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Biomedical subjects

R Galli

Publications and source records attributed to R Galli.

At least 37 records · Page 2Linked to original sources
PubMed1998

Cardiac papillary fibroelastoma of the mitral valve chordae.

Papillary fibroelastomas are rare, benign, primary cardiac tumors, usually single and small. The neoplasm consists of a leafy, soft excrescence typically located on the cardiac valves. Although papillary fibroelastomas are usually an asymptomatic incidental finding at autopsy, or during cardiac operation, they are occasionally associated with embolic coronary or cerebral symptoms. A case of a patient is reported with papillary fibroelastoma of the mitral valve chordae, who presented several transitory ischemic attacks characterized by loss of conscience, visual bilateral deficit and right emiparesis. Because of their potential systemic embolization, we believe that these lesions should be always excised.

Aged↗
PubMed1998

Evolution of post-traumatic aortic aneurysm in the subacute phase: magnetic resonance imaging follow-up as a support of the surgical timing.

OBJECTIVES: A recent surgical series documented that in traumatic aortic rupture (TAR) a surgical repair postponed to the treatment of associated lesions reduced operative and overall mortality. Nevertheless some isolated cases may develop to free rupture. Until now, no imaging follow-up studies of post-traumatic aortic lesions have been reported in the early stage. The aim of this study is to analyze the behaviour of traumatic aortic ruptures in the subacute phase, in order to detect the morphological characteristics of unstable post-traumatic aneurysms. METHODS: Twenty-five consecutive patients affected by traumatic aortic rupture (one intimal hemorrhage, 19 partial lesions and five circumferential lesions) were admitted to the department of cardiac surgery. Magnetic resonance imaging (MRI) was the imaging method used to confirm the diagnosis. No one was operated on during the acute phase. All patients were treated with beta-blockers and vasodilators as well as limited fluid administration. Delayed surgery was carried out in 18 patients at 243 days (+/-127), after the resolution of associated lesions. A scheduled MRI follow-up was performed at 7, 15 and 30 days and immediately before the operation. The parameters examined were increase of post-traumatic aneurysm, increase of periaortic hematoma and modification of the thoracic associated lesions. RESULTS: At 30 days a 3.0 +/- 3.7 mm median increase of the aneurysm was observed, while in the subsequent period the lesions became substantially stable, resulting in a 4.4 +/- 3.6 mm increment at the end of the follow-up. The circumferential lesions presented a higher increment with respect to the partial lesions. In three cases an augmentation of 6, 7 and 12 mm was detected and surgical repair was anticipated. In 13 cases a periadventitial hematoma surrounding the aortic aneurysm decreased through the time. One case of intimal hemorrhage healed spontaneously, with no aneurysm formation. Thoracic associated lesions (pleural and pericardial effusions, rib fractures, lung focal contusions and two cases of ARDS) resolved at 30-60 days. CONCLUSIONS: Despite common knowledge, considering TAR highly evolutive in the acute and subacute phase, this study demonstrated that this pathological entity is relatively stable if a proper pharmacological treatment is administrated. MRI follow-up is recommended in order to detect isolated cases of unstable aneurysm.

Aorta, Thoracic↗
PubMed1997

Osmotherapy for increased intracranial pressure: comparison between mannitol and glycerol.

Osmotic agents are still the most common treatment for controlling intracranial hypertension (ICH). Mannitol, glycerol, sorbitol, and hypertonic serum saline are the agents currently available. This work was designed to compare mannitol and glycerol in a similar population of brain injured patients, randomly divided into two groups of eight. The following mean day parameters were obtained: number of infusions, hydric balance, mean arterial pressure (MAP), and intracranial pressure (ICP). Cerebral perfusion pressure (CPP) was calculated. Brain computed tomographies (CT) were obtained on arrival, at follow-up whenever justified and at discharge. For comparison of both groups a modified therapeutic intensity level (mTIL) was used. Both agents induced a statistically equally effective decrease on ICP and increase on CPP evaluated at one and two hours post infusion but the mean day mTIL showed a statistically significant difference in favour of glycerol. The possible explanations of this difference are discussed. According to our results mannitol would be most indicated as a bolus to control sudden rises in ICP whereas glycerol would be most indicated as a basal treatment.

Adolescent↗
PubMed1997

Alteration of cardiac function in patients with temporal lobe epilepsy: different roles of EEG-ECG monitoring and spectral analysis of RR variability.

