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Biomedical subjects

A Piga

Publications and source records attributed to A Piga.

At least 55 records · Page 3Linked to original sources
PubMed1995

Continuing medical education through the videotex system in Italy.

Continuing education for medical doctors is not compulsory in Italy. The link with the university is lost shortly after the final medical examination, and there is no other teaching institution for structured continuing medical education (CME). Distance learning gives physicians the opportunity to use updating programs at home at their convenience. Videotel, the Italian videotex system, is the first telematic tool that, at low cost, can reach every home nationwide. Through this system information can be exchanged 24 hours a day, using the Videotel database as central memory, the telephone network as connecting system, and low-cost devices as peripherals. The authors evaluated the technical capacity and didactic efficacy of the Videotel system as a vehicle for CME (in both oncology and general medicine). In an exploratory phase they surveyed physicians of the Italian Province designated for the study, with the objective of promoting the initiative and enrolling physicians interested in this innovative approach to CME. Teachers at Italian universities provided the educational material: interactive lessons, clinical case discussions and problem solving, and multiple-choice questions. Twenty-nine physicians agreed to participate. Despite the interest shown by these physicians, they made very little use of the didactic database. The main reasons for failure to connect with the educational database were the lack of time and unfamiliarity with the instrument. Although the results of the study were discouraging, the authors believe that the resolution of technical problems linked with the system and an increasing familiarity of physicians with telematic and informatic tools in general, together with appropriate incentives, will make the videotex system a feasible, low-cost, efficient vehicle for CME.

Adult↗
PubMed1995

Synchronous primary hepatic lymphoma and epidermoid lung carcinoma treated with chemotherapy and surgery.

While involvement of the liver by non-Hodgkin's lymphoma is a relatively frequent event, primary liver lymphoma is an uncommon disease. We describe a case of synchronous primary hepatic lymphoma and epidermoid lung carcinoma occurring in a 61-year-old male patient. Complete remission of both diseases was achieved with a radical approach, which included combination chemotherapy and surgery. The patient has now been in persisting complete remission for 40 months after surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Metastatic tumors of the adrenals.

Adrenals are a common site of metastasis for many solid tumors. Adrenal metastases, and related symptoms of adrenal failure, are usually overlooked in clinical practice. This is probably due to the functional compensation of the adrenal glands and to the fact that signs and symptoms of adrenal insufficiency are aspecific, and often masked by symptoms of the neoplastic disease. In some tumors in which adrenal involvement is particularly frequent, adrenal evaluation should be an essential part of the preoperative diagnostic work-up. In case of demonstration of metastatic involvement the patient could be spared a useless resection of the primary tumor. However, in selected patients, even after the demonstration of an adrenal metastasis, radical surgery could still be considered for tumors with favorable biological behaviour. In patients with widespread disease, if clinical indicators of possible adrenal involvement are present an adequate palliative therapy should be started, thus ameliorating the quality of life of the patients.

Addison Disease↗
PubMed1994

MR imaging of hepatic masses: diagnostic significance of wedge-shaped areas of increased signal intensity surrounding the lesion.

