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Biomedical subjects

G Messina

Publications and source records attributed to G Messina.

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

Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients. Gruppo Italiano Trapianti di Midollo Osseo.

BACKGROUND AND OBJECTIVE: Autologous transplantation is a better treatment for multiple myeloma (MM) than chemotherapy, but uncertainty remains about patient selection, optimal timing of autograft, conditioning regimen, need for a second autograft, and role of maintenance. To provide partial answers to these questions we assessed the results of autologous transplantation in a large cohort of patients whose data were reported to the GITMO registry. DESIGN AND METHODS: We retrospectively analyzed data from 290 patients with MM (M = 150; F = 140; median age 52 years, range 19-70; stage I = 34, stage II = 75, stage III = 167) reported to the GITMO. At the time of autograft, 20% were in CR, 66% in PR, while the remaining had non-responsive or progressive disease. Median time between diagnosis and transplant was 16 months (1-90). Seventy-two patients (26%) had been planned to receive a double autograft, but this was actually done in only 35 (12%). The conditioning was chemotherapy in 90%. Peripheral blood was the only source of stem cells in 94%, and purging was applied in 10% of cases. For statistical analysis of data, differences between patient subsets were analyzed using the chi-square test, while the Kaplan-Meier method was used to estimate event-free survival (EFS) and survival (OS) probabilities. The Cox model was used for multivariate analysis. RESULTS: Following the autograft, 116 patients (40%) were in CR, 144 (50%) in PR, 24 (8%) did not respond or progressed and 6 (2%) died before response evaluation. Transplant-related mortality occurred in 3%. At a median follow-up of 23 months, 223 (77%) patients are alive, 71 (24%) of them in CR, and 67 (23%) patients have died at a median time of 20 months (0-70). OS and EFS at 6 years are 47% and 28%, respectively, but the EFS curve shows no plateau. In multivariate analysis, age, beta2-microglobulin level and status at transplant emerged as significant prognostic factors for both OS and EFS, while time from diagnosis to transplant showed borderline significance. INTERPRETATION AND CONCLUSIONS: Based on the prognostic factors identified in multivariate analysis, we were able to assess the weight of a single prognostic factor or their combinations on transplant outcome. We also calculated the probability of OS and EFS by the number of factors at the time of autograft. Autologous transplantation is a safe and effective procedure, not only in sensitive patients, but also in resistant cases, provided they are <55 years of age and have low beta2-microglobulin. It should be applied early after the diagnosis of multiple myeloma, following the delivery of brief primary chemotherapy.

Adult↗
PubMed1999

[Conservative treatment of upper anterior dental discrepancy during orthodontic therapy].

The orthodontic therapeutic sequence used in cases with dento-dental discrepancy for reduced mesiodistal size and congenital absent lateral upper incisors, is described. The importance of correct conoid tooth replacement in the programmed space between the other teeth and its restorative treatment in order to obtain the best biomechanical control is stressed. The contemporaneous presence of the form and volume anomaly of the 12th and the missing 22nd due to agenesia demanded an interdisciplinary approach. For the restoration of the conoid tooth the authors used a microhybrid composite for the alloy properties with the grain size of the inorganic particles. In fact this type of composite responds well to mechanical stress and has a high shining capacity and good aesthetical rendering. Meanwhile the temporary dental prothesis solution of the 22nd in this case has suggested the application of the artificial element on the superior Hawley holding plaque.

Adolescent↗
PubMed1998

[Ultrasonography, with Doppler color, and cytologic correlations in Plummer's disease].

