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Biomedical subjects

E Micheletti

Publications and source records attributed to E Micheletti.

At least 19 recordsLinked to original sources
PubMed2006

Optimization of copper sorbing-desorbing cycles with confined cultures of the exopolysaccharide-producing cyanobacterium Cyanospira capsulata.

AIM: The aim of this study was to compare the copper removal capability of the exopolysaccharide-producing cyanobacterium Cyanospira capsulata confined into various filtering devices and to assess its reuse for several metal sorbing-desorbing cycles. METHODS AND RESULTS: C. capsulata cultures were confined into three dialysis devices and two hollow fibre systems with different surface to volume ratios. The maximum amount of Cu was removed by the biomass confined into dialysis cassettes, followed by the dialysis tubing systems and by the two hollow fibre devices. The experiments on the sorbing-desorbing cycles showed that, with the most effective desorbing agents, the same biomass can be utilized for eight consecutive sorbing-desorbing cycles. CONCLUSIONS: The efficiency of the metal removal process is directly related to a high surface to volume ratio of the confining system and the biomass can be utilized for multiple sorbing-desorbing cycles without significant loss in the metal removal efficiency. SIGNIFICANCE AND IMPACT OF STUDY: The feasibility of a metal removal process using EPS-producing cyanobacteria confined into filtering devices has been shown, pointing out the potential of this technique for industrial applications in the removal of metals from waste waters or in the recovery of valuable metals from water solutions.

Adsorption↗
PubMed2003

Fatal thrombocytopenia and thrombocytopathia: an unusual onset of non-small cell lung cancer.

BACKGROUND: Although bone marrow is a common site of micrometastases for non-small cell lung cancer (NSCLC), thrombocytopathia and hemorrhagic diathesis are rare causes of death. CASE REPORT: A 57-year-old patient was admitted to the emergency room because of massive nosebleeding and hemoptysis. Routine blood analysis showed thrombocytopenia and prolonged bleeding time; results of functional platelet tests suggested concomitant thrombocytopathia. Routine chest X-ray revealed an 18 mm large spot in the right superior lobe. During the first hour of recovery the patient had another episode of nosebleeding. A bone marrow biopsy showed a wide infiltration with neoplastic cells. Histology was compatible with NSCLC. The clinical conditions and hematological parameters progressively deteriorated, and on the third day the patient died because of hypovolemic shock. CONCLUSION: This is a very rare clinical presentation of NSCLC characterized by massive bleeding due to thrombocytopenia and thrombocytopathia secondary to wide bone marrow infiltration.

Biopsy↗
PubMed2001

[Adolescent health care in pediatric departments of Tuscany].

BACKGROUND: Admission to Pediatric Departments for 0/18- year-old patients is an important issue for the best organization of pediatric hospital assistance. Aim of the study. To locate adolescent health care and identify the percentage of adolescent admissions to Pediatric Departments in an Italian region (Tuscany). METHODS: Adolescent health care in pediatric departments and pediatric admissions (0-18 years old) in 1999 into the reference hospital of Pisa and into 5 other regional hospitals in Tuscany are reported. The percentages of patients, subdivided by age, hospitalyzed in Pediatric Departments have been determined. RESULTS: In 1999 the admissions for subjects aged 0 to 18 years were 12573 of which 4966 adolescents (39.6 %). The percentage of adolescent admissions is not smaller than children's admissions (aged 0 to 1 year: 16.2%; aged 2 to 5 years: 26.2%; aged 6 to 9 years: 17.8%; aged 10 to 14 years: 20.4%; aged 15 to 18 years: 19.2%). Analysis by age demonstrated a continuous decrease of patient percentages admitted to Pediatric Departments with the increased age. A minority of 15/18- year-old subjects has been admitted to Pediatric Departments. CONCLUSIONS: The percentage of adolescent admissions is similar to there of children. Most adolescents are admitted to structures unsuitable for assistance to subjects aged 0 to 18 years. These data underline the necessity for a strong recovery of adolescent admissions to pediatric structures also equipping suitable nursing rooms.

