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Biomedical subjects

M Mercuri

Publications and source records attributed to M Mercuri.

At least 163 records · Page 9Linked to original sources
PubMed1988

Neoadjuvant chemotherapy in the treatment of osteosarcoma of the extremities: preliminary results in 131 cases treated preoperatively with methotrexate and cisdiamminoplatinum.

The results of 131 cases of classic non-metastatic osteosarcoma of the extremities treated with preoperative chemotherapy, surgery and postoperative chemotherapy are reported. Preoperatively, the patients were given Methotrexate (MTX) intravenously (high and average doses) and Cisplatinum (CDP) intraarterially. For postoperative chemotherapy, the drugs and treatment protocols were based on the degree of necrosis observed (good, fair, poor). Conservative surgery was performed in 73% of the cases and amputation in 27%. At an average 30 month follow-up (9-48 months) 59.5% of the patients had remained disease-free, 37.5% had developed metastases, and 3% had developed local recurrence. The percentage of disease-free patients was higher for those treated with high doses of MTX (68% vs. 51%) and for those in whom preoperative chemotherapy had induced good necrosis (75% vs. 44%). Neither the age or sex of the patients, nor the site of the tumor or type of surgery performed influenced prognosis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Haemorheological markers in 89 patients with stage II peripheral vascular disease (PVD).

Although it is universally accepted that the grade of reduction of district blood flow in PVD is directly correlated to alteration of the haemorheological pattern, there is still no uniformity of opinion regarding the existence of a specific rheological alteration in PVD. The scope of our study was to discover the existence of possible PVD-specific markers; we thus carried out a comparative evaluation of the rheological characteristics in blood of controls and patients affected with PVD. Eighty-nine males between the ages of 50 and 65 years (median 58 +/- 1 SE) were studied, all with a stage II vascular pathology with clinical onset of less than three months. Exclusion criteria were: diabetes mellitus, hyperlipaemia, stable hypertension, presence of vascular disease in other districts, cardio-circulatory problems and serious medical or surgical pathologies, previous vascular surgery, a history of acute thrombo-embolic episodes, and chronic alcoholism. Each patient, after a drug wash-out of 20 days, was monitored for haemorheological parameters. At the same time, the above parameters were measured in a group of 50 male controls of the same age range. All 139 subjects were smokers (10-15 cigarettes average per day). Our results indicate that modification in the bio-humoral (fibrinogen and plasma globulins) parameters, a reduced red blood cell filterability and a relative increase in the number of activated polymorphonucleate cells are probably specific haemorheological markers of the clinical onset of PVD.

Blood Cell Count↗
PubMed1986

The role of haemorheological factors in the ageing brain: long-term therapy with pentoxifylline ('Trental' 400) in elderly patients with initial mental deterioration.

Sixty elderly patients suffering from initial mental deterioration (less than 6 months) were divided at random into two groups, homogeneous for age, sex and life habits. For 28 weeks Group I was given a placebo and Group II was given 400 mg pentoxifylline ('Trental' 400) 3-times daily for two 3-month periods interrupted by a 4-week wash-out period. Neuropsychological performance and haemorheological parameters were evaluated at the beginning and at the end of each phase of the study. The results showed that pentoxifylline medication significantly improved the psycho-intellectual performance, decreased whole blood viscosity and increased red cell filterability. The results indicate a need to concentrate further study on haemorheological factors in the clinical aspects of the ageing brain, also with a view to allowing for sufficiently long treatment periods.

Aged↗
PubMed1985

Haemorheological pattern in initial mental deterioration: results of a long-term study using piracetam and pentoxifylline.

A group of 80 elderly subjects affected with recent onset (less than 6 mth) slight to moderate mental deterioration was observed before and after oral drug treatment for a period of 28 wk. The study consisted of four randomized groups of subjects homogeneous for age, sex and life habits. The first group received a placebo, the second group received piracetam (1600 mg 3 times a day), the third group received pentoxifylline (400 mg 3 times a day), and the fourth group received a combination of piracetam and pentoxifylline. At the beginning and end of each phase of the study, neuropsychological and haemorheological parameters were evaluated in all subjects. The results show that the most evident improvement in psycho-intellectual performance, associated with an increase of whole blood filtration values, was obtained in the group treated with the two-drug combination.

Aged↗
PubMedDate not supplied

Vascular homografts for vessel substitution in skeletal and soft tissue sarcomas of the limbs.

Large vessel involvement by skeletal and soft tissue sarcomas of the extremities does not change the modern limb sparing surgery for those neoplasms. An arterial and, if the vein is open, a venous bypass should always be offered to any patient young or old, with high or low grade sarcoma, because preserving the limb permits quicker rehabilitation, which is particularly useful in the case of a short life expectancy. In 650 cases of skeletal sarcomas, 10 arterial (1.5%) and four venous bypasses were done, all with autologous veins but one in PTFE; we had no problems except a silent arterial occlusion. Of 1000 patients with soft tissue sarcomas, 32 (3%) had vessel involvement permitting limb sparing surgery. The arterial bypass, which is the limb-saving operation, was performed 16 times with a PTFE with one early occlusion and four cases of prosthesis infection, with two amputations despite redo operation with an autologous vein. The more recent 16 cases were, therefore, always done with biological vessel substitution--autologous vein or tissue bank vessel--with only one infection that healed without operation and one case of homograft rupture followed by amputation. Since 1999 in all 13 resected cases with an open vein, we did the arterial and the venous bypass (twice PTFE, six autologous vein, and five bank vessel) with the aim of avoiding postoperative venous hypertension, but only four of the venous bypasses remained open. Venous bypasses are a harmless, but still experimental, procedure.

