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C Iannuzzi

Publications and source records attributed to C Iannuzzi.

At least 19 recordsLinked to original sources
PubMed2000

The effect of disease and treatment-related factors on biopsy results after prostate brachytherapy: implications for treatment optimization.

BACKGROUND: Posttreatment prostate biopsy is a method of assessing local control after irradiation for prostate carcinoma. An analysis of the effect of disease- and treatment-related factors on biopsy results after prostate brachytherapy was performed to aid in patient selection and treatment optimization. METHODS: Two hundred sixty-eight patients underwent posttreatment prostate biopsy (6-8 cores) 2 years after brachytherapy alone without external beam irradiation. Follow-up ranged from 24 to 111 months (median, 43 months). Implants were performed using a real-time ultrasound guided technique with the isotopes (125)I in 186 and (103)Pd in 82 patients. Ninety-eight patients underwent hormonal therapy (HT) 3 months before and 2-3 months after implant. Implant dose was defined as the D90 (dose delivered to 90% of the gland from the dose volume histogram generated using 1-month computed tomography-based dosimetry). RESULTS: Overall, 89% of patients (238 of 268) had negative biopsies. A positive biopsy was a predictor of biochemical failure. Patients with a positive biopsy had a 5-year freedom from biochemical failure of 40% versus 76% for patients with a negative biopsy (P = 0.0003). Univariate and multivariate analysis found that risk group, HT, and implant dose significantly affected biopsy outcome. Patients with low risk features (prostate specific antigen [PSA] </= 10 ng/mL; Gleason score </= 6; and classification T2a or lower) (n = 104) had a negative biopsy rate of 95% versus 85% for those with high risk features (PSA > 10 ng/mL or Gleason score >/= 7 or classification T2b or higher) (n = 164) (P = 0.008). Hormonal therapy was associated with a negative biopsy rate of 98% versus 84% for implant alone (P = 0.003). Patients receiving a high implant dose (D90 >/= 140 grays [Gy] for (125)I or >/= 100 Gy for (103)Pd) (n = 174) had a negative biopsy rate of 95% versus 77% for those receiving a low dose (D90 < 140 Gy for (125)I or < 100 Gy for (103)Pd) (n = 87; P < 0.001). CONCLUSIONS: Biopsy results support the use of brachytherapy without external beam irradiation for patients with low risk features and highlight the importance of achieving an adequate implant dose.

Biopsy, Needle↗
PubMed1998

A dose-response study for I-125 prostate implants.

PURPOSE: No dose-response study has ever been performed for I-125 prostate implants using modern techniques of implant evaluation and modern treatment outcome end points. The amount of activity per volume implanted was increased over time based on review of postimplant dosimetry. This resulted in different delivered dose levels. This study explores the relationship between dose, biochemical failure, and biopsy results. MATERIALS AND METHODS: 134 patients with T1-T2 prostate cancer were implanted with I-125 radioactive seeds and followed from 12 to 74 months (median: 32) postimplant. No patient received external beam irradiation or hormonal therapy. All patients implanted with I-125 had Gleason scores < or =6. One month postimplant, a CT-based three-dimensional dosimetric evaluation was performed on all patients. Using TG43 guidelines, dose-volume histograms were calculated. The dose delivered to the gland was defined as the D90 (dose delivered to 90% of prostate tissue as defined by CT). The D90s ranged from 26.8 to 256.3 Gy (median: 140.8 Gy). Biochemical failure was defined as two consecutive rises in prostate specific antigen (PSA) or a nadir level above 1.0 ng/ml. Posttreatment prostate biopsies (six to eight core samples) were routinely performed at 2 years postimplant. RESULTS: Improvements in freedom from biochemical failure (FFBF) rates were seen with increasing D90 levels. The 4-year FFBF rates for patients with D90 values < 100 Gy, 100-119.9 Gy, 120-13.9 Gy, 140-159.9 Gy, and > or =160 Gy were 53, 82, 80, 95, and 89%, respectively (p = 0.02). Patients receiving a D90 < 140 Gy (65 patients) were similar with respect to presenting disease prognostic factors to those receiving a D90 > or =140 Gy (69 patients). Patients receiving a D90 < 140 Gy had a 4-year FFBF rate of 68% compared to a rate of 92% for those receiving a D90 > or =140 Gy (p = 0.02). Two-year posttreatment biopsies were negative in 70% (33 of 47) of patients with a D90 < 140 Gy compared to a rate of 83% (24 of 29) in patients with a D90 > or =140 Gy (p = 0.2). A multivariate analysis using dose, PSA, score, and stage revealed that dose was the most significant predictor of biochemical failure (p = 0.001). This dose response was more pronounced in patients presenting with PSA levels > 10 ng/ml. In these patients, the 4-year FFBF rates were 51 and 100% for the low and high dose groups, respectively (p = 0.009) and the negative biopsy rates were 64% (14 of 22) and 100% (8 of 8), respectively (p = 0.05). In patients with presenting PSA <10 ng/ml, the 4-year FFBF rates were 82 and 88% for the low and high dose groups, respectively (p = 0.29). CONCLUSION: A dose response was observed at a level of 140 Gy. Adequate I-125 implants should deliver a dose of 140-160 Gy using TG43 guidelines.

