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M Bertocchi

Publications and source records attributed to M Bertocchi.

33 records · Page 2Linked to original sources
PubMed1997

Lung perfusion demonstrated by contrast-enhanced dynamic magnetic resonance imaging. Application to unilateral lung transplantation.

RATIONALE AND OBJECTIVES: The authors evaluate the use of magnetic resonance (MR) to image pulmonary perfusion in healthy controls and to detect pulmonary defects in patients with unilateral lung transplantation, using dynamic images after contrast administration. METHODS: Five patients with right lung transplantation and nine healthy volunteers underwent MR imaging. Twenty-five subsecond contrast-enhanced MR images (turbo-fast low-angle shot [FLASH]) were obtained at the level of the pulmonary arteries after a single injection of gadopentetate dimeglumine (0.1 mmol/kg) in an antecubital vein. Perfusion lung scintigraphy was done within 24 hours after the MR imaging examination in the transplanted patients. RESULTS: Before administration of contrast material, MR images showed both lungs to be homogeneous and of low signal intensity in healthy controls and in patients with lung transplantation. After contrast administration in controls, the mean signal intensity of the dependent lung increased markedly to 171 +/- 24% above baseline, whereas the nondependent signal intensity lung increased by only 105 +/- 17%; these changes were significantly different. In all patients with lung transplantation, a clear perfusion defect was demonstrated in the native lung. This defect was confirmed in all cases by perfusion nuclear scintigraphy, which showed that the majority of lung perfusion is directed to the transplanted allograft, compared with the native contralateral lung. CONCLUSIONS: Our results suggest that dynamic contrast-enhanced MR imaging is a potential method for detecting pulmonary perfusion defects in patients with lung transplantation.

Adult↗
PubMed1997

Intracellular thiopurine nucleotides and azathioprine myelotoxicity in organ transplant patients.

AIMS: Despite widespread use of azathioprine in organ transplant recipients, the mechanism of its myelotoxicity remains unclear. The aim of this study was to assess the importance of thiopurine metabolites on bone marrow toxicity. METHODS: We investigated the relationship between intracellular concentrations of 6-thioguanine (6-TGN), 6-mercaptopurine (6-MPN) and 6-thioxanthine (6 TXN) nucleotides and the absolute count of white or red cells in forty-seven lung or heart/lung transplant patients after oral administration of azathioprine. RESULTS: No significant correlation between red cell concentrations of 6-TGN or total thiopurine metabolites and white or red cell counts was found, with no difference between the sexes. Likewise, high 6-TGN levels were not related to bone marrow depletion. CONCLUSIONS: These results suggest that red blood cell 6-TGN alone do not predict the haematopoietic toxicity of azathioprine.

Adolescent↗
PubMed1997

[Severe infections after orthotopic hepatic transplant].

METHODS: The authors analysed severe infections in 43 consecutive patients undergoing orthotopic liver transplant. Prophylaxis and full anti-infection monitoring was performed in all cases. Immunosuppressive therapy was administered in the form of primary cyclosporine in 27 cases and primary OKT3 in 16 cases. RESULTS: Twenty-seven patients are still alive (median 8 months, range 2-40) and 16 died (median 22 days, range 10-92) of whom 4 without and 12 with infection, including two deaths owing to non-correlated causes with infection after recovery. Twenty-three patients underwent 33 episodes of severe infection (plus four with inconclusive positive cultures) without any case of protozoal or viral infection. All episodes occurred within two months of surgery and affected the lung (10), abdomen (7), lung + abdomen (1), urinary tract (1), lung + urinary tract (1), as well as two diffused cases and 7 cases of isolated bacteremia deriving from the donor (1), venous catheters (3), mild otorhinolaryngeal infection (1) and two unknown sources (2). Eighteen infective agents were identified in 45 cases. The bacteria involved in single-agent episodes were: 11 Gram+, 9 Gram- and five fungi. Polymicrobic and bacterial/fungal episodes were repeatedly observed in two and two cases. Postoperative renal insufficiency significantly influenced both the incidence of and mortality due to infection. Overall mortality was also influenced by early graft function, postoperative complications and reoperations, and the incidence of infections by the portal clamping stage, reject and prolonged coma. CONCLUSIONS: The absence of severe viral infections and the gradual reduction of mortality caused by infection appear to be parallel to the aggressive antiviral prophylaxis, the gradual improvement of intra- and postoperative management and primary immunosuppression with OKT3.

