Biomedical subjects
Publications and source records attributed to M Monti.
The Authors dissert on some technical details for a correct use of staplers in colorectal surgery. Surgical skill and technology assure always better results, nevertheless the experience and knowledge of the single surgeon must be a guide for further research.
1. Gluteal adipose tissue was examined in 13 patients with generalized adiposis dolorosa, a clinical condition characterized by painful adiposity with a chronic intractable course. The total metabolic activity of fat cells, isolated by collagenase and suspended in Krebs-Ringer bicarbonate buffer with glucose and insulin, was assessed by the measurement of heat production at 37 degrees C using microcalorimetry. 2. Fat cells were markedly enlarged; their metabolic activity expressed in terms of microW/g, but not in pW/cell, was significantly decreased when compared with both lean and weight-matched non-painful subjects. Both mean values were, however, significantly higher than in grossly obese subjects with similar mean cell size. Heat production as expressed per g of tissue, but not per cell, was inversely correlated with body mass index. One additional patient had unilateral disease, and fat cells from the painful side had a lower heat production than cells from the unaffected side. 3. The fatty acid composition of adipose tissue, as determined by g.c., revealed a significantly increased proportion of monounsaturated (18:1 and 16:1) at the expense of saturated (14:0 and 18:0) fatty acids compared with healthy control subjects. The activity of adipose tissue lipoprotein lipase was slightly, but not significantly, decreased. 4. It is concluded that a metabolic pathogenetic factor cannot be ruled out in adiposis dolorosa. As the results do not explain the nature of the diffuse pain, further studies need to be performed.
The case of a patient who developed multiple soft fibroma-like lesions on his lower extremities affected by lymphedema and Kaposi's sarcoma is reported. To the best of our knowledge, the coexistence of these three pathologic processes is unusual and has never been described before in the literature.
Serum samples from 66 seropositive subjects (56 with a history of intravenous drug abuse), including asymptomatic carriers and patients with persistent generalised lymphadenopathy (PGL), AIDS related complex (ARC), and AIDS, were tested by indirect immunofluorescence on rat tissue sections and HEp-2 cells for the presence of antibodies to nuclei, smooth muscle, intermediate filaments (anti-IMF) and microfilaments (anti-MF). Counterimmunoelectrophoresis was also used to detect antibodies to extractable nuclear antigens. Smooth muscle antibodies with the V pattern or antinuclear antibodies, mainly of the speckled type, or anti-IMF, occurred in 35 cases, being widely distributed in all groups. Such an autoantibody response resembles the "viral" autoimmunity described in various infectious diseases and in particular that of non-A, non-B post-transfusion hepatitis. Autoantibodies may be of some prognostic relevance, as the prevalence of smooth muscle antibodies V increased as the disease progressed (asymptomatic carriers 20%, those with PGL 29%, those with ARC 47%, and those with AIDS 63%. In the PGL group autoantibody positivity correlated with the presence of skin anergy. The fact that autoantibodies were more frequently detected in patients with circulating immune complexes suggests that these can contain autoantibodies and the corresponding autoantigens.
The study was made in vitro of reactions elicited by contact of granulocytes suspended in autologous plasma with three polymers: polyacrylonitrile (AN); polyetherpoly-carbonate (PC), and regenerated cellulose (Cu). Alterations in basal metabolism and biological function of the human blood granulocytes induced by interfacial reactions were determined by direct microcalorimetry. The polymers, which are commonly used as membranes in artificial kidneys, were found to activate granulocytes to degrees which were inversely correlated with their response to zymosan. The compatibility of the granulocytes and each of the membranes was of the order: AN greater than PC greater than Cu.
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The retrospective analysis of a series of 350 cases of intrathoracic goiters, out of a total of 5,000 thyroid operations derived from the joined case records of the 3rd General Surgery Institute (Director: Prof. G. Di Matteo) and the 8th Chair of Surgical Pathology (Director: Prof. F.P. Campana), has induced the authors to reconsider the surgical approach to this pathology on the basis of anatomo-surgical factors.
