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Biomedical subjects

L Martinelli

Publications and source records attributed to L Martinelli.

At least 91 records · Page 5Linked to original sources
PubMed1991

Thalassaemia trait and myocardial infarction: low infarction incidence in male subjects confirmed.

A total of 4401 subjects admitted to the Medical Division of St Camillo Hospital in Comacchio (Ferrara, Italy) over a period of 7 years were prospectively evaluated in order to determine whether the heterozygous beta-thalassaemic (HBT) could be considered as a protective factor against the occurrence of acute myocardial infarction (AMI). Of the total patient sample, 3954 subjects were non beta-thalasaemics (NBTs), and 447 subjects were heterozygous beta-thalassaemics (HBTs). AMI was diagnosed in 384 patients, of whom 17 individuals were HBTs and 367 subjects were NBTs. The prevalence of HBTs in this group was significantly lower than expected (4.43%, P less than 0.0001). Furthermore, an analysis by sex showed that this lower prevalence could be attributed to male patients. Moreover, only in male subjects was a significant negative correlation observed between AMI and HBT. The mean age at which AMI occurred in male HBTs was significantly higher than in male NBTs (72 +/- 2.69 vs. 63 +/- 0.7 years, P less than 0.05), while no differences were found in the mean age at which AMI occurred between HBT and NBT female subjects. This study demonstrates that the thalassaemic trait may afford some protection against the occurrence of AMI in men.

Aged↗
PubMed1991

[Coronary disease of transplanted heart: prevalence, angiographic and etiopathogenetic aspects].

Progressive coronary artery disease is the most important factor influencing late mortality after heart transplantation. The aim of the study was to evaluate prevalence and clinical and angiographic findings of accelerated atherosclerosis in cardiac transplanted patients. During the first 5 years of the Heart Transplant Clinical Program at Policlinico S Matteo, Pavia, 81 patients underwent 156 coronary angiographies. The immunosuppressive therapy was based on cyclosporine, azathioprine and steroids; in some patients a reduced immunosuppressive schedule was started because of the presence of adverse effects. Coronary angiographies were performed in 68 patients after 1 year, in 40 patients after 2 years, in 19 patients after 3 years and in 18 patients after 4 years. The presence of coronary artery disease was defined by the angiographic occurrence of any decrease in the luminal diameter (including minor irregularities): according to these criteria coronary artery disease was found in 29 angiographies, performed in 13 patients, with a prevalence of 16% (13/81). An evaluation of the annual incidence showed respectively 14.7% at 1 year, 22.5% at 2 years, 31.5% at 3 years, 22.2% at 4 years. Coronary artery disease involvement was predominantly monovascular (56%) after 1 year and with a multivessel expression in the following years (2-vessel disease 33%, 3-vessel disease 50%). The major clinical problems in the transplanted patients with coronary artery disease were 3 deaths, related with heart failure in 2 cases and with sudden death in 1 case, and a new transplantation procedure in 2 patients. Prevalence and incidence of coronary artery disease observed after heart transplantation in this population were similar to those reported by other Authors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Endomyocardial biopsy in the heart transplant patient: the state of the art].

Data regarding 2176 endomyocardial biopsies (EMB) (Nov. '85-Dec. '89) performed in 164 transplanted hearts (4 etherotopic) from 158 patients (6 retransplants) are herein reported. This study was aimed to evaluate: 1) Incidence and characteristics of early ischemic myocardial damage. 2) The influence of different immunosurveillance protocols on incidence, degree and aggressiveness of acute rejection and the inflammatory infiltrate composition. 3) The immunophenotype of infiltrating cells in moderate acute rejection episodes. 4) HLA-DR antigen expression on myocyte sarcolemma. 5) Characterization of cells expressing immune response mediators. 6) Myocardial localization of opportunistic infections. 7) Useful information on chronic rejection. Our results demonstrate that: a) Mild rejection seldom progresses to moderate degree. b) Different immunosuppressive protocols can influence the incidence of acute rejection: in fact, in OKT3 protocol, the incidence of rejection episodes is higher than in other protocols as well as aggressiveness toward myocytes. c) Infiltrating cells maintain T lymphocyte prevalence with minor amounts of B lymphocytes and macrophages in the 3 different protocols. T cell subset characterization showed a slight prevalence of CD8 bearing cells over CD4 positive cells whereas CD57 cells were few and scattered. d) Class II Major Histocompatibility Complex (HLA-DR) expression never occurs on myocyte sarcolemma. e) TNF alpha is expressed in acute cardiac rejection by immunologically activated T lymphocytes and macrophages and the number of immunoreactive cells increases with progression of the rejection. f) Human cytomegalovirus infections can be primary or recurrent. Myocardial involvement has been observed in primary forms. Virus can affect endothelial cells (with no inflammatory reaction) or myocytes (myocarditis) and its diagnosis requires a combination of immunohistochemical and molecular biology techniques. Diagnosis of Toxoplasma gondii infection can be usually accomplished by routine histopathological study. g) Chronic rejection diagnosis is rarely based on biopsy derived information.

