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Biomedical subjects

A Sacchetti

Publications and source records attributed to A Sacchetti.

At least 55 records · Page 3Linked to original sources
PubMed1991

Testicular dislocation following minor scrotal trauma.

Traumatic dislocation of the testicle is a rare injury generally resulting from severe scrotal trauma and displacement of the testicle into the subcutaneous tissue surrounding the external inguinal ring. The authors report here the extremely unusual case of an abdominal dislocation of the testicle in a young patient with an indirect inguinal hernia. In addition this case is particularly atypical in that the injury resulted from a trivial blow to the scrotum. A new mechanism involving preloading of the cremaster muscle as the source of the dislocation is postulated.

Abdomen↗
PubMed1986

Community hospital management of pediatric emergencies: implications for pediatric emergency medical services.

The ability of emergency physicians in a general community hospital to manage pediatric patients was evaluated. Essential diagnostic and therapeutic procedures performed in the emergency department on pediatric patients transferred for admission to a tertiary care center were compared with those initially performed on the same patients by the pediatricians and residents of the tertiary care center. The overall care rendered by the emergency physicians correlated well with that of the referral center. Ninety one per cent of diagnostic studies and 96% of therapeutic interventions were performed in the emergency department. Implications for the care of seriously ill pediatric patients by emergency physicians and the role of community hospital emergency departments in pediatric emergency medical services (EMS) systems are discussed.

Adolescent↗
PubMed1986

Ingestion of Compound W, an unusual caustic.

A case of an unusual caustic ingestion involving Compound W, an over the counter wart remover is presented. Chemical burns of the tongue, pharynx and larynx developed. The active ingredient in this preparation: salicylic acid in a flexible collodion vehicle produces caustic injury through a keratolytic action, which may be enhanced by the presence of collodion.

Administration, Oral↗
PubMed1980

[Medulloblastoma. Report of 13 cases (author's transl)].

Thirteen patients with medulloblastoma were admitted to the Clinica Puerta de Hierro (Department of Radiotherapy) between 1964 and 1977. Two subtypes of medulloblastoma (classical and desmoplastic) with different histologic pattern, age of onset, clinical manifestations and clinical course have been identified. Radical surgery does not increase overal survival. X-ray treatment should be applied according to the following principles: a) the central nervous system should be irradiated; b) dosage on the posterior cranial fossa over 5,000 rad (50 Gy); c) dosage on the neuroaxis under 2,000-3,000 rad (25-30 Gy). Tumor recurrences should be treated in order to obtain a more comfortable life and a prolonged survival. Association of chemotherapy to surgery and radiotherapy have yielded promising results.

Adolescent↗
PubMedDate not supplied

Nonclassic history in children with radial head subluxations.

Radial head subluxation (RHS) is a common pediatric orthopedic injury, frequently diagnosed through the classic history of axial traction to the upper extremity of a child. However, not all children with RHS will present with this classic history. This may result in misdiagnosis and delay of appropriate treatment. To evaluate the prevalence of non-classic presentations, a retrospective study was conducted of 45 emergency department patients with RHS. Of these patients, 15 presented with an atypical history. All patients were in minimal distress, holding their affected arms semiflexed and pronated (the nursemaid's position). The classic and nonclassic history groups were equivalent in patient age, spontaneous reductions, and physician reductions. A trend towards more radiographs was noted in the nonclassic group. This study suggests that even in the absence of the classic history of upper extremity traction, radial head subluxation should be suspected in any pediatric patient with an upper extremity complaint who presents with the affected arm in the nursemaid's position.

Accidental Falls↗
PubMedDate not supplied

Leukocyte larceny: spurious hypoxemia confirmed with pulse oximetry.

Leukemic patients with extremely high white blood counts may exhibit the phenomenon of leukocyte larceny, in which white blood cells metabolize plasma oxygen in arterial blood gas samples (ABG) producing a spuriously low oxygen tension. We report the case of a leukemic patient with a white blood count in excess of 500,000 in whom multiple ABGs documented hypoxemia out of proportion to his clinical picture. Pulse oximetry was used to confirm higher hemoglobin oxygen saturation to establish the leukocyte larceny.

Adult↗
PubMedDate not supplied

Emergency department presentation of renal dialysis patients: indications for EMS transport directly to dialysis centers.

