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Biomedical subjects

G Gandini

Publications and source records attributed to G Gandini.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Intraluminal ultrasonography of the biliary ducts].

We report our 4 years' experience with intraluminal US of the biliary ducts performed on 24 patients via a biliary transhepatic-duodenal drainage catheter or a surgically inserted T tube (2 cases). The final diagnosis was a malignant disease in 16 patients and a benign disease in 8 patients. We used an Intra Vascular Ultra Sound (Diasonics) unit with a 20 MHz transducer inserted into a 9 F catheter with closed tip, which in turn was pushed through the biliary ducts in a 12 F sheathed introducer which provides a safety metal guide wire in the duodenum. US examinations lasted only a few minutes and caused no additional patient discomfort; no complications followed. Intraluminal US confirmed the results of other clinical and instrumental tests in 18/24 patients and improved the diagnostic yield in assessing lesion nature and operability in 6 cases (25%). Its cost is high, but the Intra Vascular Ultra Sound includes a 3.5 MHz and a 7 MHz probes and can therefore be used for all the other US examinations needed in interventional radiology rooms and in the study of the biliary ducts. To decrease the cost, we used the Intra Vascular Ultra Sound in less than 10% of the patients treated for biliary obstruction in the same period of time, namely those with questionable diagnosis and operability. We conclude that intraluminal US of the biliary ducts is a useful tool in the centers using interventional radiology to treat many obstructive jaundice patients by a transhepatic approach.

Adult↗
PubMed1997

[Doppler-color ultrasonography in the diagnosis of parotid tumors].

Today ultrasound, often integrated with CT and NMR, is used in the differential diagnosis of parotid masses. Color-Doppler Sonography is a recently introduced method which makes it possible to evaluate intra- and perilesional vascularization and to perform a hemodynamic study of the area being explored. Using an Acuson 12P ultrasound unit 21 patients with surgically treated parotid neoformations were examined. All had previously undergone traditional ultrasound and CT. An abundant vascularization, both intralesional and peripheral, was found in 4 malignant lesions, in one intraglandular granulomatose lymph adenopathy, in one pleomorphic adenoma of the deep lobe and in one case of Sjögren's syndrome. In the remaining cases (7 pleomorphic adenomas and 7 cystoadenolymphomas) vascularization was either totally absent or only slightly visible in the periphery. These preliminary results would appear to indicate that the presence of hypervascularization testifies to a malignant lesion or to an inflammatory disorder. The Color-Doppler Sonography can provide a useful adjunct to conventional ultrasound, increasing diagnostic accuracy in cervical-parotid masses.

Adolescent↗
PubMed1996

YAC clone H10 discriminates between 3q26.2 and 3q27 chromosome rearrangements in hematological disorders.

To discriminate with molecular-cytogenetic resolution between 3q26.2 breakpoint, associated to various myeloproliferative disorders, and 3q27 breakpoint, recurrent in several types of non-Hodgkin lymphoma, we tested the feasibility of using a yeast artificial chromosome, YAC clone H10, mapped on 3q26.3. Fluorescent in situ hybridization of the biotinylated polymerase chain reaction product of the YAC H10 was performed in three myeloproliferative diseases and one follicular non-Hodgkin lymphoma carrying different rearrangements of chromosome 3 involving region q26-q27. Our study shows that YAC H10 signal was telomeric to all three myeloid breakpoints, while it was centromeric in the lymphoid one thus showing that this probe can discriminate between these two subsets of chromosome 3 rearrangements. These results point out the opportunity of using additional YACs in the characterization of polymorphic chromosome alterations acquired in neoplastic cells.

Aged↗
PubMed1996

[Report of a rare case of Langerhans-cell histiocytosis of the skull base].

