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Biomedical subjects

F Invernizzi

Publications and source records attributed to F Invernizzi.

At least 37 records · Page 2Linked to original sources
PubMed1995

Cryoglobulinaemias: a multi-centre study of the early clinical and laboratory manifestations of primary and secondary disease. GISC. Italian Group for the Study of Cryoglobulinaemias.

In a multi-centre retrospective study, we compared clinical and laboratory data in 913 patients with cryoglobulinaemias, divided as: (i) essential cryoglobulinaemias; (ii) cryoglobulinaemias secondary to connective tissue diseases (CTD), lymphoproliferative or other haematological diseases (LPD), chronic liver diseases (CLD), and 'other diseases'. Purpura was the commonest presenting feature in all groups and was more common in essential cryoglobulinaemias (p < 0.0001). Meltzer's triad (purpura, arthralgia, weakness) was less frequent, but similarly distributed. Renal involvement was randomly distributed. Neurological impairment was less frequent in cryoglobulinaemias secondary to CLD (p < 0.002). Raynaud's phenomenon, arthritis and sicca syndrome were more frequent in cryoglobulinaemias secondary to CTD. Essential cryoglobulinaemias had a significantly higher percentage of serum complement C4 < 8 mg/dl (p < 0.004), of detectable rheumatoid factor activity (p < 0.0002), and of type II cryoglobulins (p < 0.0001). Liver involvement was evident at presentation in 32.6% of essential cryoglobulinaemias, 27.1% of cryoglobulinaemias secondary to LPD and 12.2% of cryoglobulinaemias secondary to CTD. Antibodies to hepatitis B surface (HBsAg) and core (HBc) antigens were more frequent in cryoglobulinaemias secondary to CLD; anti-HBs antibodies were randomly distributed. Antibodies to hepatitis C (HCV) were tested for in 224 patients, and prevalence was high in all the groups, but lower in cryoglobulinaemias secondary to CTD (p < 0.0001). Type II and type III essential cryoglobulinaemias differed significantly in renal involvement (p < 0.0001), cryocrit > 3% (p < 0.0001), C4 < 15 mg/dl (p < 0.001), HBsAg prevalence (p < 0.01) and purpura (p < 0.05). Despite the high prevalence of HCV markers in all groups, the role of HCV in essential cryoglobulinaemia is not well defined; HBV seems to play only a marginal role.

Adolescent↗
PubMed1994

Chemotherapy vs supportive care in advanced non-small-cell lung cancer. Results of a meta-analysis of the literature.

STUDY OBJECTIVE: To contribute to the current debate about the relative merits of meta-analysis of the literature (MAL) and of individual patients data (MAP). DESIGN: Identification of published randomized trials and extraction of essential results directly from the published reports. SETTING: Chemotherapy vs supportive care in advanced non-small-cell lung cancer. MEASUREMENTS AND RESULTS: Survival probability at 6 months after randomization, as estimated from the published survival curves, has been considered as the end-point of interest. Quality scoring of the studies has also been performed. Specific methodologic issues concerning the estimation of relevant quantities necessary for the MAL have been addressed. The estimated pooled odds ratio of death was 0.44, with 95 percent confidence interval of 0.32 to 0.59, thus significantly favoring chemotherapy, and it corresponds to an estimated increase in median survival from 3.9 months for best supportive care to 6.7 for chemotherapy. CONCLUSIONS: The results of our MAL, favoring chemotherapy, are in line with those of a MAP recently published. However, they have to be considered in the light of their actual clinical relevance and of the balance between quality of life, toxicity, and costs of chemotherapy and best supportive care.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

A new case of IgE myeloma.

A new case of IgE myeloma is described. A 77-year-old woman presented with bone pain and fatigue. Serum protein analysis revealed a paraprotein of the IgE kappa type; bone marrow aspirate and immunofluorescence confirmed the diagnosis; ultrastructural examination showed immature plasma cells. Treatment with prednisone, melphalan, cyclophosphamide and interferon alfa did not produce any improvement and the patient died 5 months after diagnosis. The patient's clinical and laboratory data are compared with those of IgE myeloma cases reported in the literature.

Aged↗
PubMed1987

Mycosis fungoides with mixed cryoglobulinemia and pulmonary vasculitis. A case report.

A 54 year old patient suffering from mycosis fungoides developed an immune complex disease with mixed cryoglobulinemia (type III) and pulmonary vasculitis, an association so far unreported. We believe that the pathogenesis could be ascribed to a T-cell imbalance (increase in OKT4+ cells with inversion of the OKT4/OKT8 ratio) and to a functional T-cell defect, as suggested by the reduced mitogenic responses to PHA and ConA we observed.

