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Biomedical subjects

Massimo Cirillo

Publications and source records attributed to Massimo Cirillo.

32 records · Page 2Linked to original sources
PubMed2003

Anasarca caused by Cryptococcus neoformans after heart transplantation.

Cryptococcosis is an opportunistic infection caused by the yeast-like fungus Cryptococcus neoformans. The infection predominantly strikes patients with cell-mediated immunodeficiency, that is, patients with organ transplants, leukemia, lymphoma, AIDS, and those receiving steroids or immunosuppressants. We describe a patient with skin lesions and anasarca secondary to intestinal infection from Cryptococcus neoformans after heart transplantation. We based diagnosis on histologic examination of the cutaneous lesions and of the duodenal mucosa. This case demonstrates that in immunosuppressed patients with anasarca of unknown origin, a diagnosis of intestinal opportunistic infection also should be considered.

Cryptococcosis↗
PubMed2003

Cross-sectional and prospective data on urinary calcium and urinary stone disease.

BACKGROUND: Urinary calcium is considered a risk factor for urinary stone disease (USD), although prospective data are missing. This epidemiologic study investigates cross-sectionally and longitudinally the relation of urinary calcium excretion to USD. METHODS: In the Gubbio Population Study, data on USD were collected by questionnaire during medical examinations from 1989 to 1992 (baseline) and telephone interviews in 1997 to 1998 (follow-up). Baseline data collection included overnight urinary calcium excretion and use of medications. Study cohort was made of 1458 men and 1799 women, age 25 to 74 years, and not on treatment with diuretics at baseline. USD was diagnosed by: excretion of stone(s), and/or radiographic or ultrasonic evidence, and/or surgical or endoscopic removal of stone(s). RESULTS: At baseline, urinary calcium excretion was higher in persons with than without USD (215 and 182 micromol/hour, P < 0.001) and related to USD prevalence independent of gender, age, and other variables (P < 0.001). Among persons without USD at baseline, baseline urinary calcium excretion was higher in persons with than without incident USD at follow-up (202 and 181 micromol/hour, P = 0.034) and related to incident USD independent of gender, age, and other variables. A difference of 100 micromol/hour (about 1 SD) in urinary calcium excretion related to a difference in USD risk of 1.32 for prevalence and 1.21 for incidence (95% CI = 1.15/1.52 and 1.01/1.45, respectively) in multivariate analyses controlled for gender, age, body mass index, parental history of USD, urinary excretion of urea, sodium, and potassium. CONCLUSION: Cross-sectional and prospective data show that urinary calcium excretion is a risk factor for USD.

Adult↗
PubMed2003

Low urinary albumin excretion in astronauts during space missions.

BACKGROUND: Physiological changes occur in man during space missions also at the renal level. Proteinuria was hypothesized for space missions but research data are missing. METHODS: Urinary albumin, as an index of proteinuria, and other variables were analyzed in 4 astronauts during space missions onboard the MIR station and on the ground (control). Mission duration before first urine collection in the four astronauts was 4, 26, 26, and 106 days, respectively. On the ground, data were collected 2 months before mission in two astronauts, 6 months after in the other astronauts. A total of twenty-two 24-hour urine collections were obtained in space (n per astronaut = 1-14) and on the ground (n per astronaut = 2-12). Urinary albumin was measured by radioimmunoassay. For each astronaut, mean of data in space and on the ground was defined as individual average. RESULTS: The individual averages of 24 h urinary albumin were lower in space than on the ground in all astronauts; the difference was significant (mean +/- SD, space and on the ground = 3.41 +/- 0.56 and 4.70 +/- 1.20 mg/24 h, p = 0.017). Dietary protein intake and 24-hour urinary urea were not significantly different between space and on the ground. CONCLUSIONS: Urinary albumin excretion is low during space mission compared to data on the ground before or after mission. Low urinary albumin excretion could be another effect of exposure to weightlessness (microgravity).

Albumins↗
PubMed2002

Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage.

