8 results on '"di Grazia, C."'
Search Results
2. Small bowel intussussception due to metastatic melanoma of unknown primary site. Case report
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STAGNITTI, F., ORSINI, S., MARTELLUCCI, A., TUDISCO, A., AVALLONE, M., AIUTI, F., DI GIROLAMO, V., STEFANELLI, F., DE ANGELIS, F., COSTANTINO, A., DI GRAZIA, C., NAPOLEONI, A., NICODEMI, S., CIPRIANI, B., CECI, F., MOSILLO, R., CORELLI, S., CASCIARO, G., and SPAZIANI, E.
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Male ,Oncology ,Pathology ,medicine.medical_specialty ,Ileum ,Metastasis ,Clinical Practice ,Internal medicine ,medicine ,Humans ,Malignant melanoma ,Unknown primary ,Intestinal intussusceptions ,Disseminated disease ,Melanoma ,Gastrointestinal tract ,business.industry ,Middle Aged ,medicine.disease ,Ileal Neoplasms ,medicine.anatomical_structure ,Iron-deficiency anemia ,Neoplasms, Unknown Primary ,Segmental resection ,business ,Intestinal Obstruction ,Brain metastasis - Abstract
Malignant melanoma is characterized by metastases also to the gastrointestinal tract, especially in the small bowel. The diagnosis is often delayed because unspecific clinical presentation (frequently as chronic iron deficiency anemia, rectal bleeding or intestinal obstruction). We present a case of melanoma of unknown primary site, with clinical presentation of intestinal obstruction. A segmental resection of the ileum was performed including mesentery with lymph nodes. Histology revealed metastatic melanoma from unknown primary. PET and MRI confirmed disseminated disease without brain metastasis.
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- 2014
3. Risk management in surgery
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Messano, GIUSEPPE ALESSIO, Spaziani, Erasmo, Turchetta, F., Ceci, F., Corelli, S., Casciaro, Giovanni Enrico, Martellucci, A., Costantino, A., Napoleoni, A., Cipriani, B., Nicodemi, S., Di Grazia, C., Mosillo, R., Avallone, M., Orsini, S., Tudisco, A., Aiuti, F., and Stagnitti, Franco
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antibiotic therapy ,laparoscopic drainage ,liver abscesses ,percutaneous drainage ,risk management ,Risk Management ,Italy ,Surgical Procedures, Operative ,Humans ,Focus on ,Checklist - Abstract
Malpractice is the responsible for the greatest number of legal claims. At the present time, legal actions against physicians in Italy are 15,000 per year, and a stunning increase about costs to refund patients injured by therapeutic and diagnostic errors is expected. The method for the medical prevention is “Risk Management”, that is the setting-up of organizational instruments, methods and actions that enable the measurement or estimation of medical risk; it allows to develop strategies to govern and reduce medical error. In the present work, the reconstruction about the history of risk management in Italy was carried out. After then the latest initiatives undertaken by Italy about the issue of risk management were examined.
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- 2013
4. Reducing transplant-related mortality after allogeneic hematopoietic stem cell transplantation
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Bacigalupo, A., Sormani, M. P., Lamparelli, T., Gualandi, F., Occhini, D., Bregante, S., ANNA MARIA RAIOLA, Di Grazia, C., Dominietto, A., Tedone, E., Piaggio, G., Podesta, M., Bruno, B., Oneto, R., Lombardi, A., Frassoni, F., Rolla, D., Rollandi, G., Viscoli, C., Ferro, C., Garbarino, L., and Lint, M. T.
