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Biomedical subjects

A Terzi

Publications and source records attributed to A Terzi.

At least 37 records · Page 2Linked to original sources
PubMed1999

Immunocytochemical assessment of bone marrow aspirates for monitoring response to chemotherapy in small-cell lung cancer patients.

Recent reports have suggested that tumour cell immunodetection in bone marrow of small-cell lung cancer patients is by far more frequent than found cytohistologically and may have clinical relevance. This study evaluates primarily the efficacy of chemotherapy as method of in vivo purging, but also the relationship of marrow involvement with survival. A total of 112 bone marrow aspirates from 30 chemo-naïve patients were stained twice using anti-NCAM antibodies, first at diagnosis and then after chemotherapy (24 patients) or at disease progression (six patients). Marrow contamination was associated with lower survival (P = 0.002), and was also detected in 7/17 patients conventionally staged as having limited disease. At multivariate analysis, marrow involvement was an independent factor of unfavourable prognosis (P = 0.033). The amount of tumour contamination, before and after chemotherapy, remained unchanged also in responders and even in the subset of patients with apparent limited disease. Following chemotherapy, bone marrow became tumour negative only in 25% of initially positive responders and in none of non-responders. Our results indicate that (i) chemotherapy is not effective in purging bone marrow even in chemo-responsive patients and (ii) a subset of patients with limited disease and negative bone marrow aspirates might have a more favourable prognosis.

Aged↗
PubMed1998

Assessment of myocardial viability by radionuclide imaging.

The differentiation of viable from non viable myocardium is a key issue in the current era of revascularization. Several methods have been used to assess myocardial viability. The radionuclide detection of dysfunctional but viable myocardium depends upon the use of radiotracers whose uptake and trapping are related to presence and amount of living cells. The choice of the diagnostic technique to be applied in clinical practice depends on accuracy of the method and availability of resources. SPECT imaging with TI-201 and Tc-99m-myocardial perfusion tracers are widely available diagnostic tools. Several studies have documented their reliability to detect myocardial segments which may improve in both perfusion and function after revascularization. Positron emission tomography after injection of glucose analogues is a more sophisticated and accurate technology to detect viability, whose utilization is at present limited to few centers due to its high cost. Therefore an accurate selection of patients requiring viability studies is needed in order to identify the most appropriate diagnostic test.

Heart↗
PubMed1998

[Lung resection after pneumonectomy for bronchogenic carcinoma].

METHODS: Four patients who previously underwent pneumonectomy for lung cancer, underwent a new contralateral resection for a metachronous cancer. Functional evaluation of these patients was not different from the standard one and included ECG, spirometry, blood gas analysis and a careful clinical evaluation. A femoro-femoral bypass was used in 2 patients to work on a collapsed lung, High Frequency Jet Ventilation was used in 1 while the last patient was hyperoxygenated and then ventilation was discontinued for the time required for the resections. RESULTS: Each method was free of complications. Operative mortality was nil. Two patients are alive free of disease at 66 and 14 months, two died for metastatic disease at 4 (N2 paratracheal nodes) and 12 months. CONCLUSIONS: Patients with a single lung should not be denied a further resection on contralateral lung. A routine evaluation of cardiopulmonary function may be sufficient but a more sophisticated evaluation including exercise oxygen consumption test, cardiac catheterization, lung perfusion scan, should be used when there is some doubt on the possibility of the patients to sustain the resection. Due to the high operative risk of this kind of patients mediastinoscopy should be performed even if preoperative CT scan of the chest shows minimally enlarged mediastinal nodes.

Adenocarcinoma↗
PubMed1997

Lung resection on single residual lung after pneumonectomy for bronchogenic carcinoma.

Seven patients who had undergone a pneumonectomy for lung cancer developed a second tumor in the remaining lung after a mean time of 28.5 months and underwent a further resection. Preoperative evaluation was based on standard functional tests and on the "stair climbing test". Three patients were operated on using an extracorporeal oxygenator to work on a collapsed lung, three using standard anesthesiologic techniques, and one using high-frequency jet ventilation. There was no operative mortality. Complications occurred in two patients, requiring a temporary tracheostomy in one case. No patient required home oxygen supplementation. Four patients died of metastatic disease after 4, 8, 10, and 12 months, while two patients are alive and free of disease after 83 and 9 months, one is alive and free of symptoms but with a local recurrence after 29 months. Lung resection for bronchogenic carcinoma on a single lung can be safely performed provided that careful clinical judgment is used; long-term survival can be achieved with the resection of the new tumor.

