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Biomedical subjects

E Bartoli

Publications and source records attributed to E Bartoli.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Oxdralazine, a new peripheral vasodilator, combined with propranolol and hydrochlorothiazide: a rational approach to antihypertensive treatment.

Forty-three patients suffering from hypertension of different origin (chronic renal failure, gout, or idiopathic) were treated with propranolol (121 +/- 12 mg q.d.) plus hydrochlorothiazide (50 mg q.d.) for 75 +/- 9 days. Blood pressure did not return to normal limits in 15 patients, who were continued on the same protocol plus 10 to 50 mg oxdralazine q.d. After an average of 68 +/- 35 days blood pressure fell from 180/110 mm Hg to 145/90 mm Hg without orthostatism, significant side effects, or changes in GFR. This combination seems particularly successful since propranolol will prevent the undesired rise in cardiac output due to oxdralazine as well as the activation of the renin-angiotensin axis due to diuretics. Thus, the antihypertensive properties of each agent will be enhanced by a reduction in side effects by the associated drug, resulting in optimal blood pressure control.

Adult↗
PubMedDate not supplied

Anti-envelope antibodies in anti-hepatitis C virus (HCV) positive patients with and without liver disease.

Our aim was to verify whether the presence of antibodies to HCV envelope protein might mark the occurrence of liver damage, as recently suggested in the literature. Sera from 104 patients (62 male, 42 female) were tested: 84 were positive and 20 were negative to a second generation enzyme immunoassay for anti-HCV antibodies; 51 patients had mild chronic liver disease (44 chronic hepatitis, seven steatosis), 43 had liver cirrhosis (superimposed by hepatocellular carcinoma in 18) and ten were asymptomatic anti-HCV positive subjects with normal liver function tests. Besides, all sera were tested by means of an enzyme immunoassay for the presence of serum antibodies to the synthetic peptide S24A (SIYPGHVSGH RMAWDMMMNW SPTA) derived from amino acids 307-330 of HCV polyprotein. Anti-S24A antibodies were detected in 40/84 sera positive and 1/20 negative at anti-HCV testing (Pearson chi 2 12.29; p = 0.005). Among anti-HCV positive sera, no significant difference existed in anti-S24A status with regard to clinical evidence of liver disease, ALT concentration or HCV RNA positivity. Thus, anti-S24A antibodies are detectable in approximately half of HCV-positive sera, but they do not seem to add significant clinical information to existing tests or to be useful as putative markers of viraemia.

Adult↗
PubMedDate not supplied

Intestinal leiomyosarcoma and gastroparesis associated with von Recklinghausen's disease.

The rare association between intestinal leiomyosarcoma, von Recklinghausen's disease (type-1 neurofibromatosis) and gastroparesis is described. A 20-year-old male, diagnosed 12 years earlier as having pelvic von Recklinghausen's disease, presented with nausea and vomiting. A gastric scintigraphy demonstrated an extremely slow gastric emptying time in the absence of obvious causes for gastroparesis. A small ileal leiomyosarcoma was later found and removed by surgery. The latter was followed by a marked improvement in the clinical condition of the patient.

Adult↗
PubMedDate not supplied

Micropuncture study of the effect of furosemide on proximal and distal tubules of the rat nephron.

The tubular effects of furosemide were studied by micropuncture and clearance techniques on 20 rats. Collections of tubular fluid (TF) from early distal (ED) and late proximal (LP) segments of the same nephrons and of different nephrons were performed during baseline conditions. Re-collections were taken from the same sites and new collections from different nephrons after 10 mg/kg furosemide. The glomerular filtration rate (GFR) was 1,309 +/- 212 microliters/min during baseline, and 1,348 +/- 199 microliters/min after furosemide (p > 0.89); while the urine flow rate rose from 36 +/- 8 to 167 +/- 30 microliters/min (p < 0.001). The nephron filtration rate (NFR) was not different in 46 paired distal (33.3 +/- 2.6 nl/min) versus proximal samples (34.2 +/- 2.9 nl/min, p > 0.72), neither was it different during baseline (37.2 +/- 1.4, n = 120) as compared to furosemide (37.2 +/- 2.7, n = 91, p > 0.99). The percent reabsorption (PR) at the ED sampling site was 87 +/- 4% during baseline, and 89 +/- 3% in 13 paired samples during furosemide (p > 0.47). PR at the LP sampling sites was 83 +/- 2% during baseline, and 80 +/- 2% in 26 paired samples during furosemide (p > 0.63). In 31 paired ED-LP collections, PR was 82 +/- 4 (ED) versus 72 +/- 4% (LP) during baseline, and 87 +/- 3 versus 74 +/- 6%, respectively, during furosemide. The respective collection rates were 4.6 +/- 1.0 versus 9.5 +/- 1.3 nl/min during baseline (p < 0.0001), 5.8 +/- 2.3 versus 8.7 +/- 3.0 nl/min during furosemide. The LP-ED differences obtained during baseline were not different from those measured during furosemide for the collection rate, PR and NFRs. The absolute LP resorption rate was not significantly different during baseline as compared to furosemide. Thus, furosemide did not affect the difference between ED and LP collection sites in collection rate, absolute and fractional reabsorption, in the absence of changes in GFR and NFR. These data indicate that furosemide acts solely along Henle's loop, where it blocks Na+ transport. The urine flow rate rises during furosemide because water abstraction along the distal tubule is reduced by the isotonicity of ED TF, and along the collecting ducts by the isotonicity of the medullary and papillary interstitium caused by the diuretic. We conclude that under the conditions of the present study, furosemide has no proximal effect.

