Search PubMed⌕ Search

Biomedical subjects

S Baldelli

Publications and source records attributed to S Baldelli.

At least 19 recordsLinked to original sources
PubMed2005

Influence of co-medication with sirolimus or cyclosporine on mycophenolic acid pharmacokinetics in kidney transplantation.

The pharmacokinetics of mycophenolic acid (MPA)--the active metabolite of mycophenolate mofetil (MMF)--is significantly influenced by co-medications. The impact of sirolimus on daily MPA exposure, however, has not been investigated so far. As a part of the study aimed at investigating the efficacy of Campath-1H induction therapy in a steroid-free regimen in kidney transplantation, MPA plasma levels were serially measured in 21 patients treated with low-dose sirolimus (SRL) or low-dose CsA both in addition to low-dose MMF over 12 months post-operatively. Full pharmacokinetic profiles were compared at month 6 and 12 post-surgery. Mean dose-adjusted MPA trough levels were 4.4-fold higher in patients on combined SRL and MMF than in those given CsA and MMF. Pharmacokinetic studies demonstrated that mean MPA C(max) and T(max) were comparable in the two groups, while mean MPA AUC(0-12) was higher in SRL than CsA treated patients. The pharmacokinetic profile of SRL- but not of CsA-group showed a second peak consistent with the enterohepatic recirculation of MPA. These findings suggest that SRL and CsA have different effects on MPA metabolism and/or excretion eventually affecting its immunosuppressive property and/or toxicity. CsA, but not SRL, inhibits MPA enterohepatic recirculation, reducing MPA daily exposure.

Adult↗
PubMed2001

Potential-dependent vibrational spectroscopy of solvent molecules at the Pt(111) electrode in a water/acetonitrile mixture studied by sum frequency generation.

Sum frequency generation (SFG) vibrational spectra of D(2)O and/or acetonitrile (CH(3)CN) on a Pt(111) single-crystal electrode were obtained as a function of applied potential in a 5 mol % water/acetonitrile mixed solvent with different 0.1 molar MSO(3)CF(3) salts (M = H(+), Li(+), Na(+), K(+), and Cs(+)). The results provide a very specific model for the composition of the inner Helmholtz layer as a function of potential and surface charge. Acetonitrile dominates the inner layer with the CN group directed toward the metal at potentials where the metal has a positive charge. As the surface becomes negatively charged, the acetonitrile orientation flips 180 degrees, with the CH(3) group pointing toward the surface. At even more negative surface charge, D(2)O displaces acetonitrile from the inner layer and is the predominant molecule on the surface. Here water is present as an oriented molecule with the oxygen end pointing toward the metal. The potential (and surface charge) where water is the dominant molecule in the inner Helmholtz layer is determined by the solvation energy of the cation.

Journal Article↗
PubMed2000

The differing patterns of subclinical pulmonary involvement in connective tissue diseases as shown by application of factor analysis.

To explore common patterns of interstitial lung disease (ILD) in symptomless patients with connective tissue disease (CTD), we applied factorial analysis to determine the relationship among the factors. A selected cohort of 71 non-smoking patients with a confirmed diagnosis of CTD [24 with primary Sjögren's syndrome (pSS), 21 with systemic sclerosis (SS), 20 with rheumatoid arthritis (RA) and six with polymyositis/ dermatomyositis (PM/DM)] were identified. The diagnostic techniques included pulmonary function tests, bronchoalveolar lavage (BAL), chest radiographs and high-resolution computed tomography (HRCT). Disease extent and severity were assessed by a radiological and HRCT grading system. Three factors, accounting for 67% of the total variance, were extracted. The first factor (disease duration, diffusing lung capacity, neutrophils and CD8+ T cells on BAL, radiographic score and HRCT reticular score), with the highest percentage of variance (36.5%), defines a fibrotic lung pattern. The second factor (17.9% of variance) identifies an inflammatory lung pattern (macrophages, lymphocytes and eosinophils on BAL and HRCT ground-glass score). The third factor (12.6% of variance) represents a ventilatory function pattern (forced vital capacity, total lung capacity and forced respiratory volume in 1 s). The negative correlation between the fibrotic lung pattern and ventilatory function pattern, but not with the inflammatory lung pattern, suggests the presence of a significant derangement of the alveolar structures. In conclusion, application of factor analysis reveals various lung disease patterns in patients with CTD that might have different prognostic implications.

