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2.
Cell Death Dis ; 7: e2164, 2016 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-27031961

RESUMO

Data on immune responses during human Ebola virus disease (EVD) are scanty, due to limitations imposed by biosafety requirements and logistics. A sustained activation of T-cells was recently described but functional studies during the acute phase of human EVD are still missing. Aim of this work was to evaluate the kinetics and functionality of T-cell subsets, as well as the expression of activation, autophagy, apoptosis and exhaustion markers during the acute phase of EVD until recovery. Two EVD patients admitted to the Italian National Institute for Infectious Diseases, Lazzaro Spallanzani, were sampled sequentially from soon after symptom onset until recovery and analyzed by flow cytometry and ELISpot assay. An early and sustained decrease of CD4 T-cells was seen in both patients, with an inversion of the CD4/CD8 ratio that was reverted during the recovery period. In parallel with the CD4 T-cell depletion, a massive T-cell activation occurred and was associated with autophagic/apoptotic phenotype, enhanced expression of the exhaustion marker PD-1 and impaired IFN-gamma production. The immunological impairment was accompanied by EBV reactivation. The association of an early and sustained dysfunctional T-cell activation in parallel to an overall CD4 T-cell decline may represent a previously unknown critical point of Ebola virus (EBOV)-induced immune subversion. The recent observation of late occurrence of EBOV-associated neurological disease highlights the importance to monitor the immuno-competence recovery at discharge as a tool to evaluate the risk of late sequelae associated with resumption of EBOV replication. Further studies are required to define the molecular mechanisms of EVD-driven activation/exhaustion and depletion of T-cells.


Assuntos
Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Doença pelo Vírus Ebola/patologia , ADP-Ribosil Ciclase 1/metabolismo , Adulto , Anticorpos Monoclonais/uso terapêutico , Apoptose , Linfócitos T CD4-Positivos/citologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/citologia , Linfócitos T CD8-Positivos/imunologia , Ebolavirus/fisiologia , ELISPOT , Citometria de Fluxo , Antígenos HLA-DR/metabolismo , Doença pelo Vírus Ebola/tratamento farmacológico , Doença pelo Vírus Ebola/imunologia , Humanos , Imuno-Histoquímica , Interferon gama/análise , Estudos Longitudinais , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Receptor de Morte Celular Programada 1/metabolismo , Receptor fas/metabolismo
3.
Clin Neurol Neurosurg ; 141: 43-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26731463

RESUMO

OBJECTIVES: To evaluate the efficacy and safety of Gamma Knife Radiosurgery (GKRS) in the treatment of single and multiple brain metastases. PATIENTS AND METHODS: From October 2012 to June 2014 106 patients were treated with Radiosurgery (RS) for brain metastases at University of Florence. 77 out of 106 patients had a radiological follow up and their data were analyzed. The target was defined as the enhancing lesion. The prescription dose was defined depending on tumor volume and tumor location. Each patient performed an MRI one month after GKRS for the first three months and every 3 months thereafter. Overall survival was calculated from the day of RS until death. Local recurrence (LR) was defined as radiologic growth of the irradiated lesion, while distant brain recurrence (DBR) was the evidence of brain lesion outside the previous irradiated field. Both the LR and DBR were calculated from the RS till the day of radiological evidence of relapse. The correlations within patient and disease characteristics and the outcomes of survival and disease control were analyzed. RESULTS: Mean follow up was 7.2 ± 4.8 months (range: 2.4-22.8 months). At the time of analysis 21 patients (27.3%) were dead. The overall survival (OS) at 1 year was 74%. On univariate Cox Regression analysis female gender (p=0.043, HR: 0.391, 95% CI: 0.157-0.972) and age >65 years (p=0.003 HR: 4.623, 95% CI: 1.687-12.663) were predictive for survival. On multivariate analysis, age older than 65 years (p=0.005HR: 4.254, 95% CI: 1.544-11.721) was confirmed as associated with worsened overall survival. 19 patients (24.7%) had recurrence in the radiosurgery field. The median time to local failure was 4.8 ± 2.0 months (range: 1.8-9.4 months) from GKRS. On Cox Regression univariate analysis, the only factor associated with higher risk of local failure was a number of treated lesions more than 4 (p=0.015, HR: 3.813, 95% CI: 1.298-11.202), no significant parameters were found at the multivariate analysis. The median time to develop distant brain failure was 6 ± 4.32 months (range: 1.08-21.6 months). Median distant brain control was 74% at 1 year. None of the factors analyzed was statistically significant for the distant brain relapse. The radiosurgery treatment was well tolerated. One patient treated for seven metastases developed seizures 8h after GKRS, he was treated with steroids and anticonvulsants. One patient had radiologic evidence of radionecrosis without any neurological symptoms. CONCLUSIONS: In well-performing patients with stable systemic disease radiosurgery can be performed as an exclusive treatment for brain metastases. Younger patients could have a greater benefit from the RS, on the other hand our finding confirm no correlation between the survival outcome and the number of lesions treated.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Gerenciamento Clínico , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
J Biol Regul Homeost Agents ; 27(4): 1001-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24382181

