Biomedical subjects
Publications and source records attributed to M Galli.
Haemochromatotic cardiomyopathy is the main cause of morbidity and mortality in patients with beta thalassaemia major. Once congestive heart failure develops most patients die in a few months. Congestive heart failure was reversed and echocardiographic findings were restored to normal in a 24 year old woman with beta thalassaemia who resumed treatment with chelation therapy (desferrioxamine).
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Recurrent pericardial effusion or tamponade can complicate malignant disease. The medical approach with pharmacologic agents has a high recurrence rate. Balloon pericardiotomy (BP) may provide a less invasive alternative to surgery. We performed BP in ten high-risk patients with malignant pericardial tamponade (MPT). BP was performed with aseptic technique under fluoroscopic and echocardiographic guidance. We used a percutaneous subxiphoid approach. A 20- to 25-mm-wide and 4-cm-long balloon was introduced over a stiff guide wire, positioned across the parietal pericardium, and manually inflated until the waisting disappeared. Echocardiographic study and chest radiograph were taken before, immediately after the procedure, and during follow-up. The procedure was successful and well tolerated in all patients. There were no immediate or late complications. No patients developed recurrence of pericardial effusion at up to 10 months' follow-up. In conclusion, BP can be performed in patients with MPT with high rate of procedural success. It may become the preferred treatment to avoid a more invasive procedure in these critically ill patients.
AIDS epidemic began about 15 years ago; since then, the number of new cases have increased over time. By the end of 1994, 1,025,073 AIDS cases had been reported to the WHO, with a 20% increase in the number of cases since December 1993. As is now evident that the majority of cases occur in developing countries, under-diagnosis, under-reporting and delays in reporting explain the big difference existing between reported and estimated AIDS cases, giving a 4.5 million cumulative AIDS cases worldwide, as of late 1994. In the industrialized countries, the spread of HIV infection began in the late 1970's or early 1980's among homosexual men and IVDU's. Heterosexual transmission was, at first, very limited, though recent data has shown an increase in its diffusion. On the contrary, in Sub-Saharan Africa and the Caribbean, transmission was almost exclusively heterosexual. High rates of infection among young women led to a corresponding increase of perinatal transmission, infecting more than 1.5 million children since the beginning of the pandemic. The estimated number of HIV infections worldwide, as of late 1994, is of 17 millions. Thus, even if some evidence indicates a possible decline of the pandemic in industrialized countries over the next few years, probably because heterosexual transmission was less common, developing countries appear to present an increasing number of HIV infections in young people and, consequently, in children. The real impact of such an epidemic is stressed by the fact that HIV is becoming the leading cause of death among, young people, both in industrialized and developing countries.(ABSTRACT TRUNCATED AT 250 WORDS)
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In a multi-centre retrospective study, we compared clinical and laboratory data in 913 patients with cryoglobulinaemias, divided as: (i) essential cryoglobulinaemias; (ii) cryoglobulinaemias secondary to connective tissue diseases (CTD), lymphoproliferative or other haematological diseases (LPD), chronic liver diseases (CLD), and 'other diseases'. Purpura was the commonest presenting feature in all groups and was more common in essential cryoglobulinaemias (p < 0.0001). Meltzer's triad (purpura, arthralgia, weakness) was less frequent, but similarly distributed. Renal involvement was randomly distributed. Neurological impairment was less frequent in cryoglobulinaemias secondary to CLD (p < 0.002). Raynaud's phenomenon, arthritis and sicca syndrome were more frequent in cryoglobulinaemias secondary to CTD. Essential cryoglobulinaemias had a significantly higher percentage of serum complement C4 < 8 mg/dl (p < 0.004), of detectable rheumatoid factor activity (p < 0.0002), and of type II cryoglobulins (p < 0.0001). Liver involvement was evident at presentation in 32.6% of essential cryoglobulinaemias, 27.1% of cryoglobulinaemias secondary to LPD and 12.2% of cryoglobulinaemias secondary to CTD. Antibodies to hepatitis B surface (HBsAg) and core (HBc) antigens were more frequent in cryoglobulinaemias secondary to CLD; anti-HBs antibodies were randomly distributed. Antibodies to hepatitis C (HCV) were tested for in 224 patients, and prevalence was high in all the groups, but lower in cryoglobulinaemias secondary to CTD (p < 0.0001). Type II and type III essential cryoglobulinaemias differed significantly in renal involvement (p < 0.0001), cryocrit > 3% (p < 0.0001), C4 < 15 mg/dl (p < 0.001), HBsAg prevalence (p < 0.01) and purpura (p < 0.05). Despite the high prevalence of HCV markers in all groups, the role of HCV in essential cryoglobulinaemia is not well defined; HBV seems to play only a marginal role.
