PubMed Health⌕ Search

Biomedical subjects

G Castelli

Publications and source records attributed to G Castelli.

At least 37 records · Page 2Linked to original sources
PubMed1994

Hair dye use and other risk factors for leukemia and pre-leukemia: a case-control study. Italian Leukemia Study Group.

A case-control study was carried out to examine the relation of three subtypes of leukemia cells and refractory anemia with excess of blasts to selected behavioral and environmental factors. Cases aged 15 years or older were recruited in three hospitals located in Rome, Bologna, and Pavia, respectively. Outpatients who were either normal or had nonneoplastic hematologic disorders and were seen in the same hospitals as the cases were enrolled as controls. Two hundred fifty-two patients with acute myeloid leukemia, 100 with acute lymphocytic leukemia, 111 with refractory anemia with excess of blasts, 156 with chronic myeloid leukemia, and 1,161 controls were included in the study. Refractory anemia with excess of blasts and chronic myeloid leukemia were included because they are regarded as forms of pre-leukemia. Odds ratio estimates were generally imprecise, but associations were suggested between specific case subtypes and exposure to dark hair dye, selected occupations (shoemaker, painter, electrician, child care), residence in houses built with tuff, and smoking. Although the exploratory nature of the study and its limited statistical power preclude firm conclusions, its results are consistent with those of previous studies, and are in general biologically plausible.

Adolescent↗
PubMed1994

Early-stage Hodgkin's disease: long-term results with radiotherapy alone or combined radiotherapy and chemotherapy.

BACKGROUND: Controversy still exists over the optimal management of early-stage Hodgkin's disease (HD); presentation features may have a different prognostic impact according to initial therapy, and long-term toxicity must be fully evaluated. PATIENTS AND METHODS: This study included 164 patients with stage IA-IIA HD treated with radiotherapy (RT) alone or combined radio- and chemotherapy (CT) according to presenting features and their attendant prognostic significance. The RT group included 88 patients with favorable prognostic features; the combined modality group included 76 patients with one or more unfavorable features. In the RT group, 85% of patients received extended-mantle or STNI; in the combined modality group, RT consisted of mantle- (49%), extended mantle- (37%), and involved-field irradiation (14%); CT consisted of 6 cycles of MOPP before 1984; 3 cycles of ABVD were substituted for MOPP thereafter. RESULTS: Complete remission was obtained in 94% and 99% of patients of the RT and combined modality groups, respectively. The 10-year actuarial relapse-free survival (RFS) in the RT group was 62% and was influenced by stage (p = 0.04) and histology (p = 0.01); in the combined modality group, RFS was 88% and was influenced by the presence of bulky disease. Overall survival and tumor mortality between the therapy groups were comparable. RT-related toxicity consisted of mediastinal fibrosis (8 cases), myelitis (3), hypothyroidism (2); other long-term events included 2 cases of acute leukemia in the combined MOPP and RT group. Altogether, 8 of 20 patients who died were in their first complete remission. CONCLUSIONS: In stage IA-IIA HD, the combined modality therapy reduced the risk of relapse compared to radiation alone; long-term toxicity of RT was not negligible and relapses could occur late.

Adolescent↗
PubMed1994

Analysis of long-term results and prognostic factors among 138 patients with advanced Hodgkin's disease treated with the alternating MOPP/ABVD chemotherapy.

