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G Paladini

Publications and source records attributed to G Paladini.

At least 19 recordsLinked to original sources
PubMed2006

Switching to anastrozole versus continued tamoxifen treatment of early breast cancer. Updated results of the Italian tamoxifen anastrozole (ITA) trial.

BACKGROUND: Tamoxifen, for many years the 'gold standard' in the adjuvant setting for the management of endocrine sensitive early breast cancer, is associated with an increased risk of endometrial cancer and other life-threatening events. Moreover, many women relapse during or after tamoxifen therapy due to the development of resistance. This provided the rationale for a switching trial with anastrozole, the updated results of which are reported here. PATIENTS AND METHODS: This trial investigated the efficacy of switching to anastrozole for women already receiving tamoxifen. After 2-3 years of tamoxifen treatment, postmenopausal, node-positive, ER-positive patients were randomized to receive either anastrozole 1 mg/day or to continue tamoxifen, 20 mg/day, giving a total duration of 5-years treatment. The primary end point was disease-free survival and secondary endpoints were event-free survival, overall survival and safety. RESULTS: A total of 448 patients were enrolled. At a median follow-up time of 64 months (range 12-93), 63 events had been reported in the tamoxifen group compared with 39 in the anastrozole group [HR 0.57 (95% CI 0.38-0.85) P = 0.005]. Relapse-free and overall survival were also longer in the anastrozole group [HR 0.56 (95% CI 0.35-0.89) P = 0.01 and 0.56 (95% CI 0.28-1.15) P = 0.1]. However, the latter difference was not statistically significant. Overall more patients in the anastrozole group experienced at least one adverse event (209 versus 151: P = 0.000). However, numbers of patients experiencing serious adverse events were comparable (37 versus 40, respectively: P = 0.7). CONCLUSIONS: Switching to anastrozole after the first 2-3 years of treatment was confirmed to improve event-free and relapse-free survival of postmenopausal, node-positive, ER-positive early breast cancer patients already receiving adjuvant tamoxifen.

Anastrozole↗
PubMed2001

Quantitative p21(waf-1)/p53 immunohistochemical analysis defines groups of primary invasive breast carcinomas with different prognostic indicators.

We used image cytometry to quantify the immunohistochemical expression of p21(waf-1) and p53 in primary breast carcinoma. Ratio analysis of the quantified p53/p21(waf-1) protein expression allowed us to define 3 groups of carcinomas, each characterized by specific pathological and biological profiles. The negative (NEG) group, characterized by negligible expression of both proteins, comprised small-sized, low-grade tumors associated with high contents of hormonal receptors and low growth fraction. In the NEG group, Ki-67 labelling index area (%LIa) was the only significant prognostic indicator. The P53H group, characterized by prevalence of p53 %LIa, was constituted by large-sized, high-grade tumors showing low hormonal receptor contents and high growth fraction. In the P53H group, both p53 and Ki-67 were inversely associated with both estrogen receptor (ER) and progesterone receptor (PGR), suggesting that extensive p53 immunostaining is related to poor differentiation and high proliferation. Only N status was prognostically significant in the P53H group. The P21H group, characterized by prevalence of p21(waf-1) %LIa, displayed intermediate pathological and biological features. A significant association between p53 and p21(waf-1) expression suggested functional stabilization of wtp53 and therefore possible DNA damage-dependent G1/S arrest (genetic instability) in the P21H group; P21(waf-1)expression was significantly associated with the presence of node metastasis. Patients in the P21H group had a higher recurrence rate and a shorter disease-free time interval from surgery with respect to the NEG group. Proportional hazard regression analysis disclosed Ki-67 %LIa and, to a lesser degree, PGR %LIa as significant relapse-free survival prognostic indicators.

Adult↗
PubMed2000

[Total arterial myocardial revascularization with both mammary arteries without extracorporeal circulation].

