[Public health universities of Switzerland and training in nursing care. The work progresses].
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Clinical Competence↗
Biomedical subjects
D Castelli
Publications and source records attributed to D Castelli.
Prevalence of Helicobacter pylori and hepatitis C virus infections among non-Hodgkin's lymphoma patients in Southern Switzerland.
BACKGROUND AND OBJECTIVE: Several recent studies have reported a high rate of previous hepatitis C virus (HCV) infection in patients with non-Hodgkin's lymphoma (NHL). However, it appears that there are marked geographical differences in the prevalence of HCV among NHL patients. There is further controversy concerning a possible pathogenetic link between HCV and certain histologic lymphoma subtypes, in particular MALT lymphomas, and it has recently been speculated that HCV might be involved in the multistep process of gastric lymphoma genesis, in addition to the well established role of chronic Helicobacter pylori infection. The aim of this study was to investigate the prevalence of HCV and H. pylori infections in patients with B-cell NHL in Southern Switzerland. DESIGN AND METHODS: One hundred and eighty newly diagnosed HIV-negative B-cell NHL patients, consecutively seen at a referral oncology center in Southern Switzerland between 1990 and 1995 were prospectively studied. A microparticle enzyme immunoassay was used to detect antibodies to HCV. Serologic determination of HCV genotype was done by the Murex method. The quantitative detection of IgG anti-H. pylori was performed by the Biorad GAP test. RESULTS: Infection with HCV was detected in 17/180 patients (9.4%; 95% C.I., 6%-15%). This prevalence is significantly higher than that observed in a large survey of 5424 new blood donors from the same area tested in 1992-97 (0.9%; 95% C.I., 0.7-1.2). Neither histologic subtypes nor specific extranodal presentations of NHL were associated with a higher prevalence of HCV. HCV serotype 2 (corresponding to genotypes 2a-c) was the most common. HCV infection was significantly associated with a shorter progression-free survival at both univariate and multivariate analysis. Anti-Helicobacter antibodies were detected in 81/180 patients (45%; 95% C.I., 38%-53%) and H. pylori infection was significantly associated with the development of primary lymphomas of the stomach. INTERPRETATION AND CONCLUSIONS: A high prevalence of HCV infection was detected in NHL lymphoma patients and was associated with a shorter time to lymphoma progression. HCV infection was not correlated with primary gastric presentation or with MALT-type histology. Our findings further support the key role of H.pylori infection in the pathogenesis of primary gastric lymphoma of MALT-type. The possible role of HCV in the pathogenesis of NHL should be further investigated.
Aged↗
[Usefulness of atrial vulnerability in predicting atrial fibrillation in patients with sick sinus syndrome treated with DDD pacemaker].
BACKGROUND: Atrial fibrillation (AF) is common in patients with sick sinus syndrome (SSS) treated with dual-chamber pacing and it may complicate their management. This study was undertaken to establish the usefulness of atrial vulnerability (AV), determined by means of transesophageal electrophysiological study (TES), in predicting the risk of developing AF and in deciding the type and program of pacemaker (PM) to be implanted in patients with SSS. METHOD: AV was assessed preoperatively using TES in 81 consecutive patients with SSS. AV (AF > 1 min) was divided into "low threshold" (induction with burst < or = 300/min) and "high threshold" (induction with burst > or = 350 min or with incremental ramp). The PM was programmed to ensure constant atrial capture in all patients. Follow-up lasted three years. No patients received antiarrhythmic drugs. RESULT: AV was positive in 52% of patients (Group A) and negative in 48% of patients (Group B). A history of paroxysmal AF was present in 52% of patients in Group A and in 12% of patients in Group B. At follow-up, 38% of Group A and 2% of Group B patients had chronic AF. AV had sensitivity, specificity, positive predictive value (ppv) and negative predictive value (npv) of 94, 59, 38 and 97%, respectively. Thirty-eight percent of patients showed low threshold vulnerability, with sensitivity, specificity, ppv and npv of 87, 92, 87 and 93%, respectively. Sensitivity, specificity, ppv and pnv for history of AF were 93, 100, 98 and 84%, respectively. When the vulnerability threshold and the history of paroxysmal AF were considered together, the sensitivity, specificity, ppv and npv was 94, 100, 100 and 83%, respectively. Multivariate analysis was shown to be an independent predictive value only for history of AF (p = 0.0002). CONCLUSION: AV determined by means of TES, especially with a low induction threshold, shows excellent sensitivity and specificity in evaluating the risk of chronic AF. It could be useful in patients with SSS undergoing cardiac pacing who have never had AF, thus allowing a more accurate choice of the type and program of PM to be implanted. Case histories of paroxysmal AF could represent useful criteria for selecting patients at a high risk of developing chronic AF.
