Biomedical subjects
Publications and source records attributed to N Spagnolo.
The authors present their experience with breast augmentation using endoscopy. They use an axillary approach to insert inflatable breast implants above the pectoralis muscle. The advantages of this method are that it is more comfortable to the patient, recovery is faster, it leaves no scars on the breasts, and there is no change in sensation.
A rat model of chronic staphylococcal osteomyelitis was developed. Fibrin glue (5 microliters) and Staphylococcus aureus (2 x 10(6) CFU/5 microliters) were inoculated into the proximal metaphysis of the tibia. The rats were killed at intervals of between 1 and 6 months, and the tibias were removed. Induced lesions were evaluated by radiographic, macroscopic, and histological examinations and bacterial counts. Roentgenograms revealed osteomyelitis in more than 90% of the tibias. Gross bone pathology revealed skeletal deformation, new bone formation, abscesses, and draining skin fistulas in more than 80% of cases. Histological examination revealed osteomyelitis in more than 90% of cases, and bacterial counts were positive in 86% of cases. Only fibrin glue (5 microliters) was inoculated into controls. Controls showed no osteomyelitic lesions, and counts were negative in seven of eight control tibias. The main feature of this model is the use of fibrin glue instead of the sclerosing agents and foreign bodies used in other models. The model reproduces lesions similar to those of human posttraumatic osteomyelitis and can be reliably used in pathophysiological and therapeutic studies.
An in vitro study assessing the kinetics of drug release from antibiotic-fibrin seal compounds and the antibacterial efficacy of the delivered drug has been performed. Antibiotic sensitivity and the amount of drug released was measured by means of agar diffusion test. Standard and experimental curves were established for each antibiotic and each bacterial test in order to evaluate the quantities of the drug released during each 24 h period. The reconstitution of lyophilized human fibrin with an aqueous solution containing an antibiotic resulted in only minor modification of the clotting process, with the exception of those solutions containing cefotaxim and mezlocillin which failed to clot altogether and were excluded from further study. The evaluation of the kinetics of elution of the antibiotics from the fibrin clots showed that all of the antibiotics had been almost completely released by 96 h. The delivered amount of each drug was enough to maintain the Minimal Inhibitory Concentration (MIC) until the 4th day of culture for the most of antibiotics, resulting in a prolonged release of the drug.
Plasma atrial natriuretic factor, aldosterone, renin activity, and antidiuretic hormone were studied in low output heart failure syndromes: cardiogenic shock in ten patients with acute myocardial infarction of the anterior wall (first group), hypovolemic shock after melena from peptic ulcer in ten subjects (second group), and hypotension with bradycardia syndrome in ten patients with acute myocardial infarction of the inferior wall (third group). Circulating atrial natriuretic factor in patients with cardiogenic shock (102.4 +/- 7.4 pg/ml) was significantly higher than in healthy volunteers matched for sex and age (8.4 +/- 0.3 pg/ml). In these patients there was a positive correlation between atrial natriuretic factor and central venous pressure values. Atrial natriuretic factor and central venous pressure values in the second and third groups were within normal range. Plasma aldosterone was high in all groups, plasma renin activity was elevated in the first and third groups, and high antidiuretic hormone was observed in the first and second groups. These findings indicate that in low output heart failure syndromes only hemodynamic changes affecting the atria stimulate atrial natriuretic factor release. No correlations were found between plasma atrial natriuretic factor and other hormones. In particular, high atrial natriuretic factor levels in the patients with cardiogenic shock did not inhibit release of aldosterone, renin, or antidiuretic hormone. It may be surmised that in these patients the hemodynamic effects override the inhibitory effects of atrial natriuretic factor.
