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Biomedical subjects

M Esposito

Publications and source records attributed to M Esposito.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Multiphase helical CT findings after percutaneous ablation procedures for hepatocellular carcinoma.

BACKGROUND: Multiple-phase helical computed tomography (CT) has been regarded as the method of choice in the evaluation of patients with hepatocellular carcinoma (HCC) treated by nonsurgical procedures. The aim of this article was to report our experience in the assessment of nodular and parenchymal changes recognizable after various percutaneous ablation therapies. METHODS: We reviewed the studies of 116 consecutive patients with HCC treated with multisession percutaneous ethanol injection (56 patients, 98 nodules), single-session percutaneous ethanol injection (14 patients, 31 nodules), radiofrequency thermal ablation (32 patients, 48 nodules), and interstitial laser photocoagulation (14 patients, 25 nodules). CT had been performed 3-28 days after the last session (mean = 18 days) with unenhanced helical acquisition and with contrast-enhanced double- or triple-phase helical acquisition. RESULTS: Persisting neoplastic tissue was identified within 54.5% of the nodules. It was located centrally in 4.5% of these nodules, peripherally in 11%, and eccentrically in 84.5%, and its shape was crescent in 58%, globular in 24.5%, and other in 16%. On arterial phase scans, viable tumor was hyperdense in 97% of the lesions and isodense in 3%; on portal phase scans, the tumor was hyperdense in 20%, isodense in 28%, and hypodense in 52%; on delayed phase scans, the tumor was consistently hypodense. Tumor necrosis was always hypodense on contrast-enhanced scans. On unenhanced images, 7.4% of the nodules were undetectable. Nodule diameter appeared as unchanged in 53% of the nodules and as larger in 47%; its shape was unchanged in 54% and modified in 46%; its margins were unchanged in 36% and modified in 64%. A rim of granulation tissue was detected around 15% of the nodules, and a perilesional transient attenuation difference was detected in 21%. Perihepatic effusion was seen in 13% of the patients, segmental biliary duct dilation and local atrophy each in 9%, arterioportal fistula in 6%, portal vein thrombosis, subcapsular collection and pleural effusion each in 7%, hepatic infarction in 5%, and inferior vena cava thrombosis in 2%. CONCLUSION: Percutaneous ablation of HCC may cause several changes. Knowledge of their CT appearance is mandatory to correctly assess and manage this tumor.

Adult↗
PubMedDate not supplied

Hepatocellular carcinoma recurrence after percutaneous ablation therapy: helical CT patterns.

BACKGROUND: To categorize the helical computed tomographic (CT) intrahepatic recurrence patterns of hepatocellular carcinoma (HCC) after treatment with percutaneous ablation procedures. METHODS: Double-phase helical CT studies of 67 patients with HCC recurrence were reviewed. The study population had undergone percutaneous ablation therapy procedures (multisession or single-session ethanol injection therapy, radiofrequency thermal ablation therapy, and interstitial laser photocoagulation therapy) for 120 HCC nodules. RESULTS: Four patterns were defined. (A) Enhancing tissue within the edge of the ablated nodule on arterial phase images (ingrowth): this pattern was seen in five treated lesions (4.2% of all treated nodules) in five patients (7.5% of all patients with recurrence) 3-7 months after treatment (mean = 4 months). (B) Enhancing tissue around the treated nodule but continuously to its border on arterial-phase images (outgrowth): this pattern was found in 12 (10%) treated lesions in 12 patients (18%) 3-6 months after ablation (mean = 4 months). (C) Enhancing tissue within the same segment of the treated nodule on arterial phase images (spread): this pattern was detected in 10 (8%) treated lesions in 10 patients (15%) 3-6 months after treatment (mean = 5 months). (D) Enhancing tissue within different segments from the treated nodule on arterial phase images (progression): this pattern was identified in 34 patients (51%) with 53 (44%) treated tumors 5-22 months after ablation (mean = 8 months). A mixed pattern was found in six subjects (9%) with seven (6%) treated nodules. Among the 61 patients with a nonmixed pattern, there were 85 treated nodules with persistent necrosis, 17 treated nodules with local recurrence (pattern A or B), and 107 new nodules due to nonlocal recurrence (pattern C or D). Portal phase enhanced images and especially unenhanced images showed a lower detection rate and a lower lesion-to-liver conspicuity score (for all patterns but mainly for pattern C). CONCLUSION: Four patterns of recurrence after percutaneous ablation procedures can be categorized on double-phase helical CT and are best depicted on arterial phase images. Knowledge of these patterns is relevant for early detection and may be helpful in understanding the recurrence mechanism.

