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Biomedical subjects

S Palma

Publications and source records attributed to S Palma.

At least 19 recordsLinked to original sources

Effect of p53 haploinsufficiency on melphalan-induced genotoxic effects in mouse bone marrow and peripheral blood.

Mice heterozygous for a p53 null mutation develop tumours induced by genotoxic carcinogens with a shorter latency than wild type mice and have been proposed as an alternate animal model for carcinogenicity testing. Some literature data suggest that p53+/- mice might also be more sensitive to the short-term effects of genotoxic agents and manifest a haploinsufficiency phenotype that could contribute to the higher tumour susceptibility. We have compared the induction of micronuclei in bone marrow and blood of p53+/- and p53+/+ isogenic mice after treatment with a single or multiple doses of melphalan (MLP), a crosslinking genotoxic carcinogen. We have also characterized the mechanism of micronucleus induction with CREST staining of kinetochore proteins to distinguish between chromosome break- and chromosome loss-induced micronuclei. Significant increases of micronucleated bone marrow polychromatic erythrocytes and blood reticulocytes were induced under all MLP exposure conditions. The frequency of micronucleated blood erythrocytes increased linearly with duration of exposure. Micronuclei were essentially a consequence of chromosome break events. After a single MLP dose, a significant reduction of the frequency of polychromatic erythrocytes in bone marrow of p53+/+ animals suggested the induction of cytotoxicity/cell cycle delay. This effect was not observed in p53+/- mice. We believe this finding to provide some evidence of a haploinsufficiency phenotype in the modulation of cell cycle/apoptotic pathways mediated by the p53 protein. In bone marrow of wild type mice, an increased effect of multiple MLP doses was detected over that of a single administration, whereas, in p53+/- mice, no differential effect was found of different exposure durations. Possibly, the probability of micronucleus formation increased under chronic exposure because of increased cell division in response to peripheral anemia and a reduction of p53 protein level had a small effect on cell cycle modulation and on such indirect mechanism of micronucleus induction. However, pairwise comparisons between the frequencies of cells with micronuclei in wild type and p53+/- mice under all exposure conditions did not show statistically significant differences, suggesting that the observed effects of p53 haploinsufficiency were weak and temporary and a higher/faster induction of irreversible chromosome damage could not account for the increased susceptibility of p53+/- mice to MLP-induced tumours.

Animals↗

Relative binding affinity of novel steroids to androgen receptors in hamster prostate.

The in vivo and in vitro antiandrogenic activity of four aromatic esters 10a-10d, one aliphatic ester 10e based on the pregna-4,16-diene-6, 20-dione structure and two aromatic 17c, 17d and two aliphatic valeroyloxy esters 17a, 17b based on the more saturated 4-pregnene-6,20-dione skeleton was examined. The biological activity of steroids 9, 10a-10e and 17a-17d, was determined using prostate glands from gonadectomized adult male golden hamsters. In the in vitro studies, the relative binding affinity of these steroids to cytoplasmic androgen receptor (AR) of hamster prostate was determined from, the corresponding IC50 values obtained from the competitive binding plots. The standards dihydrotestosterone (DHT) and cyproterone (CA) acetate used have displaced [3H]DHT from the AR with an IC50 value of 3.2 and 4.4 nM respectively. All steroidal compounds synthesized in this study showed a binding affinity for the androgen receptor, present in the cytosol from prostate hamster; compounds 10a-10c showed the highest affinities for this receptor. The in vivo experiments showed that all steroidal derivatives were subcutaneously active, since they decreased the weight of the prostate gland in gonadectomized hamsters treated with DHT, and are antagonists for the androgen receptor since they block the DHT-induced prostate weight gain. The derivatives having the more conjugated 4,16-pregnadiene-6, 20-dione system (10a-10c) exhibited a higher antiandrogenic activity than the corresponding steroids (17a-17d) based on the more saturated 4-pregnene-6,20-dione system.

Androgen Antagonists↗

Relationship between hospital infection and long-term mortality in general surgery: a prospective follow-up study.

A prospective study of 1431 patients admitted to a general surgery department were followed up for a median of 6.2 years after discharge (7679 person-years of follow-up). We collected information on underlying conditions, including severity of illness, and healthcare-related variables. Relative rates of death and their 95% confidence interval (CI) were estimated using person-years as the denominator. Multiple-risk factors adjusted for relative rates (RR) were obtained using Poisson regression analysis. There were 172 deaths during the follow-up period after hospital discharge (2/100 person-years). Follow-up was complete in 91% of the cohort. There were no important differences in demographic characteristics or risk factors between patients followed up and those lost to follow-up. The death rate in patients with any hospital-acquired infection was 5.3/100 person-years, and the relative rate was 3.07 (95% CI: 2.20-4.24). After adjusting for the main predictors of mortality, we found an effect modification by the presence of chronic disease (P = 0.01 for the product-term between hospital infection and the diagnosis of chronic diseases). Among patients without any underlying chronic disease, hospital-acquired infection was related to a significantly higher long-term mortality (RR = 2.47, 95% CI: 1.24-4.91). In these patients, surgical wound infection yielded a RR of mortality of 3.44 (95% CI: 1.63-7.27). Among patients with underlying chronic disease no association between hospital infection and long-term mortality was found. No evidence of an important modification of the relative rate along the follow-up period was observed. In conclusion surgical patients without chronic disease developing hospital-acquired infection have an increased risk of long-term mortality.

