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Biomedical subjects

G Zuccaro

Publications and source records attributed to G Zuccaro.

At least 55 records · Page 3Linked to original sources
PubMed1996

Complications in paediatric craniopharyngioma treatment.

Forty-eight consecutive children treated for craniopharyngioma at the Juan P. Garrahan National Paediatric Hospital (Buenos Aires, Argentina) from 1988 to 1994 are described. Complications of patients undergoing total resection alone and those undergoing subtotal or partial resection plus radiotherapy were compared. Survival time and quality of life proved more satisfactory in the former group, as there were no recurrences. In contrast, among the latter patients, 53% suffered relapses. Endocrinological complications were similar in the two groups. Postsurgical subdural haematomas were quite frequent and eight patients required treatment for intracranial hypertension. Vascular complications, though less common, led to high morbidity and mortality. There was a considerable incidence of shunt malfunction (80%), arguing against placement of a preoperative shunt, which tended besides to foster postsurgical subdural haematomas.

Adolescent↗
PubMed1996

Granular cell tumors of the esophagus: a clinical and pathologic study of 13 cases.

BACKGROUND: Fewer than 200 cases of esophageal granular cell tumors (GCT) have been reported. However, determination of malignant potential and appropriate management are as yet unresolved issues. METHODS: We evaluated the clinical and pathologic features of 13 esophageal GCTs. RESULTS: This group included 11 women and 2 men. Six patients were black. Patient ages ranged from 27 to 69 years (median, 47 years). Tumors were found incidentally in 10 patients. Only 2 patients were symptomatic. Most tumors were in the distal esophagus and were less than 8 mm. In 5 patients, multiple GCTs were found, including 3 patients with multiple esophageal GCTs. In 11 cases, the tumor was diagnosed by endoscopic biopsy. Ten patients were treated with biopsy alone, without further attempt at tumor excision. No recurrent or metastatic disease developed within the follow-up period. In all but 1 case, tumors were characterized by nests of cells with pyknotic nuclei, abundant granular cytoplasm, an absence of mitotic figures, and strong S-100 protein positivity. One patient who presented with dysphagia had a 2.5-cm distal esophageal GCT that showed atypical histologic features, including cellular spindling, nuclear pleomorphism, and mitoses. Because of this patient's symptoms, the large tumor size, and atypical endoscopic ultrasonographic and histologic features, the lesion was surgically excised. CONCLUSIONS: Esophageal GCTs are usually asymptomatic, small, and found incidentally on upper endoscopy done for other reasons. Flexible esophagoscopy and biopsy are the mainstay in diagnosis, and endoscopic ultrasound can provide additional information on the layer of origin and tumor extension. Observation of these tumors is indicated unless the patient is symptomatic or the tumor is greater than 1 cm or has atypical endoscopic ultrasonographic or histologic features.

Adult↗
PubMed1996

Stage II esophageal carcinoma: the significance of T and N.

OBJECTIVE: Stage II esophageal carcinomas are a heterogeneous group of uncommon malignant tumors that include both node-negative (IIA; T2 N0 M0 and T3 N0 M0) and node-positive (IIB; T1 N1 M0 and T2 N1 M0) carcinomas. The purpose of this study was to evaluate this heterogeneity and to identify predictors of improved survival. RESULTS: Ninety-four of 345 patients undergoing esophageal resection at the Cleveland Clinic Foundation between 1985 and 1994 had stage 11 carcinomas; 70 stage IIA (24 T2 N0 M0 and 46 T3 N0 M0) and 24 stage IIB (9 T1 N1 M0 and 15 T2 N1 M0). Pathologic stage and T and N status were the only identifiable predictors of survival. Stage IIA survival was significantly better than stage IIB (p = 0.01). T2 N0 M0 survival was not different from T1 N0 M0 survival (p = 0.83). T3 N0 M0 survival was significantly worse than T1 N0 M0 (p = 0.03) and intermediate between T2 N0 M0 survival (p = 0.06) and T1 N1 M0 and T2 N1 M0 survivals (p = 0.07). T1 N1 M0 and T2 N1 M0 survival was not significantly different from T3 N1 M0 survival (p = 0.63). CONCLUSIONS: (1) N1 disease is the principal predictor of reduced survival and N1 is independent of T. Therefore the distinction between T1 N1 M0, T2 N1 M0, and T3 N1 M0 carcinomas is not warranted. (2) N0 disease is the principal predictor of improved survival but N0 is not independent of T. T1 N0 M0 and T2 N0 M0 survivals are similar and therefore distinction between these subgroups is not warranted. T3 N0 M0 survival is intermediate between T1 N0 M0 and T2 N0 M0 carcinomas and between T1 N1 M0, T2 N1 M0, and T3 N1 M0 carcinomas. Therefore stratification by T for N0 carcinomas is warranted.

Adenocarcinoma↗
PubMed1996

Transvaginal sonographic tubal patency testing using air and saline solution as contrast media in a routine infertility clinic setting.