PURPOSE: Because several reports have described the relation between epilepsy and cardiac arrhythmias and suggest that changes in autonomic neural control of the heart could be involved in the pathogenesis of sudden unexplained death in patients with epilepsy, the aim of this study was to evaluate cardiac function in patients with temporal lobe epilepsy. METHODS: Sixty-five patients with epilepsy were evaluated by simultaneous ambulatory 24-h EEG-ECG monitoring, and in 30 of these, power spectral analysis of relative-risk (RR) variability also was carried out, both in the supine position and in a passive tilt position at 60 degrees. The power spectrum of RR variability, the two major spectral components detectable at low frequency (LF) and at high frequency (HF), respectively, and the LF/HF ratio were calculated. RESULTS: By EEG-ECG monitoring, we recorded six partial seizures, and in four cases, discharges were associated with sinus tachycardia. However, interictally the occurrence of ventricular and supraventricular arrhythmias was not different from that in normal subjects. The spectral analysis of RR variability, on the other hand, demonstrated in patients with epilepsy a significant decrease in the total RR variability and in both of its components (LF and HF) in the supine position, and of the LF/HF ratio in orthostatic position. CONCLUSIONS: These findings suggest that the spectral analysis of RR variability may detect disorders of autonomic cardiac control in patients with epilepsy, even in the absence of abnormal findings during ECG monitoring. This alteration, which is more severe in cases with right EEG focus, could play a role in the pathogenesis of cardiac arrhythmias.

Arrhythmias, Cardiac↗
PubMed1997

A quantitative study of daytime sleepiness induced by carbamazepine and add-on vigabatrin in epileptic patients.

INTRODUCTION: The clinical relevance of daytime sleepiness associated with carbamazepine (CBZ) and vigabatrin (VGB) was objectively assessed by the multiple sleep latency test (MSLT) and nocturnal sleep recordings. MATERIAL AND METHODS: Twenty-six patients with partial epilepsy and mean monthly seizure frequency of 4, aged 18 to 48 years, receiving chronic monotherapy with CBZ and subsequent VGB addition for 2 months (14 patients), were compared with a group of healthy subjects. Subjective daytime sleepiness was complained by 13 patients on CBZ monotherapy and 9 patients during VGB add-on treatment. RESULTS: No differences in nocturnal sleep parameters, but significantly shorter daytime sleep latencies at the MSLT, were detected in CBZ-treated patients as compared with healthy controls. Addition of VGB therapy did not further enhance objective daytime sleepiness. CONCLUSION: Some sleepiness occurs in chronically CBZ-treated epileptic patients, which can be objectively measured by the MSLT, but it is not aggravated by add-on VGB.

Adolescent↗
PubMed1997

Catamenial epilepsy, progesterone and its metabolites.

This study was undertaken to determine plasma allopregnanolone (3alpha-hydroxy-5alpha-pregnan-20-one, A-PREG) and pregnanolone (3alpha-hydroxy-5beta-pregnan-20-one, PREG) concentrations in the luteal phase (22nd to 24th day of the ovarian cycle) in 15 women with partial epilepsy and catamenial exacerbation of the seizures in the intercritical phase and in 15 healthy women matched for age in order to determine if an impaired metabolism of 3alpha-hydroxymetabolites of progesterone (P) occurs in this convulsive disorder. No significant differences between the two groups were found with respect to the mean plasmatic A-PREG and PREG levels. A significant correlation was found instead between P and A-PREG or PREG concentrations.

Adolescent↗
PubMed1997

Leiomyosarcoma of the pulmonary vein: case report with immunohistochemical and ultrastructural findings.

We report a case of neoplasia of pulmonary vein in a 45-year-old woman who presented with increasing dyspnea. As a consequence, the neoplasia filled the entire left atrium and appeared to be attached to the left superior pulmonary vein on surgical excision. Histologically, it was composed of a proliferation of sarcomatous cells, with a high mitotic rate and diffuse immunohistochemical positivity for smooth muscle actin, consistent with a leiomyosarcoma. The microscopic, immunohistochemical, and ultrastructural findings are discussed.

Female↗
PubMed1997

[The surgical treatment of a rare primary cardiac tumor: hemangioma. A report of 2 cases].

