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1.
Transplant Proc ; 48(2): 395-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27109964

RESUMO

BACKGROUND: Recent studies have challenged the dogma that the adult heart is a postmitotic organ and raise the possibility of the existence of resident cardiac stem cells (CSCs). Our study aimed to explore if these CSCs are present in the "ventricular tip" obtained during left ventricular assist device (LVAD) implantation from patients with end-stage heart failure (HF) and the relationship with LV dysfunctional area extent. METHODS: Four consecutive patients with ischemic cardiomyopathy and end-stage HF submitted to LVAD implantation were studied. The explanted "ventricular tip" was used as a sample of apical myocardial tissue for the pathological examination. Patients underwent clinical and echocardiographic examination, both standard transthoracic echocardiography (TTE) and speckle tracking echocardiography (STE), before LVAD implantation. RESULTS: All patients presented severe apical dysfunction, with apical akinesis/diskinesis and very low levels of apical longitudinal strain (-3.5 ± 2.9%). Despite this, the presence of CSCs was demonstrated in pathological myocardial samples of "ventricular tip" in all 4 of the patients. It was found to be a mean of 6 c-kit cells in 10 fields magnification 40×. CONCLUSIONS: Cardiac stem cells can be identified in the LV apical segment of patients who have undergone LVAD implantation despite LV apical fibrosis.


Assuntos
Insuficiência Cardíaca/terapia , Ventrículos do Coração/citologia , Coração Auxiliar , Isquemia Miocárdica/terapia , Miocárdio/citologia , Células-Tronco/citologia , Biópsia , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Fibrose , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/patologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/patologia , Miocárdio/patologia , Implantação de Prótese
2.
Mult Scler ; 21(10): 1244-50, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25583850

RESUMO

OBJECTIVE: To assess multiple sclerosis (MS) incidence from 1998 to 2007, and MS prevalence on 31 December 2007, in the province of Genoa, Italy. METHODS: We identified MS cases diagnosed before 31 December 2007 by analyzing archives of hospitals with neurological or rehabilitation wards, the local Italian MS society, family doctor records and requests for oligoclonal band analysis on cerebrospinal fluid (CSF). RESULTS: A total of 1312 MS patients were residing in the province of Genoa on the prevalence day; 431 (32.85%) were men and 881 (67.15%) were women; mean age was 50.6 (± 13.9). The overall crude MS prevalence rate was 148.5/100,000; 103.1/100,000 in men and 189.1/100,000 in women. The crude mean annual MS incidence rate was 6.6 cases/100,000 (4.4/100,000 men; 8.6/100,000 women). Mean age at diagnosis was 39.5 ± 12.3 (men: 39.9 ± 13.0; women: 39.3 ± 11.9). A mean annual incidence of 4 MS patients ≥ 60 was observed. CONCLUSIONS: We observed an increased MS prevalence in the province of Genoa, compared to 1997. The mean age at diagnosis was relatively high (39 years old), 18% of our MS patients were over 65, and a notable incidence increase was seen in patients over 60. This has important implications, in terms of the need to organize the health system to better serve elderly MS patients, especially considering comorbidities and different medical needs of elderly MS patients; and to increase awareness within the medical community about the increasing risk of newly-presenting MS in the older population.


Assuntos
Envelhecimento/fisiologia , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Adulto Jovem
3.
Eur Rev Med Pharmacol Sci ; 18(3): 416-20, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24563444

RESUMO

INTRODUCTION: Carbon dioxide (CO2) therapy refers to trans-cutaneous or sub-cutaneous administration of CO2 for therapeutic purposes, and recent studies have pointed out that it produces a vasodilation effect after it is locally injected, which helps amplify the reconstructive potentiality of an expanded-muscle flap. MATERIALS AND METHODS: Thirty male Wistar rats, weighting between 350 and 400 g, were randomly divided into three groups of 10. In the first group, single intra-operative rapid expansion was carried out under the right latissimus dorsi muscle. In the second group, for five days prior to surgery, a pre-treatment with intramuscular injections of CO2 was performed. The third group served as controls. For each group, the latissimus dorsi muscle was fixed as soon possible after mice died, and ultrathin sections of it examined with transmission electron microscope. RESULTS: In the treated group, the majority of expanded muscles showed a normal striation pattern, whereas a few fibers showed mild disorganization of the myo-filaments in the sarcomeres, which appeared overstretched (average 2.37 µm). CONCLUSIONS: This evidence could demonstrate a greater capacity of muscle recovery after treatment by CO2 expansion.


