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C Brambilla

Publications and source records attributed to C Brambilla.

At least 199 records · Page 11Linked to original sources
PubMed1986

[Heterogeneity of malignant bronchial tumors. Problems of histogenesis].

The 1981 WHO classification of bronchial carcinoma, based on light microscopic analysis, proposed 4 principal classes: epidermoid carcinoma, adenocarcinoma, small cell carcinoma and large cell undifferentiated carcinoma. This apparently simple nosology underestimates the difficulties of classifying a good number of these tumors, due to a great diversity in appearance within the same histologic group. Experimental studies on the regeneration of bronchial epithelium, on lesions induced by irritants and carcinogens, suggest one undifferentiated cell line as the origin of all malignant proliferations, including neuro-endocrine tumours. To support this histogenetic hypothesis, an ultra-structural analysis of the carcinomas shows the existence and frequency of heterogenous forms, multi-differentiated, up to the level of individual cells. The same cell line may express several ways of differentiation simultaneously (bi or tri-partite differentiation). Equally immunohistochemical methods reveal antigenic differentiation (intermediary filaments, neuro-endocrine antigens) and establish a means of identifying different cellular constituents. These two methods have allowed real progress in the diagnosis of neuro-endocrine tumours, placing them firmly with bronchial tumours and seem particularly helpful in the analysis of undifferentiated small and large cell carcinomas. By another way, one finds in the majority of bronchial tumours the different antigens expressed, certainly following their histological type in variable degrees, yet with an antigenic (phenotypic) profile showing great similarity. This is a reflection of multi-differentiation in these tumours and appears as a direct consequence of their common histogenetic origin. Bronchial carcinomas are placed along a continuous spectrum of three parallel and/or simultaneous differentiations. They represent a single tumour having a tendency to express one or several ways of differentiation.

Carcinoma, Bronchogenic↗
PubMed1986

[Value of computed tomography in the diagnosis of the intrathoracic extension of bronchial cancer].

In 76 patients the diagnosis of the mediastinal extension of a bronchial cancer, assessed by computed tomography (CT), was compared to histological specimens obtained by mediastinoscopy and surgery (58/76). The extension to mediastinal nodes was present in 26 subjects (34.2%) and yet was not recognised 15 times on CT. There were 15 false negatives (FN) and 3 false positives (FP). Sensitivity 43%, specificity 94%, predictive value for positives (VPP) 70%, predictive value for negatives (VPN) 75%. Extension was present in 18 patients. These were recognised 14 times by CT. There were no false positives. (Sensitivity 70%, specificity 100%, VPP 100%, VPN 94%). We conclude That CT is useful for diagnosing direct mediastinal extension and allows the juxta-hilar extension of the cancer to be assessed. CT has no place in the diagnosis of mediastinal gland involvement. Mediastinoscopy (5.2% FN; no FP) is better than TDM for the diagnosis of extension to the mediastinal nodes both for peripheral and central cancers.

Carcinoma, Bronchogenic↗
PubMed1985

Fibronectin patterns in hepatocellular carcinoma and its clinical significance.

Fibronectin, a high molecular weight glycoprotein component of the extracellular matrix, was localized extracellularly and intracellularly in the nuclei and the cytoplasm of hepatocellular carcinomas (HCC) by the use of the biotin-avidin method on paraffin-embedded, pepsin-treated tissue. The specificity of the staining was confirmed by absorbing the antibodies with purified fibronectin. Twenty HCC were investigated (7 were autopsy specimens and 13 biopsy and surgical specimens). The fibronectin was either increased or decreased. When increased the fibronectin consisted of thin or thick feathery strands and was either pericellular, sinusoidal, periglandular, or stromal. Marked increase of fibronectin was seen in fibrolamellar HCC, clear cell HCC, and encapsulated HCC, correlating with the better prognosis. Decreased fibronectin was seen in two undifferentiated HCC. HCC obtained at autopsy displayed nuclear and cytoplasmic fibronectin staining. Nuclear fibronectin may be an expression of the DNA binding ability of fibronectin which becomes demonstrable in cells with increased membrane permeability.

Carcinoma, Hepatocellular↗
PubMed1985

Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer.

