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Biomedical subjects

P Zanon

Publications and source records attributed to P Zanon.

At least 19 recordsLinked to original sources
PubMed1996

Economic analysis of two structured treatment and teaching programs on asthma.

The aims of the present study were as follows: 1) to evaluate the medical outcomes of two treatment and educational asthma programs 2) to determine by cost-analysis both cost and economic outcome of the programs 3) to perform a cost-benefit analysis (determining the net cost-benefit) and a cost-effectiveness analysis (determining the cost per unit of effect and the incremental cost-effectiveness ratio) from the perspective of health program policy makers (HPP; indirect costs, i.e., loss of productivity, excluded) and of society as a whole (SaW, all costs included). Patients were randomly assigned to a complete (CP; n = 32) or reduced (RP; n = 33) program: the RP group received a reduced education (self-reading of an educational booklet on asthma), while the CP group attended an "asthma school", consisting of six lessons based on the same booklet and including educational videotapes. Both programs included peak-flow monitoring and treatment according to international guidelines, and follow-up. The outcome variables (asthma attacks, urgent medical examinations, admission days, working days lost) did not differ significantly between CP and RP. Morbidity savings were $1894.70 (CP) and $1697.80 (RP) according to SaW, and $1349.50 and $1301.80, respectively, according to HPP. The net cost-benefit was $1181.50 for CP and $1028.00 for RP, and the cost-benefit ratio per dollar spent was 1:2.6 for CP and 1:2.5 for RP, according to SaW. One day of admission prevented had a cost of $110.20 (CP) and $94.10 (RP). CP gave slightly better results and was slightly more cost-effective than RP in improving patients' welfare. It cannot be excluded that the retrospective analysis used to determine baseline costs might have inflated differences for both groups. Sensitivity analysis was slightly in favor of RP when the outcome variables were tested at their upper and lower 95% CI.

Adult↗
PubMed1994

Mast cells in the airway lumen and bronchial mucosa of patients with chronic bronchitis.

In order to evaluate the degree of mast cell infiltration and determine their granulation state in the airways of patients with chronic bronchitis, bronchoscopy was performed in 25 chronic bronchitis subjects (10 smokers and 15 ex-smokers) with mucoid sputum production and in seven normal nonsmoking control subjects. Bronchoalveolar lavage and bronchial biopsies were examined using histochemical techniques. Subjects with chronic bronchitis had higher numbers of mast cells both in the epithelium (1.22 +/- 1 versus 0.22 +/- 0.2 mast cells per mm) and in the bronchial glands (137.4 +/- 37.9 versus 38 +/- 5.1 mast cells per mm2) than did control subjects (p < 0.01 and p < 0.001, respectively), whereas the numbers of mast cells in bronchoalveolar lavage (0.21 +/- 0.1 versus 0.18 +/- 0.1 mast cells percentage, nonsignificant [NS]) and in the lamina propria (87.5 +/- 66.4 versus 87.2 +/- 61.8 mast cells per mm2, NS) were similar in the two groups. In the smoking group of bronchitics an increase in mast cell numbers was observed in epithelium (1.6 +/- 1.3 versus 0.95 +/- 0.7 mast cells per mm, NS), in lamina propria (112.2 +/- 86.5 versus 71.7 +/- 45.7 mast cells per mm2), and in BAL (0.26 +/- 0.21 versus 0.16 +/- 0.17 mast cell percentage of total cells, NS) in comparison with the ex-smoker's group of bronchitics.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchi↗
PubMed1994

Lower respiratory tract inflammation in chronic bronchitis. Evaluation by bronchoalveolar lavage and changes associated with treatment with Immucytal, a biological response modifier.

