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Lavie C, Rollot F, Durand-Dubief F, Marignier R, Ionescu I, Casey R, Moreau T, Tourniaire P, Hutchinson M, D’Hooghe MB, Laplaud DA, Clavelou P, De Sèze J, Debouverie M, Brassat D, Pelletier J, Lebrun-Frenay C, Le Page E, Castelnovo G, Berger E, Hautecoeur P, Heinzlef O, Durelli L, Clerico M, Trojano M, Patti F, Vukusic S, Alpérovitch A, Carton H, d’Hooghe M, Hommes O, Hutchinson M, Adeleine P, Biron A, Cortinovis-Tourniaire P, Grimaud J, Hours M, Moreau T, Vukusic S, Confavreux C, Chauplannaz G, Confavreux C, Cortinovis-Tourniaire P, Grimaud J, Latombe D, Moreau T, Clanet M, Lau G, Rumbach L, Goas J, Rouhart F, Mazingue A, Roullet E, Madigand M, Hautecoeur P, Brunet P, Edan G, Allaire C, Riffault G, Leche J, Benoit T, Simonin C, Ziegler F, Baron J, Rivrain Y, Dumas R, Loche D, Bourrin J, Huttin B, Delisse B, Gibert I, Boulay C, Verceletto M, Durand G, Bonneviot G, Gil R, Hedreville M, Belair C, Poitevin R, Devoize J, Wyremblewski P, Delestre F, Setiey A, Comi G, Filippi M, Ghezzi A, Martinelli V, Rossi P, Zaffaroni M, Tola M, Amato M, Fioretti C, Meucci G, Inglese M, Mancardi G, Gambi D, Thomas A, Cavazzuti M, Citterio A, Heltberg A, Hansen H, Fernandez O, Romero F, Arbizu T, Hernandez J, De Andres de Frutos C, Geffner Sclarky D, Aladro Benito Y, Reyes Yanes P, Aguilar M, Burguera J, Yaya R, Bonakim Dib W, Arzua-Mouronte D, d’Hooghe M, Sindic C, Carton H, Medaer R, Roose H, Geens K, Guillaume D, Van Zandycke M, Janssens J, Cornette M, Mol L, Weilbach F, Flachenecker P, Hartung H, Haas J, Tendolkar I, Sindrn E, Kölmel H, Reichel D, Rauch M, Preuss S, Poser S, Mauch E, Strausser-Fuchs S, Kolleger H, Hawkins S, Howell S, Rees J, Thompson A, Johnson M, Boggild M, Gregory R, Bates D, Bone I, Hutchinson M, Polman C, Frequin S, Jongen P, Hommes O, Correia de Sa J, Rio M, Huber S, Lechner-Scott J, Kappos L, Ionescu I, Cornu C, Confavreux C, Vukusic S, El-Etr M, Baulieu E, El-Etr M, Schumacher M, Ionescu I, Confavreux C, Cornu C, Vukusic S, Hartung H, Miller D, Hutchinson M, Pugeat M, d’Archangues C, Conard J, Ménard J, Sitruk-Ware R, Pelissier C, Dat S, Belaïsch-Allard J, Athéa N, Büschsenschutz D, Lyon-Caen O, Gonsette R, Boissel J, Ffrench P, Durand-Dubief F, Cotton F, Pachai C, Bracoud L, Vukusic S, Ionescu I, Androdias G, Marignier R, Chauplannaz G, Laplaud D, Wiertlewski S, Lanctin-Garcia C, Moreau T, Couvreur G, Madinier G, Clavelou P, Taithe F, Aufauvre D, Guy N, Ferrier A, De Sèze J, Collongues N, Debouverie M, Viala F, Brassat D, Gerdelat-Mas A, Henry P, Pelletier J, Rico-Lamy A, Lebrun-Frenay C, Lepage E, Deburghraeve V, Edan G, Castelnovo G, Berger E, Hautecoeur P, Blondiau M, Heinzlef O, Coustans M, Clerc C, Rieu L, Lauxerois M, Hinzelin G, Ouallet J, Minier D, Vion P, Gromaire-Fayolle N, Derache N, Thouvenot E, Sallansonnet-Froment M, Tourniaire P, Toureille L, Borgel F, Stankoff B, Grimaud J, Moroianu C, Guennoc A, Tournier-Gervason C, Peysson S, Trojano M, Patti F, D’Amico E, Motti L, Zaffaroni M, Durelli L, Tavella A. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS. Mult Scler 2018; 25:591-600. [DOI: 10.1177/1352458518763080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.
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Affiliation(s)
- Caroline Lavie
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Fabien Rollot
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | | | - Romain Marignier
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Centre de Recherche en Neurosciences de Lyon,
INSERM U1028, CNRS UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France;
Université de Lyon 1, Lyon, France
| | - Iuliana Ionescu
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Romain Casey
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | - Thibault Moreau
- Department of Neurology, EA4184, University Hospital of
Dijon, Dijon, France
| | | | - Michael Hutchinson
- School of Medicine and Medical Science, University College
Dublin, Dublin, Ireland/Department of Neurology, St Vincent’s University Hospital,
Dublin, Ireland
| | - Marie Béatrice D’Hooghe
- National MS Center Melsbroek, Melsbroek, Belgium; Center
for Neurosciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - David-Axel Laplaud
- Service de Neurologie, CHU de Nantes, CIC015 INSERM,
Nantes, France/INSERM UMR1064, Nantes, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand,
Clermont-Ferrand, France/INSERM UMR1107, Clermont Université, Université d’Auvergne,
Neuro-Dol, Clermont-Ferrand, France
| | - Jérôme De Sèze
- Department of Neurology, Clinical Investigation Center
INSERM 1434, Hôpitaux Universitaires de Strasbourg, FMTS INSERM 1119, Strasbourg,
France
| | - Marc Debouverie
- EA 4360 APEMAC, University of Lorraine, Nancy,
France/Department of Neurology, Nancy University Hospital, Nancy, France
| | - David Brassat
- Pôle Neurosciences, CHU Toulouse Purpan, Toulouse,
France/INSERM U1043, CNRS UMR 5282, Université Toulouse III, Toulouse, France
| | - Jean Pelletier
- Service de Neurologie, Hôpital de la Timone, Pôle de
Neurosciences Cliniques, AP-HM, Aix-Marseille Université, Marseille, France/CNRS,
Aix-Marseille Université, CRMBM UMR7339, Marseille, France
| | | | - Emmanuelle Le Page
- Clinical Neuroscience Centre, CIC-P 1414 INSERM, Rennes
University Hospital, Rennes, France
| | | | - Eric Berger
- Department of Neurology, CHU Besançon, Besançon,
France
| | - Patrick Hautecoeur
- Service de Neurologie, Groupement des Hôpitaux de
l’Institut Catholique de Lille, Lille, France
| | - Olivier Heinzlef
- Department of Neurology, Hôpital CHI de
Poissy/Saint-Germain-en-Laye, Paris, France
| | - Luca Durelli
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Marinella Clerico
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and
Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences, and Advanced
Technologies, G.F. Ingrassia, Multiple Sclerosis Center, University of Catania, Catania,
Italy
| | - Sandra Vukusic
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques
(OFSEP), Lyon, France/Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS
UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France/Université de Lyon
1, Lyon, France
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Gambi D. Blocking mechanisms of impulse propagation along CNS fibres studied by means of evoked cortical responses. Contrib Nephrol 2015; 45:97-100. [PMID: 3979057 DOI: 10.1159/000410451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gambi D, Giordano C, Teschan PE, La Greca G, Bates D, Savazzi G, Albertazzi A, Zucchelli P, Pagani C. Discussion. Contributions to Nephrology 2015. [DOI: 10.1159/000410452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Reale M, Kamal MA, Velluto L, Gambi D, Di Nicola M, Greig NH. Relationship between inflammatory mediators, Aβ levels and ApoE genotype in Alzheimer disease. Curr Alzheimer Res 2012; 9:447-57. [PMID: 22272623 PMCID: PMC5215089 DOI: 10.2174/156720512800492549] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/05/2011] [Accepted: 11/09/2011] [Indexed: 11/22/2022]
Abstract
Activation of inflammatory processes is observed within the brain as well as periphery of subjects with Alzheimer's disease (AD). Whether or not inflammation represents a possible cause of AD or occurs as a consequence of the disease process, or, alternatively, whether the inflammatory response might be beneficial to slow the disease progression remains to be elucidated. The cytokine IL-18 shares with IL-1 the same pro-inflammatory features. Consequent to these similarities, IL-18 and its endogenous inhibitor, IL-18BP, were investigated in the plasma of AD patients versus healthy controls (HC). An imbalance of IL-18 and IL-18BP was observed in AD, with an elevated IL-18/IL-18BP ratio that might be involved in disease pathogenesis. As part of the inflammatory response, altered levels of RANTES, MCP-1 and ICAM- 1, molecules involved in cell recruitment to inflammatory sites, were observed in AD. Hence, correlations between IL-18 and other inflammatory plasma markers were analyzed. A negative correlation was observed between IL-18 and IL-18BP in both AD and HC groups. A positive correlation was observed between IL-18 and ICAM-1 in AD patients, whereas a negative correlation was evident in the HC group. IL-18 positively correlated with Aβ in both groups, and no significant correlations were observed between IL-18, RANTES and MCP-1. An important piece of evidence supporting a pathophysiologic role for inflammation in AD is the number of inflammatory mediators that have been found to be differentially regulated in AD patients, and specific ones may provide utility as part of a biomarker panel to not only aid early AD diagnosis, but follow its progression.