Aged↗
Industrial pollutants in ground waters from northern Milan.
Ground water samples from an industrialised area near Milan were analysed by gas chromatography-mass spectrometry (GC-MS) to identify the main pollutants and to quantify two classes of chemicals: polychloro-1,3-butadienes (PCBD) and some aromatic amines. The water contained several halogenated aromatic and aliphatic compounds and heavy contamination due to PCBD, probably arising from contaminated land where a disused chemical plant is located. All the samples contained low levels of aromatic amines indicating a diffuse contamination probably arising from different sources.
Amines↗
Pretreatment of skin with a Ginkgo biloba extract/sodium carboxymethyl-beta-1,3-glucan formulation appears to inhibit the elicitation of allergic contact dermatitis in man.
The clinical efficiency of mitigating contact dermatitis with a Ginkgo biloba extract and carboxymethyl-beta-1,3-glucan formulation was investigated in a double-blind versus placebo study using 22 subjects (Caucasian women aged 22-55 years) with allergic contact dermatitis from various substances in the European standard series. The formulation was applied to intact skin 2X a day for 2 weeks ("in use" application) prior to a single application of a selected contact allergen under a Finn Chamber for 24 h. Readings were carried out in a blind study by a dermatologist 2 and 3 days after patch removal. Representative photographs were taken of treated, placebo and untreated test areas. 68.2% of the panelists showed significantly reduced skin reactivity (p = 0.037*) on the treated site 2 days after patch removal, versus untreated and/or placebo sites. This finding indicates that the Ginkgo biloba/carboxymethyl-beta-1,3-glucan formulation can mitigate against allergic contact dermatitis.
Adult↗
Ageing and rheological properties of facial skin in women.
Ageing affects the mechanical properties of skin. Studies using objective measurements on facial skin have been rare and yielded contradictory information. In the present study, the age-related changes occurring in the mechanical properties of facial skin were reviewed using a computerized suction method. A total of 200 healthy women, aged from 17 to 68 years, were enrolled. Data show a significant increase in skin extensibility and a significant decline in elasticity with ageing. These changes become obvious in women approaching 40 years.
Adolescent↗
Intrapatient comparison of an intermittent and a continuous flow cell separator for the collection of progenitor and stem cells from the blood.
BACKGROUND AND OBJECTIVES: Continuous-flow and intermittent-flow blood cell separators (CFCS and IFCS) are both used to collect stem cells from the blood to rescue patients undergoing myeloablative treatment for cancer. MATERIALS AND METHODS: We designed a study to compare the collection efficiency of the two systems. The continuous-flow Cobe Spectra and the intermittent-flow Haemonetics MCS-3P were used to collect cells on consecutive days from 9 patients mobilised with G-CSF with or without chemotherapy. Blood obtained before leukapheresis and the leukapheresis product were analysed for their content of red and white cells, platelets, CD34-positive cells, GM-CFC, CFC-E, and BFU-E. An extraction ratio was calculated. RESULTS: We found that the CFCS extracted about 4 times more mononuclear cells per unit time, 3 times more CD34-positive, and 4 times more clonogenic cells than the IFCS. The subject acceptability of the two systems was similar. CONCLUSION: The CFCS is a more efficient system for stem cell collection. IFCS requires a longer harvesting time for the same result.
Adult↗
High-dose chemotherapy with autologous stem cell transplantation is feasible and safe in a regional hospital. A 6-year experience in southern Switzerland.
