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Biomedical subjects

G Merli

Publications and source records attributed to G Merli.

14 recordsLinked to original sources
PubMed2001

Results of a pilot study involving the use of an antisense oligodeoxynucleotide directed against the insulin-like growth factor type I receptor in malignant astrocytomas.

PURPOSE: Preclinical animal experiments support the use of an antisense oligodeoxynucleotide directed against the insulin-like growth factor type I receptor (IGF-IR/AS ODN) as an effective potential antitumor agent. We performed a human pilot safety and feasibility study using an IGF-IR/AS ODN strategy in patients with malignant astrocytoma. PATIENTS AND METHODS: Autologous glioma cells collected at surgery were treated ex vivo with an IGF-IR/AS ODN, encapsulated in diffusion chambers, reimplanted in the rectus sheath within 24 hours of craniotomy, and retrieved after a 24-hour in situ incubation. Serial posttreatment assessments included clinical examination, laboratory studies, and magnetic resonance imaging scans. RESULTS: Other than deep venous thrombosis noted in some patients, no other treatment-related side effects were observed. IGF-IR/AS ODN-treated cells, when retrieved and assessed, were < or = 2% intact by trypan blue exclusion, and none of the intact cells were viable in culture thereafter. Parallel Western blots disclosed IGF-IR downregulation to < or = 10% after ex vivo antisense treatment. At follow-up, clinical and radiographic improvements were observed in eight of 12 patients, including three cases of distal recurrence with unexpected spontaneous or postsurgical regression at either the primary or the distant intracranial site. CONCLUSION: Ex vivo IGF-IR/AS ODN treatment of autologous glioma cells induces apoptosis and a host response in vivo without unusual side effects. Subsequent transient and sustained radiographic and clinical improvements warrant further clinical investigations.

Adult↗
PubMed2001

Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease.

BACKGROUND: Low-molecular-weight heparins administered subcutaneously once or twice daily have been reported to be as safe and efficacious as intravenous unfractionated heparin in the treatment of acute venous thromboembolic disease. OBJECTIVE: To determine whether subcutaneous enoxaparin administered once or twice daily is as effective as continuously infused unfractionated heparin in acute symptomatic venous thromboembolic disease. DESIGN: Randomized, controlled, partially blinded equivalence trial. SETTING: 74 hospitals in 16 countries. PATIENTS: 900 patients with symptomatic lower-extremity deep venous thrombosis, including 287 (32%) with confirmed pulmonary embolism. INTERVENTIONS: Initial therapy with dose-adjusted intravenous unfractionated heparin compared with subcutaneous enoxaparin at fixed dosages of 1.0 mg/kg of body weight twice daily or 1.5 mg/kg once daily. Long-term oral anticoagulation was started in all patients within 72 hours of randomization. MEASUREMENTS: Clinical end points assessed during a 3-month follow-up period. RESULTS: Equivalent efficacy was seen in the heparin group and both enoxaparin groups. Symptomatic venous thromboembolism recurred in 12 of 290 patients receiving unfractionated heparin (4.1%), 13 of 298 patients receiving once-daily enoxaparin (4.4%), and 9 of 312 patients receiving twice-daily enoxaparin (2.9%). Compared with unfractionated heparin, the treatment difference was 0.2% (95% CI, -3.04% to 3.49%) for once-daily enoxaparin and -1.2% (CI, -4.2% to 1.7%) for twice-daily enoxaparin. Incidence of major hemorrhage did not differ among the three treatment groups. Major hemorrhage occurred in 6 of 290 patients (2.1%) in the unfractionated heparin group, 5 of 298 patients (1.7%) in the once-daily enoxaparin group, and 4 of 312 patients (1.3%) in the twice-daily enoxaparin group. CONCLUSIONS: Subcutaneous enoxaparin once or twice daily is as effective and safe as dose-adjusted, continuously infused unfractionated heparin in the prevention of recurrent symptomatic venous thromboembolic disease.

Administration, Cutaneous↗
PubMed2000

[The timing of tracheotomy. Advantages of early timing].

Tracheotomy is widely performed in Intensive Care Units, but no general agreement exists about its correct timing in ventilated patients. Many articles examine the complications of long-term endotracheal intubation and tracheotomy; few data, however, relate these damages and ventilated patients outcome to tracheotomy timing. No universally accepted guidelines exist, but last years clinical practice prefer early tracheotomy, particularly if performed by percutaneous approach. Many authors suggest prospective and randomized clinical trials in order to evaluate tracheotomy performance correct time. At this time decision making must consider risks and benefits related to patient clinical conditions: at this regard some reports seem to advantage early tracheotomy.