Adolescent↗

[Selective parathyroidectomy with unilateral cervical exploration for primary hyperparathyroidism].

Primary hyperparathyroidism (pHPT), is caused in over 90% of the cases by a single parathyroid adenoma. Preoperative diagnostic imaging techniques, in particular dual phase scintigraphy with SestaMIBI/TC99 and high frequency probe ecography, are able to pinpoint it 90% of the time. These are the two cornerstones of modern pHPT surgery, which has witnessed the passage from cervical exploration of all the most common parathyroid glandular sites to a more carefully targeted, restricted approach in the side of the neck where the adenoma is suspected to be. This is how selective parathyroidectomy with unilateral cervical exploration and, recently, mini-invasive parathyroidectomy, came into being. Between 1996 and 2001, in the Otolaryngology Department of S. Maria della Misericordia Hospital in Udine, 39 patients affected by pHPT, half of whom (49%) were asymptomatic, underwent selective parathyroidectomy with unilateral cervical exploration. The object of this paper was to evaluate the efficacy of this surgical technique by comparing the pre- and post-operative calcaemia and parathormone levels. The normalization of these parameters, and particularly of the latter, was considered indicative of successful treatment. All the postoperative calcaemia levels were normal, while elevated parathormone levels persisted in only 2 cases (5%). Our statistics showed a 95% efficacy for selective parathyroidectomy, a result that is comparable to the percentages described in the literature. There were, furthermore, no significant peri- or postoperative complications in any of the cases. These observations, together with the brief operating times required for the procedure (20-25 minutes on average) and the low cost of the material employed, enable us to conclude that selective parathyroidectomy with unilateral cervical exploration continues to hold its own as a valid option in the present scenario of surgical pHPT treatment, also in consideration of the fact that it does not present the rigid inclusion criteria characteristics of mini-invasive techniques.

Adult↗

Antenatal exercise and birthweight.

Does strenuous antenatal exercise reduce birthweight? Does reducing maternal exercise increase birthweight? What to advise about exercise during pregnancy? We recruited 117 women who intended to exercise 5 or more times weekly during pregnancy to a study of whether reducing the amount of maternal exercise during pregnancy is associated with an increase in birthweight. Only 61/117 (52%) of women agreed to be randomised to either continue or to reduce (to 3 or fewer sessions of exercise weekly) their intended pregnancy exercise program. Most women who refused randomisation did not want to risk being asked to reduce their exercise during pregnancy. Within the randomised trial, there was no statistically significant difference between the mean birthweight of babies born to women who continued and those who reduced their intended exercise program. The high rate of refusal of randomisation limits the power of the study to find a difference in birthweight, limits the generalisability of the results and shows that many women intending to exercise at this level during pregnancy have an uncompromising attitude to exercise.

Birth Weight↗

Acanthamoeba keratitis associated with contact lenses; report of three cases in Italy.

Three female patients, aged from 17 to 44 years, developed Acanthamoeba keratitis associated with the use of soft contact lenses and cosmetic contact lens. Two of these patients were myopic and wore soft contact lenses for optical purpose, while the third patient used a cosmetic lens. In this paper we describe the related risk factors, the success of cultural procedures and the outcome of medical management. In 2 out of the 3 cases we obtained cultures positive for Acanthamoeba, from the contact lenses and the contact-lens case. The isolated strains belong to the group II according to Pussard and Pons and they were proven pathogen for experimentally infected mice. All infections were treated successfully; however in 2 out of the 3 patients the visual acuity was reduced to the light perception.

Acanthamoeba↗

[Biopsy of the temporal artery].

