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Biomedical subjects

A Galassi

Publications and source records attributed to A Galassi.

At least 19 recordsLinked to original sources
PubMed2005

Facial changes in adult uremic patients on chronic dialysis: possible role of hyperparathyroidism.

BACKGROUND: Uremic patients on regular dialytic treatment (RDT) are often affected by a complex metabolic syndrome leading to osteodystrophy. Bone changes are primarily due to high bone turnover, often combined with a mineralization defect leading to increased bone fractures and bone deformities. Although rarely considered, the craniofacial skeleton represents one of the peculiar targets of this complex metabolic disease whose more dramatic pattern is a form of leontiasis ossea. This complication, although described, has never been evaluated in depth nor quantitatively assessed. In order to assess facial deformities in uremic conditions and to understand the possible relation with hyperparathyroidism, we undertook a quantitative evaluation of soft facial structures in a cohort of uremic patients undergoing RDT. METHODS: The three-dimensional coordinates of 50 soft-tissue facial landmarks were obtained by an electromagnetic digitizer in 10 male and 10 female patients with chronic renal insufficiency aged 53-81 years, and in 34 healthy individuals of the same age, ethnicity and sex. Uremic patients were enrolled according to hyperparathyroid status (PTH < 300 pg/mL and PTH > 500 pg/mL). From the landmarks, facial distances, angles and volumes were calculated according to a geometrical face model. RESULTS: Overall, the uremic patients had significantly larger facial volumes than the reference subjects. The effect was particularly evident in the facial middle third (maxilla), leading to an inversion of the mandibular-maxillary ratio. Facial dimensions were increased in all three spatial directions: width (skull base, mandible, nose), length (nose, mandible), and depth (mid face, mandible). The larger maxilla was accompanied by a tendency to more prominent lips (reduced interlabial angle). Some of the facial modifications (nose, lips, mandible) were significantly related to the clinical characteristics of the patients (age, duration of renal insufficiency and PTH levels). CONCLUSIONS: This report, the first in the literature, shows that facial structures of uremic patients are enlarged in comparison with matched normal subjects and that increased bone turnover could be responsible--at least in part--for facial bone changes.

Aged↗
PubMed1999

[Heart rupture in acute myocardial infarct: the advantages of using M-2D color Doppler echocardiography in a coronary intensive therapy unit].

BACKGROUND: Free-wall rupture of the heart is the second most common cause of death in acute myocardial infarction (AMI), following pump failure. Acute rupture is more common and rapidly fatal, while subacute rupture, which accounts for about 30% of total cases of mortality in AMI, can be diagnosed early by clinical signs with the support of echocardiography in coronary intensive care units. METHODS: From March 1996 to December 1997, 293 patients diagnosed with acute myocardial infarction were admitted to the coronary intensive care unit of our hospital. Of these patients, 71 (23.8%) were treated with thrombolysis within 6 hours of onset of symptoms. All patients were observed daily with M-2D color Doppler echocardiography and in the event of renewed chest pain, electrocardiogram changes, abrupt hypotension, syncope or clinical signs of low output syndrome. RESULTS: We observed 11 cases (3.8%) of free-wall rupture of the heart in acute myocardial infarction with echocardiography, 6 females and 5 males, with a mean age of 74.2 +/- 7.8 years (min. 56-max 84), none of whom had prior AMI. Six of them received thrombolytic therapy, six were hypertensive (54.5%) and three were diabetics (27.2%). Surgical repair was performed in two patients with subacute rupture, but one died a few days later. The echocardiography data at bedside for diagnosis of cardiac rupture were confirmed in 5 patients with autopsy and intraoperatively in two of them. CONCLUSIONS: Routine use of echocardiography in coronary intensive care units allows prompt diagnosis of cardiac rupture in acute myocardial infarction, and in the event of subacute rupture it can accelerate surgical decision-making.

Aged↗
PubMed1998

Atrial fibrillation in elite athletes.

