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Biomedical subjects

G Elia

Publications and source records attributed to G Elia.

At least 73 records · Page 4Linked to original sources
PubMed1995

A cohort study comparing laparoscopic-assisted vaginal hysterectomy and extrafascial hysterectomy.

STUDY OBJECTIVE: To compare extrafascial hysterectomy (TAH) and laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN: Consecutive women scheduled for hysterectomy, who entered one group or the other based on personal preference. SETTING: A university-affiliated women's hospital. PATIENTS: Thirty-seven women with benign gynecologic pathology. INTERVENTIONS: Eighteen underwent TAH and 19 had LAVH. All were followed for 6 months postoperatively. MEASUREMENTS AND MAIN RESULTS: The duration of LAVH was significantly longer than that of TAH; estimated blood loss was significantly higher for TAH; and the duration of use of narcotic analgesics, length of hospital stay, and length of time to resumption of routine working activity were significantly shorter after LAVH. No difference was found in the two groups with respect to Q-Tip test preoperatively and 6 months after surgery. CONCLUSIONS: We believe LAVH is a valid and safe alternative to TAH in selected patients. The two procedures do not alter the mobility of the bladder neck on short-term follow-up. Additional prospective studies are necessary to confirm our data.

Activities of Daily Living↗
PubMed1995

Analysis of crypt cell proliferation in coeliac disease using MI-B1 antibody shows an increase in growth fraction.

This study aimed to investigate the pattern of cellular proliferation and to calculate the growth fraction of small intestinal crypts in 24 patients--eight with untreated coeliac disease (CD), six with treated CD, and 10 controls with normal villous architecture. Duodenal biopsy specimens were stained with MI-B1 antibody using an immunoperoxidase method. Positive stained crypt cells were counted and their position within each intact crypt column was noted. These were used to construct proliferation index distribution curves for each cell position from which the crypt growth fraction for each group of patients was calculated. The crypt growth fraction was found to be higher in the untreated CD group (0.57) than in the treated patients (0.39) and the controls (0.44). The mean (SEM) proliferative index for each crypt was significantly higher in the untreated group (42.3 (10.8)%; p < 0.05) than in the treated CD (21.7 (8.5)%) and control (19.7 (7.5)%) groups and correlated closely with the surface:volume index and enterocyte cell height measurements in all three groups. An increased growth fraction may contribute to other changes in crypt cell kinetics to produce the histological changes seen in untreated CD.

Adult↗
PubMed1995

Expression of trefoil peptides pS2 and human spasmolytic polypeptide in gastric metaplasia at the margin of duodenal ulcers.

Duodenal ulcers are associated with gastric metaplasia in the duodenum, both at the ulcer margin and at more distant sites in the duodenal bulb. pS2 and human spasmolytic polypeptide (hSP) are secretory peptides expressed in gastric epithelial cells and in gastric metaplasia. As these peptides may be important in ulcer healing, this study investigated the possibility that the expression of pS2 and hSP is increased in gastric metaplasia at the margin of duodenal ulcers. Duodenal bulb biopsy specimens from 12 duodenal ulcer patients were assessed. Sections were immunostained with monoclonal antibodies for pS2 and hSP. Cytoplasmic stain intensities were measured by an image analysis system and expressed as integrated optical density (IOD) units, In situ hybridisation for pS2 and hSP mRNA was carried out on parallel sections. Duodenal sections were also stained with diatase periodic acid Schiff/alcian blue to localise areas of gastric metaplasia. pS2 antigen staining in the duodenum was restricted to surface epithelial cells, and hSP to acinar and ductular components of Brunner's gland. mRNA localisation corresponded to immunostaining cells. In gastric metaplasia, pS2 expression was greater at the ulcer margin than away from the ulcer, as judged by the intensity of antibody staining (mean IOD units (SEM), 20.6 (3.3) v 9.5 (3.0); p < 0.001). There was a trend towards greater hSP staining at the ulcer margin but this did not achieve statistical significance. These findings support the putative role of pS2 and possible hSP in mucosal healing and providy further evidence for an autocrine 'ulcer-gastric metaplasia-repair' loop involving these trefoil peptides.

