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Biomedical subjects

A Morabito

Publications and source records attributed to A Morabito.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation.

From 1990 to 1993, 115 diabetic patients were consecutively hospitalized in our diabetologic unit for foot ulcer and 27 (23.5%) major amputations were carried out. The major amputation rate of this series of cases was compared with that occurring in diabetic subjects taken into our hospital for foot ulcer in two previous periods: 1979-1981 (17 major amputations in 42 inpatients or 40.5%) and 1986-1989 (26 major amputations in 78 inpatients or 33.3%). The comparison shows a progressive reduction in major amputation rate [Odds ratio 0.66, 95% confidence interval (CI) 0.46-0.96]. Univariate and multivariate analysis, carried out in the population of the 1990-1993 period, in order to detect the independent factors associated with major amputation show the following prognostic determinants of major amputation: Wagner grade (odds ratio 7.69, CI 1.58-37.53), prior stroke (odds ratio 35.05, CI 3.14-390.53), prior major amputation (odds ratio 3.49, CI 1.26-9.38), transcutaneous oxygen level (odds ratio 1.06, CI 1.01-1.12), and ankle-brachial blood pressure index (odds ratio 4.35, CI 1.58-12.05), while an independent protective role was attributed to hyperbaric oxygen treatment (odds ratio 0.15, CI 0.03-0.64). In accordance with other studies, we, therefore, conclude that a comprehensive protocol as well as a multidisciplinary approach in a dedicated center can assure a decrease in major amputation rate. The parameters of limb perfusion were the modifiable prognostic determinants most strongly predictive for amputation.

Amputation, Surgical↗
PubMedDate not supplied

Prognostic significance of necrosis, elastosis, fibrosis and inflammatory cell reaction in operable breast cancer.

We analyzed retrospectively the relationships and the prognostic significance of four anatomopathological features (elastosis, fibrosis, necrosis, inflammatory cell reaction) of the primary tumor in a series of 1,457 cases of infiltrating ductal carcinoma observed at our institution from January 1978 to December 1991. Necrosis, elastosis, fibrosis and inflammatory cell reaction were strongly associated among themselves (all p < 0.0001), the only exception being necrosis and elastosis. Necrosis was significantly related to tumor size (odds ratio [OR] = 5.40, p < 0.0001) and tumor grade (OR = 2.22, p < 0.0001). Univariate analysis showed that the presence of necrosis and cell reaction were significantly related to worse survival (p < 0.0001 and p = 0.03, respectively). Multivariate analysis, including the four variables plus nodal status, tumor size, grading, adjuvant therapy, age and first order interactions, revealed that greater tumor size (p < 0.0001), positive nodal status (p < 0.0001), higher histologic grade (p < 0.0001) and presence of inflammatory cell reaction (p = 0.0007) independently worsened survival. On the other hand, adjuvant therapy had a significant independent role in preventing deaths (p = 0.03). The only first-order interaction retained in the model was that between grading and cell reaction (p = 0.002). Cell reaction had a different prognostic behaviour in the groups G1-G2 and G3: in the former group, survival was worse (p = 0.0001) when the inflammatory cell reaction was present. In conclusion, we demonstrate that cell reaction is an independent prognostic factor in the G1-G2 subgroup of patients, and propose a hypothesis as to the role of cell reaction in primary breast cancer.

Adolescent↗
PubMedDate not supplied

Clinical management of a case of recurrent apocrine gland carcinoma of the scalp: efficacy of a chemotherapy schedule with methotrexate and bleomycin.

Apocrine carcinoma of the skin is a rare tumor. Wide surgical excision with complete removal of the neoplasm is the standard therapy and this appears to offer the best chance of cure. Radiotherapy may be used in case of local relapse or regional lymph node involvement. Systemic chemotherapy has not proved to be effective in the treatment of this tumor. We report on a 46-year-old woman with a recurrent apocrine carcinoma of the scalp that had previously been treated with surgery, radiotherapy and chemotherapy (Al-Saraff schedule). The patient was responsive to a second-line systemic chemotherapy regimen consisting of a weekly combination of methotrexate and bleomycin, and achieved long-term progression-free survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Clinical relevance of vascular endothelial growth factor and thymidine phosphorylase in patients with node-positive breast cancer treated with either adjuvant chemotherapy or hormone therapy.

