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Biomedical subjects

C Ricci

Publications and source records attributed to C Ricci.

At least 145 records · Page 8Linked to original sources
PubMed1994

Comparative merits of thoracoscopy, mediastinoscopy, and mediastinotomy for mediastinal biopsy.

Between April 1992 and April 1993, we performed fifty-four mediastinal biopsies in 51 patients with a mediastinal mass. Nine of these had lung cancer with mediastinal lymphadenopathy, and the remaining 42 had various primary mediastinal lesions. We have performed twenty video-assisted thoracic surgical procedure, twenty-six mediastinoscopies, and eight anterior mediastinotomies. In 3 patients the diagnosis was not obtained by mediastinoscopy, and video-assisted thoracoscopy was performed. We conclude that mediastinoscopy is indicated for the majority of lesions involving the peritracheal space. Restaging of lymphoma and highly infiltrative lesions are better managed by video-assisted thoracic surgery. Anterior mediastinotomy is indicated when feasible under local anesthesia for tumors infiltrating the anterior chest wall. In all other cases video-assisted thoracic surgery is preferable because it allows removal of large tissue biopsy specimens and even resection with wide surgical exposure and low operative trauma.

Adolescent↗
PubMed1994

Reconstruction of the pulmonary artery in patients with lung cancer.

Between March 1990 and December 1992, we performed 17 resections and reconstructions of the pulmonary artery (PA) in patients with lung cancer. Three patients with intrapericardial infiltration of the PA underwent left pneumonectomy and PA angioplasty through a median sternotomy during cardiopulmonary bypass. The first patient survived in excellent general health for 25 months and then died of brain metastases; the second died of bronchopneumonia on postoperative day 24; and the third died of generalized tumor spread after 3 months. Fourteen patients had extrapericardial infiltration of the PA. They underwent sleeve upper lobectomy and PA reconstruction instead of pneumonectomy. In 6 patients we performed a sleeve resection of the PA, and in 8, the vessel was reconstructed using a patch of autologous pericardium. Two minor postoperative complications occurred. Three patients died after 14, 15, and 20 months; the remaining 11 are alive and well 5 to 31 months after operation. We conclude that PA reconstruction associated with sleeve lobectomy is an advantageous alternative to pneumonectomy in select patients with lung cancer. Intraoperative indications, surgical technique, and perioperative management are crucial to achieve good results. Reconstruction of the main PA during cardiopulmonary bypass in association with left pneumonectomy can be performed successfully. The long-term results need further evaluation.

Adult↗
PubMed1994

Haemostasis profile in smoking and nonsmoking women taking low-dose oral contraceptives.

The effects of oral contraceptives on coagulation in 258 nonsmoking and in 190 smoking women were determined. In smokers and in nonsmokers taking oral contraceptives, fibrinogen and fibrinopeptide A concentrations were higher than in oral contraceptive nonusers. In nonsmokers, oral contraceptives increased antithrombin III activity. The effects on coagulation of oral contraceptives with a different ethinylestradiol content (from 35 mcg to 20 mcg) were then evaluated in 333 of these women. The biggest changes in coagulation were observed in smokers taking the preparation with the highest estrogen content. Reduction of the ethinylestradiol dose caused a decrease of the changes in coagulation induced by oral contraceptives both in smokers and nonsmokers. These results might suggest that during oral contraception the coagulation system is affected mainly in smokers and that the decrease of the estrogen dose might lower the effects of the association of smoking and oral contraception on coagulation.

Adolescent↗
PubMed1994

Effects of finasteride, a 5 alpha-reductase inhibitor, on circulating androgens and gonadotropin secretion in hirsute women.

An oral 5-mg dose of finasteride, a 5 alpha-reductase inhibitor, was administered for 3 months to 10 hirsute women to determine the effect on gonadotropin secretion, on basal and stimulated androgen secretion, and on hair growth. Hair growth was assessed by the Ferriman-Gallwey score. All of the above determinations were evaluated before and after 1 and/or 3 months of finasteride treatment. Basal and GnRH-stimulated gonadotropin secretions were not affected. Indeed, finasteride did not modify the pulsatility of LH secretion. No change was seen in estradiol, PRL, free testosterone, androstenedione, dehydroepiandrosterone sulfate, and sex hormone-binding globulin concentrations. Serum concentrations of cortisol (F) were significantly reduced after 1 month of finasteride treatment. The F levels returned to pretreatment levels after 3 months. Plasma levels of dihydrotestosterone and 3 alpha-androstanediol glucuronide significantly decreased during finasteride treatment. A significant increase in testosterone concentrations was observed after 3 months. Finasteride did not modify the responses of testosterone, androstenedione, and dehydroepiandrosterone sulfate to ACTH-(1-24) injection. Conversely, finasteride blunted the F response to corticotropin stimulation. Three months of finasteride treatment significantly decreased the Ferriman-Gallwey score. In conclusion, finasteride significantly decreased dihydrotestosterone and hair growth in hirsute women without negatively affecting gonadotropin secretion.