UNLABELLED: Lung uptake of 201Tl is a reliable marker of left ventricular dysfunction. The goal of our study was to establish whether the evaluation of lung-to-heart uptake ratios (LHR) with 99mTc-sestamibi imaging may provide valuable information. METHODS: We studied 72 male subjects with recent anterior myocardial infarction undergoing 99mTc-sestamibi first-pass ventriculography and SPECT perfusion imaging. A group of 46 gender-matched subjects with low pre-test likelihood of CAD and normal exercise and rest 99mTc-sestamibi perfusion images was used as a control. The lung-to-heart count ratios (LHR) were calculated on planar projections from the sets of SPECT images. RESULTS: Both groups were studied at rest and after a symptom-limited exercise tolerance test. In the control group a significant decrease in LHR was observed during stress (p < 0.001). The infarcted group showed significantly higher LHR values both at rest and at stress. Exercise and rest LHR values did not differ significantly. A positive correlation was observed between LHR values and left ventricular ejection fraction at rest and stress. CONCLUSION: LHR, measured by 99mTc-sestamibi imaging, gives clinically useful information. Both resting and postexercise values are correlated with ejection fraction and should predict left ventricular dysfunction.
The intraoperative frozen section technique has proven to be valid and accurate in the diagnosis of palpable breast lesions, while its use in non-palpable lesions of the breast has been recently discussed. In order to estimate the accuracy of frozen section technique in non-palpable breast lesions we reviewed our series of 672 cases of non-palpable lesions examined intraoperatively between January 1977 and December 1991. Frozen section diagnoses were compared with diagnoses obtained at review of the permanent paraffin sections. A review of the mammographic pattern of each lesion was also carried out. Frozen section diagnosis was replaced by permanent paraffin sections in 22 cases (3.3%). Benign or malignant (in situ and invasive carcinomas) frozen section diagnoses were accurate in 623 of 650 cases (95.8%). Frozen section diagnosis was modified on the basis of permanent sections in 27 cases (4.2%), with 3 false positives and 24 false negatives. Sensitivity and specificity of frozen section technique were 91.7% and 99.2%, respectively. Comparing frozen section and definitive diagnosis according to the mammographic pattern, sensitivity was lower in patients with microcalcifications as the only alteration (88.8%) compared with patients with opacities (94.9%). On the basis of our results the frozen section technique in non-palpable breast lesions is to be considered a valid and reliable diagnostic procedure, particularly in lesions detectable at mammography as an opacity and identifiable on gross examination of the surgical specimen.
