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Biomedical subjects

G Vespasiani

Publications and source records attributed to G Vespasiani.

At least 55 records · Page 3Linked to original sources

[Ultrasonically guided access to the kidney].

Ultrasonography is an ideal procedure to guide and control the diagnostic and therapeutical percutaneous renal puncture. Some procedures considered in pre-echographic period, long, complicated and not free from risks and complications, were transformed in routine manoeuvres by the advent of ultrasound. Nowadays, thanks to the ultrasound guide, is possible to perform a rapid, accurate, safe and without anesthesia puncture of the kidney and of the upper urinary tract. Several procedures contemplating the renal puncture, can be performed in out-patients.

Biopsy↗

[Echography in andrological emergencies].

Ultrasonography is the first imaging method to undertake in all acute andrological disorders. It gives an accurate diagnostic picture in a high percentage of cases and is extremely useful for following patients during therapy and after surgery. The forms of acute andrological disorders, of both medical and surgical pertinence, that can be evaluated ultrasonographically include many prostate, seminal vesicle and external genital afflictions. Among the prostate and seminal vesicle disorders, of particular importance are acute prostate vesiculitis and prostatic abscess. Ultrasonography can be used to advantage in the latter as a guide to percutaneous transperineal drainage. The acute penis disorders that can be assessed by are essentially vascular affections (priapism and thrombosis of the corpus cavernosum). Ultrasonography, however, find its widest field of application in acute scrotum disorders. Ultrasonography is the most valid diagnostic aid for confirming clinical data in all forms of these disorders. It allow these that need medical treatment to be differentiated from those requiring surgery. Ultrasonography has good specificity in the differential diagnosis of spermatic cord and Morgagni's hydatid torsion, an acute scrotal affliction not uncommon in childhood, which is often self-limiting and, therefore, does not necessitate emergency surgery. Finally, ultrasonography is useful for distinguishing minor scrotal trauma which can be treated medically from major scrotal trauma which requires surgical intervention.

Acute Disease↗

Partial gastrectomy and mineral metabolism: effects on gastrin-calcitonin release.

Bone mineral metabolism was studied in 20 male patients, between 8 and 18 years, after surgical treatment for peptic ulcer (ten Billroth 1 and ten Billroth 2 gastrectomies) and in 16 sex- and aged-matched healthy controls. The bone mineral content was statistically reduced only in the Billroth 2 group. Serum 25(OH)D was lower in all patients, but fractional calcium absorption was similar to the control value. This may be due to increases in 1,25(OH)2D and parathyroid activity (particularly in Billroth 2). Serum osteocalcin levels and hydroxyproline excretion were higher than in the controls. A positive linear correlation emerged not only between serum 1,25(OH)2D and PTH levels but also between each of these and serum osteocalcin and urine hydroxyproline. Both PTH and calcitriol were inversely correlated with the bone mineral mass in Billroth 2, confirming a trend observed in Billroth 1. Although calcitonin values were normal, basal gastrin levels were severely impaired in all patients. In response to a mixed meal, increases in gastrin and calcitonin were significantly lower than in the controls. The calcitonin response to intravenous calcium and pentagastrin infusion was not significantly different to the controls. The percentage increase in gastrin and calcitonin responses to oral calcium correlated positively with the reduction in bone mineral content only in the Billroth 2 group, suggesting a reduction in calcitonin release may contribute to gastric surgery osteopenia in these patients.

Adolescent↗

Diuretic ultrasound. A non-invasive technique for the assessment of upper tract obstruction.

A study was made of the diagnostic reliability of renal ultrasound with a diuretic in the evaluation of upper tract obstruction. The test comprised an initial renal ultrasound examination followed by the intravenous injection of 250 ml physiological saline with 40 mg frusemide; further ultrasound scans were carried out from 5 to 150 minutes later. A total of 67 patients was studied and the results were compared with those of diuretic intravenous urography, diuretic renography and, in some cases, the Whitaker test. Dynamic ultrasound with a diuretic showed a sensitivity of 94%, specificity of 94%, positive predictive value of 91% (obstructive), negative predictive value of 96% (non-obstruction) and a total diagnostic capacity of 94%.

Adolescent↗

Real-time transrectal sonographic voiding cystourethrography.

Transrectal linear array transducer makes possible a sagittal view of the bladder base-plate, prostatic urethra, and membranous urethra yielding an image similar to that obtained with voiding cystourethrogram. This permits lack of time limitation, such as imposed by the use of fluoroscopy, and the possibility of visualizing not only the lumen of the bladder neck and urethra but also the surrounding soft tissue. Using ultrasonographic urodynamics in neuromuscular dysfunctions of the bladder and urinary voiding obstructions we obtained excellent results in patients with detrusor-sphincter dyssynergia and in those with posterior ledge at the bladder neck. Both conditions are clearly visualized, particularly the existence of the posterior ledge which is responsible for the failure of the sphincterotomy in patients with periurethral striated sphincter spasm.