Adult↗
PubMedDate not supplied

Hepatocellular carcinoma treated with chemoembolization: assessment with contrast-enhanced doppler ultrasonography.

PURPOSE: To report our preliminary experience concerning the use of Doppler ultrasonography (DUS) techniques after intravenous injection of the galactose-based contrast agent Levovist in the assessment of hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). The sonographic findings are correlated with those obtained using iodized oil (Lipiodol) helical computed tomography (CT). METHODS: For 7 months we studied 28 patients with cirrhosis and HCC (a total of 43 nodules) who had undergone TACE between 18 and 30 days previously. The lesions were investigated with color Doppler ultrasonography (CDUS) and power Doppler ultrasonography (PDUS), before and after infusion of the echo-contrast agent (300 mg/ml, maximum 1 injection for each nodule, administered at constant velocity within 60-90 sec), and with helical Lipiodol-CT (0-7 days after DUS). In the retrospective analysis, special attention was given to the Doppler signals related to pulsatile intra- and perinodular flow and to the detection of new vessels after contrast agent injection. The signal intensity was graded as 0 (absent), 1 (low), 2 (medium), or 3 (high), while its distribution was classified as peripheral, central, or diffuse. Oily agent retention on CT scans was assessed as 0 (absent), I (<10%), II (<50%), III (>50%), or IV (homogeneous). These scores were awarded separately, without knowledge of the other judgments. RESULTS: An hepatic global echo-enhancing effect was identified in all cases and always lasted long enough to allow an accurate analysis of all parenchymal lesions (at least 8 min). The signal scores could be evaluated in 39 of 43 HCCs, as follows: basal CDUS: grade 0 in 17 lesions, grade 1 in 16, grade 2 in 6; contrast-enhanced CDUS: grade 0 in 12 lesions, grade 1 in 10, grade 2 in 14, grade 3 in 3; basal PDUS: grade 0 in 15 lesions, grade 1 in 13, grade 2 in 9, grade 3 in 2; contrast-enhanced PDUS: grade 0 in 11 lesions, grade 1 in 9, grade 2 in 15, grade 3 in 6. Lipiodol-CT scoring was: grade 0 in 1 lesion, grade I in 7, grade II in 11, grade III in 9, grade IV in 11. In all but one nodule the difference between CDUS and PDUS scores, compared both with each other and with nonenhanced and contrast-enhanced examinations, was never greater than one grade. CONCLUSIONS: Contrast-enhanced DUS is a simple and fast procedure allowing a valuable, constant echo-enhancing effect of sufficient duration. DUS techniques, especially contrast-enhanced PDUS, offer an effective and realistic analysis of HCC nodules treated with TACE and show more evident agreement with Lipiodol-CT findings than baseline studies.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Effect of the cisplatin-procaine complex DPR in combination with several anticancer agents on murine P388 leukemic cells in vitro and in vivo.

We evaluated in vitro the antiproliferative activity of DPR (Fig. 1), a new cisplatin-derived compound, in combination with five conventional anticancer drugs: the antimetabolites 5-fluorouracil (5FU) and methotrexate (MTX), the alkylating agent mitomycin C (MMC), the antimicrotubule agent taxol (TAX) and the intercalating agent of the antracycline group doxorubicin (DOX), against murine P388 leukemic cells. MTT assay was used to determine growth inhibition after incubation of cells for 72 hours in the presence of single or combined drugs. The additive, synergistic or antagonistic nature of the combined drug effect was determined using the isobole method. In our cellular model, synergism was the prevailing result observed when DPR was combined with MMC. Conversely, antagonism was observed when DPR was combined with TAX. When DPR was administered together with the other antineoplastic drugs, the final effect was dependent on the concentrations of single agents. The study in vitro of the association between DPR and MMC was extended in vivo in BDF-1 female mice bearing i.p. P388 leukemic cells. Our data in vivo confirmed those obtained in vitro, demonstrating the therapeutic advantage of the association of ineffective doses of DPR (2 and 7 mg/kg) and MMC (3.2 mg/kg) over the administration of MMC alone.

Animals↗
PubMedDate not supplied

In vivo/ex vivo cellular interactions with titanium and copper.

