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Biomedical subjects

M Bernardi

Publications and source records attributed to M Bernardi.

At least 91 records · Page 5Linked to original sources
PubMed1999

Influence of antineoplastic drugs on morphine analgesia and on morphine tolerance.

The possible influence of cisplatin, methotrexate, adriamycin and vincristine on thermal pain threshold, morphine analgesia and development of morphine tolerance was investigated in mice. In the hot-plate test, the nociceptive threshold was not affected by acute or repeated administration of any of the antineoplastic drugs used. The analgesic activity of morphine was significantly reduced by pretreatment with cisplatin, intraperitoneally (i.p.) injected at the dose of 2 mg/kg. In contrast, methotrexate, subcutaneously (s.c.) injected at the dose of 1 and 5 mg/kg, adriamycin (1 and 3 mg/kg s.c.), vincristine (0.25 and 0.5 mg/kg i.p.) and a lower dose of cisplatin (1 mg/kg i.p.) had no effect. The development of tolerance to morphine analgesia was delayed by adriamycin but was not influenced by the other antineoplastic drugs used. These data show that, of the four antineoplastic agents used in this study, cisplatin may interfere in the mechanism of action of morphine, and that adriamycin may delay the development of opiate tolerance.

Analgesics, Opioid↗
PubMed1999

Ischemia-reperfusion injury in rat fatty liver: role of nutritional status.

Fatty livers are more sensitive to the deleterious effects of ischemia-reperfusion than normal livers. Nutritional status greatly modulates this injury in normal livers, but its role in the specific setting of fatty liver is unknown. This study aimed to determine the effect of nutritional status on warm ischemia-reperfusion injury in rat fatty livers. Fed and fasted rats with normal or fatty liver induced by a choline deficient diet underwent 1 hour of lobar ischemia and reperfusion. Rat survival was determined for 7 days. Serum transaminases, liver histology and cell ultrastructure were assessed before and after ischemia, and at 30 minutes, 2 hours, 8 hours, and 24 hours after reperfusion. Survival was also determined in fatty fasted rats supplemented with glucose before surgery. The preischemic hepatic glycogen was measured in all groups. Whereas survival was similar in fasted and fed rats with normal liver (90% vs. 100%), fasting dramatically reduced survival in rats with fatty liver (14% vs. 64%, P <.01). Accordingly, fasting and fatty degeneration had a synergistic effect in exacerbating liver injury. Mitochondrial damage was a predominant feature of ultrastructural hepatocyte injury in fasted fatty livers. Glucose supplementation partially prevented the fasting-induced depletion of glycogen and improved the 7-day rat survival to 45%. These data indicate that rat fatty livers exposed to normothermic ischemia-reperfusion injury are much more sensitive to fasting than histologically normal livers. Because glucose supplementation improves both the hepatic glycogen stores and the rat survival, a nutritional repletion procedure may be part of a treatment strategy aimed to prevent ischemia-reperfusion injury in fatty livers.

Alanine Transaminase↗
PubMed1999

Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites.

Patients with advanced cirrhosis frequently show hemodynamic abnormalities. Autonomic dysfunction (AD) is also common and, owing to the importance of autonomic function in cardiovascular homeostasis, it may be involved in the pathogenesis of the hyperdynamic circulation. We, therefore, evaluated the hemodynamic status and autonomic function in 30 patients with cirrhosis, most of them with an advanced stage of the disease. Autonomic function was assessed with 7 cardiovascular tests exploring the vagal or sympathetic function. Each test was scored from 1 to 3 (normal, borderline, altered). Cardiac index (CI) was measured by an echocardiogram. Twenty-four (80%) patients showed an AD, this being definite in 14 (47%) patients. A vagal dysfunction (VD) was found in 19 patients (63%), this being definite in 11 patients (37%), and a sympathetic dysfunction (SD) in 7 patients (definite in 3 [10%] patients). The patients with AD showed a faster heart rate (P =.021), lower indicized peripheral vascular resistance (P =.013), and increased CI (P =.004) than patients without AD whereas mean arterial pressure did not differ. Similar results were seen by grouping patients according to the VD. AD score was directly correlated with heart rate (r = 0.53; P =.002) and CI (r = 0.45; P =. 016), and inversely correlated with peripheral vascular resistance (r = 0.46; P =.013). Even closer correlations were found with vagal score. AD (mainly VD) may be involved in the pathogenesis of the hyperdynamic circulatory syndrome of patients with advanced cirrhosis.

