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Biomedical subjects

Antonio Pinto

Publications and source records attributed to Antonio Pinto.

At least 37 records · Page 2Linked to original sources
PubMed2004

Gallstone ileus analysis of radiological findings in 27 patients.

PURPOSE: We retrospectively compared the clinical value of plain abdominal film, abdominal sonography and abdominal CT in diagnosing gallstone ileus in 27 patients. MATERIAL AND METHODS: 27 patients (23 women and 4 men, age range 58-96 years; mean age 71.5 years) with surgically proven gallstone ileus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain films were performed in 19 cases in upright position (postero-anterior projection), in eight cases in supine position. Abdominal US were performed with 3.5 and/or 7.5 MHz probes. CT was performed with a helical unit (slice thickness 4mm, reconstruction interval 4mm, pitch 1.5), after intravenous contrast agent (120 ml) infusion (3 ml/s, 55 s acquisition delay from bolus starting) and using a power injector. The following findings were searched on: pneumobilia, air in gallbladder, cholecysto-digestive fistula, extraluminal fluid, bowel loops dilatation, intestinal air-fluid levels, ectopic stones. RESULTS: Plain abdominal films showed the following findings: air-fluid levels (77.78% of cases), bowel loops dilatation (88.89%), site of obstruction (44.4%), pneumobilia (37.04%), air in gallbladder (3.70%), ectopic stone (33.33%). Abdominal sonography demonstrated bowel loops dilatation (44.44%), extraluminal fluid (14.81%), ectopic stones (14.81%), gallbladder abnormalities, (37.04%), pneumobilia (55.56%). CT findings retrospectively observed were: bowel loops dilatation (92.59%), air-fluid levels (37.04%), bilio-digestive fistula (14.81%), pneumobilia (88.89%), ectopic stone (81.48%), extraluminal fluid (22.22%). The Rigler's triad, that is pneumobilia, bowel mechanical obstruction and ectopic stone detection was observed 4 times with RX (14.81%), 3 times with US (11.11%) and 21 times with CT (77.78%). CONCLUSIONS: Air-fluid levels and bowel loop dilatation were the radiological findings more frequently observed in our series. Plain abdominal film allowed us mainly to identify signs of obstruction, US were more effective in disclosing biliary pathology, CT allowed us to correctly diagnose biliary ileus with much higher accuracy.

Aged↗
PubMed2004

Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients.

INTRODUCTION: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. MATERIAL AND METHODS: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the "A.Cardarelli" Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. RESULTS: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24 (16,4%) of them showed indirect findings of perforation. In other 12 patients no direct or indirect finding of free peritoneal air was detected. CONCLUSIONS: Our experience documents that in 146 gastroduodenal perforations the free peritoneal air was not evident in 12 cases and in 66% of these patients the presence of intraperitoneal fluid could be the only sign of perforation. If free peritoneal air was detected with conventional radiography, other investigations were not indicated. In the absence of direct or indirect findings of pneumoperitoneum, US examination could help to confirm intestinal paresis and the evidence of intraperitoneal free fluid. Helical CT examination was useless before at least 6h from the onset of symptomatology, because in the absence of direct or indirect findings of penumoperitoneum at abdominal plain film and sonograpy, CT could not demonstrate any additional diagnostic information.

Abdomen, Acute↗
PubMed2004

Cerebrovascular risk factors and clinical classification of strokes.