Machined, commercially pure titanium (Ti) disks were coated with approximately 400 nm copper (Cu) by physical vapor deposition or left uncoated. The kinetics of inflammatory cell recruitment, distribution and viability was evaluated around Ti, Cu, and in sham sites after 1, 3, 12, 18, 24, and 48 h in a rat subcutaneous (s.c.) model. Further analysis of the cells on implant surfaces was performed by ex vivo incubation of the disks. Ti and Cu stimulated an increased recruitment of inflammatory cells in comparison with sham sites. A markedly higher amount of cells, predominantly polymorpho-nuclear granulocytes (PMN), was detected around Cu after 18 h and onwards. More cells were found at the implant surfaces than in the surrounding exudates after 18 h. The total amount of lactate dehydrogenase (LDH), an indicator of plasma membrane injury, was higher in Cu exudates after 18 h in comparison with Ti and sham. In contrast, no differences in the proportion of dead cells (trypan blue dye uptake) were detected in the exudates. Further, LDH levels were higher around Ti than Cu during the initial 18 h of ex vivo incubation. The results of this study indicate that the early inflammatory process associated with a cytotoxic material in soft tissues is largely attributed to the induction of a markedly strong and prolonged chemotactic response. In contrast, this process is characterized by a higher amount of inflammatory cells around a biocompatible material than in sham sites, but with a transient course and total LDH similar to sham sites.

Journal Article↗
PubMedDate not supplied

Mitoxantrone in elderly patients with advanced breast cancer: pharmacokinetics, marrow and peripheral hematopoietic progenitor cells.

The aims of this study were to evaluate the pharmacokinetics, tolerability and hematopoietic toxicity of mitoxantrone in elderly women. Thirteen patients with advanced breast cancer, median age of 73 years, received escalating doses of mitoxantrone 8, 10, 12 and 14 mg/m2 on day 1, q 21. There was a linear relationship between the mitoxantrone dose administered and the mitoxantrone exposure (AUC) in plasma (r = 0.856, pc0.001). After 4 courses of treatment, a significant decrease in bone marrow cellularity (p = 0.0067), and HPC content (BFU-E p = 0.0077) was observed. A remarkable, though not statistically significant decrease in circulating HPCs was observed after 4 courses and was still present 8-12 months after the termination of treatment. Therapy with mitoxantrone in elderly women was well tolerated at the dose of 12 mg/m2 for four courses. The significant hematological toxicity observed in marrow cellularity and HPC content warrant further studies.

Aged↗
PubMedDate not supplied

Iron-ethanol synergism and pathological liver transformation.

The synergistic effects of iron overload and ethanol on the liver of mice were studied over a period of 46 weeks. The determination of several parameters (iron, calcium, magnesium, alpha-hydroxyproline, lipid peroxidation, hepatomegalic and splenomegalic indexes) showed that ferrous and ferric lactates provoke an increase of calcium in the liver, higher than that of ethanol in the control animals. The relationship between liver calcium homeostasis modification and the increase of collagen and lipid peroxidation is discussed. Histological examinations showed differences in the tissular characteristics especially when iron and ethanol were given together. These findings suggest the liver calcium homeostasis changes found as a synergistic effect in the early stages of chronic iron overload may be of importance as a trigger of events leading to the pathway of fibrosis-->cirrhosis-->hepatocarcinoma reported in pathologies such as nutritional siderosis and hemochromatosis.

Animals↗
PubMedDate not supplied

Differential diagnosis and treatment strategies for biologic complications and failing oral implants: a review of the literature.

The aim of this article was to review the literature on differential diagnosis and treatment of biologic complications and failing implants. All types of publications, with the exception of abstracts, published in English up to December 1998, were included. A multi-layered search strategy was used. Controlled clinical trials (CCTs) were searched in the Cochrane Oral Health Group's Specialized Register of Trials. This database contains all CCTs identified in MEDLINE and EMBASE. PubMed was searched using various key words and the "related articles" feature. All identified publications were obtained and none were excluded. Infection, impaired healing, and overload are considered the major etiologic factors for the loss of oral implants. Only a few clinical and animal investigations were found that tested the validity of the proposed therapeutic approaches. The treatment of failing implants is still based mainly on empirical considerations, often derived from periodontal research, from data extrapolated from in vitro findings, or from anecdotal case reports performed on a trial-and-error basis.

Animals↗
PubMedDate not supplied

Histopathologic observations on early oral implant failures.

The purpose of this study was to morphologically describe the tissues surrounding 20 early failed (prior to prosthesis placement) Brånemark System oral implants. The implants and their surrounding tissues were consecutively retrieved and analyzed with light microscopy and transmission electron microscopy. Failures were chronologically divided into those occurring prior to, at, and after abutment connection. The clinical conditions varied from osteomyelitis to totally asymptomatic but mobile implants. Different histopathologic pictures were observed, ranging from a stratified, almost acellular, connective tissue layer, via a capsule with a great number of inflammatory cells, to a heterogeneous interface with areas of highly vascularized connective tissue and portions of poorly mineralized bone detached from the implant surface. The histopathologic variation may reflect different etiologies and/or time stages of the failure process. Epithelial downgrowth was occasionally observed for asymptomatic submerged implants. Epithelial cells were attached to the failed implant surface via hemidesmosomes. The histologic, clinical, and radiographic findings together indicated that 3 major etiologies might have been implicated in the failure processes: impaired healing ability of the host bone site, disruption of a weak bone-to-implant interface after abutment connection, and infection in situations with complicated surgery.