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Affiliation(s)
- M Reale
- Dept. of Oncology and Experimental Medicine, Unit of Immunodiagnostic, University "G. D'Annunzio", Chieti, Italy.
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Menéndez P, Gambi D, Villarejo P, Cubo T, Padilla D, Martín J. [Biliary ileus as a consequence of a cholecystoduodenal fistula (Bouveret syndrome)]. Rev Clin Esp 2009; 208:321-2. [PMID: 18620667 DOI: 10.1157/13123202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Menéndez P, Gambi D, Villarejo P, Cubo T, Padilla D, Menéndez JM, Martín J. [Quality indicators in bariatric surgery: weight loss valoration]. NUTR HOSP 2009; 24:25-31. [PMID: 19266109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Accepted: 05/17/2008] [Indexed: 05/27/2023] Open
Abstract
The medical management of MO may be effective in the short and intermediate terms, although it usually fails then leading to surgical management. Our goal is to assess Capella's surgical technique by means of quality indicators including weight loss. The present work has been performed with surgical MO patients at the 12 de Octubre University Hospital during 2000-2001, and registering the follow-up checkups for the period 2000-2001/2003-2004. We reviewed the clinical charts of 23 patients. The average Body Mass Index (BMI) was 52.24 +/- 10.07 kg/m(2), (range, 41-74.41). When compiling the statistical results, we observed statistically significant post-surgical decreases with no differences whether the PEIMCP outcome was excellent (>or= 65%), fair (= 50-65%) or failure (<or= 50%) in the following parameters: BMI (p <or= 0.001); Comorbidities (p <or= 0.001); Hemoglobinemia (p <or= 0.005); Glycemia (p <or= 0.001); Triglyceridemia (p <or= 0.001); Total cholesterolemia (p <or= 0.001); Sideraemia (p <or= 0.001); and serum cianocobalamine (p <or= 0.001). We could not demonstrate statistically significant changes in the remaining parameters. However, under the presumption that the lack of evidence does not mean the evidence of the absence, that is to say, the results have been obtained from a small sample (N = 23) so that they may not be considered definitely conclusive. Considering the percentage of the loss of Body Mass Index excess as one of the quality indexes in bariatric surgery, we may state that Capella's gastric by-pass is efficient in obese patients with BMI <or= 50 kg/m(2), doubtfully effective in patients with BMI 50-60 kg/m(2), and ineffective in super obese patients with BMI >or= 60 kg/m(2).
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Affiliation(s)
- P Menéndez
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General de Ciudad Real, Ciudad Real, España.
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Iarlori C, Gambi D, Lugaresi A, Patruno A, Felaco M, Salvatore M, Speranza L, Reale M. Reduction of free radicals in multiple sclerosis: effect of glatiramer acetate (Copaxone). Mult Scler 2008; 14:739-48. [PMID: 18505779 DOI: 10.1177/1352458508088918] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Free radicals have been found in high concentrations within inflammatory multiple sclerosis (MS) lesions. The superoxide anion (O(2)(-)) reacts rapidly with nitric oxide (NO), producing peroxynitrite (ONOO(-)). Glatiramer acetate (GA) is a specific MS immunomodulator that induces the synthesis of Th2 cytokines, and reduces the frequency of relapses and the formation of active brain lesions. Proinflammatory cytokines could play a role in free radicals production in the peripheral immune system as well as in the central nervous system (CNS). The effect of GA on iNOS, superoxide radicals (O(2)(-)) and 3-nitrotyrosine production by peripheral blood adherent mononuclear cells (PBAMs) was assessed. Our findings demonstrate that in vitro GA reduced spontaneous and LPS-induced iNOS, 3-nitrotyrosine, NO and O(2)(-) production, and that similar inhibition can be demonstrated ex vivo in mononuclear cells obtained from GA-treated patients. The inhibition of the production of free radicals in PBAMs may represent a new therapeutic mechanism against inflammation during MS.
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Affiliation(s)
- C Iarlori
- Department of Oncology and Neuroscience, University G. D'Annunzio, Chieti, Italy
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Ciccocioppo F, Lanuti P, Marchisio M, Gambi F, Santavenere E, Pierdomenico L, Bascelli A, Velluto L, Gambi D, Miscia S. Expression and Phosphorylation of Protein Kinase C Isoforms in Aβ1–42 Activated T Lymphocytes from Alzheimer's Disease. Int J Immunopathol Pharmacol 2008; 21:23-33. [DOI: 10.1177/039463200802100104] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The protein kinase C (PKC) family of enzymes is a regulator of transmembrane signal transduction. There is evidence demonstrating altered activity of some PKC isoforms (PKC-α, PKC-δ and PKC-ζ) in the neurons of brains of Alzheimer's Disease (AD) sufferers, but little is known about their involvement in the intracellular machinery of amyloid β protein-reactive T lymphocytes in AD. By applying a modified “split-well culture system” for Aβ1–42 reactivity, we carried out flow cytometry analysis and biochemical investigations on the possible involvement of PKC-α, PKC-δ and PKC-ζ in the signalling system activated in Aβ-reactive T cells purified from peripheral blood mononucleate cells (PBMC) from healthy subjects and patients with AD. Flow cytometry analysis of Aβ1–42 activated T lymphocytes in the majority of AD patients highlighted a distinct cellular cluster highly expressing phospho-PKC-δ (P-PKC-δ), while most full-blown AD patients highly expressed two distinct P-PKC-δ and phospho-PKC-ζ (P-PKC-ζ) bright sub-populations. The same investigation performed in freshly purified peripheral T lymphocytes, did not highlight any subpopulation, suggesting that the detection of P-PKC-δ and P-PKC-ζ bright subpopulations is specifically linked to Aβ1–42 activated T lymphocytes. The data presented here, therefore, suggest possible novel hallmarks to discriminate between healthy elderly subjects and beginning or full-blown Alzheimer's Disease patients.
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Affiliation(s)
- F. Ciccocioppo
- Cell Signalling Unit, Department of Biomorphology, “G d'Annunzio” University of Chieti-Pescara, Chieti
- Center for Ageing Sciences (Ce.S.I.), “Università G. d'Annunzio” Foundation, Chieti
| | - P. Lanuti
- Cell Signalling Unit, Department of Biomorphology, “G d'Annunzio” University of Chieti-Pescara, Chieti
- Center for Ageing Sciences (Ce.S.I.), “Università G. d'Annunzio” Foundation, Chieti
| | - M. Marchisio
- Cell Signalling Unit, Department of Biomorphology, “G d'Annunzio” University of Chieti-Pescara, Chieti
- Center for Ageing Sciences (Ce.S.I.), “Università G. d'Annunzio” Foundation, Chieti
| | - F. Gambi
- Department of Oncology and Neuroscience, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - E. Santavenere
- Cell Signalling Unit, Department of Biomorphology, “G d'Annunzio” University of Chieti-Pescara, Chieti
| | - L. Pierdomenico
- Cell Signalling Unit, Department of Biomorphology, “G d'Annunzio” University of Chieti-Pescara, Chieti
- Center for Ageing Sciences (Ce.S.I.), “Università G. d'Annunzio” Foundation, Chieti
| | - A. Bascelli
- Cell Signalling Unit, Department of Biomorphology, “G d'Annunzio” University of Chieti-Pescara, Chieti
- Center for Ageing Sciences (Ce.S.I.), “Università G. d'Annunzio” Foundation, Chieti
| | - L. Velluto
- Center for Ageing Sciences (Ce.S.I.), “Università G. d'Annunzio” Foundation, Chieti
- Department of Oncology and Neuroscience, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - D. Gambi
- Center for Ageing Sciences (Ce.S.I.), “Università G. d'Annunzio” Foundation, Chieti
- Department of Oncology and Neuroscience, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - S. Miscia
- Cell Signalling Unit, Department of Biomorphology, “G d'Annunzio” University of Chieti-Pescara, Chieti
- Center for Ageing Sciences (Ce.S.I.), “Università G. d'Annunzio” Foundation, Chieti
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Marini F, Bellugi I, Gambi D, Pacenti M, Dugheri S, Focardi L, Tulli G. Compound A, formaldehyde and methanol concentrations during low-flow sevoflurane anaesthesia: comparison of three carbon dioxide absorbers. Acta Anaesthesiol Scand 2007; 51:625-32. [PMID: 17430327 DOI: 10.1111/j.1399-6576.2007.01278.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine compound A, formaldehyde and methanol concentrations in low-flow anaesthesia using different carbon dioxide absorbers. METHODS Fifteen patients scheduled for general or urological surgery were exposed to low-flow (500 ml/min) anaesthesia with sevoflurane. The patients were randomly allocated to three groups: soda lime, DrägerSorb Free or Amsorb Plus. The concentrations of compound A, formaldehyde and methanol were sampled and analysed from the limbs of the anaesthesia circuit at T30 (30 min after the start of low-flow sevoflurane anaesthesia), T90 (90 min) and T150 (150 min). The temperatures of the absorbers were measured at the same time. RESULTS Statistically significant differences (P < 0.05) were found in the production of compound A from soda lime (with the highest values), DrägerSorb Free and Amsorb Plus at each measurement time. Only traces of methanol (ranging from < 0.131 to 3.799 mg/m(3)) were measured, higher with Amsorb Plus (statistically significant differences were found only at T90). The formaldehyde values (ranging from < 0.1227 to 17.79 mcg/m(3) p.p.b.) were higher with soda lime, and the difference was statistically significant at T150 and, in the inspiratory limb only, at T90. The temperatures of the absorbers were higher for soda lime and lower for Amsorb Plus; the difference was statistically significant at T0 in the upper canister and at T30 in both canisters. CONCLUSION The concentrations of harmful products in the circuit were negligible and were lower using the new-generation absorbers. Using Amsorb Plus, the temperatures in the canisters were lower than with the other two absorbers.
