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Biomedical subjects

A Antonaci

Publications and source records attributed to A Antonaci.

At least 19 recordsLinked to original sources
PubMed2004

Lung metastases from differentiated thyroid carcinoma. A 40 years' experience.

AIM: Retrospective studies have been carried out to estimate the survival of 96 patients with lung metastases from differentiated thyroid carcinoma, observed from 1958 to 2000. METHODS: All patients had undergone total thyroidectomy. Case histories were analysed with respect to age at diagnosis, sex, histology, local lymph node involvement, size of lung metastases and 131I uptake by metastases. Survival functions were calculated. Cox regression was performed. RESULTS: There was no statistically significant difference in histological type and lymph node involvement, whereas a significantly longer survival time was observed in patients under 45 years of age at diagnosis (p= or <0.0001), in those with metastases concentrating 131I (p= or <0.0001) and in those with fine miliaric metastases (p=0.0037). Multi-variate analysis revealed that the risk of death increases about 5.4-fold in patients over 45 years old, whereas 131I treatment is likely to reduce this risk to nearly 1/6. Conclusion. In conclusion, in patients with lung metastases from differentiated thyroid carcinoma, young age at diagnosis and 131I uptake by metastases are the most important factors positively affecting survival time. Radioiodine therapy, also with high cumulative 131I activity, can lead to longer survival time or complete recovery.

Adenocarcinoma, Follicular↗
PubMed2003

[Clinical significance of thyroid nodule calcification].

To confirm the predictive value of calcifications in thyroid nodules as a risk factor for malignancy and to detect specific aspects for tumours, in a set of 175 patients--30 papillary carcinoma (PC) and 145 multinodular goiters (MNG) with dominant nodule--calcifications were detected by ultrasound scan. Calcifications were significantly more frequent in PC than in MNG (40% vs 20.7% p < 0.05) but their considered characteristics (size, number, position, location in the gland, sonographic features of the nodule) did not show any particular difference between PC and MNG. The frequency of calcifications in our series was higher in older patients (mean age 58.7 +/- 13.3 vs 51.1 +/- 12.7 in patients without calcifications, p < 0.001) and this could imply that their onset is time-dependent. Calcifications can be a useful indicator of enhanced risk, to be considered in the overall process of surgical decision making.

Adult↗
PubMed2001

Single brain metastasis from thyroid cancer: report of twelve cases and review of the literature.

Brain metastases from thyroid carcinoma is unusual, with a frequency of 1%. We report twelve patients, with single brain metastases and with a karnofsky performance scale score >60 at admission. No metastasis was seen during the uptake of iodine-131, even in the cases from differentiated thyroid carcinoma, suggesting absence of differentiation between primary and metastasic disease. The histopathology of thyroid carcinomas was anaplastic in five cases, differentiated in six, and medullary in one. Only in four patients, brain was the unique site of metastatic spread; in others, bones and lungs were also involved. All metastases were surgically removed, and all patients were treated with radiotherapy (45 Gy) in the postoperative course. The survival average was 19.8 months, and the quality of life was satisfactory in all patients. One patient remained alive till 5 years. Anaplastic histopathology and size of the primitive, and also bone involvement of thyroid disease were significant risk factors in our cases (p < 0.05). According to the literature, surgery is the best therapeutical choice. Alternative strategies in the management of brain metastasis, such as iodine-131 therapy, are discussed, paying particular attention to the relevant side effects.

Brain Neoplasms↗
PubMed2001

Multiple viral infections in a group of intravenous drug users: hepatitis B virus exposure is the risk factor.

OBJECTIVE: Infection with hepatotropic viruses is associated with a variable degree of liver disease, and there is evidence that more severe lesions are related to the association with another viral infection. The aim of this investigation is to establish the relationship between different viral infections occurring in the same individual and the presence and progression of liver disease. DESIGN: The study population comprises 754 intravenous (IV) drug abusers exposed to hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) or cytomegalovirus (CMV). All individuals were followed for an average of 2 years. Liver disease was assessed by liver function tests, 99m-technetium (99mTc) liver scintigraphy, and also by liver biopsy in a subset (n = 136) of patients. The different viral patterns and presence of disease were analysed by logistic regression, and the risk factors were calculated. Contingency tables of patients with single or associated infections were drawn up to evaluate progression of liver disease. RESULTS: Association of HIV with at least one other viral infection was constant. Surface antigens of HBV (HBsAg) were always associated with HIV (n = 19); in this group, 18 patients had signs of liver disease. A past infection with HBV, as revealed by the presence of at least antibodies against the surface antigen (HBsAb) and antibodies against the core antigen of HBV (HBcAb), was detected in 463 patients (61.4%). The overall prevalence of HCV antibodies was 63.91% (n = 482). In 96.8% of the 406 patients tested, HCV-RNA was detected by reverse transcriptase polymerase chain reaction (RT-PCR). The majority of patients with high alanine transaminase (ALT) had anti-HBV antibodies in the presence of HCV (56.1%). At the end of follow-up, all of these patients showed signs of active liver disease, and scoring was significantly worse than in patients with either HBV or HCV alone. An infection/reactivation of CMV was found in patients previously exposed to HBV and with increased ALT values. CONCLUSIONS: Data emerging from this study reveal the association of HCV or CMV, or both, with a previous HBV infection, as demonstrated by HBsAb and HBcAb, and rapid progression of the disease in this group of patients. A previous HBV infection therefore appears to be an important risk factor for subsequent viral-related liver disease.

