Biomedical subjects
Publications and source records attributed to M Nardi.
This retrospective study was undertaken to evaluate the utility of Ultrasound Biomicroscopy (UBM) in the assessment of the anterior chamber in patients affected by silicone oil-related glaucoma after vitreoretinal surgery. UBM showed high reflectivity of angular structure, anterior chamber alterations and a fairly trophic ciliary body.
Ultrasound biomicroscopy (UBM) was employed in the assessment of the anterior chamber in patients affected by penetrating and blunt traumas. UBM detected correctly the extent and the localization of penetrating injuries and the presence of foreign bodies, IOL dislocation, and angular structures or ciliary body damages.
The prognosis of primary choroidal malignant melanoma (PCMM) is fatal if no early reliable diagnosis is performed. Any incisional biopsy is impossible, and diagnosis is only based on instrumental examinations. The purpose of this study is to evaluate the reliability of ultrasonography, fluorescein videoangiography (FV), indocyanine green videoangiography (ICGV), magnetic resonance (MR) and radioimmunoscintigraphy (RIS) in the diagnosis of PCMM in a series of 12 eyes in which the tumor was suspected. A presumed diagnosis of PCMM was made when a positive result was obtained with 3 or more methods. The presumed diagnosis was then compared with histological findings (true value) in 4 enucleated eyes. The sensitivity and specificity of every single method were evaluated comparing its results with the final presumed diagnosis and with the histological findings. Sensitivity and specificity of every single method have been expressed as percentage of correspondence with the presumed diagnosis. Sensitivity was 100% for ultrasonography, MR, FV, ICGV and 67% for RIS. Specificity was 92% for ultrasonography, 87% for RIS, 83% for MR and 82% for FV and ICGV. This study indicates that the ophthalmologist can obtain a good diagnostic reliability in the case of PCMM using only ultrasonography, FV and ICGV. Besides MR and RIS are important adjunctive methods to ophthalmological investigations for the diagnosis of PCMM.
The aim of this study is to evaluate the reliability of the ultrasonographic and angiographic follow-up of primary choroidal malignant melanoma (PCMM) after proton beam irradiation therapy in a series of 14 patients. All patients underwent standardized A and B scan ultrasonography, fluorescein and indocyanine green videoangiography (FV, ICGV) before and after treatment with proton beam irradiation. The follow-up was carried out at 1, 3, 5, 8 months and then every 6 months. The mean follow-up was 26 months (range 6-46 months). The thickness of the tumors was demonstrated to be decreased and the internal reflectivity to be enhanced in 12 out of 14 cases from 8 months after treatment till the end of the follow-up period. In 2 eyes which were enucleated 5 months after treatment, histopathology confirmed that medium-low internal reflectivity corresponded to several areas of high cellularity and cellular mitosis. FV and ICGV were impossible because of opacities of dioptric media in 2 cases. From 8 months after treatment till the end of the follow-up period, in all the examined patients, FV demonstrated large hypofluorescent zones of the lesions which represented the destruction of the vascular tree of the tumor. From 8 months after treatment till the end of the follow-up period, ICGV demonstrated hypofluorescence of the lesions in 8 cases; mild hyperfluorescence and zones of colorant staining were present in late angiograms in 2 cases. The results of our study seem to confirm the reliability of standardized A and B scan ultrasonography in the follow-up of PCMM treated with proton beam irradiation; if ultrasonography is used together with FV and ICGV, the reliability of this combination is surely higher.
The aim of this study is to evaluate the ultrasonographic aspects of primary choroidal malignant melanoma (PCMM) after proton beam irradiation therapy and the reliability of its ultrasonographic follow-up in a series of 10 patients. All patients were examined with standardized A and B scan ultrasonography before and after treatment with proton beam irradiation therapy. The follow-up was carried out at 1, 3, 5, 8 months and then every 6 months. The mean follow-up was 20 months (range 6-34 months). The thickness of the tumors was demonstrated to be decreased and the internal reflectivity to be enhanced in 9 out of 10 cases from 8 months after treatment till the end of the follow-up period. Histopathology confirmed in 1 eye enucleated 5 months after treatment that medium-low internal reflectivity coresponded with several areas of high cellularity and cellular mitosis. The results of our study indicate the reliability of standardized A and B scan echography in the follow-up of PCMM treated with proton beam irradiation therapy.
Vitreous and vitreoretinal interface changes were evaluated in giant retinal tears in order to plan surgical approach. Vitreal sineresis was evident in patients affected by primary giant retinal tears; in patients affected by retinal disinsertion the vitreous was adherent to the edge of the posterior flap, and in giant retinal tears secondary to IOL implantation, posterior vitreous detachment but no sineresis was displayed.
Standardized A- and B-scan echography was performed in 45 patients (68 eyes) affected by proliferative diabetic retinopathy, before vitreoretinal surgery, to evaluate the percentage of agreement between the ultrasonographic data and the surgical findings. The agreement was quite good for tractional retinal detachment (93%) and for posterior vitreous detachment (91%). The main cause of failure was the presence of vitreoschisis, while preretinal and vitreal membranes can easily be detected.
