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Biomedical subjects

Alessandro Colombo

Publications and source records attributed to Alessandro Colombo.

14 recordsLinked to original sources
PubMed2006

Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition.

BACKGROUND: An increase in troponin I soon after high-dose chemotherapy (HDC) is a strong predictor of poor cardiological outcome in cancer patients. This finding has important clinical implications and provides a rationale for the development of prophylactic strategies for preventing cardiotoxicity. Angiotensin-converting enzyme inhibitors slow the progression of left ventricular dysfunction in different clinical settings, but their role in the prevention of cardiotoxicity has never been investigated. METHODS AND RESULTS: Of the 473 cancer patients evaluated, 114 (72 women; mean age, 45+/-12 years) who showed a troponin I increase soon after HDC were randomized to receive (angiotensin-converting enzyme inhibitor group; 20 mg/d; n=56) or not to receive (control subjects; n=58) enalapril. Treatment was started 1 month after HDC and continued for 1 year. Cardiological evaluation was performed at baseline and at 1, 3, 6, and 12 months after HDC. The primary end point was an absolute decrease >10 percent units in left ventricular ejection fraction, with a decline below the normal limit value. A significant reduction in left ventricular ejection fraction and an increase in end-diastolic and end-systolic volumes were observed only in untreated patients. According to the Kaplan-Meier analysis, the incidence of the primary end point was significantly higher in control subjects than in the angiotensin-converting enzyme inhibitor group (43% versus 0%; P<0.001). CONCLUSIONS: In high-risk, HDC-treated patients, defined by an increased troponin I value, early treatment with enalapril seems to prevent the development of late cardiotoxicity.

Adult↗
PubMed2006

Acute coronary syndrome induced by oral capecitabine.

A 41-year-old woman who was undergoing oral chemotherapy with capecitabine for metastatic breast cancer presented with recurrent episodes of chest pain associated with electrocardiographic signs of diffuse ST segment elevation. After spontaneous pain relief, the electrocardiogram showed ischemic evolution in the anterior precordial leads. Coronary and ventricular angiography, performed 24 h later, showed normal coronary arteries and normal left ventricular function. After therapy with capecitabine was discontinued, the patient did not experience further episodes of chest pain. After a nine-month follow-up, she remains alive, with a good performance status and without clinical evidence of persistent ischemia.

Acute Disease↗
PubMed2006

Histological evaluation, in rabbit tibiae, of osseointegration of mini-implants in sites prepared with Er:YAG laser versus sites prepared with traditional burs.

OBJECTIVE: The aim of this study was to evaluate the different bone reactions in rabbit tibiae after the insertion of mini-implants by using two different techniques of site preparation: the superpulsed Er:YAG laser (VPS system) versus the traditional technique with burs. METHODS: One mm wide and 2 mm long implant sites were made in the tibiae of 12 rabbits (8 for each tibia): the authors used an Er:YAG laser with a sapphire tip on a contra-angle hand piece with a 1.0 mm diameter in a VPS mode (with 200 mJ and 30 Hz) to make 4 bone sites and a calibrated traditional bur to drill the other 4 sites in each tibia. The authors inserted a threaded mini-implant, with a sandblasted and acid-etched surface, in the 2 laser implant sites and in the 2 drilled sites of each tibia. The other sites were used as controls. At 0, 7, 15, 30, 45, and 60 days from the surgery, 2 animals each were euthanized, and the retrieved specimens were evaluated. RESULTS: No implant was lost, and the osseointegration was comparable in all implant sites. Histologically, in the 7- and 15-day postoperative specimens, the laser sites showed some amorphous tissue caused by the carbonization of bone during the laser procedure. The sites without implants showed good regeneration of the bone: it was faster in the drill defects because in the laser ones there was some carbonized amorphous tissue. After 30 days postoperatively, the regeneration was the same in all sites. CONCLUSIONS: In comparison with the traditional drilling procedures, Er:YAG laser can be considered efficient in surgery of the bone without inducing irreversible damages, even if it is possible to observe the presence of some carbonized amorphous tissue in the early part of the healing process. This tissue is progressively resorbed in a way similar to a bone graft and doesn't impede the bone formation and osseointegration processes. Further clinical and histological studies are necessary to better define this amorphous tissue and an efficient and safe operative protocol in the surgery of bone with an Er:YAG laser.

