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Biomedical subjects

G Guida

Publications and source records attributed to G Guida.

At least 19 recordsLinked to original sources
PubMed2006

ZAP-70 expression, as detected by immunohistochemistry on bone marrow biopsies from early-phase CLL patients, is a strong adverse prognostic factor.

Zeta-associated protein-70 (ZAP-70), mostly assessed by flow-cytometry (FC), recently emerged as reliable prognostic factor in chronic lymphocytic leukaemia (CLL) at presentation. We evaluated ZAP-70 expression in 156 CLL patients by immunohistochemistry (IHC) on formalin-fixed bone marrow (BM) biopsies at diagnosis. At presentation, 117 patients (75%) were with Binet stage A, 27 (17%) stage B and 12 (8%) stage C. Median follow-up was 61 months (range 6-242). ZAP-70 was expressed in neoplastic lymphocytes of 69 patients (44%). Concordance between ZAP-70 by IHC and ZAP-70 by FC, immunoglobulin heavy chain variable genes (IGHV) mutational status and CD38 expression was found in 41/46 (89%), 41/49 (80%) and in 60/88 (68%) tested cases, respectively. ZAP-70 expression significantly correlated with advanced Binet stage (B-C), diffuse BM infiltration, increased lactate dehydrogenase (LDH) and beta2-microglobulin serum levels and lymphocyte doubling time <12 months. ZAP-70 positivity was significantly related to poorer time to progression (median 16 months vs 158 of ZAP-70-negative cases) (P<0.0001) and overall survival (median 106 months vs not reached) (P=0.0002); this correlation was confirmed at multivariate analysis. ZAP-70 expression correlated with poorer outcome also when evaluated only in the 117 stage A patients. In conclusion, immunohistological detection of ZAP-70 on formalin-fixed BM biopsies at diagnosis appears a useful methodological approach to identify patients with poor prognosis in CLL.

ADP-ribosyl Cyclase 1↗
PubMed2006

Incidence and costs of hip fractures compared to acute myocardial infarction in the Italian population: a 4-year survey.

INTRODUCTION: Few data are available about the incidence and costs of hip fractures in Italy. We aimed to determine the impact of hip fractures vs. acute myocardial infarction (AMI). METHODS: We studied the national hospitalization database to calculate their incidence and costs in adults aged >or=45 between 1999 and 2002. RESULTS: In 2002, there were 86,719 hip fractures with a 10.0% increase over 4 years. We observed a predominance of women (77.1%) and a strong age effect: 92.7% of patients were >or=65 years old and 80% of fractures occurred in women aged >or=75, showing a clear relationship with the incidence of osteoporosis. Hospitalizations due to AMI after 45 years of age in 1999 were only 9% higher than those for hip fracture, although this difference increased over the 4 examined years up to 24%. Considering the DRGs costs, hip fractures resulted in being more expensive than AMI overall and concerning elderly people. CONCLUSIONS: This study shows that in the Italian population aged >or=45, hospitalizations following hip fracture and AMI between 1999 and 2002 were comparable, while hip fractures' direct costs were higher and grew faster than costs for AMI. Hip fractures in Italy are a serious medical problem and a leading health-cost driver.

Age Distribution↗
PubMed2005

Inguinal neurectomy for nerve entrapment after open/laparoscopic hernia repair using retroperitoneal endoscopic approach.

BACKGROUND: Inguinal neuralgia after open and laparoscopic hernia, repair occurs in about 0.5% of treated patients. If the pain and the functional inability persist, it is possible that the genitofemoral nerve and ileoinguinal nerve are involved in entrapment, and surgical treatment is a possible option. This paper reports a personal endoscopic retroperitoneal approach for ileoinguinal and genitofemoral branches neurectomy. METHODS: A 12-mm trocar is inserted into the lower retroperitoneum and insufflated to create a work space. Neurectomy is performed under endoscopic guidance. RESULTS: Six patients were treated using this technique. The operating time was 55 min, and all patients were completely pain-free after surgery. All patients were discharged the first day after operation and there were no complications. CONCLUSION: This retroperitoneal endoscopic approach is proposed as a new surgical technique for treating inguinal entrapment neuralgia. It is simple and feasible.

