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Biomedical subjects

V Valentini

Publications and source records attributed to V Valentini.

At least 55 records · Page 3Linked to original sources
PubMed1997

Paranasal sinus mucocele: diagnosis and treatment.

Several controversies still exist regarding the etiopathogenesis, diagnosis, and type of surgical treatment used in response to paranasal sinus mucocele. We wish to contribute to the standardization of therapeutic treatment for paranasal sinus mucocele by reporting our clinical experience in "open surgery." This analysis considers 53 patients--23 males and 30 females (age range: 11-80 years)--affected by frontoethmoidal or sphenoidal sinus mucocele whom we have surgically treated. Patients were classified according to age, sex, previous surgical treatment in the nasal area, symptoms, and acute visual difficulties; 15 patients showed disease in the frontal area, 28 in frontoethmoidal area, and 10 in the posterior ethmoidal or sphenoidal area (or both); in 18 patients the disease had reached the intracranial region. Transfacial approaches were used in all patients who did not show evidence of disease in the intracranial region. Of all the incisions performed 18 were coronal, 16 were paralateral, and 4 were through upper eyebrow approaches; a transnasal endoscopic approach was used in only 1 patient in whom the intracranial region was affected by disease. All patients showed satisfying functional and aesthetic results during and after recuperation.

Adolescent↗
PubMed1997

[Neoadjuvant combined hormonal therapy and radiotherapy with external beam irradiation in prostatic carcinoma].

From January, 1991, to December, 1995, forty-two patients with prostatic cancer (T2-T4: 40 patients) were treated with a luteinizing hormone-releasing hormone (LHRH) analog (2 administrations before and 3 during irradiation), Flutamide (1 month) and external beam radiation therapy (45 Gy to the whole pelvis and a 20 Gy boost). All patients completed the protocol and the LHRH analog was continued for 1-6 months in 5 patients with partial response at the end of radiotherapy. The incidence of acute toxicity was low according to the Radiation Therapy Oncology Group and European Organization for Research and Treatment in Cancer score (grades 1-2; 19% hematologic, 36% intestinal and 38% urological toxicity). At a median follow-up of 21 months (range: 1-60 months), one patient had local disease progression and lung metastases and two had bone metastases; the three relapsing patients were given the LHRH analog and exhibited partial response to rectal examination (1 case) and to bone scan (2 cases). Pain disappeared completely in both the patients with bone metastases. Overall 3-year survival and disease-free survival rates were 97% and 79%, respectively. Disease-free survival was significantly related to cT (at 3 years: cT2: 100%; cT3: 81.2%; log rank test: 0.0081). Late toxicity was observed in two patients: rectal bleeding in one case and chronic diarrhea in the other. The combined protocol used in this study was feasible and well tolerated. Our results seem to confirm the promising preliminary results of Radiation Therapy Oncology Group 8610 study.

Adenocarcinoma↗
PubMed1997

[The anal canal: 2 cycles of radiochemotherapy and boost brachytherapy].

From 1988 to 1996, twenty-six patients with epidermoid anal cancer were examined at the Radiotherapy Department of Università Cattolica del S. Cuore, Rome. At diagnosis, 13 patients were stage II, 11 patients were stage III, 2 patients had a small recurrence after local excision. All the patients were treated with concomitant radiochemotherapy followed by a brachytherapy boost. Treatment was carried out in two cycles 4-5 weeks apart. Chemotherapy consisted of 5FU (1,000 mg/sqm, continuous infusion over the first 4 days) and Mitomycin C (10 mg/sqm on day 1, bolus administration). Radiotherapy was administered with two AP opposed coaxial beams of the same size. The target was T and inguinal, external, internal and common iliac lymph nodes. The total dose for each cycle was 23.4 Gy, administered with conventional fractionation and a daily dose of 180 cGy. Four-six weeks after the end of cycle 2, the patients received a boost of interstitial brachytherapy. During concomitant radiochemotherapy, grade 3-4 (RTOG-EORTC scale) acute hematologic and cutaneous toxicities were observed in 15% and 4% of patients, respectively; treatment was discontinued in 4 patients. Complete response was observed in 21 patients (81%) and partial response in 5 (19%). The later underwent surgery, namely local excision in 1 patient and abdominoperineal resection in 4 patients. The median observation period of our study population was 45 months. Five-year actuarial local control of the 26 patients was 88%. Five year actuarial survival was 75% and sphincter conservation 77%. Our results confirm the data reported by Cummings of Princess Margaret Hospital, who observed low toxicity when the two cycles of concomitant radiochemotherapy are split. Randomized phase-III studies should clarify the potential role of the new radiochemotherapy combinations which should be compared with reference treatments providing repeatable results and low toxicity. Our treatment may make a reference for more innovative combinations of radiochemotherapy.

