Biomedical subjects
Publications and source records attributed to M Cottone.
Scanning of 31 cirrhosis and 25 cancer-cirrhosis patients has been carried out using 198Au and then 67Ga. In 23/25 cancer-cirrhotic patients 67Ga was picked up in areas cold to 198Au (8% false negatives); such behaviour was not observed in any of the 31 cirrhotics (no false positive).
CONTEXT: The benefit of adjuvant radiotherapy for resectable rectal cancer has been extensively studied, but data on survival are still equivocal despite a reduction in the rate of local recurrence. OBJECTIVE: To assess the effectiveness of preoperative radiotherapy followed by surgery in the reduction of overall and cancer-related mortality and in the prevention of local recurrence and distant metastases. DATA SOURCES: Computerized bibliographic searches of MEDLINE and CANCERLIT (1970 to December 1999), including non-English sources, were supplemented with hand searches of reference lists. The medical subject headings used were rectal cancer, radiotherapy, surgery, RCT, randomized, and clinical trial. STUDY SELECTION: Studies were included if they were randomized controlled trials (RCTs) comparing preoperative radiotherapy plus surgery with surgery alone and if they included patients with resectable histologically proven rectal adenocarcinoma, without metastatic disease. Fourteen RCTs were analyzed. DATA EXTRACTION: Data on population, intervention, and outcomes were extracted from each RCT according to the intention-to-treat method by 3 independent observers and combined using the DerSimonian and Laird method. DATA SYNTHESIS: Radiotherapy plus surgery compared with surgery alone significantly reduced the 5-year overall mortality rate (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.72-0.98; P =.03), cancer-related mortality rate (OR, 0.71; 95% CI, 0.61-0.82; P<.001), and local recurrence rate (OR, 0.49; 95% CI, 0.38-0.62; P<.001). No reduction was observed in the occurrence of distant metastases (OR, 0.93; 95% CI, 0.73-1.18; P =.54). CONCLUSIONS: In patients with resectable rectal cancer, preoperative radiotherapy significantly improved overall and cancer-specific survival compared with surgery alone. The magnitude of the benefit is relatively small and criteria are needed to identify patients most likely to benefit from adjuvant radiotherapy. JAMA. 2000;284:1008-1015
Fifty patients with 81 abdominal hydatid cysts were followed with ultrasound during and after treatment with albendazole. In 61 cysts (75%), regressive changes were observed after treatment. Detachment of the membrane and change to a solid pattern in anechoic cysts were observed. Disappearance of septa or change to a solid pattern in anechoic cysts with intracystic septation were also found. There was an increase of hyperechoic structures in cysts with a mixed pattern. Follow-up ultrasound examination showed disappearance of 7 cysts, while anechoic structures reappeared in five cases. In anechoic cysts, regressive changes due to albendazole seem to be permanent, but in cysts with a mixed pattern recurrences are sometimes observed.
A case-control study of risk for hepatocellular carcinoma (HCC) was carried out in our Department from December 1980 to December 1983. One hundred and twenty consecutive inpatients with HCC were compared with 360 controls pair-matched by sex and age (within years). For each case three different controls were selected from inpatients at the same hospital: one patient with liver cirrhosis; one patient with solid tumor and one patient with chronic illness other than neoplasm or liver disease. We report here the results on alcohol consumption, smoking habit and hepatitis B virus infection. The risk factors investigated are distributed similarly in HCC and cirrhosis. The prevalence of alcohol abuse in HCC is similar to that in cirrhosis and is significantly higher than in other neoplastic or otherwise chronically ill patients (odds ratio 2 X 3 and 3 X 2 respectively). Thus alcohol abuse is probably a risk factor for HCC as a cause of cirrhosis. Smoking habits were similar among the various disease groups and independent of alcohol consumption. The prevalence of heavy smoking was comparable in cases and controls. HbsAg negative-HCC with an ultrasonographic pattern of 'diffuse' alteration was more frequent in heavy smokers.
The incidence of inflammatory bowel diseases is similar throughout Italy. Two prospective multicentre studies in the same period have shown an incidence very similar to Northern Europe. The incidence of ulcerative colitis ranged from 3.4 to 10.5. The incidence of Crohn's disease ranged from 1.9 to 6.6. The time trends seem to indicate an increase in both diseases. The need to set up General Registries of disease is underlined. The clinical behaviour and the diagnostic approach are homogeneous throughout the country. Compared to Northern Europe, surgery was less common in ulcerative colitis. Among the risk factors, familial occurrence has been shown to have the same prevalence as in Northern Europe suggesting a common genetic background. Studies on other risk factors are warranted considering the lack of data. Data on mortality show that there is a decrease in deaths in ulcerative colitis and a slight increase in mortality for Crohn's disease in the first few years after diagnosis. A retrospective study on costs has shown a greater economic burden from ulcerative colitis, however, new multicentre prospective studies are necessary.
