Biomedical subjects

A Pera

Publications and source records attributed to A Pera.

At least 73 records · Page 4Linked to original sources

PubMed1993

Better quality of therapy with 5-ASA colonic foam in active ulcerative colitis. A multicenter comparative trial with 5-ASA enema.

We evaluated the efficacy, tolerance, and acceptance of a new 5-ASA colonic foam versus 5-ASA liquid enema in the short-term treatment of active ulcerative colitis in a three-week prospective, randomized, investigator-blind study, enrolling 233 patients from 12 outpatient clinics in Italy. In arm 1 of the study, 117 patients with mild attacks received 2 g of 5-ASA as foam or enema at bedtime. In arm 2, 116 patients with moderate attacks were given 4 g of 5-ASA as foam or enema at bedtime. End points were defined as complete relief of symptoms, and endoscopic and histological evidence of remission or improvement. In patients with mild relapse, 34 of 63 (54%) treated with foam were in clinical remission after only 10 days compared with 17 of 51 (31%) treated with enemas (P < 0.05). However, there was no statistically significant difference between foam (83%) and enema (74%) after three weeks. In patients with moderate relapse, a higher proportion of patients achieved complete clinical remission in the foam group (63%) compared with enema group (52%) after three weeks (difference 11%, 95% CI -7 to 29). No significant differences were observed in endoscopic and histological evaluation of colonic mucosa between treatment groups in either arm. 5-ASA foam was well tolerated. No unexpected adverse events were reported. Patient evaluation of therapy showed that foam was much better accepted than enema because foam was more comfortable, more practical, easier to retain, and interfered less with daily living.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Rectal↗

PubMed1993

Continuously infused cyclosporine at low dose is sufficient to avoid emergency colectomy in acute attacks of ulcerative colitis without the need for high-dose steroids.

A dosage of 4 mg/kg/day intravenous cyclosporine as an adjunct to high-dosage hydrocortisone has been recommended to avoid colectomy in acute steroid-resistant ulcerative colitis. In treating eight such patients, four of whom presented with toxic megacolon, we immediately tapered the steroid dosage and infused a lower dosage of only 2 mg/kg cyclosporine for 15 days to fit a therapeutic range of 60-240 ng/ml, as previously designed for a kidney transplant program. Seven of the eight (87.5%), including three with megacolon, went into remission and started the chronic phase of treatment; the eighth patient underwent colectomy. Of the seven, one died on day 3 of the chronic phase because of pulmonary embolism while in clinical remission, and another discontinued treatment. The other five (62.5%) remain in remission on 6 mg/kg oral cyclosporine, or have already switched from cyclosporine to azathioprine. Two episodes of reversible nephrotoxicity appeared in the chronic phase only. These results emphasize the efficacy and safety of cyclosporine in acute ulcerative colitis, but there is still a need for further dose-response and drug association relationship studies.

Acute Disease↗

PubMed1993

[Combined treatment of colorectal polyps with diathermy and the Nd-YAG laser. Our experience].

Among colorectal polyps, those of the sessile and villous type are said to bear a high frequency cancer degeneration. While surgery is considered the cure, alternative choices are to be offered in the presence of contraindications or lack of an informed consent. We analyzed the results of the "combined therapy" that requires the use of the ND-YAG laser following the ablation of the lesion with diathermic snare. We used an EV laser 132 with double wavelength to allow the ablation of flat lesions and minimize the risk of perforation. We included 12 patients with sessile colorectal polyps. In 9/12 complete eradication was obtained over a follow-up 11 months; of the remaining 3, 2 dropped out, 1 did not respond. Owing to the small series, the relationship between the successful eradication and the size of the polyp cannot be evaluated. We conclude that the treatment of sessile colorectal polyps with this combined approach may be a promising one.

Aged↗

PubMed1993

[A new catheter for enteroclysis: Torino 1. Results in 398 cases].

