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Biomedical subjects

M De Santis

Publications and source records attributed to M De Santis.

At least 91 records · Page 5Linked to original sources
PubMed1994

Cohort mortality study of rock salt workers in Italy.

A cohort mortality study of rock salt workers was carried out in Volterra, Italy. The occupational risk factors identified during environmental hygiene surveys were high noise levels and exposure to dusts and to chrysotile asbestos. The cohort consists of 487 subjects (367 males and 120 females) employed in the mine between 1/1/1965 and 12/31/1989. At the end of follow-up, 387 individuals were alive (295 males and 92 females), and 100 were decreased (72 males and 28 females). For two decedents, the cause of death was unknown. Regional rates were used for the computation of standardized mortality ratios (SMRs). In the entire cohort, observed mortality for all causes was similar to expected (SMR = 98, 100 obs); SMR for all cancer was 127 (41 obs); for lung cancer, the SMR was 146 (10 obs). Two cases of pleural mesothelioma, both in males, resulted in a statistically significant elevation of this cause (SMR = 741, 90% confidence interval (CI) 131-2,332). Two malignant brain tumors were detected (SMR 328, 90% CI 58-1,032); one of these was identified as a secondary neoplasm with consideration of additional clinical information. Among males, mortality for all cancers was significantly increased (SMR = 140, 90% CI 106-192). The observed mortality for malignant tumors of the digestive and the respiratory systems was higher than expected. In women, two cases of malignant ovarian cancer were observed vs. 0.42 expected on the basis of the regional rates. Increased mortality from lung and pleural tumors was consistent with the exposure to asbestos, which has also been shown to play a role in the development of ovarian tumors. The main limitations of this study were the small number of subjects and the definition of exposure solely in terms of duration of employment. Further studies of rock salt workers are needed to elucidate our findings.

Adult↗
PubMed1994

Increase in serum alpha-fetoprotein without recurrent disease after hepatectomy for hepatocellular carcinoma.

The case of a 58-year-old man with clinically-stable and compensated HBsAg-positive liver cirrhosis is reported. In April 1991, the patient underwent partial hepatectomy to treat a solitary 3.5 cm hepatocellular carcinoma (HCC), (Edmonson scale I), in the 5th liver segment. His serum alpha-fetoprotein (AFP) level was 24 ng/ml. After hepatectomy, the AFP level dropped to 8 ng/ml, but between the 4th and 12th month it rose gradually from 72 ng/ml to 4,520 ng/ml. Hepatic recurrence of HCC was excluded, but a 6 cm solitary metastasis (Edmonson scale III-IV) was detected on the right adrenal. Adrenalectomy was performed and two months later the patient is doing well and his AFP level is 51 ng/ml. The methodological approach to diagnosis, treatment and follow-up of HCC, and the relationship between AFP and liver and metastatic HCC, are discussed.

Adrenal Gland Neoplasms↗
PubMed1994

[Treatment of pancreatic stump after duodenopancreatectomy. Our experience].

The authors describe the experience gained during the four-year period 1988-1991 regarding the treatment of the pancreatic stump after DCP independently of the base pathology. The techniques used and conceptual evolution which led us to leave the pancreatic anastomosis are shown here; likewise the morbid physiology induced by this technique with all this variation is here tested. The positive results obtained support the method and encourage further developments.

Anastomosis, Surgical↗
PubMed1994

[Role of Gadolinium-DTPA in the assessment of renal tumors with magnetic resonance].

To investigate the role of Gd-DTPA in the MR study of renal cancers, 30 patients affected with primary (28) or recurrent (2) renal cancers were submitted to high-field MRI (1.5 T). T1- and T2-weighted and Gd-DTPA-enhanced T1-weighted sequences were always acquired. Based on qualitative and quantitative criteria (calculation of the signal-to-noise ratio in the tumor mass and of the signal-difference-to-noise ratio between tumor and renal parenchyma), Gd-DTPA influence was studied on the following variables: signal intensity and tumor demonstration, detectability of morphostructural features of tumor tissue and staging accuracy. As for the latter variable, MR results were compared with the results of anatomical and surgical staging (28 cases). Relative to unenhanced T1- and T2-weighted sequences, on Gd-DTPA-enhanced sequences 80% of the lesions were markedly hypointense relative to renal parenchyma and they were better demonstrated in 93% of cases. The S/N and the SD/N ratios were higher on Gd-DTPA-enhanced than on unenhanced images. After Gd-DTPA administration, the intratumoral necrotic areas, the walls and the septations of the cystic masses and the boundaries between tumors and renal parenchyma were better demonstrated. Staging accuracy was the same (90%) on both Gd-DTPA-enhanced T1-weighted and unenhanced images. Therefore, Gd-DTPA, although failing to increase staging accuracy, improves tumor depiction and demonstrates the morphostructural features of the mass. Since Gd-DTPA caused no side-effects, Gd-DTPA-enhanced T1-weighted sequences can replace T2-weighted sequences, whose acquisition time is definitely longer.

