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Biomedical subjects

G Sacchi

Publications and source records attributed to G Sacchi.

At least 19 recordsLinked to original sources
PubMed2005

Simple peritoneal sclerosis and sclerosing peritonitis: related or distinct entities?

AIM: The etiopathogenesis of sclerosing peritonitis is still debated, with some sustaining that it is a rare form of progression of simple peritoneal sclerosis and others that it is a primitive form. The aim of the present research was to clarify this question. MATERIAL AND METHODS: 438 peritoneal biopsies from 253 patients were re-examined. 174 were obtained prior to peritoneal dialysis and 224 after various periods of dialysis. Forty biopsies were from peritoneal dialysis patients who developed sclerosing peritonitis. Peritoneal morphology was studied for signs of transition from simple sclerosis to sclerosing peritonitis. RESULTS: Evidence was found sustaining the hypothesis that simple sclerosis to sclerosing peritonitis patients have distinct pathologies. CONCLUSIONS: The results confirm previous observations, excluding the existence of any type of relation between simple peritoneal sclerosis to sclerosing peritonitis.

Basement Membrane↗
PubMed2005

Prevention of peritoneal sclerosis: a new proposal to substitute glucose with carnitine dialysis solution (biocompatibility testing in vitro and in rabbits).

AIM: Commercial glucose peritoneal dialysis solutions expose the peritoneum to hyperosmolar glucose containing variable amounts of non-enzymic breakdown products of glucose. These solutions are toxic for the peritoneum. The aim of the present study is to compare in vitro and in vivo characteristics of a new dialysis solution containing carnitine, a naturally occurring compound, as substitute of glucose. MATERIAL AND METHODS: We compared in vitro and in the rabbit a new peritoneal dialysis solution containing carnitine, with two standard bicarbonate glucose peritoneal dialysis solutions and a solution containing icodextrin. RESULTS: In vitro and in vivo the solution containing carnitine seems to be more biocompatible than standard glucose solutions and those containing icodextrin. CONCLUSIONS: In our study the peritoneal dialysis solution containing carnitine seems to prevent the mesothelial changes observed with solutions containing glucose. Since carnitine has been extensively studied and seems to be well tolerated by hemodialysis patients, even at high doses for long periods, clinical trials in humans may be planned in the near future.

Animals↗
PubMed2005

Experimental evaluation of transport force in the rabbit ureter.

BACKGROUND: Cleaning the urinary tract by so-called 'wash-out effect' and promoting high diuresis has long been advocated but has had very little scientific backing and few prospective studies in international journals. AIM: To verify whether the physical laws describing the transport force of water in rivers and pipes are also valid for urinary outflow. METHODS: A laboratory model for measuring transport force, given liquid and solid capacity, was adapted to create an in vivo model based on the rabbit urinary tract. RESULTS: Fluid flow in the rabbit renal pelvis and ureters was found similar to flow in pipes, obeying the physical laws of water transport to some extent. When the quantity of liquid flowing in the urinary tract in unit time was doubled, the transport force increased by various orders of magnitude. When the liquid increased by a larger factor, the transport force became enormous. CONCLUSIONS: The results confirm the utility of maintaining high diuresis in patients with renal calculus, but stress the utility of drinking 1-2 liters of hypotonic water in a short time to obtain an enormous increase in transport force which increases the probability of a cleansing effect.

Animals↗
PubMed2004

The pattern of fibrillin deposition correlates with microfibril-associated glycoprotein 1 (MAGP-1) expression in cultured blood and lymphatic endothelial cells.

Fibrillins constitute the major structural components of 10-12nm microfibrils of the extracellular matrix of several elastic and non elastic tissues and of initial lymphatic vessel anchoring filaments. Microfibril-Associated Glycoprotein-1 (MAGP-1) binds fibrillin to tropoelastin during elastogenesis. We recently reported that cultured blood endothelial cells deposit fibrillin in a honeycomb pattern, whereas lymphatic endothelial cells form an irregular web. The aim of this immunohistochemical study was to verify whether the deposition pattern of fibrillin is related to the expression of MAGP-1 in confluent and postconfluent cultures of bovine aortic (AEC), pulmonary artery (PAEC) and lymphatic endothelial cells (LEC). In AEC and PAEC, MAGP-1 and fibrillin co-localized and their deposition increased with time in culture. In AEC, both proteins formed a honeycomb pattern. In LEC, MAGP-1 deposition was still negligible when fibrillin formed an irregular web covering the entire surface. PAEC, which in vivo are exposed to physiological conditions intermediate between AEC and LEC, had an intermediate pattern of deposition of fibrillin and MAGP-1. Assuming that early elastogenesis is an intrinsic functional need for the aorta, but not for the thoracic duct, we propose that delayed appearance of MAGP-1 in LEC may correlate with their irregular fibrillin deposition. Different fibrillin scaffolds could in turn account for the specificity of elastic fibers in compliance with the specific functional requirements of the tissue.

