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A Grassi

Publications and source records attributed to A Grassi.

At least 37 records · Page 2Linked to original sources
PubMed1997

Quantitative liver parameters of HCV infection: relation to HCV genotypes, viremia and response to interferon treatment.

BACKGROUND/AIMS: This study aimed to evaluate the relation between the number of hepatocytes positive for HCV antigens and the amount of HCV RNA in the liver and to evaluate the relationship between the above parameters and viremia levels, HCV genotype and response to interferon treatment. METHODS: This was a retrospective study on 31 consecutive patients with chronic HCV-related liver disease, selected on the basis of the availability of frozen liver tissue for both liver HCV antigens detection and liver HCV RNA quantitation. HCV antigens (immunohistochemistry), liver and plasma HCV RNA (competitive RT-PCR), and HCV genotype (commercial kit) were studied. RESULTS: A significant correlation (p=0.0005) was found between the amount of liver HCV RNA (log 10 copy/microg of extracted RNA) and the number of HCV-infected hepatocytes (scored from 0 to 3). These parameters were not significantly correlated with viremia levels. The highest liver HCV RNA levels and HCV antigen scores were found in patients infected with genotype 1b. Liver HCV RNA (median 541 x 10(3) vs 118 x 10(3) copy number/microg, p=0.031) and liver HCV antigens (mean score 2.3 vs 1.3, p=0.018) but not plasma HCV RNA (median 14956 x 10(3) vs 2885 [correction of 2.885] x 10(3) copy number/ml, ns) were significantly higher in patients not responding to interferon treatment compared to responders. CONCLUSIONS: The tissue parameters tested in this study were significantly correlated, shared the same clinical implications and predicted short-term response to interferon treatment better than viremia levels. We suggest that these tests should be included in the study protocol of patients under evaluation for interferon treatment, basing the choice on local facilities.

Adult↗
PubMed1997

Clinical implications of GBV-C/HGV infection in patients with "HCV-related" chronic hepatitis.

BACKGROUND/AIMS: To evaluate the clinical, biochemical and histological implications of a concomitant HGV infection in "HCV-related" chronic liver disease. METHODS: Eighty-three HCV-RNA positive patients with chronic liver disease were tested for GBV-C/HGV coinfection by heminested PCR. RESULTS: Twenty-two (26.5%) patients were found to be positive for GBV-C/HGV RNA. GBV-C/HGV+ patients differed significantly from GBV-C/HGV- ones for younger age, higher frequency of history of drug addiction, which in turn might favor coinfection with interferon-sensitive HCV genotypes (3a), and increased probability of long-term response to interferon. GBV-C/HGV infection appears to have no responsibility for specific aspects of HCV infection such as biochemical or histological cholestatic features, lymphoid follicles, symptomatic cryoglobulinemia or presence of serum autoantibodies, including LKM1. It does not worsen the HCV-related disease (ALT levels and histological activity) and does not significantly interfere with HCV infection, as explored by the number of hepatocytes positive for HCV antigens. The amount of steatosis (mean score) was shown to be higher in GBV-C/HGV+ patients. A virological follow up was performed in 17 interferon-treated GBV-C/HGV+ patients On the whole, GBV-C/HGV seems to be as sensitive to IFN treatment as HCV, but recurrence after withdrawal is more frequent. In spite of this, ALT levels often remain normal after treatment withdrawal. CONCLUSIONS: The present data suggest that GBV-C/HGV infection, apart from more marked liver steatosis, does not modify the overall picture of chronic hepatitis due to HCV infection.

Adolescent↗
PubMed1997

Rapid detection of neonatal sepsis using polymerase chain reaction.

Clinical diagnosis of sepsis in newborn infants is not easy and there is no laboratory test with 100% specificity and sensitivity, with the exception of blood culture, the results of which are not available for at least 48-72 h. Polymerase chain reaction methodology has been used to diagnose different bacterial, viral and protozoal infections, and the possibility of amplifying the DNA region common to all bacteria could represent an optimal method for the diagnosis of sepsis. The authors have performed PCR in a group of 33 neonates at risk for early-onset sepsis, correlating molecular data with blood culture results. The presence of bacterial DNA in blood samples was evaluated, amplifying the DNA region encoding the 16S rRNA. There were no false negative results (four positive blood cultures and four positive PCR), with competitive costs and time. This method also allows the diagnosis of sepsis due to uncommon species and also, using a second PCR with specific primers, an aetiological diagnosis.

DNA, Bacterial↗
PubMed1997

Medium-large polyps of the colon: a contribution for their clinical profile and a proper surveillance.

