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Biomedical subjects

F Consorti

Publications and source records attributed to F Consorti.

At least 37 records · Page 2Linked to original sources

A second generation of terminological systems is coming.

Diverse achievements by recent computer-based terminological systems are outlining a new generation of systems (i.e. a "second generation"). We collected the relevant features of various advanced terminological systems and we systematized these features into four components of a unique framework. We review a set of systems according to our framework, and we discuss how standardization activities can support the evolution of computer-based terminological systems towards a complete set of new performances.

Humans↗

Conceptual schemata for terminology: a continuum from headings to values in patient records and messages.

We developed a technique of reverse engineering to extract a conceptual schema--also called "categorial structure" in the European standard CEN ENV 12264 (MoSe)--from a set of terminological phrases. The technique was originally applied to coding systems, ie. to large value sets. We applied this technique to subsets of two new terminological resources for message standards: headings of patient record from Clinical LOINC and names of "Context Groups" for structured reporting from SNOMED DICOM Microglossary (SDM). Both sources provide context-independent names for message fields and domains of admitted values. Therefore conceptual schemata on the potential content for a field are compatible with the ones on names of the fields themselves. Both kinds of schemata can be compared and integrated with conceptual schemata for the information system that manages the patient record. This continuity in the schemata allows the coupling of applications with different organization of data, and will facilitate mapping from an application to standard messages and viceversa. Moreover, the simplified representation produced according the MoSe approach is easy to understand by healthcare operators, allowing their progressive involvement in cooperative efforts of design, discussion and validation of the schemata.

Medical Records↗

An ontological perspective on surgical procedures.

We studied terminological phrases on surgical procedures-from coding systems, controlled vocabularies, textbooks, and medical records-by an ontological point of view. A surgical procedure can be accurately described only by a set of sentences, in textbooks or surgical reports; a terminological phrase is just a short synthesis of that description. We outline three points of view actually used to construct a phrase, based on i) relevant phases and variants; ii) focus on structures, functions and pathologies; iii) evolution of information and decisions during the process of care. For each of them we discuss potential principles and mechanisms, with the aim of deriving guidelines to generate homogeneous systematic names, to organize regularities in classifications and nomenclatures, to normalize expressions in formal languages.

Medical Informatics Computing↗

[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↗

[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↗

Usefulness of preoperative CEA levels in the assessment of colorectal cancer patient stage.

In order to demonstrate a prognostic value of preoperative CEA levels, we have tried to define a correlation between CEA and histologic stage of tumor in 124 patients with colorectal carcinoma. CEA concentration has been evaluated by radioimmunologic assay and the histologic stage following Dukes' classification. The results show a 25.0% positivity rate for patients in stage A, 48.2% for stage B, 61.1% for stage C, and 85.7% for stage D. The mean CEA values are 7.8 ng/ml in the first group, 30.3 ng/ml in the second, 58.1 ng/ml in the third, and 134.3 ng/ml in the last group. Furthermore, we have tried to relate the histopathologic grade of the tumor (G) with CEA levels in 54 patients of the 124. We conclude that preoperative CEA has a prognostic value, and it is useful in the staging of colorectal cancer patients. A low concentration indicates an early stage of the tumor, while a high concentration indicates a wide spread of disease; on the other hand, there are not significant correlations with cancer grading.

Carcinoembryonic Antigen↗

Effect of l-carnitine on lipid pattern in debilitated patients treated with Intralipid.

Ten surgical patients--4 males and 6 females, mean age: 46.7 years--affected by various pathological conditions were selected for this clinical trial. The patients were divided into two groups of 5 as follows: Group I on the third day received 10%. Intralipid (500 mg) + l-carnitine i.v. (100 mg/kg); on the sixth day 10% Intralipid (500 mg) infusion was given alone. Group II on the third day received 10% Intralipid (500 mg) infusion, and on the sixth day 10% Intralipid (500 mg) + l-carnitine (100 mg/kg). The laboratory parameters (cholesterol, triglycerides, HDL, LDL, VLDL, apolipoprotein A and B) showed that the lipids administered with l-carnitine were more rapidly metabolized than those without.

Carnitine↗

Correlations between serial CEA levels and surgery in patients with colorectal carcinoma.

Nowadays the evaluation of serial carcinoembryonic antigen (CEA) levels represents an important parameter for the prognosis of patients with carcinoma of the large bowel. Changes in CEA values allow the drawing of conclusions regarding the effectiveness of therapy. We have studied 63 patients with colorectal carcinoma that underwent surgical treatment. Serial CEA levels were tested in each patient before surgery and 15 days after. The 53 patients were considered surgically cured; and among these 7 did not have a significant decrease of CEA values after surgery. The percentage of recurrences among these patients has been 71.4%; meanwhile patients who showed a decrease of CEA values below cutoff values had recurrences only in 17.3% of cases. For this reason is our opinion that patients considered surgically cured who have postoperative high CEA levels cannot be considered really cured from a biological point of view.

