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Biomedical subjects

S Gallo

Publications and source records attributed to S Gallo.

At least 37 records · Page 2Linked to original sources
PubMed1984

[Telethermographic patterns in scrotal diseases. Analysis of the causes of hypothermia].

One hundred fifty six telethermographic exams, carried our for scrotal pathology (testicular and extratesticular), have been analyzed. In 80% of cases the pathological area has determined a remarkable hyperthermic thermographic pattern. On the contrary, in the remaining 20% of cases, the affected area has resulted iso- or hypothermic. In this work the eventual pathologic substrate, responsible of the different thermographic patterns, is discussed, also taking into account the echographic results.

Body Temperature↗
PubMedDate not supplied

Can case-finding instruments be used to improve physician detection of depression in primary care?

OBJECTIVE: To explore the issue of diagnostic specificity for major depression in the primary care setting by examining the relative accuracy of 3 methods to detect major depression in primary care. DESIGN: Comparison of performance characteristics of 3 case-finding methods for depression (ie, the Center for Epidemiologic Studies-Depression scale [CES-D], unaided physician detection, and "augmented" physician detection by use of a case-finding instrument), with the standard criterion being the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R). SETTING: The offices of 50 family physicians from private and academic practice in southeastern Michigan. PATIENTS: Adult patients (N = 1580) who presented for routine care, from which a weighted random sample of 425 patients completed the Structured Clinical Interview for DSM-III-R. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, and positive likelihood ratio for each case-finding method. RESULTS: Major depression was present in 13.4% of the sample. Both the CES-D and unaided physician detection methods performed poorly in identifying patients who met DSM-III-R criteria for major depressive disorder. The CES-D had high sensitivity but low specificity at standard and high cut points, resulting, respectively, in low positive predictive values (0.307 and 0.385) and low positive likelihood ratios (2.9 and 4.0). Unaided physician detection showed lower sensitivity, higher specificity, and a slightly higher positive predictive value (0.45) and positive likelihood ratio (4.9). Raising of the CES-D threshold for a positive test did not enhance the detection of depression. Augmented physician detection with CES-D scores resulted in minimal improvement. Although the positive predictive value and positive likelihood ratio increased to 0.50 and 6.1, respectively, using the most stringent case-finding definition (ie, physician identification plus the CES-D score [score > or = 22]), the proportion of depressed patients who were correctly identified decreased to 26.9%. CONCLUSIONS: Neither high scores on the CES-D nor unaided physician detection accurately identified patients with major depression who were seen in primary care settings, while the supplementation of physician detection with CES-D scores had a minimal net effect on the accuracy of detection. The data do not support the routine use of the CES-D as a primary care screening instrument for depression, either as a stand-alone measure or as a supplement to physician detection.

Adult↗
PubMedDate not supplied

False positives, false negatives, and the validity of the diagnosis of major depression in primary care.

OBJECTIVE: To explore the issues of diagnostic specificity and psychiatric "caseness" (i.e., whether a patient meets the conditions to qualify as a "case" of a disease or syndrome) for major depression in the primary care setting. DESIGN: A cross-sectional study comparing the demographic, clinical, and mental health characteristics of patients identified as depressed by their family physicians with those meeting diagnostic criteria for major depression on the criterion standard Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. SETTING: The offices of 50 family physicians from private and academic practice in southeast Michigan. PATIENTS: A total of 1580 consecutive adult patients being seen for routine primary care services, from whom a weighted sample of 372 patients completed a set of mental health screening and diagnostic instruments. MAIN OUTCOME MEASURES: Patients were assigned to 1 of 4 groups (true positive, false positive, false negative, and true negative) based on clinician identification and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition diagnosis. Differences between the 4 groups in demographic and clinical characteristics, scores on mental health instruments and mental health history were explored. RESULTS: Physician identification of depression was strongly associated with increased familiarity with the patient and the presence of suggestive clinical cues, such as history of or treatment for depression, patient distress, and presence of vegetative symptoms. Patients in the false-positive group displayed significantly higher levels of distress and impairment and were significantly more likely to have a history of mental health problems and treatment than were those in the true-negative group. The 2 "misidentified" groups, false positives and false negatives, were indistinguishable in their clinical characteristics (impairment, distress, or mental health history). Both groups' scores occupied the middle ground between true positives and true negatives on most clinical characteristics. Physicians appeared to discriminate between these 2 groups on the basis of their knowledge of the patient's clinical history. CONCLUSIONS: Misidentification of depression in primary care may be in part an artifact of the use of the psychiatric model of caseness in the primary care setting. Our results are most consistent with a chronic disease-based model of depressive disorder, in which patients classified as false positive and false negative occupy a clinical middle ground between clearly depressed and clearly nondepressed patients. Family physicians appear to respond to meaningful clinical cues in assigning the diagnosis of depression to these distressed and impaired patients.

Adult↗
PubMedDate not supplied

Chemotherapy enhances endothelial cell reactivity to platelets.