Adult↗
PubMed1999

Effects of a low-intensity conditioning programme on VO2max and maximal instantaneous peak power in elderly women.

The effects of 12 weeks of a low-intensity general conditioning programme on maximal instantaneous peak power (Wpeak) and maximal oxygen uptake (VO2max) were examined in 20 elderly women. After medical, familiarisation, and ethical procedures, the subjects were randomly divided into either a training and or a control group. The training group [n = 11; mean (SD) age 63.0 (3.1) years] agreed to take part in a 12-week training programme at an exercise intensity kept under 60% of the heart rate reserve for about 60 min, 3 times a week. The control group [n = 9; mean (SD) age 63.5 (3.3) years] did not perform any particular physical training. Before and after the training period, all participants underwent anthropometric measures and a maximal cycling test to exhaustion to measure their VO2max. In addition, Wpeak was determined 1 week later by the subjects performing a vertical jump from a squatting position on a force platform. Following training, neither the anthropometric characteristics nor the VO2max changed in either of the groups. In contrast, Wpeak increased significantly (P < 0.001) in the training group, but did not change in the control group. This result could be interpreted as the result of an improved level of neuromuscular activation. Furthermore, it shows that although muscle power declines with age at a faster rate than does aerobic power, its sensitivity to training seems to be higher than that of the aerobic system.

Age Factors↗
PubMed1999

A case of segmental myoclonus in amputation stump: evidence for spinal generator and physiopathogenetic hypothesis.

We describe a 68-year-old woman who experienced pain and phantom limb sensation following an above-the-knee amputation of the right leg. A month later, the patient had myoclonic jerks of the stump. Polymyo-graphic recordings showed synchronous jerks in the vastus medialis and adductors of the thigh on the right side. The patient responded to clonazepam. We conclude that the myoclonic jerks were of spinal cord origin.

Aged↗
PubMed1999

Interferon-alpha plus ribavirin in chronic hepatitis C resistant to previous interferon-alpha course: results of a randomized multicenter trial.

BACKGROUND/AIMS: Interferon-alpha plus ribavirin seem to be more efficacious than interferon monotherapy in chronic hepatitis C. In a multicenter randomized trial, we evaluated the efficacy of this association for interferon-alpha resistant chronic hepatitis C. METHODS: Fifty patients who were non-responders to recombinant or lymphoblastoid interferon-alpha were randomized to receive either ribavirin (800 mg/day) plus leucocytic interferon-alpha (3 mega units thrice weekly) or the same dose of interferon-alpha alone, for 6 months. Effects of therapy were evaluated by serum aminotransferase and hepatitis C virus RNA levels and control liver biopsies. RESULTS: At the end of treatment, aminotransferase levels become normal in 9/26 patients receiving combination therapy (35% [confidence interval, 16% to 53%]) and in 2/24 receiving interferon-alpha alone (8% [confidence interval, -3% to 19%]) (p = 0.03). Aminotransferase normalization was never associated with hepatitis C virus RNA clearance. All patients with normal aminotransferase relapsed after discontinuation of therapy. At the end of treatment, mean hepatitis C virus RNA levels significantly decreased only in the group receiving combination therapy, but returned to pretreatment values 6 months thereafter. No histological improvement was observed in either group. CONCLUSIONS: There is no indication for treatment with interferon-alpha at the dose of 3 mega units thrice weekly plus 800 mg/day of ribavirin for 6 months in chronic hepatitis C resistant to interferon-alpha.

Antiviral Agents↗
PubMed1999

Force generation performance and motor unit recruitment strategy in muscles of contralateral limbs.

The purpose of the present study was to determine whether the motor unit (MU) recruitment strategy of the agonist and antagonist muscles in the dominant arm differs from that in the non-dominant arm. The median frequency (MF) of the power density spectrum (PDS) of the electromyogram (EMG) was used as a tracking parameter to describe the MU recruitment. In 8 subjects the EMG was recorded from the biceps brachii and triceps brachii of each limb during isometric elbow flexion performed in a ramp fashion. Force was increased from 0 to 100% of the maximum voluntary contraction (MVC) in 3 s following a track displayed on an oscilloscope. When comparing the dominant versus non-dominant arm we found no statistical difference in the MU recruitment pattern of the biceps brachii and the triceps. Because the dominant arm was not always the better performing arm, we grouped the data according to the ability of the subjects to track the ramp signal. In this case we found a statistically significant difference between the better and worse performing arm in the full MU recruitment of the biceps. A more precise and accurate control of the increase in force was obtained when the central nervous system selected a slower and prolonged recruitment of MUs in the agonist muscle.

