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C Cappelli

Publications and source records attributed to C Cappelli.

At least 19 recordsLinked to original sources
PubMed2007

Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience.

BACKGROUND: Papillary thyroid carcinoma (PTC) represents 70%-75% of well-differentiated thyroid cancers. Although most reports have shown that papillary thyroid microcarcinomas (PMC) follow an indolent course, a few series have demonstrated that a significant number of them are associated with extrathyroidal extension and nodal or distant metastases. METHODS: Four hundred eighty-four patients with papillary thyroid cancer (102, PMC; 382, PTC) were enrolled in this study. The median follow-up was 102 months. RESULTS: No difference between PTC and PMC patients was observed for age, gender, multifocality, extrathyroidal extension, and lymph nodes metastasis. The prevalence of nodal involvement developing during the follow-up period was significantly higher in PMC than PTC (58.8% vs. 38.5%, P = 0.002). An unfavorable clinical course occurred in 96 subjects (21.8%). Logistic analysis showed that the strongest association with the worst prognosis was found for age and TNM stage III (P < 0.001). Analysis also confirmed that the presence of intranodular vascularity is a predictor of unfavorable outcome (P = 0.044). CONCLUSIONS: We suggest always performing a total thyroidectomy followed by radiometabolic therapy in papillary carcinomas independent of their size. If the choice in PMCs should be more conservative (hemithyroidectomy), we purpose to limit this procedure to the cancers without Doppler features suggesting intranodular vascular pattern.

Adult↗
PubMed2006

The predictive value of ultrasound findings in the management of thyroid nodules.

BACKGROUND: Thyroid nodules are a common medical problem, but whether fine-needle aspiration cytology (FNAC) is mandated for smaller non-palpable nodules, is controversial. AIM: To evaluate whether ultrasonographic features of thyroid nodules are associated with histological malignancy, and to identify useful criteria for clinical decision-making. DESIGN: Prospective observational study. METHODS: From January 1991 to September 2004, 5198 patients were referred to our hospital for ultrasound evaluation of thyroid nodules. Overall, 7455 nodules (diameters from 6 to 100 mm) were examined; 2865 (38.4%) were <10 mm in diameter. All patients with suspicious or malignant cytology underwent surgery. RESULTS: Of the 349 nodules undergoing surgery, 284 were malignant. The prevalence of cancer was slightly higher in nodules>or=10 mm in diameter vs. those<10 mm (5.5% vs. 3.0%, p<0.01). However, histological type and local aggressiveness were largely independent of nodule size. Microcalcifications (72.2% vs. 28.7%; p<0.001; OR 6.4, 95%CI 4.9-8.4), blurred margins (52.8% vs. 18.8%; p<0.001; OR 4.8, 95%CI 3.8-6.1), solid hypoechoic appearance (80.6% vs. 52.4%; p<0.001; OR 3.8, 95%CI 2.8-5.1), size>or=10 mm (77.4% vs. 64.9%; p<0.001; OR 1.9, 95%CI 1.4-2.5) and intranodular vascular pattern type 2 (61.6% vs. 49.7%; p<0.001; OR 1.6, 95%CI 1.2-2.0) were all significantly more frequent in malignant than in benign nodules. These associations were similar when large and small nodules were analysed separately. DISCUSSION: No single parameter, including nodule size, satisfactorily identifies a subset of patients to be electively investigated by FNAC, although several may be useful in this regard.

Biopsy, Fine-Needle↗
PubMed2006

Ectopic lingual thyroid tissue and acquired hypothyroidism: case report.

Ectopic thyroid tissue with thyroid gland in its normal location is an extremely rare phenomenon. We present a case of a 38-year-old woman who was referred to our hospital with symptoms of hypothyroidism. Thyroid hormone measurement revealed clinical hypothyroidism with elevated anti-thyroid antibodies, neck ultrasonography showed a small tissue with the characteristic of Hashimoto thyroiditis, while the scintigraphy demonstrated only a lingual thyroid. Treatment consisted in L-thyroxine replacement to the euthyroid state. We reviewed the literature with respect to the embryological background and the clinical management of such cases.