Twenty-four patients (47 eyes) affected by Graves' disease were enrolled to evaluate the role of standardized echography, pattern electroretinogram (P-ERG), visual evoked potentials (P-VEPs) and automated perimetry in the early diagnosis of the compressive optic neuropathy (CON). The P-ERG amplitude reduction was the most sensitive parameter to demonstrate an early impairment of the optic nerve (ON) function. We found a significant negative correlation between the ON diameter and the P-ERG amplitude. VEPs responses were also altered, but their ability in detecting an early ON damage was less sensitive and specific than P-ERG. The visual field damage was often aspecific and delayed with respect to electrophysiological alterations.
BACKGROUND: Several approaches have been used for noninvasive estimation of right atrial pressure (RAP), but, no currently available method has gained any definite validation. The purpose of this study was to evaluate the accuracy of two-dimensional and Doppler echocardiography in estimating mean RAP in patients with cardiac disease. METHODS: We examined the relation of mean RAP to right atrial size and function, size and respiratory changes of inferior vena cava and Doppler parameters of tricuspid and hepatic vein flow in 114 consecutive patients (77 men, 37 women; mean age 57 +/- 12 years) with various cardiac diseases undergoing cardiac catheterization. Echocardiographic studies were performed within 24 hours before catheterization (mean interval 6 +/- 3 hours). Patients were assigned to 3 groups according to the values of mean RAP (group 1, < or = 8 mmHg; group 2, between 9 and 12 mmHg; group 3, > 12 mmHg). RESULTS: Mean RAP ranged from 3 to 20 mmHg (mean 9.1 +/- 4.3 mmHg). It correlated most strongly with the collapsibility index of inferior vena cava (IVCCI) (r = -0.76), minimal inspiratory diameter of inferior vena cava (r = 0.72) and deceleration time of early tricuspid flow (DT) (r = -0.61). Discriminant analysis demonstrated that IVCCI and DT were major determinants of mean RAP with 81.6% of cases correctly assigned to study groups: 96% of patients of group 1 and 87% of patients of group 3 were identified, whereas the accuracy in identifying the patients of group 2 was lower (46%). An IVCCI > 45% was the best cutoff point in predicting a mean RAP < or = 8 mmHg; an IVCCI < 35% and a DT < 150 msec were the best cutoff points in predicting a mean RAP > or = 15 mmHg. The best multivariate equation predicting mean RAP was: mean RAP = 23.3 - 0.2 IVCCI -0.026 DT (r = 0.80, R2 = 0.64). This equation was 81% sensitive and 84% specific in detecting a mean RAP < or = 8 mmHg and 74% sensitive and 97% specific in detecting a mean RAP > 12 mmHg. CONCLUSIONS: Mean RAP can be estimated noninvasively by two-dimensional and Doppler echocardiography. The combined analysis of IVCCI and DT provides an accurate prediction on mean RAP < or = 8 mmHg and > 12 mmHg, whereas the prediction of intermediate values is less accurate.
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This study demonstrated an immediate and short-lasting endothelin-1 release in the circulation of patients with severe chronic congestive heart failure during isometric handgrip exercise, but not in normal subjects. Our data suggest that endothelin-1 levels may increase transiently during daily physical activity, thus contributing to progressive deterioration of left ventricular function.
Paclitaxel is the prototype of a new class of chemotherapeutic agents with an antimitotic effect that is related to its ability to interfere with the microtubule system. It causes peripheral neurological toxicity by means of its activity on the axonal microtubules. To define the clinical and neurophysiological characteristics of paclitaxel neuropathy 23 patients undergoing paclitaxel therapy at a dose of 175 mg/m2 were studied. The patients were divided into two groups, with only one group receiving pretreatment with potentially neurotoxic drugs such as cisplatin and carboplatin. The results showed a high incidence of mild neurotoxicity in both groups. Treatment was discontinued due to severe neurotoxicity in only one patient pretreated with platinum-compounds. The clinical and neurophysiological data make it possible to define paclitaxel neurotoxicity as a distal axonal neuropathy with a summatory effect in patients pretreated with cisplatin; the possible reversibility of paclitaxel neurotoxicity requires further confirmation.
PURPOSE: To evaluate possible damage of foldable silicone or acrylic intraocular lenses caused by the use of incorrect lens folder forceps. METHODS: Ten silicone and 10 acrylic intraocular lenses were divided into two groups, each containing five silicone and five acrylic lenses. Two easily mistaken folder forceps, each expressly designed for either silicone or acrylic lenses only were properly used to fold the intraocular lenses in group 1 whereas in group 2, the silicone lenses were folded with the forceps designed for the acrylic lenses, and the acrylic lenses were folded with the forceps designed for the silicone lenses. We observed the lenses by transmission and scanning microscopy after folding. RESULT: The acrylic lenses folded with forceps designed for the silicone lenses (group 2) disclosed considerable damage of the lens optic. CONCLUSION: Incorrect folder forceps may damage acrylic intraocular lenses.
