Biomedical subjects
Publications and source records attributed to L Vlahos.
Myofibroblastoma of the breast is a rare benign tumor seen predominantly in men in the sixth to seventh decades of life. We present a case of breast myofibroblastoma in a man and describe the mammographic, sonographic, and MR findings.
BACKGROUND/AIMS: A prospective study was performed to compare the sensitivities of computed tomography, magnetic resonance imaging and CTAP (CT during arterial portography) in the detection of focal malignant hepatic lesions. METHODOLOGY: Twenty-eight (28) patients with primary and secondary hepatic malignant tumors were evaluated. All of these patients underwent hepatic resection and a lesion-to-lesion imaging-pathological analysis was performed. RESULTS: The overall sensitivities were 53% for CT, 66% for MRI sequences and 88% for CTAP. For lesions smaller than 1 cm the sensitivities were 6% for CT, 17% for MRI and 72% for CTAP. The combination of CTAP and MRI yielded an overall detection rate of 93%. The difference between the sensitivity of CTAP and that of the other two imaging techniques was statistically significant (P < 0.04) according to the McNemar test. CTAP demonstrated four false-positive lesions, two of which were correctly characterized by MRI and one by CT. In 6 patients (21.4%) the surgical plan was modified after CTAP. CONCLUSIONS: We conclude that, CTAP has the highest sensitivity and should be part of the preoperative examination. In some instances, the addition of MR imaging must be considered a helpful adjuvant. Both techniques should be considered complementary in the preoperative diagnostic algorithm.
BACKGROUND: Somatostatin is a naturally occurring hormone widely identified in a number of human tissues, with a broad spectrum of physiological actions. Octreotide is a synthetic analogue of somatostatin, which seems to be promising in clinical use. AIMS: a. to evaluate the efficacy of octreotide in pain control of patients with advanced gastrointestinal cancer, as well as octreotide's outcome in the hepatic function; b. to investigate the relationship between pain intensity and beta-endorphin blood levels in the patients. PATIENTS: The study group consisted of 25 patients (age range: 48-89 years, 14 males, 11 females) with far advanced gastrointestinal cancer. METHODS: All the patients were under s.c. morphine administration using a continuous infusion pump. When pain intensity increased, 0.6 mg/day of octreotide was added to the therapeutic regimen in the same syringe of the continuous infusion pump. Pain intensity and beta-endorphin blood levels were measured five times: Once before octreotide administration and the other four 12, 24, 48 hours and 7 days after. A complete blood count and a biochemical screening profile were taken before the administration of octreotide as well as on the 7th and the 14th day. RESULTS: 24 out of 25 cases showed a reduction in pain intensity (pretreatment x = 5.3, post-treatment x = 0.6). beta-endorphin blood levels increased significantly during the study (an increase of 184.78% was observed on the 7th treatment day). In one patient pain control was achieved by increasing morphine dosage. Statistically significant changes were observed in hepatic function indices (p < 0.02). Significant side-effects were not observed. CONCLUSION: Octreotide can be used as an adjuvant analgesic in the management of gastrointestinal cancer pain which is managed by continuous s.c. administration. Although fuither research needs to be done, octreotide's administration seemed to improve hepatic function of these patients, therefore, it could potentially have a positive effect in the patient's quality of life.
BACKGROUND: Fentanyl is a synthetic opioid, suitable for transdermal delivery, offering an interesting solution as a step 3 opioid in cancer pain treatment. The purpose of the study was to carefully investigate: 1) the feasibility of the direct conversion from codeine to TTS fentanyl, in patients already receiving codeine and requiring strong opioids for their analgesia; 2) the safety of 25 microg/hour incremental steps and at shorter than 72-hour intervals, if clinically required. PATIENTS AND METHODS: 130 patients were judged eligible for the study. All the patients were receiving 280-360 mg or more of codeine and required strong opioid for their analgesia. The study lasted 56 days. The initial dose was 25 microg/hour. TTS fentanyl for all patients. Data assessments were made on baseline, day 1, day 2, day 3, in the hospital and thereafter on days 7, 14, 21, 28, 42 and 56. After the patch application, all the patients were given an immediate release oral morphine (5 mg) every 4-6 hours for the first 12 hours and then if needed only as rescue doses. The patients remained in the hospital for the first three days of the study where follow-up (pain score, satisfaction, side effects etc.). was recorded by the palliative care team and by daily cards. RESULTS: The itnitial dose of fentanyl was 25 microg/hour while the mean dose on day 3 was 45.9 microg/hour. All the patients required upward titration of the study medication during follow-up visits. On day 56 the mean dose of fentanyl was 87.4 microg/hour. Mean pain intensity decreased from an initial 5.96 on the baseline to 0.83 on day 3. Karnofsky scale measurements between treatment phases revealed non-significant changes. The rate of overall satisfaction was quite high. Nine patients discontinued the study due to inadequate pain relief or side effects between day 7 and day 28, while five patients died between day 28 and day 56. Constipation, nausea and vomiting were the most common side effects. Skin reaction was relatively mild and acceptable during the study. CONCLUSION: Under controlled conditions, TTS fentanyl seems to be feasible for direct conversion from mild to strong opioids and additionally, 25 microg/hour incremental steps day by day can be made by palliative care specialists, if clinically required for cancer pain management.
