Biomedical subjects

F Falcone

Publications and source records attributed to F Falcone.

At least 19 recordsLinked to original sources

PubMed2005

Asthma is not a common cause of severe chronic respiratory failure in non-smokers: ALOT study.

BACKGROUND: Little is known about the long-term natural history of asthma and the long-term clinical and functional consequences in non-smoking patients. From a functional point of view, non-smoking asthmatic patients may have a significantly greater decline in forced expiratory volume in one second (FEV1) compared with non-asthmatic subjects and may develop chronic irreversible (fixed) airflow limitation. This has been related to the physiological consequences of chronic airway inflammation causing airway remodeling. However these lesions are all potentially reversible and there is little radiological evidence indicating lung destruction (pulmonary emphysema), which is potentially irreversible, in non-smoking asthmatics. Severe chronic respiratory failure is the major cause of mortality in patients with severe chronic lung diseases. Domiciliary long-term oxygen therapy (LTOT) is an accepted treatment for patients with severe chronic respiratory failure. Our reasoning, therefore, was that if asthma is a cause of severe chronic respiratory failure in non-smokers we should be able to find non-smoking asthmatics within a large population of patients on LTOT. The aim of our study (Asthma and Long-term Oxygen Therapy, "ALOT") was to investigate the prevalence of non-smoking asthmatics in patients on LTOT in a multi-centre, cross-sectional study. METHODS: Between June and September 2003 we screened all subjects on long-term domiciliary oxygen therapy in three different hospitals in the North-East area of Italy (within the provinces of Ferrara and Bologna). Taken collectively, we have found one-hundred and eighty-four patients on LTOT. We have reviewed their clinical data (age, sex, smoking, history and physical examination, arterial blood gas analysis, pulmonary function). RESULTS: 114 patients (all smokers) fulfilled the diagnostic criteria for COPD. Seventy patients (all smokers) had other diseases. We were unable to find any non-smokers in our screened population of subjects on long-term domiciliary oxygen therapy. Furthermore, there was no past history of asthma and/or acute wheezing episodes in either of the patient groups. CONCLUSIONS: This data suggests that asthma is an uncommon cause of severe chronic respiratory failure necessitating long-term domiciliary oxygen therapy in non-smokers and supports the current consensus that asthma and COPD are different diseases with differing stages of severity and the concept that long-term avoidance of active smoking is fundamental for the prevention of severe chronic respiratory failure.

Aged↗

PubMed2005

Barriers to effective tuberculosis control: a qualitative study.

SETTING: Emilia Romagna region, Italy. OBJECTIVE: To explore chest and infectious disease physicians' views of barriers to effective tuberculosis (TB) control and possible solutions. DESIGN: A series of nine focus groups including a total of 49 physicians. RESULTS: Three categories of barriers to effective TB control were identified: 1) uncertainty about appropriate clinical practice in the treatment of specific sub-groups of patients, such as the elderly or immigrants; 2) organisational factors, such as the availability of diagnostic services and of sufficient resources; and 3) multiple barriers to a viable and effective TB control programme in a country with a low prevalence of TB. CONCLUSIONS: The lack of integration and coordination of health services, as well as the scarcity of dedicated TB nurses, were perceived by the participants as crucial barriers to effective TB control. As a result of this study, a regional programme was started with the goals of quantifying the need for TB nurses and developing a better network for required health services. Qualitative studies such as this can be useful in improving TB control in a low-prevalence TB country, to identify problems and increase the participation of key professionals.

Attitude of Health Personnel↗

PubMed2004

Babinet principle applied to the design of metasurfaces and metamaterials.

The electromagnetic theory of diffraction and the Babinet principle are applied to the design of artificial metasurfaces and metamaterials. A new particle, the complementary split rings resonator, is proposed for the design of metasurfaces with high frequency selectivity and planar metamaterials with a negative dielectric permittivity. Applications in the fields of frequency selective surfaces and polarizers, as well as in microwave antennas and filter design, can be envisaged. The tunability of all these devices by an applied dc voltage is also achievable if these particles are etched on the appropriate substrate.

