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Biomedical subjects

G Paoletti

Publications and source records attributed to G Paoletti.

At least 37 records · Page 2Linked to original sources

Amikacin plus ceftazidime versus amikacin plus piperacillin versus amikacin plus aztreonam in infections in neoplastic patients with granulocytopenia.

Sixty granulocytopenic patients (granulocytes less than 1000/mm3) affected with solid tumors, previously submitted to antiblastic therapy and with infections, were treated with three antibiotic combinations: amikacin + ceftazidime, amikacin + piperacillin or amikacin + aztreonam. In 68% of the cases the infections were due to gram-negative and in the remaining 32% to gram-positive microorganisms. The results obtained with the three treatments show a slight but significant statistical difference (p less than 0.05), due to the greater efficacy of the amikacin + ceftazidime combination on gram-positive and amikacin + aztreonam on gram-negative bacteria.

Adult↗

[Spiro-ergometric evaluation of a group of healthy young subjects: sedentary females, sedentary males and practicing male sports amateurs (jogging)].

In order to assess the qualitative and quantitative differences in physical performance, twenty sedentary females (Group A), twenty sedentary males (Group B) and twenty amateur sportsmen who jogged 45-60 min 2-3 times a week (Group C), have been evaluated by spiroergometric test on bicycle ergometer. At the submaximal level of 90 Watts the cardiorespiratory efficiency, as reflected by the values of double product (DP) and ventilatory equivalent (VE) was statistically different in the three Groups (A less than B less than C). At the maximal work the females, compared to sedentary males, achieved lower values (P less than 0.001) of maximal working capacity (MWC), total work (TW), systolic blood pressure (SBP), maximal O2 uptake (VO2 max), O2 pulse (O2P) and a greater (P less than 0.001) energetic cost (EC = HRmax/TW): sedentary males, compared to amateur sportsmen, achieved lower values (P less than 0.001) of MWC, TW, VO2 max, O2P and greater values (P less than 0.001) of VE, EC, HR, and DP (P less than 0.02). The lower VO2 max in females can be mainly ascribed to the lower stroke volume which in turn correlates with smaller body surface area. The greater VO2 max and O2P max of amateur sportsmen can be ascribed to larger stroke volume and muscular O2 uptake brought about by jogging. Furthermore the females, compared to sedentary males, have achieved VO2 max and O2P max that were 29% lower, a TW 43% lower, while EC was 73,4% higher. The sedentary males, compared to amateur sportsmen, have achieved lower values of VO2 max (-14,3%), O2P max (-17,5%) and TW (-31,3%) with DP and EC 8,3% and 50,7% higher, respectively. On the grounds of these data sedentary subjects, particularly females, pay a high energetic cost during physical activity. The practice of an aerobic sport such as jogging, may notably increase cardiovascular and respiratory efficiency.

Adult↗

[The nuclear family and social protection of children].

The nuclear family is the consequence and reflection of rapid industrialization of the country. It requires a wider safeguarding of infancy in the framework of more extensive social and care service structures. Kindergartens and nursery schools are the basic answers to child care, coupled with the network of independent institutions, and hospitals, out-patients centres and school medical services, and the local health unit, which supervises services in its district. Mention is also made of the measures still needed to ensure that kindergartens and nursery schools are available and efficient, and what must still be done with regard to school medicine (prophylaxis, retrieval of the handicapped, rehabilitation) to achieve a more advanced system of social protection in childhood.

Child↗

[Evaluation of the efficacy of cis-diamino-dichloro-platinum as monochemotherapy in the treatment of advanced malignant tumours of the bladder (author's transl)].

