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Biomedical subjects

P Gallo

Publications and source records attributed to P Gallo.

At least 145 records · Page 8Linked to original sources
PubMed1990

Relation of complex ventricular arrhythmias to presenting features and prognosis in dilated cardiomyopathy.

To evaluate whether complex ventricular arrhythmias relate to presenting features and prognosis of dilated cardiomyopathy, 104 patients were studied from 1977 to 1987. At diagnosis, the 19 patients with complex ventricular arrhythmias (18%), as compared to the 85 patients without (82%), had a higher incidence of palpitation (P less than 0.01), severe dyspnea (P less than 0.001) and atrial fibrillation (P less than 0.01). They showed also higher mean right atrial pressures (10 +/- 5 vs 6 +/- 4 mm Hg, P less than 0.001) and higher right ventricular end-diastolic pressures (11 +/- 4 vs. 7 +/- 4 mm Hg, P less than 0.001) than patients without complex ventricular arrhythmias. Histologic samples were collected from the 32 patients (31%) studied since 1984 and semiquantitatively graded. The 11 patients with complex ventricular arrhythmias showed a higher frequency of severe interstitial fibrosis than the 21 patients without (64% vs. 24%, P less than 0.05), but they were otherwise similar as to the frequency of marked myocellular hypertrophy, changes of myocardial regression, endocardial fibrosis, attenuation of myocytes, hyperplasia of smooth muscle cells and infiltration by inflammatory cells. During a follow-up of 3.8 +/- 3.5 years, 35 patients (34%) died. Mortality was 58% (11 out of 19) in patients with complex ventricular arrhythmias and 28% (24 out of 85) in patients without (P less than 0.025). These results show that complex ventricular arrhythmias in dilated cardiomyopathy are associated with impairment of function of the right heart and severe interstitial fibrosis of the left ventricle, rather than with left ventricular dysfunction. Presence of complex ventricular arrhythmias also seems to identify those at high risk for death.

Adult↗
PubMed1990

IgG oligoclonal bands in sera of HIV-1 infected patients are mainly directed against HIV-1 determinants.

In a series of 60 HIV-1-infected individuals, serum electrofocusing analysis disclosed clonally restricted IgG patterns in 9 patients (15%), most with limited disease progression (stages WR1-WR3). These oligoclonal bands had a very heterogeneous light chain pattern, and most showed specificity for HIV-1 in affinity-driven transfer studies; virus specificity was more clear-cut following adsorption of sera with the relevant antigen. These findings further stress the profound B-cell function derangement in HIV-1 infection; their possible relevance to AIDS-associated lymphoma development is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Current therapy of peripheral obstructive arterial disease. The non-surgical approach.

In recent years double-blind trials have proved the effectiveness of nonsurgical therapy in the treatment of peripheral obstructive arterial disease (POAD). Among the non-pharmacologic measures taken, walking distance was increased by 40% in subjects who stopped smoking and by more than 100% in those who undertook physical exercise. Drug treatment reduces the atherosclerotic process and brings about an improvement in the symptoms of the disease. In subjects given hypolipidemic treatment the progression of the disease was reduced by two thirds. Two separate studies suggest that antiplatelet drugs, taken over a period of two to four years, significantly slow the progression of atherosclerosis in lower extremity arteries. In the treatment of claudication, two vasodilating drugs, naftidrofuryl and buflomedil, have shown a significant improvement in painfree walking distance and/or total walking distance, compared with treatment with placebo. Another effective approach is in the treatment of blood rheology through drugs such as pentoxifylline or by hemodilution. Double-blind trials with pentoxifylline demonstrated an average increase of 66% in maximum walking distance as compared with 22% with placebo. The effectiveness of hemodilution was demonstrated by two controlled trials, during which the reduction of the hematocrit to values of 40-42 for periods of four to six weeks increased both walking distance and resting blood flow. When introduced intraarterially in low doses in the vicinity of the occluding thrombus, thrombolytic agents have been found to be helpful in the treatment of acute and chronic POAD. This therapy should, however, be regarded as a substitute for surgical treatment only in high-risk patients. Further, after having produced the lysis of thrombi, the treatment permits the underlying parietal lesions to be accurately identified; at this point the appropriate therapy can be decided upon, either an operative procedure or a balloon dilation. In conclusion the many controlled clinical trials carried out over the past few years have clearly demonstrated that conservative treatment can alleviate clinical signs and symptoms in patients with claudication and pain at rest.

