Red cell transfusions in neonatal care.
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Journal Article↗
Biomedical subjects
C De Felice
Publications and source records attributed to C De Felice.
Infantile hypertrophic pyloric stenosis and asymptomatic joint hypermobility.
A significant association with asymptomatic joint hypermobility was observed in 37 children with a history of infantile hypertrophic pyloric stenosis (P =.0016) and their parents (mothers, P <.0001; fathers, P <.05). The subjects with articular hypermobility showed an increased frequency of absent mandibular frenulum, thereby suggesting the presence of a previously unrecognized, systemic abnormality of the extracellular matrix.
Extracellular Matrix↗
Chorioamnionitis and fetal/neonatal brain injury.
Chorioamnionitis (CA) is the leading cause of preterm birth and neonatal complications. Even in the absence of a proven infection, fetuses and neonates present a systemic inflammatory response which can be identified by radiological and morphological examination of the thymus. The frequent occurrence of brain injury in neonates with CA is probably linked to systemic, unspecific mechanisms which have not yet been completely clarified. Only by relating placental pathology to clinical evaluation of the newborn will it be possible to achieve a better understanding of these infections and to reduce long-term morbidity and mortality.
Brain Diseases↗
Red cell transfusions in neonatal care.
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Anemia↗
[Idiopathic sudden hearing loss: role of the posterior communicating cerebral arteries of the Willis' circle].
Sudden hearing loss (SHL) is a neurosensorial hearing loss of variable entity with an onset of less than three days. In most cases (85-90%) it is of unknown etiology (idiopathic sudden hearing loss--ISHL). The most accredited hypotheses for origin are: viral, immunitary and vascular. ISHL accounts for approximately 1% of all neurosensorial hearing loss; onset is most frequent in winter, i.e. January and February, and it most frequently affects women, particularly at 15 and between 40-50 years of age. In order to evaluate the role of vascular condition on the onset of ISHL, we focused our attention on the circle of Willis. The results confirm that, in the absence of cerebro-vascular pathology, posterior communicating arteries (PCAs) that cannot be activated--evaluated by transcranial Doppler (TCD)--are associated with ISHL. Moreover, hemodynamic alterations detected in the basilar artery in ISHL patients are correlated with the final prognosis for hearing. These observations highlight the importance of TCD in testing subjects at risk for idiopathic SHL and show that PCAs are essential in maintaining normal cochlear function.
Adult↗
Non-functioning posterior communicating arteries of circle of Willis in idiopathic sudden hearing loss.
Most cases of sudden hearing loss have no identifiable cause. A link between compensatory blood flow through the circle of Willis and recovery from sudden hearing loss has, however, been suggested. We assessed 22 patients with sudden hearing loss who had no cerebrovascular disease, and 41 controls matched for age and sex. We took ultrasonographic doppler flow measurements of the extracranial carotid and vertebrobasilar systems and independent audiological measurements. 12 patients with sudden hearing loss, compared with four controls had bilateral non-functioning posterior communicating arteries (p=0.00019). Our findings suggest a strong association between a non-functioning posterior communicating artery of the circle of Willis and sudden hearing loss.
Adult↗
Acute thymic involution in fetuses and neonates with chorioamnionitis.
Chorioamnionitis represents the leading cause of preterm birth and related pathologic conditions as well as of fetal death and frequently occurs in symptom-free mothers. Recent radiologic findings have indicated that thymus size is significantly reduced in preterm infants born to mothers with subclinical, histologically proven chorioamnionitis. However, an accurate morphologic description of the thymus gland in fetuses and neonates with chorioamnionitis is lacking, although it is known that infection and other stress processes may cause lymphocyte depletion in the thymuses of infants and older babies (acute stress involution). We describe morphologic modifications in the thymus of fetuses with histologically proven chorioamnionitis and newborn infants with chorioamnionitis and proven sepsis. The main findings included (1) decreased organ volume (ANOVA, P < .0024); (2) reduced corticomedullary ratio (P < 10(-6)); (3) significant changes in the relationship between thymic parenchyma and thymic interstitial tissue with resulting increased organ complexity (P = .03); (4) severe reduction of thymocytes; and (5) other degenerative processes such as monocyte/macrophage infiltration of Hassall's bodies. These results indicate that chorioamnionitis, with or without sepsis, is associated with significant morphologic modifications in the thymus. We wish to note that the described thymic pathology is only one aspect of the fetal systemic inflammatory response syndrome with which chorioamnionitis is associated.
