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Biomedical subjects

M Bertini

Publications and source records attributed to M Bertini.

At least 73 records · Page 4Linked to original sources
PubMed1994

P-VEBEC: a new 8-weekly schedule with or without rG-CSF for elderly patients with aggressive non-Hodgkin's lymphoma (NHL).

BACKGROUND: Chemotherapy regimens devised for elderly patients with intermediate-high grade NHL are a matter of discussion. The aim is to reduce general toxicity without loosing an antilymphoma effect. The most important limiting factor of chemotherapy is myelotoxicity; for this reason the use of growth factor may be useful in these patients. PATIENTS AND METHODS: From November '91 to November '92, 67 pts older than 65 years with intermediate-and high-grade advanced-stage NHL were treated with the P-VEBEC regimen, an original scheme with epirubicin 50 mg/m2, cyclophosphamide 350 mg/m2 and etoposide 100 mg/m2 on weeks 1, 3, 5, 7; vinblastine 5 mg/m2 and bleomycin 5 mg/m2 on weeks 2, 4, 6, 8, prednisone 50 mg/m2/day p. os in the first 2 weeks and thereafter every other day. Twenty-eight pts received r-GSF 5 micrograms/kg/day throughout the treatment starting on day 2 of every week for 4 consecutive days. Their median age was 71 years (65-80), 31 pts were male and 36 female, histology according W.F. was D 6; E 17; F 16; G 19; H 9. Twenty-five percent of pts had B symptoms, 35% had bulky disease, 41% LDH level > normal, 44% stage IV and 26% had B.M. involvement. RESULTS: C.R. was achieved by 66% of pts. Adverse prognostic factors for CR were E histology, stage IV, bone marrow infiltration and LDH above normal. Severe toxicity was never recorded, no toxic death was observed. With a median follow-up of 24 months OS, DFS and EFS were 55%, 52%, and 33%, respectively. EFS was influenced by stage, BM involvement and level of LDH. The relative dose intensity (RDI) was calculated by the method of Hryniuk and Bush. Patients who received rG-CSF had a significantly higher median RDI (94% vs 79%) and lower myelotoxicity (neutrophil nadir < 500 18% vs 56%). The rate of CR was influenced by RDI > 80% (89% vs 56%). EFS was also better in pts who received a RDI higher than 80% (50% vs 18% p = 0.05). CONCLUSION: P-VEBEC is a feasible cycle in elderly patients; the use of rG-CSF improves RDI. In patients with adverse prognostic factors (BM involvement, poor performance status) a RDI > 0.80 could play a role in improving the outcome.

Aged↗
PubMed1993

Psychosocial factors and clinical evolution in HIV-1 infection: a longitudinal study.

The aim of the study was to assess the relationship between the initial psychosocial situation and the probability of later symptom development in HIV-1 infection. One hundred HIV-1 seropositive subjects, 79 in Stage III (LAS) and 21 in Stage II (asymptomatic), were examined both immunologically (CD4+, Skin Test) and psychologically (test battery). Follow-up at 6 and 12 months involved clinical and immunological reassessment of subjects, who were then classified as fully symptomatic (S, Stage IV) or unchanged (U). The two groups were compared through ANOVA on initial psychosocial measures, while stepwise logistic multiple regression was employed to assess the predictive value of psychosocial measures on clinical and immunological evolution. Psychosocial measures most clearly showing an association with clinical evolution were Denial/Repression attitudes (negatively) and Fighting Spirit (positively), whereas aspects of Hardiness and Social Support showed an effect in interaction with initial CD4+ levels. No stable results were obtained on immunologic evolution. The two groups (U and S) did not show significant differences on other independent variables, with the exception of age.

Adult↗
PubMed1993

Effects of L-NG-nitro arginine on cholinergic transmission in the gastric muscle of the rabbit.

In the circular muscle of the rabbit gastric corpus, the nitric oxide-synthesis inhibitor L-NG-nitro arginine (L-NOARG), enhanced the neurally-induced cholinergic responses evoked by electrical field stimulation (EFS) and ganglionic stimulating agents (nicotine, dimethylphenyl piperazinium iodide). The muscular contractions caused by acetylcholine (Ach) and methacholine were not influenced by the nitric oxide-synthesis inhibitor. The nitric oxide-releasing compound sodium nitroprusside (SNP) did not affect the Ach-induced muscular responses. Our results suggest that L-NOARG enhances gastric cholinergic responses by removing an inhibitory influence exerted at the prejunctional level in the nerve-muscle pathway.

Acetylcholine↗
PubMed1993

Reflux esophagitis in children: a scanning and transmission electron microscopy study.

