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1.
Brain Inj ; 35(5): 530-535, 2021 04 16.
Article in English | MEDLINE | ID: mdl-33734911

ABSTRACT

Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC).Design: multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular = 125, traumatic = 83, anoxic = 56, others = 14).Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity.Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO.Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.


Subject(s)
Consciousness , Ossification, Heterotopic , Consciousness Disorders/etiology , Cross-Sectional Studies , Humans , Ossification, Heterotopic/etiology , Persistent Vegetative State/etiology
2.
Brain Inj ; 35(1): 1-7, 2021 01 05.
Article in English | MEDLINE | ID: mdl-33331792

ABSTRACT

Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies..Design: Multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury.Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications.Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology.Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.


Subject(s)
Brain Injuries , Consciousness , Consciousness Disorders/etiology , Cross-Sectional Studies , Humans , Persistent Vegetative State/etiology
3.
J Synchrotron Radiat ; 26(Pt 4): 1316-1321, 2019 Jul 01.
Article in English | MEDLINE | ID: mdl-31274460

ABSTRACT

The factors limiting the performance of alternative polycrystalline solar cells as compared with their single-crystal counterparts are not fully understood, but are thought to originate from structural and chemical heterogeneities at various length scales. Here, it is demonstrated that multimodal focused nanobeam X-ray microscopy can be used to reveal multiple aspects of the problem in a single measurement by mapping chemical makeup, lattice structure and charge collection efficiency simultaneously in a working solar cell. This approach was applied to micrometre-sized individual grains in a Cu(In,Ga)Se2 polycrystalline film packaged in a working device. It was found that, near grain boundaries, collection efficiency is increased, and that in these regions the lattice parameter of the material is expanded. These observations are discussed in terms of possible physical models and future experiments.

4.
Clin Genet ; 93(3): 712-718, 2018 03.
Article in English | MEDLINE | ID: mdl-29120065

ABSTRACT

Mitochondrial aminoacyl-tRNA synthetases (mtARSs) are essential, ubiquitously expressed enzymes that covalently attach amino acids to their corresponding tRNA molecules during translation of mitochondrial genes. Deleterious variants in the mtARS genes cause a diverse array of phenotypes, many of which involve the nervous system. Moreover, distinct mutations in mtARSs often cause different clinical manifestations. Recently, the gene encoding mitochondrial tryptophanyl tRNA synthetase (WARS2) was reported to cause 2 different neurological phenotypes, a form of autosomal recessive intellectual disability and a syndrome of severe infantile-onset leukoencephalopathy. Here, we report the case of a 17-year-old boy with compound heterozygous mutations in WARS2 (p.Trp13Gly, p.Ser228Trp) who presented with infantile-onset, Levodopa-responsive Parkinsonism at the age of 2 years. Analysis of patient-derived dermal fibroblasts revealed decreased steady-state WARS2 protein and normal OXPHOS content. Muscle mitochondrial studies suggested mitochondrial proliferation without obvious respiratory chain deficiencies at the age of 9 years. This case expands the phenotypic spectrum of WARS2 deficiency and emphasizes the importance of mitochondrial protein synthesis in the pathogenesis of Parkinsonism.


Subject(s)
Alleles , Mutation , Parkinsonian Disorders/diagnosis , Parkinsonian Disorders/genetics , Tryptophan-tRNA Ligase/genetics , Adolescent , Age of Onset , Biopsy , DNA Mutational Analysis , Fibroblasts/metabolism , Genetic Association Studies , Genotype , Humans , Levodopa/therapeutic use , Magnetic Resonance Imaging , Male , Parkinsonian Disorders/drug therapy , Phenotype , Polymorphism, Single Nucleotide , Precision Medicine
5.
Eur Rev Med Pharmacol Sci ; 21(4): 819-826, 2017 02.
Article in English | MEDLINE | ID: mdl-28272700

