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Biomedical subjects

G Casella

Publications and source records attributed to G Casella.

At least 37 records · Page 2Linked to original sources
PubMed2001

Outcome of percutaneous coronary angioplasty (PTCA) performed in a low-volume institution by low-volume operators, evaluated by means of the one-month major adverse cardiac event rate.

BACKGROUND: Since an inverse relationship between percutaneous coronary angioplasty (PTCA) case-load and in-hospital major adverse cardiac events (MACE) exists, we intended to evaluate the performance of low-volume PTCA operators, during the first year of our interventional program, by applying the more accurate index represented by the MACE rate within the first month. METHODS: The data relative to both the PTCA procedure and the control visit 3-4 weeks later, were retrospectively reviewed. Death, myocardial infarction and need for revascularization were the end-points evaluated, both globally and with respect to the individual operators. RESULTS: During 1999, 61 consecutive patients (53M, 8F; mean age: 59.9+/-10.4 years) were treated by two full-trained operators. Stable angina was the indication in 75% of cases. Comorbidities as diabetes and prior revascularization, were present in 16 and 5% of cases, respectively. Multivessel procedures were performed in 33% of cases, with a total number of lesions of 84 (77% A/B1 type). Stents were implanted in 70% of cases, as a bail-out in 12%. Procedural success rate was 93%. Overall one-month MACE rate was 3.3%, accounted for by 1 in-hospital emergency coronary surgery occurred to operator 1 (3.6% one-month MACE rate) and 1 elective coronary operation performed in a stable patient previously treated by operator 2 (3% one-month MACE rate). CONCLUSIONS: PTCA performed in a low-volume center by low-volume operators is not necessarily associated with a poor outcome, provided that adequate selection of low-risk cases is accomplished. Although only 52% of the Italian centers met in 1999 the recommended volume standards, reaching optimal case-load should anyway be pursued. Some time should however be conceded, provided that close monitoring of one-month MACE rate shows adequate performance of both the institution and the operators.

Angioplasty, Balloon, Coronary↗
PubMed2000

Variation in the volume of zebra finch song control nuclei is heritable: developmental and evolutionary implications.

In many songbird species, females prefer males that sing a larger repertoire of syllables. Males with more elaborate songs have a larger high vocal centre (HVC) nucleus, the highest structure in the song production pathway. HVC size is thus a potential target of sexual selection. Here we provide evidence that the size of the HVC and other song production nuclei are heritable across individual males within a species. In contrast, we find that heritabilities of other nuclei in a song-learning pathway are lower, suggesting that variation in the sizes of these structures is more closely tied to developmental and environmental differences between individuals. We find that evolvability, a statistical measure that predicts response to selection, is higher for the HVC and its target for song production, the robustus archistriatalis (RA), than for all other brain volumes measured. This suggests that selection based on the functions of these two structures would result in rapid major shifts in their anatomy. We also show that the size of each song control nucleus is significantly correlated with the song related nuclei to which it is monosynaptically connected. Finally, we find that the volume of the telencephalon is larger in males than in females. These findings begin to join theoretical analyses of the role of female choice in the evolution of bird song to neurobiological mechanisms by which the evolutionary changes in behaviour are expressed.

Animals↗
PubMed2000

Hyperventilation increases muscle protein synthesis in critically ill trauma patients.

BACKGROUND: Critically ill trauma patients are often in negative nitrogen balance and demonstrate advanced muscle protein wasting, which is in part due to a decrease in muscle protein synthesis. Previous studies have been performed on the relationship between pH and protein metabolism. Some evidence suggests that alkalosis might enhance protein synthesis. The purpose of the present study is to determine whether protein synthesis is increased in trauma patients who have a respiratory alkalosis from hyperventilation. METHODS: Trauma patients in the intensive care unit (n = 8) who were treated with hyperventilation for elevated intracranial pressures were enrolled. Muscle protein synthesis rates were determined in vivo using the flooding method with l-[(2)H(5)]phenylalanine. Measurements were performed twice on each patient within a 36-h period, first during hyperventilation and then after hyperventilation was discontinued. Hemoglobin oxygen saturation was maintained above 95% for all measurements. RESULTS: Protein synthesis in muscle was 1.38 +/- 0.11%/day during hyperventilation (pH 7.50 +/- 0.02, pCO(2) 27.3 +/- 1.0 mm Hg) and 0.93 +/- 0.15%/day after respiratory parameters were normalized (pH 7.39 +/- 0.01, pCO(2) 39.4 +/- 1.5 mm Hg). The synthesis rate was significantly higher (P < 0.01, paired t test), 0.46 +/- 0.13%/day (32.6%), at the time of hyperventilation. CONCLUSION: Muscle protein synthesis is elevated during hyperventilation in critically ill patients with traumatic brain injury. We believe this preliminary study provides data that warrant confirmation in larger clinical studies. It suggests that this ventilatory therapeutic strategy may have a role in mitigating the negative nitrogen balance and muscle protein wasting that can impair the recovery of these patients.

