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Biomedical subjects

F Costa

Publications and source records attributed to F Costa.

At least 109 records · Page 6Linked to original sources
PubMed1994

Microneurographic evidence of sudden sympathetic withdrawal in carotid sinus syncope; treatment with ergotamine.

A proportion of patients with carotid sinus syncope (CSS) remain symptomatic even after pacemaker implantation because of persistence of a vasodepressor component. We report a patient with CSS whose syncopal episodes could be reproduced by carotid sinus massage and were due to profound hypotension associated with sudden sympathetic withdrawal, based on direct measurements of sympathetic nerve traffic. A double-blind trial with inhaled ergotamine provided significant symptomatic relief.

Administration, Inhalation↗
PubMed1993

Anti-HIV 1 antibodies prevalence in parturients through newborn testing: results of the Italian anonymous serosurvey. The Italian Collaborative Study Group of HIV Prevalence in Newborns.

A prevalence assessment of HIV infection among parturients was performed in order to estimate the future incidence of pediatric AIDS cases and obtain data on the trend of the infection in Italy. Consecutive whole blood samples from newborns collected on filter paper from all regions of Italy (October-December 1990) for routine metabolic screenings, were anonymously examined for HIV-1 antibodies by an ELISA technique. Positive results were confirmed by Western blot. Among 97,658 blood samples tested, 121 (0.124%, 95% confidence interval Poisson distribution 0.103-0.148) were positive. A high prevalence of HIV infection (> 0.2%) was observed in four regions from North and Central Italy while, in some regions in the South, the seroprevalence was ten times lower. In the Lazio Region, namely in Rome, 5 inner-city hospitals with a particularly high prevalence of HIV infection were identified. Assuming that the prevalence of HIV infection observed in the population in this study may reflect the infection rate in the total population of childbearing women, we estimate that approximately 700 newborn babies were delivered from HIV-positive mothers in Italy during 1990. The identification of high prevalence areas could allow for the development of "targeted" testing programs to plan and provide adequate counselling and care of HIV-infected women and their infants.

Female↗
PubMed1993

Clinical efficacy of dirithromycin versus miocamycin in tonsillopharyngitis.

A single-blind, randomized, parallel-group study was conducted to compare the efficacy and safety of dirithromycin with miocamycin in the treatment of streptococcal pharyngitis/tonsillitis caused by Group A streptococci. The study population consisted of 60 patients: 30 were randomized to receive 500 mg dirithromycin od and 30 to receive 600 mg miocamycin bd. All 30 dirithromycin-treated patients were eligible for efficacy analysis. A favourable clinical response was observed in 100% of these patients at the post-therapy visit. In the miocamycin-treated group, 28 of 30 (93.3%) patients were eligible for efficacy analysis; a favourable clinical response was observed in 100%. Bacteriological cure of evaluable dirithromycin- and miocamycin-treated patients was 96.7% and 92.9%, respectively. No statistically significant post-therapy differences in clinical or bacteriological response rates were noted between the two groups. Adverse event analysis showed no significant differences between treatment groups. There were no serious adverse events during the study. Two miocamycin-treated patients were prematurely withdrawn from the study due to adverse events (diarrhoea). Analysis of clinical laboratory data revealed no statistically significant differences between the treatment groups that were considered to be drug related. The results of this study suggest that dirithromycin has comparable safety and efficacy to miocamycin in the treatment of streptococcal pharyngitis/tonsillitis infections caused by Group A streptococci.

Adolescent↗
PubMed1993

Adenosine activates afferent fibers in the forearm, producing sympathetic stimulation in humans.

