Biomedical subjects

A Nicolini

Publications and source records attributed to A Nicolini.

At least 73 records · Page 4Linked to original sources

PubMed1996

Plasmatic parameters of coagulation activation in thrombotic microangiopathy.

Coagulation activation and fibrinolysis parameters were studied in eleven cases of thrombotic microangiopathy concerning eight adult patients. In addition to routine coagulation tests, antithrombin III, von Willebrand factor (vWF), prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), D-dimer (DD), and plasminogen activator inhibitor type 1 (PAI-1) were measured in the plasma at the time of diagnosis and as soon as remission was achieved after therapy with plasma exchange and Iloprost. In the acute phase all patients showed normal aPTT, normal or slightly prolonged prothrombin time, normal or enhanced plasma levels of fibrinogen and antithrombin III, at variance with results in patients affected by disseminated intravascular coagulation. Mean F1+2, TAT, DD, vWF and PAI-1 were elevated in the acute phase, but decreased significantly in the early phase of remission. Our data provide evidence of increased thrombin generation rate which takes place in the acute phase of the disease and does not result in consumption coagulopathy, due to appropriate inhibition by antithrombin III; blood coagulation activation promptly decreased as soon as remission was achieved. Cross-linked fibrin deposition together with PAI-1 may consolidate the platelet plug, eventually resulting in microvascular occlusion and ischemia.

Adolescent↗

PubMed1996

Thrombotic and hemorrhagic complications in chronic myeloproliferative disorders.

Bleeding and thrombosis are major causes of morbidity and mortality in patients with chronic myeloproliferative disorders. We retrospectively evaluated 101 consecutive patients affected by primary thrombocytosis (46 male, 55 female, aged 18-84 years; mean +/- SD 61 +/- 15) followed for a period ranging from 6 months up to 10 years (median 5 years) at our hematological unit. At the time of diagnosis 48 patients were asymptomatic; 26 had clinical evidence of atherothrombosis (cerebral ischemic attacks, ischemic heart disease, peripheral occlusive arterial disease), ten had venous thrombosis, four experienced major hemorrhages, 23 presented microvascular ischemic manifestations namely erythromelalgia, paresthesias, acrocyanosis and dizziness. At presentation 51.2% of the patients had elevated serum lactic dehydrogenase, 34.5% hyperuricemia, and 23.4% serum creatinine > 1.2 mg/dL. Color Doppler ultrasound provided evidence of vascular stenosis or medium-intimal hyperplasia of epiaortic vessels in 48.9% of patients studied, and similar alterations of lower limb arteries in 23.8% of cases. Therapy modality included an antiplatelet agent (picotamide 300 mg/bid); a cytoreductive agent (busulphan, hydroxyurea, pipobroman or melphalan) was used when platelet count was > 800000/microL. Symptoms due to microvascular ischemia promptly regressed after picotamide and cytoreductive therapy. During follow-up. nine patients suffered from atherothrombotic events (transient ischemic attacks, ischemic stroke, unstable angina pectoris) and five developed deep vein thrombosis or superficial thrombophlebitis. Five patients experienced major hemorrhages (two melena, two hematuria, one perioperative bleeding); the two gastrointestinal hemorrhages occurred in patients self-medicated with non steroidal anti-inflammatory drugs, and the two episodes of hematuria occurred on oral anticoagulant therapy and aspirin respectively. No major bleeding occurred in patients on continuative therapy with picotamide, even in the presence of upper digestive tract disorders. Seven patients died: mortality resulted from one sudden coronary death, three solid neoplasia, one blast crisis, one anile, and one massive hemorrhage due to abdominal aortic prosthesis tearing. Our study suggests that a long-term antithrombotic prophylaxis with picotamide may be of benefit in patients affected by primary thrombocytosis; a controlled clinical trial is warranted to assess whether picotamide can ameliorate the natural history of the disease.

Adolescent↗

PubMed1996

Interferon-gamma and nitric oxide down-regulate lipopolysaccharide-induced prostanoid production in cultured rat microglial cells by inhibiting cyclooxygenase-2 expression.

