Showing papers by "Catherine Klersy published in 1997"

Treatment outcome and prognostic factors for primary mediastinal (thymic) B-cell lymphoma: a multicenter study of 106 patients.

Abstract: PURPOSETo define clinicopathologic features, response to treatment, and prognostic factors of primary mediastinal B-cell lymphoma (MBL), a CD20+ tumor recognized as a distinct entity among non-Hodgkin's lymphomas (NHL).PATIENTS AND METHODSOne hundred six patients presented with disease confined to thorax (86%), bulky mediastinum (73%), superior vena cava syndrome (47%), and contiguous infiltration (57%). Ninety-nine received doxorubicin-containing chemotherapy (CHT).RESULTSThirty-five of 99 patients were primarily CHT-resistant, and 64 responded: 23 achieved complete response (CR) and 41 achieved response with residual mediastinal abnormality. Seventy-seven percent of responders received mediastinal radiotherapy (RT). Of 64 responders, 18 (28%) relapsed: none of 23 CR patients and 18 of 41 (44%) with residual mediastinal abnormality. Relapse-free survival rate of responders was 71% at 3 years. Actuarial 3-year survival rate was 52% for all patients and 82% for responders. Predictive factors of poor outcom...

Bone marrow T-cell subsets in patients with monoclonal gammopathies: correlation with clinical stage and disease status

Abstract: BACKGROUND AND OBJECTIVE: The existence of an imbalance in T-cell subpopulations in patients (pts) affected by monoclonal gammopathies (MG) has been well established. This imbalance might be correlated with different control of plasma cell growth and, particularly in MM, with the severity of the disease. The aim of this study was to verify whether the alteration of the T lymphocyte subsets in bone marrow correlates with the diagnosis, clinical status and disease phase in patients with monoclonal gammopathies. METHODS: We performed a study on bone marrow (BM) T-cell subsets in 49 multiple myelomas (MM) and in 17 monoclonal gammopathies of uncertain significance (MGUS), using as controls 20 BM aspirates from normal subjects. RESULTS: The percentages of BM CD4 cells in MM pts at onset were slightly lower than in controls and in MGUS pts, who showed normal percentages of CD4. The percentages of CD8 cells were lower than in controls in both MM and MGUS (p = 0.02 and p = 0.007, respectively), and consequently the CD4/CD8 ratios were significantly higher than in normal subjects (p = 0.01 and 0.008, respectively). Analysis of BM T-cell subpopulations in MM pts showed a progressive decrease in the percentage of CD4 cells from stage I to stage III (I vs III p = 0.008) and an increase in CD8 cells, although not statistically significant. The same trend was observed when the different phases of MM (onset, plateau, progression) were analyzed: a lower percentage of CD4 cells and an increase of CD8 cells characterized the advanced phases. Treatment did not seem to alter significantly the distribution of T-cell subsets in MM patients. INTERPRETATION AND CONCLUSIONS: The imbalance in T-cell involving the bone marrow lymphocytic populations that exist in MG is somewhat different in MGUS and MM. In MM patients this disturbance is related to the disease stages and phases, reflecting an important role for T-cell subsets in tumor cell control.

Heart surgery and quality of life: a prospective study on ischemic patients.

Abstract: Objective: Recently, an interest has developed in the use of quality of life instruments to provide a more comprehensive assessment of the impact of disease and treatments on patients’ everyday lives over time, particularly in the cardiovascular field. To evaluate changes in quality of life of patients with a coronary heart disease and undergoing heart surgery and to identify patients on which to concentrate stronger rehabilitative intervention, an observational prospective study with repeated measurements has been designed. Methods: A total of 259 consecutive coronary heart disease patients (211 males, 48 females, aged 63 (S.D., 9 years) are included into the study. Quality of life has been assessed by means of Karnofsky Performance Status Scale and Nottingham Health Profile (6 dimensions of quality of life) preoperatively, at 2 and 6 months. Changes in quality of life scores at short and mid term and the influence of possible predictors have been investigated. Separate scores have been considered for each dimension of quality of life as well as a global statistics accounting for the multidimensionality of quality of life. Results: Quality of life increased by 57, 64, 72, 52, 23, 44 and 56% for Karnofsky Performance Status Scale, energy, pain, emotion, sleep, social and mobility respectively at 2 months; at 6 months a further increase of 18% in sleep only occurred. Global scores appeared to be significantly influenced by sex, age class, preoperative NYHA, type of angina, associated procedure and complication at surgery. Conclusions: The increase of quality of life concentrates mainly at an early stage of post-operative period. The preoperative factors tested, allow to stratify patients based on quality of life and to identify those on which to concentrate stronger rehabilitative intervention. © 1997 Elsevier Science B.V.