Adult↗
PubMed1997

[Comparison between measured and computed absorbed dose values in the tangential treatment of the breast].

The calculated absorbed dose values to the reference point of the breast tangential irradiation, obtained by 2-dimensional (2D) Treatment Planning Systems (TPS), were compared with the measured absorbed dose values obtained with a ionization chamber in an anthropomorphic phantom treated with two opposed photon beams of 60Co, 6 MV and 10 MV. This comparison was aimed at assessing the 2D algorithm dose overestimation due to the effect of missing tissue in the irradiated field. The ratio between the computed dose, Dc, and the measured dose, Dm, reached 1.08 for 60Co beams and 1.04 for X-ray beams of linacs. The Clarkson method gives an adequate correction factor for the calculated absorbed dose value in the reference point. The portal films of some patients were studied to estimate the correction factor for the treatment time or monitor units evaluated by TPS using tomographic breast central plane. The values of the correction factors reached 1.10 for 60Co photon beams and 1.04 for X-ray beams. The measurements were carried out with TLDs positioned in the central plane of the breast, covered by a special bolus, of a second anthropomorphic phantom. The dose homogeneity as well as the accuracy of the relative computed dose values in the breast phantom irradiated with 10 MV X-ray beams were assessed.

Absorption↗
PubMed1997

[Computerization experience in a day hospital of integrated radiochemotherapy].

INTRODUCTION: We report on a cost-effective easy-access software developed for the functional integration of the clinical records and history of oncologic patients with the management of the Day Hospital of the Radiotherapy Department of the University Hospital A. Gemelli, in Rome. MATERIAL AND METHODS: The software was designed to archive the clinical records and history of oncologic patients and the relative chemotherapy, to manage the examination scheduling, to draw up nursing files with the planned therapy and to make statistical analyses of the department activity. Five forms are available: the patient form, recording patient data; the admission form, recording the type of therapy (e.g., chemotherapy, tests, medical examinations, etc.), the relative cost and chemotherapy protocol, detailing for instance the type of drug; the nursing file, detailing chemotherapy schedule and the dilution of each drug; the menu, to select and retrieve any record. The minimum configuration requires a 386 Intel CPU, 4 Mb RAM and 4 Mb free on the hard disk. The software is the File Maker Pro 2.1 for Windows which can interact with Apple Macintosh computers. RESULTS: Since October, 1995, we have saved the clinical records of 272 oncologic outpatients (2415 entries in all), with a mean of 201/month. This computer system permitted us to save and retrieve data for both clinical and didactic purposes and to plan our activity. CONCLUSIONS: One year after it was implemented and used in clinical practice, the system is a cost-effective and user-friendly tool for the management of the Radiochemotherapy Day Hospital of our Radiotherapy Department.

Combined Modality Therapy↗
PubMed1996

Local excision and external beam radiotherapy in early rectal cancer.

PURPOSE: To assess the local control and survival of local excision and postoperative radiation in patients with early stage rectal cancer. METHODS AND MATERIALS: From 1980 to 1992, 21 patients with clinical stage T1-2NxM0 adenocarcinoma of the middle and lower rectum were treated with transanal excision and postoperative external beam radiotherapy (44.6 Gy). The pathologic T stages were: 9 T1 (43%) and 12 T2 (57%). One patient had unassessable resection margins. The median follow-up was 54 months (range: 18-128 months). RESULTS: The actuarial local recurrence-free survival at 5 years was 85.2%, and the overall survival at 5 years was 80.6%. One patient developed a local recurrence and distant metastases at 22 months, and two patients had local recurrence at 11 and 15 months, respectively; both had abdomino-perineal resection (APR) and one remained free of disease 16 months after APR. The incidence of Grade 3 diarrhea was 5%. Sphincter function was good to excellent in the 18 patients with local control. No patients developed clinical evidence of pelvic lymph node recurrence. CONCLUSION: These results are similar to other published series and suggest that this approach is feasible in selected patients with T1-2NxM0 rectal cancer and results in good long-term control of the disease.

