Preliminary studies for clinical applications of Novac7, a robotic mobile intraoperative electron beam therapy unit.
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Combined Modality Therapy↗
Biomedical subjects
C Stucchi
Publications and source records attributed to C Stucchi.
[Stereotactic radiotherapy with linear accelerators. Dosage considerations on collimators and photon beam energy].
The small X-ray beam profiles produced by linear accelerators and used in stereotactic radiosurgery were studied. Circular focusing and not-focusing beams outlined by additional collimators (diameter ranging 10 to 30 mm) and square field outlined by the jaws (field size 10 to 30 mm) were measured. 6 and 18-MV X-ray beams from a dual energy accelerator and 6 and 15-MV X-ray beams produced by 2 single-energy accelerators were used. Measurements were carried out with Kodak X Omat V films in a perspex phantom in the same conditions for all the fields. To study the profile characteristics we introduced the V80/V20 = (R80/R20)3 ratio where R80 and R20 are respectively the mean distance of the 80% and 20% isodose lines from the beams axis. Measurement results show that 6-MV X-ray beams have a higher V80/V20 ratio than the ones obtained with the other energies. There is no significant difference between the beams produced with focused collimators and those produced with not-focused collimators. Square fields outlined by the jaws have a V80/V20 ratio greatly dependent on the accelerator used. This ratio is generally worse than the ones obtained with beams outlined by additional collimators.
Photons↗
[Design, development, and dosage control of individual compensatory filters for 6 MV X-ray radiotherapy].
An automated system for the design and manufacturing of individual compensators has been implemented. The system based on computed tomography enables 3D compensation of missing tissue and tissue heterogeneities. The relationship between Hounsfield numbers and electron densities was obtained empirically. Compensator design is based on the calculation of the water equivalent thicknesses between the compensation plane and the patient surface. After calculation a styrofoam mould is cut by a computer driven machine and filled with bee's wax or tin granules. Compensator thickness is calculated by means of the conversion ratio tau, which is defined as t/x, where t is the compensator thickness equivalent to the missing tissue in the treatment geometry. Relations between tau and field size, depth of compensation plane and focus-compensation plane distance were assessed. The conversion ratio is a linear function of the missing tissue and depends markedly on field size; for a 10-cm-deep compensation plane at 1 m from the accelerator target the tau value, calculated for bee's wax, decreases by 25% from 7 x 7 cm2 to 23 x 23 cm2 field size. Conversion ratio rises by approximately 10% for a 3-cm increase in compensation plane depth and reduces by about 5% when increasing the focus-compensation plane distance from 100 cm to 140 cm. It must be stressed that a 10% variation of tau, for bee's wax, involves only a 2% dose variation in the compensation plane. Therefore, for compensator design it is enough to consider tau as depending on field size only. Compensation effectiveness has been tested by a film-densitometric technique using phantoms with tilted incident surfaces and heterogeneities. The results show that the compensators reduce the flatness of the beam profile below 4% and increase the relative dose uniformity on the compensation plane from 18% to 60%.
Filtration↗
Microbiological events during commercial meat fermentations.
Microbiological developments during industrial meat fermentations (salami), made with and without commercial starter cultures, were followed at two factories in Germany and Italy. In the German product microbial growth was evident only for the first 48 h, followed by a gradual decline in numbers of most micro-organisms. The pH fell from 5.8 to 4.8 in the 28 d required for production. In Italy a similar situation was seen, except that a second period of bacterial growth began around 15 d, coincident with the appearance of intentional surface mould growth which reversed the pH fall, the final pH being 6.2. The German starter culture was a mixture of Lactobacillus plantarum and Staphylococcus carnosus, whereas in Italy only Staph. carnosus was used. The strain of Lact. plantarum used did not grow in the German product whereas the Staph. carnosus grew well in both products to form a substantial proportion of the final microflora.
Bacteriophages↗
[Treatment technique and in vivo dosimetry in half body irradiation].
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Humans↗
Total body irradiation and high-dose melphalan with bone marrow transplantation at Istituto Nazionale Tumori, Milan, Italy.
