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Biomedical subjects

R Cimino

Publications and source records attributed to R Cimino.

At least 37 records · Page 2Linked to original sources

Recombinant interferon alpha-2b in the treatment of polycythemia vera.

We studied the effects of recombinant alpha 2-b interferon (alpha 2-b IFN) in a dose of 3 x 10(6)U intramuscularly three times a week for 1 year in 13 patients affected by polycythemia vera (PV) previously treated with phlebotomy only. Response to treatment was evaluated by reduction of the number of phlebotomies required to retain normal hematocrit value. Ten out of 13 patients (77%) responded to treatment; in 4 of them the exigency of phlebotomy was completely eliminated. In all responders a concomitant decrease of platelet count and splenomegaly was obtained. Treatment was well tolerated and side effects were easily controlled. We conclude that alpha-IFN may represent an attractive therapeutic option in the management of the proliferative stages of PV.

Adult↗

Dislipemia in patients undergoing continuous ambulatory peritoneal dialysis: pharmacological therapy (simvastatin) versus hemodialysis.

Peritoneal dialysis can worsen dislipemia, which is frequent in chronically uremic patients. In order to verify the therapeutic possibilities, we retrospectively studied 20 chronically uremic patients who had been previously treated with continuous ambulatory peritoneal dialysis (CAPD) and who had developed an IV-type dislipemia. Twelve have continued CAPD treatment and have been simultaneously treated with simvastatin; 8 have withdrawn from CAPD and have begun HD, without any antidislipemic pharmacological support. The results, after 3, 6, 12, and 18 months of treatment, showed the following: in patients treated with CAPD and simvastatin, highly significant decreases were noted in total cholesterol (T-cho) and triglycerides (TG) (p < 0.001), and highly significant increases were noted in HDL-cholesterol (HDL-cho) (p < 0.005) and apolipoprotein-A1 (Apo-A1) (p < 0.01). In patients treated with HD, only slightly significant decreases were noted in T-cho (p < 0.01) and TG (p < 0.02), a slightly significant increase in Apo-A1 (p < 0.05), and no significant change in HDL-cho. Apolipoprotein-B showed no change in the two groups. Therefore, patients undergoing CAPD, with dislipemia only, can continue the treatment, because simvastatin is capable of correcting dislipemia, while those patients who have displemia as well as other complications strictly due to CAPD must abandon treatment and must be transferred to extracorporeal methods.

Female↗

Clinical relevance of immunological dissection in T-ALL: a report on 20 cases with stem cell (CD7+, CD4-, CD8-, CD1-) phenotype.

In a prospective study on 44 cases of T-cell origin acute lymphoblastic leukemia, 20 patients were found to display an immature immunophenotype (CD7+, CD4-, CD8-, CD1-) and were classified as T-stem cell leukemia (T-SCL). Twenty-four patients expressed CD4 and/or CD8 antigens on their blast cells, designated T acute lymphoblastic leukemia (T-ALL). The T-SCL subset showed a significantly higher median age, a more frequent incidence of extramedullary leukemia, a morphology L1 in most cases, and a poor response to treatment in terms of either complete remission rate or median survival duration. In addition, significant differences between the two groups were found in evaluating the number of days of blast disappearance from peripheral blood, of CR achievement, and of neutrophils and platelets recovery. We conclude that T-SCL represents a distinct clinical entity, characterized by a poor response to ALL conventional chemotherapy. Alternative therapeutic approaches should be developed for patients suffering from this form of leukemia, to modify its severe prognosis.

Adult↗

Recombinant interferon-alpha 2A as maintenance treatment for patients with advanced stage chronic lymphocytic leukemia responding to chemotherapy.

Forty-five patients suffering from advanced B-CLL were randomized to receive interferon-alpha (IFN alpha) or no treatment after achieving complete remission or partial response, following a chemotherapy protocol called MiNa. The two groups were fully comparable in terms of clinical characteristics and level of response obtained by chemotherapy. IFN alpha was given at a dose of 3 megaunits three times a week intramuscularly for 1 year. The IFN-treated patient group showed a significantly longer duration of response and a less frequent incidence of infections as compared to the no treatment group. A minority of patients who had had partial response to chemotherapy obtained complete remission while on therapy with IFN alpha. Toxicity was mild and patient compliance was excellent. We conclude that IFN alpha may have a role as maintenance therapy in CLL for patients responding to chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

Short time treatment with high-efficiency paired filtration dialysis for chronic renal failure.

