Camilla Di Nunzio

Publications of Camilla Di Nunzio

• Autologous bone marrow stem cell intralesional transplantation repairing bisphosphonate related osteonecrosis of the jaw.

  Authors: Luigi Cella, Aldo Oppici, Mariacristina Arbasi, Mauro Moretto, Massimo Piepoli, Daniele Vallisa, Adriano Zangrandi, Camilla Di Nunzio, Luigi Cavanna

  Head & face medicine. 08/2011; 7:16.

  Bisphosphonate - related osteonecrosis of the JAW (BRONJ) is a well known side effect of bisphosphonate therapies in oncologic and non oncologic patients. Since to date no definitive consensus hasBisphosphonate - related osteonecrosis of the JAW (BRONJ) is a well known side effect of bisphosphonate therapies in oncologic and non oncologic patients. Since to date no definitive consensus has been reached on the treatment of BRONJ, novel strategies for the prevention, risk reduction and treatment need to be developed. We report a 75 year old woman with stage 3 BRONJ secondary to alendronate and pamidronate treatment of osteoporosis. The patient was unresponsive to recommended treatment of the disease, and her BRONJ was worsening. Since bone marrow stem cells are know as being multipotent and exhibit the potential for differentiation into different cells/tissue lineages, including cartilage, bone and other tissue, we performed autologous bone marrow stem cell transplantation into the BRONJ lesion of the patient. Under local anesthesia a volume of 75 ml of bone marrow were harvested from the posterior superior iliac crest by aspiration into heparinized siringes. The cell suspension was concentrated, using Ficoll - Hypaque® centrifugation procedures, in a final volume of 6 ml. Before the injection of stem cells into the osteonecrosis, the patient underwent surgical toilet, local anesthesia was done and spongostan was applied as a carrier of stem cells suspension in the bone cavity, then 4 ml of stem cells suspension and 1 ml of patient's activated platelet-rich plasma were injected in the lesion of BRONJ. A week later the residual spongostan was removed and two weeks later resolution of symptoms was obtained. Then the lesion improved with progressive superficialization of the mucosal layer and CT scan, performed 15 months later, shows improvement also of bone via concentric ossification: so complete healing of BRONJ (stage 0) was obtained in our patient, and 30 months later the patient is well and without signs of BRONJ. To our knowledge this is the first case of BRONJ successfully treated with autologous stem cells transplantation with a complete response.

• Return to work after treatment for breast cancer.

  Authors: Luigi Cavanna, Massimo Ambroggi, Elisa Stroppa, Camilla Di Nunzio, Laura Dallanegra, Michela Monfredo

  Breast cancer research and treatment. 02/2011; 128(1):287-8.

• Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: a prospective observational study of 1,978 consecutive catheterizations.

  Authors: Luigi Cavanna, Giuseppe Civardi, Daniele Vallisa, Camilla Di Nunzio, Lorella Cappucciati, Raffaella Bertè, Maria Rosa Cordani, Antonio Lazzaro, Gabriele Cremona, Claudia Biasini, Monica Muroni, Patrizia Mordenti, Silvia Gorgni, Elena Zaffignani, Massimo Ambroggi, Livia Bidin, Maria Angela Palladino, Carmelina Rodinò, Laura Tibaldi

  World journal of surgical oncology. 10/2010; 8:91.

