Organ shortage and a long waiting list allow local kidney allocation to insure both short ischemia time and good HLA-A, B, DR matching.
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Biomedical subjects
Publications and source records attributed to G Taddei.
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Intestinal resection in the natural history of Crohn's disease is a forced step. Unfortunately surgery is not curative as disease inexorably recurs. The frequency of recurrence varies according to the definitions adopted, being high when endoscopical criteria are used (70-90% at one year). Among risk factors, the most convincing is a smoking habit. The pathogenesis of recurrence is still unknown. Particular attention was paid to colo-ileal reflux which occurs after the resection of the ileocecal valve. The diagnosis should always be based on morphological criteria (endoscopy or radiology). In fact symptoms occur late and are often uncharacteristic. A particular problem in the management of patients with Crohn's disease is the prevention of post-operative recurrence. Recent randomized, controlled trials of which the first has been published by the authors of this article, demonstrated that the administration of 5-ASA early after resection may prevent, delay or attenuate such recurrences. Cessation of smoking also plays a central role in prevention. The final message is that in active Crohn's disease surgery should not be excessively delayed. Early resection followed by prophylactic treatment seems to improve the quality of life in patients with more severe Crohn's disease.
Receptor content of human decidua in early pregnancy (weeks 6-12) was investigated. Fifty-three tissue samples were obtained from voluntary patients undergoing abortion and whose gestational age range from 6 to 12 weeks. Blood samples were drawn at the time of operation in order to measure circulating estradiol (E) and progesterone (P) concentrations. Tissue samples underwent first histological confirmation and then were analyzed for receptor content by immunohistochemistry (IH) and by the conventional ligand binding technique (LBA). Estrogen receptors (ER) appeared to be always undetectable by IH (53 samples). LBA measured a significant amount of ER (> 10 fmol/mg) in two samples, borderline values (3-10 fmol/mg) in 6 and no binding in the other three. No relation was apparent between PR levels and either gestational age or blood P concentration. ER were possibly downregulated by the high E levels, and their synthesis inhibited by the high P levels.
In 20 women with vulvar lichen sclerosus (LS) we analyzed the immunohistologic features of the dermal lymphoid infiltrate and the number of epidermal CD1a+ cells (Langerhans cells). Activated (HLA-Dr+) T cells, associated with CD1a+ accessory cells, were found in the dermis in all cases. The number of CD1a+ epidermal cells was increased, and the cells expressed strong HLA-DR+ staining. These findings suggest activation of the skin immune system in vulvar LS lesions. Conventional 2% testosterone therapy failed to modify the immunohistologic features. Clobetasol, 0.05%, application seemed more effective in down-regulating the skin's immune system activation profile.
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Restenosis is the major limit of arterial recanalization devices. Directional atherectomy has allowed for the first to remove atheroma samples by a percutaneous approach. A group of patients affected by superficial femoral artery disease who underwent directional atherectomy were studied. The patients were treated for primitive stenosis, restenosis after balloon angioplasty and thermal laser angioplasty. Intimal hyperplasia was the distinctive feature of restenosis and the cells were identified by immunohistochemistry and transmission electron microscopy as smooth muscle cells in an active synthetic phenotype. No differences were found in the restenosis process after balloon angioplasty and laser thermal angioplasty. Directional atherectomy is a useful tool to ameliorate our knowledge in the restenosis process after invasive procedure of recanalization.
"Hot tip" laser angioplasty has been used in the treatment of peripheral artery disease. The purpose of our study (the largest in Italy) is to evaluate the complications during the recanalization of stenotic and occluded iliac and femoro-popliteal arteries, using a hot tip laser system coupled to an Argon or Nd Yag laser. One hundred twenty-three patients have been treated. The complications were: arterial spasm in 2 patients; distal embolizations in 6 patients; arterial dissections in 35 patients; vessel wall perforations in 20 patients. Vessel wall perforation is the more severe complication and did never allow to complete the procedure. The presence of intravascular calcified deposits increases the risk of perforation, due to the loss of the coaxial position of the probe. Only the development of a guided laser system could allow a safer delivery of laser radiation, reducing the risk of arterial wall perforation.
