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Biomedical subjects

U Tirelli

Publications and source records attributed to U Tirelli.

At least 181 records · Page 10Linked to original sources
PubMed1994

The aged patient with lung cancer. Management recommendations.

Elderly patients with lung cancer have not benefited from the therapeutic improvements obtained during the 1980s with younger adults. Potentially operable non-small-cell lung cancers are more common in elderly patients, who are more likely to have localized disease at diagnosis. Even so, elderly patients are rarely treated with surgery. Radiotherapy remains the most frequently adopted tool to treat non-small-cell lung cancer in this age group. Epipodophyllotoxin derivatives constitute the best option for chemotherapy of elderly patients with small-cell lung cancer. When used as single agent regimens, these drugs show the same overall response rate as combination chemotherapy, but with reduced toxicity. Haematopoietic growth factors are used to reduce bone marrow damage following cytotoxic chemotherapy, and may be a promising tool in elderly patients. Special attention should be given to increasing the number of elderly patients with small-cell lung cancer enrolled in phase I and II studies to investigate new agents for the treatment of this tumour.

Aged↗
PubMed1994

Burkitt's like lymphoma in patients with and without HIV infection. A report of 33 patients from north-east Italy.

With the aim of comparing the clinical features of Burkitt's like lymphoma (BL) in HIV-infected patients and in the general population, we retrospectively analyzed 35 patients with HIV-positive non-Hodgkin's lymphoma (NHL) and 535 patients with HIV-negative NHL, from 1985 to 1990. A total of 33 patients with BL were diagnosed at our institute: 18 without and 15 with HIV infection; 3.3% and 43% of all HIV-seronegative and HIV-seropositive NHL respectively. No significant differences were found between these two series concerning clinical features, with the exception of peripheral adenopathy that was more common in the HIV infected patients (p = 0.05). In both groups BL was characterized by advanced stage and high incidence of bone marrow and gastrointestinal involvement. Response rate was lower in the HIV-positive patients, but the difference was not significant. No relevant differences in the toxicity after chemotherapy were observed. The median survival in the HIV-infected patients was lower (7 months) than in the other group (14 months), with borderline statistical significance (p = 0.06).

Adult↗
PubMed1994

Serum levels of intercellular adhesion molecule 1 in patients with HIV-related Kaposi's sarcoma.

Infection with the human immunodeficiency virus type 1 (HIV-1) in man is associated with an increase in the incidence of Kaposi's sarcoma (KS). The biological and clinical characteristics of these patients differ from those of subjects with other HIV-associated diseases. Here we report that levels of serum-soluble intercellular adhesion molecule 1 (sICAM 1) are increased in HIV-1-positive patients with KS, but not in patients belonging to other CDC classification groups. KS patients with elevated levels of serum sICAM 1 had a significant lowering of CD4 cell counts during the follow-up period compared with those KS subjects whose sICAM 1 levels were only moderately higher. We suggest that increased sICAM 1 levels may have a pathogenetic role in the development of HIV-associated immunodeficiency in KS patients and may also be considered an important prognostic factor.

Antigens, CD↗
PubMed1994

AIDS-associated Kaposi's sarcoma and non-Hodgkin's lymphomas reporting in Italy: a linkage study.

To evaluate the completeness and accuracy in the reporting of AIDS-associated Kaposi's sarcoma (KS) and non-Hodgkin's lymphomas (NHL) in Italy, a linkage study of the notifications to the Italian AIDS Registry (RAIDS--the national compulsory AIDS surveillance system) and the clinical and pathological records of the Italian Cooperative Group on AIDS-related tumors (GICAT--a nationwide voluntary reporting system for HIV-infected individuals who develop cancer) was carried out. A total of 288 cases of KS and 258 cases of NHL fulfilling the AIDS definition criteria, histologically diagnosed by the GICAT centers between January 1987 and March 1992, were matched with the 16,860 AIDS cases reported to the RAIDS up to March 1993. The linkage procedure, based on name, gender, and date of birth, identified 276 cases of KS (96%) and 241 cases of NHL (93%) present in both files ("linked" cases). The diagnosis of KS did not appear among the clinical manifestations of AIDS in the RAIDS file in 67 out of the 276 linked KS (24%), either with coincident dates of KS diagnosis and of case notification (19 cases) or when the KS diagnosis followed by > or = 2 months the case notification to RAIDS (48 cases). Of the 241 linked NHL, 84 (33%) had no such neoplastic complications of AIDS listed in the RAIDS file, 23 with coincident dates of NHL diagnosis and of case notification and 61 with the NHL diagnosis made > or = 2 months after the notification. A noteworthy discrepancy in the classification of the three histologic subtypes of NHL emerged between the GICAT and the RAIDS. The degree of underreporting of AIDS-associated cancers that emerged from the present study suggests that augmentation with other sources of oncological information is important to better estimate the burden of AIDS-related tumors and to study the interaction between HIV infection and cancer.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Human immunodeficiency virus-related lymphoma treatment with intensive combination chemotherapy. French-Italian Cooperative Group.

