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Biomedical subjects

P Bignami

Publications and source records attributed to P Bignami.

At least 37 records · Page 2Linked to original sources
PubMed1990

Mutagenicity studies on dihydroergocristine.

Dihydroergocristine (DHEC) is an ergot derivative used for the therapy of patients with cerebrovascular insufficiency. It was tested for mutagenicity by means of four tests. In the mutagenicity in vitro assay on Salmonella typhimurium, DHEC was checked at 10,000 micrograms/plate on TA98 and TA1538 strains and at 3000 micrograms/plate on TA1535, TA1537 and TA100 strains with and without metabolic activation. In a quantitative in vitro test for mutagenicity in V79 Chinese hamster cells, DHEC was studied at concentrations between 30 and 0.3 microgram/ml with and without metabolic activation. DHEC was tested for its ability to induce chromosomal damage in human lymphocyte cultures utilizing the concentrations of 10, 3 and 1 microgram/ml. In the in vivo mouse (Swiss strain) micronucleus assay, DHEC was orally administered at two dosages (50% and 16% of LD50) following the schedule of the test. Dihydroergocristine is a drug free of mutagenic activity on the basis of all the results obtained from the above in vitro and in vivo tests.

Animals↗
PubMed1989

[Activity of topical flunoxaprofen in nonspecific vaginitis. Comparison with meclocycline sulfosalicylate].

A trial was performed in 30 patients affected by non-specific vaginitis. The results show that the topical application (by vaginal washings) of flunoxaprofen produces a high therapeutic activity like that of meclocycline. Contrary to meclocycline, flunoxaprofen does not possess bactericidal and bacteriostatic properties. Therefore, the normalization of vaginal flora, with a remarkable increase of Döderlein bacillus, is exclusively due to local antiphlogistic activity of flunoxaprofen. Contrary to meclocycline, flunoxaprofen induces a precocious increase of Döderlein bacillus, necessary for a definitive normalization and to limit the possibility of relapses.

Administration, Intravaginal↗
PubMed1988

Intrahepatic chemotherapy for unresectable hepatocellular carcinoma.

From 1976 to 1983, 28 patients (24 male and four female) with unresectable hepatocellular carcinoma (HCC) were treated by intraarterial chemotherapy at the Istituto Nazionale Tumori of Milan, Milan, Italy. Tumors were retrospectively classified by a previously proposed staging system. Two patients were classified as Stage I and 26 as Stage II. Liver cirrhosis was present only in the males (in 50% of them). Nineteen patients were treated with doxorubicin (Adriamycin [Adria Laboratories, Columbus, OH]) and nine with 5-fluorouracil. Systemic toxicity was mild, but the treatment induced hepatic toxicity (ascites, clinical jaundice, or biochemical impairment) in 18% of noncirrhotic and 66% of cirrhotic patients. Clinical reduction of hepatomegaly was observed in 50% of noncirrhotic versus 16% of cirrhotic patients. Doxorubicin was effective in 66% of noncirrhotic patients and 20% of cirrhotic patients, with an overall response rate of 42%. 5-fluorouracil was effective only in patients without cirrhosis, with an overall response rate of 22%. Overall median actuarial survival was 3.5 months, with a significant difference between noncirrhotic and cirrhotic patients (6 versus 2 months, respectively). Overall median survival of patients who responded to the treatment was 13 versus 2 months for nonresponders (P less than 0.001). Liver cirrhosis was the most important prognostic factor in terms of liver toxicity, response rate, and survival. This study emphasized the negative impact of the treatment on cirrhotic patients. Also, the real value of intraarterial administration of doxorubicin was investigated.

Adult↗
PubMed1988

Chordoma: natural history and treatment results in 33 cases.

Thirty-three chordomas were observed at the Istituto Nazionale Tumori of Milan from 1933 to 1983: 27 sacrococcygeal, 3 spheno-occipital, and 3 vertebral. The male:female ratio was 2.7, and the median age was 63 yr for patients with sacrococcygeal and 35.2 yr for those with nonsacral chordomas. After pathologic reassessment, distinct cytologic patterns were found: physaliphorous, syncytial, and mixed subtypes, with variable degrees of cytologic atypia. However, no evident difference in survival was documented in relation to these cytohistologic features. Four cases had a prior traumatic fracture, and the pathogenetic role of trauma is stressed. Eight cases were operated with adequate surgery and only three recurred, whereas of 11 inadequate operations, 10 developed local relapse. However, follow-up for recent adequate operations is short. Radiation therapy seemed to be effective with adjuvant or palliative aims. No chemotherapeutic regimen achieved any result; one case had a short complete remission after cis-dichlorodiammineplatinum + vinblastine + bleomycin (PVB). This analysis confirms the possibility of achieving radicality with high resection of the sacrum for lesions confined below the second sacral vertebra. Nonsacral chordomas were all unresectable. The best treatment for unresectable lesions seems to be palliative surgery plus radiotherapy.

Adolescent↗
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↗
PubMed1986

[Comparison of the performance of a totally implantable pump and conventional access systems in regional arterial chemotherapy of liver tumors].

Forty-nine patients with liver tumors have been submitted to regional arterial chemotherapy by means of either totally implantable Infusaid 400 pumps (29 casse) or implantable ports (20 cases). The latter were subsequently perfused with external pumps. There was one single major operative complication and no operative deaths. Most patients underwent continuous FUDR infusion. Access related complications in the Pump and Port groups respectively included 1 and 0 malfunctions, 7 and 2 seromas, 2 and 0 pocket necroses, 8 and 10 thromboses, 2 and 4 catheter dislocations, 0 and 2 portal breakages. Treatment was stopped for access related complications in 5 and 5 patients respectively. In most of those cases, however, more than 6 cycles of chemotherapy have been performed. The Infusaid 400 pumps showed a 12-month duration of 58.4% with a 13 month median versus 17% and 9 month median of the Ports. The difference was not significant. The new implantable systems give better results in comparison with traditional regional methods; the performance of the Port systems appear very similar to the totally implantable pumps, with an obvious advantage, however, for the pumps as far as quality of life is concerned.