Adult↗
PubMed2000

A phase I study of gemcitabine and epirubicin for the treatment of platinum-resistant or refractory advanced ovarian cancer.

BACKGROUND: Gemcitabine is active in patients with otherwise resistant or refractory ovarian cancer. As the drug is well tolerated, studies using gemcitabine combined with other antineoplastic agents are needed. The aim of the study was to determine the maximum tolerated dose (MTD) of epirubicin combined with gemcitabine, with and without support of G-CSF. PATIENTS AND METHODS: Patients with platinum-resistant or refractory ovarian cancer were eligible. Gemcitabine (G) (starting dose 800 mg/m2 day 1 and 8; 200 mg/m2 escalation per level) and epirubicin (E) (starting dose 60 mg/m2 day 1; 15 mg/m2 escalation per level) were given every 21 days for four to six cycles. G-CSF (filgrastim 5 microg/kg/die) was given in case of grade 4 neutropenia (levels without support) or from day 9 up to leukocyte count > 10.000/mm3 after nadir (levels with support). Cohorts of three patients were enrolled at each level, and another three patients were planned, if one dose-limiting toxicity (DLT) was registered. MTD was determined first without and then with G-CSF. RESULTS: Four levels were studied (G 800 + E 60; G 1000 + E 60; G 1000 + E 75; G 1000 + E 75 + G-CSF) with four, four, three and three patients enrolled, respectively. DLT (grade 4 febrile neutropenia) was observed in two patients at level 3. Thus, G1000 + E 60 mg/m2 was the MTD without G-CSF. The addition of prophylactic G-CSF did not allow a further increase of the dose and grade 4 thrombocytopenia was the DLT at level 4. Non-hematological toxicity was mild. Grade 2 mucositis was reported in four patients. Among the 13 patients with measurable or evaluable disease, 3 partial responses were observed for an overall response rate of 23.1%. CONCLUSIONS: The combination of gemcitabine 1000 mg/m2 (day 1, 8) and epirubicin at 60 mg/m2 (day 1) is a feasible therapy. Grade 4 neutropenia is frequent and G-CSF support is often required. With prophylactic support of G-CSF, the DLT is thrombocytopenia.

Adult↗
PubMed2000

Phase I study with weekly cisplatin-paclitaxel and concurrent radiotherapy in patients with carcinoma of the cervix uteri.

BACKGROUND: Cisplatin and paclitaxel are active in cervical cancer and both are able to potentiate the effects of radiotherapy. In this study we evaluated the maximum-tolerated dose (MTD) of paclitaxel in combination with a fixed dose of cisplatin when given weekly concurrently with pelvic radiotherapy to patients with carcinoma of the cervix uteri. PATIENTS AND METHODS: Eighteen patients with cervical cancer were enrolled in this study. Cisplatin (30 mg/m2) and paclitaxel (starting dose 40 mg/m2; 5 mg/m2 escalation per level) were given on day 1 of radiotherapy and then weekly for six times. Radiotherapy was given to the pelvis with a four-field box technique for five days each week. Patients received 65 Gy in 1.8 Gy fractions. Cohorts of three patients were enrolled at each level and three further patients were included if one or two dose-limiting severe adverse events (SAE) were recorded. SAE was defined as grade 3 or 4 nonhematologic toxicity, excluding nausea or vomiting and alopecia, grade 4 neutropenia or thrombocytopenia, and prolonged (> 1 week) neutropenia or thrombocytopenia. RESULTS: Four levels were studied (paclitaxel 40, 45, 50, 55 mg/m2) with three, five, four and six patients enrolled, respectively. The MTD of paclitaxel was found at 50 mg/m2/wk and cisplatin 30 mg/m2/wk. Diarrhea was the dose-limiting toxicity. Thirteen patients were evaluable for response: seven complete and five partial responses were obtained with an overall response rate of 92.3%. CONCLUSIONS: The MTD of paclitaxel is 50 mg/m2/wk when associated to cisplatin 30 mg/m2/wk and concurrent pelvic radiotherapy. Diarrhea is the dose limiting side effect. Preliminary data suggest that concurrent chemoradiotherapy with paclitaxel and cisplatin could be a very active treatment for patients with locally advanced carcinoma of the cervix.

