[Behavior of thyroid hormones in chronic hepatopathies].
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Adult↗
Biomedical subjects
M Campanini
Publications and source records attributed to M Campanini.
Sequential changes in plasma renin activity and plasma catecholamines in mildly hypertensive patients during acute, furosemide-induced body-fluid loss.
To evaluate the role of adrenergic mechanisms in the acute response of renin to furosemide, plasma renin activity (PRA) and plasma catecholamine concentrations were measured for 3 h after i.v. administration of furosemide 1 mg/kg to 8 patients with mild essential hypertension. Furosemide induced a prompt and long-lasting increase in renin, with PRA more than doubled at all times. The increase in PRA within the first 30 min paralleled the peak increases in urinary water and sodium flow rates, and significant decreases in plasma volume and central venous pressure. There was no change in plasma catecholamine concentrations. Plasma noradrenaline was increased significantly at 60 min and adrenaline at 90 min, once furosemide had induced a marked loss of body-fluid and approximately 65% decrease in central venous pressure. Both catecholamines remained elevated until the end of the study, whereas urinary water and sodium flow rates had returned to their pre-treatment values by 150 min. Mean blood pressure was essentially unchanged throughout the study, whereas heart rate increased significantly after 90 min. The findings suggest that in mildly hypertensive patients adrenergic mechanisms are not involved in the initial renin response to furosemide, but they come into play later, probably as a result of reflex sympathetic activation triggered by marked volume depletion.
Adult↗
Effects of light saline loading on renal renin and catecholamine release in hypertensive humans.
In 8 essential hypertensive patients infusion of 7.5 ml kg-1 b.w. of isotonic saline over 20 min decreased plasma renin activity but did not affect plasma adrenaline or noradrenaline concentrations in suprarenal aortic, renal venous and caval blood. Mean blood pressures and heart rates were unchanged throughout the saline infusion period, whereas the hematocrit was significantly decreased. These data suggest that inhibition of renin secretion after slight volume expansion with saline in hypertensive humans occurs without parallel inhibition of either renal neurosympathetic drive or humoral adrenergic tone to the kidney through circulating catecholamines.
Adult↗
[Clinical effects of a clonidine-chlorthalidone combination in the treatment of arterial hypertension].
Clonidine (0.075-0.225 mg/day) and chlorthalidone (0.15-0.45 mg/day) were associated in the management of 23 cases of arterial hypertension of varying nature and gravity. A significant and satisfactory decrease in pressure was accompanied by reduced cardiac frequency. Diuresis, body weight and the main biohumoral indices were not significantly affected. The mechanism of action of the two drugs is explained and the reason why success was obtained with their combination in less-than-normal doses is discussed.
Adult↗
Hypocryoglobulins: a method to increase cryoprecipitation.
We used both the conventional test and a modified assay, the hypocryoglobulin test, to detect cryoprecipitates in 90 patients; 79 of them had different diseases in which cryoglobulins are frequently seen. For 11, type II essential mixed cryoglobulinemia had previously been diagnosed. It is still uncertain whether dilution of serum is a real help for detection of cryoglobulins. In the group of 79 patients, we found enhancement of cryoprecipitation in hypotonic sera in 33% of the cases, all with low cryocrit levels (less than 2%). In all but one of the patients with type II cryoglobulins, the hypocryocrit was equal to or lower than the cryocrit. The hypocryoglobulin test can detect a cryoprecipitate in patients with conventional cryocrits near the limits of visibility. In a few cases of cryoglobulinemic vasculitis, dilution of the serum can disclose a cryoprecipitate otherwise not visible.
Adolescent↗
Cryodependent and cryoproducing involvement of organs in type II essential mixed cryoglobulinemia.
