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Biomedical subjects

G Marini

Publications and source records attributed to G Marini.

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

Peptichemio, teniposide and high-dose dexamethasone: a new active combination for relapsing and refractory multiple myeloma. A pilot study.

Twelve patients with refractory (8 pts) and relapsing (4 pts) myeloma were treated with Peptichemio. Teniposide and high-dose dexamethasone. Eight patients experienced an objective response (5 out 8 with refractory and 3 out 4 with relapsing disease) with a median duration of 10+ months. Overall toxicity was mild to moderate and chiefly haematological. Our preliminary results seem very promising and justify a larger phase II study with this regimen.

Adult↗
PubMedDate not supplied

Patient characteristics and pre-operative therapeutic modalities.

The International Cooperative Study on the Timing of Aneurysm Surgery included 68 participating centers from 16 different countries. Eight Italian neurosurgical units participated in the Study: Bellaria Hospital, Bologna; Neurological Institute of Milan, Milan; University Hospital, Brescia; University of Milan, Milan; University of Padova, Padova; University of Rome, Rome; Civil Hospital, Verona; and Civil Hospital, Vicenza. The overall case contribution from the Italian centers was 485 cases, 14.1% of the total study population. As compared to the other centers included in the Study, the Italian centers exhibited a higher percentage of patients with impaired consciousness; a later interval of planned surgery from SAH; frequent use of preoperative lumbar drainage, as well as antihypertensives, anticonvulsants, antifibrinolytics, steroids, diuretics and LMW dextran; and less frequent use of sedatives and narcotics. The individual Italian centers differed significantly in regard to patient characteristics and preoperative therapeutic modalities. There was a relatively high number of stuporous or comatose patients admitted to Centers 1, 7 and 8, very few admitted to Centers 5 and 6, and none admitted to Center 2. The different distribution of key prognostic factors prevents a direct comparison of the overall management results of the centers. A stratification of the patients according to a risk scale and/or a prognostic model is required for comparison of the management results.

Female↗
PubMedDate not supplied

Surgical findings and postoperative therapeutic modalities.

The 8 Italian centers participating in the International Cooperative Study on Timing of Aneurysm Surgery operated upon 68% of their patients eligible for the study. This low operative rate is mainly explained by the prevailing use of a delayed surgical policy. Only 28% of cases were operated on within 3 days of hemorrhage. Although early surgery was applied in more than 50% of patients from Centers 2, 6 and 7, most other centers operated on approximately 10% of patients within this time interval. Italian centers exhibited a wide variation in planned and actual surgery interval, with only 48% of their patients eventually operated on at the planned time. Differences from planned and actual timing of surgery were less consistent in the units performing early surgery. Preoperative conditions were different between the individual centers. The percent of patients alert at the time of surgery varied from approximately 50% in Centers 3 and 7 to 90% in Center 5. Centers 2 and 6 never operated on comatose patients and rarely stuporous patients. During surgery, induced hypotension was used in 67% of Italian patients. The brain was tight at exposure in 42% of patients from Italian centers; the difference from the other study centers was very significant (p = 0.0009). Consequently major brain resection was more frequently performed in Italy than in the other centers. Brain conditions depended mainly upon timing of surgery and preoperative grade (except for comatose patients) and varied accordingly between the individual centers. Temporary arterial occlusion was rarely used in Italian centers. Intraoperative bleeding from the aneurysm was slightly more frequent than in the other centers. The overall incidence of intraoperative complications was unremarkable. There were significant differences between the Italian and the other centers regarding the use of postoperative routines and medications. In Italian centers ventricular CSF drainage, shunt insertion, ICP monitoring, sedatives and analgesics were less frequently used; lumbar CSF drainage, anticonvulsants, steroids, and diuretics were applied more frequently. In the individual centers the major differences were in the use of antihypertensives, vasopressor agents, diuretics, hypervolemia, and low-molecular weight dextran.

