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Biomedical subjects

M Mercuri

Publications and source records attributed to M Mercuri.

At least 91 records · Page 5Linked to original sources
PubMed1996

Ultrasound protocol and quality control procedures in the European Lacidipine Study on Atherosclerosis (ELSA).

The European Lacidipine Study on Atherosclerosis (ELSA) is a multinational interventional clinical trial aimed at determining the antiatherosclerotic effects of Lacidipine, a calcium antagonist, when compared to atenolol, a beta-blocker, on the carotid arteries of 2300 cardiovascular asymptomatic patients with moderately high blood pressure. Quantitative B-mode ultrasound imaging is being used to measure the intima-media thickness of a standardized section of the carotid arteries including the distal common, bifurcation, and proximal internal carotids. Prospective investigations of large samples of population using ultrasonographic endpoints rely heavily on the precision and reproducibility of the method. Therefore, specific quality control protocols are required to determine and monitor cross-sectional and longitudinal stability of the measurement reproducibility. In ELSA, the ultrasound methodology was specifically designed to include a set of procedures to quality control the critical components of measurement variation including instrumentation, and ultrasound operators, i.e. sonographers and readers. The ELSA clinical trial will provide the largest set of prospective quality control data on the use of quantitative B-mode ultrasound imaging.

Arteriosclerosis↗
PubMed1996

[Extraskeletal retroperitoneal osteosarcoma. A case report and review of the literature].

Extraskeletal osteosarcomas, localized in the retroperitoneal space, are very rare neoplasms (only 200 cases have been described); the case indicated is the second one observed in Literature. The extraskeletal osteosarcomas are very malignant mesenchymal neoplasms reproducing osseous and cartilaginous tissue disconnected from the skeletal system. From a histological point of view, the extraskeletal osteosarcomas are constituted of osseous and cartilaginous tissue with osteo-fibro-chondroblastic cells: the different representation of three types of cells define the variety of extraskeletal osteosarcomas (osteoblastic, chondroblastic, fibroblastic). Histological and ultrastructural study failed to find differences between skeletal and extraskeletal osteosarcomas. In the clinical history of some patients traumas or irradiation has been referred; although extraskeletal osteosarcomas etiology is frequently unknown. Diagnosis is generally delayed because symptoms are often absent of uncertain. Prognosis of these neoplasms is always very poor, and specially in relation to the dimension and to the possibility of its radical removal. All patients died until 2-3 years after surgery.

Aged↗
PubMed1995

Inverse relationship between cardiorespiratory fitness and carotid atherosclerosis.

The association between cardiorespiratory fitness (VO2max) and carotid atherosclerosis was analyzed in 163 men, aged 50 to 60 years. VO2max was assessed using breath-by-breath respiratory gas analyses during maximal exercise stress test. Atherosclerosis was evaluated quantitatively as intima-media thickness (IMT) of the right and left carotid arteries by high-resolution B-mode ultrasonography. Mean VO2max was 29.6 ml/kg per min (95%CI 28.7;30.5), common carotid IMT 1.04 mm (95%CI 1.01;1.07) and carotid bifurcation IMT 1.73 mm (95%CI 1.66;1.81). VO2max correlated inversely with carotid bifurcation IMT (r = -0.31, P < 0.001), but not with common carotid IMT (r = -0.13, P = 0.102). Men in the highest quartile of VO2max had lower (P < 0.001) bifurcation IMT 1.51 mm (95%CI 1.41;1.61) than men in the lowest (1.95 mm (95%CI 1.75;2.16)) and in the second lowest VO2max quartile (1.79 mm (1.63; 1.95)). The difference persisted (P = 0.014) after controlling for age, LDL-cholesterol, systolic blood pressure, saturated fat intake, current health status and exercise-induced ST-segment depression. These data suggest that cardiorespiratory fitness is an important independent predictor of carotid atherosclerosis in middle-aged men.

Arteriosclerosis↗
PubMed1995

Dedifferentiated chondrosarcoma.

