Efficacy of continuous venovenous haemofiltration (CVVH) in the treatment of severe phenformin-induced lactic acidosis.
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Acidosis, Lactic↗
Biomedical subjects
G Lanza
Publications and source records attributed to G Lanza.
[The use of allografts in the surgical treatment of patients with infected vascular prostheses].
The article is devoted to analysis of surgical treatment of patients with such a dangerous complication as infection of the vascular prosthesis. The authors have performed 25 operations for substituting the infected prostheses for allografts. In 18 patients the infected prostheses were located in the aorto-iliac segment, in 5 patients in the femoro-popliteal segment, 1 patient had it in the aorta, and 1 in the subclavian segment. The prostheses were removed and a simultaneous revascularization was made. The authors make a conclusion that it is very expedient to use alloprostheses as a protective measure against persistent or recidivating infections. The allografts have both early and long-term resistance to infection.
Aged↗
[Expression of protein p53 in the adenoma-colorectal carcinoma sequence].
To further evaluate the role of the p53 gene in the development of colorectal carcinoma we examined by immunohistochemistry p53 protein expression in a series of 136 colorectal adenomas, 25 adenomas containing early invasive carcinoma (pT1) and 160 advanced adenocarcinomas (pT3-pT4). p53 overexpression was detected in 22% of adenomas, 64% of adenomas with invasive carcinoma and 60% of advanced adenocarcinomas. In colorectal adenomas p53 expression was related to tumour size (P = 0.0013), histologic type (P < 0.0001) and grade of dysplasia (P < 0.0001). Only 7.5% of adenomas with low grade dysplasia were found to be p53 positive, whereas 73.3% of adenomas with high grade dysplasia demonstrated p53 overexpression. Most p53 positive adenomas and adenomas with invasive carcinoma showed intratumoural heterogeneity of p53 immunoreactivity. Conversely advanced adenocarcinomas were always uniformly p53 positive or negative. Our data show that p53 protein overexpression occurs at the transition from low grade dysplasia to high grade dysplasia, indicating a likely role for the p53 gene in the conversion of benign adenoma to malignant carcinoma.
Adenocarcinoma↗
[Aneurysm of the hepatic artery. Report of a case].
Hepatic artery aneurysms are considered a rare event even though their report in the literature are becoming more and more frequent. A case of a 50-year-old man with common hepatic artery arterial aneurysm is reported. Initially, aspecific upper abdominal symptoms were found, but the great improvement in the diagnosis of vascular disease allows us to recognize this pathology which has a high risk of rupture so that an aggressive treatment is required.
Aneurysm↗
[Insufficient correction of blood bicarbonate levels in biguanide lactic acidosis treated with CVVH and bicarbonate replacement fluids].
BACKGROUND: In the course of Continuous Veno-Venous Hemofiltration (CVVH), bicarbonate buffer instead of lactate is suitable for the treatment of combined renal and hepatic failure and for patients suffering from lactic acidosis, type A or B, joined with acute renal failure (ARF). METHODS: We applied the CVVH buffered with bicarbonate for the treatment of two patients affected by ARF and severe lactic acidosis type B (due to biguanide intoxication) and we evaluated its ability to correct the acid-base balance. RESULTS: Clinical and laboratory data show that this technique, performed in standard conditions (plasma flow: 70 ml/min, ultrafiltration: 25 ml/min, bicarbonate concentration in the infusion fluid: 30 mEq/L), was inadequate to compensate for the high requirement of bicarbonate (approximately 280 mEq/hr during the first 6 hours of observation) and the severe metabolic acidosis, thus additional bicarbonate infusion was needed. CONCLUSIONS: In particular, from ascertained data and theoretical considerations, in the course of lactic acidosis caused by biguanide, in order to correct acidosis a positive balance of bicarbonate could be obtained only by means of a bicarbonate-based replacement fluid and of a continuous high flow hemofiltration, such as to assure an ultrafiltrate volume exceeding 150 ml/min.
