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Biomedical subjects

A Pierro

Publications and source records attributed to A Pierro.

At least 127 records · Page 7Linked to original sources
PubMed1990

Adriamycin and cis-platinum administered by continuous infusion preoperatively in hepatoblastoma unresectable at presentation.

Hepatoblastoma deemed surgically unresectable at presentation is fatal unless conversion to resectability is attained. We report a series of six consecutive patients, ranging in age from newborn to 5.75 years with hepatoblastoma unresectable at presentation, either because of size of tumor or its anatomical boundaries, or because of metastatic disease. All were treated with preoperative continuous infusions of cis-platinum and Adriamycin. All achieved resectability, and there was only one operative death. The five surviving patients are alive and free of disease off therapy. Potential benefit may accrue from preoperative chemotherapy in most cases of hepatoblastoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Preoperative chemotherapy in 'unresectable' hepatoblastoma.

Chemotherapy was used to treat 11 children with hepatoblastoma that was judged to be unresectable because of tumor tissue in both lobes of the liver (eight patients) or because of size of the primary tumor (three patients). Three with bilobar involvement also had metastatic disease. Adriamycin was used in all patients. In nine, it was used in combination with cisplatin. A combination of other agents was used in four of these children. After two to six cycles (mean, 4 cycles), eight primary tumors exhibited marked response with greater than 50% reduction in size. Metastases disappeared in two patients. Complete resection of residual tumor was attempted in eight cases, and was successful in seven. One patient died at the time of surgery during an extended right hepatectomy. Two children had anaplastic hepatoblastomas that did not respond to chemotherapy, and the children died. One responder with giant cell hepatitis died from a severe coagulopathy and bleeding during chemotherapy before surgery. With preoperative chemotherapy, seven of 11 children with "unresectable" hepatoblastoma are now alive without disease 4 to 42 months following successful resection.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Metabolism of intravenous fat emulsion in the surgical newborn.

The metabolism of an intravenous (IV) fat emulsion was investigated by the combination of chemical balance and computerized indirect calorimetry techniques in 21 newborns (birth weight, 3.0 +/- 0.1 kg; mean +/- SE). All babies were appropriate for gestational age and received total parenteral nutrition after a major surgical procedure. The study was divided into two consecutive periods. Phase 1 consisted of infusion of 10% glucose and 2% amino acid solutions for 24 hours, and phase 2 involved the "Intralipid utilization test" (isocaloric and isovolemic infusion of Intralipid 10% for four hours). The caloric intake was 67.1 +/- 1.9 kcal/kg/d during both phases of the study. The resting energy expenditure was 44.8 +/- 1.6 and 46.5 +/- 1.8 kcal/kg/d during phases 1 and 2 respectively. During glucose/amino acid infusion, 12 patients oxidized endogenous fat, and de novo lipogenesis from glucose was observed in nine. During the Intralipid infusion, there was a significant and progressive decrease of carbon dioxide production, respiratory quotient, and carbohydrate utilization (oxidation plus conversion to fat). Net lipogenesis ended and fat utilization significantly increased. By the second hour of Intralipid infusion, 58% of energy expenditure was derived from fat oxidation. The drop in carbon dioxide production correlated positively with the decrease in carbohydrate utilization (r = .07; P less than .001). During the third and fourth hours of phase 2, the percentage of fat utilized was negatively correlated with the amount of fat given (r = -.07; P less than .01). The surgical neonate showed rapid metabolic adaptation to Intralipid infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary Carbohydrates↗
PubMed1989

Resting energy expenditure is increased in infants and children with extrahepatic biliary atresia.

To determine if liver dysfunction in children affects energy and macronutrient homeostasis, we performed 13 metabolic studies in 11 patients (age, 17.8 +/- 5.9 months [mean +/- SEM]) with extrahepatic biliary atresia (EHBA). Nutritional balance, indirect calorimetry, anthropometry, and biochemical liver function tests were utilised. Sixty-four percent of the energy losses were in the form of stool fat. Energy expenditure (68 kcal/kg/d) was 29% higher than normal (P less than 0.0025). Only one third of the metabolisable energy intake (37 kcal/kg/d) was stored in the body for new tissue synthesis. In spite of the bountiful protein intake for age, the increased protein oxidation (2g/kg/d) resulted in a virtually zero mean nitrogen balance. In addition, four patients oxidised endogenous protein as well. The respiratory quotient was 0.96, and did not change significantly between pre- and post-meal measurements, suggesting a predominant utilisation of carbohydrate for energy metabolism. Net lipid oxidation was severely diminished. We found that the higher the serum aspartate aminotransferase level (previously named SGOT), the lower the net fat oxidation, and the higher the conversion of glucose to fat. These data suggest that markedly increased energy expenditure contributes to the malnutrition of patients with EHBA. We characterised for the first time how severe liver disease in infants and children affects carbohydrate, fat, and protein metabolism, thus inducing protein-energy malnutrition.

Basal Metabolism↗
PubMed1989

[Intestinal polyposis in children. Description and differential diagnosis of 2 cases].

The case of a 21-month-old girl with lymphoid nodular hyperplasia and the case of a 9-year-old girl with familial adenomatous polyposis are described. Both patients presented rectal bleeding. A defect of secretory IgA was found in the first patient. In both cases diagnosis was based on medical history, barium enema with aircontrast technique, colonscopy, and endoscopic biopsy. Differential diagnosis and diagnostic procedures in these two diseases are discussed.

