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Biomedical subjects

A Magni

Publications and source records attributed to A Magni.

At least 37 records · Page 2Linked to original sources

Pneumonia complicating abdominal sepsis: an experimental model of hematogenous contamination of the lung.

Pulmonary infection complicating intra-abdominal sepsis is a major clinical problem. An experimental model for intra-abdominal sepsis was created with implantation of gelatin capsules, containing 3 x 10(8) cfu E. coli strain no. 2554, in the peritoneal cavity of 20 rats (10 animals received and 10 did not receive antibiotic therapy with ceftriaxone) in order to verify the role of the primary site of infection in the pathogenesis of pneumonia. Ten rats were sacrificed to determine the relative pulmonary weight and 10 were submitted to simple laparotomy and insertion of a germ-free capsule (sham-operated group). In this group of animals there was only one death (10%). All the rats that received antibiotic therapy survived until sacrifice while all the rats that did not receive ceftriaxone died, 7 within the 2nd and 3 on the 6th postoperative day. Pneumonia and peritonitis developed only in the animals that did not receive ceftriaxone. Bacteriological findings of material obtained from peritoneal and pleural cavities revealed the same strain of E. coli used for the experiment, suggesting that bacteria involved in the pleuro-pulmonary infections may originate in the primary site of infection and that antibiotic therapy started at the moment of contamination, can prevent this major complication.

Abdomen↗

The risk of breast cancer subsequent to histologic diagnosis of benign intraductal papilloma follow-up study of 339 cases.

The risk of developing breast cancer was investigated in 339 patients in whom histologically confirmed intraductal papilloma had been surgically removed. Follow-up ranged from 2 to 14 years, (average, 6.62 years). Ten breast cancers were observed, whereas 3 were expected on the basis of age-specific incidence rates drawn from local cancer registries (relative risk = 3.33, 95% confidence interval = 1.60-6.13). No significant difference in the relative risk was observed as far as papilloma type (single or multiple) was concerned. All breast cancers observed occurred in the same breast as the papilloma. Women in whom a benign intraductal papilloma has been excised should be carefully followed since they at are higher risk for ipsilateral breast cancer.

Adult↗

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.

Animals↗

Influence of aztreonam-netilmicin association on outer membrane proteins of P. aeruginosa strains.

P. aeruginosa is highly resistant to a wide range of antimicrobial agents. This intrinsic resistance mainly depends on the rate of permeation across the outer membrane (o.m.). In order to promote antibiotic uptake across the hydrophilic channel of the o.m. porins, a permeator can be used with a hydrophilic antibiotic. In the present study we assess the o.m. electrophoretic profile of three P. aeruginosa strains cultured with and without antibiotic Aztreonam and Netilmicin (A:N) using the MIC concentration in the association (3:1). The observed increase in the band can be referred to the F porin when the strains are treated with Aztreonam.

Aztreonam↗

Hydrocephalus, bronchiectasis, and ciliary aplasia.

A girl presented in the neonatal period with hydrocephalus, bronchiectasis, and ciliary aplasia. A common defect both in respiratory tract cilia and in ventricular ependyma cilia may explain the association of the two diseases.

Bronchi↗

Adherence of Pseudomonas aeruginosa elastase deficient mutant.

Pseudomonas aeruginosa produces several extracellular substances such as enzymes and toxins which seem to contribute to its pathogenicity. In particular, alkaline protease and elastase production seems to affect bacterial adherence. Aim of this study was to isolate an elastase deficient mutant of P. aeruginosa and to demonstrate a possible correlation between enzyme production and adherence to WEHI cells. Mutant strain showed a significant reduction of elastase and protease alkaline activity, as the decrease of absorbance values demonstrate. Furthermore the adherence to WEHI cells of mutant strain was strongly reduced with respect to the wild strain. Our results prove that proteolytic enzymes play an important role in adherence, probably modifying the cell surfaces and so enhancing adherence.