Eighty-seven laser angioplasty procedures were performed on 85 patients (73 men and 12 women). In the first phase (54 patients) a broad selection process included long occlusions (23.9 cm avg) and vessels with heavy calcification; in the second phase (31 patients) the authors treated vessels with shorter occlusions (10 cm avg) and less calcific. The primary success rate, based on number of procedures (73.5% overall) was 69% in the first phase but reached 81.3% in the second phase. There were 14 perforations (16%), 8 dissections (9.4%), and 4 peripheral emboli (4.7%). Six-month follow-up shows that the Winsor index maintained its initial improvement in 76.5% of all patients, or 62% in just the long occlusions. These data and a review of the cases suggest that no more of 10-20% of patients with claudication in lower extremities can be treated by laser angioplasty; the authors consider ideal candidates those patients who noncalcific lesions in the common iliac or superficial femoral arteries at the III medium level with obstructions shorter than 8 cm and good runoff.
One hundred forty-three women complaining for couple infertility (more than 2 yr), were investigated for luteal phase deficiency (i.e. insufficient endometrial luteinization) by endometrial biopsy and serial determinations (in days -10, -7 and -4 respect the onset of the next menses) of plasma progesterone during luteal phase. One hundred-three women had the first endometrial biopsy in phase (IP), 36 had the biopsy "out of phase" (OOP). Among them 13 did not repeat endometrial biopsy, 12 had the second biopsy out of phase (and then classified as Luteal Phase Deficiency) and 11 had the second biopsy "in phase". Only the women affected by luteal phase deficiency had the plasma progesterone (mean of 3 samples) significantly lower than that of infertile women with normal endometrial luteinization. However the majority of the individual progesterone values of these two groups overlapped. The endometrial biopsy seems to be the most practicable method for investigating luteal phase deficiency in women complaining for couple infertility.
The systemic haemodynamic pattern and its changes after at least 6 months of successful percutaneous transluminal angioplasty (PTRA) was evaluated in a group of patients with renovascular hypertension (RVH). Fourteen patients, nine males and five females, aged 21 to 58 years, were studied; 12 had fibrodysplastic and two had atherosclerotic stenosing renal vascular lesions. Seven were cured and seven improved. Hypertension was characterized by increased plasma volume (PV) and total peripheral vascular resistance (TPR). Mean peripheral plasma renin activity (PRA) and 24-h urine aldosterone (UA) were elevated. However, the vasoconstriction did not appear to be related to the increased activity of the renin-angiotensin system. After at least 6 months of a successful PTRA, the fall in blood pressure (BP) was associated with a decrease in TPR; PV appeared normal, and PRA and UA became normal.
The brachiocephalic, carotid, vertebral and intra-cranial vessels of 497 patients presenting reversible ischemic attacks (R.I.A.) were evaluated with venous digital subtraction angiography (V.D.S.A.). Alterations of the vascular wall were observed in 289/497 (58.2%) patients, of whom 60% presented multiple locations (539 lesions): obstruction (12%), stenosis greater than 50% (29%), stenosis less than 50% (49.8%), kinking (9%), aneurysm (0.2%). An ulcerating arteriosclerotic plaque was observed in 24.6% of the stenoses less than 50% and in 48% of the stenoses greater than 50%. The incidence of vascular lesions was higher (p less than 0.01) in patients with multiple R.I.A. (66.6%) than in those with one isolated R.I.A. (55.6%). Among the patients (207/497) studied also with cerebral computed tomography (C.T.) no relationship could be defined between the extra-cranial vascular lesions demonstrated by V.D.S.A. and the cerebral alterations shown by C.T. Among the patients (64/497) studied also with high frequency ultrasonography (U.S.), the lesion shown by V.D.S.A. could be also demonstrated by U.S. in 84.8% of cases. The personal flow-chart in the study of R.I.A. is described emphasizing the primary role played by V.D.S.A. as well as the complementary role of the other techniques, both non invasive (U.S., C.T.) and invasive (conventional or digital subtraction angiography).