The paper reviews all adjuvant studies carried out since 1973 at the Milan Cancer Institute in women with resectable breast cancer and positive axillary nodes. The updated results essentially confirm previous findings, and indicate that CMF-based chemotherapy is able to exert a prolonged therapeutic activity in a fraction of patients bearing micrometastases. In particular, the first randomized study testing no postoperative chemotherapy vs 12 CMF cycles, showed a 10-year relapse free survival (RFS) of 31.4% vs 43.4% (P less than 0.001) and an overall survival (OS) of 47.3% vs 55.2% (P = 0.10), respectively. Findings related to subsets indicated that RFS and OS benefit was significant in premenopausal and not in postmenopausal women, and in both treatment groups the observed findings were always related to the number of histologically positive nodes. On relapse, salvage therapy administered to controls failed to produce superior results compared to those achieved in the CMF group. The 8-year results of the second study testing 12 vs 6 CMF cycles failed to show a significant difference between the two treatment groups. This indicated that the maximum tumor cell kill occurred during initial chemotherapy cycles. In the third study, carried out only in postmenopausal women less than or equal to 65 years, sequential non-cross resistant combinations (CMFP----AV) at full dose achieved superior results compared to CMF in the subset with limited nodal extent. Acute side effects were moderate and no delayed morbidity, including increased incidence of second neoplasms, was observed. We conclude that the tumor cell heterogeneity, and in particular primary drug resistance, represents the major obstacle to adjuvant systemic therapy in high risk breast cancer. Current results suggest that 6 cycles of CMF can be considered a simple, safe, and moderately effective adjuvant therapy. Future trials should contemplate treatments of different intensity related to major prognostic subsets, while in women at very high risk of early relapse more vigorous drug regimens should be concentrated within the first six months from local-regional therapy.

Adult↗
PubMed1985

[Pneumopathies induced by amiodarone. Clinical, paraclinical and physiopathological data. Apropos of 2 cases].

The authors report the cases of two men with coronary artery disease by amiodarone for 8 and 24 months respectively. They developed clinical and radiological changes of diffuse interstitial pneumonia, characterised by an inflammatory syndrome, restrictive changes on spirometry, reduced CO transfer and abnormal blood gases. Broncho-alveolar lavage showed a lymphocytosis with a large quantity of iodine in the macrophages and the presence of amiodarone and its metabolite in the supernatant fluid. The responsibility of this drug is imputed and the patients were cured within 3 months of its withdrawal with regression of clinical, radiological, spirometric and control alveolar lavage abnormalities. A favourable outcome without steroid therapy is practically unknown in the literature. These cases illustrate the possible risk of alveolitis or diffuse interstitial pneumonia during long term amiodarone therapy, the pathogenesis of which is discussed: iodine overload, direct drug toxicity or an immunological mechanism.

Aged↗
PubMed1984

Phase I study with 4'-deoxydoxorubicin.

4'-Deoxydoxorubicin (dxDx), a new doxorubicin analogue, was administered intravenously on a 3-week schedule to 73 patients affected by advanced malignant neoplasms. Sixty-five patients, treated with eight dose levels ranging from 10 to 45 mg/m2, were evaluable. The dose-limiting toxicity was myelosuppression, mainly leukopenia. About one third of the patients complained of vomiting which was almost always mild. Minimal hair loss was also documented in about 40% of patients. No hepatic or renal toxicity was observed. Transient and aspecific electrocardiographic changes were recorded in 6% of patients after 1 h and in 3% after 24 h from drug injection. Left ventricular ejection fraction was decreased in two patients after a cumulative dose of 90 mg/m2. One patient died with cardiorespiratory insufficiency and his initial cardiovascular disease might have been aggravated by dxDx. No changes in myocardial function parameters were documented in 18 patients who reached higher cumulative doses, i.e. greater than or equal to 100 mg/m2 and greater than or equal to 200 mg/m2. The highest total dose administered in this study was 340 mg/m2. Therapeutic activity was observed with doses ranging from 25 to 45 mg/m2. Partial response was documented in pancreatic, colon, anal and breast carcinomas as well as in non-Hodgkin's lymphoma. Minor response was observed in prostatic, thyroid, and renal carcinomas as well as in chronic lymphocytic leukemia. The maximum tolerated dose was assessed to be between 40 and 45 mg/m2. A Phase II trial is ongoing utilizing the dose of 35 mg/m2 every 3 weeks.

Adolescent↗
PubMed1984

Double-blind placebo-controlled trial of baclofen, alone and in combination, in patients undergoing voluntary abortion.

