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1.
Int J Environ Sci Technol (Tehran) ; 19(12): 11685-11698, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35126566

RESUMO

The technique of air sterilization by thermal effect was revisited in this work. The impact of incorporating a high efficiency heat recovery exchanger to a sterilizing cell was especially assessed. A mathematical model was developed to study the dynamics and the steady state of the sterilizer. Computer simulation and reported data of thermal inactivation of pathogens permitted obtaining results for a proof-of-concept. The simulation results confirmed that the incorporation of a heat recovery exchanger permits saving more than 90% of the energy needed to heat the air to the temperature necessary for sterilization, i.e., sterilization without heat recovery consumes 10-20 times the energy of the same sterilization device with heat recovery. Sanitization temperature is the main process variable for sanitization, a fact related to the activated nature of the thermal inactivation of viruses and bacteria. Heat recovery efficiency was a strong function of the heat transfer parameters but also rather insensitive to the cell temperature. The heat transfer area determined the maximum capacity of the sterilizer (maximum air flowrate) given the restrictions of minimum sanitization efficiency and maximum power consumption. The proposed thermal sterilization device has important advantages of robustness and simplicity over other commercial sterilization devices, needing practically no maintenance and eliminating a big variety of microorganisms to any desired degree. For most pathogens, the inactivation can be total. This result is not affected by the uncertainties in thermal inactivation data, due to the Arrhenius-like dependence of inactivation. Temperature can be adjusted to achieve any removal degree.

2.
Eur Cell Mater ; 41: 485-501, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33948929

RESUMO

The aim of the present study was to fabricate and characterise chitosan scaffolds from animal and fungal sources, with or without gelatine as a co-polymer, and cross-linked to 3-glycidyloxyproply trimethoxysilane (GPTMS) or genipin for application in dental root tissue engineering. Chitosan-based scaffolds were prepared by the emulsion freeze-drying technique. Scanning electron microscopy (SEM) and nano-focus computed tomography (nano-CT) were used to characterise scaffold microstructure. Chemical composition and cross-linking were evaluated by Fourier transform infrared-attenuated total reflectance spectroscopy. Compression tests were performed to evaluate scaffold mechanical properties. Scaffold degradation was evaluated by gravimetric method and SEM. Scaffold bioactivity immersed in simulated body fluid was evaluated by SEM, with associated electron dispersive X-ray spectroscopy, and apatite formation was examined by X-ray diffraction. Finally, human dental pulp stem cells (hDPSCs) viability was evaluated. The fabrication method used was successful in producing scaffolds with organised porosity. Chitosan source (animal vs. fungal), co-polymerisation with gelatine and cross-linking using GPTMS or genipin had a significant effect on scaffold properties and hDPSCs response. Chitosan-genipin (CS-GEN) scaffolds had the largest pore diameter, while the chitosan-gelatine-GPTMS (CS-GEL-GPTMS) scaffolds had the smallest. Animal chitosan-gelatine co-polymerisation increased scaffold compressive strength, while fungal chitosan scaffolds (fCS-GEL-GPTMS) had the fastest degradation rate, losing 80 % of their weight by day 21. Gelatine co-polymerisation and GPTMS cross-linking enhanced chitosan scaffolds bioactivity through the formation of an apatite layer as well as improved hDPSCs attachment and viability. Tailored chitosan scaffolds with tuned properties and favourable hDPSCs response can be obtained for regenerative dentistry applications.


Assuntos
Quitosana/química , Polpa Dentária/efeitos dos fármacos , Alicerces Teciduais/química , Adolescente , Adulto , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/química , Células Cultivadas , Força Compressiva/efeitos dos fármacos , Feminino , Humanos , Iridoides/administração & dosagem , Masculino , Teste de Materiais/métodos , Porosidade , Impressão Tridimensional , Silanos/administração & dosagem , Células-Tronco/efeitos dos fármacos , Engenharia Tecidual/métodos , Adulto Jovem
3.
Mol Neurobiol ; 55(6): 5321-5336, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28921456