Chronic bronchitis (CB) is characterized by inflammatory changes in the bronchial tissue and by recurrent bronchitis exacerbations. In addition, defective systemic and local immune mechanisms have been demonstrated and biologic response modifiers (BRMs) have been recently introduced for clinical use in patients with CB. We studied 24 patients with CB by bronchoalveolar lavage (BAL), before and after a 4-week treatment protocol with inhaled Immucytal (Pierre-Fabre Pharma Srl, Milan, Italy), a BRM composed of bacterial ribosomal fractions and membrane proteoglycans. Compared with normal controls (NC), before treatment BAL in patients with CB contained increased proportions of neutrophils (NC, 0.8 +/- 0.2 percent; CB, 3 +/- 1 percent), of eosinophils (NC, 0.1 +/- 0.02 percent; CB, 0.6 +/- 0.2 percent); and of lymphocytes (NC, 6 +/- 1 percent; CB, 13 +/- 2 percent; p < 0.01 each comparison) with higher percentages of CD3+ and CD8+ lymphocytes (p < 0.01 each comparison). In BAL from patients with CB there were also higher levels of albumin and of the ratio IgG/albumin (p < 0.01 and p < 0.05, respectively, compared with NC). After Immucytal treatment, the proportions of lymphocytes in BAL in patients with CB were decreased (13 +/- 2 percent before, 6 +/- 1 percent after; p < 0.01). In addition, the posttreatment BAL samples contained significantly fewer neutrophils per milliliter of BAL (3.7 +/- 0.8 x 10(3) neutrophils per milliliter of BAL before, 1.5 +/- 0.5 x 10(3) neutrophils per milliliter after; p < 0.05). No differences were seen for the proportions of lymphocyte subpopulations and for the protein levels between the BAL obtained before and after Immucytal treatment. These data demonstrate the presence of a lower respiratory tract inflammation in patients with CB and suggest that treatment of patients with CB with a BRM may change the proportions of inflammatory cells present in BAL.

Aerosols↗
PubMed1994

Inhalation anti-asthma therapy with spacers: technical aspects.

Inhalation is the method of choice for delivering therapeutic agents to the lung. The advent of metered-dose inhalers (MDIs) has made inhalation easier, less expensive and more efficient. However, 20-50% of patients are unable to use MDIs correctly. The main problems are: 1) impact of aerosol particles in the mouth (responsible for side-effects); 2) poor co-ordination between firing the MDI and breathing; 3) and too fast an inspiration. Various spacer devices have been designed to overcome these problems. These are: large volume devices, which reduce the oral impact and select the respirable particles; devices equipped with a one-way valve that reduces co-ordination problems; indication of too rapid an inspiration by a high-flow mark. The introduction of these devices has resulted in an improved bronchial/oral deposition rate and a reduced incidence of side-effects. Training and education of patients is fundamental in ensuring the correct use of inhalers.

Adult↗
PubMed1988

Distribution of bronchial nonspecific reactivity in the general population.

We investigated 654 subjects of a small Lombardy (Italy) town between 15 and 64 years of age who were representative of the general population. By clinical examination, the sample included 535 normal subjects (164 normal smokers, 341 normal nonsmokers, 30 normal subjects with acute upper respiratory illness within 30 days before the challenge), 50 with chronic bronchitis, 26 with asthma, and 43 with allergic rhinitis. Subjects whose FEV1 was 75 percent or more than the predicted value (654) underwent methacholine bronchial challenge by means of 1 percent metered-dose solution. The test result was considered positive at a drop of more than 15 percent in FEV1 (compared with buffer). Normal smokers and all of the groups with disease had a significantly different distribution of reactivity compared with normal nonsmokers. The difference between asthmatic and these "normal" subjects was highly significant; nevertheless, a clear cut-off between the two groups does not appear to exist.

Acute Disease↗
PubMed1988

Immunoprophylaxis for influenza: comparison of a subunit and a whole virion vaccine.

In order to evaluate and compare immunogenicity, reactogenicity and protection of a subunit vaccine and a whole virus vaccine 102 elderly subjects were vaccined against influenza in November 1986: 53 received the subunit vaccine and 49 were immunized with the whole virus preparation. Local and systemic reactions following immunization, as well as the presence of influenza clinical symptoms were recorded throughout the study period (November 1986 - June 1987). Antibodies against influenza were detected using the Single Radial Haemolysis (S.R.H.) technique on two serum samples obtained from volunteers prior to immunization and 1 month later. The subunit vaccine showed equal immunogenicity, equal protection and lower reactogenicity as compared with the whole virus preparation.

Aged↗
PubMed1988

[Calcification of the mitral ring and semilunar valves: clinico-instrumental aspects. Sensitivity and diagnostic specificity of M-mode echocardiography versus autopsy findings].

