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Biomedical subjects

N Virgili

Publications and source records attributed to N Virgili.

At least 19 recordsLinked to original sources
PubMed2003

Plasma urea-cycle-related amino acids, ammonium levels, and urinary orotic acid excretion in short-bowel patients managed with an oral diet.

BACKGROUND AND AIMS: The small intestine contains several enzymes involved in arginine synthesis and converts glutamine to citrulline, the major compound for endogenous arginine synthesis. This study was conducted to assess the plasma status of urea-cycle intermediates and orotic urinary excretion in short-bowel patients. METHODS: Thirteen stable short-bowel syndrome patients (7 men; 60.2+/-15.2 years) were studied. Patients were divided into moderately resected (Group A; n=6) and severely resected (Group B; n=7) according to their remnant bowel length (Group A: 61-150 cm; Group B: < or =60 cm). All subjects were consuming an oral diet plus dietetic supplements. Plasma urea-cycle amino acids, ammonium and urinary orotic acid were determined. RESULTS: Plasma glutamine levels were significantly higher in both patient groups than in the control group (P<0.001). Regarding citrulline, Group B levels were significantly lower vs. controls (P<0.001). Comparisons between patient groups showed higher arginine in Group A (P<0.05) and non-statistically lower citrulline in Group B. Blood ammonium and orotic urinary excretion were normal. CONCLUSIONS: Although plasma citrulline and glutamine alterations were found, patients showed no hyperammonemia or orotic aciduria, which suggests a certain degree of adaptation in arginine and related amino acid metabolism, when an adequate dietary supply of arginine is provided.

Adult↗
PubMed2001

Do corticosteroids add any benefit to standard GVHD prophylaxis in allogeneic BMT?

In a retrospective study, we compared 15 patients who received cyclosporine (CsA), methotrexate (MTX) and prednisone (PDN) and 15 patients who received CsA-MTX for GVHD prophylaxis after allogeneic BMT (HLA-identical sibling (n = 22), related one HLA mismatch (n = 1), unrelated matched donors (n = 6), unrelated one HLA mismatch (n = 1)). The primary objectives of this study were to compare the incidence of GVHD and post-transplantation complications. Secondary objectives were to compare relapse rate, transplant-related mortality and overall survival. The incidence of acute GVHD grade III-IV was similar between the two groups (P = 0.66), as was the incidence of chronic GVHD (P = 0.67). Incidence of arterial hypertension was significantly higher in patients who received prophylactic PDN, (P = 0.03) and more insulin treatment was required in this group (P = 0.003). We observed no differences in the incidence of infections or upper digestive tract bleeding. Musculoskeletal complications appeared earlier in the group which received PDN. With a median follow-up of 4.4 years, patients in the CsA-MTX group had better overall survival, 46.7% vs 13.3% (P = 0.026). Relapse was a more frequent cause of death in the CsA-MTX group, whereas procedure-related mortality was more frequent in the CsA-MTX-PDN group (P = 0.013). These results suggest that prophylactic prednisone when combined with cyclosporine and methotrexate adds no benefit in acute or chronic GVHD prevention and may increase the morbidity of allogeneic transplantation. Corticosteroids may be reserved for GVHD treatment.

Adolescent↗
PubMed2001

Serum albumin as indicator of clinical evolution in patients on parenteral nutrition. Multivariate study.

BACKGROUND AND AIMS: The aim of this study is to establish whether serum albumin concentration at the beginning of parenteral nutrition is related to morbidity and mortality. METHODS: In this cohort study spanning four years, a number of patients were classified into twelve groups, depending on their clinical status at the beginning of parenteral nutrition. Their serum albumin concentration and other clinical parameters were then measured and twelve multiple logistic regression models were thus generated in order to model the relationship between initial albumin concentration and risk of morbidity/mortality. RESULTS: 1953 (84%) of the 2321 patients studied were hypoalbuminemic. In six models, this condition was associated with a significant increase in the risk of nosocomial infection. However, no model could be associated to significant risk of renal failure, and only patients with previous hepatopathy were at risk for hepatic failure. In seven models, there was a significant increase in mortality. CONCLUSIONS: Serum albumin concentration at the beginning of parenteral nutrition is related to mortality and morbidity associated with nosocomial infection in some groups of the study.

Biomarkers↗
PubMed2000

Serum leptin concentrations in patients with short-bowel syndrome.