Journal Article↗

PubMed2001

Delayed non-infectious lung disease in allogeneic bone marrow transplant recipients.

BACKGROUND AND AIM OF THE WORK: The studies on late-onset non-infectious respiratory complications after allogeneic bone marrow transplantation (allo-BMT) have been mainly focused on bronchiolitis obliterans to date. The aim of this work was to analyze the incidence, clinico-pathologic characteristics and outcome of the entire spectrum of entities falling into the group of delayed non-infectious lung disease (DLD). METHODS: Retrospective chart review was carried out of 112 patients who underwent allo-BMT for hematologic malignancies between April 1995 and November 1998 at a single Institution. The categorization of the pulmonary disease was made by analyzing clinical data, bronchoalveolar lavage (BAL), high-resolution computed tomography (HRCT) and histology when possible. RESULTS: DLD occurred in 10 (10%) out of 97 recipients who survived at least 100 days following allo-BMT and was defined as bronchiolitis obliterans (BO; 4 cases), acute lung injury (ALI; 1 case) and subacute cellular interstitial pneumonia (SCIP; 5 cases). The BAL-profile was characterized by a marked increase of the neutrophil percentage in BO cases and of the lymphocyte (predominantly CD8+) percentage in parenchymal DLDs (SCIP, ALI). HRCT proved to be helpful to correctly identify BO cases, whereas histology was always needed to better define DLD presenting with an interstitial and/or alveolar pattern. The predominant airway involvement as well as the acute-onset of a respiratory illness with histological evidence of diffuse alveolar damage were associated with a worse prognosis because of a poor response to the immunosuppressive treatment. CONCLUSIONS: DLDs represent a group of entities heterogeneous in regard to variables such as onset and clinical behaviour (acute, subacute or chronic), predominant pattern of lung involvement (airway or parenchymal), response to treatment. Although immunopathologic mechanisms related to c-GVHD probably have a relevant pathogenic importance in this setting, the possible role of associated events (eg, drug toxicity and infections) at least in priming the lung damage need to be better clarified for its therapeutical implications.

Adolescent↗

PubMed2001

Acute lung injury associated with 5-fluorouracil and oxaliplatinum combined chemotherapy.

Diarrhoea, T-CD4+ lymphopenia and bilateral patchy pulmonary infiltrates developed in a male 60 yrs of age, who was treated with oxaliplatinum and 5-fluorouracil for unresectable rectum carcinoma. The findings from transbronchial lung biopsy and bronchoalveolar lavage (BAL) were consistent with an organizing diffuse alveolar damage pattern. Once extensive microbiological studies proved negative, corticosteroids were given and a complete remission of clinical and radiological abnormalities was achieved. It is concluded that the aforementioned pathological manifestations were due to chemotherapy and included a pulmonary adverse reaction, a feature never previously associated with oxaliplatinum and 5-fluorouracil regimens.

Acute Disease↗

PubMed2000

Bronchoalveolar lavage in bronchiolitis obliterans organizing pneumonia primed by radiation therapy to the breast.