Animals↗
PubMedDate not supplied

Lack of Fas and Fas-L mutations in patients with lymphoproliferative disorders associated with Sjögren's syndrome and type II mixed cryoglobulinemia.

OBJECTIVE: Murine models (MRL/gld/gld mice) and recent evidence in humans suggest a possible role of Fas and Fas ligand (Fas-L) germline mutations in the pathogenesis of autoimmune-related lymphoproliferation, including adult cases. In this study, the presence of Fas and Fas-L germline mutations was investigated in a consecutive series of adult patients with lymphoproliferative disorders occurring in the context of Sjögren's syndrome (SS) and type II mixed cryoglobulinemia (MC). METHODS: 11 patients (8 primary SS and 3 type II MC; F/M: 10/1; mean age 64 yrs.) were investigated. All patients were suffering from atypical lymphoproliferative disorders or MALT lymphoproliferative lesions (mean duration 3.5 yrs.). Four patients later developed a malignant lymphoma. DNA from peripheral blood mononuclear cells from 11 patients and 10 controls was tested for germline mutations in the Fas gene (exons 4, 8 and 9) and Fas-L gene (exon 4) by the polymerase chain reaction-single strand conformation polymorphism (SSCP) method. RESULTS: All DNA samples from both patients and controls showed amplification of Fas and Fas-L specific fragments. Identical SSCP migration patterns were observed in all the cases, indicating the lack of mutations in the whole series. CONCLUSION: Although it cannot be excluded that Fas and Fas-L mutations might be present in exons different from those analyzed, our data do not support the hypothesis that germline mutations in these genes are responsible for a major subset of lymphoproliferative syndromes in adult patients with SS and type II MC. Additional studies would be worthwhile in SLE-related lymphoproliferation, which is, however, a subset of limited clinical relevance when considering all cases with autoimmune-related lymphoproliferation.

Aged↗
PubMedDate not supplied

Measurement of reabsorption by single segments of the human nephron.

A widely diffused method to measure the reabsorption by single segments of the nephron in humans is based on water diuresis (WD), assuming that the peak urine flow rate approximates proximal delivery (PD). However, back-diffusion of an unknown volume of solute-free water (CH2O-BD) from lumen to the interstitium even in the absence of antidiuretic hormone (ADH) introduces a significant error in the estimate of PD. We herein describe an improved method that more precisely estimates the rates of segmental reabsorption. It is based on the assumption that the volume back diffusing during WD will not be subtracted when the hypertonicity of the interstitium is dissipated during the action of furosemide (F); hence, it will be estimated by the difference in urine flow rates measured before (V) and at the peak effect of F (Vf), such that CH2O-BD = Vf - V. Therefore, Vf (the urine flow rate during F) is assumed to directly measure PD of filtrate to the distal tubule (DT) during maximal WD. Adding CH2O-BD to the free water excreted during baseline WD (CH2O) yields the total volume (CH2O-T) of solute-free water formed: CH2O-T = CH2O + CH2O-BD. Therefore, the solute-free water generated by the ascending limb of Henle's loop (CH2O-HL) can be separated from that formed by the convoluted DT (CH2O-DT), since the latter is the only free water formed and excreted during F. Therefore CH2O-DT = CH2Of. Subtracting CH2Of from the total yields the free water formed by Henle's loop: CH2O-HL = CH2O-T - CH2Of. A suitable modification of this method allows the estimation of CH2O-HL even during maximal antidiuresis (AD). The present paper describes the theory, discusses its assumptions, the experimental validation by micropuncture experiments in rats, the results in humans, in health and disease, by simple experiments carried out at the bedside. The data show that this new method represents a significant improvement in accuracy with respect to former techniques to estimate segmental reabsorption, and that it can be suitably used to disclose the pathophysiologic derangements of the nephron in a number of diseases.

