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Biomedical subjects

A Siani

Publications and source records attributed to A Siani.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Popliteal trauma due to posterior dislocation of the knee].

Popliteal artery injuries have an incidence ranging between 5% and 19% of all traumatic arteria lesions. A high index of amputation, when associated with lesions of the infrapopliteal branches, and a 4-5% overall mortality are recorded in these conditions. Three patients with popliteal artery injury due to posterior knee dislocation were operated upon in our department during the last 12 months. In one case, the physical examination revealed a warm limb, with peripheral pulse; angiography showed a pseudoaneurysm of the popliteal artery with intimal dissection and partial thrombosis. In the last two cases an acute ischemia of the limb was present; in one case the angiographic study showed a complete transection of the artery, while in the second case an obstruction of popliteal artery. In all cases the dislocation was corrected and a the reconstruction carried out by inverted autologus saphenous vein with termino-terminal anastomosis. In all cases a good patency of the popliteal reconstruction was achieved with limb salvage. Prognosis of popliteal injuries is related to an early diagnosis and they should be suspected even in absence of overt signs of acute ischemia. Surgical timing cannot be the same in all cases. The need for a preliminary orthopedic phase with its modality must be established case by case, relating to the severity of ischemia, to the time elapsed between trauma and surgery, to the peculiarities of skeleton and joints lesions.

Acute Disease↗
PubMed2001

[Elective and emergency surgical treatment of popliteal aneurysms. Indications and results].

BACKGROUND: The aim of this paper is to evaluate the long term results related to surgical technique and to prosthetic material in planned and emergency conditions. METHODS: From January 1990 to December 1999, fourty-five patients with popliteal aneurysms were observed. Eighteen patients (40%) were asymptomatic; eleven (24.4%) suffered from claudicatio; six had an acute ischemia (13.3%) and four presented (8.9%) clinical signs of rest pain; in four cases (8.9%) symptoms were related to venous compression and to rupture in two (4.4%). Diagnosis was obtained by ultrasounds, angiography and CT-scan. All patients were operated on and in four cases (8.9%) the procedure involved both legs. The prosthetic material was reversed autologous saphenous vein (ASV) in 30 patients (61.2%), PTFE-EXS-TW in 16 (32.6%), homologous vein in one (2%), composite graft in one (2%), and a Dacron in the last one (2%). RESULTS: Six patients died for causes not related to the operation and eight bypasses (18.2%) became occluded. Amputation was needed in two patient, in relation to late bypass occlusion. In one cases an amputation was carried out for acute thrombosis of the contralateral aneurysm which was not treated for patients refusal. The long term patency rate was 81.8%. CONCLUSIONS: Popliteal aneurysms must be considered for reconstructive surgery, also when asymptomatic and with a diameter over 2 cm. The routinely use of the ASV improves the long-term patency rate. Best long term results are obtained in elective surgery.

Aneurysm↗
PubMed2001

Role of diet and lifestyle in the prevention of cardiovascular disease: knowledge and attitude of physicians and patients in Southern Italy.

BACKGROUND: The present study aimed to investigate the knowledge and attitude of family physicians and their patients respectively in prescribing and adopting lifestyle and dietary changes in order to prevent cardiovascular disease which is the main cause of mortality in the industrialized Western countries. METHODS: All physicians working in two suburban areas of Naples and in the city of Avellino were invited to participate in the study and 63% accepted (n = 218). A sample of lay people living in the same areas was randomly selected and 59% accepted (n = 267). Two different questionnaires were used to assess the knowledge and attitudes of physicians and lay people about the role of nutrition and lifestyle in the prevention of cardiovascular risk. RESULTS: Physicians showed satisfactory knowledge and a good attitude to non-pharmacological prevention--particularly secondary prevention--of cardiovascular disease. The opinions of the lay people interviewed on the impact of lifestyle changes on cardiovascular disease prevention were similarly satisfactory although some inconsistencies were noted. CONCLUSIONS: In spite of the good propensity of both physicians and their patients to the implementation of lifestyle changes, it appears that dietary modifications prescribed by physicians are not accurately followed or even misunderstood by their patients. This suggests the need of implementing further educational programs.

Adolescent↗
PubMed2001

[Indication for short stripping of the great saphenous vein. Results and indications].

