Search PubMed⌕ Search

Biomedical subjects

M Bernardi

Publications and source records attributed to M Bernardi.

At least 163 records · Page 9Linked to original sources
PubMed1995

[Endoscopic papillotomy in benign biliary tract diseases: nature, frequency and severity of complications].

The purpose of this study was to evaluate the frequency, nature and significance of the complications of endoscopic sphincterotomy. Between 1989 and 1993 endoscopic sphincterotomy was performed in 973 patients with benign affections of the bileducts. 398 patients were our own and 575 were admitted from other hospitals. The complications were recorded retrospectively on the basis of the discharge reports, which were available for each of our own patients (group A) and for 85% of the admitted patients (group B). Complications in all group A patients mentioned in the discharge reports were recorded and their clinical relevance was evaluated based on the patient records. Complications were mentioned in the reports of 82 (9.2%) of 887 cases and were more frequent in patients of group B (52 of 489: 10.6%) than in patients of group A (30 of 398: 7.6%). Pancreatitis was mentioned significantly more frequent in group B (2.5% vs 5.7%, p < 0.02). Reviewing the patient records of group A showed that clinically significant complications occurred in only 8 (2%) of 398 cases. The other complications mentioned in the discharge reports could not be confirmed or were without clinical significance. Hospitalization was short for these patients (5.3 +/- 2.2 days), which points to the fact that the findings were insignificant. 2 (0.2%) of 887 patients underwent surgery and 2 (0.2%) of 887 patients died due to a complication. These results clearly show that the complication rate determined on the basis of the discharge reports alone overestimates the true morbidity of the procedure. Often, an elevated amylase after ERCP/endoscopic sphincterotomy was erroneously interpreted as a pancreatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Motor unit recruitment strategy of knee antagonist muscles in a step-wise, increasing isometric contraction.

The purpose of this study was to determine if differences exist between the control strategies of two antagonist thigh muscles during knee flexion and extension muscular coactivation. Surface myoelectric signal (MES) of the quadriceps (rectus femoris) and the hamstrings (semitendinosus) were obtained from both muscles while performing step-wise increasing contractions during flexion and extension with the knee at 1.57 rad of flexion (90 degrees). The median frequency of the power density spectrum, which is related to the average muscle fiber action potential conduction velocity and therefore to motor unit recruitment, was calculated from each MES. The results suggest that, in all the subjects tested, when the muscle acts as antagonist most motor units are recruited up to 50% of the maximal voluntary force, whereas when the muscle acts as antagonist motor units are recruited up to 40% of the maximal voluntary force. The force range past 40-50% of the maximal force is also characterized by differences between the agonist/antagonist.

Adult↗
PubMed1995

Bone mass and metabolism in patients with celiac disease.

BACKGROUND & AIMS: Several aspects of the pathogenesis of osteopenia in celiac disease are still unclear. Therefore, bone mass and metabolism were evaluated in adults with celiac disease in a cross-sectional study. METHODS: Bone mineral density (BMD), assessed by total body dual-photon absorptiometry, and serum indices of bone metabolism and remodeling were evaluated in 17 patients with untreated celiac disease, 14 with celiac disease on a gluten-free diet, and 24 healthy volunteers. RESULTS: BMD, expressed as a z score, was significantly lower in patients with untreated celiac disease than in patients with treated celiac disease and volunteers and lower in patients with treated celiac disease than in volunteers. Similar changes were observed in serum calcium level, whereas intact parathyroid hormone level was significantly higher in untreated than in treated patients with celiac disease and volunteers, and no difference was found between the latter two groups. 25-Vitamin D level was significantly lower and 1,25-vitamin D level significantly higher in untreated celiac disease than in treated celiac disease and volunteers. Indices of bone remodeling were significantly higher in untreated than in treated patients and volunteers and significantly and positively correlated with iPTH in untreated patients with celiac disease. CONCLUSIONS: BMD is almost invariably low in patients with untreated celiac disease. Results in treated patients suggest that gluten-free diet improves but does not normalize BMD. Untreated celiac disease is characterized by high levels of 1,25-vitamin D and by increased bone turnover, caused by the increase in intact parathyroid hormone level.

