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Ruzzo A.,Urbino University | Graziano F.,Azienda Ospedaliera Ospedali Riuniti Marche Nord | Galli F.,Laboratorio Of Ricerca Clinica | Giacomini E.,Urbino University | And 23 more authors.
Scientific Reports

We investigated 17 polymorphisms in 11 genes (TS, MTHFR, ERCC1, XRCC1, XRCC3, XPD, GSTT1, GSTP1, GSTM1, ABCC1, ABCC2) for their association with the toxicity of fluoropyrimidines and oxaliplatin in colorectal cancer patients enrolled in a prospective randomized trial of adjuvant chemotherapy. The TOSCA Italian adjuvant trial was conducted in high-risk stage II-III colorectal cancer patients treated with 6 or 3 months of either FOLFOX-4 or XELOX adjuvant chemotherapy. In the concomitant ancillary pharmacogenetic study, the primary endpoint was the association of polymorphisms with grade 3-4 CTCAE toxicity events (grade 2-4 for neurotoxicity). In 517 analyzed patients, grade ≥ 3 neutropenia and grade ≥ 2 neurotoxicity events occurred in 150 (29%) and in 132 patients (24.8%), respectively. Diarrhea grade ≥ 3 events occurred in 34 (6.5%) patients. None of the studied polymorphisms showed clinically relevant association with toxicity. Hopefully, genome-wide association studies will identify new and more promising genetic variants to be tested in future studies. Source

Cappelleri G.,Ferrari | Ghisi D.,Azienda Ospedaliera di Cremona | Fanelli A.,Azienda Ospedaliera di Cremona | Albertin A.,Ospedale San Giuseppe Milan | And 2 more authors.
Regional Anesthesia and Pain Medicine

INTRODUCTION: The aim of this prospective, randomized, double-blind study was to evaluate whether continuous sciatic nerve block can improve postoperative pain relief and early rehabilitation compared with single-injection sciatic nerve block in patients undergoing total knee arthroplasty (TKA) and lumbar plexus block. METHODS: After ethical committee approval and written informed consent, 38 patients with ASA physical status I to II were enrolled. The first group received continuous sciatic and continuous lumbar plexus blocks (group regional or R, n = 19), whereas the second group received a single sciatic nerve block followed by saline infusion through the sciatic catheter and continuous lumbar plexus block (group control or C, n = 19). We assessed morphine consumption, scores for visual analog scale for pain at rest (VASr), and during continuous passive motion (VASi during CPM) for 48 hours postoperatively. Effectiveness of early ambulation was also evaluated. RESULTS: Scores for VASr and VASi during CPM, as well as morphine consumption, were significantly higher in group C than in group R (P < 0.01). Moreover, patients in group R showed earlier rehabilitation with more effective ambulation (P < 0.05). CONCLUSIONS: Continuous sciatic nerve block improves analgesia, decreases morphine request, and improves early rehabilitation compared with single-injection sciatic nerve block in patients undergoing TKA and lumbar plexus block. Copyright © 2011 by American Society of Regional Anesthesia and Pain Medicine. Source

Tamborini S.,Azienda Ospedaliera di Cremona | Poli R.,Azienda Ospedaliera di Cremona | Agrimi E.,Azienda Ospedaliera di Cremona
Journal of Psychopathology

Objective: The aim of this study was to investigate the extent (in terms of number of contacts) and trends in psychiatric consultations at the General Cremona Hospital over three years (2007-2009), and to compare data with those of international literature. Methods: We recorded the number of conducted consultations, divided between emergency department and hospital wards and verified the quantitative differences between the different specialist departments, grouped in medical and surgical areas. The information obtained from patients include socio-demographic data (age and sex) and psychiatric diagnoses according to the following grouping: organic mental disorders and dementia, alcoholism and drug addiction, psychosis, mood disorders, anxiety disorders, personality disorders, no psychiatric disorder. Data were statistically processed through the SPSS 12.0 for Windows software. Results: The average annual rate of psychiatric consultation was 1.45% in 2007, 1.2% in 2008 and 1.2% in 2009. With regard to differences by gender, there were no significant differences. Almost seventy percent of psychiatric consultations were required by the emergency department (ED). The other requests came from medical departments (83.5%) and from surgical wards (16.5%). Regarding individual departments, we observed a very low percentage of requests from the Gynecology and Obstetrics Division, that was about one third compared to other surgical wards. The same numerical proportion within medical areas was observed for the Oncology Unit in relation to other departments in the medical area. With regard to psychiatric diagnoses, the most common in all departments were mood disorders. Among the ED and wards we observed the following differences: greater representation of psychosis in ED compared to organic mental disorders and greater occurrence of anxiety disorders in ED. Conclusions: The average annual rate of psychiatric consultations conducted over three years in the Cremona Hospital was 1.28%, shortly lower than that reported in the literature. With regard to diagnoses the most frequent were mood disorders followed by anxiety disorders, personality disorders, organic mental disorders and dementia, schizophrenia and psychotic disorders, alcoholism and addictive disorders. Source

Dalla Chiesa M.,Azienda Ospedaliera di Cremona | Dalla Chiesa M.,Concordia Medical | Tomasello G.,Azienda Ospedaliera di Cremona | Buti S.,Azienda Ospedaliera di Cremona | And 5 more authors.
Cancer Chemotherapy and Pharmacology

Purpose: To evaluate a new strategy of two sequential, intensified chemotherapy regimens in metastatic gastric cancer. Patients and methods: Chemo-naïve patients with metastatic gastric cancer were enrolled to receive 4 cycles of TCF-dd (docetaxel initially 85 mg/m2 and cisplatin initially 75 mg/m2 on day 1 [later modified due to toxicity: 70 and 60 mg/m2 respectively], l-folinic acid 100 mg/m 2 on days 1 and 2, 5-fluorouracil 400 mg/m2 bolus and then 600 mg/m2 as a 22 h continuous infusion on day 1 and 2, every 14 days). Subsequently, patients with CR, PR or SD received 4 cycles of COFFI (oxaliplatin 85 mg/m2, irinotecan 140 mg/m2, l-folinic acid 200 mg/m2, 5-fluorouracil bolus 400 mg/m2 on day 1 followed by 2,400 mg/m2 as a 48 h continuous infusion, every 14 days). In both regimens pegfilgrastim 6 mg subcutaneously on day 3 was included. Results: Forty consecutive patients were enrolled. TCF-dd regimen achieved an ORR of 55% (95% CI, 40-70). Twenty-three patients proceeded to COFFI. After this regimen the ORR was then increased to 60% (95% CI, 45-75). Among the 21 patients treated with TCF-dd after the protocol amendments, main grade 3-4 toxicities were: neutropenia (29%), thrombocytopenia (19%), asthenia (24%) and diarrhea (14%). COFFI caused grade 3-4 neutropenia (all not febrile) and diarrhea in 35% and 17% of patients respectively. Conclusions: A sequential strategy with TCF-dd followed by COFFI is very active and may be of special interest in selected patients. © 2010 Springer-Verlag. Source

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