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Biomedical subjects

V Pugliese

Publications and source records attributed to V Pugliese.

At least 55 records · Page 3Linked to original sources
PubMed1983

Left-sided stenosing lesions in colonoscopy.

Of 2625 consecutive colonoscopic examinations, 122 stenotic lesions interfered with endoscopy. The sigmoid was the most frequent site of stenosis (64%). Of the two types of endoscopic patterns, type A, in which there is an intraluminal protruding mass, is the most frequent, and type B, in which a segment of colon gradually narrows, has intact mucosa. Adenocarcinoma was the most frequent cause of type A (83%), and complications related to diverticular disease (32%) and adenocarcinoma (27%) were most often associated with type B. Colonoscopy, guided multiple biopsies, and brushing cytology gave high diagnostic accuracy for type A lesions. In type B cases, brushings were usually negative.

Adenocarcinoma↗
PubMed1983

"Splitting" and stretching dilation of esophageal strictures.

The "Splitting" action of metal olives, and the stretching effect of tapering Neoplex tubes of increasing diameter on dysphagia in a group of 55 consecutive patients with esophageal strictures are compared. Dilators were passed over a fibreoptic endoscopically positioned guide wire. Greater relief of dysphagic symptoms was obtained with the stretching procedure, mainly in postanastomotic and peptic strictures. Both procedures were safe, but the stretching technique was easier and resulted in wider dilations in most patients. Consecutive dilations using stretching procedures in malignant strictures appear to be an appropriate easy and safe alternative to endoprosthesis insertion.

Adult↗
PubMed1982

Left-sided colonoscopy in screening programs. What preparation?

In order to limit patients' refusal to undergoing colorectal cancer endoscopic screening procedures, traditional cleansing enemas were compared with a new simpler oral cleansing preparation by means of a randomized controlled trial. Ninety-three patients were evaluated both for compliance and effectiveness of the two modalities tested. No difference in acceptability or effectiveness was detected. The authors discuss more rigorous cleansing techniques routinely used in diagnostic schedules which cannot be considered for preparation for colonoscopy in screening programs.

Administration, Oral↗
PubMed1981

Value of multiple forceps biopsies in assessing the malignant potential of colonic polyps.

Fifty-nine colo-rectal polyps were detected at endoscopy and repeatedly biopsied before removal by endoscopic snare polypectomy. The aim of the present paper was to evaluate the reliability of multiple forceps biopsies in assessing both the malignant potential and the presence or absence of invasive cancer (IC) in colo-rectal adenomas (CRA). In order to achieve the first objective, the histologic types and the degree of dysplasia have been defined. The data obtained by means of multiple biopsies examination, compared with those of polyp in toto study, show that fractional biopsies were of value in the histologic classification of only the smallest 41 polyps (agreement 88.09%), whilst no reliability of biopsies was demonstrated in the 18 largest polyps (agreement 27.68%). In the field of dysplasia grading, the agreement was 55% and 61% for the smallest and the largest CRA respectively. These last figures are hardly acceptable. Biopsies examination gave also under- and overestimation of the histologic severity and of dysplasia as well as a significant incidence of false negative results in IC detection. It is concluded that polypectomy is the only method which provides adequate material for precise diagnosis, no matter how large a polyp. Therefore it should be performed whenever possible. Finally the authors discuss the management of small sessile adenomas.

Biopsy↗
PubMed1981

Endoscopy in asymptomatics previously submitted to anterior resection for colorectal cancer.

Eighty-two colonoscopies were performed in 58 asymptomatic subjects previously submitted to anterior resection for colorectal cancer. In 6 patients endoscopy disclosed recurrent cancer at the anastomosis; in 1, a cancer synchronous to the primary neoplasia was detected 6 months from resection. Twenty-four polyps were detected in 19 patients. Severe epithelial dysplasia was present in two adenomatous polyps, and invasive cancer in another. From these findings, it appears that an endoscopic periodic surveillance of this high risk group is strongly advisable.

Colonic Neoplasms↗
PubMed1979

Prolonged endoscopic and manometric observations of the pylorus.

Functional aspects of the antral-pyloric segment were evaluated in 30 patients without gastroduodenal disorders by means of prolonged endoscopic observations. Patients were examined in standardized conditions. Pressure measurements of the antrum, pylorus and duodenal bulb were assessed by means of water-perfused polyvinyl tubes in 7 patients of the same group a few days after the endoscopy. The pylorus appeared open in above 80% of the total endoscopic observation time. Pyloric closure was observed only for few seconds at the end of 30-40% of antral peristaltic waves. The antrum and pylorus appeared to contract in sequence. Antral peristaltic waves moved at a mean rate of 2.4 per minute and duodenal reflux was observed at a mean rate of 0.96 per minute usually in the form of bubbles. The manometric measurements by means of pull through in 7 patients and immediately after by means of prolonged registration carried out in a fixed position in 4 patients failed to show a high pressure zone in the gastroduodenal junction. In some cases it was possible to observe a peculiar phasic activity in the pyloric tract. The endoscopic and manometric observations suggest that human pylorus does not act as a true physiological sphincter. These findings confirm the functional aspects described by radiology and manometry in other studies. In this way, endoscopy appears to be a useful procedure to evaluate some functional aspect of the gastroduodenal tract.

Adult↗
PubMedDate not supplied

LH-RH analogue treatment in adenocarcinoma of the pancreas: a phase II study. Gruppo Ligure per lo Studio del Pancreas.

