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P Bossi

Publications and source records attributed to P Bossi.

At least 37 records · Page 2Linked to original sources
PubMed2003

Meningeal melanocytoma of the temporal lobe. An uncommon tumor in an unusual location. Case report.

Meningeal melanocytomas are rare pigmented tumors of the central nervous system. These tumors are benign melanotic lesions that derive from the melanocytes of the leptomeninges. They may occur anywhere in the cranial and spinal meninges; however, they are found prevalently in the posterior fossa and in the spinal cord. Their epidemiological features, natural history and response to treatment remain poorly understood, even if, in the last 2 years, some reviews have been published about it. We report a new case of intracranial supratentorial meningeal melanocytoma, in the temporal lobe, occurring in a 27-year-old man, admitted to our Institute with a long-time history of seizures. We report histological and radiological characteristics of our case, and briefly review the therapeutical options reported in literature. Preoperative neuroradiological finding is unclear; the preoperative diagnosis is usually meningioma, because of the long duration of symptomatology and the radiological appearance of the lesion as an extra-axial mass. Diagnosis of these lesions, as in our case, is made intraoperatively by the gross, jet-black appearance of the tumor and by histological examination. In spite of the benign biologic behaviour, the prognosis remains uncertain, because of the possible local recurrences. According to the results of some works of the last years, it seems appropriate to use postoperative radiotherapy for those patients with symptomatic residual, progressive or recurrent tumors not amenable to further resection.

Adult↗
PubMed2002

[Current clinical aspects of HIV/AIDS].

OF NEW CLINICAL DEMONSTRATIONS: Since the use of HAART, morbidity and mortality in HIV-infected patients have decreased dramatically. But increased survival in these patients is associated with other diseases (malignant diseases, inflammatory reactions after initiation of HAART) and with drug toxicity (lipodystrophy, mitochondrial toxicity). TRANSMISSION AND REVELATION: Despite widespread information on HIV, new HIV-infected patients with an AIDS-defining illness are still detected. At present, heterosexuality is the most frequent risk factor for HIV-infection (51%). Pneumocystis pneumonia remains the most common opportunistic illness in HIV-infected patients (28%).

AIDS-Related Opportunistic Infections↗
PubMed2002

[Genital herpes: epidemiology, transmission, clinic, asymptomatic viral excretion, impact on other sexually transmitted diseases, prevention, and treatment].

Genital herpes is one of the most widespread sexually transmitted diseases in the world. HSV2 predominates (60-80 p. 100), but the prevalence of HSV1 genital herpes is rising (20-40 p. 100). Erosive lesions of the genital organs due to HSV infection are a factor favoring HIV contamination and other sexually transmitted diseases. The main factor of transmission is asymptomatic viral excretion. Aciclovir, valaciclovir and famciclovir are effective treatment for genital herpes (primary infection, curative and preventive treatment of recurrence), but none of these compounds alters the natural history of the infection. Aciclovir given as a preventive measure reduces the load of asymptomatic viral excretion. Information and education of patients with genital herpes are key elements for prevention. Use of preservatives appears to be effective. New vaccine strategies favoring humoral and cellular response should be studied.

2-Aminopurine↗
PubMed2001

[Management of therapeutic failure in HIV-infected patients].

A COMMON SITUATION: Among HIV-infected patients treated with antiretroviral regimens, 20% to 50% escape therapeutic control. The principal factors predictive of treatment failure are low CD4 counts and high viral load prior to institution of the antiretroviral treatment. Several virological and pharmacological mechanisms are implicated. GENOTYPING AND PHENOTYPING: Genotyping is particularly useful to optimize treatment in HIV-infected patients who escape therapeutic control, irrespective of the therapeutic strategy. A committee of experts has developed a scheme for adapting treatment to the very complex results of genotyping tests. The benefit of phenotyping remains to be established. MANAGEMENT: Serum concentrations of antiretroviral agents should be determined and adapted in order to maximize the treatment effect. However, to manage therapeutic escape, the only method with a proven impact is genotyping. The possible usefulness of regular drug assays for adjusting treatment doses in case of therapeutic escape remains to be assessed in prospective trials.

Algorithms↗
PubMed2001

[Current antiretroviral therapy].

