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Biomedical subjects

A Pinto

Publications and source records attributed to A Pinto.

At least 127 records · Page 7Linked to original sources
PubMed1998

[Integrated study of fecal incontinence with defecography, anal ultrasonography, perineography, and manometry].

INTRODUCTION: Imaging methods such as defecography, anal US and perineography, combined with manometry, now permit to identify a growing number of causes of anorectal and pelvic floor deficiency. Fecal incontinence patients can thus be approached correctly relative to both diagnosis and treatment. We investigated the role of these techniques in the work-up of fecal incontinence. MATERIAL AND METHODS: Thirty-eight subjects suffering from fecal incontinence were examined. Defecography was carried out with a special commode and videorecorded on a VHS cassette. Anal US was performed with a 7-MHz rotating probe (type 1846) with 3-cm focus length. Perineography was carried out in 15 female patients. RESULTS: The anorectal angle (ARA) at rest was increased (mean: 106 degrees; normal range: 90-100 degrees) in 34 cases; involuntary barium leakage was seen in 8 patients, especially on coughing. On squeezing, ARA was normal in 10 cases (mean: 72 degrees; normal range: 60-90 degrees); in 5 cases of puborectal hypotonia there was no angular excursion between rest and squeezing (mean: 105 degrees). During evacuation, the average ARA value was 166 degrees in 21 cases and ARA stretched to verticalization in 8 cases (mean: 179 degrees). Morphofunctional anorectal changes appeared as rectal mucosal prolapse (12 cases), rectocele (10 cases), perineal descent syndrome (8 cases) and external rectal prolapse (3 cases). Anal US identified 15 interruptions in sphincterial rings: 12 patterns were hypoechoic, 2 mixed and 1 hyperechoic. Atrophic thinning of internal anal sphincter was seen in 5 idiopathic incontinence patients. Perineography demonstrated cystocele in 5 cases and cystourethrocele in 1 case. Manometry showed sphincterial hypotonia at rest in 15 cases, lower values of anorectal pressure on squeezing in 8 and smaller air volumes inhibiting external sphincterial tone in 19 cases. CONCLUSIONS: Defecographic studies with evaluation of ARA and its changes are an important tool with high diagnostic yield. When combined with other techniques, they provide differential criteria for sphincterial and puborectal causes and permits to identify associated pelvic floor dysfunctions. We believe that defecography, anal US (and perineography in complex disorders) are necessary techniques for the correct clinical approach to fecal incontinence patients, whose role and diagnostic yield are a valid support to manometry.

Adult↗
PubMed1998

[Gallbladder blunt trauma: comparison between radiologic and anatomo-surgical findings].

PURPOSE: To assess the diagnostic accuracy and the possible role of ultrasonography (US) and Computed Tomography (CT) in a small group of patients who had a blunt abdominal trauma involving the gallbladder. MATERIAL AND METHODS: We retrospectively reviewed the US and CT findings of five patients with surgically confirmed post-traumatic gallbladder injury. The whole series consisted of 196 consecutive patients submitted to laparotomy for blunt abdominal trauma in the past 7 years. The following US and CT findings were considered at least suggestive of a possible post-traumatic gallbladder injury: pericholecystic fluid collection, ill-defined wall margin, collapsed lumen, high intraluminal density. RESULTS: At surgery, the following findings were observed: gallbladder hematoma (1 case), acute colecystitis (1 cases), gallbladder tear (3 cases), gallbladder tear associated with post-traumatic hepatic injuries (2 cases), duodenal tear (2 cases), hemoperitoneum alone (2 cases), hemoperitoneum associated with choleperitoneum (1 case), choleperitoneum alone (1 case). The US and CT findings were pericholecystic fluid collections (4 cases), ill-defined gallbladder wall margins (3 cases), collapsed lumen with intraluminal high density (1 case) and free intraperitoneal fluid collections (4 cases). They were suggestive of a possible post-traumatic gallbladder injury in all the five patients. CONCLUSIONS: The radiologic findings of our five patients were suggestive of a gallbladder damage but did not permit to distinguish minor from major injuries, the latter requiring surgical treatment. US proves to be a useful screening tool which can also help timing surgery in these patients. CT confirmed the US suspicions and also permitted accurate assessment of associated post-traumatic injuries to the liver and duodenum. Nevertheless, the clinical presentation was the most important factor as to the therapeutic management of these blunt abdominal trauma patients.

Cholecystography↗
PubMed1998

[Computerized tomography in the study of jejuno-ileal perforations. Personal case load].

