[Enzyme markers in the calculation of the extent of infarction. Criteria of prognostic evaluation].
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Biomedical subjects
Publications and source records attributed to A Costa.
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Prolactin and TSH were determined in serum samples obtained at 4-hourly intervals throughout a 24-hour span from healthy women and from women with fibrocystic mastopathy, fibroadenoma or carcinoma of the breast. Data were subjected to analysis by the population mean-cosinor method. Differences in circadian mesor of prolactin among the 4 groups were statistically significant (P < .01), with healthy women having the lowest value. Prolactin amplitude differences among the groups were of borderline statistical significance (P = .05), while no differences in circadian acrophase were apparent. No statistically significance differences in TSH circadian mesor, amplitude or acrophase could be demonstrated. Individual values from subjects with breast disease were compared with time-qualified tolerance intervals based on data from healthy subjects. If these results can be corroborated on larger populations, sampling about 3 hours after arising may best detect an abnormal serum prolactin elevation. Results from this and other studies indicate the need for multi-variable and multifrequency investigations of breast disease.
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Local factors with a possible influence on the frequency and histological type of thyroid cancer are examined in the light of cases observed at the Mauriziano Hospital in the last 10 years. The overall number of cases has been increasing and papilliferous forms have been more common than follicular forms. Iodine deficiency and thyrotropin hyper-stimulation encourage onset and account for the higher frequency of thyroid cancer in endemic areas, where, however, follicular forms are more common. Ironising radiation is a direct cause, particularly of papilliferous forms arising after exposure during youth.
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A case history of a patient who developed mammary cancer (T1N1bMo) after 5 1/2 years of continuous treatment with Levodopa for Parkinson's disease is presented. The prolactin inhibition by the Levodopa was verified, and the clinical and mammographic growth, the doubling time, and the labeling index of the tumor were determined. The results were not significantly different than those obtained from patients with breast cancer not under treatment with Levodopa. The rapid growth and evolution of this tumor suggests that prolactin does not have an inducer or promoter effect in mammary cancer.
A study of endemic goitre was carried out in the western part of the province of Foggia (Daunia's pre-Appennines). About 50% of a total of 2719 children aged 6-15 years examined in the agricultural and hill towns of Accadia, Bovino, Candela, Deliceto and Sant'Agata di Puglia (500 to 800 m above sea level), presented a thyroid enlargement (usually of Grade 1). Urinary creatinine values were normal, while urinary iodine was low: 37.7 +/- 28.39 mug/g creatinine (mean +/- SD for 319 subjects). Serum levels of thyroid hormones were normal: T4 = 7.89 +/- 2.61 mug/dl; T3 = 114.72 +/- 40 ng/dl; T3 (T4 X 100) = 0.166 +/- 0.09. Subjects with Grade 2 thyroid enlargement had significant lower urinary iodine and serum T4, and higher T3 and T3/T4 ratio than children without goitre (Grade 0). Serum thyrotropin was rather high (3.79 +/- 4.17 muU/ml), but bore no straight relation to the thyroid size; in subjects with Grade 2 thyroids there was an inverse relationship between plasma T4 and TSH levels. Drinking water iodine was generally low (2-3 mug/l), though some richer sources (18, 38, 66 mug/l) were noted. Iodine contents of locally produced foodstuffs were below those found in food on Turin markets.
Total iodine contents were determined in 209 bioptic or autoptic specimens of various extrathyroidal tissues. Fifty-two of the 80 subjects examined had no previous exposure to excessive iodine, 24 were tested after administration of x-ray contrast media and 4 after treatment with various iodine containing drugs. Unexposed subjects had tissue iodine contents (mean +/- SD) ranging from 0.85 +/- 0.17 microgram/100 g in the brain and 9.78 +/- 2.75 microgram/100 g in the liver of adults. A significantly lower iodine concentration was found in the liver of newborns (2.79 +/- 1.00 microgram, p less than 0.001). Most of the other tissues had iodine concentrations of 2-4 microgram/100 g. Subjects with previous exposure to iodine containing drugs or x-ray contrast media showed increased iodine contents of various degree in all examined tissues, including adipose tissue, bone, brain, kidney, liver, lung, skeletal muscle, skin and spleen. Accumulation of iodine in adipose tissue was still demonstrable more than two years after cholecystography.
The labeling index has been determined in 34 non-Hodgkin malignant lymphomas. The kinetic parameter has been analyzed in relation to the different histologic types, according to the Kiel calssification, and a kinetic classification with three main groups at low, intermediate, and high proliferative activity has been proposed. The analysis of the survival of the patients in relation to the labeling index of the malignant lymphoma cell population has shown that the potential proliferative activity has an important prognostic significance.
Radical mastectomy should be replaced by a number of different types of operation which are either more conservative or more extended according to the spread of the disease. For T1N0 cases a new procedure consisting of removal of a quadrant of the breast, with axillary dissection plus radiotherapy on the residual breast tissue, is under evaluation. In T2N0 cases modified radical mastectomy is suggested as a procedure of choice, whilst T3 cases and all N1 cases should still undergo radical mastectomy. Cases with tumor of inner quadrants with positive axillary nodes with benefit from removal of internal mammary nodes. Superradical mastectomy is limited to selected special cases with extensive lymphnode invasion. All N+ cases receive adjuvant chemotherapy (CMF). In locally advanced cases "reductive" surgery may form part of an aggressive chemotherapy programme.
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