Animals↗
PubMedDate not supplied

Bursting metastasis in thymic carcinoma.

Thymic carcinomas (primitive malignant epithelial neoplasms of the thymus) are rare tumors which generally remain silent for long periods and rarely metastatize outside the chest. The authors present a case of a 49 year-old patient, with mediastinal mass complicated by pericardial effusion and rapidly extensive liver metastasis. Data in the literature indicate that completeness of the excision at initial operation is the most important prognostic factor, but the presence of necrosis, high number of mitosis and endolymphatic emboli in the specimens could indicate a poor prognosis, suggesting a tempestive treatment and a close follow-up.

Diagnosis, Differential↗
PubMedDate not supplied

Heterogeneous derangement of cellular sodium metabolism in Bartter's syndrome. Description of two cases and review of the literature.

The basic tubular alteration present in Bartter's syndrome is still a subject of controversy. The possibility that a generalized defect in transmembrane ion transport underlies the disease has been extensively investigated. Previous evaluations of cellular sodium metabolism in Bartter's patients showed extremely variable findings. In the present study we have examined in red blood cells of two patients with Bartter's syndrome the intracellular Na+ and K+ concentrations, the activity of ouabain-sensitive Na+/K+ pump, furosemide sensitive Na+/K+ cotransport, Na+/Li+ countertransport, and the rate constant of Na+ and K+ passive permeability. We have compared these values with those of a control group. Ouabain-sensitive Na+/K+ pump activity was decreased in both patients, whereas Na+/Li+ countertransport was activated. One of the patients also exhibited markedly decreased intraerythrocyte K+ concentration and decreased furosemide-sensitive Na+/K+ cotransport. The other had increased Na+/K+ cotransport activity and Na+ passive permeability. Intracellular Na+ and passive permeability to K+ were normal in both subjects. Our results are partially consistent with previously reported observations, and indicate the existence of heterogeneous alterations of erythrocyte sodium transport systems in patients with Bartter's syndrome. Although some of these alterations could be secondary to the electrolyte metabolism derangements of this disease, others might be genetically transmitted and could cause the different renal tubular defects shown in Bartter's disease so far.

Adult↗
PubMedDate not supplied

[Increase of circulating levels of insulin and C-peptide: common factors in essential hypertension and overweight].

The aim of our study was to investigate the hypothesis that insulin resistance is involved in the pathogenesis of essential hypertension, and to explain whether hyperinsulinemia in this condition is the result of either pancreas overproduction or defective hepatic insulin clearance. In 14 lean normotensive, 17 overweight normotensive, 17 lean essential hypertensive, and 20 overweight essential hypertensive subjects, we measured, after overnight fasting, blood glucose, serum insulin, and serum C-peptide, and calculated the glucose/insulin and the insulin/C-peptide ratios, which can be commonly taken as indexes of peripheral sensitivity to insulin and hepatic insulin clearance, respectively. When compared to lean normotensives, overweight and/or hypertensive patients exhibited higher serum insulin and C-peptide concentrations, and a lower glucose/insulin ratio. No difference was found in the insulin/C-peptide ratio between normotensive and hypertensive subjects. Diastolic blood pressure was directly correlated with serum insulin (p less than 0.01) and C-peptide (p less than 0.01), and inversely correlated with the glucose/insulin ratio (p less than 0.02). We conclude that insulin resistance is present in both essential hypertensive and overweight subjects. Considering the normality of the insulin/C-peptide ratio when taken as the hepatic insulin clearance index, we believe that hyperinsulinemia is caused by a beta-cell hypersecretory response to the defective peripheral action of the hormone.

Adult↗
PubMedDate not supplied

POEMS syndrome: a case report.

A case of POEMS syndrome in a 43-year-old male with polyneuropathy, osteolytic lesion of the basin due to solitary IgA-lambda plasmacytoma, cutaneous scleroderma-like changes, diffuse lymphadenopathy and hepatosplenomegaly is described. Liver biopsy showed a regenerative process of the parenchyma without laboratory and histologic evidence of necrosis. A peculiar finding was the onset of a right hemiparesis in the absence of signs of vascular disease or other predisposing factors. The possible links between the peculiar elements of the POEMS syndrome are briefly analyzed and discussed.

Bone Neoplasms↗