BACKGROUND: The aim of surgical therapy of varicose veins is the elimination of reflux from the deep to superficial system at the saphenous crosse and perforant vessel and conservation of the superficial venous system due to possible surgical procedures for arterial revascularization. This latter condition leads to an extension of indications for short stripping procedures, although the venous distal segment may undergo hypoplastic degeneration not compatible for revascularization purposes. Another important reason is the minor incidence of neurologic complication due to saphenous nerve lesion which may occur during long saphenous stripping. METHODS: From January 1994 to June 1999, we considered 233 patients (182 women, 51 men); 180 cases underwent long saphenous stripping procedures, whereas 53 a short stripping of GSV. The incidence of neurologic complications of the saphenous nerve were recorded in 11.6% of the patients treated with the standard procedure, whereas no such complication was observed in all cases treated with the short stripping procedure. RESULTS: ECD follow-up performed for a period of three months from the surgical procedure revealed the patency of the residual saphenous vein, with a minimum diameter of 3 mm, in 28 patients (56.6%). CONCLUSIONS: Our opinion is to extend the indication for short stripping of the saphenous vein to all cases where the distal saphenous trunk is not involved, when the ECD shows a pathological ostial reflux, a truncular reflux limited to the thigh, which may be associated with incontinence of the perforant vein of Dodd.

Female↗
PubMed2001

The BRAVO project: screening for childhood obesity in a primary school setting.

BACKGROUND AND AIM: The prevalence of childhood obesity is increasing worldwide, raising a number of public health concerns. First, childhood obesity is a strong predictor of adult obesity; second, the low long term success rate and the high social cost of the treatment of obesity suggest that attention should be paid to the prevention of obesity early in childhood. The objective of the present study was to evaluate dietary habits and anthropometric factors in a sample of schoolchildren aged 6-12 years living in Southern Italy in the framework of an ongoing prospective study aimed at childhood obesity prevention. METHODS AND RESULTS: The BRAVO Project is carried out in co-operation with the school staff and is a part of an educational program on nutrition for the schoolchildren and their families. During the first phase of the study, the prevalence of overweight and obesity was evaluated in 363 children adopting the criteria for definition of childhood obesity recently proposed by the International Obesity Task Force (IOTF). The main result of this study was that in our cohort an exceedingly high risk of becoming overweight in adult age was observed for any one-year age class. CONCLUSIONS: The results of the present study confirmed the trend toward an increasing prevalence of childhood obesity observed in other Western countries. Moreover, out data--though preliminary--suggest that the large scale involvement of primary school in screening programs could represent an effective preventive strategy against the increased risk of childhood obesity.

Anthropometry↗
PubMed2001

Dietary habit profile in European communities with different risk of myocardial infarction: the impact of migration as a model of gene-environment interaction. The IMMIDIET Study.

The risk of myocardial infarction (MI) is lower in southern than in northern European countries. The lower rate of MI in the Mediterranean regions of Europe suggested a potential role of the traditional Mediterranean diet in the prevention of MI. Unfortunately, in the last 20 years, a tendency to adopt Westernised food habits even in southern regions of Europe is reflected by an increase in the prevalence of obesity. Therefore the impact of diet on MI risk profile among European populations needs to be reconsidered. Genetic risk factors have also been implicated in the development of MI. Genes, indeed, continuously interact with environmental factors in determining the pathogenesis of MI. The aims of the IMMIDIET study are to evaluate: 1. The present dietary habits and the risk profile of three European communities at different risk of MI; 2. The impact of migration on risk factors for MI. Dietary habits and genetic polymorphisms will be evaluated in an Italian, Belgian and British population sample. The historical Italian migration to Belgium and the integration through mixed marriage will be considered as a model of gene-environment interaction. As an index of MI risk profile, factors that are most likely under the combined influence of both dietary and genetic determinants will be investigated.

Belgium↗
PubMed2000

Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis.

A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures.

Acute Disease↗
PubMed2000

Blood pressure and metabolic changes during dietary L-arginine supplementation in humans.