BACKGROUND AND AIMS: Celiac disease is the most common severe food intolerance in the Western world and is due to gluten ingestion in genetically susceptible children and adults. Intestinal biopsy is the golden standard for evaluation of mucosal damage associated with celiac disease. Gluten-free diet is the key treatment for celiac disease. Data on the long-term control of celiac disease are few and limited to small series of patients. The study reports data on the control of celiac disease and on its correlates in a large cohort of celiac adults during long-term treatment with gluten-free diet. METHODS: The study cohort comprises 91 men and 299 women having undergone treatment with a gluten-free diet for at least 2 years and with complete records for visits at the time of diagnosis of celiac disease (baseline). Data collection included gender, age, education, weight, bowel habit, blood hemoglobin, plasma albumin and cholesterol, serum antiendomysium antibodies (EMA), dietary compliance to gluten-free diet (coded as good, low, or very low), and intestinal damage at biopsy (coded as absent, mild, or severe). RESULTS: The duration of follow-up was 6.9 +/- 7.5 years (mean +/- SD, range 2-22 years). At follow-up visit, intestinal damage was absent in 170 patients (43.6%), mild in 127 (32.6%), and severe in 93 (23.8%). At follow-up, intestinal damage was significantly associated with dietary compliance, EMA, and plasma albumin (follow-up value and change value from baseline to follow-up). Baseline education significantly predicted dietary compliance and intestinal damage at follow-up. CONCLUSIONS: Celiac disease is often poorly controlled in the majority of patients on long-term treatment with a gluten-free diet as demonstrated by intestinal biopsy. Lack of adherence to strict gluten-free diet is the main reason of poorly controlled disease in adults. Laboratory and clinical information have a high positive predictive value and low negative predictive value for intestinal damage on long-term treatment. Dietary compliance as assessed by interview is the best marker of celiac disease control due to low cost, noninvasivity, and strong correlation with intestinal damage.

Adult↗
PubMed2002

Red blood cell count in short-term prediction of cardiovascular disease incidence in the Gubbio population study.

OBJECTIVE: The Gubbio Study is an Italian population study measuring risk factors and incidence for major cardiovascular diseases. This analysis investigates the association between red blood cell (RBC) count, after preliminarily taking into account haematocrit, and incidence of coronary and cardiovascular events. METHODS: A population sample of 2,469 men and women aged 35-74 years, free from major cardiovascular diseases and in whom RBC count and haematocrit were measured in 1983 along with other standard risk factors, were followed up for 6 years and incidence was estimated for both fatal and non-fatal coronary heart disease (CHD) and all cardiovascular atherosclerotic (CVD) events. Proportional hazards models were solved for the prediction of these events. RESULTS: In six years 61 CHD hard criteria, 109 CHD any criterion and 149 CVD events were recorded. Preliminarily, both haematocrit and RBC count, two highly correlated variables, were studied to predict CVD events; however, haematocrit did not contribute multivariately, in the overall population and separately in men and women. Age-adjusted rates per 1,000 of the 3 event categories were computed in sex-specific RBC count quintiles (Q) and a difference was observed between Q5 and Q1 (with 5.21 +/- 0.31 and 4.18 +/- 0.23 x 10(6) per microl, respectively) for CHD any criterion (p < 0.07) and CVD (p < 0.05). P on trends was < 0.05 for both end-points. In multivariate models, adjusted for 7 other risk factors, RBC count contributed a weak statistical significance to predict CVD incidence [relative risk (RR) for a 0.5 x 10(6) per microl difference 1.23 with 95% confidence intervals (CI) 1.00- 1.51], whereas its contribution to predict CHD any criterion (RR = 1.19 with CI 0.93- 1.51) and CHD hard criteria (RR = 1.15 with Cl 0.83-1.58) was not statistically significant. Inclusion of blood glucose and presence of diuretics (11.33% of the population) as possible confounders had no major effect although the latter were, as expected, a significant risk factor (RR = 1.90 with Cl 1.28-2.82) which further diluted the CVD predictive role of RBC count (RR = 1.22 with CI 0.99- 1.50). CONCLUSIONS: Increased RBC count is independently (yet weakly) associated with risk of CVD events in the 6-year follow-up of the Gubbio Study. Longer follow-up is needed before the contributory role of RBC count can be properly assessed to explain CHD incidence.

Adult↗
PubMed2002

Urinary albumin in space missions.

