61 research outputs found
I bilanci coloniali / G. Fasolis
No full textI bilanci coloniali / G. Fasolis
Roma : Stab. poligrafico editoriale romano, 1925
19 p. ; 25 cm
Estr. da: Rivista coloniale, anno 20., n. 2, 1925
Morbidity associated with anterior iliac crest bone graft
No full textObjective. The aim of this retrospective study was to assess the morbidity of the harvest of the anterior iliac bone graft and the overall satisfaction rates in a group of patients who underwent harvesting of iliac crest bone graft.Patients and Methods. Patients who underwent iliac crest bone graft procedures from January 2002 to August 2009 were recalled and invited to answer a questionnaire about postoperative pain, sensory disturbance, functional limitations, and cosmetic appearance.Results. A total of 61 patients were included in this retrospective study. Seventeen patients (28%) reported postoperative pain. A patient reported an intraoperative hip fracture. Sensory disturbances were reported by 3 patients.Conclusions. Anterior iliac crest can still be considered a favorable donor site for preprosthetic and cleft surgery. Given its relatively low morbidity rate, early ambulation, and hospital discharge, anterior iliac crest still remains the donor site of choice according to the authors. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:586-591
Postoperative infections associated with microvascular free flaps in head and neck reconstruction: Analysis of risk factors and results with a standardized prophylaxis protocol
No full textCurrently, large defects of the head and neck regions are mainly reconstructed using microvascular free flap. Postoperative infections, including surgical site infections (SSIs) and medical postoperative infections (MPI), are important causes of morbidity and worsening of surgical outcomes. The authors aimed to analyze the results obtained using a standardized prophylaxis protocol in a series of 100 consecutive patients who underwent microvascular re- construction surgery between 2016 and 2021 at a single institution, to identify the risk factors, which could be overcome, to minimize the incidence of infectious complications. In this study, 24 patients developed infectious complications. Higher American Society of Anesthesiologists (ASA) score was statistically associated with higher risk of infectious com- plications (p = 0.01), need for postoperative transfusions (p = 0.01), and higher T and N stage (p = 0.03 and p = 0.02, respectively) in patients with cancer. We also found a correlation between the increase in surgery duration, hospitalization, and intensive care unit (ICU) stay with higher risk of infection (p = 0.03, p = 0.01, and p = 0.001, respectively). Nine patients reported partial or total flap necrosis and in this group of patients, a higher incidence of in- fectious complication was recorded (p = 0.001). Our experience shows that SSIs and MPIs affect the global and surgical outcomes of patients and both their incidences can be reduced by correcting potential risk factors preoperatively (e.g., anemia), intraoperatively (amount of blood loss and duration of surgery), and postoperatively (duration of hospitalization and ICU stay and early elimination of potential sources of infection). (c) 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd
Incidence of skeletal complications in patients with bone metastatic prostate cancer and hormone refractory disease: predictive role of bone resorption and formation markers evaluated at baseline.
No full textPURPOSE: We evaluated the incidence of skeletal complications in patients with bone metastatic prostate cancer and hormone refractory disease. We also assessed the predictive role of bone turnover markers determined at baseline. MATERIALS AND METHODS: A total of 112 patients were consecutively enrolled in our study from July 1990 to July 1998 and followed until death or the last followup. Bone pain, disease extent in bone, serum prostate specific antigen, hemoglobin, and a panel of bone formation and resorption markers were assessed at baseline before any second line treatment. RESULTS: Skeletal complications in 34 patients (30.3%, estimated yearly incidence 12.3%) involved vertebral deformity or collapse requiring spinal orthosis in 20 (17.9%), spinal cord compression in 7 (6.2%), pathological bone fracture in 10 (8.9%), symptomatic hypercalcemia in 1 (0.9%) and symptomatic hypocalcemia in 1 (0.9%). Median time to the evidence of the initial skeletal complication was 9.5 months. These adverse events did not influence overall survival. At baseline patients with eventual skeletal complications had greater bone pain (p = 0.02), a heavier tumor load in bone (p = 0.005), lower performance status (p = 0.05), and higher serum alkaline phosphatase (p <0.02) and urinary deoxypyridoline (p <0.05) than their counterparts. Multivariate analysis revealed that only urinary deoxypyridinoline was independently associated with the onset of these events (p <0.02). The scatterplot of urinary deoxypyridinoline values in patients with and without skeletal complications enabled us to detect a cutoff of 38 pM./mM. for predicting 51% of skeletal events with only an 8% false-positive rate. CONCLUSIONS: Skeletal complications are common in patients with prostate cancer and hormone refractory disease. Bone loss is the major cause of onset. Baseline deoxypyridinoline at the cutoff point noted had moderate sensitivity but high specificity for predicting these adverse skeletal events
Standard vs. anatomical 180-W GreenLight laser photoselective vaporization of the prostate: a propensity score analysis.
