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Biomedical subjects

F Gigli

Publications and source records attributed to F Gigli.

At least 19 recordsLinked to original sources
PubMed2006

Low dose Velcade, thalidomide and dexamethasone (LD-VTD): an effective regimen for relapsed and refractory multiple myeloma patients.

From January 2004, R/R MM cases referred to the Institution received LD-VTD regimen. Patients, irrespective of age, PS and life expectancy, were enrolled in the study once they had a measurable disease. Planned therapy: Velcade 1.0 mg m(-2) i.v. twice weekly for 2 weeks of a 28-day cycle for up to 6 cycles, oral Dexamethasone 24 mg on the day of and the day following each Velcade dose and Thalidomide 100 mg each evening. DVT prophylaxis with warfarin to maintain international normalized ratio between 2.0-3.0 was planned in all patients. As of 1 June 2005, 18 were the treated patients: median age 63 years, median time from diagnosis 5.8 years, a median of 4 previous therapy lines. Seventeen were the valuable patients and 9 (53%) were the responders: 2 CR, 6 PR, 1 MR. Six were the stable disease and 2 the progressive ones. Median time to best response was 2 months. Toxicity was negligible. No case of DVT was recorded. Except for the first cycle, subsequent cycles were delivered on an outpatient basis. After a median follow-up of 11 months, 12 patients were alive and 5 died (3 disease progression, 1 heart failure, 1 intestinal bleeding). Thus, the LD-VTD regimen applied appears feasible and effective in elderly and heavily pre-treated R/R myeloma patients.

Aged↗
PubMed2004

Internal tandem duplications of Flt3 gene (Flt3/ITD) predicts a poor post-remission outcome in adult patients with acute non-promyelocytic leukemia.

Despite progress in AML therapy, most patients eventually relapse, even the ones with normal or favorable karyotype. Since survival is poor once relapse occurs, new genetic tools above karyotype at diagnosis are needed to predict leukemia free survival. Recently, Flt3/ITD has been reported as an independent marker for clinical outcome in most studies concerning adult AML patients. To assess the prognostic relevance of activating mutations of Flt3, pretreatment samples of 100 not-M3 AML patients, all of them subjected to an intensive chemotherapy regimen, were analyzed for Flt3/ITD; 25/100 patients had one or more Flt3-ITD. Flt3/ITD patients had higher WBC count (P = 0.005), a lower incidence of a preceding MDS (P = 0.004) and most of them had a normal karyotype. Flt3/ITD had no impact on CR achievement while karyotype remained the most powerful prognostic factor (HR 2.8 95% CI 1.2 6.3). However, post-remission outcome was significantly worsened by the presence of Flt3/ITD. Median RFS of the Flt3/ITD patients was 5 vs. 27 months compared to the patients with wild-type Flt3 (P = 0.0002); moreover, Flt3/ITD patients had a significantly poorer post-remission survival (11 vs. 38 months, P = 0.01). On multivariate analysis, the presence of Flt3-ITD significantly affected relapse free survival and post-remission survival (HR 3.1 and 2.1, respectively). Thus, post-remission outcome highly depends on Flt3 status. Flt3 mutations identify patients at high risk of relapse, who should prospectively receive, according to age, either more aggressive or alternative therapeutic approaches.

Acute Disease↗
PubMed2003

The detection of morphine and codeine in human teeth: an aid in the identification and study of human skeletal remains.

When studying unidentified putrefied or skeletonised human remains it may be difficult to obtain information on drug habits which may prove important for the construction of a biological profile or lead to hypotheses on the manner of death. The detection of morphine and codeine in teeth from human remains may prove crucial in obtaining such information and thus give forensic odontology and anthropology a further tool for identification. Because teeth can be an important deposit of exogenous substances accumulated both in the pulp and in the calcified tissues, they are an invaluable source of data from a toxicological point of view. The authors therefore tested 3 groups of teeth for morphine and codeine: the first group consisted of artificially aged teeth from individuals known to have died of heroin overdose; the second, of teeth from individuals with no history of drug abuse; the third, of teeth from cases of burnt, putrefied and skeletonised remains found in conditions strongly suggestive of a drug-related death. Results showed that in groups 1 and 3 morphine and codeine could still be identified in the teeth, proving that these tissues may be a reliable source for toxicological information concerning the history of the individual. Further studies are needed to verify whether the substances detected reflect drugs in circulation in an acute phase (and therefore present in blood vessels in the pulp) or whether they represent drugs which have percolated and been stored in dentine and enamel and thus denote a history of drug abuse. Nonetheless this study shows that teeth may be an important source of toxicological information in the forensic scenario.

Adult↗
PubMed1999

[Comparison of various parameters (pitch 1 and 2) in the study of the lung with spiral computerized tomography].

