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Biomedical subjects

G Abate

Publications and source records attributed to G Abate.

At least 37 records · Page 2Linked to original sources
PubMed1999

Chronic lymphocytic leukaemia and neuroendocrine cancer.

We report a unique association between neuroendocrine cancer and chronic lymphocytic leukaemia (CLL) in a 63-year-old man. Neuroendocrine cancer was resistant to various conventional treatments and following locoregional progression we treated the patient with hypoxic pelvic perfusion of cisplatin 100 mg/m2 plus mitomycin 40 mg/m2, using the stopflow method, for three cycles: a dramatic and surprising reduction of > 75% in the evaluable lesions was observed. The cumulative effect of treatment produced a complete response from CLL. At cytogenetic examination the neuroendocrine cells were diploid, whereas CLL cells showed trisomy 12. Moreover, deletion of the short arm of chromosome 3 was found in both neoplastic populations. Whether the abnormality seen on chromosome 3 in the two diseases represents a critical event is not known.

Chromosome Deletion↗
PubMed1999

Blood pressure rhythm and prevalence of vascular events in hypertensive subjects.

OBJECTIVES: To evaluate the influence of age on the day-night blood pressure rhythm and on the prevalence of vascular events in those whose systolic blood pressure (SBP) fell by <10% overnight (non-dippers). DESIGN: Cross-sectional observational cohort study. SETTING: Outpatient hypertension clinic. PARTICIPANTS: 419 Hypertensive patients (214 male, 205 female). METHODS: All subjects were submitted to ambulatory blood pressure monitoring (Spacelabs 90207). The nocturnal fall of SBP was calculated from (day SBP--night SBP)/day SBP, where 'day' values were recorded between 0600 h and 2200 h and 'night' values between 2200 h and 0600 h. Dippers and non-dippers were divided in two subgroups according to age (under or over 65 years). Information on gender, smoking, diabetes mellitus and body mass index was collected and cerebrovascular and cardiovascular events, evaluated by history and medical records, were registered. RESULTS: The day-night difference in blood pressure significantly decreased with age and the prevalence of non-dippers was greater in elderly than in younger subjects (65.1% vs. 29.8%). No difference was found between groups for cerebrovascular events, irrespective of age. A relationship between non-dipping pattern and cardiovascular events was found only in younger hypertensive non-dippers (odds ratio, 2.0; 95% confidence interval, 1.20-3.21); in elderly people the prevalence of cardiovascular events was similar in dippers and non-dippers. CONCLUSIONS: Cardiovascular risk is not increased in elderly non-dipper hypertensive subjects. This contrasts with results in younger populations.

Aged↗
PubMed1999

Combination of granulocyte-macrophage colony-stimulating factor (GM-CSF) anf erythropoietin (EPO) for the treatment of advanced non-responsive chronic lymphocytic leukemia.

We report the use of a colony-stimulating granulocyte-macrophage factor (GM/CSF) and erythropoietin (EPO) combination as salvage treatment in four heavily-pretreated patients with refractory/ recurrent B-CLL. Induction therapy was subcutaneous GM-CSF 2.5 microg/ kg, and EPO, 150 units/kg both daily for the first 14 d. Maintenance therapy was GM-CSF on days 1, 3 and 5 and Epo on days 2, 4 and 6 at the same doses with weekly recycling. All the patients responded favourably. A significant reduction of lymphocytosis, lymphoadenomegaly, and organomegaly was obtained within one month of therapy. The number of infections and transfusional requirement decreased dramatically. The hemoglobin increased to over 11 g/dl in 3 out of 4 patients. With a median follow-up of 11 months (range 5-13) we observed 4 partial responses (NCI/IWCLL) and only one progression after a 10-month partial response. This combination regimen seems very active, safe and easy to administer. It may represent a promising therapeutical option in heavily pretreated patients. Further clinical and biological studies on a larger cohort of patients are needed to confirm these preliminary data, to clarify the hypothetical interactions between these cytokines and B-CLL cell proliferation pathways, and to establish if this therapy may have an impact on survival.

