Biomedical subjects
Publications and source records attributed to M Pozzi.
The authors report a case of bullous erythema observed in a young woman affected with II B stage carcinoma of the cervix, whose clinical course was likely to be a paraneoplastic lesion. The aim of the report is to outline such a rare association between a dermatologic pattern and a gynecologic tumor and to synthesize the literature's data concerning this matter.
The authors present two cases of non-traumatic subdural haematomas associated with a meningioma. Relevant literature is reviewed and the pathogenesis of this rare condition is discussed.
Nineteen patients with simple endometrial hyperplasia presenting metrorrhagia or menometrorrhagia were treated with 4 injections of Goserelin depot, one every 4 weeks. 12/19 patients were refractory after previous medical therapy. The treatment with Goserelin depot resulted in a complete remission of the symptoms, occurring within the first month of treatment and still present after a median follow-up of 12 months, and in the normalization of the histological profile. No patient experienced clinically relevant side effects.
Ninety-three patients with gallstones were selected for extracorporeal shock wave lithotripsy (ESWL) with a piezoelectric device (EDAP LT-OI) to verify the efficacy and safety of this technique. Neuroleptoanalgesia with intravenous diazepam and phentanyl was performed in almost all patients. The treatment was combined with adjuvant litholytic therapy using oral ursodeoxycholic acid. Follow-up period was nine months. Piezoelectric ESWL was able to disintegrate radiolucent gallstones in 97.9% of cases. By the ninth month 68 patients (73.1%) were stone-free. Best results were obtained with single stones smaller than 20 mm. After ESWL, surgical cholecystectomy was necessary in 2.1% of cases. This study confirms the efficacy and safety of piezoelectric extracorporeal shock wave lithotripsy combined with ursodeoxycholic acid adjuvant therapy for selected cases of gallstone disease.
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The prevalence of HCV antibodies in IH and PCT patients was examined. It was found that both groups are characterized by increased incidence of HCV infection. These results suggest a possible connection between HCV and iron overload.
We report an unusual case of association of aortic coarctation with a calcified thrombus at the site of coarctation. To the best of our knowledge this is also the first such case that has been successfully treated.
Atrioventricular septal defects were repaired in 87 patients from 1981 to 1988. Interventricular communications were present in 73 patients, and major associated anomalies were present in 17 (tetralogy of Fallot in four, double-outlet right ventricle in two, multiple ventricular septal defects in 11). Five deaths occurred in the hospital (5.7%; 70% confidence limits, 3.2% to 9.7%). A preoperative New York Heart Association class V functional condition was the only incremental risk factor (p = 0.02) for death in the hospital. No patient (0%; 70% confidence limits, 0% to 2.15%) had complete heart block. Actuarial survival rate at 80 months was 81.4%. The only incremental risk factor (p = 0.005) leading to reoperation was a preoperative valve incompetence. Actuarial rate at 80 months for freedom from reoperation was 84.2% in the overall group of patients after repair of atrioventricular septal defect. We conclude that an improvement in survival and success rates should be found when a policy of earlier repair is followed.
In recent years, the association between breast and endometrial cancer has been the subject of many studies. The present report describes four cases of this association in which tamoxifen had been administered to all of the patients. Data have been published regarding the possibility that tamoxifen may be responsible for the subsequent development of carcinoma of the corpus uteri in these patients. The authors intend to carry out a case-control study on patients treated with tamoxifen for breast carcinoma to reveal the possible presence of endometrial carcinoma.
In our study we have examined 314 samples of cyst fluid taken from women suffering from fibrocystic breast disease (gross cystic disease). We have subdivided the cyst fluid with respect to epithelial coating and we have related trophoblastic protein content of the cyst fluid with age, seriousness of illness, and cytology of epithelial lining. We have performed RIA analysis of the trophoblastic proteins betahCG, beta1-SP-1, and alphahCG and in a smaller (n=84) group of specimens we have also tested for CEA, TPA, and ferritin. Trophoblastic proteins were positive in cystic fluids but the biological meaning of this is not known and the values are not related to clinical manifestations, except in a group of patients with apocrine metaplasia in which we tried to find a relationship between fertile age and increased betahCG. This finding presumably has a prognostic meaning that can be further understood by epidemiologic studies (of dietary intake and evaluation of lipid metabolites) and by information about inflammatory state of cystic fluid.
