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Biomedical subjects

G Marra

Publications and source records attributed to G Marra.

103 records · Page 6Linked to original sources
PubMed1981

Theophylline distribution in the premature neonate.

Theophylline (T) tissue distribution was studied in 11 premature newborns treated with T for prematurity apnea, who had died from severe pathology. To investigate the pattern of distribution of T, in particular the role of the blood-brain barrier in this period of life, two animal species were employed (rat and guinea pig), differing widely in their postnatal development. T was administered to the animals acutely and chronically and the resulting data were compared to human findings. In human prematures no specific accumulation and a wide variety in tissue concentrations, as in tissue/blood ratios, were observed. In the rat, unlike the guinea pig, brain/blood ratios of T concentration declined as postnatal age rose, suggesting that development of the blood-brain barrier plays a major role.

Aging↗
PubMed1981

Theophylline metabolism during the first month of life and development.

The metabolic pathway of theophylline (T) was studied in 12 newborns, one young infant, six children, and three adult volunteers. T was injected IV, and blood and urine samples were assayed for T, caffeine (C), and their metabolites by a high-pressure liquid chromatography technique. We confirmed the methylation of T to C in newborn infants but not in older subjects. Demethylation of T to 3-methylxanthine was found in the young infant, in children, and in adults, but not in newborns. The major products excreted by neonates were T, 1-methyluric acid, and 1,3-dimethyluric acid. Children excreted a larger fraction of methyluric acids than adults. Renal and body clearance of T and C are reported and discussed in relation to the age.

Adult↗
PubMedDate not supplied

Indwelling interscalene catheter anesthesia in the surgical management of stiff shoulder: a report of 100 consecutive cases.

One hundred consecutive stiff shoulders in 93 patients resistant to conservative therapy were treated with surgery and intermittent regional anesthesia via indwelling interscalene catheter. Each patient underwent manipulation and one of several operative treatments to release any additional contracture. The indwelling interscalene catheter remained in place and functioned well for an average of 3 days in 87 shoulders. At an average follow-up of 3.0 years, overall clinical results according to Neer's criteria were excellent in 39 shoulders (39%), satisfactory in 28 (28%), and unsatisfactory in 33 (33%). Patients reported no or mild pain in 83 (83%) of the shoulders in the study. At final follow-up, average gains in motion were 44 degrees of elevation (115 degrees to 159 degrees), 31 degrees of external rotation (22 degrees to 53 degrees), and 5 spine segments of internal rotation (L4 to T11). At final follow-up, 95% of the elevation and 79% of the external rotation achieved intraoperatively were maintained. The best results were obtained in those shoulders with idiopathic stiffness (88% excellent or satisfactory results); the worst results were in the postsurgical shoulders (47% excellent or satisfactory results). There were no catheter-related complications. The use of an indwelling interscalene catheter for postoperative pain control is a safe technique that facilitates early physical therapy in a patient population with a high risk of developing recurrent stiffness.

Adult↗
PubMedDate not supplied

Portal-extension approach for the repair of small and medium rotator cuff tears.

One hundred ten consecutive cases (110 patients) of arthroscopically assisted rotator cuff repair through a limited, portal-extension approach were retrospectively reviewed. The average age of our patients was 58 years (range, 30 to 79). There were 35 women and 75 men. The dominant shoulder was affected in 67 patients (61%). All patients underwent a standard arthroscopic decompression. Acromioclavicular resections were performed in 15% of patients. The anterolateral portal was extended in the direction of Langer's lines to a total length of no more than 3 cm. The torn tendon was accessed through a small deltoid muscle split and repaired with nonabsorbable sutures. At an average follow-up of 35 months (range, 24 to 86), 106 patients (96%) had achieved excellent or satisfactory results. The average American Shoulder and Elbow Surgeons pain score improved from 7 preoperatively to 2 postoperatively. All but four patients were satisfied with the clinical result and reported significant improvement in active elevation and strength and a significant lessening of pain. Late acromioclavicular joint pain contributed to failure in three of the four patients with unsatisfactory results in this series. The results of this study suggest that, in selected patients with small to medium rotator cuff tears, arthroscopically assisted repair through an anterolateral portal-extension approach can produce excellent results.

Adult↗
PubMedDate not supplied

Prognostic factors in oral squamous cell carcinoma. A review of the literature.