PURPOSE: To determine the role of the two angiogenic peptides, vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP) (the latter also being a target enzyme for cytotoxicity of 5-fluorouracil and methotrexate), and conventional prognostic factors in predicting relapse-free survival (RFS) and overall survival (OS) probabilities in two cohorts of patients with node-positive breast cancer (NPBC) treated with either adjuvant chemotherapy (CMF [cyclophosphamide, methotrexate, 5-fluorouracil] schedule) or hormone therapy (tamoxifen). PATIENTS AND METHODS: We studied two groups of 137 and 164 patients with NPBC, median follow-up of 72 months for both, treated with adjuvant chemotherapy or hormone therapy, respectively. The cytosolic levels of VEGF and TP were determined in the primary tumor by original immunometric methods. The association between VEGF and TP and of these angiogenic peptides with other prognostic indicators were tested by using the Spearman correlation coefficient (for continuous variables) or the Kolmogorov-Smirnov test (for dichotomous variables). Results of the clinical outcome were analyzed by both univariate and multivariate (for RFS only) Cox regression models in which VEGF and TP were treated as continuous variables. RESULTS: In the CMF group, the concentrations of VEGF and TP ranged from 5.8 to 7798 pg/mg of protein (median, 87.5 pg/mg) and from 1.2 to 904 U/mg (median, 138.2 U/mg), respectively. There was no significant association between the two angiogenic peptides. VEGF was not associated with any other variable, whereas TP showed a positive association with age and an inverse association with the number of involved nodes. In the tamoxifen group, the concentrations of VEGF (5.9-2482; median, 79.3 pg/mg protein) and TP (6.1-1542; median, 146.5 U/mg) were similar to those of the CMF group, and the two angiogenic peptides were not correlated. VEGF was positively associated with age and was inversely associated with estrogen receptor and progesterone receptor, whereas TP was not associated with any other variable. Univariate analysis in the CMF group showed that VEGF and TP were significantly predictive of both RFS and OS. Likewise, the number of involved axillary nodes was significantly associated with both RFS and OS. Univariate analysis in the tamoxifen group showed that TP did not significantly influence either RFS or OS. On the contrary, VEGF levels were significantly predictive of both RFS and OS, as were the number of involved nodes, estrogen receptor concentrations, and progesterone receptor concentration. In the multivariate analysis on RFS in the CMF group, VEGF, TP, their first-order interaction term, and age were significant and independent predictive factors. In the tamoxifen group, only VEGF and the number of involved nodes were significant and independent predictive factors. DISCUSSION: The results of our study suggest that high levels of TP and low levels of VEGF characterize the patients with NPBC treated with adjuvant CMF who have the highest likelihood of favorable outcome. Low levels of VEGF and the presence of less than three involved axillary nodes characterize the patients with NPBC treated with adjuvant tamoxifen who have the highest likelihood of favorable outcome. This information may be useful to plan future studies to better select the patients with NPBC for conventional adjuvant treatments as well as to monitor the efficacy of novel therapeutic strategies of adjuvant therapy based on inhibition of angiogenesis.

Adult↗
PubMedDate not supplied

[The liver in patients with beta-thalassemia major. Determination of iron levels with magnetic resonance].

INTRODUCTION: We investigated the clinical usefulness of liver MRI in a large multicenter study because the control of iron concentration (LIC) is crucial in thalassemia major (TM) prognosis and conflicting results have been reported in small and heterogeneous groups of patients using Magnetic Resonance Imaging (MRI), the only very common non-invasive procedure. MATERIAL AND METHODS: One hundred and eight consecutive TM patients, selected according to a specific protocol, were included in the study. In 29 of these LIC was measured by atomic absorption spectrophotometry on liver biopsy and expressed as microgram/gr dry weight. MRI was performed with a 0.5 T superconducting unit. The ratio of the average signal intensity (SIR) of the liver to that of paraspinal muscle was calculated and expressed as a percentage. RESULTS: Mean +/- (SD) of SIR was 100 +/- 26% (test for normality: p = 0.02) and of LIC was 3677 +/- 4662 micrograms/g/dry liver (test for normality: p < 0.00001). The logit transformation of LIC (lLIC) achieved both normality of distribution of lLIC and linear regression of lLIC on SIR (t = 7.36; p < 0.00001) according to the equation: Y = -0.0136 + SIR* (0.157) = lLIC log10 (K-LIC/LIC) where K = 79.433. Thus the values of LIC are expressed by the equation LIC K/(1 + 10 y) micrograms/g/dry liver. Moreover, a mild correlation was found between SIR and AST (p = 0.01; r = -0.30), ALT (p = 0.02; r = -0.21), gamma GT (p = < 0.01; r = -0.37; r = -0.25). CONCLUSIONS: This study shows that LIC can be calculated as a function of SIR. A validation study is necessary before introducing this prediction rule in clinical practice.

Adult↗
PubMedDate not supplied

A SEM investigation on pulpal-periodontal connections in primary teeth.

The ideal goal of pulpotomy procedure in a primary tooth is to maintain space length, preserve masticatory function, and remove infection and chronic inflammation from the oral cavity. From a population of 150 patients between the ages of four and seven years, we collected a sample of 30 primary (nine maxillary and twenty-one mandibular) molars used in this investigation. The aim was to observe the presence of accessory channels on the pulpal floor; they were found in twenty-one of the thirty teeth examined. The scanning electron microscope proved to be an excellent means of evaluating the pulpal floor, where failure of pulp treatment often has its cause.

Child↗
PubMedDate not supplied

[Hypercoagulation and recurrence of cerebral infarct].

We measured plasma levels of fibrinopeptide A (FPA) and beta-thromboglobulin (BTG) in 27 patients, two months after first stroke. FPA, a sensitive index of "in vivo" hypercoagulability, was significantly higher in stroke patients than in 40 age- and sex-matched controls, and in patients with cerebral infarction who experienced recurrence within 5 years than in those who remained asymptomatic. On the contrary, FPA levels had no prognostic significance among patients with hemorrhagic stroke. Also BTG, an index of platelet activation, was higher in patients than in controls, but it was not associated with stroke recurrence. In a multivariate analysis of hemostatic and clinical variables, only FPA levels greater than 4 ng/ml were significantly related to cerebral reinfarction. These results support the role of hypercoagulability in the recurrence of ischemic stroke and allow identification of patients at high risk of cerebral reinfarction, providing a rationale for clinical trials of anticoagulant therapy in this subgroup.

Adult↗