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Biomedical subjects

M Pirovino

Publications and source records attributed to M Pirovino.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Aortic valve stenosis in the old age: clinical and echocardiographic aspects].

Among 380 consecutive patients > 70 years of age, patients with a systolic heart murmur were investigated both clinically and by doppler echocardiography. The aim of the study was to compare the validity of the clinical diagnosis of valvular aortic stenosis in elderly patients with the results of doppler echocardiography. 138/380 patients (36%) had a systolic heart murmur. 130 were investigated by doppler echocardiography. 23/130 patients with systolic murmur (18%) had moderate or severe aortic stenosis. Clinically, patients with moderate or severe aortic stenosis had a pulsus parvus et tardus of the carotid artery more often than patients with only slight or no evidence of aortic stenosis (61% vs 16%; p < 0.0001). In patients with moderate or severe aortic stenosis, the murmur radiated more often to the carotid vessels (65% vs 19%; p < 0.0001). Systolic blood pressures and pressure amplitudes were lower in patients with moderate or severe aortic stenosis (132 vs 141 mm Hg; p < 0.01; 61 vs 68 mm Hg; p < 0.001). Electrocardiography showed left ventricular hypertrophy or bundle branch block more often in patients with moderate or severe aortic stenosis (57% vs 15%; p < 0.01). We conclude that moderate or severe aortic stenosis is a frequent finding in elderly patients. Diagnosis by clinical examination may be difficult. For this reason, doppler echocardiography should be performed, especially when therapeutic consequences are to be expected from the diagnosis, such as aortic valve replacement or vasodilator treatment in the case of congestive heart failure.

Aged↗
PubMed1993

[The alcoholic emergency].

Gastric lavage, intestinal charcoal decontamination and specific drug antagonism, therapeutic measures widely applied in other intoxications, are of no clear benefit or unavailable in patients with alcohol intoxication. The gastric first-pass-effect is important in modifying the kinetics of alcohol, and clinically relevant drug-alcohol interactions occur in situations of both acute and chronic alcohol abuse. Alcohol-induced hypoglycemia and ketoacidosis should be considered in every severely ill alcoholic patient. The recognition of alcoholism is important and rewarding, since therapeutic action by the practicing physician can be of significant help.

Acidosis↗
PubMed1992

Successful treatment of disseminated nocardiosis complicated by cerebral abscess with ceftriaxone and amikacin: case report.

We report the case of an 85-year-old female patient who suffered from disseminated Nocardia asteroides infection complicated by a cerebral abscess. Treatment with amikacin for 2 weeks and ceftriaxone for 6 weeks led to complete recovery, and there was no recurrence of disease over a follow-up period of 12 months after therapy. The use of ceftriaxone in combination with amikacin might significantly shorten the duration of treatment for patients with disseminated nocardiosis. This combination of antibiotics merits further investigation with use of a larger sample of patients.

Aged↗
PubMed1992

[Interferon treatment of chronic viral hepatitis].

The interferon treatment of chronic viral hepatitis leads to a measurable inhibition of replication of the various hepatitis viruses. In adult patients with chronic HBe-Ag-positive hepatitis B, the seroconversion rate is tripled by therapy when compared with untreated controls. In chronic hepatitis C, biochemical remission is achieved in about 50% of patients, but there is a high tendency to relapse. Interferon treatment has little effect in hepatitis B virus infection transmitted perinatally and in chronic delta hepatitis. Better knowledge of prognostic variables and deeper insights into the mechanisms of chronic hepatitis C virus infection should help both to increase rates and duration of remissions and to reduce the rates of relapse in the future.

Hepatitis B↗
PubMed1992

[Mycotic aneurysm of the iliac artery caused by Salmonella infection. A case report].

Localized extra-intestinal manifestations of salmonella infections are rare, but will be encountered more frequently due to the increasing number of salmonellosis in recent years. We report a 55-year-old patient with an infected aneurysm of the right iliac artery caused by S. enteritidis. Vascular surgery with resection of the aneurysm, debridement, reconstruction with direct anastomosis of the mobilized artery was successful in combination with antibiotic therapy, but the course was complicated by a deep venous thrombosis, ileus and abdominal wall hemorrhage. A short review of the pertinent literature follows the case report, with emphasis on the surgical aspects. Autogenous reconstruction is considered the surgical treatment of choice for infected iliac aneurysms.