RESUMO

The blood-brain barrier (BBB) is mainly made up of tightly connected microvascular endothelial cells (BMECs), surrounded by pericytes (BMPCs) which regulate BBB tightness by providing soluble factors that control endothelial proliferation. Haemophilus influenzae type a (Hia) is able to reach the BBB, crossing it, thus causing meningitis. In this study, by using an in vitro model of BBB, performed with human BMECs and human BMPCs in co-culture, we demonstrated that, after Hia infection, the number of hBMPCs decreased whereas the number of hBMECs increased in comparison with non-infected cells. SEM and TEM images showed that Hia was able to enter hBMECs and reduce TEER and VE-cadherin expression. When the cells were infected in presence of SCH58261 and PSB603 but not DPCPX, an increase in TEER values was observed thus demonstrating that A2A and A2B adenosine receptors play a key role in BBB dysfunction. These results were confirmed by the use of adenosine receptor agonists CGS21680, CCPA, and NECA. In infected co-cultures cAMP and VEGF increased and TEER reduction was counter-balanced by VEGF-R1 or VEGF-R2 antibodies. Moreover, the phosphorylated CREB and Rho-A significantly increased in infected hBMECs and hBMPCs and the presence of SCH58261 and PSB603 significantly abrogated the phosphorylation. In conclusion, this study demonstrated that the infection stimulated A2A and A2B adenosine receptors in hBMECs and hBMPCs thus inducing the pericytes to release large amounts of VEGF. The latter could be responsible for both, pericyte detachment and endothelial cell proliferation, thus provoking BBB impairment.


Assuntos
Barreira Hematoencefálica/metabolismo , Infecções por Haemophilus/metabolismo , Infecções por Haemophilus/virologia , Haemophilus influenzae/fisiologia , Receptor A2A de Adenosina/metabolismo , Receptor A2B de Adenosina/metabolismo , Barreira Hematoencefálica/patologia , Barreira Hematoencefálica/ultraestrutura , Caderinas/metabolismo , Contagem de Células , Técnicas de Cocultura , AMP Cíclico/biossíntese , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico/metabolismo , Impedância Elétrica , Células Endoteliais/metabolismo , Células Endoteliais/ultraestrutura , Haemophilus influenzae/ultraestrutura , Humanos , Microvasos/patologia , Pericitos/metabolismo , Fosforilação , Fator A de Crescimento do Endotélio Vascular/metabolismo , Proteínas rho de Ligação ao GTP/metabolismo
4.
Surg Oncol ; 16 Suppl 1: S161-3, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18032024

RESUMO

Although endometriosis is a common disease in women of childbearing age, intestinal endometriosis is unusual and may cause clinically significant complications. We report a 35-year-old woman with endometriosis involving the ileocaecal junction and rectum who presented with intestinal obstruction. She was operated with a preoperative diagnosis of malignancy. The diagnosis of endometriosis was made only after histological examination of the resected specimen. Intestinal endometriosis has a diverse clinical spectrum, with nonspecific features in many patients. In female patients who have unexplained digestive complaints, endometriosis should also be considered in the differential diagnosis.


Assuntos
Endometriose/complicações , Enteropatias/complicações , Obstrução Intestinal/etiologia , Adulto , Feminino , Humanos , Linfonodos/cirurgia
5.
Artigo em Inglês | MEDLINE | ID: mdl-17095797

RESUMO

PARKSERVICE is a telemedical application currently being validated in the EU. The objectives are to provide a combination of home clinical and social support for people with Parkinson's disease with a revolutionary walking aid that uses "visual cues" to enable improved mobility. Early results are presented and the outlook of home telemedicine and visual cueing for people with PD is discussed.


Assuntos
Serviços de Assistência Domiciliar , Limitação da Mobilidade , Doença de Parkinson/fisiopatologia , Tecnologia Assistiva , Telemedicina , Percepção Visual , Caminhada/psicologia , Sinais (Psicologia) , Óculos , Humanos , Ilusões , Desenvolvimento de Programas , Caminhada/fisiologia
6.
Int J Radiat Biol ; 82(8): 561-7, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16966183

RESUMO

PURPOSE: To detect possible clastogenic and aneugenic properties of a 50 Hz, 650 muT magnetic field. MATERIALS AND METHODS: The micronucleus test with CREST (Calcinosis, Raynaud's phenomenon, Esophageal dismotility, Sclerodactility, Telangectasia) antibody staining was performed on liver and peripheral blood sampled from newborn mice exposed to an ELF (Extremely Low Frequency) magnetic field during the whole intra-uterine life (21 days), and on bone marrow and peripheral blood sampled from adult mice exposed to the same magnetic field for the same period. RESULTS: Data obtained in newborn mice show a significant increase in micronuclei frequencies. In absolute terms, most of the induced micronuclei were CREST-negative (i.e., formed by a chromosome fragment). However, in relative terms, ELF exposure caused a two-fold increase in CREST-negative micronuclei and a four-fold increase in CREST-positive micronuclei (i.e., formed by a whole chromosome). No significant effect was recorded on exposed adults. CONCLUSIONS: These findings suggest the need for investigation of aneugenic properties of ELF magnetic fields in order to establish a possible relationship to carcinogenesis.


