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Mosconi P, Roberto A, Cerana N, Colombo N, Didier F, D’Incalci M, Lorusso D, Peccatori FA, Artioli G, Cavanna L, Ceccherini R, Cirigliano G, Comerci G, Cormio G, Crippa A, Farolfi A, Febbraro A, Giardina D, Greggi S, Lalle M, Lapresa M, Marzola M, Merisio C, Mosconi AM, Peiretti M, Ricci G, Ronzino G, Scambia G, Scollo P, Sina F, Stella GC, Tomao F, Vici P, Zola P. Knowledge and attitudes towards clinical trials among women with ovarian cancer: results of the ACTO study. J Ovarian Res 2022; 15:45. [PMID: 35422000 PMCID: PMC9010065 DOI: 10.1186/s13048-022-00970-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite several initiatives by research groups, regulatory authorities, and scientific associations to engage citizens/patients in clinical research, there are still obstacles to participation. Among the main discouraging aspects are incomplete understanding of the concepts related to a clinical trial, and the scant, sometimes confused, explanations given. This observational, cross-sectional multicenter study investigated knowledge, attitudes and trust in clinical research. We conducted a survey among women with ovarian cancer at their first follow-up visit or first therapy session, treated in centers belonging to the Mario Negri Gynecologic Oncology (MaNGO) and Multicenter Italian Trials in Ovarian Cancer (MITO) groups. A questionnaire on knowledge, attitudes and experience was assembled ad hoc after a literature review and a validation process involving patients of the Alliance against Ovarian Cancer (ACTO). Results From 25 centers 348 questionnaire were collected; 73.5% of responders were 56 years or older, 54.8% had a high level of education, more than 80% had no experience of trial participation. Among participants 59% knew what clinical trials were and 71% what informed consent was. However, more than half did not know the meaning of the term randomization. More than half (56%) were in favor of participating in a clinical trial, but 35% were not certain. Almost all responders acknowledged the doctor’s importance in decision-making. Patients’ associations were recognized as having a powerful role in the design and planning of clinical trials. Conclusions This study helps depict the knowledge and attitudes of women with ovarian cancer in relation to clinical trials, suggesting measures aimed at improving trial “culture”, literacy and compliance, and fresh ways of communication between doctors and patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13048-022-00970-w.
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Papiccio M, Boschi AC, Ferrara F, Missiroli S, Zagonari S, Paganotto MC, Comerci G. Spontaneous angular dichorionic diamniotic twin pregnancy: a case report. Fertil Steril 2021; 117:155-159. [PMID: 34961613 DOI: 10.1016/j.fertnstert.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report a peculiar case of ultrasound diagnosis of spontaneous angular twin pregnancy. In literature, the terms "angular," "interstitial," and "cornual" pregnancies are often used inappropriately. Confusion in terminology may have contributed to difficulties in developing diagnostic ultrasound criteria to differentiate these ectopic pregnancies. DESIGN Case report. SETTING Obstetrics and Gynecology, Community Hospital "S. Maria delle Croci." PATIENT A 28-year-old patient with a previous cesarean delivery was admitted to our hospital for management of a presumed angular ectopic pregnancy. Transvaginal ultrasound confirmed an ectopic dichorionic diamniotic twin pregnancy eccentrically located in the right superior angle of the uterine cavity: the first gestational sac appeared to have right angular implantation, whereas the second gestational sac seemed to deepen inside the myometrium, with a thin myometrial margin of only 3 mm. INTERVENTIONS After discussing the risks, the patient requested to proceed with termination. A single intramuscular injection of 75 mg of methotrexate was administered, followed by ultrasound-guided hysterosuction after 19 days due to severe vaginal bleeding. MAIN OUTCOME MEASURES An early and accurate ultrasound diagnosis of a high-risk condition allowed for conservative medical treatment. RESULTS The serum beta-human chorionic gonadotropin levels progressively decreased. After 1 month, a clinical and ultrasound examination showed a regular endometrial line with a regular reappearance of menstrual bleeding. CONCLUSIONS Although there are remarkable advances in ultrasound techniques, angular pregnancy remains a condition of difficult diagnosis and management; it is potentially dangerous and may lead to severe complications. An early and accurate diagnosis of this condition is necessary to avoid complications and individualize the subsequent management.
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Affiliation(s)
- Maria Papiccio
- Obstetrics and Gynecology, Hospital "S. Maria delle Croci," Ravenna, Italy.
| | - Anna Chiara Boschi
- Obstetrics and Gynecology, Hospital "S. Maria delle Croci," Ravenna, Italy
| | - Filippo Ferrara
- Obstetrics and Gynecology, Hospital "S. Maria delle Croci," Ravenna, Italy
| | - Stefano Missiroli
- Obstetrics and Gynecology, Hospital "S. Maria delle Croci," Ravenna, Italy
| | - Sara Zagonari
- Obstetrics and Gynecology, Hospital "S. Maria delle Croci," Ravenna, Italy
| | | | - Giuseppe Comerci
- Obstetrics and Gynecology, Hospital "S. Maria delle Croci," Ravenna, Italy
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3
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Bogani G, Scambia G, Cimmino C, Fanfani F, Costantini B, Loverro M, Ferrandina G, Landoni F, Bazzurini L, Grassi T, Vitobello D, Siesto G, Perrone AM, Zanagnolo V, De Iaco P, Multinu F, Ghezzi F, Casarin J, Berretta R, Capozzi VA, Zupi E, Centini G, Pellegrino A, Corso S, Stevenazzi G, Montoli S, Boschi AC, Comerci G, Greco P, Martinello R, Sopracordevole F, Giorda G, Simoncini T, Caretto M, Sartori E, Ferrari F, Cianci A, Sarpietro G, Matarazzo MG, Zullo F, Bifulco G, Morelli M, Ferrero A, Biglia N, Barra F, Ferrero S, Leone Roberti Maggiore U, Cianci S, Chiantera V, Ercoli A, Sozzi G, Martoccia A, Schettini S, Orlando T, Cannone FG, Ettore G, Puppo A, Borghese M, Martinelli C, Muzii L, Di Donato V, Driul L, Restaino S, Bergamini A, Candotti G, Bocciolone L, Plotti F, Angioli R, Mantovani G, Ceccaroni M, Cassani C, Dominoni M, Giambanco L, Amodeo S, Leo L, Thomasset R, Raimondo D, Seracchioli R, Malzoni M, Gorlero F, Di Luca M, Busato E, Kilzie S, Dell'Acqua A, Scarfone G, Vercellini P, Petrillo M, Dessole S, Capobianco G, Ciavattini A, Delli Carpini G, Giannella L, Mereu L, Tateo S, Sorbi F, Fambrini M, Cicogna S, Romano F, Ricci G, Trojano G, Consonni R, Cantaluppi S, Lippolis A, Tinelli R, D'Ippolito G, Aguzzoli L, Mandato VD, Palomba S, Calandra D, Rosati M, Gallo C, Surico D, Remorgida V, Ruscitto F, Beretta P, Benedetti Panici P, Raspagliesi F. Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic. J Gynecol Oncol 2021; 33:e10. [PMID: 34910391 PMCID: PMC8728669 DOI: 10.3802/jgo.2022.33.e10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/03/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic. The prevalence of patients with early-stage endometrial cancer (EC) has been lower during coronavirus disease 2019 (COVID-19) pandemic than before its onset. Further evidence is needed to assess the impact of COVID-19 pandemic on survival outcomes of EC patients.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Cimmino
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Barbara Costantini
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Loverro
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Luca Bazzurini
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Tommaso Grassi
