Calcified gastric cancer: report of a case and review of literature.
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Adenocarcinoma, Mucinous↗
Biomedical subjects
R Grassi
Publications and source records attributed to R Grassi.
Intrarectal ultrasound and computed tomography in the pre- and postoperative assessment of patients with rectal cancer.
The ability of intrarectal ultrasound to recognize the local extent of disease was investigated in 23 patients with histologically proven adenocarcinoma of the lower two-thirds of the rectum before operation. Two probes, 12 cm long, working at a frequency of 3.5 and 7.5 MHz, were used. The results were compared with those of pre-operative computed tomography (CT) and with the pathological report of the resected specimens. Sonography correctly staged 20 of 23 tumours with two false negatives and one false positive, while CT correctly staged 19 of 23 tumours with two false negatives and two false positives. The results of ultrasound were found to be as accurate as those of CT; the low cost and simple use of ultrasound makes it preferable in the pre-operative assessment of the depth of invasion of rectal cancer. In addition, intrarectal ultrasound was routinely performed in 42 patients, operated on for rectal cancer by means of sphincter-saving procedures, at variable intervals in the first 2 years postoperatively. Eight local recurrences were recognized and confirmed by CT. Based on the low cost, reliability and simple use, intrarectal ultrasound is proposed as first examination for local recurrence detection in the follow-up of patients with low anterior resection for rectal cancer.
Adenocarcinoma↗
[Contribution to the serologic study of toxoplasmosis in pregnancy].
Toxoplasma antibodies in five women sera during the pregnancy were detected by direct agglutination and immunofluorescent tests both for IgG and IgM. The presence and the changes of the IgG and IgM titers are related to the abortion and/or foetal pathology. In order to prevent such a risk the authors suggest to test all the women before or early in the pregnancy for toxoplasma antibodies.
Adult↗
[Glycosylated hemoglobin in chronic renal insufficiency].
Glycosylated haemoglobin (Hb A1) was measured by ion-exchange column chromatography in 70 normal subjects, 40 diabetics and 83 patients with chronic renal failure, including 54 on chronic dialysis. The results, compared with glycemic balance and renal function, suggest that the coexisting occurrence of any kind of chronic renal failure can really interfere with the blood level of the fast haemoglobin fractions, disclosing new interesting perspectives of diagnostic and clinic employment.
Blood Glucose↗
[Echocardiographic and haemodynamic correlations in a case of hypoplasia of the right ventricle (author's transl)].
The authors correlate echocardiographic and haemodynamic reports of a 12 year old patient with congestive heart failure and enlarged heart, secondary to fibrotic cardiomyopathy which effected the right ventricle (RV) and left ventricle (LV) apex. The echocardiographic M-mode examination showed: dilatation of the RV; ectasis and akinesis of the apex of the LV; the left auricle small for hypoafflux; tricuspid valve very noticeable with defective end-diastolic closure, delayed 0,80 msec as regards to the mitral valve, and in which it was not possible to identify the proto-diastolic opening; typical movement of the pulmonary valve, according to French's description, with synchronous opening to the atrial systole; paradoxical movement of septum, with the peculiarity of showing the maximum posterior movement relating to the atrial systole. Catheterism indicated same pressures in the right auricle, RV and pulmonary artery, as is typical of right ventricle ipoplastic. Angiography confirmed echocardiographic reports revealing an enlarged right auricle and an ectasic and akinetic RV; the tricuspid valve was normally established and it remained almost constantly open; the apex of the LV was ectasic and akinetic. In conclusion, for the akinesis of the RV, the blood flow in the pulmonary artery was secured by atrial systole; such a haemodynamic situation had already been indicated by the echocardiographic examination for the absence of the real systolic closure of the tricuspid valve that the authors indicate as the most characteristic sign of such a table, together with the opening of the pulmonary valve with atrial systole.
Angiocardiography↗
[Neuroendocrine repercussions of hypernatremic dehydration].
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Brain Diseases↗
[Natremia and serum and urine osmolarity in febrile convulsions].
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Child↗
[New demands in the epidemiological control by chemical antibiotics].
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Anti-Bacterial Agents↗
Morphological and functional abnormalities in platelets exposed in vitro to ioglicinic acid, a new ionic contrast medium.
