Assessment of surgical treatment in elderly patients with breast cancer.

Aims And Background: The incidence of breast cancer increases with advancing age and in clinical practice approximately 50% of new cases occur in women over the age of 65 years. Although breast cancer in elderly patients presents more favorable biological characteristics than similar-stage cancer in younger women, disease control still remains uncertain and is becoming a major health problem.

Patients And Methods: Between 1984 and 2006, 133 patients aged over 65 with operable breast cancer underwent surgical treatment.

Risk of mortality from cardiovascular and respiratory causes in patients with chronic obstructive pulmonary disease submitted to follow-up after lung resection for non-small cell lung cancer.

Aim: Considerable controversy surrounds mortality from non-neoplastic diseases during the postoperative follow-up of patients with non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD). This study investigated the incidence of mortality from cardiovascular and respiratory (CVR) causes in patients with COPD submitted to follow-up after lung resection for NSCLC, and identified preoperative and postoperative risk factors.

Methods: A total of 398 patients with mild or moderate COPD were followed up in our department after lung resection for NSCLC (median follow-up 61 months).

Early gallbladder carcinoma: a single-center experience.

Aims And Background: Controversy continues regarding the best surgical treatment for early gallbladder carcinoma defined as a tumor confined to the mucosa (pT1a) or to the muscularis propria (pT1b) according to the TNM classification. This study evaluates the effectiveness of different surgical approaches in patients with early gallbladder carcinoma in terms of long-term survival.

Materials And Methods: From 1980 to 2001, 175 patients with gallbladder carcinoma were admitted to our department.

Malignant fibrous histiocytoma of the breast. Report of two cases and review of the literature.

Sarcomas of the breast are uncommon, accounting for less than 1% of all primary malignancies. Among these tumors, malignant fibrous histiocytoma (MFH) is very rare. Two cases of this neoplasm are reported, with histological findings and surgical treatment.

Respiratory and cardiovascular function at rest and during exercise testing in a healthy working population: effects of outdoor traffic air pollution.

Background: There is controversy regarding long-term adverse effects of urban pollutants in urban workers.

Aim: The aim of this study was to evaluate the effects of urban pollutants on respiratory and cardiovascular function in exposed traffic policemen compared to a control group.

Methods: Sixty-eight traffic policemen and 62 controls (all male) were investigated at rest and during symptom-limited incremental exercise test (performed with a cycle ergometer).

Lymph node dissection in papillary or follicular thyroid carcinoma.

Background: Prospective randomized studies aimed at evaluating the different therapeutic protocols for the treatment of papillary or follicular carcinoma are lacking at the moment. Although total thyroidectomy is widely accepted, indication to locoregional lymphadenectomy is strongly debated.

Materials And Methods: Fifty-four patients with papillary or follicular thyroid carcinoma (45 papillary and 9 follicular) underwent functional evaluation of the gland before intervention, FNAB included Surgical management was carried out as follows: 41 total thyroidectomy, 6 lobectomy with further totalization in 5, 6 total thyroidectomy plus central compartment lymphadenectomy and 1 left laterocervical lymphadenectomy (papillary carcinoma, treated elsewhere through total thyroidectomy plus central and right laterocervical lymphadenectomy).

Nuclear methylation levels in normal and cancerous thyroid cells.

Background: Most cancers show abnormal DNA methylation and a positive correlation between hypomethylation and tumour progression.

Patients And Methods: In our laboratory the extent of DNA methylation in individual nuclei in normal, cancer and non-cancer thyroid tissue samples was quantified according to a previously described method of computer-assisted semi-quantitative analysis. Cancer and non-cancer samples were obtained from nine patients with different thyroid pathologies (one multinodular goitre and eight carcinomas).

Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial.

Background: Gastroenterostomy was the palliative treatment of choice in patients with malignant unresectable gastric outlet obstruction. Palliative endoscopic treatment of malignant gastric outlet obstruction with endoluminal self-expanding metallic stents is nowadays a well-established procedure.

