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Biomedical subjects

L Stendardi

Publications and source records attributed to L Stendardi.

34 records · Page 2Linked to original sources
PubMed1996

Cause of oral ulcers in HIV-infected patients: a study of 19 cases.

OBJECTIVES: To study the cause and clinical aspects of oral ulcers in HIV-infected patients. STUDY DESIGN: Forty-one consecutive HIV-positive patients with long-standing oral ulcers were examined; 19 were evaluated by biopsy. From these 19 cases, viral, bacterial, and fungal cultures and biopsies were taken in each patient. When indicated, special microbial stains were undertaken to identify bacteria or fungi. Ten cases without granulomatous bacterial fungal or lymphomatous features were available for in situ hybridization to detect viral DNA of herpes simplex virus 1 and 2, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus. RESULTS: Most of the oral ulcers occurred in patients with severe immunodepression. Median CD4 T-lymphocyte count was 60 cell/mm3 (range, 3 to 335). It was ascertained that nine (47%) patients had nonspecific aphthous-like ulcers, and ulcers caused by herpes group viruses were identified in six (31.5%) patients. One (5%) person was diagnosed with non-Hodgkin's lymphoma; and in one (5%) patient, multiple ulcers were an expression of lues maligna. Two ulcers (10.5%) in the palate harbored mycotic granulomatous foci (cryptococcosis, histoplasmosis). In this population, almost all of these ulcers were found to be large, persistent, and painful. CONCLUSIONS: Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers because either infection or a neoplastic process may be extant. In the absence of infection or neoplasm, such lesions are then designated as ulcers not otherwise specified.

AIDS-Related Opportunistic Infections↗
PubMed1993

Early oral presentation of lues maligna in a patient with HIV infection. A case report.

We present a case of a patient infected with the human immunodeficiency virus who developed syphilis manifested by atypical early oral and skin ulcerations. The profound immune defects associated with human immunodeficiency virus may lead to an altered clinical presentation and a more aggressive course in patients infected with Treponema pallidum. The unusual clinical manifestations observed in this case emphasize the importance of considering secondary syphilis in the differential diagnosis of any inflammatory mucosal and skin disorder in patients with the human immunodeficiency virus.

AIDS-Related Opportunistic Infections↗
PubMed1993

Preventive effects of beclomethasone on histamine-induced changes in breathing pattern in asthma.

Bronchial mucosa inflammation is a hallmark of asthma. Epithelial damage due to inflammatory process may contribute to induce a pattern of rapid and shallow breathing (RSB). Probably due to its effects on inflammatory process, beclomethasone dipropionate (BDP) decreases bronchial hypersensitivity (BH), as assessed in terms of histamine concentration causing a 20 percent FEV1 decrease from saline solution (PC20FEV1); however, no data are available on the effect of BDP on RSB. We studied 32 asymptomatic asthmatic subjects with a severe to moderate levels of BH (PC20FEV1 0.01 to 1.7 mg/ml). After they were randomly assigned to one month of either BDP (2 mg daily, 17 patients) or placebo (15 patients), they inhaled progressively doubling concentrations of histamine phosphate by tidal breathing method. With histamine in seven BDP-treated and in five placebo-treated patients, decrease in FEV1 > or = 20 percent from saline solution was paralleled by a significant decrease in tidal volume (VT), inspiratory time (Ti), and expiratory time (Te), and increase in respiratory frequency (RF). In the remaining patients, histamine failed to change the breathing pattern. In the seven RSB patients, BDP resulted in a smaller VT decrease (p < 0.02) and a smaller RF increase (p < 0.02) with histamine. The five RSB placebo-treated patients were then given one month BDP (2 mg daily): inhaled BDP, but not placebo, resulted both in a significant increase in PC20FEV1 and modulation in histamine-induced changes in breathing pattern. We conclude that high doses of BDP seem to be able to modulate histamine-induced RSB, an effect that might be linked to reversal of airway inflammation.

Adolescent↗
PubMed1987

Effect of inhaled histamine on occlusion pressure and breathing pattern in asthmatic patients.

