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Biomedical subjects

P Pepe

Publications and source records attributed to P Pepe.

At least 19 recordsLinked to original sources
PubMed2005

Incidence of prostate cancer in Sicily: results of a multicenter case-findings protocol.

OBJECTIVE: To establish the incidence of prostate cancer (PCa) in Sicily in patients who entered an early detection protocol. METHODS: From February 2002 to February 2004, 16,298 subjects aged 40-75 entered the protocol. Patients with suspicious DRE, PSA>10 ng/ml, PSA<or=2.5 ng/ml, from 2.6 to 4 ng/ml or from 4.1 to 10 ng/ml with F/T PSA of <or=15%, <or=20% and <or=25% respectively underwent needle biopsy according to an extensive protocol. RESULTS: 3266 patients were eligible for biopsy; PSA was <or=4 in 12.7% and <or=10 ng/ml in 63.9% of patients. A PCa was found in 1171 cases (36.9%) with a relationship between PCa incidence and PSA and age respectively (chi2-test, p<0.0001); 51.8% of patients with PCa had a PSA<10 and 8.8% a PSA<4 ng/ml; 49% were clinically staged as T1c. The estimated odds ratios for each age group showed increased risk for PCa in the fourth decade with PSA between 2.6 and 4 ng/ml (12.5 times higher) and in the fifth decade with PSA between 4.1 and 10 ng/ml (6.2 times higher). CONCLUSIONS: Age and serum PSA levels are the major risk factors for PCa. On their basis it is possible to modulate the most suitable timing for early diagnosis in individual patients.

Adult↗
PubMed2005

Prediction by quantitative histology of pathological stage in prostate cancer.

AIMS: To find a predictor of extraprostatic extension in clinically localized prostate cancer (PCa), pre-operative ultrasound-guided prostate needle biopsies and clinico-pathological data were reviewed. METHODS: One hundred and eighty-three consecutive patients who underwent radical retropubic prostatectomy for clinical T1-T2 PCa and serum PSA <10 ng/ml were reviewed. Pre-operative biopsy was performed according to an extended protocol and whole-mount prostatectomy specimens were processed. The following biopsy variables were categorized to this analysis: Gleason score (< or =6, >6), TPC (< or =20%; >20%), GPC (< or =50%; >50%), cancer-positive cores (< or =2; >2), cancer-positive cores in both lateral portions (yes; no), PCa (monolateral; bilateral). RESULTS: Only 60/183 specimens showed an organ-confined PCa; the remaining ones showed pT3a in 57 cases, pT3b in 11 and pT3 with positive surgical margins in 55. A locally advanced PCa was found in 60.2 and 76.8% of T1c and T2 clinical stage, respectively. The positive predictive value and negative predictive value of biopsy findings to predict a locally advanced PCa was 89.9 and 75%, respectively. All biopsy variables associations were statistically significant; however, among these variables (non-categorized), in multivariate logistic regression analysis, only GPC was significantly associated with pathologic stage (odds ratio estimate was 1.075, 95% CI: 1.053-1.098). CONCLUSIONS: Quantitative histology, especially GPC, seems to be helpful for pre-operative staging of PCa in patients with T1c-T2 clinical stage and PSA < 10 ng/ml.

Aged↗
PubMed2005

Isolated local recurrence of renal neoplasm with caval involvement 16 years after radical nephrectomy.

OBJECTIVE: To report a case of local recurrence 16 years after radical nephrectomy; to analyse literature data concerning, treatment and prognosis. METHODS/RESULTS: We report a case of local recurence associated with caval trombosis who was underwent an en-bloc resection of vena cava along with pericaval lesion and caval replacement with PTFE prosthesis. The Authors reviewed and analysed literature data. CONCLUSIONS: Local recurrence after radical nephrectomy is rare as it is reported only in 2-4% of patients. This condition is even rarer beyond 10 years especially if associated with caval trombosis. A case of isolated local recurrence of renal cell carcinoma with caval involvement 16 years after radical nephrectomy is described herein. To the best of our knowledge, this is the first case reported in literature. This case highlights the opportunity of a periodic checkup of patients submitted to radical nephrectomy, even many years after surgery.

Aged↗
PubMed2003

Does the adjunct of ecographic contrast medium Levovist improve the detection rate of prostate cancer?