We reviewed 74 cases of dedifferentiated central and peripheral chondrosarcoma. Histologically these tumours consist of an underlying cartilaginous component (either benign or malignant) juxtaposed to a high-grade non-cartilaginous component, with a typically abrupt transition between the two tissue types. The non-cartilaginous component may constitute a very small or a very large proportion of the tumour, so diagnosis often requires histological evaluation of the entire tumour. The diagnosis is often suspected on the basis of the clinical course and careful evaluation of the radiographic characteristics. Central dedifferentiated chondrosarcoma can be classified radiographically into three types. In type I (36 cases in our review) the radiographic features are the same as those of a central chondrosarcoma, with the addition of a region with very aggressive radiographic features. Type 2 lesions (20 cases) resemble the underlying benign enchondroma but also have destructive changes and/or a large soft tissue mass. Type 3 lesions (8 cases) are not distinctive radiographically and present as a very high grade destructive lesion of bone. These cases are diagnosed following biopsy or tumour resection. The prognosis of these tumours is extremely poor, with 13% overall 5-year survival in this series. Improved survival was found in those cases where diagnosis was prompt and surgical treatment with a wide or radical margin was attained. No benefit was found from the use of adjuvant chemotherapy or radiotherapy. Thus, early recognition of the characteristic radiographic features, adequate histological sampling, and wide or radical surgical margins are necessary for satisfactory management of this highly malignant variant of chondrosarcoma.

Adult↗
PubMed1995

Ultrasonographic correlates of carotid atherosclerosis in transient ischemic attack and stroke.

BACKGROUND AND PURPOSE: Atherosclerotic plaques in extracranial carotid arteries, particularly in the bifurcation of the common carotid and internal carotid arteries, may cause transient cerebral ischemia and stroke by lumen stenosis or plaque-related thromboembolism. B-mode ultrasound imaging has the capability of providing information on plaque thickness, characteristics, and location in carotid arteries. METHODS: A retrospective analysis of 242 stroke and 336 transient ischemic attack (TIA) patients, recruited for the B-Scan Ultrasound Imaging Assessment Program, was performed to determine the ultrasonographic correlates of carotid atherosclerosis and acute cerebral ischemia. A matched case-control study design was used to compare brain hemispheres with ischemic lesions ("cases") to unaffected contralateral hemispheres ("controls") with regard to the presence and characteristics of carotid artery plaques. RESULTS: The first set of analyses examined the association between the presence of carotid plaques ipsilateral to the brain lesion and the occurrence of stroke or TIA and showed an association with recent episodes of TIA and stroke (odds ratio [OR], 1.6; P = .03) but not with past episodes. In a subset (n = 232) of patients with plaques in both carotid arteries and recent cerebral ischemic events, stroke was associated with ipsilateral carotid artery occlusion (P = .02). Lumen measurements at the site of the minimum residual lumen (MRL) diameter showed a significant association between a narrower lumen diameter in the carotid artery ipsilateral to case hemisphere and stroke (difference, 1.0 mm; P = .0003). TIA patients showed an association between both hypoechoic carotid plaques (OR, 3.0; P = .005) and the presence of longitudinal lesion motion (OR, 3.0; P = .02) with ipsilateral brain involvement. Plaque thickness at the MRL was positively correlated with both ipsilateral TIA (ipsilateral side, 4.4 +/- 0.15 mm; contralateral side, 3.9 +/- 0.16 mm; P = .007) and stroke (ipsilateral side, 4.2 +/- 0.23 mm; contralateral side, 3.3 +/- 0.21 mm; P = .0006). CONCLUSIONS: These data demonstrate significant relationships between carotid artery ultrasound plaque characteristics and ischemic cerebrovascular events. These findings encourage further prospective studies in asymptomatic subjects focused on echographic carotid plaque characteristics as predictors of subsequent TIA or stroke.