Adenocarcinoma↗
PubMed2000

Hypocalcemic tetany due to coeliac disease. May this symptoms disappear?

We described a rare case of hypocalcemia whit tetanic symptoms. This condition of our patient could be avoided if some symptoms, present from many years, were diagnosed as factors related to coeliac disease, anemia was present from many years and it was more important during four pregnancies. The appearance of diffuse bone pain from two years is correlated to a metabolic osteopathy due to coeliac disease. Unexplained increase of liver enzymes is an expression of coeliac disease. We stress the importance to always consider extra-intestinal manifestation of coeliac disease in every patients, because this disease has an high incidence (1 in 200 people). Our patient could had important clinical advantages, if his disease was diagnosed by extra-intestinal alterations (anaemia, bone pain and increased blood levels of liver enzymes in our patient). Coeliac disease must be researched in every different and particular clinical and sub-clinical manifestation; in 65% of all cases, the patients with coeliac disease haven't gastrointestinal symptoms.

Journal Article↗
PubMed1999

Pressure-wire guided balloon angioplasty in allograft coronary vasculopathy.

We report a case of successful percutaneous transluminal coronary angioplasty guided from pressure-wire measurements in a transplanted patient. Fractional flow reserve, a lesion-specific, pressure-independent index of functional stenosis severity, was used to guide the intervention.

Angioplasty, Balloon, Coronary↗
PubMed1999

A phase I study of paclitaxel and epirubicin, without and with filgrastim, for the treatment of platinum-resistant advanced ovarian cancer.

The aim of the study was to determine the maximum tolerated dose (MTD) of epirubicin combined with a fixed dose of paclitaxel, without and with support of filgrastim, in patients with platinum resistant or refractory ovarian cancer. Paclitaxel (150 mg/m2) and epirubicin (starting dose 90 mg/m2, 15 mg/m2 escalation per level) were given on day 1, every 28 days for 4-6 cycles. Filgrastim (F) (5 microg/kg/die) was given in case of grade 4 leukopenia (levels without support) or from day 4 up to leukocyte count >10,000/mm3 after nadir (levels with support). Cohorts of 3 patients were enrolled at each level and further 3 patients were planned if 1 or 2 unacceptable toxic events (UTE) were registered. MTD was determined first without and then with filgrastim. Four levels were studied (90, 90+F, 105+F, 120+F) with 4, 6, 5 and 4 patients enrolled, respectively. UTE (grade 4 neutropenia) were observed in 3 patients at level 1. Thus, 90 mg/m2 was the MTD for epirubicin without filgrastim. MTD of epirubicin with filgrastim was not reached at 120 mg/m2. Hematological toxicity was mild. Grade 3 mucositis was reported in 1 patient. Among the 14 patients with measurable or evaluable disease, 3 objective responses were observed (1 complete and 2 partial) for an overall response rate of 21.4%. The combination of paclitaxel 150 mg/m2 and epirubicin at 120 mg/m2 with filgrastim is a feasible therapy. Grade 4 leukopenia is the dose limiting toxicity using epirubicin at 90 mg/m2 without filgrastim.

Adult↗
PubMed1999

Phase II study of cisplatin and vinorelbine as first-line chemotherapy in patients with carcinoma of the uterine cervix.

PURPOSE: To evaluate the activity and toxicity of the combination of cisplatin (80 mg/m2 day 1) and vinorelbine (25 mg/m2 days 1 and 8) in patients with carcinoma of the uterine cervix that has not been previously treated with chemotherapy. PATIENTS AND METHODS: Fifty patients with cervical cancer were enrolled onto this study (27 stage IB-III, 23 stage IVB-recurrent). A two-stage optimal Simon design was applied. Thirteen responders of 29 treated patients were required to proceed beyond the first stage, and 28 responders were needed overall. RESULTS: Hematologic toxicity was mild, with neutropenia being the most frequent side effect. Nonhematologic toxicity was frequent but never severe; one patient had grade 3 peripheral neurotoxicity. Objective responses were recorded for 32 patients (64%): 11 patients (22%) achieved a complete response (CR) and 21 patients (42%) achieved a partial response (PR). The response rate was 81.5% in patients with IB-III stage (25.9% CR rate) and 43.5% in patients with IVB-recurrent disease (17.4% CR rate). Responses were seen both in stage IVB patients (one CR and two PRs, for an overall rate of 37.5%) and in patients with recurrent disease (three CRs + four PRs, for an overall rate of 46.7%). CONCLUSION: The combination of cisplatin and vinorelbine is an active regimen in the treatment of patients with early-stage and advanced carcinoma of the uterine cervix. The hematologic and nonhematologic toxicity of this combination is mild.