Adenocarcinoma↗
PubMed1996

Anticonvulsant effect of felbamate in the pentylenetetrazole kindling model of epilepsy in the rat.

The present study was designed to examine the ability of felbamate, a novel antiepileptic agent, to antagonize the increase in seizure severity (i.e., chemical kindling) produced by chronic treatment with initially subconvulsant doses of pentylenetetrazol (PTZ). Rats were treated with PTZ (30 mg/kg, i.p., three times a week) for 8 consecutive weeks. Two other groups of rats received felbamate (300 or 400 mg/kg, i.p.), 90 min before each dose of PTZ. Pretreatment with felbamate at either dose prevented the progression of rank of seizures during chronic treatment with PTZ. Thus, the mean seizure score by the end of the chronic treatment (0-5 scale) was 0 in vehicle treated controls, 3.3 in rats treated with PTZ alone, 1.5 in rats treated with PTZ plus felbamate (300 mg/kg, i.p.) and 0.9 in the group treated with PTZ plus felbamate (400 mg/kg, i.p.). Felbamate also antagonized the long-term increase in the sensitivity to the convulsant effects of GABA function inhibitors observed in PTZ-kindled rats. Thus, the administration of a challenge dose of isoniazid (120 mg/kg, s.c.), picrotoxin (1.5 mg/kg, i.p.) or PTZ itself (15 mg/kg, i.p.), 15 to 45 days after the end of the chronic treatment regimen, induced convulsions in > 80% of PTZ-kindled rats and in < 20% of rats treated with PTZ + felbamate (400 mg/kg). The results are discussed in terms of the multiple mechanisms that can contribute to the anticonvulsant action of felbamate in the PTZ kindling model of epilepsy.

Animals↗
PubMed1996

Intraoperative radiation therapy in integrated treatment of rectal cancers. Results of phase II study.

PURPOSE: Risk of local recurrence of rectal cancer remains high despite extensive therapeutic strategies, many of which have been tried to achieve better local control (i.e., external beam radiation therapy (EBRT)). Recently, intraoperative radiation therapy (IORT) has been introduced in clinical protocols to boost the areas at risk of local recurrence. METHODS: Between April 1990 and December 1995, 44 patients with "high risk" (T3,N0-2 primary tumors) extraperitoneal rectal tumors and 24 patients with "locally advanced" (2 T3,N3 and 11 T4,N0-3 primary tumors; 11 local recurrences) tumors entered a protocol that included preoperative EBRT (38 Gy), surgery plus IORT (10 Gy) in the high-risk group, and preoperative EBRT (45-48 Gy) and concomitant computerized tomography (5-fluorouracil plus mitomycin C), surgery plus IORT (10-15 Gy), and postoperative adjuvant computerized tomography (5-fluorouracil plus folinic acid) in the locally advanced group. RESULTS: In the high-risk group, acute Grade 3 (Radiation Therapy Oncology Group scale) skin toxicity, attributable to preoperative treatment, involved one patient (2.2 percent); among locally advanced cases, Grade 3 hematologic toxicity was observed in one patient (4.1 percent). Treatment was discontinued in no patients. On average, IORT prolonged surgery by 48 minutes. There was no mortality. Four anastomotic leakages, one pelvic infection, and five wound infections were observed. No chronic IORT-related toxicity occurred. After mean follow-up periods of 28.3 and 25.9 months, 41 and 15 patients in the high-risk and locally advanced groups, respectively, are alive and disease-free. In one high-risk patient, an anastomotic recurrence occurred. In four patients with locally advanced tumors (1 T4 primary, 3 local recurrences) an unresectable tumor relapse developed locally. Distant metastases occurred in two high-risk patients and in eight patients with a locally advanced tumor. Three-year actuarial survival was 100 percent in both high-risk and locally advanced primary tumors and 68.2 percent in local recurrences. CONCLUSIONS: Results of this study suggest that multimodal treatment (including IORT) in rectal cancer is safe, has no significant increase of mortality and morbidity, and also shows a trend for local improvement. A longer term follow-up and larger numbers of patients could demonstrate the therapeutic efficacy of IORT in rectal cancer.