Acidosis, Lactic↗
p53 expression in colorectal cancer: relation to tumor type, DNA ploidy pattern and short-term survival.
p53 protein expression was evaluated in a series of 204 primary colorectal adenocarcinomas by immunohistochemistry using frozen tissue sections and monoclonal antibody DO-7. Nuclear staining of more than 5% of neoplastic cells was observed in 124 (60.8%) adenocarcinomas, which were classified as p53 positive. p53 immunoreactivity was found to he unrelated to several clinical and pathologic variables, including age and sex of patient, tumor site, tumor stage, grade of differentiation, pattern of growth, degree of peritumoral lymphocytic infiltration, and venous invasion. A strong association was demonstrated between p53 immunostaining and tumor type. Only 4 of 21 mucinous carcinomas examined (19%) were p53 positive. Conversely, 120 of 183 (65.6%) nonmucinous adenocarcinomas showed positive p53 immunostaining (P <.0001). p53 expression also was related to the flow cytometric DNA ploidy pattern, aneuploid carcinomas with DI >1.20 showing higher frequency of p53 overexpression than DNA diploid, and aneuploid tumors with DI < or = 1.20 (P = .0003). No relationship was found between p53 expression and the Ki-67 proliferation index. With respect to the total study population (mean follow-up 33.4 months; range 19-47 months) the duration of overall survival was independent of p53 expression. In the group of 141 patients with stage I, stage II, and stage III disease who had undergone curative resection, positive p53 immunostaining was associated with poorer overall survival (P = .029). Subgroup analysis showed that the reduced survival conferred by p53 overexpression was confined to patients with stage III tumors (P = .027). However, in multivariate analysis, p53 expression failed to demonstrate independent prognostic significance. Our results indicate that immunohistochemical analysis of p53 expression provides valuable information for the understanding of colorectal cancer biology and clinical behavior.
Adenocarcinoma↗
[Femoro-distal revascularization with the saphenous vein in critical ischemias. An analysis of the results obtained and the criteria for choosing the most appropriate method].
Critical ischemia is a pathology which requires the collaboration of a number of specialists and is often burdened by high morbidity and mortality rates. There are several possible therapeutic solutions, although each has its limits. The authors present a series of operated cases and compare the results of two different but alternative surgical methods (in situ and reversed saphena by-pass) depending on the patient's conditions. Perioperative and long-term results were comparable in both groups of patients.
Aged↗
Biologic characterization of hereditary non-polyposis colorectal cancer. Nuclear ploidy, AgNOR count, microvessel distribution, oncogene expression, and grade-related parameters.
The identification of hereditary non-polyposis colorectal cancer (HNPCC) is important not only for the patient, but also for family members who are at increased risk of developing cancer. To determine if measuring various pathobiologic features of the colon carcinomas is useful in separating sporadic from HNPCC tumors, the authors studied tumor tissues from 46 patients with HNPCC and compared them to 70 with sporadic colorectal carcinoma. Parameters investigated included DNA ploidy (flow cytometry), AgNOR count (by silver staining), microvessel density (immunohistochemistry), p53 and K-ras expression, and grade-related parameters. Diploid tumors were more frequent in patients with HNPCC (65% vs 40%, P < .02), thus confirming previous observations concerning such an association. Higher AgNOR counts and greater AgNOR areas were observed in sporadic tumors than in HNPCC (5.2 +/- 1.5 vs 4.5 +/- 1.8, P < .01). Hereditary tumors tended to be less vascularized, whereas oncogene expression and grade-related parameters did not show appreciable differences between the two types of tumors. In conclusion, some of the investigated parameters may contribute to defining the biologic profile of HNPCC. In addition, these findings support the clinical impression of a more favorable outcome that is frequently seen in HNPCC patients.
Adult↗
[Benign rectal stenosis: its dilatation with a balloon catheter under fluoroscopic guidance. The diagnostic and therapeutic considerations].
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Aged↗
[Clinico-pathological features and biological characterization of mucoid colorectal carcinoma].