INTRODUCTION: Tector has described the off-pump total arterial revascularization technique, using multiple anastomosis with both internal thoracic arteries. To reduce surgical morbid-mortality, we have proposed the use of this technique without extracorporeal circulation. PATIENTS AND METHODS: From April, 1998 the off-pump < > technique was performed in 92 patients, 74 male (80%) and 18 female (20%), with a mean age of 64.9+/-8.1 years (42-78). Preoperative angiography demonstrated triple-vessel disease in 58 (63%) patients, and left main disease was present in 19 (20.5%) patients. Forty patients (43.5%) showed unstable angina, 24 patients (26%) significant peripheral vascular disease, and 26 (28%) diabetes mellitus. Both internal thoracic arteries were harvested using the skeletonization technique and were used like a < > graft. The flow in the graft was measured using a flowmeter, and in 24 (26%) patients by angiographic study. RESULTS: A total of 274 distal anastomoses were performed, 122 (44.6%) in the lateral or inferior wall, and 69 (25.2%) were sequential, with an average of 2.98 bypass/patient. In 59.8% of the patients a triple bypass was performed, 22% double bypass, 17% cuadruple bypass and 1 patient a quintuple bypass. During the initial six hours 64.9% of patients were extubated. Only one patient (1.1%) needed intraaortic ballon pumping and 3 (3.2%) inotropics during the postoperative course. Hospital mortality was 3 (3.2%) patients. Reoperation for bleeding was needed in just one patient (1.1%), and 78.3% of patients were not transfused. Mediastinitis occurred in 3 patients (3.2%). Postoperative stroke was not observed. At 7.7+/-2.8 months of mean follow-up all patients were free of symptoms and the global patency rate of 94%. CONCLUSIONS: Off-pump Tector technique appears to be safe, offering a complete arterial revascularization and showing a reduction of surgical morbidity.

Adult↗
PubMed1994

Is HLA B27 a true marker of axial involvement in psoriatic arthropathy?

Sixty-six patients with psoriatic arthropathy were subdivided into nine groups on the basis of the presence of peripheral arthritis, axial disease whether or not fulfilling the New York criteria for ankylosing spondylitis both associated and not associated with peripheral arthropathy and bilateral or monolateral lateral sacro-iliitis. Only the group with axial disease sacroiliitis+spondylitis) without peripheral arthritis and not fulfilling the NY criteria showed a truly increased B27 prevalence. However, in this atypical group, only 2 patients had a true ankylosing pattern-like spondylitis. On the other hand, in the group with axial disease fulfilling the NY criteria, only one of 9 patients was B27+. We conclude that B27 is not a true marker of axial involvement in psoriatic arthropathy.

Arthritis, Psoriatic↗
PubMed1991

[Rheumatoid arthritis and chronic granular T-cell lymphocytosis with neutropenia. A clinical condition distinct from Felty's syndrome].

103 cases of rheumatoid arthritis who had been diagnosed between 1984 and 1985 have retrospectively been analyzed, in order to identify those patients who had presented with associated neutropenia and in whom it was thus possible to suggest a presumptive diagnosis of either Felty's syndrome or chronic granulated lymphocytosis with neutropenia. Four patients (3.8%) satisfied the clinical criteria for the latter diagnosis while only one had typical Felty's syndrome. They were again studied using blood counts, microscopy of bone marrow and surface antigen analysis of mononuclear cells and the above mentioned diagnoses were confirmed. Though clinically indistinguishable, these two conditions are clearly distinct on both hematologic and immunological grounds. The four patients with rheumatoid arthritis and chronic granulated T cell lymphocytosis with neutropenia represent 36.3 per cent of our institution's patients with chronic granulated T cell lymphocytosis of undetermined significance. Caution should be used in the treatment of rheumatoid arthritis of the patients with associated granular lymphocyte proliferation, considering the possible adverse effects that drugs such as gold salts, penicillamine, cyclosporine and methotrexate may exert not only on the immunological system but also on granulocytopoiesis.

Adult↗
PubMed1989

Prophylactic and therapeutic role of rioprostil in NSAIDs induced gastroduodenal lesions.

In a randomized, double-blind, placebo-controlled, prospective trial, the activity of rioprostil, a new prostaglandin E1 alcohol analogue, on non-steroidal anti-inflammatory drug-induced gastroduodenal mucosal lesions is studied in 30 patients with rheumatic diseases. Both treatment regimens, rioprostil, 150 micrograms t.i.d., and rioprostil, 200 micrograms b.i.d., for a period of 12 weeks, significantly reduce the rate of mucosal lesions in all patients when compared to placebo. Furthermore, rioprostil achieves a reduction in gastrointestinal symptoms without enhancement of joint disease activity, and significantly reduces antacid intake. Therapy is safe and well tolerated by all patients. It can be concluded from this study that prostaglandins could play an important part in the prevention and treatment of gastrointestinal damage due to NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

[Chronic granular T lymphocytosis of undetermined significance].

