Preoperative weekly cisplatin, epirubicin, and paclitaxel (PET) improves prognosis in locally advanced breast cancer patients: an update of the Southern Italy Cooperative Oncology Group (SICOG) randomised trial 9908.

BACKGROUND: The present article reports the updated survival outcome of the 200 patients enrolled in the Southern Italy Cooperative Oncology Group 9908 trial, which compared 12 weekly cycles of cisplatin-epirubicin-paclitaxel (PET) with 4 triweekly (once every 3 weeks) cycles of epirubicin-paclitaxel (ET) in patients with locally advanced breast cancer (LABC). METHODS: The effects of treatment, pathologically documented response (pathological response), pre- and post-treatment biomarkers on relapse-free survival (RFS), distant metastasis-free survival (DMFS), and overall survival (OS) are analysed. RESULTS: At a median follow-up of 74 (range 48-105 months) months, the 5-year RFS, DMFS, and OS were 64 % versus 53% (P = 0.11), 73% versus 55% (P = 0.04), and 82% versus 69% (P = 0.07) in PET and ET, respectively. At multivariate analysis, after adjusting treatment effect for pretreatment biomarkers, PET independently predicted better DMFS (P = 0.018) and OS (P = 0.03), whereas the impact on RFS was of borderline significance (0.057). PET treatment was significantly better than ET treatment only in high-grade or highly proliferating tumours. The better outcome in PET arm was the results of both the higher rate of patients with optimal pathological response and the lower rate of patients with biologically aggressive residual tumour. CONCLUSIONS: The PET weekly regimen significantly improves both DMFS and OS in LABC patients, compared with the triweekly ET combination. The therapeutic advantage is limited to patients with highly aggressive tumours.

The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases.

BACKGROUND: Mean platelet volume (MPV) is arousing increasing interest as a new independent cardiovascular risk factor. AIM: To provide a comprehensive review on the biological significance, the main determinants and the prognostic implications of MPV. METHODS: A literature search was performed using key terms, such as 'MPV' or 'mean platelet volume', together with 'stroke', 'myocardial infarction' and 'diabetes and 'obesity'. RESULTS: Large platelets are likely more reactive: elevated MPV values are associated with a shortened bleeding time and increased thromboxane B2 plasma levels. Thus, MPV could be considered an indicator of platelet function. Platelet size is mainly determined in the bone marrow during megakaryocytopoiesis, and subsequently does not substantially change. MPV is only partially regulated by thrombopoietin: in fact, growth factors and cytokines may also elicit the production of larger and more reactive platelets in the bone marrow, in the presence of conditions capable of increasing their concentrations, such as obesity, endothelial dysfunction and possibly myocardial and cerebral ischaemia. This phenomenon could play an important role in vascular diseases. In fact MPV is predictive of stroke, acute myocardial infarction (AMI) and restenosis of coronary angioplasty, is increased in the presence of obesity, diabetes mellitus, metabolic syndrome, AMI and stroke and has been shown to have a prognostic significance in patients with stroke and AMI. CONCLUSION: In assessing whole blood count, MPV should not be undervalued, as its increase should suggest a careful assessment of cardiovascular risk.

Amiodarone-associated hemoptysis.

The manifestations of amiodarone pulmonary toxicity (APT) are generally nonspecific, and a diagnosis requires appropriate clinical history, laboratory testing consistent with toxicity, and exclusion of other disease entities. To our knowledge, hemoptysis associated with APT has not been described before; the following report describes such a case. We suggest that APT should be considered among the differential diagnosis of hemoptysis in a patient receiving amiodarone.

Cord diameters and their significance in prognostication and decisions about management of cervical spondylotic myelopathy.

The cases of 35 cervical spondylotic myelopathy patients exhibiting areas of high signal intensity within the cervical cord on T2 and proton density weighted MR images were reviewed. In each case, the ratio of the anteroposterior diameter to the transverse diameter (anteroposterior compression ratio or APCR) at the most compressed segment of the cervical cord was measured on axial MR images and compared with the patient's neurological status. The patients with APCR of 40% or more had a better neurological condition than those with APCR of 38% or less. At the same time, the neurological condition was worse in the patients with APCR of 10% or less than in those with APCR of 15% or more. All patients underwent surgery. The preoperative APCR was compared with the outcomes. The patients with preoperative APCR of 15% or more improved after the operation, but the degree of recovery varied considerably from case to case. The patients with preoperative APCR of 10% or less remained unchanged postoperatively.

