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1.
Hand Surg Rehabil ; 36(4): 281-285, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28552760

RESUMEN

The goal of wrist denervation is to decrease pain at the wrist, whether caused by an intra- or extra-articular problem or even when the reason for the pain is unknown. It is an alternative to partial or total arthrodesis and proximal row carpectomy. Our hypothesis was that wrist denervation with a two-incision technique was a reliable and efficient way to treat painful degenerative wrists. Thirty-three patients, 48years old on average, were included in this study. Indications were scapholunate advanced collapse (SLAC) in 18 cases, scaphoid nonunion advanced collapse (SNAC) in 10, distal radius fracture sequelae with advanced radiocarpal osteoarthritis in 4, and post-traumatic ulnocarpal impingement in 1 case. At 41 months' follow-up (12-161), there was a 75% reduction in pain levels, decreasing from 7.1 to 1.8 on a visual analog scale (VAS). There were no modifications related to wrist range of motion or grip strength. The QuickDASH averaged 23 points (5 to 70). Radiographic evaluation showed progression of intracarpal degeneration in 6 patients. All but 2 patients returned to their previous work. Persistent dysesthesia was observed in 7 patients; it resolved in 3 cases and persisted in 4. One patient developed complex regional pain syndrome (CRPS). A midcarpal arthrodesis with scaphoidectomy was performed in one patient because of disabling pain 5months after surgery. Wrist denervation with a two-incision technique for post-traumatic osteoarthritis led to satisfactory results in 75% of cases with reduction in pain, preservation of range of motion and grip strength. However, this technique does not stop the progression of osteoarthritis. It can be discussed as a therapeutic alternative to proximal row carpectomy or intracarpal arthrodesis to treat degenerative painful wrists. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Asunto(s)
Desnervación/métodos , Osteoartritis/cirugía , Articulación de la Muñeca/cirugía , Adulto , Anciano , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Osteoartritis/fisiopatología , Reoperación , Estudios Retrospectivos , Escala Visual Analógica , Articulación de la Muñeca/fisiopatología , Adulto Joven
2.
J Ultrasound ; 19(2): 145-7, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27298645

RESUMEN

PURPOSE: Multiple miliaryosteoma cutis (MMOC) is a rare nodular skin disease, characterized by tiny bone nodules in the dermis and subcutaneous tissue, presenting clinically as multiple normochromic papules and nodules, usually on the face. We described the case of MMOC of the face in a woman, ultrasonically evaluated with very high frequency probe. MATERIALS AND METHODS: A 45-year-old patient with multiple papules, 3-5 mm in diameter, grouped in the frontal region. Skin ultrasound examination, cutaneous biopsy and laboratory evaluation were performed. RESULTS: High-frequency ultrasound showed the presence of multiple hyperechogenic linear and roundish structures, associated by hypoechogenic shadow. The histology revealed a normal orthokeratotic stratified epithelium with fragment of mature lamellar bone localized at level of the reticular dermis. Laboratory evaluation was normal. According to the clinical, pathological, laboratory and instrumental analyses, a final diagnosis of miliaryosteoma cutis (or primary osteoma cutis not associated with Albright's hereditary osteodystrophy) was made. CONCLUSION: In case of multiple papules of subcutaneous tissue, the diagnosis of MMOC, although rare, should be considered and high-frequency sonography, identifying the calcifications, suggests diagnosis.