PURPOSE: We carried out a retrospective study to assess the different B-mode and color Doppler features of Plummer's disease and to compare them with cytologic findings. MATERIAL AND METHODS: One hundred and eighty autonomous nodules were studied with B-mode US. Mean patient age was 55 years for women and 56 years for men. Twenty-seven patients were also submitted to color Doppler US. Forty-nine autonomous nodules were also submitted to cytologic examination by fine needle aspiration (FNA). RESULTS: The most frequent US pattern was a hypoechoic solid nodular lesion (59.8%), while 45.6% of the nodules exhibited a mixed US pattern. No mixed areas were found in 100% of the nodules in the patients under 20 and over 60. In contrast, various degrees of mixed areas were found in the patients 20-59 years old, with the highest rate (24.9%) in the 40-49 age range and the lowest rate (6.2%) in the 20-29 age range. The mixed areas were most frequently correlated with bigger nodules and the toxic phase. Calcifications were found in 4.3% of the partially autonomous nodules in 4.1% of the pretoxic nodules and in 8.6% of the toxic nodules. Color Doppler US showed rich internal and peripheral vascularization (pattern A) in 74.1% of the nodules and a mostly perilesional flow (pattern B) in 25.9% of the cases. Pattern A prevailed in the toxic phase (75%), while pattern B in the partially autonomous nodules (85.7%). Simple hyperplasia was the most frequent (63.3%) cytologic feature in the solid nodular lesions, while bleeding (10.2%) was typical of the mixed anechoic nodular lesions. Cytologically undifferentiated lesions were found in the toxic phase of Plummer's disease (50%). DISCUSSION: Solid lesions in Plummer's disease are characterized by hyperplasia, while the diagnosis of hemorrhagic pseudocyst is typical of mixed lesions. CONCLUSIONS: Color Doppler US provides data on the functional phase of Plummer's disease and is a very useful tool to monitor medical treatment results; moreover, it permits to characterize the lesions with the richest vascularization, avoiding inadequate cytologic sampling.

Adult↗
PubMed1998

Chlorambucil synergizes with purine analogs in inducing in vitro cytotoxicity in B-cell chronic lymphocytic leukemia.

Combinations of different drug concentrations of CLB + FAMP and CLB + 2-CDA were synergistic in, respectively, 42.9% and 34.8%. At leukemic cell survival < or = 50%, 16.4% and 23.4% of all combinations were synergistic in the 2-CDA and FAMP groups, respectively. A significantly higher mean value of antagonistic interactions was observed in the 2-CDA group (p = 0.037).

Antimetabolites, Antineoplastic↗
PubMed1997

[Clinical significance of Hürthle cell in the cytology of thyroid disease].

The natural history of Hürthle cell (HC) lesions has been the focus of a considerable debate. The difficulties in defining the malignant potential of HC has led to the current designation of HC tumor, with the implication that it may behave as either a benign or a malignant lesion. The objective of our study was to verify the clinical and prognostic relevance of the cytological diagnosis of HC in the thyroid lesion, 10,950 consecutive patients (F/M = 5.6/1) with thyroid nodules were evaluated by means of fine needle aspiration biopsy (FNAB). Cytological diagnosis showed the presence of HC in 285 cases (2.6%), with a F/M ratio of 8.2/1. In 123 cases (43.2%) cytologic diagnosis resulted benign. A suspicious pattern of follicular neoplasm was observed in 159 cases (55.8%). Only in 3 cases (1%) thyroid carcinomas were preoperatively identified. No false positive or negative cases were observed. Among the HC lesions, 85 patients (29.8%) underwent thyroid surgery because of a malignant or suspicious cytologic diagnosis, continuous nodular growth despite LT4 therapy, mechanical compression or clinical judgement. The other two hundred patients were clinically evaluated and, one year later, repeated FNAB confirmed the cytologic diagnosis of benignity. Among the follicular neoplasm nodules, 80 cases (55.3%) were surgically explored, and thyroid carcinoma diagnosed in 30 of them (37.5%), this percentage being greater than that observed in the group of non-HC follicular neoplasm (17%). Pathologic criteria for malignancy (vascular invasion, transcapsular penetration, destructive capsular invasion) were described in 25 out of all carcinomas.

Adenocarcinoma, Follicular↗
PubMed1997

[Variations in the anatomy and physiology of the thyroid gland in old age].

Recently, the anatomical and physiological modifications of thyroid gland in the elderly have been undergone to many investigations. However, it does not exist an univocal interpretation about the results. Furthermore, non-thyroidal diseases, in the elderly, can modify TSH, FT3 and FT4 serum levels because of an important inhibition of T3 and T4 peripheric conversion; moreover, many drugs have been reported interactions with hypothalamus-hypophysis-thyroid axis in the senescence. At present, the international literature confirm, in the elderly, a reduction of the activity of the hypothalamus-hypophysis-thyroid axis, associated with an adaptation of hormones production; moreover, the thyroid gland undergoes anatomical (weight) and physiological (captation of iodine and hormones synthesis) adaptations, age-related, which witness for a reduction of thyroid function. Furthermore, FT3 and FT4 plasma levels present in old persons are comparable to younger subjects; in fact, in the elderly, it has been proved a reduction of T4 peripheric degradation which equilibrates its low production. So, the progressive reduction of thyroid gland activity in the old men must be explained like an adaptation to the new metabolic rhythm associated with a reduced TSH secretion and with a smaller body mass in the elderly. However, this peculiar new steady-state is not like an hypothyroidism syndrome, because there is not a real hormones reduction.

