Biomedical subjects

A Verrotti

Publications and source records attributed to A Verrotti.

At least 109 records · Page 6Linked to original sources

PubMed1998

Relationship between contrast sensitivity and metabolic control in diabetics with and without retinopathy.

Contrast sensitivity was studied in diabetic adolescents and young adults with and without retinopathy in order to evaluate their central vision, to analyze the relationship of metabolic control to the presence and severity of retinopathy, and to re-evaluate the response to this test after a significant improvement in metabolic control. Twenty adolescent and young adult diabetics without retinopathy and 40 diabetics with retinopathy of varying degree were enrolled in the study; 20 healthy age and sex-matched subjects served as controls. Contrast sensitivity was assessed with a CSV-1000 contrast testing instrument, testing for four spatial frequencies, 3, 6, 12 and 18 cycles per degree (cpd). Diabetics with no retinopathy showed a weak but significant difference at 18 cpd compared with controls (P = 0.04), while diabetics with background retinopathy showed a significant reduction of contrast sensitivity at 12 and 18 cpd when compared with controls (P < 0.001). In patients with preproliferative/proliferative retinopathy a highly significant reduction of contrast sensitivity at all frequencies was found compared with controls. Furthermore, these patients had a significantly lower mean contrast sensitivity than patients without retinopathy. The patients were re-evaluated after a significant amelioration of metabolic control. An improvement in contrast sensitivity was found in diabetics without retinopathy and with background retinopathy, while there was no change observed in diabetics with severe retinopathy. These results show that diabetic adolescents and young adults with and without signs of retinopathy observed by fluorescein angiography have a reduced contrast sensitivity, which is more severe in patients with preproliferative/proliferative retinopathy. A significant amelioration of metabolic control is associated with an improvement of contrast sensitivity in all patients with the exception of those patients who had signs of preproliferative/proliferative retinopathy observed by fluorescein angiography. In summary, this longitudinal study provides the first evidence that reduced contrast sensitivity is reversible in diabetics with or without background retinopathy only.

Adolescent↗

PubMed1998

Persistently low cardiac output predicts high mortality in newborns with cardiogenic shock.

BACKGROUND: Cardiogenic shock is an acute "unstable" state of circulatory dysfunction. OBJECTIVE: To evaluate the haemodynamic aspects of 45 newborn infants affected by cardiogenic shock, in relation to etiologies and the mortality rate. DESIGN: Retrospective, correlation study of etiologies, mortality rate and haemodynamic measurements by Doppler ultrasound parameters. PATIENTS: 45 newborn infants with cardiogenic shock, Gestational Age (GA) 37 (34-41), Birth Weight (BW) 2750 (1600-3600) g and and a control group of 20 neonates [GA 38 (34-40) wks, BW 2960 (1750-3800) g]. MEASUREMENTS: Left ventricular Cardiac Output (CO) was measured by a duplex scanner with pulsed Doppler and color flow mapping echocardiography in the first 48 hours of life. RESULTS: In healthy newborns CO was 240 mL/min/kg (210-280), in newborns with cardiogenic shock CO was 170 mL/min/kg (f130-200), p < 0.01. The Stroke Volume was 1.80 mL/kg (1.70-1.90) in the control group and 1.20 (1.15-1.80) in the shocked group (p < 0.05); Heart Rate was 146 beats/min (130-160) and 160 beats/mm (140-194), (p < 0.01) respectively. Twenty-nine infants with cardiogenic shock had CO < or = 150 mL/min/kg and 5 of them (17.2%) died; 16 neonates had CO > 150 mL/min/kg and only one (6.2%) died (p < .01). Twenty-six of 36 newborns with perinatal asphyxia had CO < or = mL/min/kg and 5 of them died, while only one of 10 infants with CO > 150 mL/min/kg died. CONCLUSIONS: Our results show that persistently low CO (< or = mL/min/kg) during the first 48 hours life, in newborns with cardiogenic shock due to perinatal asphyxia is associated with a significantly higher mortality.

Cardiac Output, Low↗

PubMed1998

Controversies on the prevention of diabetic nephropathy.