We have used purified microglial cultures obtained from neonatal rat brains to study some aspects of the regulation of prostanoid production in these cells. We found that nitric oxide, which is released into the culture medium along with prostanoids when the cells are exposed to lipo-polysaccharide (1-100 ng/ml), can down-regulate prostanoid biosynthesis. Indeed, the abrogation of endogenous nitric oxide production, obtained by depleting the medium of the precursor L-arginine or by blocking the activity of nitric oxide synthase by the specific inhibitor NG-monomethyl-L-arginine, led to a remarkable increase in lipopolysaccharide-induced prostanoid release. Moreover, the nitric oxide-generating compound 3-morpholinosydnonimine caused a substantial reduction of prostanoid formation, in the absence of endogenous nitric oxide, suggesting that both endogenous and exogenous nitric oxide may inhibit the induced prostanoid production. We also found that interferon-gamma potentiated the effect of lipopolysaccharide on nitrite accumulation as previously described by others and depressed the lipopolysaccharide-evoked production of prostaglandin E2, prostaglandin D2, and thromboxane. It is interesting that the inhibitory effect of interferon-gamma on prostanoid production did not appear to depend on the potentiation of NO release, as it was present also when the endogenous synthesis of nitric oxide was abrogated. Additional experiments showed that interferon-gamma and nitric oxide act mainly by down-regulating the lipopolysaccharide-induced enzymatic activity and expression (analyzed by western blot) of cyclooxygenase-2. Our data indicate that microglial prostanoid biosynthesis induced by proinflammatory stimuli, such as lipopolysaccharide, is tightly regulated by nitric oxide. Interferon-gamma appears to affect the balance between these local mediators by favoring nitric oxide production and inhibiting the prostanoid cascade and may thus contribute to the modulation of inflammation, local immune reactivity, and neuronal damage.

Animals↗

PubMed1996

The non-producer phenotype of the human immunodeficiency virus type 1 provirus F12/HIV-1 is the result of multiple genetic variations.

A cell clone (Hut-78/F12) chronically infected with a non-producer human immunodeficiency virus type 1 (HIV-1) variant showed an abnormal pattern of virus structural proteins and released no detectable virus particles. Exchanges of homologous parts of the F12/HIV provirus and a replication-competent HIV (strain NL4-3) were undertaken to define the genetic determinants of the F12/HIV phenotype. The non-infectious phenotype was reproduced by replacing an NL4-3 genomic fragment encoding the C terminus of gp 120 and the N terminus of gp41 with the corresponding parts of the F12/HIV provirus. Conversely, a much more extended genomic fragment (encompassing the vif, pol and env genes) was necessary to convert the F12/HIV phenotype. These results demonstrate that the F12/HIV non-producer phenotype is the result of mutations scattered along most of the genome, rendering the conversion to an infectious phenotype a very unlikely event. The F12/HIV genome is thus a reliable model for preclinical studies of anti-HIV gene therapy.

Defective Viruses↗

PubMed1996

Needle aspiration techniques in preoperative selection of patients with thyroid nodules: a long-term study.

PURPOSE: Long-term evaluation of the combination of two needle aspiration techniques (NAT) (fine-needle aspiration [FNA] and aspiration needle biopsy [ANB]) in performing an efficient preoperative selection of palpable thyroid nodules. PATIENTS AND METHODS: Eight years of extensive use of surgery for the detection of thyroid cancer was compared with 12 years of preoperative selection of by NAT. RESULTS: A total of 1,140 operations were performed from 1972 to 1979, and 35 malignant nodules were discovered (3.1%). Five thousand four hundred three patients were examined by NAT from 1980 to 1992; 483 (9%) underwent surgery and 158 malignant nodules were excised. The number of malignant nodules identified by NAT was 166 (eight were not excised) (3.1% of the total population examined). The principal clinical and pathologic features were similar in both groups. ANB yielded a definite benign diagnosis in 88 patients with inadequate FNA findings, it correctly identified four malignant nodules diagnosed as benign by FNA, it showed a macrofollicular component in 115 nodules diagnosed by FNA as microfollicular nodules, and it significantly changed the predictive value of 79 suspicions FNA diagnoses. CONCLUSION: Introduction of NAT reduced the number of operations for palpable thyroid nodules from 143 to 40 per year and increased from four to 13 the number of malignant nodules excised without any change in the overall incidence of malignant nodules. The combination of ANB to FNA significantly contributed to the high and efficient preoperative patient selection, principally by reducing the number of indeterminate or suspicious, as well as false-negative, preoperative FNA diagnoses.

