The gated equilibrium ventriculography in the diagnosis of the diastolic heart failure.
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Diastole↗
Biomedical subjects
A Indovina
Publications and source records attributed to A Indovina.
Diagnosis of coronary artery disease based on blood pool radioisotope angiography at rest.
BACKGROUND: The author wanted to determine which of 3 parameters (global left ventricular ejection, regional left ventricular ejection fraction, or isocontours together with peak filling rate and time of peak filling rate) measured with blood pool radioisotope angiography at rest was sufficient to permit diagnosis of coronary artery disease. METHODS: Thirty-one patients with coronary artery disease and 11 hypertensive patients without coronary heart disease were assessed with blood pool radioisotope angiography using a computerized large-field gamma camera. RESULTS: Of the 3 parameters measured, only assessment of isocontours with peak filling rate and time of peak filling rate provided sufficient information for establishing a diagnosis of coronary artery disease. In contrast, measurement of global left ventricular ejection provided equivocal data, as did that of regional left ventricular ejection fraction. CONCLUSIONS: In combination with peak filling rate and time of peak filling rate, measurement of isocontours by blood pool radioisotope angiography at rest provided sufficient information for establishing a diagnosis of coronary artery disease.
Adult↗
Satellite DNA analysis shows stability of donor hematopoiesis following allogeneic transplantation of peripheral blood stem cells.
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Biomarkers↗
Evaluation of heart dysfunction using non-invasive methods. A comparison between left ventricular end diastolic volume measured using blood pool gated radioisotope angiography and left ventricular transverse end diastolic diameter measured using two dimensional echocardiography.
BACKGROUND: The author aimed to compare two heart function indexes by studying left ventricular end diastolic volume measured using blood pool gated radioisotope angiography, and left ventricular end diastolic diameter measured using echocardiography. METHODS: The patients were divided into two groups depending on whether left ventricular ejection fraction was greater than or equal to 50% or less than 50%, namely into a group of patients without myocardial dysfunction and one with myocardial dysfunction. The results were analysed using Fisher's discriminant analysis. RESULTS: The author observed that 41.18% of patients were correctly classified using the end diastolic volume and 82.35% using transverse end diastolic diameter. Student's "t"-test was also performed on end diastolic volumes in the first and second group, although this was not significant. On the contrary, the "t" test between the transverse end diastolic diameters of patients in the first and second group was significant with p < 0.05. CONCLUSIONS: The author concludes that the end diastolic transverse diameter of the left ventricle is a reliable index of myocardial dysfunction.
Adult↗
Allogeneic transplantation of unmanipulated peripheral blood stem cells in patients with multiple myeloma.
In multiple myeloma (MM), allogeneic bone marrow transplantation may produce complete and durable responses, but is accompanied by significant transplant-related mortality (TRM). To assess feasibility and possible advantages offered by the use of allogeneic, growth factor-primed PBSC instead of marrow, we analyzed the data of 10 patients with MM (IgG = 6, IgA = 1, BJ = 2, non-secreting = 1; stage II = 1, stage III = 8, plasma-cell leukemia = 1) who received an allogeneic transplant with PBSC. Their age ranged between 35 and 53 years (median 45). All were HLA-identical to their sibling donors. Prior to allograft, six patients received standard-dose chemotherapy (DAV or CY-Dexa) and four a sequential intensified scheme with autologous PBSC support. At the time of transplantation, three patients were in CR, three in PR, three had refractory disease, one progressive disease. Patients were conditioned with busulfan-melphalan (n = 9) or busulfan-cyclophosphamide (n = 1), and were allografted with unmanipulated PBSC obtained by apheresis after treatment with G-CSF alone (n = 6) or GM-CSF followed by G-CSF (n = 4). All patients engrafted, with 0.5 x 10(9)/l PMN and 50 x 10(9)/l platelets on (median) day 13. Four patients had > or =grade II acute GVHD (grade II in 3, grade III in 1). Following allograft, CR was achieved in 71% patients. Eight are currently alive, with six in CR at a median of 18.5 months (range 7-28) from the transplant. Two patients died, 1 and 4 months from the allograft, respectively, and one is alive with progression. A PCR analysis of IgH rearrangement showed that residual disease was no more molecularly detectable in four out of seven evaluated patients following allograft. The results suggest that PBSC may improve the therapeutic efficacy of allogeneic transplant in MM, not only by a reduction of TRM but also by an improvement of rate and quality of response.
