Biomedical subjects

Luca Grimaldi

Publications and source records attributed to Luca Grimaldi.

7 recordsLinked to original sources

PubMed2006

In vivo dosimetry by an aSi-based EPID.

A method for the in vivo determination of the isocenter dose, Diso, and mid-plane dose, Dm, using the transmitted signal St measured by 25 central pixels of an aSi-based EPID is here reported. The method has been applied to check the conformal radiotherapy of pelvic tumors and supplies accurate in vivo dosimetry avoiding many of the disadvantages associated with the use of two diode detectors (at the entrance and exit of the patient) as their periodic recalibration and their positioning. Irradiating water-equivalent phantoms of different thicknesses, a set of correlation functions F(w, l) were obtained by the ratio between St and Dm as a function of the phantom thickness, w, for a different field width, l. For the in vivo determination of Diso and Dm values, the water-equivalent thickness of the patients (along the beam central axis) was evaluated by means of the treatment planning system that uses CT scans calibrated in terms of the electron densities. The Diso and Dm values experimentally determined were compared with the stated doses D(iso,TPS) and D(m,TPS), determined by the treatment planning system for ten pelvic treatments. In particular, for each treatment four fields were checked in six fractions. In these conditions the agreement between the in vivo dosimetry and stated doses at the isocenter point were within 3%. Comparing the 480 dose values obtained in this work with those obtained for 30 patients tested with a similar method, which made use of a small ion-chamber positioned on the EPIDs to obtain the transmitted signal, a similar agreement was observed. The method here proposed is very practical and can be applied in every treatment fraction, supplying useful information about eventual patient dose variations due to the incorrect application of the quality assurance program based on the check of patient setup, machine setting, and calculations.

Humans↗

PubMed2002

Adjuvant epirubicin with or without Ifosfamide for adult soft-tissue sarcoma.

This randomized study compared the efficacy of epirubicin-based adjuvant chemotherapy on the disease-free interval (DFI) and overall survival of patients with high-risk soft-tissue sarcomas. After curative surgery, 43 of the 88 enrolled patients were assigned to surgery with or without radiotherapy and 45 to surgery plus chemotherapy (26 epirubicin, 19 epirubicin + ifosfamide) with or without radiotherapy. The trial closed prematurely because of poor patient accrual. There was a statistical significant difference in the 5-year disease-free survival of the patients receiving adjuvant chemotherapy with or without radiotherapy (69%) and that of those treated with surgery with or without radiotherapy (44%) ( p= 0.01). The 5-year survival of the patients treated with adjuvant chemotherapy with or without radiotherapy was 72% as against 47% of those treated with surgery with or without radiotherapy ( p= 0.06). The power of the study was 0.65 for both the DFI and overall survival. The results of the study suggest a possible advantage of epirubicin-based adjuvant chemotherapy in patients with soft-tissue sarcoma at high risk of relapse.

Antibiotics, Antineoplastic↗

PubMedDate not supplied

Carbon dioxide therapy: effects on skin irregularity and its use as a complement to liposuction.

For a successful conventional or superficial liposuction, it is necessary to consider the competence of the surgeon who is to administer the procedure necessary for this type of surgery as well as the physical and psychological evaluation of the determined patient. A poor result often is related to the persistence of adipose tissue irregularity in the form of fatty tissue accumulation. This complication, common to this type of surgery, has called for research to determine methods for its treatment. Carbon dioxide (CO2) therapy refers to the transcutaneous and subcutaneous administration of CO2 for therapeutic purposes. This treatment originated at the Royal Spas of France in 1932 with the treatment of patients affected by obliteration of arteriopathies. Recent studies have demonstrated the effect of subcutaneous CO2 therapy performed to improve local parameters of circulation (performed by Doppler, laser-Doppler, and trans-cutaneous partial pressure of oxygen determination), and to reduce localized adiposities (verified reporting variations in maximum circumference and performing histologic studies). With these results, the absence of toxicity, and the relevant side effects related to this treatment taken into consideration, the Plastic Surgery Unit of Siena has been committed to researching the role that CO2 therapy can play in the treatment of skin irregularity and as a complement to liposuction. The authors report their experience using Carbomed programmable automatic CO2 therapy apparatus and 30GA1/2 0,3X13 microlance needles for the treatment of patients with adipose tissue accumulations located on the thighs and knees. In their study, 42 patients were divided into three groups: A, B, and C. In Group A, only liposuction was performed. In group B 3 weeks after liposuction CO2 therapy was administered in two weekly subcutaneous applications of CO2 for 10 consecutive weeks. In group C, CO2 therapy alone was administered with the same contingencies used for group B (two weekly subcutaneous applications of CO2 for 10 consecutive weeks). The objective was to assess the effectiveness of CO2 therapy for skin irregularity and as a complement to liposuction for adipose tissue accumulation by reporting variations in circumference and skin elasticity monitored by the Cutometer SEM 474 in all treated areas. The data obtained were analyzed statistically. Values of p less than 0.05 were considered significant. The authors report their experience and the results achieved from the study.