Cerebrovascular risk represents a progressive and evolving concept owing to the particular distribution of risk factors in patients with ischemic stroke and in light of the newest stroke subtype classifications that account for pathophysiological, instrumental, and clinical criteria. Age represents the strongest nonmodifiable risk factor associated with ischemic stroke, while hypertension constitutes the most important modifiable cerebrovascular risk factor, confirmed by a host of epidemiological data and by more recent intervention trials of primary (HOT, Syst-Eur, LIFE) and secondary (PROGRESS) prevention of stroke in hypertensive patients. To be sure, a curious relationship exists between stroke and diabetes. Although the Framingham Study, The Honolulu Heart Program, and a series of Finnish studies reported a linear relationship between improved glucose metabolism and cerebral ischemia, the clinical and prognostic profile of diabetic patients with ischemic stroke remains to be fully understood. Our group, on the basis of TOAST classification--a diagnostic classification of ischemic stroke developed in 1993 that distinguishes five different clinical subtypes of ischemic stroke: large-artery atherosclerosis (LAAS), cardioembolic infarct (CEI), lacunar infarct (LAC), stroke of other determined origin (ODE), and stroke of undetermined origin (UDE), and now extensively used in clinical and scientific context--analysed the prevalence of cerebrovascular risk factors and the distribution of TOAST subtypes in more 300 patients with acute ischemic stroke in two consecutives studies that reported the significant association between diabetes and the lacunar subtype and a better clinical outcome for diabetic patients, most likely related to the higher prevalence of the lacunar subtype. Well-confirmed are the roles of cigarette smoking, atrial fibrillation, and asymptomatic carotid stenosis as cerebrovascular risk factors. Particularly interesting seems to be the function of inflammation markers (CRP, TNF-alpha, IL-1 beta, ISPs) as potential risk factors. Still elusive remains the association between cholesterol serum levels and stroke, on the basis of the epidemiological data regarding this causative relationship, confirmed only by the results of intervention trials (4S, LIPID, CARE, HPS, ASCOT). Ultimately, cerebrovascular risk appears peculiar owing to the unique relationship between some modifiable risk factors (mainly diabetes and cholesterol) and the possible preferential association with stroke subtypes and specific cerebrovascular risks.

Albuminuria↗
PubMed2004

Rapid reversion of Loeffler's endocarditis by imatinib in early stage clonal hypereosinophilic syndrome.

Endomyocardial fibrosis (Loeffler's endocarditis) is the main cause of poor outcome in Hyper Eosinophilic Syndrome (HES) and Eosinophilic Leukemia (EL). Reversion of the cardiac damage has been seldom reported, and thrombi can superimpose on infiltrated walls, originating oembolic complications. The tyrosine kynase inhibitor imatinib has been recently employed in patients affected by HES or EL, with impressive results. We have treated with imatinib a young patient affected by Loeffler's endocarditis during EL. Loeffler's endocarditis was studied by transthoracic Doppler echocardiography with and without the contrast agent SonoVue. Cytogenetics, FISH and molecular analysis showed the presence of the FIP1L1/PDGFRA fusion gene, recently detected in a majority of HES patients. Standard echocardiography revealed a large infiltration of the apical region, with apparently pedunculate corpora floating in the LV chamber; after SonoVue injection, a thick endo-myocardial infiltration involving papillary muscles and tendinous chords appeared, which simulated mobile thrombi at standard echography. Treatment with low dose imatinib caused rapid regression of both eosinophilic proliferation and endomyocardiopathy. The fusion gene FIP1L1-PDGFRA was found significantly decreased after a few months of treatment. Using a contrast echocardiographic approach, we demonstrated the non-thrombotic origin of the "in plus" image in our patient and its rapid resolution following imatinib treatment. Imatinib is an excellent candidate for first line treatment of Loeffler's endocarditis, especially when the FIP1L1/PDGFA fusion gene is detected.

Adult↗
PubMed2004

[Pictorial essay: foreign body of the gastrointestinal tract in emergency radiology].

The ingestion of a foreign body is a relatively common gastrointestinal emergency that causes significant morbidity. Radiological procedures play a very important role in revealing the presence, the location and the nature of an ingested foreign body, thus enabling the best therapeutic approach. We present the radiological features of common and uncommon foreign bodies ingested or with transanal insertion, differentiated on the basis of the location in the gastrointestinal tract. Diagnostic pitfalls are also considered.

