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Biomedical subjects

M Balducci

Publications and source records attributed to M Balducci.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

[Epoetin alfa in radiotherapy].

Sixty per cent of oncologic patients need radiation therapy for cure or palliation. In fact, in most neoplastic diseases, a better local control positively impacts on disease-free survival and overall survival. The efficacy of radiotherapy depends on several factors: while some are tumor-related, others are host-related. Radiobiological phenomena are also important: ionizing radiation is responsible for cell damage (double rupture of DNA chains), mostly an indirect mechanism with the formation of free radicals. Their toxic action is enhanced by the oxygen partial pressure at the cellular level. A number of studies have confirmed that good tissue oxygenation is a function of a high hemoglobin level in the peripheral blood (Hb > or = 13 g/dL). Unfortunately, these values are rarely present in oncologic patients due to the disease-related toxicosis as well as to the therapy induced hematologic toxicity. The treatment of anemia is free of risk for the recent developments in technology which with gene cloning and the technique of recombinant DNA has allowed the production of human recombinant erythropoietin. Erythropoietin is produced by the interstitial cells of renal tubules in response to hypoxia. It prevents apoptosis and promotes erythroid proliferation and differentiation with consequent reticulocyte release and hemoglobin synthesis. It is not completely understood whether the efficacy of radiotherapy depends on hemoglobin values present at the start of irradiation (often less than 12-13 g/dL) or on the higher ones observed during and at the end of radiotherapy. Therefore, preventive systemic erythropoietin therapy in non anemic patients in terms of costs/benefits is at present non sustainable. To the contrary, in patients undergoing radiotherapy to extended fields or aggressive multimodal treatments, for the higher risk of anemia, the early use of this treatment can be hypothesized in case of initial anemia to improve therapy compliance and prevent negative conditioning of results. Keeping in mind that grade 1 minimum toxicity for red cells, according to the Radiation Therapy Oncology Group (RTOG) is equal to 11 gHb/dL we think that this value can be considered as cutoff to start erythropoietin therapy.

Anemia↗
PubMedDate not supplied

Tick-borne encephalitis (TBE) in Italy: report of the first clinical case.

Previous studies on the clinical features of meningoencephalitis in Italy did not help to indicate the nature of the causative agents. On the other hand during the past decade nine arboviruses were isolated in Italy, some of which are yet to prove pathogenic for man. A systematic study was carried out in cooperation between the Department of Neurology of the University of Florence and the Istituto Superiore di Sanità (Rome), in order to understand a possible role of arboviruses as etiologic agents of meningoencephalitis in Italy; in this preliminary communication the first clinical case of Tick-Borne Encephalitis (TBE) virus infection is described.

Adult↗
PubMedDate not supplied

Advances in the treatment of lung cancer: economic and organizational aspects.

The organizational optimization in radiotherapy tends to a correct balance of quality of service and containment of health care expenditure; this goal is necessarily correlated with the real potentialities available to each center while considering the possible clinical benefits for the patient. In lung cancer, outcomes achieved with radiation therapy are encouraging in terms of local control and survival when treatment is performed with the available modern technology whose costs from an exclusively economic analysis are shown to be still quite high. In an assessment focused on clinical outcomes, better local control, higher survival and improved quality of life represent tangible benefits: this has a positive impact on community costs and may represent a high priority goal for health care providers, yielding a benefit that can be quantified with the most recent analyses of health care economy.

Costs and Cost Analysis↗
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Research trends in the treatment of colorectal cancer.

Colorectal carcinoma ranks second in incidence after lung cancer in males and breast carcinoma in females. Within the clinical research on this tumor, new molecules of antineoplastic agents and new combined modality treatments have been introduced. From the examination of ongoing protocols some trends can be identified: the interest in immunotherapy and genetic therapy, frequently tested in combination with chemotherapy; the effort at the optimization of the administration of antineoplastic agents in the most common sites of metastatic lesions by hepatic or intraperitoneal infusion; the trend to a more aggressive treatment of metastastatic lesions with hyperthermia and cryoablation as well with the combination of systemic therapy and surgery. As far as radiotherapy is concerned, the main goals of clinical research seem represented by the need to optimize combined modality therapy in T3-4 rectal carcinoma both in terms of pre- and postoperative radiotherapy timing as well as of the combination with adjuvant chemotherapy. There is a growing interest in new drugs which in the future may replace the conventional 5-fluorouracil in concurrent chemoradiation.

Colorectal Neoplasms↗
PubMedDate not supplied

[The outpatient care in the Latium region (Italy) in 2001].

