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Biomedical subjects

R Bonardi

Publications and source records attributed to R Bonardi.

At least 55 records · Page 3Linked to original sources
PubMed1992

Sarcomas of the breast: a multicenter series of 70 cases.

A multicenter retrospective series of 70 breast sarcomas (malignant cystosarcoma phyllodes (25), osteosarcoma (12), liposarcoma (10), stromal sarcoma (8), angiosarcoma (7), mixed types sarcoma (4), malignant histiocytoma (3), leiomyosarcoma (1)) was reviewed. The average follow-up was 5.9 years. Diagnostic tests (palpation, mammography, sonography and cytology) were poorly sensitive, and a large proportion of cases, appearing as regular, sharp bordered, rounded masses were diagnosed as benign fibroadenomas. Surgery (limited (29), mastectomy (41)) was the treatment of choice. Axillary nodes were rarely involved (2 of 31) at pathologic staging. No significant predictors of local recurrences (12 cases) were observed although recurrences were more frequent in larger lesions (0-20 mm = 1.1%, 21-50 mm = 1.7%, > 50 mm = 6.1% women-year) and in cases treated with limited surgery (limited surgery 4.6%, mastectomy 2.0% women-year). Distant metastases (16 cases) were less frequent in malignant cystosarcoma phyllodes or liposarcoma patients, but no other significant predictors of distant metastases were evidenced. Five-year disease-free or overall survival was 50% or 66%, respectively. The study confirms that breast sarcomas are rare, difficult to diagnose, but can be cured by surgical treatment in a considerable proportion of cases.

Adult↗
PubMed1992

[Role of echography in the differential diagnosis of accessory lobulations and small capsular traumatic fissures of the spleen].

Emergency US in patients with abdominal trauma has become a routine diagnostic exam thanks to both its high reliability and its short acquisition time. US allows the overall evaluation of the patient, relative to both the localization of even very small fluid collections and the evaluation of traumatic changes in parenchymatous abdominal organs, especially the spleen which is often injured. Twelve patients were selected of all the cases submitted to emergency abdominal US between February 1989 and March 1992. All the cases with evident traumatic lesions of the spleen were excluded. In 10 cases US demonstrated interrupted splenic parenchyma, which was highlighted by intraperitoneal fluid collections; the interruption of splenic parenchyma is also evidenced by a thin hyperechoic capsular line with no changes in the echopattern of deep parenchyma. Surgery in 6 patients--4 of them as an emergency for hemoperitoneum and 2 operated subsequently--and US monitoring in the extant cases confirmed the diagnosis of simple accessory splenic lobulations. On the contrary, in 2 patients hospitalized in emergency, US showed no evident traumatic splenic alterations but only interruption of the hyperechoic capsular line with low hypoechogenicity in the splenic parenchyma below and a small fluid collection next to the lower splenic pole. Splenectomy confirmed a limited marginal tear of about 1.5 cm. The misdiagnosis of traumatic tears can be avoided if congenital splenic lobulation--evidenced by hemoperitoneum--is considered. US must also be employed to demonstrate minimal alterations in the hyperechoic capsular line of the spleen, in order to point out possible small tears and, if necessary, to suggest the need for clinical monitoring.

Diagnosis, Differential↗
PubMed1992

Nuclear grading and prognosis in node negative breast cancer.

The authors evaluated retrospectively 287 node negative breast cancer patients treated solely with surgery and followed-up for at least five years. Cases were retrospectively classified according to nuclear grade. The prognostic value of T category and nuclear grade were compared at univariate and multivariate analysis. Five-year overall or relapse-free survival was dependent on T (T1 = 0.96 or 0.86, T2 = 0.88 or 0.76, T3 - 4 = 0.58 or 0.38, T2 - 4 = 0.86 or 0.72) and on nuclear grade (G1 = 0.94 or 0.82, G2 = 0.88 or 0.74, G3 = 0.80 or 0.72, G2 - 3 = 0.88 or 0.74). Nuclear grade was associated to T category, as low grading tumors were more frequent among T1 as compared to T2 - 4 cases (chi-square = .09, df = 2, p less than 0.05), but both nuclear grade (G2 - 3 vs. G1: relative risk = 1.89, p = 0.022) and T category (T2 - 4 vs. T1: relative risk = 2.23, p = 0.013) were independently and significantly associated to overall survival. Although their limited discriminating power does not justify their clinical use in selecting high risk node negative patients to adjuvant therapy, they should be used as prognostic factors as they are as efficient as other new indicators and by far cheaper and simpler to assess.