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Adult ,Male ,Neutropenia ,Transplantation Conditioning ,Multiple Organ Failure ,Premedication ,Graft vs Host Disease ,Infections ,Anti-Infective Agents ,Actuarial Analysis ,Cause of Death ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Transplantation, Homologous ,Bone Marrow Transplantation ,Retrospective Studies ,Salvage Therapy ,Infection Control ,Peripheral Blood Stem Cell Transplantation ,Leukemia ,Remission Induction ,Hematopoietic Stem Cell Transplantation ,Middle Aged ,Combined Modality Therapy ,Survival Analysis ,Treatment Outcome ,Hematologic Neoplasms ,Female ,Lung Diseases, Interstitial ,Immunosuppressive Agents - Abstract
Transplant-related mortality (TRM) following allogeneic hematopoietic stem cell transplantation (HSCT) has been reported to be related to disease stage, duratiion of disease and type of donor. Furthermore, the outcome of transplants performed in the 1990s appears to be better than that of transplants done in the previous decade. The aims of this study were to determine whether these relationships still hold and whether the outcome of transplants is continuing to improve.We analyzed 1180 consecutive patients with leukemia (n=979) or other hematologic malignancies (n=201) undergoing HSCT in 4 time periods: before 1990, 1991-1995, 1996-2000, and 2001-2002. Changes during these eras include increasing patient age, more unrelated transplants, more patients with advanced disease, different graft-versus-host disease (GvHD) prophylaxis, and different management of infections.The actuarial 2-year transplant-related mortality (TRM) differed significantly between the transplant eras (p0.001) with a significant interaction with disease phase (p=0.018). In patients in first remission (n=585) TRM was 34%, 25%, 21% and 6% in the four transplant eras. The reduction in TRM was less evident in patients in second remission (n=284) (37%, 35%, 30%, 25%) and absent in relapsed patients (n=311) (TRM=45%, 41%, 29%, 51%). This is a consequence of reductions in GvHD, infections and multiorgan failure among patients in remission but not among those who relapse. The actuarial 2-year survival has improved significantly in patients in first remission (54%, 66%, 72%, 78%) but not in those in second remission (38%, 46%, 52%,45%), or relapsed patients (31%, 25%, 36%, 21%).In conclusion, TRM has been significantly reduced in first remission patients, suggesting an allograft should be considered in this phase, when appropriate, without delay. There has been no improvement in survival for patients beyond first remission, due to persisting high risk of infections and organ toxicity, a possible consequence of prolonged pre-transplant chemotherapy and neutropenia.
5. Liver resection for hemoperitoneum caused by spontaneous rupture of unrecognized hepatocellular carcinoma
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giovanni casciaro, Spaziani, E., Costantino, A., Ceci, F., Di Grazia, C., Martellucci, A., Pecchia, M., Cipriani, B., Angelis, F., Corelli, S., Napoleoni, A., Stefanelli, F., Salvadori, C., Parisella, M., Nicodemi, S., and Stagnitti, F.
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Aged, 80 and over ,Male ,Carcinoma, Hepatocellular ,Rupture, Spontaneous ,Hemoperitoneum ,Liver Neoplasms ,Hepatectomy ,Humans - Abstract
Hepatocellular carcinoma (HCC) is an increasingly common form of cancer. Although its spontaneous rupture is rare in Western countries, it constitutes a surgical emergency and is associated with high mortality. There is a lack of consensus as to the best approach and what parameters to use in choosing it. The three main approaches are conservative, endovascular and resection - the treatment of choice for acute abdominal bleeding. We report a case of hemoperitoneum following the spontaneous rupture of an unrecognized HCV-related HCC in a patient with no history of liver disease. The patient was successfully treated by emergency surgery, with resection of two segments of the left liver.
6. Treatment of steroid resistant acute graft versus host disease with an anti-CD26 monoclonal antibody-Begelomab
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Edoardo Benedetti, Carlo Borghero, Francesca Gualandi, Anna Paola Iori, Mattia Algeri, Carmen Di Grazia, Patrizia Chiusolo, Maurizio Musso, Carmine Selleri, Antonio M. Risitano, Anna Maria Raiola, Francesca Bonifazi, Massimo Martino, Alice Bertaina, Francesco Onida, Emanuele Angelucci, Alessandro Rambaldi, Riccardo Varaldo, Andrea Bacigalupo, Simona Sica, Franco Locatelli, Francesco Zallio, Fabio Ciceri, Lucia Prezioso, Matteo Parma, Bacigalupo, A., Angelucci, E., Raiola, A. M., Varaldo, R., Di Grazia, C., Gualandi, F., Benedetti, E., Risitano, A., Musso, M., Zallio, F., Ciceri, F., Chiusolo, P., Sica, S., Rambaldi, A., Bonifazi, F., Parma, M., Martino, M., Onida, F., Iori, A. P., Selleri, C., Borghero, C., Bertaina, A., Prezioso, L., Algeri, M., and Locatelli, F.