Dietary L-arginine supplementation has been proposed to reverse endothelial dysfunction in such diverse pathophysiologic conditions as hypercholesterolemia, coronary heart disease, and some forms of animal hypertension. In particular, chronic oral administration of L-arginine prevented the blood pressure rise induced by sodium chloride loading in salt-sensitive rats. To investigate the effects of L-arginine-rich diets on blood pressure and metabolic and coagulation parameters we performed a single-blind, controlled, crossover dietary intervention in six healthy volunteers. The subjects (aged 39+/-4 years, body mass index [BMI] 26+/-1 kg/m2, mean +/- SEM) received, in random sequence, three different isocaloric diets, each for a period of 1 week (Diet 1: control; Diet 2: L-arginine enriched by natural foods; Diet 3: identical to Diet 1 plus oral L-arginine supplement). Sodium intake was set at a constant level (about 180 mmol/day) throughout the three study periods. A blood pressure decrease was observed with both L-arginine-rich diets (Diet 2 v 1, SBP: -6.2 mm Hg [95% CI: -0.5 to -11.8], DBP: -5.0 mm Hg [-2.8 to -7.2]; Diet 3 v 1, SBP: -6.2 mm Hg [-1.8 to -10.5], DBP: -6.8 mm Hg [-3.0 to -10.6]). A slight increase in creatinine clearance (P = .07) and a fall in fasting blood glucose (P = .008) occurred after Diet 3 and, to a lesser extent, after Diet 2. Serum total cholesterol (P = .06) and triglyceride (P = .009) decreased and HDL cholesterol increased (P = .04) after Diet 2, but not after Diet 3. These results indicate that a moderate increase in L-arginine significantly lowered blood pressure and affected renal function and carbohydrate metabolism in healthy volunteers.

Administration, Oral↗
PubMed2000

Increasing evidence for the role of salt and salt-sensitivity in hypertension.

The paper focuses on some aspects of the complex relationship between dietary salt intake and blood pressure. The first part is a short review of the evidence available from epidemiological and clinical studies, indicating that a moderate reduction in dietary salt intake represents an effective non-pharmacological measure for the treatment of hypertension and for the prevention of hypertension-related cardiovascular complications, namely stroke and ischemic heart disease. The second part deals with the role of inherited and acquired factors in the phenotypic expression of the salt-sensitivity of blood pressure. In particular, the influence of sympathetic nervous system hyperactivity, of insulin resistance and of alterations of endothelial function in the pathogenesis of salt-related forms of hypertension are discussed.

Age Factors↗
PubMed2000

[Multiphasic helical computerized tomography of hepatocarcinoma. Assessment after chemoembolization].

PURPOSE: To report our personal experience with the addition of contrast-enhanced multiphase helical CT to unenhanced CT (Lipiodol CT) in the evaluation of patients with hepatocellular carcinoma treated with chemoembolization and to analyze the present role of oily agent CT. MATERIAL AND METHODS: We retrospectively reviewed the examinations of 42 consecutive patients submitted to global chemoembolization over a 2-year period. CT was performed 18-30 days after the treatment. The Lipiodol CT study was carried out with volume acquisitions. We considered as nodules all well-defined areas with dense oily agent uptake; uptake itself was classified as: 0 = absent, I = lower than 10% of the tumor volume, II = lower than 50%, III = higher than 50%, IV = homogeneous. Contrast-enhanced helical CT was performed with the 2-phase technique in 28 patients and with the 3-phase technique in 14; we considered as nodules all well-defined and relatively homogeneous areas with hyperattenuation in the arterial phase and hypo-isoattenuation in the portal and/or delayed phase, or with hypo-isoattenuation in the arterial phase and in the portal and/or delayed phase. RESULTS: Lipiodol CT permitted to recognize 65 nodules (1-5/patient, mean 1.5), namely 15 grade I, 21 grade II, 20 grade III and 9 grade IV. Multiphase CT identified 6 additional nodules in 5 patients, 5 hypervascular and 1 hypovascular, and better assessed the correct morphology and volume of grade I nodules. Only 4 of 6 nodules missed on Lipiodol CT showed oily agent uptake after a new chemoembolization session. Moreover after retreatment, carried out in 6 of 9 patients with grade I uptake (11 nodules in all), we found persistence of the grade I pattern in 5 nodules, grade II in 5, and grade III in 1. CONCLUSION: Lipiodol CT may miss liver nodules and underestimate the volume of nodules with poor uptake. Though Lipiodol CT should still be considered slightly more sensitive than multiphase CT, in our opinion this technique has several limitations, as also shown in recent literature papers, and its clinical applications should be reduced. Multiphase helical studies may provide useful information and should be performed routinely in patients treated with chemoembolization. The present availability of alternative tools such as contrast-enhanced Doppler US and MRI should also be stressed and their potential role investigated.