Digestive System Surgical Procedures↗
PubMed2001

Managing uncertainty in diagnosis of acute coronaric ischemia.

The paper presents the reasoning mechanism of COR, a knowledge-based system (KBS) able to provide support for the diagnosis of coronaric ischemia by integrating the interpretation of chest pain, 12-lead ECG, and bio-marker concentrations. Chest pain features are collected interactively through a questionnaire. The ECG signal is acquired in SCP format. Any set of bio-markers can be considered. Data input is incremental and possibly incomplete. Reasoning is based on revised uncertainty calculus, which allows a formal treatment of verbally expressed uncertainty concerning both input data and diagnostic rules. Each diagnosis is supplemented by a linguistic label, expressing the plausibility of the disease identified, given the symptoms observed.

Artificial Intelligence↗
PubMed2001

Hemofiltration reduces the serum priming activity on neutrophil chemiluminescence in septic patients.

BACKGROUND: Priming of the polymorphonuclear neutrophil (PMN) response has been implicated in the activation of oxidative burst and tissue injury in patients with septic shock and acute renal failure (ARF). This study evaluated whether hemofiltration (HF) removes substances able to enhance the oxidative burst of PMNs. METHODS: Chemiluminescence (CL) priming activity induced by sera and ultrafiltrates of seven patients with septic shock, multiorgan dysfunction syndrome, and ARF (ARF/HF group) and of 10 uremic stable patients (Control/HF group) was evaluated on normal human PMNs stimulated with bacterial formyl-methionyl-leucyl-phenylalanine (FMLP). Patients submitted to HF were studied by determining blood and ultrafiltrate interleukin-8 (IL-8), platelet-activating factor (PAF), and CL priming activity at the beginning (T0), and after four hours (T4) of treatment. RESULTS: Preincubation of normal human PMNs with sera and ultrafiltrates from septic patients induced a potent priming of CL activity in subsequent FMLP stimulation. In the ARF/HF group, the prefilter blood concentrations of IL-8 and CL PMN-priming activity significantly decreased during the four hours of HF treatment, with a loss of IL-8 in the ultrafiltrate of 6930 (median, range 4292 to 9282) ng per four hours. PAF detected in the ultrafiltrate and associated with the membrane (7.3 ng, range 1.45 to 9.89) was minimal. In the ARF/HF group, a significantly positive correlation between CL PMN-priming activity and IL-8 concentrations was observed. The CL priming activity in blood and ultrafiltrates was reduced to 55 and 46% by preabsorption with monoclonal antibody (mAb) anti-IL-8. In contrast, the PAF receptor antagonist WEB 2170 did not affect CL priming activity. In the control/HF group, the CL PMN-priming activity was significantly lower than in the ARF/HF group and was independent of IL-8. CONCLUSIONS: Sera from septic patients demonstrate an enhanced CL priming activity on PMNs. This activity is reduced by ultrafiltration and is due, at least in part, to ultrafiltered IL-8.

Acute Kidney Injury↗
PubMed2000

Tyrosinase gene expression in the Kupffer cells of Rana esculenta L.

The liver of Amphibia and Reptilia shows a dark-brown pigmentation due to the presence of particular melanin-containing cells that are different from melanocytes and derive from cells of macrophage lineage (Kupffer Cells), which have been shown to have an autonomous capacity to synthesize melanins. To date, as far as we know, there are no reports in the literature about the genetic system of tyrosinase as regards these melanin-synthesizing cells; we carried out the present study to analyze how the tyrosinase gene may function. We showed that the Kupffer cells of Rana esculenta L. do indeed have a transcriptionally active tyrosinase gene. Evidence of this was obtained by reverse transcription polymerase chain reaction analysis carried out on both the liver tissue and the Kupffer cells in culture. Moreover, analysis of the cells in culture enabled us to observe that, by increasing the culture time from 0 to 72 hr, an appreciable increase occurred in the amplification products of the tyrosinase gene, as well as in the level of dopa oxidase activity and in the quantity of melanin in the cells. The results of the present study demonstrate that frog Kupffer cells possess an active tyrosinase gene and that the increase of the tyrosinase mRNA accumulation closely correlates with phenotypic differentiation, in terms of increased dopa oxidase activity and melanosome content. This provides further strong support of the hypothesis that amphibian Kupffer cells possess an endogenous ability to synthesize melanin and suggests the involvement of the transcriptional level of control in the modulation of their melanogenic activity.