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Domenico Vitobello
- Unit of Gynecology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Gabriele Siesto
- Unit of Gynecology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | | | - Vanna Zanagnolo
- Department of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Francesco Multinu
- Department of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Roberto Berretta
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Vito A Capozzi
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Errico Zupi
- Department of Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, ASST Lecco - Ospedale Alessandro Manzoni, Lecco, Italy
| | - Silvia Corso
- Department of Obstetrics and Gynaecology, ASST Lecco - Ospedale Alessandro Manzoni, Lecco, Italy
| | - Guido Stevenazzi
- Department of Obstetrics and Gynaecology, ASST OVEST MI, Legnano (Milan) Hospital, Legnano, Italy
| | - Serena Montoli
- Department of Obstetrics and Gynaecology, ASST OVEST MI, Legnano (Milan) Hospital, Legnano, Italy
| | - Anna Chiara Boschi
- Department of Obstetrics and Gynaecology, AUSL Romagna, Ospedale "Santa Maria delle Croci", Ravenna, Italy
| | - Giuseppe Comerci
- Department of Obstetrics and Gynaecology, AUSL Romagna, Ospedale "Santa Maria delle Croci", Ravenna, Italy
| | - Pantaleo Greco
- Clinica Ostetrica e Ginecologica - Dipartimento Scienze Mediche - Università di Ferrara, Ferarra, Italy
| | - Ruby Martinello
- Clinica Ostetrica e Ginecologica - Dipartimento Scienze Mediche - Università di Ferrara, Ferarra, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Maria Grazia Matarazzo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria - Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria - Federico II, Naples, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynaecology, AO "S.S. Annunziata", Cosenza, Italy
| | - Annamaria Ferrero
- Academic Department of Obstetrics and Gynecology, Mauriziano Hospital, Torino, Italy
| | - Nicoletta Biglia
- Academic Department of Obstetrics and Gynecology, Mauriziano Hospital, Torino, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Stefano Cianci
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Alfredo Ercoli
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Angela Martoccia
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Sergio Schettini
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Teresa Orlando
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Francesco G Cannone
- Department of Obstetrics and Gynaecology, ARNAS Garibaldi Catania, Catania, Italy
| | - Giuseppe Ettore
- Department of Obstetrics and Gynaecology, ARNAS Garibaldi Catania, Catania, Italy
| | - Andrea Puppo
- Department of Obstetrics and Gynaecology, ASO Santa Croce e Carle, Cuneo, Italy
| | - Martina Borghese
- Department of Obstetrics and Gynaecology, ASO Santa Croce e Carle, Cuneo, Italy
| | - Canio Martinelli
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lorenza Driul
- Department of Maternal and Child Health, University-Hospital of Udine, Udine, Italy
| | - Stefano Restaino
- Department of Maternal and Child Health, University-Hospital of Udine, Udine, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giorgio Candotti
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giulia Mantovani
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital Negrar, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital Negrar, Verona, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Laura Giambanco
- Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy and Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Silvia Amodeo
- Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy and Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Livio Leo
- Departments of Gynecology & Obstetrics, Hopital Beauregard, AUSL Valleè d'Aoste, Aosta, Italy
| | - Raphael Thomasset
- Departments of Gynecology & Obstetrics, Hopital Beauregard, AUSL Valleè d'Aoste, Aosta, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | - Franco Gorlero
- Department of Obstetrics and Gynaecology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Martina Di Luca
- Department of Obstetrics and Gynaecology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Enrico Busato
- Department of Obstetrics and Gynaecology, Ospedale di Treviso, Treviso, Italy
| | - Sami Kilzie
- Department of Obstetrics and Gynaecology, Ospedale di Treviso, Treviso, Italy
| | - Andrea Dell'Acqua
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Scarfone
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Dessole
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Giannella
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Liliana Mereu
- Gynecological Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Saverio Tateo
- Gynecological Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Flavia Sorbi
- Gynecology Unit, Careggi University Hospital, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Massimiliano Fambrini
- Gynecology Unit, Careggi University Hospital, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Stefania Cicogna
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Federico Romano
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Giuseppe Ricci
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynaecology, Madonna delle Grazie Hospital ASM, Matera, Italy
| | | | | | - Antonio Lippolis
- Unit of Obstetrics and Gynaecology, Valle D'Itra Hospital, Martina Franca, Taranto, Italy
| | - Raffaele Tinelli
- Unit of Obstetrics and Gynaecology, Valle D'Itra Hospital, Martina Franca, Taranto, Italy
| | - Giovanni D'Ippolito
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Vincenzo D Mandato
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Stefano Palomba
- Unit of Obstetrics and Gynecology, GOM of Reggio Calabria & Magna Grcia University of Catanzaro, Catanzaro, Italy
| | - Davide Calandra
- Unit of Obstetrics and Gynecology, University G. D'Annunzio of Chieti, Pescara, Italy
| | - Maurizio Rosati
- Unit of Obstetrics and Gynecology, University G. D'Annunzio of Chieti, Pescara, Italy.,Unit of Obstetrics and Gynecology, Santo Spirito Hospital, Pescara, Italy
| | - Cinzia Gallo
- Unit of Obstetrics and Gynecology, Università "Magna Graecia" di Catanzaro - AO "Pugliese - Ciaccio" Catanzaro, Italy
| | - Daniela Surico
- Unit of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Valentino Remorgida
- Unit of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Francesco Ruscitto
- Gynecology Unit, Ospedale Valduce, Como - ASST Lariana, S. Anna, Como, Italy
| | - Paolo Beretta
- Gynecology Unit, Ospedale Valduce, Como - ASST Lariana, S. Anna, Como, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Narducci M, Scacciavillani R, Pinnacchio G, Bencardino G, Perna F, Comerci G, Campisi M, Ceccarelli I, Pavone C, Spera F, Bisignani A, Crea F, Pelargonio G. The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs. Int J Cardiol Heart Vasc 2021; 35:100841. [PMID: 34345651 PMCID: PMC8319739 DOI: 10.1016/j.ijcha.2021.100841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
75 patients with ACS or CCS underwent S-ICD screening upon arrival and after PCI. Before PCI, STEMI patients had lower screening pass rates than NSTE-ACS ones STEMI was the only predictor of screening failure at multivariate regression analysis. Patient selection and dynamic device programming are fundamental in ischemic subjects
Background The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. Objectives We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. Methods We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. Results Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77–41.38, p = .001) Conclusion The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.
