Characterization of biochemical and clinical correlates of hypocholesterolemia after hepatectomy.
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Cholesterol↗
Biomedical subjects
Francesco Greco
Publications and source records attributed to Francesco Greco.
[Prevalence of structural abnormalities of the atrial septum and their association with recent ischemic stroke or transient ischemic attack: echocardiographic evaluation in 18631 patients].
BACKGROUND: Ischemic stroke is one of the most frequent causes of morbidity and mortality in industrialized countries. In more than 40% of cases the cause of the ischemic event is not recognized, especially in young patients in whom, moreover, the presence of a structural abnormality of atrial septal aneurysm (ASA) and patent foramen ovale (PFO) is more frequently reported. The prevalence of this two minor atrial septal defects is strongly related to the study population (unselected patients and patients with recent ischemic stroke/transient ischemic attack-TIA) and to the diagnostic tool employed (transthoracic echocardiography--TTE or transesophageal echocardiography--TEE). METHODS: We retrospectively evaluated the prevalence of ASA in 16,836 patients who underwent TTE from January 1, 1994 to June 30, 2002. During this time period we also evaluated the prevalence of ASA, PFO and their association in 1795 patients in whom a TEE was performed. The patients who underwent TEE were divided into two groups: group A included 430 patients with recent stroke/TIA or suspect cardioembolic event, and group B included 1365 patients as controls. RESULTS: An ASA was detected in 1.6% of the whole study population; 0.7% of the patients underwent TTE and 10.2% of the patients underwent TEE. In group A the prevalence of ASA was 24%, in group B 4.7% (p < 0.001). A PFO was identified in 9.9% of patients in whom a TEE was performed; the rate was 24% in group A and 5.3% in group B (p < 0.001). In a subgroup of 65 patients, < 60 years (mean age 45 +/- 8 years), with cryptogenic or unexplained stroke/TIA a TEE examination identified the presence of ASA, PFO and their association in a rate of 20, 15 and 34%, respectively. CONCLUSIONS: Our data show, in a large study population, a prevalence of ASA and PFO not negligible. The association of this two atrial septal abnormalities in patients with stroke/TIA, especially those classified as cryptogenic, suggests to study in depth these minor atrial septal defects and in particular: 1) to standardize ASA definition; 2) to identify the etiopathogenetic mechanisms leading to embolic events; 3) to define the best pharmacological treatment.
Adult↗
[Combined diagnostic approach to venous thromboembolism with multidetector computed tomography].
BACKGROUND: Multidetector computed tomography (CT) improves scan length and spatial resolution. The availability of a single test that allows a comprehensive evaluation of the chest and pulmonary arteries, of the deep venous system of the abdomen and legs and the hemodynamic impact of pulmonary emboli on the right heart could be a new and effective strategy for patients with venous thromboembolic disease. We assess a combined study protocol on venous thromboembolic disease by multidetector CT. METHODS: Twenty-four patients with confirmed acute pulmonary embolism, in stable clinical conditions, underwent multidetector CT. After antecubital intravenous infusion of 120 ml of contrast medium at a rate of 4 ml/s followed by 30 ml of saline solution a CT of the chest was performed using 4 x 1 mm collimation, pitch 1.5 and 500 ms rotation time of the X-ray tube; the start delay was checked for each single patient. Indirect CT venography study was acquired 150s after starting the infusion using a 5 mm section width from the diaphragm to the popliteal zone. We evaluated: 1) the presence of intraluminal filling defects in the pulmonary arteries and in the deep venous system from the inferior vena cava to the popliteal veins, and 2) the presence of right ventricular dilation with a right ventricle/left ventricle (RV/LV) ratio > 1. The patients with CT diagnosis of deep vein thrombosis (DVT) and and RV/LV ratio > 1 underwent venous compressive ultrasound and/or echocardiography. RESULTS: Pulmonary embolism was detected in 12% in the main arteries and in 66, 87 and 20% in the lobar, segmental and subsegmental arteries respectively. DVT was found in 14/24 (58%) patients with pulmonary embolism involving the ileo-femoral district in 14% of the whole group. Thirteen patients (54%) showed a volumetric prevalence of the right ventricle on the left ventricle. CT data in the presence of DVT and an RV/LV ratio > 1 was confirmed at ultrasonography. CONCLUSIONS: Multidetector CT allows to obtain rapidly and in one examination useful information about the source and pulmonary involvement of venous thromboembolic disease and about the hemodynamic impact on the right heart.