Absorptiometry, Photon↗
PubMed1995

Celiac disease and alopecia areata: report of a new association.

Celiac disease is frequently associated with other autoimmune disorders but has never been reported in association with alopecia areata. In a routine clinical practice, 3 patients with such an association were observed. In one of the patients, celiac disease was diagnosed after the occurrence of malabsorption symptoms. In the youngest patient, a 14-year-old boy, gluten-free diet resulted in complete regrowth of scalp and body hair. A prospective screening program for celiac disease using antigliadin and antiendomysial antibodies was therefore set up in 256 consecutive outpatients with alopecia areata. Three patients, all completely asymptomatic for intestinal diseases, were found to be positive and underwent biopsy. Histological analysis showed a flat intestinal mucosa consistent with the diagnosis of celiac disease. The results show that alopecia areata may constitute the only clinical manifestation of celiac disease and that the association between these two conditions is a real one because the observed frequency of association is much greater than can be expected by chance. It is suggested that antigliadin and antiendomysial antibodies should be included in the work-up of patients with alopecia areata.

Adolescent↗
PubMed1995

Hemodynamic and renal effects of ascites apheresis, concentration and reinfusion in advanced cirrhosis.

BACKGROUND/AIMS: We studied the effects of ascites apheresis, concentration and reinfusion, a new form of treatment for tense or refractory ascites, on systemic hemodynamics and renal function. METHODS: Twelve patients with advanced cirrhosis (two belonging to Child-Pugh's class B and the remainder to class C) were monitored. They were evaluated under baseline conditions, just after the treatment, and 24 and 48 h after baseline assessment. In addition to systemic hemodynamics--as evaluated by Doppler echocardiography--and renal function, indirect markers of effective volemia, such as atrial natriuretic factor, plasma renin activity and aldosterone concentration, and plasma norepinephrine were also measured. RESULTS: The technique led to significant changes in systemic hemodynamics, such as an increase in stroke volume and cardiac output. However, due to a striking reduction in peripheral vascular resistance, mean arterial pressure also declined. The hemodynamic changes were associated with a parallel increase in atrial natriuretic factor. Despite the reduction in arterial pressure, plasma renin activity also significantly declined, while plasma norepinephrine did not undergo significant changes. Although an improvement in glomerular filtration rate and renal sodium excretion occurred, neither change reached statistical significance. All the hemodynamic, renal and neuro-humoral changes described above subsided almost entirely after 48 h, when no significant changes with respect to baseline values were any longer detectable with the exception of a slight reduction in mean arterial pressure. CONCLUSIONS: In advanced cirrhosis ascites apheresis, concentration and reinfusion enhance central volemia, but an exaggerated peripheral vasodilation largely wastes the potential favourable effect on arterial volemia. As a result, no significant improvement in renal perfusion and sodium excretion can ensue.

Adult↗
PubMed1995

Hyperdynamic circulation of advanced cirrhosis: a re-appraisal based on posture-induced changes in hemodynamics.

Little is known about the effect of posture on the circulatory abnormalities of advanced cirrhosis. We evaluated the systemic hemodynamics, measured by Doppler-echocardiography, atrial natriuretic factor, plasma renin activity and plasma norepinephrine, in 10 patients with cirrhosis and ascites and 10 healthy controls, after 2 h of standing and during lying down for a further 2 h. Standing hemodynamic patterns of controls and patients with cirrhosis did not differ significantly. The latter, however, showed higher plasma renin activity, norepinephrine and atrial natriuretic factor. The assumption of the supine position led to greater increases in cardiac index and atrial natriuretic factor, and reduction in systemic vascular resistance in patients with cirrhosis. Norepinephrine and plasma renin activity declined in both groups to a similar extent, while heart rate only slowed in controls. Thus, after 2 h in the supine position, patients with cirrhosis showed hyperdynamic circulation with increased cardiac index and heart rate and reduced systemic vascular resistance. Norepinephrine, plasma renin activity and atrial natriuretic factor were also elevated. The hyperdynamic circulation in advanced cirrhosis appears during or is enhanced by lying down. This finding suggests that this syndrome is, at least in part, attributable to excessive blood volume translocation towards the central area. However, the persistent activation of renin-angiotensin and sympathoadrenergic systems suggests that a concomitant reduced vascular sensitivity to vasoconstrictors concurs in its development.