Tubal patency testing by transvaginal sonography has been implemented in our infertility clinic since 1991. We report our experience with this technique during the last year of routine outpatient activity. A total of 154 infertile patients, including three patients on two occasions, underwent tubal patency testing by transvaginal sonography; 36 also underwent laparoscopy or hysterosalpingography, with a further three undergoing both. A detailed account of the method used to visualize the passage of air and saline through the salpinx is described. The 'gold standard' for tubal patency was laparoscopy. In any cases that were doubtful or if there was tubal occlusion, laparoscopy was advised. The diagnoses by transvaginal sonography in the 154 patients consisted of: 106 with bilateral tubal patency (68.8%), 34 with unilateral tubal occlusions (22.1%), and 13 with bilateral occlusion (8.4%); one case was undiagnosed. Tubal disease was present in 25 out of the 36 (69.4%) patients undergoing laparoscopy or hysterosalpingography (69.4%). The sensitivity, specificity, accuracy, positive and negative predictive values were respectively 80, 85, 82.7, 85 and 80% for the 29 patients undergoing transvaginal sonography and laparoscopy. When the number of tubes examined was considered, these values were respectively 85, 91.6, 89.3, 85 and 91.6%. No discordance was observed in the ten patients undergoing hysterosalpingography. Demonstration of the tubal course relies on a positive contrast medium filling the tubal lumen. Air and saline were successful for this purpose. In our study, the results of tubal patency testing by transvaginal sonography were very similar to those of hysterosalpingography, but differed in about 10% of the cases from those of laparoscopy. The most difficult problem to rule out was distal tubal occlusion without hydrosalpinx. Tubal patency testing by transvaginal sonography can be used safely as a first-step examination of tubal patency. Easy tubal passage can allow medical treatment, while a doubtful or frankly occluded salpinx should be investigated by laparoscopy.

Adult↗
PubMed1996

Case report: successful treatment with cimetidine and zinc sulphate in chronic mucocutaneous candidiasis.

The authors evaluated the clinical efficacy of a treatment with cimetidine and zinc sulphate in a patient with chronic mucocutaneous candidiasis. Cimetidine was given at a dose of 400 mg three times daily; zinc sulphate at a dose of 200 mg daily, then adjusted to maintain blood zinc levels at the upper normal range. This treatment lasted 16 months. An impressive and significant reduction of the infectious events and an increased CD4 (helper/inducer) cell counts were observed. The authors conclude that this combined immunopotentiating treatment is safe and inexpensive to treat immunodeficiency disorders.

Adjuvants, Immunologic↗
PubMed1995

A prospective, double-blind trial of somatostatin analog (octreotide) versus glucagon for the inhibition of small intestinal motility during endoscopic retrograde cholangiopancreatography.

BACKGROUND: Glucagon is effective when used as an antimotility agent during ERCP, but at high doses it may cause nausea and vomiting. Octreotide acetate, a long-acting synthetic analog of somatostatin, inhibits contractility of the small intestine and is generally well tolerated. The purpose of this study was to determine if octreotide given prior to ERCP reduced the requirement for glucagon and enhanced patient tolerance for the procedure. METHODS: Patients undergoing ERCP (n = 100) performed for a variety of indications (but not sphincter of Oddi manometry) were randomly assigned to receive normal saline solution or octreotide at a total dose of 25 micrograms, 50 micrograms, or 100 micrograms diluted in normal saline solution prior to the procedure. Glucagon was subsequently administered (as needed, to inhibit intestinal motility) by endoscopists who were blinded to the test substance given prior to the procedure. RESULTS: For all treatment groups, the dose of glucagon required to inhibit intestinal motility in patients who received octreotide prior to the procedure was not significantly different from the dose administered to patients who received normal saline solution. There was no significant difference in the incidence of nausea and vomiting when individual test groups were compared to the control group. CONCLUSION: Nausea and vomiting after ERCP were uncommon in all treatment groups. Administration of octreotide prior to ERCP did not significantly reduce the dose of glucagon required to inhibit intestinal motility. Tolerance for ERCP was similar for patients given octreotide when compared with those given glucagon to inhibit small intestinal motility.

Adult↗
PubMed1994

A new technique to test tubal patency under transvaginal sonographic control.

OBJECTIVE: Since 1990 we have undertaken a trial to evaluate if TVS, even without contrast media, could diagnose tubal patency. MATERIALS AND METHODS: A detailed description of the technique is given. Two hundred and seventy-three patients underwent sonosalpingography in our department in the period 1990-1993. The sonographic findings were matched in 43 cases to hysterosalpingography and in 55 cases to laparoscopy. RESULTS: Tubal patency was demonstrated in 218 patients (80.5%), monolateral patency in 41 (15.1%) patients and bilateral tubal occlusion in 12 (4.4%) patients. In the 43 patients undergoing hysterosalpingography, discordance between the two examinations was observed in five cases (11.6%). However, only six out of 86 salpinxes had different results (6.9%). In only one case was total discordance observed. In three out of four other cases the difference was due to patency diagnosed at SSG and occlusion at HSG. Of the 55 patients undergoing laparoscopy 12 cases (21.8%) had discordant results. Complete discordance was observed in two cases while in ten cases one salpinx had a different patency report. The discordance goes to 12.7% when we take into account all the salpinxes evaluated. CONCLUSION: Sonosalpingography gives very similar results to hysterosalpingography and may be used on clinical basis for tubal patency evaluation.