PURPOSE: An increased risk of high-grade non-Hodgkin's lymphoma is observed in patients who are seropositive for human immunodeficiency virus (HIV). Treatment of such patients is complicated by their underlying acquired immunodeficiency syndrome (AIDS). Intensive strategies such as those used in non-HIV-related lymphoma may be poorly tolerated. However, patients without severe AIDS may derive significant benefits from such an approach. In a prospective multicenter study, treatment outcomes were assessed in 141 cases of HIV-seropositive lymphomas submitted to aggressive chemotherapy. PATIENTS AND METHODS: Adult patients with lymphoma with a performance status less than 3 and no active opportunistic infection were consecutively treated with three cycles of doxorubicin 75 mg/m2, cyclophosphamide 1,200 mg/m2, vindesine 2 mg/m2 for 2 days, bleomycin 10 mg for 2 days, and prednisolone 60 mg/m2 for 5 days (ACVB). This treatment was followed by a consolidation phase of high-dose methotrexate plus leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH84). Central nervous system prophylaxis with intrathecal methotrexate was routinely used. Zidovudine maintenance therapy was started after chemotherapy. Ninety-three patients had high-grade lymphomas (59 Burkitt's type) and 48 had intermediate-grade lymphomas. Disseminated stage III-IV was present in 86 patients, meningeal involvement in 29, and bone marrow infiltration in 30; 62 patients had more than 2 extranodal localizations. Lactate dehydrogenase levels were above the normal value in 95 cases. The median CD4-positive lymphocyte count was 227 x 10(6)/L. RESULTS: Eighty-nine patients (63%) achieved complete remission (CR) and 19 (13%) partial remission, whereas 13 did not respond and 20 (14%) died during the course of ACVB, 8 of them from progressive disease. With a median follow-up of 28 months, median survival and disease-free survival were 9 and 16 months, respectively. Median survival for nonresponders was 5 months; 23 patients died of opportunistic infections while in persistent CR. In multivariate analysis, four factors were strongly associated with shorter survival: (1) CD4 count less than 100 x 10(6)/L, (2) performance status greater than 1, (3) immunoblastic lymphoma, and (4) prior AIDS. In the absence of all risk factors, the probability of survival at 2 years was 50%. CONCLUSION: In a selected group of HIV-related lymphomas, intensive chemotherapy with LNH84 is feasible and yields a high CR rate. Survival is short due to death from HIV-related infections; however, in a subgroup of patients without adverse prognostic factors, long-term remission was observed.

Adult↗
PubMed1993

Increased frequency of lymphocyte depletion and mixed cellularity subtypes of Hodgkin's disease in HIV-infected patients. Italian Cooperative Group on AIDS and Tumours.

To assess whether the histological pattern of Hodgkin's disease (HD) in human immunodeficiency virus (HIV)-infected patients differs from that among HD patients without HIV infection, the observed (O) number of HD cases according to histological subtype [i.e. lymphocyte predominance (LP), nodular sclerosis (NS), mixed cellularity (MC) and lymphocyte depletion (LD)] among 92 Italian HIV-infected patients was compared with the expected (E) number derived from two case series of HD from Europe and the U.S.A. (14,315 cases of HD) and Italy (125 cases). After age standardisation, the O/E ratio was computed, along with its 95% confidence interval (CI). In comparison with 125 Italian HD patients not infected with HIV, a 4-fold higher frequency of the MC histological subtype (95% CI: 2.9-5.1) and an approximately 12-fold higher frequency of the LD subtype (95% CI: 7.0-18.0) emerged among HIV-infected patients. These results were substantially confirmed when the comparison was made with the case series from Europe and the U.S.A. These data show different histological patterns of HD between a group of HIV-infected patients and HD patients from the general population. Although caution is needed in their interpretation, the study results seem to indicate that HD of the MC or LD subtypes may be considered an AIDS-related malignancy.

Adult↗
PubMed1993

Head and neck manifestations during HIV infection.

