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Biomedical subjects

F Cirillo

Publications and source records attributed to F Cirillo.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Colorectal obstruction caused by cancer].

The authors report their experience, matured in 10 years, in the management of cancer of the rectum and large bowel complicated by obstruction; 425 patients out of 493 total cases of colorectal cancer presented an intestinal obstruction and underwent emergency surgery. In 386 cases it was possible to perform resection (91%). The surgical treatment of the patients with right colon obstruction usually consisted of a right hemicolectomy. The surgical treatment of left colon obstruction is still controversial; in the experience of the authors it was accomplished by Hartmann operation mainly until 1985; in recent years the authors have introduced a procedure of intraoperative anterograde irrigation of the colon and they have performed resection-anastomosis in a single stage successfully but only in selected patients. In 4 out of twelve cases of cancer of the splenic flexure a subtotal colectomy was performed with one stage ileo-sigmoid anastomosis crowned with success. The authors examine the operative and postoperative mortality of the patients with colorectal cancer and point out that 5 years survival is worse in patients with colorectal obstruction compared to elective operations (24% versus 41%).

Adult↗
PubMed1995

Spondyloepiphyseal dysplasia tarda and nephrotic syndrome in three siblings.

The association of a spondyloepiphyseal dysplasia tarda (SED-T) with the nephrotic syndrome (NS) was found in three siblings. They have counsaguineous (first cousins) healthy parents. Patient 1 was a boy who was admitted to hospital for oedema at the age of 8 years; NS was diagnosed, renal biopsy revealed mesangioproliferative glomerulonephritis. After 4 years he developed end-stage renal failure and died whilst on haemodialysis. Combined therapy with cyclophosphamide and prednisone was of no benefit. At the age of 11 years his height was 122 cm (< 3rd percentile -3.2 SD); he had a short neck, broad and prominent chest and a short wide trunk. Patient 2, another male, had non-nephrotic proteinuria in a 24-h urinary sample at the age of 11 years; this was confirmed in a later analysis; mild lymphopenia and a reduction of helper T cell (OKT4)/suppressor T cell (OKT8) ratio was also detected. At 22 years of age he was admitted to hospital with end-stage renal failure. He was on haemodialysis for a few months until his mother donated a kidney. At the age of 22 years his height was 157 cm (< 3rd percentile), he had a short trunk with the thoracic cage increased in anteroposterior diameter and shoulder elevation. Roentgenograms revealed a disostosis of the spinal column and pelvis and a slight lombar platyspondylia. Patient 3, a girl, was admitted to hospital at 12.5 years for pain and restricted mobility of the right hip. X-rays showed deep acetabula and short femoral necks and mild dysplastic changes, especially in the right hip.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Cu/Zn superoxide dismutase in patients with non-familial Alzheimer's disease.

Chromosome 21 contains genes whose altered expression has long been associated with Down's syndrome and whose altered structure with some cases of Alzheimer's disease (AD). The gene for the Cu/Zn superoxide dismutase enzyme (SOD-1), a key enzyme in the metabolism of oxygen free radicals, is located on the distal portion of chromosome 21. Due to the triplication of the SOD-1 gene, patients with Down's syndrome have an almost 50% increase in their SOD activity. On the other hand, almost 25% of the patients with Down's syndrome over 40 years of age develop progressive dementia, with clinical symptoms of AD. Therefore, we decided to evaluate whether abnormalities in the production of free radicals could be detected in blood cells from AD patients, and whether they correlated with molecular variations in the Cu/Zn SOD-1 gene. Superoxide anion production was evaluated spectrophotometrically in suspensions of monocytes from 9 sporadic AD patients, and from 9 aged-matched apparently normal controls. After stimulation with increasing concentrations of n-formyl-methionyl-leucyl-phenylalanine (fMLP) or Ca ionophore A23187, monocyte free radical generation was quantitatively and qualitatively normal. Furthermore, restriction fragment length polymorphism (RFLP) analysis of leukocyte DNA digested with a variety of enzymes, gave comparable results in patients and controls. Our data support the possibility that in addition to the generation of free radicals, other directions should be explored to elucidate the mechanisms of dementia in AD.

