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Biomedical subjects

B Guarneri

Publications and source records attributed to B Guarneri.

At least 37 records · Page 2Linked to original sources
PubMed1996

Critical illness myopathy and neuropathy.

BACKGROUND: Critically ill patients may develop muscle weakness or paralysis during the course of sepsis and multiple-organ failure. We studied peripheral nerve and muscle disorders (NMD) in comatose patients. METHOD: Comatose patients who developed paralysis associated with absent deep-tendon reflexes had electroneuromyography (ENMG) and muscle-nerve biopsy specimens taken. Onset and duration of sepsis, multiple-organ dysfunction and failure, biochemical alterations, and drugs potentially interfering with nerve-muscle function were recorded. FINDINGS: 24 patients became quadriparetic or quadriplegic; muscle changes were found in 23. Axonal neuropathy was found in eight of 22 patients examined. All patients had prolonged sepsis and multiple-organ dysfunction, but only 14 had multiple-organ failure. Drugs such as steroids, neuromuscular-blocking agents, and aminoglycosides were not responsible for paresis, and the part played by hyperglycaemia and hypoalbuminaemia is uncertain. Attending physicians predicted a fatal outcome in all cases, although six of seven survivors fully recovered within 115-210 days from the onset of paralysis. INTERPRETATION: Comatose patients may become completely paralysed because of NMD. The diagnosis is important to avoid unnecessary investigations and unreasonably pessimistic prognosis. ENMG is essential for the diagnosis and for planning further clinical management. Biopsy needs to be done only when it is necessary to properly classify NMD.

Biopsy↗
PubMed1996

Behaviour of laminin 1 and type IV collagen in uninvolved psoriatic skin. Immunohistochemical study using confocal laser scanning microscopy.

Previous studies have demonstrated the presence in psoriatic lesions of ultrastructural and molecular alterations of the basement membrane and an altered polarized distribution of the integrins; this latter alteration has also been observed in uninvolved skin. The aim of the present study was to determine, by means of immunolocalization with monoclonal antibodies directed against laminin 1 and type IV collagen and using confocal scanning laser microscopy, whether there are also alterations of the main components of the basement membrane in uninvolved skin. The findings showed a discontinuous and fragmented staining of laminin 1 and a normal distribution of type IV collagen. Taking into account both these results and the results of studies on epithelial cell lines, the authors hypothesize the existence of a functional deficit in psoriatic keratinocytes affecting the synthesis of the alpha 1 subunit of laminin. This deficit would explain: (1) the incapacity to produce mature trimeric laminin; (2) the altered assembly into a distinct basal lamina; (3) the loss of keratinocyte adhesion to the basement membrane; (4) alterations in the polarized distribution of the integrins; and (5) the consequent total or partial block of the cell signals regulating the processes of cytomorphosis. Already present in uninvolved skin, and enhanced by various irritative stimuli, this situation could be decisive for the appearance of psoriatic lesions.

Adolescent↗
PubMed1994

Psoriasis and cyclosporin: immunohistochemical aspects of the basement membrane.

We have demonstrated both in vivo and in vitro that Cyclosporin (CsA) treatment during psoriasis induced a regression of typical keratinocyte alterations and normalization of the basement membrane (BM). It is also known that the structure of BM implies cohesion between the networks formed by laminin and type IV collagen and that these components positively influence the cytomorphosis processes of keratinocytes. According to these results, we have evaluated, by immunohistochemical study, the behaviour of laminin and type IV collagen on psoriatic skin prior to the therapy and at the end of pharmacological treatment with CsA. This study was carried out on biopsies of involved skin taken from 12 patients with severe psoriasis and with PASI between 50 and 70. Our results can be summed up as follows: Untreated psoriasis: absence of laminin within BM; modest staining in basal keratinocytes; intense staining in suprabasal keratinocytes; discontinuous staining of Type IV collagen in the BM. After treatment: evident and continuous staining of laminin and Type IV collagen within the BM. The obtained results confirm the positive effect of immunomodulation determined by CsA in the regulation of the functional activity of cells implicated in BM component production. In conclusion, the authors discuss the pathogenesis of the disease.