Renal function declines progressively in patients with diabetic nephropathy and the decline may be slowed by some preventive interventions. Optimized and intensive insulin therapy delays the onset and slows the progression of diabetic nephropathy. Moreover, dietary restriction, avoiding a high protein intake, could be effective in reducing glomerular hyperfiltration. Finally, there is evidence that angiotensin-converting enzyme inhibitors reduce renal damage by one or more mechanisms independent of their antihypertensive effects. Some controversial aspects of the prevention of diabetic kidney disease are presented and discussed.

Albuminuria↗

PubMed1998

Focal ischemic injury of middle cerebral artery in newborn infants.

Three full term newborns with focal ischemic injury of the middle cerebral artery (MCA) were observed. Diagnosis was suspected by cerebral ultrasonography (US) in the first year of life and then was confirmed by CT-scan and/or MRI. All children had a history of pre-perinatal risk factors of fetal impairment. Neuropsychological outcome, ranging from normal to severe, was evaluated in all three patients; it appears to be related to the type and extension of cerebral injury. In full-term neonates with discrete, moderate or severe neurologic symptoms the possibility of focal ischemic injury in the MCA territory should be considered.

Cerebral Arteries↗

PubMed1998

Laser-Doppler-flowmetry in preterm newborns during apneic events.

MATERIALS AND METHODS: We have studied with Laser-Doppler-Flowmetry (LDF) Skin Blood Flow Perfusion (SBFP) during apneic events in 15 preterm newborns (mean GA 32.4 w; mean B.W. 1620). Eighty-four apneic episodes were analyzed and the results were gathered into two groups. Group 1 with SBFP belonging to preterms aged up to 5 days and Group 2 with SBFP records of some older newborns (from 5th to 10th day of life). At first a decrease of LDF was often observed during apneic events. RESULTS: A statistically significant difference between the two groups was noted considering the SBFP percentage reduction, the hematocrit and the time of appearance of the skin blood flow decrease. We also studied the mean of all apneic SBFP reductions in each of those newborns (11/14) who had apneic events in both periods, observing a remarkable increase in mean SBFP reduction when the newborns were older than five days. CONCLUSIONS: These differences can be caused by rheologic factors such as high hematocrit, less pronounced red cell deformability and a sort of cold vasoparalysis more evident in the first days of life. We think laser-Doppler-flowmetry be suggested when the newborn is able to better contrast the negative effects of apnea, for example centralizing the circle in favour of vital organs.

Apnea↗

PubMed1997

The cardio-facio-cutaneous syndrome: a long-term follow-up of two patients, with special reference to the neurological features.

The cardio-facio-cutaneous (CFC) syndrome is a newly recognized syndrome characterized by congenital heart defects, a particular facial appearance and abnormalities of hair and skin; apart from these, the most evident signs are mental retardation and other neurological abnormalities. Some of the phenotypic manifestations resemble those of Noonan syndrome, but this involves different neurological problems. We report on two children affected by cardio-facio-cutaneous syndrome who have been followed up for at least 6 years. The psychomotor retardation was severe. During the follow-up period we made a careful analysis of the neurological aspects of the course in these two patients and wish to stress that some neurological features are peculiar to this syndrome and can be useful in the diagnosis.

Abnormalities, Multiple↗

PubMed1997

Lipids and lipoproteins in diabetic adolescents and young adults with retinopathy.

PURPOSE: To compare serum concentrations of lipoproteins and apolipoproteins in insulin-dependent diabetic patients with and without retinopathy. METHODS: A cross-sectional study was performed on 42 diabetic adolescents and young adults with different degrees of retinopathy. The mean +/- SD age of the patient was 21.1 years (range 12.8-27.9 years); their mean duration of diabetes was 12.3 years (range 7.1-19.9 years). Their glycosylated haemoglobin (HbA1c) and fructosamine were respectively 10.2% (8.2-15.4%) and 280.8 mumol/l (202.1-458.5 mumol/l). Forty-two diabetics without retinopathy similar to the study population as regards age, sex, duration of disease, HbA1c and microalbuminuria values, and 42 healthy subjects, served as controls. RESULTS: Serum lipid and lipoprotein concentrations were not different from those of healthy controls in patients either with or without retinopathy. The diabetic patients were subdivided in two groups according to the degree of their retinopathy: background and preproliferative/proliferative retinopathy. Patients with preproliferative/proliferative retinopathy were found to have significantly higher lipoprotein (a) values than the other group (background, 73.3 IU/l; preproliferative/proliferative, 205.9 IU/l; p < 0.001). CONCLUSION: The increase in lipoprotein (a) levels might play a role in the development of severe retinopathy.

