Biomedical subjects

M Verga

Publications and source records attributed to M Verga.

At least 37 records · Page 2Linked to original sources

PubMed1997

Common bile duct exploration and laparoscopic cholecystectomy: role of intraoperative ultrasonography.

BACKGROUND: In October 1993, to detect associated common bile duct (CBD) stones, we started an evaluation program of patients with symptomatic cholelithiasis who were candidates for laparoscopic cholecystectomy. STUDY DESIGN: We used a standard preoperative algorithm and a laparoscopic ultrasonographic (LUS) examination. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was reserved for high-risk patients for CBD stones. Laparoscopic ultrasonographic examination during cholecystectomy was routinely performed to identify stones unsuspected preoperatively. Two-hundred-sixteen patients with symptomatic cholelithiasis were included in the study; 177 patients (82%) were at low risk for choledocholithiasis and 39 patients (18%) were at high risk and had preoperative ERCP. In 17 patients (43.5%) CBD stones were found, and in 16 patients (41%) they were removed by endoscopic sphincterotomy. RESULTS: In all patients, the main intra- and extrahepatic ducts were well documented by LUS, but in eight cases the distal tract of the CBD was not well-visualized. In eight patients, small stones were found in the CBD. A subsequent peroperative cholangiography or CBD exploration confirmed the diagnosis. In one patient, both LUS and cholangiography suspected a small stone; the CBD exploration did not confirm it (false positive). In two patients a small stone in the CBD was found during the followup period (two false negatives). An endoscopic sphincterotomy solved the problem. CONCLUSIONS: Laparoscopic ultrasonographic examination may be a real alternative to cholangiography during laparoscopic cholecystectomy: this may be reserved for selected instances on the basis of LUS findings. On the other hand, considerable ultrasonographic experience is required for LUS to be performed successfully.

Algorithms↗

PubMed1997

NCAM and schizophrenia: genetic studies.

The hypothesis of a neurodevelopmental dysfunction being involved in the etiology of schizophrenia is suggested by the observation of morphological alterations in the brains of schizophrenia patients. These alterations may be caused by defects in neural cell differentiation or migration, which could lead to disrupted neuronal circuitry and to the schizophrenia symptomatology. The neural cell adhesion molecule (NCAM) plays a major role in cell migration and axon outgrowth, and is involved in synaptic plasticity mechanisms implicated in adult cognitive functions. Altered levels of the NCAM polysialylated form, PSA-NCAM, in the brain of schizophrenia patients have been reported, and are supportive of a role for this molecule in the disorder. To investigate the possible involvement of the NCAM gene in schizophrenia, we conducted a comprehensive genetic study, which included linkage analysis and an association study employing the Haplotype Relative Risk (HRR) design in nuclear families. Our results indicate that structural alterations in the NCAM gene are unlikely to play a major role in schizophrenia, although a function for the NCAM molecule in the etiology of the disease remains an intriguing hypothesis.

Adult↗

PubMed1997

Soft-tissue "rim" sign in the diagnosis of ureteral calculi with use of unenhanced helical CT.

PURPOSE: To determine the value of the ureteric soft-tissue "rim" sign for differentiation of ureteral calculi from phleboliths on unenhanced helical computed tomographic (CT) scans and to identify factors that are associated with the presence of the rim sign. MATERIALS AND METHODS: Of 442 patients with ureteral obstruction confirmed at CT, 200 had documented ureteral stone disease; 136 of these patients had ureteral calculi, excluding the ureterovesical or ureteropelvic junctions. Each calculus and phlebolith along the course of the ureter were evaluated retrospectively and blindly for the presence of the rim sign, stone location, and stone size; the duration of symptoms was documented when available. RESULTS: The rim sign was present in 105 of 136 ureteral calculi (77%) and in 20 of 259 phleboliths (8%) and yielded a sensitivity of 77% and a specificity of 92% for distinguishing a calculus from a phlebolith. Calculi associated with the rim sign had a mean size of 4.3 mm, and calculi without a rim sign had a mean size of 6.3 mm (P < .001). There was no difference in duration of symptoms among patients who did or did not exhibit a rim sign. CONCLUSION: In patients with flank pain, the presence of a rim sign is a strong indicator that a calcification along the course of the ureter is a stone. Absence of the rim sign indicates that a calcification remains indeterminate.

Calculi↗

PubMed1997

Ureteral calculi in patients with flank pain: correlation of plain radiography with unenhanced helical CT.

