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Biomedical subjects

C Gavazzi

Publications and source records attributed to C Gavazzi.

At least 19 recordsLinked to original sources
PubMed2006

CT and MR imaging of neuroaxonal leukodystrophy presenting as early-onset frontal dementia.

CT and MR imaging showed diffuse changes of the frontal white matter and genu of the corpus callosum with minimal atrophy and no contrast enhancement in a 41-year-old woman with progressive dementia. Brain biopsy disclosed axonal spheroids and gliosis in the white matter without macrophage or inflammatory infiltration or vessel abnormalities consistent with neuroaxonal leukodystrophy. This disease can be suspected on CT and MR imaging findings but requires neuropathologic examination to be diagnosed.

Adult↗
PubMed2003

Cytoreductive surgery followed by intra peritoneal hyperthermic perfusion in the treatment of peritoneal surface malignancies: morbidity and mortality with closed abdomen technique.

AIMS: The purpose of this phase II study was to analyze the morbidity and mortality of cytoreductive surgery (CRS) + intraperitoneal hyperthermic perfusion (IPHP) in the treatment of peritoneal surface malignancies. PATIENTS AND METHODS: One hundred and sixty four patients (36 ovarian cancer, 32 abdominal sarcomatosis, 34 peritoneal mesothelioma, 36 pseudomyxoma peritonei, 12 gastric cancer, 8 colon adenocarcinoma and 8 from other origins) underwent 166 procedures. Two patients underwent the intervention twice due to disease relapse. The mean follow-up was 20.6 months (range: 0.4 - 91.3). The mean age was 52 years (range: 24-76). CRS was performed with peritonectomy procedures. IPHP through Closed abdominal technique was conducted with preheated (42.5 degrees) perfusate containing cisplatin+mitomycin C or cisplatin+doxorubicin for 60/90 minutes. RESULTS: grade 3/4 morbidity rate was 12.0%. Some frequent post-operatory complications were intestinal fistulas (17), respiratory (5) and abdominal bleeding (4). Multivariate analysis with logistic regression model with the backward elimination method identified carcinomatosis extension (OR: 5.3, CI95%: 1.2-24.5) as the best predictor of morbidity grade 3/4. Four patients presented grade 3/4 toxicity. Operative mortality rate was 0.6%. CONCLUSIONS: CRS+ IPHP presented acceptable morbidity 3/4 toxicity and mortality rates what support the need to be tested in prospective phase III clinical trial.

Adult↗
PubMed2001

Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial.

BACKGROUND: Although current opinion favours the use of enteral over parenteral nutrition, the clinical benefits of early postoperative nutrition in patients undergoing elective surgery have never been clearly shown. We aimed to test the hypothesis that postoperative enteral nutrition is better (fewer postoperative complications) than parenteral nutrition containing similar energy and nitrogen amounts (112 kJ kg(-1) day(-1) and 1.4 g aminoacid kg(-1) day(-1)). METHODS: We did a randomised multicentre clinical trial in patients with gastrointestinal cancer who were malnourished and candidates for major elective surgery. 159 patients were assigned to enteral nutrition and 158 to parenteral nutrition. The primary endpoint was the occurrence of postoperative complications, and secondary endpoints were length of postoperative hospital stay, adverse effects, and treatment crossover. Analysis was by intention to treat. FINDINGS: Postoperative complications occurred in 54 (34%) patients fed enterally versus 78 (49%) fed parenterally (relative risk 0.69, 95% CI 0.53-0.90, p=0.005). Length of postoperative stay was 13.4 days and 15.0 days in the enteral nutrition and parenteral nutrition groups, respectively (p=0.009). Adverse effects occurred in 56 (35%) patients fed enterally versus 22 (14%) patients fed parenterally (2.50, 1.61-3.86, p<0.0001). 14 (9%) patients on enteral nutrition had to switch to parenteral nutrition, whereas none of those fed parenterally crossed over to enteral feeding. INTERPRETATION: We conclude that early enteral nutrition significantly reduces the complication rate and duration of postoperative stay compared with parenteral nutrition, although parenteral nutrition is better tolerated than enteral nutrition.