Abortion, Spontaneous↗
Hypoplastic or absent mandibular frenulum: a new predictive sign of infantile hypertrophic pyloric stenosis.
Among 25 patients with hypertrophic pyloric stenosis, a hypoplastic or absent mandibular frenulum was noted in 92%, compared with 1.6% of 319 control infants (P <.001). This previously unrecognized sign may prove helpful in identifying newborns at risk of developing the disorder.
Female↗
EEG in assessing hydroxycobalamin therapy in neonatal methylmalonic aciduria with homocystinuria.
We performed serial electroencephalograms (EEG) in a newborn with methylmalonic aciduria and homocystinuria to assess the effects of hydroxycobalamin (OHcbl) therapy on the CNS. Diagnosis was made at 22 days of age: she had torpor, failure to thrive and hypotonia of the limbs, and intermittent opisthotonus. The first EEG, performed on the first day of therapy, showed abnormal and immature transients, low voltage and very long flat periods in the discontinuous part of the tracing. These features quickly improved during therapy. After 13 days of OHcbl therapy, the EEG tracing became normal for conceptional age and showed normal sleep phases with only minor anomalies; only mild hypotonia still remained and biochemical parameters normalized. The decrease in blood homocysteine (index of blood detoxification) was statistically correlated to the reduction of the length of flat periods in EEG (p < 0.01). In conclusion, changes in neonatal EEG, particularly the length of interburst periods in the intermittent part of the tracing, appeared to be a reliable index for evaluating drug effectiveness in methylmalonic aciduria and homocystinuria.
Electroencephalography↗
Effects of estrogens and androgens on erythrocyte antioxidant superoxide dismutase, catalase and glutathione peroxidase activities during the menstrual cycle.
The effects of physiological changes in estrogens and androgens on the erythrocyte antioxidant superoxide dismutase, catalase and glutathione peroxidase enzyme activities during the menstrual cycle were investigated in healthy eumenorrheic women. Blood samples were taken on alternate days from twelve normally cyclic women (age range: 20 to 27 years; mean age: 24.1 years) from the first day of one menstrual cycle until the first day of the subsequent one. Plasma was analyzed for FSH, LH, estradiol, progesterone, testosterone, free testosterone and androstenedione concentrations. Erythrocyte superoxide dismutase, catalase and glutathione peroxidase activities were evaluated on the same days and cycle length was standardized on the basis of the preovulatory estradiol peak. Significant cyclic phase-related changes were observed in glutathione peroxidase (P<0.05), with higher glutathione peroxidase activity levels from the late follicular to the early luteal phase compared with those found in the early follicular phase (P<0.001 and P<0.002 respectively). A significant positive correlation was observed between mean estradiol and glutathione peroxidase cycle-related variations (r=0.80, P<0.001), whereas no significant cycle phase-dependent changes were seen in superoxide dismutase and catalase. No effect of progesterone and androgens on the erythrocyte antioxidant enzyme system was documented. The findings indicate that physiological ovarian estradiol production during the menstrual cycle may have an important role in regulating erythrocyte glutathione peroxidase activity.
Adult↗
[Conservative therapy in dentigerous cysts. A case report].
Dentigerous cysts are one of the most common embryological anomalies of the maxilla and mandible. They are connected with one or more permanent tooth germs. For this reason, therapy is very important to preserve the vitality of the permanent germs and to allow them a complete growth and a functional migration in the alveolar arch. In the present paper, the clinical features and the surgical conservative treatment of a case personally observed, are described.
Child↗
Congenital cystic adenomatoid malformation of the lung associated with esophageal atresia and tracheoesophageal fistula.
Bronchopulmonary malformations associated with esophageal atresia (EA) and tracheoesophageal fistula (TEF) are extremely rare. The authors describe a case of type II congenital cystic adenomatoid malformation (CCAM) of the right lower lobe associated with EA and TEF (Vogt-Gross type C) in a full-term female infant. The CCAM presented as an incidental radiologic finding, and a contralateral tension pneumothorax developed shortly after surgical repair of the EA. Early recognition of this rare association is essential for correct operative management.