Administration, Cutaneous↗
PubMed1999

Treatment of hypertension in the elderly.

Several trials performed in elderly patients have demonstrated that antihypertensive drugs are effective in both systo-diastolic and isolated systolic hypertension, reducing the incidence of fatal and nonfatal cardiovascular events. However because of technical and design problems, the studies carried out to date have involved highly selected patients, almost always without any target organ damage, independent, cognitively normal and with low comorbidity. Therefore, trial results may be transferred to clinical practice only with some caution. Therapeutic behavior could be different in the presence of diseases associated with hypertension: a) in case of associated specific cardiovascular complications and/or diseases, such as diabetes or dyslipidemia, which could increase cardiovascular risk, treatment must be more aggressive; b) in case of associated diseases with fatal prognosis, treatment is aimed at preventing hypertensive emergencies; c) in case of associated diseases, which are not life-threatening but require chronic pharmacological intervention, drug interaction must be carefully considered. Finally, sudden and significant blood pressure drops due both to overdosage of antihypertensive drugs and/or to intercurrent illnesses must be prevented, because the reduction of blood flow may induce severe target organ ischemia.

Antihypertensive Agents↗
PubMed1999

Factors related to the length of in-hospital stay of geriatric patients.

The aim of this study was to evaluate factors predicting length of stay in hospital of geriatric patients. Study participants were 402 patients (183 males and 219 females) consecutively admitted to four geriatric wards located in Chieti, Perugia, Pescara and Prato, Italy. Information on potential predictors of length of stay was collected; in particular, we assessed the presence and severity of specific chronic medical conditions, level of physical function, cognitive status, and depressive symptoms. Moreover, information on family and social support was obtained. In general, participants were old, often cognitively impaired and physically disabled. Average length of stay ranged from 9.4 +/- 3.3 days (Perugia) to 14.1 +/- 7.2 days (Chieti), and was statistically different across centers (p < 0.001). None of the specific medical diagnoses was associated with different length of stay. However, higher comorbidity score (p < 0.001), living alone (p < 0.01), lower MMSE score (p = 0.03), and poor functional status (p = 0.05) were all associated with longer length of stay. When these variables were included in a multivariate model predicting length of stay, differences between centers were no longer statistically significant. Findings of this study show that specific medical diagnoses are not adequate instruments to estimate length of stay in geriatric units. Other assessment systems based on extension of the social network, comorbidity, and the cognitive as well as the functional level need to be developed.

Age Distribution↗
PubMed1998

Characteristics of geriatric patients related to early and late readmissions to hospital.

The aim of the study was to evaluate which characteristics of geriatric patients account for readmission to hospital, 6 months after discharge. All patients (203 females, 176 males) consecutively admitted over a two-month period to four acute geriatric care units, located in the cities of Chieti, Perugia, Pescara and Prato, participated in the study. Data that could potentially explain early and late readmissions were collected for each patient. Prevalence of diseases and comorbidity were assessed with the Cumulative Illness Rating Scale (CIRS); physical function by self-report (ADL, IADL) and objective (Stand and Walking Speed) measures; cognitive level by MMSE; and depressive symptoms by the Geriatric Depression Scale (GDS). Information on family and social support were also obtained. After discharge, data on hospital readmissions were collected for six months. For each readmitted patient (cases), medical records were reviewed, and supplementary information was obtained from families and general practitioners. Readmissions were classified as "early" (within the first three months), "late" (within the third and sixth month), and "multiple" (2 or more readmissions irrespective of the period). Patients not readmitted (alive at home) were considered as controls. Systematic differences between centers and between periods of readmissions were evaluated using one-way analyses of variance, and Pearson's chi 2 test. Factors related to early, late, and multiple readmission were identified in multivariate logistic regression models. On univariate analysis, patients readmitted over the first three-month period were sicker than controls (CIRS classes 3-4: 52.1% vs 34.1%), had more social problems or behavioral symptoms, and were more functionally impaired (ADL dependencies 3.3 +/- 0.4 vs 2.1 +/- 0.2). Patients who were readmitted between the third and the sixth month after discharge had a significantly higher CIRS total score (p = 0.006). Patients with multiple readmissions had more severe diseases, and more social problems. On multivariate analysis, early readmission was associated with unsatisfactory social conditions, living alone, severity of diseases and cognitive impairment, while late readmission was associated with comorbidity only. Multiple readmissions were related only to social factors, and to hospital admission before the baseline evaluation. The findings of this study suggest that interventions aimed at improving unfavorable social conditions may reduce the rate of rehospitalization in geriatric patients.