Adult↗
PubMedDate not supplied

Time-dependent influence of procaine hydrochloride on cisplatin antitumor activity in P388 tumor bearing mice.

In previous papers (1,2) we demonstrated that procaine hydrochloride may increase the therapeutic index of cisplatin by an improvement of its antitumor activity and a reduction of its nephrotoxicity. In the present study we investigated the relationship between the antitumor activity obtained by cisplatin associated with procaine hydrochloride and the relative time of administration of these two agents. When procaine hydrochloride (40 mg/Kg body wt) was administered 30 or 120 minutes before cisplatin (16 mg/kg) diluted in normal saline (i.e. clinical condition) it increased, although not significantly, its percent increase in life span (%ILS) and cure rate (%ILS: +292 and +217 vs +150; cure rate: 46.2% and 42.3% vs 23%, respectively), compared to cisplatin alone treatment. These results became statistically significant when procaine hydrochloride was given either simultaneously with cisplatin or 30 and 120 minutes thereafter (%ILS: > 400 vs +150; cure rate: 65.4%, 73.1% and 68% vs 23%, respectively). In conclusion procaine hydrochloride increased the antitumor activity of cisplatin independently from its timing of administration, although it seemed to be a better potentiating agent when administered after cisplatin.

Anesthetics, Local↗
PubMedDate not supplied

Quality assessment of randomized controlled trials of oral implants.

The aim of this study was to assess the quality of randomized controlled trials (RCTs) concerned with the effectiveness of oral implants and to create a trial register. A multilayered search strategy was used to identify all RCTs published by the end of 1999 in any language. The Cochrane Oral Health Group specialist register, PubMed, and personal libraries were searched. Seventy-four RCTs were identified. Forty-three articles, not presenting the same patient material, were independently assessed by 3 researchers using a specially designed form. A statistician assessed all trials for the appropriateness of statistics. The quality of each study was assessed on 7 items, including 3 key domains. Randomization and concealment allocation procedures were not described in 30 articles (70%). Reasons for withdrawals were not given in 10 reports (23%). No attempt at blinding was reported in 31 studies (72%). The quality of RCTs of oral implants is generally poor and needs to be improved.

Databases, Bibliographic↗
PubMedDate not supplied

Synthesis and antitumor activity of a new cis-diammineplatinum (II) complex containing procaine hydrochloride.

This paper refers to some of the chemical and biological properties of a new platinum (II) complex where the aromatic amino group of procaine is involved in the coordination with platinum and whose structure was defined by UV, IR, 1H-NMR, and elemental analysis. This new cationic platinum-triamine complex (DPR) displays excellent solubility (> 50 mg/ml) and stability in water. DPR has significant in vitro cytotoxicity against murine P388 leukemic cell line, human K562 erythroleukemic cell line and human Jurkat T cell line. The in vitro cytotoxic effects of DPR on P388 and Jurkat leukemic cells were comparable to those of cis-diamminedichloroplatinum (II) (DDP), while its activity on K562 cells was significantly better than that of DDP [IC50 = 1.07 +/- 0.36 (SD) microM vs 2.62 +/- 0.23 (SD) microM, P < 0.01]. The in vitro Pt accumulation rate for P388 cells was twice as rapid after DPR than after DDP exposure, while no difference in cellular platinum efflux was observed. The antitumor activity of DPR was tested in vivo against P388 leukemic cells in BDF1 mice and gave a % ILS value (75%) similar to that of the maximum tolerated dose (MTD) of DDP (8 mg/Kg). A comparative study of plasma urea nitrogen (PUN) levels and kidney morphological analysis in tumor-bearing mice receiving the LD50 dose of both drugs (39.3 mg/Kg and 16.5 mg/Kg for DPR and DDP, respectively), showed DPR to be less nephrotoxic than DDP. These results indicate that this new cationic platinum-triamine complex containing primary amine ligand is surprisingly active both in vitro and in vivo. In summary, the good characteristics of DPR in terms of high solubility, encouraging anticancer activity and absence of nephrotoxic effects make DPR a promising new platinum anticancer agent for preclinical development.

Animals↗