Primary benign tumors of the heart are particularly rare; cardiac hemangioma is one of the most rare primary benign cardiac tumors. Natural history, symptoms and prognosis of the disease depend on the potential complications due to the location and diffusion of the mass. We report on 2 cases of cardiac hemangioma, diagnosed occasionally in the first patient or due to gastroenteric symptoms in the second patient. The diagnosis was obtained by 2-D-echo and magnetic resonance imaging. In both cases the hemangioma was located on the right ventricle. Both patients underwent tumor resection in hypothermic cardiopulmonary bypass. In one case, a graft to the right coronary artery was associated; in the other case, the right ventricular outflow tract was reconstructed with an infundibular patch. Histology showed mixed hemangioma in one case and cavernous hemangioma in the other. The postoperative course was uneventful. At a follow-up of 8 years and 1 year, respectively, both patients are classified as NYHA 1 and both 2-D-echo and magnetic resonance imaging did not show any residual tumoral mass. This experience demonstrates that, depending on their location, benign neoplastic masses may be radically resected with acceptable operatory risks and excellent long-term results.

Aged↗
PubMed1996

Delayed surgery of traumatic aortic rupture. Role of magnetic resonance imaging.

BACKGROUND: Traumatic aortic rupture (TAR) is a pathological entity with a high mortality, both spontaneous and perioperative. Delayed surgical repair has been proposed when associated lesions are stabilized. The aim of this study was to validate MRI for detecting both the presence and type of TAR and to monitor posttraumatic aneurysm and associated lesions. METHODS AND RESULTS: Twenty-four consecutive patients with acute chest trauma and suspected aortic rupture, as suggested by emergency CT or chest radiographs, were subjected to MRI and/or angiography in random order. Such parameters as the presence and type of lesion; presence of periaortic, pericardial, mediastinal, or pleural effusion; and presence of associated lesions were considered in every patient. Follow-up imaging was performed exclusively by MRI every 1 to 2 months. TAR was present in 20 patients. No patient underwent surgery in the acute phase; 14 patients underwent surgery at 6.8 +/- 2.7 months; 5 are waiting for surgery; and 1 healed spontaneously. There was no overall mortality. For detection of TAR, the accuracy of MRI was 100%; angiography, 84%; and CT, 69%. In detecting the type of lesion, the diagnostic accuracy of MRI was 92%. During follow-up, a significant increase in the posttraumatic aneurysm was observed in 2 patients, and surgical repair was initiated. CONCLUSIONS: In chest trauma patients, MRI provides complete anatomic data to assess the severity of aortic and thoracic lesions. Moreover, along with the concept of delayed surgical repair of TAR, MRI is the ideal modality to monitor and follow TAR before surgical repair.

Adolescent↗
PubMed1996

A videodensitometric study of transmural heterogeneity of cyclic echo amplitude variation in human myocardium.

The aims of this study were: (1) to assess whether variations in cyclic echo amplitude might be detected across the human myocardium by videodensitometric analysis of images obtained with epicardial echocardiography; and (2) to explore the possible relation between cyclic gray level variation and left ventricular (LV) hypertrophy and function. Experimental studies show that transmural differences in contractile performance across the normal myocardium are paralleled by differences in the cyclic (diastolic-to-systolic) variation of myocardial echo amplitude. Thirty-three patients (aged 60 +/- 11 years) undergoing cardiac surgery were studied by intraoperative epicardial echocardiography. LV mass index as normal (<110 g/m2 in women, <131 g/m2 in men) in 10 patients and increased in 22. Two-dimensional echocardiographic images were obtained with a 5 MHz transducer and digitized off-line. Videodensitometric analysis was performed at end-diastole and end-systole with regions of interest across the septal and posterior wall. The cyclic variation was more pronounced in the left than in the right septal subendocardium (31% +/- 14% vs 16% +/- 14% <0.01) and higher in the subendocardial than in the subepicardial layer of the posterior wall (30% +/- 21% vs 23 +/- 18%, p <0.01). Cyclic variation of the left septal subendocardium was higher in 11 patients with nonhypertrophic ventricles than in 22 with hypertrophic left ventricles (42% +/- 15% vs 27% +/- 12%; p <0.01). The percent cyclic variation of the left septal subendocardium appeared to be much more tightly related to percent systolic thickening in patients with eccentric LV hypertrophy (r=0.80 p <0.01) than in patients with concentric LV hypertrophy (r=0.27, p=0.9) or normal LV mass (r=0.43, p=0.2). A cyclic gray level variation can be consistently detected in different human myocardial regions and layers. It is more obvious in the subendocardial than in the subepicardial layer, and in nonhypertrophic than hypertrophic ventricles. The cyclic subendocardial variation is tightly related to regional systolic thickening in patients with eccentric LV hypertrophy.

