Biomedical subjects
Publications and source records attributed to F Grimaldi.
Aim of this study was the literature review regarding esophageal perforations and fistulas. We examined the most common causes, clinical findings (symptoms and signs), laboratory and imaging studies for differential diagnosis and complications. Finally, we examined the surgical or endoscopic treatment and the prognosis.
OBJECTIVES: To clarify the relationship between interferon-alpha (IFN-alpha) therapy and autoimmune thyroiditis in chronic hepatitis C virus (HCV) infection, we investigated a selected number of patients without basal thyroid dysfunctions. MATERIALS AND METHODS: 130 patients (average age: 20-70), with chronic HCV infection and without basal clinical and laboratory signs of autoimmune thyroiditis were divided into two groups: IFN-alpha treated (A) and untreated (B) patients. Group A received IFN-alpha (three million U.I./3 times a week) for six months; group B was followed for the same period. Thyroid peroxidase and thyroglobulin autoantibodies were measured by radioimmunoassay; thyroid function was measured by radioimmunoassay (free thyroxine and triiodothyronine) and immunoradiometric assay (thyroid stimulating hormone). RESULTS: After a 6-month period, thyroid autoantibodies positivity was documented in 21.1% of group A and in 10.3% of group B patients, both statistically relevant (p<0.001 and p<0.011, respectively). The comparison between the two groups was not statistically relevant (p=0.142). CONCLUSIONS: Our study showed a prevalence of de novo thyroid autoimmunity in chronic HCV patients treated with IFN-alpha, confirming previous data in literature. The lack of a significant difference between treated and untreated patients strongly suggests that the anti-thyroid autoimmune response is linked to the HCV infection itself. Moreover, IFN-alpha therapy probably does not represent a risk factor in renewing the autoimmune processes of the thyroid gland. Thyroid function and autoantibodies must be systematically monitored in patients with HCV infection, especially in female and IFN-alpha treated population, not only to verify the possible thyroid abnormalities but also to rule out concomitant autoimmune diseases.
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BACKGROUND: Aim of the study was to assess the correlation between clinical stage of HCV-related liver disease and viraemia to immune response to different viral antigens. METHODS: We considered 1330 patients with HCV chronic infection followed up from 6 months up to 6 years divided into two groups according to RIBA 3 (Abbott) response: Group I, 1231 patients with positivity for at least two bands (83 subjects with asymptomatic infection, 941 with chronic hepatitis, 201 with cirrhosis and 6 with HCC); Group II, 99 patients with positivity at only one band (45 with asymptomatic infection, 53 with chronic hepatitis and 1 cirrhotic). RESULTS: We noticed a major percentage of positive patients for at least three bands in more severe clinical forms (90% of chronic hepatitis or cirrhosis versus 60% of asymptomatics, p < 0.005, chi 2 test). Moreover we noticed a percentage increase of positivity for antibodies anti-c100 and anti-NS5 with the progression of liver damage, statistically significant differences between asymptomatics and patients with chronic forms. We also observed that viraemia is related neither to clinical stage nor to different reactivity to RIBA 3, albeit viraemia is usually detected more frequently among patients with liver damage, but unrelated to different reactivities. CONCLUSIONS: Our results show a clear correlation between number of reactivities towards HCV proteins and progression of liver damage, pointing out that immune response plays a direct role in the long-term outcome of HCV infection.
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The Authors report their fifteen years experience in the surgical treatment of hepatic hydatid cysts. They emphasize the difference in the incidence of radical procedures (pericystectomy and hepatic resections) registered in the two periods examined (1980-83 and 1987-93), stressing the role of current diagnostic imaging techniques and improved surgical procedures which allow to perform standard operations for a radical treatment of hepatic hydatid cysts. Total pericystectomy is considered the procedure of choice; rarely it can't be performed (high vascular risk in central cysts located between portal and hepatic veins) and consequently subtotal pericystectomy or conservative treatment are the only possible procedures. Hepatic resection is preferred in case of multiple cysts involving the same lobe or when a giant hydatid cyst replaces the lobe. A further therapeutical resource--in radical procedures--is offered by the use of antihelminth drugs with marked antiparasitic action (albendazole).