Assuntos
Aneuploidia , Campos Eletromagnéticos/efeitos adversos , Exposição Ambiental/efeitos adversos , Mutação/efeitos da radiação , Efeitos Tardios da Exposição Pré-Natal/etiologia , Efeitos Tardios da Exposição Pré-Natal/genética , Animais , Animais Recém-Nascidos , Feminino , Camundongos , Gravidez , Doses de Radiação
7.
Ann Ig ; 16(6): 721-6, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15697001

RESUMO

The aim of the study was to survey the current extension of the infected brown rats (Rattus norvegicus) living on the site Ripa Grande-San Michele port located in the center of the sity along the accessible right bank of the Tiber river by using a specific molecular technology. The detection of Leptospira, in 11 trapped brown rats, by tube-based Polymerase Chain Reaction (PCR) was performed. The amplified samples were analysed by capillary zone electrophoresis (CZE). Sequence analysis of the amplified DNAs confirmed the specificity of the detection of leptospires. Five out of 11 brown rats exhibited positivity for Leptospira. The survey points out the high rate of leptospiral infection in the brown rats living in the most ancient urban area of Rome.


Assuntos
Reservatórios de Doenças , Leptospira/isolamento & purificação , Leptospirose/transmissão , Ratos/microbiologia , Zoonoses , Animais , Sangue/microbiologia , Reanimação Cardiopulmonar , DNA Bacteriano/análise , Eletroforese Capilar , Feminino , Rim/microbiologia , Masculino , Cidade de Roma , Sensibilidade e Especificidade , Baço/microbiologia
8.
Ann Ital Chir ; 74(3): 319-26, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14677289

RESUMO

BACKGROUND AND AIMS: Improved medical therapy and bowel sparing and sphincter saving techniques have changed surgery for UC and CD. Collaboration between gastroenterologists and surgeons is necessary to uniform the indications for surgical treatment reducing emergency operations. GISMII multicentric study aimed to show indications, timing and impact of surgery, through retrospective analysis of cases observed between 1992 to 1996. METHODS: Data were obtained by 16 departments of General Surgery. RESULTS: 102 UC and 376 CD patients were analyzed. In UC patients surgery was performed for failure of medical therapy in 54%, complications in 28.4%, cancer or dysplasia in 10% of cases, 83.3% elective procedures. 30.4% ileo-anal pouch, 30.4% total procto-colectomies with definitive ileostomies, 32.4% total colectomies with ileo-rectal anastomosis, 6.8% segmental resections, were performed. In CD patients surgery was performed in 21% for medical therapy failure, in 79% for complications. 53.4% of patients were submitted to 1 operation, 84% elective procedures. Reoperations were performed in 46.6% of patients, 70.3% elective procedures. In the first operation bowel resection was performed in 79.1%, stricturoplasty in 14.3%; in the subsequent operations bowel resection 62.8%, stricturoplasty 21.7%, increasing number of temporary or definitive ileo-stomies. CONCLUSIONS: Collaboration between gastroenterologists and surgeons is necessary to obtain optimal results, reducing the incidence of emergency surgery, and complications. The short period observed between diagnosis and operation (21.4 months) is due to the increasing tendency of gastroenterologists to anticipate a surgical procedure when young patients with a chronic disease need a prolonged medical therapy.