Aged↗
Cytokines and growth factors in the protruded intervertebral disc of the lumbar spine.
Nerve root irritation induced by factors produced by the intervertebral disc may play a crucial role in the pathophysiology of sciatic pain production. In this study we used immunohistochemistry to investigate the presence of transforming growth factor-beta1 (TGF-beta1), insulin-like growth factor-1 (IGF-1), interleukin-6 (IL-6), IL-6-receptor (IL-6R) and fibronectin in lumbar disc bioptic specimens from 30 patients with disc herniation (protrusion type). Chondrocytes of herniated discs stained positive for TGF-beta1, IGF-1, IL-6 and fibronectin. We demonstrated for the first time the presence of IL-6-R in the chondrocytes of herniated tissue. Specimens from autoptic healthy tissue were used as controls. In these sections no immunoreaction for TGF-beta1, IL-6, or IL-6R was found, while they expressed IGF-1 and fibronectin, but in lower quantities than herniated discs. These results demonstrated the production of factors such as TGF-beta1, IGF-1, IL-6, IL-6R and fibronectin at the site of lumbar disc herniation.
Adult↗
Increased plasma C-reactive protein in familial hypoalphalipoproteinemia: a proinflammatory condition?
BACKGROUND: HDL molecules have an established role in the regression processes of atherosclerosis as well as a putative role as antiinflammatory agents. Our study investigated whether familial hypoalphalipoproteinemia, a genetic form of dyslipidemia characterized by very low HDL levels, might be associated with increased inflammation markers such as C-reactive protein. METHODS AND RESULTS: A total of 50 subjects with hypoalphalipoproteinemia (age, 53.1+/-16.7 years) were compared with 64 healthy controls (age, 51.9+/-12.4 years). Apart from significantly lower values of HDL cholesterol (30.2+/-4.0 versus 52.5+/-12.7 mg/dL, P<0.0001) and apolipoprotein AI (113.3+/-20.0 versus 155.4+/-24.9 mg/dL, P<0.0001) and higher levels of triglycerides (141.3+/-62.9 versus 73.5+/-39.9 mg/dL, P<0.0001), patients did not show different plasma values of total cholesterol and LDL cholesterol when compared with healthy controls (181.5+/-36.6 versus 186.3+/-32.6 mg/dL; 123.0+/-31.5 versus 119.1+/-30.3 mg/dL). CRP plasma values were significantly higher in patients than in controls (median 0.34 [range 0.02 to 4.66] versus 0.07 [0.02 to 0.85] mg/dL, P<0.0001). In the patient group, CRP values were significantly higher in subjects with angiographically documented coronary atherosclerotic disease than in those without. Moreover, CRP concentrations were inversely correlated with both HDL cholesterol (r= -0.44, P=0.0006) and apolipoprotein AI (r= -0.45, P=0.0006) values. CONCLUSIONS: Elevation of C-reactive protein values in familial hypoalphalipoproteinemia, in the absence of signs and symptoms of local or systemic inflammation or systemic or recurrent disease, may suggest an upregulation of proinflammatory mechanisms, which is further exacerbated by the presence of coronary atherosclerotic disease.
Adult↗
Modifications of metabolic and cardiovascular risk factors after weight loss induced by laparoscopic gastric banding.
BACKGROUND: The well-known inverse relation between life expectancy and BMI, particularly in morbid obesity, is presumably in large part due to multiple cardiovascular and metabolic comorbidities. Severely obese patients treated with laparoscopic adjustable silicone gastric banding (LASGB) were evaluated for such risk factors before and 1 year after LASGB. METHODS: 130 individuals (age 20-66, BMI 34-59 kg/m2) who underwent LASGB between 1996 and 2000 were studied; 50 of them were available for reevaluation 12 months after surgery. The presence and severity of diabetes (DM), hypertension (HTN), hypercholesterolemia (HC) and hypertriglyceridemia (HT) were assessed before and after surgery. In 18 of them erythrocyte sedimentation rate (ESR) were also measured. RESULTS: Comorbidities were highly prevalent at the initial evaluation: DM 10%, HTN 32%, HC 37%, HT 27%. In the subgroup reevaluated after surgery, prevalence of DM decreased from 15% to 6%, HTN from 37% to 25%, HC from 36% to 25%, and HT from 29% to 13%, with an average BMI loss from 44.1 to 35.9. ESR decreased from a preoperative value of 36.7 +/- 22.6 mm/hr to 18.3 +/- 11.9 mm/hr at 1 year (p < 0.001). CONCLUSION: Morbidly obese subjects respond to LASGB with an impressive reduction of comorbidities which is sustained for at least 1 year, well after the initial acute negative energy balance and when weight tends to stabilize. The high prevalence of elevated ESR, which has been considered a strong predictor of coronary mortality, confirms previous reports of its association with obesity, and the clear tendency to normalization with weight loss may represent a further element contributing to lower morbidity.