Plasma atrial natriuretic factor (ANF), renin activity (PRA), aldosterone and antidiuretic hormone (ADH) were determined in 16 patients with uncomplicated acute myocardial infarction (AMI) for 7 days in all patients and in six patients for 8 more days. Echocardiograms were performed and central venous pressure (CVP) was measured on the 2nd, 7th and 15th days. On admission, plasma ANF was higher in patients with AMI (129.8 +/- 70.6 pg ml-1, mean +/- SD) than in healthy volunteers (50.6 +/- 10.0 pg ml-1) (P less than 0.05). Arterial pressure, heart rate, CVP were normal. Left atrial (LAD) and left ventricular diameters (LVDD) were increased in six patients. Ejection fraction (EF) was reduced in all. A significant inverse relationship between ANF and EF was observed. Patients with EF less than or equal to 45%, high LAD and LVDD had the highest plasma ANF and showed steady high plasma ANF for 15 days. Patients with EF greater than 45%, normal LAD and LVDD had elevated plasma levels only for 10 days, rising significantly on days 3-7 after admission. PRA and ADH values were normal throughout the study, whereas aldosterone was above the normal range only on admission. These findings suggest that the reduction in myocardial contractility induced by the infarction may account for the rise in ANF secretion via increased left atrial pressure or left atrial dilatation.
The aim of this paper was to study atrial natriuretic factor, plasma renin activity and antidiuretic hormone values during paroxysmal atrial arrhythmias with different ventricular rates before and after pharmacological cardioversion and during chronic atrial flutter-fibrillation. The study was carried out: 1) during acute arrhythmias (atrial flutter-fibrillation or supraventricular tachycardia) and after restoration of normal sinus rhythm in 2 patients without heart disease, in 13 with chronic heart disease and in 6 with acute myocardial infarction; 2) during chronic atrial flutter-fibrillation in 5 patients with chronic ischemic heart disease, without congestive heart failure. Atrial natriuretic factor, aldosterone, plasma renin activity and antidiuretic hormone values were measured by radio-immunoassay. During paroxysmal atrial arrhythmias atrial natriuretic factor levels were higher than normal in all patients, particularly in those with supraventricular tachycardia. Most of the aldosterone measurements were above the normal range. As far as plasma renin activity and antidiuretic hormone values are concerned, levels higher than the normal range were found in the patients with severe hemodynamic impairment. Central venous pressure was above normal in all patients except in the 2 without heart disease, and there was a positive correlation between atrial natriuretic factor and central venous pressure values. After restoration of normal sinus rhythm atrial natriuretic factor values returned to normal except in acute myocardial infarction patients, in 1 chronic ischemic heart disease patient with congestive heart failure and in 3 patients with mitral valve disease. In all patients with chronic atrial flutter-fibrillation and in 5 patients with acute atrial flutter-fibrillation and low rate, above normal atrial natriuretic factor values were found with normal central venous pressure values. Atrial distension due to high central venous pressure values, lack of atrial contraction and rhythmic detension of the atrial stretch receptors, may be considered the major stimuli responsible for atrial natriuretic factor release during acute paroxysmal atrial arrhythmias and atrial flutter-fibrillation with low ventricular rate, respectively.
The aim of this paper was to study plasma atrial natriuretic factor, renin activity, aldosterone and antidiuretic hormone in low-output heart failure syndromes such as cardiogenic shock, hypovolemic shock and hypotension with bradycardia syndrome. A total of 30 patients were investigated: 10 with cardiogenic shock due to acute myocardial infarction of the anterior wall (systolic and diastolic blood pressure 56.0 +/- 3.7/40.5 +/- 2.0 mmHg; heart rate 119.7 +/- 1.2 beats/min; central venous pressure 16.2 +/- 0.6 cmH2O) (I group), 10 with hypovolemic shock induced by melena in peptic ulcer (systolic and diastolic blood pressure 74.5 +/- 1.5/57.5 +/- 1.7 mmHg; heart rate 111.0 +/- 1.4; central venous pressure 6.3 +/- 0.5 cmH2O) (II group), 10 with hypotension with bradycardia syndrome which occurred in patients during acute myocardial infarction of the inferior wall (systolic and diastolic blood pressure 71.9 +/- 2.0/58.0 +/- 2.6 mmHg; heart rate 52.0 +/- 2.2 beats/min; central venous pressure 4.6 +/- 0.4 cmH2O) (III group). Plasma atrial natriuretic factor values were measured using radioimmunoassay after chromatographic pre-extraction; plasma renin activity, aldosterone and antidiuretic hormone values were calculated using radioimmunoassay. Circulating atrial natriuretic factor was significantly (p less than 0.01) higher in patients with cardiogenic shock (102.4 +/- 7.4 pg/ml) than in healthy volunteers (8.4 +/- 0.3 pg/ml). In the former there was a positive correlation between atrial natriuretic factor and central venous pressure values. Atrial natriuretic factor and central venous pressure values in the IInd and IIIrd groups of patients were in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