Proteinuria was hypothesized for space mission but research data are missing. Urinary albumin, as index of proteinuria, was analyzed in frozen urine samples collected by astronauts during space missions onboard MIR station and on ground (control). Urinary albumin was measured by a double antibody radioimmunoassay. On average, 24h urinary albumin was 27.4% lower in space than on ground; the difference was statistically significant. Low urinary albumin excretion could be another effect of exposure to weightlessness (microgravity).

Journal Article↗
PubMed2002

Urinary albumin in head-down bed rest.

Previous studies reported low urinary albumin excretion in astronauts during space missions, suggesting an effect of microgravity on renal albumin handling. To test this hypothesis, urinary albumin excretion was investigated with use of head-down bed rest at -6 degrees (HDBR), an experimental model of microgravity. Eight healthy young men underwent two phases. Each phase included 2 days of dietary adaptation (run-in), 4 days of baseline (light activities and bed rest), and 6 days of experiment: HDBR 24h every day for intervention light activities and bed rest for control. The study was done in metabolic ward (DLR, Cologne, Germany). Urine were collected in days 3-4 of baseline and days 4-6 of experiment. Urinary albumin was measured by a double antibody radioimmunoassay, creatininuria by automated colourimetry. Data are expressed as albumin/creatinine ratio to control for timing and completeness of urine collection. Compared to baseline, albumin/creatinine ratio decreased by 9.3% during HDBR and increased by 14.9% during control. The difference in changes over baseline was significant between HDBR and control (p < 0.01 by paired comparison). The data support the hypothesis that low gravity reduces renal albumin excretion.

Journal Article↗
PubMedDate not supplied

Pierre-Joseph Desault (1738-1795)--a forerunner of modern medical teaching.

Pierre-Joseph Desault (1738-1795) was the first French professor of clinical surgery. He was chief surgeon at La Charité and Hôtel-Dieu in Paris, where he developed a new method for teaching anatomy and modified the teaching of surgery. His fame was due to his dedication and to the number and quality of fellows, who included Bichat, Louis, Corvisart, Dupuytren, Percy, Richerand, Petit, Chopart, and Gavard. He taught while performing surgery, and his school included up to six hundred fellows at a time, practicing in the 1200-bed Hôtel-Dieu. He "imprinted" his pupils with his professional teaching, his surgical procedures and his personal charm.

Anatomy↗
PubMedDate not supplied

Unusual cases of chronic intoxication by vitamin D.

A 62-year-old man was hospitalized for recent renal colic and neurologic disorders. Routine biochemistry indicated the presence of hypercalcemia (serum total calcium = 15.3 mg/100 mL) and renal failure (serum creatinine = 3.72 mg/100 mL). The patient reported that he had been on treatment with a slow-release multivitamin preparation containing vitamin D and vitamin A, administered by i.m. injection. Plasma 25-OH vitamin D was > 150 ng/mL (normal range 16-74 ng/mL), plasma 1,25-(OH)2 vitamin D was 32.5 pg/mL (normal range 14-60 pg/mL), plasma parathyroid hormone 1.3 pg/mL (normal range 10-65 pg/mL). There were calcifications of left and right iliac artery at abdomen x-ray. Ultrasound and computed tomography of the glutei showed alterations of skeletal muscle and calcifications. Immediate treatment with infusion of isotonic saline, furosemide and prednisone induced rapid control of hypercalcemia and renal failure. Chronic treatment per os was discontinued after six months. The patient reported that the treatment with vitamin D had been prescribed by a physician also to his wife (55-year-old). For the woman, routine biochemistry indicated the presence of hypercalcemia (serum total calcium = 11.3 mg/100 mL) and renal failure (serum creatinine = 1.8 mg/ mL). Plasma 25-OH vitamin D was > 150 ng/mL, plasma 1,25-(OH)2 vitamin D 47.9 pg/mL, plasma parathyroid hormone was 2.5 pg/mL. Hypercalcemia was acutely treated by oral hydration, furosemide, and prednisone. Chronic treatment per os was discontinued after five months.

Acute Disease↗
PubMedDate not supplied

Vascular access for hemodialysis: the impact on morbidity and mortality.

