bluuebunny/crossref_metadata_2025_split huggingface dataset:
L'approccio Chirurgico Nella Palliazione Del Carcinoma Pancreatico
Authors: Delrio Paolo , Izzo Francesco , Cremona Francesco , Palaia Raffaele , Ruffolo Fulvio , Fumo Fabio , Parisi Valerio 
Published: April 2018

Pancreatic carcinoma is an aggressive disease and its prognosis is dismal. Patients present with an advanced stage of disease and only a small number of patients undergo resection with a curative intent; thus the 5 years survival rate is very low. Several Improvements have been made in the surgical approach with a decrease in perioperative morbidity and mortality. Results offered by chemotherapy and radiotherapy remain unsatisfactory despite a number of new drugs and considerable advancements in irradiation techniques. Jaundice, pain and gastrointestinal obstruction are the main clinical problems to be dealt with in advanced patients. Surgical palliation still represents a widely preferred option but non surgical approaches appear promising. The Authors analyse the possible options in palliation for pancreatic carcinoma. The various surgical procedures for biliary bypass are described. Hepaticojejunostomy is the operation of choice and offers the best results in terms of quality of life and time of palliation. A possible role for resective operation also in advanced cases has been proposed by some groups and is gaining wide acceptance in referral centres where low morbidity and mortality are now routine. Percutaneous and endoscopic approaches to jaundice represent a valid alternative in some patients with a low life expectancy and in those centres with a high experience. Gastrointestinal bypass in symptom-free patients or advanced cases only is an unsolved dilemma. New approaches such as locoregional chemotherapy with curative or neoadjuvant intent are also described in this paper. Many chemotherapic agents have been tested in various settings and appear to offer promising results in palliation and also, in some cases, in downstaging tumors then amenable to resection. Pain control is a major aspect in management of advanced pancreatic carcinoma. Appropriate pain therapy has to be established in all patients in order to obtain a better quality of life. Various options are available such as intraoperative alcohol injection or CT guided percutaneous splanchnicectomy. Palliation in patients with pancreatic carcinoma is a major aspect of management because of the high percentage of non curable cases; multimodality approach is mandatory and all possible problems have to be dealt with in order to increase survival and, more importantly, quality of life.
La Radiologia Interventistica Nella Palliazione Del Carcinoma Pancreatico
Authors: Mazza Ernesto , Carmignani Luca , Stecco Alessandro , Lucibello e Paolo 
Published: April 2018

Aims and background Pancreatic carcinoma often involves the head of the pancreas and obstructive jaundice is its earliest sign. It sometimes extends to celiac plexus and duodenum causing pain and bowel obstruction respectively. Only 20% of cases are totally resectable (stage I) at the time of diagnosis. Palliative treatment is the only available therapeutic option when the tumor extends surrounding organs or has given lymphatic metastases (stage II, III, IV). The aim of this study is to evaluate effectiveness of interventional radiology procedures on unresectable cancer palliative treatment. Methods Between Jan 90 and Sep 98, 195 patients with unresectable pancreatic carcinoma received percutaneous treatments. They were 104 males and 91 females with mean age of 74 years (range, 48-95). One hundred eighty four patients underwent biliary drainage, six patients underwent celiac plexus block, two patients were treated by bowel stenting. Two patients received both biliary and bowel stents, one patient underwent biliary drainage and celiac plexus block. Results Jaundice treatment was performed by placement of drainage catheters in 48 patients, polymeric endoprostheses in 58 and metallic stents in 77 (67 Wallstents). Biliary drainage was successful in all cases obtaining appreciable bilirubin serum levels reduction and jaundice regression in 175 patients (95%). In 44 patients Wallstents were placed during a single PTC session time (“one step” technique). In 21 cases (11%) peri-procedural complications occurred. Follow-up related to 85 patients shows survival rate covered between 30 and 570 days (mean, 142). Best survival values occurred in patients who underwent “one step” technique. Celiac plexus block was successful in 5/7 cases (71%) with no complications, total pain relief and withdrawal of pharmacological treatment. Bowel stenting achieved complete recanalization of intestinal loop in 2 cases but showed troubles related to management of these patients. Conclusions In patients with unresectable pancreatic carcinoma palliation is the only therapeutic option and has the purpose to achieve biliary tree decompression and eliminate jaundice associated symptoms, improving quality of life and reducing hospitalization. Jaundice relief is reachable by surgical, endoscopic or percutaneous approach. Surgical palliation is characterized by disadvantageous cost-effectiveness rate. Endoscopic and percutaneous palliations are alternative, although, in selected patients, percutaneous Wallstents placement by one step technique is perhaps the most successful procedure, showing high rate of technical outcome with low complications and short time spent in hospital. Celiac plexus block under CT guidance constitutes a reliable method for management of pain. At present bowel stricture treatment is surgical.
Ruolo Dell'Endoscopia Nella Palliazione Del Carcinoma Pancreatico
Authors: Spinelli Pasquale , Schicchi Angelo Aldo , Schiavo Marcello 
Published: April 2018

