PubMed HealthSearch

Biomedical subjects

G De Simone

Publications and source records attributed to G De Simone.

At least 19 recordsLinked to original sources

Conformational studies of heterochiral peptides with diastereoisomeric residues: crystal and molecular structures of linear dipeptides derived from leucine, isoleucine, and allo-isoleucine.

The x-ray diffraction analyses of three N- and C-terminally blocked L,D dipeptides, namely t-Boc-D-Leu-L-Leu-OMe (1), t-Boc-L-Ile-D-aIle-OMe (2), and t-Boc-D-aIle-L-Ile-OMe (3) containing enantiomeric or diastereomeric amino acid residues have been carried out. The structures were determined by direct methods and refined anisotropically to final Rf actors of 0.077, 0.058, and 0.072 for (1), (2), and (3), respectively. Peptides 1-3 all assume a similar U-shaped structure with phi and psi torsion angles corresponding to one of the possible calculated minimum energy regions (regions E and G for L residues, and F*, D* and H* for D residues). The peptide backbones of 1-3 are almost superimposable [provided that the appropriate inversion of the chiral centers of (2) is made]. Side-chain conformations of Leu residues in peptide (1) are g- (tg-) for the L-Leu residue and the mirrored g+ (tg+) for the D-Leu residue; however, in peptides (2) and (3) the conformations of the isoconfigurational side chains of the Ile or allo-Ile residues are (g-t) t and (tg+) t for the L-Ile and the D-allo-Ile moieties, respectively. In all cases, these conformations correspond to the more populated conformers of beta-branched residues statistically found in crystal structures of small peptides. The results seem to indicate that, at least in short peptides with enantiomeric or diastereoisomeric residues, the change in chirality in the main-chain atoms perturbs the backbone conformation to a lesser extent and the side chain conformation to a greater extent.

Crystallography, X-Ray

Familial adenomatous polyposis and inflammatory bowel disease associated in two kindreds.

We describe two families in which some members are affected by familial polyposis syndrome: in one family a case of ulcerative colitis and in the other a case of Crohn's disease were found. This is the first report about this family association, but in our opinion the fact that two cases have been found in one series suggests that this association could be more frequent than reported so far. The research for a genetic pattern of inflammatory bowel disease could be addressed towards chromosome 5.

Adenomatous Polyposis Coli

Echocardiographically guided repair of tetralogy of Fallot.

Although 2-dimensional, Doppler, color flow echocardiography is accepted as a safe diagnostic method to guide the surgical treatment of certain heart defects, cardiac catheterization remains mandatory for patients with tetralogy of Fallot. Based on the excellent diagnostic correlation between echocardiography and angiocardiography, a policy of echo-guided primary repair of uncomplicated, selected cases of tetralogy of Fallot was introduced at Ospedale Bambino Gesù. In the last 5 years, of 139 patients who had surgery for tetralogy of Fallot, 105 underwent primary repair. In 56 patients (53.3%), surgery was guided only by echocardiography (group I). In the remaining 49 patients (46.7%) (group II), unclear imaging of cardiovascular anatomy (n = 23), or echo-suspected associated malformations (n = 26) prompted cardiac catheterization. The 2 groups did not differ in age and weight at surgery. Intraoperative examination did not show diagnostic errors in patients of group I; cardiac catheterization and surgery confirmed the suspected associated anomalies in 16 of 26 patients of group II (38.4% false-positive). Echocardiography showed an overall sensitivity of 100% and specificity of 85% for detection of associated malformations. In conclusion, echocardiography proved to be adequate for selection of patients with uncomplicated forms of tetralogy of Fallot for primary repair.

Cardiac Catheterization

Effects of new fish oil derivative on fatty acid phospholipid-membrane pattern in a group of Crohn's disease patients.

Fish oil has been recently proposed as a possible effective treatment in inflammatory bowel disease (IBD); however, a lot of annoying side effects (ie, belching, halitosis, diarrhea, etc) affect patient compliance. We carried out a study of patient tolerance in a group of Crohn's disease (CD) patients with a new fish oil derivative consisting of 500-mg capsules of eicosapentaenoic-docosahexaenoic (EPA 40%-DHA 20%), a free fatty acid mixture (Purepa), and we also evaluated its incorporation into phospholipids, both in plasma and in red cell membranes. Five groups of 10 CD patients in remission received nine Purepa capsules daily in four different preparations (A: uncoated, B: coated, pH 5.5; C: coated, pH 5.5, 60 min time release; D: coated, pH 6.9) and 12 x 1-g capsules daily of a triglyceride preparation (Max-EPA, EPA 18%-DHA 10%), respectively. We coated three of the four Purepa preparations in order to delay the release of contents in an attempt to minimize the side effects. After six weeks of treatment, the group taking Purepa capsules, coated, pH 5.5, 60 min time release (group C) showed the best incorporation of EPA and DHA in red blood cell phospholipid membranes (EPA from 0.2 to 4.4%, DHA from 3.7 to 6.3%), and no side effects were registered, whereas in all other groups side effects were experienced in 50% or more of subjects. This new preparation will make it possible to treat patients for long periods.