OBJECTIVES: To evaluate whether the adjunct of an ultrasound contrast medium improves the detection rate of prostate cancer. METHOD: In 34 patients, scheduled to undergo a trans-perineal extended prostate biopsy, we carried out a color-Doppler ultrasound (CDU) of the prostate before and after i.v. injection of Levovist, an ultrasound contrast medium. Further bioptic samples were taken in the areas where a marked increase in vascularization was noticed. RESULTS: The overall diagnostic sensitivity, specificity and efficiency were respectively 72.7, 56.2 and 62.9% for transrectal ultrasound (TRUS); 80, 56.2 and 65.3% for CDU and 88.8, 54.5 and 68% for CDU after Levovist injection; 66.5, 72.6 and 65.1% for digito-rectal examination (DRE); 100, 51.4 and 65.4% for total PSA; and 100, 88.8 and 94.3% for PSA free/total. In the 16 patients with prostate carcinoma, the sensitivity of CDU after Levovist was 92.3, 66% for both DRE and TRUS, and 80% for DRE plus TRUS. CONCLUSIONS: Considering the cost and the results obtained (high sensitivity and low specificity), a routine use of Levovist does not seem indicated in patients undergoing prostatic biopsy. An exception may be represented by patients with both negative DRE and TRUS.

Aged↗
PubMed2001

[Office surgery: legislative, medicolegal and economic aspects].

An analysis of Italian legislation shows that while there are national guide lines (not organic on the subject of day surgery), a more fragmentary situation exists at a regional level (the authors work in Lazio and give details on the specific regional legislation). These differences may engenger confusion or, worse, discretion in their application. It has also been seen that at an international level there are no organic laws, except in rare cases. At both a national and international level, experience has been acquired in this direction, always with positive RESULTS. The authors underline the pre, intra and postoperative role of nurses and the economic aspects are analysed, regarding both the resources needed to create structures and provide maintenance costs, as well as those to cover the cost of individual procedures. In conclusion, the authors affirm that the matter is not clear in statutory terms. In some disciplines and for some types of surgery in suitable areas, day surgery is reliable; it is also economically and psychologically beneficial. The authors hope that the legislation will be harmonised and specific evaluation structures will be set up to monitor the quality of structures and also to authorize them.

Adult↗
PubMed2000

[Legislative, medicolegal and economic aspects of day hospitals].

After a short historical review and having dwelled on the nomenclature and legislative framework, the authors describe the medicolegal implications of the day hospital. They describe international experience within the various disciplines, with reference to economic aspects in terms of costs and the increased efficacy of these structures, the quality of service and government policies, in particular in industrialised countries. The authors conclude that day hospitals present considerable advantages both in economic terms and for patients. However, the organisation of the system needs to be improved and, where possible, procedures standardised. Bearing in mind the importance of costs to modern medicine, it is impossible not to take economic aspects into account, while also improving the quality of relations between doctors, patients and the health system.

Adolescent↗
PubMed2000

[Male cervico-urethral obstruction of organic cause: transrectal prostatic ultrasonography versus permicturition and urethral ultrasonography].

AIM: This paper reports personal experience relating to the use of "static" and "permicturition" prostatic transrectal ultrasonography and urethral ultrasonography in the imaging diagnosis of obstructed patients. METHODS: Between January 1996 and January 1998 we selected 96 consecutive patients aged between 25 and 73 years old (mean 54 years) with symptoms of obstructive dysuria with pathological uroflowmetry and pressure/flow rates (Qmax ranging between 5-12 ml/sec and URA between 34-81). Eighteen of the patients selected had previously undergone prostate surgery for benign pathologies. All patients underwent a standard and permicturition transrectal ultrasonography and urethral ultrasonography using a retrograde approach. The results were compared with those obtained by retrograde urethrocystography and urethrocystoscopy, regarded as the "gold standard" for the diagnosis of urethral obstruction. RESULTS: Sixty-three (65.5%) patients were able to execute the permicturition phase, but only 54 (56.2%) reported that the test was indicative of "real urination", whereas retrograde urethral ultrasonography was well tolerated in all cases and easy to accomplish. In 19 (20%) patients (6 of whom had undergone prostate surgery and 13 were suffering from urethral stenosis), "major" organic alterations responsible for urethral obstruction were observed with the combined use of these ultrasonographic methods. These were not evident using static transrectal ultrasonography and increased the diagnostic sensitivity from 80 to 98%. CONCLUSIONS: We feel that an increasingly complete ultrasonographic study of the lower urinary tract is necessary, above all in obstructed patients. This can be achieved using permicturition and urethral transrectal ultrasonography, ensuring an accurate diagnosis and optimising health expenditure.

