Biomedical subjects

O De Divitiis

Publications and source records attributed to O De Divitiis.

At least 19 recordsLinked to original sources

PubMed2001

Inverse correlation of TRF1 expression and cell proliferation in human primary intracranial tumors.

BACKGROUND: The telomeric-repeat binding factor (TRF1) participates in a physiological homeostatic mechanism controlling cellular proliferative potential. TRF1 is involved in a negative feedback mechanism that allows telomere shortening by inhibiting the activity of telomerase. Down-regulation of TRF1 expression results in telomere elongation and may be involved in cell immortalization. The goal of the present study was to determine whether routine immunohistochemical (IHC) techniques can characterize TRF1 expression in different human brain tumor specimens and whether it correlates with other indices of brain tumor's proliferative potential. METHODS: A cohort of 20 flash-frozen surgical specimens [14 meningiomas and 6 anaplastic astrocytomas (AA)] were evaluated for TRF1 expression. Results of parallel investigations of tumor's proliferative indices as assessed by Ki67 labeling index (LI) determinations were cross-correlated with TRF1 expression results and histotype. RESULTS: We demonstrated variable levels of TRF1 expression in 12 out of 14 (87.5%) meningioma samples. By contrast, we detected no expression of TRF1 in tissue samples from AA (p=0.008). The Ki67 LI was higher in AA than in meningioma samples (15.21+/-9.34 vs 26.6+/-13.89, p=0.044). Statistical analysis revealed a significant inverse correlation between TRF1 expression, histotype, and LI (c2=14.1; p=0.0008). CONCLUSIONS: We demonstrated for the first time that routine IHC techniques are capable to identifying TRF1 expression in intracranial tumors. The results suggest that TRF1 is heterogeneously expressed in meningiomas, and absent in AA. The TRF1 status in intracranial tumors might be of prognostic value and possibly represent a potential application for biologically targeted therapeutic strategies.

Antibodies↗

PubMed1999

Anterior thoracic intradural arachnoid cysts. Case report and review of the literature.

Anterior thoracic intradural arachnoid cysts (ATIACs) are a rare cause of spinal cord and nerve root compression, for which different treatment strategies have been proposed. Although ATIAC represents a well-known clinical entity, the choice of surgical method has not been uniform, and no study has been specifically designed to compare the results of the different treatment options adopted. The authors report the case of a 40-year old man with a 1-year history of dorsal pain, weakness in the lower extremities, gait disturbance, and mild sexual and urinary dysfunction. On neurological examination spastic paraparesis, lower-extremity hypertonia, and hypesthesia below T-2 were demonstrated. Magnetic resonance imaging revealed the presence of an ATIAC at the T-2 level. The patient underwent complete microsurgical removal of the cyst. The authors conducted a Medline search of the relevant literature from 1966 to 1998 and also obtained data on other cases in which patients underwent surgical treatment of ATIAC. The literature search yielded five such cases. Treatment strategies were complete excision and fenestration followed by placement of a shunt. In addition, one case was characterized by intraoperative cyst rupture during retraction of the spinal cord. Correct preoperative workup coupled with microneurosurgical technique allow for successful removal of the lesion and excellent outcome. Based on the literature review and the results in our case, the complete excision of ATIAC is associated with an excellent outcome, which is different from results achieved using other surgical strategies.

Journal Article↗

PubMed1998

Neuropsychological outcome of operated cerebral aneurysms: prognostic factors on 148 patients.

OBJECTIVES: To analyse prognostic factors in patients operated upon for cerebral aneurysms. A previous investigation by our group showed that patients operated later than 10 days after bleeding have a worse neuropsychological prognosis, but the number of patients operated upon within 3 days was not sufficient. Here, a new sample of patients with early surgery is included in the analyses. MATERIAL AND METHODS: Patients numbered 148 (65 with ACoA, 39 with MCA, and 44 with PCoA aneurysms): 56 were operated within 3 days, 44 within 4-10 days, and 48 after at least 10 days from bleeding. A standardized battery of 13 neuropsychological tests was adopted: we considered both the number of defective scores and the average performance. RESULTS: Patients operated later than 10 days after bleeding had a worse prognosis than the 2 groups with early and intermediate surgery, which were not different. Aneurysm site was not relevant. Old age and low education were associated with a worse prognosis. Hunt and Hess scores at operation and post operation were also predictive of the outcome. CONCLUSION: On the whole, patients operated upon later than 10 days after bleeding have a less favourable prognosis than those with earlier operation timing.