Adolescent↗

PubMed1997

Changes in serum lipids and lipoproteins in epileptic children treated with anticonvulsants.

OBJECTIVE: To assess the effect of long-term treatment of phenobarbital, carbamazepine and sodium valproate on serum lipids and lipoproteins in epileptic children. METHODOLOGY: One hundred and fourteen (55 male, 59 female) children and adolescents suffering from various types of epilepsy who received different antiepileptic drugs were studied. The patients were subdivided into three groups according to their therapy: (i) carbamazepine (35 patients); (ii) phenobarbital (34 patients); and (iii) sodium valproate (45 patients). One-hundred healthy sex- and age-matched children served as controls. Lipids and lipoprotein profile were evaluated before the beginning of the anticonvulsant therapy and after at least 2.5 years. In the patients receiving phenobarbital, we re-evaluated 12 children (seven male, five female) at the end of therapy. RESULTS: The children receiving phenobarbital showed high levels of serum total cholesterol and low-density lipoprotein (LDL) cholesterol and low levels of triglycerides, while children treated with carbamazepine had high levels of total cholesterol, triglycerides, LDL and high-density lipoprotein (HDL) cholesterol. Children treated with valproate had low triglycerides and LDL cholesterol levels with high levels of HDL cholesterol. The patients treated with phenobarbital showed a normalization of all parameters after the end of therapy. CONCLUSIONS: Anticonvulsant drugs significantly modify serum lipids and lipoproteins in epileptic children. The changes due to phenobarbital seem to be transient.

Adolescent↗

PubMed1997

The importance of microalbuminuria as an indicator of incipient diabetic nephropathy: therapeutic implications.

Nephropathy is the major life-threatening complication of insulin-dependent diabetes mellitus (IDDM). The clinical syndrome is characterized by persistent albuminuria (greater than 300 mg day), a rise in arterial blood pressure, and a relentless decline in glomerular filtration rate leading to end-stage renal failure. The availability of a radioimmunoassay for detecting albumin in low concentrations in urine has allowed the study of urinary albumin excretion rates in diabetics well before clinically persistent proteinuria develops. An albumin excretion rate greater than that in normal subjects and lower than that in macroalbuminuric subjects is called microalbuminuria (range 20-200 microg/min or 30-300 mg/24 h). Although recent studies have challenged the predictive value of microalbuminuria for later development of overt diabetic nephropathy, albumin excretion rate in the microalbuminuric range and its tracking (i.e. annual increase) are still considered reliable markers for prediction of later overt diabetic kidney disease. Overnight urinary collection is preferred for calculation of the rate of albumin excretion, but may be difficult to perform precisely. The albumin:creatinine ratio of the first morning urine sample is a reliable screening method: the microalbuminuric range is considered to be 2.5-25 mg/mmol or 30-300 mg/g (3.5 mg/mol has been proposed as lower limit in females because of their lower creatinine excretion). Irrespective of the procedure used, at least two samples over a 3-6-month period should test positive before microalbuminuria is confirmed and 'persistent microalbuminuria' defined. If the albumin excretion rate is persistently in the microalbuminuric range it is of crucial importance to define strategies and carry out interventions for prevention of decline in kidney function. The goal of achieving the best glycaemic control as early as possible in as many IDDM patients as is safely possible is particularly important in microalbuminuric patients. Although it is unsafe to reduce dietary protein intake drastically, particularly in children and adolescents, moderate decrease of protein intake (i.e. 0.9-1.1/g/kg day) is advisable in diabetic patients from the very beginning of the disease. Timely treatment with an angiotensin-converting enzyme inhibitor, independently of rise in arterial blood pressure, should be considered if improvement of glycaemic control and moderate decrease of dietary protein intake for 6-12 months have failed to reduce the albumin excretion rate. Screening programmes for microalbuminuria and early intervention can substantially modify the natural history of diabetic renal involvement and disease and possibly reduce the incidence of end-stage renal failure.