Brunner Glands↗
PubMed1995

Genuine stress urinary incontinence with low urethral pressure. Five-year follow-up after the Ball-Burch procedure.

OBJECTIVE: To evaluate long-term results of the Ball-Burch procedure in women with genuine stress incontinence (GSI), low urethral pressure type. STUDY DESIGN: Sixty women with a clinical and urodynamic diagnosis of GSI, low urethral pressure type, underwent the Ball-Burch procedure between May 1987 and February 1988. They were evaluated preoperatively and one and five years after surgery. The urogynecologic workup consisted of a history, physical examination, urine culture, neurologic examination, urethrocystoscopy, cotton swab test, urethrocystometry, urethral profilometry and uroflowmetry. Forty-eight women were available at the one-year follow-up, and 32 of the 48 (66.7%) were available after five years; the mean age at the time of surgery was 58.7 years and mean parity, 2. Twenty-seven women were premenopausal and 33 postmenopausal; at the five-year follow-up all but 2 were postmenopausal. All postmenopausal women received estrogen replacement therapy prior to urodynamic evaluation. Cure was defined as absence of loss of urine by history (subjective) and during urodynamic evaluation (objective). The t test and paired t test were used for statistical analysis. RESULTS: Forty-two of 48 women (87.5%) were cured after one year, and 27 of 32 (84%) were cured after five. There was a statistically significant difference between the preoperative and five-year follow-up values for the swab test, maximum urethral closure pressure and pressure transmission ratio at the proximal and mid urethra. Twenty-six of 29 patients with a negative swab test at the one-year follow-up were cured after five years, resulting in a predictive value of 89% for cure after a negative test. CONCLUSION: In our series the Ball-Burch procedure was an effective surgical treatment for patients with GSI and low urethral pressure. The swab test, when negative one year after surgery, was predictive of a successful long-term outcome.

Adult↗
PubMed1995

Surgical management of patients with endometrial cancer and cervical involvement.

OBJECTIVE: To evaluate the role of extrafascial hysterectomy in the management of women with endometrial carcinoma and cervical involvement. METHODS: A review of 238 medical records of patients with endometrial cancer treated at the Weiler Hospital of the Albert Einstein College of Medicine and Montefiore Medical Center from 3/86 to 3/91 was performed. Thirty-one patients were selected based on histopathologic documentation of cervical involvement in the surgical specimen. Fisher exact probability test, Kaplan-Meier and Log-Rank procedures were used for the statistical analysis of the data. RESULTS: Two patients were excluded as they received preoperative radiotherapy. Nineteen patients had Stage II disease and ten were found to have Stage III (two for positive washings, eight for positive pelvic and/or para-aortic nodes). Sixteen of 19 patients with Stage II disease received postoperative pelvic radiotherapy. Six patients with Stage III received postoperative radiotherapy, four with Stage III received chemotherapy. The probability of survival for Stage II patients was 72%, for Stage III 33% and the entire group was 60% (median follow-up 55 months). CONCLUSIONS: Extrafascial hysterectomy was performed without major complications in 86% of patients with endometrial carcinoma and microscopic cervical involvement. This procedure may be considered an adequate first line of treatment for patients without gross cervical spread of the disease.

Aged↗
PubMed1995

Diagnostic considerations in coexisting bladder and urethral leiomyomata. A case report.

