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Biomedical subjects

V Lepore

Publications and source records attributed to V Lepore.

At least 19 recordsLinked to original sources
PubMed2002

Course and prognosis in early-onset MS: comparison with adult-onset forms.

OBJECTIVES: To establish the prognostic role of clinical and demographic factors in a hospital-based cohort of MS patients categorized by age at clinical onset and clinical course. METHODS: Eighty-three patients with MS had a clinical onset of the disease in childhood (age <16 years; early-onset MS [EOMS]) and 710 in adult age (between 16 and 65 years; adult-onset MS [AOMS]). Patients were followed for a mean period of observation of 5 years. Univariate and multivariate analyses of clinical and demographic predictors for rapid progression and disability were performed using a stepwise Cox regression model with time-dependent covariates. RESULTS: In EOMS, the Expanded Disability Status Scale (EDSS) evaluated at last clinical examination was lower than in AOMS, despite a longer disease duration. The probability to reach growth disability and progression was significantly lower in EOMS than in AOMS. Median times to reach EDSS score of 4 and secondary progression were longer in EOMS than in AOMS, but the age at both endpoints was significantly lower in EOMS. In EOMS and AOMS, an irreversible disability was related to a secondary progressive course, a sphincteric system involvement at onset, and an older age at onset (in EOMS only for the group >14 years); in AOMS, other unfavorable factors were a pyramidal involvement at onset and a high relapse frequency in the first 2 years. The risk of entering secondary progression was significantly influenced by a high number of relapses in EOMS and by a higher age at onset and a short interattack interval in AOMS. CONCLUSION: A slower rate of progression of disease characterized EOMS patients, suggesting more plasticity to recover in developing CNS, but the early clinical manifestation cannot be considered a positive prognostic factor.

Adolescent↗
PubMed2001

Melatonin reduces dinitrobenzene sulfonic acid-induced colitis.

Inflammatory bowel disease (IBD) is characterized by oxidative and nitrosative stress, leukocyte infiltration, and up-regulation of intercellular adhesion molecule 1 (ICAM-1) expression in the colon. The aim of this study was to examine the effects of the pineal secretory product melatonin in rats subjected to experimental colitis. Colitis was induced in rats by intracolonic instillation of dinitrobenzene sulfonic acid (DNBS). Rats experienced bloody diarrhea and a significant loss of body weight. Four days after DNBS administration, the colon damage was characterized by areas of mucosal necrosis. Neutrophil infiltration (indicated by myeloperoxidase [MPO] activity in the mucosa) was associated with up-regulation of ICAM-1, expression of P-selectin, and high levels of malondialdehyde (MDA). Immunohistochemistry for nitrotyrosine and poly (ADP-ribose) synthetase (PARS) showed an intense staining in the inflamed colon. Staining of colon tissue sections obtained from DNBS-treated rats with an anti-cycloxygenase-2 (COX-2) antibody showed a diffuse staining of the inflamed tissue. Furthermore, expression of inducible nitric oxide synthase (iNOS) was found mainly in the macrophages of the inflamed colons from DNBS-treated rats. Treatment with melatonin (15 mg/kg daily, intraperitoneally) significantly reduced the appearance of diarrhea and the loss of body weight. This was associated with a remarkable amelioration of the disruption of the colonic architecture, as well as a significant reduction of colonic MPO activity and MDA levels. Melatonin also reduced the appearance of nitrotyrosine and PARS immunoreactivity in the colon, as well as reducing the up-regulation of ICAM-1 and the expression of P-selectin. The intensity and degree of the stainings for COX-2 and iNOS were markedly reduced in tissue sections obtained from melatonin-treated rats. The results of the this study suggest that the administration of melatonin might be beneficial for the treatment of IBD.

Animals↗
PubMed2001

Beneficial effects of tempol, a membrane-permeable radical scavenger, on the multiple organ failure induced by zymosan in the rat.