Animals↗
PubMed2005

Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity.

BACKGROUND: High-dose chemotherapy (HDC) is utilized in high-risk cancer patients. This type of treatment may induce cardiac toxicity which becomes clinically evident weeks or months after HDC. Hence, the possibility of early identification of patients who will develop cardiac impairment is strategic for its clinical implications. The aim of this study was to identify possible early changes of left ventricular contractile reserve (LVCR) in cancer patients undergoing HDC, as well as to evaluate the relevance of such changes as predictors of chemotherapy-induced cardiotoxicity. METHODS: In forty-nine female patients scheduled for HDC, due to poor-prognosis breast cancer, dobutamine stress echocardiography (DSE) was performed, before each of the three HDC cycles (C1, C2, C3), and 1, 4, and 7 months after the end of chemotherapy. According to rest left ventricular ejection fraction (LVEF) evaluated within 18 months after HDC (f-LVEF), patients were allocated to Group A (LVEF < 50% and >10 absolute units reduction) and to Group B (LVEF > or = 50%). RESULTS: Rest LVEF didn't show any significant difference between the two groups except at f-LVEF. Peak LVEF and LVCR significantly decreased in Group A only, starting from C3. At C3, a > or = 5 units fall in LVCR was found to be predictive for f-LVEF drop below 50%. CONCLUSIONS: In patients undergoing HDC, low-dose DSE allows the early identification of patients at a high risk of developing cardiac dysfunction.

Adult↗
PubMed2005

Setting up an early warning system for epidemic-prone diseases in Darfur: a participative approach.

In April-May 2004, the World Health Organization (WHO) implemented, with local authorities, United Nations (UN) agencies and non-governmental organisations (NGOs), an early warning system (EWS) in Darfur, West Sudan, for internally displaced persons (IDPs). The number of consultations and deaths per week for 12 health events is recorded for two age groups (less than five years and five years and above). Thresholds are used to detect potential outbreaks. Ten weeks after the introduction of the system, NGOs were covering 54 camps, and 924,281 people (IDPs and the host population). Of these 54 camps, 41 (76%) were reporting regularly under the EWS. Between 22 May and 30 July, 179,795 consultations were reported: 18.7% for acute respiratory infections; 15% for malaria; 8.4% for bloody diarrhoea; and 1% for severe acute malnutrition. The EWS is useful for detecting outbreaks and monitoring the number of consultations required to trigger actions, but not for estimating mortality.

Altruism↗
PubMed2004

Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy.

BACKGROUND: In patients with aggressive malignancies who are undergoing high-dose chemotherapy, even minimal elevation of troponin I (TnI) is associated with late left ventricular dysfunction. The time course of the subclinical myocardial damage and its impact on the clinical outcome have never been investigated previously. METHODS AND RESULTS: In 703 cancer patients, we measured TnI soon after chemotherapy (early TnI) and 1 month later (late TnI). Troponin was considered positive for values > or =0.08 ng/mL. Clinical and left ventricular ejection fraction evaluation (echocardiography) were performed before chemotherapy, 1, 3, 6, and 12 months after the end of the treatment, and again every 6 months afterward. Three different TnI patterns were identified, and patients were grouped accordingly. In 495 patients, both early and late TnI values were <0.08 ng/mL (TnI-/- group); in 145, there was only an early increase (TnI+/- group); and in 63 patients, both values increased (TnI+/+ group). In the TnI-/- group, no significant reduction in ejection fraction was observed during the follow-up, and there was a very low incidence of cardiac events (1%). In contrast, a greater incidence of cardiac events occurred in TnI-positive patients, particularly in the TnI(+/+) group (84% versus 37% in the TnI+/- group; P<0.001). CONCLUSIONS: TnI release pattern after high-dose chemotherapy identifies patients at different risks of cardiac events in the 3 years thereafter. This stratification allows us to differentiate the monitoring program and to plan, in selected patients, preventive strategies aimed at improving clinical outcome.

Adult↗
PubMed2004

Angiographic demonstration of coronary dethrombosis with eptifibatide.

