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Biomedical subjects

A Vaccaro

Publications and source records attributed to A Vaccaro.

At least 37 records · Page 2Linked to original sources
PubMed1998

Long-term course of interferon-treated chronic hepatitis C.

BACKGROUND/AIMS: To evaluate whether sustained response to a-interferon improves clinical outcome in patients with chronic hepatitis C. METHODS: A cohort of 410 consecutive patients (65% with chronic hepatitis, 35% with cirrhosis) were treated with a-interferon in two trials (mean follow-up 62.1 months, range 7-109 months). All were serum HCV RNA positive before therapy and received first 10 then 5 million units of a-2b or a-nl interferon three times weekly for 6 to 12 months. Sustained response was defined as normal aminotransferases 12 months after stopping interferon. RESULTS: Sixty-two patients (15.1%: 54 with chronic hepatitis, eight with cirrhosis) were sustained responders. At the end of follow-up, 56 out of 62 sustained responders (90.3%) were serum HCV RNA negative. No biochemical relapse after 12 months was seen in sustained responders, regardless of initial histology, HCV genotype or persistence of HCV RNA. Although three died of non-hepatic causes, no liver-related events were observed among sustained responders. Complications of liver disease occurred in 34 relapsers/non-responders: nine hepatocellular carcinomas, 21 ascites and four portal hypertensive bleedings. Eleven relapsers/nonresponders died: eight of hepatic and three of non-hepatic causes. Event-free survival was significantly longer in sustained responders than in all the remaining patients. In a regression analysis, sustained response to interferon, low age and absence of cirrhosis were independent predictors of event-free survival. CONCLUSIONS: Hepatitis C virus is probably eradicated and progression of liver disease is prevented in most patients who remain HCV RNA negative with normal transaminases for more than 1 year after stopping treatment.

Adult↗
PubMed1998

Neurologic deterioration after cervical spinal cord injury.

Neurologic deterioration after cervical spinal cord injury (SCI) at a regional spinal cord center was examined. This study examined the incidence of neurologic deterioration as well as associated risk factors in our patient population. Up to 5.8% of cervical SCI patients have been noted to deteriorate neurologically after admission. Risk factors have been early surgery, halo application, traction, and Stryker frame rotation. All cervical SCI patients admitted between 1978 and 1993 who had neurologic deterioration were studied for characteristics of their event, operative status, risk factors, mortality, and neurologic return at 1 year postinjury. Patients were divided into minor and major groups based on the degree of neurologic loss. Nineteen of 1,031 patients were identified as neurologically deteriorated (1.84%). There were 8 major and 11 minor group patients. The average time from injury to deterioration was 3.95 days. Of 10 patients undergoing surgery at < or =5 days, 8 deteriorated postoperatively. Potential risk factors were ankylosing spondylitis (three patients), sepsis (four patients), and intubation (four patients). Neurologic recovery at 1 year showed that 11 of 12 patients were improved. Neurologic deterioration occurred in 1.84% of our patients. Deteriorations were associated with surgery at <5 days after injury, ankylosing spondylitis, sepsis, and intubation.

Adult↗
PubMed1998

Foraminal pressure changes during intervertebral distraction simulating anterior cervical discectomy.

Distraction of the disc space over baseline height has been shown to increase foraminal size. The purpose of this procedure is to determine pressure changes, with disc space distraction simulating an anterior cervical discectomy and fusion (ACDF). An analysis of pressure changes during disc space distraction at C5-C6 was performed. Data were analyzed for maximal pressure observed and for pressure change with prolonged distraction. Five cadaveric specimens underwent a discectomy at the C5-C6 level. Distraction of the disc space was performed and pressure measurements were obtained from within the foramen. Measurements were made for maximal pressure with an intact posterior longitudinal ligament (PLL), divided PLL, and with the nerve root removed from within the foramen. Pressures were also recorded with prolonged distraction until a steady state was achieved. Incremental distraction of +2, +4, and +6 mm resulted in pressure increases within the foramen. Sectioning of the PLL did not affect these increases. Removal of the nerve root from the foramen resulted in pressure increases; however, these were not significantly different from baseline. Prolonged distraction produced an initial increase and a gradual return toward baseline. Final pressures still differed significantly from baseline. Increase intraforaminal pressures can be seen with increasing disc space distraction such as occurs during an ACDF. This suggests that either the foramen narrows in at least one dimension and/or soft-tissue attachments to the nerve produce a tensile force in the nerve as they tighten. The pressure increases relax over time.

Aged↗
PubMed1997

A randomized controlled trial of high-dose maintenance interferon therapy in chronic hepatitis C.