ABSTRACT

OBJECTIVE: Conventional colonoscopy (CC) is the gold standard to diagnostic and therapeutic approach to colon. However, in few cases, cecal intubation could fail due to colon anatomy, patient compliance and physician expertise. Endotics robotic colonoscopy is a novel, safe, mini-invasive modality to explore the entire colon. Our aim was to assess, in a retrospective study, Endotics ability of cecal intubation in all cases in which CC failed. PATIENTS AND METHODS: Between January 2008 and December 2012, 276 Endotics robotic colonscopy examinations were performed at the Gastroenterology and Metabolic Diseases Unit of Pisa University Hospital, Pisa, Italy, in a series of consecutive patients who had undergone CC and failed cecal intubation. RESULTS: We assessed the cecal intubation rate in 102 patients addressed to Endotics after previous incomplete CC. Overall, endotics system was successful in 93.1% of the incomplete conventional colonoscopy cases (95% performance). CONCLUSIONS: Whenever the intended exploration of the entire colon with CC failed, the endotics robotic endoscopy represented a useful tool as it helped examine the entire colon in almost all cases.


Subject(s)
Colonoscopy , Robotic Surgical Procedures , Adult , Cecum , Endoscopy , Female , Humans , Intubation, Gastrointestinal , Italy , Male , Middle Aged , Retrospective Studies
6.
Rev Sci Instrum ; 86(11): 113705, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26628142

ABSTRACT

In situ characterization of micro- and nanoscale defects in polycrystalline thin-film materials is required to elucidate the physics governing defect formation and evolution during photovoltaic device fabrication and operation. X-ray fluorescence spectromicroscopy is particularly well-suited to study defects in compound semiconductors, as it has a large information depth appropriate to study thick and complex materials, is sensitive to trace amounts of atomic species, and provides quantitative elemental information, non-destructively. Current in situ methods using this technique typically require extensive sample preparation. In this work, we design and build an in situ temperature stage to study defect kinetics in thin-film solar cells under actual processing conditions, requiring minimal sample preparation. Careful selection of construction materials also enables controlled non-oxidizing atmospheres inside the sample chamber such as H2Se and H2S. Temperature ramp rates of up to 300 °C/min are achieved, with a maximum sample temperature of 600 °C. As a case study, we use the stage for synchrotron X-ray fluorescence spectromicroscopy of CuIn(x)Ga(1-x)Se2 (CIGS) thin-films and demonstrate predictable sample thermal drift for temperatures 25-400 °C, allowing features on the order of the resolution of the measurement technique (125 nm) to be tracked while heating. The stage enables previously unattainable in situ studies of nanoscale defect kinetics under industrially relevant processing conditions, allowing a deeper understanding of the relationship between material processing parameters, materials properties, and device performance.

7.
Neuroradiol J ; 25(3): 311-7, 2012 Jul.
Article in English | MEDLINE | ID: mdl-24028983

ABSTRACT

This study evaluated whether different imaging techniques correlate with specific variables routinely used to grade the types and complexities of patient conditions in neurorehabilitation services and their clinical outcomes, and if there are radiological patterns, topography or distribution of the lesions correlated to spasticity. The cohort studied included 75 patients, 38 patients with multiple sclerosis (MS) and 37 patients with acquired brain injuries (ABI) referred to the neurorehabilitation department from April 2009 to March 2010. Data included age, gender, diagnoses, complications, spasticity, length of stay, Rehabilitation Complexity Scale (RCS) and Northwick Park Dependency (NPDS) scores on admission and discharge. Forward stepwise multiple regressions were performed considering Spasticity as dependent and considering NPDS, RCS on admission and discharge, age, gender and length of stay as independent variables. Standardized intra-axial lesions in those with spasticity were fused with standardized axial DTIs from normal controls obtained under 3 T and 1.5 T MRI scanners. Spasticity was present in 36 patients. Regression was found between spasticity and all the other variables with r = 0.42, r(2) = 0.17, adjr(2) = 0.12(r), F(4,66) = 3.53, p < 0.01. Residuals were acceptable. If the same is calculated excluding MS patients the results are higher with: r = 0.59, r(2) = 0.35, adjr(2) = 0.30, F(2,27) = 7.1885, p < 0.003. In MS subjects, spasticity appeared if lesions affected pyramidal tracts, callosal radiations extensively or brainstem. Those with ABI did develop spasticity if the lesion involved the internal capsules, pericommissural areas, optochiasmatic cistern or brainstem. Findings suggest that NPDSa and discharge and RCSd are higher in those developing spasticity. No obvious correlation between spasticity and RCSa was found. Subjects with MS are more likely to develop spasticity especially if the lesions are numerous and affect the corticospinal tracts, callosal radiations extensively or brainstem. In patients with ABI lesions affecting pyramidal tracts, pericommissural areas and optochiasmatic cisterns seem more likely to develop spasticity.

