PubMed Health⌕ Search

Biomedical subjects

A Gardini

Publications and source records attributed to A Gardini.

At least 19 recordsLinked to original sources
PubMed2005

Expression of connective tissue growth factor is a prognostic marker for patients with intrahepatic cholangiocarcinoma.

BACKGROUND AND AIMS: Connective tissue growth factor is a member of the 'CCN' protein family. Consistent with its profibrotic properties, it is over-expressed in several human epithelial malignancies. PATIENTS AND METHODS: We have retrospectively evaluated by immunohistochemistry the presence of connective tissue growth factor in archival tissues from 55 resected intrahepatic cholangiocarcinomas and compared its expression to the main pathological parameters, disease free and overall survival. RESULTS: Tumours were scored as high and low/absent expressers (> or =50%, 0-50% cells, respectively). Thirty-three of 55 cholangiocarcinomas (60%) were high and 22 (40%) low expressers. No significant correlation was found between connective tissue growth factor and tumour grade, tumour location, vascular and perineural invasion. Eighteen of 22 (82%) low/absent expressers and 12/33 (36%) high expressers had recurrence of disease (P=0.001). Low/absent expressers showed a poor disease free and overall survival compared with the higher expressers (P<0.001). Vascular invasion was related to tumour recurrence (P=0.025) and to decreased disease free survival (P<0.05). During proportional hazard regression analysis, only connective tissue growth factor was found to influence disease free survival (P=0.01). CONCLUSIONS: Expression of connective tissue growth factor is an independent prognostic indicator of both tumour recurrence and overall survival for intrahepatic cholangiocarcinoma patients regardless of tumour location, tumour grade, vascular and perineural invasion.

Adult↗
PubMed2003

Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre.

BACKGROUND: Differences in risk factors for survival and recurrence after liver resection for hepatocellular carcinoma (HCC) in patients with or without cirrhosis are not fully clarified. AIM: To review a single-centre experience of curative liver resections for HCC in order to evaluate clinicopathologic features and the long-term outcome of cirrhotic and noncirrhotic patients. METHODS: From 1981 to 2002, 308 curative liver resections for HCC on cirrhosis (Group 1) and 135 for HCC without cirrhosis (Group 2) were performed. The main demographic, clinicopathologic and operative parameters, as well as early results were analysed and compared. Overall and disease-free survival were evaluated. Prognostic factors for survival and for tumour recurrence were studied by univariate and multivariate analysis. RESULTS: Group 1 had worse preoperative liver function and higher frequency of hepatitis C virus infection. In Group 2, HCC showed larger mean tumour diameter (P < 0.001), poorer differentiation (P < 0.05) and more frequent macrovascular invasion (P < 0.05). Although more extended resections were performed in Group 2 (P < 0.001), there were no differences in blood transfusions, while post-operative complication rate was higher in Group 1 (P < 0.005). After 1992, in-hospital mortality was 2.9% in Group 1 and 1.1% in Group 2 (P = N.S.). The 3- and 5-year overall survival was 63.7% and 42.2% in Group 1, and 67.9% and 51% in Group 2 (P < 0.05). The 3- and 5-year disease-free survival was 49.3% and 27.8% in Group 1, and 58% and 45.6% in Group 2 (P < 0.005). Serum bilirubin level > 1.2 mg/dL, multiple nodules, micro and macrovascular invasion, diaphragm infiltration and blood transfusions independently affected survival in Group 1. Blood replacement was the only negative prognostic factor in Group 2. Independent risk factors for tumour recurrence were satellite nodules and resection performed before 1992 in Group 1, and age < 60 in Group 2. CONCLUSIONS: Despite a more aggressive behaviour, HCC without cirrhosis led to better overall and disease-free survival compared to HCC with cirrhosis after curative liver resection. Age and intra-operative blood transfusions are the only predictors of outcome in patients without cirrhosis. The impact of the latter on long-term survival in both our groups outlines the importance of surgical technique on the results of hepatectomies.