Horton temporal arteritis, or gigantocellular arteritis, is a panarteritis involving the mid-size and large arteries, in particular the temporal surface artery. This pathology is normally found in the elderly, particularly females. It can be manifest with some typical symptoms (i.e. cephalea, fever, visual disorders even leading to blindness mandibular claudication, high ESR, moderate anemia), there may be aspecific, atypical signs (i.e. only cephalea and fever, or widespread myalgia and artralgia) or it may arise following a cerebro-vascular accident. Treatment of this form of arteritis is based on the use of high doses of corticosteroids over a long period of time (at least 1-2 years). The present work describes a surgical technique for biopsying the temporal artery. The technique consists of withdrawal of a segment of the artery from the main branch and the frontal branch of the temporal surface artery. Since this form of arteritis often presents segmentary lesions, it is advisable to take a 4-5 cm sample so as to prevent false negatives. This simple surgical procedure can be performed under local anesthesia and is practically complication-free. The authors then discuss the indications for temporal artery biopsy and report 3 clinical cases (case no. 1 is an example of the classical manifestation while cases no. 2 and 3 are atypical, aspecific forms). Since both the classical and atypical forms of gigantocellular arteritis require high doses of corticosteriods over a long period of time, the temporal artery biopsy procedure is highly useful in formulating an accurate diagnosis. The well known side effects to long-term cortisone use make it necessary to use all the available instruments in making the correct diagnosis. Bilateral biopsy can be performed in those cases where the first biopsy proved negative but gigantocellular arteritis is still suspected.

Aged↗

[The contralateral ear in acquired cholesteatoma in children and adults].

Contralateral ear pathologies are frequently found in patients suffering from acquired cholesteatoma. A retrospective study was performed on 85 pediatric patients and 105 adults surgically treated for acquired middle ear cholesteatoma. All the patients were checked and the otomicroscopic picture photographed and compared in an attempt to gain insight into the pathogenesis and clinical indications by comparing two samplings from different age groups. In both groups the frequency of pathological contralateral ear manifestations was higher than found in the normal population. Similar results were obtained in the two groups and indicate that the same mechanisms come into play in both ears, starting at infancy. The finding of a particularly common association between cholesteatoma and contralateral retraction pockets with sinus cholesteatoma or pars tensa in the pediatric group appears to confirm that tubal dysfunction plays a pathogenic role in the genesis of cholesteatoma. From the practical point of view, systematic preventative measurement of the contralateral ear can lead to a reduction in major surgery and can affect the choice between open or closed tympanoplasty. Moreover, it may also condition the precision and length of the follow-up.

Adolescent↗

[Lyme disease in Chile. Prevalence study in selected groups].

BACKGROUND: The prevalence of Lyme disease in Chile is unknown. AIM: To study the existence and epidemiology of Lyme disease in Chile. PATIENTS AND METHODS: One hundred eighteen patients with signs or symptoms suggestive of Lyme disease were studied. Antibodies against Borrelia burgdorferi were measured using ELISA and indirect immunofluorescence screening tests. Positive cases were confirmed with ELISA using a purified antigen and Western Blot analysis. Human biological samples and ticks were cultured in BSK-H medium. RESULTS: Five patients, three with dermatological manifestations and two with facial palsy and other neurological symptoms, had antibodies against Borrelia, measured by ELISA and indirect immunofluorescence. However the presence of IgM antibodies by ELISA using purified antigen, was confirmed in only one case. All sera and cerebrospinal fluids were negative on Western Blot Analysis. No plasma, skin, CSF or thick culture yielded Borrelia CONCLUSIONS: We could not confirm the existence of Lyme disease in Chile. Positive screening with negative confirmatory test suggests false positive non-specific reactivity or that local Borrelia are antigenically different compared to North American strains.

Adolescent↗

[Current issues in the endoscopic treatment of tracheobronchial foreign bodies in pediatric age: personal observations].

The present paper reports some organizational hypotheses and presents personal experience in the endoscopic management of tracheobronchial foreign bodies in children. Many changes have taken place in endoscopy and anesthetic techniques over the last twenty years and these are reviewed. The present experience is based on data for 42 pediatric patients who had undergone tracheobronchial endoscopy from 1974 to 1994. Within this time lapse 3 separate periods have been identified-1974-1978, 1979-1990 and 1991-1994-for which there was a progressive improvement in endoscopic techniques. During the first period endoscopy was performed with the patient in apnea. During the second period endoscopy was able to last longer as the patient was periodically ventilated by means of the bronchoscope set in the trachea and by intermittently closing the proximal hole in the bronchoscope with a finger. During the third period endoscopy was made easier by the use of rod-lens telescopes attached to the forceps: this provided a better view when grasping the foreign body. Extractive tracheobronchial endoscopy requires close cooperation between anesthesiologist and endoscopist. As there is the risk of complications, the patient must be closely followed, not only during diagnosis and treatment but also post-operatively. For this reason parenteral administration of corticosteroids and antibiotics is advisable during the post-operative stage. Since extractive tracheobronchoscopy in pediatrics is still high risk surgery, the authors suggest three different solutions for the medical organization: a) The Pneumology-Bronchoscopy wards could be totally responsible for extracting the above-mentioned foreign bodies in children. b) An E.N.T.-Pneumological department could be set up aimed at improving rigid and flexible bronchoscope methods in both fields; this is suggested in view of the shortage of operating rooms in pneumology wards and the availability of E.N.T. specialists. c) The most important, most qualified E.N.T. wards (at least one for reach region) could be equipped with all the necessary tools. In this case the medical and paramedical staff would be kept up to date, also by attending bronchoscopy centers for adults. Hence the number of patients treated by each center would increase and the tracheobronchoscopic expertise of the E.N.T. specialists would improve. This would translate into a lowering of the risks and a better prognosis for these young patients.