BACKGROUND: A prospective study was conducted to assess (a) the long-term results and toxicity of the alternating MOPP/ABVD regimen in advanced Hodgkin's disease; (b) the prognostic value of pretreatment variables and of drug dose intensity. PATIENTS AND METHODS: A total 138 consecutive patients with advanced Hodgkin's disease entered this study; patient selection included stages IIB (33% of total), IIIB (26%), IV (25%), and stages IIA-IIIA (16%) with bulky disease and pulmonary hilum involvement. The MOPP/ABVD program was delivered in an 8-month program; adjuvant radiotherapy on sites of bulky disease was delivered in 24 patients. RESULTS: Complete remission was obtained in 106 (77%) patients; significant factors for CR in univariate analysis were stage, symptoms, histology, and bone marrow involvement. The five-year relapse-free survival (RFS) was 83%; in a multivariate analysis, histology only correlated with RFS (p = 0.04). The five-year freedom from tumor mortality and overall survival (OS) were 79% and 67%, respectively. An adverse prognostic significance for OS was observed for B symptoms and bone marrow involvement. The median percentage of relative dose intensity (RDI) was as follows: Adriamycin 86, mechlorethamine 85, vincristine 73, vinblastine 84, bleomycin 79, procarbazine 74, dacarbazine 81. No significant association was found between RDI and clinical outcome. No severe pancytopenia or life-threatening complications occurred during therapy. CONCLUSIONS: Alternating MOPP and ABVD cured more than 65% of patients with advanced HD; acute and late toxicity were acceptable. Prognostic analysis defined subgroups with a lower chance of cure which may deserve a more intensive initial therapy.

Adolescent↗
PubMed1994

Results of CAV regimen (CCNU, melphalan, and VP-16) as third-line salvage therapy for Hodgkin's disease.

BACKGROUND: A prospective study was conducted to assess the efficacy and toxicity of a salvage regimen consisting of CCNU, Melphalan, and VP-16 (CAV) given at 28-day intervals in patients with Hodgkin's disease (HD) relapsing after primary therapy or refractory to the alternating MOPP/ABVD regimen. PATIENTS AND METHODS: This study included 58 patients (median age: 34 years), with resistant or relapsing HD. Primary therapy had consisted of alternating MOPP/ABVD (81%) or MOPP alone (19%); 38% of patients were relapsing from prior complete remission (CR) while 62% had resistant disease. Extranodal disease was present in 55% and B-symptoms in 72% of patients; one-fifth had bulky disease and/or bone marrow involvement. The CAV was used as first salvage in half of the patients. RESULTS: Complete remission was obtained in 17 patients (29%); unfavorable factors for CR in univariate analysis were the presence of bulky disease and the failure to achieve CR with prior therapy. Nine patients (53% of remitters) have subsequently relapsed with a 10-month median duration of CR. The 3-year overall survival after CAV was 25% with an 18-month median survival; significant differences in survival were found according to the extent of disease, the presence of B-symptoms and the HD status (prior sensitive or resistant disease, first or subsequent relapse). Seven patients are long-term remitters (12%), and one of them has been given high-dose chemotherapy and autologous bone marrow transplantation at relapse after CAV. The CAV toxicity was mostly hematological; severe pancytopenia occurred in six cases with two cases of fatal infections and one of fatal hemorrhage. CONCLUSION: CAV therapy was moderately effective as third-line salvage in patients with HD resistant to alternating MOPP/ABVD or previously given two different regimens for relapse; the toxicity was mostly hematological and supportive therapy was needed in one-third of the patients.

Adolescent↗
PubMed1994

Ranitidine multicenter study on slow-response duodenal ulcer patients.

Twenty-six Italian Centers participated in the present study, the aim of which was to compare, in a double blind manner, the effectiveness of ranitidine 150 mg b.i.d. and ranitidine 300 mg b.i.d. in duodenal ulcer patients, who were considered likely to be slow-responders on the basis of clinical and anamnestic criteria. The results of this study show no statistically significant differences in healing rates between the two groups of patients treated with the different doses of ranitidine. After 4 weeks of treatment, healing rates were 73.3% for ranitidine 150 mg b.i.d. (131 patients) and 76.1% for ranitidine 300 mg b.i.d. (134) patients). After 8 weeks of treatment, cumulative healing rates were 91.5% and 93.9%, respectively. There were no differences in the relief of symptoms. The percentage of ulcers healed after four weeks of treatment with ranitidine 150 mg b.i.d. was lower than generally reported (1, 2), probably reflecting the strict selection criteria. However, at least in this population, the higher dose, with its increased inhibition of gastric acid secretion, failed to offer any significant advantage. Other factors, not dealt with in this study, might help identify the slow-responder and the non-responder, as also those who would benefit from an increased dose.