The clinical, pathological and biologic features of 79 mucinous colorectal carcinomas were compared with those of 602 non-mucinous adenocarcinomas. The two groups did not show appreciable differences in patients' age, stage distribution, extent of lymph node involvement, grade of differentiation, pattern of growth and venous invasion. Mucinous carcinomas occurred more frequently among female patients (P < 0.05) and in the proximal colon (P < 0.01). Moreover, mucinous carcinomas more often demonstrated origin within villous adenomas (P < 0.0001) and lacked pronounced peritumoural lymphocytic infiltration (P < 0.001). A strong association was found between tumour type and flow cytometric nuclear DNA content. A high proportion of mucinous carcinomas showed DNA index (DI) values < or = 1.20 (26/38, 68.4%); conversely only 103 of 322 (32%) non-mucinous carcinomas had a DI < or = 1.20 (P < 0.0001). In addition mucinous carcinomas were characterized by infrequent p53 overexpression (4/21, 19% versus 120/183, 65.6%; P < 0.001) and higher levels of proliferative activity (P < 0.0001) compared to non-mucinous adenocarcinomas. Our data support the hypothesis that mucinous carcinoma represents a distinct clinicopathologic and genetic entity.
Adenocarcinoma↗
Relationship of nuclear DNA content to clinicopathologic features in colorectal cancer.
Nuclear DNA content was determined in 123 colorectal adenocarcinomas by flow cytometry using multiple frozen tumor samples. Thirty-three (26.8%) carcinomas were classified as diploid and 90 as aneuploid (73.2%). Presence of DNA aneuploidy was found to be unrelated to tumor stage and grade of differentiation and to other histopathological variables such as pattern of growth, degree of peritumoral lymphocytic infiltration, and venous invasion. However, multiploid tumors (20/123, 16.3%) were more frequently noted in advanced stages of disease (Stages III and IV, P < 0.025) and more often showed unfavorable histopathological features, especially an infiltrating pattern of growth (P < 0.05), compared with diploid and single aneuploid carcinomas. Nuclear DNA content was found to be closely related to tumor site. Carcinomas of the proximal (right and transverse) colon were more frequently diploid (19/43, 44.2% versus 14/80, 17.5%--P < 0.005) and more often displayed a DNA index (DI, defined as the ratio of the DNA content of neoplastic cells to that of normal cells) < or = 1.20 (27/43, 62.8% versus 19/80, 23.7%--P < 0.001) than did tumors localized distally to the splenic flexure. Nuclear DNA content was also found to be related to tumor type. A high proportion of mucinous adenocarcinomas showed DI values < or = 1.20 (14/21, 66.7%); conversely only 32 of 102 (31.4%) non-mucinous adenocarcinomas had a DI < or = 1.20 (P < 0.01). The nuclear DNA content of mucinous adenocarcinomas seemed to be independent of tumor location.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
[Evaluation of prognostic parameters in colorectal carcinoma. II. Ploidy determination with flow cytometry].
The prognostic value of DNA ploidy in large bowel cancer is still controversial. In the present investigation we have evaluated the nuclear DNA content in 123 colorectal adenocarcinomas by flow cytometry using multiple frozen tumour samples. Thirty-three (26.8%) carcinomas were classified as diploid and 90 as aneuploid (73.2%). Presence of DNA aneuploidy was found to be unrelated to age and sex of patients, tumour stage and grade of differentiation, as well as to several other histopathological variables. However, multiploid tumours (20/123, 16.3%) resulted to be more frequently in advanced stages of disease (stages III and IV, P < 0.025) and more often showed unfavourable histopathological features, especially an infiltrating pattern of growth (P < 0.05), compared to diploid and single aneuploid carcinomas. Nuclear DNA content was found to be closely related to tumour site. Carcinomas of the proximal colon were more frequently diploid (P < 0.005) and more often displayed a DI < or = 1.20 (P < 0.001) than tumours of the distal colon. Nuclear DNA content was also found to be related to tumour type. In fact, a high proportion (66.7%) of mucinous carcinomas showed DI values < or = 1.20; conversely only 31.4% of nonmucinous adenocarcinomas had a DI < or = 1.20 (P < 0.01). Intratumoural heterogeneity in nuclear DNA content was found in 23% of cases. These results seem to suggest that the DNA ploidy pattern probably reflects different genetic mechanisms involved in the development of carcinomas in the proximal and distal colon. Furthermore our data support the hypothesis that mucinous carcinoma represents a distinct clinicopathologic entity, possibly related to pathogenetic factors different from those acting in the majority of nonmucinous adenocarcinomas. Finally, the analysis of multiple tissue samples taken from different areas of each tumour is necessary to assess carefully the DNA ploidy pattern of large bowel carcinomas.
