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M Gargiulo

Publications and source records attributed to M Gargiulo.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Early detection of heart involvement using serial cardiologic controls in the follow-up of patients with AIDS].

New effective therapies have been producing longer survival times for HIV-patients. Thus non-infectious complications of late stage of HIV infection (such as the development of left ventricular dysfunction) have emerged; in fact cardiac involvement has been identified frequently at autopsy and is described in 80% of patients with acquired immunodeficiency syndrome (AIDS) as an evidence of the virus cardiotrophism, while clinical findings of left ventricular dysfunction were only detected in about 15% of the patients. It is possible that the development of heart failure had been underestimated in those years; in fact signs and symptoms of cardiac involvement had been often misinterpreted as the results of non cardiac causes (pulmonary failure or infections) also determining a delay in the beginning of cardiac therapy. The aim of this study was to follow 16 human immunodeficiency-virus positive patients during a 3-year period to evaluate the usefulness of early detection of heart failure in order to start a specific therapy as soon as possible. The follow-up consisted of a clinical and electrocardiographic control every 4 months. Echocardiography was carried out when involvement of the cardiac muscle was suspected. During the follow-up we could reveal an early involvement in 5/16 patients (31.2%) and in 2 of them (40%) early therapy caused clinical and echocardiographic regression of left ventricular dysfunction. The present study demonstrates that periodical clinical and echocardiographic controls are useful in patients with HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1997

Biochemical response to interferon of chronic hepatitis in drug-addict patients infected with human immunodeficiency virus.

The effects of IFN treatment were retrospectively evaluated for 18 drug-addict patients with symptomatic HIV infection and chronic hepatitis C. Most of the patients were receiving concomitant treatment with zidovudine. Seven out of the 18 patients (39%) stopped IFN after less than three months, most of them for non-compliance. Among the 11 patients who completed a 6-12 month period of IFN treatment, 3 (27%) normalized and maintained normal ALT levels during therapy: for 2 of them the response was sustained after IFN discontinuation. The response to IFN therapy was neither correlated to the CD4+ levels nor to the clinical stage of the HIV infection. Instead, the response seemed to be influenced by pre-therapy ALT levels and liver histology. Tolerance to IFN treatment was good. These data show that IFN may be indicated in the therapy of chronic HCV infection for HIV-positive patients.

Journal Article↗
PubMed1996

Extracranial internal carotid artery aneurysms: results of a surgical series with long-term follow-up.

PURPOSE: The purpose of this study was to analyze mode of presentation, surgical treatment, and early and long-term results of a series of extracranial internal carotid artery aneurysms (EICAA). METHODS: A retrospective analysis was performed on all cases treated for EICAA in a single institution from March 1974 to March 1995. Patient follow-up was obtained by a surveillance protocol, with duplex scanning performed 3 months after surgery and yearly thereafter. RESULTS: Twenty-four EICAA in 20 patients were treated over a 21-year period. The cause was fibromuscular dysplasia in 12 cases (50%), nonspecific "atherosclerosis" in nine (37.5%), previous carotid artery surgery in two (8.3%), and trauma in one case (4.1%). Neurologic symptoms were present in a total of nine cases (37.5%) and were hemispheric in seven (29.1%) and nonhemispheric in two (8.3%). Operative techniques were performed with patients receiving general anesthetic and included aneurysm excision with internal carotid artery reanastomosis (8 cases [33.3%]) or reimplantation onto the external carotid artery (1 case [4.1%]); interposition graft (10 cases [41.6%]), 7 veins, 3 polytetrafluoroethylene) or simple aneurysmectomy and closure of the wall defect either with (3 cases [12.5%]) or without (2 cases [8.3%]) a patch. Elective surgery was performed in 22 cases, with a 0% mortality rate and 4.5% stroke rate. Emergency operations were performed in two cases of ruptured aneurysms (one spontaneous and one iatrogenic); one patient (50%) died. Cranial nerve morbidity occurred in five cases (20.8%). Mean follow-up was 96.7 +/- 88.15 months (range 4 to 240 months) and included 2 of 7 (28%) complications in saphenous vein grafts, 1 (4.1%) late transient ischemic attack, and a recurrent aneurysm after 19 years. CONCLUSIONS: Symptoms and potential complications caused by EICAA suggest a broad surgical indication. EICAA can be treated safely because of the good early and long-term results.

Aged↗
PubMed1996

[Angiomas of the maxillofacial area: a clinical study with MR and angio-MR].

