Biomedical subjects
Publications and source records attributed to R Bruni.
The development of a renal fistula is a rare event which results from an acute or chronic inflammatory process in the kidney. The authors report a very rare case of nephrojejunal and nephro-cutaneous fistulas due to acute and chronic pyelonephritis in a patient with staghorn stones of the left kidney.
The authors report a rare case of spontaneous nephrocutaneous fistula. The patient was asymptomatic and with a negative history for renal lithiasis, inflammation, trauma or tuberculosis. Radiological and echographical examinations permitted a complete study of the fistulous tract and the renal function; the staghorn calculi and pyelonephritis guided the decision to operate on the patient performing a nephrectomy and ureterectomy with a quick complete recovery. Biological test for micobacterium tuberculosis resulted positive after 60 days.
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In cats, horizontal (HVOR) and vertical (VVOR) vestibulo-ocular reflexes were studied alone and combined with optokinetic stimulation. The upright VVOR (VVOR O degree) only showed higher gain and smaller phase lead compared to those of HVOR at frequencies below 0.05 Hz. The addition of optokinetic stimulation to the vestibular stimulation increased the gain of the horizontal and vertical ocular responses close to 1. VVOR was also studied in side down position (VVOR 90 degrees). In VVOR 90 degrees the ocular responses were asymmetric. The downward directed eye responses of VVOR 90 degrees showed lower gain and greater phase lead compared to those of VVOR 0 degree for the whole range of tested frequencies (0.01-0.4 Hz), while the upward eye responses only showed a lower gain at the lower range of frequencies tested. In the light the gain of VVOR 90 degrees increased, but the gain of downward directed eye responses was consistently lower than 1 at lower frequencies. The higher gain of the VVOR 0 degree compared to the VVOR 90 degrees and HVOR was attributed to the maculo-ocular reflex (MOR) evoked by the gravity modulation of the otolithic receptors, when the animals were oscillated in the pitch plane. The MOR was isolated from the VVOR 0 degree by plugging all semicircular canals. At very low frequencies the gain of the MOR was 0.3-0.35 and the phase was close to 0 degree. This reflex showed a progressive gain decrease and phase lag by increasing the stimulation frequencies. This suggests a low pass filtering process of the otolithic signal. Furthermore in plugged animals the asymmetry of the vertical optokinetic responses was reduced by adding the MOR. The quick phases (QPs) of the vestibular responses were also different depending upon the stimulation plane. The QPs of VVOR 0 degree were smaller and more delayed than those of HVOR and VVOR 90 degrees. In conclusion the main effects observed during otolithic coactivation in the VVOR 0 of the cat are: 1) the enhancement of gain and reduction of phase lead at low frequency vestibular stimulation, resulting in similar vertical and horizontal gaze stability; 2) the equalization of the upward and downward responses of both vestibulo-ocular and optokinetic responses; 3) the reduction of the amplitude and frequency of vertical quick phases.
A case of ovarian pregnancy in a patient with intrauterine device is reporter. The patient was hemodynamically instable and immediate laparotomy was indicated. The treatment was left oophorectomy. Ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted in the ovary. The incidence appears to be of 1 to 3 per cent of all ectopic gestations with a frequency of one in 7000 to 40000 deliveries and it is now believed to occur four times more frequently than previously thought. It has been suggested that the increasing incidence is caused by the use of IUD. In contrast to patients with tubal pregnancy traditional risk factors such as pelvic inflammatory disease, prior surgical procedure upon the pelvis may not apply. The clinical signs are similar to those found in tubal pregnancies and in hemorrhagic corpus luteum cysts. The treatment is emergency laparatomy followed by oophorectomy in many instances. When the patient is hemodynamically stable laparoscopy and the ovarian wedge resection should be the treatment of choice.
BACKGROUND: The diagnosis of uterine rupture is aided by the identification of risk factors, such as oxytocin administration. In several experiments, cocaine has been shown to stimulate uterine contractility. Complications from cocaine abuse during pregnancy have increased dramatically in the United States, and cocaine may increase the risk for uterine rupture. CASES: Two cases of uterine rupture were associated with recent cocaine abuse. CONCLUSION: These cases and recent experiments on the effect of cocaine on the pregnant uterus suggest that antepartum cocaine abuse may increase the risk of uterine rupture.
The primary function of lung surfactant is to form monolayers at the alveolar interface capable of lowering the normal surface tension to near zero. To accomplish this process, the surfactant must be capable of maintaining a coherent, tightly packed monolayer that avoids collapse during expiration. The positively charged amino-terminal peptide SP-B1-25 of lung surfactant-specific protein SP-B increases the collapse pressure of an important component of lung surfactant, palmitic acid (PA), to nearly 70 millinewtons per meter. This alteration of the PA isotherms removes the driving force for "squeeze-out" of the fatty acids from the primarily dipalmitoylphosphatidylcholine monolayers of lung surfactant. An uncharged mutant of SP-B1-25 induced little change in the isotherms, suggesting that a specific charge interaction between the cationic peptide and the anionic lipid is responsible for the stabilization. The effect of SP-B1-25 on fatty acid isotherms is remarkably similar to that of simple poly-cations, suggesting that such polymers might be useful as components of replacement surfactants for the treatment of respiratory distress syndrome.
