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Biomedical subjects

G Zuccaro

Publications and source records attributed to G Zuccaro.

15 recordsLinked to original sources

Endoscopic ultrasonography in the diagnosis of chronic pancreatitis.

Endoscopic ultrasonography (EUS) is highly accurate in the diagnosis of chronic pancreatitis. Both parenchymal and ductal changes indicative of chronic pancreatitis can be identified. Parenchymal changes include small cystic abnormalities and hyperechoic foci scattered throughout the gland; the entire gland may be enlarged in early chronic pancreatitis, or small and atrophic in advanced disease. Ductal changes include enlargement of the main pancreatic duct or secondary branches, and the presence of stones or proteinaceous plugs within the ducts. Pseudocysts appear as cystic structures of mixed echogenicity; EUS is able to detect small pseudocysts or masses not identified by conventional imaging modalities. EUS has some difficulty in distinguishing benign from malignant pancreatic masses, particularly when the lesions are small. EUS should not supplant the use of CT scan or ERCP in the differential diagnosis of pancreatic disease, but is rather an adjunct to these studies. Future clinical research should focus on determining the appropriate indications for EUS in pancreatic disease, and determining if patient outcomes are favorably affected by the diagnostic information obtained.

Chronic Disease

Pouch ileitis.

Pouch ileitis is the most poorly understood complication of ileal reservoir surgery. Variability in definition of this syndrome may account for differences in incidence rate, associated symptoms, and response rate to therapy present in the literature. Outcomes of 19 episodes of pouch ileitis in patients having undergone prior colectomy and continent ileostomy construction for presumed ulcerative colitis were analyzed. An episode of pouch ileitis was characterized by: (1) abdominal pain, (2) increased ileal output, (3) mucosal inflammation within the continent ileostomy, and (4) absence of other recognized concurrent postoperative complications. The mean time of occurrence after construction of the continent ileostomy was 25 months (range 3-54 months). The mean length of follow-up of patients included in this analysis was 49 months from the time of continent ileostomy construction (range 22-101 months). Associated clinical symptoms included bloody effluent (53%), nausea or emesis (47%), and fever (42%). Endoscopic features were often nonspecific, with mucosal erythema (84%), edema (79%), friability (58%), and mucosal ulceration (53%) the most common. In those episodes of pouch ileitis where ileoscopy revealed no evidence of mucosal ulceration, complete resolution of the episode occurred 89% of the time, with 78% treated with antibiotics alone. In those episodes where mucosal ulceration was described on ileoscopy, 40% of episodes completely resolved after medical treatment, 20% with antibiotics alone. The varied clinical symptoms, endoscopic findings, and response to treatment raises the possibility that what has previously been described in the literature as pouch ileitis may be a heterogeneous group not of single etiology.(ABSTRACT TRUNCATED AT 250 WORDS)

Colectomy

Intracranial neoplasms during the first year of life.

During a 7-year period, from January 1976 to December 1982, 470 brain tumors were treated at the Hospital de Niños Ricardo Gutierrez in Buenos Aires, 40 of which occurred in infants under 1 years of age. Diagnosis was at best tentative because most cases were referred on account of symptoms and nonspecific signs, e.g., macrocephaly, vomiting, and altered behavior. The supratentorial location was predominant over the infratentorial, with a ratio of 4:1. Craniotomies with resection of tumor were performed on all but four infants. Optic chiasm pilocytic astrocytoma, superficial brain astrocytoma, and choroid plexus papilloma were the most common histologic types. Thirty-three infants (80%) were found to have hydrocephalus complicating the brain tumor, but only 15 of them were shunted, because 4 infants died, and in 14, hydrocephalus remitted after the operation. After 2-9 years of postoperative observation, 16 infants (40%) live tumor-free and have normal neurological examinations, 5 (12%) suffer moderate deficits, and 19 (48%) have died.

Astrocytoma