Adult↗
PubMed1998

A longitudinal study of pulmonary involvement in primary Sjögren's syndrome: relationship between alveolitis and subsequent lung changes on high-resolution computed tomography.

Eighteen non-smoking women suffering from primary Sjögren's syndrome (pSS) with previously documented alveolitis were re-examined, clinically and by pulmonary function tests (PFT), bronchoalveolar lavage (BAL), chest X-ray and high-resolution computed tomography (HRCT) after a 2 yr follow-up period. Longitudinal evaluation revealed unchanged PFT. The final BAL study showed a normal differential count in six of 14 patients with initial lymphocyte alveolitis, and a persistent alveolar lymphocytosis in the remaining eight patients, associated with an increased percentage of neutrophils in one of them. In four patients with initial mixed alveolitis, the BAL cell profile was unchanged 2 yr later. Five of 18 patients (28%) had abnormal HRCT, represented by isolated septal/subpleural lines in three patients, ground-glass opacities with irregular pleural margins in one patient, and ground-glass opacities associated with septal/subpleural lines in another. All these patients had abnormal BAL results with an increased proportion of both neutrophils and lymphocytes. The presence of alveolar neutrophils was associated with a significantly (P=0.005) greater mean rate of reduction of carbon monoxide diffusing capacity (DLCO) -- more than four times the normal rate of loss of DLCO. Chest X-ray, repeated at the end of the 2 yr follow-up period, showed parenchymal abnormalities in only one patient who had evidence of fibrosis on HRCT. This study provides evidence that lung involvement is not an uncommon extraglandular manifestation of pSS and that a BAL neutrophilia may play an important role in the pathogenesis of pulmonary disease in this autoimmune disorder.

Adult↗
PubMed1997

[Quantitative analysis of radiologic progression in rheumatoid arthritis: controversies and perspectives].

Rheumatoid arthritis (RA) is a chronic inflammatory disease with symmetrical polyarthritis as the major feature. Persistent inflammation leads to largely irreversible joint damage which can be seen radiographically. Radiographs depict the progression of joint damage and alterations, which are one of the major parameters of RA evolution. Delayed radiologic progression is a good indicator of the success/failure of long-term drug treatment, but the quantitative analysis of changes over time and the reliability of scoring systems remain difficult steps. This paper focuses of the main current scoring systems, with an emphasis on the following four: Larsen method and its modification by Kayle, Sharp method and its modification by van der Heijde. The scoring method--be it grading, counting, or weighted counting--did not appear to influence reliability or repeatability, while the radiologist's training and the film reading technique were critical to identify disease progression accurately. Our data consistently suggest the paired reading method as the most suitable for radiologic progression assessment in RA. The radiologic studies of 62 patients with early RA after 7 years' follow-up showed joint damage in 82% of patients. The average annual progression rate of the total radiologic score obtained with Sharp method, summing erosions and joint space abnormalities, was faster in the earlier years of the disease (8.8 units/year) than later on (4.9 units/year) (p < 0.01). From the trialist's point of view, these results imply that disease duration is a critical feature for RA treatment outcome.

Adult↗
PubMed1997

[Virtual bronchoscopy: the correlation between endoscopic simulation and bronchoscopic findings].