Aged↗
PubMed1996

Endobronchial extramedullary plasmacytoma. Report of one case.

A patient underwent a subtotal resection of the tracheobronchial carina for an obstructing endobronchial lesion. Preoperative biopsies of the lesion were not diagnostic. After resection, the histological examination of the specimen removed demonstrated an extramedullary plasmacytoma infiltrating the bronchial wall. Immunohistochemical studies showed monoclonality for kappa light chains. The postoperative course was uneventful and the screening for multiple myeloma was negative. No adjuvant treatment was given and the patient is currently alive and free of disease 63 months after the resection. Primary endobronchial plasmacytoma is a very rare disease: it is unclear which is the best treatment for endobronchial plasmacytoma. However, complete surgical resection has allowed a long-term survival, free of disease.

Aged↗
PubMed1996

Left pneumonectomy for a second primary tumor after right upper lobectomy for superior sulcus tumor.

We report on a patient who underwent a left pneumonectomy for a second primary lung cancer after a right upper lobectomy and upper chest wall resection for a superior sulcus tumor. Although the postoperative course was complicated by sputum retention which required a temporary tracheostomy the outcome was good and the patient is now living without supplementary oxygen supply. Left pneumonectomy may be considered in patients with previous contralateral lobectomy when the preoperative evaluation of the patient shows an acceptable predicted postoperative pulmonary function. A long-term cure and a good quality of life must, however, be offered.

Carcinoma, Large Cell↗
PubMed1996

Prevention of atrial tachyarrhythmias after non-cardiac thoracic surgery by infusion of magnesium sulfate.

The possible role of magnesium sulfate (MgSO4) infusion in the prevention of atrial tachyarrhythmias after non-cardiac thoracic surgery was evaluated through a prospective study of two hundred patients who underwent non-cardiac thoracic surgery. The patients (who fulfilled the following requirements among others: no myocardial infarction in the previous six months, normal renal function, no use of digitalis or antiarrhythmic drugs, not undergone emergency operations or video-assisted thoracic surgery), were randomly assigned to receive MgSO4 infusion in all circumstances (Mg group), or either no treatment or, if aged over 70 or in cases of pneumonectomy or an intrapericardial procedure, application of digoxin starting on the day of operation (control group). 95 patients were enrolled in the Mg group and 105 in the control group. 93 patients in the Mg group and 101 in the control group were evaluated. Post-operative atrial tachyarrhythmias, mainly atrial fibrillation, occurred in 10 patients (10.7%) in the Mg group and in 27 (26.7%) patients in the control group (chi 2 = 7.009, df = 1. p = 0.008). It is concluded that infusion of MgSO4 is an effective means of reducing the incidence of atrial tachyarrhythmias after non-cardiac thoracic surgery.

Aged↗
PubMed1996

Defective calcium increase and inositol phosphate production in anti-CD3-stimulated lymphocytes of alcoholics without progressive liver disease.

Intracellular free calcium concentration, phosphoinositide turnover, and inositol phosphate production were analyzed in peripheral blood lymphocytes from seven well-nourished alcoholic patients without severe acute or chronic liver disease, before and after stimulation with anti-CD3 antibody. Seven comparable nondrinkers were studied as controls. A lower increase in intracellular free calcium concentration was detected in alcoholics, after anti-CD3 stimulation of lymphocytes, than in control subjects. Lymphocyte activation generated inositol phosphates in both controls and alcoholics, but inositol phosphate production was significantly lower in alcoholics. The agreement between these findings indicates that the reduction in inositol phosphates is one of the most important events in the early phases of lymphocyte activation in alcoholics.

Adult↗
PubMed1996

Arterial switch operation: myocardial ischemia reversed by internal mammary artery graft.

We report a case in which an internal mammary artery graft to the left anterior descending coronary artery was successfully used in a newborn boy to reverse life-threatening myocardial ischemia 24 hours after arterial switch operation. One year later, angiography showed patency of both the graft and the transposed coronary ostium with normal left ventricular function. A brief review of the literature shows encouraging results of internal mammary artery grafts in pediatric patients.