5-alpha Reductase Inhibitors↗
PubMed1994

Enhanced pressor responsiveness to norepinephrine in type II diabetes. Effect of ACE inhibition.

OBJECTIVE: To evaluate the effect of angiotensin-converting enzyme (ACE) inhibition on the pressor responsiveness to norepinephrine in type II diabetes. RESEARCH DESIGN AND METHODS: Eight normotensive subjects, eight mild-to-moderate hypertensive type II diabetic patients, and eight nondiabetic patients with essential hypertension were studied before and after 4 weeks of being administered enalapril. The pressor response to norepinephrine was assessed by infusing the hormone in an antecubital vein at incremental doses of 30 ng.kg-1.min-1 for periods of 5 min until reaching an increase of 20 +/- 2 mmHg in mean arterial pressure (MAP) measured by an automatic device at 1-min intervals. An effective dosage of norepinephrine that increased MAP by 20 mmHg (EDNE 20) was thereafter calculated. Before and during the last minute of norepinephrine infusion at maximum dosage, a venous blood sample was drawn to determine plasma renin activity (PRA), aldosterone, and norepinephrine levels. RESULTS: In the three groups of patients, blood pressure and aldosterone were reduced while PRA was raised following ACE inhibition. Basal and maximum postinfusion levels of norepinephrine were not modified by enalapril. The EDNE 20 was basally lower in diabetic patients and remained unchanged after ACE inhibition, contrary to that observed in nondiabetic patients with essential hypertension. CONCLUSIONS: Both normotensive and hypertensive type II diabetic patients have an increased pressor responsiveness to norepinephrine that is not modified by therapeutic doses of enalapril, contrary to what is observed in nondiabetic patients with essential hypertension.

Adult↗
PubMed1994

Protection and revascularization of bronchial anastomoses by the intercostal pedicle flap.

We used an improved method for preparation of the intercostal pedicle flap for encircling bronchial anastomoses, and we studied its vascular supply after the operation. The flap was used in 56 patients undergoing various types of sleeve resection and in three patients undergoing single lung transplantation. The technique is simple, fast, and causes neither extra surgical trauma nor complications. It allows satisfactory isolation and sealing of the bronchial anastomosis. Even if complete anastomotic dehiscence occurs (one case), the flap preserves the continuity of the airway, thus avoiding bronchopleural fistulas or other complications. The postoperative arteriographic study of the intercostal artery supplying the flap (performed in 14 patients) demonstrated the full patency of the vessel in all cases. It also showed that a fine vascular network develops around the anastomosis early in the postoperative period.

Anastomosis, Surgical↗
PubMed1993

[Benign esophageal-respiratory fistulae. The surgical treatment and results of 10 cases].

Benign esophago-respiratory fistula is a relatively rare condition of great surgical interest because of its potential total curability. The ratio of benign to malignant fistula is around 1:5. Sometimes the diagnosis is difficult because of the non specific nature of presenting symptoms. This report concern 10 cases of benign esophagorespiratory fistulas observed during a period of twenty years. There were 6 esophago-tracheal fistulas and 4 esophagobronchial fistulas. In 4 cases the fistulas were congenital, in 1 the fistula was due to perforation of esophageal diverticulum and in 3 patient the fistula developed after prolonged intubation. All patient underwent surgical treatment consisted of division of the fistula and suture of both esophageal and respiratory defect. In 4 cases we performed pulmonary parenchyma resection because of irreversible inflammatory lesions. There were no perioperative death. One young patients with tubercular fistula developed a dehiscence of esophageal suture successfully treated with pleural drainage and several application of fibrin glue. All patient were considered to have very good results.

Adolescent↗
PubMed1993

Nicotinamide mononucleotide adenylyltransferase activity in human erythrocytes.