Adult↗
PBSC mobilization, collection and positive selection in patients with chronic lymphocytic leukemia.
We report the results of PBSC mobilization and immune selection in 17 patients with advanced chronic lymphocytic leukemia (CLL) enrolled in a multicenter Italian study of autologous transplantation with peripheral CD34+ selected cells. Mobilization was achieved by cyclophosphamide (CY) 4 g/m2 + G-CSF 5 microg/kg. CD34+ cells were positively selected by means of avidin-biotin immunoaffinity columns (Ceprate SC) or immunomagnetic beads (Isolex 300i) systems. Evaluation of minimal residual disease was performed by PCR analysis of the IgH gene rearrangment on the apheresis product before and after selection. Our results showed that after CY a median of 3.6 x 10(6)/kg (0.5-12.8) CD34+ cells were collected with a median of two aphereses in 14 out of 17 patients; three failed to mobilize a number of CD34+ cells adequate for subsequent manipulation. We found that in CR patients CD34+ cell yield per apheresis was significantly higher than in PR patients (P < 0.05). Sixteen selection procedures were performed in 13 patients. CD34+ cell recovery was 33.5% (10-85) with a median final yield of 1 x 10(6)/kg CD34+. Two patients underwent marrow collection due to the low number of CD34+ cells recovered. Final purity was 59% (range 22-94) and CD5/20+ cell depletion was 2.7 log (1.6-4.4). Our data showed a statistically higher CD34+ cell recovery and purity with the Isolex device compared to Ceprate (P < 0.01 and 0.01, respectively). All the evaluable samples remained PCR positive after selection. The main issues to be addressed in the future are the identification of patients who fail mobilization and the improvement of purging methods.
Adult↗
[Single photon emission computed tomography in focal liver lesions].
BACKGROUND: Sixteen parameters of liver diseases including echography, liver scintigraphy with radioactive colloids, slices of the SPECT and the 3 dimensions surface display of the SPECT, were examined in 17 patients with liver disease. METHODS: The findings of imaging examinations were classified with a code of letters and numbers and patients with the same code were given the same number. The measured values were submitted to a multivariate analysis to evaluate which variable were significant to predict focal liver lesions. RESULTS: The slices of SPECT, TGP and bilirubin were the most significant indexes of liver lesions. CONCLUSIONS: The validity of SPECT in the study of focal liver lesions is confirmed.
English Abstract↗
Transplantation of unmanipulated allogeneic PBSC: preliminary report on 24 patients.
To explore the feasibility and potential advantages of PBSC in allogeneic transplantation, we grafted 24 patients (age 16-57, median 37) with different hematologic diseases (ALL = 10, AML = 5, MM = 4, NHL = 2, CML = 1, MDS = 1, AA = 1), 23 HLA-identical to their siblings and 1 partially matched. Cells were collected from donors by apheresis after G-CSF 10 to 16 mg/kg/day for 4 to 5 days, and stored at 4 degrees C until infusion. The patients were conditioned with chemotherapy regimens including busulfan and cyclophosphamide in the majority of cases and received GVHD prophylaxis with CSA-MTX in all but two. The graft consisted of PBSC alone, with a median of 143.5 (range 18.1-358.9) x 10(4)/kg CFU-GM, 9.0 (range 3.3-18.0) x 10(6)/kg CD34+ cells and 2.8 (range 1.2 to 8.6) x 10(8)/kg CD3+ and cells. An ANC >0.0.5 x 10(9)/L was recovered on (median) day 13 (range 11-17), and a platelet count >50 x 10(9)/L on (median) day 13 (range 12-55) post graft. There was no correlation between CD34+ cells or CFU-GM number in the inoculum and time to hematologic reconstitution. Acute GVHD (grade II-IV) occurred in 10 out of 22 (45%), chronic GVHD in 10 out of 18 evaluable (55%) patients. We found no relationship between occurrence of acute or chronic GVHD and number of CD3+ cells in the graft. Four patients relapsed and 7 died after transplantation. Fifteen patients are currently alive and disease-free 67 to 710 (median 286) days from the graft. Allogeneic transplantation with unmanipulated PBSC ensures a fast and stable engraftment. Acute GVHD incidence and severity seems comparable to that of bone marrow transplantation, but there may be an increase in chronic GVHD, mainly of the extensive form.