PURPOSE: To determine the sensitivity and specificity of plain radiography for the detection of ureteral calculi with use of unenhanced helical computed tomography (CT) as the standard of reference. MATERIALS AND METHODS: Plain radiographs and helical CT scans of 178 patients with acute flank pain were reviewed retrospectively. Three interpretations of plain radiographs were used: (a) Original reading. This was the report made at the time of the patient's evaluation before the patient underwent CT. (b) Blinded retrospective reading. Each plain radiograph was interpreted without knowledge of the CT findings. (c) Unblinded retrospective reading. The plain radiograph of each patient whose CT scan showed a stone was reviewed with the CT scan. RESULTS: The original reading had a sensitivity of 45% and a specificity of 77% for the detection of ureteral calculi. The blinded retrospective reading had a sensitivity of 59% and a specificity of 71%. The unblinded retrospective reading had a sensitivity of 59% (95% confidence interval: 47%, 70%). CONCLUSION: Plain radiography is of limited value for aiding the diagnosis of ureteral stones. All patients with acute flank pain for whom radiologic imaging is recommended can directly undergo unenhanced helical CT; plain radiographs need not be obtained first.

Acute Disease↗

PubMed1996

No evidence for association of dopamine D2 receptor variant (Ser311/Cys311) with major psychosis.

We investigated a variant of the dopamine D2 receptor gene (Ser311/Cys311 substitution) in Caucasian patients with schizophrenia (n = 273), delusional disorder (n = 62), bipolar I affective disorder (n = 63), and controls (n = 255). No evidence for association between the receptor variant and any of the diseases was found, even when patients with younger age-of-onset (< 25 years) were compared with controls. Furthermore, in a subgroup of schizophrenia patients whom we assessed for negative symptoms, those with the Cys allele did not differ from the remainder of the group. Also, the bipolar affective disorder patients with psychotic features did not show evidence for association with the receptor variant. Thus, our results do not provide evidence for an association between this D2 receptor variant and schizophrenia, or delusional disorder, or bipolar affective disorder.

Adult↗

PubMed1996

Intraoperative ultrasonography (IOUS) during laparoscopic cholecystectomy.

BACKGROUND: The purpose of this study was to evaluate the usefulness of intraoperative ultrasonography (IOUS), a new method of imaging the biliary tree and related structures, during laparoscopic cholecystectomy. METHOD: An IOUS probe (Aloka, Tokyo, Japan) with a 7.5-MHz linear-array transducer was used during cholecystectomy in 124 patients with symptomatic cholelithiasis (45 men, 79 women; mean age, 48 +/- 14 years). RESULTS: The examination of the common bile duct (CBD) was excellent in 117 patients but unsatisfactory in 7 cases (5.6%) at the level of the head of the pancreas. In 5 patients, IOUS showed unsuspected choledocholithiasis: a subsequent intraoperational cholangiogram confirmed this. In five cases IOUS was able to help the surgeon to localize a Calot area obscured by inflammation. Postoperatively, one patient had an injury of the cystic duct stump: a nasobiliary tube resolved the bile leakage after 7 days. Another patient was submitted to postoperative endoscopic retrograde cholangiopancreatography (ERCP) for a choledocholithiasis recognized by a trans-cystic-tube cholangiography: the stone was suspected but not demonstrated either by laparoscopic IOUS or by intraoperative cholangiography. During the follow-up period, one patient had an episode of acute pancreatitis. ERCP showed a small stone wedged in the sphincter of Oddi. CONCLUSIONS: IOUS may be a real alternative to cholangiography during laparoscopic cholecystectomy since it is safer and offers a complete examination of the biliary tree. It has some disadvantages which can solved by additional experience.

Adult↗

PubMed1996

Technical difficulties and complications during laparoscopic cholecystectomy: predictive use of preoperative ultrasonography.

