Biomedical subjects
Publications and source records attributed to V Costantino.
The sterol composition of the Caribbean sponge Iotrochota birotulata was investigated. Structure of a new ecdysteroid 2beta,3beta,14alpha, 20beta-tetrahydroxy-22alpha-(2-hydroxyacetiloxy)-5b eta-colest-7-en-6- one (1) was assigned on the basis of spectroscopic and chemical evidence and molecular mechanics calculations. Isolation of the widespread ecdysteroids 2-5 is also reported.
The new glycolipids simplexides (1) have been isolated from the marine sponge Plakortis simplex, and their structure determined by spectroscopic data and microgram-scale chemical degradation. Simplexides are composed of long-chain secondary alcohols glycosylated by a disaccharide chain, and represent a new structural kind of glycolipids. Simplexides strongly inhibit proliferation of activated T-cells by a non-cytotoxic mechanism and can be regarded as simple model molecules for designing immunosuppressive drugs.
Three new 9,11-secosterols, 3 beta,6 alpha,11-trihydroxy-9,11-seco-5 alpha-cholest-7-ene-9-one (1), 24S- (2a), and 24R-methyl-3 beta,6 alpha, 11-trihydroxy-9,11-seco-5 alpha-cholest-7,22E-diene-9-one (2b), were isolated from the Indian Ocean gorgonia, Subergorgia suberosa. Their structures were established by spectroscopic data.
Solitary true cysts of the pancreas are extremely rare: to date, only eight cases have been reported in the English literature, four of which had clinical significance. An additional three cases of solitary true cysts of the pancreas are presented. One patient was incidentally found at operation, performed for other disease, to have a cystic lesion in the body of the pancreas; the other two patients experienced abdominal pain and nausea. Abdominal US, CT, and MR showed a unilocular cyst in the body and tail of the pancreas. In both cases, preoperative diagnosis of pancreatic cystic neoplasm was made. Two patients underwent excision of the mass and one distal pancreatectomy. Analysis of the cyst fluid revealed high CA 19-9 levels in two and CA 125 levels in one case. All cysts were lined by cuboidal epithelium, without morphological alterations. Preoperative differential diagnosis with the most common cystic pancreatic lesions (inflammatory or neoplastic) is difficult.
The sterol composition of the Caribbean sponge Neofibularia nolitangere has been investigated. In addition to usual sterols this sponge elaborates comparable amounts of 24-methylene-4 alpha-methyl-5 alpha-cholest-8-en-3 beta-ol (1), which is very unusual among sponge sterols, and lesser quantities of two new polyoxygenated sterols, (24S)-24-ethyl-5 alpha-cholest-8-ene-5,6 beta,7 alpha-triol (2) and (24S)-24-ethyl-5 alpha-cholest-8(14)-ene-5,6 beta,7 alpha-triol (3).
In view of forecasting the effect of octreotide acetate (Sandostatin) in preventing fistula formation after pancreatic surgery, 9 patients, who had pancreatoduodenectomy 8-12 days before, underwent a 2-day study. The first day, by means of a catheter located in the jejunal loop separately anastomosed to the pancreatic remnant, basal and after secretin stimulation pancreatic secretion was evaluated. During the 2nd day the possible inhibitory effect of octreotide on basal and stimulated secretion was investigated. Under the experimental conditions of the study Sandostatin showed little effect on the water and bicarbonate increase as stimulated by secretin. A greater hormone inhibitory effect on amylase production and pancreatic endocrine function was seen. On the basis of these results the use of Sandostatin can hardly be seen as useful in preventing fistula formation after pancreatic resection.
The Senegalese sponge Microscleroderma spirophora has been found to produce exclusively very unusual 3 beta-methoxysteroids in place of the common 3 beta-hydroxysteroids. Six different methoxysteroids (three of which are novel compounds) have been isolated and identified by spectroscopic means (MS, IR, 1H and 13C NMR), and their taxonomic significance discussed. A new method for the determination of the configuration at C-24 in saturated 24-ethyl side chains is also proposed.
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We evaluated the sensitivity and specificity of the carbohydrate antigen TAG-72 as a tumor marker for pancreatic cancer compared with the serum values of CA 19-9. Forty healthy controls, 58 patients with pancreatic carcinoma, and 45 patients with chronic pancreatitis were studied. In patients with pancreatic cancer, 47/58 (81%) and 26/58 (45%) had raised serum levels of CA 19-9 and TAG-72, respectively; the sensitivity of the tests was not influenced by jaundice. In the chronic pancreatitis patients, both CA 19-9 and TAG-72 were elevated in 2/45 patients (4.4%). Both tests showed a specificity of 95%. Consequently, the sensitivity of TAG-72 was too low compared with CA 19-9. Moreover, serum TAG-72 could not detect small pancreatic cancers. High levels of both tumor markers were found in advanced stages of cancer. No advantage was found using both CA 19-9 and TAG-72 for improving the detection of pancreatic cancer. TAG-72 serum levels > 10 U/mL are closely related to unresectability of the tumor. Only 4/17 (23%) of patients with resectable tumor had high TAG-72 levels. Serum TAG-72 expression seems to be more frequent in poorly-differentiated tumors than in well-differentiated cancers (56 vs 30% positivity rate).