BACKGROUND: Leiomyomata of the lower urinary tract in women are rare. Coexisting urethral and bladder leiomyomata have never been reported before. CASE: A 45-year-old woman, gravida 6, para 5, abortus 1, presented with a one-year history of increasing frequency, nocturia and hesitancy of up to 10-15 minutes at times. An intravenous pyelogram showed an extrinsic mass at the bladder neck. Urethrocystoscopy revealed a regular bulge at the level of the bladder neck on the right side without involvement of the bladder mucosa. Ultrasound showed a 5 x 4.7 x 4-cm mass of heterogeneous echogenicity, posterior to the bladder and anterior to the lower uterine area, with a normal-appearing uterus. The patient underwent surgery for vaginal excision of the tumor. Two separate masses were found at surgery. One small, firm, solid, 2-cm mass was found on the posterior proximal aspect of the urethra, and a larger, soft, 3 x 3-cm mass was found on the posterior lower aspect of the bladder. The masses clearly arose from the urethra and bladder, respectively. Rapid frozen section revealed smooth muscle cells consistent with leiomyomata. Both leiomyomata were entirely resected. CONCLUSION: Lower urinary tract leiomyomata should always be considered in the differential diagnosis of an anterior vaginal mass in premenopausal women.

Female↗
PubMed1994

Regulation of heat shock protein synthesis by quercetin in human erythroleukaemia cells.

Synthesis of heat-shock proteins (HSPs) is universally induced in eukaryotic and prokaryotic cells by exposure to elevated temperatures or to other types of environmental stress. In mammalian cells, HSPs belonging to the 70 kDa family (HSP70) have a regulatory role in several cellular processes, and have been shown to be involved in the control of cell proliferation and differentiation. Although many types of HSP70 inducers have been identified, only a few compounds, all belonging to the flavonoid group, have been shown to inhibit HSP70 induction. Because inhibitors of HSP70 synthesis could be an important tool with which to study the function of this protein, we have investigated the effect of quercetin, a flavonoid with antiproliferative activity which is widely distributed in nature, on HSP70 synthesis in human K562 erythroleukaemia cells after treatment with severe or mild heat shock and with other inducers. Quercetin was found to affect HSP70 synthesis at more than one level, depending on the conditions used. Indeed, after severe heat shock (45 degrees C for 20 min) treatment with quercetin, at non-toxic concentrations, was found to inhibit HSP70 synthesis for a period of 3-4 h. This block appeared to be exerted at the post-transcriptional level and to be cell-mediated, as the addition of quercetin during translation of HSP70 mRNA in vitro had no effect. After prolonged (90 min) exposure at 43 degrees C, however, quercetin was found to inhibit also HSP70 mRNA transcription. Pretreatment of K562 cells with quercetin had no effect on HSP70 expression, and quercetin needed to be present during induction to be effective. Under all conditions tested, the quercetin-induced block of HSP70 synthesis was found to be transient and, after an initial delay, synthesis of HSP70 reached the control rate and continued at the same level for several hours after the time at which HSP70 synthesis had been turned off in control cells. Finally, inhibition of HSP70 synthesis by quercetin appeared to be dependent on the temperature used and on the type of stressor.

Cell Survival↗
PubMed1994

Expression of the trefoil peptides pS2 and human spasmolytic polypeptide (hSP) in Barrett's metaplasia and the native oesophageal epithelium: delineation of epithelial phenotype.

The distribution of the two trefoil peptides pS2 and human spasmolytic polypeptide (hSP) and their mRNAs was investigated in 90 selected oesophageal biopsies, 23 of which contained epithelium with wholly gastric cardiac-type morphology, 52 specialized (intestinal)-type metaplasia, and 15 non-metaplastic oesophageal epithelium. No fundic-type epithelium was represented. The cardiac-type epithelium resembled true gastric antral epithelium, with hSP and pS2 mRNA localization to the superficial/foveolar compartment and hSP mRNA alone in deeper glands. The pattern of peptide distribution was broadly in line with the mRNA, but hSP peptide was generally not demonstrable in the surface epithelium. pS2 immunostaining was diffusely cytoplasmic, whereas in specialized-type mucosa it was aggregated and cytoplasmic. hSP mRNA was demonstrable in surface epithelium of incomplete- but not complete-type intestinal (specialized) metaplasia. Deep glands with morphological features of pyloric glands/ulcer-associated cell lineage (UACL) typically contained only hSP peptide and its mRNA. In three biopsies containing specialized epithelium, small foci morphologically identical to true small intestinal surface epithelium were seen in which only pS2 mRNA and peptide were found and then only in rare goblet cells. Neither squamous epithelium nor oesophageal glands contained demonstrable pS2/hSP mRNA or peptide. The function of these proteins in the metaplastic mucosa of Barrett's oesophagus is unknown but they may reflect an epithelium responding to repeated insult. Their localization facilitates definition of the disparate epithelium types seen in this portion of the gut, with both native gastric and intestinal epithelia, and may help to pinpoint high-risk epithelium in Barrett's oesophagus, a potentially preneoplastic condition.

