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Biomedical subjects

M Romanelli

Publications and source records attributed to M Romanelli.

At least 19 recordsLinked to original sources
PubMed2000

Subcortical vascular dementia as a specific target for clinical trials.

Vascular cognitive impairment is considered the second most common form of mental deterioration in the elderly after degenerative dementias. Therapeutic approaches to vascular dementia mainly rely on the identification and treatment of risk factors. A number of drugs have also been tested with the aim of improving or slowing cognitive decline in patients affected by various forms of cerebrovascular disease. Most of these trials have yielded unsatisfactory results. We hypothesize that some of these failures depend on the inclusion of patients with pathophysiologically heterogeneous types of vascular cognitive decline. In this paper, we review some of the most important trials that tested drugs with a preventive or therapeutic aim in vascular dementia patients. Preliminary results suggest that some beneficial effects can be detected only when the trial population is homogeneous on a clinical and pathogenic basis. In particular, subcortical vascular dementia, a form with a rather univocal clinical, radiological, and pathological picture, seems a particularly apt choice as a target for future clinical studies. At present, only one therapeutic trial is being conducted in patients affected by this specific form of vascular dementia.

Aged↗
PubMed1998

Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomized trial.

To test the efficacy of surgical treatment of non-infected neuropathic foot ulcers compared to conventional non-surgical management, a group of diabetic outpatients attending our diabetic foot clinic were studied. All patients who came to the clinic for the first time from January to December 1995 inclusive with an uncomplicated neuropathic ulcer were randomized into two groups. Group A received conservative treatment, consisting of relief of weight-bearing, regular dressings; group B underwent surgical excision, eventual debridement or removal of bone segments underlying the lesion and surgical closure. Healing rate, healing time, prevalence of infection, relapse during a 6-month period following intervention and subjective discomfort were assessed. Twenty-four ulcers in 21 patients were treated in group A (17 Type 2 DM/3 Type 1 DM, age 63.24 +/- 13.46 yr, duration of diabetes 18.2 +/- 8.41 yr, HbA1c 9.5 +/- 3.8%) and 22 ulcers in 21 patients in group B (19 Type 2 DM/2 Type 1 DM, age 65.53 +/- 9.87yr, duration of diabetes 16.84 +/- 10.61 yr; HbA1c 8.9 +/- 2.2%). Healing rate was lower (79.2% = 19/24 ulcers) in group A than in group B (95.5% = 21/22 ulcers; p < 0.05), and healing time was longer (128.9 +/- 86.60 days vs 46.73 +/- 38.94 days; p < 0.001). Infective complications occurred significantly more often in group A patients (3/24, 12.5% vs 1/22, 4.5%; p < 0.05), as did relapses of ulcerations (8 vs 3; p < 0.01). There were only two minor perioperative complications in group B patients. Patients reported a higher degree of satisfaction in group B (p < 0.01) as well as lower discomfort (p < 0.05) and restrictions (p < 0.05). Thus surgical treatment of neuropathic foot ulcers in diabetic patients proved to be an effective approach compared to conventional treatment in terms of healing time, complications, and relapses, and can be safely performed in an outpatient setting.

Aged↗
PubMed1998

Incidence and determinants of poststroke dementia as defined by an informant interview method in a hospital-based stroke registry.

BACKGROUND AND PURPOSE: Inconsistent information about incidence and determinants of poststroke dementia might be related to patient attrition, partly because of nonapplicability of formal neuropsychological testing to a large proportion of patients registered in a definite setting. METHODS: Using a proxy-informant interview based on ICD-10 criteria, we determined dementia at stroke onset and 1 year after stroke in the 339 patients who survived, were available for follow-up, and were not demented at stroke onset of 635 patients entered over a 1-year period in a stroke registry taken at 2 community hospitals in Florence, Italy. RESULTS: Of the 339 patients, 57 (16.8%) proved to have poststroke dementia. These patients were older, more frequently female, and more often (multivariate odds ratio, 2.35; 95% CI, 1.21 to 4.58) had atrial fibrillation than those without dementia. Aphasia and the clinical features expressing the severity of the stroke event in the acute phase predicted poststroke dementia. CONCLUSIONS: In a hospital-based nonselected series of stroke survivors, despite the use of a method with low sensitivity for defining dementia, our study confirms that dementia is a frequent sequela of stroke and is mainly predicted by stroke severity. Certain determinants could be controlled in the prestroke phase, thus reducing its risk.

Age Distribution↗
PubMed1997

[Antiblastic locoregional perfusion with control of the aorto-caval flow: technique of percutaneous access].

