Search PubMed⌕ Search

Biomedical subjects

M Romano

Publications and source records attributed to M Romano.

At least 217 records · Page 12Linked to original sources
PubMed1996

[Hyperthermia and palliative radiotherapy for sarcoma].

The current treatment of bone and soft tissue sarcomas consists of a multimodality approach based on the combination of surgery, radiotherapy and, more rarely, chemotherapy. Since local recurrence is an important cause of failure and morbidity, new treatment modalities such as hyperthermia, have been proposed to try to overcome this problem. July, 1982, to June, 1993, twelve patients (15 lesions) with recurrent or locally advanced sarcoma, were treated at the Department of Radiation Oncology, S. Chiara Hospital-Trento (Italy) with irradiation and hyperthermia. Radiation therapy was delivered with different techniques using palliative or radical doses (24-70 Gy) and different fractionation schedules. Local microwave hyperthermia was given in 2-9 sessions (mean 4.7). Eight (53.3%) complete responses and 4 (26.6%) partial responses were observed. Three lesions recurred at 11, 13, and 30 months; 5-year actuarial local control was 25.4 +/- 13.4%. Actuarial 5-year overall survival was 49.5 +/- 16.4%. Toxicity was mild: two superficial necroses, spontaneously healed after few months, were observed; local pain during hyperthermic treatment was recorded in 15% of sessions. Lesion volume and total radiation dose appeared to be correlated with the response. In our experience, the combination of radiotherapy and hyperthermia seems to be a valuable therapeutic approach in the treatment of locally advanced or recurrent sarcomas.

Actuarial Analysis↗
PubMed1996

Evaluation of brain perfusion with high resolution single photon emission tomography in the diagnosis of brain death.

Nuclear Medicine studies performed with tomographic acquisition and tracers such as Technetium-99m hexamethyl-propyleneamine oxime (99mTc-HMPAO) are able to assess cerebral blood flow. A case is reported of a patient with a large intracranial tumor, of possible pituitary origin, with a clinical and electroencephalographic suspicion of brain death. The patient had endocrinous-metabolic impairments for a history of impotence, since 18 months, and diabetes insipidus with a urine output of 350 ml/hr in the first 24 hours from the clinical suspicion of brain death. Due to the endocrinous-metabolic impairments, according to Italian law, it was necessary to confirm the diagnosis of brain death by performing a study able to assess cerebral blood flow. A single Photon Emission Tomography (SPET) scan was performed after the intravenous administration of 99mTc-HMPAO using a high resolution, brain dedicated device. No tracer uptake was evident in cerebral, cerebellar and brain stem structures. The cerebral blood flow study by SPET confirmed the diagnosis of brain death and made the organ transplant possible in a short period of time. High resolution SPET studies are useful to confirm the diagnosis of brain death when there are factors that can influence clinical and electroencephalographic signs, reducing time to authorise the organ explant.

Adult↗
PubMed1996

Electrophysiological alterations in hepatic encephalopathy detected by brain mapping.

Analogical electroencephalogram has been used to study electric alterations in the brain during liver encephalopathy. We adopted digital technique brain mapping to study the electric background activity in the brain and to evaluate the diagnostic and prognosis usefulness of this technique compared with the methods routinely used in this disease. We studied 18 patients with liver cirrhosis and varying degrees of liver encephalopathy and 7 healthy control subjects to assess correlation between the severity of encephalopathy and abnormal electric activity in the brain, and to detect the main differences between the brain mapping findings obtained in the two groups. The findings revealed an overall reduction in the rhythm, increased amplitude and anomalous distribution of the waveforms in the cirrhotic patients. Although similar results have already been reported, brain mapping furnished prompt and more easily visualised findings. Moreover, brain mapping facilitated detailed analysis of wave amplitude, frequency and topographic location indicating that this technique is a valid tool in diagnosing brain disorders.

Brain Mapping↗
PubMed1996

[Erythropoietin in hepatocellular carcinoma].

Hemopoietic alterations may occur during tumoral diseases, determining anemia. In most cases, serum EPO levels were lower than normal values. Hepatocellular carcinoma (HCC), one of the most frequent malignancies world-wide, is often characterized by mild anemia and increased serum EPO levels. We studied 30 HCC patients and 20 healthy subjects. We found that HCC patients presented higher serum EPO levels than healthy controls. In HCC patients, there was a significant inverse correlation between serum EPO levels and red blood cell count or hemoglobin levels. We postulated that the elevated serum EPO levels observed in these patients may be due to reduced hepatic clearance of EPO, and to the influence of cytokine-mediated inflammatory factors.

Aged↗
PubMed1995

Peptido-leukotrienes are potent agonists of von Willebrand factor secretion and P-selectin surface expression in human umbilical vein endothelial cells.