In children, excess of gastroesophageal reflux causes lesions of the esophageal mucosa that we have studied by scanning and transmission electron microscopy (SEM and TEM respectively) in 27 grasp biopsies prelevated during endoscopic procedures. Ultrastructural lesions can be graded on the basis of their severity. In grade I, epithelial cells are well preserved in the deepest layers whereas the superficial cells display ultrastructural alterations such as irregular microridges or reduced intercellular junctions. In grade II, the surface is composed of extruding cells and in the intermediate layer, large intercellular spaces containing lympho-monocytic cells are visible. In grade III, the mucosal surface is characterized by crater-like erosions, degenerating cells are visible in all the layers; in two patients columnar epithelium-lined areas (Barrett's esophagus) have been identified. Our results suggest that in patients with reflux esophagitis, ultrastructural examination of grasp biopsies prelevated by pediatric endoscopes allows a grading of the anatomical lesions providing data that can not be obtained by conventional histology.

Adolescent↗
PubMed1993

[Evaluation of regression of left ventricular hypertrophy after antihypertensive therapy. Comparative echo-Doppler study of ace inhibitors and calcium antagonists].

This study evaluates 33 patients suffering from mild-moderate arterial hypertension (systolic blood pressure over 160 mmHg; diastolic blood pressure over 95 mmHg) and with concomitant indications of concentric left ventricular hypertrophy at echocardiography. Twenty patients completed the trial according to the criteria established in the protocol and were found suitable for evaluation of the results at the end of the study. Ten patients were treated with 40 mg of nifedipine retard tablets, administered twice (1 x 20 mg tablet twice daily) and 10 patients were treated with a single administration of 20 mg quinapril (1 x 20 mg tablet per day). Total follow-up was performed for one year (variability 12-14 months) with evaluation of the pressure response at 1-3-6-12 months and clinical evaluation and echocardiographic control for comparison with the baseline at the end of the study. The left ventricular mass values measured at the end of the study presented a statistically significant reduction (p < 0.001) with respect to the baseline in both groups. In the patients treated with quinapril the percentage regression of left ventricular hypertrophy was 19.39%, and slightly higher (19.5%) in the patients treated with nifedipine. Finally, although the series is perhaps too limited to draw conclusions, the finding that the indicators of diastolic filling of the left ventricle improved, and, in particular, were correlated with an increase in the speed of the first fast filling phase, and thus that there was a partial improvement in left ventricular compliance, is important.

Adult↗
PubMed1992

Surfactant-like material in the antral gastric mucosa of children.

It has been proposed that the hydrophobicity of the gastric mucosa is due to surfactant-like material (SLM), mainly composed of phospholipid, adsorbed to the mucosal surface. Biochemical and physiological studies have been performed in different mammals but morphological data on children are lacking. In the present work, the presence of SLM on the antral gastric mucosa of children has been studied by electron microscopy. The results demonstrate that SLM is present and shows two different forms, lamellar bodies and lamellar layers. In the mucosae without endoscopic, histologic, and ultrastructural alterations we have found SLM when the tannic acid method has been used but not when the tissue has been fixed only in glutaraldehyde. Our results suggest that in children with ultrastructural alterations of the epithelium, the amount of gastric SLM is increased in respect to children with a normal mucosa and that the amount of SLM on the surface of the gastric antral mucosa is modified in pathologic conditions.

Adolescent↗
PubMed1992

MACOP-B treatment in diffuse large-cell lymphoma: identification of prognostic groups in an Italian multicenter study.

PURPOSE: The prognosis of advanced-stage diffuse large-cell lymphoma (DLCL) has improved with the use of the third-generation regimens such as methotrexate with leucovorin, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B). However, different results have been reported. Therefore, we started a cooperative study to confirm the efficacy of MACOP-B. An analysis of prognostic factors was also performed to identify poor-prognosis patients. PATIENTS AND METHODS: Between June 1986 and March 1989, 180 patients with advanced-stage DLCL were treated with MACOP-B. MACOP-B was given according to the original scheme. Numerous clinical features possibly predictive for complete response (CR), disease-free survival (DFS), and survival were analyzed in univariate and multivariate analyses. RESULTS: One hundred twenty-seven patients (71%) achieved a complete remission, 20 (11%) achieved a partial remission, 24 (13%) had unchanged or progressive disease, and nine (5%) died due to toxicity. With a median follow-up of 28 months, 71% of 127 CRs remain in first remission. Predicted 3-year survival for all 180 patients is 60%, and 3-year DFS for the 127 CRs is 67%. Overall toxicity was acceptable, with mucositis being the most frequent severe side effect. A multivariate regression analysis identified lactate dehydrogenase (LDH) level, bone marrow involvement, and tumor burden as independent risk factors for survival. These factors were also important for achievement of remission and DFS and allowed us to identify three distinct risk groups of patients with good, intermediate, and poor prognosis, with 3-year survival rates of 80%, 59%, and %29, respectively. CONCLUSIONS: These results confirm the effectiveness of MACOP-B in advanced-stage DLCL at low or intermediate risk; however, high-risk patients are in urgent need of new therapeutic approaches. A better definition of prognostic features would allow a more reliable comparison of different treatment regimens, as well as an effective tailoring of therapy by prognostic groups.

