Thromboembolism and breast cancer: the hidden risk for patient and physician.
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Aged↗
Biomedical subjects
A Grieco
Publications and source records attributed to A Grieco.
Anticholinergic syndrome due to 'Devil's herb': when risks come from the ancient time.
We describe a case of Mandragora autumnalis poisoning which occurred in a 72-year-old female patient who had eaten the venenous M. Autumnalis, picked near her home, mistaking it for the edible Borago Officinalis. M. Autumnalis is a solanaceous plant, common in the Sicilian countryside, which contains a variable concentration of solanum alkaloids, causing gastrointestinal irritation, and tropane alkaloids, with anticholinergic properties. Unluckily, M. Autumnalis is often mistaken for the edible B. Officinalis, likewise widespread in Sicilian countryside. The diagnosis of Mandragora poisoning was made on the basis of clinical symptoms and signs of anticholinergic syndrome associated with a history of vegetable meal of uncontrolled origin, moreover analysing the vegetable obtained from gastric lavage. Decontamination and symptomatic treatment were useful in our patient to control acute poisoning.
Cholinergic Antagonists↗
Fulminant liver failure caused by cyproterone.
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Aged↗
Long-term effects of MDMA (Ecstasy) on the human central nervous system revealed by visual evoked potentials.
Several studies indicate long-term cognitive impairment of MDMA (ecstasy) users. In the present study we attempted to establish whether electrophysiological correlates of low-level cognitive processes present a long-term alteration, dependent on the level of use of ecstasy. We addressed this issue by investigating amplitude and latency of VEPs related to a very simple discrimination task involving sustained attention (arousal). Eight heavy-MDMA users, eight moderate-MDMA users and 18 drug-free control subjects were asked to discriminate whether the digit at the centre of the screen was 1 or 2. None of the subjects (except one) had used MDMA in the 6 months previous testing. We measured psychophysical performance and EEG, recorded in Oz and Fz during task execution. The heavy-MDMA users made significantly more errors than the other two groups (p < .05). Moreover, they presented reduced amplitude but not latency of VEPs in both Oz and Fz. The effect in Oz is present in P200 (for heavy users only, p < .05) and in P300 components (for both MDMA groups; heavy users: p < .001, moderate users: p < .0.5). In Fz, the amplitude effect is present in N250 (for heavy users only, p < .05) and in P300 components (for both MDMA groups; heavy users: p < .05, moderate users: p < .05). The three groups do not differ in early components, reflecting low-level processing. These results provide evidence of long-term electrophysiological abnormality displayed by ecstasy users and agree with the suggestion that even typical recreational doses of ecstasy are sufficient to cause long-term altered cortical activity in humans.
Adult↗
Prognostic factors for survival in patients with early-intermediate hepatocellular carcinoma undergoing non-surgical therapy: comparison of Okuda, CLIP, and BCLC staging systems in a single Italian centre.
BACKGROUND: Several prognostic models have been developed to stage hepatocellular carcinoma (HCC) but there is no general consensus on which is the most reliable. We compared three prognostic indices (Okuda, CLIP, and BCLC scoring systems) in a large series of cirrhotic patients with HCC undergoing non-surgical treatment in terms of their ability to classify patients into different risk groups METHODS: We retrospectively studied 268 Italian patients with HCC. A total of 146 patients were treated with ablation, 132 with percutaneous ethanol injection, and 14 with radiofrequency ablation; 103 underwent transcatheter arterial chemoembolisation and 19 had supportive care alone. Factors determining survival were analysed by univariate and multivariate analysis using the Kaplan-Meier method and Cox proportional hazard regression models. Okuda, CLIP, and BCLC scores evaluated before treatment were applied. RESULTS: Median survival was 25.7 months. In a multivariate analysis, portal vein thrombosis, alpha fetoprotein, total bilirubin, and tumour size were significant predictors of survival. Okuda, CLIP, and BCLC scores were all able to predict survival (p<0.001). They identified two, four, and six risk groups, respectively, with a median survival ranging from 27 to 19 months for Okuda, 30 to 5 months for CLIP, and 43 to 7 months for BCLC. CONCLUSIONS: Both CLIP and BCLC scores were more effective than the Okuda score in stratifying patients into different risk groups with early-intermediate HCC. However, the BCLC scoring system gave a better prediction of prognosis in patients with disease diagnosis at a very early stage.
Adult↗
High efficacy of 1-week doxycycline- and amoxicillin-based quadruple regimen in a culture-guided, third-line treatment approach for Helicobacter pylori infection.
