[Prevention of infection of surgical wounds using chlorhexidine].
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Biomedical subjects
Publications and source records attributed to G Landi.
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To evaluate the clinical significance of hemostatic abnormalities in acute stroke, we studied coagulation and platelet function in 70 patients with recent cerebral infarction or hemorrhage and in 45 age-matched controls. Higher levels of one-stage factor VIII coagulant activity, fibrinopeptide A (FPA), and beta-thromboglobulin were associated with the occurrence of stroke. All hemostatic test results were remarkably similar in patients with ischemic and hemorrhagic stroke. FPA levels and size of the lesion on CT were the only variables independently predicting mortality in a multivariate regression analysis. Our findings demonstrate that hypercoagulability is an important prognostic factor in stroke and lend support to clinical trials of drugs interfering with the coagulation system in the early phase of cerebral ischemia.
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The prolactin lowering activity of dihydroergokryptine was investigated both in rats and in humans. The drug was administered orally at the doses of 0.2, 1 and 5 mg/Kg to intact or reserpinized male rats. Nine male adult volunteers were given 300 mg cimetidine iv 90 min after receiving 2, 3 or 4.5 mg of dihydroergokryptine and 3, 4.5 and 6.75 mg of dihydroergocristine or placebo per os in a randomized, cross-over design. Eight young adult males were injected im with 10 mg sulpiride 120 min after randomly receiving dihydroergokryptine 2.5 and 5 mg or placebo in a cross-over manner. Finally, five healthy young women were given dihydroergokryptine 2.5 and 5 mg, bromocriptine 2.5 mg and placebo in a cross-over design. Dihydroergokryptine caused a strong, long-lasting, dose-dependent fall of plasma prolactin concentrations in both rats and humans. Moreover, it inhibited the reserpine-induced rise of plasma prolactin in rats, as well as the cimetidine-or sulpiride-induced hyperprolactinemia in humans. Dihydroergokryptine proved twice as potent as dihydroergocristine and about half as potent as bromocriptine. Effective doses of both dihydrogenated ergot alkaloids were much better tolerated than bromocriptine.
Technetium-99m and/or 111In labelled F(ab')2 fragments of a melanoma associated MoAb 225.28S were injected i.v. in 80 patients affected by stage I to IV malignant melanoma. Seventy five percent of metastatic lesions already documented by other methods were detected by immunoscintigraphy, which was also capable of detecting a certain number of unknown metastases. However, we observed a lower percentage of positive scans in liver, lung and skin because of the poor tumour to background ratio. In some patients, subcutaneous (s.c.) injection allowed us to visualize documented metastases undetected by i.v. administration. An equal amount of non-specific F(ab')2 fragments (MoAb 4C4) injected s.c. as a negative control showed no positive scans. Clinical studies and chromatographic patterns of patient serum samples suggest that the s.c. route of administration offers, with respect to the i.v. route, the advantage of reducing vascular background and aspecific accumulation in liver, probably because of retention of possible contaminants by the lymphatic system.
Prognostic significance of hyperglycemia on short-term survival was evaluated in 72 patients with acute hemispheric stroke. All patients were admitted within 48 hours of onset, and the neurologic deficit was assessed by means of a standardized score. A computed tomogram was taken in all cases on admission. Mortality was higher in hyperglycemic patients with no history of diabetes mellitus (78%) than in diabetic (45%) and in normoglycemic nondiabetic (29%) patients. In nondiabetic patients, the glucose level correlated with the neurologic score and with lesion size on computed tomogram. Reactive hyperglycemia due to a major stress response accounts for the worse prognosis of these patients. This correlation was not found in diabetic patients. Preexisting hyperglycemia, as well as systemic complications, could explain the higher mortality in these patients compared with normoglycemic nondiabetic patients.
Acute transverse myelitis was observed as a complication of intravenous heroin addiction in a young man. Recovery within seven weeks was good, but not complete. The literature is reviewed and the possible pathogenetic mechanisms are discussed.
The cervico-cranial arteries were studied using digital subtraction angiography in 50 patients with reversible cerebral ischaemic attacks and normal continuous wave Doppler examination. Digital subtraction angiography was able to visualise the arteries satisfactorily in 45 patients (90%), and revealed minor arterial abnormalities in 12 patients (24%). However, neither occlusions nor stenoses greater than 50% of the diameter of the vessel lumen were found. Although digital subtraction angiography is more accurate than continuous wave Doppler examination in detecting arterial lesions, it did not provide alternative therapeutic choices in any of these patients.
One hundred seventeen patients with reversible ischemic attacks were divided into two groups according to the presence of atheromatous lesions on angiography. Female sex, vertebrobasilar territory involvement, and younger age were related to normal angiograms. Among risk factors, only hypertension was associated with atheroma. However, the number of risk factors in each patient was related linearly to angiographic abnormality. Later stroke and myocardial infarction were significantly more common in patients with atheromatous lesions.
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After a reversible right hemispheric stroke, a patient with bilateral carotid occlusion developed left motor seizures and bilateral TIAs, both triggered by orthostatic hypotension. A CT-scan showed a right frontal hypodense area. Hemodynamic factors may cause focal seizures in patients with cortical lesions.
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In a patient with transient global amnesia, computed tomography demonstrated a left temporal haemorrhage sparing the hippocampal region.
Lymphocyte subpopulations were studied in 16 myasthenic patients by means of E and EA7s rosettes and surface membrane immunofluorescence. Myasthenic patients showed an increase in lymphocytes with surface IgM an IgD when compared to a control group. In female patients this increase was highly significant, and lymphocytes bearing membrane IgG and IgA were also augmented. No difference was found in male patients when compared with sex-matched controls. These results suggest an activation of the B cell compartment restricted to female patients, and support the hypothesis of different immunopathogenetic mechanisms in this disease.
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