The inhibitory effect on platelet function induced by several radiographic contrast media is still poorly understood. In this study platelet abnormalities caused by in vitro addition of ioglicinic acid, a new ionic contrast medium, were evaluated. The appearance of several granules similar to dense bodies associated with shape change and internal reorganization were detected by electron microscopy techniques. A functional study revealed a marked decrease in the aggregating response of platelets to adenosine diphosphate and calcium ionophore A23187, while aggregation in response to collagen was completely normal. It is suggested that ioglicinic acid induces platelet abnormalities related to the effect on calcium movements and that studies with this contrast medium may help the understanding of some basic events of platelet activation.
Adult↗
CT and anal endosonography in the evaluation of electrically stimulated neoanal sphincter: a preliminary report.
We report a preliminary experience concerning the postoperative assessment of three patients who underwent gracilis neosphincter operation for severe fecal incontinence and were studied by computed tomography and anal endosonography soon after gracilis transposition and later after 6-8 weeks of neuromuscular training. Morphologic assessment was correlated with physiologic testing (manometry). Continence was satisfactorily improved in all patients. Both imaging techniques demonstrated the anatomy of the transposed muscle. Computed tomography also assessed lead placement onto the gracilis nerve root and the completeness of muscle transposition around the anal canal. Anal endosonography provided a more accurate assessment of the relation between the neosphincter and residual external sphincter.
Adult↗
Multiple jejunal angiodysplasia detected by enema-helical CT.
The small bowel angiodysplasia is a rare entity that causes lower intestinal bleeding; the diagnosis is difficult and based on selective angiogram. In our case, an 85-year-old woman was hospitalized after frequent episodes of melena. We performed an enema-helical CT abdominal examination before and after contrast medium administration per venam, detecting some increased intensity areas that surgery confirmed to be a vascular dysplasia on the jejunal first loop. We found the source of hemorrhage without performing an angiographic examination.
Aged↗
Comparison of technetium 99m-tetrofosmin and thallium-201 single photon emission computed tomographic imaging for the assessment of viable myocardium in patients with left ventricular dysfunction.
BACKGROUND: Tetrofosmin is a new technetium 99m-labeled myocardial perfusion agent that has demonstrated favorable imaging characteristics in recent clinical trials. However, it is not certain whether 99mTc-tetrofosmin compared with thallium 201 would underestimate myocardial viability in regions with left ventricular dysfunction. METHODS: To this end 15 patients (mean age 52+/-7 years) with coronary artery disease and left ventricular dysfunction (ejection fraction 35%+/-8%) documented on angiography underwent both quantitative rest-redistribution 201Tl and rest 99mTc-tetrofosmin single photon emission computed tomography imaging. RESULTS; Of 240 total segments on rest-redistribution 201Tl protocol 139 (58%) segments had irreversible 201Tl defects. Of these segments 79 (57%) had only mild to moderate reduction of 201Tl uptake (51% to 85% of normal uptake), whereas the remaining 60 (43%) had severely reduced tracer uptake (< or = 50% of normal uptake). On 99mTc-tetrofosmin protocol 180 (75%) segments had abnormal 99mTc-tetrofosmin uptake; of these segments 120 (67%) had mild to moderate reduction of 99mTc-tetrofosmin uptake, whereas 60 (33%) had severely reduced activity. Among hypokinetic regions concordance between 201Tl and 99mTc-tetrofosmin regarding myocardial viability with a cutoff point of 50% of peak activity was obtained in 28 (90%) of 31 segments (K' = 0.80), leaving only 3 of 31 regions discordant (p = NS). Similarly, among akinetic or dyskinetic regions concordance between the two tracers regarding myocardial viability was achieved in 54 (93%) regions (K' = 0.75), leaving only 4 of the 58 regions discordant (p = NS). CONCLUSIONS: These data show that when the severity of uptake was considered within abnormal segments, a similar amount of 201Tl viable regions were observed by 99mTc-tetrofosmin. Thus these two agents may provide comparable information about myocardial viability when quantitative analysis of defect severity is performed.
Adult↗
Self-image of adolescent survivors of long-term childhood leukemia.
