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Milano G, Colosio A, Scaini A, Motta M, Raggi A, Zanoni F, Galli S, Saccomanno MF. A new knee arthrometer demonstrated to be reliable and accurate to assess anterior tibial translation in comparison with stress radiographs. Arch Orthop Trauma Surg 2022; 143:3241-3250. [PMID: 36344784 DOI: 10.1007/s00402-022-04679-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION For several years, many arthrometers have been developed to assess anterior knee laxity. The aim of our study was to evaluate the validity of a new practical and handy testing device with the hypothesis that the new arthrometer had good validity in terms of reliability and accuracy. METHODS Lachman test was performed on five fresh frozen cadaveric knees by five examiners. Anterior tibial translation (ATT) was measured with a new arthrometer (BLU-DAT) and on lateral stress radiographs. Data on ATT were obtained under 7 kg (69 N), 9 kg (88 N), and maximum manual traction (MMT). Tests were performed on the same specimens before and after arthroscopic ACL excision. Inter-rater reliability of the BLU-DAT measures was assessed with the intraclass correlation coefficient (ICC) for single and average measurements. The Bland-Altman method was used to estimate agreement between the BLU-DAT and stress radiographs. RESULTS ICC values for single measurements were 0.62, 0.54 and 0.58 for 7-kg, 9-kg and MMT assessment, respectively. Overall reliability was good (ICC = 0.63). ICC values for average measurements were 0.89, 0.85 and 0.88 for 7-kg, 9-kg and MMT assessment, respectively. Overall reliability was very good (ICC = 0.90) SEM ranged from 1.4 mm to 1.6 mm for single measurements and was below 1 mm at each testing condition for average measurements. Analysis of agreement between BLU-DAT and radiographic measurements showed a mean difference equal to 0.83 mm ± 2.1 mm (95% CI: 0.55-1.11). Upper LOA was equal to 4.9 mm (95% CI: 5.39-4.41). Lower LOA was equal to - 3.2 mm (95% CI: - 2.71 to - 3.69). CONCLUSION Measurement of anterior knee laxity with the BLU-DAT testing device has a good to very good inter-rater reliability and good agreement with a gold standard such as stress radiographs. Cadaveric Diagnostic Study, Level of Evidence IV.
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Affiliation(s)
- Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1 c/o Ortopedia e Traumatologia 2, 25123, Brescia, Italy.,Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Alessandro Colosio
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1 c/o Ortopedia e Traumatologia 2, 25123, Brescia, Italy.
| | - Alessandra Scaini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1 c/o Ortopedia e Traumatologia 2, 25123, Brescia, Italy
| | - Marcello Motta
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1 c/o Ortopedia e Traumatologia 2, 25123, Brescia, Italy
| | - Andrea Raggi
- Department of Biomedical Engineering, FGP Srl, Dossobuono, VR, Italy
| | - Fabio Zanoni
- Department of Biomedical Engineering, FGP Srl, Dossobuono, VR, Italy
| | - Stefano Galli
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Maristella F Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1 c/o Ortopedia e Traumatologia 2, 25123, Brescia, Italy.,Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Abstract
The increasing use of chemotherapy in association with surgery has prompted the suggestion that cancer chemotherapeutic drugs may interfere with the healing process. To test this hypothesis 30 Wistar rats were subjected to laparotomy and colonic resection and treated with 5-Fluorouracil or Mitomycin C. The bursting strength of the abdominal scars and the colonic anastomotic bursting pressure revealed some interference in the rats treated with 5-Fluorouracil (Student's t test P < 0.05) but none in the case of Mitomycin C. This preliminary study deserves to be followed up.
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Abstract
The paper reports 5 cases of paratesticular rhabdomyosarcoma in patients of 10 to 18 years of age out of 438 cases of testicular tumours admitted to the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan (1.14%). Two cases were far advanced and died within a few months despite chemotherapy and radiotherapy. Only one of the three operated patients was cured and is still living 4 years after treatment. This patient had negative nodes and a full course of post-operative chemotherapy. The causes of failure in the other two cases are believed to be: not performing retroperitoneal lymphadenectomy in one and not giving post-operative chemotherapy in both. It is concluded that radical orchiectomy, retroperitoneal lymphadenectomy (followed by radiotherapy in N+ cases) and post-operative chemotherapy are the treatment of choice for operable paratesticular rhabdomyosarcoma.
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Abstract
Since 1944, 8 patients under 15 years of age have been hospitalized at the National Cancer Institute in Milano for testicular neoplasms, that is 2 % of all cases. Four were embryonal carcinomas (pure or with associated teratoma and choriocarcinoma), and two were rhabdomyosarcomas. Only one case of seminoma and one case of benign mesothelioma of the tunica vaginalis propria of testis were described. Embryonal carcinoma and rhabdomyosarcoma in infants and children should be managed by radical orchiectomy and bilateral retroperitoneal lymphadenectomy. Inoperable cases have a very poor prognosis and adequate chemotherapy may prolong survival. Pure seminoma should be treated by radical orchiectomy and radiotherapy on the lymph-nodes as indicated by the extent of the disease. In advanced cases, alkylating agents are very useful. Mesotheliomas are not true testicular tumors, as they arise from the tunica vaginalis propria of testis. They may be benign or malignant. In benign cases orchiectomy alone is sufficient for cure, whereas in malignant instances bilateral retroperitoneal lymph-node dissection in mandatory.
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Abstract
Since 1961, 285 cases of testicular neoplasms have been investigated by means of lymphangiography at the National Cancer Institute of Milan. Bilateral foot lymphangiography was performed in 233 cases, 46 patients had combined funicular and foot lymphangiography, and in 6 only funicular lymphangiography was performed. Lymphangiograms were probative for secondaries in the retroperitoneal lymph-nodes in 162 cases (56.8 %). The most frequent site of metastasis was the para-aortic nodes (154 cases) with bilateral involvement in 68. Funicular lymphangiograms showed metastasis in the primary testicular lymph-centre in 28/52 investigated cases, and in 6 this was the only site of metastasis. These lymph-nodes are not visualized by foot lymphangiography. Radiological investigations other than lymphangiography were performed in 236 instances. I.V.P. was unable to visualize involved but not enlarged lymphnodes, but proved to be useful in defining the extent of large metastases. G.I.T. was performed in 59 cases and in 4 instances showed retrogastric metastases, which were not visualized by lymphangiography. Also R.P.P. visualized high retroperitoneal metastases in 2 cases with negative lymphangiograms. V.I. were positive only in far advanced cases. Histological lymphographic correlation was possible in 61 cases. Sensitivity (% correct positive lymphangiograms) was 96 % and specificity (% correct negative tests) was 89 %. False negative lymphangiograms occurred only in previously operated patients. In these cases only foot lymphangiography may be performed and the primary testicular lymph-center cannot be visualized.