Albuminuria↗

PubMed1997

Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 levels in children with precocious puberty treated with gonadotropin-releasing hormone analog without or in combination with cyproterone acetate.

In order to assess the behavior of growth hormone, insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) in girls with central precocious puberty treated with gonadotropin-releasing hormone (GnRH) analog-therapy, we studied 14 girls with this condition, the patients were subdivided into two groups, according to the therapy followed. Group A (n = 7; age 4.2-7.1 years) received GnRH analog in combination with cyproterone acetate, and Group B (n = 7; age 4.4-6.9 years) received long-acting analog alone. Before treatment, IGF-I levels were significantly increased compared to healthy age-matched children in the two groups (447 +/- 33 micrograms/l for Group A and 435 +/- 38 micrograms/l for Group B vs. control 175 +/- 78 micrograms/l; p < 0.01). Moreover, serum IGFBP-3 levels were significantly higher than the age-related reference range for IGFBP-3 (4478.2 +/- 178 micrograms/l for Group A and 4532.3 +/- 167 micrograms/l for Group B vs. control 2905 +/- 641 micrograms/l; p < 0.01). During the two years of gonadal suppression, Group A patients showed a significant decrease in IGF-I and IGFBP-3 levels, while in Group B there was no significant change in IGF-I; moreover, in Group B, IGFBP-3 levels increased significantly compared to baseline values during the first year of treatment (4532.3 +/- 167 micrograms/l vs. 5410.3 +/- 169 micrograms/l; p < 0.05) and decreased significantly at the end of the second year of treatment (3816.1 +/- 189 micrograms/l vs. 5410.3 +/- 169 micrograms/l; p < 0.01). Our study shows that the two different treatments of precocious puberty (with and without cyproterone acetate) have different effects on IGF-I and IGFBP-3, and suggests that these growth factors are under different metabolic regulation.

Child↗

PubMed1997

Flicker perimetry in diabetic children without retinopathy.

OBJECTIVE: To determine the flicker fusion frequency in children and adolescents with insulin-dependent diabetes mellitus (IDDM) who did not have fluorescein angiographic signs of retinopathy. DESIGN: Cross-sectional study. SETTING: Antidiabetic Centre, departments of Ophthalmology and Pediatrics, University of Chieti, Chieti, Italy. PATIENTS: Forty-five patients aged 9 to 18 years with IDDM without fluorescein angiographic signs of retinopathy. Forty-five healthy subjects matched for sex and age constituted the control group. The patients were classified into two subgroups according to their metabolic control: good (percentage hemoglobin Alc 9% or less) or poor (percentage hemoglobin Alc greater than 9%). OUTCOME MEASURES: Retinal flicker fusion frequency, evaluated with an automated flicker perimeter in the central 30 degrees of the visual field. RESULTS: The subjects with poor metabolic control had a significantly lower mean flicker fusion frequency than the control subjects (27.43 Hz [standard deviation (SD) 5.16 Hz] vs. 38.72 Hz [SD 4.27 Hz]) and the patients with good metabolic control (33.94 Hz [SD 5.54 Hz]) (p < 0.001). There was a significant relation between flicker fusion frequency and the percentage of hemoglobin Alc (r = -0.533, p < 0.001). CONCLUSIONS: Our results show that children with poorly controlled IDDM without fluorescein angiographic signs of retinopathy have an impairment of retinal flicker sensitivity in the central 30 degrees of the central visual field and that this impairment is related to the degree of metabolic control. Flicker perimetry is a simple, noninvasive tool that may be useful to evaluate the eye function of diabetic children.

Adolescent↗

PubMed1996

Early infantile epileptic encephalopathy: a long-term follow-up study.