Cystic Adenomatoid Malformation of Lung, Congenita↗
Small thymus in very low birth weight infants born to mothers with subclinical chorioamnionitis.
Chorioamnionitis, a major cause of preterm birth with significant neonatal morbidity and mortality, frequently occurs in mothers who are free of symptoms. A combined clinical, radiologic, and pathologic study of 129 very low birth weight infants indicated a significant association between a markedly decreased thymic size at birth and subclinical chorioamnionitis.
Atrophy↗
Androgens and osteocalcin during the menstrual cycle.
The relationship between physiological variations in female sex and androgenic hormones and calciotropic hormones was investigated during the menstrual cycle. Estradiol, progesterone, total and free testosterone, androstenedione, immunoreactive PTH, calcitonin, osteocalcin (OC), and ionized calcium serum levels were determined throughout the menstrual cycle in a population of healthy eumenorrhoic women (n = 12; age range: 20-29 yr; mean: 24.2 yr). The women were studied from the first day of a menstrual phase until the first day of the following menstrual phase. Cycle length was standardized on the preovulatory estradiol peak (day 0), and values were given for the first day of a menstrual phase, and days -12, -10, -8, -6, -4, -2, 0, 2, 4, 6, 8, 10, 12, and 14 of the menstrual cycle. All subjects had a regular ovulatory cycle, as indicated by the hormonal profile. No significant cycle phase-dependent changes in calciotropic hormones were present. Significant positive correlations between total testosterone (r = 0.32, P < 0.001), free testosterone (r = 0.26, P < 0.001), androstenedione (r = 0.35, P < 0.0001), and OC were observed. The significant relations between these variables were confirmed by a time series analysis. For the first time, these findings indicate a relationship between androgens and OC serum levels during the menstrual cycle. An important regulatory role of endogenous androgens in OC secretion, bone formation, and maintenance of normal bone mineral content in the healthy eumenorrhoic woman is hence suggested.
Adult↗
Transvaginal sonographic evaluation of endometrial polyps: a comparison with two dimensional and three dimensional contrast sonography.
Endometrial polyps are a frequent cause of menorrhagia and are often associated with infertility. Routine transvaginal (TV) ultrasound evaluation may detect intrauterine anomalies. Sonographic evaluation of the endometrium after uterine cavity distention, called hystero-sono-salpingography (HSSG), improves the resolutive effectiveness of TV sonography. Recently the development of three-dimensional (3D) scanning of the uterine cavity has provided accurate images. The purpose of this study was to compare conventional 2D and 3D scanning of the uterine cavity with or without saline contrast medium in the detection and evaluation of focal endometrial polyps. Twenty-three patients out of 642 women suggestive for intrauterine anomalies at routine TV sonogram were examined by 2D and 3D sonography before and after intrauterine saline contrast medium. Sonographic appearance was verified by hysteroscopic and histologic evaluation. Two-dimensional TV sonography diagnosed 23 polyps versus 16 confirmed at hysteroscopic and histologic examinations, revealing a specificity of 69.5%; 2D TV HSSG diagnosed 17 polyps, with a specificity of 94.1%; 3D TV sonography diagnosed 18 polyps, with a specificity of 88.8%; 3D HSSG diagnosed 16 polyps according to hysteroscopic and histologic findings, with a specificity of 100%. HSSG has been demonstrated to be an effective and suitable method in the detection of intrauterine anomalies, particularly with 3D sonography.
Adult↗
Fractionated total body irradiation in allogeneic bone marrow transplantation in leukemia patients: analysis of prognostic factors and results in 136 patients.
