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Biomedical subjects

G Motta

Publications and source records attributed to G Motta.

At least 91 records · Page 5Linked to original sources
PubMed1990

Improving clinical efficacy of computed tomographic scan in the preoperative assessment of patients with non-small cell lung cancer.

The criterion of choice for computed tomographic scan identification of metastatic mediastinal nodes is not clearly fixed. This prospective study was designed to define the most suitable computed tomographic criterion for detection of nodal metastasis, enabling improvement of the test's clinical efficacy. One hundred twenty-three patients with potentially operable non-small cell lung cancer underwent mediastinal evaluation by computed tomographic scan and cervical mediastinoscopy followed by thoracotomy with mediastinal node dissection. There were 116 men and seven women; the mean age was 59.3 +/- 9.1 years. Forty-six tumors were classified after operation as stage I, 20 as stage II, 27 as stage IIIa, and 30 as stage IIIb. Mediastinal nodes were classified as metastatic according to the following computed tomographic scan criteria: (1) shorter axis 1 cm or larger; (2) shorter axis 1.5 cm or larger (nodes less than 1 cm were classified as negative and those 1 to 1.5 cm as indeterminate); and (3a) shorter axis 1 cm or larger, plus evidence of central necrosis or discontinued capsule, or (3b) shorter axis 2 cm or more, regardless of the nodal morphologic condition. The highest sensitivity rate was achieved by using criterion 1 (90%) and the poorest by criterion 3 (75%). The greatest specificity rate was obtained by applying criterion 3 (90%) and the lowest by criterion 1 (54%). The prediction by using computed tomographic criterion 3 correlated better with pathologic findings than that derived by adopting the criterion 1 or 2. When mediastinal nodes were identified as negative according to criterion 1, 2, or 3, the complete resection rate was 92%, 92%, or 95%, respectively, rendering cervical mediastinoscopy unnecessary. When mediastinal nodes were classified as positive, the resectability rate was 55%, 27%, or 13%, respectively. In these instances cervical mediastinoscopy allowed identification of different degrees of mediastinal involvement; it proved to be the most useful procedure for preoperative selection of those patients with N2 tumors who are amenable to a complete resection. In conclusion, the use of computed tomographic criterion 3 does improve the clinical efficacy of the test, by sparing a large number of unnecessary mediastinal explorations, without increasing the rate of useless thoracotomies.

Adenocarcinoma↗
PubMed1990

[Immediate and long-term results of endoscopic or surgical Oddi sphincterotomy in the treatment of lithiasis of the common bile duct].

Ninety-one patients with choledocholithiasis were admitted for endoscopic (51 cases) or surgical (40 cases) sphincterotomy of Oddi's muscle, and were followed up on a yearly basis thereafter for a period spanning 1 to 5 years. The study protocol included clinical examinations, ultrasonographic investigations and biochemical tests. The post-surgery mortality rate was 3.9% following endoscopic sphincterotomy versus 0% after surgery. Postoperative complications occurred in 3.9% of patients treated endoscopically (bleeding, angiocholitis) and in 5% of surgical patients (bronchopneumonia, suppuration of abdominal wall). Attempts to remove calculi via endoscopic Oddian sphincterotomy failed in 37% of cases. Long-range results were classified as excellent or good in 92% of patients treated endoscopically, and in 100% of cases treated surgically. Endoscopic division of Oddi's sphincter was unsuccessful in 4 patients (8%), who either had recurrent bile-duct stones (2 cases) or developed sphincteric stenosis. Among biochemical indices of biliary stasis, only alkaline phosphatase contents showed a greater increase following endoscopic sphincterotomy than after surgical treatment. Ultrasonographic studies of the bile duct evidenced a greater incidence of air entrapment in the bile ducts of patients subjected to surgical sphincterotomy.

Adult↗
PubMed1989

Grading as a prognostic factor: review of 209 primary gastric cancer patients.

Two hundred and nine cases of primary gastric cancer were treated surgically from January 1968 to December 1983 and analyzed retrospectively. All patients were followed up for a minimum of 5 years. There were 25 SI cases (12%), 22 SII (10.5%), 55 SIII (26.3%) and 107 SIV (51.2%). Tumor grade according to Broders classification showed 50 cases of G1 lesions (23.9%), 44 G2 (21.1%) and 115 G3 (55%). Patients with well differentiated G1 lesion, compared to G2-G3 patients, presented a greater incidence of T1-T2 tumors and decreased incidence of T4 tumors (p less than 0.05). The lymph node involvement rate significantly increased with variation of T (p less than 0.001) but not with tumor grade. Survival results correlated with tumor stage (p less than 0.01) but not with tumor grade or histological type.