Aged↗
PubMed1995

Carotid atherosclerosis in middle-aged men. Relation to conjugal circumstances and social support.

The purpose of this study was to examine the association of conjugal circumstances and social support with carotid atherosclerosis. The subjects were 212 men randomly selected from those (N = 4,853) aged 50-60 years, living in Kuopio and a nearby residental area in eastern Finland. Social network and support levels were assessed with a structured 34-item questionnaire. Conjugal circumstances were constituted by cohabition or otherwise. Intima media thickness of the carotid artery (IMT) was chosen to designate atherosclerosis, and determined by quantitative B-mode ultrasonography. The analyses showed that the men living alone had greater common carotid (p = 0.008) and carotid bifurcation (p = 0.011) IMT values than their cohabiting counterparts. The differences remained significant even when the confounding factors (age, health status and education level) and potential intervening factors (saturated fat consumption and smoking) were allowed for. Of the social support subindices, strong adequacy of emotional support (p < 0.001) and of the social network subindices, strong social anchorage (p = 0.031) were correlated to increased common carotid IMT. The present data suggest that conjugal circumstances are an independent social factor predicting carotid atherosclerosis.

Arteriosclerosis↗
PubMed1995

Quantitative ultrasonographic evaluation of the carotid arteries in hypertension.

Current treatment goals for hypertension include the prevention of end-organ injuries. Hypertension is certainly among the major contributors to atherogenesis, and many antihypertensive drugs seem to have wall-protecting properties. It is critical to identify, test, and implement non-invasive methods for the screening of the population in order to detect early wall abnormalities and to monitor the long-term effects of different antihypertensive treatments. Among these methods, B-mode ultrasound examination of carotid arteries has shown great potential in evaluating treatments that may prevent hypertension-related wall injuries.

Antihypertensive Agents↗
PubMed1995

[Endobronchial lipoma: endoscopic resection or surgical excision? Report of a case and review of the literature].

The Authors report a case of endobronchial lipoma, a rare, benign lung lesion. Literature data show that a correct preoperative diagnosis of nature is possible in less than 50% of all the cases and a thoracotomy is mandatory in 85% of the patients because FNAB or brushing rarely allow a certain cytological diagnosis. When a benign tumor is suspected, an endobronchial resection is the treatment of choice, allowing a correct histological diagnosis and in the same time a definitive therapy with resolution of symptoms. Surgical option is reserved for the not certainly determined benign or malignant lesions.

Aged↗
PubMed1995

[Neoadjuvant treatment of Ewing's sarcoma: results obtained in 122 patients treated with a 6-drug chemotherapeutic protocol (vincristine, adriamycin, cyclophosphamide, dactinomycin, ifosfamide and etoposide)].

From January 1988 to October 1991, one hundred and twelve patients with non metastatic Ewing's sarcoma of bone were treated with a 6 drugs neoadjuvant chemotherapy protocol (IOR/Ew2) in which, to the four drugs usually used in the treatment of this tumor (vincristine, adriamycin, cyclophosphamide and dactinomycin), Ifosfamide and VP-16 were added. The local treatment consisted of radiation therapy in 52 cases, a surgical treatment was performed in 27 cases and in the remaining 33 cases both the previous treatments were used. At a mean follow-up of 4.5 years (3-6.5), 62 patients (55.3%) remained continuously free of disease and 50 relapsed: 41 with metastases, 8 with mestastases and local recurrence and 1 with local recurrence alone. These results do not differ from the ones obtained in our Institution in 98 patients treated between 1983 and 1988 with a neoadjuvant protocol (IOR/Ew1) in which only VCR, ADM, CTX and actD were used (3 year CDFS: IOR/Ew2 = 60.7%-IOR/Ew1 = 55.1%). In IOR/Ew2 a higher DFS rate was observed in the patients with tumor located in the axile bones in comparison with that obtained in the previous study (IOR/Ew2 = 48.6%, IOR Ew1 = 25.6%). Despite the fact that these results came from a not-randomized study, the authors conclude that the addition of Ifosfamide and VP-16 to the four drugs standard regimen do not improve the outcome of patients with Ewing's sarcoma of bone, with the possible exception of the patients with tumor located in the axile bones. This data should be confirmed in further and larger studies.

