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Biomedical subjects

F Ferrario

Publications and source records attributed to F Ferrario.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Surgical treatment of otosclerosis in the aged. Results of retrospective analysis].

Otosclerosis is, per se, a disease which rarely occurs after the age of 50. This is why stapes surgery is seldom performed in advanced age and there are few reports on the topic in the literature. The authors have performed a retrospective analysis of patients over the age of 65 who had undergone surgery for otosclerosis in the last 27 years. Out of a total of 3585 surgical procedures, 106 patients were analyzed. Most of the cases were in the advanced stages. Assessment of the outcome included pre- and post-operative audiometry, one year after surgery. Inner ear performance was established by evaluating air and bone conduction at 0.5, 1, 2, 3 and 4 kHz. The results showed that performing otosclerosis surgery is worthwhile even in the elderly with mixed auditory impairment, as long as the air-bone gap is limited to 20-30 dB and the surgical procedure is through. In this light, stapedotomy appears to be the most adequate technique. When evaluating the results the possibility of adopting a less powerful hearing aid should also be considered a success.

Age Factors↗
PubMed1996

Prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal mucosal injury. A meta-analysis of randomized controlled clinical trials.

BACKGROUND: The policy of prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal mucosal injury is still a matter of discussion. Indeed, no consensus exists as to whether cotherapy with histamine type 2 (H2) blockers or misoprostol is cost-effective. METHODS: Placebo-controlled randomized clinical trials on the use of H2 blockers or misoprostol, as preventive agents (published between) January 1970 and December 1994), were identified through MEDLINE and reference lists from literature reviews. Crude rates of endoscopic lesions with short-term (< 2 weeks) and long-term (> 4 weeks) NSAID treatment were systematically assessed by 3 independent observers based on the intention-to-treat principle. The method of DerSimonian and Laird was used for pooling data. Heterogeneity was evaluated by using the Q statistic and the plots described by L'Abbe and colleagues. RESULTS: Twenty-four trials met the criteria for entry into the study. Gastric ulcer was found to be significantly reduced by misoprostol-both in short-term (pooled rate difference [RD], -13%, 95% confidence interval [CI], -26% to -1%) and long-term (RD, -8%; 95% CI, -18% to -1%) NSAID treatment-but not by H2 blockers. The risk for duodenal ulcer was significantly reduced by H2 blockers (RD, -2%; 95% CI, -5% to -0.2%) and by misoprostol (RD, -3%; 95% CI, -6% to -0.1%) in long-term but not in short-term administration. CONCLUSIONS: The use of misoprostol, but no that of H2 blockers, was beneficial in the prevention of NSAID-induced gastric ulcers. The number of patients to be treated to prevent 1 gastric ulcer with short- and long-term NSAID treatment is 11 and 15, respectively, for an intermediate baseline risk of 10%. Misoprostol and H2 blockers were beneficial in the long-term prevention of duodenal ulcers; misoprostol or H2 blockers in the short-term prevention of duodenal ulcers remains to be confirmed.

Adolescent↗
PubMed1996

Intraglomerular and interstitial leukocyte infiltration, adhesion molecules, and interleukin-1 alpha expression in 15 cases of antineutrophil cytoplasmic autoantibody-associated renal vasculitis.