Activities of Daily Living↗
PubMed1998

Susceptibility of multidrug-resistant strains of Mycobacterium tuberculosis to amoxycillin in combination with clavulanic acid and ethambutol.

Thirty clinical isolates of Mycobacterium tuberculosis, 20 of which were multidrug-resistant (MDR), were tested for susceptibility to different combinations of amoxycillin, clavulanic acid and subinhibitory concentrations of ethambutol. beta-Lactamase production was assessed semiquantitatively with the nitrocefin method and susceptibility testing was performed with the BACTEC method. All isolates were beta-lactamase positive and were resistant to 16 mg/L amoxycillin. The MIC of amoxycillin in combination with clavulanic acid was > or =2 mg/L for 27/30 (90%) isolates. Addition of subinhibitory concentrations of ethambutol significantly reduced the MIC of amoxycillin for all tested isolates. Twenty-nine (97%) isolates had an MIC of amoxycillin of < or =0.5 mg/L when subinhibitory concentrations of ethambutol were added; this is well below the concentrations achievable in serum and tissue.

Amoxicillin↗
PubMed1998

Tc-99m sestamibi imaging in the diagnostic assessment of patients with lymphomas: comparison with clinical and radiological evaluation.

Tc-99m MIBI imaging has been used in nuclear oncology, but its role in detecting lymphomas has not been widely investigated. In this study, 31 patients with lymphomas (20 non-Hodgkin's and 11 Hodgkin's) underwent Tc-99m MIBI whole-body imaging. A total of 74 tumor lesions were detected in 25 patients, while the remaining 6 patients were disease-free. The diagnostic accuracy of MIBI imaging for lesion detection was 85%. A total of 11 unknown tumor lesions in 3 patients were discovered on MIBI scans. Tumor size was significantly (p = 0.01) higher in lesions with increased MIBI uptake (3.5 +/- 2.0 cm) compared with those with no uptake (1.8 +/- 1.0 cm). No false positive MIBI findings were observed. The accuracy of MIBI scintigraphy in patients with Hodgkin's disease was lower (72%) compared to that of patients with non-Hodgkin's lymphomas (94%). However, this difference was not related to tumor type, but to lesion size. In fact, tumor size was significantly (p = 0.02) lower in lesions of patients with Hodgkin's disease (2.5 +/- 1.3 cm) compared to those of patients with non-Hodgkin's lymphomas (3.7 +/- 2.2 cm). MIBI imaging may be useful in patients with lymphomas for detecting tumor lesions and, hence, may be considered an alternative to gallium scanning, providing better imaging quality. However, the intense Sestamibi activity in the lower chest and abdomen as well as tumor size may limit the diagnostic sensitivity of this radionuclide technique in patients with lymphomas.

Abdominal Neoplasms↗
PubMed1998

Use of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide for rapid detection of rifampin-resistant Mycobacterium tuberculosis.

We describe a test which uses the ability of viable cells to reduce 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) to detect resistance to a bactericidal drug, rifampin, in in vitro-cultured Mycobacterium tuberculosis. The assay shows a linear relationship between the number of viable bacteria and the ability to reduce MTT. Dead mycobacteria were unable to reduce MTT. Rifampin-sensitive M. bovis (BCG) and M. tuberculosis exposed to rifampin showed a rifampin concentration-dependent inhibition of the ability to reduce MTT, while the resistant strains were unaffected. The inhibition of MTT reduction after treatment with rifampin paralleled the reduction in the number of CFU. By using mixing experiments in which the population percentages of rifampin-sensitive and -resistant strains were varied, the assay could detect the presence of rifampin resistance in the mixture when at least 1% of the bacterial population was composed of drug-resistant strains. The assay is cheap, can be visually read, and requires less than 3 days to obtain susceptibility results. The total time required to obtain results, from the time sputum is received in the laboratory, is, in most cases, less than 4 to 5 weeks, which is the time required for primary culture of the bacteria. The MTT assay could, in combination with a test to detect resistance to isoniazid, be a cheap and rapid screening method for multidrug-resistant M. tuberculosis that is affordable even by low-income countries where tuberculosis is a major public health problem.

