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P De Simone

Publications and source records attributed to P De Simone.

At least 37 records · Page 2Linked to original sources
PubMed1998

Combined cytology and colposcopy to screen for cervical cancer in pregnancy.

OBJECTIVE: To evaluate the accuracy of cytologic screening in pregnancy through routine colposcopy and to confirm the safety of conservative management of cervical intraepithelial neoplasia (CIN) in pregnancy. STUDY DESIGN: In total, 3,658 pregnant women, screened for cervical cancer with either cytology or colposcopy, were prospectively evaluated. Patients with abnormal findings underwent colposcopically directed biopsy and, in case of CIN, repeat cytology and colposcopy. Biopsy was repeated in case of suspected progression of the lesion. Suspected microinvasion was the only reason for diagnostic conization during pregnancy. After delivery, excisional treatment provided a final specimen from all patients. Diagnostic methods were compared. RESULTS: Comparison between cytology and colposcopy showed 97.1% concordance with a few false positives (2.5%) and false negatives (0.2%). Abnormal cytology and colposcopy, as compared with histology, showed similar concordances, but the risk of underestimation by cytology was significantly higher (P < .05). Initial and final histology of the 63 cases of CIN and microinvasive carcinoma showed 88.9% concordance. Progression of the lesion was not observed. CONCLUSION: These data do not justify combined use of cytology and colposcopy to improve screening for cervical cancer in pregnancy. Delayed treatment of CIN after delivery is safe.

Adolescent↗
PubMed1996

The role of preoperative investigations in predicting difficult laparoscopic cholecystectomies. Results in 200 consecutive cases.

BACKGROUND: When we began laparoscopic cholecystectomy (LC) we set up a strict preoperative workup in order to assess whether currently available investigations could help predict difficult laparoscopic procedures. METHODS: Reported here are the results of a prospective trial carried out in our first 200 consecutive patients, who underwent routine intravenous cholangiography (IVC), abdominal ultrasound scan (US), blood tests-namely, markers of biliary stasis (MBS)-and preoperative endoscopic retrograde cholangiopancreatography (ERCP) in case of clinically suspected common bile duct stones (CBDS). RESULTS: On the basis of our experience we think that the US findings relate to the difficulty of the laparoscopic procedure more closely than the other preoperative investigations, and the association of US and liver chemistry provides an accurate evaluation of biliary stones. CONCLUSIONS: In agreement with data emerging from the literature, the preoperative investigations do not seem to be useful in predicting biliary and vascular complications, whose prevention lies in the adoption of correct surgical technique and a low threshold for conversion.

Adult↗
PubMed1996

[Ultrasonography in the preoperative assessment of candidates for laparoscopic cholecystectomy: examination technique and results].

Laparoscopic cholecystectomy needs a more specific preoperative diagnostic approach than open cholecytsectomy. We investigated the role of US in the preoperative assessment of patients candidate to laparoscopic cholecystectomy. Two hundred patients were examined and then submitted to laparoscopic cholecystectomy regardless of US results: the surgical approach had to be changed from laparoscopy to laparotomy only in 10 of them. We focused our study on two major parameters to reduce the surgical risk: the anatomical study of the so-called "Calot's triangle" (the hepatic artery, common duct and cystic duct) and the study of the gallbladder bed and of pericystic structures. In the study of gallbladder walls and bed, US had high sensitivity (100%) and diagnosed no false negatives and 11 false positives of pericholecystitis (94.5% specificity), with a trend toward overstaging; in these 11 cases, gallbladder wall thickening was seen but the organ was not particularly difficult to remove at surgery. In cystic duct studies, we correctly diagnosed 6 abnormalities (3 cystic duct stones, 2 anatomical variants and 1 anatomical variant plus stone), with no false-positive and 2 false-negative diagnoses of abnormal insertion (75% sensitivity and 100% specificity). The common duct was shown along its whole course in 80% of cases; both sensitivity and specificity were 100% in dilatation detection, while the presence of stones was diagnosed with 70% sensitivity and 100% specificity.

Adult↗
PubMed1994

Alternative laparoscopic management of perforated peptic ulcers.

Surgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.

Adult↗
PubMed1994

[Discrepancy between histopathological diagnosis based on guided biopsy and cone biopsy of the cervix uteri: analysis of 346 cases of laser conization].

