A reversible posterior leukoencephalopathy syndrome.
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Brain Diseases↗
Biomedical subjects
S Romano
Publications and source records attributed to S Romano.
Training to criterion in eyeblink classical conditioning in Alzheimer's disease, Down's syndrome with Alzheimer's disease, and healthy elderly.
The cholinergic antagonist scopolamine delays acquisition of eyeblink classical conditioning (EBCC) in rabbits and humans, but scopolamine-treated organisms eventually acquire conditioned responses (CRs). Patients with probable Alzheimer's disease (AD) and older adults with Down's syndrome (DS/AD) have disrupted cholinergic systems and perform EBCC very poorly. It was hypothesized that patients with probable AD and DS/AD, like scopolamine-injected organisms, would acquire CRs if given sufficient training. Twelve probable AD patients, 12 DS/AD patients, and 6 healthy elderly control individuals participated in 5 daily 90-trial sessions of EBCC. Fifty-eight percent of the probable AD, 92% of the DS/AD, and 100% of the control participants achieved learning criterion. Probable AD, DS/AD, and control participants had statistically significant increases in the percentage of CRs produced over 5 EBCC sessions. The neural substrate for EBCC was not eliminated in probable AD or DS/AD patients, although the learning mechanism was disrupted.
Adult↗
Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicentre randomised study.
After curative resection for gastric adenocarcinoma, 103 patients, all with positive nodes, were randomised so that 48 received adjuvant chemotherapy of epidoxorubicin (EPI) 75 mg m-2 on day 1, leucovorin (LV) 200 mg m-2 on days 1-3 and 5-fluorouracil (5-FU) 450 mg m-2 on days 1-3, every 21 days for 7 months, whereas the remaining 55 did not. During the first year of observation, 21 control patients (38%) and five treated patients had recurrences. After a follow-up period of 36 months, 12 of the treated patients (25%) and only seven controls (13%) were still alive. At that point, the median survival was 13.6 months for the 55 untreated patients and 20.4 months for the 48 treated patients, a significant difference. We found a survival advantage for patients treated with the EPI-LV-5-FU regimen and a consistent delay in the appearance of recurrent or metastatic cancer. Acute toxicity was mild and treatment was well accepted by all patients. There was no long-term toxicity or any cardiac toxicity. We conclude that this particular chemotherapy, administered shortly after gastric resection, improves survival rate in node-positive gastric cancer patients, even although final assessment of this particular adjuvant approach must await completion of the trial.
Adenocarcinoma↗
Cardiovascular and ventilatory response to isocapnic hypoxia at sea level and at 5,050 m.
To assess the effect of chronic hypoxic conditions on ventilatory, heart rate (HR), and blood pressure (BP) responses to acute progressive isocapnic hypoxia, we studied five healthy Caucasian subjects (3 men and 2 women). Each subject performed one rebreathing test at sea level (SL) and two tests at the Pyramid laboratory at Lobuche, Nepal, at the altitude of 5,050 m, 1 day after arrival (HA1) and after 24 days of sojourn (HA2). The effects of progressive isocapnic hypoxia were tested by using a standard rebreathing technique. BP, electrocardiogram, arterial oxygen saturation, airflow and end-tidal CO2 and O2 were recorded. For each subject, the relationships between arterial oxygen saturation and HR, systolic BP and minute ventilation (VE), respectively, were evaluated. At HA1, the majority of subjects showed a significant increase in VE and BP response and a decrease in HR response to progressive isocapnic hypoxia as compared to SL. At HA2, VE and BP responses further increased, whereas the HR response remained similar to that observed at HA1. A significant relationship between hypoxic ventilatory responses and both systolic and diastolic BP responses to progressive hypoxia was found. No significant correlation was found between hypoxic ventilatory and HR responses.
Adult↗
Prostaglandin E1 versus mixture of prostaglandin E1, papaverine and phentolamine in nonresponders to high papaverine plus phentolamine doses.
PURPOSE: We evaluated the efficacy of 40 micrograms/ml, prostaglandin E1 versus a combination of 17.64 mg./ml. papaverine hydrochloride, 0.58 mg./ml. phentolamine mesylate and 5.8 micrograms/ml. prostaglandin E1 (3-drug mixture). MATERIALS AND METHODS: A total of 32 patients randomly received 1 ml. of either medication by the intracavernous route. All patients had presented with erectile dysfunction longer than 6 months in duration and had failed to respond to high doses of papaverine (60 mg.) plus phentolamine (1 mg). RESULTS: Of 32 patients 7 (22%) responded to prostaglandin E1 and 16 (50%) to the 3-drug mixture, achieving erections allowing penetration (grade E4 or E5, p < 0.05). Pain was reported by 41% of the patients receiving prostaglandin E1 and 12.5% administered the 3-drug mixture. CONCLUSIONS: The 3-drug mixture may be regarded as more effective than prostaglandin E1 alone in inducing an erectile response with a decreased incidence of pain.