A review of the less frequent organ damage seen in the so-called essential mixed cryoglobulinemia, and distinguishing between cryodependent and cryofavouring organ involvement, is presented in this paper. In the first group, along with the well-known renal, cutaneous and articular lesions, the peripheral neuropathy and respiratory involvement, to date too little considered, are worthy of more accurate study. Gastroenteric and cardiac participations are rare. Among the cryofavouring manifestations of the disease, we have pointed out those affecting the liver. In our experience, however, as the immunohistochemical findings suggest, the histological patterns usually considered to be chronic persistent hepatitis are frequently an expression of a lymphoproliferative lymphoma-like process. A noteworthy percentage of lymphoid cells in the bone marrow has been found in 22 type II cryoglobulinemias after either needle puncture or osteomedullary biopsy. The histological pictures often resemble a lymphoproliferative disease. Clinical and laboratory (computerized tomographic scan) researches frequently show a moderate splenomegaly, but in none of the patients was superficial or deep lymph node enlargement found. The authors conclude by considering type II essential cryoimmunoglobulin to be a sign and a marker of a low-grade proliferative disease with rare evolution into overt lymphoma. At the same time, however, cryoimmunoglobulins themselves cause important injuries that affect the prognosis of the syndrome.
Bone Marrow↗
Flare and tumor lysis syndrome with atypical features after letrozole therapy in advanced breast cancer. A case report.
Tumor lysis syndrome, which develops after effective therapy of malignant conditions and leads to hyperuricemia, hyperkaliemia, hyperphosphatemia, hypocalcemia and elevated lactate dehydrogenase, is uncommon in solid tumors. In breast carcinoma it can be associated with tamoxifen flare, i.e. a transient increase in symptoms, mainly bone pain, observed shortly after the start of tamoxifen therapy. We report the case of a patient with advanced breast carcinoma involving the pleural space, unresponsive to combined chemotherapy, who experienced rapid worsening after the initiation of letrozole. Her symptoms included shock, bilateral pleural effusion, cardiac tamponade and oliguria. Laboratory parameters disclosed elevated transaminase, lactate dehydrogenase, uric acid and D-dimer blood levels. The patient was in critical condition for nearly 2 weeks. She improved progressively and has remained well and in complete remission for 20 months. This clinical picture suggests increased damage to the pleura (and probably the pericardium) and rapid leakage of tumor products, following the start of endocrine therapy. Letrozole is a non-steroidal aromatase inhibitor which is used in advanced breast cancer, resistant to first-line endocrine/chemotherapeutic treatment. Our review of the literature did not disclose any other descriptions of flare and tumor lysis syndrome after aromatase inhibitor therapy. Moreover, this case was characterized by atypical and complex clinical features. The aim of this presentation is to point out the practical significance, in neoplastic patients, of the differential diagnosis between symptoms due to tumor progression and those associated with anomalous reactions to therapy.
Antineoplastic Agents↗
[Renal transport and blood levels of uric acid during long-term administration of a derivative of pyrazinamide, the morphazinamide].
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Adult↗
Hepatotoxicity of hydroxy-methyl-glutaryl-coenzyme A reductase inhibitors.
The first clinical studies on hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors reported a low incidence of liver toxicity. The personal observation of a case of simvastatin-induced acute cholestatic hepatitis prompted us to evaluate the true incidence of hepatic side effects of these drugs in a large Italian population. One hundred patients taking simvastatin and ninety patients treated with pravastatin were followed-up six months with periodical evaluation of serum lipid levels and liver function test. In 5% of simvastatin-treated patients and 4.5% of pravastatin-treated patients significant liver toxicity was observed, which required drug discontinuation. The mechanism of liver damage was direct, idiosyncratic, but immunological features of drug toxicity could be hypothesized in one patient.
Chemical and Drug Induced Liver Injury↗
[Heart involvement in anorexia nervosa: an electrocardiographic, functional and morphological study].
