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Biomedical subjects

P Fusco

Publications and source records attributed to P Fusco.

At least 19 recordsLinked to original sources
PubMed2002

Intraoperative fetal oxygen saturation during Caesarean section: general anaesthesia using sevoflurane with either 100% oxygen or 50% nitrous oxide in oxygen.

BACKGROUND AND OBJECTIVE: The study was designed to evaluate whether the administration of sevoflurane in 100% oxygen for anaesthesia during Caesarean section would improve fetal and neonatal oxygenation compared with the administration of sevoflurane with 50% nitrous oxide in oxygen. METHODS: The randomized, single-blind controlled study examined 24 mothers, ASA I-II, at term undergoing Caesarean section who were allocated to receive sevoflurane in either 100% oxygen (n = 13) or 50% nitrous oxide in oxygen (n= 11). General anaesthesia was induced in both groups with thiopental 4-5 mg kg(-1) followed by succinylcholine 1.5 mg kg(-1) to facilitate tracheal intubation. Parturients received sevoflurane given either in 100% O2 or in a 50:50 nitrous oxide and oxygen mixture, using 0.5-1.0% progressive incremental dosing up to 1.5-2.0 MAC. Non-invasive fetal oxygen saturation was measured between induction to delivery, and umbilical artery and vein PaO2 were evaluated at birth. RESULTS: Intraoperative fetal oxygen saturation increased in all patients after maternal 100% oxygen administration (P < 0.01). Maternal hyperoxygenation significantly increased the umbilical vein and umbilical artery PaO2 and the umbilical artery SaO2 at birth (P < 0.0001). CONCLUSIONS: Maternal hyperoxygenation significantly improves fetal as well as neonatal oxygenation.

Adult↗
PubMed1999

Relative potencies of bupivacaine and ropivacaine for analgesia in labour.

We have used the technique of randomized, double-blind sequential allocation to compare the minimum local analgesic concentrations (MLAC) of epidural bupivacaine and ropivacaine for women in the first stage of labour. The test bolus was 20 ml of local anaesthetic solution. The concentration was determined by the response of the previous woman to a higher or lower concentration of local anaesthetic, according to up-down sequential allocation. Efficacy was assessed using a 100-mm visual analogue pain score (VAPS). The test solution had to achieve a VAPS of 10 mm or less to be judged effective. For bupivacaine, MLAC was 0.093 (95% CI 0.076-0.110)% w/v, and for ropivacaine, 0.156 (95% CI 0.136-0.176)%w/v (P < 0.0001, 95% CI difference 0.036-0.090). The analgesic potency of ropivacaine was 0.60 (0.47-0.75) relative to bupivacaine. Claims for reduced toxicity and motor block must be considered with differences in analgesic potency in mind.

Adult↗
PubMed1998

Minimum local analgesic concentration of extradural bupivacaine increases with progression of labour.

We have used the technique of double-blind sequential allocation to quantify the minimum local analgesic concentration (MLAC) of extradural bupivacaine for women in early (median cervical dilatation 2 cm) and late (median cervical dilatation 5 cm) labour. The first bolus was 20 ml of the bupivacaine test solution. The concentration was determined by the response of the previous woman to a higher or lower concentration of bupivacaine according to up and down sequential allocation. Efficacy was assessed using a 100-mm visual analogue pain score (VAPS). The test solution had to achieve a VAPS of 10 mm or less to be judged effective. In early labour, the MLAC of bupivacaine was 0.048% w/v (95% confidence intervals (CI) 0.037-0.058% w/v), and 0.140% w/v (95% CI 0.132-0.150% w/v) in the late group. The MLAC of bupivacaine in late labour was greater by a factor of 2.9 (95% CI 2.7-3.2) compared with the MLAC in early labour (P < 0.0001, 95% CI difference 0.08-0.11). We conclude that advancing labour requires an increased concentration of extradural bupivacaine for pain relief.

Adult↗
PubMed1992

Immunoglobulin and HLA-DP genes contribute to the susceptibility to juvenile dermatitis herpetiformis.