Despite diagnostic and therapeutic progress, the overall prognosis of oral squamous cell carcinoma remains poor and prognostic information is essential for the evaluation and optimal treatment of patients. The prognosis of oral carcinoma depends primarily on clinicopathological factors, that however, have showed a limited predictive value for the identification of patients with high risk of disease relapse. In recent years, the analysis of DNA ploidy, cellular proliferation and oncogenes amplification have been used in attempt to identify new prognostic indicators. The review of the literature shows that TNM stage, tumor grading evaluated at the deep invasive margins and maximal tumor thickness effect on the prognosis. Moreover, the assessment of DNA ploidy and proliferative activity can be used to obtain additional prognostic informations. In contrast, additional studies are needed to understand the prognostic value of oncogenes expression in oral carcinoma.

Biomarkers, Tumor↗
PubMedDate not supplied

Prevalence of malnutrition assessed by bioimpedance analysis and anthropometry in children on peritoneal dialysis.

OBJECTIVE: To evaluate the sensitivity of anthropometry and bioelectrical impedance analysis (BIA) in detecting alterations in body composition of children treated with peritoneal dialysis (PD), and to determine the prevalence of malnutrition in this population, in short- and long-term PD duration, using anthropometric and BIA-derived indices. PATIENTS: Eighteen children treated with automated PD (11 males, 7 females; mean age 8.7 +/- 4.7 years). DESIGN: Eighteen patients were studied using anthropometry and BIA at the start (t0) and after 6 months (t1) of PD, 15 of these patients at 12 months (t2), and 8 at 24 months (t3) of PD. Midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA) were calculated from anthropometric measures according to Frisancho (FrisanchoAR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981; 34:2540-5.). The bioelectrical measures of resistance (R) and reactance (Xc) were obtained directly from the impedance signal; phase angle (PA) and distance (D) were calculated using mathematical formulas. Nutritional status was assessed by anthropometric measurements and BIA-derived indices, expressed as standard deviation scores (SDS), and by a score system based on BIA and anthropometric parameters. The percentage of children with values of anthropometric and BIA-derived indices below the 3rd percentile or between the 3rd and 25th percentiles, and the percentage of children with scores of 7-12 and 4-6 were calculated in order to detect patients with severe or moderate derangement of nutritional status. RESULTS: The mean SDS values of Xc, PA, and D significantly improved (p = 0.05, p = 0.001, p = 0.02) during the first 6 months of PD and remained almost stable during the following months. The SDS values of the anthropometric indices were less compromised than those of the BIA-derived indices, particularly at the start of dialysis. By 6 months, the percentages of children with values of BIA and anthropometric indices below the 3rd percentile had decreased. The percentages of patients with moderate and severe derangement of BIA and anthropometric indices remained substantially unchanged after 12 months. However, at 24 months, the percentage of patients with moderate derangement of BIA indices increased. All these findings were confirmed by the nutritional score system. CONCLUSION: BIA is more sensitive than anthropometry in detecting alterations in body composition of children on PD. The prevalence of malnutrition, high at the commencement of PD, decreases during the first year of treatment but not over the long term.

Adolescent↗
PubMedDate not supplied

[Genetic basis for malformation-associated uropathy and renal dysplasia].

The wide association between urinary tract malformations and dysplastic kidneys, known as CAKUT (Congenital Anomalies of the Kidney and Urinary Tract), could be caused by a single disorder of the embryonic development of the kidney and urinary tract. These complex patterns of development are under genetic control. A positive family history strongly suggests a genetic origin of these conditions. Linkage studies show an extreme genetic heterogenicity and an important phenotypic and clinical variability of the same mutation. Some urinary tract malformations have been investigated in the context of clinical syndromes. The renal-coloboma syndrome is an autosomal dominant human disease, secondary to mutation of the PAX2 transcription factor, characterized by optic nerve coloboma, renal anomalies and vesicoureteral reflux. However, most of the urinary tract anomalies can occur in isolation. Studies have shown the association of hereditary hydronephrosis with HLA antigens on chromosome 6 and the association of VUR with the mutations in a locus of chromosome 1. The higher frequency and severity of some uropathies in the male gender may be explained by a linkage-disequilibrium phenomenon or a X-linked transmission pattern. For example, the mutations in the AGTR2 gene on chromosome X were observed in animal models but not yet confirmed in human subjects. Finally, the ACE gene polymorphism is associated with a higher incidence of congenital hypo-dysplastic kidneys and represents a significant risk factor for the development of progressive renal damage.

Abnormalities, Multiple↗
PubMedDate not supplied

Complications of epidural and combined spinal-epidural analgesia in labour.