Soft cervical disc herniation. An analysis of 187 cases.

METHODS: During the period from January 1986 to December 1994, 187 consecutive patients (102 males and 85 females, between the ages of 24 and 63 years) with soft disc herniations of the cervical spine were operated on by anterior approach. RESULTS: One hundred and twenty-seven (67.9%) patients presented pure radicular syndrome, 17 (9.1%) with pure medullary syndrome, and 43 (23%) with myeloradiculopathy. Disc herniation was at the C3/4 level in 8 (4.3%) cases, at the C4/5 level in 17 (9.1%) cases, at the C5/6 level in 101 (54%) cases, and at the C6/7 level in 87 (46.6%) cases. In 18 (30%) patients suffering from myelopathy (with or without radiculopathy) an area of high MR signal intensity was observed within the cervical cord on T2-weighted images; such area corresponded at the level of cord compression by the herniated disc and was not demonstrated on T1-weighted images. All patients underwent microdiscectomy without bone grafting. Complete or almost complete relief of preoperative symptomatology was observed in 95.6% of patients with radiculopathy and in 83.3% of those with myelopathy.

Supratentorial intracerebral hemorrhage after posterior fossa surgery. Case report.

One case of supratentorial intracerebral hemorrhage after posterior fossa surgery is described. The possible causes and relative surgical problems are discussed on the basis of the other reported cases.

Auditory middle latency responses in patients with intracranial space-occupying lesions.

Auditory middle latency responses (MLRs) and auditory brainstem responses (ABRs) were investigated pre- and postoperatively in three patients operated on of intracranial tumor (craniopharyngioma in cases 1 and 2, left-temporal cystic astrocytoma in case 3). In each case examined, preoperative MLRs were informative in evaluating the damage to supratentorial neural structures owing to the tumor; furthermore, they allowed a precious evaluation of the functional integrity of these structures after surgery. Likewise, in case 2 the ABRs indicated a brainstem injury secondary to overzealous manipulation of the right temporal lobe. Finally, in case 3, the most prominent complex of the MLRs, ie Na-Pa, was abnormal both before and after intervention; indeed, in pre- and postoperative MLRs, Na could be identified in both ears, whereas Pa was greatly reduced in amplitude or absent: this finding would seem to suggest that Na and Pa have different generator sites.

MR signal enhancement in cervical spondylotic myelopathy. Correlation with surgical results in 35 cases.

In a review of Magnetic Resonance (MR) imaging findings of 35 cervical spondylotic myelopathy patients, a localized increased signal intensity was observed within the most compressed segment of the cervical cord on T2 and proton density weighted images. Size and duration of cervical cord constriction seemed to be the predisposing factors in producing such an abnormality. All patients underwent surgery. Postoperatively the high MR signal intensity disappeared in 3 (8.6%) cases, decreased in other 20 (57.1%) cases, and did not change in the remaining 12 (34.3%) cases. Thus reversible (edema, transient ischemia) and/or irreversible (malacia, gliosis) histological changes seemed to be represented in MR signal enhancement.

A rare case of Toxocara canis arachnoidea.

The Authors present a case of Toxocara canis arachnoidea located in the cervical zone. The rarity of the case and the extreme rarity of the position are emphasized. In fact in medical literature there exists a description of only one similar case which was also observed by one of the authors.

Metastasis of breast carcinoma to intracranial meningioma. Case report and review of the literature.

A case of metastasizing breast carcinoma to an intracranial meningioma is presented. The pathogenesis and principles of diagnosis of this rare occurrence are discussed in light of the data reported from the literature.

Traumatic aneurysms of the carotid artery. Case report.

The Authors report a rare case of traumatic aneurysm of the internal carotid artery observed in a 19-year-old man after a car accident. The aneurysm was recognized by cerebral angiography performed immediately after trauma and clipped to avoid delayed rupture. The literature on traumatic aneurysms is reviewed.

Supratentorial dermoid cysts. Presentation and management of five cases.