Adult↗
Intravenous administration of gentamicin once daily versus thrice daily in adults.
The efficacy and safety of intravenous gentamicin administered once daily versus thrice daily was evaluated in adults. Patients over 16 years of age with a suspected or documented gram-negative infection were randomly divided into two groups: one group received gentamicin intravenously 4.5 mg/kg once daily (n = 48), and the other received 1.5 mg/kg every eight hours (n = 52). Baseline characteristics were comparable in the two groups. The mean peak level of gentamicin in the once daily group was significantly higher than that in the thrice daily group, 8.7 +/- 2.3 mg/l versus 4.6 +/- 1.2 mg/l (p < 0.005), and the trough level lower, 0.7 +/- 0.3 mg/l versus 1.1 +/- 0.9 mg/l (p < 0.005). The clinical cure rate was significantly higher in the once daily group, 42 of 48 (87.5%) versus 36 of 52 (69.2%). The microbiological cure rate was also better in the once daily group than in the thrice daily group (31 of 36 versus 28 of 38 patients evaluated), although this difference was insignificant. Nephrotoxicity was not observed in either group, but ototoxicity was present in three of the patients treated thrice daily. A once daily dosing regimen of gentamicin is more effective and less ototoxic than a thrice daily regimen.
Adolescent↗
Spontaneous resolution of ectopic tubal pregnancy: natural history.
OBJECTIVE: To determine the characteristics and long-term outcome of women succeeding or failing expectant management of ectopic pregnancy (EP). DESIGN: Prospective, defined protocol. SETTING: University-affiliated gynecology department. PATIENTS: We used a protocol that selected women with laparoscopic confirmed ectopic tubal pregnancy and declining plasma hCG values. Over a 5-year period, 60 women representing 20.1% of EPs fulfilled the inclusion criteria. Women were followed with serial hCG testing and transvaginal ultrasound. MAIN OUTCOME MEASURE: Success or failure of expectant management. RESULTS: Expectant management was successful in 28 (47.7%) of the patients. Thirty-two (53.3%) failed expectant management, and a treatment procedure was required. There was no difference in the resultant ipsilateral tubal patency or 1-year fertility rates of those women succeeding or failing expectant management. Analysis showed that in the face of declining values and with a starting hCG > 2,000 mIU/mL (conversion to SI unit, 1.00), 93.3% failed expectant management, whereas < 2,000 mIU/mL, 60.0% succeeded. CONCLUSION: We conclude that expectant management should be offered as a treatment option only in those women fulfilling the criteria for a good prognosis.
Adnexa Uteri↗
Limited role for intratubal methotrexate treatment of ectopic pregnancy.
OBJECTIVE: To test the effectiveness of laparoscopic intratubal methotrexate (MTX) injection or salpingostomy in the treatment of ectopic pregnancy (EP). DESIGN: Prospective predefined protocol. SETTING: Department of Obstetrics and Gynecology of a university-affiliated hospital. PATIENTS AND INTERVENTIONS: Between January 1988 and December 1993, we treated 342 women with EP, of which 99 were treated by either laparoscopic salpingostomy (n = 55) or intratubal MTX injection (n = 44). MAIN OUTCOME MEASURES: The success and failure rates were calculated for each treatment protocol. Also analyzed were subsequent tubal patency and fertility rates. RESULTS: Salpingostomy was successful in 51 of 55 patients (92.7%), whereas intratubal MTX injection was successful in only 27 of 44 women (61.4%). Methotrexate injection particularly was unsuccessful if the initial hCG was > 2,000 mIU/mL (conversion factor to SI unit, 1.00) or the size of the tubal mass was > 2.0 cm as measured during laparoscopy. There was no difference in the subsequent tubal patency rates of fertility rates between women undergoing MTX injection or salpingostomy. CONCLUSIONS: These results suggest that salpingostomy is effective in the treatment of EP. Methotrexate injection failed in more patients despite preferential selection criteria, suggesting that its use should be limited to the subgroup of women with initial hCG < 2,000 mIU/mL and size at laparoscopy < 2.0 cm.