Aorta↗
PubMed1996

Technetium-99m-sestamibi SPECT to detect restenosis after successful percutaneous coronary angioplasty.

UNLABELLED: This study evaluated the accuracy of 99mTc SPECT in predicting restenosis after primary successful PTCA. METHODS: Thirty-seven patients with equivocal symptom-limited exercise stress testing were evaluated. All patients underwent separate day exercise-rest 99mTc-sestamibi SPECT. The perfusion studies were evaluated using three different methods of analysis: visual inspection, semiquantitative and quantitative polar map analysis. The perfusion studies were interpreted in absence of a pre-PTCA scan. All patients underwent a control coronary angiography within 1 mo. RESULTS: Sensitivity and specificity of 99mTc-sestamibi SPECT in predicting restenosis were 87.5-78%, 50-65% and 75-74% for visual inspection, semiquantitative and quantitative polar map analysis, respectively. Sensitivity and specificity related to the vascular territories were: LAD territory 93-73% (qualitative analysis), 53-60% (semiquantitative analysis), 80-67% (quantitative analysis); LCX territory 83-100% (qualitative analysis); and 33-100% (semiquantitative analysis), 67-100% (quantitative analysis); and RCA territory 67-80% (qualitative analysis), 67-60% (semiquantitative analysis), 67-80% (quantitative analysis). CONCLUSION: These data suggest that 99mTc-sestamibi SPECT is a useful noninvasive tool in the follow-up evaluation of patients who have undergone angiographically successful coronary angioplasty even in the absence of a pre-PTCA perfusion study.

Angioplasty, Balloon, Coronary↗
PubMed1995

Completion pneumonectomy: experience with 47 cases.

From 1982 through March 1994, fourty-seven patients underwent completion pneumonectomy for a reappearing lung cancer, lung metastases, late complications, benign lung diseases, and early complication of bronchial or pulmonary artery sleeve resections. Intraoperative bleeding was higher than in standard pneumonectomy; there was one intraoperative mortality (2.3%). Operative mortality was 14.9% overall but was 3.6% in completion pneumonectomy for lung cancer, 20% for late complications and benign disease, and 57% for the treatment of early complications of sleeve resections. Three and five-year survival in patients with lung cancer who survived the operation was 43.8% and 28.7% according to the Kaplan-Meier method; no significant difference in long-term survival was present between patients with a second primary lung cancer or recurrence. Completion pneumonectomy is indicated in reappearing lung cancer and should be considered in benign disease when a less invasive procedure is not available. Completion pneumonectomy for the treatment of early complications of bronchial or pulmonary artery sleeve resections has a very high mortality but no alternative is available.

Female↗
PubMed1994

Lung resections concomitant to coronary artery bypass grafting.

From 1980 through 1993 ten patients underwent concomitant coronary artery bypass grafting and lung resection via median sternotomy. In eight patients a lung malignancy was resected, of which one was a small cell lung cancer. The lung resection was carried out before cardiopulmonary bypass in eight patients and during cardiopulmonary bypass in two. Coronary artery bypass grafting was performed using saphenous vein in eight patients; internal mammary artery was used as arterial conduit in two patients. There was one postoperative death while postoperative complications during hospital stay occurred in two patients. Pulmonary bleeding did not occur in any patient in whom lung resection was performed either before or during cardiopulmonary bypass. Both the patients who had internal mammary artery grafting experienced complications related to an associated lobectomy. A staged procedure is advisable if internal mammary artery has to be used and a lobectomy is required. The long-term survival in the patients with lung cancer was less than expected but the number of patients is too small to draw definite conclusions.

Carcinoma, Small Cell↗
PubMed1994

Chylothorax after pleuro-pulmonary surgery: a rare but unavoidable complication.

