Biomedical subjects

C Terzano

Publications and source records attributed to C Terzano.

At least 19 recordsLinked to original sources

PubMed2006

Assessment of right ventricular function by strain rate imaging in chronic obstructive pulmonary disease.

The purpose of the current study was to compare right ventricular (RV) myocardial wall velocities (tissue Doppler imaging) and strain rate imaging (SRI) parameters with conventional echocardiographic indices evaluating RV function in chronic obstructive pulmonary disease (COPD) patients. In total, 39 patients with COPD and 22 healthy subjects were included in the current study. Seventeen patients had pulmonary artery pressure <35 mmHg (group I) and 22 patients had pulmonary artery pressure >35 mmHg (group II). Tissue Doppler imaging, strain and strain rate (SR) values were obtained from RV free wall (FW) and interventricular septum. Respiratory function tests were performed (forced expiratory volume in one second/vital capacity (FEV(1)/VC) and carbon monoxide diffusion lung capacity per unit of alveolar volume (D(L,CO)/V(A))). Strain/SR values were reduced in all segments of group II patients compared with group I patients and controls with lowest values at basal FW site. A significant relationship was shown between peak systolic SR at basal FW site and radionuclide RV ejection fraction. A significant relationship was shown between peak systolic SR at basal FW site and D(L,CO)/V(A) and FEV(1)/VC. In conclusion, in chronic obstructive pulmonary disease patients, strain rate imaging parameters can determine right ventricular dysfunction that is complementary to conventional echocardiographic indices and is correlated with pulmonary hypertension and respiratory function tests.

Case-Control Studies↗

PubMed2006

Aspiration pneumonia. Pathophysiological aspects, prevention and management. A review.

Aspiration pneumonias occur more frequently than reported and, in many cases, the disease is not recognised. In hospitalised and institutionalised patients with predisposing diseases prompt diagnosis of this complication and correct preventive measures can drastically reduce the worsening of clinical conditions and the deaths due to aspiration pneumonia. Normal airway structure, effective defence mechanisms, and preventive measures are decisive in reducing aspiration episodes. An increased aspiration risk for food, fluids, medications, or secretions may lead to the development of pneumonia. Pneumonia is the most common respiratory complication in all stroke deaths and in mechanical ventilation patients. In addition, the increased incidence of aspiration pneumonia with aging may be a consequence of impairment of swallowing and the cough reflex. Dysphagia, compromised consciousness, invasive procedures, anaesthesia, insufficient oral care, sleep disorders, and vomiting are all risk factors. Aspiration pneumonia includes different characteristic syndromes based on the amount (massive, acute, chronic) and physical character of the aspirated material (acid, infected, lipoid), needing a different therapeutic approach. Chronic patients education and correct health care practices are the keys for preventing the events of aspiration. In patients at risk a clinical and instrumental assessment of dysphagia should be evaluated. Management includes the removal of etiologic factors (drugs, tubes, mobilisation, oral hygiene), supportive care, and in bacterial pneumonias a specific antibiotic therapy for community-acquired or nosocomial events.

Humans↗

PubMed2003

Comparison of the efficacy of beclometasone dipropionate and fluticasone propionate suspensions for nebulization in adult patients with persistent asthma.

