Biomedical subjects

S Viscomi

Publications and source records attributed to S Viscomi.

12 recordsLinked to original sources

PubMed2005

Life expectancy as an indicator of outcome in follow-up of population-based cancer registries: the example of childhood leukemia.

BACKGROUND: Survival analysis is a standard methodology to assess progress in oncology disease treatment. However, survival analysis commonly only measures survival during the treatment period (and the period immediately afterwards), and does not provide an estimate of life expectancy, which is often of more interest to patients and to health policy makers. In this paper we propose a method to estimate childhood acute lymphoblastic leukemia (ALL) life expectancy through the integration of traditional survival analysis and life expectancy tables. PATIENTS AND METHODS: The study included 305 incident cases registered by the Childhood Cancer Registry of Piedmont in 1979-1991. Vital status on 30 June 2004 was known for 304 cases. Survival analyses were carried out using the Kaplan-Meier method and the Gompertz model, according to the time period of diagnosis and gender. RESULTS: Cumulative survival at 5 years increased from 58.6% (95% CI 48.9-68.3) for cases diagnosed in March 1979-July 1982 to 79.1% (95% CI 70.8-87.5) in March 1987-February 1991 (P = 0.002). Average life expectancy increased from 46.1 years for boys and 42.6 years for girls diagnosed in March 1979-July 1982 to 58.3 and 69.1, respectively, in March 1987-February 1991. CONCLUSIONS: These analyses show an improvement over the time period of diagnosis of life expectancy for children with ALL.

Adolescent↗

PubMed2004

Interpretation of expression-profiling results obtained from different platforms and tissue sources: examples using prostate cancer data.

The analysis of expression signatures is a powerful tool for the classification of cancer and other tissue samples. Several protocols and platforms are available on the market, and these lead to both confirmatory and complementary results. We review the main processing techniques for cross-platform comparisons and the different tissue sources for cancer profiling. Some examples and the cross-interpretation of bibliographic data related to prostate cancer are also presented.

Data Collection↗

PubMed2003

Population-based survival after childhood lymphoblastic leukaemia in time periods corresponding to specific clinical trials from 1979 to 1998--a report from the Childhood Cancer Registry of Piedmont (Italy).

This study evaluated the outcome after childhood acute lymphoblastic leukaemia (ALL) in a population aged 0-14 years served by the Childhood Cancer Registry of Piedmont (CCRP) during the accrual periods to nationwide clinical studies run by the Italian Association for Paediatric Haematology and Oncology (AIEOP). In the time period considered (March 1979-December 1998) the CCRP recorded 498 incident cases of ALL. The living status on 31 December 2000 was known for 497 cases. Overall survival at 5 years was 74.1% standard error (S.E.) 2.0%). It increased from 58.6% (S.E. 4.9%) for cases diagnosed in March 1979-July 1982 to 87.3 (S.E. 3.6) in May 1995-December 1998. Results observed from data in our population-based study in Piedmont were similar to those presented in the nationwide clinical trials. Survival was better (statistically significant) for children aged 1-4 years, with a white blood cell (WBC) count lower than 10 000 x 10(3) cells/litre and for B-precursor ALL. Differences by immunophenotype were statistically significant only in the univariate analyses. Girls showed a non-statistically significant survival advantage over boys. Results of the present study show the impact on the population of recent clinical trials and emphasise the role of population-based cancer registries in evaluating childhood cancer care delivery in a given population.

Adolescent↗

PubMed2001

Survival of childhood lymphomas in Europe, 1978--1992: a report from the EUROCARE study.