To determine the pattern of emergency department (ED) utilization by renal dialysis (RD) patients, a prospective study was conducted of dialysis patients presenting to the ED of a regional dialysis center. The most common presenting complaints were shortness of breath (SOB), chest pain, abdominal pain, and vomiting; the most common diagnoses were congestive heart failure, chest wall pain, and electrolyte abnormalities. Interventional dialysis (ID), defined as emergent dialysis required to treat the patient's presenting complaint, was required for 30 patients, with the most common presenting complaints of these patients being shortness of breath, weakness, and chest pain. Only SOB was statistically significant in predicting the need for ID (P less than 0.001), with a positive predictive value of 0.63 and a negative predictive value of 0.85. Prehospital implications of these data suggest that RD patients with a chief complaint of SOB should be transported directly to a facility capable of dialysis on an emergent basis.

Emergencies↗
PubMedDate not supplied

Utility of UB-92 data for monitoring emergency department performance improvement.

The Universal Billing Code of 1992 (UB-92) is a standard database used by hospitals to generate itemized charges for patient visits. This study examined the use of UB-92 information to monitor emergency department performance improvement projects. UB-92 data were used to determine whether urine tests had been ordered for emergency department patients. A population of patients at low risk for requiring a urine culture was defined as discharged female patients between 16 and 60 years of age undergoing a urinalysis as part of their emergency department treatment during a 10-month period. Based on UB-92 data, only a total of 2,138 patients were identified who met the study's low-risk criteria. Recommendations for the optimum use of these tests were presented to the emergency physicians as part of departmental performance improvement activities. Additional logistical problems associated with the procedure for ordering this test were identified and corrected as part of this project. After an additional 5-month period, a second analysis of the entire 15 months of UB-92 data was performed. Prior to physician notification, 41.6% of low-risk patients underwent both a urinalysis and a urine culture and sensitivity in the emergency department. In the 5-month follow-up period, the percentage of patients undergoing both tests decreased 18% to only 23%.

Adolescent↗
PubMedDate not supplied

Intravenous ascorbic acid in hemodialysis patients with functional iron deficiency: a clinical trial.

BACKGROUND: Hemodialysis (HD) patients with functional iron deficiency (FID) often develop resistance to recombinant human erythropoietin (rHuEpo). In these patients, iron therapy may be a hazard, leading to iron overload and consequently to hemosiderosis. Recent studies suggest that intravenous ascorbic acid (IVAA) may circumvent rHuEpo resistance. The aim of our study was to show the effects of IVAA on FID and whether this results in a better correction of anemia in HD patients with stable hemoglobin (Hb) concentration and FID. METHODS: Twenty-seven HD patients with serum ferritin >300 microg/l, transferrin saturation (TS) <20% and hemoglobin (Hb) <10 g/dL were selected andrandomly divided into two groups to enter a cross-over trial with IVAA. In group I IV vitamin C 500 mg was administered three times a week for three months and discontinued in the next three months of the study. Vitamin C was not given the first three months in group II (control group, first three months of the study), who then received 500 mg IV three times a week for the next three months. RESULTS: Hb and TS% significantly increased (baselines vs 3 months, Hb 9.2 +/- 0.2 vs 10.0 +/- 0.3 g/dL, TS% 17.5 +/- 0.6 vs 25.7 +/- 1.7, respectively p < 0.01 and p <0.001) in group I after three months; ferritin fell significantly from 572 +/- 40 to 398 +/- 55 microg/L (p<0.004). Ten patients completed the study: mean Hb and TS% fell significantly (3 months vs final, Hb 9.9 +/- 0.3 vs 8.9 +/- 0.2 g/dL, TS% 25.1 +/- 1.2 vs 19.1 +/- 1.1, respectively p < 0.01 and p <0.001), while mean ferritin did not change. Mean Hb, ferritin and TS% remained unchanged in group II after three months. Hb and TS% mean values rose significantly (3 months vs final, Hb 9.0 +/- 0.2 vs 9.9 +/- 0.2 g/dl, TS% 18.4 +/- 1.0 vs 27.0 +/- 1.0, respectively p < 0.005 and p <0.001), and ferritin markedly decreased from 450 +/- 50 to 206 +/- 24 microg/L (p < 0.001) at the end of the study. The rHuEpo dose was kept unchanged throughout the study. Differences were analyzed after three months. Mean Hb rose (0.8 +/- 0.2 g/dL) in group I but dropped (-0.1 +/- 0.1 g/dL) (p< 0.009) in group II. Ferritin dropped in both groups (group I vs group II, -173 + /-48 vs - 33 +/- 21 microg/L) (p < 0.01) while TS% increased (group I vs group II, 8.2 +/- 1.5 vs 0.4 +/- 0.7) (p < 0.001). CONCLUSION: IVAA may partially correct FID and consequently help rHuEpo hyporesponsive anemia.

