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Biomedical subjects

G Buonocore

Publications and source records attributed to G Buonocore.

At least 55 records · Page 3Linked to original sources

Pulmonary pathology in surfactant-treated preterm infants with respiratory distress syndrome: an autopsy study.

The present study examines the histological features of the lungs of neonates who died of respiratory distress syndrome or related complications after surfactant therapy. Our aim was to determine whether these lungs showed any unusual histological findings. Complete autopsies were performed 6-12 h after death in 10 surfactant-treated preterm infants and in 30 infants who died before surfactant therapy was available. Representative paraffin sections of all pulmonary lobes, stained with haematoxylin and eosin, were examined microscopically. A few selected slides were also stained with periodic acid-Schiff, Vierhoff-van Gieson, and Mallory trichrome. Hyaline membrane disease and bronchopulmonary dysplasia were present in each group, although there was an increased incidence of intra-alveolar haemorrhage in surfactant-treated babies (in 8 of 10 surfactant-treated as compared with 7 of 30 untreated babies). Amongst those treated with surfactant, we observed the persistence of acute alveolar damage with unresolved hyaline membrane disease in 5 infants who died at the ages of 5, 6, 10, 12, and 13 days, respectively, and histological evidence of pneumocyte type 2 hyperplasia and dysplasia in 2 infants who died at 22 and 41 days of age, respectively. These observations reveal that surfactant-treated infants who fail to respond to therapy have continuing alveolar injury and an increased incidence of intra-alveolar haemorrhage. Since oxygen radicals can induce pneumocyte damage and necrosis and since free radicals provoke alveolar haemorrhage in animal models, we propose that the lesions we observed may stem from a lack, in some preterm babies, of specific mechanisms that detoxify oxygen radicals.

Bronchopulmonary Dysplasia↗

Changes in the erythrocyte antioxidant enzyme system during transdermal estradiol therapy for secondary amenorrhea.

Twenty-two hypothalamic amenorrheic patients, who were non-smokers and of normal weight, received replacement therapy for 1 month with transdermal patches containing 8 mg estradiol. No other drugs were prescribed or taken during the study. Before treatment (time 0) and 1 month after its start, blood samples were taken for assay of plasma estradiol levels, the erythrocyte antioxidant enzyme activities of superoxide dismutase, catalase, glutathione peroxidase (GSH-Px), and an age-dependent erythrocyte enzyme activity, pyruvate kinase. Plasma malondialdehyde levels, as an index of lipoperoxidation products, were also detected. The results showed no significant variations in superoxide dismutase, catalase, pyruvate kinase erythrocyte enzyme activities or plasma malondialdehyde levels. A significant increase in plasma estradiol levels (time 0, 17.33 +/- 4.12 pg/ml; 1 month, 81.25 +/- 10.45 pg/ml; means +/- SD; p < 0.0001) and in GSH-Px erythrocyte activity (time 0, 11.97 +/- 2.31 IU/g hemoglobin; 1 month, 16.88 +/- 4.38 IU/g hemoglobin; p < 0.004) was found. Plasma estradiol levels correlated significantly with GSH-Px erythrocyte activity 1 month after therapy was begun (r = 0.776, p < 0.003). We suggest that estrogens restored to physiological plasma levels, stimulate erythrocyte antioxidant GSH-Px activity, improving the antioxidant power of amenorrheic patients.

Administration, Cutaneous↗

Maternal and neonatal plasma cytokine levels in relation to mode of delivery.

