Unusually high plasma CEA values in a patient with idiopathic pulmonary fibrosis.
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Biomarkers, Tumor↗
Biomedical subjects
M Costantini
Publications and source records attributed to M Costantini.
Clonazepam microencapsulation in poly-D,L-lactide-co-glycolide microspheres.
The work is aimed at the preparation and characterization of biodegradable microspheres of poly-D,L-lactide-co-glycolide (PLGA), for the controlled release of clonazepam. The solubility characteristics of this drug make it an interesting example to evaluate the performances of the two most widely used microencapsulation techniques, emulsification solvent evaporation and spray-drying. Several biodegradable PLGA copolymers have been evaluated (RG 502H, RG 503H, RG 503, Boerhinger Ingelheim). They differ in terms of molecular weight and physico-chemical characteristics. The microspheres obtained have been characterized for their morphology, physico-chemical properties (DSC) and in vitro dissolution behaviour. Between the two preparation methods, only spray-drying was suitable for the microencapsulation of clonazepam in PLGA microspheres. In vitro dissolution tests highlight that more sustained release of drug is achieved with the higher (molecular weight) polymer.
Anticonvulsants↗
[Quality of life at the end of life. Analysis of the quality of life of oncologic patients treated with palliative care. Results of a multicenter observational study (staging)].
Outcome in palliative care can be defined as patients' quality of life, quality of death and satisfaction with care. In an Italian multicentre prospectic study ('Staging') the quality of life of 571 palliative care patients with advanced cancer disease was assessed since the beginning of palliative care till the end of the study. We analyzed the tissue of quality of life missing data and the possibility to input the missing quality of life evaluation through the quality of life evaluation made by a proxy (doctor, nurse). The greatest functional impairment and an increasing level of some symptoms (fatigue, general malaise, emotional status) were observed during the last two weeks of life, whereas for other symptoms (gastro-intestinal, pain) some degree of control was possible. The quality of life analysis for palliative care patients should consider the different response of different quality of life components to the palliative care intervention.
Aged↗
The safety and feasibility of laparoscopic cholecystectomy.
This study analyzes data from 100 consecutive patients with gallstone disease who underwent laparoscopic cholecystectomy (LC), a surgical technique rapidly emerging as the treatment of choice for this disease. LC has two major advantages: reduction of postoperative pain and a shortened hospital stay. LC was successfully completed in 88 patients, the main cause of conversion to open cholecystectomy being acute or chronic inflammation of the gallbladder. Analysis of risk factors showed that age, obesity, episodes of jaundice, pancreatitis, and acute or chronic cholecystitis are not absolute contraindications to LC. Mortality was absent and the intraoperative morbidity rate was 2%. No lesion of the main bile duct occurred. Seven minor post-operative complications that did not prolong hospital stay were also observed. These figures compare well with the mortality and morbidity of open cholecystectomy, and demonstrate that the significant benefits in terms of patient welfare and hospital costs of LC are not obtained at the expense of increased surgical risk.
Adult↗
T AILD-like non Hodgkin lymphoma complicated by malignant mesenchymal ocular neoplasia: a case report.
We report a case of T AILD-like NHL in a 50-year-old man who partially responded to combined therapies. The course of the disease was complicated by a malignant mesenchymal ocular neoplasia. The patient died because of severe infections and lymphoma dissemination. The association between T AILD-like NHL and carcinomas has been described: no case of concomitant malignant mesenchymal neoplasia is reported in literature.
Combined Modality Therapy↗
Treatment of lymphocele following renal transplantation by laparoscopic surgery.
We describe a new technique for internal drainage of lymphocele following renal transplantation performed by laparoscopy. After induction of the pneumoperitoneum, using the cautery hook, a wide opening in the lymphocele peritoneal wall has been performed allowing the lymph flow to enter the peritoneal cavity. A portion of the omentum has been pushed inside the lymphocele cavity and fixed to the parietal peritoneum in order to avoid closure of the peritoneal window. A postoperative CT scan control has shown the complete disappearance of the fluid collection. Internal drainage of lymphocele performed by laparoscopy allows a radical treatment with minimal trauma for the patient and has therefore potential advantages over the other current procedures.
Adult↗
[Limitations of the traditional manometric test and advantages of computerized manometry in the study of esophageal motility].
The analysis of esophageal motility tracings is laborious, time consuming and subject to reader variability. The motility traces of five patients were analyzed separately by five experienced readers, in order to assess the inter and intra observer variability. Later on, the manual analysis of the motility traces of five healthy volunteers and four patients was compared to the automatic analysis performed by a computerized system. The inter- and intra-observer variability (expressed as coefficient of variation) was high in the manual analysis, especially for the abdominal length of the lower sphincter and the duration of the esophageal body contractions (coefficient of variation ranging from 18 to 43%). On the contrary, automatic readings proved almost identical to the means obtained by manual analysis (Pearson factor 0.988 for amplitude and 0.89 for the duration of contractions). Moreover, the computerized automatic analysis gave a significant time gain in respect to manual readings and eliminated the inter and intra-observer variability.