  A central venous catheter (CVC) currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with hematopoieticA central venous catheter (CVC) currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with hematopoietic stem-cell transplantation and parenteral nutrition. CVC insertion represents a risk for pneumothorax, nerve or arterial punctures. The aim of this prospective observational study was to explore the safety and efficacy of CVC insertion under ultrasound (US) guidance and to confirm its utility in clinical practice in cancer patients. Consecutive adult patients attending the oncology-hematology department were eligible if they had solid or hematologic malignancies and required CVC insertion. Four types of possible complication were defined a priore: mechanical, thrombotic, infection and malfunctioning. The patient was placed in Trendelenburg's position, a 7.5 MHZ puncturing US probe was placed in the supraclavicular site and a 16-gauge needle was advanced under real-time US guidance into the last portion of internal jugular vein. The Seldinger technique was used to place the catheter, which was advanced into the superior vena cava until insertion into right atrium. Within two hours after each procedure, an upright chest X-ray and ultrasound scanning were carried out to confirm the CVC position and to rule out a pneumotorax. CVC-related infections, symptomatic vein thrombosis and malfunctioning were recorded. From December 2000 to January 2009, 1,978 CVC insertional procedures were applied to 1,660 consecutive patients. The procedure was performed 580 times in patients with hematologic malignancies and 1,398 times those with solid tumors. A single-needle puncture of the vein was performed on 1,948 of 1,978 procedures (98.48%); only eighteen attempts among 1,978 failed (0.9%). No pneumotorax, no major bleeding, and no nerve puncture were reported; four cases (0.2%) showed self-limiting hematomas. The mean lifespan of CVC was 189.7 +/- 18.6 days (range 7-701). Symptomatic deep-vein thrombosis of the upper limbs developed in 48 patients (2.42%). Catheter-related infections occurred in 197 (9.96%) of the catheters inserted. They were successfully treated with antibiotics and only in 48 (2.9%) patients definitive CVC removal was required for infection and/or thrombosis or malfunctioning. This study represents the largest published series of consecutive patients with cancer undergoing CVC insertion under US guidance; this procedure allowed the completion of the therapeutic program for 1,930/1,978 (97.6%) of the catheters inserted. The absence of pneumotorax and other major complications indicates that US guidance should be mandatory for CVC insertion in patients with cancer.

• Elderly cancer patients' preferences regarding the disclosure of cancer diagnosis. Experience of a single institution in Italy.

  Authors: Luigi Cavanna, Camilla Di Nunzio, Pietro Seghini, Elisa Anselmi, Claudia Biasini, Fabrizio Artioli, Patrizia Mordenti

  Tumori. 95(1):63-7.

  The disclosure of a diagnosis of cancer is complex, particularly in older patients for reasons related to the wishes of the family, fear of discouraging the patient, or the patient's inability toThe disclosure of a diagnosis of cancer is complex, particularly in older patients for reasons related to the wishes of the family, fear of discouraging the patient, or the patient's inability to understand the information. So our insight into older people's perspectives regarding the disclosure of their cancer diagnosis is fragmentary and inadequate. To examine the views of older adults regarding this issue, we performed a prospective observational study in an inpatient oncology clinic. From January 2006 to June 2006, a sample of 132 consecutive cancer patients aged over 70 years with a variety of solid tumors, recently diagnosed and mainly at an advanced stage, agreed to take part in a survey about the disclosure of the diagnosis of their disease. Of the 132 patients who verbally agreed to participate and were given questionnaires, 106 returned data. The majority of patients (64.1%) in this study wanted to be informed about the diagnosis of their disease also if it was cancer, and 58.5% were in fact informed about the exact nature of their disease. Male patients were more keen to know the diagnosis than female patients (P = 0.002) and they were in fact more informed about their diagnosis than female patients (P = 0.005). Patients with more formal education were more informed than patients with less formal education (P = 0.035). This study demonstrates that the preferences of older patients regarding cancer diagnosis disclosure are highly similar to those of younger people. Male patients and patients with more formal education were more informed than female patients and patients with less formal education.

• Cancer diagnosis disclosure in a northern Italian hospital. Report on 312 consecutive cancer patients.

  Authors: Luigi Cavanna, Elisa Anselmi, Antonio Lazzaro, Pietro Seghini, Camilla Di Nunzio, Laura Dallanegra, Michela Monfredo

  Tumori. 93(3):290-1.

  To evaluate cancer diagnosis disclosure in a cohort of cancer patients attending an outpatient oncology unit, a prospective observational study was performed. Three hundred twelve consecutiveTo evaluate cancer diagnosis disclosure in a cohort of cancer patients attending an outpatient oncology unit, a prospective observational study was performed. Three hundred twelve consecutive patients were accrued between January and June 2005. A questionnaire was given to each patient; the questions were very simple and related to demographics, residence, sex, educational background, employment status, time elapsed after diagnosis, treatment received, existence of relatives, and health insurance. All patients but one entered the study. There were 185 women and 127 men; 120 patients had breast cancer, 84 colorectal cancer, 34 lung cancer, 28 ovarian cancer, 34 gastric cancer, and 12 pancreatic cancer. Of the total 311 evaluable cancer patients, 171 (54.98%) were correctly informed; of the remaining 140 patients, 67 (21.54%) were not sure, and 73 (23.47%) thought their disease was not cancer. These data suggest that the majority of cancer patients attending our outpatient oncology unit are being correctly informed about their diagnosis. In our series the type of tumor had an important impact on diagnosis disclosure, while age and educational status did not.