Antibodies against phospholipid antigens (APA) have been demonstrated in idiopathic thrombocytopenic purpura (ITP), but their clinical and pathogenetic significance has remained elusive. In this study we analyzed the prevalence and clinical features of ITP patients with elevated APA. In addition, we prospectively evaluated APA levels after treatment with corticosteroids and compared them with platelet-associated immunoglobulin (PAIgG) titers. We studied 149 patients with newly diagnosed ITP. Of these, 78 had a platelet count less than 50 x 10(9)/L and received an initial treatment with oral prednisone (PDN). In 71 asymptomatic cases with platelet counts between 50 x 10(9)/L and 120 x 10(9)/L, no therapy was scheduled. However, in five of them, the platelet count fell below 50 x 10(9)/L after more than 12 months; these patients were treated with PDN. Tests for APA included the measurement of anticardiolipin antibodies (ACA) with a solid-phase immunoassay and the detection of the lupus-like anticoagulant (LA) activity with coagulation tests that included kaolin-clotting time, dilute Russel's Viper venom time, activated partial thromboplastin time (aPTT), and dilute aPTT. Controls consisted of 174 apparently healthy subjects. Either LA or elevated ACA was seen in 69 patients (46.3%) at diagnosis. LA and ACA were both elevated in 24 cases (16.1% of the overall patient population and 34.8% of patients with high APA concentrations). No correlation was found between LA ratio values and ACA-IgG or -IgM titers, or between ACA-IgG and ACA-IgM levels. The presence of these antibodies was not associated with sex, age, platelet count, or the severity of hemorrhages. PAIgG was detected in 106 of 127 cases (83%). Again, no relationship was observed with clinical parameters or with APA levels. However, all cases with elevated APA also had increased PAIgG. With regard to the clinical course, we were not able to detect any significant difference between patients with normal and elevated APA. An initial complete response to prednisone treatment was observed in 43 of 83 cases (51.8%), with 13 (15.7%) achieving a prolonged complete remission. APA levels were not significantly modified after PDN therapy and on relapse. We conclude that APA positivity is a common finding in patients with ITP and does not select a category with different clinical features. APA levels are not influenced by immunosuppressive therapy with steroids and are not related to the activity of the disease. Therefore, we do not support a role for APA in the pathogenesis of ITP.
We have developed a monoclonal antibody (BAT) to Daudi B lymphoblastoid cell line membranes. The antibody was selected for its ability to stimulate lymphocyte proliferation. Splenocytes of BALB/c or C57BL mice given i.v. injections of 10 micrograms/mouse of BAT exhibited increased proliferation and cytotoxic activity. A single i.v. administration of BAT monoclonal antibody 2 weeks after B16 melanoma cell inoculation resulted in a striking antitumor effect as manifested by the elimination of lung metastases and prolonged survival of the treated mice. BAT monoclonal antibody was also effective in the regression of tumors in mice bearing 3LL (Lewis lung carcinoma) and MCA-105 (fibrosarcoma). Transfer of 10(7)-10(8) splenocytes from mice that had been given injections of BAT to B16- or 3LL-inoculated recipients led to a reduction of lung metastases. Splenocytes from B16-inoculated mice that were cured by BAT were more effective than those from mice treated with BAT alone against recipients bearing either B16 or 3LL tumors. The antitumor activity of BAT is related to its immunostimulatory properties.
Myocardial sestamibi uptake reflects regional flow distribution and cellular integrity; however, some segments showing reduced tracer uptake at rest may consist of viable, although hypoperfused, myocardium. It is speculated that the administration of nitroglycerin (NTG) before the sestamibi injection would improve the tracer uptake in resting hypoperfused regions. Thirty-six stable patients with previous myocardial infarction (56 +/- 2 years; mean ejection fraction 42 +/- 2%), in whom perfusion defects could be seen at resting sestamibi tomography, repeated the scintigraphic study 2 to 6 days later, receiving NTG (0.3 to 0.6 mg sublingually) before the tracer injection. The size of the tracer uptake defect was quantified from circumferential profiles in 3 short-axis slices by integrating the area below the lower normal limit (mean -2 SD). After NTG, the mean perfusion defect significantly decreased (from 6,324 +/- 619 to 5,365 +/- 516, p < 0.01). The defect was reduced beyond the reproducibility limits in 20 patients (56%, group 1) and was unchanged or increased in 16 (44%, group 2). The resting sestamibi defect size was comparable between the 2 groups. The average percent reduction of the perfusion defect after NTG was 29 +/- 4% (range 7 to 74).(ABSTRACT TRUNCATED AT 250 WORDS)
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A total of 339 post-menopausal women with gastric cancer (GC) and 515 population controls were interviewed in a multicenter study in Italy for information on reproductive history, dietary habits and other socio-demographic variables. After adjusting for these factors, GC risk was significantly higher among women reporting menopause below age 45, while no effect was shown for age at menarche, parity, age at first livebirth, and number of abortions. When age at menopause was considered together with age at menarche for an index of fertility years, GC risk showed a significant inverse relation to duration of fertility. These results suggest a protective role for endocrine or other factors related to late age at menopause or to length of fertility. These findings may be relevant to explain the fact that rates of GC reported among females are lower than among males around the world, and suggest the need for further research into hormonal and other related risk factors.