In most developed countries, malignant lymphomas account for 10--15% of all cancers occurring among children aged 0--14 years. The present study estimates survival after a diagnosis of lymphoma in childhood, based on the EUROCARE II database which includes 34 population-based cancer registries from 17 European countries. The survival pattern of children with malignant lymphoma diagnosed in 1985--1989 is reported, as well as the time trends since 1978. The analyses focus on Hodgkin's disease (HD, 1696 cases) and on non-Hodgkin's lymphoma (NHL, 2255 cases including Burkitt's lymphoma and unspecified lymphomas). For HD, the European weighted average 5-year survival rate was 93% (95% confidence interval (CI) 82--98) in 1985--1989. The survival rates were not affected by either age or gender. 5-year survival rates ranged from 68% (95% CI 34--90) in Estonia to 96% (95% CI 92--98) in Germany and 100% (95% CI 57--100) in Slovenia. Multivariate analyses for the time period 1978--1989 gave little suggestion of an improvement in survival over the later time periods of diagnosis. For NHL, the European weighted average 5-year survival rate was 74% (95% CI 67--80) in 1985--1989. Gender did not influence the survival rate. Children in the age group 0--4 years had a poorer prognosis compared with older cases (5-year rate: 66% versus 77% in the pool). 5-year survival rates ranged from 53% (95% CI 30--76) (Estonia) to 83% (95% CI 62--94) in France and 83% (95% CI 66--92) in Scotland. Multivariate analysis show a decreasing HR for the more recent periods of diagnosis from 1 in 1978--1981 to 0.67 (95% CI 0.56--0.79) in 1982--1985 to 0.48 (95% CI 0.40--0.57) in 1986--1989. Exploratory analysis, conducted including the cancer registries which provided cases diagnosed until 1992, show a positive trend over time for both types of lymphoma.

Adolescent↗

PubMed2001

Childhood malignancies in the EUROCARE study: the database and the methods of survival analysis.

This paper describes the database of children with cancer in the EUROCARE study and the methodology used to analyse and report survival. This is the first systematic evaluation of survival after childhood cancer on a large scale in Europe: approximately 45,000 cases were included, diagnosed between 1978 and 1992 (34,814 cases diagnosed in 1978--1989 and an additional set of 9495 cases diagnosed in 1990--1992) and followed-up until 1995. Data were provided from 34 population-based registries (four specialised for childhood cancer registrations and one specialised registry for childhood leukaemia) in 17 countries of Europe (where there was national coverage in 10 countries). Quality of the data was fairly good, given the general differences among the countries and their health systems, thereby allowing for comparisons between them. Among cases diagnosed in 1978--1989, overall 2.0% were lost to follow-up, 91.8% were microscopically diagnosed and 93.4% of alive cases had at least 5 years of observation. Survival proportions (observed survival) were calculated for each of the countries involved, by age group (0, 1--4, 5--9, 10--14 years), gender, different time periods and selected diagnostic groups. Age-standardised cumulative survival rates and European averages (weighted and pooled) were also computed. Cox regression models were used to evaluate geographical and temporal differences. The EUROCARE database represents a unique source of information on survival of childhood cancer patients in Europe, intercountry differences and time trends in survival.

Adolescent↗

PubMed2001

Variation in survival of children with central nervous system (CNS) malignancies diagnosed in Europe between 1978 and 1992: the EUROCARE study.

EUROCARE is a population-based survival study including data from European Cancer Registries. The present paper analyses survival after a malignant neoplasm of the central nervous system (CNS) in childhood (aged 0--14 years at diagnosis). The database includes 6130 cases from 34 population-based registries in 17 countries: 1558 were primitive neuroectodermal tumours (PNET) and 4087 astrocytoma, ependymoma or other gliomas: these morphologies were grouped in the analyses in order to reduce the diagnostic variability among the registries. 87% of cases were microscopically diagnosed (range among registries 71--100%) and losses to follow-up were limited to 2% (range 0--14%). Actuarial analyses indicate that the European (weighted) average of 5 years cumulative survival for cases diagnosed in 1978--1989 was 53% (95% confidence interval (CI) 49--57) for CNS neoplasms, 44% (95% CI 37--50) for PNET and 60% (95% CI 55--65) for the glioma-related types. Analysis of the sub-set of cases diagnosed in 1985--1989 revealed better results: cumulative survival at 5 years was 61% (95% CI: 55--65) for all CNS neoplasms; 48% (95% CI 41--56) for PNET and 68% (95% CI 62--73) for glioma-related types. Compared with older children, infants showed poorer prognosis: in 1978--1989 the 5-year survival rate was 33% (95% CI 23--45) and in 1985--1989 it was 46% (95% CI 34--59). Variability among countries was very large, with 5-year survival for CNS tumours diagnosed in 1985--1989 ranging from 28% in Estonia (95% CI 17--43) to 73% Sweden (95% CI 59--83) and 75% in Iceland (95% CI 35--95) and 73% in Finland (95% CI 66--79). Time trends were studied in a multivariate analysis observing a reduction in the risk of death in periods of diagnosis 1982--1985 (hazard ratio (HR)=0.85; 95% CI 0.78--0.93) and 1986--1989 (HR=0.70; 95% CI 0.64--0.77) compared with 1978--1981. The analysis were extended to 1990--1992 for the countries whose registries provided data for that period did not indicate any further progress. Results of this study confirm the large variability in European countries and indicate a positive trend in the survival probability for cases diagnosed in the 1980s.