The incidence of pancreatic cancer continues to increase and, although improving of diagnostic techniques, the prognosis is very poor with 5-year survival less than 5% and high mortality cancer rate. Neural and lymphatic micrometastases appear in early stages and curative resection is possible in few selected cases; in these patients there is a high local recurrence rate and a low median survival. Most patients with pancreatic cancer need palliative care of the obstructive jaundice (90%), duodenal stenosis and abdominal pain; endoscopic procedures have an important role in the treatment of these patients. Endoscopic placement of plastic biliary stents is a safe and efficient technique to perfom a biliary drainage with a short hospital stay. The use of metal stent, instead of plastic prosthesis, improve median patency of the prosthesis with a low incidence of cholangitis, but they should be used only in patients with a life expectancy of more than six months, because of their high costs. Laparoscopic gastro-entero-anastomosis is a valide alternative to laparotomic procedure in the treatment of the duodenal stenosis, with a shorter hospital stay and a lower morbidity rate. The endoscopic treatment of abdominal pain with pancreatic endoprosthesis placement or with endosonography-guided celiac plexus neurolysis is an alternative approach to radiotherapy and analgesic drugs.
Results of Valve Replacement Surgery with Mechanical Prostheses
Authors: Pellegrini A. , Peronace B. , Marcazzan E. , Rossi C. , Colombo T. 
Published: April 2018

The clinical study is reported of the results of heart valve replacement surgery with a new pyrolytic carbon tilting disc prosthesis manufactured in Italy. From March 1977 to January 1981, at the «De Gasperis» Cardiosurgery Center, this prosthesis has been implanted in 644 patients: 283 for mitral valve replacement, 240 for aortic valve replacement, and 121 for the replacement of both mitral and aortic valves. To have a sufficiently long period of post-surgery follow-up, we considered the results of 207 patients (124 cases of isolated mitral valve replacement and 83 cases of isolated aortic valve replacement), who underwent surgery consecutively from March 1977 to December 1979. The hospital mortality was 10.5% for mitral valve replacement and 4.8% for aortic valve replacement. All patients who were discharged from hospital, except 2, were subjected to clinical, electrocardiographic, phonocardiographic, ecocardiographic and radiological checks. The average follow-up period was approximately 20 months: clinical results were satisfactory. The probability of survival, expressed by actuarial curve, was, three years after surgery, 94% for patients who underwent mitral valve replacement and 97.5% for those who underwent aortic valve replacement. The probability of embolism was, three years after surgery, 8.5% for patients with mitral replaced and 5% for aortic. Even if further confirmations are needed the mortality rate and the probability of embolism related to this new prosthesis, are lower, over the same period of follow-up, than that found in the groups of patients who underwent valve replacement surgery, at the same Center, with Starr-Edwards and Björk-Shiley prostheses. The phonocardiographic and ecocardiographic characteristics of this new prosthesis were also investigated.
Anatomical Bases of Peritoneal Permeability: A Reappraisal. Anatomy of Peritoneum
Authors: Feriani M. , Biasioli S. , Chiaramonte S. , Fabris A. , Pisani E. , Ronco C. , La Greca G. 
Published: April 2018

The peritoneal membrane consists of flat mesothelial cells linked together with digitations and containing vesiculae with pinocytic capacity, of endothelial cells (containing Weibel-Palade's bodies and vesiculae) and of an interstitial tissue consisting of a network of watery channels. The cellular structures of mesothelium and endothelium are characterized by tight and gap junctions or perhaps by macular junctions. The visceral peritoneum shows a prevalence of gap junctions, the pericytic veins contain only tight junctions while both types can be found in the arterioles. Two different ways for solute transport are theoretically possible: the vesicles of plasmalemma (via pinocytosis) and the junctions (via size-sieving effect). Studies with tracers did not furnish unequivocal data on this problem and did not clarify if these structures could be the equivalent of the pores of the Landis-Pappenheimer's theory. The studies of Karnowsky and Simionescu, using tracers, have in fact given opposite results.
Lymphocyte Subsets Assayed by Numerical Tests in CAPD
Authors: Giacchino F. , Pozzato M. , Formica M. , Quattrocchio G. , Quarello F. , Belardi P. , Piccoli G. 
Published: April 2018