INTRODUCTION: Atrial fibrillation (AF) is a rare event in people younger than 25 years of age, but is probably more frequent in competitive athletes. We analyzed the presence of AF, paroxysmal or chronic, in a population of young elite athletes, including previous Olympic and World champions, who were studied for arrhythmias that endangered their athletic careers. METHODS AND RESULTS: From 1974 to June 1977, 1,772 athletes identified with arrhythmias (1,464 males and 308 females; mean age 21 years) underwent individualized work-ups. Among these, 146 (122 males and 24 females; mean age 24 years) were young elite athletes. They were studied from 1985 to 1997, with a mean follow-up of 62 months. Of the 146 young elite athletes, 13 (9%) had AF (paroxysmal in 11 and chronic in 2); all were male. The paroxysmal AF occurred during effort (n = 7), after effort (n = 1), or at rest (n = 3) and was reinduced by transesophageal pacing or endocavitary electrophysiologic testing under the same clinical circumstances. AF was the cause of symptoms in 13 (40%) of 22 young elite athletes with long-lasting palpitations. Five young elite athletes had a substrate for AF: Wolff-Parkinson-White syndrome (WPW) in 3, arrhythmogenic right ventricular dysplasia (ARVD) in 1, healed myocarditis in 1, and was considered idiopathic in 8. All elite athletes are alive with a mean follow-up of 62 months and 7 continue in their sports: 3 after radiofrequency catheter ablation (of WPW in 2 and AF with maze-type nonfluoroscopic approach in 1) and 4 after a period of de-training. CONCLUSIONS: AF, occurring in young elite athletes and affecting only males, is one of the most frequent causes of prolonged palpitations and is reproduced easily by transesophageal atrial pacing or electrophysiologic testing. AF may be a cause of disqualification from sports eligibility, but may disappear if the athletic activity is stopped for an adequate period of time, if trigger mechanisms are corrected (i.e., WPW), or if the substrate is modified.

Adult↗
PubMed1997

The "proximal isovelocity surface area" method in assessing mitral valve area in patients with mitral stenosis and associated aortic regurgitation.

BACKGROUND: This study compares the mitral valve area determined by Doppler color mapping of the proximal isovelocity surface area (PISA) and by Doppler pressure half-time with that obtained by two-dimensional planimetry in patients affected by mitral stenosis, with and without associated aortic regurgitation. Pressure half-time frequently overestimates the mitral valve area in patients with mitral stenosis and associated aortic regurgitation. PISA is an alternative method for determining mitral valve area in mitral stenosis and is not influenced by regurgitant lesions. METHODS: We studied 76 patients with mitral stenosis; aortic regurgitation > or = 2 was present in 24 patients. The PISA was recorded from the apex and the transmitral maximal flow rate, Q (ml/s), was calculated using the hemispheric equation Q = 2 pi R2 x AV x alpha/180, where R (cm) is the maximal radius of the PISA, AV (cm/s) is the aliasing velocity and alpha/180 is a correction factor accounting for the alpha inflow angle formed by the mitral leaflets. Mitral valve area, A (cm2), was calculated by continuity equation A = Q/V, where V (cm/s) is the peak transmitral flow velocity measured by continuous wave Doppler. RESULTS: The mitral valve area by two-dimensional planimetry (range 0.5-2.4 cm2; mean 1.33 +/- 0.41 cm2) was consistent with both PISA (r = 0.83; SEE 0.23 cm2) and pressure half-time (r = 0.79; SEE 0.25 cm2) methods. Similar agreement was found for the 36 patients with mitral regurgitation and for the 30 patients in atrial fibrillation. However, in patients with aortic regurgitation > or = 2, pressure half-time overestimated two-dimensional and PISA determined mitral valve areas by 0.24 +/- 0.25 cm2 (p < 0.01). CONCLUSIONS: In patients with mitral stenosis and significant aortic regurgitation, the PISA method is more accurate than pressure half-time in assessing mitral valve area. This method may be a reliable alternative when pressure half-time is affected by aortic regurgitation and two-dimensional planimetry images are unsuitable for anatomic evaluation.

Adolescent↗
PubMed1996

The efficacy of drugs in the management of endometriosis.

