Search PubMed⌕ Search

Biomedical subjects

R D'Alessandro

Publications and source records attributed to R D'Alessandro.

At least 37 records · Page 2Linked to original sources
PubMed1997

Quantitative analysis of CEA expression in colorectal adenocarcinoma and serum: lack of correlation.

Tissues and sera from 110 patients diagnosed with colorectal primary carcinoma, 20 patients with benign colorectal diseases and 31 healthy donors were subjected to quantitative CEA analysis. Multiple samples from tumor lesions and autologous histologically normal mucosa (10 cm from the tumor) were obtained at the time of surgery (cancer patients) or endoscopy (benign patients and healthy volunteers). CEA content was measured in protein extracts obtained from these tissues using a quantitative RIA method. A limit of normality for CEA content was established as 300 ng/mg of protein. When this was taken as cut-off, 104 of 110 (94.5%) tumor lesions and 51 of 110 (46.4%) autologous histologically normal colonic mucosa from cancer patients had elevated CEA levels. No correlation with stage of disease was found, while a correlation was observed with degree of tumor differentiation. A statistically significant difference between CEA content in tumor lesions and in histologically normal mucosa from cancer patients was observed (p = -0.001). Moreover, CEA content was statistically higher in the normal mucosa from cancer patients than in that from healthy donors (p = 0.005). CEA content in tissue specimens from benign lesions differed significantly from that in tissue from healthy donors (p = 0.005) and in carcinoma lesions (p < 0.001). The highest CEA content was observed in benign lesions with severe dysplasia. No statistical correlation between CEA content in carcinoma tissues and serum CEA levels (r = 0.195, p = .13) was found. Therefore, in considering diagnosis or therapy with anti-CEA MAbs for colorectal-carcinoma patients, or potential therapies with anti-CEA recombinant vaccines, serum CEA levels should not be taken as indicating CEA expression in tumor lesions.

Adenocarcinoma↗
PubMed1997

Dystonia as an isolated symptom of multiple sclerosis?

Sustained dystonia has seldom been reported during the course of multiple sclerosis (MS) [5-8, 10], and has been described as the first manifestation of the disease in only three cases [1,3]. We describe a patient with a diagnosis of laboratory-supported, defined MS in which sustained dystonia was the only neurological symptom.

Brain↗
PubMed1997

Altered thymic endocrine activity along with impairments of peripheral zinc metabolism and T-lymphocyte populations are associated with myasthenia gravis: a follow-up study.

Thymic endocrine activity was assessed by a bioassay to determine the basal activity of thymulin (TH), a zinc dependent hormone, and its in vitro reactivation in two different age groups of patients with myasthenia gravis (MG). Before thymectomy, basal TH plasma levels were increased in patients over the age of 50 years. Plasma zinc levels were increased in all patients, this increment being very high in old patients. One year after thymectomy both TH and zinc plasma levels decreased. While zinc plasma levels were within the normal ranges for their respective ages, TH levels were lower in young and higher in old patients than in age comparable controls. Young patients with MG showed increased CD3,DR positive peripheral T-cells as well as lymphocytes with the CD16,CD56 phenotype. An increment of CD3 positive cells along with CD4 and CD16,CD56 positive cells were found in older patients. Thymectomy partially affected blood lymphocyte representation only in young patients, since CD3,DR T-cells decreased one year after surgery. No significant variations in T-cell representation were found in old patients after thymectomy. Immunosuppression in thymectomized patients did not significantly affected TH and zinc plasma levels. Very high levels of TH and the presence of additional alterations in T-lymphocyte subsets in old patients suggested that differential age related pathogenetic immunological mechanisms might be associated with the disease.

Adolescent↗
PubMed1997

Brain and skeletal muscle bioenergetic failure in familial hypobetalipoproteinaemia.

OBJECTIVE: To determine whether a multisystemic bioenergetic deficit is an underlying feature of familial hypobetalipoproteinaemia. METHODS: Brain and skeletal muscle bioenergetics were studied by in vivo phosphorus MR spectroscopy (31P-MRS) in two neurologically affected members (mother and son) and in one asymptomatic member (daughter) of a kindred with familial hypobetalipoproteinaemia. Plasma concentrations of vitamin E and coenzyme Q10 (CoQ10) were also assessed. RESULTS: Brain 31P-MRS disclosed in all patients a reduced phosphocreatine (PCr) concentration whereas the calculated ADP concentration was increased. Brain phosphorylation potential was reduced in the members by about 40%. Skeletal muscle was studied at rest in the three members and during aerobic exercise and recovery in the son and daughter. Only the mother showed an impaired mitochondrial function at rest. Both son and daughter showed an increased end exercise ADP concentration whereas the rates of postexercise recovery of PCr and ADP were slow in the daughter. The rate of inorganic phosphate recovery was reduced in both cases. Plasma concentration of vitamin E and CoQ10 was below the normal range in all members. CONCLUSIONS: Structural changes in mitochondrial membranes and deficit of vitamin E together with reduced availability of CoQ10 can be responsible for the multisystemic bioenergetic deficit. Present findings suggest that CoQ10 supplementation may be important in familial hypobetalipoproteinaemia.