Patients And Methods: Eighteen patients referred for treatment with diagnosis of malignant strictures of the antro-pyloric tract presenting at an advanced unresectable stage.

Palliative management of malignant rectosigmoidal obstruction. Colostomy vs. endoscopic stenting. A randomized prospective trial.

Background: Colostomy was the palliative treatment of choice in patients with malignant unresectable rectosigmoid obstruction. Palliative endoscopic treatment of malignant rectosigmoid obstruction by endoluminal self-expanding metallic stents is nowadays a well-established procedure.

Patients And Methods: Twenty-two patients, referred for treatment with diagnosis of malignant obstruction of the rectosigmoid region presenting an advanced unresectable stage, were enrolled.

Comparative analysis of clinical features and prognostic factors in resected bronchioloalveolar carcinoma and adenocarcinoma of the lung.

Background: Over the past few years, clinical, radiological and pathological classification of lung adenocarcinoma and its subtypes, particularly bronchioloalveolar carcinoma (BAC), has radically changed.

Patients And Methods: Out of a series of 384 non-small cell lung cancer (NSCLC) patients, submitted to surgical resection and followed-up in our Department from 1981 to 1999, the data of 151 adenocarcinomas (35 BAC and 116 non-BAC) were reviewed and analyzed for prognosis.

Results: BAC and non-BAC series were similar in clinical and radiographic findings, type of resection and stage.

Mediastinal lymph node involvement in non-small cell lung cancer: evaluation with 99mTc-tetrofosmin SPECT and comparison with CT.

Unlabelled: In patients with non-small cell lung cancer (NSCLC), surgical resection offers the best chance of cure. The preoperative assessment of mediastinal lymph node involvement is crucial to selecting those patients for whom surgery is indicated.

Methods: To evaluate the possible clinical role of (99m)Tc-tetrofosmin scintigraphy in the presurgical detection of mediastinal node metastases from NSCLC, we performed a prospective comparative study with CT on 83 patients (48 men, 35 women; age range, 38-81 y) with primary NSCLC (36 adenocarcinomas, 39 epidermoid squamous cell carcinomas, and 8 large cell anaplastic carcinomas).

Subcutaneous metastasis of pancreatic cancer in the site of percutaneous biliary drainage.

A subcutaneous metastatic lesion from a carcinoma of the pancreas or common bile-duct along the tract of a percutaneous transhepatic biliary drainage is a rare finding. Prompted by a case that came to our observation by chance, we reviewed the literature and analysed the 29 cases collected. Neoplastic cell seeding along a percutaneous drainage tract, albeit rare, must be kept in mind.

Giant diverticulum of the sigmoid colon with perforation. Report of a case.

We present a case of perforated giant diverticulum of the sigmoid colon. This condition is extremely rare and only a few cases have so far been reported in the literature. Our case involved a 55-year old woman.

Bronchioloalveolar carcinoma: clinical, radiographic, and pathological findings. Surgical results.

Background: Bronchioloalveolar carcinoma (BAC) remains one of the most controversial of lung cancer subtypes.

Methods: From 1980 to 1998, 374 resected patients for NSCLC were followed up in our department. Of the 147 cases histologically defined as adenocarcinoma, 34 were pure BAC.

Surgical approach to non-small cell lung cancer involving the chest wall.

Treatment of NSCLC invading the chest wall (T3) remains controversial. Surgery is undoubtedly the only chance for these neoplasms, but its role regarding the T3N2 tumors is highly questionable. Between 1975 and 1994, 710 NSCLC patients underwent surgery in our department.

Pericardial cysts of the mediastinum.

Pericardial cysts are an uncommon benign disease. Their treatment, in the past, was based on excision by thoracotomy or, in selected cases, on percutaneous aspiration. The progress of video-assisted thoracoscopy gave new possibilities, but most surgeons still consider the thoracotomic approach as the treatment of choice.

[The usefulness and limits of echo-endoscopy in the clinical staging of esophageal cancer].