With the aim of treating with short sessions even chronic uremic patients with cardiovascular instability, we have developed our previous findings about paired filtration dialysis (hemofiltration-hemodialysis in series) by a method we call high-efficiency paired filtration dialysis (HEPFD). We have treated with this method for 6 months 6 chronic anuric uremic patients previously treated for 6 months with hemofiltration (HF) because of their cardiovascular instability. By comparison with HF, HEPFD shows much higher clearances of small molecules with consequent significant decrease of their predialytic values, improvement of Kt/V value, lower beta 2-microglobulin clearance (its predialytic value remains unchanged), and the same tolerability. HEPFD allows short, efficient, and well-tolerated treatments even in patients with cardiovascular instability.

Adult↗

Improvement of continuous arteriovenous hemofiltration (CAVH) and hemofiltration (HF) efficiency by adding hemoperfusion (HP).

Aiming to improve the efficiency of the blood purification convective methods either with spontaneous (CAVH) or with pump-assisted (HF) extracorporeal circulation we inserted after the hemofilter a cartridge containing 70 g of collodion-coated activated charcoal (CAC) microencapsulated, obtaining so hemofiltration and hemoperfusion in series (HF+HP). The obtained results show that in both methods HP addition gives a negligible increase of urea clearance and a practically null increase of phosphate clearance, whereas creatinine and uric acid clearances increase is remarkable especially, in percentage, with low blood flows (CAVH). In the HF+HP system we have also been studying B2-microglobulin (B2-M) clearance aiming at examining the possibility of increasing the removal of substances with higher molecular weight. We have been finding HP addition increases further on B2-M clearance already high in HF. Therefore we think HP addition to convective methods is an interesting step in the attempt to carry out highly efficient blood purification methods.

Creatinine↗

Differentiation of human leukaemic cell lines and fresh leukaemia cells by low dose Ara-C: monitoring by expression of c-myc and c-fos oncogenes.

The effects of low dose Ara-C on cellular oncogene expression were measured in HL-60 and U-937 cell lines and in primary cultures from leukaemic patients. Expression of c-myc was completely abolished in U-937 and greatly reduced in HL-60 after a 3 day exposure to the drug, whereas specific c-fos transcripts were increased. In fresh myeloid leukaemia samples, growth and DNA synthesis were reduced as in the two cell lines. Conversely, changes compatible with the induction of differentiation along the myelomonocytic pathway were much less pronounced than in cell lines treated with the same dose of Ara-C. Cells from one patient did not show any appreciable morphological change. The same sample displayed a greatly reduced expression of c-myc accompanied by a concurrent 10-fold increased expression of c-fos. The data suggest that the action of low dose Ara-C on oncogene expression is comparable to that of other differentiation-inducing agents that display both cytostatic and maturation promoting effects. Evaluation of cellular oncogene expression may therefore represent a useful tool for monitoring effects of low dose Ara-C on leukaemia cells.

Cell Differentiation↗

[Hypotensive drugs and first-dose syndrome. Considerations on 6 cases observed during treatment with ACE inhibitors].

An examination of the literature provides the basis for a definition of first dose iatrogenic hypotension or "first dose syndrome", its nature, degree and frequency. The drugs that often cause this phenomenon are listed with details of the mechanisms involved as are the physiological, pathological and iatrogenic conditions that may trigger and/or exacerbate the gravity and duration of the syndrome. In a series of patients with essential arterial hypertension treated with ACE inhibitors, 6 developed first dose syndrome, two of them after captopril and 4 after enalapril maleate, two of whom were also receiving theophylline and nitro derivates. Though wide personal experience suggests that first dose syndrome caused by ACE inhibitors is a rare event and those drugs are undeniably effective and well tolerated, treatment should always start with minimum doses administered before bed time especially in patients receiving other medication and/or presenting the physiological or pathological conditions in which first dose syndrome has already been observed and described.

Aged↗