Diagnosis, Differential↗
PubMed2004

Comparison between the site of multislice CT signs of gastrointestinal perforation and the site of perforation detected at surgery in forty perforated patients.

PURPOSE: To compare the site of multislice spiral computed tomography (MSCT) signs of gastrointestinal perforation and the site of perforation at surgery in forty perforated patients. MATERIALS AND METHODS: Between January 1 and July 31, 2003, a total of 40 patients (23 men and 17 women) underwent surgery for gastrointestinal perforation. In all cases, plain radiography of the abdomen was integrated by MSCT with the following parameters: 0.5 seconds gantry rotation time, 2.5-5.0 mm slice thickness, 3.75 reconstruction interval, 120 kV, 250-300 mAs, pitch 1.5, after intravenous administration of 140 ml of contrast agent at 3 ml/s with an automatic injector and a delay time of 70 seconds from the injection of the contrast agent. The MSCT findings were: free air and free fluid observed in supramesocolic compartments and/or in inframesocolic compartments and bowel wall discontinuity. The sites of the MSCT findings were compared with the site of perforation observed at surgery. RESULTS: Free air was detected in 60%, free intraperitoneal fluid in 92.5%, and a combination of both findings in 57.5% of the 40 cases examined. There were no cases of bowel wall discontinuity. In nine patients with gastroduodenal perforation, free air and free fluid were detected in combination and free air was localised in supramesocolic compartments in all cases; in two patients with jejunal perforation, free intraperitoneal fluid was observed both in supramesocolic and inframesocolic compartments; in six patients with acute perforated appendicitis, free air was never detected, while free fluid was observed in all cases in inframesocolic compartments; in six patients with isolated sigmoid perforation free air was observed in four cases in supramesocolic compartments while free fluid was seen in both supramesocolic and inframesocolic compartments. CONCLUSIONS: MSTC is the most reliable diagnostic method with which to assess gastrointestinal perforation as it allows detection of even small amounts of free air in the abdomen, which are a sign of perforation. In our study, the comparison of the sites of MSCT signs of perforation with those observed at surgery showed that in gastroduodenal perforations free air and free fluid are present in combination and free air is localised in supramesocolic compartments; in acute perforated appendicitis free air is absent, while free fluid is present in inframesocolic compartments; in isolated sigmoid perforations free air, if present, is localised in supramesocolic compartments, while free fluid is seen in both compartments.

Adolescent↗
PubMed2003

Effects of phenformin on the proliferation of human tumor cell lines.

Phenformin is a biguanide that has been largely used in the past for its anti-diabetic activity. A large body of evidence suggests additional effects of phenformin including antitumoral activity in different animal models in vivo. Thus, the present study has been conducted in order to elucidate possible mechanisms involved in the antitumoral effects of phenformin. In various tumoral cell lines (SH-SY5Y neuroblastoma and LNCaP prostate adenocarcinoma cells), increasing concentrations of phenformin (50-500 microM) induced a concentration-dependent inhibition of cell proliferation. This effect was not dependent on the ability of the drug to reduce glucose levels and was accompanied by induction of apoptotic cell death as measured by cytofluorometric analysis. In addition, a short-time incubation of SH-SY5Y cells with phenformin induced enhanced and transient expression of the cell cycle inhibitor p21 suggesting that phenformin causes inhibition of cell cycle progression prior to induction of apoptosis. These results demonstrate an activity at the cellular level of phenformin that supports its antitumoral effect observed in vivo.

Adenocarcinoma↗
PubMed2003

Aging and the hemopoietic system.