BACKGROUND: Short-bowel syndrome is a state of severe malabsorption resulting from absence or removal of the small bowel for several causes. A number of short-bowel patients develop hyperphagia. Leptin, a protein secreted from adipose tissue, signals the amount of energy stores to the brain. OBJECTIVE: To study body composition and leptin regulation in short-bowel patients and to determine whether or not leptin concentrations are linked with hyperphagia. DESIGN: We studied 25 short-bowel patients (remnant bowel less than 150 cm) and 31 controls and 10 oral nutrition. Fifteen patients received total parenteral nutrition and 10 oral nutrition. Anthropometric measurements, body composition (by bioelectrical impedance), and cholesterol, triacylglycerol and leptin concentrations were studied in all subjects. RESULTS: There were no differences between short-bowel patients and controls in anthropometric variables, body composition, or leptin concentrations. Leptin concentrations were higher in short-bowel women than men (9.21+/-8.54 vs. 3.22+/-1.86 ng/ml, P=0.01). Leptin concentrations correlated positively with age (r=0.4, P=0.045), body mass index (r=0.52, P=0.007), fat mass (r=0.67, P=0.001) and body fat (r=0.68, P=0.0001); there were no correlations with other body composition parameters. We found no correlations between parenteral or oral nutrition and body composition parameters, or between leptin concentrations and the presence of hyperphagia. Logistic regression analysis showed that body fat correctly identified leptin concentrations in 60% of patients. CONCLUSIONS: Body composition, leptin concentrations and leptin regulation in patients with short-bowel syndrome are similar to those of controls. Leptin concentrations do not correlate with hyperphagia in short bowel-patients.

Adipose Tissue↗
PubMed1999

[Home enteral nutrition].

Enteral nutrition in the home is applied to stabilized patients who do not require hospitalization or to chronically ill patients who can stay in their homes. However, ensuring the correct administration of this treatment requires a coordinated, expert multidisciplinary team. This article reviews the conditions for use of enteral nutrition in the home, the means of access, the nutritional formulas, the administrative technique, and the complications enteral nutrition in the home may present. Furthermore, the composition and characteristics of the multidisciplinary team which will be in charge of carrying out this treatment is discussed.

Community Health Nursing↗
PubMed1997

Evaluation of immune markers in asymptomatic AIDS patients receiving fish oil supplementation.

The effects of oral fish oil (FO) supplementation (8 g/day, capsules) on nutritional status and selected immune markers (CD4/CD8 ratio, IL-1beta, erythrocyte MDA release, dehydroepiandrosterone sulfate [DHEA-S]) were studied in a homogeneous group of asymptomatic HIV-infected patients during 6 weeks. All subjects were classified clinically as A2 according to the CDC revised criteria (mean CD4 count 290 +/-123 cells/mm(3)) and were receiving zidovudine retroviral treatment. The calculated mean energy intake was 3437 +/- 372 Kcal/d, composed of 14% protein, 38% lipids and 48% carbohydrates, and was not modified during the study. The anthropometric parameters, and hematological and plasma biochemistry data showed non-significant changes after FO supplementation. Mean malonyldialdehyde (MDA) release before treatment was: unstimulated 71.5 +/- 37 and stimulated 350.9 +/- 79.8 nmol/g Hb. After FO supplementation (T(6)) MDA release showed unstimulated values of 96.1 +/- 62, and a significant increase after stimulation of 614.1 106.4 nmol/g Hb, which was, however, within the normal range. In the patient's samples, IL-1beta levels in the unstimulated blood culture showed a statistical increase with respect to the normal range before (T(0)) and after (T(6)) FO supplementation with a slight decrease after (mean 49.8 vs 40.9 pg/ml). The stimulated IL-1beta levels after treatment showed a statistically significant decrease that was maintained within the normal range (T(0): 797.7 vs T(6): 535.6 pg/ml). Taken collectively, these results suggest a tendency toward improvement in immune function.

Journal Article↗
PubMed1992

Growth hormone response to thyrotropin-releasing hormone in acromegalic patients: reproducibility and dose-response study.

The aim of the study was to analyze 14 consecutive patients with active acromegaly who had not undergone any therapy, the dose response of growth hormone (GH) to thyrotropin-releasing hormone (TRH), the existence of reproducibility of such response as well as to rule out the possibility of spontaneous fluctuations of GH which would mimic this response. On several nonconsecutive days, we investigated the GH response to saline serum, 100, 200 (twice) and 400 micrograms of TRH administration. We also studied both basal serum prolactin, serum prolactin after TRH administration and thyrotropin values. Our results show an absence of GH response after saline serum infusion, whereas after TRH doses, 36.3 42.8 and 45.4% positive responses were obtained, respectively. All GH responders were concordant to the different doses administered. The mean of GH concentrations of the different doses at different times did not reach significant differences. The response to the administration of the same dose brought about a significative increase, although it was not identical. It demonstrated a progressive increase of the area under the response curve, as did the means of increments after each TRH administration, albeit without reaching statistical significance. Between the GH-responding and GH-nonresponding groups there were no differences in either basal serum prolactin or serum prolactin and thyroid-stimulating hormone levels after TRH stimulation. The present study clearly shows that TRH elicits serum GH release from GH-secreting pituitary tumors. The response was reproducible in qualitative terms rather than quantitative, and no dose-response relationship was found between the TRH concentrations and the amounts of GH secreted.

