Search PubMed⌕ Search

Biomedical subjects

A Bruno

Publications and source records attributed to A Bruno.

At least 199 records · Page 11Linked to original sources
PubMed1988

Neurologic problems in renal transplant recipients.

Renal transplant recipients are at an increased risk of developing certain neurologic problems. These problems differ from those encountered in recipients of other organs. Development of atherosclerosis is accelerated in renal transplant patients and results in an increased incidence of thromboembolic events. Immunosuppressive therapy predisposes to infection with opportunistic organisms, including reactivation of latent viruses and also is associated with an increased incidence of de novo neoplasia. The transplantation procedure may be complicated by a neuropathy and occasionally by distal spinal cord infarction. Some immunosuppressive agents have a direct adverse effect on the nervous system, particularly when toxic levels accumulate in the body. Uremia prior to, and if present after transplantation, has a toxic effect on the nervous system as well. The reasons for these problems are discussed. Awareness of these special problems in renal transplant patients will facilitate their prevention and diagnosis. A recommended diagnostic approach has been outlined. After the etiology has been established, treatment can be tailored to the individual patient.

Central Nervous System Diseases↗
PubMed1988

Prevention of pulmonary complications by 6-methylprednisolone in major abdominal surgery.

Methylprednisolone sodium succinate (MPSS) was compared in a randomized, double blind study to placebo in the prevention of respiratory complications in patients submitted to abdominal (vascular, pancreatic or hepatic) surgery. Two out of 42 (4.8%) patients treated with MPSS and 9 patients out of 40 (22.5%) who received placebo experienced a pulmonary complication (p less than 0.05) The results indicate that methylprednisolone could prevent the onset of respiratory complications in patients undergoing major abdominal surgery.

Abdomen↗
PubMed1987

Deflazacort vs prednisone. Effect on blood glucose control in insulin-treated diabetics.

Glucocorticoid treatment produces a deterioration of blood glucose control in diabetics. Recent reports have indicated that deflazacort is less diabetogenic than prednisone in healthy subjects. Ten insulin-treated diabetics who required steroid drugs were treated with deflazacort (30 mg/d for four weeks) and prednisone (25 mg/d for four weeks) in randomized, double-blind design after a pretreatment period of four weeks. At the end of each treatment, plasma glucose profile (five determinations per day), hemoglobin A1 level, and insulin requirements were compared. Mean (+/- SEM) plasma glucose level (139 +/- 28 vs 169 +/- 32 mg/dL [7.7 +/- 1.5 vs 9.4 +/- 1.8 mmol/L]) and hemoglobin A1 values (8.81% +/- 1.19% vs 10.71% +/- 1.17% of total hemoglobin) were significantly lower after deflazacort than after prednisone. Also, insulin requirement was significantly lower after deflazacort than after prednisone (29.3 +/- 11.6 vs 47.3 +/- 2.0 U/d). These results indicate that deflazacort, when employed in an anti-inflammatory dose equivalent to prednisone, should prove advantageous in insulin-treated diabetics who require steroid treatment.

Aged↗
PubMed1987

Further observations on cerebral or retinal ischemia in patients with right-left intracardiac shunts.

Between October 1983 and November 1986, 20 patients suspected of having a paradoxical cerebral or retinal embolism were identified. Cerebral infarction was the most common presentation. Six patients had a patent foramen ovale demonstrated by cardiac catheterization or surgery. Three patients had a newly discovered atrial septal defect, and one had an atrial septal defect that had previously been treated surgically. Results of the cardiac physical examination, chest roentgenography, and electrocardiography were unremarkable in 12 patients. Eighteen patients had a right-to-left shunt demonstrated by contrast echocardiography. Nine of these patients underwent cardiac catheterization; seven had abnormal catheterization study results: four had a patent foramen ovale and three had an atrial septal defect. Sixteen patients received medical therapy only while four underwent surgery. All patients survived the initial insult. There were no deaths or ischemic recurrences on follow-up ranging from one month to three years. We believe that contrast echocardiography can provide important diagnostic information, even in situations in which cardiac involvement is not suspected. Additional studies are needed before the optimal treatment of presumptive paradoxical cerebral embolism can be determined.

Adult↗
PubMed1987

Pentylenetetrazol-induced spike wave discharges in rats: a polygraphic study.