Age Factors↗

[Anticardiolipin antibodies in connective tissue diseases].

The incidence of anticardiolipin (ACL) antibodies in connective tissue disorders other than systemic lupus was investigated in 113 subjects: 68 had rheumatoid arthritis, 23 primary Sjogren syndrome and 22 had systemic sclerosis. VDRL, thromboplastin time and determination of IgG and IgM ACL antibodies (ELISA) were performed in all subjects. Overall, 45% of patients were positive for ACL antibodies, mostly of the IgG variety (90%). No differences were observed among the investigated diseases. Positive ACL antibodies were not related to evidence of antiphospholipid syndrome nor to clinical characteristics of the different diseases. These results confirm that ACL antibodies may be present in connective tissue disorders other than systemic lupus, but they do not predict the development of antiphospholipid syndrome nor help to characterize the severity of the disease.

Antibodies, Anticardiolipin↗

[Severe ischemia of the hand. Treatment with regional intravenous sympathicolysis with reserpine].

Treatment of severe hand ischemia a associated to progressive systemic sclerosis and other disorders is controversial. We studied prospectively 45 patients, 41 female and 4 males, over an 11 year period. Age ranged from 16 to 73 years, mean 46. Underlying disease was systemic sclerosis in 30, CREST in 8, overlapping syndrome in 4, systemic lupus in 1 and non rheumatic vasculitis in 2 patients. Treatment consisted of intravenous injection of reserpine, 1 mg, at a superficial arm vein after controlled local circulatory block for 15 min. Regional anesthesia was required in 38 patients. Adequate follow up was obtained in 32 females and 2 males, receiving a mean of 3.1 therapy sessions (range 1 to 13). Morphologic improvement from 3.09 +/- 0.16 to 1.57 +/- 0.13 and functional improvement from 3.6 +/- 0.12 to 1.75 +/- 0.14 (5 grade scoring system), was observed (p < 0.001). These results correlate with adequate rehabilitation confirmed clinically.

Adolescent↗

[Anticardiolipin antibodies in systemic lupus erythematosus: prevalence and clinical associations].

Anti-cardiolipin antibodies have been recently described in patients with systemic lupus erythematosus and other autoimmune disorders. Venous and arterial thrombosis, thrombocytopenia and recurrent abortion have been associated to the presence of these antibodies. Among 161 patients with systemic lupus we found 66% with anticardiolipin antibodies, mostly IgG type. Thrombosis and thrombocytopenia were more frequent in these patients (p < 0.05), especially among those with high titers. No association was found with central nervous system involvement, recurrent abortion, antinuclear or anti-DNA antibodies nor positivity for VDRL. These results support the frequent presence of anti-cardiolipin antibodies in patients with systemic lupus and their association to thrombosis and thrombocytopenia.

Adolescent↗

[Anticardiolipin antibodies and primary antiphospholipid syndrome of the central nervous system: report of 10 clinical cases].

An association between anti-phospholipid antibodies and different disorders of the central nervous system has been described recently. We used an ELISA technique and detected anti-cardiolipin antibodies of the IgG or IgM variety in a series of 10 patients: 4 had occlusive stroke, 2 brain hemorrhage, 2 chorea, 1 a Sneddon syndrome and 1 vascular cephalea. The diagnosis of primary anti-phospholipid syndrome was suggested after ruling out systemic lupus in all patients.

Adult↗

Evolution of the indications for cesarean section. Results of a retrospective study.

We have analysed in retrospect the incidence of cesarean section during the years 1977-1989 in the 1st Obstetric and Gynecologic Clinic of the University of Bologna, and the development over time of the principal indications. The average incidence (17.1%) of cesarean section increased progressively from 9% in 1977 to 28% in 1989 with a peak at the beginning of the '80s (the period during which cardiotocographic monitoring became routinely used). With regard to the indications from 1977 up to date cesarean sections carried out on account of fetal distress increased almost five-fold. The increase in cesarean sections carried out on account of maternal disease, breech presentation and previous cesarean section was less important, while those performed for dystocia resulted markedly reduced.

Adult↗