After birth, host defences must be recruited to manage the transition from an almost sterile to a normal environment. The present study was undertaken to evaluate the relationship between cytokine plasma levels and phagocyte burst in mothers and neonates during the peripartal period. Plasma levels of interleukin (IL)-1, IL-6, tumour necrosis factor (TNF)-alpha, interferon (IFN)-gamma, and granulocyte-macrophage colony-stimulating factor (GM-CSF) and whole blood superoxide anion (.O2-) generation were evaluated in 27 healthy mothers, 16 undergoing vaginal delivery (VD) and 11 elective caesarean section (ECS) and in their babies. Blood specimens were taken from the mothers at the beginning of labour, during labour, immediately after delivery and 4 days later in the VD group, and before anaesthesia, immediately after delivery and 4 days later in the ECS group; neonatal samples were taken at birth (cord blood) and 4 days later. After delivery by VD, these mothers had higher plasma levels of IL-1 beta, IL-6, IFN-gamma and higher .O2- generation than those delivered by ECS. IL-6 plasma levels and .O2- generation were higher in babies born by VD than in those born by ECS. A statistically significant correlation between IL-6 plasma levels and .O2- release was observed in cord blood of babies born by VD (r = 0.69; p < 0.006). The study demonstrates that labour plays an important role in modulating host defences in the newborn.

Adult↗

[Use of polypropylene (Marlex) prosthesis in the surgical treatment of inguinal and crural hernia].

High biocompatibility, low cost and easiness in use are most important reasons for the spread of biological prosthesis in inguinal and femoral hernia repairs; this fact has changed the surgical approach to this kind of pathologies. This new approach consists in re-creating a normal anatomic function of the abdominal wall, without new tension between muscles and aponeurotic structures. The authors present their experience after 379 inguinal and femoral hernia repairs between January 1992 and December 1993.

Adult↗

Superoxide anion release by polymorphonuclear leukocytes in whole blood of newborns and mothers during the peripartal period.

Superoxide anion (.O2-) production was investigated in whole blood of mothers in the peripartal period and in neonates. Blood samples from 14 mothers undergoing vaginal delivery (VD) were tested at the beginning of labor, during labor, after delivery, and 4 d after delivery. Nine mothers undergoing elective cesarean section (ECS) were tested before anesthesia, after extraction of the fetus, and 4 d later. Seventy-two healthy, full-term newborn infants were examined at birth and on the fourth day of life. Red cell glutathione peroxidase, catalase, glutathione reductase, and superoxide dismutase activities were also measured at birth and on the fourth day of life in 26 of the 72 neonates. Higher .O2- levels were detected in mothers undergoing VD compared with ECS (p < 0.05). A significant decrease was detected in zymosan-stimulated .O2- production between cord and fourth-day blood samples in both VD- and ECS-delivered infants (p < 0.01). Zymosan-stimulated samples showed higher values after VD than ECS, both in cord blood (p < 0.004) and on the fourth day of life (p < 0.006). A positive correlation was found between .O2- release in zymosan-stimulated cord blood and that found in the mothers at the beginning of labor (r = 0.654; p < 0.01), during labor (r = 0.721; p = 0.008), and after delivery (r = 0.832; p = 0.0008). A positive correlation was also found between .O2- release and glutathione peroxidase on the fourth day (r = 0.709, p = 0.014).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Is the flavin-deficient red blood cell common in Maremma, Italy, an important defense against malaria in this area?

There is a high prevalence of a familial flavin-deficient red blood cell in Ferrara province in the Po delta in northern Italy, believed to have been selected for by malaria which was endemic from the 12th century. In the present study, activities of FAD-dependent red-cell glutathione reductase (EGR) in the Grosseto area of Maremma on the west coast of Italy where malaria was endemic from 300 B.C. are compared both with activities in the Ferrara area and with activities where there was no history of endemic malaria--in the Florence area and in London in people of Anglo-Saxon origin. EGR activities were similar in Grosseto and Ferrara and were significantly lower than in Florence and London. As previously found in Ferrara, low EGR activity in Grosseto was shown to be unrelated to low dietary riboflavin intake. These findings in Grosseto, suggesting selection by malaria, are particularly interesting because, unlike the situation in Ferrara and most other malarial areas, the prevalence of thalassemia and glucose-6-phosphate dehydrogenase deficiency is very low, and they do not appear to have been selected for in Maremma. It is possible that a flavin-deficient red cell, known to inhibit growth of the malaria parasite, was an important protecting factor in the population of this area over the centuries.