Adolescent↗
PubMed1997

Continuous infusion of carboplatin during conventional radiotherapy treatment in advanced squamous carcinoma of the cervix uteri IIB-IIIB (UICC). A phase I/II and pharmacokinetic study.

OBJECTIVE: A prospective, single-arm phase-I/II trial performed to assess the efficacy and toxicity of the concomitant use continuous infusion of low-dose carboplatin and pelvic conventional radiotherapy in patients with locally advanced squamous cell carcinoma of the cervix. MATERIALS AND METHODS: Between January and July 1994, a total of 12 patients consecutively diagnosed to have squamous cell carcinoma of the cervix uteri stages IIB-IIIB UICC-TNM (five patients, IIB; and seven patients, IIIB) entered the study. All patients were evaluated by a gynecologist and a radiation oncologist and were submitted to standard pretreatment staging procedures. Radiation was delivered with 10-MeV photon beams with the shrinking-field technique. The patients received 2 Gy radiotherapy daily, 5 fractions per week, up to a planned total of 60 Gy in 6 weeks to the primary tumor and 46 Gy in 4 weeks to the whole pelvis. Irradiation was performed using four fixed orthogonal fields. One intracavitary insertion, 8 Gy to point A (dose rate, 1.1 Gy/h), was performed immediately after external pelvic irradiation. Carboplatin (12 mg/m2/day) was also administered in a continuous infusion, starting 1 day before the first fraction of radiotherapy. The platinum in plasma and urine, as well as the platinum concentration in the cytosols of lymphocytes and tumor, was measured weekly. RESULTS: A complete response was seen in nine (75%) of the 12 patients. Of the nine patients who achieved a complete remission, only one had subsequent failure in the pelvis. The total pelvic failure rate was 33.3% (four of 12 patients). With a median follow-up time of 20 months, the actuarial survival rate at 24 months was 64.8%. All patients completed the treatment without major protocol violations. Grade-2 leukopenia (in nine patients) and grade-1 nausea and vomiting (in five) were the most common acute toxicities. There was one grade-3 hematologic toxicity. Grade-3 late complications were observed in 16.6% of cases (two of 12 patients). On days 28 and 42 of the treatment, the mean total platinum plasma concentrations were 491 micrograms/L (SD = 129) and 672 micrograms/L (SD = 160), and the ultrafilterable fraction was 8-10%. At the same time points, the concentration in lymphocytes was constant at 21 picograms (pg) platinum/lymphocyte. The levels of platinum concentration measured on days 14 and 28 in the cytosols of tumor cells were 0.3 microgram/g (SD = 0.1) and 0.93 microgram/g (SD = 0.2). CONCLUSION: The combination of continuous infusion of carboplatin and radiotherapy at the aforementioned doses in patients with locally advanced cervical carcinoma resulted in a relatively low frequency of significant acute and late complications. Platinum in normal tissue (picograms per lymphocyte) was stable from week 1 of treatment, whereas the platinum steady state in plasma and in tumor cells was not reached in 6 weeks and was below that required in vitro to produce radiopotentiation. Further studies to determine the optimal dose of carboplatin and irradiation are needed prior to the initiation of phase-III studies.

Adult↗
PubMed1997

[Management control and operative outcome of the Radio Institute "O. Alberti." Management of oncologic follow-up].