Adult

Steroid treatment in active Crohn's disease: a comparison between two regimens of different duration.

BACKGROUND: Steroids are highly effective in active Crohn's disease; clinical relapse following steroid withdrawal, however, is frequent. We used two steroid regimens of different duration in order to compare their efficacy in inducing and maintaining clinical remission. METHODS: Seventy patients with active Crohn's disease were treated with methylprednisolone 40 mg/day i.m. for 3 weeks and then with two different regimens of tapering dosage: one for a further 4 weeks and another for a further 12 weeks. RESULTS: Steroid therapy induced remission within 3 weeks in 91% of the whole group of patients; at the end of each protocol remission rates were 85% of patients in the group treated for the shorter period and 87% of those treated for the longer period (difference 2%, CI = -14 to 18, P = NS); remission rates within 6 months after stopping steroids were 53% and 37% respectively (difference 16%, CI = -9 to 41, P = NS). CONCLUSIONS: No significant differences were found between the two regimens. Multiple courses of steroid treatment in the previous 3 years and a short time interval following previous steroid treatment seem to be risk factors for relapse.

Adult

Effectiveness of 5-aminosalicylic acid for maintaining remission in patients with Crohn's disease: a meta-analysis.

OBJECTIVES: We conducted a meta-analysis of the published randomized clinical trials to evaluate the effectiveness of 5-aminosalicylic acid (5-ASA) for maintaining remission in inactive Crohn's disease. METHODS: The trials were identified by standard computerized techniques for literature search. All studies included in the meta-analysis were aimed at evaluating the effectiveness of 5-ASA in comparison with a control group receiving either no treatment or placebo. RESULTS: Our meta-analysis of five clinical trials published as full-length articles indicates that 5-ASA significantly reduces the relapse frequency in patients with inactive Crohn's disease [odds-ratios (95% CI): 0.56 (0.37-0.84) at 6 months, 0.47 (0.33-0.67) at 12 months, 0.53 (0.38-0.73) at 24 months]. The pooled relapse-free rates in the treatment group were 91% at 6 months, 84% at 12 months, and 72% at 24 months; the corresponding rates in the control group were 77%, 60%, and 52%. A second meta-analysis, conducted using the additional information deriving from four randomized trials published as abstracts, gave essentially the same results. CONCLUSIONS: Whereas our meta-analysis shows that the effectiveness of 5-ASA is statistically significant, a simple pharmacoeconomic assessment indicates that the cost for preventing each relapse can lie between $4,000 and $10,000. This cost compares favorably with the average cost for treating a relapse.

Aminosalicylic Acids

Comparison of scintigraphy with indium-111 leukocyte scan and ultrasonography in assessment of X-ray-demonstrated lesions of Crohn's disease.

The aim of this study was to compare the results obtained with an indium-111 scan with those obtained with less expensive and harmless ultrasonography to evaluate the location and inflammatory activity of Crohn's disease. Thirty-one patients previously studied with x-ray underwent abdominal 111In scans and ultrasonography (US). Sensitivity and specificity of US in detecting lesions seen with 111In scan were 77% and 92.8%, respectively. Sensitivity and specificity of 111In scan in detecting x-ray-defined lesions were 69.2% and 92.7%; the figures for US were 73% and 93.3%, respectively. Considering the evaluation of disease activity, ultrasonographic bowel wall thickness was significantly related to scintigraphic intensity of emission (r = 0.75 P < 0.01). Our experience suggests that US provided information about the location and inflammatory activity of lesions similar to that obtained from 111In scan.

Abdomen

Total cavopulmonary direct anastomosis: a logical approach in selected patients.