Adipose Tissue↗

PubMedDate not supplied

Octyl-2-cyanoacrylate adhesive for skin closure and prevention of infection in plastic surgery.

No complete scientific study has yet investigated the incidence of surgical-site infections in plastic surgery operations. However, it has been noted that in the case of wound infection, the aesthetic and sometimes the functional results become invalidated by delay and an alteration of the healing processes, thus necessitating surgical correction. This study aimed to evaluate the effectiveness of applying tissue adhesive on surgical wounds in plastic surgery as a protection capable of reducing the onset of infection, and to verify the existence of a statistically significant difference between treated and untreated wounds, and to determine patients' satisfaction with their cicatricial results.

Adult↗

PubMedDate not supplied

Virtual simulation: fifteen years later.

In the last two decades there was a radical change in radiotherapy setup. The growing availability of CT equipment and console for computer-aided treatment planning setup enabled the use of advanced technologies as conformal 3D radiation therapy in most centers. In particular in 1987 virtual simulation was proposed for setup. During its use a number of application modalities appeared. Virtual simulation in some centers is applied alone while in others it is associated with conventional simulation. However, from numerous reports published in last years it seems that virtual simulation significantly improves treatment quality independently of radical or palliative intent and of the size of treated volumes (high doses to small volumes or wide shaped fields). Some studies stressed that virtual simulation could significantly shorten treatment planning times with consequent cost reduction. The use of virtual simulation evidenced associated problems and in particular setup limitations due to the CT gantry size, the need to up-date the conventional modalities of setup verification according to the new technologies and more generally to up-date quality assurance procedures in an advanced technological setting. Finally there was the self-evident need of a better knowledge of the anatomy on axial sections, of tumor spread routes in particular.

Computer Simulation↗

PubMedDate not supplied

Surgical treatment of wounds of the lower leg and foot with loss of substance.

In the surgical treatment of wounds of the distal regions of the leg with loss of substance, particular anatomical conditions and the frequent coexistence of previous diseases or of diseases connected to the trauma make it hard to choose the most appropriate surgical strategy and require a multidisciplinary approach. Timing and treatment modalities must be decided by different operators in order to ensure a lower risk of post-surgical complications and disabling outcomes. The need for plastic and reconstructive treatment is growing as a result both of the improvement in reconstructive techniques and of the increased incidence of major injuries. The authors report their own experience with the treatment of 21 patients (14 males and 7 females). Partial-thickness skin grafts were performed in 11 cases (7 lower-third leg injuries and 4 foot wounds). Fasciocutaneous flaps were used in 8 patients (5 lower-third leg injuries and 3 wounds to the distal third of the foot), while microsurgical flaps were used in 2 cases of exposed injuries to the foot. The authors report the results obtained and the healing times in relation to the severity of the injuries and the complications observed. Patient treatment modalities are discussed and the results analysed.

Adolescent↗

PubMedDate not supplied

Use of a protease-modulating matrix in the treatment of pressure sores.

Improved diagnostic and therapeutic possibilities lead to a higher incidence of chronic ulcerative lesions. Several sociological and nursing problems related to these pathologies have oriented the research towards new specific materials and methodologies in wound dressing. The main concept is to modulate the environment of wounds in order to reduce healing time, thus minimising costs and the incidence of disabling outcomes. The Authors report on their experience with the use of a protease-modulating matrix (Promogran) in the treatment of pressure sores. A cohort of 80 selected patients was randomly divided into two groups, one of which was treated with the test material, while the other was submitted to conventional dressings and used as a control group. A cost-effectiveness analysis was carried out. Compared to the controls, the treated group showed a lower mean healing time and a greater frequency of complete healing. The cost-effectiveness balance was found to be more advantageous in the treated group as well. Due to its reliability and absence of adverse reactions, the use of a matrix with a modulating action on proteases may represent an effective treatment in the management of cleansed chronic cutaneous losses.

Adult↗