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Affiliation(s)
- F Marini
- Department of Anaesthesia and Intensive Care, Nuovo Ospedale San Giovanni di Dio, Via Mannelli no. 87, 50136 Florence, Italy.
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Muraro PA, Liberati L, Bonanni L, Pantalone A, Caporale CM, Iarlori C, De Luca G, Farina D, Lugaresi A, Gambi D. Decreased integrin gene expression in patients with MS responding to interferon-beta treatment. J Neuroimmunol 2004; 150:123-31. [PMID: 15081256 DOI: 10.1016/j.jneuroim.2004.01.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 01/05/2004] [Accepted: 01/05/2004] [Indexed: 11/21/2022]
Abstract
Interferon-beta (IFN-beta) ameliorates disease course in a subset of patients with MS. The reasons for heterogeneity of clinical responses, however, are unclear. We assessed possible effects of IFN-beta on the gene expression of the leukocyte adhesion molecules VLA-4 and LFA-1 during the first year of treatment of 50 patients with relapsing-remitting MS who showed differential clinical responses. We observed a significant reduction of VLA-4 (P=0.002) and LFA-1 (P=0.03) mRNA expression compared to baseline in first-year clinical responders (n=22). In contrast, first-year IFN-beta non-responders (n=28) had unchanged levels of VLA-4 and LFA-1. In vitro treatment of PBMC with IFN-beta indicated a direct effect on transcription of the integrins' genes. Transcriptional downmodulation of adhesion molecules during IFN-beta treatment may contribute to its mode of action in MS.
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Affiliation(s)
- P A Muraro
- Neuroimmunology Unit, Department of Oncology and Neuroscience, Medical School, University G. D'Annunzio, Via dei Vestini, Chieti 66013, Italy.
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Mariotti C, Gellera C, Rimoldi M, Mineri R, Uziel G, Zorzi G, Pareyson D, Piccolo G, Gambi D, Piacentini S, Squitieri F, Capra R, Castellotti B, Di Donato S. Ataxia with isolated vitamin E deficiency: neurological phenotype, clinical follow-up and novel mutations in TTPAgene in Italian families. Neurol Sci 2004; 25:130-7. [PMID: 15300460 DOI: 10.1007/s10072-004-0246-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 05/10/2004] [Indexed: 12/12/2022]
Abstract
Ataxia with vitamin E deficiency (AVED) is a rare autosomal recessive neurodegenerative disorder due to mutations in the alpha-tocopherol transfer protein (TTPA) gene on chromosome 8q13. AVED patients have progressive spinocerebellar symptoms and markedly reduced plasma levels of vitamin E. We studied neurological phenotype at diagnosis, and long-term effect of vitamin E supplementation in 16 patients from 12 Italian families. The most common mutations were the 744delA and 513insTT. Two novel TTPA mutations were identified: a severe truncating mutation (219insAT) in a homozygous patient, and a Gly246Arg missense mutation (G246R) in a compound heterozygous patient. The missense mutation was associated with a mild and slowly progressive form of the disease. Vitamin E supplementation therapy allowed a stabilization of the neurological conditions in most of the patients. However, development of spasticity and retinitis pigmentosa was noted in a few patients during therapy. Prompt genetic characterization of AVED patients may allow an effective early treatment and an adequate genetic counseling.
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Affiliation(s)
- C Mariotti
- Division of Biochemistry and Genetics, C. Besta National Neurological Institute, Via Celoria 11, I-20133 Milan, Italy.
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12
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Di Muzio A, De Angelis MV, Di Fulvio P, Ratti A, Pizzuti A, Stuppia L, Gambi D, Uncini A. Dysmyelinating sensory-motor neuropathy in merosin-deficient congenital muscular dystrophy. Muscle Nerve 2003; 27:500-6. [PMID: 12661054 DOI: 10.1002/mus.10326] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 20-year-old man with mild myopathy, external ophthalmoparesis, epilepsy, and diffuse white matter hyperintensity in the brain on magnetic resonance imaging had partial merosin deficiency in muscle and absent merosin in the endoneurium. Motor and sensory nerve conduction velocities were slow. Nerve biopsy showed reduction of large myelinated fibers, short internodes, enlarged nodes, excessive variability of myelin thickness, tomacula, and uncompacted myelin, but no evidence of segmental demyelination, naked axons, or onion bulbs. Thus, in congenital muscular dystrophy, merosin expression may be dissociated in different tissues, and the neuropathy is sensory-motor and due to abnormal myelinogenesis.
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Affiliation(s)
- A Di Muzio
- Center for Neuromuscular Diseases, University G. d'Annunzio, Chieti, Italy
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13
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Muraro PA, Bonanni L, Mazzanti B, Pantalone A, Traggiai E, Massacesi L, Vergelli M, Gambi D. Short-term dynamics of circulating T cell receptor V beta repertoire in relapsing-remitting MS. J Neuroimmunol 2002; 127:149-59. [PMID: 12044987 DOI: 10.1016/s0165-5728(02)00105-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To understand the short-term dynamics of the circulating T cell receptor V beta (TCRBV) repertoire in relapsing-remitting multiple sclerosis (MS), we monitored the TCRBV profiles of untreated MS patients and healthy controls. Expansions of TCRBV genes in MS patients were significantly more frequent than in controls (P<0.001), were predominantly oligoclonal (80%) and were significantly correlated with immune responses to myelin basic protein (MBP) (P<0.02) and with inflammatory disease activity detected by magnetic resonance imaging (MRI) (P<0.05). Autoreactive T cell responses against myelin antigens may be implicated in perturbations of TCR repertoire in untreated MS patients, detectable even in the absence of clinically evident manifestations.
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MESH Headings
- Adult
- Female
- Gene Expression/immunology
- Humans
- Immunoglobulin Variable Region/genetics
- Immunoglobulin Variable Region/immunology
- Immunoglobulins
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Multiple Sclerosis, Relapsing-Remitting/immunology
- Multiple Sclerosis, Relapsing-Remitting/pathology
- Myelin Basic Protein/immunology
- Oligoclonal Bands
- Polymorphism, Single-Stranded Conformational
- RNA, Messenger/analysis
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- T-Lymphocytes/immunology
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Affiliation(s)
- P A Muraro
- Neurological Clinic, Department of Oncology and Neuroscience, Nuovo Ospedale Clinicizzato, G.D. Annunzio University, Via dei Vestini, 66013 Chieti, Italy.
