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Biomedical subjects

M Grasso

Publications and source records attributed to M Grasso.

At least 55 records · Page 3Linked to original sources
PubMed2000

Postural coordination in elderly subjects standing on a periodically moving platform.

OBJECTIVE: To test body segment coordination during dynamic equilibrium on a moving platform, and assess age-related differences in the performance. DESIGN: Subjects had infrared light-emitting diode (LED) markers fixed on their temporomandibularjoint, greater trochanter, and lateral malleolus. Subjects stood upright on a sinusoidally translating platform with both feet, either with eyes open (EO) or eyes closed (EC). The platform was displaced horizontally in an anteroposterior direction at frequencies of 0.2 or 0.6Hz. Each trial, for either visual condition, was repeated twice, lasted 30 seconds, with 30-second intervals, for up to 1 hour. PARTICIPANTS: Fifty-three healthy subjects, aged 17 to 89 years. MAIN OUTCOME MEASURES: Kinematics of head and hip were analyzed by measuring periodic shift of LED markers using an optoelectronic device. Standard deviation on traces of the markers were taken as a comprehensive index of segment placement. Cross-correlation between marker traces was determined to obtain measures of degrees of coupling between body segments. RESULTS: At the low translation frequency (0.2Hz), with EO, subjects behaved like a noninverted pendulum, whereby the head tended to be stabilized more than the hip, and the legs taking up most of the imposed displacement. Aging was associated with greater head stabilization, and a looser coupling between head and hip. With EC, the body attitude changed to an inverted pendulum, whereby the head overshot the platform displacement. Aging was associated with reduced head stabilization, and a stronger coupling between head and hip. When the frequency of the platform translation increased to 0.6Hz, with EC, the general picture was similar to the above, but in older subjects vision was no longer able to counteract the imposed head displacement. At this frequency, with both EO and EC, there was a poor coupling between body segments across all ages. CONCLUSIONS: Periodic shift of the support base may be a valid protocol to test the ability to control balance in the elderly, and may be a useful tool to assess age-related changes of the sensorimotor mechanisms underlying dynamic equilibrium.

Adolescent↗
PubMed2000

Enteroviral infection causing fatal myocarditis and subclinical myopathy.

UNLABELLED: Enteroviral RNA detection in myocarditis and dilated cardiomyopathy is rare. Enteroviral particles and RNA have recently been identified in patient's skeletal muscle, suggesting that skeletal more than heart muscle hosts the virus in chronic infection. Enteroviral RNA and virus-like particles were found in the myocardium and in the skeletal muscle of two patients with fatal myocarditis: a 39 year old man who died five days after the onset of febrile flu; and a 49 year old woman, assisted for 50 days with a left ventricular assist device, who then died from cerebral haemorrhage. Automated sequencing, alignment, and sequence comparison confirmed the enteroviral origin of polymerase chain reaction products and excluded contamination. These findings agree with prior observations of enteroviral localisation in the skeletal muscle of patients with dilated cardiomyopathy, and further support the hypothesis that skeletal rather than heart muscle may host the virus and serve as a reservoir in cardiomyopathies related to chronic infection. KEYWORDS: enterovirus; myocarditis; viral particles; skeletal muscle

Adult↗
PubMed2000

Restricted dissociated sensory loss in a patient with a lateral medullary syndrome: A clinical-MRI study.

BACKGROUND: Various sensory syndromes in lateral medullary infarctions are described. A small variation in the location of a lesion may lead to very different clinical features, owing to the complex anatomy of the medulla oblongata. MRI may identify the location and extent of the ischemic lesions, allowing a clear clinical-anatomical correlation. CASE DESCRIPTION: We describe a man with an ischemic lesion in the right portion of the lower medulla that presented a contralateral impairment of spinothalamic sensory modalities and an ipsilateral impairment of lemniscal modalities with a restricted distribution (left forearm and hand, right hand and fingers, respectively). The restricted and dissociated sensory abnormalities represent the only permanent neurological consequence of that lesion. CONCLUSIONS: The atypical sensory syndrome may be explained by the involvement of the medial portion of spinothalamic tract and the lateral portion of archiform fibers at the level of the lemniscal decussation.

Arm↗
PubMed2000

Dose-intensive melphalan with stem cell support (CM regimen) is effective and well tolerated in elderly myeloma patients.