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Adult ,medicine.medical_specialty ,medicine.drug_class ,Graft vs Host Disease ,Monoclonal antibody ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Acute graft versus host disease ,medicine ,Humans ,Prospective Studies ,Treatment of steroid resistant acute graft versus ,Stage (cooking) ,Adverse effect ,Prospective cohort study ,Transplantation ,biology ,business.industry ,Hematopoietic Stem Cell Transplantation ,Compassionate Use ,Antibodies, Monoclonal ,Hematology ,Steroid resistant ,Settore MED/15 - MALATTIE DEL SANGUE ,begelomab ,methylprednisolone ,acute respiratory failure ,030220 oncology & carcinogenesis ,Acute Disease ,biology.protein ,Steroids ,Antibody ,business ,treatment of steroid resistant acute graft versus host disease with an anti cd26 monoclonal antibody begelomab ,030215 immunology - Abstract
We have treated 69 patients with steroid refractory acute graft versus host disease (SR-aGvHD), with an anti-CD26 monoclonal antibody (Begelomab): 28 patients in two prospective studies (EudraCT No. 2007-005809-21; EudraCT No. 2012-001353-19), and 41 patients on a compassionate use study. The median age of patients was 42 and 44 years; the severity of GvHD was as follows: grade II in 8 patients, grade III in 33, and grade IV in 28 patients. There were no adverse events directly attributable to the antibody. Day 28 response was 75% in the prospective studies and 61% in the compassionate use patients, with complete response rates of 11 and 12%. Response for grade III GvHD was 83 and 73% in the two groups; response in grade IV GvHD was 66 and 56% in the two groups. Non relapse mortality (NRM) at 6 months was 28 and 38%. Overall there were 64, 56, 68% responses for skin, liver, and gut stage 3-4 GvHD. The overall survival at 1 year was 50% for the prospective studies and 33% for the compassionate use patients. In conclusion, Begelomab induces over 60% responses in SR-aGvHD, including patients with severe gut and liver GvHD, having failed one or more lines of treatment.
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- 2020
7. Extracorporeal photopheresis for the treatment of steroid refractory acute GVHD
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Bénédicte Bruno, Stefania Bregante, Adalberto Ibatici, P Perfetti, P Stura, Almalina Bacigalupo, C. Di Grazia, Domenico Occhini, Teresa Lamparelli, P. Carlier, M. T. Van Lint, G M Ferrari, Francesca Gualandi, Enrico Pogliani, Alida Dominietto, Paolo Strada, A M Raiola, S Zia, Perfetti, P, Carlier, P, Strada, P, Gualandi, F, Occhini, D, Van Lint, M, Ibatici, A, Lamparelli, T, Bruno, B, Raiola, A, Dominietto, A, Di Grazia, C, Bregante, S, Zia, S, Ferrari, G, Stura, P, Pogliani, E, and Bacigalupo, A
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Male ,Adult ,medicine.medical_specialty ,Transplantation Conditioning ,Adolescent ,medicine.medical_treatment ,education ,Drug Resistance ,Graft vs Host Disease ,Hematopoietic stem cell transplantation ,Gastroenterology ,Young Adult ,fluids and secretions ,Photopheresis ,Retrospective Studie ,Internal medicine ,Immunopathology ,Extracorporeal Photopheresis ,medicine ,Humans ,Steroid ,Survival rate ,Retrospective Studies ,Photopheresi ,Aged ,Immunosuppression Therapy ,Transplantation ,business.industry ,Hematopoietic Stem Cell Transplantation ,Hematology ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Treatment Outcome ,Graft-versus-host disease ,Methylprednisolone ,Acute Disease ,Chronic Disease ,Steroids ,Female ,business ,Immunosuppression ,Human ,medicine.drug - Abstract
Extracorporeal photopheresis (ECP) was given to 23 patients with steroid-refractory acute GVHD (aGVHD, grade II (n=10), III (n=7) or IV (n=6)). The median duration of ECP was 7 months (1-33) and the median number of ECP cycles in each patient was 10. Twelve patients (52%) had complete responses. Eleven patients (48%) survived and 12 died, 10 of GVHD with or without infections and two of leukaemia relapse. The average grade of GVHD was reduced from 2.8 (on the first day of ECP) to 1.4 (on day +90 from ECP) (P=0.08), and the average dose of i.v. methylprednisolone from 2.17 to 0.2 mg/kg/d (P=0.004). Complete responses were obtained in 70, 42 and 0% of patients, respectively, with grades II, III and IV aGVHD; complete responses in the skin, liver and gut were 66, 27 and 40%. Patients treated within 35 days from onset of aGVHD had higher responses (83 vs 47%; P=0.1). A trend for improved survival was seen in grade III-IV aGVHD treated with ECP as compared to matched controls (38 vs 16%; P 0.08). ECP is a treatment option for patients with steroid refractory aGVHD and should be considered early in the course of the disease.
