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Biomedical subjects

M Anselmi

Publications and source records attributed to M Anselmi.

At least 37 records · Page 2Linked to original sources
PubMed1996

Aspecific membranous laryngitis after infectious mononucleosis.

Aspecific membranous laryngitis is an unusual but very serious complication of viral infections. Here, we report the uncommon finding of infectious mononucleosis characterized by aspecific membranous laryngitis with fever, dysphonia and severe dyspnea in a 12-year-old girl. Endoscopy showed mucopus and sloughed epithelium forming a pseudomembrane covering almost all the supraglottal region and a supraglottal swelling including the epiglottis and arytenoids. The importance of suspecting diphtheria, epiglottitis, viral or bacterial croup and laringo-tracheo-bronchitis and including them in the differential diagnosis is emphasized.

Anti-Bacterial Agents↗
PubMed1996

Onchocerciasis in Ecuador: evolution of chorioretinopathy after amocarzine treatment.

AIMS: To investigate the impact of the macrofilaricidal drug, amocarzine, on the evolution of chorioretinopathy in onchocerciasis. METHODS: A prospective uncontrolled cohort study was performed using subjects infected with Onchocerca volvulus in a hyperendemic onchocerciasis focus in Esmeraldas Province in Ecuador. Study subjects were recruited into four cohorts in which ophthalmic and parasitological data were collected for 2, 3, 4, and 5 years respectively. RESULTS: Complete ophthalmic follow up was obtained for 294 individuals in the four cohorts. The incidence of retinal pigment epithelial atrophy tended to remain constant between cohorts while that of chorioretinal scarring with a greater observation period. The incidence rate of cases with new or extending chorioretinal lesions was greater with an increasing period of follow up. An association was seen between the cumulative microfilarial loads in the skin and the development of new chorioretinal lesions (p < 0.05). No relation was noted between cumulative microfilarial loads and the progression of existing disease. CONCLUSION: Amocarzine therapy did not prevent the natural evolution of chorioretinal disease. It was suggested that ocular microfilariae were necessary for the induction of chorioretinopathy in previously unaffected eyes and that extension of existing disease might also be related to the presence of ocular microfilariae or to other immunological mechanisms.

Adolescent↗
PubMed1995

Onchocerciasis in Ecuador: ocular findings in Onchocerca volvulus infected individuals.

Little is known of the epidemiology and clinical picture of ocular onchocerciasis in South America. A survey of onchocercal eye disease was performed in the hyperendemic area of a rain forest focus of onchocerciasis in Esmeraldas Province in Ecuador. A total of 785 skin snip positive individuals from black and Chachi Amerindian communities were examined. The blindness rate attributable to onchocerciasis was 0.4%, and 8.2% were visually impaired. Onchocercal ocular lesions were seen in a high proportion of the study group: 33.6% had punctate keratitis, microfilariae in the anterior chamber and cornea were seen in 28.9% and 33.5% respectively, iridocyclitis was seen in 1.5%, optic atrophy in 5.1%, and chorioretinopathy in 28.0%. Sclerosing keratitis was not seen. The prevalence of all ocular lesions increased with age. Punctate keratitis was strongly associated with microfilarial counts in the cornea and chorioretinopathy was correlated with infection intensities in the cornea and anterior chamber. Chachi Amerindians had higher anterior chamber microfilarial counts and a greater prevalence of punctate keratitis than blacks though blacks had a greater prevalence of iridocyclitis and optic nerve disease. The pattern of ocular disease resembled rain forest onchocerciasis in west Africa with few severe ocular lesions in the anterior segment and all blinding lesions attributable to posterior segment disease.

Adolescent↗
PubMed1995

Yaws in Ecuador: impact of control measures on the disease in the Province of Esmeraldas.

OBJECTIVES: To determine the impact of a community-based programme of yaws control in Esmeraldas province in Ecuador. METHODS: Community health workers provided mass treatment and subsequent surveillance for the detection and treatment of new cases and their contacts over the period 1988 to 1993. Clinical and serological surveys were performed in the study area in 1988 and 1993. RESULTS: Over the 5 year observation period, the number of communities with active infections had decreased by 75%, from 20 communities in 1988 to 5 in 1993. In 1993, 4 communities were found free of clinical infections as well as latent infections. There was a corresponding decrease of 94.6% in the prevalence of dermal lesions (from 11.2% to 0.6%), and a reduction of 97.3% in latent infections (from 93.6% to 2.5%). CONCLUSIONS: The control of yaws using existing community-based health workers has proved very effective in Ecuador.