Adult↗
PubMed1989

[Sessile tubulo-villous polyps in the rectum: problems of diagnosis and treatment. Personal experience].

A retrospective analysis was performed on 22 patients (mean age 65) in whom preoperative rectosigmoidoscopy had diagnosed tubulovillous rectal polyp. In 12 cases the polyps were removed transanally and the remaining 10 were subjected to laparotomy. The incidence of error in the preoperative histological diagnosis was 18.2% (9% for the nature and 10% for degree of dysplasia of the polyp). There were 25% recurrences after transanal exeresis, 10% after laparotomy. Total survival at 42 months was 86.3%. The study confirms the validity of transanal exeresis of tubulovillous polyps of the rectum assuming careful preoperative patient selection.

Aged↗
PubMed1989

The contribution of saccadic eye movements analysis, visual and auditory evoked responses to the diagnosis of multiple sclerosis.

A number of tests have been used to identify paraclinical evidences of central nervous system (CNS) lesions in multiple sclerosis (MS). The present study was aimed to test and compare the diagnostic value of saccadic eye movements (SEM) analysis, and visual and auditory brain stem evoked responses (VER, ABER) in MS, and to study the correlation between electrophysiologic findings and clinical data. The reference group for epidemiological and statistical analysis was selected from the group of 109 suspected MS patients included in the study. SEM analysis resulted at least as sensitive as VER and ABER. SEM analysis showed good sensitivity and positive predictive value. Saccade latency resulted the most sensitive SEM parameter. Subclinical internuclear ophthalmoparesis resulted highly specific. We suggest that SEM analysis could be included into the electrophysiologic tests for identifying paraclinical evidences of CNS lesions in MS. Correlations between electrophysiologic findings and clinical data are discussed.

Adolescent↗
PubMed1989

[Colorectal cancer: prognosis after curative surgical treatment without extended elective lymphadenectomy in patients in Dukes C stage].

A retrospective analysis has been carried out on a group of 103 Dukes C cases from a series of 412 patients with colorectal carcinoma, operated on from January 1970 to November 1983. The 5-year survival rate was 32% in patients who had a curative resection (median survival: 24 months). Larger numbers of lymph nodes were obtained with right or left colectomy. As regards the treatment of rectal cancer, similar numbers of nodes were obtained either with anterior resection or with Miles' operation. Prognosis was significantly correlated to tumor location, number of involved nodes (p less than 0.01) and grading of the primary tumor (p less than 0.01). The use of extended left colectomy with elective abdominopelvic lymphadenectomy was associated with a small raise of survival and a definite increase of perioperative morbidity and mortality compared to conservative surgical resection.

Adult↗
PubMed1989

Endoscopic papillosphincterotomy and surgical sphincteroplasty for the treatment of bile duct stones: a comparative analysis.

UNLABELLED: One hundred and ten subjects with cholelithiasis entered this retrospective study. Early and late results of 73 patients treated by endoscopic papillosphincterotomy (EPST) were compared to those of 37 patients who had surgical transduodenal papillo-sphincteroplasty (SST). The comparative analysis was made in terms of clinical, biochemical and ultrasonographic findings. The follow-up period ranged from 1 to 5 years in the first group and from 1 to 15 years in the second group. EPST and SST proved to be comparable in regard to operative mortality and morbidity. EPST failed in removing large or impacted bile duct stones in 47% of cases, while SST was uniformly successful. Long-term results were good in most patients, either when treated by EPST or SST. The 5-year failure rate was 8% after EPST and 0% after SST. In the surgical group, the 15-year failure rate was 5%. Serum alkaline phosphatase levels were higher after EPST than after SST, suggesting the persistence of some degree of biliary stasis in endoscopically managed patients. Pneumobilia was detected more often in surgical patients, indicating that SST does create a wide and permanent communication between the duodenum and the biliary system. IN CONCLUSION: 1) EPST may achieve acceptable success rates with low mortality and morbidity, even in high risk patients; 2) the high number of long-term good clinical results seems to indicate that sphincter re-stenosis after EPST is rare, at least for the first 5 years from operation; 3) SST is an effective and safe procedure, ensuring excellent long-term results, provided that the technique of and the indication for are correct (including Wirsung assessment); 4) the wide and permanent stoma created by SST is not associated with recurrent cholangitis, if bile duct re-stenosis does not occur.