INTRODUCTION: Langerhans cell histiocytosis, once called histiocytosis X, is a rare disease. Usually it can occur in children and is characterized by granulomas (eosinophilic granuloma and Hand-Schueller-Christian disease) or by a extensive involvement of various organs (Letterer-Siwe disease). The etiology remains uncertain and could be related to undefined immunologic disturbance. Lesions can involve bone marrow, skin, oral mucosa, retro-orbital tissue, central nervous system, lymph nodes, spleen, liver, lung, and gastroenteric tract. Surgery, radiotherapy and chemotherapy can be employed as treatment. Prognosis is different in relation to the extension of the disease. CASE REPORT: In our case (a 33 year old female) came to observation for swelling in temporal region. The patient underwent clinical and radiological examinations: the lesion involved the skull base in the right part of the sphenoid bone. CT and MRI showed a "clepsydra" lesion with wider extension to infratemporal fossa and to intracranial middle fossa and shrinking in the base of the skull; inside the lesion a lot of wider calcifications were present. A biopsy proved a diagnosis of Langerhans cell histiocytosis. No other localizations of disease were found. The patient was treated with chemotherapy followed by localized radiotherapy. Chemotherapy was performed with 3 cycles of etoposide 260 mg for 3 days every month. After this treatment a response of 25% was observed. Afterwards a radiotherapy with cobalt 60 was employed through two angled wedged fields for a total dose of 22 Gy and conventional fractionation. During the follow-up a slow, partial regression of the lesion with increase of the extension of the calcifications documented by CT and MRI was observed. After 5 years follow-up no progression of disease was observed. DISCUSSION: The usual treatment of Langerhans cell histiocytosis is surgery and eventually radiotherapy for localized disease and chemotherapy for extended disease. The prognosis is related to the number of involved organs: usually favorable with only one site of disease and unfavorable when more organs are involved. Other unfavorable prognostic factors are the age < 2 years, the presence of anemia, liver and spleen involvement and respiratory failure. In our case only one site of disease was evident and the clinical behavior has been quite favorable. The main peculiarities are the radiologic aspect and the slow, partial regression after the treatment; this fact could be related to the presence of wide calcifications inside the lesion. After 5 years follow-up it is possible to consider the absence of progression as a response to the treatment.

Adult↗
PubMed1995

Chromosome rearrangements at telomeric level in hematologic disorders.

Following retrospective screening of our karyotype data from 414 consecutive non-childhood, neoplastic, and preneoplastic hematologic diseases, we have isolated 11 cases with alterations involving one or two chromosome termini, including: a) nonclonal telomeric telomeric associations (tas), b) subclonal terminal rearrangements consisting of additional (add) material of unknown origin fused at the end of the chromosome, c) clonal telomere-centromere fusion (t telcen) with pseudodicentric structure. Most of these abnormalities were present in karyotypes with multiple alterations and associated to an evolutive stage of the disease (9 of 94 cases studied in progression, including three of 22 CML studied in blast crisis). The immunophenotype of the cell populations was lymphoid in eight cases, six of which were NHL, and myeloid, erythroid, and undifferentiated in the other three. More data on telomeric abnormalities may clarify whether there is ubiquitous genomic instability of neoplastic cells or an inborn cell lineage predisposition favoring rearrangements involving telomeres.

Adult↗
PubMed1995

Assessment of minimal residual disease in acute promyelocytic leukaemia with t(15;17) by chromosome painting.

To detect the minimal residual disease (MRD) in acute promyelocytic leukaemia patients treated with all-trans retinoic acid, we compared the sensitivity of metaphase fluorescence in situ hybridization (FISH) with conventional analysis of G-banded metaphases. 5 out of 6 patients studied at diagnosis showed the t(15;17) translocation. 4 out of 5 patients carrying t(15;17) achieved complete remission and conventional cytogenetic conversion. In 3 cases the whole chromosome painting (WCP) probe 17 discovered one normal chromosome 17 and two fragments indicative of t(15;17) persistence. The FISH-WCP technique seems to be highly sensitive and recommendable in monitoring leukaemias with specific chromosome rearrangements.

Adult↗
PubMed1995

[Radiologic features of osteosarcoma of the jaw].

Osteosarcoma of the jaw differs from that in other sites because it is less aggressive, rarely metastasizes and appears later in life. The literature lacking a systematic treatise on the radiologic features of this disease, the authors decided to collect the case histories of 9 patients, 5 men and 4 women, 24 to 48 years old, suffering from osteosarcoma of the jaw. Both conventional radiography and CT were used to examine all patients. The accurate study of radiologic findings made it possible to establish 3 basic lesion patterns. The first and very rare one, is characterized by the total absence of neoplastic tissue ossification processes; in this case, the radiologic diagnosis is extremely difficult, even with CT support. The second and more common pattern exhibits evident tumor neo-ossification, the most representative cases present several bone lamellae radiating from the lesion, with a sunburst-like appearance. The disease can be diagnosed with conventional radiography alone, especially in the most advanced cases; CT permits the identification of early forms, missed with conventional methods. The third pattern is characterized by amorphous lesion ossification: there are small areas of structureless ossification and a patchy appearance, separated by non-ossified neoplastic tissue. CT shows tumor ossification missed at conventional radiography. Finally, the authors observed an extremely rare case of parosteal sarcoma of the jaw, considered a variety of osteosarcoma by some pathologists. The lesion presented uniform neo-ossification which was highly sclerotic and separated from cortical bone by a thin layer of radiolucent tissue: both findings were clearly visible with CT. In conclusion, the systemic use of CT has led to a marked improvement in the radiologic diagnosis of osteosarcoma of the jaw.