Endoscopy and biopsy of the upper gastrointestinal tract and terminal ileum were performed in 24 patients with familial polyposis or Gardner's syndrome in order to further define the incidence of extracolonic adenomatous polyps. Polyps, usually multiple and small in size, were detected in the gastric fundus (12.5 percent), antrum (29.1 percent), duodenum (66.6 percent), and terminal ileum (41.7 percent). Histology showed hyperplasia of the fundic glands and cystic dilatation in the polyps of gastric fundus, and adenomas in several cases of antral (three patients) or duodenal polyps (14 patients). Polyps of the terminal ileum were either adenomas (five patients) or lymphoid aggregates. Patients with stigmata of Gardner's syndrome, desmoids or mesenteric fibromatosis presented a major incidence of adenomas in the duodenum, but not in other parts of the digestive tract investigated. Subsequent checkup after an average of 33 months in ten patients revealed an increase of lesions only in the duodenum in two patients. These findings confirm that adenomatous polyps are not limited to the colon and rectum, as previously believed, but can affect the whole gastrointestinal tract. Periodic surveillance of mucosa seems to be indicated, especially for the duodenum, since degeneration of adenomas into carcinoma is possible.
The study of renovascular hypertension (R.V.H.) presently requires multiple non invasive examinations in order to select between patients with R.V.H. or other kind of hypertension, before resorting to angiography. The use of venous digital subtraction angiography (V.D.S.A.) may change this diagnostic flow-chart. For this purpose, 100 patients with clinical and laboratory data suspect of R.V.H. underwent V.D.S.A. Compared to angiography, V.D.S.A. showed a 100% sensitivity and 93% specificity. Since the sensitivity and specificity of the non invasive techniques vs. V.D.S.A. in the same series was always lower, V.D.S.A. may be proposed as the first examination in the study of R.V.H. The arterial route for D.S.A. is generally not required for diagnostic purposes.
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The feasibility of assessing regional cerebral perfusion using the new brain imaging agent N,N,N'-trimethyl-N'-(2)-hydroxy-3-methyl-5-(123I) iodobenzyl)-1,3-propanediamine 2 HCl (I-123 HIPDM) and single photon emission computed tomography (SPECT) was evaluated in normal subjects and patients with cerebrovascular disorders. Following intravenous injection, I-123 HIPDM was rapidly extracted from the circulating blood by the brain (6.7%) and other organs. Its intracerebral distribution, as tomographically assessed by SPECT with a rotating gamma camera, reflected the distribution of blood flow within brain structures (gray and white matter, basal ganglia, etc.). Asymptomatic patients with history of transient ischemic attacks or minor stroke and angiographic evidence of internal carotid artery occlusion showed large cortical areas of reduced I-123 HIPDM distribution with normal or slightly positive CT. After extracranial-intracranial bypass surgery, reperfusion could be shown in previously ischemic areas. This study indicates the clinical usefulness of using I-123 HIPDM and gamma camera SPECT for the functional evaluation of brain disorders.
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Three cases of pelvic lipomatosis and a review of the literature are presented. One patient with pelvic lipomatosis was found at radiographic exploration to have retroperitoneal fibrosis with obstruction of the inferior vena cava. The classic roentgen triad which includes 1) pelvic radiolucency, 2) elevation of an intact rectosigmoid, and 3) elevation of the urinary bladder (the radiologic features simulate, in the first case, a pelvic malignancy) is present in two patients; the case 3 suggested a theoretical possibility: the pelvic lipomatosis and retroperitoneal fibrosis may be a variant of the same disease.