Aged↗
PubMed1995

Early postoperative myocardial ischemia after coronary artery bypass grafting. Detrimental effects of nitroglycerine infusion.

This study was aimed at assessing the incidence and mechanisms of myocardial ischemia early after coronary artery bypass grafting and the effects of treatment with nitroglycerine. The electrocardiogram of 35 patients (29 males and 6 females, mean age 61 +/- 8 years) with stable angina and multivessel coronary disease, was monitored continuously for 24 hours after uncomplicated coronary artery bypass grafting. Patients were randomized to receive nitroglycerin infusion or placebo. Fourteen of the 35 patients (40%) had 24 transient ischemic episodes (mean duration 11.8 +/- 3.5 min; range 6-20 min with ST segment elevation in 6, ST segment depression in 7 and both ST segment elevation and depression in 1. Seventy-five per cent of the ischemic episodes occurred within the first 6 postoperative hours. The mean ejection fraction prior to surgery and the mean number of stenosed vessels and of the implanted grafts were similar in patients with and without postoperative ischemia (57 +/- 5 vs 57 +/- 6%, p = 0.86; 2.7 +/- 0.5 vs 2.8 +/- 0.4, p = 0.52 and 3.0 +/- 0.9 vs 3.2 +/- 0.7, p = 0.51, respectively) as well as total bypass time and cross-clamp time (123 +/- 38 vs 124 +/- 18 min, p = 0.89 and 67 +/- 20 vs 70 +/- 14 min, p = 0.68, respectively). The values of heart rate and systolic blood pressure at the onset of the ischemic episodes were similar to those recorded 15 min before (103 +/- 16 vs 106 +/- 18 b/min, p = 0.36 and 119 +/- 12 vs 121 +/- 14 mmHg, p = 0.48). Ischemic episodes were recorded in 9 of the 16 patients (56%) randomized to receive nitroglycerine and in 5 only of the 19 patients (26%) randomized to receive placebo (p = 0.05). Thus, transient ischemic episodes occurring early after coronary artery bypass grafting are not preceded by an increase in myocardial oxygen consumption; they appear to be due, therefore, to a primary reduction in coronary blood flow. Treatment with nitroglycerine is associated with a higher prevalence of ischemic episodes, thus suggesting that myocardial ischemia is unlikely to be caused by spasm of large epicardial vessels or grafts. Myocardial ischemia may be caused, instead, by extracorporeal circulation-induced alterations enhanced by the hypotensive effects of nitroglycerine.

Aged↗
PubMed1995

Improved beta-adrenergic receptor function after coronary artery bypass grafting in patients with congestive heart failure.

BACKGROUND: To evaluate whether coronary artery bypass grafting (CABG) in patients with congestive heart failure (CHF) modifies beta-adrenergic receptor dysfunction, we measured lymphocytic beta-adrenergic receptor density and function, and plasma catecholamine levels in patients with congestive ischaemic disease scheduled for CABG. METHODS: Assays were performed on 20 patients with CHF at admission and 6 months following CABG; 20 age-matched healthy subjects served as the control group. RESULTS: Preoperative lymphocyte beta-adrenergic receptor density was significantly reduced in patients with CHF compared with the control group. Similarly, basal adenylyl cyclase as well isoproterenol- and NaF-stimulated adenylyl cyclase activity was significantly reduced in lymphocytic membranes of patients with CHF compared with controls. Conversely, no difference was found in forskolin-stimulated adenylyl cyclase activity between the two groups of patients. Preoperatively, plasma levels of both noradrenaline and adrenaline were significantly higher in patients with CHF compared with the control group. CABG was associated with clinical and haemodynamic improvement in all patients. Lymphocyte beta-adrenergic receptor density and function were also improved. Basal beta-adrenergic receptor density improved from 39.2 +/- 1.7 to 46 +/- 1.5 fmol/mg protein. Basal adenylyl cyclase activity increased from 33.1 +/- 2.6 40 +/- 2.4 pmol/mg protein per min; a significant increase in activity stimulated by isoproterenol (from 41.5 +/- 3.1 to 61 +/- 3.8 pmol/mg protein per min) and by NaF (from 71.8 +/- 2.7 to 85.3 +/- 3.5 pmol/mg protein per min) was also observed. Although postoperative plasma catecholamine levels tended to decrease, the difference compared with preoperative values was not significant. CONCLUSION: The results of our study indicate that CABG in patients with CHF is accompanied by the restoration of an almost normal functional state of the lymphocytic beta-adrenergic receptor system.