Post-treatment cancer patient surveillance is an area with few given standards where the need of guidelines has become imperative with the recent emphasis on controlling the ever-increasing health care cost. Unfortunately, literature reports are often inconclusive and ambiguous, mostly because of the lack of properly controlled trials comparing the cost and benefits of various follow-up protocols. In addition, the actual impact on patient survival and quality of life is questionable. At the Istituto del Radio "O. Alberti" (IRA), we consider the follow-up as a sort of population screening aimed at the early detection and treatment of recurrent disease. While aggressive surveillance undoubtedly detects some cancers before symptoms develop, it is debated whether the impact on survival and quality of life are measurable. The early detection of relapse is only a potential survival benefit if recurrent disease is curable with further treatment or at least if salvage treatment is more effective in patients with less severe disease. We investigated the effectiveness, efficacy and medical care of our follow-up protocol. April to June, 1996, we examined 1,223 of 2,148 expected patients; 225 patients disattended the scheduled visits. IRA spent about It. L. 33,800 per examination. Fifty-seven patients were hospitalized to carry out treatment and IRA hospitalization charges were about It. L. 1,100,000 while overall social expenses were about It. L. 6,600,000. Regular visits to see an oncologist provide easy access to specialist medicine and convey a sense of being looked after with a caring system. 94.5% of patients prefers to continue the follow-up program with scheduled visits. Most patients (70%) know about the examinations they undergo but consistently overestimate the importance of laboratory tests and imaging findings and underestimate the importance of medical history and physical examination. In addition, most patients (95%) misinterpret the term "normal" relative to a test result. This study suggests that patients are unfamiliar with the limitations of more costly diagnostic and follow-up studies, which reflects the fact that physicians spend little time discussing follow-up strategies with their patients, especially regarding the cost-benefit analysis and the sensitivity and specificity of the laboratory tests and imaging examinations. Finally, in our opinion follow-up cost is acceptable even though expenses should be reduced optimizing the request of instrumental examinations. Therefore, oncologists should definitely try to inform their patients about the clinical importance of follow-up.

Cancer Care Facilities↗
PubMed1997

[Intracavitary brachytherapy in esophageal neoplasms. Experience at the Radiology Institute of Brescia].

We investigated the role of brachytherapy in the management of esophageal cancer. From March, 1990, to December 1994, seventy patients, with biopsy-proved esophageal carcinoma, were treated with brachytherapy +/- external beam radiotherapy. According to the TNM staging system, 24 patients were graded as T1, 24 as T2, 10 as T3, 9 as T4, and 3 as Tx. Median Karnofsky score was 80. Dysphagia was the major symptom in 68% of cases. Treatment consisted of low dose rate first, and then high dose rate brachytherapy, with progressive optimization of doses and fractions, up to total doses of 15-30 Gy in low dose rate and 7-21 Gy in high dose rate. When associated, external beam radiotherapy was delivered with conventional schedules. Tolerance to treatment was good with slight acute toxicity. Symptoms were markedly improved, with reduction of dysphagia in 100% of cases. Overall survival was 75%, 47%, 23% and 18% at 6, 12, 24, 36 months; no significant difference was found between low and high dose rate groups. Furthermore, no difference was shown in the overall survival of the group treated with brachytherapy alone and the one with associated external beam radiotherapy. Late toxicity occurred in 10% of patients and was managed by endoscopic procedures in all cases. In our opinion, brachytherapy appears to be an effective palliative treatment; its role as radical treatment remains to be defined.

Adult↗
PubMed1996

[Locally advanced carcinoma of the cervix uteri (stage IIB-IIIB TNM-UICC): radiotherapy combined with simultaneous daily low-dose platinum. Phase II study].

A prospective, single arm, phase-II trial was performed to assess the efficacy and local toxicity of the combination of low doses of platin and pelvic radiotherapy in patients with locally advanced carcinoma of the cervix. January, 1993, through August, 1994, twenty-three previously untreated patients with squamous carcinoma (stages IIB-IIIB UICC) entered the study. All patients were examined by a gynecologist and by a radiation oncologist and then submitted to conventional pretreatment staging procedures. Nine patients were classified as stage IIB and 14 patients as stage IIIB. Radiotherapy consisted of 60 Gy external beam irradiation (46 Gy to pelvis + 14 Gy boost to cervix uteri and parametria) plus one low dose rate intracavitary treatment to a dose of 8 Gy to point A. Cisplatin (3 mg/m2/day) or carboplatin (12 mg/m2/day) was also given for 6 weeks starting on radiotherapy day 1. The treatment was well tolerated and no patient required radiotherapy discontinuation. With a median follow-up time of 20 months, complete response was seen in 74% (17/23) of the patients. One of the 17 patients who achieved a complete remission, during follow-up, relapsed in the pelvis and one developed lung metastases. Total failure rate in the pelvis was 30.5% (7/23). Distant metastases were observed in 17.5% (4/23) of the patients. Actuarial overall and disease-free survival rates at 33 months were 69.1% and 65.2%, respectively. Late gastrointestinal toxicity (grade 3) occurred in 8.6% (2/23) of patients, with one patient developing a rectal ulcer-which was submitted to colostomy- and one patient a vaginal necrosis. The combination of platin and radiotherapy appears to be an effective regimen for the patients with locally advanced carcinoma of the cervix and caused a relatively low rate of late gastrointestinal complications.