Animals↗
PubMed2002

Microalbuminuria is an integrated marker of subclinical organ damage in primary hypertension.

Increased urine albumin excretion is associated with an unfavourable cardiovascular risk profile and prognosis in primary hypertension, even though its pathogenesis is currently unknown. Microalbuminuria (Mi) has been proposed as an integrated marker to identify patients with subclinical organ damage, but its routine use is still too often neglected in clinical practice. The aim of our study was to evaluate the relationship between urinary albumin excretion and early signs of subclinical target organ damage (TOD), namely left ventricular hypertrophy and carotid atherosclerosis in a large group of non diabetic hypertensive patients. A group of 346 never treated patients with primary hypertension (212 men, 134 women, mean age 47 +/- 9 years) referred to our clinic were included in the study. They underwent the following procedures: (1) family and personal medical history and physical examination; (2) clinical blood pressure measurement; (3) routine blood chemistry and urine analysis including determination of urinary albumin excretion (ACR); (4) electrocardiogram; (5) ultrasound evaluation of left ventricular mass (LVMI) and carotid artery thickness (IMT). The overall prevalence of Mi, left ventricular hypertrophy, and carotid plaque was 13, 51, and 24% respectively. Mi was significantly correlated with LVMI (P < 0.0001), IMT (P < 0.0001) and several metabolic and non-metabolic risk factors (blood pressure, body mass index, serum lipids). Cluster analysis identified three subgroups of patients who differ significantly with regards to TOD and albuminuria (P < or = 0.001 for each of the examined variables). Patients with higher IMT and LVMI values also showed increased ACR levels. Furthermore, patients with microalbuminuria were more likely to have both LVH and IMT values above the median for the study population (OR 21, C.I. 4.6-99.97, P < 0.0001). Mi is an integrated marker of subclinical organ damage in patients with primary hypertension. Evaluation of urinary albumin excretion is a specific, cost-effective way to identify patients at higher risk for whom additional preventive and therapeutic measures are advisable.

Albuminuria↗
PubMed2001

[Fallopian tube adenocarcinoma: synchronous neoplasia and severe uterine endocervical squamous epithelial dysplasia].

We report a rare case of primary carcinoma of the fallopian tube. A 72-year-old post-menopausal woman presenting with abnormal secretion of blood-stained liquid, underwent surgery because of findings of atypical squamous cells (ASCUS) on a routine Papanicolaou smear. The histological diagnosis on cervical biopsy was of CIN 3. Adenocarcinoma of the Fallopian tube was incidentally found.

Adenocarcinoma↗
PubMed2000

A novel monoclonal antibody specific for lymphatic endothelium.

The difficulty of identifying and differentiating lymphatic and blood microvessels in tissue sections can be overcome by a monoclonal antibody specific for lymphatic endothelium. Unfortunately, the only known antibody also reacts with the endothelium of some blood vessels. The technique of double immunization (passive, with an antiserum to blood endothelium, and active, with a suspension of lymphatic endothelial cells) was, therefore, used to increase the chances of recognizing specific lymphatic antigens by the mouse immune system. The monoclonal antibody obtained, LyMAb, a G1 immunoglobulin, reacted strongly with the endothelium of bovine thoracic duct, mesenteric collecting vessels and lymphatic vessels of gallbladder and lymph nodes and moderately with those of the intestinal wall. Blood vessels (intercostal arteries, azygos vein and blood microvessels of all organs tested) were consistently negative. The antibody was species-specific and did not react with formalin-fixed, paraffin-embedded sections. Cross-reactivity was limited to some connective tissue fibres and scattered cells in the lymph node parenchyma, intestinal villi and hepatic lobules.

