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Biomedical subjects

A Colombo

Publications and source records attributed to A Colombo.

At least 55 records · Page 3Linked to original sources
PubMed2001

Recovery from moderate aphasia in the first year poststroke: effect of type of therapy.

OBJECTIVES: (1) To determine whether 2 model-based remediation programs affect writing performance in unselected subjects with moderate aphasia and whether there is consequent improvement in everyday life, and (2) to interpret the potential changes observed by recourse to a theoretical model. DESIGN: Consecutive sample, multiple baseline, within subject crossover study. SETTING: Ambulatory care units. PARTICIPANTS: Eight subjects with moderate aphasia from 6 to 12 months postonset. INTERVENTION: A standardized test for reading and writing skills was given at the beginning and the end of each therapy program and 1 month after therapy stopped. MAIN OUTCOME MEASURES: Functional outcome measures were the Communicative Abilities in Daily Living (CADL) test and subtests from standardized aphasia assessment. RESULTS: After the 2 programs, there was improved writing performance, which was maintained after therapy stopped. Patterns of improvement corresponded to each of the 2 programs. Learning transfer was observed on the CADL test and functional writing, but gains on oral language were limited. Only 1 program was effective for 6 of the 8 patients. CONCLUSION: Specific rehabilitation programs aid recovery from aphasic symptoms from 6 to 12 months postonset. Individual response is linked to type of treatment. The interpretation is linked to a model-based description of aphasic symptoms and mechanisms of functional recovery.

Activities of Daily Living↗
PubMed2001

The influence of stent length on clinical and angiographic outcome in patients undergoing elective stenting for native coronary artery lesions; final results of the Magic 5L Study.

AIMS: To prospectively evaluate the influence of stent length on 6 month clinical and angiographic outcome, in patients with native coronary lesions up to 45 mm in length, undergoing elective Magic Wallstent implantation. METHODS AND RESULTS: On the basis of pre-procedural angiography, 276 patients (aged 61.3+/-10.2 years; 78.6% male; 41.7% unstable angina) with a total of 302 lesions were prospectively assigned to one of five different length categories of Magic Wallstent. Angiography in multiple matched projections before and after implantation and at 6 months follow-up was analysed at the core laboratory. Primary end-points for the efficacy analysis were cumulative incidence of major adverse cardiac events and quantitative coronary angiography analysis 6 months after stent implantation. Magic Wallstent implantation was successful in 301 of 302 lesions and in 98.6% a residual stenosis <20% by online quantitative coronary angiography was achieved. At 30 days, 6.2% (1.8% subacute occlusion) of patients had experienced major adverse cardiac events, 27.5% at 6 months and 30.4% at 9 months. Angiographic restenosis occurred in 37%. Restenosis rates for the mini, extra-short, short, medium and long Wallstent groups were 25.9%, 25%, 22.6%, 36.2% and 67.5%, respectively. Multivariate analysis revealed stent length to be independently associated with greater angiographic restenosis and major adverse cardiac events. CONCLUSIONS: While shorter Magic Wallstents provided late outcomes comparable with short balloon-expandable stents, excessive restenosis with longer Wallstents should obviate their use in elective percutaneous intervention. Long coronary lesions provide a challenging substrate for emerging antirestenosis therapies, such as stent coatings and brachytherapy.

Aged↗
PubMed2001

Morphometry of the orbital region: a soft-tissue study from adolescence to mid-adulthood.

The objective of this study was to gain information about normal sex-related linear and angular dimensions of the orbital region; left-right symmetry; and growth changes between adolescence and mid-adulthood. The three-dimensional coordinates of several soft-tissue landmarks on the orbits and face were obtained by an electromagnetic digitizer in 40 male and 33 female adolescents aged 12 to 15 years, 73 female and 89 male young adults aged 19 to 30 years, and 41 male and 38 female adults aged 31 to 56 years. From the landmarks-binocular and intercanthal widths; paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane; length and inclination of the eye fissure; and the orbital height to eye fissure length ratio were calculated and averaged for age and sex. Comparisons were performed by factorial analysis of variance. Both the linear dimensions and the angular values were significantly larger in male subjects than in female subjects of corresponding age (p < 0.05). A significant effect of age was found (p < 0.05): while the linear distances and the orbital height-to-length ratio were greater in older people of the same sex, the inclination of the eye fissure decreased as a function of age. Both orbital inclinations were larger in the young adult group than in the adolescent and middle-aged groups. On average, the paired measurements were symmetrical, with similar values within each sex and age group. Data collected in this investigation could serve as a database for the quantitative description of human orbital morphology during normal adolescent and adult growth.

