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Biomedical subjects

A Pagano

Publications and source records attributed to A Pagano.

120 records · Page 7Linked to original sources
PubMedDate not supplied

[Unusual pathology caused by Salmonella in the Greater Hospital of Milan in the 3-year period of 1977-1979].

At the Central Laboratory of the Medical School, University of Milano, Italy, 44 Salmonella strains were isolated from morbid materials other than stools during the three-years period 1977-79 (blood 26, urine 6, pus 3, pleural fluid 4, bile 3, upper respiratory mucus 2). In the present paper, nine cases of Salmonella infections, selected for their unusual localization a/o their peculiar clinical onset, are reviewed. From most of the clinical histories it appears that, in quite a few occasions, the episode due to Salmonella has been favoured or conditioned by a preexisting disease, therefore suggesting a nosocomial-type event. It also appears that the help from the microbiologist was often requested less than promptly, and minimal requirements for its efficacy were seldom achieved.

Adolescent↗
PubMedDate not supplied

[Electronic organization in the management of a central reference for pathogenic enterobacteria].

Since 1978 as a pilot study and, since 1979 in routine way, an epidemiological form is used at the Reference Center for Pathogenic Enteric Bacteria of Northern Italy; it accompanies all strains of enteric bacteria sent by hospital, clinical and public health laboratories. Results obtained through the use of this form from 1979 through June 1981 are reported and the steps of the computerized management of the Center and of the Bacteriological Laboratory of the University Hospital of Milan are illustrated.

Computers↗
PubMedDate not supplied

Metabolic effects of metformin addition to chronic glibenclamide treatment in type 2 diabetes.

In a randomized double-blind cross-over study the addition of metformin to chronic glibenclamide treatment was assessed conventionally (plasma glucose profile and HbA1c measurement) and with an euglycaemic-hyperinsulinaemic glucose clamp in ten non obese (body mass index 22.3 +/- 0.5 (+/- SE)kg.m-2) Type 2 diabetic patients with poor metabolic control. Metformin (500 mg twice a day) or placebo were added in randomized sequence for 6 weeks to their usual sulphonylurea treatment (glibenclamide 5 mg three times a day, before meals). On the last day of each administration period, an euglycaemic (glucose 5.5 +/- 0.5 mmol.l-1), hyperinsulinaemic (insulin 698.1 +/- 22.9 pmol.l-1) clamp was performed, together with a study of insulin binding to circulating monocytes. Metformin reduced fasting glucose levels (6.1 +/- 0.4 vs 6.4 +/- 0.4 mmol.l-1, P = 0.036), mean daily plasma glucose concentrations (9.2 +/- 0.4 mmol.l-1, P < 0.001), and HbA1c (8.7 +/- 0.3 vs 9.3 +/- 0.2%; P = 0.027). No variations were registered in fasting plasma insulin or body weight. A significant reduction of basal hepatic glucose production (12.8 +/- 2.7 vs 33.9 +/- 4.5 mumol.kg-1 min-1, P < 0.001), together with an increase in glucose utilization during the clamp (33.4 +/- 2.8 vs 25.9 +/- 1.1 mumol.kg-1.min-1, P = 0.033), was found after metformin, whereas residual glucose production during insulin infusion did not change. Insulin binding to circulating monocytes was higher after metformin (4.8 +/- 0.9 vs 3.2 +/- 0.6%, P = 0.020), while the lipaemic profile showed a reduction in triglycerides (1.2 +/- 0.1 vs 1.7 +/- 0.3 mmol.l-1, P = 0.039) and an increase in HDL-cholesterol (1.3 +/- 0.1 vs 1.0 +/- 0.1 mmol.l-1, P = 0.004) without variations in total cholesterol. These findings offer further evidence that metabolic control is improved after biguanide addition to sulphonylurea treatment, and support the hypothesis that biguanides improve insulin sensitivity both at the hepatic and peripheral (muscular) levels, as well as triglyceride metabolism.

Aged↗
PubMedDate not supplied

[Intraoperative cholangiography in laparoscopic cholecystectomy. Our experience].

Cholangiography during conventional cholecystectomy has always been useful for anatomo-topographic study and for research of the stones of biliary tree. After a natural period of training the authors included the easy technique of cholangiography in laparoscopic cholecystectomy. The study was performed in 13 patients using Olsen's cannula with an internal a normal catheter for cholangiography. The catheterization of the cystic duct was performed in 85% of cases (11 patients), in the other 15% (2 patients) it was not possible to cannulate the cystic duct. Non complication. The mean duration of the study was 14 minutes. The authors describe the technique and conclude, after a brief discussion of the reports in the literature and personal experience, that peroperative cholangiography is an easy and safe procedure without risk and prevents the injuries to the biliary tract whose incidence is about 1.3%.