8.
J Bone Joint Surg Br ; 92(9): 1262-6, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20798445

ABSTRACT

This study assessed if transfer of the extensor hallucis longus is a valid alternative treatment to split transfer of the tibialis anterior tendon in adult hemiplegic patients without overactivity of the tibialis anterior. One group of 15 patients had overactivity of tibialis anterior in the swing phase, and underwent the split transfer. A further group of 14 patients had no overactivity of tibialis anterior, and underwent transfer of extensor hallucis longus. All patients had lengthening of the tendo Achillis and tenotomies of the toe flexors. All were evaluated clinically and by three-dimensional gait analysis pre- and at one year after surgery. At this time both groups showed significant reduction of disability in walking. Gait speed, stride length and paretic propulsion had improved significantly in both groups. Dorsiflexion in the swing phase, the step length of the healthy limb and the step width improved in both groups, but only reached statistical significance in the patients with transfer of the extensor hallucis longus. There were no differences between the groups at one year after operation. When combined with lengthening of the tendo Achillis, transfer of the extensor hallucis longus can be a valid alternative to split transfer of the tibialis anterior tendon to correct equinovarus foot deformity in patients without overactivity of tibialis anterior.


Subject(s)
Clubfoot/surgery , Foot Deformities, Acquired/surgery , Hemiplegia/complications , Tendon Transfer/methods , Adult , Aged , Disability Evaluation , Humans , Metatarsal Bones/surgery , Middle Aged , Retrospective Studies , Stroke/complications , Walking , Young Adult
9.
Neuroradiol J ; 23(6): 711-7, 2010 Dec.
Article in English | MEDLINE | ID: mdl-24148727

ABSTRACT

This study evaluated the correlation between manual and automated morphometric measurements of hippocampi and amygdalae. Twenty-three patients with no history of seizures and normal electroencephalograms were examined with a standardized MRI protocol that included isovoxel volumetric acquisitions of the brain. Images were evaluated in axial-oblique plane to trace manually the grey matter contours of hippocampi and amygdalae obtaining their volumes. They were also processed automatically carrying out segmentation and sub segmentation aligning images (AC-PC) and standardizing them into Talairach space to obtain then comparable grey matter volumes. Tabled results were age, gender and volumes of each side from both, manual and automated measurements. Forward stepwise multiple regression analyses were carried out considering sex and age as independent and hippocampi-amygdalae as dependent variables. Linear regression analyses were then carried out considering for the total of cerebral hemispheres each manual measurement as independent and automatically obtained volumes as dependent variables. In the multiple regression analyses the following values were obtained: age-gender vs. manual measurements showed r=0.83; r(2)=0.69; adjustedr(2)=0.64; F(3,19)=14.36 while age-gender vs. automated values showed r=0.86; r(2)=0.74; adjustedr(2)=0.70; F(3,19)=18.81. Linear regression between manual and automated measurements for all hemispheres showed for hippocampus: r=0.97; r(2)=0.95; F(1,44)=896.59. For amygdala results were: r=0.94; r(2)=0.89; F(1,44)=391.11. The results of these analyses suggest that both manual and automated procedures of measurement are highly consistent. A regression between age and volumes of both hippocampus and amygdala was also noted.

10.
Eur J Phys Rehabil Med ; 44(4): 461-5, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19002096

ABSTRACT

Pain after hip replacement is one of the most common problems during rehabilitation and is often the main obstacle in rehabilitation, even though it can often be controlled by localized cryotherapy and/or administration of analgesics. However, patients with positive anamnesis for hip arthritis and long-lasting pain may report persistence of symptoms for months after surgical intervention; often, in these patients, contractures and muscle retraction in the pelvic region are observed. The present study reports the case of a female patient who suffered from complications after total hip replacement (THR) for osteoarthritis. Due to severe pain in the gluteal region not responding to standard treatments the patient was unable to stand in an upright position or walk, so she was forced to stop the rehabilitation program. Treatment by injection of botulinum toxin type A (BTX-A) in the gluteus maximus muscle brought about the complete resolution of pain and functional recovery. The follow-up visits, carried out after 6 and 16 months, confirmed the complete healing of the patient. BTX-A has been shown to be effective in the treatment of painful localized contractures even in the absence of neurological lesions. Therefore, BTX-A could be a feasible option to treat painful localized contractures that do not respond to standard treatments. Further investigations are suggested to better identify appropriate dosages and the best inoculation schedule.