In animals, histamine inhalation is known to increase either respiratory frequency or respiratory drive by stimulation of airway vagal sensitive endings. However, it is not well known whether these changes are concomitant in man. In order to elucidate this point, we carried out the present investigation in thirty-five asthmatic patients who underwent bronchial provocation test by progressively doubling the dose of inhaled histamine. Bronchial reactivity to histamine allowed two populations of patients to be defined: group I with moderate and group II with mild, increased reactivity. In the twenty-three group I patients, neuromuscular inspiratory drive, assessed by mouth occlusion pressure (P0.1), was found to be significantly increased while no significant changes in breathing pattern were noted. In the twelve group II patients histamine did not modify P0.1 or breathing pattern. However, we were able to separate in group I a sub-group of ten patients, as with atopic asthma, in which histamine-induced increase in P0.1 was paralleled by rapid and shallow breathing (RSB). Changes in P0.1 and breathing pattern did not depend on baseline airway calibre. In group I, after bronchoconstriction had been reversed by inhaling a beta 2-agonist bronchodilator agent (fenoterol), P0.1 decreased significantly and RSB was found to be reversed; however, these changes were not interrelated. We concluded that: in asthmatics, histamine-induced increase in P0.1 is not necessarily paralleled by, nor related with, change in breathing pattern and in atopics a 'sensitization' of vagal receptors could account for the concomitance of enhanced P0.1 with RSB.

Administration, Inhalation↗
PubMed1986

Functional evaluation in stage I pulmonary sarcoidosis.

A functional evaluation was performed in 9 non-smoking patients suffering from sarcoidosis characterized, on chest roentgenograms, by hilar adenopathies (stage I). Frequency dependence of compliance (5 cases) and decreased conductance of the upstream segment (3 cases) were the major findings. From this it is concluded that, even at stage I, small-airway impairment may be documented in some patients, suggesting the existence of peribronchiolar granulomatous infiltration.

Adult↗
PubMed1986

Effects of histamine and reproterol inhalation on mouth occlusion pressure in patients with bronchial asthma.

Both vagal and non-vagal afferences from the lung or chest wall contribute to increasing neural drive to the respiratory muscles, but only the former are known to change the breathing pattern by increasing respiratory frequency (RF) during bronchoconstriction. In order to evaluate the relative contribution of vagal and non-vagal afferences to increasing neural drive to the respiratory muscles in 14 asymptomatic asthmatic patients known to be responsive (decrease in FEV1 greater than 20% of the control values) to previous bronchial provocation test (BPT) with aerosolized histamine, we evaluated FEV1, breathing pattern and neuromuscular drive, as assessed by mouth occlusion pressure (PO.1), under control conditions, during BPT with progressive doubling doses of inhaled histamine (H) and 5 min after inhalation of a bronchodilator agent (Reproterol) (B). During HBPT FEV1 exhibited a significant decrease (p less than 0.01) while PO.1 was found to increase significantly (p less than 0.01). However, no significant changes were noted in breathing pattern. After B FEV1 returned to control values while PO.1, even if significantly reduced (p less than 0.01), did not. Changes in PO.1 were found to be significantly related to changes in FEV1 both during HBPT and B (p less than 0.05). The data suggest that in these patients non-vagal afferences, linked to the abnormalities of thoraco-pulmonary mechanics, could play a major role in changing neural drive to the respiratory muscles.

Adult↗
PubMed1984

Comparative effects of SCH 1000 and fenoterol after histamine-induced bronchoconstriction in asymptomatic asthmatics.

In 16 asymptomatic asthmatics a functional study was carried out under controlled conditions during histamine bronchial provocation test (HBPT) and after bronchodilation test with either SCH 1000 or fenoterol by evaluating both SRAW and the slope of the alveolar plateau of nitrogen washout curve (N2 ph III). During HBPT, 9 of 16 subjects showed a central response (increase in RAW and SRAW only), whereas in the remaining 7 subjects histamine induced a mixed response due to an increase in both SRAW and N2 ph III. No differences between the two groups were observed in age and functional data during controlled conditions. Doses of delivered histamine were not significantly different. In 5 of 9 central responders to HBPT, SCH 1000 induced a decrease in SRAW only, whereas in 3 of the remaining 4 fenoterol caused both central and peripheral bronchodilation (decrease in both SRAW and N2 ph III). All mixed responders to HBPT showed a mixed bronchodilation during SCH 1000 (three subjects) or fenoterol (the remaining four). These data seem to indicate that the mechanism of bronchodilation induced by SCH 1000 is related to that of histamine-induced bronchoconstriction. Moreover, bronchodilation due to fenoterol could be related to a vagal modulation or be a systemic direct effect.