Adult↗
PubMed1999

Cost of walking and locomotor impairment.

The aim of the present study was to evaluate the importance and the necessity of metabolic measurements to quantify locomotor impairment in a clinical context. Oxygen consumption, heart rate, pulmonary ventilation and walking speed were measured during locomotion in 14 normal subjects, used as a control group, and 82 patients with different pathologies [hemiparetic, paraparetic, tetraparetic, orthopaedic and paraplegic patients, who walked using a reciprocating gait orthosis (RGO)]. The subjects were characterized on the basis of a cumulative impairment score (CIS), based on clinical scales commonly used to evaluate impairment and disability in locomotion. Appropriate indices of energy, cardiac and ventilatory costs expressed per metre walked, globally called physiological costs, were obtained. It resulted that the most comfortable speed (MCS) of normal subjects was significantly higher than that of each group of patients. Normal subjects' physiological costs were found to be significantly lower than those of patients who needed either a device or the help of a person to walk. All measured parameters correlated significantly with each other. The MCS was found to be the most correlated parameter with the CIS (r = 0.8), and therefore it must be considered the best single measurement, if only one is to be used. Measurements more precise than MCS, such as the physiological costs, may be necessary in clinical trials.

Adult↗
PubMed1999

Serum pancreatic enzyme concentrations in chronic viral liver diseases.

Serum amylase and lipase concentrations were determined in 78 patients with chronic liver diseases [26 chronic active hepatitis (CAH) and 52 liver cirrhosis] and in 15 healthy subjects. Pancreatic isoamylase concentrations and macroamylase complexes were assayed in hyperamylasemic sera. Serum amylase levels were abnormally elevated in 27 patients (35%; 22 liver cirrhosis, 5 CAH), whereas serum lipase levels were elevated in 16 patients (21%; 15 liver cirrhosis, 1 CAH). In 9 of the 27 hyperamylasemic patients, the hyperamylasemia was of pancreatic type. Macroamylasemic complexes were not detected in hyperamylasemic sera. Patients with liver cirrhosis had serum levels of amylase and lipase significantly higher than both the healthy subjects and the patients with CAH, while no significant differences were found in serum levels of these enzymes in patients with CAH as compared to the healthy subjects. A decreased liver metabolism of serum amylase and lipase in patients with chronic infective liver disease, especially in those having liver cirrhosis, may lead to an accumulation of these enzymes in the blood.

Adolescent↗
PubMed1999

Ambulation training of neurological patients on the treadmill with a new Walking Assistance and Rehabilitation Device (WARD).

STUDY DESIGN: Patients with neurological walking impairment were rehabilitated with a new system, consisting of an apparatus to constantly relieve the body weight and a treadmill: The Walking Assistance and Rehabilitation Device (WARD). Patients were evaluated before and after rehabilitation with clinical scales and physiological measurements. OBJECTIVES: To evaluate the effectiveness of the WARD in improving walking capability in these patients. SETTING: The study was carried out in a clinical environment (IRCCS S. Lucia, Rehabilitation Hospital, Rome, Italy). METHODS: Seven patients (six with spinal cord injuries, one with brain injury) underwent a 1 - 2 month training period with the WARD. During the WARD training the body weight constant unloading (BWCU) applied to the patient through the WARD was regularly evaluated. Oxygen consumption, carbon dioxide production and heart rate were measured in order to obtain energy and cardiac costs of walking. These measurements were carried out while walking with the WARD at an appropriate treadmill speed (ATS) and in the open field at the most comfortable speed (MCS). All measurements, in addition to clinical scores related to the walking capability, were carried out at the beginning of the WARD training period (BWT) and at the end (EWT). At the EWT the patients were tested walking with the WARD observing the same BWT conditions (same ATS and BWCU), referred to as beginning conditions second measurements (BCSM). The relationships between physiological costs and ATS were described through second order polynomial regression curves and studied. RESULTS: Comparing the data obtained at the BWT and EWT, the following results were found significantly different: (1) Clinical scores improved; (2) All patients increased their ATS; (3) The BWCU was reduced; (4) The Walking Energy Cost (WEC) and the Walking Cardiac Cost (WCC) measured when walking with the WARD at the ATS improved in all patients; and (5) The WEC and WCC measured in the open field improved in all patients. The WEC vs ATS curve found at the EWT in the BCSM was found significantly different from the BWT curve, demonstrating a major improvement due to the WARD training. CONCLUSION: Despite some limitations due to sample size and functional ambulation scale, this study has demonstrated that the WARD training is effective in improving the walking capability and efficiency of the patients.