Adolescent↗

PubMed1996

Prevention of variceal rebleeding and treatment of liver carcinoma by consecutive transjugular intrahepatic portosystemic shunt and hepatic artery chemoembolization.

Variceal bleeding and hepatocellular carcinoma are two severe complications of cirrhosis. One of our patients who bled from oesophageal varices was found to have a malignant hepatic nodule. As the patient refused liver transplantation, a transjugular intrahepatic portosystemic stent was carried out for portal hypertension, and transcatheter arterial chemoembolization for cancer. Both procedures were successful and one year later liver function has not deteriorated. This case shows that intrahepatic stent placement and selective arterial chemoembolization can be safely performed in cirrhotic patients with a solitary hepatocarcinoma nodule and a good liver function reserve.

Aged↗

PubMed1995

Cancer incidence and mortality in patients with heart disease. Effect of oral anticoagulant therapy.

Cancer incidence and mortality were reviewed in patients (683) who, during the period 1969-1988, had been attending the Cardiological Center of Pisa University for more than 1 year for valvular (494), ischemic (183), or myocardial (6) disease. Oral anticoagulant therapy (tromexan, acenocoumarol or warfarin) was administered to 312 of these 693 patients and regulated to prolong prothrombin time to a value between 20% and 40% of normal controls. The duration of treatment ranged from 1 to 14 years, with a mean of 4 years. As clinical and radiological controls were performed on all the patients at regular intervals (2-12 months), cancer incidence and mortality were recorded. Cancer incidence and mortality in the 312 patients treated with anticoagulants were compared with that of the 381 patients who did not receive this therapy. Furthermore, cancer mortality in the patients on anticoagulants was compared to that expected on the basis of national tumor registry rates. The age of the patients varied from 20 or under to 80 or over in both groups. The total observation period was 1415 patient-years (555 for males and 860 for females) in the former and 1617 patient-years (735 males and 882 females) in the latter. The proportion of the patient-years of the men over 45 (with the highest risk of cancer mortality) was higher in the group treated with anticoagulants (83%) than in the controls (72%) (p < .001). The proportion of the patient-years of the women over 45 was also higher in the former (84% vs 62%; p < .001). Six cancers were observed in the patients treated with oral anticoagulants (3 men, 3 women), while 12 cancers occurred in the control group (9 men, 3 women). There were 3 deaths in the former (1 man, 2 women) and 6 in the latter (5 men, 1 woman). On the basis of the national tumor registry rates, deaths expected in men and women on oral anticoagulants were 3 and 2. These data are compatible with the hypothesis that oral anticoagulants might reduce cancer incidence and mortality in humans.

Administration, Oral↗

PubMed1995

Usefulness of CEA, TPA, GICA, CA 72.4, and CA 195 in the Diagnosis of primary colorectal cancer and at its relapse.

