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Gagliardi G.,Coloproctology Unit | Gagliardi G.,Tulane University | Pucciarelli S.,University of Padua | Asteria C.R.,Azienda Ospedaliera C. Poma | And 20 more authors.
Techniques in Coloproctology | Year: 2010

Background: There is good evidence that radiotherapy is beneficial in advanced rectal cancer, but its application in Italy has not been investigated. Methods: We conducted a nationwide survey among members of the Italian Society of Colo-Rectal Surgery (SICCR) on the use of radiation therapy for rectal cancer in the year 2005. Demographic, clinical and pathologic data were retrospectively collected with an online database. Italy was geographically divided into 3 regions: north, center and south which included the islands. Hospitals performing 30 or more surgeries per year were considered high volume. Factors related to radiotherapy delivery were identified with multivariate analysis. Results: Of 108 centers, 44 (41%) responded to the audit. We collected data on 682 rectal cancer patients corresponding to 58% of rectal cancers operated by SICCR members in 2005. Radiotherapy was used in 307/682 (45.0%) patients. Preoperative radiotherapy was used in 236/682 (34.6%), postoperative radiotherapy in 71/682 (10.4%) cases and no radiotherapy in 375 (55.0%) cases. Of the 236 patients who underwent preoperative radiotherapy, only 24 (10.2%) received short-course radiotherapy, while 212 (89.8%) received long-course radiotherapy. Of the 339 stage II-III patients, 159 (47%) did not receive any radiotherapy. Radiotherapy was more frequently used in younger patients (P < 0.0001), in patients undergoing abdominoperineal resection (APR) (P < 0.01) and in the north and center of Italy (P < 0.001). Preoperative radiotherapy was more frequently used in younger patients (P < 0.001), in large volume centers (P < 0.05), in patients undergoing APR (P < 0.005) and in the north-center of Italy (P < 0.05). Conclusion: Our study first identified a treatment disparity among different geographic Italian regions. A more systematic audit is needed to confirm these results and plan adequate interventions. © 2010 Springer-Verlag.

Sollena P.,Sacro Cuore Catholic University of Rome | Del Regno L.,Sacro Cuore Catholic University of Rome | Fargnoli M.C.,University of LAquila | Peris K.,Sacro Cuore Catholic University of Rome
Giornale Italiano di Dermatologia e Venereologia | Year: 2015

Basal cell carcinoma (BCC) is the most common non melanoma skin cancer (NMSC) in white individuals over the age of 40 years. BCCs usually grow slowly and rarely metastasize, but can be locally invasive if neglected or of an aggressive subtype. The local tissue destruction caused by an untreated BCC can be extensive, therefore optimal treatment should lead to tumour clearance. Surgery and topical medical treatments are successful therapeutic options for most superficial and nodular BCC. Systemic medical treatments may be considered when surgical procedures are not recommended on the basis of the anatomical site and tumor-extension, and patients' associated comorbidities. Expected cure rates and cosmetic outcome should be also carefully considered. A better understanding of the molecular mechanisms of BCC pathogenesis can lead to new developing target medical therapies, and data on their efficacy seem encouraging.

Lapadula G.,Clinic of Infectious Diseases | Chatenoud L.,Istituto di Ricerche Farmacologiche Mario Negri | Gori A.,Clinic of Infectious Diseases | Castelli F.,University of Brescia | And 37 more authors.
PLoS ONE | Year: 2015

Background: Immunological non-response (INR) despite virological suppression is associated with AIDS-defining events/death (ADE). Little is known about its association with serious non-AIDS-defining events (nADE). Methods Patients highly-active antiretroviral therapy (HAART) with <200 CD4+/μl and achieving HIVRNA <50 copies/ml within 12 (±3) months were categorized as INR if CD4+ T-cell count at year 1 was <200/μl. Predictors of nADE (malignancies, severe infections, renal failure-ie, estimated glomerular filtration rate <30 ml/min, cardiovascular events and liver decompensation) were assessed using multivariable Cox models. Follow-up was right-censored in case of HAART discontinuation or confirmed HIV-RNA>50. Results: 1221 patients were observed for a median of 3 (IQR: 1.3-6.1) years. Pre-HAART CD4+were 77/μl (IQR: 28-142) and 56% of patients had experienced an ADE. After 1 year, CD4+ increased to 286 (IQR: 197-387), but 26.1% of patients were INR. Thereafter, 86 nADE (30.2% malignancies, 27.9%infectious, 17.4%renal, 17.4%cardiovascular, 7% hepatic) were observed, accounting for an incidence of 1.83 events (95%CI: 1.73-2.61) per 100 PYFU. After adjusting for measurable confounders, INR had a significantly greater risk of nADE (HR 1.65; 95%CI: 1.06-2.56). Older age (per year, HR 1.03; 95%CI: 1.01-1.05), hepatitis C co-infection (HR 2.09; 95%CI: 1.19-3.7), a history of previous nADE (HR 2.16; 95% CI: 1.06-4.4) and the occurrence of ADE during the follow-up (HR 2.2; 95%CI: 1.15-4.21) were other independent predictors of newly diagnosed nADE. Conclusions: Patients failing to restore CD4+ to >200 cells/μl run a greater risk of serious nADE, which is intertwined or predicted by AIDS progression. Improved management of this fragile population and innovative therapy able to induce immune-reconstitution are urgently needed. Also, our results strengthen the importance of earlier diagnosis and HAART introduction. © 2015 Lapadula et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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