A technique has been developed for studying the overall metabolism in small numbers of cells in monolayers and in suspensions by measuring the heat exchange rate with a thermopile heat-conduction microcalorimeter. The system was tested with alveolar macrophages from rabbits, and heat flux-time curves could be monitored from numbers of cells as low as 0.05 . 10(6). The metabolic activity was found to be unchanged or to decrease very slowly over a period of 20 h. In a conventional cell medium, without the addition of serum, a mean heat flux value of 19.4 (S.D. 3.2) pW. cell-1 (37 degrees C, pH = 7.4) was obtained for alveolar macrophages in monolayers. The corresponding value for cells in the same medium, with the addition of 20% homologous rabbit serum, was 27.0 (S.D. 2.0). We suggest that this calorimetric method can be used as a short-term cytotoxic test for measuring potentially toxic agents in our environment; this test can involve alveolar macrophages of either animal or human origin. In such an assay, the cells should be used in monolayers, and suspensions should be avoided. We found that when alveolar macrophages were used in suspension, the metabolic activity, measured as heat flux, was dependent on cell concentration, even at values as low as 0.2. 10(6) cells per ml.
Serum levels of total sialic acid, carcinoembryonic antigen (CEA), ferritin, lactate dehydrogenase, and creatine phosphokinase were measured both in tumor drainage blood (axillary vein) and in peripheral blood obtained from 121 breast cancer patients during surgery. No significant differences between mean values in peripheral and tumor draining blood, between cancer patients and healthy controls, or between patients with or without axillary lymph node metastases were found for any of the markers. Both ferritin and CEA levels were higher in axillary and peripheral blood from patients with central breast cancer versus other sites but the difference was significant only for CEA (p less than 0.05). CEA levels were significantly higher (p less than 0.01) in patients with greater than 2 cm diameter carcinomas versus T1 stage patients in axillary but not in peripheral blood. When the cephalic vein was clamped before the axillary sample was taken, ferritin showed a significant increase (p less than 0.05). We conclude that measurement of sialic acid, CEA, and ferritin in axillary venous blood in breast cancer patients is not of clinical benefit, although further data are needed to clarify whether other advantages can be derived.
In the present study, the heat production of liver biopsies (5-8 mg) was measured by a microcalorimetric technique. Tissue incubated in Leibowitz L-15 medium (L-15) showed a higher metabolic rate compared to tissue incubated in a medium without substrate 2.8 microW/mg and 1.75 microW/mg, respectively. Heat production was found to be related to weight density. No difference in the metabolic rate was found after organ perfusion in comparison to nonperfused liver. Storage in medium L-15 at 4 degrees C caused a lower rate of heat production, but if the tissue was stored in an electrolyte balance solution without substrate, no difference was seen compared to fresh tissue. Recording heat production with the present calorimetric technique is relatively simple and rapid and allows measurement of small samples.
An open clinical study was undertaken to evaluate the anti-photoageing efficacy of topical tretinoin. A length of cream of approximately 1 cm was applied to the face daily in the evening for 6 months: during month 1 of therapy 0.01% tretinoin cream was administered; 0.025% was given during month 2; and 0.05% was given in months 3-6. The clinical symptoms of photoageing (coarse wrinkling, fine wrinkling, skin thinning, mottled hyperpigmentation, laxity and xerosis) were evaluated before and after therapy. A total of 19.1% of patients withdrew from the study; only 5.6% were for treatment-related reasons. At the end of the treatment period all the clinical parameters, except xerosis, were improved. The amount of improvement varied, but only 4.2% of patients failed to show any improvement. Tolerability was excellent in 51.4% of patients, good in 44.4% and fair in 4.2%, and compliance was excellent in 47.0% of patients, good in 48.5% and fair in 4.5%. Tolerability and compliance were improved by applying the same amount of cream each day but increasing the concentration of tretinoin over the 6-month period. Silicone skin replicas of the same area of skin taken before and after treatment, analysed by scanning electron microscopy, profilometry and computer image analysis, showed a decrease in the width of wrinkles, and an improvement in skin texture and follicle density.
The heat production rate in peripheral blood lymphocytes was evaluated by direct calorimetry in 76 untreated adults with non-Hodgkin's lymphoma (NHL). Elevated values were recorded for 20 out of 54 patients with lymphomas of high or intermediate malignancy grade (37%) and for 1 out of 22 patients (5%) with low grade lymphomas (p = 0.01). Median survival was 39 months for patients with normal values and 8.5 months for those with elevated values (p = 0.005). In a subgroup of 38 patients with high or intermediate grade NHL stage III-IV, 17 patients with abnormally high lymphocyte heat production rates had a significantly shorter survival than 21 patients with normal values (p = 0.01). In a multivariate analysis the prognostic impact of lymphocyte heat production was superior to histologic malignancy grade, clinical stage and age.