Adolescent↗
PubMed1995

[Prevention of surgical wound infections after appendectomy: intravenous versus rectal metronidazole].

AIM: To compare the efficacy of rectal and intravenous metronidazole in the prevention of anaerobic wound infections after appendicectomy. PATIENTS AND METHODS: One hundred patients subjected to appendicectomy were randomly assigned to receive, 2 hours before operation, gentamycin 80 mg i.v. and metronidazole 1 g i.v. or the same amount of gentamycin and 1 g of metronidazole as a suppository. Surgical wounds were observed for infections until the tenth day of the postoperative period. RESULTS: Seven of 45 patients receiving intravenous metronidazole and six of 44 receiving the drug as suppositories had wound infection. The frequency of infections was higher among patients with gangrenous or perforated appendices. They were detected at the fifth postoperative day in 8 patients and the most frequently isolated bacteria were E coli and S aureus. CONCLUSIONS: Rectal metronidazole is equally effective than intravenous metronidazole in the prevention of would infections after appendicectomy.

Administration, Rectal↗
PubMed1994

Usefulness of transesophageal atrial pacing combined with two-dimensional echocardiography (echo-pacing) in predicting the presence and site of residual jeopardized myocardium after uncomplicated acute myocardial infarction.

The usefulness of transesophageal atrial pacing combined with 2-dimensional echocardiography (echo-pacing) in predicting the presence and site of jeopardized myocardium, defined as areas of myocardium perfused by a vessel with a stenosis > or = 75% or by a collateral circulation if the supplying vessel was occluded, was evaluated in 31 patients with uncomplicated acute myocardial infarction who underwent coronary angiography. All 5 patients without jeopardized myocardium had a negative test, whereas 24 of 26 with jeopardized muscle had a positive test (sensitivity 92%; specificity 100%). To identify the site of jeopardized myocardium, tests that were positive for development of new asynergies were analyzed further, distinguishing those positive in the infarct or remote zone. Seven of 8 patients with new asynergies in the remote zone had areas of jeopardized myocardium outside the territory of distribution of the infarct-related vessel, whereas only 2 of 12 with new asynergies in the infarct zone had areas of jeopardized myocardium outside that territory (p < 0.01), correctly predicting the site of jeopardized myocardium in 17 of 20 cases. In conclusion, echo-pacing is useful for detecting the presence and site of jeopardized myocardium after an acute myocardial infarction.

Adult↗
PubMed1994

Reperfusion reduces left ventricular dilatation by preventing infarct expansion in the acute and chronic phases of myocardial infarction.

Reperfusion reduces left ventricular dilatation in patients with acute myocardial infarction, but it is unclear to what extent this is a primary effect or only a consequence of the limiting effect of reperfusion on infarct size. To address this issue, 56 consecutive patients were examined by means of two-dimensional echocardiography on day 1, on day 3, before discharge, and at 6 months after an acute myocardial infarction. From this population two groups of 12 patients each, perfectly matched for site of myocardial infarction, extent of ventricular asynergy at two-dimensional echocardiography (akinesis + dyskinesis), and clinical characteristics were identified according to the creatine kinase (CK) time to peak, which was regarded as a marker of spontaneous or induced reperfusion: (1) CK time to peak of 12 hours or less (reperfused patients, n = 12), and (2) CK time to peak of more than 12 hours (nonreperfused patients, n = 12). In these two groups of patients end-diastolic and end-systolic left ventricular volumes and endocardial lengths of asynergic and normal ventricular segments, imaged in a cross-sectional view at the level of the papillary muscles, were then computed. At the first examination end-diastolic volume, end-systolic volume, and endocardial segment lengths of normal and asynergic segments were similar in the two groups of patients. Patients with late CK time to peak, however, showed a progressive increase in left ventricular systolic volumes and in asynergic endocardial segment lengths between the first and third (predischarge) examinations (p < 0.05 for both), with no change in systolic length of the normal myocardium. The left ventricular end-systolic volume and the asynergic endocardial segment length of patients with early CK time to peak, however, did not increase during hospitalization. The increment in end-systolic volume and in systolic infarct segment length from the first to the third examinations was higher in nonreperfused patients (p = 0.018 and p = 0.04, respectively). Changes similar to those detected in systole were found for diastolic volume and diastolic infarcted and noninfarcted segment length in both groups, but they did not reach statistical significance. After 6 months, an increases in volume and endocardial length were found in both groups of patients. Relative to the first examination, however, the increase in systolic volume and in asynergic systolic endocardial lengths remained greater for nonreperfused patients (p = 0.077 and p = 0.01, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

[Isolated left ventricular myxoma discovered by two-dimensional echocardiography].