The authors introduce a new technique for performing aortic stop-flow infusion (ASI) or hypoxic abdominal perfusion (HAP) to treat advanced thoracoabdominal tumors, via an angiographic percutaneous approach. To date, the maneuver has always been performed with surgical exposure of vascular sites in the groins. The materials available on the market were initially used and then dedicated materials have been developed, such as 11-F vascular sheaths, 8-F catheters, latex balloons with maximum phi's of 4 cm and maximum capacity of 70 ml. We performed 72 maneuvers in 56 patients during 22 months. No technical or instrumental complications occurred and all treatments were successful. Three patients (6%) died within 12 hours, two because of ARDS following thoracic perfusion and one for acute renal failure and disseminated intravascular coagulation following abdominal perfusion. The percutaneous approach provides the same mechanical-occlusive efficacy for aortocaval occlusion and therefore the same therapeutic results as surgery, but it has fewer risks of technical complications and no technical failures. Moreover, this technique is more repeatable and less expensive than surgery and its hospital stay and recovery time are shorter. To conclude, the ASI/HAP procedure is an interesting therapeutic chance in otherwise untreatable advanced cancer patients offering several prospects of technical and pharmacologic development to further increase its efficacy.

Aorta↗
PubMed1995

Use of a durometer to measure the degree of skin induration in lipodermatosclerosis.

BACKGROUND: Chronic lipodermatosclerosis is characterized by indurated skin on the medial aspect of the leg and is common around venous ulcers. The severity of induration of lipodermatosclerosis has been associated with poor ulcer healing. Clinical assessment of lipodermatosclerosis presently relies on a clinical skin severity score adapted from studies of patients with systemic sclerosis. OBJECTIVE: It would be desirable for prognostic reasons to develop an objective method for measuring skin hardness in lipodermatosclerosis. METHODS: The degree of skin induration at the midpoint between the upper and lower margin of lipodermatosclerosis in 30 sequential nonselected patients with lipodermatosclerosis was assessed by a blinded observer's clinical score and by quadruplicate determinations with a hand-held type O durometer. Skin induration on the medial aspect of the leg was similarly measured in five normal volunteers. Transcutaneous oxygen pressure was measured at the same sites. RESULTS: A direct linear relation (r = 0.962) was found between skin severity scores and durometer readings (p < 0.01). A clinical skin score of 2 reflected a higher durometer reading compared with a skin score of 1 (p = 0.0016) and, similarly, higher durometer readings were found in skin score of 3 compared with score 2 skin (p = 0.0093). Transcutaneous oxygen pressure was uniformly reduced in lipodermatosclerosis (p < 0.02). CONCLUSION: The durometer is a reliable instrument for measuring skin hardness in patients with lipodermatosclerosis. It may be used to test the prognostic value of lipodermatosclerosis on ulcer healing.

Blood Gas Monitoring, Transcutaneous↗
PubMed1995

Relationship between cathepsin D and other pathological and biological parameters in 1752 patients with primary breast cancer.

The relationship between cathepsin D and other pathological or biological prognostic parameters has not yet been defined through systematic studies in breast cancer. The aim of the present investigation was to define the relationship between cathepsin D and nodal status, tumour size, steroid receptors and tumour grade in a wide patient series. Cytosol cathepsin D was assayed with an immunoradiometric assay in tumour samples from 1752 patients. A statistically significant, but not biologically meaningful association was found between cathepsin D and both tumour size and grade. Cathepsin D was significantly higher in node-positive than in node-negative tumours. However, cathepsin D is not of great use in order to predict the risk of axillary metastases in individual patients, due to overlapping of cathepsin D values between node-positive and node-negative cases. A significant, direct association was found between cathepsin D and both oestrogen receptor and progesterone receptor cytosol levels. Nevertheless, preliminary data indicate that cathepsin D and steroid receptors provide independent prognostic information.

Adult↗
PubMed1994

[Microcystic adenoma of the pancreas. Immunohistochemical and ultrastructural study of 7 cases].

Microcystic cystadenoma of pancreas is a rare benign neoplasm with peculiar pathologic characteristics. It is more frequent in women and in elderly age. Macroscopically it is composed of a spongy, microcystic mass with a starry central fibrous core. Histologically serous cysts are lined by cuboidal or flattened epithelium without nuclear atypias and with PAS positive cytoplasms. A surgical conservative approach is the treatment of choice. Seven cases of microcystic cystoadenomas of the pancreas observed within ten years at Osp. San Carlo Borromeo-Milano and Osp. Santa Maria degli Angeli-Pordenone from 6 women and 1 man aged 54-87 years are described. The preoperative and intraoperative investigations that have been necessary for reaching its diagnosis are discussed.

Aged↗
PubMed1992

p53 over-expression is an early event in the development of human squamous-cell carcinoma of the larynx: genetic and prognostic implications.

The tumor-suppressor protein p53 is over-expressed in a large fraction of squamous-cell carcinomas of the larynx (LSCCs). p53 overexpression is dependent upon the synthesis of mutated versions of the protein and has been associated with the malignant progression of certain tumor types. In order to examine the prognostic value of p53 immunodetection in LSCCs, we performed a retrospective analysis on a selected series of tumors, using the PAb 1801 and CM1 antibodies. No significant difference in the frequency of p53 over-expression was observed between tumors from patients with early relapse (67%) and those who had been disease-free for more than 5 years (84%). The lack of correlation of p53 immunoreactivity with clinical stage and differentiation grade of LSCCs, together with the coordinated expression of p53 in primary tumors and the corresponding lymph-node metastases, indicate that p53 over-expression is probably unrelated to the biological aggressiveness of these tumors. In addition, the detection of p53 immunostaining in pre-invasive areas as well as in preneoplastic lesions suggests that p53 abnormalities probably constitute a very early event in LSCC development.