We investigated an 8-year-old Arab girl with severe factor XI deficiency; one sibling and her father also have severe factor XI deficiency. Her parents and her father's parents are first cousins. Restriction analysis and DNA sequencing excluded the type I, II, III and IV mutations. We demonstrated a previously undescribed C-->A mutation at nucleotide 1254 in exon 11 resulting in a threonine to asparagine (T-->N) substitution at amino acid 386. We postulate that this substitution interferes with folding and secretion of the molecule.
The response rate to salvage chemotherapy in advanced ovarian cancer has been disappointing in patients who do not respond or who relapse after platinum-containing regimens. In these cases, the identification of new drugs is a substantial challenge. The efficacy of one of these, paclitaxel, has already been assessed in many phase II trials. From July 1993 to October 1995, 33 patients with advanced ovarian cancer, recurrent or refractory after platinum-based regimens, entered our study. Paclitaxel was given by 3-hour intravenous infusion every 3 weeks. All the patients were evaluable for toxicity and 27 for response. Nine patients (33.3%) responded: 6 complete (22.2%) and 3 partial responses (11.1%). Six responses (35.3%) were observed in the 17 platinum-resistant patients and 3 (30%) in the 10 platinum-responders. World Health Organization (WHO) grade 3-4 neutropenia was common (13/33 patients, 39.4%) and peripheral neurotoxicity was observed in 29 patients (87.8%), but was WHO grade 3 in four cases (12.1%). Alopecia was ubiquitous, whereas other toxic effects were not significant. The overall response rate to paclitaxel in this study is similar to that reported in others and the high complete response (CR) rate should be emphasized. These data confirm the significant activity and safety of this drug in patients with advanced ovarian cancer, even in platinum-resistant cases.
The gene corresponding to the lactococcal oligopeptidase PepF1 (formerly PepF [V. Monnet, M. Nardi, A. Chopin, M.-C. Chopin, and J.-C. Gripon, J. Biol. Chem. 269:32070-32076, 1994]) is located on the lactose-proteinase plasmid of Lactococcus lactis subsp. cremoris NCDO763. Use of the pepF1 gene as a probe with different strains showed that pepF1 is present on the chromosome of Lactococcus lactis subsp. lactis IL1403, whereas there is a second, homologous gene, pepF2, on the chromosome of strain NCDO763. From hybridization, PCR amplification, and sequencing experiments, we deduced that (i) pepF1 and pepF2 exhibit 80% identity and encode two proteins which are 84% identical and (ii) pepF2 is included in an operon composed of three open reading frames and is transcribed from two promoters. The protein, encoded by the gene located downstream of pepF2, shows significant homology with methyltransferases. Analysis of the sequences flanking pepF1 and pepF2 indicates that only a part of the pepF2 operon is present on the plasmid of strain NCDO763, while the operon is intact on the chromosome of strain IL1403. Traces of several recombination events are visible on the lactose-proteinase plasmid. This suggests that the duplication of pepF occurred by recombination from the chromosome of an L. lactis subsp. lactis strain followed by gene transfer. We discuss the possible functions of PepF and the role of its amplification.
PURPOSE: Neovascularization of the cornea occurs in numerous pathologic states causing decreased visual acuity and blindness and is a major complication of corneal allotransplantation. The purpose of this study was to investigate the effect of topical and systemic cyclosporin A (CsA) on corneal angiogenesis induced by xenotransplantation or by chemical cauterization. The subcutaneous disc angiogenesis system (DAS) also was used to study the effects of CsA on angiogenesis in a nonocular site. METHODS: Corneal angiogenesis was provoked by either xenotransplantation or chemical cautery. Rats from experiments using both of these models were subdivided into four treatment groups. Topical treatment was administered by using 4% CsA eye drops or vehicle (castor oil) four times daily for 10 days. Systemic therapy consisted of daily (5 mg/kg per day) subcutaneous injections of CsA or vehicle. In the DAS experiments, rats received CsA or vehicle systemically or intradisc. The amount of neovascularization was quantitated by digital image analysis in corneal flat preparations and sections of discs. RESULTS: Rats that received xenografts or cautery manifested less corneal neovascularization than did control animals after topical of subcutaneous CsA treatment. CsA also enhanced the survival of corneal xenografts. A difference between CsA and vehicle-treated animals in the DAS experiments was not detected. CONCLUSIONS: CsA effectively retards the growth of new vessels in the cornea after xenotransplantation or chemical cauterization and prolongs xenograft survival. However, CsA does not suppress angiogenesis in all systems, because it was ineffective in blocking vessel growth in the subcutaneous DAS.
Intraoperative cholangiography, a diagnostic method through images introduced in to clinical use in 1932, has recently become a different technical support from that attributed by traditional surgery and it has got a different diagnostic meaning with the introduction of video surgery. The authors used it in 54 of 194 patients submitted to a CVL, always making use of the trans-cystic access, with a percentage of success of 82.6%. It was not possible in 8 patients due to the complete section of the cystic duct during the work (3 cases) and the impossibility of introducing the catheter (5 cases). There is still no common agreement about the opportunity to use IC daily: the authors think selective use is better preceded by a careful clinical laboratory instrumental preoperative study to find patients with the common duct stone. Besides, they are of the opinion that a rigorous surgical technique is fundamental to reduce the lesions of the VBP that there are not in their experience.