E Zanella

Analysis of adenomatous polyposis coli gene in thyroid tumours

Familial adenomatous polyposis (FAP) is known to be associated with neoplasia of various tissues, including thyroid carcinoma. Germline mutations of the tumour-suppressor gene APC, responsible for the predisposition to FAP, may therefore be involved in the pathogenesis of these tumours. In this report the structure of the APC gene has been investigated in 26 thyroid tumours, at different stages of dedifferentiation, that were surgically excised from patients with a negative history of FAP. Approximately 35% of the APC gene coding region, where most of the mutations are clustered, has been analysed by a combination of single-strand conformation polymorphism and direct sequencing. No significant alterations could be demonstrated in any sample examined. It is concluded that, at least in patients not affected by FAP, APC gene abnormalities do not seem to play a relevant role in the pathogenesis of thyroid carcinoma.

Prevalence of Thyroid Cancer in Hyperthyroid Patients Treated by Surgery

A retrospective study has been carried out to evaluate the prevalence of malignant thyroid tumors in 202 patients submitted to surgery for hyperthyroidism. Thyroid cancer was diagnosed in 12 cases (5.9%); the final histologic examination revealed nine papillary carcinomas, one follicular carcinoma, and two Hürthle cell carcinomas. Concurrence of hyperthyroidism and thyroid cancer was more frequent in patients with single toxic adenomas than in those with toxic diffuse or multinodular goiters. In five cases thyroid malignancy was detected in the context of the hyperthyroid lesion (three toxic adenomas and two diffuse goiters). In eight patients the malignant lesion showed a maximum diameter of less than 1 cm, although in five of these cases unfavorable histologic features, such as minimal capsular invasion or multifocality, were present. All patients presenting with thyroid cancer are currently alive and apparently free of residual disease. It is concluded that hyperthyroid patients, particularly those with single toxic adenomas, should be carefully evaluated to exclude the presence of an associated malignancy and to plan the most appropriate therapeutic options.

Aztreonam Biliary Excretion in Bile Duct Ligated Jaundiced Rats

An experimental study was undertaken to assess aztreonam biliary concentrations in bile duct ligated jaundiced rats. The study proved that aztreonam biliary concentrations are sufficient to inhibit Gram-negative bacteria within the first and the second hour after antibiotic administration. The experimental model suggests that clinical conditions such as lithiasis or neoplasms of the biliary tree should not totally inhibit the antibiotic excretion.

Diagnostic Accuracy of Radionuclide Venography in the Assessment of Incompetent Perforating Veins of the Legs

The purpose of this study was to evaluate the accuracy of radionuclide venography (RV) (with 99mTc-marked red blood cells) in the identification of incompetent perforating veins (IPVs) of the legs in patients with chronic venous insufficiency. After informed consent, RV, followed by contrast phlebography (CP), of the symptomatic leg was performed in 14 patients (20 legs). The results of RV were compared with those of CP, which was considered the standard technique in detecting IPVs of the leg. The sensitivity of RV was 92.3%; the specificity, 93.7%; the positive predictive value, 96%; the negative predictive value, 88.2%; and the accuracy, 92.9%. The authors conclude that RV has a high diagnostic accuracy in detecting IPVs of the leg.

Correlation of Tc-99m-Red Blood Cell Phleboscintigraphy with Clinical Severity of Chronic Venous Disease

Equilibrium red blood cell phleboscintigraphy of the lower limbs for the diagnostic management of chronic venous disease has been proposed. The aim of this study was to verify the correlation of the phleboscintigraphic assessment of chronic venous disease with the clinical grading of the severity of the disease, since other diagnostic modalities have been recently demonstrated a poor and only partial correlation. Equilibrium Tc-99m-red blood cell phleboscintigraphy was performed in 27 patients with chronic venous disease. Scintigraphic images of 52 limbs were classified according to a four-class qualitative grading of the severity of the venous disease, and a quantitative scintigraphic index (saphena /femoral ratio) was assigned to each limb. The scintigraphic qualitative grading showed a highly significant correlation with the clinical grading (Rs=0.82, p<0.01), a good interobserver and intraobserver agreement (86.5% and 92.3%, respectively) and more than 90% sensitivity and specificity to identify the categories “minimal or no chronic venous disease“ or “more significant disease” (assessed according to the Bayes theorem). Sensitivity and specificity results for the quantitative assessment were not as good. Phleboscintigraphy correlates well with the clinical grading of the severity of chronic venous disease of the lower limbs and may have potential as a valuable diagnostic tool for the noninvasive assessment of chronic venous disease.

Renal failure complicating obstructive jaundice. An updating

The association between renal failure and obstructive jaundice is a well-known clinical setting. Despite numerous clinical and experimental contributions on this topic we are still far from defining the etiology and pathogenesis of renal failure complicating obstructive jaundice. The aim of this chapter is to assess the current extent of the problem, with a close analysis of pathophysiological data concerning the “hepato-renal syndrome”.

Cystic tumors of the pancreas : serous cystadenoma and mucinous cystic neoplasm

Serous cystadenoma and mucinous cystic neoplasm are acquired neoplastic cysts, which together account for approximately 10-15% of all pancreatic cysts. When a cystic lesion is encountered, the first priority is to determine whether it is an inflammatory or neoplastic cyst. Failure to recognize the true nature of a neoplastic cyst will lead to an incorrect treatment strategy. Despite progress made in diagnostic techniques, the pre-operative differentiation between benign and malignant cystic neoplasms of the pancreas remains problematic. This chapter aims at an attempt to analyze and discuss these problems.

Acute acalculous cholecystitis. clinical and experimental remarks

Acute acalculous cholecystitis is an entity on the increase. The disease causes high rates of morbidity such as those normally observed in critically ill patients. Acute acalculous cholecystitis should be promptly suspected and diagnosed, for timely surgical treatment. This chapter will deal with the experimental and clinical work out that has led to better knowledge of this topic.