PubMed Health⌕ Search

Biomedical subjects

A Spinelli

Publications and source records attributed to A Spinelli.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Care in pregnancy, labor, and during the puerperium in Italy].

In 1995-96 a KAP (knowledge, attitude and practice) survey on care during pregnancy, delivery and in the post-natal period was carried out in Italy by the National Institute of Health (Istituto Superiore di Sanità). A sample of 9004 women was interviewed in 13 regions within two months of the delivery. Care during pregnancy was generally at a good standard, but with an excessive use of some medical procedures. The level of knowledge was often low and some non-invasive but effective methods for preventing negative outcomes were not widely adopted. Many women were ill informed about the procedures to which they were subjected and their degree of satisfaction was often low. In general, a wide geographic variability and a lack of continuity in pre- and post-natal care were observed.

Cross-Sectional Studies↗
PubMed1999

[Evolution of voluntary interruption of pregnancy in Italy from its legalization until today].

Induced abortion was legalized in Italy in 1978. After an initial increase in the incidence, from 187,631 in 1979 to 234,801 in 1983, induced abortion has steadily decreased to 140,398 in 1996. Analysis of the abortion rates has shown that the main decrease has been among married women aged 25-35, while there has been an increase among unmarried women. Women with lower levels of education tend to have higher rates and housewives have higher rates than women in paid work. Programmes for the prevention of induced abortion should be directed at directed at easily accessible groups: women who have just delivered a baby, couples who marry, teenagers in school and women who have already had an induced abortion. In any case, the need for rationalisation of the procedure to obtain an induced abortion is urgent.

Abortion, Legal↗
PubMed1998

Modifications of general parameters of immune activation in the sera of Sicilian patients with Boutonneuse fever.

The serum levels of beta2-microglobulin (beta2-M), soluble HLA class I antigen (sHLA-I), soluble CD4 (sCD4) and CD8 (sCD8) were studied in 98 Sicilian patients with Boutonneuse fever (BF). In different stages of infection all markers were significantly increased in sera from Sicilian patients with acute BF compared with healthy controls. sCD8 and sHLA-I reached the peak in the second week after the onset of symptoms, whereas sCD4 and beta2-M reached the peak in the first week. Afterwards sCD8 decreased to the levels of controls within the third week, the other parameters decreased later and were unmodified until the third week of infection. Significant correlations were found between sCD4 and sCD8 and the sIL-2R, as well as between serum levels of beta2-M and sCD8. The reduction of CD3+ and CD4+ and the increase of CD8+ T cells in the blood indicate that these cells are involved in the response to rickettsia, and their activation might be in part responsible for the release of sCD4 and sCD8. Our data suggest that these soluble markers, indexes of immune activation of T cells both in the circulation and the affected tissues, may be used in monitoring BF evolution.

Adult↗
PubMed1998

Efficacy and safety of permanent cardiac DDD pacing with contemporaneous double spinal cord stimulation.

Spinal cord stimulation (SCS) is currently used to treat peripheral vascular disease (PVD) and refractory angina pectoris not amenable to revascularization. In a case of contemporaneous SCS implant and permanent cardiac pacemaker (PPM), if multipolar electrodes are used it is possible to avoid any interference between the systems. We describe the case of a patient with a DDD pacemaker, in whom two bipolar SCSs were implanted at different times: one to control refractory angina pectoris and the other for PVD. No interference between the three systems has been observed.

Aged↗
PubMed1998

Palliation of tracheobronchial malignant obstruction with metal stents in emergency conditions.

BACKGROUND: Endoluminal obstruction, caused by tracheobronchial malignancies, can require urgent treatment in case of severe respiratory distress. In emergencies, self-expanding metal stents can be endoscopically employed to solve acute symptoms. METHODS: Between April 1992 and August 1996, 7 patients were treated by positioning of metal stents in emergency conditions and observed to verify the immediate efficacy of endoscopic therapy. Tracheal stenosis, stenosis of trachea and right main bronchus and obstruction of trachea and left main bronchus were present in 5, 1 and 1 patient, respectively. Metal stents for intravascular use (Wallstent, Schneider, Zurich, Switzerland) were positioned on a guide wire by fiber- or video-bronchoscope, after local anaesthesia, monitoring the arterial oxygen saturation of every patient. RESULTS: In six patients breathlessness was resolved immediately. The last patient, suffering from severe mediastinal involvement, died from cardiac failure. No complication occurred. Mean survival was 40 days. CONCLUSIONS: Self-expanding metal stent placement is an easy and safe method, does not require general anaesthesia, is less traumatic and well tolerated, is quick to be performed and then can be used in emergencies. Nevertheless, it is impossible to remove the stent in case of malpositioning. Although this group is small, endobronchial stenting using metallic prostheses permits immediate ventilation and palliation of large airway obstruction.

Aged↗
PubMed1997

Induction of tolerance with nondepleting anti-CD4 monoclonal antibodies is associated with down-regulation of TH2 cytokines.