Adult↗
PubMed1999

Successful treatment of coronary artery perforation during angioplasty using a new membrane-coated stent.

We report a case of successful treatment of coronary artery perforation and cardiac tamponade, which developed during percutaneous transluminal coronary angioplasty, with a PTFE-coated stent. Intravascular ultrasound was first used to overcome the shortcomings of conventional angiography and overlapping of a conventional stent was not as effective as coated-stent placement in sealing a further leakage. Thus, PTFE-coated stents may be an effective alternative to emergency surgery or autologous venous covered stenting and should be considered when coronary artery perforation occurs.

Aged↗
PubMed1998

Antithrombin III (ATIII) replacement therapy in patients with sepsis and/or postsurgical complications: a controlled double-blind, randomized, multicenter study.

BACKGROUND: ATIII is decreased in sepsis and/or shock and its baseline value correlates with mortality. The efficacy of ATIII therapy on mortality was assessed in a selected group of patients admitted to the intensive care unit (ICU) in a double-blind, randomized, multicenter study. METHODS: 120 patients admitted to the ICU with an ATIII concentration < 70% were randomized to receive ATIII (total dose 24000 units) or placebo treatment for 5 days; 56 patients had septic shock. RESULTS: ATIII concentrations in the treated group remained constant throughout the treatment period (range 97-102%). The Kaplan-Meier analysis showed no difference in overall survival between the two groups: 50 and 46% for ATIII and placebo, respectively. Septic shock and hemodynamic support were unbalanced in the two groups at admission. Therefore the Cox analysis was carried out after adjusting for these two variables. Treatment with ATIII decreases the risk of death with an odds ratio (OR) of 0.56. Of the covariates analyzed, septic shock and the baseline multiple organ failure score were negatively associated with survival and plasma activity level was positively associated with survival with an OR of 0.97 for each 1% increase in the ATIII plasma concentration at baseline. CONCLUSIONS: The results of ATIII treatment in this population of patients suggests that replacement therapy reduces mortality in the subgroup of septic shock patients only.

APACHE↗
PubMed1998

Long-term prognosis of painless exercise-induced ischemia in stable patients with previous myocardial infarction.

OBJECTIVES: This study was designed to better understand the functional correlates and the prognostic relevance of exercise-induced painless ischemia relative to painful ischemia in patients with stable coronary artery disease and previous myocardial infarction (MI). BACKGROUND: The usefulness of exercise testing (ET) for predicting cardiac events, years after MI, although suggested and widely applied, is questionable. In particular, previous studies have reached conflicting conclusions as to whether exercise-induced painless ischemia is related to a less severe myocardial ischemia or to a different prognosis than painful ischemia. METHODS AND RESULTS: Seven hundred sixty-six consecutive stable patients (mean age 57+/-8.6 years, 89% men) with previous MI (mean time from MI 2.8+/-0.75 years) who underwent a Bruce treadmill test and whose data were prospectively entered into our institutional database were enrolled. Patients were followed up for an average of 7+/-0.6 years. End points were (1) cardiac death, (2) cardiac death or nonfatal reinfarction (primary), (3) cardiac death, nonfatal reinfarction, or unstable angina (secondary), and (4) cardiac death, nonfatal reinfarction, unstable angina, or revascularization procedures (secondary, restricted). These patients were retrospectively classified into 4 groups according to exercise test results: (1) painless ischemia, 156 patients; (2) painful ischemia, 75 patients; (3) negative ET, 99 patients; and (4) nondiagnostic ET, the remaining 436 patients. Patients with painless ischemia had less functional impairment and less exercise ischemia than the symptomatic patients (longer exercise duration [P < .001], higher double product [P < .001], higher ischemic threshold [P < .001], and shorter time to ST normalization [P < .001]). Patients with painful ischemia had significantly (P < .0005) increased 6-year risk rates of secondary and restricted end points (49% and 64%, respectively) versus those with painless ischemia (28% and 35%), no inducible ischemia (25% and 27%), or nondiagnostic ET (32% and 37%). Adverse outcomes were mainly the result of higher incidence of unstable angina or revascularization procedures. At multivariate analysis, neither painless nor painful exercise-induced ischemia were independent predictors of end points. CONCLUSIONS: Stable patients with previous MI represent a very low-risk population. In this subset, painless exercise-induced ischemia signifies less severe ischemia than the symptomatic one and has a limited prognostic power. Thus painless exercise-induced ischemia in stable patients with previous MI does not identify patients at increased risk.

