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Biomedical subjects

U Tirelli

Publications and source records attributed to U Tirelli.

At least 217 records · Page 12Linked to original sources
PubMed1991

Risk factors for human immunodeficiency virus infection in 581 intravenous drug users, northeast Italy, 1984-1988. The AIDS and Related Syndromes Study Group.

Prevalence and risk factors for human immunodeficiency (HIV) virus infection were assessed in 581 heterosexual intravenous drug users (IVDUs), recruited from eight public drug assistance centres in the northeast of Italy, an area at low risk for AIDS. The overall seroprevalence for HIV antibody was rather high, 39% (95% confidence interval (CI): 35-43%). HIV prevalence had risen from 32% in 1984-1985 to 52% in 1987-1988. Thirty-three per cent of female and 41% of male IVDUs had antibodies to HIV (p = 0.07). Seropositivity rates showed a strong east-west geographical gradient (from 16% to 60%, p = 0.005): IVDUs living in the western part of the study area had a nearly sevenfold higher risk of infection (odds ratio (OR) = 6.9, 95% CI: 4.4-13.9) than those living in the eastern part. Sharing of drug injection equipment (OR = 3.6), duration of drug addiction (OR = 2.6), use of heroin in high-incidence cities (OR = 2.3), use of cocaine in addition to heroin (OR = 1.5) and history of prostitution (OR = 2.3) increased the risk of acquiring HIV infection. Over the study period, the ORs associated with area of residence decreased, whereas those associated with the use of heroin in high-incidence cities and with prostitution increased.

Adult↗
PubMed1991

Epidemic Kaposi's sarcoma in Italy, a country with intravenous drug users as the main group affected by HIV infection.

The Italian Cooperative Group on AIDS & Tumors (GICAT) is collecting data on the epidemiological and clinical features of Kaposi's sarcoma (KS) in Italy, a country where intravenous drug users (IVDUs) comprise the largest group affected by AIDS. As of December 31st 1989, among 5317 cases of CDC-defined AIDS reported to the National Registry of AIDS, there were 419 (8%) cases of KS. Twenty-five percent of all of the homosexual men with CDC-defined AIDS had KS, while only 3% of the IVDU patients with CDC-defined AIDS had KS. The first case of KS was observed in 1982, 2 cases in 1983, 7 cases in 1984, 17 cases in 1985, 55 cases in 1986, 89 cases in 1987, 120 cases in 1988 and 128 cases in 1989. Of the 226 cases of KS reported to GICAT, 60% were in homosexual men, 21% in IVDUs, and 9% in heterosexuals. An increased number of KS has been observed since 1982, although the number of new cases in the past year seems to have been stable, possibly due to the usual delay in notification. There is, however, an actual decrease of the percentage of KS among AIDS patients, from 18% in 1984 to 6% in 1989. Almost half of the patients had had a diagnosis of AIDS prior to the appearance of KS, but in 25% of the patients KS was the first AIDS manifestation. Almost all patients had skin involvement either alone or in association with other sites, whereas very few patients had only lymph node involvement. Only treatment with alpha-2 interferon was able to obtain complete remission in 9% of evaluable patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

A phase II study of oral idarubicin (4-demethoxidaunorubicin) in previously untreated elderly patients with non-Hodgkin's lymphoma.

Eighteen untreated elderly patients (median age 75 years) with non-Hodgkin's lymphoma (NHL) entered a phase II study with oral Idarubicin (4-demethoxidaunorubicin) at a dosage of 30-35 mg/m2 on day 1 and every 3 weeks thereafter. The medium number of cycles administered was three (range one to nine). We obtained one (6%) complete response and four (25%) partial responses in 16 evaluable patients. Toxicity was mild and no cardiotoxicity was found. At this dosage Idarubicin showed little anticancer activity in NHL.

Administration, Oral↗
PubMed1991

Feasibility of total body irradiation in chronic lymphocytic leukemia and low-grade non-Hodgkin's lymphomas.

