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Biomedical subjects

G L Rapaccini

Publications and source records attributed to G L Rapaccini.

At least 55 records · Page 3Linked to original sources
PubMed1991

Hypoechoic lesions in fatty liver. Quantitative study by histomorphometry.

Ten patients with fatty liver changes were subjected to liver biopsies. In seven, ultrasonography showed focal hypoechogenicity within a "bright" liver, generally interpreted as focal sparing. Three patients had hyperechoic areas surrounded by "normal" parenchyma usually felt to represent local fat accumulation without diffuse involvement. Morphometric analysis was used to determine the total area occupied by fat (area density) and the number of lipid droplets (numerical density) per microscopic field in lesional and perilesional specimens. Compared with respective perilesional values, hypoechoic lesional numerical densities were significantly lower in 6 of 7 patients; the three hyperechoic samples had significantly higher values. In most cases, lesional and perilesional area densities were not significantly different. These hypoechoic focal lesions are believed to be merely areas in which a similar quantity of fat is contained in fewer droplets, and focal hyperechogenicity is believed to result from a larger number of fat-filled vacuoles with respect to that of the surrounding parenchyma. Variation in the number of solid-liquid interfaces causes the ultrasonic contrast between these lesions and the similarity fatty liver parenchyma surrounding them.

Biopsy, Needle↗
PubMed1991

Gastric emptying rate and hormonal response in type II diabetics.

Gastric emptying time was measured by ultrasonography in 18 NIDDM patients with and without autonomic neuropathy, evaluated by cardiovascular autonomic tests and in 10 controls before and after a physiologic test meal. Six neuropathic subjects showed gastrointestinal symptoms such as fullness and early satiety. Blood glucose, gastrin and pancreatic polypeptide were evaluated before and up to 200 min after the test meal. The gastric emptying rate was similar in controls (275 +/- 45 min) and in diabetic patients without (260 +/- 49 min) and with autonomic neuropathy (257 +/- 48 min) (p = ns), while diabetic symptomatics showed a significant reduction of gastric emptying rate (420 +/- 19.7 min) (p less than 0.001). Basal serum glucose concentration was similar in all diabetic patients (132 +/- 18 mg/dl, 166 +/- 52 mg/dl, 161 +/- 61 mg/dl, p = ns). A basal value of serum gastrin was similar in all groups while the test meal produced a rise with a peak at 40' significantly higher only in symptomatics (195 +/- 58 pg/ml vs control 107 +/- 88 pg/ml, diabetics without and with autonomic neuropathy: 98 +/- 12 pg/ml and 88 +/- 22 pg/ml respectively; p less than 0.01). Basal and stimulated PP values were similar in all groups. In conclusion ultrasonography is a simple, reliable method to evaluate gastric emptying rate without any interference in the mechanism of digestion and absorption of nutrients. The presence of non specific symptoms, such as nausea and gastric fullness, may indicate an early gastric involvement as supported by sonographic evidence of impaired emptying.

Adult↗
PubMed1990

Clinical suspicion of pancreatic neoplasm: does echo-guided fine-needle biopsy modify patient management?

The following parameters were retrospectively evaluated in 64 patients with suspected pancreatic neoplasm: (1) time required to obtain cytohistologic diagnosis, (2) days in hospital, (3) number and type of surgical operations, and (4) total hospital costs. Echo-guided fine needle biopsy (FNB) was performed on 34 patients (FNB group) and in a further 30 patients diagnostic workup did not include percutaneous biopsy (laparotomy group). Both diagnostic and hospital stay were shorter (8 and 7 days, respectively) in the FNB group than in the laparotomy group. In the FNB group, surgery was avoided in 18 patients, while in the laparotomy group 18 explorations proved diagnostic alone. Finally, FNB was shown to reduce hospital costs by 23%.

Biopsy, Needle↗
PubMed1990

Focal ultrasound lesions in liver cirrhosis diagnosed as regenerating nodules by fine-needle biopsy. Follow-up of 12 cases.

In the period 1985-1988, 62 focal liver lesions in 58 cirrhotic patients were studied by ultrasonography; 12 of these focal lesions were documented to be regenerating lesions by echo-guided fine-needle biopsy. During an average follow-up period of 10.2 months (range 3-22 months), hepatocellular carcinoma was subsequently found in 10 of the cases of regenerating nodules, whereas the initial diagnosis of regenerating nodule was confirmed in the remaining two cases. Based upon this finding, it is suggested that every focal mass visualized by ultrasonography in a cirrhotic liver should either be considered to be a neoplastic lesion or at least a preneoplastic lesion if the possibility of either a metastatic or benign lesion (eg, hemangiomas, focal fatty liver change areas) can be excluded. Therefore either fine-needle aspiration or biopsy of all ultrasonographically revealed mass lesions within a cirrhotic liver is advised, such that early appropriate treatment for hepatocellular carcinoma can be instituted.