INTRODUCTION: The most frequent cause of pneumoperitoneum is gastroduodenal ulcer. Perforations of the small bowel are uncommon compared with perforations of the rest of the alimentary tract and radiological findings of jejunoileal perforation have not been frequently reported. The aim of our retrospective study was to assess the CT findings in 18 patients with jejunoileal perforation. MATERIAL AND METHODS: We retrospectively reviewed the CT findings in 18 patients (12 men and 6 women, age ranging 14 to 84 years, mean age 42 years) operated for jejunoileal perforation at Cardarelli Hospital, Naples. CT examination was performed in all patients after i.v. injection of contrast medium and in two cases after oral contrast medium administration. Free intraperitoneal air, extravasation of ingested contrast media and visualization of a discontinuity in the bowel wall were considered direct findings of jejunoileal perforation, while intraperitoneal free fluid, thickened bowel wall and the presence of a streaky density within the mesentery were considered indirect diagnostic findings. RESULTS: The site of perforation was the jejunum in 6 cases and the ileum in 12 cases. The following CT findings were retrospectively observed: intraperitoneal free fluid (61%), free intraperitoneal air (33%), thickened bowel wall (22.2%), presence of a streaky density within the mesentery (5.5%). Visualization of a discontinuity in the bowel wall and extravasation of ingested contrast media were never seen. We observed two findings of perforation in 7 cases, and a single finding in 8 cases. CT examination was negative in 3 cases. CONCLUSIONS: Jejunoileal perforations are difficult to identify by CT. In our series, free intraperitoneal air, as a direct finding of perforation, was observed in 33% of cases, while free intraperitoneal fluid, as an indirect diagnostic finding, was the most frequent sign.

Adolescent↗
PubMed1998

Micro-albuminuria in obese subjects: relationship among body fat distribution, blood pressure and left ventricular structure and function.

OBJECTIVE: To evaluate the relationships among micro-albuminuria, blood pressure and measurements of left ventricular structure and function in centrally and peripherally obese subjects compared with members of a lean control group. METHODS: Centrally obese subjects were subdivided according to whether they had levels of micro-albuminuria higher than 30 mg/24 h (micro-albuminuric group) or lower than or equal to 30 mg/24 h (normo-albuminuric group). For all the subjects we measured heart rate, casual mean blood pressure (MBP), 24 h MBP, total cholesterol level, high-density lipoprotein cholesterol, lipoprotein (a) level, fasting immunoreactive insulin level, plasma renin activity, plasma aldosterone level and micro-albminuria (UAE) by current methods. Left ventricular mass indexed for body height, left ventricular diastolic and systolic diameters, interventricular septal thickness and left ventricular ejection fraction were measured by echocardiography. Peak filling rate was also calculated by radionuclide study. Family history of cardiovascular disease was evaluated for all the obese subjects.RESULTS: Lipoprotein (a) level, total cholesterol level, 24 h MBP and interventricular septal thickness were significantly (P < 0.05) greater for micro-albuminuric than they were for normo-albuminuric centrally obese subjects, whereas high-density lipoprotein cholesterol level and left ventricular ejection fraction were significantly (P < 0.05 lower. In addition, UAE levels of centrally obese subjects were significantly (P < 0.05) higher than those of peripherally obese subjects. UAE of all the centrally obese subjects was correlated directly to lipoprotein (a) level (r = 0.33, P < 0.009), 24 h MBP (r = 0.41, P < 0.002), interventricular septal thickness (= 0.36, P < 0.005) and family history of cardiovascular disease (r = 0.33, P < 0.007). Multiple regression analysis indicated that UAE was independently related to 24 h MBP and family history of cardiovascular disease. CONCLUSION: Our data indicated that measurement of micro-albuminuria is useful for evaluating cardiovascular risk profiles of obese subjects with a central fat distribution.

Journal Article↗
PubMed1998

Follicular thyroid carcinoma: chromosome analysis of 19 cases.

Short-term cultures of 19 follicular thyroid carcinomas were examined cytogenetically. Clonal chromosomal changes were detected in 12 tumors. Two follicular carcinomas had only numerical alterations: one with a hyperdiploid karyotype with trisomies/polysomies of chromosomes 7 and 12, similar to the karyotypes previously identified in a sub-group of benign thyroid lesions, and the other with monosomy 20. In the remaining ten cases several structural chromosome anomalies were found. Loss of the short arm of chromosome 3 was observed in one tumor. In two widely invasive and metastasizing follicular carcinomas there was a t(7;8)(p15;q24) as the sole abnormality in one case and a der(8)t(7;8)(p15;q24) together with other cytogenetic alterations in the other case. This finding suggests that t(7;8)(p15;q24) may be related to an aggressive behavior of follicular thyroid carcinomas.