Assuntos
Dióxido de Carbono/farmacologia , Músculo Esquelético , Retalhos Cirúrgicos/irrigação sanguínea , Expansão de Tecido , Animais , Dióxido de Carbono/administração & dosagem , Masculino , Microscopia Eletrônica de Transmissão , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/ultraestrutura , Ratos Wistar
4.
Neuromuscul Disord ; 20(8): 512-6, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20580235

RESUMO

Mutations in the lamin A/C gene (LMNA) are known to be involved in several diseases such as Emery-Dreifuss muscular dystrophy, limb-girdle muscular dystrophy type 1B and dilated cardiomyopathies with conduction disease, with considerable phenotype heterogeneity. Here we report on a novel autosomal dominant mutation in LMNA in two direct relatives presenting with different clinical phenotypes, characterized by severe life-threatening limb-girdle muscle involvement and cardiac dysfunction treated with heart transplantation in the proband, and by ventricular tachyarrhythmias with preserved cardiac and skeletal muscle function in her young son. To our knowledge, this is the first report of a duplication in the LMNA gene. The two phenotypes described could reflect different clinical stages of the same disease. We hypothesize that early recognition and initiation of therapeutic manoeuvres in the younger patient may retard the rate of progression of the cardiomyopathy.


Assuntos
Cardiopatias/genética , Cardiopatias/fisiopatologia , Transplante de Coração/fisiologia , Coração/fisiopatologia , Lamina Tipo A/genética , Distrofia Muscular do Cíngulo dos Membros/genética , Adulto , Sequência de Aminoácidos , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/genética , Cardiomiopatia Dilatada/patologia , Eletrocardiografia , Feminino , Duplicação Gênica , Cardiopatias/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Dados de Sequência Molecular , Debilidade Muscular/genética , Músculo Esquelético/patologia , Distrofia Muscular do Cíngulo dos Membros/diagnóstico por imagem , Distrofia Muscular do Cíngulo dos Membros/patologia , Proteínas Nucleares/genética , Linhagem , Fenótipo , Volume Sistólico/fisiologia , Tomografia Computadorizada por Raios X
6.
Neurol Sci ; 31 Suppl 1: S73-6, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20464588

RESUMO

The prevalence of headache decreases with age. However, headache is still ranked as one of the most frequent complaints in the elderly. Aging is accompanied by a decline in the incidence of most primary headache disorders and by an increase in organic causes of headache, especially after 55-60 years of age. New onset headaches or a change in headache pattern in this age group carries a high index of suspicion for organic diseases. A broad differential diagnosis and unique diagnostic considerations must be considered. Secondary headache disorders reflect underlying organic diseases such as giant cell arteritis, intracranial mass lesion, cerebrovascular diseases or metabolic abnormality.


Assuntos
Transtornos Cerebrovasculares/complicações , Arterite de Células Gigantes/complicações , Transtornos da Cefaleia Secundários/epidemiologia , Transtornos da Cefaleia Secundários/etiologia , Doença de Parkinson/complicações , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Diagnóstico Diferencial , Dor Facial/complicações , Transtornos da Cefaleia Secundários/diagnóstico , Humanos , Incidência , Pessoa de Meia-Idade , Prevalência
7.
Eur J Clin Invest ; 39(12): 1065-72, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19811526

