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Biomedical subjects

A Grandinetti

Publications and source records attributed to A Grandinetti.

At least 37 records · Page 2Linked to original sources
PubMed1997

The insulin resistance syndrome in native Hawaiians. Native Hawaiian Health Research (NHHR) Project.

OBJECTIVE: To investigate whether fasting hyperinsulinemia is associated with a clustering of cardiovascular disease (CVD) risk factors, manifesting as the insulin resistance syndrome (IRS), in a population of native Hawaiians. RESEARCH DESIGN AND METHODS: A total of 574 native Hawaiians > or = 30 years of age were examined for blood pressure, waist-to-hip ratio (WHR), BMI, oral glucose tolerance, and fasting lipid, insulin, and C-peptide concentrations. All statistical analyses (n = 384) excluded 190 individuals who had NIDDM or who were taking hypertension medication. Using logistic regression analysis, fasting insulin and C-peptide levels were compared with CVD risk factors (glucose intolerance, hypertension, central adiposity, elevated triglyceride levels, and low HDL cholesterol levels) after adjusting for age and obesity. RESULTS: Sixty-six percent of native Hawaiians were overweight or obese, and 70% were found to have central adiposity. Fasting insulin concentrations were correlated with BMI, WHR, blood pressure, and triglyceride, HDL cholesterol, and glucose concentrations. Fasting insulin was also significantly associated with an increasing number of CVD risk factors in each participant (P < 0.001). Fasting insulin and C-peptide concentrations were independently associated with glucose intolerance, high triglyceride levels, and low HDL cholesterol levels. However, only fasting C-peptide concentrations were independently associated with hypertension and central adiposity. Apparent differences in the correlates of fasting insulin and C-peptide may be related to multiple factors and warrant further evaluation. CONCLUSIONS: This study provides cross-sectional data confirming the existence of the IRS in native Hawaiians. However, further longitudinal studies are needed to examine the relationship of insulin resistance and/or surrogate markers to increased rates of NIDDM and CVD mortality in native Hawaiians.

Adult↗
PubMed1996

Observations on serum uric acid levels and the risk of idiopathic Parkinson's disease.

Uric acid, an antioxidant found in high concentrations in serum and in the brain, has been hypothesized to protect against oxidative damage and cell death in Parkinson's disease. The authors tested this hypothesis among men participating in a 30-year prospective study known as the Honolulu Heart Program. Serum uric acid was measured in 7,968 men at the baseline examination held from 1965 to 1968. Of these men, 92 subsequently developed idiopathic Parkinson's disease (IPD). In analyses adjusted for age and smoking, men with uric acid concentrations above the median at enrollment had a 40% reduction in IPD incidence (rate ratio (RR) = 0.6; 95% confidence interval (CI) 0.4-1.0). Reduced IPD incidence rates persisted in analyses restricted to nonsmokers (RR = 0.5; 95% CI 0.3-1.0) and cases younger than age 75 years (RR = 0.5; 95% CI 0.3-0.9). Incidence rates were not notably affected when analyses were restricted to cases that occurred more than 5 years after uric acid measurement (RR = 0.6; 95% CI 0.4-1.0). Inclusion of known or computed correlates of uric acid in regression models did not substantially change risk of IPD. This study provides prospective evidence of an association between uric acid and reduced occurrence of IPD and indicates that further investigations of this association are warranted.

Aged↗
PubMed1996

Evidence against the operation of selective mortality in explaining the association between cigarette smoking and reduced occurrence of idiopathic Parkinson disease.

To investigate the association between idiopathic Parkinson disease (IPD) and reduced frequency of prior cigarette smoking, the authors compared the 29-year follow-up mortality rates and IPD incidence rates of men who were either cigarette smokers or nonsmokers at the time of enrollment in the Honolulu Heart Study (1965-1968). Based on IPD cases detected up to June 30, 1994, the age-adjusted incidence rate in smokers was less than half that in nonsmokers: 34.4 versus 94.2 cases per 100,000 person-years of pre-illness follow-up, respectively. When data were stratified by 5-year age group, lower IPD incidence in smokers was observed at all ages between 50 and 90 years. Age-specific mortality trends for smokers and nonsmokers with and without IPD suggested that increased mortality in IPD patients was mostly associated with IPD itself and not with smoking. The slight excess mortality in smokers without IPD, versus nonsmokers without IPD, appeared insufficient to account for the "missing" incident IPD cases in smokers. These IPD incidence and mortality data are not highly consistent with the "selective mortality" hypothesis, which attributes reduced prior smoking frequency, typically reported by persons with IPD, to accelerated mortality in undiagnosed IPD-affected persons who smoke. The "protective" association of cigarette smoking with IPD occurrence may thus be real, suggesting the need for further study of biologic mechanisms of protection.

