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F Fiaccadori

Publications and source records attributed to F Fiaccadori.

90 records · Page 5Linked to original sources
PubMedDate not supplied

Negative nitrogen balance in cirrhotics. (A correct therapeutic approach).

The aims of this study were: 1. the assessment of the nitrogen balance (NB) in both compensated and encephalopathic cirrhotics, 2. the evaluation of the efficacy of a new therapeutic approach: amino acid solutions enriched with branched chain (BCAA) but poor in aromatic (AAA) amino acids. Solutions containing only BCAA were also employed: 42 cirrhotics were divided into the following groups: 1st group (26 cases), cirrhosis without hepatic encephalopathy (HE); 2nd group (16 cases), cirrhosis with HE. Six patients (23%) in the 1st group showed a positive NB at the beginning; 20 (77%) were negative; 18 of them were fed an oral diet (0.8 g protein/kg/day; 35 cal/kg/day) as a result of which they were brought into a positive NB within 5 days (from - 7.38 +/- 0.95 to + 3.67 +/- 0.46 g N/24 h). In two cases the diet failed to give a positive NB, so it was replaced by a BCAA enriched solution infusion (NB raised from - 1.0 +/- 5.4 g N/24 h). Patients in the 2nd group were put on total parenteral nutrition (TPN); two cases receiving glucose alone achieved a positive NB only when BCAA enriched solutions were added (from - 4.0 to + 3.0 g N/24 h). Four patients treated for 3 days with BCAA alone did not achieve a positive NB; in these cases likewise, BCAA enriched solutions were added in order to achieve a positive NB (from - 0.8 to + 4.2 g N/24 h); all 14 cases treated from the beginning with glucose + BCAA enriched solutions became positive, on average, within 5 days (from - 4.82 +/- 0.89 to + 3.15 +/- 0.61 g N/24 h). In addition to the NB, other parameters (blood ammonia, BCAA/AAA ratio, blood urea, electroencephalograms) and clinical symptoms were beneficially influenced by these solutions.

Aged↗
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[Fulminant acute hepatitis treated by immunologic therapy (author's transl)].

Following the most recent results on immunological pathogenetic mechanism, on which seems to be based the malignant evolution of acute viral hepatitis the AA. have treated a patient affected of acute fulminant hepatitis by means of immunologic therapy with specific globulins anti-HBsAg. The result of this personal experience and the analysis of the data from the literature suggest the opportunity to use specific antibodies (HBsAb) associated with syntomatic and depurative therapies, with obvious limits of single experience.

Acute Disease↗
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[The immunopathogenesis of hepatitis B].

Knowledge of hepatitis B immunopathogenesis has greatly improved in the last few years thanks to the development of new methods of lymphocyte culture and the introduction of molecular techniques in the study of the cell-mediated antiviral immune responses. Some of the immune mechanisms likely responsible for liver cell injury and viral clearance during hepatitis B have recently been characterized. By using synthetic peptides and high efficiency recombinant expression vectors. HLA class I restricted cytotoxic T cells specifically able to recognize the nucleocapsid antigen of the hepatitis B virus (HBV) have been isolated from the blood of patients with acute self-limited hepatitis B. The observation that this cytotoxic response is lacking or very weak in chronic patients who do not succeed in clearing the virus suggests a major role for cytotoxic T cells in terminating virus infection. Similar behaviour is shown by HLA class II restricted CD4+ T cells which express much stronger levels of response to HBV nucleocapsid antigens in acute than in chronic HBV infection. Whether these defective responses in chronic patients are due to an actual lesion of the host's immune system or to viral mutations affecting immune surveillance and thereby allowing virus escape, still remain open issues. A definitive answer to these questions will, we hope, provide the appropriate tools to devise effective immune therapies against chronic HBV infection.

B-Lymphocytes↗
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[Fluoroquinolones: a new era in antibiotic therapy?].