RESUMO

Type III interferons (IFN-lambda) are the most recently discovered members of IFN family. Synergism between different IFN types is well established, but for type I and type III IFNs no conclusive evidence has been reported so far. Possible synergism/antagonism between IFN-alpha and IFN-lambda in the inhibition of virus replication (EMCV, WNV lineage 1 and 2, CHIKV and HSV-1), and in the activation of intracellular pathways of IFN response (MxA and 2'-5' OAS) was evaluated in different cell lines (Vero E6, A549 and Wish cells). The antiviral potency of IFN-lambda1 and -l2 was lower than that of IFN-alpha. When IFN-alpha and -lambda were used together, the Combination Index (CI) for virus inhibition was greater than 1 virtually for all virus/host cell systems, indicating antagonistic effect. Antagonism between IFN-alpha and -l was also observed for the induction of mRNA for both MxA and 2'-5'OAS. Elucidating the interplay between IFN-alpha and -lambda may help to better understand innate defence mechanisms against viral infections, including the molecular mechanisms underlying the influence of IL-28B polymorphisms in the response to HCV and other viral infections.


Assuntos
2',5'-Oligoadenilato Sintetase/genética , Antivirais/antagonistas & inibidores , Interferon-alfa/antagonistas & inibidores , Interferons/farmacologia , Interleucinas/farmacologia , Animais , Chlorocebus aethiops , Vírus da Encefalomiocardite/efeitos dos fármacos , Humanos , Proteínas de Resistência a Myxovirus/genética , Células Vero , Replicação Viral/efeitos dos fármacos
5.
Euro Surveill ; 15(7)2010 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-20184855

RESUMO

In October 2009, a traveller returning from Africa to Italy was hospitalised with symptoms suggestive of a haemorrhagic fever of unknown origin. The patient was immediately placed in a special biocontainment unit until laboratory investigations confirmed the infection to be caused by a dengue serotype 3 virus. This case reasserts the importance of returning travellers as sentinels of unknown outbreaks occurring in other countries, and highlights how the initial symptoms of dengue fever resemble those of other haemorrhagic fevers, hence the importance of prompt isolation of patients until a final diagnosis is reached.