Cryoglobulinemia↗
PubMed1986

In vitro synthesis of IgM rheumatoid factor by lymphocytes from patients with essential mixed cryoglobulinemia.

Peripheral blood mononuclear cells (PBMC) from patients with Essential Mixed Cryoglobulinemia (EMC) were studied for their ability to synthesize polyclonal IgM and rheumatoid factor (RF) IgM in vitro. Our results indicate: that EMC-PBMC produce smaller amounts of polyclonal IgM but higher quantities of IgM-RF than normal PBMC after pokeweed mitogen (PWM) or Staphylococcus aureus activation, so that the IgM-RF to total IgM ratio is significantly greater in EMC than in normal cultures; that enriched EMC-B lymphocytes display a significantly higher spontaneous synthesis of IgM-RF than normal B lymphocytes and that the IgM-RF B cell clones are receptive to T cell regulation. Taken together these findings suggest an expansion of B cell clones committed to IgM RF production and the presence in peripheral blood of differentiated B lymphocytes capable of secreting IgM-RF in EMC.

Adult↗
PubMed1985

Complement anaphylatoxins in idiopathic mixed cryoglobulinemia.

Basophil activation, observed in patients with idiopathic mixed cryoglobulinemia, has been related to the complement anaphylatoxins C4a, C3a and C5a. In the present study the plasma levels of the complement anaphylatoxins have been evaluated in 21 patients affected with idiopathic mixed cryoglobulinemia. The plasma concentration of C3a desArg was significantly higher in the patients than in the healthy controls; conversely the plasma values of C4a desArg were significantly lower. C5a desArg was not detectable in plasma from any subject. The high plasma level of C3a desArg in our patients may suggest a role for C3a anaphylatoxin in 'in vivo' basophil activation. No correlation was found between the plasma concentrations of C3a desArg or C4a desArg, the amount of cryoprecipitate and the clinical activity of the disease.

Adult↗
PubMed1985

Treatment with sulfinpyrazone of essential mixed cryoglobulinemia.

Platelet production time (PPT), circulating platelet aggregates (CPA ratio) and plasma beta-thromboglobulin (beta TG) were determined in patients with essential mixed cryoglobulinemia (EMC) before and after two months' treatment with sulfinpyrazone. Sulfinpyrazone determined a clinical improvement in 8 of the 16 patients. Basal PPT and CPA ratio were reduced compared with normal values but not significantly; after sulfinpyrazone treatment both PPT and CPA ratio increased to normal levels. High plasma beta TG levels were found before and after treatment. These data suggest that in some cases of EMC there is a picture of in vivo platelet activation, but with the small number of patients it was not possible to evaluate a possible correlation between platelet hyperactivity and the clinical picture.

Adult↗
PubMed1984

Abnormalities of in vitro immunoglobulin synthesis by peripheral blood lymphocytes from patients with essential mixed cryoglobulinemia.

Peripheral blood mononuclear cells from patients with essential mixed cryoglobulinemia (EMC) were studied for their ability to differentiate into cells containing cytoplasmic immunoglobulins (Ig) and to synthetize Ig after in vitro pokeweed mitogen activation. EMC lymphocytes showed a significant defective differentiation and Ig synthesis compared to normal controls. Coculture experiments carried out mixing enriched normal T- and EMC B-cell suspensions, and vice versa, showed that (a) the EMC B-cell-defective Ig synthesis still persisted after removal of suppressor activity by irradiation, both with autologous and with normal allogeneic T suspensions and (b) EMC T cells displayed a less efficient activity in helping Ig production by normal B lymphocytes. A comparable, reduced response was also found after activation with Staphylococcus aureus strain Cowan I. Taken together these results seem to indicate that in essential mixed cryoglobulinemia an impaired T-cell helper activity coexists with a B-lymphocyte impairment. The significance of these abnormalities in the pathogenesis of EMC is discussed.

Adult↗
PubMed1984

Detection of circulating DNA in plasma of patients with pulmonary embolism by counterimmunoelectrophoresis.

In order to confirm the usefulness of free plasma DNA detection in the diagnosis of pulmonary embolism (PE), we have studied 16 patients with PE, 33 with various diseases, and 13 normal subjects. Free plasma DNA was detectable in 15 of 16 patients with PE (94%) and in 3 control patients, but never in plasma from normal subjects. In most cases, DNA was detectable until the 10th day after PE. In conclusion, counterimmunoelectrophoresis is a rapid, inexpensive and specific test which may be used as an exclusion test in the detection of patients suspected of having PE, who will have to undergo more extensive evaluation.