BACKGROUND: Induction of tolerance with anti-CD4 has mainly focused on monoclonal antibodies (mAbs) that deplete CD4+ T cells. In this study, the mechanisms by which nondepleting anti-CD4 mAbs induce tolerance in the Dark Agouti to PVG rat heart graft model were examined. METHODS: Five anti-CD4 mAbs were tested. Immunohistology and cytokine mRNA profiles were analyzed within grafts. Effects of combining anti-CD4 therapy with alloantibody (alloAb), interleukin (IL)-4, and anti-IL-4 mAb were also examined. RESULTS: All mAbs tested induced indefinite graft survival (>150 days), with blocking of alloAb production. Exogenous alloAb did not restore rejection. Similar T cell receptor alphabeta+, CD8+, IL-2 receptor+ T cell, macrophage, and natural killer cell infiltration and comparable MHC II and intercellular adhesion molecule-1 levels were seen in rejecting and tolerant grafts. mRNA for IL-2, interferon-gamma, lymphotoxin, tumor necrosis factor-alpha, transforming growth factor-beta, cytolysin, and granzyme-A/B was comparable, although inducible nitric oxide synthase was slightly reduced in tolerant grafts. IL-4 and IL-5 were significantly reduced in tolerant grafts, although IL-6, IL-10, and IL-13 levels were similar; this was consistent with partial T helper (Th)2 response inhibition, which was also manifested by inhibited alloAb. The combination of alloAb, IL-4, or anti-IL-4 mAb with anti-CD4 did not prevent tolerance induction. CONCLUSIONS: This study demonstrated that anti-CD4 mAb therapy did not inhibit activation and infiltration of Th1 and CD8+ effector T cells. Preferential induction of Th2 responses, especially IL-4, was not essential for the induction of tolerance. Our studies also found no evidence to support induction of anergy or transforming growth factor-beta as mechanisms of tolerance induction. These results question whether IL-4 is required for induction of transplantation tolerance.

Animals↗
PubMed1997

Possible pathogenetic role of activated platelets in the primary antiphospholipid syndrome involving the central nervous system.

Neurological disorders occurring in the primary antiphospholipid syndrome (neuro-PAPS) have not yet been completely understood. Platelet activation has been suggested to play a crucial role in the pathogenesis of hemostatic disorders in the antiphospholipid syndrome, but no association with neuro-PAPS has been investigated so far. Therefore, we investigated 16 patients with PAPS by flow cytometry in the presence of circulating activated platelets as defined by the surface expression of activation-dependent glycoprotein CD62. In addition, the relationship among activated platelets and anticardiolipin antibodies (aCL) was evaluated. Compared to normal subjects CD62 was found significantly increased in these patients. Furthermore, a significantly increased percentage of CD62-positive platelets was found in the neuro-PAPS group (nine patients) compared to the non-neuro-PAPS patients (seven subjects). On the contrary, no significant difference was found between the two groups with regard to aCL IgG and platelet number. Furthermore, within the neuro-PAPS group, no difference was evidenced, in the CD62-positive platelet percentage, between the four subjects with thrombocytopenia and the five with the normal blood platelet count. Similarly, neuro-PAPS subjects with previous peripheral arterial and/or venous thrombosis did not show a significantly more elevated level of CD62-positive platelets. Finally, a linear correlation was found between the aCL IgG level and the CD62-positive platelet percentage in all the patients and, more significantly, in the neuro-PAPS group, but not within the non-neuro-PAPS patients. Our data demonstrate that circulating activated platelets are detectable by flow cytometry in the majority of PAPS patients and suggest the existence of a relationship among activated platelets, aCL, and neurological disease that patients affected by PAPS might undergo.

Adult↗
PubMed1997

Time to pregnancy and occupation in a group of Italian women.

BACKGROUND: It is estimated that 10-15% of all couples have experienced an infertility problem. The objective of this study was to evaluate the effect of occupation on the time interval between when a couple starts unprotected intercourse and a clinically recognizable pregnancy time to pregnancy (TTP). METHODS: Data from 622 women who successfully delivered in the week preceding the interview were analysed using the Cox proportional hazards regression. Thirty independent variables were included in the full model. RESULTS: Eleven per cent of women had to wait more than one year before conceiving (mean TTP = 6.7 months). The regression analysis showed that the most important determinants of TTP are the age of the woman (rate ratio = 0.44 for age 35+) and her parity (rate ratio = 1.39). TTP also increased significantly with maternal smoking (rate ratio = 0.77), and decreased with coital frequency (rate ratio = 1.24 for > or = 6 per month) and consumption of coffee (rate ratio = 1.29). None of the female occupational exposures has been found to have an independent statistically significant effect, while male occupation in industry and exposure to welding fumes were associated with an increase of TTP (rate ratio = 0.73 and 0.78, respectively). CONCLUSIONS: Female occupational exposures seem to have only a small effect on TTP compared with biological and lifestyle factors. The present data also suggest that work-related factors may have a bigger influence on male fecundity.

