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Biomedical subjects

A Losito

Publications and source records attributed to A Losito.

At least 19 recordsLinked to original sources
PubMed2000

ACE gene polymorphism and survival in atherosclerotic renovascular disease.

Renovascular disease (RVD) is an important cause of end-stage renal disease and is associated with a high mortality rate, mostly because of coexisting cardiovascular and cerebrovascular disease. The deletion (DD) polymorphism of the angiotensin-converting enzyme (ACE) gene has been described in association with severe vascular disease affecting major organs. To investigate whether DD genotype is a risk factor for mortality in RVD, we performed a follow-up study of 61 patients with this disease. Patients (age, 68.0 +/- 6.5 years) affected by atherosclerotic vascular disease were enrolled after angiographic demonstration of a renal artery stenosis. The average follow-up was 48.1 +/- 14.9 months. Genotype was insertion/deletion (I/D) in 30 patients, DD in 27 patients, and II in 4 patients. At enrollment, a complete assessment of heart, blood vessels, and renal function was performed. During the follow-up period, 13 patients died (9 DD, 4 ID) and 7 patients evolved into end-stage renal failure. The cumulative survival rate at 5 years was 45.4% +/- 13.4%. Factors associated with mortality were analyzed with Cox proportional hazard regression. The multivariate analysis showed that DD genotype, severe carotid disease, and smoking were independent predictors of mortality. The multivariate analysis of predictors of renal failure showed that the only significant association was found with baseline serum creatinine level of 265 micromol/L or greater. We conclude that the DD genotype of the ACE gene is a marker for mortality in RVD.

Aged↗
PubMed2000

Angiotensin-converting enzyme gene I/D polymorphism and carotid artery disease in renovascular hypertension.

There is evidence linking the activation of the renin-angiotensin system (RAS) with target organ damage in renovascular hypertension (RVH). A genetic association of the DD genotype of the angiotensin-converting enzyme (ACE) gene with cardiovascular complications has been found in various clinical conditions. The aim of our study was to determine whether the insertion/deletion (I/D) polymorphism of the ACE gene is associated with the high prevalence of target organ damage reported in RVH. A total of 65 atherosclerotic patients (age 68.2 +/- 5.2 years) with RVH and 49 atherosclerotic patients (age 68.0 +/- 6.3 years) with essential hypertension (EH) were sequentially enrolled when attending the outpatient clinic for specialist assessment of their vascular disorder. Cardiac, renal, and vascular involvement were assessed in both groups and blood was taken for genetic analysis. Patients with RVH had a higher prevalence of left ventricular hypertrophy (LVH), carotid artery disease, and albuminuria than those with EH. In RVH, but not in EH, the DD genotype was significantly associated with severe arterial disease. In RVH, carotid disease (lumen narrowing >60%) was present in 62% of DD patients versus 25% of the other genotypes (OR = 4.90, 95% CI: 1.70-14.13). Such an association was also present in peripheral vascular disease: 72.4% in DD patients versus 41.6% in the other genotypes (OR = 3.67, 95% CI = 1.29-10.36). Logistic regression analysis showed that the DD genotype was the strongest predictor of risk of severe carotid disease. We conclude that, in atherosclerotic RVH, there is an association of the severity of vascular disease with the DD genotype of the ACE gene.

Adult↗
PubMed1999

Survival of patients with renovascular disease and ACE inhibition.

AIM: Renovascular hypertension (RVH) is associated with a high prevalence of target organ damage and a high mortality. We have undertaken this follow-up study to assess the role played by comorbid conditions, and pharmacological treatment on survival, and on renal function in 64 patients with diffuse atherosclerotic vascular and renovascular disease (RVD). PATIENTS AND METHODS: The patients were followed for an average period of 37.3+/-20.4 months. RESULTS: At the end of the follow-up we found a cumulative survival at 5 years of 60%+/-10. Cerebrovascular and cardiovascular disease were responsible for 92% of deaths. A decrease in creatinine clearance >10 ml/min at 5 years was found in 65% of patients, 3 of whom ended in dialysis. Multivariate analysis of predictors of survival showed that treatment with angiotensin converting enzyme inhibitors (ACEi) was significantly associated with a favourable outcome (p = 0.019). Conversely, proteinuria had a negative effect. Renal survival was best predicted by the level of renal function at entry (p = 0.02), and was not influenced by pharmacological treatment. CONCLUSION: We conclude that ACEi exerts a beneficial effect on survival without affecting renal function in patients with RVD due to unilateral renal stenosis.