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Affiliation(s)
- M.L. Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - R. Scacciavillani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - G. Pinnacchio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Corresponding authors at: Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome 00168, Italy.
| | - G. Bencardino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Corresponding authors at: Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome 00168, Italy.
| | - F. Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - G. Comerci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - M. Campisi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - I. Ceccarelli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - C. Pavone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - F. Spera
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - A. Bisignani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - F. Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - G. Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
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5
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Zola P, Ciccone G, Piovano E, Fuso L, Peirano E, Di Cuonzo D, Perrone AM, Mandato VD, Zavallone L, Chiudinelli F, Berretta R, Loda S, Valenzano Menada M, Greggi S, Adorni M, Busato E, Marinaccio M, Comerci G, Fambrini M, Ferrero A. Intensive versus minimalist follow-up in patients treated for endometrial cancer: A multicentric randomized controlled trial (The TOTEM study—NCT00916708). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5506 Background: Intensive follow-up in cancer patients, which absorbs a lot of health system resources and can be a source of increased stress for patients, are often proposed on the assumption that an early recognition of relapse will translate in better outcomes. In endometrial cancer few randomized controlled trials were conducted to assess the role of a reduced number of the scheduled visits and of different settings of the follow-up, but did not investigate the contribution of routine serum, cytological or imaging follow-up investigations in improving overall survival or quality of life. The TOTEM study was planned to compare an intensive (INT) vs minimalist (MIN) 5- year follow-up regimen in endometrial cancer patients in terms of overall survival (OS). Methods: Patients surgically treated for endometrial cancer, in complete clinical remission confirmed by imaging, FIGO stage I-IV, were stratified by center and in low (LoR) or high (HiR) risk of recurrence and then randomized to INT or MIN hospital-based follow-up regimens. The main study hypothesis was to demonstrate an improvement from 75% to 80% (expected hazard ratio, HR = 0.78) of the 5-year OS with the INT regimen. Secondary objectives were to compare relapse free survival (RFS), health-related quality of life (HRQL) assessed at baseline, at 6 and 12 months and then yearly (with the SF-12 Physical and Mental Health Summary Scale) and costs. Results: 1884 patients were randomized in 42 centers between 2008 and 2018, and 1847 patients were available for the final analysis (60% LoR). Compliance with the follow-up scheduled visits was 75.3%, similar between INT (74.7%) and MIN (75.9%) arms, whereas the mean number of recorded exams (laboratory or imaging) was markedly higher in the INT than in the MIN arms (9.7 vs 2.9, p < 0.0001). After a median follow-up of 66 months, the overall 5-year OS was 91.3%, 90.6% in the INT and 91.9% in the MIN arms, respectively (HR = 1.12, 95%CI 0.85-1.48, p = 0.429). Comparing the INT vs MIN arms, the 5-year OS were 94.1% and 96.8% (HR = 1.48, 0.92-2.37, p = 0.104) in the LoR and 85.3% and 84.7% (HR = 0.96, 0.68-1.36, p = 0.814) in the HiR group. No relevant differences emerged in RFS between INT and MIN regimens, (HR = 1.13, 0.87-1.48, p = 0.365). At the time of the relapse most women were asymptomatic (146/228, 64.0%), with a tendency of higher proportions in the INT than in the MIN arm, both in the LoR group (78.8% vs 61.1%, p = 0.070) and in the HiR one (64% vs 60%, p = 0.754). HRQL was available only for a subgroup of patients (50% at baseline) and did not differ between arms. Conclusions: Intensive follow-up in endometrial cancer treated patients showed a weak and uncertain advantage in detecting earlier asymptomatic relapses but did not improve OS, even in HiR patients, nor influenced HRQL. Frequent routine use of imaging and laboratory exams in these patients should be discouraged. Clinical trial information: NCT00916708.
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Affiliation(s)
- Paolo Zola
- Departement of surgical sciences University of Turin, Turin, Italy
| | - Giovannino Ciccone
- Cancer Epidemiology Unit, CeRMS and CPO Piemonte, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Elisa Piovano
- Obstetrics and Gynecology Unit Ospedale Regina Montis Regalis, Mondovì, Italy
| | - Luca Fuso
- Obstetrics and Gynecology Unit ASO Ordine Mauriziano, Torino, Italy
| | - Elena Peirano
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | | | | | - Laura Zavallone
- Department Medical Oncology, Infermi Hospital, Biella, Italy
| | | | - Roberto Berretta
- U.O.C. Ginecologia e Ostetricia, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Serena Loda
- Obstetrics and Gynecology Unit AO Spedali Civili, Brescia, Italy
| | - Mario Valenzano Menada
- Obstetrics and Gynecology Unit, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - Stefano Greggi
- MITO & Gynecologic Oncology, Instituto Tumori Fondazione G. Pascale, Naples, Italy
| | - Marco Adorni
- Obstetrics and Gynecology Unit, ASO San Gerardo de' Tintori, Monza, Italy
| | - Enrico Busato
- Obstetrics and Gynecology Unit, Treviso Hospital, Treviso, Italy
| | - Marco Marinaccio
- Department of Gynecology and Obstetrics, University Medical School, Bari, Italy
| | - Giuseppe Comerci
- Obstetrics and Gynecology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Massimiliano Fambrini
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
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6
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Vagliasindi A, Moriconi L, Ferrara F, Missiroli S, Casanova C, Comerci G. Abdominal Wall Metastases from Ovarian Cancer: Should It Be Considered an Advanced Stage? Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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7
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Vagliasindi A, Moriconi L, Ferrara F, Missiroli S, Casanova C, Comerci G. Multivisceral Resection in the Surgical Treatment of Ovarian Cancer: Our Experience. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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8
