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M Montanari

Publications and source records attributed to M Montanari.

At least 37 records · Page 2Linked to original sources
PubMed1999

Ex vivo pharmacological purging of leukapheresis collections with nitrogen mustard: amifostine pretreatment improves both early and late peripheral blood progenitor cell recovery.

Ex vivo pharmacological purging of bone marrow has been used to eliminate clonogenic tumor cells contaminating the autograft and potentially responsible of relapse. A considerable improvement of pharmacological purging would be achieved only if normal marrow progenitor cells could be selectively protected by the cytotoxicity of these agents. Amifostine (WR-2721; Ethyol), a phosphorylated aminothiol compound, has been shown to have this property both in vivo and in vitro. We describe here, an experimental model for ex vivo purging of peripheral blood progenitor cell (PBPC) collections based on the combination of 3 mg/ml of amifostine and the alkylating agent nitrogen mustard. Amifostine pretreatment resulted in a statistically significant protection of normal late and early progenitor cells. Under the same experimental conditions, we observed a 4-6 log reduction of contaminating leukemic cells (i.e., K-562 and CEM) and in contrast to the protection of normal peripheral blood progenitor cells, preincubation of contaminating K-562 or CEM with amifostine did not significantly alter the LD95 nitrogen mustard concentration. Moreover, when we tested fresh human leukemia progenitor cells, amifostine pretreatment sensitized the leukemic cells to the cytotoxic effects of NM.

Amifostine↗
PubMed1999

Infectious complications after autologous peripheral blood progenitor cell transplantation followed by G-CSF.

Infectious complications after autologous peripheral blood progenitor cell transplantation (PBPCT) have been reported in a few studies including small patient numbers. The present study was performed to assess the incidence, types, outcome and factors affecting early and late infections in 150 patients aged 18 to 68 years (median 46.5) who underwent high-dose therapy, with G-CSF. Patients were kept in reverse isolation rooms and received antimicrobial chemoprophylaxis with oral quinolone and fluconazole. One hundred and fifteen patients (76.7%) developed fever (median 3 days, range 1-29); 20 patients (55.5%) had Gram-positive and 13 (36. 2%) Gram-negative bacterial infections. There were no fungal infections or infection-related deaths. Mucositis grade II-IV (P = 0. 0001; odds ratio 3.4) and >5 days on ANC <100/microl (P = 0.0001; odds ratio 2.3) correlated with development of infection. Only days with ANC <100/microl affected infection outcome (P = 0.0024) whereas the antibiotic regimen did not. After day +30 there were four cases of bacterial pneumonitis (2.7%), one case of fatal CMV pneumonia (0. 8%) and 20 of localized VZV infection (13.3%). Reduction of neutropenia duration with PBPCT and G-CSF is not enough to prevent early infectious complications since only a few days of severe neutropenia and mucositis are related to development of early infections. However, no infection-related deaths were seen. Although Gram-positive organisms were the major cause of bacteremia, a glycopeptide in the empirical antibiotic regimen did not affect infection outcome. In PBPCT recipients, early and late opportunistic infections were notably absent, which was at variance with what was seen with bone marrow recipients. Efforts should be made to prevent mucositis and neutropenia and identify new strategies of antibacterial prophylaxis.

Adolescent↗
PubMed1999

Selection and transplantation of autologous CD34+ B-lineage negative cells in advanced-phase multiple myeloma patients: a pilot study.

The feasibility of sequential positive and negative selection of mobilized CD34+ B-lineage negative cells to achieve tumour-free autografts in multiple myeloma (MM) patients was evaluated. Peripheral blood stem cells (PBSC) of 14 patients with advanced disease were mobilized. CD34+ cells were enriched in 12 of the patients by the avidin-biotin immunoabsorption technique. Subsequently, CD10+, CD19+, CD20+ and CD56+ cells (B-lin cells) were removed by immunomagnetic depletion. Minimal residual disease (MRD) was detected by flow cytometry and PCR-based molecular analysis of the patient specific IgH complementary-determining region III (CDRIII). Positive selection of stem cells produced a median recovery of 54.7% of the initial content of CD34+ cells (median purity 71.9%). Negative depletion of B-lineage cells reduced the number of CD34+ cells to 33.3% of the baseline value (median purity 72.7%). However, long-term culture assays showed the recovery of >60% of primitive haemopoietic progenitor cells after depletion of the B-lineage-positive cells. All evaluable patients had detectable disease in PBSC collections. The first step of positive selection of CD34+ cells resulted in >2 logs of tumour cell purging. However, molecular assessment showed the persistence of the disease in 6/7 cases. Immunofluorescence analysis demonstrated 1 additional log of B-cell purging by negative depletion. More importantly, molecular evaluation of IgH CDRIII region showed the disappearance of myeloma cells in 6/7 patients. 12 patients received a median of 3.9 x 106 CD34+ B-lin- cells/kg after conditioning with high-dose melphalan and showed a rapid reconstitution of haemopoiesis. These results were similar to two similar cohorts of patients who received either unmanipulated PBSC or positively selected CD34+ cells after the same conditioning regimen. Severe extrahaematological toxicity was limited to mucositis; no late infections were observed. We concluded that autotransplantation of purified CD34+ B-lin- cells was associated with a rapid and sustained recovery of haemopoiesis and low peritransplant morbidity. Sequential positive and negative enrichment of stem cells reduced tumour cell contamination in B-cell malignancies below the lower limit of detection of molecular analysis.