OBJECTIVE: Wedge-shaped areas of increased signal intensity surrounding focal hepatic lesions on T2-weighted images have been described as an occasional finding in patients with hepatic metastases. We reviewed MR images of patients with benign and malignant focal hepatic lesions to determine the prevalence and diagnostic significance of this finding, and in particular to determine if these wedge-shaped areas are characteristic of cancer. MATERIALS AND METHODS: One hundred twenty-one patients with focal hepatic lesions (65 patients with metastases, 14 patients with hepatocellular carcinoma, and 42 patients with benign conditions) underwent MR imaging of the liver at 1.0 T. Axial spin-echo T1-weighted and spin-echo and turbo spin-echo T2-weighted MR images were obtained. The MR images were retrospectively evaluated: the number and size of the lesions and the presence of wedge-shaped areas surrounding the lesions were recorded; in patients with cancer, follow-up MR images and a clinical course were used to study the evolution of the lesions and the adjacent wedge-shaped areas. The final diagnosis in patients with cancer was proved by clinical course (54 patients) or fine-needle aspiration biopsy (25 patients); in patients with benign lesions, the findings on various other imaging techniques were accepted as conclusive. RESULTS: The wedge-shaped areas were noted on T2-weighted images in 16 (25%) of 65 patients with metastases, in 3 (21%) of 14 patients with hepatocellular carcinoma, and in 5 (12%) of 42 patients with benign lesions. In 11 of the 16 patients with metastases and wedge-shaped areas of increased signal intensity, a metastatic lesion within the wedge-shaped area was detectable; in the remaining five patients, a metastatic lesion appeared during the subsequent clinical course. In some instances, the wedge-shaped area obscured the lesion. In patients with benign conditions, the wedge-shaped area was frequently seen in association with hemangiomas (4 of 13, 31%). CONCLUSION: Our results show that wedge-shaped areas of increased signal intensity surrounding lesions on T2-weighted MR images are a common finding in patients with focal hepatic lesions. The wedge-shaped areas cannot be considered pathognomonic of malignant lesions because they are also seen in patients with benign conditions (hemangioma, abscess). However, the appearance of these wedge-shaped areas in a patient with cancer should suggest a metastasis. The possibility that hepatic lesions could be obscured by these wedge-shaped areas also should be considered when response to treatment is being evaluated.

Adult↗
PubMed1994

[Isolated thyroid and skin metastases of renal carcinoma].

Metastases to the thyroid gland from renal carcinoma are observed in 10% of the uncommon metastatic thyroid tumours. They are the first sign of renal carcinoma in 25% of cases or appear after primary treatment of renal neoplasia, up to 27 years later. Metastases are more frequent in pathological glands, perhaps because intraparenchymal blood flow is slowed and tissue oxygen partial pressure is reduced. Thyroid metastases are frequently associated with lung ones, whether those associated with metastases to other organs (duodenum, pancreas, skin) are very unusual. Clinical manifestations are thyroid node without hormonal modifications or acute swelling of the gland with hormonal hyperfunction; other signs are dysphonia and/or dysphagia. Thyroid nodes are "cold" at 131I scanning and with mixed structure at ultrasonography. Fine needle aspiration is often diagnostic. Problems in differential diagnosis are among clear-cell renal carcinoma and some types of thyroid adenoma, adrenal carcinoma, parathyroid carcinoma, testicular seminoma and hypernephroid thyroid carcinoma. Treatment is surgical: subtotal or total lobectomy, with or without isthmectomy, if metastasis is single, total thyroidectomy in diffuse disease. Some Authors always choice total thyroidectomy to erase microscopic foci of disease in contralateral lobe. Reported survival after treatment is from a few months to 27 years. Survival is longer with a metastasis appearing after nephrectomy and with unique versus multiple ones.

Abdominal Muscles↗
PubMed1993

The teaching of clinical oncology in Italian medical schools. A survey among teachers and students.

BACKGROUND: Oncologists, health care workers and health organizations consider well-performed teaching programs in clinical oncology a fundamental step in cancer control. The aim of our study was to assess the views of teachers and students on the present status of oncology teaching in Italian medical schools and on the most common shortcomings in cancer education. MATERIALS AND METHODS: A survey was carried out among teachers and students of 17 Italian medical schools using two different questionnaires. Six hundred forty-seven students of Northern, Central and Southern Italy in the final two years (5th and 6th) of their medical curriculum and 87 professors of pathology, surgery, internal medicine and medical oncology completed the questionnaires. RESULTS: Doctor/patient relationships and integration among disciplines were the most unsatisfactory aspects of oncology teaching, according to students. Biology, epidemiology, radiotherapy, and medical treatment were felt to be insufficiently treated, whilst diagnostic aspects, clinical management and surgery were rated sufficient. The median number of cancer patients to whom each student had access during his/her training was limited, averaging only 13 patients; however, a high degree of variability was noted. A larger number of patients was generally observed in smaller, less crowded medical schools, with notable exceptions. Although the majority of teachers had clinical practices related to their disciplines, only a small number of students underwent a period of clinical training. Traditional methods of teaching were preferred to innovative methods, while interaction among disciplines was uncommon. CONCLUSIONS: This survey emphasizes the dualism between students' expectations and teachers' ideas about cancer teaching. Doctor/patient relationships and poor attention to practical clinical problems seem the most critical issues for clinical oncology training in Italian medical schools.