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Early poststress thallium-201 reinjection to obviate the need for two sets of redistribution images has been proposed as an alternative reinjection protocol although, in a preliminary study, it did not reduce the frequency of late redistribution. The efficacy of the early reinjection protocol was assessed in 102 patients with chronic ischemic heart disease and left ventricular dysfunction who showed severe thallium-201 defects on planar stress images. Thallium-201 was reinjected immediately after the poststress study, and redistribution images were acquired 4 and 24 hours later. By quantitative analysis, a further increase in thallium-201 uptake on 24-hour imaging was documented in only 48 (6%) of 740 segments still abnormal on 4-hour images, 26 (54%) of which were represented by partially reversible or not severe fixed defects. Overall, late thallium-201 uptake was less frequently observed in patients with depressed ejection fraction (p < 0.05). Clinically relevant late reversibility was found in only 3 (3%) of 94 patients. Scans were repeated after revascularization in 20 patients. Tracer uptake improved in 40 (34%) of 118 segments with 4-hour defect: the improvement mainly (85%) involved those segments already showing partial 4-hour reversibility or mild fixed defects on the preoperative study. Thus a negligible late tracer redistribution was found in patients with severe stress thallium-201 defects undergoing early reinjection and 4-hour imaging; no significant 24-hour improvement was observed in those patients with depressed ventricular function and fixed 4-hour defects. This simpler imaging protocol could obviate the need for additional late imaging to detect residual viability.
We studied upper limb somatosensory evoked potentials (SEPs) in 11 patients with MRI and clinical evidence of cervical spondylotic myelopathy (CSM), before and after cervical open-door laminoplasty. SEP studies before surgery revealed two main types of abnormality, the first characterized by the isolated loss of the spinal N13 response, reflecting the dysfunction of dorsal horn cervical cells in 4 patients. The second combined abnormalities of both spinal N13 and scalp far-field P14 potential, suggesting the involvement of both dorsal horn cells and dorsal columns at the cervical level in 7 patients. After surgery, N13 recovered in 9 patients, while P14 abnormalities remained unchanged. Clinical recovery, evaluated by means of the Japanese Orthopaedic Association (JOA) disability scale, was accompanied by SEP improvement. Moreover, this improvement was more pronounced in patients with isolated loss of the N13 than in patients with combined abnormalities of the N13 and scalp P14 response. Our data strongly suggest that upper limb SEPs can be useful in monitoring the effectiveness of surgery, as well as in selecting before surgery patients who are likely to have a better postsurgical outcome.
Twelve pathologists independently examined and classified a set of 25 cases of non palpable breast lesions selected from the archival files of the Pathology Department in Florence. A final consensus diagnosis was reached for all cases at a slide seminar. Individual diagnoses were first combined in 3 broad categories (benign lesion, in situ and invasive carcinoma), then compared to each other and then to the "consensus". Results show that among these 12 pathologists there was complete agreement in 14 cases. Discrepancies for the other 11 cases varied in the number of pathologists and diagnostic categories involved. Overall agreement was excellent (median kappa 0.86) but cases of potentially harmful errors were evident. The authors discuss these findings in the frame of a breast cancer screening program planning.