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Biomedical subjects

R Cianci

Publications and source records attributed to R Cianci.

87 records · Page 5Linked to original sources
PubMedDate not supplied

Pleural abrasion in the treatment of recurrent or persistent spontaneous pneumothorax. Results of 94 consecutive cases.

In the ten-year period 1982 to 1991, 94 patients underwent pleural abrasion as definite treatment for spontaneous pneumothorax. Surgical indications included: 1) third recurrence of homolateral pneumothorax, 2) second recurrence of homolateral pneumothorax in the presence of alternating pneumothorax, and 3) persistent air leak with incomplete lung re-expansion in the presence of spontaneous pneumothorax treated with pleural drainage for more than 10 days. No deaths were observed in the present series. Post-operative complications were minimal and all reversible, including two cases of pleural effusion, one case of hemothorax, and one case of Horner's syndrome. Eighty cases were followed up from 7 to 91 months. No recurrences occurred during the follow-up period. Clinical, radiological and functional results appear satisfactory. Pleural abrasion seems to represent a valid surgical option in the treatment of recurrent or persistent spontaneous pneumothorax.

Adolescent↗
PubMedDate not supplied

The impact of biological agents interfering with receptor/ligand binding in the immune system.

We herein discuss the impact of biological agents based on the ability of monoclonal antibodies to target specific molecules. This approach has given to clinical immunologists a spectrum of drugs able to manipulate the immune system. In the first session, we discuss drugs targeting T-cell function by: (1) targeting CD28 mediated costimulation (Abatacept and Belatacept); (2) interfering with interleukin-2 receptor (Basiliximab and Daclizumab); (3) blocking cell adhesion and homing (Alefacept, Efalizumab, Natalizumab). The second session is dedicated to drugs targeting cytokines or their receptors. The best known and largely experimented case is represented by drugs targeting tumor necrosis factor (TNF) (Infliximab, Adalilumab, Certolizumab) or its p75 receptor (Etanercept). However, newer products are now available to target other inflammatory cytokines including IL-6, IL-8, IL-12, IL-15, IL-18, IL-23. These agents have the potential to become powerful tools in the control of several immune-mediated diseases, especially auto-immune and inflammatory ones. They traslate into reality the prediction that antibodies will eventually become "magic bullets which seek their own target" (P. Ehrich, 1906).

Binding, Competitive↗
PubMedDate not supplied

Body fluid compartments in hypertension.

BACKGROUND AND OBJECTIVES: There is a correlation between the fluid and ionic homeostasis and blood pressure but it is not known if these body fluid changes represent the cause or rather the effect of the blood pressure rise. We have estimated the compartmental distribution of body fluids by means of the Bioimpedance Spectroscopy (BIS) analysis in a hypertensive cohort compared to control subjects. MATERIAL AND METHODS: We have enrolled 28 hypertensive patients (14 females, 14 males, mean age 47 +/- 5) and a sex- and age-matched control group of 37 healthy subjects (17 females and 20 males, mean age 45 +/- 8). They underwent anthropometric measurements, then extracellular (ECW) and intracellular water (ICW) were assessed using BIS. RESULTS: Both mean weight and BMI of hypertensive patients resulted significantly higher than of the control group (p < 0.05). We found higher ICW values in hypertensive compared to normotensive subjects. This difference was proportional to the difference of mean blood pressure values, reaching significance only as regards the stage II hypertensive subgroup (p < 0.03). DISCUSSION: Our data confirm that the blood pressure increases are associated to TBW, and caused mainly by ICW increases. The BIS, a simple, reliable, non invasive and cost effective methodical approach, estimating the distribution of body fluids, offers new possibility of the management of the hypertensive disease, to establish a more appropriate antihypertensive treatment. Moreover, the BIS, estimating the volume restoration of the different body compartments, may be helpful in evaluating the effectiveness of the pharmacological treatment.

Anthropometry↗
PubMedDate not supplied

Body composition analyses in normal weight obese women.