In the last five years fluoroquinolones have been extensively used in clinical practice and proved to represent a real step forward in antibiotic therapy. In this short overview, their mechanism of action (interaction with the bacterial DNA-gyrase and effect on bacterial membrane integrity) and pharmacological properties, with special emphasis on pharmacokinetics, distribution of the drug in the body at the level of the different target organs (urinary, gastrointestinal and respiratory tracts, soft tissues, bone and sexual organs) are analyzed. The problem of the resistance to fluoroquinolones, which can develop more frequently during treatment of Staphylococcus and Pseudomonas infection, and the possibility of preventing bacterial resistance through concurrent therapy with other antimicrobial agents such as aminoglycosides are also discussed. Finally, the general antimicrobial spectrum as well as some unusual antibacterial effects, toxicity, pharmacological compatibilities and incompatibilities and clinical indications are reported.

Anti-Infective Agents↗
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[Surgical risks for cirrhotic patients].

Evaluation of the surgical risk in cirrhotic patients undergoing emergency operations must take into account potential anesthesia-related problems, the specific type of operation, and altered liver function. Therefore, (a) the generic surgical risk, (b) the specific surgical risk and (c) the anesthetic risk, must be distinguished. The factors which affect the generic risk are the conditions which can worsen pre-existing liver failure (e.g. cardiopulmonary disease, area of surgical intervention, stage of liver cirrhosis). Splanchnic reflexes as well as lower venous return to the heart are the potential factors which may lead to reduced hepatic blood perfusion and, therefore, represent the specific surgical risk. The anesthetic risk is due to negative interference with the splanchnic circulation by both artificial ventilation and direct pharmacologic vasoconstrictor effects. Finally, the possibility that the patient is positive for HBV or HIV markers must be considered in order to carry out the necessary measures to avoid direct contact with the blood.

Abdomen↗
PubMedDate not supplied

Selective amono acid solutions in hepatic encephalopathy treatment (a preliminary report).

Hepatic encephalopathy may complicate chronic liver diseases and portosystemic shunting. Recently it has been suggested that a change in the blood amino acid pattern (with elevated phenylalanine, tyrosine, methionine and depressed branched chain amino acids) and increased levels of octopamine and phenylethanolamine (a false neurotransmitter) are related causally to neurological symptoms. Previous works have suggested that an amino acid mixture of special formulation (enriched in branched chain amino acids and poor in aromatic amino acids) can normalize the plasma amino acid levels and consequently improve the neurological state. In order to test the actual therapeutic effect of these specially formulated solutions, the following therapeutic protocols were administered to 3 groups of cirrhotic patients: group 1 (15 cases): lactulose; group 2 (8 cases): special amino acid solutions; group 3 (8 cases): special amino acid solutions and lactulose. Clinical, laboratory and EEG examinations in a preliminary experiment, before and after treatment, showed that the best effect was obtained by the combined treatment with amino acid solutions and lactulose.

Adult↗
PubMedDate not supplied

[Cytokine mediators in acute inflammation and chronic course of viral hepatitis].

Cytokines constitute a complex network of molecules involved in the regulation of the inflammatory response and the homeostasis of organ functions. Cytokines coordinate physiologic and pathologic processes going on in the liver, such as liver growth and regeneration, inflammatory processes including viral liver disease, liver fibrosis and cirrhosis. Liver growth and regeneration are regulated by several cytokines. The platelet-derived hepatocyte growth factor, in particular, delivers a strong mitogenic stimulus for hepatocyte regeneration. The cell-mediated immune response plays a central role in hepatocellular necrosis and in the immunopathogenetic mechanisms involved in viral clearance and persistence in liver disease of viral etiology. In this context, cytokines modulate the immune system and exert direct antiviral activity by cytopathic and non-cytopathic mechanisms, as demonstrated in a transgenic mouse model. IL-6, TNF-alpha, IL-1 and IL-2 increase in acute fulminant viral hepatitis; in fact, they have pro-inflammatory and cytotoxic effects. Reduced IL-2 and IFN-alpha synthesis and increased serum levels of IL-1 and IL-2 soluble receptor (IL-2R) have been observed in HBV chronic liver disease. In HCV chronic hepatitis, IL-2R increases as well, while IFN-gamma and IL-2 decrease. In personal experimental observations, intra-hepatic messenger RNA expression of several cytokines was measured in liver specimens of patients with chronic HBV and HCV infections: patients with HCV chronic liver disease had higher levels of IL-2, IL-6, IL-10, and IFN-gamma. These data are in accordance with immunological studies showing a vigorous cell-mediated immune response in HCV chronic liver disease and a deficient immune response in HBV chronic hepatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
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[Emergent pathologies: Rhodococcus equi infection in the acquired immunodeficiency syndrome].