BACKGROUND AND PURPOSE: The results of a single-institution series of patients with chronic and acute leukemias are analyzed with regard to literature-reported predictor variables. MATERIALS AND METHODS: Between 1985 and 1994, 136 patients, 82 patients with chronic myeloid leukemia (CML) and 54 with acute leukemia (AL), received a uniform preparatory regimen of fractionated total body irradiation (TBI; 12 Gy in 3 days) plus different chemotherapy regimens before bone marrow transplantation. Eighty-six patients were considered to be in early phase of disease (CML in chronic phase or AL in first complete remission) and 50 in advanced phase (all those beyond first remission or first chronic phase). Ninety-five patients received unmanipulated allogeneic BM, and 41 T-lymphocyte-depleted BM. RESULTS: The 5-year overall survival (OS) and disease-free survival (DFS) of the whole series were 43% and 31%, and median survival was 43 and 10 months, respectively. A Cox proportional hazard model identified variables related to overall and disease-free survival. For OS, graft versus host disease (GVHD) was the first independent variable (P < 0.0001), followed by age (P < 0.001), T-depletion (P < 0.01), disease status (P < 0.05) and type of leukemia (P < 0.05). With regard to DFS, only T-depletion (P < 0.0001), disease status (P < 0.01) and GVHD (P < 0.01) resulted predictor factors. Early complications after BMT were reported in 59 patients, TBI-induced delayed toxicity in 9 patients, and 16 patients suffered late complications. CONCLUSIONS: Our results confirm the curability of early phase leukemias with standard fractionated TBI-induced Allogeneic bone marrow transplantation (ABMT). With an homogeneous fractionated TBI schedule as employed in our series, T-cell depletion negatively affected the outcome.
Acute Disease↗
Variations in erythrocyte antioxidant glutathione peroxidase activity during the menstrual cycle.
OBJECTIVE: Antioxidant enzymes are an important part of the defence mechanisms against free radical damage. Little is known, however, about the relationship between sex steroid hormones and cellular antioxidant systems. We have investigated the effect of physiological sex steroid changes on the erythrocyte antioxidant glutathione peroxidase (GSH-Px) activity during the menstrual cycle in a population of healthy normomenorrhoic women. DESIGN: Prospective, controlled. PATIENTS: Ten normally cycling women (age range: 19-28 years; mean: 23.3 years) were recruited for alternate-day blood sampling from the first day of one menstrual bleed until the first day of the subsequent menstrual phase. MEASUREMENTS: Plasma was analysed for LH, FSH, oestradiol (E2) and progesterone (P4) concentrations. Erythrocyte GSH-Px activity was evaluated on the same days in all subjects. Pyruvate-kinase (PK) activity, as an index of red blood cell population age, was also determined. RESULTS: All the women examined had a normal ovulatory cycle, as indicated by the hormone plasma pattern. Cycle length was standardized on the basis of the preovulatory E2 peak. Significant cycle phase-related changes in GSH-Px (P < 0.03) were observed, with higher GSH-Px activity levels being found from the later follicular to early luteal phase as compared to early follicular phase (chi 2 = 8.53, P < 0.001 and chi 2 = 5.54, P < 0.002, respectively). A significant positive correlation was observed between mean E2 and GSH-Px cycle-related changes (r = 0.78, P = 0.001). Conversely, no significant cycle phase-dependent variations were detected in PK. CONCLUSIONS: The findings support the hypothesis that physiological ovarian E2 production during the menstrual cycle may play an important role in regulating erythrocyte glutathione peroxidase activity.
Adult↗
Chronic unexplained liver disease in children with primary immunodeficiency syndromes.
Liver disease may be found in patients with primary immunodeficiency syndromes because of the high risk of infection with hepatotropic viruses related to the treatment with blood derivatives. The prevalence of liver disease in these patients and its etiology, however, is still not completely understood. We have evaluated the prevalence and the etiology of liver disease in children with different forms of primary immunodeficiencies. Thirty patients included in the study underwent molecular studies to detect common hepatotropic viruses, including hepatitis C and G viruses. Liver involvement was found in 11 of 30 (36.6%) patients. All patients with liver disease had deficiencies of specific immunity, with a prevalence in this subgroup of 47.8%. Liver disease was more severe in patients with T and B cell combined immune disorders than in those with a selective T cell immunodeficiency. Moreover, the severity of the disease correlated with an overall more rapid fatal outcome. A viral etiology was found in only six of these patients, whereas in the remaining five patients, no cause of liver injury was identified. In the virally infected patients, hepatitis C virus was the most common viral agent. In patients with immunodeficiencies, there is a high prevalence of liver disease not fully explained on the basis of the common viral infections.
Adolescent↗