Adult↗
PubMed1995

Interventional radiology of the adrenal glands.

Interventional radiology of the adrenal glands comprises angiographic and percutaneous procedures. Vascular maneuvers have never received widespread application. Venous retrograde adrenal gland ablation fell into disuse because it induced only temporary reduction of adrenal function, caused intense long lasting pain, and was considered unsafe. Chemoembolization of cortico-adrenal carcinoma has been shown to slow tumor growth and may be employed if the patient is inoperable. Percutaneous FNB, routinely performed in large hospital centers, has a high diagnostic yield and a low complication rate. The procedure is performed in the staging of oncological cases or in patients with incidentally found adrenal lesion with no evidence of adreno-cortical or adrenal medullary hypersecretion. Abscesses and adrenal cysts are rarely encountered in clinical practice. Percutaneous drainage of such lesions is readily accomplished under radiological guidance with little hazard for the patient. Furthermore treatment failure does not compromise surgical treatment. Percutaneous ethanol injection has been recently suggested for treatment of hormone producing adreno-cortical adenomas in patients at high surgical risk. Results are promising but further trials are required to ascertain the efficacy and the safety of the procedure.

Abscess↗
PubMed1995

[Comparative evaluation of ultrasonography, computerized tomography, angiography and lipiodol CT in defining extent of hepatocarcinoma. A multicenter study].

The authors report the results of a multicentric trial on hepatocellular carcinoma (HCC) patients, whose lesions were confirmed with biopsy or by high (> 400 ng/ml) alpha-fetoprotein levels. The series consisted of 149 patients examined in 8 different centers and submitted to ultrasonography (US), Computed Tomography (CT) before and after contrast agent administration, angiography and Lipiodol CT. According to lesion size and number, the patients were divided with each imaging modality into three groups: a) group 1: unifocal HCC < 5 cm diameter; b) group 2: multifocal HCC with 2-3 nodules and/or tumor mass < 80 ml; c) multifocal HCC with more than 3 nodules (with total tumor mass not exceeding 40% of liver volume) or with total tumor mass > 80 ml. In 77 patients all the examinations were available for comparison. US and CT diagnosed more patients as belonging to group 1 than angiography and Lipiodol CT, while more patients were classified as groups 2 and 3 with angiography and Lipiodol CT, meaning that US and CT may understage some HCC cases (about 15%) because they show a lower number of nodules. This observation was confirmed by the direct comparison between US and Lipiodol CT (in 114 patients), CT and Lipiodol CT (in 103 patients) and angiography and Lipiodol CT (in 116 patients). US and Lipiodol CT were in disagreement in 18 cases, CT and Lipiodol CT in 16 cases and angiography and Lipiodol CT in 13 cases. In most of these cases, Lipiodol CT showed more lesions than the other techniques. The size of the undetected lesions was small, ranging few mm to 2 cm in nearly all cases. To conclude, the results of this multicentric trial show that Lipiodol CT is a fundamental tool to evaluate HCC extent. In contrast, conventional CT appeared not to add any significant piece of information and can therefore be excluded from the diagnostic protocol of HCC.

Angiography↗
PubMed1995

Postoperative infections after neurosurgery and cardiosurgery: the value of labelled white blood cells.

Post surgical-infections in neurosurgery and cardiosurgery are infrequent, but potentially fatal complications. The aim of this study was to compare the utility of 99mTc-HMPAO white blood cells scintigraphy (WBCS) with traditional diagnostic approaches in post-surgical complications, in order to obtain timely demonstration of a current infection. We studied 23 patients with a suspicion of infection after major cardiosurgery or neurosurgery. Planar imaging was performed at 4 and 20 hours after injection of autologous white blood cells labelled with 99mTc-HMPAO. Eight patients underwent CT scan, but only in one case did CT findings lead to a clear definition of a bulky inflammation process of the chest. WBCS identified one or more sites of focal increased uptake of the radiopharmaceutical in 6 patients: five of these patients were scheduled for a "second look" surgical operation that confirmed the sites and extention of the primary infection, thus confirming the presence of an abscess. In 3 cases WBCS showed only a weak increase of focal uptake and in 14 cases there was no evidence of abnormal uptake. The absence of deep infections was confirmed at surgery or at clinical follow-up. Thus WBCS seems to be useful in evaluating patients with the clinical suspicion of infective complications after surgery.