Electronic Data Processing↗
[Unusual beginning of a case of chronic myeloid leukemia].
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Aged↗
Suramin and serum insulin-like growth factor levels in metastatic cancer patients.
Suramin, a polysulphonated naphthylurea, inhibits the activity of several growth factors in in vitro experiments and clinical responses have been reported in human solid tumors. We decided to investigate the relationship between suramin treatment and serum levels of insulin-like growth factor I (IGF-I) and II (IGF-II) in advanced breast, prostate and lung cancer patients. The serum IGF-I, IGF-II levels were determined by radioimmunoassay. A significant decline of IGF-I and IGF-II serum levels was demonstrated in suramin treated patients. Our results suggest that suramin-induced IGF suppression could be one of the possible mechanisms of suramin action.
Aged↗
[Perioperative teicoplanin prophylaxis in patients undergoing breast reconstruction with the abdominal wall. A case-control study].
The authors report the results of a randomized clinical trial of antibiotic prophylaxis of postoperative infection following breast reconstruction by transposition of rectus abdominis myocutaneous flap (TRAMF). The aim was to evaluate the efficacy and tolerability of a short-term parenteral prophylaxis with Teicoplanin and the end-point of the study was the evaluation of wound contamination assessed by means of microbiologic culture of drainage fluid. From October 1990 to March 1992 38 patients were recruited: 20 patients in the antibiotic prophylaxis arm and 18 patients in the control group. Analysis of drainage fluids showed a higher contamination rate (15/18 = 83%) in the control group as compared to the prophylaxis arm (2/20 = 10%) (p < 0.0001). Moreover, 11 patients in the control arm suffered from fever > 37.5 degrees C for at least 3 days as compared to 1 patient in the antibiotic prophylaxis group; the postoperative stay was 13.3 +/- 4.3 and 9.0 +/- 1.6 in the control and antibiotic arm respectively. No antibiotic related side effects were evidenced through the study. These results seem to confirm the value of parenteral short-term antibiotic prophylaxis of postoperative infection in such kind of "clean" operative procedure.
Abdominal Muscles↗
Effects of smoking and occupational exposures on pulmonary function impairment in Italian shipyard workers.
We examined the association of job title and duration of employment with the smoking-adjusted prevalences of chronic bronchitis, obstruction, restriction, and mixed pulmonary function impairment in 657 white male shipyard workers aged 20 to 60 years. Logistic regression was used to compute odds ratios (OR) and confidence intervals (CI) for risk of chronic bronchitis and pulmonary function impairment. Compared to employment for less than 20 years, employment for more than 20 years was independently associated with chronic bronchitis (OR = 2.0; 95% CI: 1.2-3.5), restriction (OR = 2.6; CI: 1.4-4.6), and mixed impairment (OR = 2.5; 95% CI: 1.1-5.5). Compared to metal-workers, which was the lowest exposure job category, four job categories were independently associated with restriction: gas welders (OR = 3.6; 95% CI: 1.5-8.9), arc welders (OR = 4.1; 95% CI: 1.5-11.4), masons (OR = 6.2; 95% CI: 1.0-39.0), and insulators (OR = 8.0; 95% CI: 1.8-35.2). These results suggest that exposure to pulmonary toxic agents in the shipyard environment can lead to both parenchymal inflammation (restriction) and airways inflammation (obstruction).
Adult↗
Manual verification of computer analysis of 24-hour esophageal motility.
The application of solid-state technology to intraesophageal pressure monitoring over an entire circadian cycle has resulted in large amounts of data that require computer analysis. Recently available commercial software has yet to be validated. The aim of this study was to compare the analysis of ambulatory esophageal manometry by an automated computer program with manual analysis and make the software modifications necessary to validate the automated system for clinical use. Computer-aided analysis of a large number of esophageal contractions recorded during ambulatory esophageal manometry was compared with manual analysis by four experienced physicians. Good correlations were found between manual and computerized measurements of contraction amplitude and duration (r = 0.99 and r = 0.73, respectively). Software modifications resulted in correct identification of 94% of contractions and correct classification of 93.3% of these waves as peristaltic or simultaneous. These results demonstrate that the evaluated program for automated analysis of ambulatory esophageal manometry is accurate and reliable for research and clinical applications.
Circadian Rhythm↗
Laparoscopic treatment of gastro-esophageal reflux disease: indications and results.