Bacterial Adhesion↗

Plasma retinol level reduction by the synthetic retinoid fenretinide: a one year follow-up study of breast cancer patients.

Fenretinide (HPR) is a synthetic retinoid which has been shown to cause a reduction in the incidence of carcinogen-induced epithelial tumors in experimental animals, and it has been chosen to be tested as a chemopreventive agent in humans. A study on plasma concentrations of HPR, of its metabolite N-(4-methoxyphenyl)retinamide (MPR), and on its effects on endogenous retinol was performed in groups of 14 to 18 breast cancer patients who received p.o. daily doses of placebo or 100, 200, and 300 mg of HPR for 6 mo and subsequently 200 mg for an additional 6 mo. After the first 5 mo of treatment, there was a linear relationship between doses of HPR administered and HPR, MPR, and retinol levels. HPR and MPR levels increased with the increase in dose, whereas retinol levels decreased, and the reduction was statistically significant compared with the placebo group after all the doses tested. Plasma retinol binding proteins (RBP) decreased proportionally to retinol (r = 0.96). The effect of HPR on retinol and RBP occurred early, since retinol and RBP levels had already been decreased, compared with the initial levels, by 38% and 26%, respectively, 24 h after a 200-mg HPR dose. After 12 mo of treatment, in patients treated with 200 mg daily, the dose chosen for a chemopreventive trial, HPR and retinol levels were similar to those found at 5 mo, suggesting no drug accumulation and no further retinol reduction, whereas MPR levels were higher. Following interruption of treatment, as HPR decreased, retinol increased with a linear relationship between log levels (r = 0.78); after about 50 days, HPR was present in trace amounts, and retinol levels were in the range of those of the placebo group. These data show that HPR treatment lowers retinol and RBP plasma concentrations. This effect is related to HPR levels and is reversible on cessation of HPR administration.

Antineoplastic Agents↗

Tolerability of the synthetic retinoid Fenretinide (HPR).

Fenretinide, N-(4-hydroxyphenyl)retinamide (HPR), is a synthetic retinoid which has been proven effective in inducing cell differentiation and in inhibiting carcinogen induced mammary tumors in rodents. Because of its efficacy and low toxicity in animals, HPR has been proposed for chemopreventive evaluation in humans. Thus, a randomized trial has been conducted to select a dose which can be administered over a lengthy period of time and with acceptable toxicity. The retinoid was administered orally to patients already operated on for breast cancer in daily doses of 100, 200 and 300 mg for 6 months and subsequently at 200 mg for another 6 months. No acute toxicity was found. Dermatological toxicity was minimal and no liver function abnormalities were observed. Nausea and headaches were infrequent and always mild. Menstrual irregularities were recorded with similar frequency in the treatment and placebo groups and appeared to be more age related than drug dependent. After 6 months of treatment one of 25 patients taking 300 mg HPR daily experienced impaired night vision, confirmed by the electroretinogram, and resolved by interruption of treatment. Because the 300 mg daily dose is possibly associated with impaired dark adaptation, the recommended dose for chemoprevention trials of HPR is 200 mg per day.

Adult↗

Mitral valve replacement with the Hancock, Björk-Shiley and Lillehei-Kaster prostheses. A comparison based on a 15-year follow-up.