Adult↗
PubMed2001

Mechanisms and immediate outcome of in-hospital cardiac arrest in patients with advanced heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

To differentiate patients with congestive heart failure who are more prone to develop malignant ventricular tachyarrhythmias or severe bradyarrhythmias as the terminal event, we retrospectively evaluated a group of 48 patients with advanced heart failure who experienced a monitored cardiac arrest during hospital stay. We found no significant differences with respect to several variables, apart from clinical status, which was worse in patients whose cardiac arrest was precipitated by severe bradycardia or electromechanical dissociation.

Adult↗
PubMed2000

Clinical feasibility of low energy internal atrial cardioversion with a three-electrode configuration in patients with unsuccessful conventional configurations.

Low energy internal cardioversion is a safe and highly effective method for atrial fibrillation termination. We will describe 6 patients in whom the conventional 2-electrode systems with the defibrillation leads positioned in the right atrium and in the coronary sinus or left pulmonary artery failed to terminate the arrhythmia despite the use of maximal available energies. A 3-electrode configuration including right atrium, coronary sinus and left pulmonary artery was used in order to encompass as much atrial mass as possible between the cathode and the anode. The atrial fibrillation was successfully interrupted in 4 out of 6 patients. The creation of a 3-electrode configuration may be a further technical expedient in order to increase the success rate of internal cardioversion when usual manoeuvres like lead repositioning, reversion of polarity, or addition of antiarrhythmic drugs are ineffective.

Aged↗
PubMed1998

An appraisal of percutaneous treatment of liver metastases.

Percutaneous treatments, such as ethanol injection and radiofrequency, have been recently proposed for the treatment of liver metastases. The aim of this study was to evaluate the effects of these treatments in a series of 8 patients who subsequently underwent liver resection. These patients had been treated with percutaneous methods between December 1995 and May 1997. In 6 patients, the primary tumor was colonic; in 2 patients, carcinoid; and in 1 patient, ileal leiomyosarcoma. The lesions were all initially small in size (1.5 to 3.5 cm), single in 7 patients, and multiple in 1 patient with a carcinoid tumor. The initial decision for percutaneous treatment had been made on subjective grounds by the radiologists who originally saw the patients. The number of percutaneous treatment sessions ranged from 2 to 21. In all patients, a progression of the disease occurred. Four patients underwent a right hepatectomy; 1 patient, a left lobectomy; 2 patients, a segmentectomy; and 1 patient, a wedge resection. There was no operative mortality in any of these 8 patients. Two patients presented with seeding of the neoplasm on the diaphragm, which was resected. Histologic examination of all surgical specimens revealed the presence of vital neoplastic tissue; only two specimens of carcinoid tumors showed more than 50% necrosis of the nodules treated percutaneously. These results led us to express doubts as to the efficacy of percutaneous ablative treatment for liver metastases.

Carcinoid Tumor↗
PubMed1998

Adjuvant adoptive immunotherapy with tumour-infiltrating lymphocytes and modulated doses of interleukin-2 in 22 patients with melanoma, colorectal and renal cancer, after radical metastasectomy, and in 12 advanced patients.

