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Biomedical subjects

E Castelli

Publications and source records attributed to E Castelli.

At least 19 recordsLinked to original sources
PubMed2005

Psychological and adjustment problems due to acquired brain lesions in childhood: a comparison between post-traumatic patients and brain tumour survivors.

OBJECTIVE: To define and differentiate psychological and adjustment problems due to brain injury or brain tumour in children and adolescents. METHODS: Two groups of patients with acquired brain lesions (24 post-traumatic patients and 22 brain tumour survivors), ranging in age between 8-15 years, received a psychological evaluation, including the Child Behaviour Checklist for Ages 4-18 (CBCL) and the Vineland Behaviour Adaptive Scales (VABS). RESULTS: Both groups showed psychological and social adjustment problems. Post-traumatic patients were more impaired than brain tumour survivors. Social adjustment problems were associated to externalizing problems in post-traumatic patients and internalizing problems in brain tumour surviving patients. CONCLUSIONS: These differences in psychological and behavioural disorders between the two groups must necessarily be considered when developing psychological treatment, rehabilitation plan and social re-entry.

Adaptation, Psychological↗
PubMed2003

The number of lymph nodes examined and staging accuracy in renal cell carcinoma.

OBJECTIVE: To determine the number of lymph nodes that need to be examined to accurately stage the pN variable in patients undergoing radical nephrectomy (RN) for renal cell carcinoma (RCC). PATIENTS AND METHODS: We reviewed the operative and pathology reports of 725 patients with RCC submitted for RN. All tumours were classified using the fifth edition of the Tumour-Nodes-Metastasis classification. For each patient the number of lymph nodes removed was recorded. The patients were divided into five different groups according to the number of nodes removed, i.e. group 1, 1-4; group 2, 5-8; group 3, 9-12; group 4, 13-16; and group 5, >or= 17. We evaluated the factors that affected the number of lymph nodes removed with nodal dissection and the variables that influenced the incidence of nodal involvement. RESULTS: Lymphadenectomy was performed in 608 patients (83.8%); in these patients the rate of lymph node metastases was 13.6%. The median (range) number of nodes removed was 9 (1-43); there was a statistically significant correlation between the number of nodes removed and the percentage of nodal involvement (r = 0.6; P < 0.01). The rate of pN+ was significantly higher in the patients with >or= 13 than in those with < 13 nodes examined (20.8% vs 10.2%; P < 0.001). For organ-confined and locally advanced tumours there was a statistically significant difference in the pN+ rate between patients with < 13 or >or= 13 nodes examined (3.4% vs 10.5%, and 19.7% vs. 32.2%, respectively). CONCLUSIONS: The proportion of tumours classified as pN+ increased with the number of lymph nodes examined. In RCC,> 12 lymph nodes need to be assessed for optimal staging.

Adult↗
PubMed2002

Preliminary study on extremely small angle x-ray scatter imaging with synchrotron radiation.

Among the medical physics community, there is nowadays a great interest in the possible implementation of scatter imaging techniques, especially in the field of breast imaging. It is well known that malignant lesions and normal tissue differ in their scattering signatures, and thus scattered radiation can provide a powerful tool to distinguish between the two cases. Up to now, most of the proposed techniques rely on the detection of radiation scattered at angles of the order of a few degrees, which in most cases results in very high contrast values. On the other hand, at those relatively large angles the scattered flux is relatively low with respect to the primary, which often implies the necessity of increasing the dose delivered to the sample in order to achieve sufficient statistics. Furthermore, most of these techniques are based on pencil beam set-ups, which results in an increase of the overall duration of the examination. We propose here an alternative approach based on the detection of radiation scattered at extremely small angles, of the order of approximately 100-200 microrad. This results in a relatively high scattered flux (5-10% of the primary) and in the possibility of utilizing a fan beam geometry, which reduces the acquisition times with respect to pencil beam set-ups. Images of several samples have been acquired, demonstrating that the proposed technique results in an increased contrast with respect to absorption imaging. Possible in vivo implementations of the technique at no dose expense are finally discussed.