Varicose veins resection on a day-case basis has the advantage of the early return of the patient to his usual activities, thus also reducing the cost and occupation of hospital beds. Between 1980-1992, 1710 patients (2325 extremities) were operated on as outpatients. The preoperative management included: clinical examination, Doppler ultrasounds, Duplex scanning, ambulatory venous pressure and phlebography. The surgical method was based on two axioms: resection of affected segments only, and functional operation according to the hemodynamic parameters. At the end of the first trimester, 1.572 (91.9%) patients showed satisfactory results. One to twelve years later 72.1% with surgical therapy alone and 82% in combination with sclerotherapy. The serious complications were injury in 2 cases, one of the common peroneal nerve and the other of the posterior tibial artery. In conclusion, patients with varicose veins may be operated as outpatients with good results.
Three radiolabelled substances, 111In-pentetreotide, 99mTc-(V)DMSA and 123I-MIBG with different kinetics but similar tumor seeking behavior, were i.v. injected to assess and correlate their clinical value in metastatic malignant pheochromocytomas (4 patients), stage III and IV neuroblastomas (7 patients) and medullary thyroid carcinomas (6 patients). All II pheochromocytoma/neuroblastoma patients received i.v. a dose of III MBq (3 mCi) of 123I-MIBG and 185 MBq (5 mCi) of 111In-pentetreotide, within approximately weeks each other. Furthermore, in 4 of these patients as well as in all medullary thyroid carcinoma patients 111 MBq (3 mCi) of 99mTc-(V)DMSA were applied i.v. I week prior to the pentetreotide/mlBG scans. Four patients (malignant pheochromocytoma) with a total of 7 foci showing MIBG accumulation had 3 sites with pentetreotide and 1 site with (V)DMSA uptake, while in 7 patients (neuroblastora) with 15 foci showing MIBG accumulation 10 sites had detectable pentetreotide and 3 sites detectable (V)DMSA. Of the three radiotracers, 111In-pentetreotide used for somatostatin receptor identification holds promise mainly in cases where foci imaged with 123I-MIBG are negative. 111In-pentetreotide is unlikely to replace 123I-MIBG as a first-line routine diagnostic scintigraphic modality; compared to pentetreotide or MIBG, (V)DMSA seems to be highly sensitive only in medullary thyroid carcinomas.
In-111 pentetreotide is a new radiolabelled [OctreoScan 111, Mallinckrodt Medical BV, Petten] somatostatin analog with high affinity to somatostatin receptors (SR). introduced for the in vivo imaging of SR positive tissues. In an attempt to evaluate its clinical usefulness for tissue characterization in malignancies without neuroendocrine expression in parallel with histological and radiological examinations, specific scintigraphy was performed on brain (6 cases), thyroid (6 cases) and breast (9 cases) tumors, and in lymphomas (9 cases) and melanomas (6 cases). A dose of 111MBq of In-111 pentetreotide was injected i.v. to each patient and scintimages at 6 and 22 hours (for comparison) p.i. were obtained. The primary lesion of the breast cancer population was imaged in all 9 cases as well as all the palpable axillary nodes in 4 cases. Three women with impalpable axillary lymph nodes scanned negative but had a positive biopsy. Both meningiomas were positive for SR scans: positive results were also obtained for the high grade astrocytoma and the craniopharyngioma: Two out of 6 patients with papillary thyroid cancer showed a marked radiotracer accumulation. Scintigraphy in all 5 lymphomas was positive for SR but did not detect the Tc-99m sulphur microcolloid [Lymphoscint, Solco, Basel, Suitzerland] imaged lymph nodes in 5 melanomectomized patients. When judging the imaging results of these non-neuroendocrine malignancies definite conclusions should not be drawn since the number of studied cases polymorph, was small for every cancer histotype; nevertheless SR scintigraphy does not seem to be reliable for tumor staging in non-neuroendocrine malignancies, but is more suitable for a tissue characterization and monitoring changes of SR expression during and after therapy.
