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Supplemented Very Low Protein Diet (sVLPD) in Patients with Advanced Chronic Renal Failure: Clinical and Economic Benefits. Nutrients 2023; 15:3568. [PMID: 37630758 PMCID: PMC10457928 DOI: 10.3390/nu15163568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The supplemented very low-protein diet (sVLPD) has proven effective in slowing the progression of stage 5 chronic renal failure and postponing the start of the dialysis treatment. However, sVLPD could expose the patient to the risk of malnutrition. This diet is also difficult to implement due to the required intake of large number of keto-analogue/amino acid tablets. In our Center, the Department of Nephrology and Dialysis of Azienda Sanitaria Territoriale n 1, Pesaro-Urbino, of Italy, respecting the guidelines of normal clinical practice, we prescribed sVLPD (0.3 g/prot/day) supplemented with only essential amino acids without the use of ketoanalogues in stage 5 patients and verified its efficacy, safety and clinical and economic effects. Over the 24 months period of observation the progression of chronic kidney disease (CKD) slowed down (mean eGFR 11.6 ± 3.3 vs. 9.3 ± 2.7 mL/min/1.73 m2, p < 0.001) and the start of the dialysis treatment (adjusted HR = 0.361, CI 0.200-0.650, p = 0.001) was delayed without evidence of malnutrition, in compliant vs. non-compliant patients. This led to a substantial cost reduction for the National Health System. This non-interventional longitudinal observational study is part of standard clinical practice and suggests that VLPD supplemented with essential amino acids could be extensively used to reduce the incidence of dialysis treatments, with a favorable economic impact on the NHS.
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Affective temperaments and obesity: Is there an association with binge eating episodes and multiple weight cycling? J Affect Disord 2021; 295:967-973. [PMID: 34706470 DOI: 10.1016/j.jad.2021.08.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/23/2021] [Accepted: 08/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND affective temperaments have been so far understudied in the field of obesity. Therefore, we aimed to assess affective temperaments in outpatients with obesity reporting symptoms of binge eating (BE) and multiple weight cycling (MWC) and to investigate the likelihood of an association between affective temperaments and risk of both conditions. METHODS A total of 300 individuals with obesity seeking treatment at the Obesity Unit of an academic hospital were asked to complete self-report measures of affective temperaments, BE, depressive and anxiety symptoms, and quality of life. RESULTS Even in the absence of full-blown mental disorders, symptoms of anxiety and depression emerged in the sample; 197 individuals (65.6%) reported BE and 162 (54%) MWC. The most frequent affective temperament was the depressive one. Depression symptoms and cyclothymic scores (directly), and age and hyperthymic score (inversely) were significantly associated with BE risk, while being an active smoker (directly) and hyperthymic score (inversely) were significantly associated with MWC risk, after controlling for confounders in a multiple logistic regression. LIMITATIONS sample size was small, the study was limited to a single center, no formal definition of weight cycling exists and MWC was self-reported. CONCLUSIONS A substantial number of outpatients with obesity reported BE and MWC notwithstanding the absence of a formal psychiatric diagnosis. Cyclothymic scores were positively associated with BE while the hyperthymic temperament showed a protective effect on both BE and MWC. These findings suggest the need for multidisciplinary treatments for people with obesity enhancing research on temperament-based psychological interventions.
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Ten years of experience with DPP-4 inhibitors for the treatment of type 2 diabetes mellitus. Acta Diabetol 2019; 56:605-617. [PMID: 30603867 DOI: 10.1007/s00592-018-1271-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022]
Abstract
Achieving and maintaining recommended glycemic targets without causing adverse e ffects, including hypoglycemia, is challenging, especially in older patients with type 2 diabetes mellitus (T2DM). The introduction of dipeptidyl peptidase-4 (DPP-4) inhibitors, more than 10 years ago, has provided an alternative to conventional medications for the intensification of glucose-lowering treatment after failure of metformin monotherapy, and therefore, marked an important advance in the management of T2DM. By prolonging the activity of incretin hormones, DPP-4 inhibitors induce insulin release and decrease glucagon secretion in a glucose-dependent manner. This results in a more physiologic glycemic control as compared to that ensured by insulin secretagogues (sulfonylureas and glinides). Overall, DPP-4 inhibitors have a favorable safety profile and can be used without dose adjustments in older adults and in patients with mild renal impairment; they have a neutral effect on body weight and do not cause hypoglycemia by themselves. Safety issues, reported mainly in post-marketing surveillance programs and including cardiovascular outcomes and the risk of acute pancreatitis, are being extensively investigated. The aim of this review is to discuss the impact of DPP-4 inhibitors on the treatment of T2DM, after 10 years of experience, with an emphasis on diabetes care in Italy. We will first describe T2DM treatment in Italy and then provide an overview of the main findings from randomized controlled trials, real-world studies and post-marketing surveillance programs with DPP-4 inhibitors.
