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Biomedical subjects

R Romagnoli

Publications and source records attributed to R Romagnoli.

At least 91 records · Page 5Linked to original sources
PubMed1996

Does the measurement of portal flow velocity have any value in the identification of patients with cirrhosis at risk of digestive bleeding?

Upper gastrointestinal bleeding is a leading cause of death in patients with liver cirrhosis. In most cases haemorrhage originates from oesophageal varices or from congestive gastropathy, and the evaluation of the bleeding risk is based on oesophagogastroduodenoscopic data. The aim of this prospective study was to determine whether the measurement of portal flow velocity by Duplex-Doppler, compared with endoscopic data, can help in detecting patients with cirrhosis at risk of bleeding. One hundred and seventy-three patients underwent endoscopy to ascertain the size of the varices and the severity of congestive gastropathy. For each patient maximal portal flow velocity measurements were obtained. No difference in portal flow velocity was observed between patients with or without oesophageal varices or congestive gastropathy. During a 2-year observation period, 27 patients (15.6%) had at least one episode of acute digestive bleeding. Stepwise multiple logistic regression analysis demonstrated a correlation between oesophageal varices and congestive gastropathy endoscopic grading and the incidence of bleeding; only the former was entered into the final regression equation (p < 0.001). No relationship between the max portal flow velocity value and incidence of bleeding was found. This study shows that portal flow velocity is unrelated to the degree of the endoscopic abnormalities in patients with liver cirrhosis and that it has no value in the identification of patients with cirrhosis at risk of upper gastrointestinal bleeding.

Adult↗
PubMed1996

Heller-Dor procedure for achalasia: from conventional to video-endoscopic surgery.

A Heller-Dor procedure was performed by laparotomy (group A: n = 8) or by laparoscopy (group B: n = 12) after failure of one to 17 sessions of intraluminal dilatations (n = 13) or as a primary treatment of oesophageal achalasia (n = 7). The oesophagomyotomy was extended over the thoracic oesophagus by thoracoscopy in two patients having vigorous achalasia. Injury to the oesophageal mucosa occurred in two group A patients who had previously been dilated. At follow-up (range: 1 to 113 months), 6 patients of group A (75%) and 10 of group B(83.3%) had no residual dysphagia. The four patients (group A: n = 2; group B: n = 2) who complained of heartburn prior to the operation were asymptomatic, only one group A patient developed symptoms of reflux, and oesophageal pH-monitoring was normal in the 6 group B patients investigated at follow-up. The laparoscopic approach reduces the magnitude of the operation, and the magnified overview permits precise dissection of the intraparietal adhesions which may develop after numerous sessions of dilatation.

Adult↗
PubMed1996

[Magnetic resonance of the brachial plexus: anatomy and study technique].

Brachial plexopathies are a common diagnostic problem: conventional imaging techniques can be useful in the detection of associated conditions (Pancoast tumors, first rib or clavicle fractures, etc.) but they cannot visualize brachial plexus structures directly. Also Computed Tomography (CT) is limited in the study of the retroclavicular region because of the artifacts due to the presence of the humeral heads in the slice. CT myelography exhibits very high accuracy in posttraumatic brachial plexopathies but fails to reveal the postganglionic plexus. In contrast, Magnetic Resonance Imaging (MRI) allows the direct detection of the brachial plexus, from spine to axilla, thanks to its multiplanarity and high contrast resolution. However, MR images are so rich in anatomical details (particularly on the oblique planes) that sometimes they become very difficult to interpret. To better define the anatomical relationships of the brachial plexus and to assess the best planes to study its different portions, 9 healthy volunteers were examined with MRI and MR images were compared with anatomical drawings and frozen cadaver sections. MRI depicts the brachial plexus from its origin to the axilla, but none of the investigated planes is sufficient, alone, to study the whole plexus adequately. The paraganglionic portion is clearly depicted on oblique sagittal images, while coronal and sagittal images are more useful for primary trunks and spinal nerves; the distal portion is perfectly visualized on sagittal images. Thus, we conclude that different examination protocols are necessary for every specific plexus portion, which means that brachial plexus MRI must be performed to try to solve a specific question by the orthopedic surgeon or the clinician.

Brachial Plexus↗
PubMed1996

Synthesis, antiviral and antiproliferative activity of a new class of 5-(alkyl or arylthio)-6-vinyl uracils.

