Biomedical subjects
Publications and source records attributed to D Costantini.
Renal involvement has rarely been reported in patients with cystic fibrosis. We describe severe nephropathy with a rapidly fatal outcome in three adolescents with cystic fibrosis, and evaluate the important repercussions that the nephrotic syndrome had on the precarious clinical situation of these patients.
An Italian multicenter study has been carried out in order to obtain data on survival and prognostic factors in CF. We report data from four CF Centers: Milan, Neaples, Cagliari, Rome, Anagraphic data, mode of presentation and of diagnosis were collected, using CFDB database, from 536 CF pts. 39 pts had meconium ileus (7.3%); 269 (50%) were diagnosed before 12 months of age. 27 pts were lost to follow-up (5%); and 65 pts died (12%). Statistical analysis was performed by Kaplan-Meier survival curves compared by Logrank test.
Nasal polyposis appears frequently in C. F. patients. Our study intends to evaluate the efficacy of topical beclomethasone dipropionate (BMD) when administered in a position designed to increase exposure of nasal and paranasal sinuses mucosa to the drug. 14 patients were analysed: the size of the polyps was assessed by rhinoscopy and rhinomanometry at the beginning and at the end of the therapy. Our findings show that nasal polyps can be successfully treated medically in a significant number of C. F. patients.
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We evaluated nutritional status, pulmonary impairment, nutritional intake, and fat absorption in 73 cystic fibrosis (CF) patients to identify the primary factor(s) influencing growth. In general, the growth pattern in our patients was satisfactory since 60/73 were not underweight. When caloric intake is greater than or equal to 95% of RDA, wasting does not occur regardless of the degree of malabsorption, dietary fat content, or lung involvement. In the group of patients who consume less than the RDA, underweight is related to the severity of pulmonary disease; indeed, 11/13 underweight patients have a chest x-ray score over 15. Steatorrhea is well controlled in most patients; only 11 of 73 show a fat excretion greater than 25% of fat intake. The daily number of capsules of Pancrease varies from 4 to 57. The amount of Pancrease to be given was individualized to meet each patient's requirements using fat balance studies to determine the necessary daily Pancrease dose, then distributing the total dose in proportion to the fat content of each meal.
In this article the authors propose: 1) a typology of drug addiction cases consisting of four main classes: A. traumatic drug addiction, B. drug addiction from actual neuroses, C. transitional drug addiction, and D. sociopathic drug addiction; 2) a clinical study (with 18 months of follow-up data) involving 131 heroin addicts mostly treated with structural or counterparadoxical family therapy in the same psychotherapy center and in the same year; and 3) some preliminary conclusions emerging from an examination of the four-class typology with respect to the effectiveness of family therapy interventions. If, for example, structural family therapy techniques seem more suitable in type-B cases (similar to cases described by Haley in his Leaving Home), the counterparadoxical techniques are likely to be more effective in type-C cases (similar to the anorectics described by Selvini-Palazzoli).
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The aim of this study was to evaluate the problems found in performing chest physiotherapy (PKT) by patients with Cystic Fibrosis (CF) and by their families. The research has been based upon processing 389 questionnaires (46 items) that were compiled by the families. Thirteen CF centers all over the nation have participated in this study. Patients' mean age was 7.4 years (range 2 months to 14 years). Data about the socio-economic status and illness severity were available for every patient. Many graphs (line connects points with a line = n. 8; bar charts = n. 17; pie charts = n. 13) show the results and their statistical processing. Our purpose was to solve the following problems: 1) What is the extent of the compliance? 2) Who perform, or should perform, PKT in the family environment? 3) What is the kind and extent of the help request? 4) What are the mistakes made in executing PKT? 5) What is the usefulness of precursors and aerosol therapy? 6) What is the link between physical activity and PKT? 7) What are the main difficulties in performing PKT? 8) How effective is PKT? 9) What is the extent of the parents' faith in their capabilities? 10) Are there any prejudices against PKT? Three major findings emerge from this study: 1) the compliance appeared good; 2) the average family understood the meaning of PKT correctly and 3) PKT is usually executed properly. As for negative results are concerned, it is to be noted that the burden of performing PKT is usually up to the mother. This finding is linked both to the socio-economics status of the family and to the severity of the illness. On the other hand, a home PKT service is only asked in very extreme situations such as sudden worsening of the patient's illness. The difficulties met in performing PKT range from the patient's refusal to logistical and organization problems, which are correlated with the socio-economic status of the family. The relationship between PKT and sport is understood well and there is a high percentage of patients doing regular physical activity, even if it is often hindered by the severity of the disease. In conclusion, although there are many problems, there are also many methods to use in order to improve the acceptance and the effectiveness of the PKT.
To evaluate whether the addition of an aminoglycoside might enhance the clinical efficacy of ceftazidime in cystic fibrosis patients with acute exacerbations of chronic Pseudomonas lung infections we carried out a prospective, comparative, randomized blind study with three schedules: ceftazidime vs. ceftazidime plus sisomicin (C/S) vs. piperacillin plus sisomicin, for a total of 60 courses of 14 days of treatment. Each treatment led to clinical and radiologic improvement with marked reduction of signs of acute infection. Statistically there was no significant difference in clinical responses among the schedules. No side effect appeared during treatments with ceftazidime or C/S. Hyperpyrexia was seen in 35% of patients receiving piperacillin. Decrease in Pseudomonas aeruginosa count to less than 10(5) colony-forming units/ml of sputum was achieved in 60% of patients treated with C/S and in 30% of patients who received ceftazidime or piperacillin plus sisomicin (statistically not significant). A transient increase in mean geometric minimal inhibitory concentrations for ceftazidime and piperacillin was observed at the end of the combined therapies. A larger percentage of persistent resistant strains of P. aeruginosa was seen after the combined therapies. We conclude that ceftazidime as monotherapy may be an effective alternative in Pseudomonas lung infections in cystic fibrosis patients. Its clinical efficacy seems not to be enhanced by the addition of an aminoglycoside, although reduction of Pseudomonas in the sputum was better achieved by the combination of C/S.
C 1740 is an immunmodulating agent of biological origin proposed for the prevention of infectious exacerbations in chronic bronchopathy. The first placebo-controlled double-blind randomized clinical trials have led to opposite conclusions regarding the utility of C 1740. The rate of infectious exacerbations in the placebo group and a large Type II error could explain the "negative clinical trials". However, two out of four "positive clinical trials" were associated with high risk of falsely positive results. The activity of C 1740 is discussed here.
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The purpose of our investigation is to evaluate the action of C 1740 (Biostim tablets) on bronchopulmonary cellular defense mechanisms through the study of bronchoalveolar lavage samples. C 1740 is a non-specific immuno-stimulant whose effectiveness in preventing suprainfection of chronic bronchopathies has been demonstrated in clinical studies. Ten patients (mean age 51.5 years; range 37 to 68) with a history of recurrent bronchial infections, but currently free of such disease, were randomly divided into two groups. Five constituted the control group and five were given Biostim (8 mg/day) for 15 days. In both groups a bronchoalveolar lavage with cytological and biochemical studies was done in each patient, at identical intervals (DO and D16). Despite technical difficulties due to bronchial obstruction, which partly hindered the study, significant differences were found between the two groups, showing quantitative and qualitative cellular changes in patients under Biostim, with increased cell, especially lymphocyte, counts. This may be the result of stimulation by Biostim of immunological reactions normally found during the course of bronchopulmonary infections and which undoubtedly play a part in preventing new episodes. These preliminary results need confirmation but throw light on one of Biostim's possible mechanisms of action upon immunological defenses.
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