Adult↗

Antioxidant erythrocyte enzyme activities during oral contraception.

Nineteen healthy young women, non-smokers and of normal weight, used a combined oral contraceptive, consisting of 20 micrograms ethinylestradiol and 150 micrograms desogestrel, for 9 cycles and were investigated before starting oral contraceptive use, and during the 3rd, 6th and 9th cycle. In all cases, the antioxidant erythrocyte enzyme activities, superoxide-dismutase (SOD), catalase (CAT) and glutathione-peroxidase (GSH-Px), were determined. Pyruvate-kinase (PK) activity was also considered as a predictable index of the age and constancy of the erythrocyte population. A steady, significant increase in GSH-Px and CAT enzyme activities was found. No significant variations were found in SOD and PK enzyme levels. These findings clearly suggest that the use of combined oral contraceptives leads to an increase in antioxidant defenses. The specific physiological and biochemical mechanisms of this response merit further investigation.

Adolescent↗

A new case of severe congenital nemaline myopathy.

The case of a neonate with a rapidly fatal course of nemaline myopathy is reported. Neonatal history and clinical findings suggested a postasphyxia syndrome, but dependence on mechanical ventilation in the absence of severe brain damage or evidence of heart and lung involvement prompted us to perform a muscle biopsy. The typical rod-shaped bodies of nemaline myopathy were observed in skeletal and heart muscle which is unusual in infantile forms. Neonatal bone fractures, which have not been reported previously, were detected. Due to the rapid evolution of the neonatal form, many of these patients may die undiagnosed in the perinatal period, the families remaining unaware of the existence of the genetic disorder. Therefore, if severe hypotonia persists in a neonate, together with dependence on assisted breathing, specific examinations, such as muscle enzyme determination, NCV, EMG and if indicated, muscle biopsy should be performed to rule out neuromuscular disease.

Female↗

Serum IgE concentrations in the neonatal period.

The aim of the present study was to evaluate the IgE-mediated response as a predictable index of immunosensitization to different types of feeding (breast milk, adapted formula, soya formula and serum protein hydrolyzate formula) in the first days of life. The study population included 231 newborns (128 males and 103 females). There was a family history of atopy (at least 1 parent with an atopic disease) in 116 subjects at risk for allergy. 115 newborns were without any family history of atopy. The results showed significantly higher total IgE levels on the 4th day than in cord serum in the whole group of newborns. The same result was obtained comparing subjects at risk and controls separately. No significant difference was detectable between serum IgE levels in the cord blood of the four groups. Conversely, a significant increase in IgE levels between cord and 4th day blood in soya-fed and adapted-formula-fed babies was noticed. This increase did not occur in neonates fed breast milk and serum protein hydrolyzate.

Age Factors↗

Characteristics and functional properties of red cells during the first days of life.

In order to evaluate postnatal red blood cell (RBC) properties and whole-blood rheology, 36 healthy full-term newborn infants were tested twice (cord blood, 4th-day blood) for whole-blood flow rate, hematocrit, hemoglobin (Hb), RBC count, mean corpuscular volume, mean corpuscular Hb and its concentration, white blood cell and platelet count, plasma fibrinogen, erythrocyte glucose-6-phosphate dehydrogenase, glutathione peroxidase (GSH-Px), glutathione reductase, catalase and superoxide dismutase. Another 38 healthy full-term newborns were tested twice for separation of erythrocytes into fractions of different density. Healthy adults were taken as control. The results showed a decreased whole-blood flow rate in blood drawn on the 4th day with respect to cord blood. A multivariate analysis with flow rate as dependent variable demonstrated a significant positive correlation with GSH-Px on the 4th day. The assays of RBC densities showed a significant increase in the first 4 days.