BACKGROUND AND OBJECTIVE: Multiple myeloma (MM) typically afflicts elderly patients. High-dose therapy has recently been shown to lead to a better outcome than standard treatment, mainly in younger patients. The extent to which older subjects can benefit from intensified approaches without excessive toxicity is examined in this study. DESIGN AND METHODS: Between December 1994 and May 1997, 12 Italian Multiple Myeloma Study Group institutions entered 68 patients at diagnosis (median age 65) into an intensified chemotherapy regimen: cyclophosphamide (CY) 3 g/m(2) plus melphalan 60 mg/m(2) followed by peripheral blood progenitor cells (PBPC) and G-CSF (CM regimen). CY (day 0) and G-CSF were used to mobilize PBPC harvested by a single leukapheresis on day 10. Melphalan was infused on day 11. PBPC were kept unprocessed at 4 degrees C for 48 hours and reinfused on day 12. Three CM regimens were delivered at 6-month intervals. RESULTS: Sufficient PBPC to support the first CM cycle were available (median CD34(+) harvest: 4.9x10(6)/kg), but dropped significantly after the second (median CD34(+) harvest: 2x10(6)/kg) and the third (median CD34(+) harvest: 0.9x10(6)/kg). The median durations of severe neutropenia (absolute neutrophil count < 500 microL) were 3, 4, and 3 days, and those of severe thrombocytopenia (platelets < 25,000/microL) were 2.5, 2, and 1 days, after the first, second and third courses, respectively. The frequency of extramedullary toxicities was low. Treatment-related mortality (TRM) was 3% after the first CM, only. Complete remission (CR) was 14% after the first, 16% after the second and 27% after the third CM. After a median follow-up of 34 months (range 19-49 months), median event-free survival was 35.6 months. INTERPRETATION AND CONCLUSIONS: These results indicate that dose-intensity of melphalan can be increased by reinfusing PBPC with acceptable low toxicity. The combination of CY and melphalan followed by PBPC is an effective chemotherapy for elderly myeloma patients. Repeated melphalan infusion hampered subsequent CD34(+) harvests.

Aged↗
PubMed2000

Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser.

PURPOSE: We defined the safety and efficacy of retrograde ureteroscopic endopyelotomy using the holmium:YAG laser. METHODS AND MATERIALS: Between July 1996 and December 1999 a total of 28 renal units in 21 women and 6 men 7 to 75 years old (mean age 43.5) with ureteropelvic junction obstruction were treated at our institution with retrograde ureteroscopic endopyelotomy. Ureteropelvic junction obstruction was bilateral in 1 case, primary in 20 and secondary in 8. Endoluminal ultrasound was done before endopyelotomy in all cases. Patients with renal calculi underwent antegrade percutaneous nephrostolithotomy and traditional cold knife endopyelotomy. Endoluminal ultrasound revealed posterior and lateral crossing vessels in 5 patients, who did not undergo the endoscopic approach. Retrograde endopyelotomy was performed using the holmium:YAG laser in 23 cases and electrode incision with pure cutting current in 5. Postoperatively a ureteral stent remained indwelling for an average of 6 weeks. Thereafter patients were followed with serial ultrasound, excretory urography and renal scan at 3 to 6-month intervals. RESULTS: We evaluated 28 upper urinary tracts, including 19 (67.9%) with high insertion ureteropelvic junction obstruction and 9 with an annular stricture. As directed by ultrasound images, the incision location was posterolateral, posterior, lateral and posteromedial in 16, 5, 4 and 3 cases, respectively. Followup was available in all cases at a mean of 10 months (range 3 to 35). Success, defined as improved drainage on radiographic study and absent clinical symptoms, was achieved in 19 of the 23 patients (83%) treated with the holmium:YAG laser. Repeat laser incision resulted in a successful outcome in 2 of the 4 treatment failures. There were no acute surgical complications. CONCLUSIONS: Retrograde ureteroscopic endopyelotomy with the holmium:YAG laser is safe and minimally invasive therapy for primary and secondary ureteropelvic junction obstruction. Endoluminal ultrasound aids in decision making when retrograde endopyelotomy is done.

Adolescent↗
PubMed2000

[Ultrasonographic, serologic, and clinical characteristics of a case of prostatic malacoplakia].

An additional case of malakoplakia of the prostate in described to highlight its clinical, echographic and serum features. It's a rarest disease especially when prostate is involved, but well known in world literature. This case is reported to describe more accurately its echographic patterns and also for growing up precision in linguistical expressions used by echographists. We hope to contribute in collecting data about an uncommon pathology. At last we discuss about differential diagnosis when biopsy is negative for neoplasia and how it's possible to end further biopsies.