STUDY OBJECTIVE: To establish the crude effects of danazol and gonadotropin-releasing hormone (GnRH) analogs in the management of endometriosis. DESIGN: Prospective case-control study. SETTING: Unit of the Pathophysiology of Reproduction outpatient department. PATIENTS: Two groups of 110 women each with endometriosis (American Fertility Society score 1-3) who received danazol and GnRH analogs, and a control group who did not receive any drugs. INTERVENTIONS: Women in the treatment groups received danazol 200 mg every 8 hours for 6 months, or a different GnRH agonist at standard dosages for 6 months. Laparoscopy was performed twice, at the time of diagnosis and just before the end of treatment (or no therapy for controls). Surgical treatment of the implants was performed at the second laparoscopy. MEASUREMENTS AND MAIN RESULTS: Samples of both eutopic and ectopic endometrium were collected during both laparoscopies. Both danazol and GnRH agonists were useful in reducing the AFS scores to inactive endometriotic implants, and there were no significant differences between the effects (p <0.001). Fibrosis was found after 6 months of observation in the implants in one control woman (0.9%), in 20 patients (18.2%) treated with danazol (p <0.001 vs controls), and in 4 patients (3.6%) treated with GnRH agonists (NS vs controls). A correlation between a clinical diagnosis of AFS score zero and histologic features of fibrosis in the ectopic specimens after therapies was observed in 28% of women, with poor agreement (k = 0.07). CONCLUSIONS: Fibrosis, which represent the absence of endometrial cells within the specimens of endometriotic lesions or eutopic endometrium, did not appear in eutopic endometria but it was found in some endometriotic implants. Danazol and GnRH agonists reduced the clinical AFS scores of endometriosis, but their histologic effects in completely and permanently eliminating endometriotic implants were unacceptable.

Adolescent↗
PubMed1996

Transforming growth factor-beta 1 in the human endometrium.

Transforming growth factor-beta 1 (TGF-beta 1) is a polypeptide involved in a variety of important physiological and pathophysiological processes such as the implantation of the embryo into the endometrium. Many factors seem to be related to this event. TGF-beta 1 is involved in many mechanisms both in endometrial and in embryonic tissues: it induces proliferation and differentiation, it regulates proteolytic activity and it modulates the maternal immune response. This study evaluated the presence of TGF-beta 1 in the endometrium during normal menstrual cycles and in the uterine fluids during induction of ovulation in the framework of an in vitro fertilization program. Immunohistochemistry was used to identify TGF-beta 1 in the endometrium and immunodot-blot to quantitate TGF-beta 1 in the uterine cavity fluid. The study shows that TGF-beta 1 is present in the endometrial tissue and its secretion is modulated during the menstrual cycle, as demonstrated immunohistochemically; its production seems to be controlled by ovarian steroids. In conclusion, TGF-beta 1 influences the growth and differentiation of the embryo, as well as the activation of embryonic proteolytic enzymes, and it modulates the maternal-embryonic immune response. Its variability in the uterine cavity is demonstrated in this study, and the underexpression of TGF-beta 1 in the uterine cavity might be responsible for failed implantation.

Cytoplasm↗
PubMed1995

Comparison of rest-redistribution thallium-201 imaging and reinjection after stress-redistribution for the assessment of myocardial viability in patients with left ventricular dysfunction secondary to coronary artery disease.

Thallium (Tl)-201 reinjection after stress-redistribution (RI) imaging has been proven to accurately identify ischemic and viable myocardium. Quantitative Tl-201 analysis after stress has also shown viable myocardium in most mild to moderate (51% to 85% of normal uptake) irreversible Tl-201 defects. However, if the main clinical question is whether a region is viable, and not whether there is inducible ischemia, a resting protocol may be more appropriate. The aim of this study was to determine whether rest-redistribution (RD) quantitative Tl-201 single-photon emission tomographic imaging provides the same information on viable myocardium as Tl-201 RI. Thus, 15 patients (mean age 58 +/- 9 years) with chronic coronary artery disease and left ventricular dysfunction (ejection fraction 35 +/- 8%) were studied by both RI and RD Tl-201 single-photon emission tomography. Regional Tl-201 uptake was assessed quantitatively using a 16-segment model. When Tl-201 images were classified as normal/reversible (viable) or irreversible (nonviable), RI showed viable myocardium in 145 of 240 myocardial regions (60%), whereas RD showed it in 103 of 240 myocardial regions (43%). The 2 imaging protocols provided concordant information in 176 of 240 myocardial regions (73%). Among the 64 (27%) discordant regions, 53 (22%) were viable by RI and nonviable by RD, whereas 11 (5%) were viable by RD and nonviable by RI (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Benign myxoid hepatocellular tumor: a variant of liver cell adenoma.

