Paolo Zampieri

Phase II trial with BCNU plus α-interferon in patients with recurrent high-grade gliomas

Malignant gliomas are primary CNS tumors with a poor prognosis which has not improved recently.

Early chemotherapy and concurrent radio-chemotherapy in high grade glioma.

SummaryPurpose: The poor results from treatment of high grade glioma prompted us to explore new protocols involving concurrent radio-chemotherapy. Our primary objective was to evaluate the feasibility of very early postoperative chemotherapy with BCNU, concurrent radio-chemotherapy with carboplatin and teniposide, and post-radiotherapy BCNU. Our secondary objectives were to evaluate time to progression, and overall survival. Patients and methods: We treated 24 newly diagnosed patients (pts) with BCNU 150 mg/m2 seven days after surgery. Thirty days later, we started radiotherapy, 1.8 to 2 Gy/day for 5 days a week on limited fields up to 60 Gy, and concurrent chemotherapy with carboplatin 250 mg/m2 on days 1, 22, and 43, and teniposide 50 mg/m2 on days 1, 2, 3, 22, 23, 24, 43, 44 and 45. Two cycles of 150 mg/m2 BCNU were then given at 30 and 70 days, respectively, after the end of the radio-chemotherapy course. Therapy was then suspended, but if disease progression was evident, treatment was resumed with drugs that had not been previously employed. Surgical reintervention was not routinely considered. Results: Following radio-chemotherapy treatment in the 24 pts evauble for response, we observed partial remissions in 8 cases (33%) and stable disease in 12 (50%). Actuarial estimates of progression free survival (PFS) were 33 weeks, with 56 wks for anaplastic astrocytoma and 31 weeks for glioblastoma. Median survival time (MST) of all pts was 58 weeks; 51 weeks for glioblastoma and was not reached for anaplastic astrocytoma. This regimen was feasible. Of 144 planned cycles, 139 were delivered, and among these only in 13 and 9 cycles the doses were reduced by 75 and 50%, respectively. We did not observe any gastrointestinal toxicity. Grade 2 hematological toxicity occurred in 25% of pts, grade 3 in 4% and neurological toxicity in 3% of the pts during BCNU delivery, probably due to a sharp increase in intracranial pressure. Conclusion: Early chemotherapy, concurrent chemo-radiotherapy and brief post-radio-therapy chemotherapy are feasible and well tolerated. The objective response and disease stabilization rates appear similar to previous experiences.

Risk factors for cerebral glioma in adults: a case-control study in an Italian population

SummaryA case-control study on risk factors for cerebral tumors was conducted on an adult Italian population by the four Neurosurgical Departments of the Veneto Region, i.e. Padua, Treviso, Verona and Vicenza. The study recruited 195 cases of histologically-confirmed cerebral glioma. One hospital control was selected for each case. Cases and controls were matched for age, sex, date of hospitalization and residence. Information on both cases and controls was obtained from a relative. Uninvolved interviewers administered a structured questionnaire including items on the subjects education, occupation, lifestyle, medical history, exposure to radiation for diagnosis or therapy, head trauma and blood group and the medical history of family members.The series of cerebral tumors was first considered as an indistinct set: none of the risk factors examined showed a statistically significant association. A positive association was found with blood group A (OR = 6) when low-grade astrocytomas (n = 41) were considered separately. As for the malignant astrocytomas (n = 132), there was a suggestive but not statistically significant association with the presence of CNS tumors among first-and second-degree relatives (OR = 7.0).On the whole, this study yielded no clear and meaningful association for the various risk factors analyzed.

Simplified seismic assessment of railway masonry arch bridges by limit analysis

In this work, the seismic capacity of single and multi-span masonry arch bridges was assessed by limit analysis. A preliminary statistical survey was carried out on a stock of about 750 railway bridges in Italy, classified according to characteristics and expected collapse mechanisms under seismic excitation. A comprehensive parametric study was carried out on identified homogeneous classes, to calculate limit horizontal accelerations triggering the collapse mechanism in longitudinal and transverse directions. Iso-acceleration envelope curves, representing limit horizontal acceleration of the bridge as a function of geometric parameters, were then derived. These graphs can be used for preliminary seismic safety checking of existing masonry bridges, once the main geometric parameters are available by simple visual inspections and geometric surveys, and can easily be implemented in a Bridge Management System to prioritise seismic retrofitting interventions.