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Bogani G, Matteucci L, Tamberi S, Ditto A, Sabatucci I, Murgia F, Arcangeli V, Maltese G, Comerci G, Stefanetti M, Sonetto C, Calareso G, Marchiano A, Chiappa V, Lorusso D, Raspagliesi F. RECIST 1.1 criteria predict recurrence-free survival in advanced ovarian cancer submitted to neoadjuvant chemotherapy. Eur J Obstet Gynecol Reprod Biol 2019; 237:93-99. [PMID: 31029972 DOI: 10.1016/j.ejogrb.2019.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/06/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Neoadjuvant chemotherapy plus interval debulking surgery is growing treatment strategy for advanced ovarian cancer patients with unresectable disease. Here, we aimed to assess predictors of surgical unresectability and survival of patients submitted to neoadjuvant chemotherapy plus interval debulking surgery. METHODS Data of consecutive 193 patients undergoing neoadjuvant chemotherapy plus interval debulking surgery were retrospectively evaluated in four Italian oncologic centers. RECIST 1.1 guidelines were used to assess response to neoadjuvant chemotherapy. Survival outcomes were evaluated using Kaplan-Meier and Cox proportional hazard models. RESULTS Overall, 155 (80.3%) and 38 (19.7%) patients had optimal and non-optimal cytoreduction at the time of interval debulking surgery. Via multivariate analysis, age (OR: 2.87 (95%CI: 1.29, 6.36) per 10-year increase) and radiological response to neoadjuvant chemotherapy (OR: 48.1 (95%CI: 6.33, 365.3)) impact on the inability to perform a complete cytoreduction. Patients having complete or partial response experienced a significant better disease-free survival than patients having stable or progressive disease at radiological examination (median disease-free survival 16.8 vs. 11.0 months; HR: 0.42 (95%CI: 0.09, 0.78); p = .001). Radiological response did not predict for overall survival (p = .719). CONCLUSIONS RECIST1.1 response criteria might be helpful to predict surgical resectability and disease-free survival of advanced stage ovarian cancer patients undergoing neoadjuvant chemotherapy plus interval debulking surgery.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | | | - Antonino Ditto
- Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Ilaria Sabatucci
- Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Ferdinando Murgia
- Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | | | - Giuseppa Maltese
- Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giuseppe Comerci
- Obstetrics and Gynecology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | | | - Cristina Sonetto
- Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Alfonso Marchiano
- Department of Radiology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Domenica Lorusso
- Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
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9
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Pinnacchio G, Pelargonio G, Narducci ML, Bencardino G, Perna F, Comerci G, Spera FR, La Rosa G, Crea F. 2119Ventricular arrhythmias recurrence in patients with ischemic and non ischemic cardiomyopathy: insight into pathological substrate from electroanatomic remapping. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Pinnacchio
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - G Pelargonio
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - M L Narducci
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - G Bencardino
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - F Perna
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - G Comerci
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - F R Spera
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - G La Rosa
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
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10
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Pinnacchio G, Pelargonio G, Narducci ML, Bencardino G, Perna F, Comerci G, Spera F, Pieroni M, Bellocci F, Crea F. P1010Long term arrhythmic risk assessment in biopsy-proven myocarditis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Pinnacchio
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - G Pelargonio
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - M L Narducci
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - G Bencardino
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - F Perna
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - G Comerci
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - F Spera
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - M Pieroni
- San Donato Hospital, Cardiovascular Medicine, Arezzo, Italy
| | - F Bellocci
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy
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11
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Pinnacchio G, Pelargonio G, Narducci ML, Bencardino G, Perna F, Comerci G, Bartoletti S, Pieroni M, Bellocci F, Crea F. P957Long term arrhythmic risk assessment in biopsy proven myocarditis. Europace 2017. [DOI: 10.1093/ehjci/eux151.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Zoli A, Bosello S, Comerci G, Galiano N, Forni A, Loperfido F, Ferraccioli GF. Preserved cardiorespiratory function and NT-proBNP levels before and during exercise in patients with recent onset of rheumatoid arthritis: the clinical challenge of stratifying the patient cardiovascular risks. Rheumatol Int 2015; 37:13-19. [DOI: 10.1007/s00296-015-3390-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/02/2015] [Indexed: 12/14/2022]
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13
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Mandato VD, Abrate M, De Iaco P, Pirillo D, Ciarlini G, Leoni M, Comerci G, Ventura A, Lenzi B, Amadori A, Rosati F, Martinello R, De Palma R, Ventura C, Belotti LMB, Formisano D, La Sala GB. Clinical governance network for clinical audit to improve quality in epithelial ovarian cancer management. J Ovarian Res 2013; 6:19. [PMID: 23547941 PMCID: PMC3623733 DOI: 10.1186/1757-2215-6-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/20/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Epithelial ovarian cancer (EOC) is the most lethal gynecological cancer. Several hospitals throughout the region provide primary treatment for these patients and it is well know that treatment quality is correlated to the hospital that delivers. The aim of this study was to investigate the management and treatment of EOC in a Region of the North Italy (Emilia-Romagna, Italy). METHODS A multidisciplinary group made up of 11 physicians and 3 biostatisticians was formed in 2009 to perform clinical audits in order to identify quality indicators and to develop Region-wide workup in accordance with the principles of evidence-based medicine (EBM). The rationale was that, by setting up an oncogynecology network so as to achieve the best clinical practice, critical points would decrease or even be eliminated. Analysis of cases was based on the review of the medical records. RESULTS 614 EOC patients treated between 2007 and 2008 were identified. We found only 2 high-volume hospitals (≥ 21 patients/year), 3 medium-volume hospitals (11-20 operated patients/year), and 7 low-volume hospitals (≤ 10 operated patients /year). Only 222 patients (76.3%) had a histological diagnosis, FIGO surgical staging was reported only in 206 patients (70.9%) but not all standard surgical procedures were always performed, residual disease were not reported in all patients. No standard number of neoadjuvant chemotherapy cycles was observed. CONCLUSIONS The differences in terms of treatments provided led the multidisciplinary group to identify reference centers, to promote centralization, to ensure uniform and adequate treatment to patients treated in regional centers and to promote a new audit involving all regional hospitals to a complete review of the all the EOC patients.