Uracil derivatives bearing substituted or unsubstituted vinyl groups at position C6 and alkyl- or arylthio groups at position C5 were synthesized and tested in vitro for antiviral and antiproliferative activity. None of the compounds were active against HIV-1. However, some of them inhibited the proliferation of leukemia, lymphoma and solid tumor-derived cell lines at micromolar concentrations. The maximum potency of antiproliferative activity correlates with the presence of unsubstituted vinyl groups and alkyl- or arylthio substituents.

Anti-HIV Agents↗
PubMed1996

[Liver metastasis from carcinoid: diagnostic imaging].

Our study was aimed at describing the diagnostic imaging patterns of carcinoid liver metastases. Six patients with liver metastases secondary to carcinoid tumor were examined. The metastases were histologically proved in each patient. All patients were examined with ultrasonography (US), Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Digital Subtraction Angiography (DSA). All patients were treated with transcatheter embolization of liver metastases. Diagnostic imaging methods showed ten to many dozen metastases in each patient. Tumor size ranged 0.5 to 14 cm. US showed hypoechoic, hyperechoic and isoechoic carcinoid liver metastases with a hypoechoic halo. Large lesions had anechoic central areas due to colliquative necrosis. Hypoechoic patterns were the most frequent ones. Precontrast CT showed hypodense metastases; very small lesions were isodense relative to surrounding liver. CT during contrast agent injection showed that the metastases were hyperdense in the arterial phase; contrast enhancement was poorer in the portal phase. Large lesions showed a hypodense central area due to necrosis which remained hypodense in the late phase. The metastases were hypointense on T1-weighted and hyperintense on T2-weighted MR images. Gradient echo dynamic imaging with Gd-DTPA showed high-signal metastases in the arterial phase and lower signal intensity in the portal phase. DSA, an essential exam before embolization, showed tortuous and elongated intra- and extrahepatic arteries and tumor neovascularization with no malignant abnormalities. In the capillary phase, tumor uptake and inhomogeneous hypervascular patterns were shown. Portal veins were only displaced and compressed, but never infiltrated by the metastases. All the techniques we used contributed to assess liver involvement by carcinoid metastases. DSA must be used only before treatment; both CT and MRI showed the hypervascular patterns of the metastases, but no technique could predict their nature.

Adult↗
PubMed1996

[Interactive atlas with magnetic resonance on CD-ROM for Macintosh].

Computer assisted education in radiology has been increasingly used during the past ten years and now complements traditional learning resources. Magnetic Resonance Imaging (MRI) of musculoskeletal anatomy, and particularly of joints, lends itself naturally to learning modules on computer. This paper describes the design, development and use of an interactive computer assisted teaching module of MR joint anatomy on CD-ROM for Macintosh: to date, we have used this atlas for ankle and elbow anatomy. The atlas is divided into three main sections: MR anatomy, traditional anatomy and a quiz. On each MR image, any anatomical detail can be identified clicking on it with the mouse. Buttons allow to visualize cross-reference points and to go directly on the desired image. If the student wants to look at anatomical drawings of the last identified structure, a button retrieves all the cards in the traditional anatomy section containing that structure. Finally, the student can make his own self-assessment, verifying his learning immediately with the exam mode: the software makes a random selection of 10 MR images where an anatomical structure must be indicated: if the answer is wrong, the software gives the right one and shows the misinterpreted structure. Then, the student is given a total score for his performance. The computer assisted teaching modules present some advantages: the images can be viewed in a given sequence (like traditional learning resources) or in any self-paced, customized way; this possibility, together with the friendly interface of Macintosh computers could make learning more active and pleasant.

Anatomy↗
PubMed1996

[Use of a digital radiology system with phosphors in the assessment of thoracic diseases in bedside radiography].

We report our experience with a storage phosphor radiography system; to assess both the image resolution and the dynamic range of the system, a phantom simulating chest average density was used. Finally, we investigated the system impact on portable chest radiographs. The radiographs were taken on 35 x 43 cm phosphor plates, with 80 kV, 3 mAs and focus-film distance of 130 cm. The phosphor plates were scanned with a 75 microns laser beam, postprocessed with the system software and, finally, printed on a 20 x 25 cm film. As reported by other Authors, the storage phosphor system showed similar spatial resolution to conventional radiography (2.5 lp/mm for 35 x 43 cm films and 4.5 lp/mm for 20 x 25 cm films), a wide dynamic range always allowing correcting exposure, but increased noise; these features allow film density optimization even in such "critical" situations and bedside radiographs. Pneumonia, pneumothorax, emphysema, pleural effusions and catheters or tubes positioning were always easily depicted. In our experience, the phosphor plate storage system exhibits many advantages over conventional radiography, namely image postprocessing, the opportunity to choose between several sizes of laser films and finally, the possibility of linking the system to a network and possibly to a digital archive. The main drawbacks of the system are its increased noise and, at present, with the available hardware, slow plate reading.