We describe the case of a young patient in whom two-dimensional echocardiography, performed because of mild palpitation, discovered the presence of a small mass into the left ventricle, attached to the interventricular septum. The patient was operated upon on cardiopulmonary by-pass, and the mass was removed through the aortic valve, without any complication during the postoperative period. On histology the mass appeared to be a typical myxoma. This case has been reported because the infrequency of ventricular location of the myxoma is unusual, and because the use of 2D-echocardiography, even in the absence of significant symptoms and/or clinical signs, avoided dangerous embolic complications, which often represent the first sign of this neoplastic pathology.

Adult↗
PubMed1993

Ventricular remodeling and infarct expansion.

Infarct expansion, defined as an alteration in the ventricular topography due to thinning and lengthening of the infarcted segment, develops within the first few hours of the acute symptoms, mostly in patients with a large, transmural, anterior myocardial infarction. Shape changes, peculiar to risk region location and due to disparity in regional ventricular architecture, could be posited as the first step in the process of infarct expansion, with various cellular mechanisms contributing to subsequent continued early and late ventricular dilation. Because the increase in left ventricular volume is expected to be linearly dependent on the extent of the infarction, limiting infarct size, by thrombolysis, would proportionally reduce enlargement of the cavity. The effect of thrombolysis on left ventricular volume, however, seems not to be completely accounted for by the lessening effect of reperfusion on infarct size, because data suggest a restraining effect of reperfusion on the process of ventricular dilation in addition to the lessening effect on infarct size. If this turns out to be true, then the achievement of a patent vessel even beyond the time period when that patency may be expected to salvage myocardium would be further justified. Theoretical predictions substantiate the potential effectiveness in restraining ventricular dilation of stiffening of the necrotic region alone, independently of myocardial salvage in infarcted patients. The process of progressive ventricular dilation involves not only a primary alteration in function of the infarcted region, but also a time-dependent secondary change in the noninfarcted tissue itself, finalized to restore stroke volume despite a persistently depressed ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Treatment of acute myocardial infarction with prolonged intracoronary urokinase delivery through intracoronary infusion catheter.

Severe acute myocardial infarction in young patients is plagued by high mortality. We report the case of a 25-year-old man, with a family history of ischemic heart disease, who was treated with acute and prolonged intracoronary urokinase infused through a miniaturized catheter engaged in a large thrombus occluding the left anterior descending artery. Rapid and stable recanalization was achieved with complete lysis of thrombotic material.

Adult↗
PubMed1993

[Global and regional function in microvascular angina].

Because of the existing relation between myocardial blood flow and systolic function, various noninvasive techniques, capable of assessing regional and global left ventricular function, especially two-dimensional echocardiography, have been used in patients with chest pain, ECG evidence of myocardial ischemia and/or reduced coronary flow reserve and angiographically detected normal coronary vessels. The results, however, have been contradictory, while only few of them have reported stress-induced regional or global left ventricular dysfunction combined with ST-segment depression and/or angina. The reason for such discrepancy could be due to a diffuse but patchy distribution of myocardial ischemia, or to a non-ischemic origin of the clinical and instrumental features of this syndrome, relying on the effect of algogenic mediators, as suggested from recent metabolic studies. Even if the most recent theories agree on the functional involvement of the small coronary vessels, many points on microvascular angina remain confused. An agreement on the nosological classification of this syndrome would be welcome, given the high technological cost required for the study of coronary microcirculation.

Humans↗
PubMed1993

[Ventricular remodelling and modifications in ventricular filling in the acute phase of a myocardial infarct].