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Abstract
The paper retrospectively reviews the modalities and the long-term results of treatment of 200 consecutive patients with pure seminoma and of 125 patients with testicular carcinomas admitted to the Istituto Nazionale per lo Studio e la Cura dei Tumori of Milan from 1929 to Jan 1973. Radical orchiectomy with high ligation of the spermatic cord at the internal inguinal ring was performed in all previously untreated patients. Those who had had a scrotal operation performed elsewhere were radically reoperated upon. Lymphography and cobalt 60 telecurietherapy were introduced in 1960 and new treatment plans were employed for the irradiation of the deep lymphnodes. Since 1968 all operable carcinomas have undergone bilateral retroperitoneal lymphadenectomy and since 1964 all patients with advanced disease have been treated with chemotherapy (single agent or combination). Survival rates were calculated by the actuarial method. The new treatment modalities proved to be significantly superior to the old ones. In pure seminoma a 92 % cure rate was obtained in NO patients after prophylactic irradiation of retroperitoneal nodes (2,500-3,000 rad in 3 weeks). In N1-3 patients the cure rate was as high as 75% after radical irradiation of retroperitoneal nodes (3,500-4,000 rad in 4 weeks) as well as prophylactic irradiation of mediastinum and both supraclavicular fossae. Extended radical radiotherapy (combined with chemotherapy in some patients) cured 2/6 N4 and 3/8 Ml patients. According to the old modalities of treatment, figures were respectively 72% in NO cases, 40% in N1-3 and 0% in N4 and Ml patients. In carcinomas, the cure rate after retroperitoneal lymphadenectomy was 91% in N–- patients and 47% in N+ cases. In N+ patients post-operative radiation was also performed (4,000-5,000 rad in 5 weeks). After radiotherapy alone (without lymphadenectomy) the rates were 62% in NO and 28% in N1-2 patients. In primary inoperable patients (N3-4 and Ml) chemotherapy, with or without radiation, significantly prolonged the survival rate. It is concluded that radiotherapy is the treatment of choice for pure seminoma and in N4 and Ml cases a full course of chemotherapy must be combined with extensive irradiation. Retroperitoneal lymphadenectomy is mandatory in all operable cases of testicular carcinoma while adjuvant chemotherapy may further improve the prognosis in N+ cases. For inoperable carcinomas chemotherapy (plus radiotherapy) is the treatment of choice. The new multiple drug regimens are providing encouraging results.
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Jordao M, Zanoni F, Pessoa F, Fonseca K, Salemi V, Souza L, Ribeiro O, Fernandez F, Mady C, Ramires F. P4468Relationship between autonomic activity, beta receptors and catecholamines after sympathectomy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4468] [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)
- M.R. Jordao
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - F. Zanoni
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F.G. Pessoa
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - K.C.B. Fonseca
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - V.M.C. Salemi
- Heart Institute of the University of Sao Paulo (InCor), Heart Failure Department, Sao Paulo, Brazil
| | - L.E. Souza
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - O.N. Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - F. Fernandez
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - C. Mady
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - F.J.A. Ramires
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
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Van Londen M, Humalda JK, Aarts BM, Sanders JS, Bakker SJL, Navis GJ, De Borst MH, Pazik J, O Dak M, Lewandowski Z, Podgorska M, Sadowska A, Sitarek E, Malejczyk J, Durlik M, Drechsler C, Philstrom H, Meinitzer A, Pilz S, Tomaschitz A, Abedini S, Fellstrom B, Jardine A, Wanner C, Maerz W, Holdaas H, Halleck F, Staeck O, Neumayer HH, Budde K, Khadzhynov D, Rostaing L, Allal A, Congy N, Aarninck A, Del Bello A, Maggioni S, Debiols B, Sallusto F, Kamar N, Stolyarevich E, Artyukhina L, Kim I, Tomilina N, Zaidenov V, Kurenkova L, Keyzer CA, De Borst MH, Van Den Berg E, Jahnen-Dechent W, Navis G, Bakker SJL, Van Goor H, Pasch A, Aulagnon F, Avettand-Fenoel V, Scemla A, Lanternier F, Lortholary O, Anglicheau D, Legendre C, Zuber J, Furic-Cunko V, Basic-Jukic N, Coric M, Kastelan Z, Hudolin T, Kes P, Mikolasevic I, Racki S, Lukenda V, Orlic L, Dobrowolski LC, Verberne HJ, Ten Berge IJM, Bemelman FJ, Krediet CTP, Ferreira AC, Silva C, Remedio F, Pena A, Nolasco F, Heldal K, Lonning K, Leivestad T, Reisaeter AV, Hartmann A, Foss AE, Midtvedt K, Vlachopanos G, Kassimatis T, Zerva A, Kokkona A, Stavroulaki E, Agrafiotis A, Sanchez Sobrino B, Lafuente Covarrubias O, Karsten Alvarez S, Zalamea Jarrin F, Rubio Gonzalez E, Huerta Arroyo A, Portoles Perez J, Basic-Jukic N, Kes P, Baek CH, Kim M, Kim JS, Yang WS, Han DJ, Park SK, Zulkarnaev A, Vatazin A, Cabiddu G, Maxia S, Castellino S, Loi V, Guzzo G, Piccoli GB, Pani A, Bucsa C, Tacu D, Harza M, Sinescu I, Mircescu G, Stefan G, Alfieri CM, Laura F, Danilovic B, Cresseri D, Meneghini M, Riccardo F, Regalia A, Messa P, Panuccio V, Tripepi R, Parlongo G, Quattrone S, Leonardis D, Tripepi G, Zoccali C, Mallamaci F, Amer H, Geerdes PA, Fettes TT, Prieto M, Walker RC, Edwards BS, Cosio FG, Khrabrova M, Nabokov A, Groene HJ, Weithofer P, Kliem V, Smirnov A, Dobronravov V, Sezer S, Gurlek Demirci B, Tutal E, Guliyev O, Say N CB, Ozdemir Acar FN, Haberal M, Albugami MM, Hussein M, Alsaeed S, Almubarak A, Bel'eed-Akkari K, Go biewska JE, Tarasewicz A, D bska- lizie A, Rutkowski B, Albugami MM, Hussein M, Almubarak A, Alsaeed S, Bel'eed-Akkari K, Ailioaie O, Arzouk N, Tourret J, Mercadal L, Szumilak D, Ourahma S, Parra J, Billault C, Barrou B, Alfieri CM, Floreani R, Ulivieri FM, Meneghini M, Regalia A, Zanoni F, Croci D, Rastaldi MP, Messa PG, Keyzer CA, Riphagen IJ, Joosten MM, Navis G, Muller Kobold AC, Kema IP, Bakker SJL, De Borst MH, Santos Lascasas J, Malheiro J, Fonseca I, Martins L, Almeida M, Pedroso S, Dias L, Henriques A, Cabrita A, Vincenti F, Weir M, Von Visger J, Kopyt N, Mannon R, Deng H, Yue S, Wolf M, Halleck F, Khadzhynov, D, Schmidt D, Petereit F, Slowinski T, Neumayer HH, Budde K, Staeck O, Hernandez Vargas H, Artamendi Larranaga M, Gil Catalinas F, Ramalle Gomara E, Bello Ovalle A, Pimentel Guzman G, Coloma Lopez A, Dall Anesse C, Gil Paraiso A, Beired Val I, Sierra Carpio M, Huarte Loza E, Slubowska K, Szmidt J, Chmura A, Durlik M, Staeck O, Khadzhynov D, Schmidt D, Niemann M, Petereit F, Lachmann N, Neumayer HH, Budde K, Halleck F, Alotaibi T, Nampoory N, Gheith O, Halim M, Aboatteya H, Mansour H, Abdulkawey H, Said