This study evaluated the analgesic efficacy of baclofen in relation to specific pain stimuli in 83 women (27 nulliparas and 56 multiparas) undergoing voluntary abortion (clamping of the cervix and dilatation and curettage). The patient population was divided into five treatment groups as follows: group 1, placebo; group 2, baclofen, 0.3 mg/kg, administered intravenously (IV); group 3, baclofen, 0.6 mg/kg IV; group 4, baclofen, 0.3 mg/kg IV, and fentanyl, 1.5 mg IV; and group 5, baclofen, 0.3 mg/kg IV, and diazepam, 5 mg given orally and 5 mg IV. In each case the surgical intervention was started using analgesia only. When the first sensation of pain was recorded, a paracervical anesthetic block was performed to provide pain relief for completion of the operation. The results showed that baclofen had significantly better analgesic properties than did placebo, with no important side effects. Its analgesic action seemed to be dose-dependent, since better results were obtained with the higher dose. The analgesic effect was slightly potentiated when baclofen was combined with fentanyl, but not when it was combined with diazepam. Factors independent of the pain stimuli and drugs used--the most important being parity--influenced the results.

Abortion, Induced↗
PubMed1984

[Pulmonary arterial pressure in chronic bronchitis with respiratory insufficiency on long-term oxygen therapy. Outcome of 16 patients with review of the literature].

A study was made of pulmonary artery pressure in 16 chronic bronchitics with severe respiratory failure, who were treated with continuous oxygen therapy at home. At the beginning of the study these patients presented with a pure and severe obstructive syndrome with marked hypoxaemia at rest (mean PaO2 = 6.8 kPa), had a suitable interval from a recent exacerbation, in a stable clinical and functional respiratory state. The duration of longterm oxygen therapy was controlled, as the efficacy of the blood gases (PaO2 of O2 greater than or equal to 8 kPa). The pulmonary artery pressure was measured using a microcatheter, at the beginning, and for most of the 18 months breathing ambient air in a stable state. At the end of this time a significant diminution of the FEV1 (VEMS) (a mean of 100 ml, p less than 0.01). This was evidence of the deterioration in the ventilatory state which contrasted with the improvement in the diminution of pulmonary artery hypertension (HTAP) from 3.43 to 2.97 kPa (p less than 0.05) without the deterioration in the other values. The good result above in chronic bronchitics contrasts with a stable or deteriorating pulmonary arterial pressure in a group of emphysematous (n = 6) and bronchiectatic subjects (n = 4) with somewhat similar functional characteristics but in whom the effect was too small to allow for any statistical comparison. Our results are compared with those in the literature much of which applies to only a few patients and for the great part revealed only haemodynamic stability of oxygen therapy. Possible reasons for these discordant findings are discussed.

Blood Pressure↗
PubMed1984

[Desaturation and nocturnal pulmonary arterial hypertension in C.O.P.D.: effects of oxygen therapy].

The influence of low flow oxygen on saturation (SaO2) and mean nocturnal pulmonary artery pressure (PAP), was studied in a group of chronic bronchitics suffering from severe airflow obstruction with moderate respiratory failure. 20 patients had oxymetry on ambient air, six underwent a continuous recording of SaO2 and of PAP for 2 nights; the first on ambient air, the second on Oxygen. The six patients showed transitory desaturation, accompanied by instantaneous rise in PAP. The oxygen greatly improved the mean values and maximal variation of SaO2 and PAP, supporting the hypothesis that this treatment is capable of preventing T.A.P., and chronic cor pulmonale in patients whose diurnal blood gas values do not justify continuous oxygen therapy, according to classical criteria.

Aged↗
PubMed1983

[Home treatment of chronic respiratory insufficiency. Sociodemographic aspects of chronic respiratory insufficiency in France. Preliminary results of a survey concerning 3120 patients registered in a district association for assistance to patients with respiratory insufficiency].

The observations of the National Association for the Domiciliary treatment of respiratory failure (A.N.T.A.D.I.R.) affords the opportunity for some hard information on the complex problem of chronic respiratory failure in France. The objectives were to perceive the demographic fluctuations of the population, to follow the development of the distribution of health care, to assess the cost effectiveness of the activities and to place the different participants in the overall schema of the system. The initial results on 3,120 patients show one female for every 2.5 males with a mean age of 62.87. Disorders with chronic airflow obstruction account for 60% and restrictive disorders for 20%. Assisted tracheal ventilation (20% overall) was applied, particularly to this latter type, long term oxygen (O.L.D.) 28% or assisted ventilation with a mouthpiece (VAB) to 45% with chronic airflow obstruction. VAB is still widely practised in France but there is a trend towards O.L.D. VAT and VAB use oxygen bottles as a supply while O.L.D. uses nitrogen extraction in 2 cases out of 3. These are preliminary results and it will be interesting to follow the outcome of these techniques of assisted ventilation in the home, so that there efficacy by gathering functional data (particularly blood gases) may be assessed and either the survival curves analysed or the time spent in hospital.

Adult↗