The importance of infarct expansion in determining global ventricular remodelling and prognosis after myocardial infarction is well known, whereas how infarct expansion affects left ventricular filling dynamics is not defined. To address this issue two-dimensional and Doppler echocardiography was performed in 28 consecutive patients admitted to our Coronary Care Unit for a first acute transmural myocardial infarction 1) within 24 hours of symptoms' onset and 2) at predischarge. A semiquantitative echocardiographic infarct size index was computed, while the infarct and non-infarct segment length was measured in a short-axis papillary muscle section. Peak velocity of early (E) and late (A) transmitral Doppler curves were also measured. An increment in infarct segment length > or = 1.2 cm between baseline and predischarge examination was chosen as target to divide patients with (N = 8) and without (N = 20) infarct expansion. Patients with expansion had a higher echocardiographic infarct size index (3.5 +/- 1.4 versus 2.3 +/- 0.6 segments, p < 0.0001) and a higher CK-MB infarct size (336 +/- 235 versus 129 +/- 87 UI, p = 0.002), while ejection fraction was lower (36 +/- 8% versus 48 +/- 7%, p < 0.001). A linear correlation was found between the increment in infarct segment length and in left ventricular volume between the baseline and the predischarge examination (r = 0.58, p < 0.01). Doppler parameters were not different at baseline examination between patients with and without expansion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Effect of cholelithiasis and cholecystectomy on duodenogastric biliary reflux].

The aim of this work was to study the influence of cholelithiasis and cholecystectomy on duodenogastric biliary reflux. Total bile acid concentration (TBAC) in fasting gastric juice was measured in 23 consecutive patients with cholelithiasis and functioning gallbladder before and at least 3 months after cholecystectomy (group 1) and in 14 healthy volunteers (group II). In group two, TBAC was 8.5 +/- 2.8 uMol/l (mean +/- sem), the preoperative value in group I was 32.8 +/- 8.9 uMol/l and the postoperative value 69.9 +/- 14 uMol/l (p < 0.002 compared with group II and < 0.035 compared with preoperative values). These results suggest that cholelithiasis, even with a functioning gallbladder is associated with a significant increase in bile reflux to the stomach, with raises further after cholecystectomy.

Adult↗
PubMed1991

Onchocercacidal effect of three drug regimens of amocarzine in 148 patients of two races and both sexes from Esmeraldas, Ecuador.

The objective of this multidisciplinary clinical investigation was to test whether amocarzine was absorbed effectively and safely in patients of two races and either sex infected with Onchocerca volvulus while living in the holoendemic area of Esmeraldas Province, Ecuador. The prerequisite for a systemic onchocercacidal effect is the regular absorption of orally administered amocarzine. Single dosing after overnight fasting proved to produce irregular absorption of amocarzine, although some microfilaricidal effect was achieved. A pilot study with repeated low dose and postprandial administration of amocarzine showed a regular and predictable absorption with acceptable tolerability and a microfilaricidal effect lasting up to one year post-therapy. Since amocarzine and its major N-oxide metabolite are coloured agents, urine colorimetry was used to assess the urinary excretion of the N-oxide qualitatively. For the postprandial drug regimens plasma concentrations of amocarzine and its metabolite were determined at two selected time points in patients of two races and either sex; the results showed no major differences. Excision of onchocercal nodules was performed four months post-therapy. The pooled results of the histologic analysis of 100 patients with the same drug regimen read under blinded condition showed that 65% of the adult female worms were dead, 20% necrobiotic and 15% alive. The male worms were fewer and mainly necrobiotic. Control worm populations in Esmeraldas without chemotherapy showed that on the average 81.5% were alive and 18.5% dead. Amocarzine was also microfilaricidal producing a reduction of skin dwelling microfilariae to about 10% of the initial value within the first week after start of therapy and lasting for half a year at a 20% level. The reduction of ocular microfilarial was slower and reached 35-40% after one year. The general tolerability was acceptable to good. Reversible dermal reactions were usually mild and peaked as a rash in 57% of the patients on day 6. No prohibitive ocular intolerance was observed. Mild and reversible dizziness peaked on day 4 in 74% of patients. A positive reversible Romberg sign was found in 12 patients on day 4. Amocarzine, the first oral micro- and macrofilaricidal agent administered as a low dose repeat regimen (3 mg/kg twice daily and postprandial for three consecutive days) can be recommended for oral onchocercacidal therapy in adult patients. Clinical trials in juveniles should be encouraged.

Absorption↗