Brain↗
PubMed1997

Variables associated with hospital arrival time after stroke: effect of delay on the clinical efficiency of early treatment.

BACKGROUND AND PURPOSE: A limiting criterion for the eligibility of patients in clinical trials investigating acute stroke therapies is that time between onset of symptoms and arrival in the hospital should fall within the "therapeutic window." The aims of this study were to estimate hospital arrival time in an unselected sample of stroke patients, to assess the association with some clinical and demographic variables, and to evaluate the effects of the delay on the clinical efficiency of an effective treatment. METHODS: We evaluated the delay in hospital arrival time in 189 patients (84 men, 105 women; mean age, 76.5 years) prospectively collected in the S Orsola-Malpighi Community Teaching Hospital in Bologna, Italy. Cutoffs of 2 and 5 hours were chosen to allow for hypothetical treatment within 3 and 6 hours, respectively. Exact multiple logistic regression was used to predict the delay as a function of dichotomized age, sex, symptoms on awakening, day of the week, hour of the day, area of residence, level of consciousness, and level of motor power defect. We then projected the effectiveness of tissue plasminogen activator (TPA) on disability as estimated with the aid of the odds ratio from the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial onto our unselected sample to evaluate clinical efficiency of treatment as a function of arrival time and of hypothetical effects of educational efforts to reduce it. RESULTS: The mean interval between onset of symptoms and hospital arrival was 680 minutes; 59 patients (31%) arrived within 2 hours and 100 (53%) within 5 hours. Onset of symptoms when awake, drowsiness or coma, and paralysis of at least one limb were the only independent predictors of hospital arrival within 2 and 5 hours in both the total sample and the subgroup of patients who were awake at stroke onset. The effectiveness of 17%, extrapolated with the aid of the odds ratio of 1.6 of having a favorable outcome (Barthel Index > or = 95 at 3 months) in treated versus untreated patients in the NINDS rt-PA Stroke Trial, corresponded to a projected clinical efficiency of 5%. This could be doubled by hypothesizing a 100% effect of educational efforts in reducing the delay in hospital arrival time. CONCLUSIONS: Patients with milder symptoms, for whom treatment might be more effective, were less likely to arrive in time for therapy. The proposed model of the relationship between the delay in hospital presentation after a stroke and the clinical efficiency of a given treatment might be useful for planning future clinical trials on early stroke treatment and predicting the impact of an educational program aimed at shortening arrival time.

Aged↗
PubMed1996

Prevalence of dementia among elderly people in Troina, Sicily.

We performed a two-stage survey on the prevalence of dementia among people aged over 74 in Troina, northern Sicily, Italy. During the first stage people were screened by the Mini Mental Status Examination (MMSE), previously validated in our population for the cut-off score with 100% sensitivity and the best specificity to diagnose dementia. During the second stage people scoring 19 or less at the MMSE test were invited to be examined by a neurologist who diagnosed dementia according to DSM-III R. Out of 365 subjects of the initial sample 347 were screened by MMSE test and 163 scored 19 or less. Of these, 135 were neurologically and neuropsychologically examined in the second stage, and 80 proved to be demented. The minimal estimate of prevalence of dementia in our sample was 21.9% (21.9% men, 21.8% women). The poor education and psychosocial life may be the underlying condition favoring dementia in this sample of elderly people.

Age Distribution↗
PubMed1996

Neurological complications of liver transplantation.

We examined 199 consecutive patients who underwent 220 liver transplantations, to define the type, frequency and aetiology of posttransplant neurological complications and their prognostic value. We found neurological complications in 63 patients (32%), mostly involving the central nervous system. The most frequent complications were mental status changes ranging from delirium to coma and seizures. The aetiology was multifactorial, cyclosporin A neurotoxicity being the main cause. Patients with neurological complications had a higher mortality rate than those without. In our series, neurological complications represented a major medical problem with increased morbidity and mortality.

Adolescent↗
PubMed1996

Use of benzodiazepines in the Italian general population: prevalence, pattern of use and risk factors for use.