Adolescent↗
PubMed2001

Late acute thrombosis after paclitaxel eluting stent implantation.

Late (more than six months) total occlusion after coronary stenting is a progressive phenomenon occurring in approximately 4% of patients, leading to acute myocardial infarction in less than 0.5%. The process must be related to severe and progressive intimal hyperplasia. In patients receiving coronary stenting with simultaneous brachytherapy, late total occlusion has been reported at a higher rate and to be related to stent thrombosis rather than intimal hyperplasia. Late total occlusion presenting with an acute clinical event seven months after the implantation of a paclitaxel drug eluting stent is reported. The occlusion developed soon after the interruption of ticlopidine treatment, suggesting that the event had a thrombotic genesis and that the risk is not confined to the first six month period.

Acute Disease↗
PubMed2001

Measurement of inflammatory mediators of mast cells and eosinophils in native nasal lavage fluid in nasal polyposis.

BACKGROUND: Nasal polyposis (NP) often coexists with asthma, rhinitis and sinusitis. Polyp histology typically shows chronic, eosinophilic inflammation. The inflammatory cell infiltrate generally includes eosinophils, lymphocytes, plasma cells and mast cells. OBJECTIVE: To gain insight into the natural history of NP, we analysed mediator levels and leukocyte values in nasal fluids and eosinophil cationic protein (ECP), total IgE levels and eosinophils in the blood in several groups of both allergic and non-allergic patients with nasal polyps and in patients with allergic rhinitis (AR). METHODS: Thirty-two patients with nasal polyps entered the study. As a control group, we studied 55 patients with AR, i.e. 20 patients with seasonal AR to grass pollen, 24 with AR sensitive to Parietaria and 11 with AR sensitive to house dust mite (HDM). Eighteen patients with nasal polyps were also allergic patients (8 were sensitive to Parietaria and 10 were sensitive to HDM), whereas 14 were non-allergic patients. Tryptase and histamine values were assayed in nasal fluids, whereas total IgE was determined in serum. ECP values were assayed both in nasal fluids and serum. Eosinophils were quantified both in the blood and nasal fluids. RESULTS: Tryptase levels were significantly higher in the nasal lavages from patients with NP than in those from patients without NP (4.7 vs. 3.5 U/l, p < 0.001) and correlated with symptom scores (r(s) = 0.42, p < 0.0001). The median levels of histamine in nasal fluids from patients with NP were also significantly higher than those observed in patients without NP (50.0 vs. 21.3 ng/ml, p < 0.001), but did not correlate with symptom scores. Finally, the median levels of ECP in nasal fluids from patients with NP were significantly higher than those observed in patients without NP (38.1 vs. 16.1 ng/ml, p < 0.001) and correlated with symptom scores (r(s) = 0.38, p < 0.001). Analysis of variance showed that, among the variables studied, the presence of nasal polyps was the factor responsible for the higher levels of tryptase, histamine and ECP in nasal fluids. With regard to leukocyte counts in nasal fluids, no significant differences were observed between rhinitis patients with NP and those without NP. With regard to serum ECP and serum total IgE, no significant differences were detected between the two groups under study. Blood eosinophil levels in patients with NP were significantly higher than those observed in patients without NP (5.8 vs. 5.6, p = 0.002). Analysis of variance showed that both the presence of nasal polyps and the type of sensitisation were important. Considering the total symptom scores, no significant differences were observed between rhinitis patients with NP and those without NP. CONCLUSIONS: The present findings are consistent with the view that chronic eosinophil mucosal inflammatory disease in NP involves a self-sustaining mechanism, i.e. local release of inflammatory mediators, independent of allergen stimulation of nasal mucosa. Increased release of inflammatory mediators contributes to the development of nasal polyps, determining oedema and an increased recruitment of inflammatory cells. Besides eosinophils, mast cells also play a key role in this process.