Adult↗
PubMed1995

Ergonomy of paraplegic patients working with a reciprocating gait orthosis.

A reciprocating gait orthosis (RGO) is, among others, the most widely adopted device to restore the standing and walking capability of paraplegic patients. The aim of the present study was the evaluation of the energy demand (VO2), and cardiopulmonary load (HR and VE) imposed on the subject by different working tasks while sitting in a wheelchair or standing using a RGO. In addition, a comparison with the performance of normal subjects was also attempted. The RGO use allowed a dramatic improvement of patients' mobility and reach space in the workplace. A further advantage provided by the use of the RGO was represented by the increased mobility of the subjects with respect to the wheelchair confined situation. The energy demand and the cardiorespiratory load imposed on the subjects by the use of the RGO were not different from those observed both in the same subjects sitting in a wheelchair and in the controls. The energy demand slightly exceeded the values typical of light work and was, thus, compatible with the normal duration of a working day. On the other hand, the cardiac load corresponded to that typical of moderate activity, thus limiting the duration of the working task to 5-8 h. Based on the ergometry test, all of the working activities considered can be classified as aerobic activities, energy demand being under the ventilatory threshold.

Adult↗
PubMed1995

The efficiency of walking of paraplegic patients using a reciprocating gait orthosis.

A number of orthoses have been designed to restore stance and walking in paraplegic subjects. Among them, the reciprocating gait orthosis (RGO) appears to be one which is most widely adopted. The great energetic cost of orthotically aided walking is the main factor limiting the walking capability of paraplegic subjects. The purpose of the present research was to give a complete biomechanical evaluation of RGO locomotion in order to provide data that can be used for further improvements of the orthosis. From the whole body kinematics the mechanical work done to move the orthosis was estimated; by measuring the actual metabolic cost of RGO locomotion the efficiency was evaluated as the ratio between mechanical work and energy expenditure. It is found that RGO locomotion is a very demanding task in terms both of energy expenditure and of the mechanical work required. Furthermore, it is evident that the major determinant of this poor efficiency of RGO locomotion is the enormous amount of work required to move the orthosis which, in turn, reflects its poor mechanical characteristics. To accomplish the demand of real mobility, devices for transferring work from the upper to the lower portion of the body must be substantially improved. This technical aspect must be parelleled by suitable training programmes especially designed to improve the aerobic power of paraplegic subjects and their body composition (ie less fat and more muscle).

Adult↗
PubMed1995

Decrease of endurance performance during Olympic Triathlon.

The present study was carried out in order to quantify the athlete's endurance impairment after two out of three sequential events of Olympic Triathlon (OT). Furthermore the significance of ventilatory threshold (Tvent) and peak of oxygen uptake (VO2peak) as triathlete's performance predictors was assessed. Tvent and VO2peak were measured in six male triathletes performing an incremental treadmill test a week before an ad hoc triathlon event. The same test was applied immediately after the first two segments of the triathlon (1.5 km swim, 32 km bike). VO2peak and Tvent measured during the latter test were reduced compared to the first test. VO2peak decreased from 69 to 64 ml.kg-1.min-1 and Tvent from 58 to 51 ml.kg-1.min-1 p < 0.01), respectively. VO2peak and Tvent measured in the first test were well correlated (P < 0.05) to both running and cycling times. The Tvent measured during the second test was related to the running time but with a higher significance (p < 0.01) than in the first test. The impairment in the endurance performance induced by the first two segments of OT is an important aspect to consider both in training and in race strategy. These results also provide evidence that VO2peak and Tvent are good predictors of triathlon performance at least in cycling and running events.