The purpose of our research was to evaluate the attitude to face the life cycle and the impact that the experience of childhood leukemia may have had in a group of adolescents who had the disease cured. A questionnaire was administered at the Pediatric Hematology Center, San Gerardo Hospital, Monza, Italy, to all former patients age 12 to 20 years and off therapy from leukemia for at least 2 years (total of 116 adolescents) during 1997; 70 patients responded to the mailing and a comparison group of 70 secondary-school students was investigated. The two groups were matched as closely as possible on key characteristics (age, gender, socio-economic level of families, education and occupation of the parents, and geographic area of residence). The Offer Self-Image Questionnaire was the instrument used in this study. Overall, the teenagers in whom leukemia was cured showed a more positive and mature self-image (psychologic, social, attitude toward family, and coping) compared with the student group (statistical evidence, P < 0.05). An effective psychosocial support for patients and their families during their treatment, in addition to medical therapy, is strongly recommended. The majority of survivors of childhood cancer grow successfully without serious psychologic sequelae.
Adaptation, Psychological↗
Circulating immunocomplexes in the diagnosis of autoimmune and neoplastic disorders: new perspectives.
Two new competitive immunoenzymatic assays ("C.I.C.-conglutinin" and "C.I.C.-C1q") were employed to evaluate circulating immunocomplexes in 90 patients with a variety of autoimmune and neoplastic disorders. In autoimmune diseases the assays appeared very sensitive and relatively concordant, while in malignancies sensitivity was high with the C.I.C.-conglutinin method but much lower with the C.I.C.-C1q method. The clinical significance of these results is discussed with particular regard to the possibilities of application of the two assays in the diagnostic routine of a general hospital laboratory.
Antigen-Antibody Complex↗
Expression of bcl-2 in oral squamous cell carcinoma: an immunohistochemical study of 90 cases with clinico-pathological correlations.
Apoptosis is a genetically determined process playing an active role in tissue size regulation, morphogenesis and removing damaged cells that could be potentially dangerous for their host. Several agents involved in apoptosis regulation, such as the bcl-2 family components, act as oncogenes and are involved in oral carcinogenesis. Aim of this study is to explore bcl-2 immunoreactivity in oral cancers and to assess its potential clinico-pathological implications. Ninety oral squamous cell carcinoma and 10 normal mucosal formalin-fixed, paraffin-embedded samples were analysed for bcl-2 expression by immunohistochemistry. Normal oral mucosa showed a cytoplasmic pattern of bcl-2 immunoreactivity in the basal cell layers. Seventy-four cases of carcinoma (83%) showed no immunoreactivity, at variance with 16 cases (17%) manifesting consistent cytoplasmic positivity. Overall, the peripheral cells of differentiating epithelial tumour islands were intensely stained, with decreasing immunoreactivity toward the centre of the neoplastic nests. Fully keratinised tumour cells showed inconspicuous or absent bcl-2 immunoreactivity. No statistically significant correlations could be demonstrated between bcl-2 immunoreactivity and the sex of the patients, tumour size and with the occurrence of lymph node metastases. Though a direct correlation was found between bcl-2 immunoreactivity and increasing tumour stage, this did not reach statistical significance. Furthermore, G1 and G3 tumours displayed higher percentages of bcl-2-positive cells in comparison with G2 neoplasms and the different distribution of bcl-2 immunoreactivity in G2 and G3 was statistically significant (p<0.05). Finally, patients with absent or low (scores 0 and 1) bcl-2 immunoreactive tumours manifested poorer overall survival rates in comparison with patients with moderate or high (scores 2 and 3) bcl-2 immunoreactive tumours but the difference was not statistically significant. In normal oral mucosa bcl-2 protein is selectively present in the basal cell layers and possibly participates in the control of the terminal keratinocytes differentiation. The study of bcl-2 immunoreactivity possibly may be useful for better characterising and predicting the prognosis of oral SCC but cooperative studies are needed to assess its applications in the clinical practice.
Aged↗
[Diagnostic sensitivity of computerized tomography in closed trauma of the diaphragm. Retrospective study of 35 consecutive cases].