Asunto(s)
Enfermedades Óseas Metabólicas/diagnóstico por imagen , Dermatosis Facial/diagnóstico por imagen , Osificación Heterotópica/diagnóstico por imagen , Enfermedades Cutáneas Genéticas/diagnóstico por imagen , Biopsia , Enfermedades Óseas Metabólicas/patología , Diagnóstico Diferencial , Dermatosis Facial/patología , Femenino , Humanos , Persona de Mediana Edad , Osificación Heterotópica/patología , Enfermedades Cutáneas Genéticas/patología , Ultrasonografía
3.
Orthop Traumatol Surg Res ; 100(8): 843-8, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25453926

RESUMEN

BACKGROUND: The many radiographic views suggested for evaluating anterior femoroacetabular impingement (FAI), due to a cam effect, are not specific for this condition and have not been proven of diagnostic value in studies, including control groups. Using a new and specific radiographic view, we evaluated the reproducibility of the main radiographic criteria for FAI, determined normal values for these criteria in a control group, and established diagnostic threshold values. HYPOTHESIS: This specific view offers good reproducibility and effectively detects abnormal values of criteria for FAI. MATERIALS AND METHODS: Inter-observer and intra-observer reproducibility of specific radiographic criteria (αangle and modified head-neck offset [HNO]) were computed from preoperative and postoperative radiographs of 96 hips (75 patients, 61 males and 14 females) using the specific 45°-45°-30° frog-leg view (F45 view). Values in the group with FAI were compared to those in a control group of asymptomatic volunteers (100 hips, 27 males and 23 females). RESULTS: Inter-observer and intra-observer reproducibility was very good, with intra-class correlation coefficients of 0.955and 0.987, respectively, for the α angle and of 0.895 and 0.984, respectively, for the HNO. Mean values of both parameters differed significantly between the FAI and control groups: 73.9° (53° to 96°) vs. 49.3° (35° to 69°) for the αangle, respectively; and 2.5mm (-4.6 to 9.4) vs. 7.6mm (1.7 to 11.8) for HNO, respectively. The normal values defined as the boundary of the 95% reference interval in the control group were<60.2° for the α angle, and>4.6mm for the HNO. DISCUSSION: The45°-45°-30° frog-leg view is useful for diagnosing FAI due to a cam effect. This view is easy to perform, and the thresholds determined in our study assist in its interpretation: α angle values>58° in females and>63° in males indicate cam-type femoral geometry. In both genders, HNO values<5mm support a diagnosis of anterior FAI. LEVEL OF EVIDENCE: Level III, case-control study.


Asunto(s)
Artrografía/métodos , Pinzamiento Femoroacetabular/diagnóstico por imagen , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados
4.
Case Rep Rheumatol ; 2012: 208606, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23243547

RESUMEN

Bevacizumab is a recombinant humanised monoclonal antibody directed against the vascular endothelial growth factor (VEGF). The drug, alone or in combination with other anticancer agents, has been shown to be effective against several types of neoplasms. We report a case of a woman with a history of severe psoriasis who developed psoriatic arthritis during a course of bevacizumab, which was administered for a malignant glioma.

5.
G Ital Dermatol Venereol ; 147(4): 407-11, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23007215

RESUMEN

AIM AND METHODS: Pilonidal sinus is a not infrequent disease, probably due to a disontogenetic origin. Histologically, there is a pseudocystic formation in the subcutaneous adipose tissue, containing some hair bulbs. It usually presents a recurring inflammatory course. The pathologic formation does not normally have thick wall, being made up of thin epidermal epithelium, without internal vascularisation and with frequent subcutaneous fistulae. Even though the clinical diagnosis is rather easy, surgery may prove, on the contrary, a demanding task, with a high incidence of recurrence and complications. An adequate knowledge of the condition and its development, with a precise definition of the margins of the lesions, may simplify the surgery, reducing the chance of recurrence or complications. The use of echography in the diagnosis of this disease, in our cohort of 72 patients, has always provided valuable information. In particular, 13 and 18 MHz linear probes and 20 MHz mechanical array have been used, and the latter in particular for the evaluation of fistolous cavities/passageways under the skin. Results. In all our cases, echography has demonstrated pseudocystic formations, without real walls, with fairly high levels of internal echoes, compared to the hair follicles, or, more rarely, true macrocalcifications with one or more cavities/passageways near the skin, without internal vascularisation, according to the histological findings. Echographic data are rapidly obtained, and can prove useful for surgeons for a a better management of patients. Conclusion. We consider diagnostic echography, using high frequency probes, useful for the anatomical definition of this disease, as well as to enable better surgical management.


