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C Alessandri

Publications and source records attributed to C Alessandri.

123 records · Page 7Linked to original sources
PubMedDate not supplied

Relationship between prothrombin activation fragment F1 + 2 and serum cholesterol.

Plasma levels of fibrinogen, factor VIIc and prothrombin fragment F1 + 2, a marker of thrombin generation in vivo, were studied in 68 subjects with serum total cholesterol (TC) levels between 135 and 349 mg/dl but without clinical evidence of cardiovascular disease and other atherosclerotic risk factors. F1 + 2 plasma levels were directly correlated with TC (p < 0.0004), low-density lipoprotein cholesterol (LDL-C; p < 0.0018) and factor VIIc (p < 0.024). Thirty-five subjects with TC greater than 249 mg/dl (median value of the whole group) showed higher levels of F1 + 2 (p < 0.0001) and fibrinogen (p < 0.0015) than those with TC lower than 249 mg/dl. In subjects with TC > 249 mg/dl and F1 + 2 > 1.2 nM (median value of the whole group), a cholesterol-lowering drug (simvastatin) was able to reduce F1 + 2 (p < 0.009) as well as TC and LDL-C. This study shows a relationship between serum cholesterol and the rate of thrombin generation supporting the hypothesis that a hypercoagulable state may occur in hypercholesterolemic subjects before the onset of clinical evidence of atherosclerotic cardiovascular disease.

Adult↗
PubMedDate not supplied

[Usefulness of anti-cyclic citrullinate peptide antibody determination in synovial fluid analysis of patients with rheumatoid arthritis].

OBJECTIVE: To assess the role of anti-cyclic citrullinated peptide (CCP) antibody detection in synovial fluid (SF) of RA patients compared to OA patients. METHODS: We evaluated in 25 RA subjects and 14 OA patients, presenting a knee-joint effusion, the main clinical and laboratory parameters including the number of painful and/or swollen joints, Ritchie index, morning stiffness, ESR, CRP and analysis of SF obtained by therapeutic arthrocentesis. IgG anti-CCP (ELISA), rheumatoid factor (RF) and total IgG (nephelometry method) were measured in SF and paired serum samples. RESULTS: We found anti-CCP antibodies and RF in 64% (16/25) and 60% (15/25) of RA sera, respectively; 72% (18/25) of RA patients were positive for anti-CCP antibodies or RF. We found a higher SF/serum ratio for anti-CCP (p<0.004) compared to that for total IgG. The calculation of anti-CCP concentration as IgG anti-CCP (units)/total IgG (g L-1) revealed higher values in SF than in serum (p<0.046) in RA patients. Among these, correlation analysis showed that anti-CCP/total IgG values in SF correlated with the relative concentration of serum anti-CCP/total IgG (rs=0.842; p<0.00001) and serum anti-CCP antibody levels (rs=0.799; p<0.0001). We did not find any correlation between SF anti-CCP levels and the main characteristics of SF as well as the clinical or laboratory parameters. CONCLUSION: Our study give evidence for a preferential production of anti-CCP antibodies at RA joint level, confirming the pathogenetic role of these autoantibodies. Moreover, SF determination of anti-CCP, corrected for the total amount of the corresponding immunoglobulin, may be helpful as diagnostic tool in selected cases.

Adult↗
PubMedDate not supplied

[Ultrasonographic assessment of the response to Etanercept treatment in patients with rheumatoid arthritis].

OBJECTIVES: To evaluate, using musculoskeletal ultrasound (MSUS), the effects of Etanercept therapy in patients with rheumatoid arthritis (RA) over 3 months of treatment. METHODS: Eighteen consecutive patients, 3 male and 15 female, affected by RA (ACR criteria) who were non-responders or partial responders to DMARDs therapy were commenced on Etanercept treatment. MSUS was performed bilaterally in the 2nd and 5th metacarpophalangeal, 3rd interphalangeal, wrist and knee joints, using a Philips/HP Image Point HX machine with a 7,5 MHz linear probe for knee joints and a 14 MHz probe for the hands and wrists. In addition, power Doppler was used with the following settings: PRF 700-1000Hz, gain 60-65 dB, low filter. For all the changes a semi-quantitative score (0-3) was used to indicate the presence of a localised inflammatory process (synovitis, tenosynovitis). An overall score was then calculated based on the sum of the single scores in order to obtain a comprehensive score indicative of the global pathological change. RESULTS: The overall score significantly (p<10-5) reduced between T0 (8,5) and T3 (5). Even the most part of the local joint scores significantly reduced. CONCLUSIONS: A positive response to treatment with Etanercept was demonstrated by MSUS examination of several joints. The results of our study are supportive of those presented in other reports where MSUS was used to monitor disease activity. We were able however to demonstrate this in a wider range of anatomical targets than in previous studies. MSUS is a useful tool in the monitoring of biologic therapy in RA.