BACKGROUND: Helicobacter pylori infection may persist after both first- and second-line current treatments. AIM: To assess the efficacy of a third-line, culture-guided treatment approach for the eradication of H. pylori. METHODS: Patterns of resistance were analysed in H. pylori isolates from 94 consecutive patients in whom H. pylori infection had persisted after two eradication attempts. Using the epsilometer test, susceptibility analysis was performed for amoxicillin, clarithromycin, metronidazole, tetracycline and levofloxacin. Patients were then treated with a culture-guided, third-line regimen: 89 patients with a 1-week quadruple regimen including omeprazole, bismuth, doxycycline and amoxicillin, and five patients with a 1-week triple regimen containing omeprazole, amoxicillin and levofloxacin or clarithromycin. RESULTS: Ninety-four subjects (100%) were resistant to metronidazole, 89 (95%) to clarithromycin, 29 (31%) to levofloxacin and five (5%) to tetracycline. No resistance to amoxicillin was found in any patient. Overall, H. pylori eradication was obtained in 90% of subjects. The quadruple regimen was effective in 81 patients (92% by per protocol and 91% by intention-to-treat analysis). Four patients (80%, both per protocol and intention-to-treat analysis) were H. pylori-negative after the triple regimen. CONCLUSIONS: A culture-guided, third-line therapeutic approach is effective for the eradication of H. pylori. Furthermore, the 1-week doxycycline- and amoxicillin-based quadruple regimen is a good third-line 'rescue' treatment option.
Amoxicillin↗
A randomized controlled trial of amantadine plus interferon-alpha2a vs. interferon-alpha2a alone in naive patients with chronic hepatitis C randomized according to the early virological response to interferon-alpha2a monotherapy.
BACKGROUND: An early virological response to interferon-alpha treatment is a strong predictor of sustained response, but it has never been exploited to stratify patients in clinical trials. AIM: To evaluate the efficacy of amantadine plus interferon-alpha compared with interferon-alpha alone in naive patients with chronic hepatitis C who were randomized on the basis of the early virological response to interferon-alpha. METHODS: One hundred and eighty-one patients received recombinant interferon-alpha2a (3 MU three times weekly) for 2 months and 164 were evaluated for early (i.e. month 2) virological response. Hepatitis C virus (HCV) RNA-negative patients (n = 66) were randomized to receive 3 MU of interferon-alpha three times weekly, with or without amantadine (200 mg/day); HCV RNA-positive patients (n = 98) were randomized to receive 6 MU of interferon-alpha three times weekly, with or without amantadine (200 mg/day). HCV RNA-positive patients at 6 months discontinued treatment, and all others completed 12 months. RESULTS: At month 6, HCV RNA-negative patients made up 54.2% of the interferon + amantadine group and 42.0% of the monotherapy group (P = 0.07). At month 12, HCV RNA-negative patients made up 38.5% of the interferon + amantadine group and 28.4% of the monotherapy group (N.S.). The sustained virological response rates were 21.6% and 20.9%, respectively (N.S.). CONCLUSION: The addition of amantadine does not enhance the sustained virological response to interferon-alpha in naive patients with chronic hepatitis C; however, an additive effect of amantadine occurs in the first 6 months, mainly in patients without an early response to monotherapy. Early response to interferon-alpha is a strong predictor of sustained virological response.
Adolescent↗
Review article: breath testing for human liver function assessment.
Carbon-labelled breath tests were proposed as tools for the evaluation of human liver function 30 years ago, but have never become part of clinical routine. One reason for this is the complex role of the liver in metabolic regulation, making it difficult to provide essential information for the management of patients with liver disease with a single test and to satisfy the hepatology community. As a result, a battery of breath tests have been developed. Depending on the test compound administered, different metabolic pathways (microsomal, cytosolic, mitochondrial) can be examined. Most available data come from microsomal function tests, whilst information about cytosolic and mitochondrial liver function is more limited. However, breath tests have shown promise in some studies, in particular to predict the outcome of patients with chronic liver disease or to monitor hepatic function after treatment. Whilst we await new substrates that can be used to measure liver function in a more valid manner, and large prospective studies to assess the usefulness of available test compounds, the aim of this review is to describe how far we have come in this controversial and unresolved issue.
Breath Tests↗
Reproducibility of asystole during head-up tilt testing in patients with neurally mediated syncope.