Asunto(s)
Seno Pilonidal/diagnóstico por imagen , Adolescente , Adulto , Femenino , Humanos , Masculino , Seno Pilonidal/cirugía , Cuidados Preoperatorios , Ultrasonografía/métodos , Adulto Joven
7.
J Eur Acad Dermatol Venereol ; 26(5): 627-33, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-21645122

RESUMEN

BACKGROUND: Most of the data currently available on early psoriatic arthritis (EPsA) derive from studies performed in rheumatological settings. However, in recent years, there has been an increase in the amount of data from dermatologic centres. OBJECTIVES: To describe the prevalence, clinical, laboratory and imaging characteristics of psoriatic patients with EPsA seen at a dermatological outpatient psoriasis centre. METHODS: From January 2007 to May 2010, all patients with psoriasis who visited the psoriasis centre were asked about inflammatory joint involvement. A diagnosis of psoriatic arthritis was made on the basis of clinical, laboratory and imaging studies. The patients were diagnosed with early PsA (EPsA) if their inflammatory articular symptoms had been present for ≤ 1 year. RESULTS: We diagnosed EPsA in 33 patients. Joint involvement was polyarticular (>5 joints involved) in 20 patients (60.6%) and oligoarticular (≤5 joints involved) in the remaining 13 patients. Quality of life due to skin involvement and the degree of functional impairment due to joint inflammation were only mildly affected, as measured by DLQI and HAQ, respectively. A direct correlation between the number of tender joints (ACR 68) and HAQ was found (r = 0.36; P = 0.04). Imaging studies showed that in spite of the absence of radiologic findings of peripheral joint damage, ultrasonography and contrast enhanced ultrasonography showed signs of articular inflammation in all patients. CONCLUSIONS: A diagnosis of EPsA can be correctly performed in a dermatologic outpatient facility. To do so, a close collaboration among dermatologists, rheumatologists and radiologists is necessary.


Asunto(s)
Atención Ambulatoria/organización & administración , Artritis Psoriásica/diagnóstico , Diagnóstico Precoz , Femenino , Humanos , Masculino
8.
Int J Immunopathol Pharmacol ; 24(1): 243-6, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21496409

RESUMEN

Atherosclerosis is a complex, multifactorial disease. Several studies have reported a possible association between infection with microbial agents and atherogenesis. Chlamydia pneumoniae (C. pneumoniae), Herpes Simplex Virus 1 (HSV1), Human Cytomegalovirus (HCMV), and Epstein Barr Virus (EBV) have been widely investigated for their possible role in atherosclerosis development, but the results obtained to date are contradictory. The aim of our study is to search DNA of the aforementioned infectious agents by means of Quantitative Real Time PCR in atherosclerotic plaques from carotid arteries obtained from 17 patients. Genomic sequences of C. pneumoniae, HSV1, HCMV were not found in any atherosclerotic lesion. Therefore, our results do not support the hypothesis of an association between these infectious agents and atherosclerosis. Conversely, three patients were found to be positive for EBV DNA, thus indicating that, at least in a limited number of patients, EBV could play a role in atherogenesis.


Asunto(s)
Placa Aterosclerótica/microbiología , Placa Aterosclerótica/virología , Anciano , Enfermedades de las Arterias Carótidas/microbiología , Enfermedades de las Arterias Carótidas/virología , Chlamydophila pneumoniae/genética , Citomegalovirus/genética , ADN Bacteriano/análisis , ADN Viral/análisis , Femenino , Herpesvirus Humano 1/genética , Herpesvirus Humano 4/genética , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa
9.
Dermatology ; 220(1): 25-31, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-19907135