Animals↗
PubMed2000

Genetic polymorphism of the renin-angiotensin system and organ damage in essential hypertension.

BACKGROUND: The renin-angiotensin-aldosterone system (RAAS) plays a significant role in the development of hypertensive cardiac and vascular remodeling. Recently, several genetic variants of its key components, which may be clinically relevant and thus prove to be useful in the evaluation of cardiovascular risk, have been described. We therefore investigated the association between ACE I/D, AGT M235T, and AT1 A1266C gene polymorphisms and early signs of target organ damage in 215 untreated patients with essential hypertension (EH). METHODS: Genotyping was based on the polymerase chain reaction technique, with further restriction analysis when required. Albuminuria was measured as the albumin-to-creatinine ratio (ACR). The left ventricular mass index (LVMI) was assessed by echocardiography (LVH = LVMI > or = 125 g/m2), carotid wall thickness (IMT) by an ultrasonographic (US) scan, and retinal vascular changes by direct ophthalmoscopy (Keith-Wagener classification). RESULTS: The prevalence of microalbuminuria (Mi), LVH, and retinal vascular changes was 14, 46, and 74%, respectively. ACE, AGT, and AT1 genotype distribution was in agreement with the Hardy-Weinberg equilibrium. There was no difference in age, duration of disease, body mass index (BMI), blood pressure, and lipid profile when data were analyzed on the basis of genotype. Serum levels of angiotensin-converting enzyme (ACE) were related to the ACE genotype (10.2 +/- 0.5, DD; 8.2 +/- 0.3, ID; 6.5 +/- 0.4 IU/mL, II; P < 0. 0001 by analysis of variance). The ACE genotype independently influences serum ACE levels and accounts for approximately 14% of its variations (F = 26.7, r2 = 0.1393, df 1 to 214, P < 0.0001). Patients with DD and ID genotypes showed higher levels of ACR (1.59 +/- 0.2, DD + ID; 0.8 +/- 0.2 mg/mmol, II; P < 0.006 by ANOVA) and bigger LVMI (124.1 +/- 2.3, DD + ID vs. 117.8 +/- 3.6 g/m2, II; P < 0.01 by ANOVA). No differences in the prevalence and degree of target organ damage (TOD) were found when data were analyzed on the basis of the AGT and AT1 genotypes, respectively. Potentially unfavorable combinations of genotypes were also investigated by K-means cluster analysis. Two subgroups of patients were identified (cluster 1, N = 70; cluster 2, N = 57), and each differed significantly with regards to the presence and degree of TOD and patterns of RAAS gene polymorphisms (F, 15.97 for ACR; F, 7.19 for IMT; F, 217.03 for LVMI; F, 3.91 for ACE; F, 4.06 for AGT; and F, 5. 22 for AT1; df 1 to 214, P < 0.02, for each one of the variables examined). CONCLUSION: The D allele of the ACE gene may be an independent risk factor for the development of target organ damage, and evaluating it could be useful for assessing cardiovascular risk in EH. Unfavorable patterns of RAAS genotypes seem to predispose patients to subclinical cardiovascular disease in EH.

Adolescent↗
PubMed1999

Lymphatic vessels of the human heart: precollectors and collecting vessels. A morpho-structural study.

Only topographic and distributional data are available on the lymphatic outflow vessels of the human heart. Here we describe their structural and ultrastructural features. Fragments of the atria, ventricles and fat surrounding the major coronary branches were obtained from hearts of dilated cardiomyopathy patients. Serial semithin sections were observed under light microscopy and used for tridimensional reconstructions. Ultrathin sections were observed by transmission electron microscopy. Precollectors, the initial lymphatic outflow routes of the heart, are small valved vessels with irregular, discontinuous musculature. They originate in the subepicardial region from a network of epicardial, and from scattered myocardial absorbing lymphatic vessels and drain into the collecting vessels accompanying the major coronary branches. Collecting vessels are larger but structurally similar to precollectors. Wall musculature is independent of the size of the vessel. Their ultrastructure is the same as that of precollectors. Endothelial cells have many Weibel-Palade bodies, cytoplasmic filaments and focal adhesions. The basement membrane is discontinuous and anchoring filaments are frequent and conspicuous. The subendothelial layer contains much elastin. Human heart collecting vessels and precollectors may only be distinguished by their size. The scarcity of musculature suggests that lymph progression in this district is mainly ensured by cardiac revolutions. Their ultrastructural features are determined by adaptation to dynamic forces. The architecture of these vessels (random, disorderly, discontinuous, lacking any exact plan) and their large variations in caliber are in line with the ontogenetic hypothesis that peripheral lymphatic vessels originate from the coalescence of mesenchymal lacunae.