When dealing with acute coronary syndromes, the interventionists often go straight to balloon and stents, because they work quick and well in the majority of cases. However, it is not to forget that vigorous antithrombotic treatment is frequently highly beneficial in these settings. We report here on two clinical cases of coronary thrombosis in which we could appreciate on the angiograms the effect of GP IIb/IIIa inhibitor eptifibatide alone or in conjunction with alteplase.

Aged↗
PubMed2004

A case of life-saving pharmacologic and mechanical coronary dethrombosis.

The present report refers to a case of life-threatening acute myocardial infarction due to thrombotic occlusion of the left main stem, in which an aggressive dethrombotic intervention (pharmacologic and mechanical) was totally successful, thanks to a well developed right coronary system and the use of intra-aortic balloon pump.

Angioplasty, Balloon↗
PubMed2003

Challenges for communicable disease surveillance and control in southern Iraq, April-June 2003.

The recent war in Iraq presents significant challenges for the surveillance and control of communicable diseases. In early April 2003, the World Health Organization (WHO) sent a team of public health experts to Kuwait and a base was established in the southern Iraqi governorate of Basrah on May 3. We present the lessons learned from the communicable disease surveillance and control program implemented in the Basrah governorate in Iraq (population of 1.9 million) in April and May 2003, and we report communicable disease surveillance data through June 2003. Following the war, communicable disease control programs were disrupted, access to safe water was reduced, and public health facilities were looted. Rapid health assessments were carried out in health centers and hospitals to identify priorities for action. A Health Sector Coordination Group was organized with local and international health partners, and an early warning surveillance system for communicable disease was set up. In the first week of May 2003, physicians in hospitals in Basrah suspected cholera cases and WHO formed a cholera control committee. As of June 29, 2003, Iraqi hospital laboratories have confirmed 94 cases of cholera from 7 of the 8 districts of the Basrah governorate. To prevent the transmission of major communicable diseases, restoring basic public health and water/sanitation services is currently a top priority in Iraq. Lack of security continues to be a barrier for effective public health surveillance and response in Iraq.

Communicable Disease Control↗
PubMed2003

Locoregionally advanced carcinoma of the oropharynx: conventional radiotherapy vs. accelerated hyperfractionated radiotherapy vs. concomitant radiotherapy and chemotherapy--a multicenter randomized trial.

PURPOSE: To compare conventional fractionation radiation therapy (RT), Arm A, vs. split-course accelerated hyperfractionated RT (S-AHF), Arm B, vs. conventional fractionation RT plus concomitant chemotherapy (CT), Arm C, in terms of survival and toxicity for advanced, unresectable epidermoid tumors of oropharynx. METHODS AND MATERIALS: Between January 1993 and June 1998, 192 previously untreated patients affected with Stage III and IV oropharyngeal carcinoma (excluding T1N1 and T2N1) were accrued in a multicenter, randomized Phase III trial (ORO 93-01). For Arms A and C, 66-70 Gy in 33-35 fractions, 5 days a week, were administered in 6.5-7 weeks to tumor and positive nodes. In Arm B, the dose delivered to tumor and involved nodes was 64-67.2 Gy, giving 2 fractions of 1.6 Gy every day with an interfraction interval of at least 4 h and preferably 6 h, 5 days a week. At 38.4 Gy, a 2-week split was planned; after the split, RT was resumed with the same modality. In Arm C, CT regimen consisted of carboplatin and 5-fluorouracil (CBDCA 75 mg/m(2), Days 1-4; 5-FU 1,000 mg/m(2) i.v. over 96 h, Days 1-4, recycling every 28 days (at 1st, 5th, and 9th week). RESULTS: No statistically significant difference was detected in overall survival (p = 0.129): 40% Arm A vs. 37% Arm B vs. 51% Arm C were alive at 24 months. Similarly, there was no statistically significant difference in terms of event-free survival (p = 0.196): 20% for Arm A, 19% for Arm B, and 37% for Arm C were event free at 24 months. On the contrary, the 2-year disease-free survival was significantly different among the three arms (p = 0.022), with a superiority for Arm C. At 24 months, the proportion of patients without relapse was 42% for Arm C vs. 23% for Arm A and 20% for Arm B. Patients in Arm A less frequently developed G3+ acute mucositis than their counterparts in Arm B or C (14.7% vs. 40.3% vs. 44%). Regarding the CT-related acute toxicity, apart from 1 case of fatal nephrotoxicity, only hematologic G3+ (Grade 3 or higher) acute sequelae were observed (World Health Organization scale), most commonly leukopenia (22.7%). Arm C showed slightly more G3+ skin, s.c. tissue, and mucosal late side effects (RTOG scale), although significant sequelae were relatively uncommon, and mucosal sequelae were most commonly transient. The occurrence of persistent G3 xerostomia was comparable in all three treatment arms. CONCLUSIONS: The combination of simultaneous CT and RT with the regimen of this trial is better than RT alone in advanced oropharyngeal squamous-cell carcinomas, by increasing disease-free survival. This improvement, however, did not translate into an overall survival improvement, and was associated with a higher incidence of acute morbidity.