Peripheral and peritoneal lumphocytes were assayed by numerical tests in adults on peritoneal dialysis. T lymphocytes were classified by monoclonal antibodies (OKT3, OKT4, OKT8) and B lymphocytes by the presence of surface immunoglobulins, using the immunofluorescence technique. Peripheral T cells showed no significant change from the normal, except for T suppressor cells which increased in patients with 2 or more peritonitis episodes. Examination of peritoneal lymphocytes showed a significant reduction in S-IgA lymphocytes (B cells bearing IgA receptors) and an increase in T-suppressor cells (OKT8+) in patients who developed peritonitis in the follow-up study. The implications of these results are discussed with particular reference to susceptibility to peritonitis.
Branched Chain and Aromatic free Amino Acids in Plasma and Skeletal Muscle of uremic Patients Undergoing Hemodialysis and CAPD
Authors: Graziani G. , Cantaluppi A. , Casati S. , Citterio A. , Ponticelli C. , Trifirò A. , Borghi L. , Sani E. , Simoni I. , Montanari A. , Novarini A. 
Published: April 2018

Plasma and skeletal muscle free amino acids were measured in patients submitted to Hemodialysis (HD) or Continuous Ambulatory Peritoneal Dialysis (CAPD) in order to evaluate the effects of these different dialysis modalities on amino acid pools; the data were compared with those obtained in control subjects and in patients with advanced Chronic Renal Failure (CRF) not submitted to Regular Dialysis Treatment (RDT). Our findings show low intracellular concentrations of VAL, total Branched Chain Amino Acid (BCAA) and TYR in uremic patients treated with CAPD but not in those undergoing HD. The observed differences in muscle amino acid pattern could be well explained by a changed amino acid metabolism regulation in CAPD, possibly related to the sustained hyperinsulinism and to an increased rate of hepatic protein synthesis.
Membrane Plasma Fractionation: Effect of the Surface Area
Authors: Wojcicki J. , Piatkiewicz W. , Werynski A. , Waniewski J. , Goch H. , Hay M. 
Published: April 2018

The influence of the surface area on the performance of plasma filters for dead-end mode of filtration is presented in this paper. Theoretical analysis of the dead-end filtration was performed and verified experimentally (using ENKA cellulose-diacetate PF-100 membranes) in respect to β-lipoprotein. The theoretical model allows to optimize the course of the transmembrane pressure during plasma fractionation procedure in dependence of the surface area, initial concentration of macromolecules, total volume of the feed and membrane structure. The results indicate that the surface area effect is an important factor in the operation of membrane plasma fractionation and should be considered in the design of the plasma fractionation filter.
Micro-Pressure Sensor for Continuous Monitoring of a Ventricular Assist Device
Authors: Nitta S. , Katahira Y. , Yambe T. , Sonobe T. , Hayashi H. , Tanaka M. , Sato N. , Miura M. , Mohri H. , Esashi M. 
Published: April 2018

We have been involved in the development of a clinical ventricular assist device (VAD) system. Here, we report our investigation of in vitro and in vivo stability and sensibility of pressure microsensors. The sensors were mounted in the inflow and outflow cannulae wall to measure the left atrial and aortic pressures during VAD pumping. The pressure sensitive surface of the piezoresistive effect absolute pressure sensor was coated with a thromboresistant polymer, as was the inner surface of the cannulae of the VAD. In the in vitro and chronic animal experiments which were of more than a month duration, reliable stability and sensitivity, without any thrombus formation on the blood contacting surface of the sensors, and high sensitivity were observed. After chronic experiments, the sensitivity of sensors was reevaluated in the mock circulatory system as compared to reference values. The relationship between the output of the micro-sensors and the reference value was linear and correlated well.
Autologous Blood Stem Cell Collection after Chemotherapy in Patients with Sensitive and Refractory Malignancies: A Multicenter Retrospective Study
Authors: Pierelli L. , Iacone A. , Quaglietta A.M. , Nicolucci A. , Menichella G. , Panici P. Benedetti , De Laurenzi A. , De Rosa L. , Fioritoni G. , Indovina A. , Leone G. , Majolino I. , Montuoro A. , Scimé R. 
Published: April 2018