While increasing numbers of elderly patients are expected to require chemotherapy and/or radiotherapy in the future, the application of standard-dose chemotherapy in unselected cohorts of older patients usually results in a higher rate of life-threatening myelosuppression and treatment-related deaths compared to young individuals treated with the same chemotherapy regimens. The biologic mechanisms underlying reduced tolerance to chemotherapy of the hemopoietic system in older individuals are still poorly understood. Unveiling such mechanisms therefore represents a fundamental issue to ameliorate chemotherapy strategies for older cancer patients. Current evidence suggests that aging-related bone marrow changes are rather subtle and most probably irrelevant for the hemopoietic function of normal older individuals. These changes, however, may become clinically evident under conditions of severe hemopoietic stress such as the administration of repeated courses of chemo-radiotherapy. The mechanisms underlying age-dependent decline in the hematopoietic reserve are not fully clarified and probably involve age-associated changes in the stem and progenitor cells compartments which may ultimately lead to a reduced ability of recovery from hematologic stress. Age-related changes in endogenous anti-tumor immune responses also need to be accounted for in the aim of managing residual disease in elderly cancer patients treated with effective chemo-radiotherapy. Since dendritic cells (DCs) generated from older individuals appear fully functional, dendritic cell-based immunotherapy may represent an important tool to treat residual disease in aged cancer patients. While it is clearly established that primary prophylaxis with hemopoietic growth factors currently enables a large fraction of older cancer patients to receive appropriate chemotherapy, innovative strategies in the use of such growth factors may allow time-intensification of standard-dose chemotherapy for treating chemosensitive tumors, i.e. non-Hodgkin's lymphomas (NHLs), occurring in older individuals.

Aging↗
PubMed2003

Adrenal injuries: spectrum of CT findings.

Injury to the adrenal gland is often incidentally diagnosed with Computed Tomography (CT) following blunt abdominal trauma. In a high percentage of cases, it is accompanied by other intra-abdominal, retroperitoneal or intrathoracic injuries. Although not usually clinically significant, adrenal traumatic lesions can be a source of infection, as well as a cause of acute adrenal insufficiency. We discuss and illustrate typical and less common CT findings of adrenal injuries.

Journal Article↗
PubMed2003

Relationship between circulating E-selectin, DD genotype of angiotensin-converting-enzyme, and cardiovascular damage in central obese subjects.

Fifty-six young central obese patients were investigated to evaluate relationships between soluble E-selectin (sE-S), angiotensin-converting enzyme (ACE) gene polymorphism, left ventricular function and structure, and carotid morphology by determination of sE-S and ACE genotypes. Our results indicated that central obese subjects with concomitant higher levels of sE-S and ACE DD genotype may be characterized by early cardiovascular alterations and then considered a particular subset of subjects at higher risk of cardiovascular disease.

Adult↗
PubMed2003

Regarding three cases of descending necrotizing mediastinitis: spiral CT assessment.

Descending necrotizing mediastinitis (DNM) is a rare and life-threatening complication of deep neck space infection which occurs when infection spreads from the deep spaces of the neck, propagating within the soft tissue into the mediastinal spaces. The disease has a high mortality rate due to frequent delay in diagnosis and treatment. Computed Tomography (CT) is important in determining the level of infection, showing the presence and extension of fluid collections (with or without gas bubbles) and diffuse soft-tissue infiltration of the mediastinal fat, and indicating the best surgical approach and progress of treatment. Three cases of DNM evaluated with spiral CT from June 1999 to June 2001 are presented.

Adult↗
PubMed2002

Value of contrast-enhanced CT for managing mesenteric injuries after blunt trauma: review of five-year experience.

