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Biomedical subjects

G Gozzetti

Publications and source records attributed to G Gozzetti.

At least 19 recordsLinked to original sources
PubMed1992

Indications for 24-hour gastric pH monitoring with single and multiple probes in clinical research and practice.

The methodology of prolonged gastric pH monitoring has not yet been standardized with regard to the number and position of pH probes. Twenty-seven healthy volunteers and 11 patients affected by nonulcer dyspepsia have been submitted to 24-hr ambulatory simultaneous pH monitoring of the distal esophagus, fundus, and antrum. Fundic and antral pH profiles have been compared and causes of pH variations (pH > 4) identified. Both in healthy volunteers and dyspeptic patients, percentile curves of fundic and antral pH were statistically different in more than one of the daily periods considered (24-hr, postprandial, interdigestive, nocturnal). Percent time of duodenogastric reflux is significantly higher in the antrum than in the fundus in both groups. Modalities of gastric alkalinization secondary to food or duodenogastric reflux were different for the fundus and for the antrum both in healthy and dyspeptic subjects and between the two groups. These differences suggest that single and multiple pH monitoring of the stomach have different indications, and the position of the probes should vary according to the purpose of the test.

Adult↗
PubMed1992

Liver resection for hepatocellular carcinoma in cirrhotic patients.

The results of a multicentric retrospective analysis of 265 liver resections for hepatocellular carcinoma in cirrhotic patients have been collected and assessed. Overall operative mortality was 9.1%. The actuarial 3-year survival was 46.5%. Better results were obtained in patients with encapsulated lesions and alphafetoprotein levels less than 400 ng/dl. Tumoral recurrence, which was the main cause of late death, was related to alphafetoprotein higher levels and to the type of surgery performed: tumor resection with short tumour free margin had the highest recurrence rate. Results were significantly better in those centers where intraoperative ultrasonography was systematically employed.

Adult↗
PubMed1991

[Monitoring esophageal pressure: comparison of various methods and a unique solution].

Ambulatory monitoring of intraesophageal pressure requires probes and techniques which are different from those used in the laboratory approach. In particular the perfusion system for the measurement of the pressure is not suitable and the development of alternative solutions is mandatory. In this perspective an accurate analysis of the theoretical basis of different methods is necessary in order to avoid incorrect results and difficulties in the subsequent phase of analysis. A prototype probe, which is based on inextensible thin plastic balloons filled with oil or saline, was tested in comparison with traditional (perfused) and microtransducer systems to outline the positive and negative aspects of the solution. The results were satisfactory as regards linear output and frequency response up to 5 Hz for the prototype probe and even superior, for instance, to the response of the perfused system to applied pressure, whose curves of the four open tips resulted different, and to the response of Millar transducer. The new prototype probe seems to be adequate to the clinical and research needs.

Equipment Design↗
PubMed1991

[Intraoperative esophageal manometry].

Intraoperative manometry has been proposed as a supportive procedure during the execution of anti-reflux operations and in the surgical treatment of achalasia. This procedure is not necessary in preparing anti-reflux plasty such as Belsey or Nissen, the outcome of which depends mostly on the correct execution of the surgical technique. Utilization of intra-operative manometry provides considerable benefits during the surgical treatment of achalasia, both when executing the extra-mucous myotomy and for the correct preparation of the anti-reflux plasty according to Dor, which is associated to it. Manometric control has made it possible to define the various anatomical components that, at both the esophageal and gastric levels, constitute the area which functionally corresponds to the lower esophageal sphincter and therefore a correct execution of the myotomy. As demonstrated by the follow-up study of our surgical patients, the intraoperative manometric measurement of the strain and of the length of the anti-reflux plasty is the determining factor affecting outcome over time. The pressure is apt to decrease even 5 year after surgery; maintaining given length and strain standards when executing the plasty can prevent delayed complications, such as esophagitis from gastro-esophageal reflux.

Esophageal Achalasia↗
PubMed1991

[Definition of a normal tracing in pH monitoring].