A retrospective study was undertaken to assess the factors affecting the yield of peripheral blood stem cell (PBSC) collections after chemotherapy. Fifty-five patients with malignancies, observed in 4 Italian Institutions from January 1987 to June 1991 were eligible for evaluation. This series included 19 non-Hodgkin lymphoma, 11 multiple myeloma, 9 ovarian cancer, 7 Hodgkin disease, 7 acute non-lymphocytic leukemia, 1 acute lymphoblastic leukemia, 1 neuroblastoma. Five hundred and twenty two PBSC collections were performed on 55 patients after a median of 18 days after the start of chemotherapy. The yields of PBSC collections were related to the dose of cytoreductive chemotherapy exploited for PBSC mobilization and to the number of circulating white blood cells, colony forming unit granulocyte/macrophage (CFU-GM) and the percentage of monocytes at the time of collection. Forty-eight patients out of 55 transplanted (87%) had rapid, complete and sustained engraftment. Three patients (5%) died of transplant related complications.
Clinical Application of Growth Factors for Collection of Circulating Hematopoietic Progenitors in Breast Cancer Patients Treated with Highdose Cyclophosphamide
Authors: Ravagnani F. , Notti P. , Siena S. , Bregni M. , Zorzino L. , Di Nicola M. , Belli N. , Gianni A.M. , Pellegris G. 
Published: April 2018

Seventy-seven (68 operable breast cancer with > 9 metastatic axillary nodes and 9 inflammatory breast cancer) entered this study. During hematopoietic recovery after cancer therapy with highdose cyclophosphamide (7 g/m2; HD-CTX) circulating hematopoietic progenitors were collected by leukapheresis (LK) in all patients and then cryopreserved for autologous transplantation. Following HD-CTX, 70 patients were treated with hematopoietic growth factor(s) for 14 days: 38 with rhGM-CSF (group a), 16 with rhlL-3 (group b), 11 with sequential rhlL-3 and rhGM-CSF (group c), 5 with sequential rhlL-3 and rhG-CSF (group d). Seven control patients (group e) did not receive any growth factor. Leukaphereses, carried out over 2-4 consecutive days per patient, were started earlier in group c and in group d patients (mean day: +12 after HD-CTX). The sequential administration of rhIL-3 and rhG-CSF (group d) resulted in clearly higher yield of CFU-GM and CD34+ cells per leukapheresis (65.9x104/Kg versus 20.9x106/Kg, respectively) if compared with other groups of treatment.
Biology and Clinical Applications of Longterm Bone Marrow Cultures
Authors: Carlo-Stella C. , Mangoni L. , Rizzoli V. 
Published: April 2018

A number of clonogenic assays for short-term bone marrow culture is now available for the quantitative analysis of the various hematopoietic progenitor cell classes. The short-term assays are not suitable to analyse either stem cell selfrenewal or interactions of hematopoietic progenitors with stromal cells, especially those requiring direct cell-to-cell or cell-to-matrix contact. The technique of longterm bone marrow culture (LTBMC) allows a sustained production of myeloid cells when marrow is placed in liquid culture at relatively high cell concentration, with appropriate supplements, temperature and feeding conditions. A peculiar feature of LTBMC is that the stromal cells promote selfrenewal as well as differentiation of the stem cells, without the need to add exogenous growth factors. The LTBMC system offers an approach able to investigate not only the proliferative and differentiative events but also sustained cell production and selfrenewal of any clonogenic cell types. In the last years, the technique of LTBMC has been increasingly used by several groups to investigate hematopoietic regulation, stromal cell function and the interactions among stromal and hematopoietic cells. In the present report, the biology of LTBMC and their possible clinical applications will be reviewed.
CD34+ Cell Selection: Focus on Immunomagnetic Beads and Chymopapain
Authors: Silvestri F. , Banavali S. , Savignano C. , Preisler H.D. , Baccarani M. 
Published: April 2018