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Affiliation(s)
- Vincenzo Dario Mandato
- Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova- IRCCS, Reggio Emilia, Italy
| | - Martino Abrate
- Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova- IRCCS, Reggio Emilia, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Debora Pirillo
- Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova- IRCCS, Reggio Emilia, Italy
| | - Gino Ciarlini
- Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova- IRCCS, Reggio Emilia, Italy
| | - Maurizio Leoni
- Oncology and Gynecology Unit, Ospedale Civile, Ravenna, Italy
| | | | - Alessandro Ventura
- Department of Obstetrics and Gynecology, Ospedale Civile, Guastalla, Reggio Emilia, Italy
| | - Bruno Lenzi
- Unit of Medicine, Hospital of Argenta, Ferrara, Italy
| | - Andrea Amadori
- Unit of Obstetrics and Gynecology, Ospedale G.B. Morgagni-L.Pierantoni, Forlì, Italy
| | - Federica Rosati
- Unit of Obstetrics and Gynecology, Ospedale degli Infermi, Rimini, Italy
| | - Ruby Martinello
- Unit of Obstetrics and Gynecology, University Hospital S. Anna, Ferrara, Italy
| | - Rossana De Palma
- Clinical Area Government, Health and Social Agency of Emilia-Romagna, Emilia-Romagna, Italy
| | - Chiara Ventura
- Clinical Area Government, Health and Social Agency of Emilia-Romagna, Emilia-Romagna, Italy
| | | | - Debora Formisano
- Statistics and Clinical Epidemiology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Giovanni Battista La Sala
- Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova- IRCCS; University of Modena and Reggio Emilia, Reggio Emilia, Italy
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Pham QH, Von Lueder TG, Namtvedt SK, Rosjo H, Omland T, Steine K, Timoteo AT, Mota Carmo M, Simoes M, Branco LM, Ferreira RC, Kato R, Ito J, Tahara T, Yokoyama Y, Ashikaga T, Satoh Y, Na JO, Hong HE, Kim MN, Shin SY, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Ticulescu R, Brigido S, Vriz O, Sparacino L, Popescu BA, Ginghina C, Carerj S, Nicolosi GL, Antonini-Canterin F, Onaindia Gandarias JJ, Romero A, Laraudogoitia E, Velasco S, Quintana O, Cacicedo A, Rodriguez I, Alarcon JA, Gonzalez J, Lekuona I, Onaindia Gandarias JJ, Laraudogoitia E, Romero A, Velasco S, Cacicedo A, Quintana O, Subinas A, Gonzalez J, Alarcon JA, Lekuona I, Abdula G, Lund LH, Winter R, Brodin L, Sahlen A, Masaki M, Cha YM, Yuasa T, Dong K, Dong YX, Mankad SV, Oh JK, Vallet F, Lequeux B, Diakov C, Sosner P, Christiaens L, Coisne D, Kihara C, Murata K, Wada Y, Uchida K, Ueyama T, Okuda S, Susa T, Matsuzaki M, Cho EJ, Choi KY, Kwon BJ, Kim DB, Jang SW, Cho JS, Jung HO, Jeon HK, Youn HJ, Kim JH, Cikes M, Bijnens B, Velagic V, Kopjar T, Milicic D, Biocina B, Gasparovic H, Almuntaser I, Brown A, Foley B, Mulvihill N, Crean P, King G, Murphy R, Takata Y, Taniguchi M, Nobusada S, Sugawara M, Toh N, Kusano K, Itoh H, Wellnhofer E, Kriatselis C, Nedios S, Gerds-Li JH, Fleck E, Poulsen MK, Henriksen JE, Dahl J, Johansen A, Haghfelt T, Hoilund-Carlsen PF, Beck-Nielsen H, Moller JE, Dankowski R, Wierzchowiecki M, Michalski M, Nowicka A, Szymanowska K, Pajak A, Poprawski K, Szyszka A, Kasner M, Westermann D, Schultheiss HP, Tschoepe C, Watanabe T, Iwai-Takano M, Kobayashi A, Machii H, Takeishi Y, Paelinck BP, Van Herck PL, Bosmans JM, Vrints CJ, Lamb HJ, Doltra A, Vidal B, Silva E, Poyatos S, Mont L, Berruezo A, Castel A, Tolosana JM, Brugada J, Sitges M, Dencker M, Bjorgell O, Hlebowicz J, Szelenyi ZS, Szenasi G, Kiss M, Prohaszka Z, Patocs A, Karadi I, Vereckei A, Saha SK, Anderson PL, Govind S, Govindan M, Moggridge JC, Kiotsekoglou A, Gopal AS, Loegstrup BB, Christophersen TB, Hoefsten DE, Moeller JE, Boetker HE, Egstrup K, Wellnhofer E, Kriatselis C, Nedios S, Gerds-Li JH, Fleck E, Graefe M, Huang FQ, Zhang RS, Le TT, Tan RS, Sattarzadeh Badkoubeh R, Tavoosi A, Elahian AR, Drapkina O, Ivashkin VI, Vereckei A, Szelenyi ZS, Fazakas A, Pepo L, Janosi O, Karadi I, Kopitovic I, Goncalves A, Marcos-Alberca P, Almeria C, Feltes G, Rodriguez E, Garcia E, Hernandez-Antolin R, Macaya C, Silva Cardoso J, Zamorano JL, Navarro MS, Valentin M, Banes CM, Rigo F, Grolla E, Tona F, Cuaia V, Moreo A, Badano L, Raviele A, Iliceto S, Tarzia P, Sestito A, Nerla R, Di Monaco A, Infusino F, Matera D, Greco F, Tacchino RM, Lanza GA, Crea F, Nemes A, Balazs E, Pinter KS, Egyed A, Csanady M, Forster T, Loegstrup BB, Christophersen TB, Hoefsten DE, Moeller JE, Boetker HE, Egstrup K, Holte E, Vegsundvag J, Hole T, Hegbom K, Wiseth R, Nemes A, Balazs E, Pinter KS, Egyed A, Csanady M, Forster T, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Zagatina A, Zhuravskaya N, Tyurina TV, Tagliamonte E, Cirillo T, Coppola A, Marinelli U, Romano C, Riccio G, Citro R, Astarita C, Capuano N, Tagliamonte E, Cirillo T, Marinelli U, Quaranta G, Desiderio A, Riccio G, Romano C, Capuano N, Frattini S, Faggiano P, Zilioli V, Locantore E, Longhi S, Bellandi F, Faden G, Triggiani M, Dei Cas L, Dalsgaard M, Kjaergaard J, Iversen K, Hassager C, Dinh W, Nickl WN, Smettan JS, Koehler TK, Scheffold TD, Coll Barroso MCB, Guelker JG, Fueth RF, Kamperidis V, Hadjimiltiades S, Sianos G, Efthimiadis G, Karvounis H, Parcharidis G, Styliadis IH, Velasco Del Castillo MS, Cacicedo A, Onaindia JJ, Quintana O, Alarcon JA, Rodriguez I, Telleria M, Subinas A, Lekuona I, Laraudogoitia E, Carstensen HG, Nordenberg C, Sogaard P, Fritz-Hansen T, Bech J, Galatius S, Jensen JS, Mogelvang R, Bartko PE, Graf S, Rosenhek R, Burwash IG, Bergler-Klein J, Clavel MA, Baumgartner H, Pibarot P, Mundigler G, Kirilmaz B, Eser I, Tuzun N, Komur B, Dogan H, Taskiran Comez A, Ercan E, Cusma-Piccione M, Zito C, Oreto G, Piluso S, Tripepi S, Oreto L, Longordo C, Ciraci L, Di Bella G, Carerj S, Piatkowski R, Kochanowski J, Scislo P, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Sknouril L, Dorda M, Holek B, Gajdusek L, Chovancik J, Branny M, Fiala M, Szymanski P, Lipczynska M, Klisiewicz A, Hoffman P, Jander N, Minners J, Martin G, Zeh W, Allgeier M, Gohlke-Baewolf C, Gohlke H, Nistri S, Porciani