Adult↗
Fibrous cartilage in the rotator cuff: A pathogenetic mechanism of tendon tear?
There is no consensus on the pathogenesis of rotator cuff tears. Fibrous cartilage has been hypothesized to develop in some tendons as a result of shear or compressive forces, resulting in a tissue less capable of resisting normal tensile load and more prone to tearing. To test the hypothesis that metaplastic fibrocartilage in the rotator cuff could be involved in the pathogenic mechanism of its tear, samples from 34 acute and chronic torn rotator cuffs were subjected to histologic and immunohistologic study for the presence and type of cartilage (hyaline, fibrous, or elastic) in the area of the lesion and surrounding tissues. Detection of type I and II collagen, S-100 protein, and chondroitin sulfate allowed areas of fibrous cartilage to be seen in all samples, suggesting that the characteristic of rotator cuff tendons to work both in tension and in compression may stimulate fibrocartilaginous metaplasia and lead to a complete tear.
Adult↗
[Laparoscopic splenectomy: analysis of 60 consecutive cases].
The purpose of the study was to analyze the results of 60 patients who were candidates for laparoscopic splenectomy. Over the period from May 1994 to May 2001, 60 patients were candidates for splenectomy. Laparoscopy was contraindicated in 3 cases because of ASA III and marked splenomegaly (2 cases) and previous gastric resection (1 case). The procedure was indicated for benign disease in 38 cases and for malignant disease in the remainder. Fifty-three procedures were completed laparoscopically (92.9%). Conversion proved necessary in 4 patients (6.7%) due to large incisional hernia, perisplenic abscess, bleeding of major splenic vessels at the hilum and marked splenomegaly (2 cases of lymphoma). The mean operative time was 200 min for the malignancies and 110 min for the benign conditions (P < 0.05). Major morbidity occurred in 5 cases (8.7%). No deaths were registered. The mean postoperative hospital stay was 7.5 days for patients with malignancies and 5.2 days for patients with benign disease (P < 0.05). Laparoscopic splenectomy was safe and effective in patients with benign disease, even in cases of marked splenomegaly. The morbidity rate was significantly higher in lymphoma patients than in patients with benign haematological disorders.
Adolescent↗
Laparoscopic splenectomy in the management of benign and malignant hematologic diseases.
OBJECTIVES: The use of laparoscopy to treat malignant hematological diseases is not completely accepted. Our aim was to analyze operative and postoperative results of laparoscopic splenectomy performed for benign versus malignant hematological disorders. METHODS: Between 1994 and 2003, 76 consecutive patients underwent laparoscopic splenectomy. The first 38 cases were performed by using an anterior approach, whereas in the remaining 38 cases a semilateral position was used. RESULTS: Baseline characteristics showed that patients with malignant diseases were significantly older (56.9 vs 32.6 years, P < 0.001). Seventy-two (94.7%) procedures were completed laparoscopically. Conversion was required in 4 cases (5.2%). Mean operative time was 138.5 minutes for benign and 151.0 minutes for malignant diseases, (P > 0.05, ns). The hand-assisted technique was used in 3 patients with massive splenomegaly. Pathologic features showed that spleen volume was higher in patients with malignant diseases (mean interpole diameter 18.1 cm vs 13.7 cm, P < 0.001). Massive splenomegaly (interpole diameter over 20 cm, weight over 1000 g) was present in 13 patients (17.1%); 9 had malignant diseases. Overall perioperative mortality was 1.3% and major postoperative complications occurred in 6 patients (7.8%). Postoperative splenoportal partial thrombosis was identified in 9.7% of patients. CONCLUSIONS: Laparoscopic splenectomy is a well-accepted, less-invasive procedure for hematological disorders. Neoplastic diseases or splenomegaly, or both, do not seem to limit the indications for a minimally invasive approach after the learning curve.
Adolescent↗