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Biomedical subjects

L Gandolfi

Publications and source records attributed to L Gandolfi.

At least 37 records · Page 2Linked to original sources
PubMed1996

Ultrasound follow-up of patients at risk for hepatocellular carcinoma: results of a prospective study on 360 cases.

OBJECTIVES: We performed a prospective study with ultrasound (US) follow-up on a population at risk for hepatocellular carcinoma (HCC) to evaluate the possibilities of diagnosis of HCC at an early stage. METHODS: We studied 360 patients; 254 of those patients had cirrhosis of the liver (of which 167 had HCV, 28 had HBV, 53 were alcoholic, and six had autoimmune disease), and the remaining 106 patients had chronic hepatitis. US scan was performed and alpha-fetoprotein was measured every 6 months. Mean duration of follow-up was 56 months (range 18-72). We compared the results of HCC detection with those of 2170 patients with cirrhosis or chronic hepatitis observed with US in the same period, outside the follow-up protocol. RESULTS: In 24 of the follow-up patients, hepatic lesions were detected with US and proved to be HCC with fine needle biopsy, with a cumulative incidence of 6.6% and an annual incidence of 1.4%. The HCC was unifocal in 18 patients, always with diameter < or = 3 cm (small HCC). All but one of the 24 patients who developed HCC had liver cirrhosis, and the remaining patient had HBV-correlated chronic hepatitis. In the group of 2170 patients without serial follow-up, the percentage of detected unifocal tumors with diameters < or = 3 cm was only 15.5%, compared with 75% in the patients with serial follow-up. CONCLUSIONS: The US follow-up of a population at risk for HCC, consisting of patients with chronic liver diseases, made it possible to diagnose tumor < or = 3 cm in a high percentage of cases, with a statistically highly significant difference (chi 2, p = 0.000) compared with the patients not in the follow-up. Follow-up could increase the percentage of HCCs detected at a potentially curable stage. Cirrhosis is confirmed as being the main risk cause, regardless of etiology.

Adolescent↗
PubMed1995

Endoscopic ultrasonography in the diagnosis of gastrointestinal amyloid deposits: clinical case report.

A case of systemic amyloidosis of the digestive tract is described here, with particular attention to the endoscopic ultrasonography aspects, characterized by a wide-spread thickening of the stomach and rectum walls, with loss of the normal layer structure of the mucosa and submucosa. Endoscopic ultrasonography, especially in pseudotumoral forms, may contribute to the differential diagnosis from neoplastic lesions, in which the wall thickening appears to be localized and accompanied by parietal infiltration.

Aged↗
PubMed1994

DNA analysis with flow cytometry and image cytometry in colorectal polyps.

Ploidy was studied with flow and image cytometry in 51 polyps removed endoscopically from 44 patients. Evaluation was carried out on frozen material in 34 cases and on material fixed in formalin and embedded in paraffin in the remaining 17. Data analysis showed a statistically significant correlation between polyp size and aneuploidy frequency (P > 0.05). No statistically significant correlation was found between aneuploidy frequency and histological type. The linear correlation study did, however, show a correlation tendency between histological type and aneuploidy (R = 0.42211).

Adenoma↗
PubMed1993

Echo-guided percutaneous ethanol injection in small hepatocellular carcinoma: personal experience.

We performed echo-guided percutaneous ethanol injection of the lesion in 26 cirrhotic patients with 33 hepatocellular carcinomas measuring 3 cm in diameter or less. Post-treatment lesions had disappeared in 4 patients, while in the remaining 22 patients the echo pattern of the lesion had changed and biopsies were negative. Fifteen patients (follow-up 11-30 months) remain disease-free, while recurrence occurred between 3 and 36 months in 7 cases. Percutaneous ethanol injection was successfully repeated in 4 cases; 5 patients died, 1 of HCC, 2 of esophageal variceal bleeding, and 2 of liver failure; 3 of the last four patients had Child's C disease. Percutaneous ethanol injection is a valuable treatment for hepatocellular carcinomas measuring not more than 3 cm. It has yet to be established how far this treatment influences the survival rates of patients and the natural course of hepatocellular carcinoma.

Administration, Cutaneous↗
PubMed1993

[Comparison of magnetic resonance (0,5 T), computed tomography, and endorectal ultrasonography in the preoperative staging of neoplasms of the rectum-sigma. Correlation with surgical and anatomopathologic findings].