RESUMEN

BACKGROUND: Radiographic examination (Rx) is still the best method to obtain an accurate diagnosis of psoriatic arthritis (PsA). Nevertheless, ultrasound (US) examination of the potentially involved joints has started to play a leading role. The sensitivity and specificity of a scan can be determined by contrast enhancement in the diagnosis of arthritis during PsA in comparison with basal US with MRI. METHODS: Our study was made on 22 uninformed patients showing clinical suspicion of PsA. The patients were submitted to clinical evaluation, Rx, US with and without contrast enhancement and MRI. The parameters evaluated by basal US were effusion, synovial hypertrophy, positiveness to color power Doppler signals and bone erosion. RESULTS: Contrast-enhanced US (CEUS) seems to amplify small alterations previously detected by US and, moreover, increases the diagnostic confidence in cases of suspected symptomatology with a negative diagnosis. Finally, CEUS appears to have a concordance of almost 100% with the results of MRI with contrast enhancement. CONCLUSION: US appears to be an effective method for detecting the alterations in bone outline and soft tissues, such as synovitis. Furthermore, US provides useful information concerning the evolution of vascularization and the dynamic behavior of tendons.


Asunto(s)
Artritis Psoriásica/diagnóstico por imagen , Medios de Contraste , Ultrasonografía Doppler en Color/métodos , Adulto , Anciano , Artritis Psoriásica/patología , Diagnóstico Precoz , Femenino , Humanos , Italia , Articulaciones/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Radiografía , Sensibilidad y Especificidad , Sinovitis/diagnóstico
10.
Dig Liver Dis ; 40(3): 206-15, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18054850

RESUMEN

BACKGROUND AND AIM: Aim of this study was to compare contrast-enhanced ultrasound and multi-detector row computed tomography in detecting arterial hypervascularity in small cirrhotic nodules. PATIENTS AND METHODS: Sixty-two nodules (41 measuring 1.0-2.0 cm, 21 measuring 2.1-3.0 cm) found in 55 cirrhotic patients were examined with both methods. Lesions displaying arterial hypervascularity with washout in the portal/venous phase on both studies were considered hepatocellular carcinomas and treated; all other nodules were subjected to ultrasound-guided fine-needle biopsy. RESULTS: The larger nodules (2.1-3.0 cm) included 19 hepatocellular carcinomas (90%), 1 macroregenerative nodule type I and 1 macroregenerative nodule type II; 35 (87%) of the smaller nodules were hepatocellular carcinomas, 2 were macroregenerative nodules type I, 2 macroregenerative nodules type II and 2 hemangiomas. The two studies yielded concordant findings for 54 nodules (87%), including 46 hypervascular on both examinations and 8 that were consistently hypovascular. Two of the latter nodules were hepatocellular carcinomas. The other eight nodules displayed arterial hypervascularity on only one of the studies. Six of these (75%) were hepatocellular carcinomas, including five that were negative in the contrast-enhanced ultrasound study. CONCLUSION: Computed tomography and contrast-enhanced ultrasound show high agreement in the vascular classification of small nodules detected by ultrasound in cirrhotic livers, although the former technique was slightly more sensitive in the detection of arterial hypervascularization.


Asunto(s)
Cirrosis Hepática/diagnóstico por imagen , Hígado/irrigación sanguínea , Neovascularización Patológica/diagnóstico por imagen , Fosfolípidos , Hexafluoruro de Azufre , Ultrasonografía Doppler/métodos , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Carcinoma Hepatocelular/diagnóstico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hemangioma/diagnóstico , Humanos , Inyecciones Intravenosas , Hígado/diagnóstico por imagen , Cirrosis Hepática/patología , Neoplasias Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Neovascularización Patológica/patología , Fosfolípidos/administración & dosificación , Estudios Prospectivos , Hexafluoruro de Azufre/administración & dosificación , Tomografía Computarizada por Rayos X
11.
Pediatrics ; 118(2): 536-48, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16882805