The aim of this study was to evaluate ultrasound findings as predictors of potential operative difficulties and complications during laparoscopic cholecystectomy (LC). From October 1993 to June 1995 a total of 143 patients with symptomatic cholelithiasis (50 males, 93 females, mean age 49.5 +/- 15 years) were evaluated by ultrasound (US) the day before LC. The US examination assessed six parameters: gallbladder (GB) volume, GB wall thickness, GB neck position, GB stone mobility, stone maximum size, and GB adhesions. On the basis of these US findings, a predictive judgment of technical difficulties was expressed by degree: easy, difficult, and very difficult. Altogether 101 patients presented with uncomplicated symptomatic cholelithiasis, and 42 had acute cholecystitis. The operation was predicted to be easy in 38% of cases, difficult in 49%, and very difficult in 13% with a good correlation with the surgeon's intraoperative judgment (r = 0.66). A significant association was found between stone mobility (r = 0.37), presence of adhesions (r = 0.36), and the difficulty of the procedure. The predictive US evaluation was significantly correlated with some intraoperative technical steps [dissection of Calot's triangle (r = 0.41), dissection of the gallbladder bed (r = 0.41)], and intraoperative bleeding (r = 0.27). Our results suggest that preoperative US is a useful screening test for patients undergoing LC, and it can help predict technical difficulties. On the other hand, a relevant number of cases still exist wherein the concordance between the preoperative US classification and the surgical findings is unsatisfactory. In this group the surgeon cannot safely rely on the US examination alone.

Adolescent↗

PubMed1996

Diagnosis of acute flank pain: value of unenhanced helical CT.

OBJECTIVES: The purpose of our study was to determine the value of unenhanced CT in the diagnosis of acute flank pain. We determined the accuracy of unenhanced Ct for stone detection as well as the detection of abnormalities unrelated to stone disease. MATERIALS AND METHODS: During an 18-month interval, 292 patients with acute flank pain were imaged with unenhanced CT. Confirmation of the CT diagnosis was obtained for 210 patients: One hundred patients were proved to have ureteral stones based on other imaging studies (58 patients), lithotripsy (seven patients), ureteroscopic stone extraction (five patients), and stone recovery (30 patients). One hundred ten patients were proved not to have ureteral stones based on other imaging studies (24 patients), failure to recover a stone (56 patients), or a confirmed diagnosis unrelated to stone disease (30 patients). This latter group of 30 patients included diagnoses of adnexal masses (eight patients), appendicitis (five patients), diverticulitis (four patients), and common bile duct stones (three patients), as well as other diagnoses. RESULTS: Unenhanced CT findings were falsely negative for stone disease in three patients and falsely positive for stone disease in four patients. These data yield a sensitivity of 97%, a specificity of 96%, and an accuracy of 97% for diagnosing ureteral stone disease. Of 31 patients with a CT abnormality unrelated to stone disease, there was one false-negative diagnosis of acute appendicitis. CONCLUSION: Unenhanced CT is a valuable technique for examining patients with acute flank pain in whom a clinical diagnosis is uncertain. It can accurately determine the presence or absence of ureteral stones as well as extraurinary causes of acute flank pain. In most cases, other imaging studies are not required.

Acute Disease↗

PubMed1996

Acute ureteral obstruction: value of secondary signs of helical unenhanced CT.

OBJECTIVE: The purpose of our study was to determine the value of secondary signs of ureteral obstruction on helical unenhanced CT. MATERIALS AND METHODS: Over a 19-month interval, 312 patients with acute flank pain were imaged with helical unenhanced CT. Ureteral stone disease was confirmed to be present in 109 patients and confirmed to be absent in 111 patients Ninety-two remaining patients had no confirmatory imaging studies or surgery and were unable to be contacted for follow-up. For each of the 220 patients with a confirmed diagnosis, we determined the presence or absence of ureteral or collecting system dilatation, perinephric stranding, symmetry of renal size, and renal stones. In all patients with a ureteral stone, we noted the presence or absence of a circumferential rim of soft-tissue attenuation ("tissue-rim" sign) surrounding each stone and each phlebolith. RESULTS: The sensitivity of each secondary sign was ureteral dilatation, 90%; perinephric stranding, 82%; collecting system dilatation, 83%; and renal enlargement, 71%. The specificity of each secondary sign was ureteral dilatation, 93%; perinephric stranding, 93%; collecting system dilatation, 94%; and renal enlargement, 89%. Ureteral dilatation and perinephric stranding were both present or both absent in 181 of the 220 patients with a confirmed diagnosis. In this subgroup, this combination of signs had a positive predictive value of 99% and a negative predictive value of 95%. The odds ratio for the frequency of the tissue-rim sign with stones versus tissue-rim with phleboliths was 31:1. CONCLUSION: When using unenhanced CT to help diagnose acute flank pain, if one does not see a ureteral stone or does see an indeterminate but suspicious calcification, then secondary signs of obstruction are important for diagnosis. The results of this study form the basis of an imaging algorithm that can be used when interpreting unenhanced CT images of patients with acute flank pain.