BACKGROUND AND METHODS: We investigated the effects of tempol, a membrane-permeable radical scavenger, on the multiple organ failure (MOF) caused by zymosan in the rat. Zymosan (500 mg/kg, suspended in saline solution, ip) enhances formation of reactive oxygen species, which contribute to the pathophysiology of MOF. After zymosan or saline administration, animals were monitored for 12 days. RESULTS: Treatment of rats with tempol (10, 30, or 100 mg/kg ip, 1 and 6 hrs after zymosan) attenuated the peritoneal exudation and the migration of polymorphonuclear cells caused by zymosan in a dose-dependent fashion. Tempol also attenuated the lung, liver, and intestinal injury (histology) as well as the increase in the concentrations of myeloperoxidase and malondialdehyde caused by zymosan in the lung, liver, and intestine. Immunohistochemical analysis for nitrotyrosine and for poly(adenosine 5'-diphosphate-ribose)synthetase demonstrated a positive staining in lung, liver, and intestine from zymosan-treated rats. The degree of staining for nitrotyrosine and for poly(adenosine 5'-diphosphate-ribose) synthetase was markedly reduced in tissue sections obtained from zymosan-treated rats that had received tempol (100 mg/kg ip). Furthermore, treatment of rats with tempol significantly reduced the following: a) the formation of peroxynitrite, b) the DNA damage, c) the impairment in mitochondrial respiration, and d) the decrease in the cellular concentration of oxidized nicotinamide adenine dinucleotide observed in macrophages harvested from the peritoneal cavity of rats treated with zymosan. CONCLUSION: This study provides the first evidence that tempol, a small molecule that permeates biological membranes and scavenges reactive oxygen species, attenuates the degree of MOF associated with zymosan-induced peritonitis in the rat.

Analysis of Variance↗
PubMed2001

Aortic surgery in patients with marfan syndrome: long-term survival, morbidity and function.

BACKGROUND AND AIM OF THE STUDY: The natural history of patients with Marfan syndrome is depressing, but surgical intervention on the aorta can improve the prognosis. Study results were analyzed with reference to long-term survival, morbidity and function. METHODS: Seventy-four Marfan patients (51 males, 23 females; mean age 41+/-14 years), underwent first-time aortic surgery between 1977 and 1998. Follow up information regarding mortality, morbidity and functional status was obtained from patient records and by questionnaire. The mean follow up was 5 years (range: 0-19 years). Forty-seven patients (64%) had a dissection, 27 (36%) an aneurysm, and 45 (61%) patients underwent emergency operations (<4 h from arrival at hospital). In 72 patients (97%) the disease affected the ascending aorta, and implantation of a composite graft was the most frequent operation. RESULTS: Overall 30-day mortality was 12% (3% in elective cases, 18% in emergency cases, p <0.05). Emergency operations and surgery extended to the aortic arch were risk factors for early mortality. Overall actuarial survival was 63.4+/-8% at 10 years. Age was the only risk factor for late mortality. Seventeen patients were reoperated on due to pathologies of the remaining aorta (n = 12), pseudoaneurysms (n = 4) and aortic valve endocarditis (n = 1). A total of five patients had endocarditis; one patient with a homograft required surgery, and medical treatment was successful in the other four patients. Five patients had neurological thromboembolic episodes without permanent damage, and six had minor bleeding complications. Freedom from early and late mortality, reoperation on the aorta and major cardiovascular events (endocarditis episodes, thromboembolic/hemorrhagic strokes and other major bleeding/embolic episodes) was 33.3 +/- 8.1% at 10 years. At follow up, 98% of patients were in NYHA functional class I or II, and 80% were working. CONCLUSION: Elective aortic surgery in Marfan patients can be performed with good results. Close follow up of patients undergoing surgery is important. The long-term functional status of surviving patients is satisfactory.

Adolescent↗
PubMed2000

Tempol, a membrane-permeable radical scavenger, reduces dinitrobenzene sulfonic acid-induced colitis.

