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Biomedical subjects

C Capuano

Publications and source records attributed to C Capuano.

At least 19 recordsLinked to original sources
PubMed2004

Occipital condyle fractures: a hidden nosologic entity. An experience with 10 cases.

INTRODUCTION: To report the incidence, treatment and outcome of occipital condyle fractures (OCFs) based on the experience of a single neurosurgical department over a period of two years. MATERIAL AND METHODS: From April 1999 to April 2001, ten cases of OCFs were identified in 110 cervical traumas observed over a period of two years. Patients were studied by cervical x-rays, high-resolution CT scan with a 1-2 mm slice of the cranio-cervical junction (CCJ) and MRI in selected cases to evaluate the integrity of supporting ligaments. According to the Anderson and Montesano classification, 5 cases of type III, 3 cases of type II and 2 cases of type I fractures were found. Dysfunction of lower cranial nerves was observed in 8 cases. Treatment was conservative in all cases. RESULTS: At follow-up, ranging from 18 months to 2 years, fusion was obtained in all cases; 8 patients were neurologically intact, one patient presented a mild persistent dysphonia and another mild trapezius weakness. CONCLUSION: OCFs are actually not rare, rather they are often overlooked. In cases of high-energy trauma of the cervical spine, the diagnostic suspicion should be kept in mind.High-resolution CT scan with slice at 1-2 mm of the CCJ is the key radiological examination in the diagnosis of this lesion. Conservative treatment using a hard collar is sufficient to obtain sound fusion.

Adolescent↗
PubMed2004

Left ventricular diastolic impairment during coronary arteriography with a non-ionic contrast medium.

AIM: The aim of this study was to assess the influence of coronary arteriography with the use of a non-ionic low molecular monomer (iopromide) on left ventricular function. METHODS: Fifty consecutive patients with coronary artery disease (CAD) and normal left ventricular ejection fraction were studied by coronary arteriography for a stable or unstable coronary syndrome by using iopromide. They were divided into 2 groups: group 1, patients with one vessel disease; group 2, patients with multiple vessel disease. A >50% reduction of the lumen diameter by on-line quantitative angiography was considered a significant coronary stenosis. Coronary arteriography was performed by hand injection of 5 ml of iopromide avoiding the use of nitrates during the procedure. Doppler echocardiography monitoring was performed immediately before the coronary arteriography and at the end of the last coronary injection. The following parameter were recorded: E peak velocity (E) (cm/s), A peak velocity (A) (cm/s), E/A ratio, E deceleration time (EDT) (ms), isovolumic relaxation time (IRT) (ms), and left ventricular ejection fraction (EF) (%). RESULTS: No complications were observed during the procedures. A mean amount of 40+/-8 ml of iopromide was used. No significant variation of heart rate and arterial pressure was shown during coronary arteriography. No changes were observed either for E, A, E/A ratio or for left ventricular EF in any group of patients. A significant increase of EDT and IRT in comparison with baseline values was documented only in group 2 (from 140+/-77 to 199+/-44 and from 98+/-33 to 144+/-44, p<0.01), returning to baseline values after 10+/-3 minutes. A positive correlation was observed between EDT and IRT shift from baseline values (r=0.77; p<0.01). CONCLUSION: In conclusion, iopromide temporarily impairs left ventricular diastolic dynamics during selective coronary angiography, but only in patients with multivessel CAD.

Adult↗
PubMed2003

Percutaneous closure of patent foramen ovale: pathophysiology, indications, and technique.

The percutaneous closure of patent forame ovale (PFO) is currently performed in patients with cryptogenic stroke or paradoxical systemic embolism. The availability of new user friendly devices and the increase in knowledge of the pathophysiology, epidemiology, and follow-up of these patients has broadened the indications and drastically reduced the morbidity related to the intervention. This review considers the main pathophysiological and epidemiological features of PFO and discusses the indications and results of the intervention.

Cardiac Catheterization↗
PubMed2003

[Campaign to eradicate yaws on Santo Island, Vanuatu in 2001].