The technique of total body irradiation (TBI) developed at Istituto Nazionale Tumori, Milan, Italy, is described. This technique consists of i) administration of 12.5 Gy and 14.85 Gy TBI for autologous and allogeneic bone marrow transplantation respectively; ii) in all cases in vivo dosimetry of absorbed TBI dose; and iii) radiation doses to lungs higher than previously described. As of June 1988, seventeen patients with Hodgkin's disease and four with lymphoblastic lymphoma received TBI and 120-180 mg/m2 melphalan. Respiratory function was prospectively evaluated demonstrating moderate and transient reduction of pulmonary function.
Adolescent↗
Prospective evaluation of pulmonary function in cancer patients treated with total body irradiation, high-dose melphalan, and autologous hematopoietic stem cell transplantation.
Pulmonary function tests (standard vital capacity, SVC; total lung capacity, TLC; forced expiratory volume in 1 second-forced vital capacity ratio, FEV1/FVC; carbon monoxide transfer factor, DLCO) were prospectively evaluated in patients (median age 25 years, 13-52 years; median follow-up 20 months, 6-51 months) with Hodgkin's disease (15 patients), non-Hodgkin's lymphoma (9 patients), and inflammatory breast cancer (3 patients) treated with sequential high-dose therapy comprising the following phases over approximately 2 months: a) cyclophosphamide (7 g/m2); b) vincristine (1.4 mg/m2), methotrexate (8 g/m2), and cisplatinum (120 mg/m2) or etoposide (2 g/m2); c) total body irradiation (TBI; 12.5 gy, 5 fractions over 48 hours), intravenous melphalan (120-180 mg/m2), and transplantation of autologous peripheral blood and/or bone marrow hematopoietic stem cells. Within 2 months after transplantation, 12 patients also received 25 Gy radiotherapy boost to mediastinum and clavicular regions. In vivo dosimetry evaluations of fractionated TBI treatments showed that mean radiation dose absorbed by lungs was 12.18 Gy (97.4% of TBI dose). Despite such a high radiation dose, we observed only transient and subclinical decrease of SVC, TLC, and DLCO. The decrease of SVC, TLC, and DLCO was more evident and prolonged in patients receiving radiotherapy boost. All parameters progressively recovered to normal values within 2 years after transplantation. In contrast, FEV1/FVC remained within normal limits in all patients, thus demonstrating the absence of obstructive ventilatory changes. In addition, no interstitial pneumonia was observed.
Adolescent↗
[Use of fast electrons in oncologic therapy. More than a decade's experience].
Criteria of choice in the utilization of fast electrons in radiotherapy on the basis of 2400 cases and 13 years of experience in the radiotherapy department of Cancer Institute in Milan are discussed. In the opinion of the authors fast electrons represent the most rational treatment to homogenize or differentiate the dose distribution according to space as a complementary technique after first time treatments by different ionizing radiation. Authors demonstrate also that fast electron treatment is the most rational technique for metastases in the retina and for recurrence of rhinopharynx cancer. Radiotherapy by fast electrons allows to deliver to the patient's body on integral dose lesser than with ionizing radiation of other type. Sequelae are regarding in most of the cases soft tissues and are caused by an unrecognized distribution of dose delivered by the ionizing radiations of other type in the first time treatment more than by difficulty im dosimetry of post-electrons.
Electrons↗
[Treatment technic and clinical dosimetry in whole-body irradiation].
At the Istituto Nazionale Tumori, Milan, total-body irradiation (TBI) is delivered by a 15 MV linear accelerator, with two lateral opposed beams. Maximum build-up at the skin is achieved by lateral slabs of perspex 3 cm thick. Attenuation filters or bolus are used for dose compensation, or reduction, to the head and lungs. The dose delivered to clinically relevant anatomic regions is determined by "in vivo" dosimetry. For this purpose, calibrated diodes are employed, which are positioned at the entrance and at the exit of the beams. "In vivo" dosimetry data show our TBI technique to allow an homogeneous irradiation of all body areas, with maximum deviation of the mean dose value from reference point dose of -11% in the posterior abdomen, at the spinal cord shielded by arms.
Humans↗
Contralateral breast cancer after limited surgery plus radiotherapy of early mammary tumors.