Adult↗
PubMed1996

[Is radiotherapy still the first choice treatment in spinal metastases from breast cancer?].

The skeletal system is a frequent site of metastatic involvement from breast cancer, whose pattern of spread is such that cure becomes practically impossible. The best palliation with the minimum discomfort for the patient must therefore be the major objective. With an increasing number of reports about major surgical procedures for spinal metastases, we reviewed our series of patients submitted to radiotherapy. Of 2,189 breast cancer patients, we selected 28 who might have been potential candidates for surgical resection (with lesions only in the spine, only one or no more than three contiguous bodies involved and no other metastases). All these patients had been treated with 20 or 30 Gy plus systemic (chemo, hormone, or both) therapy. Follow-up revealed that all of them had developed new metastases outside the treated field within one year. Local control was achieved in 68% of patients and 75% of them had stable or better performance status at 3 months. Median survival was 36 months. From our analysis, even patients with a so called "solitary lesion" seem not to have a better prognosis than others. We conclude that radiotherapy is still the method of choice to treat vertebral metastases from breast cancer. The role of surgery should be limited to patients with neurologic compression or severe mechanical instability.

Breast Neoplasms↗
PubMed1995

[Aneurysm of the popliteal artery in a patient over 80 years of age].

The authors report an aneurysm in the popliteal artery surgically treated with success. The operation consisted on the installation of one tubular prosthesis femoro-poplitea with a termino-terminal anastomosis. The follow-up to 3 and 6 months from the operation showed good functional recovery.

Age Factors↗
PubMed1994

High-dose interstitial brachytherapy for glioblastoma multiforme.

AIMS AND BACKGROUND: The long-term prognosis for survival of patients with inoperable glioblastoma multiforme (GBL) is very poor. Conventional external radiotherapy gives only transitory result. This severe prognosis led us to elaborate a high-dose rate (HDR), after-remote-loading brachytherapy treatment protocol: our aim was both therapeutic and psychologic. METHODS: Five patients with GBL (T1 G4 UICC) were treated with stereotactic biopsy followed by HDR brachytherapy. A unique coaxial after-loading catheter was stereotactically inserted through the center of the target volume. The treatment schedule considered 5 fractions, 5 Gy/fraction at the dose specification surface, 2 fractions per day. RESULTS: The treatment was well tolerated. Tumor progression started again at the 8th to the 16th week from the end of the treatment. ECOG performance status at the 8th week was better than before the therapy in 2 of 5 patients and was stable in 2 of 5 patients. Order neuroperformance status was stable in 2 patients at 8 weeks. At the 16th week there was neurologic deterioration. The average survival was 21 weeks. CONCLUSIONS: Our approach seems to be of some interest for the palliation of GBL, and it offers some advantages, in particular regarding the short treatment period. Our procedure can be improved: a multi-catheter implant and a more fractionated schedule could be taken into account.

Aged↗
PubMed1992

Total lymphoid irradiation in chronic progressive multiple sclerosis.

6 patients with severe chronic progressive multiple sclerosis were subjected to total lymphoid irradiation (TLI) to assess clinical efficacy and side effects. During a 4 year follow-up the disability progression was continuous. Side effects during TLI were well tolerated; side effects after TLI brought about a worsening of the quality of life. One patient died of pneumonia. In this preliminary study TLI did not reduce the worsening of disability in MS patients.

Adult↗
PubMed1991

Primary radiotherapy versus surgery and radiotherapy in the management of postmenopausal locally advanced breast cancer.

