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Biomedical subjects

R Utili

Publications and source records attributed to R Utili.

108 records · Page 6Linked to original sources
PubMed1976

Cholestatic effects of Escherichia coli endotoxin endotoxin on the isolated perfused rat liver.

The effects of Escherichia coli endotoxin on the function of the ex vivo perfused rat liver were examined in order to investigate the possible role of circulating endotoxin in the pathogenesis of cholestatic jaundice observed in humans with gram-negative bacterial infections. Endotoxin led to a dose-dependent impairment of bile flow and of sulfobromophthalein (BSP) excretion. The demonstration that indocyanine green excretion was also significantly decreased by endotoxin suggests that the impaired dye excretion was not due to an inhibition of BSP conjugation in the hepatocyte. Analysis of the kinetic data suggested that the effects of endotoxin were on the excretory mechanisms of the hepatocyte. These effects did not seem attributable to endotoxin-mediated changes in perfusate flow since a mechanical reduction in perfusate flow caused no decrease in the excretion of bile or BSP. The results of the present study provide supportive evidence for the hypothesis that circulating endotoxin can adversely affect hepatic function and may contribute to the production of intrahepatic cholestasis seen during bacterial infection. Hepatocyte injury by endotoxin, as judged by the leakage of enzymes from hepatocyte suspensions or from the perfused rat liver, could not be demonstrated.

Animals↗
PubMed1975

[Value of a low-calorie diet in the diagnosis of Gilbert's syndrome].

Reduction of the calorie intake to 400 per day was employed in clinching the diagnosis in a case of Gilbert's disease admitted in the course of remission. This diet, in fact, results in a marked increase in serum bilirubin concentration. The non-conjugated form, in fact, reached values 5 times greater than those observed initially, within 24 hr after commencing the diet. Unlike other cases reported in the literature, this increase occurred in spite of an initially normal blood bilirubin level.

Adult↗
PubMedDate not supplied

Cholestasis induced by estradiol-17 beta-D-glucuronide: mechanisms and prevention by sodium taurocholate.

Estradiol-17 beta-D-glucuronide (E-17G), a metabolite of natural estrogen, is a potent cholestatic agent in vivo. We, therefore, studied the mechanisms of E-17G cholestasis using in vitro perfused rat liver system. Furthermore, since it has been postulated that sodium taurocholate (TC) may interfere with either uptake or biliary excretion of other steroid agents, we tested whether E-17G cholestasis could be modified by TC administration. During a constant infusion of TC at a physiological rate (0.50 mumole per min), a dose-dependent decrease of bile flow was observed after E-17G addition from 1.5 to 5 X 10(-5) M. E-17G decreased bile acid excretory rate but not bile acid concentration in bile. In separate experiments, TC was infused at different rates (0, 0.25, 0.50, and 0.75 mumole per min) into the perfusate over the entire experimental period, and E-17G was added at 1.75 X 10(-5) M. In this setting, E-17G cholestasis was diminished by increasing TC infusion rate and was prevented by TC at 0.75 mumole per min. Infusion of sodium dehydrocholate (0.75 mumole per min), a nonmicelle-forming bile acid, did not prevent E-17G cholestasis. During E-17G cholestasis, an increased biliary permeability to 14C-sucrose was observed. This effect was also prevented by TC, but not by sodium dehydrocholate which was infused at 0.75 mumole per min. The perfusate disappearance curves of 3H-E-17G at the different TC infusion rates showed no changes in the initial uptake phase, but a profound dose-dependent difference in the excretory phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphatases↗
PubMedDate not supplied

Visceral leishmaniasis during pregnancy treated with meglumine antimoniate.

Data on the efficacy and safety of pentavalent antimony in the treatment of visceral leishmaniasis during pregnancy are scanty. A case of visceral leishmaniasis in a 39-year-old woman in the second trimester of pregnancy is reported here. The patient was hospitalized in poor condition with high fever and pancytopenia which had lasted for 6 weeks. A bone marrow aspirate revealed numerous amastigotes and serodiagnosis for Leishmania was positive at a high titer. The patient was successfully treated with meglumine antimoniate at a daily dose of 850 mg of antimony for 20 days. She delivered at term a healthy female baby who remains in good condition at 18 months of age. Thus a dose of 850 mg of antimony, which is lower than that presently recommended, seems to be effective and non toxic to the fetus when administered at the second trimester of pregnancy.