Adenylyl Cyclases↗
PubMed1993

Abnormally high thromboxane biosynthesis in homozygous homocystinuria. Evidence for platelet involvement and probucol-sensitive mechanism.

Homocystinuria due to homozygous cystathionine beta-synthase deficiency is an inborn error of metabolism characterized by a high incidence of thrombosis and premature atherosclerosis. We evaluated TXA2 biosynthesis in vivo and several in vitro tests of platelet function in 11 homocystinuric patients and 12 healthy controls. In vitro, patients' platelet aggregation was within control values as were TXB2 formation, fibrinogen binding, and ATP secretion in response to thrombin. In contrast, the urinary excretion of 11-dehydro-TXB2, a major enzymatic derivative of TXA2, was > 2 SD of controls in all patients (1,724 +/- 828 pg/mg creatinine, mean +/- SD, in patients vs. 345 +/- 136 in controls, P < 0.001). The administration to four patients of low-dose aspirin (50 mg/d for 1 wk) reduced metabolite excretion by > 80%. The recovery of 11-dehydro-TXB2 excretion over the 10 d that followed aspirin cessation occurred with a pattern consistent with the entry into the circulation of platelets with intact cyclooxygenase activity. Prolonged partial reduction in the abnormally high excretion of both 11-dehydro-TXB2 and 2,3-dinor-TXB2, was also observed in seven patients who ingested 500 mg daily for 3 wk of the antioxidant drug probucol. These results provide evidence for enhanced thromboxane biosynthesis in homocystinuria and for its partial dependence on probucol-sensitive mechanisms. Furthermore, the elevated TXA2 formation in homocystinuria is likely to reflect, at least in part, in vivo platelet activation.

Adolescent↗
PubMed1993

[Autohemotransfusion in cardiac reoperations].

OBJECTIVE: To evaluate the efficacy of intraoperative autotransfusion with hemodilution (AHT) to reduce postoperative transfusion of blood or blood products (BT) after cardiac surgery reoperation. DESIGN: Retrospective study, follow-up control. SETTING: Italian Institution of Cardiac Surgery (IICC). PATIENTS: 169 patients (51 males, 118 females; mean age 49.5 years) undergoing a reoperation from May 1982 to December 1991. INTERVENTIONS: 143 patients single valve replacement, 16 patients double valve replacement and 10 patients radical correction for tetralogy of Fallot. AHT (mean 620.2 +/- 226.9 ml) was performed in all patients. The shed blood was reinfused at the end of the surgery. PT, PTT, TT, TT Coagulase, FDP, pre- and postoperative platelet count, bleeding and needs for BT were recorded. RESULTS: Preoperatively: PT 71.3 +/- 8.1, PTT (sec.) 36.9 +/- 3.5, TT (sec.) 16.2 +/- 2.3, TTC (sec.) 16.9 +/- 1.7, FDP (ng% ml) 3.8 +/- 2.7, Platelet count (No./mu 11 170 +/- 58. Postoperatively: PT 36.5 +/- 6.5, PTT(sec.) 49.5 +/- 8.7, TT(sec.) 19.1 +/- 1.8, TTC(sec.) 18.9 +/- 2.1, FDP (ng% ml) 13.5 +/- 8.9, Platelet count (No./mu 11) 85 +/- 34. We had one reentry because of bleeding. The mean units of blood or blood products need after surgery were 2.2 +/- 1.02. Bleeding from the drainage was 105.2 +/- 103.8. Two patients died in the postoperative period because of low output syndrome. In a period of one year of F.U. we had only one patient with hepatitis B. CONCLUSIONS: These data suggest that AHT is a safe method, reduces needs for banked blood or blood products, risks of infectious disease transmission and of immunologic reactions and presents hemorheologic benefits because of the diminished blood viscosity.