Endoscopic ultrasonography (EUS) is a diagnostic method of considerable value for the local staging of esophageal cancer, in particular for T and N evaluation. After an extensive review of the literature, the authors underline the possibility of using EUS to improve the treatment and prognosis of esophageal neoplasms based on the use of various stage-dependent therapeutic strategies. EUS is regarded as a gold-standard technique for esophageal cancer staging in order to select appropriate treatment options, but is currently hampered by the intrinsic difficulty and subjectivity of interpreting ultrasonographic images.

Noncalcified pulmonary hamartomas: computed tomography enhancement patterns with histologic correlation.

The objective of this study was to correlate contrast-enhanced computed tomography images of noncalcified hamartomas with histologic specimens to find specific computed tomography enhancement patterns. Over 4 years, 30 noncalcified hamartomas were surgically resected. Enhanced computed tomography images of these hamartomas were reviewed and correlated with histologic findings.

[Pericardial cysts. Report on 9 treated cases].

From 1976 to 1993, nine patients (5 men, 4 women) with pericardial cysts were treated in Authors' Department. Of the nine cysts, six were located in the right cardiophrenic angle, one in the subcarinal site, one in the right tracheobronchial angle, and one in the para-auricular site just above the diaphragm. Four patients were asymptomatic.

Hemodynamic and pulmonary changes during and after laparoscopic cholecystectomy. A comparison with traditional surgery.

Background: The cardiopulmonary changes experienced by patients who undergo laparoscopic cholecystectomy (LC) and the prognostic value of patient characteristics are not well understood.

Methods: Cardiorespiratory changes were investigated in 120 patients undergoing LC or open cholecystectomy (OC). The results and their relation to patient variables were statistically evaluated.

[Evaluation of the respiratory function by lung scintigraphy in patients candidates for pulmonary resection].

Sixty-one patients undergoing pulmonary resection were studied pre- and post-operatively by spirometry, arterial gas determination, and quantitative ventilation/perfusion lung scanning. Our results showed that ventilation and/or perfusional scintigraphic scanning is currently the most reliable method in identifying patients at risk for postoperative respiratory insufficiency. Specifically, this technique was successful in detecting pulmonary areas other than those to be resected presenting ventilation or perfusional abnormalities.

Rhodococcus equi pneumonia in a patient with occult HIV infection: successful therapy.

We report a case of Rhodococcus equi cavitary pneumonia in a 37-year-old patient with occult HIV infection. Because of his good immune status, the patient was given oral erythromycin and rifampin which rapidly resolved the infection. This modality of treatment may be sufficient in HIV-positive selected patients fur the resolution of Rhodococcus equi pneumonia.

Carcinoma of the duodenum: management and survival in 14 cases.

Aims: The aim of this study is to evaluate the role of surgery in the treatment of adenocarcinoma of the duodenum.

Methods: From 1955 to 1994, 14 patients with primary adenocarcinoma of the duodenum underwent surgical treatment in our department. Presenting signs and symptoms were mainly related to obstruction and bleeding.

[The role of surgery in the treatment of primary carcinoma of the gallbladder. Review of 86 cases].

The records of 86 patients with primary adenocarcinoma of the gallbladder were reviewed. All patients were staged according to the Nevin classification. Twenty-nine patients underwent resection, 57 were submitted to palliative procedures or exploratory laparotomy.

Ventilation-perfusion mismatching as prognostic factor of respiratory failure after pulmonary resection.

This paper reports the results of a retrospective study undertaken to assess the reliability of regional ventilation-perfusion pulmonary scanning in predicting the remaining respiratory function (pFEV1), and the early and long-term outcome of 33 patients with chronic airways disease, submitted to pulmonary resection at the 1st Department of Surgery. All patients had been diagnosed as resectable with the traditional tools and had a traditional pFEV1 (tpFEV1) greater than 800 ml. All pFEV1 were re-calculated (npFEV1) with our new formula which also includes as lost for function all lung areas not to be resected with V/Q mismatching.