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Biomedical subjects

M Giovannini

Publications and source records attributed to M Giovannini.

At least 127 records · Page 7Linked to original sources
PubMed1998

[Ecoendoscopy in the assessment of esophageal neoplasms].

OBJECTIVE: To asses the diagnostic accuracy of endoscopic ultrasonography (EUS) for the local and regional staging of esophageal cancer, and its possible alteration resulting from the performance of preoperative chemoradiation. METHODS: Prospective study of 85 consecutive patients with esophageal cancer evaluated by EUS and operated between January 1992 and December 1995. 28 of these patients had received previous induction therapy. In all cases, EUS examination was performed by the same physician not informed about the results of previous morphological explorations. Histopathological analysis of all specimens was performed by the same pathologist, not informed about the results of the EUS. Data were collected by another independent observer. RESULTS: EUS examination resulted in incomplete staging in 8 patients (9.5%) with severe stenosis precluding endoscope passage. The accuracy, specificity and sensibility of EUS in detecting the depth of esophageal involvement (T0-2 vs T3-4) were 82.3%, 78% and 86% respectively, and 72%, 70% and 73% respectively for the lymph node metastasis. The overall accuracy of EUS in identifying the preoperative stage was 67% with a clear-cut alteration when patients had received induction therapy (61% vs 72%). On the other hand, 7(64%) of the 11 patients thought to have a complete response at endosonography had no residual tumor. CONCLUSION: EUS provides precise information for the preoperative identification of locally advanced esophageal tumor, even after induction therapy. The latter alters the diagnostic accuracy of EUS, although complete responders could be identified in two-thirds os cases.

Adult↗
PubMed1998

Plasma arachidonic acid and serum thromboxane B2 concentrations in phenylketonuric children are correlated with dietary compliance.

Phenylketonurics display lower arachidonic acid levels in plasma lipids, reflecting the lower intake due to the dietary treatment poor in phenylalanine-rich animal foods. Plasma arachidonic acid levels and serum thromboxane B2 concentrations have been measured in 13 treated phenylketonuric children and compared with those of 12 healthy controls. A direct relationship between plasma arachidonic acid and thromboxane B2 concentrations has been observed only in phenylketonurics, whose plasma arachidonic acid status correlated negatively with their dietary compliance. These results suggest that the low consumption of animal fats may contribute to modulate the production of arachidonic acid-derived platelet eicosanoids.

Adolescent↗
PubMed1998

[Spatio-temporal control of oncogenesis].

Experimental carcinogenesis has, until recently, relied on the use of animal models in which the tumorigenic process is distantly related to that observed in humans. More recently the use of transgenic mice has open new opportunities but has also revealed two limitations: firstly, some of the most prominent tumors observed in genetically predisposed humans are not observed in the corresponding mice; secondly, in most instances mice carrying a totally inactivated tumor suppressor gene die early during development. To overcome these difficulties we have developed a modular transgenic mouse model for the tissue-specific inactivation of the neurofibromatosis type 2 (NF2) tumor suppressor gene. Mutations are induced by breeding mice carrying different combinations of null and targeted but functional alleles. The regulated induction of tissue-specific somatic lesions is achieved by in vivo activation of site-specific recombination with Cre recombinase that mediate excision of sequences at specific recognition sites (loxP). In this conditional knock-out model, an additional degree of sophistication enables to trigger the creation of defined somatic mutations not only in a tissue-specific manner but also at a time that is decided by the investigator. This approach is made possible by the development of inducible regulatory systems. This further development should provide excellent flexibility to analyse in detail the consequences of the occurrence in time of the different mutations that contribute to tumor initiation and progression.

Animals↗
PubMed1998

Myocardial damage after spider bite (Latrodectus tredecimguttatus) in a 16-year-old patient.

The case of a 16-year-old patient with L. tredecimguttatus poisoning complicated by myocardial damage is reported. Symptoms (typical chest pain), electrocardiographic (ST-T changes in precordial leads) and echocardiographic (akinesia of interventricular septum with depressed left ventricular function) features and laboratory findings (increased myocardial enzymes) are described.

Adolescent↗
PubMed1998

[Lipomatous hypertrophy of the interatrial septum: its assessment with TEE, CT and MRI].