At the beginning of the 1960s a campaign was carried out to eradicate endemic trepanematosis in the South Pacific. During the year 2000, twenty cases of yaws were diagnosed on Santo Island in Vanuatu. Recrudescence of this disease was confirmed by a seroprevalence testing showing 20.9% positive VDRL in 273 serum tests. In view of these findings, the Health Minister in collaboration with the WHO office in Vanuatu undertook mass benzathine-benzylpenicilline treatment in the population of the Santo and Malo (SANMA) province. The objective was to treat at least 85% of the population. Treatment was administered to 36,414 of the 39,397 inhabitants identified in 587 villages during the campaign, i.e., 92.4%. Coverage varied from 87.6 to 97.3% depending on the zone. Positive VDRL was obtained in 96 of the 230 serum samples collected for suspicion of yaws. All documented cases of yaws were found in the southeastern part of the island. Treatment had a dramatic effect on lesions within 24 hours. Cooperation of the population and involvement of mobile units and primary health-care providers were key factors in the success of this campaign. Further action will include training of health care workers and improvement of sanitary conditions in villages. Seroprevalence testing to assess the effectiveness of this campaign is to be carried out in 2003.

Adolescent↗
PubMed2002

[Diabetes and alternative medicine: diabetic patients experiences with Ayur-Ved, "clinical ecology" and "cellular nutrition" methods].

In the last two years we discovered that three of our patients with type 1 diabetes mellitus (0.8%) suffered an unexpected worsening in their glycemic control due to a reduction of their insulin dosage in favour of some "alternative" diabetes treatments using herbs, vitamins, fantastic diets and trace elements prescribed by non-medical practitioners. The first patient, a 6.6 year old boy, was admitted to hospital because of a severe ketoacidosis with first degree coma as a result of his parents having reduced his insulin dosage by 77% and replacing the insulin with an ayurvedic herbal preparation (Bardana Actium Lapp). The second patient, a 10.4 year old boy, was admitted to hospital after his teachers noticed that he appeared tired, thinner and polyuric. During hospital admission for mild ketoacidosis the mother, reluctant at first, finally confessed that her son was under the care of a "clinical ecologist". Having identified several food allergies this "clinical ecologist" had placed the child on a spartan diet of bread, water and salt, and had reduced his insulin dosage by 68%. The third patient, a 21 year old male, upon transfer to the Adult Diabetic Center, reported that he had been under the care of a pranotherapist for several years. The pranotherapist had prescribed a cellular nutrition preparation (called "Madonna drops"), a meditation program and also a 50% reduction in his insulin dosage. During this period his HbAlc values had increased from 6.4% to 12%. Current orthodox diabetes treatments are considered unsatisfactory by many people and it is thus not surprising that they search for "miracle" cures. It is important, however, that hospital staff do not ridicule the patients or their parents for trying these alternative therapies. Nevertheless, it would be useful for staff to discuss in advance these "therapies" with patients, highlighting their ineffectiveness and strongly discouraging cures that call for a reduction or elimination of the insulin treatment.

Adult↗
PubMed2002

Restenosis after NIR stent implantation.

The NIR stent is a "second-generation" slotted-tube stent that was developed after the Palmaz Schatz and the Gianturco-Roubin stents, and introduced into clinical practice in 1992. This review of the literature describes its clinical performance and the long-term outcomes after implantation in different anatomical and clinical subsets of patients. It also considers clinical experience with the gold-plated NIR stent.

Angioplasty, Balloon, Coronary↗
PubMed2001

Acute stent recoil: in vivo evaluation of different stent designs.

