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Biomedical subjects

F Pacini

Publications and source records attributed to F Pacini.

At least 37 records · Page 2Linked to original sources

An insight into post-gastrectomy "alkaline reflux gastritis".

One hundred and ten partially-gastrectomized patients were studied in order to assess prevalence of symptoms, entero-gastric reflux, endoscopic erythematous changes and histological gastritis and to explore some aspects of the pathogenesis of gastritis syndrome. Prevalence of symptoms (37.2% of the patients) was lower than prevalence of reflux (86.9% and 72.9% of patients with fasting bile reflux or scintigraphic assessment, respectively) endoscopic hyperaemia (72.7% of patients) and remnant chronic gastritis (88.3% of patients). Histological appearance in the perianastomotic area was mostly identifiable as hyperplastic-regenerative. While histological findings, gastric pH, bacteria and nitrite concentration and patients' age were reciprocally correlated, symptoms, endoscopic changes, remnant chronic gastritis and gastric environmental changes were not more severe in patients with more abundant enterogastric reflux. Therefore, as far as the methods for reflux assessment used in the present study are concerned, postgastrectomy findings (symptoms, extent of erythematous changes, severity of remnant chronic gastritis) are not related to reflux. These results suggest that the term "alkaline reflux gastritis syndrome", at this stage of knowledge, should be used with caution.

Adult

Impaired ventilatory drive in short-term primary hypothyroidism and its reversal by L-triiodothyronine.

Alveolar hypoventilation is known to occur in myxedema. Reduction of hypercapnic ventilatory drive has not been reported, up to now, in patients with short-term hypothyroidism. Eleven patients with short-term hypothyroidism, before and after L-triiodothyronine (L-T3) replacement therapy, and 10 normal controls were studied. Hypercapnic ventilatory drive was assessed by the evaluation of the relation between the response of ventilation and mean expiratory flow to CO2 rebreathing and by the evaluation of ventilation and mean expiratory flow at a fixed level of carbon dioxide. In patients with short-term hypothyroidism these parameters were reduced as compared with normal controls and returned to normal after L-T3 replacement. We conclude that hypercapnic ventilatory drive is blunted by short-term hypothyroidism and normalizes following replacement therapy.

Adult

Diagnostic value of a single serum thyroglobulin determination on and off thyroid suppressive therapy in the follow-up of patients with differentiated thyroid cancer.

To assess the significance of a single serum thyroglobulin (Tg) determination on and off thyroid suppressive therapy, serum Tg measurements have been performed in 349 serum samples from 82 patients with differentiated thyroid cancer. All samples were collected after total thyroidectomy with or without subsequent ablation of residual thyroid tissue by radioiodine. One hundred and fifty-three samples were obtained while the patients were on thyroid suppressive therapy and 196 after withdrawal of medication. The results of serum Tg assays were analysed in relation to the presence or absence of residual or metastatic thyroid tissue, as assessed by clinical and laboratory evaluation, including 131I whole body scan. In patients with thyroid residue but no metastases, undetectable serum Tg (false negative results) occurred in 45% of cases off therapy and in 92.9% of cases during therapy. In the presence of metastases no undetectable serum Tg result was found in patients off therapy, while four (6.9%) out of 58 samples from patients with bone and/or lung metastases and seven (31.8%) out of 22 samples from patients with lymph node metastases alone were undetectable (falsely negative) during suppressive therapy. Serum Tg was undetectable in sera from patients with no evidence of thyroid residue or metastatic disease in all but one (1.7%) of 59 samples on and three (5.4%) of 56 samples off suppressive therapy. These Tg results were confirmed to be truly rather than falsely positive, since evidence of metastatic disease was obtained by whole body scan after the administration of therapeutic doses of 131I.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma

Humoral markers for thyroid carcinoma.