From 1978 through 1984, 103 postmenopausal patients with locally advanced breast cancer (T4 N1-2-3 MO) were treated by definitive radiotherapy (XRT, 35 patients) or mastectomy and postoperative radiotherapy (RM + XRT, 68 patients). A control group of 35 of the 68 RM + XRT patients was selected by matching several prognostic variables with the XRT group. Patients were followed for 4 to 10 years. At 5 years the probabilities of overall survival and relapse-free survival were 49.9% and 33.2% for XRT patients and 49.2% and 42.8% for RM + XRT patients, respectively (with no significant difference). The probability to remain free of local-regional progression at 5 years, with censoring of deaths, was 71.9% in the XRT group and 79.8% in the RM + XRT group. Of the patients treated with definitive radiotherapy, those who received 60 Gy or more to the primary tumor had a significantly better 5-year rate of local control: 88.0% vs. 68.0%, p less than 0.05. Our results suggest that adequate doses of radiotherapy can provide long-term local-regional control in a large proportion of survivors and can spare mastectomy in most patients, without however achieving substantial improvements in the poor survival results.

Breast Neoplasms↗
PubMed1991

[Role of postoperative adjuvant radiotherapy in the treatment of class T2-3 NO MO adenocarcinoma of the kidney].

From 1968 to 1983, in the Department of Urology and in the Institute of Radiotherapy of the University of Brescia, the role of postoperative radiotherapy (PORT) in 95 patients with renal adenocarcinoma (T2-3 N0 M0) was investigated. From 1968 to 1978, 46 patients underwent radical nephrectomy and PORT; from 1978 to 1983, 49 patients were submitted to radical nephrectomy with regional lymphadenectomy (CH). Overall survival (PCS) at 5 years is 63% (PORT) vs 57% (CH) (p greater than 0.05). The probability of survival is better for left-sided neoplasms than for right-sided ones. In the CH group, the 5-year PCS is 40% vs 70%, respectively, for right vs left neoplasms (p less than 0.05); in the PORT group, PCS is 59% (right) vs 70% (left). For right-sided cancers, 5-year PCS is higher for PORT (59%) than for CH (40%) patients (p less than 0.05). In the PORT group acute bowel toxicity was 24% (grade 2, WHO). In 2 patients only (4.3%) PORT was stopped because of toxicity. PORT sequelae were investigated in: spinal cord, contralateral kidney, liver and bowel. Bowel sequelae (grade 2, Dische) were observed in 3 patients only (6.5%). In the T2-3 N0 M0 classes, radical nephrectomy with PORT may give the same results as aggressive surgery, with a low biological cost. Prognostic data might mean a different and more favorable loco-regional evolution for left-sided renal cancers.

Adenocarcinoma↗
PubMed1991

[Progressive multiple sclerosis. Evaluation of the effectiveness of total lymph node irradiation].

A long-lasting immunological suppression action seems to be produced by total lymphoid irradiation; some authors emphasize the favorable effect of this treatment on chronic progressive multiple sclerosis. In order to evaluate the actual role of TLI, 6 patients affected with chronic progressive multiple sclerosis were submitted to TLI with shaped and personalized fields at the Instituto del Radio, University of Brescia, Italy. The total dose delivered was 19.8 Gy in 4 weeks, 1.8 Gy/day, 5d/w; a week elapsed between the first and the second irradiation course. Disability according to Kurtzke scale was evaluated, together with blood lymphocyte count and irradiation side-effects, over a mean follow-up period of 20.8 months (range: 13-24). Our findings indicate that: a) disease progression was not markedly reduced by TLI; b) steroid hormones responsivity was restored after irradiation, and c) side-effects were mild and tolerable.

Adult↗
PubMed1990

[Prosthetic valve endocarditis].

The Authors report their experience of the surgical treatment of cardiac prosthetic endocarditis. Between September 1974 and December 1988, 2,796 cardiac prostheses were implanted. An endocarditis in the follow-up of 23 patients involving 27 prostheses was diagnosed. The operative mortality was high in patients with mitral prosthetic endocarditis; in patients with infected aortic prosthesis operative mortality was low, but there was a high incidence of recurrence. The Authors emphasize the difficulty of diagnosis and the importance of the surgical treatment for eradication of the infection and for resolution of the haemodynamic defect.

Aortic Valve↗