Adult↗
PubMed1995

Synthesis of 1,4-disubstituted-2-methylpiperazines and study of their analgesic properties.

A series of N,N-disubstituted-2-methylpiperazines (3a-e) has been synthesized and compounds tested both in vitro and in vivo for their analgesic properties. Binding studies showed that the new compounds are devoid of relevant affinity towards mu receptors. However, compound 3a displayed significant analgesic properties both in the hot plate test and in the mouse phenyl-p-benzoquinone induced abdominal constriction test (MAC), whereas the other derivatives were found active only in MAC test. Moreover, it should be noted that compound 3a elicited a Straub-tail reaction also at the lowest administered dose (10 mg/kg, ip) and this effect was antagonized by naloxone.

Analgesics↗
PubMed1994

Influence of ifenprodil on the ACTH-induced behavioral syndrome in rats.

Ifenprodil--an antagonist at the modulatory site of the NMDA receptor complex sensitive to polyamines--intraperitoneally injected at doses of 3 or 10 mg/kg, dose dependently prevented the behavioral syndrome induced by intracerebroventricular administration of adrenocorticotropin (ACTH)-(1-24) in adult male rats (excessive grooming, stretching, yawning, penile erections). These data further support a role of the brain ornithine decarboxylase (ODC)-polyamine system in the ACTH-induced behavioral syndrome, and may suggest an involvement of excitatory amino acids.

Adrenocorticotropic Hormone↗
PubMed1994

Effects of prolonged ingestion of graded doses of licorice by healthy volunteers.

Licorice can induce a hypermineralocorticoid syndrome. Current literature usually refers to the effects of sweets containing glycyrrhizin, but little is known about the consequences of a prolonged intake of "pure licorice". We administered graded daily doses of dried, aqueous extract of licorice root, containing 108, 217, 380 and 814 mg of glycyrrhizin, to 4 groups of 6 healthy volunteers of both sexes for 4 weeks. No significant effects occurred in groups 1 and 2. After 2 weeks, side effects leading to withdrawal from the protocol occurred in a female in group 3 (headache), a male with a family history of hypertension in group 4 (arterial hypertension), and a female also taking oral contraceptives in group 4 (hypertension, hypokalaemia and peripheral edema). In group 4, transient reduction in kalaemia and increase in body weight were found after 1 and 2 weeks, respectively. A depression of plasma renin activity occurred in groups 3 and 4. In healthy subjects, only the highest doses of licorice led to untoward effects. These were favoured by subclinical disease or oral contraceptives, and were less common and pronounced than what has been reported after the intake of glycyrrhizin taken as such or as a flavouring agent in confectionery products.

Adult↗
PubMed1994

ACTH-(11-24) antagonizes ACTH-(1-24)-induced behavioral syndrome.

The possible involvement of the ACTH-(11-24) fragment on the stretchings, yawnings and penile erections induced by the intracerebroventricular injection of ACTH-(1-24) in rats, was studied. The results indicate that this C-terminal fragment is devoid of any behavioral activity, but inhibits the behavioral syndrome induced by ACTH-(1-24). This suggests that the fragment-(11-24) of the ACTH molecule may contain or represent an address sequence for brain ACTH receptors and may be involved in the termination of the behavioral response to melanocortins.

Animals↗
PubMed1994

Differential modulation of invertebrate hemocyte motility by CRF, ACTH, and its fragments.