Adult↗
PubMedDate not supplied

Role of immunosuppressive regimen on the incidence and characteristics of cytomegalovirus infection in heart transplantation: a single-center experience with preemptive therapy.

OBJECTIVE: This retrospective single-center report sought to evaluate the relation of immunosuppressive regimen with the incidence and characteristics of cytomegalovirus (CMV) infection from 1999 to 2003. PATIENTS AND METHODS: Immunosuppression consisted of cyclosporine microemulsion (Neoral), azathioprine (AZA), and prednisolone associated with either thymoglobulin or ATG high-dosage induction from 1999 to 2000 (AZA, 64 patients [AZA-Thymo = 38 patients and AZA-ATG 26 patients]), or cyclosporine microemulsion (Neoral), mycophenolate mofetil (MMF), and prednisolone with low-dose thymoglobulin induction from 2001 onward (n = 52 patients). Ganciclovir preemptive therapy was guided by pp65 antigenemia monitoring without CMV prophylaxis. RESULTS: The study groups were homogeneous with respect to major perioperative risk factors. Comparing the two AZA subgroups no difference emerged as to percentage of pp65 antigenemia-positive, preemptively treated patients reflecting CMV disease incidence and relapses. AZA-Thymo patient showed significantly shorter time to first positive pp65-antigenemia and higher viral load (AZA-Thymo vs AZA-ATG, P = .004 and P = .009). The two subgroups did not differ with regard to incidence of rejection, superinfection, and graft coronary disease. By shifting from AZA to MMF no difference emerged as to incidence and characteristics of CMV infections, but there was a significant reduction in acute rejection and superinfection (AZA vs MMF P = .001 and P = .008). CONCLUSIONS: The distinct immunological properties of thymoglobulin versus ATG significantly altered the pattern of CMV expression. MMF with reduced-dose induction did not engender a higher CMV morbidity.

Adult↗
PubMedDate not supplied

Superior vena cava thrombosis after intravascular AICD lead extraction: a case report.

Pacemaker lead extraction has been shown to be an effective and safe treatment in the case of infected per-manent pacemaker leads. However, it can lead to potentially serious complications, usually occurring during the ex-traction procedure. This report describes a case of a 74-year-old male with a persistent superior vena cava thrombo-sis related to an infected permanent pacemaker lead transvenous extraction. Clinical and surgical management are discussed.

Aged↗
PubMedDate not supplied

[Gram-positive bacterial infections resistant to antibiotic treatment].

Antibiotic resistance has become a major problem in the treatment of gram-positive bacterial infections. These organisms are able to escape antibiotic activity through several mechanisms including beta-lactamase production, altered penicillin-binding proteins, aminoglycoside-modifying enzymes, modification of the target site of the antibiotic, and active efflux. Resistant determinants may be carried on the chromosome, and are transmitted vertically by clonal dissemination, or on mobile elements such as plasmids, transposons or integrons capable of horizontal transfer both within and between species. Several resistant genes can be inserted in a given integron, resulting in multi-drug resistance. Antimicrobial resistance mechanisms can be caused or induced following the widespread use of antibiotics. The most important gram-positive resistant organisms include penicillin-resistant Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, methicillin-resistant Staphylococcus aureus with intermediate resistance to vancomycin, and enterococcal strains that express high-level resistance to aminoglycosides and/or resistance to vancomycin. In several instances, these strains show multi-drug resistance and cannot be treated with currently available agents. Therapeutic strategies include the use of a higher antibiotic dosage, the use of alternative, non-conventional drugs, alone or in combination, after demonstration of their efficacy in vitro and in experimental animal models, and the development of new drugs. New agents available include quinupristin/dalfopristin and line-zolid with activity against most resistant gram-positive bacteria. Promising new drugs that may reach the market in the near future include daptomycin and oritavancin. Careful use of antibiotics and adherence to infection control standards are crucial in preventing the development and the spread of resistant organisms.