The ENT manifestations of HIV infection are well known and the findings in AIDS patients have been described, nevertheless there are no reports of the frequency of head and neck involvement during the various stages of the disease. From 1987 to 1991, 210 HIV positive patients had ENT evaluation without symptoms-related selection. The majority of them were men and intravenous drug users. The frequency of enlarged neck nodes, neck mass, nasopharyngeal lymphatic tissue hypertrophy, extranodal localization of non-Hodgkin's lymphomas, Kaposi's sarcoma, oral hairy leukoplakia, candidiasis and other less common findings is reported, in relation to the stage of the disease. Overall 84 per cent of the observed patients had head and neck manifestations. An ENT evaluation in every HIV infected patient is suggested.

Adolescent↗
PubMed1993

Comparison of two dose regimens of zidovudine in an open, randomized, multicentre study for severe HIV-related thrombocytopenia.

OBJECTIVE: To compare the effect of two dose regimens of zidovudine in the treatment of severe HIV-related thrombocytopenia (TP). DESIGN: Eighty-four patients with severe HIV-related TP and platelet counts < 50 x 10(9)/l were enrolled in an open study at six centres. Patients were randomized into two groups to receive zidovudine (group A, 500 mg per day; group B, 1000 mg per day) for 6 months. METHODS: Platelet counts were determined monthly and patients categorized as complete responders (CR; platelets > 100 x 10(9)/l), partial responders (PR; platelets > 50 to < 100 x 10(9)/l), or failures (F; platelets to < 50 x 10(9)/l). CD4+ and CD8+ lymphocytes, HIV antigenaemia, beta 2-microglobulin, white blood cells, mean cell volume and haemoglobin were also determined. RESULTS: Seventy-one patients (35 and 36 in groups A and B, respectively) completed the study; 11.4% of group A patients were CR and 45.7% PR; 38.9% of group B were CR and 33.3% PR. Increase in mean platelet counts was dose-related, more rapid in the higher dose group and remained significantly higher after 6 months of treatment (56.4 x 10(9)/l in group A versus 98.2 x 10(9)/l in group B; P < 0.01). CONCLUSIONS: The results confirm the efficacy of zidovudine in the treatment of severe HIV-related TP. The average for CR and PR in the two groups was 64.8%; the higher dose of zidovudine was more effective at increasing platelet counts.

Adult↗
PubMed1993

Human immunodeficiency virus-associated systemic lymphomas may be subdivided into two main groups according to Epstein-Barr viral latent gene expression.

PURPOSE: We report a pathologic characterization of human immunodeficiency virus (HIV)-associated systemic lymphomas, including the association of Epstein-Barr virus (EBV) in different categories. PATIENTS AND METHODS: Eighty-seven HIV-associated non-Hodgkin's lymphoma (NHL) were classified according to classic NHL classification and a recent description of morphologic variants of high-grade B-cell NHL. Seventy-one cases were immunophenotypically-genotypically characterized, whereas, in 49 representative cases, the association of EBV was assessed by nonisotopic in situ hybridization (ISH) and the immunohistochemical demonstration of latent membrane protein-1 (LMP-1). In addition, 14 Hodgkin's disease (HD) cases, occurring in patients with HIV infection, were investigated for the frequency of LMP-1 expression. RESULTS: Most lymphomas were of B-cell derivation and showed a blastic cell morphology, with (1) small noncleaved cells (SNCCs; 36 cases), (2) large noncleaved cells (10 cases), and (3) immunoblasts, usually polymorphic (12 cases). Moreover, 12 cases were classified as anaplastic large-cell (ALC) Ki-1-positive (Ki-1+) lymphoma. Combined ISH studies (for viral DNA and EBV RNA [EBER]) and immunohistologic demonstration of LMP-1 suggested that there were differences in viral latent gene expression between ALC Ki-1+ or immunoblastic lymphomas (usually EBV+, LMP-1+), and EBV-infected cells of SNCC lymphomas, which did not show LMP-1 expression. A high proportion (10 of 14) of LMP-1+ HD cases was found. CONCLUSION: Differences in EBV association and LMP-1 expression were found between a major group of HIV-associated systemic NHL with blastic cell morphology, including SNCC lymphoma and its variants, and anaplastic cell lymphomas. A proportion of immunoblastic (polymorphic) lymphomas was different in viral latent gene expression from other blastic cell systemic lymphomas. It is concluded that only a group of these lymphomas (most ALC Ki-1+ and HD cases, along with a nonnegligible fraction of immunoblastic lymphomas) seems to be linked etiopathologically to EBV.

Gene Expression Regulation, Viral↗
PubMed1993

The expansion of CD8 lymphocytes using T cell receptor variable gene products during HIV infection.

