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Biomedical subjects

A Mazzotta

Publications and source records attributed to A Mazzotta.

At least 37 records · Page 2Linked to original sources
PubMed1993

Effect of rehydration on guaiac-based faecal occult blood testing in colorectal cancer screening.

Screening for colorectal cancer by means of unhydrated Hemoccult (HO) is in progress in the Province of Florence since 1982. In 1990 rehydrated HO was introduced in the town of Empoli. Five adjacent municipalities where screening had started in 1987 were selected for comparison. In both areas subjects aged 40-70 were invited by mail to undergo the screening protocol. HO-positive subjects were invited to undergo either pancolonoscopy or a combination of left colonoscopy and double contrast barium enema. HO-negative subjects were invited to repeat screening 2 years later. The positivity rate of HO was significantly higher (P < 0.001) for rehydrated (5%) as compared to unhydrated (3.1%) HO. The positive predictive values for cancer (unhydrated: 5.8%; rehydrated: 8.9%) and for adenomas (unhydrated: 26.7%; rehydrated: 25.5%) did not significantly differ. The detection rates of rehydrated HO were significantly higher as compared to unhydrated HO both for cancer (0.37% vs 0.15%; P < 0.05) and adenomas (1.06% vs 0.72%; P < 0.05%). In the present experience rehydration doesn't produce any decrease in the positive predictive value for cancer or adenomas and the increase in the positivity rate appears quite acceptable when considering the significant increase in the detection rates of cancer and adenomas. We conclude that rehydrated HO should be introduced as the standard test for screening in order to increase sensitivity for colorectal cancer and adenomas.

Adenoma↗
PubMed1993

New reinfusate composition in high UF haemodiafiltration: electrolyte solution combined with bicarbonate.

When high-permeability membranes are employed, high UF should be used in order to obtain optimal uraemic toxin removal and to avoid backfiltration. A high UF requires the infusion of an electrolyte solution including Ca2+ and Mg2+ which cannot be associated with bicarbonate in prepackaged solutions because of the risk of precipitation; therefore acetate or lactate are used as buffers. This study evaluated whether bicarbonate can be infused together with an electrolyte solution in high UF HDF, and if so, the clinical advantages that could be obtained by substituting acetate with bicarbonate in the reinfusate. In 12 patients on postdilutional high UF (121 +/- 10 ml/min) HDF (Qb 400, Qd 500 ml/min, dialysate containing Na, 141 +/- 2; K, 2.5; Ca, 3.5; Mg, 0.7; Cl, 111 +/- 2; acetate, 3; bicarbonate, 34 mEq/l; TMP 400 mmHg), an acid bag (Na, 128; K, 4; Ca, 7; Mg, 2; Cl, 141; acetate, 8 mEq/l), and a basic bag (Na, 150; HCO3, 80; Cl, 70 mEq/l), each containing 2 litres, were simultaneously infused through a Y connection. The final composition of reinfusate at the drip-chamber, combined with the above dialysate, allowed a negative intradialytic mass balance for Na, K, Mg and a positive one for Ca, acetate, to maintain prepostdialytic plasma values of these ions as well as bicarbonate close to normal limits. Furthermore, in five high-risk patients, clinical data were evaluated on high UF HDF, infusing a solution containing either acetate or bicarbonate, and an improvement of vascular stability was observed with the bicarbonate reinfusate.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1993

[Clinico-echographic screening in the early diagnosis of prostatic carcinoma. Preliminary results of a feasibility study of a randomized trial].

The preliminary results of a feasibility study of a randomized trial for the early detection of prostate carcinoma are reported. 4,229 healthy men aged 60-75 years were invited to undergo digital rectal examination (DRE) and transrectal ultrasonography (TRUS); 1,284 of them responded and were thus examined. Subjects with suspicious findings at DRE and/or TRUS underwent transperineal US-guided biopsy and prostate-specific antigen (PSA) determination. Subjects with equivocal findings were controlled after 6 months with DRE, TRUS and PSA. The screening program was rather simple (examination time < 10') and cost was limited (cost x subject = US $25). So far, 27 biopsies (2.1%) have been performed. Eighteen cancers have been detected (1.41%), the prevalence/expected incidence ratio being 10.6:1. Stage at diagnosis was B1 in 12, B2 in 3, C in 2 and D in one case, respectively. Cancer had been suspected at DRE in 12, at TRUS in 17 and at PSA (cutoff = 4 micrograms/ml) in 15 of 18 cases, respectively. This study provides evidence that screening for prostate cancer is feasible at a moderate cost and diagnostic anticipation is relevant. A prospective randomized trial is needed to assess whether early detection has any impact at all on mortality. When designing such a study, the effect of compliance, which was low in our experience, on the statistical power should be carefully evaluated. The possibility of pre-screening with PSA, which is much more accepted and might improve attendance rates, should also be evaluated by specific studies.