Adult↗
[The usefulness of noninvasive diagnostic methods in postinfarct prognostic stratification].
We have studied 455 consecutive patients with acute myocardial infarction to assess the early and mid-term prognostic value of clinical and laboratory findings in the acute (i.e. Killip classification, arterial PO2, echocardiographic extent of necrotic area) and subacute phase (exercise test, ambulatory ECG). Results showed that clinical examination, blood gas analysis and two-dimensional echocardiography have a high predictivity for in-hospital risk stratification. In particular, two-dimensional echocardiography showed that patients with diffuse wall motion abnormalities had a worse prognosis during the follow-up. Exercise test and, to a lesser extent, ambulatory ECG have well identified patients at risk for new coronary events.
Adult↗
[Frequency and mode of use of testing for HIV infection in women hospitalized for childbirth].
OBJECTIVE: To assess the use of HIV testing "because of pregnancy". DESIGN: Cross-sectional study. PATIENTS: Parturients admitted to the obstetric divisions of a public hospital located in Rome (February-April 1994). INTERVENTION: Standardized interview during post test counseling. OUT-COMES: Frequency and characteristics of HIV testing "because of pregnancy" and women's know ledge on HIV sexual and vertical transmission. RESULTS: Among the 506 women admitted all consented to be tested and 3 were found HIV seropositive (0.6%). A total of 239 (47%) unselected parturients were interviewed; the remaining differ only for a lower rate of cesarean delivery (13% vs 54%). Of the interviewed, 140 (58%) had been already tested for HIV infection, 91 (38%) during the current pregnancy according to gynaecologist's prescription (79.87%) and without counseling (55.60%) or ascertained risk factors (82.90%); 40% had been tested after the first trimester of pregnancy. Rate of vertical transmission was estimated higher than 50% in 147 cases; 150 women knew the "window period" but less than half estimated it correctly. CONCLUSIONS: The study showed a unsatisfactory use of HIV testing "because of pregnancy" and suggests the need for implementing in Italy information campaigns targeted both to women and gynecologists.
Adult↗
Intraamniotic infection with Candida albicans successfully treated with transcervical amnioinfusion of amphotericin.
We present a case in which a pregnant woman was seen at 27 weeks' gestation with premature rupture of membranes and intraamniotic infection with Candida albicans, which was treated with transcervical amnioinfusion of amphotericin B. After 7 days of treatment spontaneous vaginal labor developed. A female newborn of 1030 gm was delivered. The infant was normal and did well.
Adult↗
Ventilatory response to spontaneous resistive load variations during sleep.
We investigated the ventilatory response to spontaneous changes in resistive load during sleep in nine adult asthmatic patients, four of whom were snorers. All patients had a history of nocturnal worsening of respiratory symptoms and were submitted to a nocturnal polysomnographic study in a sleep laboratory. During the night, all patients showed spontaneous increases in pulmonary resistance due to bronchoconstriction. A temporary additional increase in inspiratory resistance (RI) was observed as a result of snoring. In all patients, a highly significant inverse linear relationship was found between ventilation (VE) and RI, but the slopes of the regressions varied considerably among patients; the decrease in VE was due to a reduced mean inspiratory flow. The most effective ventilatory compensation to increasing resistive load (lowest absolute values in the VE/RI slopes) was observed in two patients: one nonsnorer and one snorer. Effective VE compensation appeared to be dependent on the individual's combined adjustments of transpulmonary pressure (Ptp) and duty cycle (TI/TT). In fact, an increase in Ptp, linearly related to RI, was observed in all patients except one (a snorer during nonsnoring breathing); however, the Ptp increase was able to compensate VE only when TI/TT increased. We conclude that, in sleeping asthmatic patients, VE adaptation to increased spontaneous load is highly variable among patients and its effectiveness is related to individual strategies on the basis of adequate adjustments of neuromuscular output and timing of the breathing cycle.
Adult↗
Time course of right ventricular stroke volume and output in obstructive sleep apneas.
