Biomedical subjects
R Bonardi
Publications and source records attributed to R Bonardi.
[Use of a chronomulticorticoid in the therapy of ulcerous rectocolitis].
Explore the source record for details and available documents.
[Goodpasture's syndrome. Observations on a case].
Following a review of the most recent aetiopathogenetic theories and therapeutic records of Goodpasture's syndrome, a personal case is reported. Stress is laid on the extreme clinical variability of the disease and on the role which disseminated intravascular clotting can have on its course.
[Immunologic classification of paraproteins (proceedings)].
Explore the source record for details and available documents.
Surgical treatment of acute diverticulitis by staged procedures.
A retrospective 10-year experience with the traditional three-stage plan (diverting colostomy, resection, colostomy closure) for perforated diverticulitis of the colon in four urban hospitals was reviewed to accurately assess the mortality rate. Only patients who were admitted in a non-elective manner with signs of an acute abdomen or who were already hospitalized with another illness and developed an acute abdomen were considered. Fecal or generalized purulent peritonitis, or pelvic peritonitis with abscess were observed at laparotomy in all instances. Two hundred and eight patients representing 211 episodes met the above stated criteria for inclusion in the study. A transverse colostomy was performed in 203 instances associated with 16 deaths, and 8 sigmoid colostomies were associated with two deaths. The overall mortality after the first stage was 8.5%. A loop colostomy was constructed most frequently and a completely divided colostomy performed in only 31 of 211 (15%) instances. Of 147 instances in which the diseased sigmoid colon was resected, 44 (30%) had the colostomy ablated at the same operation, resulting in only one death (0.7% mortality). Colostomy closure as a separate procedure in 103 instances resulted in 4 deaths (3.9% mortality). The highest mortality rate occurred in patients in the in the eighth decade. Staged procedures for perforated colonic diverticula can be carried out with a mortality rate of 11%.
[New power sources for pacemakers].
Explore the source record for details and available documents.
Lung neoplasia and paraproteinaemia.
Explore the source record for details and available documents.
[New power sources for pacemakers].
Explore the source record for details and available documents.
[Benign concomitant paraproteinemias. Immunoclinical study].
Explore the source record for details and available documents.
Performance of fine-needle aspiration cytology of the breast-multicenter study of 23,063 aspirates in ten Italian laboratories.
AIMS AND BACKGROUND: The aim of this study was to assess the performance of routine breast cytology in a group of Italian laboratories, as a basis for interlaboratory quality control. METHODS: A multicenter retrospective consecutive series of 23,063 aspirates from breast lesions (5,130 invasive carcinoma, 247 intraductal carcinoma, 2,386 benign lesions [histological], 13,144 benign lesions [follow-up], 2,156 other [no follow-up]) was reviewed. Standard accuracy measurements (inadequacy rate, sensitivity, specificity, predictive value) were determined, as well as the contribution of diagnostic tests such as physical examination and instrumental diagnostic procedures (mammography, sonography). RESULTS: Overall, inadequacy rate was 6.5% for malignant and 23.2% for benign lesions. Sensitivity was 92.2%, specificity was 95.3%, and the positive predictive value of an equivocal or malignant report was 53.4% or 96.9%, respectively. Sensitivity was associated with histological type (intraductal vs invasive: 77.0% vs 92.9%, p < 0.000001; lobular vs other invasive: 85.5% vs 94%, p = 0.0025) as well as with tumor size (pT1 = 91.6%, pT2 = 94.3%, pT3-4 = 96.0%, p < 0.000001). Observed differences in performance indicators between centers may be explained by variability in sampling or reading accuracy, and warrant the need for some adjustment in single centers, especially, as far as the criteria to report an equivocal smear are concerned. Cytology contributed to detect otherwise unsuspected carcinomas, although in some centers this benefit was poor and not cost-effective because a large number of unnecessary biopsies were caused by false equivocal/positive reports. CONCLUSIONS: Although centers scored, on average, well within standards recommended by national authorities, this study suggests the opportunity of interlaboratory quality control to achieve more homogeneous criteria.
Comparing two modalities of screening for prostate cancer: digital rectal examination + transrectal ultrasonography vs. prostate-specific antigen.
