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Biomedical subjects

R Bergamaschi

Publications and source records attributed to R Bergamaschi.

At least 109 records · Page 6Linked to original sources
PubMed1996

Routine compared with nonscheduled follow-up of patients with "curative" surgery for colorectal cancer.

BACKGROUND: The main rationale for follow-up of colorectal cancer patients resected for "cure" is that early detection and treatment of recurrence and metachronous disease should result in improved survival. Our purpose was to assess in a prospective fashion the impact on survival of a follow-up program versus that of undergoing nonscheduled visits. METHODS: Within the 14-year period from 1975 through 1988, a prospective study was carried out on 800 patients with colorectal adenocarcinoma radically resected with no evidence of synchronous cancers of the colon and rectum or in other organs, of whom 322 patients were to attend a 5-year follow-up, and 478 patients were free to make nonscheduled visits on account of symptoms. RESULTS: Asymptomatic recurrence was found at follow-up in 92 (28%) of 322 patients, whereas 175 (36%) of 478 patients had a symptomatic recurrence detected at a nonscheduled visit. Diagnosis of resectable recurrence was established within a median time of 21.5 months. Surgical resection of recurrence was performed in 30 (32%) of 92 and in 13 (7%) of 175 patients (32 vs. 7%; p < 0.001). Resection was curative in 13 (14%) of 92 and in two (1%) of 175. Five-year survival of resected recurrence was 10% in 30 of 92 patients and 0.8% in 13 of 175 (10 vs. 0.8%; p < 0.01). Two patients are alive with no evidence of disease or two (2%) of 92. Metachronous colorectal lesions were treated for cure in 63 (19.5%) of 322 patients. The effectiveness of scheduled follow-up was 4% (13 of 322 patients). CONCLUSIONS: These results underline the rationale for a follow-up program in early detection and surgical treatment of recurrent disease in patients operated on for colorectal cancer.

Adenocarcinoma↗
PubMed1996

Estimating reliability of evoked potential measures from residual scores: an example using tibial SSEPs.

A normative study of tibial SSEPs was performed in 74 healthy subjects, and the effects of the variables sex, age and height on SSEP parameters were assessed. In a subgroup of 20 subjects a test-retest study was also performed, which allowed us to estimate the reliability of the different parameters by means of the intraclass correlation coefficient. We demonstrated that the intraclass correlation coefficient may be biased by predictable effects of subject-related variables (such as age, height and sex), if it is computed from raw original values. This bias can be eliminated by estimating reliability indices on residual scores calculated as the differences between observed values and those predicted by subject's age, height and sex.

Adolescent↗
PubMed1996

Cerebral visual impairment in periventricular leukomalacia: MR correlation.

PURPOSE: To evaluate the involvement of central visual pathways in cases of periventricular leukomalacia, and to correlate the neuroradiologic findings with the degree of visual acuity. METHODS: The MR brain examinations of 27 preterm children affected by cerebral palsy resulting from periventricular leukomalacia and without significant ophthalmologic lesions were reviewed retrospectively to search for possible involvement of the optic radiations and/or of the calcarine cortex. The data were compared with the degree of visual acuity estimated by means of the Teller Acuity Cards test. RESULTS: Seventeen (63%) of the 27 patients had cerebral visual impairment, which correlated strongly with MR lesions. Quantitative reduction and signal hyperintensity of the peritrigonal white matter and atrophy of the calcarine cortex were present in the more severe cases. In two blind patients, an altered MR signal was detected in the lateral geniculate bodies. CONCLUSION: This study clearly establishes a relationship between specific MR findings and visual impairment in children with periventricular leukomalacia. The finding of hyperintensity in the lateral geniculate bodies was interpreted as an axonal reaction. MR imaging is useful for detecting potential visual impairment and for improving clinical diagnosis.

Atrophy↗
PubMed1996

[Cancer of the gallbladder. A surgical experience. A propos of 143 cases].

The records of 143 patients with gallbladder carcinoma operatively treated between 1975 and 1995 were retrospectively reviewed. Abdominal pain was the most common symptom and was present in 103 patients (72%). Jaundice was present in 83 patients (58%) and weight loss in 68 (47.5%). Pre-operative diagnosis was made in 40.5% of the patients. Surgical procedures included cholecystectomy alone (16.8%), cholecystectomy with resection of the hepatic bed and lymphadenectomy (11%), cholecystectomy with biliary drainage (57.3%), and exploration with biopsy (14%). Surgery was considered as curative in 21.5% of the patients. Overall five-year survival rate was 11%. Actuarial 5-year survival rate was 100%, 29% and 23% in patients with T1, T2 and T3 tumors. The five-year survival rate was nil in patients with T4 and T5 cancers.

Adenocarcinoma↗
PubMed1995

Leber's hereditary optic neuropathy (LHON)-related mitochondrial DNA sequence changes in italian patients presenting with sporadic bilateral optic neuritis.