30 patients--13 with active steroid-dependent/resistant Crohn's disease (CD), 8 with active steroid-dependent/resistant disease complicated by fistulas and 9 with fistulas only (perianal or abdominal)--were treated with infliximab. "Clinical response or remission" were defined as the reduction by 70 or more points or below 150 points of the CDAI score, respectively. As regards fistulas, "response" was defined as the reduction of 50 percent or more from baseline in the number of draining fistulas or of the quantity of drainage, "remission" as their closure. At 8 weeks 13/21 (61.9%) patients treated for active disease went on remission and 6/21 (28.5%) had a clinical response; 6/17 (35.2%) patients treated for fistulas went on remission and 8/17 (47%) had a response, while 3/17 (17.6%) didn't have any response. At 24 weeks, 9/12 (75%) patients treated for active disease and 13/16 (81.25%) treated for fistulas had a recurrence in a median time of 18.3 weeks (range, 1-36 weeks) after the first infusion.
BACKGROUND AND OBJECTIVES: Faecal calprotectin is predictive of clinical relapse in inflammatory bowel disease and ultrasound is sensitive in detecting its post-surgical recurrence. However, no data regarding the role of calprotectin in predicting post-surgical recurrence in asymptomatic Crohn's disease are available. The aim of this study was to prospectively evaluate the role of calprotectin as a predictive marker for one year post-surgical endoscopic recurrence in comparison with ultrasound in patients with asymptomatic Crohn's disease. MATERIAL AND METHODS: We consecutively enlisted 50 patients who had undergone a resection for Crohn's disease. Faecal calprotectin was analysed and ultrasound were performed at the third month, and a colonoscopy after one year. The sensitivity and specificity of these two techniques were evaluated using endoscopic findings as a golden standard. A Receiver Operator Curve (ROC) curve was plotted, in order to identify the best-cut off value for calprotectin. RESULTS: 39 out of 50 patients were evaluated by performing a colonoscopy after one year; 19 patients had an endoscopic recurrence after one year. Calprotectin sensitivity and specificity were calculated for 5 different cut-off values; the best cut-off value for calprotectin sensitivity (63%) and specificity (75%) was > 200 mg/L. The US sensitivity and specificity at the third month were 26% and 90% respectively. CONCLUSIONS: When performed three months after surgery ultrasound is more specific than calprotectin in predicting endoscopic recurrence. Faecal calprotectin at a dosage > 200 mg/L seems to have a better sensitivity than ultrasound. Values of calprotectin > 200 mg can be an indication to colonoscopy in the group of patients with negative ultrasound in order to detect early recurrence.
The authors retrospectively reviewed the radiographic (double-contrast small-bowel enema) examinations of 20 patients with primitive small intestinal lymphomas. The diagnosis was histologically confirmed in all cases. The technique was very sensitive (100%) in detecting small-bowel abnormalities. On the contrary, a definite differential diagnosis was difficult to make (65%), except for 4 cases of lymphoma complicating celiac disease in which the presence of a nodular pattern and of thickened and irregular mucosal folds seemed to be highly specific. The most difficult differential diagnosis was with Crohn's disease. In all the cases with surgical confirmation (17), disease extent exactly corresponded to that suggested by small-bowel enema. Primitive small intestinal lymphoma is not radiologically distinguishable from secondary involvement during systemic lymphoma. From the analysis of radiological abnormalities, the authors observed that, different from previous reports, severe luminal narrowing was frequent, whereas "aneurysmal" dilatations of intestinal loops were never observed. CT was confirmed as the best technique for staging. Clinical implications of double-contrast enema in the diagnosis of primitive small intestinal lymphomas are discussed; radiographic patterns are reviewed.
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Cancer of the pancreas is the fourth cause of death for tumor in USA; ultrasound has been shown a sensitive and specific technique in detection of this condition. We have prospectively studied with ultrasound 76 patients with clinical suspicion of cancer of the pancreas. Forty of these patients had carcinoma of the pancreas (histologically proved) and in the other 36 patients the cancer was clinically and/or surgically excluded. Sensitivity of ultrasound was 100%; specificity was 73%. The great part of our false-positive results were patients in which ultrasound detected a modification in the head of the pancreas and in which we couldn't have a biopsy from surgeons. The role of ultrasound scanning as first procedure to use in patients with clinical suspicion of carcinoma of the pancreas is confermed.
Seven patients with inactive ulcerative colitis and seven patients with Crohn's disease (5 inactive, 2 mildly active) received interferon treatment for associated chronic active hepatitis. Neither relapse (except in one patient) nor worsening of the clinical course of the inflammatory bowel disease was observed during treatment. According to these results chronic active hepatitis associated with inflammatory bowel disease can be treated with interferon without the risk of deteriorating the course of the inflammatory bowel disease.