After having adopted the arterial switch operation as an alternative to the Mustard operation we decided to review our results with this protocol in order to evaluate the validity of our choice. From June 1984 to Oct. 1989 a total of 50 patients underwent an arterial switch operation in our department: 36 (72%) with simple transposition of the great arteries and an essentially intact ventricular septum; 9 (18%) with transposition of the great arteries and ventricular septal defect and 5 (10%) with the Taussing-Bing anomaly. In the group with simple transposition, the age ranged between 3 and 24 days (mean 8.7 +/- 4.3 S.D.) and the weight was between 2.4 and 4.9 kg (mean: 3.46 +/- 0.42 S.D.). In the group with transposition of the great arteries and ventricular septal defect the age ranged between 7 and 690 days (mean: 194 +/- 206 S.) and the weight was between 3.1 and 9.7 kg (mean 6 +/- 2.34 S.D.). In the group with Taussig-Bing anomaly the age ranged between 9 and 216 days (means: 132 +/- 75 S.D.) and the weight was between 3.2 and 5.1 kg (mean: 4.1 +/- 0.75 S.D.). A balloon atrial septostomy was performed in 43 (86%) patients. The Lecompte manoeuvre was adopted in 49 (98%) patients. The total early mortality was 10% (5/50). In the 36 neonates with simple transposition of the great arteries, 4 (11.1%) died. Among the 14 patients with transposition of the great arteries and ventricular septal defect and Taussig-Bing anomaly there was 1 (7.1%) death. There was also 1 (2.2%) late death.(ABSTRACT TRUNCATED AT 250 WORDS)
Six patients were studied to evaluate the efficacy and safety of plasma exchange (PE) in the treatment of primary biliary cirrhosis (PBC). All patients were affected by PBC at stage III-IV and presented symptoms refractory to pharmacologic therapy. Patients underwent PE for a mean period of 40 weeks (range 10-88). A mean of 33 liters (range 17-64) of plasma per patients was removed. Patients reported less fatigue (4/6), pruritus (5/5), nausea (3/3), Sjogren's syndrome (2/6), and painful neuropathy (2/3). A reduction of xanthomata was noted in one of the three affected patients. Definitive improvement was seen in the patient with Raynaud's phenomenon. A significant reduction was noted for serum cholesterol and gammaglobulins. ALT, AST, gamma-GT, alkaline phosphatase, bilirubin, prothrombin activity, AMA titers were not affected by PE. All patients suffered some mild adverse effects during PE. Two patients (IV stage) developed late edema and ascites after 34 and 44 weeks of treatment. We conclude that PE can be considered effective chronic treatment for advanced symptomatic PBC refractory to pharmacological therapy.
Between February 1, 1965, and December 31, 1985, 426 patients affected with Stage I adenocarcinoma of the endometrium were submitted to surgery in the Department of Gynecologic Oncology of the Regina Elena Cancer Institute. The value of the present survey is represented by the homogeneous diagnostic data on the basis of which the treatment was planned. Criteria of histological grading and myometrial invasion were always followed, making it possible to carry out a protocol combining surgery with radiotherapy, chemotherapy, and/or hormone therapy. In fact, an accurate evaluation of the grading, the infiltration of the myometrium, and the localization and size of the lesion are necessary to establish the risk of lymph node invasion. This last parameter is the most important as far as the therapeutic protocol, recurrences, and/or metastases and survival are concerned. The high 5-year survival rate, despite the high average age of the patients (74.7% between the ages of 51 and 70), associated pathologies, and the relatively low incidence of complications from treatment, demonstrate the validity of the protocol adopted.