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- 2008
8. A boost of CD34(+)-selected peripheral blood cells without further conditioning in patients with poor graft function following allogeneic stem cell transplantation
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Larocca, Alessandra, Piaggio, Giovanna, Podesta, Marina, Pitto, Anna, Bruno, Barbara, Di Grazia, Carmen, Gualandi, Francesca, Occhini, Domenico, ANNA MARIA RAIOLA, Dominietto, Alida, Bregante, Stefania, Lamparelli, Teresa, Tedone, Elisabetta, Oneto, Rosi, Frassoni, Francesco, Lint, Maria Teresa, Pogliani, Enrico, Bacigalupo, Andrea, Larocca, A, Piaggio, G, Podestà, M, Pitto, A, Bruno, B, Di Grazia, C, Gualandi, F, Occhini, D, Raiola, A, Dominietto, A, Bregante, S, Lamparelli, T, Tedone, E, Oneto, R, Frassoni, F, Van Lint, M, Pogliani, E, and Bacigalupo, A
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Male ,Adult ,Peripheral Blood Stem Cell Transplantation ,Adolescent ,MED/15 - MALATTIE DEL SANGUE ,Graft Survival ,Graft vs Host Disease ,Humans ,Female ,Antigens, CD34 ,Treatment Failure ,Middle Aged ,Transplantation, Homologou - Abstract
Background and Objectives. A proportion of patients develop poor graft function (PGF) following an allogeneic hemopoietic stem cell transplant (HSCT). It is uncertain whether a boost of donor marrow or blood cells is beneficial in terms of trilineage recovery and nonrelapse-related mortality (NRM). Design and Methods. The aim of this study was to compare outcomes in patients with PGF and full donor chimerism following an allogeneic HSCT who did or did not receive a boost of donor stem cells. The study included patients with primary PGF - i.e. those failing to achieve sustained graft function- and secondary PGF - i.e. those developing PGF after complete hematologic recovery. We studied 54 patients with PGF: 20 patients received no further donor cell infusion (group A), 14 received a boost of unmanipulated marrow or blood cells from the original donor, without further conditioning (group B), and 20 received donor cells after CD34 selection without conditioning (group C). The three groups were comparable for disease phase, patients' age, donor type, primary or secondary PGF, full donor chimerism and duration of PGF. Results. Trilineage recovery was seen in 40%, 36% and 75% of the patients in, respectively, groups A, B and C (p=0.02). In multivariate Cox analysis trilineage recovery was more frequent in patients with secondary PGF (RR of complete recovery 2.82, p=0.01) and in patients receiving CD34(+)-selected cells (RR of complete recovery 3.0; p=0.007). There was no effect of donor type on hematologic recovery. The rate of NRM was 55%, 64%, 20% in groups A, B and C, respectively (p=0.06) and was highly correlated with trilineage recovery (RR 0.36, p < 0.0001). PGF was the primary cause of death in 30%, 21% and 10% of the patients in the three groups, graft-versus-host disease (GVHD) in 5%, 36%, and 10%. Interpretations and Conclusions. In patients with poor graft function (a) a boost of CD34(+)-selected peripheral blood donor cells is associated with a high chance of trilineage recovery and a low risk of acute GVHD; (b) a boost of unmanipulated donor cells does not seem to offer a survival advantage over no infusion of cells; and (c) NRM is lower when using peripheral blood cells for the boost. These data may be useful when discussing second stem cell donations for patients with poor graft function
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