Aged↗
PubMed1989

Improvement of anemia in patients on chronic dialysis treated by hemodiafiltration.

A group of patients with severe anemia on standard hemodialysis were transferred to polyacrylnitrile hemodiafiltration (HDF), which was arranged in order to obtain an ultrafiltration rate (UF) higher than 100 ml/min. During HDF, despite a significant reduction of the dialysis time, all patients had a significant decrease of predialytic BUN and serum creatinine, and a significant improvement of anemia. Furthermore, a close direct correlation was detected between the percent increase of hemoglobin and the length of time on HDF. Therefore, high-UF HDF represents a valid dialytic strategy to improve anemic states, permitting a significant reduction of the dialysis time and, thus, offering a better life quality for the patients.

Anemia↗
PubMed1988

Improved bone morphology by normalizing serum magnesium in chronically hemodialyzed patients.

The dialysate magnesium concentration (dMg) was reduced from 1 to 0.5 mEq/l in a group of patients on chronic hemodialysis (RDT). Serum parameters and bone biopsy findings were evaluated before and after a 1-year period on the lower dMg. All patients were receiving only calcium carbonate before and during the study period. Serum magnesium (sMg) decreased significantly and fell in the normal range with low dMg, whereas the other serum parameters did not change significantly except serum phosphorous which increased, still remaining within the normal limits. Furthermore, a significant reduction of the osteomalacia pattern (evaluated by osteoid volume, osteoid surface and osteoid thickness index) was observed in all patients after 1 year on dMg of 0.5 mEq/l, whereas there was no significant variation in bone resorption patterns (resorption surface and osteoclasts). Therefore, normal sMg is recommended in RDT patients, by arranging their dMg according to individual need, in the hypothesis that high bone Mg content, attributed to hypermagnesemia, could interfere with the mineralization process.

Adult↗
PubMed1986

The optimal use of PAN membrane in RDT.

In order to compare the efficiency of PAN (Biospal 3000S) for small molecules, Cr, BUN, UA and Pi clearances were determined during hemodiafiltration with both pre and postdilution fluid (PreHDF, PostHDF) and during biofiltration in 3 regular dialysis treatment patients. The highest clearances were obtained during PostHDF. Therefore, since the small molecules are still considered the most important toxins in chronic renal failure, these findings indicate that optimal use of PAN is with PostHDF, in which high diffusion and convection are combined, in order to obtain best dialytic efficiency.

Acrylic Resins↗
PubMedDate not supplied

Comparing two modalities of screening for prostate cancer: digital rectal examination + transrectal ultrasonography vs. prostate-specific antigen.

AIMS AND BACKGROUND: To evaluate the performance and feasibility of screening for prostate cancer by comparing screening modalities. METHODS: Prospective study of two comparable cohorts of healthy resident males aged 60 to 75 years. Screening attenders in the two invited cohorts were screened either by digital rectal examination (DRE) and transrectal ultrasonography (TRUS), or by serum prostate-specific antigen determination (PSA: cutoff 4 ng/ml). Attendance and biopsy rates, predictive values, prevalence of screen-detected cancers, as well as screening costs were determined, and the efficiency of the two screening modalities was compared. RESULTS: 1425 subjects were screened by DRE+TRUS. Attendance rate was 33.7%, the biopsy rate was 2.7%, and the prevalence of detected cancers was 1.82%. A total of 1315 subjects was screened by PSA. Attendance rate was 66.9%, the biopsy rate was 2.8%, and the prevalence of detected cancers was 1.67%. Screen-detected cancer stage was more favorable than observed in clinical practice, and early detection was evident, with the prevalence/incidence ratio higher than 10:1 in both programs. The cost per subject screened was about 34,000 Lire for DRE+TRSU and about 30,000 Lire for PSA program. CONCLUSIONS: The study confirms that early detection of prostate cancer is possible and that screening is practically feasible. Both screening modalities achieved comparable results as regards early detection, but screening by PSA had a higher compliance and lower costs. PSA seems the ideal test to be used in prospective controlled studies aimed at demonstrating screening efficacy.

Aged↗
PubMedDate not supplied

A feasibility study of screening for endometrial carcinoma in postmenopausal women by ultrasonography.

BACKGROUND: Abnormal endometrial thickness assessed by ultrasonography has been reported as a reliable indicator for early asymptomatic endometrial carcinoma. STUDY DESIGN: We evaluated the feasibility and the performance of screening by ultrasonography in a consecutive series of postmenopausal volunteers. RESULTS: A total of 2,025 women were screened, and 117 (5.8%) showed abnormal endometrial thickness. Ninety-eight subjects consented to be assessed by outpatient endometrial biopsy, which was not possible in 32 for cervical stenosis. Three cancers were detected among 66 assessed subjects, 34 not-assessed subjects were controlled by repeat sonography (no change), and 17 were lost to follow-up. No other cancer was recorded by the local Cancer Registry among screened subjects. The prevalence/incidence ratio was 2.65:1, and the cost per screen-detected cancer was 18,571,000 Italian lire. CONCLUSIONS: Screening by endometrial sonography is feasible on a practical basis, but its efficacy needs to be proven by prospective controlled studies which would enroll large populations to ensure sufficient statistical power, considering the low incidence and the low lethality of the disease. Studies of screening for other carcinomas may be considered of higher priority.