Adult↗
PubMed1991

Is breast cancer ever cured? Follow-up study of 5623 breast cancer patients.

The authors evaluated 5623 cases of primary breast cancer followed for 1 to 21 years. Overall and breast cancer death rates were determined and compared to expected rates. Breast cancer patients showed overall and breast cancer death rates significantly higher than expected and which persisted at long-term follow-up. The observed/expected overall death ratios for follow-up periods of 0-5, 6-10, 11-15 or 16-20 years were 3.61, 2.55, 1.60 and 2.11, respectively. Death rates from breast cancer at 5, 10, 15 and 20 years were 20%, 32%, 40% and 48% respectively. The evidence of a persistent excess mortality even after long-term follow-up suggests the hypothesis that breast cancer is a systemic disease when clinically diagnosed. This study provided no evidence of a "clinical" cure for breast cancer patients. Even for N- patients the 5, 10, 15 and 20 year death rates from breast cancer were 12%, 20%, 28% and 38%, respectively. N- breast cancer, which is currently considered as a localized disease cured by surgery in most cases, would be better regarded to as a slow-growing metastatic disease, although "personal" cure may be achieved in many subjects dying of causes other than breast cancer.

Breast Neoplasms↗
PubMed1991

Hemoccult sensitivity estimate in a screening program for colorectal cancer in the Province of Florence.

The sensitivity of Hemoccult testing (HO) in a population-based screening for colorectal cancer was evaluated. HO sensitivity estimates were calculated as the ratio of screen-detected HO-positives to total screen or interval-detected cancers. Sensitivity was estimated according to 1, 2, and 3-year rescreening intervals. Corresponding estimates are 69.4%, 61.8% and 57.7%, respectively. No significant correlation was observed between HO sensitivity and other variables, such as calendar period, tumor stage or site, or patient age or sex. HO sensitivity as estimated in the present experience is consistent with other reports of population-based screenings. Screening every year would achieve too limited an increase in sensitivity, compared to biennal screening, to be worth the difficulties of doubling organizational efforts and costs.

Adult↗
PubMed1991

Attendance to a screening program for cervical cancer in the city of Florence.

The study was aimed to assess: a) the proportion of true refusers among non-attenders resulting from residents and screening database matching, b) the typology of refusers compared to attenders, and c) the reasons for non-attendance as stated by refusers. Three hundred and forty-one non-attenders according to computer-produced lists were interviewed: 29 were not evaluable, 148 had had a Pap test, 18 had not attended for valid reasons, and 146 were true refusers; 94 refusers accepted the interview as far a points b) and c) were concerned. Ninety-four attenders, matched by age and residence, were interviewed for comparison. Attendance at private laboratories or incorrect identification of subjects on the screening record accounted for 45% or 55% of misclassified cases, respectively. The adjusted true refusal rate in the last 10 years was 18.1% compared to a computer-assessed non-attendance rate of 40.7%. Refusal was significantly associated to socioeconomic status (geographic origin, working activity and educational level of both women and husbands), whereas no significant association was observed for sexual history (deliveries, age at first sexual relation, number of partners) or health-related behavior. Attendance and counseling at the gynecologist's office were strongly associated to attendance, and gynecologists should be stimulated to promote opportunistic screening. The belief that screening is useless in the absence of symptoms, the fear of cancer being detected, postponement or laziness were the reasons for non-attendance stated by 80% of refusers. Improving knowledge about the purpose of the Pap test should be the main goal of any action aimed to improve screening attendance.

Adult↗
PubMed1991

The risk of breast cancer subsequent to histologic diagnosis of benign intraductal papilloma follow-up study of 339 cases.

The risk of developing breast cancer was investigated in 339 patients in whom histologically confirmed intraductal papilloma had been surgically removed. Follow-up ranged from 2 to 14 years, (average, 6.62 years). Ten breast cancers were observed, whereas 3 were expected on the basis of age-specific incidence rates drawn from local cancer registries (relative risk = 3.33, 95% confidence interval = 1.60-6.13). No significant difference in the relative risk was observed as far as papilloma type (single or multiple) was concerned. All breast cancers observed occurred in the same breast as the papilloma. Women in whom a benign intraductal papilloma has been excised should be carefully followed since they at are higher risk for ipsilateral breast cancer.