T, Nair P, WazNa-Jab O Ska E, Durlik M, Elias M, Caillard S, Morelon E, Rivalan J, Moal V, Frimat L, Mourad G, Rerolle JP, Legendre C, Mousson C, Delahousse M, Pouteil-Noble C, Dantal J, Cassuto E, Subra JF, Lang P, Thervet E, Roosweil D, Molnar MZ, Fornadi K, Ronai KZ, Novak M, Mucsi I, Scale TM, Robertson S, Kumwenda M, Jibani M, Griffin S, Williams AJ, Mikhail A, Jeong JC, Koo TY, Jeon HJ, Han M, Oh KH, Ahn C, Yang J, Bancu I, Canas L, Juega J, Malumbres S, Guermah I, Bonet J, Lauzurica R, Basso E, Messina M, Daidola G, Mella A, Lavacca A, Manzione AM, Rossetti M, Ranghino A, Ariaudo C, Segoloni GP, Biancone L, Whang E, Son SH, Kwon H, Kong JJ, Choi WY, Yoon CS, Ferreira AC, Silva C, Aires I, Ferreira A, Remedio F, Nolasco F, Ratkovic M, Basic Jukic N, Gledovic B, Radunovic D, Prelevic V, Stefan G, Garneata L, Bucsa C, Harza M, Sinescu I, Mircescu G, Tacu D, Aniort J, Kaysi S, Mulliez A, Heng AE, Su owicz J, Wojas-Pelc A, Ignacak E, Janda K, Krzanowski M, Miarka P, Su owicz W, Filipov JJ, Zlatkov BK, Dimitrov EP, Svinarov DA, Champion L, Renoux C, Randoux C, Du Halgouet C, Azeroual L, Glotz D, Vrtovsnik F, Daugas E, Musetti C, Battista M, Cena T, Izzo C, Airoldi A, Magnani C, Stratta P, Fiskvik I, Holte H, Bentdal O, Holdaas H, Erkmen Uyar M, Sezer S, Bal Z, Guliyev O, Colak T, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Kara E, Ahbap E, Basturk T, Koc Y, Sakaci T, Sahutoglu T, Akgol C, Sevinc M, Unsal A, Seyahi N, Abdultawab K, Alotaibi T, Gheith O, Mansour H, Halim M, Nair P, Said T, Balaha M, Elsayed A, Awadeen W, Nampoory N, Hwang JC, Jiang MY, Lu YH, Weng SF, Madziarska K, Zmonarski SC, Augustyniak-Bartosik H, Magott-Procelewska M, Krajewska M, Mazanowska O, Banasik M, Penar J, Weyde W, Boraty Ska M, Klinger M, Swarnalatha G, Narendranath L, Shanta Rao G, Sawhney A, Subrahmanyam L, Kumar S, Jeon H, Hakim A, Patel U, Shrivastava S, Banerjee D, Kimura T, Yagisawa T, Nanmoku K, Kurosawa A, Sakuma Y, Miki A, Nukui A, Lee CH, Oh IH, Park JS, Watarai Y, Narumi S, Goto N, Hiramitsu T, Tsujita M, Yamamoto T, Kobayashi T, Muniz Pacios L, Molina M, Cabrera J, Gonzalez E, Garcia Santiago A, Aunon P, Santana S, Polanco N, Gutierrez E, Jimenez C, Andres A, Mohammed M, Hammam M, Housawi A, Goldsmith DJ, Cronin A, Frame S, Smalcelj R, Canoz MB, Yavuz DD, Altunoglu A, Yavuz R, Colak T, Haberal M, Tong A, Hanson CS, Chapman JR, Halleck F, Budde K, Papachristou C, Craig J, Zheng XY, Han S, Wang LM, Zhu YH, Zeng L, Zhou MS, Guliyev O, Erkmen Uyar M, Sezer S, Bal Z, Colak T, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Ranghino A, Diena D, De Rosa FG, Faletti R, Barbui AM, Guarnaccia C, Corcione S, Messina M, Ariaudo C, Segoloni GP, Biancone L, Patel R, Murray PD, Moiseev A, Kalachik A, Harden PN, Norby G, Mjoen G, Holdaas H, Gilboe IM, Shi Y, Luo L, Cai B, Wang T, Tao Y, Wang L, Erkmen Uyar M, Sezer S, Bal Z, Guliyev O, Tutal E, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Di Vico MC, Messina M, Mezza E, Giraudi R, Nappo A, Boaglio E, Ranghino A, Fop F, Segoloni GP, Biancone L, Carta P, Dattolo E, Buti E, Zanazzi M, Villari D, Di Maria L, Santoro G, Li Marzi V, Minetti EE, Nicita G, Carta P, Zanazzi M, Buti E, Antognoli G, Dervishi E, Vignali L, Caroti L, Di Maria L, Minetti EE, Dorje C, Kovacevic G, Hammarstrom C, Strom EH, Holdaas H, Midtvedt K, Reisaeter AV, Alfieri CM, Floreani R, Meneghini M, Regalia A, Zanoni F, Vettoretti S, Croci MD, Rastaldi MP, Messa P, Heldal K, Lonning K, Reisaeter AV, Bernklev T, Midtvedt K, Strakosha A, Pasko N, Nasto F, Cadri V, Dedei A, Thereska N. TRANSPLANTATION CLINICAL 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Previtali SC, Corradi A, Croci L, Zanoni F, Broccoli V, Consalez GG, Quattrini A. Abnormal Schwann Cell‐Axon Interaction In EBF‐2 “Knock Out” Mice. J Peripher Nerv Syst 2001. [DOI: 10.1046/j.1529-8027.2001.01007-44.x] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- SC Previtali
- Dept. Neurosciences and DIBIT, San Raffele Scientific Institute
| | - A Corradi
- Dept. Neurosciences and DIBIT, San Raffele Scientific Institute
| | - L Croci
- Dept. Neurosciences and DIBIT, San Raffele Scientific Institute
| | - F Zanoni
- Dept. Neurosciences and DIBIT, San Raffele Scientific Institute
| | - V Broccoli
- Dept. Neurosciences and DIBIT, San Raffele Scientific Institute
| | - GG Consalez
- Dept. Neurosciences and DIBIT, San Raffele Scientific Institute
| | - A. Quattrini
- Dept. Neurosciences and DIBIT, San Raffele Scientific Institute
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Piva L, Nicolai N, Di Palo A, Milani A, Merson M, Salvioni R, Stagni S, Vecchio D, Zanoni F, Ferri S, Pizzocaro G. [Therapeutic alternatives in the treatment of class T1N0 squamous cell carcinoma of the penis: indications and limitations]. Arch Ital Urol Androl 1996; 68:157-61. [PMID: 8767503] [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: 02/02/2023] Open
Abstract
At INT of Milan between 1964 and 1990, 204 consecutive native patients suffering from penile cancer have been treated. 101 (59%) patients out of 171 with invasive cancer (23 affected with Tis were excluded) have been classified T1N0M0. 74 patients have been treated with penis conserving methods, such as circumcision, radiotherapy, laser excision and primary chemotherapy + conserving surgery. Overall local failure and/or nodal relapses occurred in 27% (20/74). Relapses are significantly related with grading but there isn't any relationship with macroscopical aspect or size of the tumor. The conservative treatment had been possible in 80% of patients. In our experience T1N0 clinical stage conservative therapy does not worsen the prognosis.
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Affiliation(s)
- L Piva
- Divisione di Urologia, Istituto per lo Studio e la Cura dei Tumori di Milano
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Pizzocaro G, Piva L, Faustini M, Mangiarotti B, Nicolai N, Salvioni R, Milani A, Zanoni F. [Interferon and vinblastine in presumably operable metastases of renal carcinoma]. Arch Ital Urol Androl 1993; 65:177-80. [PMID: 8330064] [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: 01/29/2023] Open
Abstract
From January 1987 to December 1990, 14 consecutive patients with resectable metastases from renal cell carcinoma, underwent 3 cycles of preoperative alpha-2a Interferon (INF), 18 MUI s.c. 3 times a week, and Vinblastine (VLB), 0.15 mg/kg on day 1, every 21, days. Out of the 13 patients who completed the treatment, 4 (30.7%) achieved a clinical response (1 CR and 3 PR). Nine (69.3%) patients were submitted to surgery: all, including the CRer, had residual cancer and only 4 were radically resected. The latter were further submitted to 3 INF and VLB cycles: 2 relapsed after 7 and respectively 30 months, whilst 2 (15.4%) are alive disease-free at 12 and 52 months respectively.