This study sought to investigate the degree of acute recoil of four different stents by means of quantitative coronary angiography. Four hundred and six patients underwent stent implantation for single discrete coronary artery lesion: 105 received a 16 mm Paragon stent, 112 an 18 mm Multilink Duet, 97 a 16 mm NIR Primo stent, and 92 a 15 or 18 mm NIR Royal Advance. Elastic recoil was defined as the difference between mean balloon cross-sectional area (CSA) at the highest pressure and mean CSA after PTCA. The mean stent recoil was 13% +/- 10% CSA (P < 0.001), being statistically greater for the nitinol Paragon stent (21% +/- 11%), intermediate for the multicellular Multilink Duet stent (14% +/- 7%), and minimum for the NIR family (9% +/- 6% and 8% +/- 7%, respectively). The recoil was not homogeneously distributed along the stent length but was lower at the two ends (11% +/- 12% and 13% +/- 11%) and highest in the central part (15% +/- 12%)(P < 0.001). Thus, acute recoil is a significant phenomenon regardless of the mechanical properties and design of new-generation tubular stents.

Aged↗
PubMed2001

A randomised comparison of the use of 4 and 6 French diagnostic catheters: the limits of downsizing.

BACKGROUND: The use of small catheters for coronary angiography can reduce the risk of vascular complications and allow early ambulation, but excessive downsizing may lead to poor quality imaging. The aim of this study was to assess the feasibility of performing coronary angiography using 4 French (4 F) femoral catheters. METHODS: In total, 400 consecutive elective patients were randomised to undergo coronary angiography with 4 F or 6 F catheters. The puncture site was manually compressed and inspected before and after ambulation, and 24 h later. The handling difficulty of the catheters was semi-quantitatively evaluated using a three grade scoring system; angiogram quality was evaluated by two independent physicians. RESULTS: No major procedure-related complications were observed. Coronary arteriography with 4 F catheters was possible in all of the attempted cases. There were no statistical differences between the two groups in terms of procedural or fluoroscopy time, the amount of contrast medium used, or the incidence of vascular complications, while compression time was significantly shorter in the patients studied using the smaller catheter (3.4 vs. 9.9 min; P<0.0001). Catheter stability was similar in the two groups, whereas catheter torque and the quality of the coronary angiograms were statistically better in the patients studied using six French catheters. CONCLUSIONS: Coronary angiography with 4 F catheters is technically feasible and permits early ambulation after the procedure. Although the radiological resolution of the images obtained using 4 F catheters was always adequate for clinical decision-making, the angiogram quality and catheter handling were significantly better using the 6 F system.

Cardiac Catheterization↗
PubMed2001

[New coronary imaging modality. I. Digital angiography (cineless) and low-energy digital fluoroangioscopy systems].

The advent of digital medical imaging offered unique new possibilities of analyzing, visualizing and communicating medical images. This article reviews the impact of the digital technology in the cardiac catheterization laboratory and covers a range of topics such as the standard DICOM, the transition to cineless angiography, the digital cardiac archive, the network system for imaging exchange and the role of the cardiac digital mobile imaging systems.

Angiography, Digital Subtraction↗
PubMed2001

Palivizumab in infants with gestational age < or = 28 weeks and bronchopulmonary dysplasia.

We report data from 11 patients < or = 28 weeks' gestation with severe bronchopulmonary dysplasia (BPD) prophylactically treated with palivizumab for prevention of respiratory syncytial virus (RSV) infection. All babies were receiving pharmacologic respiratory therapy at the moment of discharge from neonatal intensive care unit. Babies received 15 mg/kg i.m. palivizumab every 4 weeks to a max of 5 doses during the period November-March. We compared them with 8 similar infants that did not require therapy at discharge, nor were given any placebo. The treated infants did not present significant side effects. No baby in both groups was infected with RSV during the period of observation. We conclude from these preliminary data that palivizumab did not present contraindications in infants < or = 28 weeks' gestation with severe BPD requiring pharmacologic therapy at discharge. More data are required to evaluate efficacy to prevent RSV infection in these infants.

Analysis of Variance↗
PubMed2000

[Mortality and morbidity in extremely premature newborns].