Because the behavior of right ventricular stroke volume (RVSV) in the obstructive sleep apnea syndrome (OSAS) is undefined, we studied the time course of RVSV by right heart catheterization during sleep in five OSAS patients. In 55 obstructive apneas, heart rate (HR) and RVSV were calculated beat-by-beat. RVSV was estimated by integrating the area under the pulmonary arterial (PA) blood velocity signal obtained by a velocity sensor-/micromanometer-tipped catheter. Compared with preapnea, mean RVSV did not change significantly during apnea, but decreased by 15% during postapnea. Analysis of RVSV in the respiratory cycle showed that postapneic RVSV was mostly reduced at maximal inspiration, suggesting a role of increased lung volume in decreasing RVSV. As for HR, it decreased significantly during apnea in four out of five patients. In all patients, HR returned to preapneic values during postapnea. Therefore, right ventricular output decreased slightly in most patients during late apnea because of decreased HR, whereas it decreased in all patients during postapnea because of decreased RVSV. These results, together with the known finding that PA pressure increases towards the end of apneas and remains elevated in the immediate postapnea, suggest that the most relevant changes in the pulmonary circulation occur at the resumption of ventilation, not during the apneic phase.
Adult↗
Slow and fast changes in transmural pulmonary artery pressure in obstructive sleep apnoea.
Our purpose was to assess how pulmonary artery pressure changes in relation to hypoxia and oesophageal pressure during obstructive sleep apnoeas. Transmural systolic pulmonary artery pressure (Ppa,STM), oxyhaemoglobin saturation (SaO2) and oesophageal pressure were analysed in two samples of consecutive obstructive apnoeas in each of four patients. In the first samples (samples A; probably recorded during non-rapid eye movement (NREM) sleep), SaO2 swings were small and repetitive. In the second samples (samples B; probably recorded during rapid eye movement (REM) sleep), they were large and more variable. Oesophageal pressure oscillated similarly in the two groups of samples. In all cases, transmural systolic pulmonary artery pressure progressively increased throughout apnoeas, and subsequently decreased in the interapnoeic periods. However, both early and end-apnoeic transmural systolic pulmonary artery pressure, remained stable in samples A; whilst they progressively increased in samples B. Transmural systolic pulmonary artery pressure at the beginning of each apnoea was inversely correlated with SaO2 at the end of the preceding apnoea. These results suggest that transmural systolic pulmonary artery pressure is influenced by SaO2, but does not vary at the same speed as SaO2. In all cases, beat-by-beat analysis showed, as expected, that the lower the oesophageal pressure, the higher the transmural systolic pulmonary artery pressure however, at each oesophageal pressure level, transmural systolic pulmonary artery pressure was more variable and higher, in samples B. In conclusion, transmural systolic pulmonary artery pressure in obstructive apnoeas shows rapid changes, which reflect oesophageal pressure variations, and slower changes, which are likely to be caused by SaO2.
Blood Pressure↗
Cytokines in acute myocardial infarction: selective increase in circulating tumor necrosis factor, its soluble receptor, and interleukin-1 receptor antagonist.
Cytokines play a pathogenetic role in a variety of infective and inflammatory diseases. In the present study, we had two objectives: (a) to define the kinetics of tumor necrosis factor (TNF) in plasma after acute myocardial infarction (AMI) in patients treated with early thrombolysis, and (b) to measure other cytokines, interleukin-1 (IL-1) and TNF receptor antagonists, in plasma. TNF-alpha, but not IL-1 beta or IL-8, was present in plasma of 6 of 7 patients with severe AMI (Killip class 3 or 4). No TNF (< 50 pg/ml) was detected in a group of 11 patients with uncomplicated myocardial infarction (Killip class 1) or in control patients without AMI. Soluble TNF receptor type I and IL-1 receptor antagonist (IL-1Ra) were also significantly increased in the group with severe AMI compared with those with uncomplicated AMI. Circulating TNF is increased only in AMI complicated by heart failure at hospital admission. This finding may have diagnostic and therapeutic relevance.
Aged↗
[ACE-inhibitors after infarction: current knowledge and future prospects].
Experimental and clinical findings showing a beneficial effect on ventricular remodelling have led to a widespread use of ACE-inhibitors in myocardial infarction. Recent trials (SAVE, AIRE, GISSI 3, ISIS 4) have clearly demonstrated that in patients with left ventricular dysfunction and/or heart failure the treatment with ACE-inhibitors is mandatory, although several questions remain unanswered. Recent experimental observations on the relationship between ACE and endothelial function, and between ACE and intimal proliferation have gone forward leading to new perspectives on the potential use of ACE-inhibitors in all patients with acute myocardial infarction.
Angiotensin-Converting Enzyme Inhibitors↗
[Influence of the early mother-infant contact in the delivery room on short or long term breast feeding].
