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Biomedical subjects

F Milani

Publications and source records attributed to F Milani.

At least 19 recordsLinked to original sources
PubMed2000

Some aspects of erythrocyte metabolism in a dog with polycythaemia vera.

An 11-year-old female crossbred dog showed signs of polyuria, polydipsia, vomiting, posterior weakness and ataxia. Clinical and laboratory findings suggested the diagnosis of polycythaemia vera. The haematological values shown over a six-month period are presented. In four samples some aspects of erythrocyte function (glucose-6-phosphate dehydrogenase [G6PD] and pyruvate kinase [PK] activities, 2,3 diphosphoglycerate [2,3 DPG] concentration, osmotic fragility and intracellular sodium and potassium concentrations) were studied. Variable activities of G6PD and PK, probably related to different reticulocyte number, were detected together with normal osmotic fragility and intracellular sodium and potassium concentrations. 2,3 DPG concentration was higher than normal in all four samples. This could be interpreted as a response to a low tissue perfusion rather than a higher content of 2,3 DPG in red blood cells from the polycythaemic dog.

2,3-Diphosphoglycerate↗
PubMed2000

Cutaneous manifestations of marantic endocarditis.

A 70-year-old patient with a history of hypertension and hypercholesterolemia was referred for evaluation of necrotic toes. The patient had a history of several cerebrovascular accidents during the previous month. Initially, she developed sudden-onset left upper extremity weakness which, over the ensuing 4 days, progressed to complete left-sided weakness. This was followed by the development of acute dysarthria. A transesophageal echocardiogram revealed moderate left ventricular hypertrophy, several vegetations on her tri-leaflet aortic valve associated with moderate aortic regurgitation, and a large right atrial thrombus with a mobile component. Bubble studies failed to reveal any septal defects. The patient's electrocardiogram was nonspecific. As serial blood cultures were negative despite fevers of up to 39.8 degrees C, the patient was treated with a 6-week course of intravenous ceftriaxone, ampicillin, gentamicin, and ciprofloxacin for a presumed diagnosis of culture-negative endocarditis. Fungal cultures of the blood were negative. The patient, however, progressed and developed several necrotic toes. Physical examination was significant for ischemic changes of the left first, second, third, and fifth toes, as well as the right first and second toes. Diffuse subungual splinter hemorrhages in the toenails, numerous 2-4-mm palpable purpuric papules on the lower extremities, and nontender hemorrhagic lesions of the soles were also noted. Peripheral and carotid pulses were intact and no carotid bruits were heard. Cardiopulmonary and abdominal examinations were unremarkable. Neurologic examination revealed a disoriented, dysarthric patient with left central facial nerve paralysis, as well as spasticity, hyperactive reflexes, and diminished strength and sensation in the left upper and lower extremities. A left visual field defect and left hemineglect were also present. The patient's last brain computerized tomogram revealed areas of low attenuation consistent with cerebral infarctions in three distinct areas of the brain. These included the left occipitotemporal area, the right parieto-occipital area, and the right posterior frontal region. The regions affected were in the distribution of both the anterior and posterior circulation. No evidence of hemorrhage was noted. The patient subsequently complained of abdominal discomfort. A computerized tomogram of the abdomen with oral and intravenous contrast revealed a 4-cm x 3-cm irregular mass in the tail of the pancreas with several low-attenuation lesions throughout the liver which were consistent with infarctions or metastases. Several splenic infarctions were also present. A biopsy of the tumor revealed pancreatic adenocarcinoma. The patient's carcinoembryonic antigen level was 18. 4 ng/mL (0-3) and the CA 19-9 antigen level was 207,000 U/mL (0-36). The alpha-fetoprotein level was normal. Other significant laboratory findings included a prothrombin time of 16.7 (international normalized ratio, 1.4), an activated partial thromboplastin time of 32 (ratio, 1.3), and a platelet count of 85,000/mm3. The Russell viper venom time, sedimentation rate, and C3 levels were normal, and the patient was negative for antinuclear antibodies, anticardiolipin antibodies, and antibodies to extractable nuclear antigens. Of note, the patient was not receiving any anticoagulation. Blood cultures for mycobacteria and fungi, human immunodeficiency virus serology, and urinalysis and culture were negative. The patient subsequently developed an inferior wall myocardial infarction and was transferred to the coronary care unit. In line with the family's request, aggressive care was ceased and the patient expired. The patient's family refused an autopsy.