The aim of the present study is to evaluate the real need and the sensitivity of serum myoglobin levels as an early index for the diagnosis of acute myocardial infarction. A total of 62 patients (38 suffering from acute myocardial infarction, 16 from "angina pectoris", 8 from heart failure) and 20 healthy volunteers were included in the study. The patients with acute myocardial infarction were divided in 3 subgroups according to the time passed between the beginning of the pain and their admittance to our Department (Coronary Care Unit), that was, less than 6 hours, between 6 and 12 hours, between 12 and 24 hours. Among the patients with "angina", 8 presented spontaneous crisis whereas 4 had crisis only during treadmill test. 8 of the healthy volunteers received intramuscular injections of physiological solution every 12 hours during the 3 days preceding the study. In all subjects serum myoglobin level were measured by radioimmunoassay; in patients with acute myocardial infarction serum CK and MBCK levels with enzymatic method were measured too. No variation of plasma myoglobin levels was seen in patients with angina, neither in healthy volunteers had they received or not intramuscular injections. The low increase in plasma myoglobin levels observed in patients with heart failure might be due to a deficit of renal function. Serum myoglobin levels were significantly elevated in all the patients with acute myocardial infarction, whereas plasma CK and MBCK levels were significantly high only 6 hours after the necrosis. In myocardial infarction the levels of myoglobin rise during the first hours, peak at 10 hours and return to normal in 20 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
We investigated the factors able to stimulate (hormones, drugs, fluid volume changes and prostaglandin precursors) or inhibit (NSAIDs) renal prostaglandin synthesis. We then assessed the effects of NSAIDs on: A) the efficacy of certain drugs (furosemide, ACE-inhibitors), whose action is mediated by a stimulation of prostaglandin synthesis; B) the physiopathology of cardiovascular diseases such as myocardial infarction and heart failure, in which renal and circulatory output is reduced; C) arterial hypertension.
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The results of a study on the incidence of nosocomial infections in a 1800 bed University hospital are reported. The study, carried out over a 9 months period, included: continuous microbiological surveillance, and a clinical and epidemiological survey. On the basis of the microbiological data collected and analyzed by a computer data system, developed and employed for the control of nosocomial infections, a weekly bed-to-bed survey was carried out by the staff of the Institute of Infectious Diseases. Among 2777 suspected nosocomial infections, as revealed by microbiological monitoring, 701 were confirmed after the bed-to-bed survey. The nosocomial infection rate was 6.75 per 100 discharges. It was higher in the surgical than in the medical wards (7.3 and 6 per 100 discharges, respectively). Nosocomial urinary tract infections were the most frequent (74.2%). The urinary infection rate was higher in the surgical than in the medical wards (5.3 and 4.6 per 100 discharges, respectively). Escherichia coli (19.4%), Pseudomonas aeruginosa (19.3%), Proteus spp. (18.4%) were the pathogens most frequently associated with nosocomial infections. They were followed by Klebsiella pneumoniae (7.8%) and Staphylococcus aureus (6.5%) in frequency. Among the risk factors, involved in nosocomial infections, the importance of catheterization was confirmed: among our patients with nosocomial urinary tract infections, 73.4% and 79.5%--in the medical and surgical wards, respectively--underwent urological instrumentation, mainly catheterization. An analogous and more detailed study is now in progress and will be extended in the next years.
An investigation was made into the antibacterial activity in vitro of CMW cement and antibiotic mixtures. The results of this study are reported and the risk factors are discussed. On the basis of our studies, the use of this mixture in clinical practice would appear to be premature.
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A study of the in vitro antibacterial activity of a new aminoglycoside, sisomicin, is reported. The results show no significant differences between the activity of sisomicin and gentamicin.
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