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Biomedical subjects

L Grassi

Publications and source records attributed to L Grassi.

At least 37 records · Page 2Linked to original sources
PubMed1999

HIV-risk behaviour and knowledge about HIV/AIDS among patients with schizophrenia.

BACKGROUND: Recent literature has demonstrated that psychiatric patients, particularly those with a diagnosis of schizophrenia, may be at high risk for HIV infection. In fact, HIV-risk behaviour, such as intravenous drug with sharing needles, promiscuity associated with unprotected sex and high-risk sexual activity after using drugs has been reported by a substantial proportion of mentally ill patients. METHODS: In order to examine this problem in Italy, HIV-risk taking behaviour and knowledge about HIV/AIDS was investigated among 91 schizophrenic patients by using two self-report questionnaires (HIV-Risk Behaviour Questionnaire; AIDS-Risk Behaviour Knowledge Test). RESULTS: One-third of the patients reported having been tested for HIV infection and one tested seropositive (prevalence 3.4%). A high proportion of patients reported HIV-risk behaviour, such as injected drugs use (22.4%) and engaging in high risk sexual activity (e.g. multiple partners, 58%; prostitutes, 45%; occasional partners, 37%). Condoms were 'never used' by 41% of the patients and 'almost never used' by another 25%. In spite of these behaviours, 65% reported no concern of HIV infection. Knowledge about AIDS was lower among psychiatric patients than a healthy control group. Patients with long-lasting illness and numerous psychiatric admissions were less acknowledgeable about HIV infection. Certain misconceptions on HIV transmission were related to HIV risk behaviour. CONCLUSIONS: These results indicate the urgent need for HIV educational programmes within mental health community-care settings.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Dissociative disorder after traumatic brain injury.

Several episodes of dissociative disorder, including depersonalization and multiple personality, have been observed in a 32-year old man during a period of a few months following a mild traumatic brain injury. The psychogenic or organic aetiology of these psychiatric disorders remains undetermined. This case highlights the need to consider dissociative disorder among the possible (temporary) outcomes of a brain injury.

Adult↗
PubMed1999

Illness behavior, emotional stress and psychosocial factors among asymptomatic HIV-infected patients.

BACKGROUND: Over the last years the way in which patients with chronic physical illness respond to their illness (illness behavior) has been explored by several studies. This study sought to examine characteristics of illness behavior and to investigate the association between illness behavior and psychosocial and clinical variables among asymptomatic HIV-infected subjects. METHODS: Seventy-three asymptomatic HIV+ outpatients completed self-report questionnaires to evaluate illness behavior (Illness Behavior Questionnaire), psychological stress symptoms (Brief Symptom Inventory), personality variables (External Locus of Control and Courtauld Emotional Control Scales) and social support (Social Provision Scale). RESULTS: Psychological morbidity ('caseness' = 34%) was associated with a pattern of illness behavior characterized by conviction of disease progression, irritability, dysphoria, psychological perception of illness and low denial. Individual capacity to express emotions, adequate levels of social support and low levels of depression, as well as clinical variables (high number of CD4+ cells, recent notification of HIV infection and nonintravenous drug use category) influenced a more adaptive illness behavior. Psychological stress and low CD4+ cell count were the main predictors of the affective dimension of illness behavior. CONCLUSIONS: Psychosocial variables resulted to influence the tendency to interpret illness in a nonadaptive way in asymptomatic HIV-infected subjects. Such variables merit to be routinely examined within the doctor-patient relationship in AIDS clinics.

Adaptation, Psychological↗
PubMed1999

Microsatellite instability and frameshift mutations in genes involved in cell cycle progression or apoptosis in ovarian cancer.