In renal biopsy specimens from 15 patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated renal vasculitis, the infiltrating intraglomerular and interstitial leukocytes were localized and the adhesion molecules intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) and the cytokine interleukin-1 alpha (IL-1 alpha) were studied by an immunohistochemical method. Intraglomerular leukocytes were mainly macrophages (13.46 +/- 9.29 cells/glomerular cross-section) and, to a lesser extent, T lymphocytes (4.61 +/- 2.81 cells/glomerular cross-section). Staining with VCAM-1, which was negative in the undamaged tufts, was strongly positive in necrotizing-extracapillary lesions. Staining with ICAM-1 was also present in the damaged tufts, but its pattern was more diffuse. Intraglomerular IL-1 alpha was found in all biopsy specimens. Where the Bowman's capsule was not damaged, the periglomerular infiltrating cells were macrophages (42.6 +/- 25.2 cells/glomerular cross-section) and T lymphocytes (51.06 +/- 33.0 cells/glomerular cross-section). When there was a granulomatous lesion involving the glomerulus, the number of cells per granulomatous area revealed a massive number of CD45-positive leukocytes (345.83 +/- 237.47 cells/granulomatous lesion), many of them positive for activity markers (HLA-DR, IL-2R), adhesion molecules, and IL-1 alpha. Many activated cells were also present in interstitial areas of perivascular clusters of leukocytes, in which T lymphocytes (prevalently CD4+ cells) outnumbered the macrophages (331.55 +/- 207.85 cells/0.05 mm2 area v 125.68 +/- 60.57 cells/0.05 mm2 area). Adhesion molecules and IL-1 alpha were found in both tubular and vascular areas in all biopsy specimens. Our data strongly support the involvement of both the adhesion molecules ICAM-1 and VCAM-1 in the recruitment of intraglomerular leukocytes in renal vasculitis, indicate that VCAM-1 is a very good marker of necrotizing-extracapillary damage, and suggest its crucial connection with the macrophage recruitment in these vasculitic lesions. The presence of histochemically detectable levels of IL-1 alpha in glomeruli, tubules, and vessels and on some inflammatory cells supports its involvement in the vasculitic lesions, probably by triggering a positive feedback that increases the damage.

Adult↗
PubMed1996

Renal vasculitis.

The term 'vasculitides' encompasses a group of inflammatory disorders which may affect the kidney by damaging its blood supply. Although the kidney may be affected by many types of systemic vasculitis, renal involvement is particularly frequent in some forms of systemic necrotizing vasculitis which are considered primary, such as Wegener's granulomatosis and microscopic polyarteritis, including its 'renal-limited' variant. Renal vasculitis can occur at any age, but is seen particularly frequently in middle-aged and elderly subjects, in whom clinical presentation and prognosis are significantly worse. In addition to the specific problems related to age, this review focuses on a few aspects that are still the subjects of debate: classification, the role of ANCA, renal pathology and the treatment of renal vasculitis.

Age Factors↗
PubMed1996

The renal histopathology in systemic vasculitis: an international survey study of inter- and intra-observer agreement.

In order to relate histopathological findings of the kidney in systemic vasculitis to renal outcome, scoring of various morphological parameters is necessary. Therefore, we conducted a standardization study for evaluating renal biopsies from patients with systemic vasculitis. Four experienced renal pathologists from four European centres joined in the study. A scoring protocol was devised that required the observers to score an extensive number of histopathological lesions either quantitatively (as a percentage of the total number of glomeruli) or dichotomously (on a present/absent scale). Twenty renal biopsies were scored individually by all the observers, from which the inter-observer variability was analysed. Ten randomly chosen biopsies were scored again, in order to obtain the intra-observer variability. For inter-observer agreement, the evaluation of the quantitative variables was satisfactory for both rounds (0.55 < or = Kendall's W < or = 0.95 and 0.59 < or = W < or = 0.96, respectively, with all P < 0.05). However, the inter-observer agreement for the dichotomous data was poor (kappa < or = 0.30 in more than half of the parameters in both rounds). Also the data on intra-observer agreement showed more favourable results for the analysis of the quantitative data (Pearson's r > 0.45 in more than 85% of the variables in both rounds) than for the dichotomous scoring system (kappa < or = 0.30 in more than half of the variables). It is concluded that even between experienced renal pathologists discrepancies occur in scoring kidney biopsies. Inter- and intra-observer agreement is greater if a quantitative method for reviewing the biopsies is applied that requires the observers to score the tissue specimens systematically.

Biopsy↗
PubMed1996

Adhesion molecules expression in noncrescentic acute post-streptococcal glomerulonephritis.

