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Biomedical subjects

R Sacco

Publications and source records attributed to R Sacco.

At least 19 recordsLinked to original sources
PubMed1997

Liver inflammation and acute respiratory distress syndrome in a patient receiving hepatitis B vaccine: a possible relationship?

We describe a patient in whom clinical evidence of liver and lung dysfunction developed after he received the second dose of recombinant hepatitis B vaccine, despite no serologic evidence of viral hepatitis. However, liver biopsy specimens demonstrated both surface antigens and core antigens, possibly indicating silent hepatitis B virus infection. A search for an infective etiology for the patient's subsequent clinical deterioration in lung function did not yield pathogens: postmortem examination revealed evidence of immune complex-mediated organ injury in the liver, lungs, and kidneys.

Antigen-Antibody Complex↗
PubMed1997

The prevalence of hepatitis C virus types in patients of the same geographic area, according to the source of infection and liver disease.

BACKGROUND: The duration and stage of hepatitis C might be associated with the source of infection and hepatitis C virus (HCV) types. OBJECTIVE: We studied the relationship among the different HCV types, source, duration, and stage of infection in 100 patients from the Apulia, southern Italy, selected from consecutive clinical records. They were 20 parenterally infected haemophiliacs with 10-20 years of disease history, but without cirrhosis; 20 patients (matched for sex, age and disease) and without known risk factor for parenteral infections; 60 patients with community acquired infection (ten with CAH and ten with cirrhosis with less than 20 years disease history; 20 with cirrhosis and hepatocellular carcinoma (HCC) and more than 20 years of liver disease and 20 matched cases with cirrhosis without HCC). RESULTS: Type 1 and 2 HCVs had comparable prevalence in patients with long lasting and recent HCV infection, 56 and 64%, 26 and 30% respectively. HCV type 3 was found in 6.5-12% of the patients with recent HCV infection, but it was not detected in those with infection longer than 20 years. Type 1 b HCV was more frequently found in HCC patients (68% of cases) than in the other forms of liver disease. The opposite was observed for HCV types (2 and 3). CONCLUSIONS: The prevalence of the different HCV types appears associated with the source and duration of the infection. The interesting association between HCV type 1 b and HCC prompts further studies in larger series of patients.

Adolescent↗
PubMed1997

Necrotizing pneumonia caused by Penicillium chrysogenum.

We report a case of necrotizing pneumonia due to Penicillium chrysogenum in a 57-year-old woman operated on for lung cancer. The residual right lower pulmonary lobe was infiltrated by Penicillium chrysogenum. The patient underwent a second pulmonary right lobectomy and was successfully treated with oral itraconazole. To our knowledge, this is the first case of pneumonia due to P. chrysogenum.

Antifungal Agents↗
PubMed1997

[Diagnosis of thoraco-pulmonary disorders: role of videothoracoscopy].

Videothoracoscopy can be used for diagnostic purposes when the other non-invasive methods are not satisfactory for an accurate histological diagnosis in lung and pleural pathology. The role of VTS was confirmed in the cases, observed from 1993 and surgically treated, which are herein discussed.

Adolescent↗
PubMed1996

Dissociative trance disorder: clinical and Rorschach findings in ten persons reporting demon possession and treated by exorcism.

Although dissociative trance disorders, especially possession disorder, are probably more common than is usually though, precise clinical data are lacking. Ten persons undergoing exorcisms for devil trance possession state were studied with the Dissociative Disorders Diagnostic Schedule and the Rorschach test. These persons had many traits in common with dissociative identity disorder patients. They were overwhelmed by paranormal experiences. Despite claiming possession by a demon, most of them managed to maintain normal social functioning. Rorschach findings showed that these persons had a complex personality organization: Some of them displayed a tendency to oversimplify stimulus perception whereas others seemed more committed to psychological complexity. Most had severe impairment of reality testing, and 6 of the participants had an extratensive coping stile. In this group of persons reporting demon possession, dissociative trance disorder seems to be a distinct clinical manifestation of a dissociative continuum, sharing some features with dissociative identity disorder.

Adult↗
PubMed1996

[Spiral computerized tomography and videothoracoscopy in the assessment of contralateral nodular lesions in patients with bronchogenic carcinoma].