Acute Disease↗

PubMed1995

Association study of dopamine D3 receptor gene and schizophrenia.

Several groups have reported an association between schizophrenia and the MscI polymorphism in the first exon of the dopamine D3 receptor gene (DRD3). We studied this polymorphism using a North American sample (117 patients plus 188 controls) and an Italian sample (97 patients plus 64 controls). In the first part of the study, we compared allele frequencies of schizophrenia patients and unmatched controls and observed a significant difference in the total sample (P = 0.01). The second part of the study involved a case control approach in which each schizophrenia patient was matched to a control of the same sex, and of similar age and ethnic background. The DRD3 allele frequencies of patients and controls revealed no significant difference between the two groups in the Italian (N = 53) or the North American (N = 54) matched populations; however, when these two matched samples were combined, a significant difference was observed (P = 0.026). Our results suggest that the MscI polymorphism may be associated with schizophrenia in the populations studied.

Alleles↗

PubMed1995

Association study between the dopamine D4 receptor gene and schizophrenia.

The dopamine D4 receptor is of major interest in schizophrenia research due to its high affinity for the atypical neuroleptic clozapine and a high degree of variability in the receptor gene (DRD4). Although several genetic linkage analyses performed on schizophrenia multiplex families from different regions of the world have either excluded or failed to prove that DRD4 is a major genetic factor for the development of schizophrenia, analyses for moderate predisposing effects are still of significant interest. We performed a study examining differences in allele frequencies of 4 different DRD4 polymorphisms in schizophrenia patients and age, sex, and ethnic origin matched controls. None of these 4 polymorphisms showed evidence for genetic association with schizophrenia, although a trend towards excess of the allele with 7 repeats in the (48)n bp exon III polymorphism was observed. Complexities in the DRD4 genetic investigation and further analytic approaches are discussed.

Female↗

PubMed1995

Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography.

PURPOSE: To compare non-contrast-enhanced computed tomography (CT) and intravenous urography (IVU) in the evaluation of patients who present with acute flank pain and in whom ureteric obstruction is suspected. MATERIALS AND METHODS: The findings at non-contrast-enhanced CT and IVU in 20 patients with acute flank pain were compared for the presence or absence of ureteric obstruction and delineation of ureteric stones. RESULTS: Twelve of the 20 patients had non-contrast-enhanced CT and IVU findings consistent with ureteric obstruction. Of these 12 patients, five had a ureteric stone that was demonstrated on both non-contrast-enhanced CT scans and IVU radiographs, six had a stone that was depicted on non-contrast-enhanced CT scans only, and in one patient a stone could not be delineated definitively on either non-contrast-enhanced CT scans or IVU radiographs. Eight patients had findings at non-contrast-enhanced CT and IVU consistent with the absence of obstruction. CONCLUSION: Non-contrast-enhanced CT is more effective than IVU in precisely identifying ureteric stones and is equally effective as IVU in the determination of the presence or absence of ureteric obstruction.

Acute Disease↗

PubMed1993

Review of the putative association of dopamine D2 receptor and alcoholism: a meta-analysis.

Eight recent studies have focused on the putative association of the dopamine D2 receptor (DRD2) gene and alcoholism. In this report, these studies are reviewed and the data and findings are examined in a meta-analysis. Four reports find a statistically significant increased risk for alcoholism in subjects carrying the A1 allele and 4 failed to observe a significant increase in risk. Overall, our meta-analysis of the results from all 8 studies supported a statistically significant association between the A1 allele of DRD2 and alcoholism, with an apparent increase in relative risk associated with increased severity of alcoholism. These results must be interpreted cautiously because the A1 allele of DRD2 varies significantly in frequency from one population to another. This variability in the population frequency of the A1 allele could result in an apparent association resulting from unrelated population differences. These findings support the need for carefully designed studies that minimize the ethnic heterogeneity of the subject and control populations.

Alcoholism↗

PubMed1993

Screening for breast cancer: report of a population-based experience in the city of Milan, Italy.