Adolescent↗
PubMed1998

Adhesion of water-borne particulates on freshwater biota.

The retention of suspended particles transported by river flow on surfaces of freshwater plants is a potentially important process in the contamination of aquatic biota. Field experiments have been performed to test the role of benthic algae (periphyton) in trapping inorganic suspended solids transported by the river water and to discriminate between the caesium content of periphyton caused by the adherence of inorganic solids and by the active uptake inside the organisms. The contribution of caesium of suspended solids adhering to biotic surfaces was estimated by determining the scandium content (scandium method). The scandium method was used because this element is geologically ubiquitous in soils and it is not taken up actively by plants and other organisms. The mass of suspended particles retained on the surfaces of microorganisms growing on submerged substrates were determined by comparing the scandium content of suspended material with that in algal communities. Neutron activation analysis was used as the analytical method for determination for both scandium, and caesium. The results indicate that the suspended particle fraction can contribute up to 80% of the caesium contamination of periphyton samples. Active caesium uptake and accumulation by aquatic biota represents the remaining 20% of the total caesium contamination.

Cell Adhesion↗
PubMed1998

Paroxysmal atrial fibrillation after high-dose melphalan in five patients autotransplanted with blood progenitor cells.

Among the drugs used in conditioning regimens for stem cell transplantation, high-dose melphalan (HDM) plays an important role for both its strong myeloablative effect and for its favourable dose-response ratio. Here we report five cases of high frequency atrial fibrillation (AF) developing after HDM. Duration of the arrhythmia was always very short, beginning at variable intervals after the administration of HDM, in the absence of other factors potentially able to trigger AF. In all patients sinus rhythm was restored within 72 h and the follow-up did not show any cardiac damage. To the best of our knowledge, this side-effect has never been reported to occur after HDM.

Antineoplastic Agents, Alkylating↗
PubMed1998

PBSC mobilization, collection and positive selection in patients with chronic lymphocytic leukemia.

We report the results of PBSC mobilization and immune selection in 17 patients with advanced chronic lymphocytic leukemia (CLL) enrolled in a multicenter Italian study of autologous transplantation with peripheral CD34+ selected cells. Mobilization was achieved by cyclophosphamide (CY) 4 g/m2 + G-CSF 5 microg/kg. CD34+ cells were positively selected by means of avidin-biotin immunoaffinity columns (Ceprate SC) or immunomagnetic beads (Isolex 300i) systems. Evaluation of minimal residual disease was performed by PCR analysis of the IgH gene rearrangment on the apheresis product before and after selection. Our results showed that after CY a median of 3.6 x 10(6)/kg (0.5-12.8) CD34+ cells were collected with a median of two aphereses in 14 out of 17 patients; three failed to mobilize a number of CD34+ cells adequate for subsequent manipulation. We found that in CR patients CD34+ cell yield per apheresis was significantly higher than in PR patients (P < 0.05). Sixteen selection procedures were performed in 13 patients. CD34+ cell recovery was 33.5% (10-85) with a median final yield of 1 x 10(6)/kg CD34+. Two patients underwent marrow collection due to the low number of CD34+ cells recovered. Final purity was 59% (range 22-94) and CD5/20+ cell depletion was 2.7 log (1.6-4.4). Our data showed a statistically higher CD34+ cell recovery and purity with the Isolex device compared to Ceprate (P < 0.01 and 0.01, respectively). All the evaluable samples remained PCR positive after selection. The main issues to be addressed in the future are the identification of patients who fail mobilization and the improvement of purging methods.

Adult↗
PubMed1998

Factors affecting hemopoietic recovery after high-dose therapy and autologous peripheral blood progenitor cell transplantation: a single center experience.