The loss of mismatch repair enzymes increases the mutation rate in microsatellites and coding regions of the genome and appears to be involved in drug resistance. The replication error (RER+) phenotype, associated with microsatellite instability, has been widely described for both familial and sporadic colon cancers and for gastric and endometrial tumors. For ovarian cancer, the incidence of RER+ cases among sporadic tumors is still uncertain. We analyzed epithelial ovarian tumors and ovarian carcinoma cell lines for microsatellite instability and for mutations in the coding regions of different genes, including the recently discovered human CHK-1 gene, which has an important role in controlling cell cycle progression and whose coding region contains a poly(A)9 tract. Microsatellite instability and frameshift mutations in coding regions of BAX, TGFbetaRII, IGFIIR, E2F-4, ICE, and CHK-1 genes were analyzed in ovarian cancer samples and cell lines by polymerase chain reaction (PCR). Approximately 26% of patients showed microsatellite instability in two or more loci. BAT-26 locus showed no alteration in primary tumors. We detected a BAX mutation in one tumor sample and a TGFbetaRII mutation in one cell line. Our findings confirm the presence of the RER+ phenotype in sporadic ovarian cancer. The low rate of mutation in genes previously reported to be altered in colon and gastric cancer suggests that other not yet identified genes might be altered and could play a role in tumor progression and response to treatment in RER+ ovarian tumors.

Adult↗
PubMed1997

Depression, psychosocial variables and occurrence of life events among patients with cancer.

Depressive disorders and psychosocial related factors were investigated in 113 patients one year after the diagnosis of cancer. Patients with an ICD-10 diagnosis of depression (31% of the sample) showed higher external locus of control, poorer social support, higher incidence of undesirable and/or uncontrollable events than non-depressed patients. They also differed in reporting more frequently a life-time history of emotional disorders, inability to adjust to the diagnosis of cancer and in having a lower score on the performance status. Of these factors, past psychiatric history, early maladjustment to cancer, poor social support and low performance status were predictors of depressive symptoms. However, because of the cross-sectional nature of the study, no conclusion regarding a causal relationship between depression and psychosocial variables is possible.

Adolescent↗
PubMed1997

Incidentally discovered adrenal masses: evaluation with gadolinium enhancement and fat-suppressed MR imaging at 0.5 T.

The purpose of the study is to evaluate the ability of Gd-enhancement and fat-suppressed MR imaging operating at midfield strength to characterize incidentally discovered adrenal masses. Sixty patients with 72 adrenal masses incidentally discovered during US or CT exams were studied with a 0.51 MR unit following clinical and laboratory evaluation. After Gd-DTPA intravenous administration a modified three-point Dixon technique was performed in all patients. This technique provided three images sets: conventional T1-weighted SE images, fat-suppressed T1-weighted images and water-suppressed T1-weighted images. Diagnosis was established by means of surgery (11 lesions), fine-needle biopsy (21 lesions) and stability on ultrasonographic follow-up for at least 1 year (range, 12-87 months) from adrenal lesion discovery (40 masses). In most of adenomas (n = 55) an homogeneous enhancement was observed on postcontrast T1WI; however, 15 out of these lesions showed a small focal spot of high intensity in Gd-enhanced fat-suppressed images. On the contrary, malignant conditions (n = 6) and pheochromocytoma (n = 1), all had inhomogeneous signal intensities which were relatively higher after Gadolinium injection as compared with the liver. The fat suppression technique demonstrated areas of bright signal intensity related to high vascularity. The performance of three observers in order to differentiate malignant from benign conditions showed sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of 100, 88.5, 90, 50 and 100% on the basis of gadolinium enhancement only, by utilizing the Dixon technique. In conclusion, although Gd-enhancement and fat-suppressed sequence helped correctly differentiate among the groups of incidentally discovered adrenal masses, the degree of overlap suggests that it is still difficult to characterize individual patients. However, the modified three-point Dixon technique after contrast material administration appears to be a further capability of midfield MRI in the characterization of adrenal tissue.

Adenoma↗
PubMed1997

Psychosocial factors and breast cancer: a 6-year Italian follow-up study.