A retrospective analysis of polypoid lesions of the colon larger than 1 cm was performed with the aim to study their characteristics and a proper surveillance schedule. We reviewed all colon polypoid lesions larger than 1 cm found and treated during the period January 1984- December 1993 that were not considered cancer macroscopically. The records of 361 patients with 391 polyps are the object of this report. The polyps were divided into subgroups according to size: A) less than 20 mm, B) between 21 and 30 mm, and C) larger than 30 mm. Out of 391 polypoid lesions 373 were adenomas: 60% were found in males. The age group distribution showed no differences among the subgroups. The pedunculated type showed a decrease from 69.1% to 43.3% with the increasing of size: inverse figures were observed for sessile polyps. The lesions were mainly located in left colon. Synchronous adenomas were found in 25.4% patients, and metachronous and previous adenomas respectively in 24.8% and 5.2%: no significant difference was present in the subgroups. Synchronous malignancy in the colon was found in 2% of the patients. Histological characteristics demonstrated a decrease of tubular adenoma from 46.5% to 22.6% from subgroup A to C, while villous adenomas increased inversely from 6.6% to 15.1%. The presence of severe dysplasia ranged from 20.9% to 56.1% in subgroups A and C, respectively, and adenomas with invasive cancer showed a significant increase from the subgroup A to C, respectively from 4.3% to 10.5%. During an average 36-month follow-up we observed 2 metachronous colon cancers, surgically treated in Dukes stage B, 84 metachronous adenomas, all less than 10 mm and without malignant alterations. Our data confirm other literature reports regarding the profile of colon adenomas with an increasing risk of malignancy with the increase of size and the presence of villous structure. In our opinion the assessment of a "clean colon" status is important when an adenoma is found in the colon. The proper follow-up for adenomas must be tailored for any individual patient when risk factors such as size, villous structure, personal and family history of neoplastic lesions of the colon are present. The follow-up schedule, presently recommended for colon adenomas, must be flexible according to these parameters.

Adenoma↗
PubMed1997

[Diagnostic and therapeutic problems in tubal adenocarcinoma. Report of a case].

Primary adenocarcinoma of the Fallopian tube is one of the most rare tumours: its incidence varies from 0.5% to 1.1% of all gynecological neoplasias. In 1988 a total of 1,200 cases had been reported, the majority grouped in small series and/or individual case reports. The first case was reported by Renauld in 1847. The preoperative diagnosis has increased over the past forty years from 0.26% to 6.38%, and is still extremely low. The diagnosis of primary adenocarcinoma of the uterine tube is basically achieved by exclusion, and in fact the metastasization of the tubes by adjacent gynecological organs must be excluded. The trio of abdominal pain, leukorrhea, metrorrhagia is regarded by many authors as being pathognomonic of tubal adenocarcinoma. In about half of patients the interval between the onset of symptoms and histological diagnosis is 2-3 months, and in 30% less than one month. The authors report their experience of a case in a 62-year-old patient with typical symptoms of primary tubal adenocarcinoma.

Adenocarcinoma↗
PubMed1997

[Proposed medical record to be used in rape cases. New diagnostic and medicolegal aspects].

The latest report of 1996 on human development in the UN development programme (UNDP) states that 130,000 women are raped every year in the industrialized countries. Illegal "violation" is defined as the sexual penetration of any orifice of the body without the victim's consent. The doctor's contribution is essential in order to ascertain this offence. It can be divided into two stages: precise and complete (... missing? ...) information regarding the sexual aggression which might have taken the form of rape. Management of a rape case represents an extremely complex undertaking for the doctor since it involves medical and legal aspects and requires a number of interventions that lead to a rational evaluation and appropriate treatment. In this context, the doctor's role is not only to protect the psychophysical integrity of the victim, but also to contribute, following an early diagnosis of sexual aggression, to the identification of the particulars of an offence which still risks remaining unpunished, owing to the difficulty of diagnosis and in spite of the recent enactment of Law no. 66 on 15 February 1996. The medical record proposed by the authors consists of a descriptive anamnestic part and a graphic part, thus making the evaluation of the victim more rapid and precise. The proposed medical record is subdivided into anamnesis, objective examination, psychological examination, laboratory tests, any consultancy requested and therapy.

Female↗
PubMed1997

Turcot syndrome: case report and nosological aspects.