Age Distribution↗
PubMed1996

Epidemiologic observations on Parkinson's disease: incidence and mortality in a prospective study of middle-aged men.

We determined age-specific and age-adjusted incidence rates and mortality rates of idiopathic Parkinson's disease (PD) in a cohort of men followed for 29 years. Since enrollment in 1965, the Honolulu Heart Study has followed 8,006 American men of Japanese or Okinawan ancestry. Rescreening of the entire cohort, completed in 1994, included attempts to detect all prevalent and incident cases of PD, parkinsonism, and related conditions. PD incidence rates and age-incidence patterns were similar to rates previously published for Caucasian men in Europe and the United States, and were higher than incidence rates published for Asian men living in Asian nations. Prevalence patterns appeared to correspond more closely to patterns observed in developed nations than in Asian nations. PD was associated with markedly increased mortality that appeared to result from effects of both absolute age and disease duration. There was no firm evidence for differences in birth cohort risks of PD. These data may have implications for maturational and environmental theories of PD etiology.

Aged↗
PubMed1996

Case-control study of idiopathic Parkinson's disease and dietary vitamin E intake.

A nested case-control study of 84 incident cases of patients with idiopathic Parkinson's disease (PD) detected by June 30, 1994 and 336 age-matched control subjects, compared previously-documented intake of total dietary vitamin E and of selected vitamin E-containing foods. All study subjects had been followed for 27 to 30 years after diet recording in the 8,006-man Honolulu Heart Study cohort. We determined PD outcomes by periodic cohort re-examination and neurologic testing, private physician reports, examination of O'ahu neurologists' office records, and continual death certificate and hospital discharge diagnosis surveillance. Data on vitamin E intake, obtained from three dietary data sets at the time of cohort enrollment (1965 to 1968), included a food-frequency questionnaire and a 24-hour photograph-assisted dietary recall administered by trained dietitians. Although absence of PD was significantly associated with prior consumption of legumes (adjusted OR = 0.27, 95% CI 0.09 to 0.78), a dietary variable preselected for high vitamin E content, neither food categories nor quartiles nor continuous variables of vitamin E consumption were significantly associated with PD occurrence. Though consistent with prior reports of PD protection afforded by legumes, and with speculation on the possible benefits of dietary or supplemental vitamin E in preventing PD, these preliminary data do not conclusively document a beneficial effect of dietary vitamin E on PD occurrence.

Aged↗
PubMed1995

Cigarette smoking and protection from Parkinson's disease: false association or etiologic clue?

We reviewed 46 published reports associating cigarette smoking and Parkinson's disease. Although the majority indicated an approximate halving of smoking frequency in persons with Parkinson's disease, many observers have suggested that the effect could be a spurious result. That the association may be real is suggested by at least six observations: (1) the consistency of findings between independent studies of different design, conducted by different investigators, in different nations, over 35 years; (2) the association's predominance and strength in prospective studies; (3) the apparent detection of a dose-response relation; (4) the inability to explain the association by confounding variables; (5) the flaws in certain arguments against the association's validity; and (6) the identification of a similar association, of similar magnitude, between smoking and reduced occurrence of Alzheimer's disease. A protective association of cigarette smoking for Parkinson's disease may constitute an important etiologic clue.

Female↗
PubMed1995

[Renovascular hypertension-bilateral kidney: autotransplantation and reconstruction of the aorta with autologous saphena].

The authors describe a patient with stenosis of the renal artery undergoing bilateral kidney autotransplantation and reconstruction of the aorta with autologous saphena. This study also provides a general evaluation of renovascular hypertension incidence, etiopathogenesis, symptomatology, diagnostic criteria, therapy. The presence of a diastolic pressure > 110 mmHg, with normal creatinin levels and urinalysis results, is very significant and leads to invasive investigations. Site and size of the anatomic anomaly are evaluated by arteriography. Surgery is the treatment of choice.

Angiography↗
PubMed1994

Prospective study of cigarette smoking and the risk of developing idiopathic Parkinson's disease.