6-Monoacetylmorphine and morphine were determined simultaneously in plasma, whole blood and urine, after solid-phase extraction, by high-performance liquid chromatography using amperometric detection at 600 mV oxidation potential. The recoveries ranged from 92 to 99%. The reproducibility study indicated that the coefficients of variation were less than 11% for morphine and 12.4% for 6-monoacetylmorphine. The determination limits were 1 ng/ml for morphine and 4 ng/ml for 6-monoacetylmorphine. The method had a good selectivity towards opiate and nonopiate analgesics and other drugs. The stability of the analytes in methanol (standard solutions), in samples (plasma, whole blood and urine) at -20 degrees C and at 20 degrees C, and in samples after enzymatic hydrolysis at 37 degrees C, was also studied. For sample containing 6-monoacetylmorphine, inadequate storage or hydrolysis could lead to overestimation of morphine or its conjugates. The technique described can be applied for the study of the pharmacokinetics of heroin; it is also available for forensic toxicology to distinguish heroin use from medical prescription of morphine and other opiate drugs.
Dextromoramide, propoxyphene and its main metabolite, norpropoxyphene, were determined in blood after solid-liquid extraction by means of an HPLC method using photodiode-array detection. Two cases of fatal overdose resulting from abuse of the two drugs are presented. In case 1 the necropsic whole blood contained dextromoramide at toxic level (194 ng ml-1) and propoxyphene (614 ng ml-1) and norpropoxyphene (1100 ng ml-1) within the therapeutic range; the death could be due to the combined effect of the two analgesics and, perhaps, other associated drugs. In case 2, the necropsic whole blood concentrations of propoxyphene and norpropoxyphene were 4330 and 3800 ng ml-1, respectively, and could be considered as lethal.
Nicotine and its main metabolites (cotinine, trans-3'-hydroxycotinine, trans-3'-hydroxycotinine glucuronide, nicotine-1'-N-oxide and 3-pyridylcarbinol) were analysed in urine after liquid-liquid extraction by high-performance liquid chromatography using norephedrine as internal standard, ultraviolet detection at 260 nm and scanning ultraviolet spectra with a photodiode-array detector. The conjugated trans-3'-hydroxycotinine was determined after enzymatic hydrolysis. Specific determination of 3-pyridylcarbinol was also carried out. Owing to its good selectivity, sensitivity and reproducibility, the method was applied to the analysis of urine samples from smokers and non-smokers. The results obtained suggest that the urinary markers used to assess active smoking or exposure to environmental tobacco smoke must be not only nicotine and cotinine, but also their main free and conjugated metabolites.
The presence of circulating hepatitis C virus genome (HCV-RNA), elevated ALT levels and antibodies to an NS5-derived synthetic peptide have been examined in 13 subjects with isolate positivity for antibodies to the HCV core antigen (C22) on RIBA-2 testing. All subjects were followed up for 8-18 months (mean 12.4 months). In seven subjects (54%), intermittent or persistent viremia was associated with abnormal ALT levels (6 subjects) and with positivity for antibodies to NS5-peptide (6 subjects). On the other hand, in 6 out of 13 subjects (46%) no viral replication, no liver cytonecrosis and no antibodies to NS5 were found. It is concluded that isolate reactivity to C22 by RIBA-2 is a heterogeneous condition that corresponds to two distinct categories of subjects: those with active HCV infection and those without evidence of virus replication. Although HCV-RNA determination is the most reliable means of identifying HCV carriers, antibodies to NS5 can be a useful marker of virus activity. In fact, antibodies to NS5 were detected in 6 out of 7 viremic patients, compared to 0 out of 6 non-viremic patients (P = 0.004). It remains to be elucidated whether the isolate reactivity to core antigen found in non-viremic subjects represents a specific, HCV-induced antibody response, or is an unrelated crossreactivity.
