Benefits of colorectal cancer patient follow-up.
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Colorectal Neoplasms↗
Biomedical subjects
R Audisio
Publications and source records attributed to R Audisio.
Total rectal resection and colo-anal anastomosis with colonic reservoir for low rectal cancer.
From March 1990 to December 1992, 47 patients with primary or recurrent low rectal cancer underwent total rectal resection and a coloendoanal anastomosis. Rectal resection was extended downward to the ano-rectal junction. The restorative technique included a colo-endoanal anastomosis between the dentate line and a J-shaped colic reservoir. All lesions were located within 7 cm of the anal verge (within 6 cm in 33 primary cases). Macroscopic and histological radicality was documented in all cases. Pelvic recurrence occurred in six patients and was para-anastomotic in one case. Post-operative morbidity was low. Perfect continence was documented in 36 patients and 72 of the cases had one or two bowel movements a day. All but four patients are alive at a follow-up ranging from 6 to 40 months (median 20 months). This approach is a safe option to conventional total rectal excision with permanent colostomy for lower third rectal carcinoma.
Adenocarcinoma↗
A phase II study of mitoxantrone combined with beta-interferon in unresectable hepatocellular carcinoma.
BACKGROUND: Chemoimmunotherapy is being evaluated in the most common gastrointestinal tumors, but little data are available on hepatocellular carcinoma (HCC). Considering the encouraging objective response rates and the absence of important side effects obtained with mitoxantrone in HCC, we tested the activity and feasibility of a schedule combining beta-interferon (beta-IFN) and mitoxantrone. METHODS: Forty patients (ECOG Performance Status 0-1) with unresectable HCC received mitoxantrone (12 mg/m2 intravenously every 3 weeks) plus beta-IFN (3 x 10(6) U on days 1, 2, and 3; 6 x 10(6) from day 4 to day 60; and then 6 x 10(6) U three times a week for 10 months). RESULTS: Thirty-eight patients were evaluable for response and toxicity with a median of four administered cycles (range, 2-10 cycles). Nine patients achieved a partial response (23%) (95% confidence interval, 11-40%) with a median duration of response of 4 months. In 15 cases, the disease was stable for at least 2 months; 14 patients had disease progression. The median survival time of the group as a whole was 8 months. Patients who were alpha-fetoprotein positive had a median survival time of 7 months; those who were alpha-fetoprotein negative had a median survival time of 9 months. The most common side effects were hematologic (World Health Organization Grade 3, 15 patients; Grade 4, 3 patients). Mild or moderate flu-like syndrome was present in 50% of treated patients, whereas 10 patients experienced mild or moderate nausea. CONCLUSIONS: The schedule was active on advanced tumors with high alpha-fetoprotein values, and side effects were manageable. However, the addition of beta-IFN did not seem to improve significantly the response rate in HCC.
Adult↗
[Familial polyposis: epidemiology].
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Adenomatous Polyposis Coli↗
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↗
[Proposal for a radiological classification of multiple adenomatosis of the colon].
The double contrast enemas of 47 patients with multiple adenomatosis of the colon and rectum were analyzed. According to the density and the distribution of polyps on the mucosal surface, the radiological patterns were classified into three different groups: sporadic, dense and confluent adenomas. Radiographic patterns of each patient were related to the clinical and pathological data collected during the diagnosis and the follow-up. The clinical and pathological features and the evolution of the disease appear to be different in each group of patients (identified by the radiological classification). The occurrence of cancer at the time of the diagnosis of polyposis is closely correlated either to the number of polyps or to their size and the age of patients. The occurrence of metachronous cancer is correlated only to the number of polyps, not to their size, nor to the surgical treatment of the polyposis. If these data are confirmed on a wider number of patients, the role of radiological survey might become a more prominent one, not only in diagnosing, but also in therapy planning, as well as in the prognostic evaluation of multiple adenomatosis of colon.
Adenoma↗
Intra-arterial adriamycin for limb sarcomas.
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Adolescent↗
Ruptured hepatic adenoma in liver adenomatosis: a case report of emergency surgical management.
In hepatic adenomatosis, multiple liver cell adenomas (usually > or = 10) generally affects patients with no prior history of oral contraceptive use, androgenic steroid use, or glycogen storage disease. We report a rare case of a 44 year-old female who underwent emergency surgery for hemoperitoneum due to spontaneous rupture of a liver cell adenoma in hepatic adenomatosis, after prolonged use of two different contraceptives (Gestodene and Ethinylestradiol).
Adenoma, Liver Cell↗
[Health surveillance of the exposed to anesthetics in the environment: a complete program of preventive medicine for health personnel].
Hospital workers often can be simultaneously exposed to several potentially hazardous (biological, chemical, and physical) agents. Consequently the environmental controls and the periodic health assessments must be overall and systematic, but not too frequent. The authors suggest the establishment of an interdisciplinary group, including: Hospital Management, Technical Staff, Occupational Physician, Occupational Health Nurses, Environmental Hygienists.