RESUMEN

OBJECTIVES: The aim was to survey the range of cerebral injury and abnormalities of cerebral development in infants born between 23 and 30 weeks' gestation using serial MRI scans of the brain from birth, and to correlate those findings with neurodevelopmental outcome after 18 months corrected age. METHODS: Between January 1997 and November 2000, consecutive infants born at < 30 weeks' gestational age underwent serial MRI brain scans from birth until term-equivalent age. Infants were monitored after 18 months of age, corrected for prematurity, with the Griffiths Mental Development Scales and neurologic assessment. RESULTS: A total of 327 MRI scans were obtained from 119 surviving infants born at 23 to 30 weeks of gestation. Four infants had major destructive brain lesions, and tissue loss was seen at term for the 2 survivors. Fifty-one infants had early hemorrhage; 50% of infants with term scans after intraventricular hemorrhage had ventricular dilation. Twenty-six infants had punctate white matter lesions on early scans; these persisted for 33% of infants assessed at term. Early scans showed cerebellar hemorrhagic lesions for 8 infants and basal ganglia abnormalities for 17. At term, 53% of infants without previous hemorrhage had ventricular dilation and 80% of infants had diffuse excessive high signal intensity within the white matter on T2-weighted scans. Complete follow-up data were available for 66% of infants. Adverse outcomes were associated with major destructive lesions, diffuse excessive high signal intensity within the white matter, cerebellar hemorrhage, and ventricular dilation after intraventricular hemorrhage but not with punctate white matter lesions, hemorrhage, or ventricular dilation without intraventricular hemorrhage. CONCLUSIONS: Diffuse white matter abnormalities and post-hemorrhagic ventricular dilation are common at term and seem to correlate with reduced developmental quotients. Early lesions, except for cerebellar hemorrhage and major destructive lesions, do not show clear relationships with outcomes.


Asunto(s)
Daño Encefálico Crónico/patología , Encéfalo/patología , Discapacidades del Desarrollo/patología , Enfermedades del Prematuro/patología , Imagen por Resonancia Magnética , Ganglios Basales/patología , Daño Encefálico Crónico/etiología , Hemorragia Cerebral/etiología , Hemorragia Cerebral/patología , Infarto Cerebral/etiología , Infarto Cerebral/patología , Parálisis Cerebral/epidemiología , Parálisis Cerebral/etiología , Ventrículos Cerebrales/patología , Estudios de Cohortes , Discapacidades del Desarrollo/etiología , Dilatación Patológica/etiología , Dilatación Patológica/patología , Femenino , Retardo del Crecimiento Fetal/patología , Estudios de Seguimiento , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Recién Nacido Pequeño para la Edad Gestacional , Unidades de Cuidado Intensivo Neonatal , Leucomalacia Periventricular/etiología , Leucomalacia Periventricular/patología , Londres/epidemiología , Masculino , Pruebas Neuropsicológicas , Índice de Severidad de la Enfermedad
12.
G Ital Nefrol ; 19(3): 316-25, 2002.
Artículo en Italiano | MEDLINE | ID: mdl-12195400

RESUMEN

Over the last few years emerging evidence indicate the involvement of herpes viruses in the pathogenesis of several medical complications in transplanted patients. Herpes viruses are transmitted via inter-human contact and cause a primary infection, which commonly fails to give clinical signs and may persist even for years in a latent state in healthy subjects. In transplanted patients, herpes viruses may be transmitted through the transplanted organ or may be reactivated because of the use of powerful immunosuppressive drugs. Moreover, the persistence of immunosuppression greatly favours the clinical expression and severity of virus infection. Thus, herpes viruses seem to be involved in both acute and chronic deterioration of graft function, in the pathogenesis of post-transplant lymphoproliferative disorders and Kaposi sarcoma, and even in vessel atherosclerosis. This review will focus on relevant clinical aspects of herpes-virus infection, namely cytomegalovirus, EBV, herpes simplex 1 and 2, varicella zoster virus, HHV-6, HHV-7 and HHV-8, in kidney transplanted patients.