INTRODUCTION: In Spiral CT, the pitch is the ratio of the distance the tabletop travels per 360 degrees rotation to nominal slice width, expressed in mm. Performing Spiral CT examinations with pitch 2 allows to reduce examination time, exposure and contrast dose, and X-ray tube overload. We investigated the yield of pitch 2 in lung parenchyma studies, particularly relative to diagnostic image quality. MATERIAL AND METHODS: Thirty patients were submitted to Spiral CT with pitch 1 [10 mm slice thickness, 10 mm/s table feed; 10 mm (a') and 5 mm (a") reconstruction index: protocol A] and with pitch 2 [10 mm slice thickness, 20 mm/s table feed; 10 mm (b') and 5 mm (b") reconstruction index: protocol B]. Five expert radiologists evaluated the images separately and blindly, grading noise, bronchial wall resolution and diagnostic yield on a 0-5 point scale. The results of protocol A versus protocol B images were analyzed statistically using the Mann-Whitney U-test. RESULTS: The mean scores for each parameter ranged 4.13 (.70 standard deviation) for protocol B with 5 mm reconstruction index (b") to 4.81 (.44 standard deviation) for protocol A with 10 mm reconstruction index (a'). These values (max: 5) indicate very positive results on both protocol A and B images. There were no statistically significant interprotocol differences, except for bronchial wall resolution, in favor of protocol A with 5 mm reconstruction index (a") (p = .025), and for diagnostic yield, in favor of protocol A with 10 mm reconstruction index (a') (p = .018). CONCLUSIONS: Spiral CT with pitch 2 is a reliable tool for lung parenchyma studies which permits to reduce examination time and contrast dose, as well as X-ray tube overload and exposure dose.

Aged↗
PubMed1992

The relationship between education and risk factors for coronary heart disease. Epidemiological analysis from the nine communities study. The Research Group ATS-OB43 of CNR.

In nine samples of adult populations (2707 males and 2871 females, aged 20-59 years) we studied the relationship between educational level and several lifestyle factors at risk for coronary heart disease (CHD), (i.e., smoking, alcohol consumption, dietary fat intake, sedentary behaviour at work and leisure) and the association between education and certain CHD risk factors (i.e., total cholesterol, HDL-cholesterol, triglycerides, systolic and diastolic blood pressure, body mass index). The data were analyzed separately in samples from North, Central and Southern Italy. The results show that educational level is often associated to the lifestyle factors considered here. This association was positive for both men and women for physical activity at leisure and work stress and only for women with respect to smoking. It was negative for both men and women for alcohol consumption and physical activity at work and for men only for cigarette smoking. The age-adjusted mean levels of the CHD risk factors show some significant differences among subjects with different educational levels, which were not always the same for the three geographical areas. This was with the exception of BMI in females, which appears negatively associated to education in all areas. These differences decreased after adjustments were made for daily cigarette smoking, wine consumption and dietary fat intake. Education seems to play a determining role in lifestyle, however, its direct and indirect effects on some major CHD risk factors are somewhat different in areas at different socio-economic conditions.

Adult↗
PubMed1992

[Inherent problems of the use of magnetic resonance in patients with metallic implants currently used in orthopedic practice].

Forty-eight patients with oncologic prosthetic devices (modular rotatory shoulder, Kotz, custom made) and metallic means of fixation (Sherman's plates, Ender's rods, etc.) underwent MRI in order to: 1) assess possible physical changes in the magnetic field or the alloys under examination; 2) detect the presence and type of artifacts, and 3) verify the onset of eventual noxious effects of the alloy on the patient. The diagnostic investigation was preceded by an experimental phase which was characterized by: A) a study of the temperature fluctuations of the alloys when submitted to the magnetic field and to radiofrequency; B) the identification and characterization of the artifacts, as well as C) their physical interpretation. During examination, there was no evidence of any mobilization of the means of fixation, sensation of endogenous heat, or other subjective complaints on the part of the patient. The authors observed that, even in the presence of artifacts, MRI provided good evaluation of the soft tissues around the devices by identifying tumor recurrences in the presence of an oncological prosthesis. MRI was also capable of showing trophic changes in the tissues surrounding the means of fixation. Thus, the method exhibits no contraindications in the study of these patients but, on the other hand, does not allow the evaluation of the integrity or mobilization of the prosthetic devices.

Adolescent↗
PubMed1991

[Magnetic resonance in the study of Wilm's tumor and neuroblastoma].

