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Biomedical subjects

R De Maria

Publications and source records attributed to R De Maria.

102 records · Page 6Linked to original sources
PubMedDate not supplied

Correlation between extent of myocardial dysfunction and markers of irreversible damage in failing hearts.

BACKGROUND: The structural correlates of 201Tl uptake in patients with advanced postischemic pump dysfunction are unclear. There are no good experimental models adequately reflecting the mixture of normal, dysfunctional but viable, and necrotic regions characteristic of chronic ischemic heart disease in human beings. METHODS AND RESULTS: Four heart transplant candidates with idiopathic dilated cardiomyopathy and seven with ischemic heart disease underwent rest-injection 4-hour redistribution 201Tl single-photon emission computed tomography before surgery. Delayed tracer uptake was categorized into severely reduced (<50%), mildly or moderately reduced (50% to 74%), and normal (> or =75%) and related to echocardiographic wall motion and histologic findings in the hearts excised at transplantation. In idiopathic dilated cardiomyopathy, despite severe wall motion impairment, minimal or mild myocardial damage and homogeneously high 201Tl uptake were found. In ischemic heart disease, wall motion did not discriminate extensive from mild structural damage. 201Tl activity was inversely related to myocardial fibrosis (r = -0.50, p = 0.0001). Severe defects in 201Tl uptake (<50%) predicted extensive (>30%) fibrosis with 83% sensitivity and 63% specificity. Segmental akinesis and apical location resulted in loss of sensitivity (74% and 58%, respectively). No histologic or wall motion abnormality accounted for poor specificity. In the individual patient, more than nine segments determined viable by imaging criteria predicted left ventricular fibrosis of less than 15% with 86% accuracy. CONCLUSIONS: This histopathologic-clinical correlative study supports current evidence of good sensitivity but limited specificity of 201Tl rest-redistribution tomographic imaging in the evaluation of viable myocardium. In the individual patient, more than nine viable segments reliably predicted a limited extension of fibrosis.

Adult↗
PubMedDate not supplied

Infections in heart transplant recipients: the experience of the Italian heart transplantation program. Italian Study Group on Infections in Heart Transplantation.

Infectious complications are an important cause of morbidity and mortality in heart transplantation. In this report we describe their incidence in the Italian Heart Transplantation Program and their relationship to induction immunosuppressive protocols used. A total of 662 heart transplantations in 651 patients had been performed by March 1, 1990, in 10 Italian centers, with a follow-up of 12,022 patient-months. Actuarial survival at 54 months was 80%. There were 115 deaths, 28 as a result of infection (24%); 30 were perioperative. Mortality from infection was 15% in the first 30 postoperative days and 35% thereafter. During follow-up, 256 life-threatening infectious episodes occurred in 180 patients, for a mean of 1.42 infections/patient. Of these episodes, 28 (10.9%) were lethal. The rate at 54 months, excluding perioperative deaths, was 0.021 episodes/patient-month, with a mean of 0.39 infections/patient in the 651-patient series. At 6 months, 72% of patients were free from infection. This value did not change significantly during subsequent follow-up. Bacterial infections were most frequent (49.2%); fungal (10.5%) and protozoan (5.9%) infections had the worst outcome (lethality 26% and 20%, respectively). A primary cytomegalovirus infection was observed in 23 cases (12 mismatches). Lung involvement (99 episodes) and bacterial sepsis (47 episodes) were most common. Eighty episodes of infection (31.2%) were preceded by a supplementary treatment for rejection with steroid pulses (69%), prednisone boost (20%), or cytolytic therapy (11%). Treatment had preceded the infection by less than 15 days in 55% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Transplantation↗
PubMedDate not supplied

The Italian Heart Transplant Project: organization of a multicenter program.

The Italian Heart Transplant Project is a national program coordinated by the Health Ministry and involves eight cardiac surgery centers, two coordination centers for organ procurement, and one national registry. An intercenter network for the solution of logistic problems regarding organ procurement and assignment has been built up. Preintervention and clinical follow-up data are recorded in each center and in a national registry by the implementation of a computerized data base. This is realized by employing low cost and diffuse software and hardware. The complex goal of common data collection and standardization is also being pursued for collateral areas such as cardiac pathology and immunologic surveillance. Data collection is useful for clinical monitoring and also for costs and/or requirements analysis.

Data Collection↗
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[Case of benign familial chorea].

The authors present a family affected by benign chorea. It is a hereditary disease, characterized by dominant autosomic transmission, with incomplete penetrance. Genetic, clinical and evolutional features are reported. The choreic movements rise in the first twenty years of life but psychological deterioration, epilepsy or other neurological symptoms did not emerge. Pharmacological treatments did not help in such non progressive abnormal movements in our subjects. Computerized tomographic scan resulted negative in four subjects, examined in different phases of the disease. This confirms the hypothesis of a functional, rather than structural, lesion in this benign form of familial chorea.