Whereas adenosine is generally considered an inhibitory neuromodulator, there is evidence that adenosine may excite a variety of afferent fibers thereby evoking sympathetic activation. To determine whether adenosine also excites afferent fibers located in the forearm, adenosine was administered into the left branchial artery at doses without systemic effects while sympathetic nerve activity was monitored through a recording electrode placed in the right peroneal nerve in the lower limb. The i.a. adenosine produced a dose-dependent increase in forearm blood flow (647 +/- 209% above base line at a dose of 1.5 mg i.a.) and in muscle sympathetic nerve activity (97 +/- 30% above base line). No significant effect was observed on heart rate or systemic blood pressure. The effects of i.a. adenosine were not caused by spill over into the systemic circulation because these doses had no effect when given i.v. The increase in sympathetic nerve activity was not secondary to the local vasodilatory effects of adenosine because nitroprusside, given i.a. at doses that evoked the same degree of vasodilation, had no effect on muscle sympathetic nerve activity. The authors interpreted these results as indicative of activation of forearm afferent fibers by adenosine. The precise nature of these afferent fibers cannot be determined from these studies and may include sensory afferents and chemosensitive afferents involved in the exercise pressor reflex. By contrast with the known neuroinhibitory actions of adenosine in the central nervous system and in efferent nerves, these observations are in agreement with the concept that adenosine-induced activation of sympathetic afferent fibers is a widespread phenomenon.

Adenosine↗
PubMed1993

[Ischemic hepatitis. Description of 4 cases and review of the literature].

We studied four patients who presented a striking elevation of blood transaminases suggesting acute hepatitis. The post mortem histological examination of the liver revealed centrolobular necrosis that is commonly diagnosed as ischaemic hepatitis. The liver necrosis arose from heart failure which was worsened by an acute anaemia in one patient and by a severe hypoxemia, due to respiratory failure, in another. In three subjects there was evidence of disseminated intravascular coagulation that may be responsible for aggravating the condition of liver hypoxia. The authors also review the literature on the various aspects of ischaemic hepatitis.

Aged↗
PubMed1993

Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycemia in IDDM patients. Evidence for a critical role of free fatty acids.

In this study, we assessed the effects of alcohol intake on glucose counterregulation in response to acute insulin-induced hypoglycemia in IDDM patients and in normal control subjects. Nine euglycemic IDDM patients and 9 normal control subjects were studied. After a baseline period, insulin (0.15 U/kg) was administered subcutaneously to induce hypoglycemia. Each IDDM patient was studied 3 times. In the first study, alcohol was orally administered as wine. In the second (control) study, water was administered instead of wine. In the third study, wine was given; however, a continuous infusion of heparin plus intralipid was administered to prevent the fall in plasma free fatty acid. Normal control subjects underwent only the alcohol and the control studies. In IDDM patients alcohol intake impairs, whereas in normal subjects it supports glucose counterregulation. Alcohol intake is associated with normal catecholamine responses in both IDDM diabetic patients and normal subjects. In both IDDM patients and normal subjects, hepatic glucose production in the recovery phase of the alcohol study was normal. Plasma glucose rate of disappearance was significantly increased by alcohol intake in IDDM (13.72 +/- 0.82 vs. 11.84 +/- 0.53 mumol.kg-1 x min-1; P < 0.05). Alcohol intake in both normal subjects and IDDM patients decreased plasma free fatty acid (267 +/- 22 vs. 156 +/- 20 microM; P < 0.01 and 356 +/- 29 vs. 96 +/- 12 microM; P < 0.01). We hypothesized that in IDDM patients, deficient glucose recovery during alcohol intake is the result of the ability of alcohol to depress lipolysis.

Acute Disease↗
PubMed1993

Cisapride improves gallbladder kinetics in patients affected with myotonic muscular dystrophy.

Smooth muscle involvement is relatively common in myotonic muscular dystrophy (MMD). The effects of cisapride on gallbladder motor function in myotonic patients have been investigated in 10 alithiasic patients and in 10 healthy volunteers. Gallbladder volumes were measured by ultrasonography in fasting state and 15, 30, 45 and 60 min after milk intake. The patients were treated with cisapride for two months, after which they underwent a second ultrasonographic examination. Gallbladder emptying was slower and less effective in dystrophic patients than in healthy volunteers. Cisapride was found to improve gallbladder kinetics (efficacy of contraction and rate of emptying) in patients affected with myotonic muscular dystrophy.