High-dose therapy with bone marrow (BM) or blood stem cell (BSC) support is a high-technology technique usually administered in specialized tertiary centers. The use of BSC has made this technique simpler and accessible also to smaller hospitals. We retrospectively analyzed the data of patients with lymphoma, leukemia and other tumors who received high-dose therapy and BM or BSC transplantation in our district hospital, looking at the type of procedure performed, complications, use of growth factors, and progression-free and overall survival. A total of 40 patients were transplanted over 6 years. No procedure-related deaths and no permanent organ toxicities were seen. The use of BSC brought about a great reduction in the duration of hospital stay, septic complications and transfusion of blood components. For patients with lymphoma (n = 20) the probabilities of progression-free survival and of overall survival at 2 years are 48% (95% C.I. 28-68%) and 68% (95% C.I. 46-84%), respectively. Based on these data, we believe that ABMT and BSC transplantation are feasible and safe in a peripheral hospital when the appropriate human and technical conditions are present. Treatment outcome is then comparable to that of specialized centers.
Adolescent↗
The task difficulty of free throw shooting for males and females.
The study demonstrated how the binomial trials model could be used to enhance performance evaluation of a psychomotor task. The study was designed to accomplish three purposes: (a) calibrate the task difficulty of shooting free throws; (b) determine if free-throw shooting is a more difficult task for females than males; and (c) demonstrate how grading scales could be developed when a difference in task difficulty exists. Adults (202 males and 196 females) ranging in age from 18 to 55 years shot 17 consecutive free throws. The performance scores were analyzed using the binomial trials model. The model fit the data for the total group and the females. Because no males scored 0 or more than 13, the model did not fit the data at the extremes of the score continuum. The task difficulty for females was 0.793 (SE = 0.084) and 0.068 (SE = 0.081) for males, which indicated differential item functioning, Chi 1(2) = 38.73, p < .0001. Shooting free throws with a men's regulation basketball was a more difficult task for females than males, which indicates the task does not measure the same latent trait ability for both groups. On average the males' probability of making a free throw was .146 units higher than for the females. Ability estimates were mapped to observed scores for males and females separately and used to illustrate how fair grading scales could be developed.
Adult↗
Monitoring of osteoblast activity with an immunoradiometric assay for determination of bone alkaline phosphatase mass concentration in patients receiving renal transplants.
We examined the diagnostic validity of an immunoradiometric assay for determination of mass concentration of bone alkaline phosphatase (EC 3.1.3.1) in 134 sera from 35 patients receiving renal transplants. Comparison between bone alkaline phosphatase concentration and total alkaline phosphatase activity yielded a strong correlation (r = +0.860; P < 0.001). Nine (17%) of 54 sera which were characterized by a total alkaline phosphatase activity between 100 units/l and the upper reference limit (178 units/l (males) and 160 units/l (females), respectively) showed an increased bone alkaline phosphatase concentration (> 21.3 micrograms/l (males) and > 15.0 micrograms/l (females), respectively). There was also a correlation between bone alkaline phosphatase values and parathyroid hormone levels both before (r = +0.640 (n = 23), P < 0.001) and after renal transplantation (r = +0.528 (n = 111), P < 0.0001). A follow-up of 15 patients after renal transplantation revealed that the median of bone alkaline phosphatase values increased from 5.5 micrograms/l before transplantation to 14.9 micrograms/l 3 months after transplantation (P < 0.0001). Nevertheless no correlation could be observed between parathyroid hormone concentrations and bone alkaline phosphatase values at any time following renal transplantation in these 15 patients (P > 0.1). Rise of bone alkaline phosphatase concentration following renal transplantation is most probably due to an activating effect of cyclosporin A upon osteoblasts.
Adult↗
Current problems with autologous blood supply.