Eighteen Italian patients presenting with sporadic, bilateral, simultaneous, or sequential optic neuritis (ON) were evaluated for 14 base changes in mitochondrial DNA (mtDNA) previously found associated with Leber's hereditary optic neuropathy (LHON), aiming to identify at a molecular level LHON cases with nontypical phenotypes. During a 36-month follow-up, 11 ON patients developed clinical or laboratory features allowing diagnosis of clinically definite multiple sclerosis (MS). None was positive for any of the "primary" LHON-associated mutations. However, single or multiple "secondary" LHON-associated sequence changes at 4216/ND1, 4917/ND2, and 13708/ND5 were detected in ON and ON-MS patients. MS controls without visual failure as well as healthy control subjects harbored the same base changes at similar frequencies. In addition, coexistence of three sequence changes was found in two cases (1 ON-MS patient and 1 MS control patient). We also report finding two new neutral sequence base changes in the ND-4 gene which were identified by SSCP and confirmed by automated DNA sequence analysis. The results suggests that these secondary mutations do not contribute to MS susceptibility in these patients, but rather represent neutral mitochondrial DNA polymorphisms. In addition, whether there are biochemical abnormalities related to single and multiple secondary mtDNA sequence changes remain to be demonstrated.

Adult↗
PubMed1995

Management of large encircling mid-rectal adenomas in frail patients.

Frail patients with extensive circumferential mid-rectal adenomas should be offered adequate surgery given the risk of local recurrence due to unrecognized malignancy. Accordingly, five poor-risk patients aged 77 years on average underwent segmental resection of the rectum with double stapled anastomosis via the Kraske approach. Tumour length varied from 4 to 5 cm and the distance from the anal verge from 6 to 8 cm. There were no complications aside from five painless incisional hernia. Segmental resection of the rectum via a posterior approach offers adequate treatment with low morbidity and is therefore suitable in frail patients for whom laparotomy may carry unacceptable risks.

Adenoma↗
PubMed1995

HLA complement gene polymorphisms in multiple sclerosis. A study on 80 Italian patients.

We studied C4A, C4B, and Bf complement gene polymorphisms in 80 Italian patients with multiple sclerosis (MS). We observed a significantly higher frequency of C4AQ0 allele in patients with the relapsing-remitting form of MS than in ethnically homogeneous controls. Restriction fragment length polymorphism analysis by Southern blotting of the C4/CYP21 gene complex showed that a structural gene deletion was present in 45% of patients with the C4AQ0 allele. Our data support the hypothesis that relapsing-remitting MS and primarily chronic progressive MS are immunogenetically distinct diseases; further, complement factor abnormalities typical of autoimmune diseases could influence the pathogenesis of MS.

Case-Control Studies↗
PubMed1995

Recovery functions of early cortical median nerve SSEP components: normative data.

The recovery functions of parietal P14-N20, N20-P27 and frontal P22-N30 amplitudes were assessed in 17 healthy controls aged 20-50 years by means of the paired stimulus technique. One unpaired and 4 paired stimuli with interstimulus intervals (ISIs) of 25, 50, 75 and 100 msec were cyclically presented in a single run. Responses to the unpaired stimulus were subtracted off-line from paired stimulus responses. The highest suppression was reached at shorter ISIs for components with shorter latencies. The mean suppression of P22-N30 was influenced by the subject's age, being greater in younger subjects. Normative data are reported.

Adult↗
PubMed1994

Pancreatoduodenectomy for hemosuccus pancreaticus in silent chronic pancreatitis.

Hemorrhage is an infrequent but known complication of chronic pancreatitis. The pathogenesis of spontaneous bleeding includes splenic vein thrombosis, pancreatic lithiasis, and erosion of a pseudocyst into vessels incorporated in its wall. Bleeding may occur into the gastrointestinal tract, the peritoneal cavity, or retroperitoneum. Moreover, bleeding can be severe, with rapid development of shock, or mild in patients who have exhibited minimal clinical symptoms. "Hemosuccus pancreaticus" is the term coined to describe the rare case of bleeding observed to occur through the ampulla of Vater. Exceedingly rare, as was the case in our patient, is when hemosuccus pancreaticus is due to a bleeding pseudocyst of the head of the pancreas in the absence of gastrointestinal blood loss as well as abdominal pain.

Chronic Disease↗
PubMed1994

Sensitivities and predictive values of paraclinical tests for diagnosing multiple sclerosis.

The sensitivities and predictive values of visual, somatosensory, and brain auditory evoked potentials (EPs), cerebrospinal fluid oligoclonal banding (CSF-OB) and magnetic resonance imaging (MRI) were evaluated for the early diagnosis of clinically definite multiple sclerosis (CDMS). Paraclinical evidence of asymptomatic lesions allows a diagnosis of CDMS. Eighty-two patients in whom MS was suspected but diagnosis of CDMS was not possible entered the study prospectively. Paraclinical examinations were performed at entry. Patients were examined and underwent EPs every 6 months, and MRI yearly. After a mean follow-up of 2.9 years, 28 patients (34%) had developed CDMS (McDonald-Halliday criteria). The initial MRI was strongly suggestive of MS in 19 of these (68%), while 27 (96%) had at least one MS-like abnormality in the initial MRI. CSF-OB and EPs had lower sensitivities. CDMS developed during follow-up in 19 of the 36 patients (53%) who had an initial MRI strongly suggestive of MS but in only 1 of the 25 who had normal MRI when first studied. These results support previous conclusions that MRI is the most sensitive test for detecting white matter asymptomatic lesions, and the most predictive for the diagnosis of CDMS.

