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Biomedical subjects

A Andriulli

Publications and source records attributed to A Andriulli.

At least 19 recordsLinked to original sources
PubMed1995

Minute and small early gastric cancers in a Western population: a clinicopathologic study.

Early endoscopic diagnosis improves the prognosis of patients with gastric cancer, as shown by the finding that 5-year survival rates exceeding 90% are observed in Japanese patients with early gastric cancer. It has been hypothesized that tumor size may have prognostic significance; therefore, a distinction between minute, small, and large early gastric cancers has been proposed. The aim of this study was to determine the prevalence of minute and small early gastric cancers in Western countries and to compare their clinicopathologic features with those of large early gastric cancers. Of 465 Italian patients with gastric cancer who were studied, 20.5% had an early gastric cancer, and 34.7% of these were minute or small. Tumor size is correlated with intramural spreading and metastasis to perigastric lymph nodes. Nodal involvement occurs more frequently in the diffuse than in the intestinal type of early gastric cancer. Long-term survival rate is not correlated with tumor size, intramural spreading, or nodal metastasis. The minute and small early gastric cancers of Italian patients are indistinguishable from those occurring in Japanese patients. These lesions are more common than previously thought and should be carefully searched for by endoscopists. The correlation of tumor size with intramural invasion and perigastric lymph node metastasis suggests that minute and small early gastric cancers are precursors of large early gastric cancers. Although the distinction between minute, small, and large early gastric cancers is of low prognostic value, the distinction might be useful for selecting different therapeutic approaches.

Female↗
PubMed1995

The urea breath test: a non-invasive clinical tool for detecting Helicobacter pylori infection.

The urea breath test exploits the urease enzyme of Helicobacter pylori. The hydrolysis of labelled urea releases labelled carbon dioxide that is excreted in the breath. Distribution of urea throughout the stomach prevents sampling errors and allows for semiquantitative assessment of the extent of Helicobacter pylori infection. The urea breath test is very specific and sensitive and can be proposed as the method of choice for detecting Helicobacter pylori infection in ulcer patients before and after eradicating treatment as well as in epidemiological studies.

Breath Tests↗
PubMed1994

[Treatment of primary hepatocarcinoma with chemoembolization and alcohol injection. Personal experience].

The comparative efficacy of transcatheter arterial chemoembolization and percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC) was investigated in a series of 243 consecutive patients: 146 of them were submitted to 1-6 chemoembolization sessions at 1 and 3 months' intervals and 30 to PEI; the remaining 67 patients refused any treatment. The follow-up ranged 3 to 36 months. Survival rates were statistically analyzed with the life table analysis. Patients' survival was affected by the number of nodules and by Child's and Okuda's classes; no relationship was found between survival rates and histologic grade or nodule vascular feeding. In case of single lesions, chemoembolization was more effective than PEI in Okuda's class I. In case of multifocal HCC, chemoembolization was better than no treatment in Okuda's class I and Child's class A. In conclusion, we suggest chemoembolization as the treatment of choice in Child A or Okuda I patients with multifocal HCCs, while its use seems of little help in Child B-C or Okuda II-III patients. In case of unifocal HCC, PEI or surgical resection should be combined with chemoembolization.

Adult↗
PubMed1994

[Osteoarticular manifestations during liver and gastrointestinal diseases].

The most important osteoarticular complications occurring during gastrointestinal and liver diseases are reviewed. Although etiopathogenesis of these disorders is not yet fully understood, their knowledge is required to gastroenterologists for two main reasons: to establish a correct diagnosis and to start an appropriate therapy.

Bone Diseases↗
PubMed1994

Segmental motor abnormalities of the distal oesophagus.

Patients with chest pain and/or dysphagia may present non-specific motor abnormalities that do not fit into classical categories of primary motor disorders. Two such patients are described, both with segmental aperistalsis of the distal oesophagus and with fairly normal proximal motility and LES function. Delayed radionuclide oesophageal transit was noted in both cases. Medical treatment was only partially effective and one patient required pneumatic dilatation. The aperistaltic segments have remained unchanged over 3-4 year follow-ups. These patients account for less than 1% of all those diagnosed with oesophageal motor abnormalities in our hospital in the last ten years.

Esophageal Motility Disorders↗
PubMed1993

Fine-needle liver biopsy in patients with severely impaired coagulation.