Animals↗
PubMed2000

EDTA-dependent pseudothrombocytopenia in a case of liver cirrhosis.

Pseudothrombocytopenia (PTCP) is the consequence of an EDTA-activated platelet agglutination, resulting in a spuriously low platelet count. We report the case of a 54-year-old man with EDTA-dependent PTCP associated with liver cirrhosis. He couldn't undergo endoscopic examination and dental care for two years because of a previous diagnosis of severe thrombocytopenia secondary to liver cirrhosis. Lack of PTCP recognition may lead the physician to misdiagnosis and mismanagement of the patient.

Anticoagulants↗
PubMed1999

Production of platelet-activating factor in patients with sepsis-associated acute renal failure.

BACKGROUND: Studies in experimental animals have suggested that platelet-activating factor (PAF) is a mediator of sepsis-associated acute renal failure (ARF). In the present study we have evaluated whether an increased concentration of PAF within circulation or urine of septic patients correlated with the worsening of renal function. METHODS: The concentration of PAF and selected cytokines (TNF, IL-1, IL-6, IL-8) was evaluated in blood and urine of 12 patients with septic shock and ARF for 4 consecutive days. RESULTS: The data obtained indicate that blood and urinary concentrations of PAF and of IL-1, IL-6 and IL-8 were significantly higher in septic patients than in controls subjects and in patients with chronic renal failure. The concentration of TNF was significantly increased only in urine. A significantly positive correlation was found among blood concentration of PAF and heart rate (r = 0.4193, P < 0.017), serum creatinine (r = 0.3671, P < 0.038), serum IL-6 (r = 0.5475, P < 0.005) and urine excretion of IL-8 (r = 0.3984, P < 0.044), whereas a negative correlation was present with the number of circulating platelets (r = -0.4285, P < 0.018). Moreover, a positive correlation among the concentration of PAF in urine and the serum concentration of IL-6 (r = 0.5654, P < 0.006) and urine excretion of IL-6 (r = 0.6589, P < 0.0008) and IL-8 (r = 0.6371, P < 0.0004) were found. CONCLUSIONS: These results demonstrate in humans during ARF associated with septic shock the production of PAF, a mediator that has been previously implicated in the pathogenesis of experimental endotoxin-induced shock and renal injury. The observation that blood and urinary concentrations of PAF correlated with some of the clinical and laboratory parameters related to the severity of ARF and sepsis suggests that PAF may contribute to the development of renal injury in septic patients.

Acute Kidney Injury↗
PubMed1998

Ultrastructural and functional study of the liver pigment cells from Rana esculenta L.

A study of the liver pigment cells of Rana esculenta L. has been performed on both liver in toto and cells in culture. Ultrastructural and cytochemical analyses showed a close relationship between this visceral pigment cell system and the cells of hepatic macrophage lineage. Like the latter, the liver pigment cells present phagocytic activity, in the sinusoids and in vitro, and give a positive response to tests for peroxidase and lipase. The liver pigment cells are isolated, together with the Kupffer cells, from the sinusoidal cell fraction of the liver. In culture, they maintain their melanogenetic ability, demonstrated by the presence of dopaoxidase activity in the soluble, membranous, and melanosome fractions. Analysis of the cultures showed that as culture time increased, so did melanosome dopaoxidase activity, the number of pigmented fields, and the level of pigmentation of the cells. The values of dopaoxidase activity of the pigment cells in culture show the same seasonal oscillations as the system in toto, indicating that the cells maintain an internal clock, at least in the first 72 h of culture. There is evidence that the pigment cells are macrophages which can express a melanogenetic function. Our results and other experimental data provide a basis for hypothesizing that the pigment cells in Rana esculenta L. liver may derive from, or have a common origin with, the Kupffer cells.

