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Biomedical subjects

A Nunziata

Publications and source records attributed to A Nunziata.

At least 19 recordsLinked to original sources
PubMed2006

Carcinoid of the vermiform appendix. Description of three clinical cases and review of the literature.

Carcinoids of the appendix represent a separate class of tumours with characteristics that vary between benign (adenomas) and malignant (carcinomas) neoplasias. A recent nomenclature identifies them as diffuse neuroendocrine system (DNS) and/or, parallely, as neuroendocrine tumours (NET): the gastroenteric tract is the site of about 64.3% of carcinoids, followed by the respiratory tract with 25.3%. Among the gastrointestinals, tumour of the small intestine is the one with the highest incidence with 28.5%, followed by the appendix with 4.77%, the rectum with 13.6% and the stomach with 4.6%. Carcinoid of the colon has an incidence of 8.62%, with the caecum which alone represents 34.5% of colic localisations. The 3 cases described are an example of the behavioural unpredictability of intestinal carcinoids. The first case is that of a female patient in whom the primary tumour was only discovered after liver metastasis was documented. The second case regards a girl who, at admission, presented a picture of acute abdomen with the symptomatological characteristics of acute appendicitis. She was submitted to an appendicectomy. Subsequent investigations carried out in the postoperative period documented the presence of liver metastasis at the V and VI liver segments. The last case, similar to the second from certain points of view, shows the need to carry out a right hemicolectomy with removal of locoregional lymphnodes in the event of an appendicular carcinoid >2 cm. Both laboratory and instrumental examinations contribute to the diagnosis of intestinal carcinoid. The main laboratory examinations are based on the measurement of serotonin and urinary 5-hydroxy-indolacetic acid. First level instrumental examinations for the diagnosis of intestinal carcinoid are represented by CT with and without contrast medium, diagnostic endoscopy and, to better highlight the presence of locoregional metastases, scintigraphy with octreotide and PET. An alternative treatment of liver metastases other than surgery is most certainly chemoembolisation. This latter treatment has also proved very effective as a neoadjuvant treatment for liver metastases before subjecting the patient to liver resection. Treatment with somatostatin, on the other hand, proved effective in controlling tumour secretion, so attenuating the inconveniences of carcinoid syndrome.

Journal Article↗
PubMed2002

A comparative study of cytotoxic effects of N-ethyl-N-nitrosourea, adriamycin, and mono-(2-ethylhexyl)phthalate on mouse primordial germ cells.

Several strategies for the assessment of reproductive toxicity of chemical compounds has have been proposed. In the present work, we devised experimental in vitro assays to test the effect of potential toxicants on proliferating primordial germ cells (PGCs) in vitro using recently developed methods for isolation and culture of mouse PGCs. Primordial germ cells are the embryonic precursors of gametes of the adult that carry the genome from generation to generation. Any damage or mutations caused to these cells by potential toxicants might impair normal reproduction and be transmitted to next generation. Three representative compounds, N-ethyl-N-nitrosourea (ENU), adriamycin (ADR), and mono-(2-ethylhexyl)phthalate (MEHP), toxic to different targets and known to affect germ cell development and impair fertility, were tested on PGCs in culture using three different experimental protocols. Survival and growth of PGCs and their ability to adhere to cell monolayers, were taken as endpoints for drug effects. For each compound, sublethal and acute toxicity doses were determined. In addition, information about the mechanisms of action of these compounds on PGCs was obtained. Whereas the effects of ENU and ADR on PGCs were attributable to growth inhibition and apoptosis induction, MEHP affected PGC adhesion to somatic cells without significantly altering their growth and survival. The results of our in vitro tests were not always exactly predictive of the effects of the tested compounds on PGCs in vivo, determined in parallel experiments in which pregnant mice were exposed to the same compounds. Nevertheless, they can provide information on the sensitivity of PGCs to the direct action of drugs or the mechanisms of action of such agents.

Animals↗
PubMed2000

[Craniocerebral trauma from bullets: the correlation between computed tomography, the clinical picture, neurosurgical treatment and the long-term sequelae].