Fresh peripheral blood was obtained from HIV-infected subjects and from age-matched healthy controls. Single-, two- and three-colour flow cytometry was performed using FITC-labelled MoAbs directed against the following TCR V beta subfamilies: V2, V3, V5a, V5b, V5c, V6, V8, V12, V13.3, V17, V19, alone or in combination with PE-labelled CD4, CD8, HLA-DR, CD28, CD38 and with Peridinin-chlorophyll A protein (PerCP)-conjugated CD8. The percentages of each V beta subfamily did not differ in HIV+ patients compared with healthy controls. However, we were able to find in four patients (one CDC group II, one group III and two group IV) an expansion of a TCR V beta subfamily (V3 in two, V5a and V19 in one patient). These cells were mainly CD8+. Three-colour flow cytometry allowed us to define that the expanded V beta+, CD8+ T lymphocytes were characterized by the low/intermediate expression of activation markers (HLA-DR, CD28, CD38). In some HIV+ patients there is an expansion of T cells expressing a TCR V beta subfamily; the nature of this expansion may be related to factors that are still unknown, such as the genetic background of each individual and the antigenic specificity of T cells. These populations may be relevant in the host response to the virus and in disease progression.

Antigens, CD↗
PubMed1993

[Solid tumors associated with HIV infection].

Between December 1986 and December 1991, the Italian Cooperative Group on AIDS-related tumours documented 94 HIV related solid tumours. Of 21 germinal testicular tumours collected, ten were seminomas. Cervical carcinoma was observed observed in 28 IVDAs (intraepithelial in 8 and advanced, with rapid progression, in one). Lung cancer associated with HIV infection was reported in 14 patients. Also reported were two cases of colorectal carcinoma, one anorectal carcinoma, one pancreatic carcinoma, one carcinoid, one oral carcinoma. Of the central nervous system tumours, were diagnosed 3 cases of glioblastomas, one medulloblastoma and one meningioma. This retrospective study shows that while oral and anorectal tumours were very rarely observed, a wide spectrum of other HIV-related solid tumours were found in this series. The required therapeutic approaches may not necessarily be influenced by the HIV infection, in contrast with the observed pattern for treatment of EKS and lymphomas in HIV infected subjects.

Adult↗
PubMed1992

Condom use and sexual habits of heterosexual intravenous drug users in northern Italy.

In order to assess modes of human immunodeficiency virus (HIV) transmission from heterosexual intravenous drug users (IVDUs) to their partners, condom use and sexual habits with both steady and occasional partners were investigated. A total of 349 heterosexual IVDUs (247 men and 102 women) who ignored, at the time of interview, their HIV serostatus were interviewed. Respondents were asked for information on condom use and sexual habits for the three year period prior to the interview. Nearly 40% of IVDUs reported sexual intercourse with both steady partners and occasional partners. Fifty-four percent of their steady partners and 48% of their occasional partners were individuals who did not belong to groups at risk for HIV infection. Anal intercourse with steady partners was reported by 29% of IVDUs and 24% of IVDUs with occasional partners. Condom use during vaginal intercourse was seldom reported: 83% of IVDUs never used a condom with steady partners and 75% did not use one with occasional partners. IVDUs who were 1) unmarried, 2) enrolled in the study after 1986, 3) partners of not at-risk individuals, 4) partners of a foreigner and, 5) aware of their partners HIV seropositivity showed significantly higher, albeit still low, frequencies of condom use with steady partners. Conversely, all these factors seemed to have little impact on condom use with occasional partners. Condom use and sexual habits were similarly reported by HIV-positive and HIV-negative IVDUs. The present study shows that high-risk sexual behaviours among IVDUs are very widespread and it stresses the need for intensive counselling to promote condom use among IVDUs.

Adult↗
PubMed1992

An unusual presentation of vulvar carcinoma in a HIV patient.

A report of a case of rapidly growing vulvar cancer associated with vulvar condylomas in a patient with HIV infection is given. This aggressive tumor resembles those epithelial tumors observed in women with iatrogenic immunosuppression and lymphoid neoplasia currently observed in HIV patients.

Adult↗
PubMed1992

Phase II study of cytarabine in Hodgkin's disease. The EORTC Lymphoma Cooperative Group.

Cytarabine was administered to 24 patients with previously treated Hodgkin's disease in the EORTC Lymphoma Cooperative Group. The drug was administered at the dose of 80 mg/m2 subcutaneously twice a day on 5 consecutive days every 3 weeks. The overall response rate was 17.6% (3 responses among 17 evaluable patients) with a short duration (2-6 months). The main toxicity was myelosuppression. Our experience in the EORTC Lymphoma Cooperative Group could not demonstrate a significant activity at this dose and schedule in Hodgkin's disease.

Adult↗