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Biomedical subjects

M De Santis

Publications and source records attributed to M De Santis.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Congenital cystic adenomatoid malformation of the lung: antenatal ultrasound findings and fetal-neonatal outcome. Fifteen years of experience.

Seventeen cases of congenital cystic adenomatoid malformation of the lung (CCAM) are reported. They were followed up over a period of 1 month to 15 years. Diagnosis was made by prenatal ultrasound. Our purpose was to evaluate the fetal-neonatal outcome and the prognostic elements observable through ultrasound techniques, and to compare all types of CCAM. The outcome observed ranged from total prenatal resolution to postnatal spontaneous regression of the lesion, to complications due to the presence of nonimmune fetal hydrops (NIFH), intrauterine death and the necessity of surgical intervention. In our experience only hydrops represented a negative predictor of outcome since death occurred in all cases with this pathology. In the absence of NIFH, counselling should stress the prevalence of a positive outcome, even in cases of surgical intervention.

Cesarean Section↗
PubMedDate not supplied

Immune thrombocytopenic purpura and percutaneous umbilical blood sampling: an open question.

We performed a retrospective study of 26 pregnancies with chronic immune thrombocytopenic purpura (ITP) or incidental ITP. Thirteen pregnancies were followed without the use of percutaneous umbilical blood sampling (PUBS) and 13 were followed sampling PUBS at 36-40 weeks of gestation. The overall prevalence of neonatal thrombocytopenia was 27%: 50% in chronic ITP, 12.5% in incidental ITP. Symptomatic thrombocytopenia occurred only in infants born to mothers with chronic ITP. Without the use of PUBS, 2 symptomatic thrombocytopenic fetuses were vaginally delivered and there was a high rate of cesarean sections in normal fetuses. Owing to PUBS, a decrease of the cesarean section rate in normal fetuses was observed, but one fetal bradycardia (due to the technique) was encountered. PUBS resulted helpful to indicate the best route of delivery and reducing unnecessary cesarean sections in women with chronic ITP, but in presence of incidental ITP the use of PUBS remains an open question.

Adult↗
PubMedDate not supplied

Coenzyme Q10 in pregnancy.

Our objectives were to assess the plasma coenzyme Q10 (CoQ10) levels in normal pregnancy, in pregnancy with a spontaneous contractile event, in spontaneous abortion and in threatened abortion. Six hundred and fifteen CoQ10 levels were analyzed in 483 pregnant women: 350 patients were employed to design a normal curve; 66 patients with spontaneous contractile activity underwent two or more CoQ10 analyses in different trimesters; 49 patients presented spontaneous abortion, and 18 patients threatened abortion. The normal curve of plasma CoQ10 levels rises during each trimester of pregnancy, while there is a correspondence between a low CoQ10 level and spontaneous abortion. Furthermore we found a statistically significant difference between the plasma CoQ10 value in spontaneous contractile activity, mainly in the third trimester. We found an increase in the plasma CoQ10 level in relation to the contractile activity of the uterine muscle. Further studies are necessary to explain the involvement of this marker on pregnancy in clinical practice.

Abortion, Spontaneous↗
PubMedDate not supplied

Double shunt in a case of fetal low-level obstructive uropathy.

This report describes a pregnant woman at 22 weeks of gestation examined for fetal bilateral dilated renal pelvis and oligohydramnios. Ultrasound evaluation confirmed the diagnosis of low-level obstructive uropathy. At 26 weeks of gestation, the increase in hydronephrosis prompted us to introduce a vesicoamnionic shunt. Because of unusual intraperitoneal dislocation of the shunt and an increase in ascites and hydronephrosis, we had to insert a peritoneoamnionic shunt at 30 weeks of gestation. The patient underwent cesarean section at 31 weeks for obstetric complications. The infant, at 15 months of age, showed mild renal failure.

Adult↗
PubMedDate not supplied

Modification of soluble immunological parameters during treatment with interleukin-2.