Aged↗
PubMed1997

[Graves' disease: ultrasonographic, color Doppler and histological aspects].

The aim of the present work was to study the relationship between thyroid low echogenicity, the thyroid blood flow by color-Doppler (CD) and histological features in patients with Graves' disease (GD). Thyroid ultrasonography and CD was performed on 28 patients with GD. In 5 patients has been compared CD with histology. The thyroid volume was higher in 100% of patients with GD at the onset rather than in euthyroidism. Diffuse hypoechogenicity of the thyroid was discovered in 100% of patients with GD at the onset and it persisted in 57.1% of patients that became euthyroid after therapy. Qualitative CD resulted in different patterns that were classified as follow: pattern A ("thyroid inferno") in 17 patients (60.7%); pattern B (mildly increased of parenchymal blood flow) in 11 patients (39.3%). In the 5 histological proven cases, in the pattern A (3 cases) there was a diffuse microfollicular hyperplasia with functional activation notes. There was lymphocytic infiltration. While in the pattern B (two cases) there were a non-follicular hypercellular nodule with pseudocapsule and rare colloid. We conclude that there are two different histological types with different CD patterns in GD.

Adolescent↗
PubMed1996

Abdominal lymphadenopathy in benign diseases: sonographic detection and clinical significance.

We prospectively evaluated the frequency of lymphadenopathy in the right upper abdominal quadrant as detected by sonography in 650 consecutive unselected patients, after excluding patients with a known lymphoma or abdominal carcinoma and patients with acquired immunodeficiency disease. Evidence of enlarged lymph nodes (few in number, with an elongated shape and isoechoic to the liver, 8 to 22 mm in size), found primarily in the gastrohepatic ligament and porta hepatis, was seen on sonographic scans in 106 patients (16.3%). Associated conditions in 69 of 106 patients (65%) were hepatobiliary or pancreatic diseases and, less frequently, other benign entities (12 patients; 11.3%); in 25 cases (23.5%) no significant abdominal or systemic disease was present. Comparison with CT or surgical findings, or both, was available in 36 cases. We conclude that lymphadenopathy in the right upper abdominal quadrant may be found in relation to different non-neoplastic conditions as well as in the absence of any significant intra-abdominal disease. The frequency of this finding on sonographic scans must be recognized to prevent misdiagnosis of lymphoma or metastatic disease as well as to avoid overstaging of local (hepatobiliary, pancreatic, gastric) neoplasms.

Abdomen↗
PubMed1996

The second example of Lu:-7 phenotype: serology and immunochemical studies.

We describe the second example of red blood cells (RBCs) with the Lu:-7 phenotype in a 37-year-old Latino female (SA). Her RBCs were nonreactive with anti-Lu7 (Mrs. GA) but were reactive with all other antibodies to high-prevalence antigens tested, including those in the Lutheran blood group system. No Lu:-7 RBCs were available for testing. SA's serum was nonreactive by the indirect antiglobulin test against (1) recessive and dominant Lu(a-b-) RBCs and (2) trypsin-treated or a-chymotrypsin-treated RBCs of common phenotype. By immunoblotting, eluates containing anti-Lu7 from both Mrs. GA and SA reacted with apparently the same bands in RBC membranes of common phenotype as did human anti-Lub, reacted weakly with Lu(a-b-) RBCs of the dominant type, and were nonreactive with SA's RBC membranes. These findings raise the Lu7 antigen from its Lutheran-related (para-Lutheran) status to a bona fide member of the Lutheran blood group system.

Journal Article↗
PubMed1996

[Our experience in the surgical treatment of pharyngoesophageal diverticula].

The authors review a consecutive series of 7 pharyngo-oesophageal diverticula surgically treated from 1979 to 1994. In their opinion, surgery of diverticula to be effective must be preceded by dynamic and functional studies to outline the motor impairment often associated. Surgical indications and the different surgical techniques are also emphasized.

Aged↗
PubMed1996

[Clinico-ultrasonographic assessment of the thyroid volume and function in chronic enteritis and colitis: preliminary data].