In chronic hepatitis C virus (HCV) infection, the rate of sustained response to interferon is low. We evaluated, in patients responding to a 26-week course of interferon, the effect of high-dose maintenance therapy in preventing relapse. Three hundred and ten patients with chronic HCV infection (38.3% with cirrhosis, 80.6% with HCV type 1) received interferon alfa-2b for 26 weeks (10 MU tiw for 8 weeks, then 5 MU tiw for 18 weeks). One hundred and twenty-four subjects (40%) normalized aminotransferases, and were allocated randomly either to continue on 5 MU tiw for a further 26 weeks (prolonged therapy group: 60 patients) or to stop interferon (brief therapy group: 64 patients). Fifty-two weeks after stopping interferon the overall sustained biochemical response rate was 13.2% (41/310). The number of patients with normal aminotransferases was comparable between the prolonged and brief therapy groups (30% vs. 35.9%, P = n.s.), and the rate of HCV-RNA clearance was similar (48.8% vs. 42.4%, P = n.s.). The timing of posttreatment relapse was not influenced by the duration of therapy. Fifty-nine patients (19%) did not complete therapy due to adverse effects. Multivariate analysis identified four features predicting sustained biochemical response in subjects normalizing aminotransferases under therapy: negative HCV-RNA at end of therapy, normal aminotransferases at 4 weeks of therapy, high baseline aminotransferases, and high baseline platelets. Infection with HCV type 1 was not a significant predictor of response, due to its high prevalence in our population (80.6%). It is concluded that in patients with chronic hepatitis C mostly infected by HCV type 1, a prolonged high-dose interferon course (900 MU over 52 weeks) did not increase the rate of sustained biochemical response and of HCV-RNA clearance in comparison to a brief course (510 MU over 26 weeks).

Adolescent↗
PubMed1997

[Transurethral incision of the prostate].

In this paper the Authors present the preliminary results of an investigation of a series of a patients with BPH who have undergone TUIP by modified monolateral incision. Post-operative complications, hospital stay and short-term urine flow values have been assessed. From June '94 to April '96 at the Department of Urology of the Hospital of Matera, 56 patients with BPH-induced cervico-urethral obstruction undergone TUIP. Their average age was 66; the average follow up was 9.5 months. Thirty-one of them ha bladder catheters. The patients were selected by ultrasonographically measured prostatic volume (< or = 30 gr). The operation was almost in all cases conducted under spinal anaesthesia. A 5-10 mm-long monolateral incision was made medial to the right urinary meatus, starting just behind the trigonal bar and going up to the pre-spyncteric region, laterally to the veru montanum. The incision was made up to the section of the muscle fibres of the trigone and those of the prostate capsule, exposing the fat. Post-operative assessment included a urine culture after 15 days as well as a urine flow measurement every three months. The operative took an average of 10.3 minutes. The catheter was removed on average after 2 days. Post-operative hospitalization lasted on average 3.9 days. No post-operative complications were encountered. Only in 3 cases in which a catheter with no Coudè tip was used, was it difficult to insert. In no case was a blood transfusion necessary. Six patients with normal pre-operative sexual activity maintained their normal ejaculation. Of the 29 patients that had got through the 3-months' follow-up, seven who had been catheterized before the operation, showed, along with an average volume of urine of 236.7 cc, a maximum flow value of 10.8 ml/sec., an average flow of 6.8 ml/sec. and a bladder emptying time of 36.8 sec. The other 22 patients had an average maximum flow speed of 20.5 ml/sec. (+121.5%), an average flow of 10.3 (123.9%), an emptying time of 33 sec. (-8.8%) with an average volume of urine of approximately 300 cc (+58.9%). Thus, in view of the noteworthy post-operative improvement in the symptomatology, both in subjective and objective terms, as well as the low rate of complications and the considerably reduced costs, TUIP may be considered a valid surgical alternative for treatment of BPH with adenomas weighing < or = 30 gramis in selected patients.

Aged↗
PubMed1996

HCV viraemia is more important than genotype as a predictor of response to interferon in Sicily (southern Italy).