Assuntos
Doenças Inflamatórias Intestinais/cirurgia , Adolescente , Adulto , Anastomose Cirúrgica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Bolsas Cólicas/estatística & dados numéricos , Feminino , Hospitais Gerais/estatística & dados numéricos , Humanos , Ileostomia/estatística & dados numéricos , Neoplasias Intestinais/cirurgia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Centro Cirúrgico Hospitalar/estatística & dados numéricos
9.
Aliment Pharmacol Ther ; 18(10): 1009-16, 2003 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-14616167

RESUMO

BACKGROUND: Although bowel ultrasound is a widely accepted diagnostic tool in bowel diseases, its value as the primary imaging procedure in patients with symptoms/signs suggestive of inflammatory bowel disorders is still unclear. AIM: To investigate the accuracy of bowel ultrasound compared with barium X-ray studies, computed tomography, endoscopy and bowel surgery in the initial assessment of inflammatory bowel disorders. METHODS: Four hundred and eighty-seven patients hospitalized consecutively for symptoms or signs suggestive of a bowel disorder between December 1999 and March 2002 were initially enrolled in the study. All patients underwent bowel ultrasound as the first imaging procedure within 36 h of admission; radiographic evaluations, endoscopy and/or surgery were then performed as appropriate and the results of these investigations were used as the gold standard. RESULTS: Three hundred and thirty-six patients had pathological findings of the bowel detectable at ultrasound as the final diagnosis. The main organic disorders found were Crohn's disease (56%), ulcerative/indeterminate colitis (30%), bowel tumours (5%), appendicitis/diverticulitis (2%) and other inflammatory conditions (8%). The overall sensitivity and specificity of bowel ultrasound were 85% and 95%, respectively, whereas the positive and negative predictive values were 98% and 75%, respectively. Comparisons of ultrasound with X-ray or endoscopic results by disease localization showed that the diagnostic performance of ultrasound was higher for inflammatory conditions of the ileum and sigmoid/descending colon (sensitivity of 92% and 87%, respectively), whereas abnormalities localized in the rectum, duodenum and proximal jejunum were often missed by ultrasound. CONCLUSIONS: In expert hands, bowel ultrasound is highly predictive of inflammatory disease localized in the ileum or colon, and may well be used as the primary imaging method when Crohn's disease or ulcerative colitis is suspected on a clinical basis.


Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Doenças Retais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia
10.
Aliment Pharmacol Ther ; 18(7): 749-56, 2003 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-14510749

RESUMO

AIM: To establish whether intestinal ultrasound, clinical or biochemical indices of activity can assess histological features of ileal stenosis in Crohn's disease. METHODS: In 43 patients undergoing surgery for a single ileal stenosis, clinical and biochemical parameters, as well as intestinal ultrasound, were assessed prior to surgery. The echo pattern of thickened bowel segments at the site of stenosis was classified as hypoechoic, stratified or mixed (segments with/without stratification). During surgery, stenoses were identified, resected and then histologically examined using standardized criteria. RESULTS: Clinical and biochemical indices of activity showed an overall weak positive correlation with histological inflammatory parameters and a negative correlation with fibrosis. The intestinal ultrasound echo pattern at the stenosis site was stratified in 25 patients, hypoechoic in 14 and mixed in four. Stenoses characterized by a stratified echo pattern showed a significantly higher degree of fibrosis, those characterized by hypoechoic echo pattern showed a higher degree of inflammation, while stenoses with a mixed echo pattern showed high degrees of both fibrosis and inflammation. CONCLUSION: Ultrasound and, to a lesser degree, clinical and laboratory indices discriminate between inflammatory and fibrotic ileal stenoses complicating Crohn's disease, thus allowing appropriate medical and/or surgical treatment to be defined.


Assuntos
Doença de Crohn/patologia , Doenças do Íleo/patologia , Obstrução Intestinal/patologia , Adulto , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/cirurgia , Feminino , Fibrose/diagnóstico por imagem , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Ileíte/diagnóstico por imagem , Ileíte/patologia , Ileíte/cirurgia , Imuno-Histoquímica , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Cuidados Pré-Operatórios/métodos , Recidiva , Sensibilidade e Especificidade , Ultrassonografia
11.
Environ Res ; 91(1): 54-61, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12550088

RESUMO

Doñana Park (Spain), a protected area in Europe, was affected by an environmental disaster in April 1998 that caused the spreading of acidic water and mud full of toxic metals from the Aznalcollar pyrite mine. In order to assess the contamination in the area and to monitor the possible biological effects of the toxic spill, a series of coordinated studies was performed utilizing several animal species living in that area. We performed genotoxicity monitoring using the Comet assay on peripheral blood leukocytes of the Algerian mouse (Mus spretus), a nonprotected rodent suitable as a bioindicator. The mice were sampled in different areas 6 months after the ecological disaster and again 1 year later. Our results showed that in 1998 all the areas examined were contaminated, as determined by an increase in the Comet assay parameters in the analyzed animals, whereas a significant decrease in the values of these parameters was observed in the 1999 samples, which were collected in a riverside area subject to tide flows. Thus, the Comet assay has proven to be an interesting and sensitive tool in studies of environmental genotoxicity.