The adoption of specific criteria for the reading of tracings, together with a comparison of the results obtained during the course of patient tests with the thresholds of normality calculated in groups of healthy volunteers, are required to determine the normality or abnormality of pH monitoring. From such comparisons performed among groups of healthy volunteers, selected especially on the basis of age or nationality, it was found that age bears no significant influence in calculating the parameters pertinent to pH monitoring. On the other hand, different dietary and life habits could be responsible for a few, albeit limited, discrepancies, such as, for instance, the number of recorded occurrences of gastro-esophageal acid reflux. Use of esophago-gastric pH monitoring, which makes it possible to identify both acid and non-acid gastro-esophageal reflux (mixed and alkaline), authorizes the diagnosis of that limited number of patients in whom this latter component of reflux only exceeds normal limits (3.3%) and an improved definition of the clinical picture in a larger share of patients (20%). Use of different statistical methods to calculate the thresholds of normalcy does not substantially improve the sensitivity of the examination, changing the thresholds by a few tenths of a unit and the fact that the examination is slightly over, or slightly under, the threshold being of ineffectual clinical significance. The study of the correlation between symptoms and pH monitoring events seems a valid interpretative criterion of these tests and capable of improving the diagnostic efficiency of the examination (0.88) when combined with mathematical evaluation.

Adult↗
PubMed1991

An unusual case of hepatic tumor.

A case is reported of a large hepatic tumor in a patient aged 71. Preoperative diagnostic techniques, including echography, CT and angiography, did not provide sufficient criteria for a precise diagnosis. The mass was removed with an extended right hepatectomy with no particular physiopathological consequences. Histological analysis revealed that this was a metastasis from a melonoma of the choroid, operated on 17 years previously.

Aged↗
PubMed1991

Coagulation and fibrinolysis in orthotopic liver transplantation: role of the recipient's disease and use of antithrombin III concentrates. S. Orsola Working Group on Liver Transplantation.

In this study we report the data obtained from extensive haemostatic testing of 25 patients undergoing orthotopic liver transplantation and the results of an open randomized pilot trial of antithrombin III concentrate administration during surgery. Marked differences in transfusional needs and in pre- and intraoperative blood coagulation and fibrinolytic changes were observed between recipients with liver cirrhosis and those with primary biliary cirrhosis. In the former, the increases in tissue-type plasminogen activator activity, total euglobulin fibrinolytic activity, and fibrin-derived degradation products occurred earlier and were more marked, as were the signs of increased thrombin formation. Supplementation of antithrombin III concentrate during surgery failed to induce significant changes in the main parameters studied and in the transfusional needs.

Adult↗
PubMed1991

Reversal of primary liver graft non-function using prostaglandins.

Primary graft non-function remains one of the most life-threatening problems after liver transplantation. Its etiology is still unclear. Liver retransplantation is the only therapeutic alternative to this problem. The PGE1 series of prostaglandins have recently been successfully used in the treatment of transplanted organ dysfunction. In this paper we describe a case of primary graft non-function successfully treated with continuous infusion of prostaglandin PGE1, and we briefly discuss the pathogenetic and therapeutic hypotheses.

Alprostadil↗
PubMed1991

[Imaging techniques in the staging of carcinoma of the esophagus].

Forty-four patients affected with thoracic esophageal carcinoma underwent preoperative CT to evaluate the value of this method in both staging and assessing the resectability of esophageal tumors. The authors compared the CT findings with intraoperative macroscopic ones, pathologic, and bronchoscopic results in mid-high neoplasms. CT staging criteria were drawn from a careful review of literature and from personal experience. Thirty-nine patients were submitted to surgery, and esophagectomy was possible in 34 of them. CT diagnostic accuracy was higher in proximal esophageal tumors than in sub-bronchial ones; as for the surgical choice, CT provided fundamental guidelines, especially if the choice was a blunt esophagectomy where it is important to exclude tumoral involvement of the airways (accuracy: 82.6%) or of the aorta (accuracy: 89.7%). CT staging accuracy was limited by the low sensitivity of the method in detecting lymphatic (local: 66.6%, distant: 64.2%) and hepatic metastases. Combined thoraco-abdominal CT, tracheobronchoscopy and liver US, besides MR imaging and endoscopic US, allow a better preoperative evaluation of esophageal carcinomas.

Adenocarcinoma↗
PubMed1990

[Neoplastic occlusion of the right colon].

On the basis of more than 10 years' clinical experience of 122 patients operated on for cancer of the right colon, stress is laid on intestinal occlusion which is one of the most frequent complications of this pathology. The factors that make the event to be avoided and that lead to the poor short and long-term results are analysed.

Adenocarcinoma↗
PubMed1990

Ambulatory 24-hr pH monitoring of esophagus, fundus, and antrum. A new technique for simultaneous study of gastroesophageal and duodenogastric reflux.

