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Biomedical subjects

L Carbone

Publications and source records attributed to L Carbone.

At least 37 records · Page 2Linked to original sources
PubMed1991

Diabetes mellitus and localizations of obliterating arterial disease of the lower limbs.

Thirty patients with intermittent claudication (IC) and treated diabetes mellitus and 30 age- and gender-matched nondiabetic claudicants underwent a vascular examination by noninvasive ultrasound methods (continuous-wave Doppler, duplex scanner). The ankle/arm systolic pressure index did not differ in the two groups. Diabetic patients with IC had more (p less than .001) non-flow-reducing stenoses (lumen reduction less than 50%) and fewer (p less than .002) flow-reducing obstructions (lumen reduction greater than 50%) of the iliac arteries than nondiabetics had. These data are consistent with a preferentially distal (below the inguinal ligament) localization of arterial stenoses in diabetic patients, whereas iliac artery diseases are relatively more severe in nondiabetics.

Ankle↗
PubMed1990

Early signs of vascular disease in homocystinuria: a noninvasive study by ultrasound methods in eight families with cystathionine-beta-synthase deficiency.

Fourteen patients (six males, eight females; mean age, 20 years) with homocystinuria due to homozygous cystathionine-beta-synthase (CBS) deficiency, underwent a vascular examination. Fourteen heterozygotes (seven males, seven females; mean age, 46 years), including 12 parents and one daughter of homozygotes (obligate heterozygotes), and one sister of a homozygote (with low enzyme activity as evaluated in vitro), were also examined. Homozygotes and heterozygotes were compared with two separate control groups of different age (mean age, 20 and 43 years, respectively). Ankle/arm systolic pressure index (by continuous-wave Doppler) was, on average, lower in homozygotes (P less than .01) and heterozygotes (P less than .05) as compared with the controls. An ankle/arm index less than 0.97 and suggesting flow-reducing arterial lesions was found in six (21%) lower limbs of homozygotes versus zero in controls (P less than .05). Echo Doppler (Duplex Scanner) abnormalities, indicating early, non-flow-reducing lesions of iliac arteries were more frequent in homozygotes (seven wall abnormalities or stenoses less than 15%) than in young controls (P less than .05). The corresponding figures for heterozygotes were seven wall abnormalities or stenoses (1% to 15% and one stenosis 16% to 50%) (P less than .01 v middle-aged controls). Early lesions (three wall abnormalities or stenoses less than 15%, three stenoses 16% to 50%) were detected in six (23%) internal carotids of heterozygotes versus three (3%) of corresponding controls (P less than .05). Technical limitations precluded the accurate detection of early lesions in the internal carotid arteries of young homozygotes and controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Alterations of glucose metabolism in chronic liver disease.

The prevalence of glucose intolerance has been studied by oral glucose tolerance test in 670 patients affected by chronic liver disease. The glycometabolic status was evaluated by criteria given by WHO in 1980. Sixty-nine subjects appeared to be affected by chronic persistent hepatitis and 140 by chronic active hepatitis. In these patients the prevalence of diabetic responses (DR) did not differ much from that of the general population in our geographic area. In contrast, a markedly higher frequency of DR appeared in a cirrhotic group of 401 patients compared to non-cirrhotic subjects. The cirrhotics, divided according to different disease stages, showed a higher DR frequency in decompensated patients than in well compensated patients, the prevalence reaching 63% in the former subgroup. The coincident presence of hepatocarcinoma - documented in 60 other cirrhotic patients - does not modify the prevalence of diabetes. Other risk factors for diabetes such as age, sex, and family history have been considered. Our results suggest that: (1) all these factors seem not to play a major role in the pathogenesis of alterations of glucose metabolism in patients suffering from chronic liver disease, and therefore (2) liver cirrhosis by itself might be a risk factor in the disturbance of glucose tolerance.

Adult↗
PubMed1989

Different localization of early arterial lesions in insulin-dependent diabetes mellitus and in familial hypercholesterolemia.

Ultrasound methods have been used for the vascular examination of middle-aged patients with insulin-dependent diabetes mellitus (IDDM, n = 44) or heterozygous familial hypercholesterolemia (FH, n = 37); they were compared with 50 healthy controls. To define the localization of the early arterial lesions in these two conditions, the determination of ankle pressure by Doppler ultrasound and the detection of flow disturbances in the iliac arteries by echo-Doppler technique have been combined in a single vascular investigation. There were no major differences in mean age, degree of overweight, sex distribution, blood pressure, or smoking habits among the three groups. Total serum cholesterol in patients with FH was almost double compared with diabetics and controls. Triglyceride, HDL cholesterol, and blood pressure values did not differ. Nine of 88 limbs of patients with IDDM had an abnormally low ankle-arm pressure ratio (less than 0.97), and there were three cases of low ratio of 100 limbs in the control subjects (P less than .02). The corresponding figure for heterozygous FH was of three of 74 limbs (not different from controls). Echo-Doppler abnormalities suggesting lesions in the iliac arteries were significantly increased (P less than .01) in FH patients (13 limbs with lesions of 74) compared with controls (four of 100 limbs). The proportion of echo-Doppler abnormalities in IDDM (four of 88 limbs) was practically the same as compared to the controls.