A discrepancy between the clinical impression of disease activity and basal serum levels of growth hormone is often seen in patients with acromegaly. A slightly better relation has been found to serum levels of IGF-I, but a technique for evaluation of cell metabolic activity in this disease is still missing. For this purpose we used microcalorimetry to determine heat production rate in lymphocytes from 15 patients with acromegaly. The mean heat production rate was 2.90 +/- 0.15 pW/cell, significantly higher than in 13 healthy subjects, 2.31 +/- 0.12 pW/cell (p less than 0.01). Heat production rates did not correlate significantly with basal growth hormone levels, but increased, in a statistically significant manner (p less than 0.001), in parallel with the score index used to evaluate the clinical activity of the disease. Using the technique of microcalorimetry we could thus demonstrate an increased metabolic activity at a cellular level in patients with acromegaly, a finding that is in accordance with the view that an increased cell metabolic activity is a component of the disease process in acromegaly.
We used microcalorimetry to measure lymphocyte heat production rate in patients with clinical and laboratory hyperthyroidism (serum TSH decreases, serum FT4 increases, serum FT3 increases), subclinical hyperthyroidism (serum TSH decreases, serum FT1 increases, serum FT3 =), and subclinical hypothyroidism (serum TSH increases, serum FT4 decreases, serum FT3 =) compared with healthy controls (N = 13). The lymphocyte heat production rate was significantly correlated to the free thyroxine level (r = 0.53, p less than 0.01) and to the free triiodothyronine level (r = 0.51, p less than 0.01) when calculated from pooled data for the three patients groups. The hyperthyroid patients (N = 8) had a significantly increased lymphocyte heat production rate, 3.43 +/- 0.25 pW/cell, as compared with 2.31 +/- 0.12 pW/cell in the control group (p less than 0.001). The groups with subclinical hyperthyroidism (N = 7) and subclinical hypothyroidism (N = 9) had lymphocyte heat production rates of 2.14 +/- 0.11 and 2.56 +/- 0.15 pW/cell, respectively, not significantly different from that in the controls. Consistently, there was no significant difference between patients with subclinical hyperthyroidism (N = 5) and controls (N = 5) with regard to lymphocyte energy production as calculated from separately measured oxygen consumption rates in vitro, 1.36 +/- 0.20 and 1.56 +/- 0.12 pW/cell, respectively. Thus microcalorimetry seems to be suitable for studying the influence of thyroid hormones on cellular metabolism. Subclinical thyroid dysfunction does not seem to alter the overall rate of lymphocyte metabolism.
Hyperkeratosis of the follicular channel is the most common finding in acne skin. The hyperkeratosis may represent an altercated keratinization process or the consequence of the abnormal sebum production and excretion. Several review demonstrated the anti-comedo activity of azelaic acid in acneic skin. This action may be due either to an anti-hormonal effect or to a change in keratin production. The aim of this work is to investigate the anti-comedo activity of 20% azelaic acid cream topically applied in a group of teen-agers affected by acne. A horny layer biopsy with cyanoacrylate glue was performed before and after four months of treatment with azelaic acid cream in ten acne patients. About 1 cm square horny layer biopsy was metallized and observed at the scanning electron microscopy to count the number of comedos. With this method we detected a reduction of about 26% of the comedos after four months of azelaic acid treatment. The result we obtained is in accordance with previous works about the anti-comedo activity of azelaic acid.
A total of 89 patients (mean age 42 years) with clinical signs of photo-ageing were evaluated in an open study to determine the clinical efficacy and tolerance of topical tretinoin therapy. Each evening for 6 months about 1 cm of cream containing tretinoin was applied to the face. Patient compliance and tolerance were maximized by gradually increasing the tretinoin concentration in the cream over the treatment period: 0.01% tretinoin for 1 month, then 0.025% for 1 month and finally 0.05% for 4 months. By the end of the 6 months' treatment period, 95.8% of patients showed improvement in the clinical symptoms of photo-ageing (coarse and fine wrinkling, skin thinning, mottled hyperpigmentation and laxity), except for xerosis. During treatment, 17 (19.1%) patients withdrew from the study, in five (5.6%) this was due to treatment-related side-effects. Patient compliance was rated as excellent in 47.0% of cases, good in 48.5% and fair in 4.5%; tolerability was excellent in 51.4% of cases, good in 44.4% and fair in 4.2%. Improvements were confirmed by scanning electron microscopy, computerized profilometry and computerized image analysis of skin replicas of the same areas taken before and after treatment, with a reduction in width and depth of wrinkles, improved skin texture and increased follicle density.