PURPOSE: To demonstrate the usefulness of CT findings in the planning of brain neurosurgery in gunshot victims, for prompt and successful treatment. MATERIAL AND METHODS: Thirty patients with brain gunshot wounds were examined with CT over 5 years. The patients were 27 men and 3 women whose mean age was 33 years (range: 17-56). Brain CT was carried out with thin (5-mm) slices and 10-mm gap; dynamic scanning (3-mm interscan time) was used especially in case of posterior fossa involvement and diffuse brain damage. The examination was integrated with cervical scout views to detect bullets in the neck and cervical dislocation. CT follow-up was carried out in 20 patients 24 hours postoperatively and every 6 hours in 9 patients in a severe postoperative coma. RESULTS: Twelve intracranial hematomas and 9 subdural hematomas, 3 of them bilateral, were treated and hemorrhage was resolved in 8 lacerocontusive foci. Skull plastic surgery was carried out in 5 cases. Surgical maneuvers were most difficult in the 5 crash bone injuries with wedged splinters; postoperative subarachnoid hemorrhage followed in 3 cases. Blood effusion in ventricles was drained in 6 cases; in 2 of them with permanent catheters. Eleven patients died: 4 right after surgery and 7 an average 15 days postoperatively. DISCUSSION AND CONCLUSIONS: In our series the mortality rate of firearm wounds of the skull base was 34% higher than that of the hemisphere; this is due to carotid hemorrhage and midbrain damage. Such traumas require emergency radiological diagnosis and neurosurgical treatment because of their severity and early irreversible complications. Complex operations and skilled surgeons may prevent disabling postoperative sequels. CT findings are indispensable and must be correctly interpreted. The radiologist and the neurosurgeon must collaborate closely and both must consider several diagnostic and prognostic factors affecting surgical planning.

Adolescent↗
PubMed2000

[Suburban amebiasis: the diagnostic aspects via computed tomography and echography and the percutaneous treatment of amebic liver abscesses].

INTRODUCTION: Liver is the most common site of extraintestinal amebiasis and hepatic abscesses are the most frequent symptom, occurring in 3-9% of patients with amebic infection. Several studies have shown that drug treatment is more efficacious when combined with percutaneous drainage of the abscess, yielding quicker recovery and a positive body response. We report our US and CT findings in 16 patients with amebic abscesses, 12 of whom lived in a temperate peripheral area north-east of Naples. All patients had a clinical-diagnostic condition that we called "suburban amebiasis". Finally we report our personal experience with the US-guided therapeutic drainage of amebic abscesses with repeated cavity washings, which is important for positive parasitology. MATERIAL AND METHODS: We retrospectively reviewed the findings of 16 patients (11 men and 5 women; age range 36-78 years; mean 52) with amebic abscesses of liver examined with US and CT. US with a 3.5 MHz transducer was the technique of choice in all patients. 94% of liver abscesses and some extraintestinal complications were easily shown with this technique. CT angiography was then performed to detail and clarify US findings. Abscesses over 4 cm in diameter were submitted to US-guided percutaneous treatment which permitted abscess drainage, the collection of material for parasitology and repeated cavity washings. RESULTS: US showed multiple liver abscesses in 12 patients, which were multiseptate and formed by multiple hypo-/hyperechoic microabscesses in 4 of them. Four non-European patients had a single abscess, which is typical of tropical endemic forms. CT showed the amebic abscesses as hypodense roundish masses with clear-cut outline most often localized in the right lobe in the 12 multiple cases. After percutaneous drainage 13/16 patients (81%) reported less pain in the right hypochondrium and had a lower temperature; their hospitalization was also shorter. DISCUSSION AND CONCLUSIONS: Combined US and CT assessment facilitated the diagnosis of amebiasis and its differentiation from pyogenic abscess and hepatoma. The combination of US-guided drainage and drug treatment provides better results than either treatment alone and quicker improvement of patient conditions, with fewer extraintestinal complications. Percutaneous drainage should be used in abscesses bigger than 4-5 cm, those with questionable clinical-laboratory findings and finally those failing to respond to drug treatment alone. Positive parasitology of abscess content is related to repeated cavity washings after percutaneous drainage, likely because peripheral layers are much richer in amebae.

Adult↗
PubMed2000

[Multiphasic helical computerized tomography of hepatocarcinoma. Assessment after chemoembolization].

