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Biomedical subjects

G Chiesa

Publications and source records attributed to G Chiesa.

At least 55 records · Page 3Linked to original sources
PubMed1991

Safety of high-dose vitamin A. Randomized trial on lung cancer chemoprevention.

The paper reports on the efficacy and side effects of high-dose vitamin A, administered as adjuvant treatment for resected stage I lung cancer in a randomized clinical trial. After a median follow-up of 28 months, 283 patients were evaluable: 138 allocated to treatment with retinol palmitate (300,000 IU daily for at least 12 months) and 145 to standard observation. The clinical results available to date do well justify a continuation of the study. Skin dryness and desquamation were the most frequent symptoms, affecting 60% of all treated patients. Other symptoms such as dyspepsia, headache, nosebleeds and mild hair loss occurred in less than 10% of patients, and were self-terminating. Only in 4 patients (3%) was the treatment interrupted because of symptoms potentially related to vitamin A administration. As for laboratory tests, gamma-GT levels were abnormally elevated in 69% of treated patients vs. 39% of controls at 24 months (mean 149 vs. 58 IU/l; p less than 0.05). Serum triglyceride concentrations over 150 mg/dl were seen in 74% of treated patients vs. 43% of controls at 12 months (mean 283 vs. 179 mg/dl; p less than 0.05). There were no other laboratory signs of toxicity attributable to vitamin A. In our experience, high-dose retinoyl palmitate administration was a well-tolerated and safe treatment. The long-term impact on lipid metabolism still remains to be determined.

Alkaline Phosphatase↗
PubMed1991

Management of lipoprotein-X accumulation in severe cholestasis by semi-selective LDL-apheresis.

Liver disorders characterized by prolonged bile stasis are often associated with the accumulation of an abnormal lipoprotein, lipoprotein-X (LP-X), in plasma. LP-X is separated in the low-density lipoprotein (LDL) density range, but lacks apolipoprotein B and does not interact with the LDL receptor; LP-X can cause hyperlipidemia, cutaneous xanthomas, and worsening of arterial disease. We report the case of a patient with severe cholestasis, markedly elevated plasma cholesterol levels (26.8 to 31.5 mmol/L), mainly due to a massive accumulation of LP-X in plasma, and diffuse xanthomas. To reduce the elevated cholesterol levels, the patient was given extracorporeal treatment aimed at removing atherogenic lipoprotein (LDL-apheresis). LDL-apheresis was performed at weekly or bi-weekly intervals, either by a semi-selective technique using filters with a defined pore diameter (double filtration, DF) or by a more selective technique using dextran-sulfate-cellulose (DSC) columns able to bind LDL. The semi-selective DF technique proved more effective than DSC, removing 48% of total cholesterol (compared to 30% with DSC), and lowering cholesterol levels to 11.1 mmol/L in 6 weeks. DF removed both LDL and LP-X from plasma, whereas DSC selectively decreased the LDL content. The reduction of plasma cholesterol levels was associated with a complete regression of the xanthomas, supporting DF apheresis as a first-choice treatment for patients with massive LP-X accumulation due to cholestasis.

Adult↗
PubMed1991

Impaired efficacy of selective LDL-apheresis in primary biliary cirrhosis.

Low-density lipoprotein apheresis (LDL-apheresis) was done with either cascade filtration (DF) or dextran sulfate cellulose adsorption (DSC) in a patient with primary biliary cirrhosis who developed severe dyslipidemia associated with cholestasis and accumulation of lipoprotein-X (LP-X). The extracorporeal treatment was initially performed weekly, and resulted in a sharp drop in total cholesterol from 1038 to 430 mg/dl. During the next four months the patient was treated every 10-15 days, and pre-apheresis cholesterol levels were maintained between 438 and 505 mg/dl, until an orthotopic liver transplantation was successfully performed. With semi-selective DF a mean 47.1% of total cholesterol was removed per procedure compared to 30.0% with DSC, although the volume of treated plasma was 38.0 vs 49.9 ml/kg body weight. The changes in plasma cholesterol levels during DSC and DF showed that the kinetics of cholesterol removal were similar with both techniques, but the efficacy differed; DF removed both LDL and LP-X from plasma, whereas DSC selectively lowered the LDL content. Cascade filtration may therefore be considered as a first-choice treatment for patients with LP-X accumulation due to cholestasis.

Adult↗
PubMed1990

In vitro activity of probucol on cholesteryl ester transport.