Adult↗
PubMed1999

A prospective study of hypertension and the incidence of kidney stones in men.

OBJECTIVE: To examine whether hypertension predicts the incidence of kidney stone disease. DESIGN: Prospective cohort study (the Olivetti Prospective Heart Study). SETTING: The Olivetti factory in Southern Italy. SUBJECTS: Five hundred and three male workers, aged 21 - 68 years, with no evidence of kidney stone disease at baseline. Follow-up 8 years. MAIN OUTCOME MEASURES: Anthropometry, blood pressure, biochemistry and history of kidney stone disease were evaluated at the baseline examination in 1987. Occurrence of kidney stone disease was evaluated again in 1994-1995. Hypertension was defined as systolic blood pressure > or = 160 or diastolic blood pressure, > or = 95 mmHg or both, or being on drug therapy for hypertension. Occurrence of kidney stone disease was defined as radiological or echographic evidence of calculi or documented passage of one or more stones. RESULTS: At baseline, 114/503 men (22.7%) had hypertension and 32 were on drug treatment. After 8 years, 52 (10.3%) incident cases of kidney stone disease were detected. The majority (n = 45) had a documented passage of one or more stones. The incidence of kidney stone disease was higher in hypertensive than in normotensive men (19/114 (16.7%) versus 33/389 (8.5%); P = 0.011). Hypertensive men had a greater risk of developing kidney stones than normotensive ones (RR 1.96; 95% confidence interval 1.16-3.32). The risk was unaffected by the exclusion of treated hypertensives (2.01; 1.13-3.59) and after adjustment for age (1.89; 1.12-3.18), body weight (1.78; 1.05-3.00) or height (2.00; 1.19-3.38). CONCLUSIONS: Hypertension in middle-aged men is a significant predictor of kidney stone disease rather than a consequence of renal damage caused by the kidney stones.

Adult↗
PubMed1999

[Contrast media extravasation in upper abdominal injuries: detection with spiral computerized tomography].

PURPOSE: The possibility of detecting contrast agent extravasation (i.e., active hemorrhage) with dynamic conventional Computed Tomography (CT) in patients with abdominal trauma has already been reported in small series. We report our experience in the demonstration of contrast material extravasation using helical CT; we also investigate the diagnostic and clinical value of this finding. MATERIAL AND METHODS: January 1997 to July 1998, we examined 41 consecutive patients with upper abdominal trauma. Twelve patients (29%) had contrast material extravasation. The examinations were performed with a helical unit and volumetric acquisitions (thickness 8-10 mm, pitch 1, reconstruction interval 5-8 mm). The intravenous contrast medium (350 mgI/mL, 130-140 mL) was administered with rapid infusion (2-2.5 mL/s, 40-50 s acquisition delay from bolus starting) and using a power injector. We reviewed the CT studies and clinical records of these 12 patients. Contrast agent extravasation was considered present when this finding, not recognizable on plain scans, showed equal attenuation to or higher attenuation than the vessels within the same level. Moreover we assessed leak site, CT appearance, the direct visualization of the involved vessel, the evidence of other abdominal or extra-abdominal injuries, the CT signs of hypovolemic shock, clinical and surgical data. For comparison, we finally evaluated 50 examinations performed with a conventional CT scanner in subjects with abdominal trauma. RESULTS: Active hemorrhage involved the abdominal wall in 1 case (intercostal artery), the solid organs in 4 (splenic in 2, hepatic in 1, of the middle hepatic vein in 1), the peritoneal cavity in 3 (splenic, midcolic, and gastroduodenal artery in 1 each), the retroperitoneum in 4 (renal pedicle in 2, renal parenchyma in 1, lumbar artery in 1). In all cases the site of contrast extravasation corresponded at surgery to the site of active bleeding. The pattern was localized in 10 cases and diffuse in 2. The involved vessel could be identified in 5 cases while in the other ones the origin could be inferred from the leakage site. Associated injuries of upper abdominal organs were seen in 11 of 12 patients and extra-abdominal trauma in 6. In 4 cases there were CT features of hypovolemia. One patient died during transport to the operating room and another after surgery, while all the others survived. Contrast extravasation was identified in 9 (18%) of the patients examined with a conventional CT unit. CONCLUSIONS: Active contrast material extravasation can be recognized with conventional CT scanners, though it has been considered a rare finding. Helical CT seems to increase the detection rate and especially to boost the radiologist's confidence in this diagnosis. Though active bleeding is identified in severely-injured subjects requiring urgent intervention and may be associated with findings of hypovolemic shock, it should not be considered itself as a negative prognostic factor. Contrast extravasation is due to ongoing hemorrhage and its detection is critical for urgent treatment. Accurate anatomical location permits to choose surgical management or transcatheter embolization and thus decreases time consumption for precise bleeding site identification.