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14
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De Angelis MV, Gatta V, Stuppia L, Passamonti L, Gambi D, Uncini A. Autosomal dominant distal spinal muscular atrophy: an Italian family not linked to 12q24 and 7p14. Neuromuscul Disord 2002; 12:26-30. [PMID: 11731281 DOI: 10.1016/s0960-8966(01)00241-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Distal spinal muscular atrophy is genetically heterogeneous, as sporadic cases and both autosomal dominant and recessive inheritance have been described. An autosomal dominant distal spinal muscular atrophy with upper limb predominance has been mapped to chromosome 7p, and more recently, an autosomal dominant distal spinal muscular atrophy with lower limb predominance has been linked to chromosome 12q24. We describe a four generation Italian family with autosomal dominant distal spinal muscular atrophy starting between 8 and 30 years with weakness and atrophy of distal leg muscles. The older patients also presented sensorineural deafness. We performed genetic linkage analysis with microsatellite markers D12S366, D12S349, D12S86, D12S321, D12S1612, D12S1349, D12S342, PLA2A on chromosome 12q24 and D7S516, D7S2496, D7S632, D7S2252 on chromosome 7p14. No support for linkage to chromosome 12q24 and 7p14 was found in our family, confirming a genetic heterogeneity within autosomal dominant distal spinal muscular atrophy.
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Affiliation(s)
- M V De Angelis
- Center for Neuromuscular Diseases, University G d'Annunzio, Via Dei Vestini, 66013 Chieti, Italy
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15
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De Angelis MV, Di Muzio A, Lupo S, Gambi D, Uncini A, Lugaresi A. Anti-GD1a antibodies from an acute motor axonal neuropathy patient selectively bind to motor nerve fiber nodes of Ranvier. J Neuroimmunol 2001; 121:79-82. [PMID: 11730943 DOI: 10.1016/s0165-5728(01)00434-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute motor axonal neuropathy (AMAN) is associated with high titer anti-GD1a antibodies. We have found that very high titer IgG anti-GD1a antibodies (Ab) from one AMAN patient selectively bind to motor, but not sensory, nerve nodes of Ranvier. Binding is abolished by preadsorption with GD1a. Sera negative for Ab do not immunostain motor and sensory nerve roots. We have also found that botulinum toxin A (BTA), which binds to GD1a, stains both motor and sensory nerve nodes of Ranvier. Our results strongly support the pathogenetic role of anti-GD1a antibodies in AMAN. Why BTA also binds to sensory fibers still remains to be elucidated, although the different size of BTA and its specificity to other gangliosides present in sensory axons might represent important factors.
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Affiliation(s)
- M V De Angelis
- Center for Neuromuscular Diseases, University "Gabriele d'Annunzio", Via dei Vestini, I-66013, Chieti, Italy
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16
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Lugaresi A, Caporale C, Farina D, Marzoli F, Bonanni L, Muraro PA, De Luca G, Iarlori C, Gambi D. Low-dose oral methotrexate treatment in chronic progressive multiple sclerosis. Neurol Sci 2001; 22:209-10. [PMID: 11603629 DOI: 10.1007/s100720170026] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We aimed to further assess the safety and efficacy of low-dose oral methotrexate (LDOM) treatment for chronic progressive MS (CPMS). We studied 20 CPMS patients, including 16 with secondary progressive MS who had shown disease progression in the previous year. The mean follow-up was 23 months. The mean EDSS score was 6.3+/-1.1 before treatment and 6.4+/-1.1 after one year of treatment. At one year, 15 of 20 patients were still being treated, and 10 were stable. Twelve patients have completed 18 months of treatment, and eight are stable. Two patients stopped treatment because of side effects, two more because they did not perceive benefit, and one was lost to follow-up. Six patients had mild, transient increases in liver enzymes not requiring treatment interruption, and two had localized herpes zoster. Magnetic resonance imaging (MRI) performed before treatment and at one year remained unchanged in responders. We confirm that LDOM is safe in carefully selected and monitored CPMS patients. MTX is inexpensive and, given its anti-inflammatory and immunomodulatory properties, may be used as add-on therapy in non-responders to interferon beta, although hepatic toxicity may be a problem in long-term treatment.
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Affiliation(s)
- A Lugaresi
- Department of Oncology and Neuroscience, Gabriele d'Annunzio University, Chieti, Italy
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17
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De Luca G, Capasso M, Iarlori C, Paganelli R, Gambi D, Uncini A, Lugaresi A. Oncostatin M (oncM) Spontaneous Production By Peripheral Blood Mononuclear Cells (PBMC) Is Increased In Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). J Peripher Nerv Syst 2001. [DOI: 10.1046/j.1529-8027.2001.01007-18.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- G De Luca
- Neuroimmunology Unit, Dept. of Oncology and Neuroscience and Dept. of Medicine and Aging, University of Chieti, Italy
| | - M Capasso
- Neuroimmunology Unit, Dept. of Oncology and Neuroscience and Dept. of Medicine and Aging, University of Chieti, Italy
| | - C Iarlori
- Neuroimmunology Unit, Dept. of Oncology and Neuroscience and Dept. of Medicine and Aging, University of Chieti, Italy
| | - R Paganelli
- Neuroimmunology Unit, Dept. of Oncology and Neuroscience and Dept. of Medicine and Aging, University of Chieti, Italy
| | - D Gambi
- Neuroimmunology Unit, Dept. of Oncology and Neuroscience and Dept. of Medicine and Aging, University of Chieti, Italy
| | - A Uncini
- Neuroimmunology Unit, Dept. of Oncology and Neuroscience and Dept. of Medicine and Aging, University of Chieti, Italy
| | - A. Lugaresi
- Neuroimmunology Unit, Dept. of Oncology and Neuroscience and Dept. of Medicine and Aging, University of Chieti, Italy
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18
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Iarlori C, Reale M, Lugaresi A, De Luca G, Bonanni L, Di Iorio A, Feliciani C, Conti P, Gambi D. RANTES production and expression is reduced in relapsing-remitting multiple sclerosis patients treated with interferon-beta-1b. J Neuroimmunol 2000; 107:100-7. [PMID: 10808056 DOI: 10.1016/s0165-5728(00)00261-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RANTES (regulated upon activation, normal T-cell expressed and secreted), a CC chemokine, appears to play a role in the pathogenesis of relapsing-remitting multiple sclerosis (RR-MS), enhancing the inflammatory response within the nervous system. We have demonstrated that RANTES production is increased in RR-MS compared to controls. Interferon-beta-1b (IFN-beta-1b) treatment reduces RANTES production in sera and peripheral blood adherent mononuclear cell (PBAM) supernatants both in relapse and remission. IFN-beta-1b also reduces RANTES expression in PBAM. Our results suggest that RANTES modulation might represent one of the mechanisms of action of IFN-beta-1b in RR-MS.
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Affiliation(s)
- C Iarlori
- Department of Oncology and Neuroscience, Neuroimmunology Unit, University 'Gabriele d'Annunzio', Via dei Vestini, 66013, Chieti, Italy
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19
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D'Alfonso S, Nisticò L, Bocchio D, Bomprezzi R, Marrosu MG, Murru MR, Lai M, Massacesi L, Ballerini C, Repice A, Salvetti M, Montesperelli C, Ristori G, Trojano M, Liguori M, Gambi D, Quattrone A, Tosi R, Momigliano-Richiardi P. An attempt of identifying MS-associated loci as a follow-up of a genomic linkage study in the Italian population. J Neurovirol 2000; 6 Suppl 2:S18-22. [PMID: 10871779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Subsequent to a genomic linkage study on Sardinian and Continental Italian families, we considered the possibility that some of the tested microsatellite markers showed association to MS. Markers selected on the basis of the data obtained in the original set of 70 multiplex families were tested for MS association in an additional set of 154 simplex families. A limited set of markers were further tested on an additional set of 100 simplex families. The results indicate the presence of a putative MS gene in 19q13.13.