Reporting 3 cases of hemangiomas of the maxillo-facial area the authors describe, proper use, of RBc scintigraphy, CT with contrast media, MR, angio-MR. Comparing these methods it will results that RBc scintigraphy is a very useful method in a screening phase providing data concerning kind of blood flow, morphology of lesions and also detecting unknown lesions by total body scanning. CT imaging with contrast media is a useful method in a presurgical phase providing the exact anatomical limits of the lesions especially when involving bone tissue. MR imaging provides precise anatomic limits specially for low flow lesions; it also provides a vascular map of the arterial afferent vessels in high flow vascular lesions, without any use of ionogenic radiations. For these reasons MR is advisable in pediatric age and allergic patients. Super-selective embolization, sclerosant therapy and surgery therapy are indicated for treatment of high flow and low flow hemangiomas.

Adult↗
PubMed1995

[In vivo experimental research in vascular surgery. Methodology and current Italian law].

Authors underscore the importance of research in vascular surgery progress and approach some basic aspects on the correct conduction of an experimental research in vascular surgery fields and in particular on synthetic prosthesis of different diameter. Some important aspects of the current Italian law on animal experimentation are shown because they could cause new changes either on methodology or animal selection. Finally some experimental models adopted in the department of experimental surgery of the Rizzoli Orthopaedic Institutes on vascular prosthesis are described.

Animal Welfare↗
PubMed1995

The morphology of elastin in non-specific and inflammatory abdominal aortic aneurysms. A comparative transmission, scanning and immunoelectronmicroscopy study.

The maintenance of the mechanical properties of the vessels results from the correct arrangement of smooth muscle cells and extracellular fibrous proteins (elastin and collagen) in their wall. The morphology of extracellular matrix modifications, particularly of elastin, was investigated in inflammatory (IA) and non specific (NSA) abdominal aortic aneurysms by scanning (SEM), transmission (TEM) and immunoelectron microscopy. Both NSAs and IAs were significantly characterized by extensive extracellular matrix remodelling, including different patterns of elastin degradation. Elastic and collagen fibres distribution appeared to be extensively altered in IAs, while it conformed more to a normal pattern in NSAs. With respect to NSAs, the morphology of elastic fibres in IAs was modified to such an extent that their identification by TEM had a rely on immunocytochemical methods and by SEM on back-scattered electron analysis. The observed ultrastructural changes are indicative of the central role of extracellular matrix modifications in the pathogenesis of IAs and NSAs.

Aortic Aneurysm, Abdominal↗
PubMed1995

Defining biologic width in crown lengthening.

Clinicians must be very careful when making clinical evaluations of the need for crown lengthening procedures and margin placement and subsequent determinations about the dento-gingival junction and biologic width. Clinicians have tried to standardize a biologic phenomenon and assign the same standard to all patients regardless of the circumstances.

Adult↗
PubMed1994

Morphology of small aneurysms: definition and impact on risk of rupture.

BACKGROUND: Parietal characteristics of small aortic aneurysms predictive of increased risk of rupture are unknown. METHODS: Prospective morphologic evaluation was performed in 135 consecutive cases of small (< 5 cm) abdominal aortic aneurysm. Twelve cases (9%) were found to be ruptured and sent for emergency surgery. The remaining 123 patients were evaluated with ultrasonography, angiography, and intraoperatively during elective surgery. Ninety-six (78%) also underwent computerized tomography (CT) scanning. The evaluation assessed the thickness of the endoluminal thrombus and arterial wall as well as the presence of saccular outpouchings ("blisters"). Also noted were any areas of impending rupture, defined as discontinuity of the arterial wall with only a thrombus preventing rupture. RESULTS: Blisters were discovered intraoperatively in 12 aneurysms. Digital subtraction angiography (DSA) revealed 3 (25%) of these preoperatively. Eleven of the patients with blisters were examined preoperatively with CT scanning, which detected 3 blisters (27%). Both endoluminal thrombus and wall thickness were measurable by CT scan but not ultrasonography. The incidence of impending rupture was significantly greater in patients with blisters than in those without (71% versus 29%, P = 0.0001). The incidence of impending rupture was similar whether the amount of endoluminal thrombus was more or less than 2 cm (57% versus 40%, P = 0.386). Rupture was no more frequent when aneurysmal walls were thicker or thinner than 0.3 cm (14% versus 20%, P = 0.719). In an analysis using logistic regression, the presence of a blister was the only independent morphologic predictor of impending rupture (P = 0.001, Wald = 15). CONCLUSION: In patients with small aneurysms, increased attention should be directed to the preoperative detection of blisters.

Aged↗
PubMed1994

Left-side inferior vena cava and inflammatory abdominal aortic aneurysms: a case report.