Subject(s)
Arthroplasty, Replacement, Hip/rehabilitation , Botulinum Toxins, Type A/administration & dosage , Contracture/drug therapy , Neuromuscular Agents/administration & dosage , Aged , Arthroplasty, Replacement, Hip/adverse effects , Contracture/etiology , Female , Humans , Osteoarthritis, Hip/surgery
11.
Clin Rheumatol ; 24(4): 431-4, 2005 Aug.
Article in English | MEDLINE | ID: mdl-15906110

ABSTRACT

A 61-year-old female with a history of vaginal dryness, Raynaud's phenomenon, xerostomia and xerophthalmia presented with exertional dyspnoea and weakness. Laboratory and instrumental examinations enabled us to make the diagnosis of primary Sjögren's syndrome, while cardiologic and imaging investigations evidenced isolated pulmonary hypertension and ruled out pulmonary fibrosis. Oral anticoagulant and furosemide therapy induced a partial improvement of exertional dyspnoea and weakness.


Subject(s)
Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosis , Sjogren's Syndrome/complications , Sjogren's Syndrome/diagnosis , Anticoagulants/therapeutic use , Drug Therapy, Combination , Electrocardiography , Female , Follow-Up Studies , Furosemide/therapeutic use , Humans , Hypertension, Pulmonary/drug therapy , Middle Aged , Respiratory Function Tests , Risk Assessment , Severity of Illness Index , Sjogren's Syndrome/drug therapy , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler
12.
Eur J Intern Med ; 14(7): 434-437, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14614977

ABSTRACT

A 35-year-old female with a history of Hashimoto's thyroiditis (HT) presented with episodic dysphasia and a burst of axial jerks with abdominal muscle contraction and asymmetric blepharospasm as manifestations of encephalopathy associated with HT. Brain magnetic resonance imaging (MRI) showed scattered supratentorial white matter hyperintense T2 foci. Brain single photon emission computerized tomography (SPECT) demonstrated a cortical hypoperfusion in the upper frontal and parietal areas. Corticosteroid therapy induced a rapid improvement of the clinical picture.

13.
Dig Liver Dis ; 34(6): 419-23, 2002 Jun.
Article in English | MEDLINE | ID: mdl-12132789

ABSTRACT

BACKGROUND: With the extensive use of mesalamine, the natural history of ulcerative colitis is probably changed. AIM: To evaluate the relapse rate and the duration of remission in patients with ulcerative colitis on maintenance treatment with mesalamine. PATIENTS AND METHODS: Enrolled in the study were 95 patients divided into 4 groups according to macroscopic location of the disease and treated with the same therapy starting from the date of enrolment. Patients in all 4 groups were followed-up until relapse occurred. The disease activity was evaluated by the Clinical Activity Index and Endoscopic Index. Patients suitable for recruitment showed a Clinical Activity Index and Endoscopic Index lower than 6 and 4, respectively. The patients with ulcerative pancolitis or left-sided colitis were treated with 1.6 g/day while the cases with proctosigmoiditis or proctitis were treated with 5-acetylsalicylic acid enemas 4 g/day Each patient was evaluated with clinical and endoscopic assessment at a 6-month interval. Relapse was defined as an increase in Clinical Activity Index and Endoscopic Index, of more than 6 and 4, respectively. RESULTS: Five patients dropped-out. All enrolled patients showed a clinical and/or endoscopic relapse within 10 years, the majority 2 or 3 years after diagnosis: pancolitis and left-sided colitis within 2-3 years and patients with distal colitis within 9-10 years. CONCLUSIONS: A relapse was observed in most cases within 3 years, and in all recruited patients within a space of ten years. The extent of the disease in the colon is an important prognostic factor, as patients with distal colitis showed a lesser tendency to relapse.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Colitis, Ulcerative/drug therapy , Mesalamine/therapeutic use , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Recurrence , Remission Induction , Severity of Illness Index
14.
Planta Med ; 68(3): 209-12, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11914955