Clinicomorphological features of 11 cases of non-crescentic acute post-streptococcal glomerulonephritis (APSGN) were reviewed. Intraglomerular and interstitial leukocytes and their possible correlation with the adhesion molecules intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and endothelial-leukocyte adhesion molecule-1 (ELAM-1/E-selectin) were investigated by an immunohistochemical method. Intraglomerular leukocytes were primarily granulocytes (11.4 +/- 10 cells/glomerular cross-section) and monocytes-macrophages (13.4 +/- 19.4 cells/glomerular cross-section). The granulocytes outnumbered monocytes-macrophages in 7 of 11 specimens. The number of intraglomerular leukocytes correlated with proteinuria at the time of renal biopsy. Intraglomerular ICAM-1 staining was strongly positive in all biopsies, especially when intraglomerular monocytes-macrophages prevailed. Expression of intraglomerular VCAM-1 and E-selectin in diseased kidneys did not differ from that in normal kidneys. Interstitial leukocytes were primarily monocytes-macrophages (158.9 +/- 96.8 cells/mm2) and T lymphocytes (102.2 +/- 63.9 cells/mm2). The number of interstitial leukocytes, especially monocytes-macrophages, correlated with serum creatinine level at the time of biopsy. Interstitial ICAM-1 staining was strongly positive on tubules, peritubular capillaries, and small vessels. The tubular positivity for ICAM-1 correlated with the number of interstitial monocytes-macrophages. Interstitial VCAM-1 and E-selectin were expressed as in normal kidney tissues. The data from this study demonstrate that APSGN is characterized by the presence of both intraglomerular and interstitial leukocyte infiltration, correlating respectively with proteinuria and serum creatinine at the time of renal biopsy. Among the adhesion molecules studied, ICAM-1 seems the most involved in leukocyte recruitment, especially in that of monocytes-macrophages.

Acute Disease↗
PubMed1995

Tubulointerstitial damage in glomerular diseases: its role in the progression of renal damage.

The evidence that tubular damage, interstitial infiltration, and interstitial fibrosis occur in all glomerular diseases, either immunologically or non-immunologically mediated, is reviewed on the basis of personal data and data from the literature. The proposed mechanisms linking glomerular and tubular damage to the interstitial recruitment of mononuclear leukocytes and fibroblast proliferation, with abnormal extracellular matrix production leading to interstitial fibrosis, also are analyzed. The role of persistent heavy proteinuria and exposure to proinflammatory cytokines in inducing the damage of the tubular epithelial cells, with consequent acquisition by these cells of the ability to interact as antigen-presenting cells with T lymphocytes, is especially emphasized. Finally, the importance of the tubulointerstitial damage as a marker of unfavorable prognosis in glomerular diseases is documented.

Atrophy↗
PubMed1995

Occult thyroid carcinoma presenting as a parapharyngeal mass.

This report describes a 47-year-old male who had an occult papillary carcinoma of the thyroid present as a nodal involvement of the parapharyngeal space, in the retrostyloid compartment. To the best of our knowledge, this is an extremely rare condition.

Carcinoma, Papillary↗
PubMed1995

Prevention of NSAID-induced gastroduodenal mucosal injury: meta-analysis of clinical trials with misoprostol and H2-receptor antagonists.

In order to provide a systematic overview of the available information on the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal mucosal injury, we performed a meta-analysis based on all the in extenso published randomized clinical trials comparing H2-blockers or misoprostol to placebo for the prevention of NSAID-induced gastrointestinal mucosal injury in arthritis patients or normal subjects. The main endpoints after NSAID therapy were considered the number of subjects developing gastric ulcer, or clinically relevant gastric lesions (i.e. more than 10 erosions or 1 ulcer), or duodenal ulcer, or clinically relevant duodenal lesions (i.e. more than 10 erosions or 1 ulcer). The total number of patients studied was 1,955, and that of normal subjects was 715. Results were analyzed by the DerSimonian and Laird method, as well as by the Peto one. The data available from the trials suggest that misoprostol prevention is of benefit in patients under NSAID treatment for the prevention of NSAID-induced gastroduodenal mucosal injury. The effect of prevention is statistically significant with both methods, and ranges from -42% (duodenal ulcer) to -79% (gastric ulcer). The prevention estimates for gastric and duodenal erosions are in between. H2-blockers seem to be less effective: prevention is not indeed demonstrable for the more relevant lesions, like gastric and duodenal ulcer.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

[Cutaneous head and neck carcinomas: personal experience].

The Authors reviewed the personal surgical series about three hundred ninety-nine nonmelanoma skin cancers of the head and neck, examined from 1984 to 1993. The commonest histologic types were basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The median age was 70 and 69 years and the male to female ratio was 2:1 and 3:1, respectively for BCC and SCC. The distribution of sites of origin showed a clear tendency of BCC for arising in the midface region and SCC in the auricolar area and the nose. The correlation between local recurrence rates and duration of follow-up has proposed again the necessity of a long-term observation (over a 5-year period) in order to early detect a relapse or a new primary skin cancer. Finally, the Authors examine some clinical factors related to a high risk of local recurrence. These variables are: site, size, histologic differentiation, stage and previous surgical treatment. The final results are comparable to those described in the late Literature.