The authors report the results of a trial of the treatment of recurrences of advanced carcinomas of the bladder using Cis-Diamino-Dichloro-Platinum administered by continuous IV infusion over a period of 24 hours at a dose of 100 mg/m2, under cover of hyperhydration and anti-haematizing drugs. The trial involved 10 patients who has had the following initial treatment : - excision for 8 of them (2 total cystectomies for T4, one total cystectomy for T3B, 2 total cystectomies for T3A and 3 partial cystectomy for T1); - preoperative cobalt therapy for 7 of them (2 flashes of 7.5 gray) - postoperative chemotherapy (VM26 and 5FU) for 5 patients. The targets evaluated were : 7 remaining pelvic tumours or recurrences, 3 lung metastases, two cases of venous compression with oedema of the lower limbs, 3 node metastases, 3 bone and 1 sciatic metastases. Results : - 1 complete remission with disappearance for 10 months in the same patient of pulmonary metastases, venous compression and an inguinal node; - 3 partial remissions for 2 to 9 months; - 2 minor remissions of 3 to 5 months; - 3 stabilizations and 1 progression. It is interesting to note the greater efficacy on distant metastases (2/3 complete disappearances of lung metastases, 2/2 disappearances of oedema of the lower limbs) than on pelvic tumours (4/7 regressions). In total, 4 objective responses out of 10 occurring between the 2nd and 6th week after the first course. The authors announce a valuable synergism of DDP with cyclophosphamide and adriamycin.

Aged↗

[Gemcitabine in peritoneal mesothelioma: a case report].

Malignant peritoneal mesothelioma is a rare tumor whose prognosis is poor. We report a case history of a 57-year old woman with large peritoneal masses and ascites refractory to several chemotherapeutic regimens. The patient benefited of a dramatic regression of disease with symptomatic improvement during chemotherapy with gemcitabine. Serum CA-125 values declined consensually to tumor regression. The duration of response was 12 months. The activity of gemcitabine in malignant mesothelioma has been already confirmed in phase II studies. Data are also available suggesting that better results can be obtained combining this agent with cisplatin, and a multicenter phase II study is now exploring the activity of this combination.

Antimetabolites, Antineoplastic↗

[Gemcitabine in advanced stage soft tissue sarcoma: a phase II study].

PURPOSE: To assess the activity and toxicity of gemcitabine in locally advanced or metastatic soft tissue sarcoma patients (pts). PATIENTS AND METHODS: Gemcitabine was administered on days 1, 8, 15 every 4 weeks at a dose of 1.000/1.250 mg/m2, respectively, in pretreated or not pretreated pts. RESULTS: Eighteen pts entered this phase II trial; sixteen had been previously treated with anthracyclines and ifosfamide. A partial response was observed in a woman with fibrous malignant istocytoma, whereas in 7 pts the disease remained stable. Median time to progression was 4 months. The treatment was well tolerated. Grade 4 toxicity was not observed. CONCLUSIONS: These results do not suggest that gemcitabine, in the dose and schedule used in this trial, may be of value in the treatment of soft tissue sarcomas.

Antimetabolites, Antineoplastic↗

A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIR-spheres in unresectable, colorectal liver metastases refractory to i.v. chemotherapy: preliminary results on toxicity and response rates.

BACKGROUND: In patients locally progressing after two lines of chemotherapy, some locoregional approaches showed encouraging results in terms of local control of disease. The aim of our study was to evaluate toxicity, clinical response and quality of life in 48 patients with unresectable colorectal liver metastases submitted to selective internal radiotherapy (SIRT). MATERIALS AND METHODS: Up to now 35 patients with unresectable colorectal liver metastases, refractory to two lines of chemotherapy, underwent intra-arterial infusion of resin microspheres with yttrium-90 (SIR-spheres). Pre-treatment evaluation included a CT scan, blood tests, a PET scan and arteriography of celiac trunk, hepatic and superior mesenteric artery; extrahepatic uptakes and pulmonary shunts more than 10% were excluded by a Scinti-scan. The gastroduodenal artery was embolized before the SIR-spheres injection. Other exclusion criteria were liver dysfunction and anatomical vascular anomalies. The clinical response was evaluated by CT-scan following the RECIST criteria. Median follow-up was 4 months. RESULTS: Median number of metastases was 4 (range, 1-15), 38% of cases presenting hepatic involvement < 25%. The median SIRT dose delivered was 1.7 GBq. Median pulmonary shunt was 6%. No operative mortality occurred; early toxicity (within 48 hours) was 20.6%, shown as fever, acute pain and leucocytosis. The late toxicity was 24.1% with chronic pain, jaundice and nausea being the most frequent. All the toxic events were graded 2 or 3 according to the WHO scale. Preliminary results were available in terms of clinical response after 6 weeks: 12.5% had a partial response, 75% a stable disease, while progression of disease, was observed in 12.5% of the patients. CONCLUSION: SIRT is a safe treatment in terms of acute and late toxicity. Intra-arterial microspheres could represent a good therapeutic option for patients with progressing liver metastases only, after two lines of systemic chemotherapy.