Combined total body irradiation (TBI) and Prednimustine were prospectively evaluated in 30 patients affected either with chronic lymphocytic leukemia (CLL) or with low-grade non-Hodgkin's lymphoma (NHL) eleven patients were previously treated. Between January 1984 and May 1987, 20 evaluable patients with CLL, median age 66 years (range 43-82), classified according to Rai (4 in stage I, 10 in stage II, 4 in stage III, 2 in stage IV) and 10 evaluable patients with NHL low-grade malignancy according to the Working Formulation, Stages III and IV, median age 54 years (range 32-71) were treated using a 6 MeV Linear Accelerator, applying two opposite alternating fields including total body, with a fraction of 15 cGy, 2 fractions weekly (3-day interval) for a total dose of 150 cGy given over 5 weeks. Prednimustine (100 mg/m2, orally, for 5 consecutive days, every 3-4 weeks, for 6-9 courses) was administered 2 months after TBI treatment, as consolidation therapy. By May 1989, a total of 85% hematological responses (defined as normalization of the differential white cell count, of the total blood cell count and of bone marrow infiltration) were obtained after combined treatment in CLL patients; moreover 3 CR (according to the WHO criteria), 75% with splenomegaly reduction and 40% with lymphadenopathy reduction were seen. Ninety percent objective responses (5 CR and 4 PR) were observed in the NHL patients, with 50% having splenomegaly reduction and 67% lymphadenopathy reduction. The median response time in the two groups was, respectively, 14 and 23 months. The overall toxicity (WHO grades 1,2,3,4) after combined treatment was 65% and 70% in the two patient groups. WHO grade III toxicity, completely reversible, was verified in only 16.6% of the cases; all cases, except one, were previously treated. Additionally, 1 toxic death (grade IV thrombocytopenia and leukopenia) was observed in a heavily pretreated patient affected with CLL after TBI alone. Prednimustine regimen was generally well tolerated. The high response rate and acceptable toxicity, confirms the feasibility and the usefulness of TBI in the context of a combined treatment for CLL and low-grade NHL patients. However in order to further reduce the severe toxic side effects, observed in one patient, white blood cells and platelet count should be plotted and monitored carefully, particularly in pretreated patients.

Adult↗
PubMed1990

Non-Hodgkin's lymphoma in the elderly. I. Pathologic features at presentation.

The pathologic findings of 118 patients aged 70 years or older with non-Hodgkin's lymphoma (NHL) are reported. These patients formed 27.2% of 433 consecutive cases of NHL seen in a single institution over a 5-year period. Thirty-one of 433 NHL cases were histologically not classified, whereas the remaining 402 could be classified according to the International Working Formulation (WF) of NHL for clinical usage. Immunophenotypic analyses were carried out in 112 NHL cases; of this group 28 were NHL in elderly patients. Of the 95 elderly NHL that could be classified in the histologic categories of the WF 28 cases were in the low-grade, 41 in the intermediate-grade, and 26 in the high-grade categories. Eighty-one cases had diffuse histologic types and 14 had follicular/nodular histologic types. Thirty-five cases were of the G (diffuse large cell) + H (large cell, immunoblastic) categories. No significant differences in the prevalence of the different subtypes were observed among patients younger or older than 70 years. Immunohistologically, most NHL cases in the elderly expressed B-cell phenotype. Sixty-two NHL in the elderly were extranodal at presentation. The results of this study indicate that elderly patients form a relevant proportion of patients developing NHL and thereby present a very difficult management problem. The pathologic features of NHL in the elderly does not differ significantly from those of their younger counterparts, although an increase in diffuse versus follicular histologic patterns, and in extranodal versus nodal disease was observed with advancing age.

Aged↗
PubMed1990

Report of an unusual small lymphocytic B-cell lymphoma selectively involving the B-zone of lymph node.

Selective involvement of the B-cell compartment of lymph node by B-cell malignant lymphomas is an occasional finding related to early phases of lymph node infiltration. The authors have observed a unique case of diffuse small lymphocytic lymphoma that consisted of immunohistologically and genotypically proven B-clonal population exhibiting a repetitive pattern of infiltration in three lymph node samples obtained from the patient during a 9-year period. This pattern consisted of a selective and complete replacement of the B-areas with disappearance of follicles and widening of the medullary cords, an expanded T-zone showing features consistent with dermatopathic lymphadenitis and well-preserved sinuses. Clinically, multiple involved sites at presentation (lymph nodes, spleen, skin, bone marrow, and peripheral blood) and during the 9-year follow-up (testis) were detected, and the disease was associated with a relative indolent course like other low-grade lymphomas. The phenotypic profile of lymphoma cells studied by immunoperoxidase method, and by single-labeling and double-labeling flow cytometric analyses (SIg+, K+, LN2+, MB1+, MB2+, HLA-DR+, CD 9+, CD19+, CD 20+, CD 21+, CD 22+, CD 24+, Leu 8+, CD 5-, CD 10-, CD 11b-, CD 11c-, CD 25-, CD 38-, PCA-1-, FMC-7-, CD 23-) was consistent with a B-cell proliferation at an intermediate stage of differentiation but distinct from other well-defined B-cell neoplasms. Whether such unique B-zone pattern was due to an intrinsic property of this lymphoma or it is to be related to the coexisting reactive T-zone expansion remains controversial.