We investigated the usefulness and limits of serum thyroglobulin, serum calcitonin, and serum tissue polypeptide antigen as humoral markers for thyroid carcinoma in 364 patients with papillary, follicular, medullary, and undifferentiated types of thyroid cancer. In agreement with other studies we found that serum thyroglobulin was a specific and sensitive marker for well-differentiated thyroid cancer after total thyroidectomy. Lymph node, lung, and bone metastases were associated with high serum thyroglobulin concentrations, both during and after thyroid-suppressive therapy with L-thyroxine. Serum thyroglobulin determination was superior to whole body scanning in predicting the presence of differentiated metastases, because patients with nonfunctioning metastases and negative whole body scan also had high levels of serum thyroglobulin. Serum calcitonin levels were increased in all patients with active medullary thyroid cancer, confirming the specificity of this marker in detecting tumors arising from parafollicular C-cells. Furthermore, in medullary thyroid cancer serum tissue polypeptide antigen levels were also increased in most patients. This last substance was found to be increased also in undifferentiated thyroid cancer. Of particular interest was the finding of increased serum tissue polypeptide antigen levels in 15 cases of differentiated thyroid cancer, whose metastases underwent a progressive process of "dedifferentiation."

Calcitonin

Metastatic medullary and undifferentiated thyroid cancers are not associated with elevated levels of serum thyroglobulin.

It is now well accepted that serum thyroglobulin (Tg) determination is a specific marker of disease activity in well-differentiated thyroid cancer after total thyroidectomy. In this study we examined 15 thyroidectomized patients with metastases from medullary thyroid cancer and 10 patients with metastases from undifferentiated thyroid cancer, to determine whether serum Tg measurement could be useful also in these types of thyroid tumors. In contrast with differentiated thyroid cancer, which had high levels of circulating serum Tg, patients with medullary and undifferentiated thyroid cancer had undetectable or low levels of serum Tg. Thus, serum Tg measurements are not useful in the diagnosis of metastatic disease in these patients.

Calcitonin

Serum tissue polypeptide antigen (TPA) in thyroid cancer.

Serum tissue polypeptide antigen, (TPA), carcinoembryonic antigen (CEA), calcitonin (CT) and thyroglobulin (Tg) have been measured by specific radioimmunoassays in 174 patients with various types of thyroid cancer previously submitted to thyroidectomy. Elevated serum TPA concentrations were found in 12 of 13 patients with local invasion or distant metastases from undifferentiated thyroid cancer or thyroid lymphosarcoma, while serum Tg and CEA values were normal or undetectable. In 123 patients with well differentiated thyroid cancer serum TPA was usually normal regardless of the presence or absence of functioning metastases. On the contrary, 14 of 15 patients with "dedifferentiated" metastases from previously differentiated thyroid cancer had elevated serum TPA values, while serum CEA was normal and serum Tg variable. Serum CT was confirmed as the most sensitive marker of metastatic medullary thyroid carcinoma, but elevated serum TPA values were also found in most of these cases. The present data indicate that serum TPA provides a new humoral marker in the follow-up of undifferentiated and "dedifferentiated" thyroid carcinoma and may also be usefully employed as an additional marker for medullary thyroid carcinoma.

Adolescent

Serum thyroglobulin in newborns' cord blood, in childhood and adolescence: a physiological indicator of thyroidal status.