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Effects of Self-Conditioning Techniques (Self-Hypnosis) in Promoting Weight Loss in Patients with Severe Obesity: A Randomized Controlled Trial. Obesity (Silver Spring) 2018; 26:1422-1429. [PMID: 30226009 DOI: 10.1002/oby.22262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The usefulness of the rapid-induction techniques of hypnosis as an adjunctive weight-loss treatment has not been defined. This randomized controlled trial evaluated whether self-conditioning techniques (self-hypnosis) added to lifestyle interventions contributed to weight loss (primary outcome), changes in metabolic and inflammatory variables, and quality of life (QoL) improvement (secondary outcomes) in severe obesity. METHODS Individuals (with BMI = 35-50 kg/m2 ) without organic or psychiatric comorbidity were randomly assigned to the intervention (n = 60) or control arm (n = 60). All received exercise and behavioral recommendations and individualized diets. The intervention consisted of three hypnosis sessions, during which self-hypnosis was taught to increase self-control before eating. Diet, exercise, satiety, QoL, anthropometric measurements, and blood variables were collected and measured at enrollment and at 1 year (trial end). RESULTS A similar weight loss was observed in the intervention (-6.5 kg) and control (-5.6 kg) arms (β = -0.45; 95% CI: -3.78 to 2.88; P = 0.79). However, habitual hypnosis users lost more weight (-9.6 kg; β = -10.2; 95% CI: -14.2 to -6.18; P < 0.001) and greatly reduced their caloric intake (-682.5 kcal; β = -643.6; 95% CI: -1064.0 to -223.2; P = 0.005) in linear regression models. At trial end, the intervention arm showed lower C-reactive protein values (β = -2.55; 95% CI: -3.80 to -1.31; P < 0.001), higher satiety (β = 19.2; 95% CI: 7.71-30.6; P = 0.001), and better QoL (β = 0.09; 95% CI: 0.02-0.16; P = 0.01). CONCLUSIONS Self-hypnosis was not associated with differences in weight change but was associated with improved satiety, QoL, and inflammation. Indeed, habitual hypnosis users showed a greater weight loss.
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SP485SUPPLEMENTATION OF FOLIC ACID IN CHRONIC HEMODIALYSIS PATIENTS: THERAPEUTIC ADEQUACY AND DIALYTIC REMOVAL. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Effects of self-conditioning techniques in promoting weight loss in patients with severe obesity: a randomized controlled trial protocol. ACTA ACUST UNITED AC 2017. [DOI: 10.18203/2349-3259.ijct20170304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<p><strong>Background:</strong> Obesity is a worldwide epidemic; most obese individuals who lose weight after lifestyle educative treatments, soon regain it. Our aim is to evaluate the effectiveness of a training to teach self-conditioning technique (self-hypnosis) added to standard care in determining weight loss compared with standard care in patients with obesity</p><p><strong>Methods: </strong>This randomized controlled open trial will recruit 120 obese patients (BMI 35-50 Kg/m<sup>2</sup>), aged 20-70 years. The control group will receive a traditional approach: diet + exercise + behavioral recommendations. The experimental group will receive self-conditioning techniques + traditional approach.</p><p>Three individual sessions of hypnosis with rapid-induction techniques will be administered by trained personnel. All the participants of both groups will be assessed at three, six, nine and twelve months after randomization. The primary outcome is weight loss difference between groups at 12 months after randomization; secondary outcomes are changes in adherence to dietetic and exercise recommendations, appetite and satisfaction/well-being, waist circumference and body fat, blood pressure and blood metabolic and inflammatory variables.</p><p><strong>Conclusions: </strong>The results of this trial will assess whether a self-conditioning approach, based on self-hypnosis, is able to help participants to modulate unhealthy patterns of eating and sustain weight loss in the long term.<strong></strong></p>
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Acute effects of acylated ghrelin on salbutamol-induced metabolic actions in humans. Endocrine 2015; 48:937-41. [PMID: 25012253 DOI: 10.1007/s12020-014-0343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study is to describe a potential modulatory effect of acute acylated ghrelin (AG) administration on the glucose, insulin, and free fatty acids (FFA) responses to salbutamol (SALBU). Six healthy young male volunteers underwent the following four testing sessions in random order at least 7 days apart: (a) acute AG administration (1.0 μg/kg i.v. as bolus at 0'); (b) SALBU infusion (0.06 μg/kg/min i.v. from -15' to +45'); (c) SALBU infusion+AG; and (d) isotonic saline infusion. Blood samples for glucose, insulin, and FFA levels were collected every 15 min. As expected, with respect to saline, SALBU infusion induced a remarkable increase in glucose (10.8±5.6 mmol/l×min; P<0.05), insulin (2436.8±556.9 pmol/l×min; P<0.05), and FFA (18.9±4.5 mmol/l×min; P<0.01) levels. A significant increase in glucose (7.4±3.9 mmol/l×min; P<0.05) and FFA levels (10.0±2.8 mmol/l×min; P<0.01) without significant variations in insulin levels were recorded after AG administration. Interestingly, the hyperglycemic effect of AG appeared to be significantly potentiated during SALBU infusion (26.7±4.8 mmol/l×min; P<0.05). On the other hand, the stimulatory effect of SALBU on insulin and FFA was not significantly modified by AG administration. The results of this study show that acute AG administration has a synergic effect with β2-adrenergic receptor activation by SALBU on blood glucose increase, suggesting that their pharmacological hyperglycemic action takes place via different mechanisms. On the other hand, AG has a negligible influence on the other pharmacological metabolic effects of SALBU infusion.
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Impact of short-term treatment with benzodiazepines and imidazopyridines on glucose metabolism in healthy subjects. J Endocrinol Invest 2014; 37:203-6. [PMID: 24497220 DOI: 10.1007/s40618-013-0016-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 11/16/2013] [Indexed: 11/29/2022]
Abstract
AIM In the last years there has been a progressive reduction of the average duration of sleep and an increase in the incidence of sleep disturbances. At the same time, an increase of the incidence of the metabolic syndrome has been described, partly attributable to the progressive worsening of dietary habits and the increase in sedentary lifestyle. Recent studies suggest that adequate sleep is essential to maintain good glucose metabolism and sleep disturbances may contribute to the manifestation of the metabolic syndrome. Benzodiazepines (BZ), such as brotizolam, and imidazopyridines, such as zolpidem, are frequently used as hypnotics but their potential impact on glucose metabolism has never been evaluated so far. METHODS In 12 healthy volunteers [age (mean ± SEM) 38.3 ± 8.1 years; body mass index (BMI) 21.9 ± 0.8 kg/m²] we studied glucose and insulin responses to oral glucose tolerance test (OGTT, 75 g) before and after 15 days treatment with brotizolam 0.25 mg/day or zolpidem 10 mg/day. RESULTS Brotizolam increased glucose delta area under curve response to the OGTT by 122 % (p < 0.01) and zolpidem by 86 % (p < 0.01) without significant variations of insulin levels, suggesting an impact on insulin sensitivity and/or insulin secretion. CONCLUSIONS This study suggests that BZ and imidazopyridines have a rapid glucometabolic effect that is detectable as early as after 15 days treatment.
