Circadian rhythm in primary affective disorder.
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Blood Pressure↗
Biomedical subjects
S Romano
Publications and source records attributed to S Romano.
Evidence for bone mass and body fat distribution relationship in postmenopausal obese women.
The measurement of bone mass, a reliable predictor of osteoporotic fractures, in obese subjects has yielded conflicting results and bone mass has been reported to be elevated, normal or decreased. These observations indicate that factors other than body weight may be involved in the less risk for osteoporosis in obese subjects. In order to clarify the role of body fat distribution on bone density we studied sixty postmenopausal overweight/obese women with Body Mass Index (BMI) over 25 kg/m(2). Thirty five age-matched, nonobese postmenopausal women, served as controls. Bone mineral density (BMD) was measured at the proximal and ultradistal non dominant forearm using a double energy X-ray absorption (DEXA) apparatus. The waist/hip circumferences ratio (WHR) was used, in obese group, as an anthropometric estimation of the abdominal (WHR>0.85) to lower-extremity (WHR>0.85) fat proportion. The results were analyzed by Student t-test, ANOVA, and multiple linear regression analysis. No difference was found in BMD between obese group and controls, but a highly significant (P<0.001) positive correlation has been documented between proximal and ultradistal radius bone mineral density and waist/hip ratio in the obese group. Instead not significant correlation was found with BMI. Regional fat topography may influence the bone mass independently of total adiposity and visceral fat was the primary parameter accounting for higher bone mineral density values. These finding suggest that women with android-like obesity are protected from osteoporosis.
Journal Article↗
Multiple jejunal angiodysplasia detected by enema-helical CT.
The small bowel angiodysplasia is a rare entity that causes lower intestinal bleeding; the diagnosis is difficult and based on selective angiogram. In our case, an 85-year-old woman was hospitalized after frequent episodes of melena. We performed an enema-helical CT abdominal examination before and after contrast medium administration per venam, detecting some increased intensity areas that surgery confirmed to be a vascular dysplasia on the jejunal first loop. We found the source of hemorrhage without performing an angiographic examination.
Aged↗
Chlamydia pneumoniae infection in patients with acute coronary syndrome: a clinical and serological 1-year follow-up.
The role of Chlamydia pneumoniae infection in pathogenesis and prognostic stratification of patients with acute coronary syndromes is still unclear. However, a limitation of many studies is the evaluation of the long-term prognostic role of a sample obtained during the acute phase, whereas the assessment of the temporal trend of antibody titers could be more useful. One-hundred and fourteen consecutive patients with acute coronary syndromes (71 with acute myocardial infarction and 43 with unstable angina) were studied. Blood samples were obtained immediately after hospital admission and 1, 3, 6 and 12 months after the acute event. The microimmunofluorescence test was used to detect C. pneumoniae specific antibodies. The incidence of new coronary events (death, myocardial infarction, recurrent angina) was recorded during the 1-year follow-up period. No significant difference was found between patients with (n = 35) or without (n = 79) new coronary events (N.C.E.) regarding baseline and serial values of C. pneumoniae antibodies. The rate of high titers at any time of follow-up was also similar in the two groups: IgG > or =1:512 were present in 52%, 64%, 55% and 32% of N.C.E.+ patients, and in 48%, 54%, 52% and 36% of N.C.E.- patients at 1, 3, 6 and 12 months respectively; IgA > or =1:256 were present in 26%, 23%, 30% and 23% of N.C.E.+ patients and in 20%, 30%, 25% and 19% of N.C.E.- patients at 1, 3, 6 and 12 months respectively. Our data indicate that elevated titers of C. pneumoniae antibodies, even with a serial 1-year evaluation, are not a predictor of future coronary events in patients with acute myocardial infarction or unstable angina.
Angina, Unstable↗
P2Y2 receptor up-regulation induced by guanosine or UTP in rat brain cultured astrocytes.
