Biomedical subjects
Publications and source records attributed to Carlo Lombardi.
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The International Reactor Innovative and Secure is a modular pressurised water reactor with an integral design. This means that all the primary system components, such as the steam generators, pumps, pressuriser and control rod drive mechanisms, are located inside the reactor vessel, which requires a large diameter. For the sake of better reliability and safety, it is desirable to achieve the reduction of vessel embrittlement as well as the lowering of the dose beyond the vessel. The former can be easily accomplished by the presence of a wide downcomer, filled with water, which surrounds the core region, while the latter needs the presence of additional internal shields. An optimal shielding configuration is under investigation, for reducing the ex-vessel dose due to activated internals and for limiting the amount of the biological shielding. MCNP 4C calculations were performed to evaluate the neutron and the gamma dose during operation and the 60Co activation of various shields configurations. The gamma dose beyond the vessel from activation of its structural components was estimated in a shutdown condition, with the Monte Carlo code FLUKA 2002 and the MicroShield software. The results of the two codes are in agreement and show that the dose is sufficiently low, even without an additional shield.
STUDY OBJECTIVE: Angiotensin-converting enzyme inhibitors (ACE-I) are considered safe, but they are associated with characteristic side effects, namely cough and angioedema, usually requiring discontinuation. We perceived that referrals for these side effects have become more and more frequent; therefore, we evaluated the degree of knowledge on the safety of ACE-I in different medical categories. DESIGN: A questionnaire (13 questions) on side effects of ACE-I was posted to physicians. SETTING: Everyday clinical practice. PARTICIPANTS: Cardiologists, allergists, and general practitioners (GPs) from the National Healthcare System. MEASUREMENT AND RESULTS: Three hundred twelve physicians were contacted, and 154 returned questionnaires that could be analyzed. Of the 154 physicians (mean age, 45 years) 48 were cardiologists, 52 were GPs, and 54 were allergists. The percentage of correct answers was low: 31.9% for cardiologists, 40% for GPs, and 33% for allergists. Thus, GPs provided a significantly higher percentage of correct answers with respect to the remaining categories (p = 0.05). The lower rate of correct answers (0 to 15.9%) concerned the time of onset of cough and the action to take. Cardiologists seemed to be less aware of the fact that angiotensin receptor blockers (sartans) can cross-react with ACE-I. CONCLUSION: Overall, there was a poor knowledge of the side effects of ACE-I. This may account for the increased referrals for chronic cough and angioedema.
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OBJECTIVE: To review the available published data concerning the use of sublingual immunotherapy (SLIT) in respiratory allergy to primarily evaluate the clinical efficacy and safety of the treatment and to secondarily consider the mechanisms of action and any unresolved questions. DATA SOURCES: Articles in the medical literature (starting from 1986 up to November 2003) derived from searching the MEDLINE database with the keywords sublingual immunotherapy, respiratory allergy, asthma, and rhinitis. Sources included review articles, randomized controlled clinical trials, postmarketing surveillance studies, and relevant reports from meeting proceedings. STUDY SELECTION: Articles concerning safety, efficacy, and mechanisms of SLIT published in English-language, peer-reviewed journals. RESULTS: SLIT proved effective and safe in adults and children. As with traditional subcutaneous immunotherapy, SLIT has long-lasting efficacy and a preventive effect on new sensitizations. CONCLUSION: SLIT is a viable alternative to subcutaneous immunotherapy. Its use in pediatric patients seems to be particularly promising.
PURPOSE OF REVIEW: Sublingual immunotherapy is now officially accepted as a viable alternative to the traditional subcutaneous route, and it is widely used especially in European countries. Despite the large amount of experimental evidence on the safety and efficacy of the method, some concerns still exist, and several aspects need to be clarified: magnitude of the efficacy, adherence, long-lasting effect and others. Recently published studies have provided answers to some of these points. RECENT FINDINGS: The most recent studies have shown that sublingual immunotherapy exerts a long-lasting effect up to 5 years after discontinuation and that it is able to prevent the onset of new sensitizations. Moreover, when systematically assessed, the adherence to treatment is quite satisfactory, despite the treatment being self-administered. In addition, evidence has been provided that sublingual immunotherapy is effective in treating allergic conjunctivitis, and a metaanalysis has confirmed its efficacy in rhinitis. Moreover, some studies have addressed the possibility of simplifying the schedule of administration by shortening the build-up phase. SUMMARY: More and more new data on sublingual immunotherapy are rapidly appearing in the international literature. These data confirm the clinical value of this treatment and show that it is comparable to subcutaneous immunotherapy from several points of view.