Antimetabolites, Antineoplastic↗
PubMed1996

[Trauma to the anterior cranial base. Report of a case].

The authors present a case of foreign body retention, following car accident, localized on superior medial corner of the right orbit. The traumatic impact, involving endo-orbital structures, owing to the peculiar direction of the foreign body, caused a fracture in the anterior cranial base and laceration of the dura madre. As the anatomical structures involved did not concern only the MaxilloFacial district, the choice of the protocol to be applied to the patient was taken in accordance with the neurosurgical équipe. An intra cranial surgical approach has allowed to remove, by retrograding the foreign body on its trajectory path, in order not to injure further the already damaged structures involved. Then the tissues have been reconstructed; in particular, the anterior cranial base was restored through the use of pericranial strip. This technique is the elective surgical treatment in lesions of such small entity, as it is able to grant a solid support to the overhanging cerebral parenchyma. Besides, this reconstruction technique provides a complete protecting isolation of the ocular globe from compressive and pulsative phenomena, due to the neurocranial adjacent structures. With this technique, after a 8 month's follow-up. The patient has obtained optimum functional and aesthetic results.

Accidents, Traffic↗
PubMed1996

[The role of SMAS in the prevention of Frey's syndrome].

Frey's syndrome is the most common postoperative complication in the parotid gland surgery. The authors report their own experience with 80 patients who underwent surgical operation of superficial or total parotidectomy. In 45 of them was performed the SMAS flap, no SMAS flap performed in the remaining 35 patients. The follow-up was performed by interviewing the patients about their symptoms. The purpose of this work is to show the role of SMAS flap, that minimize the frequency and the intensity of symptoms of the Frey's syndrome.

Adolescent↗
PubMed1994

Concomitant preoperative radiochemotherapy in operable locally advanced rectal cancer.

PURPOSE: The aim of this study was to examine the effectiveness of a combination of preoperative radiotherapy and chemotherapy for operable locally advanced rectal cancer (Stages II and III). METHODS: Chemotherapy and radiotherapy are started jointly on day one of the therapy. 5-Fluorouracil is given in a dosage of 1000 mg/m2/day as a continuous 24-hour infusion for 4 days. Mitomycin C is given as a bolus intravenous at a dosage of 10 mg/m2 the first day. The radiation therapy is given to a total dosage of 37.8 Gy. Surgery is generally performed four to five weeks following completion of the radiation therapy. From March 1990 to April 1993, 34 patients with histologically documented adenocarcinoma of the rectum have been treated. Twenty-one lesions were located in the lower third of the rectum. Twenty-nine neoplasms were judged by initial clinical staging as Stage III. RESULTS: Patients compliance to the treatment have been 97 percent. Toxicity of treatment has been low (15 percent). Tumor sizes decreased 50 percent or more in about 80 percent of patients. Distance of the tumor from the anal canal increased in all but seven cases. Twenty-two anterior resections have been performed. The morbidity rate has been 24 percent. No postoperative mortality has been reported. Histologic examination of surgical specimens after integrated treatment showed in 10 cases a tumor confined to the rectal wall (T2), in 3 patients only a residual tumor limited to submucosa (T1), and in 5 (15 percent) patients no evidence of neoplastic cells (T0). CONCLUSIONS: We conclude that preoperative radiochemotherapy was generally well tolerated; in all cases we had a reduction of tumor sizes, surgery presented no technical difficulties, and there was the effect of stage reduction.

Adenocarcinoma↗
PubMed1992

Whole liver intraoperative irradiation after partial hepatectomy produces minimal functional and pathologic lesions.

Intraoperative radiation therapy (IORT) was delivered to remnant rat liver after partial hepatectomy to determine the chronic effects of treatment on survival, blood chemistry, liver weight, and histology. Survival at one year was 100%. Remnant liver weight was markedly increased in all animals. Liver function appeared to be unaltered in all groups and at all observation times. Inflammatory cell infiltration occurred immediately after treatment in all animals, showing a slight progression until day 45; by day 180 the values had returned to baseline. Vascular changes were seen early in all groups, then progressively decreased; the vascular score was back to baseline at days 180 and 365. Nuclear alterations were observed in both irradiated and nonirradiated hepatic cells; in all cases these were limited to isolated or focal areas of hepatocytes. There was little fibrosis formation and by day 180 all scores were back to baseline. We conclude that the chronic effects of whole liver IORT after one-third hepatectomy are minimal in the rat and are similar to those observed after surgery alone.