The authors describe the electroclinical aspects and long-term evolution of five (in one male and four female patients) cases of early infantile epileptic encephalopathy in the neonatal period, the most common seizures were tonic spasms (either generalized or lateralized) that, very often, occurred in series. All newborns showed the typical suppression-burst pattern. The neurological status (initially normal) progressively deteriorated in the subsequent months, and all infants suffered from severe mental insufficiency and daily intractable seizures. Four out of the five children developed hypsarrythmia and one, Lennox-Gastaut syndrome. The authors discuss the main problems related to the suppression-burst pattern and the long-term prognosis of this abnormality.

Anticonvulsants↗

PubMed1996

Severe hypoglycemia in insulin-dependent diabetic children treated by multiple injection insulin regimen.

The occurrence and risk factors of severe hypoglycemic attacks were analyzed during a 4-year study in a group of children and adolescents who received human insulin and followed a multiple daily injection regimen (three or four injections per day); 29 patients experienced severe hypoglycemia at least once in 4 years. Of these, 13 suffered recurrent episodes: 8 had two episodes, 4 had four episodes, and 1 patient had seven episodes. For comparative purposes, the nonhypoglycemic population (217 diabetic children) was used as a control group. The hypoglycemic children received insulin doses which were significantly higher than for nonhypoglycemic patients (1.05 +/- 0.6 U/kg daily vs 0.87 +/- 0.7; P < 0.05). Moreover, the hypoglycemic group had a significantly higher mean number of previous episodes of severe hypoglycemia than the nonhypoglycemic group (0.98 +/- 1.2 vs 0.26 +/- 0.7; P < 0.001). There was no significant difference in age, sex, duration of disease, and metabolic control between hypoglycemic and nonhypoglycemic children. There was no association between severe hypoglycemia and the presence of retinopathy, persistent microalbuminuria, or autonomic neuropathy. Severe hypoglycemia is a recurrent problem, not related to the quality of metabolic control nor to the presence of long-term microvascular complications, and diabetic children with a personal history of severe hypoglycemia are at risk for future episodes.

Adolescent↗

PubMed1996

Neonatal diagnosis of tuberous sclerosis.

Intracranial tumors are rare in the neonatal period, and generally the most common histological types are astrocytoma, medulloblastoma, choroid plexus papilloma and neuroectodermal tumors. The early diagnosis of these tumors is often very difficult. The authors report a case of a full-term newborn who presented with opisthotonus. A subependymal mass was detected by cerebral ultrasonography, and when the child was 1 month of age depigmentations appeared on the trunk and on the right leg, confirming the suspicion of tuberous sclerosis. At 3 months of age the child suffered infantile spasm with hypsarrhythmia. The developmental delay, the marked progressive neurological deterioration and the daily seizures suggested surgical resection. Histologic studies showed a subependymal giant cell astrocytoma such as typically occurs in tuberous sclerosis.

Brain↗

PubMed1996

Macular recovery time in diabetic children without retinopathy.

The aim of this study was to evaluate whether patients with initial diabetic nephropathy (defined as persistent microalbuminuria) have an impairment of macular recovery time and if this impairment changes in a long-term follow-up. Eighty insulin-dependent diabetic children without fluorescein angiographic signs of retinopathy and 80 controls were included in the study. All patients underwent nyctometry at the beginning of the study; diabetic children repeated the same test after 7 years. Diabetics were divided into two subgroups as regards presence of persistent microalbuminuria (albumin excretion rate > 20 micrograms/min/1.73 m2). At the beginning of the study, diabetics as a whole and normoalbuminuric patients showed similar data to controls, while microalbuminuric ones showed worse data at nyctometry (initial recovery time (IRT): 44.89 +/- 12.50; Summation method (SM): 509.1 +/- 312.0) in comparison with normoalbuminuric (IRT: 38.12 +/- 10.31, P = 0.010; SM 648.6 +/- 272.2, P = 0.036) and control subjects (IRT: 37.77 +/- 11.82, P = 0.004; SM: 661.5 +/- 297.5, P = 0.013). After 7 years, normoalbuminuric subjects showed a slight, but not significant worsening of nyctometry, while in microalbuminuric ones a significant difference between baseline and the end of follow-up was found (IRT: 44.89 +/- 12.50 vs. 52.91 +/- 13.9, P < 0.01; SM: 509.1 +/- 312.0 vs. 374.8 +/- 271.9, P < 0.05). Diabetic patients had a higher rate of abnormal IRT and SM than controls (P = 0.0004 and P = 0.0006, respectively). A higher number of patients in microalbuminuric subgroup than in normoalbuminuric one were found (both at baseline and at the end of follow-up) above the 95th centile of IRT (baseline 3 vs. 15; P = 0.0002; end of follow-up 5 vs. 23; P < 0.0001) and below the 5th centile of SM (baseline 5 vs. 14; P = 0.004; end of follow-up 5 vs. 19; P < 0.0001). Nyctometry was found more altered in microalbuminuric patients than in normoalbuminuric and controls. Unfortunately, there is a large overlap between the two diabetic subgroups and between diabetics and controls; for this reason, this technique is not suited for everyday practice.

