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Biomedical subjects

A Nocera

Publications and source records attributed to A Nocera.

At least 37 records · Page 2Linked to original sources
PubMed1998

Severe tiger snake envenomation in a wilderness environment.

A 44-year old bushwalker was envenomed in an isolated area late in the afternoon, and a succession of difficulties with his rescue resulted in his not reaching hospital until nearly 24 hours later. This case highlights the problems of prolonged delays before treatment for envenomation, and points to the advantages of physician-staffed emergency helicopter services carrying snake antivenoms into the field.

Adult↗
PubMed1998

Acyclovir plus CMV immunoglobulin prophylaxis and early therapy with ganciclovir are effective and safe in CMV high-risk renal transplant pediatric recipients.

Cytomegalovirus (CMV) infection is still a major cause of morbidity in high-risk renal transplant recipients. In the present report, we have reviewed our records of renal transplant pediatric recipients (RTPR; mean age 14.1 +/- 4.9 years) since 1991, when we started a policy of CMV prophylaxis constituting high-dose oral acyclovir plus CMV hyperimmune immunoglobulins (HIg) followed by early i.v. ganciclovir therapy in high-risk patients (i.e., CMV donor+/recipient-). Four patients received a kidney from a living relative (LR), 2 patients had one previous transplant, and 1 had a combined liver-kidney transplant. Thirty-three patients who were negative for CMV antibodies (ab) before transplantation received a kidney from CMV ab positive donors. The immunosuppressive regimen included cyclosporine A and steroids, with the addition of azathioprine in the 4 patients who received an LR kidney. Serial assessments for CMV antigenemia (pp 65) were routinely performed for 6 months after transplantation to define CMV infection. Among the 33 CMV seronegative recipients (R-) who received the graft from a CMV seropositive donor (D+), 18 (54.5%) experienced CMV infection, whereas among the 28 CMV R+, who received a graft from a CMV D+, 11 (39.3%) experienced CMV infection. With regard to CMV- related symptoms, only 2 patients suffered from a CMV syndrome (fever and leukopenia in 1 patient, fever and arthralgia in the other). In no case did the spectrum of CMV disease occur; only minor symptoms were present in 7 of the remaining CMV-infected patients (fever in 6 and leukopenia in 1). Rejection episodes and renal function did not differ between CMV-infected and non-CMV-infected patients. Our experiences support the use of prophylactic acyclovir plus CMV HIg followed by early therapy with i.v. ganciclovir to combat the risk of increased morbidity in high risk RTPR.

Acyclovir↗
PubMed1998

Angiotensin-converting enzyme gene polymorphism and reversibility of uremic left ventricular hypertrophy following long-term antihypertensive therapy.

BACKGROUND: Prolonged antihypertensive therapy might be less effective in reversing the left ventricular hypertrophy (LVH) in uremics bearing the deleted (DD) allele of the angiotensin converting enzyme (ACE) gene than in patients with the inserted (II) allele or in those heterozygous (ID) for the gene. METHODS: Thirteen DD and 17 II + ID hemodialyzed uremics were followed-up with yearly echocardiography and 24-hour blood pressure (BP) monitoring over five years while on an antihypertensive therapy that included ACE inhibitors as first line drugs. RESULTS: In the II + ID group there were significant decreases of the left ventricular mass index (LVMi) and of both systolic and diastolic BPs. These changes were less pronounced in the DD group, but the difference was not statistically significant given the wide overlap between the two groups. Further analysis of the data revealed that the only factor associated to a decreased LVMi was the decrease of the systolic BP irrespective of the ACE gene genotype of each individual patient. CONCLUSIONS: The ACE-gene genotype does not necessarily predict the extent to which LVMi will be lowered by ACE-inhibitors therapy. The LVH of hypertensive uremics is amenable by long-term antihypertensive therapy provided that it results in significantly decreased systolic blood pressure.

Adult↗
PubMed1998

Cadaver kidney allocation in the north Italy transplant program on the eve of the new millennium.