Adult↗
PubMed1989

Course and prognosis of human immunodeficiency virus-associated nephropathy.

PURPOSE: Patients infected with the human immunodeficiency virus (HIV) have been described to have an unusual form of renal disease known as HIV-associated nephropathy. This condition is characterized by severe proteinuria, rapid progression to renal insufficiency, and a morphologic pattern of focal segmental glomerulosclerosis (FSGS) on renal biopsy. Despite increasing awareness of this entity, the epidemiology and clinical course of HIV-associated nephropathy are not yet well defined. We therefore decided to study HIV-infected patients with this biopsy-proven pattern of focal sclerosis. PATIENTS AND METHODS: Using life-table analysis, we evaluated the clinical features and course of 26 patients with HIV infection and biopsy-proven FSGS and compared them with those in 24 subjects with HIV infection who had no glomerular disease at autopsy. RESULTS: The group with FSGS had a higher percentage of blacks (96% versus 46%) and intravenous drug abusers (42% versus 17%), and had a higher mean serum creatinine level (5.4 mg/dL versus 1.0 mg/dL) than the group of HIV-infected subjects without glomerular disease. At the time of diagnosis of FSGS, six patients had clinical acquired immunodeficiency syndrome (AIDS), eight had AIDS-related complex (ARC), and 12 patients had no evidence of AIDS or ARC. The progression to end-stage renal disease for all patients was rapid, with a median time to dialysis of 10.9 weeks. Duration of patient survival was dependent upon the stage of HIV infection at the time of diagnosis of renal disease. Patients who presented with AIDS had a median survival of 1.9 months, compared to a median survival of 3.6 months for those with ARC and 9.7 months for initially asymptomatic HIV carriers (p less than 0.05). Fifteen patients either presented with or developed AIDS during the course of the study, and all died as a consequence of their immunodeficiency. Survival curves from the diagnosis of AIDS to death were similar in the group with HIV-associated nephropathy (7.3 weeks) compared to the control AIDS group without renal disease (6.9 weeks). CONCLUSION: Our data indicate that FSGS associated with HIV infection can occur before other manifestations of AIDS, is more common in blacks and in intravenous drug abusers, and is rapidly progressive to uremia. Patient survival is dependent upon the stage of HIV infection. These findings may prove useful in devising more effective strategies for the care of this growing patient population.

AIDS-Related Complex↗
PubMed1989

Pathology of HIV-associated nephropathy: a detailed morphologic and comparative study.

Clinical and pathologic findings in the kidneys of 30 consecutive acquired immunodeficiency syndrome (AIDS) autopsies and in 34 consecutive renal biopsies performed on HIV infected patients at our institution between 1983 and 1987 were studied. To determine if the lesions of HIV-associated nephropathy have morphologic specificity, a subgroup of 13 biopsies with a diagnosis of HIV-associated nephropathy (HIVN) were compared to 13 biopsies each of heroin-associated nephropathy (HAN) and of idiopathic focal segmental glomerulosclerosis (IFSGS) matched for patient age, proteinuria and serum creatinine. A diagnosis of HIVN was made in 1 of 30 (3.3%) AIDS autopsies and 26 of 34 (76.5%) renal biopsies. When compared to HAN and IFSGS, HIVN had more globally "collapsed" glomeruli (P less than 0.001), less glomerular hyalinosis (P less than 0.02), more severe visceral epithelial cell swelling (P less than 0.05), more numerous visceral epithelial cell droplets (P less than 0.002), more prevalent and severe tubular microcystic dilatation (P less than 0.02), and tubular cell degenerative changes (P less than 0.001). Focal glomerular electron-dense deposits were present in 14 of 26 cases. Tubuloreticular inclusions were extremely numerous in glomerular and interstitial capillary endothelial cells as well as in interstitial leukocytes (P less than 0.001). Granular degeneration of nuclear chromatin was present in 10 of 26 cases. Nuclear bodies were more numerous in tubular and interstitial cells of HIVN (P less than 0.01), particularly type 3 (P less than 0.001). Reversal of tissue T4/T8 ratio was observed. We conclude that while no single morphologic feature of HIVN is specific, the combination of clinical and pathologic findings is quite distinctive and permits a presumptive diagnosis of HIVN in otherwise asymptomatic carriers.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Reproducibility of non-invasive vascular diagnosis in patients with diabetes mellitus.