Brachytherapy↗
PubMed1998

Acute urinary morbidity following I-125 interstitial implantation of the prostate gland.

The objective of this paper was to evaluate the acute urinary morbidity associated with I-125 interstitial implantation of the prostate gland. From 1991-1995, 117 patients underwent ultrasound (U/S)-guided implantation of the prostate gland. Median dose to 90% of the gland (d90) was 14.68 Gy (range = 1.65-21.75 Gy). The patients' urinary symptoms were recorded pre-implantation and at regular intervals after implantation using the International Prostate Symptom Score (IPSS), a self-assessment questionnaire in which patients scored 7 symptoms: incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Median follow-up was 12 months. The natural history of implant-related urinary symptoms was assessed in this manner. In addition, dosimetric factors including U/S prostate volume, total activity, activity per seed, dose volume histogram (DVH) values for dose to gland, and dose area histogram (DAH) values for dose to urethra and bladder were examined for correlation to the severity of each symptom as well as to total IPSS (sum of the individual symptom scores). Total IPSS peaked at 1 month post-implant and gradually returned to approximately baseline at 24 months. Total IPSS directly correlated with total activity and DVH for the prostate. Total IPSS, however, did not correlate with bladder or urethral DAH. With the exception of frequency, individual symptoms did not correlate with dose to gland, bladder, or urethra. Frequency scores did, however, correlate not only with dose to prostate gland but also dose to urethra. The acute urinary side effects of I-125 prostate implantation are transient and peak at 1 month post-implant. The severity of the urinary irritative symptoms developed are closely related to total dose to the gland. Urethral dose appears to affect frequency most significantly. Urinary symptoms, therefore, may be a limiting factor when considering dose escalation with I-125.

Acute Disease↗
PubMed1998

Information systems for the management services organization.

The growth of the management of services organization has been accompanied by the need for better information technology systems to track both patient and physician utilization. The author describes some possible benefits of customizing an information system to meet the needs of these specialized organizations.

Ambulatory Care Information Systems↗
PubMed1996

Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer.

PURPOSE: The effect of a therapeutic modality on sexual potency is often an important consideration for patients choosing a treatment for prostate cancer. We prospectively assessed patients' penile erectile function before and following interactive ultrasound-guided transperineal permanent radioactive seed implantation to determine its effect on sexual function. METHODS AND MATERIALS: Eighty-nine patients underwent permanent radioactive seed implantation from June 1990 to April 1994 for localized prostate cancer (T1-T2) and were followed for a median of 15 months (1.5-52 months). 125I seeds were implanted in 73 patients with a combined Gleason grade of 2-6, and 103Pd seeds were implanted in 16 patients with higher grade lesions. The sexual potency of these patients was assessed prior to, at 3 and 6 months, and every 6 months after implantation. Erectile function was graded using a numerical score of 0 to 3 (0 = impotent (no erections), 1 = ability to have erections but insufficient for vaginal penetration, 2 = erectile function sufficient for vaginal penetration but suboptimal, 3 = normal erectile function). The pretreatment potency scores were as follows: 0 in 24 patients, 1 in 6 patients, 2 in 22 patients, and 3 in 37 patients. RESULTS: The actuarial impotency rates (score = 0) following implantation for those patients possessing some degree of erectile function prior to implantation (65 patients) were 2.5% at 1 year and 6% at 2 years. The actuarial decrease in sexual function rates (a drop in score of at least one point) were 29% at 1 year and 39% at 2 years. Only two patients became impotent following treatment and this occurred at 1 year and 16 months. The time period for a decrease in erectile function to occur ranged from 1.8 months to 32.7 months, with a median of 6.8 months. Patients with higher grade tumors showed a greater decrease in potency score compared to patients with lower grade tumors. CONCLUSION: Interactive ultrasound-guided transperineal brachytherapy for the treatment of localized prostate cancer is associated with preservation of erectile function in the vast majority of patients, although a minor decrease in potency is not uncommon.