Double-Blind Method↗
PubMed1993

The spectrum of left ventricular size in dilated cardiomyopathy: clinical correlates and prognostic implications. SPIC (Italian Multicenter Cardiomyopathy Study) Group.

To address the issues of variability and prognostic role of left ventricular dimensions in dilated cardiomyopathy (DCM), 144 patients with DCM were studied. They were arbitrarily assigned to two groups according to an echocardiographic left ventricular end-diastolic diameter index < or = 15% (45 patients with mildly dilated cardiomyopathy) and above 15% (99 patients with typically dilated cardiomyopathy) of the upper normality range. Among the patients with mildly dilated cardiomyopathy, there were more men (89% vs 66%; p < 0.01). This group of patients also had a greater prevalence of atrial fibrillation (22% vs 3%; p < 0.001) higher left ventricular fractional shortening (15 +/- 6% vs 13 +/- 5%; p < 0.05), higher ejection fraction (28 +/- 8% vs 24 +/- 8%; p < 0.01), and a lower exercise tolerance (5 +/- 2 MET vs 6 +/- 2 MET; p < 0.05). At the time of follow-up examination (30 +/- 15 months), event-free survival was not significantly different between patients with mildly dilated cardiomyopathy and those with typically dilated cardiomyopathy. Pulmonary capillary wedge pressure (p < 0.001) and left atrial dimension index (p < 0.01) were significant predictors of prognosis as determined by Cox multivariate analysis. Minimal or mild ventricular dilatation is not uncommon in DCM, and it identifies a heterogenous group of patients--some who are in the early stages of disease and others with severe pump dysfunction and persistently small hearts. Ventricular dilatation is not an independent predictor of prognosis.

Adult↗
PubMed1993

[Role of transesophageal echography in the diagnosis of aortic dissection and in therapy programming].

The diagnostic accuracy of transesophageal echocardiography and its relevance on the decision making process were evaluated in 80 patients with suspected aortic dissection during a 37-month period. The diagnosis was proven by aortography and/or magnetic resonance and/or computerized tomography and/or surgery and/or autopsy in each case. Transesophageal echocardiography had no serious complication. A correct diagnosis of aortic dissection was made in 39 of 40 patients (sensitivity, 97.5%; specificity, 100%) and the type of dissection was correctly demonstrated in each case. Thrombi in the false lumen were detected in 16 patients. The primary entry site was correctly identified in 33 patients (85%). Aortic regurgitation was detected in 25 cases (severe in 9) and pericardial effusion in 14 (with tamponade in 2). Transesophageal echocardiography was more accurate than aortography in the diagnosis of noncommunicating intramural dissection (2 cases) and identified more precisely the retrograde extension of the dissection in DeBakey type III patients (4 cases). In 9 cases surgical indication was based on clinical data and transesophageal echocardiography alone. We conclude that transesophageal echocardiography allows a bedside, safe and accurate diagnosis of aortic dissection. In the majority of the patients it provides the minimal diagnostic information necessary to the therapeutical decision making.

Acute Disease↗
PubMed1993

[Late ventricular potentials in patients with dilated cardiomyopathy. Correlations with spontaneous ventricular tachycardia and clinical course].

In a series of 55 patients with dilated cardiomyopathy, the presence of noninvasive recordings of late ventricular potentials (LVP) was correlated to ventricular tachycardia (VT), as detected by a 24-hour Holter monitoring obtained one week within LVP recording. LVPs were found in 12/55 patients (21.8%) and in 2 of a series of 66 normal subjects of the same age and sex. In all patients with LVP either non sustained (11 cases) or sustained (1 case) VT was present at Holter monitoring. In the other 43 patients without LVP only 13 (30%) had non sustained VT (p < 0.01). During the follow-up period (mean 17 months) six patients died suddenly; three of them had LVP and VT (sustained in one); two had non sustained VT, but no LVP; one had neither. This study suggests that the presence of LVP predicts VT recording in ambulatory ECGs. On the contrary, VT may be recorded in patients without LVP. Further studies are necessary to ascertain the value of LVP as a marker of sudden death in patients with dilated cardiomyopathy.