Adolescent↗
PubMed1995

Potential modification of plaque behavior through the European lacidipine study on atherosclerosis.

The European Lacidipine Study on Atherosclerosis (ELSA) has been designed to compare the effects of two antihypertensive agents, the calcium antagonist lacidipine and the beta-blocker atenolol, on the development of atherosclerosis in hypertensive patients stratified according to the presence of carotid plaques, or the presence or absence of carotid artery intima-media thickening. ELSA is a multinational, multicenter, randomized, double-blind, parallel group study that is to be conducted over a 5-year period. Recruitment and treatment will take place at 23 referral centers in seven countries. A total cohort of 3,660 patients, aged between 45 and 75 years, with diastolic blood pressure 95-115 mm Hg and systolic blood pressure < or = 210 mm Hg at enrollment, will be stratified into three groups according to a B-mode ultrasound analysis of the carotid wall morphology. After a 1-month placebo run-in period, patients will be randomized to receive either lacidipine (4-6 mg once daily) or atenolol (50-100 mg once daily). Nonresponders will be treated with hydrochlorothiazide (12.5 mg, eventually titrated to 25 mg if required), on an open basis. During the course of the study, patients will be monitored by carotid ultrasound assessment and ambulatory blood pressure monitoring. The results of this study should further understanding of the pathobiology of atherosclerosis, and its development and prevention.

Adrenergic beta-Antagonists↗
PubMed1994

Noninvasive imaging protocols to detect and monitor carotid atherosclerosis progression.

It has been shown that B-mode ultrasound imaging is a valid and reliable technique to measure arterial wall thickness. Based on the results of early validation studies and relatively small-scale investigations, large-scale epidemiologic studies using high-resolution ultrasonography were designed to provide information on the association of wall thickness and cardiovascular risk factors, and to determine the prevalence, extent, and severity of peripheral atherosclerosis. Recent reports indicate that ultrasonographic endpoints correlate with the most important cardiovascular risk factors. Furthermore, noninvasive carotid endpoints have been shown to be predictive of clinical atherosclerosis status with a high degree of confidence. B-mode ultrasonography has also been used to evaluate prospectively the natural history of peripheral atherosclerosis by monitoring lesion growth over time. Recently, ultrasonographic measurements of the arterial wall have been chosen as the primary and secondary endpoints for several clinical trials of the antiatherogenic effects of behavioral and pharmacologic interventions on major cardiovascular risk factors such as hypercholesterolemia and hypertension.

Angiography↗
PubMed1994

Association of risk factors and body iron status to carotid atherosclerosis in middle-aged eastern Finnish men.

High body iron stores have been proposed as a risk factor for advanced atherosclerosis. We investigated the prevalence of early atherosclerotic changes, and their relation to conventional CHD risk factors and body iron status. A cross-sectional study was carried out in 206 men aged 50 to 60 years (6% random population sample). Intima-media thickness (IMT) of the carotid artery was evaluated with high-resolution B-mode ultrasonography. Statistical analyses were performed separately for men with and without cardiovascular disease (CVD). Among all the study participants, 6.6% had IMT > 1.3 mm in the common carotid artery, whereas 53.8% had IMT > 1.5 mm in the carotid bifurcation. Respective values were 4.8% and 46.8% for those without CVD, and 8.5% and 62.2% for those with CVD. Mean IMT in the carotid bifurcation, the predilection site for atherosclerosis, was 1.85 mm (95% CI 1.72; 1.98) in the men with CVD, as compared to 1.65 mm (95% CI 1.56; 1.73) in the men free of CVD. Serum LDL cholesterol (beta = 0.26), saturated fat intake (beta = 0.20), blood haemoglobin (beta = -0.29), systolic blood pressure (beta = 0.21) and smoking (beta = 0.19), jointly explained 23% of the variance in the carotid bifurcation IMT in the men without CVD. Neither serum ferritin, transferrin nor dietary iron levels were associated with carotid bifurcation atherosclerosis. On the other hand, in the men with CVD, age (beta = 0.34) and physical activity (beta = -0.25) jointly explained 16.5% of the IMT variance in the carotid bifurcation.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Stenosis↗
PubMed1994