The use of nebulization for the administration of inhaled steroids plays an important role in asthma patients who are unable to use pressurized aerosol or dry-powder inhalers effectively. Moreover, the type of nebulizer used may affect how much drug is delivered to the lungs. The objective of this multinational, multicentre, randomized, active-controlled, parallel-group study was to compare the efficacy and safety of nebulized corticosteroids in adult patients with chronic asthma. Following a 1-week placebo run-in period, 205 patients, aged 18-65 years, with moderate persistent asthma were randomized to one of two treatment groups for 12 weeks: beclometasone dipropionate (BDP) suspension for nebulization 2,400 microg day(-1) b.i.d. (n = 103), or fluticasone propionate (FP) suspension for nebulization 2,000 microg day(-1) b.i.d. (n = 102), both administered by a jet nebulizer Comparable efficacy in controlling asthma was demonstrated by the two treatments at study end, as evident when evaluating various efficacy parameters (pulmonary function tests, asthma exacerbations and symptoms, and the use of rescue salbutamol). The primary efficacy endpoint was the variation in the pulmonary expiratory flow (PEF) at treatment end over the baseline visit. For the intent-to-treat population, in the BDP group mean PEF values increased statistically significantly from 5.2 +/- 1.31 s(-1) to 5.7 +/- 1.61 s(-1), while in the FP group the increase was from 5.2 +/- 1.21 s(-1) to 5.8 +/- 1.81 s(-1). Mean PEF values as per cent of predicted also increased in a statistically significant way, from 71% to 77.1 % in the BDP group, and from 70.1% to 76.9% in the FP group. The two treatments were equally well tolerated.A total of 23 and 32 patients in the BDP and FP groups, respectively, reported adverse events during the treatment period, and these were generally mild. In conclusion, the results of this study demonstrate that BDP 2,400 microg day(-1) and FP 2,000 microg day(-1), both suspensions for nebulization administered via a jet nebulizer, are equally effective, with an acceptable safety and tolerability profile, when used in adult patients with moderate persistent asthma.

Administration, Inhalation↗

PubMed2002

Importance of drug delivery system in steroid aerosol therapy via nebulizer.

Aim of our study was to evaluate if the type of nebulizer can influence the effects of steroid aerosol therapy. We considered 27 asthmatics allergic to grasses with FEV1<80% of the predictive value or methacholine PD20 FEV1<750 mcg. The patients were divided into three groups in relation to the type of nebulizer they used and treated 9 weeks by aerosol therapy with beclomethasone dipropionate bid (800 mcg). Respect to the values recorded at the beginning and at the end of the therapy we found different variations of spirometric indeces and PD20 values among the three groups. We can conclude that the type of nebulizer influences steroid aerosol therapy and, particularly, jet nebulizers seem more efficient than ultrasonic nebulizers.

Adult↗

PubMed2002

Addition of an extra dose of salmeterol Diskus to conventional dose of salmeterol Diskus in patients with COPD.

Patients experiencing dyspnoea can request an additional dose of salmeterol during the dose interval for the control of their symptoms, although under treatment with salmeterol. In this study we have explored the effects on respiratory function of an additive dose of salmeterol Diskus in 15 chronic obstructive pulmonary disease (COPD) patients in regular treatment with a conventional dose of 50 microg salmeterol. On two different days, patients inhaled 50 microg Diskus. After 240 min, they inhaled additional 50 microg salmeterol Diskus (salmeterol arm) or placebo Diskus (placebo arm). Lung function was controlled before first drug administration and 0.5, 1, 2, 3, 4, 4.5, 6, 8, 10, and 12 h thereafter. The mean (95% CI) peak increase in FEV1 from baseline was reached after 4 h in the salmeterol arm (0.174 L; 0.144-0204) and after 5 h (0.141 L; 0.115-0.168) inthe placebo arm; after 12 h, the mean (95% Cl) increase in FEV1 from basal values was still 0.149 L (0.119-0.179) in salmeterol arm, but only 0.041 L (0.017-0.064) in placebo arm. The mean (95% CI) FEV1 AUC0-12h for all patients were 2.01 (1.72-2.30) L when salmeterol was added and 1.30 (1.03-1.58) L when placebo was inhaled. The difference (mean; 95% CI) between the FEV1 AUC0-12h of the two arms (0.71 L; 0.47-0.95) was statistically significant (P<0.0001), although the difference (mean; 95% CI) between the FEV1 AUC0-4h of the two treatments (0.08 L; -0.02-0.18) was notstatistically significant (P=0.126). The addition of an extra dose of salmeterol did not significantly increase the heart rate or decrease the SpO2. This study suggests that the addition of an extra dose of salmeterol does not give room for further increase in peak FEV1, but the effect of adding salmeterol to salmeterol is largely additive when considering the duration of action and safe.

Albuterol↗

PubMed2002

Acute effects of higher than customary doses of salmeterol and salbutamol in patients with acute exacerbation of COPD.