Recent improvements in endoscopic technology and surgical techniques have widened the application field of video-assisted thoracoscopy (VAT). We report our personal experience in 14 male patients (mean age: 67 years, range: 55-73 years) in whom one or multiple indeterminate contralateral lung nodules were found during bronchogenic carcinoma staging and then surgically resected with VAT. All patients underwent volumetric CT of the chest. Sixteen lung nodules were detected contralateral to the neoplasm; their mean diameter was 5 mm (range: 2-10 mm). The mean distance between pleural surface and lung nodule was 8 mm. All patients had primary lung cancer (3 central and 11 peripheral lesions), histologically confirmed by bronchoscopic or percutaneous CT-guided biopsy. None of them had any contraindication to surgery because of extrathoracic pathologic conditions. VAT was performed as normal, under general anesthesia, with assisted ventilation with a double-lumen endotracheal tube and using a percutaneous mechanical stapler. The nodules were easier to identify using a skin reference point corresponding to the parietal projection of the nodule, positioned with CT before surgery. Surgery lasted 58 minutes on the average (range: 30-120 minutes). In all patients VAT was successful in resecting the nodule. In 9 patients a metastasis from a contralateral lung cancer was found: 4 adenocarcinomas, 4 epidermoid carcinomas and 1 small cell carcinoma. In the remaining 5 patients, VAT-resected lung nodules were of chronic inflammatory nature. The latter patients underwent definitive surgery of the primary tumor (2 adenocarcinomas, 2 epidermoid and 1 large cell carcinomas) ten days later (range: 9-30 days). There were no major complications but a prolonged air leak in one patient, which needed drainage to be maintained for 5 days. Presently, VAT permits an atypical resection, avoiding the morbility of thoracoscopy and thus represents a mandatory technique in selected patients amenable to definitive surgery.

Aged↗
PubMed1996

[Endobronchial foreign bodies: surgical indications].

Removal of foreign bodies from the tracheobronchial tree is generally possible by bronchoscopy. Seldom requested is a thoracotomy, to be considered an "ultima ratio" for cases with asphyxia, with an acute or chronic obstructive pulmonary infection, for cases-finally-of very little foreign body in a peripheral location. We collected in the past fifteen patients who had a thoracotomy for a tracheobronchial foreign body: extensive description is given of our most recent case.

Adolescent↗
PubMed1995

Automated analysis of urinary catecholamines by high-performance liquid chromatography and on-line sample pretreatment.

A simple and automated solid-phase extraction for the selective and quantitative HPLC analysis of free catecholamines in urine is described. The urinary catecholamines react with diphenylboric acid, giving a complex at pH 8.5 which is strongly retained on a PLRP-S cartridge; elution is accomplished with the same mobile phase used for HPLC analysis. Separation is performed by ion-pair reversed-phase HPLC, with sodium heptanesulphate as counter-ion, and a totally end-capped C18 analytical column. Quantitation is achieved with an electrochemical detector. A Spark Holland Prospekt system controls the on-line solid-phase extraction, preconcentration and direct elution to the LC column. Chromatography run-time is 10 min and the total time to process one urine sample is ca. 12 min.

Autoanalysis↗
PubMed1995

[Epidemiological behavior of perforated peptic ulcer before and after the introduction of the antisecretory drug therapy. Our experience].

The diagnostic iter and treatment of peptic ulcer have evolved considerably over the past 20 years. The capillary spread of endoscopy has permitted secure and precise diagnoses to be made, in terms of both the site and size of the anatomic lesion, on the one hand, and on the other, the introduction of antisecretory drugs has led to the resolution of the majority of ulcers, so much so that the ulcer is no longer managed using strictly surgical methods but is now treated medically and only emergency cases, such as perforations, undergo surgery. Complications, such as digestive hemorrhage, penetration and stenosis, may lead to the need for surgery. In particular, perforation seems to be the only complication which has not been significantly influenced by the introduction of antisecretory therapy, the point that its status as a "complication" has been questioned leading to the suspicion of its nosological autonomy. The authors review the series of ulcer patients admitted to hospital during the period 1968 to 1991, paying special attention to the correlation with the use of antisecretory drugs which were introduced during the period 1978-1981, the trend of ulcer complications over the entire period, the duration of symptoms and the epidemiology of peptic and perforated ulcers.