Choristoma↗
PubMed2006

Genetic mutation screening in an italian cohort of nonsyndromic pheochromocytoma/paraganglioma patients.

To assess the prevalence of genetic mutations in nonsyndromic pheochromocytoma/paraganglioma (PHEO/PGL) patients we have performed a systematic search for mutations in the succinate dehydrogenase (SDH) B, C, and D subunits, von Hippel-Lindau (VHL), and RET genes by direct bidirectional sequencing. Patients were selected from the medical records of hypertension centers. After exclusion of syndromic patients, 45 patients with familial (F+, n=3) and sporadic (F-, n=42) cases of isolated PHEO/PGL were considered. They included 35 patients with PHEO, 7 with PGL, and 3 with head/neck PGL (hnPGL). Three patients with PHEO (2F-, 1F+) presented VHL mutations (P86A, G93C, and R167W), six with PGL (4F-, 2F+) were positive for SDH or VHL mutations (SDHB R230G in two patients, SDHB S8F, R46Q, R90Q, and VHL P81L in one subject each), and one with hnPGL carried the SDHD 348-351delGACT mutation. We have also detected missense (SDHB S163P, SDHD H50R and G12S), synonymous (SDHB A6A, SDHD S68S), and intronic mutations that have been considered nonpathological polymorphic variants. No mutation was found in SDHC or RET genes. Our data indicate that germline mutations of VHL and SDH subunits are not infrequent in familial as well as in sporadic cases of nonsyndromic PHEO/PGL (overall, 12 of 45 probands, 22%). Accordingly, screening for such mutations seems to be justified. However, a more precise characterization of the functional relevance of any observed sequence variant and of other genetic and environmental determinants of neoplastic transformation is essential in order to plan appropriate protocols for family screening and follow-up.

Adrenal Gland Neoplasms↗
PubMed2005

Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types.

OBJECTIVE: To compare the cytological findings of hypoechoic thyroid nodules with intranodular vascular pattern (pattern II) obtained by two different needles (Neolus 25 gauge, Chemil, Wenzhou, China vs Yale Spinal 25 gauge, Becton Dickinson, Madrid, Spain) in euthyroid patients and to evaluate their cost-effectiveness. METHODS: From January 2001 to December 2003, 480 euthyroid patients with a hypoechoic thyroid nodule pattern II were referred for US-FNAC. The nodules were alternatively evaluated by Neolus or by Yale Spinal with the stylet (YS+) or without the stylet (YS-), in order to evaluate if the cytological results could be due to the presence of the stylet or to the different length of the two needles. For each nodule two passes were performed and the material was obtained by capillary action. Material was smeared on slides, fixed, and stained by Papanicolaou techniques. Cytological specimens were evaluated in blind by the same experienced cytopathologist. RESULTS: Inadequate cytological specimens because of blood contamination were present in 30 (18.7%) samples by Neolus needle and in 22 (13.8%) by YS- compared to only 5 (3.1%) by YS+. In 6 (20%) cases of the 30 repeated US-FNAC by Neolus and in 4 (18%) of the 22 US-FNAC by YS-, material remained inadequate for diagnosis because of blood contamination. All the five repeated samples obtained by YS+ became adequate for diagnosis and resulted benign nodules. Direct costs of US-FNAC procedure are currently 72.30 Euro including cytological examination. The cost of Neolus and Yale needles is 0.19 Euro and 3.0 Euro, respectively. The estimated total cost to obtain a cytological diagnosis by a Neolus needle (160 + 30 repeated US-FNAC) was 13809.2 Euro vs 12919.5 Euro by Yale Spinal needle (160 + 5 repeated US-FNAC). CONCLUSION: This study demonstrates that the use of Yale Spinal needles greatly reduces inadequate cytological specimens, and therefore limits both direct and indirect costs.

Biopsy, Fine-Needle↗
PubMed2004

Multirow CT in the follow-up of pancreas transplantation.

