Multiple sclerosis and HTLV retroviruses.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
M Salvetti
Publications and source records attributed to M Salvetti.
Susceptibility and resistance of human autoimmune T cell activation to the immunoregulatory effects of transforming growth factor (TGF) beta 1, beta 2, and beta 1.2.
The transforming growth factors type beta (TGF-beta) regulate immune responses by suppressing a variety of leukocyte functions. Using a panel of human autoimmune T cell lines specific for the acetylcholine receptor (AchR) we investigated the immunoregulatory effects of TGF-beta 1, TGF-beta 2, and TGF-beta 1.2. The cytokines have identical effects inhibiting activation of most T line cells and the activation-dependent changes in interleukin-2 (IL-2) receptor and T cell receptor expression. IL-2-dependent growth was not modulated by TGF-beta. However, autoimmune T cell lines specific for AchR differ in their susceptibility to TGF-beta and some are completely refractory. Resistance of autoimmune T cell activation to immunosuppressive cytokines might be an element in the development of chronic autoimmune disease.
Antigens, Surface↗
[Rare vascular complications of Behçet's disease (so-called angiobehçet)].
Vascular involvement in Behçet's disease is rare and may cause life-threatening complications. We report on 3 patients who presented with vascular problems in the course of the illness. (1) A 37-year-old woman suffered multiple pulmonary artery aneurysms (PAA) 3 years after the first symptoms of Behçet's disease (BD) had been noted. They completely regressed under three-month high-dose corticosteroid therapy and remission has lasted now for 2 years. (2) The second patient, a 22-year-old man, developed 2 vascular complications of BD: first (1986-1987), he was shown to have a sinus venous thrombosis which resolved under prednisone and oral anticoagulation therapy. Then (1988) he presented with multiple large PAA and high fever. Despite marked radiological regression of the multiple PAA under high-dose prednisone treatment, he remained symptomatic. Repeated hemoptysis in September 1988 prompted us to add cyclosporine A in a dosage providing whole blood levels of 250-350 ng/ml. Four months later pulmonary radiological studies had normalized, but manifestations of BD on the skin and mucosa remained unchanged. 7 months after starting Cy A therapy the patient died suddenly of massive hemoptysis. (3) The third patient, a 23-year-old Spanish immigrant, had a diagnosis of BD when presenting with sinus thrombosis. Later he underwent surgery 3 times for false aneurysms of the common femoral artery which developed at the site where he had been punctured for angiography.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Systemic hypertension as a treatable risk factor for cerebrovascular disease.
It has long been established that hypertension is the major risk factor for stroke. Three Italian studies have been reviewed in order to examine different aspects of the problem. In the first study, the role played by the systolic, diastolic and systodiastolic components of hypertension in causing atherosclerotic damage of extracerebral and intracerebral arteries was examined. At the extracranial level, a significant correlation between systolic hypertension and atherosclerotic lesions was evident. The second study evaluated the risk of major stroke, myocardial infarction and death in patients with transient ischemic attacks and reversible ischemic neurologic deficits. Possible prognostic predictors of these events were thoroughly considered: Cumulative survival with the multivariate Kaplan-Meier analysis was significantly lower in hypertensive than in normotensive subjects, particularly for cerebral deaths and for all deaths. The third study was aimed at assessing the risk factors for transient ischemic attacks and stroke in young adults. Again, hypertension emerged as a fundamental risk factor, significantly more frequent in the subgroup of older patients than in the younger subgroup.
Age Factors↗
[Percutaneous biopsy of paracardiac masses].
Computed tomography was used to guide 55 biopsies on paracardiac masses. The authors' experience, gained with over 800 thoracic biopsies, points to CT as the method of choice for paracardiac masses, especially in those cases where the masses are located close to mediastinal and cardiovascular structures, which are not easily evaluated with fluoroscopy and, therefore, imply a greater bioptic risk. Furthermore, CT allows a more accurate needle trajectory to be selected than fluoroscopic guidance does. A diagnosis was reached in 47 of 55 cases, with 85% diagnostic accuracy. No complications such as hemoptysis, hemothorax, pericarditis and hemopericardium were observed. Only one patient required drainage after pneumothorax.
Biopsy, Needle↗
Changing prognosis of primary intracerebral hemorrhage: results of a clinical and computed tomographic follow-up study of 104 patients.
One hundred four consecutive cases of primary intracerebral hemorrhage hospitalized at the time of stroke were followed until death or for 1 year. All were treated nonsurgically. The 30-day mortality rate was 30%. Good clinical outcome and complete resolution of the lesion on computed tomography were observed in 49 and 13% of patients, respectively. Age, state of consciousness, and size of the hemorrhage on computed tomography scan were reliable prognostic indicators. The long-term survival rate, 66%, was higher than that previously reported and should be considered in future trials evaluating medical and surgical treatment of intracerebral hemorrhage.