The purpose of this study was to identify new indexes of body composition that characterize the normal weight obese (NWO) women. We measured body composition by dual energy x-ray absorptiometry (DXA) and resting metabolic rate (RMR) by indirect calorimetry in a cohort of seventy-five healthy Italian women, subdivided into three groups (nonobese/controls, NWO, preobese-obese women). Despite a normal body mass index (BMI), the NWO women have a higher body fat mass percentage (FAT %) (38.99 +/- 6.03) associated to a significant (p = 0.02) lower amount of lean mass of legs (12.24 +/- 1.31) and lean mass of left leg (6.07 +/- 0.64) with respect to the control group. The NWO group showed a significant (p = 0.043) lower RMR (1201.25 +/- 349.02) in comparison with nonobese and preobese-obese women. To classify NWO individuals among general population, we identified three significant body composition indexes: abdominal index, leg index and trunk index. The NWO women showed significant increased value in the three indexes (p < 0.001). Our results suggest that, despite a normal BMI, the NWO women displayed a cluster of anthropometric characteristics (body fat mass percentage, leg indexes) not different to obese women ones. An appropriate diet-therapy and physical activity may be protecting NWO individuals from diabetes and cardiovascular diseases associated to preobese-obese women.

Abdominal Fat↗
PubMedDate not supplied

Normal Weight Obese syndrome: role of single nucleotide polymorphism of IL-1 5Ralpha and MTHFR 677C-->T genes in the relationship between body composition and resting metabolic rate.

We have identified a subset of metabolically obese, but normal weight individuals, with potentially increased risks of developing the metabolic syndrome, despite their normal body mass index. We determined the relationship among body fat distribution, resting metabolic rate (RMR), total body water amount (%TBW), selected gene polymorphism on interleukin-15 receptor-alpha (IL-15Ralpha) and methylenetetrahydrofolate reductase 677C-->T (MTHFR 677C-->T), to distinguish normal weight obese (NWO) from nonobese with a normal metabolic profile and obese individuals. We analysed anthropometric variables, body composition by Dual energy X-ray Absorptiometry (DXA), RMR by indirect calorimetry, %TBW by bioimpedence analysis (BIA), MTHFR 677C-->T and IL-15Ralpha genotypes of 128 clinically healthy Caucasian individuals. We compared a group of female, defined as NWO and characterised by a BMI < or = 25 kg/m(2) and FM > or = 30% with groups of others female, and males, represented by nonobese with a BMI < or = 25 kg/m(2) and FM < or = 30%, and preobese-obese individuals with BMI > or = 25 kg/m(2) and %FM > or = 30%; none of the males was classified as NWO. Significant correlations were found among body fat mass distribution, metabolic variables, percentage of total body water distribution and selected genetic variations. The variables that contributed significantly to the separation of classes were body tissue (Tissue), %TBW, RMR, the volumes of both oxygen (VO2) and carbon dioxide (VCO2). The distribution of MTHFR 677C-->T and IL-15 genotypes was significantly different between classes. Our data highlight that NWO individuals showed a significant relationship between the decrease in the basal metabolism (RMR), body fat mass increasing and total water amount. Possession of wild type homozygotes genotypes regarding IL-15Ralpha cytokine and 677C-->T MTHFR enzyme characterised NWO individuals.

Adult↗
PubMedDate not supplied

Resection and radical lymphadenectomy for lung cancer: prognostic significance of lymphatic metastases.

From 1979 to 1987, 1103 thoracotomies were performed in patients with lung cancer: 824 (74.7%) radical resections, 141 (12.7%) palliative resections and 138 (12.5%) exploratory thoracotomies. Among the 965 patients who underwent resection, 539 patients were N0, 190 patients N1 and 236 patients N2. Among patients with N1 disease we observed more frequent hilar metastases in the more advanced tumors (p less than 0.05). In 84 out of the 232 N2 patients (36.2%; 13.4% of all patients) a skipping of all pulmonary sites was observed. The most commonly invaded mediastinal levels were the paratracheal nodes on the right and the aortic nodes on the left, followed by the subcarinal nodes. The greater the neoplastic involvement of pulmonary nodal sites, the higher the percentage of patients with N2 disease and the number of mediastinal levels with tumor cells (p less than 0.05). The 5-year survival rate is 60% for N0, 46% for N1 and 23% for N2 disease. There is no significant difference in survival between N2 and N1 + N2 patients. Metastatic involvement of both upper and lower mediastinal levels carries a poorer prognosis compared to involvement of one compartment only (p less than 0.02). Patients with findings of mediastinal metastatic involvement should be selected: studies on lymphatic metastases are useful to better establish surgical indications for N2 patients.

