Type 1 gastric carcinoid: is the conservative approach always indicated?
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Aged↗
Biomedical subjects
M Ronconi
Publications and source records attributed to M Ronconi.
Retrospective histologic comparison of Helicobacter pylori infection in gastric carcinoma, ulcerous disease and non-ulcerous dyspepsia.
Although a number of epidemiological, biological and clinical studies have been published, the effective role of Helicobacter pylori infection in gastric carcinogenesis remains unclear. In the present work we retrospectively compared Helicobacter infection rate, by means of histologic examination of gastric bioptic samples, in 70 patients affected by gastric carcinoma, 70 with ulcerous disease and 70 with non-ulcerous dyspepsia. The analysis was carried out by a single pathologist. The differences between the 3 groups were not statistically significant. From our present and previously reported data, the Helicobacter infection cannot be considered per se a significant risk factor for malignant gastric disease and further studies are needed to evaluate the role of Helicobacter infection in the development of some preneoplastic conditions such as chronic atrophic gastritis and intestinal metaplasia.
Adult↗
D2 lymphectomy in the treatment of gastric cancer: a retrospective view on our experience (1990-1997).
From 1990 to 1997 we observed, in our department, 267 patients affected by gastric cancer. In the first four years of our experience (1990-93) we resected 87 patients out of 136 gastric cancers observed (63.9%): 56 pts. (64.4%) were classified as ASA I-II, 21 (24.1%) as ASA III, 10 (11.5%) as ASA IV. In 2 cases (2.3%), operated in emergency, a DO-1 lymphectomy was performed, with a mean of 4 nodes resected; 67 pts. (77.0%) had a D2, with a mean of 36.5 nodes resected; in 18 pts. (20.7%) we performed a D3, with a mean of 64.3 nodes resected. Post-operative technical complications were 13 (14.9%). We observed 5 post-operatory deaths (5.7%), 3 due to technical complications. Absolutely and relatively curative resections have been 62 (71.3%). In the second period (1994-97) we resected 89/131 patients (67.9%): in this group 50 pts. (56.2%) were classified as ASA I-II, 24 (26.9%) as ASA III, 15 (16.9%) as ASA IV. With the exception of 3 patients (3.4%) who were operated in emergency (D0-1 procedures, with a mean number of 2.3 nodes resected) we adopted D2 lymphadenectomy plus hepatic peduncle as the procedure of choice, performed in 86 pts. (96.6%), with a mean of 34.1 nodes resected. Post-operative technical complications were 5 (5.6%). We observed 5 post-operatory deaths (5.6%), 1 due to technical problems. Absolutely and relatively curative resections have been 76 (85.4%). Morbidity and mortality due to technical complications in the second period are lower than observed in the first period, without any difference in the curability rate. D2 lymphectomy seems to be an effective procedure, safe even in high anesthesiological risk patients. Increasing experience and standardization of the technique reduced risk of surgical complications and mortality.
Aged↗
Vasopressin, atrial natriuretic factor and renal water homeostasis in premature newborn infants with respiratory distress syndrome.
Arginine vasopressin (AVP), human atrial natriuretic peptide (hANP), and body fluid and electrolyte balance were examined during the first five days of life in eleven premature infants (birthweight 1610 +/- 240 g, gestation 30 +/- 1 weeks) receiving mechanical ventilation for respiratory distress syndrome (RDS). Plasma hANP and urine AVP concentrations were determined by radioimmunoassay on the first, third and fifth days. Arginine vasopressin urine levels remained constantly elevated during the study period (mean +/- SD 13.5 +/- 7.8 day 1, 12.0 +/- 9.9 day 3, 13.2 +/- 5.1 ng/l day 5, p = n.s.), while plasma hANP was significantly increased on the third day (626 +/- 495 vs. 298 +/- 240 pg/ml on day 1, p < .05). Urine sodium concentration, urine osmolality and osmolality and osmolar clearance were elevated significantly as well on day 3, p < .05, and correlated to hANP levels. Body weight decreased during the study by 8.2% on the third day and by 11.3% of birthweight on the fifth day. A significant increase in creatinine clearance occurred after the third day (p < .01), while free water clearance remained essentially the same during the first five days of life. We speculate that an increase in plasma hANP concentration on day 3 of life results in a natriuresis and osmolar diuresis without correlations or temporal relationships to hypervasopressinemia of the premature neonate with RDS.
