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Biomedical subjects

F Antonucci

Publications and source records attributed to F Antonucci.

At least 19 recordsLinked to original sources
PubMed1998

A randomized study comparing methylprednisolone plus chlorambucil versus methylprednisolone plus cyclophosphamide in idiopathic membranous nephropathy.

To assess whether chlorambucil or cyclophosphamide may have a better therapeutic index in patients with idiopathic membranous nephropathy, we compared two regimens based on a 6-mo treatment, alternating every other month methylprednisolone with chlorambucil or methylprednisolone with cyclophosphamide. Patients with biopsy-proven membranous nephropathy and with a nephrotic syndrome were randomized to be given methylprednisolone (1 g intravenously for 3 consecutive days followed by oral methylprednisolone, 0.4 mg/kg per d for 27 d) alternated every other month either with chlorambucil (0.2 mg/kg per d for 30 d) or cyclophosphamide (2.5 mg/kg per d for 30 d). The whole treatment lasted 6 mo; 3 mo with corticosteroids and 3 mo with one cytotoxic drug. Among 87 patients followed for at least 1 yr, 36 of 44 (82%; 95% confidence interval [CI], 67.3 to 91.8%) assigned to methylprednisolone and chlorambucil entered complete or partial remission of the nephrotic syndrome, versus 40 of 43 (93%; 95% CI, 80.9 to 98.5%) assigned to methylprednisolone and cyclophosphamide (P = 0.116). Of patients who attained remission of the nephrotic syndrome, 11 of 36 in the chlorambucil group (30.5%) and 10 of 40 in the cyclophosphamide group (25%) had a relapse of the nephrotic syndrome between 6 and 30 mo. The reciprocal of plasma creatinine improved in the cohort groups followed for 1 yr for both treatment groups (P < 0.01) and remained unchanged when compared with basal values in the cohort groups followed for 2 and 3 yr. Six patients in the chlorambucil group and two in the cyclophosphamide group did not complete the treatment because of side effects. Four patients in the chlorambucil group but none in the cyclophosphamide group suffered from herpes zoster. One patient per group developed cancer. It is concluded that in nephrotic patients with idiopathic membranous nephropathy both treatments may be effective in favoring remission and in preserving renal function for at least 3 yr.

Adolescent↗
PubMed1996

QT interval and QT dispersion in multiple system atrophy (Shy-Drager syndrome).

To evaluate the influence of autonomic function on the QT interval and QT dispersion, 18 patients (10 males and 8 females; mean age 61 +/- 9 years) with multiple system atrophy (MSA, Shy-Drager syndrome) were studied. Cardiovascular tests were performed to assess the degree of autonomic dysfunction. The QT interval, corrected QT (QTc), QT dispersion (QTd), corrected and adjusted QTd were calculated from a standard 12-lead electrocardiogram. Fifteen healthy subjects matched for sex and age were studied as controls. Nine MSA patients showed severe autonomic dysfunction with orthostatic hypotension. In the remaining patients definite autonomic impairment was found. No statistically significant difference was found in QTd and only a trend towards higher values of maximal QTc was found in patients compared with controls. QTc prolongation, defined as greater than the mean +/- 2 SD of the controls, was detected only in three out of the 18 MSA patients (17%). No correlation was found between the severity of autonomic impairment and repolarization parameters. Our data suggest that chronic autonomic impairment in patients with MSA does not significantly affect ventricular repolarization and ventricular dispersion.

Adult↗
PubMed1996

Effects on renal function of a continuous infusion of nifedipine during cardiopulmonary bypass.