A 2.5-year-old boy with a diagnosis of situs solitus, tricuspid atresia, anatomically corrected malposition of the great arteries (S,D,L), left juxtaposition of atrial appendages, and pulmonary stenosis underwent successful total cava-to-pulmonary connection by means of a superior vena cava-to-pulmonary artery end-to-side anastomosis associated with an inferior vena cava-to-pulmonary artery direct anastomosis. Anatomic features and surgical technique are described.

Abnormalities, Multiple

Management of the patient with left ventricular hypertrophy.

The management of left ventricular hypertrophy (LVH) presupposes that the patient is identified by echocardiography and is carefully evaluated for risk stratification, taking into consideration possible associated complications. The role of non-pharmacological treatment is limited, except in obese patients. Drug treatment, especially using calcium antagonists, angiotensin converting enzyme inhibitors and beta-blockers, has proved to be effective in reducing LVH. These drugs are also effective in controlling, if not reversing, the associated pathophysiological changes and complications, such as impaired systolic and diastolic function, and ventricular arrhythmias. There is, however, no evidence of any beneficial effect on myocardial ischaemia. The desirable goal is LVH regression, but it may not be achievable in over 50% of patients, and it is not possible to identify patients in whom regression is likely. Regression, or control of each sequelae, could prevent sudden death, the evolution of hypertensive heart disease leading to heart failure and, probably, myocardial infarction. Patients must be followed carefully during and, particularly, at the beginning of the antihypertensive therapy which has to be gradually introduced. At best, blood pressure must be reduced while avoiding hypotension. The strategy of antihypertensive treatment has to be reconsidered on the basis of the presence of LVH and could lead to decreased cardiovascular morbidity and mortality of patients with LVH.

Antihypertensive Agents

Zinc supplementation restores plasma concentrations of zinc and thymulin in patients with Crohn's disease.

The aim of this work was to evaluate whether oral supplementation with zinc sulphate (ZnSO4) could restore thymic endocrine function in patients with Crohn's disease who showed decreased plasma concentrations of zinc and active thymulin, a zinc-dependent thymic hormone. Twenty-seven patients in clinical remission were randomly assigned to receive, for 3 months, one of the following treatments: 60 mg/day ZnSO4; 200 mg/day ZnSO4 or placebo. Plasma thymulin activity and zinc concentrations significantly increased only in patients treated with 200 mg/day ZnSO4. Lymphocyte subpopulations, within the range of normality before zinc supplementation, were unaffected by any of the administered treatments. In conclusion, low plasma concentrations of zinc and thymulin in Crohn's disease patients were restored by the administration of high doses of zinc.

Adult

Tricuspid valve vegetation in a child with periarteritis nodosa.

We report a case of a child who was first seen for acute renal failure and periarteritis nodosa. Angiography findings confirmed this diagnosis. Ultrasound scan revealed large tricuspid valve vegetation, as well as minute vegetation on the right ventricular wall. All vegetation disappeared after 12 months of immunosuppressive therapy. Serology findings for lupus were negative. All clinical and laboratory findings strongly support the hypothesis that this previously undescribed heart involvement is caused by PAN.

Acute Kidney Injury

[A clinical instrumental assessment of professional ex-athletes: the long-term effects on the cardiovascular system].

BACKGROUND: Although many authors have been interested in the athlete's heart since the 1899, several aspects are still being debated. Among them, the issue concerning long-term morphologic and functional cardiac changes induced by vigorous physical activity can be considered of great importance. The aim of this study was to use Doppler echocardiography to evaluate the association of vigorous physical activity with morphologic and functional cardiac modification. METHODS: A total of 30 healthy ex-professional athletes who had discontinued their activity at least 10 years previously, and 30 healthy subjects without a history of regular physical exercise were recruited for the study. Clinical examination, thorax radiography, routine laboratory tests and ergometric test were performed. Morphologic and functional cardiac modification were evaluated by using Doppler-echocardiography. Data were analysed by performing the Student's t-test for unpaired samples and the Kruskall-Wallis' test. RESULTS: Radiologic and echocardiographic findings showed a complete regression of potential morphologic modifications which had occurred during the period of physical activity. The ergometric data showed both a normal working capacity and a reduced energetic demand. Doppler flow shapes were consistent with a normal pattern, although significantly reduced compared to controls. Doppler data of intracardiac flow showed a reduction of peak flow velocity (PFVA) and acceleration time (AccTA) across the aortic valve, and, across the pulmonary valve, a reduction of peak flow velocity (PFVP), flow velocity integral (FVIP) and acceleration time (AccTP). These data give evidence of a reduction in both left and right systolic ventricular function. In diastole the Doppler flow across mitral valve shows an increase in peak flow velocity E (PFVEM), E velocity--A velocity ratio (E/Am) and deceleration time (DecTM). The Doppler flow across the tricuspid valve shows a reduction in peak flow velocity E (PFVET) and in diastolic slope (slopeT) with an E velocity--A velocity ratio (E/AT) increased. Overall, these findings are consistent with an increase in left ventricular parietal stiffness, while the right ventricular wall shows a reduced active relaxation. Nonetheless, an overall diastole disfunction could not be excluded. CONCLUSIONS: Our findings on ex-professional athletes in resting conditions support a "non pathological" ventricular function modification measured with echocardiographic and Doppler flow methods. The ergometric data showing both a normal working capacity and a reduced energetic demand, and morphology of the Doppler flow shape that is (in absolute) normal would seem to confirm the results. We hope that our data will stimulate future trials on larger populations in order to increase the knowledge of the long-term effects of regular physical activity.