Abdominal Injuries↗
PubMed1999

[Diagnostic imaging and interventional radiology of amebic liver abscesses. Personal experience].

PURPOSE: The diagnostic imaging findings in hepatic amebiasis and the capabilities of percutaneous drainage have already been described but some debate is open on both diagnosis and treatment. We report our experience with ultrasound (US) and Computed Tomography (CT) studies of the hepatic amebic abscess and its management. MATERIAL AND METHODS: During the last 4 years we examined 14 patients with liver abscess: 11 men and 2 women; 13 were Italian and 1 African (25-61 years old, mean 36). All subjects underwent US and contrast-enhanced CT (with a conventional scanner in 12 and a helical unit in 2). The first 4 cases were also submitted to US-guided diagnostic aspiration. Six patients were treated with percutaneous drainage under US guidance using an 8-10 F pig-tail catheter which was removed 4-18 days later (mean 6). RESULTS: The abscesses were always single and uniloculated, in most cases located peripherally in the right lobe. They were large (2-11 cm, mean 7) and had round, oval, or irregular shape in 9, 3, and 2 cases respectively. US generally showed the abscess as an inhomogeneously hypoechoic mass with ill-defined walls. CT demonstrated a homogeneously hypodense collection with a thick peripheral hypodense halo; after contrast agent administration wall attenuation was increased between the edematous halo and the cavity, and an incomplete idosense ring appeared. Biphasic helical acquisitions allowed demonstration of some difference between the two vascular phases and yielded other interesting findings. Drug treatment provided complete abscess resolution in 8 patients, though in 2 it was badly tolerated. In one case no improvement was found and the patient was submitted to percutaneous drainage, which was the treatment of choice in the remaining 5 patients. The treatment was successful in all cases, but 1 patient who discontinued the combined medical therapy developed a heterotopic lesion. CONCLUSION: US and CT findings, though variable and partially different from those previously reported, may be considered sufficient for diagnostic assessment, especially if in the proper clinical and biohumoral setting. Both drug treatment and percutaneous drainage (to be considered for selected cases) are effective in the treatment of this type of abscess.

Adult↗
PubMed1999

[The angiogram sign in pulmonary atelectases studied by spiral computed tomography. Its incidence and semeiologic value].

PURPOSE: We investigated the yield of Helical CT in the study of lung vessels, the incidence of the angiogram sign and its actual value. MATERIAL AND METHODS: July 1997 to December 1998, we studied 30 cases of pulmonary collapse of different origin. We found 15 cases of passive collapse (10 from pleural effusion, 2 from diaphragmatic compression, 2 from traumatic pneumothorax, and 1 from isthmic aortic aneurysm), 12 cases of obstructive collapse (9 from bronchogenic carcinoma, 1 from mucoid obstruction, 1 from hilar lymphadenopathy, and 1 from mediastinal cancer), 2 cases of adhesive collapse and 1 case of round atelectasis. All the examinations were performed with the Helical technique during nonionic iodinated contrast agent injection (bolus, 300-350 mg/mL); we used an automatic injector set at 2-3 mL/s. We studied the images for the angiogram sign, that is hyperdense bands, usually longer than 2 cm, through the collapsed lung, which correspond to normal pulmonary vascular branches. RESULTS: The angiogram sign was found in 95% of passive (14/15) and in 80% of obstructive (10/12) collapses. However in 2 of those we also found some hyperdense spots referable to vessels seen on transverse slices. The angiogram sign was missing in 1 of 2 adhesive collapses because of vascular distortion from irradiation-related fibrosis. The "comet-tail" vascular pattern was seen in round atelectasis. We had no cases of cicatricial collapse. CONCLUSIONS: Thanks to its fast acquisition capabilities, Helical CT well depicts peak vascular enhancement, which permitted identification of the angiogram sign in several pulmonary collapse cases. Thus, this sign becomes even less specific, and just one of the signs of pulmonary consolidation.

Angiography↗