Arginine Vasopressin↗
Correct placement of endotracheal tube by single strand fiberoptic light in prematures. Initial clinical experience.
In order to reduce non radiographically improper placement of the endotracheal tube, we manufactured a single fiberoptic strand, connected to a high-intensity illuminator, to be introduced by reference marks up to the tip of conventional endotracheal tube. This system showed, in our initial clinical experience, confirmed by radiograms, to be non invasive and safe. Use of this method could be useful when the intubated premature is moved for necessary procedures, and a chest-X-ray film is not allowed. Infact, it permits the visualization of the tip of the endotracheal tube by a circle of light on the neck at the suprasternal notch. Furthermore, it results useful for all conventional tubes, without constant reduction in cross-sectional area or modification of mechanic characteristics of the tube wall.
Fiber Optic Technology↗
Early screening and treatment of "silent" patent ductus arteriosus in prematures with RDS.
From January 1987 to December 1989, prematures with RDS weighing 1750 g or less admitted to the Neonatal Intensive Care Unite (NICU) were submitted from the third postnatal day to serial two-dimensional and pulsed Doppler (ATL MK 600) echocardiographic evaluation for "silent" patent ductus arteriosus (PDA). PDA was diagnosed in 36/175 prematures with RDS (20.5%). Thirty patients had indomethacin treatment and the PDA closed completely in 27 (90%); five needed a second course of indomethacin, that was effective in two (40%). Four RDS patients (4/36-11%) already weaned from the respirator, needed supplemental oxygen. The three non-responders and six other prematures with counterindications to the drug underwent surgical ligation (25%). As historical control, we retrospectively evaluated the population of preterm infants with RDS weighing less than or equal to 1750 g treated for hemodynamically significant PDA during three previous years before the screening protocol; in this group the echocardiographic and Doppler evaluations were done when congestive heart failure and pulmonary edema were clinically evident. In comparison, we found a reduced incidence of prematures with RDS treated for PDA, 7/120 (5.8%) a higher age at medical treatment (9 +/- 1.4 vs 4.4 - 2.3 days) and a larger prevalence of patients underwent ductal ligation (71.4%). These data show that early screening and treatment of "silent" PDA may result advantageous to improve the efficacy (90%) of indomethacin, in a critical time for the recovery of RDS, and furthermore decreasing the need of surgical ligation.
Birth Weight↗
Long-term follow-up results after surgical repair of esophageal atresia.
Fiftytwo of 55 children, surviving surgical repair of tracheo-esophageal fistula between 1975 and 1985, were reviewed in relation to birth weight and Waterston's risk group after a mean follow-up of 7.5 years. The long-term results of esophageal atresia patients seem good in 30% of the follow-ups. Esophageal dysfunctions and respiratory difficulties were found respectively in 23 (44.2%) and 26 (50%) of the children; all the patients were improving after the first years of life. Scoliosis affected 27 children (51.9%) and its incidence increased with growth. Waterston's classification was a poor prognostic guide, but children weighing less than 2500 g at birth remained of relatively lower weight. The frequent development of scoliosis with age leads to continue evaluations after that respiratory and alimentary problems which might occur in the early years have been overcome.
Adolescent↗
Plasma arginine vasopressin, diuresis, and neonatal respiratory distress syndrome.