This study compared the sensitivity and specificity of CA 50 and CA 19-9 as serum tumour markers for pancreatic cancer. One hundred and seventy one subjects were evaluated: 50 healthy controls, 50 patients with pancreatic carcinoma and 71 patients with chronic pancreatitis. Eighty per cent of the pancreatic cancer patients had raised CA 19-9 serum levels and 82% had raised CA 50 serum levels. In the group of patients ith chronic pancreatitis, false positive tests occurred in 8.4% for CA 19-9 and 11.3% for CA 50. For both markers the serum level showed a severe elevation in the advanced stage of cancer disease. Despite the good sensitivity and specificity of CA 50 as a serum tumour marker for pancreatic carcinoma, no major advantage was found compared to CA 19-9. Moreover, if the CA 50 cut-off, level is raised to 85 U/ml to exclude overlap with chronic pancreatitis, sensitivity falls sharply to 46% compared with 72% for CA 19-9 when a 100 U/ml cut-off level is used.
Cytologic results were retrospectively evaluated in 83 patients who underwent CT-guided fine-needle aspiration of pancreatic lesions during a 5-year period. Sixty seven patients had malignant disease and 16 benign disease. The sensitivity, specificity, positive and negative predictive values, and diagnostic efficiency of fine-needle aspiration (FNA) cytology in detecting malignancy were 91%, 100%, 100%, 73%, and 93%, respectively. In solid pancreatic masses the sensitivity of FNA cytology rose to 98%, while in cystic pancreatic masses sensitivity fell to 62%. In 18 patients with cystic lesions (12 benign and 6 malignant), the cystic fluid was analyzed for amylase, CEA and CA 19-9 content. Amylase levels were high in pseudocysts and in 4/6 malignant cysts. CEA levels were low in benign cysts, and high in all malignant cysts. CA 19-9 levels were high in one pseudocyst and in all malignant cysts. Tumour marker content analysis enhanced the sensitivity of the cytologic diagnosis of malignant cysts to 92%. FNA cytology is a simple and highly accurate method in the differential diagnosis of solid pancreatic lesions. In cystic lesions, tumour marker fluid content determination increases the sensitivity of FNA cytology.
Malignant tumors of the breast arising from the connective tissue of the gland are rare and underestimated. Three new cases are here reported: 1 malignant fibrous histiocytoma and 2 malignant phylloides tumors. Tumor size, mammographic findings and cytologic aspect of the needlebiopsy lead to the correct diagnosis. Large excision or radical mastectomy are treatments of choice, while axillary lymph nodes dissection does not appear justified, since metastatic spread via lymphatics is rare. Postoperative radiation and chemotherapy seem not effective in preventing local recurrences.
A case of type-IA biliary cyst, according to the Todani classification, is reported in a 44-years-old man admitted to hospital with epigastric pain. Ultrasound was misleading; CT scanning and preoperative cholangiography confirmed the biliary duct's dilatation. Cyst excision and hepaticojejunostomy were performed with a view to avoiding possible cyst cancerization.
Cystic masses of the adrenal gland are clinically and pathologically rare findings and few cases have been reported up to now in the medical literature. In the present work 5 new cases are reported: 3 adrenal pseudocysts, 1 lymphangioma, 1 cystic pheochromocytoma. In 3 cases there were clinical symptoms of retroperitoneal mass (lumbar pain, palpable mass, digestive symptoms); in 3 cases conventional radiology was helpful; ultrasonography was used for diagnosis in 1, CT scan in 2. In the pheochromocytoma case the real nature of the mass was determined through fluid hormone determination after fine needle puncture. All cases were treated by surgery.
Omeprazole, 20 mg every second day, in prevention of duodenal ulcer relapse has been tested. 15 patients with peptic ulcer, which was endoscopically proved and then healed, underwent the treatment. No matter of ulcer original seat as well as antacid drug previously employed, recurrences were not seen after a 6 months period, while clinical symptoms and possible adverse reactions appeared to be very slight. The proposed regimen of omeprazole seems to be cost-saving and worth proving.
Adrenal cysts are uncommon. A case of left adrenal cystic lymphangioma in 16 year old boy is reported. The adrenal cyst was a chance finding during radiological investigation for abdominal pain. Ultrasound and CT scan showed the cyst and suggested the correct diagnosis of cystic lymphangioma of the left adrenal gland. The patient underwent surgery and a left adrenalectomy was performed. Histology confirmed the previous diagnosis of cystic lymphangioma.
A patient with chronic pancreatitis was admitted for digestive bleeding from esophageal varices. Portal thrombosis and cavernomatous periportal collateral circulation were found at laparotomy. The partially recanalized portal tree was excluded from the portal circulation and filled with pancreatic juice due to a communication with a pancreatic pseudocyst. Splenectomy, partial left pancreatectomy, Roux en Y pancreatico-cysto-jejunostomy, and external drainage of the portal tree were performed. The postoperative course was uneventful and the patient is symptom-free and doing well 2 yr after surgery.