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Biomedical subjects

F Fallo

Publications and source records attributed to F Fallo.

At least 109 records · Page 6Linked to original sources
PubMed1985

Usefulness of dynamic reno-scintigraphy in the follow-up of patients treated by surgery or percutaneous transluminal angioplasty for renovascular hypertension.

The aim of this study was to assess the role of dynamic reno-scintigraphy (DRS) in follow-up of 21 hypertensive patients who underwent surgery or percutaneous transluminal angioplasty (PTA) for renal artery stenosis. Dynamic reno-scintigraphy was recorded following injection of 0.12 mCi/kg 99Tcm-glucoheptonate i.v. before and after reconstructive vascular surgery or PTA. Serial images and renal time activity were analysed according to established criteria of interpretation. In terms of blood pressure response, 14 patients were cured or improved after surgery or PTA; DRS normalized or markedly improved in all these cases. Dynamic reno-scintigraphy did not change in seven patients who did not benefit from surgery or PTA. In three of them, repeated angiography showed, respectively, a by-pass occlusion, a renal artery re-occlusion after PTA, and a renoparenchymal disease. Dynamic reno-scintigraphy appears to reflect well the recovery of renal perfusion in patients treated by surgery or PTA for suspected renovascular hypertension.

Adult↗
PubMed1984

The contact phase of blood coagulation and renin activation in essential hypertension before and after captopril.

The contact phase of blood coagulation in a group of patients suffering from essential hypertension was studied before and after captopril administration. The baseline levels of factor XII, factor XI and plasminogen were significantly higher than in normals and correlated with baseline diastolic blood pressure levels. On the contrary, plasma prekallikrein was not significantly different from normal. These results suggest the presence of a hypercoagulable state in essential hypertension. After captopril administration, factor XII, factor XI and prekallikrein rapidly decreased, perhaps as a consequence of the drug's effect on the vascular endothelial surface. There was no correlation between the changes of active and inactive renin and the changes of prekallikrein and plasminogen levels. Our data do not support the view that factor XII-plasma kallikrein or plasmin dependent pathways are involved in the activation of inactive renin in vivo. Captopril, by provoking rapid pressure changes, appears to be able to affect the clotting system.

Adult↗
PubMed1983

Effect of metergoline on the aldosterone-stimulating properties of metoclopramide.

The mechanism by which metoclopramide stimulates aldosterone secretion is still unclear, since it cannot be explained by known regulatory systems. On the other hand we have recently shown that serotonin is also a potent aldosterone-stimulatory substance in man and its action can be blunted by the antiserotoninergic drug, metergoline. To test if metoclopramide could act through a serotoninergic pathway we have studied the effect of metergoline on the aldosterone response to metoclopramide in 8 normal subjects. The effect of metoclopramide (10 mg i.v.) on plasma aldosterone, PRA, cortisol, prolactin and K was studied before and after acute metergoline administration. Metergoline pretreatment significantly reduced the aldosterone response to metoclopramide, together with a slight reduction of prolactin, whereas no changes were seen on PRA, cortisol and K. In vitro, metoclopramide induced a significant aldosterone output from human adrenal adenoma cells, which was partially reduced by metergoline and not by bromocriptine. Despite a lack of specificity of metergoline these data may suggest the hypothesis of a serotoninergic component in the aldosterone-stimulating properties of metoclopramide.

Adenoma↗
PubMed1983

Effect of captopril on blood pressure and on the renin-angiotensin-aldosterone system in coarctation of the aorta.

UNLABELLED: To investigate the role of the renin-angiotensin-aldosterone system in hypertension due to coarctation of the aorta (COA), upright mean arterial pressure (MAP), plasma renin activity (PRA) and plasma aldosterone (Aldo) were determined before and 90 minutes after a single oral dose of captopril (25 mg) in eight patients with COA and in fourteen with essential hypertension (EH). There was no significant difference in MAP, PRA or Aldo values between the two groups in baseline conditions. After captopril administration, MAP and Aldo decreased significantly in both groups (p less than 0.01), whereas PRA showed a marked increase in patients with COA (p less than 0.001) and no significant changes in EH patients (from 1.5 +/- 2.2 to 49.7 +/- 9.8 and from 5.6 +/- 0.9 to 8 +/- 1.5 ng/ml/3h respectively). CONCLUSIONS: 1) MAP reduction and marked renin increase after captopril in COA patients support the view that systemic hypertension in COA is, at least in part, renin mediated and 2) the evaluation of PRA after captopril could be helpful in the decision to proceed with more invasive procedures in patients with suspicious clinical features of COA or with residual post-coarctectomy hypertension.