BACKGROUND: The peptido-leukotrienes (LTs) and lipoxins (LX) are produced by platelets through the transcellular conversion of leukocyte-derived LTA4 at sites of vascular inflammation and injury, such as during coronary artery balloon angioplasty. We studied the actions of these eicosanoids on vascular endothelium. METHODS AND RESULTS: We found that stimulation of cultured human umbilical vein endothelial cells (EC) with LTC4 and LTD4 resulted in the release of high-molecular-weight multimers of von Willebrand factor (vWF) in a concentration- and time-dependent fashion, as measured by ELISA. Neither LXA4 nor LXB4 stimulated vWF release. LTC4 and LTD4 also stimulated a rapid increase in the surface expression of P-selectin indicated by increased binding of anti-P-selectin monoclonal antibody-coated beads. Fluorescence cytometry detected prolonged peaks of [Ca2+]i in EC in response to concentrations of thrombin and LTD4 that induce near-maximal vWF secretion. In contrast, concentrations of LTC4 that induce similar levels of vWF secretion produced only asynchronous oscillations of [Ca2+]i in most EC and rarely induced prolonged peaks of [Ca2+]i. Depletion of external Ca2+ had no apparent impact on LT-stimulated [Ca2+]i transients and vWF secretion, implicating an intracellular pool as the source of this response. Staurosporine, sphingosine, and H-7 each had only modest effects on peptido-LT-induced vWF secretion, suggesting that protein kinase C is not a primary mediator of peptido-LT-induced exocytosis. Inhibitors of cyclooxygenase and platelet-activating factor had no effect on peptido-LT-mediated vWF secretion. CONCLUSIONS: Through the induction of vWF secretion and P-selectin surface expression, peptido-LTs are likely to play an important role in the interrelated processes of hemostasis and inflammation.

Calcium↗
PubMed1995

Regional distribution of transforming growth factor-alpha and epidermal growth factor in normal and portal hypertensive gastric mucosa in humans.

This study was designed to evaluate the concentration and the regional distribution of TGF-alpha and EGF in normal and portal hypertensive human gastric mucosa. To this end we measured by RIA the gastric and duodenal concentration of TGF-alpha and EGF in subjects with chronic hepatitis, who had normal gastric endoscopic appearance, and in patients with liver cirrhosis with and without congestive gastropathy. Our results show that TGF-alpha concentration is significantly higher than EGF concentration in both the stomach and duodenum. No significant regional differences in the distribution of the two peptides were found. Moreover, the gastroduodenal tissue levels of TGF-alpha were comparable in subjects with and without hypertensive gastropathy. EGF gastric concentration was not altered in patients with congestive gastropathy. However, EGF duodenal tissue levels were significantly lower in patients with liver cirrhosis than in noncirrhotic subjects. We speculate that the higher level of TGF-alpha in the gastroduodenal mucosa may support the hypothesis that TGF-alpha and not EGF is the major physiological ligand for TGF-alpha/EGF receptor in the intact gut. Furthermore, the lower duodenal concentration of EGF in cirrhotics might partially explain the increased susceptibility of cirrhotic patients to duodenal ulcer.

Adult↗
PubMed1995

The genetic relationships between Echinostoma caproni, E. paraensei, and E. trivolvis as determined by electrophoresis.

Adults of Echinostoma caproni, E. paraensei, and E. trivolvis were processed for starchgel electrophoresis. Ten enzyme systems representing 12 structural loci were examined using three different buffer systems. E. paraensei and E. caproni were found to be genetically inbred as indicated by the lack of heterozygosity in individual worms. All three taxa showed fixed differences indicating they are distinct species. Fixed differences were found between E. paraensei and E. caproni in six enzyme systems, between E. paraensei and E. trivolvis in five enzyme systems, and between E. trivolvis and E. caproni in five enzyme systems. Phenic relationships among the three species showed E. caproni was genetically more similar to E. trivolvis than to E. paraensei.

Animals↗
PubMed1995

Iron overload augments the development of atherosclerotic lesions in rabbits.