Primary mediastinal B-cell lymphoma: update of its clinicopathologic features.

Abstract: The peculiar clinical, histomorphological and biological characteristics of PMBCL are reviewed. Special emphasis is given to the frequent aggressive clinical behaviour of this lymphoma in which conventional prognostic factors seem inadequate to identify high risk cases. The need for new clinical and/or biological prognostic markers is stressed.

A 3-19-year follow-up study on diabetic retinopathy in patients diagnosed in childhood and treated with conventional therapy.

Abstract: Few data are available from follow-up studies on diabetic retinopathy in patients diagnosed with insulin-dependent (Type 1) diabetes mellitus in childhood and treated with conventional therapy. We report the results of conventional insulin therapy on development of diabetic retinopathy in 100 children and adolescents (47 females and 53 males), aged 8.3 ± 3.5 (1.2–16.4) years at diagnosis of disease. Oral or intravenous fluorescein angiography was performed during a 3–19 year follow-up in all patients. Retinopathy was staged according to the criteria of the Italian Society of Diabetology (SID). During follow-up, retinopathy was observed in 28 patients (28 %). At the end of follow-up, retinopathy was present in 23 patients and had disappeared in 5. Life-table analysis showed a median disease-free interval of 10.8 years. At 10 years from diagnosis the percentage of patients free of retinopathy was 66 %. Poor metabolic control, age, and degree of pubertal development at diagnosis were the most important risk factors. © 1997 John Wiley & Sons, Ltd.

Factors increasing the risk of allograft vascular disease in heart transplant recipients.

Abstract: Allograft vascular disease is the major cause of late cardiac graft failure. A multifactorial etiopathogenesis is supposed. Our study investigated factors associated with allograft vascular disease occurrence. After stratifying our series on the basis of potential risk factors, we calculated allograft vascular disease incidence rate in 267 grafts from 258 patients who underwent transplant between November 1985 and August 1996. Chi-square test was used for the identification of univariate risk factors to be included in a multivariate model. Multivariate analysis was based on a Poisson model. Seventy of the 267 grafts (26.2%) were diagnosed with allograft vascular disease. Heart disease other than idiopathic dilated cardiomyopathy, donor's age, number of mismatches for HLA-B = 2, presence of systo-diastolic hypertension, number of acute rejection positive endomyocardial biopsies > or = 7 and the association of human Cytomegalovirus and hepatitis C virus infections proved to be univariate risk factors, and were included in the Poisson multivariate model. The association of Cytomegalovirus and hepatitis C infections multiplied allograft vascular disease incidence rate by 3.9, systo-diastolic hypertension by 2.2, occurrence of 2 HLA-B mismatches by 2, a high number (> or = 7) of acute rejection positive-endomyocardial biopsies by 1.8, and heart disease other than idiopathic dilated cardiomyopathy by 1.8. The association of human Cytomegalovirus and hepatitis C virus infections, of HLA-B mismatches, of acute rejection-positive endomyocardial biopsies, as well as post-transplantation hypertension and native heart disease other than idiopathic dilated cardiomyopathy, proved to be positively associated with an increased risk of allograft vascular disease. Given the concordance of our data with those of numerous prior series, we are going to adopt a special surveillance angiographic protocol for patients with these factors.

Graphic data representation in anaesthesiological journals : A proposed methodology for assessment of appropriateness

Abstract: Few authors have addressed the topic of graphic data presentation The purpose of our study was to combine several guidelines in order to evaluate three anaesthesiology journals listed in Index Medicus (Australian, American and Italian) in terms of the appropriateness and the quality of presentation of graphs Our analysis was based on concepts expressed by Cox and Tufte We calculated the optimization of the amount of information in each graph using two parameters: Data Density Index (DDI) and Data Ink Ratio (DIR) The correctness and clearness of each component of the graph (scale, title, axes, legends and abbreviations) was evaluated on the basis of a binary score We analysed 300 exploratory plots, quantitative graphs and summaries of statistical analysis About 50% of papers had more than three graphs Mean scores were 322 for the Italian journal, 347 for the American journal and 382 for the Australian journal Tufte parameters were calculated on 42 scatterplots: DDI was 54 +/- 139 and DIR was 07 +/- 01 The criteria applied in our study appear sufficiently sensitive to differentiate the quality of graphs

Absence of correlation between coronary thrombosis and postatherectomy restenosis.

Abstract: This study endeavored to assess whether thrombus in directional coronary atherectomy was correlated with later subsequent restenosis. We concluded that the presence of thrombus in native plaque is not correlated with the occurrence of postatherectomy restenosis.