Aging↗

Double valve Implantation. Long-term evaluation of 8 different bioprostheses.

From January 1976 through December 1987, 194 patients with a mean age of 43.3 +/- 13.7 years (range, 11 to 74 years) underwent double (mitral and aortic) replacement of native valves with 8 types of bioprostheses: Carpentier-Edwards, 127 valves; Hancock, 76 valves; Liotta-Bioimplant, 57 valves; Ionescu-Shiley, 53 valves; Vascor, 27 valves; Carpentier-Edwards Pericardial, 22 valves; Angell-Shiley, 20 valves; and Implamedic, 6 valves. Concomitant cardiac procedures were performed in 25 patients (12.8%). There were 18 operative deaths (9.27%). Our retrospective analysis was restricted to 352 bioprostheses implanted in the 176 patients who survived surgery and were considered at risk for valve tissue failure. The overall cumulative duration of follow-up was 1,174.1 patient-years (range, 1 to 13 years). The durations of follow-up for specific valves were: Carpentier-Edwards, 920.2 valve-years; Hancock, 383.8 valve-years; Liotta-Bioimplant, 310.2 valve-years; Ionescu-Shiley, 357.7 valve-years; Vascor, 131.2 valve-years; Carpentier-Edwards Pericardial, 52.0 valve-years; Angell-Shiley, 167.0 valve-years; and Implamedic, 31.0 valve-years. Thirty patients had thromboembolic accidents, for a linearized incidence of 2.5% per patient-year. At 13 years, the actuarial freedom from thromboembolic accidents was 85.8% +/- 10.7%. Nine patients had endocarditis, for a linearized incidence of 0.7% per patient-year. At 13 years, the actuarial freedom from endocarditis was 92.0% +/- 1.5%. Twenty-four patients had valve tissue failure, for a cumulative linearized incidence of 1.87% per valve-year. The cumulative actuarial probability of freedom from valve tissue failure was 78.6% +/- 3.7% at 10 years and 51.2% +/- 10.7% at 13 years. The 24 patients with valve tissue failure all underwent reoperation: 20 of these had double valve replacement, 3 had aortic valve replacement alone, and 1 had mitral valve replacement alone. The mean interval between initial valve implantation and reoperation was 66.9 +/- 28.8 months. At reoperation, the hospital mortality was 15.1% (5 patients). This study showed that the long-term results of valve implantation are not significantly influenced by either prosthesis design or material. Moreover, the incidence of degenerative change was similar in the aortic and mitral positions.

Journal Article↗

Epidemiologic study of neonatal jaundice. A survey of contributing factors.

In the attempt to detect factors influencing bilirubinemia in healthy full-term or near-term newborn infants, a statistical analysis was carried out on a population of 1,126 neonates to study the variables possibly associated with maximum bilirubin values reached in the first days of life. The following variables were studied: maximum bilirubin level (maxBIL), sex, mode of delivery, gestational age, birthweight, ratio of birthweight/weight on 5th day, Apgar score, Rh and ABO incompatibility. Blood glucose and calcium levels, haematocrit, intake of breast milk, formula and glucose solution were also evaluated during the first 5 days of life. Higher maxBIL was found in males compared to females, after spontaneous delivery vs. emergency caesarean section, after caesarean section without fetal distress vs. emergency caesarean section, and in ABO incompatibility vs. no ABO incompatibility. Statistically significant inverse correlations were observed between maxBIL and gestational age, birth weight, blood glucose, and SE-calcium. Significant positive correlations were found between maxBIL and haematocrit and breast milk intake. A multiple regression analysis between maxBIL and the significantly correlated parameters showed that only gestational age and birth weight remained significantly correlated with maxBIL. The results of the present investigation confirm that the factors most commonly reported as being responsible for neonatal hyperbilirubinemia do in fact play a role, although it can be considered almost negligible with the exception of gender, mode of delivery, ABO incompatibility, birthweight and gestational age.