Humans↗
PubMed2000

Ureteroscopic management of upper urinary tract urothelial malignancies.

The endoscope has made the transition from diagnostic tool to therapeutic aid in the upper urinary tract in recent years. Because of success using the ureteropyeloscope in the treatment of patients with upper tract stones and strictures, investigators are now looking at endoscopic management of urothelial malignancies above the bladder.

Journal Article↗
PubMed2000

Abdominal pain associated with an intra-abdominal gonad in an adult.

Controversy still surrounds management of cryptorchidism in adults. Options include orchiectomy, orchiopexy, and close observation. What about fertility if orchiectomy is chosen? How is the risk of cancer affected when observation is the choice? Follow the reasoning for the management strategy for this adult presenting with abdominal pain.

Case Reports↗
PubMed1999

Mosaicism for the full mutation and a microdeletion involving the CGG repeat and flanking sequences in the FMR1 gene in eight fragile X patients.

The molecular mechanism of the fragile X syndrome is based on the expansion of an unstable CGG repeat in the 5' untranslated region of the FMR1 gene in most patients. This expansion is associated with an abnormal DNA methylation leading to the absence of production of FMR1 protein (FMRP). Such expansion apparently predisposes the repeat and flanking regions to further instability that may lead to mosaic conditions with a full mutation and a premutation or, rarely, with normal or reduced alleles that can sometimes be transcriptionally active. In this study we describe eight unrelated fragile X patients who are mosaic for both a full mutation and an allele of normal (four cases) or reduced size (four cases). Sequencing analysis of the deletion breakpoints in 6 patients demonstrated an internal deletion confined to the CGG repeat in four of them, which represents the most likely explanation for the regression of the full mutation to a normal sized allele. In two patients with a reduced allele, the deletion encompassed the entire CGG repeat and part of the flanking regions. Analysis of FMRP by Western blot was performed in one of the mosaics with a normal sized allele and in three of those with a reduced allele. In the first patient's lymphocytes FMRP was detected, whereas in the three other patients the deletion is likely to impair transcription as no FMRP was present in their lymphocytes.

Base Sequence↗
PubMed1999

Retrograde ureteropyeloscopy for lower pole caliceal calculi.

PURPOSE: Contemporary treatment of lower pole renal calculi includes extracorporeal shock wave lithotripsy, percutaneous nephrostolithotomy and retrograde ureteropyeloscopy. Success rates for shock wave lithotripsy are reduced in this setting, especially for stones greater than 1 cm. and/or in patients with anatomical variants. Percutaneous treatment, although effective, subjects the patient to increased morbidity. We studied the safety and efficacy of retrograde ureteroscopic treatment of lower pole intrarenal calculi. MATERIALS AND METHODS: We evaluated 90 stone burdens localized to the lower pole and treated with a small diameter, actively deflectable, flexible ureteropyeloscope and a 200 micron holmium laser fiber. Stone burdens were classified as group 1--10 or less, group 2--11 to 20 and group 3--greater than 20 mm. in largest diameter. Patients with calculi less than 2.5 cm. were treated as outpatients unless concurrent medical conditions required hospitalization. Larger stones and partial staghorn calculi (group 3) frequently required 2-stage endoscopic procedures with retrograde intrarenal irrigation for 36 hours to clear debris. An acceptable immediate surgical outcome was defined as complete fragmentation reducing the stone burden to dust and 2 mm. or less fragments. Success was defined as clear imaging (that is stone-free) on renal sonography with minimum 3-month followup. Extreme anatomical variants, including a long infundibulum, acute infundibulopelvic angle and a dilated collecting system, were noted and correlated with surgical failures. RESULTS: Endoscopic access and complete stone fragmentation were achieved in 94, 95 and 45% of groups 1, 2 and 3, respectively. After a second treatment the success rate increased to 82% in group 3, with an overall rate of 91%. Of the 19 surgical failures 8 were secondary to inability to access the lower pole and 11 were secondary to inability to render the patient stone-free. In 2 of the 19 cases infundibular strictures hindered ureteroscopic access. In addition, of the anatomical variants a long lower pole infundibulum was the most statistically significant predictor of failure. Mean operative time ranged from 38 minutes for small to 126 for the largest calculi. There were no major complications. Overall stone-free rates with minimum 3-month followup were 82, 71 and 65% in groups 1, 2 and 3, respectively, and 88, 77 and 81%, respectively, in patients with an acceptable initial surgical outcome (that is excluding those with access failures from analysis). CONCLUSIONS: Retrograde ureteropyeloscopy is a safe and effective surgical treatment for lower pole intrarenal calculi.

