Biomedical subjects

A Boiardi

Publications and source records attributed to A Boiardi.

At least 19 recordsLinked to original sources

PubMed1992

Efficacy of '8-drugs-in-one-day' combination in treatment of recurrent GBM patients.

Thirty-five adult recurrent GBM patients, divided randomly in two groups of 19 and 16 cases, had been treated with two regimens of chemotherapy: a) 'eight-drugs-in-one-day'; b) procarbazine + CCNU + vincristine (PCV) respectively. Chemotherapy was planned at the tumour relapse and delivered as long as tolerated without irreversible sequelae or until the CT scan showed tumor progression. Multiple agents are used simultaneously in the therapeutic approach using 'eight-in-one' to kill as many heterogeneous cells of malignant glial tumor as possible and minimize the emergence of cellular resistance to chemotherapy. Rate response to chemotherapy and the median adjunctive survival time (6.5 and 6 months, respectively) are not significantly different in the two arms of this study. Our experience with such an aggressive multi-drugs combination 'eight-in-one-day' was disappointing if compared with less toxic, better tolerated and easy delivered (PCV) regimen.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1992

Peripheral nerve involvement in Churg-Strauss syndrome.

Peripheral neuropathy associated with bronchial asthma, multisystem organ dysfunction and idiopathic hypereosinophilia may be found in Churg-Strauss syndrome, hypereosinophilic syndrome and polyarteritis nodosa. Some authors have diagnosed their patients according to the presence in tissue biopsies of the three histological criteria of Churg and Strauss (necrotizing vasculitis, tissue eosinophilic infiltration, extravascular granulomas). We have observed three patients with a common history of a prodromal phase of allergic diseases (bronchial asthma and rhinitis) followed by a vasculitic phase with mononeuritis multiplex, purpura and arthritis, associated with hypereosinophilia of more than 1500 cells/mm3. All responded well to steroid treatment. Sural nerve biopsy revealed true vasculitis in two of these cases and a mild perivascular inflammatory infiltration in the other. On the basis of their characteristic clinical pattern, we think that our cases best fit the diagnosis of Churg-Strauss syndrome even though the typical histological features were not found in the sural nerves examined.

Adolescent↗

PubMed1992

Cisplatin neuropathy in brain tumor chemotherapy.

38 patients with glial brain tumors received 135 mg/m2 cisplatin intravenously every month for 5 courses. Signs and symptoms of peripheral neuropathy were evaluated clinically and electrophysiologically. This approach differs from methods previously reported in that it offers two major advantages: primary brain tumors do not cause paraneoplastic neuropathy; no neurotoxic drugs other than cisplatin were employed. Our study confirmed in this highly specific clinical model the existence of cisplatin peripheral neuropathy: we observed definite clinical signs or symptoms of neuropathy in 80% of patients receiving a cumulative cisplatin dosage of 675 mg/m2; there was a progressive dose-related decrease in SAP amplitudes, expression of a sensory axonopathy or neuronopathy.

Adult↗

PubMed1992

Carboplatin combined with carmustine and etoposide in the treatment of glioblastoma.

The aim of this study was to verify the tolerability and efficacy of therapeutic chemotherapy protocols, employing different combinations of cisplatin, carboplatin, etoposide and carmustine in primary glioblastoma patients. The purpose was focused on 2 end points: the response index to treatment, the TTP (tumor progression) and the ST (survival time). Eighty-four out of a group of 99 consecutive glioblastoma patients, entered this study. Patients were divided into 4 disparate treatment groups: (A) BCNU alone; (B) CDDP + VP-16; (C) CBDCA + BCNU; (D) CBDCA + BCNU + VP-16. The effectiveness and the TTP of the protocols differed, but differences were not statistically significant. Data concerning platinum treatment compare favorably with the best literature results. At 18 months more than half the carboplatin-treated patients are alive. Moreover these patients had a significantly longer ST than those treated with BCNU. We conclude that platinum-based chemotherapy has a beneficial effect on glial tumors.

Adult↗

PubMed1992

Gliomatosis cerebri. Report of a case with isolated amnesic disorders.

We describe the case of a female patient with behavioral and memory disorders. A neuropsychological evaluation confirmed the absence of mental deterioration and the presence of the psychometric features of the amnesic syndrome. The clinical diagnosis was supported by MRI and histological examination.

Adult↗

PubMed1992

Neoadjuvant chemotherapy in the treatment of recurrent glioblastomas (GBM).

We wondered whether second line chemotherapy in recurrent GBM patients might be useful for debulking the tumor mass and improving patient performance status to prepare the way for second surgical intervention. We have treated 18 recurrent glioma patients with high dose methotrexate (HDMTX) plus 5-fluorouracil (5FU). 5 Patients were responders, 6 had stable disease, and 7 disease progression. 5 patients, 3 PRs and 2 SDs, underwent a second operation after two chemotherapy cycles. Disease progression resumed at 11.5 +/- 7 weeks in the non reoperated patients, and at 32.6 +/- 9.3 weeks in the reoperated group from initiation of neoadjuvant treatment. Survival time in reoperated patients was 82.6 weeks. Although our experience with this policy is still limited, we believe that reoperation in selected recurrent GBM patients can be worthwhile.

Adult↗

PubMed1991

Natural history and postsurgical outcome of syringomyelia.