The aim of the present study was to develop immunoadsorption techniques for purifying CD34+ cells from the peripheral blood (PB) and the bone marrow (BM). First, we compared two methods for isolating CD34+ cells from patients with acute non-lympho-cytic leukemia. Twenty-two samples (17 PB, 5 BM) were obtained from 19 patients, were density cut and, after incubation with My 10 antibody, were separated by panning or by immunomagnetic beads. Beads allowed a significantly better separation, either in terms of purification of CD34+ cells (85.5± 11.1% vs 55.7±23.8%, p= 0.003) or in terms of depletion of CD34+ cells from the negative fractions (3.9±7.6 vs 30.9±25.1%, p= 0.008). In a second study, 2 BMs from healthy subjects and 1 BM and 2 PBs from chronic myeloid leukemia patients were separated using immunomagnetic beads. The results confirmed the previous study the overall frequency of CD34+ cells in the isolated positive fractions was 85.0± 10.6% (with a recovery of 64.0±5.7%), while it was only 2.7±6.6% in the negative fractions. In particular the purity in the two normal BMs was respectively 86 and 97%. According to these results, the great majority of clonogenic cells was separated in the CD34+ fractions. Chymopapain, that was used to detach the beads from the cells, was shown to be non-toxic to the clonogenic cells. Positive selection of CD34+ cells with immunomagnetic beads and chymopapain is a useful method for isolating almost pure progenitors from the PB and the BM for experimental use and is under investigation for clinical applications.
Umbilical Cord Blood Stem Cell Transplantation
Authors: Miniero R. , Ramenghi U. , Crescenzio N. , Perugini L. , Busca A. , Vassallo E. , Timeus F. 
Published: April 2018

Human umbilical cord blood as an alternative source of hematopoietic stem cells for bone marrow reconstitution, has recently been demonstrated to yield successful HLA-matched placental blood grafts in children. It has been shown that cord blood contains sufficient progenitor cells to effect hematological reconstitution. Since then, more than 25 cord blood stem cells (CBSCs) transplants have been performed worldwide for the treatment of a variety of malignant and nonmalignant diseases. The majority of the grafts performed thus far have utilized CBSCs from HLA-identical siblings. However, much of the interest in this setting is devoted to the potential use of CBSCs for HLA-mismatched and unrelated transplants. Preliminary results suggest that allorecognition and graft-versus-host disease may be less intense in CBSCs transplants than in recipients of similarly compatible bone marrow. This review summarizes the results and potential future applications of cord blood transplantation.
German Multicenter Studies on Plateletpheresis from Healthy Donors
Authors: Kretschmer V. , Müller N. , Godehardt E. , Borberg H. , Neumann H.J. , Weßwange T.G. ,   German Hemapheresis Study Group
Published: April 2018

It is reported on two German Multicenter Plateletpheresis Studies with the Fresenius AS 104 cell separator accompanied by a Multicenter Counting Study. 15 centers participated, a total of 1884 separations were evaluated. It could be shown that multicenter studies help to give a more objective opinion about a cell separator and the separation protocol used if it is possible to improve the counting methods and to eliminate individual center effects by an accompanying Multicenter Counting Study. The AS 104 proved to be a good cell separator for platelet collection regarding platelet yields (3.1 x 11″ from 3.5 I citrated blood), separation efficiency (about 45%), yield prediction (SD = ≠ 15%) and leukocyte contamination (median WBC 47x106).
Applications of Extracorporeal Photochemotherapy in “Non-oncological” Diseases
Authors: Dall'Amico R. , Zulian F. , Montini G. , Andretta B. , Murer L. , Rossetti F. , Livi U. , Zacchello G. , Zacchello F. 
Published: April 2018

Photopheresis (ECP) is a new therapy for oncological and autoimmune diseases consisting in the reinfusion of 3-9x 109 leukocytes, taken from the patient by leukapheresis, and treated in an extracorporeal system with 8-methoxypsoralen and ultraviolet light A. Nine patients affected by T cell immunomediated diseases (2 scleroderma, 1 chronic GVHD, 1 polyarteritis, 1 rheumatoid arthritis and 4 heart transplant patients with numerous episodes of acute rejection) were treated with ECP. Photopheresis was performed on 2 consecutive days every 3-4 weeks. All patients affected by autoimmune diseases experienced an improvement during treatment with ECP. In 2 of the 4 patients with heart transplant, rejection was reversed by photopheresis. No major side effects were observed during the treatment. In conclusion ECP is a safe and well tolerated therapy. Although the number of patients is small, ECP seems to be an effective modality in many diseases.