Adult↗
PubMedDate not supplied

Association between histological diagnosis of Helicobacter pylori and coronary heart disease: results of a retrospective study.

OBJECTIVE: Several epidemiological and clinical reports have investigated the relationship between Helicobacter pylori (H. pylori) infection and ischemic heart disease (IHD). All studies utilized for the diagnosis of H. pylori infection the antibody titre that is unable to distinguish an actual from a previous H. pylori infection. PATIENTS AND METHODS: We report a retrospective analysis on 149 subjects, who underwent an esophago-gastro-duodenoscopy, in whom the search for H. pylori was histologically performed. RESULTS: The prevalence of IHD is not significantly different from that observed in H. pylori free patients (26% vs 21%, p = 0.527). CONCLUSIONS: The mechanism underlying the possible role of H. pylori needs further investigation and prospective studies to further analyze the relationship between "active" H. pylori infection and ischemic heart disease were necessary.

Adult↗
PubMedDate not supplied

Wrist joint involvement in systemic lupus erythematosus. An ultrasonographic study.

OBJECTIVE: To define joint alterations in the wrists of patients with systemic lupus erythematosus (SLE) by ultrasonography (US). METHODS: Fifty-two wrists of 26 SLE patients and 30 wrists of 15 healthy controls were evaluated using US by two different experienced operators, blinded to the clinical data. A 14 MHz linear probe was used. Power Doppler (PD) was applied to evaluate the presence of synovial neoangiogenesis as a parameter of active local synovitis. The findings were correlated to the clinical evaluation, serological systemic disease activity parameters (ESR, C3 levels) and the SLE-disease activity score (SLEDAI). Statistical analysis was performed by the EPISTAT program. RESULTS: Signs of synovitis were found in 22 wrists (42.3%). Synovial proliferation was present in 10 joints (19.2%), PD positivity in 5 (9.6%) and joint effusion in 13 (25%). Erosions were present in both wrists (3.8%) of one patient. Signs of tenosynovitis of one or more tendons were shown in 23 cases (44.2%). Ganglia were found in 2 joints (3.8%). Changes of the median nerve, joint dislocations, tendons' ruptures, cysts and nodules were never detected. In 14 wrists (26.9%) no alterations were found. There was no correlation between sonographic findings and clinical, laboratory and indexes signs of disease activity. In the control group the only alteration found was tenosynovitis in 1 joint (p < 0.0001). CONCLUSION: US proved to be an useful technique to detect wrist joint alterations in SLE. These findings may help the physician to modulate treatment strategies and to perform a low cost monitoring of joint disease activity.

Adult↗
PubMedDate not supplied

[Anti-endomysium antibodies: a new marker for the diagnosis and treatment of celiac disease].

Coeliac disease is the most frequent cause of chronic diarrhea (1:1000 children) in Italy. It often has atypical symptoms, so a sensitive and specific test is needed that can both simplify the ESPGAM criteria and monitor compliance of patients to their gluten free diet. The AEmA (anti endomysium antibody), found by Chorzelsky in 1984, appears to be a very sensitive and specific screening test in the diagnosis of coeliac disease (CD). Sera from 150 children, mean age 4 years (range 6 months to 20 years) were tested for endomysium antibodies (IgA class) and anti gliadin antibodies (IgG class). From our preliminary study IgA-AEmA seem to be more specific for CD than IgG class anti-gliaadin antibodies.

Adolescent↗
PubMedDate not supplied

Leishmania in SLE mimicking an exacerbation.

Systemic lupus erythematosus is a protean disease which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Visceral leishmaniasis is a parasitic infection, endemic in 88 countries, whose hallmarks may mimic a lupus flare. Fever, pancytopenia, splenomegaly, hypergammaglobulinemia, production of autoantibodies and complement consumption are some of the overlapping features between the two diseases. Thus, extra attention must be paid to patients with lupus who present with the mentioned symptoms. Diagnosis of visceral leishmaniasis relies on the detection of leishmania antibodies, on the presence of amastigotes in bone marrow aspirates, biopsies and cultures of the parasite. Treatment is based on the use of i.v. liposomal amphotericin B. The missed recognition of a leishmania infection in a lupus patient may lead to death, since both the omission of a specific anti-parasite treatment and the increase of the immunosuppressive therapy, in the conviction of a lupus flare, accelerate a fatal outcome. In this paper we present a case of visceral leishmaniasis occurring in a lupus patient. The clinical and laboratory features that overlap in the two diseases and the current literature on the topic were discussed.

Adult↗
PubMedDate not supplied

Long-term peripheral stent evaluation using angioscopy.