BACKGROUND: Growing evidence indicates that unilateral lung irradiation for breast cancer may "prime" the development of migratory lung infiltrates with histologic features of bronchiolitis obliterans organizing pneumonia. OBJECTIVE: Our purpose was to evaluate the cytologic and immunocytologic features of bronchoalveolar lavage in this condition. METHODS: We analyzed the profile bronchoalveolar lavage cell differentials and lymphocyte subpopulations of 11 women with bronchiolitis obliterans organizing pneumonia syndrome after radiation therapy for breast cancer in comparison to 9 healthy women. RESULTS: The bronchoalveolar lavage analysis demonstrated a significant increase in the percentage of lymphocytes (36.7% +/- 5.4% vs 8.6% +/- 1.1%, P =.0002), neutrophils (3.8% +/- 1.2% vs 0.6% +/- 0.2%, P =.005), eosinophils (2.4% +/- 1% vs 0.3% +/- 0.1%, P =.01), and mast cells (1.4% +/- 0.6% vs 0.1% +/- 0.02%, P =.05) with a significant decrease in the percentage of macrophages (56.1% +/- 6% vs 90.3% +/- 1.4%, P =.0002) in patients with bronchiolitis obliterans organizing pneumonia compared with the control subjects. The percentage of CD3(+) cells was significantly increased in patients with bronchiolitis obliterans organizing pneumonia (93.7% +/- 1.3% vs 70.9% +/- 4%, P =.0004), with a significant decrease in CD4(+) cells (32.7% +/- 4.7% vs 55.4% +/- 2. 6%, P =.002) and a significant increase in CD8(+) cells (61.2% +/- 4. 8% vs 37.5% +/- 2.9%, P =.003) in comparison to control subjects. The CD4/CD8 ratio was significantly reduced in patients with bronchiolitis obliterans organizing pneumonia compared with control subjects (0.6% +/- 0.1% vs 1.5% +/- 0.1%, P =.001). CONCLUSION: These data add to the view that unilateral lung irradiation for breast cancer may "prime" the development of a syndrome quite similar to idiopathic bronchiolitis obliterans organizing pneumonia.

Aged↗

PubMed2000

Bronchiolitis obliterans-organizing pneumonia: an Italian experience.

The purpose of this study was to describe the clinical features at onset and outcome and the diagnostic approach in subjects with bronchiolitis obliterans-organizing pneumonia (BOOP). Over a 7-year period we observed 78 cases of biopsy-proven bronchiolitis obliterans-organizing pneumonia, in which well documented clinical and radiographic data were available. The final diagnosis of BOOP was validated when patients presented: (i) negative microbiological analysis on BAL fluid; (ii) a well documented improvement either spontaneous, or after steroid treatment or (iii) cases with progressive respiratory failure and increasing radiographic shadows, an open lung biopsy or autopsy that excluded other entities. There were 42 males and 36 females; the mean age was 61+/-12 years (range 12-85 years). Forty-two (54%) patients were current smokers, 25 (32%) had never smoked and 11 (14%) were ex-smokers. The clinical pattern at presentation of BOOP was more frequently similar to classical acute or sub-acute infectious pneumonia. Fever (63%), dyspnoea (58%) and dry cough (53%) were the typical symptoms on admission. A flu-like syndrome preceeding BOOP was observed in 21 cases (27%). Inspiratory crackles (78%) were the most typical finding at physical examination. However, 13% of the patients were asymptomatic and an abnormal chest X-ray film was the reason for seeking medical attention. Radiographically the most frequent pattern of BOOP was a unilateral consolidation (44%) with lower field predominance. A migratory behaviour was present in 22% of the cases. High-resolution computed tomographic (HR-CT) scan when performed, was more sensitive in detecting ground glass infiltrates, sub-pleural or peri-bronchovascular distribution or the presence of nodules or cavitation. Most patients (68%) were classified as having idiopathic BOOP. However, the same clinical-roentgenological pattern was observed in patients after radiotherapy for ductal breast carcinoma (6%), in collagen-vascular diseases (6%), related to drugs (9%), to infections serologically documented (4%), and to graft vs. host disease (4%). Four patients (all of whom had idiopathic BOOP) presented a rapid progressive respiratory failure needing mechanical ventilation. In another two cases respiratory failure appeared after a long period during which patients experienced exertional dyspnoea and low grade fever. BAL profile was characterized by lymphocytosis with a reduction of the CD4/CD8 ratio, associated with a slight increase of neutrophils and eosinophils and scattered mast cells. However in two cases we had an increased CD4/CD8 ratio and in one case the presence of a significant 12% of polyclonal B cells. In a few cases atypical (cytokeratin-positive cells) epithelial cells were detected: these cells were constantly present in the BAL fluid of patients with rapidly progressive respiratory failure. From the diagnostic point of view this series documents that transbronchial lung biopsy (coupled with BAL) can be the first diagnostic step. However, therapy can be started on the basis of BAL data (when a characteristic morphological and phenotypical profile is evident) in cases in which the clinical presentation is suggestive and a biopsy cannot be made. Most patients showed a rapid and good response to steroid therapy. However, three patients died (4%) in spite of steroid therapy (two cases) and steroid and cyclophosphamide therapy (one case). In conclusion, although clinical findings, chest X-ray film and CT Scan findings usually suggest the diagnosis a definite confirmation requires transbronchial lung biopsy and BAL and, less frequently, open lung biopsy.