Humans↗
PubMedDate not supplied

Results of treatment.

Overall results of management in patients admitted to the 8 Italian centers participating in the International Cooperative Study on Timing of Aneurysm Surgery were rather unsatisfactory, with good recovery in only 42% of patients, and death in 45% of patients. As compared to the other centers included in the Study, Italian centers exhibited a significantly lower recovery rate and a significantly higher mortality rate. There were significant differences also between the individual Italian centers; independently of admission neurological status and timing of surgery, the outcome was better in centers 2 and 6 (a mortality rate under 20%) and worse in centers 1 and 8 (a mortality rate around 60%). Using prognostic factor models, higher than expected mortality rates were observed in 4 centers, and lower than expected good recovery rates in 3 centers. In Italian centers vasospasm accounted for the highest morbidity and mortality rate; the difference in mortality rate from vasospasm between Italian and other centers was very significant. Other important causes of death and disability were constituted by direct effect of the initial bleed and by recurrent hemorrhage. Patients operated on in Italian centers exhibited a good recovery in 57% of cases; the mortality was 27%. Differences from the other centers were less marked than for the overall management results. Mortality rates from vasospasm and from surgical complications were significantly higher in Italian than in the other study centers. Between the individual Italian centers, vasospasm accounted for the highest mortality rate in centers 7 and 8 (17% and 28% respectively). Postoperative pneumonia was significantly more frequent in Italian than in the other centers. In regard to timing of surgery, the differences in results between Italian and other centers were less marked when surgery was performed after 10 days from hemorrhage. In Italian centers as a whole, a delayed operation was linked with a better outcome than an early or subacute operation. The lowest recovery rate was observed in drowsy patients operated on between 4 and 10 days from the hemorrhage. Focal ischemic deficits and pneumonia were prevalent after an operation within 3 days of hemorrhage, while postoperative brain swelling was most frequent in patients operated on between 4 and 10 days from hemorrhage. The differences in results between Italian and other centers and among the individual Italian centers are widely discussed; possible explanations include inadequate modalities of treatment (especially inadequate management of vasospasm) and structural deficiencies of intensive care management in seriously ill patients.

Humans↗
PubMedDate not supplied

Cyclophosphamide, epirubicin and cisplatin (CEP) in advanced breast cancer: preliminary results.

Twenty-five patients with advanced breast cancer were treated every 28 days with Cisplatin, 30 mg/m2 iv on days 1,3,5; Epirubicin, 40 mg/m2 iv on day 1; Cyclophosphamide, 200mg/m2 iv on days 1,3,5. Partial remission was achieved by 7 patients (33%), all of whom had been untreated with chemotherapy. Overall toxicity was moderate but manageable. Severe haematological toxicity was experienced by 5 patients (20%) with grade III anemia; 2 patients had grade II oral mucositis; 4 had grade II diarrhoea Moderate nausea and vomiting were seen in all patients. Although they are only preliminary, our results suggest that this treatment had considerable activity as first line chemotherapy in advanced breast cancer and deserves further evaluation.

Adult↗
PubMedDate not supplied

Phenol injection into cisterna magna for relief of advanced intractable cancer pain in the faciocephalic area.

Between 1973 and 1980 a solution of phenol in glycerin into the cisterna magna was injected in 38 patients suffering from advanced intractable pain due to neoplasm of faciocephalic area. Owing to the poor neurological and general condition of our patients, surgical procedures were discarded. Patient's age ranged from 36 to 76 years and pain diffusion involved many cranial and cervical nerves. Follow-up studies after phenol injections were carried out in 22 patients: mean survival time proved to be 137 days. In 76% of cases, before neurolytic treatment, narcotics had been administered. In this series pain relief seemed to be poor in 50%, good in 34% while it was unclassifiable in the remaining 16% of the cases due to an incomplete follow-up. These last patients were likely to show favorable results. Complications arising immediately after phenol injections are described. Long lasting disabling neurological deficits were recorded in 18% of cases. Less severe complications were shown in 71% of the patients. The most frequent ones were impairment of sensory functions of the trigeminal area and reversible paresis of the 7th cranial nerve. Despite the poor general conditions, no fatal outcome was seen in our patients. No significant relationship between pain relief and sensory deficit was found. The pathophysiological mechanisms of pain suppression, induced by phenol injection in the faciocephalic area are discussed. The value of this simple technique is briefly assessed in comparison to other analgesic procedures.