Adult↗
PubMedDate not supplied

[Evaluation of quality of life by improving the uraemic anaemia status].

BACKGROUND: Anaemia is one of the most common signs of chronic uraemia that determines an increase in both morbidity and mortality, as well as a deterioration in the quality of life of affected patients. We evaluated the impact of the application of the European Best Practice Anaemia Guidelines to the quality of life of dialysed patients. PATIENTS AND METHODS: We studied for 12 months (from December 2000 to November 2001) 62 patients in haemodialysis and 22 patients in peritoneal dialysis. For the statistical analysis the following parameters were examined: haemoglobin levels, TSAT, and weekly doses of Epo. To assess the quality of life we asked the patients, at the initial visit and 12 months after treatment, to fill out the "Medical Outcome Study Short Form 36 items Heath Survey" and "Kidney Disease Quality of Life". RESULTS: The significant increase in TSAT levels attained in haemodialysed patients (p = 0.03) induced an increase in haemoglobin levels and consequent reduction in EPO administration (p = 0.04). During the study, a significant improvement in General Health (GH) (p = 0.03) was observed. At the end of the treatment, Physical Functioning (PF) (p = 0.04), Role and Physical Health (RP) (p = 0.02) and Social Functioning (SF) (p = 0.005) showed significant variations. CONCLUSIONS: The application of the European Best Practice Anaemia Guidelines improves the management of anaemia and the Global Health Assessment in uraemic patients. These data demonstrate how inappropriate anaemia management can negatively affect the quality of life of these patients and increase the medical costs.

Aged↗
PubMedDate not supplied

[Child sexual abuse primary prevention: outcome evaluation of a health education project implemented in Milan's elementary schools].

The study we present is aimed at evaluating the efficacy of a child sexual abuse prevention program that involved children attending 4th and 5th grade in Milan's (Italy) elementary schools. The project involved 53 classes (10 of 4th, 43 of 5th grade) during school year 2000-2001. Children filled a questionnaire before the beginning of the project and two months after the end; the questionnaire evaluates children's perception of risk and their self-efficacy skills in adopting protective strategies when involved in at risk situations. Final analysis has involved 674 children, 51.8% girls, 48.2% boys; 19.6% of children attended 4th grade, 80.4% 5th grade. Percentage of children that recognize the potential danger in the suggested at-risk situation is higher in post-test then in pre-test (87.9% vs 73.2%) and the number of them that does not adopt any self-defence strategy decreases (from 35.3% to 21.0%). The project increased the number of children that know body puberal changes (from 16.0% to 32.8%). According to these results it is evident that the program increased children's capacity to recognize and use self defence strategies in at risk situations. These results call for a potential extention and replication of this health education program.

Child↗
PubMedDate not supplied

[Epidemiologic data on breast feeding in Florence and the province. Survey carried out in 1364 children born between 1985 and 1987].

We have studied the breast-feeding frequency in Florentine Area. We investigate a group of 1364 children born between January 1985 and June 1987. We collected following data: 1) Kind of feeding at birth. 2) Duration of breast-feeding related with birth-weight, kind of delivery, mother's age, mother's working activity. 3) Growth in relation to feeding practices from birth to 3rd month. The percentage of infants breast-feed in the hospital was 81.6%, 50.5% at the end of third month, 21.9% at the end of sixth month. We have found that children weighing more than 3000 g at birth had an higher frequency of breast-feeding at birth and last longer than children weighing less than 3000 g (p less than 0.01). Maternal age had a clear effect on both the incidence and the duration of breast-feeding. Mother aged 30 years or more begin to breast-feed in lower percentage but they continue breast-feeding for a longer time. One of the factors that has a negative influence on breast-feeding at birth is caesarean section since it precludes early mother-infant contact and early initiation of breast-feeding. Mother's resume working has a negative influence on breast-feeding duration. With regard to growth in first three months of life related with different kind of feeding we have found no differences between breast-feeding and artificial-fed infants.

Age Factors↗