Conservative treatment of early breast cancer with limited surgery requires a mandatory irradiation of the affected breast, which implies a low but measurable irradiation of contralateral breast too. As ionizing radiations can produce an oncogenic effect on mammary tissues, the series of 701 patients of the Milano clinical trial on T1 No breast cancer (1973-1980) was investigated to compare the incidence of contralateral breast cancer in the Halsted group (not irradiated) and in the QU.A.RT. group (irradiated on the operated breast with a total dose of 50 Gy plus a limited boost of 10 Gy). In March 1986, a contralateral breast cancer was diagnosed in 17/349 patients (4.9%) of the Halsted group and in 18/352 patients (5.1%) of the QU.A.RT. group after a median follow-up of 108 months. The sites of contralateral cancer were superimposable in the two groups of patients, with a constant prevalence of external quadrants, despite the great difference of dose distribution in the irradiated patients. Our data on the incidence of contralateral breast cancer failed to demonstrate an oncogenic effect of irradiation to date, but the follow-up is still in progress and any future event will be registered and discussed.
Axilla↗
[Multifactorial analysis of the cardiocirculatory compromise in children with chronic renal insufficiency in hemodialysis. An echocardiographic study].
M-mode echocardiographic assessment of cardiovascular state and function was performed in 15 children (mean age 10.8 +/- 3.36 years) with chronic renal failure (CRF) on regular chronic hemodialysis. The echocardiograms were recorded just before the routine dialytic session and usual echocardiographic measurements of cardiac sections were analyzed according to the standard criteria. Subsequently, shortening fraction (SF) of the left ventricle (LV), ratio LVPEP/LVET (LV preejection period/ejection period) and LV mass were calculated. All the echocardiographic measured and derived parameters were therefore compared by means of multiple regression analysis with the following factors potentially influencing cardiac performance in CRF: age, duration of CRF, time on dialysis, presence of hypertension, mean arterial pressure, degree of anemia (Hct) and degree of uremia (blood urea). Left ventricular concentric hypertrophy, significantly correlated with the presence and severity of hypertension (p less than 0.001) was found in 80% of cases; LV dilatation was present in 46.67%. The LV function was not significantly impaired on the whole: mean values for group of the SF and of the ratio LVPEP/LVET were normal; four patients (26.7%) showed a slight decrease of the SF and two other cases had an abnormal LVPEP/LVET ratio. These abnormalities cannot be clearly attributed to a specific myocardial impairment and reflect probably the changes in preload and afterload secondary to volume and pressure variations. None of the other analyzed factors (duration of CRF, time on dialysis, Hct, blood urea) showed a significant correlation with the echocardiographic parameters.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Antiglaucomatous cycloanemization. Review of 207 operations performed during eight years.
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Diathermy↗
[Meningococcal sepsis and DIC in childhood: a report of a clinical case].
Disseminated intravascular coagulation (DIC) is a frequent complication of meningococcal sepsis in children. The clinical course variability, the severity of manifestations and the need of an early diagnosis for appropriate treatment, guides us to report a case of meningococcal sepsis and DIC. The patient, male, prematurely born, 11 months years old, presented himself with high fever of sudden onset, malaise, diarrhea, diffuse skin rash with abdominal petechiae, and no clinical evidence of meningitidis. Initial hematochemical findings, peripheral leukocytosis, quantitative and qualitative changes in plasma coagulation factors, liquoral hypocellularity together with the development of signs of meningeal irritation (stiff neck and back) were considered diagnostic clues for meningococcal sepsis associated with DIC. A gram-negative diplococcus was cultured from liquor. Primary goals of the treatment of this life-threatening clinical picture were the elimination of the bacterial component, the correction of clotting disorders and careful control of shock and metabolic acidosis often related with DIC. The patient then received a wide spectrum Cephalosporin, fresh frozen plasma, appropriate electrolyte solutions and eventually heparin, which led to a complete control and resolution of symptomatology.
Acidosis↗
[Children with hemorrhagic diathesis: correct diagnostic and therapeutic approach].