Ampulla of Vater↗
PubMed1989

[A new type of small calibre carbon fiber arterial prosthesis].

A new type of vascular prosthesis, made of pyrolytic carbon fibres, was tested on growing pigs. Fourteen grafts (4 x 33 mm) were implanted on the infrarenal aorta and removed 15 s, 60 m and 7, 15, 30, 60 and 120 days after surgery. Specimens were examined by light and scanning electron microscopy. As controls ten pigs underwent excision and re-implantation of a 30 mm segment of infrarenal aorta. Autografts were removed 7 to 120 days after surgery. All but one carbon grafts, as well as all autografts were patent at the time of removal. Basic characteristics of carbon grafts, as shown by the present study, may be summarized as follows: 1) thromboresistance of the inner surface, at the time of implantation, 2) development of a thin neo-intima, 3) rapid and complete endothelialization of the flow surface, 4) good viability of the inner layers and 5) solid anchorage to peri-graft tissues.

Animals↗
PubMed1989

[Carbon fiber composite biomaterials in the substitution of the inferior vena cava].

A new type of vascular prosthesis made of pyrolytic carbon fibres, was tested on growing pigs. Fourteen graft (8 x 30 mm) were implanted as inferior vena cava (IVC) substitutes. The blood conduits were removed 15 s, 60 min and 7, 15, 30, 60 and 120 days after implantation. Specimens were examined by light and scanning electron microscopy. Ten similar pigs underwent excision and re-implantation of 30 mm segment of IVC, and where used as controls. Carbon fibres grafts removed within 7 days after implantation were patent: at the subsequent observation times, the prosthetic segments appeared completely or partially thrombosed. Four of the 10 venous autografts failed. Shortly after implantation, a thick neointimal layer covered the inner surface of carbon grafts. This phenomenon delayed organization and neo-endothelialization of the neointima, exposing carbon segments to blood deposits.

Animals↗
PubMed1989

Postoperative surveillance of colorectal cancer according to risk category.

Over about a 7-year period, 138 colorectal cancer patients undergoing potentially curative surgery were prospectively entered into postoperative surveillance programs that differed according to risk category. Of the 138 patients, 28 (20%) have been lost to follow-up. Of the 110 remaining patients, thirty (27.3%) were classified as low risk cases since they had stage A-B1, well differentiated tumors (G1) primary tumors with preoperative CEA values of less than 7.5 ng/ml (group 1) and the remaining 80 patients (72.7%) were considered high risk cases (group 2). Overall 5 year survival was 64.5%; group 1 patients had a significantly better 5-year survival rate (90%) as compared to group 2 patients (55%) (p less than 0.01). Of the 20 asymptomatic patients with distant metastases only 4 (20%) underwent potentially curative surgery, whereas of 13 asymptomatic patients who recurred locally surgery was undertaken in 9 (69%) (p less than 0.05). At 5 years from the diagnosis of local recurrence, 5 of 11 patients (45.4%) who underwent curative second-look surgery are still alive. The survival of low risk patients was not negatively influenced by less frequent follow-up. Endoscopy and echotomograms were the most useful diagnostic tools in detecting early local anastomotic recurrence and hepatic metastases, respectively. Individualized follow-up programs for various risk categories of colorectal cancer patients are recommended.

Adult↗
PubMed1988

Mapping of six epitopes on haemocyanin subunit Aa 6 by immunoelectron microscopy.

Monoclonal antibodies directed against the haemocyanin of the scorpion Androctonus australis were raised in order to map antigenic determinants (epitopes). The method of mapping employed in this study is molecular immunoelectron microscopy. It consists of a direct electron microscopic observation of antigenic molecules labelled with monoclonal antibodies. The epitopes are then localized in a small region of the external surface of the antigenic molecule whose architecture and quaternary structure are well known. Six monoclonal antibodies have been selected and epitopes have been circumscribed within a small area of one subunit among the 24 subunits composing the whole antigenic molecule.

Animals↗
PubMed1988

Intramolecular localization of epitopes within an oligomeric protein by immunoelectron microscopy and image processing.