Aged↗
PubMed1990

Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications. A retrospective study on 2091 biopsies.

Two thousand and ninety-one ultrasound-guided fine-needle biopsies were performed in 1946 patients to diagnose focal liver lesions. The diagnostic accuracy of fine-needle biopsies is very high (only one false positive was observed), both for aspiration biopsy (93.4%) and for cutting biopsy (95.1%). The difference is not statistically significant. In cases of hepatocellular carcinoma (but not in cases of metastasis or hepatic lymphoma), double biopsy (aspiration and cutting) showed higher diagnostic sensitivity than single methods. A certain number of benign focal liver lesions were also diagnosed. In the present series, no case of death following liver puncture was observed. Intraperitoneal hemorrhage was the most common complication. The risk with a cutting needle being higher than with an aspirative needle.

Biopsy, Needle↗
PubMed1990

Ultrasound-Doppler diagnosis of Budd-Chiari syndrome.

We report a case of apparently idiopathic Budd-Chiari syndrome, diagnosed by ultrasound and Doppler sonography, in a patient with latent myeloproliferative disease. This case proves that Doppler sonography shows in the hepatic veins a flow pattern suggestive of partial thrombotic obstruction. Moreover, we suggest that the search for a latent myeloproliferative disorder, by means of the spontaneous erythroid colonies formation in culture of bone marrow or blood mononuclear cells, should be routinely included in the diagnostic evaluation of each case of hepatic vein thrombosis without other recognizable causes.

Blood Flow Velocity↗
PubMed1989

Real-time ultrasound guided renal biopsy in diffuse renal disease: 114 consecutive cases.

The usefulness of real-time ultrasonography as a guidance method in performing percutaneous renal biopsy is evaluated on the basis of a series of 114 patients with diffuse nephropathies. Sufficient renal tissue for light microscopy was obtained in 102 patients (89.5%) and enough for electron microscopy in 93 patients (81.6%) and for fluorescence microscopy in 91 patients (79.8%). A final histological diagnosis was possible in 106 patients (93%). The high diagnostic rate, the reduction in the contraindications to the procedure, the lack of major postbiopsy complications, and the cost effectiveness probably make realtime ultrasound scanning the method of choice when performing renal biopsy in patients with diffuse nephropathies.

Adult↗
PubMed1988

Gastric wall thickness in normal and neoplastic subjects: a prospective study performed by abdominal ultrasound.

Gastric wall thickness (body-antrum) was blind measured prospectively by real-time ultrasound in 58 patients (30 with gastric cancer and 28 healthy) who had previously undergone endoscopy. Gastric wall thickness on the average measured 15.933 +/- 4.471 mm in the neoplastic patients and 5.107 +/- 1.100 mm in the normal subjects. Seven millimeters was the highest value found in the normal subjects (4 cases) and the minimum value found in the neoplastic patients (1 case). Knowing the normal gastric wall thickness value on a standard ultrasound examination of the upper abdomen is useful, as ultrasound is often performed as a screening or first-step procedure, in order to address the patients with higher values toward more specific techniques.

Humans↗
PubMed1987

Ultrasonography and echo-guided fine-needle biopsy in the diagnosis of focal fatty liver change.

The usefulness of ultrasound and echo-guided fine-needle biopsy (FNB) in the diagnosis of focal fatty liver change (FFLC) is stressed, on the basis of a retrospective series of 21 patients (8 of whom with a past history of primary cancer), followed-up for a mean period of 13.7 months. FFLC presented with various echographic patterns, shapes, dimensions and localizations. In 17 patients the diagnosis of FFLC was made by FNB, yielding cytologic and/or histological samples with steatotic, but also normal, hepatocytes. In another 4 patients the diagnosis was made by echographic follow-up. In all patients, clinical, hematological and echographic follow-up excluded the onset of neoplastic disease, confirming the high specificity of FNB in diagnosing FFLC. The possibility of changing appearance over time, and the inconstant correlation of FFLC with known causes of hepatic steatosis are discussed, as well as the hypothesis that the focal defect seen with ultrasound, could be an area of normal hepatic tissue in a fatty liver. The authors affirm the necessity to perform FNB on each doubtful lesion, but certainly when the patient has a history of malignancy.