Curriculum↗
PubMed1993

Inadequacy of ultrasonography for monitoring response to treatment of liver metastases.

PURPOSE: We prospectively evaluated the clinical efficacy of ultrasonography (US) in monitoring the effect of medical treatment in patients with liver metastases, by comparing serial US assessment with serial magnetic resonance imaging (MRI) evaluation and clinical outcome in a group of 41 patients with solid tumors. PATIENTS AND METHODS: Both examinations were performed in patients with metastatic liver disease at the start of a new treatment modality and monthly thereafter for 3 months; close monitoring was prolonged beyond the third month in cases in which there was disagreement between the two techniques and the clinical course was not conclusive. RESULTS: Planned follow-up was completed in 37 cases. There was limited concordance between the two examinations: in 21 cases only (56.8%), US and MRI gave concordant information on the evolution of hepatic metastases; in eight cases, both agreed on progression of disease (PD), in 11 cases on stable disease (SD), and in one case each on partial response (PR) and complete response (CR). In the remaining 16 cases (43.2%), there was disagreement between the two examinations. On the basis of subsequent clinical course, this discrepancy was shown to be due to US inadequacy in 13 cases and to MRI inadequacy in one case; in two cases, the clinical course was not conclusive. The most striking limits of US appeared to be twofold: (1) a progressive appearance, with chemotherapy, of a diffusely inhomogeneous structure of the liver, resulting in obscuration of focal lesions (and a subsequent judgement of CR) in cases in which lesions were, on the contrary, detected at MRI and usually confirmed by subsequent clinical course; and (2) false US-determined PD in cases in which lesions proven at baseline MRI were noted at US only after one to two courses of therapy. CONCLUSION: We conclude that US, which is known to be inaccurate for screening of liver metastases, is unreliable for the follow-up of metastatic liver disease; despite its wide availability, low cost, and noninvasiveness, critical therapeutic decisions should not be made based on the outcome of this test.

Adult↗
PubMed1992

[Carcinoma of the surgically treated stomach. Our experience].

Between 1977 and 1991, 12 patients (11 males and 1 female; median age of 62.7 years) with gastric stump cancer were observed. All patients were previously operated for benign gastric (4) or duodenal (8) ulcer disease. Median duration interval between first operation and the diagnosis of gastric carcinoma was 22.0 years (range 7-39 years). Only in 5 patients total gastrectomy was carried out. Two out of these 5 patients are still alive at 2 and 24 months after surgery, while the median survival of remaining patients was about 9 months. The usefulness of close follow-up and digestive endoscopy in peptic ulcer patients who had surgical treatment is considered in order to detect an early gastric stump cancer.

Aged↗
PubMed1992

[Hürthle-cell tumors of the thyroid].

In the last 10 years 20 patients with Hürthle tumors were observed at Institute of Surgery and Oncology of Cagliari University. 17 were females and 3 males with a median age of 42 years. Tumors were malignant in 7 cases and benign in 13. A total thyroidectomy was performed in all patients with carcinoma and in 2 with adenoma because of concurrent goiter. The remaining patients were treated with a less extensive surgery. Two patients with carcinoma had a cervical node metastases at 12 and 67 months, treated by surgery (followed by radioiodine therapy in one). All patients are alive and disease free at 72 months of median follow-up. None of patients with benign adenomas recurred at 47 months of median follow-up. A longer-term follow-up is necessary in order to evaluate the benignity of adenomas.

Adenocarcinoma↗
PubMed1991

The value of necropsy in oncology.