RESUMO

BACKGROUND: Advanced glycation endproducts (AGEs), particularly carboxymethyl(lysine)-adducts (CML), exert part of their cellular effects by binding to a receptor, named receptor for AGEs (RAGE). The soluble form of this receptor (sRAGE) has been shown to have an athero-protective role. We hypothesized the existence of a relationship between the AGE-RAGE axis and the occurrence of symptoms related to carotid atherosclerosis in nondiabetic conditions. MATERIALS AND METHODS: We evaluated plasma levels of CML and sRAGE (by ELISA), and tissue levels (tAGEs and tRAGE, semiquantitatively, by immunohistochemistry) in endarterectomy carotid plaque tissue in 29 nondiabetic patients. At the time of surgery, 10 patients were asymptomatic and 19 were symptomatic. RESULTS: Plasma levels of sRAGE were higher in symptomatic patients than in asymptomatic patients [median (interquartile range): 676 (394-858) pg mL(-1) vs. 347 (284-479) pg mL(-1), P = 0.009]. In symptomatic patients, plasma levels of sRAGE correlated positively with CML (r = 0.60, P < 0.01), C-reactive protein (CRP) (r = 0.618, P < 0.01) and fibrinogen (r = 0.522, P<0.005), while in asymptomatic patients, no correlation was observed. Although tissue and plasma levels of AGEs and RAGE did not correlate between each other, tAGEs and tRAGE were also positively correlated only in symptomatic patients (chi(2) = 8.93, P = 0.003). CONCLUSIONS: Plasma levels of sRAGE are higher in symptomatic than asymptomatic carotid atherosclerosis. Higher levels of sRAGE in symptomatic patients may be markers of a higher degree of vascular inflammation in such patients.


Assuntos
Aterosclerose/sangue , Doenças das Artérias Carótidas/sangue , Artéria Carótida Primitiva , Produtos Finais de Glicação Avançada/sangue , Lisina/análogos & derivados , Receptores Imunológicos/sangue , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/patologia , Proteína C-Reativa/análise , Doenças das Artérias Carótidas/patologia , Estenose das Carótidas/patologia , Ensaio de Imunoadsorção Enzimática , Feminino , Fibrinogênio/análise , Humanos , Imuno-Histoquímica , Modelos Lineares , Lisina/sangue , Masculino , Receptor para Produtos Finais de Glicação Avançada
8.
Arch Gerontol Geriatr ; 49(1): 180-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19095314

RESUMO

Our aim was to evaluate the factorial structure of the mini mental state examination (MMSE) in Alzheimer's disease (AD). Five hundred and twenty-four consecutive outpatients at their first diagnostic work-up (age 78.02+/-6.07 years, education 6.62+/-3.48 years, mean MMSE score 20.23+/-4.89) (+/-S.D.) with probable AD (based on DSM-IV and NINCDS-ADRDA criteria) were enrolled in a multicenter, cross-sectional, regional-based study. For the purpose of the present study, the 11 subtests composing the MMSE and the global MMSE score (ranging from 10 to 29, included) were considered. Factor analysis with Varimax rotation method identified two factors that explained about the 85% of total variance. The first factor explained the 65% of variance and mainly included temporal orientation, delayed recall, attention/concentration, and constructional praxia. The second factor explained the 20% of variance and included reading a sentence, writing a sentence, naming, verbal repetition and immediate memory. The first factor was a reliable index of cognitive deterioration along the MMSE score interval between 29 and 10, whereas the second factor was not a suitable marker in this range. The two-factor structure of the MMSE in AD is shown in a large series of patients. The first factor expresses the ability to use new information and is related with working memory. The second factor is related with a more consolidated knowledge, namely verbal abilities, and is essentially useless in mild to moderate AD.


Assuntos
Doença de Alzheimer/diagnóstico , Testes Neuropsicológicos , Idoso , Doença de Alzheimer/epidemiologia , Análise Fatorial , Feminino , Humanos , Masculino , Índice de Gravidade de Doença
9.
Neurol Sci ; 28(3): 156-8, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17603770

RESUMO

Oxcarbazepine (OXC) is an anitepileptic medication recently approved as monotherapy for partial onset seizure and demonstrated to be useful in the treatment of several neuropathic pain. We performed an open-label pilot study of OXC (dosage 600-1200 mg/day) in 12 multiple sclerosis (MS) patients suffering painful paroxysmal symptoms. Eight subjects were female and 4 male, with a mean age of 43.6 years, mean disease duration of 7.3 years and mean score at the EDSS of 3.2. Ten patients had a relapsing-remitting disease course, 1 had secondary progressive and 1 had primary progressive course. Painful paroxysmal symptoms (PPS) were defined as transient painful symptoms in any area of the body, with abrupt onset, brief duration, from a few seconds to a few minutes, with repetitive and stereotyped features. The subjective level of the PPS was scored using a three-point scale (0-3). The mean dosage of OXC was 1033 mg daily. Nine patients experienced a complete and sustained recovery within 1 month from treatment initiation (T0 vs. T1, p>0.05). Two patients dropped out of the study due to adverse effects: 1 case of nausea and dizziness, 1 case of C. hyponatraemia. The medication was well tolerated in the majority of the subjects. The study results provide a new possibility for treating painful symptoms in MS, but efficacy on PPS must be confirmed in a larger study.