Aged↗
PubMed1996

Long-term survival of cortical neurones from adult guinea-pig maintained in low-density cultures.

In vitro survival of neurones isolated from adult mammalian brain is normally scarce and the postnatal age limit for obtaining viable cultures of cortical, hippocampal and diencephalic neurones is commonly two weeks. Here we describe a novel procedure for the establishment and long-term maintenance of cortical neurones of the adult mammalian brain in low-density cultures. Neurones isolated from the piriform cortex of 30- to 90-day-old guinea-pigs were initially grown in a chemically defined medium enriched with basic fibroblast growth factor (bFGF); later, a small quantity of foetal bovine serum (FBS) was added to facilitate cell differentiation. Under these conditions cells could be maintained in culture for at least 3 weeks, when indirect immunocytochemistry and whole-cell patch-clamp recordings were performed. Cells exhibiting neuronal morphology expressed the neuronal marker microtubule associated protein-2 (MAP2) and generated action potentials. Moreover, about 70% of the MAP2-immunoreactive cells were simultaneously labelled with anti-gamma-aminobutyric acid (GABA) antibody. Cells expressing neuronal antigens were never labelled by antibody raised against the glial marker glial fibrillary acidic protein (GFAP). These results indicate that long-term survival of adult neurones can be achieved under definite culture conditions.

Animals↗
PubMed1996

Multipotential stem cells from the adult mouse brain proliferate and self-renew in response to basic fibroblast growth factor.

It has been established that the adult mouse forebrain contains multipotential (neuronal/glial) progenitor cells that can be induced to proliferate in vitro when epidermal growth factor is provided. These cells are found within the subventricular zone of the lateral ventricles, together with other progenitor cell populations, whose requirements for proliferation remain undefined. Using basic fibroblast growth factor (bFGF), we have isolated multipotential progenitors from adult mouse striatum. These progenitors proliferate and can differentiate into cells displaying the antigenic properties of astrocytes, oligodendrocytes, and neurons. The neuron-like cells possess neuronal features, exhibit neuronal electrophysiological properties, and are immunoreactive for GABA, substance P, choline acetyl-transferase, and glutamate. Clonal analysis confirmed the multipotency of these bFGF-dependent cells. Most significantly, subcloning experiments demonstrated that they were capable of self-renewal, which led to a progressive increase in population size over serial passaging. These results demonstrate that bFGF is mitogenic for multipotential cells from adult mammalian forebrain that possess stem cell properties.

Action Potentials↗
PubMed1996

Circulating levels of anticonvulsant metabolites of progesterone in women with partial epilepsy in the intercritical phase.

The 3alpha-hydroxy metabolites of progesterone (P), 3alpha-hydroxy-5alpha-pregnan-20-one (allopregnanolone, A-PREG) and 3alpha-hydroxy-5beta-pregnan-20-one (pregnanolone, PREG), have been found to be among the most potent ligands of gamma-aminobutyric (GABA)-A receptors; in experimental animals, they have been found to have anxiolytic, hypnotic and anticonvulsant effects. Similar to those of the benzodiazepines and barbiturates that interact with GABA-A receptors. The present study was undertaken to determine plasma A-PREG and PREG concentrations in the luteal phase in women with partial epilepsy, in order to determine if an impaired metabolism of P occurs in this convulsive disorder. We measured plasma P, A-PREG and PREG levels in 15 women with partial epilepsy in the intercritical phase, and in 15 age-matched healthy women, during the luteal phase of the ovarian cycle (22nd-24th day). The mean plasma +/- S.E. A-PREG levels (three blood samples) were 0.7 +/- 0.6 ng/ml in the epileptic women and 0.5 +/- 0.2 ng/ml in controls, with no significant difference between the two groups (p = NS); the PREG levels were also similar (1.4 +/- 1 ng/ml and 1 +/- 1.1 ng/ml, respectively: p = NS). A significant correlation was found between P levels and both A-PREG and PREG levels (r = 0.72, p < 0.001 and r = 0.79, p < 0.001, respectively). There were no significant differences between the two groups in terms of serum adrenocorticotropic hormone, cortisol, dihydroepiandrosterone-sulfate, follicle stimulating hormone, prolactin, luteinizing hormone or estradiol levels.

Adolescent↗
PubMed1996

[Brucella endocarditis: role of drug treatment associated with surgery].