Humans↗
PubMedDate not supplied

Alpha-fetoprotein as tumor marker in lung cancer diagnosis.

Authors have studied AFP serum levels in 289 lung cancer. Only 2 cases (0.7%) showed little increase of this glycoprotein and liver pathologies were present in both patients, authors believe immunohistochemical study is necessary in lung cancers that show AFP increase.

Biomarkers, Tumor↗
PubMedDate not supplied

Computerized morphometric analysis of the femoral diaphyseal canal.

The constant increase in the use of hip arthroplasty and the continuous search for the best possible adaptation of the implant to femoral anatomy have led to the development of methods of radiographic analysis that are increasingly precise and reliable. Among these the methods that include the use of traditional radiograms-despite their limits-deserve a place of importance. In fact, these methods offer the advantage of being easy to apply and of allowing for a comparison to be made with pre-existing files. Computer science is useful in this field, in particular, computerized analysis, both morphometric and statistical, of the data acquired by digitizer. The protocol of acquisition and analysis that we applied to x-rays in anteroposterior view allowed for an evaluation to be made of some of the morphologic parameters of 354 femurs (corresponding to 264 patients), relating them with the pathologies that led to hip arthroplasty. The duration of a cementless hip prosthesis strongly depends on primary stability. For this reason, an ever-increasing number of studies tends to make a precise evaluation of the morphology of the joint, in order to obtain excellent contact between bone and prosthetic component. The methods used are essentially radiological, with the use of computerized tomography and stereophotogrammetry. Morphometric studies of the proximal femoral area have in particular considered the width of the medullary canal at various levels; the cervico-diaphyseal angle; the flare index of the femoral canal (relationship between the internal metadiaphyseal diameter and that of the isthmus) and the distance between the rotation center of the femoral head and the diaphyseal axis. The evident absence of proportion between femoral sizes and shape of the medullary canal has led to the search for parameters capable of describing in simple fashion the shape of the femoral diaphyseal canal. A good describer of femoral morphology is the flare index, that allows for classification of the various shapes of the diaphyseal canal in three families: "stove-pipe like", "normal", "champagne glass like". The distinction between these groups is not clear, as the passage from one shape to another is gradual. The idea of obtaining more knowledge on femoral morphology, also to the purpose of determining possible new criteria that may be of help in preoperative planning and in the choice of a model to be implanted, has suggested our study on modifications caused by some of the pathologies that most frequently lead to arthroplasty.

Adult↗
PubMedDate not supplied

A computerized morphometric evaluation of x-ray films for preoperative planning of hip arthroplasty.

Methods for measuring metric size on radiograms constitute an instrument of proven utility. For example, when preoperatively evaluating hip arthroplasty the diameter of the medullary canal and the cervicodiaphyseal angle, must be measured in order to determine the center of rotation of the femoral head, and to establish the flare index of the diaphyseal canal. These results may be obtained by using a computer-controlled graphic table to place the coordinates for the areas of greater anatomical and physiological importance on the radiologic image. Thus, a calculation of distances, anatomical axes and angles is obtained immediately, accurately defining the morphometry of the joint. In this study, the anteroposterior preoperative radiographic views of 87 femurs in 84 patients were evaluated by this method. The values provided by the morphometric analysis were then related to sex, age and weight. The diaphyseal canal was classified by typology for the preoperative planning of hip arthroplasty.

Adult↗
PubMedDate not supplied

Results of surgical resection of stage IIIa (N2) non small cell lung cancer, according to the site of the mediastinal metastases.