The incidence of isolated left-side inferior vena cava ranges from 0.2-0.5%. This anomaly is associated infrequently with an abdominal aortic aneurysm. A case is reported of left-side inferior vena cava associated with a symptomatic, 5-cm inflammatory abdominal aortic aneurysm. Preoperative computed tomography showed a perianeurysmal mantle strongly adherent to a left-side inferior vena cava. This report is the first of an infrarenal inferior vena cava anomaly associated with an inflammatory abdominal aortic aneurysm. The technical details required to perform the aortic reconstruction via a transperitoneal approach are described and discussed.

Aortic Aneurysm, Abdominal↗
PubMed1994

[Alternative therapy of deep venous thrombosis in patients at hemorrhagic risk].

The authors report on the pharmacological employment of defibrotide in the treatment of a case of deep vein thrombosis (DVT) of the left iliac-femoral veins in a patient with a high-risk of hemorrhage (haematuria from kidney neoplasm, rupture of basilar artery aneurysm, urethral bleeding from catheter trauma). Alternatively to the traditional thrombolytic and anticoagulants, not indicated here for their haemorrhagic risk potential, defibrotide promptly resolved the DVT without any major effect on blood coagulation parameters. Initially, 1 gr of defibrotide in 250 ml of glucose-1-phosphate solution was administered twice-daily for the first two days when improvement had been observed. An additional 5 days of therapy was continued under the same regimen, then 400 mg intravenously every 2 hours for 14 days, and 400 mg intramuscularly every 24 hours until the 30th day. The patient was dismissed from the hospital on therapy with indobufen 200 mg orally, and elastic support stocking. After 6 months the patient is well. An echo color Doppler evaluation showed a normal venous blood flow through the femoral, iliac and caval veins, and venous blood reflux in the iliac-femoral and femoral saphenous veins due to valvular insufficiency. Caval filters, although recognized by many institutions as a preferred method of protection against pulmonary thromboembolism especially in patients with a contraindication to anticoagulation therapy or recurrent pulmonary embolism, was not used in this case, since the patient was critically ill. From this case report and the review of the literature it seems that defibrotide may represent a valid alternative therapy in the treatment of DVT, especially in high risk haemorrhagic patients.

Aged↗
PubMed1994

Long-term cryopreservation of autologous veins in rabbits.

This study was undertaken to determine the effect of long-term cryopreservation on graft ultrastructure and endothelial cell viability in an animal model. The jugular veins from 12 New Zealand White rabbits were excised with a 'no-touch' technique and divided into four groups: control group (fresh veins); group 1, veins cryopreserved for 1 month; group 2, veins cryopreserved for 2 months; and group 3, veins cryopreserved for 3 months. Cryopreservation was accomplished by rapid freezing (-5 degrees C s-1 to -196 degrees C) in a solution of 17.5% dimethylsulphoxide and 20% fetal bovine serum and by storage in liquid nitrogen. Veins were then implanted as a carotid autograft (three grafts/group). At the time of graft implantation a segment of the paired matched vein was perfusion-fixed and evaluated by scanning and transmission electron microscopy, whereas the remainder were subjected to endothelial cell culture techniques to determine cell viability. Autografts were removed 1 month after implantation and subjected to similar evaluations. Histological changes seen in cryopreserved veins were dependent on preservation time and included focal endothelial cell blebbing, cytoplasmic vacuolization and disruption of cell-to-cell contacts. Smooth muscle cells showed mitochondrial swelling. Patency was identical in all groups (66.6%). Explants at 1 month were similar in histological appearance to fresh veins with a smooth endothelial cell lining arranged longitudinally and intact cell junctions. Endothelial cells could be cultured from fresh veins and 1-month-old explants but not from the cryopreserved graft surface before implantation. the present technique of cryopreservation leads to some damage of graft architecture and loss of endothelial cell viability.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1993

Postoperative course of inflammatory abdominal aortic aneurysms.