Reproducibility of noninvasive ultrasound methods for vascular diagnosis was studied in 36 patients with Insulin Dependent Diabetes Mellitus. The vascular examination included a) the measurement of ankle systolic arterial pressure and ankle/arm pressure index (c.w. Doppler), b) Echo-Doppler examination of iliac arteries with measurement of maximum systolic frequency, systolic spectrum width and diastolic reverse flow component. A grading of iliac artery stenosis was also performed. The examination was repeated after one month according to a blind protocol. The coefficients of variation were as follows: 8% for ankle pressure; 8% for ankle/arm pressure index; 9% for the maximum systolic frequency; 18% for the spectrum width and 15% for the reverse flow component. The reproducibility of the grading of iliac artery stenosis based on the combined use of the three Echo-Doppler parametres was measured by the Kendall coefficient (W = 0.865). These results confirm that non invasive methods are suitable and reliable for investigating vascular disease in diabetic patients. Accurate estimates of reproducibility are essential pre-requisites for the planning of studies on the natural history of vascular disease and on progression-regression of arterial lesions.

Aged↗
PubMed1979

[Vascular alterations and GH secretion in latent chemical diabetes].

The AA. have investigated the relationship between the secretion of GH and diabetic angiopathy a group of 17 subjects with chemical diabetes during a standard dexamethasone os i.v. glucose test. The results show that functional subclinical microangiopathy was present in the majority of the diabetics studied, who also showed an exaggerated growth hormone response to glucose. Thus, these results suggest that a positive correlation exists between alterations in the secretion of growth hormone and the development of diabetic microangiopathy.

Blood Glucose↗
PubMedDate not supplied

Incidence of altered glucose tolerance in liver cirrhosis.

Even though the association between liver cirrhosis and glucose tolerance alterations has been well documented, no data are available on the incidence of this association. In this paper we firstly report the results of a 4-year prospective longitudinal study performed on well-compensated cirrhotic patients with a normal glucose tolerance, in order to evaluate the incidence of glucose tolerance alterations with respect to liver efficiency during the time. The incidence of a diabetic response to a standard OGTT was 4.4% after a 1-year and 21.2% after a 4-year follow-up in stable cirrhotics. These figures are significantly higher than in the general population of our country. This large incidence was even significantly higher in cirrhotics with worsening liver efficiency at the end of the study (35.3%, P < 0.0001). Sex, family history of diabetes, alcoholic aetiology of the cirrhosis, and increment of portal hypertension do not seem to have any significant influence on the frequency of altered glucose tolerance. Therefore, we propose that liver cirrhosis and its worsening play a primary role as diabetogenic risk factors.

Adult↗
PubMedDate not supplied

[Nitro derivatives: considerations on their antiplatelet activity].

The antischemic effect of nitrates is known and well accepted since more than 100 years, but recently many and interesting studies about antiaggregant property of such drugs have been reported. This action would be lied to increased synthesis of GMPc. The antiaggregant property pf nitrates may be leave open the problem to include the nitrates between the drugs able to influence the prognosis of myocardial infarction both in acute and chronic phase, such as betablockers, ASA and thrombolytics.

Coronary Thrombosis↗
PubMedDate not supplied

[A clinical case of hepatic psittacosis with ultrasonography anomalies of the liver].

Psittacosis marked by liver and spleen involvement and minimal pericarditis was observed in an 18-year-old patient hospitalized for fever of 1 month duration. Liver tests revealed cholestasis. Ultrasonography revealed multiple nodular formations in the liver and spleen, images confirmed on computed tomography. Liver biopsy showed granulomatous with hyperplasia of the Kupffer cells surrounded by healthy tissue. The diagnosis was confirmed by complement fixation. Treatment with tetracycline led to rapid remission of the fever and normalization of the liver tests and hepatic images.

Adolescent↗
PubMedDate not supplied

Early signs of carotid and iliac atherosclerosis in patients with severe hyperlipoproteinemia.

Hyperlipidemia is a major risk factor for atherosclerosis. Early signs of cardiovascular disease can be detected also in asymptomatic patients with hyperlipidemia. Forty-four patients with serum cholesterol greater than 300 mg/dl (7.8 mmol/l) and/or serum triglycerides greater than 500 mg/dl (5.6 mmol/l) and 35 healthy controls had their carotid and iliac arteries examined by echo-Doppler with spectral analysis. Systolic ankle pressure was also measured. A vascular score was calculated: a 0 score was assigned to normal findings and a 1 score for each artery with abnormality at echo-Doppler or Winsor index less than 0.97. The XbaI Restriction Fragment Length Polymorphism of Apo B gene was investigated in all hyperlipidemic patients. Arterial lesions, especially those of internal carotid and iliac arteries, were more frequent (p less than 0.01) in patients with high serum lipids, compared to controls. Patients with lesions were older and had higher serum triglyceride concentrations compared to those without lesions. When divided according to serum triglycerides, patients with concentrations exceeding 200 mg/dl had higher vascular score (p less than 0.02) compared to those with serum triglycerides less than 200 mg/dl. No difference in restriction fragment length polymorphism (XbaI) of Apo B gene was demonstrated in patients with arterial lesions compared to those without lesions. Non-invasive echo-Doppler examination gives useful information on the arterial involvement of hyperlipidemic patients and its use should therefore be implemented, especially when high triglyceride concentrations are present.

Apolipoproteins B↗