Humans↗

Classification of idiopathic hypercalciuric patients by isotopic calcium absorption: a comparison with oral calcium tolerance test.

To test the accuracy of calcium tolerance test in estimating calcium absorption, we have measured the radioactive calcium absorption (expressed as Fx) in 27 patients with IH and renal calcium stones. The results of this test were compared with those of a standard oral calcium tolerance test. Although only seven of nine AH patients displayed normal fasting calcium excretion, they all displayed Fx values above normal and a normal parathyroid activity. Conversely, only 5 of our 18 RH patients demonstrated a hyperabsorption of radioactive calcium and an elevation in iPTH and cAMP above normal limits, yet all of them showed an increased calciuric response to an oral calcium challenge. Calcium absorption was inversely related to iPTH (r = -082; P less than 0.001) and cAMP (r = -064 P less than 0.05) in AH, but directly proportional to these parameters (r = 0.62 P less than 0.001 and r = 0.46 P less than 0.05, respectively) in RH patients. In view of these results, two ratios, iPTH/Fx and cAMP/Fx were used to discriminate between the two groups of patients. Both ratios were over normal limits in all RH patients and within normal range in all but one AH patient. Furthermore, no overlap was found between the two groups. Conversely, we were unable to completely separate AH from RH subjects on the basis of the oral calcium tolerance test, since in both groups the fasting and the absolute (or percentage) changes in urinary calcium, cAMP and blood iPTH levels following oral calcium loading, overlapped in each instance.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗

Incidentally detected renal cell carcinoma: role of ultrasonography.

The widespread use of modern diagnostic imaging techniques, especially computed tomography and sonography, has led to the detection of an increasing number of serendipitous renal neoplasms, with no signs nor symptoms related to the neoplastic renal disease. In the last 4 years, 54 consecutive patients (20 females and 34 males) with renal cell carcinoma were reviewed. In 26 patients (48.15 per cent) the diagnosis was made as an incidental finding by an abdominal ultrasound examination. Clear signs and symptoms related to the neoplastic disease were present in 28 cases (51.85 per cent). The pathologic type of each neoplasm was categorized, and each carcinoma was staged. In the patients not surgically treated, the stage was determined on the basis of the diagnostic imaging reports. The results of this study suggest that the incidentally detected tumors are of a significantly lower stage than the symptomatic tumors (Wilcoxon rank sum test: P less than 0.0073 and X2 test: P less than 0.013). Early detection of renal tumors may improve the prognosis and the overall survival of patients with renal cell carcinoma and allow one to plan radical or partial nephrectomy, since local extension has a considerable impact on the operative strategy. Our experience emphasizes the role of ultrasound in the increased early detection of renal cell carcinoma.

Adult↗

Prostatic small cell carcinoma diagnosed by tru-cut needle biopsy: discussion of clinico-pathological findings.

The small cell carcinoma is a neuroendocrine tumour characterised by an aggressive clinical course and a high mortality rate. It occurs most commonly in the lung. Small cell carcinomas originating in the genitourinary system have been diagnosed with increasing frequency in recent years, because of the use of immunohistochemistry. Prostatic small cell carcinomas present the same biological behavior and similar histological, immunohistochemical and ultrastructural features to small cell carcinomas of the lungs. We describe the clinico-pathological findings in a 65-year-old male patient with a diagnosis of prostatic small cell carcinoma, obtained by means of a tru-cut needle biopsy. We performed the immunohistochemical tests using neuron-specific enolase and chromogranin A antibodies, according to the literature. On the basis of our experience we stress the malignant features of small cell carcinoma and the difficulty in obtaining an early diagnosis and treatment because of the aggressive course of the lesion and the late symptomatology.

Aged↗

[Inflammatory pseudotumor of the bladder: etiopathologic and clinical features].

The Authors present a case of inflammatory pseudotumour (IPT) of the urinary bladder occurring in a 57-year-old female patient, who was referred to our department with haematuria, stranguria and hypogastric pain. Ultrasonographic, radiological and endoscopic examinations showed a sessile, ulcerated, easily bleeding bladder formation; urinary cytology revealed no atypical transitional cells. Abdomino-pelvic computed tomography analysis showed thickening of the bladder walls and infiltration of the perivesical fat. Histopathologically, the formation was indicated as an inflammatory pseudotumour (IPT) of the bladder. The patient underwent TURB (transurethral resection of the bladder) and was discharged clinically healed on postoperative day 4. A one-year follow up revealed no evidence of recurrence. On the basis of their experience and a thorough review of the literature review, the Authors discuss the clinico-pathological features of IPT of the bladder and the possible factors involved in the malignant transformation of IPT. In conclusion, the benign nature of the lesion is stressed.

Female↗