Adolescent↗

PubMed1999

Bronchoalveolar lavage and transbronchial lung biopsy in alveolar and/or ground-glass opacification.

In order to assess the diagnostic yield of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBB) in pulmonary diseases with a ground-glass and/or alveolar pattern on high-resolution computed tomography (HRCT) scan, a prospective study was undertaken. Thirty-six patients (17 males, 19 females), mean age 53 yrs, selected on the basis of the presence of an alveolar and/or ground-glass pattern on chest HRCT scan, were submitted to fibreoptic bronchoscopy. All patients underwent BAL. TBBs were performed in 33 cases. A specific diagnosis was achieved, taking into account data obtained by means of serology, microbiology, cytology and histopathology in appropriate clinical settings. Twelve (33%) patients only had the appearance of a ground-glass opacity, whereas 24 (67%) had associated areas of airspace consolidation. BAL was performed in all cases and gave a definitive diagnosis in 21 (58%). The diagnostic yield of BAL in patients with only ground-glass opacities was no different from that in those patients also showing areas of alveolar consolidation (58 versus 58%). In eight patients (six with ground-glass opacity and two with alveolar consolidation), BAL provided useful but not definitive information. In these patients, a definitive diagnosis was achieved by means of TBB in seven cases and by open lung biopsy in one case. TBB was performed in 33 out of 36 patients and gave positive results in 25 (76%). The diagnostic yield of TBB in patients showing areas of alveolar consolidation was significantly higher than in those with pure ground-glass opacity, i.e. 95% (21 of 22) and 36% (4 of 11) respectively (p < 0.001). BAL and TBB were performed during the same bronchoscopy in 33 patients, and an accurate diagnosis was achieved in 30 (91%). Overall, the diagnostic yield of TBB (76%) and BAL (56%) did not differ significantly in the whole patient group (p = 0.12), or in patients with a ground-glass opacification (58 versus 36%, p = 0.3). However, in patients with areas of alveolar consolidation, the diagnostic sensitivity of TBB (95%) was significantly greater than the diagnostic sensitivity of BAL (54%) (p = 0.03). In conclusion this study shows that high-resolution computed tomography can be helpful in predicting the diagnostic accuracy of bronchological procedures, in particular of bronchoalveolar lavage and transbronchial biopsy, and that alveolar and/or ground-glass are favourable patterns for these diagnostic tools.

Adolescent↗

PubMed1999

Photodynamic laser therapy for the treatment of early-stage bronchogenic carcinoma.

Photodynamic therapy (PDT) is an effective modality that can be used in the treatment of bronchogenic squamous cancer. PDT can be curative in cases of early-stage central type lung cancer and, for this reason, is an alternative to surgery in patients with in situ carcinoma or minimally invasive squamous cell carcinoma. PDT was performed in 26 early bronchogenic cancers in 23 patients, and 16 complete remissions and 10 partial remissions were obtained. It is concluded that photodynamic therapy is effective in the treatment of superficial lung cancer in which complete remission can be expected. The combination of different endoscopic therapeutic modalities and trials comparing endoscopic therapy with surgical resection are anticipated.

Carcinoma, Bronchogenic↗

PubMed1997

Telehealth in Africa.

