Monitoring warfarin therapy in patients with lupus anticoagulants.
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Anticoagulants↗
Biomedical subjects
L Crippa
Publications and source records attributed to L Crippa.
Antithrombin III (ATIII) replacement therapy in patients with sepsis and/or postsurgical complications: a controlled double-blind, randomized, multicenter study.
BACKGROUND: ATIII is decreased in sepsis and/or shock and its baseline value correlates with mortality. The efficacy of ATIII therapy on mortality was assessed in a selected group of patients admitted to the intensive care unit (ICU) in a double-blind, randomized, multicenter study. METHODS: 120 patients admitted to the ICU with an ATIII concentration < 70% were randomized to receive ATIII (total dose 24000 units) or placebo treatment for 5 days; 56 patients had septic shock. RESULTS: ATIII concentrations in the treated group remained constant throughout the treatment period (range 97-102%). The Kaplan-Meier analysis showed no difference in overall survival between the two groups: 50 and 46% for ATIII and placebo, respectively. Septic shock and hemodynamic support were unbalanced in the two groups at admission. Therefore the Cox analysis was carried out after adjusting for these two variables. Treatment with ATIII decreases the risk of death with an odds ratio (OR) of 0.56. Of the covariates analyzed, septic shock and the baseline multiple organ failure score were negatively associated with survival and plasma activity level was positively associated with survival with an OR of 0.97 for each 1% increase in the ATIII plasma concentration at baseline. CONCLUSIONS: The results of ATIII treatment in this population of patients suggests that replacement therapy reduces mortality in the subgroup of septic shock patients only.
APACHE↗
Gastric spiral bacteria in wild rats from Italy.
Forty-three wild rats (Rattus norvegicus) trapped in Milan (Italy) were examined for gastric spiral bacteria and to evaluate associated histological lesions. Spiral bacteria were histologically detected in the stomach of 10 rats (23%). The morphological features of these microorganisms, observed using both light and electron microscopy, correspond to those of Helicobacter heilmannii. Mild gastritis characterized by focal lymphoplasmacytic infiltration of the lamina propria was observed in six rats with gastric spiral bacteria. Our findings suggest a causal role of these bacteria in inducing a gastric inflammatory response.
Animals↗
Outbreaks of hyperkeratotic dermatitis of athymic nude mice in northern Italy.
Hyperkeratotic dermatitis of athymic nude mice is an infectious disease caused by a coryneform bacterium. During the spring of 1995, outbreaks of hyperkeratotic dermatitis were observed in several nude mice facilities in northern Italy. In this report we describe the clinical, histopathological and microbiological features of the disease in two different animal facilities. Affected animals showed a typical 'scaly' appearance with small white flakes of material adherent to the skin. In one of the outbreaks (facility 2) the lesions were less severe and involved only limited areas of the body. The infection spread very quickly and the morbidity reached more than 80% in a few days, while the mortality was about 1%. The lesions resolved spontaneously within 7-10 days. Histological examination of affected skin revealed orthokeratotic hyperkeratosis, acanthosis and dermal inflammatory infiltration which were more severe in mice from facility 1. In Gram-stained sections groups of rods consistent with coryneform bacteria were detectable in the keratin layers covering the epidermal surface. A coryneform bacterium, biochemically typed as Corynebacterium bovis, was isolated from 11 out of 11 mice from facility 1 and from 8 out of 11 mice from facility 2.
Animals↗
Asymptomatic adenoviral respiratory tract infection in guinea pigs.
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Adenoviridae Infections↗
Relationship of lupus anticoagulant, anticardiolipin, anti-beta2-GPI and anti-prothrombin autoantibodies with history of thrombosis in patients with the clinical suspicion of APA-syndrome.
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Adult↗
Evaluation of a new rapid quantitative D-dimer assay in patients with clinically suspected deep vein thrombosis.
