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Biomedical subjects

M Croci

Publications and source records attributed to M Croci.

At least 19 recordsLinked to original sources
PubMed2005

Binge eating disorder in obesity: comparison of different therapeutic strategies.

The aim of this study (duration: 12 months) was to compare different integrated therapeutic approaches for the therapy of Binge Eating Disorder (BED). A sample of 65 female severely obese BED was randomly divided into 3 groups: the first one was treated by Cognitive-Behavioural Therapy (CBT) alone; the second one was treated by SSRI antidepressant therapy (fluoxetine) alone; the remaining was treated by a combination of CBT plus fluoxetine. All groups received group nutritional training and individual dietary counselling. The initial fluoxetine dose (20 mg/day) was adjusted (up to 60 mg/day) according to frequency of binge eating. During the first 4 weeks, all subjects underwent an in-patient dietary treatment aimed to achieve at least a 5% weight loss, which was continued during the out-patient treatment phase. At the beginning and at the end of the therapy the patients were evaluated by the Minnesota Multiphasic Personality - 2 and by the Eating Disorder Inventory - 2. The results showed that the two groups which underwent psychotherapy resulted in a better outcome - in terms of number of bingeing episodes, maintenance of weight loss reduction from baseline and psychological well being - than the group treated with pharmacological therapy alone. Finally, the study underlines the importance of a multidisciplinary approach to the treatment of Binge Eating Disorder.

Adult↗
PubMed2001

The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation.

The aim of this study was to investigate the effects of different pressurization rates during pressure support ventilation on breathing pattern, work of breathing, gas exchange and patient comfort in patients with acute lung injury. The pressurization rate modifies the initial pressure ramp by changing the initial peak flow rate: the increase in pressurization rate is associated with a decrease in the time to reach the level of pressure support ventilation by increasing the peak flow rate. Ten intubated patients (age 64+/-17 yrs, body mass index 24+/-17 Kg x m(-2), arterial oxygen tension/inspired oxygen fraction 214+/-59) were studied in random order varying the pressurization rate at 5 and 15 cmH2O of pressure support ventilation. Breathing comfort was evaluated by a visual analogue scale. Increasing the pressurization rate caused an increase of peak flow rate from 473+/-141 mL x s(-1) to 758+/-302 mL x s(-1) at pressure support ventilation 5 (p<0.05) and from 481+/-126 mL x s(-1) to 1,121+/-175 mL x s(-1) at pressure support ventilation 15 (p<0.05). At the lowest pressurization rate the tidal volume was the lowest, the respiratory rate and the work of breathing were the highest (p<0.05) compared with other pressurization rates. Excluding the lowest pressurization rate, in all the other pressurization rates tested the breathing pattern and the work of breathing did not change. The lowest and the highest pressurization rates caused the worst patient comfort (p<0.05). The gas exchange was stable throughout the study. The presented results suggest: 1) the lowest pressurization rate caused the lowest tidal volume, highest respiratory rate and highest work of breathing; 2) at the other pressurization rates no differences in breathing pattern and work of breathing were observed; and 3) the patient's comfort was worse at the lowest and highest pressurization rates.

Adult↗
PubMed2001

Characterization of the immunophenotype and the metastatic properties of a murine T-lymphoma cell line. Unexpected expression of cytoplasmatic CD4.

We report the first characterization of a mouse T-lymphoma cell line that surprisingly expresses cytoplasmatic (cy) yCD4. Phenotypically, LBC cells are CD5+, CD8+, CD16+, CD24+, CD25+, CD2-/dim, CD3-/dim, TCRbeta-/dim, TCRgammadelta, CD154 , CD40-, and CD45R. Coexpress cyTCRbeta, cyCD3, cyCD4, and yet lack surface CD4 expression. Transplantation of LBC cells into mice resulted in an aggressive T-lymphoblastic lymphoma that infiltrated lymph nodes, thymus, spleen, liver, ovary, and uterus but not peripheral blood or bone marrow. LBC cells display a modal chromosome number of 39 and a near-diploid karyotype. Based on the characterization data, we demonstrated that the LBC cell line was derived from an early T-cell lymphocyte precursor. We propose that the malignant cell transformation of LBC cells could coincide with the transition stage from late double-negative, DN3 (CD4- CD8 CD44-/low, CD25+) or DN4 (CD4-low, CD8-/low, CD44-, CD25-) to double-positive (DP: CD4+CD8+) stage of T-cell development. LBC cells provide a T-lymphoblastic lymphoma model derived from a malignant early T-lymphocyte that can be potentially useful as a model to study both cellular regulation and differentiation of T-cells. In addition, LBC tumor provides a short latency neoplasm to study cellular regulation and to perform preclinical trials of lymphoma-relatel clisorders.