Adenocarcinoma, Follicular↗
PubMed1998

[Nine consecutive patients with gallstone ileus. Personal experience].

INTRODUCTION: Gallstone ileus is a mechanical obstruction of the gastrointestinal tract caused by the impaction of one or more gallstones within the bowel lumen. The insidious clinical presentation and the lack of specific signs of biliary disease are responsible for the delayed preoperative diagnosis which leads to an overall mortality rate of 15%. MATERIAL AND METHODS: A series of 9 consecutive patients (7 women and 2 men, age ranging from 17 to 83 years), with surgically proved gallstone ileus, was retrospectively reviewed: the authors report the radiologic procedures performed preoperatively and the diagnostic findings. Plain abdominal radiographs were performed in 4 of 9 patients, abdominal US in 4 and CT in 7 patients. All radiologic examinations were retrospectively reviewed by all authors independently, to recognize the different signs of gallstone ileus. RESULTS: The signs of Rigler's triad (small bowel obstruction, ectopic gallstones and air in the biliary tree) were observed on plain abdominal films in two cases, and ectopic gallstones and pneumobilia in two cases. The ectopic gallstones and the small bowel obstruction were demonstrated on abdominal US images in three cases. Rigler's triad was identified on abdominal CT images in 4 cases, while two findings (small bowel obstruction and ectopic gallstones) were observed in three cases. CONCLUSIONS: When the bowel is obstructed by a radiopaque calcified stone, plain radiographs and US of the abdomen are usually enough to diagnose gallstone ileus and no further studies are required.

Adolescent↗
PubMed1998

Liver ultrastructural pathology in mice infected with Plasmodium berghei.

As liver can be an important target organ in malaria, we performed an ultrastructural study of hepatic alterations in the final stage of Plasmodium berghei infection in mice. Significant hepatocyte abnormalities were found. An elevated number of cells showed mitochondria with a high electron-dense matrix and multiple changes in shape and size, alterations in the structure of Golgi complex, swelling and disorganisation of both rough and smooth-surfaced endoplasmic reticulum, differently shaped peroxisome nucleoids, and disappearance of glycogen granules. In other areas the hepatocytes were significantly altered with diminished microvilli and exhibited myelin-like figures, autophagic vacuoles, abundant lipid droplets, and swollen mitochondria in their cytoplasm. Necrotic and atrophied hepatocytes with scarce microvilli in the Disse space and biliary canaliculi could be seen. Parasitised red blood cells and parasite debris were found inside degenerated hepatocytes. Alterations were also noticed in microvasculature, including thickened endothelial cells with swollen mitochondria, lysosomes and autophagic vacuoles in their cytoplasm. Our results demonstrate that hepatocyte damage is an important finding associated with the advanced stages of P. berghei malarial infection, which may lead to liver dysfunction in this disease.

Animals↗
PubMed1998

[New computerized tomography sign of intestinal infarction: isolated pneumoretroperitoneum or associated with pneumoperitoneum or late findings of intestinal infarction].

INTRODUCTION: We retrospectively reviewed the CT findings of the acute abdomen patients examined in the last two years to investigate the frequency of a new CT sign of intestinal infarction, the pneumoretroperitoneum, and its association with other CT findings highly suggestive of this condition. MATERIAL AND METHODS: The CT findings of 60 patients with diagnostic confirmation of intestinal infarction were retrospectively reviewed. CT was performed without (no. = 55) and with (no. = 5) oral administration of contrast material and without (no. = 3) and with (no. = 57) the i.v. injection of nonionic contrast agents in repeated 50 mL boluses. To assess the specificity of this sign, we selected a control group of 400 patients submitted to CT for acute abdomen, but not blunt trauma; 19 of these patients had pneumoretroperitoneum. RESULTS: Pneumoperitoneum was found in five patients with intestinal infarction; it was an isolated sign in two cases and it was associated with few small perihepatic air bubbles in one case. Finally, it was associated with highly suggestive findings of late intestinal infarction in the other two cases. All cases of pneumoretroperitoneum in the control group had been correctly referred to other diseases by previous plain film and/or CT findings and surgery and/or endoscopy confirmed this diagnosis. DISCUSSION AND CONCLUSIONS: Pneumoretroperitoneum has been described as a complication of different benign or severe disorders; prompt recognition of its origin is essential since surgical and/or septic conditions may be involved. However, if the patient's history is negative for abdominal trauma, gastroduodenal ulcer or sepsis, pneumoretroperitoneum is generally cured with conservative treatment. Intestinal infarction or severe ischemia, a usually surgical conditions, should be considered among the different causes of pneumoretroperitoneum alone or associated with pneumoperitoneum or with highly suggestive late findings of infarction such as portal venous gas or pneumatosis intestinalis. This sign had a non-negligible incidence in intestinal infarction in our review (8.5%), but it should be known of and sought with specific window setting to enhance gas depiction on CT images to avoid false negatives.