PURPOSE: Isolated pancreas or combined kidney-pancreas transplantation represents the only therapeutic weapon for complete resolution of type I diabetes mellitus. The purpose of the present study was to investigate the role of multirow CT in the follow-up of these patients. MATERIALS AND METHODS: Thirty patients who underwent isolated (n = 13) or combined kidney-pancreas (n = 17) transplantation, using systemic-bladder (n = 7) or enteric-portal (n = 23) drainage, were evaluated with multirow CT (Light Speed Plus, GE Medical System). The CT study included unenhanced, arterial, and portal phases of the isolated pancreas, and a urographic phase for combined kidney-pancreas transplants. The acquisition was done with 1.25-mm collimation, 0.6-mm reconstruction interval, and a pitch of 6. A CT scan of the thorax was included if patients were suspected to have pulmonary complications. RESULTS: In all cases it was possible to recognize the surgical technique performed for endocrine and exocrine pancreatic drainage, to evaluate the transplanted pancreas, and to identify possible complications. For example, CT identified thrombosis or stenosis of the arterial graft, partial thrombosis of the venous graft, ectasia of the common iliac artery and arterial graft, dehiscence of the duodenal-bladder anastomosis, infected abdominal collections, thrombosis of the internal iliac vein, and pulmonary infections. CONCLUSIONS: Because multirow CT detects complications it is useful to follow isolated pancreas or combined kidney-pancreas transplants.

Diabetes Mellitus, Type 1↗
PubMed2004

[Bone density and mineral metabolism in calcitonin-deficiency patients].

AIM: Calcitonin is a hormone secreted by thyroid C-cells. Its primary effect seems to be a direct inhibition of bone degradation, but the physiological function of calcitonin in humans is still uncertain. The role of this hormone in the development of osteoporosis is unknown, but few authors have shown bone mass reduction in thyroidectomy patients. METHODS: To investigate the influence of calcitonin deficiency on bone turnover, 9 males (age 31 to 66 years) submitted to total thyroidectomy in 1996 for non-toxic goitre have been studied. These patients received thyroxine treatment at individual dose but never with suppressed TSH levels. Moreover 8 sex-, age- and Body Mass Index-matched normal subjects have also been studied as control group. RESULTS: Calcitonin was undetectable in thyroidectomized patients, while the mean value was 7.1+/-3.2 pg/ml in the control group. At bone ultrasonography 50% of patients showed osteopenia, while only 1 subject showed osteopenia in the control group. The mean calcium serum level of patients was significant lower than in the control group (p<0.001). Calcium urinary level was increased in patients than controls. PTH serum levels were statistically decreased (p<0.001) in patients more than in controls. Osteocalcin showed a significantly (p<0.05) lower bone formation in patients than in controls, while the markers of resorption, deoxypyridinoline and N-terminal telopeptide of type I collagen, suggested an increased bone turnover in calcitonin-deficiency patients. CONCLUSION: The results of this study show that the chronic lack of calcitonin in total thyroidectomized patients may play a role in increased bone degradation and osteopenia with a higher risk of bone fracture.

Adult↗
PubMed2004

Von Recklinghausen's neurofibromatosis associated with duodenal somatostatinoma. A case report and review of the literature.

Somatostatin producing duodenal carcinoids are rare, comprising a mere 2% of small bowel carcinoids and 5-10% of all duodenal tumors. Since the 1st case described by Kaneko in 1979 more than 50 cases have been reported in the world literature. From these reports, it is gradually emerging that duodenal somatostatinomas may show a strong association with von Recklinhausen's neurofibromatosis (VRNF) as a distinct neuroendocrine syndrome. A case of a patient affected by VRNF associated with duodenal somatostatinoma with consequent obstructive jaundice is reported. The authors discuss the characteristics of these tumors and review the literature. A total of 27 patients with Von Recklinghausen's disease associated with immunohistologically proved duodenal somatostatinoma have been identified and compared with 29 duodenal somatostatinoma not associated with VRNF, and with 32 cases of pancreatic somatostatinomas.

Adult↗
PubMed2004

[Erdheim-Chester disease: a non-Langerhans cell histiocytosis. A clinical-case and review of the literature].