MC, Attanasio M, Abbate R, Gensini GF, Pepe G, Duncan RF, Piantadosi C, Nelson AJ, Wittert G, Dundon B, Worthley MI, Worthley SG, Jung P, Berlinger K, Rieber J, Sohn HZ, Schneider P, Leibig M, Koenig A, Klauss V, Tomkiewicz-Pajak L, Kolcz J, Olszowska M, Pieculewicz M, Podolec P, Pieculewicz M, Przewlocki T, Tomkiewicz-Pajak L, Suchon E, Sobien B, Podolec P, Pieculewicz M, Przewlocki T, Wilkolek P, Tomkiewicz-Pajak L, Ziembicka A, Podolec P, Pieculewicz M, Przewlocki T, Tomkiewicz-Pajak L, Hlawaty M, Wilkolek P, Sobien B, Suchon E, Podolec P, Van De Bruaene A, Hermans H, Buys R, Vanhees L, Delcroix M, Voigt JU, Budts W, De Cillis E, Acquaviva T, Basile D, Bortone AS, Kalimanovska-Ostric D, Nastasovic T, Vujisic-Tesic B, Jovanovic I, Milakovic B, Dostanic M, Stosic M, Frogoudaki A, Andreou K, Parisis J, Triantafyllidi E, Gaitani S, Paraskevaidis J, Anastasiou-Nana M, Pieculewicz M, Przewlocki T, Tomkiewicz-Pajak L, Sobien B, Hlawaty M, Podolec P, De Pasquale G, Kuehn A, Petzuch K, Mueller J, Meierhofer C, Fratz S, Hager A, Hess J, Vogt M, Attenhofer Jost CH, Dearani JA, Scott CG, Burkhart HM, Connolly HM, Vitarelli A, Battaglia D, Caranci F, Padella V, Continanza G, Dettori O, Capotosto L, Vitarelli M, De Cicco V, Cortez Morichetti M, Mohanan Nair KK, Sasidaharan B, Thajudeen A, Tharakan JM, Mertens L, Ahmad N, Kantor PK, Grosse-Wortmann L, Friedberg MK, Bernard YF, Morel MA, Descotes-Genon V, Jehl J, Meneveau N, Schiele F, Kaldararova M, Simkova I, Tittel P, Masura J, Trojnarska O, Szczepaniak L, Mizia -Stec K, Cieplucha A, Bartczak A, Grajek S, Tykarski A, Gasior Z, Attenhofer Jost CH, Babovicvuksanovic D, Scott CG, Bonnichsen CR, Burkhart HM, Connolly HM, Morgan GJ, Slorach C, Hui W, Sarkola T, Lee KJ, Chaturvedi R, Benson L, Mertens L, Bradley T, Iancu ME, Ghiorghiu I, Serban M, Craciunescu I, Hodo A, Popescu BA, Ginghina C, Morgan J, Morgan GJ, Slorach C, Hui W, Roche L, Lee K, Chaturvedi R, Benson L, Bradley T, Mertens L, Morgan J, Morgan GJ, Slorach C, Hui W, Sarkola T, Lee K, Chaturvedi R, Benson L, Bradley T, Mertens L, Milanesi O, Favero V, Padalino M, Biffanti R, Cerutti A, Maschietto N, Reffo E, Vida V, Stellin G, Irtyuga O, Gamazin D, Voronkina I, Tsoyi N, Gudkova E, Moiseeva O, Aggeli C, Kazazaki C, Felekos I, Lagoudakou S, Roussakis G, Skoumas J, Pitsavos C, Stefanadis C, Cueff C, Keenan N, Steg PG, Cimadevilla C, Ducrocq G, Vahanian A, Messika-Zeitoun D, Petrella L, Mazzola AM, Villani CV, Giancola RG, Ciocca MC, Di Eusanio DEM, Nolan S, Ionescu A, Skaug TR, Amundsen BH, Hergum T, Torp H, Haugen BO, Lopez Aguilera J, Mesa Rubio D, Ruiz Ortiz M, Delgado Ortega M, Villanueva Fernandez E, Cejudo Diaz Del Campo L, Toledano Delgado F, Leon Del Pino M, Romo Pena E, Suarez De Lezo Cruz-Conde J, De Marco E, Colucci A, Comerci G, Gabrielli FA, Natali R, Garramone B, Savino M, Lotrionte M, Sonaglioni A, Loperfido F, Zdravkovic M, Perunicic J, Krotin M, Ristic M, Vukomanovic V, Zaja M, Radovanovic S, Saric J, Zdravkovic D, Cotrim C, Almeida AR, Miranda R, Almeida AG, Picano E, Carrageta M, D'andrea A, Cocchia R, Riegler L, Golia E, Scarafile R, Citro R, Caso P, Russo MG, Bossone E, Calabro' R, Noman H, Adel A, Elfaramawy AMR, Abdelraouf M, Elnaggar WAEL, Baligh E, Sargento L, Silva D, Goncalves S, Ribeiro S, Vinhas Sousa G, Almeida A, Lopes M, Rodriguez-Manero M, Aguado Gil L, Azcarate P, Lloret Luna P, Macias Gallego A, Castano SARA, Garcia M, Pujol Salvador C, Barba J, Redondo P, Tomasoni L, Sitia S, Atzeni F, Gianturco L, Ricci C, Sarzi-Puttini P, Turiel M, Sitia S, Tomasoni L, Atzeni F, De Gennaro Colonna V, Sarzi-Puttini P, Turiel M, Uejima T, Jaroch J, Antonini-Canterin F, Polombo C, Carerj S, Hughes A, Vinereanu D, Evanvelista A, Leftheriotis G, Fraser AG, Lewczuk A, Sobkowicz B, Tomaszuk-Kazberuk A, Sawicki R, Hirnle T, Michalski BW, Filipiak D, Kasprzak JD, Lipiec P, Dalen H, Haugen BO, Mjolstad OC, Klykken BE, Graven T, Martensson M, Olsson M, Brodin LA, Antonini-Canterin F, Ticulescu R, Vriz O, Enache R, Leiballi E, Popescu BA, Ginghina C, Nicolosi GL, Penhall A, Perry R, Altman M, Sinhal A, Bennetts J, Chew DP, Joseph MX, Larsen LH, Kjaergaard J, Kristensen T, Kober LV, Kofoed KF, Hassager C, Moscoso Costa F, Ribeiras R, Brito J, Boshoff S, Neves J, Teles R, Canada M, Andrade MJ, Gouveia R, Silva A, Miskovic A, Poerner TP, Stiller CS, Goebel BG, Moritz AM, Stefani L, Galanti GG, Moraldo M, Bergamini C, Pabari PA, Dhutia NM, Malaweera ASN, Willson K, Davies J, Hughes AD, Xu XY, Francis DP, Jasaityte R, Amundsen B, Barbosa D, Loeckx D, Kiss G, Orderud F, Robesyn V, Claus P, Torp H, D'hooge J, Kihara C, Murata K, Wada Y, Uchida K, Nao T, Okuda S, Susa T, Miura T, Matsuzaki M, Shams K, Samir S, Samir R, El-Sayed M, Anwar AM, Nosir Y, Galal A, Chamsi-Pasha H, Ciobanu A, Dulgheru R, Bennett S, Vinereanu D, De Luca A, Toncelli L, Cappelli F, Stefani L, Cappelli B, Vono MCR, Galanti G, Zorman Y, Yilmazer MS, Akyildiz M, Gurol T, Aydin A, Dagdeviren B, Kalangos A. Poster session V * Saturday 11 December 2010, 08:30-12:30. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Natali R, Lotrionte M, Marchese N, Di Giannuario G, Brugaletta S, Pisanello C, Comerci G, Savino M, Lombardo A, Forni F, Vigna C, Loperfido F. Prediction of functional capacity by low-dose dobutamine stress echocardiography in chronic heart failure. Minerva Cardioangiol 2008; 56:277-285. [PMID: 18509288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM The aim of this study was to determine if low-dose dobutamine stress echocardiography (LD-DSE) is associated with functional capacity in unselected elderly patients with chronic heart failure. METHODS This was a prospective trial. Thirty five consecutive patients were included, with age >65 years and left ventricular dysfunction (12 ischemic), by blindly assessed LD-DSE and cardiopulmonary exercise testing (CPT). Contractile reserve was defined as a change (D) in wall motion score index (WMSI) = or <0.2 at peak dose dobutamine. At CPT treadmill exercise time, peak VO2, %Vo2 and VE/VCO2 slope were determined. Preserved functional capacity was defined as percent of maximal predicted O2 consumption (%VO2) >80%. Baseline NT-proBNP plasma levels were assessed. RESULTS CPT variables were not related to clinical and baseline echocardiography characteristics but were related to DWMSI (exercise time, P=0.004; peak VO2, P=0.008; %VO2, P<0.001; VE/Vco2, P<0.001). Contractile reserve was present in 16 of 17 patients with preserved functional capacity (sensitivity=94%) and in 2 of 13 patients without (specificity=85%). Baseline NT-proBNP levels were lower in patients with contractile reserve (476+/-365 pg/mL) than in those without (1 345+/-1 219 pg/mL) (P=0.019), but were mildly related to CPT variables (P=0.049 and 0.027 with exercise time and %VO2, respectively). CONCLUSION Contractile reserve elicited at LD-DSE is associated with functional capacity in unselected elderly patients with chronic heart failure.