OBJECTIVES: To evaluate the effects on renal function of continuously administered nifedipine during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery. DESIGN: The study was prospective, randomized, and controlled. SETTING: The study was performed in the Department of Anesthesia and intensive care unit of a regional hospital in Italy. PARTICIPANTS: Thirty-four patients scheduled for elective coronary artery surgery; all patients had preoperative renal and hemodynamic function within normal limits. INTERVENTIONS: The patients were randomly divided into two equal groups: nifedipine and control. Twenty patients were included in the study: 10 patients in the nifedipine group (group A) and 10 patients in the control group (group B). In group A, nifedipine was continuously administered during CPB at an infusion rate ranging from 0.24 to 0.59 micrograms/kg/min to maintain the mean systemic arterial pressure (MAP) between 60 and 70 mmHg. In group B, increases of MAP above 70 mmHg were treated with IV boluses of urapidil (5 mg). MEASUREMENTS AND MAIN RESULTS: Renal function was studied using creatinine clearance (CRCL), determined before, during, and after the operation, and the glomerular filtration rate (GFR) was measured the day before and after the operation by plasma and urine clearance of 51-chromium edetic acid (51Cr-EDTA). Hemodynamic monitoring was performed using a pulmonary artery catheter. In comparison with preoperative determinations, CRCL and GFR values increased significantly after CPB (p < 0.001) and after the operation (p < 0.01) in the patients treated with nifedipine, whereas the two parameters showed a small and not significant reduction at the same times in the control patients. Hemodynamic function was well maintained in all patients throughout the study. CONCLUSIONS: It is concluded that, besides the maintenance of adequate hemodynamics, a continuous infusion of nifedipine during CPB can be an additional therapeutic tool to protect renal function in cardiac surgical patients.

Aged↗
PubMed1996

Nifedipine can preserve renal function in patients undergoing aortic surgery with infrarenal crossclamping.

Sixteen patients diagnosed with an aneurysm of abdominal aorta or Leriche disease underwent elective aortic surgery involving crossclamping of infrarenal aorta (ICC). These patients were randomized into two equal groups and 8 patients were infused with nifedipine starting from the isolation of aorta until the end of surgery (group A) while another 8 patients were infused with low-dose dopamine (group B) over the same surgical course. Plasma endothelin (ET) was measured before the induction of anesthesia, at the beginning and at the end of the clamp period and at the end of the operation. Intraoperatively, creatinine clearance and urinary excretion of PGE2, 6-keto PGF1 alpha and TxB2 were also determined before, during and after aortic crossclamping. Preoperative GFR as well as preinduction cardiac index (CI) and pulmonary capillary wedge pressure (PCWP) of the two groups did not differ. During cross-clamping plasma ET rose significantly in both groups. However, after clamp removal, plasma ET decreased in group A while it remained elevated in group B. Urinary excretion of TxB2, PGE2 and 6-keto PGF1 alpha increased during clamp in both groups, but the ratio of PGE2 + 6-keto PGF1 alpha/TxB2 during and after clamp was significantly higher in group A than in B. Postclamp creatinine clearance decreased in group B, and increased in group A; postoperative value of GFR was unchanged in group A and decreased significantly in group B. In conclusion, infusion of nifedipine, in contrast to dopamine, prevented the decrease of GFR in patients undergoing aortic surgery. This effect could be mediated by a nifedipine modulation of ET vascular synthesis and/or a preferential renal synthesis of vasodilating prostanoids.

Aged↗
PubMed1996

[Cytogenic characterization of chromosome markers detected at amniocentesis: implications for karyotype-phenotype correlations].

The detection of marker chromosomes at prenatal diagnosis raises serious concerns regarding the phenotypic consequences on the fetus. Traditionally the classical approach to the problem relied upon the cytogenetic analysis of the marker chromosome by different banding techniques to ascertain its euchromatic content. This indirect methodology doesn't allow to trace the origin of the marker and to properly narrow the molecular boundaries of the euchromatic region. FISH technology by means of DNA probes regionally localized is a powerful tool to address these issues, allowing to determine the exact origin of the markers and more refined criteria for studying karyotype-phenotype correlations. This facilitates genetic counseling and the decision making for the parents. Here we describe our experience of integrated approach (molecular and classical cytogenetics) in two de novo cases of marker chromosomes (iso 18p and inv dup 15), detected at amniocentesis.

Adult↗
PubMed1994

Localization of parathyroid enlargement: experience with technetium-99m methoxyisobutylisonitrile and thallium-201 scintigraphy, ultrasonography and computed tomography.