Inflammatory bowel disease is characterized by oxidative and nitrosative stress, leukocyte infiltration, and up-regulation of intercellular adhesion molecule 1 (ICAM-1) expression in the colon. The aim of the present study was to examine the effects of tempol, a membrane-permeable radical scavenger, in rats subjected to experimental colitis. Colitis was induced in rats by intracolonic instillation of dinitrobenzene sulfonic acid. Rats experienced bloody diarrhea and significant loss of body weight. At 4 days after the administration of dinitrobenzene sulfonic acid, the colon injury comprised of large areas of mucosal necrosis. Neutrophil infiltration (measured as increase in myeloperoxidase activity in the mucosa) was associated with up-regulation of ICAM-1 and expression of P-selectin and high levels of malondialdehyde (an indicator of lipid peroxidation). Immunohistochemistry for nitrotyrosine and poly (ADP-ribose) synthetase showed an intense staining in the inflamed colon. Treatment of rats with tempol (15 mg/kg daily i.p.) significantly reduced the appearance of diarrhea and the loss in body weight. This was associated with a remarkable amelioration of the disruption of the colonic architecture as well as a significant reduction in the degree of both neutrophil infiltration and lipid peroxidation in the inflamed colon. Tempol also reduced the appearance of nitrotyrosine and poly (ADP-ribose) synthetase immunoreactivity in the colon as well as the up-regulation of ICAM-1 and P-selectin. The results of this study suggest that membrane-permeable radical scavengers, such as tempol, exert beneficial effects in experimental colitis and may, hence, be useful in the treatment of inflammatory bowel disease.

Animals↗
PubMed2000

Ectopic metaplastic ossification after sternotomy.

Ectopic ossification is a rare complication after a major operation. We report a case of cutaneous infection and metaplastic ossification in an 80-year-old man who underwent coronary artery bypass grafting 4 years earlier. Computed tomographic scan demonstrated a partial pseudarthrosis of the corpus sterni. The infected part of the sternal scar was excised and sternal wires were removed. Eight months later, the wound has healed without complications and the cutaneous ossification is unaltered.

Aged↗
PubMed2000

The tyrosine kinase inhibitor tyrphostin AG 126 reduced the development of colitis in the rat.

Inflammatory bowel disease is characterized by oxidative and nitrosative stress, leukocyte infiltration, up-regulation of the expression of intercellular adhesion molecule-1 (ICAM-1), and up-regulation of P-selectin in the colon. Here we investigate the effects of the tyrosine kinase inhibitor, Tyrphostin AG 126, in rats subjected to experimental colitis. Colitis was induced in rats by intracolonic instillation of dinitrobenzene sulfonic acid (DNBS). Rats experienced hemorrhagic diarrhea and weight loss. Four days after administration of DNBS, the mucosa of the colon exhibited large areas of necrosis. Neutrophil infiltration (determined by histology as well as an increase in myeloperoxidase activity in the mucosa) was associated with up-regulation of ICAM-1 and P-selectin, as well as high tissue levels of malondialdehyde. Immunohistochemistry for nitrotyrosine and poly(ADP-ribose) polymerase showed an intense staining in the inflamed colon. Staining with an anti-COX-2 antibody of sections of colon obtained from DNBS-treated rats showed a diffuse staining of the inflamed tissue. Furthermore, expression of inducible nitric oxide synthase was found mainly in macrophages located within the inflamed colon of DNBS-treated rats. Tyrphostin AG 126 (5 mg/kg daily ip) significantly reduced the degree of hemorrhagic diarrhea and weight loss caused by administration of DNBS. Tyrphostin AG 126 also caused a substantial reduction of (1) the phosphorylation of tyrosine residues of proteins (immunoblots of inflamed colon), (2) the degree of colonic injury, (3) the rise in myeloperoxidase activity (mucosa), (4) the increase in the tissue levels of malondialdehyde, (5) the increase in staining (immunohistochemistry) for nitrotyrosine and poly(ADP-ribose) polymerase, as well as (6) the up-regulation of ICAM-1 and P-selectin caused by DNBS in the colon. Thus, we provide the first evidence that the tyrosine kinase inhibitor Tyrphostin AG126 reduces the degree of colitis caused by DNBS.