Aged↗
PubMed1994

Diagnostic significance and antigen specificity of antineutrophil cytoplasmic antibodies in renal diseases. A prospective multicentre study. Italian Group of Renal Immunopathology.

In a prospective multicentre study on the clinical significance of ANCA in renal diseases, sera from 920 patients with rapidly progressive renal failure and/or renal disease in association with extrarenal signs suggestive of a systemic vasculitis were tested for the presence of ANCA by indirect immunofluorescence (IIF) and ELISA. 193 of 920 cases (20.9%) were positive by IIF and 180 (19.5%) by ELISA, using a 'crude' cytoplasmic extract as substrate. The sensitivity and specificity of IIF for 'pauci-immune' cresentic necrotizing GN (CNGN), in association or not with systemic vasculitis, was 87.5 and 95.6% respectively. The IIF pattern and antigen specificity (alpha granules and MPO) correlated well with the clinical features: a cANCA pattern (alpha granules) was associated with ENT involvement (probable Wegener's granulomatosis); a pANCA pattern (MPO) with 'idiopathic' CNGN and small-vessel vasculitis without respiratory tract disease (microscopic polyarteritis); patients with a pulmonary-renal syndrome had either c or pANCA in a similar proportion. Our study confirms a high sensitivity and specificity of ANCA for patients with CNGN. ANCA should be considered an important diagnostic test in patients with renal diseases, especially in the presence of rapidly progressive renal failure.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1994

Critical re-evaluation of 41 cases of "idiopathic" crescentic glomerulonephritis.

Despite the availability of different classifications for rapidly progressive glomerulonephritis (RPGN), patients with "idiopathic crescentic GN" have not been yet inserted as a precisely defined subgroup, pointing to their probable heterogenicity. Trying to better define their characteristic, we retrospectively analyzed the clinical, histological and immunopathological features of 41 patients diagnostically labelled "idiopathic RPGN" because they had no evidence of systemic disease (including systemic vasculitis), no anti-GBM mediated glomerulonephritis and no clearly defined primary glomerulopathy. Starting by a thorough morphological review, 2 subgroups were defined: group I (25 patients) with variable degrees of intraglomerular necrosis, and group II (16 patients) with no intracapillary necrotizing lesions. Group I showed no or minimal endocapillary proliferation, intense interstitial infiltrates with periglomerular localization, frequent ruptures of Bowman's capsule and mild degree of glomerular and/or interstitial sclerosis. 16 patients in this group (64%) had irregular deposits of complement C3 at immunofluorescence while the remaining 9 (36%) had no immune deposits. Clinically they had no previous history of preceding urinary abnormalities, had a mean of 1.8 g/day proteinuria and a positivity for ANCA in 92% (12/13). In group II there was frequently marked mesangial proliferation, scarce interstitial infiltrates, no ruptures of Bowman's capsule and marked degrees of glomerulosclerosis and interstitial fibrosis. All patients in this group had clearly defined immune deposits of C3 and/or IgG. Clinically 50% of these patients had a history of recurrent microhematuria and/or proteinuria, a mean of 4.5 g/day proteinuria and negativity for ANCA in all 8 patients tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Rapidly progressive glomerulonephritis (RPGN): is there still an "idiopathic" subgroup?

In order to clarify if "idiopathic" RPGN still exists as a distinct entity we reviewed 41 patients with histological picture of diffuse crescentic GN (60% of crescents) and no clinical evidence of systemic disease. According to the presence or absence of intraglomerular necrotizing lesions we subdivided the patients into two different morphological groups: Group I (25 pts) with necrotizing GN and massive periglomerular infiltrates; Group II (16 pts) with intra-extracapillary proliferation and no interstitial infiltrates. Our data suggest that "idiopathic" RPGN does not exist as a distinct entity, but is an expression either of renal limited vasculitis or crescentic GN complicating primary proliferative GN.

Capillaries↗