Among P2 metabotropic ATP receptors, P2Y2 subtype seems to be peculiar as its upregulation triggers important biological events in different cells types. In non-stimulated cells including astrocytes, P2Y2 receptors are usually expressed at levels lower than P2Y1 sites, however the promoter region of the P2Y2 receptors has not yet been studied and little is known about the mechanisms underlying the regulation of the expression of this ATP receptor. We showed that not only UTP and ATP are the most potent and naturally occurring agonist for P2Y2 sites, but also guanosine induced an up-regulation of astrocyte P2Y2 receptor mRNA evaluated by Northern blot analysis. We also focused our attention on this nucleoside since in our previous studies it was reported to be released by cultured astrocytes and to exert different neuroprotective effects. UTP and guanosine-evoked P2Y2 receptor up-regulation in rat brain cultured astrocytes was linked to an increased P2Y2-mediated intracellular calcium response, thus suggesting an increased P2Y2 activity. Actinomycin D, a RNA polymerase inhibitor, abrogated both UTP and guanosine-mediated P2Y2 up-regulation, thus indicating that de novo transcription was required. The effect of UTP and guanosine was also evaluated in astrocytes pretreated with different inhibitors of signal transduction pathways including ERK, PKC and PKA reported to be involved in the regulation of other cell surface receptor mRNAs. The results show that ERK1-2/MAPK pathway play a key role in the P2Y2 receptor up-regulation mediated by either UTP or guanosine. Moreover, our data suggest that PKA is also involved in guanosine-induced transcriptional activation of P2Y2 mRNA and that increased intracellular calcium levels and PKC activation may also mediate P2Y2 receptor up-regulation triggered by UTP. The extracellular release of ATP under physiological and pathological conditions has been widely studied. On the contrary, little is known about the release of pyrimidines and in particular of UTP. Here we show that astrocytes are able to release UTP, either at rest or during and following hypoxia/hypoglycemia obtained by submitting the cells to glucose-oxygen deprivation (OGD). Interestingly, also P2Y2 receptor mRNA increased by about two-fold the control values when the cultures were submitted to OGD. It has been recently reported that P2Y2 receptors can play a protective role in astrocytes, thus either guanosine administration or increased extracellular concentrations of guanosine and UTP reached locally following CNS injury may increase P2Y2-mediated biological events aimed at promoting a protective astrocyte response.
Adenosine Triphosphate↗
[Diagnostic sensitivity of computerized tomography in closed trauma of the diaphragm. Retrospective study of 35 consecutive cases].
PURPOSE: To evaluate the effectiveness and role of CT in blunt diaphragmatic injuries by reviewing our 8-year experience. MATERIAL AND METHODS: We reviewed the preoperative CT findings of 35 patients with surgically confirmed diaphragmatic rupture. Surgical repair was performed in the acute setting (within 12 hours of trauma) in 22 cases, and late (8 months-5 years) in 13 cases. Twenty-eight patients (80%) were examined with conventional CT and 7 (20%) with Helical CT. Scans were initiated at the thoracic inlet to the pubic symphysis, with 8-mm slice thickness, after i.v. contrast agent administration. Four-mm slices were acquired in the region of interest; sagittal and coronal reformations were obtained for Helical CT images. RESULTS: In the acute group, 20 patients had left hemidiaphragmatic and 2 right hemidiaphragmatic rupture; thoracic herniation of the abdominal organs was seen in all cases. Of the 13 patients examined long after trauma, the left hemidiaphragm was ruptured in 12 cases (with visceral herniation in 4), and the right hemidiaphragm in 1, with no herniation. The diaphragmatic rent was found in the dome (15 cases, 43%), musculotendinous junction (11 cases, 31%), muscular portion (8 cases, 23%), and at the muscular attachments on the ribs (1 case, 3%). CT diagnosed diaphragmatic rupture in all the acute cases (22/35 patients, 63%) and in 4 patients with visceral herniation (11%) examined long after trauma. CT findings were questionable in the 9 cases (25%) not presenting visceral herniation. As for the site of diaphragmatic injury, CT never depicted the diaphragmatic rent in the dome and at the musculotendinous junction (74%), not even with thin slices and the multiplanar Helical technique. CT detected indirects signs of injury at the muscular portion (23%), showing the injury site directly in the case with diaphragmatic avulsion (3%). CONCLUSION: CT is a reliable tool in the diagnosis of suspected diaphragmatic injury in the acute trauma setting. Long after trauma, CT performs poorly because it depicts the diaphragmatic rent only in some peripheral traumas. Helical CT has greater diagnostic potentials, but the injury site and type do affect its capabilities.
Diaphragm↗
[Personal experience in 71 consecutive patients with acute cholecystitis].