Adult↗
Increased left ventricular mass in normotensive diabetic patients with autonomic neuropathy.
The possible relationship between diabetic autonomic neuropathy, circadian blood pressure changes, and echocardiographic parameters was investigated in 27 normotensive diabetic patients (10 with and 17 without autonomic neuropathy) who underwent 24 h noninvasive ambulatory blood pressure monitoring and M-mode echocardiographic recording. The two groups were comparable for age, sex, duration of diabetes, body mass index, and metabolic control. There were no significant differences in 24 h average and diurnal values of systolic, diastolic, or mean blood pressure. The percent changes from day to night of systolic, diastolic, and mean blood pressures were significantly lower in diabetics with neuropathy than in those without (P < .04 or less). Increased left ventricular mass index (LVMI) (135.4 +/- 10.2 v 102.9 +/- 6.3; P < .005), septal wall thickness, and posterior wall width were observed in neuropathic patients. Fractional shortening, peak velocity of early left ventricular filling (E), peak velocity of late ventricular filling (A), and their ratio (E/A) were similar in the two groups. The increased LVMI we observed may represent a possible link between diabetic autonomic neuropathy, nocturnal blood pressure levels, and higher cardiovascular mortality rate.
Adult↗
A Doppler guided retrograde catheterization system.
A Doppler guided retrograde catheterization system was developed to accurately catheterize the aortic root and left ventricular chamber without X-ray. This system consists of a 20 MHz, 0.076 mm thick x 1.016 mm diameter pulsed Doppler crystal integrated into the tip of a 100 cm multipurpose triple lumen catheter. Two lumens (0.61 mm) are used for electrodes; a third lumen (1.245 mm) may be used for guidewire and pressure determination; and the system is attached to a flow velocimeter. In an aortic arch flow model, the principles of Doppler signal guidance were confirmed with flow toward the catheter tip demonstrating positive signals and flow away from the catheter tip demonstrating negative signals. The magnitude and polarity (direction) of the detected phasic and mean velocities were utilized to guide catheterization in six dogs. Using the reversal of Doppler signal polarity to indicate branch entry and manipulating the catheter so as to maintain maximal positive axial velocity, the Doppler catheter was successfully advanced from the femoral artery to the aortic valve. Branches detected by the Doppler system were confirmed by fluoroscopy. The aortic valve was audible when approached and the left ventricular chamber was recognized by its characteristic pressure waveform. The Doppler guided retrograde catheterization system offers new technology to perform left heart catheterization without X-ray and may prove useful in a variety of settings including the development of invasive ultrasonic diagnostic and therapeutic technology.
Animals↗
[Arterial hypertension and macroangiopathic complications in a group of diabetic out-patients].
We have retrospectively studied 814 diabetic outpatients, 407 hypertensives and 407 normotensives. The aim of the study was to investigate on possible associations between macroangiopathic complications (coronary heart disease, peripheral and cerebral arteriopathy) and well recognized risk factors for atherosclerosis. Macroangiopathy was present in 27% of males and 24% of females (p = NS), and in 32% of hypertensives and 18% of normotensives (p < 0.0001). Macroangiopathy associated, in both sexes, with age and duration of diabetes, but did not correlate, instead, with metabolic control, obesity, serum cholesterol and triglycerides. High triglyceride levels were associated strictly with arterial hypertension, in both sexes, but are more elevated in men. Risk factors for atherosclerosis seem not to be simply considered in the same way in diabetic and non diabetic populations.
Aged↗
Reliability of 3H-thymidine labeling index: cell proliferation of colorectal carcinoma in three different centers.