HLA-DQ genes and gluten diet are the main factors involved in the pathogenesis of Dermatitis Herpetiformis (DH), as well as Coeliac Disease (CD). However other genetic factors are probably relevant, since about 10% of the patients with DH and CD lack the DQA1*0501/B1*0201 heterodimer while the majority of individuals presenting this genotype and also being exposed to gluten diets did not suffer from these diseases. To evaluate the role of other genes, 36 Northern Italian children with DH were analysed for DNA polymorphisms at HLA-DP and immunoglobulin (Ig) heavy chain loci. DPA1*0201 and DPB1*1301 frequencies were higher in patients than in controls (Pc = 0.0357 and Pc = 0.0273). With respect to immunoglobulin heavy chain restriction fragment length polymorphisms (RFLP), the 4.6 kb SacI RFLP at the switch alpha 2 gene was more frequent in patients (0.13) than in controls (0.019; Pc = 0.036). Moreover, rare alleles or duplications in the switch regions occurred more frequently in the patients than in the controls. These results support the hypothesis of a multifactorial inheritance of DH, the HLA and Ig constant heavy chain genes being some of the loci contributing to the susceptibility. In accordance with previous CD studies, these data also confirm that DP subregion is probably involved in the pathogenesis of DH.

Adolescent↗
PubMed1990

HLA in juvenile dermatitis herpetiformis: clinical heterogeneity correlated with DNA and serological polymorphism.

A group of 30 Italian children affected by Dermatitis Herpetiformis (DH) was analysed for HLA region polymorphisms with both serological and DNA methods. Serological typing was performed on HLA-A, B, C, DR, DQ antigens and C4A, C4B, Bf polymorphisms. DNA RFLPs obtained with TaqI enzyme were investigated with cDNA probes specific for DR beta, DQ alpha and DQ beta genes. The results were correlated with intestinal involvement and age at onset of the disease. The following observations were made: (1) the intestinal biopsies revealed a direct correlation between degree of lesions and age at onset of DH; (2) a significantly increased relative risk (RR) was found for the following HLA antigens: A1 (RR = 2.2), B8 (RR = 6.2), Cw7 (RR = 3.9), C4AQ0 (RR = 7.4), DR3 (RR = 5.2), DR7 (RR = 4.4), DRw53 (RR = 4.7), DQw2 (RR = 6.0); (3) B8 and DR3 were significantly more frequent in patients with severe intestinal lesions; and (4) of the two DR3 subtypes revealed by RFLP typing, only 3.1 showed an increased frequency in DH patients (RR = 8.4). It is suggested that the susceptibility to Juvenile DH is determined by the same genes, within the HLA region, that are associated with Coeliac Disease.

Adolescent↗
PubMed1989

[Evaluation of the antigliadin antibody titer in adult celiac disease].

Serum gliadin antibodies of the IgA and IgG isotypes were assessed with an enzyme-linked immunosorbent assay technique in adults during different phases of coeliac disease (30 on a gluten-containing diet and 24 on a gluten-free diet), in patients with other gastrointestinal disorders (Crohn's disease, ulcerative colitis) and in healthy controls. Significantly higher antibody values were found in 70% of coeliacs on a gluten-containing diet, compared with the findings in the healthy controls and with those in the same subjects after one year on a gluten-free diet. Serum antibodies of the IgA class were associated with severe small intestine villous atrophy and were found exclusively in coeliac disease. Gliadin antibodies of IgG class were less disease-specific and were occasionally detected in sera from patients with gastrointestinal diseases and in 6% of healthy controls.

Adolescent↗
PubMed1987

HLA and antigluten antibodies in children with celiac disease.

IgG and IgA antigluten antibodies (Gab) were assayed in 83 celiac disease (CD) patients typed for HLA and Gm markers. Their titer and frequency were lower when a gluten-free diet was given than in active CD; these were significantly correlated, whereas no correlation was found between titer and serum Ig. Persistence of high titers was mainly confined to HLA-DR3 negative females (45% vs 6.7% of DR3 positive females and 19.3% of males). No association was found with any Gm allotype, in contrast with the previously reported involvement of the "fnb" haplotype with both CD susceptibility and Gab persistence in patients on a gluten-free diet. A technical and/or genetic explanation could be given for these differences.

Celiac Disease↗
PubMed1982

Reactogenicity, immunogenicity and efficacy studies of Escherichia coli type 1 somatic pili parenteral vaccine in man.