The Turcot syndrome has been defined as the simultaneous presence of multiple polyposis of the colon and a malignant brain tumor. This association is supposed to be genetically transmitted, even though we still do not exactly know whether this occurs in a dominant or recessive way. The case of a 47-year-old man submitted to a right hemicolectomy for cancer and polyposis, following a series of endoscopic polypectomies and, finally, removal of left temporal glioma is here presented.

Adenomatous Polyposis Coli↗
PubMed1997

[Preliminary diagnostic evaluation of submucosal myoma using operative hysteroscopy].

BACKGROUND AND AIM: The authors aim to underline the importance of preliminary diagnostic evaluation in the treatment of submucous leiomyoma using hysteroscopy. MATERIALS AND METHODS: The study examined 18 patients monitored at the Institute of Obstetrics and Gynecology of "La Sapienza" University of Rome between January and December 1995 in whom it was possible to make a correct definition of the lesion to be treated (number, site, size, etc.) using 3 different diagnostic methods: hysteroscopy (HS), transvaginal scan (TSV) and transvaginal echohysterography (TVHS) The authors focused attention on three different parameters: leiomyoma size, extension (intracavity/intramural portion) and evaluation of the residual leiomyoma, which are essential for optimal endoscopic resection. RESULTS: HS enabled the number, size, site, origin, base, submucous portion and relations with tube operings to be evaluated, but did not allow the myometrial part of the lesion to be examined. CONCLUSIONS: Integration with TSV, even if this does not allow a precise definition of the extension, highlights the size, site, involvement of myometrial structure and relations with the perimetrium, thus allowing the possibility of evaluating the residual myometrium. Compared to the above methods, TVHS highlights the effective extension (namely the submucous/intramural portion) and localization of the neoformation.

Adult↗
PubMed1996

Platelet-derived microvesicles in thrombotic thrombocytopenic purpura and hemolytic uremic syndrome.

Thrombotic thrombocytopenic purpura (TTP) and the related hemolytic uremic syndrome (HUS) are disorders characterized by thrombocytopenia, microangiopathic hemolytic anemia, a variable degree of impairment of renal function and fluctuating neurological symptoms, which are thought to be due to platelet activation and subsequent formation of thrombi in the microcirculation. Since platelet activation is accompanied by the generation of microvesicles (PMPs), we determined their presence in patients with TTP and HUS by flow cytometry. The analysis was performed in whole blood, using FITC-conjugated monoclonal antibodies (CD 42b and/or CD 61a). PMPs were discriminated from platelets on the basis of size and fluorescence profiles. Their levels in 21 normal controls ranged between 2.4% and 9.4% (mean +/- SD: 5.2 +/- 1.99%). No correlations were found with platelet number. PMPs were then evaluated in 13 patients with TTP and 2 cases of HUS. In all patients they were found higher than in controls, ranging from 11.0 to 91.1% (45.0 +/- 26.0%; p = 0.0001 vs controls). PMPs were serially measured in patients with TTP: at diagnosis a correlation between PMPs and platelet number was found (R]2 = 0.669) and the time-course showed that the improvement of both microangiopathy and clinical manifestations of cerebral and renal involvement was accompanied by a progressive normalization of PMP levels and platelet count. PMP levels were measured also in patients suffering from other forms of thrombocytopenia: they were 17 patients with idiopathic thrombocytopenic purpura and 10 patients with acute leukemias and severe thrombocytopenia during the aplastic phase following chemotherapy. PMP ranges were: 2.0-79.6% (21.6 +/- 20.8%; p = 0.001 vs controls) and 4.6-12.5% (8.8 +/- 2.4%; p = 0.0001 vs controls), respectively. No correlations were found between platelet number and the absolute number of PMPs in these 2 groups of patients. These findings show that increased levels of PMPs may be found in peripheral thrombocytopenias and suggest that their presence may be clinically relevant, particularly in the microangiopathic forms.

Adolescent↗
PubMed1996

[Pancreatic beta-cell hyperplasia in adults. A clinical case].

The author describe a rare case of pancreatic beta-cell hyperplasia. The patient was referred to us because of serious hypoglycemic crises. During hospitalization, endogenous hyperinsulinism was confirmed by hematochemical and instrumental tests. AngioCT of the pancreas evidenced a small lesion of the corpus, suspected of insulinoma. The patient underwent a corpus caudalis pancreatectomy: a small nodule with histologic neuroendocrine traits was ablated. A few days after the operation, new symptomatic hypoglycemia appeared. The hormonal tests confirmed a recurrence of endogenous hyperinsulinism. The patient underwent a new operation for pancreaticoduodenectomy: histological examination confirmed a pancreatic beta-cells hyperplasia. This condition has to be taken into account in the differential diagnosis of post prandial hypoglycemia. Besides, the observation of an insulinoma doesn't exclude the presence of a diffused disorder of islet cells as in the case above described.