Adult↗
PubMedDate not supplied

Risk of endometrial cancer in breast cancer patients under long-term adjuvant treatment with tamoxifen.

AIMS: To evaluate the relative risk of endometrial cancer with respect to the expected underlying incidence in breast cancer patients undergoing long-term adjuvant tamoxifen therapy. METHODS: A total of 1010 postmenopausal breast cancer patients receiving adjuvant tamoxifen and with a first negative endometrial ultrasonography (cutoff for abnormal endometrial thickness >5 mm) were followed by annual transvaginal ultrasonography. Abnormal endometrial thickness prompted an outpatient endometrial biopsy or curettage under anesthesia in the case of cervical stenosis and increasing endometrial thickness. The standardized incidence ratio (SIR) with respect to underlying incidence was determined. RESULTS: A total of 1,010 eligible subjects who had been receiving tamoxifen for an average of 51 months were enrolled and followed for a total of 2,361 patient-years between January 1993 and December 1996. Five cases of endometrial cancer were observed in the study period: 1 was detected at screening, and 4 were diagnosed for vaginal bleeding in the interval between screening examinations. SIR was 4.0 (95% confidence interval, 1.3-9.4) and increased to 4.8 (CI, 1.6-10.5) when the single cancer detected at first screening was considered as incident. CONCLUSIONS: This study adds evidence to the hypothesis that long-term tamoxifen treatment may be responsible for a relevant increase in the risk of developing endometrial cancer. Surveillance based on endometrial ultrasonography was poorly sensitive, but the favorable stage at diagnosis of screen-detected or interval endometrial cancers does not support a more aggressive screening approach.

Aged↗
PubMedDate not supplied

Reliability of volume or age-adjusted prostate specific antigen to improve diagnostic accuracy.

Prostate Specific Antigen (PSA), PSA density, PSA excess, and PSA age-specific range have been compared in 331 subjects (35 cancers, 296 benign) with equivocal findings at screening by PSA or palpation+transrectal ultrasonography. The specificity of PSA using a cut-off of 4 ng/ml was only 0.49. A cutoff of 10 ng/ml improved the specificity to 0.88 but the sensitivity decreased from 0.97 to 0.63. The sensitivity and specificity for PSA density (cutoff 0.15), PSA excess (cutoff -5), and age-specific range were 0.86 and 0.80, 0.80 and 0.82, and 0.91 and 0.67, respectively. Avoided benign biopsies vs missed cancers on the basis of PSA density, PSA excess and PSA age-specific range would have been 19 and 5, 26 and 7, and 16 and 3, respectively. Methods adjusting for prostate volume allow a better interpretation of PSA values and may reduce the benign biopsy rate, but the consequent cost of delayed cancer diagnoses when the choice of biopsy is based only on these methods seems unacceptable.

Age Factors↗
PubMedDate not supplied

[C-reactive protein and homocysteinemia in patients undergoing on-line hemodiafiltration].

PURPOSE: In renal disease therapy (RDT) patients, high plasma homocysteine (tHcy) is common and high C-reactive protein(CRP) levels can be observed, attributed to the inflammatory process caused by the dialysis itself. Hyperhomocysteinemia and bioincompatibility are considered independent vascular risk factors. This study evaluated the behavior of these parameters in patients undergoing on-line hemodiafiltration (OL-HDF). METHODS: In 56 patients, HDF was performed using high permeability polyamide membranes, exchanging in the post-dilution mode 16-18 L/session of a reinfusate obtained by the on-line system (triple filtration AK200, Gambro). CRP was measured by an immunological method at the start and the end of the session in patients without comorbidities (group 1, n=30)and with inflammatory diseases (group 2, n=26). In 23 of the 56 patients, tHCY was measured (by high performance liquid chromatography (HPLC)) before and after the mid-week session on different schedule of folinic acid, vitamin B12 and vitamin B6. RESULTS: Pre-dialytic CRP was in the normal range in group 1 patients, whereas it was higher in group 2 patients; dialysis did not induce a significant change in either group. The intradialytic percentage tHcy decrease was approximately 50% regardless of the pre-dialytic value, which was significantly different according to the vitamin supplements administered. CONCLUSIONS: HDF, as performed in this study, demonstrated biocompatibility and efficient Hcy removal; therefore, it can prevent cardiovascular disease (CVD) in patients on regular extracorporeal dialysis.

Aged↗