The sensitivity and specificity for deep vein thrombosis (DVT) of a new rapid, quantitative and precise (total imprecision < 10%) D-dimer assay suitable for individual measurements (VIDAS D-DIMER, bio-Mérieux, France) were evaluated in a consecutive series of 103 in- and out-patients submitted to serial compression ultrasonography (C-US) for the clinical suspicion of DVT (n = 66) or of DVT recurrence (n = 37) and symptoms lasting from 1 to 15 days. DVT was found in 22 patients at baseline testing and no patient with an initially negative C-US developed vein incompressibility at follow up. The time elapsed from the onset of symptoms was negatively associated with D-dimer levels both in patients with and in those without DVT. In the entire series of patients, the sensitivity of a positive D-dimer test ( > or = 1.0 microgram/ml) for the presence of DVT was 96% (21/22 patients, 95% confidence interval 75-100%) with a specificity of 75% (64-84%), a negative predictive value of 98% (90-100%), a positive predictive value of 51% (35-67%), and an overall accuracy of 80% (70-87%). A normal D-dimer value (0.22 microgram/ml) was observed in one patient with DVT and symptoms lasting from 15 days. The approach of withholding C-US testing in patients with symptoms lasting from less than 11 days and D-dimer levels below the cut-off value was compared to serial C-US testing alone in a cost-effectiveness analysis subdividing the 66 patients with a first episode according to their clinical pretest probability of DVT. Thrombosis was detected in 6.7% of the patients in the low probability group (n = 15), 16.7% of the patients in the moderate probability group (n = 24), 51.9% of the patients in the high probability group (n = 27) and 8.1% of patients with suspected DVT recurrence. Calculated cost-savings for each DVT diagnosed ranged from 5% in the high pretest probability group to 55% in the low pretest probability group and to 77% in patients with suspected DVT recurrence. The safety of avoiding C-US testing in symptomatic patients with a negative D-dimer test should be evaluated in clinical management studies.
Adult↗
Potential failure of the International Normalized Ratio (INR) System in the monitoring of oral anticoagulation in patients with lupus anticoagulants.
Patients with antiphospholipid antibody syndrome (APS) experience a higher rate of recurrence of thrombosis than the general population of patients with thrombotic disease. Based on a retrospective analysis, it has been suggested that patients with APS should be kept on prolonged anticoagulation aiming at international normalised ratio (INR) values > 3.0. To evaluate whether the requirement for more intense anticoagulation depends on the variable sensitivity of thromboplastin reagents to the influence of aPLA, we monitored oral anticoagulant treatment in 10 patients with persistent lupus anticoagulants (LA) and venous thromboembolic disease using two thromboplastin reagents: Pro-IL-Complex (Instrumentation Laboratory, combined) and Recombiplastin (Ortho, recombinant). Acenocoumarol dosage was always assigned based on INR values obtained with the combined thromboplastin using diluted (1:20) test plasma, aiming at an INR interval of 2.0 to 3.0. Single INR determinations with both reagents were obtained throughout the study period for 110 aPLA-free patients on stable oral anticoagulation. Using the manufacturer's instrument-certified international sensitivity index (ISI) values, INR obtained with the recombinant reagent were significantly higher than those obtained with the combined reagent in LA-positive patients, but they were lower in LA-negative patients. After correction for local ISI calibration in LA-negative patients, INR values of 3.1 and 4.6 with Recombiplastin corresponded, respectively, to INR values of 2.0 and 3.0 with Pro-IL-Complex. These results indicate the thromboplastin-dependency of INR values in patients with LA, thereby questioning the validity of the INR system for the monitoring of oral anticoagulant treatment in these patients.
Administration, Oral↗
Leptospira interrogans serovar sejroe infection in a group of laboratory dogs.
Interstitial nephritis was seen histologically in 19 (59%) out of 32 pure-breed beagle dogs (16 males and 16 females) subjected to standard safety tests. In these animals no clinical abnormalities were observed and all the tested parameters (haematology, biochemistry and urine analysis) were within the normal ranges. Leptospiral antibody titres ranging from 1 : 100 to 1 : 6400, against a serovar (hardjo) belonging to the Sejroe serogroup, were detected by the microscopic agglutination test (MAT) in the serum of the 19 dogs with interstitial nephritis. All animals without renal lesions were seronegative. Leptospiral antigen was detected immunohistochemically in the kidneys of 4 dogs; leptospires were detected in Warthin-Starry stained sections of one dog. Leptospires were isolated from the kidneys of 3 of the 4 dogs examined by bacterial culture. The isolated strains were typed as serovar sejroe by restriction endonuclease digestion and Southern blot hybridization analysis of their DNA. It was concluded that Leptospira interrogans serovar sejroe, was responsible for an asymptomatic chronic renal infection which was widespread in this group of laboratory dogs.