BACKGROUND: Over the last 20 years contradictory results have been obtained as regards to the role of psychosocial factors in favouring the onset of breast cancer and/or in influencing disease progression. METHODS: The present study prospectively investigated the association between psychosocial variables and breast cancer in 95 out-patients. Within 3 months from the diagnosis the patients completed a series of questionnaires to evaluate psychological disturbances, emotional repression, adjustment to cancer, social support and occurrence of life events in the past. At a distance of 6 years from the first assessment, the patients' charts were re-examined in order to evaluate the course of cancer. RESULTS: A higher volume of primary tumour at surgery was shown in patients who had had stressful events in the 6 months preceding cancer diagnosis. At follow-up, no relationship was found between psychosocial variables and the course of disease. The analysis of the frequency of relapses and deaths, and the survival analysis indicated that positivity of loco-regional lymph nodes, infiltrating histotype of the tumour and tumour stage were the only significant predictors of the time of death. CONCLUSIONS: The study suggests that clinical and biological rather than psychosocial factors exert a major role in breast cancer progression.

Adaptation, Psychological↗
PubMed1996

Depressive symptoms and quality of life in home-care-assisted cancer patients.

To examine the prevalence of depressive symptoms and its relationship with quality-of-life domains in home-care cancer patients at an advanced stage of illness, 86 patients were given psychological tests for depression (Hospital Anxiety Depression Scale) (HAD) and quality of life (EORTC-QLQ-C30) 1 week after admission to the home-care program. Using a proper cut-off score on the HAD-Depression subscale, depressive symptoms were reported by 45% of the patients. The quality of life of depressed patients was more affected than non-depressed patients in the social, emotional, cognitive, and physical domains. Significant correlations were found between depression scores and impairment in most quality-of-life areas. These findings support the importance of depression and quality-of-life evaluation in patients with advanced cancer who are followed in a home-care setting. This evaluation is needed to provide patients, their families, and caregivers with appropriate psychosocial interventions.

Adult↗
PubMed1996

Risk of HIV infection in psychiatrically ill patients.

The growing spread of HIV infection and AIDS incidence has led the medical milieu to increase efforts in the study of the at-risk population and in the development of prevention programmes. Nevertheless, little attention has been focused on psychiatric patients as a vulnerable and disadvantaged segment of the population with high risk of HIV infection. In fact, several studies in the last years have shown that high-risk behaviour, especially intravenous drug abuse and non-protected at-risk sexual intercourse, is reported by 20-50% of psychiatric patients, particularly those affected by bipolar disorders and schizophrenia. The prevalence of HIV infection has also been found to be higher in psychiatric patients than in the general population. In general, only a proportion (15-50%) of HIV-positive psychiatric patients have knowledge about their serological status, while the others do not know that they have been infected. Preliminary studies show that educational programmes specifically developed for psychiatric patients improved knowledge of HIV infection and reduced the patients' HIV-risk behavior. Specific intervention strategies should also be known when dealing with mentally ill HIV-positive patients. Open problems and further issues to be addressed by future research are discussed.

Female↗
PubMed1996

Poorly differentiated oxyphilic (Hurthle cell) carcinomas of the thyroid.

A series of 60 cases of oxyphilic (Hurthle cell) carcinomas (HCC) of the thyroid were reviewed to determine whether it is possible to correlate morphologic and clinical features as a means of assessing prognosis. Twenty cases showing predominant solid or trabecular patterns (as described in poorly differentiated carcinomas with a follicular pattern) were selected and the clinicopathological features were investigated. Based on cell size, two groups of solid or trabecular HCCs were identified: The first group (17 cases) was made up of typical large granular oxyphilic cells, and the second (three cases) had small oxyphilic cells. All tumors were reactive for thyroglobulin and for a mitochondrial antigen, selectively marking oxyphilic, mitochondrial-rich cells. Nuclear pleomorphism in individual cells was a common feature, but foci of anaplastic carcinoma were never found. Four cases overexpressed p53 protein and 10 expressed bcl-2 gene product. At follow-up, among the high-stage (pT3-pT4) tumors, seven patients had recurrences or metastases, six of whom were alive with disease or died of disease. In the control group of HCC with predominant follicular patterns, only one of 40 cases had a fatal outcome. The difference was statistically significant. Small-cell patterns and a p53 protein-positive/bcl-2 gene product negative phenotype were features of clinically aggressive HCC cases. We suggest that within the spectrum of oxyphilic (Hurthle cell) tumors, poorly differentiated HCC showing solid or trabecular patterns are a distinct group, based on both morphological and clinical features.