Antibodies, Monoclonal↗
PubMed1990

AIDS-related B-cell non-Hodgkin's lymphomas in direct blood-stream HIV-infected patients: pathogenesis and differentiation features.

Six AIDS-related NHLs from direct blood-stream HIV-infected patients were characterized for clonality, maturation cell characteristics, activation of c-myc proto-oncogene and presence of HIV and EBV genomes. Four out of the 6 AIDS-related NHLs were of immature B-cell origin, contrasting with the lower frequency (2 out of 31) of immature B-cell NHLs occurring in HIV-negative patients. Moreover, 3 out of the 4 AIDS-related pre-B-NHLs were extranodal lymphomas. C-myc translocations or rearrangements were not found in Italian AIDS-related NHLs, unlike c-myc activation which had a high prevalence in the American series of AIDS-related NHLs. HIV and EBV are not, or only occasionally, directly involved in AIDS-related NHL pathogenesis since HIV genome has never been found in the neoplastic clones and EBV genome was detected in only 1 out of the 6 lymphomas analyzed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Combined radiotherapy and chemotherapy versus radiotherapy alone in locally advanced epidermoid bronchogenic carcinoma. A randomized study.

Between June 1980 and December 1983, 111 patients with inoperable epidermoid bronchogenic carcinoma (limited disease) were entered into a randomized trial comparing radiotherapy alone versus radiotherapy and combination chemotherapy with cyclophosphamide, Adriamycin (doxorubicin), methotrexate, and procarbazine. Thirty-five of 62 (56.4%) patients treated with 4500 rad in 15 fractions in 3 weeks and 19 of 49 (38.8%) patients treated with the same radiation treatment and chemotherapy had an objective response. The difference in response rate was not significant (P = 0.900). Median time to progression was 5.9 and 7.02 months, respectively, for the radiation treatment and the combined treatment. Median survival was 11.74 and 10.03 months, respectively, without statistically significant differences between the two groups of patients. The toxicity was acceptable and no treatment-related death occurred in either treatment schedule. In this study no significant superiority of combined radiotherapy and chemotherapy treatment over radiation therapy alone was evidenced. Whether different chemotherapy regimens may prove more effective in this context should be clarified by further studies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Nasopharyngeal lymphatic tissue in patients infected with human immunodeficiency virus. A prospective clinicopathologic study.

A prospective clinicopathologic study of the nasopharyngeal lymphatic tissue, using a standardized approach, was carried out in 66 patients infected with human immunodeficiency virus (HIV) in Aviano, Italy. Two hundred eighteen patients without HIV infection served as a control group. A significantly higher percentage of nasopharyngeal lymphatic tissue hypertrophy was observed in HIV-infected patients compared with the control group, both clinically and pathologically. The finding of a higher incidence of nasopharyngeal lymphatic tissue hypertrophy during some stages of the disease, when cervical lymph nodes are enlarged, suggests that the extranodal nasopharyngeal district behaves in the same way as the lymph nodes. Nasopharyngeal lymphatic tissue hypertrophy should be placed at the forefront of the hitherto known head and neck manifestations of HIV infection. An ear, nose, and throat examination is mandatory for all patients with known or suspected HIV infection.

AIDS-Related Complex↗
PubMed1990

Pharmacokinetics of 4-demethoxydaunorubicin in cancer patients.

The clinical pharmacokinetics of 4-demethoxy-daunorubicin was investigated in 28 cancer patients who received the drug orally. The majority of the patients were elderly (median age, 72 years). Nine of them also received an i.v. dose, and the bioavailability of the oral dose ranged between 9% and 39%. 4-Demethoxydaunorubicin peak levels were achieved 2-4 h after the oral dose in most patients. The drug was rapidly and extensively metabolized to 4-demethoxy-13-hydroxydaunorubicin, which is probably as active as the parent drug. The metabolite levels were much higher and longer lasting than the parent drug, suggesting that it may play an important role in the drug's pharmacological effects.