Adult↗
PubMed1993

The "Telefono Rosso": a service for the prevention of birth defects and for the evaluation of teratogenic risk.

The "Telefono Rosso" ("Red telephone") is a specialized service for preconceptional counselling and teratogenic risk evaluation. In both cases the choice of telephone communication allows to reach a wide basin of users with personalized information. The service finds one of its main reasons in the marked disinformation which exists in this field and in the wrong risk perception shown by a high proportion of users. In addition to serving the community to prevent birth defects and to prevent some induced abortions, the "Telefono Rosso" represents a unique opportunity to add to the current body of knowledge by documenting the outcomes of pregnancies exposed to a variety of agents. In this respect the "Telefono Rosso" may be considered an additional source of post-marketing surveillance.

Abortion, Induced↗
PubMed1993

[Evaluation of aortic distensibility using cine-MR before and after antihypertensive treatment with calcium antagonists and ACE-inhibitors].

Several studies have been performed in the last years to evaluate arterial distensibility, particularly of the aorta, in hypertension and to estimate the changes of this distensibility after anti-hypertensive treatment. The aim of this study was to assess the aortic distensibility in a group of 10 patients with essential hypertension in comparison with a control group, with regard to the vascular effects of a long-term anti-hypertensive treatment with calcium-antagonists and ACE-inhibitors. All patients were studied using cine-MR imaging, a technique with several peculiarities (multiplanar scanning, intrinsic contrast, etc) that allows simple and quick assessment of the aortic vascular parameters in the ascending and descending tracts. The results of our study show the absence of a significant improvement of aortic vascular areas, and therefore of vessel distensibility, even in the presence of a complete blood pressure normalization in all patients after a 3-month treatment. These data do not confirm previous reports in this setting, based on the ultrasonographic techniques (2D and Doppler echocardiography). Two major reasons may explain our results: first, the rigorous criteria of patient enrollment that we have stated in order to avoid any influence of age and/or other pathologies; second, the ability of MR imaging to allow accurate estimation of aortic vascular parameters and to achieve an excellent intraobserver and interobserver reproducibility in comparison with other techniques. We conclude that MR imaging is the method of choice for the assessment of cardiovascular function and morphology.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1993

[MR in the characterization of benign ovarian masses].

To investigate the role of MRI in characterizing benign ovarian masses, the MR images of 64 patients affected with benign ovarian masses were retrospectively reviewed. The benign nature of the masses was proven at surgery (42 cases), fine-needle biopsy (10 cases), laparoscopy (6 cases) and follow-up (6 cases). MRI correctly characterized 56 of 64 masses (87.5%). In particular, all the cases of simple serous cyst (9), of hemorrhagic cyst (10), of fibroma (4), of dermoid cyst (18) and of tubo-ovarian abscess (7). MRI misdiagnosed 4 endometrial cysts--2 of them as hemorrhagic cysts and 2 as dermoid cysts-, 1 serous cystoadenoma as cystoadenocarcinoma and 1 suppurative mucinous cystoadenoma as tubo-ovarian abscess. Moreover, 1 angiofibroma and 1 hematosalpynx were misdiagnosed as endometrial cysts. In conclusion, MRI can be considered a second-choice diagnostic tool which can replace CT in the evaluation of the patients in whom US alone fails to yield an unquestionable diagnosis.

Adolescent↗
PubMed1992

Urothelial toxicity following conditioning therapy in bone marrow transplantation and bladder cancer: morphologic and morphometric comparison by exfoliative urinary cytology.