Rhodococcus equi is an intracellular facultative, gram-positive, partially acid-fast, cocco-bacillary microorganism of increasing importance as a pathogen in severely immunocompromised HIV-positive patients. Rhodococcus equi may cause invasive pulmonary infection, bacteremia and disseminated infection. Rhodococcus equi is easily cultured from blood or sputum on standard media, but is frequently regarded as a contaminant. Delay in establishing a definite diagnosis may result in a poor outcome in most cases. Treatment in humans is not standardized. Surgical intervention may be beneficial in selected cases.

AIDS-Related Opportunistic Infections↗
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[Retrospective study of Mycobacterium avium complex infection in the acquired immunodeficiency syndrome].

We discuss here our experience with Mycobacterium avium complex (MAC) infection in 446 HIV-positive patients. MAC was found in 13 cases (2.9%): 10 males, 3 females, age range 21-47 years. Infection was disseminated in 10 cases and limited to the lung in 3. CD4+ cells were, on average, 48 per microliters. At clinical onset, all patients suffered from fever and weight loss, 10 from anemia, and 5 from diarrhea. MAC was found in its disseminated form in cultures of blood (10 patients), stool (5 patients) and urine (1 patient). Broncho-alveolar lavage seemed to be the most specific diagnostic method for lung infection. Twelve patients were treated with a multi-drug regimen consisting of an association of 4 or 5 antibiotics, selected on the basis of antibiogram, from the following: clofazimine, rifabutin, ciprofloxacin, ethambutol, isoniazid, amikacin and piazofolin. Mean survival of patients was 91.7%, 83.4%, 71.8% and 58.4% at 4, 5, 6 and 7 months of treatment respectively. Although the mean survival of the treated group is similar to that of untreated patients, multi-drug therapy seems to improve quality of life inasmuch as it brings temperature to normal and enables weight gain. Dissemination was never observed after treatment in patients with pulmonary infection only.

AIDS-Related Opportunistic Infections↗
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[Spontaneous bacterial peritonitis during liver cirrhosis: the clinical findings and therapeutic considerations].

Among 1211 consecutive patients admitted to hospital for liver cirrhosis, 625 (51.6%) had ascites. Forty-four of them (7%) had ascitic infection. Thirty-four cases (5.4%) of spontaneous bacterial peritonitis (SBP) and 10 cases (1.6%) of culture-negative neutrocytic ascites (CNNA) were diagnosed. The infecting organism was most likely Gram-negative of enteric origin (80%), CNNA mortality (30%) was lower than that of SBP (47%). High mortality suggests to treat patients affected by either SBP or CNNA with antibiotics.

Adult↗
PubMedDate not supplied

[Pancreatitis caused by Cryptosporidium parvum in patients with severe immunodeficiency related to HIV infection].

Up to the present, pancreatic complications due to cryptosporidium parvum infection have been described only in a few patients with acquired immunodeficiency syndrome (AIDS). We report our experience with 3 subjects with AIDS who presented with acute or chronic pancreatitis related to cryptosporidiosis. All 3 patients had abdominal pain resistant to analgesics, increased serum amylase and abnormalities at both sonography and computed tomography. Endoscopic retrograde cholangiopancreotography revealed papillary stenosis in all patients; one patient also had stenosis of the Wirsung duct. Cryptosporidium was found in both bile and stool samples in all patients, while viral cultures were negative, even in the 2 patients who had cytomegalovirus retinitis. Endoscopic sphincterotomy temporally relieved abdominal pain in all patients, but did not prevent either acute or recurrent pancreatic inflammation. Several antibiotic therapeutic protocols were ineffective against the parasite.

AIDS-Related Opportunistic Infections↗