BACKGROUND/AIMS: To investigate host- and virus-related factors predictive of early and sustained alanine aminotransferase normalization after interferon therapy for HCV-related chronic liver disease, in an area where genotype 1 is highly prevalent. METHODS: We studied 100 patients with HCV-RNA positive chronic liver disease (73 chronic hepatitis and 27 cirrhosis) undergoing alpha-interferon treatment. Thirty-four patients had an early response but relapsed, 15 patients remained into sustained response for at least 12 months after therapy, and 51 patients did not respond. Serum HCV-RNA levels were assessed by bDNA (Chiron), and genotype by LiPA (Innogenetics) and by sequencing of the 5' non-coding region. RESULTS: Mean pre-treatment HCV-RNA level (x 10(3) genome equivalents/ml +/- SD) was lower in sustained responders (3854 +/- 7142) than in relapsers (9587 +/- 10163) or in non-responders (5709 +/- 6618). HCV subtype 1b was highly prevalent (82%), while types 1a, 2a, 3 and 4 were rare (about 5% each). However, the prevalence of 1b was much lower (31%) under 40 years of age. The prevalence of subtype 1b among sustained responders (74%) was similar to that observed among relapsers (82%) or non-responders (84%), but some nucleotide substitutions in the putative RNA loop of the 5' non-coding region were seen only among relapsers or non-responders. Multiple logistic regression model showed that early response to interferon was predicted by absence of cirrhosis and a pre-treatment HCV-RNA level below 350. Sustained response to interferon was predicted by pre-treatment HCV-RNA level below 350 and a low fibrosis score. CONCLUSIONS: Among patients with hepatitis C from an area where subtype 1b is highly prevalent, absence of cirrhosis and low pre-treatment serum HCV-RNA level are the most important predictors of response to IFN. Some nucleotide substitutions found in the 5' non-coding region of subtype 1b are associated with non-response or relapse.

Adult↗
PubMed1996

Interferon and steroid treatment in patients with chronic hepatitis C and antinuclear or anti-liver-kidney microsomal antibodies.

Treatment of HCV-related chronic hepatitis is controversial when non-organ specific autoantibodies are present, due to potential severe autoimmune reactions under interferon. We evaluated, in an open study, a sequential approach (steroid->interferon) in 20 consecutive patients with biopsy-proven chronic hepatitis, anti-HCV positive (EIA2/RIBA2) and autoantibody positive at a titre > or = 1/80 (18 antinuclear and 2 anti-liver-kidney microsomal antibodies). Nine patients responded to steroids (ALT reduced by > or = 50% at 12 weeks) and continued on prednisone up to one year. Notably, ALT did not return to normal and steroid treatment was ineffective in controlling necroinflammation on follow-up biopsies. After stopping prednisone, ALT rebounded to pre-treatment levels in 6/9 cases. Four of these 6 then received interferon: 3 of them had a complete response (e.g. normal ALT at end of therapy), in 2 with loss of HCV RNA. Eleven patients were, instead, steroid resistant and after wash-out were switched to lymphoblastoid alfa-interferon (6 MU t.i.w. for 8 weeks, 3 MU t.i.w. for 16 weeks). Four cases had a complete response to interferon (3 with loss of HCV RNA) with follow-up biopsies showing definite reduction of necroinflammation. None of the 15 receiving interferon in the present study experienced ALT peaks, deterioration of liver disease, autoimmune-like phenomena. We suggest that antiviral treatment with alfa-interferon could be the first choice in chronic hepatitis C, even in autoantibody positive cases.

Adult↗
PubMed1994

Spinal disorders at the cervicothoracic junction.

STUDY DESIGN: This study reviewed 36 retrospective patients who underwent surgeries for rare cervico-thoracic junctional problems. OBJECTIVES: The authors review cervico-thoracic junctional disorders and study diagnostic methods, surgical approaches, surgical outcomes, and associated complications. SUMMARY OF BACKGROUND DATA: The literature is sparse on cervico-thoracic junctional problems. This paper is the largest series to date on this subject. METHODS: Thirty-six patients who underwent surgeries for spinal problems at the cervico-thoracic region (C7-T3) were reviewed. These included 18 patients with trauma, 15 patients with tumors, 2 patients with herniated discs, and one patient with postlaminectomy instability. There were 20 males and 16 females. The age ranged from 17 to 83 years with a mean of 43.5 years. Surgically, 21 patients had only posterior procedures, that included 12 wiring, 5 Luque rodding, 1 plate-screw fixation for postlaminectomy instability, 1 transpedicular biopsy, 1 foraminotomy for herniated C7-T1 disc, and 1 costotransversectomy for T2-T3 herniated disc. Neurologically, the majority of traumatic patients presented with neurologic deficits (10 complete and 4 incomplete, and 1 root injuries), and nontraumatic disorders were associated with 10 incomplete cord syndromes and 5 root dysfunctions. RESULTS: Follow-up average was 38 months based on 33 of 36 patients. There were three postoperative deaths (two sternotomies, one anterior C7 corpectomy). Neurologically, patients with complete cord injuries remained complete, whereas patients with incomplete or root deficits improved significantly. Complications included C6-C7 subluxation after C7-T2 fusion, pseudomeningocele, vocal cord paralysis, dysphagia, and Horner's syndrome. Other complications included wound infections, urinary tract infections, decubiti, deep vein thrombosis, pneumonia, and tumor recurrence. CONCLUSIONS: In treating patients with cervico-thoracic problems, one should do careful clinical and radiologic survey to avoid missed or delayed diagnoses, and the surgeon must be thoroughly familiar with anterior and posterior landmarks and associated vital structures and remember that the cervico-thoracic junction is an area of potential instability particularly after trauma or laminectomy. Complications of surgery at the cervico-thoracic junction are frequent, and meticulous surgical techniques and postoperative care are important in the prevention of these complications.