Adolescent↗
PubMed2001

Endovascular stenting for the nutcracker phenomenon.

PURPOSE: To present a case highlighting the efficacy of stent implantation for left renal vein (LRV) entrapment, otherwise known as the nutcracker phenomenon. CASE REPORT: A 17-year-old boy presented with a history of gross hematuria and left flank pain. Magnetic resonance angiography documented compression of the LRV between the superior mesenteric artery and aorta. A Memotherm stent was successfully placed across the LRV to restore adequate luminal flow after a Wallstent failed to adequately span the narrowed segment. Spiral CT angiography at 6 months confirmed LRV patency; the patient remains asymptomatic and free of hematuria at 12 months. CONCLUSIONS: Endovascular stenting for the nutcracker phenomenon is safe and effective and may represent a valuable approach for lessening the morbidity of surgical procedures.

Adolescent↗
PubMed2001

Characterization of total occlusions with intracoronary ultrasound: the importance of the duration of occlusion.

OBJECTIVE: To assess the impact of the occlusion duration on the characteristics of coronary occlusive plaques. BACKGROUND: The percutaneous recanalization of chronic total coronary occlusions is a technically demanding and yet often unsuccessful procedure due to unfavorable morphological changes described by histology but not well defined in vivo. METHODS: Thirty-five consecutive total occlusions of > or = 1 month duration in previously untreated native coronary arteries were studied using intracoronary ultrasound following dilatation with a 1.5 mm balloon. Plaque characteristics of lesions with an occlusive duration of > or = 3 months (old occlusions) and those of < 3 months (recent occlusions) were then compared. The ultrasound cross-section where there was maximal plaque accumulation at the site of occlusion was analyzed for its qualitative and quantitative characteristics. The lesion remodeling index was defined as the vessel area at occlusion divided by the vessel area at a proximal reference. RESULTS: The old occlusion group comprised 11 lesions whereas 16 lesions were found in the recent occlusion group; the occlusion duration was undetermined in the remaining 8 lesions, and the mean occlusion duration was found to be 4.9 +/- 4.3 months, over a range of 1 36 months. The baseline clinical and angiographic characteristics were similar in the 2 groups. The lesion remodeling index was found to be significantly lower in older occlusions than in the more recent occlusions (0.75 +/- 0.14 vs. 1. 06 +/- 0.25; p = 0.007) and the duration of the occlusion also correlated with the length of calcified segment as determined by ultrasound (p = 0.040), and with a smaller angiographic proximal reference diameter (p = 0.043). CONCLUSION: Long-standing occlusions undergo lesion shrinkage and exhibit more extensive calcification.

Adult↗
PubMed2001

Surgical and percutaneous myocardial angiogenesis induction. Part II--neoangiogenesis.

Coronary artery bypass surgery and angioplasty provide symptomatic relief in patients with ischemic heart disease, but despite advancement in technique and devices, these methods are not applicable to a subset of patients with angina refractory to medical treatment. Bypass surgery might not be feasible because of lack of suitable conduits, diffuse coronary disease or poor distal run-off, and coronary angioplasty is sometimes not applicable due to chronic total occlusion, diffuse disease or extreme tortuosity. We have previously reviewed the available experience with laser-induced direct myocardial revascularization, one of the new potential treatment modalities for this patient subset. One of the potential mechanisms of action for laser treatment is the induction of neoangiogenesis. In the second part of our article we review the available experience with the induction of myocardial angiogenesis using different growth factors or the genes encoding for them.

Coronary Disease↗
PubMed2001

Assessment of the functional significance of coronary lesions using a monorail catheter.

