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.

Vertebroplasty in the treatment of osteoporotic vertebral fractures: results and functional outcome in a series of 175 consecutive patients.

Osteoporosis is the most common cause of vertebral collapse, which significantly impairs mobility and quality of life. Primary management consists of conservative therapeutic measures such as analgesics, bed rest, external bracing and rehabilitation. Percutaneous vertebroplasty for the treatment of osteoporotic compressive fractures has gained popularity during the last decade. The limited invasiveness and encouraging results of vertebroplasty obtained in the treatment of patients with symptomatic osteoporotic compression fractures have favored an extensive use of the procedure for the management of patients with disabling pain refractory to conservative therapy. In the present paper, the authors provide procedure results and functional outcomes in a series of 175 consecutive patients with 242 symptomatic osteoporotic vertebral compression fractures treated by means of percutaneous polymethylmethacrylate vertebroplasty.

Endoscopic release in carpal tunnel syndrome: analysis of clinical results in 200 cases.

Carpal tunnel syndrome is the most common peripheral neuropathy. Conventional carpal tunnel surgery has been performed as a primary procedure for the decompression of the median nerve at the wrist in patients who have idiopathic carpal tunnel syndrome. While the results have been excellent, this surgical procedure has been reported to be related to high postoperative morbidity and extended length of recovery time. Over the past decade, endoscopic release of the transverse carpal ligament has been developed as a new, alternative method to the open procedures. Endoscopic carpal tunnel release has been reported to ensure less postoperative morbidity, more rapid recovery of strength, with earlier return to work, reduced disability time and a better cosmetic result. The authors present a surgical series of 200 hands in 164 patients (36 bilaterals) with idiopathic carpal tunnel syndrome, who underwent a single-portal endoscopic carpal tunnel release (Agee technique), with regards to the clinical outcome and complications occurred after 4-months follow-up.

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.

Diabetes insipidus and increased serum levels of leptin and lactate-dehydrogenase (LDH) in an adolescent boy with a primary intracranial germinoma. Case report and an endocrinological revaluation of literature.

A 16-year-old boy presented with a four-month history of polyuria-polydipsia and a diplopia which had reverted after treatment. The neuroimaging studies performed had been strongly suggestive of an optic nerve glioma, while endocrinological investigation (beta-hCG 420 IU/L) has lead to the correct diagnosis later confirmed at the immunohystochemical analysis performed at biopsy. The high serum level of hCG was unaffected by bromocriptine nor octreotide, while the PRL level (80.0 microg/L) was reduced only by bromocriptine. Among the several tumor markers which may be secreted by such lesions, ours is the first reported case of an elevation of serum LDH for a primary intracranial germinoma. Moreover, the elevated value of serum leptin reported by us might be due to the insensitivity of the hypothalamic structures to endogenous leptin.

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.

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.

Intracranial epidermoid and dermoid cysts. Results of microneurosurgery.

The authors present their series of intracranial epidermoid and dermoid cysts. Clinical, radiological and anatomopathological features of these tumors are analyzed. Appropriate surgical treatment and results are discussed in light of the pertinent literature.

[Surgical aspects of frontal lobe tumors]. / Aspetti chirurgici dei tumori del lobo frontale.

The authors analyze possibilities and limitations of surgery in the treatment of frontal lobe tumors. They also stress the importance of microtechnique and propose notes of operative management.

[The microsurgical treatment of the carpal tunnel syndrome]. / Trattamento microchirurgico della sindrome del tunnel carpale.

Between 1988 and 1994, 101 patients with carpal tunnel syndrome underwent microsurgical treatment. In 69 (68.3%) patients, simple incision of the transverse carpal ligament was performed. The remaining 32 (31.7%) patients also required neurolysis: external neurolysis in 17 (16.8%) patients, both external and internal neurolysis in 15 (14.9%) patients. There were no intra- and postoperative complications. After surgery, preoperative symptoms completely disappeared in 98 (97.1%) patients and improved in 3 (2.9%).

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.

[The neuropsychological study of 21 patients with expanding cerebral lesions. Preliminary results]. / Studio neuropsicologico in 21 pazienti con processo espansivo cerebrale. Risultati preliminari.

Twenty-one right-handed patients with cerebral expanding space-occupying lesion underwent neuropsychological evaluation before surgery. Testing included the Bender Motor Gestalt Test (BMGT), the Benton Visual Retention Test (BVRT), and four subtests of the Wechsler Adult Intelligence Scale (WAIS), namely Digit span, Digit symbol, Picture completion, and Block design. Statistical analysis showed significant differences in cognitive efficiency between the groups defined by the side and biological behaviour of the lesions.

[Solitary capillary hemangioblastoma, cellular variant. Clinical, radiological, and anatomo-pathological study of 2 cases]. / Emangioblastoma capillare solitario, variante cellulare. Studio clinico, radiologico ed anatomo-patologico in due casi.

Two cases of the rare cellular variant of the solitary capillary haemangioblastoma are reported. On MR study both tumors appeared as cerebellar contrast-enhancing masses, without evidence of intra- or perilesional blood vessels. Histologically, they showed compact groups of polygonal or rectangular cells separated by compressed small capillaries. There were no reticulin fibres among cell clusters. The stromal cells were found to be immunopositive for neuron-specific enolase (NSE), factor VIII-related antigen (von Wille-brand factor), Ulex europaeus lectin, and glial frillary acidic protein (GFAP). The findings are discussed in light of the pertinent literature.

[Cortical function in 107 patients with supratentorial expanding mass. Pre- and postoperative study]. / Funzioni corticali in 107 pazienti con P.E. cerebrale. Studio pre- e postoperatorio.

A clinical study on functions of the cerebral cortex is reported. In this regard, 107 patients with a supratentorial expanding mass have been investigated before and after surgical removal of the lesion. The results obtained are discussed in the light of what is available in the literature.

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.

Intramedullary cavernoma: a case report and review of the literature.

A case of spinal cord cavernoma is presented. The pertinent literature is reviewed and the problems of diagnosis and management of this rare condition are discussed.

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.

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.

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.

Comparison of the Raja and the Abrams pleural biopsy needles in patients with pleural effusion.

In 31 patients with exudative pleural effusions, we compared the diagnostic yield of the Abrams pleural biopsy needle with that of a new instrument, the Raja pleural biopsy needle. Each patient was randomly biopsied with both needles, and a total of 153 pleural biopsies were done, 73 with the Abrams needle and 80 with the Raja needle. No complications resulted from biopsies with either needle. Etiologic diagnoses were possible in 38 (52%) biopsies obtained using the Abrams needle, compared with 66 (82.5%) for those using the Raja needle; the difference in proportions for the diagnostic yield was statistically significant (p < 0.01, two-tailed Fisher's exact test). There were no significant differences between the needles in obtaining etiologic diagnoses in any specific disease category. The difference between the mean size of the pleural specimens obtained with the two needles was also statistically significant (p < 0.001, Mann-Whitney U test). The Raja pleural biopsy needle is easy and safe to use, and despite its smaller external diameter yields a significantly larger pleural tissue sample and significantly increases the diagnostic yield of pleural biopsies compared with the Abrams pleural biopsy needle.