Animals↗
PubMed2000

The compliance of hypocaloric diet in type 2 diabetic obese patients: a brief-term study.

In studies of the effect of diets in obese type 2 diabetic patients, information about the degree of compliance or non-compliance is generally lacking or incomplete, though their poor long-term success rate is widely recognized. We have quantified the degree of short-term compliance with a personalized hypocaloric diet (800-1500 kcal) in 77 obese type 2 diabetic patients (mean age 60, mean BMI 34.4) three months after explaining their dietary schedule and its expected advantages by means of simple but essential nutritional advice lasting about 20 minutes of the type currently used for such patients attending diabetes care institutions or outpatient departments. Even though a mean 14% reduction in daily food intake was achieved, the mean daily energy intake at the interview (assessed by means of the 3-day recall method) still exceeded the prescribed diet by 40-50%. The worst compliance in terms of total excess energy intake or carbohydrate and fat intake was found in the older patients. The greater the excess of food intake, the poorer the metabolic control, as expected.

Adult↗
PubMed2000

Glucocorticoids and neuroendocrine function.

Recent experimental evidence supports the role of glucocorticoids in the neuroendocrine control of food intake and energy expenditure. In particular, glucocorticoids promote food consumption directly through stimulation of NPY and inhibition of CRH and melanocortin release. CRH and NPY are also functionally linked by a mutual regulation. CRH is anorexigenic when secreted acutely while it exerts the opposite effect when, upon sustained secretion, it stimulates the hypothalamo-pituitary-adrenal (HPA) axis. The orexigenic effects of glucocorticoids are counteracted by a steroid-induced rise in leptin levels that closes a regulatory loop regarding food consumption. Furthermore, glucocorticoids may alter body fat distribution, increasing truncal adiposity both directly and by inhibition of growth hormone secretion. No clearcut alterations of the HPA function are apparent in obesity as a whole. However, subtle and specific abnormalities may be noted in subsets of obese patients. Indeed, obesity, mostly visceral type, is associated with an increased cortisol clearance and 11-beta hydroxysteroid dehydrogenase activity in the omental fat. In the same vein, an increased cortisol rise following a mixed meal has been observed in obese subjects. Finally, it has been proposed that adrenal incidentalomas, often characterized by enhanced cortisol secretion, might be a clinical expression of the X syndrome.

Animals↗
PubMed2000

Mass volume measurement in severe head injury: accuracy and feasibility of two pragmatic methods.

OBJECTIVE: To assess the clinical feasibility and the accuracy of two pragmatic methods in comparison with a conventional computer based method of measurement of masses from CT. METHODS: Nineteen CT scans of 11 patients with severe head injury, showing 34 traumatic lesions, were examined. The volume of every lesion was digitally measured, then a panel of three examiners independently repeated the measurement using the ellipsoid and the Cavalieri method in random order. RESULTS: All the lesions were identified by all the readers and the mean volume measured by each examiner differed by less than 1.5 ml. The average reading time for each scan was 4 minutes for the ellipsoid and 7 minutes for the Cavalieri method. The average volume of the lesions was 34.2 (SD 35) ml with the digital system, and 38.4 (SD 41) ml and 34.8 (SD 36) ml for the ellipsoid and the Cavalieri readings respectively. The average difference between the applied technique and the digital system was 0.57 (SD 9.99) ml for the Cavalieri direct estimator and 0.20 (SD 15.48) ml for the ellipsoid method. The 95% confidence interval for this difference fell between -2.75 and 3.89 ml for the Cavalieri, and between -4.94 and 5.35 ml for the ellipsoid method. There were 19 lesions >25 ml; the ellipsoid method identified 16 of them, whereas 17 were classified with the Cavalieri method. When considering individual lesions rather than the average volume, discrepancies were detected with both methods. The ellipsoid method was less precise, especially when extracerebral lesions were measured. CONCLUSIONS: Both pragmatic methods are inferior to computer based reading, which is the choice when accurate volume estimation is necessary. However, if a digital volumetric determination of the lesions using a CT computer is not possible, the two pragmatic methods offer an alternative.

Analysis of Variance↗
PubMed1998

High cerebral perfusion pressure improves low values of local brain tissue O2 tension (PtiO2) in focal lesions.