Eighteen cases of rectal carcinoma were staged preoperatively with transrectal endosonography (EUS), CT and MRI (0.5 T). The results were compared with surgical specimens and histology to evaluate the accuracy of the imaging modalities in staging rectal carcinomas which had been quantified according to Astler-Coller's classification. All methods identified the lesion (100% sensitivity). EUS and MRI correctly staged 8 cases (44%) and CT 9 cases (50%). CT and MRI mistakes were relative to overstaging, whereas EUS understaged 4 cases (22%) and overstaged 6 cases (33%). In local tumor staging ("T" variable), CT and MRI understaged no lesions, thus exhibiting 100% sensitivity, which was higher than EUS sensitivity (92%). Conversely, CT and MRI more frequently overstaged the lesions, thus demonstrating lower sensitivity than EUS (55% and 50%, respectively, versus 76% for EUS). As for the "N" variable, EUS identified node metastases in one case only (25%) and misdiagnosed as positive 4 cases of negative node involvement. All the C-stage lesions were correctly diagnosed by CT and MRI (whose findings were in agreement) which also overstaged as C three cases with hyperplastic node enlargement. The diagnostic accuracy of EUS, which was highest for the A and B1 stages, progressively decreased for bigger lesions, clearly understaging node involvement. On the contrary, CT and MRI accuracy rates were lower in small tumors involving the rectal wall only, whereas they always identified tumor spread beyond the bowel wall into perirectal fat, and node metastases. Therefore, to conclude, EUS can be used first: in case of extraluminal tumor spread, CT is the method of choice, more accurate than MRI in identifying node involvement and equally effective in evaluating perirectal fat infiltration and pelvic structures involvement. Whenever the pelvic floor is involved, MRI is the best imaging method, thanks to its multiplanar capabilities, for better detailing of musculoskeletal involvement.

Aged↗
PubMed1991

Natural history of hepatic haemangiomas: clinical and ultrasound study.

Hepatic haemangiomas are the most common benign tumours of the liver and commonly present as incidental findings on sonographic examination of the abdomen. Since little is known of the natural course of these tumours, we performed a clinical and sonographic follow up of 123 haemangioma patients. Our prospective study investigated clinical and sonographic findings in 158 haemangiomas for periods of 12 to 60 months. Ninety nine haemangiomas measured less than 2 cm and had an echogenic pattern; 40 were between 2 cm and 5 cm with a mainly echogenic structure; 19 measured greater than 5 cm and showed a mixed echo pattern. At the first examination only eight patients, all with giant haemangiomas, presented symptoms which could be attributed to the tumour. During follow up only one haemangioma changed in shape and size. One patient who was symptom free at the first examination experienced right upper abdominal quadrant pain during follow up. No deterioration occurred in any of the patients with symptoms at the first examination, and all had a satisfactory quality of life. No complications arose during the follow up period. This study shows that in adults haemangiomas remain stable in size and echo patterns rarely change. Only haemangiomas greater than 5 cm may cause symptoms. Prolonged clinical and sonographic follow up of small and medium sized haemangiomas is not warranted.

Adult↗
PubMed1990

Problems of gastrointestinal endoscopy in Italy.

The authors discuss some aspects of Gastrointestinal Endoscopy in Italy emphasizing, in accordance with other countries, the importance of preventing the separation of Gastrointestinal Endoscopy and Gastroenterology. An endoscopist should be a gastroenterologist capable of clinically assessing endoscopic results and not just an individual providing a technical service. In a hospital organization, excessive diffusion of the method in small hospitals should be avoided and the more complex techniques should be concentrated in the Gastroenterology and Gastrointestinal Endoscopy Departments in order to guarantee the quality of care and patient safety. Great attention must be given to the training of endoscopists and an adequate preparation of the nursing staff in also important.

Endoscopy, Gastrointestinal↗
PubMed1989

Comparison between the 21-gauge Urocut needle and the 21-gauge Surecut needle in echo-guided percutaneous biopsy of neoplastic liver lesions.