Tilt induced prolonged asystole has been considered to identify a distinct subgroup of patients with neurally mediated syncope and management including permanent pacemaker implantation has been suggested. To evaluate the reproducibility of asystolic response during head-up tilt testing (HUT), 33 patients with neurally mediated syncope and asystolic response (> or = 3 seconds) during HUT prospectively underwent two consecutive tests 13 +/- 15 days apart. On repeat tilt testing asystole was reproduced in 12 patients (36%), while 8 patients still had a positive HUT, but without asystole. Remarkably, 13 patients (40%) had a negative repeat HUT. Among 12 patients with asystole on both HUTs there was no significant difference in duration of asystole (14 371 +/- 11 430 ms vs 13 707 +/- 10 470 ms, P = ns) and time to syncope (36 +/- 20 min vs 37 +/- 20 min, P = ns) during initial and repeat HUTs. In conclusion, asystole during tilt testing does not seem to be a reproducible response.
Adolescent↗
Gastrointestinal stromal tumor (GIST) and ulcerative colitis.
A 57 year old woman, affected by Ulcerative Colitis (UC) in remission, was admitted to our unit with a history of episodic melena and progressive anemia. Computed tomography (CT) of the abdomen revealed a solid mass in the upper left pelvic cavity. After surgical laparotomy, the mass showed histological characteristics of a gastro intestinal stromal tumor. This report describes a GIST in a patient with extensive UC, which was in remission at the time of diagnosis. To our knowledge, this is the first report of an association of this type.
Anemia↗
Discrimination of an orientation difference in dynamic textures.
We investigated whether the response of a motion sensor was related to the specificity of sensory information (orientation and direction of motion) used to compute motion energy. This was done in two ways. First, we assessed whether orientation discrimination of a target line, which segregated by an orientation difference from a textured background, was improved with two-frame apparent motion stimulation (as compared with static presentation). Second, we investigated whether the amount of improvement (in either orientation or direction of motion discrimination) depends on a particular combination of target orientation and direction of motion (either orthogonal or parallel). We found that the percentage of correct responses in the discrimination task (a) was higher for a moving target than for a static one; (b) was higher when the target was oriented more orthogonally to motion direction than background elements; (c) was little affected by background motion and (d) decreased with frame duration in the direction of motion task whereas it was largely unaffected by frame duration in the discrimination of orientation task. These results suggest that discrimination of moving texture boundaries is based on a motion sensor tuned to a particular combination of orientation and direction of motion, which is capable of signalling the orientation of a moving target more accurately than a static sensor.
Analysis of Variance↗
Spontaneous daily variability of atrial sensitivity. A study with an implanted DDD pacemaker.
BACKGROUND: Spontaneous variations in the chronic stimulation threshold were widely investigated in the last few years and formed the basis of the safety margin concept of stimulation energy. The dynamic variability of sensitivity, particularly in the atrium, is less studied and, in the literature, contrasting data are present about the actual entity of these variations. A 2:1 safety margin is still recommended by many authors, although some papers reported that this value was inadequate to guarantee a correct sensing function. AIM OF THE STUDY: We evaluated daily variability of atrial sensitivity (AS) in patients implanted with the Cosmos 3 DDD cardiac pacemaker, with a special algorithm that continuously measures the minimum-maximum sensitivity values in atrium or in the ventricle during a 12-h sampling period. MATERIALS AND METHODS: 34 patients, 20 males and 14 females, with a mean age of 72+/-5 years, were implanted with a Cosmos 3 DDD pacemaker (PM). The indication to implant a PM was sick sinus syndrome in 21 patients and a high degree of AV block in 13 patients. Atrial bipolar leads were always employed. At 1, 2, 3 and 6 months after the implant, we analyzed the minimum-maximum values of atrial sensitivity for the last 12-h. This analysis was performed in the late afternoon. RESULTS: The mean AS varied more than threefold, from a mean minimum of 0.68 to a mean maximum value of 2.19 mV at 1 month, from 0.68 to 2.21 mV at 2 months, from 0.69 to 2.19 mV at 3 months and from 0.67 to 2.17 mV at 6 months, without significant differences among the four follow-up controls. In seven patients, there was a fourfold variation, while the variation was fivefold in five patients. CONCLUSION: In conclusion, from our data, we can confirm that atrial sensitivity may vary widely during the day and, consequently, we recommend that a 3:1 safety margin should be programmed and the recommended 2:1 ratio should be abandoned. Moreover, at implant, particular attention should be paid to obtaining the best atrial signal amplitude, at least threefold higher than the highest sensitivity value available in the implanted PM. To achieve this goal and to obviate to the oversensing phenomena, bipolar leads are preferable to unipolar leads.
