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Biomedical subjects

E Micheletti

Publications and source records attributed to E Micheletti.

At least 19 recordsLinked to original sources
PubMed1992

Total lymphoid irradiation in chronic progressive multiple sclerosis.

6 patients with severe chronic progressive multiple sclerosis were subjected to total lymphoid irradiation (TLI) to assess clinical efficacy and side effects. During a 4 year follow-up the disability progression was continuous. Side effects during TLI were well tolerated; side effects after TLI brought about a worsening of the quality of life. One patient died of pneumonia. In this preliminary study TLI did not reduce the worsening of disability in MS patients.

Adult↗
PubMed1991

Primary radiotherapy versus surgery and radiotherapy in the management of postmenopausal locally advanced breast cancer.

From 1978 through 1984, 103 postmenopausal patients with locally advanced breast cancer (T4 N1-2-3 MO) were treated by definitive radiotherapy (XRT, 35 patients) or mastectomy and postoperative radiotherapy (RM + XRT, 68 patients). A control group of 35 of the 68 RM + XRT patients was selected by matching several prognostic variables with the XRT group. Patients were followed for 4 to 10 years. At 5 years the probabilities of overall survival and relapse-free survival were 49.9% and 33.2% for XRT patients and 49.2% and 42.8% for RM + XRT patients, respectively (with no significant difference). The probability to remain free of local-regional progression at 5 years, with censoring of deaths, was 71.9% in the XRT group and 79.8% in the RM + XRT group. Of the patients treated with definitive radiotherapy, those who received 60 Gy or more to the primary tumor had a significantly better 5-year rate of local control: 88.0% vs. 68.0%, p less than 0.05. Our results suggest that adequate doses of radiotherapy can provide long-term local-regional control in a large proportion of survivors and can spare mastectomy in most patients, without however achieving substantial improvements in the poor survival results.

Breast Neoplasms↗
PubMed1991

[Role of postoperative adjuvant radiotherapy in the treatment of class T2-3 NO MO adenocarcinoma of the kidney].

From 1968 to 1983, in the Department of Urology and in the Institute of Radiotherapy of the University of Brescia, the role of postoperative radiotherapy (PORT) in 95 patients with renal adenocarcinoma (T2-3 N0 M0) was investigated. From 1968 to 1978, 46 patients underwent radical nephrectomy and PORT; from 1978 to 1983, 49 patients were submitted to radical nephrectomy with regional lymphadenectomy (CH). Overall survival (PCS) at 5 years is 63% (PORT) vs 57% (CH) (p greater than 0.05). The probability of survival is better for left-sided neoplasms than for right-sided ones. In the CH group, the 5-year PCS is 40% vs 70%, respectively, for right vs left neoplasms (p less than 0.05); in the PORT group, PCS is 59% (right) vs 70% (left). For right-sided cancers, 5-year PCS is higher for PORT (59%) than for CH (40%) patients (p less than 0.05). In the PORT group acute bowel toxicity was 24% (grade 2, WHO). In 2 patients only (4.3%) PORT was stopped because of toxicity. PORT sequelae were investigated in: spinal cord, contralateral kidney, liver and bowel. Bowel sequelae (grade 2, Dische) were observed in 3 patients only (6.5%). In the T2-3 N0 M0 classes, radical nephrectomy with PORT may give the same results as aggressive surgery, with a low biological cost. Prognostic data might mean a different and more favorable loco-regional evolution for left-sided renal cancers.

Adenocarcinoma↗
PubMed1991

[Progressive multiple sclerosis. Evaluation of the effectiveness of total lymph node irradiation].

A long-lasting immunological suppression action seems to be produced by total lymphoid irradiation; some authors emphasize the favorable effect of this treatment on chronic progressive multiple sclerosis. In order to evaluate the actual role of TLI, 6 patients affected with chronic progressive multiple sclerosis were submitted to TLI with shaped and personalized fields at the Instituto del Radio, University of Brescia, Italy. The total dose delivered was 19.8 Gy in 4 weeks, 1.8 Gy/day, 5d/w; a week elapsed between the first and the second irradiation course. Disability according to Kurtzke scale was evaluated, together with blood lymphocyte count and irradiation side-effects, over a mean follow-up period of 20.8 months (range: 13-24). Our findings indicate that: a) disease progression was not markedly reduced by TLI; b) steroid hormones responsivity was restored after irradiation, and c) side-effects were mild and tolerable.