Coffee↗
PubMed1997

Flow cytometric detection of circulating activated platelets in primary antiphospholipid syndrome. Correlation with thrombocytopenia and anticardiolipin antibodies.

Platelet activation has been suggested to play a crucial role in the pathogenesis of haemostatic disorders in antiphospholipid syndrome (APS). In 16 patients with primary APS (PAPS) we investigated by flow cytometry the presence of circulating activated platelets as defined by the surface expression of activation-dependent glycoproteins CD62 and CD63. In addition, the relationships among activated platelets, thrombocytopenia, antiphospholipid antibodies (aPL) and platelet associated IgG (PalgG) were evaluated. Compared to normal subjects CD62, but not CD63 expression, was found significantly increased in patients. All thrombocytopenic subjects showed a percentage of CD62 expressing platelets above the cut off. In thrombocytopenics a significantly increased percentage of CD62 and higher levels of aCL IgG were found compared to PAPS patients with normal platelet count. No correlation was found between activated platelets and both lupus anticoagulant antibodies and PalgG. Our data demonstrate that circulating activated platelets are detectable by flow cytometry in the majority of PAPS patients and suggest the existence of a relationship among activated platelets, thrombocytopenia and aPL levels.

Adult↗
PubMed1996

Reducing pain of first trimester abortion under local anaesthesia.

The study aimed to estimate the pain related to first trimester abortion under local and general anaesthesia. One hundred and eighty-one women undergoing abortion of first trimester under local anaesthesia and 198 under general anaesthesia were interviewed 1 h after the end of the procedure. About 50% of all women described their experience as less painful than expected. Over 50% of the women described the pain during the procedure as mild or moderate according to the verbal rating scale. The step-up logistic regression analyses identified four important variables: time interval less than 2 min from local anaesthesia injection to the beginning of the procedure (RR = 3), lack of choice between local and general anaesthesia (RR = 1.9), history of frequent use of analgesics (RR = 1.9) and nulliparity (RR = 1.7). These data indicate that skillfully performed abortion with local anaesthesia is a procedure tolerated by most women. Moreover, because it carries lower risk of complications and costs less, its use should be encouraged.

Abortion, Induced↗
PubMed1996

Depression of CD4 T cell subsets and alteration in cytokine profile in boutonneuse fever.

Interferon (IFN)-gamma, interleukin (IL)-10, IL-6, and tumor necrosis factor (TNF)-alpha were significantly increased in sera from Sicilian patients with acute boutonneuse fever (BF) compared with those of healthy controls. IFN-gamma levels dropped sharply within the second week after infection. IL-6, IL-10, and TNF-alpha levels gradually declined; in convalescent patients only were they in the normal range. In contrast, peripheral blood mononuclear cells (PBMC) stimulated in vitro with phytohemagglutinin (PHA) produced low levels of IL-10 and IFN-gamma in acute BF that were compatible with the reduction in the levels of CD4+, CD4+/CD45RO+, and CD4+/CD45RA+ cells. In vitro production of TNF-alpha and IL-6 from PBMC stimulated with PHA was not significantly modified during the various phases of the infection compared with control PBMC, which could be due to the persistence of high levels of CD14+ monocytes compensating for the decrease in CD20+ B cells.

Adult↗
PubMed1996

Seeking medical help for subfecundity: a study based upon surveys in five European countries.

OBJECTIVE: To study care-seeking behavior for infertility treatment in different European countries. DESIGN: Multicenter surveys of randomly selected women in the child bearing age. SETTING: Five countries participated in the study: Denmark, Germany, Italy, Poland, and Spain. Data were collected from 1991 to 1993 as part of a concerted action. PATIENTS: Population-based samples of women 25 to 44 years of age. The sample sizes ranged from 442 women in Poland to 2,729 in Italy. Participation rates ranged from 54% in Germany to 87% in Denmark. Data were collected by means of a highly structured questionnaire used at a face-to-face interview. MAIN OUTCOME MEASURES: Waiting time to pregnancy, time, and type of treatment for infertility. RESULTS: Less than half of the infertile couples seek medical help in most European countries. The lowest proportion seeking help was found in Poland and the highest in Denmark. CONCLUSION: The increasing demand for infertility treatment is expected to continue, because the potential unmet need is outspoken in most European countries.

Adult↗
PubMed1995

Intralesional administration of I-131 labelled monoclonal antibodies in the treatment of malignant gliomas.

The authors report their preliminary experience with the use of radiolabelled monoclonal antibodies (MAb) as an adjuvant treatment for 33 malignant gliomas. MAbs employed in this study are raised against Tenascin (TN) which is an antigen of the extracellular matrix of the tumour. It has also been found in neoplastic cells but never in normal brain tissue. This therapy is aimed to give a local high dose radiation (boost) while sparing healthy brain structures. This treatment has always been well tolerated and no adverse reactions at the level of CNS or major extraneural organs has been observed. Significant improvement of median survival has been obtained but this result should be cautiously evaluate since the study is non-randomized. Comparison with other current adjuvant technique is briefly discussed.

Adult↗