Humans↗
PubMed1995

Esophageal replacement: gastric tube or whole stomach?

BACKGROUND: The stomach can be used either in its entirely or as a greater curvature tube for esophageal replacement. METHODS: The study compares the gastric tube (group A; n = 112) to the whole stomach whose lesser curvature is denuded (group B; n = 100) in terms of technical complication and alimentary comfort. The clinical results are substantiated by assessment of the eating performance of patients and control subjects at a test meal, measurement of the gastric dimensions before and after both tailoring procedures, and intraarterial staining of the gastric wall. RESULTS: Major differences between the two groups are cervical anastomosis stenoses (22.3% versus 6% [A versus B]; p = 0.008), fistulas (7.9% versus 1%; p = 0.0209), number of meals and snacks per day (4.6 versus 4; p = 0.0275), sensation of early fullness at meals (52.4% versus 17.8%; p < 0.0001), ratings given to the long-term alimentary comfort (presymptomatic condition = 10 points) (7.6 versus 8.8 out of 10 on average; p < 0.0001), and calories consumed in 1 minute at a test meal (59% [p < 0.05] versus 77% of those consumed by control subjects). The volume of the stomach is reduced by a range of 21.4% to 47.2% after tubulization (group A) whereas it increases by a range of 4.9% to 17.4% after denudation of the lesser curve (group B). Intraarterial staining of the gastric wall reveals the poor vascularity of the upper-most segment of the greater curve. CONCLUSION: Slight increase of the gastric capacity and maintenance of the submucosal vascular network account for the better results achieved with the whole stomach.

Adolescent↗
PubMed1995

Cytokines in the viviparous reproduction of squamate reptiles: interleukin-1 alpha (IL-1 alpha) and IL-1 beta in placental structures of a skink.

Placental viviparity is known in many species of squamate reptiles. Among these, some scincids have developed an epithelio-chorial chorio-allantoic placenta which in the structure of its central ridged zone is similar to those of certain therian mammalian species. A broad range of immunoregulatory peptides, cytokines, has been identified at the maternofetal interface of several species of mammals, either with invasive or non-invasive types of placenta. Thus we began to study whether interleukin-1, which is considered to play a crucial role in mammalian pregnancy, might also be involved in the viviparity of reptilian species. Placentae of Chalcides chalcides L. were processed by immunohistochemistry and incubated in a culture medium for different times. A very strong immunoreactivity for interleukin-1 alpha (IL-1 alpha) and for interleukin-1 beta (IL-1 beta) was present in the chorial epiblast and in uterine epithelial cells, with varying degree and localization in different periods of pregnancy. IL-1 beta was also released into the medium at different amounts during incubation. In light of the mammalian data, our results suggest that the role of cytokines in pregnancy may represent a significant event in the evolution of placental viviparity.

Animals↗
PubMed1995

Thrombomodulin levels in insulin-dependent diabetic patients with microalbuminuria.

Thrombomodulin (TM) plays an important role in the regulation of blood coagulation at the endothelial surface. TM is also present in plasma, where an increase of its level seems to reflect endothelial damage. Since microalbuminuria is associated with an increased atherothrombotic risk and is considered an expression of widespread vascular damage, we evaluated plasma thrombomodulin levels, blood pressure, and plasma lipid values in Type 1 diabetic patients with micro- and normoalbuminuria. Thrombomodulin was measured in 12 microalbuminuric (albumin excretion rate 20-200 micrograms min-1 in 2 of 3 overnight urine collections) and in 12 normoalbuminuric (albumin excretion rate < 20 micrograms min-1) Type 1 diabetic patients matched for age, sex, body mass index, smoking habits, diabetes duration, and glycated haemoglobin. Mean thrombomodulin was significantly higher in micro- than in normalbuminuric group (59.34 +/- 3.58 vs 43.56 +/- 3.52 ng ml-1 p < 0.01). Systolic and diastolic blood pressure were significantly higher in micro- than in normoalbuminuric group (p < 0.05). There was a positive correlation between plasma thrombomodulin and albumin excretion rate (p = 0.013, r = 0.49), and between thrombomodulin and diastolic blood pressure (p = 0.023, r = 0.46) in diabetic patients as a whole but not in the individual groups. These findings suggest the presence of an endothelial injury in microalbuminuric patients.