Action Potentials↗
PubMed1993

[The prevalence, risk factors and clinical significance of atherosclerosis of the thoracic aorta: a transesophageal echocardiographic study].

Available information on atherosclerosis of thoracic aorta in man is scanty and mostly derived from pathological or surgical series. Transesophageal echocardiography makes a clear definition of the entire thoracic aorta possible and enables large, population based studies. In order to define prevalence, risk factors and clinical implications of aortic atherosclerosis, the echocardiographic recordings of 220 patients suitable for both evaluation of thoracic aorta and risk factors analysis were reviewed. Transesophageal echocardiography has been performed because of valvular diseases (78), suspected aortic aneurysm or trauma (43), evaluation of valve prosthesis (39), previous cerebral or peripheral embolic events (22), infective endocarditis (14), cardiac mass lesions (12) or other indications (12). Age ranged from 5 to 81 years (55 +/- 15), male to female ratio was 0.99. Simple and complex atherosclerotic plaques were identified in 33% and 10% respectively. Complex atheromas were more frequent among patients with previous embolic episodes (6/22, 27% versus 17/198, 8.5%; p = 0.019). The prevalence of any type of atherosclerosis progressively increased from the fourth (8%) to the eighth (88%) decade of age. By univariate analysis age (p < 0.001), history of hypertension (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.05) pressure, type II diabetes mellitus (p < 0.01), HDL cholesterol (p < 0.01), HDL/total cholesterol (p < 0.01) and uricaemia (p < 0.05) were associated with aortic atherosclerosis. Discriminant analysis identified 5 independent variables associated with the presence and the extent of atherosclerosis (Wilk's Lambda = 0.43): number of cigarettes per day, age, history of hypertension, systolic pressure and type II diabetes mellitus. This model provided a 63% correct classification rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[The effect of peripheral reflections on the left ventricle].

In order to evaluate the effect of modifications in reflections timing on the ventricular performance, 10 isolated rabbit hearts were connected to rubber tubes of different lengths (0.5, 0.8, 1.0, 2.5 m) with terminal stopper and 2 cylindric small tubes as constant hydraulic resistance. The terminal connection produced wide reflections which returned to the ventricle in early, mid, late systole and in the diastolic phase (2.5 m). Ventricular and aortic pressure, and aortic flow were continuously recorded, sampled and stored on a personal computer. Instantaneous and total systolic ventricular work and stroke volume were calculated using an automatic procedure. Mean coronary perfusion pressure was calculated as difference between aortic and ventricular pressure in diastolic phase. The results demonstrate an important modification of the ventricular performance related to the anticipation of the reflected pulse. The anticipation produces a decrease in the stroke volume (-14.5%), a decrease in the external work of the ventricle (-21%) and a decrease in mean coronary perfusion pressure (-28%). The first two parameters describe the performance of the pump with respect to the load, and the third evaluates the perfusion of the pump itself. Reported to the clinical situation, these results demonstrate that an increased stiffness of the aorta has a double negative effect, a decrease in cardiac output and in external ventricular work, and moreover a decrease in coronary pressure, which produces a reduction of coronary flow.

Animals↗
PubMed1991

[A "signal averaging" analysis of the P wave in patients with a history of isolated paroxysmal atrial fibrillation].

The aim of this study was to verify the utility of the signal averaged electrocardiogram for the analysis of the P wave in patients with paroxysmal lone atrial fibrillation. We studied 22 patients with documented paroxysmal atrial fibrillation without cardiovascular or endocrine diseases. The results were compared with 24 normal subjects. Signal averaged electrocardiogram was recorded from bipolar orthogonal leads X, Y, Z using ART equipment mod. 1200 EPX, with 50-250 Hz filter and effective time-base resolution of 100 mm/sec and voltage of 1 mm/microV. Signal averaging of at least 300 beats was performed to reduce noise level under 0.3 microV. In patients with atrial fibrillation the duration of the P wave was significantly longer (135.0 +/- 13.0 msec) than in the normal subjects (109.4 +/- 11.4 msec) (p less than 0.000001). These results were steady in successive recordings (2-30 days after the first recording). The analysis of the P wave signal averaging seems useful in identifying patients with lone paroxysmal atrial fibrillation.