Adult↗
PubMed1993

Bleeding peptic ulcer: pathogenesis and endoscopic therapy.

The presence of stigmata of hemorrhage in a peptic ulcer indicate an increased risk of rebleeding and the need for endoscopic intervention. Clinical trials indicate that laser photocoagulation, multipolar and heater probe coagulation, and injection therapy are all effective in decreasing bleeding from peptic ulcer disease. The modality used for the individual patient depends on available resources and the experience of the endoscopist. Laser photocoagulation is used infrequently, not because of a lack of efficacy but because of its increased cost and impracticality, including its lack of portability. Multipolar coagulation and heater probe coagulation are commonly employed but may give way to injection therapy as first-line therapy, because it is equally effective, cost less, and is easy to implement in a variety of clinical settings.

Clinical Trials as Topic↗
PubMed1992

Endoscopic ultrasonography in the diagnosis of chronic pancreatitis.

Endoscopic ultrasonography (EUS) is highly accurate in the diagnosis of chronic pancreatitis. Both parenchymal and ductal changes indicative of chronic pancreatitis can be identified. Parenchymal changes include small cystic abnormalities and hyperechoic foci scattered throughout the gland; the entire gland may be enlarged in early chronic pancreatitis, or small and atrophic in advanced disease. Ductal changes include enlargement of the main pancreatic duct or secondary branches, and the presence of stones or proteinaceous plugs within the ducts. Pseudocysts appear as cystic structures of mixed echogenicity; EUS is able to detect small pseudocysts or masses not identified by conventional imaging modalities. EUS has some difficulty in distinguishing benign from malignant pancreatic masses, particularly when the lesions are small. EUS should not supplant the use of CT scan or ERCP in the differential diagnosis of pancreatic disease, but is rather an adjunct to these studies. Future clinical research should focus on determining the appropriate indications for EUS in pancreatic disease, and determining if patient outcomes are favorably affected by the diagnostic information obtained.

Chronic Disease↗
PubMed1989

Pouch ileitis.

Pouch ileitis is the most poorly understood complication of ileal reservoir surgery. Variability in definition of this syndrome may account for differences in incidence rate, associated symptoms, and response rate to therapy present in the literature. Outcomes of 19 episodes of pouch ileitis in patients having undergone prior colectomy and continent ileostomy construction for presumed ulcerative colitis were analyzed. An episode of pouch ileitis was characterized by: (1) abdominal pain, (2) increased ileal output, (3) mucosal inflammation within the continent ileostomy, and (4) absence of other recognized concurrent postoperative complications. The mean time of occurrence after construction of the continent ileostomy was 25 months (range 3-54 months). The mean length of follow-up of patients included in this analysis was 49 months from the time of continent ileostomy construction (range 22-101 months). Associated clinical symptoms included bloody effluent (53%), nausea or emesis (47%), and fever (42%). Endoscopic features were often nonspecific, with mucosal erythema (84%), edema (79%), friability (58%), and mucosal ulceration (53%) the most common. In those episodes of pouch ileitis where ileoscopy revealed no evidence of mucosal ulceration, complete resolution of the episode occurred 89% of the time, with 78% treated with antibiotics alone. In those episodes where mucosal ulceration was described on ileoscopy, 40% of episodes completely resolved after medical treatment, 20% with antibiotics alone. The varied clinical symptoms, endoscopic findings, and response to treatment raises the possibility that what has previously been described in the literature as pouch ileitis may be a heterogeneous group not of single etiology.(ABSTRACT TRUNCATED AT 250 WORDS)

Colectomy↗
PubMed1986

Intracranial neoplasms during the first year of life.

During a 7-year period, from January 1976 to December 1982, 470 brain tumors were treated at the Hospital de Niños Ricardo Gutierrez in Buenos Aires, 40 of which occurred in infants under 1 years of age. Diagnosis was at best tentative because most cases were referred on account of symptoms and nonspecific signs, e.g., macrocephaly, vomiting, and altered behavior. The supratentorial location was predominant over the infratentorial, with a ratio of 4:1. Craniotomies with resection of tumor were performed on all but four infants. Optic chiasm pilocytic astrocytoma, superficial brain astrocytoma, and choroid plexus papilloma were the most common histologic types. Thirty-three infants (80%) were found to have hydrocephalus complicating the brain tumor, but only 15 of them were shunted, because 4 infants died, and in 14, hydrocephalus remitted after the operation. After 2-9 years of postoperative observation, 16 infants (40%) live tumor-free and have normal neurological examinations, 5 (12%) suffer moderate deficits, and 19 (48%) have died.

Astrocytoma↗
PubMed1980

[Pneumopericardium in neonatal resuscitation].

Pneumopericardium is a serious complication that may appear during artificial ventilation in the treatment of newborns with hyaline membrane disease. Its frequency may be greater than is generally supposed, since not all cases are diagnosed in vivo. Data from the literature and an account of the symptom picture and treatment of this form are followed by the presentation of two cases successfully resolved by means of pericardiocentesis.

Female↗