Assuntos
Vírus da Dengue/classificação , Dengue/diagnóstico , Viagem , Adulto , África , Dengue/fisiopatologia , Dengue/virologia , Vírus da Dengue/genética , Vírus da Dengue/isolamento & purificação , Febre de Causa Desconhecida/diagnóstico , Genótipo , Humanos , Itália , Masculino , Isolamento de Pacientes , Filogenia
6.
Arch Virol ; 151(2): 369-77, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16155806

RESUMO

Vero cells transfected with either neo- or bcl-2-plasmid were infected with SARS-CoV at a high multiplicity of infection. Apoptosis appeared after the onset of CPE and completion of virus replication, and could be prevented by Bcl-2 expression. Apoptosis is likely mediated by the mitochondrial pathway, as demonstrated by its inhibition using Bcl-2, and by the activation of the caspase cascade, resulting in PARP cleavage. Prevention of apoptosis did not affect susceptibility to infection, kinetics and extent of viral replication and release, thus implying that apoptosis is not involved in facilitating release and/or dissemination of SARS-CoV in Vero cells.


Assuntos
Apoptose , Caspases/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/fisiologia , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/patogenicidade , Replicação Viral , Animais , Chlorocebus aethiops , Proteínas Proto-Oncogênicas c-bcl-2/genética , Fatores de Tempo , Células Vero
7.
J Matern Fetal Neonatal Med ; 16(4): 245-6, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15590455

RESUMO

Cerebrovascular diseases are rare in pregnancy and mostly caused by rupture of an arterial aneurysm. We present the case of a pregnant woman at 36 weeks of gestation who had a subarachnoid hemorrhage resulting from rupture of an unknown aneurysm, and who underwent a Cesarean section and an endovascular treatment to embolize the aneurysm.


Assuntos
Aneurisma Roto/complicações , Aneurisma Intracraniano/complicações , Complicações Cardiovasculares na Gravidez , Hemorragia Subaracnóidea/etiologia , Adulto , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Angiografia Cerebral , Cesárea , Embolização Terapêutica , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Gravidez , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Clin Exp Immunol ; 138(2): 251-8, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15498034

RESUMO

In HIV infection, continuous immune activation leads to accelerated ageing of the adaptive immune system, similar to that observed in elderly people. We investigated the expression of WRN and BLM (genes involved in disorders characterized by premature ageing, genomic instability and cancer predisposition) in peripheral blood mononuclear cells (PBMC) activated in vitro with phytohaemagglutinin (PHA) and infected with different HIV-1 strains. The steady state levels of mRNA were analysed by reverse transcription-polymerase chain reaction (RT-PCR), and protein expression was assayed using immunocytochemistry and Western blot techniques. In uninfected PBMC, PHA stimulation induced an increase in BLM mRNA and protein expression, while WRN expression remained virtually unchanged. When PBMC were infected in vitro with a lymphotropic HIV-1 strain, the level of BLM mRNA showed a peak at 24 h of infection, followed by a decline to uninfected culture levels. A similar result failed to be seen using an R5-tropic HIV-1 strain. In accordance with mRNA expression, in HIV-infected cultures PBMC were stained more frequently and more intensely by a BLM-specific antibody as compared to uninfected cultures, staining peaking at 24. Conversely, WRN expression was not modulated by HIV-1. The proportion of cells showing BLM up-regulation, established by immunocytochemical staining, was much greater than the proportion of productively infected PBMC, as established by proviral DNA measurement. This result indicates that BLM up-regulation is probably a result of an indirect bystander cell effect. Activation of the BLM gene in infected PBMC suggests that premature ageing could be a further immunopathogenetic mechanism involved in HIV-induced immunodeficiency, and points to a possible new candidate target for innovative therapeutic intervention.


Assuntos
Adenosina Trifosfatases/genética , Síndrome de Bloom/genética , DNA Helicases/genética , Infecções por HIV/imunologia , HIV-1/imunologia , Leucócitos Mononucleares/imunologia , Síndrome de Werner/genética , Adenosina Trifosfatases/imunologia , Síndrome de Bloom/imunologia , Células Cultivadas , DNA Helicases/imunologia , Exodesoxirribonucleases , Regulação da Expressão Gênica/genética , Regulação da Expressão Gênica/imunologia , Infecções por HIV/genética , HIV-1/genética , Humanos , Imuno-Histoquímica/métodos , Proteínas Nucleares/genética , Proteínas Nucleares/imunologia , Fito-Hemaglutininas/imunologia , RNA Mensageiro/análise , RNA Viral/análise , RecQ Helicases , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Síndrome de Werner/imunologia , Helicase da Síndrome de Werner
9.
Mol Biol Cell ; 12(3): 753-60, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11251085

