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Biomedical subjects

U Tirelli

Publications and source records attributed to U Tirelli.

At least 253 records · Page 14Linked to original sources
PubMed1989

Hodgkin's disease in association with acquired immunodeficiency syndrome (AIDS). A report on 36 patients. Gruppo Italiano Cooperativo AIDS and Tumori.

In an Italian cooperative study on AIDS and cancer a diagnosis of Hodgkin's disease was established in 36 HIV-positive patients. The series was characterized by a high proportion of drug abusers, a high proportion of mixed cellularity and lymphocytic depletion subtypes and short survival. It is still unclear if HIV infection promotes the development of Hodgkin's disease or only modifies the course of the disease. According to the authors, however, patients who are HIV seropositive and have biopsy-proven Hodgkin's disease should be considered as fulfilling the criteria for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Management of malignant lymphoma in the elderly. An EORTC retrospective evaluation.

A retrospective EORTC study was carried out in order to evaluate the incidence, clinico-pathological findings and outcome of non-Hodgkin lymphoma and Hodgkin's disease in patients 70 years of age or older. A significant proportion of non-Hodgkin lymphoma, mostly with high-intermediate grade of malignancy occurs in these patients. Aggressive treatment, in particular chemotherapy with 3 drugs or more administered to elderly patients 70 years or older, median age 77 years, is associated with significant lethal and severe toxicity. Prospective randomized studies are clearly needed in order to evaluate the activity and the toxicity of intensive chemotherapy regimens specifically devised for patients aged 70 years or older with unfavourable non-Hodgkin lymphoma. Hodgkin's disease is infrequently (5%) seen in patients 70 years of age or older. Mixed cellularity, B symptoms and stage III and IV account for 50, 47 and 47% of the cases respectively. Aggressive treatment is not associated with an increased lethal and severe toxicity compared with conservative treatment although 1 patient died of bone marrow toxicity after MOPP. Survival of patients 70 years or more with Hodgkin's disease seen in 1984 seems shorter than that in younger patients, especially due to high incidence of unfavourable prognostic factors, such as B symptoms and advanced stages.

Age Factors↗
PubMed1989

Risk factors for human immunodeficiency virus (HIV) infection among homosexual and bisexual men in a region at low risk for AIDS: the northeastern part of Italy. AIDS and Related Syndromes Study Group.

Prevalence and determinants of HIV infection were assessed in 127 homosexual and bisexual men in the northeastern part of Italy. The overall prevalence of HIV seropositivity was still rather low: 20% (95% confidence interval -CI- 13-27%). The most important risk factor for acquiring HIV infection turned out to be having has sexual intercourses in high-risk areas. Relative risks (RRs) for those who have travelled and had sex in North Europe and in the U.S., were, respectively, 2.7 (95% CI: 1.0-7.3) and 5.6 (95% CI: 1.2-25.9). A significantly increased risk was also seen for having a steady sexual partner (RR = 3.1, 95% CI: 1.3-7.5). Use of nitrite inhalants, high number of occasional sexual partners and habitual receptive anal intercourses were also associated with elevation of risk, whereas prostitution was not. The present study confirms the patterns of HIV spread among homosexual and bisexual men from high-risk areas to low-risk areas and prompts urgent educational intervention, in order to prevent the epidemics of AIDS among Italian homosexuals from reaching the size documented in other countries.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Non-Hodgkin's lymphoma in the elderly: a retrospective evaluation of toxicity related to aggressive vs. conservative treatments.

The outcome of 70 elderly patients aged 65 years or more (median, 71 years) with non-Hodgkin's lymphoma (NHL) treated between 1973 and 1981 with aggressive (AM) or conservative modalities (CM) was retrospectively evaluated. A significantly higher incidence of lethal and severe toxicity was observed in patients treated with AM than in those treated with CM (32% vs 3%, p less than 0.01), with 10% treatment related deaths in the AM group. Only 56% of the deaths were attributed to NHL; other major causes were treatment-related deaths, infection and cardiac diseases. No significant difference in response and survival was found between AM and CM groups (complete remission rates were 35% vs 42%, and 10 year survival rates were 31% vs 19%, respectively), but the prevalence of stages III-IV in patients treated with AM makes these results meaningless. Prospective randomized trials with AM vs CM are clearly needed in elderly patients with advanced unfavorable NHL.

Aged↗
PubMed1988

Risk factors for HIV infection in drug addicts from the northeast of Italy.