Animals↗
PubMed2000

Management of extensive lesions of the aortic arch: review of 42 consecutive cases.

This retrospective study reviews the long-term results in aortic arch surgery. Forty-two consecutive patients (44-74 years) were operated on between 1980 and 1995. Nineteen patients had acute dissections of the aortic arch, 11 had chronic dissections and 12 had aneurysms. Twenty patients were given emergency surgery and 22 were operated on electively. Reconstruction of the aortic arch alone (31%) or with other aortic segments (69%) was performed during antegrade cerebral perfusion (81%) or circulatory arrest (17%). Sixteen patients died during the first 30 days (38%). Early mortality rates were 60% in emergencies and 18% in elective cases. Early mortality in the group with aneurysms was 33% and 40% in patients in the dissection group. Long-term follow-up to July 1998 is now complete. Twelve patients (28%) died during the follow-up period; 4 of these deaths were due to a rupture of the descending aorta. Three patients (11.5%) underwent late reoperations on the remaining aorta, without operative mortality. We recommend careful follow-up of patients with aortic arch disease and, when indicated, surgery to avoid the rupture of the remaining aorta.

Adult↗
PubMed1998

Possible risk factors for primary adult onset dystonia: a case-control investigation by the Italian Movement Disorders Study Group.

OBJECTIVES: Little is known about the aetiology of idiopathic adult onset dystonia. The Italian Movement Disorders Study Group promoted a case-control study on some hypothetical risk factors including past medical events, life events, life habits, occupational hazards, and family history of dystonia, parkinsonism, and tremor. METHODS: Cases affected by idiopathic adult onset dystonia (age at symptom onset >20 years, duration of disease >one year and <five years) were selected among consecutive outpatients attending 14 Italian centres. Control outpatients matched for age (+/-5 years), sex, and referral centre were identified among diagnostic categories thought to be unassociated with study exposures. Information was obtained by a standardised questionnaire administered by medical interviewers. Conditional logistic univariate and multivariate regression analyses were performed by a standard statistical package. RESULTS: Multivariate analysis on 202 cases and 202 age and sex matched control outpatients indicated that head or facial trauma with loss of consciousness, family history of dystonia, and family history of postural tremor independently increased the risk of developing adult onset dystonia, whereas hypertension and cigarette smoking exerted a protective effect. The findings also suggested a positive association between local body injury-for example, previous ocular diseases and neck or trunk trauma-and dystonia of the same body part. CONCLUSIONS: The results support the idea that environmental and genetic factors may both be important in the aetiology of adult onset dystonia, and suggest aetiological clues worthy of further analytical investigation.

Adult↗
PubMed1998

Estrogen-replacement therapy and Alzheimer's disease in the Italian Longitudinal Study on Aging.