Assuntos
Ensaio Cometa , Dano ao DNA , Exposição Ambiental , Monitoramento Ambiental/métodos , Metais Pesados/efeitos adversos , Camundongos/genética , Acidentes , Animais , Feminino , Concentração de Íons de Hidrogênio , Leucócitos , Masculino , Mineração , Espanha
12.
Scand J Gastroenterol ; 38(12): 1249-55, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14750645

RESUMO

BACKGROUND: The test and treat strategy for Helicobacter pylori infection has raised some concern since young gastric cancer patients may have no alarm symptoms. In this study the frequency of alarm symptoms was assessed in a series of young gastric cancer patients, as well as the impact of absence of alarm symptoms on delay in diagnosis and stage of gastric cancer at diagnosis and survival. METHODS: A retrospective study was carried out on 92 gastric cancer patients < or = 45 years of age identified from databases in four hospitals between January 1985 and December 2001. Characteristics analysed included duration and features of dyspeptic symptoms, presence of alarm symptoms, time interval from the onset of symptoms to diagnosis, pTNM stage and survival. RESULTS: Of the 92 patients, 54 (58.7%) presented uncomplicated dyspepsia and 38 (41.3%) alarm symptoms. In those with uncomplicated dyspepsia, epigastric pain was the most common complaint (64.1%) followed by vomiting (30.4%), heartburn and nausea. Weight loss was the most common alarm symptom (30.4%), followed by anorexia (10.9%), dysphagia or anaemia (7.6%). The mean delay from first symptoms to final diagnosis was 16.8 +/- 13.9 weeks in patients with alarm symptoms and 29.3 +/- 39.9 weeks in patients without alarm symptoms (P:ns). Patients without alarm symptoms showed significantly less aggressive gastric cancer compared to patients with alarm symptoms in relation to TNM stage and survival (cumulative 5-year survival rate: 76% versus 49% P: 0.01). The survival rate, at 5 years, of patients without alarm symptoms, and with a history of dyspepsia of more than 24 weeks, was higher than that in patients with early diagnosis (93.4% versus 66.5%: P: 0.05). CONCLUSIONS: A large proportion of young gastric cancer patients present without alarm symptoms. Despite the delay in diagnosis, these patients have a better outcome than those with alarm symptoms. Thus the delay in diagnosis of patients without alarm symptoms does not affect survival.


Assuntos
Neoplasias Gástricas/diagnóstico , Adulto , Fatores Etários , Dispepsia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Redução de Peso
13.
Dig Liver Dis ; 34(10): 696-701, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12469796

RESUMO

AIMS: To assess whether plasma peroxidation and plasma levels of antioxidant compounds are correlated with clinical and biochemical activity in complicated Crohn's disease patients, and to evaluate whether the relief of obstructive complication by conservative surgery has any effect on the oxidative stress. PATIENTS AND METHODS: From May 1998 to May 2000, 20 Crohn's disease patients were studied. Basal peroxidative state (basal thiobarbituric acid reactive substances), peroxidative state after stimulation with copper sulfate (stimulated thiobarbituric acid reactive substances], lag time of plasma peroxidation susceptibility, plasma levels of vitamin E and A, C reactive protein, erythrocyte sedimentation rate and Crohn's disease activity index, were determined, before surgery, then 2 months and 1 year after surgery. A group of 134 healthy volunteers were used as controls. All patients were treated by conservative surgical procedures (i.e., strictureplasty and/or minimal resections). Student t test for paired and unpaired data and Spearman R correlation coefficient were calculated. RESULTS: Peroxidative plasma levels, as well as inflammatory indices, are significantly reduced 2 months and 1 year after surgery (p < 0.005), but basal levels of peroxidation and antioxidant scavengers seem to be disregulated in Crohn's disease patients compared to those in controls (p < 0.005). A correlation was found between basal thiobarbituric acid reactive substances, lag-time and erythrocyte sedimentation rate (R:0.51; p < 0.05. R:0.56; p < 0.05) and C reactive protein (R:0. 6; p < 0.005. R:0. 65; p < 0.005). CONCLUSIONS: An imbalance between pro- and antioxidant mechanisms, due to chronic gut inflammation, is present in complicated Crohn's disease, and an excess of lipid peroxidation is probably an important pathogenetic factor Conservative surgery can reduce the oxidative stress avoiding repeated or extended resections that could lead to intestinal malabsorption and short bowel syndrome.