Technetium-99m methoxyisobutylisonitrile (MIBI), like thallium-201, has recently been introduced as a myocardial perfusion agent and is now also showing very promising results in parathyroid scintigraphy. The results of 201Tl/99mTc-pertechnetate and 99mTc-MIBI/99mTc-pertechnetate subtraction scintigraphy, ultrasonography and computed tomography are presented in a series of 43 patients operated on for hyperparathyroidism. All four imaging modalities were confirmed to be reliable, scintigraphy being the most accurate. Sensitivities ranged from 81% to 95%, that of 99mTc-MIBI being the highest. Moreover this tracer, which has more favourable physical and also biochemical properties, yielded images of superior quality. This allowed localization of the lesion by visual inspection only in as many as 86% of the patients with positive 99mTc-MIBI/99MTc-pertechnetate subtraction scintigraphy. We believe that the higher sensitivity, superior image quality and lower cost of 99mTc-MIBI imaging will make 99mTc-MIBI the new radiopharmaceutical of choice for parathyroid scintigraphy (when one take into account the stability of labelling with large activities it is possible to perform three or four cardiac studies together with one parathyroid scintigraphic examination using one lyophilized vial).

Adenoma↗
PubMed1994

[The palliative treatment of venous stenoses in tumor patients with self-expanding vascular prostheses].

During 53 months 14 patients with tumour-induced obstructions of the superior vena cava (n = 8), the inferior vena cava (n = 2) and iliac veins (n = 4) were treated with self-expandable metallic stents. 21 Wall stents and 5 Gianturco double stents were applied. The follow-up lasted from 2 weeks to 16 months (range = 5.7 months). All patients showed a marked relief of inflow obstruction after stent placement. 6 of 7 patients, who died of their disease during follow-up, were asymptomatic regarding vein obstruction until their death (3 weeks to 16 months). In 6 of 7 still living patients no re-obstruction occurred during follow-up (2 to 16 months). Patency rate was 82%. These results suggest that self-expanding stents are a successful palliative therapy of malignant vein obstructions.

Constriction, Pathologic↗
PubMed1994

Malignant biliary obstruction: clinical and histopathologic correlation after treatment with self-expanding metal prostheses.

PURPOSE: To analyze clinical and autopsy findings in patients with malignant biliary obstruction treated with biliary endoprostheses. MATERIALS AND METHODS: Stents were inserted endoscopically in nine patients and transhepatically in 50. In 24 patients, autopsy was performed; in 22 cases, histologic analysis of the area in which the stent was placed was available. RESULTS: The technical success rate was 100%, and the clinical success rate was 92%. Complications occurred in 16 patients, with one procedure-related death. The rate of severe complications was 19%, primarily due to acute cholangitis (n = 9). Mean survival time was 175 days. Stent obstruction was found in 12 patients and occurred on average 196 days after stent placement. Secondary treatment was successful in all 12 patients. Only one of 24 autopsy specimens demonstrated macroscopic nonobstructive tumor ingrowth. Histologic analysis showed that the main reaction to the stent was connective tissue formation, which never occurred before 3 months. Invasion by tumor cells was noted in only five cases. CONCLUSION: Tumor ingrowth is not a major cause of stent obstruction.

Adult↗
PubMed1994

[Treatment of venous stenoses and occlusions of benign etiology with vascular endoprostheses: a new, non-operative therapeutic concept].

8 patients (7 women and 1 man, age between 35 and 66 years, mean 46.3) suffering from a stenosis or occlusion of the pelvic or superficial femoral vein after surgical or percutaneous intervention were successfully treated with endovascular stents of the wallstent type. Clinical and Doppler sonographic as well as phlebographic controls showed patency of all stented lesions at followup times between 3 and 82 months (average 27 months). The use of percutaneous transluminal angioplasty (PTA) in the venous system in combination with implantation of self-expanding vascular endoprostheses offer a new therapeutic modality to treat veins with stenosis or occlusion of benign etiology without surgical intervention.

Adult↗
PubMed1993

Effects of a continuous diltiazem infusion on renal function during cardiac surgery.