The clinical, morphologic, immunologic, functional, serologic and cytogenetic features of 4 cases of chronic granular T cell lymphocytosis with neutropenia were studied. The records of these patients were reviewed and an infectious event preceding the development of the disorder could be documented in 3 cases, suggesting a cause and effect relationship. A benign monoclonal gammopathy was detected in the remaining patient. The clinical picture was characterized by moderate blood and bone marrow lymphocytosis, neutropenia, hepatosplenomegaly, absence of lymphadenopathy, and a stable course, observed over a period of up to 11 years. Surface marker analysis in all the patients showed the common membrane phenotype of granular T cell lymphocytosis (CD3+, CD4-, CD8+, Leu7+). One patient treated with steroid therapy had reversal of lymphocytosis and severe neutropenia, which both recurred after steroids were withdrawn. The disorder again resolved after pulse steroid treatment. From these findings and a review of the literature, we suggest that granular T cell lymphocytosis with the immunologic phenotype exemplified by our cases is a distinct reactive or immunoregulatory disorder. In view of the similarities in character to benign monoclonal B cell lymphocytosis and idiopathic paraproteinaemia, we suggest that this disorder be termed chronic granular T cell lymphocytosis of undetermined significance.

Adult↗
PubMed1989

[Idiopathic monoclonal gammopathy. Long-term study of 313 cases].

The records of 519 patients with a paraproteinaemia who where examined at our institutions before January, 1, 1983, were reviewed. After patients with multiple myeloma, macroglobulinemia, amyloidosis, lymphoma or related diseases had been excluded, 363 cases remained which fulfilled the criteria for a diagnosis of idiopathic monoclonal gammopathy (IMG). Also excluded were the cases in which follow-up efforts failed and those in which the paraprotein had disappeared. A long-term study was thus possible in 313 patients with IMG. They were arbitrarily subdivided into two groups: 213 patients with a follow-up of 5-8 years and 100 patients whose follow-up was longer than 8 years. Fourteen per cent of the patients from the former group and 18 per cent from the latter developed a malignant B cell dyscrasia, on the average this event becoming clinically detectable after 63 months (27-138 months) from initial recognition of the paraprotein. A retrospective analysis of the clinical data at the diagnosis of IMG, revealed that none of the patients could have been identified in advance in whom a malignant transformation later occurred.

Adult↗
PubMed1988

[Selective hypoaldosteronism with hyperkalemia. Clinical and physiopathological study of 22 cases with hypo- or hyperreninemia].

Twenty-two patients with selective hypoaldosteronism (SH) were studied. In 18 of them decreased levels of plasma renin activity (PRA) were associated with the syndrome: 12 patients showed the idiopathic form of SH, while in 6, the syndrome was attributable to the administration of non-steroid anti-inflammatory drugs. In the remaining 4 patients, the hypoaldosteronism was characterized by associated increased PRA levels but functional studies excluded a diagnosis of adrenocortical insufficiency. From a critical review of the literature and from the present observations it seems likely that SH is a syndrome with a heterogeneous pathogenesis. The possibility exists that the major alterations in potassium homeostasis that characterize the syndrome of SH, though mainly attributable to deficiency of aldosterone secretion may actually depend on the concurrence of underlying mechanisms, in particular on the presence of distal nephron dysfunctions.

Aged↗
PubMed1988

[Chronic idiopathic neutropenia: a benign hematological disorder].

Clinical data in 23 consecutive patients with chronic idiopathic neutropenia are reported. During a long-term follow-up (4 to 11 years), none had leukemia or autoimmune diseases. In particular, in no case did serious recurrent infections develop despite severe neutropenia. Immunological studies showed the presence of antibodies to neutrophils in a unique case and of the marker make-up of K lymphocytes in other two with chronic T8 lymphocytosis and associated neutropenia. The immunological features of this syndrome is briefly discussed. Chronic idiopathic neutropenia, even in the presence of an immunological imbalance, is a benign haematological disorder and does not need any treatment.

Agranulocytosis↗
PubMed1987

[Angiosarcoma of the breast].

Two cases of angiosarcoma of the breast observed in 1981 and 1982 are reported; one of these is still living, but with local recurrence. The pathogenesis, classification, prognosis and therapy of this malignant tumor are analysed. The review of the literature and personal experience seem to suggest that the treatment of choice should be surgical with complementary radiotherapy.

Adult↗
PubMed1986

[Side effects of d-penicillamine in the treatment of rheumatoid arthritis].

In the present study, the side effects of d-Penicillamine therapy in 54 patients with rheumatoid arthritis are analyzed. The therapeutic efficacy of the drug is emphasized; but in the meantime, the necessity is also stressed that the choice of this antirheumatic agent must imply the knowledge of the possible complications caused by its use and of the clinical features and laboratory data which would be useful for their early detection.

Adult↗
PubMed1985

[Development of polycythemia vera during chronic idiopathic myelofibrosis].

A case of typical idiopathic myelofibrosis turning into polycythaemia vera 6 years after diagnosis is reported. This transformation occurred after treatment with busulphan. The present case is added to similar previous observations to give further support to the contention that the transition of chronic idiopathic myelofibrosis to polycythaemia vera may be a consequence, though rare, of therapy rather than a spontaneous event occurring during the course of the disease.

Adult↗