Anticoagulants↗
PubMed1990

Postinflammatory scarring of cardiac valves of rheumatic and nonrheumatic etiology.

In rheumatic heart disease, cardiac valves often display only a nonspecific postinflammatory scarring, without specific features, such as the rheumatic granuloma. Fifty-five native valves excised from 47 patients, exhibiting postinflammatory scarring, were studied. Patients were subdivided into three groups according to their case histories: patients with both streptococcal infection and rheumatic fever (group I), with streptococdal infection without noncardiac major manifestations of rheumatic fever (group II), and without either of these features (group III). Pathological examination alone was unable to differentiate among the three groups, all the valves showing the same general pathological features. Differences in terms of sex, age, and valvular involvement were detected among group III and the others, whereas patients belonging to the first two groups did not differ significantly. These results suggest that diagnostic criteria for rheumatic fever are too restrictive and that a postinflammatory valvular scarring of nonrheumatic etiology does exist.

Aortic Valve↗
PubMed1989

Determinants of end-stage idiopathic dilated cardiomyopathy: a multivariate analysis of 104 patients.

Our purpose in this study was to investigate the correlation of clinical, electrocardiographic, hemodynamic, and histopathologic features at diagnosis with the long-term prognosis in 104 patients with idiopathic dilated cardiomyopathy to determine which factors are the independent determinants of the end-stage disease. During a mean follow-up of 3.8 +/- 3.5 years, 35 patients (33%) died, 14 (13%) suddenly and 21 (20%) from congestive heart failure. Univariate analysis of survival curves disclosed that clinical and electrocardiographic variables at diagnosis were similar in survivors and non-survivors. On the contrary, patients who subsequently died had higher mean right atrial pressure (p = 0.0001), right ventricular end-diastolic pressure (p = 0.0061), mean pulmonary artery pressure (p = 0.0001), and left ventricular systolic (p = 0.0049) and end-diastolic (p = 0.0021) pressure than survivors. They also exhibited larger left ventricular end-diastolic (p = 0.0046) and end-systolic (p = 0.0027) volumes, lower ejection fraction (p = 0.0001), and a greater proportion had severe mitral regurgitation (p = 0.0095). Univariate analysis of histologic findings collected in a subgroup of patients referred since 1984 revealed a mild degree of myocellular hypertrophy to be associated with a poor prognosis (p = 0.0217). Multivariate analysis selected only mean right atrial pressure (p = 0.0022), ejection fraction (p = 0.0089), and end-systolic volume (p = 0.0265) as independent determinants of cardiac death. Our results suggest that cardiac catheterization is mandatory for risk stratification of patients with idiopathic dilated cardiomyopathy, since it allows the assessment of hemodynamic, angiographic, and histopathologic features helpful in identifying patients with a poor prognosis.

Adult↗
PubMed1989

Clinical significance of intraoperative cultures of aneurysm walls and contents in elective abdominal aortic aneurysmectomy.

To investigate the clinical significance of intraoperative cultures in elective abdominal aortic aneurysmectomy, we cultured the aneurysmal wall and contents in 90 patients undergoing vascular graft surgery. Prosthetic graft infection was documented in 1 out of 62 patients with negative cultures and in none of 28 patients with positive cultures (chi 2 = 0.4, p greater than 0.1). Bacterial growth was seen in neither of 2 inflammatory aneurysms, 3 of 14 atherosclerotic aneurysms and 2 of 5 aneurysms without specific features. A retrospective analysis of patients' charts aimed at finding possible risk factors failed to identify any correlation between results of cultures and length of hospitalization before surgery, time interval between angiography and surgery, route of angiography procedure or minutes of surgery before sample collection. We conclude that positive cultures may not imply clinical infection at the time of surgery and that prolonged post-operative organism-specific antibiotic therapy does not appear necessary to prevent graft contamination in patients undergoing elective abdominal aortic aneurysmectomy.

Adult↗
PubMed1989

Experimental allergic encephalomyelitis in the monkey: humoral immunity and blood-brain barrier function.

Acute monophasic experimental autoimmune encephalomyelitis (AMEAE) was induced in 5 Macacus cynomolgus monkeys. Serum and cerebrospinal fluid (CSF) paired samples were collected before and four weeks after immunization, time of complete development of AMEAE clinical picture. After immunization the CSF/serum albumin ratio and the IgG index were markedly increased. Agarose isoelectric focusing (AIEF) followed by immunofixation revealed faint IgG oligoclonal bands in both serum and CSF of all monkeys, which became more evident after Kappa and Lambda assessment. Intrathecal synthesis of IgG oligoclonal bands was detected in only one CSF. Affinity-driven immunoblotting failed to detect anti-myelin basic protein (MBP) oligoclonal IgG. No free light chain (FLC) patterns or IgA and IgM oligoclonal bands were detected.