A protocol with tumor markers as guidelines to follow up colorectal cancer patients was designed using criteria other than those commonly reported. They included combination of several markers and their dynamic evaluation of three different levels of increase: isolated elevated value (IEV), constant level of elevation (CE), and progressive increase (PI). In a total of 90 patients, the levels of combined serum CEA-TPA and GICA were serially measured, and in 71 of them, CA 72.4 and CA 195 levels were also determined. The tumor markers were measured during the first few months after surgery, and the usefulness of combined CEA-TPA-GICA and other, possibly more favorable combinations was determined in relation to "early" detection of recurrence and development of metastases. In addition the usefulness of conventional radiologic examinations and the impact on patients survival following "early" diagnosis was evaluated. A positive correlation was found between elevated preoperative serum tumor marker levels and the stage of disease. The postoperative variation of high serum CEA values was useful in identifying micrometastases after primary tumor resection. In the "early" diagnosed 14 patients with recurrence during the postoperative follow-up period, the highest sensitivity was found for TPA (87%) and, of the marker combinations, TPA-GICA (93%) with a lead time of 4.6 +/- 5.6 and 5.4 +/- 7.8 months (mean +/- SD) respectively. In nonrelapsed patients, falsely positive results of TPA-GICA (25%) were fewer than those for TPA-CA 195 (31%) and TPA-GICA-CA72-4 (35%). However, TPA-CA 195 and TPA-GICA-CA72-4, based upon their high sensitivity in patients with metastases, seemed in keeping with the effectiveness of TPA-GICA for monitoring of postoperative patients with colorectal cancer. In patients who developed recurrences, PI was more frequently present than IEV. In patients without recurrence, the opposite occurred. CE had less frequently discriminatory capability between these two groups than IEV and PI. Routine radiographic studies were ineffective whereas liver echography with its high sensitivity revealed the first sign of recurrence. Eight (50%) of the 16 relapses (two patients relapsed twice) were suitable for surgery because only one organ with a single metastasis was involved. Three (75%) of the 4 patients with "early" diagnosis of recurrence are alive without evidence of disease 5, 18, and 20 months after the last surgery. The results of this study revealed the importance of "early" diagnosis of recurrence for improved survival of patients with colorectal cancer.

Antigens, Neoplasm↗

PubMed1994

The value of aspiration needle biopsy in evaluating thyroid nodules.

From 1980 to 1990 4,229 consecutive euthyroid patients with thyroid nodule (73% with single and 27% with multiple nodules) were examined by FNA cytology for preoperative selection. One thousand four hundred and eight of these patients (33%) had nodules also suitable for evaluation by large needle biopsy histology (Aspiration Needle Biopsy, ANB). No significant complications occurred following ANB. The proportion of inadequate specimens was 25% for ANB and 15% for FNA, however a definite diagnosis was obtained with ANB in 62 patients with inadequate FNA finding. Diagnostic sensitivity was higher (93%) for FNA than for ANB whereas specificity was better (82%) for ANB diagnoses. Nonetheless ANB contributed to the increase of overall sensitivity as four of all the malignant nodules diagnosed as benign by FNA were correctly identified by ANB. Analysis of the postoperative results of 102 nodules with FNA and ANB finding of benign nodule or of suspected cancer showed that the addition to the same FNA finding (benign nodule or suspected cancer) of a different ANB diagnosis (suspected cancer or benign nodule) greatly changed the probability of finding a malignant nodule at postoperative histology. ANB was also useful in showing a macrofollicular component in 52% of 150 nodules diagnosed by FNA as pure microfollicular nodules.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

[Renal arteriovenous fistulae].

Arteriovenous fistulas (AVFs) involving the kidney are rare. They are generally classified as congenital, idiopathic or acquired. The authors present 5 cases of renal arterio-venous communications observed in recent years. These cases don't include the congenital type and represent the forms of AVFs that are more frequently observed (1 idiopathic, 3 iatrogenic, 1 associated with malignancy). This study is aimed at examining the clinical picture and the procedures of detection and monitoring of renal AVFs. The various adopted therapeutic procedures (nephrectomy, surgical ablation, radiological embolization) are analyzed.

Adult↗

PubMed1993

Evaluation of CEA, TPA, CA 15-3, CA 549 and TPS in the monitoring of metastatic breast cancer.