Adolescent↗
PubMed1982

Peripheral and renal vein plasma renin activity in hypertensive urological patients.

Upright plasma renin activity (PRA) was measured in 112 patients suffering from urological diseases associated with hypertension, and was found to be predominantly low. In 40 cases with normal or elevated peripheral PRA, renal venous PRA was measured and their ratios calculated. There was a significant decrease of blood pressure in 14 patients who had undergone surgery and both ratios were significant. The patients whose blood pressure remained unchanged had no significant renal vein PRA ratios. However, one case with nonlateralising renal venous PRA ratios responded well to surgery. It is concluded that although peripheral vein PRA is of limited value in hypertension associated with urological diseases, the measurement of PRA in renal vein plasma offers, in a number of cases, useful prognostic information.

Adult↗
PubMed1982

Effect of captopril on inactive renin and contact phase of coagulation system.

It has been suggested that a Factor XII-plasma Prekallikrein dependent pathway might play an important role in the activation of inactive renin. Since Captopril has the potential to affect the kinin-kallikrein system, we have studied in a group of 16 patients with essential hypertension its acute effect both on the levels of active, inactive and total renin, and on the contact phase of the coagulation system. Our results show that a single dose of Captopril (25 mg) induces a rapid and persistent increase of active and total renin, while inactive renin tends to decrease. Together with blood pressure, plasma Prekallikrein(PK), Factor XII(FXII) and Factor XI(FXI) concomitantly decrease, although not significantly, and their values seem to return to basal levels soonafter. However, no correlation was found at any time between the levels of any of these coagulation factors, including PK, and those of inactive, active or the ratio inactive/total renin. In spite of that, it is still possible that an activation of PK, which is likely to occur under Captopril administration, may affect at least the conversion of vessel-bound prorenin rather than the circulating form.

Adolescent↗
PubMed1981

Mineralocorticoid hypertension due to a nasal spray containing 9 alpha-fluoroprednisolone.

The finding of hypokalemia and of low plasma renin activity (PRA) in a hypertensive patient suggests a diagnosis of primary hypermineralocorticoidism. Medications containing compounds with mineralocorticoid-like activity (licorice, carbenexolone) may also cause the same syndrome. Recently, we carried out detailed studies on 10 patients with severe hypertension and hypokalemic alkalosis, suppressed PRA and low aldosterone levels. Plasma levels of cortisol and ACTH were suppressed in most of the cases. Measurement of deoxycorticosterone and corticosterone (and in some patient of 18-hydroxydeoxycorticosterone and 18-hydroxycorticosterone) was not significantly higher than normal. Therapeutic trials of dexamethasone and aminoglutethimide were ineffective. In contrast, spironolactone and amiloride treatment resulted in substantial but incomplete amelioration of both hypertension and hypokalemia. All of the patients share a common history of chronic rhinitis and habitual use of large doses of nasal spray containing 9 alpha-fluoroprednisolone and vasoconstrictor agents. Withdrawal resulted in a complete remission of hypokalemia in one to two weeks in all patients. The hypertension and depressed levels of PRA, aldosterone and cortisol took longer to return to normal, varying from case to case; in all but one patient, the values returned to normal within two months. This report reveals another cause of factitious mineralocorticoid excess which may be considered in the differential diagnosis of hypokalemic hypertensive syndromes.

Administration, Intranasal↗
PubMed1981

Effect of angiotensin II and converting enzyme inhibitor (captopril) on blood pressure, plasma renin activity and aldosterone in primary aldosteronism.

1. Patients with idiopathic hyperaldosteronism (IHA) show a response of aldosterone to posture which is not present in patients with aldosterone-producing adenoma (APA). We have determined whether this could be explained by a different sensitivity to angiotensin II. 2. Angiotensin II was infused in gradually increasing doses in six patients with APA and in seven patients with IHA. No changes in aldosterone concentration were found at the end of each period in APA, whereas there was a significant increase in IHA; blood pressure rose by a similar extent in both groups. 3. In order to evaluate the role of endogenous angiotensin II, captopril, a converting enzyme inhibitor, was administered to six patients with APA and five patients with IHA at a dose of 75 mg/day for 1 week. There was a significant fall of mean blood pressure in IHA and only minimal changes in APA. Plasma renin activity and plasma in urinary aldosterone were unchanged in APA. In IHA there was a small increase in upright plasma renin activity and a slight decrease in both plasma and urinary aldosterone, but these changes were not significant. 4. These findings further support the idea that idiopathic hyperaldosteronism is a clinical state different from that occurring in primary aldosteronism due to adenoma, and may be more closely related to essential hypertension.