Adult↗
PubMed1991

Different dosage regimens of ranitidine in the short-term therapy of duodenal ulcer: a multicentre trial.

A multicentre clinical trial was conducted in 114 Italian endoscopy centres in order to evaluate the comparative efficacy of four different ranitidine dosage regimens in the short-term treatment of active duodenal ulcer. Results were analysed in a total of 1745 patients randomly allocated to treatment with ranitidine 150 mg twice daily - morning and 19h30 (440 patients), ranitidine 150 mg twice daily - morning and 22h30 (438 patients), ranitidine 300 mg once daily at 19h30 (434 patients) or ranitidine 300 mg once daily at 22h30 (433 patients). The four groups were well matched for patient characteristics at entry. Initial treatment was for three weeks, with continuation to six weeks in cases with endoscopically unhealed ulcers at three weeks. Efficacy was evaluated in terms of endoscopic ulcer healing and control of pain symptoms in 24 h (daytime, nocturnal, daytime plus nocturnal). No statistically significant differences were found between any of the groups either as regards control of pain symptoms or ulcer healing rates (mean healing rates at three and six weeks were 77% and 98%, respectively). The results in this very large patient sample confirm equivalent efficacy of twice daily and single bedtime dose regimens and provide no evidence for superior efficacy of early evening compared with bedtime administration. In the population as a whole, concomitance of the three main risk factors (more than 20 cigarettes/day, ulcer size greater than 1 cm, deformation of the duodenal cap) was associated with a distinctly lower three-week healing rate (40.9% versus 87.4% in patients presenting none of these factors), though this difference tended to disappear at six weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Duodenal Ulcer↗
PubMed1990

[The prognostic assessment of dilated cardiomyopathy: a follow-up of 138 patients].

A total of 138 patients with idiopathic dilated cardiomyopathy were assessed and followed-up between July 1973 and October 1985 in order to evaluate prognostic risk indicators. Of these 102 were male and 36 were female with a mean age of 49.1 years. Each patient underwent physical examination, electrocardiography, echocardiography, cardiac catheterization and coronary angiography. The mortality rate was low for the first 3 years (respectively 8, 12.5 and 20%) while it was 57.5 at the end of the 5-year follow-up period. Univariate analysis at the time of the diagnosis revealed that five factors were predictive of the clinical course at the end of the fifth year: the NYHA functional class IV (p less than 0.0001); LV ejection fraction less than 0.30 (p less than 0.01); left ventricular failure, bi-ventricular failure and left ventricular end-diastolic pressure greater than 20 mmHg (p less than 0.05). Multivariate analysis was used to determine which combination of factors could most accurately predict survival. The most important prognostic factor was again the IV NYHA functional class (p less than 0.01) and, to a lesser degree, left ventricular end-diastolic pressure (p less than 0.05). The present study underlines that the survival rate of patients with dilated cardiomyopathy depends upon the selection of patients. This can explain the low 3-year mortality found in our patients. The NYHA functional class may be a useful practical guide for cardiac transplantation.

Adolescent↗
PubMed1989

Is the published literature a reliable guide for deciding between alternative treatments for patients with early cervical cancer?