Adult↗
PubMed1991

Low lumbar burst fractures. Comparison among body cast, Harrington rod, Luque rod, and Steffee plate.

Burst fracture of the low lumbar spine are rare and have not been well delineated in the literature. Thirty-one low lumbar burst fractures (L3-L5) were treated from 1981 through 1989. Average follow-up for 27 of the 31 patients was 46 months. Persistent complaints of back pain seemed to be found more in patients with long instrumentation and fusion and in patients with loss of lordosis. Conservative treatment of low lumbar burst fractures with body cast is a viable option in the neurologically intact patients with minimal height loss and minor angulation. If surgery is chosen, short rigid instrumentation (eg, transpedicular device) is best in accomplishing shorter fusion, maintaining vertebral height, and restoring lumbar lordosis. Harrington distraction rods improve vertebral height but produce loss of lumbar lordosis. Luque rods do not restore vertebral height and are only moderately effective in restoring lumbar lordosis. If patients are neurologically impaired in association with low lumbar burst fractures, posterior decompression by laminotomy or a transpedicular approach is generally effective. Maintaining vertebral height and restoring lumbar lordosis may be important in the prevention of disability from back pain.

Back Pain↗
PubMed1990

Modular total shoulder: early experience and impressions.

All design considerations in shoulder arthroplasty are based on reconstructing normal anatomy and enhancing prosthetic fixation, particularly on the glenoid side. These goals are further enhanced by meticulous attention to detail in placement of the component parts relative to the bony anatomy. In addition, great attention must be paid to management of the soft tissue tensions and placement of the component parts relative to soft tissue origins and insertions so that asymmetric overloading of the components can be avoided and loosening and wear can be minimized. The problem of management of prosthetic replacement with associated massive rotator cuff tears continues to be a dilemma. Use of an oversized humeral head articulating with the acromion can offer a compromise solution to the problem. This technique can be combined with altered glenoid component placement or reshaping of the bony glenoid to accommodate its altered relationship with the humeral articular surface. Future design changes are needed to deal with this complex problem.

Evaluation Studies as Topic↗
PubMed1990

Herniated lumbar disc in patients over the age of fifty.

Fifty patients ranging in age between 50-78 years (mean, 56) underwent surgery for a herniated lumbar disc between January 1986 and July 1988. All had objective clinical and radiographic evidence of a herniated disc. All had had failure during an appropriate period of conservative treatment. Far lateral herniation occurred in 8%, and 28% had disc herniations at L2 or L3. Surgical results were 64% excellent, 28% good, 6% fair, and 2% poor. Complications including urinary tract infection, wound infection, myocardial infarction, and pulmonary embolism were observed in 8% of patients. Lumbar disc herniation in the elderly is common. After thorough evaluation to exclude neoplasm or infection, decompression of neural structures can lead to 90% good to excellent results. Spinal stenosis must be carefully considered both preoperatively and intraoperatively. Also, a higher incidence of more cephalad lumbar herniations and far lateral herniations was observed in older patients.

Age Factors↗
PubMedDate not supplied

Biochemical studies on equine infectious anaemia.

A description is given of an outbreak of equine infectious anaemia (E.I.A.) in Campania [at Naples and Aversa (Caserta)]; it was diagnosed by clinical, pathological and serological examinations (Coggins test). Using the serum of 45 horses with E.I.A. and 11 healthy horses (controls), numerous investigations were carried out on: enzymes, intrinsic coagulation factors, lipids and other substances. The results obtained were very interesting and show that in this disease there are significant increases in many enzymes (LDH, LAP, gamma-GT, CPK, PK and ALD) and copper. Insignificant increases were found in other enzymes (SDH, GLDH, MDH, ICDH, AIP, lysozyme, cholinesterase, GOT and GPT) and also intrinsic coagulation factors, lipid substances (total cholesterol, esterified cholesterol, triglycerides) and glucose. LDH-1-isoenzyme remains unchanged, whilst AcP decreases slightly.

Animals↗