Adult↗
Percutaneous gastrostomy in oncologic patients: analysis of results and expansion of the indications.
BACKGROUND: Percutaneous gastrostomy is generally performed for permanent enteral nutrition or gastric decompression. METHODS: In our series of oncologic patients, percutaneous gastrostomy was also used temporarily in some patients for enteral nutrition while awaiting functional recovery of swallowing, in preparation for surgery, or for the treatment of fistulas in the upper digestive tract. Fifty-one procedures were performed in 50 patients: 42 for feeding, eight for decompression, and one for transgastric drainage of a duodenal fistula. RESULTS: Of the 35 patients treated for permanent enteral nutrition, four are still alive, with a total survival time of 2,167 days. In three patients, gastrostomy was performed for temporary feeding and was removed once the ability to swallow was restored. In four patients, it was created to restore metabolic balance before surgery. In the patient with a duodenal fistula, healing was achieved in 19 days. The seven patients in whom the procedure was performed for decompression survived for a mean of 19.2 days. There was only one major procedure-related complication (peritonitis). CONCLUSIONS: Percutaneous gastrostomy is a safe, low-cost method that allows the patient to maintain essential nutrition without the discomfort of a nasogastic tube and therefore warrants wider and earlier use. We feel that its application should also be extended to temporary feeding of patients about to undergo long courses of chemotherapy and radiotherapy, which can lead to severe deterioration of nutritional status.
Aged↗
In vivo study of polyurethane-coated Gianturco-Rosch biliary Z-stents.
PURPOSE: Prototypes of Gianturco-Rosch Z-stents coated with polycarbonate urethane (PCU) were placed in the biliary tree of pigs, in order to test their biomechanical behavior, stability, and biocompatibility. METHODS: The stents were surgically implanted in the common bile duct of three pairs of pigs, which were killed after 1, 3, and 6 months respectively. Explanted livers from pigs of the same race, age, and size were used to provide comparative data. The bile ducts were radiologically and histopathologically examined; the stents were processed and examined by scanning electron microscopy. RESULTS: No complications occurred and the animals showed a normal weight gain. The main bile duct appeared radiologically and macroscopically dilated, but the stents proved to be in place. Histologically, the bile duct epithelium was destroyed, but neither hyperplastic nor inflammatory fibrotic reactions of the wall were evident. Both the metallic structure and the polymeric coating of the stents were intact. A layer of organic material with a maximum thickness of approximately 3 micron was evident on the inner surface of the stents. CONCLUSION: The present in vivo study demonstrates the biocompatibility, efficacy, and stability of PCU-coated Gianturco-Rosch stents in the biliary environment.
Animals↗
CT-fluoroscopy link-up (CTF): potential for special procedures.
Some interventional radiological procedures call for unrestricted axial vision and monoplanar fluoroscopy at different angles. We have mounted a fluoroscopic image intensifier in front of the gantry of a CT scanner to assess whether the combination would be useful. This link-up has been tested in a variety of situations and, even with the shortcomings of makeshift equipment, the combination filled some gaps in our vision of what is going on inside the patient, especially before an invasive procedure. It also proved useful in the planning of multiple procedures in a single session, especially when they had to be performed under general anesthesia in children or in the management of critical cases. We feel that the possibilities afforded by CTF (computed tomography plus fluoroscopy) need further exploration prior to the construction of purpose-built equipment. The interim information supplied suggests that it will be worth developing.
Biopsy↗
Continuous infusion with implantable pumps: expanding the radiologist's role.
Drug infusion systems attract increasing attention as biomedical technology offers miniaturized devices for targeted delivery of therapeutic substances on an outpatient basis. We have used a totally implantable, subcutaneous pump, externally programmable by radiofrequency link, learning the technique of implantation and management and using various imaging modalities for the diagnosis and control of complications. The procedure for implanting systems for continuous intrathecal analgesia and systemic intravenous chemotherapy is described. Our experience of the latter is made up of 296 implants in 290 patients. The selected infusion pump proved reliable and acceptable to patients and the quality of life, given the reduced drug toxicity, more than good. The complications were few both in frequency and in severity. The setting-up of a long-term infusion system, when major surgery is not needed, can fall within the interventional radiologist's field, partly because of a good cost-benefit ratio.
Cost-Benefit Analysis↗
Double-contrast barium enema and computerised tomography in the pre-operative evaluation of rectal carcinoma: are they still useful diagnostic procedures?