This paper deals with the developments of the project "Telehealth in Africa", to establish a link between more European reference Hospital Centers and some African Hospital Centers, connected with Peripheral Units of Assistance, to transmit and receive health diagnostic images, etc. The project has been developed by the European Collaboration Group for Telemedicine in developing countries which was created in collaboration with ITU (International Telecommunication Union). A demonstration of telehealth from Milan (Italy), Toulouse (France), to Abidjan (Ivory Coast, Africa) and Midrand (South Africa) proves that it is possible for a diverse group of intergovernmental organizations, non-governmental organizations and the private sector to work together for the benefit of all participants and, most of all, for developing countries.

Africa↗

PubMed1997

The mortality rate of lung diseases eligible for transplant: national figures for 1989-1991.

Some patients with disabling and potentially fatal lung disease, who are nonresponders to conventional treatment, could benefit from lung transplantation (LT). It is, therefore, necessary to know the number of patients who are potentially eligible for such a therapeutic procedure. A retrospective study of the mortality rate of the Italian population from 1989-1991 was carried out. Groups of non-neoplastic chronic respiratory diseases, for which LT is indicated, were identified according to the Italian Central Statistical Institute (ISTAT), analytical international classification of diseases, trauma and causes of death (9th revision of 1975). The distribution of these diseases was considered both in terms of the total number of deaths (all ages) and in the relative number prior to 60 yrs of age (the maximum acceptable age for LT). Twenty five ISTAT codes referring to chronic non-neoplastic lung diseases for which LT is indicated were identified, and grouped according to disease type. The total national mortality rate from 1989-1991 due to selected lung diseases for which transplant is indicated was 44,915 (14,335 in 1989, 15,271 in 1990, and 15,309 in 1991), and 2,774 (6%) of these deaths occurred below the age limit of 60 yrs (986 in 1989, 889 in 1990, and 899 in 1981). Considering the normal limitations of retrospective studies on mortality rate, and the fact that only one eligibility criterion for LT (age) was considered, the results obtained provide an indirect evaluation and overestimation of the potential candidates for such treatment in Italy, and the relative need for organ donation.

Chronic Disease↗

PubMed1995

The botryoid odontogenic cyst: case report and twenty-five year literature review.

The botryoid odontogenic cyst (BOC) is a rare entity which has been sporadically reported in the literature since Weathers and Waldron coined the term in 1973. Approximately twenty-five such lesions have been described in the last twenty-one years. However, the histologic origin and nomenclature of this cyst have been quite controversial. Cysts with similar characteristics may have been seen even earlier than 1973, but were classified as other types of cysts of odontogenic or mesenchymal origin. The purpose of this article is to chronicle a case and its management, and to delineate several criteria to insure the proper diagnosis of the botryoid odontogenic cyst clinically, radiographically and histologically.

Diagnosis, Differential↗

PubMed1994

Extradural haematoma. Report of 37 consecutive cases with survival.

The availability of CT scanning has considerably improved the results in patients with extradural haematoma (EDH). However, only few reports referred the "zero-mortality" which today could be considered as possible. This goal was achieved by us recently even in those patients suffering from rapidly developing EDH. A series of 37 consecutive patients with EDH operated on during the last years is presented. 27 patients were comatose GCS 3-8 on admission (within 6 hours after the injury) and underwent surgery immediately; in 7 cases the operation was performed 6 to 25 hours after the injury, soon after the worsening of the level of consciousness; 3 patients were awake at time of surgery and were operated on later than 24 hours after the injury when signs of neurological deterioration appeared. All of our patients survived and 35 of them (95%) fully recovered. We believe that the duration of brain compression is the main factor strongly correlated with outcome. Therefore, in our opinion the primary prerequisite in order to obtain a good result is the prompt evacuation of EDH; furthermore, in this was it is possible to try to prevent brain ischaemia due to clot pressure, mostly the infarction on deeply situated territories.