Arteries↗
PubMedDate not supplied

Non conventional fractionation in radiotherapy of the musculo-skeletal sarcomas.

In 1989 we started an accelerated hyperfractionated schedule of radiotherapy (two 1.6 Gy daily fractions) in standard risk localized Ewing's sarcoma of bone, with the aim at reducing late effects in young patients and at improving disease control through a better integration of treatment modalities. From 1991, the same schedule was used in preoperative radiotherapy of adult soft tissue sarcomas of the extremities: the main purpose was to reduce the time to surgery and to evaluate surgical complications in comparison with a previous experience of hypofractionated radiotherapy (one 3 Gy daily fraction). From 1991 to 1997, 76 patients with Ewing's sarcoma and 24 patients with soft tissue sarcoma were treated at our Institution. Results and complication rates are analyzed in comparison with historical data. In Ewing's sarcoma, a correct evaluation of improvement in local control was difficult because of changing treatment policy (bulky disease was not included in the present series). Late effects, as evaluated in patients with a minimum follow-up of 3 years, occurred with similar incidence, but at higher total dose levels in patients treated with accelerated hyperfractionation. In patients with soft tissue sarcomas, incidence of surgical complications is reduced as compared to historical experience. Major problems of wound healing were seen in association with intraoperative brachitherapy boost.

Adult↗
PubMedDate not supplied

Nonmetastatic osteosarcoma of the extremity: results of a neoadjuvant chemotherapy protocol (IOR/OS-3) with high-dose methotrexate, intraarterial or intravenous cisplatin, doxorubicin, and salvage chemotherapy based on histologic tumor response.

AIMS AND BACKGROUND: From 1986 to 1989, a study for the treatment of nonmetastatic osteosarcoma of the extremity (IOR/OS-2) was carried out at the Rizzoli Institute. The cumulative dose of doxorubicin delivered was 480 mg/m2, and severe heart failure developed in 5 (3%) of the 164 treated patients. The specific aim of the subsequent study was to assess the efficacy of a protocol, similar to IOR/OS-2, but with a reduced cumulative dose of doxorubicin (390 mg/m2). Additional aims were to assess the role of the route of infusion (intraarterial or intravenous) of cisplatin on histologic response of the primary tumor and the use of ifosfamide as salvage chemotherapy in poor responders. METHODS: The new chemotherapy regimen (IOR/OS-3) was comprised of a preoperative phase with methotrexate (10 g/m2), cisplatin (120 mg/m2 intraarterially or intravenously), and doxorubicin (60 mg/m2). After surgery, the same drugs were administered, with the addition of ifosfamide (10 g/m2) in patients who had a poor histologic response to primary chemotherapy. RESULTS: Ninety-five patients entered the study. The rate of good histologic response was 64% with intraarterial cisplatin and 43% with intravenous cisplatin (P = 0.05). The 8-year event-free survival and overall survival were 54% and 61%, respectively, with no significant difference according to the histologic response. No cases of clinical doxorubicin-induced cardiopathy were recorded. Event-free and overall survival did not significantly differ from those achieved with IOR/OS-2 (8-year disease-free and overall survival, respectively 63% and 72%). CONCLUSIONS: The reduction in the doxorubicin cumulative dose avoided episodes of cardiotoxicity, without consequences on the efficacy of treatment. The addition of ifosfamide was an effective "salvage" therapy for poor responders. A better histologic response with intraarterial cisplatin was observed, but owing to the availability of an effective salvage therapy for poor responders, the advantages in terms of histologic response did not compensate for the cost and discomfort for the patients of this modality of infusion of cisplatin.

Adolescent↗
PubMedDate not supplied

Ewing's sarcoma of bone: relation between clinical characteristics and staging.

Patients with metastatic Ewing's sarcoma of bone have a poor prognosis. A relation between clinical characteristics and presence of metastatic disease at diagnosis in patients with Ewing's sarcoma of bone was investigated. Data from 618 patients [136 (22%) with metastases at diagnosis] registered at the authors' institution between April 1972 and December 1997 were collected. The distribution of several clinical and hematologic parameters in patients with metastases and those without metastases was analyzed, and clinical risk factors of metastatic disease at presentation were analyzed by means of multivariate logistic regression analysis. All the variables significant at the univariate analysis (age, fever, site, volume, lactic dehydrogenase, anemia, and interval between onset of symptoms and diagnosis) were considered in the multivariate analysis. Pelvic location of the tumor, high level of lactic dehydrogenase, presence of fever, an interval between onset of symptoms and diagnosis less than 3 months, and age older than 12 years were found to be risk factors of clinically evident metastatic disease. In the subset of patients with no risk factors the rate of metastatic disease at presentation was only 4%; in case of contemporary presence of two factors it was 23%, although it was almost double (44%) if three or four factors were present. Only six patients were positive for five factors and all of them had metastases at presentation. The parameters identified are clinical markers of Ewing's sarcoma having a particularly aggressive metastatic behavior.