Aged↗
Non-alcoholic steatohepatitis induced by carbamazepine and variegate porphyria.
A 42-year-old woman presented with acute bullous skin lesions and angio-oedema that had developed 3 months after initiation of treatment with carbamazepine for epilepsy. Chromatographic analysis of urinary porphyrins was compatible with variegate porphyria. This was manifested initially by neurological symptoms that were mistaken for epilepsy and later by cutaneous symptoms also. Histological findings excluded hepatic porphyria, but revealed severe fatty changes thought to be caused by idiosyncratic metabolism of carbamazepine. While the porphyrinogenicity of carbamazepine is well known, the presence of variegate porphyria has not been reported. The toxic hepatic effects of the drug on hepatic cytochrome P-450, which is involved in haem metabolism, could have aggravated the pre-existent porphyria, provoking the onset of skin lesions.
Adult↗
Mapping B-cell epitopes of hepatitis C virus E2 glycoprotein using human monoclonal antibodies from phage display libraries.
Clinical and experimental evidence indicates that the hepatitis C virus (HCV) E2 glycoprotein (HCV/E2) is the most promising candidate for the development of an effective anti-HCV vaccine. Identification of the human epitopes that are conserved among isolates and are able to elicit protective antibodies would constitute a significant step forward. This work describes the mapping of the B-cell epitopes present on the surface of HCV/E2, as recognized by the immune system during infection, by the analysis of the reciprocal interactions of a panel of human recombinant Fabs derived from an HCV-infected patient. Three unrelated epitopes recognized by antibodies with no neutralization-of-binding (NOB) activity were identified; a fourth, major epitope was defined as a clustering of minor epitopes recognized by Fabs endowed with strong NOB activity.
Antibodies, Monoclonal↗
Sporadic HEV hepatitis in Italy.
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Acute Disease↗
Is coeliac disease a confounding factor in the diagnosis of NASH?
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Adult↗
Non-Invasive assessment of human hepatic mitochondrial function through the 13C-methionine breath test.
BACKGROUND: Mitochondrial metabolism is essential for liver function, and the availability of simple and non-invasive tests able to assess hepatic mitochondrial function could be extremely useful. Since the amino acid methionine is mostly oxidized by liver mitochondria, we investigated the feasibility of a breath test with 13C-methionine in healthy subjects to assess hepatic mitochondrial function before and after ethanol-induced oxidative stress. METHODS: Twenty healthy male volunteers received 2 mg/kg body weight [methyl-13C]-methionine. Breath 13CO2 enrichment was measured at base line and every 15 min thereafter for 180 min. Forty-eight hours later the test was repeated 30 min after the ingestion of ethanol (0.3 g/kg body weight). RESULTS: After oral administration of methionine, 13CO2 excretion reached a peak (4.76% +/- 0.9%) within 30-60 min and then decreased progressively. The cumulative 13CO2 excretion within 3 h was 7.81% +/- 0.66%. After ethanol-induced oxidative stress, 13CO2 excretion increased slowly, with a delayed and significantly decreased peak (2.13% +/- 0.45%; P < 0.05). The cumulative 13CO2 exhalation was significantly decreased already at 60 min (1.22% +/- 0.29%; P < 0.05). CONCLUSIONS: The present results seem to indicate that the 13C-methionine breath test could act as a marker to estimate the oxidative capacity of liver mitochondria in healthy subjects. Further study, however, is still needed to confirm the validity of the test, which could yield clinically useful information in various liver pathologic conditions.
Adult↗
Visual search for single and combined features by children and adults: possible developmental inferences.
Visual search time was measured in four groups of children 4 to 10 years of age and in young adults, as a function of display size for both target present and target-absent conditions. The slopes of regression lines in a simple search (search for \ within /) were compared with those obtained in within-dimension conjunction target searches, within either homogeneous (search for the inverted T within Ts) or heterogeneous distractors (search for arrow within Ys and inverted Ys). Analysis indicated that simple search was always preattentive (slopes near 0) after 5 years of age and serial (with positive slopes) before this age. Searching within heterogeneous distractors apparently involved element-by-element scrutiny and focal attention in all groups whereas searching within homogeneous distractors required distributed attention, perhaps based on parallel grouping of distractors in adults, though distractors were focally attended to by children.
Adult↗