Myocardial fractional flow reserve (FFR) < 0.75 is a reliable index of a functionally severe coronary stenosis. FFR is best assessed by a sensor-tipped pressure monitoring guidewire (PW). The purpose of this study was to assess whether a multifunctional probing catheter (MFP), a 3 French dual-lumen monorail catheter, can be used to accurately measure intracoronary pressure and FFR. In 35 lesions (35 patients; learning group), we calculated FFR by both PW (FFRPW) and MFP (FFRMFP). Using ROC analysis, the FFRMFP value of 0.65 had the highest sensitivity with the FFRPW < 0.75. FFRMFP cut-off (0.65) was tested in 40 patients (testing group). In all cases, lumen diameter was documented by an intracoronary ultrasound examination. In the learning group, the FFRPW was 0.82 +/- 0.17 and FFRMFP was 0.70 +/- 0.23 (r = 0.88; p < 0.001). The FFRMFP cut-off value (0.65) correctly predicted the FFRPW in 37/40 cases in the testing group. In the 3 discordant cases, FFR was critical (< 0.65) by MFP and normal (> 0.75) by PW. In all these cases, minimal lumen cross-sectional area was < 2.8 mm2. When FFRMFP is > 0.65, FFRPW is always > 0.75. These data demonstrate that even with larger cross-sectional area than a pressure wire, the MFP catheter can easily and reliably be used to assess the functional severity of coronary stenosis.

Cardiac Catheterization↗
PubMed2001

Predictors of re-occlusion after successful recanalization of chronic total occlusion.

UNLABELLED: The objective of this study was to highlight the incidence and predictors of re-occlusion after successful recanalization of chronic total coronary occlusions. METHODS AND RESULTS: Following successful recanalization and stent implantation in 716 coronary lesions (665 patients) with chronic total occlusion, four hundred and five (56.6%) lesions (375 patients) underwent repeat angiography within 6 months. Restenosis (> or = 50% lumen narrowing) was observed in 151 (37.3%) lesions; forty-three (10.6%) of these lesions had complete re-occlusion and constituted the study population. In this group, final angiographic minimal lumen diameter (MLD) was 2.6 +/- 0.51 mm and final percent diameter stenosis was 18 +/- 11. Univariate analysis revealed significant correlation between re-occlusion and restenotic lesions, final balloon diameter, final percent diameter stenosis, final angiographic MLD, number of stents per lesion and total stent length. By multivariate analysis, the only independent predictor of re-occlusion was total stent length (OR = 1.46, 95% CI = 1.12-1.82; p = 0.0069). CONCLUSION: Re-occlusion occurs in about 11% of cases after stenting chronic total occlusion. The most important predictor of re-occlusion seems to be stent length.

Aged↗
PubMed2001

[The autonomic nervous system in myocardial infarction].

The occurrence of alterations in the autonomic control of cardiovascular function has long been known. Nevertheless, only in the last 15 years with the development and utilization of techniques such as heart rate variability and baroreflex analysis, unforeseeable amounts of information have been collected. The appraisal of alterations in the autonomic control mechanisms in the acute and post-acute phase of myocardial infarction has not only confirmed the presence of an increased sympathetic and of a reduced vagal modulation in most of post-myocardial infarction patients. It has also allowed the clinically relevant identification of those patients with an increased arrhythmic and total cardiac mortality. Most the high-risk patients are indeed characterized by a marked reduction in heart rate variability that can be detected using different methodologies. For example, with time-domain analysis of heart rate variability, it has been shown that an SDNN < 70 ms identifies patients at risk. By using spectral analysis, it has been possible to realize that the loss or marked attenuation of those rhythmical components that reflect autonomic modulation is also a characteristic of the high-risk patients. A decreased responsiveness of the sinus node to autonomic inputs may also explain the reduction in baroreflex sensitivity that characterizes patients with an increased arrhythmic mortality. In conclusion, the appraisal in each patient of the extent of the alterations in the autonomic control mechanism is nowadays a critical component of the clinical assessment not only for risk stratification but also in order to guide the prescription of new pharmacological and non-pharmacological therapies.

Autonomic Nervous System↗