Thirty-five male patients undergoing coronary artery surgery were studied to investigate renal function during a continuous infusion of the calcium channel blocker diltiazem. All patients had preoperative renal function within normal limits (serum creatinine below 0.133 mmol/L) and were randomly divided into three groups: Control (C), Diltiazem 1 (D1), and Diltiazem 2 (D2). Diltiazem was infused in D1 (1 microgram/kg/min) and D2 (2 micrograms/kg/min) patients throughout surgery and during the following 36 hours. Glomerular function was investigated using the endogenous creatinine clearance while tubular function was assessed by means of water and sodium reabsorption tests, as well as urinary enzyme activity measurements. Hemodynamic monitoring was performed using a pulmonary artery catheter. The glomerular filtration rate of C and D1 patients showed a significant fall during cardiopulmonary bypass (CPB) with respect to the prebypass period and returned to the baseline values only in the postoperative period. A similar change was not observed in D2 patients. The analysis of variance demonstrated that the glomerular filtration rate was significantly higher in Group D2 versus Group C during and after CPB (P = 0.03 and P = 0.04, respectively). Furthermore, after CPB, urinary output was significantly improved in D2 patients, both versus C and D1 patients (P = 0.003), notwithstanding a lower mean arterial pressure in the D2 Group (P = 0.04 v C Group). Tubular function was not influenced by diltiazem infusion. It is concluded that a continuous diltiazem infusion, at a dose of 2 micrograms/kg/min during cardiac surgery, may be useful to prevent a decrease in glomerular function secondary to cardiopulmonary bypass.

Acetylglucosaminidase↗
PubMed1992

Biliary obstruction: treatment with self-expanding metal prostheses.

The authors percutaneously and endoscopically inserted 58 Wallstent endoprostheses in 42 consecutive patients with benign and malignant obstructive biliary stenoses. The three patients with benign obstructive jaundice were followed up for 48 months. Two of the stents occluded due to sludge formation, prompting percutaneous reentry. The 39 patients with malignant disease were followed up for 18 months. Twenty-six of these patients died 3 days to 1.5 years (mean, 133 days) after the procedure. Thirteen are alive after 2-12 months (mean, 242 days). Recurrent jaundice occurred in 11 patients (28%): in four patients due to tumor growth over the proximal end of the stent, in one patient due to excessive gallbladder hydrops, and in six patients due to liver failure. Although autopsy investigations revealed the possibility of tumor growth onto the inner surface of the stent through the stainless steel mesh of the endoprosthesis, stent occlusion by tumor ingrowth into the lumen was not encountered.

Adult↗
PubMed1992

Eating behavior and adherence to dietary prescriptions in obese adult subjects treated with 5-hydroxytryptophan.

Previous observations have shown that oral administration of 5-hydroxytryptophan (5-HTP) without dietary prescriptions causes anorexia, decreased food intake, and weight loss in obese subjects. To confirm these data over a longer period of observation and to verify whether adherence to dietary restriction could be improved by 5-HTP, 20 obese patients were randomly assigned to receive either 5-HTP (900 mg/d) or a placebo. The study was double-blinded and was for two consecutive 6-wk periods. No diet was prescribed during the first period, a 5040-kJ/d diet was recommended for the second. Significant weight loss was observed in 5-HTP-treated patients during both periods. A reduction in carbohydrate intake and a consistent presence of early satiety were also found. These findings together with the good tolerance observed suggest that 5-HTP may be safely used to treat obesity.

5-Hydroxytryptophan↗
PubMed1992

Placement of venous stents: clinical experience with a self-expanding prosthesis.

A self-expanding vascular prosthesis was used to treat 20 venous stenoses or occlusions in 13 patients. The lesions were caused by tumor (n = 5), postoperative fibrous scars (n = 2), and chronic hemodialysis fistulas (n = 13). Follow-up ranged between 6 weeks and 53 months (mean follow-up, 14.9 months). Acute occlusion occurred in two stents, one within a tumor stenosis and one in a dialysis shunt after 3 days and 2 days, respectively. Balloon angioplasty, thrombolysis, and aspiration in the first case and balloon angioplasty and thrombolysis in the second case successfully restored patency. Definite occlusion occurred in these two patients after 8 weeks and 5 months, respectively. Ten secondary interventions were performed in three patients with 10 restenoses who had stenotic arm veins in chronic hemodialysis at presentation. Five of seven patients who received treatment for stenoses associated with hemodialysis underwent successful kidney transplantation 5-27 months after placement of vascular stents. Both patients who received treatment for benign strictures had patent stents at follow-up examinations performed at 45 and 53 months, respectively. Four of five stents placed for malignant stenoses were patent at venography (n = 3) or autopsy (n = 1).