AIMS AND BACKGROUND: To evaluate the performance and feasibility of screening for prostate cancer by comparing screening modalities. METHODS: Prospective study of two comparable cohorts of healthy resident males aged 60 to 75 years. Screening attenders in the two invited cohorts were screened either by digital rectal examination (DRE) and transrectal ultrasonography (TRUS), or by serum prostate-specific antigen determination (PSA: cutoff 4 ng/ml). Attendance and biopsy rates, predictive values, prevalence of screen-detected cancers, as well as screening costs were determined, and the efficiency of the two screening modalities was compared. RESULTS: 1425 subjects were screened by DRE+TRUS. Attendance rate was 33.7%, the biopsy rate was 2.7%, and the prevalence of detected cancers was 1.82%. A total of 1315 subjects was screened by PSA. Attendance rate was 66.9%, the biopsy rate was 2.8%, and the prevalence of detected cancers was 1.67%. Screen-detected cancer stage was more favorable than observed in clinical practice, and early detection was evident, with the prevalence/incidence ratio higher than 10:1 in both programs. The cost per subject screened was about 34,000 Lire for DRE+TRSU and about 30,000 Lire for PSA program. CONCLUSIONS: The study confirms that early detection of prostate cancer is possible and that screening is practically feasible. Both screening modalities achieved comparable results as regards early detection, but screening by PSA had a higher compliance and lower costs. PSA seems the ideal test to be used in prospective controlled studies aimed at demonstrating screening efficacy.
A feasibility study of screening for endometrial carcinoma in postmenopausal women by ultrasonography.
BACKGROUND: Abnormal endometrial thickness assessed by ultrasonography has been reported as a reliable indicator for early asymptomatic endometrial carcinoma. STUDY DESIGN: We evaluated the feasibility and the performance of screening by ultrasonography in a consecutive series of postmenopausal volunteers. RESULTS: A total of 2,025 women were screened, and 117 (5.8%) showed abnormal endometrial thickness. Ninety-eight subjects consented to be assessed by outpatient endometrial biopsy, which was not possible in 32 for cervical stenosis. Three cancers were detected among 66 assessed subjects, 34 not-assessed subjects were controlled by repeat sonography (no change), and 17 were lost to follow-up. No other cancer was recorded by the local Cancer Registry among screened subjects. The prevalence/incidence ratio was 2.65:1, and the cost per screen-detected cancer was 18,571,000 Italian lire. CONCLUSIONS: Screening by endometrial sonography is feasible on a practical basis, but its efficacy needs to be proven by prospective controlled studies which would enroll large populations to ensure sufficient statistical power, considering the low incidence and the low lethality of the disease. Studies of screening for other carcinomas may be considered of higher priority.
Endometrial ultrasonography - An alternative to invasive assessment in women with postmenopausal vaginal bleeding.
AIMS AND BACKGROUND: To test the reliability of endometrial sonography in selecting women with abnormal postmenopausal vaginal bleeding for further diagnostic assessment. METHODS: Endometrial thickness was measured in 368 consecutive women by abdominal or vaginal sonography prior to invasive assessment (hysteroscopy, curettage). The association of abnormal and endometrial thickness (4 mm or greater) with endometrial cancer was determined. RESULTS: Abnormal endometrial thickness was observed in 116 of 368 women. Subsequent assessment diagnosed endometrial carcinoma in 16 subjects, 15 of whom had abnormal endometrial thickness. One case with normal endometrial thickness was suspected at sonography because of the irregular appearance of the endometrium. CONCLUSIONS: Had it been used to select subjects for further assessment, sonography would have missed no cancer, and unnecessary invasive assessment (under general anesthesia in 20% of cases) would have been spared in 68% (251/368) of the subjects. Endometrial sonography should be routinely used to select women with postmenopausal vaginal bleeding for further investigations.
Training in colposcopy: experience with a videocolposcopy test.
The authors evaluate the results of a videocolposcopy test (330 total cases, 12 cases of histologically confirmed CIN2 or more severe lesions) taken by 9 accredited and 17 unaccredited colposcopists during 1995. Seven of 9 accredited and 4 of 13 unaccredited colposcopists reached the requested standard (sensitivity > 90%, biopsy rate < 60%). Performance was definitely better when the test was not blind to the cytologic report (4 of 13 reached the requested standard) with respect to blind reading (none of 17). The study confirmed that colposcopy at unaccredited practices is poorly accurate. Colposcopic assessment of patients with abnormal smears should be centralized in accredited practices, which should undergo periodic quality control to guarantee screening efficacy. Tape-recorded videocolposcopy tests are a good, simple, practical and inexpensive method for interobserver quality control of colposcopic performance.