located in the pelvic or scapular girdle). Of 52 cases operated on with the intent of radicality, 5 were intralesional operations, 20 marginal and 27 radical. The local recurrence rate was dependent upon the degree of surgical radicality (60%, 35% and 11% respectively for intralesional, marginal and radical surgery). Age, site, type of first symptom and pathological grading were significant as prognostic factors. The type of the first symptom was directly correlated to the site of the tumour. Sex, tumour size and degree of surgical radicality were not relevant.

Adolescent↗
PubMed1986

Actual role of Hartmann's resection in elective surgical treatment for carcinoma of rectum and sigmoid colon.

A consecutive series of 50 patients who underwent Hartmann's resection from 1967 to 1981 because of carcinoma of the rectum and sigmoid colon is reported upon herein. Indications for Hartmann's resection were palliation because of advanced disease (62 per cent of the patients), poor risk conditions and advanced age (24 per cent) and intraoperative complications or difficult primary anastomosis (14 per cent). The overall operative mortality and morbidity rates were 8 and 80 per cent, respectively--pelvic sepsis accounted for 37.5 per cent of the complications. The five year survival rate for patients with radical operations was 46 per cent. The choice of Hartmann's resection for patients with advanced disease was unfair because of the high postoperative morbidity and the discomfort of colostomy. The indications for intestinal resection without primary anastomosis because of general conditions or technical difficulties to perform the anastomosis are actually reduced by the improved perioperative care and by the confidence in using stapling guns. Hartmann's resection is still indicated in elderly patients, in instances of locally advanced tumors and when the primary anastomosis is judged to be unfeasible.

Adenocarcinoma↗