Adult↗
PubMed1999

[Breast reconstruction: a possible balance between oncological therapy, reconstructive methods and the patients].

BACKGROUND: Based on their experience of oncological surgery and wishing to respond to the patients' reconstructive requirements, the authors analyse the damage caused by medical therapy (chemo-hormone therapy and radiotherapy) in terms of reconstructive techniques; they aim to establish whether the tissues used in reconstruction interfere with the diagnosis and treatment of recidivations and to identify the best reconstructive strategy in relation to "timing"; lastly, they examine the possibility of realising a cosmetically improved breast. METHODS: A 2-year retrospective study was made during which 3 patients underwent immediate reconstruction using expanders (including 2 with bilateral reconstruction) and 1 patient underwent postradiotherapy differed reconstruction; all patients were followed up for a maximum of 4 years. The following surgical methods were used to improve cosmetic results: 1) conservation of the pectoralis minor which was turned sideways to create the muscular pocket; 2) costal and sternal disinsertion of the pectoralis major; 3) the implant was covered with the muscular pocket in the upper quadrants and with subcutaneous tissue in the lower quadrants; 4) realisation of a mammary groove; 5) immediate mastopexy of the surviving breast. All patients underwent intraoperative and postoperative polychemotherapy. RESULTS: At present (January 1997) none of the patients treated shows signs of locoregional recidivation or general metastases. Complications were observed in the form of subacute infection of the prosthetic flap exposing the expander and infection of the suture material used to reshape the breast in contralateral mastopexy in the patient undergoing reconstruction after radiotherapy. When evaluating the cosmetic results, scar diastasis varied in all patients. Smoothing of the scars, slight implant distortion observed echographically, grade 2 contraction of the periprosthetic capsule were assessed using Baker's scale and all patients were found to be grade I or II. In the light of these results and their personal experience, the authors then analyse, with reference to the literature, the effect of radiotherapy on reconstruction using tissular expansion, the effect of chemotherapy on reconstruction using expansion or autologous implants; the combined effect of radio and chemotherapy on reconstruction using autologous implants or tissues. Timing and the difficulty of diagnosis locoregional recidivation are also discussed. CONCLUSIONS: The authors fully agree with the need to carry out immediate reconstruction, when indicated (above all in bilateral reconstruction) using implants since it is simpler. Chemotherapy does not interfere with the expansion process whereas, if it is deemed necessary to use radiotherapy, it is certainly better to undertake reconstruction using autologous tissues. For special reconstruction methods (replacement of the expander, differed reconstruction with expander), greater use should be made of the day hospital, or better still office surgery.

Adult↗
PubMed1999

[Folate consumption in the preconception period of Sicilian pregnant women and their knowledge about the prevention of neural tube defect by folate supplementation].

BACKGROUND AND AIMS: To define the frequency of Sicilian pregnant women taking folic acid during the periconceptional period (three months before and two months after conception) and how many are familiar with the preventive effects of folic acid on NTD. METHODS: 987 pregnant women from eastern Sicily, mainly with low incomes and low levels of education, most with secondary school certificates, underwent biochemical screening for Down's syndrome and NTD in the second trimester of pregnancy. RESULTS: An anencephalous fetus was diagnosed (frequency 0.1%) in a non-risk couple who had not taken folic acid during the periconceptional period: 4.1% (41 cases) of pregnant women reported having taken folic acid before pregnancy and 12.3% (122) during the first two months of pregnancy: five (0.5%) took folic acid during the periconceptional period (three months before conception and two months after). None of the 5 patients with a positive family history of NTD had taken folic acid. In all 122 cases the intake of folic acid supplements during pregnancy started after the positive results of the pregnancy test or echographic evidence of pregnancy, namely between the fifth and eighth week of pregnancy. Only the 5 pregnant women (0.5%) who took folic acid during the periconceptional period were aware of the possibility of preventing NTD through supplements of this vitamin. CONCLUSIONS: Greater efforts must be made to increase periconceptional use of folic acid for the prevention of NTD in pregnant women in Sicily.