Adult↗
PubMed1990

[Prosthetic valve endocarditis].

The Authors report their experience of the surgical treatment of cardiac prosthetic endocarditis. Between September 1974 and December 1988, 2,796 cardiac prostheses were implanted. An endocarditis in the follow-up of 23 patients involving 27 prostheses was diagnosed. The operative mortality was high in patients with mitral prosthetic endocarditis; in patients with infected aortic prosthesis operative mortality was low, but there was a high incidence of recurrence. The Authors emphasize the difficulty of diagnosis and the importance of the surgical treatment for eradication of the infection and for resolution of the haemodynamic defect.

Aortic Valve↗
PubMed1990

[Intermediate echocardiographic follow-up of a new model of pericardial prosthesis (Pericarbon)].

The paper deals with the echocardiographic medium-term follow-up of 11 patients fitted with a Sorin Pericarbon bioprosthesis. Four hundred and ninety-seven biological prostheses were implanted during the period January 1975 to December 1988, of which 22 (4.42%) were Pericarbon. The first 11 patients (mean age 55.3 years) who underwent isolated mitral or aortic valve replacement were included in the study. In 5 patients the bioprosthesis was implanted in mitral site, and in 6 in aortic. Post-operative 2D-Doppler echocardiographic tests revealed good hemodynamic performance indices, even in small calibre vessels, and the absence of early malfunctions. Although the number of patients studied is small, the absence of early malfunctions and the technical innovations of the bioprosthesis make it preferable to other pericardiac prostheses.

Adult↗
PubMed1988

Bladder cancer prognostic indices: analysis of 286 patients treated with radical radiation therapy.

From 1974 through 1982, 286 patients with histologically proven bladder cancer (Tis 8, T1 62, T2 109, T3 86, T4 21 NXMO) were treated with external irradiation after transurethral resection. Irradiation was given with 260 degrees arc technique photon beam from a Cobalt Unit; the tumor doses ranged from 52.5 to 65 Gy in 21-50 days, with a TDF between 75 and 110. The analysis was conducted with the log rank test on the cumulative percent survival (CPS) at 5 years. The study pointed out the importance of risk factors other than clinical stage on cumulative survival in bladder cancer. Prognostic factors associated with a relatively successful outcome (p less than 0.001) were the Karnofsky performance status (100 vs others) (CPS 75% vs 30%), the absence of ureteral obstruction on the initial intravenous pyelogram (CPS 50% vs 35%), a negative urine culture (CPS 60% vs 30%), normal bladder capacity (CPS 50% vs 35%), low-grade histology (CPS 65% vs 35%), and grossly complete resection (55% vs 40%). The data from this analysis should be taken into consideration when radical radiotherapy is considered in new clinical trials.

Cobalt Radioisotopes↗
PubMed1988

Cardiac valve replacement during pregnancy. Report of two cases.

Two successful cases of mitral valve replacement with cardiopulmonary by-pass and myocardial protection are reported. Postoperative anticoagulation was obtained with oral anticoagulants. The patients delivered two healthy newborns. The report suggests that an open-heart operation can be performed in pregnant women with an acceptable risk for the mother and the fetus.

Adolescent↗
PubMed1988

Clinical results after isolated aortic valve replacement with Sorin prosthesis: a 6-year experience.

The mechanical valve produced by Sorin is a modified tilting disc device. Over about a 6-year period, 763 Sorin Prostheses were implanted in 710 patients. No structural failure has been observed. 282 prostheses were implanted in aortic position with the large orifice oriented towards the right coronary sinus. Hospital mortality was 5% (14/282). Actuarial survival at 78 months was 94.68% +/- 1.6%, with a linearized mortality rate of 1.7% pt-years. There were 11 late deaths (9 valve related and 2 non valve-related). The linearized rate of occurrence of embolic events was 0.32 pt-years (2/268). Actuarial survival complication free at 78 months was 90.88% +/- 2.83%. Preop. 19.8% patients were in class II N.Y.H.A, 68.5% in III, 11.7% in IV; postop. 79.3% patients were in class I, 19.5% in II, 1.2% in III. The durability and satisfactory complication-free survival rate indicate the Sorin prosthesis as a fully reliable device for aortic valve replacement.