The pathogenesis of the diuresis that precedes the recovery from respiratory distress syndrome (RDS) in preterm infants has not been clearly delineated. To define the role of Arginine Vasopressin (AVP) or Antidiuretic Hormone in the diuretic phase of RDS, we obtained plasma AVP levels (radioimmunoassay) and sequential time-urine-plasma collections during the first, the third and the fifth days of life in twelve premature ventilated newborns. AVP levels were persistently elevated (12.7 +/- 7.6; 9 +/- 4.7 and 10.4 +/- 6.6 pg/ml, respectively) despite normal plasma sodium and osmolality. Maximum diuresis (output/intake greater than 0.72) occurred at 72 hours and preceded the improvement in FiO2/PaO2, significant on 5th day (p less than 0.01), and associated with a 10.6% decrease in body weight. These results suggest a nonosmotic release of AVP in ventilated newborns, and show a hypervasopressinemia unrelated to the diuresis associated with the recovery phase of RDS.
Arginine Vasopressin↗
Age and blood pressure changes. A 20-year follow-up study in nuns in a secluded order.
In a prospective study, 144 white nuns belonging to a secluded monastic order and 138 white control laywomen were followed for 20 years to investigate whether living for a long time in a stress-free environment influences the effect of aging on blood pressure. Silence, meditation, and isolation from society are the distinctive features of the life-style examined. At study entry, blood pressure was not dissimilar in the nuns and the control group, but it increased over time only in the controls, with a mean slope of the regression line (beta coefficient) of 0.089 in the nuns (NS) and 2.171 in the controls (p less than 0.0001) for systolic blood pressure and of 0.054 in the nuns (NS) and 0.742 in the controls (p less than 0.0001) for diastolic blood pressure. Weight and body mass index increased similarly over time in the two groups. Family history of hypertension was not dissimilar between the groups. Serum cholesterol and triglycerides, higher at study entry in the nuns, increased similarly over time in the two groups. Twenty-four-hour urinary sodium excretion, collected randomly in both groups, did not differ over time between nuns and controls. None of the women smoked or used oral contraceptives. Educational level was higher in the control group, but subgroups of 48 nuns and 52 laywomen of comparable educational level maintained the same difference in the blood pressure trend over time as in the main cohort. Parity affected the increase of systolic, but not of diastolic, blood pressure with age among the laywomen, but nuns and no-childbirth controls maintained a significantly different blood pressure trend over time.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Reversal of left ventricular hypertrophy after one-year treatment with clonidine: relationship between echocardiographic findings, blood pressure, and urinary catecholamines.
Previous studies have shown that some antihypertensive drugs, beside controlling arterial pressure (AP), reverse left ventricular hypertrophy (LVH) by reducing adrenosympathetic activity. The aim of our study was to evaluate the relationship between AP levels, echocardiographic LVH and 24-h urinary excretion of epinephrine (UE) and norepinephrine (UNE) in 23 previously untreated stable hypertensive individuals with LVH and in 18 healthy normotensive control subjects before and after 1-year treatment with oral clonidine. Intraventricular septal (IVS) and posterior wall (PW) thickness and left ventricular mass index (LVMI) were related to systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP), as well as to UE and UNE by multivariate regression analysis. Before clonidine treatment increased values for IVS and PW thickness correlated with DAP (r = 0.54; p less than 0.05), and MAP (r = 0.50; p less than 0.05), a positive relation between IVS thickness and LVMI and UNE was found. After clonidine treatment, in addition to a statistically significant reduction in SAP, DAP, MAP, and in NE and UNE (all p less than 0.01), a decrease in IVS (12.5 to 9.5 mm; p less than 0.01) and in PW (11.2 to 9.3 mm; p less than 0.01) thickness as well as in LVMI (152.3 to 108.6 g/m2; p less than 0.01) was observed in hypertensive patients. LVMI weakly correlated with UNE change (r = 0.50; p less than 0.05). These data support a possible influence of catecholamines in modulating the development of LVH. They also confirm the parallel action of clonidine in controlling AP, in reducing UE and UNE, and in reversing LVH in hypertensive patients.
Adult↗
Effect of biofiltration on cardiac arrhythmias.