Comorbidity↗
PubMed2001

Permanent brain damage following acute clonidine poisoning in Munchausen by proxy.

A child presented with recurrent episodes of lethargia for which he underwent several hospital admissions and investigations. A further episode culminated in respiratory arrest and hypoxic ischemic encephalopathy with permanent mental regression. Eighteen months later the mother was discovered while providing clonidine pills to the child; the mother appears to feature a Munchausen syndrome by proxy.

Acute Disease↗
PubMed1999

Artificial nutrition in cancer patients: which route, what composition?

The state of art of artificial nutrition in depleted cancer patients is reviewed in brief. Because cancer cachexia cannot be equated to simple nutrient deficiency but is due instead to complex metabolic abnormalities, the nutritional effects of total parenteral (TPN) and enteral (EN) nutrition are more limited than in starving subjects. TPN and EN usually prevent further deterioration of the nutritional status, although they are not able to fully reverse a state of depletion. There is evidence that quantitative and qualitative modulation of certain nutrients may obtain better results because of a favorable impact on host metabolism. Research in this field is fully warranted. Moreover, the effects of some substrates on tumor metabolism and tumor growth require further investigation to define a nutritional regimen able to maintain the host metabolism with minimum stimulation of tumor growth.

Cachexia↗
PubMed1998

Effects of cachexia due to cancer on whole body and skeletal muscle protein turnover.

BACKGROUND: Data available in the literature regarding whole body protein (WBP) kinetics in patients with cachexia due to cancer are conflicting. Some authors have reported an increase of WBP synthesis and breakdown, whereas others have not found any significant changes; only a few researchers have investigated more compartments simultaneously. The main purpose of this study was to investigate WBP and skeletal muscle protein (SMP) turnover simultaneously in cachectic patients to understand better the mechanisms underlying the general wasting of the host present in cancer cachexia. METHODS: WBP and SMP synthesis and breakdown were studied in malnourished patients with advanced gastric carcinoma and in healthy volunteers. Protein turnover was evaluated in a postabsorptive state, using a model based on a primed constant infusion of L-[(2)H5] phenylalanine and L-[(2)H4]tyrosine, and by determining the isotopic enrichment and concentration in plasma during a plateau phase by gas chromatography and mass spectrometry. RESULTS: Rates of WBP synthesis and breakdown did not differ significantly between the two groups (whole body synthesis [WBS] of 4.35 +/- 0.2 g/kg/day and whole body breakdown [WBB] of 4.77 +/- 0.2 g/kg/day in the control group and WBS of 3.34 +/- 0.7 g/kg/day and WBB of 4.5 +/- 0.4 g/kg/day in the patient group). The skeletal muscle compartment of the patients showed a significantly lower synthesis compared with controls (patients, 9.6 +/- 1.8 nmol/100 mL/minute and control, 25.9 +/- 7.6 nmol/100 mL/minute; P < 0.05), whereas the breakdown was similar in the two groups. Such reduction in SMP synthesis in the gastric carcinoma patients resulted in a more negative net balance. CONCLUSIONS: Conflicting data in the literature may be accounted for by the different selection of patients and controls. Furthermore, WBP kinetics is the result of the metabolism of at least two compartments, the muscle and the nonmuscle compartments (including the tumor), which can change in opposite ways. In patients with cachexia due to cancer, the skeletal compartment appears to be the more compromised, with a significant decrease in SMP synthesis.

Adult↗
PubMed1996

Total nutritional manipulation in humans: report of a cancer patient.

We report here on a patient requiring home total parenteral nutrition (TPN) for a huge intra-abdominal desmoid associated with chronic small bowel pseudo-obstruction who was kept on a special lipid-based calorie regimen for 5 months. The rationale was to attempt to feed the host with a minimal stimulation of tumour growth by using lipid as caloric substrate instead of glucose which is utilized by the tumour. Gluconeogenesis was tentatively inhibited at the level of phosphoenolpyruvate-carboxy-kinase through the oral intake of hydrazine sulphate. The regimen consisted of 28 non-protein lipid Kcal/kg/day plus 1.5 g amino acid per kg/day. Only a small amount of glucose (approx. 40 g/day) was allowed. Tolerance to the regimen was good and body weight maintained. Liver enzymes remained within the normal range and liver sonography was normal throughout the 5 months' therapy and there were no episodes of symptomatic hypoglycaemia. The tumour volume did not substantially change.