Aged↗
PubMed1994

[Inflammatory carcinoma of the breast: the immunological findings].

The authors discuss a case of inflammatory breast cancer, treated by interdisciplinary therapy (surgical, radiating immuno and chemo therapy). The immune status was evaluated by the determination of the lymphocytes population, monocytes and granulocytes. This evaluation was made before and after immunotherapy (i.e. subcutaneous administration of IL 2). IL 2 receptors were evaluated too. A daily dose of recombinant IL 2 (18 millions U.I.) was administered for six consecutive days. The follow-up studies showed a clear increase of total T lymphocytes, a normalization of T helper/inducers ratio, an improvement of T cytotoxic/suppressors ratio, an increased level of IL 2 receptors. The induction of mRNA for CM-CMF, G-CFS, IL 3, IL 5, IL 6, was also demonstrated, as well as a plasmatic increase of all the growth factors. A rise in neutrophils and eosinophils was documented. These results allowed the continuation of therapeutic approach with the complex radiation-chemotherapy program.

Adenocarcinoma↗
PubMed1994

[Preoperative and immediate postoperative respiratory therapy in patients with pulmonary resection].

Twenty patients with a resectable lung cancer and with a low respiratory function were included in this study. During the preoperative period all patients underwent a physiokinesic preparation in view of some improvement of their ventilation performances. Methodology as well as results are reported good response to the program, better post-operative functional recovery and absence of complications were observed in this group of patients.

Aged↗
PubMed1994

In vitro proliferation and production of gamma interferon by murine CD4+ cells in response to Cryptosporidium parvum antigen.

Spleen cells from mice immunized with Cryptosporidium parvum were enriched for T cells by passage over an affinity chromatography column. The proliferative response of these cells was > 2-fold higher than the response of unenriched cells. T-enriched cells were enriched further for either CD4+ cells or CD8+ cells. The proliferative response of CD4-enriched cells was > 4-fold higher than the response by unenriched cells. CD8+ cells were essentially nonresponsive to C. parvum antigen. Culture supernatant fractions from these variously enriched splenocyte populations were assayed for cytokine production. Cultures containing CD4+ cells produced gamma interferon and interleukin-2 following incubation with C. parvum antigen. None of the cultures produced interleukin-4. Production of gamma interferon and interleukin-2, but not interleukin-4, is characteristic of the previously described Th1 helper cell subset. Our data indicate that a subset of murine lymphocytes consistent with the Th1 helper cell phenotype proliferates following in vitro stimulation with C. parvum antigen.

Animals↗
PubMed1993

[Ultrasonographic and urodynamic evaluation in stress incontinence].

Transvaginal sonography can show partial urinary penetration in the urethra in patients with no clinical incontinence. The Fluid Bridge Test-Pressure urodynamically demonstrates the same phenomenon. We compared these two technics in women with stress urinary incontinence (SUI). 49 patients underwent urodynamic testing and transvaginal sonography; 18 had SUI, 20 were asymptomatic postoperatively (Burch procedure) and 11 were normal controls. Urodynamics consisted of filling cystometry with saline (infusion speed: ml 70/min) using transurethral Foley catheter (n degree 14 Fr), and a profilometric-pressure Bard catheter (10 Fr); micturitional cystometry; uroflowmetry; clino- and orthostatic urethral pressure profile (UPP) (extraction speed: cm 0.5-1/sec; infusion speed: cm 1.2/min); sphincteric electromyography (EMG); FBT-P with the Bard catheter only. During extraction patients were requested to cough (stress condition). If the urethra is incompetent pressure is transmitted to the water column connected to the pressure transducer, and a "spike" is observed. A competent urethra shows little pressure variation. Ultrasound (US) equipment consisted in a General Electric (RT 3600) sonograph with an electronic transvaginal probe (7.5 MHz) inserted in a gel-lubricated condom. The probe was positioned in the vaginal vestibule in direct proximity to the urethra. Axial and coronal scannings were performed. Echo-imagings were submitted to "post-processing" on US recording equipment. Fluid penetration in the urethra was evident if iperchogenic "turbulence" was observed on playback of the dynamic sonogram on a videocassette recorder (VCR) connected to the sonograph. The SUI group shows leakage of water under stress without detrusorial activity and dynamic UPP with reduced transmission of abdominal pressure on the urethra.(ABSTRACT TRUNCATED AT 250 WORDS)

Electromyography↗
PubMed1993

[Comparison of methods for the diagnosis of urinary obstruction in women].