Adult↗
PubMed2003

Absence of clinical signs of cardiac denervation after percutaneous myocardial laser revascularization.

BACKGROUND: Percutaneous myocardial revascularization with laser (PMR) is a catheter-based technique that has generated much interest in the treatment of patients with severe coronary artery disease. Several mechanisms have been proposed to explain the reported clinical benefits of this technique. Cardiac autonomic denervation is among these. METHODS: We studied 32 consecutive patients with chronic severe angina not suitable for other revascularization approaches. Canadian Class Society (CCS) class clinical assessment, Naughton exercise stress test, and scintigraphic myocardial perfusion were evaluated before and 1 and 6 months after PMR. Ewing's autonomic tests, heart rate variability (HRV), and plasmatic catecholamines were assessed before revascularization in non-diabetic and diabetic patients and repeated 1 month after PMR in 13 non-diabetics. A psychological test was carried out before PMR to evaluate the attitude towards this new procedure. RESULTS: All the markers of autonomic cardiac control were unmodified after the procedure. Moreover, scintigraphic perfusion measured in the lasered areas was similar before and after the procedure. On the other hand, the clinical conditions significantly improved (CCS class from 3+/-0.8 to 1.9+/-0.9 at 1 month, P<0.01) and the exercise-related ischemic threshold was significantly better (from 311+/-28 to 453+/-51 s, P<0.05). The patients with a psychologically 'positive' expectation for this new procedure had results comparable to those with a 'negative' expectation. CONCLUSIONS: PMR improves symptoms in patients with end-stage coronary artery disease in the absence of any detectable clinical sign of heart denervation.

Aged↗
PubMed2002

Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study.

PURPOSE: Neoadjuvant chemotherapy (NACT) and radical surgery (RS) have emerged as a possible alternative to conventional radiation therapy (RT) in locally advanced cervical carcinoma. In 1990, a phase III trial was undertaken to verify such a hypothesis in terms of survival and treatment-related morbidity. PATIENTS AND METHODS: Patients with squamous cell, International Federation of Gynecology and Obstetrics stage IB2 to III cervical cancer were eligible for the study. They received cisplatin-based NACT followed by RS (type III to V radical hysterectomy plus systematic pelvic lymphadenectomy) (arm A) or external-beam RT (45 to 50 Gy) followed by brachyradiotherapy (20 to 30 Gy) (arm B). RESULTS: Of 441 patients randomly assigned to NACT+RS or RT, eligibility was confirmed in 210 and 199 patients, respectively. Treatment was administered according to protocol in 76% of arm A patients and 72% of arm B patients. Adjuvant treatment was delivered in 48 operated patients (29%). There was no evidence for any significant excess of severe morbidity in one of the two arms. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 58.9% and 55.4% for arm A and 44.5% and 41.3% for arm B (P =.007 and P =.02), respectively. Subgroup survival analysis shows OS and PFS rates of 64.7% and 59.7% (stage IB2-IIB, NACT+RS), 46.4% and 46.7% (stage IB2-IIB, RT) (P =.005 andP =.02), 41.6% and 41.9% (stage III, NCAT+RS), 36.7% and 36.4% (stage III, RT) (P =.36 and P =.29), respectively. Treatment had a significant impact on OS and PFS. CONCLUSION: Although significant only for the stage IB2 to IIB group, a survival benefit seems to be associated with the NACT+RS compared with conventional RT.

Adult↗