A case of myxoid hepatocellular adenoma in the non-cirrhotic liver of a 26-year-old man is described. Grossly, the tumor was well circumscribed, rounded and measured 16 cm in diameter. Histologically, the tumor was characterized by nests and strands of polygonal cells embedded in a myxoid extracellular matrix. Electron microscopy confirmed the hepatocellular nature of the neoplastic cells. The patient is alive and well, without evidence of disease, 2 years after a local excision.

Adenoma, Liver Cell↗
PubMed1995

Predictive and prognostic markers in a series of patients with head and neck squamous cell invasive carcinoma treated with concurrent chemoradiation therapy.

It has been proposed that diverse anticancer drugs and radiation therapy may induce a mode of cell death with the characteristics of apoptosis. Since apoptosis is under the control of several oncogenes, we analyzed the expression of the protein encoded by the proto-oncogenes bcl-2 and p53. Furthermore, we studied cell proliferation [using PC-10 mAb to proliferating cell nuclear antigen (PCNA)] and vascularization [using the CD-31 mAb and by counting intratumoral microvessel density (IMD)] using immunocytochemistry. A series of 73 patients with clinical stage II-IV squamous cell invasive carcinoma of the head and neck (H&N) were treated with concurrent chemoradiation therapy (cisplatin, 80 mg/m2, versus carboplatin, 375 mg/m2, three times every 3 weeks and a total dose of radiation therapy of 64 Gy in 6-8 weeks). We correlated the expression of these markers, determined prior to treatment, with response to the therapy and prognosis. Bcl-2 protein was expressed in 37.4% of the carcinomas (25/67 evaluable), and it was not significantly associated with any other feature studied. Forty (56. 4%) of the 71 carcinomas evaluable for p53 were p53 positive; the median IMD was 38 microvessels/field at the hot spot (range, 18-80), and the median percentage of nuclei labeled by the PC-10 mAb was 50% (range, 0-95%). In the univariate analysis, regional lymph node negativity (P = 0.016), good performance status (PS) (PS >/= 90; P = 0.044), bcl-2 positivity (P = 0.070), and low vascularization (P = 0. 085) were significantly associated with a higher probability of complete remission. In the multivariate analysis (final model), only IMD (continuous variable; P = 0.045) and PS (P = 0.017) retained significance. As far as prognosis is concerned, in the univariate analysis, patients with tumors with low histological grading (grades 1-2; P = 0.006), p53 negative (P = 0.09), bcl-2 positive (P = 0.08), and high PCNA labeling (P = 0.06) had a significantly better disease-free survival. In the multivariate analysis, only grading (P = 0.003) and p53 (P = 0.04) retained significance for disease-free survival. For overall survival, in the univariate analysis, the following markers were significantly prognostic when only deaths due to progression are considered: response to therapy (P = 0.00001), PS (P = 0.04), nodal status (P = 0.028), PCNA (P = 0.04), p53 (P = 0. 08), and grading (P = 0.01). In the multivariate analysis, only patients who achieved complete response (P = 0.00002), high PCNA values (P = 0.002), and low histological grading (P = 0.01) retained a statistically significant probability of better overall survival. Our results suggest that in this series of H&N cancer patients the markers capable of predicting response to therapy are distinct from those associated with prognosis, once the remission has been achieved. This information is potentially useful to the clinician for developing a more rational therapeutic approach for H&N cancer patients eligible for concurrent chemoradiation therapy.

Adult↗
PubMed1994

[Pulmonary hamartoma: a case report].

The authors describe a case of lung hamartoma recently observed. Diagnosis occurred by chance through routine chest X-rays. A stationary radiological aspect of the hamartoma, regularly followed up, suggested to defer surgery up to the moment of a visible radiologic enlargement of the lesion.

Hamartoma↗
PubMed1994

Dating the endometrial biopsy by flow cytometry.