Adenocarcinoma↗
PubMed1996

Psychiatric and psychosocial concomitants of abnormal illness behaviour in patients with cancer.

BACKGROUND: Previous studies of medically ill patients suggest that abnormal illness behaviour (i.e. high hypochondriasis, disease conviction, dysphoria and irritability) is associated with depressive symptoms. The present study was carried out in order to examine more in detail the role of psychiatric and psychosocial variables in moulding abnormal illness behaviour in patients with cancer. METHODS: Two-hundred and one newly diagnosed cancer patients were submitted to a semistructured interview to assess past and current psychiatric disorders (DSM-III-R) and social support. Self-report questionnaires were also given in order to evaluate psychological stress symptoms (Symptom Check List-90-R-SCL-90-R), external locus of control (ELC) and illness behaviour (Illness Behaviour Questionnaire-IBQ). RESULTS: A pattern of abnormal illness behaviour was shown in patients with a life-time history of psychiatric disorders (n = 33) and in those with a current DSM-III-R diagnosis (n = 101). IBQ dimensions were associated with SCL-90-R, ELC and low social support. The patients' tendency to deny life events other than cancer was related both to the progression of the illness and to their receiving chemotherapy. CONCLUSIONS: The study confirms the association between psychological disorders and abnormal illness behaviour and points out a role for personality variables (external locus of control) and low social support in favouring maladaptive responses to cancer.

Activities of Daily Living↗
PubMed1996

[Occult post-traumatic osteochondral changes in the knee. Assessment with magnetic resonance].

Occult posttraumatic osteochondral injuries of the knee are bone and/or cartilage abnormalities which cannot be detected on plain radiographs. This study was aimed at investigating MR capabilities in the detection and characterization of occult bone and/or cartilage injuries in symptomatic patients with previous musculoskeletal trauma of the knee. We retrospectively selected 60 patients (45 men and 15 women; mean age: 33.1 +/- 16.3 years; range: 12-70 years) from our patients submitted to MRI of the knee during a 3-year period. These patients had a history of previous acute musculoskeletal trauma, negative conventional radiographs and MR signal intensity changes of the osteochondral structures. MR protocol included: SE T1-, PD and T2-weighted images and GRE T2-weighted images; imaging planes were the sagittal, the axial and the coronal planes. Plain radiographs and MR images were interpreted by three experienced readers in musculoskeletal radiology. Our reviewers confirmed normal conventional radiographic findings in all the patients enrolled in the study. According to morpho-topographic and signal intensity patterns, we identified three types of occult posttraumatic injuries: bone contusions or bone bruises or occult subcortical fractures (n 30), osteochondral injuries (n 26) and chondral injuries (n 4). A bone contusion was defined as a typical subcortical area of signal loss, with various shapes, on T1-weighted images and increased signal intensity on T2-weighted images. The cortical bone and articular cartilage below were normal in all cases. On the contrary, osteochondral lesions presented an association of cartilage and bone injuries with the same M(R) signal abnormalities. Thinning and focal interruptions of the cortical bone were demonstrated in all cases. Chondral lesions were characterized by a sudden discontinuity and irregularity of cortical bone outline and by small high-intensity spots in cartilage thickness on T2-weighted images, in the absence of any subchondral bone abnormality. Finally, 42 of 60 patients (70%) had an anterior cruciate ligament tear and 28 (45%) had a medial meniscus tear. In conclusion, MRI appears a very useful tool in the detection and characterization of the different types of occult bone and/or cartilage injuries of the knee in the patients with previous acute trauma. Moreover, the correct and early diagnosis of an osteochondral lesion does affect prognosis.

Adolescent↗
PubMed1996

Psychological stress symptoms before and after autologous bone marrow transplantation in patients with solid tumors.