BACKGROUND AND OBJECTIVE: While the minimum number of CD34+ cells required for complete and long-lasting engraftment is quite well established, there is not general agreement about the optimal number of CD34+ per kg needed in order to obtain engraftment as rapidly as possible. In the present study we assess factors affecting hemopoietic recovery and the optimal peripheral blood progenitor cell (PBPC) number for rapid engraftment in patients treated with high-dose therapy. DESIGN AND METHODS: We enrolled 80 consecutive patients affected by hematologic and non-hematologic malignancies treated with a median of 10 chemotherapy courses (range 3-38). PBPC collection was performed after mobilization with high-dose chemotherapy and G-CSF 5 micrograms/kg/day. The circulating and harvested CD34+ cells were recognized in the cytofluorimetric CD45+/CD14- lymphocyte gate. After myeloablative therapy, PBPC infusion was followed by G-CSF 5 micrograms/kg/day from day +5 until WBC > or = 5.0 x 10(9)/L. Univariate and multivariate Cox analyses were performed to investigate factors affecting hemopoietic recovery. The Kaplan-Meier probabilities of hemopoietic reconstitution were compared by log-rank test to assess the optimal CD34+ cell number for rapid engraftment. RESULTS: We performed a median of two apheresis (range 1-4) per patient and we infused a median of 6.1 x 10(6) CD34+ cells/kg (range 0.5-30.5). Absolute neutrophil count (ANC) > 0.5 x 10(9)/L was reached after 11 days (range 8-15). The only factor affecting granulocyte recovery proved to be the CD34+ cell number; 5.0 to 7.8 x 10(6) CD34+ cells/kg allowed a significantly faster granulocyte recovery than < 2.5 x 10(6) CD34+ cells/kg (p = 0.0312). Platelet transfusion independence (> 20 x 10(9)/L) and 50 x 10(9)/L platelets were reached after 12 (range 8-24) and 15 days (range 9-40), respectively. The CD34+ cell number was also the only factor affecting platelet recovery; the number of 5.0 to 7.8 CD34+ cells/kg allowed a significantly faster platelet recovery than the lower dose, whereas a higher number did not. No late graft failures were observed. Patients receiving 5.0 to 7.8 x 10(9) CD34+ cells/kg had a significantly shorter duration of neutropenia, fewer platelet transfusions and less time spent in hospital than those receiving lower number did, whereas patients transplanted with a higher number had no advantage. INTERPRETATION AND CONCLUSIONS: When G-CSF is employed both for PBPC mobilization and after PBPC transplantation, the CD34+ cell number is the only factor that affects hemopoietic recovery. Moreover, > 5.0 x 10(6) CD34+ cells/kg is the optimal number for obtaining rapid platelet recovery and reducing the costs of HDT but there is no advantage exceeding the threshold of 7.8 x 10(6) CD34+ cells/kg.

Adolescent↗
PubMed1997

Pharmacologic bone marrow purging: is there any place for etoposide? In vitro comparison with mafosfamide.

Residual leukemic cells in a bone marrow graft may increase the risk of relapse after autotransplantation. We have compared the efficacy of etoposide with that of mafosfamide, which has been used mainly for purging in acute leukemias. First, we examined the effects of VP-16 and ASTA-Z on the normal hematopoietic progenitors and on the erythroleukemic cell K562. Subsequently, we evaluated purging activity in cocultures using two different ratios of leukemic contamination. The most effective drug concentrations in inhibiting 100% of K562 growth were 50 micrograms/ml of ASTA-Z and 70 micrograms of VP-16. Residual growth of normal colony-forming units-granulocyte-macrophage (CFU-GM) was 4.8% with VP-16 and 32.5% with ASTA-Z. In treated cocultures, ASTA-Z produced a higher inhibition of the K562 line than VP-16 at both levels of leukemic cell contamination. At 0.5% contamination, VP-16 showed higher toxicity toward normal hematopoietic progenitors than ASTA-Z. At the 5% contamination level, VP-16 completely inhibited colony formation, whereas ASTA-Z spared some normal progenitor cells (21.2%). In conclusion, in our experimental model, VP-16 did not show improved efficacy over ASTA-Z in killing leukemic cells and in sparing normal progenitors.

Antineoplastic Agents↗
PubMed1996

Hepatic hydrothorax without diaphragmatic defect. An original surgical treatment.