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Four different dosage regimens of interferon (IFN) alfa-2b (3 million units (MU) three times weekly for three months, 3 MU three times weekly for six months, 6 MU two times weekly for six months, and 6 MU three times weekly for six months) were compared in patients with chronic hepatitis C. There was no significant difference measured by percentage of responders to treatment between the four groups, but the degree of response was inversely correlated with the severity of liver damage. Viraemia was undetectable in most (75%) of responders treated with interferon and also in 20% of those who did not respond to treatment.
Nodular lymphoid hyperplasia (NLH) is a reaction of the intestinal lymphatic tissue to specific inflammatory stimuli. Radiologically, it presents with multiple nodular filling defects of various sizes (2-4 mm) and with segmental, focal or diffuse distribution. The condition may be benign but, under particular circumstances (chronic stimuli), it may evolve to neoplastic forms. Seven hundred and sixty-eight patients underwent small bowel X-rays from January 1990 to April 1992. Twenty-two patients with NLH with or without associated mucosal or wall lesions were selected. The radiologic and histologic features of the lesions, together with the clinical data, were helpful to make the diagnosis. In 8 patients the hyperplastic nodules were benign, while 10 patients were affected with Crohn's disease and 4 with Herman's syndrome or common variable immunodeficiency. This work was aimed at defining NLH from a diagnostic point of view relative to both morphology and extent of lesions and at stressing the role of radiology of the small bowel in the follow-up of the cases at risk of evolving to cancer.
The Authors report their limited series of neoplasms of the adrenal cortex, and underline the decisive role of the modern diagnostics based on imaging techniques (US--TC--NMR). These, in fact, often allow a good definition also in the non-functioning adrenal masses incidentally discovered (incidentalomas). The authors emphasize the high quality of such diagnostic methods offering a good reliability in discriminating the nature of the adrenal mass. These undeniable diagnostic advantages have a positive impact on the surgical strategy, allowing together with a careful morphological study of the lesion, to program in detail possible demolitive operations. The authors finally underline the importance of the surgical access: they are persuaded the best is the bilateral under-rib incision. This surgical approach assures a complete exploration of the abdominal and pelvic cavity; moreover, it allows to face every complication.
Dextromoramide was determined in plasma and whole blood after solid-phase isolation by high-performance liquid chromatography using dextropropoxyphene as internal standard and ultraviolet detection at 215 nm. Owing to its good selectivity, sensitivity and reproducibility, the technique is available for forensic toxicology purposes as well as for clinical pharmacology. The concentrations of dextromoramide were determined in three cancer patients receiving intravenous treatment with one to three 5-mg daily doses. On the fourth day the plasma level was 13.85 +/- 3.27 ng ml-1 just before the first daily dose and 84.28 +/- 12.60 ng ml-1 30 min after dosing. The whole blood concentration, determined in one of the patients, was undetectable just before the dose and was 76 ng ml-1 30 min after dosing.
Fifty-five patients with antibodies to HCV and chronic liver disease have been enrolled in the study. Thirty-four patients were treated with recombinant alpha interferon (IFN, 3 MU daily for 10 days followed by 3 MU twice/week for 3 months), and were compared to 21 untreated controls. Alanine aminotransferase (ALT) normalization was observed in a significant proportion of treated patients (52.9%), but 66.6% of them experienced a relapse after discontinuation of the therapy. The evaluation of the early ALT behavior after the 10 days priming with daily IFN administration was useful in predicting the response. The administration of a second IFN course with the same schedule and duration as the first course did not increase the efficacy of the treatment. Increased dosage and/or prolonged administration are probably required.
We describe the anatomical abnormalities in the hypothalamic-pituitary region revealed by magnetic resonance imaging (MRI) in 10 patients, 8 men and 2 women, affected by idiopathic anterior hypopituitarism (IAH). In all cases contiguous sagittal and coronal T-1 weighted images were obtained. In 9 patients the high-intensity posterior lobe was missing, in almost all patients the pituitary stalk was thin and/or transected, and in 8 a bright T-1 nodule was detected at the infundibular apex, near the tuber cinereum, in the median eminence. None had diabetes insipidus. MRI proves to be very useful in understanding the etiopathogenesis of IAH.