Iron, a major oxidant in vivo, could be involved in atherosclerosis through the induction of the formation of oxidized LDL, a major atherogenic factor. This study was designed to test this hypothesis experimentally. Four groups of New Zealand White rabbits were included: iron-overloaded/hypercholesterolemic (group A, n = 8), iron-overloaded (group B, n = 6), hypercholesterolemic (group C, n = 6), and untreated (group D, n = 6). Iron overload was achieved by the intramuscular administration of 1.5 g of iron dextran divided in 30 doses. Hypercholesterolemia was produced by feeding rabbit chow enriched with 0.5% (wt/wt) cholesterol. Serum iron, ferritin, cholesterol, triglycerides, and lipoperoxides in serum were measured throughout the study. Lipoperoxides were measured at the end of the study in liver, aorta, and spleen homogenates. Aortas of groups A and C had multiple lesions; however, group A had greater lesional involvement than group C (P < .05). Lesions were not observed in rabbits fed normal chow (group D). As expected, serum iron and ferritin were above normal levels in groups A and B. Serum cholesterol increased in groups A and C. Lipoperoxides in liver and spleen homogenates of iron-overloaded rabbits were increased. Interestingly, iron deposits were seen by ultrastructural studies in the arterial walls of rabbits in groups A and B. Our study suggests that iron overload augments the formation of atherosclerotic lesions in hypercholesterolemic rabbits.

Animals↗
PubMed1995

Regulation of aldosterone biosynthesis by adrenal renin is mediated through AT1 receptors in renin transgenic rats.

The transgenic (TG) rat (mREN2)27 is characterized by overexpression of the additional mouse Ren-2d gene in the adrenal cortex with marked suppression of renal renin. We have previously shown that in salt-depleted TG rats enhanced activation of mineralocorticoid biosynthesis is associated with selective stimulation of adrenal renin. To investigate whether the local renin-angiotensin system regulates aldosterone biosynthesis in the adrenal cortex of TG rats, we studied the effects of the AT1-angiotensin subtype receptor antagonist DuP 753 on aldosterone production in 5-week-old TG rats during salt restriction. All the rats (n = 56) were shifted from regular chow to a diet containing only 0.04% NaCl for 1 week. The AT1-receptor antagonist DuP 753 (10 mg/kg per day in drinking water) was administered to 27 of these rats during low-salt diet. Subgroups of rats were killed at 0,4, and 7 days. Low-salt diet increased both adrenal renin activity (from 31 +/- 3 to 77 +/- 4 and 85 +/- 2 ng angiotensin I.h-1.mg protein-1 at 4 and 7 days, respectively; P < .001) and mRNA (by 68.4 +/- 10% and 80 +/- 17% from baseline, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex↗
PubMed1995

Managed care. Pennies from heaven?

Managed care now covers almost a quarter of all Medicaid participants, but only a handful of those receiving long term care. And no wonder: Where could the savings be found? A few model programs indicate how--and whether--Medicaid managed care for long term care can work.

Aged↗
PubMed1995

Incidence and complexity of ventricular ectopy during Holter monitoring in patients with exercise-induced myocardial ischemia and normal or mildly reduced left ventricular function.

We aimed to assess the relationship between frequent and complex ventricular ectopy by continuous electrocardigraphic 24-hours Holter monitoring in patients with coronary artery disease and inducible ischemia during exercise procedures. We investigated 609 consecutive patients. They were referred for chest pain (28% with a previous myocardial infarction, older than 6 months). In all population patients radionuclide ventriculography showed a global normal or mildly reduced left ventricular function (ejection fraction > 45%). All patients showed exercise-induced myocardial ischemia (ST depression) and exercise thallium-201 reversible defects. During Holter monitoring, in study population, divided according to incidence of premature ventricular complexes (PVC), we found a higher prevalence of complex ventricular arrhythmias (CVA) (bigeminy, couplets, ventricular tachycardia, multiformity) in patients with high incidence of PVC. The relationship between frequent and complex ventricular ectopy has been observed also during ischemic ST shifts occuring during 24-hours monitoring. In contrast, the R on T phenomenon was not related to incidence of PVC. Therefore, in patients with exercise-induced myocardial ischemia and global normal or mildly reduced left ventricular function there is a relationship between frequent and complex ventricular ectopy, as previously suggested in CAD patients with depressed left ventricular function.

Adult↗
PubMed1995

Different protocols generate variations in systolic blood pressure response after exercise in patients with coronary artery disease.

Some patients with coronary artery disease (CAD) and exercise-induced myocardial ischemia demonstrate no change or a paradoxical increase in systolic blood pressure (SBP) during recovery following exercise. Previous studies have investigated the significance and clinical usefulness of analysis of recovery SBP response in detecting CAD, but conflicting data have been reported. Different protocols were used for the time of SBP recording and either bicycle or treadmill testing. We studied the exercise response in 64 male patients investigated for CAD who underwent symptom-limited treadmill stress testing during electrocardiographic monitoring and serial recording of blood pressure. Forty-three patients showed on or more stenoses of at least 70% at angiography (CAD). Twenty-one patients with normal coronary tree or slight lesions served as controls. The sensitivity (true positive/all CAD patients), specificity (true negative/all CAD-free patients), and the correct classification rate (correct diagnoses/all subjects) were assessed by standard ST segment analysis and two recovery SBP ratios calculated by dividing the first minute recovery SBP by the immediate postexercise value (RR/R) or by the true peak exercise value (RR/P). ST segment analysis achieved 53% sensitivity, 57% specificity, and 54% correct classification, the RR/R ratio achieved 73%,23%, and 60%, and the RR/P ratio 53%, 71%, and 59%, respectively. There were significant differences in results using these ratios. Time of SBP recording generated discrepancies in recovery SBP ratios. Therefore, differences in the timing of SBP measurement may generate conflicting clinical indications.