Aged↗
PubMed1996

Comparison of target organ damage in renovascular and essential hypertension.

In many reports, the prevalence of target organ damage in renovascular hypertension (RVH) appears to be higher than in essential hypertension (EH). Since in most studies the renal artery stenosis is part of a diffuse atherosclerotic disease, it is not known whether these complications are due to RVH itself or to the vascular disease. We have undertaken a case control study of 92 patients divided into two groups (46 in each), one with RVH and the other with EH and abdominal aortic aneurysm, with a comparable degree of diffuse atherosclerotic vascular disease. The vascular state of the extracranial carotid arteries and abdominal and inferior limb districts was investigated with angiography and sonography. The prevalence of left ventricular hypertrophy (LVH) and ischemic heart disease (IHD) were assessed by electrocardiography. Serum creatinine and urinary protein excretion were employed in the renal evaluation. While the analysis of the results confirmed an even diffusion of atherosclerotic vascular disease between the two groups, a significant difference was found in the prevalence of heart and renal damage. LVH was present in 32.6% of RVH patients versus 10.8% in EH (P = .02). Serum creatinine > 1.4 mg/dL was found in 50% of RVH and in 23.9% of EH, (P = .01). The prevalence of proteinuria in RVH was also higher although not reaching the statistical significance. The results suggest that, in patients with comparable degrees of atherosclerotic vascular disease, RVH is responsible for the higher prevalence of target organ damage in this condition compared to those with EH.

Aged↗
PubMed1993

[Gastric localization of sarcoidosis].

Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by an immunological disorder with accumulation of activated lymphocytes and macrophages in all the organs and apparatus. The intrathoracic lymphnodes and the lung remain the most common sites of such disease. The gastrointestinal sarcoidosis, particularly of the stomach, is very rare. The stomach may be the primitive or the secondary (systemic sarcoidosis) site of sarcoid granuloma. The endoscopic aspects of the gastric mucosa are variable: localized or diffused hyperemia, single or multiple ulcers, aspects of atrophic gastritis with easy bleeding during contact, rigid mucosa and so on. Generally asymptomatic, the disease may show symptoms as pain in the epigastrium, nausea, vomiting, haematemesis and so on. The wide range of gastric pathologies resembling sarcoidosis both on a histological level and on a clinic-endoscopical one (syphilis, histoplasmosis, Crohn's disease, stomach cancer) require an extremely accurate diagnosis above all for the setting out of the therapy with steroids which are the most appropriate drugs (prednisone). Three out of thirty-two patients observed for respiratory problems, already affected by cutaneous and pulmonary sarcoidosis, started suffering from gastric symptoms of different kind: pain in the epigastrium, haematemesis, weight loss, nausea and post-prandial vomiting. Gastroscopy and biopsy, with histopathologic examination of gastric mucosal specimens taken from the most suspicious sites, confirmed the diagnosis of sarcoidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Derotation osteotomy in the treatment of congenital dislocation of the hip: a review of long-term results.

The authors clinically and radiographically evaluate the long-term results of 257 femoral derotation osteotomies performed between 1959 and 1970 for congenital dysplasia and dislocation of the hip. Tracing the patients was very difficult because of the prolonged follow-up, yet a group of 36 patients was finally gathered. These patients were then uniformly studied and classified through precise quantification, with a numeric reference value, of clinical deficits and radiographic changes. The evaluation of the results confirmed that the effectiveness of femoral derotation osteotomy depends upon its timeliness, correct execution, and potential association with corrective surgery of the acetabular dome. Finally, both preexistent joint damage and the presence of genetic factors in the disease, which often causes relapse in spite of a technically perfect operation, are very important in determining the final result.

