Biomedical subjects
Publications and source records attributed to R Gandini.
A personally observed case of internal chest injury is described with emphasis on the clinical and radiological features of the contusion and lung haematoma produced and the relative therapeutic problems.
We reviewed our personal experience in 46 patients with biliary strictures, who underwent percutaneous balloon dilatation between 1983 and 1988. The strictures were iatrogenic in 24% of the cases, anastomotic in 52%, inflammatory in 17%, and associated with sclerosing cholangitis in 7%. The treatment consisted in dilating the bile ducts with balloon catheters of different kinds and sizes ("bilioplasty") and placing an internal drainage catheter for a varying period of time ("stenting"). In 22 patients the catheter was removed after an average time of 7.7 months. The rate of stricture recurrence was 13.5% (average follow-up: 20 months). In the remaining 24 patients the stents are still in situ, waiting for removing. Major complication rate was 6.4% (2 pleural effusions and 1 hepatic artery bleeding). We also report our initial experience with metallic self-expanding stents which appear as a promising tool in the management of recurring strictures.
Isosorbide-5-mononitrate (IS-5-MN) is an active metabolite of isosorbide dinitrate with a longer plasma half life. Aim of the study was the evaluation of the effects of 40 mg/day of IS-5-MN on exercise capacity in patients with heart failure NYHA class II. After 1 week of wash-out, 10 patients with heart failure NYHA Class II, assumed 20 mg bid for 3 weeks. Bicycle ergometer tests were performed before (A), at the end of therapy (B), and 1 week later (C); in phase B the stress test was performed after 6 hours from the last assumption of IS-5-MN. We measured 24 hour urinary 6K-PGF1 alpha, the stable metabolite of prostacyclin, basal plasma renin activity (PRA) and plasma aldosterone, exercise-release of epinephrine and norepinephrine at the end of each phase of the study. The treatment with IS-5-MN improved the exercise capacity sigma (Watt.min), A less than (B = C), (p less than 0.01), while delta of heart rate (HR) during exercise (basal HR - maximal exercise HR)/(Watt.min), decreased, A greater than (B = C), (p less than 0.008). Basal BP and HR did not change. This fact seems consistent with the hypothesis of a combined effect of nitrates on both the venular and the arteriolar districts. Basal PRA and aldosterone, and catecholamine release during exercise after IS-5-MN did not change, while only norepinephrine increased 1 week after the end of the therapy, (A = B) less than C, (p less than 0.05): 24 hour urinary 6-K-PGF1 alpha increased after IS-5-MN A less than (B = C), (p less than 0.05). The results indicate that medium-term IS-5-MN treatment increases exercise capacity in patients with heart failure NYHA class II and that the effect lasts for 1 week after nitrate withdrawal at least. Prostacyclin is probably involved in medium-term clinical effect of IS-5-MN.
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In a 24-week multicenter double-blind clinical trial, efficacy and safety of the novel nonsteroidal anti-inflammatory drug imidazole salicylate (750 mg t.i.d. per os) and ibuprofen (600 mg t.i.d. per os) were compared in 60 patients with classical or definite rheumatoid arthritis, randomly assigned to one of the two treatment groups. The patients improved significantly with both treatments in all the clinical parameters examined such as the duration of morning stiffness, grip strength of both hands, Ritchie's articular index and severity of joint pain. The systemic tolerability, assessed by hematological, liver and kidney function tests was excellent with both treatments. The incidence of side effects was overall fairly low with both drugs, and lower in the group treated with imidazole salicylate (23% vs. 33%).
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In this study the pharmacokinetics of a new slow-release formulation of bezafibrate (a hypolipaemic drug) were evaluated in a group of six healthy volunteers. In the first part of the study the bioavailability of this formulation was compared to the normal preparation of bezafibrate. In the second part of the experiment the possible accumulation was studied. The subjects were administered the slow-release preparation at 08h00 for seven consecutive days. The resulting data indicate that the slow-release formulation shows a lower dispersion of Tmax values. There was an increase of the plasma half-life from 1.9 to 5.5 h, but a possibility of accumulation could be excluded.