BACKGROUND: In chronic hemodialysis (HD), central venous catheter (CVC) use seems associated with an increased risk of death. This study, using registry data, evaluated the morbidity and mortality risk associated with the use of different permanent vascular access (VA) in a HD patient cohort. METHOD: We evaluated hospitalization and death rate in prevalent and incident HD patients recorded in the uremic registry of Campania (southern Italy) for 2001. Patients were divided into three groups: CVC, artero-venous graft (AVG) and artero-venous fistula (AVF). RESULTS: One hundred and eleven dialysis units in the Campania region (69%) provided data. A total of 2201 out of 3387 prevalent HD patients were included: 92 patients (4.2%) were on CVC, 24 patients (1.1%) were on AVG and 2085 patients (94.7%) were on AVF. In comparison with AVF, the CVC group had a greater prevalence of female gender, old age, diabetes, comorbidities, hypoalbuminemia, anemia, erythropoietin (EPO) resistance, and less frequent synthetic membrane use, but had a similar dialysis duration (hr/week). Similar data were collected in the 635 incident patients registered in 2001. During the study, in both prevalent and incident CVC patients, either hospitalization or death rates were enhanced; however, the difference in the relative risk (RR) of death disappeared after correction for age, gender, malnutrition, diabetes, hemoglobin, albumin and comorbidity. Among incident patients, survival analysis was performed in patients remaining on the same VA type throughout the follow-up period; while a similar survival between groups was demonstrated in the 1st year of follow-up, survival was worse in the CVC group during the 2nd year of follow-up; however, this difference also disappeared in the adjusted analysis. CONCLUSION: This cohort study demonstrates that in chronic dialysis patients CVC choice, with respect to AVF, is mainly associated with female gender, advanced age and worse clinical conditions at baseline, and a worst outcome in both prevalent and incident CVC patients compared to AVF patients. Hospitalization, mortality rate and RR of death increased significantly; however, differences disappeared after correction for comorbidity. Therefore, these data suggest that CVC use per se is not associated with increased mortality risks with respect to AVF.

Aged↗
PubMedDate not supplied

History of fluid balance and kidney function in space.

During the last four decades, about 400 people have been in Space, since Yuri Gagarin was sent in 1961 as the first human into Earth orbit. From the very beginning, the circulatory system of astronauts (meaning heart, vascular system, body fluid distribution and balance, and the kidney) was central to the medical concerns of Space physiologists and physicians because of its gravity-dependence. The present manuscript puts emphasize on some key scientists who worked in the field of body fluid regulation and kidney function in the USA, in Russia and in Europe during recent decades. The manuscript in particular summarizes the outcome of this research and describes the present understanding of how the body fluid regulatory system adapts to the extreme environment of Space.

Adaptation, Physiological↗
PubMedDate not supplied

The build-up of clinical science.

In the years 1720-1820 medicine changed from an art into a science. The slow construction of clinical science, a process still to be completed, has many founding fathers. Here the transition is analyzed through the biographic studies of John Hunter (1728-1793), Domenico Cotugno (1736-1824) and Pierre Joseph Desault (1738-1795) who respectively taught in London, Naples and Paris. Because of their scientific stature they were able to plan, build and foresee the impact of these changes.

Education, Medical↗
PubMedDate not supplied

Mariano Semmola (1831-1895): the effect of low protein diet in primary albuminuria.

Mariano Semmola (1831-1895), the first Italian professor of pharmacology and clinical pharmacology, was born into a family of illustrious intellectuals and trained as a fellow of Claude Bernard, Trousseau and Rayer in Paris. His scientific activity included both animal investigations and clinical research. He is credited with important contributions to several areas of clinical medicine, from infectious diseases (cholera, and tuberculosis) to renal, cardiovascular and liver diseases. He had a lifelong interest in chronic Bright's disease. His seminal papers in that field were published in international journals and presented at international congresses and the most important European academies. As a scientist of great charisma and international reputation, he received many academic and governmental awards and even served in the Italian Parliament. His name is linked in particular with the hematogenous-dyscrasic theory of Bright's disease. He made important contributions to the pathogenesis of 'large white kidneys', as well as to the albuminuria-dependent lesion in renal disease. He also described in Bright's disease the effects of nitrogen-poor diets on specific gravity, albuminuria and urea excretion. It is evident from the renal literature from 1850 to 1908 that he achieved fame as a scientist, and that his theories on kidney disease were adopted in clinical practice.

Albuminuria↗