The Region of Latium has been operating an Outpatient Care Information System (SIAS) since 1997 to monitor the supply of outpatient care in a territory with a population of over five million. The present work has the aim of describing the outpatient care in the region, in terms of number of facilities involved by category (public and private, operating in the regional public health system) and volume of procedures rendered to residents in 2001. Of the 971 outpatient facilities operating in hospitals and elsewhere--37% state managed and 67% private--distributed in a non-uniform manner throughout the region, the majority is concentrated in the city of Rome, which by itself accounts for 49% of its total amount of facilities, and in a lesser measure in the other provincial capitals (Viterbo, Rieti, Frosinone, Latina). In 2001, 71 million procedures were performed, comprising 17 million prescriptions, for an economic value of over 400 million Euros. The three specialties of greatest use were Lab Analysis, Physical Therapy and Rehabilitation, and Radiology, making up 88% of the total outpatient procedures performed within the precinct of the regional health service, in respective measures of 57%, 27%, and 4%. It is noted that the public facilities are prevalently polyspecialistic while a great number of private facilities are monospecialistic and perform procedures almost exclusively (96%) in the three specialties of greatest use. The other specialties which receive notable use are Cardiology, Eye Care, Orthopedics and Neurology. In general, the greater the number of facilities there are in either the public or private sector, the greater the level of activity in terms of procedures performed, with the exception of the area of Physical Therapy and Rehabilitation where the correlation is inversely proportioned; in fact, for this specialty the public facilities, which are represented in a much greater number throughout the region, supply only 7% of the volume of activity.

Ambulatory Care Facilities↗
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[Virus transmission to man from Phlebotomus flies: role of the Tuscany virus (Bunyaviridae, Phlebovirus) in the etiology of infections of the central nervous system].

During field studies on the ecology of arboviruses in Italy, strains of a new virus were isolated from sand flies, mostly females, of a pure colony of Phlebotomus perniciosus collected in a central Italian region (Tuscany). The prototype was named Toscana (TOS) virus, assigned to the Phlebotomus fever serogroup of arboviruses (family Bunyaviridae, genus Phlebovirus) and registered in 1980 in the International Catalogue of Arboviruses. Neutralizing antibodies to TOS virus were detected in human sera. Serologic surveys were carried out to estimate the natural distribution of TOS virus in Italy and it was shown that antibodies to this virus could be detected in humans mainly of the Tuscany region. In particular, a high infection rate (24.8%) was observed among residents of the province of Florence. Furthermore, several patients with a diagnosis of aseptic meningitis presented a serologic response which reflected a recent infection with TOS virus in the Tuscany and Marche regions. Consequently, between 1980 and 1986 studies were conducted at selected sites of the Tuscany region to determine the possible occurrence of vectors and presence of foci of TOS virus and to assess its public health importance. As a result of these investigations, several virus strains were isolated from pools of wild caught Ph. perniciosus and Ph. perfiliewi. Of the virus isolates obtained, 37 were identified as TOS virus and 47 as a new serotype, member of the Phlebotomus fever group. For this virus we suggested the name of Arbia (ARB) virus, Arbia being the river flowing across both Florence and Siena provinces from which the isolates originated.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
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[Role of computerized tomography in the definition of the area to be irradiated in bone metastases].

In the Department of Radiology of the Catholic University S. Cuore in Rome, a review was made of 342 CT examinations with a view towards optimizing the therapeutic planning in patients affected by bone metastases. All patients were submitted to radiological positioning and then to CT evaluation in order to assess the volume to be treated. In 224 cases it was not necessary to perform wide CT examination (3-5 standard tomograms being enough, 2 of which at the superior and inferior margins of the planned field). In the second group of 118 patients it was necessary to perform CT (serial axial scans)--increasing by 1-1.5 cm--up to the superior and inferior margins of the lesion. The existence of 2 types of lesions was confirmed: those involving mainly bony structures and those infiltrating the soft tissues. CT evaluation allowed the definition of the target volume to the real extension of the lesion in 14% of the whole of cases, while in the group of 118 cases studied more thoroughly, the percentage went up to 41%. CT allowed a better assessment of secondary bone lesions, especially in kidney and lung neoplasms. The metastatic site that required a more frequent modification of the irradiation field was the chest. To conclude, the authors emphasize the importance of CT in assessing the target volume, especially in those cases in which conventional radiology does not allow a reliable evaluation of the lesion, possibly compromising the local monitoring of the disease.

Bone Neoplasms↗
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Danazol reverses endometrial hyperplasia to normal endometrium.

Danazol, an isoxazol derivate of ethinyltestosterone, was used in the treatment of thirtyone postmenopausal patients with endometrial hyperplasia at the dose of 400 mg/day for three months. A profound growth-inhibitory effect of danazol on human endometrium was previously suggested. The present study shows that this compound is effective to reverse the endometrial hyperplasia to normal endometrium in 97% of cases. Atrophic changes of endometrial hyperplasia to normal endometrium after danazol-treatment were observed in 68% of patients. These results strongly suggest that danazol has a significant antiproliferative effect on the endometrium.

Danazol↗