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Affiliation(s)
- G Pizzocaro
- Divisione di Oncologia Urologica, Istituto Nazionale Tumori, Milano
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Pizzocaro G, Nicolai N, Salvioni R, Piva L, Faustini M, Zanoni F, Milani A. Comparison between clinical and pathological staging in low stage nonseminomatous germ cell testicular tumors. J Urol 1992; 148:76-9. [PMID: 1319508 DOI: 10.1016/s0022-5347(17)36514-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [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: 12/26/2022]
Abstract
Between January 1985 and December 1990, 208 consecutive patients with low stage nonseminomatous germ cell testicular tumors underwent retroperitoneal lymphadenectomy. In all of the patients the disease was staged with post-orchiectomy serum alpha-fetoprotein and beta subunit of human chorionic gonadotropin determinations, as well as chest x-rays and computerized tomography or magnetic resonance imaging of the abdomen and pelvis. Bipedal lymphangiography was performed in 139 patients. Of the 208 patients 173 (83%) had clinical stage 1 and 35 (17%) had low clinical stage 2 disease: 21 had tumors on radiographic imaging that were smaller than 2 cm. (clinical stage 2A) and 14 had tumors between 2 and 3 cm. (clinical stage 2B less than 3 cm.). Retroperitoneal metastases were found in 31 of 156 clinical stage 1 cancer patients (19.8%) with negative or normally decreasing serum tumor markers after orchiectomy, 15 of 16 (93.8%) with persistent positive markers, 8 of 14 clinical stage 2A cancer patients (57.1%) with negative or normally decreasing markers, all 7 stage 2A cancer patients with positive markers and all 14 clinical stage 2B cancer patients. Lymphangiography added little to the reliability of clinical staging. We conclude that due to the relatively low accuracy of clinical staging, retroperitoneal lymphadenectomy remains the treatment of choice for clinical stages 1 and 2A nonseminomatous germ cell testicular tumors with normal serum markers after orchiectomy.
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Affiliation(s)
- G Pizzocaro
- Division of Urologic Oncology, Istituto Nazionale Tumori, Milano, Italy
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Damascelli B, Marchianò A, Frigerio LF, Salvetti M, Spreafico C, Garbagnati F, Zanoni F, Radice F. Flexibility and efficacy of automatic continuous fluorodeoxyuridine infusion in metastases from a renal cell carcinoma. Cancer 1991; 68:995-8. [PMID: 1833043 DOI: 10.1002/1097-0142(19910901)68:5<995::aid-cncr2820680514>3.0.co;2-d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [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: 12/29/2022]
Abstract
Complete and lasting control of diffuse metastases from a renal cell carcinoma has been achieved by automatic continuous infusion of a single cytotoxic agent, fluorodeoxyuridine (FUDR). A patient with a single brain metastasis from renal cell carcinoma developed pulmonary, mediastinal, and retroperitoneal metastases after radical nephrectomy. A Medtronic Synchromed pump (Medtronic Inc., Minneapolis, MN) was implanted for the circadian systemic infusion of FUDR in 14-day courses with 14-day drug-free intervals. A complete response (CR) at all sites, was obtained in 3 months, and maintained for 22 months. After a second brain metastasis, treated by radiation therapy and cisplatin as radiosensitizer, a CR was obtained again and is now of 31 months' duration, which is four times the record to date. The overall hospitalization was 2 days. Acceptance of the pump is excellent and it functions precisely and reliably. This case should stimulate greater interest in techniques of automatic continuous infusion of cytostatics, given its greater efficacy and lower toxicity.
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Affiliation(s)
- B Damascelli
- Servizio di Radiologia, Istituto Nazionale Tumori, Milano, Italy
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14
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Tamburini M, Filiberti A, Barbieri A, Zanoni F, Pizzocaro G, Barletta L, Ventafridda V. Psychological aspects of testis cancer therapy: a prospective study. J Urol 1989; 142:1487-9; discussion 1490. [PMID: 2585622 DOI: 10.1016/s0022-5347(17)39133-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [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: 01/01/2023]
Abstract
We examined the impact of testis cancer and its curative therapies on the outlook of life, working activity, partner relationship and sexual function in 31 consecutive patients 18 to 51 years old (mean age 29.3 years, median 28 years) who already had undergone orchiectomy. Of the patients 13 subsequently were treated with chemotherapy alone, 6 with retroperitoneal lymph node dissection alone, and 7 with chemotherapy and an operation, while 5 seminoma patients were treated with radiotherapy. The patients were examined 3, 6 and 18 months after orchiectomy. Each patient was required to fill out a questionnaire to gather information relative to their work activities, emotional relationship with the partner and sexual life. The patients also completed an assessment form on the quality of life (Spitzer QL-Index) and a series of horizontal analogues to evaluate anxiety, mood, nausea, weakness and general health status. The statistical analysis of the linear and quadratic components for the variables under study was done with the general linear model for block design. Psychosocial adaptability of these patients, regardless of the treatment they underwent, in time became progressively less problematic and the development of psychosocial problems during the long-term adjustment was low. Only 2 patients reported worsening of the emotional relationship with the partner after treatment: 1 underwent chemotherapy and an operation, and 1 underwent radiotherapy. With regard to sexual life, no serious dysfunction was noted apart from the loss of ejaculation in 11 of 13 patients who underwent retroperitoneal lymph node dissection. Of our sample patients who had lost ejaculation only 2 suffered from a high state of anxiety. The anxiety scores on the last completed linear analogue were 2.6 and 4.1, whereas at the same time the mood scores were 1.9 and 4.4. Therefore, it is important for the clinician to assess the psychogenic aspect of this side effect when this type of operation is proposed.
