Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple-negative, early high-risk and locally advanced breast cancer: NeoTRIP Michelangelo randomized study.

BACKGROUND: High-risk triple-negative breast cancers (TNBCs) are characterized by poor prognosis, rapid progression to metastatic stage and onset of resistance to chemotherapy, thus representing an area in need of new therapeutic approaches. Programmed death-ligand 1 (PD-L1) expression is an adaptive mechanism of tumour resistance to tumour-infiltrating lymphocytes, which in turn are needed for response to chemotherapy. Overall, available data support the concept that blockade of PD-L1/programmed cell death protein 1 checkpoint may improve efficacy of classical chemotherapy. PATIENTS AND METHODS: Two hundred and eighty patients with TNBC were enrolled in this multicentre study (NCT002620280) and randomized to neoadjuvant carboplatin area under the curve 2 and nab-paclitaxel 125 mg/m2 intravenously (i.v.) on days 1 and 8, without (n = 142) or with (n = 138) atezolizumab 1200 mg i.v. on day 1. Both regimens were given q3 weeks for eight cycles before surgery followed by four cycles of an adjuvant anthracycline regimen. The primary aim of the study was to compare event-free survival (EFS), and an important secondary aim was the rate of pathological complete response (pCR defined as the absence of invasive cells in breast and lymph nodes). The primary population for all efficacy endpoints is the intention-to-treat (ITT) population. RESULTS: The ITT analysis revealed that pCR rate after treatment with atezolizumab (48.6%) did not reach statistical significance compared to no atezolizumab [44.4%: odds ratio (OR) 1.18; 95% confidence interval 0.74-1.89; P = 0.48]. Treatment-related adverse events were similar with either regimen except for a significantly higher overall incidence of serious adverse events and liver transaminase abnormalities with atezolizumab. CONCLUSIONS: The addition of atezolizumab to nab-paclitaxel and carboplatin did not significantly increase the rate of pCR in women with TNBC. In multivariate analysis, the presence of PD-L1 expression was the most significant factor influencing the rate of pCR (OR 2.08). Continuing follow-up for the EFS is ongoing, and molecular studies are under way.

Endoscopic mucosal resection in high- and low-volume centers: a prospective multicentric study.

BACKGROUND: Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study. METHODS: This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR. RESULTS: A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4% and females for 39.6% of the patients. Most of the EMRs (84.8%) were performed in HVCs and only 15.2% in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7% of the patients in HVCs only. Complete excision was achieved for 98.6% of the lesions in HVCs and 98.8% of the lesions in LVCs. The complication rate was 4.4% in HVCs and 4.6% in LVCs (p = 0.94). Delayed bleeding occurred in 2.5% of the HVC cases and 3.1% of the LVC cases. Perforation occurred in 1.9% of the HVC cases and 1.5% of the LVC cases (p = 1.00). Recurrences were experienced with 15% of the lesions: 15.5% in HVCs and 14% in LVCs (p = 0.79). CONCLUSIONS: The study showed that EMR can be performed also in LVC.

Sero-epidemiology of toxocariasis in a rural settlement in São Paulo state, Brazil.

The seroprevalence of Toxocara canis and risk factors for infection with this parasite were explored in a rural settlement in São Paulo state, Brazil. Total IgA and IgE levels in 79 subjects were determined by turbidimetry and chemiluminescence, respectively. Total counts of leucocytes and erythrocytes and differential counts of leucocytes were made by flow cytometry. ELISA for the detection of anti-Toxocara IgG, IgA and IgE were standardized using Toxocara excretory-secretory antigens (TES) obtained from the cultured second-stage larvae of T. canis. Seventeen (21.5%) of the subjects were found positive for anti-Toxocara IgG, with no significant differences in such seropositivity with age or gender. Thirty (38%) of the subjects showed eosinophilia and 70 (89%) had elevated levels of total IgE. Among the 17 subjects found seropositive for anti-Toxocara IgG, the percentage of leucocytes represented by eosinophils (P=0.0069) and total levels of IgE (P=0.0452) were positively correlated with the levels of anti-TES IgE. Although anti-TES IgA was detected in 10 (59%) of the subjects, there was no significant correlation between the levels of total IgA and those of Toxocara-specific IgA. Only one of the 17 subjects found positive for anti-Toxocara IgG had attended a secondary school and all but two belonged to households with monthly incomes of

Ki-67 scores and AgNor counts in transitional cell carcinoma of the bladder: apparent lack of prognostic value.