Serum thyroglobulin (Tg) was measured in the cord blood of 635 newborns and serum thyroxine (T4) reverse triiodothyronine (rT3), TSH and T3 were measured in about 200 of them. Cord Tg was detectable in all newborns with a mean +/- SE value (50 +/- 1.3 ng/ml) higher than that found in the serum of adult subjects (n = 144; Tg = 13 +/- 1.1; p less than 0.0001). Cord Tg had a log-normal distribution. A low, but positive correlation was found between cord Tg and cord TSH (n = 242; r = 0.17; p less than 0.05) but not with cord T4 or cord rT3. Gestational age was negatively correlated with cord Tg or cord rT3 (rS = 0.97; p less than 0.01; rS = -0.89; p less than 0.02, respectively) while was positively correlated with cord T4 or cord TSH (rS = 0.85; p less than 0.05; rS = 0.86; p less than 0.01, respectively). Birth weight, maternal diabetes, induction of labor with oxitocin, cesarian section and newborns' illness showed no influence on cord Tg levels when considered alone, but decreased cord Tg levels were found in ill newborns delivered by cesarian section. On the contrary, increased cord Tg levels were present in cord blood of newborns who developed hypoglycemia soon after birth and in small for gestational age newborns. In 24 newborns studied daily for the first 6 days of life, serum Tg was always detectable with mean values not different from those found in the cord blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

[Screening for colo-rectal neoplasms by the study of fecal occult blood].

Occult blood testing has been proposed as a screening tool for colorectal cancer. At the present time guaiac testing is considered the most suitable for mass screening. The specificity of the test is affected by diet. For this reason it is necessary to adhere to a meat-free diet while the necessity of eliminating peroxidase containing foods as uncooked vegetables and fruit is controversial. The sensitivity of guaiac test is affected by the intermittence of colorectal cancer bleeding, by the quantity of ascorbic acid and fibers in the diet and by the development modality of the test. The experience of the authors is based on a screening protocol applied on some populations in the province of Florence (Italy). The protocol is based on guaiac test and an anamnestic selection of high-risk patients. 6029 patients have performed guaiac test. In 1159 patients, the results of occult blood testing and sigmoidoscopy have been compared. This analysis accounts for a predictive value of 50%, a specificity of 95.6%, and a sensitivity of 68% for carcinomas and 21.3% for adenomas. In conclusion, guaiac testing seems to warrant a good cost/benefit ratio but because its sensitivity is too low, it is necessary to include other selective tools (the anamnestic questionnaire) as well as an over-all major effort in the research of more sensitive ways of testing.

Colonic Neoplasms

Binding of immunoglobulin-G from patients with thyroid autoimmune disease to normal T lymphocytes.

Sera from patients with Graves' disease and Hashimoto's thyroiditis were reacted with normal T lymphocyte preparations in an attempt to detect binding of immunoglobulin G (IgG) to T cells. Sera from normal subjects and patients with toxic adenomas served as controls. Each serum was reacted with at least three different preparations of normal T cells. Bound IgG was identified using a fluoresceinated second antibody, antihuman IgG. Positive cells were enumerated by means of epifluorescent microscopy. IgG from 57.8% of toxic Graves' patients, 30.7% of Graves' patients who were euthyroid after treatment, and 41.6% of Hashimoto's patients bound to normal T cells more than did IgG from normal controls. Reactivity of toxic adenoma sera was similar to that of normal sera. When the positive sera were reacted with helper or suppressor/cytotoxic T cell preparations (separated by negative selection technique), the binding was shown to be directed against suppressor/cytotoxic T cells but not against helper cells. These data indicate that a significant proportion of patients with autoimmune thyroid disease have IgG in their serum which react with a subset of normal T suppressor/cytotoxic cells. This phenomenon could be the expression of anti-lymphocyte antibodies, which may relate to previously recognized reductions in number and function of suppressor T cells in autoimmune thyroid disease.

Adenoma

Effect of hypo- and hyperthyroidism on the balance between helper and suppressor T cells in rats.

The proportion of total, helper and suppressor T lymphocytes among mononuclear cell preparations from blood and spleen of rats made hypo- and hyperthyroid was measured using three monoclonal antibodies specifically directed against total, helper and suppressor T cells. Compared to normal rats, hypothyroid (thyroidectomized or treated with 6-propyl-2-thiouracil (PTU) rats had a decreased proportion of suppressor T cells in the spleen, which produced an increase in the helper/suppressor T cells ratio. The opposite alterations (increased suppressor T cells and decreased ratio) was found in the blood of the same animals. Triiodothyronine (T3) added to PTU in the drinking water prevented these alterations. Animals treated with high doses of T3 for 17 days did not develop any alteration either in the proportions or in the ratio of helper/suppressor T cells. Our results suggest that hypothyroidism but not hyperthyroidism alters the normal balance between helper and suppressor T cells in rats.