Birth Weight↗

Neonatal hyperbilirubinemia. Evidence for a role of the erythrocyte enzyme activities involved in the detoxification of oxygen radicals.

Determinations of erythrocyte enzyme scavengers of oxygen radicals (glutathione-peroxidase, superoxide-dismutase and catalase) and determinations of erythrocyte age-dependent glycolytic activities (glucose-6-phosphate-dehydrogenase, pyruvate-kinase and glucose-phosphate-isomerase) were carried out in cord blood and in the blood taken on the 4th day of life in 152 newborn infants with different peak bilirubin levels. The enzyme activities scavenging oxygen radicals, glutathione-peroxidase and superoxide-dismutase were significantly lower in infants with peak bilirubinemia higher than 214 mumol/l, compared to less-jaundiced neonates, both at birth and on the 4th day of life; their values correlated negatively with peak bilirubinemia at birth and on the 4th day of life. Glycolytic age-dependent enzyme activities were significantly higher in more jaundiced newborn infants only on the 4th day of life, when their values correlated positively with peak bilirubinemia. The results of this investigation suggest that a deficiency of factors protecting from oxygen toxicity, may play a role in the development of neonatal hemolysis and jaundice.

Age Factors↗

Changes in erythrocyte properties during the first hours of life: electron spin resonance of reacting sulfydryl groups.

In an attempt to clarify the mechanism by which the red cells (RBC) of newborn infants are protected against oxidative agents, electron spin resonance (ESR) assays were carried out using the nitroxide radical 4-maleimide-2,2,6,6-tetramethylpiperidinyl-1-oxyl (Mal-6), a sulfydryl-reacting agent. The ESR assays were performed in 24 samples of cord blood, 20 samples of blood from 4-day-old infants, and eight samples of 8-h-old infants. The analyses were carried out on whole blood and washed erythrocytes were resuspended in buffered saline. The same experiments were performed in 10 blood samples from healthy adults as controls. Whole blood, before and after removing the buffy coat, and cell-free plasma were also examined by ESR assay. Cell-free plasma and buffy coats proved not to be appreciably involved in the Mal-6 behavior. The data of the ESR spectroscopy demonstrated a significantly slower reaction rate in the samples of cord blood and in blood of 8-h-old infants, compared to that of 4-day-old infants and adults. No significant differences in Mal-6 behavior could be detected between cord blood and 4-day-old infant blood in the results of ESR assays performed in washed red cells. Chemical determination of RBC-reacting sulfydryl groups and the assays of glutathione also demonstrated the absence of differences between cord blood and blood of 4-day-old infants. The results of our investigation suggest that the RBC-sulfydryl-reacting groups are less involved in the detoxification of oxidative agents during the first hours of life than in the following days.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclic N-Oxides↗

Calcium homeostasis in the first days of life in relation to feeding.

Determinations of serum calcium (Ca), phosphorus (P), magnesium (Mg), calcitonin (CT) and parathyroid hormone (PTH) were carried out in full term newborn infants during the first 168 h of life. The infants were randomly assigned to two different diets: glucose and breast feeding (BF) only or early formula feeding (F). The Ca serum levels decreased from birth to the 24th h; after that time they increased until the 72nd h. The values of serum Ca at the 48th and 72nd h were significantly lower in the F than in the BF group. In contrast, the P serum levels increased from birth to the 48th h and then they decreased; the values of serum P at the 48th h were significantly higher in F than in the BF group. The CT serum levels increased from birth to the 24th h and then they decreased. No difference between the F and BF groups was found during the first 48 h, while at the 72nd h the F group demonstrated significantly higher values of serum CT. PTH serum levels also increased from birth to the 24th h with significantly higher values at the 72nd h in the F group. The results of this investigation demonstrate that the difference in feeding in the first hours of life affects the calcium homeostasis and the secretion of hormones involved in the regulation of serum Ca levels.

Bottle Feeding↗