Ten years experience in the treatment of pseudomyxoma peritonei by cytoreduction, peritonectomy and semi-closed hyperthermic antiblastic peritoneal perfusion.

BACKGROUND: In the literature good results have been reported for the treatment of Pseudomyxoma peritonei (PMP) by cytoreduction, peritonectomy and hyperthermic antiblastic peritoneal perfusion (H.A.P.P.). Forty-eight patients affected by PMP have been treated with this technique over the past ten years. PATIENTS AND METHODS: Peritoneal perfusion has been performed with the original semiclosed tecnique after complete surgical cytoreduction in 188 patients affected by peritoneal carcinomatosis. In 48 of the cases the patients were affected from PMP. Aggressive surgical cytoreduction was performed with multiple visceral resections and peritonectomies. RESULTS: Seventeen patients (38%) presented major perioperative complications, and in five cases the reoperation of the patient was required. In spite of this high complication rate, there was no perioperative mortality. The results of the Kaplan-Meier 5- and 10-year survival analysis, were 94% and 82%, respectively, with a disease-free survival of 80% at 5 years and 70% at 10 years. Thirty-nine patients (81.2%) had no evidence of disease at follow-up (range 1-120 months). DISCUSSION: Up to date, the most effective treatment for PMP has been aggressive cytoreduction plus H.A.P.P.

Treatment of pseudomyxoma peritonei with two times--cytoreduction and hypertermic antiblastic peritoneal perfusion (HAPP).

Pseudomyxoma peritonei is a rare neoplasia with a low grade of clinical malignity in which neoplastic masses product large amount of mucinous material. Its treatment advocates an aggressive cytoreduction of all visceral and peritoneal lesions and Hyperthermic Antiblastic Peritoneal Perfusion (HAPP). In three cases we programmed a two stage surgical approach for the massive amount of peritoneal implants. Two times we achieved our aim, while one time, the wide progression of the disease during the two surgical procedures made useless our efforts to have a complete cytoreduction and the following HAPP. This last patient refused systemic chemotherapy between the two surgeries and we think that this should be one of the reasons of the failure.

[Up-date on acute ischemia of the limbs]. / Aggiornamenti in tema di ischemia acuta degli arti.

The authors report their experience in the treatment of acute ischemia of the limbs during the last year. They underline the importance of a right diagnostic and therapeutic treatment particularly in a little hospital, as reported in an algorytm published recently in the literature. They analyze 11 patients, one of them with an embolism of the arm, with a different degree of ischemia. The results are similar to those reported in the literature.

[Acute intestinal ischemia. Review of the literature and personal experience]. / Ischemia intestinale acuta. Revisione della letteratura ed esperienza personale.

The authors report the experience of their surgical department in the diagnosis and treatment of acute arterial mesenteric ischaemia. Their results are similar to those of the literature. Stress is laid on early diagnosis and interest of mesenteric angiography, laparoscopy and color flow ultrasound. Arterial revascularisation must be the surgical aim but the prognosis of acute mesenteric ischaemia remains very severe.

[Carotid vessels studied by Doppler color echography and digital angiography. Results of meta analysis]. / Studio dei vasi carotidei mediante eco color-Doppler ed angiografia digitale. Risultati di una meta-analisi.

Twenty patients were studied by color Doppler flow imaging and digital angiography. According to the literature the results support necessity of color flow in the study of the patients with plaque. The authors emphasize the role of angiography only in the surgical patients for the anatomic evaluation of the carotid territory.

[Complications of cytoreductive surgery associated with intraperitoneal chemohyperthermia: prevention and treatment]. / Complicanze della chirurgia citoriduttiva associata a chemioipertermia intraperitoneale (CIIP) prevenzione e trattamento.

New approach to peritoneal carcinomatosis combining cytoreductive surgery and hypertermic intraperitoneal chemotherapy suggest improved survival when it is possible to achieve a complete cytoreduction. In this study we consider the major complications related to this procedure and purpose our approach for their prevention and treatment.