No full textPURPOSE:
To compare the efficacy, safety, Patient Global Impression of Improvement (PGI-I), and complications rates after 180-W GreenLight laser (180-W GL laser) standard and anatomical photoselective vaporization (sPVP and aPVP).
METHODS:
Within a multi-institutional database, we identified patients who underwent sPVP or aPVP to relief BPH symptoms. IPSS, Q max, and prostate-specific antigen (PSA) were measured at baseline and during the follow-up. PGI-I score as well as early and late complications were recorded at follow-up visits. Log-binomial and multivariable proportional odds regression models were fitted to estimate the effect of aPVP vs. sPVP on PGI-I as well as on early and late complication rates, before and after adjustment for propensity score.
RESULTS:
813 patients were included. Of those, the 50.4% underwent aPVP. Patients who underwent aPVP had larger prostate (64 vs. 55 mL, p < 0.001) and higher baseline PSA levels (3.1 vs. 2.5 ng/mL, p < 0.001). PGI-I score was signaled as very improved, improved, slightly improved, unchanged, or worsened in 55.5, 32.8, 8.3, 2.3, and 1.2% of the cases, respectively, with no differences according the technique used (p = 0.420). Acute urinary retention occurred in 9.2 vs. 8.9% of patients after aPVP vs. sPVP (p = 0.872). All models failed to find differences in: patients' satisfaction (OR 1.19, p = 0.256), early complications (RR 0.93, p = 0.387), early urge/incontinence symptoms (RR 0.97, p = 0.814), and late complications rates (RR 0.70, p = 0.053), after aPVP vs. sPVP.
CONCLUSION:
Our results showed similar functional results and complication rates after aPVP and sPVP. However, aPVP was used in larger prostates. Both techniques guarantee high patient's satisfaction
Management and outcomes of three cases of rhinocerebral mucormycosis
No full textMucormycosis is a rare opportunistic infection caused by fungi belonging to Mucorales order. The infection usually starts in the middle or inferior nasal meatus and then spreads to the paranasal sinuses and the orbit. Then it reaches the brain through the ethmoid and the orbit apex and can lead to lethargy, paralysis, and death. The majority of cases of rhinocerebral mucormycosis are diagnosed in patients with immunologic and metabolic disorders. Early diagnosis is fundamental, and so is medical therapy with amphotericin B along with surgical toilet of the compromised tissues. This article presents and discusses the management of 3 cases of rhinocerebral mucormycosis with different onsets, progressions, and outcomes. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:e69-e74
Redox state and carbonic anhydrase isozyme IX expression in human renal cell carcinoma: biochemical and morphological investigations
No full textClear renal cell carcinomas (RCC) frequently express carbonic anydrase IX (CA IX) because of non-functional mutation of von Hippel Lindau (VHL) tumor suppressor gene. CA IX is a tumor-associated transmembrane antigen, which catalyzes the extracellular, reversible hydration of carbon dioxide to bicarbonate and proton and thereby contributes to acidification of extracellular milieu. Extracellular acidic pH facilitates tumor growth and progression. CA IX expression is upregulated by Hypoxia Inducible Factor-1 (HIF-1), which is negatively controlled by oxygen via wild type VHL protein and is also regulated by the cell redox state. We investigated the immunohistochemical pattern of distribution of CA IX in a small series (14 cases) of RCCs. CA IX expression was matched with the redox state of RCC, stratifying our series in relation to clinical and histopathological parameters, such as Fuhrman grade, staging, proliferation markers expression, and particularly, the presence of necrosis. Our results show for the first time the existence of a perivascular pattern of CA IX distribution in RCC. We also found a significant relationship between CA IX expression and the presence of necrosis. Tumors with higher CA IX expression exhibited higher degree of necrosis (p < 0.05). Notably, an almost significant relationship between the redox state and CA IX expression was detected in RCC patients with 5 years disease-free survival, most of them showing organ-confined disease. Tumors with lower redox state showed an algebraically higher degree of CA IX expression. On the contrary, tumors with higher redox state exhibited an algebraically lower CA IX expression (p = 0.057). The observed relationship of CA IX expression and necrosis suggests a role for CA IX in RCC. Further investigations are necessary to further establish the role of the redox state in regulation of CA IX expression in RCC
Changes in free and free-to-total prostate specific antigen after androgen deprivation or chemotherapy in patients with advanced prostate cancer.