Adult

Weight reduction lowers blood pressure independently of salt restriction.

The existence of a link between obesity and hypertension is nowadays universally accepted; however, there are still some doubts about the fact that weight reduction induces a significant long-term decrease in blood pressure. This clinical trial aimed at evaluating the effects of marked weight loss (at least 30% of excess body weight) induced by a low-energy (600 Kcal), normal sodium diet in severely obese patients, on blood pressure at rest and during sympathetic stimulation. Eight of the 20 patients initially recruited for the study were able to reach the therapeutical goal and brought their body weight from 107 +/- 6 to 91 +/- 4 kg. Their blood pressure (BP) at rest was at the same time reduced from 137/81 +/- 5/4 to 122/74 +/- 4/4 mmHg. Also, blood pressure measured during three different stimuli (cold pressor test, handgrip and mental arithmetic test) was lowered by this nonpharmacological means. These effects are related solely to weight reduction, since no change in salt intake occurred, as demonstrated by measurements of the 24-h sodium excretion test (191 +/- 13 vs 185 +/- 10 mEq/24 h). In conclusion, these results support the hypothesis that a drastic weight loss, independently of salt restriction, significantly reduces BP at rest and during stimulation of the adrenergic nervous system.

Adult

Early congestive heart failure due to origin of the right coronary artery from the pulmonary artery.

We describe a two-month-old infant with early congestive heart failure due to anomalous origin of the right coronary artery from the pulmonary artery. The diagnosis was made by two-dimensional and color flow Doppler echocardiography, confirmed by angiocardiography, and the case was successfully corrected at surgery. As opposed to the more frequent anomalous origin of the left coronary artery from the pulmonary trunk, this anomaly generally does not cause any typical clinical finding, often becoming an autoptic or surgical surprise after infancy or in adult age.

Coronary Vessel Anomalies

Influence of steroid treatment's duration in patients with active Crohn's disease.

Steroids are very useful drugs in the treatment of active Crohn's disease (CD), but clinical relapses after steroid withdrawal may be very high. We investigated the efficacy of two steroid regimens of different duration in inducing remission and in maintaining it after drug suspension. Patients with active CD were randomly assigned to scheme A, lasting 7 weeks (27 patients), or to scheme B, lasting 15 weeks (27 patients). Remission rates at the end of the treatment were 81% for scheme A and 85% for scheme B. Relapse rates at 6 months after stopping the treatment were 50% (11 patients) and 52% (12 patients), respectively. Remission rates seem not to be influenced by the duration of the treatment, but patients recently treated with steroids showed a higher relapse rate if they received the short-duration treatment.

Adult

[Normal anatomy and findings in traumatic pathology of the popliteal system. A MR study].

To date, the lesions of the popliteal system, which are responsible for the so-called postero-lateral knee instability, are still an imperfectly known chapter of knee conditions. We retrospectively analyzed 215 consecutive MR examinations performed May-August 1991 to evaluate MR capabilities in correctly depicting both the normal anatomy and the pathologic conditions of the popliteal system. Using our standard protocols for knee study and two different magnets (0.064 and 0.5 T), we identified 23 lesions of the popliteus and of its meniscal and peritoneal insertions, and 17 lesions involving also other capsular and ligamentous structures of the knee. Coronal T1-weighted images were the best ones to correctly identify normal knee anatomy, whereas sagittal T2-weighted images were more sensitive in detecting popliteal lesions. Our results had clinical or surgical confirmation in all cases.

Humans