We make a retrospective evaluation of clinical and radiologic features, treatment, and outcome of Erdheim-Chester disease, a rare non-Langerhans cell histiocytosis. We report a case of Erdheim-Chester disease and review 60 cases from the literature. These cases are consider to have Erdheim-Chester disease when they have either typical bone radiographs (symmetrical long bones osteosclerosis) and/or histologic criteria disclosing histiocytic infiltration with distinctive immunohistochemical phenotype of the non-Langerhans cell histiocytes with positive staining for CD68 and negative staining for S-100 protein and CD1a. Our patient undergoes chemiotherapy according to the LCH-II stratification and therapy plan (Vinblastine, Etoposide and Prednisone) and thereafter receives Carboplatin and Etoposide, and Somatostatin. She is alive and clinically well 33 months after onset of symptoms and the lesions don't appear to progress at imaging examinations. In conclusion, Erdheim-Chester disease may be confused with Langerhans cell histiocytosis as it sometimes shares the same clinical (exophthalmos, diabetes insipidus) or radiologic (osteolytic lesions) findings. However, the characteristics radiological pattern of Erdheim-Chester disease together the immunohistochemical phenotype of hystiocytic infiltration supports the theory that Erdheim-Chester disease is a unique disease entity distinct.

Adolescent↗
PubMed2004

[Russell's syndrome: a case of long-term survival and review of the literature].

We report the case of a two years old, normally eating child, affected by organic macies and severe dystrophy. After the negative response of blood and laboratory examinations let us exclude a malabsorption syndrome, only the performance of neuro-radiologic exams showed evidence of a subthalamic tumor as the cause of a "Diencephalic syndrome". Diencephalic syndrome or Russell's syndrome is a diencephalic tumor induced disease, which sets in the first time of life. The disease clinical markers are a severe emaciation with appetite preservation and absence or very scarce evidence of any telltale neurological sign. The tumoral histo-pathology most frequently shows a low grade of malignancy astrocytoma, whose eradication is very often difficult because of particular anatomic site. Treatment of choice includes an excisional biopsy with chemotherapy and radiotherapy. We report a clinical case of long-term survival and review of the literature.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Long term prognosis in patients with peripheral arterial disease treated with antiplatelet agents.

OBJECTIVE: To determine the fatal and non-fatal cardiovascular event rate in patients with intermittent claudication treated with antiplatelet agents. METHODS AND DESIGN: Patients with PAD-II stage Fontaine (n=223) and sex and age matched controls (n=446) were followed up from 1974 to 1998. All patients were treated with antiplatelet agents (aspirin, 325 mg once daily or ticlopidine, 250 mg twice daily) and for risk factors, if present. The end points were death for any cause (vascular event, cancer, and others) and non-fatal vascular events (myocardial infarction, ischemic/hemorrhagic stroke, and leg amputation). RESULTS: PAD patients had a significantly higher mortality rate than controls (3.99 vs. 2.53 deaths for 100 patients per year, respectively), cancer (mostly lung, stomach and colon) and vascular mortality accounted for such difference. The incidence of non-fatal vascular events was three times higher in patients than in controls (1.7 vs. 0.56, 100 patients per year, respectively, p<0.05) even considering amputation separately (0.28 vs. 0.00, 100 patients per year, p<0.05). No difference between patients treated with aspirin or ticlopidine could be found in both end points. CONCLUSIONS: Vascular mortality and morbidity, despite the use of antiplatelet agents, are still higher than sex and age matched controls; however, the commonest cause of death is cancer.

Adult↗
PubMed2002

[Prevalence and aggressiveness of thyroid carcinoma with diameter less than one centimetre in iodine deficiency areas].