OBJECTIVE: The purpose of the present study consists in an updated review of recent progress in the field of autologous blood supply. At different medical centers, autologous blood products are collected by quite different procedures, which may be applied during pre-, intra- and/or postoperative periods according the technical possibilities of the local blood supply systems. The products are very different, consisting in whole blood, red cell concentrates, platelet concentrates, fresh-frozen plasma (from whole blood and from plasmapheresis), as well as in wound and drainage fluid and in washed red cell concentrates. Iron therapy against autologous blood donation--or against surgical bleeding-induced anemia--is now well established, but it is unclear whether it should be given perorally or intravenously. In addition, erythropoietin substitution may be necessary for some but not all patients. DATA SOURCES: For our review we have used as sources, beyond our own published reports, studies devoted to clinical experience as well as to pathophysiological aspects of blood donation. RESULTS AND CONCLUSIONS: It becomes apparent that the practice of autologous blood supply has now reached peripheral hospitals not affiliated with bigger medical centers. Smaller hospitals may share expensive equipment necessary for autologous blood collection. Such progress contrasts with persistent uncertainties regarding iron and erythropoietin substitution.
Blood Component Removal↗
Amlodipine versus nifedipine retard in the treatment of chronic ischemic heart disease.
The efficacy of amlodipine, a long half-life dihydropyridine calcium antagonist, at the dosage of 5-10 mg/day in a single daily administration, has been compared with that of nifedipine R, a short half-life dihydropyridine, at the dosage of 20-40 mg b.i.d. in 29 patients with chronic ischemic heart disease. After a one week placebo period, patients were assigned to the treatment with amlodipine or nifedipine R, according to a randomized sequence and a cross-over, single-blind design, for two control periods of four weeks and without a wash-out interval between these two phases. During the stress test, a significant increase from baseline in test duration and in time to onset of ischemia and of angina have been obtained with both treatments; moreover amlodipine increased significantly the time to onset of ST segment deviation (-1 mm) and the time to maximum ST segment deviation compared with nifedipine R changes. Also with Holter monitoring and in the angina diary there was a significant reduction of anginal episodes. As regards safety profile, amlodipine treatment was associated with a significantly lower incidence of side effects compared with nifedipine R. This is probably due to the particular pharmacokinetics of amlodipine which, besides the long half-life which allows a single daily administration, shows a retarded peak (between the 6th and the 12th hour) with consequent reduction of phenomena connected with fast and excessive peripheral vasodilatation. In conclusion, amlodipine was as effective in reducing the signs of ischemia as nifedipine R, but compliance was better due to the single daily administration and so was tolerability.
Adult↗
Plasma protein binding of theophylline during development in the rabbit.
The plasma protein binding profile of theophylline was investigated in the rabbit during the perinatal and developmental period. The roles of unbound plasma theophylline fraction (THu), albumin, nonesterified fatty acids (NEFA) and plasma bilirubin levels were analyzed. Plasma total protein and albumin levels doubled with age from the 1st day of life to maturity (from 3.1 to 5.3 and 1.6 to 3.7 g/l, respectively). THu, NEFA and bilirubin levels were inversely related to age, and decreased from 81 to 37%, 2,136 to 239 microEq/l and 2.4 to 0.20 mg/dl, respectively. A linear correlation was shown between THu and albumin, NEFA, and bilirubin plasma concentrations. Stepwise multiple linear regression analysis, including albumin, NEFA and bilirubin values as independent variables, identified NEFA as the variable explaining most of the variability in plasma protein binding of theophylline. Findings support the need for careful interpretation (with a view to therapeutic utilization) of estimates of plasma protein unbound fraction of a drug during development. This fact highlights the importance of considering not only protein but NEFA concentrations too.
Age Factors↗
Review on therapeutic options in HIV associated thrombocytopenia with emphasis on i.v. immunoglobulin treatment.
Thrombocytopenia as a complicating event in human immunodeficiency infection is a rather common hematological disorder and in many aspects resembles idiopathic(immune) thrombocytopenic purpura (ITP). Consequently, treatment of severe cases is similar to treating ITP, but steroids should be administered with particular caution in patients suffering from AIDS. Alternatives to steroids are considered in the present article with emphasis on intravenous immunoglobulin as a means to favourably influence the pathogenic events on the platelet surface.
Acquired Immunodeficiency Syndrome↗
Clinical significance of platelet-associated immunoglobulins in narcotic addicts with human immunodeficiency virus infection.