Assuntos
Anticonvulsivantes/administração & dosagem , Carbamazepina/análogos & derivados , Esclerose Múltipla/complicações , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Adulto , Carbamazepina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxcarbazepina , Medição da Dor , Projetos Piloto
10.
Mult Scler ; 13(3): 428-32, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17439914

RESUMO

We evaluated upper limb function in multiple sclerosis (MS) subjects (11 clinically definite MS patients and seven clinically isolated syndrome (CIS) subjects), with a normal upper limb standard neurological examination. Subjects performed center-out reaching movements under visual control, with and without vision of the hand. Their movements were recorded through a digitizing tablet. Motor performance was also related to lesion load, estimated from magnetic resonance imaging (MRI). We found that in MS and CIS subjects, under the hand vision condition, movements were significantly less smooth, and had a less symmetric speed profile. However, the observed impairment did not correlate with MRI findings. This result may be interpreted as evidence of a compensatory strategy, elicited by subtle alterations in sensorimotor control.


Assuntos
Braço , Encéfalo/patologia , Atividade Motora , Esclerose Múltipla/fisiopatologia , Desempenho Psicomotor , Adulto , Idade de Início , Doenças Desmielinizantes/fisiopatologia , Doenças Desmielinizantes/psicologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Esclerose Múltipla/psicologia , Valores de Referência
11.
Eur J Neurol ; 13(12): 1374-7, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17116223

RESUMO

Epidemiological data show a higher prevalence of late-onset Alzheimer's disease (AD) in women. The estrogenic deficiency in the post-menopausal period is suspected to be the cause of the gender-related risk of the disease, but studies on the estrogenic therapy and occurrence of AD were not consistent and sometimes contradicting. The aim of this study is to investigate whether a higher exposure to endogenous estrogens is associated with lower risk of dementia or not. Two hundred and four AD patients and 201 control women were considered. By interviews, we evaluated different variables, indirectly correlated to estrogenic natural exposure, as well as educational level and head trauma. These data were correlated in the AD group with the disease progression, as well as with the age at onset. Unexpectedly, we found a significant higher number of pregnancies in the AD than in the control group. Within the AD cases, the number of lifetime pregnancies is related to an earlier onset of the disease. As previously reported, we confirmed that the educational level is a protective factor and that major head trauma represents a risk factor in developing AD. The higher number of pregnancies and a less frequency of nulliparous women, indirectly relate the AD group to a higher estro-progestinic exposure. These findings suggest that it is the increase of progesterone or estrogens level--and not the estrogens decrease, as previously indicated by other authors--that could play a role in the Alzheimer's pathology.


Assuntos
Doença de Alzheimer/epidemiologia , Paridade/fisiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/prevenção & controle , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/prevenção & controle , Terapia de Reposição de Estrogênios , Feminino , Humanos , Incidência , Gravidez , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
12.
Neurol Sci ; 26(1): 43-5, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15877187

RESUMO

The pathogenetic role of patent foramen ovale (PFO) in embolic stroke and its prognostic and therapeutic implications have not yet been clearly defined. Nonetheless, recent availability of non-invasive diagnostic techniques, such as the transcranial Doppler (TCD), has increased the frequency with which this anomaly is diagnosed. Here we present the case of a young woman affected by post-partum peripheral facial palsy: further exams disclosed not only its truncal-ischaemic origin, but also, significantly, the presence of PFO, as well as of anticardiolipin antibodies (acL). Given the increased embolic risk in labouring women, this study highlights the importance of searching for PFO in case of a stroke during pregnancy.