Reinforced concrete and masonry arch bridges in seismic areas: typical deficiencies and retrofitting strategies

In recent years, appraisal of the condition and rehabilitation of existing bridges has become an ongoing problem for bridge owners and administrators in all developed countries. Reliable methodologies are therefore needed in the assessment and retrofit design phases, to identify the vulnerability of each bridge class. The specific problems of common arch bridge types are discussed herein, for both reinforced concrete and masonry structures, proper interventions for their static and seismic retrofitting are illustrated and several examples of applications are provided. Retrofitting is usually coupled with functional refurbishment, according to a methodological approach that takes into account bridge characteristics, state of maintenance and functional requirements, and environmental aspects connected with repair and strengthening systems.

Limit analysis of transverse seismic capacity of multi-span masonry arch bridges

Thousands of road and railway masonry arch bridges are still in service in the Italian and European transportation network, and many of them are located in highly seismic areas. In this work, a kinematic analysis procedure is developed to assess the transverse seismic capacity of multi-span masonry bridges with slender piers, as they may be vulnerable to transverse seismic action. The procedure can calculate the limit horizontal load multiplier of overall collapse mechanisms involving transverse deformation of deck and piers. The procedure is then adopted in a parametric study describing the typical ranges of the main parameters influencing bridge transverse capacity. Parametric analysis yielded a set of iso-acceleration envelope curves which supply the resistant seismic acceleration of a bridge as a function of simple geometric parameters. The resulting graphs can thus be used for preliminary seismic assessments.

The Acromegaly-Gigantism Syndrome Report of Four Cases Treated Surgically

Four cases of growth-hormone-secreting pituitary adenoma, with associated aspects of acromegaly and gigantism, are reported in patients aged 12-26. All of the patients had macroadenomas and were treated surgically, three by the transsphenoidal approach and one with a transfrontal craniotomy. Histologic examination revealed eosinophilic adenomas in three of the cases and a mixed eosinophilic--chromophobe adenoma in one, all with cellular irregularities (mitosis and cellular and nuclear polymorphism), local invasivity, or both. Because surgical treatment did not produce complete normalization of growth hormone levels, radiotherapy followed the operations in all four cases. In our opinion, the treatment of acromegalic gigantism poses more therapeutic problems than that of simple acromegaly, with combined treatment (surgical, radiation, and medical) often being necessary.

Contribution of in situ and laboratory investigations for assessing seismic vulnerability of existing bridges

This work describes the main results of an in situ experimental campaign carried out in the context of the seismic assessment of 71 existing road bridges as representative of the main structural typologies located in the Veneto region and pertaining to the regional roadway managing authority Veneto Strade SpA. An initial in situ and laboratory experimental campaign on basic materials and an overall geometrical survey were carried out for each bridge, using different tests according to the construction typologies, with the aim of characterising the main mechanical parameters of the significant structural elements. Structural assessment has been subsequently carried out according to the parameters derived from the above campaign and the design ground motion action. The results have been compared with those deriving from a preliminary analysis conducted on the basis of some assumptions on materials’ mechanical characteristics related to the original design documents and the construction practice at the time of the structures’ edification. This comparative analysis could give some insights on appropriate and rational planning of inspections on existing bridges and reliability of basic assumptions for their seismic assessment.

Simplified seismic assessment of multi-span masonry arch bridges

The paper describes a simplified methodology for the evaluation of the seismic retrofit intervention types to be performed on clusters of multi-span masonry arch bridges, on the basis of the main bridges geometrical characteristics. The structural behaviour of the analysed sample bridges has been evaluated in their principal directions highlighting the potential local and global vulnerabilities and the related retrofit intervention typologies that need to be selected. The main aim of this study is to take the form of an useful tool for identify the best retrofit strategies for each masonry bridge structure in function of its geometrical characteristics and thus planning rationally the management of bridges belonging to rail and road networks.

Post-quake urban road network functionality assessment for seismic emergency management in historical centres

Abstract In this paper, a procedure for the evaluation of the interaction between existing buildings and urban roadway networks after a seismic event is proposed. This question is relevant in historical urban centres, where urbanisation typology has evidenced, in the past, lack of road networks’ residual connectivity in post-earthquake conditions. The present study proposes a method for the evaluation of the residual functionality in urban context, moving from the execution of building surveys, the application of probabilistic concepts and fuzzy logic with the aim to define probable urban road network damage scenarios. The methodology is applied to the Municipality of Conegliano (northeastern Italy) evaluating the potential seismic damage scenario to the historical urban centre and highlighting criticisms in the post-earthquake rescue operations.