Biopsy↗
PubMed1991

[Loss of plasma protein in open-heart surgery].

The changes in the concentrations of nine serum proteins were studied in ten patients who underwent open-heart surgery for mitral or aortic valve replacement. alpha 1-glycoprotein, albumin, transferrin, alpha 2-macroglobulin, IgG, IgA, IgM, C3, and C4 were assessed before anesthesia induction, after sternotomy, ten minutes after the beginning of CPB, and ten minutes following the end of CPB; values were corrected for haemodilution. All the proteins, with the exception of alpha 1-glycoprotein, showed similar trends that were characterized by a significant decrease after CPB. Linear contrasts did not show any significant difference among the proteins expressed as per cent of the initial values. Such generalized decrease was probably due to the aspecific damage caused by oxygenators, pumps and aspirators. On the contrary, specific mechanisms, as IgM aggregation or complement activation, do not affect significantly the concentration of single proteins. Also the hypothesis of a relevant protein migration toward the extravascular space was rejected because of the absence of any significant relation between the molecular weight of the proteins and their decrease after CPB.

Adult↗
PubMed1991

Expression of tumor necrosis factor in human acute cardiac rejection. An immunohistochemical and immunoblotting study.

The authors performed an immunohistochemical study on expression of tumor necrosis factor alpha (TNF alpha) in endomyocardial biopsies from human cardiac allografts. TNF alpha immunoreactivity was found in 45% biopsies with mild acute rejection, in 83% biopsies with focal moderate rejection, in 80% biopsies with diffuse moderate rejection. Biopsies with absent rejection did not show immunoreactive cells. In mild rejection, positive cells were few and scanty monocytes and macrophages (MAC-387 and LN5 positive cells) and T lymphocytes (UCHL-1/CD45 RO positive cells) (up to 20% of all infiltrating cells). Expression of major histocompatibility complex (MHC) class II antigens on infiltrating and endothelial cells occurred earlier and independent of TNF alpha reactivity. Number of immunoreactive cells increased in moderate rejection (up to 50%). Immunoreactivity was also present in nonpigmented macrophages in part of the biopsies with resolving rejection (45%). The authors conclude that TNF alpha is expressed in acute cardiac rejection by immunologically activated inflammatory cells. Immunoreactive cells increase in number with increasing severity of the reaction.

Biopsy↗
PubMed1990

Expression of natriuretic peptide in ventricular myocardium of failing human hearts and its correlation with the severity of clinical and hemodynamic impairment.

Atrial natriuretic peptide (ANP) was immunohistochemically investigated in (1) right ventricular endomyocardial biopsy specimens from 87 apparently healthy donor hearts taken from victims of cerebral accidents; (2) 1 normal heart not suitable for transplantation (HBsAg carrier); (3) right ventricular endomyocardial biopsy specimens from 151 patients with dilated cardiomyopathy (DC); and (4) 57 explanted hearts, 26 with DC and 31 with ischemic heart disease. No ANP immunoreactivity was found in normal ventricles. Failing hearts showed ventricular positivity in 31% of the DC biopsy series, in 61% of the left ventricles, and in 30% of the right ventricles of the explanted heart series. An endoepicardial gradient was observed, because ANP positivity was greater and more extensive in the subendocardial layers. Ultrastructural studies were performed on biopsy specimens from 10 normal hearts and 132 DC biopsy samples. No ANP-storing granules were found in biopsy samples of normal ventricles, whereas ANP granules were seen in 15 of 132 (11.4%) DC cases. In parallel immunoblotting, investigation showed the same 13 kDa band protein in 1 normal atrium as well as in 8 failing atria and ventricles. ANP immunoreactivity was positively correlated with higher New York Heart Association functional classes as well as with higher left ventricular end-diastolic pressure (p less than 0.005), end-diastolic volume (p less than 0.005) and end-diastolic volume index (p less than 0.005). In conclusion, apparently healthy ventricles do not show ANP immunoreactivity, whereas failing ventricles do. ANP expression seems to be independent of the underlying disease, but positively related to the clinical status and the degree of left ventricular impairment and dilatation.

