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Biomedical subjects

C Cartoni

Publications and source records attributed to C Cartoni.

At least 37 records · Page 2Linked to original sources

Recurrence of Hodgkin's disease after 10 years: observation of 5 cases.

Five patients whose Hodgkin's disease recurred 10 years or more after the achievement of complete remission are reported. Four out of 5 patients had shown an advanced stage at the onset of disease and therefore had received combination chemotherapy (ABVD or MOPP-like) as primary treatment. Involved-field irradiation was delivered as consolidation therapy in 1 patient only. All pathologically proven relapses occurred in a previously affected area and the histologic subtype differed from the primary subtype. The time interval between the achievement of the first complete remission and the relapse was 120, 170 and 190 months in 3, 1, and 1 patient, respectively. All 5 patients are alive in second complete remission. This paper emphasizes the risk of late relapse even after a prolonged disease-free interval for patients with Hodgkin's disease. Close follow-up is therefore recommended also in this clinical setting.

Adult↗

Extended-field radiotherapy is superior to MOPP chemotherapy for the treatment of pathologic stage I-IIA Hodgkin's disease: eight-year update of an Italian prospective randomized study.

PURPOSE: To compare the effectiveness of chemotherapy (CHT) with extended-field radiotherapy (RT) in the treatment of early-stage Hodgkin's disease (ESHD), we report an 8-year updated analysis of a study in which treatment with six cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) CHT was randomly compared with extended-field RT. PATIENTS AND METHODS: From August 1979 to December 1982, 89 adult patients with pathologic stage I-IIA Hodgkin's disease (HD) were randomly allocated to receive either RT with mantle field followed by periaortic irradiation (n = 45) or six monthly courses of MOPP CHT (n = 44). RESULTS: All patients in the RT arm and 40 of 44 in the CHT arm achieved complete remission. Twelve relapses occurred in each group. Eight patients treated with MOPP and two of the RT arm died of HD. Three other patients of the CHT group died because of a second cancer. With a median follow-up greater than 8 years, the overall survival rate is significantly higher in the RT than in the CHT group (93% v 56%; P less than .001), whereas the rates of freedom from progression and relapse-free survival (RFS) were similar in the two groups (76% v 64% and 70% v 71%, respectively). Of the 12 patients relapsing after RT, 11 (92%) achieved a second CR, compared with only six of the 12 (50%) in the MOPP group. Analysis of the response rate to salvage treatments showed that the type of relapse in the MOPP group was a prognostic indicator for the achievement of a second CR, whereas in the RT group, a second CR was obtained regardless of the characteristics of the relapses. At 80 months, the probability of survival of relapsing patients calculated from time of relapse was 85% and 15% in the RT and CHT groups, respectively (P = .02). CONCLUSION: We conclude that RT alone is the treatment of choice for adult patients with ESHD with favorable prognostic factors.

Actuarial Analysis↗

[Fungal lesions of the organs of the upper abdomen].

The authors report on 14 cases of fungal parenchymal infections of the abdomen detected with CT and/or US in immunodepressed patients. Image patterns and the capabilities of the two diagnostic techniques are analyzed in the early detection of fungal lesions. CT was the first-choice examination, followed by US, in 9 patients; laboratory tests followed in 3 cases; US was performed first (and CT second) in 1 patient; finally, US alone was performed in 1 patient. The information yielded by CT and that given by US overlapped in 8/9 cases: in the extant patient, US demonstrated multiple fungal microabscesses of liver, while CT was negative, probably due to low liver density. CT patterns were multiple, small and round nonenhanced areas. Since the indiscriminate administration of intravenous contrast medium is unsuitable, CT cannot be performed first. On the other hand, in several patients liver CT with no contrast medium gave the same results for venous and fungal lesions. Compared with CT, US is a safer technique which is easier to perform and to evaluate. Therefore, US should be the exam of choice in immunodepressed patients with suspected fungal lesions. US is likely to demonstrate, in most cases, a pathologic condition (fungal microabscesses) as well as vascular and biliary anatomy.