Five patients with supratentorial dermoid cysts who were surgically treated are presented. There were three males and two females, between the ages of 17 and 35 years (mean 26.6 years). The tumor location was frontobasal and/or temporobasal. The duration of illness before the diagnosis ranged from 1 to 14 months (mean 7.4 months). Clinical presentation included seizures, intracranial hypertension syndrome, aseptic meningitis, homonimous lateral hemianopsia, and memory defect. Preoperatively, all patients were investigated by computerized tomography (CT); in two cases, magnetic resonance (MR) imaging was also obtained. Tumor removal was performed by microsurgical procedures; it was total in 3 cases and subtotal in the remaining 2 cases. Histologically, all of the tumors exhibited the typical dermoid cyst pattern. There were no operative deaths. Two patients experienced postoperative language dysfunction and/or hemiparesis. No patient developed clinicoradiological evidence of tumor recurrence at 1 to 10 years (mean 5 years) following surgery. These results are discussed in light of the data previously reported by the literature.

Myeloradicular damage in traumatic cervical disc herniation.

BACKGROUND: The literature on pure traumatic disc herniation is now voluminous but diversity of opinion exists regarding frequency, pathogenesis and management of this type of lesion. As a further contribution to the solution of the question it is thus justified to report our series of cervical traumatic disc herniation. METHODS: During the period from January 1986 to December 1994, 41 patients (25 males and 16 females, between the ages of 24 and 51 years) with traumatic cervical disc herniations were operated on by anterior approach. Twenty-six (63.4%) patients presented with radicular syndrome, 3 (7.3%) with medullary symptoms and signs, and 12 (29.3%) with myeloradiculopathy. Disc herniation was at the C3/4 level in 4 (9.7%) cases, at the C4/5 level in 7 (17.1%) cases, at the C5/6 level in 24 (58.5%) cases, and at the C6/7 level in 8 (19.5%) cases. In 6 (40%) patients suffering from myelopathy (with or without radiculopathy) an area of high MR signal intensity was observed within the cervical cord on T2-weighted images; such area corresponded at the level of cord compression by disc and was not demonstrated on T1-weighted images. All patients underwent discectomy without bone grafting. RESULTS: Among patients with radiculopathy, 27 (71%) experienced complete relief of preoperative symptomatology, and 11 (29%) minor pain and/or neurological deficits without interference with work activities. The myelopathy completely disappeared in 11 (73.3%) cases whereas remained unchanged in 3 (20%); 1 patient with myelopathy experienced amelioration of preoperative specific symptoms and signs. CONCLUSIONS: The results of surgery for cervical radiculopathy due to traumatic disc herniation are satisfactory since 92 to 100% of the patients postoperatively regain prior activities, an observation we have confirmed with our own series. The results in cases of myelopathy are less satisfactory: although approximately 73% of our patients with myelopathy reported total relief of preoperative symptomatology, published reports indicate that a significant postoperative improvement is seen in 33 to 56% of patients.

Prognostic significance of lymphoid infiltration in cerebral malignant gliomas.

Data concerning a study on lymphoid infiltration in 61 cerebral malignant gliomas are reported. Lymphoid cellular infiltrates were found in 28 cases (45.9%): 8 (13.1%) with marked and 20 (32.8%) with slight infiltration; the remaining 33 cases (54.1%) did not exhibit lymphoid infiltration. The mean survival time (+/- standard deviation) of patients harboring gliomas with marked lymphoid infiltration was 20.5 (+/-19.9) months, and that of patients with slight lymphoid infiltration in their glioma was 10.3 (+/- 7.5) months; those patients having gliomas without lymphoid cellular infiltrates showed a mean survival time (+/- standard deviation) of 7.2 (+/-6.1) months.

Paravertebral retropleuric microsurgery approach to the treatment of thoracic disc herniation. Personal experience and consideration of unsatisfactory results.

AIM: The authors report their experience on the paravertebral retropleuric microsurgery approach to the treatment of thoracic disc herniation. The paper describes both the approach and its result and it further expands on the reason behind the few cases of unsatisfactory results. METHODS: Twenty-three patients were operated upon for thoracic disc herniation between 1994 and 2000. The paravertebral retropleuric microsurgery approach was used in each. RESULTS: The results were very satisfactory in 20 cases, with all symptoms completely disappearing. In only 3 cases we had unsatisfactory results. CONCLUSION: We think that the postero-lateral retropleuric approach is a correct method for the treatment of thoracic disc herniation because it did not cause any significant bone intervention.