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Affiliation(s)
- S D'Alfonso
- Chair of Human Genetics, Department of Medical Sciences, University of Eastern Piedmont 'A. Avogadro', Novara, Italy
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20
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De Angelis M, Stuppia L, Passamonti L, Palka G, Gambi D, Uncini A. JUVENILE, AUTOSOMAL DOMINANT, DISTAL SPINAL MUSCULAR ATROPHY AND NEUROSENSORIAL DEAFNESS NOT LINKED TO CHROMOSOME 12q24. J Peripher Nerv Syst 2000. [DOI: 10.1046/j.1529-8027.2000.00513-16.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - L. Stuppia
- Center for Neuromuscular Diseases and
- Institute of Genetics, University “G d'Annunzio” Chieti
| | | | - G. Palka
- Institute of Genetics, University “G d'Annunzio” Chieti
| | - D. Gambi
- Center for Neuromuscular Diseases and
| | - A. Uncini
- Center for Neuromuscular Diseases and
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21
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Muraro PA, Martin R, Lassmann H, Gambi D. Plaques, T cells and beyond: report on an international meeting on the immunological basis of multiple sclerosis held at the University of Chieti, Italy. J Neuroimmunol 1999; 96:251-4. [PMID: 10337925 DOI: 10.1016/s0165-5728(99)00028-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P A Muraro
- Neurology Clinic, Department of Oncology and Neuroscience, Medical School, University G. D'Annunzio, Chieti, Italy
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22
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D'Alfonso S, Nisticò L, Zavattari P, Marrosu MG, Murru R, Lai M, Massacesi L, Ballerini C, Gestri D, Salvetti M, Ristori G, Bomprezzi R, Trojano M, Liguori M, Gambi D, Quattrone A, Fruci D, Cucca F, Richiardi PM, Tosi R. Linkage analysis of multiple sclerosis with candidate region markers in Sardinian and Continental Italian families. Eur J Hum Genet 1999; 7:377-85. [PMID: 10234515 DOI: 10.1038/sj.ejhg.5200301] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Previous genome screens in multiple sclerosis have shown some evidence of linkage in scattered chromosomal regions. Although in no case the evidence of each single study was compelling and although in general the linkage 'peaks' of the different studies did not coincide, some regions can be considered likely candidates for the presence of MS risk genes because of the clustering of MLS scores and homology with eae loci. We performed a linkage analysis of markers in these regions and of intragenic markers of some individual candidate genes (HLA-DRB1, CTLA-4, IL9, APOE, BCL2, TNFR2). For the first time, Southern European populations were targeted, namely Continental Italians and Sardinians. A total of 69 multiplex families were typed for 67 markers by a semi-automatic fluorescence-based assay. Results were analysed for linkage by two non-parametric tests: GENEHUNTER and SimIBD. In general, the linkage scores obtained were low, confirming the conclusion that no gene is playing a major role in the disease. However, some markers, in 2p11, 3q21.1, 7p15.2 and 22q13.1 stood out as promising since they showed higher scores with one or the other test. This stimulates further association analysis of a large number of simplex families from the same populations.
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Affiliation(s)
- S D'Alfonso
- Chair of Human Genetics, University of Piemonte Orientale A. Avogadro, Novara, Italy
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23
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Uncini A, De Angelis MV, Di Muzio A, Callegarini C, Ciucci G, Antonini G, Lugaresi A, Gambi D. Chronic inflammatory demyelinating polyneuropathy in diabetics: motor conductions are important in the differential diagnosis with diabetic polyneuropathy. Clin Neurophysiol 1999; 110:705-11. [PMID: 10378742 DOI: 10.1016/s1388-2457(98)00028-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE It is important to recognize CIDP occurring in diabetics because, unlike diabetic polyneuropathy, it is treatable. The aim of this study was to find out whether there are clues which help to differentiate CIDP in diabetics from diabetic polyneuropathy. METHODS We compared the electrophysiological and pathological findings of 7 diabetics, who developed a predominantly motor polyneuropathy with the features of CIDP, with a group of diabetics referred for symptomatic polyneuropathy. RESULTS Of the 7 diabetics we believe developed CIDP, 6 met at least 3 and one patient two of the 4 electrophysiological criteria of demyelination. Of the 100 patients referred for diabetic polyneuropathy, only 4 fulfilled two criteria and none 3. Nerve biopsy findings were not helpful in differential diagnosis, as segmental demyelination and remyelination, onion bulbs and inflammatory infiltrates, which are the histologic features of CIDP, were also present in diabetic polyneuropathy. CONCLUSIONS CIDP can be diagnosed in a diabetic patient when motor symptoms are predominant, are more severe than expected in diabetic polyneuropathy and 3 of the 4 electrophysiological criteria for demyelination are fulfilled. When only two criteria are met, we believe that a trial with one of the established treatments for CIDP may be helpful in confirming the diagnosis.
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Affiliation(s)
- A Uncini
- Center for Neuromuscular Diseases, University G d'Annunzio, Chieti, Italy.
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24
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De Luca G, Lugaresi A, Iarlori C, Marzoli F, Di Iorio A, Gambi D, Uncini A. Prednisone and plasma exchange improve suppressor cell function in chronic inflammatory demyelinating polyneuropathy. J Neuroimmunol 1999; 95:190-4. [PMID: 10229130 DOI: 10.1016/s0165-5728(98)00266-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We have recently demonstrated that ConA-induced suppressor cell function is defective in chronic inflammatory demyelinating polyneuropathy (CIDP). To assess whether this defect plays a role in disease activity and its reversal is important in recovery, we studied modifications of ConA-induced suppressor cell function induced by prednisone and plasma exchange in 20 patients with CIDP. We found a significant increase towards normal of ConA-induced suppressor cell function after treatment in concurrence with clinical improvement. Induction of suppression, presumably through favorable modifications of the cytokine network or other humoral mediators, might be one, among others, of the mechanisms through which prednisone and plasma exchange are effective in CIDP.
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Affiliation(s)
- G De Luca
- Center for Neuromuscular Diseases, Department of Oncology and Neuroscience, University of Chieti, Policlinico Clinicizzato Colle Dell'Ara, Italy
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25
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Abstract
To assess whether TNF-alpha causes inflammatory demyelination or axonal degeneration, we injected into rat sciatic nerve saline, 100 U and 1000 U of rhTNF-alpha and studied the electrophysiological and pathological effects. At day 1 electrophysiology showed a slight reduction of proximal compound muscle action potential amplitude and pathology showed edema, inflammatory infiltration of vessel walls and endoneurium only in nerves injected with 1000 U of rhTNF-alpha. At day 5, there was no demyelination and a percentage of degenerated fibers similar in the three groups. To study the blood-nerve barrier, fluorescein isothiocyanate-labelled albumin was given intravenously after intraneural injection. The nerves injected with 1000 U rhTNF-alpha showed a leakage of the tracer in the endoneurium. TNF-alpha does not appear, at the doses used, to have myelinotoxic or axonopathic properties. The electrophysiological effect at day 1 may be due to mechanical compression of nerve fibers as a result of the blood-nerve barrier damage with consequent endoneurial edema.
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Affiliation(s)
- A Uncini
- Center for Neuromuscular Diseases, University of Chieti, Italy.
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26
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Porrini AM, De Luca G, Gambi D, Reder AT. Effects of an anti-IL-10 monoclonal antibody on rIFNbeta-1b-mediated immune modulation. Relevance to multiple sclerosis. J Neuroimmunol 1998; 81:109-15. [PMID: 9521612 DOI: 10.1016/s0165-5728(97)00165-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The mechanism of action of recombinant IFNbeta1b (IFNbeta-1b), as a therapy for multiple sclerosis (MS), is still unknown but may result from the enhancement of ConA-induced suppressor cell function and the inhibition of IFNgamma secretion by lymphocytes. We previously demonstrated that IFNbeta-1b stimulated modest amounts of IL-10 secretion by monocytes and IL-10 activity, as cytokine synthesis inhibitory factor, was normal in MS. To determine whether IL-10 plays a role in IFNbeta-1b modulation of immune function in MS, we studied ConA-induced suppressor cell function and IFNgamma production in presence of IFNbeta-1b and an anti-IL-10 monoclonal antibody (mAb). Anti-IL-10 mAb significantly reduced the effect of IFNbeta-1b on ConA-induced suppressor cell function and IFNgamma production in healthy subjects; MS patients showed a trend of inhibition. We hypothesized that IL-10 may play a role in mediating the effects of IFNbeta-1b on suppressor cell function and IFNgamma production but suppressor molecules other than IL-10 could be also involved.
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Affiliation(s)
- A M Porrini
- Institute of Clinical Neurology and Behavioral Sciences, University of Chieti, Italy
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27
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Millefiorini E, Gasperini C, Pozzilli C, D'Andrea F, Bastianello S, Trojano M, Morino S, Morra VB, Bozzao A, Calo' A, Bernini ML, Gambi D, Prencipe M. Randomized placebo-controlled trial of mitoxantrone in relapsing-remitting multiple sclerosis: 24-month clinical and MRI outcome. J Neurol 1997; 244:153-9. [PMID: 9050955 DOI: 10.1007/s004150050066] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We designed a randomized, placebo-controlled, multicentre trial involving 51 relapsing-remitting multiple sclerosis patients to determine the clinical efficacy of mitoxantrone treatment over 2 years. Patients were allocated either to the mitoxantrone group (27 patients receiving I.V. infusion of mitoxantrone every month for 1 year at the dosage of 8 mg/m2) or to the placebo group (24 patients, receiving I.V. infusion of saline every month for 1 year) using a centralized randomization system. Disability at entry and at 12-24 months was evaluated by four blinded neurologists trained in the application of the Kurtzke Expanded Disability Scale (EDSS). In addition, the number and clinical characteristics of the exacerbations over the 24 months were recorded by the local investigators. MRI, at 0, 12 and 24 months, was performed with a 0.2 T permanent unit. MRI data were analysed by two blinded neuroradiologists. All patients underwent a clinical evaluation. A statistically significant difference in the mean number of exacerbations was observed between the mitoxantrone group and placebo group both during the 1st and the 2nd year. Although there was no statistically significant benefit in terms of mean EDSS progression over 2 years, the proportion of patients with confirmed progression of the disease, as measured by a one point increase on the EDSS scale, was significantly reduced at the 2nd year evaluation in the mitoxantrone group. Forty-two (23 mitoxantrone, 19 placebo) patients underwent all MRI examinations during the 24-month period. We observed a trend towards a reduction in the number of new lesions on T2-weighted images in the mitoxantrone group. Our study suggests that mitoxantrone might be effective in reducing disease activity, both by decreasing the mean number of exacerbations and by slowing the clinical progression sustained by most patients after 1 year from the end of treatment.