RESUMO

Transcription by RNA polymerase I in Saccharomyces cerevisiae requires a series of transcription factors that have been genetically and biochemically identified. In particular, the core factor (CF) and the upstream activation factor (UAF) have been shown in vitro to bind the core element and the upstream promoter element, respectively. We have analyzed in vivo the DNAse I footprinting of the 35S promoter in wild-type and mutant strains lacking one specific transcription factor at the time. In this way we were able to unambiguously attribute the protections by the CF and the UAF to their respective putative binding sites. In addition, we have found that in vivo a binding hierarchy exists, the UAF being necessary for CF binding. Because the CF footprinting is lost in mutants lacking a functional RNA polymerase I, we also conclude that the final step of preinitiation-complex assembly affects binding of the CF, stabilizing its contact with DNA. Thus, in vivo, the CF is recruited to the core element by the UAF and stabilized on DNA by the presence of a functional RNA polymerase I.


Assuntos
Proteínas Pol1 do Complexo de Iniciação de Transcrição , RNA Polimerase I/metabolismo , Proteínas de Saccharomyces cerevisiae , Saccharomyces cerevisiae/metabolismo , Fatores de Transcrição/metabolismo , Sítios de Ligação/genética , DNA Fúngico/genética , DNA Fúngico/metabolismo , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Proteínas Fúngicas/genética , Proteínas Fúngicas/metabolismo , Genes Fúngicos , Mutação , Regiões Promotoras Genéticas , RNA Polimerase I/genética , Saccharomyces cerevisiae/genética , Fatores de Transcrição/genética , Transcrição Gênica
10.
Ital Heart J Suppl ; 1(2): 241-9, 2000 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-10731382

RESUMO

BACKGROUND: The aim of this study was to verify the changes in the autonomic balance by means of heart rate variability assessment in patients with myocardial infarction referred for cardiac rehabilitation. METHODS: We studied 122 patients (79 males, 43 females, mean age 56 +/- 5 years), with a first uncomplicated myocardial infarction (anterior 48, thrombolysis 72), Killip class 1, preserved left ventricular function (ejection fraction 49 +/- 6%). All patients were free of inducible residual ischemia. Four weeks after myocardial infarction, patients were randomized into two groups; Group 1 (n = 58) referred for an 8 week cardiac rehabilitation program (scheduled: 24 sessions); Group 2 (n = 64): normal daily physical activity. During a 24-hour Holter ECG monitoring the following parameters were calculated in pharmacological wash-out at randomization (T0) and at the end of cardiac rehabilitation/control period (T1): mean value of RR intervals (RR), its standard deviation (SDNN), pNN50, rMSSD in the time domain; low frequency (LF) and high frequency (HF) value and the LF/HF ratio in the frequency domain. T1-T0 changes in percent values (delta %) were considered and compared between the two groups. RESULTS: Thirty-one patients were excluded from the study either for insufficient adhesion to the cardiac rehabilitation program (< 13 sessions, 22 patients) or recurrent ischemia (3 Group 1 patients and 3 Group 2 patients) and non-assessable 24-hour Holter ECG monitoring (3 patients). Thirty-one Group 1 patients and 60 Group 2 patients completed the study with a first and a second 24-hour Holter ECG monitoring performed at 30 +/- 3 days and 60 +/- 4 days respectively. At the same time an ergospirometric test was performed to evaluate cardiopulmonary function by means of exercise time, maximum oxygen consumption, anaerobic threshold, exercise time at the anaerobic threshold, and maximum oxygen consumption at the anaerobic threshold. Twenty-eight Group 1 patients and 44 Group 2 patients completed the study with a first and a second ergospirometric test. Baseline heart rate variability parameters were comparable in the two groups. During the observation period only in Group 1 patients heart rate variability parameters changed significantly: RR (Group 1 = +18.3 +/- 21.3; Group 2 = +4.2 +/- 5.2, p = 0.000), pNN50 (Group 1 = 45.0 +/- 38.9; Group 2 = +24.2 +/- 34.7, p = 0.011), HF (Group 1 = +81.6 +/- 124; Group 2 = -28.7 +/- 75.4, p = 0.014) and LF/HF ratio (Group 1 = -26.0 +/- 16.1; Group 2 = -4.9 +/- 6.1, p = 0.062). There were no significant differences in SDNN, rMSSD and LF. A linear correlation between delta LF/HF ratio and baseline LF/HF ratio values was found in Group 1 (r = 0.489, p = 0.006), whereas no correlation was found between this parameter and age, ejection fraction, creatine phosphokinase, and infarct localization. Group 1 patients had a significant improvement in exercise tolerance compared to Group 2 patients. CONCLUSIONS: A cardiac rehabilitation program positively modifies the sympatho-vagal balance in patients with uncomplicated myocardial infarction, increasing the parasympathetic tone and exercise tolerance.