Asunto(s)
Infecciones por Herpesviridae/etiología , Trasplante de Riñón/efectos adversos , Infecciones por Citomegalovirus/etiología , Infecciones por Virus de Epstein-Barr/etiología , Humanos
13.
J Exp Clin Cancer Res ; 19(3): 399-400, 2000 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11144536

RESUMEN

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer which seems to be common in transplant recipients. We describe the case of a renal transplant patient who developed a MCC on the right glutaeus eight years after transplantation.


Asunto(s)
Carcinoma de Células de Merkel/etiología , Trasplante de Riñón/efectos adversos , Neoplasias Cutáneas/etiología , Carcinoma de Células de Merkel/patología , Carcinoma de Células de Merkel/terapia , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia
14.
Arch Ital Urol Androl ; 72(4): 221-4, 2000 Dec.
Artículo en Italiano | MEDLINE | ID: mdl-11221041

RESUMEN

Acquired cystic kidney disease (ACKD) is characterized by the substitution of renal parenchyma with multiple cysts in patients either with end stage renal disease who are treated for uremia with dialysis (as on haemodialysis--HD--as on peritoneal dialysis--PD) due to non cystic kidney diseases. The aim of our study was to value the prevalence of ACKD in our haemodialysed patients (with exclusion of polycystic disease and obstructive nephropathy), its relationship between clinical and bioumoral parameters, and its complications in the follow-up. We have studied 56 uremic patients (32f and 24m) on bicarbonate HD three in a week. All our patients underwent renal echography using ECO B mode ALOKA SSD500 with electronic convex sector probe 3.5 MHz for to diagnose ACKD. We divided the population of the study in two groups: the group A includes 23 patients with ACKD; the group B includes 33 patients without ACKD. We analyzed in all patients body mass index (BMI), protein catabolic rate normalized (nPCR), dialitic adequacy index (KT/V), Hb, the serum levels of EPO by ELISA test (MEDAL GmbH, GE, Diagnostika, Hamburg; normal values 5 divided by 30 mUI/ml). We have found a prevalence of 42% for ACKD and statistical significance between the two groups for the duration of HD and BMI (Anova p < 0.01). The EPO serum concentration was higher in the group A (p < 0.05), while their rhuEPO requirement was lower. In two patients of group with ACKD we have found renal carcinoma. In conclusion, by our experience should be opportune to carry out a renal echography at the start of dialysis treatment and every six months for patients with ACKD and every year for those without ACKD. It is necessary to perform the echography of the kidney in all uremic patients before the start of haemo or peritoneal dialysis and report this examination in those patients with ACKD every six months and every year in those without ACKD.


Asunto(s)
Enfermedades Renales Quísticas/epidemiología , Enfermedades Renales Quísticas/terapia , Anciano , Femenino , Unidades de Hemodiálisis en Hospital , Humanos , Masculino , Persona de Mediana Edad , Prevalencia
15.
Eur Radiol ; 10(12): 1877-85, 2000.
Artículo en Inglés | MEDLINE | ID: mdl-11305564