Counterimmunoelectrophoresis↗
PubMed1984

Transient symptomatic cryoglobulinemia in gram-negative bacteria infections.

Mixed polyclonal cryoglobulinemia was observed in seven patients suffering from severe gram-negative bacterial infections and/or septicaemias and presenting with arthralgia and purpuric manifestations on admission. Cryoglobulins disappeared after recovery from infection in all of them and were never found during a longterm follow-up. In our opinion, gram-negative bacteria may induce the synthesis of cryoglobulins via a non-specific T-independent B-cell stimulation triggered by cell-wall lipopolysaccharides. This kind of infections, especially if chronic or relapsing, might play a role in the aetiology of some so-called essential mixed cryoglobulinemias.

Aged↗
PubMed1983

[Therapy of multiple myeloma. Study of hospital patients: 81 cases in 16 years' observation].

The results achieved with different approaches of chemotherapy protocols applied to 81 patients affected by multiple mieloma and followed up for a duration of 16 years in the geographical area pertaining to the Saronno County Hospital are presented. All the patients are divided into sub-groups, according to the type of treatment they required while being monitored over the years. Each single sub-group is evaluated according to the following criteria: objective response to therapy; median survival rates; toxic effects due to drug exposure. The results are analyzed with reference to the most relevant literature on the matter. A comprehensive retrospective review of emerging data suggests an overlapping median survival--30 and 31 months--in patients given monochemotherapy as such as in those given polychemotherapy. Evidence is also made for a clearly meaningful increase of survival in treated patients compared with that of untreated ones. Median survival depends significantly on the initial stage of the disease. Both therapeutical effectiveness and toxicity are shown to be higher, in accordance with the current literature, in polychemotherapy which include vincristine--especially when a large tumor cell mass is pointed out--compared with therapy based on alkilating agents and prednisone.

Adult↗
PubMed1983

Secondary and essential cryoglobulinemias. Frequency, nosological classification, and long-term follow-up.

The clinical and immunochemical classification of 166 patients with cryoglobulinemia are presented. 52% of the cryoglobulins were detected in patients hospitalized because of various causes. The most frequent association was with liver and lymphoproliferative diseases (in particular with Waldenström's macroglobulinemia); two thirds of the patients with liver diseases presented with a purpura-arthralgia syndrome, and the hepatic involvement was only brought to evidence by subsequent laboratory investigation. The presence of cryoglobulins did not usually interfere with the clinical course of the basic condition. In 79 patients the cryoglobulinemia was considered idiopathic. In order to study the natural course of the disease in the idiopathic cases, a group of 35 patients had been followed up for 8-17 years: 37% developed a membranous proliferative glomerulonephritis, and more than half died of renal insufficiency; in 11% cirrhosis was diagnosed after a period of 4-9 years; another 11% developed a lymphoproliferative disease; of the remaining 40%, 2 are still asymptomatic, and the others are affected by purpura-arthralgia syndrome.

Adult↗
PubMed1983

Hypergammaglobulinemic purpura of Waldenström: characterization of circulating immune complexes.

Circulating immune complexes were detected in the sera of 7 patients with hypergammaglobulinemic purpura of Waldenström by the following methods: KgB-SP, mRF-LIA, Cc test, ClqBA. Analytical ultracentrifugation showed intermediate complexes between 7S and 19S (16S-19S); simple immunodiffusion of the complexes, purified by 2.5% PEG precipitation, revealed the presence of IgG3, IgA, IgM, Clq, C3 and C4. Constant high titers of rheumatoid activity in the sera in toto and after purification, and normal serum complement levels were also detected.

Adult↗
PubMed1982

Basophil activation in idiopathic mixed cryoglobulinemia.

We studied basophil activation in patients affected by idiopathic mixed cryoglobulinemia in order to investigate the role of the basophil cell in the pathogenesis of the vasculitis typical of this disease. We selected 13 patients and we performed the in vitro basophil degranulation test with cryoprecipitate; in 5 cases the test was positive when it was performed in whole blood, while it was negative when it was performed with cells washed and resuspended in Tyrode's buffer. In 6 subjects it was not possible to perform the test because of the very low number of circulating basophil cells. Finally, in 2 subjects the in vitro basophil degranulation test with cryoprecipitate was negative; this result may be related to the very low levels of complement factors in the sera of these subjects. These findings suggest that the pathogenetic mechanism of vasculitis in idiopathic mixed cryoglobulinemia could be started by basophil activation.

Adult↗