BACKGROUND: The introduction of highly sensitive imaging techniques has made it possible to detect many non-palpable thyroid nodules with size less than 1 centimetre. The prevalence of these lesions appears to be high in the general population and increases in iodine deficiency areas. Fine needle aspiration biopsy (FNAB) is considered the most reliable test for the diagnosis of thyroid nodules. METHODS: From January 1991 to December 2000, 6627 nodules were referred for FNAB to our department. In 4871 (73.5%) euthyroid patients the mean daily urinary excretion of iodine was 73+/-18 micromg/day. RESULTS: In 2401 nodules (36.2%) the diameter was less than one centimetre. Histologic confirmation of malignancy was available in 187 (89.9%) of 208 operated nodules with diameter more than 1 cm and in 64 (78%) of 82 with diameter less than 1 cm. Logistic regression analysis indicated that a solid hypoechoic feature was a useful criterion to predict malignancy (p<0.001), as well as the presence of calcification (p<0.5) and blurred margins (p<0.5). Lymph node metastases were present in 24.3% of carcinomas with diameter more than 1 cm but, surprisingly, also in 20.3% of those with diameter less than 1 cm. No correlation was seen between diameter of carcinoma nodules and presence of lymph node metastasis. CONCLUSIONS: These data suggest that the potential malignancy of thyroid nodules is not only correlated to the diameter but to other parameters such as the biological difference of thyroid cancer that could be hypothesized in an iodine deficiency area. In conclusion, FNAB is recommended for nodules with diameter less than 1 centimetre when sonographic findings suggest malignancy such as a hypoechoic pattern, an irregular margin or internal microcalcification.

Adenocarcinoma, Follicular↗
PubMed2001

[CT virtual angioscopy in the study of thoracic aortic dissection].

PURPOSE: Virtual endoscopy is a technique in which helical-CT and MR data sets are processed by a special software creating a three-dimensional viewing of the inner surface of hollow viscera that simulates the endoscopic view. We report our 2.5-year experience with virtual intraluminal endoscopy (VIE) in the study of the thoracic aorta in patients with aortic dissection and in patients with normal aorta. MATERIAL AND METHODS: From December 1997 to June 2000, CT angiography (CTA) data sets of the thoracic aorta obtained in a series of 43 patients were retrospectively evaluated. Our series included 23 patients with clinical or radiological suspicion of aortic dissection and 20 patients in whom the study of the thoracic aorta was carried out as a necessary completion of an abdominal aortic disease. CTA data sets were processed with a dedicated software (Navigator); the view point and view direction could be set arbitrarily in the vessel, obtaining an intraluminal endoscopic view of the inner surface of the vessel. Multiple views were obtained and visualised consecutively through a cine-loop technique. The entire thoracic aorta was studied. RESULTS: VIE enabled correct visualisation of the intimal flap in all cases of aortic dissection (=23) and of its origin at the level of the ascending aorta in 16 cases (Stanford A) and in the descending aorta in the remaining 7 patients (Stanford B). In the control group (=20) no signs of intimal flap were identified with the VIE. In all patients with aortic dissection false and true lumen were entirely visualised. VIE allowed the understanding of the relation between false lumen and supraaortic vessels that originated from the true lumen in all cases and were found to be dissected in 6 patients. In 16 cases the dissection included thoracic and abdominal aorta. In some cases the endoscopic view was altered by artifacts related to the selected threshold levels and represented by pierced surface and floating shape artifacts. A correlation with axial and multiplanar (MPR) images allowed the correct interpretation of such artifacts. CONCLUSIONS: According to our experience, virtual endoscopy represents a useful tool in the evaluation of the dissection of the thoracic aorta, allowing a better definition of anatomical details. A correlation with axial images and multiplanar views remains compulsory for a better understanding of VIE findings, which is nevertheless significantly influenced by the operator's experience.

Aortic Dissection↗
PubMed1999

Radiation-induced cerebral vasculopathy in children with neurofibromatosis and optic pathway glioma.

Occlusive vasculopathy is a potential complication of radiotherapy in children with optic pathway glioma. With a median follow-up of 7 years, 13 of 69 children in this study developed clinical and radiological signs of occlusive vasculopathy after radiotherapy within a median interval of 36 months. The major risk factor was neurofibromatosis type 1. Radiotherapy should no longer be the first treatment in these settings. When radiotherapy is unavoidable, regular screening for cerebral vasculopathy is mandatory, as preventive treatment is available.