Cardiomyopathy, Dilated↗
PubMed1998

Microalbuminuria is an early marker of target organ damage in essential hypertension.

Microalbuminuria has been associated with a cluster of metabolic and nonmetabolic risk factors, suggesting that it might indicate the presence of generalized microvascular damage in patients with essential hypertension. To explore whether microalbuminuria is associated with early target organ damage, two groups of essential hypertensive patients, with (n = 17) (HtAlb+) and without (n = 16) (HtAlb-) microalbuminuria, and a control group (C) of healthy normotensive subjects (n = 20) were studied. The study groups, selected among participants of a large epidemiologic trial, were carefully matched for several potentially confounding variables such as gender, age, duration of hypertension, and body mass index. Albumin excretion rate was evaluated by radioimmunoassay in three nonconsecutive timed overnight collections after 3 weeks of pharmacologic wash-out. Left ventricular mass was assessed by M-B-mode echocardiography, carotid wall thickness by a high resolution ultrasound scan, and renal vascular impedance by Doppler scan. Office as well as 24-h ambulatory pressure monitoring (Takeda TM-2420) were also evaluated. There was no difference between the two hypertensive groups for office and 24-h blood pressure levels except for a lower daytime/nighttime systolic blood pressure ratio in the group with microalbuminuria. Microalbuminuric patients showed signs of early organ damage as compared to normoalbuminuric patients and normal subjects, namely greater left ventricular mass indices (LVMI 167+/-7 g/m2 in HtAlb+; 139+/-9 g/m2 in HtAlb-; 118+/-5 g/m2 in C, P < .001) and increased wall thickness of common carotid arteries (intima plus media thickness 12.5+/-0.2 mm in HtAlb+; 11.7+/-0.3 mm in HtAlb-; 11.2+/-0.2 mm in C, P < .001) as well as higher intrarenal vascular resistance (mean resistive index 0.62+/-0.01 in HtAlb+; 0.59+/-0.01 in HtAlb-; 0.59+/-0.01 in C, P < .05). In conclusion, microalbuminuria is an early marker of diffuse target organ damage in essential hypertension and therefore can be useful to identify patients for whom more aggressive preventive strategies or additional treatment measures are advisable.

Albuminuria↗
PubMed1998

[Stromal tumor of the ileum (GIST) at the same time as a renal carcinoma. Description of a case and review of the literature].

The gastrointestinal mesenchymal tumors from a heterogenous group that include several entities: leiomyomas, schwanomas and less differentiated tumors often referred as GIST. These neoplasm are uncommon and their clinical behaviour is most difficult to predict. We describe a malignant gastrointestinal stromal tumor of the ileum coexisting with renal cell carcinoma. The neoplasms were fixed in formaldehyde, embedded in paraffin and stained with hematoxylin-eosin. For immunohistochemical studies deparaffinized tissue sections were incubated with antibodies against vimentin, desmin, muscle specific actin, S100, CD34, GFAP, NSE and keratin. The epithelioid and spindle cells of ileal neoplasm were arranged in interlacing fascicle with occasional palisading and were positive for vimentin and CD34. Positivity for muscle specific actin was focally found. The renal neoplasm required differential diagnosis from metastatic GIST. The morphological and immunohistochemical investigations in our case were consistent with GIST coexisting with primitive renal cell carcinoma. One of the problems connected to the anatomo-clinical evaluation of GIST consist in the difficulty of making a prognosis. An almost complete review of the literature and view point on the topic has been performed. As a conclusion judging from papers regarding this argument, no clear parameters of biological behaviour exist excluding mitotic index.

Adenocarcinoma, Clear Cell↗
PubMed1997

The structure of superficial lymphatics in the human thigh: precollectors.