Adult↗
PubMed1983

Effects of steroid therapy on pulmonary involvement in sarcoidosis.

In eleven patients with stage II-III pulmonary sarcoidosis as assessed by mediastinoscopy or open lung biopsy, we carried out a functional study by evaluating static and dynamic pulmonary volumes, diffusing lung properties (TLCO, KCO), and mechanical properties: resistance of the airway, flow-volume curve, pressure-volume curve, flow-pressure curve, and dynamic compliance. In 7 of 11 patients a clinical and functional follow-up during steroid treatment over a period of 5 months to 3 years was also performed. Before treatment diffusing properties were in the normal range in 6 of 11 subjects, reduced in 4, and increased in 1. Elastic properties studied in 8 patients were in the normal range, whereas peripheral airway involvement was noted in 4 nonsmokers. During the follow-up the changes noted in diffusing lung properties on the whole parallelled the clinical and radiologic improvement or relapses after cessation of therapy. In contrast, no changes in elastic properties or lung volume were noted. We concluded that steroid treatment seems to improve parenchymal lung involvement in most cases as shown by the increase in diffusing lung properties.

Adult↗
PubMed1982

Site of action of inhaled histamine in asymptomatic asthmatic patients.

Histamine inhalation provocation-tests were performed in twenty-two young asthmatics with normal lung-function tests with progressive, increasing doses of a pressurized aerosol of histamine phosphate. Airway resistances (Raw) and N2 washout-curves were recorded. Two different types of response have been observed: (1) in thirteen cases, there was an increase of both Raw and the N2 phase III slope; and (2) in eight cases, there was only an increase in Raw (in one subject there was an increase in the N2 phase III slope only). Comparing the two groups of patients there was no difference in the inhalation procedure, the dose of histamine delivered or the smoking habits and lung-function data, except a slightly higher residual volume/total lung capacity (RV/TLC) ratio in the first group. The histamine-induced changes could not be related to any of the control lung-function data. We conclude that histamine inhalation may induce either peripheral bronchoconstriction only, or central bronchoconstriction with or without peripheral bronchoconstriction. A local and/or peripheral vagal-mediated bronchoconstrictor effect could account for the different site of airway response.

Adult↗
PubMed1982

Lung mechanics after aerosol and intravenous SCH 1000 in normal humans.

A functional study was carried out in six normal subjects before and after 0.5 mg of an intravenous atropine congener (SCH 1000) by evaluating the following parameters: static pulmonary volumes, resistance of the airways (Raw), N2 closing volume/vital capacity ratio, maximal expiratory flow volume, and the pressure-volume curves. From these curves we calculated the maximum flow-static recoil curves and the resistance of the airways upstream from the equal pressure point (Rus). On the following day four of six subjects inhaled 6 puffs (240 micrograms) of aerosolized SCH 1000 and the same parameters were evaluated. Both procedures caused a significant increase in maximum expiratory flow and a decrease in Raw. However, only intravenous SCH 1000 caused an increase in lung compliance and a decrease in Rus. When compared with previous data, our results show no dose-response effect on the atropine-induced modifications of pulmonary mechanics, and thus confirm the exclusive central bronchodilator effect of the aerosolized SCH 1000.

Adult↗
PubMed1980

Circulating immune complexes in bronchial asthma.