OBJECTIVE: To study the association of estrogen-replacement therapy and other estrogen-related variables with Alzheimer's disease in postmenopausal women. BACKGROUND: Postmenopausal estrogen use has been reported to lower the risk of Alzheimer's disease. DESIGN: A population-based, multicenter survey was carried out in eight Italian municipalities. The sample of 2,816 women, aged 65 to 84 years, was randomly selected from the population register of each municipality and stratified in 5-year age groups. All women were screened using the Mini-Mental State Examination and interviewed concerning risk factors. Those who screened positive underwent a clinical assessment. Dementia syndrome was diagnosed according to DSM-III-R criteria, and Alzheimer's disease was diagnosed according to NINCDS-ADRDA criteria for possible and probable Alzheimer's disease. RESULTS: The estimated prevalence of postmenopausal estrogen use adjusted to the 1991 Italian female population was 12.3%. The frequency of estrogen use was higher among nonpatients compared with Alzheimer's disease patients (odds ratio, 0.24; 95% confidence interval, 0.07 to 0.77). The inverse association between estrogen therapy and Alzheimer's disease remained significant after adjustment for age, education, age at menarche, age at menopause, smoking and alcohol habits, body weight at the age of 50 years, and number of children (odds ratio, 0.28; 95% confidence interval, 0.08 to 0.98). CONCLUSIONS: Our data from a population-based study support the hypothesis that estrogen-replacement therapy is associated with a reduced prevalence of Alzheimer's disease in postmenopausal women. Prospective clinical trials are required to enable women and their physicians to weigh risks and benefits of estrogen-replacement therapy for the prevention of dementia.

Age Distribution↗
PubMed1998

[Spontaneous rupture of the spleen in a patient treated with chemotherapy and growth factors for stem cell mobilization].

The Authors report a case of spontaneous spleen rupture in a woman with breast cancer treated with chemotherapy and growth factors for stem cell mobilization. After a wide review of the literature, they suppose this therapy, causing a considerable increase of immature cells, that promote the stasis of the splenic microcirculation, can sometime elicit a spontaneous rupture of the organ.

Adult↗
PubMed1998

[Clinical considerations and therapeutic options in papillomatosis of common bile duct. Clinical case].

The Authors report a case of endoscopic treatment of common biliary tract papillomatosis. This therapeutic option derive by patient's clinical evaluation and clinical reports from literature. Agreeing with Cornud, we have opted for endoscopic conservative management with drainage of common biliary tract; furthermore endoscopic procedure permit, by an intensive follow-up, identification and management of possible recurrences. This approach, minimally invasive, is in our opinion the first option for the biliary papillomatosis management.

Aged↗
PubMed1997

The de-airing clamp in cardiac surgery.

De-airing of the heart in open heart surgery is a necessary routine. Most of the air is evacuated from the heart before the aortic cross clamp is removed, but the de-airing may be continued even after declamping. One way to continue de-airing is to partially clamp the ascending aorta, proximally to the aortic cannula, in order to create a pocket for trapping residual air coming from the left ventricle. This paper describes a clamp specially designed and developed for this purpose. It has been used in our center since 1990 and our experience is reported. The clamp has been used on 250 patients and in 50% ultrasonography has been used to examine the heart being free from air bubbles within 20 min from releasing the aortic cross clamp.

Cardiac Surgical Procedures↗
PubMed1996

Magnetic resonance imaging in the follow-up of patients after aortic root reconstruction.

Long-term survival after replacement of the aortic root with a composite graft is improving. Late deaths are in several cases due to complications related to the previous surgery or to pathologies of the remaining aorta. Regular follow-up of these patients is of paramount importance. The purpose of this study is to evaluate the reliability of magnetic resonance imaging (MRI) in such cases. Twenty-seven patients (9 dissections and 18 aneurysms) who had undergone replacement of the aortic root with a composite graft were studied 20 to 167 months after surgery using magnetic resonance imaging with a 1.5 Tesla magnet. The left-ventricular outflow tract, the mechanical valve function, the proximal part of the coronary arteries, the graft, and the remaining aorta could be examined. No aortic insufficiency, ectasy of the proximal part of the coronaries, or pseudoaneurysms were seen. A widening of the remaining ascending aorta was noted in 4 cases. A still open, dissected pipe was visualized in 7 patients. Our conclusions are that MRI provides excellent images of the thoracic and abdominal aorta following surgical repair. The examination is becoming cost-competitive. More import is its very low risk for the patient group considered here: since it is non-invasive and requires no contrast medium or X-ray exposure, examinations can be repeated as required.

Aortic Dissection↗
PubMed1996

Replacement of the ascending aorta with composite valve grafts: long term results.