BACKGROUND: Lipomatous atrial septal hypertrophy (LHS) is an uncommon condition characterized by the deposition of excessive adipose tissue in the atrial septum. The fossa ovalis is spared by this infiltration of fat. A variety of atrial arrhythmia has been associated with this lesion, which is more common in obese, elderly female patients. Because of the lack of specific symptoms, LHS is the outcome of casual observation during echo-Doppler or autopsy studies. METHODS: We describe the case of a 76-year-old woman who came under our observation due to stroke and atrial arrhythmia. Transesophageal echocardiography clearly revealed lipomatous atrial septal hypertrophy. RESULTS: The MRI confirmed the diagnosis, visualizing the typical "dumbbell" interatrial septum. Computed tomography made it possible to define the anatomic substance of the lesion as "fatty". CONCLUSIONS: Transesophageal echocardiography is the method of choice in the diagnosis of LHS. Other techniques such as RMI or CT-scan can be useful only in selected patients with large fatty infiltration of the atrial wall or marked hypertrophy of the interatrial septum.

Aged↗
PubMed1997

Cre-mediated somatic site-specific recombination in mice.

Conditional mutant mice equipped with heterologous recombination systems (Cre/lox or Flp/frt) are promising for studying tissue-specific gene function and for designing better models of human diseases. The utility of these mice depends on the cell target specificity, on the efficiency and on the control over timing of gene (in)activation. We have explored the utility of adenoviral vectors and transgenic mice expressing Cre under the control of tissue-specific promoters to achieve Cre/lox-mediated somatic recombination of the LacZ reporter gene, using a newly generated flox LacZ mouse strain. When adeno Cre viruses were administered via different routes, recombination and expression of LacZ was detected in a wide range of tissues. Whereas in liverbeta-galactosidase activity was quickly lost by turnover of expressing cells, even though the recombined allele was retained,beta-galactosidase in other tissues persisted for many months. Our data indicate that the flox LacZ transgenic line can be utilized effectively to monitor the level and functionality of Cre protein produced upon infection with adeno Cre virus or upon crossbreeding with different Cre transgenic lines.

Actins↗
PubMed1997

A double-blind, multicentre comparison of intravenous dolasetron mesilate and metoclopramide in the prevention of nausea and vomiting in cancer patients receiving high-dose cisplatin chemotherapy.

The potent serotonin receptor (5-HT3) antagonists are new highly selective agents for the prevention and control of chemotherapy-induced nausea and vomiting that have been shown to be comparable to or more effective than traditional metoclopramide regimens. This study was designed to compare the antiemetic efficacy of dolasetron and metoclopramide in chemotherapy-naive and non-naive cancer patients receiving high-dose cisplatin-containing chemotherapy. This multicentre, double-blind, randomized trial compared the efficacy and safety of single i.v. doses of dolasetron mesilate salt (1.2 or 1.8 mg/kg) and metoclopramide (7 mg/kg) in 226 patients for the prevention of acute emesis and nausea associated with the administration of high-dose (> or = 80 mg/m2) cisplatin. Efficacy and safety were evaluated for 24 h. Complete responses were achieved by 57%, 48%, and 35% of patients given dolasetron mesilate 1.8 mg/kg (P = 0.0009 vs metoclopramide), dolasetron mesilate 1.2 mg/kg (P = 0.0058 vs metoclopramide), and metoclopramide, respectively. Overall, dolasetron was significantly more effective than metoclopramide for time to first emetic episode, nausea, patient satisfaction, and investigator global assessment of efficacy. Males, chemotherapy-naive patients, and alcoholics had higher response rates. Dolasetron was well tolerated, with mild-to-moderate headache most commonly reported. Twelve percent of patients receiving metoclopramide reported extrapyramidal symptoms compared with 0% of patients receiving dolasetron. In conclusion, dolasetron mesilate was effective for the prevention of CINV with high-dose cisplatin. Single i.v. doses of dolasetron mesilate were more effective than 7 mg/kg metoclopramide in preventing nausea and vomiting induced by highly emetogenic cisplatin-containing chemotherapy. In addition, 1.8 mg/kg dolasetron mesilate consistently produced the highest response rates and appears to be the most effective dose for further clinical development.

Acute Disease↗
PubMed1997

Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.