Mitral ring calcification is a frequent finding in geriatric patients. The aim of this study was: 1) to analyze clinical and instrumental features of patients with calcific mitral ring identified through M-mode echocardiography (group A: 96 pts) with respect to those observed in a control group (group B: 104 pts); 2) to define the sensitivity and specificity of M-mode echocardiography in the diagnosis of mitral ring and aortic valve calcification by means of comparison with autopsy findings. Data on arterial hypertension, previous myocardial infarction, heart failure, phosphoremia and calcemia values were similar in both groups. On the contrary, in group A, permanent or paroxysmal atrial fibrillation, aortic valve calcification and left atrial diameter was significantly higher then in group B (p less than 0.05; p less than 0.001; p less than 0.001 respectively). The prevalence of AV and IV cardiac blocks was similar in both groups. Twelve group A patients were restudied with M-mode echocardiography, after a variable period of time, to evaluate the velocity of calcification progression. An autopsy was carried out on the twenty-six pts who died within 3 months after the M-mode echocardiography study. The evaluation of the autoptic findings was performed with high resolution radiographic image, obtained from a heart transverse section containing mitral and aortic plane.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Evaluation of the host defense system in asthmatic patients.

The efficiency of some components of the host defense system has been evaluated in 32 atopic patients with rhinitis, asthma or asthma and rhinitis. No alterations in components of complement (C3 and C4), serum immunoglobulins (IgG, IgA, and IgM) and neutrophil functional parameters were found. As expected, serum IgE values were higher than in controls. A decreased percentage of total circulating T lymphocytes, an increased percentage of Ia1-positive cells, but normal values of OKT4- and OKT8-positive T lymphocytes were demonstrated. However, a greater heterogeneity in the distribution of the suppressor-cytotoxic subset was shown in atopic patients.

Adolescent↗
PubMed1986

An overview of clinical trials with high-dose medroxyprogesterone acetate (HD-MPA) in endocrine-related tumors other than breast cancer.

High-dose medroxyprogesterone acetate (HD-MPA) has been successfully employed in the treatment of hormone-related tumors, especially advanced breast cancer. However, progestins in general and MPA in particular are considered a useful treatment also in other types of tumors such as endometrial, prostatic and renal cancer. Furthermore, MPA has been evaluated in tumors which are not classically considered hormone-related, such as ovarian cancer. Therapy with one of a number of progestational agents has been the conventional approach to the management of endometrial carcinoma not amenable to surgery or radiation therapy. Among the various synthetic progestins, MPA has been the most widely employed both by i.m. and oral routes, according to a variety of doses and schedules. Objective responses have been obtained in a percentage of women varying between 30 and 50% in the different series. While the role of MPA in the palliative treatment of advanced disease is well accepted, opinion is divided on the role of progestins in the adjuvant setting. On the basis of available data, it should be concluded that the usefulness of adjuvant therapy with progestins in high risk, early-stage endometrial cancer has not yet been clearly demonstrated. As far as prostatic cancer is concerned, data coming from comparative trials show that MPA is less effective than diethylstilbestrol (DES), and therefore should not be considered the first choice for previously untreated patients. However, it can achieve responses in patients who no longer respond or who are refractory to DES, and represents the treatment of choice for those patients who, due to their cardiovascular conditions, cannot be given estrogens.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1985

Acute effect of indenolol on human airways.

Airways resistance and expiratory flow have been investigated in 6 healthy volunteers given single doses of indenolol, propranolol, atenolol and placebo in a randomized, double-blind, cross over study. The three active drugs significantly decreased the effort-induced rise in systolic pressure, and they also reduced the resting heart rate. The relative potency against exercise-tachicardia was propranolol greater than atenolol greater than indenolol. The double and triple product were significantly decreased, too, without any difference between the active treatments. After placebo or indenolol, an exercise-induced increase in the forced expiratory flow at low pulmonary volumes (MEF50 and MEF75) was observed. The two control beta-blockers caused a fall in exercise expiratory flow as compared to the resting values. The noncardioselective agent (propranolol) was more effective than the cardioselective compound (atenolol) in decreasing the expiratory flow. The mechanism of action of indenolol is discussed in the light of the lack of its acute effect on airways resistance.

Adolescent↗
PubMed1985

Early ultrastructural changes in RU-486-exposed decidua.