OBJECTIVE: To determine endometrial changes throughout the menstrual cycle. DESIGN: Flow cytometric analysis of endometrial cells versus chronological dating. SETTING: Women volunteers with a normal menstrual cycle participated in this study that was done in an academic research environment. PATIENTS: Two hundred thirty regular menstruating women with adequate luteal phase underwent endometrial biopsy at different days of their menstrual cycle; 138 biopsies were analyzed both histologically and by flow cytometry. MAIN OUTCOME MEASURE: Percentage of biopsies correctly classified in terms of chronological dating. RESULTS: Flow cytometry correctly classified the chronological day of biopsies in 59% of cases, the proliferative versus secretory days in 91% of cases, and the early, mid, and late secretory phases of the menstrual cycle were correctly predicted in 86% of cases. CONCLUSION: Flow cytometry is a good method to determine growth and differentiation of the endometrium during the menstrual cycle. Detection of phases of the whole endometrial cell population offer information on the biological adequacy of endometrial response to the biochemical environment.

Biopsy↗
PubMed1993

Variability of coronary blood flow reserve assessed by Doppler catheter after successful thrombolysis in patients with acute myocardial infarction.

To establish whether abnormal function of small coronary vessels might limit the advantages of thrombolytic treatment, coronary flow reserve in the infarct-related artery was measured in nine patients with acute myocardial infarction early after successful coronary thrombolysis by using a Doppler catheter and intracoronary adenosine infusion. In each patient coronary flow reserve was calculated as the ratio between coronary blood flow velocity during the highest tolerated intracoronary dose of adenosine (0.5 mg/min in five patients and 1 mg/min in four patients) and baseline velocity. Coronary flow reserve ranged from 1 to 3 (mean 2 +/- 0.7). No correlation (r = 0.20; p = 0.58) was found between coronary flow reserve and the severity of residual coronary stenosis, which ranged between 23% and 76% (mean 47% +/- 17%). No correlation (r = 0.33; p = 0.39) was found between either coronary flow reserve and the interval between pain onset and administration of the thrombolytic treatment, which ranged between 2.2 and 6 hours (mean 4.2 +/- 1.4 hours). Thus, in patients with acute myocardial infarction, coronary flow reserve early after successful thrombolysis is strikingly variable and may be extremely low despite widely patent epicardial coronary arteries. This restriction of coronary blood flow, probably caused by abnormal function of small coronary vessels, might limit the potential benefit from successful coronary thrombolysis.

Adenosine↗
PubMed1993

A cancer day hospital: an alternative approach to caring for patients in clinical trials.

The National Institutes of Health recently established a large cancer day hospital (CDH) to address the need to support new research initiatives in the face of a shrinking research budget. By design, the CDH is very much a nursing unit. It employs a collaborative practice model of patient care delivery that emphasizes the nurses' independent clinical- and protocol-related responsibilities and roles. The CDH is designed to be budget neutral. An increased outpatient throughput and a decrease in inpatient days for at least one large protocol population (patients receiving therapy for prostate cancer) have been demonstrated. With a steadily increasing number of patients, the CDH appears to be a well-accepted and cost-effective site for the care of patients enrolled in oncology clinical trials.

Aftercare↗
PubMed1992

The next generation: new chemotherapy agents for the 1990s.

The progress in cancer chemotherapy since the 1940s has been tremendous with over 40 cytotoxic agents, excluding hormones, that have undergone clinical trials and been approved by the Food and Drug Administration (FDA). Preclinical drug development and clinical trials have made this progress possible. Several new agents that are either undergoing clinical trials or have recently been approved by the FDA include idarubicin, ICRF-187, piroxantrone, all-trans-retinoic acid, fludarabine phosphate, taxol, and suramin.

Antineoplastic Agents↗
PubMed1992

[Validity of the proximal isovelocity surface area color Doppler method for calculating the valve area in patients with mitral stenosis; comparison with the two-dimensional echocardiographic method].