BACKGROUND: Little is known about the morphology of precollectors, the lymphatic vessels connecting the absorbing and the collecting vessels, which are regarded as the initial drainage routes of lymph. The aim of this study was to describe the structural features of human precollectors. METHODS: Samples of fat from around the saphenous veins were obtained from patients undergoing varicotomy, and serial sections were observed under light and transmission electron microscopy. Tridimensional reconstructions were also obtained by computer analysis. RESULTS: Precollectors were characterized by an irregular and discontinuous arrangement of smooth muscle cells in their wall. This arrangement was unrelated to the site of valves. When present, muscular elements were arranged helicoidally, as shown in tridimensional reconstructions. Under transmission electron microscopy, the endothelium of precollectors was similar to that of absorbing lymphatic vessels, irrespective of the presence of smooth muscle cells, and was thin, rich in pinocytotic vesicles, supported by a discontinous basal lamina, and connected by anchoring filaments to the surrounding connective tissue. Myoendothelial contacts were frequent. Valves were similar to those of collecting vessels, except for the presence of numerous zonulae adherentes connecting the characteristic "tip cells" of the free edge. CONCLUSIONS: Human thigh precollectors are characterized by the alternation of portions with a well-developed muscular coat and portions with an absorbing structure. These morphological features suggest that the precollectors contribute to fluid absorption and lymph propulsion. The frequent myoendothelial contacts suggest that smooth muscle contraction is regulated locally.

Aged↗
PubMed1997

Correction of erythrocyte shape abnormalities in familial hypercholesterolemia after LDL-apheresis: does it influence cerebral hemodynamics?

It is well known that red blood cells incubated in low-density lipoprotein (LDL)-rich medium show shape abnormalities that revert to normal after reincubation in normal plasma. Patients with homozygous familial hypercholesterolemia (HFH) have an increased percentage of abnormally-shaped erythrocytes (mostly stomatocytes, knisocytes, and crenated cells) compared to normocholesterolemic controls: 7.73+/-0.96 versus 3.52+/-0.52 (mean+/-SEM; P = 0.001). To confirm the role of high LDL concentration in inducing red cell shape abnormalities we determined the percentage of abnormally shaped erythrocytes in seven HFH patients 1 day after the procedure of LDL-apheresis with a 40% cholesterol decrease. A reduction in kniscocytes, stomatocytes, and crenated cells was observed in the patients treated by LDL-apheresis (P < 0.01). To investigate the possible benefit of a reduction in erythrocyte shape abnormality on cerebral hemodynamics, cerebral flow velocity, as evaluated by transcranial Doppler, was evaluated concomitantly and found to be remarkably increased after apheresis (P < 0.01). No significant change in hematocrit, plasma viscosity, blood viscosity, mean pressure, or cardiac output was detected, 1 day after apheresis. An inverse correlation was demonstrated (r = 0.55; P = 0.04) between changes in the percentage of knisocytes+stomatocytes +crenated cells and percent changes in middle cerebral artery peak systolic velocity. The correction of erythrocyte shape abnormalities after LDL-apheresis might be related to dramatic changes in plasma phospholipid concentration and proportion occurring after this procedure in HFH patients. The reduction of erythrocyte shape abnormalities could contribute, together with other hemorheological factors, to the improvement of cerebral hemodynamics after LDL-apheresis.

Blood Component Removal↗
PubMed1997

Prevalence and clinical correlates of microalbuminuria in essential hypertension: the MAGIC Study. Microalbuminuria: A Genoa Investigation on Complications.

The prevalence of microalbuminuria and its relationship with several cardiovascular risk factors and target organ damage were evaluated in a cohort of 787 untreated patients with essential hypertension. Albuminuria was measured as the albumin-to-creatinine ratio in three nonconsecutive, first morning urine samples. The prevalence of microalbuminuria was 6.7%. Albuminuric patients were more likely to be men and to be characterized by higher blood pressure, body mass index, and uric acid levels and lower HDL cholesterol and HDL cholesterol-to-LDL cholesterol ratio. Piecewise linear regression analysis demonstrated that uric acid and diastolic blood pressure significantly influence albuminuria and together account for a large part of its variations. K-means cluster analysis performed on the entire cohort of patients confirmed that microalbuminuria is associated with a worse cardiovascular risk profile. Furthermore, microalbuminuria was associated with the presence of target organ damage (eg, electrocardiographic [ECG] abnormalities and retinal vascular changes). Age and the presence of microalbuminuria act as independent risk factors for the development of ECG abnormalities and retinal vascular changes. Cluster analysis allowed us to identify three subgroups of patients who differed in the presence or absence of microalbuminuria, retinopathy, and ECG abnormalities. We conclude that the prevalence of microalbuminuria in essential hypertension is lower than previously reported. Increased urinary albumin excretion is associated with a worse cardiovascular risk profile and is a concomitant indicator of early target organ damage.