ABSTRACT

Four macrocyclic trichothecenes, roridin A, roridin E, verrucarin A and verrucarin J, produced by the hypocrealean epibiont of Baccharis coridifolia, were evaluated for their inhibitory activity against the arenavirus Junin (JUNV), the etiological agent of Argentine hemorrhagic fever. The trichothecenes achieved a dose-dependent inhibition of JUNV multiplication at concentrations not affecting cell viability. The 50 % inhibitory concentration (IC50) values determined by a virus yield inhibition assay were in the range 1.2 - 4.9 ng/ml. The most active compound was verrucarin J which reduced JUNV yield more than 2 log units and had a similar effect against the arenavirus Tacaribe. The trichothecenes lacked virucidal effects on JUNV virions. From time of addition and removal experiments, it can be concluded that verrucarin J inhibited a late stage in the replicative cycle of JUNV, after 5 h of adsorption.


Subject(s)
Antiviral Agents/pharmacology , Asteraceae/virology , Junin virus/drug effects , Trichothecenes/pharmacology , Animals , Chlorocebus aethiops , Dose-Response Relationship, Drug , Junin virus/growth & development , Plant Extracts/chemistry , Plant Extracts/pharmacology , Trichothecenes/chemistry , Vero Cells
15.
J Comput Assist Tomogr ; 25(4): 612-6, 2001.
Article in English | MEDLINE | ID: mdl-11473194

ABSTRACT

PURPOSE: Our aim was to evaluate the accuracy of spiral CT study of small-bowel Crohn disease with use of oral hyperhydration with isoosmotic solution. METHOD: We prospectively analyzed 33 consecutive patients and 10 control subjects with spiral CT after oral administration of 2,000 ml of polyethylene glycol electrolyte-balanced solution. The CT diagnoses were compared with the results of conventional radiologic oral barium examination (33 cases), ileum colonoscopy (8 cases), and surgery (4 cases). RESULTS: The final diagnoses were Crohn disease (14 cases), no small-bowel disease (16 cases), cancer of ileocecal valve (1 case), carcinosis of mesenteric root (1 case), and intestinal lymphangiectasia (1 case). In the control group, no abnormalities of the small bowel were found. The sensitivity of spiral CT was 85.7%, specificity 100%, positive predictive value 100%, negative predictive value 90%, and diagnostic accuracy 93.9%. CONCLUSION: Our method allowed adequate distension of the small bowel for spiral CT studies, thus resulting in a safe and effective alternative to small-bowel spiral CT enema, which can be used in patients that refuse the nasojejunal balloon catheter.


Subject(s)
Calcinosis/diagnostic imaging , Crohn Disease/diagnostic imaging , Intestine, Small/diagnostic imaging , Adolescent , Adult , Aged , Calcinosis/pathology , Excipients/administration & dosage , Female , Fluid Therapy , Humans , Intestine, Small/pathology , Isotonic Solutions/administration & dosage , Male , Mesentery/diagnostic imaging , Mesentery/pathology , Middle Aged , Polyethylene Glycols/administration & dosage , Prospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed
16.
Forensic Sci Int ; 119(2): 263-5, 2001 Jun 15.
Article in English | MEDLINE | ID: mdl-11376995

ABSTRACT

A 49-year-old male pharmacist suffering from depression phoned the emergency services telling of how he had ingested barium chloride. He was found semicomatose in bed and resuscitation attempts were to no avail and he died at the scene. A white plastic container labelled "Barium chloride... Poison", and a book with a writing on a blank page... "give sulphate... SO(4)" were found. At autopsy, 1l of whitish-yellow fluid was found in the stomach. Autopsy barium levels were: blood 9.9mg/l; bile 8.8mg/l; urine 6.3mg/l; gastric 10.0g/l. Cause of death was given as cardiorespiratory arrest due to barium chloride poisoning. The issue of barium toxicity in a variety of itatrogenic and non itatrogenic situation is discussed together with the two only other cases of suicidal barium ingestion, and the feasibility of early intervention at the scene by an emergency team.