Adolescent↗
PubMed1991

MACOP-B for advanced stage large cell lymphoma (DLCL). More is better? Italian Multiregional Cooperative Study Group (IMCSGL).

A study of the predictive value for CR, DFS and OS of the presenting features was carried out on 180 patients with advanced stage DLCL treated with MACOP-B between June 1986 and March 1989. A multivariate regression analysis identified LDH level, bone marrow involvement and tumor burden as independent risk factors with a 4 year survival rate of 79%, 58% and 28% respectively. Therefore MACOP-B proved to be an adequate treatment for the first two groups of patients but not for the third which requires a more aggressive treatment. A sequential single drug high dose chemotherapy with collection of peripheral blood stem cell program followed by bone marrow harvesting, super-intensive radio-chemotherapy and bone marrow transplant has been activated. Seven patients have been so far enrolled: preliminary results demonstrated the feasibility of the program. A larger number of cases and a longer follow-up is required for assessing the efficacy of this approach.

Adolescent↗
PubMed1989

MACOP-B treatment for advanced stage diffuse large cell lymphoma: a multicenter Italian Study.

Seventy-one patients with advanced stage diffuse large cell lymphoma were treated with MACOP-B. Sixty-nine per cent of patients achieved a complete response (CR), 10% a partial remission, while 11% had no response and 10% died because of toxicity. The CR rate was adversely affected by immunoblastic type, poor performance status and bone marrow involvement. Two-year survival for all 71 patients was 55% and 2-year disease-free survival (DFS) for the 49 CRs was 73%. Relapses were lower (P less than 0.05) in patients achieving CR in 8 weeks or less (DFS 83% vs. 59%) and in patients without tumor bulk (DFS 87% vs. 54%). Overall toxicity was acceptable with mucositis proving to be the most frequent severe side-effect. However, treatment-related deaths were unacceptably high in patients over 59 years of age (30% vs. 7%). Thus for the elderly MACOP-B is potentially lethal and must be used cautiously. These preliminary results confirm the effectiveness of MACOP-B. The delay of response and/or the presence of tumor bulk may be important prognostic factors in identifying a subset of poor risk patients with a high incidence of relapse.

Adolescent↗
PubMed1989

Trisomy 11 in myelodysplastic syndrome-derived acute myeloblastic leukaemias.

Here we report 3 cases of trisomy 11 observed in 1 patient with secondary acute myeloblastic leukaemia and in 2 patients with spontaneous acute myeloblastic leukaemia. In all 3 patients, the picture of overt acute leukaemia arose following a clinically established myelodysplastic syndrome. These findings, together with the previously reported occurrence of trisomy 11 in myelodysplastic syndrome and in acute myeloblastic leukaemia, suggest that this abnormality can be considered specifically associated with myelodysplastic syndrome and with the subsequent and related acute myeloblastic leukaemia.

Aged↗
PubMed1987

Predictive value of the early response to chemotherapy in high-risk stages II and III Hodgkin's disease.

A series of 60 patients with "high risk" Stage II and III Hodgkin's disease (B symptoms, or large mediastinal mass, or E lung disease) were staged without laparotomy and treated with combined modality treatment: mechlorethamine, vincristine, procarbazine, and prednisone (6 MOPP) plus radiotherapy. Patients were restaged after the first three courses of MOPP and the status of response to therapy at that time was called early response to chemotherapy (ERC). The rate of nitrogen mustard and procarbazine delivery (MRD) during the first three cycles of chemotherapy also was assessed. At the completion of the therapy patients were restaged and the final response was assessed. Fifty-two (86.7%) patients entered complete remission (CR). Forty-eight percent of the complete responders achieved CR in the first three courses of MOPP. Eight-year survival and disease-free survival (DFS) rates of the patients achieving CR were 71% and 73%, respectively. Survival and DFS were significantly better for the patients who achieved CR in the first three cycles of chemotherapy than for patients who entered CR at a later stage of therapy: 8-year survival 90% versus 55% (P = 0.00); 8-year DFS 87% versus 59% (P = 0.01). The attainment of a complete ERC was adversely affected by lymphocyte depletion (LD) histologic type (P = 0.01) and MRD less than 65% (P = 0.04). However, when a multivariate regression analysis was used, ERC was the only significant prognostic variable for survival and DFS and its predictive value was confirmed even after correction by MRD. These data suggest that the rapidity of response to chemotherapy could be an important prognostic factor in high-risk Stage II and III Hodgkin's disease.