The clinical presentation, diagnosis, and surgical treatment of 63 patients with doubly committed subarterial ventricular septal defects (DCVSD) were analyzed retrospectively. The patients were divided into three groups. Thirty-one patients had severe congestive heart failure in infancy and presently have a large ventricular septal defect that has no tendency to close or to produce aortic valve regurgitation (Group 1). Ideally, these defects should be closed in infancy, and the transpulmonary approach is recommended to achieve closure. In the first group, there was one death in a patient with a hypoplastic right ventricle. In Group 2, nineteen patients had aortic valve prolapse or aortic valve regurgitation. The DCVSD were moderately large or small. A number of DCVSD in Group 2 patients had maintained the normal offsetting of the arterial valves. These defects must be closed by the time mild aortic valve regurgitation has occurred. In Group 2, there was one late death in a patient who developed subacute bacterial endocarditis. The two patients who had severe aortic valve regurgitation required aortic valve replacement and underwent multiple surgical procedures to replace calcified bioprostheses. Group 3 comprised 13 patients who were diagnosed with tetralogy of Fallot. All of these patients had a large DCVSD with aortic valve overriding. All Group 3 patients survived radical repair of the defect, which required a transannular patch in most cases (76%).
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12 patients (9 males, 3 females; aged 35-63 years, mean 55) with chronic obstructive pulmonary disease (COPD) were studied in order to determine the correlation between the values of pulmonary arterial pressure and the M-mode echographic size of the right pulmonary artery (RPA) from the subxiphoid approach. Both the largest (systolic) and smallest (diastolic) size of the vessel were considered, and both were corrected for body surface area ('index size' - PA/BSA). The reliability of this echographic size is supported by the evidence that the tract of the pulmonary artery considered in this study is perpendicular to the ultrasonic beam. Both the systolic and diastolic size of RPA correlated with the systolic, diastolic, and mean pulmonary arterial pressure, detected by catheterization. Measurements of RPA size were made from the suprasternal approach in 8 patients out of 12. The size of RPA from the subxiphoid approach was also estimated in 21 normal subjects, serving as controls. Measurements of RPA size from the suprasternal approach were made in 12 of these subjects. Both the systolic and diastolic size of RPA from the subxiphoid approach correlated with the systolic and diastolic size of the suprasternal view in patients and in normal subjects. Subxiphoid M-mode echocardiography seems to be a valuable noninvasive technique in assessment of pulmonary hypertension, particularly in patients affected by COPD.
The purpose of the study was to analyze the medium-term results (late mortality, thromboembolism, valve failure) in patients who underwent bioprosthetic valve replacement at "A. De Gasperis" Cardiovascular Surgery Division. From October 1975 to December 1982, 195 patients were consecutively operated on and discharged (118 with mitral prosthesis, 54 with aortic prosthesis, 22 with mitral and aortic prosthesis, 1 with mitral and tricuspid prosthesis). We reviewed 115 (97.45%) of 118 patients with mitral prosthesis (mean follow-up 46.61 months) and 54 (100%) patients with aortic prosthesis (mean follow-up 38 months). Eleven late deaths (2.4%/pt-yr) and 13 thromboembolic events (2.8%/pt-yr) occurred in patients with mitral prosthesis, 6 late deaths (3.5%/pt-yr) and 5 thromboembolic events (2.9%/pt-yr) occurred in patients with aortic prosthesis. Actuarial survival curves and actuarial incidence of thromboembolic event-free patients at 5 years are, respectively, 91.2% and 87.3% in patients with mitral prosthesis, 82.8% and 86.3% in patients with aortic prosthesis. The risk factors for thromboembolism were analyzed. Reoperation was requested in 14 cases (10 mitral and 4 aortic prostheses) for prosthetic leak (6 patients) or valve failure (8 patients). In linearized terms, the rate of valve failure requiring reoperation is 1.3%/pt-yr for mitral prostheses and 1.1%/pt-yr for aortic prostheses. The medium-term results suggest that the bioprostheses are, at the present time, an effective choice to the mechanical prostheses, nevertheless they are not free from risks of thromboembolic complications.
Thirty-two hyperactive children who were under imipramine or methylphenidate medication took part in the experiment. The children were asked to learn a set of paired associate pictures containing a salient, central, figure and a secondary figure below. Free recall of all pictures was scored both immediately and seven days later. The children were subdivided into four groups according to the classical state-dependent learning paradigm. Group 1 was withdrawn from medication on both trials, groups 2 and 3 were withdrawn from medication on the first or second trial and group 4 received medication on both trials. No drug effects were found in immediate total recall. Delayed free recall was improved when original learning was under the drug state. This result was related to the proposal that arousing words are better remembered in delayed recall. Delayed recall of the secondary stimuli was particularly improved by the drugs during learning. Drug state dependency of the children's memory was also shown.