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Biomedical subjects

E Martelli

Publications and source records attributed to E Martelli.

32 records · Page 2Linked to original sources

Leucocyte rheological properties are altered in patients with diffuse atherosclerosis.

To evaluate whether atherosclerosis may be associated with altered leucocyte rheology, we assessed leucocyte count (by Coulter counter), aggregation (by means of the leukergy test) and expression of adhesion molecules integrin LFA-1 and CD 44 (by means of immunofluorescence staining and flow cytometry) in 9 patients with carotid plus lower limb artery atherosclerosis (group A), 14 patients with carotid atherosclerosis only (group B) and 23 controls without atherosclerosis (group C). The level of LFA-1 (calculated as mean fluorescence channels-MFCs) on neutrophils, lymphocytes and monocytes was significantly higher (p < 0.05) in group A and B patients than in controls (group A-mean +/- SE: 383.77 +/- 9.42 vs 295.45 +/- 5.76; 474.22 +/- 8.86 vs 388.35 +/- 7.84; 457.66 +/- 12.03 vs 396.25 +/- 4.37. Group B: 322.42 +/- 6.36 vs 295.45 +/- 5.76; 421.42 +/- 7.21 vs 388.35 +/- 7.84; 415.71 +/- 7.73 vs 396.25 +/- 4.37, respectively); furthermore, the MFC of LFA-1 on neutrophils was significantly different (p < 0.05) between group A and B patients. The percentage of aggregated leucocytes was significantly higher (p < 0.05) in group A patients (4.46 +/- 1.07) than those in groups B (1.75 +/- 0.38) and C (1.43 +/- 0.25), whereas no significant difference was detected between groups B and C. Leucocyte number and expression of CD44 were not significantly different among the 3 groups. In conclusion, changes in leucocyte rheology are present in patients with atherosclerosis and may contribute to chronic ischaemia.

Aged↗

Effects of sympathetic stimulation on microcirculatory dynamics in patients with essential acrocyanosis. A study using mental stress.

With the aim of examining possible alterations of the neurogenic regulation of microvascular hemodynamics, the cutaneous microcirculation in 21 patients with essential acrocyanosis was studied using a laser-Doppler method both in basal conditions and during mental stress using an arithmetic test. The analysis of results showed a significant reduction in basal flow (p < 0.02) in patients with acrocyanosis in comparison to control subjects. In 15 out the 21 patients studied it was found that there was an increase in the flowmetric curve during mental stress, whereas the test caused a diminished flow in normal subjects. The altered response to sympathetic stimulus might be the result of microcirculatory stasis which would provoke an alteration in the neurogenic regulation mechanisms of microvascular dynamics.

Adolescent↗

[Microcirculatory changes in mitral prolapse as an expression of a systemic change in the connective tissue].

Many authors hypothesize that mitral valve prolapse (MVP) can be, in most cases, only a clinical sign of a primitive and systemic disorder of the connective tissue, like in Marfan Syndrome (MS). In our previous works we supported the presence of morphological and functional alterations of the microcirculation in patients affected by MS. In order to characterize a possible common denominator between these pathologies we have studied the cutaneous microcirculation in a group of patients affected by MVP, divided into 2 groups: anatomic MVP (MVP) and MVP syndrome (MVPS). The morphologic parameters have been investigated by nailfold capillaroscopy while digital laser-Doppler was used to study skin flowmetry. The results have been compared with a control group. Capillaroscopic remarkers showed an architecturally disorganized microvasculature with aspects related to a reduced compactness of the microvasculature unit with a significatively higher score compared with controls (7.3 +/- 2.9 vs 3.6 +/- 1 p less than 0.0005). Laser-Doppler flowmetry showed a significatively reduced rest flow; ischemic test showed: spike time 48.9 +/- 36.9 vs 15.3 +/- 7.7 s (p less than 0.0005), hyperemic acme 6.6 +/- 2.7 vs 12.5 +/- 8.4 UP (p less than 0.002); % increase 32.1 +/- 20.2 vs 51.5 +/- 15.4 (p less than 0.002). Thermic test showed a significatively higher thermic acme 8.7 +/- 4.2 vs 12.6 +/- 9.11 UP (p less than 0.05). These results appeared to be correlated with stage pathology as it was observed a severe microvasculature disorders in MVPS. Therefore we suppose that a phenotypic continuum may exist between MS and MVP.

Adult↗

[Effect of guar on plasma lipids and on the biological activity of insulin in patients with type 2 diabetes mellitus].

10 patients with type 2 diabetes mellitus, in stable weight and diet therapy, followed a 2 months nutritional supplementation with guar, 15 g/day. Their previous nutritional and pharmacological therapy was not modified throughout the study. No changes occurred in body weight or major parameters of metabolic control. However, a significant fall occurred in fasting plasma, total and LDL cholesterol, and apolipoprotein B concentrations. Insulin sensitivity, measured by the "steady state plasma glucose", obtained after a 150 min glucose-insulin-somatostatin infusion, improved in all patients but two. A significant correlation was observed between steady state plasma glucose variations, the glycosylated haemoglobin A1c (r = 0.70; p less than 0.005), total (r = 0.77; p less than 0.001), and LDL cholesterol (r = 0.69; p less than 0.005) and apolipoprotein B concentrations (r = 0.75; p less than 0.005).

Adult↗

Somatomedin-C levels related to gestational age, birth weight and day of life.