Monitoring the response to treatment in relapsed breast cancer patients is one of the chief uses of tumor markers. Thus far the carcinoembryonic antigen (CEA)-tissue polypeptide antigen (TPA)-breast cancer associated antigen 115 D8/DF3 (CA 15-3) association has been routinely used to follow-up breast cancer patients. We have found that TPA reflects the response to treatment much better than CEA and slightly better than CA 15-3. Recently carcinoma associated antigen 549 (CA 549) and tissue polypeptide specific antigen (TPS) have been reported to be highly sensitive tumor markers for breast cancer. TPS is claimed to be particularly suitable for monitoring the response to treatment because of its more specific assessment of proliferation activity. Therefore, in 13 relapsed patients with prolonged follow-up and detailed clinical-instrumental information, the mean percentage of samples with high CEA, TPA, and CA 15-3 values and their expressions were compared with those of CA 549 and TPS. All markers were also evaluated in terms of their correspondence with the evolution of disease. The correspondence with clinical-instrumental behaviour was scored absent (0), poor (1), good (2) and very good (3) by three different observers. Other more suitable associations than those already used were also investigated. It was found that CA 15-3 and CA 549 were expressed more often (92%) than TPS (85%), TPA (60%) and CEA (46%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Evaluation of serum CA15-3 determination with CEA and TPA in the post-operative follow-up of breast cancer patients.

The usefulness of post-operatively serial serum CA15-3 determination with CEA and TPA was evaluated in a group of 285 breast cancer patients. In particular, the CA15-3 sensitivity to 'early' diagnosis and monitoring of the response to treatment of breast cancer relapses, was compared with those of the two other markers in order to define the most suitable association. Moreover, in a group of 169 non relapsed patients with a prolonged follow-up (40 +/- 8 months; mean +/- s.d.) CA15-3 specificity was investigated. During post-operative follow-up in 27 (10%) patients, distant metastases occurred. In most of them, elevated values of one or more tumour markers were the first pathological sign and CA15-3, CEA and TPA sensitivity to 'early' diagnosis of metastases were 46%, 7% and 63% respectively. When each tumour marker was considered in combination, CA15-3-CEA-TPA association showed a higher sensitivity (87%) than both CA15-3-TPA (83%) and the CEA-TPA (70%). Serum CA15-3 increase preceded the certain sign of metastases 2.7 +/- 2.6 months (mean +/- s.d.). Shortly before appearance and during treatment of distant metastases, constant elevation and/or progressive increase in serum CA15-3 values occurred in all evaluated patients except three in whom isolated elevated values were found as well. In 24 (14%) of 169 non relapsed patients with prolonged follow-up (40 +/- 8 months; mean +/- s.d.) high serum CA15-3 values occurred. In 16 of these 24 patients, an isolated elevated value was found, while four (2.3%) or the eight remaining ones with constant elevation and/or progressive increase were falsely suspected of metastases. In this group of non relapsed patients, chronic liver failure, diabetes and/or hepatic steatosis were the reasons more commonly responsible for the CA15-3 increase. In metastatic patients, no organ-specificity was shown either by CA15-3 or by CEA and TPA. In these patients serum TPA values showed the highest sensitivity and paralleled clinical and/or instrumental signs better than the CA15-3 and even more than CEA values. These data indicate that in the post-operative follow-up of breast cancer patients, TPA is the most useful tumour marker and TPA-CA15-3 the most suitable association. Contemporaneous measurement of serum CEA levels only slightly increases sensitivity and positive predictive value of TPA-CA15-3 combination.

Adult↗

PubMed1991

The thyroid nodule: diagnostic strategy.

This paper comments on the principal techniques (nuclear imaging echography and needle aspiration) and the most widely used protocols available for preoperative selection of thyroid nodule patients. Successively, the authors report the principles to define a new appropriate protocol based on needle aspiration and hormone assays and evaluate their experience with this new simple protocol. Long term clinical practices shows that surgical excision can be avoided for more than 90% of the nodule patients and that thyroid scintigraphy can be avoided for most of these patients, without appreciable disadvantage.

Adult↗

PubMed1991

The role of arthrography in the diagnosis of meniscal tears.

The authors discuss the value of arthrography as a supplement to arthroscopy in the diagnosis of meniscal tears. Arthrography is superior to arthroscopy in its ability to detect lesions of the posterior horn of the medial meniscus, which are the most common meniscal tears. Moreover, arthrography can be done on an out-patient basis and at low cost. In any case, the best screening remains thorough clinical examination supplemented, if necessary, by imaging studies.

Adolescent↗

PubMed1989

A rational postoperative follow-up with carcinoembryonic antigen, tissue polypeptide antigen, and urinary hydroxyproline in breast cancer patients.