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Affiliation(s)
- R Natali
- Division of Heart Failure and Cardiac Rehabilitation, Department of Cardiovascular Surgery, Sacro Cuore Catholic University, Rome, Italy.
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Lotrionte M, Palazzoni G, Natali R, Comerci G, Abbate A, Loperfido F, Biondi-Zoccai G. Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy. Minerva Cardioangiol 2007; 55:711-20. [PMID: 18091640 DOI: pmid/18091640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Anthracycline (ANT) chemotherapy for breast cancer, while associated with high response rates, is fraught by risks of irreversible cardiotoxicity. Unfortunately means to detect such cardiotoxicity early on and at a sublinical stage are lacking. We evaluated the role of systolic tissue Doppler imaging (TDI) in appraising postchemotherapy left ventricular (LV) remodelling. METHODS Patients undergoing ANT-chemotherapy for breast cancer were enrolled, and underwent baseline and >6-months echocardiography (standard and TDI). According to the pattern of LV-TDI systolic remodelling from baseline to follow-up, patients were stratified in: group 1 (no LV-TDI worsening), group 2 (minor LV-TDI worsening), and group 3 (major LV-TDI worsening). Fifty-six patients were included (follow-up 9+/-6 months). RESULTS At baseline, no patient had abnormal LV ejection fraction (LVEF), LV-TDI systolic dysfunction or New York Heart Association (NYHA) >1. Follow-up overall analysis showed significant deterioration in LVEF, end-diastolic diameter (EDD) end-systolic diameter (ESD), and TDI-systolic parameters (all P<0.05). Specifically, 29 (51.8%) patients showed no adverse LV-TDI systolic remodelling, while 17 (30.4%) were in group 2, and 10 (17.9%) in group 3. All groups shared similar conditions at baseline. Patients with adverse LV-TDI remodelling had significant increases in EDD and ESD, as well as a significantly decreased LVEF (all P<0.05). No patient in group 1 had abnormal LVEF at follow-up, while 1 patient in group 2 and 2 patients in group 3 had abnormal LVEF (P<0.05). CONCLUSION Subclinical systolic dysfunction occurs in almost 50% of patients early after chemotherapy for breast cancer, with a more adverse by LV-TDI remodelling implying a more pronounced deterioration of standard echocardiographic parameters.
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Affiliation(s)
- M Lotrionte
- Division of Heart Failure and Cardiac Rehabilitation, Cardiovascular Department, Catholic University of the Sacred Heart Rome, Italy
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Comerci G, Colombo FM, Stefanetti M, Grazia G. Isolated fallopian tube torsion: a rare but important event for women of reproductive age. Fertil Steril 2007; 90:1198.e23-5. [PMID: 17953952 DOI: 10.1016/j.fertnstert.2007.08.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 08/25/2007] [Accepted: 08/25/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report two cases of isolated fallopian tubal torsion that emphasize the rarity and difficult of diagnosis. DESIGN Case report. SETTING A district general hospital. PATIENT(S) We report two cases of hematosalpinx due to torsion of the fallopian tube. The symptoms were not specific; both patients had acute lower abdominal pain. The first diagnosis in both cases was a torsion of a pelvic complex mass like a tumor. INTERVENTION(S) Laparoscopy is necessary, but often surgery is performed too late to preserve the tube. MAIN OUTCOME MEASURE(S) Resolution of symptoms with preservation of fertility. RESULT(S) Both patients had the tube removed. CONCLUSION(S) Early diagnosis and surgical intervention is mandatory when isolated fallopian tube torsion is suspected, particularly in a nulliparous young woman.
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Affiliation(s)
- Giuseppe Comerci
- Department of Obstetrics and Gynecology, Infermi Hospital, Rimini, Italy.
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Lavie O, Maini I, Pilip A, Comerci G, Sabo E, Cross PA, Dawlatly B, Lopes A, Auslender R. Computerized nuclear morphometry for the prediction of inguinal lymph nodes metastases in squamous cell carcinoma of the vulva. Int J Gynecol Cancer 2006; 16:556-61. [PMID: 16681725 DOI: 10.1111/j.1525-1438.2006.00447.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study evaluated the sensitivity and specificity of computerized morphometry in predicting lymph nodes metastases (LNM) in patients with squamous cell carcinoma (SCC) of the vulva. Histologic samples obtained from 20 consecutive cases of SCC of the vulva with positive inguinal LNM were morphometrically assessed and compared with samples from 20 consecutive cases of vulvar SCC negative for LNM. Computerized morphometry was performed on tumor cells and on adjacent nonneoplastic epithelial cells located 2-4 mm from the tumor margins. Computerized morphometric variables of tumor cell nuclei in patients with negative LNM significantly differed from those in patients with positive LNM. Morphometric differences in nuclear size and contour regularity were detected when comparing the nonneoplastic nuclei adjacent to the tumor of both groups. Multivariate analysis showed that the only independent predictors of LNM were the depth of the invasion (P= 0.005) and the mean nuclear roundness of the nonneoplastic nuclei adjacent to the tumors (P= 0.008). Using these variables, a discriminant score revealed a sensitivity of 90% and a specificity of 86.4% for predicting LNM in SCC of the vulva. Our data suggest that cells from the primary tumors with LNM differ morphometrically from primary tumors with no LNM. In addition, normal epithelial cells adjacent to the tumor express morphometric changes between the two groups. The results of our study justify the need for a prospective study of a larger number of patients to evaluate the reproducibility and the clinical use of the data.
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Affiliation(s)
- O Lavie
- Gynecologic-Oncology Unit, Carmel Medical Center, Haifa, Israel.
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Bulletti C, Colombo F, Comerci G. 235. J Minim Invasive Gynecol 2005. [DOI: 10.1016/j.jmig.2005.07.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- Marco Stefanetti
- Department of Obstetrics and Gynecology and Reproductive Medicine, Infermi Hospital, Rimini, Italy
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Colizzi C, Rizzello V, Angiolillo DJ, Liuzzo G, Ginnetti F, Monaco C, Comerci G, Vitrella G, Maseri A, Biasucci LM. In vitro hyperreactivity to lipopolysaccharide in patients with history of unstable angina is not associated with seropositivity for Cytomegalovirus, Helicobacter pylori and Chlamydia pneumoniae. Cardiologia 1999; 44:377-80. [PMID: 10371790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Inflammation and possibly chronic infections are associated with acute coronary syndromes; however, the mechanisms responsible for this association are not yet fully elucidated. The aim of this study was to assess whether the hyperreactivity of the inflammatory system, that we have shown in unstable patients with persistently elevated C-reactive protein and with recurrence of symptoms, was associated with chronic infection. METHODS In 20 unstable angina patients seropositivity and antibody levels vs Cytomegalovirus, Helicobacter pylori and Chlamydia pneumoniae were measured and correlated with the interleukin-6 production in vivo in 1 ml of whole blood stimulated with 0.1 microgram lipopolysaccharide for 4 hours. RESULTS No positive correlation was found between antibody titer and interleukin-6 levels. No correlation was also found between seropositivity to Cytomegalovirus, Helicobacter pylori or Chlamydia pneumoniae and interleukin-6 levels. CONCLUSIONS Our study suggests that seropositivity for infective agents, including Chlamydia pneumoniae, does not affect the monocyte response to lipopolysaccharide and thus cannot account for the enhanced interleukin-6 production observed in unstable angina patients with raised levels of C-reactive protein and worse prognosis, and suggests the predominant role of the individual response to different stimuli.