Animals↗
PubMed1997

Clinical efficacy and endocrine activity of vorozole in postmenopausal breast cancer patients. Results of a multicentric phase II study.

BACKGROUND: Aminoglutethimide was the first aromatase inhibitor to be used successfully in breast cancer patients. However, this drug also inhibits mineralcorticoid and glucocorticoid synthesis, making co-medication with corticosteroids necessary, and it is often poorly tolerated. The primary objective of this trial was to evaluate the clinical efficacy and tolerability of vorozole, a new non-steroidal oral aromatase inhibitor, in postmenopausal breast cancer patients. The secondary objective was to evaluate the pharmacodynamic activity of the drug. SUBJECTS AND METHODS: Thirty-four postmenopausal patients previously treated with tamoxifen in the adjuvant setting and/ or for advanced disease were treated with vorozole, 2.5 mg once daily. Patients were monitored with respect to treatment efficacy and safety. Hormonal evaluations were performed at baseline and during the course of treatment in order to evaluate the pharmacodynamic efficacy and safety of vorozole. RESULTS: According to UICC criteria, there were seven responders, one complete and six partial, for an overall response rate of 21% (95% confidence interval (CI) 9%-38%). The median duration of response was 9.6 months (95% CI 4.6-0), the median time to progression for the entire group was 4.7 months (95% CI 2.9-6.6) and the median survival time was 29.7 months (95% CI 19.1-0). Tolerability was excellent to good in 97% of the patients. Oestradiol and oestrone levels were suppressed to the limit of detection of the assays used. No effect was observed on the other endocrine parameters. CONCLUSIONS: Our results suggest that vorozole is an effective and safe drug for the treatment of advanced postmenopausal breast cancer following tamoxifen failure.

Aged↗
PubMed1997

In-situ polymerization behaviour of bone cements.

The polymerization behaviour of bone cements during total hip replacements is characterized by a fast and highly non-isothermal bulk reaction. In the first part of this paper the reaction kinetics are analysed by calorimetric analysis in order to determine the rates of polymerization in isothermal and non-isothermal conditions. A phenomenological kinetic model, accounting for the effects of autoacceleration and vitrification, is presented. This model, integrated with an energy balance, is capable of predicting the temperature across the prosthesis, the cement and the bone and the degree of reaction in the cement, during in situ polymerization. The temperature and the degree of reaction profiles are calculated, as a function of the setting time, taking into account the system geometry, the thermal diffusivity of bone, prosthesis and cement, and the heat rate generated by the reaction according to the kinetic model. Material properties, boundary and initial conditions are the input data of the heat transfer model. Kinetic and heat transfer models are coupled and a numerical solution method is used. The model is applied in order to study the effects of different application procedures on temperature and degree of reaction profiles across the bone-cement-prosthesis system.

Journal Article↗
PubMed1997

[Enterococcal endocarditis: clinical features and therapeutic approach].

Enterococci are implicated in about 20% of cases of infective endocarditis, topically in aged subjects with gastro-intestinal and/or genitourinary diseases. These forms are usually associated with an increased morbidity and mortality, in that also reflecting the difficulties encountered to set up a specific therapeutic approach. Among the various antibiotics effective against enterococci, particular attention has been recently given to those belonging to glycopeptide group. In the current study we have assessed the efficacy of teicoplanin associated to ampicillin plus sulbactam in 27 consecutive patients with enterococcus-mediated endocarditis, admitted to our hospital between June 1987 and September 1995. In 17 patients the source of infection has been identified in the gastrointestinal tract. The clinical recovery and the bacteriologic eradication have been achieved in 24/27 (88.8%) patients. The results indicate the necessity of a prophylactic antibiotic treatment in aged individuals with diseases affecting the gastrointestinal tract and further suggest the efficacy of teicoplanin and ampicillin plus sulbactam association for the treatment of endocarditis caused by enterococci.

