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Biomedical subjects

A Girolami

Publications and source records attributed to A Girolami.

675 records · Page 38Linked to original sources
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Myelodysplastic syndrome and thrombocytosis: a random association?

We describe a case characterized by the onset of bone marrow hypoplasia. After treatment with steroid and anabolic compounds, it evolved into a myelodysplastic syndrome (MDS) as demonstrated by morphological and karyotypic analysis. Despite the dysplastic nature of the disorder, a unique feature was its association with a high platelet count. The pathogenesis of the thrombocytosis could not be clearly identified. In fact, the course of the disease was complicated by severe infections that, together with therapy, could have played some role in stimulating thrombopoiesis. However, since MDS can precede or follow a chronic myeloproliferative disease, it is also possible that the platelet elevation in our patient could have been sustained by a primitive thrombocyte disorder.

Anabolic Agents↗
PubMedDate not supplied

Myeloproliferative disease in patients with a history of multiple blood donations: a report of 8 cases.

BACKGROUND: The clonal origin of myeloproliferative disorders has been clearly demonstrated and it is known that reactive thrombocytosis occurs as a non specific response to various inflammatory or neoplastic conditions. Only a few papers have discussed the topic of myeloproliferative diseases in blood donors. MATERIALS AND METHODS: We report 8 cases of myeloproliferative diseases (3 polycythemia vera and 5 essential thrombocythemia) in blood donors out of a total of 44 myeloproliferative disorders diagnosed in our Department during the last 5 years on the basis of the criteria established by the Polycythemia Vera Study Group criteria. As controls we considered 61 patients with reactive thrombocytosis referred to our Department in the same period of time. The estimated odds ratio was calculated according to standard methods. RESULTS: The prevalence of blood donors with myeloproliferative disorders was 18.1%, while that of donors with reactive thrombocytosis was 3.2%. The estimated odds ratio was 6.56 with a 95% confidence interval between 1.07 and 17.3. No other single factor except blood donations was frequent in the past history of these patients. CONCLUSIONS: Our data seem to indicate that both thrombocytosis and erythrocytosis resembled primary forms in these subjects; however, none of them suffered serious thrombotic and/or hemorrhagic symptoms. Our study indicates the importance of paying due attention to the blood cell counts of blood donors.

Adult↗
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Serum neopterin levels in haematological malignancies.

BACKGROUND: Neopterin is an intermediate in the pathway of pteridines released in vitro from non proliferating activated cells such as macrophages stimulated with interferons. Increased urinary excretion of neopterin has been described in conditions of cell-mediated immune activation and in neoplastic diseases, including haemopoietic tumours. METHODS: We studied by radioimmunoassay serum neopterin levels of 91 patients with haematological malignancies differing in diagnosis, stage, treatment, and disease duration. RESULTS: Mean patient neopterin (13.5 nmol/L) was increased compared to 69 healthy controls (5.4 nmol/L, P < 0.001), and individual levels were related to patient survival (P = 0.006). No relevant differences were found among the various disorders, whilst advanced stages and active diseases had higher levels than initial stages and non-active diseases. Furthermore, off-therapy patients in stable remission did not differ from normals. Among subjects on therapy, patients on alpha-interferon had a higher percentage of (dose-related) neopterin elevation, in spite of a steady disease. CONCLUSIONS: We suggest that serum neopterin dosage has prognostic value in staging and follow-up, and may provide a useful tool for monitoring the therapy (particularly with biological response modifiers) of haematological neoplasias.

Adult↗
PubMedDate not supplied

[Use and misuse of hospital admission in a department of medicine in Padua].