Journal Article↗
PubMed1985

Changes in plasma catecholamines in response to reflex modulation of sympathetic vasoconstrictor tone by cardiopulmonary receptors.

The effects of selective deactivation and stimulation of cardiopulmonary receptors on plasma noradrenaline (radioenzymatic method) were studied in nine normotensive subjects by reducing and increasing central venous pressure for 20 min via lower body suction and leg-raising manoeuvres that did not alter arterial blood pressure and heart rate. Deactivation of cardiopulmonary receptors was accompanied by a rise in plasma noradrenaline that achieved a peak within 5 min (91.8 +/- 22%, mean +/- SE) and was then sustained. Stimulation of cardiopulmonary receptors was accompanied by a fall in plasma noradrenaline (-16.6 +/- 3.4%) that levelled off at the second minute and was then sustained. On average the increase and the reduction in plasma noradrenaline had a time course and a magnitude similar to the increase (80.5 +/- 10.5%) and the reduction (-28.4 +/- 5%) in forearm vascular resistance (derived from plethysmographic flow measurement) concomitantly caused by cardiopulmonary receptors. Furthermore, analysis of individual data showed that changes in plasma noradrenaline and forearm vascular resistance were linked by a positive relationship (r = 0.64). Thus the cardiopulmonary receptor reflex can produce rapid, marked and sustained changes in both plasma noradrenaline and forearm vasomotor tone. This is in sharp contrast with the previously observed inability of the carotid baroreflex to alter both these humoral and haemodynamic variables. Taken together these findings support the hypothesis that sympathetic tone to skeletal muscle is an important determinant of the concentration of plasma noradrenaline in blood.

Adult↗
PubMed1984

Role of cardiopulmonary receptors in reflex control of renin release in man.

Animal studies have shown that renin release is reflexly modulated by cardiopulmonary and arterial baroreceptors, and that during changes in posture the former receptors play a major role. This role has been challenged in man, however, by reflex modulation of renin secretion which has been claimed to take place only if arterial and cardiopulmonary receptor areas are engaged together. We studied 19 normotensive and essential hypertensive subjects in which plasma renin activity was assessed by radioimmunoassay during a mild 20 min increase and a mild 20 min reduction in central venous pressure (+1.1 +/- 0.2 mmHg and -2.6 +/- 0.4 mmHg). The increase and reduction in central venous pressure were accompanied by no change in systolic blood pressure, diastolic blood pressure and heart rate which indicated that the increased and reduced stimulus had involved only cardiopulmonary receptors and not arterial baroreceptors as well. During the increase in central venous pressure plasma renin activity showed a significant (P less than 0.01) reduction (-18 +/- 3%) whereas during the reduction in central venous pressure it showed a significant (P less than 0.01) and more marked increased (+64 +/- 17%). The plasma renin activity increase observed during lower body suction was not significantly different from that observed during a 20 min tilting, a manoeuvre that reduced central venous pressure to an extent similar to that observed during lower body suction, but that also deactivated carotid baroreceptors by positioning the carotid sinuses above the heart and reducing their transmural pressure. Thus in normotensive and hypertensive humans renin release can be reflexly modulated by selective engagement of cardiopulmonary receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Alterations in plasma noradrenaline in response to reflex modulation of sympathetic vasoconstrictor tone to skeletal muscles.