Adult↗
PubMed1996

Enterocytozoon bieneusi as a cause of chronic diarrhea in a heart-lung transplant recipient who was seronegative for human immunodeficiency virus.

Enterocytozoon bieneusi is a major cause of chronic diarrhea and malabsorption in patients with AIDS. We report what we believe is the first case of intestinal infection due to E. bieneusi in a heart-lung transplant recipient who was seronegative for human immunodeficiency virus (HIV). The clinical presentation and the evolution of the disease were identical to those usually observed in patients with AIDS and included diarrhea, massive weight loss, and persistent infection despite treatment with albendazole. E. bieneusi was identified in the patient's duodenal mucosa by electron microscopy. No other etiologic agent was detected. We conclude that E. bieneusi may be responsible for serious intestinal infections in patients whose immunosuppression is not related to HIV.

Animals↗
PubMed1996

[Intensive care in lung and heart-lung transplantation].

Intensive care after lung, and heart-lung transplantation may have simple post operative course specially after preventive procedures of reperfusion injury, nosocomial infections during mechanical ventilation and immunosuppression risks. Nevertheless a severe mediastinal shift may occurred after single lung transplantation in emphysema. Rapid changes in ventilation/perfusion ratio during lung infection or rejection specially in pulmonary hypertension are responsible of dramatic respiratory failure. Knowledge of multiorgan dysfunction and multidisciplinary experience encourage to future development.

Critical Care↗
PubMed1996

[Type AA renal amyloidosis in sarcoidosis].

Sarcoidosis is an uncommon cause of secondary amyloidosis. We describe in this paper the case of a 39 years old patient, with a pulmonary and hepatosplenic sarcoidosis. A nephrotic syndrome led to a renal biopsy which showed AA type amyloidosis. As no other cause of amyloidosis has been found we admitted that it was a result of sarcoidosis which was associated with the unusual inflammatory syndrome.

Adult↗
PubMed1995

[Lung transplantation in COPD].

Pulmonary transplantation can be performed as a treatment for panlobular emphysema. Young patients can benefit from pulmonary transplantation: double lung transplantation for patients aged less than 55 years and single lung transplantation for patients aged less than 60 years. Only patients with major functional impairment should be considered for transplantation. It is assessed by pulmonary function tests, but also by evaluating the intensity of dyspnea and the decreased quality of life. In emphysema, transplantation is the treatment of the respiratory handicap without decreased life expectancy. The results of pulmonary transplantation in emphysema are similar to that of other indications. Mean actuarial survival is 65% at one year, and 40% at four years. Quality of the survival should be considered in assessing the results of pulmonary transplantation. It is estimated that 50% of the surviving patients have a satisfactory improvement in the quality of life.

Contraindications↗
PubMed1995

Bronchiectasis detected with thin-section CT as a predictor of chronic lung allograft rejection.

PURPOSE: To evaluate bronchiectasis detected with thin-section computed tomography (CT) as a potential early finding of chronic lung allograft rejection. MATERIALS AND METHODS: Forty patients were studied at least 6 months after transplantation. Follow-up CT scans were obtained 6-48 months after transplantation and were retrospectively reviewed for evidence and anatomic extent of bronchiectasis. Irreversible dysfunction of the lung transplant, called the bronchiolitis obliterans syndrome (BOS), was staged according to pulmonary function testing. Pathologic proof of bronchiolitis obliterans was obtained. RESULTS: BOS occurred in 14 (35%) of the 40 patients. When considering bronchiectasis preceding BOS, bronchiectasis was a predictor of chronic rejection with a sensitivity of 14%, a specificity of 77%, a positive predictive value of 25%, and a negative predictive value of 63%. Bronchiectasis appeared concomitantly with BOS in eight (67%) of 12 patients. CONCLUSION: The diagnosis of chronic rejection relies on the degree of impairment of pulmonary function. When the diagnosis is only suspected on the basis of minimal impairment, CT can aid in the diagnosis of rejection by depicting early pulmonary changes.

Adolescent↗
PubMed1995

[Results of 100 pulmonary and cardiopulmonary transplants in 95 patients at the Louis Pradel Hospital (Lyon) from 1988 to 1994].