Algorithms↗
PubMed2002

Impaired tuftsin activity in cirrhosis: relationship with splenic function and clinical outcome.

BACKGROUND: Cirrhotic patients show increased susceptibility to bacterial infections. It is not known whether tuftsin deficiency, which is associated with an increased incidence of infections in many disease states, is present in cirrhosis. Our aims were to determine whether tuftsin activity is deficient in cirrhosis and if so, whether this deficiency is related to splenic function, contributes to altered neutrophil granulocyte function, or influences the occurrence of bacterial infections and patient survival. METHODS: Tuftsin activity and splenic function were assessed in 31 patients with liver cirrhosis and 31 healthy subjects. The phagocytic activity of neutrophil granulocytes from 23 patients was tested in vitro with addition of both autologous and pooled sera from healthy subjects. In 10 patients and eight controls it was also tested with addition of synthetic tuftsin. Patients were followed up until death or liver transplantation. RESULTS: Patients had reduced tuftsin activity (median 8% (range 3-24.5)) compared with controls (17% (11.5-37)) (p<0.001) and a higher pitted red cell count (p<0.001). Tuftsin activity was correlated with pitted cell count (p=0.02) and the Child-Pugh score (p=0.002). Nineteen of 23 patients showed deficient phagocytic activity of neutrophil granulocytes, which was correlated with tuftsin activity (p<0.001), improved in all cases but one with addition of serum from healthy subjects, and normalised with addition of synthetic tuftsin. Reduced tuftsin activity did not influence patient survival but was associated with a higher incidence of bacterial infections (p=0.029). COMMENT: Tuftsin activity was reduced in cirrhosis, and contributed to impaired phagocytic activity of neutrophil granulocytes. Such an abnormality appears to be related to impaired splenic function and severity of cirrhosis, and probably favours the occurrence of bacterial infections.

Adult↗
PubMed2001

An innovative digital imaging set-up allowing a low-dose approach to phase contrast applications in the medical field.

Recently, new imaging modalities based on the detection of weak phase perturbations effects, among which are phase contrast and diffraction imaging, have been developed by several researchers. Due to their high sensitivity to weakly absorbing details, these techniques seem to be very promising for applications in the medical field. On the other hand, digital radiology is undergoing a wide diffusion, and its benefits are presently very well understood. Up to now, however, the strong pixel size constraints associated with phase contrast pattern detection limited the possibility of exploiting the advantages of phase contrast in digital radiology applications. In this paper, an innovative setup capable of removing the pixel size constraints, and thus opening the way to low dose digital phase contrast imaging, is described. Furthermore, we introduce an imaging technique based on the detection of radiation scattered at small angles: the information extracted from the sample is increased at no dose expense. We believe that several radiological fields, mammography being the first important example, may benefit from the herein described innovative imaging techniques.

Diagnostic Imaging↗
PubMed2001

Iatrogenic ejaculation disorders and their prevention.

Ejaculation is mediated by sympathetic fibers originating from the D10-L2 medullar center. These nerves rise from the lumbar ganglia of the paravertebral sympathetic trunk and travel posteriorly to the vena cava and then to the interaortocaval space, on the right side, and laterally to the aorta, on the left side. They are the principal constituents of the superior hypogastric plexus. Many surgical operations can cause an ejaculation disorder, but the most important is retroperitoneal lymphadenectomy (RL) for testis cancer, because it involves young patients and it has been the subject of important researches in order to perform lymph node dissection without ejaculation loss (unilateral lymphadenectomy and nerve sparing lymphadenectomy). Our experience concerns 41 patients who underwent RL for testis cancer from 1983 to 1998. Survival rate was 95.2% (mean follow up 64 months). RL was performed bilaterally in 14 patients. Two of them died of metastases within 2 years after the operation. Ejaculation was maintained in only 4 of the 12 surviving patients (33%). All the 17 patients (100%) underwent right monolateral RL and 7 of the 10 (70%) underwent left monolateral RL preserved ejaculation. The anatomosurgical concepts of the RL sparing the ejaculation can be adopted in other retroperitoneal surgical operations that can produce ejaculation disorders, such as wide lymphadenectomy for renal cell carcinoma or tumors of the upper urinary tract, exeresis of pre- aortic tumors, exeresis or disjunction of horseshoe kidney and aorto-iliac revascularization. Surgical therapy of benign prostatic hyperplasia (BPH) (open surgery or transurethral prostatic resection) is associated with retrograde ejaculation in nearly 100% of cases. The mechanism of the dysfunction is clear, if following the procedure the bladder neck remains opened. Loss of ejaculation is reported in variable percentage after the newer endoscopic techniques for the treatment of BPH. Transurethral needle ablation (TUNA) seems to have the lower risk of retrograde ejaculation. Retrograde ejaculation can also be related to a traumatic injury of the posterior urethra, because of the trauma itself or the therapy. Finally, the ejaculation disorder can be produced by several drugs that block, as a main or secondary effect, the alpha-adrenoreceptors or act at the central level. This side effect has to be kept in mind when these drugs are used in young or sexually active patients.