The effect of biofiltration-PAN system and acetate-cuprophan hemodialysis on ventricular arrhythmias detected by long-term ECG monitoring was assessed in 12 patients with end-stage renal failure, studied according to a randomized cross-over design. Low and high risk ventricular ectopic beats were significantly (p less than 0.001) more frequent both during acetate dialysis and in the post-dialytic period than with biofiltration at any time. A significant inverse correlation was found in regression analysis (r = 0.40, p less than 0.001) between total ventricular ectopic beats and pH values in the pre-dialytic, intra-dialytic, early post-dialytic and total post-dialytic periods. The lower frequency of ectopic ventricular beats in biofiltration dialysis makes this technique more suitable for patients with dangerous and disabling arrhythmias.
Acetates↗
[Postoperative evolution in 65 interventions for esophageal atresia].
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Esophageal Atresia↗
Blood pressure changes over 20 years in nuns in a secluded order.
Blood pressure was recorded for 20 years in 138 nuns in a secluded order and in 126 lay women taken as controls. During the study period none of the nuns or control women smoked, took oral contraceptives or changed residence. Diet was unrestricted and comparable in the two groups. Subjects of both groups were consecutively enrolled without any selection parameters. During the 20 years of observation, systolic and diastolic blood pressure rose with age in the control women but remained almost unchanged in the nuns. The mean of the regression slope of systolic and diastolic blood pressure versus age, which was calculated for each subject, was 0.089 and 0.054 respectively in the nuns, as opposed to 2.171 and 0.742 in the lay women (both P < 0.001). Secluded nuns, who spend almost all their time in silence and prayer in the virtual absence of company apart from when attending religious celebrations, thus showed almost no change in blood pressure with age over a 20-year period. The results support the hypothesis that, at least in women, everyday stress may be a determinant of the progressive increase in blood pressure with ageing.
Adult↗
[Left ventricular function in patients under peritoneal dialysis treatment].
M-Mode echocardiogram and systolic time intervals were obtained in 24 patients with end-stage chronic renal failure before and after peritoneal dialysis in order to evaluate their left ventricular function. Before dialysis 9 patients (group A) showed an echocardiographic pattern of dilated cardiomyopathy, i.e. increased left ventricular end-diastolic dimension (EDD) and volume (EDV), reduction of fractional shortening (FS%), of circumferential fiber shortening (Vcf) and of ejection fraction (EF). Seven patients (group B) had the morphological and functional features of asymmetric septal hypertrophy: ratio of interventricular septum to posterior wall thickness (IVS/PWT) greater than 1.3, reduced EDD and EDV. Eight uraemics (group C) had no specific feature of cardiac disease, but only aspecific echocardiography signs of myocardial derangement. Peritoneal dialysis appeared to be associated with gradual improvement of the contractile state in group A patients, with reduction in echocardiographic asymmetric septal hypertrophy in group B uraemics, and with an aspecific increase in cardiac performance in group C patients. It is concluded that: end-stage chronic renal failure may have echocardiographic pattern of dilated or asymmetric hypertrophic cardiomyopathy; peritoneal dialysis significantly improves the morphological and functional derangements of both clinical conditions.
Adult↗
[Adrenaline, noradrenaline and 11-hydroxycorticosteroid during operatory stress of surgeons and after administration of oxprenolol (author's transl)].
Urinary levels of free adrenaline, noradrenaline and 11-hydroxycorticosteroid were measured in 30 surgeons while they operated, to test the hypothesis that sympathetic and adrenocortical systems are overactivated by occupational environment of surgery procedures. They were divided in two groups according to a crossover design in which the surgeons had taken alternatively an oral dose of 40 mg oxprenolol and placebo. During operations with placebo urinary free adrenaline, noradrenaline and 11-hydroxycorticosteroid rose significantly compared with the control values obtained during ward-round performed by the same surgeons. The increase of adrenaline, noradrenaline and 11-hydroxycorticosteroid was abolished by 40 mg of oxprenolol which contained their urinary concentration to the control values. These data support the concept that operating stress of surgeons influences the adrenosympathetic and adrenocortical systems and they indicate a possible role of beta-blocking drugs in minimizing the adverse reactions of a such hormonal overactivity.