Carcinoembryonic Antigen↗

[Genetic factors and colorectal cancer: a new approach to clinical experimentation].

The Authors point out the basis for a better characterisation of colo-rectal cancer and precursory lesions. In fact the etiology of familial adenomatous polyposis (FAP), aberrant crypt foci (ACF), hereditary non polyposis colon cancer syndrome (HNPCC) seems to be correlated to molecular pathology. Therefore the Authors review colo-rectal cancer natural history which frequently appears to be not related to clinical evolution.

Colorectal Neoplasms↗

Altered expression of hMSH2 in sporadic colorectal cancer, surrounding mucosa and at distant colonic mucosa.

BACKGROUND: Mismatch repair gene hMSH2 is involved in correction of mispairing during replication and its mutation is associated both with microsatellite instability and with hereditary colorectal cancer. We evaluated its involvement in sporadic colorectal cancer tumorigenesis too. MATERIALS AND METHODS: The protein expression pattern of hMSH2 was evaluated on 29 cases of resected sporadic adenocarcinoma using an immunohistochemical approach. RESULTS: In 14 cases, lack of hMSH2 protein expression was observed in adenocarcinoma and in peritumoral mucosa. In 12 patients, hMSH2 resulted in strong expression in the tumour as well as in the surrounding mucosa and at distant mucosa. In three cases, hMSH2 protein expression in tumoral, adjacent and at distance normal mucosa resulted negative. CONCLUSION: Repair genes could play an important role in tumour progression and in sporadic colorectal cancer. Detection of protein expression by immunohistochemistry may be a method to select tumours for successive genetic investigations.

Adenocarcinoma↗

Microcarcinoma and incidental carcinoma of the thyroid in a clinical series: clinical behaviour and surgical management.

OBJECTIVES: Papillary thyroid microcarcinomas (PTM) have not yet an agreed clinical management. The Authors compared PTMs with papillary thyroid carcinoma of larger size (LPTC) and incidental and not-incidental carcinomas. MATERIALS AND METHODS: Review of clinical data of 67 patients (54 women, 13 men) prospectively stored in a standardised way in an electronic patient record system. RESULTS: There were 36 cases of microcarcinoma (53.7%). Differences were not significant between PTM and LPTC groups as to patients personal data, TNM and MACIS staging, nodal involvement (8.3% vs 19.3%) and multifocality (25% vs 38.7%) while capsular invasion was significantly higher in LPTC (25% vs 54.8%). Nineteen incidental tumors were detected at pathological examination and they were all microcarcinomas. They were smaller than the remaining 17 not-incidental microcarcinomas but showed a similar clinical behaviour. There were not cancer related deaths nor recurrences in the follow up period in any group. CONCLUSIONS: Despite the excellent prognosis of PTM, a subset of these tumours shows aggressive biological and clinical features, like nodal or capsular invasion and multifocality. Actually, with the exclusion of size, they do not show any relevant difference from differentiated thyroid carcinoma of larger size. Since predictive cytogenetic markers are still missing, their treatment should then be the same as for conventional thyroid cancers.

Adult↗

[Antibiotic prophylaxis in the control of infections in surgery: comparison of treatment in different types of surgery].

Despite the development of the most recent and powerful antimicrobic agents, surgical infections are to this day a constant threat to surgeons, rendering negative otherwise successful surgical results. It seems therefore essential that during surgical operations--which according to Altemeier's classification are defined as "contaminated" and "potentially contaminated"--patients undergo a perioperative antibiotic prophylaxis in order to assure elevated tissue levels of antibiotic as necessary. A perspective trial of two standard protocols of short term prophylaxis versus cefoperazone has been here outlined, given that in a recent study cefoperazone showed a positive effect in destroying the intestinal flora of patients even though this was carried out in experimental and not in clinical conditions. 177 patients were selected for this study with a breakdown of 26 and 42, that is twenty-six underwent potentially contaminated procedures and 42 contaminated procedures. Selecting at random, fifty percent of the first group was treated with cefoxitin, and the other half with cefoperazone; as far as the second group is concerned half the sample of patients was treated with cefoperazone and then compared with the other half who had been given an association of piperacillin and metronidazole. Primary septic complications amounted to 7.3% (13 cases); 7.6% in the first group (2 cases) and 21% in the second (9 cases). The different of sepsis between the two groups was not statistically significant although cefoperazone showed a higher septic result in contaminated surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