Biomedical subjects
Publications and source records attributed to G Ferrara.
A case of carcinoid tumor associated with pancreatic heterotopy in Meckel's diverticulum, in a 35 years old man is presented. The lesion was not grossly evident. The diagnosis was suspected on histological examination, and confirmed by electron microscopy.
A case of in situ and invasive ductal carcinoma with areas of squamoid differentiation arising in a phyllodes tumor is reported. This last aspect has never been described before and is discussed reviewing the previously reported cases in the literature.
Seven patients with OSAS were studied during nocturnal sleep in order to assess the trend of PAP throughout apneas and to identify factors possibly associated with such a trend. All patients underwent a polysomnography including the monitoring of PAP and esophageal pressure. While intravascular PAP decreased during apneas and increased at the resumption of breathing, transmural PAP values (ie, corrected for intrathoracic pressure swings) showed a trend toward a progressive increase throughout apneas and toward a decrease once ventilation had been resumed. The measurement of transmural values allowed a reliable assessment of PAP changes occurring during apneas, and different degrees of such changes shown by different patients may be related to a host of factors relevant to wakefulness and sleep, including individual responsivity to hypoxic stimulus.
The effects of a new inhaled antimuscarinic drug, oxitropium bromide, and of a slow-release theophylline preparation upon nocturnal asthma were compared in a placebo-controlled double-blind study. Two samples were studied: 12 patients received oxitropium at 600 micrograms (6 subjects) or at 400 micrograms t.i.d. (6 subjects) whereas 11 received theophylline at 300 mg b.i.d. Morning dipping, assessed by the fall in peak flow overnight, was significantly reduced in the periods when either active drug was taken, whereas no difference was noticed during the placebo administration. No significant difference was noticed between results obtained with either active drug, as well as with either dosage of oxitropium. No subject reported side effects of oxitropium, as compared to three subjects reporting nausea, vomiting and tremors after theophylline. Oxitropium proves to be a valuable alternative to theophylline in nocturnal asthma, since it is equally potent, safer and does not require the titration of dosage.
Overnight falls in peak expiratory flow (PEF) (with the morning dip of the index) may be considered the hallmark of nocturnal asthma. To validate the morning dip a quantitative marker of the degree of nocturnal bronchoconstriction, the dip was measured in 11 subjects (six with a history consistent with nocturnal asthma) undergoing all-night monitoring of lower respiratory resistance by a double-catheter method. In six subjects, marked and recurrent increases in resistance were recorded, along with morning dips higher than 20 percent; however, on the following morning, only two of them reported having suffered significant breathlessness and wheeze. Peak and average values for resistance, as well as the duration for which resistance was increased, were closely correlated with the magnitude of morning dips. Therefore, unlike the subjective report, PEF may be considered a reliable quantitative indicator of nocturnal bronchoconstriction.
We tested the effects of continuous positive airway pressure (CPAP) in 8 patients with obstructive sleep apnea syndrome (OSAS). The comparison of a nocturnal polygraphic study performed during spontaneous breathing with a study during CPAP administration performed the following night showed a significant reduction in stage 1 and increase in REM, the abolition of obstructive apneas and a significant increase in mean oxyhemoglobin saturation. Most patients reported marked relief of symptoms after the first night of treatment. However 3 patients, though confirming the improvement refused further CPAP. We conclude that CPAP is an effective measure for prevention of apneas in OSAS and that in compliant patients it may be regarded as a short-term measure when a permanent correction of the causes is planned, or as a long-term treatment when the latter is not feasible.
In a 6-month, double-blind multicenter trial conducted over the winter, the effects of daily administration of ambroxol retard (75 mg) were compared with those of placebo in preventing exacerbations and improving symptoms and clinical signs in chronic bronchitis patients. The trial was completed by 110 patients in the ambroxol group and by 104 in the placebo group. Initially, there were no significant differences between the groups. By the end of the 2nd month of treatment, 67.2% of the ambroxol group had had no exacerbations compared to 50.4% in the placebo group. At the end of the 6-month trial, 45.5% of the treatment group had had no exacerbations, compared to only 14.4% of the control group. These differences were statistically significant. Patients in the treatment group lost significantly fewer days through illness (442) and had fewer days when they needed antibiotic therapy (371) compared to the placebo group patients (837 and 781). Ambroxol also produced statistically significant symptomatic improvement, measured as difficulty in expectoration, coughing, presence of dyspnea and the auscultatory signs as compared to controls. Since ambroxol was well tolerated and compliance was good, it appears like a drug of choice for pharmacological prophylaxis of chronic bronchitis.