BACKGROUND: The proximal isovelocity surface area (PISA) method, assessed by color Doppler echocardiography, has gained acceptance as a means of calculating flow rate through regurgitant orifice. The method can also be used to derive mitral valve area (MVA), by continuity equation, in patients with mitral stenosis (MS). The aim of this study was to compare the PISA method with the two-dimensional echocardiographic planimetry (2D) method and pressure half-time method (PHT) in MVA calculations in a group of 37 patients with MS. METHODS AND RESULTS: All of these patients had satisfactory MVA by 2D method. There were 22 female and 15 male; age 56 +/- 11 years (range 32-71); 19 were in sinus rhythm (SR) and 18 in atrial fibrillation (AF); 17 patients had pure MS, while the remaining 20 had associated mitral regurgitation (MR); in 23 patients the orifice morphology was circular or elliptic, and was defined as regular; while in 14 patients the morphology was irregular for the presence of two or more nodular calcifications on the commissures or leaflet's edges. MVA by PISA method was calculated assuming a uniform radial flow convergence region along a hemispherical surface, according to the formula: MVA = 2 pi r2 Vn(1-cos theta)/Vmax; where r was the PISA radius measured in 2D from the first alias to the mitral leaflet's edge; Vn was the flow velocity at radial distance from the mitral orifice; Vmax was the peak transmitral velocity by CW Doppler; 1-cos theta was a factor that accounted for the inflow angle formed by the mitral leaflets. The Nyquist limit was lowered to 29 cm/sec. Alpha angle formed by the mitral leaflets ranged between 86 degrees and 134 degrees; average 110 degrees +/- 10 degrees. 2D MVA was 1.33 +/- 0.37 cm2; range 0.69-2.2 cm2; PHT MVA was 1.29 +/- 0.34 cm2; range 0.70-2.1 cm2; PISA MVA was 1.18 +/- 0.36 cm2; range 0.47-1.95 cm2. The PISA method underestimates MVA by 0.15 +/- 0.21 cm2, in comparison with the 2D method; and by 0.11 +/- 0.18 cm2 in comparison with PHT method (p ns). The correlation between 2D and PISA MVA was: r = 0.84; p < 0.001; y = 0.83x + 0.06; 95% confidence intervals +/- 0.40 cm2; and between PHT and PISA MVA was: r = 0.79; y = 0.84x + 0.09; p < 0.001; 95% confidence intervals +/- 0.46 cm2. The correlation coefficient was similarly good in patients with SR or AF, and did not significantly change in patients with pure MS or MS+MR; neither did it vary with respect to the orifice morphology (p < 0.001 for all the variables considered), except for the correlation PHT-PISA in the group of patients with irregular orifice morphology (r = 0.70; p = 0.005). The interobserver and intraobserver variability were, respectively: 2.2% and 4.4% for 2D MVA; 3.4% and 3.8% for PHT MVA; 5.2% and 3.5% for the PISA radius; 6.1% and 4.4% for the alpha angle; 10.2% and 7.2% for PISA MVA (F ratio of variances ns). CONCLUSIONS: In conclusion, the PISA method allows accurate assessment of MVA in patients with MS, regardless of cardiac rhythm or additional MR. Moreover, our study suggests that orifice morphology does not affect the accuracy of this method.

Adult↗
PubMed1992

[Iontophoresis of tenoxicam in the therapy of osteoarthrosis].

After a brief physiopathological research about iontophoresis applications, the authors examine this treatment by two drugs (Tenoxicam and acetylsalicylic acid) in a group of patients suffering from painful osteoarthritis. They came to the conclusion that the treatment is efficacious with both substances though realising a quicker analgesic result in the group treated with tenoxicam.

Aged↗
PubMed1991

Factors regulating interaction between trophoblast and human endometrium.

Implantation is a crucial step in human reproduction. Disturbances of this process are responsible for pregnancy failure after both in vivo and in vitro fertilization. The endometrium provides the implanting embryo with a unique substratum where the embryo communicates with biochemical signals, attaches itself, penetrates and grows without blood circulation. The highly proliferative phase of the cytotrophoblast, during early human embryogenesis, may be due to endogenous production of growth factors that may establish autocrine/short range paracrine stimulator loops which explain the tumor-like properties of these tissues. Endometrial BM penetration and stroma invasion may be due to the proteolytic capability of the human embryo. It is suggested that collagenase and the urokinase-like plasminogen activator are responsible for this activity. To clarify the molecular mechanisms involved in human embryo implantation several models are suggested: culture of blastocysts, culture of endometrial cells, and endometrial explant co-culture. Human blastocysts cultured with whole perfused human uteri make it possible to recognize some aspects of the entire implantation process and give us the possibility of improving the benefits provided by new technologies in reproductive medicine and reducing embryonic loss at an early stage.

Endometrium↗