The International Continence Society does not offer secure guidelines for the diagnosis of micturitional obstruction. The problem has been extensively addressed in relation to male voiding difficulties. Little is known on the subject in female patients. Two criteria for the diagnosis of obstructed micturition are in clinical use. The Sussett formula divides the maximum micturitional pressure by the square of the corresponding maximum urinary flow rate. Two cutoffs, corresponding approximately to the 90th and 95th centiles can be used (0.15, and 0.5). A more complex graphic nomogram developed by Schafer plots maximum flow versus maximum detrusor pressure, identifying obstruction and detrusor dysfunction simultaneously according to the author. We feel that these methods, extensively tested on a male population, can both be used on a female population. We noticed that in some instances the results were different. 469 women referred for micturitional disturbances underwent pressure/flow studies. 62 (13.2%) were obstructed according to the Schafer nomogram, 103 (21.9%) and 31 (6.6%) respectively using the Sussett mathematical formula using two different cutoffs (0.15 and 0.5). The two methods identify the same patients only if micturitional pressures are normal (40 to 60 cmH2O) to high (over 60 cmH2O) and the Sussett formula is used with a higher (95th centile) cutoff. This means that both methods are clearly insufficient in the diagnosis of obstruction if detrusor function is impaired. This can happen in case of chronic retention due to detrusor failure after a long-standing obstruction or for primary failures due to central nervous system lesions. Extreme care should be exercised if pressure-flow studies indicate obstruction at low micturitional pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1993

[Acute urinary obstruction in pregnancy].

Five cases of acute urinary obstruction during pregnancy are presented. A complete urodynamic workup, including pressure-flow studies showed high micturitional pressures with little or no flow, with at least 60% residual urine. Filling cystometry, urethral profilometry (static and dynamic), pelvic electromyography were normal. Two cases were due to uterine pelvic incarceration. One of these cases happened very early during pregnancy, because of extensive fibroids. Any cause of abnormal uterine enlargement can lead to early obstruction. Three cases were associated with paraurethral abscess (skenitis in 2 cases, urethral diverticulum in 1). Manual reduction in case of pelvic incarceration or surgical draining and antibiotic therapy in case of abscess were effective in all cases. Immediate catheterization is possible and indicated as soon as urinary obstruction is diagnosed. This prevents neuromuscular dysfunction due to excessive bladder distention. The transurethral catheter might work as a stent, and periurethral surgical drainage is probably safer with a catheter in place. Suprapubic catheterization is probably less useful in this respect. An indwelling catheter removes any urgency in treatment. Voiding difficulties can persist for some days after surgical treatment. Urodynamic testing performed in all indicated acute micturitional obstruction. Anyway, it added little to the clinical understanding of the problem, which was obvious, and the Authors feel that extensive urodynamic testing should be limited to cases presenting with a complex preexisting dysfunction or performed after treatment if symptoms do not disappear completely. All clinically doubtful cases should likewise be investigated. If periurethral abscess or incarceration are evident, simple evaluation of residual urine percentage should be sufficient in establishing the diagnosis.

Acute Disease↗
PubMed1993

[Chest drainage combined with intracavitary therapy in neoplastic pleural effusion: comparison of three different protocols].

Twenty-eight patients with malignant pleural effusion observed in a two year period were treated with intrapleural instillation of different substances: Tetracycline, Corynebacterium parvum and Beta-Interferon. Different results were observed: complete responsiveness (no recurrence of pleural effusion within three months); partial responsiveness (recurrence of moderate pleural effusion within one month after drainage removal); insufficient responsiveness (recurrence of massive effusion within one month). Among patients treated with Tetracycline seven complete, five partial and one insufficient responses were observed. Instillation of Corynebacterium parvum allowed two complete, two partial and three insufficient responses. Finally, in the group treated with Beta-Interferon complete responsiveness was obtained in just one patient, partial responsiveness in three, while the treatment was insufficient in the last two. These results suggest pleural drainage is the best treatment in patients with malignant pleural effusion, however, the association of Tetracycline instillation allows better results.

Adolescent↗