Adult↗
PubMed1999

Cytological and immunocytochemical evaluation of thyroid and breast masses in patients with a previous neoplasm: case reports.

The diagnosis of secondary tumours represents one of the most important fields in the application of fine needle aspiration cytology (FNAC). We studied two patients, one with a history of breast cancer and one with a previous tumour of the thyroid, who showed a second mass, in the thyroid and in the breast, respectively, during follow up. The aim of our study was to evaluate if cytology, performed on FNAC smears, may distinguish a metastatic lesion from a second primary tumour, or if further immunocytochemistry should be performed. Our data demonstrate that, while cytology may be indicative of a second primary tumour, the histotype should be confirmed by immunocytochemical staining.

Aged↗
PubMed1999

[Guidelines for the routine assessment of respiratory surgical risk: thoracic radiography].

Through the three years between June 1995 and June 1998 the authors applied an evaluation schedule for the respiratory surgical risk to all the patients undergoing general surgery. Chest X-ray was included in this schedule as a first-level test and it was performed systematically on all the patients. The purpose of the study was to verify the effectiveness of chest X-ray as a routine examination of the respiratory performance, evaluating its predictive value on 1715 cases. The routine employment of this preoperative test on patients resulting risk-free at an accurate clinical anamnestic examination doesn't seem to be justified, basing on the preliminary results achieved. Therefore, chest X-ray should be considered a second-level test, to be performed on the basis of a precise clinical query only. This way a significant health-care cost reduction could be achieved, without affecting the quality of patient's management.

Adult↗
PubMed1999

Vitiligo, autoimmune thyroiditis: a rare thyroid cancer arising with bone metastates on maxillofacial area.

An association between vitiligo and autoimmune thyroid disorders had previously been postulated. Thyroid disorders were found in 18.5% of 15,126 patients with vitiligo, on the basis of the anamnestic data. Then, we investigated 255 healthy relatives in whom we tested only T3, T4 and TSH. With the immunological investigation we detected a higher incidence of TMA in vitiligo patients and in the family members. Therefore, on the basis of the immunologic and thyroid pathology functional data, we observed a thyroid pathology in 25% of the 890 vitiligo patients and in 21.1% of their first degree relatives. Then, clinical observation enabled to discover that 3 of 15,126 patients had undergone exeresis for a thyroid carcinoma and in the 890 vitiligo patients, who had undergone particular investigations, we found a thyroid carcinoma in 3 subjects. In one case lymphnodal involvement and bone metastases in the maxillary district were found. The purpose of this work is to evaluate the incidence of thyrosis and of thyroid carcinoma in vitiligo patients observed for 20 years.

Adolescent↗
PubMed1999

Expression of bcl-2, c-erbB-2, p53, and p21 (waf1-cip1) protein in thyroid carcinomas.

The study was carried out on 53 patients who had thyroid cancer with various degree of differentiation. We studied the expression of bcl-2, a-erbB-2, p53, and p21 ras protein. The protein encoded by bCL-2 proto-oncogene is implicated in the prolongation of cell survival by blocking programmed cell death, i.e. apoptosis. The role of p53 and bcl-2 genes in the regulation of apoptosis has important implications in oncogenesis. Wild-type p53 is thought to promote apoptosis, whilst mutant p53 has a similar effect on apoptosis as bcl-2 that is inhibition of programmed cell kinase activity. C-erb-2 protein overexpression is currently being evaluated as a potential risk factor in breast cancer patients? The ras gene family codes for a 21 kD protein (p21), which binds guanine nucleotides and possesses GTPase activity. Through this mechanism, the ras p21 protein participates in the control of cell proliferation, possibly as a signal transducer from cell surface receptors to the nucleus. Activation of ras genes has been implicated in neoplastic transformation of cells. The aim of our study is to evaluate the expression of these markers in thyroid carcinomas. All immunohistochemical study was performed in paraffin-embedded tissues pathology specimen. Any well differentiated tumor in our study was positive for bcl-2 protein. C-erb-2 immunostaining was present in tumor samples in 60% of cases. In most cases, specific membrane staining as well as a weak cytoplasmic positivity of tumor cells were seen. Immunoreactivity for p53 was positive only in 10% of cases. By immunostaining, p21 protein was expressed in 55% of the 53 tumors tested, with different degree of expression. Only some poorly differentiated tumours were positive for bcl-2, furthermore all markers tested were strongly positive in these tumours. In conclusion, our results indicate that bcl-2, c-erbB-2, p53, and p21 ras protein are differently expressed in thyroid carcinomas in relation to the degree of aggressiveness and differentiation.