Assuntos
Doença de Crohn/metabolismo , Doença de Crohn/cirurgia , Vitamina A/metabolismo , Vitamina E/metabolismo , Adulto , Antioxidantes/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Peroxidação de Lipídeos , Masculino , Estresse Oxidativo , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo , Fatores de Tempo
14.
Gut ; 50(4): 490-5, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11889068

RESUMO

BACKGROUND AND AIM: Despite the fact that bowel ultrasound (US) has recently been proved to be useful in the assessment of bowel diseases, uncertainty persists as to its diagnostic role in patients with complicated Crohn's disease (CD). Therefore, we have prospectively investigated the accuracy of US compared with x ray procedures and intraoperative findings in detecting small bowel strictures complicating CD as well as its reliability in assessing disease extent and location within the bowel. METHODS: A series of 296 consecutive patients with proven CD admitted to L Sacco University Hospital between 1997 and 1999, having undergone complete radiographic evaluation (including small bowel x ray, colonoscopy, or double contrast barium enema), were enrolled in the study. Bowel US was performed in each patient by two experienced operators unaware of the results of other diagnostic procedures. The accuracy of US in detecting strictures compared with x ray studies was determined separately in two different groups of patients: 211 patients treated conservatively (non-operative CD) and 85 patients who were candidates for surgery for CD complications or unresponsiveness to medical therapy (operative CD). RESULTS: Overall sensitivity and specificity of US in assessing the anatomical distribution of CD were 93% and 97%, respectively. The extent of ileal disease measured at US correlated well with that determined by x ray (r=0.52, p<0.001) in medically treated patients as well as with that measured intraoperatively in surgical patients (r=0.64, p<0.001). One or more stenoses were detected in 75 patients (35.5%) at small bowel enteroclysis in the non-operative CD group compared with 70 (82%) in the operative CD series. Sensitivity, specificity, and positive predictive values of bowel US in the detection of strictures were 79%, 98%, and 95% in non-operative CD patients and 90%, 100%, and 100% in operative CD cases, respectively. CONCLUSIONS: In experienced hands, bowel US is an accurate technique for assessing CD extent and location and is very helpful in detecting small bowel strictures, especially in very severe cases that are candidates for surgery. The use of bowel US is therefore justified as a primary investigation in CD patients in whom complications are suspected.


Assuntos
Doença de Crohn/diagnóstico por imagem , Adulto , Idoso , Sulfato de Bário , Meios de Contraste , Doença de Crohn/cirurgia , Enema/métodos , Feminino , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva , Sensibilidade e Especificidade , Ultrassonografia
15.
Gut ; 50(4): 496-500, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11889069

RESUMO

AIM: To evaluate the efficacy of power Doppler sonography (US) in depicting internal fistulae and their vascularity, and to study the characteristics of blood flow within the fistula wall. PATIENTS AND METHODS: The study involved 45 consecutive patients with Crohn's disease and suspected internal fistulae detected by grey scale US. The fistulae were subsequently evaluated using power Doppler US to reveal any areas of increased vascularity, and the results were compared with radiographic, endoscopic, or intraoperative findings. Whenever feasible, we also performed spectral analysis of blood flow revealed by power Doppler US, calculated its resistance index (RI), and analysed its characteristics, reproducibility, and relationship with biochemical and clinical variables (Crohn's disease activity index, disease duration, location, and abdominal complications). RESULTS: Power Doppler US revealed vascularity in all of the internal fistulae that where subsequently confirmed by diagnostic procedures. In the case of intra-abdominal abscesses in the vicinity of the fistula, vascular signals were detected mostly around and not within the lesions. The intensity and distribution of the signals differed within the fistulae tracks and had only slight day to day reproducibility; furthermore, there was no significant correlation with clinical or biochemical variables. Spectral analyses of blood flow within the fistulae revealed arterial flow in 96.7% of patients (median RI 0.715). RI was a more reproducible parameter and significantly correlated with clinical (r= 0.54) and biochemical activity (r= 0.56) of CD. It was also higher in fistulae complicated by abscesses. CONCLUSION: Power Doppler US can reveal the presence of vasculature within the wall of internal fistulae and therefore enhance grey scale US performance. The RI characteristics of blood flow within the fistulae are reproducible and correlate with biochemical and clinical disease activity.