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Affiliation(s)
- M Tamburini
- Division of Pain Therapy and Palliative Care, Istituto Nazionale Per Lo Studio e La Cura dei Tumori, Milano, Italy
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Jaehne J, Meyer HJ, Wittekind C, Maschek H, Pichlmayr R, Jacobi G, Weiermann G, Vitzthum HG, Schwabe D, Manegold C, Krempien B, Kaufmann M, Bailly M, Doré JF, Fodstad Ø, Kjønniksen I, Brøgger A, Flørenes VA, Pihl A, Aamdal S, Nesland JM, Geldof AA, Rao BR, De Giovanni C, Lollini PL, Del Re B, Scotlandi K, Nicoletti G, Nanni P, Van Muijen GNP, Van Der Wiel-Miezenbeek JM, Cornelissen LMHA, Jansen CFJ, Ruiter DJ, Kieler J, Oda Y, Tokuriki Y, Tenang EM, Lamb JF, Galante E, Zanoni F, Galluzzi D, Cerrotta A, Martelli G, Guzzon A, Reduzzi D, Barberá-Guillem E, Barceló JR, Urcelay B, Alonso-Varona AI, Vidal-Vanaclocha F, Bassukas ID, Maurer-Schultze B, Storeng R, Manzotti C, Pratesi G, Schachert G, Fidler IJ, Grimstad IA, Rutt GT, Riesinger P, Frank J, Neumann G, Wissler JH, Bastert G, Liebrich W, Lehner B, Gonzer S, Schlag P, Vehmeyer K, Hajto T, Gabius HJ, Funke I, Schlimok G, Bock B, Dreps A, Schweiberer B, Riethmüller G, Nicolai U, Vykoupil KF, Wolf M, Havemann K, Georgii A, Bertrand S, N'Guyen MJ, Siracky J, Kysela B, Siracka E, Pflüger E, Schirrmacher V, Boyano MD, Hanania N, Poupon MF, Sherbet GV, Lakshmi MS, Van Roy F, Vleminckx K, Fiers W, Dragonetti C, De Bruyne G, Messiaen L, Mareel M, Kuhn S, Choritz H, Schmid U, Bihl H, Griesbach A, Matzku S, Eccles SA, Purvies HP, Miller FR, McEachern D, Ponton A, Waghorne C, Coulombe B, Kerbel RS, Breitman M, Skup D, Gingras MC, Jarolim L, Wright JA, Greenberg AH, N'Guyen MJ, Allavena G, Melchiori A, Aresu O, Percario M, Parodi S, Schmidt J, Kars P, Chader G, Albini A, Zöller M, Lissitzky JC, Bouzon M, Martin PM, Grossi IM, Taylor JD, Honn KV, Koch B, Baum W, Giedl J, Gabius HJ, Kalden JR, Hakim AA, LadÁnyi A, Timár J, Moczar E, Lapis K, Müller K, Wolf MF, Benz B, Schumacher K, Kemmner W, Morgenthaler J, Brossmer R, Hagmar B, Burns G, Erkell§ LJ, Ryd W, Paku S, Rot A, Hilario E, Unda F, Simón J, Aliño SF, Sargent NSE, Burger MM, Altevogt P, Kowitz A, Chopra H, Bandlow G, Nagel GA, Lotan R, Carralero D, Lotan D, Raz A, Skubitz APN, Koliakos GG, Furcht LT, Charonis AS, Hamann A, Jablonski-Westrich D, Jonas P, Harder R, Butcher EC, Thiele HG, Breillout F, Antoine E, Lascaux V, Boxberger HJ, Paweletz N, Bracke M, Vyncke B, Opdenakker G, Castronovo V, Foidart JM, Camacho M, Fras AF, Llorens A, Rutllant ML, Erkell LJ, Brunner G, Heredia A, Imhoff JM, Burtin P, Nakajima M, Lunec J, Parker C, Fennelly JA, Smith K, Roossien FF, La Rivière G, Roos E, Erdel M, Trefz G, Spiess E, Ebert W, Verhaegen S, Remels L, Verschueren H, Dekegel D, De Baetselier P, Van Hecke D, Hannecart-Pokorni E, Falkvoll KH, Alonso A, Baroja A, Sebbag U, Barbera-Guillem E, Behrens J, Mareel MM, Birchmeier W, Waterhouse P, Khokha R, Chambers A, Yagel S, Lala PK, Denhardt DT, Hennes R, Frantzen F, Keller R, Schwartz-Albiez R, Fondaneche MC, Mignatti P, Tsuboi R, Robbins E, Rifkin DB, Overall CM, Sacchi A, Falcioni R, Piaggio G, Rizzo MG, Perrotti N, Kennel SJ, Girschick H, Müller-Hermelink HK, Vollmers HP, Wenzel A, Liu S, Günthert U, Wesch V, Giles M, Ponta H, Herrlich P, Stade B, Hupke U, Holzmann B, Johnson JP, Sauer A, Roller E, Klumpp B, Güttler N, Lison A, Walk A, Redini F, Moczar M, Leoni F, Da Dalt MG, Ménard S, Canevari S, Miotti S, Tagliabue E, Colnaghi MI, Ostmeier H, Suter L, Possati L, Rosciani C, Recanatini E, Beatrici V, Diambrini M, Polito M, Rothbächer U, Eisenbach L, Plaksin D, Gelber C, Kushtai G, Gubbay J, Feldman M, Benke R, Benedetto A, Elia G, Sala A, Belardelli F, Lehmann JM, Ladanyi A, Hanisch FG, Sölter J, Jansen V, Böhmer G, Peter-Katalinic J, Uhlenbruck G, O'Connor R, Müller J, Kirchner T, Bover B, Tucker G, Valles AM, Gavrilovic J, Thiery JP, Kaufmann AM, Volm M, Edel G, Zühlsdorf M, Voss H, Wörmann B, Hiddemann W, De Neve W, Van Den Berge D, Van Loon R, Storme G, Zacharski LR, Wojtukiewicz MZ, Memoli V, Kisiel W, Kudryk BJ, Stump D, Piñol G, Gonzalez-Garrigues M, Fabra A, Marti F, Rueda F, Lichtner RB, Khazaie K, Timar J, Greenzhevskaya SN, Shmalko YP, Hill SE, Rees RC, MacNeil S, Millon R, Muller D, Eber M, Abecassis J, Betzler M, Bahtsky KP, Umansky VY, Krivorotov AA, Balitskaya EK, Pridatko OE, Smelkova MI, Smirnov IM, Korczak B, Fisher C, Thody AJ, Young SD, Hill RP, Frixen U, Gopas J, Segal S, Hammerling G, Bar-Eli M, Rager-Zisman B, Har-Vardi I, Alon Y, Hämmerling GJ, Perez M, Algarra I, Collado MD, Peran E, Caballero A, Garrido F, Turner GA, Blackmore M, Stern PL, Thompson S, Levin I, Kuperman O, Eyal A, Kaneti J, Notter M, Knuth A, Martin M, Chauffert B, Caignard A, Hammann A, Martin F, Dearden MT, Pelletier H, Dransfield I, Jacob G, Rogers K, Pérez-Yarza G, Cañavate ML, Lucas R, Bouwens L, Mantovani G, Serri FG, Macciò A, Zucca MV, Del Giacco GS, Pérez M, Kärre K, Apt D, Traversari C, Sensi M, Carbone G, Parmiani G, Hainaut P, Weynants P, Degiovanni G, Boon T, Marquardt P, Stulle K, Wölfel T, Herin M, Van den Eynde B, Klehmann E, Büschenfelde KHMZ, Samija M, Gerenčer M, Eljuga D, Bašić I, Heacock CS, Blake AM, D'Aleo CJ, Alvarez VL, Gresser I, Maury C, Moss J, Woodrow D, von Ardenne M, Krüger W, Möller P, Schachert HK, Itaya T, Frost P, Rodolfo M, Salvi C, Bassi C, Huland E, Huland H, Sersa G, Willingham V, Hunter N, Milas L, Schild H, von Hoegen P, Mentges B, Bätz W, Suzuki N, Mizukoshi T, Sava G, Ceschia V, Zabucchi G, Farkas-Himsley H, Schaal O, Klenner T, Keppler B, Alvarez-Diaz A, Bizzari JP, Barbera-Guillem F, Osterloh B, Bartkowski R, LÖhrke H, Schwahn E, Schafmayer A, Goerttler K, Cillo C, Ling V, Giavazzi R, Vecchi A, Luini W, Garofalo A, Iwakawa M, Arundel C, Tofilon P, Giraldi T, Perissin L, Zorzet S, Piccini P, Pacor S, Rapozzi V, Fink U, Zeuner H, Dancygier H, Classen M, Lersch C, Reuter M, Hammer C, Brendel W, Mathé G, Bourut C, Chenu E, Kidani Y, Mauvernay Y, Schally AV, Reizenstein P, Gastiaburu J, Comaru-Schally AM, Cupissol D, Jasmin C, Missot JL, Wingen F, Schmähl D, Pauwels-Vergely C, Poupon MF, Gasic TB, Ewaskiewicz JI, Gasic GJ, Pápay J, Mauvernay R, Schally A, Keiling R, Hagipantelli R, Busuttil M, VoVan ML, Misset JL, Lévi F, Musset M, Ribaud P, Hilgard P, Reissmann T, Stekar J, Voegeli R, Den Otter W, Maas HA, Dullens HFJ, Merriman RL, Tanzer LR, Shackelford KA, Bemis KG, Campbell JB, Matsumoto K. Late abstracts 186–187. Clin Exp Metastasis 1988. [DOI: 10.1007/bf01888832] [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: 12/01/2022]
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Pizzocaro G, Zanoni F, Salvioni R, Milani A, Piva L, Pilotti S. Difficulties of a surveillance study omitting retroperitoneal lymphadenectomy in clinical stage I nonseminomatous germ cell tumors of the testis. J Urol 1987; 138:1393-6. [PMID: 2824862 DOI: 10.1016/s0022-5347(17)43652-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.5] [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: 01/02/2023]
Abstract
Between August 1981 and December 1984, 85 consecutive patients with clinical stage I nonseminomatous germ cell tumors of the testis who were suitable for close observation entered a surveillance study after orchiectomy alone. All patients had unequivocally negative chest x-ray, bipedal lymph-angiography, and computerized tomography of the abdomen and pelvis, and normal levels of alpha-fetoprotein and human chorionic gonadotropin before entering the study. Patients were followed closely for 24 to 64 months (median 42 months) with regular chest x-rays, plain films of the abdomen for lymphangiography control, and serum determinations of alpha-fetoprotein and human chorionic gonadotropin but it was difficult to obtain computerized tomography scans of the abdomen at scheduled intervals for such a long period. Followup was closed December 31, 1986. At that date 62 patients (73 per cent) were continuously free of disease after orchiectomy alone and 23 (27 per cent) suffered relapse. The over-all occurrence rate of retroperitoneal relapses was 16.5 per cent and they usually were detected late, 4 to 36 months (median 10 months) after orchiectomy. Lung metastases were detected much earlier, 2 to 10 months (median 3 months) after orchiectomy. Alpha-fetoprotein and human chorionic gonadotropin elevations preceded the radiographic demonstration of metastases in 8 patients only (35 per cent) and in 1 they were the only sign of relapse. All but 1 patient with relapse were cured with chemotherapy and/or surgery, with an over-all survival rate free of disease of 98.8 per cent. Invasion of the epididymis, rete testis and spermatic cord, primary scrotal surgery, peritumor vascular invasion and embryonal carcinoma were associated with a higher risk for relapse but it was impossible to find clear-cut indications to select patients for adjuvant chemotherapy, retroperitoneal lymphadenectomy or no treatment. Furthermore, the followup of retroperitoneal nodes proved to be much more difficult than expected. Unilateral or modified retroperitoneal lymphadenectomy facilitates management of clinical stage I nonseminomatous germ cell tumors of the testis: only the chest and markers must be followed, the status of the retroperitoneal nodes is known immediately and antegrade ejaculation is preserved in the majority of cases.