Adolescent↗
PubMed1989

The kidney in essential hypertension.

With the effectiveness of today's antihypertensive agents, it is possible to reduce blood pressure without harming the kidney, and also to improve renal function, thus delaying the otherwise unavoidable decline that follows organ damage induced by hypertension.

Antihypertensive Agents↗
PubMed1988

Impaired renal functional reserve and albuminuria in essential hypertension.

The stimulatory effects of an infusion of amino acids on glomerular filtration rate has previously been used to measure renal functional reserve and detect glomerular hyperfiltration. Thirty four patients with mild to moderate essential hypertension and seemingly normal renal function and 22 healthy controls were given infusions of amino acids to investigate whether renal functional reserve is reduced in essential hypertension and to detect patients at risk of renal damage. Although basal creatinine clearance increased after the infusion of amino acids in the controls (mean 27.9 ml/min; 95% confidence interval 18.2 to 37.6), the overall change was lower in the patients (mean 13.4 ml/min; 8.3 to 18.5), 11 of the 34 showing no increase at all. In these 11 non-responders the mean systolic blood pressure was higher than that in the 23 others (178.5 mmHg v 157 mmHg, respectively). Mean urinary albumin excretion was abnormal in the patients (93.3 mg/24 h; 44.2 to 142.4); eight of the 11 non-responders had an albumin excretion above the normal range (greater than 20 mg/24 h). In the 11 patients without renal functional reserve a positive correlation was found between basal creatinine clearance and albumin excretion (r = 0.695). As consumed renal reserve and albuminuria are markers of glomerular hyperfiltration studying renal function before and after infusion of amino acids can detect hypertensive patients at risk of progressive renal damage.

Adult↗
PubMed1983

The in vivo effect of thymic factor (thymostimulin) administration on circulating immune complexes and serum lysozyme levels in untreated Hodgkin's disease patients.

The in vivo effect of a calf thymus extract, thymostimulin, on the levels of circulating immune complexes (CIC) and serum lysozyme was evaluated in 32 patients with untreated Hodgkin's disease. Using the platelet aggregation test for detecting CICs, 12 patients (37%) had positive titers before thymostimulin treatment; 3 patients (10%) remained positive following therapy. Serum levels of Clq-binding immune complexes were evaluated (greater than 24.5 micrograms/ml) in 8 patients prior to thymostimulin therapy (mean value: 42.3 micrograms/ml); 3 patients continued to have elevated levels after treatment. Serum lysozyme levels for Hodgkin's patients was similar to control values (10.6 vs. 8.3 micrograms/ml); however, the Hodgkin's patients with initially elevated CICs had a lower serum lysozyme level than patients with initially normal CICs (12.9 vs. 7.3, p less than 0.02). Thymostimulin increased serum lysozyme levels in the Hodgkin's patients in whom the CICs were initially elevated (7.3 vs. 10.4 micrograms/ml, p less than 0.05). These data suggest that thymostimulin exerts an effect on the nonspecific immune system of Hodgkin's disease patients.

Animals↗
PubMed1983

Abnormal leucocyte locomotion induced by haemodialysis membranes. A clue to dialysis leucopenia.

In a study on polymorphonuclear leucocyte (PMN) chemotaxis and random locomotion carried out on 16 patients undergoing haemodialysis and on the same functions in normal PMN which were separated from plasma and subjected to laboratory haemodialysis, it was shown that random PMN locomotion is reduced and that there is a concomitant fall in the leucocyte count in haemodialyzed patients. The laboratory haemodialysis demonstrated that serum factors were not responsible for the PMN dysfunction, which lasted for the entire period of the procedure. The changes were observed only when cellulose membranes were used, and not when haemodialysis was performed with polyacrilonitrile membranes. The reduction in random PMN locomotion may be involved in the genesis of dialysis leucopenia, as well as in the increased susceptibility of uremic patients to infections.