Arterial hypertension is widely applied to improve regional cerebral blood flow (rCBF). We measured local brain tissue O2 pressure (PtiO2) in low density lesions at computerized tomography (CT) of the head before and after manipulation of mean arterial pressure (MAP) in order to increase cerebral perfusion pressure (CPP). Nine patients, 7 subarachnoid hemorrhage (SAH), 1 severe head injury, 1 meningeoma, were included in our study. A flexible polarographic microcatheter for PtiO2 measurement was placed at the border of the low density area found at CT. PtiO2 was continuously measured for 615 hours. Hypoperfusion in low density areas was detected by perfusional single photon emission computed tomography (SPECT). We recorded 22 episodes of induced or spontaneous increase of MAP. Initial PtiO2 regularly improved after the CPP increase (r2 0.74 in induced episodes). Low PtiO2 showed a greater percent increase for unitary changes of CPP than normal-high PtiO2. Baseline PtiO2 below 20 mm Hg was associated with normal CPPs; 5 readings of PtiO2 below 20 mm Hg normalized when a higher CPP was obtained. Our results show that in ischemic areas PtiO2 is dependent on CPP suggesting both a derangement of pressure autoregulation and high regional cerebrovascular resistences (CVRs). Low PtiO2 was associated with normal CPP, thus indicating that CPP could be an inadequate estimate of rCBF in focal ischemic areas. Arterial hypertension, capable of increasing CPP above normal values, appeared useful in normalizing tissue oxygenation in ischemic areas.

Adult↗
PubMed1998

An experimental model of diabetes and cancer in rats.

The aim of this study was to develop an experimental model for the study of cancer associated with diabetes. For diabetes induction, Sprague-Dawley rats were given streptozotocin (STZ, 90 mg/kg body weight (BW), by intraperitoneal injection on the second day of life. For mammary tumour induction, rats were injected with 50 mg/kg BW of N-nitroso-N-methylurea (NMU) at 50, 80 and 110 days old. The neoplastic process and the effect of tamoxifen treatment was examined in non-diabetic and diabetic rats. The latency period, NMU-induced tumour incidence and the number of tumours per rat in diabetic rats versus controls were 117 +/- 7 days versus 79 +/- 9 days (P < 0.001); 93% versus 95% (NS); and 5.2 +/- 1.6 versus 2.7 +/- 0.5 (P < 0.02). A more benign histological pattern for tumours in diabetic animals was observed. Mammary tumours in diabetic rats grew more slowly than in controls. Tamoxifen (1 mg/kg/day) treated diabetic rats showed tumour regression in 67% of NMU-induced mammary tumours versus 53% in controls (NS). Our results show that tumour progression seems to be affected by diabetes in this experimental model. We suggest this is the result of changes to insulin-like growth factors and their receptors, which occur in diabetics, and our future research will examine this hypothesis.

Animals↗
PubMed1998

The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia.

UNLABELLED: We investigated the effects of body mass index (BMI) on functional residual capacity (FRC), respiratory mechanics (compliance and resistance), gas exchange, and the inspiratory mechanical work done per liter of ventilation during general anesthesia. We used the esophageal balloon technique, together with rapid airway occlusion during constant inspiratory flow, to partition the mechanics of the respiratory system into its pulmonary and chest wall components. FRC was measured by using the helium dilution technique. We studied 24 consecutive and unselected patients during general anesthesia, before surgical intervention, in the supine position (8 normal subjects with a BMI < or = 25 kg/m2, 8 moderately obese patients with a BMI >25 kg/m2 and <40 kg/m2, and 8 morbidly obese patients with a BMI > or = 40 kg/m2). We found that, with increasing BMI: 1. FRC decreased exponentially (r = 0.86; P < 0.01) 2. the compliance of the total respiratory system and of the lung decreased exponentially (r = 0.86; P < 0.01 and r = 0.81; P < 0.01, respectively), whereas the compliance of the chest wall was only minimally affected (r = 0.45; P < 0.05) 3. the resistance of the total respiratory system and of the lung increased (r = 0.81; P < 0.01 and r = 0.84; P < 0.01, respectively), whereas the chest wall resistance was unaffected (r = 0.06; P = not significant) 4. the oxygenation index (PaO2/PAO2) decreased exponentially (r = 0.81; P < 0.01) and was correlated with FRC (r = 0.62; P < 0.01), whereas PaCO2 was unaffected (r = 0.06; P = not significant) 5. the work of breathing of the total respiratory system increased, mainly due to the lung component (r = 0.88; P < 0.01 and r = 0.81; P < 0.01, respectively). In conclusion, BMI is an important determinant of lung volumes, respiratory mechanics, and oxygenation during general anesthesia with patients in the supine position. IMPLICATIONS: The aim of this study was to investigate the influence of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia.