Assuntos
Doença de Crohn/diagnóstico por imagem , Doenças do Íleo/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Adulto , Idoso , Doença de Crohn/patologia , Doença de Crohn/fisiopatologia , Feminino , Humanos , Doenças do Íleo/patologia , Doenças do Íleo/fisiopatologia , Íleo/irrigação sanguínea , Fístula Intestinal/patologia , Fístula Intestinal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Ultrassonografia Doppler em Cores/métodos , Resistência Vascular
16.
Environ Pollut ; 115(1): 43-8, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11586772

RESUMO

The Doñana National Park (Spain), one of the most important wildlife sites in the West of Europe, was affected (25 April 1998) by the spill of acidic waste rich in toxic metals (mainly zinc, lead, copper, etc.), arsenic and aromatic amines from the Aznalcollar mine accident. Micronuclei test with May Grunwald-Giemsa and with CREST-antikinetocore staining using DAPI as counter-staining were performed on peripheral blood erythrocytes from Algerian mice to evaluate genotoxic damage. Animals were collected in four locations each differently affected by the disaster. Higher frequencies of micronuclei and CREST-positive micronuclei were observed in the sites, which were reached by toxic sludge and contaminated water in comparison with those located within the park. The results obtained applying the two methods indicate that DAPI staining is more sensitive in detecting micronuclei. Genotoxic biomonitoring should be further carried out in the area to control the mutagenetic level in natural populations.


Assuntos
Dano ao DNA , Exposição Ambiental , Resíduos Industriais/efeitos adversos , Metais Pesados/efeitos adversos , Camundongos/genética , Animais , Animais Selvagens , Monitoramento Ambiental , Feminino , Concentração de Íons de Hidrogênio , Masculino , Testes para Micronúcleos
17.
Ann Surg ; 233(3): 345-52, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11224621

RESUMO

OBJECTIVE: To evaluate in patients with Crohn's disease, using transabdominal ultrasound, the morphologic characteristics of the diseased bowel wall before and after conservative surgery and to assess whether these characteristics and their behavior in the postoperative follow-up are useful and reliable prognostic factors of clinical and surgical recurrence. SUMMARY BACKGROUND DATA: Ultrasound is effective for evaluating the thickness of bowel wall, the most typical and constant finding of Crohn's disease. No data are currently available concerning the behavior of the diseased intestinal wall after conservative surgery and whether the preoperative characteristics of bowel wall or its behavior after conservative surgery may predict recurrence. METHODS: In 85 consecutive patients treated with strictureplasty and miniresections for Crohn's disease, clinical and ultrasonographic evaluations were performed before and 6 months after surgery. Assessed before surgery were the maximum bowel wall thickness, the length of bowel wall thickening, the bowel wall echo pattern (homogeneous, stratified, and mixed), and the postoperative bowel wall behavior, classified as normalized, improved, unchanged, or worsened. RESULTS: A significant correlation was found between a long preoperative bowel wall thickening and surgical recurrence. Bowel wall thickness after surgery was unchanged or worsened in 43.3% of patients; in these patients, there was a high frequency of previous surgery. Patients with unchanged or worsened bowel wall thickness had a higher risk of clinical and surgical recurrence compared with those with normalized or improved bowel wall thickness. CONCLUSION: With the use of abdominal ultrasound, the authors found that the thickening of diseased bowel wall may unexpectedly improve after conservative surgery, and this is associated with a favorable outcome in terms of clinical and surgical recurrence. In addition to its diagnostic usefulness, ultrasound also provides reliable prognostic information concerning clinical and surgical recurrence in patients with Crohn's disease in the postoperative follow-up.