PURPOSE: Acute cholecystitis is one of the most frequent abdominal inflammatory processes. If untreated or misdiagnosed it can result in severe complications such as gallbladder rupture, abscesses, or peritonitis. We retrospectively reviewed a series of 71 consecutive patients with surgical confirmation of acute cholecystitis and now compare the results of the diagnostic techniques we used preoperatively. MATERIAL AND METHODS: Over 16 months, 71 consecutive patients (42 women and 29 men; age range: 34-84 years, mean: 58) with acute abdominal pain were operated on for acute cholecystitis at Cardarelli Hospital, Naples. Abdominal plain film was performed in 65 of 71 cases, abdominal US in 69 and abdominal CT in 6. On abdominal plain films, we retrospectively searched the following signs: densities projected over the gallbladder, linear calcifications in gallbladder walls, gallbladder enlargement, focal gas collections within the gallbladder, and air-fluid levels in the gallbladder lumen. On US images we looked for: gallbladder wall thickening (> 3 mm), intraluminal content in the gallbladder, pericholecystic fluid, US Murphy's sign, and gallbladder distension. On CT images, we investigated: gallbladder distension, wall thickening, intraluminal content, pericholecystic fluid, and inflammatory changes in pericholecystic fat. Associated complications of cholecystitis were also searched on all images. RESULTS: On plain abdominal films we found densities projected over the gallbladder (16.9%) and linear calcifications in the gallbladder wall (4.6%). Abdominal US demonstrated gallbladder wall thickening (56.5%), one or more gallstone(s) (85.5%), pericholecystic fluid (14.5%), gallbladder distension (46.4%), and US Murphy's sign (39.1%). Abdominal CT showed gallbladder wall thickening (83.3%), gallbladder distension (66.6%), pericholecystic fluid (66.6%), gallstones (50%), inflammatory changes in pericholecystic fat (33.3%), and increased bile density (> 20 HU) (33.3%). CONCLUSIONS: US appears to be the most useful imaging technique in patients with suspected acute cholecystitis, for both screening and final diagnosis. CT plays a limited role in the early assessment of these patients, but can be a useful tool in diagnosing acute cholecystitis in patients with questionable physical findings or in investigating related complications.
Acute Disease↗
[Diagnostic and therapeutic strategies in post-infarct].
It is of primary importance for the clinical cardiologist to keep in mind the parameters allowing an adequate prognostic stratification in post-infarct patients in view of making the best diagnostic and therapeutic choices. A diagnostic strategy, based on a pathophysiologic approach, should evaluate four aspects: spontaneous and stress-induced ischemia, myocardial viability, and ventricular arrhythmias. Spontaneous ischemia has an undefined prognostic value, especially in the thrombolytic era; therefore it seems reasonable to perform invasive procedures in patients who are not stabilized by an adequate medical therapy or with large jeopardized areas. In asymptomatic patients, a provocative stress test allows a more articulated decisional iter. It is preferably to perform the test by the most physiological exercise EKG, together with the echocardiographic imaging, after the acute phase. It has a high negative predictive value, but a low positive predictive value. The detection of myocardial viability is frequently performed, mainly in patients with large post-ischemic myocardial dysfunction. Among all the proposed methods, the echo-dobutamine test mainly allows to estimate patients in whom revascularization may result in more benefit. The role of ventricular arrhythmias as an independent prognostic factor is debated and has to be always considered in relationship to other parameters, particularly left ventricular function. Regarding the therapeutic strategy, the indications from recent trials, related to antithrombotic drugs, beta-blockers, ACE-inhibitors, nitrates, Ca-blockers and antiarrhythmic drugs, are emphasized.
Adrenergic beta-Antagonists↗
[The radiological diagnostic and clinical approach to the patient with stab and cut wounds of the chest. The authors' personal experience].