RESUMEN

The aim of this study was to evaluate the accuracy of dynamic CT in the preoperative staging of gastric cancer. One hundred seven patients affected by gastric cancer diagnosed by endoscopic biopsy were prospectively staged by dynamic CT prior to tumor resection. After an oral intake of 400-600 ml of tap water and an intravenous infusion of a hypotonic agent, 200 ml of non-ionic contrast agent were administered by power injector using a biphasic technique. The CT findings were prospectively analyzed and correlated with the pathological findings at surgery. The accuracy of dynamic CT for tumor detection was 80 and 99% in early and advanced gastric cancer, respectively, with overall detection rate of 96% (103 of 107). Three early (pT1) and one advanced (pT2) cancers were undetected. Tumor stage as determined by dynamic CT agreed with pathological findings in 83 of 107 patients with an overall accuracy of 78%. The accuracy of CT in detecting increasing degrees of depth of tumor invasion when compared with pathological TNM staging was 20% (3 of 15) and 87% (80 of 92) in early and advanced cancer, respectively. The sensitivity, specificity, and accuracy of CT in the preoperative staging (pT3-pT4 vs pT1-pT2) was 93, 90, and 91.6%, respectively. The sensitivity, specificity, and accuracy of CT in assessing metastasis to regional lymph nodes was 97.2, 65.7, and 87%, respectively. Computed tomography correctly staged liver metastases in 105 of 107 patients with an overall sensitivity of 87.5% and specificity of 99 %. The sensitivity of peritoneal involvement was 30% when ascites or peritoneal nodules were absent. Our findings show that dynamic CTcan play a role in the preoperative definition of gastric cancer stage. The results can be used to optimize the therapeutic strategy for each individual patient prior to surgery, thus avoiding unnecessary intervention and allowing careful planning of extended surgery in eligible patients.


Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Femenino , Humanos , Yopamidol , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/secundario , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Estómago/diagnóstico por imagen , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía
16.
Tumori ; 85(1): 28-31, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10228493

RESUMEN

AIMS AND BACKGROUND: The phenotypic expression of different APC mutations in familial adenomatous polyposis (FAP) is variable: two to three variants of the disease have been defined based on the severity of colonic manifestations. Age of onset and number of polypectomies per person-year of post-surgical follow-up were compared in two FAP families with very close mutation sites in the APC gene, in order to ascertain mutation-specific variation of expressivity. FAMILIES AND APC MUTATIONS: Family A (5 patients) carried a newly characterized mutation, a four bp deletion at codon 843. Family B (5 patients) carried a previously identified mutation at codon 835. RESULTS: Mean age of onset was 49.7 years in family A and 30.5 years in family B; number of polypectomies per person-year of follow-up was 1.05 for family A and 10.1 for family B (P < 0.001). CONCLUSIONS: There is significant variation of expressivity (allelic heterogeneity) in FAP between two mutations separated by only eight codons, located at the 5' extremity of APC gene exon 15.


Asunto(s)
Poliposis Adenomatosa del Colon/genética , Genes APC/genética , Mutación , Poliposis Adenomatosa del Colon/cirugía , Edad de Inicio , Femenino , Humanos , Masculino , Linaje
17.
Compr Ther ; 21(1): 35-40, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7697980

RESUMEN

There are many current opinions of how to diagnose and treat carcinoma of the prostate. The authors' believe that it is imperative to remember that physicians are treating people with disease and not the disease itself. Especially in the geriatric population with concurrent medical diseases, physicians must be sure that the treatment benefits the individual patient.


Asunto(s)
Neoplasias de la Próstata/terapia , Humanos , Masculino , Persona de Mediana Edad
18.
Ann Surg Oncol ; 2(1): 61-70, 1995 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-7834457

RESUMEN

BACKGROUND: Therapies of advanced melanoma patients with interleukin-2 (IL-2) and cytotoxic lymphocytes have produced interesting results, but a larger diffusion of these treatments is limited by the severe side effects due to IL-2 systemic infusion. A strictly regional administration of IL-2 and cells by an isolation perfusion (IP) in extracorporeal circulation (ECC) for the treatment of regional melanoma metastases could improve tolerability and efficacy of this specific modality of immunotherapy. METHODS: Ten patients were submitted to adoptive immunotherapy with IL-2 and lymphokine-activated killer (LAK) cells by IP in ECC. The schedule of treatment included the first course of a 5-day systemic administration of IL-2 (Proleukin, EuroCetus 9-12 x 10(6) IU/m2/day continuous infusion); autologous LAK cells were obtained via leukapheresis and after in vitro activation were given (range 8-28 x 10(9)) along with IL-2 (120-2,400 IU/ml of perfusion priming) to the affected limb by IP; IL-2 (9-12 x 10(6) IU/m2/day) was also administered by systemic continuous infusion for 5 days starting on the day after IP. RESULTS: All patients concluded the treatment without any major local or systemic toxicities. Clinical responses included one complete and six partial remissions; three patients had stable disease. All patients are alive. Follow-up after IP ranged from 12 to 35 months (median: 22). The analysis of circulating lymphocytes revealed the rapid disappearance of LAK cells, suggesting their extravasation and/or endothelial adhesion in perfused tissues. CONCLUSIONS: IP with IL-2 and LAK cells is a new approach for the treatment of in-transit metastases due to cutaneous melanoma. The treatment appears to be feasible and reliable. Further biological and immunological studies should permit amelioration of the present modality of treatment.