Prevalence and determinants of HIV infection were assessed in 313 parenteral drug addicts admitted to five Centers for Drug-Addict Assistance and two prisons located in the northeast of Italy (Friuli Venezia-Giulia), an area some distance from the major Italian cities first reached by the AIDS epidemic. The overall prevalence of HIV positivity was also rather high in this area, ie 30% with 24-36% confidence interval. The most important risk factors (besides syringe sharing applicable to all drug addicts), turned out to be of a geographical nature, ie living in Pordenone province (where a US military base is located) or coming from other endemic areas and having travelled long distances in the past three years. Prostitution also seemed to increase the risk of infection, but duration of drug addiction had little effect. In addition to persistent generalized lymphadenopathy (closely linked to HIV infection), reversal of helper:suppressor T-cell ratio was found in 67% of HIV positive individuals, but also in 31% of HIV negative ones. Clinical signs and symptoms strongly linked with HIV positivity were fatigue, weight loss, splenomegaly, fever and nocturnal sweats.

Adolescent↗
PubMed1988

Chemotherapy of advanced non-small-cell lung cancer with cyclophosphamide, adriamycin, methotrexate, and procarbazine versus cisplatin and etoposide. A randomized study.

All consecutive eligible patients with non-small-lung carcinoma seen at Centro di Riferimento Oncologico and Istituto Nazionale per la Ricerca sul Cancro were entered into a randomized chemotherapy study. Conditions of eligibility included advanced stage (stage III not amenable to radiation therapy or i.v.), measurable or evaluable lesions, age less than 70 years, performance status (PS) greater than 40, and no previous chemotherapy. Patients were randomized to either CAMP (cyclophosphamide 300 mg/m2 i.v., adriamycin 20 mg/m2 i.v., methotrexate 15 mg/m2 i.v. days 1 and 8, procarbazine 100 mg/m2 orally from day 1 to day 10, every 4 weeks) or DE (cisplatin 20 mg/m2 i.v. for five consecutive days and etoposide 75 mg/m2 i.v. on the same days, every 3 weeks). Treatment was continued until progression. Out of the 136 patients randomized, 133 were eligible (CAMP 62, DE 71) and 108 evaluable. Patient characteristics included male/female ratio 57/5 (CAMP) and 61/10 (DE), median age of 60 years (CAMP) and 59 years (DE), PS greater than or equal to 70 for 39 (CAMP) and 50 (DE), PS less than 70 for 23 (CAMP) and 21 (DE), stage III for 18 (CAMP) and 15 (DE), and stage IV for 44 (CAMP) and 56 (DE). DE was superior to CAMP in terms of response rate, defined as responding/evaluable patient ratio (38.2% versus 20.8%); however, the responding/eligible patient ratio was not significantly different in the two groups. The superiority of DE tended to be more marked in stage III patients, in patients with PS greater than or equal to 70, and in the squamous histological type. Toxicity was acceptable (one toxic death) and evenly distributed in the two treatment groups; only renal toxicity was prevalent in the DE group. Survival (all eligible patients) was significantly better in the DE than in the CAMP group. Whether DE chemotherapy is superior to a no-chemotherapy approach has not been evaluated in this study and remains to be determined.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

HIV-related malignant lymphoma: a report of 46 cases observed in Italy.

We report 36 patients with non-Hodgkin's lymphomas (NHL) and 10 patients with Hodgkin's disease (HD), predominantly intravenous drug abusers (IVDA; 35 patients), diagnosed in 16 different Italian centers. The group of NHL has a median age of 26 years (range 16-64): 26 were IVDA, 3 polytransfused, 3 IVDA and homosexual men, 2 homosexual men and 2 without apparent risk for AIDS but carrying HIV antibodies. 81% of the evaluable patients had high-grade NHL (32% Burkitt's type) according to the Working Formulation, 15% intermediate and 4% low-grade. Out of 23 patients with stage reported, 16 (70%) were stage IV, 2 (9%) stage III, 1 (4%) stage II and 4 (17%) stage I (CNS involvement). The group with HD has a median age of 25 years (range 20-40), 9 were IVDA and 1 IVDA and homosexual. Of the 7 patients with subtype reported, 4 patients had nodular sclerosis and 3 mixed cellularity subtype. Stage III and IV were reported in 66% of the patients. The median survival is 4 months for NHL and 10 months for HD. The most common cause of death is opportunistic infection in 86% of the evaluable cases.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Non-Hodgkin's lymphomas in 137 patients aged 70 years or older: a retrospective European Organization for Research and Treatment of Cancer Lymphoma Group Study.