Adult↗
PubMed1991

A splice site mutation of the beta-spectrin gene causing exon skipping in hereditary elliptocytosis associated with a truncated beta-spectrin chain.

We studied a French kindred with hereditary elliptocytosis associated with a spectrin variant (spectrin LePuy) containing a beta-spectrin chain that is truncated at its C terminus (Dhermy, D., Lecomte, M., Garbarz, M., Bournier, O., Galand, C., Gautero, H., Feo, C., Alloisio, N., Delaunay, J., and Boivin, P. (1982) J. Clin. Invest. 70, 707-715). The structure of the 3' end of the beta-spectrin gene, the region encoding the C terminus of beta-spectrin, was determined. Nucleotide sequencing of amplified genomic DNA revealed a mutation at position +4 (A----G) of the 5' donor consensus splice site of the intron following the third-to-last exon (exon X) in one beta-spectrin allele of a heterozygous patient. Agarose gel electrophoresis of polymerase chain reaction-amplified cDNA revealed an extra band of lower molecular weight, suggesting that the shortened beta-spectrin chain of spectrin LePuy arises from aberrant mRNA splicing. Nucleotide sequencing of the shorter cDNA amplification product revealed that the sequences encoding exon X were absent. Southern blotting of cDNA amplification products confirmed this result. The skipping of exon X causes a shift in the normal reading frame resulting in the encoding of a new amino acid sequence at the C terminus of the mutant beta-spectrin chain. A new in-frame stop codon is encountered following a single residue of this novel sequence.

Amino Acid Sequence↗
PubMed1991

Carbohydrate and lipid metabolism in patients with non-insulin-dependent diabetes mellitus: effects of a low-fat, high-carbohydrate diet vs a diet high in monounsaturated fatty acids.

Nineteen patients affected by non-insulin dependent diabetes mellitus (NIDDM), in good glycemic control (fasting plasma glucose 7.2 +/- 0.3 mmol/L, glycosylated hemoglobin 6.3 +/- 0.2%), underwent three isocaloric dietary phases. In phases 1 and 3 the diet was rich in complex carbohydrates (Carbo) whereas in phase 2 it was rich in monounsaturated fatty acids (Mono). Plasma glucose concentrations were 7.1 +/- 0.3 and 7.2 +/- 0.3 mmol/L for the two Carbo phases and 7.5 +/- 0.4 mmol/L for the Mono phase (NS). Plasma total cholesterol values for the Carbo phases were 6.2 +/- 0.2 and 6.4 +/- 0.2 mmol/L, respectively, and 6.5 +/- 0.2 mmol/L on the Mono phase (NS). Similarly, no significant changes were noticed for plasma triglycerides and high-density-lipoprotein (HDL) cholesterol. Thus, both diets were well-tolerated and did not alter glucose homeostasis or worsen plasma lipid concentrations. Consequently, these results suggest that a wider dietary choice can be made available to NIDDM patients without producing unwanted side effects.

Adult↗
PubMed1991

Observing countertransference in brief dynamic psychotherapy.

Six cases treated with Brief Dynamic Psychotherapy were studied. Initial countertransferential reactions were identified, and expectations were determined concerning the evolution of the patient-therapist relationship. The existence of a basic pattern of emotional response to the patient in the therapist throughout the treatment was observed, and the authors propose to denominate it countertransferential focus. Three clinical vignettes are reported.

Adult↗
PubMed1991

[Atrial fibrillation in a cohort of the elderly: etiopathogenic role of occult hyperthyroidism and diagnostic and therapeutic considerations. Results of the CASTEL (CArdiovascular STudy in the ELderly)].