Animals↗
PubMed1989

Immune activation in multiple sclerosis: study of IL-2, sIL-2R, and gamma-IFN levels in serum and cerebrospinal fluid.

Serum and cerebrospinal fluid (CSF) levels of interleukin-2 (IL-2), soluble IL-2 receptor (sIL-2R), and gamma-interferon (gamma-IFN) were measured in multiple sclerosis (MS) patients, human immunodeficiency virus type 1 (HIV-1)-infected patients and normal controls (NC). Increased levels of both IL-2 and sIL-2R were found in MS serum. Moreover, 11 of 50 MS patients showed detectable levels of IL-2 in the CSF. HIV-1-infected patients had increased levels of sIL-2R in serum and, less frequently, in the CSF. gamma-IFN was never detected in serum and CSF of all the patients studied. These findings confirm preliminary reports, further stress a systemic T-cell activation in MS, and support the hypothesis that an immunologic disorder exists in such patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Immunoglobulin light chain patterns in the cerebrospinal fluid. A study with special reference to the occurrence of free light chains in cerebrospinal fluid with and without oligoclonal immunoglobulin G.

The immunoglobulin light chain patterns were studied in paired cerebrospinal fluid (CSF) and serum samples from 30 controls, 70 multiple sclerosis (MS) patients, 18 subjects with other inflammatory neurological diseases and 17 patients with other non-inflammatory neurological disorders. In MS, all CSF samples examined by two-dimensional gel electrophoresis exhibited clonally restricted light chain components. Isoelectric focusing and immunoblotting detected free light chains in around 90% of CSF samples from patients with MS or other inflammatory diseases. These components were clonally restricted, appeared in both mono- and dimeric forms and occurred in CSF samples with as well as without oligoclonal immunoglobulin G bands. Generally, the positive CSF samples contained kappa as well as lambda free lights chains. Such components were not detected in the sera, nor in the CSF samples from controls or patients with non-inflammatory diseases.

Brain Diseases↗
PubMed1989

Human immunodeficiency virus type 1 (HIV-1) infection of the central nervous system: an evaluation of cytokines in cerebrospinal fluid.

Cytokines play an important role not only for initiation of immune reactivity but also for development of tissue injury. Of 38 patients infected with human immunodeficiency virus type 1 (HIV-1) interleukin-1 beta (IL-1 beta) and interleukin-6 (IL-6) were identified in cerebrospinal fluid (CSF) of 22 (58%) and 16 (42%) patients, respectively. Among the IL-1 beta- and IL-6-positive CSF were eight of 15 HIV-1 patients with no clinical signs of central nervous system involvement and four of five patients with acquired immunodeficiency syndrome (AIDS) dementia complex. The presence of IL-6 was often associated with IL-1 beta and soluble interleukin-2 receptor in CSF as well as with intrathecal IgG synthesis. In none of the CSF samples tumor necrosis factor-alpha or interleukin-2 was detected.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Tumor necrosis factor alpha (TNF alpha) and neurological diseases. Failure in detecting TNF alpha in the cerebrospinal fluid from patients with multiple sclerosis, AIDS dementia complex, and brain tumours.

The presence of tumor necrosis factor alpha (TNF alpha)/cachectin was investigated in 180 paired cerebrospinal fluid (CSF) and serum samples from patients with neurological diseases, and in five paired CSF and serum samples of Macaca cynomolgus monkeys with acute monophasic experimental autoimmune encephalomyelitis (AMEAE). TNF alpha was never detected in human CSF, even when an extensive demyelination was documented (active multiple sclerosis, acquired immunodeficiency syndrome (AIDS) dementia complex). Only one Macaca with AMEAE had detectable levels of TNF alpha in CSF but not in serum, suggesting an intrathecal synthesis of this cytokine in AMEAE.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Brain tumors: detection of B-cell stimulatory factor-2/interleukin-6 in the absence of oligoclonal bands of immunoglobulins.