Increased amounts of platelet-associated immunoglobulin G (PAIgG) have been reported in human immunodeficiency virus (HIV)-infected patients with thrombocytopenia. We have prospectively investigated PAIgG in 21 asymptomatic (group A; CDC stages IIA-IIB) and 9 symptomatic (group B: CDC stages IIIB-IV) HIV-infected narcotic addicts. In both groups only two subjects presented with a decreased platelet count. By competitive ELISA, we found a 1.8- and 2.3-fold greater total PAIgG (PAIgGtot) as measured on platelet lysates in group A and B, respectively; surface-bound IgG (PAIgGsurf) as measured on intact platelets was 2.5- and 3.0-fold greater in groups A and B, respectively, as compared to 36 controls. The ratio between PAIgGtot and PAIgGsurf was lower in HIV-infected addicts when compared to controls (P less than 0.05). This indicates that platelets from HIV-infected subjects not only have increased surface and internal pools of PAIgG, but also present with a distribution between these two pools that differs from that of normal platelets. In addition, levels of circulating immune complexes (CIC) were abnormally raised in 17/21 (81%) subjects of group A in 6/9 (66%) subjects of group B.
Adult↗
Hematology and serum chemistry values of adult, pregnant and newborn New Zealand rabbits (Oryctolagus cuniculus).
Hematological and serum chemistry values were determined in adult female and pregnant New Zealand rabbits (Oryctolagus cuniculus) and their newborn at delivery. No significant difference was found between adult and pregnant hematological profiles. In the newborn, RBC were significantly lower and WBC, MCV and MCH higher than in their mother and adults. A characteristic protein profile was observed for the serum of each animal group, as well as for amniotic fluid. Lipoprotein pattern of the newborn was close to that of the dam, which differed from the adult female rabbit profile. The serum biochemical patterns are close to those of humans, suggesting that the New Zealand rabbit could be a reliable animal model for studies in the perinatal field involving monitoring of selected variables.
Animals↗
[Platelet-associated immunoglobulin G (PAIgG) and circulating immune complexes in asymptomatic and symptomatic HIV-seropositive patients].
Circulating immune complexes and platelet associated immunoglobulins G (PAIgG) were measured in 14 clinically asymptomatic and 9 diseased HIV infected subjects and compared to their platelet counts in the peripheral blood. In both groups, circulating immune complexes were found to be increased even in the presence of normal platelet counts. Increased PAIgG levels were found in symptomatic HIV infected subjects, along with thrombocytopenia. This study indicates that the mere occurrence of circulating immune complexes is an insufficient finding for induction of thrombocytopenia. Either the molecular composition of the complexes is different in both patient groups, or the thrombocytopenia is induced by additional platelet damaging compounds, e.g. specific antiplatelet antibodies induced by the viral infection.
Acquired Immunodeficiency Syndrome↗
Trends in clinical hemapheresis 1986. Progress report on the 4th annual meeting of the European Society for Hemapheresis.
After a rather long initial period fraught with difficulties, plasma exchange has become an adjunct to the treatment of numerous diseases, such as hyperviscosity syndrome, where it alleviates disease symptoms, hemophilia due to inhibitors to clotting factor VIII, thrombotic thrombocytopenic purpura, rapidly progressing and Goodpasture glomerulonephritis, myasthenia gravis and Guillain Barré syndrome. In addition, plateletpheresis has also grown from being a procedure of experimental clinical application to one of practical routine importance; at the Berne University Hospital, approximately 25% of all transfused platelets in 1986 were apheresis platelets, a proportion that elsewhere may reach 40%. Despite the successes so far obtained with apheresis, many aspects of this therapy remain to be reconsidered. Improvement of donor-recipient matching and of yield in plateletpheresis, better selection of replacement fluids, and increased donor and patient safety and comfort may further strengthen the value of apheresis in therapeutic protocols. This was the major background for the scientific program of the 4th Annual Meeting of the European Society for Hemapheresis that was assembled to shed light on those aspects of the apheresis field which are still unclear. A total of 31 lectures and 76 individual contributions were debated by 280 participants from Europe and overseas. The present essay is a review of the highlights of this meeting, the main lectures of which were published in Plasma Therapy and Transfusion Technology, vol. 7, 1986.
Acquired Immunodeficiency Syndrome↗