Premature carotid atherosclerosis: does it occur in both familial hypercholesterolemia and homocystinuria? Ultrasound assessment of arterial intima-media thickness and blood flow velocity.

BACKGROUND AND PURPOSE: Homocystinuria due to cystathionine beta-synthase deficiency and familial hypercholesterolemia are inherited disorders of metabolism that are associated with premature development of cardiovascular disease. This study addresses the possibility that different patterns of carotid wall damage and cerebral blood flow hemodynamics are present in these two metabolic diseases. METHODS: Twelve patients with homocystinuria due to cystathionine beta-synthase deficiency (mean age, 24 years), 10 patients with homozygous familial hypercholesterolemia (mean age, 26 years), and 11 healthy control subjects (mean age, 26 years) underwent a vascular examination by noninvasive methods. B-mode ultrasound imaging was used to obtain measurements of intima-media thickness of common carotid, bifurcation, and internal carotid arteries as an index of atherosclerosis. Cerebral blood flow velocity was estimated from vascular examination of the middle cerebral artery by transcranial Doppler. Systolic, diastolic, and mean velocities were measured. Pulsatility index, a possible indicator of vascular resistance in the cerebral circulation, was also calculated. RESULTS: Mean maximum intima-media thickness was 1.4 mm in patients with familial hypercholesterolemia, 0.6 mm in patients with homocystinuria, and 0.6 mm in control subjects. The difference between hypercholesterolemic and homocystinuric patients or control subjects was statistically significant (P < .001). Diastolic blood flow velocities were significantly reduced in the middle cerebral arteries of hypercholesterolemic patients compared with homocystinuric patients or control subjects (P < .05), whereas systolic or mean velocities did not differ. The pulsatility index, a possible indicator of vascular resistance in the cerebral circulation, was significantly higher in hypercholesterolemic patients compared with homocystinuric patients or healthy control subjects (P < .01). A direct relation was demonstrated between pulsatility index of the middle cerebral artery and mean maximum intima-media thickness of carotid arteries on the same side (P < .001). CONCLUSIONS: Familial hypercholesterolemia is responsible for diffuse and focal thickening of carotid arteries and possibly also for hyperlipidemic endothelial dysfunction extending to small resistance arteries and leading to a disturbed cerebral blood flow. Patients with homocystinuria due to homozygosis for cystathionine beta-synthase deficiency seldom have plaques in their carotid arteries. They are similar to healthy control subjects with regard to both intima-media thickness and blood flow velocity in the middle cerebral artery. Therefore, it is unlikely that typical atherosclerotic lesions precede thrombotic events in homocystinuria. However, it is possible that arterial dilatations caused by medial damage lead to thrombosis in homocystinuric patients.

Adolescent↗
PubMed1994

Ankle resection arthrodesis in patients with bone tumors.

The authors report 12 cases of bone tumors localized in the distal tibia treated by resection and reconstruction with ankle arthrodesis, using bone grafts and fixation with Kuntscher or Grosse-Kempf nail or plate. In seven cases autografts were used, and in five cases autografts combined with allografts were used. In three of these five patients, a vascularized fibula combined with a "gutter-like" allograft was used to reconstruct the bone defect. In all cases, the functional and oncologic results were good and all patients were disease free at an average follow-up of 68 months.

Adolescent↗
PubMed1994

Apolipoprotein(a), fibrinopeptide A and carotid atherosclerosis in middle-aged men.