In the present study we tested numerous soluble immunological parameters (soluble Interleukin 2 receptor, Beta 2 microglobulin, Neopterin, soluble CD8 antigen, gamma Interferon and alpha Tumor Necrosis Factor) in sera obtained from 18 advanced cancer patients during subcutaneous treatment with recombinant Interleukin 2. The treatment cycles consisted of a dose of 9 x 10(6) IU/m2 twice daily for 2 days followed by 1.8 x 10(6) IU/m2 twice daily for 5 days/week during 6 weeks. Even before therapy, neoplastic patients had higher levels of soluble Interleukin 2 receptor than a group of healthy subjects. Moreover, basal soluble CD8 antigen levels showed significant differences (p < 0.01) in patients with different clinical responses (responders and non-responders). During treatment we observed a fast increase (in the first or second week) of all parameters considered; soluble Interleukin 2 receptor and soluble CD8 antigen were the markers that were best related to the course of immunotherapy. In conclusion, monitoring recombinant Interleukin 2 immunotherapy with immunological parameters in serum seems to be of interest. However, more data are necessary to confirm the real value of the single markers.

Adult↗
PubMedDate not supplied

[An epidemiological study of workers exposed to vinyl chloride in the plants of Ferrara, Rosignano and Ravenna].

The aim of the present study is to investigate cause-specific mortality among male workers employed in vinyl chloride manufacture and polymerization in three Italian plants located in Ferrara, Rosignano and Ravenna. The cohorts include all workers hired between start of operation and, respectively 1985, 1978 and 1985, amounting to 418, 206 and 635 subjects followed up for mortality until 1996 (Ferrara and Rosignano) and 1997 (Ravenna). Cause specific SMRs (Standardized mortality ratios) were computed. Expected figures were obtained from mortality rates for the population resident in the region where the plant was located, for each SMR value a 90% confidence interval (CI) was calculated on the assumption of a Poisson distribution. The study detected an increased mortality for primary liver cancer in all three plants; SMR values were 444 in Ferrara (4 Obs. 90% CI 160-1069), 200 in Rosignano (1 Obs. 90% CI 10-869) and 375 in Ravenna (3 Obs. 90% CI 110-1038). In the pooled cohort liver cancer SMR was equal to 364 (8 Obs. 90% CI 108-390). In one plant, Ferrara, observed mortality was above the expected for lung cancer, SMR = 146 (14 Obs. 90% CI 89-229) and for larynx cancer, SMR = 500 (4 Obs. 90% CI 174-1167). One death from pleural cancer was observed in Rosignano (SMR = 1000 90% CI 47-4331). A non significant increase was detected for liver cirrhosis, in Ferrara (SMR 108, 6 Obs. 90% CI 73-332) and Rosignano (SMR 129, 3 Obs. 90% CI 35-332). The study results are confirming the carcinogenic action of vinyl chloride on the liver, they are pointing to its possible role in lung cancer development, as already shown for workers employed in Porto Marghera; an increased risk for larynx cancer is also shown.

Adult↗
PubMedDate not supplied

[A cohort study of art glass workers in the Empoli area].

The investigation aimed at studying cause-specific mortality of art glass workers employed in 17 industrial facilities in Tuscany, Italy. A cohort of 3390 workers employed for at least 1 year was obtained from company payrolls. Follow-up was between the year each factory started operations, mostly in the mid-fifties, and the end of 1993. The cause specific expected mortality was computed relative to Tuscany rates, specified for gender, 5-year age groups and calendar year. Separate analyses were carried out for the job titles of makers, batch mixers and grinders. For males, 3180 individuals, the observed mortality for cancer causes was above the expected for the lung [standardized mortality ratio (SMR) 123, 10 observed (Obs)], larynx (SMR 166, 10 Obs), stomach (SMR 105, 30 Obs) and brain (SMR 150, 7 Obs). For non-cancer causes observed mortality was above expected for hypertensive diseases (SMR 178, 10 Obs) and diseases of the genitourinary system (SMR 169, 11 Obs). Increases for the above listed causes were shown also among makers. Mortality for larynx and lung cancer increased with time since first exposure and significantly increased SMRs were observed for 21 or more years since first exposure: this pattern was still present with smoking adjustment. The results showed consistently increased mortality for lung and larynx cancer in the overall cohort and among makers. Stomach cancer, brain cancer, hypertensive diseases and diseases of the genitourinary system were also increased in the overall cohort and among makers.

Adult↗
PubMedDate not supplied

[Asthma in hairdressers: a report of 5 cases].