We evaluated retrospectively 357 consecutive inpatients (M = 157; F = 200) 14=93 wars old (mean 60.9 +/- 1.0, SF: M = 59.5 +/- 1.4: F = 61.9 +/- 1.4) treated by a same physician at the 2nd Division of Medicine, Padua University Hospital, from January 1993 to July 1995. Such Division, which is representative of the Internal Medicine of an important Center has a high medical standard, as evaluated on the basis of academical and scientific titles of its staff, but no specific geriatric facilities. Patients had been assigned to the Division and, within it, to a given physician at random. 38.1% of patients were older than 70 (M = 30.0; F = 44.5, p < 0.01). Apart from the previous group, 29.1% of admissions (M = 28.0; F = 30.0) were inappropriate. 4.5% of admissions were terminally-ill cancer patients, already diagnosed and treated at other divisions and not further susceptible of specific therapy. Only 28.3% of patients (M = 38.2; F = 20.5, p < 0.0005) did not fall within any of the previous categories, but 33% of the days of their hospital stay were inappropriate (M = 30; F = 37). The mean hospital stay was 10.2 +/- 0.5 SE days (M = 10.4 +/- 0.6; F = 10.1 +/- 0.6). Considering patients altogether, the mean hospital stay was longer for patients older than 70 than for the others (12 +/- 0.9 vs. 9.3 +/- 0.5 days, p < 0.01) and a significant correlation was observed between age and stay length (r = 0.249, p < 0.0001). The educational level of inpatients was as follows: no education and elementary 65.8%; junior-high 20.7%; high 8.9%; university 4.4% with no difference between sexes, nor as compared to the general population, adjusted for age. It is concluded that a highly qualified division, to which it would appear appropriate applying only for cases not manageable as outpatients or by less qualified institutions, is suboptimally utilized with waste of money and resources. This is due to a deficiency in geriatric and residential facilities as well as in community and domiciliary care, to a noxious culture subordinating internal medicine to specialty branches and to the inadequate use of resources by both physicians and patients, in particular, among them, by females.

Adolescent↗
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Venous and arterial thrombophilia.

BACKGROUND AND OBJECTIVE: The thrombophilic state may be defined as a condition which predisposes to thrombosis. It is well know that the pathogenesis of venous and arterial thrombosis may be different. However, such differences may be more apparent than real. In fact, both venous and arterial thrombosis may occur in any given patient with a thrombophilic state. The aim of this review is to critically analyze the thrombophilic state and define a rational approach to the patient with overt or suspected venous and/or arterial thrombosis. EVIDENCE AND INFORMATION SOURCES: The material examined in the present review includes personal papers in this field, and articles and abstracts published in journals covered by the Science Citation Index. STATE OF ART AND PERSPECTIVES: Both venous and arterial thrombosis may occur in thrombophilic states such as APC resistance, protein C or S defects, and antiphospholipid antibody syndrome. Venous thrombosis is surely more frequent than arterial thrombosis in such conditions but, fortunately, it is usually less severe. Antithrombin deficiency is almost exclusively associated with venous thrombosis. In foreseeing the occurrence of venous or arterial thrombosis in a given thrombophilic patient, one must explore the state of the vessels carefully. Often venous or arterial thrombosis occurs only because a vessel injury is present. Severely decreased blood flow, such as that seen in policythemia vera, may be responsible for arterial or venous thrombosis without any other predisposing cause. From a laboratory stand point there is no sure demonstration that some changes may indicate a more likely occurrence of arterial or venous thrombosis. The same alteration of one or more than one test may be accompanied by either arterial or venous thrombosis or both. One exception to this rule is represented by increased blood viscosity, which is usually associated with arterial thrombosis. The hypercoagulable or thrombophilic state is a single clinical entity that cannot be divided into arterial and venous thrombophilia, although the unfortunate outcome, namely thrombosis, tends to manifest itself in just one district. The preexisting condition of the vessels, together with sudden triggering factors, plays an important role in the transformation of the "sol" into the "gel" that is a thrombosis in any given district.

Algorithms↗
PubMedDate not supplied

The clinical course of deep-vein thrombosis. Prospective long-term follow-up of 528 symptomatic patients.