Assuntos
Frequência Cardíaca/fisiologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/reabilitação , Idoso , Distribuição de Qui-Quadrado , Terapia Combinada , Eletrocardiografia Ambulatorial/métodos , Eletrocardiografia Ambulatorial/estatística & dados numéricos , Teste de Esforço/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
13.
J Neurosurg Sci ; 42(1 Suppl 1): 53-5, 1998 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9800605

RESUMO

Many references and communications regarding neurosurgical topics in elderly patients underline the interest of our Unit for this subject. We already presented in 1978 a series of 75 patients over 60 years of age operated on for intracranial aneurysms; we reported a 90% of success in all the cases operated with clinical grade 1 or 2 according to Botterel grading system on admission. In 1986, during the XXXV Congress of the Italian Neurosurgical Society, we presented other 15 cases operated for intracranial aneurysm over 70 years of age. We present an upgrading of our casistic.


Assuntos
Aneurisma Intracraniano/cirurgia , Idoso , Feminino , Humanos , Aneurisma Intracraniano/mortalidade , Aneurisma Intracraniano/fisiopatologia , Masculino , Fatores de Tempo , Resultado do Tratamento
14.
J Endocrinol Invest ; 20(4): 240-4, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9211134

RESUMO

In this report we describe the case of a young female patient with amenorrhea-galactorrhea syndrome apparently due to pituitary PRL-secreting adenoma who, after three years of dopaminergic therapy without any shrinkage of the tumor, developed true Cushing's disease. Progression from hyperprolactinemia to hypersecretion of ACTH has been rarely described and it may be due to different possibilities. However, histopathological and immunohistochemical studies of the adenoma showed a pattern of PRL negative and ACTH positive cells, excluding mixed pituitary tumor. In order to explain the progression from hyperprolactinemia with amenorrhea-galactorrhea to an ACTH hypersecretion syndrome, it must be hypothesized either pituitary stalk compression or the influence of paracrine regulation factor(s) (such as Galanine) due to an "initially silent" corticotropinoma. This case confirms that the presence of hyperprolactinemia in a patient with pituitary tumor and amenorrhea-galactorrhea syndrome is insufficient to confidently conclude for prolactinoma. Furthermore, it underlines the importance both of clinically monitoring the patient with prolactin pituitary adenoma if dopaminergic therapy does not reduce tumor volume, and of accurately and repeatedly measuring the other pituitary hormonal secretions.