Probucol treatment in hypercholesterolemic patients promotes the transfer of cholesteryl esters from high-density-lipoproteins (HDL) to lower-density lipoproteins. In vitro studies, on hypercholesterolemic plasma incubated with or without probucol, show that drug binding to lipoprotein particles does not affect either cholesteryl ester transfer, or the lipoprotein modifications occurring in the process. Probucol stimulates reverse cholesteryl ester transfer in vivo apparently by mechanisms independent of lipoprotein binding.

Biological Transport↗
PubMed1989

Plasma lipoprotein changes after treatment with pravastatin and gemfibrozil in patients with familial hypercholesterolemia.

The ability of pravastatin, a new hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, to lower plasma lipid levels and modify lipoprotein patterns was compared with that of gemfibrozil in 18 patients with familial hypercholesterolemia who participated in a 16-week, double-blind, parallel trial. Pravastatin proved better than gemfibrozil in lowering total and low-density lipoprotein (LDL) cholesterolemia: -23.6% and -28.2% versus -18.1% and -21.4%, respectively. A significant positive correlation was found between the starting level of serum cholesterol (both total and LDL) and the gemfibrozil-induced reduction (r = 0.72 and 0.69), whereas the hypocholesterolemic effect of pravastatin was apparently independent from pretreatment levels (r = 0.32 and 0.10). Apolipoprotein B concentrations were lowered by 25.4% (pravastatin) and 22.0% (gemfibrozil). Pravastatin and gemfibrozil reduced triglyceride levels by 13.9% and 49.4%, respectively. Both drugs increased the level of high density lipoprotein (HDL) cholesterol, but this change was significant only with gemfibrozil (p less than 0.05). The HDL subfraction structure and distribution were not modified by pravastatin treatment. Gemfibrozil, in contrast, increased HDL3 cholesterol level by 9% because of an enrichment of HDL3 particles in both free cholesterol and cholesteryl esters and lowered the flotation rate of HDL3 (p less than 0.05). LDL particles became smaller after gemfibrozil treatment (diameter: 25.4 +/- 0.3 nm vs 26.1 +/- 0.4 nm, p less than 0.01) and were not modified by pravastatin. This comparison shows a more pronounced efficacy of the HMG CoA reductase inhibitor on total and LDL cholesterol levels, also indicating that pravastatin acts by a single major mechanism, reducing the number of circulating LDL particles. Gemfibrozil may exert additional activities, possibly consequent to the stimulation of very low density lipoprotein catabolism.

Apolipoproteins↗
PubMed1988

Phase III randomized study of fluorouracil, epirubicin, and cyclophosphamide v fluorouracil, doxorubicin, and cyclophosphamide in advanced breast cancer: an Italian multicentre trial.

From February 1983 to January 1985, 497 patients with advanced breast cancer were randomly allocated to receive either epirubicin or doxorubicin in the following combination chemotherapy regimen: fluorouracil (5-FU) 500 mg/m2 intravenous (IV) on days 1 and 8; epirubicin or doxorubicin 50 mg/m2 IV on day 1; cyclophosphamide 500 mg/m2 IV on day 1 (FEC or FAC). Cycles were repeated every 21 days until progression or to cumulative doses of 700 mg/m2 for epirubicin and 550 mg/m2 for doxorubicin. Dose reductions were applied according to the standard criteria. Activity was evaluated in 443 patients (222 in the FEC arm and 221 in the FAC arm). The two experimental groups were comparable in age, performance status, menopausal status, histology, previous treatments, and site of the disease. The overall response rate (complete response and partial response [CR + PR]) was not significantly different: 53.6% for FEC and 56.5% for FAC. The median time to progression was 273 days for FEC and 314 days for FAC; the median survival time was 591 and 613 days, respectively. Leukopenia, anemia, nausea, and vomiting were significantly lower in patients treated with FEC. As for cardiotoxicity, four cases of congestive heart failure (CHF) were recorded among patients treated with FAC while only one was observed in the FEC group. These results indicate that epirubicin in a combination chemotherapy regimen is as active as doxorubicin and is significantly less toxic.

Adult↗
PubMed1988

Lung cancer chemoprevention with retinol palmitate. Preliminary data from a randomized trial on stage Ia non small-cell lung cancer.