AIMS AND BACKGROUND: Mammographic screening is recommended as a current health practice. The aim of the present study is to report the results of a new program which started in the city of Milan in 1989. METHODS: A total of 4882 women aged 50 to 61 years and resident in quarter no. 16 of Milan were invited by mail to attend the screening at the San Paolo Hospital based on two-view mammography and physical examination. RESULTS: A total of 2953 (60.5%) women attended the first screening round, and 18 cancers were detected (1 Tis, 8 T1, 9 T2). The detection rate was 6.9 x 1000, and the prevalence/incidence ratio was around 3.5. CONCLUSIONS: The study confirms the feasibility of breast cancer screening in an urban setting by using the existing general hospital facilities and should be considered as a possible model for other urban experiences.

Aged↗

PubMed1993

[Clinical and mammographic screening in a district of Milan: organization, social influence and results].

A reduction in the mortality rate for breast cancer in women over 50 years undergoing mammographic screening has been reported in many studies. Since the first experience in Florence in 1970, mammographic screenings on a population from different areas of Italy began. We report the experience carried out in the 16th District of Milan among women from 50 to 60 years of age. A promotional activity with the use of local media supported the program. The screening was based on two-view conventional mammography and clinical examination. Immediate response was given to the women. The compliance was 60%. Mainly immigrants, with only primary school education, mothers of several children and freelancers seem to be the main features of the women in the non-attenders group.

Breast Neoplasms↗

PubMed1991

The use of immunohistologic analysis in differentiating cutaneous T-cell lymphoma from psoriasis and dermatitis.

BACKGROUND AND DESIGN: --Many investigators have applied immunohistologic analysis to skin biopsy specimens to distinguish cutaneous T-cell lymphoma (CTCL) from benign inflammatory diseases, such as psoriasis and dermatitis, which can clinically mimic early-stage CTCL. We studied the number and distribution of epidermal cells labeled with various monoclonal antibodies in normal skin and in psoriatic, dermatitic, and CTCL lesions by the immunoperoxidase technique. RESULTS: --Extensive staining of keratinocytes (KCs) with HLA-DR was seen in 27 of 41 patients with CTCL, but in only one of 14 patients with psoriasis and zero of 10 patients with dermatitis. CD2+ and CD3+ cells were present in the middle and upper epidermis of CTCL lesions in much greater numbers than in normal, dermatitic, and psoriatic skin. The percent epidermal area covered by CD1+ cells in psoriatic lesions (1.13%) and dermatitic lesions (1.65%) was significantly lower than that found in CTCL lesions (3.60%). CONCLUSION: --Epidermal immunohistologic patterns using anti-CD1, anti-CD2, anti-CD3, and anti-HLA-DR antibodies have the potential to distinguish CTCL from psoriasis and dermatitis in clinically ambiguous cases.

Adult↗

PubMed1989

Effects of blood sampling procedures, grouping and adrenal stimulation on stress responses in the growing pig.

Changes in the blood and the behaviour of 14 growing pigs from 4 different litters were evaluated under different experimental conditions of blood sampling, grouping and adrenal stimulation. The results showed that the different techniques of blood sampling influenced lactic dehydrogenase (LDH) and creatine kinase (CK) activities. Cortisol, proteins and CK levels were negatively correlated with social hierarchy after regrouping. Cortisol was also correlated with total activity levels. Adrenal stimulation by adrenocorticotropic hormone (ACTH) administration caused a sharp increase in plasma cortisol levels. However, plasma glucose, plasma proteins and total leukocyte counts were not affected by the ACTH treatment.

Adrenal Cortex↗

PubMed1987

Fine-needle aspiration of breast lesions: role and accuracy in a review of 7,495 cases.

In the past 10 years, 7,495 cytological breast fine-needle aspirations (FNAs) were performed (4,756 FNAs of solid nodes and 2,739 of cystic nodes). Of these, 2,099 cases underwent surgery; 650 (31%) had histologically proven carcinoma. Sensitivity was 83.9%, specificity was 99.5%, the predictive value for negative results was 93.2% and for positive results was 98.6%, and the accuracy was 94.6%. Inadequate (13.3%) and doubtful samples (8.1%) were excluded from calculation. False-negative results (82 cases) mainly resulted from sampling errors. False suspicious results (six cases) lessened with increasing experience in breast pathology and with the application of strict diagnostic criteria, but most likely they will never reach zero. Frozen-section diagnosis could be bypassed only in selected cases. Guidelines on the role of FNA in management of solid breast lesions are given. FNA deserves further evaluation in diagnosing early stages of breast carcinoma: sensitivity was 7.5% in 57 carcinomas in situ, 67.5% in 55 minimally invasive carcinoma, and 92.7% in 538 nonminimally invasive carcinomas.

Biopsy, Needle↗