In this phase II study, we treated 7 patients, all males, with stage III or IV pancreatic cancer with goserelin (an LH-RH analogue). Goserelin was administered at a dose of 3.6 mg every 4 weeks. The tumour response was assessed by measuring lesions with US- or CT-scan studies, according to WHO criteria. No response was observed. The median survival was 8 months in locally unresectable tumours and 4 months in advanced disease. The accrual was actually stopped at 7 cases because there were no responses in either of our series or in those published during our study. The authors conclude that the treatment with LH-RH analogue alone cannot be recommended for further studies.

Adenocarcinoma↗
PubMedDate not supplied

Endoductal tissue sampling of biliary strictures through endoscopic retrograde cholangiopan creatography (ERCP).

AIM AND BACKGROUND: Pathological proof of malignant in biliary strictures is useful in the preoperative setting as it helps define therapeutic planning and prognosis, and reduces the length of the subsequent surgical intervention. However, it is difficult to obtain. The aim of this study was to evaluate the yield of histological and cytological examination of endobiliary samples obtained during endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Endobiliary forceps biopsy and brush cytology were performed during ERCP examination in 52 consecutive patients, 36 with malignant and 16 with benign strictures. RESULTS: Histology and cytology turned out to have the same sensitivity (53%). The gain in sensitivity achieved by combining the two techniques was limited, reaching a value of 61%. The specificity, however, was 100% for both methods. Most of the few complications observed were due to sphincterotomy and subsided spontaneously or with medical treatment. However, one patient experienced a serous complication and chose to be treated by surgical intervention. The complication was caused by forceps biopsy. CONCLUSIONS: This study shows that 1) sampling of biliary strictures during ERCP is the primary approach to tissue diagnosis; 2) brush cytology alone is sufficient in clinical practice; 3) forceps biopsy must always be used to sample intra-ampullary strictures but should be considered as a secondary step to sample strictures located more proximally, in the bile ducta, if previous cytology was negative.

Biliary Tract↗
PubMedDate not supplied

CA 19-9 assay in patients with extrahepatic cholestatic jaundice.

Serum concentrations of the CA 19-9 tumour marker were determined in 35 patients with histologically proven bilio-pancreatic malignancies associated with obstructive jaundice and in 35 patients with benign extrahepatic jaundice due to choledocholithiasis. At a cut-off level of 37 U/ml the sensitivity of this assay was 82.8%, but the specificity was very low (45.7%). Thus CA 19-9 can not be employed to differentiate between malignant and benign extrahepatic jaundice. Serial samples of CA 19-9 were achieved in 7 patients with benign and in 6 patients with malignant biliary obstruction, before and after the disappearance of jaundice. Serum concentrations of this tumour-antigen returned to normal concurrently with the bilirubin values only in patients with benign obstruction, remaining unchanged in all cases of malignancies. The data suggest that patients with extrahepatic jaundice should be evaluated by other examinations or by collecting serial samples for this assay.

Adenocarcinoma↗
PubMedDate not supplied

Hepatitis G virus/GB virus C in Brazil. Preliminary report.

Hepatitis G virus/GB virus C is a novel flavivirus recently detected in hepatitis non A-E cases. In this study, the presence of this virus in chronic non-B, non-C hepatitis patients was evaluated using GBV-C specific PCR and this virus was detected in one out of thirteen patients. This patient has presented a severe liver failure, has lived for a long time in the Western Amazon basin and no other cause for this clinical picture was reported. The impact of the discovery of this new agent is still under evaluation throughout the world. The study of the prevalence of this virus among chronic hepatitis patients and healthy individuals (as blood donors) will furnish subside to evaluate its real pathogenicity.

Adult↗
PubMedDate not supplied

[Liver transplantation from living related donors]

OBJECTIVES: To present the experience with the first 12 living related liver transplants performed at Hospital Sírio-Libanês in São Paulo. METHODS: The donors were the fathers (6) and the mothers (6) with age ranging from 30 to 48 years. All candidates for donation were submitted to a full informed consent form, clinical and radiological evaluation and had blood withdrawn for autotransfusion. Recipient age ranged from 7 months to 10 years whereas recipient weight varied from 6.3 to 34 kg. Six patients were considered as high risk due to complications of advanced liver disease and were submitted to urgent transplantation. RESULTS: Mean donor hospital stay was 10 days with no mortality. Technical complications were observed in 4 recipients. Seven patients presented at least one episode of bacterial, viral or fungal infection. One or more biopsy proven rejection episodes were disclosed in 7 patients. Overall recipient survival was 67%, being 83% for elective cases and 50% for urgent cases. Long term follow up ranged from 8 to 25 months. Seven out of 8 survivors present excellent quality of life and normal liver function. The other patient is currently under reduced immunosuppression due to Epstein-Barr virus infection.CONCLUSIONS: These results demonstrate the safety and viability of living related liver transplantation which, in face of the current donor scarcity, should be considered as a valid option for the treatment of children with end stage liver disease.

Journal Article↗
PubMedDate not supplied

Detection of K-ras mutations by denaturing gradient gel electrophoresis (DGGE): a study on pancreatic cancer.

In pancreatic neoplasias mutations in the first exon (codon 12) of K-ras gene occur at high frequency and seem to have a diagnostic significance. We set up the DGGE conditions to search for these mutations in pancreatic tumor sample DNAs. All samples were directly classified by simply comparing their DGGE patterns with those of control cell lines carrying known K-ras base substitutions. We found a mutation frequency of 73% in pancreatic adenocarcinoma, whereas no mutations were observed in benign lesions. The non-isotopic method we used turned out to be rapid and sensitive. DGGE could therefore be utilized for the detection of K-ras mutations in pancreatic lesions, to evaluate their actual or potential malignancy. In general, DGGE could be useful for K-ras gene screening on pathological tissue samples.

Adenocarcinoma↗