Cerebrovascular Disorders↗
PubMed1998

Preclinical development of camptothecin derivatives and clinical trials in pediatric oncology.

Although the prognosis of childhood cancers has dramatically improved over the last three decades, new active drugs are needed. Camptothecins represent a very attractive new class of anticancer drugs to develop in paediatric oncology. The preclinical and clinical development of two of these DNA-topoisomerase I inhibitors, i.e. topotecan and irinotecan, is ongoing in paediatric malignancies. Here we review the currently available results of this evaluation. Topotecan proved to be active against several paediatric tumour xenografts. In paediatric phase I studies exploring several administration schedules, myelosuppression was dose-limiting. The preliminary results of topotecan evaluation in phase II study showed antitumour activity in neuroblastoma (response rate: 15% at relapse and 37% in newly diagnosed patients with disseminated disease) and in metastatic rhabdomyosarcoma (40% in untreated patients). Topotecan-containing drug combinations are currently investigated. Irinotecan displayed a broad spectrum of activity in paediatric solid tumour xenografts, including rhabdo-myosarcoma, neuroblastoma, peripheral primitive neuroectodermal tumour, medulloblastoma, ependymoma, malignant glioma and juvenile colon cancer. For several of these histology types, tumour-free survivors have been observed among animals bearing an advanced-stage tumour at time of treatment. The clinical evaluation of irinotecan in children is ongoing. Irinotecan undergoes a complex in vivo biotransformation involving several enzyme systems, such as carboxylesterase, UDPGT and cytochrome P450, in children as well as in adults. Preclinical studies of both drugs have shown that their activity was schedule-dependent. The optimal schedule of administration is an issue that needs to be addressed in children. In conclusion, the preliminary results of the paediatric evaluation of camptothecin derivatives show very encouraging results in childhood malignancies. The potential place of camptothecins in the treatment of paediatric malignant tumours is discussed.

Animals↗
PubMed1998

Long-term follow up of 69 patients treated for optic pathway tumours before the chemotherapy era.

AIM: To analyse the long-term results of conservative management with radiotherapy in patients with optic pathway tumours. DESIGN: All 69 patients were symptomatic at diagnosis and most neoplasms involved the optic chiasm and hypothalamus. RESULTS: At 10 years, overall survival and progression free survival were 83% and 65.5%, respectively. After radiotherapy, vision improved in 18 patients and remained stable in 29 other patients. Cerebrovascular complications occurred in nine of 53 patients treated with radiotherapy after a median interval of two and a half years. These complications were five times more frequent in patients with neurofibromatosis type 1 (NF1). Severe intellectual disabilities were present in 18 children, most of whom underwent irradiation at a very young age (median age, 4 years). IMPLICATIONS: Radiotherapy is a valuable treatment in terms of tumour response, visual outcome, and progression free survival. However, in young children and in patients with NF1, major sequelae are encountered and new treatment strategies should be proposed for these patients.

Adolescent↗
PubMed1998

[The accidental diagnosis of a left atrial myxoma in an 80-year-old female].

Left atrial myxoma is usually diagnosed in patients between the ages of 30 and 60 and this diagnosis follows non-specific symptoms (i.e. temperature, anemia, weakness), and obstructive or embolic episodes. There are few cases in the literature of this disease in patients older than 80. We report the case of an 80-year-old female admitted to our institute for an episode of supraventricular tachycardia. After successful treatment of the arrhythmia using verapamil i.v., a routine echocardiographic examination showed the presence of a left atrial mass, and its appearance suggested the diagnosis of a left atrial myxoma. A CT scan and a transesophageal echocardiography confirmed the diagnosis. The patient subsequently underwent cardiac catheterization and coronary angiography. In the absence of significant lesions of the coronary artery, a decision was made to remove the myxoma surgically, based on two considerations: the good clinical status of the patient and the high current risk of peripheral embolization. The operation was successful in removing the myxoma and the patient continues to be in good clinical condition.

Aged↗