The authors report on the use a new barium enema catheter employed in 398 patients from January, 1990 through June, 1991. Its innovative characteristics and several possible uses are compared with those of conventional equipment. Particularly, the advantages offered by the various possible placement sites of the catheter--i.e., the II duodenal portion and beyond the ligament of Treitx--are discussed, together with its different uses according to clinical symptoms: its best location is beyond the ligament of Treitz in subocclusions, versus in the II duodenal portion if tumors or other duodenal conditions are suspected. The new catheter exhibited 100% accuracy; the average exposure time for radioscopy during its positioning was 3 minutes. A selected group of 149 patients was examined for complications, which were few (8%), of poor importance, short and completely curable.

Adolescent↗

PubMed1992

Familial aggregation of inflammatory bowel disease in northern Italy: a multicenter study. The Gruppo di Studio per le Malattie Infiammatorie Intestinali (IBD Study Group).

To assess the familial aggregation of inflammatory bowel disease (IBD) in Italy, the family pedigrees of 411 patients with ulcerative colitis (UC) and 241 patients with Crohn's disease (CD) seen at 14 participating hospitals were studied. Sufficient information was obtained on 97% of 3752 first-degree relatives, 80% of 8869 second-degree relatives, and 74% of 5791 cousins. Thirty-six propositi (5.52%) had a total of 44 affected relatives (16 CD, 28 UC). The prevalence of IBD was higher in first- than in second-degree relatives and cousins (791, 112, and 163 in 100,000, respectively). A strong intrafamilial disease concordance was observed, with 26 cases of UC and 6 of CD among relatives of UC patients and 10 cases of CD and 2 of UC among relatives of CD patients. The prevalence of UC among first-degree relatives of UC patients and that of CD among first-degree relatives of CD patients was 680 and 531 in 100,000, respectively. In conclusion, there is a high degree of familial aggregation for IBD in Italy, with a strong intrafamilial disease concordance.

Adolescent↗

PubMed1991

Antibodies to Mycobacterium paratuberculosis in patients with Crohn's disease.

IgG antibodies against Mycobacterium paratuberculosis protoplasmic antigen were looked for by an enzyme immunosorbent assay in patients with Crohn's disease, Ulcerative colitis, active pulmonary tuberculosis, past pulmonary tuberculosis, and in healthy controls. Serum reactivity for these antibodies was not correlated to PPD skin test positivity without history of mycobacterial disease. A cutoff based on the mean absorbance value of a pool of healthy blood donors was chosen. Positive values were found in 12/24 (50%) patients with active pulmonary tuberculosis and 2/10 (20%) skin-test-positive subjects with past pulmonary tuberculosis as expected, because antigenic sharing is common among different mycobacteria. The control group of blood donors showed borderline positivities in 3/149 cases (2.01%). Positive values were found in 4/108 (3.70%) patients with Crohn's disease and 2/40 (5%) with ulcerative colitis. We conclude that our data do not support a causal relationship between the M. paratuberculosis and Crohn's disease, but occasional patients with inflammatory bowel diseases show unexpected positivities for these mycobacterial antibodies.

Adolescent↗

PubMed1990

[Mesenteric fibromatosis in Gardner's syndrome].

The paper reports a case of mesenteric fibromatosis with familial polyposis, an association which was diagnosed as Gardner's syndrome, and highlights the complications connected to mesenterial desmoid tumours. In addition, the importance of radical surgical therapy of these neoplasias is underlined. Lastly, it is hypothesised that full screening of patients affected by familial polyposis might show a greater incidence of association between widespread polyposis and pathological changes attributable to Gardner's syndrome.

Adult↗

PubMed1990

Magnetic resonance imaging and neurobehavioral correlates in schizencephaly.