Adult↗
PubMed1998

[Cardiopulmonary resuscitation. The effect of severe hypothermia on clinical outcome].

BACKGROUND: Evaluation of outcome after CPR in severe hypothermic patients. DESIGN: Perspective study from October 1995 to April 1996. SETTING: First aid team of Italian Red Cross, Busto Arsizio (Varese), Italy. METHODS: A population of 22 patients in cardiac arrest in which CPR was performed immediately after rescue team's arrival is studied. ECG, core temperature, SpO2 and MAP were monitored whereas vital parameters were present during Basic Life Support. Outcome after CPR was evaluated with GOS scale. RESULTS: It has been observed that severe hypothermia and time of cardiac arrest impact on the clinical outcome after CPR. The high mortality rate after CPR with BLS standard is worsened by a core temperature < or = 33 degrees C. CONCLUSIONS: Severe hypothermia seems to have a dangerous effect upon outcome after cardiopulmonary resuscitation; heating systems for body temperature could prevent this situation improving CPR results.

Body Temperature↗
PubMed1997

Respiratory system mechanics in sedated, paralyzed, morbidly obese patients.

The effects of inspiratory flow and inflation volume on the mechanical properties of the respiratory system in eight sedated and paralyzed postoperative morbidly obese patients (aged 37.6 +/- 11.8 yr who had never smoked and had normal preoperative seated spirometry) were investigated by using the technique of rapid airway occlusion during constant-flow inflation. With the patients in the supine position, we measured the interrupter resistance (Rint,rs), which in humans probably reflects airway resistance, the "additional" resistance (delta Rrs) due to viscoelastic pressure dissipation and time-constant inequalities, and static respiratory elastance (Est,rs). Intra-abdominal pressure (IAP) was measured by using a bladder catheter, and functional residual capacity was measured by the heliumdilution technique. The results were compared with a previous study on 16 normal anesthetized paralyzed humans. Compared with normal persons, we found that in obese subjects: 1) functional residual capacity was markedly lower (0.645 +/- 0.208 liter) and IAP was higher (24 +/- 2.2 cmH2O); 2) alveolar-arterial oxygenation gradient was increased (178 +/- 59 mmHg); 3) the volume-pressure curve of the respiratory system was curvilinear with an "inflection" point; 4) Est,rs, Rint,rs, and delta Rrs were higher than normal (29.3 +/- 5.04 cmH2O/l, 5.9 +/- 2.4 cmH2O.l-1.s, and 6.4 +/- 1.6 cmH2O.l-1.s, respectively); 5) Rint,rs increased with increasing inspiratory flow, Est,rs did not change, and delta Rrs decreased progressively; and 6) with increasing inflation volume, Rint,rs and Est,rs decreased, whereas delta Rrs rose progressively. Overall, our data suggest that obese subjects during sedation and paralysis are characterized by hypoxemia and marked alterations of the mechanical properties of the respiratory system, largely explained by a reduction in lung volume due to the excessive unopposed IAP.

Adult↗
PubMed1996

Prone positioning improves pulmonary function in obese patients during general anesthesia.

We investigated the effects of prone position on functional residual capacity (FRC), the mechanical properties (compliance and resistance) of the total respiratory system, lung and chest wall, and the gas exchange in 10 anesthetized and paralyzed obese (body mass index more than 30 kg/m2) patients, undergoing elective surgery. We used the esophageal balloon technique together with rapid airway occlusions during constant inspiratory flow to partition the mechanics of the respiratory system into its pulmonary and chest wall components. FRC was measured by the helium dilution technique. Measurements were taken in the supine position and after 15-30 min of prone position maintaining the same respiratory pattern (tidal volume 12 mL/kg ideal body weight, respiratory rate 14 breaths/ min, fraction of inspired oxygen [FIO2]0.4). We found that FRC and lung compliance significantly (P < 0.01) increased from the supine to prone position (0.894 +/- 0.327 L vs 1.980 +/- 0.856 L and 91.4 +/- 55.2 mL/cm H2O vs 109.6 +/- 52.4 mL/cm H2O, respectively). On the contrary, the prone position reduced chest wall compliance (199.5 +/- 58.7 mL/cm H2O vs 160.5 +/- 45.4 mL/cm H2O, P < 0.01), thus total respiratory system compliance did not change. Resistance of the total respiratory system, lung, and chest wall were not modified on turning the patients prone. The increase in FRC and lung compliance was paralleled by a significant (P < 0.01) improvement of PaO2 from supine to prone position (130 +/- 31 vs 181 +/- 28 mm Hg, P < 0.01), while PaCO2 was unchanged. We conclude that, in anesthetized and paralyzed obese subjects, the prone position improves pulmonary function, increasing FRC, lung compliance, and oxygenation.