Adult↗
PubMed1991

Fine-needle cytology of the breast: a controlled study of aspiration versus nonaspiration.

We report on 534 breast masses examined by fine-needle aspiration cytology. Two samples were obtained from each mass, one with aspiration and the other without. Aspiration, equivalent to that obtained by a 20-ml syringe on full aspiration, was obtained by an automatic aspirator. The two sampling modalities did not differ apart from aspiration and were compared in terms of inadequate sampling rates. The inadequacy rate was the same in 166 cancers (6.6%), whereas a significant difference was recorded in favor of aspiration (13.6 versus 24.4%) in 368 benign masses. When inadequate results were excluded, the accuracy of the two modalities was almost the same. Sensitivity was 97.4% and 96.7% and specificity was 99.4% and 99.3% for sampling with and without aspiration, respectively. Reducing the rate of inadequate sampling from benign masses seems to be the major advantage of aspiration. Double sampling, independent of the specific techniques, reduced inadequacy rates to very low levels (1.2% for cancers; 5.9% for benign masses) and may be useful as a routine policy.

Biopsy, Needle↗
PubMed1991

[Treatment of small hepatocarcinomas by percutaneous ultrasound-guided alcohol injections. Personal experience in 14 lesions].

From May 1988 to March 1990, 57 patients with focal solid lesions of the liver underwent percutaneous US-guided fine-needle biopsy which demonstrated the primitive neoplastic nature of these tumors--mainly trabecular hepatocellular carcinoma (HCC). Eight of these patients affected with chronic liver disease presented with 14 lesions (less than 3 cm phi); they were considered inoperable and therefore treated with percutaneous ethanol injection (PEI) under US guidance. Three to eleven sessions of PEI (total: 78) were administered to each nodule, according to nodular size and to modality of ethanol distribution within the tumor. All these lesions showed post-treatment US and CT structural changes of fibronecrotic degeneration: the final fine-needle biopsy demonstrated the absence of malignant cells in all cases. Today all patients are alive and 7 present no recurrences of HCC on US and CT scans; the follow-up period was 18 months for 3 patients and 12, 9, 6, and 3 months for the extant 4 patients, respectively. The nodules have a smaller diameter than the primitive tumors. In conclusion PEI, besides being a simple and cheap method, is also readily available and effective for the treatment of small inoperable hepatocellular carcinomas.

Aged↗
PubMed1990

Intraductal breast carcinoma. Review of a multicenter series of 350 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy.

A multicenter series of 350 intraductal breast cancers (DCIS) is reported. Mammography was the most sensitive test but suspicion arose only at palpation in 13% of cases whereas in 10% of cases biopsy was recommended for a benign lesion and DCIS was an unexpected finding. Mammography, physical examination and cytology must be combined to achieve optimal sensitivity. Systematic biopsy of apparently benign masses would increase DCIS detection rates but the cost-effectiveness of such a policy is questionable. A trend of conservative surgery was evident over time (from 1968-79, 28%; 1985-1989, 50%) but breast irradiation followed only in one fourth of the cases. The local recurrence rate was significantly higher in cases of limited surgery (with or without irradiation) with respect to mastectomy (1.2 vs 0.2 x 100 patient-years at risk). Most recurrences (7 of 8) in the conserved breast were infiltrating, but no recurrence was seen in subclinical DCIS cases. Three patients died of breast cancer after local recurrence in the conserved breast (2 cases) or mastectomy scar (1 case). Eligibility for conservative surgery of DCIS needs to be carefully discussed to avoid under-treatment. Contralateral breast cancer was recorded in 44 cases and the incidence of further metachronous cancer to the other breast was ten times higher than expected in normal breasts. Four patients died of contralateral breast cancer, free of ipsilateral recurrence. A careful follow-up of the contralateral breast in DCIS cases looks as important as surveillance of the conserved breast.

Adult↗
PubMed1990

Male breast carcinoma: review of a multicenter series of 150 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy.

