Biomedical subjects

D Dallari

Publications and source records attributed to D Dallari.

At least 37 records · Page 2Linked to original sources

PubMed1988

Neoadjuvant chemotherapy in the treatment of osteosarcoma of the extremities: preliminary results in 131 cases treated preoperatively with methotrexate and cisdiamminoplatinum.

The results of 131 cases of classic non-metastatic osteosarcoma of the extremities treated with preoperative chemotherapy, surgery and postoperative chemotherapy are reported. Preoperatively, the patients were given Methotrexate (MTX) intravenously (high and average doses) and Cisplatinum (CDP) intraarterially. For postoperative chemotherapy, the drugs and treatment protocols were based on the degree of necrosis observed (good, fair, poor). Conservative surgery was performed in 73% of the cases and amputation in 27%. At an average 30 month follow-up (9-48 months) 59.5% of the patients had remained disease-free, 37.5% had developed metastases, and 3% had developed local recurrence. The percentage of disease-free patients was higher for those treated with high doses of MTX (68% vs. 51%) and for those in whom preoperative chemotherapy had induced good necrosis (75% vs. 44%). Neither the age or sex of the patients, nor the site of the tumor or type of surgery performed influenced prognosis.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1987

Prognostic value of serum alkaline phosphatase in osteosarcoma.

In 163 patients with osteosarcoma of the extremities treated with adjuvant chemotherapy, serum alkaline phosphatase (SAP) levels were evaluated before treatment and successively closely monitored in an attempt to determine whether serum levels of this enzyme had clinical value in predicting the course of the disease. Of 121 patients with elevated preoperative SAP levels, 78 (64%) recurred. Of 42 patients with normal preoperative SAP levels, only 8 (19%) recurred (P less than 0.00001). Of the 140 patients locally treated with amputation, SAP returned to normal values in 77 patients; 46 of these (59%) relapsed. Of the 21 patients whose SAP remained elevated after amputation, all but 2 relapsed (90%). Among 119 patients with normal postoperative values of SAP, at the time of relapse SAP resulted elevated in 22 of 41 patients (53%). These data confirm that in osteosarcoma, preoperative SAP levels have a definite value in establishing the prognosis and that posttreatment follow-up examination should include SAP determination, since persistent elevated or increasing values herald the appearance of a recurrence.

Adolescent↗

PubMedDate not supplied

Prognostic significance of serum lactic acid dehydrogenase in Ewing's tumor of bone.

Pretreatment serum lactic acid dehydrogenase (LDH) levels were examined in 82 patients with Ewing's tumor of bone (23 metastatic and 59 localized). The percentage of patients with increased serum LDH levels was significantly higher in the metastatic group than in the group of patients with localized disease (87 vs. 45%). After treatment with combined therapy, in this latter group the recurrence rate was significantly higher in patients with elevated serum LDH levels at admission than in those with normal serum LDH levels (50 vs. 9%). Of the 16 patients with localized disease who relapsed, 13 (81%) had elevated serum LDH levels at the time of recurrence. These results indicate that in Ewing's tumor serum LDH levels may serve as useful prognostic markers and could be valuable in monitoring the effectiveness of combined therapy.

Adolescent↗

PubMedDate not supplied

Loss of bone mass after total hip replacement: preliminary data.

In a total of 37 females with cemented total hip replacement for monolateral coxarthrosis, of which 13 with prosthetic stem loosening, and 11 with monolateral coxarthrosis that is not prosthetized, bone mineral density (BMD) is determined by dual ray photonic absorbimetry selecting regions of interest (ROI) on the cortex of the femurs 4 cm under the lesser trochanter and on the ischium bilaterally. In females that are not prosthetized there are differences in bone mass between the two femurs and the ischium on both sides. In prosthetized patients BMD of the femur and of the ischium on the side operated on is significantly less than on the contralateral one (Student's "t" test: p < 0.001). In patients with stable prostheses, BMD of the femur operated on is greater than that in females with prosthetic stem loosening (Student's "t" test: p < 0.000). Based on a comparison between these two groups we did not observe any other significant differences in BMD among the ROI analyzed. BMD was correlated with the amount of time since surgery only in the ROIs in prosthetized femurs. The study confirms the significant bone resorption of the cortex in prosthetized femurs and documents analogously significant reduction in BMD in the ischium on the side operated on. Finally, it indicates that prosthetic stem loosening may be associated with loss of BMD in the femoral cortex which is significantly greater than that observed, during analogous periods of time in stable implants.

Aged↗

PubMedDate not supplied

The prognostic value of serum alkaline phosphatase in osteosarcoma of the limbs.

