Gastric dysplasia is prognostic for recurrence of gastric ulcer.
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Gastric Mucosa↗
Biomedical subjects
G L Rapaccini
Publications and source records attributed to G L Rapaccini.
The hepatic excretion of 131I-rose bengal and 99mTc-IDA derivatives in Rotor's syndrome.
Bilirubin kinetics and hepatobiliary excretion of some exogenous anions (BSP, 131I-rose bengal, diethyl and parabutly-IDA labeled with 99mTc) were studied in three patients presenting with Rotor's syndrome. Two were brothers; a nonjaundiced fraternal twin of one of them was also evaluated. The hepatic clearance of the radiopharmaceuticals was impaired in the affected patients but the degree of impairment was different among the tested anions, i.e., maximal for 99mTc-diethyl-IDA and minimal for 131I-rose bengal. Parabutyl-IDA was cleared better than the diethyl derivative. The metabolic derangement seems to be at the level of transfer from plasma to liver and of the hepatic storage, rather than at the level of hepatocyte excretory pathways, as in the case of Dubin-Johnson syndrome.
Adult↗
[Constitutional hyperbilirubinemia and mixed bilirubin. Clinical and functional study].
Three cases of non-haemolytic constitutional icterus with prevalently conjugated bilirubin have been studied: one case of Dubin-Johnson syndrome and two cases of Rotor's syndrome. Confirmation was obtained for the differences between the two syndromes from the physiopathological (by means of the BSF load test and determination of urinary excretion of porphyrin) and morphological (macroscopic, histological, ultrastructural) viewpoints. The following were carried out in all cases: a load curve with crystalline bilirubin, study of the course of the curve and application of compartmental analysis to the curve. Findings underlie the hypothesis that Rotor's syndrome contains an uptake defect and an accumulation change on the part of the liver cell of organic anions and that it is therefore possible to suggest some identity between Rotor's syndrome and the so-called "Hepatic storage disease".
Adult↗
[Hepatobiliary excretion of 131I-rose bengal and 99Tcm in Rotor's syndrome].
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Adult↗
A controlled study comparing cimetidine treatment to an intensive antacid regimen in the therapy of uncomplicated duodenal ulcer.
The authors report the results of a randomized study in which comparison was made between two different kinds of treatment in patients affected by uncomplicated duodenal ulcer endoscopically diagnosed. The first group was treated with 1 g of cimetidine per day, during a period of four weeks (200 mg three times a day and 400 mg at bedtime); the second with a liquid Al-Mg antacid compound, 210 ml/day 30 ml, 1 and 3 hr after meals and 30 ml before bedtime) for four weeks. Fity-one patients were studied, 27 treated with cimetidine, 24 with antacids. At the end of the four-week period, 21 patients (77.7%) in the cimetidine group and 18 patients (75%) in the antacid group were completely healed. Benign side effects were remarked in both types of treatment, none of which made it necessary to suspend treatment. No significant variation of the basal and peak acid output before and after each kind of treatment was observed, while a slight but significant increase in fasting serum gastrin concentration was noted after treatment in the antacid group.
Adult↗
Erosive duodentis during cimetidine treatment.
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Cimetidine↗
[Contribution of laparoscopy-biopsy to the diagnosis of primary liver neoplasms].
After a review of the literature, personal observations of primary benign and malignant tumours of the liver, studied using laparoscopic biopsy are presented and the importance of this examination in the early diagnosis of primary hepatic tumours is stressed. This examination, particularly when associated with biopsy, is very useful since it reduces diagnosis time with little or no risk to the patient with a high percentage of positive results.
Biopsy↗
Diagnosis of hepatic lesions: ultrasonically guided fine needle biopsy or laparoscopy?
We compared the results of ultrasonically guided fine needle aspiration biopsy and laparoscopy in 63 patients who underwent both procedures. In this series, fine needle biopsy showed a sensitivity of 75.6% with a 84.1% overall accuracy. Laparoscopy demonstrated a 74.3% sensitivity with an overall accuracy of 82.7%. The combination of both procedures achieved an overall accuracy of 98.4% with a sensitivity of 97.5%. In one case only (hepatic involvement by Hodgkin's lymphoma), both laparoscopy and ultrasonically guided fine needle biopsy failed to establish the diagnosis. In small and deeply located lesions, ultrasonography is the most useful guide for biopsy. Laparoscopy is irreplaceable in the diagnosis of cirrhosis and in hepatic biopsies requiring larger bore needles. With the increasing use of ultrasonically guided fine needle biopsy, laparoscopy finds new indications, particularly in the preoperative staging of small hepatocellular carcinoma.