The performance of the standard Hancock porcine bioprosthesis (HPB), the Björk-Shiley spherical disc prosthesis (BSP) and the Lillehei-Kaster tilting disc prosthesis (LKP) was compared over a 15-year follow-up in patients who underwent isolated mitral valve replacement (502 HPB, 183 LKP and 119 BSP). The cumulative duration of follow-up is 3,488 patient-years (mean, 8.0 +/- 3.7 years) for patients with a HPB, 1,302 patient-years (mean, 8.4 +/- 4.9 years) for patients with a LKP and 718 patient-years (mean, 7.1 +/- 5.6 years) for those with a BSP. At 15 years a significant difference was found among the 3 groups in freedom from (1) anticoagulant-related haemorrhages, between HPB (83% +/- 7%) and BSP (65% +/- 8%) recipients (P less than 0.05); (2) prosthetic dysfunction, BSP (96% +/- 3%) and LKP (83% +/- 6%) versus HPB (42% +/- 5%) recipients (P less than 0.001); (3) overall reoperations, BSP (94% +/- 3%) and LKP (89% +/- 3%) versus HPB (40% +/- 5%) recipients (P less than 0.001) and (4) prosthetic failure, BSP (88% +/- 4%) and LKP (71% +/- 6%) versus HPB (38% +/- 5%) recipients (P less than 0.001). No difference was found in actuarial survival, freedom from thromboembolic episodes, treatment failure and overall prosthesis-related complications. Our results confirm that the long-term performance of the HPB in the mitral position is adversely affected by the high incidence of tissue degeneration while haemorrhagic complications may limit the advantage of the longer durability of mechanical prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Chest X-ray survey in the follow-up of breast cancer patients.

The authors report on 182 cases of intrathoracic metastases (ITM = lung, pleura or mediastinum) observed as first single recurrences in the course of the follow-up of patients treated for primary breast cancer. ITM were detected on standard two-views chest X-ray (CXR) at regular follow-up visits and in absence of subjective symptoms (102 A cases) or in the interval between two consecutive planned controls because of the onset of subjective symptoms (80 S cases). The average disease-free interval since primary treatment was significantly shorter in A with respect to S cases (40.3 vs. 28.5 months, P less than 0.001) as a consequence of the early detection achieved by CXR survey. On the contrary, prognosis was not influenced by ITM early diagnosis as the 10-year survival since primary treatment did not differ significantly between A or S cases (12% vs. 10%, P = 0.68). Results were confirmed on multivariate (Cox's) analysis, adjusting for potential confounders such as age or nodal status. Periodic CXR survey looks a very questionable policy as it does not seem to have any favourable impact on prognosis. Its routine use in breast cancer patients should thus be carefully reconsidered.

Adult↗

Role of alkaline protease and elastase in the adherence of Pseudomonas aeruginosa to WEHI cells.

Recent clinical isolates were tested for production of some extracellular factors such as alkaline protease and elastase. They were also assayed for adhesiveness to WEHI cells. It is well known that extracellular production of substances other than toxins is related to virulence and may increase adherence. The present investigation aimed to evaluate the role of extracellular proteins in adherence. Alkaline protease production was assayed using a test performed with casein as substrate while elastase activity was investigated with the elastin-congored method. Our results demonstrated that P. aeruginosa strains which are good alkaline protease and elastase producers adher better than those showing no or low protease and elastase activity.

Bacterial Adhesion↗

Aortic valve replacement with the Hancock standard, Björk-Shiley, and Lillehei-Kaster prostheses. A comparison based on follow-up from 1 to 15 years.