Adenocarcinoma↗
PubMed1997

Laser microsurgery for superficial T1-T2 basal cell carcinoma of the eyelid margins.

BACKGROUND: Basal cell carcinoma (BCC), the most common malignancy of the eyelid margins, poses therapeutic problems. Surgery, radiation therapy, and cryotherapy are the currently accepted methods for the treatment of this affliction. To verify the technical and clinical effectiveness of the surgical laser method, a specific approach was developed by performing laser-combined procedures under microscopic control. METHODS: A series of 26 patients underwent carbon dioxide (CO2) laser microsurgical excision of 27 primary superficial BCCs of the eyelid margins. Eighteen tumors were T1 and 9 were T2. The lesions were located at the lid margins in 18 and at the canthus in 9 cases. The eyelash line was involved in all cases, whereas intermarginal space was involved in 17 cases, without extension to the conjunctival border. Six lesions were in the lacrimal region. Median linear extent of the lesion was 5 mm (range, 4-10 mm). Treatment was performed with the patient under local anesthesia in a Day Hospital regimen. The authors used the microscope-mounted CO2 laser as a scalpel to excise the tumor mass, thus obtaining the specimen for histologic evaluation. The authors treated the deep and lateral resection margins with laser vaporization and left the wound bed to heal by secondary intention. RESULTS: No significant complications were observed. As full-thickness eyelid resections were avoided, the authors noted conservation of lid function and cosmetic aspect in all patients. With a median follow-up of 73 months (range, 18-118), only one patient had tumor recurrence after 22 months. This tumor, located at the outer canthus, had a second microsurgical laser excision, and the patient is disease free 51 months after the last treatment. CONCLUSIONS: Laser microsurgery appears to be a safe and effective treatment method for primary superficial T1 and T2 BCC of the eyelid margins without conjunctival extension.

Adult↗
PubMed1995

Determination of platinum in plasma of patients affected by inoperable lung carcinoma treated with radiotherapy and concurrent low-dose continuous infusion of cis-dichlorodiammine platinum(II).

Platinum microquantities were determined in plasma of patients affected by lung carcinoma during treatment with radiotherapy (RT) and concurrent low-dose continuous infusion of cis-dichlorodiammineplatinum(II) (CDDP). RT was given at 50 Gy in continuous course; CDDP was continuously infused at 4 mg/m2 daily for 100 h/week for 5 weeks, and the infusions were separated by 68 h of rest. The percentage of free drug versus total drug in plasma was about 3%. It did not vary with therapy duration and was not significantly different from that found in 5-day continuous infusions at much higher daily doses. Nevertheless, maximal values of free Pt in plasma were very low and agreed with the low level of CDDP toxicity encountered on the present administration schedule.

Carcinoma↗
PubMed1995

[Advantages of a system of positioning and localization made of thermo-conformable materials for irradiation of cervicofacial and encephalic lesions treated with stereotactic fractionated radiation].

In this work we first analyzed the reliability of materials supplied by the main firms, which must be considered when defining the lesion and planning target volume. The coordinates of specific target landmarks, i.e., bone, calcium deposition or catheters, on baseline CT scans were compared with those measured on control scans. Since the PLATO-SRS system yields 3 coordinates for each target, the final error is calculated by the evaluation of the shift of the different coordinates. The mean error reported for the first material (ORFIT) was 5 mm (13/23 patients). This margin of error is too high and was considered unacceptable; a second material was then tested. The latter, which is not recyclable and softens at higher temperatures, exhibited a mean error of 2.5 mm (10/23 patients), which allows daily repositioning of greater reliability. Treatment was repeated in 4/20 arcs in all, which number depended mainly on fraction size. Correct lesion location and patient positioning were allowed by laser landmarks on the mask made directly on the treatment couch. The laser too was checked before each treatment session, i.e., preferentially at the end of an ordinary working day.

Brain Neoplasms↗
PubMed1995

A summary of the Milan experience with multimodality therapies in patients with small cell lung cancer: attempts to improve long-term outcome.