14 male Wistar rats were studied, before and after pentylenetetrazol (PTZ) 20 mg/kg i.p., since a petit mal-like electroclinical pattern, either spontaneous or PTZ-induced was recently described in a breeding station where this strain is raised. In particular, surface EEG, muscular, respiratory and cardiac activities were recorded in order to detect possible clinical-electroencephalographic correlations. Spontaneous epileptic phenomena were never observed. In all the animals PTZ-induced short, usually generalized and synchronous spike wave discharges often concomitant with rhythmic twitches of the vibrissae. Epileptic bursts were related to arousal level, disappearing during motor behavior and arousing stimuli. Moreover individual discharges could be interrupted by a sudden noise. Photosensitivity was not present. Muscular tone and autonomic functions were not affected. The features of PTZ-induced generalized nonconvulsive seizures in rats are compared to those of cat penicillin epilepsy and human petit mal.

Animals↗
PubMed1987

[Equilibrium angioscintigraphic evaluation of sequential changes in right ventricle function in patients with lower myocardial infarct and ischemic co-involvement of the right ventricle: long-term study].

The purpose of this study was to define the sequential changes in global and regional right ventricular function, using equilibrium gated radionuclide angiography, following transmural inferior myocardial infarction (IMI) and associated ischemic right ventricular involvement. 24 patients with IMI underwent radionuclide angiography within 72 hours of onset of chest pain; subsequent studies were done at 13 +/- 5 days and at 6 +/- 2 months. Scintigraphic evidence of ischemic right ventricular involvement was defined by depression of right ventricular ejection fraction (less than 40%) and regional wall motion abnormalities (hypo-a-dyskinesia of right ventricular free wall). Significant improvement of global right ventricular ejection fraction was observed in 15 patients at the second study, and in 21 patients at the third study. Right ventricular regional wall motion showed similar improvement from the initial to the final studies. Significant changes in right ventricular function occurred without concurrent changes in global and regional left ventricular ejection fraction. We concluded that patients with IMI and ischemic right ventricular involvement show frequently improvement of global and regional right ventricular function over time. This changes tend to occur early and without significant modifications in left ventricular function. The good prognosis observed in our patients, despite the high incidence of in hospital complications, might be related to the improvement of right ventricular function.

Adult↗
PubMed1986

Endurance training in rats with chronic heart failure induced by myocardial infarction.

The response to exercise was investigated in trained and sedentary rats with moderate compensated heart failure produced by myocardial infarction (MI) and in rats that underwent sham operations. Trained rats ran on a treadmill (10% grade at 20 m/min) for 60 min/day, 5 days/week for 10 to 12 weeks, whereas sedentary rats had only limited activity. Maximal oxygen consumption normalized for body weight (ml kg-1 min-1) was determined for each rat and found to be (1) greater in trained rats when compared with sedentary rats and (2) greater in sham-operated rats when compared with their counterparts that suffered infarction. In addition, skeletal muscle succinate dehydrogenase activities were greater and the blood lactic acid response to submaximal exercise was lower in trained rats compared with sedentary rats. Left ventricular infarct size for sedentary and trained rats with infarction was 36 +/- 3% and 34 +/- 3% of the total endocardial circumference, respectively, and resulted in (1) elevated left ventricular end-diastolic pressures at rest and during exercise, (2) lower mean arterial pressures at rest, and (3) lower maximal heart rates when compared with those in their sham-operated counterparts. However, normalization of mean arterial pressures during submaximal and maximal exercise was found along with a trend toward normalization of maximal heart rate when trained rats with infarction were compared with their sedentary counterparts. Blood flows to the kidneys, organs of the gut, and skeletal muscle during both submaximal and maximal exercise were unaffected by either myocardial infarction or training; no differences between sedentary and trained rats with infarction and sedentary and trained sham-operated rats were found. These results demonstrate that an exercise training program of moderate intensity produces beneficial hemodynamic and metabolic effects in rats with moderate compensated heart failure.

Animals↗
PubMed1986

Feedback inhibition of insulin secretion is altered in cirrhosis.