Agglutination Tests↗
Lungworm infection in laboratory dogs reared in Italy.
Lungworms, Filaroides hirthi, were observed in histological lung sections in 4 out of 96 beagle dogs (4.2%) reared for experimental studies in Italy. Infected animals were 2 males and 2 females, 8 months old, with no clinical signs, while in another case a granulomatous lesion, possibly transmitted by this lungworm, was found. Histopathological changes of lung induced by F. hirthi can mimic some drug-induced and neoplastic lesions, and therefore to cause misunderstanding during interpretation of results of toxicological studies. This is the first report of F. hirthi infection of laboratory dogs reared in Italy.
Animals↗
Diagnostic value of compression ultrasonography and fibrinogen-related parameters for the detection of postoperative deep vein thrombosis following elective hip replacement: a pilot study.
To determine their ability to diagnose postoperative deep vein thrombosis (DVT) D-dimer - by three methods -, fibrinogen degradation products (FgDP) and fibrinogen levels were measured in 68 consecutive patients before elective surgery for hip replacement and on postoperative day 1, 3, 6, and 10. All patients received prophylaxis and underwent compression real-time B-mode ultrasonography (C-US) on postoperative day 5 and 9, and bilateral ascending venography on day 10. Twenty-two out of 68 patients developed asymptomatic postoperative DVT, which was limited to the calf veins in 14 and involved the proximal veins in 8 patients. C-US was negative in all patients on day 5. On day 9, C-US sensitivity and specificity for proximal DVT were 63% (95% confidence interval: 26%-90% and 98% (89%-100%) respectively. Postoperative changes in the laboratory parameters evaluated were not different in patients with or without DVT until day 10. On day 10, mean D-dimer, FgDP and fibrinogen levels were significantly higher in patients with DVT than in those without DVT (p values between 0.006 and 0.032), but only D-dimer was higher with DVT involving two or more venous segments than with thrombosis involving one venous segment only (p < 0.05). Stepwise logistic regression analysis identified D-dimer and fibrinogen on day 10 as predictors of postoperative DVT. In a receiver operator curve and after weighing for the coefficients generated by logistic regression analysis, the combination of a latex photometric immuno-assay and of PT-derived fibrinogen yielded-at a cut-off value of 7.0 a sensitivity of 100% (73%-100%) and a specificity of 58% (39%-75%) for DVT, with a negative predictive value of 100% (78%-100%), a positive predictive value of 52% (32%-71%) and an overall accuracy of 71% (55%-83%). These results suggest that two simple, fast and reproducible tests may permit the identification of patients at low risk of having postoperative DVT and that a combination of sensitive laboratory assays and of the highly specific C-US may select patients requiring anticoagulant treatment. Efficacy and cost-effectiveness of this approach should be evaluated in large clinical management studies.
Aged↗
Brief report: autoimmune protein S deficiency in a boy with severe thromboembolic disease.
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Autoantibodies↗
Argyrophil cells in gastrointestinal epithelial tumours of the dog.
Fifty-two cases of gastrointestinal mucosal tumours of the dog were examined for argyrophil cells by means of the Grimelius stain. Argyrophil cells were found in each of five cases (100 per cent) of gastric adenoma, in five (71.4 per cent) of seven large-intestine adenomas, in 13 (59.1 per cent) of 22 gastric carcinomas, in five (62.5 per cent) of eight small-intestine carcinomas and in four (40 per cent) of ten large-intestine carcinomas. The argyrophil cells represented a minority of the tumour cell population in all cases. These results demonstrate that a significant proportion of gastrointestinal mucosal tumours of the dog contain a mixture of epithelial and endocrine cells. Similar findings have been reported in man.
Adenoma↗
[Influence of maternal smoking on cord serum IgE levels in newborns].