A 58-year-old woman with a long history of well-compensated postnecrotic cirrhosis with acute massive ascites and right-sided pleural effusion was admitted. The injection of colorant and radioactive material into the peritoneal cavity didn't show up any passage through the diaphragm. After resuscitation therapy and insertion of abdominal and chest tube, effusions rapidly and massively re-accumulated. A LeVeen peritoneovenous shunt was inserted as an emergency measure owing to hepatorenal syndrome. Ascites completely resolved but pleural effosion was continuously and severely recharged. A Denver inverted shunt was subcutaneously inserted from pleural to peritoneal cavity. After operation CPAP was applied and pump device activated; pleural effusion gradually disappeared clearing completely the pleural space. The patient was discharged on the 10th postoperative day; her general condition and laboratory test have remained satisfactory up to one year without ascites and pleural effusion.

Ascites↗
PubMed1995

Familial spasmodic dysphonia with low arylsulphatase A (ASA) level.

Two familial cases of late onset spasmodic dysphonia and low Arylsulphatase A (ASA) are reported. In one case spasmodic dysphonia was associated with negative head tremor and orthostatic tremor, both displayed postural tremor of the upper extremities. A familial predisposition for both focal dystonia and metabolic lysosomal impairment is suggested by similar observations.

Aged↗
PubMed1995

Dynamic orthopaedic brace in the treatment of ankle sprains.

Ankle sprains may lead to disabling sequelae such as joint instability and persistent pain. Immobilization with plaster cast may give rise to joint stiffness and muscle atrophy. Twenty patients with acute inversion sprains of the ankle were treated with a "dynamic" orthopaedic brace after a 10-day plaster immobilization. A control group, consisting of 10 subjects, received a weight-bearing short-leg plaster cast for 25 days. A clinical evaluation and an instrumental isokinetic investigation (Cybex) were performed as scheduled. The clinical findings suggest an earlier and more comprehensive functional recovery in the group receiving the "dynamic" brace compared to the casted group. The isokinetic test revealed a statistically significantly better performance for most parameters in the brace group especially regarding the ankle joint invertors.

Adult↗
PubMed1994

Arylsulphatase A (ASA) activity in parkinsonism and symptomatic essential tremor.

Arylsulphatase A (ASA) activity was evaluated in 47 patients with a diagnosis of parkinsonism or essential tremor. Mean ASA activity was significantly reduced compared with both a healthy control group of 71 individuals (p < 0.01) and with a group of 44 neurological patients without movement disorders (p < 0.02). Using definite clinical criteria the patients were classified as typical or atypical with respect to Parkinson's disease (PD) or essential tremor (ET). A normal ASA level was found in all the cases showing typical clinical features (PD and ET), while ASA activity was significantly lowered (p < 0.01) in 55.6% of the atypical cases (Parkinsonian syndrome or symptomatic ET). Our data support the hypothesis of a non-casual association between low ASA level and the clinical features of parkinsonism or symptomatic ET.

Aged↗
PubMed1993

[Clinical consistency in the diagnostic approach to the patient. Notes relating to the use of psychometric procedures in clinical psychiatry].

The authors underline the difficulties of the introduction and use of the psychometric approach in psychiatry. The use of protocols for the standardised evaluation and measurement of psychopathological phenomena is soon revealed to be open to criticism regarding the objective character of the object of the inquiry in psychiatry; at the same time there is an equally legitimate need not only for "forms" but also clinical "contents" without which the doctor's role loses its traditional target.

Clinical Protocols↗
PubMed1990

Malignant lymphoma involving the mandible. Clinical, morphologic, and immunohistochemical study of 17 cases.

We present 17 cases of non-Hodgkin's lymphoma of the mandible, collected over a span of 10 years. Clinically, the patients showed a male:female ratio of 1:2.4 and a mean age of 60.6 years. Swelling was the most common symptom. In 11 of 17 patients, the disease presented in stage I. Radiotherapy alone was employed in 11 patients, in conjunction with chemotherapy in 5 patients, and was preceded by surgery in the remaining case. At this writing ten of the subjects are still alive, five died following progression of the disease, and two were lost during follow-up while in complete remission. Histopathology revealed 15 B-cell lymphomas (1 centroblastic/centrocytic, nine centroblastic, one Burkitt's, two immunoblastic, and two lymphoblastic) and two peripheral T-cell lymphomas (pleomorphic). The above diagnoses were confirmed by immunohistochemical analysis with a wide panel of reagents against fixative-resistant molecules. Our data suggest that (a) lymphomas of the mandible are principally represented by high-grade B-cell varieties (88%); (b) primitive T-cell lymphomas (here documented for the first time) have the same incidence in the mandible as they have in lymph nodes; and (c) immunohistochemistry, besides confirming histogenetic interpretations based on morphologic findings, provides the key to the differential diagnosis from malignant large-cell nonlymphoid tumors.

Adult↗