Subject(s)
Autopsy , Barium Compounds/poisoning , Chlorides/poisoning , Coma/chemically induced , Suicide , Cause of Death , Coma/pathology , Depression/psychology , Drug Overdose , Humans , Male , Middle Aged , Resuscitation , Suicide/psychology
17.
J Clin Gastroenterol ; 31(2): 147-51, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10993432

ABSTRACT

The aim of this study was to determine the possible influence of the initial location of Crohn's disease (CD) on the time-to-relapse in patients with quiescent CD treated only with oral mesalamine (5-ASA). We divided 74 consecutive patients in clinical remission into three groups according to the initial location of CD. Group A consisted of 30 cases with an ileal location; group B, 18 with ileocolonic location; and group C, 26 with a colonic location. The patients entered the study if they were in clinical and endoscopic remission for at least 3 months. Relapse was defined by CD Activity Index > or = 150, CD Endoscopic Index of Severity > or =4, and by an abnormal increase of C-reactive protein, white blood cell count, and erythrocyte sedimentation rate; moreover, if it was confirmed by x-ray and/or endoscopy. Time-to-relapse was defined as the interval between the date of enrollment and the date of relapse. The patients with an ileal location showed a relapse within 5 years, with a time-to-relapse of 1 year in 26% of cases, 2 years in 85%, 3 years in 92%, and 4 years in 96%. The patients with ileocolonic location showed a relapse within 4 years, with time-to-relapse of 1 year in 39% of cases, 2 years in 89%, and 3 years in 94%. The cases with a colonic location showed a relapse within 6 years, with time-to-relapse of 1 year in 33% of cases, 2 years in 71%, 3 years in 79%, and 4 years in 87%. Surgical treatment was necessary in 37% of the cases with an ileal location, in 44% with ileocolonic location, and 17% with a colonic location. In conclusion, even if our data lack a statistical significance, we have found that the initial anatomic involvement is not a valid parameter to predict the relapse risk in a homogeneous group under continuous treatment with oral 5-ASA, although ileocolonic location seems to have a more aggressive course.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Crohn Disease/diagnosis , Crohn Disease/drug therapy , Mesalamine/administration & dosage , Administration, Oral , Adult , Colitis/diagnosis , Colitis/drug therapy , Female , Humans , Ileitis/diagnosis , Ileitis/drug therapy , Male , Prognosis , Recurrence , Time Factors
18.
J Viral Hepat ; 7(1): 75-8, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10718946

ABSTRACT

The aim of this study was to evaluate the most appropriate therapeutic protocol for patients with chronic hepatitis C not responding to a previous course of recombinant interferon alpha-2b (rIFN). Sixty patients were randomly assigned to two groups of 30 subjects each: group A was treated with double dose of the same type of rIFN (6 MU t.i.w.) plus ribavirin for 6 months; group B was treated with the same rIFN dose and duration as group A, but without ribavirin. An end of treatment complete response (ETCR) was defined as alanine transaminase (ALT) normalization with undetectable serum HCV-RNA at the end of the treatment, while an end of treatment biochemical response (ETBR) as ALT normalization with still detectable viraemia. The two groups were homogeneous. The patients with ETCR or ETBR were than followed-up for at least 1 year. A sustained biochemical response (SBR) was defined as the persistence of normal ALT with still detectable viraemia after a 12-month follow-up, and a sustained complete response (SCR) as the persistence of normal ALT with undetectable viraemia. Side-effects were only observed in patients treated with rIFN plus ribavirin: four cases (13%) discontinued the therapy owing to haemolytic anaemia. Combination therapy induced an ETCR in 11 patients (37%) and an ETBR in six (20%), while a SCR was observed in two subjects (7%) and a SBR in four (13%). The use of a double dose of rIFN alone obtained an ETCR in four cases (13%) and an ETBR in five (17%), with a SCR in two (7%) and a SBR in three (10%). Hence, both combination therapy and single treatment with higher rIFN doses were unable to show statistically significant long-term benefits in patients with chronic hepatitis C resistant to a previous course of rIFN treatment.


Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Interferon-alpha/therapeutic use , Ribavirin/therapeutic use , Adult , Alanine Transaminase/blood , Drug Therapy, Combination , Female , Humans , Interferon alpha-2 , Male , Middle Aged , RNA, Viral/blood , Recombinant Proteins , Treatment Outcome
19.
Dig Liver Dis ; 32(8): 703-7, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11142581

ABSTRACT

BACKGROUND: Recently, the combination treatment of recombinant alpha-interferon plus ribavirin has been proposed for chronic hepatitis C patients unresponsive to previous therapy with recombinant alpha-interferon alone. AIM: To determine the effectiveness of the combination therapy for the re-treatment of chronic hepatitis C patients unresponsive to previous interferon therapy. Immediate and long-term follow-up data are reported. PATIENTS AND METHODS: A series of 100 patients with chronic hepatitis C not responding to recombinant alpha-interferon 3 MU tiw, were randomly assigned to two groups of 50 patients each: Group A, treated with recombinant alpha-interferon therapy for an additional six months but at a double dosage (6 MU tiw) in association with ribavirin. Group B, same treatment as group A but without ribavirin. All patients responsive to therapy were then followed-up for at least 12 months. At the end of the treatment and at the end of the follow-up period, we distinguished between complete responses (return to normal of alanine aminotransferase with undetectable serum HCV-RNA] and biochemical responses (return to normal of alanine aminotransferase still with detectable viraemia). RESULTS: Side-effects were observed only in patients treated with recombinant alpha-interferon plus ribavirin: 12% discontinued the therapy due to haemolytic anaemia. In group A, the percentages of end-of-treatment complete response, end-of-treatment biochemical response, sustained complete response, and sustained biochemical response, were 38%, 20%, 8%, and 14%, respectively, whilst in group B, these percentages were 12%, 16%, 6%, and 16%, respectively. CONCLUSION: The results indicate that in patients with chronic hepatitis C unresponsive to previous recombinant alpha-interferon therapy, re-treatment with higher recombinant alpha-interferon doses, either alone or in combination with ribavirin, lead to mild long-term benefit. However, the satisfactory end of treatment complete response in group A suggests that a significant percentage of patients are sensitive to the combination therapy; and that a more aggressive therapeutic protocol in this selected subset of patients could result in a larger number of long-lasting responses leading, in turn, to a more favourable cost-effect ratio.


Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Interferon Type I/therapeutic use , Ribavirin/therapeutic use , Alanine Transaminase/blood , Antiviral Agents/administration & dosage , Drug Administration Schedule , Drug Therapy, Combination , Female , Hepatitis C, Chronic/blood , Hepatitis C, Chronic/diagnosis , Humans , Interferon Type I/administration & dosage , Male , Middle Aged , Recombinant Proteins , Treatment Failure , Viral Load
20.
Rev. argent. microbiol ; 31(4): 193-200, oct.-dec. 1999.
Article in Portuguese | LILACS | ID: lil-332548

ABSTRACT

The strain BAFC 2336 of Curvularia pallescens is a hyphomycete isolated from internal fungi present in leaves and stems of Baccharis coridifolia. Three compounds designated B, D1 and D2 which inhibited the replication of vesicular stomatitis virus (VSV) and herpes simplex virus type 1 (HSV-1) in tissue cultures were isolated from fluid cultures of Curvularia pallescens. The purification procedure of the compounds consisted first in an organic solvent extraction followed by chromatography through a silica gel column. Fractions eluted from the column with antiviral activity were pooled and then subjected to thin layer chromatography (TLC) in silica gel plates. Three isolated bands were recognized with Rf of 0.63, 0.36 y 0.33 for B, D1 and D2, respectively. The chromatographic characteristics of the isolated metabolites were determined by TLC and HPLC and their chemical structure by means of spectroscopic methods. Analysis of the data obtained indicated that compound D2 (MW: 280 Da) is identical with Brefeldin A a macrolide with antiviral activity isolated from other fungi but not reported to be present in Curvularia pallescens. Compound D1 is similar in structure to compound D2; however, the low amount obtained after purification unabled us to obtain complete structural characterization. Compound B (MW: 332 Da) has an aromatic ring and a chemical structure related to curvularins, a generic name for certain metabolites from Curvularia. This compound appears to be a novel compound with antiviral potency similar to Brefeldin A, but less toxic.


Subject(s)
Antiviral Agents , Mitosporic Fungi/metabolism , Antiviral Agents
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