Adolescent↗

PubMed1998

Provision of a neuroendoscopy service. The Southampton experience.

BACKGROUND: A series of 21 patients (aged 1 week to 80 years) underwent a total of 22 neuroendoscopic procedures in our Unit in the period July 1993 to January 1996. METHODS: The procedures were performed by one surgeon familiar with the technique using the Stortz rigid neuroendoscope system. The most common indication for neuroendoscopy was obstructive hydrocephalus. The most frequently performed procedure was third ventriculostomy and tumor biopsy. The intended surgical procedure was successfully performed in all but two of the cases (attempted septostomy and internal cyst drainage) were both abandoned due to unrecognisable anatomy. RESULTS: Of the 19 patients treated by fenestration or ventriculostomy to relieve hydrocephalus, 5 eventually required definitive shunting procedures. CONCLUSIONS: Complications relating directly to the neuroendoscopy occurred in 2 patients (bleeding requiring temporary external ventricular drain) and there were no surgical deaths.

Adolescent↗

PubMed1996

Anti-hypertensive effect of manidipine: 24 hours monitoring evaluation and Doppler-echocardiographic remarks.

In order to evaluate the antihypertensive effects of manidipine, at the dosage of 10 or 20 mg once daily, we studied 36 patients (12 males and 24 females, mean age 54.3 years) with mild hypertension. After a wash-out period of 2 weeks and another 2 week run-in period with placebo, all the patients were assigned to a treatment with manidipine 10 mg/ day. After 2 weeks of treatment, the non-normalized (diastolic BP > 90 mmHg) and the non-responders (BP fall < 10 mmHg) received an increase in dosage to 20 mg/day. The drug effects were assessed by casual blood pressure (BP) measurement at baseline and after 4, 8, 12, 24, 36 and 52 weeks. At baseline and after 1 year of treatment a 24-h BP monitoring and a Doppler echocardiogram were performed. Routine laboratory tests were performed at baseline, after 6 months and after 1 year of treatment. At the end of the observation period, both casual systolic (p < 0.01) and diastolic (p < 0.001) BP were significantly reduced; 24-h BP monitoring showed a significant decrease in systolic (p < 0.05) and diastolic (p < 0.01) pressure, systolic and diastolic (p < 0.001) daytime and night-time measurements. The peak to through ratio was 67%. No difference was found in heart rate. Reduced interventricular septum thickness (p < 0.05), increased fractional shortening (p < 0.02), reduced end-systolic stress (p < 0.005) and systemic vascular resistances (p < 0.001), and lower values of atrial filling fraction (AFF) (p < 0.001) after 1 year of treatment have been shown at the Doppler-Echo evaluation. A multilinear regression analysis showed a relation between delta %AFF and delta %24-h systolic BP (R = 0.74; F = 7.5: p < 0.05) and with delta % daytime systolic BP (R = 0.77; F = 9.2; p < 0.02). No abnormal changes were observed in laboratory tests. Three non-responder patients and three patients with adverse effects (1 flushing and 2 ankle oedema) dropped out and were excluded from the final analysis. In conclusion, manidipine at an individualized dose of 10 or 20 mg. was effective and safe in the management of arterial hypertension. Hemodynamic evaluations after 1 year of treatment confirmed an improvement of systolic and diastolic function, with an evident reduction of afterload.

Adult↗

PubMed1993

Cerebral blood flow velocity and systemic vascular resistance after acute reduction of low-density lipoprotein in familial hypercholesterolemia.