Adult↗
PubMedDate not supplied

Third ventricle intrinsic craniopharingioma. Case report.

A case of craniopharingioma developed and situated in the cavity of the third ventricle with no connections with the base of the skull is reported. The patient was a thirty-year-old man, who within a few months had developed a diencephalic syndrome followed by psychic disorders and intracranial hypertension. Cerebral scan: large area of accumulation in the supra and retrosellar region. Bilateral carotid angiogram: no pathological staining but the venous angle and the internal cerebral vein were elevated and shifted posteriorly. Pneumoencephalogram: free and normal basal cisterns; the third ventrical is almost totally filled by a mass; small dilatation of the lateral ventricles. Operation: right trans ventricular approach to the third ventricle. The tumour was the size of an apricot encapsulated with a smooth surface, and adherent to the wall of the third ventricle only in the region of the infundibulum. There was little bleeding and no cystic component. Total removal was performed except for a few millimeters of capsule in the infundibular region. The postoperative course was complicated by an irreversible diencephalic insufficiency with death on the 27th postoperative day. Autopsy clearly showed that the inferior surface of the brain in the diencephalic region was not involved by the mass which hystologically was doubtless a craniopharingioma. Only two other cases of craniopharingioma of the third ventricle were so far reported in the literature by Cashion and Young in 1971.

Adult↗
PubMedDate not supplied

Extravasation of contrast medium from cerebral aneurysmal rupture during angiography (remarks on four cases).

The authors report four cases of contrast material extravasation during carotid angiography from cerebral aneurysmal rupture. The thesis of a coincidental event not due to an increase in the intraarterial pressure, is supported. The poor prognosis of these bleedings, detectable on angiography, is underlined and the questionable toxic effect of contrast material in the subarachnoidal space is discussed.

Adolescent↗
PubMedDate not supplied

Critical evaluation of the hemispheric perfusion brain scanning using Tc99m labeled human albumin microspheres in cerebral ischemic disorders. Preliminary report.

Twentytwo patients, 11 with Completed Stroke and 11 with Transitory Ischemic Attacks, were submitted to the Perfusional Brain Scanning (PBS). In all cases the PBS demonstred a pathologic pattern. The test explored the conditions of the arteriolar tree and acquainted us with the degree of the ischemic damage and the functional value of the interhemispheric arterial collateral circle. Further informations on the morphology, site and extension of the lesion were obtained. The pathophysiologic aspects of the procedure are discussed and its safety assessed.

Brain Ischemia↗
PubMedDate not supplied

Intramedullary spinal cord metastases.

The authors report 5 cases of intramedullary metastases, observed in the last 5 years. In 2 cases, the way of spreading was via the CSF, in 2 cases via the systemic circulation, and in 1 case along the perineural sheaths. A comparison with similar studies in the literature is followed by a brief discussion on treatment and prognosis.

Adenocarcinoma↗
PubMedDate not supplied

Intraventricular and intravenous use of amphotericin B in a case of non-surgical cerebral aspergillosis.

After a short review of the literature regarding aspergillosis, the authors report a case of a 7-year-old child suffering from cerebral aspergillosis with disseminated lesions. The authors emphasize the use of amphotericin B both intraventricularly and intravenously to obtain a longer survival when surgery is impossible because of the presence of multiple abscessual lesions in central nervous system. Authors' experience shows that the intraventricular administration of amphotericin B is well tolerated and does not cause collateral effects of the parenteral way.

Amphotericin B↗