Adolescent↗

PubMed1994

Superior orbital fissure syndrome. Secondary to infected dentigerous cyst of the maxillary sinus.

Superior orbital fissure syndrome is a rare condition that presents itself as gross and persistent edema of the periorbital tissues, proptosis, subconjunctival ecchymosis, ptosis, ophthalmoplegia, dilation of the pupil, absence of direct light reflex and presence of consensual light reflex. The corneal reflex is lost, sensation is diminished over the forehead, and it is possible that the dimensions of the superior orbital fissure are reduced. Infection, however, is not often reported as the etiology. The case presented here describes an unusual occurrence of superior orbital fissure syndrome secondary to an infected dentigerous cyst of the maxillary sinus and its management.

Blepharoptosis↗

PubMed1992

Kinetic uptake of etanidazole in lung carcinoma and normal tissue in vivo.

Thirty-four patients affected by primary pulmonary carcinoma or in a state of recurrence after surgery were analyzed and 2g/m2 of etanidazole was administered intravenously. After 30 min (group A), 60 min (group B), and 120 min (group C), both the bronchus affected by the carcinoma and the contralateral bronchus were biopsied. Of the 34 patients, 24 had histologically proven carcinoma and were enrolled in the study. Etanidazole determination was carried out with a polarographic method both in plasma and tissue. The results obtained indicate that the most favorable concentration of etanidazole in the tissue is at 30 min after administration and at this point is most beneficial when associated with radiotherapy. The tumor/plasma ratio of etanidazole examined in three phases is relatively higher than that noted with HPLC; however, it is compatible with the methodology used and previous studies carried out on other tumors.

Aged↗

PubMed1992

[Acute surgically-treated complications of myocardial infarct. Clinical experience and discussion of surgical indications].

Post-infarction free-wall, papillary muscle and septal myocardium rupture yields a lowering mortality, not only due to the improved surgical technique but also to a more careful selection of surgical candidates. The value of pericardial decompression in cases of free-wall rupture is discussed. Echocardiographic evidence of blood in the pericardium after a myocardial infarction is not a direct indication for a diagnostic sampling, decompression or surgery. Pericardiocentesis is not a risk-free procedure and should be limited to patients with life-threatening acute tamponade. Clinical results of 34 patients operated upon for myocardial rupture, regardless of adopted technique or timing of surgery, confirm that the decision about a patient's operability should follow a careful evaluation of the following risk factors in this order: infarct size, age, cardiogenic shock, multiorgan failure, rupture site, cardiac failure and associated diseases.

Aged↗

PubMed1990

Small cell bronchogenic carcinoma: a cyclical alternating combination of epirubicin plus cisplatin and cyclophosphamide plus etoposide.

Forty-seven patients with advanced small-cell bronchogenic carcinoma (SCLC) were treated with a combination of epirubicin (4-EPIDX) (60 mg/m2 i.v.) and cisplatin (CDDP) (50 mg/m2 i.v.) on day 1, alternated with cyclophosphamide (CTX) (800 mg/m2 i.v.) day 1 and etoposide (VP16) (120 mg/m2 i.v.) on days 21-23. Four patients (9%) obtained a complete remission and 27 (57%) a partial remission with an overall remission rate of 66%. The median duration of response was 37 weeks (range 13-150) and the median duration of survival was 43 weeks (range 10-150). No severe bone marrow depression was noted. The other side-effects were of a mild grade.

Aged↗

PubMed1990

The use of somatostatin in acute pancreatitis--results of a multicenter trial.

This study involves a multicenter trial aimed at evaluating the comparative beneficial therapy of somatostatin and traditional symptomatic therapy in the management of acute pancreatitis. According to our final data somatostatin has not proved to be any better than traditional medical treatment. Nevertheless, in our opinion, the advantage of a single and expeditious therapy makes somatostatin administration preferable to the combined employment of several therapeutic measures usually applied in these circumstances.

Acute Disease↗