Adoptive tumour infiltrating lymphocytes (TIL) in combination with a modulated dosage of interleukin-2 (IL-2) can be used with acceptable toxicity in the treatment of immunogenic tumours. Following an experience of reinfusion in advanced melanoma, colorectal and renal cancer patients, treatment was given to disease-free patients after metastasectomy. The high risk of relapse and favourable ratio between reinfused TIL and possible microscopic residual disease determined this choice of adjuvant treatment. A group of 12 patients with advanced disease (7 melanoma, 4 colorectal carcinoma, 1 kidney carcinoma) were treated with TIL (median 5.8 x 10(10) cells) and IL-2 (West's schedule) modulated towards a lower dosage (from 12 to 6 MIU/day) in order to maintain an acceptable level of toxicity. As treatment was well tolerated, it was offered to another 22 patients in an adjuvant setting after metastasectomy (11 melanoma, 10 colorectal carcinoma, 1 renal cancer), the median dose of TIL reinfused being 4.95 x 10(10) cells. No objective response was observed in advanced patients: all patients progressed after a median of 1.5 months (0-8 months) and median survival was 8 months (3-22+ months). Thirteen patients from the second group are still disease-free after a median of 23+ months (9+ - 47+ months). The remaining 9 patients relapsed after a median of 5 months (3-18 months). Toxicity was moderate as clinical and hepatic/renal function parameters were used to assess the need for dose reductions. Consequently, there was great diversity in IL-2 dosages administered. In particular, there seemed to be a difference in IL-2 doses administered between disease-free cases and those who progressed (17.5 MIU/day versus 7 MIU/day in melanoma patients; 11.2 MIU/day versus 7.1 MIU/day in colorectal cancer patients). By contrast, no differences were observed between number of TIL reinfused and clinical response. Phenotypical characteristics of reinfused TIL were similar to those reported in the literature: 97% were CD3 and 92% were CD8. Aspecific cytolytic activity was evaluated on 12 cases whereas, in 2 melanoma cases, autologous tumour tissue was available for the specific cytotoxicity test. Perforin levels in TIL measured at the end of culture were generally high or very high. Cytokine levels were measured on the supernatant at the end of culture, with an estreme variability in results. Finally, delta chain and p56lck were histologically assessed on the resected tissue from which TIL were cultivated. There were virtually none of the former and a complete absence of the latter, which concurs with data reported in the literature. The same immunocytochemical analysis was carried out on TIL at the end of culture. This time an almost complete restoration of both functions was seen, especially in melanoma patients, who are still free from disease. The study is on-going and it has been decided to focus on disease-free patients after metastasectomy in order to increase the number and possibility of clinical and histological correlations.

Adolescent↗
PubMed1998

Blind extrathoracic subclavian venipuncture for pacemaker implant: a 3-year experience in 250 patients.

We report our 3-year experience using a modification of the percutaneous technique for extrathoracic subclavian venipuncture proposed by Magney and colleagues for permanent pacing lead placement. Before surgery bony landmarks were marked on the skin according to Magney's description to identify the needle entry point and the target point corresponding to the ideal location of the extrathoracic portion of the subclavian vein. Then the venipuncture was accomplished by inserting the needle through a standard infraclavicular pacemaker pocket. Two hundred fifty patients undergoing primary pacemaker implant (231 patients) or reimplant or change of mode of pacing (19 patients) were included in the study. The technique was successful in 245 (98%) cases. Inadvertent puncture of the subclavian artery occurred in 5 (2%) patients but in no case did it jeopardize the success of the implant procedure. No major complications were observed. Seven (2.9%) patients experienced early complications unrelated to the venous approach: 2 subclavian vein thrombosis, 5 lead dislodgment in 4 patients, and 1 pocket hematoma. During a mean follow-up of 15.2 months (range 4-40) no lead or patient related complications occurred. In the present study the blind approach to the extrathoracic portion of the subclavian vein proved to be safe and effective for pacing lead insertion. Further observations are required to establish whether this method extends the lead survival.

Aged↗
PubMed1998

Worsening of head-up tilt test response during chronic beta-blocker therapy in patients treated for neurally mediated syncope.

The prognosis of patients with neurally mediated syncope and asystolic response at tilt test is controversial and there is no consensus regarding their management. Many patients seem to benefit from beta-blockers and their effectiveness has been assessed with repeated tilt tests in asystolic patients as well. However, little is known about the long-term effects of beta-blockers. Preliminary data and isolated reports suggest that in some cases, these agents may actually worsen the clinical outcome or the tilt test response. Three patients are described who experienced worsening of tilt test response with prolonged asystole (19.9, 9 and 5.5 sec respectively) during chronic treatment with beta-blockers in the absence of spontaneous symptoms. At discharge, one patient received a dual-chamber pace-maker combined with metoprolol, another one continued to take metoprolol and enalapril. The third patient refused any further medication. During follow-up (8, 11, 13 months respectively), they were symptom-free. The clinical and prognostic significance of this response is not clear and needs further investigation.

Adrenergic beta-Antagonists↗
PubMed1997

Thyroid carcinoma in children and adolescents.