Purified type 1 somatic pili from enterotoxigenic Escherichia coli (ETEC) strain H10407 (O78:H11) was evaluated as a parenteral immunizing agent in the hope that this antigen might enhance a contemplated polyvalent pilus vaccine. Intramuscular inoculation with 45, 90, 900 or 1 800 mcg of pili vaccine was tolerated without incident in 82 volunteers. Six of 15 persons who received a 28 day booster of 1 800 mcg developed local reactions while none of 52 persons receiving 180 or 450 mcg boosters evinced such reactions. Pili vaccine did not significantly alter intestinal transit time, absorptive capacity or the prevalence of colonic E. coli bearing type 1 somatic pili of the H10407 antigenic variety. All vaccinees developed significant rises in circulating IgG antibody to type 1 somatic pili, the magnitude of the response being directly proportioned to the vaccine dose. None of the vaccinees had significant rises to CFA I or II pili nor to heat-labile enterotoxin. However, many had rises in O antibody, particularly among those inoculated with 1 800 mcg. Three challenge studies were carried out with E. coli H10407 to assess vaccine efficacy. In the initial study the vaccinees were either protected against diarrhea (2 of 6 vaccinees versus 7/7 of controls) or had milder disease than the controls. In two subsequent challenges with H10407 significant protection was not seen. It was not clear whether protection exhibited by the vaccinee group in the first challenge was due to O antibody, pili antibody, or both acting synergistically. To clarify this, a group of the immunized volunteers were challenged with ETEC strain B7A which is a different serotype (O148:H28) lacks CFA/I or II pili, but possesses type 1 somatic pili antigenically distantly related to those of H10407. Attack rates and severity of illness were similar in both vaccinee and control groups. While most volunteers challenged with E. coli H10407 developed significant rises in circulating antibody to CFA/I, LT and O antigen, none had rises to type 1 somatic pili. It is unclear if this is due to immune tolerance to this antigen when encountered enterally or whether these pili are not present in vivo in ETEC initiating diarrhea in the proximal small intestine. In summary, parenterally inoculated type 1 somatic pili were safe and highly immunogenic in man but did not consistently induce protection. Further studies are planned to clarify the role of antibody to type 1 somatic pili in mediating protection.

Adult↗
PubMedDate not supplied

[Liver transplant in children. II].

The family physician has a central role in preparing patients for transplantation and in the follow up. In the preoperative period adequate nutritional, vitamin intake and vaccinations are the mainstay of medical therapy. Pretransplant evaluation in a Liver Transplantation Centre is an essential part of the procedure, permitting an assessment of candidate's suitability and their position on the emergency list. During or immediately after the operation immunosuppression starts, according to personalized schedules and protocols. Among various complications, rejection must be promptly identified and treated. Resumption of a normal life style is the best indicator of a successful transplantation.

Adolescent↗
PubMedDate not supplied

[Prevention of the horizontal transmission of hepatitis B in children].

The active immunisation by means of vaccination is the best strategy against the B hepatitis virus. Hevac B vaccine was administered to sixty one children (30 boys and 31 girls) aged 1 month 14 years co-inhabitants with chronic carries of virus. After administering three dosages, seroconversion, giving protecting titres (greater than or equal to mU/ml) was obtained in 57 children. Levels in three boys and one girl were not protective. Retarded immunity examination showed alterations of T-Lymphocyte subpopulations only in the girl. The four non responders received a supplementary vaccination a month later, beside the booster dose given one year later (T12). Only two boys had no seroconversion. In spite of the four vaccination four children had antibody titers below 100 mU/ml.

Adolescent↗
PubMedDate not supplied

[Antigliadin and antireticulin antibodies in juvenile insulin-dependent diabetes mellitus].

A total of 203 patients with insulin-dependent diabetes mellitus (IDDM) were screened for coeliac disease (CD) by means of serum IgA and IgG antigliadin (AGA) (ELISA) and total anti reticulin antibody (ARA) IFL assay. As suggested by Savilhati, the combination of the IgA and IgG AGA test with IgA titration in serum (to find IgA deficient individuals) identifies almost 100% of CD patients. In this study ARA antibody assay was performed and two new suspect coeliac cases were found among IgA AGA negative children. Together the ARA and AGA tests give a 3% overall prevalence of CD in IDDM. The confirmation of CD must still be obtained with jejunal biopsy. Even high titres of AGA IgG are less specific for coeliac disease and in IDDM may identify those patients who are immunologically more hyperreactive.

Adolescent↗