Adolescent↗
PubMedDate not supplied

Evaluation of homoplastic bone graft in hip replacement revision surgery.

A total of 17 patients submitted to hip replacement revision surgery in our clinic between 1986 and 1994 were evaluated in order to analyze the effectiveness of homoplastic support grafting. Loss of substance involved the acetabulum and the femur. Four parameters were evaluated radiographically: fusion time, restructuring time, flattening or collapse of grafts, and, finally, graft resorption. The results showed that the homoplastic graft is characterized by excellent biological behavior, and that the success of the new implant depends mostly on surgical method used as the graft was always integrated quickly and completely. In cases with considerable loss of substance it is important to use means of support that allow for partial unloading of the forces between prosthesis and host bone, thus avoiding excessive loading in the grafts.

Acetabulum↗
PubMedDate not supplied

Osteochondritis dissecans of the lateral femoral condyle.

Osteochondritis dissecans (OD) is a rare occurrence. In the knee, the most common localization is the lateral region of the internal femoral condyle. Involvement of the external condyle only occurs in 15% of cases, but its features are such that the situation is an entity in itself. The lesion is generally localized in the posterior site, and it is more extensive and more symptomatic as compared to medial localizations; moreover, early and rapid arthritic progression is observed. Reported here are 2 cases of OD of the lateral femoral condyle with atypical features in terms of clinical findings and progression of the disease as compared to more frequently occurring medial localizations.

Adult↗
PubMedDate not supplied

Conservative approach in the treatment of the biliary tract's iatrogenic lesions.

Iatrogenic lesions of the biliary tract have always represented a problem of real actuality in the abdominal surgery. The incidence of post-cholecystectomy complications is from 0.1% to 0.25% and it's increased to 0.3-0.6% for laparoscopic surgery. Potential predisposing factors to iatrogenic biliary lesions are anatomic anomalies, acute and chronic phlogosis and technical mistakes. Anatomic anomalies are present in 6-25% of all cases according to different statistics; an incomplete knowledge of the biliary tract can predispose to a mistake legating or dissecting a wrong branch. This paper present a caseload of 27 patients admitted to our Service of Digestive Endoscopy owing to post laparoscopic cholecystectomy complications. Patients have been recruited in a period from two days to six months to the intervention. Detected complicances have been divided in "major", which comprehended biliary lesions (7 cases) and biliary stenosis (8 cases), and in "minor" which included biliary leakages (12 cases). CPRE, PTC, Ultrasound, CT and cholangio-MR were used to diagnose the biliary damage. Conservative approach has been resolutive in all patients with minor biliary lesions and in three cases of major lesions; in seven cases of biliary stenosis endoscopic-radiologic combined treatment has been successfully performed, in the other patients surgical operation was obliged choice. Comparing our results with literature we can affirm that conservative treatment represents the first choice in case of minor lesions (100% of successes), whereas in case of major biliary lesions it constitutes a valid alternative to the reparative surgery; when surgical option results impossible to defer, it can help the surgeon identifying the damage and draining the biliary tract.

Adult↗
PubMedDate not supplied

Central venous catheter disruption and embolization: percutaneous retrieval. A case report.

Disruption followed by intravasal embolization is a rare (0.5%) however possible complication secondary to the insertion of a central venous catheter. The carriers of these implantable systems are patients who, for their cure and at times even for their survival, require the chronic intravenous infusion of drugs and solutions. Therefore materials that can allow long-term insertion with a minimum of complications are the most suitable. There are several causes of disruption and embolization of cannulae. The most common are represented by the pinch-off syndrome and catheter disconnection from reservoir. The literature on the subject is illustrated and a personal case treated with intravascular retrieval is reported.

Adult↗
PubMedDate not supplied

Chondrosarcoma of the ribs and sternum. Considerations on 20 cases treated.

Over the last 20 years at the Rizzoli Orthopaedic Institute in Bologna 20 cases of chondrosarcoma (CS) of the thoracic wall (14 males, 6 females, mean age 49 years) have been submitted to surgery. Localization was costal in 11 cases, costosternal in 3, sternal in 3, costovertebral in 3. The most frequent histological variety was central with 15 observations. All of the cases were treated surgically. Exeresis was wide in 14 cases, marginal in 6. Reconstruction of the thoracic wall took place either by direct suturing or (14 cases) using prosthetic materials (Marlex mesh, 1 or 2 shapeable metal plates). Of the 20 cases treated, 16 patients are still alive (80%) with a mean survival rate of 33.5 months and a mean reduction in the postoperative ventilative index of function of less than 10%. The results obtained lead us to believe that surgical treatment involving wide exeresis is adequate, and the reconstruction method using Marlex mesh and metal plates is reliable.

Adult↗