UNLABELLED: A clinical and pathological study was undertaken to define the prevalence, clinical presentation and outcome of thyroid carcinoma in children and adolescents. Clinical records from 48 patients under 20 years of age at diagnosis, out of 372 patients with thyroid cancer examined between 1980 and 1994, were retrospectively reviewed. Female/male ratio was 3.8/1. None had a previous positive history of head and neck irradiation. Patients underwent near-total (44 patients) or partial (4 patients) thyroidectomy followed by 131I ablation of residual thyroid tissue. The mean follow up period was 58.4 months, ranging between 2 and 190 months. Clinically a thyroid mass was present in 41 patients, 28 of whom also showed neck lymph node involvement. Node metastases were present in 50% of the patients and lung metastases in 4.2%. Histological type was papillary in 41, follicular in 6, and medullary in 1 case. Surgical complications were observed in 19 patients (40%). In 3 patients papillary thyroid cancer was associated with chronic lymphocytic thyroiditis. All patients were treated with 1-thyroxine suppressive therapy. Recurrences of cancer after surgical and radio-iodine treatment was observed only in one patient 8 months after surgery. CONCLUSION: Our experience demonstrates that thyroid carcinoma in childhood cannot be considered a rare occurrence, since it represents about 13% of all thyroid cancers, and is frequently associated with lymph node but rarely with distant metastases. Nevertheless, the prognosis of thyroid carcinoma in childhood is fairly good.

Adenocarcinoma, Follicular↗
PubMed1997

[Cardiomyopathy induced by tachycardia: description of a typical clinical case].

Different chronic tachyarrhythmias may cause a form of reversible myocardial dysfunction and left ventricular enlargement known as tachycardia-induced cardiomyopathy. Many authors in recent years observed that the control of heart rate or interruption of the arrhythmia were frequently associated with a significant improvement in ventricular function and a reduction of cardiac dimensions. We report a case of tachycardia-induced cardiomyopathy secondary to atrial fibrillation of unknown duration which occurred in a young patient with structurally normal heart. The regression of left ventricular enlargement and the recovery of left ventricular systolic function were complete few months after the restoration of sinus rhythm.

Adult↗
PubMed1996

Torsade de pointes occurring early during oral amiodarone treatment.

Amiodarone is reported to have a low incidence of proarrhythmic effects. They generally occur during chronic treatment in association with increase in amiodarone dosage, electrolyte disorders, or concomitant therapy with class IA antiarrhythmic drugs. We describe a case of amiodarone-induced torsade de pointes early after initiation of low-dose oral therapy, in absence of other predisposing factors.

Amiodarone↗
PubMed1996

[The electrotherapy of the arrhythmias in 3 cases of myotonic dystrophy (Steinert's disease)].

Myotonic dystrophy is a progressive multisystem disease with autosomal dominant inheritance. Cardiac involvement is an integral part of the disorder, the most prominent manifestations being various conduction defects and rhythm disturbances sometimes related to syncope or sudden cardiac death. We describe 3 cases admitted to our Centres. Two patients received a permanent pacemaker for atrioventricular block of different degree and in the third case an implantable cardioverter defibrillator with antibradycardia pacing was inserted for malignant ventricular tachyarrhythmias and advanced atrioventricular block during atrial flutter.

Adult↗
PubMed1996

[Post-operative hypothyroidism].

Hypothyroidism is not a rare condition, since it represents about 10% of thyroid diseases. It is more frequent in women (F/M = 5/1), and in patients older than 60 years of age. Postoperative hypothyroidism is secondary to thyroidectomy, and the incidence varies, with a reported range between 14% and 75%. This may be related to the amount of thyroid removed, the experience of the surgeon, age of patient, the function of remaining thyroid, and duration of postoperative observation. The analysis of our cohort of more than 23,000 thyroid patients showed a prevalence of hypothyroidism of 11.1%. Postoperative hypothyroidism represents about 39.7% of all hypothyroid cases, and 44% of patients underwent surgery. The prevalence is six fold higher in patients over the age of 60. Factors favoring development are the presence of lymphocytic infiltration of the thyroid and a positive serological test for thyroid antibodies. Overt hypothyroidism represented the largest proportion, prevailing in 60% of postoperative hypothyroid patients. In view of the insidious development of postoperative hypothyroidism in some patients, an accurate follow-up should be required, allowing an opportune treatment with LT4.

Adolescent↗
PubMed1995

Implantable defibrillation and thromboembolic events.