Adolescent↗

PubMed1996

Autonomic dysfunction in newly diagnosed insulin-dependent diabetes mellitus children.

In order to evaluate the presence of electrophysiologic signs of autonomic dysfunction (AD) in newly diagnosed diabetic children, cardiovascular reflex tests were performed in 55 (30 female, 25 male) newly diagnosed insulin-dependent diabetes mellitus (IDDM) patients aged 10.3-20.7 years (mean +/- S.D.: 15.2 +/- 5.6). Ten (18.2%) diabetic children had cardiovascular AD, defined as abnormal results in 2 of 5 tests. Autonomic function tests were assessed at entry and after 12, 24, and 36 months of the study. All diabetic children received human insulin and followed an intensive insulin treatment (3 or 4 injections per day), associated with a teaching program of self-management of the disease. In the 3 years of follow-up, all children improved the quality of metabolic control (glycosylated hemoglobin, HbA1c: 10.3 +/- 1.1% versus 7.7 +/- 0.9; P < .01) and manifested no significant difference between baseline and follow-up values of autonomic function tests which remained unchanged in spite of this improvement. Cardiovascular autonomic dysfunction can be present in newly diagnosed IDDM children and it seems to be stable in children who follow an intensive insulin injection therapy.

Adolescent↗

PubMed1996

Newborns with hyperbilirubinemia: usefulness of brain stem auditory response evaluation.

We describe brain stem auditory evoked potentials (BAEP) obtained in 48 full-term newborns (20 boys, 28 girls) presenting with high serum total bilirubin concentration (from 238 to 442 mM) without Rhesus of group A, B, O factors incompatibility. Recordings were performed on the 3rd day of life and repeated 5-7 days post-appropriate therapy with photostimulation and exchange transfusion (when bilirubin concentration had decreased below 136 mM). Supplementary recordings were performed 3, 6 and 12 weeks later in order to assess test-retest reliability of components. Mean values of BAEP latencies were compared with those obtained in 40 age-matched control subjects using the same recording procedures. At first recording session (on the 3rd day), latencies of waves III and V obtained in hyperbilirubinemic patients were significantly increased as compared with records in control subjects. Recordings performed 5 to 7 days post-therapy and during subsequent recording sessions showed no significant differences between patients and control groups. Serial neuropsychological evaluations obtained over a 3-year follow-up showed no subsequent neurodevelopmental abnormality for all patients. These findings suggest that hyperbilirubinemia can alter central neurotransmission in auditory brain stem pathways, but this modification is only transient.

Case-Control Studies↗

PubMed1996

Cerebral defects confirm midline developmental field disturbances in supernumerary der(22), t(11;22) syndrome.

We describe a girl with midline defects and distal limb anomalies, who had a supernumerary der(22) syndrome. The presence of some anomalies identifying the midline defects, led us to review all patients reported up to now, with interesting results. We point out the particular finding of midline defects in CNS only, in patients studied by autopsy or neuroradiologic imaging.

Abnormalities, Multiple↗