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Affiliation(s)
- C Colizzi
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
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Abstract
Thrombocytosis (platelet count >400 x 10(9)/L) is frequently found in association with malignant disease. Although the pathogenesis of thrombocytosis in malignancy is currently unclear, it appears to be a poor prognostic factor in patients with lung, colon, breast, and cervical carcinoma. The current study was initiated to assess the incidence of thrombocytosis in vulvar carcinoma and to evaluate its prognostic significance for patients with vulvar carcinoma. The pretreatment platelet counts of 201 women treated for vulvar cancer were reviewed and correlated to the patient's age, stage of disease, node status, histologic type, and outcome. Differences between categories were analyzed by means of the ANOVA test, and survival was compared using the log-rank test on the Kaplan-Meier life table. Thrombocytosis was presented in 14.92% of patients with vulvar malignancies and in 15.46% of patients with squamous cell carcinoma of the vulva. No correlation was found between thrombocytosis and tumor size, incidence of lymph node metastases, or stage of the disease. The 5-year survival rate for patients with thrombocytosis was 89.29%, which was not significantly different from the 76.47% 5-year survival of patients with normal platelet counts (P = 0.586). When adjusted for age, histological differentiation, number of tumors, staging, incidence of nodal metastases, platelet count, hemoglobin, and white blood count, only the staging, number of tumors, and histological differentiation were associated with an unfavorable prognosis (P = 0.0001, P = 0.003, P = 0.03, respectively). Thrombocytosis was not found to be a prognostic factor in patients with carcinoma of the vulva in this series of 201 patients.
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Affiliation(s)
- O Lavie
- The Department of Gynecological Oncology, Queen Elizabeth Hospital, Gateshead, England
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Comerci G, Bolger BS, Flannelly G, Maini M, de Barros Lopes A, Monaghan JM. Prognostic factors in surgically treated stage IB-IIB carcinoma of the cervix with negative lymph nodes. Int J Gynecol Cancer 1998; 8:23-26. [PMID: 11576283 DOI: 10.1046/j.1525-1438.1998.09754.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Comerci G, Bolger BS, Flannelly G, Maini M, de Barros Lopes A, Monaghan JM. Prognostic factors in surgically treated stage IB-IIB carcinoma of the cervix with negative lymph nodes. Int J Gynecol Cancer 1998; 8: 23-26. Two hundred and seventy-five females with stage IB-IIB negative lymph node cervical cancer, treated between January 1988 and December 1994 by radical hysterectomy and pelvic lymph node dissection, form the basis of this analysis. The clinical records were reviewed for all patients including histopathology, clinical features at presentation, and follow-up. Tumors were re-staged according to the 1995 FIGO classification. Median follow-up was 55 months and 85.8% were followed for longer than two years. There were 21 recurrences, 12 of which were true central recurrence (disease-free survival at 5 years: 91.66%). Fifteen of 25 deaths were due to cervical cancer (crude survival at 5 years: 93.27%). In univariate log-rank analysis, stage (P = 0.005), tumor size (P = 0.0002), and lymph-vascular space involvement (LVSI) (P = 0.01) appeared to be statistically significant factors for tumor recurrence. Other factors including age, histology type, differentiation, adjacent cervical intraepithelial neoplasia or cervical glandular intraepithelial neoplasia, and presence of intraepithelial disease at resection margin were not found to be statistically significant. In multivariate analysis (Cox regression) tumor size (P = 0.02) and LVSI (P = 0.03) were the only independent variables. In the presence of negative lymph nodes and complete surgical excision, tumor size and LVSI are important predictors of local recurrence.
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Affiliation(s)
- G. Comerci
- Regional Department of Gynaecologic Oncology, QueenElizabeth Hospital, Sheriff Hill, Gateshead, Tyne & Wear, England, UK
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Orlandi C, Costa S, Terzano P, Martinelli GN, Comerci G, Guerra B, Martellini L. Presurgical assessment and therapy of microinvasive carcinoma of the cervix. Gynecol Oncol 1995; 59:255-60. [PMID: 7590483 DOI: 10.1006/gyno.1995.0018] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Retrievable pathological specimens and clinical data on 70 patients with microinvasive carcinoma diagnosed on surgical specimens from cone biopsy or hysterectomy (Stage IA) were reviewed and compared to pertinent findings in the literature with the intent of evaluating diagnostic criteria and defining pathological features that may influence the outcome by therapy. Emphasis was given to the preoperative assessment emphasizing that both an accurate colposcopic evaluation and a detailed pathological analysis may reliably point to a conservative therapeutic approach. Increasing depth of stromal invasion was associated with lesion width as well as with endocervical extension, as measured on colposcopy, microcolpohisteroscopy, and histology. Lymph-vascular space involvement was significantly related to depth of invasion. Two patients of 28 with dissected nodes had node metastases as well as lymph-vascular space involvement. Both developed a pelvic recurrence. One had a > 1- to < or = 3-mm invasion depth, the other a > 3- to < or = 5-mm lesion invasion. While advocating a conservative procedure for Stage IA1, we suggest discrimination with regard to Stage IA2 because we believe that lymph-vascular involvement should be meticulously evaluated. In fact, > 1- to < or = 3-mm lesions without lymph-vascular space involvement can be conservatively treated, while for any other lesion falling within the Stage IA2 category a modified radical histerectomy plus pelvic lymphadenectomy should be recommended.
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Affiliation(s)
- C Orlandi
- II Department of Obstetrics and Gynecology, University of Bologna, Italy
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Abstract
Twenty-five patients with mucormycosis were seen at two university-affiliated hospitals from 1979 to 1993. These cases included 10 cutaneous, 9 rhinocerebral, and 3 disseminated infections, as well as one case each of pulmonary, renal, and peritoneal dialysis catheter-related infection. Eleven of the patients were diabetic and seven had ketoacidosis, including four who became acidotic after admission to the hospital. The mortality rates associated with rhinocerebral, disseminated, and pulmonary infections were 78%-100%, while those associated with cutaneous and miscellaneous forms were zero. In view of the prominence of cutaneous infections, the 10 cases of cutaneous mucormycosis (in addition to a case from a community hospital) are reported in detail. Systemic diseases were present in four of the 11 patients. Local factors leading to infection were identified in nine of the cases and included motor vehicle accident-related and other trauma, surgery, a spider bite, and an intravenous infusion catheter. The cases of cutaneous mucormycosis reported in the literature have been analyzed for identification of predisposing factors, treatment, and outcome. Aggressive surgical debridement is the most important component of therapy, and administration of amphotericin B is a useful adjunct. Skin grafting is useful as a method of repairing defects left by extensive debridement.
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Affiliation(s)
- R D Adam
- Department of Medicine, University of Arizona College of Medicine, Tucson 85724
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Fischler R, Comerci G, Yates A, Dover B. Evaluation, treatment, and follow-up of child abuse. J Fam Pract 1983; 17:387-403. [PMID: 6193240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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