From June 1989 to December 1994, 95 patients underwent 100 pulmonary and cardiopulmonary transplants. The patients were 58 men and 37 women with an average age of 39 +/- 15 years. In 15 of the cases, indication for a transplant was infectious pathology, in 35 of the cases; vascular pathology, in 23 of the cases; emphysema and in 22 of the cases the causes were various. 31 of the patients underwent a heart/lung transplant, 14 underwent a sequential two-lung transplant, 14 underwent a sequential two-lung transplant and 50 underwent a single lung transplant; 5 patient underwent a second transplant. The global survival percentage is 56,4 +/- 5,2 to one year, 48,5 +/- 5,4 to two years, 42,9 +/- 5,7 to three years. There are non significant statistical differences for the survival level according to the type of transplant. The best functional results were obtained from patients affected with emphysema. The survival data for patients affected with infectious pathology are not very encouraging.

Adolescent↗
PubMed1994

HLA class-I-soluble antigen serum levels in liver transplantation. A predictor marker of acute rejection.

The serum levels of sHLA-I have been determined in 16 patients following liver transplantation. sHLA-I levels did not show remarkable variations in six patients without evidence of transplant-related complications. sHLA-I levels strongly increased in 10 patients undergoing acute rejection episodes. In these patients, an average 20% daily increase of sHLA-I levels was detected on the 6 days preceding and on the 2 days following the rejection episode. A fast decrease of sHLA-I levels was observed in seven patients following treatment of acute rejection with anti-CD3 mAb. The serum level of sHLA-I antigens positively correlated with ALT serum level and inversely correlated with PT. The determination of sHLA-I in serum may therefore be proposed as a useful marker in the monitoring of patients following liver transplantation. The increase of sHLA-I antigens may predict the onset of acute rejection whereas their decrease may be related to a good response of acute rejection to immunosuppressive treatment.

Adult↗
PubMed1994

[Delayed detection of cystic fibrosis in a patient with Mycobacterium avium complex infection].

We report a case of pulmonary infection by Mycobacterium avium complex revealing in a 21 years old patient a cystic fibrosis heterozygous for the delta F 508 deletion. The role of this bacteria in the lung infection is suggested by repeated isolation. This infection caused bronchitis, hypoxemia and pulmonary nodules at CT scan. The clinical and radiological signs improved after treatment with four antibiotics whereas only clarithromycin showed in vitro activity. An obstructive disease due to allergic bronchopulmonary aspergillosis developed and was controlled by steroid therapy.

Adult↗
PubMedDate not supplied

Dopamine "renal dose" versus fenoldopam mesylate to prevent ischemia-reperfusion injury in renal transplantation.

Low dose of dopamine is commonly used after kidney transplantation as a reno-protective agent, although its benefits are controversial. Dopamine may increase renal blood flow, decrease resistive index (RI), and induce urine output in normal kidneys. Many authors hypothesized that the vasculature of a denervated renal transplant may not respond to dopamine in the same fashion as healthy native kidneys, which led us to find other drugs to attenuate the ischemia-reperfusion (I/R) injury. Fenoldopam is a selective dopamine1 (DA1) receptor agonist, most of the activity of which resides in the R-enantiomer, which also shows weaker alpha 2-adrenoceptor antagonist activities. Fenoldopam produces a vasidilatory effect in vascular beds that are rich in vascular DA1 receptors, producing increased renal blood flow at doses that do not affect blood pressure. In addition to its renal vasodilator activity, fenoldopam is natriuretic, possibly resulting from a direct effect of DA1 receptors on the proximal convoluted tubule. In animals with spontaneous or drug-induced renal failure, fenoldopam improves renal function. The aim of this study was to investigate the possible effects of fenoldopan mesylate in recent kidney transplants. Creatinine, blood urea nitrogen, urine output, and renal vascular resistive index (IR) were measured using Doppler ultrasound. Two groups of patients with no statistical differences in demographic data were treated with dopamine or fenoldopan, showing no significant difference but a trend favoring the fenoldopan group.

Adult↗
PubMedDate not supplied

[Primary intrahepatic calculosis: hepatic lithotomy or hepatectomy?].

The authors discuss about the different surgical approaches in the management of primary intrahepatic stones, conforming their experience to literature reports. In the future they hope for a more conservative treatment on the basis of the good results obtained with percutaneous transhepatic fiber cholangioscopy (P.T.C.S.) and ultrasonographic extra-body lithotripsy recently adopted in the clinical practice.

Adult↗