Brucella infective endocarditis is an uncommon, but serious complication of brucellosis. The aortic valve is the most commonly affected cardiac valve, and a fearful complication is the formation of aortic root abscess. Due to the characteristics of the infection, medical therapy alone is not sufficient in treating the disease and best results are achieved in combination with surgery. We describe 2 cases of brucella endocarditis involving the aortic valve. Aggressive treatment, with surgery performed during a period of active infection, produced good results in eradication of infection and in preventing fatal complications such as rupture of aortic root abscesses.

Anti-Bacterial Agents↗
PubMed1996

[Heart surgery with cardiopulmonary bypass in patients on chronic dialysis treatment: our experience].

METHODS: To determine the mortality and the morbidity of cardiac surgery in patients on chronic hemodialysis, we retrospectively reviewed eighteen adult patients (13 males and 5 females) with a mean age of 54.7 years (range: 30-67 years) who underwent cardiopulmonary bypass procedures between 1987 and 1995. The operations included: isolated coronary artery bypass grafting in 12 patients, coronary artery bypass grafting plus mitral ring annuloplasty in 1 patient, mitro aortic valve replacement in 2 patients, isolated aortic valve replacement in 1 patient, aortic valved conduit implantation in 1 patients and mitral valve replacement plus tricuspid annuloplasty in 1 patient. There were 10 and 3 patients in CCS functional classification III and IV respectively; 1 and 4 patients were in NYHA classification II and III respectively. All of them were hemodialyzed the day before surgery: the average time they had been on hemodialysis was 6.5 years. Anesthesia and the cardiopulmonary bypass (CPB) in these patients required attention in order to provide the optimal fluids and electrolytes balance: particularly intravenously administered fluids were kept to a minimum and drug dosages were reduced to recommended levels for anephric patients. An hemoconcentrator was used in all patients during the CPB and, in the last 4 cases, we used a dialysis filter and a sterilized perfusional solution to reduce the level of potassium and to put off postoperative dialysis. RESULTS: In three patients there were major bleeding problems resulting in reoperation; 5 perioperative deaths occurred: two of them due to myocardial infarction and three due to irreversible low cardiac output state. In our experience there were four late deaths: one patient died four months after surgery for chronic heart failure, another one died twelve months after surgery for dilated cardiomyopathy and two patients died respectively seventeen and seventy two months after discharge for myocardial infarction. Two of the remaining patients reported recurrence of angina while the others achieved symptomatic improvement. CONCLUSIONS: In conclusion, cardiac surgery is performed on chronic renal dialysis patients with high mortality and morbidity and it's indicated only if medical treatment is ineffective. The successful surgical results, obtained with an adequate management between surgeons, anesthesiologists and nephrologists, don't assure the long-term survival of the patients.

Adult↗
PubMed1996

[Intima flap of the external carotid and postoperative stroke in a patient surgically treated with thromboendarterectomy of the internal carotid].

Retrograde thrombosis of the carotid bifurcation rising from an intimal flap of the external carotid artery represent a rare complication of carotid surgery. We present the case of a patient who had undergone carotid thromboendarterectomy (TEA) whose postoperative course was complicated by the appearance of left hemiplegia and coscience disorders. The timely diagnosis of acute carotid thrombosis and the immediate reoperation prevented neurological deficits becoming settled. An attentive intraoperative evaluation of carotid bifurcation showed only the presence of an intimal flap of the external carotid artery from which a big occluding thrombus, involving the bifurcation, rose. The internal and common carotid arteries showed a successful result of the TEA and a good retrograde flow through the internal carotid artery. The authors underline the existence of this perioperative complication and the need for a timely recognition and treatment to avoid serious neurologic consequences.

Carotid Artery Thrombosis↗
PubMed1995

Basic fibroblast growth factor supports the proliferation of epidermal growth factor-generated neuronal precursor cells of the adult mouse CNS.

Stem cells isolated from the CNS of both embryonic and adult mice undergo extensive proliferation in the presence of epidermal growth factor (EGF). Removal of EGF determines the differentiation of these cells into neurons and glia. We have recently demonstrated that basic fibroblast growth factor (bFGF) regulates the proliferation of EGF-generated progenitors of the embryonic mouse striatum. We report here that bFGF induces proliferation of some EGF-generated precursors of the adult mouse striatum which, in turn, differentiate in vitro into cells possessing neuron-like morphology and neuronal antigenic properties. These results demonstrate that EGF and bFGF can act sequentially to regulate the de novo generation of neurons from the adult mouse CNS in vitro and suggest the existence of a lineage relationship between EGF- and bFGF-responsive progenitor cells of the adult murine brain.

Animals↗