From February 1985 to June 1993, 173 consecutive, previously untreated patients with small cell lung cancer received individualized treatment tailored to disease extent. Almost all patients (14 of 16) with stage I and II disease and 30 patients with operable stage III disease were submitted to surgery preceded or followed by chemotherapy. Chest irradiation and prophylactic brain radiotherapy (in complete responders) were administered at the end of treatment in 42 of 44 cases. Patients with inoperable limited disease received chemotherapy followed by radiotherapy in 67 of 71 cases, while chemotherapy alone or followed by radiotherapy in sites of either initially bulky or residual disease was administered to 58 patients with extensive disease. The overall response rate was 77% (complete response, 45%; partial response, 32%). Complete responses were documented more frequently in limited disease than in extensive disease (57% v 22%; P < .001). The 2- and 5-year freedom from progression rates (24% and 16%, respectively), as well as overall survival rates (31% and 16%, respectively) were significantly affected by disease extent. No patient with extensive disease was progression free and alive at 2 years, while more than half of stage I and II patients were disease free and alive at 5 years. This retrospective analysis performed on a large number of consecutive, nonrandomized patients suggests that, at least in patients with limited disease, it is possible to achieve favorable long-term results using treatment tailored to disease extent. Nonetheless, the disappointing results commonly achieved in the treatment of small cell lung cancer strongly support the need for either prospective, randomized studies to confirm recently reported improved results or new pilot studies with investigation of entirely innovative approaches.

Adult↗
PubMed1994

Surgery after radiochemotherapy for stage III lung cancer: postoperative complications and late results.

Fifty-seven stage III lung cancer patients underwent radiochemotherapy and subsequent surgery. Forty radical (R-), six non-radical, and eleven exploratory operations were performed. Pneumonia (five cases), pulmonary insufficiency (one case), bronchial fistula (one case) were the major non-fatal complications. Four deaths due to adult respiratory distress syndrome (ARDS) or pulmonary embolism occurred. Sixty percent of the 10 patients who had no viable tumor at operation survived 3 years, as well as 41% of those who achieved a complete remission by resection and 11% of those with residual disease (R+) after operation. However, the 1- and 2-year survival rates were similar. The main pattern of failure in R- and R+ patients was extra- and intra-RT-field progression, respectively. A slightly higher rate of postoperative complications, with respect to current practice, was observed. However, data lead to argument on the improvement of locoregional control and long-term survival following radical surgery.

Carcinoma↗
PubMed1994

[Value of magnetic resonance in the staging of non-small-cell lung carcinoma].

In the last six years, 544 consecutive patients with nonsmall-cell bronchogenic carcinoma were studied with MRI. MR results were compared with surgical specimens and pathologic findings. Both TNM classification and ATS nodal mapping were considered. Local tumor extent (T parameter) was correctly identified in 67.2% of cases, understaged in 19.4% and overstaged in 13.4%. Lymph node metastases (N parameter) were adequately assessed in 55.5% of cases, understaged in 20.3% and overstaged in 24.2%. Considering two groups of patients, the first one with early stage disease (T1-T2, N0-N1) and the second one with advanced stages (T3-T4, N2-N3), MRI exhibited 84.6% overall accuracy, 57.3% sensitivity and 93.7% specificity for the T parameter and 72.3% accuracy, 65.2% sensitivity and 75.1% specificity for the N parameter. In conclusion, MRI did not provide the expected results in the staging of nonsmall-cell bronchogenic carcinoma, but improvement will probably be achieved with technological evolution.

Carcinoma, Non-Small-Cell Lung↗
PubMed1993

Preoperative concomitant cisplatin/VP16 and radiotherapy in stage III non-small cell lung cancer.

PURPOSE: To evaluate the therapeutic effectiveness of a combined chemoradiotherapy program, followed by surgery in selected cases, in Stage III non-small cell lung cancer. METHODS AND MATERIALS: Between August 1988 and February 1990, 43 patients Staged IIIa-b (UICC 1987, 58% IIIb) have been treated with concomitant chemotherapy (cisplatin 15 mg/m2 and VP16 75 mg/m2, 5 days a week on week 1 and 5) and radiotherapy (40 Gy split course, 2 Gy/day on week 1, 2, 5, and 6), followed by attempted curative thoracotomy or more cycles of full dose chemotherapy with the same two drugs. RESULTS: Planned chemoradiotherapy has been given to 91% of patients; 13/43 patients have been operated, with 12 complete resections and three (7%) pathological complete responses. Toxicity was significant, with two postoperative deaths and two fatal radiation pneumonitis. Crude progression-free survival rate is 21% at 30 months, with nine patients (21%) alive and free from progression at follow-up times ranging from 31 to 49 months. Subset survival analysis showed a possibly greater therapeutic effect for non-squamous histology as compared to squamous carcinoma. CONCLUSION: These results are encouraging in a cohort of patients with quite advanced disease (58% Stage IIIb).