Adenomatous Polyposis Coli↗
PubMed1988

Characteristics of protein sparing effect of total parenteral nutrition in the surgical infant.

To determine the best formula to prevent protein depletion, 31 surgical infants on intravenous (IV) diet were studied. The study was divided into two phases. Phase I diet included 5% glucose and 1.5% or 2% amino acid infusion; phase II diet consisted of 5% glucose and 1.5% or 2% aminoacid plus 10% Intralipid. In each phase, oxygen consumption, carbon dioxide production, and energy expenditure were determined. The utilization of carbohydrate, fat, and protein was calculated from urinary nitrogen excretion and nonprotein respiratory quotient. The mean caloric intake during phase I and phase II was 62 and 94 kcal/kg/d, respectively. A positive nitrogen balance was obtained in infants receiving fat-free total parenteral nutrition (TPN) with a mean protein intake of 2.6 g/kg/d and a mean energy intake exceeding the energy expenditure by 24%. Infusion of more calories as Intralipid (phase II) caused a significant reduction in protein oxidation, thus protein contribution to the energy expenditure and an increase in protein retention. We conclude that supplementation of low-calorie TPN diets with Intralipid increases protein sparing and is preferable to the administration of very high glucose loads.

Amino Acids↗
PubMed1988

[Vibration-induced angiopathy: significance of urinary beta-thromboglobulin increase after cold test].

Twenty subjects working with tools generating 100-400 Hz vibrations were submitted to volumetric pulse-plethysmography with cold Test (C.T.) and to the measurement of BTGU, a thromboxane urinary catabolite. After C.T. an increase of BTGU was observed, which attained statistical significance in the subgroup with the most evident plethysmographic modifications. The meaning of these findings is discussed, also in the light their apparent contrast with some literature data. The AA believe that the prostaglandin balance can actually play a role in the pathogenesis of C.T.-induces vasomotor changes, if the tools used generate a sufficiently high number of Hz and if the workers are still rather young. This last condition corresponds to a greater intactness of endothelia and thus to the ability to modulate the vasomotor response ("hunting reaction"). This would lead to the activation of more complex pathogenetic mechanism (also biohumoral ones) among which is thromboxane release.

Adult↗
PubMed1987

Does fetal gut obstruction cause hydramnios and growth retardation?

In order to study the effects of impaired fetal intestinal absorption of amniotic fluid, two series of neonates (551 from Liverpool and 172 from Rome) with different types of congenital gut obstruction were divided into two groups and compared. Group A consisted of patients with complete obstruction at or above the proximal jejunum (within 15 cm of the ligament of Treitz). Patients of group B had either incomplete obstruction at group A level or either incomplete or complete obstruction at a lower level. Maternal hydramnios and fetal growth retardation rates were found to be significantly higher in group A than in group B. Maternal hydramnios was associated with an increased prematurity rate (P less than .001). Fetal growth retardation was not related to the presence of additional anomalies. In group A growth retardation was more frequent in babies born after 37 weeks of gestation (P less than .05). No differences were found between the Liverpool and Rome series of patients. These findings suggest that fetal gut function not only contributes to the control of amniotic fluid volume but also, in the final stages of pregnancy, to normal fetal growth. Maternal hydramnios may be the cause of premature delivery of fetuses with upper gut obstructions.

Birth Weight↗
PubMed1985

Superior mesenteric artery syndrome: an unusual cause of Watson biopsy capsule retention.

The prolonged intestinal retention of a Watson biopsy capsule in a 12-year-old girl with chronic diarrhea is reported. Radiological investigation showed a duodenal obstruction due to superior mesenteric artery syndrome. A preliminary barium study of the upper gastrointestinal tract, before performing blind intestinal biopsies, may decrease the incidence of similar complications.

Biopsy↗
PubMed1985

Glossoptosis-apnea syndrome in infancy.

The clinical and physiologic features of 28 infants with Pierre Robin syndrome and those of 20 infants with various types of nasal obstruction were reviewed to determine whether different causes of upper airway obstructure may lead to a common syndrome. The patients had no significant differences in distribution of main clinical manifestations. Their features included cyanosis with respiratory distress, apneic spells, oropharyngeal dysphagia, vomiting, failure to thrive, cor pulmonale, brain damage, and sudden death during sleep. The common physiologic manifestation appeared to be an oropharyngeal obstruction caused by glossoptosis, which occurred mainly during wakefulness. Upper airway obstruction led to hypoxemia, which, in many instances, was not associated with hypercapnia and was not relieved by oxygen administration. It is concluded that regardless of a specific cause, any airway obstruction that results in a decreased inspiratory pressure overcoming the airway maintaining genioglossus action causes a glossoptosis-apnea syndrome.

Age Factors↗
PubMed1984

Thyrotoxicosis and thyroid cancer: a report on eight operated cases.

Eight cases of hyperthyroidism and thyroid cancer, representing 0.96% of overall hyperfunctioning thyroid diseases (835), surgically treated are reported. Clinical and pathological data, and type of treatment are summarized. The etiopathogenic hypotheses about possible relations between thyrotoxicosis and thyroid cancer are discussed. In the presence of thyrotoxicosis, preoperative diagnosis of thyroid cancer is rather difficult, but awareness of the potential association and careful examination of any suspect nodularity make it possible to recognize minimal malignant foci and adequately treat them with total thyroidectomy and, when required, modified neck dissection.

Adolescent↗