The authors report on a consecutive retrospective series of 150 male breast cancers. Clinical, diagnostic and therapeutic features are compared over time and with respect to a large consecutive series of female breast cancers. Both age at diagnosis and tumor stage were more advanced in males than in females. Poor alertness of both men and doctors for this infrequent disease may account for such a delay in diagnosis. The use of mammography increased over time and sonography or cytology were frequently and successfully employed in the last decade. Unfortunately no improvement of tumor stage at diagnosis was observed over time in the present series. A time trend was also evident for the type of surgical and postoperative treatment. Modified radical mastectomy and adjuvant chemo- or hormone therapy were increasingly adopted, although Halsted operation and postoperative radiotherapy were still common in the last decade due to the relatively high proportion of locally advanced T3-4 cancers. Both disease-free and overall survival were worse in men than in women, even after adjustment by stage at diagnosis. This study suggests that male breast cancer has a worse prognosis with respect to female breast cancer and provides no complete explanation of this finding, except for an intrinsic higher aggressivity. No evidence was found which may justify a different diagnostic or therapeutic approach with respect to female breast cancer.

Adult↗
PubMed1990

Prognostic impact of early detection of contralateral primary breast cancer.

The authors report on a consecutive series of 175 contralateral metachronous breast cancers. Eighty-six cases detected in women self referring for cancer-related subjective symptoms were compared to 89 cases detected as asymptomatic at routine examination. Detection in the asymptomatic phase was associated with a more favorable stage, but no differences in survival rates were observed between asymptomatic or symptomatic cancers when survival was measured from the date of first cancer diagnosis, in order to adjust for lead time bias. The nodal status of the first or of the second cancer was the only variable of prognostic value on univariate analysis, whereas a significant association to prognosis was evidenced only for nodal status of the first cancer. The study suggests that routine clinico-mammographic check-up may achieve early detection of contralateral metachronous breast cancer in the asymptomatic phase, but this does not seem to have a relevant impact on prognosis. The occurrence of a second primary breast cancer seems to be an indicator rather than a determinant of a worse prognosis.

Adult↗
PubMed1990

The role of mammography in women under 30.

The authors report on a consecutive series of 305 women under age 30 undergoing mammography because of a solid palpable mass. The presence of diffuse parenchymal density impairing radiologic interpretation was observed in 71% of cases. Cancer was not demonstrated at mammography in 5 of 18 cases. Radiologic suspicion did not improve the cumulative sensitivity for cancer and did not influence clinical management in cancer cases. Mammographic contribution in reducing unnecessary biopsies of benign lesions was also poor and parallelled that of aspiration cytology. Mammography is not recommended in the differential diagnosis of palpable masses in women under 30 and should be limited to the preoperative assessment of cases with a strong suspicion of cancer.

Adolescent↗
PubMed1989

[The efficacy of echography in the diagnosis of gallbladder carcinoma].

The preoperative diagnosis of carcinoma of the gallbladder is very difficult because the clinical manifestations of this disease are nonspecific and often indistinguishable from those of cholecystitis. Radiography, including oral cholecystograms and i.v. cholangiograms, give aspecific findings. Ultrasound scans were performed on 13 gallbladder carcinomas: only "massive" cancer was diagnosed correctly, because sonography does not offer specific patterns for "infiltrating" and "fungating" carcinomas.

Adenocarcinoma↗
PubMed1987

[Evaluation of the hemorheologic effects of the eicosapentaenoic and docosahexaenoic acids in asymptomatic dyslipidemic and arteriopathic subjects].

The low incidence of cardiovascular disease in Greenlandic Eskimos is related to the effect of dietary omega-3 polyunsaturated fatty acids. An important anti-atherosclerotic mechanism of compounds such as EPA and DHA consist in the modulation of cell membrane and properties. A change in the lipid composition of the diet and a dietary supplementation with EPA and DHA contribute to suggested potential therapeutic effect on peripheral vascular disease. The Authors report the results obtained by Doppler C.W. ultrasound in hyperlipidemic-arteriopathic patients.

Aged↗
PubMed1986

[Doppler ultrasound method in the study of vertigo syndrome].

Doppler C.W. technique represents a non-invasive, singular method to evaluate cerebrovascular diseases; therefore is now considered a screening method for vascular insufficiency, particularly in basilar artery insufficiency. Subclavian steal syndrome functional evaluation by Doppler C.W. is an important complement to angiographic studies.

Aged↗