The values for serum alkaline phosphatase were evaluated in 340 patients affected with osteosarcoma of the limbs. The percentage of patients with high values for the enzyme at the onset of disease was significantly higher in the 69 cases who presented with metastases at the time of diagnosis, as compared to the 271 cases in which the neoplasm still appeared to be localized (81% vs 62%: p less than 0.001). In this last group of patients, treated with neoadjuvant chemotherapy, an evident relationship between values for alkaline phosphatase and prognosis was demonstrated. The percentage of patients who developed metastases was in fact 22% in the group with normal serum values for the enzyme at the onset of the disease and 40% for the patients with high values of the same (P less than 0.001). These data confirm the prognostic value for serum alkaline phosphatase in osteosarcoma, which should be taken into consideration when planning chemotherapy and in classifying patients for randomized therapeutic studies.

Adolescent↗

PubMedDate not supplied

Bone scan in the evaluation of cementless hip prostheses.

The authors report the data obtained in a bone scan study conducted in 15 patients with cementless total hip arthroplasty. The study was conducted a minimum of 6 months and a maximum of 46 months postsurgery. Contrary to what occurs for cemented prostheses, we used bone scan not as a diagnostic aid for complications, but in order to evaluate the osteogenetic response of the bone to a cementless prosthetic implant. Zonal bone scan high uptake revealed specific areas of overloading, or, when localized in the para-articular region, they anticipated the presence of ossifications before they became visible radiographically. Bone scan was also useful in monitoring the incorporation and remodelling phases of the auto and/or homoplastic bone grafts used.

Aged↗

PubMedDate not supplied

The role of surgery in the treatment of localized Ewing's sarcoma.

This study includes 193 patients affected with localized Ewing's sarcoma and treated at the Rizzoli Orthopaedic Institute between April 1972 and May 1988. It is the purpose of this study to evaluate the efficacy of surgical treatment with regard to the prognosis of patients affected with E.S. and to define its indications as well as its limits as compared with radiotherapy. Ninety patients were treated surgically: 13 underwent amputation (localization of the disease in the leg and foot), 4 underwent debulking, 48 had resection of the tumor without any reconstruction (expendable bones), while for 25 other patients resection of the tumor required alloplastic or allograft replacement. In cases of E.S. localized in the pelvis and spine, surgery did not obtain improvement in prognosis. In the other sites, the percentage of disease-free patients increased from 57% to 72% in cases where surgery +/- radiotherapy was used instead of radiotherapy alone, while the percentage of local recurrences decreased from 18% to 5.5%, respectively. As for functional results, the highest incidence of excellent to good scores was obtained with surgery associated with radiotherapy (69%). The incidence of complications was only slightly different for the two groups.

Amputation, Surgical↗

PubMedDate not supplied

An evaluation of the "in vivo" and "in vitro" biological reaction and mechanical features of carbon fibre composites.

Tissue reaction to an epoxy resin-carbon fibre composite was tested "in vivo" and "in vitro" in order to evaluate this material as an alternative to metal alloys for clinical use in orthopaedic surgery. While the "in vitro" tests suggest a mild toxic effect of the composite on cells, good biocompatibility "in vivo" was observed when debris are not generated. The mechanical tests compared the composite and stainless steel plates, confirming the expected values for static strength and elastic modulus, revealing, however, the formation of long needles of carbon fibre following breakage of the plate.

Animals↗

PubMedDate not supplied

Anatomical ceramic arthroplasty (AN.C.A.): preliminary experience with a new cementless prosthesis.

The study reports the results obtained in 100 hips operated with a new cementless arthroplasty (AN.C.A.) characterized by the anatomical shape of a stem coated with Al2O3 and by a spherical acetabulum in ceramic-titanium, stabilized to the acetabulum first by screwing of the titanium ring and then by bony ingrowth in the cupola covered with porous ceramic. The patients were followed-up after an average of 17.4 months (+/- 8 SD). The patients were clinically evaluated using on the Merle d'Aubigné system, with the following average values +/- SD: pain 5.51 +/- 1, walking 5.01 +/- 1.1, and range of motion 5.38 +/- 0.9. The radiographic stabilization of the prosthesis (considering the worst results of the acetabulum and/or of the stem) was bony (BS) in 83% of the case and fibrous (FS) in 11%; 6 cases (5 acetabulums and 1 stem) showed signs of radiographic instability. Of these, 2 were submitted to further surgery to substitute the acetabulum. Two other patients were also submitted to a second operation: 1 involved substitution of the fractured ceramic head, and the other involved substitution of the stem in a patient with progressive coxalgia and no radiographic signs of loosening. The method of radiographic evaluation was significantly correlated with pain (p = 0.0001) and with walking (p = 0.0095). Instead, there were no significant correlations between stabilization of the prosthesis and precision of the femoral fit (press-fit) of the stem, age, evaluation of preoperative mineralization of the bone, and length of the stem. 8% of the cases presented important radiographic signs of stress-shielding; while 16% presented hypertrophy of the femoral cortex. These radiographic findings were not correlated to clinical ones.

Adult↗

PubMedDate not supplied