Out of a series of 1563 consecutive patients submitted to thoracotomy for lung cancer between 1980 and 1990, 278 patients underwent a resection for a non small cell lung cancer (NSCLC) with mediastinal node metastases (N2). Selection of cases for surgery was carried out using CT from 1983 and mediastinoscopy for the patients with mediastinal lymph nodes larger than 1.5 cm from 1985: all patients with positive mediastinoscopy were excluded from thoracotomy, but 10 cases underwent a resection after neoadjuvant radio-chemotherapy. The surgical procedures were pneumonectomy (106), lobectomy (146) and atypical resection (8) with ipsilateral mediastinal lymphadenectomy. Resection was complete in 236 patients (84.8%) and incomplete in 42 patients (15.2%). Postoperative mortality was 3.2%. Almost all patients received radiotherapy after surgery. Actuarial 5-year survival was 13.7% for the entire group and 18.5% for the patients who underwent curative resection; no patients survived 5 years after palliative resection (p < 0.05). There were no differences with regard to prognosis according to the histology of the tumors and to surgical procedures. A better prognosis is associated with: completeness of resection, involvement of only one level, low T classification. Five-year survival rate of patients with metastases only in upper mediastinum was 25%; on the contrary 5-year survival rate of patients with metastases in the lymph nodes of the lower mediastinum was only 8% (p < 0.05). In our opinion better results among the patients with metastases in the upper mediastinum depends on the selection obtained with mediastinoscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Wear of the epiphysis-acetabulum in total hip arthroplasty: a review of the literature.

Problems related to the use of total hip arthroplasty and the properties of the materials used to make prostheses have encouraged wear phenomena of the epiphysis-acetabulum combination of international importance and acknowledgement. Based on a review of the literature, the authors analyze the most recent years of study of wear phenomena and discuss the choice of materials to be used in total hip arthroplasty implant, with particular interest in any potential defects.

Acetabulum↗
PubMedDate not supplied

[Spontaneous and traumatic pneumomediastinum. Analysis of 34 cases].

Pneumomediastinum (spontaneous, iatrogenic and traumatic) is a relatively uncommon infrequently reported entity. The most common cause is the rupture of marginal pulmonary alveoli, allowing bubbles of air to dissect along the vascular sheaths and connective tissue planes to the mediastinum. Rupture of the trachea or thoracic traumas are other causes of pneumomediastinum. The most common presenting complaint was retrosternal pain, dyspnea, dysphagia, weakness and neck pain. Physical finding revealed: subcutaneous emphysema extended to face, chest or neck, and Hamman's sign. Chest X-ray was made in all cases and diagnosis was completed with chest CT scan and tracheoscopy. We present our series of 34 PM between January 1.1993 to July 31.1995 and discuss about etiology, diagnosis and treatment of this entity.

Adolescent↗
PubMedDate not supplied

Metal-UHWMPE (Ultra High Molecular Weight Polyethylene) wear: experimental testing.

Testing conducted on a hip joint simulator verified the Charnley hypothesis that the diameter of the prosthetic head is proportional to wear. The study was conducted by pairing heads in Ortinox TM with acetabular cups in polyethylene at high molecular weight (UHMWPE). A comparison between the different sizes of the heads (26 and 30 mm in diameter) showed a different trend in the wear rate; in particular, the head with a smaller diameter behaves better tribologically than the head with a larger diameter.

Acetabulum↗
PubMedDate not supplied

Effect of adequate alcohol intake, with or without cigarette smoking, on the risk of Helicobacter pylori infection.

BACKGROUND/AIMS: Chronic adequate alcohol intake induces an "adaptive cytoprotection", mediated by endogenous release of prostaglandins and increased activity of gastric antioxidants, that reduces the mucosal damage caused by higher ethanol concentrations. The aim of our study was to verify the presence of a protection against Helicobacter pylori infection, induced by adequate alcohol consumption, with or without cigarette smoking. METHODOLOGY: We studied 303 consecutive dyspeptic patients, who underwent gastroscopy for the first time. The patients were allocated to four groups: A) 57 with adequate alcohol consumption; B) 88 smokers pts; C) 64 smokers pts with adequate alcohol consumption; D) 93 non-smokers and teetotalers. RESULTS: H. pylori infection was found in 32 pts of group A (56.14%), 67 of group B (77.13%), 46 of group C (71.87%) and 61 of group D (65.69%). There was a statistical significant difference in H. pylori-positivity only between group A and group B (p=0.019). CONCLUSIONS: Even if we noted a statistical difference only between group A and B, however the lower prevalence of H. pylori infection in group A than in other groups suggests a protective mechanism of adequate alcohol consumption, mediated by "adaptive cytoprotection", which reduces the risk of H. pylori infection.

Adolescent↗