Aneurysm, Infected↗
PubMed1991

[An unusual case of imported malaria].

We report a case of malaria occurring after a journey to Guadeloupe, an island, which is considered as being free of malaria. The case report serves to remind that previous areas of endemicity remain receptive for malaria, and that one has to consider malaria in the differential diagnosis of a feverish illness even when a traveller returns from a country where malaria transmission has not been reported.

Animals↗
PubMed1991

[Ovarian hyperstimulation syndrome].

The ovarian hyperstimulation syndrome is the most serious complication following ovulation induction. It is assuming greater clinical importance now that the indication for ovulation induction is no longer limited to anovulatory women but expands to other infertility problems. In its most severe manifestation the ovarian hyperstimulation syndrome consists of massive ovarian enlargement with multiple cysts, hemoconcentration, ascites, and pleural and pericardial effusion. There is no specific treatment and a reduction in the incidence of this iatrogenic syndrome can be achieved only by preventive measures.

Adult↗
PubMed1990

Differences in hepatic drug accumulation and enzyme induction after chronic amiodarone feeding of two rat strains: role of the hydroxylator phenotype?

1. It has previously been shown that the extent of hepatic phospholipidosis induced by chronic amiodarone treatment correlates with the degree of drug accumulation in liver tissue. 2. To investigate a possible influence of pharmacogenetic factors, biochemical and morphological investigations were carried out in two rat strains differing in debrisoquine hydroxylation. 3. Plasma and liver tissue concentrations of amiodarone and its main metabolite, desethyl-amiodarone, were significantly higher in rats with deficient hydroxylation. Microsomal enzyme induction, drug cytochrome P-450 complex formation and typical ultrastructural features of phospholipidosis were only seen in rats with deficient hydroxylation and in a more sensitive species, the guinea-pig. 4. It remains to be seen whether deficient debrisoquine hydroxylation in man is associated with an increased susceptibility to amiodarone side effects.

Amiodarone↗
PubMed1989

[BRL 43694A--a 5-hydroxytryptamine receptor blocker as an antiemetic in cytostatic therapy].

An open study of the new antiemetic BRL 43694A, a 5-hydroxytryptamine-3-receptor antagonist, was performed in 29 patients undergoing highly emetogenic cancer chemotherapy (25 patients received cisplatin in a dose greater than or equal to 50 mg/m2). Patients received BRL 43694A as a 30-minute infusion one hour after the administration of chemotherapy. 7 patients were treated with 40 micrograms/kg and 13 patients with 100 micrograms/kg BRL 43694A; the last 9 patients received an initial dose of 40 micrograms/kg with a provision for two additional interventional doses over 24 hours in the event of prolonged nausea or vomiting. 14 patients experienced no vomiting (48%) and 13 patients (45%) had 1-5 vomiting episodes over 24 hours following administration of the cytostatic agents. BRL 43694A did not cause major side effects. Based on our preliminary experience the new 5-HT3-receptor antagonist BRL 43694A is a potent antiemetic drug for the treatment of chemotherapy-induced nausea and vomiting.

Adult↗
PubMed1989

[Neurofibrosarcomas in neurofibromatosis 1].

Between 1983 and 1987 three patients (mean age 31 years) with neurofibrosarcoma were seen among 22 with von Recklinghausen neurofibromatosis (NF-1) at the Department of Neurology, University of Berne, Switzerland. There was an average interval of 14 months between onset of symptoms and treatment. The first presenting sign was a rapidly enlarging mass or unusual persistent pain. The occurrence of either sign, in the known presence of NF-1, should lead to immediate neuroradiological investigation. The mean survival time of the three patients was 37 months. Only early diagnosis provides any chance of curative treatment.

Adult↗
PubMed1989

[Frequency of severe abdominal wall hemorrhage with subcutaneous anticoagulation using calcium-heparin].