The paper reports 5 cases of bronchial asthma in hairdressers exposed to bleaching dusts containing potassium and ammonium persulphate. All subjects complained of asthmatic symptoms at diagnosis, and underwent measurement of non-specific bronchial hyperresponsiveness to methacholine, skin prick tests for common allergens, PEF monitoring during 2 weeks at work, specific bronchial challenge (SBC) test with bleaching dust, and assessment of airway inflammation by induced sputum technique. All subjects were reassessed during a follow-up of 1 to 5 years. All subjects were negative for skin prick tests, but 3 showed an abnormal PEF variability at work (Maximal Amplitude > 10%, in at least half of the monitoring period). All subjects showed a positive airway response to SBC with bleaching dust, and 4 subjects did not react to the control tests with lactose dust. One subject only showed a high percentage of eosinophils (> 3%) in the induced sputum, while all were hyperreactive to methacholine (PD20FEV1 < 0.3 mg). During the follow-up, 2 subjects stopped working and 4 were treated by inhaled corticosteroids and bronchodilators. All subjects reported a significant improvement in asthmatic symptoms, related partly to the reduction of occupational exposure in the workplace and to the efficacy of anti-inflammatory treatment. In conclusion, similar findings were observed in these 5 cases of hairdresser asthma: absence of atopy, positive response to SBC, mild changes in PEF and variable percentages of eosinophils in induced sputum. Pharmacological treatment, associated with reduction of occupational exposure, could improve asthmatic symptoms, despite continuing the job.

Adult↗
PubMedDate not supplied

High resolution computed tomography (HRCT) assessment of beta 2-agonist induced bronchodilation in chronic obstructive pulmonary disease patients.

The evaluation of airway obstruction reversibility in chronic obstructive pulmonary disease (COPD) patients is currently performed by means of an indirect assessment of drug inducing variations in pulmonary function tests. Imaging techniques, especially high resolution computed tomography (HRCT), usually provide a complete evaluation of lung parenchyma (bronchial and vascular structures), but so far they have never been applied to visualize the effects on the bronchopulmonary tree of some pharmacologic stimuli (beta 2 adrenergic agonist), currently used in clinical practice to disclose the presence of airway reversibility. In order to assess the possible role of HRCT in this setting, five COPD patients have been subjected to a double functional radiologic evaluation before and after salbutamol-induced broncho-dilation, with a rigorous assessment of bronchial diameter changes by means of "bronchus-vessel" ratio, currently used for diagnosing bronchiectasis in COPD patients. The results of this experimental study enable us to visualize drug induced broncho-dilation, with a direct assessment of airway reversibility in these patients, and to show a good correlation between functional and HRCT findings, raising the possibility of evaluation COPD patients with abnormal spirometric results or with early signs of lung involvement.

Administration, Inhalation↗
PubMedDate not supplied

[Antineoplastic perfusion with percutaneous stop-flow control in the treatment of advanced pelvic malignant neoplasms].

PURPOSE: The object of our study was to apply percutaneous stop-flow technique to advanced pelvic cancer in order to evaluate its feasibility, standardize the procedure and obtain preliminary results. MATERIAL AND METHODS: April to December 1997 we submitted ten patients with advanced pelvic cancer to percutaneous stop-flow technique. Seven patients had a pelvic recurrence from carcinoma of the rectum, two patients had inoperable recto-sigmoid cancer, and another one had a local recurrence of ovarian cancer. All treatments were performed under general anesthesia. A stop-flow balloon catheter was placed via a transfemoral arterial and venous access above the aortocaval bifurcation and below the emergence of renal arteries and veins. The pelvic district was isolated by filling the balloon catheters and pneumatic cuffs at the thigh, and the antineoplastic agents (cisplatinum, 80 mg/m2 followed by mitomycin C, 30 mg/m2) were sequentially infused by means of an extracorporeal circuit. Blood flow was interrupted for a maximum of 20 min to limit tissue damage, especially of the anal sphincter. Hemofiltration was run during the last 3 min of stop-flow and in the following minutes, achieving at least 5 liters of ultrafiltration. Morphological response was evaluated by CT or MR scan performed prior to and 40 days after the treatment. RESULTS: Over a 2-year follow-up 2 of our 10 patients are alive and 8/10 have died (median survival 9.6 months). Death followed tumor progression in 6 cases; one patient died during the procedure and another one after 7 days, both secondary to pulmonary embolism. Complications included intra-arterial rupture of the balloon in one case and a large inguinal hematoma 10 days after the treatment, requiring hospitalization. No patient showed positive morphological response; two patients only showed stable disease. CONCLUSIONS: This trial supports the feasibility of using the percutaneous stop-flow procedure in an angiography room setting; the stop-flow technique failed to permit the effective control of the tumors.

Aged↗
PubMedDate not supplied

New trends in the radiotherapy of brain neoplasms.