Ejaculation↗
PubMed2000

Soluble CD30 serum level in HCV-positive chronic active hepatitis: A surrogate marker of disease activity?

In the present study, high levels of CD30s, a glycoprotein preferentially expressed and released by T lymphocytes producing Th(2)-type cytokines, were seen in the sera of patients with chronic hepatitis C, and a correlation with histological activity of the disease was found. CD30s levels were assayed in the sera of 29 HCV RNA-positive patients with histologically proven chronic active hepatitis and in 30 healthy blood donors. Thirteen of 29 (45%) HCV patients had CD30s serum levels above the normal range (>20 U/ml). Mean CD30s serum levels were significantly higher in HCV patients than in controls (P<0.0005). A positive correlation was found between serum CD30s levels and both the histological activity index (r=0.59, P=0.001) and ALT serum levels (r=0.5; P=0.006). The raised CD30s level found in more severe HCV liver disease indirectly suggests activation and expansion of Th(2)cells. CD30s levels could represent a useful surrogate marker of activity in chronic HCV infections.

Adult↗
PubMed2000

Visual disorders after traumatic brain injury in developmental age.

Visual disorders secondary to TBI are common, often multiple, associated with complex clinical pictures; in developmental age they may particularly interfere with the development process, and compromise the rehabilitation and outcome processes. The aim of this study is to identify visual disorders in 56 post-traumatic children admitted to the Traumatic Brain Injury Unit. All patients underwent a complete clinical, neurological and neuroophthalmological assessment. Correlations were studied between visual disorders and clinical parameters of acute phase, age at trauma, neuroimaging data and outcome, in order to identify possible risk factors for their occurrence. A high incidence was found of complex visual disorders following head trauma: decreased visual acuity, together with a convergence oculo-motor deficit, is the most frequently detected deficit. Trauma severity, indicated by duration of coma, is associated with most of the visual disorders and appears to be the main risk factor conducive to their appearance.

Acute Disease↗
PubMed2000

Increased cytogenetic damage detected by FISH analysis on micronuclei in peripheral lymphocytes from alcoholics.

Alcohol abuse greatly increases the risk of various malignancies, including cancer of the liver and digestive tract. Although it is thought that this may be due, at least partially, to the mutagenic properties of ethanol, little is known about the genotoxic effects of ethanol in humans. We investigated the chromosomal damage in lymphocytes from 20 alcoholics and 20 controls using the micronucleus (MN) assay combined with fluorescence in situ hybridization (FISH) with a pancentromeric DNA probe capable of differentiating centromere positive (C+) from centromere negative (C-) MN. The frequency of MN in binucleate lymphocytes was significantly higher in alcoholics than in controls (12.0 +/- 5.4 and 7.6 +/- 1.6, respectively; P: < 0.05). FISH revealed significantly higher frequencies of C+ MN in alcoholics than in controls (8.2 +/- 4.8 and 3.4 +/- 1.4, respectively; P: < 0.05). In the alcoholics, no association was found between years of alcohol abuse and frequency of MN or C+ MN. However, age influenced MN and C+ MN frequency both in alcoholics and controls. These results indicate that alcohol abuse may well induce chromosome loss in humans, suggesting a possible aneugenic mechanism of alcohol. This effect could contribute to the health hazards related to alcoholism such as cancer risk.