Four cases of severe bleeding among 50 elderly patients undergoing subcutaneous calcium heparin treatment are reported. In three patients the bleeding was localized in the abdominal wall and the fourth in the retroperitoneum; 2 patients died. Heparin doses ranged between 2x12,500 and 2x20,000 I.U/day. The thrombin times, measured before the next administration, were in the subtherapeutic range in all patients. We conclude that in elderly patients subcutaneous heparin treatment in therapeutic doses should be reserved for exceptional cases.

Abdominal Muscles↗
PubMed1989

Preserved cytosolic and synthetic liver function in jaundice of severe extrahepatic infection.

We investigated prospectively 9 adult patients with the syndrome of jaundice complicating severe extrahepatic infection both clinically and by quantitative liver function tests. Five patients having severe extrahepatic infection without jaundice were used for comparison. Intraperitoneal infection was found to be a major risk factor for development of jaundice. Jaundice was mainly associated with gram-negative infection, but did not influence survival. Duration of jaundice was dependent on control of the underlying infection. Liver function tests showed a severely deranged organic anion transport, whereas synthetic, cytosolic, and microsomal functions remained preserved. Our study shows that (a) the syndrome of jaundice associated with extrahepatic infection is a functional disorder that is reversible upon control of infection, and that (b) cytosolic, synthetic, and microsomal function is preserved. This may have consequences for both assessing prognosis and clinical management.

Adult↗
PubMed1988

[Sternocostoclavicular hyperostosis. Association with pustular psoriasis and systemic vasculitis].

A female patient with sternocostoclavicular hyperostosis has been followed for 14 years. The case merits special attention because of its association with psoriasis and with an episode of systemic vasculitis. Although patients with sternocostoclavicular hyperostosis usually lack the tissue type antigen HLA-B27, there are grounds for suspicion that the disease is related to the group of seronegative spondylo-arthritides.

Female↗
PubMed1988

Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations.

Nailfold capillary microscopical and hormonal investigations were carried out in 25 patients with cirrhosis of the liver and in 20 age- and sex-matched controls. Several structural and functional capillary microscopical parameters were significantly different between the group of cirrhotics as a whole and the controls; no capillaroscopic feature helped to distinguish cirrhotics with spiders from those without. Serum estradiol and total testosterone were comparable in cirrhotics and controls; free serum testosterone was reduced in male cirrhotics, particularly in cirrhotics with spider nevi. The estradiol/free testosterone ratio was highest in male cirrhotics with spiders. Cirrhosis, thus, leads to both structural and functional effects on the cutaneous capillary system whether or not spider nevi are present. The presence of spider nevi is accompanied by an increased serum estradiol/free testosterone ratio in male cirrhotics. It remains to be determined whether the hormonal alterations described do indeed play a role in spider nevi formation.

Adult↗
PubMed1988

[Hepatic manifestations of the acquired immunodeficiency syndrome (AIDS)].

Hepatic manifestations of acquired immunodeficiency syndrome (AIDS) were analyzed in 76 consecutive patients. Serological markers of hepatitis B were found in 84%. All instances of biopsy-proven chronic hepatitis were associated with delta infection. One patient with intestinal cryptosporidiosis had a severe cholestasis. In the majority of patients histological examination of the liver revealed non-specific alterations, but in several cases was diagnostic of mycobacterial disease. The study of liver disease in HIV-infected patients could lead to a better understanding of diseases such as chronic hepatitis B and sclerosing cholangitis.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Liver cirrhosis in histiocytosis X.

Cirrhosis of the liver was diagnosed in an 18-year-old man with histiocytosis X. Electron microscopy and immunohistochemistry revealed infiltration of the liver by the typical cellular elements of histiocytosis X. Endoscopic retrograde cholangiography showed alterations resembling those of sclerosing cholangitis. Sixteen months later, the patient died of recurrent variceal bleeding and cholangiosepsis. Autopsy confirmed that cirrhosis was the main manifestations of the underlying disease. Thus, cirrhosis of liver can be a main and potentially fatal manifestation of histiocytosis X beyond the pediatric age range. Histiocytosis X may lead to parenchymal infiltration of the liver and to changes of the major bile ducts resembling sclerosing cholangitis. The diagnosis of hepatic histiocytosis X can easily be missed without relying on appropriate electron microscopic and immunohistochemical investigations.

Adolescent↗