The identification of parameters impacting on cadaver kidney graft outcome is of paramount importance to ensure proper organ allocation, a process that must take into account ethical, biological, social and administrative factors. This is particularly critical in countries where organ procurement is largely insufficient. In the present chapter we report the results of studies carried out to determine the impact of 17 factors on graft survival and function at 4 years posttransplant in 2,917 recipients transplanted from January 1990-September 1997 in the North Italy Transplant program (NITp). Patient and graft survival rates at 4 years (+/- SEM) were 93.5 +/- 0.5% and 81.4 +/- 0.8%, respectively. Excellent graft function at 4 years was shown by 69.8% of recipients. Younger donor age, absence of pretransplant transfusions, patient dialysis center in the NITp area and level of HLA match showed a statistically significant positive association with graft survival. Younger donor age and male donor gender showed a statistically significant association with excellent graft function at 4 years. These global outcomes were confirmed when the analysis was limited to the subset of the 2,617 adult recipients and to the subset of 1,211 cases for whom both donor and recipient HLA-DRB1 types were available before transplant. The results were used to develop a computer-assisted, refined version of the NITp adult kidney allocation algorithm that was named NITK3. A preliminary evaluation of 472 transplants allocated in 12 months with NITK3 compared with 459 transplants allocated in the preceding 12 months according to the previous algorithm (NITK2) showed a significantly higher proportion of recipients who had been on the waiting list for more than 3 years (33.1% vs 21.1%). The use of NITK3 was also associated with a significantly increased ability to transplant alloimmunized patients (17.7% vs 9.5% with NITK2) and recipients with 0-1 HLA mismatches (21.2% vs 13.5% with NITK2). Differences in 6-month graft survival rates and in the percentage of patients with excellent function at 6 months were not statistically significant in recipients transplanted with NITK3 versus NITK2. Survival rates were 96.9% and 92.4%, respectively. Percentages of patients with excellent renal function were 68.3% and 70.5%, respectively. These preliminary data suggest that NITK3 improves HLA match and reduces the number of patients on the waiting list for 3 or more years without determining significant modifications of 6-month graft survival and function. Moreover, it facilitates the achievement of a fair local balance between organs retrieved and transplanted, the compliance of operators with objective allocation rules and the documentation of the whole allocation process.

Adolescent↗
PubMed1997

Downregulation of HLA class I antigen expression in CD4+ T lymphocytes from HIV type 1-infected individuals.

The expression of HLA class I antigens is downregulated in CD4+ T cells following in vitro HIV-1 infection. We determined whether the expression of HLA class I antigens is downmodulated in peripheral blood lymphocytes (PBLs) of HIV-1-positive subjects and whether this defect correlates with disease progression. A cohort of 62 HIV-1-seropositive individuals in different stages of disease was studied. Among these, four subjects were evaluated at yearly intervals for 6 years. The expression of HLA class I, HLA class II, and CD38 antigens was analyzed in PBLs and in CD4+ and CD8+ T lymphocyte subpopulations. The percentage of HLA class I-positive cells and the membrane density of HLA class I antigens were significantly lower in PBLs from HIV-1-positive individuals than in PBLs from HIV-negative controls, proportionally decreased with disease progression, and significantly correlated with the decrease in CD4+ T lymphocytes. Furthermore, the percentage of HLA class I-positive cells and the membrane density of HLA class I antigens were significantly lower in CD4+ T lymphocytes from AIDS patients with respect to CD4+ T lymphocytes from HIV-negative controls and to CD8+ T lymphocytes from HIV-negative controls and AIDS patients. By contrast, the expression of HLA class II and CD38 antigens was upregulated in CD4+ and CD8+ T lymphocytes from HIV-1-positive subjects. The defective expression of HLA class I antigens could impair the lysis of HIV-infected CD4+ cells by virus-specific HLA class I-restricted cytotoxic T lymphocytes and contribute to the progression of disease.

Adult↗
PubMed1997

Risk of Kaposi's sarcoma-associated herpes virus transmission from donor allografts among Italian posttransplant Kaposi's sarcoma patients.

Kaposi's sarcoma-associated herpesvirus (KSHV) is a newly discovered herpes virus found in all forms of Kaposi's sarcoma (KS) including KS among immunosuppressed transplant patients. It is unknown whether this virus is transmitted by organ transplantation or is reactivated during immunosuppression among those patients infected before transplantation. To investigate the risk of KSHV transmission during organ transplantation, we conducted a case-control study of transplant recipients with and without KS matched to their respective donors. Sera were collected at time of transplantation and tested in a randomized and blinded fashion using four KSHV serologic assays testing for antibodies to both latent and lytic phase antigens. Ten (91%) of 11 organ recipients who developed KS were seropositive prior to transplantation by one or more of the assays compared with two (12%) of 17 control organ recipients (OR = 75, 95% CI = 4.7, 3500). KS cases were more likely to have been born in southern Italy where KS is endemic than the recipient controls or either donor group. Only four (36%) of 11 donors to case patients and three (18%) of 17 donors to control patients were seropositive (P = .38, two-tailed Fisher's exact test). KSHV transmission could not be ruled out for the single KS patient seronegative at transplantation and clear evidence for organ-related transmission was found for another KS patient outside of the case-control study. Antibodies to KSHV are detectable in the sera from most transplant recipients before initiation of immunosuppressive treatment suggesting that KS among immunosuppressed transplant patients is primarily due to virus reactivation. KSHV transmission, however, from an infected allograft can occur, and our study reports the first documented case of person-to-person transmission of KSHV.