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Affiliation(s)
- G Pizzocaro
- Section of Urologic Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
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Tesoro-Tess JD, Pizzocaro G, Zanoni F, Balzarini L, Ceglia E, Petrillo R, Musumeci R. Reliability of diagnostic imaging after orchiectomy alone in follow-up of clinical stage I testicular carcinoma: excessive cost with potential risk. Lymphology 1987; 20:161-5. [PMID: 3682940] [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: 01/06/2023]
Abstract
From 1981 to 1984, 86 consecutive patients with previously untreated nonseminomatous testicular carcinoma were classified as clinical radiological stage I and treated with orchiectomy alone. The follow-up program included chest x-ray and lymphangiography (LAG) every month and abdominal computed tomography (CT) bimonthly. All patients were followed for 15 to 63 months after orchiectomy (median 32 mo.). Metastases developed in 23 patients (26.7%) and in 13/23 there was retroperitoneal lymphadenopathy. Time of relapse after orchiectomy ranged from 2 to 36 months (median 7 mo.) with a shorter interval for chest (4 mo.) compared with retroperitoneal metastases (7 mo.). Lung metastases were readily identified at an early stage (less than 2 cm) whereas more than one-third of retroperitoneal nodal metastases were greater than 5 cm at time of diagnosis. LAG detected metastases in 8/11 patients (72.7%), abdominal CT in 8/10 (80%), and both together (LAG and CT) 7/8 (87.5%). In clinical stage I nonseminomatous testicular carcinoma, the high incidence of concomitant but often asymptomatic regional and distant metastases and the relatively high cost and inconvenience of follow-up using abdominal CT imaging, LAG and chest x-ray suggest that orchiectomy is best combined with retroperitoneal node dissection at time of initial presentation to insure more accurate and safe staging of tumor dissemination.
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Affiliation(s)
- J D Tesoro-Tess
- Department of Urologic Radiology and Lymphography, Istituto Nazionale Tumori, Milano, Italy
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Pizzocaro G, Zanoni F. Difficulties of a Surveillance Study in Clinical Stage I Non-Seminomatous Testicular Cancer. J Urol 1987. [DOI: 10.1016/s0022-5347(17)75581-4] [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: 11/25/2022]
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Abstract
Thirty-one patients were treated with cisplatin combination chemotherapy for advanced seminoma (26 Stage III or bulky Stage II testicular, and five disseminated extragonadal). Seventeen (89%) of 19 patients not previously pretreated and four (80%) of five who had received only abdominal irradiation entered continuous complete remission (CR), versus only two (28%) of seven patients who had received extensive infra- and supradiaphragmatic radiotherapy. Results were not significantly influenced by stage, human chorionic gonadotropin (HCG) titers and histologic subgroups, whereas patients with lactic dehydrogenase (LDH) values exceeding 500 mIU/ml did worse (50% continuous CR rate in 12 cases) than those with normal or less elevated titers (89% continuous CR rate in 19 cases). After a median follow-up period of 34 months (range, 12+ to 77+ months), 23 patients (74.5%) remain alive in continuous CR, two (6%) died in CR and another one (3%) entered CR after deferred treatment of residual disease. Five patients (16%) died of cancer. Toxicity was severe in extensively irradiated patients, but it was acceptable in those not pretreated and in those who had received only subdiaphragmatic radiotherapy. Cisplatin combination chemotherapy can be successfully and safely used as the primary treatment of choice in patients with advanced seminoma. It is also an excellent salvage therapy for patients who had received subdiaphragmatic irradiation only. On the contrary, it is very difficult to treat with chemotherapy extensively irradiated patients.
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Abstract
Cisplatin, vinblastine and bleomycin (PVB) is very effective therapy in disseminated testicular cancer, but toxicity is severe. A further reduction of vinblastine might reduce the acute toxicity of PVB without compromising the response rate in good-risk patients. Starting in March 1982, 42 consecutive patients with minimal or intermediate advanced disease (lymph node metastases less than 10 cm, lung nodules less than 5 cm) began a 0.2-mg/kg vinblastine PVB regimen, provided that serum alpha-fetoprotein (AFP) levels were not greater than 1000 ng/ml and human chorionic gonadotropin (HCG) values were not greater than 50,000 mIU/ml. Only 9 patients (21.4%) had leukocyte counts less than 1000/mm3, 6 (14%) had infections, but none had documented sepsis. Gastrointestinal and neuromuscular toxicities were mild. Of the 42 patients, 41 (97.6%) entered complete remission (CR), 8 with surgery. After a median follow-up period of 26 months (range, 19-40 months), 35 patients (83.3%) are continuously disease-free. Of the 6 patients with AFP levels greater than 400 ng/ml and/or HCG values greater than 1000 mIU/ml, only 2 (33.3%) entered continuous CR, versus 33 (91.6%) of the 36 patients with normal or less elevated markers (P less than 0.01). PVB with a 0.2-mg/kg vinblastine dosage is very effective and well-tolerated therapy in selected good-risk patients with disseminated germinal testis cancer.