Three epitopes have been localized by immunoelectron microscopy on subunit Aa6 of the 4 x 6-meric hemocyanin of the scorpion Androctonus australis. Soluble immunocomplexes composed of monoclonal antibodies and of native hemocyanin were purified, negatively stained with uranyle acetate by the single-layer technique, and examined under the electron microscope (EM). The molecule images were digitized, aligned, and submitted to correspondence analysis according to the method of Van Heel and Frank (Ultramicroscopy 6:187-194, 1981). A high-precision localization of the attachment point of the Fab arm to the antigen was achieved through a careful analysis of the average images. This method easily allowed the discrimination of epitopes located in different domains (Mr 20 kDa) of the same subunit. Nonoverlapping epitopes located in the same structural domain of subunit Aa6 could be distinguished by the stain exclusion patterns of their Fab arms. The method is general and may be used for epitope mapping in any antigen producing definite EM views.

Antibodies, Monoclonal↗
PubMed1988

Cord blood basophil releasability: evaluation of histamine release and leukotriene C4 generation.

This study was performed to evaluate mediator (histamine and leukotriene C4) release from cord blood and adult blood basophils, challenged with IgE-independent (calcium ionophore A23187) and IgE-mediated (anti-IgE) stimuli. IgE-independent mediator release was similar in adult blood and umbilical blood basophils. Conversely, the anti-IgE-induced histamine and immunoreactive leukotriene C4 (iLTC4) release was significantly reduced in cord blood basophils. Passive sensitization with an IgE-rich serum was followed by a significant increase in the number of eluted IgE molecules from cord blood basophils and by an increase in IgE-mediated histamine release. iLTC4 production was not affected by passive sensitization of umbilical blood basophils. The IgE-dependent mediator release from cord blood basophils was not correlated with the number of cell-bound IgE. In addition, histamine secretion and leukotriene C4 production from cord blood basophils seem to be independent events.

Antibodies, Anti-Idiotypic↗
PubMed1988

The prognostic significance of preoperative assessment of mediastinal lymph nodes in patients with lung cancer.

In order to evaluate the prognostic significance of the preoperative assessment of mediastinal lymph nodes, 100 patients with potentially operable lung cancer underwent two-plane tomography, computed tomography (CT), transbronchial needle aspiration (TBNA; 47 patients), and cervical mediastinoscopy. Mediastinoscopy proved to be the most accurate staging procedure. Tomography was less specific, detecting only advanced mediastinal node involvement, and CT was as sensitive as mediastinoscopy but sensibly less specific. TBNA gave no false positive results but a false negative rate of 25.5 percent. Accurate preoperative staging of mediastinal nodes is mandatory to optimize the resectability rate of lung cancer. Where metastatic involvement of mediastinal nodes was preoperatively documented at more than one level, tumors were invariably unresectable. Mediastinoscopic demonstration of intracapsular metastases at only one level did not preclude complete resection. Before thoracotomy, confirmation of neoplastic spread to mediastinal nodes suggests very low survival rates, especially in patients with incomplete removal of tumors.

Adult↗
PubMed1988

Lung function following upper sleeve lobectomy for bronchogenic carcinoma.

Eight patients who underwent upper sleeve lobectomy and six who underwent upper simple lobectomy for lung cancer were studied. The two groups were matched for age and preoperative lung function as assessed by standard spirometry. Post-operative lung function studies, including measurements of regional ventilation (Vr) and perfusion (Qr) by 133 Xenon technique showed that: 1) two weeks after surgery, forced expiratory volume at 1 s was more reduced after simple than after sleeve lobectomy, but in both groups Vr and its vertical gradient were similarly reduced in the operated lung compared to the contralateral; 2) one year after sleeve lobectomy, the vertical gradient of Vr tended to disappear in both lungs while Vr and Vr/Qr of the operated side increased significantly. These results indicate that early after surgery lung function may be less impaired after sleeve than simple lobectomy; however, long-term changes of regional lung function may occur after sleeve lobectomy resulting into a high Vr/Qr ratio in the operated lung.

Adult↗
PubMed1988

Cord blood basophil releasability: a predictive marker for allergy?

Liberation of histamine and LTC4 by cord-blood basophils was measured in the newborn from healthy and atopic parents. The cord-blood basophils of the second classification produced more histamine than those from the first, after challenge with anti-IgE. Thus, a newborn from atopic parent(s) probably carries more fixed IgE on the basophils than a newborn from healthy parents and so the capacity of cord-blood basophils to liberate mediators may be a good marker of allergy.

Adult↗