Adult↗
PubMed2000

Experimental evaluation of a simple algorithm to enhance the spatial resolution in scanned radiographic systems.

In order to ensure an early diagnosis of breast cancer, an imaging system must fulfil extremely stringent requirements in terms of dynamic range, contrast resolution and spatial resolution. Furthermore, in order to reduce the dose delivered to the patient, a high efficiency of the detector device should be provided. In this paper the SYRMEP/FRONTRAD (SYnchrotron Radiation for MEdical Physics/FRONTier RADiology) mammography project, based on synchroton radiation and a novel solid state pixel detector, is briefly described. Particular relevance is given to the fact that the radiographic image is obtained by means of a scanning technique, which allows the possibility of utilizing a scanning step smaller than the pixel size. With this procedure, a convolution between the real image and the detector point spread function (PSF) is actually acquired: by carefully measuring the detector PSF, it is possible to apply a post-processing procedure (filtered deconvolution), which reconstructs images with enhanced spatial resolution. The image acquisition modality and the deconvolution algorithm are herein described, and some test object images, with spatial resolution enhanced by means of the filtered deconvolution procedure, are presented. As discussed in detail in this paper, this procedure allows us to obtain a spatial resolution determined by the scanning step, rather than by the pixel size.

Algorithms↗
PubMed2000

Mammography with synchrotron radiation: phase-detection techniques.

The authors evaluated the effect on mammographic examinations of the use of synchrotron radiation to detect phase-perturbation effects, which are higher than absorption effects for soft tissue in the energy range of 15-25 keV. Detection of phase-perturbation effects was possible because of the high degree of coherence of synchrotron radiation sources. Synchrotron radiation images were obtained of a mammographic phantom and in vitro breast tissue specimens and compared with conventional mammographic studies. On the basis of grades assigned by three reviewers, image quality of the former was considerably higher, and the delivered dose was fully compatible.

Absorption↗
PubMed2000

[Retroperitoneal lymphadenectomy for testicular cancer and genito-sexual conditions: retrospective study].

OBJECTIVES: The aim of this study was to evaluate retrospectively the preservation of fertility in a number of patients with testis or funicle tumour treated with retroperitoneal lymph node dissection (RPLND). MATERIAL AND METHODS: Between 1983 and 1998, 41 patients with testis or funicle cancer (mean age 29 years, range 18-58) underwent RPLND at our institution. Clinical staging included abdominal CT scan, chest X-rays and serum tumour markers (alpha FP, beta HCG, LDH). RPLND was performed bilaterally in 14 patients and unilaterally in 13 patients (6 right and 7 left). The nerve sparing technique was used in 14 cases. Ejaculation was evaluated in 39 patients (2 patients died of metastases before the study). Mean follow up was 64 months (range 5-182). Semen was available for 21 patients before RPLND and for 19 patients after RPLND. The "t Student" test was used to compare the semen parameters before and after surgery. RESULTS: Bilateral RPLND caused loss of ejaculation in 67% of the patients (8/12). Unilateral right and left RPLND allowed to maintain ejaculation in 100% (6/6) and 57% (4/7) of cases respectively. Nerve sparing procedure preserved ejaculation in 100% of the patients (14/14). After RPLND, both mean total sperm count and mean motility rate were not significantly changed (143 +/- 124 x 10(6) vs 128.2 +/- 72 x 10(6) p > 0.05; 40.7 +/- 17.6 vs 48 +/- 15.5%, p > 0.05). The survival rate of the patients treated with RPLND was 95%. None of the patients treated with unilateral (en bloc or nerve sparing) RPLND had relapse. CONCLUSION: The evolution of surgical technique has notably reduced the andrological complications of the RPLND without affecting the oncological results.

Adolescent↗
PubMed2000

[Large calcifications on double J ureteral endoprosthesis "forgotten" in situ. Report of a clinical case].