The progress of perinatal medicine greatly reduced neonatal mortality and prognosys of the lowest gestational age (G.A.) newborns is improving continuously. The survival of the newborns with G.A. < 32 weeks doubled from the years 1973-1978 to 1995-99 in the our neonatal intensive therapy (TIN), whereas the incidence of the most serious pathologies of prematurity, which increases with the decreasing of G.A., has not changed in the years. In the surfactant era, Respiratory Distress Syndrome is not the first cause of death and Intra Ventricular Hemorrage and Retinopaty Of Prematurity occur now in the lower stage of severity in comparison with the past. Cortison profilaxys antepartum, delivery with caesarian section and agressive intensive neonatal therapy seem to be the reason of these results.

Gestational Age↗
PubMed2000

[Early discharge and breast-feeding].

Early discharge is often correlated with negative events such as feeding problems leading to hypernatremic dehydration and malnutrition and non initiation or premature cessation of breastfeeding. In the reality of Parma we have valued the impact of early discharge on breastfeeding, analyzing a cohort of 267 dyads, 134 of which were in the "late discharge" group and 133 in the "early discharge" group. Our study showed, according to the most recent literature, that early postpartum discharge did not negatively affect the start and length of breastfeeding: early discharge indeed, if associated with suppression of "hospital routines" and with home-based postpartum follow-up visits, is a determining factor for the success of breastfeeding.

Breast Feeding↗
PubMed2000

[Evaluation and impact on incidence of admission to the neonatal care unit in cases of jaundice after early discharge form the nursery].

UNLABELLED: We have evaluated the entity of admissions to the Neonatal Care Unit (NCU) for jaundice in the period 1996-2000 of babies early discharged from the Nursery (36-48 hours for spontaneous deliveries and 72-96 hours for cesarean section). We have found an increasing trend of admissions for jaundice (R2 = 0.76), proportional to the increasing practice of early discharge and the early discharge also for infants 34-37 weeks' gestation. The admissions for jaundice from home have increased about 8 times from 1996 to 2000, respectively from 8 to 65 cases. The mean value of maximum total bilirubinemia at admission was 20.5 +/- 2.7 mg/dl. None of the infants underwent exchange transfusion. The most part of the jaundices (69/123) were idiopathic in term infants, followed by those in preterm babies (24/123) and by those in ABO incompatibility without hemolytic disease (15/123). Mean age at admission of the total population was 6.5 +/- 3.0 days, and 9 newborns had signs of dehydration at admission, with weight loss between 11 and 13.8% from birth. Also the admissions for jaundice of extracomunitary babies have resulted increased and they had a longer hospitalization than the rest of the population (p = 0.02). CONCLUSIONS: Early discharge from the Nursery has determined an increase of admissions to NCU for jaundice. New criteria have to be considered to select more carefully the infants that can benefit of this practice.

Hospital Departments↗
PubMed2000

[Neonatal diabetes, heterogeneous syndrome].

Neonatal diabetes (ND) is a rare condition of hyperglycaemia which occurs, generally, within the first month of life, requires insulin therapy and lasts more than two weeks. The pathogenesis is uncertain and the different clinical variants are heterogeneous; both a "permanent" and a "transient" form of ND exist. We report the clinical history of three neonates (A.L., A.B. and V.I.) in which a tout-court diagnosis of ND was done; the follow-up allowed us to reevaluate the initial diagnoses and suppose different ethiopathogenic mechanisms. Clinical observations, insulin requirement and biochemical data obtained during the years of follow-up allowed to distinguish three different situations: a "permanent" ND (A.L.), a "transient-recurrent" ND (A.B.), and a Maturity Onset Diabetes of the Young (MODY) (V.I.).

Diabetes Mellitus↗
PubMed1999

Stent implantation without predilation in patients with a single, noncalcified coronary artery lesion.

The purpose of this study was to assess the feasibility of stent implantation without predilation in patients with a single, noncalcified coronary artery lesion. A total of 122 patients were randomized to receive a stent with or without predilation; direct stent placement was possible in 59 of the 61 patients (97%) with an immediate and long-term clinical follow-up similar to that observed in the group of patients treated conventionally.

Aged↗