Adult↗
PubMed1993

Conventional radiographic follow-up in the irradiated lung.

AIMS: To highlight the different changes induced in lung tissues by various forms of radiotherapy (RT) according to tumor site and type. METHODS: A retrospective analysis of the roentgenographic evaluation of and long-term follow-up data on 2375 patients who received RT for various intrathoracic and extrathoracic tumors at the National Cancer Institute of Milan. RESULTS: The iconographic patterns of post-RT changes, grouped by site and type of tumor and RT procedure and described in detail, afford deeper insight into a little-known area of lung pathology. CONCLUSIONS: These descriptions of common and uncommon patterns of the irradiated lung as they appear on conventional chest roentgenograms enable the radiologist and radiotherapist to assess exactly the response of tumor and lung tissues and to plan the most appropriate clinical follow-up.

Follow-Up Studies↗
PubMed1993

Radiobiologic and pathologic characteristics of the irradiated lung and roentgenographic aspects.

AIMS: Experimental radiobiologic factors help to better understand and interpret the development of radiographic alterations in lung tissues due to radiant treatments. In this paper the authors summarize the radiologic factors and technical bases about radiotherapy of the lung. METHODS: The conventional radiologic iconography has been examined in a large series of patients (n = 2151) with iatrogenic pulmonary lesions determined by various types of antineoplastic radiant treatments at the Istituto Nazionale Tumori of Milan. RESULTS: A radiologic control and a long follow-up is essential to assess the successive phases of postactinic lesions due to "passive" irradiation therapy for any type of non-endothoracic tumor as well as those due to "necessary" lung radiotherapy for endothoracic neoplasms. CONCLUSIONS: A strict relation has been found between the aspects in conventional radiologic iconography and the corresponding lesions in the irradiated lung.

Humans↗
PubMed1993

Endoscopic treatment of postradiation strictures.

BACKGROUND: Esophageal stricture is a rare complication of radiotherapy: reports on its incidence and management are therefore anecdotal. METHODS: From January 1978 to September 1992, 44 patients presenting with an esophageal stricture related to a previous radiation treatment were endoscopically dilated at the Endoscopy Division of the Istituto Nazionale Tumori of Milan. RESULTS: Esophageal recanalization was obtained in 95% of the patients treated, and in 79% of these normal eating habits were restored. No strict correlation was observed between radiation dose and severity of the stricture, or time elapsed between first treatment and endoscopic dilation. CONCLUSIONS: In our experience, endoscopic dilation was a safe effective procedure and represented an effective palliative tool in dysphagic patients with esophageal strictures due to previous local radiotherapy.

Adult↗
PubMed1993

Non-resectable Stage IIIa-b lung carcinoma: a phase II study on continuous infusion of cisplatin and concurrent radiotherapy (plus adjuvant surgery).

Thirty-eight patients with non-resectable non-small-cell Stage IIIa-b lung cancer were treated in a Phase II study with radiotherapy (50 Gy in a 25-fraction split-course) plus con-current continuous infusion of cisplatin given at a daily dose of 6 mg/m2, with the aim of investigating its radiopotentiation properties. Treatments were given on an outpatient basis by means of a central venous catheter and a portable pump. Adjuvant surgery was undertaken when feasible. Toxicity was mild to moderate. The probability of a partial or complete locoregional response at 4 weeks after treatment completion was 83% (confidence limits at 95%: 13). Eighteen patients were resected. Overall 1-, 2- and 3-year progression-free survival probabilities were 42, 24 and 21%. These figures were 63, 37 and 24% in observed survival curves. Patients with squamous-cell tumors had observed survival rates of 82, 50 and 28% at 1, 2 and 3 years, compared to 42, 19 and 19% in patients with non-squamous histology. The high response and survival rates obtained at a low price according to toxicity require further investigation.

Adult↗