PURPOSE: In modern management of rectal carcinoma, the preoperative evaluation of disease parameters is important for selection of therapeutic options. Such parameters are currently defined through endorectal ultrasonography or endoscopic ultrasonography. A retrospective analysis of the parameters obtained with double-contrast barium enema (DCBE) and endorectal balloon computed tomography (CT) was conducted to verify the diagnostic reliability of the radiological techniques and to establish whether there is still an indication for their use. METHODS: 53 consecutive patients with adenocarcinoma of the distal half of the rectal ampulla underwent double contrast barium enema examination and CT of the pelvis with endorectal balloon. On the basis of the DCBE and CT assessment we evaluated: 1) the distance between the cranial extremity of the anal canal and the distal margin of the neoplasm; 2) the radial diffusion of the tumor; 3) the metastatic involvement of the perirectal and inferior mesenteric lymph nodes. RESULTS: 1) CT and DBCE measurements of the distal margin tended to coincide, but both tended to overestimate the measurement when compared to the pathologic examination; 2) in the identification of neoplastic infiltration of perirectal fat (T3) CT had 100% sensitivity, 78.7% specificity and 86.8% accuracy; 3) the CT sensitivity for detecting lymph node metastasis was 52.6%, specificity 85.3% and accuracy 73.6%. CONCLUSIONS: The diagnostic information provided by the radiological examinations is comparable to that of clinical and instrumental methods currently employed for staging of rectal carcinoma, although the latter are preferred because they are more readily accessible and less costly. DCBE and CT can therefore be usefully employed for staging of cancer of the rectum in those cases in which there are limitations of the current standard methods.
Adenocarcinoma↗
Management of complications from hepatobiliary surgery using the percutaneous transjejunal approach.
PURPOSE: The work was aimed at presenting the indications, techniques and results of the percutaneous transjejunal approach to the biliary tree in patients with hepatobiliary complications due to surgery. PATIENTS AND METHODS: Ten patients, 7 males and 3 females, mean age 50 years (range, 10-62) with hepatico-jejunostomy, who developed cholangitis together with jaundice or bile leakage, underwent this procedure, performed through the anastomotic loop that was not surgically anchored to the abdominal wall in all cases but one. The transjejunal approach was chosen because of non-dilated bile ducts in 3 patients, complex pathologic situations in 5 patients and to avoid complications to a transplanted liver in 2 patients. The jejunal loop was identified using CT, US and fluoroscopy in 4 patients and after its opacification in the remaining 6 (by percutaneous transhepatic or intravenous cholangiography or fistulography). RESULTS: The procedure was technically and diagnostically successful in all cases. Therapeutic procedures (stenting, dilation, litholysis) were also performed using the transjejunal approach in 7 patients and in 6 of them complete pathological resolution was achieved. There were no complications. CONCLUSIONS: Different pathologies of the biliary tree, in patients with bilio-enteric anastomoses, have been identified and treated by this technique; they were fistulas, anastomotic and/or multiple segmental benign or malignant stenoses of the bile duct, and diffuse intrahepatic lithiasis. The procedure was safe and reliable.
Adult↗
Interventional radiology and radiotherapy for inoperable cholangiocarcinoma of the extrahepatic bile ducts.
AIMS AND BACKGROUND: To evaluate the effectiveness of external radiation therapy (ERT), alone or combined with endoluminal brachytherapy (BRT), following percutaneous transhepatic biliary drainage (PTBD) in the treatment of patients affected by inoperable cholangiocarcinoma. METHODS & STUDY DESIGN: From September 1980 to June 1996, 130 jaundiced patients affected by inoperable cholangiocarcinoma were submitted to PTBD at the Division of Radiology C of the National Cancer Institute of Milan. Nineteen were excluded from the present analysis due to the short survival after PTBD (< 30 days). The other 111 patients were divided into three groups according to the following therapy: no further treatment after palliative PTBD in 89 patients (80%, group 1); ERT in 10 patients (9%, group 2); ERT plus BRT in 12 patients (11%, group 3). All the ERT + BRT patients were enrolled after 1990 and were treated with high-energy photon beams followed by endobiliary insertion of one or two iridium-192 wires. RESULTS: Median overall survival among the 111 assessable patients was 126 days; for groups 1, 2 and 3 it was 108, 345 and 428 days, respectively. The patients submitted to radiotherapy (ERT alone or ERT + BRT) were evaluated by radiologic examinations after the end of radiation. In group 2, a partial remission in 3 cases, a progression of disease in 1 case, and no change in 6 cases were observed. Among the patients of group 3, complete remission in 5 and partial remission in 7 patients were achieved. In all the patients achieving complete remission, the PTBD could be removed. CONCLUSIONS: The combination of ERT plus BRT improves survival and quality of life of the patients submitted to PTBD for cholangiocarcinoma. Under the technical point of view, radiation treatment is easy to perform, but much caution is required in defining clinical and planning target volumes. Moreover, drainage during the radiation treatment has to be submitted to a very meticulous surveillance.