BACKGROUND AND PURPOSE: Low-density lipoprotein apheresis is currently used for the treatment of familial hypercholesterolemia, an inherited disorder of metabolism associated with premature development of cardiovascular disease. We wanted to evaluate cerebral blood flow velocity, cardiac output, and systemic vascular resistance in patients with familial hypercholesterolemia before and after low-density lipoprotein apheresis. METHODS: Ten patients (age range, 14 to 46 years; 4 males, 6 females) with familial hypercholesterolemia (8 homozygotes, 2 heterozygotes) and 10 healthy control subjects of comparable age and sex distribution participated in the study. Low-density lipoprotein apheresis by dextran sulfate was performed in 8 patients (7 homozygotes, 1 heterozygote). Six patients (4 homozygotes, 2 heterozygotes) underwent a procedure of extracorporeal erythrocyte filtration with the same extracorporeal volume as for low-density lipoprotein apheresis, but with the exclusion of the passage of plasma through the dextran sulfate column. Cerebral blood flow velocity (transcranial Doppler), cardiac output, and systemic vascular resistance (electric bioimpedance cardiography) were determined by noninvasive techniques before and 1 day and 7 days after low-density lipoprotein apheresis or extracorporeal erythrocyte filtration. Plasma and blood viscosities were measured at the same time. RESULTS: Before apheresis, mean and diastolic cerebral flow velocities were abnormally low in hypercholesterolemic patients (P < .01 and P < .02 vs healthy control subjects, respectively). After apheresis, low-density lipoprotein cholesterol was lowered by 40% to 60% from baseline, and cerebral blood flow velocities (mean, systolic, and diastolic velocities) were increased (P < .01). Cardiac output, systemic vascular resistance, and viscosity values were not significantly modified. Extracorporeal erythrocyte filtration (without passage of plasma through the dextran sulfate column) did not modify serum lipids, hemodynamic parameters, or viscosity values. CONCLUSIONS: Low-density lipoprotein apheresis produces potentially useful hemodynamic effects. They are not adequately explained by changes in blood viscosity alone and might reflect a restoration of endothelium-mediated vasodilation, which is inhibited by high concentrations of low-density lipoprotein.

Adolescent↗

PubMed1992

Antihypertensive effects of verapamil, captopril and their combination at rest and during dynamic exercise.

In order to investigate the antihypertensive effects of verapamil (CAS 52-53-9) and captopril (CAS 62571-86-2), administered alone or in combination therapy, the blood pressure and heart rate effects of these two drugs at rest and during dynamic exercise were evaluated in a double blind study in 30 moderate or severe essential hypertensive patients. After a 30-day placebo wash-out period, 15 patients (age 60.6 +/- 8.0 years, mean +/- SD) were allocated to verapamil sustained-release treatment (120 mg b.i.d. for the first month of therapy and 240 mg b.i.d. for the second one) and 15 patients (age 58.4 +/- 10.0 years) to captopril treatment (25 mg b.i.d. and 50 mg b.i.d. for the first and second month of therapy, respectively). At low dosage both verapamil and captopril significantly (p less than 0.001) and markedly reduced blood pressure values. Goal diastolic blood pressure of 90 mmHg was achieved in 40% and 20% of patients in the verapamil group and in the captopril group, respectively, at high dosage. In contrast to captopril, verapamil induced a significant and dose-dependent heart rate reduction and markedly attenuated the pressor and tachycardiac responses to dynamic exercise. The combination of verapamil 240 mg b.i.d. plus captopril 50 mg b.i.d. was then administered to patients, whose blood pressure was not satisfactorily controlled by monotherapy. This regimen allowed a better blood pressure control both at rest and during exercise than on monotherapy and induced a complete blood pressure normalization in 62% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1987

Hemodynamic hypertrophied left ventricular patterns in systemic hypertension.

The hemodynamic pattern of hypertrophied left ventricle in systemic hypertension was studied by M-mode echocardiography in 42 untreated hypertensive patients with left ventricular (LV) mass index greater than 2 standard deviations from the sex-specific mean of 114 normal subjects (normal values of our laboratory), and in 45 normotensive volunteers. Hypertensive patients showed cardiac dimensions, relative diastolic wall thickness, ratio of systolic pressure to end-systolic dimension, cardiac index and stroke index greater than normotensive control subjects (0.01 less than p less than 0.0001). Pressure/dimension ratio was correlated to relative wall thickness (p less than 0.005). End-systolic stress/volume ratio was normal as was systolic pressure to dimension ratio normalized for end-diastolic wall thickness. LV hypertrophy was concentric in 26% and eccentric in 74% of patients and suggested 2 different heart adaptations to overload: eccentric hypertrophy was associated with increased cardiac dimensions, high peak stress, normal systolic function and moderately increased LV contractility; concentric hypertrophy was associated with the highest blood pressure values, normal cardiac dimension, normal peak stress, normal systolic function and much increased LV contractility. Because stress/volume ratio and wall thickness-corrected systolic pressure/dimension ratio were normal in hypertensive patients, LV contractile capacity might be supported by the increase in myocardium available for contraction, rather than by increase in inotropic state.