Adult↗
PubMed1999

[Effect of immobilization after treatment of mandibular fractures].

BACKGROUND AND AIM: The aim of this study was to assess whether the duration of intermaxillary block in patients with non-condylar mandibular fractures can interfere with restored mandibular function and whether there is a statistically significant correlation between the duration of joint immobilisation and the onset of temporo-mandibular joint pathologies. METHODS: A clinical evaluation was made of 40 patients treated for non-condylar mandibular fractures during the period 1991-1992. The patients were subdivided into two groups depending on the type of treatment and the duration of the intermaxillary block. Group A included patients treated with intermaxillary block alone lasting more than 25 days. Group B included patients treated surgically with intrafocal osteosynthesis with immobilisation lasting less than 15 days. RESULTS: The follow-up of results (3.7 years) showed a maximum mean aperture in Group A of 45.1 mm compared to 50.1 mm in Group B. The mean score for mandibular clinical dysfunction in patients in Group A was 5.0 points (SD +/- 4.75), whereas it was 0.7 points (SD +/- 1.45) in patients in Group B. This difference between the two groups was statistically significant (p < 0.01). CONCLUSIONS: The results of this study suggest that jaw immobilisation in mandibular fractures may be potentially damaging for the temporo-mandibular joint, sometimes leading to painful dysfunctional syndromes. For this reason, even in the case of mandibular fractures without decomposition, the authors feel that it is advisable to avoid long periods of immobilisation in patients with a positive history of mandibular dysfunction.

Fracture Fixation↗
PubMed1999

Effect of Helicobacter pylori infection, age and epithelial cell turnover in a general population at high risk for gastric cancer.

BACKGROUND: H. pylori and age are two known risk factors for atrophic gastritis and high epithelial cell turnover may be an indicator for preneoplastic changes in the stomach. We searched for an association between H. pylori, age and gastritis in the general population together with the proliferative state into the antral mucosa. METHODS: We examined gastric biopsies from antrum and corpus of 117 consecutive volunteers which were endoscoped during a population study in San Marino. H. pylori status was determined by serum IgG antibodies, rapid urease test on biopsies and histology. Presence of gastritis and grading of inflammation, activity, intestinal metaplasia and atrophy were ascertained using Sydney System. On a subsample of 36 subjects without endoscopic lesions we performed an immunohistochemical study on gastric cell proliferation using PCNA. A computer-aided count was made on stained epithelial cells to evaluate labeling index. Statistical analysis was performed using chi 2 test and linear regression. RESULTS: Inflammatory infiltrate (both activity and mononuclear cells), (p < 0.0001) and intestinal metaplasia (p < 0.004) were significantly higher in H. pylori positive subjects. Atrophic gastritis was present in 82% H. pylori positive subjects vs 17.6% (p < 0.0001). Labeling Index was significantly higher in H. pylori positive subjects (p < 0.005) and it was correlated with inflammation and atrophy (p = 0.001). Elderly H. pylori negative subjects have a lower cell turnover (p = 0.006) but H. pylori infected subjects do not show any decrease of Labeling Index with age. CONCLUSIONS: In the general population of an area with high gastric cancer rate, H. pylori infection is associated with atrophic gastritis and with hyperproliferative gastric cell state. These conditions are present either in young and old age and increase the neoplastic risk of gastric mucosa.

Adult↗
PubMed1999

Clinical practice guidelines for the management of cirrhotic patients with ascites. Committee on Ascites of the Italian Association for the Study of the Liver.

An ad hoc Committee appointed by the Italian Association for the Study of the Liver prepared these Clinical Practice Guidelines for the Management of Cirrhotic Patients with Ascites. The initial evaluation of a patient with ascites should include a history, physical evaluation, paracentesis with ascitic fluid analysis, abdominal ultrasonography and biochemistry to assess the severity of liver disease and renal functionality. To improve the efficiency of the choice between the different opportunities available in the treatment of ascites, patients can be classified into two subgroups: patients with uncomplicated ascites and patients with complicated ascites, including refractory ascites, bacterial peritonitis, hyponatraemia and renal failure. Based upon evidence emerging from controlled clinical trials or case-control studies, satisfactory treatment for uncomplicated ascites is represented by paracentesis, sodium-restricted diet and diuretics, whereas the treatment of patients with complicated ascites requires other specific approaches. As the prognosis for most patients with ascites is poor, the last part of the paper offers simple criteria in the selection of patients candidates for liver transplantation. The aim of these guidelines is to reduce inappropriate practice and to improve efficiency in the management of patients with ascites. The Committee holds that a periodic update will be necessary to conform to future scientific developments.