AIM: The practice of relieving pain during childbirth with epidural or combined spinal-epidural analgesia is very widespread in the major Western countries, and is increasing in Italy. There are, however, numerous complications of this practice for both the woman and the mechanism of the labour. The aim of our study was to evaluate the short and long term complications of these techniques in a randomised sample of women. METHODS: A randomised, longitudinal, retrospective study was carried out in a sample of caucasian nulliparous women who gave birth in the second half of 2001. The subjects were divided into 3 groups: Group 1, women who gave birth with the aid of epidural analgesia; Group 2, women who received combined spinal-epidural analgesia during labour; Group 3, women who delivered without any analgesia. The short and long term complications of the 2 analgesic techniques were compared with those occurring in the control group, using Fisher's exact test. RESULTS: The frequency of at least one unwanted effect was higher in the 2 groups of women who received analgesia than in the control group. Hypotension and pruritus were statistically significantly more frequent in the group receiving spinal-epidural analgesia than in the other 2 groups. There were no statistically significant differences between the 3 groups in the rates of late complications or incidence of deliveries completed by cesarean section. CONCLUSIONS: The short-term complications of the analgesic techniques used during labour were not very relevant with respect to the subjects' satisfaction (excellent in 66% of the women in the group managed with epidural analgesia and 73% among those treated with the combined spinal-epidural technique). There was not a statistically significant difference in the percentage of cesarean deliveries in the 3 groups. Epidural and spinal-epidural analgesia to relieve pain during labour can, therefore, be considered safe and reliable.

Adult↗
PubMedDate not supplied

Renal function in cystic fibrosis.

The effect of saline extracellular volume expansion (4 ml/min/10 kg b.w. X 60 min) on renal function has been studied in patients with cystic fibrosis (CF) and in normal age-matched controls. Basal values for glomerular filtration rate (GFR), renal plasma flow (RPF), tubular sodium and chloride (Na, Cl) handling were similar in both groups. Saline expansion resulted in an increase in GFR and RPF in the CF patients: 127 +/- 18 ml/min/1.73 sqm BSA to 166 +/- 5; p less than 0.001, but not in the control group: 112 +/- 10 to 120 +/- 20. These hemodynamic changes were associated with increased proximal tubular reabsorption of NaCl in the CF patients whereas controls had reduced NaCl reabsorption. Renin and aldosterone levels suggested that increased NaCl reabsorption in CF patients was not secondary to chronic extracellular volume contraction or salt loss. These results support the hypothesis that the renal tubule is involved in the generalised electrolyte transport disorder exhibited in other epithelial structures. This study also indicated that the regulation of renal hemodynamics is altered in CF. The relationship between the disorder of proximal tubular salt handling and changes in renal hemodynamics is not known, but the observed changes imply a tubulo-glomerular feedback mechanism.

Absorption↗
PubMedDate not supplied

[Diagnostic and therapeutic approach in uropathic abnormalities diagnosed in utero].

Ultrasonography permits to suspect urinary tract abnormalities in fetal age: hydronephrosis is one of the most frequent anomalies detected, but renal dysplasia (multicystic kidney, renal agenesis, renal cysts) can be found in some cases. At birth, if abnormalities are confirmed by ultrasound scan other instrumental investigation are needed: cystography, to exclude vesicoureteric reflux, and sequential scintigraphy, to evaluate if obstruction of urinary tract is present or to confirm the suspect of renal agenesis or multicystic dysplasia. Urography could be necessary in some cases. For bilateral uropathy evaluation of renal function with blood tests is required. Early surgery is needed in case of severe obstructive uropathy; if obstruction is mild the patients can be followed with instrumental investigation. Antibiotic prophylaxis is required to prevent urinary tract infections in patients with vesicoureteric reflux. The indications for surgery in patients with vesico-ureteric reflux are still unclear.

Age Factors↗
PubMedDate not supplied

Node status in lower lip squamous cell carcinoma in relation to tumor size, histological variables and DNA ploidy.

We studied a consecutive series of 54 cases of lower lip squamous cell carcinoma (LLSCC) in order to identify any variables which might predict the development of lymph node metastases. The cases were divided into 38 tumors without metastases (group I) and 16 tumors with lymph node metastases (group II). The following variables were investigated: tumor size, histologic grading, tumor maximal thickness, perineural infiltration and DNA ploidy, in a group of patients undergoing surgical treatment for LLSCC, and to show which of these might be predictive of the development of lymph node metastases.

Adult↗