BACKGROUND AND OBJECTIVE: In contrast to the extensive documentation on the short-term outcome of patients with acute deep vein thrombosis (DVT) of the lower extremities, little is known about the long-term clinical course of this disease. To determine the clinical course of patients with a first episode of symptomatic DVTn over an 8-year follow-up period. The primary aims were to assess the long-term incidence of recurrent venous thromboembolism and that of the post-thrombotic syndrome. In addition, we determined mortality and evaluated potential risk factors for all these outcomes. METHODS: This was designed as a prospective cohort follow-up study. Consecutive symptomatic outpatients with a first episode of venography proven DVT were treated with an initial course of full-dose (low molecular weight) heparin, followed by at least three months of oral anticoagulants. After discharge, they were instructed to wear compression elastic stockings for at least two years. Follow-up assessments were scheduled at three and six months, and then every six months up to eight years. Diagnosis of recurrent venous thromboembolism was made according to standard criteria. The presence of post-thrombotic syndrome was evaluated using a standardized scale. RESULTS: A total of 528 consecutive patients with a first episode of venography confirmed DVT were included in the study. The cumulative incidence of recurrent venous thromboembolism after two, five and eight years was 17.2, 24.3 and 29.7%, respectively. Malignancy and impaired coagulation inhibition increased the risk of recurrent venous thromboembolism (RR = 1.48 and 2.0, respectively). In contrast, surgery and recent trauma or fracture were associated with a diminished risk of recurrent venous thromboembolism (RR = 0.65 and 0.39, respectively). The cumulative incidence of post-thrombotic syndrome after two, five and eight years was 24.5, 29.6 and 29.8%, respectively. The development of ipsilateral recurrent DVT was strongly associated with the risk for post-thrombotic syndrome (risk ratio, 2.4). Survival after eight years was 69%. The presence of malignancy increased the risk of death remarkably (risk ratio, 7.1). INTERPRETATION AND CONCLUSIONS: Symptomatic DVT carries a high risk for recurrent venous thromboembolism that persists for many years, especially in patients without transient risk factors for DVT. The post-thrombotic syndrome occurs in almost one-third of patients and is strongly related to recurrent ipsilateral DVT. Our findings challenge the widely adopted short course of anticoagulation in patients with symptomatic DVT.

Adult↗
PubMedDate not supplied

Low molecular weight heparins in clinical practice: unsolved or partially solved problems.

Low molecular weight heparins (LMWH) have been shown, in recent years, to be at least as effective as standard heparin (SH) in the prophylaxis and treatment of venous thrombosis. In spite of several studies there are still some unsolved problems to be dealt with. These may be summarized along the following lines: 1) Side effect; 2) Use in pregnancy; 3) Role in arterial thrombosis; 4) Use in severe deep venous thrombosis; 5) Use for home treatment; 6) Effect on cancer related mortality; 7) Standardization of preparations; 8) Dosage uncertainties; 9) Long term treatment. The two most important aspects are those pertaining to the potential use in arterial thrombosis and the possibility of home treatment of selected patients with venous thromboembolism. A few studies now indicate that LMWH may play an important role in several arterial thrombosis (coronary disease, ischemic stroke, etc). As far as the indications for home treatment are concerned, recent studies have given a positive answer. However, rather than home treatment it would be more appropriate to refer to early discharge from the hospital. The overall impression is that LMWH may represent an important progress in the management and prophylaxis of thrombotic disease.

Adult↗
PubMedDate not supplied

Primary breast lymphoma.

Breast involvement by non-Hodgkin lymphoma is uncommon. Differences between primary and secondary breast lymphoma have been well-defined. However, histopathological features, therapeutic approach and outcome are still debated. We report the clinical and pathological features of 5 cases of malignant lymphoma primarily involving the breast. The literature is extensively reviewed paying particular attention to pathological features, therapeutic approach and survival analysis. All patients were women; the median age was 63.2 yr. The clinical course was indistinguishable from that of breast carcinoma. High-grade lymphoma was found in 4 cases; T cell lineage antigens were expressed in one case. All patients were in stage I or II. Treatment consisted of chemotherapy and/or radiotherapy. The follow-up period ranged from 20 to 54 months (mean, 33.2). All patients are still in complete clinical remission. Analysis of the literature showed that about 80% of cases are high grade lymphoma. In this group, stage I at presentation statistically gives the best survival rate; surgery does not appear to have a role in high-grade lymphoma treatment.

Adolescent↗