PURPOSE: To evaluate the effectiveness and role of CT in blunt diaphragmatic injuries by reviewing our 8-year experience. MATERIAL AND METHODS: We reviewed the preoperative CT findings of 35 patients with surgically confirmed diaphragmatic rupture. Surgical repair was performed in the acute setting (within 12 hours of trauma) in 22 cases, and late (8 months-5 years) in 13 cases. Twenty-eight patients (80%) were examined with conventional CT and 7 (20%) with Helical CT. Scans were initiated at the thoracic inlet to the pubic symphysis, with 8-mm slice thickness, after i.v. contrast agent administration. Four-mm slices were acquired in the region of interest; sagittal and coronal reformations were obtained for Helical CT images. RESULTS: In the acute group, 20 patients had left hemidiaphragmatic and 2 right hemidiaphragmatic rupture; thoracic herniation of the abdominal organs was seen in all cases. Of the 13 patients examined long after trauma, the left hemidiaphragm was ruptured in 12 cases (with visceral herniation in 4), and the right hemidiaphragm in 1, with no herniation. The diaphragmatic rent was found in the dome (15 cases, 43%), musculotendinous junction (11 cases, 31%), muscular portion (8 cases, 23%), and at the muscular attachments on the ribs (1 case, 3%). CT diagnosed diaphragmatic rupture in all the acute cases (22/35 patients, 63%) and in 4 patients with visceral herniation (11%) examined long after trauma. CT findings were questionable in the 9 cases (25%) not presenting visceral herniation. As for the site of diaphragmatic injury, CT never depicted the diaphragmatic rent in the dome and at the musculotendinous junction (74%), not even with thin slices and the multiplanar Helical technique. CT detected indirects signs of injury at the muscular portion (23%), showing the injury site directly in the case with diaphragmatic avulsion (3%). CONCLUSION: CT is a reliable tool in the diagnosis of suspected diaphragmatic injury in the acute trauma setting. Long after trauma, CT performs poorly because it depicts the diaphragmatic rent only in some peripheral traumas. Helical CT has greater diagnostic potentials, but the injury site and type do affect its capabilities.
Diaphragm↗
[Personal experience in 71 consecutive patients with acute cholecystitis].
PURPOSE: Acute cholecystitis is one of the most frequent abdominal inflammatory processes. If untreated or misdiagnosed it can result in severe complications such as gallbladder rupture, abscesses, or peritonitis. We retrospectively reviewed a series of 71 consecutive patients with surgical confirmation of acute cholecystitis and now compare the results of the diagnostic techniques we used preoperatively. MATERIAL AND METHODS: Over 16 months, 71 consecutive patients (42 women and 29 men; age range: 34-84 years, mean: 58) with acute abdominal pain were operated on for acute cholecystitis at Cardarelli Hospital, Naples. Abdominal plain film was performed in 65 of 71 cases, abdominal US in 69 and abdominal CT in 6. On abdominal plain films, we retrospectively searched the following signs: densities projected over the gallbladder, linear calcifications in gallbladder walls, gallbladder enlargement, focal gas collections within the gallbladder, and air-fluid levels in the gallbladder lumen. On US images we looked for: gallbladder wall thickening (> 3 mm), intraluminal content in the gallbladder, pericholecystic fluid, US Murphy's sign, and gallbladder distension. On CT images, we investigated: gallbladder distension, wall thickening, intraluminal content, pericholecystic fluid, and inflammatory changes in pericholecystic fat. Associated complications of cholecystitis were also searched on all images. RESULTS: On plain abdominal films we found densities projected over the gallbladder (16.9%) and linear calcifications in the gallbladder wall (4.6%). Abdominal US demonstrated gallbladder wall thickening (56.5%), one or more gallstone(s) (85.5%), pericholecystic fluid (14.5%), gallbladder distension (46.4%), and US Murphy's sign (39.1%). Abdominal CT showed gallbladder wall thickening (83.3%), gallbladder distension (66.6%), pericholecystic fluid (66.6%), gallstones (50%), inflammatory changes in pericholecystic fat (33.3%), and increased bile density (> 20 HU) (33.3%). CONCLUSIONS: US appears to be the most useful imaging technique in patients with suspected acute cholecystitis, for both screening and final diagnosis. CT plays a limited role in the early assessment of these patients, but can be a useful tool in diagnosing acute cholecystitis in patients with questionable physical findings or in investigating related complications.
Acute Disease↗