11-Hydroxycorticosteroids↗
[Efficacy of prazosin in severe cardiac insufficiency].
A new oral vasodilator, prazosin, was evaluated in twenty patients with refractory congestive heart in a double blind non cross-over trial. Patients were divided into two groups. The first (group A) was treated by prazosin (40-50 microgram/Kg/pro die) for 20 days, the second was given placebo for the same period. Ventricular performance was assessed by measurement of the systolic time intervals, the peak time of the first derivative of the apexcardiogram (delta ACG), pressure-rate product and clinical evaluation. After ten days of prazosin left ventricular ejection time (LVET) increased (P < 0.01), pre-ejection period (PEP) and relation PEP/LVET were reduced (respectively: P < 0.05 and P < 0.01). Similarly the peak of delta ACG and pressure-rate product decreased significantly (respectively: P < 0.05 and P < 0.01). Symptomatology improved in NYHA functional class (3.7 to 2.4, P < 0.001). After twenty days of prazosin there was no further significant improvement in myocardial performance. No significant changes of clinical course and of the same parameters were observed in patients of group B. It is concluded that prazosin is effective in improving cardiac performance in refractory heart failure for its balanced dilator action on the arteriolar and venous vessels.
Adult↗
[Non fermentative gram negative bacilli isolated in a hospital laboratory].
OBJECTIVE: To report a prospective study on non fermentative gramnegative bacilli, excluded Pseudomonas aeruginosa, isolated at Dr. Julio C. Perrando Hospital in Resistencia (Argentina). The goal of this study was to know their frequency and antimicrobial susceptibility. MATERIAL AND METHODS: For bacterial identifications we used biochemical tests. RESULTS: The greatest percentages of non fermentative gramnegative bacilli isolates were found in blood samples (25%), respiratory secretions and urine (23.9%). Acinetobacter baumannii (34.7%), Pseudomonas fluorescens/Pseudomonas putida (15.2%), Stenotrophomonas maltophilia (9.7%) and Burkholderia cepacia (8.7%) were the non fermentative gramnegative bacilli species most commonly isolated. Distribution of microorganism strains according to samples and area is also assessed. Antimicrobial sensitivity of most commonly isolated non fermentative gramnegative bacilli strain analyzed. CONCLUSIONS: We concluded that non fermentative gramnegative bacilli are most frequently present in hospitalized that in outpatients and antibacterial therapy must be provided according to bacteriological information.
Argentina↗
Early and long-term prognostic factors after liver resection for HCC.
The Authors discuss the principal early and long term predictive factors after liver resection in patients with hepatocellular carcinoma (HCC). The Authors report (131 cases) early mortality as 7.6%, entirely confined in the group, numerically prevalent and affected by cirrhosis. None of the 50 patients with chronic hepatitis (29 cases) or normal liver (21 cases) died after hepatic resection. Mortality is higher in Child B patients (20.7%) and in cases in which a massive haemotransfusion was given (p < 0.05), apart from the width of resection and from the number of hepatic resections. None of 41 cirrhotic Child A patients undergoing a limited hepatic resection (< or = 1 segment) died during the perioperative period. In the group of patients which survived to the resection, global survival at 5 years was 45%. The most important prognostic factor is local recurrence while cirrhosis and the degree of liver failure are not statistically significant. No feature can identify a subgroup of patients with a higher risk of recurrence, which is observed in 52% of patients with a follow up observation after more than 1 year. Among the 29 patients alive after more than 4 years from liver resection, only 11 didn't have local recurrence. The others were treated with iterative hepatic resections or with radiological techniques. In conclusion, the present experience suggests that, in selected cases, hepatic resection could be a low risk therapy (in cirrhotic patients as well). The long term results could improve with an aggressive attitude towards recurrence.
Adult↗