A survey of the medical consequences of working with video display terminals (VDT).
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Adult↗
Biomedical subjects
A Guglielmi
Publications and source records attributed to A Guglielmi.
[Retroperitoneal Castleman's disease. Presentation of a clinical case].
Castelman disease (CD) is a rare lymphadenopathy that usually presents as a solitary, slow growing mass; its etiology is still unknown. The authors described a case of CD localized in the retro-pancreatic space. A 33-year old patient, female, underwent abdominal ultrasonography because of upper right abdominal pain. The ultrasound showed gallbladder stones and a mass of 4 cm in diameter behind the pancreatic head, modifying the shape of the inferior vena cava. The patient underwent surgical excision and histological examination showed a hyaline type of CD. In the 70% of the cases, the disease is located in the mediastinum, only in 14% of the cases in the retroperitoneal space. The case we report is a hyaline type of CD that is the most frequent histological type, constitutes 90% of the cases, occurs usually in the young population and after surgical excision has a very good prognosis. Different is the clinical behaviour of the plasma cell type of CD that has an aggressive and often fatal clinical outcome. The patient we treated is still free of any symptoms one year after the operation.
Adult↗
[Palliative treatment of pancreatic adenocarcinoma].
Carcinoma of the pancreas is the fourth leading cause of cancer related death in Western Countries. The 5-year survival for resectable tumors is 15-25%, while patients with unresectable neoplasms survive a median of 7 months. Only 30% of carcinomas of the head of pancreas and 10% of the body and tail are resectable for cure. Therefore, palliation of symptoms, namely obstructive jaundice, duodenal obstruction and pain, involve 80-90% of cases. Jaundice is frequent in tumors of the head. Palliative biliary decompression can be achieved by non surgical methods-endoscopically placed endoprostheses or percutaneous biliary drainage- or surgically. The former are indicated in patients with metastatic disease, high operative risk and short life expectancy. Surgical palliation which includes choledocho-duodenostomy, cholecystoduodenostomy, cholecystojejunostomy, hepato or choledocho-jejunostomy offers the advantage of providing a simple procedure that can treat or prevent all of the major symptoms: jaundice, duodenal obstruction and pain. Mechanical obstruction of the duodenum occurs in about 30% of cases in association with jaundice at the time of presentation and in 13-21% of patients previously subjected to biliary bypass after 8 months. Actual obstruction can be relieved by gastro-jejunostomy. Significant controversy remains concerning the role of prophylactic gastro-jejunostomy in patients requiring biliary diversion without signs of duodenal obstruction. Pain, which sooner or later affects the majority of patients, can be relieved by splanchnicectomy, either surgically or percutaneously.
Abdominal Pain↗
[Salmonella C infection of aortic abdominal aneurysm].
The infected aneurysms of the aorta represent the 0.65% of all the aneurysms and they are associated with high morbidity and mortality. The vascular infections from Salmonella are not particularly frequent, even if in the last years their reports are more numerous. The authors report their experience in the surgical treatment of one case of aneurysm of the abdominal aorta infected by group C Salmonella, making a review of the Literature on this matter.
Aged↗
[Immunohistochemical study on the prognostic value of the expression of laminin and Ki-67 receptors in advanced gastric cancer].
The expression of 67-KDa laminin receptor (LR) was investigated in a group of 75 patients who underwent curative gastrectomy for advanced gastric cancer, with special reference to the possible role in the tumor progression and in the overall survival. In 56 out of these 75 patients also the prognostic significance of proliferative activity was investigated using the monoclonal antibody Ki-67. The tumor LR expression and the Ki-67 labeling index (Ki-67 LI) were immunohistochemically determined in paraffin-embedded sections using the avidin-biotin immunoperoxidase method. The cumulative 5-years survival rate was 75.1% for patients without expression of LR, 52.6% for those with positive LR expression. Significant association between LR expression and depth of tumor invasion (p = 0.022) was found. By univariate analysis the presence of laminin receptor seemed to be associated with an higher risk of death (RR1.73-95% C.I. 0.71-4.20), but this effect disappeared after controlling for depth of tumor invasion. There was no significant relationship between the Ki-67 LI and wall invasion (p = 0.80) or nodal status (p = 0.73). The cumulative 5-year survival rates (95% CI) were 61.0% (35.3-79.2) in patients with Ki-67 index < 10%, 52.4% (29.7-70.9) with Ki-67 index = 10%-40%, 52.9% (27.6-73.0) with Ki-67 index > 40% and the differences were not statistically significant (p = 0.93). Also in multivariate analysis the proliferative activity did not independently affect survival (p = 0.98). An interaction between Ki-67 index and age was found and Ki-67 index > 40% was significantly associated with a poor prognosis in patients over 70 years old old (p = 0.002). In conclusion, tumor expression of laminin receptor could be correlated with gastric cancer aggressiveness, however its prognostic significance is already provided by depth of tumor invasion. The proliferative activity, determined with the monoclonal antibody Ki-67, does not seems to influence the survival except in elderly patients (> or = 70 years old).
Aged↗
[Occlusion of the common iliac artery caused by mycotic endocarditis].
Mycotic endocarditis has an incidence of 6.7% of all the forms of endocarditis and in 33-75% of the cases it complicates with peripheral embolization, more frequently to the lower limbs. Although the prognosis of the mycotic endocarditis is improved in the last years, it remains particularly serious especially when it's associated with arterial peripheral embolization. The authors report their experience in the surgical treatment of one case of occlusion of the iliac artery secondary to mycotic endocarditis, making a review of the Literature on this matter.
Adult↗