Adolescent↗
[Diagnostic possibilities of left ventricular systolic-diastolic volume curve computed in patients with vascular diseases by means of multigated radionuclide angiocardiography].
MATERIALS AND METHODS: In this study the multigated radionuclide angiography was performed in 54 patients with and without vascular diseases; the humeral arterial pressure was measured and the BMI was calculated in each patient by mean of the weight and height. The curve expressing the variations of the sisto diastolic volume of the left ventricle was generated from an analysis of the radioisotopic angiocardiography, and the curve, the BMI and the arterial pressure were used to calculate 14 different numeric values for each patient consisting of hemodynamic parameters of the left ventricular function. The diagnosis for each patient was then examined a posteriori and the patients were divided in 15 groups of which 1 with non-cardiovascular pathologies and 14 with cardiovascular pathologies alone or in association. A statistical analysis was performed to ascertain whether the parameters could be used to classify patients into the diagnostic groups using the Fisher's discriminant analysis. RESULTS: The obtained classification agreed in the 63% of the cases. CONCLUSIONS: This paper proved the possibility offered by the curve expressing the changes in the sisto diastolic volume of the left ventricle to discriminate between the various cardiovascular pathologies.
Adult↗
Mobilization and collection of PBSC in healthy donors: comparison between two schemes of rhG-CSF administration.
Procurement of a high number of progenitor cells is of primary interest in allogeneic PBSC transplantation. We have retrospectively compared toxicity, mobilization effect and progenitor cell yields of two different rhG-CSF schedules in 11 consecutive healthy individuals donating their PBSC. Five of them received rhG-CSF 16 micrograms/kg/d for 4 subsequent d in 2 divided subcutaneous injections (group A); similarly, 6 donors received rhG-CSF 10 micrograms/kg/d for 5 d (group B). The aphereses were started the last day of rhG-CSF treatment; 9 donors underwent 2 aphereses, one underwent 1 and another 3 procedures, always on subsequent days. Toxicity was mild, but moderate thrombocytopenia developed following apheretic collections, irrespective of rhG-CSF schedule. In all the donors WBC, as well as circulating CD34+ cells, CFU-GM, CFU-GEMM and BFU-E dramatically increased over the baseline values, peaking on d 5 or 6, with no statistical difference between the 2 groups for the height of the cell peaks. Also the peripheral lymphoid cell populations (CD3+, CD19+ and CD56+/CD3-) increased following the rhG-CSF administration. The number of MNC, CFU-GM, BFU-E, CFU-GEMM, as well as CD34+, CD3+, CD19+ and CD56+/CD3- cells collected by apheresis showed no statistical difference in the 2 groups. Overall, 8 of the 11 donors collected the target number of CD34+ cells > 4 x 10(6)/kg ideal recipient body weight with the first apheresis, with no difference between the 2 groups. Mobilization with rhG-CSF in healthy donors enables the collection of large number of progenitor cells with modest side effects. A schedule of 10 micrograms/kg for 5 d is as effective as 16 micrograms/kg for 4 d. A single apheresis would be enough in 80% of cases.
Adolescent↗
High incidence of chronic GVHD after primary allogeneic peripheral blood stem cell transplantation in patients with hematologic malignancies.
To assess feasibility and potential advantages of PBSC allograft, we transplanted nine patients (age 20-47 years) with advanced or poor-risk hematologic malignancies. These included eight HLA-identical sibling transplants and one partially matched. Cells were collected from donors by apheresis after rh-G-CSF 10-16 micrograms/kg/day for 4-5 days, and stored at 4 degrees C until infusion. Patients were conditioned with busulfan 16 mg/kg and cyclophosphamide 200 mg/kg, and received GVHD prophylaxis with CSA-MTX. The graft consisted of PBSC alone, with a median of 101.2 (range 28-254.2) x 10(4)/kg CFU-GM, 6.84 (range 4.57-15.9) x 10(6)/kg CD34+ cells and 2.5 (range 1.2-6) x 10(8)/kg CD3+ cells. An ANC > 0.5 x 10(9)/1 occurred on (median) day 13 range 11-17), and a platelet count > 50 x 10(9)/l on (median) day 15 (range 12-29) post graft. One patient died of ARDS on day 13, the others are alive 96-485 (median 245) days from the graft. Two patients have relapsed, one of them with isolated CNS involvement. Acute GVHD (grade I-II) occurred in three patients and severe chronic GVHD in six patients, with no relationship to CSA withdrawal. This unexpected incidence of chronic GVHD might be linked to the high number of CD3+ cells in the graft, contributing to a favourable GVL effect.