A 26-year follow-up study of 8,006 men enrolled in the Honolulu Heart Program examined the effect of cigarette smoking on the risk of developing idiopathic Parkinson's disease. Cases were identified through an ongoing search of hospital records and by the review of death certificates and medical records of local neurologists. Men who had smoked cigarettes at any time prior to study enrollment in 1965 had a reduced risk of developing idiopathic Parkinson's disease (relative risk = 0.39). Examination of smoking by pack-years revealed an apparent dose-response effect on the risk of idiopathic Parkinson's disease, but not on the age of onset. Coffee drinking was also associated with reduced risk, apparently because of its association with cigarette smoking. Although the detrimental health effects of cigarette smoking would far outweight any possible protective effect for smoking and Parkinson's disease, the association of smoking with apparent protection may contribute to understanding the underlying pathogenetic mechanisms.

Aged↗
PubMed1992

Validation of the Hodkinson abbreviated mental test as a screening instrument for dementia in an Italian population.

We investigated the accuracy of the Hodkinson abbreviated mental test (AMT) as a screening instrument for dementia in an Italian population. The AMT was administered by nonmedical personnel to 124 subjects > 59 years old. Each subject independently underwent a clinical evaluation for dementia (DSM-III criteria), and scores on the AMT were compared to corresponding clinical diagnoses (standard for comparison). Twenty of the 124 subjects were found to be affected by dementia upon clinical investigation. Although a score of 6 on the AMT showed the best combination of sensitivity (90%) and specificity (89%), only a score of 7 yielded 100% sensitivity (71% specificity). Specificity was higher in men, younger, and more educated subjects.

Aged↗
PubMed1991

Treatment patterns in elderly patients (greater than or equal to 70 years) with breast carcinoma. A retrospective study of the Gruppo Oncologico Clinico Cooperativo del nord-Est (GOCCNE).

The pattern of treatment used in elderly women affected by breast carcinoma was evaluated in a retrospective study by the North-East Clinical Cooperative Group in Italy (GOCCNE). Six divisions were involved in the study. The medical records of 115 elderly women were reviewed; the women's median age was 75 years (range, 70-93). Surgery was used in 70/72 operable patients (97%), although limited surgery plus radiotherapy was used in only 7.5%. Most stage II patients were treated with adjuvant tamoxifen, as were younger postmenopausal patients, according to the guidelines of the Bethesda Consensus Meeting. Comorbid conditions are of particular concern in therapy planning, considering that more stage III patients died of competing causes than for disease progression. The role of chemotherapy was very marginal.

Age Factors↗
PubMed1991

The antiemetic activity of high-dose metoclopramide and high-dose alizapride in combination with lorazepam in patients receiving cancer chemotherapy. A prospective, randomized, double-blind study.

The antiemetic efficacy of metoclopramide and lorazepam (MTC + L) versus alizapride and lorazepam (ALZ + L) was compared in 100 patients receiving chemotherapy, in a prospective randomized double-blind study. In highly emetogenic (HE) regimen (including platinum) patients received MTC 1 mg/kg or ALZ 3 mg/kg x 4 doses, and lorazepam 2.5 mg 30 min before therapy. In moderately emetogenic (ME) regimen patients received MTC 0.5 mg/kg or ALZ 1.5 mg kg x 3 doses, and lorazepam 2.5 mg 30 min before therapy. In both HE and ME regimen groups there was no statistically significant difference between MTC + L and ALZ + L treatments as regards the number of vomiting episodes, the duration of emesis and nausea, the intensity of nausea and side effects, but a statistically significant difference between treatments was found in the HE group where MTC-L was superior to ALZ + L in obtaining complete protection from vomiting (37 vs 11%, p = 0.05). No significant difference in side effects was observed.

Adolescent↗
PubMed1990

Primary non-Hodgkin lymphomas of the gastrointestinal tract: analysis of 41 cases.