This study was conducted to determine the prevalence and profile of use of benzodiazepines in the Italian population and risk factors for use. Between November 1992 and February 1993, 62 general practitioners submitted a validated self-administered questionnaire on health status and drug use to a randomised sample of 3100 subjects ( > or = 18 years of age, stratified by sex and age), of whom 2803 responded (response, rate 90.4%). Main outcome measures were point estimate (past-week) of all the drugs taken by each individual, dosage and length of use and source of the prescription. The overall past-week prevalence of use of benzodiazepines was 8.6% (5.0% males and 11.8% females). In the elderly ( > or = 65 years) 18.8% reported current use (9.0% males and 24.7% females). Fifty-six per cent of the persons exposed to a benzodiazepine were chronic users (daily, for more than 6 months), and 70.1% in subjects > or = 65 years. The average daily dose taken was relatively low: 61% of short-term users and 51% of chronic users used less than half a defined daily dose (DDD). Female sex, older age, unemployment and retirement were independently associated with the use of benzodiazepines. Benzodiazepine use in Italy appeared to be relatively high (about 9% of subjects reported current use 57% of whom were chronic users). Women were prescribed a benzodiazepine twice as often as men and one out of four elderly women was on treatment. Although the average dosage used was rather low, the high prevalence and the elevated proportion of chronic users should encourage drug information campaigns and educational interventions to promote a more conservative use of these drugs especially in the elderly.

Adolescent↗
PubMed1996

Mortality from primary malignant brain tumors in the Province of Bologna, Italy, 1986-1988.

INTRODUCTION: We performed a study of mortality from primary malignant brain tumors (PMBT) in the province of Bologna, Italy, during the years 1986 to 1988. MATERIALS AND METHODS: The study was based on death certificates from the Cancer Registry of the province of Bologna. We verified death certificates for both false-positive and false-negative cases. RESULTS: The crude mortality rate was 6.7/100,000 population per year. The age and sex-adjusted mortality rate, standardized to the Italian population (Italy 81), was 5.34/100,000 (95% CI = 3.9 to 6.7). CONCLUSION: Our figures are higher than those previously reported in Italy, but are similar to values of incidence and mortality found in northern Europe and in North America.

Adult↗
PubMed1996

Drug interaction between cyclosporine and two antimicrobial agents, josamycin and rifampicin, in organ-transplanted patients.

In the post-transplant period, antimicrobial agents are often coadministered with cyclosporine (CsA) to treat the infections occurring in the immunosuppressed patients. These agents produce drug interactions with cyclosporine and can increase or reduce the blood concentration of the immunosuppressant. We report two cases of drug interaction between cyclosporine and two antimicrobial agents, josamycin and rifampicin, coadministered in a kidney-transplanted and a liver-transplanted patient, respectively. Josamycin increased the CsA blood levels by inhibiting the CsA metabolism through the hepatic cytochrome P450 enzymes. Conversely, rifampicin decreased the CsA blood levels by stimulating the same enzymatic system. When using these agents it is necessary to adjust the CsA doses to avoid risks of CsA toxicity or allograft rejection.

Acne Vulgaris↗
PubMed1995

Arachnoid cyst in the region of the fourth ventricle mimicking clinical picture of normal pressure hydrocephalus.

Arachnoid cysts in the region of the fourth ventricle are rarely reported. Two cases with intraventricular arachnoid cysts (one in the fourth and one in the right lateral) manifesting normal pressure hydrocephalus have been described in the previous literature. Here we report a clinically similar case in which the cyst was wedged in cerebellar vermis and compressed the fourth ventricle. Slow enlargement of the cyst could explain the clinical picture. The removal of the cyst resulted in a marked improvement of the symptoms despite the lack of significant changes in ventricular size.

Aged↗
PubMed1995

Brain MRI and SPET in thrombotic thrombocytopenic purpura.

We describe 5 cases of thrombotic thrombocytopenic purpura (TTP) with neurological manifestations. All of the patients underwent brain magnetic resonance imaging (MRI) following recovery; two underwent single photon emission tomography (SPET) during the acute phase of the disease. SPET showed reduced cerebral blood flow, whereas the results of brain MRI were normal in all patients. Plasma exchange (PE) treatment was promptly instituted in all cases. Our findings show that prompt treatment with PE may avoid permanent brain damage even when the neurological signs and symptoms are relate to brain ischemia.

Adult↗
PubMed1995

No neurological improvement after liver transplantation for Wilson's disease.

Orthotopic liver transplantation (OLT) represents the sole etiological treatment for Wilson's disease (WD), but its efficacy in resolving the neurological symptoms is still a matter of debate. We present the case of a young male affected with WD with hepatic and neurological involvement, who underwent OLT for subacute liver failure. Clinical, neuropsychological and neuroradiological assessment were performed before and after OLT. OLT had no effect on neurological symptoms, suggesting that the basal ganglia damage may be irreversible. Nineteen months after OLT, the patient went on to develop new permanent extrapyramidal symptoms. We postulate a sequela of an early post-operative central pontine and extrapontine myelinolysis.

Adult↗