The association between apolipoprotein(a) [apo(a)], fibrinogen, fibrinopeptide A (FPA) and carotid intima-media thickness (IMT) was analyzed in Eastern Finnish men aged 50 to 60 years. Apo(a) correlated directly with carotid bifurcation (r = 0.26, p = 0.001), but not with common carotid IMT. Men in the lowest quartile of apo(a) had thinner (p = 0.013) IMT in bifurcation [1.59 mm (95% CI 1.49; 1.68)] compared to the men in the highest [1.91 mm (95% CI 1.73; 2.09)] apo(a) quartile. The difference remained (p = 0.038) after adjusting for confounders. Plasma fibrinogen was not related to carotid IMT, whereas FPA correlated with common carotid (r = 0.21, p = 0.016) and carotid bifurcation (r = 0.21, p = 0.018) IMT. These associations abolished after adjusting for the confounders. The data suggest that apo(a) associate with carotid atherosclerosis independent of other risk factors for ischemic cardiovascular diseases.

Anthropometry↗
PubMed1993

Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin.

BACKGROUND: Neoadjuvant chemotherapy is the most accepted treatment for localized osteosarcoma. This has led to a great improvement in limb-sparing surgery and in disease-free survival. Patients with a good response to preoperative chemotherapy showed a higher disease-free survival rate. Current studies examine the possibility of patients whose limbs could be rescued with a poor necrosis and a reduction of the side effects related to aggressive treatments. METHODS: Between September 1986 and December 1989, 164 patients entered the second neoadjuvant study conducted at the Rizzoli Institute, Bologna, Italy, for non-metastatic osteosarcoma of the extremities. Preoperative chemotherapy consisted of two cycles of high-dose methotrexate intravenously (i.v.) followed by cisplatin intraarterially and doxorubicin i.v. After surgery, patients classified as good responders (> 90% tumor necrosis) received three more cycles of these drugs, whereas poor responders (< 90% tumor necrosis) had more chemotherapy, which included ifosfamide and etoposide in addition to the other three drugs. RESULTS: Limb salvage was performed in 83% of cases. At an average follow-up of 54 months (36-76), 109 patients (66%) were continuously disease-free, 2 died from doxorubicin cardiotoxicity, and 52 experienced metastases and 3 had local recurrence. In two of these three patients, metastases followed local recurrence. The 5-year actuarial continuously disease-free survival rate was 63%, with no differences between good and poor responders. Excluding 20 patients who had major protocol violations, the projected continuous disease-free survival rate was 71%. CONCLUSIONS: With an aggressive neoadjuvant chemotherapy, it is possible to cure more than 60% of nonmetastatic osteosarcoma of the extremities, avoiding amputation in most cases. Ifosfamide and etoposide seem to be effective in patients who did not respond to preoperative chemotherapy.

Adolescent↗
PubMed1993

Osteosarcoma. Low-grade intraosseous-type osteosarcoma, histologically resembling parosteal osteosarcoma, fibrous dysplasia, and desmoplastic fibroma.

BACKGROUND: Low-grade intraosseous osteosarcoma is a rare variety of osteosarcoma and it is difficult to recognize. METHODS: A series of 10 patients with low-grade intraosseous osteosarcoma is reported. These patients were identified from the Istituto Rizzoli files, which includes approximately 1000 cases of osteosarcoma. Clinical data and radiographic and histologic features were studied. RESULTS: The radiographic appearance confirmed malignancy in five patients and suggested it in two. A benign lesion was diagnosed in three patients. Three lesions resembled parosteal osteosarcoma, two appeared similar to fibrous dysplasia, and two had features of desmoplastic fibroma. A mixed histologic pattern was found in three other tumors. Recurrence after intralesional excision in all patients indicated the aggressive nature of this lesion. The development of metastases in two patients and progression in the grade of malignancy in one of these highlighted the malignant nature of the tumor. CONCLUSIONS: The correct diagnosis would permit adequate treatment with wide surgical margins.

Adolescent↗