PURPOSE: To report our personal experience with the clinical and radiological diagnostic approach to stab and cut wounds of the thoracic cage and its content, a type of injury whose diagnosis and treatment, as well as the surgical approach, vary case by case. CT of deep penetrating wounds permits correct assessment of severe changes such as pneumothorax, hemothorax and pneumomediastinum. MATERIAL AND METHODS: In the last three years we examined 57 patients (48 men and 9 women; mean age 34 years, range 16-54): chest radiography was performed in 51 of them, with orthogonal projections in the standing and sitting positions. Chest CT was performed in emergency with i.v. contrast agent injection, with scans from the midneck to the diaphragm insertion to study border regions. Thoracostomy with pleural drainage was performed in 35 patients with pneumothorax and hemothorax while thoracotomy was performed in 8 patients, namely 4 with injury to the diaphragm, 2 to the heart, 1 with tear of the main bronchial artery and 1 of the aortic arch. RESULTS: The most frequent symptoms we found were chest pain (100% of cases) and dyspnea (84%); laboratory data showed anemia and decreased hematocrit levels in 28 cases. Chest radiography was negative in 14 cases. The patients were then examined with CT to exclude radiographic underestimation of minimal pneumothorax, small lacerocontusive or hemorrhagic foci and hemothorax, which were observed in 4, 2 and one cases, respectively, and where radiography was actually negative for traumatic changes. Chest radiography was positive in 43 cases: the most frequent finding was pneumothorax, with 37 cases (86%)--8 of them associated with hemothorax and 5 with pneumomediastinum. Lacero-hemorrhagic foci of lung parenchyma were found in 5 cases and single pulmonary hematoma from punch crossing was seen in 1 case. DISCUSSION AND CONCLUSIONS: CT was an accurate tool and had higher sensitivity than chest radiography in detecting and detailing pneumothorax, pneumomediastinum and lacero-hemorrhagic foci, as well as in quantifying hemothorax. Chest radiography had 12% false negatives and therefore we decided to perform CT in all the patients with penetrating wounds to prevent radiographic underestimation. Given the low rate of false negatives (7/57 cases) CT might appear superfluous but since in 2 of these 7 cases we had massive pneumothorax and pneumomediastinum associated with neck emphysema we suggest its use to prevent complications, clinical failures and medicolegal problems. CT permits correct assessment of penetrating stab and cut wounds of the chest and efficient and targeted treatment, which can be conservative, with thoracostomy with pleural drainage, or surgical.
Adolescent↗
[Cryptococcosis in a female patient with angioimmunoblastic lymphadenopathy and dysproteinemia].
A case of a 72-year-old woman affected by angioimmunoblastic lymphadenopathy with dysproteinemia is described. She was admitted to the hospital for serious cutaneous lesions and dementia. The patient had been treated with corticosteroids for the previous two years. Cryptococcosis was diagnosed by cutaneous biopsy. Antimycotic therapy together with corticosteroid withdrawal cured the cutaneous lesions and improved her psychiatric symptoms.
Aged↗
Chlamydia pneumoniae in asymptomatic carotid atherosclerosis.
We evaluated, in 415 patients with asymptomatic carotid atherosclerosis: (i) the prevalence of C. pneumoniae DNA in atherosclerotic carotid plaques and peripheral blood mononuclear cells (PBMC); (ii) the distribution of C. pneumoniae in atherosclerotic carotid plaques and PBMC from the same patients; (iii) the correlation between circulating anti-chlamydial antibodies and the presence of C. pneumoniae DNA. Overall, 160 atherosclerotic carotid plaques and 174 PBMC specimens from patients with asymptomatic carotid atherosclerosis were examined by ompA nested touchdown PCR for presence of C. pneumoniae. In addition, C. pneumoniae DNA was detected in 81 specimens of atherosclerotic carotid plaque and PBMC obtained from the same patients. C. pneumoniae DNA was found in 36.9% of atherosclerotic carotid plaques and in 40.2% of PBMC specimens examined (P=NS). With regard to 81 patients, C. pneumoniae DNA was detected in 27.2% of atherosclerotic carotid plaques and in 44.4% of PBMC specimens(P=0.05). In 18 patients, the presence of C. pneumoniae DNA in PBMC specimens and atherosclerotic carotid plaques coincided (P=0.005). No statistically significant association was found between anti-C. pneumoniae antibodies (IgG and IgA) and positive PCR results. In conclusion, our results suggest that the detection of C. pneumoniae DNA in PBMC specimens seems to be a first-choice method to identify the patients at risk for endovascular chlamydial infection.
Aged↗
Supernatant of human umbilical vein endothelial cell culture can favour in vivo neutropoiesis.
Umbilical vein endothelial cells are known to be able to produce interleukins and colony stimulating factors. In the present work supernatant of human umbilical vein endothelial cell culture have been administered to neoplastic patients treated with chemotherapy to reduce the iatrogenic inhibition of hemopoiesis. While no undesired effect could be observed, neutrophil count was favourably influenced by endothelial cell supernatant administration. Such data can be considered useful in order to reduce collateral effect of antineoplastic therapy.