Adult↗
PubMed1995

Effects of propranolol compared with clonidine on portal haemodynamics: a double-blind cross-over study using duplex-Doppler ultrasonography.

BACKGROUND: Patients with liver cirrhosis and large oesophageal varices run a high risk of digestive haemorrhage due to the rupture of oesophageal varices, an event associated with a high mortality. At present, the only treatment for the prevention of first bleeding from oesophageal varices on which there is general agreement is drug-based. In order to tailor drug treatment to the requirements of individual patients more precisely, an ever-increasing number of drugs is being investigated. DESIGN: Double-blind cross-over study. METHODS: Sixteen cirrhotic patients with large oesophageal varices were studied by means of duplex-Doppler ultrasonography to determine variations in portal haemodynamics after oral administration of 0.150 mg clonidine and to compare these with the variations observed after oral administration of 40 mg propranolol. RESULTS: Propranolol caused a significant reduction in maximum portal flow velocity (P < 0.001), whereas clonidine failed to cause any such variation (P = 0.194). Considering as responders those patients who exhibited at least a 10% decrease in maximum portal flow velocity, 11 patients responded to propranolol; of these, three also responded to clonidine. No patient responded only to clonidine. CONCLUSION: The absence of any effects on the parameters of portal haemodynamics would appear to deny clonidine any significant role in preventing first bleeding resulting from the rupture of oesophageal varices.

Administration, Oral↗
PubMed1994

Plasma beta-thromboglobulin and platelet factor 4 are not increased in insulin-dependent diabetic patients with microalbuminuria.

To evaluate the possibility that platelet dysfunctions contribute to the cardiovascular risk of microalbuminuric insulin-dependent diabetic (IDD) patients, we have measured beta-thromboglobulin (BTG) and platelet factor 4 (PF4) in 74 IDD patients with different degrees of albuminuria (8 macro-, 36 micro- and 30 normoalbuminuric) and in 30 non-diabetic control subjects. BTG values (20.4 +/- 1.5 SEM in normo-, 22.2 +/- 1.2 in micro-, 101.1 +/- 2.9 in macroalbuminuric patients and 21.8 +/- 1.1 IU/ml in control subjects) were significantly higher (P < 0.001) in the macroalbuminuric patients, but similar among the other groups. These results suggest that platelet hyperactivation is not present in the microalbuminuric stage of diabetic nephropathy, only in overt nephropathy.

Adult↗
PubMed1994

First trimester human trophoblast expresses both interferon-gamma and interferon-gamma-receptor.

Interferon-gamma (IFN-gamma) is a lymphokine, produced by activated T lymphocytes, which plays a key regulatory role in the host immunological responses. In addition, IFN-gamma is expressed by human and porcine trophoblast. As IFN-gamma exerts its biological functions through specific cell surface receptors and a great number of IFN-gamma receptors (IFN-gamma R) have been purified from human placenta, we have examined the relative distribution of IFN-gamma and IFN-gamma R in human placental tissues at different stages of pregnancy. By using immunohistochemical analysis and monoclonal antibodies, it was found that IFN-gamma expression is intense in the first trimester but almost imperceptible at term, whereas the expression of IFN-gamma R is present at both stages of pregnancy. For both lymphokine and receptor, the most intense expression was observed in villous syncytiotrophoblast and in extravillous interstitial trophoblast. From these results it appears that the expression of IFN-gamma R in trophoblast is related to the presence of the lymphokine in the early phase of gestation but not later. On this basis, it can be argued that IFN-gamma exerts its functional role via an autocrine and/or a paracrine loop mainly during the first trimester.

Embryonic and Fetal Development↗
PubMed1994

Prothrombin fragment 1 + 2 and antithrombin III-thrombin complex in microalbuminuric type 2 diabetic patients.