Various reports have shown that invertebrate hemocytes are responsive to mammalian neuropeptides and cytokines. In the present study, we demonstrate that corticotropin-releasing factor (CRF) and adrenocorticotropin (ACTH) fragments (1-24), (1-4), (4-9), (1-13), (1-17), and (11-24) significantly stimulate molluscan hemocyte migration, and the whole sequence (1-39) and the fragment (4-11) have an inhibitory effect. Differences between species were found with respect to the response to individual fragments. Additionally, the (4-11) fragment was able to antagonize some of the stimulatory fragments (4-9) as well as tumor necrosis factor (TNF-alpha)-induced chemotaxis. Our results suggest that invertebrate hemocytes are able to respond to CRF and ACTH fragments that in turn provide further evidence of the complexity of intercellular signaling within the immune system in relatively primitive animals. Thus, auto- and neuroimmunoregulatory activities in mammals must have had an earlier beginning than previously believed.

Adrenocorticotropic Hormone↗
PubMed1994

Ascites apheresis, concentration and reinfusion for the treatment of massive or refractory ascites in cirrhosis.

A new method for ascites recirculation, consisting of a cellulose diacetate filter to remove substances with molecular weight > or = 300,000, cell debris and bacteria, followed by the concentration of ascitic fluid prior to i.v. infusion, was used 24 times in 19 patients with cirrhosis and massive or refractory ascites. The amount of ascites removed was 7.67 +/- 0.49 l, which was reduced to 407 +/- 37 ml. The procedure took 367 +/- 22 min to complete. No statistically significant changes in liver function tests, coagulative parameters, platelet count or natremia were found. The activity of coagulation and fibrinolytic systems was further assessed in six patients. No changes suggesting an activation of intravascular coagulation and/or primary fibrinolysis were disclosed. An asymptomatic fall in mean arterial pressure (from 88.6 +/- 2.6 to 80.3 +/- 3.0 mmHg; p = 0.02) occurred after paracentesis and was still present 48 h after ascites reinfusion. Plasma renin activity significantly decreased at the end of the procedure, but was not associated with a proportional reduction of plasma aldosterone concentrations. Both variables returned to baseline values 48 h later. A significant increase in the glomerular filtration rate occurred just after the end of the procedure (from 50.4 +/- 9.1 to 73.1 +/- 23.5 ml/min; p < 0.05) and subsided 48 h later. In contrast, no significant changes in diuresis and renal sodium excretion were found. Complications due to volume overload and sepsis did not occur; in one case, spontaneous bacterial peritonitis developed 3 days after the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Renal sodium handling in cirrhosis with ascites: mechanisms of impaired natriuretic response to reclining.

We recently showed that patients with compensated cirrhosis can dispose of their fluid overload while reclining. In contrast, patients with ascites fail to develop supine-induced natriuresis. To assess the effect of reclining on renal sodium handling in patients with advanced cirrhosis and the mechanisms blunting natriuresis in this situation, renal function and plasma concentrations of atrial natriuretic factor, aldosterone and norepinephrine were evaluated in 10 nonazotemic patients with cirrhosis and ascites and 10 healthy controls standing for 2 h and reclining for 2 h. While standing, all patients showed marked sodium retention and significantly elevated plasma atrial natriuretic factor levels, aldosterone and norepinephrine. Glomerular filtration rate did not differ from healthy controls. The reclining increased renal sodium excretion in both groups, but this change was far less marked in patients; natriuresis only rose to the control range in two of them. An increase in atrial natriuretic factor and a depression of plasma aldosterone and norepinephrine was seen in both controls and patients. In the latter, despite the greater change in atrial natriuretic factor and aldosterone, the aldosterone to atrial natriuretic factor ratio, which was inversely correlated with natriuresis during both standing and reclining remained significantly elevated. In the two patients who achieved normal natriuresis during reclining, reclining was associated with both the normalization of the aldosterone/atrial natriuretic factor ratio, and with an increase in glomerular filtration rate. The supine-induced increase in atrial natriuretic factor was not only preserved but was even enhanced in cirrhosis with ascites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