Carcinoma in Situ↗
PubMed1991

The effect of topical nitroglycerin on transcutaneous oxygen.

The use of topical nitroglycerin has been reported to aid the healing of chronic skin ulcers. In this study, the effect of 2% nitroglycerin ointment on transcutaneous oxygen pressure (TcPO2) was investigated in skin adjacent to the area of ointment application. Topical nitroglycerin caused a two-fivefold decrease in TcPO2 in skin next to or up to 9 cm away from the site of application of the ointment.

Administration, Topical↗
PubMed1989

Malignant change in a benign pulmonary hamartoma.

Sarcomatous transformation in a longstanding, clinically silent hamartoma is reported. Malignant change occurred shortly after resection, suggesting that surgical manipulation may have played a part.

Female↗
PubMed1988

[Updating case studies of primary tumors of the mesentery: angiofibroma involving the superior mesenteric artery].

The authors describe a rare case of jejunal mesenteric angiofibroma involving the superior mesenteric artery, referred to them as a clinical finding of an abdominal mass with associated disorders of alimentary transit. A review of the literature reveals the controversies existing to date on the subject of mesenteric neoplasms. In addition to their rare incidence, also confirmed by our personal experience in two surgical centres, intraligamentous abdominal tumours arouse interest owing to the diagnostic difficulties which as a rule hinder a precise pre-operative orientation and to surgical problems of a tactical nature related to the frequent involvement of adjacent anatomical structures.

Adult↗
PubMed1981

[Angioimmunoblastic lymphadenopathy. Anatomoclinical and immunological study of a case].

The clinical course of a 54-year-old man with generalized lymphadenopathy bearing all physical, laboratory and histologic characteristics of angioimmunoblastic lymphadenopathy with dysproteinemia is described. Morphologic and laboratory features of a hyperimmune state with autoimmune hemolytic anemia, elevated cold agglutinin levels and polyclonal gammopathy, but with paradoxical cutaneous anergy and decrease in blood T-lymphocytes, were found. Therapy with levamisole was without significant benefit and the patient died 2 months after initial diagnosis. Our findings give further support to the contention that this disease is an abnormal, but non-neoplastic, immune reaction resulting from a loss of suppressor T cells with hyperfunction of the B lymphocyte system.

Autoimmune Diseases↗
PubMedDate not supplied

Hardness of plantar skin in diabetic neuropathic feet.

To evaluate if skin hardness in diabetic neuropathic feet was increased and if its eventual modifications could be correlated to the severity of neuropathy, we studied a group of diabetic outpatients with and without neuropathy. Patients, selected among those who were attending their routine screening for diabetic neuropathy at our diabetologic clinic, were divided into two groups according to the presence (ND+) or absence (ND-) of diabetic neuropathy with the criteria of the S. Antonio Consensus Conference on Diabetic Neuropathy. Patients then underwent an evaluation of vibration perception threshold (VPT) by means of a biotesiometer, measurement of skin hardness (DMT) by means of a durometer, and transcutaneous oxygen tension (TcPO2) determination. VPT was determined at allux (VPT-A) and external malleolus (VPT-M), DMT was measured at heel (DMT-H), at medial (DMT-M) and lateral (DMT-L) midfoot, and at posterior midcalf (DTM-C) as a control site; TcPO2 was evaluated at dorsum (TcPO2-D) and at medial midfoot (TcPO2-M), respectively. All measurements were performed on the nondominant side with the patients supine. Patients were compared with age and gender-matched healthy volunteers (Controls), who underwent the same evaluations in the same order. ND+ patients showed higher values of VPT than ND- and Controls, both at first toe and at malleolus analysis of variance (ANOVA) p<0.01), as well of DMT in all the three sites explored (ANOVA, p<0.01). Moreover, ND+ showed no difference in DMT among the sites, while both in ND- and in controls DMT-M was significantly (p<0.05) lower than DMT-H and DMT-L. No difference among the three groups were observed in TcPO2 measurements, and no difference in DMT-C was observed either. A significant correlation was observed between DMT-H and VPT-M (r2 = 0.516) and between DMT-M and VPT-A (r2 = 0.624) in ND+ patients. Skin hardness was diffusely increased in ND+ patients, and this increase strongly correlates with the severity of neuropathy. Simple, noninvasive determination of skin hardness could identify patient at potential risk to develop neuropathic foot ulcers.

Adult↗
PubMedDate not supplied

[Histological, ultrastructural and clinical study of a malignant adrenal neoplasm producing minor mineralocorticoids].

The authors describe a case of an adrenal tumor of unusual dimensions with a benign histological appearance. After a short period diffuse metastases developed. The metastases should the features a poorly differentiated carcinoma. The size of the tumor appears to be a useful element of judgement in differential diagnosis between adenoma and carcinoma of the adrenal glands.

Adenoma↗