Adolescent↗
PubMed1996

Microcolposcopic topographic endocervical assessment before excisional treatment of cervical intraepithelial neoplasia.

OBJECTIVE: To evaluate whether microcolposcopic topographic endocervical assessment reduces the failures of excisional treatment of cervical intraepithelial neoplasia (CIN). METHODS: Three hundred fifty patients with colposcopic and histopathologic findings of endocervical CIN were recruited for excisional treatment. Three hundred forty-eight of these were randomized to have or not have microcolposcopy before excisional treatment. Measurement of endocervical lesion was the only aim of microcolposcopic evaluation. When an endocervical extension was available, the cone biopsy was cut according to microcolposcopic measurement. Excision status was evaluated and related to presurgical management on operative specimens. After excision, patients were followed-up for at least 5 years after treatment. Three hundred thirty (171 and 159 with and without preoperative microcolposcopy, respectively) patients completed the study. Disease persistences were defined by cytologic, colposcopic, and histologic results. Microcolposcopic value was defined as completeness of excision and/or lack of persistent disease. RESULTS. On surgical specimens, involved margins were detected in 19 (5.4%) cases. Presurgical microcolposcopy was performed in only one of these cases. The difference of incomplete excision between cases with or without microcolposcopy was statistically significant (P < .001). In patients who were followed-up, persistent disease was detected in one (0.6%) woman in the microcolposcopy group and in 16 (10%) women in the control group. Comparison between the two groups showed a significantly lower risk of persistent disease when presurgical microcolposcopy was performed (P < .001). CONCLUSION: By measuring endocervical extension of the lesion, preoperative microcolposcopy allows individualized cones, thus improving the prognosis after excisional treatment of CIN.

Adolescent↗
PubMed1996

[In vitro and in vivo effects of cefodizime and ceftriaxone on oxygen-dependent killing of neutrophils of elderly patients with exacerbation of chronic bronchitis].

The immunomodulating activity of some chemotherapeutic agents, is particularly interesting. Our study has evaluated the in vitro and in vivo effects of two third generation cephalosporins: cefodizime and ceftriaxone, on the chemiluminescence of polymorphonuclears of 20 elderly patients affected by acute exacerbation of bronchitis. Twenty healthy patients have been also evaluated in vitro. Antibiotics have been used in vitro at the concentration of 50 g/ml while in vivo a group of 10 patients have been treated with cefodizime (2g/daily in 2 divided doses), another group of 10 patients with ceftriaxone (2g/daily as a single dose); in both groups the antibiotic treatment was given for 7-10 days. A significant potentiation of chemiluminescence has been shown in both groups of patients treated in vivo; whereas the preincubation in vitro of the polymorphonuclear suspension, both in healthy patients and in elderly bronchopathic ones, with antibiotics, has not changed the activity of oxygen dependent killing. Finally, we believe that bactericidal properties of the antibiotic still remain now the most important criteria of choice in order to assure effective control of infections.

English Abstract↗
PubMed1996

Topical thymopentin therapy in HIV positive patients with recurrent oral candidiasis: a pilot study.

Oral candidiasis frequently occurs in HIV-positive patients especially in those with advanced disease. To date, common anti-mycotic drugs are unable to prevent relapses and alternative therapy is necessary to reduce disabling effects. With the aim of verifying whether thymic hormone extract may be efficacious in these subjects, we enrolled 10 HIV-positive patients with recurrent and/or persistent oral candidiasis to be treated with thymopentin (oral inhalations). All patients benefited from the topical use of thymopentin, and in all cases there was marked increase in salivary secretory IgA which possibly accounted for the candidiasis improvement.

AIDS-Related Opportunistic Infections↗