Abdomen↗

Immune-deficiency in Hodgkin's disease (HD): a study of patients and healthy relatives in families with multiple cases.

In this study we evaluated some immunological features in both patients and healthy relatives within five families with multiple cases of Hodgkin's disease (HD). Such familial groups (at 'high risk' of HD), represent, in our opinion, a suitable opportunity to investigate the role of immune-deficiency in HD. The results obtained in the patient group confirm the well known persistent immune derangement in long term HD survivors. Regarding the group of relatives, we found a pattern similar to that of the patients. In particular, a decrease in the T helper lymphocyte subset and a lower response to Con-A mitogen were detected, which were statistically significant. These findings, confirmed in other studies of multiple case families, could support the hypothesis of a preexisting immune-deficiency in HD. This in turn would greatly contribute towards a better understanding of the role of immune-deficiency in the etiopathogenesis of the disease.

Adolescent↗

Secondary acute non lymphoid leukemia in patients treated for non Hodgkin's lymphoma: no risk of therapy-related ANLL after PROVECIP schedule.

The present study was undertaken to evaluate the frequency, characteristics and actuarial risk of secondary acute non lymphoid leukemia (s-ANLL) in 141 patients treated for non Hodgkin's lymphoma with different modalities. One hundred and twenty-four patients received chemotherapy according to PROVECIP protocol. Of these, 15 also received as induction treatment a local nodal irradiation and 33 an extended field radiotherapy. Seventeen out of 141 were treated by total body irradiation. Of these, 15 relapsed and received salvage chemotherapy. Sixteen of the 124 patients treated with PROVECIP also underwent different chemotherapeutic programs as salvage treatment. Of the entire population studied, 2 patients developed an s-ANLL, 45 and 63 months after diagnosis of NHL. The type of treatment significantly affected the occurrence of s-ANLL, since both leukemias occurred in patients treated with total body irradiation, given alone or followed by chemotherapy. The actuarial risk at 8 years was 5.24% in the whole group, whereas it greatly increased in the group of patients treated with total body irradiation (24%). Conversely, no risk was found in the group treated with PROVECIP, alone, with additional chemotherapy, or with associated local or extended field radiotherapy.

Acute Disease↗

Evaluation of therapeutic modalities in the control of Hodgkin's disease.

The results achieved in three different studies carried out on patients affected by Hodgkin's disease are discussed. In study No. 1, 58 patients with pathological Stage I-II were treated with only a "Mantle" field irradiation. The complete remission (CR) rate was 98% with an actuarial overall survival of 90%, and a median of follow-up of 80 months. Thirty-one percent of patients relapsed. In study No. 2, 42 patients were randomly allocated to receive only MOPP chemotherapy versus extended field irradiation; CR rate was 68 and 95%, respectively (p less than 0.05). The overall survival rate was 100% in the radiotherapy group and 82% in the MOPP group. No relapses have been observed in patients treated with MOPP. In study No. 3, 218 patients affected by advanced Stage HD were randomly treated with 6 cycles of MOPP chemotherapy versus 6 cycles of ABVD chemotherapy. In the MOPP group the CR rate, the relapse-free survival rate (RFS), and overall survival (OS) rates at 60 months were 77, 68, and 76% respectively, whereas, in the ABVD group the CR, the RFS, and OS rates at 60 months were 75, 77 and 80% respectively, (p less than 0.05). These data and statistical comparisons are analyzed.

Antineoplastic Combined Chemotherapy Protocols↗

Lectin I of Ulex europaeus as a marker for a subset of histiocytic tumours of the lymph node.