Nicotinamide mononucleotide adenylyltransferase (NMN-AT) activity has not hitherto been demonstrated in human red blood cells, owing to its low activity. Since it is usually located in the nucleus, the possibility of finding it in human erythrocytes was excluded. Here we report the first demonstration and characterization of NMN-AT in human red blood cells, by an HPLC method. The enzyme is Mg2+ dependent, with a Km of 0.303 mM for nicotinamide mononucleotide and 0.103 mM for ATP, and a Vmax of 346 nmol g Hb-1 h-1. The crude preparation is also active on nicotinic acid mononucleotide, producing nicotinic acid adenine dinucleotide. NMN-AT activity is inhibited by nicotinic acid mononucleotide, and nicotinic acid adenylyltransferase is inhibited by nicotinamide mononucleotide. Fiftyfold purification of NMN-AT was achieved by DEAE-Toyopearl chromatography, and the kinetic characteristics were determined. The partially purified preparation maintained its nicotinic acid adenylyltransferase activity. These findings are discussed in light of the regulation of NAD metabolism in human red blood cells.

Adenosine Triphosphate↗
PubMed1993

Alzheimer's disease histologically proven studied by MRI and MRS: two cases.

Two patients affected by severe Alzheimer's disease (AD) were investigated by MRI and image-guided 31P MRS. In one case, 1H MRS was additionally performed. In both cases the diagnosis of AD was confirmed, post mortem, by the pathologist. The spectral parameters of the 31P MR spectra were estimated by fitting the 31P MR signals in the time domain. Our 31P MRS results suggest that it is possible to detect the membrane catabolism, as indexed with the level of PDE resonances visible in in vivo 31P MRS, at least in severe AD cases. The 1H spectrum from AD brain showed a marked decrease of NAA signal respect to choline.

Aged↗
PubMed1993

Clinical and endocrine effects of flutamide in hyperandrogenic women.

OBJECTIVE: To investigate the clinical and endocrine effects of the antiandrogen flutamide in hirsute women. DESIGN: Hirsutism was assessed before and after 3 months of treatment with flutamide 500 mg/d. Endocrine evaluations were performed before and during the 2nd month of treatment with flutamide 500 mg or 750 mg/d. SETTING: Department of Obstetrics and Gynecology, Pisa, Italy. PARTICIPANTS: Eighteen hirsute women were studied: nine women were hyperandrogenic, and the other 9 had an idiopathic hirsutism. INTERVENTIONS: Women were randomly treated with flutamide 500 mg/d (9 patients) or 750 mg/d (9 patients) for 3 and 2 months, respectively. Six received placebo 1 month before flutamide treatment. MAIN OUTCOME MEASURES: Hirsutism was assessed by measuring hair diameter. Follicle-stimulating hormone and LH responses to GnRH were evaluated. Basal plasma levels of T, androstenedione (A), 17-hydroxyprogesterone (17-OHP), DHEAS, cortisol (F), and sex hormone-binding globulin (SHBG) were evaluated. The same hormones were determined after a single dose of flutamide (250 or 500 mg) or placebo throughout a 12-hour period and in samples collected 60 and 120 minutes after ACTH intravenous injection. RESULTS: Hair diameter was reduced by 30%. Both dosages of flutamide did not change basal and stimulated gonadotropin, T, A, 17-OHP, F, and SHBG levels. Both dosages reduced stimulated DHEAS levels. CONCLUSIONS: Flutamide may have a beneficial effect on hirsutism. This effectiveness is mainly due to its peripheral antiandrogen action. However, an effect on the adrenal gland seems to be present.

17-alpha-Hydroxyprogesterone↗
PubMed1993

Bronchovascular sleeve resection. Technique, perioperative management, prevention, and treatment of complications.

Between May 1989 and May 1992, we performed bronchial sleeve resections or complex reconstructions of the pulmonary artery in 55 patients. Forty-four patients had bronchogenic carcinoma, and 11 had benign lesions. One patient died (mortality 1.8%) and three (5%) had minor complications (dehiscence or granuloma), which were treated by laser recanalization and recovered within 1 year. Ten patients underwent sleeve resection of the pulmonary artery or reconstruction of the vessel with a pericardial patch with no complications. In patients with lung cancer, 2-year survival was 72%, whereas all patients with benign lesions were alive and well at 8 months to 3 years after the operation. We consider accurate surgical technique, bronchial protection with a pedicled intercostal flap, and the use of steroids in the postoperative period as the key factors for success. If anastomotic complications occur, these can be treated conservatively by laser recanalization and bronchial stenting.

Anastomosis, Surgical↗
PubMed1993

Fatty infiltration of the liver. Quantification by 1H localized magnetic resonance spectroscopy and comparison with computed tomography.

