Biomedical subjects
Publications and source records attributed to D Costa.
During treatment with gemfibrozil, 1200 mg daily, total serum triglyceride levels were reduced in 7 of the 11 patients, owing chiefly to a fall in VLDL triglyceride levels. Total serum cholesterol responded variably, falling in a majority of patients with hypercholesterolaemia. High density lipoprotein cholesterol rose during treatment in patients who had either hypertriglyceridaemia or hypercholesterolaemia.
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In order to assess the effectiveness and reliability of cytogenetic diagnosis provided by fetal blood, we report the first 186 cases of fetal blood sampling performed for rapid karyotype between 19-37 weeks of pregnancy in our Prenatal Diagnosis Unit. The overall diagnostic success rate was 98%, achieving 100% in the last period of the study. Chromosomal anomalies were detected in 16% (29/182) of the fetuses. In malformed fetuses this rate increased from 8-9% in isolated malformation or markers of aneuploidy to 50% in multiple malformations. In pregnancies in which a previous cytogenetic study in amniotic fluid was inconclusive, fetal blood made it possible to obtain a definitive result, with no discrepancies found at phenotypic follow-up examination. Interestingly enough, one of the four previously defined as pseudomosaicisms was found to be a non-mosaic in fetal blood, and only 1 of 4 mosaicisms was confirmed in fetal blood. In conclusion, cytogenetic analysis of fetal blood samples appears to be effective, rapid and reliable to establish the fetal karyotype in selected cases.
This is a prospective screening study addressed to assess the value of femur and humerus shortening in the prenatal detection of Down syndrome. Prior to amniocentesis, 1,543 consecutive pregnancies between 13 and 18 weeks were studied. Femur and humerus shortening were assessed with the use of 6 different ratios, and then correlated with the karyotype obtained in amniotic fluid. Sensitivities achieved for Down syndrome with femur ratios were lower than those using humerus (17-22 vs. 43%) for similar false-positive rates (7-8 vs. 6-8%). The most effective ratio was the observed-to-expected humerus length with 43% sensitivity for a 6% false-positive rate. Combining femur and humerus measurements did not substantially improve the prediction obtained using the best humeral ratio. In conclusion, femur and humerus shortening appears to be of limited value in the detection of Down syndrome.
Thirty cases of human kala-azar were diagnosed by iliac crest biopsy and myeloculture. Histological analysis of 12 patients showed diffuse thickening of reticulin fibers. To the best of our knowledge, this is the third report describing secondary bone marrow fibrosis (myelofibrosis-like) associated with kala-azar. Patients with positive bone marrow fibrosis (pbmf = 12) were compared to patients without detectable bone marrow fibrosis (wbmf = 18). There were no significant differences in clinical and blood parameters following treatment. All patients showed regression of hepatosplenomegaly. Our findings suggest that associated bone marrow fibrosis is transient and did not interfere in the evolution of treated patients.
We present an epidemiological and serological study in 286 health care students. We found susceptibility for measles in 11.7% individuals (95% confidence interval (95% CI): 8.0-15%), for rubella: 6.7% (95% CI: 3.8-9.6%) for mumps: 12.7% (95% CI: 8.0-16.6%) and for varicella 8.5% (95% CI: 5.3-11.7%). Compared to a similar study, performed in 1992 in a population of health care workers, we found an increasing susceptibility to these diseases except for mumps, that had decreased. Among those who received one dose of measles vaccine we found 12.1% non immune. We found an high level of immunity (97.1%) for those who received rubella vaccination. We could not draw any conclusions for mumps because only seven had been vaccinated.
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A case of diffuse eosinophilic infiltration of the gastroenteric tract which involved a large portion of the small intestine is discussed. It arose in a patient not previously affected with allergic traits and without eosinophilia in peripheral blood. Problems of differential diagnosis and clinical-therapeutic implications are reported.
A case of a patient with large cell pulmonary carcinoma is presented. Being inoperable, the patient was treated at first with multiple drug chemotherapy and the result was the disappearance of the pulmonary lesions. The unusual favourable therapeutic response and the protocols of polychemotherapy used are discussed.
The authors report two cases of granulomatous allergic angiitis (Churg-Strauss syndrome) in patients previously affected by bronchial asthma. Different clinical developments and responses to therapy are considered.
A case of a patient with angiofollicular lymph-node hyperplasia (Castleman's disease), of the plasma cell type, is described. The course of the disease evolved from an unilateral inguinal adenopathy to a generalised intraabdominal adenopathy which took the patient to death. Diagnostic and therapeutic aspects are discussed.
In order to compare its diagnostic value in the differentiation between malignant and hepatic ascites, we analysed the ascitic fluid concentrations of cholesterol (Ct) and triglycerides (Tg) and the serum-ascites albumin gradient (S-A alb grad) in 58 patients--forty one with chronic liver disease (CLD) and 17 with malignancy. In CLD group the mean values +/- SD for Ct (27.1 +/- 20.1 mg/dl), Tg (34.2 +/- 33.8 mg/dl) and S-A alb grad (1.9 +/- 0.6 g/dl) were significantly different from those obtained in malignant ascites (Ct 103.1 +/- 45.1 mg/dl; Tg 62.1 +/- 43.0 mg/dl; S-A alb grad 0.5 +/- 0.4 g/dl) (p less than 0.001 for all parameters). Application of the cutoff concentrations given in the literature revealed the following results: Ct-Sensitivity (Se) 82.4%, Specificity (Sp) 85.4%, Efficiency (E) 84.5%; Tg-Se 29.4%, Sp 95.1%, E 75.9%; S-A alb grad- Se 88.2%, Sp 97.6%, E 94.8%. The exclusion of the 4 patients with massive hepatic metastasis from malignant group by ultrasound or computer tomography gave an efficiency of 87.0% for Ct, 88.9% for Tg and 98.1% for S-A alb grad. We conclude that: 1) S-A alb grad is the best analysed parameter in the discrimination between malignant and hepatic ascites, 2) the combination with non-invasive imaging methods increases its diagnostic value.
The authors compared nocturnal variations of melatonin (MT) and cortisol levels in subjects with bulimia (n = 12), 6 with a normal body weight and 6 with anorexia nervosa, as well as 6 control subjects. The hypothesis, formulated for anorexia nervosa, that a decrease of noradrenergic activity induces a decrease of pineal activity, therefore a decrease of melatonin secretion, was not confirmed by our study. Moreover, in subjects with bulimia in the absence of anorexia nervosa, no significant decrease of nocturnal melatonin secretion was reported. Significant differences were due to cortisol variations when comparing MTmax/Cmin ratios. Melatonin did not add any complementary biological cue for diagnostic assessment for subjects with eating disorder and depression. The results of this study suggest that melatonin does not appear to be a useful biological marker in bulimia.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.