Antibiotics, Antitubercular↗
PubMed1998

Drug resistance in Mycobacterium tuberculosis strains isolated from re-treatment cases of pulmonary tuberculosis in Ethiopia: susceptibility to first-line and alternative drugs.

SETTING: Addis Ababa Tuberculosis Demonstration and Training Center, Ethiopia. OBJECTIVES: To determine the pattern of drug resistance among re-treatment cases of pulmonary tuberculosis (TB), to determine the risk factors associated with multi-drug resistant (MDR) TB, and to propose re-treatment regimens based on the patterns of susceptibility to first-line and alternative drugs. DESIGN: One hundred and seven Mycobacterium tuberculosis strains isolated from an equal number of re-treatment cases of pulmonary TB were included in the study. Drug susceptibility was determined by the Bactec method. RESULTS: About 50% of the strains were resistant to one or more of the first-line drugs and 12% of the strains were multi-drug resistant, i.e., resistant to both isoniazid and rifampicin. Previous treatment with rifampicin was the most important predictor of MDR-TB. All MDR strains were susceptible to amikacin, ciprofloxacin, ethambutol, ethionamide and clofazimine. CONCLUSION: The WHO re-treatment regimen would theoretically be effective for the treatment of all non-MDR-TB patients in this study. A proposed 12-month re-treatment regimen for MDR-TB patients would include a fluoroquinolone in combination with streptomycin, pyrazinamide, isoniazid, ethambutol and clofazimine. There is an urgent need for more research to define safe and inexpensive treatment regimens for MDR-TB patients in low-income countries.

Adolescent↗
PubMed1998

Evaluation of a colorimetric assay based on 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) for rapid detection of rifampicin resistance in Mycobacterium tuberculosis.

OBJECTIVES: To standardise the colorimetric assay based on 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) for the rapid detection of rifampicin-resistant Mycobacterium tuberculosis in clinical practice and to evaluate the assay on a collection of 92 clinical isolates. DESIGN: The Bactec method was used as the reference method. Rifampicin was used for the susceptibility testing in the Bactec method at a concentration of 2 microg/ml. The MTT assay was performed in tubes containing 3 ml Dubos broth; the assay is based on the principle that live cells convert the yellow tetrazolium salt into a blue formazan. A final concentration of 2 microg/ml rifampicin was used in the assay. Optical density (OD) values at 570 nm were recorded on the third and sixth day. A strain was defined as susceptible when the relative optical density unit (RODU) (i.e., OD of rifampicin containing tube/OD of undiluted control) was < or = 0.2, and when the OD value of the rifampicin-containing tube on the sixth day was lower than the OD value on the third day. A strain was defined as resistant when the RODU was more than 0.5, and when there was an increase in OD value in the rifampicin-containing tube on the sixth day. The tubes were also read visually. RESULTS AND CONCLUSION: The result obtained by the MTT assay perfectly matched the result obtained by the Bactec method. The MTT assay was also interpretable by the naked eye. This simple, inexpensive assay could be used as a rapid screening method for identification of rifampicin-resistant strains in low-income countries.

Antibiotics, Antitubercular↗
PubMed1997

Vascular dementia Italian sulodexide study (VA.D.I.S.S.). Clinical and biological results.