The cellular proliferative state of 18 incident cases of transitional cell carcinomas of the bladder treated with transurethral resection was blindly determined by two independent observers using Ki-67 monoclonal antibody and silver stain for nucleolar organizer regions (AgNORs). Ki-67 scores were significantly related to histological grade (WHO) (rs = 0.65, p < 0.01) and clinical stage (UICC) (rs = 0.46, p < 0.05). However, the follow-up analysis over a six year period did not demonstrate significant relationship between Ki-67 values and survival. AgNOR counting did not show significant association with any of the variables under study. The results of this investigation and the review of the pertinent literature suggest that the assessment of cell proliferation of bladder carcinoma by means of Ki-67 and AgNOR techniques is far from having immediate direct influence on patient management.

[Urethral lesion caused by a condom: description of a case]. / Lesione uretrale da "condom": descrizione di un caso.

We report a case of severe urethral lesion in a male patient with a vascular cerebral stroke. The wrong application of condom catheter without pain or other symptoms developed the urethral lesion.

[Hydatidosis of the psoas muscle. Description of a case and review of the literature]. / Hidatidosis del músculo psoas. Descripción de un caso y revisión de la literatura.

A rare case of echinococcus cyst of the psoas muscle is described in a 64-year-old male patient. Following evaluation with echotomography, CT and MRI, he was treated with Albendazole for five months. After there the cyst was evacuated by ultrasound-guided aspiration and he received another course of chemotherapy. Recent evaluation revealed the patient is well and cyst-free.

[Correlation between histological grading and cell growth fraction in bladder tumors]. / Correlazione tra grading istologico e frazione di crescita nei carcinomi vescicali.

30 carcinomas and 1 papilloma of bladder were studied by immunohistochemical method with a monoclonal antibody Ki-67 (Dako-PC) reacting with a nuclear antigen present in cells of the mitotic phases G1, S, G2 and M. Authors would like determine the growth ratio (correlation between the number of cells in mitotic cycle and the total number of cells) of the neoplastic cell populations to compare it to the grading of themselves established by traditional parameters. It was shown, as in other carcinoma type, that the down grading correspondent with augmentation of cell growth fraction. It is of interest to verify that among carcinoma of different grading there are values partially corresponding for the growth fraction. This confirm what are going to demonstrate all those studies by means of flow cytometry and image analysis: grading of neoplasias as now fixed, doesn't give a satisfactory index for prognosis.

[Computerized tomography in Peyronie's disease. Clinico-radiological comparison]. / La TC nella malattia di La Peyronie. Confronto clinico-radiologico.

The diagnostic capabilities of Computed Tomography (CT) in the study of Peyronie's disease are assessed. Twenty-four patients, with different symptoms and a variety of findings on physical examination (from normal to large painful plaques), were studied with third-generation CT equipment. CT defined the normal pattern of the albuginea, as a hyperdense (ranging from 80 to 100 HU) thin and regular line on the periphery of the corpora cavernosa. Pathologic features such as irregularities, disruptions and calcifications of the tunica can be identified; irregularities are shown as circumscribed zones of hyper or hypodensity, disruptions as small or large areas of complete absence of the thin regular line of albuginea. Calcifications are identified as hyperdense nodular or plaquelike areas of 200-300 HU. When physical examination and CT patterns are compared, the reliability of the method is revealed. It provides an accurate definition of the albugineal lesions, imaging all abnormalities detected on physical examination and demonstrating additional, non-palpable and doubtful lesions. Physical examination and CT findings concurred in 19 cases (79%), whereas disagreement was observed in 5 (12%). In 3 cases CT showed calcified plaques not revealed on physical examination; in 2 cases the plaques revealed by palpation were not confirmed by CT. Furthermore there may be a connection between CT aspects of the albuginea and the hystological findings in the disease: irregularities could represent the early stage, interruptions the mid-stage and calcifications irreversible final abnormalities. CT, being a non-traumatic, harmless diagnostic method, improves the clinical evaluation of the patient and can facilitate the choice of the most suitable therapeutic modalities, as well as the follow-up of their results.

[Liquid embolization of the renal artery with absolute ethanol]. / L'embolisation liquide de l'artère rénale avec l'éthanol absolu.

Absolute ethanol is a new agent for use in embolization which has demonstrated excellent efficacy, is simple to manage, and above all is innocuous in case of reflux into the aorta. A part from provoking irreversible occlusion of the complete renal artery circle, embolization with ethanol provokes direct cellular toxic necrosis comparable with a true mummification. This is of fundamental importance during palliative embolization for renal cancer or in all cases of medical nephrectomy for non-neoplastic disease. Results of the use of liquid embolization of the renal artery with absolute ethanol are presented, the technique, described, and mechanisms of action analyzed based on histologic findings.

Total pelvic arterial embolization in a case of massive vesical and vaginal bleeding by pelvis carcinomatosis.

A case of massive vesical and vaginal bleeding due to a primitive uterine cancer that relapsed hemorragically after bilateral hypogastric embolization and required an additional embolization of all arterial sources supplying the tumor is reported.