We studied three patients with schizencephaly and related the results of comprehensive neuropsychologic and speech/language assessments to the severity and location of the brain malformations as appreciated by magnetic resonance imaging. Level of general intellectual functioning related to the amount of brain tissue involved, and variations in specific neurobehavioral abilities reflected the location of the brain malformation and the prenatal onset of the disorder. The overall findings emphasize the importance of comprehensive neuropsychologic and speech/language studies for appreciating the impact of prenatal neural insult on the functional reorganization of the brain and subsequent neurobehavioral functioning.

Adolescent↗

PubMed1990

Three-dimensional phase-contrast MR angiography in the head and neck: preliminary report.

Morbidity and possible mortality associated with contrast angiography lead to its cautious use. A noninvasive method for screening and further delineating known abnormalities would be welcomed. This article reviews the initial results and application of MR imaging to vascular imaging in the head and neck. By using the three-dimensional phase-sensitive method of Dumoulin, Souza, and collaborators, we acquired MR angiograms in 37 min and portrayed blood flow in all the major arteries and veins. Feeding arteries and draining veins of arteriovenous malformations were well delineated; aneurysms as small as 3-4 mm were shown, and obstructed cerebral vessels and the patency of a highly stenotic internal carotid artery were demonstrated. MR angiography of the head or neck offers great promise as a noninvasive means of studying vascular abnormalities.

Adolescent↗

PubMed1990

Three-dimensional phase-contrast MR angiography in the head and neck: preliminary report.

Adolescent↗

PubMed1990

Endoscopic ultrasonography in eosinophilic infiltration of gastric wall.

The case of a young man with eosinophilic gastroenteritis with primary muscularis propria involvement in the antrum and distal ileum is presented. Initial diagnosis was based uniquely on indirect clinical and radiological findings since endoscopic and histologic data had been misled by the depth of eosinophilic infiltration. In order to directly prove the diagnosis, full-thickness operative biopsy would have been necessary but was avoided on ethical grounds. Valuable information was gained through Endoscopic Ultrasonographic (EUS) study of the antrum which showed an asymmetrical thickening of the outer hypoechoic layer of the wall corresponding to the muscularis propria. The overall thickness of the antrum amounted to 0.6 cm, clearly distinct from the 0.2 cm value in uninvolved areas. Subserosal involvement was also appreciated in spite of the absence of ascites; superficial layers, mucosa and submucosa, appeared uninvolved. The patient was restudied 6 months later when symptom-free: at this time, blood eosinophilia persisted and the EUS picture was unchanged. These observations suggest that peripheral blood eosinophilia along with eosinophilic infiltration of the gastric wall are stable conditions, unrelated to symptoms. Endoscopic ultrasonography is of value in ascertaining muscular involvement in eosinophilic gastroenteritis.

Adult↗

PubMed1989

Introduction to magnetic resonance imaging.

Magnetic resonance imaging (MRI) has become an important diagnostic tool with a wide variety of clinical applications. This article provides a qualitative description of physical principles of MRI fundamental to an appreciation of the capabilities and limitations of this complex technology. The same physical principles are used to explain the appearance of the images and the ability of MRI to provide spectroscopic data. Contrast agents, types of MRI equipment, and the safety of MRI in carrying out patient population goals are discussed. This article provides background knowledge for two subsequent articles which cover clinical application of MRI in greater detail.

Humans↗

PubMed1989

Current indications for magnetic resonance imaging.

Magnetic resonance is a well-established imaging modality for CNS, but it's utility for visualizing the rest of the body has not been appreciated fully or exploited yet. The authors believe that MRI will become one of the primary imaging modalities for the body during the next several years. Current and future indications for magnetic resonance imaging of the body are discussed.

Adult↗

PubMed1989

Magnetic resonance imaging in the CNS.

This article, aimed toward the nonneurologist specialist, presents current indications for MRI in the CNS. Primary and metastatic brain tumors, white matter disease, stroke and hemorrhage, hydrocephalus, and spinal disease are discussed. Emphasis is placed on the contribution of MRI to the evaluation of these major classes of disease. Because of its improved sensitivity and noninvasiveness, in most instances MRI is the initial imaging procedure of choice in the CNS.