Adult↗
Percutaneous intraductal sampling for cyto-histologic diagnosis of biliary duct strictures.
BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) allows ductal material to be collected for cyto-histologic examination. We evaluated the data from a large series of patients with a PTBD in whom endobiliary cyto-histologic sampling techniques were employed in order to define a strategy for their use in the diagnostic work-up. PATIENTS AND METHODS: Ductal samples for cyto-histologic examination were obtained from 409 consecutive patients with a PTBD for stenosing lesions of the biliary tree. Bile aspirate cytology was performed for all patients and ductal biopsy specimens were obtained, generally after negative cytology, from 49 of them (11.9%), all candidates for a therapeutic procedure. The cyto-histologic results of intraductal sampling were compared with pathologic surgical data in 210 patients and with clinical-radiologic follow-up in 199. RESULTS: Overall, 22 out of the 409 patients had a final diagnosis of benign stenosis and 177 had samples positive for neoplastic disease. The sensitivity of bile cytology was 43.8% while ductal biopsies showed a sensitivity of 60.4%. The combination of the two sampling techniques achieved a sensitivity of 65.1%. For both sampling methods the specificity was 100%. Hilar metastases from neoplastic lesions of the GI tract and primary lesions of the biliary ducts showed the highest sensitivity. CONCLUSION: Cyto-histologic assessment of stenosing lesions of the biliary ducts is mandatory when highly sophisticated interventions (e.g. wide hepatic resection or liver transplantation) or non-surgical treatments are envisaged. The collection of cyto-histologic samples from bile ducts, in patients with a percutaneous bile drainage, is an easy, safe and valuable method to obtain the diagnosis. In view of the absence of false positive results in our series and in others, intraductal biopsy serves no purpose when positive exfoliative cytology is positive for malignancy. In the presence of negative cytology it is felt that an intraductal biopsy should be mandatory when the choice of a therapeutic program depends on the result of the cyto-histologic diagnosis.
Adolescent↗
[Giant juvenile angiofibroma: which surgical approach?].
The juvenile angiofibroma is an uncommon, highly vascular, locally invasive, non encapsulated tumor. In spite of its benignity the above mentioned peculiarities make the therapy very hard. The estrogenic hormones and the radiotherapy were used for years but there were many iatrogenic after-effects. The preferred treatment is surgical. Many surgical approaches were used. Everyone has advantages and disadvantages. The choice may be free for tumors of small or medium size. When the tumor is very large, stage III A or more, a single approach isn't enough. A double approach is mandatory; one must be an infratemporal approach (pre o postauricular). We present a case of juvenile angiofibroma stage III B which is a good pattern of the above mentioned statements.
Adolescent↗
Relationship between bladder dysfunction and brain MRI in multiple sclerosis.
We studied 70 consecutive patients with definite multiple sclerosis (MS) to examine the relationship between magnetic resonance imaging (MRI) cerebral findings and urinary disturbances. Thirty-two subjects (46%) had urinary symptoms and 38 (54%) were asymptomatic. Patients with urinary symptoms exhibited greater overall functional disability. A significant correlation between the presence of midbrain lesions and urinary dysfunctions was found which may indicate an important role of the mesencephalic formation to preserve continence.
Adolescent↗
[Phenotypic and functional characterization of cloned T-lymphocytes from cerebrospinal fluid of patients with multiple sclerosis].
T cell clones derived from the cerebrospinal fluid of patients with multiple sclerosis were investigated for their ability to produce IL2, IL4, IFN gamma and TNF alpha. As controls, liver infiltrating T lymphocyte clones from patients with chronic active hepatitis were used. All CSF clones (both CD4+ and CD8+) produced high amounts of IFN gamma and particularly of TNF alpha. TNF was synthesized in a significantly higher amount than control clones. Moreover, they were capable of secreting IL2 but not IL4. From our results we conclude that CSF-CD4+ T clones could constitute a subset with functional properties similar to those of the Th1/inflammatory cells of the mouse. The unusually high amount of TNF produced by CSF derived T cell clones strongly suggests a significant role for this cytokine in MS immunopathogenesis.
Adult↗