Allergic diseases are among the most common diseases in childhood and their prevalence is 14%. One of the most important pathogenetic factors is the ability to produce IgE and the measurement of cord serum IgE seems to be very important for early detection of newborns at risk. Besides, cigarette smoke, among the environmental factors, has been demonstrated to influence the immunologic system, inducing an increase in IgE production. The aim of this study is to evaluate fetal production of IgE in newborns with a family history of atopy and whose mother has been smoking during pregnancy. The measurement of cord serum IgE has been performed in 215 at term newborns (weight at birth > 2500 g, Apgar score at 5' > 7). A careful history has been obtained with particular regard at the presence of familiarity for allergies and a cigarette smoking during pregnancy. According to the history, children have been divided in 3 groups: Group 1: 126 newborns without familiar history of allergy and born from no smoking mothers (control group); Group 2: 46 newborns with familiar history for allergy and born from no smoking mothers; Group 3: 43 newborns without familiar history for allergy born from smoking mothers. The II and III groups of newborns present total IgE levels on cord serum significantly higher than the control group. Besides a positive correlation between the number of cigarettes smoked during pregnancy and the value of cord serum IgE has been detected. It is well known that both genetic and environmental factors play an important role in the pathogenesis of allergic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Echocardiographic parameters and indices in the normal beagle dog.
M-mode and two-dimensional echocardiographic measurements were made from the right sternal border of 50 healthy Beagles (25 males and 25 females) approximately 7 months old. The dogs were conscious and standing during the investigation. The following parameters, in systole and diastole, were measured on the echocardiographic images: left ventricular posterior wall thickness (LVWT); intraventricular septum thickness (IST); left ventricular internal dimension (LVID); and circumference (LVC). Fractional shortening (FS) and ejection fraction (EF) were also calculated. Mean, standard deviation, range and coefficient of variation are reported for each echocardiographic parameter and for body weight. Males and females were considered separately and together. Each parameter was analysed statistically to check for differences between the sexes and for correlations with body weight. A statistically significant difference between the sexes was only observed for LVWT in systole and diastole. A linear regression with body weight was obtained only for LVID in systole and in diastole. The results show that morphofunctional cardiac homogeneity is independent of size in dogs of this breed and age.
Analysis of Variance↗
[Pharmacokinetics of broxaterol in asthmatic children].
Pharmacological profile of broxaterol, a new beta adrenergic compound, was investigated in 12 asthmatic children (6 male and 6 female with age 8-13 years). This study was performed from November to May, and venous blood was collected after 30, 45, 120, 180, 240 minutes from administration of 0.5 mg broxaterol; the urine was collected every 4 hours drug intake (0-4, 4-8, 8-12 hours). Drug absorption proved very fast: T max was 0.9 hours and Cmax was 2.05 micrograms/ml. T 1/2 was 2.3 hours. The urine concentration of broxaterol in the urine 0-4 and 4-8 hours after administration, was 6.11 and 2.3% (as drug percentage), after 8 hours no broxaterol was evaluated in the urine. Pharmacological profile of broxaterol in asthmatic children and adults is comparable.
Adolescent↗
Macroreticulate buffers: a novel approach to pH control in living systems.
It is possible to control the pH of growing living systems in vitro by adding, to the growth media, macroreticulate buffers, i.e. amphoteric resins made with buffering and titrant groups simultaneously affixed to the matrix. Such beads possess a very precise isoelectric point (pI) and are able to maintain the solutions' pH close to their pI values for extended growth periods. These pearls are made of a neutral polyacrylamide backbone containing up to 200 mM grafted weak acrylamido acids and bases. It is possible to produce such buffers with any desired pH value in the pH 2.5-11 scale. An example is given of conditioning the pH of endive plants grown hydroponically.
Acrylic Resins↗
The diagnostic value of immunoperoxidase in detecting K99+ Escherichia coli on histological sections.
The small intestine of 51 calves was examined for the presence of K99+ Escherichia coli by means of both an immunoperoxidase procedure performed on paraffin sections and by the slide agglutination test after isolation. Twelve cases resulted immunoperoxidase positive (23.5%) and 8 of them were also agglutination positive. Results of the 2 diagnostic tests agreed in 46 cases (90.2%). In immunoperoxidase positive sections a thick layer of immunoreactive bacteria was seen on the luminal surface of the enterocytes. Post-mortem autolysis or prolonged fixation did not seem to affect the immunoperoxidase reactivity of the sample.
Animals↗