24 patients with neoplasia of the central nervous system (CNS-N) were investigated for the presence of B-cell stimulatory factor-2/interleukin-6 (IL-6) in the cerebrospinal fluid (CSF). Whereas IL-6 was detected in 21 (88%) of these CSF samples, only 6% of CSF from non-inflammatory brain diseases and 12% of the samples from multiple sclerosis patients were positive. IL-6 was found in both primary and secondary CNS-N. The presence of IL-6, a cytokine which activates B-lymphocytes to produce high-rate immunoglobulin (Ig) synthesis, is in contrast to the ineffective intrathecal B-cell activation as suggested by the failure to detect oligoclonal bands of Igs in CNS-N.

Adolescent↗
PubMed1989

Tumour necrosis factor-alpha in infectious meningitis.

During a one year period tumour necrosis factor-alpha (TNF-alpha) was prospectively determined in the cerebrospinal fluid of 49 patients with infectious meningitis. TNF-alpha was found in the cerebrospinal fluid of 15 of 18 patients with bacterial meningitis. In 11 patients who had cerebrospinal fluid positive for TNF-alpha it was detected in only one serum (in low concentration). There was no significant correlation between the concentration of TNF-alpha in cerebrospinal fluid and the patient's age, duration of illness and fever, body temperature, and serum C reactive protein. However, cerebrospinal fluid protein concentrations of greater than or equal to 2 g/l and leucocyte values of greater than or equal to 2.5 X 10(9)/l were more often associated with high TNF-alpha concentrations (greater than or equal to 500 pg/ml). In contrast with bacterial meningitis, none of the 31 samples of cerebrospinal fluid from patients with viral meningitis was positive for TNF-alpha. Thus this investigation supports the conclusion, drawn from animal studies on TNF-alpha in the cerebrospinal fluid, that the presence of TNF-alpha is indicative of bacterial meningitis. Absence of TNF-alpha cerebrospinal fluid, however, was found here not to exclude a bacterial aetiology of the infection.

Adolescent↗
PubMed1989

[Influence of chronically-administered enalapril on isotonic and isometric exercise in patients with moderate grade hypertension].

We studied 11 patients affected by mild essential hypertension during chronic therapy with enalapril (E). After a pharmacological wash-out the patients were treated with E once a day (10-20 mg) for 4 weeks. Before and after the treatment period the patients were studied by means of the isotonic exercise stress test on the cycloergometer with increments of 25 W every 2 min and by means of the Sustained Handgrip test (SHG) at 70% of maximal capacity for 1 min. During the study period E reduced the blood pressure at rest in all patients without untoward effects. During the isotonic test and particularly during SHG, E reduced systolic and diastolic blood pressure (BP) and the product systolic BP x heart rate. The treatment did not influence the time length of the isotonic exercise stress test. Our results suggest that E does not increase the MVO2 at rest and during different types of exercise: this can be very important because many patients affected by hypertension suffer from ischemic heart disease. E is utilized also in patients with heart failure, some of whom have an hypertensive or ischemic cardiomyopathy.

Adult↗
PubMed1989

[Predictive value of myocellular hypertrophy in idiopathic dilated cardiomyopathy].

The role of endomyocardial biopsy (EMB) in assessing of idiopathic dilated cardiomyopathy (IDCM) is a well-recognised one. On the contrary, the value of correlating histological features, such as myocellular hypertrophy, with functional evaluation and outcome is still controversial. It was the purpose of the present study to appraise the correlation with hemodynamic data and the predictive role of histological features in 32 consecutive patients affected by IDCM who underwent left ventricular EMB between January 1984 and December 1986. Light microscopy findings were graded by means of a semiquantitative score system. In comparison with the 19 patients with mild myocellular hypertrophy, the 13 patients with marked hypertrophy showed significantly lower right ventricular end-diastolic pressure (10.4 +/- 5.8 vs 6.6 +/- 3.6 mmHg, p less than 0.05) and left ventricular end-diastolic pressure (26.9 +/- 9.0 vs 16.5 +/- 8.8 mmHg, p less than 0.01). On the contrary, different degrees of interstitial fibrosis, as well as of the other morphologic findings, could not identify patients with distinct hemodynamic patterns. However, there was a direct correlation between the amount of myocellular hypertrophy and interstitial fibrosis (p less than 0.01). During a mean follow-up period of 32 +/- 11 months (range: 12-48 months), 6 patients died and 3 further patients underwent heart transplantation. Univariate analysis of histological features (log-rank test) showed a mild degree of hypertrophy alone to be significantly related to a poor outcome (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