Assuntos
Síndrome de Cushing/etiologia , Hiperprolactinemia/etiologia , Neoplasias Hipofisárias/complicações , Prolactinoma/complicações , Adulto , Amenorreia/sangue , Amenorreia/etiologia , Síndrome de Cushing/sangue , Síndrome de Cushing/terapia , Feminino , Galactorreia/sangue , Galactorreia/etiologia , Hormônio do Crescimento Humano/sangue , Humanos , Hiperprolactinemia/sangue , Hiperprolactinemia/terapia , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/terapia , Prolactina/sangue , Prolactinoma/sangue , Prolactinoma/terapia
15.
Eur Heart J ; 18(12): 1873-81, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9447314

RESUMO

BACKGROUND: Risk stratification after uncomplicated myocardial infarction is major clinical problem. In particular, the prognostic value of residual inducible ischaemia is still controversial. We compared the relative prognostic value of exercise ECG and dobutamine stress echocardiography performed in the early post-infarction period. METHODS: Four hundred and six patients (53 female) aged 57 +/- 9 years, undergoing maximal exercise ECG and dobutamine stress echocardiography within 10 days of an uncomplicated myocardial infarction off therapy, were prospectively followed-up for 8.8 months. Age, sex, diabetes, smoking habit, hypertension, dyslipidaemia, infarct location, thrombolysis and resting wall motion score index were taken into account among clinical variables. Prognostic correlations were made vs spontaneous events (cardiac death, non-fatal reinfarction and unstable angina requiring hospitalization) whilst patients undergoing revascularization (by means of percutaneous transluminal coronary angioplasty or coronary artery bypass surgery) at the time of the procedure were censored. RESULTS: One hundred and twenty-seven events occurred during the follow-up: 41 (10%) were spontaneous (five deaths, 12 reinfarctions and 24 unstable angina) and 86 procedural (27 angioplasty and 59 bypass surgery). Spontaneous events were not predicted by any clinical, exercise ECG or dobutamine stress echocardiography variable, but the negative predictive value of both tests was excellent (91% and 90% respectively). With a multivariate Cox analysis, male gender, positive low-workload (< 100 W) exercise ECG (P < 0.0001), positive low-dose dobutamine stress echocardiography (P < 0.0001) and rest-stress wall motion score index variation (P < 0.001) were found to predict cumulative cardiac events with an independent and additive value. Dobutamine stress echocardiography was significantly more sensitive (P < 0.05) and less specific (P < 0.01) in predicting the outcome of patients with anterior infarction, whilst exercise ECG was significantly more sensitive (P < 0.05) in patients with non-Q wave infarction. CONCLUSIONS: (1) Spontaneous events are poorly predicted by provocative tests in low-risk patients after uncomplicated myocardial infarction. (2) However, both exercise ECG and dobutamine stress echocardiography can predict a favourable outcome with a very high negative predictive value. (3) Dobutamine stress echocardiography should be considered a secondary option in cases where the exercise ECG is equivocal or when the location of ischaemia is a relevant issue. (4) The possibility that the two tests have a differential utility depending on the infarct location and type (Q wave vs non-Q wave) may be clinically relevant and deserves further evaluation.


Assuntos
Infarto do Miocárdio/complicações , Isquemia Miocárdica/diagnóstico , Idoso , Cardiotônicos , Dobutamina , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Sensibilidade e Especificidade , Ultrassonografia
16.
G Ital Cardiol ; 26(2): 187-99, 1996 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-8666176