Ascites↗
PubMed1999

Interferon alpha plus ketoprofen or interferon alpha plus ribavirin in chronic hepatitis C non-responder to interferon alpha alone: results of a pilot study.

BACKGROUND: Recently, in vitro and in vivo studies demonstrated that non-steroidal anti-inflammatory drugs are able to enhance the activity of interferon alpha. AIM: To evaluate the efficacy and tolerability of ketoprofen (a non-steroidal anti-inflammatory drug) plus interferon alpha (group B) compared to interferon alpha plus ribavirin (group C) and interferon alpha alone (group A) in chronic hepatitis C non-responders after a 5-month course with interferon alpha. PATIENTS AND METHODS: Without stopping interferon alpha, 49 patients were randomized to receive one of the three treatment regimens for 4 months. RESULTS: Three patients discontinued the therapy. One out of 16 patients in group A, 6/16 in group B and 5/14 in group C, alanine aminotransferase returned to normal at the end of the therapies (B vs A: p=0.04); serum hepatitis C virus-RNA became negative in 1 patient in group A and in 4 patients in both group B and group C. Six months after treatment, normal alanine transferase and negative hepatitis C virus-RNA were observed in 3 patients in group B and 2 in group C. In these patients, liver histology significantly improved. CONCLUSIONS: These results indicate that a certain number of non-responder patients to interferon alpha can benefit from a combination therapy of interferon alpha plus ketoprofen that is at least as effective as the combination interferon alpha plus ribavirin.

Adolescent↗
PubMed1998

Prevalence of monoclonal gammopathies in patients with hepatitis C virus infection.

BACKGROUND: An association between monoclonal gammopathies and chronic liver diseases has been reported. OBJECTIVE: To determine the prevalence of monoclonal gammopathies in patients with chronic hepatitis C virus (HCV) infection and the possible association of monoclonal gammopathies with HCV genotypes. DESIGN: Prospective study. SETTING: Departments of internal medicine and hematology at two university hospitals in Italy. PATIENTS: 239 HCV-positive and 98 HCV-negative patients with chronic liver diseases were recruited consecutively. MEASUREMENTS: Clinical data were gathered, liver histologic examination was done, serum immunoglobulin and cryoglobulin levels were measured, and immunoelectrophoresis was done for monoclonal component detection. Patients with monoclonal gammopathy had serum HCV RNA measured and HCV genotype determined by polymerase chain reaction and had histologic examination of bone marrow. RESULTS: Monoclonal band was detected in 11% of HCV-positive patients and in 1% of HCV-negative patients (P = 0.004). The prevalence of HCV genotype 2a/c was higher in patients with monoclonal gammopathies than in those without (50% compared with 18%; P = 0.009). CONCLUSION: The prevalence of monoclonal gammopathies in patients with HCV-related chronic liver disease is striking and is often associated with genotype 2a/c infection.

Adolescent↗
PubMed1998

Prevention of reoxygenation injury by sodium salicylate in isolated-perfused rat liver.

Sodium salicylate can be used as a chemical trap for hydroxyl radicals, the most damaging reactive oxygen species. Because reactive oxygen species are involved in the pathogenesis of hepatic hypoxia/reoxygenation injury, the goal of this study was to determine if trapping hydroxyl radicals with salicylate would prevent or at least ameliorate such injury. Isolated rat livers, continuously perfused with Krebs-Henseleit bicarbonate buffer in the presence or absence of salicylate (2 mM), were exposed, after 30 min of recovery, to 60 min of hypoxia, followed by 30 min of reoxygenation. During reoxygenation, control livers experienced a sharp increase in the rate of lactic dehydrogenase release, taken as index of cell injury, protein carbonyl content, and malondialdehyde, taken as index of protein oxidation and lipid peroxidation, respectively. The presence of salicylate in the solution perfusion significantly reduced the rate of lactic dehydrogenase release, protein carbonyl content, and malondialdehyde production during reoxygenation. Hepatic histology documented a significantly reduced cell injury in salicylate-perfused livers compared to control livers. These data suggest that the hydroxyl radical chemical trap sodium salicylate, acting as an antioxidant, may represents an effective agent to reduce liver injury due to hypoxia/reoxygenation in a model of isolated-perfused rat liver.

Animals↗