The conservative management of cervical intraepithelial neoplasia (CIN) essentially depended on the introduction and improvement of colposcopy. This technique, allowing to locate the lesion, to estimate its extension and to perform multiple punch biopsies, becomes discriminant in therapeutic choice. Whether colposcopy reveals endocervical involvement or abnormal transformation zone (ANTZ) may be only partially explored, excisional conization should be preferred to ablative therapy since the former advantageously can verify histopathologic diagnosis, confirm completely excision of lesion and rule out invasive carcinoma. The literature shows that cases of invasive lesions can be underestimated and therefore inadequately treated by ablative therapy, emphasizing colposcopy and punch biopsy limitations about suspect and diagnosis of microinvasion. We analyzed data concerning preliminary diagnostic investigations and results of 346 CO2 laser excisional conizations performed between 1984 and 1993. Histopathologic diagnosis on punch biopsy, performed in 111 cases of ANTZ1 and in 235 cases of ANTZ2, shows an agreement with cone biopsy in 30.8% of the cases of CIN1, of 40.9% in cases of CIN2 and of 66.3% in cases of CIN3. Whereas the lesion is overestimated in 30.6% of cases, in which it is likely that punch biopsy has removed the epicenter of the lesion or the lesion in toto, we had an underestimation in 15% of cases, particularly in 4 cases of CIN2, in 38 cases of CIN3 and in all microinvasive processes. The rate of invasive lesions previously ignored and detected only by histopathologic diagnosis on cone biopsy is 2.9%. In only one of these cases colposcopy, even if attributing to each of these the higher grading, shows the suspicion of invasion, whereas the detection of invasive processes is missed in every case by punch biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Prevention of recurrent deep venous thrombosis with indobufen. A 3-year follow-up study using color duplex scanning.

After an episode of deep venous thrombosis (DVT) 123 patients were randomized into two groups: one was prophylactically treated with indobufen (60 patients), an oral antiplatelet agent, and one had no treatment (63) and acted as a control group. They were followed up for three years and scanned with color duplex scanning (CDS) every three months and any time that signs and symptoms suggested a new episode. In patients receiving indobufen the incidence of thrombosis was 5% in three years while it was significantly higher (46%) in the control group. Also 62% of the new episodes in the control group were asymptomatic (33.3% in the treated group). Results suggest that recurrent DVT is common, often asymptomatic, and confused with sequelae of the initial episode. The prophylaxis with indobufen is an effective measure in preventing recurrent thrombosis and avoiding the progressive deterioration of the deep venous system observed after deep venous thrombosis.

Female↗
PubMed1991

Long-term evaluation of indobufen in peripheral vascular disease.

Indobufen--an inhibitor of platelets aggregation--has been used in 306 patients with intermittent claudication due to peripheral vascular disease. Patients were treated and followed up for one year. One patient of every 3 treated with indobufen was treated with ASA, and a control group of patients receiving no treatment was also followed up. The authors studied by means of a treadmill exercise test the pain-free walking distance (PFWD), the global walking distance (GWD), and the recovery time after exercise. The treatment period was completed by 290 patients: 204 claudicants, 51 claudicants with diabetes, and 35 with a short PFWD and GWD (greater than 150 m). Indobufen was more effective than ASA in improving the PFWD and GWD in all groups. There were also fewer side effects with indobufen, and cardiac morbidity and mortality was also reduced. In conclusion indobufen showed its activity and safety in chronic treatment of patients with peripheral disease, and we suggest that it may be used for long periods without side effects.

Aspirin↗
PubMed1974

Terminal deoxyribonucleotidyl transferase in human leukemia.

Terminal deoxyribonucleotidyl transferase (EC 2.7.7.31; nucleoside triphosphate:DNA nucleotidylexotransferase) is usually found only in thymus, but has been reported in leukemic cells from children with acute lymphoblastic leukemia. In an unusual adult patient with acute myelomonocytic leukemia, terminal transferase was found at a level of 16 units per 10(8) bone marrow cells and 14 units per 10(8) circulating leukocytes (1 unit = 1 nmol of nucleotide per hr). This activity is comparable to that found in normal thymus. Assays of transferase in marrow and peripheral leukocytes from patients with typical acute and chronic myelogenous leukemias gave average values of 0.5 and 0.3 unit per 10(8) cells, respectively. Transferase activity is also found in normal bone marrow at about 0.07 unit per 10(8) cells. Terminal deoxyribonucleotidyl transferase in all samples of human marrow and peripheral blood had reaction characteristics, sedimentation, and chromatographic properties similar to the homogeneous enzyme from calf thymus.

Aged↗
PubMedDate not supplied

The organizational model of the interregional transplant agency Organizzazione Centro-Sud Trapianti.

In Italy, all donation and transplant activities were officially disciplined in 1999 by the law 91 of April 1, 1999. This law enacted a coordinator-based model of transplantation, instituted the National Center for Transplantation (Centro Nazionale Trapianti-CNT), and endorsed the existing interregional transplant agencies (ITA), such as the Nord Italia Transplant program (NITp), the Associazione InterRegionale Trapianti (AIRT), and the Organizzazione Centro-Sud Trapianti (OCST). Within its borders each ITA has adopted its own organizational model; there is no overt centralized control exerted by the CNT according to the law 91/1999. The aim of the current work is to report on the organizational model adopted by OCST, the ITA gathering the Italian regions of Abruzzo, Basilicata, Calabria, Campania, Latium, Molise, Sardinia, Sicily, and Umbria.