RATIONALE AND OBJECTIVES: The authors evaluated the degree of fatty infiltration of the liver in subjects with diffuse liver steatosis using image-guided 1H localized MR spectroscopy and correlated the magnetic resonance (MR)-determined fat fraction with the computed tomography (CT) liver/spleen density ratio and histologic evaluation. METHODS: MR measurements were performed at 1.5 T by applying a double-spin-echo localization sequence. Twenty-six patients underwent MR and CT examinations and ultrasound (US)-guided biopsy. Additionally, three healthy volunteers underwent MR examination. Steatosis severity was estimated using 1) the ratio between fat and total MR signal areas; 2) the ratio between liver and spleen CT number; and 3) histologic score. RESULTS: The linear correlation between MR fat/fat-plus-water signal ratio and CT liver/spleen density values ratio is statistically significant. Both techniques correlate well with histologic score. No significant correlation exists between water or fat T2 values and the severity of steatosis. CONCLUSIONS: 1H MR spectroscopy allows a noninvasive estimate of the hepatic fat content.

Adult↗
PubMed1992

Magnetic resonance imaging in right ventricular dysplasia.

Fifteen patients with right ventricular dysplasia were investigated by T1-weighted spin- and gradient-echo pulse sequences, using a protocol that enabled both a subjective analysis of myocardial signal intensity and a quantitative/qualitative analysis of right and left ventricular function. In 8 patients, 3 investigators independently recognized abnormally hyperintense areas in the anatomic sites usually affected by the disease. In 7 of these patients, these areas showed an overlap with a-dyskinetic areas imaged by both magnetic resonance imaging (MRI) and echocardiography. In 1 patient who underwent a cardiac transplant, MRI of the explanted heart showed an excellent correlation between the distribution of the lesions and the in vivo/in vitro features. The data were compared with those from an equivalent sample of patients affected by dilated cardiomyopathy. In the latter patients, no focal hyperintensities were attributed to any anatomic sites in the right ventricule, and no focal a-dyskinetic foci were observed. Furthermore, the 2 groups of patients were significantly different in regard to dimensional and functional quantitative parameters. The results suggest that MRI is useful in integrating echocardiographic data and can be helpful in diagnosing this disease in late stages.

Adipose Tissue↗
PubMed1992

Clinical and metabolic effects of a triphasic pill containing gestodene.

The clinical and metabolic effects of a low-dose triphasic oral contraceptive containing gestodene were investigated in 42 healthy women during 6 months of treatment. No pregnancies and no severe side effects occurred during the study. The pill exerted good cycle control and the incidence of irregular bleeding was very low. As for the coagulatory system, there was an increase in prothrombin activity and in fibrinopeptide A plasma levels, and a decrease in activated partial thromboplastin time. Antithrombin III activity, fibrinogen concentration and platelets count did not change during pill intake. No significant modifications in plasma total-cholesterol, low density lipoprotein-cholesterol or in the subfraction high density lipoprotein2-cholesterol (HDL2-CH) were observed. Serum triglycerides, HDL-CH and HDL3-CH levels were significantly higher at the end of treatment. The pill did not alter fasting insulin and glucose levels or their response to an oral glucose tolerance test. These minimal effects on metabolism, combined with its high efficacy and acceptability, may suggest that this triphasic formulation with gestodene seems to be a safe and reliable contraceptive agent.

Adult↗
PubMed1992

Computed tomography for preoperative assessment of T3 and T4 bronchogenic carcinoma.

Between January 1986 and January 1991, 175 patients with suspected T3 or T4 bronchogenic carcinoma underwent computed tomographic (CT) examination of the chest before thoracotomy. We considered two groups of patients: group 1 includes 98 patients with a paramediastinal mass on standard chest X-ray; invasion of hilar and mediastinal structures was preoperatively investigated with CT and then assessed at thoracotomy. The sensitivity, specificity and accuracy were 72%, 75% and 73%, respectively; positive and negative predictive values were 71% and 76%. In group 2 77 patients had a peripheral tumor suspected of invading the parietal pleura and the soft tissues of the chest wall (patients with evident rib or vertebral invasion were not included). Sensitivity, specificity and accuracy of CT were 52%, 86% and 71%, respectively; positive and negative predictive values were 74% and 70%. We conclude that CT with injection of contrast material is indispensable when direct lung cancer infiltration must be ruled out; its accuracy is however not sufficient to be relied upon in all patients.

Adult↗