Adult↗
PubMed1987

Duplication of Ph and of 9q+ chromosomes during the blastic transformation of a CML case.

We describe the blastic transformation of a case of chronic myelocytic leukemia in which, among other abnormalities, one extra Philadelphia and one extra 9q+ were observed. Molecular studies and analysis of the clonal evolution of the karyotype led to the interpretation of such an unusual finding as the result of nondisjunction, rather than of a double t(9;22) translocation.

Adult↗
PubMed1986

Lymphoblastic lymphoma in adolescents and adults. Clinical, pathological and prognostic evaluation.

Sixty-four adult patients with lymphoblasts lymphoma (LB) identified according to Kiel Classification were analyzed retrospectively. Three distinct clinical presentations were identified: prevalent abdominal disease (29 pts = 45.3%), prevalent mediastinal disease (14 pts = 21.9%) and prevalent superficial node involvement (21 pts = 32.8%). On histological grounds, the patients with abdominal disease were mainly associated to "Burkitt like" cell lymphoma (55%); patients with mediastinal disease to convoluted cell type (58%); and those with superficial node disease to unclassified cell type (48%). Immunological studies showed a significant correlation between mediastinal disease and T phenotype (P = 0.0011), abdominal disease and B phenotype (P = 0.00042), and between superficial node disease and non-B non-T phenotype (P = 0.00024). Survival was independent of the type of clinical presentation and protocol employed but was correlated with the stage (P less than 0.0005), symptoms (P less than 0.025), bulky disease (P less than 0.025) and bone marrow involvement (P less than 0.025). Furthermore the response to therapy was strongly correlated with prognosis (P less than 0.0001) with 34.5 months median survival for complete responders, 9 months for partial responders, and 3 months for non-responders. Four patients underwent bone marrow transplantation (three autologous and one allogeneic BMT in a patient in leukemic phase); three of them are still in CR (18, 22, and 27 months from the transplant) while one patient had an early relapse and died 3 months later.

Adolescent↗
PubMed1986

Does large spontaneous portal systemic shunt in cirrhosis protect from the risk of gastroesophageal bleeding?

The risk of gastroesophageal bleeding in cirrhotic patients with massive spontaneous portosystemic shunt (SPSS) has been evaluated variously in the literature. We undertook a retrospective study in a large group of cirrhotic patients admitted to our surgical department to evaluate the incidence of large SPSS and the correlation with current or previous episodes of gastroesophageal hemorrhage. Of 456 patients submitted to splenoportography or celiac-mesenteric angiography, 20 showed evidence on the roentgenograms of large self-established SPSS. They were classified into three groups: (a) splenorenal shunts (three patients); (b) mesenteric-caval shunts (two patients), and (c) large patent umbilical vein (15 patients). Twelve of these 20 patients had one or more episodes of gastrointestinal bleeding, and seven of them were submitted to surgical treatment to prevent recurrent bleeding. No correlation was found between the risk of esophageal hemorrhage and the type of SPSS. We concluded that, despite the presence of massive SPSS, cirrhotic patients have an unpredictable risk of bleeding and they often require surgical treatment to prevent recurrent episodes.

Collateral Circulation↗
PubMed1986

Improved results with pericystectomy in normothermic ischemia for hepatic hydatidosis.

Pericystectomy is an excellent surgical procedure for the treatment of hepatic hydatidosis. However, until now, it was not a widely accepted procedure among surgeons because of the lack of literature regarding the details of the surgical technique. During the past years, hepatic hydatidosis has been treated by a majority of surgeons by marsupialization. Only recently, more surgeons have stopped using external drainage procedures in favor of hepatic resection and pericystectomy. In a previous study, we defined some of the criteria for resection of the liver and treatment of hepatic hydatidosis, analyzing the risks and benefits for this procedure. In the present study, we have defined the indications for pericystectomy and discussed the advantages and disadvantages. In a group of 31 patients, a total of 49 cysts were removed by pericystectomy. Some of the major problems related to surgical technique are described and discussed in detail with particular reference to the use of the Pringle maneuver. Clamping of the hepatic ileum, that in our experience never exceeded 20 minutes, has allowed good results--most of all in terms of decreased intraoperative bleeding, postoperative complications and operating time.

Constriction↗