We describe four lymph node based tumours in which numerous neoplastic cells and some mitotic figures were characterized by staining affinity for Lectin I of Ulex europaeus (UEA-I). The patients had no vascular or epithelial tumours and presented symptoms suggestive of a systemic lymphoproliferative disease. Histologically, the tumours were composed of large, cohesive, cells which were mainly located in the paracortex. UEA-I reactivity was more evident in the Golgi area and was present in large mononucleated cells often arranged to delimit vascular-like spaces. The neoplastic cells were weakly muramidase-positive in one case, and were ANAE+/AP+ in two other cases. Large dots of UEA-I reactivity were detected in S-100+/muramidase-negative Langerhans-like cells present in one case of Letterer-Siwe disease. UEA-I staining was consistently negative in 20 cases of B cell- or T cell lymphoma and in 9 other cases of histiocytic lymphoma. It is suggested that UEA-I+ tumours of the lymph nodes are part of a distinct subset of histiocytic malignancies whose neoplastic cells present some morphological and phenotypic properties normally associated with endothelial cells.

Adolescent↗

Effects of guanethidine on the blood pressure response to splanchnic nerve stimulation in the rat: role of the adrenal medulla.

1. Splanchnic nerve stimulation provokes a larger increase in blood pressure in intact rats than in rats previously demedullated by means of expression of the adrenals in situ and adrenalectomy followed by adrenocortical grafting.2. Rats pretreated with guanethidine showed an attenuated albeit prolonged hypertensive response to splanchnic stimulation. Similar effects were exerted by guanethidine in rats demedullated by expression. In rats demedullated by grafting, smaller doses of guanethidine induced a more substantial depression of the blood pressure response without increasing its duration.3. It is concluded that inhibition of the peripheral sympathetic endings induced by guanethidine was partially compensated by the enhancement of the cardiovascular effects of the mediators released by the adrenal medulla and that demedullation by expression did not completely eliminate chromaffin tissue.

Adrenal Glands↗

Hodgkin's disease stage I and II with exclusive subdiaphragmatic presentation. The experience of the Departments of Radiation Oncology and Hematology, University "La Sapienza" of Rome.

During the period 1978 to 1994, 1054 patients with Hodgkins's disease were evaluated and treated at the Departments of Radiation Oncology and Hematology, University "La Sapienza", Rome. A total of 549 patients presented with clinical or pathological stage I and II; 37 of these had Hodgkin's disease below the diaphragm (BDHD), and 512 above the diaphragm (ADHD). A comparison of patients with BDHD versus those with ADHD showed that the first group had a higher male to female ratio. A comparison of cases with stage II BDHD versus those with stage II ADHD showed that patients with BDHD were older (48 years vs 28 years), had different histologic features and a higher incidence of systematic symptoms (67% vs 33%). Stage II BDHD patients had a worse prognosis; in fact, there were significant differences in the overall survival and relapse-free-survival rates for cases with stage II BDHD versus those with stage II ADHD (overall survival, 46% vs 80%, P<0.001; relapse-free survival, 44% vs 69%, P<0.005). Stage was found to be the most important prognostic factor for BDHD cases without systematic symptoms treated with radiation therapy alone. The type of infradiaphragmatic presentation (intra-abdominal vs peripheral disease) did not influence outcome, probably due to the more aggressive therapy received by the intra-abdominal group. Treatment recommendations for BDHD cases should be tailored to the stage and the presence or absence of intra-abdominal localization. For patients with stage IA extended fields, irradiation (inverted Y) is sufficient. However, combined modality therapy should be the treatment of choice for stage II cases, particularly in the presence of intra-abdominal disease. Patients with systematic symptoms also require combined modalities.

Adolescent↗

Combined modality (ABVD plus radiotherapy) versus radiotherapy in the management of early stage (IIA) Hodgkin's disease with mediastinal involvement.

The aim of this study was to establish whether combined modality treatment (ABVD plus radiotherapy) can reduce the risk of relapse in Hodgkin's disease patients with mediastinal involvement, as compared to radiotherapy alone. The results obtained suggest that one course of ABVD before irradiation can reduce the incidence of relapse. These findings, however, should be considered preliminary and need to be confirmed in larger studies.

Adult↗