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Affiliation(s)
- E Millefiorini
- Department of Neurological Science, Universita' La Sapienza, Rome, Italy
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28
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Onofrj M, Fulgente T, Thomas A, Gambi D, Melchionda D, Lopez L. Delayed and pseudodelayed visual evoked potentials in optic neuritis compared with long time echo-short tau inversion recovery magnetic resonance imaging of optic nerve. ACTA ACUST UNITED AC 1996; 100:275-86. [PMID: 17441298 DOI: 10.1016/0168-5597(96)95675-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Twenty patients affected by optic neuritis (ON) underwent serial visual evoked potential (VEP) recordings, performed with multiple electrode arrays, and with stimuli of 1 and 3 cycles per degree (cpd) for 1 year. VEP findings were correlated with long time echo-short tau inversion recovery (LTE-STIR) magnetic resonance imaging (MRI) of optic nerves and with visual field tests. MRI showed lesions in 95.2% of acute ON and in 66.6% of the 1 year follow-up. VEPs were classified into really 'delayed' VEPs and 'pseudodelayed' VEPs, based on their scalp distribution. Furthermore, VEPs to 1 or 3 cpd could be 'delayed' or 'pseudodelayed' in the same patient. Real delays could be recorded at onset or shortly after ON, and indicated the possibility of recovery of visual functions and good functional prognosis. Pseudodelays, to 3 cpd, corresponded to prominent central scotomata and indicated poor prognosis for the recovery of visual function, unless a breakthrough of normal or delayed components appeared in the first 4 months following acute ON. Pseudodelayed VEPs clustered in patients with longer demyelinating lesions, as shown by LTE-STIR MRI. There was no correlation between latency of VEPs and length of plaques. Our study addresses some reconsiderations of the pathophysiology of conduction delay in acute optic neuritis.
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Affiliation(s)
- M Onofrj
- Department of Neurology, State University of Chieti, Chieti, Italy.
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Tartaro A, Onofrj M, Delli Pizzi C, Bonomo L, Thomas A, Fulgente T, Gambi D. Long time echo STIR sequence magnetic resonance imaging of optic nerves in optic neuritis. Ital J Neurol Sci 1996; 17:35-42. [PMID: 8742986 DOI: 10.1007/bf01995707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Magnetic resonance images of optic nerves were obtained in 20 patients with acute optic neuritis (ON), and assessed by means of clinical, visual field and visual evoked potential evaluations; the imaging was repeated 1 year later. The results of the conventional Short Tau Inversion Recovery (STIR) sequence obtained using short time echo (STE-STIR: 22 msec) were compared with those of the long time echo sequence (LTE-STIR: 80 msec). The conventional STE-STIR sequence revealed lesions in 57.2% cases of acute ON and in 42.9% of the optic nerves affected by previous ON; the LTE-STIR sequence was diagnostic in 95.2% of acute ON cases and in 85% of patients with previous ON. The calculated length of the optic nerve lesions was significantly longer in the images obtained using the LTE-STIR sequence than in those obtained using conventional STE-STIR sequences.
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Affiliation(s)
- A Tartaro
- Istituto di Radiologia, Università degli Studi G. D'Annunzio, Chieti
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Gambi D, Fulgente T, Melchionda D, Onofrj M. Evoked potential (EP) alterations in experimental allergic encephalomyelitis (EAE): early delays and latency reductions without plaques. Ital J Neurol Sci 1996; 17:23-33. [PMID: 8742985 DOI: 10.1007/bf01995706] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Experimental allergic encephalomyelitis (EAE) in its chronic relapsing (CR-EAE), chronic progressive (CP-EAE) and acute (A-EAE) forms was obtained in 24 juvenile strain 13 guinea pigs. Visual, brainstem acoustic and somatosensory evoked potentials (EPs) were recorded in these animals prior to the sensitizing injection and during the course of the disease. Delays in the EPs appeared 15 days post-sensitization (dps), preceding or simultaneously with clinical alterations: electron microscopy revealed myelin stripping and vacuolation in the animals sacrificed 25 dps. Decreases in EP latency were recorded 32 dps; when electron microscopy revealed myelin layers indicating remyelination, whereas light microscopy showed only inflammatory changes. When confluent plaques were revealed by light microscopy 120 dps, the EP wave shapes were distorted or absent. The discussion reviews the literature on early myelin and conduction changes during central demyelination.
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Affiliation(s)
- D Gambi
- Istituto di Clinica Neurologica e Scienze del Comportamento, Università degli Studi G. D'Annunzio, Chieti, Italy
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Fulgente T, Thomas A, Lobefalo L, Mastropasqua L, Gallenga PE, Gambi D, Onofrj M. Are VEP abnormalities in optic neuritis (ON) dependent on plaque size? A reappraisal of the physiopathology of ON based on improved MRI and multiple-lead recordings. Ital J Neurol Sci 1996; 17:43-54. [PMID: 8742987 DOI: 10.1007/bf01995708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Twenty patients with optic neuritis (ON) described in the previous study [23] underwent serial VEP recordings (using multiple electrode arrays) for two years. The VEPs could be correlated with the lesions revealed by MRI, Visual Field tests and other clinical findings. On the basis of their scalp distribution, they were classified as "really delayed" VEPs and "pseudo-delayed" VEPs. Real delays could be recorded at the onset of ON or shortly afterwards, and their appearance indicated the recovery of visual function and a good prognosis. Pseudo-delays indicated an alteration in the visual field and, unless a breakthrough of normal or delayed components appeared in the first three months, following acute ON, indicate a poor prognosis for the recovery of visual function. The pseudo-delayed VEPs were mainly observed in patients with longer lesions revealed by means of LTE-STIR MRI [23]; there was no correlation between VEP latency and the length of plaques. Our findings contradict previous theories on the timing of conduction alterations in ON and multiple sclerosis.
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Affiliation(s)
- T Fulgente
- Istituto di Clinica Neurologica e Scienze del Comportamento, Università degli Studi G. D'Annunzio, Chieti, Italy
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Onofrj M, Tartaro A, Thomas A, Gambi D, Fulgente T, Delli Pizzi C, Bonomo L. Long echo time STIR sequence MRI of optic nerves in optic neuritis. Neuroradiology 1996; 38:66-9. [PMID: 8773282 DOI: 10.1007/bf00593226] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
MRI of the optic nerves was obtained in 13 patients with acute optic neuritis and 13 with a previous optic neuritis (ON), assessed by clinical features, visual fields and visual evoked potentials. Results of the conventional short tau inversion recovery (STIR) sequence obtained with a short echo time (STE-STIR; 22 ms) were compared with those of a long echo time (LTE-STIR: 80 ms) sequence. The conventional STE-STIR sequence revealed lesions in the optic nerves in 78.5% of acute and 58.8% of previous ON. The LTE-STIR sequence showed abnormalities in 92.8% of acutely symptomatic nerves and 94.1% of nerves with previous ON. The optic nerve lesions appeared significantly longer with the LTE-STIR sequence than with the conventional STE-STIR sequences, in both acute and previous ON.
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Affiliation(s)
- M Onofrj
- Department of Neurology, State University of Chieti, Ospedale ex-Pediatrico, Italy
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Porrini AM, Gambi D, Reder AT. Interferon effects on interleukin-10 secretion. Mononuclear cell response to interleukin-10 is normal in multiple sclerosis patients. J Neuroimmunol 1995; 61:27-34. [PMID: 7560009 DOI: 10.1016/0165-5728(95)00070-i] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The mechanism of action of recombinant interferon beta 1b (rIFN beta 1b/IFN beta-1b), the approved therapy for multiple sclerosis (MS), is still unclear. Here we present evidence that part of the therapeutic effects of rIFN beta 1b in MS might result from the induction of the secretion of interleukin (IL)-10, a cytokine previously designated cytokine synthesis inhibitory factor (CSIF). We observed that rIFN beta 1b stimulated significant IL-10 secretion by monocytes from MS patients after brief incubation (18 h), whereas rIFN gamma, an inducer of MS exacerbations, was unable to stimulate IL-10 production in similar conditions. To determine the role of IL-10 as CSIF in the disease, we have also investigated its effects on TNF alpha and IL-6 secretion by peripheral blood mononuclear cells from MS patients. Recombinant human IL-10 significantly inhibited tumor necrosis factor alpha and IL-6 secretion induced by rIFN gamma, lipopolysaccharide (LPS), and rIFN gamma + LPS in MS patients and in control subjects. The induction of IL-10 secretion by rIFN beta 1b and the IL-10 inhibitory activity on pro-inflammatory cytokine secretion induced by rIFN gamma in MS make this cytokine a potential candidate to treat the disease.