Mental anorexia (MA) is the most frequent condition of malnutrition in industrialized countries. Sudden death in MA is not infrequent. Furthermore, the role of nutritional state as an important determinant of myocardial function is known. Cardiovascular function was studied in 9 patients with MA. Blood electrolytes and thyroid function were assessed, basal and dynamic ECG, chest roentgenogram, M-mode echocardiography, ergometric test, cardiac output measurement and, in two cases, magnetic nuclear resonance (MNR) were performed. Our data confirm the ECG changes which were preeminent in the clinical context, as predictors of possible major, life-threatening arrhythmic events. The correct QT interval was normal in all patients. In 4 cases with heart rate less than 40 b/min, Holter ECG showed ventricular and atrial extrasystolic beats. In one case S-A blocks with idioventricular substitutive beats were recorded; the normal performance under maximal strain stands for a normal functional reserve. Blood electrolytes were in the normal range. The hypothalamic-pituitary axis can be considered as a cocausal factor by means of autonomic nervous system modulations. Echocardiography revealed only a mild reduction of ventricular wall thickness. Scattered degenerative myocardial involvement as shown by MNR imaging, could be the anatomical counterpart of a clinically emerging cardiomyopathy with potentially severe arrhythmias.
Adolescent↗
[IgE-mediated allergy to ethylene oxide in hemodialyzed patients].
Ethylene oxide (ETO) is widely employed in sterilization of hemodialysis materials. Many studies have shown that ETO may act as an antigenic compound when bound to human albumin, therefore eliciting allergic reactions during hemodialysis. In the present study, we investigated in 93 patients undergoing long-term hemodialysis the prevalence of sensitization to ETO. All the patients were investigated for the presence of allergic or pseudo allergic reactions during the treatment. Specific IgE to ETO were found in sera of 3 patients: 1 suffered from urticaria and 1 from glottic edema and hypotension during the dialysis. The third one had non symptoms. The employ of a gamma-rays sterilized filter determined the disappearance of clinical manifestations in the two symptomatic patients, therefore suggesting a pathogenetic role of the specific IgE to ETO in determining the clinical manifestations.
Angioedema↗
[Lipoprotein (a)].
Lipoprotein(a) [Lp(a)] is a high molecular weight plasma protein structurally related to low density lipoprotein (LDL), but with distinct metabolic and biologic features. Six different isotypes may be found among the general population; they are inherited as a codominant autosomic monogenic trait. Lp(a) levels in the blood are strictly conditioned by the isotype and much less, if at all, by other environmental or metabolic factors. The Lp(a) catabolic rate is very similar among different individuals and comes from the balance of two complementary pathways: uptake from blood by tissue cells via LDL-receptors, and non-receptor macrophagic internalization at the level of the reticulo-endothelial system. Its high content in lysolecithins and cholesterol, and the close structural similarity of its peptidic component to plasminogen, make Lp(a) a crucial "meeting point" of two main physiopathologic elements of atherogenesis:lipoprotein metabolism and fibrinolysis. This particular role would seem to explain the experimental finding of a close relation between Lp(a) plasmatic levels and the severity of atheromatous processes. Deep understanding of Lp(a) physiopathology is therefore expected to be a powerful tool for the creation of a comprehensive and practical model of atherogenesis and to enable us to deal with prognostic, preventive and therapeutic problems in this field from a new view point.
Arteriosclerosis↗
Primary lymphoma of the central nervous system. A clinical and immunohistological study of 8 patients.
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Adult↗
[Blood cryoglobulins and liver diseases].
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Acute Disease↗
[Determination of serum ferritin in hemodialyzed patients].
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Adolescent↗
[Lipid metabolic disorders in obesity: their epidemiology, physiopathology and clinico-therapeutic implications].
The centralization of body fat, particularly in abdominal or visceral depots, is associated with qualitative and quantitative lipid abnormalities. Examples of these qualitative alterations include changes in low density lipoprotein composition, namely an increased number of small or dense low density lipoprotein particles, which seem to be prone to increased lipid oxidation. Oxidative modification of low density lipoproteins is involved in atherosclerotic development of the arterial wall. Alterations of lipid composition often arise in a context of insulin resistance with hyperinsulinism. Genetic features, such as apolipoprotein E polymorphism, also play a significant role in lipoprotein metabolism. The principle treatment of obesity and associated dyslipidemia is to reduce energy intake through diet. Moderate exercise is effective, especially in patients with insulin resistance. Drug therapy is considered primarily for patients who refuse to make behavioral changes.
Humans↗