Blood Transfusion, Autologous↗
PubMed1992

[Zenker's diverticulum in the elderly. Description of a case and surgical treatment].

The authors report a case of Zenker's giant hypopharyngeal diverticulum in an elderly patient who underwent surgery due to the severity of symptoms. This diverticulum, which is both juxtasphincteric and epiphrenal, has a pulsion pathogenesis: the presence of a hernia on the esophageal side (jato?), with which Zenker's diverticulum is frequently associated and which is often followed by reflux esophagitis, is enough to cause motor asynchronism of the crico-pharyngeal muscle which, in the presence of hypertonic conditions during deglutition, leads to the formation of a high-pressure pouch which is then responsible for the formation of the diverticulum itself. It is therefore important to check whether an associated esophageal pathology exists once Zenker's diverticulum has been diagnosed: X-ray examinations of the upper digestive tract are undoubtedly capable of identifying the presence of the diverticulum as well as other pathological associations. In the present case it was not possible to perform a sufficiently exhaustive X-ray examination in order to exclude associated esophageal pathologies. Endoscopy may be superfluous and contraindicated in cases of large diverticular pouches. Symptoms vary depending on the size of the diverticulum. A feeling of dysphagia may precede the appearance of the diverticulum, even by several years, before the onset of symptoms related to the ingestion of food: initially the patient may experience the sensation of a foreign body while eating due to the accumulation of ingested food in the diverticulum; this is followed by halitosis, sialorrhea, noisy deglutition, regurgitation of undigested food especially during sleep, and frequently bronchopulmonary symptoms "ab ingestis".(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

In vitro inhibition by defibrotide of monocyte superoxide anion generation: a possible mechanism for the antithrombotic effect of a polydeoxyribonucleotide-derived drug.

In an attempt to elucidate the antithrombotic potential of defibrotide (D) we have evaluated several functions of monocytes from 7 healthy subjects before and after in vitro incubation of the cells with increasing concentrations of this drug. At concentrations as high as 40 micrograms/ml, D hardly affected the expression of both the procoagulant activity of monocytes and the formation of superoxide anion in response to 1 mg/ml zymosan (STZ). In contrast, at concentrations that may be achieved in vivo following the administration of the drug (5-20 micrograms/ml), D impaired in a dose-dependent manner (p less than 0.05) the generation of O-2 in response to N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP, 1 microM) or calcium ionophore A23187 (10 microM). Regardless of the agonist employed, at concentrations between 1 and 5 mM, extracellular Ca2+ had little effect on the impairment of superoxide anion generation by D. In contrast, the inhibitory effect was time-dependent, the maximum impairment (greater than 30%) being observed when the cells were preincubated with the drug for 20 h. These data support the concept that the antithrombotic potential of D involves the ability of the drug to affect the generation of free radicals by leukocytes and suggest that future in vivo studies for the evaluation of the activity of D should take into account the role of monocytes in hemostasis and thrombosis.

Adult↗
PubMed1990

[Impairment of diuresis in surgical intervention. Role of urinary prostaglandins].

In 8 patients who underwent abdominal surgery for non-neoplastic reasons, we have evaluated some parameters of renal function (PRP, NaU, GFR and diuresis) plasma levels of PRA and ADH and urinary prostaglandins PGE2 and 6-keto-PGF1 alpha. In 4 patients we found that surgery per se was associated with enhancements of PRA, ADH and 6-keto-PGF1 alpha. In other 4 patients, Indomethacin, a specific inhibitor of prostaglandin synthesis was given and this was followed by impairment of natriuresis and RPF. These data confirm the central role of prostaglandins in the control of diuresis and natriuresis and suggest that use of drugs affecting prostaglandin synthesis should be avoided in patients who are undergoing surgery.

Adult↗