Three series of patients undergoing isolated aortic valve replacement with the standard glutaraldehyde-preserved Hancock porcine bioprosthesis, the standard Björk-Shiley spherical disc prosthesis, and the Lillehei-Kaster tilting disc prosthesis were compared during a 15-year follow-up. From March 1970 to December 1985, aortic valve replacement was performed in 506 patients, 379 men and 109 women, whose ages ranged from 17 to 71 years (mean, 47 +/- 12 years); 196 had a Hancock bioprosthesis, 147 a Björk-Shiley prosthesis, and 163 a Lillehei-Kaster prosthesis. There were no significant differences among the three groups in terms of mean age, preoperative New York Heart Association class, valve lesion, associated intracardiac procedures, and operative mortality (11.7% for the Hancock bioprosthesis group, 8.8% for the Björk-Shiley prosthesis group, and 9.2% for the Lillehei-Kaster prosthesis group). Cumulative duration of follow-up is 1140 patient-years (mean, 6.6 +/- 1.5 years, 100% complete) for Hancock bioprosthesis patients, 878 patient-years (mean, 5.9 +/- 0.4 years, 98% complete) for Björk-Shiley prosthesis patients, and 1184 patient-years (mean, 7.3 +/- 0.3 years, 97% complete) for Lillehei-Kaster prosthesis patients. Actuarial survival rates at 15 years are 30% +/- 15% for Hancock bioprosthesis, 49% +/- 6% for Björk-Shiley prosthesis, and 44% +/- 7% for Lillehei-Kaster prosthesis patients. There were eight embolic episodes in Hancock valve recipients (0.7% +/- 0.1%/pt-yr), nine in Björk-Shiley prosthesis recipients (1.0% +/- 0.3%/pt-yr), and nine (0.7% +/- 0.1%/pt-yr) in Lillehei-Kaster prosthesis recipients (p = no significant difference). Actuarial freedom from emboli at 15 years is 89% +/- 4% for Hancock, 92% +/- 3% for Björk-Shiley, and 93% +/- 2% for Lillehei-Kaster prosthesis recipients (p = no significant difference). A significant difference was found in the incidence of the following complications. (1) Anticoagulant-related hemorrhage: 0.1% +/- 0.1%/pt-yr for Hancock bioprosthesis, 1.3% +/- 0.3%/pt-yr for Björk-Shiley prosthesis, and 1.9% +/- 0.4%/pt-yr for Lillehei-Kaster prosthesis patients (p less than 0.001), with an actuarial freedom at 15 years of 97.6% +/- 1% for Hancock, 85% +/- 5% for Björk-Shiley, and 68.8% +/- 10% for Lillehei-Kaster recipients (p less than 0.001). (2) Structural deterioration: 3.7% +/- 0.6%/pt-yr for Hancock and none for Björk-Shiley and Lillehei-Kaster patients (p less than 0.001), with an actuarial freedom of 100% for Björk-Shiley prosthesis and Lillehei-Kaster prosthesis patients and 38.4% +/- 12% for Hancock bioprosthesis patients at 15 years.

Adolescent↗

The Hancock II porcine bioprosthesis. A preliminary report.

From May 1983 to July 1987 a total of 153 Hancock II porcine bioprostheses have been implanted in 130 patients with a mean age of 59 +/- 8 years (range 29 to 76 years). Mitral valve replacement was performed in 72 patients, aortic valve replacement in 35, and mitral-aortic valve replacement in 23. Cumulative follow-up of 121 survivors is 223 patient-years and 100% complete (range 0.4 to 4.5 years). The actuarial survival rate at 4 years is 88% +/- 8% for mitral, 86% +/- 7.8% for aortic, and 84% +/- 8% for mitral-aortic valve replacement. Minor thomboembolism occurred in two patients (0.9% +/- 0.6%/pt-yr) with an actuarial freedom from emboli at 4 years of 100% for mitral, 96% +/- 3.7% for aortic, and 91% +/- 8.6% for mitral-aortic valve replacement. Anticoagulant-related hemorrhage occurred in 10 patients (4.4% +/- 1.4%/pt-yr) with an actuarial freedom at 4 years of 90% +/- 4.8% for mitral, 89% +/- 5.8% for aortic, and 84% +/- 10.6% for mitral-aortic valve replacement. Failure of the porcine bioprosthesis was observed in three patients with an actuarial freedom at 4 years of 96% +/- 3.6% for aortic, 91% +/- 8% for mitral, and 91% +/- 8.6% for mitral-aortic valve replacement. Actuarial freedom from all porcine bioprosthesis-related complications at 4 years is 85.7% +/- 6.6% for aortic, 79% +/- 9% for mitral, and 70% +/- 13% for mitral-aortic valve replacement. No instances of primary tissue failure occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

Psychologic aspects of patients participating in a phase I study with the synthetic retinoid 4-hydroxyphenyl retinamide.