Cell Movement↗
PubMed1983

Circulating immune complexes and serum lysozyme levels in untreated Hodgkin's disease. Their relationship to immune function.

Complement-fixing and non-complement-fixing circulating immune complexes were determined in 42 previously untreated Hodgkin's disease patients by Pl.A.T., C1qB-ELISA and KgB tests. The functional status of the monocyte-macrophage system was evaluated by measuring the serum lysozyme levels. These parameters were then correlated with the patient's immunocompetence, as assessed by the percentage of E-rosette forming cells and the PHA response. The Pl.A.T. was positive in 35.7% patients, the KgB-test in 34.3% and the C1qB-ELISA in 19%. There was overlapping of positive results in 37.5% patients. No correlation was found between CIC levels and stage, unfavourable histology or B symptoms. The PHA response was significantly depressed in CIC + patients, as detected by the C1qB-ELISA technique (p less than 0.0025). The data on serum lysozyme offer an insight into the possible mechanism regulating serum levels of CICs in Hodgkin's disease. Two distinct situations seem to exist: in the first, high CIC levels are associated with normal or low serum lysozyme values (p versus normal controls: n.s.); in the second, serum lysozyme levels are high and CIC absent (p less than 0.005 versus control values). The lowest lysozyme levels are also associated with a depressed lymphocyte PHA response. It could, therefore, be concluded that, in Hodgkin's disease, the presence, or absence, of CICs is directly correlated to the degree of monocyte-macrophage clearance activity and that the host's immunocompetence plays an important role in the induction and/or maintenance of this functional defect.

Antigen-Antibody Complex↗
PubMed1982

Stimulation of polymorphonuclear leukocyte chemotaxis by cold precipitable complexes containing DNA-anti-DNA in active nephritis of systemic lupus erythematosus.

DNA-anti-DNA cold precipitable complexes (CPC) isolated from 21 patients with systemic lupus erythematosus were tested for their ability to stimulate polymorphonuclear leukocyte (PMN) chemotaxis and to activate complement in vitro. The complexes activated complement in 20 out of 21 cases and stimulated PMN chemotaxis in 13 out of 21. The stimulation of chemotaxis was present in the majority of patients with renal involvement (10 out of 13) and active disease (8 out of 9), while being almost negligible in those without renal involvement or active disease. In patients studied sequentially, CPC-stimulated chemotaxis was reduced to nil with the remission of the disease. CPC appears to play a pathogenic role in active systemic lupus erythematosus with renal involvement.

Antibodies, Antinuclear↗
PubMed1979

Cryoglobulins in Behçet's syndrome and recurrent oral ulceration: assay by laser nephelometry.

The presence of cryoglobulins was investigated in ninety patients with recurrent oral ulcers (ROU) and sixty-one patients with Behçet's syndrome (BS). The immunodiffusion method was compared with Laser nephelometry for the analysis of IgG, IgM, IgA and C3 in cryoglobulins. Although the two methods of assessment showed a very significant agreement. Laser nephelometry was more sensitive than the double diffusion precipitation method and was used for quantitative analysis of cryoglobulins. The prevalence of any type of cryoglobulins was 64% in ROU and 75% in BS, as compared with controls (15%). In ROU significant levels of IgA were found in minor (P = 0.0196) and major (P = 0.0114) aphthous ulcers and to a lesser extent in herpetiform ulcers (P = 0.0624). Among the four types of BS signficant increases in C3 were found in the arthritic type (P = 0.0068) and ocular type (P = 0.0275), whereas IgM (P = 0.0031) and IgG (P = 0.0369) were increased only in the muco-cutaneous type. Sequential studies showed that disease remissions or exacerbations were correlated with a decrease or increase in IgM or IgG classes of cryoglobulins. However, the converse was found with IgA which may inhibit some functions of polymorphonuclear leucocytes, and this may be responsible for the failure to remove damaging IgG, IgM and C3 complexes from the circulation.

Behcet Syndrome↗