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Pizzocaro G, Zanoni F, Milani A, Salvioni R, Piva L, Pilotti S, Bombardieri E, Tesoro-Tess JD, Musumeci R. Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal. J Clin Oncol 1986; 4:35-40. [PMID: 3941332 DOI: 10.1200/jco.1986.4.1.35] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Sixty-two consecutive patients with clinical stage I nonseminomatous testicular cancer were entered into a prospective study to receive no treatment after orchiectomy until clinical evidence of recurrent disease. Of 59 evaluable cases, 41 (69.5%) remained continuously disease free for a median duration of 30 months (range, 18 to 46 months), and evidence of metastatic disease developed in 18 patients (30.5%) from 2 to 36 months after orchiectomy. The median disease-free interval for relapsing patients was 6 months. Retroperitoneal metastases developed in ten patients; seven patients had pulmonary metastases, and one patient had progressive elevation of the serum alpha-fetoprotein level. Relapses were significantly more frequent in patients with either embryonal carcinoma, infiltrating testicular cancer (pT greater than 1), peritumoral vascular invasion, or in those who underwent transscrotal biopsy. One patient with relapse refused salvage therapy and died. The remaining 17 patients have been rendered disease free with cisplatin combination chemotherapy and/or surgery. However, two patients showed further recurrence, with one in the lung and the other one also in the retroperitoneal nodes. In our opinion, surveillance following orchiectomy will provide useful information in clinical stage I nonseminomatous testicular cancer, but it is a difficult study. For the time being, it should be restricted to specialized centers only. In the meanwhile, retroperitoneal lymphadenectomy remains the standard treatment.
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Pizzocaro G, Zanoni F, Salvioni R, Milani A, Piva L. Surveillance or lymph node dissection in clinical stage I non-seminomatous germinal testis cancer? Br J Urol 1985; 57:759-62. [PMID: 3002535 DOI: 10.1111/j.1464-410x.1985.tb07049.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Surveillance following orchiectomy alone has gained popularity in the management of clinical stage I non-seminomatous germ cell tumours (NSGCT) of the testis. However, long-term follow-up of the retroperitoneal nodes can be difficult. We analysed the results of 71 consecutive patients followed for more than 1 year. Fifty men (70.5%) remain disease-free and 21 (29.5%) have relapsed. Relapses occurred 2 to 36 months after orchiectomy (median 6 months). Retroperitoneal nodes were involved in 12 cases (17%). In only one patient were retroperitoneal metastases diagnosed when smaller than 2 cm and in four they were diagnosed when larger than 5 cm. Furthermore, the late relapses occurred in the retroperitoneal nodes. After treatment of metastases, 69 patients (97%) are alive, disease-free and off therapy. As retroperitoneal relapses do not occur after a properly executed retroperitoneal lymph node dissection (RPLND) and ejaculation problems can be avoided with unilateral RPLND, it is suggested that RPLND can be used for clinical stage I NSGCT of the testis in experienced surgical centres, with the advantage of an easier follow-up.
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Abstract
Forty consecutive patients with far-advanced germinal testis tumors (lymph node metastases greater than 10 cm, pulmonary nodules greater than 5 cm, extrapulmonary spread, alpha-fetoprotein greater than 1000 ng/ml, human chorionic gonadotropin greater than 50,000 mIU/ml) were treated with five courses of cisplatin, etoposide, and bleomycin (PEB). Twenty-five patients underwent surgery for the removal of residual masses after the first three inductions. Fibrotic-necrotic tissue was resected in 11 cases, 12 had mature teratoma, and residual cancer was found in 2. After the combined-modality treatment, 37 patients (82.5%) entered complete remission (CR): 25 (62.5%) with PEB and 12 (30%) with PEB and complete removal of the residual tumor. One patient progressed on therapy, and two others had incomplete resection of the residual disease. Hematologic toxicity was moderate and gastrointestinal toxicity was very mild. After a median follow-up period of 24 months (range, 13-40), 33 patients (82.5%) remain continuously disease-free, and 4 experienced relapse. Only one of these was salvaged with further surgery and chemotherapy. First-line PEB therapy combined with early resection of residual tumor induced a very high continuous CR rate in patients with far-advanced germinal testis cancer, and toxicity was moderate.
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Abstract
Thirty-two consecutive patients with pretreated germinal testis cancer received three to four inductions of cisplatin and etoposide therapy (PE). Patients not pretreated, or only partially pretreated with bleomycin (B), also received this drug for a maximum of 12 doses. Sixteen patients underwent secondary surgery for the removal of residual masses. Twelve (37.5%) entered complete remission (CR) with chemotherapy alone, and an additional 9 cases (28%) were rendered tumor-free by surgery. The 21 disease-free patients (65.5%) received two further inductions and no maintenance. Toxicity was moderate, and 1 of the 16 patients who underwent surgery died postoperatively of pulmonary embolism. After a median follow-up period of 26 months (range, 9-60), 2 patients have died in CR and 15 (47%) are currently alive and have been continuously disease-free. The major determinant of tumor response was prior therapy. Eleven of 14 (78%) patients who were not pretreated with cisplatin achieved a continuous disease-free status versus only 4 of the 18 pretreated patients (22%, P less than 0.01). In this set of cases, complete responders to prior PVB therapy did better than incomplete responders treated for tumor progression. It can be concluded that normal-dose PE +/- B therapy, followed by surgical resection of the residual tumor, is a satisfactory salvage therapy in patients not pretreated with cisplatin and is also active in complete responders to prior PVB therapy.
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Abstract
Bilateral retroperitoneal lymphadenectomy is mainly a staging procedure in patients with stage I nonseminomatous testis cancer, and it causes permanent loss of antegrade ejaculation in approximately two-thirds of the cases. Between May 1978 and August 1981, 61 consecutive patients with no intraoperative evidence of lymph node involvement underwent unilateral retroperitoneal lymph-adenectomy for nonseminomatous germinal testis tumors. Microscopic metastases were found in 1 to 4 retroperitoneal nodes in 6 cases (9.8 per cent). Antegrade ejaculation was absent postoperatively in 11 patients (18 per cent), with no significant difference between patients who underwent lymph node dissection on the left or right side. Ejaculation returned spontaneously in 3 patients, 1 of whom fathered a child. The disease recurred in 10 patients 3 to 35 months after lymphadenectomy (median 6 months). Disease recurred in 8 of 55 patients (14.5 per cent) with negative nodes and 2 of 6 (33.3 per cent) with positive histological findings. No patient suffered retroperitoneal recurrence. The more than 3-year survival rates free of disease were 96.4 and 83.3 per cent in patients with pathological stages I and II disease, respectively. Unilateral retroperitoneal lymphadenectomy in patients with intraoperative stage I nonseminomatous germinal testis cancer preserves antegrade ejaculation in more than 80 per cent of the cases without apparently compromising the long-term survival.
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Pizzocaro G, Salvioni R, Pasi M, Zanoni F, Milani A, Pilotti S, Monfardini S. Early resection of residual tumor during cisplatin, vinblastine, bleomycin combination chemotherapy in stage III and bulky stage II nonseminomatous testicular cancer. Cancer 1985; 56:249-55. [PMID: 2408728 DOI: 10.1002/1097-0142(19850715)56:2<249::aid-cncr2820560207>3.0.co;2-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sixty consecutive patients with Stage III or bulky Stage II nonseminomatous germinal testis tumors were treated with cisplatin, vinblastine, bleomycin combination chemotherapy (PVB). One patient died of acute toxicity after the first course of therapy, 16 entered complete remission (CR) after two or three inductions, and 36 underwent surgery for removal of residual masses after the third cycle. No residual tumor was found in 16 cases, 10 had mature teratoma, and residual malignant tumor was completely resected in 8 of 10 patients. On the whole, 52 of 59 cases (88%) who completed the therapy entered CR, 34 (58%) with PVB and 18 (30%) with PVB and resection of the residual disease. The major beneficiaries of surgery were patients with bulky metastases (17 of 45, 38%) and those with primary teratocarcinoma (13 of 24, 54%). All of the patients who entered CR received two additional inductions and no maintenance. After a median follow-up period of greater than 3 years, 40 patients (68%) remain continuously disease-free, 1 died in CR, and 3 of the 11 who had relapse were salvaged. All of the 32 patients with lung deposits less than 5 cm and/or lymph node metastases less than 10 cm entered CR after the combined treatment modality, and 29 (91%) are alive disease-free. Also, 20 of 27 patients (74%) with far-advanced disease (lung and lymph node metastases larger than 5 and 10 cm, respectively, extrapulmonary disease) entered CR after PVB and surgery, but only 11 (41%) are continuously disease-free. Early resection of the residual tumor during PVB combination chemotherapy greatly increased the CR rate, but relapses were very frequent in patients with far-advanced disease.