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Measurement of height velocity is an useful marker for monitoring pituitary function in patients who had traumatic brain injury. Pituitary 2013. [PMID: 23179963 DOI: 10.1007/s11102-012-0446-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To assess the incidence of abnormal neuroendocrine function post-traumatic brain injuriy (TBI) in a large group of paediatric patients and its correlations with clinical parameters (Glasgow coma scale-GCS, Glasgow outcome scale-GOS, TC marshall scale, height velocity). We evaluated 70 patients [58 M, 12 F; age at the time of TBI (mean ± SEM) 8.12 ± 4.23 years] previously hospitalized for TBI at the "Regina Margherita" Hospital, in Turin and "Maggiore della Carità Hospital" in Novara, Italy, between 1998 and 2008. All patients included underwent: auxological, clinical, hormonal and biochemical assessments at recall (after at least 1 year from TBI to T0); auxological visit after 6 months (T6) and hormonal assessments at 12 months (T12) in patients with height velocity (HV) below the 25th centile. At T0, 4 cases of hypothalamus-pituitary dysfunction had been diagnosed; At T6 20/70 patients had an HV <25th centile, but no one had HV < the 3rd centile limit. At T12, among the 20 patients with HV <25th centile, in 13 patients the HV was below the 25th centile and GHRH + Arginine test has been performed. Four subjects demonstrated an impaired GH peak and were classified as GH deficiency (GHD). Of these 4 subjects, 3 subjects showed isolated GHD, while one patient showed multiple hypopituitarism presenting also secondary hypocortisolism and hypothyroidism. The GCS at admission and GOS do not correlate with the onset of hypopituitarism. A simple measurement of the height velocity at least 1 year after the TBI, is enough to recognize patients with a pituitary impairment related to GH deficiency. We suggest to follow-up paediatric population who had TBI with auxological evaluations every 6 months, limiting hormonal evaluation in patients with a reduction of height velocity below the 25th centile limit.
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Metabolic alterations in patients who develop traumatic brain injury (TBI)-induced hypopituitarism. Growth Horm IGF Res 2013; 23:109-113. [PMID: 23660372 DOI: 10.1016/j.ghir.2013.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 04/06/2013] [Accepted: 04/09/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hypopituitarism is associated with metabolic alterations but in TBI-induced hypopituitarism data are scanty. The aim of our study was to evaluate the prevalence of naïve hypertension, dyslipidemia, and altered glucose metabolism in TBI-induced hypopituitarism patients. DESIGN Cross-sectional retrospective study in a tertiary care endocrinology center. 54 adult patients encountering a moderate or severe TBI were evaluated in the chronic phase (at least 12 months after injury) after-trauma. Presence of hypopituitarism, BMI, hypertension, fasting blood glucose and insulin levels, oral glucose tolerance test (if available) and a lipid profile were evaluated. RESULTS The 27.8% of patients showed various degrees of hypopituitarism. In particular, 9.3% had total, 7.4% multiple and 11.1% isolated hypopituitarism. GHD was present in 22.2% of patients. BMI was similar between the two groups. Hypopituitaric patients presented a higher prevalence of dyslipidemia (p<0.01) and altered glucose metabolism (p<0.005) with respect to non hypopituitaric patients. In particular, triglycerides (p<0.05) and HOMA-IR (p<0.02) were higher in hypopituitaric TBI patients. CONCLUSIONS We showed that long-lasting TBI patients who develop hypopituitarism frequently present metabolic alterations, in particular altered glucose levels, insulin resistance and hypertriglyceridemia. In view of the risk of premature cardiovascular death in hypopituitaric patients, major attention has to been paid in those who encountered a TBI, because they suffer from the same comorbidities and may present other deterioration factors due to complex pharmacological treatments and restriction in participation in life activities and healthy lifestyle.
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The GH-releasing effect of acylated ghrelin in normal subjects is refractory to GH acute auto-feedback but is inhibited after short-term GH administration inducing IGF1 increase. Eur J Endocrinol 2013; 168:509-14. [PMID: 23295542 DOI: 10.1530/eje-12-0691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE GH secretion is regulated by an interplay between GH-releasing hormone (GHRH), somatostatin (SST), and other central and peripheral signals. Acylated ghrelin (AG) amplifies GH pulsatility acting, at least partially, independently from GHRH and SST. The GH response to GHRH is inhibited by recombinant human GH (rhGH), likely due to a SST-mediated negative GH auto-feedback. The effect of exogenous rhGH on the GH-releasing effect of AG has never been tested. DESIGN AND METHODS In six healthy volunteers, we studied the GH response to acute AG administration (1.0 μg/kg i.v.) during saline or rhGH infusion (4.0 μg/kg per h i.v.) or after 4-day rhGH (10.0 μg/kg s.c.) administration. RESULTS Compared with saline, rhGH infusion increased GH levels (P<0.01). During saline, acute i.v. AG induced a marked increase (P<0.01) in GH levels similar to those observed after AG administration during rhGH infusion. During s.c. rhGH, IGF1 levels rose from day 0 to day 5 (P<0.01). After 4-day s.c. rhGH, i.v. AG increased (P<0.01) GH levels, though significantly (P<0.05) less than on day 0. CONCLUSIONS The marked somatotroph-releasing effect of AG is refractory to a direct GH auto-feedback whereas is markedly inhibited after 4-day rhGH administration, suggesting the possibility of a selective IGF1-mediated inhibitory feedback.