PURPOSE: We carried out a preliminary clinical validation of 3D spiral CT virtual endoscopic reconstructions of the tracheobronchial tree, by comparing virtual bronchoscopic images with actual endoscopic findings. MATERIALS AND METHODS: Twenty-two patients with tracheobronchial disease suspected at preliminary clinical, cytopathological and plain chest film findings were submitted to spiral CT of the chest and bronchoscopy. CT was repeated after endobronchial therapy in 2 cases. Virtual endoscopic shaded-surface-display views of the tracheobronchial tree were reconstructed from reformatted CT data with an Advantage Navigator software. Virtual bronchoscopic images were preliminarily evaluated with a semi-quantitative quality score (excellent/good/fair/poor). The depiction of consecutive airway branches was then considered. Virtual bronchoscopies were finally submitted to double-blind comparison with actual endoscopies. RESULTS: Virtual image quality was considered excellent in 8 cases, good in 14 and fair in 2. Virtual exploration was stopped at the lobar bronchi in one case only; the origin of segmental bronchi was depicted in 23 cases and that of some subsegmental branches in 2 cases. Agreement between actual and virtual bronchoscopic findings was good in all cases but 3 where it was nevertheless considered satisfactory. The yield of clinically useful information differed in 8/24 cases: virtual reconstructions provided more information than bronchoscopy in 5 cases and vice versa in 3. Virtual reconstructions are limited in that the procedure is long and difficult and needing a strictly standardized threshold value not to alter virtual findings. Moreover, the reconstructed surface lacks transparency, there is the partial volume effect and the branches < or = 4 pixels phi and/or meandering ones are difficult to explore. CONCLUSIONS: Our preliminary data are encouraging. Segmental bronchi were depicted in nearly all cases, except for the branches involved by disease. Obstructing lesions could be bypassed in some cases, making an indication for endoscopic laser therapy. Future didactic perspectives and applications to minimally invasive or virtual reality-assisted therapy seem promising, even though actual clinical applications require further studies.

Adult↗
PubMed1995

Integration of transbronchial and percutaneous approach in the diagnosis of peripheral pulmonary nodules or masses. Experience with 1,027 consecutive cases.

A study to evaluate the usefulness of the integration of the transbronchial and percutaneous approaches in the diagnosis of peripheral pulmonary nodules or masses (PPN/M) was conducted. The authors used both procedures, performed by a single diagnostic team, a pulmonologist, radiologist, and cytopathologist, who were all simultaneously present in the radiologic suite during the maneuvers. From January 1985 to June 1993, under fluoroscopic guidance, the authors performed 557 transbronchial pulmonary biopsies (TBPB), 483 transbronchial needle aspirations (TBNA), and 652 percutaneous needle aspirations (PCNA) on 1,027 consecutive patients referred because of a PPN/M (mean diameter, 3.5 cm; range, 0.8 to 8 cm). The procedure used was as follows: (1) bronchoscopy with exploration of the upper airways and bronchial tree, followed by TBNA and immediate cytologic assessment (ICA); (2) at least three TBPB; (3) if TBNA was diagnostic, the procedure was stopped; if not, a second pass with the needle was performed and then the bronchoscope was removed; (4) if the second TBNA was not diagnostic, PCNA with ICA was performed up to a maximum of three needle passes. Diagnostic sensitivity for malignant lesions was as follows: 53.9% for TBPB, 69.3% for TBNA, 75.4% for TBPB and TBNA together, 93.2% for PCNA, and 95.2% overall. The percentage of benign nodules correctly defined was 41.4% for TBPB, 17.4% for TBNA, 45.8% for PCNA, and 59.5% overall. Examination of the upper airways and bronchial tree was positive for lesions endoscopically visible in 12.6% of cases. The authors' experience shows that transbronchial and percutaneous approaches must be considered complementary and that their integrated use not only increases diagnostic yield but also permits important information to be obtained for disease staging. The creation of teams able to use both approaches with the cytopathologist present for ICA should be encouraged to optimize the diagnostic management of PPN/M with a reduction in diagnostic and hospitalization time and consequent cost saving.

Adolescent↗
PubMed1991

Lymphangitic carcinomas of the lung as presentation of prostatic cancer. A case report.

Lymphangitic carcinomatosis of the lung is a late and often fatal manifestation of cancer. We describe a case of a biopsy-proved pulmonary lymphangitic carcinomatosis in an asymptomatic 61-year-old man. The pulmonary picture proved to be the initial sign of a prostatic cancer. Therapy with LH-RH analogues and antiandrogens achieved a complete clearance of lung involvement.

Buserelin↗
PubMed1991

[Magnetic resonance of the rheumatoid hand].