Adolescent↗

PubMed1988

Ultrasonography in the detection of Crohn's disease and in the differential diagnosis of inflammatory bowel disease.

The diagnostic accuracy of abdominal ultrasonography in inflammatory bowel disease (IBD) has been evaluated in a prospective, randomized, blind study. A total of 181 patients (89 with Crohn's disease, 57 ulcerative colitis and 35 controls) were examined. Sensitivity and specificity of diagnosis in Crohn's disease, corrected for prevalence, were 80.8 and 79.2%, respectively, and a very similar accuracy was found in the differential diagnosis of IBD. In conclusion, ultrasonography can play a role in detecting Crohn's disease and in the differential diagnosis of chronic IBD.

Adult↗

PubMed1987

Lymphangiography and CT in the follow-up of patients with lymphoma.

One hundred twenty-six patients with the diagnosis of lymphoma underwent staging with both lymphangiography and computed tomography (CT) of the abdomen and pelvis. These patients were retrospectively studied to determine the optimal imaging modality for follow-up. Six hundred seventy-four CT scans were correlated with 138 lymphangiograms and 840 follow-up KUB (kidney, ureter, bladder) radiographs. In 21 patients there was evidence of relapse, and in 105 the disease had regressed or remained stable. In all patients with evidence of progression or regression on the CT scan, there was a concomitant change in opacified lymph nodes on the KUB radiographs. It is recommended that the initial staging of lymphoma be done with lymphangiography and CT. If the findings of both are positive, then follow-up should consist of only KUB radiography. If progression is detected, restaging with CT may also be performed. This approach will not only reduce the radiation dose but will also save time and money and enable a more efficient use of radiologic equipment.

Abdominal Neoplasms↗

PubMed1987

The choice of radiologic procedures in the diagnosis of breast disease.

We have reviewed the radiologic imaging procedures related to the investigation of breast lesions, particularly carcinoma. We discussed the choice of procedure in certain clinical situations and have made suggestions. Of the imaging methods, x-ray mammography is the most useful. Ultrasound is the next most useful; however, it is not acceptable for screening. The basis for breast cancer detection and diagnosis remains palpation and x-ray mammography. Ultrasound makes a substantial contribution to the diagnostic evaluation of certain lesions. Eventually, biopsy or surgery provides the final answer in those patients with possible lesions after these diagnostic procedures. In view of the high incidence of breast carcinoma, it would be useful for the practitioner dealing with these problems to establish for his practice a standard operating procedure for examination and referral of patients for breast screening and diagnosis as well as a system of follow-up to prevent patients from avoiding the screening and diagnostic process.

Breast Diseases↗

PubMed1987

Colonoscopy in inflammatory bowel disease. Diagnostic accuracy and proposal of an endoscopic score.

Colonoscopy is used in the differential diagnosis of inflammatory bowel disease but its accuracy and the "weight" of the various endoscopic signs have not been assessed. In a prospective study 357 patients with 606 colonoscopies, in whom the endoscopic appearances were those of ulcerative colitis, Crohn's colitis, or indeterminate colitis, were followed-up for an average period of 22 mo. A final, definite, endoscopy-independent diagnosis was reached by means of autopsy, surgery, or histology on biopsy in 71% of patients. Accuracy of colonoscopy was 89%, with 4% errors and 7% indeterminate diagnoses. Errors were more frequent in severe inflammatory activity (9%). The most useful endoscopic features in this differential diagnosis were discontinuous involvement, anal lesions, and cobblestoning of mucosa for Crohn's disease, and erosions or microulcers and granularity for ulcerative colitis. After selecting the endoscopic features with best predictive value, an "endoscopic score" was calculated by means of "likelihood ratios."

Colitis, Ulcerative↗