Capillary blood samples on filter paper were assayed by means of an RIA method (Kit Nichols Institute USA) from 1096 newborns divided into full term, preterm and small-for-date infants. The somatomedin-C (Sm-C) mean value, which did not differ in the three groups, was 0.15 +/- 0.09 IU/ml. One hundred and ten (10%) showed Sm-C disc values less than or equal to 0.075 IU/ml, the minimum value measurable by our method. The day of life and birth weight had a significant influence on Sm-C levels. Gestational age did not have any significant effect. No significant interaction was found among the parameters considered. All the groups presented a progressive increase of Sm-C. Unlike preterm and small-for-date infants, in full term infants the latter increase seemed already to be evident from 5th day of life and reached higher levels from the 7th day of life onwards. In conclusion, Sm-C rates were reduced in the neonatal phase of life, but showed a tendency to rise later.

Age Factors↗

Neonatal screening for cystic fibrosis by dried blood spot trypsin assay. Results in 47 127 newborn infants from a homogeneous population.

47 127 newborn infants from the Emilia-Romagna region were screened for cystic fibrosis by dried blood spot trypsin assay. In the initial 12 099 subjects screened with a non-standardized method, two children with cystic fibrosis were observed. Of the remaining 35 028 newborn infants, 299 showed high immunoreactive trypsin values; retesting revealed persistent elevation in 11. Sweat testing confirmed cystic fibrosis in 6 subjects and was normal in 5. Clinical monitoring of these 5 children has, as yet, shown no pathological signs. No false-negative test results have yet been identified. In our region, cystic fibrosis frequency would appear to be 1 case every 5 890 newborn infants. Our study confirms that elevated immunoreactive trypsin is characteristic of newborn infants with cystic fibrosis and that screening by determination of immunoreactive trypsin is of great benefit since it allows early diagnosis and a rational approach to therapy.

Cystic Fibrosis↗

Incompetent perforating veins subfascial ligation as an important adjunct to venous surgery of the lower extremities: evaluation of surgical results.

The role of incompetent perforating veins in chronic venous disease is well established. The determination of hemodynamic alterations and perforating veins location is evaluated by physical examination, phlebography and ultrasonography. All patients with perforating veins failure underwent surgical treatment. From 1971 to 1982, 6000 patients with lower limbs primary varicose veins underwent surgical treatment: 510 more patients were hospitalized for post-thrombotic disease. In 6% of patients suffering from primary varicose veins, in 18% with recurrent varicose veins and in 76% with secondary veins (8.1% of all patients), subfascial ligation of incompetent perforating veins was associated with complete vein stripping. Incompetent perforating vein ligation alone was performed in 0.6% of cases. The technique is based on subfacial ligation of perforating veins through a small skin incision (2.3 cm). This procedure allows a fast healing of surgical wounds and a good esthetical result. The subfacial ligation allows a complete cure of the disease in primary varicose veins and avoids the main causes of recurrence. Moreover in the post-thrombotic disease treated by this procedure, symptoms and trophic lesions are markedly decreased and a dramatic reduction in the ulceration rate, 62.5% to 15% at ten year follow-up, is achieved.

Femoral Vein↗

Slow release nifedipine in the treatment of Raynaud's phenomenon.

An ever increasing interest is shown towards calcium-antagonist drugs and in particular to nifedipine in the treatment of Raynaud's Phenomenon (R.P.) On this matter a randomized double-blind study with 40 mg/die slow release nifedipine versus placebo was carried out for 30 days on 24 patients affected by R.P.-idiopathic in 16 cases and secondary in the remaining 8 cases. The evaluation of the clinical situation (hand ischemic attacks, pain, skin trophism) and the structural one (capillaroscopy of the finger nail bed and strain-gauge digital plethysmography) could be performed on 17 patients since 7 dropped out. From the clinical point of view an improvement was observed especially in the reduction of the ischemic attacks (88.8% of patients treated with nifedipine vs. 25.0% treated with placebo). Capillaroscopic results showed an improvement in 100% of the cases treated with nifedipine vs. 12.5% with placebo (p less than 0.001), as well as an improvement of the basal digit blood pressure values and after cold test in 88.8% of patients treated with nifedipine vs. 12.5% treated with placebo (p less than 0.005) and (p less than 0.0025) respectively.

Adult↗

[Assessment of "occasional" atherosclerotic lesions identified with computerized tomography. Analysis of tomodensitrometric findings and identification of "risk" groups in 1,500 patients].

Atherosclerosis is a disease with a chronic-progressive course. We report on the statistic prevalence of vascular lesions in 1,500 asymptomatic patients with vascular diseases examined with Computed Tomography (CT) for different reasons. The aortoiliac arterial district was involved in 934/1,500 patients (62.3%), with simple or calcified plaques, thrombosis or dilatations. We investigated the involvement of other arterial vessels (47%) whenever feasible (57.7% of cases). The aorta was thrombosed in 107 patients (2.8%) and the thrombus associated with a calcification and a dilated vessel in 45 of them (42.1%). The aorta or the iliac arteries were enlarged in 62 patients (4.1%) and arterial diameter exceeded 4 cm in 20 patients (1.3%). Finally, the statistical significance was analyzed considering risk factors-i.e., smoking, arterial hypertension, diabetes and hypolipoproteinemia. All the patients with 2 or more risk factors had positive CT findings; the prevalence was 75% in cigarette smokers, 83% in hypertensive, 81.3% in dislipidemic and 93.5% in diabetic patients. These data demonstrate that, in agreement with international literature reports, it is possible to single out the groups of patients that, because of their age, risk factors and sex, should be considered for color Doppler screening programs and the selected cases to be submitted to CT.

Adolescent↗