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Tesoro-Tess JD, Pizzocaro G, Zanoni F, Musumeci R. Lymphangiography and computerized tomography in testicular carcinoma: how accurate in early stage disease? J Urol 1985; 133:967-70. [PMID: 3999221 DOI: 10.1016/s0022-5347(17)49337-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The usefulness of lymphangiography and computerized tomography was evaluated in 167 consecutive patients with pathological stages I and II testicular carcinoma and metastases of less than 5 cm. Lymphangiography demonstrated 74.4 per cent sensitivity, 77.6 per cent specificity and 76.0 per cent over-all accuracy. Computerized tomography revealed comparable results, with 74.3 per cent over-all accuracy, 73.7 per cent sensitivity and 75.0 per cent specificity. The combination of lymphangiography and computerized tomography performed in 35 patients consistently improved the diagnostic possibilities of either technique alone in patients with positive nodes, reducing the false negative rate from 27 to 10 per cent. On the other hand, this combination increased the false positive rate from 25 to 37 per cent in patients with negative nodes. In patients with clinical stage I disease for whom a wait-and-see policy after orchiectomy is adopted at our institute both methods must be considered mandatory. In all other situations computerized tomography alone should be the preferred procedure in the diagnosis of retroperitoneal lymph node metastases from testicular carcinoma.
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Pizzocaro G, Pasi M, Zanoni F, Salvioni R, Milani A, Pilotti S. Relapse pattern of pathologic stage I nonseminomatous germ cell tumors of the testis following orchidectomy and lymphadenectomy. Eur Urol 1985; 11:79-82. [PMID: 2988965 DOI: 10.1159/000472460] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A retrospective analysis of patients with pathologic stage I nonseminomatous germinal testis tumors treated with orchidectomy and retroperitoneal lymphadenectomy was done in an attempt to define the relapse pattern and to eventually identify risk factors predisposing to tumor recurrence. Of 102 patients, 91 (89.2%) remain disease free with a median follow-up of greater than 5 years (range 3-10 years), and 11 (10.8%) suffered relapse 3-35 months after lymphadenectomy (median free interval 6 months). 9 of 11 patients developed primarily intrathoracic recurrences. The tumor was so rapidly progressing at relapse, that it was diagnosed when clinically advanced in 7 of 11 cases. Nevertheless, 8 of 11 patients were salvaged with effective available chemotherapy and resection of residual disease. Only scrotal violation showed a significant increased risk of tumor recurrence (5 of 24 cases, versus 6 of 78 who had inguinal orchidectomy, p less than 0.05). We recommend a very close follow-up for all patients with pathologically assessed stage I nonseminomatous germinal testis tumors during the first 3 years following orchidectomy and retroperitoneal lymphadenectomy. With early recognition of relapse, an approximately 100% cure rate will be achieved with effective available chemotherapy.
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Pizzocaro G, Zanoni F, Milani A, Piva L, Salvioni R, Pasi M, Pilotti S, Monfardini S. Retroperitoneal lymphadenectomy and aggressive chemotherapy in nonbulky clinical Stage II nonseminomatous germinal testis tumors. Cancer 1984; 53:1363-8. [PMID: 6198070 DOI: 10.1002/1097-0142(19840315)53:6<1363::aid-cncr2820530624>3.0.co;2-i] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In a former series of 60 resected Stage II nonseminomatous germinal testis tumors the authors succeeded in demonstrating that adjuvant cisplatin, vinblastine, and bleomycin (PVB) was able to significantly improve survival (100% in 11 treated versus 28.5% in 7 historical controls, P less than 0.01) only in patients with retroperitoneal metastases greater than 5 cm, macroscopic extranodal spread, tumor invasion into retroperitoneal veins (pathologic Stage II-C). Forty-eight evaluable patients with clinical nonbulky Stage II nonseminomatous testis cancer underwent retroperitoneal lymphadenectomy as primary treatment. Four courses of postoperative PVB were administered only to 18 clinically understaged patients (14 pathologic Stage II-C, and 4 postoperatively reclassified as Stage III). The remaining 30 patients were followed at monthly intervals. After a median follow-up of 25 months, relapses were: 1 (10%) in 10 pathologic Stage I patients; 8 (40%) in 20 pathologic Stage II-A and II-B; null in the 18 treated. Eight of the nine patients (89%) who had relapse entered continuous complete remission following salvage therapy. The overall 2-year disease-free survival in this case series is 98%. Retroperitoneal lymphadenectomy followed by compulsive follow-up and selective use of aggressive chemotherapy is an alternative to remission induction chemotherapy as primary treatment in clinical nonbulky Stage II nonseminomatous testis cancer, and to immediate adjuvant chemotherapy in all patients with resected Stage II disease.
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Pizzocaro G, Zanoni F, Piva L. Distribuzione Delle Metastasi Retroperitoneali Da Carcinoma Del Testicolo. Urologia 1981. [DOI: 10.1177/039156038104800132] [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: 11/16/2022]
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Pizzocaro G, Monfardini S, Zanoni F, Fossati V, Riboldi G, Alloisio M. Combined surgery and chemotherapy for retroperitoneal metastases of testicular carcinomas other than pure seminoma. Eur Urol 1979; 5:86-9. [PMID: 84759 DOI: 10.1159/000473073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The results of treatment in 210 patients with testicular carcinomas other than pure seminoma are analysed. Patients with negative retroperitoneal nodes had a very good prognosis following lymph node dissection alone. Patients with positive nodes did much better after adjunctive chemotherapy than after post-operative irradiation. Patients with advanced disease showed significant improvement with intensive chemotherapy combined with surgery. Presently retroperitoneal lymphadenectomy combined with intensive chemotherapy seems to be the treatment of choice for metastatic testicular carcinomas.
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Paolucci R, Bianchi G, Zanoni F, Fialdini G, Sharif C. [Surgical treatment of complications in cases with cancer of the colon and rectum]. MINERVA CHIR 1977; 32:19-26. [PMID: 300858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Personal experience and the literature are referred to in an examination of complications arising in the course of cancer of the large intestine. A personal series assembled in about 20 years is presented. It consists of 135 cases of heteroplasia, including 57 emergency admissions for complications. The surgical technique employed is described. The results show that surgical risk and post-operative mortality are lower in patients subjected to major radical surgery, as opposed to those for whom symptomatic management or simple, derivative operations are prescribed.
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Abstract
Twelve consecutive cases of non-Hodgkin's lymphomas with initial testicular involvement have been considered in this retrospective evaluation. In 801 cases with referred for treatment to the Istituto Nazionale Tumori of Milan from 1962 to 1974 evidence of initial testicular involvement was observed in 1,4 % of cases. Of the whole group of testicular tumors treated in our Institute only 3 % were classified as non-Hodgkin's lymphomas. Six out of 12 patients with stage I (2 cases) and II (4 cases) diseases were treated with Cobalt therapy to the retroperitoneal nodes. Only one patient remained free of disease after radiotherapy. Three patients relapsed after primary irradiation and six patients classified as stage IV were treated with chemotherapy. Patients receiving combination chemotherapy had in general a better quality of response and a larger, but not significantly different, survival, compared to patients given simple agent sequential chemotherapy. Since the differential diagnosis between testicular lymphomas and seminomas may cause some difficulties and therapeutic implications are different, clinicians should be alert to this problem: in our case series testicular non-Hodgkin's lymphomas was the most frequent non-germinal tumor of the testicle.
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