Worsening of underlying bronchospasm may be associated with acute exacerbations of chronic obstructive pulmonary disease (COPD). As airway obstruction becomes more severe, the therapeutic option is to add salbutamol, but not salmeterol, as needed to cause rapid relief of bronchospasm. Unfortunately the most effective dosage of beta2-agonists may increase above that recommended during acute exacerbations. In this study, we compared the acute effects of higher than customary doses of salmeterol and salbutamol in 20 patients with acute exacerbation of COPD. A dose-response curve to salmeterol pMDI, 25 microg/puff or salbutamol pMDI, 100 microg/puff, was constructed using 1, 1, and 2 puff' i.e., a total cumulative dose of 100 microg salmeterol or 400 microg salbutamol on 2 consecutive days. After baseline measurements, dose increments were given at 30-min intervals with measurements being made 25 min after each dose. Hear rate (HR) and pulse-oximetry (SpO2) measurements were then taken. Both salmeterol and salbutamol induced a larg and significant (P < 0.05) dose-dependent increase in FEV1 [mean differences from baseline (L) = after 100 microg salmeterol 0.174 (95% CI: 0.112 to 0.237); after 400 microg salbutamol: 0.165 (95% CI: 0.080 to 0.249)], in IC [mean differences from baseline (L) = after 100 microg salmeterol: 0.332 (95% CI: 0.165 to 0.499); after 400 microg salbutamol: 0.281 (95% CI: 0.107 to 0.456)] (Fig. 2), and in FVC mean differences from baseline (L) = after 100 microg salmeterol: 0.224 (95% CI: 0.117 to 0.331); after 400 microg salbutamol: 0.242 (95% CI: 0.090 to 0.395)]. There was no significant difference between the FEV1 values (P=0.418), the ICvalues (P=0.585), and the FVCvalue (P=0.610) after 100 microg salmeterol and 400 microg salbutamol. HR [mean differences from baseline (beats/min) = after 100 microg salmeterol: 3.15 (95% CI: -0.65 to 6.96); after 400 microg salbutamol: 2.30 (95% CI: -0.91 to 5.51)] and SpO2 [mean differences from baseline (%) = after 100 microg salmeterol: -0.20 (95% CI: -1.00 to 0.60); after 400 microg salbutamol: -0.11 (95% CI: -1.00 to 0.79)] did not change significantly from baseline (P > 0.05). These data indicate that salmeterol is effective and safe in the treatment of acute exacerbation of COPD and support its use in this clinical condition.

Acute Disease↗

PubMed2001

Pressurized metered dose inhalers and add-on devices.

Metered dose inhalers (MDIs) which have a valve holding chamber plus a mouthpiece or mask have, in recent years, markedly improved the ease, speed and reliability of aerosol therapy for reversible airflow obstruction in adults, children and infants. MDIs, effective and easily accessible when patients are away from home, are the gold standard for the treatment of reversible airflow obstruction since they provide reliable, reproducible, effort-independent dosing, protection of their contents from environmental humidity and bacterial infection and at the same time are the most readily pocketable, efficient and least expensive aerosol therapy devices available. When combined with add-on devices they are also the most versatile delivery system because they are well suited to a variety of patients and virtually any therapeutic task. With our improved understanding of the importance of drug targeting to the site of action, the most important aspects of the relationship between particle size and drug deposition throughout the lower respiratory tract are discussed. This review also looks at add-on devices and training issues related to the proper co-ordination of drug delivery with inhalation, and reports on new technology and non-ozone depleting propellants.

Administration, Inhalation↗

PubMed2001

[Significant increase of incidence of cypress pollen allergy in the city of Rome].

In the second semester of 1999, 246 patients, living in a Roman urban area, were subjected to a prick-test screening. 194 (78.9%) of the patients showed a positive answer toward almost one of the tested allergens, whereas the other 51 persons (21.1%) turned out to be negative. Of the patients with a positive cutireaction, 59 (24% of total survey and 30.4% of allergic subjects), with an average age of 29.6 (SD = 12.78) showed sensitization toward cypressus. The results were compared with a case-study of 900 atopic subjects, recruited by the same Center between 1994-96 and living in the same Roman area. In this last group we only found 84 pts (9.3%) with a positive prick-test toward Cypressus, with an average age of 35.2 (DS = 13.48). This analysis wants to stress the increasing incidence of allergy toward cypressus among atopic subjects, switching from 9.3% to 30.4%, in the same urban area, during these last three years.