Barrett Esophagus↗
PubMed1994

The ulceration-associated cell lineage (UACL) reiterates the Brunner's gland differentiation programme but acquires the proliferative organization of the gastric gland.

The ulceration-associated cell lineage (UACL) develops in the human gastrointestinal mucosa after ulceration; it grows out from the bases of adjacent crypts and ramifies in the lamina propria to form a new gland, finally giving rise to a duct by which the glandular secretion and indeed cells are carried to the surface. Using immunocytochemistry and in situ hybridization with 35S-labelled riboprobes, we have defined the pattern of trefoil peptide gene expression (pS2; human spasmolytic polypeptide, hSP), epidermal growth factor/urogastrone (EGF/URO), and the distribution of cell proliferation during the development of the UACL, as indicated by immunostaining for proliferating cell nuclear antigen (PCNA). Our studies reveal that the morphogenesis of the UACL shows a marked morphological resemblance to developing Brunner's glands; the pattern of trefoil peptide gene expression during UACL development is also very similar. However, trefoil peptide gene expression in the mature UACL complex is unique amongst gastrointestinal cells. The mature UACL shows a distinctive proliferative organization: while the early buds and glands are non-proliferative, apparently being fed by cells from the parent crypts, a definitive proliferative zone develops within the duct. This, of course, corresponds to the location of the gastric gland proliferative zone. We propose that while the UACL shows novel features, it shares its differentiation programme with Brunner's glands, but its pattern of cell renewal eventually is that of the gastric gland.

Brunner Glands↗
PubMed1994

The production and characterization of a new monoclonal antibody to the trefoil peptide human spasmolytic polypeptide.

Human spasmolytic polypeptide (hSP) is a member of the growing family of trefoil peptides which are expressed in discrete regions of the body, most notably the gastrointestinal tract. Much of the research into the localization of the spasmolytic polypeptide has relied on hybridization in situ to detect its mRNA, due to the absence of a suitable antibody. The aim of the present study was to develop and characterize a monoclonal antibody against the human spasmolytic polypeptide, using a combination of immunohistochemistry and hybridization in situ. After immunoblotting, the antibody detected a 14 kDa protein in gastrointestinal tissue extracts from the stomach and small intestine only. Using immunohistochemistry, human spasmolytic polypeptide showed a distinctive staining pattern in the duodenum which co-localized with its mRNA. The co-localization of the immunoreactive peptide with its mRNA provides good evidence that the antibody truly recognized human spasmolytic polypeptide.

Animals↗
PubMed1994

Octreotide versus terlypressin in acute variceal hemorrhage in liver cirrhosis. Emergency control and prevention of early rebleeding.

Sixty patients with endoscopically confirmed active variceal bleeding entered a randomized controlled clinical trial aimed at comparing the efficacy of octreotide vs. terlypressin in the control of acute variceal hemorrhage (period I, 24 h) and in the prevention of early rebleeding (period II, 6 days). Of the sixty 30 received octreotide (period I, 100 micrograms bolus followed by continuous intravenous infusion at 25 micrograms/h; period II, 100 micrograms t.i.d. subcutaneously), and 30 received terlypressin (period I, 2 mg intravenous bolus every 4 h; period II, 2nd day, 2 mg every 6 h; from 3th to 7th days, 1 mg every 6 h). Control of bleeding was achieved in 23 (76.6%) patients receiving octreotide and in 16 (53%) treated with terlypressin (NS); none of these patients suffered rebleeding during treatment. No significant difference in mortality was observed between the two groups during the hospitalization period. Complications due to therapy were lower with octreotide than with terlypressin (P < 0.01). Under the same effectiveness conditions the cost/benefit ratio must be taken into account.