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Quality of life, mood disturbances and psychological parameters in adult patients with GH deficiency. Panminerva Med 2012; 54:323-331. [PMID: 23123585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
An increased prevalence of depression, emotional lability, decreased energy levels, and poor quality of life have been reported in adults with GH deficiency (GHD). The impairment of psychological parameters depends on the aetiology of GHD and the presence of other pituitary hormone deficiencies because of hormonal effects on neural cell metabolism. Cognitive dysfunctions appear to be specifically related to GHD itself, whereas the lower emotional well-being and reduced motor performance are attributed to other pituitary hormone deficiencies. Traumatic Brain Injury causes very often hypopituitarism and GHD as well as other many psychological symptoms: cognitive impairment, sleeping disorders, and depression. Many neurobehavioral symptoms of postconcussion syndrome (PCS) are the same suffered by adult GHD and hypopituitaric patients but there are no data about the occurrence of hypopituitarism in PCS. In some studies treatment with rhGH is reported to have a beneficial effect and GHD could contribute itself to the global impairment of psychological dysfunctions. The link between psychosocial impairments and GHD is not fully understood. The effects of long-term rhGH therapy on cognitive functions are largely unknown. Thus, long-term placebo-controlled double-blind studies are required to investigate whether psychological dysfunctions are reversible on GH substitution.
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Abstract
Aim of this review is to highlight how and when Traumatic Brain Injury (TBI) as well as Subarachnoid Haemorrhage (SAH) and primary Brain Tumours (pBT) of the Central Nervous System (CNS) can induce hypopituitarism, an under-diagnosed clinical problem. Moreover, this review aims to clarify, on the basis of the recent evidences, how these patients have to be tested for pituitary-function. Both retrospective and prospective studies recommended that patients with more severe form of Brain Injuries (BI) and in particular, those with fractures of the base of the skull or early diabetes insipidus, have to be closely monitored for signs and symptoms of endocrine dysfunction. Further studies will be crucial to raise awareness and remind physicians on the prevalence of hypopituitarism in patients with BI and to elucidate any incremental benefits these patients may receive from hormone replacement.
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Abstract
BACKGROUND Metastatic carcinomas to the pituitary gland are uncommon, occurring in only 1% of the pituitary masses. They often originate from breast or lung carcinomas and may resemble a nonfunctioning pituitary adenoma both clinically and radiologically. Here we describe a patient with pituitary metastasis from follicular thyroid carcinoma and discuss the unique features of these lesions. SUMMARY A 45-year-old woman was admitted to the emergency rescue room of our hospital with a 2-month history of progressive headache and blurred vision. Evaluation revealed right eye amaurosis, with a mild abducens and oculomotor palsy. Pituitary magnetic resonance imaging showed a mass that was hypo-intense in T1-weighted and hyper-intense in T2-weighted-images, located from the sphenoid sinus up to chiasmatic cisterns, raising and deflecting the optic chiasm, down to hypopharynx region, and distorting the cavernous sinuses. No evidence of anterior or posterior hypopituitarism was recorded. The immediate trans-sphenoidal surgery was uncomplicated with partial improvement of the visual fields and headache. Histopathology revealed a metastasis with well-differentiated follicular thyroid architecture. Total thyroidectomy and lymph node dissection was performed with a final histopathological diagnosis of follicular thyroid carcinoma. Subsequently, her headache became more severe. 131-I ablation treatments were performed 15 days and 12 months after thyroidectomy with decrease in headache and a decline in serum thyroglobulin levels. CONCLUSIONS Pituitary metastases from thyroid carcinoma are very uncommon. As this patient illustrates, they tend to produce symptoms relating to space-occupying expansion in the parasellar region rather than to those due to destruction of the pituitary gland. Although rare, pituitary metastases caused by thyroid malignancy should be considered in patients with expanding parasellar lesions if they have thyroid cancer or uncharacterized thyroid diseases. They are unlikely to be amenable to complete resection and should be considered for 131-I treatment, perhaps avoiding the need for extensive neurological surgery.
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Update on epidemiology, etiology, and diagnosis of adult growth hormone deficiency. J Endocrinol Invest 2008; 31:6-11. [PMID: 19020378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The most updated guidelines for the diagnosis of adult GH deficiency (GHD) come from the GH Research Society Consensus Workshop held in Sydney, Australia, in 2007. Regarding who to test for GHD, advice should be extended from primitive hypothalamic- pituitary diseases and cranial irradiation to include brain injuries (Traumatic Brain Injury in particular). Regarding how to test for GHD, the insulin tolerance test (ITT) remains a provocative test of reference; among classical provocative test, glucagon test has also been validated. Above all, GHRH + arginine and GHRH + GH-secretagogues are now considered, at least, as reliable as ITT for the diagnosis of adult GHD. Interestingly, it is now accepted that very low IGF-I represents definite evidence of severe GHD in congenital forms of GHD and also in patients with acquired multiple hypopituitarism. These patients would skip provocative test; however, as normal IGFI levels do not rule out severe GHD, patients suspected for hypopituitarism showing normal IGF-I levels must undergo a provocative test of GH secretion. Retesting the GH status in the transition age is of major relevance in order to decide about continuing or not recombinant human GH replacement in adult life.
