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Biomedical subjects

M Lenti

Publications and source records attributed to M Lenti.

18 recordsLinked to original sources
PubMed2005

PAI-1 and homocysteine, but not lipoprotein (a) and thrombophilic polymorphisms, are independently associated with the occurrence of major adverse cardiac events after successful coronary stenting.

OBJECTIVE: To evaluate the role of factor V Leiden, prothrombin G20210A polymorphism, plasminogen activator inhibitor type 1 (PAI-1) 4G/5G polymorphism, PAI-1, homocysteine, and lipoprotein (a) (Lp(a)) in the occurrence of major adverse cardiac events (MACE) in patients with acute coronary syndromes who underwent coronary stenting. DESIGN: 520 patients (375 men and 145 women) with acute coronary syndromes and 520 age and sex matched controls were enrolled. MACE were recorded for 109 patients. Heterozygosity for factor V Leiden, prothrombin G20210A polymorphism, and 4G/5G polymorphism did not significantly differ between patients with and without MACE. A significantly higher percentage of patients with increased homocysteine (28% v 19%, p < 0.001) and PAI-1 concentrations (25% v 16%, p < 0.001) had MACE with respect to those who did not. In Kaplan-Meier survival analysis, the overall risk of MACE was significantly higher among patients with increased PAI-1 (p = 0.006) and homocysteine concentrations (p = 0.04). Cox regression analysis adjusted for age, sex, traditional cardiovascular risk factors, renal function, systolic left ventricular function, the number of stenosed vessels, and history of percutaneous coronary intervention or coronary artery bypass grafting showed that homocysteine (odds ratio 7.5, 95% confidence interval (CI) 1.1 to 57.7, p < 0.05) and PAI-1 concentrations (odds ratio 5.3, 95% CI 1.2 to 23.8, p < 0.05) within the fifth quintile (with respect to the first) were significant and independent risk factors for the future occurrence of MACE. CONCLUSIONS: Increased PAI-1 and homocysteine concentrations are independent risk factors for MACE after successful coronary stenting, whereas Lp(a) and thrombophilic polymorphisms are not predictive.

Adult↗
PubMed2004

Role of hyperhomocysteinemia in aortic disease.

A growing body of evidence has shown a strong association between elevated plasma homocysteine (Hcy) levels with vascular disease and thrombotic complications. Data available in literature also suggest a role of hyperhomocysteinemia in abdominal and thoracic aortic diseases. In particular, Hcy was investigated in patients with Marfan syndrome and it was demonstrated that Hcy levels were associated with the risk of severe cardiovascular manifestations or dissection. Hcy was significantly higher also in patients with abdominal aortic aneurysms and was associated with the size of aneurysms. It remains to be elucidated if this association is causal or simply an effect of the disease. A number of mechanisms may be evoked to explain these findings. Studies in animal models demonstrated that hyperhomocysteinemia could induce marked remodelling of the extracellular matrix of the arterial wall by inducing elastolysis through the activation of metalloproteinases. In addition, Hcy may directly affect fibrillin-1 or collagen by interfering with intra- and/or inter-molecular disulfide bonds through disulfide exchange, or binding to free sulphydryl groups. Further studies are needed to confirm the role of Hcy in aortic disease and the usefulness of including Hcy determination in the clinical evaluation of these patients.

Aged↗
PubMed2003

Does gender influence outcome of AAA endoluminal repair?