Recent studies indicate that chemotherapy is a cause for thrombosis in breast cancer patients. We performed experiments to determine whether the enhanced thrombosis was due, in part, to an effect of chemotherapy on endothelial cell reactivity. Heparinized blood samples were obtained from stage II breast cancer patients receiving monthly adjuvant chemotherapy consisting of cyclophosphamide, epirubicin and 5-fluorouracil. Cultured human endothelial cells were incubated with the plasmas for 2 h, and then the reactivity of the endothelial cells to normal donor platelets was determined isotopically. Endothelial cell reactivity was increased when the endothelial cells were incubated with the post-chemotherapy plasmas. The plasma effect persisted after the chemotherapy drugs were cleared from the circulation, but this plasma effect was abolished when the plasmas were heat-inactivated. Furthermore, the increase in endothelial cell reactivity correlated with the level of interleukin-1 present in the post-chemotherapy plasmas. Finally, the increased endothelial cell reactivity was inhibited by the GRGDS peptide, or by an antibody to the endothelial cell vitronectin receptor. These observations suggest that chemotherapeutic drugs alter endothelial cell reactivity to platelets by inducing the release of interleukin-1 which, in turn, facilitates adhesion molecule expression on the endothelial cell surface. If so, these observations provide a possible explanation for one mechanism which may contribute to the thrombogenic effect seen in breast cancer patients undergoing chemotherapy.

Antineoplastic Agents↗
PubMedDate not supplied

Prospective study on thyroid autoimmunity and dysfunction related to chronic hepatitis C and interferon therapy.

This study was designed to assess patients with chronic hepatitis C (CHC) for the presence of thyroid autoimmunity and dysfunction, to evaluate the risk of thyroid disorders associated with interferon (IFN) therapy, and to survey the outcome of possible treatment-related thyroid injury. Out of 104 consecutive untreated patients (30 women and 74 men; mean age, 52.7 years), 8 (7.7%) were found seropositive for thyroid autoantibodies (ThyAb), whereas seropositivity in healthy controls was 1/98 (1.3%). The relative increase in risk of developing thyroid autoimmunity associated with CHC was 760% (95% CI, 220-1300%). No patients had abnormalities of thyroid function tests, but on IFN treatment, 3/3 patients showed a rapid over-range rise in circulating thyrotropin, which returned to normal after therapy discontinuation. In the other 5 seropositive patients who refused treatment, thyroid function remained normal. Out of the 58 initially seronegative patients who consented to IFN treatment, 9 (15.5%) developed thyroid autoimmunity. Seven of them (77.7%) had thyroid dysfunction: hypothyroidism in 4 cases, transient thyrotoxicosis in 2 cases. The last patient developed TSH-receptor antibodies and Graves' disease, requiring methimazole therapy. Thyroid function recovered in the former 6 cases following IFN discontinuation. In the 28 initially seronegative patients who refused IFN and participated in a preliminary tauroursodeoxycholic acid trial, antithyroglobulin antibodies alone appeared in one case, but no thyroid dysfunction was observed. The relative risk of thyroid autoimmune disorder associated with IFN therapy was 342% (28-636%). The patients with CHC were unlikely to develop thyroid dysfunction in the absence of IFN therapy, in spite of being ThyAb seropositive. Moreover, a considerable proportion of seronegative patients, when IFN-treated, developed thyroid autoimmunity and then thyroid dysfunction. Both in seropositive and seronegative patients immediate IFN discontinuation normalized thyroid function and hormone replacement therapy was not necessary.

Adult↗
PubMedDate not supplied

Endoscopic placement of enteral feeding tubes.

The techniques for placement of feeding tubes using fiberscopes are described and an evaluation of the results obtained in the last 12 months is made. The techniques are discussed and compared with other methods of enteral feeding known at present. It is concluded that placement of feeding tubes by endoscopy can be achieved easily, that it is possible to choose the site of enteric liberation of nutrients under conditions which previously represented contraindications, and that this procedure is free of complications even during long periods of time.

Adult↗
PubMedDate not supplied

[Clinical superiority of pantoprazole over ranitidine in the treatment of reflux esophagitis grade II and III. A prospective, double-blind, double-placebo study. Mexican clinical experience. Mexican Pantoprazole Study Group].

OBJECTIVE: To compare and contrast the efficacy and tolerability of a proton pump inhibitor, pantoprazole, to that of an H2 antagonist, ranitidine, in the treatment of patients with mild to severe reflux esophagitis. BACKGROUND: Reflux esophagitis is a common illness affecting 5-10% of the world's population. Acid reflux plays a major role in the disease's genesis, as do esophageal and gastric motility disturbances. METHODS: 315 patients (intent to treat) with endoscopically confirmed reflux esophagitis (Savary-Miller (SM) stages II and III) were recruited to the study by 46 mexican investigators in nine centers. Patients received either pantoprazole 40 mg once daily or ranitidine 150 mg twice daily in this double blind, randomized, parallel group study. Patients not achieving complete endoscopic healing after four weeks of therapy received an additional four weeks of treatment. Drug tolerability was assessed by adverse event reporting during the study. RESULTS: After four weeks pantoprazole therapy, 81% of patients with SM II and 67% of the patients with SM III were healed; in contrast ranitidine healed only 67 and 30% of the patients respectively, all results expressed on an per-protocol basis. After eight weeks therapy the healing rates for pantoprazole group increased to 94% and the ranitidine group to 74% (p = 0.001). The incidence of adverse events was less than 2% in both treatment groups, thus both therapies were found to be well tolerated. CONCLUSIONS: Pantoprazole is superior to ranitidine in the treatment of mild to severe reflux esophagitis and is equally well tolerated.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMedDate not supplied

[The recurrence of duodenal ulcer in patients undergoing treatment with ranitidine and placebo. A multicenter study].