Adult↗
CD34+ cell subsets and platelet recovery after PBSC autograft.
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Antigens, CD34↗
High dose cyclophosphamide: stem cell mobilizing capacity in 21 patients.
In the present study we assess the antitumor effect and circulating stem cells (CSC) mobilizing capacity of high-dose cyclophosphamide (5 to 7 gr/m2, HDCY). This treatment was given to 21 patients with various hematologic malignancies (8 NHL, 5 MM, 4 HD, 3 CML) excluding 1 with neuroblastoma. All were eligible for later autologous blood stem cell transplantation (ABSCT). To reduce the hematologic toxicity of HDCY, GM CSF was simultaneously administered in 5 patients. HDCY produced a response (as defined by a > 50% reduction of previous tumor mass) in 3 out of 12 HD/NHL and 1 out of 3 MM. Patients with CML were not considered to be evaluable for tumor response. Cell collection yields after HDCY varied widely with a range of 1.5 to 169.9 x 10(4)/Kg (median 13.1) CFU-GM and 1.7 to 18.4 x 10(8)/Kg (median 5.8) MNC collected per patient. Hematologic recovery was rapid and sustained with a median of 16 (12-18) days to PMN > 0.5 x 10(9)/L and 14 (11-18) days to Plt > 100.0 x 10(9)/L. Granulocyte recovery was significantly faster after GM-CSF (13 vs 16 days to PMN > 0.5, p = 0.0008). Non hematologic toxicity consisted mainly of nausea and vomiting, but fatal complications occurred in 2 patients, from pulmonary infection in one and from tumor-lysis syndrome in the other. HDCY represents a useful means of increasing collection of CSC, but toxicity is not irrelevant. Whether a similar anti-tumor effect and mobilizing capacity would be offered by single lower intermediate doses of the drug is still to be ascertained.
Adolescent↗
[Evaluation of 3 calculation methods to compute the PER, PFR, TPER, TPFR with equilibrium radioisotopic angiocardiography].
The author wanted to test 3 FITS to compute the peak ejection rate, the time of the peak ejection rate, the peak filling rate, the time of the peak filling rate from the left ventricle volume curve computed by means of the multigated radio nuclide angiography; the aim of the test was to ascertain the differences between the 3 methods and the differences between them for medical applications. 25 patients were tested and they were divided as follows: 5 cases of hypertension, 2 cases of obesity, 9 cases of alimentary diabetes, 3 cases of coronary heart disease, 6 cases with other diseases. The investigated FITS were: 1) the FIT that computes the derivative curve of the volume curve; 2) the FIT that computes the derivative equation of the volume curve and that interpolates it to a polynomial; 3) the FIT of Fourier. A discriminant analysis was performed and the following observations were made: according to a significant probability P < 0.05, FIT 1 classified 40% of the cases, FIT 2 classified 48% of the cases, FIT 3 classified 64% of the cases. A Box's M test was performed and was significant for FIT 3 and FIT 2 but not for FIT 1. In conclusion the test of the 3 FITS showed that FIT 3 is a better discriminant between the diverse diseases.
Gated Blood-Pool Imaging↗
[Survival of autologous indium-111-oxine-labeled blood platelets in patients with ischemic diseases].
Platelet half-life was assessed with autologous 111In-marked platelets in fourteen subjects, four women and ten men, who previously had suffered vascular accidents (myocardial infarction, TIA, stroke or peripheral obstructive arterial disease). Results, compared to findings in low risk subjects showed a statistically significant correlation of platelet half-life to certain pathologies (TIA, stroke) as well as to habits (tobacco, alcohol) and biological variables (age, sex). By and large, data were analogous to those of the current scientific literature in so far as certain factors shorten platelet half-life. A correlation was also found between platelet half-life and time elapsed since the pathological event. Liver sequestration evaluated by total body scintigraphy showed high levels in one case each with a history of stroke, a history of TIA, and a history of peripheral arterial disease, and splenic sequestration in only one case with a history of stroke.
