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Biomedical subjects

M De Santis

Publications and source records attributed to M De Santis.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

[Computerized tomography in the study of myelopathy in cervical spondylosis].

This study involved 107 patients selected according to symptoms and signs of myelopathy due to cervical spondylosis. All patients were examined by high resolution CT without intravenous or intrathecal contrast enhancement. Diagnostic accuracy of CT is discussed with regard to idiopathic and degenerative cervical spinal stenosis. Emphasis is placed on CT findings of ossification of posterior longitudinal ligament. The authors conclude that plain CT may be a reliable method for diagnosing cervical spondylothic myelopathy. Nevertheless the authors stress how intrathecal contrast enhanced CT is far superior to plain CT in the selection of a definitive anterior or lateral surgical approach without a delay.

Adult↗
PubMedDate not supplied

Combined modality therapy of resectable high risk rectal cancer.

Aim of this phase I-II study was to evaluate the efficacy of preoperative concomitant radiochemotherapy in resectable high risk (TNM stage: II and III) rectal tumors, 64 patients entered the study: 37 had low rectal cancer, 27 mid-rectal cancer. 50 patients were clinically staged as stage III (Dukes C) and 14 as stage II (Dukes B). Treatment protocol included bolus mitomycin C at the dose of 10 mg/m2 on day 1 and 5FU continuous infusion at the daily dose of 1000 mg/m2 on day 1, 2, 3, 4. Concomitant external radiotherapy up to a dose of 3780 cGy was delivered at the daily dose of 180 cGy. Surgery was performed 4 to 5 weeks after radiation therapy (RT). Before surgery all patients were clinically restaged to evaluate the response to concomitant radiochemotherapy. Treatment compliance was 97%. Toxicity was 27% prevalently shown as bone marrow depletion and radiodermatitis. In 37 patients (61%) there was 50% reduction (partial response) of neoplastic volume. In 5 patients (8%) no neoplastic cells were evidenced in the surgical specimen on histology (complete response). The distance between the lower margin of the tumor and the internal anal orifice increased in 72% of cases. Postoperative morbidity was 28%. The incidence of anastomotic dehiscences was 8.7% over 46 anterior resections. Postoperative mortality was nil. Definitive staging evidenced 24 patients (39%) stage I or with no evidence of tumor. The incidence of local recurrence was 5% and that of distant metastasis 8%.

Antibiotics, Antineoplastic↗
PubMedDate not supplied

Combined modality follow-up and postoperative recurrence in rectal cancer.

Rectal cancer patients are at high risk for disease progression even after radical surgery for cure. Prognosis depends on a timely diagnosis for effective, curative therapies. In resected patients, an accurate follow-up especially within the first two years of surgery, is required. Clinical and radiologic follow-up is based on periodical, timed physical and instrumental exams (rectal exploration, neoplastic markers, rectoscopy, colonic enema, CT MRI, TRUS) which supply information on locoregional (liver, lymph nodes, peritoneum, chest) recurrence. Rectal exploration, endoscopy, colonic enema and TRUS enable the control of anastomosis and the identification of possible metachronous tumors. CT and MRI as liver US and chest X-ray, detect recurrence in other sites (pelvic perianastomotic recurrence, peritoneal carcinomatosis, lymph node or liver locations). A diagnostic problem is represented by the difficult differentiation of local recurrence from postoperative fibrosis. In this case, surveillance in the course of time with exams more reliable in tissue differentiation (MRI, though with some limitations) and US- or CT-guided biopsy, is required.

Biopsy↗
PubMedDate not supplied

A case of hepatocellular carcinoma that resisted identification.

The case of a 70-year-old man with clinically-compensated alcoholic liver cirrhosis is illustrated. His serum alpha-fetoprotein level was on the increase but Ultrasonography and Magnetic Resonance detected no focal lesion of the liver. Five months after Ultrasonography, Computed Tomography and Magnetic Resonance were performed because the patient's alpha-fetoprotein level indicated hepatocellular carcinoma, but none of these tests succeeded in locating the neoplasm. Digital subtraction angiography was performed and only then was a small hepatocellular carcinoma revealed under the diaphragm. The patient underwent transcatheter arterial chemo-embolization with the result that the alpha-fetoprotein level dropped immediately and is still normal after 15 months. The case described is a model of what the ideal function of a marker of neoplasia should be, namely early detection, and subsequent precise confirmation of the continuing efficacy of the treatment adopted.

Aged↗
PubMedDate not supplied

Intraoperative radiation therapy (IORT) in rectal cancer: methodology and indications.

In intraoperative radiation therapy (IORT) a high dose of radiation is delivered to the tumor or to the tumor bed, thus favouring local control with no significant increase in toxicity. At present it is used to deliver a boost dose of radiation for rectal cancer in protocols which include preoperative external beam radiation therapy (ERT). From various experiences carried out in a number of centers, the technical and methodological features of this procedure have been defined also relatively to cost-effectiveness in terms of a longer surgical treatment, involved specialized staff and resources. At the 5th IORT International Congress held in Lyon in September, 1994, of over 70 clinical studies reported, 15 were on rectal cancer with about 700 patients undergoing IORT. The growing interest in the use of this procedure in rectal cancer is explained by the natural history of the disease, burdened with a high rate of local recurrence, and by the possibility of preventing it with high doses of radiation. In primary tumors unresectable for cure and in local recurrence it is evidenced that ERT+surgery+IORT enable an improvement in local control and survival as compared to ERT alone. Results are better when surgery is radical. Several studies deal with the role of preoperative combined concomitant radiochemotherapy which can favour a radical surgery. A sizeable percentage of these patients will present with metastasis, thus adjuvant chemotherapy seems suitable. A role of IORT is envisaged also for resectable high risk tumors, however results should be confirmed by larger clinical series.

Combined Modality Therapy↗