Animals↗
PubMed1992

[The experience of diagnostic and therapeutic integration in rectal cancer. Preliminary notes].

In our University, many different radiosurgical options are available to treat rectal carcinoma. Selecting the patients to submit to treatment requires accurate clinical and radiological staging. A team of radiologists, radiotherapists, surgeons, endoscopists and pathologists has been created to stage the patients and to follow the final results. The team have decided the diagnostic and therapeutic protocols. The patients with rectal cancer undergo radiotherapy after staging and are subsequently restaged. If indicated, surgery is performed and histology is compared with restaging, to assess the accuracy of the diagnostic procedures. All diagnostic and therapeutic decisions are made collectively by the team, during scheduled meetings. All data are stored in a computer program. This paper deals with the working method we used, its advantages and the outcome of the first 23 studied patients. Restaging was compared with histology: transrectal US (performed in 8 patients) showed 100% accuracy in evaluating local tumor spread (T). CT had 91% accuracy in defining T and 60% accuracy in N, with a tendency to overstaging. In 78% of patients > 50% reduction of tumor size was observed and the distance from the anal canal increased in 95.5%. This study will provide the overall accuracy of the clinico-radiologic staging, the survival rates and the indication of prognostic signs.

Aged↗
PubMed1991

Surgical approach and sandwich radiotherapy for resectable rectal cancer: advantages and problems.

One hundred and twelve patients with locally advanced adenocarcinoma of the rectum have been treated with a protocol of adjuvant radiotherapy from 1981 to 1989. Radiotherapy was administered with a "sandwich" method at a dosage of 2700 cGy preoperatively and of 1800 cGy post-operatively. Only patients in stages B and C have been considered for results. Postoperative morbidity has been 16% and postoperative mortality 2.7%. Local failure was seen in 20% of patients without significant differences by stage, location, grading and operative technique. Distant metastases were seen in 31% of patients. Five-year actuarial survival was 49% and respectively 58% in stage B and 38% in stage C (P less than 0.01). Compared with a series of historical controls treated with surgery alone, the local recurrence rate was 20% vs. 26%, the distant metastases rate was 31% vs. 38% and the five-year actuarial survival rate was 49% vs. 36% (P greater than 0.01).

Actuarial Analysis↗
PubMed1990

Radiosurgical treatment compared to surgery alone for rectal cancer.

Between February 1981 and September 1989, 144 patients with rectal cancer were treated according to a radiosurgical sandwich protocol (27Gy + surgery + 18Gy) or postoperative radiotherapy (45Gy) at the University Hospital 'A. Gemelli' in Rome. This group is compared with a group of 133 patients operated on between January 1968 and January 1981, by the same team of surgeons but who received no radiotherapy. The historical group is comparable to the radiosurgical group in terms of stage, histology, and surgical procedures. The median follow-up period of the radiosurgical group is 38 months and 68% of cases have been observed longer than 2 years. At 2 years local recurrence in the historical control group was 22% versus 17% in the prospective group (p = 0.8). For Stage C disease, local recurrence dropped from 54% to 35% with adjuvant radiotherapy (p = 0.3). Metastases were observed in 22% of the control group versus 13% of the radiosurgical group (p = 0.2). For Stage C disease the incidence of distant metastases dropped from 59% to 26% at 2 years with the use of the prospective radiosurgical protocol (p = 0.05). The Kaplan-Meier survival rate at 5 years was 46% for the historical group and 72% for the radiosurgical group (p = 0.003) (Stage A 71% & 94%, Stage B 48% & 77%, and Stage C 16% & 38%, respectively). Neither serious nor late toxicity has been detected in the radiotherapy group, nor were surgical complications observed in the pre-operative radiotherapy group. The data strongly suggest a survival advantage for patients treated with the radiosurgical combination (p = 0.003).

Adenocarcinoma↗