Pleomorphic xanthoastrocytoma: clinical, imaging and pathological features of four cases.

Four cases of pleomorphic xanthoastrocytoma (PXA) were collected from among 688 glioma patients who underwent operation at the Institute of Neurosurgery, University of Naples "Federico II" between January 1973 and December 1994. Three were females and one male, ranging in age from 10 months to 65 years. Three tumors were superficial in location, appearing as a meningo-cerebral mass in the temporo-parietal region. In one case, the tumor was situated deep within the brain (capsulo-thalamic region), without contact with leptomeninges. Three patients had experienced epileptic seizures, whereas one patient presented with an ictal episode. Tumor excision was grossly total in two cases, and subtotal in the remaining two. In three cases, histological examination demonstrated a "typical" PXA; conversely one tumor (subtotal excised) was an "atypical" PXA. The two patients with incomplete surgical resection were postoperatively treated with fractionated brain radiation therapy. Of the two patients who had grossly total removals, one showed tumor recurrence 6 years after surgery, and underwent operation (the recurrent neoplasm did not exhibit malignant transformation); the second patient was free of tumor at 14 months following craniotomy. Of the two patients who had undergone subtotal removals, one died because of massive regrowth of the lesion 22 months after surgery, whereas the second patient was asymptomatic at 1 year follow up.

Atypical pleomorphic xanthoastrocytoma.

A 65-year-old man experienced an ictal episode. CT revealed a left capsulo-thalamic mass, and SPET showed hypoperfusion of the left cerebral emisphere. The lesion was subtotally removed, and postoperative radiotherapy was given. Pathological examination demonstrated an "atypical" pleomorphic xanthoastrocytoma. The patient died of massive regrowth of the tumor 22 months after surgery. This case is discussed in light of the pertinent literature.

Intracerebral haemorrhage: criteria for prognosis on the grounds of clinical and CT data.

The Authors report analyses on 83 cases of brain haemorrhage which were conducted over a period of 6 years. On the basis of previous studies made by the same authors, a selection was made from patients whose survival index rating did not exceed 8.1. These patients were treated only with medical and reviving therapies. In this work we attempt to formulate some considerations regarding the prognosis of brain haemorrhage on the basis of clinical and tomodensitometric data.

The operation of arthrodesis for malformations of the occipito-atloid joint, according to Gilles Bertrand.

Malformations of the occipito-vertebral hinge destabilize the bones and injure the neural structures of the bulbo-spinal junction and of the cervico-spinal cord. The Authors have found the Gilles Bertrand intra-articular C/1-C/2 bilateral arthrodesis to be an extremely efficient surgical procedure for stabilizing the occipito-atlo-axial region, producing a relative lowering of the odontoid and relieving pressure in the occipito-atloid region. Excellent post-operative results derive from the relatively easy and non-destabilizing operative procedure. No deaths have been recorded in connection with this operation. This contrasts with the traditional occipito-atloid pressure-relieving procedure (either with or without opening of the dura mater), a procedure which, in addition to not stabilizing the upper cervical spine, sometimes results in the patient's death.

Neurocysticercosis. Case report.

In the present review we report a case of a 53-year-old woman affected with a cyst solitary cerebral hemispheric lesion causing acute generalized seizure. Clinical and neuroradiologic diagnosis of cystic astrocytoma was performed and the patient was operated. Microscopic analysis of the surgical specimen led to a diagnosis of parasitic infection, consistent with neurocysticercosis (NCC). NCC is the most frequent parasitosis of the central nervous system (CNS) in the world. The infective agent is taenia solium larvae. It is endemic in Latin America, Africa and some Asiatic countries, such as India. In Europe, many cases have been reported in Portugal, Spain, Poland and Romania. In Italy NCC is a rare disease. In recent years no cases have been described, but with high rate of immigration from endemic areas (Africa and East Europe) this parasitosis will be found in our country too, particularly affecting communities where hygienic conditions are poor. In conclusion we briefly analyze the relationship between pathogenesis of this parasitosis and its clinical symptoms.