BACKGROUND AND AIMS OF THE STUDY: Long term survival after replacement of the aortic root is improving. The most common cause of late death is progression of disease in the remaining aorta (dissection or atherosclerosis). The purpose of this study was to review our clinical experience with composite graft replacement of the aortic root with special reference to long term results. MATERIALS AND METHODS: One hundred twenty-six patients (mean age: 53 years) with different pathologies of the ascending aorta underwent aortic root replacement with a composite-graft prosthesis over a 12-year period. Twenty-three patients had previously undergone cardiovascular surgery. The surgical technique included resection of the ascending aorta with the aortic valve and end-to-side anastomosis between full-thickness buttons of the aortic wall with the coronary ostia and the graft. One or more associated cardiovascular procedures were performed in 24 cases. Long term follow up to July 1995 is complete. Uni- and multivariate analysis were performed to identify risk-factors for early and late mortality and reoperation. RESULTS: Twenty-three patients died during the first 30 days (18%). Sixteen of them had aortic dissection. The most common cause of early death was heart failure. Twenty-three patients died during the follow up time with heart failure, again, being the most common cause of death. Thirteen late reoperations on the composite-graft or the remaining aorta were performed in 12 patients, six of whom had Marfan's syndrome. The 30-day mortality at reoperation was 30%. CONCLUSIONS: This surgical option offers good long term results with a five-year actuarial survival of 67% or 75% when the 30-day mortality is excluded. Careful follow up of patients with Marfan's syndrome and/or aortic dissection is mandatory to increase the long term survival.

Adolescent↗
PubMed1995

The "90 degrees bent" two-stage venous cannula.

A 90 degree bent two-stage venous cannula for cardiopulmonary bypass is presented and discussed. Its main advantages, compared to similar straight ones, are that it is out of the way of the surgeon, by being placed under the right sternum and also that the venous return seems uninfluenced by displacement of the heart when operating on the posterior side of the heart. No major drawbacks for the cannula have been noticed so far.

Cardiac Catheterization↗
PubMed1994

Factors affecting course and survival in Alzheimer's disease. A 9-year longitudinal study.

OBJECTIVE: To evaluate mean survival and to identify prognostic factors in a cohort of patients with Alzheimer's disease (AD). DESIGN: Multicentric 9-year cohort analytic study. SETTING: Seven neurology departments throughout Italy between April 1982 and January 1984. PATIENTS: We recruited a consecutive sample of 145 patients affected by probable AD (Multicenter Italian Study on Dementia protocol, National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria). Five were misdiagnosed, and 21 could not participate in the longitudinal study. The clinicodemographic characteristics of the 119 enrolled patients (49 men, 70 women; mean age, 64.7 years; SD, 4.1 years; mean duration of disease, 3.1 years; SD, 1.8 years) did not differ from those of the 26 excluded patients. All underwent extensive cliniconeuropsychological testing every 6 months for at least 2 years until the patient died or our survey ended (April 30, 1991). Mean follow-up was 5.1 years (SD, 2.5 years). MAIN OUTCOME MEASURES: Death, severe functional impairment (a score > or = 17 on the Blessed Dementia Scale), and severe cognitive impairment (a score of < or = 7 on the Information-Memory-Concentration Test). RESULTS: Survival curves obtained by the Kaplan-Meier method indicated that (1) patients with early- and late-onset disease (ie, before or after age 65 years) showed no difference either in relative survival or in time to reach predetermined functional and cognitive end points; (2) severely aphasic patients became profoundly demented significantly sooner than those with mild to moderate aphasia (P < .0001). Among clinicodemographic variables analyzed by a Cox model, severe language disability and functional loss proved to be the best predictors of death independent of age at onset or degree of dementia. CONCLUSIONS: Age at onset did not influence course and survival in AD. Severe aphasia appears to be the best predictor of death and unfavorable course.

Aged↗