Adult↗
PubMed1994

In human neutrophils the binding to immunocomplexes induces the tyrosine phosphorylation of Fc gamma RII but this phosphorylation is not an essential signal for Fc-mediated phagocytosis.

It has been recently suggested that protein tyrosine phosphorylation is involved in Fc gamma Rs-mediated signalling. In this paper we have investigated if in human neutrophils a tyrosine phosphorylation of Fc gamma RII takes places after the binding with immunocomplexes and if this phosphorylation plays a role in phagocytic signal. The immunoprecipitation with mAb anti-Fc gamma RII of lysates of neutrophils challenged in suspension with insoluble immunocomplexes (IIC) or sheep erythrocytes opsonized with IgG (E-IgG), followed by immunoblotting with anti-phosphotyrosine antibody, demonstrated that Fc gamma RII was tyrosine phosphorylated. When neutrophils were pretreated with different doses of tyrosine kinase inhibitors, genistein or erbstatin, the phosphorylation of Fc gamma RII induced by IIC or E-IgG was dose dependently inhibited. In these conditions both genistein and erbstatin failed to inhibit the phagocytosis of E-IgG. These results demonstrated that in human neutrophils in suspension the binding to Fc of IgG induces a tyrosine phosphorylation of Fc gamma RII but this phosphorylation is not an essential signal for phagocytosis of IgG-opsonized particles.

Antigen-Antibody Complex↗
PubMed1994

High serum level of the soluble form of CD30 molecule in the early phase of HIV-1 infection as an independent predictor of progression to AIDS.

OBJECTIVE: To determine the serum levels of the soluble form of the CD30 (sCD30) activation molecule in the early phase of HIV-1 infection, and to investigate the possible correlation with evolution to AIDS. METHODS: sCD30 values were determined by an enzyme-linked immunosorbent assay (ELISA) on serum samples collected at the time of the first evidence of HIV-1 infection in 110 individuals with a median follow-up of 56 months (range, 12-88 months), at the A1 (74 cases) or A2 (36 cases) stages of the 1993 revised Centers for Disease Control and Prevention classification. The data were evaluated using established clinical and immunological parameters, including circulating CD4+ T-cell count. The controls were 110 blood donors and 51 HIV-1-negative subjects belonging to groups at risk for HIV-1 infection. RESULTS: Elevated sCD30 levels (> 20 U/ml) were found in 83.6% of HIV-1-infected cases and in 47% of at-risk seronegatives. Data analysis revealed that HIV-1-infected patients with higher sCD30 levels (> 35 U/ml) experienced faster disease progression (P = 0.0002). This was also the case in patients at the earliest stage (A1) of HIV infection (P = 0.0027). In these latter cases the predictive value of sCD30 was independent of the initial absolute number of circulating CD4+ lymphocytes. CONCLUSIONS: Serum levels of sCD30 are increased in the large majority of patients in the early phase of HIV-1 infection and represent an indicator of progression to AIDS independent of other prognostic parameters.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Percutaneous gastrostomy. Personal experience in 137 cases].

Percutaneous gastrostomy is reported to be an effective alternative to total parenteral feeding or long-term nasogastric tube in the treatment of mechanical or functional dysphagia. The authors report their personal experience with 137 percutaneous gastrostomies performed on 98 men and 39 women from January 1986 through December 1993. All the maneuvers were performed under fluoroscopic guidance in the patients with head or neck cancer, neoplastic, vascular or post-traumatic neuropathy and upper GI tract cancer. To avoid left hepatic lobe trauma, percutaneous gastrostomy needs to be performed under US guidance. A 7F nasogastric tube is used to fill the stomach with air. After distending the gastric cavity, with the Seldinger technique under local anesthesia, fascial dilators of progressively increasing caliber are introduced into the gastric cavity and the final 12F gastrostomy catheter is positioned under fluoroscopic guidance. No major complications, such as hemorrhage or peritonitis, occurred. In one case, during the maneuver, the patient complained of severe epigastric pain which regressed with no further problems two hours later. In three cases the gastrostomy catheter fell out of place and was replaced by running the fistolous tract with a venous cannula and then a guidewire for gastrostomy repositioning. With this type of treatment, the patient can be given enteral feeding the following day. The maneuver requires approximately 10 minutes to perform and is well tolerated by the patient as it requires no general anesthesia. Percutaneous gastrostomy is more cost-effective than surgery or endoscopy and hospitalization is shorter. The only contraindications to this maneuver are hepatomegaly (because of the risk of liver trauma during percutaneous maneuvers), ascites (because of the risk of infection) and finally the complications resulting from gastric resection.

Adult↗