In man, stimulation and deactivation of carotid baroreceptors are accompanied by sympathetically-induced reduction and increase in total peripheral resistance, but not by alterations in plasma noradrenaline. This has been explained by the inability of arterial baroreflexes to sustainedly modulate sympathetic tone to skeletal muscle vessels on which plasma noradrenaline has been assumed largely to depend. In the present study nine subjects were submitted to procedures that cause a sustained alteration in muscle sympathetic vasoconstrictor tone, i.e. deactivation and stimulation of cardiopulmonary receptors. Cardiopulmonary receptor deactivation was achieved by a 20-min reduction in central venous pressure via application of subatmospheric pressure to the lower body, and the cardiopulmonary receptor stimulation by a 20-min increase in central venous pressure via passive leg raising. Plasma noradrenaline was measured radioenzymatically on blood sampled from an antecubital vein or the right atrium before, and at the 2nd, 5th, 10th and 20th min of each manoeuvre. The noradrenaline measurements were coupled with measurements of arterial blood pressure, heart rate and forearm blood flow and resistance (plethysmographic method). During reduction and increase in central venous pressure, blood pressure and heart rate did not change, whereas forearm vascular resistance markedly rose and fell with a peak response at 5 min and a subsequent plateau. These changes were accompanied by a marked rise and fall in plasma noradrenaline which also peaked within 5 min and were then sustained. Changes in forearm vascular resistance and noradrenaline showed a close qualitative parallelism, each increase in the former being accompanied by an increase in the latter, and vice-versa.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Mechanisms of antihypertensive action of beta-adrenergic blocking drugs: evidence against potentiation of baroreflexes.

A possibility that can be advanced to explain the antihypertensive effect of beta-blocking drugs is that they act through the baroreflex control of the cardiovascular system. In 38 essential hypertensive patients we measured 1) The lengthening and shortening in R-R interval caused by stimulation or deactivation of arterial baroreceptors (vasoactive drug technique); 2) The fall and rise in blood pressure caused by stimulation and deactivation of carotid baroreceptors (neck chamber); 3) The rise in forearm vascular resistance caused by deactivation of cardiopulmonary receptors (lower body suction). The study was made before and after 6-10 days' administration of nadolol (80-360 mg once a day) or acebutolol (200-600 mg t.i.d.). Nadolol and acebutolol similarly reduced blood pressure and heart rate. Either drug increased heart rate responses to arterial baroreceptor manipulation but the increase fell short of statistical significance. Blood pressure and vasomotor responses to carotid baroreceptor and cardiopulmonary receptor manipulation were also not significantly modified by beta blockade. The baroreceptor control of heart rate and blood pressure showed a modification, however, insofar as a resetting towards the lower blood pressure values occurred. These findings demonstrate that arterial baroreceptor and cardiopulmonary receptor control of circulation is not potentiated by beta-blocking drugs, and that therefore this mechanism cannot account for their antihypertensive effect. The resetting of the baroreflex that occurs during beta blockade may, however, contribute to maintain the hypotension obtained.

Adrenergic beta-Antagonists↗
PubMed1983

Reproducibility of laboratory tests evaluating neural cardiovascular regulation in man.

In 31 normotensive and hypertensive subjects with continuous intra-arterial blood pressure (BP) and heart rate (HR) monitoring, we examined the short term reproducibility of the haemodynamic responses to a number of tests commonly employed in studies on neural cardiovascular regulation: (1) hand-grip exercise and cold pressor tests that increase BP and HR through central and reflex mechanisms; (2) bolus injections of phenylephrine and trinitroglycerine that reflexly reduce and increase HR through stimulation and inhibition of arterial baroreceptors; (3) negative and positive pressure alterations within a neck chamber that reflexly reduce and increase BP through stimulation and inhibition of carotid baroreceptors. Each test was standardized and repeated at 30 min intervals six times in each subject. In the group as a whole the BP and HR responses to hand-grip showed a variability (mean variation coefficient, VC) of 22 and 25% respectively. BP and HR responses to cold pressor test showed a VC of 17 and 44% and HR responses to trinitroglycerine showed a VC of 28%. HR responses to phenylephrine were slightly less (19%) and BP responses to neck chamber considerably less variable (14 and 10%). The variability of the responses was not related to basal BP or HR or to the time sequence of the tests. Thus, tests commonly employed for studying neural cardiovascular control in man have a limited short-term reproducibility. This implies that caution should be used in interpreting results obtained by a single performance of any given test, and in comparing results in different states or groups such as normotensive and hypertensive subjects, unless a relatively large number of responses is available.

Adult↗
PubMedDate not supplied

Percutaneous gastrostomy in oncologic patients: analysis of results and expansion of the indications.