Inflammatory bowel diseases (IBD) such as Crohn's disease (CD) and ulcerative colitis (UC) have frequent extraintestinal (hepatobiliary, cutaneous, ocular, articular, urinary) complications. On the contrary, no data are available about possible thyroid involvement. We studied thyroid morphology and function in 39 patients affected with active IBD (13 UC; 26 CD) before (all) and 45 and 90 days after onset of therapy (21/39), and in 55 normal control subjects. Every time, the following exams were performed: thyroid US (parenchymal assessment, thyroid volume calculation), hormone and immunologic assays (T3, T4, FT3, FT4, TSH; antithyroglobulin and antithyroid microsomal/peroxidase antibodies). A statistically significant increase in thyroid volume was found in IBD (mean: 22.1 ml) compared to control subjects (mean: 15.6 ml), more frequently in CD (18/26 patients; 69.2%) than in UC (2/13 patients; 15.4%). Parenchymal structure was inhomogeneous in the two groups of patients (88.4% CD; 15.4% UC) more frequently than in control subjects (12.7%). Hormone assays demonstrated increased FT4 values in UC (9/13 patients; 69.2%) and decreased T4 values in CD (14/26 patients; 53.8%). IBD patients increased frequency of antithyroglobulin and antithyroid microsomal/peroxidase antibodies. Such abnormalities subsided only partially after therapy. Our data suggest that in IBD there is a frequent thyroid involvement with morphological, hormone, and immunologic abnormalities.

Adult↗
PubMed1996

[Unusual case of acute suppurative thyroiditis].

Acute suppurative thyroiditis is an acute disease of the thyroid gland. In this paper the authors report a case of acute suppurative thyroiditis complicated by abscessual evolution in an addict patient study with ultra-sonography and treated with fine needle aspiration and antibiotic therapy. The patient reached our observation for a swelling of the neck. Ultrasonography showed diffuse hypoechogenicity in both thyroid lobes and mixed nodule with hyperechoic trabeculas inside. This nodule underwent fine needle aspiration (FNA) for cytologic and cultural evaluation. Diagnosis was acute suppurative thyroiditis. Ultrasonography presented features similar to other thyroid pathology (sub-acute thyroiditis, haemorrhagic cyst, thyroid lymphoma and anaplastic carcinoma). In our case none of the ultrasonographic features were diagnostic except hyperechoic trabeculas inside. Ultrasonographic features of acute suppurative thyroiditis are very rare in the literature. Ultrasonography and fine needle aspiration are the only methods that confirm this diagnosis.

Acute Disease↗
PubMed1996

[Echographic diagnosis of nephro-urological neoplasia in a pediatric nephrology center].

The use of ultrasound for the diagnosis of urologic neoplasms in simple and accurate. Nowadays nephrologists and urologists advocate the use of ultrasound and the procedure now plays a complementary role of the clinical examination. We present a retrospective study regarding our experience with ultrasonography in the diagnosis of urologic problems. In the period february 95-february 96 we performed 672 ultrasound examination on children ranging in age from 30 days to 16 years. All examinations were performed using a 3.5-5 MHz real time convex scanner. The patients were examined in the supine position for imaging of the bladder and in the prone position for imaging of the kidneys. We report 3 cases of neoplasm of the genito-urinary tract screened with the use of ultrasounds in a selected paediatric population.

Adolescent↗
PubMed1995

Sonographic estimation of fetal liver weight: an additional biometric parameter for assessment of fetal growth.

A single fetal ultrasonogram was obtained between the 20th and 40th weeks of gestation in 327 pregnancies. Fetal body weight was calculated with standard methods and fetuses were classified as appropriate for gestational age (303 fetuses), large for gestational age (four fetuses), or small for gestational age (20 fetuses). Fetal liver weight was estimated on the basis of longitudinal, anteroposterior, and cephalocaudal liver dimensions multiplied by a constant (k) of 0.42 determined experimentally in a previous study of adult livers. Estimated liver weights in appropriate for gestational age fetuses were not statistically different from published standards based on autopsy findings (P < 0.005). Similar findings were obtained in two other normal pregnancies examined serially until delivery. Estimation of fetal liver weight appears to be an accurate and reproducible method and may enhance sonographic assessment of fetal growth abnormalities and conditions with fetal liver involvement.

Abdomen↗