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Biomembranes enriched with TGFbeta1 favor bone matrix protein expression by human osteoblasts in vitro. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2003; 63:577-82. [PMID: 12209903 DOI: 10.1002/jbm.10301] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The use of growth factors in oral tissue regeneration is currently under investigation. When growth factors are combined with commercial materials, the in vitro mechanisms of action still remain unclear. The present study first evaluated the capacity of barrier membranes, used in oral surgery, to sequester TGFbeta(1). Resorbable HYAFF, paroguide, poly DL-lactide and nonresorbable PTFE membranes were immersed in MEM containing 0.2 ng (125)I-TGFbeta(1) for different periods of time. It was found that HYAFF membrane and paroguide sequestered the most TGFbeta(1), which was then released in its active form (as shown by the CCL64 cell line bioassay). Untreated membranes and membranes enriched with TGFbeta(1) were then used as substrate for human bone cells to evaluate the synthesis of the osteoblast phenotype, as indicated by specific parameters. Results showed that membranes enriched with TGFbeta(1) increased alkaline phosphatase activity, collagen, and osteocalcin production more than untreated membranes. HYAFF and paroguide membranes, which sequestered the most of TGFbeta(1), were the most suitable for stimulating bone matrix proteins.
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Abstract
BACKGROUND Barrier membranes are used to prevent down-growth of the oral mucosa along the root surface and to allow alveolar bone regeneration in guided tissue regeneration. Several studies have demonstrated bone regenerates in the presence of bioabsorbable and non-resorbable membranes, but no studies have compared multiple bioabsorbable barriers to one another and to non-resorbable barriers. This study evaluated the in vitro influence of bioabsorbable and non-resorbable membranes on specific parameters of human osteoblast activity. METHODS Human osteoblasts were cultured on bioabsorbable membranes made of collagen, hyaluronic acid, and poly DL-lactide, and the most common non-resorbable membrane which is made of expanded polytetrafluoroethylene (ePTFE). The osteoblasts were cultured in vitro for 24 hours on barrier membranes in the presence of 3H-thymidine and 3H-proline to study cell proliferation and collagen synthesis. Transforming growth factor-beta1 (TGF-beta1) secretion was evaluated in conditioned media using an ELISA kit. RESULTS The results showed that collagen and poly DL-lactide stimulated DNA synthesis more than ePTFE and hyaluronic acid. All bioabsorbable membranes significantly increased collagen synthesis and alkaline phosphatase activity. Collagen and hyaluronic acid increased secretion of TGF-beta1, a growth factor involved in bone remodeling. CONCLUSIONS These data suggest bioabsorbable membranes, particularly collagen and hyaluronic acid, may promote bone regeneration through their activity on osteoblasts.
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[Effects of organic acids on corrosion of orthodontic appliances]. MINERVA STOMATOLOGICA 2001; 50:15-20. [PMID: 11378634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND During the last years orthodontic practitioners and patients have developed an increasing interest on the possible undesired effects originated by the growing use of treatments in this field. Among the several undesirable effects, we have analyzed those due to allergic phenomena or cases of direct toxicity resulting from the emission of metallic ions contained in the metallic parts of the orthodontic equipment. One of the essential requirements of metals for orthodontic use is biocompatibility; international regulations (CE, ISO) value the biocompatibility of materials for orthodontics. The analysis of biocompatibility in orthodontic equipment cannot leave out of consideration the evaluation of ion emission. METHODS In our research we have considered the release of metallic ions from orthodontic equipment in water solutions of organic acids kept at a constant temperature of 37 degrees C for 28 days. The evaluation has been possible by ionic absorption spectrophotometry. RESULTS The results show that the release of metallic ions, low as an absolute value, has a particular trend in time. The nickel, chromium and copper concentrations have been higher during the first day than in the following 27 days. CONCLUSIONS These data reassure about the use of orthodontic equipment, since the emission of ions is low, even if allergic problems not linked to the quantity of ions emitted cannot be excluded.
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Abstract
The cytotoxicity of the most common alloys used in orthodontic appliances was determined by cell culture testing. Human gingival fibroblasts were cultured on 304 and 316 stainless steel, on brazing alloy composed of palladium (Pd), copper (Cu), and silver (Ag), and on plastic substrate (control). Studies were carried out with SEM and radiolabeled precursor incorporation. Cells were cultured in MEM without serum but with the addition of (3)H-thymidine to evaluate cell proliferation and (3)H-glucosamine to evaluate glycosaminoglycan (GAG) synthesis and secretion in the culture medium. Moreover, gingival fibroblasts were cultured in the presence of some metal ions generally released by orthodontic appliances to evaluate the cytotoxic effects of single ions. Morphologic observations with SEM and radiolabeled incorporation studies showed that 304 and 316 stainless steel were more biocompatible than the brazing alloy. Among the metal ions tested, Ag and Pd, constituents of the brazing alloy, showed the highest cytotoxicity.
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Abstract
The objective of this study was to evaluate the effects of an orthodontic appliance and of its components (brackets, bands, and arch wires) on some cell functions. Fibroblasts were cultured either in the presence of one unwashed orthodontic appliance, or one orthodontic appliance immersed in MEM for 28 days before use (washed appliance), or in the presence of MEM in which the appliances had been immersed. At the end of in vitro maintenance, morphological studies were carried out with SEM and TEM. Cell proliferation and GAG synthesis and secretion by radio-labeled precursors were assessed. The data indicated that unwashed appliances were more cytotoxic than washed ones. Moreover, the arch wire was the most biocompatible component of the orthodontic appliance, and the bracket was the least biocompatible. A comparative study into the effects on cell proliferation of the most common metal ions released by the appliances was also carried out. At the concentration released by one orthodontic appliance immersed for 28 days, the highest reduction in DNA synthesis was observed in the presence of Cu(++).