Adult↗
Ultrasound and CT findings in two cases of hemangioma of the adrenal gland.
The ultrasound and CT findings in two patients with hemangioma of the adrenal gland are presented. Ultrasound showed large masses with heterogeneous nonspecific structural pattern. Unenhanced CT demonstrated lesions with hypodense centers and thick irregular peripheries with higher density. A few small peripheral calcifications were noted in one patient. Following contrast medium injection, patchy enhancement of the peripheral zone of the tumor was seen in both cases.
Adrenal Gland Neoplasms↗
Hypoechoic lesions in the 'bright liver': a reliable indicator of fatty change. A prospective study.
The accuracy of ultrasonographic diagnosis of hypoechoic focal fatty change in the 'bright liver' was evaluated in 40 lesions found in 35 patients followed up for a mean period of 37.8 months. Patients with ultrasound and laboratory findings suggesting liver cirrhosis were excluded from the study. All patients underwent a blind liver biopsy in order to verify the diagnosis of diffuse disease suggested by the finding of 'bright liver'. No guided biopsy was performed on the focal lesions in order to establish the accuracy of ultrasound alone in recognizing focal fatty change. Clinical, haematologic and echographic follow-up confirmed the diagnosis in all cases. All histological specimens revealed liver steatosis, indicating a 100% sensitivity of ultrasonography in identifying non-cirrhotic fatty liver with an accompanying focal change. Increased echogenicity and hypoechoic focal changes are reliable indicators of fatty infiltration, making ultrasonography an acceptable, non-invasive method for the diagnosis of liver steatosis.
Adult↗
Cruveilhier-Baumgarten syndrome: an efficient spontaneous portosystemic collateral preventing oesophageal varices bleeding.
The protective role of large spontaneous portosystemic shunts in oesophageal varices bleeding due to portal hypertension in liver cirrhosis is still debated. A series of 20 consecutive patients with haemodynamically efficient collaterals involving the para-umbilical-epigastric venous route (evaluated by Echo-Doppler flowmetry) is reported. All patients presented absent or mild oesophageal varices at endoscopy. During a mean follow-up period of 23.5 months, no patient developed large varices or experienced variceal bleeding. Hepatic encephalopathy was present in 35% of patients. Haemodynamically efficient spontaneous portosystemic shunts may protect cirrhotic patients from the risk of oesophageal varices forming and bleeding. The diversion of large amounts of blood from portal to systemic circulation correlates with the higher trend of hepatic encephalopathy in these patients.
Adult↗
Utility of alpha-fetoprotein (AFP) in the screening of patients with virus-related chronic liver disease: does different viral etiology influence AFP levels in HCC? A study in 350 western patients.
BACKGROUND/AIMS: Dosage of serum AFP (alpha-fetoprotein) is widely used for HCC screening in patients with chronic liver disease. Virus-related chronic liver disease is the main cause of cirrhosis and HCC in Western and Far Eastern countries, but the relationship between viral etiology and AFP levels in HCC is still unclear. The aim of this study was to verify, in Western patients with post-viral chronic liver disease, the usefulness of AFP dosage for the detection of HCC, and the influence of viral etiology on AFP levels in HCC. METHODOLOGY: The study population included 350 patients with post viral chronic liver disease that underwent liver biopsy, serum AFP determination and ultrasound liver evaluation. Seven patients had normal liver histology, 197 had chronic hepatitis, 72 had cirrhosis, and 74 had cirrhosis and HCC. ROC (receiver operating characteristic) analysis was used to assess the best diagnostic AFP threshold value for HCC detection. Logistic regression analysis was performed to individuate independent predictors of HCC diagnosis. RESULTS: No difference was observed in AFP levels between HCV- and HBV-positive patients, neither in the whole population nor in the HCC patients only. ROC area under curve for AFP was 0.801 (95% CI: 0.721-0.867). The analysis individuated a best accurate AFP threshold value for HCC diagnosis of 50 ng/mL. HCC was detected with specificity > or = 95% only for AFP > 100 ng/mL. The sensitivity however was poor (25%). Male sex, age > 60, and AFP were independent predictors of HCC diagnosis. CONCLUSIONS: Serum AFP levels in HCC patients are not influenced by virus B or C hepatitis pattern. AFP dosage should not be used for HCC diagnosis in non-cirrhotic patients. Male patients with cirrhosis should be regarded with a more "aggressive" screening program compared to females.