In order to evaluate the biological effects on some haemostasis factors of antithrombotic-hemorheological treatments on patients with vascular dementia, a multicenter, randomized, double-blind, double-dummy, study comparing sulodexide (Sdx, 50 mg bid orally for 6 months) and pentoxifylline (Ptx, 400 mg tid orally for six months) was carried out. Eighty-six patients, 46 in Sdx group, 40 in Ptx group, fulfilling the NINDS-AIREN criteria for probable vascular dementia were evaluated. Plasma fibrinogen levels showed a significant reduction in both groups, in patients with high basal levels (> or = 350 mg/dl), the reduction being earlier in Sdx group (2nd month of therapy) than in Ptx group (4th month of therapy). In Sdx group a significant reduction in factor VII-Ag (baseline 102.8 U/dl; 6th month 90.1 U/dl) was also observed. Both drugs induced a slight reduction in activated factor VII levels as well. A parallel improvement of G.B.S. Rating Scale for dementia scores was observed in Sdx group. These results seem to indicate that sulodexide treatment can have positive effects in vascular dementia.

Administration, Oral↗
PubMed1997

Autonomic nervous activity in elderly dipper and non-dipper patients with essential hypertension.

The pathogenetic mechanisms of the blunted nocturnal fall in blood pressure, frequently observed in elderly patients with essential hypertension, are unclear. The aim of this study was to evaluate the autonomic nervous system in elderly dipper and non-dipper hypertensive subjects. The study group consisted of twelve non-dipper and twelve dipper hypertensive patients (mean age 77.7 and 73.8 years, respectively). Non-dippers were defined as subjects whose nocturnal fall in systolic blood pressure (SBP), evaluated by means of Ambulatory Blood Pressure Monitoring, was less than 10% of diurnal SBP. All the patients underwent the following cardiovascular tests to explore autonomic function: Tilt Table, Valsalva Maneuver, Deep Breathing, Cough. The tests were performed under standard conditions, and heart rate and blood pressure were continuously recorded. Valsalva ratio (VR), Expiration/Inspiration Ratio (E/IR) and Cough Test Ratio (CTR) were calculated. Mann Whitney's and chi 2 tests were used for comparison between groups. Relationships were assessed by univariate and multivariate analyses. Non-dipper hypertensive subjects showed significantly lower scores in VR (11.1 +/- 0.08 vs 1.28 +/- 0.14), E/IR (1.11 +/- 0.07 vs 1.21 +/- 0.10), and CTR (1.07 +/- 0.02 vs 1.15 +/- 0.07). During the tilt test, a significant decrease in SBP and a late increase in heart rate were observed in non-dippers. The day-night difference in SBP was significantly related to VR, CTR and maximal SBP drop during tilting. The findings confirm that non-dippers show an impairment in autonomic nervous drive, which is characterized mainly by decreased parasympathetic activity. These observations may explain the increase in cardiovascular risk in non-dippers.

Aged↗
PubMed1997

Synergistic antimycobacterial activity between ethambutol and the beta-lactam drug cefepime.

The activity of cefepime alone and in combination with ethambutol was assessed, using the BACTEC radiometric system, on 33 mycobacterial strains, 14 Mycobacterium avium complex (MAC), 6 isolates of M. malmoense, and 13 multidrug-resistant (MDR) isolates of M. tuberculosis. All tested mycobacteria were resistant to 8 mg/l cefepime. However, at a concentration of 32 mg/l cefepime was active on 7/13 (54%) MDR isolates of M. tuberculosis and 2/6 (33%) M. malmoense strains. All MAC strains were also resistant to this concentration. Synergistic antimycobacterial effects were seen for the combination of cefepime and ethambutol against all isolates of MAC and M. malmoense and on 4/13 (31%) MDR M. tuberculosis isolates. Moreover, this drug combination rendered 17/24 (71%) initially resistant mycobacterial strains susceptible. These promising results suggest that the antimycobacterial activity of combinations of beta-lactam drugs and ethambutol should be studied further.

Antitubercular Agents↗
PubMed1997

Blood pressure and intellectual function in elderly subjects.