Hyperinsulinemia in human cirrhosis is generally considered an expression of reduced hepatic insulin degradation. To determine whether hyperinsulinemia may also depend on an altered feedback inhibition of insulin secretion, we performed euglycemic hyperinsulinemic clamp studies, infusing 40, 372, or 1280 mU/m2 X min biosynthetic human insulin in 30 compensated cirrhotic patients with portal hypertension and impaired glucose tolerance and 25 normal subjects, matched for age, sex, and weight. Mean fasting plasma insulin was significantly higher in cirrhotic patients [26.1 +/- 2.3 vs. 12.4 +/- 0.6 (+/- SE) microU/ml; P less than 0.001], while fasting plasma glucose levels were similar in the 2 groups. The mean plasma C-peptide level was significantly higher in cirrhotic patients, both basally (2.7 +/- 0.1 vs. 1.7 +/- 0.1 ng/ml; P less than 0.001) and during the clamp studies. Suppression of C-peptide at 120 min of the clamp was significantly less in cirrhotic patients (37 +/- 7% vs. 79 +/- 4%, 52 +/- 9% vs. approximately 100%, and 54 +/- 4% vs. approximately 100% during the 40, 372, and 1280 mU/m2 X min insulin infusions, respectively). The fasting C-peptide to insulin molar ratio was significantly lower in cirrhotic patients (5.4 +/- 0.3 vs. 6.4 +/- 0.3; P less than 0.005). The MCR of insulin at the three steady states was not significantly different between the 2 groups, whereas the basal systemic delivery rate of insulin was significantly higher in cirrhotic patients (14.7 +/- 1.7 vs. 6.5 +/- 0.4 mU/m2 X min; P less than 0.001). These results suggest that reduced feedback inhibition of insulin secretion may contribute to the hyperinsulinemia associated with cirrhosis.

Adult↗
PubMed1986

Insulin resistance in human liver cirrhosis is not modified by porto-systemic surgical shunt.

Cirrhosis of the liver is characterized by glucose intolerance and hyperinsulinaemia. It is considered an insulin resistant state with both a receptor and a post-receptor defect of insulin activity. It would appear that reduced hepatic degradation rather than increased B-cell production is responsible for hyperinsulinaemia. The effect of surgical portosystemic shunt on insulin resistance was studied in 18 cirrhotics with impaired glucose tolerance (12 males, 6 females; mean age 46.9 +/- 0.7 years) by measuring: glucose production (3H-glucose infusion), glucose utilisation (euglycaemic clamp at approximately 100, approximately 1000 and approximately 10,000 microU/1), plasma insulin and C-peptide levels, and liver function indices (serum bilirubin, albumin, ALT, GGT) before and 2 months after surgery. Liver sorbitol clearance was also employed to measure variations in the functional liver plasma flow induced by the shunt. No significant changes were noted in: glucose production (1.94 +/- 0.17 SEM vs 1.96 +/- 0.17 mg/kg/min), glucose utilisation (metabolic clearance rate: 3.32 +/- 0.48 vs 3.42 +/- 0.43 at approximately microU/ml; 9.70 +/- 1.0 vs 9.16 +/- 0.9 at approximately 1000 microU/ml; 10.92 +/- 1.1 vs 11.07 +/- 0.8 ml/kg/min at approximately 10 000 microU/ml), fasting plasma insulin, C-peptide and C-peptide/insulin molar ratio (4.66 +/- 0.47 vs 5.50 +/- 0.54), and the liver function indices. By contrast, there was a significant decrease in functional liver plasma flow (813 +/- 34 vs 604 +/- 34 ml/min, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[High prevalence of 2d and 3d grade atrioventricular block in patients with acute myocardial infarct and right ventricular ischemic involvement].

43 consecutive patients with acute inferior myocardial infarction (IMI) were evaluated with 12-lead electrocardiogram plus four additional right precordial lead V3R, V4R, V5R, V6R and equilibrium gated radionuclide angiography (EGRA) to detect ischemic right ventricular involvement. All patients were continuously monitored on the average 6 days; 11 of 43 patients had an episode of second or third degree atrioventricular block. Ischemic right ventricular involvement was diagnosed by electrocardiographic criteria in 60%, and by scintigraphic criteria in 70% of 43 patients with IMI. Utilization of electrocardiogram and EGRA for diagnosis of right ventricular involvement permit us to identify a subgroup of patients with IMI at high risk of developing second or third atrioventricular block (38% with ecg criteria and 33% with radionuclide criteria respectively) as regards those without right ventricular involvement (6% and 8%).

Adult↗
PubMed1985

Mechanism of insulin resistance in human liver cirrhosis. Evidence of a combined receptor and postreceptor defect.