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Affiliation(s)
- A M Porrini
- Institute of Clinical Neurology and Behavioral Sciences, University of Chieti, Italy
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Oggioni R, Gambi D, Iamello R, Mascii F, Morelli M, Tulli G. [Percutaneous dilatational tracheostomy. Critical considerations after one year's experience]. Minerva Anestesiol 1995; 61:307-12. [PMID: 8948742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors discuss a series of 57 patients submitted to percutaneous dilational tracheostomy (PDT) in an Intensive Care Unit during a fifteen months periods. Patients were admitted for cardiac and/or respiratory failure in 27 cases (47%), sepsis in 13 cases (23%), shock in 12 cases (21%), coma in 5 cases (9%). Length of orotracheal intubation before PDT was 8.3 days +/- 3.9 without significant differences between Apache II and Saps scores at this time (17.4 +/- 6.3 and 20.4 +/- 4.3 respectively) and on admission day (19.3 +/- 6.25 and 20.8 +/- 3.6). The main complications we had to deal with during PDT were damage to previously inserted orotracheal tube, a pneumomediastinum, a small oozing of blood in three cases a serious bleeding in a septic patient with coagulation disorder. After these we performed PDT always coupled with fibrotrachoscopy in the aim to ameliorate PDT safety. On subsequent days the more frequent complication come up at the time of changing tracheal cannula and consisted in troubles ascribed to tracheal shreds (four cases) and one major bleeding after the maneuver always overcome. We also report one death due to impossibility cannula repositioning and subsequent failed intubation in a previously decannulated patient who developed trachobronchial obstruction. Although a supposed midline approach between second and third tracheal rings, was supposed autopsy (performed in three patients) revealed a lateralized cut in one case and an approach higher in another patient. The main advantages in our practice were the absence fo PDT related infections and an optimal and fast tracheal closure after cannula removal. In spite of some limits, this technique has quickly and totally replaced in our practice surgical tracheostomy.
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Uncini A, Di Guglielmo G, Di Muzio A, Gambi D, Sabatelli M, Mignogna T, Tonali P, Marzella R, Finelli P, Archidiacono N. Differential electrophysiological features of neuropathies associated with 17p11.2 deletion and duplication. Muscle Nerve 1995; 18:628-35. [PMID: 7753126 DOI: 10.1002/mus.880180610] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
UNLABELLED Hereditary neuropathy with liability to pressure palsies (HNPP) and hereditary motor-sensory neuropathy type IA (HMSN IA) are quite distinct clinical entities recently associated to deletion and duplication, respectively, of the 17p11.2 segment including the gene for peripheral myelin protein 22 (PMP-22). We studied the electrophysiological features of 48 HNPP and 62 HMSN IA motor nerves. Conduction velocities (CV) and compound muscle action potential amplitudes were significantly reduced and distal latencies prolonged in HMSN IA compared to HNPP. CV was uniformly slowed in HMSN IA nerves whereas in HNPP it was focally slowed in 80% of ulnar and 12% of peroneal nerves at usual compression sites. Conduction block was present in 6% of HNPP nerves but in none of HMSN IA. IN CONCLUSION (1) HMSN IA with 17p11.2 duplication presents marked, diffuse, and uniform slowing; (2) HNPP with 17p11.2 deletion presents focal electrophysiological abnormalities possibly correlated with the presence of tomaculae; and (3) under- and overexpression of PMP-22 in concurrence with environmental factors might be responsible for the distinctive features of HNPP and HMSN IA.
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Affiliation(s)
- A Uncini
- Center for Neuromuscular Diseases, University of Chieti, Italy
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36
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Porrini A, Lugaresi A, Dell'Arciprete L, Gambi D. IL-10, IL-1β and TNFα levels in serum and cerebral spinal fluid (CSF) of patients with Guillain Barré syndrome (GBS). J Neuroimmunol 1994. [DOI: 10.1016/0165-5728(94)90488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Lugaresi A, Melchionda D, Uncini A, Gambi D. Anti-ganglioside antibodies: Establishment of reference values and evaluation of their prevalence and levels in neurological diseases. J Neuroimmunol 1994. [DOI: 10.1016/0165-5728(94)90419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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38
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Abstract
Dystonia is generally considered a disease of basal ganglia. We report two patients with definite MS who acutely developed hand dystonia and athetoid movements. In both patients: 1) dystonia was electrophysiologically demonstrated by lack of reciprocal inhibition between antagonistic forearm muscles; 2) SEP from median nerve stimulation showed delayed cervical N13 and absent frontal and parietal components; 3) the long latency response after stimulation of median nerve of the affected hand was absent or delayed; 4) MRI showed lesions in the posterolateral cervical spine but no involvement of basal ganglia and thalami. We think that, in these cases, dystonia and athetoid movements could be ascribed respectively to the involvement of descending pathways regulating reciprocal inhibition of motoneurons and to the involvement of large diameter afferents due to the demyelinating lesion at the cervical level.
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Affiliation(s)
- A Uncini
- Institute of Clinical Neurology and Behavioral Sciences, University of Chieti, Italy
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39
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Uncini A, Di Muzio A, Chiavaroli F, Gambi D, Sabatelli M, Archidiacono N, Antonacci R, Marzella R, Rocchi M. Hereditary motor and sensory neuropathy with calf hypertrophy is associated with 17p11.2 duplication. Ann Neurol 1994; 35:552-8. [PMID: 8179301 DOI: 10.1002/ana.410350508] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The demyelinating type of hereditary motor and sensory neuropathy (HMSN I) is characterized by progressive weakness and atrophy of leg muscles. Six patients (age, 25-79 yr) belonging to three generations had calf hypertrophy (6 of 6), foot drop or difficulty with heel walking (4 of 6), pes cavus (3 of 6), absent or depressed tendon jerks in the lower limbs (4 of 6), and mild distal sensory loss (3 of 6). No other family member had leg atrophy. Motor conduction velocities ranged from 20 to 40 m/sec. Sural nerve biopsy showed loss of large myelinated fibers, numerous onion bulbs, and segmental demyelination and remyelination. Computed tomographic scans of leg muscles and histological and morphometric findings in gastrocnemius revealed true muscular hypertrophy. Southern blot and fluorescence in situ hybridization documented the duplication of the entire 17p11.2 segment associated with classical HMSN IA. The pathogenesis of muscle hypertrophy in our cases is unclear. Chronic leg muscle weakness and long-standing partial denervation might cause calf enlargement by a combination of compensatory "work-induced" and "stretch-induced" fiber hypertrophy. Alternatively, that all the affected family members presented calf hypertrophy might suggest the action of a genetic factor associated with the duplication at 17p11.2.
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Affiliation(s)
- A Uncini
- Center for Neuromuscular Diseases, University of Chieti, Italy
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40
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Uncini A, Di Muzio A, Awad J, Manente G, Tafuro M, Gambi D. Sensitivity of three median-to-ulnar comparative tests in diagnosis of mild carpal tunnel syndrome. Muscle Nerve 1993; 16:1366-73. [PMID: 8232394 DOI: 10.1002/mus.880161215] [Citation(s) in RCA: 119] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We studied 193 hands of 113 patients referred for typical carpal tunnel syndrome (CTS). Ninety-five (49%) hands had normal median distal motor latency (< or = 4.2 ms) and normal or borderline sensory conduction velocity from digit 2 stimulation (> or = 45 m/s). In these cases we performed three median to ulnar comparative tests: (1) difference between median and ulnar distal motor latencies recorded from the second lumbrical and interossei muscles (2L-INT); (2) difference between median and ulnar sensory latencies from digit 4 stimulation (D4M-D4U); and (3) difference between median and ulnar mixed nerve latencies from palmar stimulation (PM-PU). The 2L-INT difference was > or = 0.6 ms in 10% of hands. PM-PU and D4M-D4U were > or = 0.5 ms in 56% and 77% of hands, respectively. The greater sensitivity of D4M-D4U might be explained by the funicular topography and consequent greater susceptibility to compression of the cutaneous fibers from the third interspace which, at the distal carpal tunnel, are clumped superficially in the anteroulnar portion of the median nerve just beneath the transverse ligament.