Two groups of mothers and their children were followed up in order to assess the influence of early mother-child contact on breast-feeding; a first control was carried out at discharge from the nursery and a follow-up 6 months later. All the mothers were in good health and pregnancy was physiological with uncomplicated eutocic delivery; none of the babies presented pathologies during the period of their stay in the nursery and in the subsequent 6 months. Group A comprised 126 mothers who had had contact with their babies in the delivery room for at least one hour; group B comprised 109 mothers whose first contact with their baby was only 3-6 hours after birth. Significant differences between the 2 groups were observed as early as the first control which took place at discharge from the nursery: 69.1% of the babies in group A against 51.3% in group B had taken mother's milk exclusively (p < 0.01). Equally significant differences emerged from the subsequent control at 6 months: 70 babies out of 116 (60.4%) were breast fed exclusively or partially, against 42 out of 101 (42.4%) in group B (p < 0.01). Furthermore, important data emerged from the duration of breast-feeding, whether this was exclusive or otherwise, in the first 6 months of life: group A differed significantly from group B (p < 0.002). Our figures suggest a positive influence of early mother-child contact on breast-feeding and on its duration. Notwithstanding the fact that there is no unanimous confirmation in the literature, it is considered that such behaviour will bring benefits to both mother and child.
Age Factors↗
[Thallium-dipyridamole in acute myocardial infarction treated by thrombolysis: diagnostic and prognostic value].
BACKGROUND: The management of patients who received thrombolytic therapy for acute myocardial infarction is still controversial. It is not clear if the strategies usually followed after myocardial infarction for risk stratification have the same value when applied to patients treated with thrombolysis. METHODS: To assess the diagnostic and prognostic value of dipyridamole thallium-201 scintigraphy in the "thrombolytic era", we studied 110 consecutive patients younger than 75 recovering from first uncomplicated acute myocardial infarction treated with thrombolytic agents. Patients with early angina, recurrent acute myocardial infarction, heart failure, life-threatening arrhythmias, non Q wave myocardial infarction were excluded. Ninety patients were treated with streptokinase, 14 with rtPA, 6 with APSAC: All patients underwent dipyridamole thallium scintigraphy with standard dose and coronary angiography before discharge (10-20 days). Ninety-nine patients underwent exercise test. All patients were followed-up for 22 +/- 9 months (range 8-42). Perfusion abnormalities were classified as reversible (totally or partially) defects or persistent defects and within or outside the infarct zone. RESULTS: Fifty-eight patients developed anterior and 52 inferior acute myocardial infarction. Coronary angiography showed single vessel coronary artery disease in 66 patients, multivessel disease in 34, and normal coronary arteries or sub-critical stenosis in 10. No major complications (death, myocardial infarction, threatening arrhythmias, prolonged severe hypotension) occurred after dipyridamole infusion. Sixty-two patients had reversible perfusion defects at thallium scanning (34 within the infarct zone, 21 within and outside the infarct zone, 7 outside); 38 patients had persistent defects; 10 patients had a normal scintigraphic pattern. The diagnostic value of homozonal perfusion reversible defects for identifying a patent infarct-related vessel was poor (sensitivity 69.7%, specificity 64.7%). The diagnostic values of the same scintigraphic pattern improved in detecting patent infarct-related artery with residual critical stenosis (sensibility 75.4%, specificity 77.3%); in all the false positive cases (reversible defects within the infarct zone and occluded infarct-related artery) a good collateral flow was present. The sensitivity of reversible defects outside the infarct zone in detecting multivessel disease was 64.7% vs 56.3% of exercise test; the specificity was 92% vs 64%; the positive predictive value 78.6% vs 44%; the negative predictive value 85.3% vs 74.5%; the diagnostic accuracy 83.6% vs 61.4%. During the follow-up 2 deaths, 7 recurrent myocardial infarction, 1 sustained ventricular tachycardia, 1 heart failure, 13 recurrence of unstable angina and 9 revascularization procedures occurred among patients with reversible defects (either within or outside the infarct zone) at thallium scanning. One recurrent myocardial infarction, 4 recurrence of unstable angina and 2 revascularization procedures were the events among patients with persistent defects or normal scintigraphic pattern (p < 0.001). Ischemic events occurred with similar frequency in patients with reversible perfusion defects within the outside the infarct zone (55% vs 50%, NS). CONCLUSIONS: Dipyridamole thallium-201 scintigraphy performed after uncomplicated myocardial infarction treated with thrombolytic agents is a valuable diagnostic tool in identifying viable jeopardized myocardium within the infarct zone perfused by a patent but critically narrowed vessel; it shows better diagnostic accuracy in detecting multivessel disease than does the exercise test and is able to identify a subset of patients at risk for future ischemic events after thrombolytic therapy.
Adult↗