BACKGROUND: It has been suggested that female patients have a less favourable outcome of endoluminal repair of abdominal aortic aneurysms. Yet, data on stratified per gender are lacking. METHODS: We reviewed our prospective database of 402 endografts over a 4-year period and the peri- and postoperative course in the 25 (6%) female patients was compared with the 377 (94%) male patients. Median follow-up was 24 months (range 1-56 months). Logistic regression analysis was performed to test the effect of five confounding variables (gender, age, ASA grade IV, EUROSTAR class D or E, AAA diameter) on failure of AAA exclusion. RESULTS: There were no perioperative deaths in the female group and 5 (1.3%) in the male group (p = 0.8). Major perioperative morbidity occurred in 17% versus 6% (OR 3.7; 95% CI 1.2-10.6; p = 0.026). There were 1 (4%) and 5 (1%) conversions to open repair in the female and male groups, respectively (p = 0.3). Late failure of AAA exclusion occurred in 5 (21%) and 26 (7%) patients, respectively (p = 0.03). Of the five variables examined for their influence on failure of AAA exclusion, female gender (hazard ratio 4.42; 95% CI 1.4-13.4; p = 0.009) and AAA diameter (hazard ratio 1.05; 95% CI 1.009-1.09; p = 0.017), were positive independent predictors of late failure of AAA exclusion on multivariate analysis. CONCLUSION: Endoluminal AAA repair in female patients appear associated with a less favorable outcome when compared to their male counterparts. These data may be taken into consideration when endoluminal AAA repair is suggested to a female patient.

Aged↗
PubMed2002

Does the presence of an iliac aneurysm affect outcome of endoluminal AAA repair? An analysis of 336 cases.

OBJECTIVE: To determine whether the presence of an iliac aneurysm compromises outcome of endovascular exclusion of AAA and to ascertain the fate of the iliac aneurysmal sac. PATIENTS AND METHODS: Between April 1997 and March 2001, data on 336 consecutive patients undergoing endovascular repair for AAA were entered in a prospective database. Suitability for endovascular repair was assessed by preoperative contrast-enhanced computed tomography. A maximum common iliac artery (CIA) diameter > or = 20 mm was defined as iliac aneurysm. Patients with and without iliac aneurysms were compared to early (immediate conversion or perioperative death) and late failure (increase in aneurysm diameter or persisting graft-related endoleak, or late AAA rupture or conversion). RESULTS: Fifty-nine patients (18%) had iliac aneurysms, 19 were bilateral, for a total of 78 aneurysmal iliac arteries (median diameter 23 mm; range 20-50 mm). A distal seal was achieved by landing in 33 external iliac arteries, in 20 ectatic CIAs, and in 25 normal CIAs. Operating time differed significantly between patients with and without CIA aneurysms (153 +/- 71 vs 123 +/- 55 min, p = 0.0001), whereas no statistically significant differences were found with respect to early and late failure (2% vs 3%, p = 0.5 and 14% vs 8%, p = 0.11, respectively). There were no cases of buttock or colon necrosis. At a median follow-up of 14 months (range 0-46; i.q.r. 7-27 months) common iliac diameter decreased > or = 2 mm in 49 cases, remained stable in 25, and increased > or = 2 mm in 3. CONCLUSION: The presence of iliac aneurysm rendered endoluminal AAA repair more complex but did not affect feasibility and long-term outcome of the procedure. In our experience internal iliac exclusion was never associated with significant morbidity. These data may be useful when considering endovascular repair in high-risk patients with challenging anatomy.

Aged↗
PubMed2000

Predictive factors for early success of endovascular abdominal aortic aneurysm repair.

To identify predictive factors for postoperative success and potential predictors for satisfactory outcome of endovascular grafting for abdominal aortic aneurysm (AAA), we collected data from our prospective database, which includes a series of consecutive patients undergoing endovascular repair at the Vascular Surgery Unit, Policlinico Monteluce, Perugia, Italy. From April 1997 to July 1998, 202 patients were referred to our Unit for elective AAA repair; 94 patients (47%) were selected for endografting. Placement of the graft using endovascular technique without conversion to open laparotomy, in addition to no mortality, major morbidity, or endoleak at 30-day follow-up, was defined as postoperative success. The influence of anatomical features on postoperative results was analyzed by univariate and multivariate analysis. Our experience shows that endoluminal repair of AAA is safe and effective in the short term and male patients with small aneurysms are optimal candidates for successful repair.

Aged↗
PubMed1999

Prospective, randomized, double-blind trial comparing teicoplanin and cefazolin as antibiotic prophylaxis in prosthetic vascular surgery.