Acromegaly↗
PubMed1991

[Thyroid dysfunction induced by amiodarone in Catalonia. Prevalence and characteristics].

The purpose of this study was to review the epidemiological aspects and the characteristics of the thyroid disfunction produced by amiodarone in Catalonia, an area with type I endemic goiter. For this purpose, three groups of patients have been studied: 1) 102 patients with prolonged amiodarone treatment, out of whom 6 (5.9%) presented hyperthyroidism, and 2 (1.9%) hypothyroidism. 2) 909 patients with hyperthyroidism of any origin out of which 42 (4.6%) were produced by amiodarone. 3) 203 patients presenting primary hypothyroidism of any origin out of which 11 (3.8%) were induced by amiodarone. Out of the 48 patients with amiodarone induced hyperthyroidism, 16 presented multinodular goiter, 2 toxic thyroid goiter and 7 Graves Basedow disease. Thyroid uptake of 131I was studied in 10 cases being normal or increased in six of them, all with a underlaying thyroid pathology. Out of the 13 patients with amiodarone induced hypothyroidism, 3 presented diffuse goiter; thyroid uptake of 131I was studied in 5 patients, being normal or increased in 4 cases, 2 of which with thyroid pathology. Amiodarone administration very often produces thyroid disfunction, specially hyperthyroidism. These patients with hyperfunctional thyroids usually present underlying thyroid pathologies in which thyroid uptake of 131I are frequently not suppressed as well as in those patients in whide amiodarone induced hypothyroidism.

Adolescent↗
PubMed1989

[Study of thyroid function parameters and thyrotropin in general non-thyroid diseases].

The changes in the parameters of thyroid function and thyrotropin (TSH) have been evaluated in 5 groups of patients with general non-thyroid disease (GNTD): acute severe bacterial infection (16 patients), acute myocardial infarction (22 patients), diabetic ketoacidosis (24 patients), non-ketotic hyperosmolar decompensation (8 patients), protein-calorie undernutrition (12 patients), without associated conditions or drug therapies that might have modified the thyroid hormones. These patients were evaluated at the beginning of their GNTD and after recovery. Thyroxine (T4), triiodothyronine (T3) and reverse T3 (rT3) were measured by radioimmunoassay (RIA), the TBC index by competitive analysis, the free T4 by a labeled T4 analogue and T4 by immunoradiometric analysis (IRMA). In all patients similar changes in thyroid hormones and in IRMA were found, and they returned to normal after recovery; the changes were most marked in diabetic ketoacidosis, followed by hyperosmolar decompensation and by undernutrition. When the 5 groups were evaluated together, T3 was the most commonly low value (57.3%), followed by T4 and TBC index (26.8%), free T4 (20.7%) and the free T4 index (10.9%). The level of rT3 was increased in 39% of cases. Baseline TSH was, initially, 1.05 +/- 1.05 microU/ml, and 1.36 +/- 0.85 microU/ml after recovery (p less than 0.001). It was only found to be suppressed in one patient (a female with diabetes mellitus and Graves disease); in 17 cases it had borderline values between 0.1 and 0.4 microU/ml, and in the remaining patients it was normal. GNTD induces profound changes in the thyroid functional parameters, with reductions below their normal range, including the analogue measured T4 and low TSH.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

Transient hypothyroidism after iodine-131 treatment of Graves' disease.

One hundred twenty six patients with Graves' disease, 26 with toxic multinodular goiter, and 18 with toxic adenoma were treated with 131I (3-15 mCi), and followed at monthly intervals for six months. Transient hypothyroidism occurred at two months in 22 patients with Graves' disease. In this state TSH levels became elevated in seven patients, but were normal or suppressed in seven. In 17 patients T4 and T3 levels returned to normal without T4 replacement. Five patients developed recurrent thyrotoxicosis, and required repeated doses of 131I. The possibility of transient hypothyroidism in the early months after 131I therapy in Graves' disease should be borne in mind.

Adult↗
PubMed1989

[Thyroid function parameters and TSH in patients treated with anticonvulsant drugs].

Several antiepileptic drugs change the serum levels of thyroid hormones by different mechanisms, of these diphenylhydantoin being the most known. This study was carried out on 96 patients in order to analyse the effects of long-term treatment with phenobarbital (N = 29), carbamazepine (N = 21), sodium valproate (N = 11), diphenylhydantoin (N = 6) and a combination of them all at therapeutic doses. We observed a decrease of T4 seric levels and free T4 index (in 25 and 14 patients respectively, under normal levels) free T4 normal, T3 normal, decreased rT3, and normal TSH in all groups being more noticeable in patients treated with diphenylhydantoin, carbamazepine, phenobarbital and lastly, sodium valproate. It is a different situation from a general non-thyroid disease, where there is a decrease of T3 and where the antiepileptic drugs of different chemical structure induce changes in seric levels of thyroid hormones. The basal TSH is the best measurement to reflect the euthyroidism of these patients.

Adolescent↗