Adolescent↗
PubMed1994

Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon.

PURPOSE: The operation of choice for acutely obstructed carcinoma of the left colon is controversial. The aim of the study was to evaluate the results of its management by emergency subtotal/total colectomy with immediate anastomosis without diversion. METHODS: An emergency subtotal/total colectomy was performed in 44 patients (mean age, 72.4 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively distended colon of dubious viability and likely to contain ischemic lesions, signs of impending cecal perforation, and masses suggesting synchronous colonic cancers. RESULTS: Postoperative mortality was 6.8 percent. Two patients over 90 years of age died postoperatively as a result of cardiopulmonary complications. An 83-year-old female died as a result of an anastomotic dehiscence. Morbidity was 6.8 percent including one fistula which recovered without surgery. There were three synchronous colon cancers. Six months after surgery, the mean daily stool frequency was two following subtotal colectomy and three after total colectomy. CONCLUSION: Emergency subtotal colectomy achieves in one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions and serosal tears on the cecum, ensures restoration of gut contiguity via a "safe" ileocolonic anastomosis, and removes occasional lesions proximal to the index cancer. It is a safe procedure given that operative mortality rates are as low as with elective surgery.

Acute Disease↗
PubMed1994

Lack of both spinal fluid oligoclonal bands and complement 4A protein in an MS patient.

We report the case of a multiple sclerosis (MS) patient without oligoclonal bands (OCB) in three cerebrospinal fluid samples. Restriction fragment length polymorphism analysis of Class 3 genes with radiolabelled specific cDNA probes showed a homozygous deletion of the complement 4A (C4A) genes. Consequent lack of C4A protein can alter the development of humoral immune response probably preventing OCB production. Our observation may suggest a link between a rare immunogenetic pattern and the absence of OCB in MS.

Adult↗
PubMed1994

Usefulness of trigeminal somatosensory evoked potentials to detect subclinical trigeminal impairment in multiple sclerosis patients.

Trigeminal somatosensory evoked potentials (TSEPs) by surface electric pulse stimulation were recorded in 30 normal subjects and in 70 multiple sclerosis (MS) patients, 13 of whom presenting clinical trigeminal impairment. We observed significant prolongation of all TSEPs parameters in MS group. TSEPs were abnormal in 45 patients (64.3%). Clinical and neurophysiological data agreed in 36 patients (51%) on 84 sides (60%). TSEPs were able to detect clinically silent lesions 54 times. TSEPs recording proves to be an additional useful test in MS multimodal evoked potential protocols.

Adolescent↗
PubMed1994

Spontaneous growth and pubertal development in Turner's syndrome with different karyotypes.

We studied spontaneous growth and pubertal development in 205 girls with Turner's syndrome, aged 1 month to 28.16 years, according to different karyotypes: 45,X (52%), X-mosaicism (12%), X-structural abnormalities (36%). Data on height, weight, height velocity, bone age and pubertal development were collected yearly in a mixed longitudinal and cross-sectional mode. Pelvic ultrasonography was performed in 133 patients, 46 of whom had contact breast thermography. Standards for height and height velocity (1-20 years) showed no differences when compared with other studies. Some differences were found when these data were subdivided by karyotype. In fact, X-mosaicism subjects had a pubertal growth spurt between 8 and 12 years of age. The spurt observed in this group cannot be justified by the more frequent presence of residual ovarian activity alone. It also appears in patients without ovaries and confirms the influence of a genetic factor on the X-chromosome. In spite of this spurt, the greatest final height was reached by 45,X subjects. X-mosaicism girls had more frequent spontaneous breast development linked to a higher percentage of visible ovaries. In this group the age of the first pubertal signs was similar to that of normal subjects and occurred much earlier than in the other groups.

Adolescent↗
PubMed1994

Eye movement quantitative evaluation before and after high-dose 6-methylprednisolone in multiple sclerosis.

We studied saccadic and smooth pursuit eye movements in 24 patients suffering from multiple sclerosis during disease worsening, before and after high-dose 6-methylprednisolone infusions. Quantitative evaluation of saccades was based on amplitude/duration and amplitude/peak velocity relationships, precision (i.e. the ratio of actual to desired saccade amplitude) and the latency, whereas smooth pursuit eye movements were studied using target velocity/performance index relationship. At basal recordings, 22/24 (91.7%) of the patients showed at lest one abnormality. Eleven of the 24 patients (45.8%) showed modification of one or several parameters: improvement in 6 patients, worsening in 2, coexistence of both trends in 3. Latency improvement was the only significant modification when patients were considered as a group. Neurophysiological modifications did not correspond to clinical changes.

Adult↗