Of 779 patients undergoing repair of abdominal aortic aneurysms over a 7-year period (1984-1990), 40 (5.1%) had gross features of inflammatory abdominal aortic aneurysms (IAAAs). Twenty IAAAs were assessed by CT scan preoperatively and postoperatively to evaluate the outcome of the inflammatory layer of the aneurysm in 19 cases. Complete postoperative regression was observed in nine cases (47.3%), partial regression in four (21%), and stable lesions in six (31.7%). No roentgenographic progression was found. The comparison between the roentgenologic outcome and preoperative clinical features (age, sex, erythrocyte sedimentation rate, and abdominal lumbar pain), pathologic findings, and follow-up time revealed a significant correlation (p < 0.05) between the postoperative outcome and the histologic findings in the wall (cell density and cell/fibrosis ratio). Complete regression of inflammation was observed when high cell density (16 +/- 0.7 cells/2116 microns 2) and a cell/fibrosis ratio > 1 were found. On the contrary, little or no regression of inflammation occurred when a low cell density (3.4 +/- 0.3 cells/2116 microns 2) and a cell/fibrosis ratio < 1 were found. Although it is generally thought that inflammation in IAAAs regresses after surgical repair, in our study, 31.7% of the postoperative CT scans showed no change. Histologically, the variability of morphologic aspects seemed to correlate with the relative proportions of cellular infiltrate and interstitial fibrosis in the aneurysmal wall. These proportions determine the postoperative course of the inflammation layer and, most likely, the response of the latter to steroid therapy as well.

Adult↗
PubMed1993

Content and turnover of extracellular matrix protein in human "nonspecific" and inflammatory abdominal aortic aneurysms.

Inflammatory aneurysms (IAs) have peculiar macroscopic and histological aspects which make them very different from nonspecific aneurysms (NSAs). These morphological differences seem to be determined by significant modifications of the extracellular matrix. Extracellular matrix protein component concentrations were determined biochemically in infrarenal aortic biopsies from 10 NSAs, five IAs and five non-aneurysmal aortic controls. The concentration of each wall component was expressed in % w/w (relative concentration) and in mg/wall longitudinal cm (absolute concentration) with reference to total protein recovered after hydrolysis and amino acid analysis. The biochemical results were correlated with the histological and ultrastructural features of the specimens. A significant increase in total collagen was observed in the two groups of aneurysms, with respect to the controls (NSA = 285%, IA = 382%). In contrast the 80-90% decrease in the relative concentration of elastin observed in both types of aneurysm was less marked (NSA = 55%, IA = 39%). This fall was not significant when expressed in mg/cm, although elastin derived peptide (EDP) levels in the plasma of these patients was significantly higher than in age-matched controls. The concentration of the soluble collagen fraction appeared significantly higher (Mann-Whitney, p < 0.05) in the IAs with respect to the NSAs, whilst no differences were observed between the two groups regarding the concentration of insoluble elastin and of wall and plasma EDPs. As well as providing evidence of increased elastin turnover, this study emphasises the conspicuous modifications of collagen deposition in the wall of abdominal aortic aneurysms which appeared more marked in the inflammatory group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

An immunohistochemical study of inflammatory abdominal aortic aneurysms.

Seven cases of inflammatory abdominal aortic aneurysms (IAs) were studied by light microscopy, transmission electron microscopy (TEM) and immunohistochemistry. Microscopically, atherosclerosis coexisted with adventitial fibrosis and inflammation. The inflammatory component showed a follicular and a diffuse pattern. Fibrous entrapment of fatty tissue, adventitial vasculitis, neuritis were also common findings. By TEM, sparse smooth muscle cells having dilated cisternae of rough endoplasmic reticulum, large bundles of collagen fibres and oedematous, amorphous fibrillary elastin were observed. By immunohistochemistry, the follicles mostly contained CD22+ B-cells. T4- (CD2+/CD4+/CD8-), T8-(CD2+/CD4-/CD8+) cells as well as macrophages (CD4+/CD11c+) and follicular dendritic reticulum cells (DRC1+) were also detected. The monoclonal antibody Ki-67 reacted with 2-48% of germinal center cells. In the fibrous extrafollicular adventitia, actively synthesizing plasma cells prevailed over T4-cells, and macrophages. Some of the macrophages were also activated (CD4+/CD11c+/CD25+/CD30-). IgM, IgG and C3c deposits were detected in the fibrous zone, in the germinal centers, within adventitial vessels and nerves. HLA-DR antigen was diffusely expressed in cells populating both the fibrous and the follicular zones as well as in endothelial and Schwann cells. These findings suggest that IAs could develop in some individuals affected by advanced atherosclerosis of the abdominal aorta through a pathogenic B-cell response to locally presented antigens.

Antigens, CD↗
PubMed1992

Interferon alpha 2-b therapy of HCV and nonBnonC chronic hepatitis.

Twenty-four patients with HCV and NonBNonC chronic hepatitis--4 with HIV coinfection--were treated with r-IFN alpha for at least six months. In this period 62.5% of patients show a normalization of ALT but not a sustained remission. Non-responders have histologically more severe and long-lasting chronic hepatitis.

Adult↗