Forty-one patients suffering from primary non-Hodgkin lymphomas of the digestive tract have been observed over a period of 15 years. The primary sites were: the stomach in 27 cases, the small bowel in 8, the ileocecal region in 5, and the mesentery in 1. Patients were staged according to the modified Ann Arbor staging system proposed by Mushoff (20). Four kinds of management were employed: 1) surgery alone; 2) surgery and radiotherapy; 3) surgery, radiotherapy and chemotherapy; 4) surgery and chemotherapy. One patient was treated by chemotherapy alone. Radiotherapy was administered postoperatively and chemotherapy after or during radiotherapy. Generally, 2 opposed fields largely encompassing the tumor area and lomboaortic nodes if necessary, up to 25-30 Gy to the midline, were employed, with a booster dose up to 40-45 Gy to the involved area. Total abdominal irradiation was never employed. No clear difference emerged in survival rate nor in relapse-free survival among the four subgroups, but patients who underwent complete resection fared better than incompletely resected patients. However, these two subgroups were not homogeneous. A clear difference in survival rate did not emerge between patients treated or not with postoperative chemotherapy, whereas patients who relapsed after complete remission or those who never had complete remission had a poor prognosis.

Adult↗
PubMed1990

External radiotherapy in the treatment of tonsillar carcinomas. Analysis of 183 cases.

A retrospective analysis of 183 consecutive patients with tonsillar carcinoma observed from 1970 through 1984 and treated by external radiotherapy was carried out. The data were analyzed retrospectively to determine the factors affecting prognosis. Tumor size (T) and lymph node involvement (N) were found to be predominant prognostic factors. The difference in 5 year survival rate between T2 and T3 tumors was significant, and that between N1 and N3 was highly significant, whereas difference in survival could be found between N0 and N1 groups. The primary tumor was controlled by radiotherapy alone in 90% of cases of T1 lesions, 58% of T2, 37% of T3 and 11% of T4, and lymph node metastases was controlled in 70% of N1 cases, 0 of N2 and 15.5% of N3. Twenty-three patients underwent salvage surgery after radiotherapy had failed and the actuarial 5 year survival rate was 75% for stage I, 40% for stage II, 30% for stage III and 13% for stage IV.

Adult↗
PubMed1990

[The problem of false positives in bone scintigraphy in patients with breast neoplasms. A follow-up at 10 years].

Bone scanning plays a pre-eminent role in tumor staging procedures, but its reliability is often questioned because of the high incidence of false positive results; not even bone biopsy can always clarify these questionable findings. To verify what actually becomes of the pathological hot spots lacking radiological evidence, we studied 49 patients with this discrepancy and followed them for an average period of 10 years (range: 8-11). The patients were divided into 3 subgroups: 1) 13 N+ patients with multiple hot spots (greater than 2) (N+ IM); 2) 24 N+ patients with single hot spots (less than or equal to 2) (N+ IS); 3) 12 N- patients with single hot spots (less than or equal to 2) (N- IS). Bone metastasis-free survival rate (SLMO) was calculated, which was confirmed by radiology, and overall survival rate (SG). SLMO was considered to coincide with the percentage of "true" false positives. At 10 years SLMO was 7%, 65%, and 83%, whereas SG was 15%, 70%, and 90%, respectively, in the 3 subgroups N+ IM, N+ IS, and N- IS. The Log-rank test demonstrated a highly significant difference (p less than 0.001) between SLMO and SG in these subgroups, due to the poor prognosis of N+ IM patients. The cumulative examination of all N+ N- patients with single hot spots (36 patients) demonstrated 75% probability of "true" false positives at 10 years. Moreover, the risk of bone metastases resulted higher in the hot spots of the spine than in those of the skull and ribs. The possible role is discussed of microfractures and bone traumatisms in the genesis of "true" false positives.

Adult↗
PubMed1989

The role of radiotherapy in the management of choroid plexus neoplasms.

Choroid plexus papillomas are very rarely reported neoplasms in both the surgical and radiological literature. The authors present their series of 7 papillomas and 1 carcinoma. They review the recent and former literature with the aim of demonstrating the role and usefulness of radiotherapy.

Adult↗
PubMed1988

Postoperative irradiation of brain ependymomas. Analysis of 33 cases.

Treatment and final outcome of 33 patients with brain ependymoma were reviewed. All patients had been operated, but the surgical removal was incomplete in the great majority of cases. Radiation therapy was subsequently performed using one of the following techniques; a) partial brain irradiation against the primary involved areas in 17 cases, b) whole brain irradiation plus boost against primary involved sites in 6 cases and c) total craniospinal irradiation in 7 cases. Three patients were not eligible for the present study because of underdosage. Five- and 10-year survival rates were 48 and 38% respectively. A short survey of recent literature is presented. The possible causes of failure and the methods for postoperative irradiation are discussed against the background of literature and our own cases.

Brain Neoplasms↗