Adolescent↗
PubMed1987

Analysis of prognostic factors in patients with isolated chest wall recurrence of breast cancer.

A retrospective analysis of a series of 162 patients treated for isolated chest wall recurrence of breast cancer after mastectomy was undertaken. Cumulative survival, distant relapse-free survival, and freedom from local progression after 5 years from the diagnosis of recurrence were 34%, 28%, and 45% respectively. Five prognostic factors influenced survival: axillary node status, primary T stage, length of disease-free interval, and number and size of recurrences. Four prognostic factors influenced the local control: axillary node status, primary T stage, disease-free interval, and number of recurrences. Patients with three or more, out of five, favorable prognostic factors fared much better than those with two or less: 75% versus 15% survival at 5 years. Our findings suggest that it is possible to identify a group of patients with a distinctly good medium-term survival and local control of disease.

Actuarial Analysis↗
PubMed1987

Right intracavitary cardiac tumors. Surgical management.

The surgical treatment of 6 patients affected by right cardiac tumors is reported. Three of them showed a right atrial myxoma, 1 metastases from an occult embryonal carcinoma and 1 a leiomyosarcoma of the pulmonary artery. While clinical diagnosis was not reliable, the echocardiographic examination was able to assess the site of the tumor, supplying useful information for the anatomy and surgery in 5 cases out of 6; in one case, the diagnosis was reached intraoperatively. All the patients survived the surgical treatment: while those with atrial myxoma recovered completely, the others with malignant tumors died from metastases 5 to 10 months postoperatively. The importance of early diagnosis is stressed together with the role of surgery, which permits the recovery of cases with benign tumors and a longer survival of cases with malignant tumors.

Adult↗
PubMed1987

Results of reoperation for failure of cardiac bioprostheses.

A ten-year experience with reoperations for failure of cardiac bioprostheses is reported. 362 patients were operated for valve replacement with 412 bioprostheses. There were 35 (9.64%) reoperations for valve failure. Mean time between operation and reoperation was of 64.4 months. Operative mortality was 14.28%: 3 patients died for cardiac and 2 for extra-cardiac causes. Long-term mortality after reoperation was 6.25%. Morphological examination of the explanted bioprostheses confirmed the cause of bioprosthetic valve failure, due to calcific degeneration in 88.88% of case, to post-endocarditic rupture in 5.55% and to prosthetic thrombosis in 2.77%. The importance of timing reoperation is stressed in order to reduce the operative mortality. The conditions suitable for implantation of bioprostheses are listed.

Adolescent↗
PubMed1986

[Local-regional recurrence after mastectomy. CT as a tool of diagnosis and treatment planning].

In 19 out of 25 patients with local-regional recurrence of breast cancer, CT provided significant information better than any other procedure; in 15 patients CT contributed to a change in the treatment chosen on the basis of physical examination and routine studies. CT should be considered as part of the diagnostic work-up in patients with locally recurrent breast cancer who are being planned for comprehensive radiotherapy.

Adult↗
PubMedDate not supplied

[Creation and management of a data bank in oncologic radiotherapy].

Clinical, scientific and technological development has greatly widened the scope and range of oncological radiotherapy. As for database management, favorable conditions come from new available hardware and software facilities and from well-consolidated and universally accepted classifications. The authors' aim was to create and to verify an original database management system for oncological radiotherapy, proved with internationally accepted classifications and directly interfaced to a new package for clinical and epidemiological statistics. An ordinary personal computer was used and a 802-subject statistics was analyzed relative to 1987-1988 series from the Istituto del Radio "O. Alberti", General Hospital and University - Radiotherapy Department, Brescia, Italy. The system seems to be suitable for routine use as well as for research, with good potentials for multicentric use.

Database Management Systems↗