To compare efficacy, tolerability, and cost of antibiotic prophylaxis with teicoplanin and cefazolin in clean prosthetic vascular surgery, a randomized, prospective, double-blind study was performed at the Vascular Surgery Unit of a tertiary-care university hospital. Two-hundred thirty-eight consecutive patients undergoing elective, clean, abdominal or lower-limb prosthetic vascular surgery were allocated to receive a single intravenous dose of teicoplanin (400 mg) or cefazolin (2 g) at the induction of anesthesia. Surgical-site infections occurred in 5.9% of teicoplanin recipients (4.2% wound infection, 1.7% graft infection) and 1.7% of cefazolin recipients (1.7% wound infection, 0% graft infection) (P=0.195). Other postoperative infections occurred in 10% of teicoplanin recipients (pneumonia 7%, urinary tract infection 3%) and 12% of cefazolin recipients (pneumonia 7%, urinary tract infection 2.5%, bloodstream infections 2.5%). Overall mortality rate was 3.4% in teicoplanin recipients (4 patients) and 2.5% in cefazolin recipients (3 patients). Infective deaths occurred in one patient for each group. The two prophylactic regimens were well tolerated. Cost savings of US $52,510 favoring cefazolin were related to the lower acquisition cost (US $1034 vs US $4740) and to the shorter duration of the hospital stay (1762 days vs 1928 days). Cefazolin can still be regarded as the drug of choice for prophylaxis in clean vascular surgery.

Aged↗
PubMed1999

Intraoperative assessment of technical perfection in carotid endarterectomy: a prospective analysis of 1305 completion procedures. Collaborators of the EVEREST study group. Eversion versus standard carotid endartectomy.

OBJECTIVE: to define the incidence of technical defects and the impact of technical errors on ipsilateral carotid occlusion, ipsilateral stroke, and early restenosis rates, we analysed 1305 patients undergoing carotid completion procedures. DESIGN: prospective multicentre study. PATIENTS AND METHODS: adequacy of CEA was assessed intraoperatively by angiography in 1004 (77%), by angioscopy in 299 (22%), and by duplex scan in two patients (1%). Arteriograms and angioscopic findings were interpreted at the time of the procedure by the operating surgeon, who also established the need for immediate surgical revision. RESULTS: perioperatively, 13 major strokes (0.9%, all ipsilateral) and six deaths (0.4%) were recorded. Overall, 112 defects (9%) were identified intraoperatively: 81 (72%) were located in the common carotid artery (CCA) or internal carotid artery (ICA), and 31 (28%) in the external carotid artery. In 48 patients (4%) the defects were revised. Logistic regression analysis revealed that carotid plaque extension >2 cm on the ICA was a positive independent predictor of CEA defects (odds ratio (OR) 1.5p=0.03). A significant association was found between the incidence of revised defects of the CCA and ICA and perioperative ipsilateral stroke (OR 11.5p=0.0002). In contrast, patients with minor non-revised defects had an ipsilateral stroke rate comparable to that of patients with no defects (p=0.4). No significant association was found between revised or non-revised defects and occurrence of restenosis/occlusion at 6-month follow-up. CONCLUSIONS: the incidence of major technical defects during CEA is low, yet the perioperative neurological prognosis of patients with major defects warranting revision is poor. Completion angiography or angioscopy and possible correction of defects did not protect per se from an unfavourable early outcome after CEA. Therefore, surgical excellence is mandatory to achieve satisfactory results after CEA.

Adult↗
PubMed1997

Eversion versus conventional carotid endarterectomy: a prospective study.