Adenocarcinoma, Follicular↗
PubMed1997

[Bifurcated prosthesis in infrarenal aortic position in stenosing lesions. Functional results].

Fifty-eight patients operated upon of infrarenal aortic bifurcated grafts for occlusive disease, in a 6-year period, have been followed-up with a minimum interval of 2 years. The patients were in claudication stage in 63% of the cases and in critical limb threat ischemia in 37% Bypass consisted always in a bifurcated knitted dacron graft either pre-coagulated or sealed. Infrarenal aorta has always been the donor axis, whereas distal anastomosis has been performed on both common femoral in 80% of the cases, on at least one external iliac in 20%. In 5% of the cases a femoro-popliteal bypass has been associated to the main procedure. Postoperative mortality was 3.5%. The occlusion of a prosthetic branch in the postoperative period occurred in one case, requiring a major amputation. Seven patients (12%) presented 11 late thrombosis of one prosthetic branch or both on an interval varying from 4 to 62 months. Eight occlusions required reintervention. Only one, lethal, late prosthetic sepsis was recorded. In a mean interval of 54 months, a good or fair functional result was achieved in 93% of the patients. Out of 22 patients specifically questioned upon, 82% returned to their normal work activity, whereas 18% retired but had a fully normal everyday's life. Sexual function was ameliorated or unchanged in 67% of the cases, while it was impaired in 33%. Eighty-seven percent of the followed-up patients did not require any further hospitalisation for atherosclerotic disease, while 13% of them experienced subsequent hospitalisation or reintervention for progression of the disease either at the same or at different arterial sites. Overall good results support an aggressive attitude towards aorto-iliac-femoral grafting for occlusive disease.

Adult↗
PubMed1994

[Fournier's syndrome: diagnostic and therapeutic assessment].

Fournier's syndrome is a disorder involving perineum and scrotum caused by invasive anorectal infection. Aerobic and anaerobic bacteraemia can lead to septic toxicity. Hence the importance of the multidisciplinary treatment and urgent surgical procedures including drainage and necrotic tissue removal is stressed. A case of Fournier's syndrome is reported.

Gangrene↗
PubMed1993

[Biodegradable compression ring in intestinal anastomosis].

The Authors report their experience with the use of biofragmentable anastomosis ring ("Bowel Anastomosis Ring" B.A.R.--Valtrac): 34 patients underwent colic resection and bowel anastomosis by B.A.R. No complications related to the anastomosis were recorded. The ring was always discharged in the third postoperative week and the endoscopic follow up showed no late complications. It is concluded that B.A.R. is a safe technique and represents a good alternative to hand or mechanical anastomosis with a favorable cost/benefit ratio.

Aged↗
PubMedDate not supplied

Onset of hepatocellular carcinoma in a non-cirrhotic patient affected with haemochromatosis.

The increased incidence of hepatocellular carcinoma in patients affected with haemochromatosis has previously been attributed to cirrhosis. However, some cases of hepatocellular carcinoma without cirrhosis have recently been reported in patients with haemochromatosis, leading to reconsideration of the role of iron in the tumorigenesis of hepatocellular carcinoma. We describe a 79 year old male patient affected with haemochromatosis and with a multinodular hepatocellular carcinoma, but without any evidence of cirrhosis. The absence of any other cancer risk factor (alcohol abuse, liver viral infections, heredity) has lead us to reconsider the possible role of iron as a direct carcinogen in the onset of hepatocellular carcinoma in patients with haemochromatosis.

Aged↗
PubMedDate not supplied

What sedation to use during endoscopic procedure.

Many endoscopists sometimes prefer to perform endoscopies without anaesthetic support, using only benzodiazepines. Endogenous opioid peptides are believed to play an important role in the modulation of pain within the endogenous analgesic system. A group of 40 patients undergoing diagnostic and therapeutic Endoscopic Retrograde Cholangiography and Pancreatography (ERCP) was recruited. Patients were divided into 2 groups according to Visual Analog Scale: pain 1-5 (Group A) and pain 6-10 (Group B). The beta-endorphin baseline values were significantly different between patients of Group A and Group B. Our data show that patients with levels of beta-endorphin over 8 pmol/L were less sensitive to pain, so that they become candidates for a traditional utilization of the benzodiazepines. However in the patients with beta-end levels less of 8 pmol/L should be suitable an anaesthetic as propofol because strong pain might provoke neurohumoral reflexes, cardiovascular alterations, and even a heart attack.

Adult↗