PURPOSE: To report our personal experience with the addition of contrast-enhanced multiphase helical CT to unenhanced CT (Lipiodol CT) in the evaluation of patients with hepatocellular carcinoma treated with chemoembolization and to analyze the present role of oily agent CT. MATERIAL AND METHODS: We retrospectively reviewed the examinations of 42 consecutive patients submitted to global chemoembolization over a 2-year period. CT was performed 18-30 days after the treatment. The Lipiodol CT study was carried out with volume acquisitions. We considered as nodules all well-defined areas with dense oily agent uptake; uptake itself was classified as: 0 = absent, I = lower than 10% of the tumor volume, II = lower than 50%, III = higher than 50%, IV = homogeneous. Contrast-enhanced helical CT was performed with the 2-phase technique in 28 patients and with the 3-phase technique in 14; we considered as nodules all well-defined and relatively homogeneous areas with hyperattenuation in the arterial phase and hypo-isoattenuation in the portal and/or delayed phase, or with hypo-isoattenuation in the arterial phase and in the portal and/or delayed phase. RESULTS: Lipiodol CT permitted to recognize 65 nodules (1-5/patient, mean 1.5), namely 15 grade I, 21 grade II, 20 grade III and 9 grade IV. Multiphase CT identified 6 additional nodules in 5 patients, 5 hypervascular and 1 hypovascular, and better assessed the correct morphology and volume of grade I nodules. Only 4 of 6 nodules missed on Lipiodol CT showed oily agent uptake after a new chemoembolization session. Moreover after retreatment, carried out in 6 of 9 patients with grade I uptake (11 nodules in all), we found persistence of the grade I pattern in 5 nodules, grade II in 5, and grade III in 1. CONCLUSION: Lipiodol CT may miss liver nodules and underestimate the volume of nodules with poor uptake. Though Lipiodol CT should still be considered slightly more sensitive than multiphase CT, in our opinion this technique has several limitations, as also shown in recent literature papers, and its clinical applications should be reduced. Multiphase helical studies may provide useful information and should be performed routinely in patients treated with chemoembolization. The present availability of alternative tools such as contrast-enhanced Doppler US and MRI should also be stressed and their potential role investigated.

Adult↗
PubMed1999

[Diagnostic imaging and interventional radiology of amebic liver abscesses. Personal experience].

PURPOSE: The diagnostic imaging findings in hepatic amebiasis and the capabilities of percutaneous drainage have already been described but some debate is open on both diagnosis and treatment. We report our experience with ultrasound (US) and Computed Tomography (CT) studies of the hepatic amebic abscess and its management. MATERIAL AND METHODS: During the last 4 years we examined 14 patients with liver abscess: 11 men and 2 women; 13 were Italian and 1 African (25-61 years old, mean 36). All subjects underwent US and contrast-enhanced CT (with a conventional scanner in 12 and a helical unit in 2). The first 4 cases were also submitted to US-guided diagnostic aspiration. Six patients were treated with percutaneous drainage under US guidance using an 8-10 F pig-tail catheter which was removed 4-18 days later (mean 6). RESULTS: The abscesses were always single and uniloculated, in most cases located peripherally in the right lobe. They were large (2-11 cm, mean 7) and had round, oval, or irregular shape in 9, 3, and 2 cases respectively. US generally showed the abscess as an inhomogeneously hypoechoic mass with ill-defined walls. CT demonstrated a homogeneously hypodense collection with a thick peripheral hypodense halo; after contrast agent administration wall attenuation was increased between the edematous halo and the cavity, and an incomplete idosense ring appeared. Biphasic helical acquisitions allowed demonstration of some difference between the two vascular phases and yielded other interesting findings. Drug treatment provided complete abscess resolution in 8 patients, though in 2 it was badly tolerated. In one case no improvement was found and the patient was submitted to percutaneous drainage, which was the treatment of choice in the remaining 5 patients. The treatment was successful in all cases, but 1 patient who discontinued the combined medical therapy developed a heterotopic lesion. CONCLUSION: US and CT findings, though variable and partially different from those previously reported, may be considered sufficient for diagnostic assessment, especially if in the proper clinical and biohumoral setting. Both drug treatment and percutaneous drainage (to be considered for selected cases) are effective in the treatment of this type of abscess.

Adult↗
PubMed1999

[The role of computed tomography in gunshot lesions of the chest. The authors' personal experience].