Aged↗
PubMed1998

[The defecographic and clinical aspects of the solitary rectal ulcer syndrome].

INTRODUCTION: Solitary rectal ulcer syndrome is a complex evacuation disorder characterized by a benign ulcerative lesion of the distal rectum; the main symptom is rectal bleeding, but mucus discharge and difficult evacuation may be associated. The clinical, endoscopic and radiologic findings of solitary rectal ulcer syndrome are evaluated in this study. The role of defecography in the diagnosis of mucosal ulceration and morphofunctional alterations such as rectal prolapse and intussusception are investigated. MATERIAL AND METHODS: In the last 5 years, 27 patients (19 women and 8 men; mean age: 38 years; range: 13-70 years) complaining of obstructed evacuation and rectal bleeding were examined with fibrosigmoidoscopy with biopsy, and defecography combined with videoproctography. Defecography was carried out sitting the patients on a defecographic chair with the pelvis in lateral projection. The images were acquired at rest, under straining, during squeezing and evacuation. RESULTS: Endoscopy and biopsy showed 21 cases of solitary ulcer (77.8%), 3 cases of multiple ulcers (11.1%), 2 cases of granular proctitis (7.4%) and 1 case of pseudopolyp of rectum (3.7%). Among anorectal dynamic alterations, only 1 case (3.7%) of large rectocele was detected at endoscopy under straining. Histo-pathological changes were compared according to Rutter and Riddel criteria; the "colitis cystica profunda" appearance was observed in 2 cases (7.4%). Defecography showed 18 cases (16.6%) of solitary ulcer, 1 case (3.7%) of multiple ulcers and 2 cases (7.4%) of granular proctitis; but it missed 3 cases (11.1%) of small solitary ulcer, 2 cases (7.4%) of small multiple ulcers, and 1 case (3.7%) of pseudopolyp. The dynamic abnormalities shown by defecography were 11 cases (40.7%) of rectal intussusception, 7 cases (25.9%) of recto-anal intussusception, 6 cases (22.2%) of external rectal prolapse and 8 cases (29.6%) of mucosal prolapse. In 16 patients (59.2%) videoprotography emphasized how the ulcer wall was the first to take part in the invagination complex. CONCLUSIONS: Double contrast barium enema represents a useful radiologic method to diagnose solitary rectal ulcer, but air insufflation and pharmacological hypotonia prevent the functional study of rectal walls. Endoscopy permits to detect mucosal ulcerations, erythema, pseudopolyps and granular proctitis; biopsy provides an accurate diagnosis. We suggest combined defecography and videoproctography as a useful tool for evaluating solitary rectal ulcer syndrome as a whole; defecography is necessary to identify associated functional abnormalities, such as rectal prolapse and intussusception, not detectable by other instrumental and radiologic investigations and considered by many authors the likely cause of the disease.

Adolescent↗
PubMed1998

[Microsurgical reconstruction of the upper extremity. Experience with 24 free flaps].

The authors present the experience of 24 clinical cases of microsurgical reconstruction of the upper limb. These reconstructions were accomplished by different microvascular free flaps which were selected according to the type, size and location of the defects, having applied fasciocutaneous, adipofascial, myo, myocutaneous, tendofasciocutaneous, omentum flaps and 2nd toe transfers. The etiology was traumatic in 23 cases and tumoral in 1 case. A careful analysis was made for surgical times, selection and survival rate of the free flaps and the morphofunctional quality of the reconstructions. Microvascular free flaps are considered the choice technique for upper limb reconstruction, particularly for the hand in certain defects, considering the better anatomic and functional quality of the reconstructions.

Adolescent↗
PubMed1997

Association of Kaposi's sarcoma-associated herpesvirus-positive primary effusion lymphoma with expression of the CD138/syndecan-1 antigen.