Administration, Oral↗
PubMed1990

Head and neck cancer and ageing: a retrospective study in 438 patients.

To evaluate whether age over 70 years represents a prognostic factor in head and neck cancer, we reviewed all cases observed between 1981 and 1984. Four hundred and thirty-eight (438) patients were considered in relation to three age groups (less than or equal to 59, 60-69, and greater than or equal to 70 years, defined as non-elderly, mid-elderly and elderly respectively). The main parameters analyzed included histological diagnosis (no difference emerged among the three age groups); anatomical site (hypopharyngeal carcinoma was most frequent in non-elderly patients); TNM stage (an higher incidence of early stages was seen in the elderly); performance status (better in the non-elderly); previous illnesses (life-style related diseases were more frequent in the non-elderly); contraindications to surgery (more frequent in the elderly); surgical treatment ('en bloc' resections were more often employed in the non-elderly); post-operative complications and local control (no difference between the three groups); multiple primary malignancies (head and neck, oesophagus and lung were more frequent in non-elderly patients) and survival (no difference). Although age affects several features of head and neck cancer patients, it does not appear from the present study to be an independent prognostic factor for local control and survival. With regard to survival, stage appeared to be the most important prognostic factor.

Age Factors↗
PubMed1990

Genotypic and immunophenotypic characterization of two human light chain-only B-cell non-Hodgkin's lymphomas.

Two atypical human non-Hodgkin's lymphomas (NHLs) that exhibited unusual genotypic and in situ immunophenotypic abnormalities are described. Immunophenotypically, both NHLs lacked surface Ig heavy chains. With the exception of the MB2 B-cell-associated antigen, no B- and T-cell differentiation antigen was detected in case 1. NHL 2 failed to show evidence of clonality by immunohistochemical analysis but revealed the presence of many B-lymphocytes with an abnormal phenotypic profile: CD19+, CD20+, CD22+, kappa-, lambda-, CD9-, CD10-, CD21-, and CD24-. Genotypic analysis indicated that both lymphomas derived from anomalously matured pre-B-cells that had rearranged the lambda or kappa light chain genes but not the Ig heavy chain gene. The neoplastic cells of the two NHLs resemble the light chain-only B-cells recently discovered, following Epstein-Barr virus immortalization, in the human bone marrow. The authors' data confirm, therefore, the existence of the light chain-only B-cells in the human hematopoietic compartment. Moreover, their results emphasize the conclusive role of the immunogenotypic analysis in defining clonality, lineage, and maturation abnormalities of such atypical NHLs.

Adult↗
PubMed1990

AIDS-associated non-Hodgkin's lymphoma in Italy: intravenous drug users versus homosexual men. The Italian Cooperative Group on AIDS-Related Tumors (GICAT).

Because of growing evidence that there are differences in the natural history of HIV infection in intravenous drug users (IVDU) and homosexual men, the clinicopathological features and response to treatment of AIDS-related non-Hodgkin's lymphomas (NHL) were analyzed in 150 cases (96 IVDU and 31 homosexual men) by the Italian Cooperative Group on AIDS-related tumors. Twenty-three patients fell within other risk groups. The median age was 26 years for the IVDU and 38 for the homosexual men. Forty percent of patients in both of the risk groups manifested full-blown AIDS prior to development of the lymphoma. In both groups, most of the NHL were of high or intermediate type (IVDU 96%, homosexual men 86%). In high-grade NHL, Burkitt's type lymphoma was present in 40% of the homosexual men and in 29% of the IVDU (a non-significant difference), while an immunoblastic lymphoma was diagnosed in 46% of IVDU and 27% of homosexual men (non-significant). No oral localizations were observed, and one homosexual presented with a rectal lymphoma. Almost half of the patients (47%) received no antineoplastic treatment because of rapid disease progression or of diagnosis only at post-mortem. Intensive combination regimens administered in one-third of both IVDU and homosexual men (compared to CHOP or CHOP-like combinations) provided more CR (3/13 vs 3/24 in IVDU and 2/3 vs 1/7 in homosexuals), although the overall survivals with both the intensive and less intensive chemotherapy protocols remained similar. Overall, the median survival was 3.7 months for IVDU and 3.6 months for homosexual men. The most reliable predictors for survival were opportunistic infections at onset in IVDU.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