An antiprogesterone (RU-486) was administered to women undergoing voluntary interruption of pregnancy. Five patients received 100 mg 12 h before surgical interruption, 5 others received 100 mg twice, 24 and 12 h before interruption, respectively, and another 5 received no drug at all and served as controls. Placentas and deciduae were examined morphologically with the light microscope and by electron microscopy. No specific lesions were detected in placental tissue. With conventional histology, the deciduae showed various degrees of interstitial edema and necrosis, changes which did not enable a distinction between treated cases and controls, although stromal disintegration tended to be more marked in RU-486-treated patients. At the ultrastructural level, the endothelium of decidual capillaries showed striking hyperplasia of the endoplasmic reticulum. Morphometric evaluation showed a statistically significant difference between RU-486-treated patients (2 X 100 mg) and controls. A possible link between these morphological changes and the induction of prostaglandin synthesis by the antiprogesterone is suggested. However, the full significance of the observed lesions remains uncertain and does not allow definite conclusions concerning the abortifacient effect of RU-486.

Capillaries↗
PubMed1984

In vivo study of xibornol on phagocyte functions.

Polymorphonuclear leukocytes (PML) represent the first step of defense against bacteria and fungi. Since many antimicrobial drugs have been reported to inhibit phagocyte function, we tested the interference of xibornol, a new antimicrobial agent, on phagocyte functions, in order to evaluate its possible use in chronic respiratory diseases. In the patients treated with xibornol (500 mg every 8 h for 7 days) we did not find any modification in phagocytosis frequency (PMF), phagocytosis index (PHI), nitroblue tetrazolium (NBT), reduction frequency (NRF), microbicidal activity and neutrophil mobility of PML, before, during and after the end of therapy.

Adolescent↗
PubMed1981

The immotile-cilia syndrome. Functional and ultrastructural alterations.

Literature was critically reviewed on the grounds of the ultrastructural and clinical observations made on three subjects carriers of Kartagener's syndrome. The relationship between the various ultrastructural aspects (lack of dynein arms and casual orientation of the central microtubular doublet) and the clinical evidence elicited in all the sites lined with ciliated epithelia (auditory apparatus, vestibular apparatus, genital organs and central nervous system). Attribution of the genesis of situs viscerum inversus to lack of ciliar motion was brought up for discussion again.

Adolescent↗
PubMed1980

A comparison between different methods for detecting bronchial hyperreactivity. Bronchial hyperreactivity: methods of study.

The authors evaluated bronchial hyperreactivity comparing two different methods for aspecific bronchostimulation (H2O ultrasonic mist and free running) and a bronchodilation test. The investigation had been carried out on three groups of subjects. The first included 15 nonsmoking normal subjects, the second 23 asthmatic patients and the third 16 rhinitic patients. All subjects were submitted to bronchodynamic tests in three different ways. The ventilatory parameters were FVC, FEV1, MMEF and Vmax25. In normal subjects no significant changes were found. In asthmatic patients the bronchodilation test was positive in 65% of the cases, regarding FEV1 and in 87% regarding the forced flows. The running test was positive in 26% of the cases (FEV1) and in 61% of the cases (forced flows). The ultrasonic mist caused a significant drop in FEV1 in 17% of the cases, while flows were significantly reduced in 30% of the cases. In rhinitic patients the bronchodilation test was positive in 25% of the cases both considering FEV1 and forced expiratory flows. Ultrasonic mist never induced a decrease of FEV1, while flows decreased in 12.5% of the cases. The free running test was positive in 12% of the cases regarding FEV1 and in 25% regarding forced flows.

Adolescent↗
PubMed1979

Ultrastructural study of leukemic cell phagocytosis using the myeloperoxidase reaction.

The phagocytosis (in the absence of serum factors) of zymosan particles by peripheral leukocytes isolated from ten patients with acute leukemia (AMbL, AMoL, AMML, AUL, ALL and CML-BC) was studied at the electron microscope. An evident phagocytic activity was observed only in the cells in which cytochemical and ultrastructural features suggested that the blast elements belonged to the monocytic series. However, no phagocytosis by unclassifiable leukemic blasts was observed, even though they had some submicroscopic characteristics of the monocytic series. These findings suggest that phagocytic capacity develops during the course of cell differentiation, becoming striking only when the blast cell acquires the ultrastructural features of the pro-monocytic stage. Using the myeloperoxidase reaction, this study also demonstrates a morphological alteration in the degranulation process after the ingestion of zymosan particles in both the blasts and the mature PMN cells of leukemic patients. This defect could be related to the susceptibility to severe infections usually found in subjects with hematological malignancies.

Humans↗