One hundred and one patients participating in a phase I study with the synthetic retinoid 4-HPR (4-hydroxyphenyl retinamide) were evaluated. The study was set up by Veronesi et al. during 1986 at the National Cancer Institute of Milan. The patients were randomized into 4 groups of therapy: 25 in the placebo group, 25 in the group receiving a daily dose of 100 mg of HPR, 26 in the group receiving 200 mg/day of HPR, and 25 in the group receiving 300 mg/day of HPR. All patients were previously treated at our Institute for breast cancer. None had received adjuvant therapy, chemotherapy or hormone therapy. After 4-5 months from the beginning of treatment, all patients received a series of tests to evaluate anxiety, depression and sexual life. Moreover, during one the follow-up checkups after 4-5 months, the patients filled-out a self-scoring mood questionnaire. The results did not show any particular differences between the groups, although we found that the administered drug and experimental setting do not interfere with the psychologic state of the participating patients.

Adaptation, Psychological↗

Hancock bioprosthetic valve failure: causes, and results of reoperation.

Between March 1970 and the end of December 1986, 180 porcine valve recipients underwent reoperation at our institution because of bioprosthetic failure. Of these patients, 126 (70.0%) had mitral bioprosthesis replacement (MBR), which was necessitated because of primary tissue failure in 107 cases, prosthetic valve endocarditis in eight cases, and paravalvular leakage in eleven cases. Forty-six patients (25.5%) had aortic bioprosthesis replacement (ABR), owing to primary tissue failure in 37 cases, endocarditis in six cases, and paravalvular leakage in three cases. The remaining eight patients (4.5%) all underwent double (mitral and aortic) bioprosthesis replacement (DBR) because of primary tissue failure. In a total of 152 patients who underwent reoperation for primary tissue failure, the hospital mortality was 6.5% for the MBR group, 8.0% for the ABR group, and 0% for the DBR group (mean, 6.5%). In those 14 patients who required reoperation owing to endocarditis, the hospital mortality was 75% for the MBR group and 50% for the ABR group (mean, 64%). In another 14 patients who underwent reoperation because of paravalvular leakage, the hospital mortality was 9% for the MBR group and 0% for the ABR group (mean, 7%). Morphologic studies of the explanted valves revealed that tissue calcification is the most frequent cause of primary tissue failure in Hancock-valve recipients. Calcification leads to cusp stiffening with stenosis or to cuspal and commissural rupture with incompetence. Usually, primary tissue failure causes progressive dysfunction that allows for elective reoperation, which is associated with a low mortality; rarely, however, porcine xenograft failure can occur acutely and require emergency operation, which is associated with a significantly higher risk. Such operation was necessary in nine (6%) of our patients with primary tissue failure and resulted in four deaths (44%); conversely, elective reoperation was done in 143 patients with other primary tissue failure (94%) and resulted in six deaths (4%) (p<0.001). Our long-term experience with the Hancock bioprosthesis confirms that this valve's durability is limited. Therefore, we believe that the indications for the use of porcine bioprostheses should be restricted, until consistent data become available concerning the durability of the new generation of prosthetic valves.

Journal Article↗

Chest x-ray survey in breast cancer follow-up--a contrary view.

The authors report on 83 cases of intrathoracic metastases (ITM) observed as isolated first recurrences in a ten-year experience of periodic chest x-ray (CXR) survey of primary breast cancer. In 44 of 83 cases ITM were detected on CXR in absence of subjective symptoms or clinical signs (A) whereas 39 ITM cases were detected as subjectively (S) symptomatic in the interval between two planned CXR controls. Diagnosis was anticipated by CXR survey as the disease-free interval was significantly shorter (30 vs. 43 months, p less than 0.04) for A respect to S cases. Nevertheless such a diagnostic anticipation had no prognostic impact as the ten year survival from primary treatment did not differ (0.12 vs. 0.16, p = 0.6) between A and S cases. Multivariate analysis confirmed that no impact on survival from primary treatment is expected whether ITM are detected in an earlier (asymptomatic, preclinical) or in a more advanced (subjectively symptomatic) phase. CXR survey after primary treatment of breast cancer seems thus a very questionable policy.

Breast Neoplasms↗