OBJECTIVE: The purpose of this retrospective study was to determine the value of contrast-enhanced computed tomography (CT) in the detection and management of mesenteric injuries after blunt trauma. MATERIALS AND METHODS: Between June 1995 and December 2000, 1,619 consecutive abdominal CT examinations were performed in the setting of major blunt trauma. Findings at CT were evaluated before patients were classified as having grade 1 or grade 2 lesions or none. Grade 1 represented the presence of minor injuries: mesenteric haziness, confined fluid, and/or small hematomas (<30 mm) within the mesenteric folds and abdominal injuries; grade 2 was appropriate to evidence of major injuries: moderate to large hematomas (>30 mm), active bleeding, hemoperitoneum, and further abdominal injuries. RESULTS: On the basis of the CT findings, 161 (9.9%) of 1,619 patients were classified as having grade 1 and 25 (1.5%) of 1,619 patients as having grade 2 injuries. Of the 161 (77.6%) patients with grade 1 injuries, 125 were managed conservatively, while 36 (22.4%) underwent surgery. Of the 25 (84%) patients with grade 2 injuries, 21 were treated surgically and 1 (4%) patient was followed medically. Three (12%) of the 25 patients underwent laparotomy after 24 h close clinical observation and monitoring. Initial CT findings in 1,433 (88%) of the 1,619 patients were negative for mesenteric injuries, and in 1,430 of these cases no delayed mesenteric hemorrhage was observed. CONCLUSION: Contrast-enhanced CT has a critical role in the identification and exclusion of mesenteric injuries. Persistent, active extravasation of contrast material, in isolation or associated with further abdominal lesions, is a sign of a high likelihood of injury requiring urgent laparotomy. Haziness, isolated confined clotted mesenteric hemorrhage, and small hematomas within the mesentery are nonspecific findings and should be considered in the appropriate clinical context. Close clinical observation, monitoring, and surgical expertise are mandatory for appropriate management.

Journal Article↗
PubMed2002

Expression of functional interleukin-3 receptors on Hodgkin and Reed-Sternberg cells.

The human interleukin-3 receptor (IL-3R) is a heterodimeric complex consisting of an IL-3-specific alpha chain (IL-3Ralpha) and a common beta chain (beta(c)), this latter shared with the receptors for granulocyte-macrophage colony-stimulating factor and IL-5. Despite extensive research on cytokine circuitries regulating proliferation and survival of tumor cells in Hodgkin's disease (HD) the functional expression of IL-3Rs in this pathobiological entity has not yet been investigated. In the present study, we demonstrate that the great majority (>90%) of malignant Hodgkin and Reed-Sternberg cells of classic HD (19 of 19 analyzed cases) express IL-3Ralpha by immunostaining of frozen sections and cell suspensions from involved lymph nodes. Accordingly, HD cell lines (L428, KMH2, HDLM2, L1236) expressed the alpha and beta chains of IL-3R both at the mRNA and protein level, with a molecular size of IL-3Ralpha identical (70 kd) to that expressed by human myeloid cells. Exogenous IL-3 promoted the growth of cultured Hodgkin and Reed-Sternberg cells, such effect being potentiated by IL-9 co-stimulation, and was able to partially rescue tumor cells from apoptosis induced by serum deprivation. This data suggests an involvement of IL-3/IL-3R interactions in the cellular growth of HD through paracrine mechanisms.

Apoptosis↗
PubMed2002

CD40L induces proliferation, self-renewal, rescue from apoptosis, and production of cytokines by CD40-expressing AML blasts.