In microalbuminuria there is an increased cardiovascular risk not fully explained by the excess of conventional risk factors. To investigate whether or not microalbuminuria is associated with haemostatic abnormalities in Type 2 diabetic patients, we measured the prothrombin fragment 1 + 2, a marker of thrombin generation, and the thrombin-antithrombin complex, a marker of thrombin neutralization. Plasma levels of prothrombin fragment 1 + 2 and thrombin-antithrombin complex were assayed in 17 microalbuminuric patients (albumin excretion rate, AER 20-200 micrograms min-1) and in 17 comparable normoalbuminuric (AER < 20 micrograms min-1) Type 2 diabetic patients. Plasma prothrombin fragment 1 + 2 was significantly higher in microalbuminuric than in normoalbuminuric patients (1.09 +/- 0.06 vs 0.86 +/- 0.04 nM, p = 0.003). Individual values of F1 + 2 were above the upper limit of the normal range in 8/17 microalbuminuric and in none of the normoalbuminuric Type 2 diabetic patients. Plasma thrombin-antithrombin complex values were not significantly different in the two groups and were not correlated with AER. These results suggest that microalbuminuria is associated with a prethrombotic state and a relatively defective thrombin neutralization. Coagulation abnormalities might be part of the cardiovascular risk in microalbuminuric patients.

Aged↗
PubMed1994

[The epiphyseal involvement of metaphyseal bone sarcomas in patients with fertile growth plates. A magnetic resonance assessment].

The growth plate is thought to be capable of limiting tumor spread. To assess the presence and extent of epiphyseal involvement in bone tumors, the plain radiographs and the MR images of 41 patients with metaphyseal sarcoma and radiographically apparent growth plate were studied. The results were compared with surgical, microscopic and histologic findings. Histology demonstrated that in 3 patients the tumor did not reach the growth plate, in 25 the epiphysis was involved while in 13 cases the tumor reached the physis but did not spread to the epiphysis. In the latter group of patients, histology demonstrated a microinfiltration of the physis in 5 cases. Radiography and MR sensitivities were 77.2% and 100%, respectively, while specificity was 94% for both methods. Histology showed that the epiphysis was involved in 25/41 cases (61%) and the growth plate in 30/41 (73%). Our results show that the growth plate does not usually act as a barrier against tumor spread and that MRI is the diagnostic tool of choice in the assessment of epiphyseal spread in metaphyseal tumors even though it cannot detect growth plate microinfiltrations.

Adolescent↗
PubMed1993

Duplex-Doppler ultrasonography in the assessment of portal hypertension. Utility of the measurement of maximum portal flow velocity.

To assess the utility of Duplex-Doppler ultrasonography (DDUS) in the evaluation of portal haemodynamics we studied 52 patients with compensated liver cirrhosis (mean age 53.9 +/- 9.2 years, males 32, females 20) diagnosed by laparoscopy and biopsy. All patients underwent laparoscopy and oesophageal-gastro-duodenoscopy (OGDS): we postulated that haemodynamically significant portal hypertension (PH) was present if varices were detected at OGDS and/or if collateral veins were revealed at laparoscopy. DDUS was performed with a strictly standardized method and maximum portal flow velocity (PFV) was measured in all patients. Max-PFV ranged between 3.5 and 33.4 cm/s. Overall, 36 patients (69%) had a max-PFV lower than 20.3 cm/s (normal max-PFV range in our laboratory is 20.3-33.3 cm/s), while 16 patients (31%) had normal max-PFV values. Five patients (9.6%) had no signs of PH at laparoscopy and/or OGDS and all five had normal max-PFV values. The other 47 patients (90.4%) had collateral circuli at laparoscopy and 29/47 (61.7%) exhibited also varices at OGDS: max-PFV was lower than 20.3 cm/s in 36/47 patients (76.6%). The measurement of max-PFV demonstrated a 76.6% sensitivity and a 100% specificity in detecting PH, with 100% positive predictive value and 31% negative predictive value. Three patients with PH and apparently normal max-PFV values exhibited a recanalization of the umbilical vein.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1993

Duplex Doppler ultrasonographic comparison of the effects of propranolol and isosorbide-5-mononitrate on portal hemodynamics.

Eighteen cirrhotic patients with esophageal varices at risk for bleeding took part in a double-blind study. The variations in PFV induced by either 40 mg of propranolol or 60 mg of sustained-release isosorbide-5-mononitrate on two consecutive days were evaluated with a duplex Doppler device. Both drugs caused a significant decrease in maximum (propranolol, P = 0.002; isosorbide-5-mononitrate, P = 0.021). Four patients responded to propranolol, three to isosorbide-5-mononitrate, and eight to both drugs; three did not show any change. Duplex Doppler sonography may be of use in the selection of the right pharmacologic treatment for the individual patient for the prevention of a bleeding esophageal varix.

Delayed-Action Preparations↗