Adolescent↗

PubMed2001

Survival analysis of childhood tumours: data from the Italian cancer registries.

This study shows the childhood cancer survival rates of 1,315 cases incident in the 1990-1994 period in Italy. The observed survival shows an increase over the previous period in almost all diagnostic groups. In particular, 5-year survival attained 72% overall, 78% for acute lymphatic leukaemia, about 100% for Hodgkin's disease, 70% for non Hodgkin's lymphomas, 64% for central nervous system tumours, 87% for retinoblastoma, 80% for renal tumours, 67% for hepatic tumours, 71% for bone tumours, and 70% for soft tissue sarcomas. Finally, the findings are comparable to those in other countries (USA, Great Britain, Australia, Slovakia) and they show a progressive improvement in survival.

Adolescent↗

PubMed2000

A code for hadrontherapy treatment planning with the voxelscan method.

A code for the implementation of treatment plannings in hadrontherapy with an active scan beam is presented. The package can determine the fluence and energy of the beams for several thousand voxels in a few minutes. The performances of the program have been tested with a full simulation.

Algorithms↗

PubMed1998

The effects of elevated intraabdominal pressure, hypercarbia, and positioning on the hemodynamic responses to laparoscopic colectomy in pigs.

BACKGROUND: This study investigated three factors postulated to be sources of physiological stress in laparoscopic surgery: hypercarbia, elevated intraabdominal pressure, and the steep Trendelenburg position. Our research was designed to define the effects of each of these potential stressors on hemodynamic responses observed during laparoscopic colectomy in pigs. METHODS: Twenty-four pigs were randomized into the following four groups, based on the method for obtaining surgical exposure while a colectomy or laparoscopic-assisted colectomy was performed: Open surgery (n = 6), CO2 pneumoperitoneum (n = 6), Helium pneumoperitoneum (n = 6), and abdominal wall Lifter (n = 6). The animals were paralyzed with minute ventilation adjusted. All animals underwent extensive pulmonary and hemodynamic monitoring with measurements of the following parameters: RR, Vt, minute ventilation, O2, sat, ETCO2, PVR, HR, MAP, CO, PAP, CVP, PCWP, SV, LVSWI, DO2, and VO2. The laparoscopic pigs were placed in the steep Trendelenburg position during surgery. RESULTS: The effect of a CO pneumoperitoneum was to increase PaCO2 PVR and cause an acidemia that could not be prevented by an increase in minute ventilation. Elevated intraabdominal pressure decreased UO. Both pneumoperitoneum groups had a fourfold increase in IVCP, a measure of intraabdominal pressure. Some of this increase was due to placement into the Trendelenburg position; IVCP increased to a lesser degree in the Lifter group. The steep Trendelenburg position caused significant increases in PAP, CVP, and PCWP; however, a contributory effect of elevated intraabdominal pressure cannot be ruled out. None of these procedures had any significant effect on the HR or MAP. There was a significant increase in CO in the CO2 and Lifter groups; however, when CO was controlled for HR effects, there was no significant effect on SV from any of these different procedures. LVSWI, DO2, and VO2 were not affected by any of the different exposure methods. CONCLUSIONS: The effects of laparoscopic surgery and open surgery on hemodynamic responses are minimal, and no one method is superior to another when performed in pigs that are healthy, hydrated, and hyperventilated to keep ETCO2 < 40. However, since elderly and sick patients have a lower threshold for physiologic decompensation, we can infer that the small hemodynamic changes noted in this study might become significant factors when surgery is performed on compromised patients. The finding that an abdominal wall lifting device causes the fewest metabolic and hemodynamic effects makes its use an important consideration when performing laparoscopic surgery in patients with cardiopulmonary compromise, hemodynamic instability, or any preexisting renal insufficiency.

Abdomen↗

PubMed1997

Canine model of abdominal aortic aneurysm treated by endovascular graft implantation.