Ureteral endoprostheses can be complicated by incrustations, sometimes making it impossible to withdraw the stent. A case in which the use of cistolithotripsy and of extracorporeal shock-wave lithotripsy (ESWL) allowed withdrawal of a double J ureteral stent with large incrustations is reported. The stent was placed 3 years before. Epidemiology, aetiology and therapeutic aspects of encrusted ureteral stents are discussed.

Aged↗
PubMed2000

[It is not so difficult to carry out simple things properly!].

This report is about the results of the experience we did, since 1996, in the nursing unit of a first level mountain hospital in which we work, where we followed a new childbirth and postpartum assistance protocol aimed to humanizing birth and postpartum, promoting exclusive breastfeeding and reducing childbirth risks. The results show that, since the beginning of our experience, we had an evident reduction of preterm childbirth (newborns with less than 36 weeks of gestational age). We also had a reduction of cesarian sections and of neonatal transferrals in second level neonatal units. Furthermore, we had a progressive growth of exclusive breastfeeding. The report also shows that, since 1996, the newborns discharged from our hospital are exclusively breastfed for a time longer than before and that, at 1 year, 11 percent of our children are still breastfed.

Birthing Centers↗
PubMed1999

Focal cognitive impairment in mitochondrial encephalomyopathies: a neuropsychological and neuroimaging study.

Mitochondrial encephalomyopathies (ME) are a multisystemic group of diseases characterized by a wide range of biochemical and genetic mitochondrial defects with a variable mode of inheritance. We studied the neuropsychological profile, magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) data in a group of ME patients in order to look for common or specific cognitive defects and a possible correlation with related brain areas. Three main cognitive areas were assessed: general intelligence, memory functions and visuo-perceptual skills. Our sample included 16 ME patients (nine males, seven females) aged 25-68 years (mean age 45.2, SD 13.0). No sign of mental deterioration was found in the group of elderly subjects. Despite subjects showing no global cognitive impairment they scored lower in nonverbal versus verbal tasks. Visuo-spatial skills and short-term memory were selectively impaired. There was no correlation between neuropsychological results and age, illness duration, age of onset, clinical phenotypes, genetic mitochondrial alterations and pharmacological therapy. The most frequent SPECT pattern observed was the hypoperfusion of temporal lobes, with a direct localization in the temporal cortex and with prevalent mesial involvement. The neuropsychological profile and SPECT imaging revealed similarities with focal defects.

Adult↗
PubMed1999

Expression of TGF-beta related Smad proteins in human epithelial skin tumors.

Members of the transforming growth factor (TGF)-beta family regulate cell growth and differentiation activating intracellular Smad proteins. Their role in skin and skin tumorigenesis is not well understood. Therefore we investigated the expression of TGF-beta type I receptor (TbetaR-I) and Smad-proteins involved in the TGF-beta-pathway, e.g. Smad2, Smad3, Smad4, Smad6 and Smad7. We examined the effects of TGF-beta1, -beta2, BMP2, BMP7 on five epithelial cell lines in vitro. TGF-beta1-mediated growth inhibition of HaCaT and HSC4 were observed with half maximal effects at approximately 7 pg ml-1 and 20 pg ml-1, respectively. However, malignant HSC2 and A431 cells were unresponsive to TGF-beta1. A differentiation was seen after 5 days in HaCaT and HSC4 cells only. We compared the reactivity with specific antisera against TbetaR-I and Smad proteins among the different skin tumors: seborrheic keratoses (SK), actinic keratoses (AK), basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). There were statistically significant differences of the ratio between the expression in tumor and that in non-tumorous epithelial cells in each tissue specimen. There was a tendency for the lower level of TbetaR-I expression of SCC compared with SK (p=0.08). This was accompanied by the decreased expression of the TbetaR-I. We found a markedly decreased expression of all antigens in BCC. conversion of normal keratinocytes to tumorigenic cells may in part be due to an acquisition of resistance to TGF-beta and loss of expression of intracellular signalling Smad proteins.

Activin Receptors, Type I↗