Cost-Benefit Analysis↗
PubMed1994

Biochemical composition of collagen in continent and stress urinary incontinent women.

This study was designed to assess the relationship between the amount of collagen type III in the pelvic supportive tissues and stress urinary incontinence (SUI) with or without pelvic relaxation. Fourteen women agreed to participate in the study: 6 had stress urinary incontinence and pelvic relaxation (group 1); 4 had no pelvic relaxation and no sign or symptoms of SUI (group 2); 4 had pelvic relaxation without SUI (group 3). All patients underwent gynecologic surgical procedures for benign pathology and at that time biopsies were taken from perineal skin, uterosacral ligaments and round ligaments of the uterus. Collagen type III content was measured in the specimens and compared between the groups. Each subject preoperatively underwent complete urodynamic workup. A t test was used for the statistical analysis. Collagen type III content was significantly reduced (p < 0.05) in the specimens from patients with SUI (group 1) as compared independently with each of the other two groups (groups 2 and 3). Tissues from women without SUI (groups 2 and 3) had a similar content of collagen type III. These findings suggest that women with SUI show an altered collagen profile in the skin, the uterosacral, and the round ligaments. This seems unrelated to secondary damage of the supportive tissues and degree of pelvic relaxation.

Adult↗
PubMed1993

Expression and purification of a trefoil peptide motif in a beta-galactosidase fusion protein and its use to search for trefoil-binding sites.

The cysteine-rich trefoil motif of rat intestinal trefoil factor (rITF) was cloned and expressed in Escherichia coli. A 270-bp cDNA fragment including the signal sequence and the trefoil motif was cloned into the expression vector pAX5+ to direct the expression of a beta-galactosidase collagen-hinged fusion protein in E. coli. Cultures harbouring the recombinant plasmid produced a soluble novel protein with a molecular mass of 134.5 kDa, as predicted for the trefoil-motif-containing fusion protein. Purification of the rITF moiety was achieved by p-aminophenyl-thio-beta-D-galactoside(APTG)-affinity chromatography, collagenase digestion of the hybrid molecule, and removal of the beta-galactosidase-hinge molecule by a further APTG-affinity step. It was demonstrated that intrachain disulphide-bond formation in rITF occurred during the procedure, so no refolding steps were required. Analysis by immunoblotting revealed that the fusion protein and the cleaved trefoil-motif-containing protein were recognised by an antibody raised against the chemically synthesised peptide. The trefoil motif present in the fusion protein was used to localise putative trefoil-binding sites in sections of frozen rat tissue. Binding was demonstrated using the beta-galactosidase portion of the fusion protein as a reporter moiety, either directly with 5-bromo-4-chloro-3-indolyl-beta-D-galactoside, or indirectly using a monoclonal antibody to beta-galactosidase and indirect immunohistochemistry. Binding sites were localised to the foveolar and surface epithelium of rat stomach, the collecting ducts of the kidney and within colonic crypts. The presence of a trefoil motif was necessary for binding. The use of beta-galactosidase fusion proteins for histochemical localisation of peptide-binding sites should prove more generally useful.

Animals↗
PubMed1993

Bcl-2 proto-oncogene expression in Epstein-Barr-virus-associated nasopharyngeal carcinoma.