Aldosterone↗
PubMed1981

Effect of metoclopramide on plasma aldosterone in normal subjects, primary aldosteronism and hypopituitarism.

The behaviour of plasma renin, aldosterone, cortisol and prolactin after administration of a drug with antidopaminergic action, metoclopramide, was evaluated in 6 normal subjects, 8 patients affected by primary aldosteronism and in 5 patients affected by anterior hypopituitarism. In the first two groups, besides the predictable increase of prolactin under metoclopramide, a significant aldosterone increase was noted. Cortisol remained unchanged, and PRA was not significantly increased. A similar pattern of aldosterone, cortisol and PRA was also found in patients with hypopituitarism. However, the plasma prolactin did not increase in this group. The comparative examination of three groups of patients leads us to conclude that aldosterone increase is not imputable to ACTH, renin or to prolactin. This may be explained by a possible direct effect of the antidopaminergic drug at the adrenal level, which is more likely than an effect through some yet undetermined factor.

Aldosterone↗
PubMed1981

[Surgical and medical treatment of renovascular hypertension (author's transl)].

We have studied a group of 47 patients with unilateral or bilateral renal artery stenosis; 27 of them have been operated, while 20 have been subjected to medical treatment. Among the surgically treated patients, 18 out of the 22 cases with an unilateral stenosis had satisfactory results and didn't assume any treatment after surgical cure. All the 5 cases of bilateral stenosis presented a regular blood pressure after surgery. Nine among the 12 patients affected by unilateral stenosis and 3 among the 8 patients presenting bilateral forms who received medical treatment had successful results with the conventional therapy. The parameters that seems give a better prognostic indication for the surgical cure are either significant renal veins renin ratios (Ra/Rc and Rc/P), either high peripheral PRA values combined with a renal artery stenosis greater than or equal to 70%, in all the cases without evident damages in the opposite kidney, even if the renin ratios are not significant. The results of the medical treatment may be predicted from the entity of the renal stenosis. Failures are more likely to occur in the bilateral forms. In these cases the most satisfactory results can be obtained using minoxidil or the inhibitor of the converting enzyme of angiotensin I.

Adolescent↗
PubMed1980

[One case of acquired dyserythropoietic anemia: morphologic cytochemical study (author's transl)].

A case of acquired dyserythropoietic anemia is described in a sixty-six year old patient: is characterized by a very considerable pancitopenia, and by the presence in the bone-marrow of notable morphologic atipia both in erythroblastic line and in granulocitopoietic one. The iron kinetics and erythrocitic surviving are highly altered. The citochimic study points out the presence of myelocites with perossidasis-deficit and the presence of PAS positive erythroblasts. These data indicate metabolic anomalies that seem to localize the primitive deficit in the stem-cells.

Anemia, Hemolytic↗
PubMed1979

[Diaxozide-induced acute stimulation of plasma renin activity in renal veins for diagnosis and prognosis in hypertensive patients (author's transl)].

Vena cava and renal veins PRA were measured and their ratios calculated (Ra/Rc and Rc/P) in 15 hypertensive patients before and after diazoside infusion (300 mg i.v.). Among the 4 patients with unilateral renal artery stenosis, 3 had both ratios significant in basal conditions. After diazoxide infusion, the ratios became significant in the 4th case, successfully operated. Surgery induced normalization of blood pressure also in 2 of 3 cases affected by renoparenchimal alterations: of these patients 1 had ratios significant in basal conditions and both after diazoxide. One patient had unilateral renal artery stenosis and controlateral small kidney: his ratios was significant in favour of small kidney both before and after diaxozide infusion. The correction of renal artery stenosis gave no results in blood pressure. In patients with essential hypertension the PRA values in renal veins were not significantly different either before and after diazoxide. In conclusion the acute diazoxide stimulation seems to improve the prognostic value of renal veins PRA and their ratios for the detection of surgically curable forms of renal hypertension.