The surgical treatment of syringomyelia is still debatable and the result are often poor. Several surgical procedures, based on various proposed etiopathologies, have been developed but in many cases have proved completely ineffective. We have evaluated the follow-up of 69 syringomyelic patients, some operated on, some not, in the search for clues to the management of the disease. For this purpose we devised a rating system, which we describe. 31 patients underwent surgery while 38 received no treatment. We found that half of the patients deteriorated, whether they were operated on or not; only 1 in 5 improved and the rest remained stable. For surgical treatment to be successful, the disease must be in rapid evolution but without definite paraparesis.

Adult↗

PubMed1991

Local immunotherapy (beta-IFN) and systemic chemotherapy in primary glial tumors.

Dosage and schedules for the treatment of malignant glial tumors using IFN (interferon) are still uncertain and controversial. In this study we give the preliminary results of treatment in 28 patients with glioblastoma multiforme (GBM). 6 patients were treated with local injection of beta-IFN through an Ommaya reservoir; 4 patients with beta-IFN followed by systemic chemotherapy (Cisplatin + Etoposide), and 18 patients with chemotherapy only. Two end points were evaluated: 1) Whether or not the patients responded to treatment. 2) Length of Time to Tumor Progression (TTP) after surgery. We found that IFN alone was ineffective. Results were improved when local immunotherapy was associated with systemic chemotherapy. New drugs and investigation of possible pharmacological synergism are needed.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

Cisplatin and etoposide combination therapy for primary glial tumors: preliminary results.

In this preliminary trial we studied 29 patients with primary malignant glial tumors to investigate the effectiveness of cisplatin combined with etoposide on these tumors. Hyperfractionated radiation therapy was given in the course of chemotherapy. The time to tumor progression in these glioblastoma multiforme (GBM) patients encouraged us to continue this treatment in a phase III study.

Adult↗

PubMed1991

Primary glial tumor patients treated by combining cis-platin and etoposide.

Thirty eight patients with malignant gliomas (27 GBM and 11 AA) were treated with up to 7 cycles of CDDP + VP16 every month after surgery. Chemotherapy was planned as two cycles before and 5 cycles after radiation (42 Gy) using a three times daily fractionation schedule. No severe toxicity was observed. The object of our study was to investigate the antitumor effectiveness by combining CDDP plus VP16 against primary malignant glial tumors. The time to tumor progression (TTP) and survival time (ST) of the GBM patients in the present study were 38.5 and 68.5 weeks respectively. The TTP of the AA patients was 73 weeks and the ST was not calculated as most patients are still alive. By the 18th. month after surgery, 38% of GBM and 74% of AA patients treated with (CDDP + VP16) are still alive. This study demonstrates that the combination of CDDP and VP16 is effective in patients with malignant gliomas.

Adult↗

PubMed1990

Neuron specific enolase (NSE) and thymidine kinase (TK) as markers in biological fluids of brain tumor patients.

We studied the activity of two enzymes NSE and TK in the biological fluids of 104 patients with nervous system diseases, who fell into 4 groups. 20 subjects out of 35 in the tumor group had glial tumors. We fixed a cut-off value of NSE and TK activity at the 95th percentile of the control group, both in serum and in CSF. The aim of our investigation was to assess the reliability of TK and NSE assays in separating brain tumors from other neurological diseases. In our patients, most of the TK activity above the cut-off value was found in the tumor group. Serum TK seems to be a useful marker for following up cerebral tumors after surgery, but NSE is less useful for this purpose.

Biomarkers, Tumor↗

PubMed1989

Neurogenic muscle hypertrophy. Report of two cases.

Muscle hypertrophy is rare in denervating diseases. A patient with calf enlargement associated with L5-S1 radiculopathy and another with thenar, hypothenar, forearm and calf muscle hypertrophy in the course of chronic relapsing inflammatory demyelinating polyneuropathy are described. Gastrocnemius muscle biopsy revealed both type I and type II fibre hypertrophy in the former case and predominant type I fibre hypertrophy in the latter. Passive stretching and abnormal spontaneous muscular activity might have played a role in the origin of hypertrophy in both patients, but a satisfactory explanation for denervation hypertrophy has yet to be provided.

Biopsy↗

PubMed1989

Spinal arteriovenous fistula. A possible cause of paraparesis after epidural anaesthesia.

A 62-year-old male suddenly developed a severe paraparesis after epidural anaesthesia. He recovered gradually over the next few months. He had an acute relapse one year later and a selective spinal angiography showed a dural T8 arteriovenous fistula with large draining veins. Intravascular embolisation of the fistula produced immediate and sustained clinical improvement. The mechanism commonly held responsible for neurological disturbances in spinal dural arteriovenous fistulas is cord hypoxia secondary to venous hypertension. The 20-ml of local anaesthetic solution injected into a narrow spinal canal with osteophytosis may have caused further venous engorgement, cord hypoxia and acute neurological deficit.

Anesthesia, Epidural↗

PubMed1988

Recurrent familial neuropathy due to liability to pressure palsies.

Two families with hereditary neuropathy with liability to pressure palsies (HNPP) were evaluated clinically, electrophysiologically and pathologically (2 index cases). Familial patterns suggest autosomal dominant inheritance. The clinical presentation is characteristic, with recurrent painless transitory mononeuropathy, without evident triggering factors, or caused by trivial trauma or pressure. In affected members neurophysiological studies showed diffuse slowing in nerve conduction, more evident at common sites of entrapment. Somatosensory evoked potentials (SEPs) showed bilateral peripheral abnormalities with proximal nerve involvement more pronounced in older patients. 40 to 75% of teased fibers displayed sausage-shaped swellings. Ultrastructurally some sausages showed redundant myelin loops and excessive number of myelin lamellae that seem to cause axonal constriction.

Adult↗

PubMed1988