BACKGROUND & AIMS: Endosonography-guided fine-needle aspiration biopsy (EUS-FNA) permits cytological confirmation of EUS findings. A multicenter prospective evaluation of EUS-FNA for primary diagnosis, staging, and/or follow-up purposes was undertaken. METHODS: EUS-FNA was performed in 457 patients with 554 lesions. Clinical (n = 218) or histopathologic (n = 256) confirmation was available in 192 lymph nodes, 145 extraluminal masses, 115 gastrointestinal wall lesions, and 22 cystic lesions. RESULTS: EUS-FNA sensitivity, specificity, and accuracy was 92%, 93%, and 92% for lymph nodes, 88%, 95%, and 90% for extraluminal masses, and 61%, 79%, and 67% for gastrointestinal wall lesions, respectively. The sensitivity and accuracy for lymph nodes and extraluminal masses was superior to that for gastrointestinal wall lesions. When EUS-FNA was compared with EUS size criteria in lymph node evaluation, specificity (93% vs. 24%) and accuracy (92% vs. 69%) were superior, whereas sensitivity (92% vs. 86%) was similar. The accuracy of EUS-FNA in patients with previously failed biopsy procedures was 81% (73 of 90). Five nonfatal complications occurred for a rate of 0.5% (95% confidence interval, 0.1%-0.8%) in solid lesions vs. 14% (95% confidence interval, 6%-21%) in cystic lesions. CONCLUSIONS: EUS-FNA accurately and safely evaluates solid peri-intestinal lesions and improves lymph node staging accuracy.

Abdomen↗
PubMed1997

Plasma arachidonic acid and serum thromboxane B2 concentrations in phenylketonuric children negatively correlate with dietary compliance.

The study addresses the relationship of plasma arachidonic acid and thromboxane production with the dietary compliance in treated phenylketonuric patients, whose vegan-like dietary pattern makes them a useful model to evaluate the effects of the near-total avoidance of animal fats. Thirteen treated phenylketonuric children were compared with twelve healthy controls for arachidonic acid intake, plasma fatty acids and platelet thromboxane B2 production, assessed as accumulation of this eicosanoid in serum. The calculated intake of arachidonic acid was lower in phenylketonurics than in controls and this was associated with lower levels in plasma lipids. Plasma arachidonic acid concentrations and serum thromboxane B2 levels correlated with the last 12 months phenylalanine levels, taken as negative indicator of dietary compliance. A direct relationship between plasma arachidonic acid concentration and thromboxane B2 production was observed only in phenylketonuric patients (r = 0.74, P = 0.01). While well-compliant PKU subjects have low arachidonic acid and thromboxane concentrations in plasma, the low compliance with animal food avoidance, evoking higher phenylalanine levels, results in elevation of both plasma arachidonic acid and serum thromboxane B2. This gives support to the hypothesis that the consumption of animal fats may affect the production of arachidonic acid-derived platelet eicosanoids.

Adolescent↗
PubMed1997

Ondansetron suppository: an effective treatment for the prevention of emetic disorders induced by cisplatin-based chemotherapy. French Ondansetron Study Group.

This multicentre, randomised, double-blind, double-dummy, parallel group study was investigated in order to compare on 3 days the efficacy and the safety of the 16 mg once a day (od) ondansetron suppository (suppository group) with the recommended ondansetron treatment, i.e. 8 mg intravenous (i.v.) ondansetron on day 1 followed by 8 mg tablet (p.o.) twice daily (i.v. + p.o. group) on days 2 and 3 in patients receiving cisplatin (> or = 50 mg/m2) containing chemotherapy. In the 420 patients included in the intent-to-treat population, 209 received the 16 mg suppository and 211 the i.v. + p.o. treatment. The number of emetic episodes and the nausea score were recorded each day. Concerning the primary criterion, both treatments provided good anti-emetic control with 87% of all patients having a complete or major response (0-2 emetic episodes) on day 1 in the suppository group and 92% in the i.v. + p.o. group (P = 0.058). The 90% confidence interval for the difference between the two treatments for complete or major control was included in the interval (-15%, 15%) and showed that the treatment groups could be regarded as equivalent. Small differences in favour of the i.v. + p.o. group were observed concerning the secondary parameters. Both treatments were well tolerated. The results of this study show that both treatments are equivalent in the prevention of cisplatin-containing chemotherapy induced emesis for the primary efficacy criteria and that the ondansetron suppository is efficient and well tolerated and is a suitable alternative to the anti-emetic treatment combining the intravenous and oral routes.

Administration, Oral↗
PubMed1997

The efficacy of a combination of ondansetron, methylprednisolone and metopimazine in patients previously uncontrolled with a dual antiemetic treatment in cisplatin-based chemotherapy. The French Ondansetron Study Group.