A method for outpatient 24-hr simultaneous recording of pH in the distal esophagus, fundus, and antrum was developed in order to detect acid, alkaline, alkalacid gastroesophageal reflux, and duodenogastric reflux and to study these phenomena in patients complaining of gastroesophageal reflux and dyspepsia related symptoms. Two hundred ninety-four studies were performed in 42 healthy volunteers and 237 patients. Three-probe ambulatory 24-hr esophagogastric pH monitoring applicability, tolerability, and capability to determine a relationship between symptoms which occurred during the tests, gastroesophageal reflux, and duodenogastric reflux episodes were assessed. Eighty-nine percent of the three-probe esophagogastric pH studies were easily performed. The examination was tolerated well by 86.1% of the patients and poorly by 13.9%. A temporal correlation between symptoms and pH activities was recognized in 61.3% when the esophageal tracing was considered (acid gastroesophageal reflux recording) and in 95.6% when the three pH traces were simultaneously interpreted. Alkalacid gastroesophageal reflux and duodenogastric reflux total percentage times were significantly higher in patients complaining of dyspeptic symptoms than in patients only affected by typical gastroesophageal symptoms. Three-probe 24-hr ambulatory esophagogastric pH monitoring is a simple, well-tolerated test that should be routinely adopted for the study of patients complaining of unclear upper gastrointestinal tract symptomatology.

Adolescent↗
PubMed1990

Urogenital dysfunction after abdominoperineal resection for carcinoma of the rectum.

The long-term urogenital dysfunctions in 46 of 104 surviving patients submitted to abdominoperineal resection for rectal carcinoma between 1972 and 1986 were collected and assessed. Urinary retention was present in 41 percent of the men and 35 percent of women, while incontinence was present in 10 percent of men and 29 percent of women. Impotence was reported by 59 percent of the males, all sexually active before surgery. Dyspareunia was present in 50 percent of the women in the study. The possibility of treating prostatic hypertrophy concurrently with abdominoperineal resection in selected cases to avoid urinary retention is discussed. The limited number of responders to the survey may interfere with the global statistical significance.

Abdomen↗
PubMed1990

Is living donation still justifiable?

Present 'techno-medicine' has brought about clinical results that were simply unthinkable only a few years ago. Just how positive these results really are is beginning to emerge today with growing clarity. Yet, typical of techno-medicine is the way it solves certain problems whilst at the same time creating others. Organ replacement therapy clearly illustrates this modern predicament. Nowadays the death of an organ does not necessarily spell death to the individual. But the miracle of survival thus achieved entails a whole series of complex, controversial, or unsolved repercussions (ethical, logistic, clinical, economic). To find a solution to these would require more progressive thinking by our politicians if they are to grasp the real social importance of technomedicine; and greater humility from our scientists who must be prepared to admit that the widespread application of scientific results hinges entirely on their acceptance by politicians. Such concrete, trusting collaboration between the two orders of politics and science is still utopian. The ethics of living-donor transplantation conform to the rule: results (here moral as well as clinical) following on results (the creation of the renal 'new man' brought about by present techno-medicine).

Ethics, Medical↗
PubMed1990

Rating depression and anxiety after mastectomy: observer versus self-rating scales.

Paykel's Clinical Interview for Depression (CID), an observer-rated scale, and Kellner's Symptom Questionnaire (SQ), a self-rating inventory, were administered to twenty-six patients with breast cancer: 1) the day prior to discharge after mastectomy or lumpectomy, 2) after six months, during a follow-up outpatient visit. There were no significant changes in depression and anxiety (except for self-rated anxiety) and, indeed, there were very high test-retest correlations. Observer and self-rated assessments were significantly related, and these correlations improved on outpatient follow-up. DSM-III-R diagnoses of affective illness (mood and anxiety disorders) based on pre-established cut-offs of the CID, showed considerable stability, particularly as to major depressive illness.

Adjustment Disorders↗
PubMed1990

Relationship between alpha-fetoprotein serum levels, tumour volume and growth rate of hepatocellular carcinoma in a western population.

In order to detect a possible relationship between alpha-fetoprotein (AFP) levels, total tumour volume at the moment of the discovery and the tumour volume doubling time, we studied a population of 138 patients, affected by Hepatocellular Carcinoma (HCC) discovered at abdominal ultrasound (US) examination and confirmed by liver biopsy in all cases. In each patient the serum AFP level was determined within a week before or after the US examination. A small therapy-free subgroup of 23 patients, was also serially observed for a mean period of 4 months, so making possible the evaluation of the tumour volume doubling time and its relationship with the initial value of AFP. In 81 patients (58.7%) the serum AFP resulted less than 20 ngr/ml in 21 (15.2%), between 20 and 200 and in 36 (26.1%) greater than 200ngr/ml. No statistical correlation was found between the tumour volume calculated on the basis of the US image at the moment of the discovery and the AFP level, even though very high levels (greater than 3000) were found only in large tumours. Furthermore the tumour doubling time was not correlated with the initial value of AFP.

Adult↗