This randomised, double-blind multicenter study was conducted in order to evaluate the long-term effect (one year) of 150 mg ranitidine vs placebo in 51 patients with healed duodenal ulcer. Seventeen patients had ulcer recurrence at the end of follow-up, one among the 24 patients that received ranitidine and 16 among the 27 patients that received placebo (p = 0.00009). No side effects was detected. Our results support the usefulness of a one-year maintenance therapy with 150 mg ranitidine.

Adult↗
PubMedDate not supplied

[Changes in arterial oxygen saturation in patients undergoing endoscopy of the upper digestive tract].

This study showed how often oxygen desaturation occurred in patients undergoing upper endoscopy procedures; extent of desaturation after sedation with diazepam, relationship between desaturation and respiratory function status and compared two types of instruments Olympus (XQ, K10). Ninety nine patients undergoing elective and emergency upper endoscopy procedures were monitorized with pulse oximeter before sedation, during and after the procedure. We did not find any change clinically significant.

Adult↗
PubMedDate not supplied

[Electrolyte solution with polyethylene glycol to cleanse the colon for colonoscopy or enema].

The efficacy and safety of an electrolyte-polyethylene glycol solution (SE-PEG) for colonic lavage, was compared with standard bowel preparation (SBP) in a randomized blinded study of volunteers and patients undergoing colonoscopy and barium enema examination. Side effects, biochemical and hematologic changes and quality of examinations were monitored. Colonoscopy and barium enema was scored by colonic segment for type of residual stool and percentage of bowel wall visualized. For colonoscopy and barium enema, preparation with SE-PEG allowed better visualization and produced more optimal exams (8 vs 3; p less than 0.03) and (6 vs 4; p = NS) respectively. We conclude that colonic lavage with SE-PEG is an alternative bowel preparation method and is cheaper, more safe and effective than SBP procedure.

Adult↗
PubMedDate not supplied

[Elective endoscopic sclerotherapy in esophageal varices].

We present our experience with elective sclerotherapy in ten years. 64 male and 57 females, median age 52.5 years, were treated. Post-necrosis cirrhosis was the primordial etiology in 44% followed by alcoholic in 40%. In regards to Child classification, 51% were "C"; 24% "B" and 25% "A". With variceal eradication we found no rebleeding, but in those without changes in variceal size, it was 82%. At six months, control of variceal hemorrhage was respectively to groups A, B, and C. 86%, 71% and 63%. The control at long follow-up were respectively 74%, 68% & 57%. Survival was directly related to the level of hepatic function instead of sclerosis. Complications were 2 to be 3% being the most severe: pleural effusion; mediastinitis and fiber. Mortality was 0.8% in one patient with esophageal perforation.

Esophageal and Gastric Varices↗
PubMedDate not supplied

[Endoscopic pancreatography].

A review was done on the Endoscopic Pancreatography as a method of diagnosis. Emphasis was made on the historical and technical aspects, indications, contraindications, limitations and complications of the method. Also, we reported our experience about Endoscopic Pancreatography.

Ampulla of Vater↗
PubMedDate not supplied

[Retrospective evaluation of 500 endoscopic cholangiopancreatographies performed at the Instituto Nacional de la Nutrición "Salvador Zubiran"].

We evaluated 500 endoscopic retrograde cholangiopancreatographies (ERCP) performed on 422 patients during a 5-year period in the Gastrointestinal Endoscopy Department, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F. ERCP combines endoscopic and radiologic techniques in order to obtain high quality opacification of pancreatic and biliary ducts. The rate of success for cannulation was 90%; desired duct opacification was possible in 89%. The most frequent indication for ERCP was to establish the differential diagnosis for jaundice; biliary stones in the common bile duct was the most frequent diagnosis, followed by normal biliary ducts. Pancreatography was normal in 74% of patients. ERCP complications were detected in 5.6%; fever and transient pain was the most common complaint in 1.6%. Mortality attributable to the procedure was 0.8%. From histological corroboration of cases by surgery or postmortem studies, diagnostic sensitivity was 92%, specificity 76%, positive predictive value 96% and a prevalence of 89%. We conclude that ERCP is highly sensitive and specific in diagnosing bilio-pancreatic-duodenal disease. Our results are comparable to other's experiences published throughout the world.

Adolescent↗