No full textPURPOSE: To provide preliminary data on whether the diagnostic role of serum prostate specific antigen (PSA) in assessing the response to treatment is improved by concomitant free PSA evaluation both markers were evaluated in 42 patients with advanced prostate cancer who received hormonal therapy and 57 with hormone refractory disease who received chemotherapy. MATERIALS AND METHODS: PSA was assessed at baseline and every 3 months during treatment. Free PSA was assessed in stored serum samples obtained at baseline and at maximum PSA decrease. Free PSA was not measurable in 17 patients who received androgen deprivation (40.5%) and 2 who received chemotherapy (3.5%) because it was less than 1.5 ng./ml. RESULTS: Of the 21 patients with greater than 50% PSA decrease after hormonal therapy free-to-total PSA increased in 12 (57.2%) and decreased in 9 (42.9%). Of the 20 patients with PSA response after chemotherapy free-to-total PSA increased in 18 (90.0%) and decreased in 2 (10.0%). Free-to-total PSA increased in 12 of the 20 patients (60.0%) with PSA stabilization after chemotherapy. Patients with an increase in free-to-total PSA after chemotherapy had greater survival compared to those with a decrease or no change (19.8 versus 15.5 months, respectively, p <0.03). CONCLUSIONS: These data suggest that an effective cytotoxic regimen mainly affects the protein bound PSA fraction. The absence of a clear predominant pattern of free-to-total PSA in patients with PSA response to hormonal therapy and the high percentage of hormone sensitive patients in whom free PSA was not assessable at maximum PSA decrease suggest that free PSA evaluation is less useful in prostate cancer patients undergoing androgen deprivation
Osteoblastic flare assessed by serum alkaline phosphatase activity is an index of short duration of response in prostate cancer patients with bone metastases submitted to systemic therapy.Gruppo Onco Urologico Piemontese (G.O.U.P).
No full textA transient rise in serum alkaline phosphatase (ALP) activity (ALP flare) after androgen deprivation in prostate cancer patients with bone metastases has been previously correlated with both response to therapy and poor prognosis. In the present study we analyzed data coming from an Italian multicenter phase III, trial aimed to compare the efficacy of treatment with goserelin alone with that of goserelin plus mitomycin C. Sixty-seven bone metastatic patients were enrolled: 32 were treated with goserelin and 35 with and goserelin plus mitomycin. 58 cases had ALP measured every month; and were considered for flare assessment. Remarkably elevated ALP and PSA levels at baseline were significantly correlated with poor prognosis. The addition of mitomycin to goserelin resulted in a greater percent reduction of PSA values with respect to goserelin alone but did not augment the time to progression and overall survival. The monthly profile of ALP serum levels was superimposable in patients assigned to hormone therapy or chemotherapy plus hormone therapy. Patients showing a flare in ALP activity (transient rise > 15% in ALP values with respect to baseline at the first month) were classified as responders to therapy or as having stable disease upon PSA evaluation and/or at bone pain assessment, but had a shorter time to progression (median 12 months) in comparison to those showing a different ALP pattern (median 23 months). The measurement of flare in ALP activity during androgen suppression with or without concomitant mitomycin administration, may permit the early identification of patients who are likely to progress rapidly, and hence be candidate for more aggressive treatments
Prospective assessment of taste impairment and nausea during radiotherapy for head and neck cancer
No full textDysgeusia and nausea are common side effects observed in head and neck cancer patients treated with either exclusive radiotherapy or combined modality treatment. The aim of the present study was to prospectively evaluate dysgeusia, during treatment and follow-up, using the chemotherapy-induced taste alteration scale (CiTAS), a metrics based on 18-items exploring three dimensions (quantitative and qualitative changes in taste perception, and diet-related issues) identified through a four-factor analysis: decline in basic taste, discomfort, phantogeusia–parageusia, and general taste alterations. Moreover, we scored, according to Common Toxicity Criteria Adverse Events, nausea and other treatment-related toxicities. Since, ginger is traditionally used to prevent and/or treat nausea and vomiting, we prophylactically employed a ginger-based supplement named Naumix/Naugin (Gamfarma, Milan, Italy), to potentially mitigate both nausea and taste impairment. Using the CiTAS scale, we highlighted a progressive increase in all dysgeusia dimensions, peaking at the VII week of treatment and a subsequent partial late recovery. In particular, we observed a recovery for discomfort, phantogeusia–parageusia, and general taste alterations at 6 months. Grade 2 nausea, observed to be as low as 12.9% potentially due to the use of ginger, peaked at the III week of treatment. Finally, for patients experiencing nausea, the dysgeusia dimension of discomfort was also relevant
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