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Little is known about the management of asthma in adolescents. We aimed at evaluating these aspects, through a specific questionnaire, in the real life of adolescents with allergic asthma. The questionnaire was administered to a group of adolescents after a diagnosis of allergic asthma. The diagnosis was based on history, clinical examination, pulmonary function tests and allergy tests. One hundred and fifteen adolescents (65 males, mean age 16.5 years) fulfilled the criteria for allergic asthma. The questionnaire explored demography, family history, clinical history, previous diagnosis, therapy, attitude towards therapy and social aspects. The mean actual FEV1 was 87 +/- 10%. Methacholine challenge was carried out in 79 patients and was always positive (PD20 < 1,200 microg), whereas 36 patients underwent reversibility test. According to GINA guidelines, severity of asthma resulted intermittent in 62, mild persistent in 31, moderate in 19 and severe in three patients. In 61% of cases teachers were not aware of the disease. Asthma was managed by general practitioners, allergists and pulmonologists, but PFT/allergy tests had never been performed in 14% of patients. Forty-two per cent of the adolescents received no therapy at all, and only 15% of those with persistent asthma were receiving a stable treatment. Seventy-four per cent of adolescents preferred the inhaled, as against the oral, route. From a clinical and functional point of view, asthma in adolescents did not differ from other age ranges. Nevertheless, the management (diagnosis and therapy) emerged to be unsatisfactory from many points of view.
Acquired cold urticaria is an infrequent physical urticaria that can provoke severe systemic reactions. Histamine is the primary mediator, but leukotrienes are also involved in the pathogenesis. H(1) antihistamines are recommended as first-choice treatment, but their efficacy is sometimes unsatisfactory. On the basis of pathogenic knowledge, it can be hypothesized that a combination therapy with antihistamines and leukotriene receptor antagonists is more effective than each drug given alone. We tested this hypothesis in 2 patients with severe systemic cold urticaria poorly responsive to conventional therapy. The patients underwent 3 consecutive treatment regimens (each of 2 weeks): cetirizine (10 mg once a day); zafirlukast (20 mg twice a day); and their combination. They were clinically evaluated, after each regimen, by means of a visual analog scale and ice-cube test. The combination therapy was superior to the 2 drugs given alone, as testified by subjective and objective evaluations.
The relationship between the general practitioner (GP) and the respiratory medicine physician specialist in the management of the asthmatic patients was examined. Two-hundred sixty -two GPs from Brescia and province were enrolled into the study and underwent an appropriate questionnaire, focusing the survey on three aspects: the relationship among GP-respiratory medicine physician specialist and asthma patients, the training of GP, the appraisal of the socio-economic aspects of the management of bronchial asthma. The results have shown the requirement of a GP-respiratory medicine physician specialist relationship founded on the exchange of information and experiences, rather then of synthetic diagnoses and therapeutic directions, and the opportunity to establish outpatients' departments dedicated to the management of the asthmatic patients. Moreover, it has been shown an inadequate application of international guidelines and a not full appraisal of the socio-economic aspects of the management of the asthmatic patients.
Over the last few years, the importance of sport in everyday life has rapidly increased. Asthma and allergic rhinitis are among the most common problems to be afforded in those practising sports. It is believed that allergy represents a limitation to sport activity, but many elite athletes suffer from respiratory allergy: within those participating in the Olympic Games, 49% suffered from allergic rhinitis, and 20% of winter sport athletes suffered from asthma. Exercise is a potent trigger factor for asthma both in allergic and non allergic subjects. About 70% of asthmatic patients experience asthma symptoms during exercise; skiing and running in particular can elicit bronchospasm. Swimming is usually considered a non asthmogenic sport, but the inhalation of chloride derivatives and irritants can favor asthma onset. From a pathogenic point of view, exercise induced asthma seems to be due to sudden changes of osmolarity in the mucus layer on bronchial walls induced by hyperventilation and low temperature of inspired air. Athletes also suffer from non allergic rhinitis that can influence their performance. Rhinitis in fact modify the correct ventilation and can induce lower respiratory disorders, like asthma. Recently, cold-induced rhinitis has been described in those athletes practicing winter sports, especially skiers. This rhinitis is characterized mainly by rhinorrhea, and responds to topical anti-cholinergic agents. In conclusion, sport can exacerbate or induce asthma and rhinitis but this fact does not represent a limitation to physical activity. A deep knowledge of the diseases occurring during exercise, a detailed education and a correct therapy, allow to perform sports even at high levels also in presence of respiratory allergy.