Primary effusion lymphoma (PEL) represents a novel B-cell non-Hodgkin's lymphoma (NHL) type associated with Kaposi's sarcoma-associated herpesvirus infection and typically growing as lymphomatous effusions in the body cavities. The precise B-cell subset from which PEL originates as well as the biologic mechanisms responsible for its peculiar growth pattern are unclear. In this study, we have analyzed PEL for the expression status of CD138/syndecan-1, a molecule selectively associated with late stages of B-cell differentiation and implicated in cell-to-cell and cell-to-extracellular matrix interactions. PEL patient samples (n = 7) and cell lines (n = 5) were investigated by multiple approaches, including immunocytochemistry, flow cytometry, RNA analysis, and Western blot studies. For comparison, lymphomatous effusions other than PEL (n = 13) and tissue-based NHL (n = 103) were also tested. Expression of CD138/syndecan-1 associates at high frequency with PEL (5 of 7 patient samples and 5 of 5 cell lines), whereas it is consistently absent among other lymphomatous effusions (n = 13). The CD138/syndecan-1 isoform expressed by PEL has an average molecular weight of 420 kD, which is substantially different from that of CD138/syndecan-1 molecules generally expressed by plasma cells. These data, along with previous immunophenotypic evidence, unequivocally define that PEL cells represent a preterminal stage of B-cell differentiation and may bear implications for the peculiar growth pattern of this lymphoma.

Herpesvirus 8, Human↗
PubMed1997

Establishment of HHV-8-positive and HHV-8-negative lymphoma cell lines from primary lymphomatous effusions.

Primary lymphomatous effusions are represented by cases of non-Hodgkin's lymphoma (NHL) which grow in liquid phase in the serous body cavities in the absence of solid tumour masses. Based on morphologic, immunophenotypic, virologic and genotypic features, primary lymphomatous effusions are distinguished into body cavity-based lymphoma (BCBL), Burkitt's lymphoma (BL) and immunoblastic large-cell lymphoma. The histogenesis and pathogenesis of primary lymphomatous effusions are virtually unclarified. In this study, we have established 2 cell lines (CRO-AP/1 and CRO-AP/2) representative of 2 distinct categories of primary lymphomatous effusion, BCBL (CRO-AP/2) and BL (CRO-AP/1). Both CRO-AP/1 and CRO-AP/2 carry monoclonal re-arrangements of the immunoglobulin genes which are identical to those of the respective parental tumours. Consistent with its BCBL origin, CRO-AP/2 is characterised by a non-B, non-T phenotype and harbours infection by HHV-8 (approx. 100 viral copies/cell) and Epstein-Barr virus. Conversely, CRO-AP/1 expresses several B cell-associated antigens, lacks HHV-8 infection and carries the genetic hallmark of BL, i.e., a chromosomal breakpoint of band 8q24. CRO-AP/1 and CRO-AP/2 may be valuable for the biologic characterization of primary lymphomatous effusions, particularly since the number of available cell lines derived from such lymphomatous effusions is extremely limited.

Ascites↗
PubMed1997

Interferon alpha2 recombinant and epidermal growth factor modulate proliferation and hypusine synthesis in human epidermoid cancer KB cells.

We previously found that interferon alpha2 recombinant (IFNalpha) increases the expression of epidermal growth factor receptor (EGF-R) in the human epidermoid cancer KB cell line. Here we report the effects of IFNalpha and epidermal growth factor (EGF) on KB cell cycle kinetics. IFNalpha (1000 i.u./ml) for 48 h decreased the S-phase fraction and diminished the expression of Ki67 and proliferating cell nuclear antigen on KB cells. Incubation of IFNalpha-treated KB cells with 10 nM EGF for 12 h reversed these effects. We then studied several biochemical markers of cell proliferation. Ornithine decarboxylase activity was decreased to about one-tenth by IFNalpha and partly restored by EGF. Hypusine is contained only in eukaryotic initiation factor 5A and its levels are correlated with cell proliferation. IFNalpha decreased hypusine synthesis by 75%; exposure of cells to EGF for 12 h restored hypusine synthesis almost completely. We also studied the effects of IFNalpha on the cytotoxicity of the recombinant toxin TP40, which inhibits elongation factor 2 through EGF-R binding and internalization. IFNalpha greatly enhanced the TP40-induced inhibition of protein synthesis in KB cells. In conclusion, IFNalpha, which affects protein synthesis machinery and increases EGF-R expression, enhances the tumoricidal activity of TP40 and hence could be useful in the setting of anti-cancer therapy.

Antineoplastic Agents↗