Eleven patients suffering from neuroblastoma and Wilms' tumor were examined with MR imaging (25 examinations). The results were compared with those obtained with other diagnostic methods--e.g. CT--to verify MR reliability in locating and staging the lesions. Signal patterns were studied, as recorded on T1- and T2-weighted sequences using various repetition and echo times. An attempt was made to verify the presence of pathognomonic findings and to differentiate tumors from post-therapy fibroses. All findings were subsequently confirmed at biopsy or, in the patients who underwent surgery, by surgical findings. To carry out all the procedures, the patients had to be sedated or to be administered a general anesthetic. When possible, a brain or surface coil was used to obtain a clear, well-defined image in thin-section (7-8 mm) sequences. MR imaging allowed all lesions to be detected and located in the examined population. A large thrombus in the vena cava and local adenopathy were observed in a patients suffering from Wilms' tumor. Spread into the spinal canal was present in 2 cases of neuroblastoma. One of the main advantages of MR imaging is its multiplanarity which usually allows lesion extent to be demonstrated, together with the involved organs. The additional advantages of MR imaging over CT should not be underestimated. MR allows images of the abdomen to be obtained devoid of respiratory artifacts and provides a sharp contrast between pathological and healthy tissue without contrast medium administration. In all the patients who underwent it, MR imaging proved superior to CT in the evaluation of the intraspinal spread of paraspinal lesions. MR also allowed serial follow-up to be carried out, with no risk of subsequent proteximetric problems, thus helping distinguish tumor masses from fibrous tissue in all patients.

Abdominal Neoplasms↗
PubMed1991

[Imaging techniques in the staging of carcinoma of the esophagus].

Forty-four patients affected with thoracic esophageal carcinoma underwent preoperative CT to evaluate the value of this method in both staging and assessing the resectability of esophageal tumors. The authors compared the CT findings with intraoperative macroscopic ones, pathologic, and bronchoscopic results in mid-high neoplasms. CT staging criteria were drawn from a careful review of literature and from personal experience. Thirty-nine patients were submitted to surgery, and esophagectomy was possible in 34 of them. CT diagnostic accuracy was higher in proximal esophageal tumors than in sub-bronchial ones; as for the surgical choice, CT provided fundamental guidelines, especially if the choice was a blunt esophagectomy where it is important to exclude tumoral involvement of the airways (accuracy: 82.6%) or of the aorta (accuracy: 89.7%). CT staging accuracy was limited by the low sensitivity of the method in detecting lymphatic (local: 66.6%, distant: 64.2%) and hepatic metastases. Combined thoraco-abdominal CT, tracheobronchoscopy and liver US, besides MR imaging and endoscopic US, allow a better preoperative evaluation of esophageal carcinomas.

Adenocarcinoma↗
PubMed1990

[Short TR--short TE and UTSS sequences compared in a NMR study of focal neoplastic pathology in the liver].

From December 1987 to January 1989, 66 patients were studied by liver MR imaging: 38 of them were found to have liver tumors, and 28 were studied as a control group. The authors' purpose was to compare the diagnostic accuracy of 0.5 T MR imaging to that of other techniques (CT and US), using mixed Spin-Echo and Inversion Recovery sequences (UTSS). Spin-Echo sequences were used first, with very short repetition times (TR 260, TE 20). Mixed sequences (UTSS) followed, both T1-weighted, lasting 12' and 13' respectively, and then T2-weighted Multiecho sequences lasting 9'. T1-weighted Inversion Recovery sequences provided with good contrast between normal and neoplastic parenchyma, and demonstrated all the lesions shown by other techniques. UTSS proved to be the most sensitive sequence in exactly defining the lesion and its relationship to hepatic vessels. Signal characteristics of T2-weighted Multiecho sequences allowed some neoplastic types to be distinguished that were found to have a particular behavior, especially hemangiomas. T1 and T2 maps were used to characterize the different lesions.

Adenoma↗
PubMed1989

[Retrospective analysis of 31 cases of soft tissue tumors. Comparison of MR and surgical and anatomo-pathological findings].

Twenty-five patients (16 with malignant soft-tissue tumors and 9 with suspected recurrence), previously studied with conventional radiography and Computed Tomography (CT), were examined with Magnetic Resonance (MR) imaging. MR findings were surgically and anatomo-histopathologically confirmed. Six more patients with benign lesions were examined for differential diagnosis. MR capabilities are here evaluated to detect and eventually characterize the lesion, and to assess its exact location. No false positives were found, and there was only one false negative, in a case of recurrent Malignant Fibrous Histiocytoma (MFH). In another case of MFH the infiltration of the adjacent vessels and nerves was not imaged. After a careful review of all the examinations, MR imaging appears to be able to provide much information for surgical planning about tumor extent and margins, thanks to its contrast resolution between tumor and surrounding anatomical structures. Therefore, MR imaging can be reasonably employed as the examination of choice when a soft-tissue tumor is clinically suspected, because of the multi-planar images it provides with and of its differential imaging parameters.

Adolescent↗
PubMed1989

[High-resolution computed tomography in injuries to the cervical spine].