INTRODUCTION: Advances in HIV/AIDS therapy have been rapid and profound. CURRENT KNOWLEDGE AND KEY POINTS: In developed countries the epidemic infection has stabilized and there are dramatic decreases in morbidity and mortality resulting from the use of intensive but expensive therapies. HIV patients who have detectable viral loads and/or evidence of immunologic dysfunction should be treated with a potent combination antiretroviral regimen. Currently, this consists of two nucleoside reverse transcriptase inhibitors with at least one protease inhibitor, or a non-nucleoside reverse transcriptase inhibitor, or another combination with adequate potency. Current therapies do have limitations, including side effects, cross-resistance, adherence challenges, and drug interactions. FUTURE PROSPECTS AND PROJECTS: Drug resistance is a major factor contributing to the failure of antiretroviral therapy: the ability to predict clinical response to therapy on the basis of genotype and/or phenotype depends on knowledge of appropriate data for defining drug resistance. Moreover, careful selection and monitoring of combination drug therapy along with individualized rather than standard dosage regimens may minimize the pharmacological problems and help ensure optimum antiviral activity. Further developments include new drugs, vaccine, cytokine-, and gene therapy-based treatment strategies.

Anti-HIV Agents↗
PubMed2001

[Acquired hemophilia: current diagnostic and therapeutic approaches].

PURPOSE: Acquired haemophilia is a rare disease, occurring most frequently in elderly patients, caused by the development of autoantibodies against factor VIII. CURRENT KNOWLEDGE AND KEY POINTS: The disease is characterised by spontaneous haemorrhagic complications which can be fatal in 15-20% of the patients. However spontaneous remission is possible and in fact natural evolution and aetiology are still partly unknown. Acquired haemophilia may arise in association with auto-immune diseases, lymphoproliferative malignancy, pregnancy and also as a drug reaction. The aims of the treatment are first to treat the bleeding which is the most common cause of morbidity and mortality, and second to eliminate the inhibitor by immunosuppression. However no consensus exists for these two parts of the treatment. Bleeding may be controlled by prothrombin complex concentrates, recombinant factor VIIa or porcine factor VIII. The inhibitor is abolished in up 70% of patients using prednisone and cyclophosphamide. Other combinations of prednisone with azathioprine or with cyclophosphamide and vincristine or the use of high-dose immunoglobulin or double-filtration plasmapheresis have also proven effective in some patients. FUTURE AND PROJECTS: The rare occurrence of the disease, the associated with various diseases, and lack of consensus about treatment, require multicentric prospective studies.

Aged↗
PubMed2001

[Epidemiological features and incidence trends of primary cerebral lymphomas observed in 80 HIV-infected patients from 1983 to 1999].

OBJECTIVE: To describe the epidemiological characteristics of primary central nervous system lymphoma (PCNSL) and the evolution of the incidence of this lymphoma in HIV-infected patients with a more than 17-year follow-up. RESULTS: Eighty cases of PCNSL were analyzed from a data base of 2,263 AIDS subjects followed from 1983 to 1999 (3.5% of the patients with AIDS). At the time of diagnosis, PCNSL was the first AIDS defining event in 36% of the cases, median CD4 count was 9/mm3 (0-134); 82% of the patients were given antiretroviral therapy (HAART = 0). Only eight cases of PCNSL were observed after 1996 (median HIV RNA level: 250,000 copies/mL (24,000-1,500,000)). The incidence was 39 per 100 patients-year in 1991 and decreased to 1.9 in 1999. At the end of the study, 78 patients had died (98%). The median survival was one month before 1996 ([0-27], n = 72), and was ten months after ([0-44], n = 8). Two patients were still alive 38 and 44 months after diagnosis. After 1996, survival was increased in patients with good response to antiretroviral treatment and in patients with high CD4 count at the moment of diagnosis. CONCLUSION: After the introduction of HAART (1996), the incidence of PCNSL has decreased drastically and survival was increased.

Adult↗
PubMed2000

Early virological failure in naive human immunodeficiency virus patients receiving saquinavir (soft gel capsule)-stavudine-zalcitabine (MIKADO trial) is not associated with mutations conferring viral resistance.