Allergens↗

PubMed2000

[Efficacy and safety of clarithromycin in the treatment of community-acquired pneumonia].

Community-acquired pneumonia (CAP) is a serious disease frequently treated empirically, which required the selection of an antibiotic that covers all common pathogens and achieves good pulmonary concentrations. The availability of intravenous (i.v.) formulations may also be helpful, permitting i.v./p.o. sequential therapy. From January 1992 to December 1997 we treated 290 CAP patients with clarithromycin (CL) 500 mg BID, first given i.v. in 250 or 500 ml of saline solution and then switched after 4-5 days to the same dosage given p.o. Of these 290 patients 163 were males (98 smokers) and 127 were females (41 smokers); 87 were over 65 years old and 203 had concomitant diseases (mainly cardiovascular), 172 patients were admitted after unsuccessful therapy (122 cephalosporins and 48 penicillins). Diagnosis was made based on clinical and radiological findings, therapy was initiated prior to microbiological diagnosis. Clinical and radiological improvement was achieved by 261/290 patients (90%) within 10-15 days. Mild adverse events occurred in 11 patients. This results indicate that CL is effective and safe: its antimicrobial spectrum and pharmacokinetic profile, the possibility of i.v./p.o. sequential administration, make it an ideal antibiotic for the treatment of CAP.

Administration, Oral↗

PubMed1999

Aerosol characterization of three corticosteroid metered dose inhalers with volumatic holding chambers and metered dose inhalers alone at two inspiratory flow rates.

Inhaled corticosteroids are first-choice drugs in the treatment of chronic asthma. A metered dose inhaler (MDI) equipped with a spacer device is easier to use for patients with a poor inhalatory technique; it favors a reduction in the size of the particles delivered to the patient and thus a reduction in the incidence of local and systemic side effects of these drugs. The aim of this study was to determine the particle characteristics of fluticasone propionate (FP), flunisolide (FLUN), and beclomethasone dipropionate (BDP), each administered at a rate of 250 micrograms per puff and at inspiratory flow rates of 30 and 60 L/min in vitro, to estimate the particle characteristics of these drugs aspirated via an MDI alone and via a large-volume holding chamber (Volumatic). Compared with the MDI alone, at 30 L/min, the Volumatic (Glaxo Wellcome, Ware, UK) significantly reduced the mass median aerodynamic diameter (MMAD) and increased the fine particles (< 5 microns and < 2 microns) generated by all three drugs. At 60 L/min, the MMAD increased and the generation of fine particles decreased with both devices. These data suggest that the inspiratory flow applied by means of the devices may be a determinant for the deposition of the drug in the lower airways in that by increasing the inspiratory flow, the MMAD increases and the percentage of fine particles decreases, probably because of the reaggregation favored by the higher flows.

Aerosols↗

PubMed1999

[The tolerability and therapeutic efficacy of rifabutin in the treatment of pulmonary tuberculosis].

We treated in our unit 25 patients (15M--10F) affected by pulmonary tuberculosis (TB) with rifabutin (RBT). Chronic liver disease, multidrug-resistant TB and HIV infection were featuring the clinical history of our selected patients. The treatment was carried out using a 150 mg/day dose of RBT, or 300 mg/day in case of MDR (multiple-drug-resistance)-TB or chronic TB. Rifabutin, isoniazid, ethambutol, and a fourth anti-mycobacterium drug were used when treating MDR-TB. Chest X-ray, haematological and bacteriological tests were performed on a monthly basis during the patients' follow up. No side effects were observed; only in two cases, both females, leukopenia occurred, but was not such a reason to modify our treatment plan. As a matter of fact, RBT is well tolerated by patients and it is particularly effective in bacterial eradication. In our experience, RBT did not provide the expected results only in one patient, affected by chronic TB.