OBJECTIVE: to assess the relationship between hypertension and cognitive function in elderly subjects. METHODS: 17 subjects with uncomplicated hypertension (nine male, eight female) and 27 control subjects with similar educational level and age (18 male, nine female) were studied. These individuals were recruited, according to strict selection criteria, from a random sample of 120 elderly subjects living in the community, who had a normal Mini Mental State score. An extensive neuropsychological test battery, sensitive to mild cognitive impairment, was administered in standard conditions to measure attention, concentration and judgement, psychomotor speed, memory and learning. Affective disorders were also evaluated. In all patients a computed tomography scan was performed. RESULTS: subjects with high blood pressure had lower mean levels of performance in attentional measures; tapping test (inhibition of incorrect answers), three words-three shapes test (attempts; incidental memory) and reaction time to multiple stimuli. They also scored worse in clusters 1 and 2 of the Hamilton rating scale for depression. Confluent white matter lesions were found in nine hypertensive subjects (52.9%) and five controls (18.5%; P = 0.0170). Lacunes were demonstrated in 11 hypertensive (64.7%) and four normotensive people (14.8%; P = 0.0007). In a multivariate analysis (logistic regression), three cognitive variables (tapping, Hamilton cluster 2 and Hamilton total score) remained significantly associated with hypertension, independently of the presence of cerebral lesions. CONCLUSIONS: in elderly otherwise normal hypertensive subjects, an attentional impairment may occur, which appears to be functional and possibly reversible rather than structural and progressive.

Aged↗
PubMed1996

Silent lacunar infarcts in elderly patients with chronic non valvular atrial fibrillation.

It is still debated whether non valvular atrial fibrillation (NVAF) may be responsible for "silent" lacunar lesions. The aims of our study were to compare the prevalence of subcortical lacunar infarctions in highly selected elderly subjects with or without NVAF, and to investigate the positive relationship of such lesions to the impairment in cognitive and physical functions. Thirty-eight patients with NVAF (mean age 80.6 years) were compared with 40 patients in sinus rhythm (mean age 80.4 years). Exclusion criteria were previous stroke or transient ischemic attacks, significant lesions of extracranial arteries, and any previous disease leading to cognitive impairment or potentially interfering with cognitive functions. A cranial computed tomogram was performed in every case, and the number of lacunae was recorded. Cognitive status and mood were assessed by means of Mini Mental Status Examination and the Geriatric Depression Scale, respectively. The number of impaired basic and instrumental activities of daily living (BADL e IADL) was also recorded. A significantly higher percentage of patients with lacunar lesions was detected in the NVAF group. The MMS score was lower in these patients, but did not reach significant levels. In univariate analysis, the presence of lacunae was found to be significantly associated with age, systolic blood pressure and atrial fibrillation, but, in a multiple logistic regression model, only age and atrial fibrillation retained a significant association. Similarly, in univariate analysis, a low MMS score was found to be related to age, systolic blood pressure, leukoaraiosis and both the presence and the number of lacunar lesions. In multivariate analysis, only age and the number of lacunae were significantly associated with a low MMS. It is concluded that in elderly patients NVAF is associated with subcortical ischemic lesions which may contribute to the impairment of cognitive function.

Aged↗
PubMed1996

[Clinical aspects and pathogenetic mechanisms of cognitive impairment in arterial hypertension].

Arterial hypertension may be responsible for cognitive impairment indirectly, by means of ischemic or haemorrhagic cerebral lesions. In this regard multi-infarct dementia, subcortical dementia due to "small vessel disease" and Binswanger's syndrome are the clinical pictures more commonly observed. However also in hypertensives free from cerebrovascular events, dysfunctions in memory, attention, abstract reasoning, mental flexibility and psychomotor abilities have been found. The pathogenesis of these findings is uncertain. Small cerebral asymptomatic lesions (lacunae, leukoaraiosis) could disconnect the cortical and subcortical structures in the brain; however other factors, such as global or regional reductions of cerebral blood flow or disturbances in neurotransmitters release cannot be ruled out. The effects of anti-hypertensive therapy are conflicting, some authors reporting an improvement and others a worsening of cognitive performances. In the elderly the risk linked to hypertension may be increased by several predisposing factors and therefore this condition must be considered with attention as a pathogenetic factor of senile dementia.

Aged↗