BACKGROUND: Cisplatin is one of the most effective cytotoxic drugs used in the treatment of certain neoplasms, but is also one which most frequently induces nausea and vomiting. Combination of corticosteroids with ondansetron enables greater control of emesis than that obtained with ondansetron alone, but some patients still experience symptoms. The objective of this randomised, double-blind, multicentre, parallel group study was to examine the benefit of the addition of metopimazine (MPZ), a dopamine receptor antagonist, to the combination of ondansetron + methylprednisolone (O + M) in the prevention of cisplatin-induced nausea and vomiting in patients uncontrolled [i.e., at least one emetic episode (vomiting and/or retching) or moderate or severe nausea] during their previous course of cisplatin based chemotherapy, despite antiemetic treatment with a combination of a 5-hydroxytryptamine3 receptor antagonist (5HT3) with a corticosteroid. The impact of the treatment on the patients' quality of life was also evaluated using two specific questionnaires the FLIC (Functional Living Index for Cancer), and the FLIE (Functional Living Index for Emesis). PATIENTS AND METHODS: The intent-to-treat population consisted of 338 patients; 168 patients received the triple combination of ondansetron, methylprednisolone and metopimazine (O + M + MPZ), and 170 patients received ondansetron plus methylprednisolone (O + M). Tumour type was comparable in the two treatment groups, the most prevalent being lung cancer. Patients in group O + M + MPZ received ondansetron as an 8 mg intravenous injection prior to chemotherapy on day 1 followed by 8 mg tablets b.i.d. from D2 to D3, methylprednisolone as a 120 mg intravenous injection prior to chemotherapy on D1 and followed by 16 mg tablets b.i.d. from D2 to D3, and metopimazine as a 40 mg intravenous injection prior to chemotherapy on D1 and followed by 15 mg capsules b.i.d. on D2 to D3. Patients in group O + M received treatment with ondansetron and methylprednisolone as above. RESULTS: Analysis of the primary efficacy criterion (absence of emetic episode throughout the course of chemotherapy) revealed a success rate of 53% in the group receiving O + M + MPZ and 38% in the group receiving O + M (P = 0.008). Analysis of the secondary efficacy criteria (nausea grade, number of emetic episodes and global patient satisfaction on D1 and from D2 to D3) showed a statistically significant difference between the two groups, in favour of the O + M + MPZ treatment. The scores obtained with the FLIC and FLIE questionnaires did not reveal any significant differences between the two groups. Treatment was well tolerated in both groups. CONCLUSION: The study showed that the addition of MPZ to the combination O + M was an effective and well tolerated antiemetic treatment, with a 15% increase in efficacy compared to the combination in patients not controlled during their previous course of chemotherapy. The addition of metopimazine to existing regimens containing 5HT3 receptor antagonist and steroid combination should be considered for patients who fail on their previous course.

Adolescent↗
PubMed1997

Depressed expression of calcium receptor in parathyroid gland tissue of patients with hyperparathyroidism.

The factors involved in abnormal parathyroid cell secretory function and growth in patients with primary (I degree) and secondary (II degree) hyperparathyroidism are still incompletely understood. We compared the expression of the calcium-sensing receptor (CaR) at the gene message and the protein level in parathyroid tissue obtained from patients with I degree non-uremic or II degree uremic hyperparathyroidism with that in normal parathyroid tissue, using in situ hybridization and immunohistochemistry techniques. The expression of the CaR mRNA and protein was reduced in most cases of I degree adenoma and II degree hyperplasia, compared with strong expression normal parathyroid tissue. In II degree hyperparathyroidism, expression of both receptor mRNA message and protein was often particularly depressed in nodular areas, compared with adjacent non-nodular hyperplasia. Decreased Ca-R expression in adenomatous and hyperplastic parathyroid glands would be compatible with a less efficient control of PTH synthesis and secretion by plasma calcium than in normal parathyroid tissue.

Adult↗
PubMed1997

Management of infective complications in patients with advanced hematologic malignancies in home care.

A home care service has been implemented at our center with the aim of offering domiciliary assistance to patients with hematologic malignancies in advanced phase. We report our experience concerning the home management of these patients in the setting of infective complications. Of 151 patients in home care, 70 (46%) developed a total of 109 febrile episodes, performance status and neutrophil count significantly affecting the incidence of infections. Fever was of unknown origin in 51% of cases and microbiologically and clinically documented infections accounted for 26 and 23% of the cases, respectively. Oral ciprofloxacin in patients not neutropenic and intravenous ceftriaxone plus amikacin in neutropenic patients was shown to be effective and suitable for empiric home antibacterial treatment; in fact, 65% of febrile episodes responded to the initial antibacterial therapy with a further 16% after modification. Overall, 19.3% of the infective episodes were fatal, the prognosis appearing to be similar to that usually observed in the same category of patients in an inpatient setting. Our experience appears to show that a home care program could be the option of choice for patients with advanced cancer even in the setting of infective complications. It could improve the quality of life of patients and of their families, and it could save these subjects the risk of developing infections by resistant nosocomial isolates.