Breast cancer patients (n = 224) aged 28 to 81 were postoperatively followed up with serial determinations of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), and urinary hydroxyproline (OHP). The clinical usefulness of these tumor markers to diagnose and monitor distant metastases was compared with that of the imaging techniques commonly used to monitor breast cancer patients (bone scanning [BS], liver echography [LE], chest radiograph, and skeletal radiograph). So far, 23 patients withdrew from the study, and distant metastases occurred in 33 patients. In 91% of the metastatic patients, constant elevation or progressive increase in serum CEA and/or TPA levels were the first pathologic findings of the relapse. Of the remaining 168 nonrelapsed patients, 122 were followed up longer than 24 months (43 +/- 17 months; mean +/- SD). In these 122 patients the false-positive results of CEA, TPA, and OHP were 0.8%, 2.4%, and 0%, respectively, when used simultaneously with clinical examination and the common laboratory examinations. BS and LE are the only imaging techniques that showed such a high sensitivity to be suitable in the postoperative follow-up of breast cancer patients. Nevertheless, because BS has a low specificity and is not harmless, it should be performed at longer intervals than tumor markers. Eventually, in the relapsed patients, TPA and OHP well reflected the response to treatment better than CEA and prevented useless radiologic examinations.

Adult↗

PubMed1987

Bacampicillin and the immune response.

To evaluate the possible influence of a bacampicillin on the immune response, 16 subjects, out of a group of 60 patients with bacterial respiratory tract infections, had various tests of immune function determined, before and after treatment. The peripheral mononuclear blastogenic index (ratio between PHA-induced and spontaneous proliferation), PHA-induced interferon-gamma production, percentages of T and B lymphocytes, serum immunoglobulins (IgG, IgM, IgA) levels, failed to show any significative differences before and after the treatment with bacampicillin. The PHA-induced interleukin-2 production increased after treatment but just failed to reach statistical significance (0.1 less than P less than 0.05; t = 1.9). The clinical condition of 56 of the sixty (93.3%) treated patients improved and neither side-effects nor alterations of liver or kidney function were observed. This study has shown no inhibitory effect of bacampicillin on the immune response while confirming its clinical efficacy.

Adolescent↗

PubMed1987

Hypercholesterolaemia treated by soybean protein diet.

After a period of stabilisation on a controlled low lipid low cholesterol diet with animal proteins a group of 16 children with familial hypercholesterolaemia were given a textured soybean protein based diet, with a similar fat composition. All the children had a highly significant reduction in total cholesterol, averaging -21.8% against the baseline after eight weeks. Compliance became less strict afterwards, but more than half of the patients have regularly continued the diet and results have been maintained for one year. Minimal changes were noted in triglyceridaemia and in high density lipoprotein cholesterol concentrations, which showed a slight rise only at the end of treatment. The children's growth during the trial was normal. In view of the psychological difficulties of prescribing treatment with drugs to children with severe hypercholesterolaemia before puberty and of the relative ineffectiveness of standard low lipid diets in this condition the soybean protein diet may offer a satisfactory alternative.

Child↗

PubMed1984

Relationship between the circulating levels of adenohypophyseal hormones in blood and in cerebrospinal fluid.

Concentrations of prolactin, follicle stimulating hormone, luteinising hormone and growth hormone were measured simultaneously in the serum and cerebrospinal fluid of 57 patients affected by neurologic disease without any pituitary or diencephalic involvement. Prolactin secretion was stimulated in another group of 12 patients using sulpiride or metoclopramide, and the hormone concentration was measured simultaneously in serum and in CSF during the test. Basal studies showed that the concentrations of prolactin, FSH, LH and GH in serum and in CSF were directly correlated (p varying from less than 0.001 to less than 0.05). A negative correlation was found between the molecular weight of hormones reported in this and in other studies and the natural logarithm of the CSF/serum hormone concentration ratios. During prolactin stimulation the correlation between serum and CSF concentration was maintained, nevertheless a higher increase of prolactin in blood than in CSF was observed. This last finding suggests that other mechanisms in addition to filtration from blood into CSF can be responsible for the presence of adenohypophyseal hormones in CSF.

Adolescent↗