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Biomedical subjects

P Guerra

Publications and source records attributed to P Guerra.

66 records · Page 4Linked to original sources
PubMedDate not supplied

Posttraumatic diffuse cerebral lesions. Relationship between clinical course, CT findings and ICP.

One hundred and fifty patients with posttraumatic diffuse cerebral lesions were reviewed. Criteria of inclusion were immediate coma and CT appearance of diffuse lesions, that were classified as follows: (a) Diffuse axonal injury (70 cases): patients with normal CT scan (50 cases) and patients with shearing injury (focal hemorrhages in corpus callosum, basal ganglia and brain stem; gliding contusions) (20 cases); (b) Diffuse brain swelling (80 cases): reduced or absent lateral ventricles, absence of 3rd ventricle and basal cisterns. Many of these patients had either subarachnoid haemorrhage or subdural blood effusion. Clinical course and mortality rate were in a ranking order in the considered groups. Patients with normal CT had a less severe coma and a better outcome than patients with shearing injury and diffuse brain swelling. There was evidence of high intracranial pressure in 75% of the patients with brain swelling, whereas no patient with normal CT had ICP elevation. Diffuse axonal injury represents a primary posttraumatic diffuse lesion. Secondary vascular involvement, due to hypoxia, shock and other unknown causes, is responsible for the appearance of vasoparesis, hyperemia and diffuse brain swelling.

Adult↗
PubMedDate not supplied

[131I]metaiodobenzylguanidine therapy in advanced neuroblastoma.

Forty-two children with advanced neuroblastoma who either failed with first-line therapy or relapsed after achieving a complete remission, were considered for treatment with [131I]metaiodobenzylguanidine (131I-MIBG). We subdivided 42 cases into 5 groups, in accordance with the stage of disease at diagnosis, response to first-line therapy and relapse. A total of 99 courses of 131I-MIBG were administered with doses ranging from 2.8 to 6.0 GBq. One child received six courses, 3 four courses, 18 three courses, 6 two courses and 15 one course of 131I-MIBG. The total delivered dose in single measurable lesions ranged from 286 to 1691 cGy with an uptake factor ranging from 3% to 10%. We obtained a major response in primary tumors, and a long-term response was observed in 5 cases, lasting more than 2 years without further chemotherapy.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Results of [131I]metaiodobenzylguanidine treatment in metastatic malignant phaeochromocytoma.

The results obtained with [131I]metaiodobenzylguanidine (131I-MIBG) treatment in 6 patients affected by metastatic phaeochromocytoma are reported. Single doses of 3.7-7.4 GBq were given, in 1-6 courses, up to cumulative doses of 5.4-37.8 GBq. Objective responses were observed in 5 patients (2 tumour shrinkages, even if small; 5 lowering of blood pressure), which were only temporary in 3 patients and stable in 2. Complete disappearance of pain was obtained in 2/2 patients. No adverse side-effects were observed. The problem of treatment strategy in situations of stable disease deserves further study.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Results of [131I]metaiodobenzylguanidine treatment in metastatic carcinoid.

The results obtained with [131I]metaiodobenzylguanidine (131I-MIBG) treatment in 6 patients affected by metastatic carcinoid are reported. 131I-MIBG was given in single doses of 3.7-8.0 GBq, reaching a maximum cumulative dose of 29.5 GBq in 4 courses. Objective responses were not observed, but in 4 cases an apparent stabilisation of the disease for more than 1 year was obtained. A subjective response regarding the carcinoid syndrome was observed in 4 cases. No response was seen in 2 cases. No adverse side-effects of any importance were observed, usually being prevented by a mild medication.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Traumatic fractures of the craniovertebral junction. Management of 23 cases.

Twenty-three consecutive cases of traumatic C1-C2 fractures treated at the Department of Neurosurgery, University of Milano, are reported. Of these there were 13 cases of odontoid fractures, 6 hangman fractures, 2 anterior inferior corner fractures, 2 atlas-axis combination fractures and 2 Jefferson fractures. Almost all the patients were young people involved in motor vehicle accidents. Nineteen patients were treated with external immobilization (halo vest, Minerva) for 3-6 months while 4 odontoid fractures underwent early surgical posterior stabilization. At follow-up, 20 patients had a good fusion while 3, aged over 75 years, died due to cardiopulmonary or septic complications. The appropriate management of this type of lesion is still a matter of discussion. In our opinion the Halo device allows good stabilization after correct fracture reduction.

Adolescent↗
PubMedDate not supplied

[Diagnostic and therapeutic possibilities of meta-iodobenzylguanidine in neuroblastoma].

MIBG is taken up preferentially by neuroblastoma cells. Owing to its high concentration in the neuroblastoma lesions, *I-MIBG scan is one of the most specific and effective tools in the diagnosis and staging of the disease. For most imaging purpose 123I-MIBG is the optimal agent. A rational approach 131I-MIBG has the potential for specifically delivering very large radiation doses to the malignant cells. The results obtained in more institutions are encouraging and this therapeutic modality should be included in the therapeutic strategy of neuroblastoma.

3-Iodobenzylguanidine↗
PubMedDate not supplied

[Treatment of recurrences of duodenal ulcer: seasonal or long-term therapy?].

Many recently published papers have focused on the problem of the treatment of recurring duodenal ulcers and time trends, given the rate of late recurrences observed with long-term protocol. The results of trials with seasonal protocols are therefore presented. Given the seasonal trends in duodenal ulcer recurrence, a stable oscillatory behaviour with fluctuations of 6-month periodicity was demonstrated with the use of conventional statistical methods. With the utilization of the more sophisticated spectral analysis of data from many centers in Italy, the time trends of this condition have been characterized in greater detail, and cycles of increased recurrences every 4, 6 and 12 months have been evidenced. On the basis of these data, a randomized controlled trial in 60 patients treated with cimetidine, 30 patients in long-term and 30 in seasonal treatment showed similar results: the recurrence rate was 30% in both groups over a 12-month period. Preliminary results of a new multicenter trial in 110 patients with the same protocol (cimetidine 400 mg nocte), confirm these results. In conclusion, the two trials tend to confirm the validity of preventive protocols that respect seasonal fluctuations.

Adolescent↗
PubMedDate not supplied

Breast cancer detection with sestamibi-Tc-99m and Tl-201 radionuclides in patients with non conclusive mammography.

Early diagnosis of breast cancer using breast examination, mammography and ultrasonography is highly accurate, but radiologically dense breast represent a challenge for the mammographic detection of early stage tumors. The aim of this study is to determine the clinical value of scintigraphic techniques in the early diagnosis of breast cancer when other methods give non-conclusive results. The study includes 160 women with clinical suspicion of breast cancer and non-conclusive findings in mammography, randomized either to scintigraphic scans with Sestamibi Tc 99m or Tl 201. Up to date, 64 women have been enrolled, 46 in Tl-201 and 18 in Sestamibi Tc 99m. Results obtained show 73% sensitivity and 94% specificity with Tl 201 and 77% sensitivity and 100% specificity with Sestamibi Tc 99m. In this group, diagnostic accuracy improves when the tumors are bigger than two centimetres in diameter or when they are palpable. These preliminary results show that scintigraphic breast examination seems useful when other diagnostic methods provide non-conclusive results.

Breast Diseases↗