Adult↗
PubMed1997

The St Marys fragmentation grenade explosion.

The accidental explosion of a fragmentation grenade in a munitions factory at St Marys injured four workers, two critically. The prompt response by ambulances and physician-staffed helicopter emergency medical service prevented deaths, but the incident suggests lessons for the future handling of urban explosions.

Adult↗
PubMed1996

HLA matching in pediatric recipients of a first kidney graft. A single center analysis.

We retrospectively examined the effect of HLA-A, -B, and -DR serological matching on graft survival in 88 pediatric end-stage renal disease patients who underwent primary renal transplantation. Actuarial graft survivals (GS) at 2 and 6 years in patients with zero DR mismatches (MM) (12 patients) or 1 DR MM (58 patients) were significantly higher than those in patients with 2 DR MM (18 patients) (2-year GS: 100% vs. 90% vs. 59%; 6-year GS: 100% vs. 79% vs. 59%, respectively). Because of the low number of patients in the zero DR MM group, only the GS difference between 1 DR MM and 2 DR MM had a significant result at 1 year (92% vs. 68%). No clear HLA matching effect was obtained in the HLA-A and -B loci. When DR were combined with A or B antigens (0-2 MM vs. 3-4 MM), significantly higher GS at 1, 2, and 6 years persisted for patients with 0-2 MM only in the A, DR group (96%, 94%, and 85% vs. 68%, 63%, and 56%, respectively). It is suggested that avoidance of mismatching for DR alleles at the serological level, in the selection of pediatric recipients of first cadaveric renal transplantation, leads to an improvement of both short- and longterm graft outcome.

Adolescent↗
PubMed1996

Complement-fixing islet cell antibodies in type-1 diabetes can trigger the assembly of the terminal complement complex on human islet cells and are potentially cytotoxic.

Forty-one sera of patients with IDDM (insulin-dependent diabetes mellitus) containing complement-fixing islet cell antibodies were analyzed for their ability to activate TCC (terminal complement complex). Eighteen sera were found to promote deposition of TCC on human islets of pancreatic cryostat sections with a nonhomogeneous pattern of distribution corresponding to that of insulin. Activation of TCC by IDDM serum and binding of this complex to islet cells was confirmed using purified islets. Flow cytometric analysis of islet cell treated with a TCC+ IDDM serum showed IgG binding to the cell surface. The same serum had a cytotoxic effect on islet cells in the presence of human C. These results obtained with a homologous system of C activation by IDDM sera suggest that TCC may contribute, at least in part, to the pancreatic beta cell damage.

Autoantibodies↗
PubMed1996

A flexible solution for emergency intubation difficulties.

The inability to correctly position the patient may cause difficulty during oral endotracheal intubation. Examples of such circumstances include cases of suspected cervical spine injury and cases of restricted access to the patient in the prehospital environment. The Eschmann tracheal tube introducer, more commonly called the "gum elastic bougie", is a valuable aid to oral intubation. The case reported herein, of a successful bougie-assisted oral intubation in the prehospital setting, highlights the usefulness of the technique. Physicians considering the use of the gum elastic bougie for intubation difficulties after rapid sequence induction should seek specific training in the use of the instrument.

Adult↗
PubMed1994

HLA class-I-soluble antigen serum levels in liver transplantation. A predictor marker of acute rejection.

The serum levels of sHLA-I have been determined in 16 patients following liver transplantation. sHLA-I levels did not show remarkable variations in six patients without evidence of transplant-related complications. sHLA-I levels strongly increased in 10 patients undergoing acute rejection episodes. In these patients, an average 20% daily increase of sHLA-I levels was detected on the 6 days preceding and on the 2 days following the rejection episode. A fast decrease of sHLA-I levels was observed in seven patients following treatment of acute rejection with anti-CD3 mAb. The serum level of sHLA-I antigens positively correlated with ALT serum level and inversely correlated with PT. The determination of sHLA-I in serum may therefore be proposed as a useful marker in the monitoring of patients following liver transplantation. The increase of sHLA-I antigens may predict the onset of acute rejection whereas their decrease may be related to a good response of acute rejection to immunosuppressive treatment.

Adult↗