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21
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[Release of nickel from orthodontic appliances]. MINERVA STOMATOLOGICA 2000; 49:101-105. [PMID: 20047208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The increase of orthodontic treatments in the last few years has drawn the attention of operators on the possible side effects connected with the application of fixed orthodontic appliances. These effects include allergic reactions and cytotoxic phenomena caused by orthodontic materials on tissues of the oral cavity. The introduction of high nickel content materials has received considerable attention for the high incidence of nickel sensitization. Cases of patients who developed hypersensitivity reaction after the application of orthodontic appliances are reported in the literature. These allergic reactions are the consequence of the electrochemical breakdown which the metallic alloys undergo in oral fluids. METHODS Therefore this study evaluates the quantity of nickel ions released from the orthodontic appliances in aqueous solutions at different pH during a period of 28 days. The solutions have been analyzed by atomic absorption spectrophotometry. RESULTS The results indicate that the quantities of nickel released are higher in the solutions with a lower pH and in the first days of the experiment. The cumulative values obtained after 28 days in the solutions at lower pH can be considered negligible compared to nickel dietetic daily intake. CONCLUSIONS Therefore the results are reassuring to the application of orthodontic appliances, but do not exclude that little quantities of nickel may cause a state of sensitization and allergic reaction on sensitized patients.
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22
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Abstract
OBJECTIVE The microbiological and enzymatic characteristics of the oral cavity would seem to provide a suitable environment for the corrosion of metals. We assayed the release of metal ions from one orthodontic appliance which included two 304 and 316 steel molar bands, ten 316 steel brackets, one nickel-titanium archwire and a brazing alloy to connect the elements of molar bands and brackets. METHODS The orthodontic appliance was dipped in both inorganic (pH 3.5-6.5) and organic acid solutions (w/v 1% each of tartaric, citric and ascorbic acid at pH 2.2 or 1.5% each of lactic and acetic acid at pH 2.5). The release of nickel (Ni), chromium (Cr), copper (Cu), silver (Ag) and palladium (Pd) was determined using an atomic absorption spectrophotometer Varian AA 10. RESULTS The release of Ni, Cr and Cu was markedly less at pH 6.5 than at pH 3.5 at all time points in acid solution. Daily release/single appliance after the first day decreased. Contrary to expectations, appliances immersed in organic acid solutions at pH 2.2 or 2.5 after 28 days generally released an amount of ions similar to that observed in inorganic acid solution at pH 3.5, with the exception of Cu. Release of silver and palladium, two metals present in the brazing alloy, proved to be very low (approximately 0.2 microgram after 28 days). CONCLUSIONS The daily release of Ni, Cu and Cr by an orthodontic appliance in acid pH, particularly favourable to corrosion, was well below that ingested with a normal daily diet. It is therefore concluded that the quantities of metal ions released in our experimental conditions should not be cause for concern in utilising the appliance.
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23
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Abstract
Bone cells derived from the human jaw were cultured on titanium, titanium coated with hydroxyapatite (THA) or with plasma spray (TPS) to study the behaviour of the cells anchored to implant substrates. Bone cells were cultured in MEM with the addition of [3H]-thymidine to evaluate cellular proliferation, and [3H]-glucosamine to evaluate GAG synthesis and accumulation in the extra-cellular matrix (ECM). Moreover, to study the degradation of GAG bone cells were cultured in the presence of NH4Cl, an amine known to inhibit lysosomal activity. Our results show that TPS is the substrate that favours both cellular proliferation and the accumulation of GAG in the ECM.
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24
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Phenotype expression of gingival fibroblasts cultured on membranes used in guided tissue regeneration. J Periodontol 1997; 68:857-63. [PMID: 9379330 DOI: 10.1902/jop.1997.68.9.857] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Human gingival fibroblasts were cultured in vitro using as substrates an extracellular matrix (matrix) and polytetrafluoride (PTFE) membranes, which are used in guided tissue regeneration. To test the degree of biocompatibility of these membranes, the cellular proliferation and the accumulation of extracellular matrix (ECM) macromolecules were considered as parameters. The fibroblasts were cultured in vitro for 24 and 48 hours without serum on plastic, matrix, and PTFE membranes in the presence of 3H-thymidine, 3H-glucosamine, and 3H-proline to study the neo-synthesis of DNA, glycosaminoglycans (GAG), and collagen proteins, respectively. Studies on cell proliferation showed that fibroblasts grown on matrix membrane significantly increased 3H-thymidine incorporation, while fibroblasts grown on PTFE membrane decreased 3H-thymidine incorporation, compared to plastic used as a control. Moreover, the PTFE membrane induced a marked decrease of collagen and GAG accumulation both in the cellular and extracellular pool, while the matrix membrane provoked a decrease of the two macromolecules in the cellular pool and an increase in the extracellular one, compared to the control. The data we obtained demonstrate that matrix membranes are the most suitable to stimulate both cellular proliferation and ECM macromolecule accumulation.
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25
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[Etiopathogenic hypotheses on dental ankylosis]. MINERVA STOMATOLOGICA 1997; 46:109-13. [PMID: 9173220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors review the literature about the different etiopathogenetic hypotheses of tooth ankylosis. They classified the ankylosis in three big groups: traumatic ankylosis due to direct and indirect injuries to the tooth, iatrogenic ankylosis due to unadvised maneuvers made by the dentist, and atraumatic ankylosis. The last is the most important group caused by metabolic problems and with family characteristics. Furthermore they underline the important role played by GAG and corresponding lytic enzymes in the development of atraumatic ankylosis. They described, the therapeutical procedures to be used in the different cases. The clinical cases presented are representative of the different therapeutical approaches.
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26
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[Maxillofacial-dental anomalies in cleidocranial dysostosis]. MINERVA STOMATOLOGICA 1995; 44:493-7. [PMID: 8721210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors evaluated the dento-maxillofacial anomalies in cleido-cranial dysplasia; the use of a removable orthodontic appliance can solve orthodontic problems particularly the deficiency of anchorage.