40 mg of isosorbide mononitrate (isosorbide-5-mononitrate, IS5MN) in conventional (Ismo 20) and sustained release formulations (Ismo Diffutab) were administered to 5 male healthy volunteers. The administration of the sustained release formulation was repeated for seven days in order to evaluate the possible occurrence of accumulation. Pharmacokinetic data showed that the sustained release formulation reached significantly lower and delayed mean peak plasma levels compared with the conventional formulation, respectively 452.8 +/- 67.8 ng/ml and 706.7 +/- 57.3 (mean +/- SE) (p less than 0.05). Peak times were 4.6 +/- 0.2 and 2.4 +/- 0.2 (p less than 0.005) h, respectively. A longer plasma half-life together with larger AUC for the sustained release formulation was also observed. The pharmacokinetic parameters of the sustained release formulation are consistent with a therapeutic usefulness and suggest further clinical evaluation.
The efficacy and safety of the nonsteroidal anti-inflammatory drugs imidazole.2-hydroxybenzoate and sulindac were compared in 30 patients with classical or definite rheumatoid arthritis. The trial was designed as a randomized parallel-group study comprising 15 patients given imidazole.2-hydroxybenzoate and 15 given sulindac orally for 28 days. Patients in both groups improved significantly in almost all of the variables evaluated. Imidazole.2-hydroxybenzoate was more effective than sulindac on Ritchie's articular index, left hand proximal interphalangeal joint circumference, erythrocyte sedimentation rate, and C-reactive protein. The incidence of side effects was significantly higher in patients treated with sulindac.
The efficiency of the combination of four tumor markers in recognizing advanced (recurrent or metastatic) colorectal cancer was evaluated. In 31 normal volunteers and in 31 patients with histologically documented colorectal tumor, we measured serum levels of carcinoembryonic antigen (CEA), ferritin, anionic glycoproteins, and their sialic acid content (SA). CEA, ferritin, anionic glycoproteins and SA mean levels were significantly higher in patients than in normal subjects. Among the four markers CEA was the most sensitive (87.1%) and SA the most specific (100%). By using CEA and SA in combination in 29 out of 31 patients, either marker was abnormally high. Ferritin and anionic glycoproteins did not render additional information. CEA serum levels were elevated in 14 out of 15 patients with liver metastasis, while SA was elevated in six out of 15. CEA maintains its central cole as tumor marker in colorectal cancer; the combined use of CEA and SA may add to precision in detecting patients with advanced colorectal cancer. Anionic glycoproteins and ferritin seem of limited usefulness.
Perchloric acid soluble proteins (PPS) and their content of N-acetylneuraminic acid (NANA) may serve as valuable tumor markers for a variety of malignant neoplasms. To evaluate their clinical significance, PPS, NANA and carcino-embryonic antigen (CEA) were measured in 32 patients with lung cancer. High PPS (greater than or equal to 0,73 mg/ml) and NANA (greater than or equal to 96 micrograms/ml) levels occurred in 8 of 50 (16%) healthy volunteers and respectively in 22% and 54% of patients. CEA levels were high (greater than or equal to 3 ng/ml) in 1 out of 21 (5%) healthy volunteers and in 83% of the patients; 84% of the patients showed an elevation of NANA and of CEA. The highest values of the three markers seem to be associated with extensive disease but no statistically significant difference has emerged from the comparison of patients with limited disease with the ones with extensive involvement. Changes of the tumor mass correlate with changes of serum levels of PPS, NANA and CEA. It is concluded that CEA determination is clinically valuable in lung cancer, while PPS and NANA do not provide greater information.
D-glucitol-hexanicotinate (sorbinicate) was administered at a daily dose of 1.6 mg to 16 male patients who had survived myocardial infarction. Platelet aggregation induced by collagen (5 micrograms/ml), by ADP (2, 1.2, 0.8, and 0.4 X 10(-6)M), and by epinephrine (1 and 0.5 X 10(-6)M) was significantly decreased after 3 months of therapy. In a group of 13 comparable patients, who did not receive sorbinicate, platelet aggregation induced by ADP (1.2, 0.8, and 0.4 X 10(-6)M) and by epinephrine (1 X 10(-5)M and 1 X 10(-6)M) was significantly increased 3 months after entry into the study. Sorbinicate has effective lipid-lowering activity; the combination of hypolipidemic and anti-aggregating properties may prove important in primary and secondary prevention of atherosclerotic disease.