Bleeding defects are of great interest in pediatrics since the prevalence of congenital forms and the early appearance of acquired ones. The pathology itself and the therapy indeed can often interfere with the growing-up patients. Bleeding defects have been identified with an heterogeneous group of clinical disease that differs from one another in etiology, pathogenesis, epidemiology and incidence in population. Bleeding diathesis is the common symptom: bleeding tendency may be mild, moderate or severe, localized or generalized, cutaneous or mucosal, superficial or deep. Bleeding disorders may be classified as a) defects in the primary haemostasis, which include quantitative and qualitative abnormalities of platelets and vascular disorders and b) defects in secondary haemostasis, which include intravascular disorders (blood coagulation). Careful history and clinical examination are essential in diagnosis of bleeding disorders. History of patient should be taken a) to differentiate acquired from congenital disease and to know the way of hereditary transmission (family history); b) to know exactly the disease's start and the mutual relation with former or accompanying disease; c) mutual relation with drugs token. Subsequently a careful physical examination should be done. A specific hemorrhagic diathesis has been seen with a deficiency of primary or secondary haemostasis. A deficient or late haemostatic plug in small vessels can cause superficial, interstitial bleeding that may be intracutaneous or intramucosal and is called purpura. In coagulation factor deficiency the haemostatic plug cannot be consolidated by fibrin: spontaneous hematomas, hemarthrosis and ecchymoses often occurs. The initial laboratory work up for screening patients with bleeding disorders should include first step tests to differentiate bleeding disorders for bone-marrow malignancies; from virus infections carrying screening of major viruses and from hepatic diseases. Second step laboratory examination includes a) platelet count or estimation of platelet number on blood smear; b) bleeding time to test small vessel integrity and platelet function; c) aPTT, PT, AP to measure clotting activity; d) fibrinogen determination. With this battery of screening test it is usually possible to determine the general area of the defect (abnormalities of platelets number or function or congenital defect of one or more clotting factors activity). Acute idiopathic thrombocytopenic purpura is the most common bleeding disorders in childhood. Usually no therapy may be required no matter platelet count. Patients with a significant hemorrhagic tendency are treated either with prednisone (2 mg/kg orally in divided daily doses) for a period of 2 weeks or with a 5 days course of special polyvalent intact immunoglobulin (400 mg/kg/die) for intravenous use.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
[Treatment of hemophilia in children].
Thanks to recent developments and evolution in prenatal diagnosis and early onset within the first year of life, hemophilia may now be considered a pathology of primarily pediatric interest. The treatment of hemophilia in children has furthermore undergone a number of changes that include 2 main events in therapy that have served to modify the quality of life of the hemophiliac. The first of these events regards blood products and the prevention of viral infections, hepatitis and HIV transmission. Prevention is based on various factors which include: donor selection, immunization, product testing and heat treatment of blood products. The second extremely important aspect of treatment in hemophilia is the concept of global assistance, which includes: the treatment of the bleeding episode itself, and an ongoing psycho-social support system. In this paper we suggest some practical treatment schedules for the therapy of bleeding episodes in addition to examining the severe side effects of HIV and Hepatitis viruses. The message which our paper attempts to transmit is that the hemophilic child must be ideally assisted in an exclusively pediatric environment.
Acquired Immunodeficiency Syndrome↗
[Computerized dosimetry in curie therapy].
Automatic treatment planning for calculation of absorbed dose in curietherapy has been performed at the Istituto Nazionale Tumori of Milano on a routine for some years. The radioactive implant is reconstructed from orthogonal or stereo-roentgenograms, a tabular listing of doses or dose rates can be obtained on the grid of points and the isodose curves are automatically drawn with the projection of sources onto the selected planes of calculation by an interactive plotter.
Aged↗
[Critical evaluation of the causes of death in thalassemic subjects].
We discuss 25 cases of death observed from 1971 to 1983 in a casistic of 155 patients with Thalassaemic Syndrome. Anemia as a cause of death is disappearing, new triggers are involved such as Yersinia Enterocolitica who can cause severe sepsis even in non-splenectomized patients. Iron overload appears to be the most severe complication in the second decade.
Adolescent↗
[Clinico-therapeutic findings on diabetic complications in thalassemia].
We describe 6 patients with thalassaemia major who developed diabetes. Etiopathogenesis, poor metabolic control, previous transfusion and chelation regimens are discussed. Antiaggregant therapy with A.S.A. and Dipiridamole may play a role in these patients for preventing thrombotic risk.
Arrhythmias, Cardiac↗