RESUMO

BACKGROUNDS: The aim of the study was to assess the relative prognostic accuracy of dobutamine echocardiography (TED) vs maximal bicycle exercise electrocardiography (TE) in patients with proven coronary artery disease. METHODS: One hundred and thirty consecutive patients (70 patients with uncomplicated recent myocardial infarction, 19 asymptomatic patients with previous myocardial infarction and 41 patients with stable angina pectoris and previous myocardial infarction or previous myocardial revascularization procedure) underwent TED (incremental dobutamine infusion: 5 to 40 ncg/kg/min, continued with atropine 0.25 to 1 mg iv if necessary) and TE on different days and in random order. Criteria for positivity were: new or worsening regional dyssynergy for TED; ST segment shift > or = 1 mm from baseline for TE. End points were defined as spontaneous events (cardiac death, myocardial infarction and unstable angina) and total events (spontaneous events plus myocardial revascularization procedures). RESULTS: During 15.4 +/- 7.9 (range 1-33) months of follow-up, 33 events occurred: cardiac death (1), myocardial infarction (4) unstable angina (21) myocardial revascularization (7). Sensitivity, specificity, positive and negative predictive value, prognostic accuracy were similar for TED and TE (P = NS). Cumulative event-free survival curves as a function of TED and TE results were both statistically significant. A Cox stepwise regression analysis identified TED positivity obtained without atropine administration as the best predictor of spontaneous and total events (Odds ratio 5.33 and 4.38, respectively). Cumulative survival curves obtained by the combination of TED and TE results were statistically different (P < 0.05 and P < 0.001 for spontaneous and total events, respectively) and showed a poor clinical outcome in patients with both tests or only TED positive. TED correctly predicted clinical outcome in 24/39 patients in whom there was disagreement between the two tests. CONCLUSIONS: In patients with proven coronary artery disease, TED and TE have a similar accuracy for predicting clinical outcome. Where a discrepancy is seen between the two tests, TED appears to have a slightly higher prognostic value.


Assuntos
Doença das Coronárias/diagnóstico , Dobutamina , Ecocardiografia , Teste de Esforço , Idoso , Doença das Coronárias/mortalidade , Interpretação Estatística de Dados , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Fatores de Tempo
17.
J Am Coll Cardiol ; 26(4): 887-94, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7560613

RESUMO

OBJECTIVES: The prognostic value of dipyridamole echocardiography was assessed in patients with chronic coronary artery disease and preserved left ventricular function. BACKGROUND: Few data are available on the prognostic value of dipyridamole echocardiography in patients with a low risk of cardiac events. METHODS: Two hundred sixty-eight consecutive patients with stable, proven or suspected coronary artery disease and ejection fraction > or = 0.40 underwent high dose (up to 0.84 mg/kg body weight) dipyridamole echocardiography. In 204 patients definite exercise electrocardiographic (ECG) results were also available. RESULTS: During a mean (+/- SD) follow-up period of 16 +/- 8 months (range 6 to 36), 33 spontaneous events occurred: 15 "hard" events (cardiac death [n = 6], myocardial infarction [n = 9]) and 18 "soft" events (unstable angina). Events occurred more frequently in patients with positive findings on dipyridamole echocardiography (59% vs. 3%, p < 0.001; hard events 24% vs. 2%, p < 0.01). A positive response at the low dose (up to 0.56 mg/kg) identified patients with a high incidence of hard events (7 of 16 patients, sensitivity 50%, specificity 96%). In patients with an exercise ECG, a comparable sensitivity for cardiac events was found (89% vs. 93%, p = NS), but dipyridamole echocardiography was more specific (91% vs. 61%, p < 0.01). A positive response on the low work load exercise ECG (< 8 min) and a positive response to low dose dipyridamole echocardiography had similar accuracy (82% vs. 90%, p = NS). Cox analysis identified dipyridamole echocardiography as the best predictor of cardiac events (odds ratio [OR] 20.9, 95% confidence interval [CI] 10.8 to 37.9); the highest risk of hard events was found in patients with a positive response to low dose dipyridamole echocardiography (OR 25.4, 95% CI 12.2 to 54.1). CONCLUSIONS: In patients with chronic coronary artery disease and a low incidence of cardiac events, dipyridamole echocardiography was effective in prognostic stratification, and positive low work load exercise ECG results were a reliable predictor of subsequent events. Consequently, dipyridamole echocardiography should be considered a complementary tool in the presence of high work load positivity or ambiguous exercise ECG results.