PURPOSE: CT is a valuable tool in assessing thoracic gunshot wounds. CT is also the method of choice in emergency, because it permits rapid depiction of bullet damage to the chest and to other body districts. This in turn permits correct assessment of the main thoracic injuries, plus adequate and prompt planning of surgical treatment or support intensive care. We report on the role of CT in diagnosing the complex pleuropulmonary, cardiovascular and thoracic wall injuries caused by gunshot wounds, with their specific and acute signs which differ greatly from those of other types of chest trauma. MATERIAL AND METHODS: In the last 4 years, we observed 76 cases of gunshot injury, twenty-six of them involved the chest. The patients, 25 men and 1 woman (mean age: 32 years, range: 17-48), were all submitted to emergency CT with i.v. contrast agent injection and the CT-angiography technique. The reanimator was always present to monitor the patients' vital functions and shock state. CT of the chest was integrated with CT of the abdomen and pelvis in 4 cases and with CT of the skull in 3 cases, to detect associated bullet wounds if any. RESULTS: The most frequent CT finding was lung parenchyma tear and bruise (25 cases), followed by hemothorax (18 cases) and subcutaneous chest wall emphysema (9 cases). Pneumothorax was seen in 5 cases, associated with hemothorax in 6; rib injuries were found in 7 cases; pneumomediastinum was found in 4 cases and areas of pulmonary atelectasis in 3; the diaphragm was ruptured in 4 cases. CT showed spinal involvement in 11 patients, with injury of D3 and D5 in 4 and 3 cases, respectively; signs of interrupted spinal marrow were found in 7 cases. Damage from gunshot wounds was detected in the liver, spleen, skull and limbs in 3, 2, 3 and 10 cases, respectively. DISCUSSION AND CONCLUSIONS: Chest radiography shows major gunshot wound damage to the chest and lungs, except for heart injuries and minimal pneumothorax. When abdominal and skull injuries are associated, CT should be the method of choice because it permits prompt and panoramic assessment of the severity of pulmonary and extrathoracic damage. This results in prompt and targeted treatment, avoiding unnecessary delays which may damage the patient further.

Adolescent↗
PubMed1998

[Radiologic assessment of transpyloric spread of gastric carcinoma].

PURPOSE: We report on our personal experience with the radiologic and CT demonstration of the traspyloric duodenal spread of gastric carcinoma, whose relative frequency and prognostic value are recent literature data. MATERIAL AND METHODS: In the last 4 years we submitted to double contrast studies of the upper gastrointestinal (GI) tract 49 gastric carcinoma patients with antrum involvement. Twenty-one cases were staged with CT performed with gastric water distension, pharmacological hypotonia and dynamic contrast agent perfusion. Finally, 41 patients underwent surgical treatment. RESULTS: Radiologic evidence of transpyloric gastric carcinoma spread was found in 6 cases; CT, performed in 5 of them, was always in agreement. Five of 6 positive cases had surgical confirmation while one lesion was unresectable. No radiologic or CT false negatives were found among the remaining 36 surgical patients. Barium studies showed irregular antral lumen narrowing, rigid, open and eccentric pyloric channel, duodenal bulb deformity and irregular thickening. CT demonstrated antrum infiltration along the two gastric curvatures and the tumor spread to the duodenal cap. CONCLUSION: Antral cancer transpyloric spread is more frequent than previously reported and its presence should not exclude a carcinomatous process. Double contrast barium studies are a valuable tool in the demonstration of this spread, showing good correlation with CT staging findings.

Adult↗
PubMed1998

[The color Doppler US evaluation of the ureteral jet in patients with urinary colic].

PURPOSE: To report our personal experience with color Doppler ultrasound (US) in the study of the ureterovesical jet in patients with recent renal colic. MATERIAL AND METHODS: First, the jet was studied in 10 healthy subjects and then 42 consecutive patients with urinary colic were submitted to plain radiography, which was sometimes integrated with conventional renal tomography, and real time US to detect the stone and to study the urinary tract above. Then, color Doppler function studies were carried out with transverse scans at the trigone and with the scan plane rotated on the ureterovesical junction. Retrospectively, the jet frequency, velocity, duration, volume, direction and interval were analyzed. Finally, all patients were examined with excretory urography. RESULTS: The jet had an anteromedial direction and exceeded the midline in the controls, with a peak velocity of 20-30 cm/s, mean duration of 15 s, mean frequency of 4-5 min and interjet interval 2-150 s. The jet was abnormal in the obstruction side in all renal colic patients; it was slow, continuous, decreased in volume and intensity, and prolonged in 26 patients--20 of them had incomplete lumbo-iliac ureteral obstruction and 6 pyeloureteral junction stones. The jet was diverted from its orientation in 7 subjects with intramural stones. There was no jet in 9 patients and urography demonstrated complete urinary obstruction--4 at the pyeloureteral junction and 5 at the lumbo-iliac ureter. CONCLUSIONS: Color Doppler US of the ureteral jet is a valuable tool in urinary colics because it yields in real time more pieces of functional information than radiography and B-mode US and also demonstrates the grade of urinary obstruction.

Adolescent↗