The results of a European Organization for Research and Treatment of Cancer (EORTC) retrospective study on non-Hodgkin's lymphoma (NHL) in elderly patients (greater than or equal to 70 years of age) seen in Europe in 1984 are reported. A precodified form was sent to 55 European institutes in order to evaluate the incidence of NHL in the elderly with regard to natural history, treatment-related toxicity, response, and survival. Thirteen institutes participated in the study. One hundred thirty-seven cases of NHL were observed in the elderly during 1984, making up 28% of the total number of NHL seen in those institutes. The median age was 77 years; 21% of the patients had favorable (low-grade) and 73% unfavorable (intermediate- and high-grade) histology, according to the Working Formulation. Stage at presentation was localized (I and II) in 60% and advanced in 37% of the patients. Most of the physicians used standard therapy regimens at reduced doses, from the beginning of the treatment. Sixty patients (44%) underwent a "conservative" treatment (one or two antineoplastic drugs or local field radiotherapy) and 77 (56%) an "aggressive" treatment (polychemotherapy regimens or extended field radiotherapy). Response was similar between the two treatment groups, but severe and lethal toxicity was significantly higher among patients treated with aggressive therapy. Prospective randomized studies are clearly needed to define the optimal treatment in elderly patients with advanced unfavorable NHL.

Aged↗
PubMed1988

Immunologic abnormalities related to antigenaemia during HIV-1 infection.

The expression of phenotypic markers on T and B lymphocytes in long-term human immunodeficiency virus type 1 (HIV-1) seropositive, antigen negative patients, in seropositive, antigen positive individuals without AIDS and in seronegative intravenous drug abusers was examined by two colour flow cytometry. Seropositive, antigen positive patients showed decreased CD4+ lymphocyte numbers, causing lower CD4/CD8 ratios when compared to seropositive, antigen negative subjects. While CD4 CDw29+ (4B4) lymphocytes are selectively reduced in seropositive, antigen negative individuals, both CD4 CDw29+ and CD4 CD45R+ (2H4) lymphocytes are decreased when antigenaemia is present. An increased percentage of CD3 HLA DR+ activated T lymphocytes and of CD20+ (B1) Leu 8 negative activated B cells was seen in HIV-1 seropositive antigen positive patients. These results demonstrate that, in long-term seropositive individuals, antigenaemia is associated with peculiar phenotypic changes of lymphocyte subsets.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Clinical and laboratory findings at presentation in persistent generalized lymphadenopathy vs malignant lymphoma.

The purpose of this study is to compare the clinical and laboratory findings at presentation of 38 intravenous drug abusers with pathologically documented persistent generalized lymphadenopathy and 50 patients with biopsy proven malignant lymphoma (30 Hodgkin diseases, 20 non-Hodgkin's lymphomas) not related to acquired immunodeficiency syndrome, all aged 40 years or less and consecutively seen and evaluated with a similar clinicopathological approach since May 1984 in a single institution, Centro di Riferimento Oncologico, Aviano, Italy. Our results document that, although pathology is the decisive diagnostic tool, selected clinical and laboratory findings may contribute to a better differentiation of persistent generalized lymphadenopathy from malignant lymphoma not related to acquired immunodeficiency syndrome. Therefore, young patients presenting with generalized lymphadenopathy, apparently not related to known groups at risk for acquired immunodeficiency syndrome, should be evaluated also according to a protocol which includes the detection of symptoms, signs, and laboratory data that are known to be significantly increased among patients with persistent generalized lymphadenopathy.

Adult↗
PubMed1988

Malignant lymphomas in patients with or at risk for AIDS: a report of 50 cases observed in Italy.

For the first time the presence of a consistent number of malignant lymphomas among persons at high risk for AIDS has been documented in Italy. The majority of our cases started to occur in 1983, in line with the trend for a 2-year delay in the spread of the epidemic of AIDS in Europe. The patients with non-Hodgkin's lymphomas had an increased incidence of high grade subtypes, particularly of the Burkitt type, and were in an advanced stage with frequent extranodal involvement. Patients with Hodgkin's disease had a lower incidence of extranodal localization in comparison with the North American series. American patients with malignant lymphomas were reported to be predominantly homosexual; in contrast, the Italian cases were mostly drug addicts. The occurrence of malignant lymphomas was also correlated in Italian patients as well as in American patients with a shorter survival time, when compared with malignant lymphomas occurring in the same age group of the general population.

Acquired Immunodeficiency Syndrome↗