Adult↗
PubMed1998

Can exercise testing in patients with a history of myocardial infarction predict fatal and non-fatal reinfarction?

BACKGROUND AND OBJECTIVES: Exercise testing (ET) is the preferred initial strategy for risk stratification in patients who are able to exercise and have an interpretable electrocardiogram. However, although it is often suggested and widely applied, its usefulness years after myocardial infarction (MI) is questionable. Therefore, this study was designed to assess the value of exercise testing in predicting the risk of fatal or non-fatal reinfarction in patients with chronic stable coronary artery disease (CAD) due to old myocardial infarction. METHODS: Our study involved 766 consecutive stable subjects [mean (SD) age 57 (8.6) years; male: 89%] with stable CAD due to old MI [mean time from MI: 2.8 (0.75) years], who underwent a Bruce treadmill test and whose data were prospectively entered into our institutional database. Patients were followed up for an average of 7 (0.6) years. RESULTS: Reinfarction was observed in 62 patients; 54 non-fatal and 8 (13%) fatal. Relative risk (RR) of cardiac death for subjects with reinfarction was 4.02 [95% confidence interval (CI): 2.46 to 6.55]. Univariate predictors of fatal or non-fatal reinfarction were: multivessel disease (RR 7.99, CI 1.12 to 56.82), EF < 40% (RR 2.91, CI 1.64 to 7.17), ST depression on rest ECG (RR 2.4, CI 1.30 to 4.45), BP increase with exercise < 10 mmHg (RR 2.36, CI 1.41 to 3.93), BP/HR interaction < 10 mmHg + < 85% max (RR 2.16, CI 1.24 to 3.76). Markers of reduced risk of recurrence included low-risk Duke Treadmill Score (RR 0.55, CI 0.33 to 0.91) and EF > or = 40% (RR 0.34, CI 0.19 to 0.60). A Cox regression model with clinical and exercise parameters detected ST depression on rest ECG (RR 1.47, CI 1.07 to 2.02), BP increase with exercise < 10 mmHg (RR 1.41, CI 1.07 to 1.87), low-risk Duke Treadmill Score (RR 0.79, CI 0.60 to 1.02). A model with coronary anatomy and ejection fraction was also able to identify multivessel disease (RR 2.95, CI 1.43 to 6.09), EF < 40% (RR 1.62, CI 1.17 to 2.25) and BP increase with exercise < 10 mmHg (RR 2.53, CI 1.35 to 4.71). CONCLUSIONS: Stable patients with a history of MI represent a very low-risk population in whom reinfarction continues to have a severe prognosis. ET is unable to identify subjects in whom there is a risk of recurrence, especially if only ischemic parameters are evaluated (in this setting, a clinical or anatomic risk stratification may be better). The application of the Duke Treadmill Score could help to identify a very low-risk group in which no additional testing is required. Therefore, routine ET in stable patients with a history of MI is better at identifying a very low-risk group than in predicting recurrence.

Adult↗
PubMed1998

Primary malignant melanoma of the vagina: case report.

Primary vaginal melanoma is a very rare gynecological malignant tumor (less than 150 reported cases to-date). Prognosis is poor in spite of treatment. Due to the fact that only small groups of patients have been compared, conservative treatment has usually been recommended. In recent times, radical pelvic surgery has appeared to improve the chances of survival. We present an unusual case of primitive melanoma of the upper-third of the vagina with urethral and urinary bladder infiltration in a 47-year-old woman. Treatment consisted of preliminary pelvic bilateral lymphadenectomy, anterior exenteration, and urinary bladder reconstruction according to the Bricker technique. Four months after surgical treatment, liver metastases were found. Chemotherapy was initiated consisting of 8 cycles every 21 days of fotemustine 100 mg/m2 (day 1) and dacarbazine (DTIC) 250 mg/m2 (days 2-5). Interferon alpha-2-b, 3 MU thrice weekly, for the whole period of chemotherapy, was also administered. The patient is in partial remission one year after surgical treatment.

Antineoplastic Combined Chemotherapy Protocols↗