Assuntos
Infartos do Tronco Encefálico/etiologia , Doenças do Nervo Facial/etiologia , Comunicação Interatrial/complicações , Complicações Cardiovasculares na Gravidez/fisiopatologia , Acidente Vascular Cerebral/etiologia , Adulto , Anticorpos/sangue , Infartos do Tronco Encefálico/patologia , Infartos do Tronco Encefálico/fisiopatologia , Cardiolipinas/imunologia , Causalidade , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Nervo Facial/patologia , Nervo Facial/fisiopatologia , Doenças do Nervo Facial/patologia , Doenças do Nervo Facial/fisiopatologia , Feminino , Humanos , Imunoglobulina M/sangue , Imageamento por Ressonância Magnética , Ponte/patologia , Ponte/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Fatores de Risco , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia
13.
J Neurol ; 252(4): 436-40, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15726261

RESUMO

UNLABELLED: The objective of this study was to assess the prevalence of multiple sclerosis (MS), calculated as point prevalence on 31 December 1997, in the province of Genoa, North-western Italy. METHODS: The province of Genoa is located in North-western Italy, an area of 1,835 km(2). On the point prevalence day the population consisted of 913,218 inhabitants. MS cases were identified by analysing archives of the hospitals with neurological or rehabilitation wards, neurologists serving the community, files of local chapters of the Italian MS society, all requests for oligoclonal bands analysis on CSF in the studied area. Patients included in the study were MS cases diagnosed before 31 December 1997 according to the Poser criteria resident in the province under study. RESULTS: A total of 857 subjects were alive and residing in the province of Genoa on the prevalence day. The overall crude prevalence rate was 94 per 100,000 (95% CI 88-100); 291 were males (34%) with a crude prevalence of 67 per 100,000 (95 % CI 60-76) and 566 were females (66%) with a prevalence of 118 per 100,000 (95% CI 108-128). The female/male ratio was 1.9. When age and sex were adjusted to the Italian standard population of 1991 prevalence was 85 per 100,000. Five hundred and thirty two out of the 857 patients agreed to be interviewed. The interviewed sample was representative of the prevalence sample: sex and gender distributions were identical in the two samples. The overall mean age was 48 (+/-13) years (48 +/-12 years in males; 48+/-14 years in females). Mean disease duration was 15 (+/-10) years for males and 16 (+/-11) years for females. Two hundred and ninety one (55 %) subjects had a relapsing remitting (RR) clinical course, 150 (28%) were secondary progressive (SP) and 91 (17%) were primary progressive (PP). Mean EDSS score was 5 (+/- 2; median 5). The mean age at time of onset was 33 (+/-10) years for males and 32 (+/- 11) years for females. The disease onset was monosymptomatic in 76% (n=407) patients and polysymptomatic in 24% (n=125). The mean length of time between clinical onset and diagnosis was 5 (+/- 6) years. CONCLUSION: We confirmed that the province of Genoa is a very high risk area for MS. We found a high rate of patients with a PP course; also the proportion of patients with high disability scores is greater compared to previous studies.


Assuntos
Esclerose Múltipla/epidemiologia , Adulto , Fatores Etários , Idade de Início , Estudos Transversais , Avaliação da Deficiência , Progressão da Doença , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Taxa de Sobrevida
15.
J Cardiovasc Surg (Torino) ; 42(6): 777-9, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11698945

RESUMO

Primary cardiac neurilemoma, a benign tumor, is extremely uncommon. To our knowledge only eight cases have been reported in the literature. We report a case of a 72-year-old man who presented with complaints of progressive shortness of breath and chest pain, seven years after a right nephrectomy for renal adenocarcinoma. An intra-right atrial tumor was surgically removed; the lesion was found to be a neurilemoma of the right atrium. This case report describes the surgical removal and rarity of neurilemomas, their predisposition to be right-sided in the heart and their coincidental association with other types of cancer.