Since cyclophosphamide and busulphan used for therapy of bone marrow transplantation (BMT) can cause urothelial cell changes similar to those found in bladder cancer, comparative morphologic and morphometric urinary cytologic research was carried out, examining 812 urine samples taken from 121 patients undergoing BMT and 60 urine samples from 20 patients with bladder cancer. The morphological results showed some differences in the characteristics of the urinary sediment in urothelial toxicity caused by conditioning therapy in BMT and in bladder cancer; among these were background, cellularity, leukocytes, urothelial cell arrangement, cell shape and size, vacuolization, mitosis, and nucleoli. A comparative morphometric study was also carried out, showing differences regarding cell area, nuclear area and perimeter, and N/C ratio, especially between well-differentiated bladder cancer and urothelial toxicity.

Bone Marrow Transplantation↗
PubMed1992

Early prenatal diagnosis and therapy of fetal hypothyroid goiter.

We report a case of early diagnosis of iodide-induced fetal hypothyroidism at 22 weeks of gestation, confirmed at 29 weeks by cordocentesis and successfully treated intra-amniotically. The ultrasonographic feature was the presence of two echogenic masses in the fetal neck; polyhydramnios was absent. Mild hypothyroidism was diagnosed based on fetal serum obtained by percutaneous umbilical blood sampling at 29 weeks of gestation. The persistence of fetal hypothyroidism in spite of maternal thyroid improvement was confirmed by a second cordocentesis at 35 weeks of gestation, and a single injection of intra-amniotic levothyroxine (250 micrograms) was performed. The serial ultrasonographic examinations showed disappearance of the fetal goiter. A healthy female baby (3,630 g) was delivered at term. At birth, the thyroid gland was not enlarged, and neonatal thyroid hormones were within the normal range. This case suggests that cordocentesis is a reliable method to assess the fetal thyroid status; moreover a single injection of intra-amniotic thyroxine was effective in treating fetal hypothyroid goiter.

Adult↗
PubMed1992

Mortality study of workers employed by the Italian National Institute of Health, 1960-1989.

A cohort mortality study was conducted to evaluate the cancer risk of workers employed by the National Institute of Health in Rome, Italy. Cancer mortality was evaluated for research staff. A deficit of overall cancer mortality was found for the men, but not for the women. Elevated (albeit statistically nonsignificant) standardized mortality ratios were found for cancer of the pancreas (men 155, women 236), cancer of the brain (men 159), lympho- and reticulosarcomas (men 233, women 512), and lymphatic and hematopoietic tumors (women 623). In addition the women had a statistically significantly elevated risk of breast cancer (288). Although most of these results, with the exception of breast cancer among the women, were not statistically significant, due to the limited study size, they point to the existence of excess risks for some tumors. The possibility that these increases are related to exposures occurring in the laboratory setting deserves further consideration.

Adult↗
PubMed1992

[The magnetic resonance of small hepatocarcinoma. A comparison with echography, computed tomography, digital angiography and computed tomography with lipiodol].

Diagnostic techniques as a whole and periodic ultrasonography (US) in particular frequently allows tumors < 3 cm (small hepatocellular carcinomas) to be detected in patients suffering from liver cirrhosis. Multifocal diseases are a major limitation to surgery. Recently, MR imaging has shown its capabilities in the diagnosis of small hepatocellular carcinomas. In our study the diagnostic value of MR imaging was compared with that of US, of pre- and post-contrast CT, of digital angiography and of CT after lipiodol injection (Lipiodol CT). The morphologic and signal intensity MR features of small hepatocellular carcinomas were investigated. Fifteen cirrhotic patients with 31 nodules of hepatocellular carcinoma < 3 cm were examined. All patients were studied with US, MR imaging, angiography and Lipiodol CT; 12/15 patients underwent CT. Histologic confirmation was obtained in 12 nodules (2 at surgery and 10 by means of percutaneous biopsy); in the extant 19 cases the diagnosis was made by combining US, CT, MR, angiographic and lipiodol-CT findings; in 9 tumors < 1 cm Lipiodol retention one month after angiography was considered as diagnostic. MR imaging detected 21/31 nodules (63%), US 22/31 (66.6%), CT 12/24 (50%), angiography 24/31 (74%), lipiodol CT 29/31 (92.5%). Mc Nemar test showed no difference in sensitivity between MR imaging and CT, MR and angiography, MR and US, lipiodol CT and angiography; however, the differences between the detection rates of MR imaging and Lipiodol CT and CT and lipiodol CT and US were statistically significant (p < 0.05). The difference in sensitivity between the detection rates of lipiodol CT and US was just above the threshold value which is usually considered significant (p = 0.065). One false positive was observed on US and none with MR, CT, angiography and lipiodol CT. On Se T1-weighted images 18 nodules were hyperintense, 2 isointense and 2 hypointense; on proton-density images 14 nodules were hyperintense, 7 isointense and none hypointense. On SE T2-weighted images 18 nodules were hyperintense, 3 isointense and none hypointense. A pseudocapsule was seen in 10/17 nodules (58%), especially on T1-weighted images. Accuracy and limitations of each technique and morphologic and signal intensity MR findings of small hepatocellular carcinoma are discussed. We believe that US is still the best diagnostic technique for the screening of hepatocellular carcinomas in cirrhotic livers.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1990

