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Biomedical subjects

L Balducci

Publications and source records attributed to L Balducci.

178 records · Page 10Linked to original sources
PubMedDate not supplied

Hemopoietic reserve in the older cancer patient: clinical and economic considerations.

BACKGROUND: Older individuals are at increased risk for myelosuppression, the most common complication of cytotoxic chemotherapy. Causes include reduction in hemopoietic stem cell reserve, increased prevalence of chronic diseases, and increased prevalence of anemia. Anemia is an independent risk factor for myelotoxicity, in part because it decreases the volume of distribution of anthracyclines, epipodophyllotoxins, and taxanes and increases the circulating concentration of free drugs. METHODS: The authors review the effects of aging on the hemopoietic system and the consequences of reduced hemopoietic reserve on the safety and cost of chemotherapy. RESULTS: While it is unclear whether the responsiveness of hemopoietic progenitors to physiologic amounts of growth factors is preserved in older individuals, pharmacological doses of these factors stimulate hemopoiesis and mitigate myelosuppression. It is recommended that patients aged 70 and older receiving combination chemotherapy of dose-intensity comparable to CHOP be routinely treated with myelopoietic growth factor. The hemoglobin levels of these patients should be maintained at approximately 12 g/dL with erythropoietin. This treatment may prevent costly complications such as neutropenic infections and functional dependence. CONCLUSIONS: Alternative approaches to the prevention of hemopoietic complications may include more conservative use of growth factors (later initiation of treatment and earlier termination), prophylactic antibiotics in patients at risk for prolonged neutropenia, and biological treatment. Dose-reduction of chemotherapy may lead to inferior outcomes and is not recommended for patients with good functional status.

Aged↗
PubMedDate not supplied

Management of breast cancer in the older woman.

BACKGROUND: Approximately half of all breast cancer cases occur after age 65. Several aspects for the treatment of early breast cancer may be influenced by patient age, including postoperative irradiation after partial mastectomy, axillary lymphadenectomy, primary medical treatment of early breast cancer, and adjuvant chemotherapy. METHODS: The authors review the literature regarding age-specific issues in the management of breast cancer, and they report their own experience in treating older women with breast cancer. RESULTS: In terms of survival and disease-free survival, tamoxifen alone in primary breast cancer is inferior to surgical treatment followed by adjuvant tamoxifen. Tamoxifen alone should be reserved for patients with absolute contraindications to mastectomy. Adjuvant chemotherapy is beneficial to women with hormone receptor-poor tumors. In those with hormone receptor-rich tumors, adjuvant chemotherapy is beneficial for HER2-positive tumors, and the regimen should contain an anthracycline. CONCLUSIONS: Although the risk of local recurrence after partial mastectomy declines with increasing age, the decision to forego radiation therapy is individualized based on risk of recurrence and on patient desires and resources. The advent of lymph node mapping obviates the need for lymphadenectomy in most patients. The benefits and risks of adjuvant chemotherapy should be individually assessed according to tumor stage, life expectancy, comorbidity, and expected tolerance of treatment.

Age Factors↗
PubMedDate not supplied

[Ascites as an unusual manifestation of chronic granulomatous disease in childhood].

Ascites is a late and uncommon symptom of Chronic Granulomatous Disease (CGD) of childhood following liver damage with portal hypertension due to hepatic granulomatosis. The Authors describe two patients with CGD, in whom ascites was the main symptom in the first case and the initial symptom in the second case. Ascites in these cases was not due to liver fibrosis but it was a consequence of primary bacterial peritonitis.

Ascites↗
PubMedDate not supplied

[Neurological complications of Mycoplasma pneumoniae infection. Description of a case of meningitis with clear cerebrospinal fluid].

Mycoplasma pneumoniae (M.p.) is generally responsible of upper and lower respiratory tract infections in children in school age; in about 2% of cases can be also considered the cause of a NS infection: meningitis, encephalitis, cerebellitis, transverse myelitis and ascending polyradiculitis. The authors describe a case of meningitis following an acute otitis media in a 6 years old child. This patient presented also a fourfold or greater decrease in titer of complement fixing antibodies to M.p. The authors suggest a systematic research of M.p. in patients with clear CSF meningitis.

Acute Disease↗
PubMedDate not supplied

[Epidemic parotitis in Italy: results of a 1st vaccination trial].

Forty children over 12 months of age were inoculated subcutaneously with live mumps vaccine (Jeryl Lynn strain) and tested before and 6 weeks after vaccination for complement fixing, (CF) and hemadsorption neutralizing (HN) serum antibodies against a wild-mumps virus strain. CF antibody titers were not reliable for assessing both the previous immunity and the vaccine response. Among the 13 HN seronegative subjects the responders to the vaccine were 7, with a seroconversion rate of 53.8% and a geometric mean titer (GMT) of 1:2.6. Twenty (74.1%) of the 27 subjects already seropositive before the vaccination had a booster effect with an increase of the GMT from 1:8.29 to 1:33.89.

Antibodies, Viral↗
PubMedDate not supplied

Treatment considerations for older patients with cancer.

It is apparent that cancer is primarily a burden for geriatric populations. This conclusion is based both upon the greater incidence of the disease with advancing age and the increasing distribution of elderly people in western cultures. Three questions have arisen that form the underpinnings of the evolving subspecialty of geriatric oncology. These are: Why are tumors more frequent in the elderly? Is there a difference in tumor aggressiveness with advancing age? And, should treatment be different for the older patient? Experimental data and clinical experience have indicated that tumors are not resistant to treatment by virtue of age alone. However, age is associated with slight reductions in certain organ functions, and these deficiencies might be magnified by comorbid conditions. Cancer treatments, especially chemotherapy may therefore be more toxic and therefore treatment should be tailored for the individual taking into consideration potential increased toxicities balanced by patients expectations. Quality of life considerations assume even greater importance in geriatric populations.

Adult↗
PubMedDate not supplied

Geriatric oncology. Medical and psychosocial perspectives.

PURPOSE: The authors aim to promote cancer control in the older person through an understanding of medical and psychosocial issues related to early detection, evaluation, and management of care. OVERVIEW: The management of cancer in the older adult is an increasingly common aspect of oncologic practice. Over the next decades, special concerns will be generated by the rapid rise in the number and proportion of older persons in our society. This article addresses the following: the identification of those patients who would benefit from interventions; the need for individualized treatment plans and a multidisciplinary approach; factors affecting incidence, clinical course, and treatment of cancer, barriers to cancer screening and treatment; psychological adjustment to cancer; and the medical and psychosocial management of the older person with cancer. CLINICAL IMPLICATIONS: Cancer control in the older person may be improved by removal of the barriers to appropriate screening and by individual treatment plans focused on the special needs of individual patients. The Comprehensive Geriatric Assessment allows adequate appraisal of functional status, comorbidity, life expectancy, quality of life, and economic and emotional needs of individual patients. Treatment strategies based on a global evaluation of the older person are more likely to be successful in terms of compliance and effectiveness.

Adaptation, Psychological↗
PubMedDate not supplied

Medical therapy of solid tumors in the elderly: an update.

This article explores the medical treatment of solid tumors in older individuals. After a brief review of pharmacology of anticancer agents in the elderly we will examine the treatment of common neoplasms, such as cancer of the breast, of the large bowel and of the prostate.

Age Factors↗