C-Peptide↗
PubMed1996

[Insulin, vascular reactivity and hypertension].

Several epidemiological studies have shown that there is a relationship between hyperinsulinemia, insulin resistance and arterial hypertension. Insulin produces sympathetic nervous system stimulation, enhances renal sodium retention and it directly modifies vascular mechanisms involved in both contraction and relaxation of the vascular smooth muscle. These actions of insulin could lead either to elevation or reduction of blood pressure. The absence of vasodilation due to insulin resistance and/or the enhancement of the hypertensive effects due to hyperinsulinemia could be the link between insulin and hypertension.

Animals↗
PubMed1996

[Effect of insulin on contractile response and calcium binding in rat aorta].

UNLABELLED: Insulin affects physiological mechanisms involved in blood pressure regulation, and at the cellular level modifies endothelial and vascular smooth muscle functions underlying the changes in peripheral resistance. We describe the effects of preincubation with insulin (40 microU/ml for 1-2 hs) on the contractile reactivity of intact rat aortic rings and on 45Ca2+ uptake of EGTA-hyperpermeabilized rat aortic segments. Preincubation with insulin did not affect either contractions induced by 1 microM of NA, or their relaxation induced by 10 mM of caffeine. The contractile response to 1 microM of Ang-II (which in rat aorta is endothelium-independent) was stimulated by insulin preincubation resulting in increases of both maximal developed force and velocity of its spontaneous relaxation. The difference in 45Ca2+ uptake between insulin-treated and insulin-untreated aortic segments was greater at 5 minutes than it was at 30 minutes. CONCLUSIONS: Insulin preincubation affects directly the mechanical response of Ang-II stimulated aortic smooth muscle; we suggest that the modification of SR function is one of the mechanisms involved in insulin regulation of cytosolic Ca2+.

Angiotensin II↗
PubMed1995

[Hysteroscopy in septate uterus. Diagnostic and therapeutic features].

Personal experience of diagnostic and operative hysteroscopy of septate uterus is reported. The diagnosis of septate uterus is an integrated diagnosis that makes use of hysterosalpingography, echography, hysteroscopy and laparoscopy. Of 545 hysteroscopies carried out between January and December 1993, 29 evidenced uterine septum, complete in 6 cases, incomplete in the remaining 23. Of the 29 patients, 7 underwent resection of the septum by the hysteroscopic route. No intra or postoperative complications worthy of note were observed. At follow-up after one month, the uterine cavity in 5 patients proved completely regular while in the remaining 2 one case of fundic fibrous synechia and one of small persistent fibrous bridge, of little importance within the context of the cavity, were observed. The purpose of the present paper is to demonstrate the twofold role of hysteroscopy with regard to the septate uterus; is that hysteroscopy is a diagnostic and a precise operative technique that is atraumatic, fast and of low cost.

Adolescent↗
PubMed1995

Diagnostic methods of early detection of endometrial hyperplasia and cancer.

Endometrial carcinoma is the most frequent genital neoplasia in women. Our own experience is based on a group of 3310 patients who were studied between 1985 and April 1994. In 2148 cases, equivalent to 56.4%, hysteroscopy was performed because of the presence of abnormal uterine bleeding (AUB). We found 672 endometrial hyperplasia (601 low risk-71 high risk) and 93 endometrial carcinoma. According to our experience we can assert that: hysteroscopy allows the measurement of the extension of the intracavitary neoplastic pathology and the definition of its topographic map; it is the only method that allows a target biopsy; it facilitates the evaluation of the extension of the neoplasia in the cervical canal, with the help of a deep biopsy into the cervical tissue (as proposed by La Sala) increasing its diagnostic accuracy.

Aged↗
PubMed1995

[Significance of lactose breath test in the newborn].

Lactose breath test have been performed in healthy newborns, in whom breath hydrogen excretion was preliminarily demonstrated by lactulose breath test. 27.5% of newborns showed positive lactose breath test, with no differences related to sex and gestational age, while a higher percentage of positive test has been found in < 2500 g and formula-fed neonates compared, respectively, to > or = 2500 g and breast-fed ones. In healthy newborns, without any clinical signs of lactose intolerance, it is possible to demonstrate hydrogen in expired air; this is not equivalent of lactose malabsorption, but, instead, depends on the phenomenon of colonic fermentation that allows energy and nutrient absorption.

Breath Tests↗