Severe coagulation defects, as reflected by platelet count and prothrombin time, have always been considered a contraindication to needle biopsy of the liver, but there are very limited data on the actual rate of bleeding in patients with such severe alterations and none whatsoever on the bleeding risk associated with newer, fine-gauge needles that produce less trauma to the liver tissue. In addition, there has never been any evidence that platelet count and/or prothrombin time are the most sensitive indices of bleeding risk. This retrospective study of 85 patients, with platelet counts less than 50,000/mm3 and/or prothrombin times less than 50% of controls, subjected to ultrasound-guided fine-needle liver punctures for diagnostic or therapeutic (percutaneous ethanol injection) purposes showed no bleeding episodes after any of the 229 punctures performed. No type of replacement therapy was administered to correct clotting defects prior to the procedure. Correct pathologic diagnoses were obtained in 81.2% of all patients. Ultrasound-guided fine needle puncture appears to be safer than currently believed in patients with severe clotting defects and deserves further evaluation as an alternative to surgical procedures to diagnose and treat liver lesions, even when severe coagulation impairment is present.

Adult↗
PubMed1993

[Primary hepatocarcinoma. Diagnostic imaging and chemoembolization].

The diagnostic and therapeutic approach by means of transcatheter arterial chemoembolization is analyzed in 100 patients affected with hepatocellular carcinoma (HCC): in all patients the HCC had been diagnosed by means of US-guided fine-needle biopsy: 75 of 100 patients were in Child A class, 24 in Child B and 1 in Child C class. The most sensitive imaging technique to identify HCC proved to be angiography (95%); post-Lipiodol CT was also of great value to stage the disease. The authors suggest a diagnostic-therapeutic approach including angiography and simultaneous chemoembolization right after US-guided biopsy, avoiding conventional CT; such a protocol allows high diagnostic accuracy at a lower cost. Chemoembolization proved to be a safe technique, with a low incidence of mortality and complications; the latter were easy to treat by medical therapy. The follow-up data relative to 39 of 100 patients who underwent 2 or more chemoembolization treatments prove the latter to be a valuable technique relative to both the evolution of HCC nodules (in 18/21 patients with single lesions and in 9/18 patients with multiple lesions, lesion size was unchanged or decreased) and to survival rates (70% in 65 patients followed-up 1 year at least); on the whole, 77 of 100 patients are still alive.

Carcinoma, Hepatocellular↗
PubMed1992

[Endoscopic and intraoperative ultrasonography in staging of stomach neoplasms].

In Japan a better prognosis of gastric cancer has been achieved by early diagnosis and wide, careful lymphectomy. This is not true in western countries. Thus the Authors believe that rational surgical strategy and the careful use of advanced diagnostic tools would produce a better outcome. The Authors report the new diagnostic methods that they adopt in every case of gastric neoplasm: endoscopic ultrasonography, which also proved useful in submucosal tumors, like lymphomas; parenteral nutrition, immune status assessment for a possible use of immune response modulators, single-dose antimicrobial prophylaxis, antithrombotic prophylaxis, autologous blood storage, in order to reduce transfusion-linked risks. Surgical strategy is also reported, which includes wide resection with adequate margins, R2 lymphectomy and intraoperative assessment of disease extension by ultrasonography.

Gastroscopy↗
PubMed1992

Histological study of alcoholic, nonalcoholic, and obstructive chronic pancreatitis.

Pancreatic tissue obtained from 26 patients with alcoholic chronic pancreatitis (ACP), nine patients with nonalcoholic idiopathic chronic pancreatitis (NAICP), and seven patients with obstructive chronic pancreatitis (OCP) was studied in an attempt to determine whether clinical or etiologic differences have a morphologic counterpart. Histologically it was easy to distinguish ACP from OCP occurring distal to an obstruction of the pancreatic duct. Nine patients with NAICP showed histological features similar to those found in ACP. Plugs and calcifications were found as frequently in NAICP as in ACP, suggesting that NAICP, whatever the etiology, is truly pancreatolithiasis, which leads to slowly progressive fibrosis and acinar atrophy in the obstructed pancreatic lobule. Nerve fibers were found to be more numerous in all disease categories. Inflammatory foci of lymphocytes associated with nerves were observed in 57 and 35% of cases with OCP and ACP, respectively, but only in one patient with NAICP. These findings may constitute a pathological basis for the existing clinical data showing that NAICP frequently runs a pain-free course.