Adult↗
PubMed1992

Peritoneal clearances in hypertensive CAPD patients after oral administration of clonidine, enalapril, and nifedipine.

The authors investigated whether the reduction of arterial pressure, induced by the oral administration of clonidine (CLO), enalapril (EN), and nifedipine (NIF), has any effect on peritoneal transport rates. The study was performed in nine hypertensive patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The patients were submitted to administration of CLO, EN, and NIF, each in randomized succession for two weeks, after withdrawal of any hypotensive therapy for eight days (washout period). The nine patients underwent a four-hour dwell exchange using a 2.27 g/dL glucose two-liter bag after washout and after each hypotensive period. The following parameters were analyzed: mean arterial pressure (MAP), performed in the sitting position; net ultrafiltration; effluent/initial dialysate glucose ratio (GL D/Do); peritoneal clearance of K, BUN, creatinine (Cr), phosphate, beta-2 microglobulin (beta 2), total proteins, and the ratio between beta 2 and Cr clearance. Moreover, residual renal Cr and beta 2 clearances were analyzed. The three drugs significantly reduced MAP at a similar rate. The peritoneal transport parameters after CLO were similar to the results in the washout period. On the contrary, after EN and NIF therapy, Cr and beta 2 clearances were significantly increased, and GL D/Do decreased in comparison to the washout period. The other peritoneal transport parameters after EN and NIF were similar to the washout period. Residual renal Cr and beta 2 clearances after the three drugs were similar to those in the washout. these data suggest that after two weeks of therapy with EN and NIF, glucose, Cr, and beta 2 peritoneal transports are influenced by these hypotensive drugs irrespective of the effect on the arterial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Biological Transport↗
PubMed1991

Arterial stent placement with use of the Wallstent: midterm results of clinical experience.

Self-expandable stents of the Wallstent type were used in 26 iliac and 15 femoropopliteal artery lesions of 31 patients to treat stenoses or occlusions. The indications were confined to complex lesions, including residual stenoses and dissections after percutaneous procedures or previous surgery in the iliac artery lesions, and long-segment (mean, 13.5 cm) occlusions with inadequate response to percutaneous recanalization in the femoropopliteal artery lesions. In the iliac artery group, after stent placement, 96% of the lesions were patent at a mean follow-up of 16 months (range, 6-30 months). In the femoropopliteal artery group, of 11 patients available for follow-up, only six had patent stents at 7-26 months (mean, 20 months). Four of these six patients required one to three secondary interventions. Self-expanding endoprostheses are of great value in complex iliac artery lesions where simple balloon dilation is insufficient. Stent placement for long femoral artery lesions should be performed with utmost reserve, and the extent of stent placement should be as short as possible.

Aged↗
PubMed1991

Iliac artery stenosis or obstruction after unsuccessful balloon angioplasty: treatment with a self-expandable stent.

Obstruction or stenosis of the iliac artery was treated by placement of a self-expandable stent in 91 patients. A total of 100 lesions was treated. All patients had had poor results of balloon angioplasty including residual stenosis, iliac occlusion, and dissection. The stent used in all cases was a self-expandable stainless steel endoprosthesis mounted on a 7- or 9-French catheter and covered by an invaginated tubular rolling membrane. The diameter of the expanded stent varied from 7 to 12 mm. A total of 129 stents was placed. Technical success was 97%. Thromboses occurred immediately after placement in two patients and within the first month in six; these were mainly due to residual obstruction. Eighty-two (93%) of 88 patients with a follow-up longer than 3 months had no recurrent symptoms. Restenosis caused by intimal hyperplasia inside the stent occurred in 10 patients; these required repeated intervention in only four cases. In the remaining six patients, no further complications occurred. Our results show that self-expanding endoprostheses are of value for improving the results of inadequate percutaneous transluminal angioplasty.

Adult↗