Adult↗

PubMed1987

Bisoprolol in the treatment of angina pectoris: a double blind comparison with verapamil.

In order to verify the anti-ischaemic effect of a new beta-blocking agent, bisoprolol, a double blind parallel groups trial was carried out in comparison with verapamil. 26 patients with a history of spontaneous and/or effort angina were studied. After a two-week treatment with placebo, they were randomized in two groups. One group was treated for 4 weeks with bisoprolol 10 mg o.d. and for the following 4 weeks with bisoprolol 20 mg o.d. The other group received verapamil 80 mg t.i.d. for the first 4 weeks and 120 mg t.i.d. for the remaining 4 weeks. Throughout the study isosorbide dinitrate 20 mg b.i.d. was administered and sublingual nitroglycerin was allowed when necessary. 21 patients completed the study. Both bisoprolol and verapamil significantly reduced the number of angina episodes and nitroglycerin tablets consumption, as well as ischaemic episodes recorded on Holter ECG. The total number and severity of ectopic ventricular beats were reduced too. On multistage treadmill exercise test, both drugs increased effort time and time to ST depression = 1 mm, and reduced ST depression and double-product. The effect of bisoprolol on double product was greater than that of verapamil because of the better control of heart rate. The relationship ST/double product suggested that beta-blockers act essentially through the reduction of myocardial oxygen consumption and verapamil possibly with an additive effect on coronary circulation. Radionuclide ventriculography showed no deterioration of rest ventricular function with both drugs. In conclusion, bisoprolol and verapamil showed a satisfactory anti-ischaemic effect, with good tolerability.

Adult↗

PubMed1983

Indapamide and atenolol in the treatment of hypertension: double-blind comparative and combination study.

Fifteen out-patients with moderate hypertension were randomly and sequentially treated with atenolol, indapamide and a combination of the two drugs after a wash-out period of at least 1 week and a 2-week placebo run-in period. The duration of treatment was 4 weeks in each case. The dosage was 2.5 mg indapamide and 100 mg atenolol, in single tablets which were taken at 11.00 hours. All the treatment regimens produced a highly significant (p less than 0.001) reduction in systolic and diastolic, supine and standing blood pressure; these reductions were not significantly different for the single drugs but were significantly greater for the combined therapy. The number of patients reaching the end-point of a diastolic blood pressure of 95 mmHg or less was the same with either atenolol or indapamide, i.e. 7 (46.6%), but was greater with the combined therapy, i.e. 10 (66.6%). A significant (p less than 0.001) reduction in pulse rate was observed with the treatments involving atenolol. Acceptability of the treatments was very good; the number of volunteered and elicited complaints during the different treatments being less compared to the placebo period, particularly for the combined treatment. No significant difference was observed in the blood biochemistry tests. The results are discussed in light of the mechanisms of action of the two drugs, which seem well integrated with each other, and the duration of the antihypertensive effect, which allows a single administration with consequent good treatment compliance.

Adult↗

PubMed1980

[Early diagnosis of a case of Löffler's eosinophilic endomyocardiopathy: clinical and hemodynamic findings (author's transl)].

A case of hypereosinophilic syndrome showed clinical and hemodynamic signs of Löffler's endomyocardiopathy. The case is peculiar because of the young age, the early diagnosis, the lack of clinical and hemodynamic signs of heart failure. Some peculiarities: an apical diastolic murmur and a diastolic pulmonary capillaries/left ventricle pressure gradient recalled the picture of mitral stenosis, but the echocardiographic pattern of mitral valve was normal; a sistolic aortic and pulmonary subvalvular gradient, with an increase in ventricular wall thickness, was present. Echocardiography, systolic time intervals, and maxdp/dt and Vmax showed a very good left ventricular function. The patient is still in good compensation, with unchanged clinical pattern and eosinophilia, despite the therapeutical attempt with corticosteroids and antiallergic drugs, after one year from the diagnosis. The pathogenetic hypothesis of this cardiac and hematologic disorder are discussed.

Adult↗

PubMed1972