The quality of the methodology and reporting of studies on the treatment of early cervical cancer published in English and French language over the period 1975-1985 were examined using an explicit, pre-defined protocol aimed at assessing their internal validity and generalizability. One hundred and fifty-two articles reporting results on over 40,000 patients treated with surgery, radiotherapy, or the combination of the two, were examined. The astonishing lack of formal comparative studies together with the poor quality of those actually carried out were the two major findings of our study. More than half of the reviewed papers (54%) were single series studies. Among the remaining 46% only a few formally compared the two treatments (i.e. surgery vs. radiotherapy), the remainder dealing with comparisons of specific surgical or radiotherapeutic techniques. With reference to study quality, the existence of a pre-specified research protocol could not be ascertained in most studies. A description of patients' characteristics and information on the source population were deficient in most papers reviewed; information on the two aspects was in fact satisfactorily reported in only 7% and 47% of the papers, respectively. Finally, the lack of standardization of follow-up methods (i.e. type and modalities) and of information on treatment compliance were two other severe methodological deficiencies. In view of this poor quality and of the intrinsic difficulty of drawing firm scientific conclusions from non-experimental investigations, the reliability of this literature remains highly dubious. Another possible caveat is that what is published is a biased sample of the overall evidence because of the well known tendency of authors to write about and editors to publish positive results more frequently than negative ones.

Clinical Trials as Topic↗
PubMed1989

Plasma cell leukemia: a report on 15 patients.

Plasma cell leukemia (PCL) can be considered the leukemic variant of multiple myeloma. The diagnosis is based on hematological features, including a plasmacytosis exceeding 2 x 10(9)/l and any evidence of a clonal plasma cell proliferation. There are two forms of PCL: the primary form occurring in individuals without preceding multiple myeloma, and the secondary form arising as a late manifestation in patients with multiple myeloma. From 1974 to 1988 we diagnosed 8 primary PCL cases out of a total 301 multiple myeloma cases (incidence, 2.6%) and a total of 847 acute leukemia cases (incidence, 0.9%). During the same period we observed in 7 multiple myeloma patients a terminal PCL, for an incidence of PCL in myeloma of 2.3%. Most clinical characteristics were similar in both types of plasma cell leukemia. In particular we found no difference in the average age and in the incidence of bone pain, hepatosplenomegaly, lytic bone lesions. None of our cases showed a clinically relevant lymphadenopathy either as presenting symptom or during the course of the disease. The values for hemoglobin, leukocytes, plasma cells, serum creatinine and calcium did not differ significantly between the two groups of patients. The median survival was 7 months for patients with primary PCL and 1 month for patients with secondary PCL. 5 of the 8 patients with primary PCL obtained a response to conventional myeloma therapy including single alkylating agents, with a duration ranging from 7 to 44 months. Only 1 of the patients with secondary PCL had a partial response after combination chemotherapy.

Adult↗
PubMed1989

Lack of correlation between intracavitary thrombosis detected by cross sectional echocardiography and systemic emboli in patients with dilated cardiomyopathy.

The correlation between intracavitary thrombosis detected by cross sectional echocardiography and systemic embolism was studied in 126 consecutive patients with idiopathic dilated cardiomyopathy who were examined from January 1980 to September 1987. A total of 1041 serial echocardiograms were obtained with 3.5 and 5 MHz transducers. The mean follow up period was 41.2 months. The survival rate was 88% at two years and 56% at five years. Echocardiography showed intracavitary thrombi in 14 (11.1%) patients; 13 were mural and 11 were localised at the apex of the left ventricle. Twelve patients (8.4%) had systemic emboli; this corresponded to an incidence of new embolic events of 1.4 for 100 patient-years. Patients with intracavitary thrombi or systemic emboli were treated with oral anticoagulants, as were nine in functional class IV of the New York Heart Association, for 61 patient-years. The cumulative observation period for the whole population study was 418 patient-years. None of the patients with intracavitary thrombosis had embolic complications and none of those with embolism had intracavitary thrombi. Rates of intracavitary thrombosis and systemic embolism in this series were low and there was no overlap between the two events. This may have been because the patients did not have severe dilated cardiomyopathy, because echocardiography did not detect all the thrombi, or because patients were treated with oral anticoagulants. The presence of intracardiac thrombosis detected by cross sectional echocardiography is not predictive of systemic embolism in patients with idiopathic dilated cardiomyopathy. Criteria for the use of the anticoagulant treatment remain largely empirical in these cases.

Adult↗