Improved local control and survival within an acceptable toxicity represents a difficult goal in the treatment of brain neoplasms. There are numerous staging problems and alternative therapies, therefore comparisons are difficult. Treatment planning optimization, especially with dedicated software in stereotactic radiotherapy and the use of sophisticated systems of dose delivery as multi-leaf collimator, micro-multi leaf collimator, intensity-modulated tomotherapy etc. suggests a broad range of therapeutic options with the predominant use of: a) computers; b) different strategies as high dose gradient and combination with chemotherapy; c) higher costs for specialist equipment and activity.

Brain Neoplasms↗
PubMedDate not supplied

Quality handbook in radiotherapy: personal experience.

The Quality Handbook includes the description of the activities carried out in Radiotherapy and the methodology used to ensure the Quality Assurance according to the principles indicated in national and international documents of reference and the recommendations of accreditation agencies. The structure of the Quality Handbook, the main aspects of single chapters, the selected quality indicators undergoing inspections are analysed and procedures to be followed for changes and updating of the Quality Handbook are described. The Quality Assurance program is illustrated in another article of this issue.

Humans↗
PubMedDate not supplied

Quality assurance in radiotherapy: personal experience.

The approach to the implementation of a Quality Assurance Program applied from 1 October 2000 at the Radiotherapy Service of the "Università Cattolica del S. Cuore, Policlinico "A. Gemelli" of Rome, is described. Some major aspects of this program are analyzed.

Humans↗
PubMedDate not supplied

Quality handbook in radiotherapy. Brachytherapy: personal experience.

Brachytherapy is a conventional method of radiation therapy characterized by peculiar technical, clinical, operational and radioprotection problems. Therefore, the management of a service or department of brachytherapy requires a specific organization aimed at Quality Assurance. In this report, the personal experience with the drawing up of a Quality Handbook of brachytherapy with reference to the method used and the structure of the document, is described.

Brachytherapy↗
PubMedDate not supplied

[Cohort study of mortality among leather tanners in the Lower Valdarno area].

BACKGROUND: Epidemiological studies of tanners have shown increased risk for a number of cancer sites, namely: lung, bladder, kidney and urinary organs as well as stomach, intestine, pancreas, nose and nasal cavities, together with leukemias and soft tissue sarcomas. OBJECTIVE: To study cause specific mortality of leather tanners in Tuscany (Valdarno Inferiore area). METHODS: The cohort included 4874 workers (4150 males and 724 females) employed in 92 tanneries operating in 1996 (Valdarno Inferiore Tanneries Census) which were also operating on 31-12-1970. Ascertainment of vital status was completed for all individuals on 31-12-1998 (end of follow-up), and the cause of death was known for all deceased subjects. Demographic and work history data were obtained from factory payrolls. Regional mortality rates were used for comparison to calculate SMR (Standardised Mortality Ratio) and 90% Confidence Intervals (CI). In addition to the overall cohort analysis, for men only separate analyses were completed for finishers, chrome tanners and vegetable tanners. RESULTS: The study showed an increased mortality from lung cancer among finishers, Standardised Mortality Ratio (SMR) 145, 19 observed (obs) (90% Confidence Intervals, 90% CI 95-212), from bladder cancer in the overall cohort (SMR 134, 9 obs, 90% CI 70-233) and among finishers (SMR 125, 2 obs, 90% CI 22-393) and from pancreatic cancer among finishers (SMR 120, 2 obs, 90% CI 21-379). Mortality from lymphoemopoietic cancer is above expected, and the increase is mainly due to myeloid leukaemia, both in males (SMR 208, 5 obs, 90% CI 82-437) and females (SMR 599, 2 obs, 90% CI 106-1887). No deaths from soft tissue sarcoma were observed. A new finding of the study was the increased mortality from cancer of the endocrine glands (SMR 566, 4 obs, 90% CI 194-1297), psychiatric disorders (SMR 195, 6 obs, 90% CI 85-385) and blood diseases (SMR 329, 4 obs, IC 90% 112-752). CONCLUSIONS: The observations of increased lung cancer mortality among finishers, of bladder cancer in the overall cohort and among finishers, as well as an increase in pancreatic cancer among the latter, confirm previous epidemiological findings among tanners. The increase in myeloid leukemia mortality for both males and females, and the absence of deaths from cancer of the connective tissue, which includes soft tissue sarcomas, are worthy of note. The results should be valued with caution, given the small number of cases and the novelty of some observations.

Adult↗