Adolescent↗
PubMed1978

Plasma renin activity in coarctation of the aorta before and after surgical correction.

In 37 patients with coarctation of the aorta, arterial blood pressure and ambulant plasma renin activity (PRA) were determined before and, in 15 patients, after surgical correction. The systolic blood pressure was raised in all the cases and the diastolic pressure was raised in 30 patients. Ambulant PRA was increased in 11 patients when compared with normal subjects of similar age. Twelve of the 15 operated patients had a significant decrease of systolic pressure after operation. Eight had raised PRA, and in 7 of these PRA fell to normal after operation and the blood pressure also fell; in 1 patient the decrease of PRA was unaccompanied by a fall in blood pressure. Though there was no significant correlation between the changes in blood pressure and PRA after operation it seems possible from our results that the renin-angiotensin system may be activated and contribute to the raised arterial pressure which occurs in patients with aortic coarctation.

Adolescent↗
PubMedDate not supplied

Paclitaxel is an effective antiproliferative agent on the human NCI-H295 adrenocortical carcinoma cell line.

In view of a potential clinical use, we assessed the antiproliferative effect of paclitaxel on the human steroid-secreting NCI-H295 adrenocarcinoma cell line. By MTT, paclitaxel induced a dose-dependent inhibition of cell proliferation, with IC50 lower than blood levels of the drug achieved in patients treated for other malignancies. Cell exposure to paclitaxel for 24 h at the different IC50S produced a dose-responsive increase in DNA fragmentation, morphologically confirmed by electron microscopy. A time-dependent decrease in aldosterone, cortisol and testosterone was observed. Paclitaxel is an effective antiproliferative agent in this human adrenocortical carcinoma cell line. Apoptosis induced by the drug in involved in neoplastic cell death. A potential role of the drug in the treatment of patients with adrenocortical cancer could be considered.

Adrenal Cortex Neoplasms↗
PubMedDate not supplied

A clinical index for rating severity in Cushing's syndrome.

BACKGROUND: In assessing the clinical response to medical and/or surgical treatments in patients with established Cushing's syndrome, the need for an instrument that could measure the magnitude of changes in the most common symptoms was felt. We therefore tested the usefulness of a simple clinical index, the Cushing's syndrome severity index (CSI), based on clinimetric principles. Eight clinical features were selected. Each one was graded on an ordinal 3-point scale (0-2) with specification of anchor points based on severity. The total score ranged from 0 to 16. METHODS: Interrater agreement, construct validity and concurrent validity of the index were evaluated. Fourteen patients with Cushing's syndrome were evaluated independently by 2 endocrinologists before and after successful treatment. The CSI and two global scales of illness severity were administered. Urinary cortisol measurements were also performed. RESULTS: The intraclass correlation coefficient of the CSI was 0.95 before treatment and 0.87 after treatment. The CSI significantly discriminated (p<0.001) the effects of treatment and paralleled the changes in urinary cortisol. There were significant correlations between CSI and global scales of illness severity and change after treatment. CONCLUSION: The results indicate that the CSI is a valid and reliable clinimetric method to evaluate severity in Cushing's syndrome. It may provide a tool for better assessing the complex array of signs and symptoms in this condition. The index is suitable for descriptive studies, outcome investigations and treatment trials.

Adolescent↗
PubMedDate not supplied

Clinical correlates of major depression in Cushing's disease.

Major depression is a common, life-threatening complication of Cushing's syndrome, with no significant differences between pituitary-dependent and -independent forms. Little is known about the clinical correlates of depression; in particular, whether patients with Cushing's disease and major depression show some clinical features that are distinctive compared to those who are not depressed. The occurrence of major depression according to DSM-IV criteria was ascertained in 162 patients with pituitary-dependent Cushing disease. Major depression occurred in 88 of the patients (54%). It was significantly associated with older age, female sex, higher pretreatment urinary cortisol levels, relatively more severe clinical condition, and absence of pituitary adenoma. Patients with Cushing's disease and depression appeared to suffer from a more severe form of illness, both in terms of cortisol production and clinical presentation, compared to those who were not depressed. Because of these connections, the presence of depression is an important clinical feature that should not be neglected. The findings in this study may have implications for a better understanding of the pathophysiological role of depression associated with medical illness.

Adult↗