Anesthesia, General↗
PubMed1996

Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients.

OBJECTIVE: To study the relative contribution of the lung and the chest wall on the total respiratory system mechanics, gas exchange, and work of breathing in sedated-paralyzed normal subjects and morbidly obese patients, in the postoperative period. SETTING: Policlinico Hospital, University of Milan, Italy. METHODS: In ten normal subjects (normal) and ten morbidly obese patients (obese), we partitioned the total respiratory mechanics (rs) into its lung (L) and chest wall (w) components using the esophageal balloon technique together with airway occlusion technique, during constant flow inflation. We measured, after abdominal surgery, static respiratory system compliance (Cst,rs), lung compliance (Cst,L), chest wall compliance (Cst,w), total lung (Rmax,L) and chest wall (Rmax,w) resistance. Rmax,L includes airway (Rmin,L) and "additional" lung resistance (DR,L). DR,L represents the component due to viscoelastic phenomena of the lung tissue and time constant inequalities (pendelluft). Functional residual capacity (FRC) was measured by helium dilution technique. RESULTS: We found that morbidly obese patients compared with normal subjects are characterized by the following: (1) reduced Cst,rs (p < 0.01), due to lower Cst,L (55.3 +/- 15.3 mL x cm H2O-1 vs 106.6 +/- 31.7 mL x cm H2O-1; p < 0.01) and Cst,w (112.4 +/- 47.4 mL x cm H2O-1 vs 190.7 +/- 45.1 mL x cm H2O-1; p < 0.01); (2) increased Rmin,L (4.7 +/- 3.1 mL x cm H2O x L-1 x s; vs 1.0 +/- 0.8 mL x cm H2O x L-1 x s; p < 0.01) and DR,L (4.9 +/- 2.6 mL x cm H2O x L-1 x s; vs 1.5 +/- 0.8 mL x cm H2O x L-1 x s; p < 0.01); (3) reduced FRC (0.665 +/- 0.191 L vs 1.691 +/- 0.325 L; p < 0.01); (4) increased work performed to inflate both the lung (0.91 +/- 0.25 J/L vs 0.34 +/- 0.08 J/L; p < 0.01) and the chest wall (0.39 +/- 0.13 J/L vs 0.18 +/- 0.04 J/L; p < 0.01); and (5) a reduced pulmonary oxygenation index (PaO2/PAO2 ratio). CONCLUSION: Sedated-paralyzed morbidly obese patients, compared with normal subjects, are characterized by marked derangements in lung and chest wall mechanics and reduced lung volume after abdominal surgery. These alterations may account for impaired arterial oxygenation in the postoperative period.

Abdomen↗
PubMed1995

The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension.

We investigated the effects of the prone position on the mechanical properties (compliance and resistance) of the total respiratory system, the lung, and the chest wall, and the functional residual capacity (FRC) and gas exchange in 17 normal, anesthetized, and paralyzed patients undergoing elective surgery. We used the esophageal balloon technique together with rapid airway occlusions during constant inspiratory flow to partition the mechanics of the respiratory system into its pulmonary and chest wall components. FRC was measured by the helium dilution technique. Measurements were taken in the supine position and after 20 min in the prone position maintaining the same respiratory pattern (tidal volume 10 mL/kg, respiratory rate 14 breaths/min, FIO2 0.4). We found that the prone position did not significantly affect the respiratory system compliance (80.9 +/- 16.6 vs 75.9 +/- 13.2 mL/cm H2O) or the lung and chest wall compliance. Respiratory resistance slightly increased in the prone position (4.8 +/- 2.5 vs 5.4 +/- 2.7 cm H2O.L-1.s,P < 0.05), mainly due to the chest wall resistance (1.3 +/- 0.6 vs 1.9 +/- 0.8 cm H2O.L-1.s, P < 0.05). Both FRC and PaO2 markedly (P < 0.01) increased from the supine to the prone position (1.9 +/- 0.6 vs 2.9 +/- 0.7 L, P < 0.01, and 160 +/- 37 vs 199 +/- 16 mm Hg, P < 0.01, respectively), whereas PaCO2 was unchanged. In conclusion, the prone position during general anesthesia does not negatively affect respiratory mechanics and improves lung volumes and oxygenation.

Adult↗