Down Syndrome↗
PubMed1999

[Periconceptual folic acid intake by Sicilian couples at a risk of recurrence of NTD].

BACKGROUND AND AIM: The authors aimed to evaluate the frequency with which pregnant Sicilian women with a high risk of recurring neural tube defects (NTD) attending the Ultrasonography and Prenatal Diagnosis Clinic in the Department of Diagnosis and Treatment at Ospedale S. Bambino in Catania were aware of the preventive effect of folic acid supplements during the periconceptional period and whether they therefore took folic acid supplements before the next pregnancy. METHODS: All pregnant women undergoing ultrasonography between January 1997 and December 1998 were interviewed. It was noted whether any earlier offspring had suffered from NTD or whether relatives (sisters, brothers, parents) had also suffered from the same experience. They were also asked whether they knew about the preventive effect of periconceptional folic acid supplements on the development of NTD, whether their pregnancy was planned and whether they had taken periconceptional folic acid supplements and, if so, at what dose. RESULTS: Eighteen couples were identified as being at risk for recurring NTD, in 3 cases owing to an earlier pregnancy resulting in NTD (2 cases of spina bifida and 1 case of anencephaly) with a negative family history for NTD; a further 15 couples showed a positive family history for NTD. None of the women were aware of the preventive effect of acid folic supplements during the periconceptional period on the development of NTD. Out of 11 programmed pregnancies, none of the pregnant women took folic acid during the periconceptional phase. CONCLUSIONS: Pregnant Sicilian women at risk for recurring NTD interviewed by the authors were not aware of the possible prevention of NTD using folic acid supplements during the periconceptional phase.

Adult↗
PubMed1998

Digital videomicroscopy improves diagnostic accuracy for melanoma.

BACKGROUND: To enhance the clinical evaluation of pigmented skin lesions (PSL), examination of PSL at a high magnification and computer-aided diagnosis have been introduced. Besides surface microscopes, "videomicroscopes" that are provided with polarized light are commercially available. Images recorded in the polarizing mode are comparable with those obtained after application of a drop of oil and a glass slide. OBJECTIVE: The purpose of this study was to evaluate the usefulness of a digital videomicroscope equipped with a dedicated program for the diagnosis of melanocytic PSL by assessing the digital features referring to benign and malignant PSL images and by comparing the clinical assessment performed on 20-fold magnified images to computer diagnosis that were provided by the discriminant analysis calculation carried out on the numeric values describing the images. METHODS: Nine hundred seventeen melanocytic PSL images, corresponding to 852 nevi and 65 melanomas, were considered. For microscopic examination, a 10- (39 cases), 20-(501 cases), or 50-fold magnification (377 cases) was chosen according to the size of the lesion, enabling the whole lesion to be seen on the monitor. All digital images were framed and analyzed with software that calculates different features related to the geometry, color distribution, and internal pattern of the lesion. Features referring to benign and malignant PSL were compared. Moreover, 90 PSL images recorded by a x20 magnification, corresponding to 59 benign PSL and 31 malignant melanomas, were evaluated by 2 observers, 1 observer experienced in videomicroscopy and 1 observer, an untrained dermatologist. Sensitivity and specificity were estimated for observer assessment and computer diagnosis. RESULTS: Significant differences between values referring to benign and malignant PSL were observed for most numeric features. Sensitivity was higher for the computer assessment and lower for the inexperienced observer, whereas specificity was the same for the computer and the trained observer. CONCLUSION: Numeric features referring to benign PSL significantly differ from those of malignant PSL images. Elaboration of videomicroscopic images by means of a dedicated program improves diagnostic accuracy over the simple examination of pigmented skin lesions by means of magnifying and polarizing systems.

Algorithms↗
PubMed1997

[Stress urinary incontinence in women. Our experience with 218 cases].