Adolescent↗
PubMed1997

Carcinosarcoma of penis. Case report and review of the literature.

AIMS OF THE STUDY: Carcinosarcomas (sarcomatoid carcinomas) are controversial, biphasic tumors composed of both carcinomatous and sarcomatous elements. They are uncommon and occur in numerous locations. At the time of this report only 3 cases of carcinosarcoma of penis have been reported in the literature. The aim of this article is to provide a discussion of these lesions, using informations gleaned from the pertinent literature as well as the personal experience of the authors. METHODS: The formalin-fixed paraffin-embedded tissue was stained with hematoxylin and eosin, reticulum, alcian blue and Mallory's trichrome stains. Section from selected paraffin-embedded blocks, were stained with antibodies to citokeratins, EMA, vimentin, desmin, and a actin. RESULTS: In our case the carcinomatous elements were admixed with areas of "divergent differentiation": spindle-cell and giant-cell sarcomatoid component with bone and cartilage differentiation were noted. In situ carcinoma was also detected. Immunohistochemistry showed reactivity for keratin and epithelial membrane antigen (EMA). In most of pleomorphic spindle elements. Immunoreactivity for vimentin, desmin and actin were focally found. CONCLUSIONS: The carcinosarcomas may demonstrate "divergent" differentiation into bone, cartilage or myogenous tissue, so it is possible that the cell of origin could be heterogeneous. In our case myogenous differentiation was focally found. Although the clinical data, available from the only three cases of the literature, demonstrate that the behaviour of this tumors was not different from those of squamous cell carcinoma, the authors recommended a constant careful follow-up of the patients.

Journal Article↗
PubMed1997

Vasa vasorum of superficial collecting lymphatics of human thigh.

Collecting lymphatics were obtained from human thigh fat for light microscopy and tridimensional reconstruction at time of operation for varicose veins. No patient had lymphedema and routine sections showed no inflammation or notable pathologic alteration of the surrounding soft tissue. Abundant vasa vasorum was observed around the musculature of superficial collecting lymphatics of human thigh. Within intervalvular portions of the lymphatic collectors where the muscle coat was thicker and more compact, the vasa vasorum penetrated between smooth muscle cells and was in contact with the endothelium. In valvular portions of the collecting lymphatics where the muscle layer was thinner and more fragmented, there were fewer vasa vasorum. Tri-dimensional reconstructions of the collecting lymphatic wall showed two communicating plexi of vasa vasorum--one outside and the other inside the muscle layer. Arteries and veins of similar size did not have such an abundant vasa vasorum. The explanation for this difference may relate to the fact that a relatively low oxygen and nutrient content of lymph is insufficient to nourish the collecting lymphatic. Moreover, diffusion of nutrients from the external plexus is likely also impeded by the thickness and density of the muscle layer. The vasa vasorum deep in the muscular layer and in the subendothelial space probably sustain adequate nutrition and oxygenation to the collecting lymphatic.

Adipose Tissue↗
PubMed1997

[Hepatoid adenocarcinoma of the stomach. Case report and review of the literature].

Hepatoid adenocarcinoma of the stomach is an uncommon gastric tumor. A throughout search of the literature revealed only 86 cases: the first case was reported by Bourreille et al in 1970. We describe a patient with primary gastric adenocarcinoma with high serum alpha-fetoprotein (AFP) levels (7000 ng/ml). Histologically foci strongly resembling hepatocellular carcinoma with hyaline globules were noted. Immunoreactivity for alpha-fetoprotein (AFP), a1 antitrypsin and CEA also indicate hepatocellular differentiation. This case provides informations on the DNA content and Ki67 expression of this unusual and aggressive variant of gastric adenocarcinoma.

Adenocarcinoma↗