The failure of some infants with respiratory distress syndrome to respond to therapy with surfactant may be explained in part by inactivation of surfactant caused by leakage of plasma constituents into air spaces. Surfactant-associated proteins (SP-A, SP-B and SP-C) reduce the susceptibility of surfactants to inactivation in vitro. To study this phenomenon further, we used full length synthetic proteins, SP-B [1-78] and SP-C [1-31], mixed with surfactant lipids in different ratios and different concentrations. Equilibrium and minimum surface tensions of these mixtures, with or without serum and calcium, were measured using a pulsating surfactometer. Mixtures containing both SP-B and SP-C had optimal minimum and equilibrium surface tensions of < 5 and < 28 mN/m, respectively. Mixtures with SP-B had optimal minimum surface tensions, but equilibrium surface tensions averaged 35 mN/m. Mixtures with SP-C had high minimal (19 mN/m) and high equilibrium surface tensions (35 mN/m). When serum was added to these mixtures, the least inactivation was found with mixtures containing 3% protein at 1:1 ratio of SP-B/SP-C with 2 mM calcium chloride. These data indicate that SP-B and SP-C, particularly in the presence of calcium, reduce surfactant inactivation that may be caused by plasma constituents. The results lead to the hypothesis that charge interactions among ions, lipids, surfactant proteins, and serum inactivators are a major element in pathophysiological surfactant inactivation.
The presence of circulating hepatitis C virus genome (HCV-RNA), elevated ALT levels and antibodies to an NS5-derived synthetic peptide have been examined in 13 subjects with isolate positivity for antibodies to the HCV core antigen (C22) on RIBA-2 testing. All subjects were followed up for 8-18 months (mean 12.4 months). In seven subjects (54%), intermittent or persistent viremia was associated with abnormal ALT levels (6 subjects) and with positivity for antibodies to NS5-peptide (6 subjects). On the other hand, in 6 out of 13 subjects (46%) no viral replication, no liver cytonecrosis and no antibodies to NS5 were found. It is concluded that isolate reactivity to C22 by RIBA-2 is a heterogeneous condition that corresponds to two distinct categories of subjects: those with active HCV infection and those without evidence of virus replication. Although HCV-RNA determination is the most reliable means of identifying HCV carriers, antibodies to NS5 can be a useful marker of virus activity. In fact, antibodies to NS5 were detected in 6 out of 7 viremic patients, compared to 0 out of 6 non-viremic patients (P = 0.004). It remains to be elucidated whether the isolate reactivity to core antigen found in non-viremic subjects represents a specific, HCV-induced antibody response, or is an unrelated crossreactivity.
Antioxidant delivery may be targeted toward the alveolar epithelium by encapsulating superoxide dismutase (SOD) and catalase in liposomes made from pulmonary surfactant. We studied whether antioxidant-surfactant liposomes increase cellular antioxidant activity in alveolar type II cells and whether this effect is influenced by the presence of surfactant protein A (SP-A). Cu,Zn SOD and catalase were encapsulated in liposomes made from synthetic phospholipids with or without 5% SP-A or from natural cow surfactant. Alveolar type II cells from adult rats were preincubated for 20 h, and liposome mixtures were added for 24 h, followed by measurement of cellular SOD and catalase activities (U/mg DNA). Antioxidant-surfactant liposomes increased alveolar type II cell antioxidant activity sharply. Uptake of SOD/catalase from liposomes with synthetic phospholipids and SP-A was twice that from liposomes without SP-A and did not further improve in the presence of SP-B and -C. Encapsulation of antioxidants diminished the surface activity of the surfactant liposomes, but this feature was absent in the presence of SP-A. These data suggest that: 1) antioxidant-surfactant liposomes augment alveolar type II cell antioxidant activity, 2) liposomal uptake is facilitated by the presence of SP-A, and 3) inhibition of surface activity of surfactant by encapsulated antioxidants can be reversed by SP-A.