Antineoplastic Agents↗

Dexrazoxane cardioprotection in advanced breast cancer patients undergoing high-dose epirubicin treatment.

PURPOSE: We performed a randomized trial to evaluate the cardioprotective effect of dexrazoxane (DEX) in advanced breast cancer patients (ABC) treated with high single-dose epirubicin (EPI). A secondary objective was to determine the role of radioimmunoscintigraphy (RIS) in the assessment of epirubicin cardiotoxicity. PATIENTS AND METHODS: Ninety-five patients with ABC were treated with EPI 160 mg/m2 by i.v. bolus every 3 weeks with or without DEX, 1,000 mg/m2 i.v. Cardiac monitoring included multigated radionuclide (MUGA) scan with determination of resting left ventricular ejection fraction (LVEF), and RIS with 111-Indium antimyosin monoclonal antibodies. RESULTS: The overall response rate was 69% in the EPI arm and 67% in the EPI + DEX arm; median time to response and median time to progression were identical in both arms, being 2 and 8 months, respectively. Median survival was 19 months versus 29 months (p 0.21), respectively. DEX did not appear to contribute to extracardiac EPI toxicity. Congestive heart failure occurred only in the EPI arm (2 instances). LVEF significantly decreased from baseline only in the EPI group. An abnormal tracer uptake at RIS was observed early in both arms, but the increase in heart to lung ratio was much more evident in the control group. CONCLUSIONS: DEX significantly protects against the development of high dose epirubicin cardiotoxicity apparently without evidence of an adverse impact on antitumor activity and non cardiac toxicity. RIS is a very sensitive technique in detecting anthracycline cardiac damage, but its specificity is low and cannot be considered alone a primary test for guiding anthracycline treatment.

Aged↗

[Long-term survival after hepatectomy for metastatic liver cancer originating from colorectal carcinoma: presentation of two clinical cases].

We report two case histories of long surviving patients after resection of liver methastases from colorectal cancer. In the first case the patient underwent a right hepatectomy to resect a 3 cm-lesion revealed by a CT scan three years after surgery for a rectal adenocarcinoma. Subsequently, she received two cycles of 5-day continuous infusion of fluorouracil. Four years and 11 months after hepatectomy, the patient is alive and free of disease. The second patient underwent resection of a large hepatic methastasis 3 months after left emicolectomy. The lesion substituted almost completely the right lobe and extended to the IV segment of the left lobe of the liver. After hepatectomy, the patient had a disease-free survival longer than 10 years, until a chest X-ray and a CT scan revealed a primary right lung cancer (citologically, adenocarcinoma) with a methastasis in the left lung. Surgical resection represents the only potentially curative therapy for hepatic methastases from colorectal cancer. Recent data about patient selection for hepatic methastasectomy are presented, and the opportunity of postoperative chemotherapy is discussed.

Adenocarcinoma↗

[Sequential therapy with methotrexate and 5-fluorouracil in patients with advanced colorectal cancer pretreated with 5-fluorouracil plus folinic acid].

PURPOSE: To evaluate the efficacy and toxicity of a sequential low-dose methotrexate (MTX) and 5-fluorouracil (5FU) regimen in the palliative treatment of patients with advanced colorectal cancer. PATIENTS AND METHODS: Enrolled in the study were patients with advanced colorectal cancer, refractory to 5FU + FA. Patients were treated with MTX 40 mg/m2 i.v. bolus d 1 and 8, 5FU 700 mg/m2 i.v. bolus d 2 and 9 (24 hours after MTX bolus). The cycle was repeated every 4 weeks. RESULTS: 48 patients entered the study, and 45 are evaluable. The overall response rate was 15% with 1 complete response and 6 partial responses. Eight patients obtained disease stabilization. Median time to progression was 9 months. Toxicity was mild. Grade 3 stomatitis was observed in 7 (15%) patients. CONCLUSIONS: Sequential MTX/5FU is a well tolerated regimen with mild antitumor activity in refractory advanced colorectal patients.

Antineoplastic Combined Chemotherapy Protocols↗