This study sought to examine patterns of changes of psychological stress symptoms in autologous bone marrow transplantation (ABMT) recipients. Forty-nine patients affected by solid tumors were assessed using the Symptom Questionnaire on admission to hospital (before high-dose chemotherapy and ABMT) and before discharge. Symptoms of anxiety and anger tended to decrease and relaxation of improve over time. Nevertheless, on admission to hospital 30-50% of the patients reported severe to moderate symptoms of anxiety and depression. Before discharge, the prevalence was still high (20-35%). The implications of these findings are discussed in terms of the need to monitor the evolution of emotional functioning of cancer patients undergoing ABMT.

Adult↗
PubMed1996

[Two cases of melanoma metastasis. Description and review of the literature].

The metastases of malignant melanoma can appear after many years to primitive diagnosis and can involve many organs. There are reported two cases of metastatic melanoma presenting in a parotid gland and in the small bowel. The rarity of the metastatic melanoma to parotid gland and the difficulty of diagnosing intestinal involvement are discussed together with a review of the literature. The surgical treatment was justified by therapeutic and diagnostic aim, without positive influence on survival.

Aged↗
PubMed1995

Analysis of psychiatric consultations in patients with HIV infection and related syndromes.

Patients referred to the consultation-liaison psychiatry department of the University of Ferrara over a 12 month period were studied. About 13% of referrals concerned HIV patients. Comparison of HIV infected with non-HIV infected referrals revealed differences in the reasons for psychiatric consultation and the diagnosis made after assessment, as well as in the number of follow-up consultations. The implications of the findings are discussed.

Adult↗
PubMed1991

Myelin basic protein in lipid-bound form induces experimental allergic encephalomyelitis and demyelination in Lewis rat.

Myelin basic protein (MBP) was isolated from guinea-pig spinal cord in a form retaining the binding to all the myelin lipids. This new, lipid-bound and native-like preparation was used to immunize Lewis rats in complete Freund's adjuvant (CFA) in order to produce experimental allergic encephalomyelitis (EAE). The clinical features were compared with those of Lewis rats immunized with lipid-free MBP (LF-MBP), myelin, LF-MBP + octyl-POE (the non-ionic detergent used for the purification of LB-MBP) and octyl-POE alone. The clinical observation indicate that LB-MBP exerts an encephalitogenic activity on Lewis rats which is more intense than LF-MBP and includes demyelinating lesions in the central nervous system (CNS). The data suggest that LB-MBP is a new encephalitogenic antigen, which may induce more intensive immunization in rats and may be relevant in humans for autoimmune demyelinating diseases of the CNS.

Animals↗
PubMed1991

[The echographic picture of the breast following quadrantectomy and radiation therapy].

Our experience moved from the clinical relevance of an eventual positive role of US in the follow-up of breast cancers treated with conservative therapy. This trial was suggested by the more and more frequent use of conservative therapy an by the diagnostic difficulties offered by the breasts treated with surgery and radiation therapy. Aim of the study is to analyze the diagnostic value of US in the identification of local relapse in a group of 60 patients with breast carcinoma (stages I and II) treated with conservative therapy. The patients were studied for at least 2 years following treatment, with clinical, US, and mammographic controls at 6, 12, and 24 months. The following clinical problems were considered: 1) study of the US patterns of the morphological and structural changes induced by conservative treatment; 2) observation of US and mammographic agreement in case of local relapse; 3) role of US in the follow-up of this kind of patients. US patterns and results at 6 months follow: cutaneous scar (60/60 cases), skin thickening (55/60), architectural distortion (asymmetry and amputation of the glandular cone, intramammary scar) (52/60), volumetric changes in the treated breast (50/60), skin asymmetry and retraction (50/60), "parenchymal fibrosis" (48/60), mass (8/60) and calcifications (3/60). As for the very few relapses (4 cases), US failed to reveal a ductal carcinoma which presented as microcalcifications. In our experience, US is a complementary exam to clinical and radiologic investigations, especially in the period immediately following therapy and in case of particular clinical problems, such as increased breast volume, mastitis, and appearance of a nodule.

Adult↗