The incidence of chylothorax after pleuro-pulmonary operations as well as its treatment is reported. Of 1744 operations performed postoperative chylothorax developed in 13 (0.74%). It resulted in two cases from the transection of the thoracic duct, in six from the transection of the so-called minor lymph channels, which drain lymph from mediastinal nodes straight into the thoracic duct or drain lung segments into the thoracic duct via the pulmonary ligament; the transection of these channels occurred during mediastinal lymphadenectomy or during the section of the pulmonary ligament. In 5 patients the site of leakage was not determined as reoperation was not required. Conservative treatment with low-fat diet and medium-chain triglycerides and/or total parenteral nutrition was attempted in all but one patient but was successful only in 5 cases whose mean losses were 292 ml/day. Seven patients were reoperated after a mean of 11 days; their mean losses were 930 ml/day. One patient was reoperated on the third postoperative day without attempting conservative treatment; his mean loss was 850 ml/day. Lymphadenectomy seems to be an important risk factor for postoperative chylothorax. Chyle leakage around 500 ml/day or higher that tends to decrease below 500 ml/day after a few days of dietary manipulation usually stops within 10-20 days, while leakage over 500 ml/day that does not tend to decrease below 500 ml/day seldom if ever stops without surgery, so that a more aggressive attitude is justified.

Adult↗
PubMed1994

[Pulmonary lymphangioleiomyomatosis. Case report].

Pulmonary lymphangioleyomiomatosis (LAM) is a rare disease that affects only women. About one hundred cases are reported in the literature. This disease progresses to respiratory failure and its course can be slowed by hormonal therapy. A new case is reported; this woman was admitted to our Division for a right hydropneumothorax and after pleural drainage fluid demonstrated to be a chylous effusion; after a thoraco-abdominal CT scan the diagnosis of LAM was suspected. She was operated on after a few days because of continuous air and chyle leakage. A closure of lung leakage was performed with a stapler device that allowed the removal of a small specimen of lung for histopathological examination and a parietal pleurectomy was added with the aim of obtaining a pleural space obliteration. The histopathological examination revealed changes consistent with LAM and also positive was the hormonal steroid receptors assay. Adhesion of the lung to the chest wall was obtained but an antero-basal pouch persisted with continuous chylous leakage. A transposition of omentum into the chest was made with the aim of obliterating the pouch and favour chyle reabsorption and no drainage was left. Another CT scan demonstrated complete obliteration of the pouch and no fluid accumulation; the procedure proved to be successful and the patient was discharged with hormonal therapy.

Female↗
PubMed1992

The brain damage hypothesis of the seasonality of births in schizophrenia and major affective disorders: evidence from computerised tomography.

Although the excess of schizophrenic births in the winter and early spring has been replicated and some non-conclusive work supports the same seasonal birth trend in patients with major affective disorders, the aetiopathogenetic foundations of this phenomenon remain uncertain. The primary role of perinatal seasonal factors that predispose to the development of schizophrenia via induction of brain damage has been invoked, as has a tendency for patients to conceive during the spring and early summer. In order to test these two hypotheses, cerebral ventricular size and cortical atrophy in 206 schizophrenics and 107 patients with major affective disorders were assessed by CT and analysed in relation to month of birth. Compared with schizophrenics born during the remainder of the year, those born between December and April, particularly in cases lacking a family history of schizophrenia, showed increased chances for ventricular enlargement, but not for cortical atrophy. No association between season of birth and central or cortical atrophy was found for patients with major affective disorders. This suggests that the brain-damaging effect played by perinatal seasonal factors has both a disease and an anatomical specificity.

Adult↗
PubMed1991

[Ogilvie syndrome. 2 clinical case reports].

Acute pseudo-obstruction of the colon is an uncommon syndrome usually related to other diseases. Two patients with this syndrome are described. It is stressed that it is of paramount importance to recognize this syndrome as a high mortality is present in these patients if they are not treated in a right fashion. The treatment doesn't require surgery unless a complication, like cecum perforation, doesn't appear.

Aged↗
PubMed1990

Therapeutic possibilities of 131I-MIBG in metastatic carcinoid tumors--preliminary report.

The poor results of traditional therapy in advanced carcinoid tumors and the well-proven uptake of 131I-MIBG shown by some of these tumors induced us to attempt a radiometabolic approach. We selected for the treatment 5 patients (3 men and 2 women) who showed progression of disease, a fairly good uptake of 131I-MIBG with severe related symptoms, and a poor response to traditional therapy. A cumulative radioactivity of 5.5-29.6 GBq was given. Acute side effects after 131I-MIBG administration or late radiation-induced damages were not observed. Symptoms increased during the first 2-4 weeks in 2 patients: in one of these relief was achieved with drugs. Results concerning objective remission of the disease were unsatisfactory. In contrast, definite improvement of symptoms was shown in 2 of 5 patients, resulting in a better quality of life.

3-Iodobenzylguanidine↗