Biomarkers↗
Hepatitis C virus infection: other biological fluids than blood may be responsible for intrafamilial spread.
BACKGROUND/AIMS: Several epidemiological studies have shown the existence of other routes of transmission of the hepatitis C virus besides the parenteral one, but the mechanisms involved are not yet understood. The general aim of this study was to evaluate the prevalence of hepatitis C virus infection in family contacts of infected patients and to analyze the possible risk factors and alternative transmission routes. METHODOLOGY: One hundred and thirty-eight relatives of 45 patients (index cases) affected by C virus-related chronic hepatitis were studied. The relatives were 45 spouses, 89 children and 4 cohabitants who underwent detection of serum anti-HCV antibodies; the anti-HCV-positive subjects were tested for serum HCV-RNA. The index cases, all the spouses and only other infected relatives were tested for the presence of HCV-RNA in saliva RESULTS: Antibodies to hepatitis C virus were detected in 5.7% of the family members while 11.1% of the analyzed spouses were serum HCV-RNA-positive. HCV-RNA was found in 44% of the examined saliva and 39% of these were found serum HCV-RNA-negative. The prevalence of hepatitis C virus among household contacts, excluding cases with previous parenteral exposure, was 3.6%. CONCLUSIONS: The epidemiological data on the intrafamilial spread of hepatitis C virus may be underestimated owing to the existence of infected relatives serum-negative but saliva-positive for the presence of the virus. The whole of these observations suggests a possible role of biological fluids in intrafamilial spread of hepatitis C virus.
Adult↗
[The role of ultrasonography in the diagnosis and staging of gastroenteric lymphoma].
Ultrasonography (US) plays an important role in the diagnosis, staging and follow-up of gastrointestinal lymphomas particularly when associated with complementary techniques such as echo-guided biopsy and endoscopic ultrasonography. Besides the well-known ultrasonographic "pseudo-kidney" image as sign of gastrointestinal pathology, the "spoke wheel" image is suggestive of gastroenteric lymphoma. This lesion is due to the lymphomatous infiltration of intestinal wall that looks ipoechoic compared to the iperechoic lumen. An early abdominal US study performed after clinical suspicion, should allow a presumptive identification of the enteric tract involved on the basis of the relationship between the "pseudokidney" image and the other abdominal organs. US study of the abdomen may be useful also to demonstrate enlarged retroperitoneal or visceral lymph nodes both in primary gastroenteric or systemic lymphomas. Fine needle biopsy (FNB) of deep lymph nodes is mandatory when superficial enlarged lymph nodes are not found showing a specificity and sensitivity of 100% and 66% respectively. The typical image of gastric wall on endoscopic US is constituted of five layers; the second one represents the lamina propria with the lymphatic tissue. The thickness increase of this layer suggest the diagnosis of gastric lymphoma. Therefore the endoscopic US examination is particularly important when the endoscopic features and the endoscopic biopsies are negative. Finally endoscopic US may be used to guide FNB of gastrointestinal tract lesions.
Gastrointestinal Neoplasms↗
Liver transplantation in Italy: preliminary 10-year report. The Monotematica Aisf-Olt Study Group.
Experience in liver transplantation (OLT) in Italy over a ten-year period is reported. Data were obtained using a multiple-items form collected from Italian liver transplant centres (reference centres) and other Italian institutions actively involved both in the processes of evaluation of the candidates and the follow-up of liver transplant recipients (afference centres). During this period, a total of 1046 liver transplants were performed on 954 patients, with a cumulative proportional survival of 71%. The most common indication for liver transplantation was post-hepatitic cirrhosis due to either hepatitis B virus (+/-hepatitis Delta virus) or hepatitis C virus infection. Good survival rates were observed, particularly in controversial indications, such as alcoholic cirrhosis, post-hepatitic hepatitis B virus-related cirrhosis and hepatocellular carcinoma, most likely due to proper and careful selection of the patients. Cirrhosis, secondary to an autoimmunity-based liver disease, showed the highest rate of rejection episodes. Infections, in our study population, were the most common cause of death after transplantation.
Adolescent↗