Insulin resistance in liver cirrhosis may depend on either reduced sensitivity (receptor defect) and/or reduced response to insulin (postreceptor defect). To clarify the mechanism of such resistance, a [3H]glucose infusion (0.2 microCi/min) was performed for 120 min before and during a euglycemic clamp at approximately 100, 1,000, and 10,000 microU/ml steady state plasma insulin concentration in 18 compensated cirrhotics with portal hypertension and impaired glucose tolerance, and 18 healthy volunteers with no family history of diabetes, matched for sex, age, and weight. Mean fasting plasma insulin (29.2 +/- 3.4 SEM vs. 14.8 +/- 1.1 microU/ml) was significantly higher (P less than 0.001) in cirrhotics, while fasting plasma glucose was much the same in the two groups. Glucose use (milligrams per kilogram per minute) was significantly lower in cirrhotics at all three steady state plasma insulin levels: 3.04 +/- 0.34 vs. 7.72 +/- 0.61 (P less than 0.001) at approximately 100; 6.05 +/- 1.07 vs. 11.45 +/- 1.24 (P less than 0.001) at approximately 1,000; and 11.69 +/- 0.69 vs. 14.13 +/- 0.74 (P less than 0.05) at approximately 10,000 microU/ml. Mean plasma C-peptide was significantly higher in cirrhotics both basally and during the steady states (P less than 0.001); it was completely suppressed at approximately 10,000 microU/ml in controls and only 57.5% of the baseline in cirrhotics. Endogenous glucose production (milligrams per kilogram per minute) was much the same in the two groups in the fasting state and almost entirely suppressed in the controls (0.10 +/- 0.05 vs. 0.48 +/- 0.11, P less than 0.001) at approximately 100 microU/ml; at approximately 1,000 microU/ml a residual glucose production, 0.07 +/- 0.05, was observed in the cirrhotics only. In addition, insulin binding and 3-ortho-methyl-glucose transport were studied in vitro in six cirrhotics and six controls. Insulin binding to circulating monocytes and isolated adipocytes was significantly lower (P less than 0.025) in cirrhotics in all insulin concentration studies. Glucose transport values on isolated adipocytes were significantly lower in cirrhotics both basally (P less than 0.001) and at maximal insulin concentration (P less than 0.05). These results suggest that insulin resistance in human cirrhosis is more dependent on depressed peripheral glucose use than on increased endogenous glucose production, and that a combined receptor and postreceptor defect in insulin action on target cells seems to be present.

Adipose Tissue↗
PubMed1985

Moderate guar-gum addition to usual diet improves peripheral sensitivity to insulin and lipaemic profile in NIDDM.

The addition of vegetable fibres to the diabetic diet has been reported to ameliorate glycaemic and plasma lipid profiles, and Guar flour seems to obtain the best results. At its usual dose, Guar produces several gastro-intestinal side effects. A lower dose (4 + 4 g/day) was therefore employed in 10 non-insulin dependent diabetics (NIDD). The following parameters were measured at the end of treatment and after a control period: HbA1 levels, hepatic glucose production (3H-Glucose infusion), peripheral sensitivity to insulin and insulin secretion (hyperglycaemic clamp), and specific insulin binding to isolated monocytes. The ultracentrifugal plasma lipid pattern was also measured. No significant body weight change was recorded during the study. A significant glycaemic and insulinaemic decrease in the fasting state was observed after Guar, together with a significant decrease of HbA1 levels (from 8.5 +/- 0.4 to 7.9 +/- 0.4%, p less than 0.05) and amelioration of peripheral sensitivity to insulin (M/I = 14.3 +/- 6.6 versus 24.3 +/- 8.8, p less than 0.025; 50% increase of insulin binding to circulating monocytes) without significant variation of the fasting hepatic glucose production. Decreased B-cell stimulation by flattening post-prandial glycaemic peaks may be an explanation of the reduction of insulin resistance via down-regulation mechanism. As far as the lipid profile is concerned, a significant reduction in total and LDL cholesterol (p less than 0.05 and p less than 0.01) and an increase in HDL-phospholipids (p less than 0.05) were recorded after Guar. These results suggest that Guar in low doses is well accepted and can contribute to a better glycaemic and lipaemic control in NIDDM.

Blood Glucose↗