Exogenous lipoid pneumonia (ELP) was diagnosed by bronchoalveolar lavage (BAL) in a 57-year-old woman with a long history of using oily nose drops. Since clinical and roentgenological presentations are nonspecific, BAL, along with specific staining of recovered alveolar macrophages, represents a safe alternative to more invasive diagnostic procedures whenever a diagnosis of ELP is suspected.
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We examined two rapid methods of measuring theophylline clearance using pairs of serum concentration measurements, and compared them with the steady-state values in 31 patients with acute asthma. A constant intravenous aminophylline infusion was started at a rate given by current guidelines. Theophylline clearance was estimated from two serum measurements made with an interval of at least 4 h, providing clearance estimates 5 h from commencement. Duplicate estimates were made, using either a 3rd serum measurement at 12 h or a 3rd and 4th at 7 and 14 h. A steady-state estimate was finally made after 48 h constant infusion. The two rapid estimates agreed well both between themselves and with the steady-state determination despite wide variations in the clinical status of the patients. These methods provide a rapid means of monitoring dosage in the individual patient. This is particularly important when the predicted dose is inappropriate.
In patients with chronic lung disease, the response to exercise can be impaired by ventilatory and/or circulatory disturbances. The response to a standard exercise varies according to the load in relation to the maximum load the subject can tolerate. Thus it seems more suitable to study the maximum tolerated, i.e. maximum workload expressed as VO2 max. We compared the results of VO2 max and pulmonary haemodynamic variables in 43 patients with chronic bronchitis. VO2 max ranged from 0.720 to 3.010 l/min. The relation between VO2 max and pulmonary artery pressure at rest or its increase with low level exercise was very poor, but there was a trend towards an increase in pulmonary vascular resistance in patients with low VO2 max, although a number of patients with low VO2 max had normal pulmonary vascular resistance. The ratio between heart rate at maximum workload and maximum heart rate according to age (heart rate obs/pred) was above 95% in the patients with pulmonary vascular resistance above 250 dyn.s. cm-5; it varied widely in the patients with normal or slightly elevated pulmonary vascular resistance. When VO2 max was below normal, and heart rate obs/pred low, it is probable that the decrease in VO2 max was due to ventilation impairment, or to a lack of cooperation. Oxygen pulse at VO2 max was also reduced in patients with high pulmonary vascular resistance, but a large range of values was observed in the rest of the patients. A high oxygen pulse at VO2 max however allows to rule out severe pulmonary artery hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cell surface marker analysis was carried out in 50 CLL patients; 15 were preclinical or low count, that is with a total peripheral lymphocyte count well below 15,000/cmm and little or no infiltrative syndrome. Data of the cell surface marker in these 15 patients were compared with those of 15 patients with non-neoplastic benign lymphocytosis. Monoclonal B-cell compartment proliferation was found in low count cases, with analogous immnofunctional characteristics to typical CLL. On the other hand, there was a symmetrical increase in both T and B cell compartments in non-neoplastic lymphocytosis. This suggests that cell marker analysis is a very useful diagnostic tool during the preclinical phase of CLL, as it permits it to be readily differentiated from non-neoplastic lymphocytosis.
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Maximum expiratory flows at 50% of vital capacity while breathing air and a He-O2 mixture and delta Vmax50 observed during three sittings (morning, noon and morning the day after) in reference subjects and in patients with bronchial hyperreactivity were submitted to statistical analysis by between sittings comparison, looking for correlation coefficients, paired "t" test and variation coefficient. Results of paired "t" test ruled out the influence of fatigue and of training in performing forced expiratory manoeuvres. Correlation coefficients relevant to absolute flows are highly significant in both groups, whereas coefficients of variation are satisfactory in reference subjects and slightly higher although still acceptable in patients with bronchial hyperreactivity. As far as delta Vmax50 is concerned, the results of statistical analysis are positively unacceptable, thus demonstrating that this arithmetic manipulation of absolute flows is the ground for a poor reproducibility of results.
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