The purpose of this study was to evaluate MRI diagnostic accuracy in rheumatoid arthritis (RA), to compare MRI and radiological findings and to correlate these findings with the clinical and serological profile of the disease. The hands of 24 patients (20 females, 4 males) affected with typical RA (ARA criteria) were studied using a tomograph Magnetom 1.0 T Siemens. Two patients affected with RA refractory to conventional second-line drugs who received a bolus of methylprednisolone (1 g) were studied before and after such treatment. The hands of healthy volunteers were examined as controls. Besides MRI study all patients underwent: (1) radiological examination of the hands performed with a standard technique and (2) clinical and serological investigation aimed at characterizing diseases activity and extent. The radiographic and MRI findings were evaluated by two different observers who found 15 pathological elementary lesions and assigned a MRI and a radiological score to each patient. MRI exhibited significantly higher accuracy than radiography in evaluating rheumatoid soft-tissue changes and in detecting minimal skeletal lesions, while severe skeletal lesions were better detected by radiology. No correlation was found between pathological MRI findings, radiological results and clinical or serological data. A significant drop in soft-tissue effusion was observed after methylprednisolone pulse in two patients. This study confirms MRI potential in the study of rheumatoid joint lesions and in the early detection of minimal soft-tissue changes. Its use appears to be suitable for accurate monitoring of RA patients under specific therapy.

Adult↗
PubMed1988

[Radio-urodynamic evaluation of stress urinary incontinence in women].

This work is aimed at demonstrating the validity of conventional radiological procedures, correlated with urodynamics, in the study of female urinary stress incontinence. In a study population of 110 patients with a clinical-urodynamic diagnosis of stress incontinence, radiological evaluation was performed by means of retrograde cystography, bead chain cystourethrography, and voiding cystourethrography. Radiographic findings were correlated with urodynamic data, and in particular with urethral pressure profile (functional length of the urethra, maximum closing pressure, maximum urethral pressure). In all patients the posterior urethro-vesical angle values were higher than 100 degrees; moreover, a correlation was proven to exist between an increase in the angle of front urethral inclination, the lowering and mobility of the urethrovesical junction, and the severity of urodynamic findings. Furthermore, in the different stages of urodynamic severity , urethral funneling was most frequent, and the flattening of the posterior vesical floor in voiding cystourethrography. The high reliability of the radiographic findings, although obtained by means of conventional techniques, and the variability of the morpho-dynamic results confirm the importance of a combined radiographic and urodynamic study in the evaluation of stress incontinence.

Adult↗
PubMed1987

[Role of photon absorption densitometry of the bone in uremic osteodystrophy].

The aim of this investigation is to evaluate the role of bone photonic densitometry in uremic osteodystrophy. Bone mineral content (BMC) and bone density (BD) have been measured in 80 hemodialyzed patients by double photonic emission densitometry. Photonic densitometry shows an higher sensibility to quantitative changes in bone mineral content than metacarpal index (IM). Photonic densitometry is unable to differentiate osteoporosis from osteomalacia; this differential diagnosis can be obtained by radiological analysis: low BD and low IM means osteoporosis, low BD and resorptive changes in cortical bone means osteomalacia and/or hyperparathyroidism. Photonic densitometry is particularly suitable for uremic osteodystrophy follow-up because of its easy repetitiveness and innocuousness and for its close correlation with iPTH variations.

Adult↗
PubMed1983

Reflux esophagitis: radiologic-endoscopic correlation in 39 symptomatic cases.

Thirty-nine consecutive patients with symptoms suggestive of reflux esophagitis underwent a double contrast upper gastrointestinal series and subsequently had endoscopy with biopsy. In a control group of 164 consecutive patients without symptoms of esophagitis a double contrast examination was done with the same method. We have found a significant increase of the diameter of the esophagus in its distal or cardiac segment (IDCE) in patients with esophagitis of Grades 1 and 2 when compared with the control group (p less than 0.001). Radiology was found to have correctly diagnosed 35 of the 39 cases (89.7%) and the majority of the patients had endoscopic signs of mild esophagitis.

Adolescent↗
PubMed1983

[Radiologic and clinico-serological correlates in rheumatoid arthritis].

In a study of 86 patients with rheumatoid arthritis a valid statistical correlation can be found between the entity of the osteo-articular lesions of the hand and wrist shown by radiography to a high definition and some clinical and serological parameters. The results indicate a good correlation with a large part of the considered parameters (anatomical stage, functional class, duration of the disease, VES, gamma-globulins, serological activity) and confirm the validity of the high definition radiographical study in the follow-up of the disease.

Adult↗