BACKGROUND: Percutaneous gastrostomy is generally performed for permanent enteral nutrition or gastric decompression. METHODS: In our series of oncologic patients, percutaneous gastrostomy was also used temporarily in some patients for enteral nutrition while awaiting functional recovery of swallowing, in preparation for surgery, or for the treatment of fistulas in the upper digestive tract. Fifty-one procedures were performed in 50 patients: 42 for feeding, eight for decompression, and one for transgastric drainage of a duodenal fistula. RESULTS: Of the 35 patients treated for permanent enteral nutrition, four are still alive, with a total survival time of 2,167 days. In three patients, gastrostomy was performed for temporary feeding and was removed once the ability to swallow was restored. In four patients, it was created to restore metabolic balance before surgery. In the patient with a duodenal fistula, healing was achieved in 19 days. The seven patients in whom the procedure was performed for decompression survived for a mean of 19.2 days. There was only one major procedure-related complication (peritonitis). CONCLUSIONS: Percutaneous gastrostomy is a safe, low-cost method that allows the patient to maintain essential nutrition without the discomfort of a nasogastic tube and therefore warrants wider and earlier use. We feel that its application should also be extended to temporary feeding of patients about to undergo long courses of chemotherapy and radiotherapy, which can lead to severe deterioration of nutritional status.

Aged↗
PubMedDate not supplied

Glutamine supplementation in cancer patients receiving chemotherapy: a double-blind randomized study.

The purpose of this study was to evaluate the efficacy of glutamine in preventing doxifluridine-induced diarrhea and the potential impact of glutamine on the tumor growth. We investigated 65 patients with advanced breast cancer receiving doxifluridine in a double-blind randomized fashion: 33 patients took glutamine (30 g/d, divided in 3 doses of 10 g each) for 8 consecutive days (5-12h) during each interval between chemotherapy, which was administered from day 1 to 4. Thirty-two patients took an equal dose of placebo (maltodextrine). The incidence of diarrhea was registered after each cycle of chemotherapy and severity was scored by the National Cancer Institute (NCI), Bethesda, Maryland, classification. The tumor response was evaluated by the World Health Organization (WHO) criteria. A total of 278 and 259 cycles (median 10 cycles), respectively, were delivered in glutamine and placebo groups. There were 34 and 32 episodes of diarrhea in glutamine and placebo groups, with no statistical difference overall, in the severity and duration of tumor growth, there was no difference in the response rate (21% and 28% of complete or partial response, respectively), in median time to response (2 mo), or in median duration of response. In conclusion, glutamine did not prevent the occurrence of the doxifluridine-induced diarrhea and did not have any impact on tumor response to chemotherapy.

Administration, Oral↗
PubMedDate not supplied

Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial.

BACKGROUND: Clinical trials investigating the potential benefits of perioperative total parenteral nutrition (TPN) for reducing the risk of surgery in malnourished cancer patients have yielded controversial results. METHODS: Ninety elective surgical patients with gastric or colorectal tumors and weight loss of 10% or more of usual body weight were randomly assigned to 10 days of preoperative and 9 days of postoperative nutrition vs a simple control group. The daily per kilogram body weight TPN regimen included 34.6 +/- 6.3 kcal nonprotein and 0.25 +/- 0.04 g nitrogen per kilogram in a volume of 42.6 +/- 7.3 mL of fluid. The glucose-to-fat calorie ratio was 70:30. Control patients did not receive preoperative nutrition but received 940 kcal nonprotein plus 85 g amino acids postoperatively. RESULTS: Complications occurred in 37% of the patients receiving TPN vs 57% of the control patients (p = .03). Noninfectious complications mainly accounted for this difference, which was 12% vs 34%, respectively (p = .02). Mortality occurred in only 5 of the control group patients (p = .05). The total length of hospitalization for TPN patients was longer than for control (p = .00), whereas the length of postoperative stay in the two groups did not differ significantly. CONCLUSIONS: This study shows that 10 days of preoperative TPN that is continued postoperatively is able to reduce the complication rate by approximately one third and to prevent mortality in severely malnourished patients with gastrointestinal cancer.

Aged↗