[Cytoreduction and intraoperative peritoneal chemohyperthermia in carcinomatosis from colonic carcinoma and in peritoneal pseudomyxoma]. / Citoriduzione e chemioipertermia intraoperatoria peritoneale (CIIP) nella carcinosi da carcinoma del colon e nello pseudomixoma peritonei.

New approach in treatment of peritoneal carcinomatosis combining cytoreductive surgery and intraperitoneal chemotherapy suggests improved survival when it is possible to achieve a complete cytoreduction. In this study we consider the carcinomatosis from colorectal and appendiceal adenocarcinoma. In all cases, patients in whom cytoreductive surgery was complete had a median survival much longer compared with patients in whom was not possible and, as perfusion works on minimal residual disease, peritonectomy is the only surgical technique that aim at total removal of parietal and visceral peritoneal lesions.

[Peridural morphine for postoperative analgesia in patients following Milligan-Morgan surgery]. / Morfina peridurale per l'analgesia postoperatoria nei pazienti sottoposti a intervento di Milligan-Morgan.

Postoperative analgesia and side effects of epidural morphine (3 mg in 5 ml saline) were studied in 30 patients scheduled for Milligan-Morgan surgery. The patients were pain-free for a mean duration of 10-12 hr. Urinary retention was the most prominent side effect observed.

[Changes in carcinoembryonic antigen and tissue polypeptide antigen in monitoring the post-operative course of some tumor types]. / Il comportamento del CEA e del TPA nel monitoraggio del decorso post-operatorio di alcuni tipi di tumore.

The authors tested TPA in association with CEA in colon rectal, breast and stomach cancer. The results proved the reliability of TPA in these neoplasms and the correct use of TPA in association with CEA test in monitoring breast cancer. It's use proved to be typical screening test both for the high percentage of true positive and the lack of false negative.

[Association of ferritin with the CEA test in post-operative monitoring of colo-rectal, breast and stomach carcinomas]. / L'associazione della ferritina al CEA test nel monitoraggio post-operatorio dei carcinomi del colon-retto, della mammella e dello stomaco.

On the basis of more than 3,000 tests carried out on 1,561 patients suffering from suspected or certain malignant tumours, the authors established the necessity of CEA test in post-operative follow-ups, according to the plentiful literature regarding this matter. New tumoral markers led the authors to verify if it was useful to associate the ferritin to CEA test. From the results and the statistical data, they concluded that it was useful to associate the two markers only in negative CEA test when confronted with clinical suspected metastatic diffusion.

Buserelin treatment of advanced prostatic carcinoma: prognostic factor analysis.

From August 1986 to August 1990, 116 patients with prostatic carcinoma, advanced disease (stage C-D1 only in patients older than 75 years, or D2) were treated with Buserelin (0.5 mg 3 times/day subcutaneously for 7 days, followed by 0.4 mg 3 times/day intranasally) until progression. No concomitant antiandrogens were administered. Of the 108 evaluable patients, 10 had complete remission (CR), 49 partial remission (PR), 46 remained stable while 3 progressed (response rate = 54.6%). Median duration of response was 31 months, median survival was 34 months. The toxicity of treatment was mild and mainly related to the hormonal effect of the drug. Castrate testosterone levels were obtained in all patients except 7. Slight, transient pain increase was noted at day 8 in 12 patients. Absence of symptoms at the start of treatment, well- or moderately differentiated tumor and serum testosterone negativization following Buserelin were associated with a significantly higher response rate as compared to presence of symptoms, poorly differentiated tumor and failure to obtain castrate testosterone levels, respectively. The following prognostic factors were found, at univariate analysis, to be associated with a prolonged survival: stage (C-D1 versus D2), PS (greater than 80 versus equal or less than 80), symptoms (absent versus present) and histological grade (G1 + G2 versus G3). Age and basal T levels did not influence survival. Those patients who obtained a CR or PR survived significantly longer than those with stable disease or progression.(ABSTRACT TRUNCATED AT 250 WORDS)