This work was performed in order to evaluate the weight of hyperthyroidism on the genesis of atrial fibrillation in elderly subjects. The data are from the CASTEL (CArdiovascular STudy in the ELderly), an epidemiologic study performed in a town of northern Italy (Castelfranco Veneto), whose 3088 elderly subjects were called and 2254 enrolled for a 7-year intervention trial. From 2224 elderly persons examined in the present study, 90 had atrial fibrillation (AF) as determined by the presence of Minnesota Code 8-3; the other 2134 were used as control population. In the 90 with AF and in the randomly chosen controls, the thyroid function was studied by means of the TRH-test. Taking into consideration an increase of TSH greater than 0.5 or greater than or greater than 1 muUI/ml over the basal value after TRH administration, 5.5% of subjects with atrial fibrillation had a suppressed response (i.e. hyperthyroidism); taking into consideration a peak value of TSH greater than or equal to 2.3 muUI/ml irrespective to the basal value, the prevalence of hyperthyroidism was higher (17.8%), but not different than in control subjects. In conclusion, hyperthyroidism is frequent in elderly subjects but it does not play a role in the pathophysiology of AF. On the contrary, AF may be explained in the majority of cases by concomitant cardiovascular disease, i.e. left atrial enlargement, arterial hypertension, myocardial ischemia, and heart failure.

Aged↗
PubMed1991

Blind serosurvey of HIV antibodies in newborns in 92 Italian hospitals: a method for monitoring the infection rate in women at time of delivery.

In Italy, drug abusers are the major risk category for HIV infection, representing 67% of all the reported cases of AIDS. This can in part explain the higher incidence of the infection observed in Italian females (17.7%) in comparison with the data reported in Europe (11.5%) or in the U.S. (8.5%). Therefore, anti-HIV screening in newborns reflects the serologic pattern of the respective mothers and can provide a useful tool in evaluating the incidence of the infection in a relatively unselected population. Furthermore, the data collected can provide a good predictive parameter for the rate at which pediatric AIDS will develop. Blood samples were collected on filter paper for routine screenings from 39,102 consecutive newborns in 92 hospital nurseries, from eight different Italian regions, during the period June 1988-April 1989. Blood-saturated disks were screened for anti-HIV antibodies (HIV Ab) using an ELISA; positive results were confirmed using a Western blot. Among the 39,102 blood samples tested, 51 (0.00130, 95% confidence intervals, Poisson distribution of 0.00097-0.00171) were found to be positive for HIV Ab. The distribution pattern of the positive samples among the different regions correlates to the cumulative AIDS incidence rate, with a higher prevalence in urban and industrialized areas.

Blotting, Western↗
PubMed1990

Outcome after a "perfect" Fontan operation.

A study was undertaken to determine the early and long-term outcomes dictated by the Fontan state per se (a state in which the force driving pulmonary blood flow is solely or largely a residue, in the systemic venous pressure, of the main ventricular chamber's contractile force) and the transition (by surgery) to it from the state of congenital heart disease under optimal conditions (after a "perfect" Fontan operation). The primary study design used a solution of a multivariate risk factor equation for death, by which survival rate under optimal conditions was predicted to be 92%, 89%, 88%, 86%, 81%, and 73% at 1 month, 6 months, and 1, 5, 10, and 15 years, respectively, after the Fontan operation. The hazard function (instantaneous risk of death at each moment in time after the operation) had an early rapidly declining phase of hazard that at about 6 months began to give way to a late hazard phase, which was rising by about 6 years after surgery. A secondary study design, using the theory of competing risks, yielded survival and hazard function information very similar to that of the primary study design. The functional capacity of the patients as expressed by New York Heart Association class was less, the longer the period of follow-up. No risk factors (other than older age at time of surgery) were found for the late decline in survival or the decline in functional status. The inference is that the premature decline in survival and functional status and the late rise in hazard function are from the Fontan state per se and that the Fontan operation is, therefore, palliative but not curative.

Adolescent↗