Adult↗
PubMedDate not supplied

[Internal hernia of the stomach through gastro-splenic ligament defect].

An internal hernia of the stomach through a gastro-splenic defect is presented. This exceptional condition, that we can include between abdominal internal hernias, induced an high bowel occlusion that needed of emergency surgical treatment. The dilatation of the stomach, the weakness of anchorage structures, its ability to rotation and the emptying kinetic activity posterior actually favoured the incarceration of a part of the posterior wall in a gastro-splenic defect. Detension, hernial reduction and suture of gastro-splenic defect resolved the case: no post-operative complications, the patient was discharged in eight post-operative day.

Aged↗
PubMedDate not supplied

Interaction of natural killer cells with extracellular matrix induces early intracellular signalling events and enhances cytotoxic functions.

NK cells are endowed with a wide array of adhesion molecules which mediate their interaction with endothelium and extracellular matrix components. We have shown that cross-linking of beta 1 integrins and CD44 on human NK cells induces a signal transduction pathway involving both tyrosine kinase activation and the modulation of intracellular calcium levels. Our studies have also demonstrated the ability of beta 1 integrins and CD44 to upregulate both the spontaneous and the CD16-triggered cytotoxic activity of human NK cells. Although the molecular mechanisms responsible for this costimulatory activity have not been defined yet, our studies indicate that the simultaneous cross-linking of beta 1 integrins and CD44 results in a synergistic effect on CD16-mediated enhancement of intracellular free calcium concentration, and suggest that this may be relevant for the cooperation observed.

Cell Communication↗
PubMedDate not supplied

[Natural history of breast cancer: lobular carcinoma versus ductal carcinoma in our experience].

Aim of the study is to evaluate the biology, the clinical evolution and the prognosis of lobular carcinoma of the breast. We retrospectively evaluated the patients treated in our institution during the last 13 years. 117 patients with lobular carcinoma of the breast and 117 patients, randomized out of 397 patients with 'classical' pattern of ductal carcinoma were compared. Age distribution, type of surgery, tumor size, TNM stage, axillary lymph node involvement, multifocality, multiple breast cancers, local and distant recurrences, overall survival and disease-free survival have been evaluated. There was not a significant difference in tumor size, lymph node involvement, stage distribution, estrogens and progesterone receptors status, local and distant recurrences. The only significant differences were found in multifocality and multiple breast cancers. The said difference does not seem to modify the overall survival and the disease-free survival that are the same in the two groups. Our research shows that tumor size and axillary lymph node status are the only elements that have to be considered in the choice of the surgical treatment and prognosis. It seems that the difference in distant metastatic pattern between lobular and ductal carcinoma is the distinctive feature in the follow-up of these patients.

Breast Neoplasms↗
PubMedDate not supplied

[Our experience in the surgical treatment of early breast cancer. Results of a prospective study of 204 cases].

The authors report the results of a prospective study on 204 patients (1980-1993) affected by early infiltrating breast cancer (size pounds 2 cm) as a part of a surgical series of 608 cases. 53 cases who underwent QUART (25.9%) and 151 cases (74.1%) who underwent mastectomy modified according to Patey have been collected. 10 years actuarial survival has been respectively 79% after extensive surgery and 78% after conservative treatment. Local recurrences have been observed in 9 cases after meticulous follow-up (median 74.8 months, range 12-178): 3 (5.66%) patients after QUART and 6 (3.97%) after mastectomy; furthermore 1 patients after a conservative treatment (1.88%) has developed a second tumor at the same side probably dependent on the presence in the primary tumor of an extensive intraductal component. No correlations between histological features, grading, positive nodes, receptor status and local recurrences have been found. Only the age of patients looks significantly correlated with frequency of recurrences: 44.45% of local recurrences have been observed in patients less than 45 years old. Local recurrences after QUART have obliged, in all cases, to a radical mastectomy. Furthermore, frequency of distant metastases has been considered: after QUART percentage is lower (9.43%) than after radical mastectomy (13.9%). This consideration looks correlated with the longer follow-up of the later group. A multidisciplinary approach is advised but the most important role is played by surgery. In conclusion it is outlined that conservative surgery is addressed to selection and consenting patients.

Actuarial Analysis↗
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[Primary lymphoma of the breast. Three cases of non-Hodgkin lymphoma].

Primary and sole breast lymphoma is a very rare disease. With the review of our series of 616 cases operated on for breast cancer, only 3 cases (0.48%) of primary breast non-Hodgkin lymphoma (LNH) have been observed. The authors outline the problems concerning diagnosis and therapy of this rare disease: pathological and immunohistochemical aspects are discussed. They stress the importance of staging in order to plan a correct multidisciplinary approach.

Aged↗