To assess the role of hepatitis C virus (HCV) in liver disease in Somalia, antibody to HCV (anti-HCV) was studied by enzyme-linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA) in 110 patients with chronic liver diseases, in 309 healthy adults, in 179 institutionalized subjects with a high prevalence of intestinal parasites and Schistosoma haematobium, and in 287 children with diseases other than hepatitis. According to the RIBA test, anti-HCV was present in three healthy adults (0.97%), in four institutionalized individuals (2.2%), but in none of the children. The prevalence of anti-HCV was 4.8% in patients with hepatitis B surface antigen (HBsAg)-positive chronic liver diseases and 20.6% in patients with HBsAg-negative chronic liver diseases. Thus, HCV infection appears to play a minor role in HBsAg-positive liver disease in Somalia but may be an important factor in HBsAg-negative chronic liver disease. The low anti-HCV prevalence in individuals with no hepatic disorders is consistent with the fact that HCV does not spread by nonpercutaneous transfer. We found also a large proportion of both patients with hepatic disease and institutionalized individuals who tested positive by ELISA but not confirmed by RIBA. However, the likelihood of a true positive result increases proportionally with the ELISA value; thus, in most cases a low ELISA value probably represents a false-positive reaction, while a high ELISA value probably represents a true positive reaction.
Bouveret's syndrome is represented by an intestinal occlusion due to a gallstone passed through a cholecysto-duodenal fistula and impacted in the duodenum. The authors report a case of this rare syndrome and discuss the optimal surgical approach.
In rabbits and cats vestibulo-ocular reflex (VOR) and vestibulo-ocular reflex (VCR) were tested in frontal and sagittal planes. The VOR evoked by pitching the animals in side down position showed asymmetric responses with peak eye velocity higher in upward direction than in downward one. This asymmetry was abolished when pitching the animal in upright position. This indicate that the otolithic coactivation, occurring in upright position, symmetrizes canal-induced vertical responses. Vestibulo-ocular reflex evoked by rolling the animals was also symmetric, no matter the animal position was. The electromyographic response of neck muscles to sagittal VCR showed an asymmetric behaviour as far as the timing of extensor and flexor activation was concerning. In fact, the increase of extensor muscle activity was steeper than the decrease and the activation peak was more leading than the inhibition peak. The flexor muscles showed an opposite behaviour. This flexion-extension asymmetry was present either with or without otolithic coactivation. On the contrary, the EMG responses to frontal VCR were much more symmetric. It can be suggested that the upward preponderance is present in the sagittal vestibular circuitry to enhance the upward VCR against a gravity load which opposes head stability during downward head displacements. On the contrary, at level of the eye, in which the gravity does not oppose the responses, the canal-induced vertical asymmetry is cancelled by the otolithic coactivation.
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The mechanisms by which pulmonary surfactant protein B (SP-B) affects the surface activity of surfactant lipids are unclear. We have studied the peptide/lipid interactions of the amino-terminal amphipathic domain of SP-B by comparing the secondary conformations and surface activities of a family of synthetic peptides based on the native human SP-B sequence, modified by site-specific amino acid substitutions. Circular dichroism measurements show an alpha-helical structure correlating with the ability of the peptides to interact with lipids and with the surface activity of peptide/lipid dispersions. Amino acid substitutions altering either the charge or the hydrophobicity of the residues lowered the helical content and reduced the association of the aminoterminal segment with lipid dispersions. Surface activity of peptide/lipid mixtures was maximally altered by reversal of charge in synthetic peptides. These observations indicate that electrostatic interactions and hydrophobicity are important factors in determining optimal structure and function of surfactant peptides in lipid dispersions.
The respiratory distress syndrome of premature infants is caused by both surfactant deficiency and surfactant inhibition by capillary-alveolar leakage of serum factors. Dispersions of a standard surfactant lipid mixture, with and without various synthetic peptides, modeled on human surfactant proteins SP-B (residues 1-25, 49-66, 1-78) and SP-C (residues 1-10), were evaluated for inhibition by serum and by plasma constituents using a pulsating bubble surfactometer. Inhibition was derived from the changes in surface properties of these mixtures after addition of human serum or plasma constituents. Modified bovine surfactant (TA) containing native SP-B and SP-C was used as a control. In the absence of serum inhibitors, mixtures with synthetic peptides gave results similar to surfactant TA. However, inhibition was more evident in the dispersions with synthetic peptides when compared with surfactant TA. The peptide/phospholipid mixture with the entire sequence of SP-B and the first 10 residues of SP-C were more resistant to inhibition than mixtures with synthetic peptides containing fewer domains. Addition of calcium reduced the inhibitory effects of serum both in mixtures containing synthetic peptides and in surfactant TA. Therefore, synthetic SP-B and SP-C peptides in surfactant lipids, in cooperation with calcium, permit resistance to inhibition by several plasma constituents that probably inactivate surfactant by a variety of different mechanisms.
Synthetic peptides based on the native human sequence of surfactant protein B have been used to generate polyclonal monospecific antibodies against specific segments of the native SP-B protein. Circular dichroism analysis of the synthetic peptides shows they have a dominant helical content in structure promoting environments and tensiometric measurements indicate these peptides lower surface tension at air-water interfaces implying that they contain amphipathic alpha helical motifs. Antibodies directed against the C-terminal segment of SP-B react with the native protein in the oxidized and reduced state. Antibodies directed against the N-terminal sequence of SP-B react with the native protein only in the reduced state suggesting that this domain has a conformation dependent on disulfide bond formation.