Adenocarcinoma↗
PubMed1996

Long-term interferon-alpha treatment of children with chronic hepatitis delta: a multicentre study.

We assessed the efficacy of prolonged interferon-alpha (IFN) therapy in children with chronic hepatitis caused by hepatitis delta virus (HDV) by treating 26 paediatric cases with IFN-alpha 2b (5 MU m-2, then 3 MU m-2 three times weekly for 12 (medium-term group MTG) or 24 months (long-term group, LTG). Compliance and tolerability were acceptable. At the end of therapy a complete biochemical response [normalization of alanine aminotransferase (ALT)] occurred in 12 children (5/13 in MTG and 7/13 in LTG). A relapse occurred after stopping IFN in 10 cases (five in MTG and five in LTG). Two patients from the LTG had normal liver function tests during 12 months of follow-up. Six of the eight hepatitis B e antigen (HBeAg) positive children lost HBeAg, while all six hepatitis B virus (HBV) DNA positive patients lost HBV DNA during treatment. HBeAg reappeared later in two children. HDV RNA, present in 10/10 cases of MTG before treatment, persisted after 12 months IFN therapy in 3/10. One year after stopping therapy, 8/10 patients were again HDV RNA positive. Two children cleared hepatitis delta antigen (HDVAg) from the liver. No significant improvements in liver histology were seen in both groups. Our experience suggests that IFN-alpha treatment in children with chronic type D hepatitis has a transient effect, and long-term treatment does not appear to induce a greater therapeutic benefit in terms of biochemical and virological response.

Adolescent↗
PubMed1990

Cholangitis associated with cholecystitis in patients with acquired immunodeficiency syndrome.

Four patients with acquired immunodeficiency syndrome developed severe abdominal pain and fever due to acute acalculous cholecystitis. In all patients, preoperative laboratory data showed elevation of alkaline phosphatase and gamma-glutamyltransferase levels. Endoscopic or intraoperative cholangiography showed signs of intrahepatic and extrahepatic cholangitis. Cholecystectomy was performed and prompt relief of symptoms was achieved in all patients; no postoperative complication was observed. One patient did not develop any recurrence during an 18-month period of follow-up; two patients died 2 and 3 months after the operation. One patient developed recurrent abdominal pain and cholestasis 4 months after the operation, with dilatation of the common bile duct and papillary stenosis due to progression of cholangitis. These observations suggest that cholangitis is frequently associated with cholecystitis in patients with the acquired immunodeficiency syndrome. Its pathogenesis is not known.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Heart complications in general surgery: results of a multicenter study].

Cardiac events are the most dangerous postoperative complications since they may be easily followed by the death of the patient. The related risk factors were prospectively evaluated in a study of 1182 patients. Stepwise regression logistic model was employed for statistical analysis. Preoperative cardiac and respiratory failure, ventricular arrhytmias, compromission of the nutritional status, presence of neoplastic disease and prolonged anesthesia over two hours were the only significative factors related to postoperative cardiac complications. Advanced age was not a major risk factor. The results of the study require a prospective validation. They are however comparable to those observed in the literature Preoperative cardiac evaluation is of utmost importance for cardiac prognosis and various instrumental, sometimes invasive diagnostic procedures have been proposed. The Authors provide a usefull, simple and widely employable system of general and cardiac assessment for the determination of cardiac risk.

Adolescent↗
PubMedDate not supplied

[The risk factors for liver and kidney complications in general surgery: the results of a prospective multicenter study].

A method for preoperative assessment of surgical risk, in function of several risk factors, was developed using the multiple logistic function, as a model of multivariate statistical analysis. This model has the advantage to express the two considered outcomes (perioperative complications and death) in numerical terms of probability. The data were obtained from 1182 consecutive patients, 14 yrs or more, admitted to six centres in various regions of Italy. Stepwise logistic regression model was applied to a set of preoperative and operative factors, three of which were found to significantly correlate with postoperative hepatic failure: compromission hepatic function time of surgical operation > 120' and nutritional status. The factors significantly correlate with postoperative renal failure were: compromission renal function, bacterial contamination during surgery, time of surgical operation > 120'.

Adolescent↗
PubMedDate not supplied

[Multifactorial surgical risk index of the development of respiratory complications].