Adult↗
PubMed1990

Endoscopic ultrasonography in eosinophilic infiltration of gastric wall.

The case of a young man with eosinophilic gastroenteritis with primary muscularis propria involvement in the antrum and distal ileum is presented. Initial diagnosis was based uniquely on indirect clinical and radiological findings since endoscopic and histologic data had been misled by the depth of eosinophilic infiltration. In order to directly prove the diagnosis, full-thickness operative biopsy would have been necessary but was avoided on ethical grounds. Valuable information was gained through Endoscopic Ultrasonographic (EUS) study of the antrum which showed an asymmetrical thickening of the outer hypoechoic layer of the wall corresponding to the muscularis propria. The overall thickness of the antrum amounted to 0.6 cm, clearly distinct from the 0.2 cm value in uninvolved areas. Subserosal involvement was also appreciated in spite of the absence of ascites; superficial layers, mucosa and submucosa, appeared uninvolved. The patient was restudied 6 months later when symptom-free: at this time, blood eosinophilia persisted and the EUS picture was unchanged. These observations suggest that peripheral blood eosinophilia along with eosinophilic infiltration of the gastric wall are stable conditions, unrelated to symptoms. Endoscopic ultrasonography is of value in ascertaining muscular involvement in eosinophilic gastroenteritis.

Adult↗
PubMed1989

Canrenone and androgen receptor-active materials in plasma of cirrhotic patients during long-term K-canrenoate or spironolactone therapy.

Plasma levels of canrenone and androgen receptor-active materials (ARM) were determined during long-term oral K-canrenoate or spironolactone therapy in cirrhotics with chronic recurrent ascites. Mean plasma canrenone level was approximately 3 times higher under K-canrenoate than under spironolactone treatment; moreover, the levels were not dose related. Either type of treatment did not affect plasma aldosterone and testosterone concentrations. Plasma ARM during K-canrenoate treatment did not change, whereas in the spironolactone group a 3-fold increase of ARM occurred (p less than 0.05). No dose-related effect was evident with the latter treatment. The lower incidence of gynecomastia in the K-canrenoate group was not correlated with values of plasma canrenone or ARM (p greater than 0.05). Our study questions the traditional view that the mode of action of spironolactone is via its metabolite canrenone. The two antialdosterone drugs, although equally effective in clearing ascites from cirrhotics, appear to act through partially different metabolites. The lower incidence of antiandrogenic or estrogen-like side effects during K-canrenoate seems to be related to metabolites other than canrenone itself.

Adult↗
PubMed1988

Pancreatic steatorrhea and pulmonary tuberculosis.

The authors present a case of exocrine pancreatic insufficiency in a 37 yr old woman treated for pulmonary tuberculosis. The exocrine pancreatic failure is suggested to be secondary to previous pancreatic tuberculosis since no other cause of pancreatic disease was found and the diarrhea with steatorrhea started 6 mth after the lung disease. Steatorrhea was promptly reverted after institution of oral therapy with pancreatic supplements and the patient gained 7 kg of body weight during the successive follow-up of 4 yr.

Adult↗
PubMed1986

[Prevalence of peptic ulcer in patients with various hepatopathies].

Aim of this study was to re-evaluate the overall prevalence of a peptic disease in 350 patients with liver diseases of different etiology and severity. A normal endoscopic picture was found in 82% of cases. Peptic lesions were found in 18% of total cases and were located in the duodenal (10.9%) and gastric (7.1%) wall. On the basis of the 15-20% rate, which most Authors think to be a reasonable estimate of the overall ulcer prevalence in normal population, the prevalence rate in this survey would suggest that there is no association between ulcer and liver disease. Ulcers were more commonly present in cirrhotic than in noncirrhotic patients. Both alcohol intake and cigarette smoking were identified as two ulcerogenic events in these patients while portal hypertension and etiology of liver disease were irrelevant factors. The contemporary occurrence of the three ulcerogenic factors (cirrhosis, smoking, and alcohol intake) in a given patient seems to potentiate each others as ulcerogenic event. It is concluded that patients with liver diseases share the same risk of developing a peptic disease as the general population.

Adult↗