OBJECTIVES: To analyse comparatively eversion and conventional CEA for later association with restenosis, perioperative stroke/death and ipsilateral cerebrovascular events (early, late, disabling and non-disabling). DESIGN: Prospective non-randomised clinical study. MATERIALS AND METHODS: A total of 469 patients underwent 514 procedures; 274 (53%) eversion CEA and 240 (47%) conventional CEA. Perioperative monitoring was carried out by clinical evaluation under local anaesthesia or by transcranial Doppler under general anaesthesia. Follow-up was carried out by clinical evaluation and Duplex scanning. RESULTS: Clamping time was significantly shorter in the eversion group (25.5 +/- 7.4 vs. 28.3 +/- 10.1 min; p = 0.0001; CI delta 4.40/1.12). The perioperative disabling stroke/death rate was 0.7% for eversion vs. 1.2% for conventional CEA, p = 0.6; odds ratio (OR), 0.58. There were two early carotid occlusions (within 30 days) in both groups. According to life-table analysis, after 3 years the probability of > 50% carotid restenosis was significantly lower in the eversion group (2.2% vs. 6.9%, p = 0.03; relative risk reduction 67%). There were no significant differences between the two groups relative to new cerebrovascular events (92% in both groups, p = 0.6). Using multivariate analysis (Cox regression), eversion CEA, and to a lesser extent standard CEA with patch, appeared to protect the vessel from restenosis. CONCLUSIONS: The eversion technique was associated with reduced clamping time and probability of restenosis. However, because of the nature of a non-randomised study, the present analysis should be confirmed by a multicentre randomised trial.

Aged↗
PubMed1994

[The magnetic resonance imaging of abdominal aortic aneurysms].

The diagnostic role of Magnetic Resonance Imaging (MRI) was investigated in the study of abdominal aortic aneurysms and compared with that of Computed Tomography (CT) and digital subtraction angiography (DSA). Magnetic Resonance angiography (MRA) was performed on 21 patients with radiologically proved abdominal aortic aneurysms, using a superconductive 1.5 T magnet (GE, Signa Advantage); the 2D TOF technique with gradient-echo sequences was used (SPGR: FA 45-60 degrees, TR/TE 33/7, ST 2 mm, 1 nex, 256 x 128 matrix, inferior presaturation and flow compensation). The images acquired on the axial plane were reconstructed according to MIP and rotated on the z-axis from +90 degrees to -90 degrees. In all cases SE 2D T1- and T2-weighted sequences were acquired on the axial plane. Twelve patients were examined with MRI, CT and DSA; 3 with MRI and CT; 2 with MRI and DSA and finally 4 with MRI only. The radiologic studies were then reviewed blind and the results of the different methods compared. In all cases MRI yielded similar information to CT and DSA as to aneurysm extent and size, vessel involvement, status of visceral, iliac and common femoral arteries and finally the conditions of perianeurysmatic tissues. The authors conclude that MRI is a useful and accurate technique for the preoperative examination of abdominal aortic aneurysm patients.

Adult↗
PubMed1989

[Further observations and considerations on the biological and reproductive cycle of the roe buck (Capreolus capreolus L.)].

The authors have studied the seasonal microanatomical modifications of the ovary of the roe deer and testis of the roe buck. The ovary during the month of September presents primary, secondary and mature vesicular follicles. During the month of October there is the first presence of a corpus luteum. The corpora lutea during the months of November and December increase in size and blood supply; the cells are filled with acidophil granules. The corpora lutea persist also in January and February when embryos are implanted in the uterus. This result agrees with Short's and -Hay's but differs from that of Stieve. Testes show the first spermatogenic activity during the month of April. The spermatogenesis is completed in June, persists and reaches the top during July and August, when the Leydig cells acquire a strong acidophil cytoplasm. Indeed the spermatogenesis decreases during September and October; then, during winter months the testes are devoid of all signs of spermatogenic activity, the tubules being lined only be Sertoli cells and spermatogonia.

Animals↗
PubMed1989

[Comparative macroscopic and microscopic anatomical observations on pyloric ceca in some bony fish].