Respiratory events are between the most frequent postoperative complications. The preoperative conditions associated with postoperative respiratory failure were evaluated in a prospective study of 1182 patients from six Italian Surgical Units. Multiple regression logistic analysis was employed for statistical evaluation and a predictive prognostic score was derived. Only the presence of the following conditions was significant in affecting postoperative respiratory outcomes: preoperative respiratory and cardiac failure, hypotransferrinemia, prolonged surgical procedures (above the 2 hours) and peroperative bacterial contamination. Advanced age did not appear as a major risk factor. Studies on the predetermination of the pulmonary complications have been widely published. Historical risk factors include the presence of respiratory disease, smoking habits, obesity and thoracic or upper abdominal surgical procedures. Although the results of the present study need a prospective confirmation, the predictive scoring system proves to be a usefull tool that can be employed in most of the General Surgery Units.

Abdomen↗
PubMedDate not supplied

[Evaluation of the surgical risk in general surgery: usefulness of a predictive system based on statistical analysis].

1182 patients were prospectively studied in order to evaluate the surgical risk factors. Stepwise regression logistic procedure was employed for statistical analysis. Postoperative complications included death, cardiac, respiratory, hepatic and renal failure, wound infection and sepsis. Various preoperative conditions were associated with postoperative complications but some of them, as malnutrition or operations prolonged over two hours, occurred more frequently. Age did not appear as a major risk factor. The determination of surgical risk is a major problem in general surgical practice and many attempts have been realized in order to predict postoperative outcome. Clinical judgment is still nowadays fundamental but predictive scores based on statistical analysis have proved to be valid and useful tools. The authors underline the importance of surgical risk prediction in therapeutic programming, especially in the aged and in cancer patient. The surgical or non surgical option and the type of operation to be performed result from a careful evaluation of operative risk and expectancy and quality of life.

Adolescent↗
PubMedDate not supplied

[Evaluation of prognostic factors in general surgery; methodological aspects of a multicenter prospective study of 1182 patients].

Surgical risk is defined as the probability of occurrence of early or late complications. For each patient, knowledge of factors affecting surgical risk in a basic step when evaluating prognosis after surgery and determining therapeutic decision. A greater and more effective information may be obtained studying variables within the context of the other ones that more or less condition them. Such a "multivariate" approach allows simultaneously investigating all characteristics by taking account of their correlations. Specification of the problem, choice of the relevant variables, data collection and statistical data processing were considered. Pros and cos of multiple logistic regression model in the assessment of surgical risk were reviewed. The index could be used to identify the most important factors in determining surgical risk and quantify their respective importance. In this way surgical patients could be classified according to risk level. This approach also allow for the concurrent investigation of various potential risk factors and their interactions. For this reason it is termed multifactorial.

Adolescent↗
PubMedDate not supplied

[Analysis of mortality and relative prognostic factors in general surgery: use of the multiple logistic regression model].

Surgical risk is defined as the occurrence of complications arising in the individual as a result of surgical stress. The ability to forecast these consequences is an important factor in determining decision taken by surgeon. Several attempts have been made to quantify postsurgical prospects but up till now no overall solution has been found. This paper attempts to define a multifactorial risk index for adults subjected to surgery, with respect to immediate and early per- and post-surgical complications. 1182 adult patients, 14 yrs or more, surgically treated not for urgency during 1985 in six Italian centres, were prospectively studied in order to derive a multivariate prognostic index of after surgery mortality. Stepwise logistic regression model was applied to a set of preoperative and operative factors, five of which were found significantly correlate with death: nutritional status, renal failure, reintervention, bacterial contamination during surgery, age greater than 70 years. Thus, from regression coefficients, scores were derived for modalities of significant variables, allowing to build four classes of risk patients: low (less than 1%), medium (between 1% and 10%), high (between 10% and 50%), extremely high risk (greater than 50%).

Adolescent↗
PubMedDate not supplied

[Identification of the patient at risk of postoperative infectious complications: risk factors and their evaluation].

The authors report their results of a prospective study on 1182 patients who underwent surgical operation relatively on postoperative infections. Studied variables were: structural and anamnestic: sex, age, smoking, drinking; clinical: evidence of functional changes in various organs, as assessed upon clinical basis and laboratory results; pertinent to surgical intervention: entity, duration, anaesthesia; during and early-after-surgery complications (until discharge or within 30 days since intervention). Stepwise logistic regression model was applied to this set of preoperative and operative factors, four of which were found significantly correlate with postoperative infections: bacterial contamination during surgery, duration surgical intervention greater than 120', cholestasis, serum albumin.

Adolescent↗