Blood Pressure↗
PubMed1995

Ambulatory monitoring of left ventricular function during cardiopulmonary exercise tests in normal sedentary subjects.

UNLABELLED: Ambulatory monitoring (VEST) of left ventricular (LV) function is a useful and accurate method to measure cardiac function during exercise and rest. The aim of this study was to evaluate LV response to exercise in normal sedentary subjects. METHODS: Ten normal sedentary subjects underwent continuous ambulatory monitoring of LV function by VEST during upright bicycle exercise associated with combined analysis of pulmonary gas exchange. All parameters of LV function were measured in control conditions at rest, at the anaerobic threshold (point of nonlinear increase in ventilation relative to oxygen uptake) and at peak oxygen uptake (peak VO2). RESULTS: Heart rate and cardiac output significantly increased from control conditions to anaerobic threshold (p < 0.001) and from anaerobic threshold to peak VO2 (p < 0.001). Ejection fraction, end diastolic volume and stroke volume significantly increased from control conditions to anaerobic threshold (p < 0.001), showing no significant change from anaerobic threshold to peak VO2. Finally, end-systolic volume significantly decreased from control conditions to anaerobic threshold (p < 0.001), showing no significant change from anaerobic threshold to peak VO2. CONCLUSION: VEST is particularly useful in the evaluation of cardiac response to exercise in normal sedentary subjects, providing a better understanding of the spectrum of the normal LVEF response to exercise. Our data demonstrate that ejection fraction response to exercise is variable after anaerobic threshold, and a uniform increase is not necessarily expected in normal sedentary subjects.

Adult↗
PubMed1995

[HCV superinfection in a chronic carrier of HBV].

The paper reports a case of acute hepatitis C (HCV) in a patient who was a chronic carrier of hepatitis B virus (HBV) during the course of which the authors observed a transient HBsAg clearance. The 53-year-old patient was a carrier of chronic HBV infection in an integrated minus variant phase. The patient presented an abrupt increment in aminotransferase (ALT) which was not compatible with the typical "a poussée" progress of atypical chronic HBV hepatitis in that it was associated with HbsAg clearance in the absence of signs of superinfection by delta hepatitis virus (HDV), with subsequent repositivisation of HBsAg and contemporary anti-HCV seroconversion (RIBA positive for C-22, C-33, C-100, 5-1-1) on clinical remission. Polymerase chain reaction (PCR) was negative on remission for both HBV DNA and HCV. RNA became positive six months afterwards for HCV RNA alone; moreover HBsAg, anti-HCV, RIBA C-22, C-33, C-100, 5-1-1 were constantly positive, thus further confirming the inhibitory capacity of HCV towards HBV and not vice versa, as also shown by the chronic nature of infection and deterioration of clinical conditions. The authors conclude by underlining the need to assay for HCV RNA using a PCR method in alla cases of re-acutisation of chronic hepatitis due to both wild virus B and the domestic virus during the course of which HBsAg becomes negative, even transiently, in the absence of Delta superinfection.

Chronic Disease↗
PubMed1995

[Radiotherapy of T1N0 neoplasms of the glottis. Analysis of the parameters that influence local control].

Treatment and tumor-related parameters were reviewed in 176 patients with T1N0 carcinoma of the glottic larynx submitted to primary radiation therapy from 1980 to 1992. Our aim was to analyze local control and treatment-related toxicity. Over-all local control rates at 10 years were 88.3% with irradiation alone and 94.5% after salvage surgery (larynx preservation: 91%). Verrucous histology was a negative factor affecting local control and anterior commissure involvement exhibited only a negative trend but had no statistical significance. Among treatment-related factors, local control was 76.5% after split-course and 91.1% after continuous-course irradiation (p < 0.05). With continuous-course irradiation, the total dose influenced local control only for single of 2 Gy (local control rates were 69% with 60 Gy and 93% at > or = 64 Gy; p < 0.05), but not for single doses of 2.25 Gy and total doses ranging 56.25-65.25 Gy (local control failed in 55 patients). Early and late complications did not increase with single doses > or = 2.25 Gy. Our current policy in T1N0 nonverrucous glottic carcinoma is to use a single fraction of 2.25 Gy and a total dose ranging 56.25-63 Gy according to tumor size, with a continuous course.

Actuarial Analysis↗