Biomedical subjects
Publications and source records attributed to R Ponchietti.
The results of 18 cases of surgical correction for congenital curvature of the penis are presented. In 17 out of 18 cases sexual intercourse which were very difficult or impossible before operation were referred as normal or satisfactory after surgery.
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The diagnosis of subclinical varicoceles in infertile men is available with thermographic and Eco-Doppler evaluation. In our experience the patients with both positive findings showed a more significant improvement of semen analysis after surgery of the varicocele.
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Intravesical use of chemotherapeutic agents has been documented as effective and beneficial in the treatment and prophylaxis of bladder urothelial cancer. Because of the success achieved with these agents, several investigators have proposed these same drugs as adjuvant treatment after conservative procedures for urothelial tumours of the upper urinary tract. Experiences concerning topical therapy for upper tract urothelial neoplasms are still limited, but suggest a great potential benefit in terms of improved tumour control. Advances in endourologic techniques and increasing interest in the conservative management of upper urinary tract urothelial cancer may lead to more frequent use of topical chemotherapy. Specific guidelines and surveillance protocols, similar to those with superficial bladder cancer, are required to determine the role of this adjuvant therapy in the treatment of urothelial tumours of the upper urinary tract. This report shows our experience gained on endoluminal instillation of epidoxorubicin in a selected group of 9 patients who underwent local excission of ureteral or renal pelvis tumours.
In a pilot trial, we treated thirty-three hormone resistant metastatic prostate cancer patients with a combination of androgen blockade plus weekly cytotoxic therapy and determined both response and toxicity in 32 of them. Their median Karnofsky performance status at the time of entry was 65. We administered Epidoxorubicin (EpiDx) intravenously, at a dose of 35 mg/m2, every week for 4 months. Initially, all patients had only hormonal therapy and chemotherapy was added once they progressed. In terms of W.H.O. criteria, 9 patients (28%) had a partial response, the disease was stable in 14 (44%), and progressive in 9 (28%); even in this last group, 6 patients with bone metastases experienced lasting relief from pain. No patients had to interrupt treatment due to leukopenia or cardiotoxicity. Other toxicities, including nausea and vomiting, mucositis and alopecia, were mild. Pretreatment prostate-specific antigen (PSA) levels decreased significantly (p < 0.05) in 26 patients (81%) after treatment. In our view, weekly EpiDx administration serves as an active regimen in hormone-refractory prostate cancer.
The neuroendocrine system modulates the immune response through neuropeptides and neurohormones, findings which point to the existence of a neuro-endocrine-immune system regulatory axis. At the same time, there is growing evidence that the pineal gland has anti-neoplastic properties, which include the action of its principal hormone, melatonin (MLT), on the immune system through the release of cytokines by activated T-cells and monocytes. The present study was carried out on 31 patients (19 males and 12 females, age range 46-73 years) with advanced solid tumors (7 gastric, 9 enteric, 8 renal, 5 bladder, 2 prostate) who either failed to respond to chemotherapy and radiotherapy or showed insignificant responses and were therefore shifted to MLT therapy (10 mg/die orally for 3 months). We obtained blood samples just before the start of MLT administration and after 30 days of therapy. Plasma was collected in EDTA tubes on ice, immediately centrifuged at 4 degrees C and stored frozen at -80 degrees C; samples were measured by immunoradiometric assays (Medgenix-Fleurus, Belgium) for tumor necrosis factor alpha (TNF), interleukin-1, 2 and 6 (IL-1, IL-2, IL-6) and interferon gamma (IFN). We used Student's paired t-test to compare each patient's cytokine circulating levels before and after MLT administration and found a significant differences (p < 0.05). After 3 months of therapy, none of our patients displayed adverse reactions to MLT or had to discontinue treatment. Nineteen patients (61%) showed disease progression. The other 12 (39%), however, achieved disease stabilization with no further growth of either the primary tumor or of secondaries; moreover, they experienced an improvement in their general well-being, in terms of Tchekmedyian's criteria, associated with a significative decrease of IL-6 circulating levels. These findings are consistent with the hypothesis that MLT modulates immune function in cancer patients by activating the cytokine system which exerts growth-inhibitory properties over a wide range of tumor cell types. Furthermore, by stimulating the cytotoxic activity of macrophages and monocytes, MLT plays a critical role in host defence against the progression of neoplasia.