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Affiliation(s)
- A Uncini
- Laboratory of EMG, University of Chieti, Italy
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41
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Gambi D. Teaching organization in the degree course in medicine. Ital J Neurol Sci 1993; 14:553-5. [PMID: 8132426 DOI: 10.1007/bf02336395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- D Gambi
- Clinica Neurologica, Università di Chieti
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42
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Gambi D, Oggioni R, Mangani V, Librenti M, Manescalchi F, Tulli G. [Acute carbamazepine poisoning treated with plasmapheresis. Description of a clinical case]. Minerva Anestesiol 1993; 59:547-52. [PMID: 8302453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of severe Carbamazepine poisoning initially misdiagnosed is reported. Treatment consisted in plasmapheresis (3.5 liters exchanged) repeated for 3 consecutive days, in conjunction with activated charcoal and advanced life support. It was obtained a rapid decay in Carbamazepine plasmatic level (with rebound phenomenon only after first treatment day) and a contemporary improvement in clinical conditions. The patient was discharged without complications after 6 days stay in ICU. Taking pharmacokinetic characteristics into account, it is suggested that plasmapheresis may be useful in this kind of poisoning.
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Affiliation(s)
- D Gambi
- U.O. Anestesia e Rianimazione, USL 10/C, Nuovo Ospedale S. Giovanni di Dio, Firenze
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Abstract
We describe the MRI changes preceding the onset of myoclonus in two patients whose post-mortem examination confirmed the diagnosis of Creutzfeldt-Jakob disease (CJD). MRI showed changes in the striatum early in the course of CJD (2-6 months after the onset of apathy, interpreted as depression, and 1-2 months before the onset of further clinical symptoms). Only in one patient did electroencephalography record the typical triphasic sharp-waves, 1 month after MRI.
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Affiliation(s)
- M Onofrj
- Istituto di Neurologia, Università G. D'Annunzio, Chieti, Italy
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Uncini A, Di Muzio A, Sabatelli M, Magi S, Tonali P, Gambi D. Sensitivity and specificity of diagnostic criteria for conduction block in chronic inflammatory demyelinating polyneuropathy. Electroencephalogr Clin Neurophysiol 1993; 89:161-9. [PMID: 7686848 DOI: 10.1016/0168-5597(93)90129-d] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Detection of conduction block (CB) has important clinical implications because it suggests segmental demyelination potentially reversible following treatment. There are no universally accepted criteria to define CB. We tested the sensitivity of two diagnostic criteria of partial motor CB in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and hereditary motor-sensory neuropathy type I (HMSN I) which are thought to be the prototypes of segmental and uniform demyelination respectively. Criterion I requires > 20% drop in negative peak amplitude and area and < 15% change in duration between proximal and distal compound muscle action potentials (CMAPs). Criterion II requires > 50% drop in negative peak amplitude and area of proximal CMAP independently from temporal dispersion. Twenty-eight percent of CIDP nerves and 65% of CIDP patients had CB according to criterion I. However, 29% of nerves and 61% of patients with HMSN I also fulfilled the same criterion. Thirty-four percent of CIDP nerves and 78% of CIDP patients and none of HMSN I patients fulfilled criterion II. Criterion II has the same sensitivity as criterion I, but seems to be highly specific in diagnosis of the segmental demyelination characteristic of CIDP. Therefore this criterion should be employed, as the diagnostic tool of CB, in chronic neuropathies presenting high stimulation threshold and coexisting axonal loss.
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Affiliation(s)
- A Uncini
- Center for Neuromuscular Diseases, University of Chieti, Italy
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Viola S, Tenaglia MG, De Leonardis E, Aquilone L, Gambi D. Acute hemispheric stroke: correlation between three-dimensional transcranial Doppler, MR-angiography, CT and clinical findings. Ital J Neurol Sci 1993; 14:225-32. [PMID: 8314676 DOI: 10.1007/bf02335663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We examined 50 ischemic stroke patients and 67 controls free of vascular disease, intra- or extracranial. We assessed all subjects clinically by neurological examination (quantified on the Canadian Neurological Scale or CNS), by three-dimensional transcranial Doppler sonography (TCD-3D) and by computed tomography (CT) within 24 h of the acute event, repeating CT 15 days later. 15 patients also underwent magnetic resonance angiography (MRA) and digital subtraction angiography (DSA). We used the following Doppler parameters: interhemispheric asymmetry index (AI), mean flow velocity (mV) and pulsatility index (PI) for the middle cerebral artery (MCA). The difference between patients and controls on analysis of the variance (ANOVA) in respect of AI was significant: F = 50.8, p < 0.0001. The CNS-AI correlation was equally valid: r = -0.56, p < 0.001. The CNS-CT correlation proved to be highly significant: r = -0.72, p < 0.0001. TCD-3D allowed quantitative evaluation of the hemodynamic changes and of the collateral blood supply and proved to be a sound method for the investigation of ischemic stroke, correlating well with the clinical findings, MRA and lesion size on CT.
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Affiliation(s)
- S Viola
- Clinica Neurologica, Università G. D'Annunzio, Chieti
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46
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Abstract
We instilled naphazoline Hcl (0.1%), an imidazole derivative with preferential alpha-2 activity, in 17 eyes of 12 patients with myopathic ptosis due to involvement of the levator palpebrae superioris, in the attempt to selectively stimulate Müller's smooth muscle. Naphazoline significantly widened the palpebral fissure with little change in pupillary diameter and no significant change in ocular pressure, visual acuity and near point determination. However, a reduction of the effect, probably due to tachyphylaxis, was noticed when using naphazoline regularly several times a day for few weeks. In conclusion naphazoline has powerful cosmetical and functional effects in mild to moderate myopathic ptosis above all if taken occasionally.
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Affiliation(s)
- A Uncini
- Institute of Clinical Neurology and Behavioral Sciences, University of Chieti, Italy
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47
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48
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Abstract
We recorded the sympathetic skin response (SSR) from electrical nerve stimulation in 16 patients with cerebrovascular accident (CVA). Location and nature of the lesion were documented by computerized tomography (CT). Median (pre-rolandic and parietal) somatosensory evoked potentials (SEP) were also recorded. SSR was absent bilaterally in eight hemiplegics after stimulation of the plegic side and present bilaterally after stimulation of the normal side in the first weeks after CVA. Parietal and pre-rolandic SEPs were absent in the affected hemispheres. SSR was present bilaterally after stimulation of each side in the remaining CVA cases with reduced amplitude SEPs. Absence of the electrically evoked SSR in hemispheric lesions may be due to involvement of central afferent pathways or temporary suppression of suprasegmental excitatory influences.
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Affiliation(s)
- A Uncini
- Institute of Clinical Neurology and Behavioral Sciences, University of Chieti, Italy
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49
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Onofrj M, Fulgente T, Nobilio D, Malatesta G, Bazzano S, Colamartino P, Gambi D. P3 recordings in patients with bilateral temporal lobe lesions. Neurology 1992; 42:1762-7. [PMID: 1513467 DOI: 10.1212/wnl.42.9.1762] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We recorded event-related potentials to an acoustic "oddball" paradigm from 19 scalp derivations in five patients (three women and two men; age range, 44 to 56) who had global amnesia following encephalitis. CT and MRI showed severe bilateral lesions of anterior and midtemporal lobes. A P3 component, with a peak latency within the normal limits for age-matched controls, was recorded to "target" stimuli in four patients from all leads except Fp1, Fp2, F7, F8, T3, and T4. In the fifth patient, the P3 peak was delayed.
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Affiliation(s)
- M Onofrj
- Department of Neurology and Behavioral Sciences, State University of Chieti, Italy
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50
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Santagostino G, Messeri E, Pezzati S, Gambi D. [Peridural anesthesia with 0.5% bupivacaine-fentanyl. Evaluation of the pre-heating effect]. Minerva Anestesiol 1992; 58:433-6. [PMID: 1508355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effect of preheated (37 degrees C) mixture of 0.5% bupivacaine and fentanyl on peridural anaesthesia have been studied in a double blind randomized clinical trial. Fifty patients of both sexes, ASA I-II, undergoing elective surgery for inguinal hernia repair or radical saphenectomy have been randomly assigned either to the control group (n = 25) receiving 0.5% bupivacaine-fentanyl at room temperature (20 degrees C), or to the group receiving the same anaesthetic mixture preheated for 12 hours up to 37 degrees C (n = 25). The latency period, extension, duration and quality of anaesthetic block were evaluated. A significative difference in the extension of anaesthetic block was detected at 6' (p less than 0.05 for extension up to T10 and T11, p less than 0.025 up to T12), and at 8' (less than 0.05 for extension up to T10). However no difference was observed between the two groups at 10' and later. The use of 0.5% bupivacaine-fentanyl mixture resulted in a short latency period, as previously observed, and its preheating does not seem to affect substantially the parameters evaluated in this study.
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Affiliation(s)
- G Santagostino
- U.O. Anestesia e Rianimazione, USL n. 10/C, Nuovo Ospedale S. Giovanni di Dio, Firenze
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