In ICD patients thromboembolic events (TEEs) are described as possible complications at implant or during the follow-up. We report four cases of TEEs (two peripheral and two cerebral; 6.5% of patients) that occurred in our series during a mean follow-up of 19.4 months. The patients had chronic postinfarction LV aneurysm (3) and idiopathic dilated cardiomyopathy (1). None had previous embolisms nor evidence of left atrial or LV clots at standard preoperative transthoracic echocardiography. No paroxysms of atrial fibrillation were documented prior or after ICD implant. We discuss the possible causes of embolization and the suitability of anticoagulant therapy in ICD patients.

Aged↗
PubMed1995

Congestive heart failure in patients with valvular aortic stenosis. A clinical and echocardiographic Doppler study.

The aim of this study was to evaluate echographically anatomic and functional features of the left ventricle in adult patients with valvular aortic stenosis according to the presence or absence of congestive heart failure and the level of ventricular performance. Fifty-six adult patients with moderate-to-severe aortic stenosis underwent echocardiographic Doppler examination in order to evaluate left ventricular mass and dimensions, systolic function and filling dynamics. Twenty-seven patients had no heart failure and were symptomatic for angina (5), syncope (4) or were symptom-free (group I); the other 29 had heart failure (group II): 16 with normal left ventricular systolic performance (fractional shortening > 25%, group IIa) and 13 with systolic dysfunction (fractional shortening < or = 25%, group IIb). Despite a similar left ventricular mass, compared to group IIa, group IIb showed a significant left ventricular dilatation (end-diastolic diameter: 61 +/- 6.5 vs. 45.5 +/- 6.1 mm, p < 0.001) and mild or no increase in wall thickness (11.5 +/- 1.6 vs. 14.9 +/- 2 mm, p < 0.001). Indices of left ventricular filling on Doppler transmitral flow were also significantly different between the two groups, with a higher early-to-late filling ratio and a shorter deceleration time of early filling in group IIb (2.8 +/- 1.9 vs. 1.2 +/- 0.85, p < 0.01, and 122 +/- 66 vs. 190 +/- 87 ms, p < 0.05, respectively), both indirectly indicating higher left atrial pressure. Finally, heart failure was generally more severe in group IIb patients. In some patients with aortic stenosis, symptoms of heart failure may be present despite a normal left ventricular systolic function and seem to depend on abnormalities of diastolic function. The presence of systolic or isolated diastolic dysfunction appears to be related to a different geometric adaptation of the left ventricle to chronic pressure overload.

Aged↗
PubMed1993

Prevalence of aortic valve stenosis in patients affected by gastrointestinal angiodysplasia.

OBJECTIVES: Angiodysplasia is considered to be an important cause of gastrointestinal bleeding in the elderly. An association between idiopathic gastrointestinal bleeding and aortic valve stenosis has been reported in up to 25% of the patients. The association between angiodysplasia mainly of the right colon and aortic valve stenosis has been suggested, but is not proven. The aim of this study was to examine the prevalence of aortic valve stenosis in patients with gastrointestinal angiodysplasia. METHODS: We studied retrospectively 83 patients submitted to gastrointestinal endoscopy and found affected by angiodysplasia. Of them 24 (16M and 8F) had died from causes unrelated to cardiovascular diseases. The 59 patients still alive (27M and 32F) underwent a complete clinical, electrocardiographic and echocardiographic (M-mode, B-mode, pulsed and continuous-wave Doppler) evaluation. RESULTS: Fifteen patients (25%) had a normal examination, both clinical and echocardiographic. Eleven (19%) had minor cardiac abnormalities but had no murmurs. Although no murmurs were present in 15 patients (25%), some echocardiographic abnormalities such as aortic leaflet sclerosis, mitral annular calcification, their association, or trivial mitral regurgitation detectable only at PW-Doppler were found. In 18 patients (31%) both systolic murmurs and valvular abnormalities, as revealed by echocardiographic examination, were detected: 10 had a regurgitant and 8 an ejectional murmur; of these only 1 (1.6%) had a true severe calcified aortic valve stenosis at echo-Doppler examination. CONCLUSIONS: The low prevalence of aortic valve stenosis in patients with gastrointestinal angiodysplasia (1/59 or 1.6%) in this retrospective study argues against the association of gastrointestinal angiodysplasia and aortic valve stenosis.

Aged↗