Cholangiography↗
PubMedDate not supplied

[Relationships between the National Health Service and universities as regulated by the legislative decree of 30 December 1992, No. 502 and its successive modifications and integrations].

The mutual relationship between the Schools of Medicine and the Italian National Health Service are discussed according to the commitment following the implementation of the new Health Service reorganization. The organization of teaching hospitals and the curricula for health professionals are considered in order to highlight their possible impact on the new organization. New opportunities seem to arise for the medical schools to improve the level of quality of their performance according to the aims and objectives of the National health plan for the years 1994-1996. Three topics are discussed in depth (i) the improvement of skills for health managers, (ii) the role of health service research in planning and evaluating the way health care is delivered with particular attention payed to the impact of DRGs as system of payment recently introduced for financing hospitals and community services. Finally it seems reasonable to expect a rise of quality in teaching programs and the development of newly designed ones for continuous training according to the needs of the health care system.

Hospitals, Teaching↗
PubMedDate not supplied

[Application of clinical audit to the evaluation of prescription of interferon-alpha in a teaching hospital].

Aim of this study was to evaluate through an audit tool the appropriateness of interferon-alpha (IFN-alpha) prescribing in a teaching hospital. The records of all patients (n.665) treated with IFN-alpha since 1991 were reviewed and the data concerning diagnosis and treatment collected using a standardized from. The data were submitted for peer review to a panel which included the representatives of the different medical specialties which actually prescribed the drug, external experts and members of the health management board of the hospital. The following points were discussed:-adherence to accepted therapeutic indications:-accuracy of the diagnosis prior to treatment:-scheduled doses:-criteria defining non-responders;-length of treatment and criteria for discontinuation. At the end of the study a questionnaire for evaluation of the audit was submitted to all participants. Most patients were treated according to a diagnosis of chronic hepatitis (HCV, n.448; HBV, n.54; HDV, n.22); other indications were chronic myeloid leukemia, thrombocythemia, polycythemia vera, Kaposi's sarcoma, condylomata, melanoma and mycosis fungoides. All indications were approved by the panel: no patient was treated outside established indications (85.6%) or a clinical trial protocol (14.4%). Standard schedules were initially applied to each indication, and were adjusted if needed according to the clinical response. In conclusion, the audit showed that IFN-alpha was correctly prescribed in our teaching hospital; the procedure was well accepted and its application may be useful in modifying prescribing attitudes.

Drug Utilization↗
PubMedDate not supplied

Platelet and monocyte variables in homocystinuria due to cystathionine-beta-synthase deficiency.

To gain insight into the mechanisms responsible for enhanced thromboxane (TX) A2 biosynthesis in homozygous homocystinuria due to cystathionine-beta-synthase deficiency (CBSD), we measured a series of platelet and monocyte variables in 9 homozygous and 8 obligate heterozygous CBSD patients and evaluated their relationships to thromboxane formation, as reflected by urinary excretion of its major metabolite, 11-dehydro-TXB2 (TXM). Consistent with our previous data, homozygous CBSD patients showed abnormally high TXM excretion (1175 +/- 236 pg/mg creatinine vs. 284 +/- 39 in control subjects; p < 0.001). Significantly higher TXM excretion was also found in obligate heterozygotes (755 +/- 450 pg/mg creatinine; p < 0.05 vs. control subjects). All platelet and monocyte variables fell within the normal range in CBSD patients and none showed a correlation with TXM excretion (p always > 0.05). Our results argue against abnormalities of platelet and monocyte function being responsible for the abnormally high in vivo TXA2 biosynthesis in homocystinuria due to CBSD.

Adolescent↗
PubMedDate not supplied

[Paget's disease of the breast].

Paget's disease of the nipple is a rare lesion that is not always associated with underlying breast cancer. The authors report three cases of Paget's disease; in two of the three patients examined, the disease became evident following the appearance of an erythematous and erosive lesion on the nipple and areola, but no clinical evidence of an underlying nodule. In both cases diagnosis was made by integrating cytological tests by apposition of the nipple with mammography. In the third case the disease became manifest following the onset of a lesion on the nipple and areola with the characteristics of chronic eczema in association with a retroareolar nodule, measuring 3 cm, with the mammographic characteristics of an infiltrating carcinoma. All three patients were treated by radical mastectomy modified according to Madden.

Aged↗