Adult↗
Circadian variations of plasma somatostatin levels in healthy subjects.
The plasma levels of somatostatin-like immunoreactivity, growth hormone and insulin were measured using a RIA method in healthy volunteers every 4h during the day and every 2h at night, without waking the subjects. In the waking state the fluctuation of plasma somatostatin-like immunoreactivity level only occurred near to meal time. A marked episodic surge of plasma SLI (peak value, 127.25 +/- 4.40 pg/ml (mean +/- ES)) was noted at 0200 in the initial period of slow wave sleep (SWS) 2h after the peak of GH. Insulin showed no sharp peak and its pattern was unrelated to other two hormones studied. A positive correlation was observed between SLI and GH in plasma using the mean cosinor method: the acrophase of SLI was at 0018 about 1h later than GH (at 2315). The acrophase of insulin occurred at 1525, significantly different as compared with the previous two. From these findings, it is concluded that SLI in peripheral plasma fluctuates with a significant circadian rhythm and a nychthemeral maxima as GH and that, whatever its source, that it is related to plasma GH and not to plasma insulin.
Adult↗
[Primary hyperparathyroidism: the recent findings].
Primary hyperparathyroidism is a quite frequent disease, the incidence of which has been found to increase over the past two decades. At the same time there has been a remarkable change in its clinical presentation; therefore this endocrine disorder earlier considered rare but almost always associated with complications, now appears a quite common and uncomplicated disease. In our series of 150 patients diagnosed between 1966 and 1989 the female/male ratio was found to be 1.77. The ratio has significantly increased (2.09), beginning from 1983; this was mainly due to the availability of a bone densitometer at our Mineral Metabolism Service with consequent greater demand of serum calcium determination as a part of routine metabolic screening for prevention of postmenopausal osteoporosis. Whilst the percentage of patients with renal manifestations of the disease has not significantly changed during these years, the amount of asymptomatic patients (yrs 1966-1983 = 3.7% vs yrs 1984-1989 = 39.7%) has progressively increased to the detriment of patients with skeletal symptoms. Serum intact parathyroid hormone determination by immunoradiometric assay (and possibly by immunochemiluminometric assay) seems to have overcome some of the methodological problems inherent in conventional radioimmunoassay. Surgical treatment of primary hyperparathyroidism is safe and highly effective in experienced hands. Recurrence has been observed only in three cases after resection of parathyroid adenoma, thus indirectly supporting a monoclonal origin of the tumor. Medical behavior (conservative or surgical management) in respect to patients with the mild or asymptomatic form of the disease, especially when diagnosed in old age, is uncertain at this point in time. Future prospective studies carried out on a large number of patients are needed to better clarify this issue.
Humans↗
Evaluation of creatine kinase isoenzyme BB as a marker of neoplastic growth in Yoshida ascites hepatoma of the rat.
A considerable interest has recently been shown for the measurement of isoenzyme BB of creatine kinase as a diagnostic and prognostic indicator of tumor growth. This isoenzyme belongs to the group of oncofetal antigens and in human cancer elevated levels occur frequently in patients with metastatic disease. In this study we have attempted to quantify CK-BB serum levels during the growth of an experimental tumor (Yoshida Hepatoma AH 130) in male albino rats to determine if a significant correlation exists between isoenzyme serum levels and the rate of tumor growth. Creatine kinase-BB was measured spectrophotometrically by immunoinhibition of creatine kinase-M subunits. CK-BB normal values were 4.19 +/- 0.4 U/L and between days 5 and 9, where there is an increase in the rate of proliferation of neoplastic cells, CK-BB serum levels reaches its maximum 69.01 +/- 2.2 U/L. These data are in agreement with the hypothesis that the highest isoenzyme levels are a measure of the aggressiveness of the neoplastic clone. Moreover, this hypothesis is consistent with the proposed mathematical model, and we plan to expand this line of study to evaluate the predictive potential of this tumor marker in man.
Animals↗
[Effects of a new anti-arrhythmic drug, bunaftine, on intra-atrial, atrio-ventricular and intraventricular conduction of the stimulus].
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Adult↗
[Intermittent ventricular pre-excitation during acute myocardial infarct].
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Adult↗
Plasma hydroxycorticosteroids circadian rhythm in diabetic adult subjects under different types of treatment.
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17-Hydroxycorticosteroids↗