The purpose of this study was to monitor the effects of endovascular graft implantation on a canine model of aortic aneurysm. Aneurysms were created in 10 dogs by fascial patch angioplasty of the infrarenal aorta. In five dogs, aneurysm creation was immediately followed by insertion of an endovascular graft. Central aortic and aneurysm sac pressures were then measured by needle puncture. The remaining five dogs were left untreated, as controls. Angiography was performed after aneurysm creation, after endovascular graft implantation, and at 1 month and 3 months. Following insertion of an endovascular graft, mean (s.d.) systolic pressure was lower in the aneurysm sac (82.9 (20.20) mmHg) than in the adjacent aorta (113.4 (25.9) mmHg; P < 0.002) in all the treatment group. The effects on diastolic pressure and mean pressure were less pronounced. Aneurysm size was increased in all controls (25.2 (9.55)%) and decreased in all of the treated group (22.5 (11.7)%; P < 0.001). In conclusion this model of aortic aneurysm has two important characteristics' it has multiple collateral branches, and it grows. Insertion of an endovascular graft was associated with a reduction in aneurysm sac pressure, reduced aneurysm growth, and fibrosis of the space between the aneurysm sac and the graft.

Animals↗

PubMed1997

A prospective comparison of laparoscopic exposure techniques for rectal mobilization and sigmoid resection.

BACKGROUND: We determined the efficacy of a pneumoperitoneum and a gasless abdominal wall lifting device in providing exposure for low rectal mobilization and sigmoid resection in a swine model. The results of these laparoscopic techniques were compared with those obtained using standard open surgical methods. STUDY DESIGN: We conducted a prospective randomized nonblinded trial. Twenty-four adult female pigs were randomized into three groups depending on exposure technique: group 1, open (n = 6); group 2, carbon dioxide (n = 6) or helium (n = 6) pneumoperitoneum; and group 3, a mechanical abdominal wall lifting device (n = 6). A low rectal mobilization and sigmoid resection with a double-stapled, circular, end-to-end anastomosis was performed in all pigs. In group 2, a laparoscopic-assisted approach was used. Parameters assessed included length of operation, length of the colonic specimen, number of lymph nodes per specimen, and extent of anterior and posterior rectal mobilization (centimeters from the anal verge). RESULTS: Operative times were significantly shorter for group 1 than for group 2; no significant differences were found between the two laparoscopic subgroups. No significant difference was found in length of the colonic specimen or in number of lymph nodes harvested for each group. Extent of anterior and posterior rectal mobilization was also not significantly different for the three groups. Although mean mobilization lengths for each group were not significantly different, the range of values was broader in the laparoscopic groups. CONCLUSIONS: A comparable mobilization and bowel resection can be performed laparoscopically, regardless of the exposure technique used. Gasless laparoscopy may prove useful in patients in whom pneumoperitoneum is contraindicated; it will not replace pneumoperitoneum as the only method for obtaining laparoscopic exposure because of the ease of use and frank superiority of the pneumoperitoneum in most circumstances. Abdominal wall lifting devices seem to be a reasonable alternative to pneumoperitoneum for sigmoid resection and rectal mobilization.

Animals↗

PubMed1996

Clinical experience with a bifurcated endovascular graft for abdominal aortic aneurysm repair.

PURPOSE: The purpose of this study was to test a transfemoral system of bifurcated endovascular graft insertion for aortic aneurysm repair. METHODS: Bifurcated endovascular grafts were inserted through bilateral femoral artery cutdowns in 41 patients. The results were assessed by completion angiography and follow-up computed tomography. RESULTS: The second half of the study included more aneurysms 6 cm or larger (p < 0.05) and more instances of short proximal neck (p < 0.05), proximal neck angulation (p < 0.05), and iliac angulation (p < 0.05). Despite the increasingly challenging anatomy, the results were better in the second half of the study as illustrated by the lower overall combined morbidity/mortality rate (15% vs 50%) and higher overall success rate (85% versus 65%). The mortality rate for the series as a whole was 7.5%. Mean follow-up was 18.8 months for the first 20 patients and 10.9 months for the second 20. The commonest complication in the first half of the study was graft thrombosis (n = 5). This complication was absent from the second half of the study because of routine adjunctive stenting. Two patients died of complications of endovascular repair. In both cases aneurysm rupture on the third postoperative day was associated with coagulopathy and angiographic signs of perigraft leak. CONCLUSION: Aneurysm exclusion with a bifurcated endovascular graft was feasible in a wide range of patients, but when the aneurysm was not entirely excluded from the circulation, the risk of rupture persisted.

Aorta, Abdominal↗