Basement Membrane↗
PubMed1993

[Oleoma of the knee. A clinical case].

Authors describe clinical and anatomo-pathological features of a case of oleoma of the left knee, repaired with success through the rotation of a muscular flap of lateral gastrocnemius and application of dermo-epidermal graft. Postoperative follow-up was regular; prompt healing and morpho-functional restoration of involved structures was complete.

Aged↗
PubMed1993

Intravenous immunoglobulin in two children with Guillain-Barré syndrome.

Two children with Guillain-Barrè syndrome were successfully treated with high-dose intravenous immunoglobulin (IVIG) and no relapses occurred over a 1 year follow up. No side-effects were observed. These data provide further evidence that IVIG may be safely and effectively employed in children with Guillain-Barrè syndrome.

Adolescent↗
PubMed1991

Monitoring of somatosensory evoked potentials during carotid endarterectomy: relationship with different haemodynamic parameters and clinical outcome.

The authors studied the changes of Somatosensory Evoked Potentials (SEPs) performed in 241 anaesthetised patients during 264 carotid endarterectomies (CEs). SEP responses were considered significantly modified when the central conduction time was greater than 1 ms and/or when the amplitude of the complex N20-P25 decreased by at least 50%. Both CCT and N20-P25 have been correlated with different parameters, including the presence or absence of preoperative neurological deficits, the type of general anaesthesia, the status of the contralateral and the ipsilateral carotid artery, stump pressure, the use of an intraluminal shunt and the perioperative results. After carotid cross-clamping SEP responses were within the normal range in 236 CEs (89%), and abnormal in 28 (11%). A shunt was inserted 23 times in 264 (9%) cases. None of the patients operated on in this series experienced a permanent neurological deficit; there were three (1.1%) transient deficits (two Rinds and one TIA) and two deaths from non-neurological causes. Only one of the transient deficits was present when the patient woke from the anaesthetic and this event was predicted by significant modification of the SEP which did not reverse after removal of the clamps (a shunt was not used). None of the patients in our series who did not present significant modifications of SEPs during the operation had any postoperative neurological deficit. The authors conclude that SEP recording is a highly reliable and objective method for continuous monitoring of brain function during CE.

Brain Ischemia↗
PubMed1989

Influence of contralateral carotid artery on neurologic outcome after carotid endarterectomy.

The discrepancy in the literature about the immediate results after carotid endarterectomy in the presence of occluded or seriously stenotic contralateral carotid artery, has encouraged a retrospective study on 230 patients subjected to 255 carotid endarterectomies. 63 operations (group 1) were carried out in the presence of occluded contralateral carotid artery (40 operations) or of seriously stenotic contralateral carotid artery (23 operations). In the remaining 192 operations (group 2) the contralateral carotid artery was normal or not significantly stenotic (less than 60% of diameter reduction). The indication for surgery and age and sex distribution were similar in the two groups. No operations were performed during acute stroke. Patients with previous stroke underwent surgery only after at least 1 month from the onset of symptoms, in stable neurological conditions. All the patients were operated on under general anesthesia and with systemic heparinization; the indication for intraluminal shunt was made on the basis of clinical evaluation, of back pressure value and, in 106 operated cases of somatosensory cortical evoked potentials. At the end of every operation, ultrasonographic and/or angiographic instrumental controls were carried out. No statistically significant difference was evidenced in the incidence in groups 1 and 2 of postoperative transitory neurological insufficiency (both 3.2%, P greater than 0.8), of permanent neurological insufficiency (0% and 1%, P greater than 0.9), of mortality because of neurological (3.2% and 1%, P greater than 0.5) and non neurological causes (1.6% and 0%, P greater than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