Humans↗
PubMedDate not supplied

Switch to tacrolimus for cyclosporine-induced gynecomastia in liver transplant recipients.

We report herein on two male liver transplant (LT) recipients who presented with cyclosporine (CsA)-related gynecomastia 6 and 10 months after transplantation. The clinical workup showed increased luteinizing hormone (LH), associated with a slight reduction in testosterone blood levels in one patient and increased prolactin levels in the other. After excluding concomitant primary endocrine and/or malignant disease, conversion to tacrolimus (TAC) was performed resulting in clinical improvement of gynecomastia and return of hormone blood levels to normal range within 3 months. Our report confirms a putative role of CsA in post-LT gynecomastia, reversible however upon conversion to TAC.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Appraisal of the coordinator-based transplant organizational model.

In 1999, the Italian Parliament passed a law aimed at setting the standards of practice and quality in organ, tissue and cell donation, and transplantation. For the first time in the history of Italian transplantation, a coordinator-based model reproducing some of the basic principles of the Spanish system was officially enacted by the Parliament, bringing to an end years of lacking regulation. What differentiates those coordinator-based systems adopted in Southern Europe from Northern European national and multinational transplant organizations is the functional integration of donor and transplant care activities enacted by national governments. The Italian model of transplant health care consists of four levels of transplant coordination: local, regional, interregional, and national. The latter is represented by Centro Nazionale Trapianti (CNT; the Italian National Center for Transplantation). CNT objectives consist of ensuring equitable access to donation and transplant care for all citizens according to the principles of the Italian National Health System. In achieving these goals, CNT acts in cooperation with three interregional transplant agencies: the Nord Italia Transplant program, the Associazione InterRegionale Trapianti, and the Organizzazione Centro Sud Trapianti. Whereas local and interregional coordinators are at the front line of all donation and transplant activities, regional and national coordinators function to monitor, direct, and plan donation and transplant health care activities. Based on the increase in donation and transplant activities recently achieved in those countries that have adopted a governmental coordinator-based transplant care model, we believe that such a system is appropriate to serve patients' interests according to the principles of subsidiary and equity. However, it should further be improved by expansion of the governance model throughout Europe, through implementation of current standards of care, and by adopting the definition of common European objectives, health care strategies, and research integration.

Europe↗
PubMedDate not supplied

Immunoadsorption with protein A in humoral rejection of kidney transplants.

The presence of alloantibodies may play a role in accelerated or acute humoral rejection. Different therapeutic strategies based on a removal of anti donor antibodies and prevention of their resynthesis have been used in the management of transplant rejection episodes. Immunoadsorption with staphylococcal protein A, a method to selectively remove immunoglobulin G, may represent a new treatment to reverse humoral rejection in kidney transplantation. From 1991 to January 1996, such a method was used in 23 patients in whom an acute humoral rejection developed over a mean period of 14.1 +/- 9.5 days after operation. Twenty-two patients had been transplanted from living donors and one from a cadaveric donor. The ages ranged from 23 to 58 years (mean, 34 +/- 10 years). All transplants were performed according to a negative direct crossmatch. Basic immunosuppression included cyclosporine, steroids, azathioprine, and antilymphocyte globulin or monoclonal antibodies (OKT3). Rejection was diagnosed on the basis of hematochemical tests, Doppler ultrasonography, and kidney biopsy. Only steroid and monoclonal and polyclonal antibody resistant rejections with > 165% positive direct crossmatches against the donor were treated with Protein A immunoabsorption. The procedure used is based on the treatment of 2-3 plasma volumes for the first 2 days and then every other day until a negative crossmatch is obtained, together with improvement in clinical status (mean treatments, 7.3 +/- 4.5 [range, 4-23]; mean duration of treatment, 12.3 +/- 10.2 days [range, 3-44]). From the start of treatment, azathioprine is replaced by cyclophosphamide at a dose of 1-2 mg/kg/day. During treatment, a remarkable fall in immunoglobulin G levels is achieved on the first day, whereas immunoglobulin M titers remain constant, with a slight decrease in serum albumin. Immediately after treatment, a negative crossmatch was found in 22 (95.6%) of 23 patients. In six patients (26%), graft function did not recover, and one patient (4.3%) died. Preliminary results show that immunoabsorption with staphylococcal protein A may be an effective support in the treatment of humoral acute rejection, particularly when it is performed as soon as an early diagnosis of humoral rejection is made. In fact, such treatment has a highly selective adsorption, allows treatment of large volumes of plasma, and can achieve a rapid decrease in the titer of circulating immunoglobulins.

Acute Disease↗