Adult↗
High-dose cyclophosphamide, etoposide and BCNU (CVB) with autologous stem cell rescue in malignant lymphomas.
Eighteen patients with malignant lymphoma, 10 non-Hodgkin's and 8 Hodgkin's, were treated with high-dose CVB (cyclophosphamide 4 x 1.5 g/m2, etoposide 4 x 250-400 mg/m2, carmustine 4 x 150-200 mg/m2), followed by autologous peripheral blood stem cells (PBSC, 13 patients) or bone marrow (BM, 5 patients) transplantation. At the time of autograft 6 patients were in complete remission (CR), 3 in partial remission (PR) and 5 in relapse (4 sensitive, 1 resistant), whereas 4 had progressive disease. All CR patients had poor prognostic features at presentation. PBSC were collected at the time of rapid hematologic recovery after intense chemotherapy by means of a cell separator. All patients engrafted. Median time to achieve > or = 0.5 x 10(9)/l polymorphonuclear cells (PMN) and > or = 50 x 10(9)/l platelets was 13 days for both cell types in PBSC autografted patients, versus 20 and 28 days respectively in BM autografted patients. A significant advantage of PBSC over BM was found in terms of time needed to recover either PMN > or = 0.5 and PMN > or = 1 x 10(9)/l (p = 0.01). Autograft-related toxicity consisted mainly of moderate severity interstitial pneumopathy (3 patients), and veno-occlusive disease (1 patient) that resolved completely. Of the 12 patients autografted with detectable disease, 6 (50%) obtained a CR. Seven out of 18 autografted patients (39%) had disease progression within 1 to 5 months of autograft. The projected progression-free survival is over 50% at 4 years and it was significantly longer in patients with sensitive disease than in those with resistant disease (p = 0.01). The efficacy and the low toxicity of CVB suggest that autograft with PBSC may be proposed for the primary treatment of poor prognosis malignant lymphomas.
Adult↗
Cyclophosphamide 4 g/m2 plus rhG-CSF for mobilization of circulating progenitor cells in malignant lymphomas.
We report the preliminary results of a study exploring the possibility of collecting circulating progenitor cells (PBSC) with a protocol based on the administration of single doses (4 g/m2) of cyclophosphamide and G-CSF (5 or 10-micrograms/kg) in 9 patients with non Hodgkin's lymphoma. The peak level of CD34+ cells occurred after a median of 10 days (range 8-11), generally coinciding with the median peak level of CFU-GM, with a mean 31.27 fold increase above basal levels. 3 (range 2-5) leukaphereses were required to harvest a median number of 25.1 x 10(4)/kg (8-105) CFU-GM and of 9.4 x 10(6)/kg (1.2-25) CD34+ cells. No difference was recorded between 5 and 10 micrograms/kg of G-CSF in terms of PBSC yield. In transplanted patients, a strong correlation was found between CD34+ cells infused/kg and platelet recovery (r = -0.8, p = 0.002). No toxicity was observed and apheretic procedures were regularly performed outpatiently. Our conclusion is that this protocol is particularly suitable for an outpatient treatment/collection program.
Adult↗
Autologous blood stem cell collection after chemotherapy in patients with sensitive and refractory malignancies: a multicenter retrospective study.
A retrospective study was undertaken to assess the factors affecting the yield of peripheral blood stem cell (PBSC) collections after chemotherapy. Fifty-five patients with malignancies, observed in 4 Italian Institutions from January 1987 to June 1991 were eligible for evaluation. This series included 19 non-Hodgkin lymphoma, 11 multiple myeloma, 9 ovarian cancer, 7 Hodgkin disease, 7 acute non-lymphocytic leukemia, 1 acute lymphoblastic leukemia, 1 neuroblastoma. Five hundred and twenty two PBSC collections were performed on 55 patients after a median of 18 days after the start of chemotherapy. The yields of PBSC collections were related to the dose of cytoreductive chemotherapy exploited for PBSC mobilization and to the number of circulating white blood cells, colony forming unit granulocyte/macrophage (CFU-GM) and the percentage of monocytes at the time of collection. Forty-eight patients out of 55 transplanted (87%) had rapid, complete and sustained engraftment. Three patients (5%) died of transplant related complications.
Adolescent↗