Assuntos
Neoplasias Cardíacas/diagnóstico , Neurilemoma/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Angina Pectoris/etiologia , Diagnóstico Diferencial , Dispneia/etiologia , Átrios do Coração , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Neoplasias Renais/cirurgia , Masculino , Neurilemoma/complicações , Neurilemoma/cirurgia
16.
Hum Pathol ; 32(9): 1003-11, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11567232

RESUMO

The etiopathogenesis of thoracic aortic aneurysms is currently an issue of debate. The present study investigated ultrastructural, morphometric, and immunohistochemical aspects of smooth muscle cells (SMCs) in chronic aneurysm of the thoracic aorta (aneurysm group), aortic dilatation associated with valvular disease (valvular group), and dissection of the thoracic aorta (dissection group). Fragments of the ascending aorta that had been taken from the patients during coronary bypass surgery were used as controls. No significant difference was observed in the density of SMCs between the 3 pathologic groups put together and the controls. Only separate analysis of SMC density in each of the pathologic groups showed that the valvular group samples had significantly smaller amounts of SMCs in the internal layer of the media than the dissection group samples and controls. Ultrastructural analysis, in situ end labeling, propidium iodide assay, and DNA laddering did not show apoptosis of SMCs in the samples investigated. Ultrastructure of SMCs characteristic of the synthetic phenotype, together with increased expression of osteopontin in the media of pathologic thoracic aortas indicated the transition of SMCs from the contractile to the synthetic phenotype. Immunohistochemical investigation showed that medial SMCs in the samples taken from aortas of all 3 pathologic groups expressed stronger immunoreactivity for matrix metalloproteinase 1, 2, and 9 and tissue inhibitor of metalloproteinase 1 and 2 than the controls. The present study shows that during the formation of aneurysms, dissection of the thoracic aorta, or aortic dilatation associated with valvular disease, loss of SMCs was not of great importance with respect to their transition from the contractile to the synthetic type in leading to increased production of matrix metalloproteinases.


Assuntos
Aneurisma da Aorta Torácica/patologia , Metaloproteinases da Matriz/metabolismo , Músculo Liso Vascular/patologia , Sialoglicoproteínas/metabolismo , Inibidores Teciduais de Metaloproteinases/metabolismo , Túnica Média/patologia , Adulto , Idoso , Dissecção Aórtica/metabolismo , Dissecção Aórtica/patologia , Aorta Torácica/metabolismo , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/metabolismo , Apoptose , Fragmentação do DNA , Matriz Extracelular/ultraestrutura , Feminino , Doenças das Valvas Cardíacas/metabolismo , Doenças das Valvas Cardíacas/patologia , Humanos , Imuno-Histoquímica , Marcação In Situ das Extremidades Cortadas , Masculino , Inibidores de Metaloproteinases de Matriz , Microscopia Eletrônica , Pessoa de Meia-Idade , Músculo Liso Vascular/metabolismo , Osteopontina , Túnica Média/metabolismo
18.
J Pediatr ; 138(1): 101-4, 2001 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11148520

RESUMO

The relation between clinical or histologic chorioamnionitis and early neonatal adverse neurologic outcome was investigated (n = 483). Histologic, but not clinical, evidence of chorioamnionitis was found to be a significant predictor of periventricular echodensity (odds ratio, 2.4; 95% CI, 1.8-3.2), echolucency (3.3; 1.9-5.6), ventriculomegaly (2.7; 1.8-4.2), intraventricular hemorrhage > or =3 (3.5; 2.4-5.2), and seizures (2.3; 1.4-3.7).


Assuntos
Lesões Encefálicas/etiologia , Ventrículos Cerebrais/lesões , Corioamnionite/complicações , Corioamnionite/patologia , Técnicas Histológicas/normas , Hemorragias Intracranianas/etiologia , Leucomalácia Periventricular/etiologia , Convulsões/etiologia , Fatores Etários , Lesões Encefálicas/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Hemorragias Intracranianas/diagnóstico por imagem , Leucomalácia Periventricular/diagnóstico por imagem , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Placenta/patologia , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Fatores de Risco , Convulsões/diagnóstico por imagem , Sensibilidade e Especificidade , Método Simples-Cego , Ultrassonografia Doppler Transcraniana
19.
Saudi Med J ; 21(1): 18-23, 2000 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11533745