Adolescent↗
PubMed1997

Endoscopic ultrasonography for assessment of the response to combined radiation therapy and chemotherapy in patients with esophageal cancer.

BACKGROUND AND STUDY AIMS: Measuring the response of esophageal cancer to combined chemotherapy and radiotherapy is difficult. Initial results using ultrasonography have been contradictory. The purpose of this study was to correlate the endoscopic ultrasonography (EUS) findings after preoperative chemoradiotherapy with the histology of the resected specimens, and to assess the accuracy of EUS in predicting the response to treatment. PATIENTS AND METHODS: From October 1991 to February 1995, 32 patients with esophageal cancer staged as T3 or T4 on EUS were treated by chemoradiotherapy, followed by surgical resection. There were 28 men and four women, with a mean age of 54 years (range 38-70 years). In 25 cases, the diagnosis was squamous-cell carcinoma, and in seven cases it was adenocarcinoma. EUS was carried out using a curved-array ultrasonic transducer (Pentax FG-32 UA). After two courses of chemoradiotherapy, the wall involvement was classified using the following modified post-chemoradiotherapy classification: T0, complete restitution of wall layers; Tw, echo-poor nodules located in the submucosa or muscularis propria, but with wall layers discernible; T2, echo-poor wall thickening without distinguishable layers, but not infiltrating beyond the fifth hyperechoic layer; T3, thickened hypoechoic or heterogeneous wall, no distinguishable layers, infiltrating beyond the fifth hyperechoic layer; T4: a hypoechoic or heterogeneous mass in contact with a mediastinal structure. RESULTS: Using this post-chemoradiotherapy classification, the sensitivity, specificity, and accuracy of EUS in detecting residual tumor (T0 + Tw versus T2, T3, and T4) were 91.3%, 77.7%, and 77.7%, respectively. The accuracy of EUS, endoscopic, and CT criteria in assessing the parietal response was 81.2%, 56.2%, and 59.3%, respectively. CONCLUSION: Complete restoration of the esophageal wall (T0) and Tw stage corresponded to disease-free histology in 78% of cases, and corresponded in all cases either to disease-free esophageal wall or to microscopic tumor residues in the mucosa. No conclusions could be drawn in the other categories (T2-T4), but residual tumor was detected in 87% of cases.

Adenocarcinoma↗
PubMed1997

Endoscopic drainage of pancreatic pseudocysts guided by endosonography.

Endoscopic drainage of cysts is now accepted as an effective treatment in chronic pancreatitis. Endosonography is coming to be regarded as essential before endoscopic therapy, since it can precisely identify the best and safest point at which to perform the cystoenterostomy. The present report illustrates from four cases that, in some patients, endosonography may contraindicate endoscopic drainage, while in others, it can prove the feasibility of the treatment even when there is no bulging of the cyst into the digestive tract.

Adult↗
PubMed1997

Endoscopic ultrasonographic study of the azygos vein in patients with varices.

BACKGROUND AND STUDY AIMS: Using EUS in the study of portal hypertensive patients, various divisions of the gastroesophageal collateral circulation can be demonstrated. The azygos vein, which is the main drainage system for varices, can also be scanned endosonographically. We studied the azygos vein in control subjects and portal hypertensive patients using EUS. PATIENTS AND METHODS: Our study included 17 patients with endoscopic evidence of esophagogastric varices and 11 control subjects not suffering from chronic liver disease or varices. EUS and Doppler EUS using a linear scanning echoendoscope were carried out on patients and control subjects with the aim of studying the azygos vein. RESULTS: The azygos vein could be scanned in all subjects and was found to be significantly dilated in patients with varices. Maximal velocity of its blood flow was higher among patients with varices compared to control subjects. Periazygos collaterals could be occasionally observed in portal hypertensive patients. CONCLUSION: EUS can be used both for scanning and hemodynamic studies of the azygos vein. The fact that EUS allows the collection of valuable quantitative and qualitative data from the azygos vein should encourage further studies on the clinical value of this information in the follow up of portal hypertensive patients.

Adult↗