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27
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[Maxillofacial and dental anomalies in multiple-abnormality syndromes. The clinical and therapeutic aspects in Sotos' syndrome]. MINERVA STOMATOLOGICA 1994; 43:525-9. [PMID: 7739485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors describe the maxillo-facial and dental anomalies present in a rare polymalformative syndrome: Sotos' syndrome. After having examined the syndrome and reported a case, they propose a therapeutic approach for the treatment of young handicapped cooperating patients.
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28
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[Benign obstruction of the common bile duct: what is the current role of transduodenal sphincteroplasty?]. MINERVA CHIR 1994; 49:773-8. [PMID: 7991190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper is a critical review of the clinical records of 20 patients who underwent a Transduodenal Sphincteroplasty (PSP), from October 1990 to January 1992 at our Department (General Surgery). The age was 64.9 (14.2) years (mean and standard deviation), but 14 (70%) of those patients were older than 60 (range: 63 to 89) and 9 (45%) were in the 8th up to 9th decade of their lives. In 16 patients PSP was performed at the same time as cholecystectomy. Common bile duct (CBD) exploration was decided in 11 patients only on the basis of the intraoperative cholangiographic findings (evidence of CBD stones and/or benign stenosis of the Papilla of Vater) as demonstration of the permanent role of this examination in biliary surgery. Among the patients who underwent PSP some time after cholecystectomy, one had a lesion of the choledochus, sustained when he was cholecystectomized 15 days before. Because of the fact that recovery was prompt and definitely uneventful, PSP together with the infusion of somatostatin (SMTN) can be considered a useful approach to the treatment of the biliary fistula.
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29
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[An in-vitro study of the antimicrobial activity of copper and zinc salts on pure and mixed microbial cultures]. MINERVA STOMATOLOGICA 1994; 43:393-6. [PMID: 7816012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The authors evaluated the in vitro antimicrobial activity of some copper and zinc salts. The results showed high antimicrobial activity of copper salts versus S. mutans and versus the bacterial association tested in this study.
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30
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[Transduodenal sphincterotomy and type II Mirizzi syndrome]. MINERVA CHIR 1994; 49:729-31. [PMID: 7991183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper describes the clinical course of a 76-year-old woman surgically treated in our department (General Surgery) for obstructive jaundice in Mirizzi syndrome (II). Ultrasonography and ERCP failed to demonstrate the pathological situation at the level of the biliary tree. When laparotomy was decided because of the progressive worsening of the general clinical conditions of the patient, intraoperative cholangiography showed the presence of a cholecystocholedochal fistula with multiple residual stones eroded into the common bile duct. Surgical management consisted of partial cholecystectomy, removal of the stones, choledochoplasty and exploration of the distal part of the common bile duct by a transduodenal sphincteroplasty. The post-operative period was uneventful and the patient was discharged from our department nine days after surgery. Even though the surgical approach to Mirizzi syndrome generally includes procedures other than papillosphincteroplasty+partial cholecystectomy, our experience seems to substantiate the efficacy of the previously mentioned treatment under suitable conditions.
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31
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Abstract
A case is presented of a right traumatic chylothorax, secondary to thoracic trauma with bilateral posterior eleventh rib fracture, treated by total parenteral nutrition and pleural drainage, with resolution within 2 weeks. On the basis of this clinical report and of a review of the literature, it is concluded that adequate conservative management should be initially the treatment of choice. Surgical treatment should be reserved to the cases in which clinical improvement does not occur within 2 weeks, and should consist of supradiaphragmatic thoracic duct ligation. Thoracoscopic fibrin glue injection has recently been described as a possible alternative treatment.
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32
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Abdominal aortic aneurysmectomy associated with a native iliac kidney. Case report. THE JOURNAL OF CARDIOVASCULAR SURGERY 1993; 34:83-4. [PMID: 8482712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abdominal aortic aneurysm (AAA) repair associated with a pelvic kidney is extremely rare. To date only 14 cases have been reported in the literature. The main problem during aortic cross clamping is kidney preservation. The purpose of this article is to record and additional case of AAA repair associated with a native pelvic kidney. The preservation has been successfully achieved by a distal aortic double clamping.
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33
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Thrombosis of the superior vena cava due to a central catheter for total parenteral nutrition. JPEN J Parenter Enteral Nutr 1990; 14:31-3. [PMID: 2109110 DOI: 10.1177/014860719001400131] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Total parenteral nutrition (TPN) today is a fundamental procedure in the treatment of critically ill patients, especially if they have serious gastrointestinal diseases. However, use of the central venous catheter is connected with a very important morbidity. At the "Istituto di Patologia Chirurgica" and at the "Intensive Care Unit" of the University of Ferrara, we analyzed 59 cases of deaths from different diseases, on whom a postmortem examination had been performed. Twenty-seven patients had had no central venous catheter: none of them presented thrombosis of the central veins. Thirty-two patients had had a central venous catheter for TPN: five of them presented thrombosis of the central veins at the post-mortem examination. Except for one case who had thrombosis connected with a carcinoma of the right main bronchus, four cases (12.9%) presented thrombosis due to the central venous catheter. The subclavian vein seems to be more commonly connected with thrombosis than the jugular vein.