The effectiveness of diagnostic procedures in cancer patients was evaluated by comparing clinical with necropsy findings. Necropsy and clinical records of 102 patients were reviewed for primary site and histology of tumour, metastatic sites, presence of second neoplasms, associated non-neoplastic diseases, terminal illness and cause of death. Major discordances between clinical and postmortem findings were found in 34 (33%) cases: in 10 of these a correct clinical definition of site and histology of the primary tumour would have resulted in a change of management and prognosis; in 4 cases in which a major non-neoplastic pathology had been responsible for death, correct diagnosis might have resulted in prolongation of survival. Spread of disease was generally underestimated, even for metastases in clinically accessible organs. Even more disappointing were the clinical data related to terminal illness and cause of death (43% overall concordance).

Autopsy↗
PubMed1991

A newly-characterized alpha-thalassaemia-1 deletion removes the entire alpha-like globin gene cluster in an Italian family.

We describe a new deletional form of alpha thalassaemia which encompasses the entire alpha-like globin gene cluster in a 15-year-old boy of Southern Italian descent. The deletion removes approximately 31 kb, the 5'-end point is located approximately 4 kb upstream of the xi gene, while the 3'-end point maps between the alpha 1- and theta 1-globin genes. The interaction of this deletion with the common-alpha 3.7 form gives origin to a classical form of haemoglobin (Hb) H disease in the propositus of this study. Deletional forms of xi alpha-thalassaemia are uncommon in the Mediterranean basin; as for other unusual xi alpha-thalassaemia forms, heterozygotes for this mutation may escape detection in population surveys based on zeta and alpha probes.

Adolescent↗
PubMed1990

[Carcinoma of the male breast. Review of the literature and case series contribution].

Following and exhaustive review of the literature on this topic, the paper reports the results of the treatment of 16 patients with male breast cancer. From an analysis of findings, it was observed that diagnosis is frequently delayed (mean 1 year), disease is at a locally advanced stage in the majority of patients, and there is a considerable variety of treatments in relation to the long recruitment period for the study. The difficulties of performing radical surgery which does not necessitate complex reconstructive surgery has led to the use of Limberg's flap in the last 3 cases treated. Mean survival rate was 8 years for stage 1, 4 years for stage 2, 3 years for stage 3 and 2.5 years for stage 4.

Adenocarcinoma↗
PubMed1989

Survival and causes of death in thalassaemia major.

Survival and causes of death were studied in 1087 Italian patients with thalassaemia major who were born on or after Jan 1, 1960. At the age of 15 years, the Kaplan-Meier estimate of survival after the first decade of life was 80.6% for subjects born in 1960-64, 84.2% for those born in 1965-69, and 96.9% for those born in 1970-74. At the age of 20 years, survival from the age of 10 was 59.1% for patients born in 1960-64, and 70.2% for those born in 1965-69; at 25 years, survival from the age of 10 was 40.7% in the 1960-64 cohort. Overall survival from birth for patients born in 1970-74 was 97.4% at 10 years, and 94.4% at 15 years. The most common cause of death was heart disease, followed by infection, liver disease, and malignancy.

Adolescent↗
PubMed1989

Analgesia with epidural calcitonin in cancer patients.

We evaluated the analgesic effect of salmon calcitonin (sCT) on 14 patients with intractable cancer pain. The drug was administered by epidural infusion (4-8 bolus administrations in 48 h); the dosage was 100 IU/48 h in 5 patients and 400 IU/48 h in 9 patients. Significant, although limited, pain relief and nocturnal pain relief were obtained; the requirement for conventional analgesic drugs was substantially reduced. The treatment was well tolerated and no side effect was recorded. However, only in 3/14 patients did pain relief result in improvement of mobility, with two patients becoming able to ambulate; no patient experienced absence of pain. In general, the treatment produced only limited benefit and subsequent morphine treatment was required in all instances. Widespread use of epidural sCT in intractable cancer pain is not justified as a routine procedure and more substantial evidence is required to support the clinical utility of such an approach.

Aged↗