Adult↗
[An epidemiological study of the health conditions of Milan traffic police with respect to pollution from vehicular traffic].
An investigation on the health effects of occupational exposure to motor vehicle exhaust and environmental pollutants was carried out on traffic wardens in Milan (Italy). Randomized samples of 292 traffic wardens (exposed group) and 60 hospital staff members (control group) underwent a physical examination and laboratory tests. No significant difference was observed between the exposed and control groups as regards general morbidity, apart from musculo-skeletal disorders in females. The mean blood lead level (PbB) among traffic wardens was 15.2 micrograms/dl compared with 11.7 in control (p less than 0.01). The carboxyhaemoglobin concentration (COHb) in traffic wardens at the beginning of the shift was 2.8% for smokers and 1.2% for non-smokers (3.0% and 0.9% respectively in controls). At the end of the shift COHb in the exposed group was 4.3% for smokers and 2.5% for non-smokers (p less than 0.01). PbB was significantly correlated (r = 0.17) with Median Nerve Motor Conduction Velocity (NCV) in the exposed but not in the control group. The same pattern was observed for the correlation of PbB and Systolic Blood Pressure (SBP) (r = -0.24). COHb was significantly correlated with HDL cholesterol (r = -0.20) in the exposed group only. It is questionable whether very low PbB levels can affect NCV and SBP directly or rather whether PbB, as well as COHb, should be regarded as tracers of exposure to those urban pollutants leading also to cardiovascular and nervous disorders.
Air Pollutants↗
[A monitoring system for occupational cancer].
INTRODUCTION: The Italian Occupation and Safety Act (d.lgs 626/94) provided for the establishment of a nationwide occupational cancer registry, under the National Institute for Occupational Health and Safety (ISPESL), with the aim of detecting cancer cases of occupational origin and estimating the influence of occupation in cancer causation. METHODS: Information on cancer cases, drawn from six Italian population-based cancer registries (CRs of Friuli Venezia Giulia Region, Genoa Town and Genoa Province, Macerata Town, Umbria Region, Varese Town, Veneto Region), and on a random sample of population controls selected in each CRs area were linked with data on subjects employed in private enterprises that have been available in electronic form since 1974 at the National Institute for Social Security (INPS). In this way, both for cases and controls, the occupational histories of past employment were collected. A population-based case-control study covering the period 1990-1998 was carried out with the aim of estimating occupational cancer risk in the private sector by site and economic category in each area. Since one of the major drawbacks of this approach is the difficulty in distinguishing true occupational hazards from incidental findings derived from multiple comparisons, an extensive research of occupational literature was carried out, independently of the study results, to compare our results with existing knowledge on occupational risks. RESULTS: Pooled analysis of the most recent incidence data based on 36,379 cases and 29,572 controls was performed; 34 "statistically significant" associations were found for 11 economic categories. Using our literature review, 10 associations were supported by more than 5 publishedpapers, 14 by a number of papers between 1 and 5, and 10 associations had not been previously reported. CONCLUSIONS: This system appears suitable for assessing existing occupational cancer risks and can eventually lead to detecting occupational hazards in many areas of Italy. The system can also provide a list of cases suitable for in-depth search for past occupational exposures.
Adult↗
Mitomycin C and lipiodol do not improve the effect of intermittent hepatic artery occlusion on liver tumour growth. An experimental study in the rat.
The effect of Mitomycin C (MMC 2.0 mg/kg bw), lipiodol (0.2 ml/kg bw) and intermittent hepatic artery occlusion on liver tumour growth, as well as their possible interrelation, were studied in 29 rats. An adenocarcinoma was inoculated in the left liver lobe. After one week, the tumour size was measured and the rats then divided into five different groups of treatment. Intermittent hepatic artery occlusion was performed during five days for 1 hour daily alone, of initially in combination with MMC and lipiodol. One group was treated with MMC and lipiodol in combination and one group with lipiodol only. The tumour growth six days later was compared between the groups and with control rats. It was found that intermittent arterial occlusion significantly reduced the tumour growth (P = 0.01). However, the retarding effect of intermittent arterial occlusion on tumour growth was not significantly improved with additional treatment of MMC and lipiodol.
Adenocarcinoma↗
[Preoperative hepatic vascular evaluation: comparison of angiography and Doppler-echography].
Fourteen patients candidates to surgery for liver neoplasms (7 primitive cancers and 7 liver metastases) underwent a prospective double-blind study with digital angiography and Doppler US. The latter demonstrated the presence of the hepatomesenteric artery in all the 3 patients with this anatomical variant. In 2 cases with an early origin of the common hepatic artery, Doppler US allowed the detection of unusual signals from the left hepatic artery but could not exclude its origin from the left gastric artery. The quality of US information concerning portal flow was equal or superior to that of digital angiography in all cases. The use of Doppler US is suggested before angiography when morphologic-functional information is needed concerning the portal vein. However, this method cannot replace angiography in the routine study of hepatic artery patterns.
Angiography, Digital Subtraction↗