Assuntos
Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/epidemiologia , Dipiridamol , Ecocardiografia/métodos , Vasodilatadores , Doença das Coronárias/diagnóstico , Eletrocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Função Ventricular Esquerda/fisiologia
18.
Acta Neurochir (Wien) ; 120(3-4): 103-10, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8460560

RESUMO

Fifty-one cases of posterior fossa haemangioblastoma have been seen in our department over a period of 23 years. Seven cases were associated with spinal cord lesions and one with a supratentorial lesion. There were 22 cases of Lindau's disease (43%). The onset was earlier and recurrences commoner than in isolated cases. In 10 cases the development of new tumours in different parts of the central nervous system (CNS) required re-operation, demonstrating the multicentric nature of this disease. The majority of the tumours occupying the fourth ventricle or medulla oblongata (8 cases) were macroscopically solid and had higher post-operative morbidity than the cystic tumours in the cerebellum. The recent development of magnetic resonance imaging (MRI) provides accurate anatomical information of the lesions (especially those of the brain stem and spinal cord) even while asymptomatic. The brilliant enhancement of these tumours on MRI with Gadolinium-diethyline-triamine-pentaacetic acid (Gd-DTPA) has proved to be particularly useful.


Assuntos
Neoplasias Encefálicas/cirurgia , Hemangiossarcoma/cirurgia , Adolescente , Adulto , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico , Tronco Encefálico/patologia , Tronco Encefálico/cirurgia , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/cirurgia , Angiografia Cerebral , Neoplasias do Ventrículo Cerebral/diagnóstico , Neoplasias do Ventrículo Cerebral/cirurgia , Fossa Craniana Posterior , Feminino , Seguimentos , Hemangiossarcoma/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/cirurgia , Exame Neurológico , Doença de von Hippel-Lindau/diagnóstico , Doença de von Hippel-Lindau/cirurgia
19.
Br J Neurosurg ; 7(1): 13-22, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8435140

RESUMO

Twelve patients with facial nerve neurinoma have been treated at The National Hospital, Queen Square, London, during the last 20 years. Nine tumours lay in the middle fossa arising from the area of the geniculate ganglion, two lay in the posterior fossa arising from the segment of the facial nerve in the internal auditory canal, and one tumour arose from the vertical segment of the facial nerve with extracranial extension through the stylomastoid foramen. Two patients had neurofibromatosis. The clinical and radiographic features of those tumours, the operative approaches employed, and the postoperative outcome are described. Complete tumour excision was achieved in all patients; all 12 remain free of recurrence 3-80 months after surgery. Facial nerve function was restored at least in part in all cases by transposition with end-to-end anastomosis, placement of a cable graft from the sural nerve or hypoglosso-facial anastomosis. The major determinant of the outcome of facial nerve function was the duration of preoperative facial paralysis, the results being invariably poor when this was of long duration.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Doenças do Nervo Facial/cirurgia , Neuroma/cirurgia , Adolescente , Adulto , Anastomose Cirúrgica , Neoplasias dos Nervos Cranianos/diagnóstico , Doenças do Nervo Facial/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Microcirurgia , Pessoa de Meia-Idade , Exame Neurológico , Neuroma/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Nervo Sural/transplante , Tomografia Computadorizada por Raios X
20.
Br J Neurosurg ; 5(1): 83-6, 1991.
Artigo em Inglês | MEDLINE | ID: mdl-2021438

RESUMO

A case of cavernous angioma involving the facial nerve is described. The patient presented with decreased hearing on one side and after investigation a small mass was discovered enlarging the internal auditory meatus. The final diagnosis was made at operation. The pathology of this type of malformation is discussed.


Assuntos
Neoplasias Cerebelares/diagnóstico , Ângulo Cerebelopontino , Hemangioma Cavernoso/diagnóstico , Adulto , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Doenças do Nervo Facial/cirurgia , Hemangioma Cavernoso/patologia , Hemangioma Cavernoso/cirurgia , Humanos , Masculino
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