Fine cutting needles for histology are now widely used in echo-guided biopsies of various organs. In this study we compared the results obtained in the biopsy of neoplastic hepatic lesions using two different 21-gauge cutting needles: Trucut needle (Urocut) and a modified Menghini needle (Surecut). Eighty-five patients with primary or metastatic hepatic neoplasms were biopsied with a Urocut needle and a further 85 patients underwent biopsy with a Surecut needle. The two groups were comparable for size and nature of hepatic neoplasms. The Urocut needle provided a much higher percentage of diagnostic material than the Surecut needle (94.8% vs 70.5%) regardless of the primary or metastatic nature of the lesion or its size. The diagnostic accuracy was only identical for both needles (91.3% for Urocut vs 91.5% for Surecut) whenever the diagnostic material was compared in cases in which both types of needles had been used to take the biopsy specimens. There were no complications in either of the two groups studied. Given the smaller incidence of non-diagnostic biopsies with the Urocut needle, we consider that this needle should be preferred in echo-guided biopsies of neoplastic hepatic lesions.

Adult↗
PubMed1989

The source of Campylobacter pylori.

Sera from 98 abattoir workers were tested for IgG as well as for IgA to Campylobacter pylori, C. jejuni and Klebsiella. Clerical workers had significantly lower C. pylori and C. jejuni antibody levels than any of the groups in direct contact with freshly cut animal parts. No difference was found for antibodies to Klebsiella. Twenty-nine non-clerical workers with high IgG antibody levels against C. pylori consented to upper gastrointestinal endoscopy. C. pylori associated gastritis was found in all 29, and 4 weeks of colloidal bismuth subcitrate (240 mg/twice daily) was prescribed. On repeat testing at 3 months, all showed a decrease in IgG antibody levels to C. pylori but not to C. jejuni, whereas 18 untreated non-endoscoped workers showed no change. These findings raise the possibility that C. pylori infection is a zoonosis.

Abattoirs↗
PubMed1989

Intratumoral echo-guided injection of interleukin-2 and lymphokine-activated killer cells in hepatocellular carcinoma.

Interleukin-2 has proved to be effective for the intralesional treatment of tumors of the bladder. There are examples in literature of hepatocellular carcinoma (HCC) treatment with lymphokine-activated killer (LAK) cells infused in the hepatic artery. We decided to check the effects of echo-guided intralesional injection of these cells in this disease. We treated 5 patients with inoperable hepatocellular carcinoma, following cirrhosis; in 4 cases the mass had a diameter less than 3 cm (small HCC) while in the remaining case it measured 7 cm. Tumor size remained unchanged in 3 of the 4 small HCC, and increased only slightly in the other (over a period of 10 months). This would appear to indicate that treatment halted neoplasm growth or at least slowed it down. The echo pattern of the lesions changed, with a constant reduction in echogenicity. Finally, in multiple control biopsies, fibrosis, present in only one case before treatment, was found fairly constantly after treatment. There were no significant side effects, apart from slight water retention in one patient. On the basis of our preliminary results, we consider it worthwhile continuing this study to establish the most suitable IL-2 doses and analyze in more detail the modifications induced in the neoplasm.

Aged↗
PubMed1988

Campylobacter pylori in abattoir workers: is it a zoonosis?

Sera from 98 abattoir workers were tested for IgG to Campylobacter pylori, C jejuni, and klebsiella. Clerical workers had significantly lower C pylori and C jejuni IgG titres than any of the groups in direct contact with freshly cut animal parts. No difference was found for antibodies to klebsiella. 28 non-clerical workers with high-titre C pylori IgG consented to upper gastrointestinal endoscopy. C pylori associated gastritis was found in all 28, and four weeks of colloidal bismuth subcitrate (240 mg twice daily) was prescribed. On repeat testing at three months all showed a decrease in IgG titres to C pylori but not to C jejuni, whereas 18 untreated non-endoscoped workers showed no change. These findings raise the possibility that C pylori infection is a zoonosis.

Abattoirs↗
PubMed1987

Small hepatocellular carcinoma: an Italian experience.

Recent reports have demonstrated the possibility of using ultrasound to detect hepatocellular carcinomas under 3 cm (small HCC). Our aim was to assess the incidence of small HCC in an Italian ultrasonographic series. Among 17,133 scans of unselected patients, we detected 85 HCC, 9 of which were under 3 cm. All patients had cirrhosis and 6 were HBsAg positive. An echo-guided biopsy was performed in all cases, and the diagnosis was always correct. We conclude that echographic follow-up is warranted in Italy for cases at risk for HCC such as HBsAg+ cirrhotics and patients with chronic aggressive HBsAg+ hepatitis older than 35, in agreement with the reports of Far Eastern authors.

Aged↗