Although the 3H-thymidine labeling index (TLI) has been used extensively as a biologic marker of increased susceptibility to neoplasms or as a prognostic indicator of the clinical outcome in cancer patients, there is still some concern regarding its accuracy and reliability as a marker of cell replication. A study on the prognostic value of TLI in colorectal cancer gave us the ability to evaluate how such a measurement may vary in different laboratories. A total of 150 malignant tumors of the large bowel were studied in the period from 1988 to 1989. Microautoradiography was carried out in tumor fragments taken at surgery. There were only slight differences among the three centers involved in the investigation, mainly as regards the culture medium, exposure time, and the addition of O2 + CO2 during the incubation. No significant difference was observed among TLI values recorded in the three centers (18.3 +/- 0.9; 17.4 +/- 0.9; 15.7 +/- 1.0 mean +/- SE), and the ranges of values were almost identical. Similarly, the numbers of total and of labeled cells counted for each patient were comparable among the three centers. The frequency distribution of TLI showed a peak value between 10 and 19.9% in all three centers. Moreover, more than 80% of the observed values were within the range of 10 to 29.9%. In addition, the neoplastic areas with the highest proliferative activity ("high" TLI) showed a frequency distribution once again rather similar among the three centers.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Immunohistochemical assessment of growth fractions in colorectal adenocarcinomas with monoclonal antibody Ki-67. Relation to clinical and pathological variables.
Immunostaining with monoclonal antibody Ki-67 (MAb Ki-67) has been employed to determine the growth fractions in a series of 139 primary adenocarcinomas of the large bowel. A wide range (18.9-71.4%; mean 39.4%; median 37.2%) in the percentage of Ki-67 reacting cells (Ki-67 index) was observed. The Ki-67 index was found to be unrelated to tumour stage, lymph node involvement, and presence of synchronous distant metastases. Mucinous carcinomas showed higher levels of Ki-67 reactivity than non-mucinous adenocarcinomas (P = 0.0003). Among non-mucinous adenocarcinomas a significant inverse correlation was demonstrated between the percentage of Ki-67 stained cells and the degree of differentiation (P = 0.002), and preservation of nuclear polarity (P less than 0.001). Moreover, tumours of patients younger than 45 years were generally characterized by high numbers of proliferating cells. There was no correlation between Ki-67 index and the other clinical and pathological variables examined. In most cases small differences in Ki-67 reactivity were observed in different samples from the same tumour. These results demonstrate that immunohistochemical assay with MAb Ki-67 represents a simple and reliable method for the assessment of proliferative activity in colorectal adenocarcinomas and suggest that Ki-67 labeling may provide information of clinical relevance in the management of patients with large bowel cancer.
Adenocarcinoma↗
Functional chiral asymmetry in descending thoracic aorta.
To determine whether rotational blood flow or chiral asymmetry exists in the human descending thoracic aorta, we established the ability of color Doppler ultrasound to detect rotational flow in a tornado tube model of a vortex descending fluid column. In a model of the human aortic arch with a pulse duplicator, color Doppler was then used to demonstrate that rotational flow occurs first in the transverse arch and then in the proximal descending thoracic aorta. With the use of color Doppler esophageal echocardiography, 53 patients (age range, 25-78 years; mean age, 56.4 years) were prospectively examined for rotational flow in the descending thoracic aorta. At 10 cm superior to retro-left ventricular position, 22 of 38 patients (58%) revealed rotational flow with obvious diastolic counterclockwise rotation but less obvious systolic clockwise rotation. At 5 cm superior to retro-left ventricular position, 29 of 46 patients (63%) revealed rotational flow with a tendency toward systolic clockwise and diastolic counterclockwise rotation. At the retro-left ventricular position, 47 of 53 patients (89%) revealed rotational flow, usually of a clockwise direction, occurring in systole. Our data suggest that aortic flow is not purely pulsatile and axial but has a rotational component. Rotational flow begins in the aortic arch and is carried through to the descending thoracic aorta, where flow is chirally asymmetric with systolic clockwise and diastolic counterclockwise components. These data demonstrate an aortic rotational flow component that may have physiological implications for organ perfusion.
Adult↗