Radiosurgical treatment compared to surgery alone for rectal cancer.

Between February 1981 and September 1989, 144 patients with rectal cancer were treated according to a radiosurgical sandwich protocol (27Gy + surgery + 18Gy) or postoperative radiotherapy (45Gy) at the University Hospital 'A. Gemelli' in Rome. This group is compared with a group of 133 patients operated on between January 1968 and January 1981, by the same team of surgeons but who received no radiotherapy. The historical group is comparable to the radiosurgical group in terms of stage, histology, and surgical procedures. The median follow-up period of the radiosurgical group is 38 months and 68% of cases have been observed longer than 2 years. At 2 years local recurrence in the historical control group was 22% versus 17% in the prospective group (p = 0.8). For Stage C disease, local recurrence dropped from 54% to 35% with adjuvant radiotherapy (p = 0.3). Metastases were observed in 22% of the control group versus 13% of the radiosurgical group (p = 0.2). For Stage C disease the incidence of distant metastases dropped from 59% to 26% at 2 years with the use of the prospective radiosurgical protocol (p = 0.05). The Kaplan-Meier survival rate at 5 years was 46% for the historical group and 72% for the radiosurgical group (p = 0.003) (Stage A 71% & 94%, Stage B 48% & 77%, and Stage C 16% & 38%, respectively). Neither serious nor late toxicity has been detected in the radiotherapy group, nor were surgical complications observed in the pre-operative radiotherapy group. The data strongly suggest a survival advantage for patients treated with the radiosurgical combination (p = 0.003).

Adenocarcinoma↗
PubMed1990

[Mortality in malignant tumors of the peritoneum in Italy: search for correlations with exposure to asbestos].

In the years 1981-85, 2438 malignant neoplasms of peritoneum occurred in Italy: the crude mortality rate was 0.86 X 10(-5) per year. The standardized mortality rates of Italian provinces ranged from 0.20 to 1.86 X 10(-5) per year. Some degree of misclassification can affect the ascertainment of peritoneal tumors as a death cause. In some of the Provinces with the highest mortality rates dockyards or asbestos-cement industries are located (e.g. Genova, La Spezia; Alessandria); in other Provinces the presence of industries involving an important use of asbestos could not be ruled out.

Adult↗
PubMed1990

Imipenem versus tobramycin--antianaerobe antibiotic therapy in intra-abdominal infections.

The authors compared broad-spectrum monotherapy with imipenem to an aminoglycoside-based antibiotic regimen for the management of intra-abdominal infections. One hundred and four patients who had intra-abdominal infection were randomly allocated to receive imipenem (52) or tobramycin plus clindamycin or metronidazole (52). Patients treated with imipenem had fewer febrile episodes and occurrences of breakthrough bacteremia, less antibiotic resistance and need for drug change; their hospital stay was shorter. The death rate from sepsis was 4% in patients who received imipenem and 13% in those who received the combined regimen (p = 0.08). Treatment was successful in 79% of patients on imipenem versus 67% of those receiving an aminoglycoside. Patient stratification by the APACHE II system and probability of death calculation using delayed-type hypersensitivity scores predicted a similar death rate for the two treatment groups. Imipenem appears to be a safe and efficacious alternative broad-spectrum antibiotic for treating patients who are seriously ill with intra-abdominal infection.

Abdomen↗