Adenocarcinoma↗
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

Current status of Milan adjuvant chemotherapy trials for node-positive and node-negative breast cancer.

This report summarizes the most important clinical results achieved at the Milan Cancer Institute through various randomized trials with systemic adjuvant chemotherapy. In the study testing surgery versus surgery plus 12 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) in node-positive patients, the reduction in failure rate (34%) significantly favored CMF-treated patients (P less than 0.001). Despite a reduction in the death rate of 23%, the overall survival showed only a trend for CMF compared to surgery alone (P = 0.10). In a second study, the 8-year results confirmed the lack of difference in relapse-free survival and total survival rates between patients who received 12 and 6 cycles of CMF. The third study indicated that at 6 years, postmenopausal women who had 1-3 positive lymph nodes and were treated with full-dose sequential non-cross-resistant combinations had rates of relapse-free survival and total survival that were superior to those previously achieved with CMF in the same menopausal subset. In a limited series of patients with negative axillary nodes as well as negative estrogen receptors, there was clear evidence of very poor prognosis in women given only local-regional therapy, compared to women treated with adjuvant CMF. Within the node-negative subset, the proliferative activity (labeling index) of the primary tumor appears to be a more effective prognostic discriminant than estrogen receptor status. The proportion of primary drug-resistant tumor cells as well as the lack of relative dose intensity in the drug programs tested so far probably represent the two most important causes for the failure of adjuvant chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

Results of extended surgery for cancer of the rectum and sigmoid.

The clinical records of 61 patients who underwent extended surgery, including resection of parietes or other viscera, from 1965 to 1977 for cancer of the rectum and sigmoid were reviewed. Abdominoperineal resection was performed in 41 patients, anterior resection in 18 and Hartmann's resection in 2. The postoperative mortality rate was 8.2 per cent, the non-lethal morbidity rate 30.3 per cent, but 4 patients presented multiple complications. The 5-year survival rate was evaluated separately for patients with and without microscopic evidence of neoplastic involvement of the simultaneously excised structures; in the first group it was 32 per cent, in the second 75 per cent. Local or distant recurrence occurred in 66 per cent of patients with microscopic infiltration and in 24 per cent of patients without microscopic infiltration. These results compare favourably with those reported after ordinary resections of Dukes' C cancers of the rectum and sigmoid, and seem to justify the use of extended surgery when cancer of the rectum and sigmoid has invaded contiguous structures.

Adult↗
PubMed1979

Axillary lymph node metastases from occult carcinoma of the breast.

From the case records of the Istituto Nazionale Tumori of Milan from 1956 to 1976, 49 cases of metastases in axillary lymph nodes from an occult carcinoma of the breast were selected. Forty-four patients underwent removal of the suspicious breast. In 11 patients no tumor was found at the pathologic examination. The survival of these patients was no different from the survival of those in whom the tumor was found. The 5-year survival of the total series was 87%, confirming that this type of presentation of breast cancer has a prognosis that is better than that generally reported for stage II carcinoma of the breast.

Adult↗
PubMedDate not supplied

T3b-T4 breast cancer: factors affecting results in combined modality treatments.

Two hundred and seventy-seven consecutive patients with T3b-T4 breast cancer referred to the Milan Cancer Institute between 1973 and 1980 were treated with a combined modality approach. Chemotherapy (CT) consisted of AV, i.e. adriamycin (60-75 mg/m2 day 1) and vincristine (1.2 mg/m2 days 1 and 8) and was given for three to four cycles prior to local regional modality. Local-regional treatment consisted of either radiotherapy (RT) in 198 patients or surgery (S) in 79 women. Additional chemotherapy was then administered to a total of 205 patients. In the absence of distant metastases, frequency of good local control was significantly inferior in patients given CT + RT (63.9 per cent) compared to those treated with CT + RT + CT (75.4 per cent) and CT + S + CT (82.3 per cent, P = 0.033). Also freedom from progression (FFP) and overall survival (SURV) were significantly superior in the groups receiving more prolonged chemotherapy treatment compared to patients treated with CT + RT (FFP: P less than 0.0001; SURV: P = 0.002). None of the variables examined was able to affect the response rate, while axillary nodal status and tumor size played a major role in the duration of FFP and SURV. Our findings indicate that a more aggressive treatment is needed to improve current results in this stage of disease. To overcome the problem of local-regional recurrence, treatment should probably begin with cytoreductive surgery followed by postoperative radiotherapy in all patients with the exception of those having inflammatory carcinoma. Systemic treatment should then be delivered to control distant micrometastases.

Adult↗
PubMedDate not supplied

Subcutaneous jejunostomy.

When the surgeon must obviate to an impending obstruction because of an unresectable tumor of the supramesocolic space and an intestinal bypass is not feasible, a jejunostomy is usually indicated. We describe a new method to provide enteral nutrition via a subcutaneous jejunostomy without any external device, which can be used only when the patient is at risk for developing an obstruction or dysphagia. The feeding tube is inserted into the jejunum and then connected to a Port-a-Cath lodged in a subcutaneous pocket. Subsequently, the nutrition can be delivered via a Huber needle inserted in the port, or, to minimize the need for strict aseptic surveillance, the tube can be exteriorized from the pocket and used as the usual tube jejunostomy. This procedure allows placing a precautionary jejunostomy without distortion of the body-image.

Enteral Nutrition↗