Adolescent↗
PubMed1999

Holmium:YAG lithotripsy in children.

PURPOSE: We determined the safety and efficacy of holmium:YAG lithotripsy in children. MATERIALS AND METHODS: We retrospectively reviewed the records of all holmium:YAG lithotripsy done in patients 17 years old or younger. Demographic, preoperative, intraoperative and postoperative data were collected. RESULTS: A total of 9 boys and 10 girls (26 stones) with a mean age of 11 years (range 1 to 17) were treated with holmium:YAG lithotripsy, which was chosen as initial therapy in 10 (53%). Retrograde ureteroscopy was performed in 15 patients to treat 13 ureteral and 6 renal calculi, and percutaneous nephrolithotripsy was done in 4 to treat 3 ureteral and 4 renal calculi. A complete stone-free outcome after 1 procedure was achieved in 16 children (84%) and 3 patients were rendered stone-free after 2 procedures. No patient had an intraoperative injury. Followup ranged from 0.5 to 12 months (mean 3). Followup imaging has shown no evidence of stricture or hydronephrosis. CONCLUSIONS: Holmium:YAG lithotripsy is safe and effective in children. It is a reasonable option for failed shock wave lithotripsy, or in children with a known durile stone composition or contraindications to shock wave lithotripsy.

Adolescent↗
PubMed1999

Ureteropyeloscopic diagnosis and treatment of upper urinary tract urothelial malignancies.

OBJECTIVES: To study the application of endoscopic techniques in treating upper urinary tract urothelial malignancies and to define subgroups that may benefit from these therapies. METHODS: During a 3-year period, 20 patients with upper urinary tract transitional cell carcinoma were referred specifically for endoscopic therapy. Indications for treatment included a solitary kidney, bilateral disease, modest renal insufficiency, and/or other significant comorbidities. All patients underwent retrograde ureteropyeloscopy. Lesions were biopsied, and lower grade tumors were treated with electrocautery or laser energy. High-grade lesions not amenable to minimally invasive techniques were palliated or treated with standard open surgery. Surveillance was performed at 3 to 4-month intervals by urine cytology and repeat panendoscopy on a similar schedule to lesions of the bladder treated endoscopically. RESULTS: Eleven patients (55%) were found to have low-grade, papillary transitional cell carcinoma of the upper urinary tract. Tumors ranged in size from less than 1 cm to filling the entire ureter. All papillary lesions were treated successfully using ureteroscopic techniques without any disease progression. Five small, low-grade recurrences (45%) were defined and treated endoscopically, with a mean follow-up of 17.3 months. Three patients were found at the time of initial diagnostic ureteroscopy to have higher grade lesions and endoscopic treatment was chosen in light of their severe comorbidities. On subsequent imaging, 2 of the 3 patients were suspected of having progression and underwent open surgery, both had carcinoma-in-situ only in the specimen. No tumor progression has been defined in this group to date, with mean follow-up of 16.3 months. A final third group of 6 patients were found to have nonpapillary, high-grade lesions at diagnostic endoscopy and underwent standard surgical resection. The disease of 4 of these 6 patients has progressed with metastases. CONCLUSIONS: Papillary, low-grade, low-stage tumors of the upper urinary tract are amenable to endoscopic resection irrespective of size and location. Patients with high-grade lesions defined endoscopically should be offered radical surgery in light of the high rate of disease progression.

Aged↗
PubMed1999

Ureteroscopic lithotripsy.

The indications for ureteroscopic lithotripsy have increased with endoscope miniaturization and powerful, precise endoscopic lithotrites like the holmium: yttrium-aluminum-garnet laser. Successful ureteropyeloscopic treatment with the currently available instrumentation and techniques is independent of the size, composition, and location of stones in the upper urinary tract. Extracorporeal shockwave lithotripsy maintains a major role in treating uncomplicated, moderately sized upper urinary tract calculi. Complex upper urinary tract calculi, however, are best treated endoscopically. In addition, the endoscopic treatment of ureteral calculi is efficacious and definitive, albeit more invasive than extracorporeal shock wave lithotripsy.

Humans↗