Adult↗
PubMed1990

Electrocardiographic changes suggestive of myocardial ischemia elicited by dipyridamole infusion in acute rejection early after heart transplantation.

Acute cardiac rejection, syndrome X, and arterial hypertension can induce small vessel damage and, therefore, restriction of coronary reserve in the presence of normal epicardial coronary arteries. A characteristic response pattern to dipyridamole (DIP) infusion has been previously described in syndrome X and arterial hypertension: ST segment depression without any measurable systolic dysfunction. The aim of this study was to establish whether acute cardiac rejection might induce electrocardiographic alterations during DIP infusion. Changes in the 12-lead electrocardiogram and two-dimensional echocardiogram during high-dose DIP infusion (up to 0.84 mg/kg in 10 minutes) were evaluated within 24 hours of endomyocardial biopsy in 14 transplanted patients. A total of 47 biopsy-controlled DIP studies were performed within 5 weeks after cardiac transplantation. For each patient, at least 7 days elapsed between two consecutive studies. Electrocardiographic and echocardiographic tracings were analyzed without prior knowledge of endomyocardial biopsy findings. No remarkable side effects occurred in any case, so that the DIP study could be completed in all patients. A diagnostic (greater than 0.1 mV) ST segment depression was found in 11 studies. The sensitivity and specificity of DIP-induced ST segment depression for the detection of biopsy-proven acute rejection were 72% and 94%, respectively. These data show that DIP stress is feasible and safe in transplanted patients and that acute cardiac rejection can be accompanied by DIP-induced ST segment depression without detectable impairment in systolic function. These changes might provide noninvasive markers for surveillance of rejection.

Adult↗
PubMed1990

Immunological pattern in heterozygote beta thalassemic subjects.

In heterozygote beta-thalassemic subjects in a higher incidence of infectious diseases and of liver diseases with progression toward chronic hepatitis has been assessed. This predisposition has been suggested as being related to some immunological defects and to an altered immunological reactivity in thalassemia trait carriers. In order to evaluate whether there is a real deficiency of some humoral and cellular parameters in healthy heterozygote beta-thalassemic subjects, 128 symptom-free volunteers have been studied: 40 were heterozygote beta thalassemia carriers and 88 were normal subjects. In both groups there was no difference in: number and percentage of total lymphocytes, gamma globulins, immunoglobulins A and M, number and percentage of CD21, CD3, CD4, CD8, number of OKla*1, CD4/CD8 rations and lymphocytes' ability to respond to phytohemagglutinin. The values of immunoglobulins G and percentages of OKla*1 were found to be higher only in heterozygote beta thalassemic subjects; however, the number of CD2 in these subjects was lower. The result of the present study seems to indicate there is not significant difference between heterozygote beta thalassemic carriers and normal subjects in the more usual humoral and cellular immunological parameters.

Adult↗
PubMed1990

[Heterozygote beta-thalassemia and neoplastic pathology].

To evaluate the possible correlation between heterozygote beta thalassemia (BTE) and neoplastic disease, a 5-year personal experience of clinically followed patients at Comacchio Hospital Internal Medicine and Surgery divisions is presented. The hemoglobin A2 was assayed in all patients whose medial corpuscular volume was lower than 80 fl. 589 consecutive neoplastic patients were evaluated; of these 73 were BTE. In the BTE patients the prevalence of neoplastic disease was 12.39% higher than in healthy people (8.8%, chi 2 = 8.79 and p = 0.03). In thalassaemic carriers the titres of medial annual incidence to 10,000 for neoplastic diseases were proved to be ever higher (46.08 versus 31.49/10,000). The incidence of gastric cancer was found to be greater in BTE than in non-trait carrier population (13 in 63 patients, with a 20.63% prevalence, chi 2 = 9.52 and p = 0.02). A higher prevalence of thalassaemic carriers was observed among subjects with cancer in different organs: larynx, oesophagus, gallbladder and bile ducts, pancreas, breast and kidney, but these differences were not statistically significant. As for various sites of cancer: lung, liver, uterus and ovary, bladder, prostate, skin, lymphomas, leukaemias and gammopathies, no difference in BTE prevalence was found. We conclude that a greater predisposition to neoplastic disease can be present in BTE than in healthy population.

Age Factors↗