Asunto(s)
Quimioterapia del Cáncer por Perfusión Regional , Circulación Extracorporea , Inmunoterapia Adoptiva , Interleucina-2/uso terapéutico , Células Asesinas Activadas por Linfocinas , Pierna , Melanoma/secundario , Melanoma/terapia , Neoplasias Cutáneas/terapia , Adulto , Anciano , Quimioterapia del Cáncer por Perfusión Regional/efectos adversos , Quimioterapia del Cáncer por Perfusión Regional/métodos , Circulación Extracorporea/efectos adversos , Circulación Extracorporea/métodos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Interleucina-2/administración & dosificación , Interleucina-2/efectos adversos , Células Asesinas Activadas por Linfocinas/inmunología , Leucaféresis , Recuento de Linfocitos , Persona de Mediana Edad , Inducción de Remisión , Tasa de Supervivencia
19.
J Nematol ; 25(4 Suppl): 836-42, 1993 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19279850

RESUMEN

Investigations were undertaken in 1982-88 to estimate yield losses of carrot, sugarbeet, wheat, and potato caused by cyst-forming nematodes (Heterodera and Globodera species) in several provinces of Italy. Soil samples were collected at planting in 0.5-ha sampling areas distributed in each crop's major production area. Yield loss estimates were based on nematode population estimates and on curves derived earlier relating nematode densities with crop yields in Italy. Estimated yield loss values were based on the average prices reported for Italy in 1989. Heterodera carotae caused carrot yield losses in the Foggia (20%) and Venice (12%) provinces. Heterodera schachtii was common in our samples, but sugarbeet yield losses were highest in the province of L'Aquila (21%), followed by Ferrara (4.2%), Ravenna (3.3%), Modena (2.7%), and Rovigo (2.6%). Globodera rostochiensis and G. pallida were widespread in only a few of the major potato growing areas, but yield losses are remarkably high at Forli (17%) followed by Bari (9%), Catanzaro (6%), Foggia (3%), and Trento (3%). Heterodera avenae was common on wheat in the sampled provinces, but caused less than 1% yield reductions. Values of total estimated yield losses were 21.1 billion (Italian liras) for potato, 13.8 billion for sugarbeet, 3.2 billion for carrot, and 2.6 billion for wheat.

20.
Minerva Anestesiol ; 57(6): 379-82, 1991 Jun.
Artículo en Italiano | MEDLINE | ID: mdl-1754079

RESUMEN

Ten patients who underwent surgery (5 right hepatectomy and 5 colectomy) for cancer participated in a clinical controlled study. They were treated with buprenorphine (i.v. slow infusion) to relieve postsurgical pain. We found an increased urinary excretion of this drug in patients who underwent hepatectomy as compared with patients who underwent colectomy. However no differences in the occurrence of side-effects and/or in the therapeutic effect were observed between the two groups. We conclude that buprenorphine can be effectively and safely used also in patients with a resection of liver parenchyma.


Asunto(s)
Buprenorfina/uso terapéutico , Hepatectomía , Dolor Postoperatorio/tratamiento farmacológico , Adenocarcinoma/cirugía , Adulto , Anciano , Buprenorfina/efectos adversos , Buprenorfina/orina , Colectomía , Femenino , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad
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