Adult↗
PubMed1986

Esophageal involvement in Behçet's syndrome.

Two patients with Behçet's syndrome had severe esophageal involvement. Both presented the complete clinical pattern (oral, genital, and eye lesions) of Behçet's syndrome. In both, esophageal lesions were associated with other gastrointestinal manifestations, in the first a transient episode of ulcerative ileitis, and in the second patient colitis. In both, the differential diagnosis with inflammatory bowel disease was very difficult. Histology of esophageal lesions was nonspecific; no vasculitis was found. Both patients improved on steroid therapy. Esophageal lesions also improved endoscopically and histologically with steroid therapy. When there is obvious gastrointestinal involvement in Behçet's syndrome, the differential diagnosis from inflammatory bowel disease is very difficult.

Behcet Syndrome↗
PubMed1986

Ultrasound-guided fine-needle aspiration biopsy in the diagnosis of hepatic hemangioma.

Fine-needle biopsy of hepatic hemangioma is discussed on the basis of a series of 10 biopsies performed on eight patients. The fine needle biopsies were executed because of the atypical sonographic pattern of some lesions, or in order to exclude malignancy for others (five patients were known to have neoplasms). No complication presented during or after the punctures. In six cases cytologic samples included capillary vessels or endothelial cells, supplying the diagnosis of hemangioma. It is concluded that fine-needle biopsy of a hepatic hemangioma is not loaded with complications, and moreover can yield true positive information in 60% of cases.

Aged↗
PubMed1986

Porphyrins in Rotor's syndrome: a study on an Italian family.

Porphyrins in urine, plasma, erythrocytes and feces have been tested in two brothers affected by Rotor's syndrome and in three of their phenotypically normal relatives. In all five subjects normal values of delta-aminolevulinic acid and porphobilinogen in urine, and of prophyrins in plasma, erythrocytes and feces, were found. The two patients showed a marked increase in total urinary coproporphyrin excretion with a high percentage of isomer I. These observations confirm the hypothesis of a different route of the porphyrin excretion in Rotor's syndrome with a shift from the fecal route to the urinary one, and do not agree with the suggestion of an increased hepatic porphyrin production in this type of hyperbilirubinemia.

Adult↗
PubMed1985

Malignant seeding after fine-needle aspiration biopsy of the pancreas.

The authors report the case of a patient affected with carcinoma of the pancreas who underwent fine-needle aspiration biopsy under ultrasonic guidance. 2 months later, a peritoneal metastasis was found during laparotomy at the site of the previous biopsy. This is the third reported case in the literature of neoplastic dissemination after fine-needle biopsy, a traditionally safe diagnostic procedure.

Adenocarcinoma↗
PubMed1984

Echographic follow-up of an abdominal aortic aneurysm treated with a prosthetic bypass.

The history of a patient with two thoracoabdominal aneurysms and lumbar Pott's disease is reported. A bypass was implanted from the ascending to the abdominal aorta. In the postoperative course the patient experienced acute low back pain. Ultrasonography suggested patency of the vascular graft. Therefore the symptoms were attributed to the vertebral pathology, and so the correct treatment could be given. The utility of ultrasonography in the early postoperative course, when aortography is contraindicated, is stressed.

Aorta, Abdominal↗
PubMed1983

Impaired clearance of cholephilic anions in Rotor syndrome.

The behaviour of some cholephilic anions has been studied in three male patients (two of whom are brothers) affected with Rotor syndrome. The unconjugated bilirubin clearance was markedly reduced with impairment of the plasma-liver transfer constant rate (uptake defect). BSP retention at 45 min. was elevated without late rise of the anion. Transport maximum ("Tm") of BSP was slightly reduced; relative hepatic storage capacity of BSP ("S") was significantly impaired. Plasmatic retention of 131-I-Rose Bengal was increased with a diminished hepatic uptake of the compound. The hepatic excretion of IDA-derivatives was impaired, but less for parabutyl-IDA than for diethyl-IDA. It is concluded that in Rotor syndrome there exists an alteration of uptake and storage of several cholephilic organic anions: the alteration is common not only to substances that undergo intracellular conjugation--such as bilirubin and BSP--but also to substances that are not metabolized--such as Rose Bengal and IDA--derivatives. Finally the authors suggest that the Rotor syndrome and so--called "Hepatic storage disease" are the same condition.

Adult↗