OBJECTIVE: Conflicting experimental and clinical results have been reported regarding the role of CD40 in acute myeloid leukemia (AML). In the present study, we analyzed the capability of CD40L/CD154 to modulate several functional aspects of CD40-expressing AML blasts. METHODS: After defining the constitutive expression levels of CD40 in a wide panel (n = 67) of AMLs and evaluating the capability of cytokines to modulate its expression, we investigated the effects of CD40 engagement by soluble (s) CD40L on proliferation, self-renewal capacity, apoptosis, homotypic adhesion, and cytokine production of leukemia cells. RESULTS: CD40 was detected in blast cells from about 37% of AMLs, the highest frequency being documented in monocytic subtypes, and its expression was upregulated or de novo induced by treatment with interleukin (IL)-1alpha, IL-3, IL-4, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-gamma, and tumor necrosis factor-alpha. Exposure of CD40(+) AML blasts to sCD40L resulted in a dose-dependent proliferative response, enhancement of clonogenic growth and self-renewal capacity, and a striking increase in colony size. CD40 engagement was able to rescue AML blasts from apoptosis induced by serum deprivation, as demonstrated by reduced expression of APO2.7 and annexin-V binding, as well as upregulation of the anti-apoptotic protein bcl-x(L). CD40 triggering upregulated cell surface expression of the adhesion molecules CD54, CD58, and CD15 and resulted in homotypic aggregation of leukemia cells at least in part CD54-dependent. An increased production of IL-6 and GM-CSF by CD40(+) AML blasts was also documented upon sCD40L exposure. CONCLUSIONS: This study indicates a possible involvement of CD40 in the interactions of AML blasts with other growth-sustaining microenvironmental accessory cells and immune effectors, in turn expressing CD40L. Caution in the use of CD40 triggering in immunotherapy of AMLs is also suggested.

Acute Disease↗
PubMed2002

Is the time course of clozapine response correlated to the time course of clozapine plasma levels? A one-year prospective study in drug-resistant patients with schizophrenia.

The relationship between the time course of clinical response to clozapine and the time course of clozapine plasma levels has never been investigated. In the present study, we assessed prospectively the clinical response to clozapine and the plasma levels of the drug and its major metabolites in 32 drug-resistant patients with schizophrenia kept on a fixed dose of 600 mg/day for 1 year Four of the patients met response criteria at week 4 of treatment. At weeks 8, 12, and 24, new responders were 7, 6, and 6, respectively. Nine patients never achieved clinical response. In responders at week 4, clozapine and clozapine-N-oxide plasma levels were significantly higher than in both new responders at weeks 8, 12, and 24 and nonresponders. In new responders at weeks 8, 12, and 24, in spite of a fixed clozapine daily dose, mean drug plasma levels progressively rose up to when clinical response occurred; then, the levels remained stable over time. Nonresponders exhibited mean clozapine plasma levels constantly below the value of 260 ng/ml, with N-demethylation as the preferred metabolic route. The present findings show, for the first time, that the time course of the clinical response to clozapine may be linked to the time course of plasma levels of clozapine and its major metabolites.

Adult↗
PubMed2002

Co-expression of CD30 ligand and interleukin 4 (IL-4) receptors by acute myeloid leukaemia blasts is associated with the expansion of IL-4-producing CD30+ normal T cells.

CD30 ligand (CD30L), but not its cognate receptor CD30, is frequently expressed on acute myeloid leukaemia (AML) blasts. In the present study, we found that leukaemic blasts presenting surface CD30L displayed a characteristic cytokine-receptor pattern that makes them ideal targets for those cytokines usually produced by Th2-type cell subsets. In particular, even though a broad distribution of Th2 cytokine receptors by AML blasts was shown, we demonstrated the almost exclusive expression of interleukin 4 (IL-4) receptor (R), in the absence of its cognate cytokine, by CD30L+ AML. Furthermore, a number of Th2-associated markers, including CD30, IL-4 and GATA-3, were expressed by residual T cells derived from CD30L+ AML but not from CD30L- AML, in which the presence of the Th1-associated marker LAG-3 was documented in some cases. The production of IL-4 in the absence of interferon gamma (IFN-gamma) was also detected in CD3+/CD30+ T cells from CD30L+ AML. These results, along with the shift toward IL-4-producing specific T-cell clones observed in CD30L+ AML samples by enzyme-linked Immunospot (ELISpot) assay, were consistent with the hypothesis of a Th2 polarization taking place in T cells from CD30L+ AML. The notion that IL-4 was able to enhance in vitro proliferation of CD30L+/IL-4R+ purified leukaemic blasts suggests that the selective interaction of IL-4-producing CD30+ T cells with CD30L+ leukaemic progenitors may have a role in the progression of this particular AML subset.

Acute Disease↗