Drug Resistance, Microbial↗
PubMedDate not supplied

Inhaled tobramycin in children with acute bacterial rhinopharyngitis.

Antibiotic abuse for treating rhinopharyngitis induces the occurrence of resistant bacteria. As topical drugs might reduce this phenomenon, the aims of our study were to evaluate inhaled tobramycin in children with acute bacterial rhinopharyngitis and to compare it with oral amoxicillin/clavulanate. The trial was conducted as randomized, parallel group and double blind. Children, aged 3-6 years, with acute bacterial rhinopharyngitis were treated with 15 mg of aerosolized tobramycin (Group A) or 50 mg/Kg of amoxicillin/clavulanate (Group B) twice daily for 10 days. The following parameters were assessed: nasal obstruction, mucopurulent rhinorrhea, post-nasal drip, adenoidal hypertrophy, tympanic inflammation, tympanogram, rhinomanometry and cultures. Of 416 patients screened, 311 children (178 females and 133 males), median age 4.5 years, completed the study: 156 in Group A and 155 in Group B. Both treatments improved all parameters (p<0.01 for all). Intergroup analysis showed that inhaled tobramycin induced a better improvement versus amoxicillin/clavulanate concerning nasal obstruction (p<0.05), adenoidal hypertrophy (p<0.01), tympanic inflammation (p<0.01), rhinomanometry (p<0.01) and cultures (p<0.05). In conclusion, inhaled tobramycin may represent a valid treatment for acute bacterial rhinopharyngitis in children, as it is effective, safe, economic and simple to use.

Acute Disease↗
PubMedDate not supplied

[Role of hepatitis C virus in mixed cryoglobulinemia in patients with chronic hepatitis].

To evaluate the role played by hepatitis C virus (HCV) in mixed cryoglobulinemia in subjects with chronic hepatitis, we studied 72 consecutive patients: 43 had HCV-related chronic hepatitis, 19 HBV-related chronic hepatitis, and 10 chronic hepatitis of other etiology. We used second generation ELISA and RIBA to test for mixed cryoglobulinemia and anti-HCV antibodies in both serum and cryoprecipitates; HCV RNA were evaluated by "nested" PCR. Serum levels of rheumatoid factor and complement were also determined. The immunoglobulins in the cryoimmunoprecipitate were characterized by immunofixation electrophoresis. Cryoglobulinemia was present in 47% of the patients with chronic hepatitis C but in none of the sera of patients with HBV-related chronic hepatitis nor in those with chronic hepatitis of non-viral etiology. Type II mixed cryoglobulinemia was observed in 45% of the cases, and type III in 55%. HCV RNA and anti-HCV antibodies were present in all the cryoimmunoprecipitates. Ninety-five percent of the cryoglobulinemic patients had serum rheumatoid factor and 80% of them had low serum levels of C4. Our data indicate that mixed cryoglobulinemia is frequently associated with HCV-related chronic hepatitis, and that HCV and anti-HCV antibodies play an essential role in the development of mixed cryoglobulinemia.

Chemical Precipitation↗
PubMedDate not supplied

Therapeutic index of taurocholate or tauroursodeoxycholate in experimental drug-induced cholestasis.

The therapeutic index of either taurocholate (TC) or tauroursodeoxycholate (TUDC) administration in the treatment of drug-induced cholestasis was evaluated in perfused rat liver using a dose-response study. During estradiol-17-beta-glucuronide cholestasis, TC was more effective than TUDC in ameliorating bile flow but showed a low margin of safety since high doses caused additional toxicity. In contrast, TUDC ameliorated cholestasis even at very high doses with no adverse effects. In the model of chlorpromazine cholestasis, TC infusion did not correct but rather aggravated cholestasis, whereas TUDC at nonsaturating doses reversed the cholestasis and only at very high doses caused some toxicity. TUDC shows a good therapeutic index and may be employed with a reasonable margin of safety in the treatment of drug cholestasis.

Animals↗