AIDS-Related Opportunistic Infections↗

PubMed1998

[Tobramycin aerosol: could the delivery system influence the particle size and deposition in the lower airways?].

UNLABELLED: Aerosolized tobramycin represents an efficient alternative to the systemic administration, especially in patients with cystic fibrosis and bronchiectasis affected with Pseudomonas aeruginosa infections. Aim of this study was, using a Time Of Flight Aerosol Beam Spectrometer (API Aerosizer Mach2), to compare the granulometric characteristics of tobramycin aerosolized in 1 sec by three nebulizers and, using mathematic models, to value the particles and drug deposition in the lower airways, particularly at: P level, which includes bronchiolar and alveolar tract; TB level, which includes tracheobronchial tract; ET level, which includes the extrathoracic tract; the amount of particles (Dp) and drug (Dd) dispersed. RESULTS: Nebula Nuovo: Mass Median Aerodynamic Diameter (MMAD): 3,722 microns; Geometric Standard Deviation (GSD): 2,382; Particles deposited-P: 42.86%; TB: 4.99%; ET: 8.7%; Dp: 43.45%; Tobramycin deposited-P: 36.84%; TB: 11.52; ET: 26.36%; Dd: 25.28. Pari IS2: MMAD: 3,179 microns; GSD: 1,367; Particles deposited--P: 41.99%; TB: 8.67%; ET: 17.26%; Dp: 32.07%; Tobramycin deposited-P: 33.19%; TB: 14.37%; ET: 34.12%; Dd: 18.3%. Artsana with Sidestream ampulla-MMAD: 3,083 microns; GSD: 2,313; Particles deposited-P: 43.96%; TB: 7.11%; ET: 6.23%; Dp: 42.68%; Tobramycin deposited-P: 43.63%; TB: 8.1%; ET: 15.3%; Dd: 32.97%. CONCLUSIONS: Differences in nebulizers performance influence therapeutic effects and tobramicyn deposition in the lower airways.

Aerosols↗

PubMed1997

[Study of spontaneous resolution of bronchial spasm after methacholine challenge. Comparison of patients with different degree of hyperreactivity].

The study was designed to assess the spontaneous recovery of bronchial spasm induced by methacholine in bronchial challenge tests and to examine the mechanisms and the modalities involved as well as the influence of dosage. The phenomenon was analysed in 32 hyperreactive patients diagnosed as asthmatics by measuring FEV1 as soon as maximum bronchial constriction (PD20) had been achieved and after 5, 10, 15, 30 and 60 minutes. The data obtained were subjected to variance analysis. Results show: 1) as regards duration of spontaneous recovery, that FEV1 returned to pre-challenge levels after 60 minutes in both the severely and moderately hyperreactive patients; 2) as regards onset of regression, that onset depended on the level of sensitivity, occurring after 30 minutes in the severely affected, after 15 minutes in the mild cases; 3) as regards recovery intensity, that in the moderated cases the recovery was more pronounced in the first 15 minutes than subsequently. Data show that the onset and intensity of the spontaneous recovery change according to the degree of sensitivity. That might reflect a greater affinity and/or bonding of methacholine in the muscarinic receptors of the severely affected, but the possibility of a difference in mediator metabolization speed cannot be excluded. In conclusion, research into the recovery of bronchial spasm may contribute to a better understanding of bronchial hypersensitivity and provide new information of value on the diagnosis, pathogenesis and treatment of the condition.

Adult↗

PubMed1996

Probability of particle and salbutamol deposition in the respiratory tract: comparison between MDI and Autohaler.

The aim of this study was to assess the granulometric characteristics and the deposition probabilities of particles and drug, in the respiratory tract, following one puff of salbutamol delivered by a metered-dose inhaler (MDI) and a breath-actuated metered-dose inhaler (BAI-Autohaler). Particle analysis, achieved using an API Aerosizer Mach2, showed that the two devices have similar granulometric characteristics; recording the following data for the mass median aerodynamic diameter (MMAD) and for the geometric standard deviation (GSD): MDI (MMAD 2.29 microns. GSD 1.46); BAI (MMAD 2.41 microns, GSD 1.48). Data on the percentage of drug carried by the single particles suggest a higher probability of deposition of salbutamol delivered by Autohaler in the pulmonary and tracheobronchial tracts (approximately 61 vs 48% for the conventional MDI) and a reduced deposition in the orolaryngeal tract (17 vs 26% for the conventional MDI), with a consequently lower risk of having collateral effects caused by systemic absorption of the drug and an improved effectiveness at the site of action.

