Biomedical subjects

F de Luca

Publications and source records attributed to F de Luca.

9 recordsLinked to original sources

PubMed2001

Accuracy of fine needle aspiration biopsy of thyroid nodules in detecting malignancy in childhood: comparison with conventional clinical, laboratory, and imaging approaches.

In childhood the traditional diagnostic approach to thyroid nodules consists of clinical, laboratory, and imaging evaluations. A safe and accurate procedure is needed to promptly identify patients who require surgery. In regard to the usefulness of fine needle aspiration biopsy, the data in the literature concerning children and adolescents are scanty. The aim of this study was to evaluate and compare the diagnostic accuracies of clinical, laboratory, and imaging data collected retrospectively in a group of pediatric patients with thyroid nodules submitted to fine needle aspiration biopsy. Forty-two patients who underwent surgery for thyroid nodules, recruited in 9 Italian pediatric endocrine units, were retrospectively studied. According to histological diagnosis, they were divided into 2 groups, 22 patients with benign lesions and 20 patients with malignant lesions. From clinical records we obtained data about 1) symptoms of neck compression; 2) cervical adenopathy; 3) thyroid function, calcitonin level, and antithyroid antibody titers; 4) ultrasonography; 5) (99m)Tc scintiscanning; and 6) cytology obtained with fine needle aspiration biopsy. Patients and nodule characteristics were analyzed statistically for associations with the presence of thyroid cancer. Among clinical findings, only adenopathy was significantly higher in the group with cancer (8 of 22 benign lesions vs. 16 of 20 malignant lesions; P = 0.006). Thyroid function and antibody titers were similar in the 2 groups, whereas the serum calcitonin level was elevated only in 1 patient with malignant lesions. Among ultrasonography findings, no significant statistical difference was found between the 2 groups with regard to number, dimensions, growth progression, or hypoechogenic pattern of the nodules. Regarding scintigraphic findings, no significant difference was found between the 2 groups. However, a positive correlation (r = 0.90; P < 0.0001) was found between fine needle aspiration biopsy cytological findings and histological diagnoses. The sensitivity, specificity, and accuracy of fine needle aspiration biopsy were 95%, 86.3%, and 90.4%, respectively. A multiple regression analysis showed that only fine needle aspiration biopsy (beta coefficient = 0.963; P < 0.0001) significantly contributed to detecting malignancy (multiple r = 0.973; P < 0.0001). This study provides strong evidence that fine needle aspiration biopsy is a safe technique even in childhood and adolescence, offering the best sensitivity, specificity, and accuracy in detecting malignancy compared with conventional approaches.

Adolescent↗

PubMed1997

Risk factors for intrahepatic recurrence of hepatocellular carcinoma in cirrhotic patients treated by percutaneous ethanol injection.

BACKGROUND: Hepatocellular carcinoma (HCC) complicating cirrhosis has a high intrahepatic recurrence rate after treatment by surgical resection or percutaneous ethanol injection (PEI). In this study, certain clinical, biochemical, and pathologic parameters were evaluated as risk factors for intrahepatic tumor recurrence in liver segments different from that of the first neoplasm in a group of 57 cirrhotic patients with single HCC < 5 cm treated by PEI. METHODS: After PEI treatment of HCC, the patients were followed for a mean period of 33 +/- 16 months. The following pretreatment parameters were evaluated as predictors of tumor recurrence: age, gender, Child-Pugh score, hepatitis B virus surface antigen, hepatitis C virus antibodies, alanine aminotransferase, aspartate aminotransferase, alpha-fetoprotein (AFP) level before PEI, alcohol abuse, HCC size, HCC ultrasound pattern, HCC histologic grade, HCC capsule, and time from cirrhosis diagnosis. Furthermore, the posttreatment parameters of the AFP level 1 month after PEI and recurrence of HCC in the same liver segment were also evaluated. RESULTS: The cumulative 4-year intrahepatic recurrence rate of HCC was 62%. The log rank test indicated that, among pretreatment parameters, time from cirrhosis diagnosis > 6 years (P = 0.05) and AFP level before PEI of > 25 ng/mL (P = 0.00005) were significantly linked to tumor recurrence. Cox's proportional hazards model showed that only AFP level before PEI was independently associated with recurrence (P < 0.002). With regard to posttreatment parameters, an AFP level 1 month after PEI of > 13 ng/mL was shown to be significantly related to tumor recurrence by the log rank test (P < 0.0001). CONCLUSIONS: Cirrhotic patients with single HCC treated by PEI who have slightly increased serum levels of AFP before and/or after PEI treatment are at increased risk of intrahepatic tumor recurrence and should undergo a close follow-up program.

Adult↗

PubMed1994

Ultrasonographic signs of sliding, gastric, and hiatal hernia: their prospective evaluation.

This study was conducted to identify the sonographic findings that might be used to diagnose sliding gastric hiatal hernia. We first performed a retrospective evaluation of 12 patients known to have sliding hiatal hernia and 18 normal controls. In the controls the esophagogastric junction could be visualized clearly in all cases and the alimentary tract cross section at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The esophagogastric junction was not visualized in any of the hernia patients, whose alimentary tract diameters measurements ranged from 16.0 to 21.0 mm. These two markers (non visualization of the function and diameter greater than 16 mm) were then evaluated for their ability to predict the occurrence of sliding hiatas hernia in a prospective study of 38 patients subsequently diagnosed by means of barium studies and endoscopy. In this group, each sign had a positive predictive value of 100%. The negative predictive value of the alimentary tract diameter was 90%; that of non-visualization of the esophagogastric junction was 94.7%. Inclusion of ultrasonography in the initial work-up of patients with symptoms of gastroesophageal reflux may reduce the need for more invasive diagnostic procedures.