Although bone scintigraphy using Tc-99m labelled diphosphonates is a highly sensitive modality for the detection of of the extent of secondary skeletal malignancies, it is often not sufficient since possible bone marrow participation cannot be imaged We make a preliminary report on the usefulness of bone marrow immunoscintigraphy in the follow-up of patients with skeletal metastases due to breast and prostate cancer in parallel with the interpretation of conventional Tc-99m MDP bone scans. Approximately 7 to 9 months after radionuclide therapy both Tc-99m MDP [Hellenic Nuclear Research Center "Democritos". Aghia Paraskevi, Attikil and Tc-99m Anti-Granulocyte BW 250/183 [CIS Bio International, Gif sur Yvette, France] bone scans were performed on 2 prostate cancer patients and 5 women with breast cancer with disseminated bone metastases. Bone scans preceded bone marrow scans. Bone marrow defects were concordant with cortical scans in 4 cases, while they were larger in 4 sites compared to -MDP scan. Four sites in the ribs, shown on -MDP scan could not be detected on antigranulocyte scans. Bone cortex and marrow combined imaging of osseous metastases using different radiotracers increases the information on the real extent of skeletal involvement; the scintigraphic data obtained are valuable for the further decision making for the best possible management of unexpected myelosuppressive side effects as well as the follow-up of the treated cancer patients.
The purpose of lymphoscintigraphy in patients with melanoma before surgery is to image the lymphatic drainage net and particularly to detect the sentinel node; the purpose of immunolymphoscintigraphy after surgery is to map the lymphatic drainage and to detect a possible spead of the malignancy towards the lymph nodes surrounding the surgical field or more distal regions. The aim of the present study was to assess the sensitivity of a two-phase procedure with Tc-99m-Iabelled agents for exploring possible spread of melanoma after thorough resection of the primary lesion. Seven melanomectomized patients were enrolled into the study. The melanomas were situated on the head, back, arm and buttock of these patients. Intracutaneous lymphoscintigraphy with Tc-99m sulphur microcolloid [Lymphoscint, Solco, Basel, Switzerland] and i.v. immunoscrintigraphy with Tc-99m-antimelanoma antibody [Tecnemab-K-I, Sorin Biomedica Spa, Saluggia, Italy] at a dosage of 55 MBq and 740 MBq respectively, were performed in 13 patients to define possible infiltration of lymph nodes after surgery with a time interval of 1 week between the two examinations. Tc-99s sulphur microcolloid preceded the Tc-99m anti-melanoma antibody scan. The scintigrams were evaluated by three experienced nuclear physicians. The method detected 3 out of 16 suspicious nodes as malignant. Combined two-phase technique improves the diagnostic and staging accuracy of cutaneous melanoma affected population and appears extremely useful in the surgical confrontation of the lymphatic spead.
Prostate carcinoma is the most commonly associated with osseous metastases malignancy in males. The lesions, being usually of a mixed sclerotic/lytic variety and less often of the pure sclerotic type, need to be treated by a bone seeking radioactive element with an as low as possible radiobiological burden on the surrounding (peritumoral) tissues. Rhenium-186-HEDP was used to treat these osseous metastatic lesions due to its bone seeking kinetics attractive radiochemical properties. Of a total of 16 prostate cancer patients. 3 experiment loss of pain, 8 experienced obvious and 2 some improvement. No change was observed in 3 patients. Ten patients manifested a flare syndrome increasing pain approximately 2 to 6 days, after Re-186-HEDP i.v. application. Six patients showed a definite and 9 a slight decrease in platelet levels and absolute number of polymorphonuclear white blood cells, up to fourth week following treatment. One patient underwent a whole blood transfusion and in 2 peripheral neuropathy was observed lasting about 9 to 12 days. Re-186-HEDP appears to be a promising new metal ion complex for the palliation of painful bone metastases in prostate cancer. Compared to Sr-89 therapy, it shows a longer analgetic efficacy and has the advantage of emitting gamma rays, a fact which facilitates dosimetric calculations.
The efficacy and toxicity of treatment with 1400 +/- 100 MBq of Re-186-HEDP were evaluated in women with osseous metastatic breast cancer. The follow-up period was fourteen weeks. The efficacy of treatment was assessed by a) a pain and performance questionnaire that patients were asked to complete daily and b) a CT scan comparison of a randomly preselected osseous lesion before and 30 weeks after Re-186-HEDP i.v. application. The response to treatment was also evaluated by using the Kamofsky Index. Two out of fourteen women (14%) experienced loss of pain, 6 experienced obvious and 2 some improvement. No change was observed in 4 patients. Five patients manifested a flare response to treatment, with increase in pain within the first, 4 to 5 days after Re-186-HEDP administration. Five patients showed a decrease in platelet levels and absolute number of polymorphonuclear blood transfusion; no neurologic side effects were observed. Re-186-HEDP appears to be a useful new radiopharmaceutical for pain palliation induced by osseous metastases due to breast cancer. Compared to Sr-89 chloride efficacy, it provides longer-lasting analgesia, and when needed it can be reinjected with less risk due to its improved physico- and radiochemical properties.