The authors report the variable number of pyloric caeca of some species of fish and describe their macroanatomy. They also describe and compare the microanatomy of pyloric caeca in three species; in particular they point out the thickness of tunica muscularis, the shape and length of villi which protrude into the lumen and the variable number of goblet cells. The tunica muscularis is very strong in Uranoscopus and consists of three strata: external and inner longitudinal strata, middle circular stratum. The tunica muscularis is less thick in Diplodus and in Scorpaena. The lamina propria and epithelium form villi which protrude into the lumen. They are covered with columnar epithelium and goblet cells which are more numerous in Uranoscopus and Scorpaena and less numerous in Diplodus. At last the authors describe in pyloric caeca of Scorpaena the presence of a network which engages all the lumen; it consists of connective tissue septa which directly derive from the lamina propria and is covered with the same columnar epithelium and goblet cells.

Animals↗
PubMed1984

[Comparative microscopic anatomy of the urinary bladder of various domestic and wild ruminants].

The Authors focus their interest on the microanatomical differences between urinary bladders of some domestic (sheep and cattle) and wild Ruminantia (roe and chamois). Sixteen urinary bladders of the following species have been studied by Azan, Masson and Weigert staining methods: Three urinary bladders of Ovis aries (L.) and Bos taurus (L.) drawn from animals of both sexes; seven urinary bladders drawn from female of Capreolus capreolus (L.); three urinary bladders from both sexes specimens of Rupicapra rupicapra (L.). It is possible to summarize the data on the compared microanatomy of urinary bladder in the following way: it presents three tunics: mucosa, muscularis and adventitia. The tunica mucosa is composed of lamina propria and transitional epithelium, and presents typical plicae which give a peculiar aspect to the lumen. In roe deer the lamina propria presents several smooth muscle fibers which are organized in an evident "muscularis mucosae" which is absent in all the studied species. The tunica muscularis is composed of two longitudinal (outer and inner) muscle layers and a middle circular layer. In roe this tunica is thicker and more powerful than in other species, and the single layers are more evident because of the presence of many connective septa. The tunica adventitia is composed of loose connective tissue, and some elastic fibers. Unexpectedly, the Chamois, which belongs to wild Ruminants as the roe, does not present a "muscularis mucosae". Therefore the authors suppose that the presence of "muscularis mucosae" in roe could be due to the ethology peculiar of this species which is accustomed to mark the boundary of its territory by staling frequently.

Animals↗
PubMed1983

[Innervation of the urinary bladder of Ovis aries L].

The authors have extended a preliminary study about the innervation of urinary bladder, confirming the previous results pointing out the presence of metasympathetic ganglions in the wall of urinary bladder. Therefore nine urinary bladders of Ovis aries of different age and both sexes have been studied by Ruffini, Bodian and Bielschowsky's staining methods. It's possible summarize the data on the innervation of urinary bladder in the following way: in the tunica adventitia there are motor and sensitive bundles of myelinated nervous fiber. The formers, after many divisions, penetrate into the tunica muscularis contacting bundles of smooth muscle fibers, while the latters after several divisions after giving rise to thinner bundles, produce Pacini-like and Ruffini-like sense corpuscles and free nervous terminations. Furthermore, some metasympathetic ganglions of different size have been detected throughout the running of the bundles. In the tunica submucosa a diffuse and peculiar non myelinated network is observed, arising from the vegetative nervous fibers.

Age Factors↗
PubMedDate not supplied

Homocysteine-lowering therapy and carotid intima-media thickness in renal transplant recipients.

The aim of this study was to document, in hyperhomocysteinemic renal transplant recipients, the effect of vitamin supplementation on carotid intima-media thickness (cIMT). Fifty-six hyperhomocysteinemic stable renal transplant recipients were randomly assigned to either vitamin supplementation (group A) or placebo treatment (group B). All patients underwent high-resolution B mode ultrasound to measure IMT of common carotid arteries before and after 6 months of vitamin supplementation. In group A, cIMT significantly decreased after treatment, whereas no significant changes were observed in group B. In conclusion, our results demonstrate a beneficial effect of the treatment of hyperhomocysteinemia by vitamin supplementation on an early sign of atherosclerosis in a group of renal transplant recipients.

Carotid Arteries↗