Laparoscopic surgery and corticoadrenalomas.

BACKGROUND: Nowadays, laparoscopic adrenalectomy is the "gold standard" procedure for the treatment of benign lesions. However, the situation is not so clearcut when the issue is laparoscopic excision of malignant adrenal tumors. We present our results of laparoscopic adrenalectomy for treating malignant tumors over the past decade. METHODS: Between October 1995 and June 2004, 131 consecutive laparoscopic adrenalectomies were performed on 120 patients (11 synchronous bilateral procedures). All patients underwent a standardized investigation protocol during their workup for surgery. RESULTS: There were only two conversions to laparotomy (1.6%). Complications that occurred during the procedure were limited to six patients (5%). Postoperative 30-days mortality was nil. Postoperative complications occurred in five patients (4.7%) during the first 30 days of recovery. The median hospital stay for all patients was 2.5 days (range = 2-10 days). Twelve patients (9%) had a malignant tumor: nine corticoadrenalomas, one pleomorphic sarcoma, one metastatic deposit from a previously excised colonic cancer, and one malignant pheochromocytoma. At mean followup of 34 months, mean survival time was 42.3 months for corticoadrenalomas that had undergone laparoscopy versus 29.7 months for those who had had a laparotomy. Five of the nine patients are alive and well at a mean of 37 months following surgery. One patient developed pulmonary metastases one year postsurgery; they were responsive to mitotane. Five years later, the same patient had a reoperation for an intra-abdominal retrogastric recurrence of her tumor and continues to do well. Another patient developed pulmonary metastases 22 months following adrenalectomy. Two patients died of metastatic intra-abdominal disease 20 and 7 months postsurgery. CONCLUSION: When laparoscopic surgery is to used for cancer treatment, caution is the rule to maintain the primary objective of securing a survival rate at least as high as that for open surgery, without increased risk of recurrence. Considering the results presented within this study, it seems that the laparoscopic removal of a corticoadrenaloma should not worsen the prognosis, provided the surgeon respects the primary rules of oncologic resectional surgery. Any surgical conditions that would preclude the strict application of these criteria are contraindications to a laparoscopic procedure.

Preliminary results of a dose-finding study of paclitaxel and carboplatin in patients with advanced non-small cell lung cancer.

This ongoing phase I study sought to establish the maximum tolerated dose of the combination of carboplatin and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) given without routine growth factor support to previously untreated patients with stage IIIB and IV non-small cell lung cancer. Paclitaxel was administered as a 3-hour intravenous infusion. The carboplatin infusion was administered over 30 minutes immediately afterward. Patients were assigned sequentially to one of eight treatment groups in which paclitaxel and carboplatin were administered in doses ranging from 130 to 185 mg/m2 and from 230 to 350 mg/m2, respectively. Twenty-four patients have been treated to date, and the maximum tolerated dose has been reached at paclitaxel 185 mg/m2 and carboplatin 350 mg/m2. The combination has an excellent safety profile, with only a few, short-lasting episodes of neutropenia observed and no evidence of infection. At the doses tested, thrombocytopenia has not occurred.

The incidence and early detection of spinal deformities. A study based on the screening of 16,104 schoolchildren.

Screening for spinal curvature (scoliosis and kyphosis) was carried out on children aged six to fourteen at schools in the Lazio region from 1972 to 1976 and this revealed a significant incidence of deformities. Out of 16,104 children examined, 1,163 (7.2 per cent) were affected by scoliotic or kyphotic curves. Of these, 56.5 per cent were scoliotic and 43.4 per cent were kyphotic. The female/male ratio in cases requiring orthopaedic or surgical treatment was 3.7:1. Of the total number of cases examined (16,104) the percentage of slight deformities requiring only physiotherapy or exercise treatment was 6.3 per cent (1,016 cases). 0.85 per cent (137 cases) required conservative orthopaedic treatment (plaster and corset), while 0.06 per cent (ten cases) required operation. This investigation is the first step towards the early diagnosis and treatment of vertebral deformities in Italy.

Experimental scoliosis induced by prolonged minimal electrical stimulation of the paravertebral muscles.

Experimental scoliosis was produced in the rabbit by unilateral electrical stimulation of the paravertebral muscles. The scoliosis was shown to be structural and progressive even after stimulation was stopped. The biochemical and histochemical changes in the intervertebral discs were studied.