RESUMO

During the recent years, a significant number of anti-epileptic drugs have been approved for prescription in different countries. In addition, some other promising drugs are in various stages of development. Soon after each drug has found its place in the therapeutic arsenal, pregnancies with exposure occur, with an increased risk of birth defect and developmental disturbances. As regards the possible teratogenic effect of the new anti-epileptic drugs, apart some individual reports we have only the results of pre-clinical toxicological studies which are difficult to extrapolate to the human situation, because of the well-known interspecies differences in pharmacokinetics and pharmacodynamics. Furthermore, combinations of anti-epileptic drugs are not tested pre-clinically while these new drugs are prescribed as add-on medication. So, metabolic interactions between individual components of such drug combinations may induce unexpected teratogenic effects. Also as for the teratogenic effects of the old drugs many questions have still to be defined. The most common and more important are which anti-epileptic drugs or combination of drugs is most safe for a particular woman with epilepsy and if there is an association between single anti-epileptic drugs and specific malformations. The reason is that none of the available reports to date have studied a sufficient number of women with epilepsy exposed to anti-epileptic drug monotherapy during pregnancy. Other questions concern dose-effect relationships, a universally accepted definition of major and minor malformations, and the lack of a thorough, exhaustive evaluation of the other risk factors, apart from the drugs. All these questions need to be ascertained for both the old and the new anti-epileptic drugs. Owing to these considerations, in 1998 an European Register of anti-epileptic drugs and pregnancy was instituted. The primary objective of the study is to evaluate and determine the degree of safety, with respect to the human foetus, of anti-epileptic drugs with reference to both old and new, and to individual drugs and drugs in combination. Secondary objectives are to establish the pattern of abnormalities, if any, associated with anti-epileptic drugs individually and in combination, to delineate drug-specific syndromes, if any, to evaluate dose-effect relationships. Tertiary objectives are to provide references data for use in pre-pregnancy counselling, and for development of guidelines. The evaluation of other etiological risk factors is also considered.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/epidemiologia , Anormalidades Induzidas por Medicamentos/etiologia , Anormalidades Induzidas por Medicamentos/prevenção & controle , Anticonvulsivantes/classificação , Anticonvulsivantes/farmacologia , Terapia Combinada , Relação Dose-Resposta a Droga , Feminino , Feto/efeitos dos fármacos , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto , Gravidez , Resultado da Gravidez/epidemiologia , Fatores de Risco
20.
Neurosciences (Riyadh) ; 5(1): 1-6, 2000 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24276653

RESUMO

During the recent years, a significant number of anti-epileptic drugs have been approved for prescription in different countries. In addition, some other promising drugs are in various stages of development. Soon after each drug has found its place in the therapeutic arsenal, pregnancies with exposure occur, with an increased risk of birth defect and developmental disturbances. As regards the possible teratogenic effect of the new anti-epileptic drugs, apart some individual reports we have only the results of pre-clinical toxicological studies which are difficult to extrapolate to the human situation, because of the well-known interspecies differences in pharmacokinetics and pharmacodynamics. Furthermore, combinations of anti-epileptic drugs are not tested pre-clinically while these new drugs are prescribed as add-on medication. So, metabolic interactions between individual components of such drug combinations may induce unexpected teratogenic effects. Also as for the teratogenic effects of the `old` drugs many questions have still to be defined. The most common and more important are which anti-epileptic drugs or combination of drugs is most safe for a particular woman with epilepsy and if there is an association between single anti-epileptic drugs and specific malformations. The reason is that none of the available reports to date have studied a sufficient number of women with epilepsy exposed to anti-epileptic drug monotherapy during pregnancy. Other questions concern dose-effect relationships, a universally accepted definition of major and minor malformations, and the lack of a thorough, exhaustive evaluation of the other risk factors, apart from the drugs. All these questions need to be ascertained for both the old and the new anti-epileptic drugs. Owing to these considerations, in 1998 an European Register of anti-epileptic drugs and pregnancy was instituted. The primary objective of the study is to evaluate and determine the degree of safety, with respect to the human foetus, of anti-epileptic drugs with reference to both old and new, and to individual drugs and drugs in combination. Secondary objectives are to establish the pattern of abnormalities, if any, associated with anti-epileptic drugs individually and in combination, to delineate drug-specific syndromes, if any, to evaluate dose-effect relationships. Tertiary objectives are to provide references data for use in pre-pregnancy counselling, and for development of guidelines. The evaluation of other etiological risk factors is also considered.

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