Animals

Effect of indomethacin on phytohemagglutinin-stimulated peripheral blood lymphocytes in thyroid autoimmune diseases.

Suppressor lymphocyte function was evaluated in control subjects and in patients with autoimmune thyroid disease, utilizing an assay in which indomethacin was added to lymphocyte cultures to inhibit prostaglandin-producing suppressor cells. This assay is based on the observation that the addition of indomethacin, a potent prostaglandin synthesis inhibitor, to phytohemagglutinin-stimulated peripheral blood lymphocytes should cause an increase in the incorporation of iododeoxyuridine in control subjects and a smaller increase in diseases with reduced prostaglandin-producing suppressor cells. The addition of indomethacin, 1 microgram/ml, stimulated iododeoxyuridine incorporation in phytohemagglutinin-stimulated cultures in control subjects to an index value of 1.43 (i.e., the increment in iododeoxyuridine incorporation with both indomethacin and phytohemagglutinin was 43% greater than the incorporation with phytohemagglutinin alone). The stimulation index was significantly lower in patients with Graves' disease who were toxic and untreated (1.18 +/- 0.25, mean +/- SD; P less than 0.003). Patients who were toxic while receiving antithyroid drugs or after radioiodine therapy or patients euthyroid after treatment had a mean stimulation index in the normal range, although the spread of data was very large in these groups. Responses in patients with Hashimoto's thyroiditis were also quite variable. The average response was 1.74 +/- 0.72, with 40% of the patients showing a high stimulation index. This study supports our previous investigations in which we used different assay systems for measuring suppressor-cell function in patients with thyroid autoimmune diseases and indicates that a defect in suppressor lymphocyte function is measureable by another technique. The abnormality persists in some cases after metabolic control has been achieved, but usually returns toward normal over months or years.

Adolescent

Decreased suppressor T-lymphocytes in autoimmune thyroid diseases detected by monoclonal antibodies.

Monoclonal antibodies reacting with cell surface antigens of helper (T4), suppressor (T8) T cells and common T-cell antigen (T3) were used by an immunofluorescence technique to enumerate peripheral T-lymphocytes in 42 patients with Graves' disease and 16 patients with Hashimoto's thyroiditis. The percentages of total T cells (cells which react with anti-T3) and helper/inducer cells (cells which react with anti-T4) among peripheral mononuclear cells in Graves' and Hashimoto's patients were not significantly different from those found in normal controls, except for a decrease in cells which react with anti-T3 in toxic Graves' disease without medication. The most important finding was a decrease in the percentage of cytotoxic/suppressor T cells (cells which react with anti-T8) in toxic Graves' disease and Hashimoto's thyroiditis. In patients with Graves' disease who were hyperthyroid or euthyroid on propylthiouracil treatment and euthyroid after radioactive iodide treatment, the percentage of cells which react with anti-T8 was also decreased, but this did not reach statistical significance. These findings support the hypothesis of defects in suppressor T-lymphocytes in autoimmune thyroid diseases.

Adolescent

[Multi-institution, multidisciplinary radiology and endoscopy trial of the diagnostic accuracy of the double contrast examination of the stomach surface].

In 12 X-ray and gastroenterology departments 1570 patients, clinically suspected to have a gastric pathology, have been examined by double contrast (surface) examination of the stomach followed by gastroscopy. Diagnostic accuracy was 93% in respect of endoscopic data, assumed correct by hypothesis. On the basis of a cost and benefit evaluation, made according to the well known criteria, a wider routine use of the double contrast technique is proposed.

Adolescent