Administration, Inhalation↗

PubMed1990

Ferritin and transferrin levels in human breast cyst fluids: relationship with intracystic electrolyte concentrations.

The concentrations of sodium and potassium and the content of ferritin and transferrin, proteins considered as potential markers for identifying cells undergoing divisional activity, were measured in fluid from 30 human breast cysts. On the basis of the relative electrolyte concentrations, two main classes of cysts were defined. When the cyst fluids were subdivided according to their Na+/K+ ratio, a significant difference was found between menstruating vs. menopausal patients. The relationship between the two major iron-binding proteins and the Na+/K+ ratio may indicate the expression of a local higher biosynthetic activity in apocrine cysts associated with higher cancer risk.

Body Fluids↗

PubMed1987

Lactate dehydrogenase, isoenzyme patterns and cation levels in human breast gross cyst fluid.

In order to investigate the diagnostic and/or prognostic value of total activity and isoenzymatic patterns of lactate dehydrogenase, 24 human breast gross cystic fluids were studied. A comparison of total lactate dehydrogenase activity to the serum level revealed an increased activity in about 63% of the cases examined; moreover, a significant increase in the slow-moving lactate dehydrogenase 4 and 5 isoenzymes was observed in some cyst fluids. The levels of Na+ and K+ concentrations were also analyzed and two classes of cysts were identified: one presenting Na+ and K+ levels similar to those found in extracellular compartment; the other with high K+ and low Na+ levels, characteristic of an intracellular fluid. This latter pattern could indicate an active metabolism of the epithelial cells lining the cysts. This breast cyst fluid also showed increased levels of lactate dehydrogenase 4 and 5 isoenzymes. The correlation between an increased activity of lactate dehydrogenase 4 and 5 isoenzymes and high K+ and low Na+ levels could be the expression of a high biosynthetic activity and of an anaerobic metabolism in some cysts, suggesting the evolution of the breast gross cyst lesion to malignancy. The importance of these observations is discussed.

Body Fluids↗

PubMed1987

[Carcinoembryonic antigen in a review of cases in the literature].

Literature analysis of CEA serum levels tested in 21,147 patients, with non neoplastic and neoplastic disease of various organs, are reported. The sensitivity, the specificity, the positive and negative prognostic trend and the effective value of test in different pathologic situations are evaluated on the basis of organ localization and embryological origin.

Biomarkers, Tumor↗

PubMedDate not supplied

Corticosteroids administered by nebulization to children with bronchial asthma.

Inhaled corticosteroids are recommended for long-term control of asthma in children, and nebulization simplifies administration to patients who lack hand-to-lung coordination. Information on the efficacy and safety of nebulized corticosteroids in children with mild to moderate asthma is limited, however, and comparison between corticosteroids is lacking. One hundred thirty-three patients 6 to 14 years of age with bronchial asthma were randomly assigned to receive flunisolide 500 microg or budesonide 500 microg, both administered twice daily by nebulizer for 4 weeks. Morning peak expiratory flow rate (primary efficacy endpoint) increased significantly from baseline (P<.001) with both medications (P = NS between treatments). Use of salbutamol as rescue medication decreased by 82.6% with flunisolide and by 82.7% with budesonide; respective decreases in asthma score were 78.8% and 82.3% (P<.001 vs baseline, P = NS between treatments). Only flunisolide reduced the number of nocturnal awakenings (P<.001). Ten patients in the flunisolide group and 12 in the budesonide group reported adverse events, none of which required discontinuation of treatment. In children with asthma, nebulized corticosteroids are effective and have good safety and tolerability profiles. Flunisolide and budesonide seem to produce equivalent clinical responses.

Adolescent↗