Soluble immune complexes were detected by a sold phase Clq binding assay in forty-two out of 106 well studied asthmatic patients (39.6%) and in eleven out of 145 age-matched controls (8%; P < 0.01). Clinical significance of immune complexes has been evaluated by comparing the following parameters in patients with and without such complexes: age, sex, duration of disease, IgE-mediated allergy (RAST, skin test), precipitins (Aspergillus, Candida albicans, Thermoactinomycetes), corticodependency, lung function tests, associated symptoms (hivernal bronchitis, urticaria, eczema,...), desenstization treatment, serum concentration in immunoglobulin in G, A, M and E. Immune complexes were found more frequently in female than in male patients. The prevalence of immune complexes was higher in patients treated by hyposensitization therapy and in cases with precipitating antibodies against thermophilic actinomycetes and Aspergillus.

Adult↗
PubMedDate not supplied

Respiratory muscle overloading and dyspnoea during bronchoconstriction in asthma: protective effects of fenoterol.

Whether, and to what extent, beta 2-agonists protect against respiratory muscle overloading and breathlessness during bronchoconstriction remains to be defined in patients with asthma. In a double blind placebo-controlled study, 100 micrograms of fenoterol were administered to six stable asthmatics before a bronchial provocation test, performed by inhaling doubling concentrations of histamine from a Devilbiss 646 nebulizer. We recorded breathing pattern (tidal volume VT, inspiratory time TI, total time of the respiratory cycle TTOT), inspiratory capacity (IC), dynamic pleural pressure swing (Pplsw), total lung resistance (RL) and FEV1. VT was expressed both in actual values and as % of IC. Changes in VT (%IC) during histamine inhalation reflected changes in dynamic end-inspiratory lung volume (EILV). Pplsw was expressed as % of maximal (the most negative in sign) pleural pressure, obtained under control conditions during a sniff manoeuvre (Pplsn). Pplsw (%Pplsn) is an index of inspiratory muscle effort. The test ended when the concentration of histamine which caused a decrease in FEV1 of > or = 40% post-saline was reached. Dyspnoea rating was scored by a modified Borg scale. At the ultimate degree of bronchoconstriction (UDB) with histamine: (i) decrease in FEV1 was similar after placebo and fenoterol, while increase in RL was lower after fenoterol (P < 0.005); (ii) VT(%IC) increased less after fenoterol (P < 0.027); (iii) increases in Pplsw (%Pplsn) was lower after fenoterol (P < 0.001); (iv) delta Borg (from saline) was lower (P < 0.01) after fenoterol; (v) differences in delta Borg, from placebo to fenoterol, related to concurrent changes in VT(%IC) (r2 = 0.67). In conclusion, at UDB 100 micrograms of fenoterol produced a beneficial effect on the degree of inspiratory muscle loading and breathlessness, an effect greater than it would be expected from measuring FEV1 alone.

Adrenergic beta-Agonists↗
PubMedDate not supplied

[Safety problems in the use of local anesthetics in the dental area].

In the last few years particular attention has been given to the adverse reaction to loco-regional anesthesia now widely used in dental practice. It has seemed therefore interesting to investigate the different types of adverse reactions, with particular attention to the anaphylactic-anaphylactoid ones. Although uncommon, these are interesting for the uncertain pathogenesis, the severity of the clinical picture and the complexity of the treatment. In order to find their adequate prevention, a particular approach to risk patients has been suggested to identify the eventual previous anaphylactic-anaphylactoid reactions and the drugs responsible for it. A procedure based on progressive skin test confirmed by a negative incremental challenge test has been worked out. Moreover the need has been felt for a drug surveillance program capable of collecting computerized data which allows real-time investigation of adverse reaction incidence, their typology and finally the effectiveness of prevention. This procedure should further ensure safety in loco-regional anesthesia in dental practice.

Anaphylaxis↗
PubMedDate not supplied

Plasma exchange in the treatment of acute systemic lupus erythematosus without circulating immune complexes.

One patient affected by systemic lupus erythematosus with recurrent phlebothrombosis and peripheral neuropathy is described. False positive VDRL test, anticardiolipin antibodies, and high titres of antinuclear antibodies were present. Circulating immune complexes were not found. The effect of plasma exchange on clinical symptoms and on serological abnormalities was rapid and striking.

Adult↗