On the basis of epidemiologic and experimental evidence of an anticancer activity of vitamin A, a randomized clinical trial was activated in Milan with the aim of evaluating if retinol palmitate administration (per os, 300,000 I.U. daily) after complete resection of stage Ia non small-cell lung cancer could reduce the occurrence of cancer relapses (within 3 years) and/or the occurrence of new primary tumors (beyond 3 years). By September 1987, 181 patients had entered the trial: 87 in the treatment arm and 94 in the control arm. After a median follow-up of 14 months, the interim analysis was focused on the evaluation of toxicity, compliance, and early recurrences. Although the large majority of patients were affected by skin and mucous membrane desquamation and dryness during treatment, these symptoms were generally mild and well tolerated, and never induced the patient to stop the treatment. Other side effects like headache, hair loss, itching, or dyspepsia were detected at a much lower frequency. Only in 3 patients the treatment was interrupted, because of signs or symptoms potentially related to vitamin A administration. At the time of the analysis, a total of 42 (23%) patients had relapsed; 16 (18%) in the treated arm, and 26 (28%) in the control arm. The largest difference between treated patients and controls was observed for bone metastases (2 vs. 7) and brain metastases (3 vs. 6), and for squamous histology (6 vs. 11). Only 2 cases of new primary cancer were detected, both in the control arm. These results are promising both in terms of tolerance and efficacy of treatment, but given the short median follow-up they must be very cautiously interpreted. A longer follow-up is necessary to establish whether a significant proportion of early recurrences could be prevented, or only delayed, by vitamin A administration.

Adolescent↗
PubMed1988

Synchronous brain metastasis from lung cancer. Result of surgical treatment in combined resection.

The results of combined surgical resection of brain metastasis and primary lung cancer from January 1976 to April 1986 were evaluated. In all cases the brain metastasis was single and synchronous and was resected first. There were 20 men and one woman, with an average age of 53 years. All patients initially had neurologic symptoms related to an intracranial mass. In 19 patients the primary lung cancer was roentgenologically visible, but in two the lesion was recognizable only by bronchoscopy. There were no operative deaths. Nine of 21 patients had a poor postoperative course and died during the first 6 months. The combined surgical approach improved the short-term survival rate in four patients, who died 11, 12, 18, and 21 months after the thoracic operation. In six patients (28.5%) survival for more than 2 years was obtained (three died after 27, 30, and 40 months, three are alive after 25, 28, and 48 months). Two others patients are alive and well 4 and 16 months after the thoracic operation. Synchronous onset of brain metastasis from lung cancer does not necessarily contraindicate combined operations, which can provide long-term survival in selected patients. The absence of mediastinal node metastasis is a favorable prognostic factor. Computed tomographic screening of the brain improves patient selection.

Adenocarcinoma↗
PubMed1988

[Microvascular transfer of the heel pad to a thigh stump. Functional benefit of the distal support in prosthetic fitting of the amputated thigh].

The emergency transfer of a composite microvascular graft comprising the calcaneum, heel-pad and plantar skin in a twelve-year-old child allowed the amputation level to be changed from the upper to the lower third of the thigh and full weight-bearing solely on the bottom of the prosthesis was achieved. This method has several functional and trophic advantages which justify its performance when the indications are appropriate.

Amputation, Surgical↗
PubMed1987

Endoscopic gluing of bronchopleural fistula.

Three patients with postpneumonectomy bronchopleural fistula were treated with endoscopic gluing of the fistula. The technique and the results of this method are described.

Bronchial Fistula↗
PubMed1978

The interaction between alcohol, chlorpropamide and phenformin in a severe combined poisoning: case report.

A young non-diabetic woman ingested 2.5-3.7 g of chlorpropamide and 0.6-0.9 g of phenformin together with a large dose of alcohol, nitrofurantoin and promethazine in a suicidal attempt. She developed severe metabolic acidosis, hypokalemia, polyuria and prolonged hypoglycemia in the absence of typical hypoglycemic symptoms. These unusual clinical features were in part explained on the basis of the interactions between alcohol and the other drugs.

Adult↗
PubMed1977

[Electrocardiagraphic changes of Prinzmetal's angina type in the acute phase of myocardial infarct].

The authors have studied the frequency and severity of anginal attacks of the Prinzmetal type coming on during the acute phase of a myocardial infarction in 13 patients. They have occurred in 5.50% of cases (anginal attacks of all types occurring in 18.34% of cases). The severity of these attacks is shown by their clinical features: the multiplicity of the attacks, the high incidence of arrhythmias, the difficulties encountered with medical treatment. This also confirmed by the enzyme studies: when the curve of myocardial creatinine kinase release is drawn, there is seen to be an extension of the lesion in 2/3 cases, whereas the electrocardiograph does not show this up.

Acute Disease↗