Assuntos
Doença de Crohn/patologia , Doença de Crohn/cirurgia , Intestinos/patologia , Adulto , Doença de Crohn/diagnóstico por imagem , Feminino , Humanos , Intestinos/diagnóstico por imagem , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recidiva , Reoperação , Fatores de Risco , Análise de Sobrevida , Ultrassonografia
18.
Am J Surg ; 179(4): 266-70, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10875983

RESUMO

BACKGROUND: Conservative surgery has become accepted as a useful option for the surgical treatment of complicated Crohn's disease (CD). METHODS: One hundred thirty-eight consecutive patients treated with strictureplasty or miniresections for complicated CD have been observed prospectively. The possible influence of a number of variables on the risk of recurrence was investigated using the Cox proportional hazard model, and a time-to-event analysis was made using the Kaplan-Meier function. RESULTS: There was no perioperative mortality; the morbidity rate was 5.7%. A close correlation was found between the risk of recurrence and the time between diagnosis and first surgery. The overall 5-year recurrence rate was 24%, being 36% in the patients requiring surgery within 1 year of diagnosis and 14% in those operated on more than 1 year after diagnosis. CONCLUSIONS: Risk factor analysis highlighted a group of patients at high risk of surgical recurrence. Given that our results are similar to those reported in other series, we consider strictureplasty and miniresections safe and effective procedures for the treatment of complicated CD.


Assuntos
Colectomia/métodos , Doença de Crohn/cirurgia , Íleo/cirurgia , Adulto , Colectomia/estatística & dados numéricos , Doença de Crohn/complicações , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo
19.
Dig Surg ; 17(3): 261-7, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10867460

RESUMO

BACKGROUND/AIMS: Strictureplasty (SP) or miniresective 'bowel-sparing' techniques (MR) can prevent the risk of intestinal stomia and short bowel syndrome in patients affected by Crohn's disease (CD). The aim of this study was to analyze the perioperative morbidity and mortality in 104 of 138 consecutive patients treated for CD complications using bowel-sparing techniques. We also considered the factors that may be related to the risk of perioperative complications and the long-term outcome. METHODS: One hundred and four patients were treated with SP and/or MR and then included in a prospectively maintained database. The factors claimed to influence perioperative complications were analyzed using Fisher's exact test for categorical observations and the Mann-Whitney U test for continuous variables. A multivariate analysis, using logistic regression, and a long-term time-to-event analysis using the Kaplan-Meier function, were also performed. RESULTS: Perioperative mortality was nil. In relation to the 6 postoperative complications (5.8%), 4 patients underwent minimal bowel resection (MR), 1 a MR with SP, and 1 SP alone. Three of these patients (2.9%) needed reoperation for septic complications, and 3 (2.9%) were treated as outpatients for enterocutaneous fistulas. A correlation (p < 0.05) was found between low serum hemoglobin levels and postoperative complications at univariate and multivariate analyses. The 5-year surgical recurrence-free rate was 75% overall, 73% for patients treated with SP, 78% with MR, and 77% with MR + SP. CONCLUSIONS: Postoperative complications are not related to conservative or miniresective surgery even when active disease is present at the resection margins or the site of SP. The higher risk reported for patients with low serum hemoglobin and hematocrit levels suggests that surgeons should consider using preoperative iron and vitamin support, parenteral nutrition and erythropoietin therapy, when necessary, in those cases. Our postoperative morbidity, mortality and long-term surgical recurrence rate results support the efficacy and safety of SP and MR surgery in the treatment of complicated CD.


Assuntos
Doença de Crohn/complicações , Doença de Crohn/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Adulto , Feminino , Hematócrito , Hemoglobinas/análise , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
Chir Ital ; 51(1): 87-90, 1999.
Artigo em Italiano | MEDLINE | ID: mdl-10514922

RESUMO

Although laparoscopy and endoscopy have reduced the need for laparotomies in biliary tract surgery, open surgery is sometimes still needed. One case in particular is when previous operations have significantly distorted normal upper abdomen anatomy. We chose an inframesocolic entrance to the posterior peritoneum in two patients with bile duct stones, juxtapapillary duodenal diverticulum and a history of cholecystectomy and partial gastric resectioning. The duodenum was reached at the junction between the second and third section by entering the posterior peritoneum through the inferior sheet of the mesocolon, a relatively avascular area. The diverticulum was incised, the sphincter and papilla operation was performed and the bile duct stones removed. The diverticulum was then resected. Our conclusion is that in certain cases, an inframesocolic entrance can significantly reduce technical difficulties involved in re-operating through dense adhesions, minimize surgical time and blood loss and, when operating through the open diverticulum, spare an unnecessary duodenotomy.


Assuntos
Divertículo/cirurgia , Duodenopatias/cirurgia , Cálculos Biliares/cirurgia , Esfincterotomia Transduodenal , Colecistectomia , Divertículo/complicações , Duodenopatias/complicações , Cálculos Biliares/complicações , Gastrectomia , Humanos , Reoperação
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