This paper deals with the indications, techniques and results of laparoscopic total or partial posterior fundoplications (Nissen and Toupet procedures, respectively) performed in 41 patients with gastroesophageal reflux disease (GERD) failing to respond to medical treatment. Stationary manometry and 24-hour esophageal pH monitoring established the indications for surgery. Laparoscopy was attempted in all patients, even when giant mixed or para-esophageal herniations were present. The rate of conversion to laparotomy amounted to 12.2%. There were no intraoperative complications. Major complications were observed in 3 patients (8%) and included 2 cases of slipped Nissen and 1 of pneumonia. Four patients had persistent postoperative dysphagia; two of them were re-operated and two were treated with pneumatic dilatation. Reflux only recurred in 1 patient. Functional follow-p demonstrated an overall increase in LES resting pressure and length, with no abnormal gastro-esophageal reflux episodes, findings which tended to persist in the long term.
Adolescent↗
[Myotomy of the esophageal body].
Extramucosal myotomy involving the external longitudinal and internal circular layers of the musculature of the esophagus represent the surgical therapy in patients with dysphagia and regurgitation or with angina-like chest pain secondary to functional abnormalities of the musculature of the esophagel body and sphincters. Surgery has a palliative function, because cures symptoms and complication such a diverticula, but not the disease. Modern surgical techniques also prevent recurrence of symptoms and complications are minimal with better long-term results than conservative therapy. Myotomy of the lower esophageal sphincter extended to the distal part of the esophageal body (Heller's operation) is performed as first choice or following insucces of dilatation in patients with primary achalasia of the esophagus, using a trans-abdominal or a trans-thoracic approach. Myotomy of the upper esophageal sphincter is indicated in patients with Zenker's diverticulum following diverticulectomy or diverticulopessy. Segmental myotomies are performed after diverticulectomy in patients with epiphrenic pulsion diverticula. Trans-thoracic "long" esophageal myotomy performed from the thoracic portion of the lower esophageal sphincter to the aortic arch is indicated in patients with diffuse esophageal spasm and nutcracker esophagus and sometimes in patients with aspecific abnormalities of the esophageal motor function associated with diverticula. Circular miotomies limited to the external longitudinal layer of the esophageal musculature can be performed at the level of anastomosis in order to gain tissue and reduce tissutal tension. The recent introduction of the endoscopic surgery allowed some of these operations to be performed through minimally invasive approaches. Therefore laparoscopic and thoracoscopic Heller's myotomy is feasible with clinical and functional results similar to those obtained with traditional open approach and with less postoperative discomfort and shorter hospital stay. This paper deals with the indications and surgical techniques of myotomies of the esophageal body both limited and extended to the lower esophageal sphincter.
Esophageal Diseases↗
[Surgical treatment of acid gastroesophageal reflux].
Recently, it has been demonstrated that the surgical treatment of gastro-esophageal reflux disease is superior to the medical treatment. Further, the surgical treatment gained new popularity because of the introduction and diffusion of laparoscopic techniques. A careful definition of gastro-esophageal reflux disease, based on the underlying pathophysiological abnormality (i.e.: an increased exposure of the distal esophagus to the refluxed acid juice), and a proper selection of patients candidate to surgery must however be maintained, together with a proper surgical technique, in order to achieve satisfactory results. In this paper, the authors outline in this paper the general principles of anti-reflux surgery and review the most recent results obtained with Nissen fundoplication as well as with other antireflux procedures. They describe in detail the surgical technique of the Nissen fundoplication ("Floppy" Nissen) by a laparoscopic approach. They review their experience in this with 15 operations performed since June 1992, and report the results of an Italian multicentric survey study on laparoscopic surgery for gastro-esophageal reflux disease. Recent series appeared in Literature are also reviewed. In conclusion, the authors underline the need for careful prospective studies and long-term clinical and functional follow-up of patients undergoing laparoscopic anti-reflux surgery before drawing definitive conclusions on its efficacy. However, early results seem to be really promising.
Fundoplication↗
Timing of surgery related to menstrual cycle and prognosis of premenopausal women with breast cancer.
The influence of the timing of surgery in relation to the menstrual cycle on the survival of breast cancer patients has been both advocated and disputed. The records of 165 premenopausal M- breast cancer women consecutively operated from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus postoperative radiotherapy. Node-positive patients received adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pT and pN. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for the timing of surgery according to either Badwe or Hrushesky or Senie (RR = 1.26, RR = 0.91 and RR = 0.88 respectively). Consensus on the menstrual phase related to the expected best prognosis is still required.
Adult↗
[Lacking effect of timing of surgery in relation to the menstrual cycle on prognosis of breast cancer in premenopausal women].
The influence of timing of surgery in relation to menstrual period on survival of breast cancer patients has been both advanced advocated and disputed. A meta-analysis on published series showed a statistically significant overall odds reduction when surgery is performed in the luteal phase. The records of 165 premenopausal M- breast cancer women, not on hormonal therapies, consecutively operated on from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus operative radiotherapy, Node-positive patients received standard adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pathological T and N. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for timing of surgery according to Badwe or Hrushesky or Senie criteria (RR = 1.26, RR = 0.91, and RR = 0.88 respectively). Up-to-date agreement on the menstrual phase and relative expected better prognosis is still lacking.
Adult↗