From November 1992 to March 1994, in the Gynaecological ward of the Obstetrical and Gynaecological section of Cannizzaro Hospital, 218 patients suffering from urinary stress incontinence (U.S.I.) were observed. Using computerized clinical cards, U.S.I. was found in the 71.79% cases. From the clinical evaluation 38.39% of patients were found to be suffering from 1st degree bladder prolapse, 34.82% from 2nd degree bladder prolapse and 16.97% from, 3rd degree. 9.82% of the patients did not manifest signs of bladder prolapse. Therapy was mainly surgical. Burch colposuspension was carried out on 65 patients. When necessary a total hysterectomy and perineal plastic surgery was carried out. A Perrin-Leger bladder neck suspension was carried out on 10 patients and a Pereyra-Raz on 5. Given the varied aspects of U.S.I., the Authors would conclude that the best results are obtained by combining medical, surgical and rehabilitative treatment.

Adult↗
PubMed1997

[Physiopathology of maternal and feto-neonatal thyroid in pregnant women with endemic goiter].

Endemic goitre is a socially important disease in many regions of Italy. In conditions of euthyroidism, the course of pregnancy and perinatal outcome are not burdened by significant complications. It is useful to control thyroid function and to start L-thyroxine therapy in order to avoid any further increase in thyroid size owing to the goitrogenic effect of pregnancy and to avoid transient hypothyroidism and the nodular evolution of goitre. Recent studies appear to indicate a possible physiological role for thyroid hormones in the development of the fetal CNS as early as conception, an additional motive for the administration of thyroxine in order to prevent pathologies caused by thyroid hormone deficiency in utero.

Adult↗
PubMed1997

[Screening for prostatic carcinoma in dysuric patients: diagnostic protocols and cost-benefit analysis].

This work deals with our experience of a programme of early diagnosis of prostate cancer carried out on patients suffering from dysuria through rectal-digital examination (EDR), hematic dosage of PSA (IRMA COAT-A-COUNT DPC) and transrectal echtomography. We have also quantified the costs and verified which methods, either single or combined with other methods, are most advantageous as regards costs/benefits. From Jan 1991 to Jan 1995 306 of 1185 patients (25.8%) underwent prostate biopsy by means of transperineal echograph with gauge 18 needles as in Hodge's technique. Histologic examination revealed prostate adenocarcinoma in 81 (26.5%) cases, benign prostate hypertrophy in 196 (64%), acute and/or chronic phlogosis in 26 (8.5%) and granulomatosic prostatitis in 3 (1%). The diagnostic sensitivity, preciseness and accuracy were, respectively, 92.5%, 78.3%, 79.3% for the EDR, 80.2%, 93.3% and 90% for PSA with cut-off 10 ng/ml, 91% 78.3%, and 90% for the PSA with cut-off 4 ng/ml, 100%, 30.3% and 48.6% for the echograph, 98.8%, 60% and 77% for EDR+PSA (cut-off 4 ng/ml), 98.8%, 65.8 and 79.9% for EDR+PSA (cut-off 10 ng/ml), 100%, 22% and 64.2% for EDR+echograph, 100%, 20% and 62.9% for echograph+PSA (cut-off 4 ng/ml), 100%, 26.6% and 64.9% for echograph+PSA (cut-off 10 ng/ml). We calculated that a programme of early diagnosis using the three methods, if completely at the patient's expense, would cost 207.000-437.000 lire (average 322.000) per patient for a total of 245,295,000-517,845,000 (average 381,570,000). An eco-guided prostate biopsy with a histologic examination would cost 250.000-500.000 lire (average 375.000) per patient with a total cost for 306 patients of 76,500,000-153,000,000 (average 114,750,000). We also quantified, in the light of the results reported here, the number of biopsied which would have been necessary if we had used only two methods in the screening and we also estimated the costs. The results reveal that the echograph is not to be considered as a first approach method as it gives a high number of false positive results; in fact if we had excluded it from the screening we would not have ignored any diagnosis of prostate neoplasia and we would have avoided about 141 (46.2%) biopsied with a reduction in health expenditure of 62.1%. On the contrary the EDR and the PSA have a better cost/benefit result: setting the cut-off of the PSA at 4 ng/ml or at 10 ng/ml without varying the diagnostic accuracy, the sensitivity and/or specificity of the method increase respectively. To conclude, we consider the EDR and the serum dosage of PSA necessary and adequate methods in the programme of early diagnosis and screening of prostate neoplasy. The prostate echography should be reserved for cases of doubt (hematic PSA between 4-10 ng/ml etc.) and for the exclusion of needle biopsy. These measures also result in an optimization of health expenditure.

Adult↗