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34
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[The venous circle. Cervical reflux following functional neck evacuation]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 1988; 39:175-8. [PMID: 3273548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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35
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[Lung resection in benign pathology]. MINERVA CHIR 1987; 42:1769-73. [PMID: 3696440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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36
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[Reconstructive surgery of the vena cava]. MINERVA CHIR 1987; 42:1553-7. [PMID: 3683914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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37
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[Influence of anti-H2-receptors on the surgery of peptic ulcer]. MINERVA CHIR 1987; 42:1495-7. [PMID: 2891086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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38
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[Severe arterial spasm and secondary thromboses of the limbs in chronic ergotism]. Minerva Med 1985; 76:2131-4. [PMID: 2999645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 40 year old woman who took a daily dose of 2-4 mg of Ergotamine Tartrate (Cafergot) regularly for 6 years to combat persistent migraine, was treated for a non-atherosclerotic arterial disease, severe arteriospasm of the great limb arteries, hyperplasia of the intima and segmental thrombosis. Binding of adrenergic alpha and beta receptors was investigated. Surprisingly it was found that the number of adrenergic beta receptors was significantly lower thant that of a healthy woman of the same age used as a control while the number of alpha receptors was not significantly different. This action of ergotamine on beta receptors could be explained by a dopamine-mimetic stimulation, due to the central nervous system, that could lead to the preferential regulation of beta receptors rather than alpha receptors, almost as a protective mechanism of alpha receptors.
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39
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[Personal experience in the diagnosis and treatment of neoplasms of the duodeno-pancreatic junction]. MINERVA CHIR 1985; 40:1225-31. [PMID: 4080198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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40
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[Retroperitoneal tumors. Clinical contribution]. MINERVA CHIR 1985; 40:1275-81. [PMID: 3908976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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41
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[Pulmonary surgery today. Considerations on reconstructive bronchial surgery]. MINERVA CHIR 1985; 40:183-90. [PMID: 2986051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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42
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Unstable angina: early and late results of operative treatment. THE JOURNAL OF CARDIOVASCULAR SURGERY 1984; 25:449-52. [PMID: 6334087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Between January 1978 and May 1980 at King's College Hospital 68 patients of 300 patients treated consecutively by coronary artery bypass grafting (CABG) had presented with unstable angina. There were 58 males and 10 females age range 26 to 69 years, mean 54 years. Thirty-one patients (45%) had definite evidence of previous myocardial infarction, 4 had diabetes mellitus and 7 had left main stem stenosis greater than 50%. Seven cases (9.7%) required pre or peri-operative intra-aortic balloon pump assistance. Two subsets within this group of 68 patients with unstable angina were recognised. Fifty seven patients had CABG alone without any additional surgical procedure and there were 2 peri-operative deaths (mortality 3.5%). In 11 patients who had CABG plus additional surgical procedures including valve replacement or left ventricular aneurysmectomy there were 3 peri-operative deaths (mortality 27%). The overall mortality of the 68 patients was 5 deaths (7.4%). These results indicate that the operative mortality in patients with unstable angina having CABG alone is not significantly higher than the overall mortality at that time for the patients who had CABG for stable angina (2.4%).
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43
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[Intra-operative manometry and hiatal hernia]. Minerva Med 1984; 75:317-20. [PMID: 6700837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Personal experience of the intra-operative use of oesophageal manometry in cases of hiatus hernia is presented. Using this system the pressure in the air cushion surrounding the L.E.S. can be adjusted to avoid any complications due to overtight or overlax surgery. Various types of post-operative tests confirm the value of the technique.
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44
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[Possible relations between dehiscence of the colorectal anastomosis and local recurrences after anterior resection for cancer of the rectum and sigmoid]. MINERVA CHIR 1982; 37:961-6. [PMID: 7133472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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45
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[Obliteration of the subrenal aorta]. Minerva Med 1979; 70:2199-208. [PMID: 450326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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46
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Angioplasty of the profunda femoris in revascularisation of the lower extremity. THE JOURNAL OF CARDIOVASCULAR SURGERY 1979; 20:265-72. [PMID: 447763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Excellent results with respect to preservation of the limb and improvement of claudication were obtained with profundaplasty in 29 patients with Fontaine's stage III or IV chronic obliteration. The method is regarded as one of choice for saving the limb, but not as a replacement for other methods of direct revascularisation of the femoropopliteal axis in cases where complete functional recovery is also required. A comparison is made between the results of profundaplasty and reconstruction of the axis in a personal series.
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47
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[Hemodynamics in venous diseases of the lower limbs]. Minerva Med 1978; 69:1771-7. [PMID: 662179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Venous diseases of the lower extremities have been studied haemodynamically by analysis of variations in dynamic venous pressure, which is held to be a fundamental parameter. Pressure modifications point to the state of the deep venous system, the valves and the subfascial communicating veins or to the efficiency or otherwise of the muscular pump of the lower extremities. The venous pressure curve is a reliable indicator of the various clinical stages of chronic venous insufficiency and postphlebitis syndrome. As a clinical parameter, venous pressure is sensitive to all pathological changes in the venous system of the lower extremities. It presents variations proportional to the gravity of pure phlebopathies and of venous diseases secondary to congenital dysplasias (e.g. Klippel-Trenauny syndrome) and to congenital or acquired arteriovenous shunts. An attempt is made to classify venous diseases of the lower extremities on the basis of this parameter and examples are given of dynamic venous pressure curves encountered in the various disease pictures observed.
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48
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[Echography in the diagnosis of aneurysms of the abdominal aorta]. Minerva Med 1978; 69:547-52. [PMID: 634504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The principles of echography and its technique are briefly explanded, and 8 personal cases examined for suspected aneurysm of the abdominal aorta are presented. Correct and accurate diagnosis was obtained in cases. In 1 case, aortography was also performed, though its findings were less clear. It is felt that the applications of echography can usefully be extended to the screening, diagnosis and control of this form.
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49
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[Emergency vascular reconstruction in trauma of the limbs and/or pelvis]. MINERVA CHIR 1978; 33:99-108. [PMID: 643210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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50
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[Echographic demonstration and evaluation of aneurysms of the abdominal aorta]. MINERVA CHIR 1978; 33:121-6. [PMID: 643202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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