The bcl-2 proto-oncogene product inhibits apoptosis. Increased levels of bcl-2 protein are associated with prolonged B-cell survival and have been demonstrated in a high proportion of follicular B-cell lymphoma. Recent studies have shown that bcl-2 protein expression in B cells immortalized by Epstein-Barr virus (EBV) in vitro is up-regulated by the EBV-latency-associated antigen, latent membrane protein (LMP) 1. The epithelial malignancy, undifferentiated nasopharyngeal carcinoma (UNPC), has a well-established association with EBV and the tumour cells characteristically display a restricted latent viral phenotype including LMP 1. This study has investigated the relationship between the presence of EBV DNA, EBV phenotypic profiles and bcl-2 protein expression in conventionally processed and cryopreserved samples of NPC using in situ hybridization, immunocytochemical and immunoblotting techniques. bcl-2 was detected in most (80%) samples of UNPC as well as in 1/3 samples of keratinizing NPC and 2/2 samples of nasopharyngeal adenocarcinoma. However, no close correlation was found between the presence of EBV DNA, and profiles for LMP 1 and bcl-2 protein expression in 45 UNPC. In addition, bcl-2 protein was shown to be selectively expressed in the basal compartment of normal nasopharyngeal epithelia. bcl-2 protein expression has not been reported previously in malignant tumours of epithelial origin. The findings in this study implicate a role for bcl-2 both in normal keratinocyte differentiation and in the pathogenesis of epithelial malignancy.

Adenocarcinoma↗
PubMed1993

The expression of the trefoil peptides pS2 and human spasmolytic polypeptide (hSP) in 'gastric metaplasia' of the proximal duodenum: implications for the nature of 'gastric metaplasia'.

Expression of pS2 protein (an oestrogen-induced gene discovered in the MCF-7 breast carcinoma cell line) and its homologue human spasmolytic polypeptide (hSP) was analysed, using immunohistochemistry and in situ hybridization to their mRNAs, in the proximal duodenum of 17 partial gastrectomy specimens removed from individuals with chronic peptic ulceration. Eight were found to have gastric-type metaplasia. In gastric metaplasia, mRNAs for pS2 and hSP, and pS2 peptide antibody were co-localized in the cells covering the duodenal villi. pS2 immunostaining was diffusely cytoplasmic in nature. A similar pattern was seen in Brunner's gland ducts. The trefoil peptide localization in gastric metaplasia closely resembles that seen in superficial gastric epithelium and the distal Brunner's gland duct, which in turn shares morphological similarities with gastric epithelium. We therefore conclude that gastric metaplasia may be the result of an expansion of the surface component of the Brunner's gland duct. The function of these trefoil peptides is at present unknown, but their distribution elsewhere suggests an involvement in reparative mechanisms. The similarities between gastric foveolar and Brunner's gland duct epithelium may derive from common restitution-enhancing features pertinent to a locally harsh environment.

Brunner Glands↗
PubMed1993

Platinum chemotherapy during pregnancy for serous cystadenocarcinoma of the ovary.

Ovarian carcinoma in pregnancy remains a rare event. Although concern regarding the gestation complicates therapy, platinum drug-based combination chemotherapy is often deemed warranted in such cases. We report the antepartum use of cisplatin, followed by carboplatin, for an ovarian serous cystadenocarcinoma. During this treatment, serial sonographic assessment of fetal morphometric parameters and biophysical profiles with fetal heart rate monitoring were performed to document fetal well being. Platinum-DNA adducts were measured in maternal blood, placenta, fetal amniotic cells, and cord blood. This report represents an attempt to define platinum drug transfer in utero and fetal growth and development during therapy and to document the first use of carboplatin in pregnancy.

Adult↗
PubMed1993

Torasemide versus furosemide in cirrhosis: a long-term, double-blind, randomized clinical study.

The effects of long-term therapy (70 days) with torasemide (20 mg/day), a new loop diuretic, were compared with those of furosemide (50 mg/day) in a randomized double-blind trial. Both drugs were administered in association with spironolactone (200 mg/day) in 28 nonazotemic cirrhotic patients with controlled ascites. The treatments did not modify creatinine clearance and exhibited a similar effect on body weight, urinary volume, and fractional excretion of uric acid, sodium, and chloride. The effect of torasemide on fractional potassium excretion was lower than that of furosemide. Torasemide showed higher sparing effect than furosemide on calcium, inorganic phosphate, and magnesium excretion and stronger action on free water clearance. No changes in serum parameters were induced by either treatment. Two episodes of hepatic encephalopathy occurred in the torasemide group. In view of its effects on sodium and water excretion and on other urinary parameters, torasemide can represent an alternative tool for the long-term treatment of ascites.

Ascites↗