Correct orthopedic therapy for traumas of the cervical rachis requires perfect knowledge of the spatial balance of the fracture focus. The authors believe Computed Tomography (CT) to be the most suitable, and often indispensable, method for this purpose. Twenty-four patients were examined for traumatic pathology of the cervical rachis. In 7 cases with clinically minor traumas, the negative outcome of the traditional exam was considered reliable and sufficient for therapeutic purposes. The extant 17 patients were examined also by means of CT, either to better determine the characteristics of skeletal lesions already ascertained with traditional techniques or to assess the presence of clinically-suspected osteo-articular lesions, even with negative conventional X-rays. For 9 of these patients orthopedic treatment was considered sufficient, whereas 8 patients underwent surgery and were subsequently examined with CT, which allowed correct evaluation of postoperative pictures even in the presence of metal prostheses. In 10 cases CT demonstrated the presence of lesions which had not been diagnosed with traditional X-ray techniques.

Cervical Vertebrae↗
PubMed1988

[High resolution computerized tomography in the study of traumatic pathology of the temporal bone].

Thirty-five patients with temporal bone fractures were examined; the fractures were sometimes associated with dislocation of the ossicular chain caused by road fatalities. Computed Tomography (CT) was performed either because of the presence of clinical symptoms associated with trauma of the temporal bone, or because of a hemotympanum discovered during a CT scan of the brain. Thirty-three fractures were detected: 19 longitudinal, 6 transverse, and 8 complex. An incudostapedial dislocation was also detected, together with a displacement of a stapedial prosthesis from the lenticular process of incus, and 3 incus-malleus dislocations associated with fractures. High resolution CT allows the precise definition of the course of the fractures, of the associated dislocation of the ossicular chain, and of facial nerve lesion, thus allowing a more accurate surgical intervention. In the examination of the temporal bone, high resolution CT is preferable to pluridirectional tomography because it is easier and faster to perform. Moreover, high resolution CT helps reduce the radiation dose, and yields higher-quality images with more accurate diagnostic information. High resolution CT also allows the brain and the temporal bone to be studied at the same time.

Adolescent↗
PubMedDate not supplied

Signal suppression of normal liver tissue by phase corrected inversion recovery: a screening technique.

A new pulse sequence characterized by simultaneous multislice spin echo (SE) and short inversion time (TI) with inversion recovery (STIR) acquisitions is demonstrated. For the STIR component, a repetition time of 1,000 ms and TI of 210 ms were chosen to suppress the signal from normal liver at 0.5 T and create a fast sequence suitable for screening purposes. Phase correction of the STIR with the SE's signal as a reference resulted in high contrast real IR images that were free of phase error artifact. In 13 min the entire liver could be imaged in 14 adjacent slices, each slice portrayed in an ensemble of four images: a T1-weighted SE image, IR real and modulus images, and a T1 map. Forty-one patients with liver pathology and 10 normal volunteers were examined with the sequence implemented on a commercially available 0.5 T imager (Gyroscan; Phillips). Images demonstrated high liver-lesion contrast and sensitivity to liver lesions. Lesions of less than 1 cm in diameter and lymphomatous lesions, commonly occult to magnetic resonance, were detected.

Humans↗
PubMedDate not supplied

[Reservations in the routine use of preoperative urography in colorectal carcinomas].

The diagnostic utility of preoperative intravenous urography (IVU) carried out in patients with carcinoma of the large bowel is still controversial. In the period between 1978 and 1984 only 8 out of the 347 patients undergoing surgery for carcinoma of the large bowel showed urinary tract involvement at operation. IVU had been carried out in 106 patients before surgery. The survey results agreed with histological reports in 103 case records: 101 true negative, 2 true positive. Two false positive cases and one false negative were also found. Among the eight patients who at surgery revealed urinary tract involvement, only in three IVU had been proposed; in the remaining 5 cases it had not been requested. It may be suggested that the early recognition of colon carcinoma does not allow the neoplasia to further develop in the urinary tract, at least not in as high a percentage as in the past. We therefore deem it necessary to use at first less invasive and faster methods, such as echography, limiting IVU to those cases where a well-grounded clinical suspicion or a previously executed echography suggest deeper investigation.

Adult↗
PubMedDate not supplied

The role of magnetic resonance in necrosis of the femoral epiphysis as the sequelae of acetabular fracture (preliminary results).

Eleven patients surgically treated for fracture of the acetabulum were examined postoperatively by MRI in order to reveal any signs of necrosis of the femoral head at an early stage. The means of osteosynthesis used underwent preliminary testing in order to exclude magnetic or thermal phenomena. The study confirmed the usefulness of this test in the early diagnosis of this serious complication. In 3 cases the presence of the means of osteosynthesis obstructed a correct interpretation of the images.

Acetabulum↗