Adult↗

PubMed1986

Hyperfunctioning thyroid nodules in children and adolescents.

Eight children and adolescents, seven female and one male, aged 7.1 to 15.0 years, referred over a 12-year period for a solitary mass in an otherwise normal thyroid gland, exhibited a hyperfunctioning nodule on thyroid scintiscan. Tracer uptake in the surrounding thyroid tissue was reduced or completely suppressed, but could be restored after TSH stimulation. Only one patient had mild clinical hyperthyroidism with normal T4 but increased T3 serum levels and blunted TSH responsiveness to TRH. A similar hormonal pattern suggestive of subclinical hyperthyroidism was found in three other subjects who were clinically euthyroid. One patient initially euthyroid progressed to subclinical hyperthyroidism two years later. In the whole group a significant negative relationship was found between serum T3 level and TRH-stimulated TSH peak (r = -0.829, p less than 0.02). All the patients underwent selective surgery after a 3-month to 2-year period of follow-up. Microscopic examination was consistent with adenoma in seven patients, while in one case a well-encapsulated papillary adenocarcinoma was found. Though hyperfunctioning nodules are seldom malignant, their surgical removal must be recommended when they become thyrotoxic, exceed 3 cm or show progressive enlargement.

Adenocarcinoma↗

PubMed1985

[Solitary solid cold thyroid nodule in children and adolescents].

The present series includes 19 children and adolescents aged 8 to 15 years, 14 females (74%) and 5 males (26%), who underwent surgery because of solitary hypofunctioning solid thyroid mass. Microscopic examination of the mass was consistent with adenoma in 11 cases, carcinoma in 7 cases and thyroiditis in one case. Neither clinical examination nor isotopic and endocrinological investigations were predictive of the histological diagnosis. A cold nodule which is solid by ultrasonography and hypofixing by scintiscan requires, after observation for a few months, biopsy with histologic assessment during the operation.

Adenocarcinoma↗

PubMed1983

[Transient biological hypothyroidism in an infant carrier of celiac disease].

This is the first report of a coeliac infant with biochemical findings of primary thyroid failure (decreased T4, decreased FT4, decreased T3, increased TSH). No clinical signs of this disorders and no thyromegaly were observed. Biochemical indices of thyroid function reverted to normal after two months on a gluten-free diet. Thyroid function impairment is suggested to be related with the active phase of coeliac disease.

Celiac Disease↗

PubMed1981

Persistent neonatal normoinsulinaemic hypoglycaemia.

A case is recorded of persistent neonatal hypoglycaemia characterized by early onset, normoinsulinaemia and improvement following glucagon therapy. The pancreatic A cell were very few in number and were mainly degranulated. There was a slight increase of B cells, but changes in cells producing somatostatin and human pancreatic polypeptide were not encountered. The differential diagnosis is discussed with the conclusion that the most probable causative factor was the deficiency of A cells.

Female↗

PubMed1980

Thyroid function in thalassaemia major.

Serum concentrations of T4, T3, rT3, and TSH were measured by radioimmunoassay in 45 patients suffering from beta-thalassaemia. A TRH stimulation test was performed and the binding capacity of TBG and TBPA for T3 and T4 measured by reverse flow zone electrophoresis in a group of these patients. Mean T4 serum concentration was lower in thalassaemic patients than controls; T3, rT3, TSH levels, and the pituitary response to TRH were normal. TBPA binding capacity for thyroxine was greatly decreased, probably due to iron overload impairing the liver function. The decreased circulating total thyroxine might be explained by the reduced TBPA capacity, serum free thyroid hormone concentration total thyroxine might be explained by the reduced TBPA capacity, serum free thyroid hormone concentration values being normal. It is concluded that thalassaemic children are euthyroid, despite often having low-normal or subnormal thyroxine levels.

Adolescent↗

PubMedDate not supplied

[Reciprocal changes in T3 nd rT3 serum concentrations in digestive diseases resulting in childhood protein-calorie malnutrition (author's transl)].

In 14 children affected by digestive diseases producing protein-calorie malnutrition T3 and rT3, T4, TSH serum levels and TBG and TBPA maximum binding capacity were measured at the moment of the hospitalisation and up to their clinical and biochemical amelioration. No changes in serum T4 and TSH levels and in TBGcap values were detected. TBPAcap was found to be persistently low. At the moment of the hospitalisation serum T3 and rT3 average values were found to be 65 +/- 25 ng/dl and 58 +/- 25 ng/dl respectively. Opposite changes in serum concentrations of the triiodothyronines were observed at the moment of the interruption of the study; T3 values were 200 +/- 64 ng/dl and rT3 value 25 +/- 16 ng/dl. T4 deiodination may be a homeostatic process and its preferential conversion to either activating (T3) or inactivating (rT3) pathways is related to the state of the organism.

Blood Proteins↗