To evaluate incorporation of peripheral artery stents into the arterial wall, we performed angioscopy on 13 patients fitted with Palmaz endoluminal stents. Of the 15 stents inspected, 5 were in the iliac artery, 9 in the femoral artery and 1 in the popliteal artery. The indications for placement were occlusion in 4 cases and high-grade stenosis in 11 cases including 3 restenosis after balloon dilatation and 1 restenosis after surgery. In 9 cases prosthesis insertion was preceded by laser treatment (Trimedyne Nd:YAG Cardiolase 4000). The decision to use a stent was based on radiologic findings in 3 cases (residual stenoses, dissections) and on angioscopic visualization in 7 cases (2 dissections, 5 flaps). In the remaining cases stent placement was performed electively. The only postoperative treatment was antiplatelet therapy (Ticlopidin). At the time of examination, the mean duration of placement was 6 months (extremes: 2 and 12 months). Inspection was made using Sopro-Meadox angioscope with a 0.75 mm probe mounted on an occlusive balloon for stents in the iliac artery and with a 2.2 mm probe with a working channel and sometimes a deflecting device for stents in the femoral or popliteal artery. Angioscopy was successful in all cases. Angiography was always performed at the same time as endoscopy. Endothelialization was observed in all cases. It appeared as a uniform and smooth whitish layer with a thickness proportional to the duration of placement. Endothelialization was most rapid in femoropopliteal arteries, total coverage being achieved within 4 months. Endothelialization took the longest on medial side of the iliac artery which may remain partially exposed after 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Vessel Prosthesis↗
PubMedDate not supplied

Are low levels of HDL2-cholesterol a risk factor for atherosclerosis of cerebral vascular disease? Case report.

A case of a 45 years old man with an atherosclerotic stenosis of right internal carotid and TIA event is reported. The patient showed an increase of total cholesterol and LDL-cholesterol serum levels and, in particular, a very low familiar HDL2-cholesterol serum value. The possibility that this last condition could represent an important co-factor of the extracranial cerebrovascular disease is discussed. The usefulness of a long-term follow-up of all family members, showing the same lipids pattern, is also suggested.

Carotid Artery Diseases↗
PubMedDate not supplied

Carotid surgery under cervical block anesthesia. A simple method of heart and brain protection in high risk patients.

Between January 1, 1985, and December 15, 1987, 60 patients underwent surgery for carotid lesions under local cervical block anesthesia. Sixty-seven reconstruction procedures were performed including 64 endarterectomies and 3 vein bypasses. During the same 3 year period, 938 other reconstruction procedures were carried out under general anesthesia for a total of 1005 procedures. These 60 patients, who accounted for 6.7% of our indications, were selected for surgery under local anesthesia because they were at high risk for cardiac and neurologic complications. As far as staging is concerned, this subgroup of patients included: 14 asymptomatic cases (stage 0), i.e., 21%; 44 transient ischemic attacks (stage I), i.e., 66%; 2 progressive stroke (stage II), i.e., 3%; 7 patients with neurologic sequels (stage III), i.e., 10%. In all 79% of the patients were symptomatic. The asymptomatic patients all presented bilateral tight stenosis sometimes with thrombosis of the contralateral carotid. The technique of local anesthesia and endarterectomy were classic: closing with a bougie to calibrate the lumen, systematic intraoperative arteriography and immediate correction of technical failures (2 times); no death occurred among the patients in stages 0, 1 and II; 1 early asymptomatic occlusion that was not corrected was noted; in one case, a ligation of the carotid was necessary after technical failure, without consequences; one death occurred in stage III after intracerebral hemorrhage. On the basis of our experience local cervical block anesthesia appears to be a simple and reliable method of ensuring intraoperative diagnosis of cerebral ischemia. It eliminates all intraoperative cerebral complications secondary to ischemia and allows a better understanding of the physiopathologic mechanisms underlying perioperative neurologic complications. The absence of neurologic and cardiac complications in this series of very high risk patients enables us to extend eligibility for surgery to include patients with unstable cardiac and cerebral disease.

Aged↗
PubMedDate not supplied

Blood lipid abnormalities in patients suffering from peripheral vascular disease.

Blood lipid profile was investigated in 40 patients suffering from peripheral vascular disease (PVD). The most frequent abnormality was the increase of cholesterol and triglycerides. HDL-cholesterol and the subfractions HDL2 and HDL3 were decreased but not significantly. Cholesterol/HDL-cholesterol ratio was significantly increased suggesting an abnormal cholesterol distribution on lipoprotein fractions. Apolipoproteins AI and AII were within normal range while apolipoproteins B, CII, CIII, and E were significantly increased. This study provide further findings on the blood lipid abnormalities in patients affected by PVD.

Aged↗