Critical Care↗
PubMed1996

The influence of length of stay in the ICU on power of discrimination of a multipurpose severity score (SAPS). ARCHIDIA.

OBJECTIVE: To assess how the power of discrimination of a multipurpose severity score (Simplified Acute Physiology Score; SAPS) changes in relation to the length of stay (LOS) in the intensive care unit (ICU). DESIGN: In order to compute the SAPS probability, a model derived from logistic regression was developed in a cohort of 8059 patients. Measures of calibration (goodness-of-fit statistics) and discrimination [receiver operating characteristic (ROC) curve and relative area under the curve (AUC)] were adopted in a developmental set (5389 patients) and a validation set (2670 patients), both randomly selected. Once the logit was developed and the model validated, the whole database (8059 patients) was again assembled. To evaluate the accuracy of first-day SAPS probability over time, area under the ROC curve was computed for each of the initial 10 days of ICU care and for day 15. SETTING: 24 Italian ICUs. PATIENTS: A total of 8059 patients out of 10065 consecutive admissions over a period of 3 years (1990-1992) were included in this study. Patients whose SAPS was not correctly compiled (n = 687), patients younger than 18 years (n = 442), and patients whose LOS was less than 24 h (n = 877) were excluded from this analysis. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The logistic model gave good results in terms of calibration and discrimination, both in the developmental set (goodness-of-fit: chi 2 = 9.24, p = 0.32; AUC = 0.79 +/- 0.01) and in the validation set (goodness-of-fit: chi 2 = 8.95, p = 0.537; AUC = 0.78 +/- 0.01). The AUC for the whole database showed a loss in discrimination closely related to LOS: 0.79 +/- 0.01 at a day 1 and 0.59 +/- 0.02 at day 15. CONCLUSION: The logistic model that we developed meets high standards for discrimination and calibration. However, SAPS loses its discriminative power over time; accuracy of prediction is maintained at an acceptable level only in patients who stay in the ICU no longer than 5 days. The stay in the ICU represents a complex variable, which is not predictable, that influences the performance of SAPS on the first day.

Adult↗
PubMed1993

Lymphoscintigraphy. A reliable test for the diagnosis of lymphedema.

The efficacy of lymphoscintigraphy in the diagnosis of lymphedema was evaluated in 17 patients (total of 20 extremities). Final diagnoses were: three extremities with primary lymphedema, eight with secondary lymphedema, and nine with edema due to other causes. Qualitative interpretation of image patterns was reliable in differentiating lymphedema from edema of other origins (sensitivity 73%, specificity 100%). There were eight true-positive, nine true-negative, no false-positive, and three false-negative extremities. The three false-negative results occurred in extremities that were not imaged within the first hour. Lymphoscintigraphy is a reliable, objective, and noninvasive means of supporting the diagnosis of lymphedema, and lends itself more readily to repeated studies for follow-up than other available tests.

Adult↗
PubMed1983

[Cystic dilatation of the choledochus].

The authors show a case of cystic dilatation of choledochus in a woman patient aged 10. After reporting its nosologic classification, drawn from the world literature, they dissert about the treatment, which should be essentially surgical. The Authors performed a new surgical technique, as an alternative to the suggestion of other Authors. The method adopted consists of the partial resection of the cyst and subsequent reconstruction of choledochus on Kohr's tube.

Child↗
PubMed1980

[Method for radiographic determination of body contours (author's transl)].

After a brief description of some methods used for the determination of body contour in radiotherapy, the authors present a method which using the double radiographic exposition, allows such a determination with precision and without having need of expensive equipments. They present the graphic results of the tests done on phantom and in vivo, comparing these ones with the measures obtained by CT, performed in purpose of diagnosis. For a rapid execution of the method, they list the passages to follow for its application.

Humans↗
PubMedDate not supplied

[Vascular compression of the duodenum. Apropos of a case of acute obstruction].

A case of acute obstruction of the duodenum in an aged patient due to aorto-mesenteric squeezing is described. An account of the anatomopathological features, symptomatology, radiological diagnosis, and treatment of this condition is presented. Duodedenojejunostomy is the operation of choice, but it must be adjusted to the local and general anatomopathological situation.

Aged↗