The MIKADO trial was designed to evaluate the efficacy of stavudine-zalcitabine-saquinavir (soft gel capsule) [d4T-ddC-SQV(SGC)] in 36 naive patients (-3.3 log(10) units at week 24 [W24]). Among the 29 patients remaining on d4T-ddC-SQV(SGC) until W24, 10 harbored a virological failure (viral load of >200 copies/ml at W24) (group 1). To determine the reasons for therapeutic failure, genotypic and phenotypic resistance test results and SQV concentrations in plasma were analyzed and compared to those in successfully treated patients (viral load of <200 copies/ml at W24) (group 2). Reverse transcriptase and protease genotypic analyses in group 1 revealed the acquisition of only one SQV-associated mutation (L90M) in only two patients. There was no significant increase in the 50 or 90% inhibitory concentration of SQV in patients with or without the L90M mutation. However, the fact that two patients developed an L90M mutation only 4 weeks after relapse points to the need for genotypic resistance testing in the context of an initial failure of the antiretroviral regimen. At W24, the median SQV concentration in group 1 (71 ng/ml) was significantly lower than in group 2 (475 ng/ml), and the plasma SQV concentration was correlated with the viral load at W24 (r = -0.5; P<0.05) and with the drop in viral load between day 0 and W24 (r = -0.5; P<0.01). These results and the fact that the plasma SQV concentrations in the two groups prior to relapse (W12) were not significantly different strongly suggest that the early failure of this combination is not due to viral resistance but to a lack of compliance, pharmacological variability, and drug interactions or a combination of these factors.

Anti-HIV Agents↗
PubMed1999

The vascular profile of regenerative and dysplastic nodules of the cirrhotic liver: implications for diagnosis and classification.

We investigated the angiogenic phenotype of regenerative and dysplastic hepatocellular nodules to assess whether these lesions have distinct vascular profiles compared with the adjacent nonneoplastic or malignant liver. Forty-three liver nodules surgically removed from 18 patients were classified into regenerative and dysplastic categories. Serial sections of each nodule, adjacent cirrhotic liver (16 patients), and associated hepatocellular carcinoma (HCC) (6 patients), have been immunostained against CD31 and alpha-smooth muscle actin (alphaSMA) to detect capillary and muscular vessels. The study included 20 large regenerative nodules (LRNs), 13 low-grade dysplastic nodules (LGDNs), and 10 high-grade dysplastic nodules (HGDNs). The number of both capillary units and unpaired arteries was significantly increased in HGDNs and malignant lesions over LGDNs, regenerative, and cirrhotic nodules (P <.01), which showed an overlapping vascular profile. In addition, the number of capillary units, but not that of unpaired arteries, was significantly increased in HCC compared with HGDNs (P <.01). These results show that certain angiogenic features segregate HGDNs from other nonmalignant nodules such as LRNs and LGDNs. The former group of lesions is similar to HCC whereas the latter group is undistinguishable from the adjacent cirrhosis as far as their vascular profile is concerned. The adopted investigative approach does not support the morphological distinction between LRNs and LGDNs although it suggests that HGDNs are likely advanced precursors of HCC. An abnormal number of capillary units and/or unpaired arteries in a nonmalignant hepatocellular nodule can be diagnostically helpful to identify a precancerous lesion.

Actins↗
PubMed1999

Localized oral Fusarium infection in an AIDS patient with malignant lymphoma.

We report here a case of localized oral Fusarium infection in an AIDS patient who developed an ulceration in the soft palate. Fusarium solani was identified by histopathology and culture. We believe this to be the second reported case of oral Fusarium infection in a patient with haematological malignancy and the first reported association of oral Fusarium infection with AIDS.

AIDS-Related Opportunistic Infections↗
PubMed1999

Plasma and cerebrospinal fluid human immunodeficiency virus type-1 (HIV-1) RNA levels in HIV-related cognitive impairment.

Cerebrospinal fluid (CSF) and plasma HIV-1 RNA levels were prospectively measured by the Roche Amplicor Monitor polymerase chain reaction assay in 30 HIV-1 infected patients without central nervous system opportunistic infections. All participants completed a global neuropsychological battery consisting of Mattis Dementia Rating Scale. Additional tests were used to better characterize the type of cognitive changes with a specific reference to frontal lobe function. The neuropsychological evaluation confirmed the subcortical pattern of cognitive dysfunction. CSF and plasma HIV-1 RNA levels were significantly correlated. No correlation was detected with either blood or CSF RNA levels and the global cognitive status, but when stratified in three cognitive subgroups, higher CSF HIV-1 RNA levels were observed in the more cognitively impaired subjects. Our results provide further evidence that plasma and CSF HIV-1 RNA level cannot be used as a reliable diagnostic marker for HIV-1 associated cognitive disorders. Only longitudinal studies will determine whether a high CSF HIV-1 level could be a risk factor for HIV-1 dementia.

AIDS Dementia Complex↗