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Biomedical subjects

C Macchi

Publications and source records attributed to C Macchi.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

[Effect of hospital policies on patient mobility: Siennese experience].

The Italian National Health Service (S.S.N.), adopted in 1978 (Law n 833) and based on Beveridge's model, emphasises the citizens freedom to choose and the equal opportunity in accessing health care structures. Local Health Authorities--L.H.A. (U.S.L.--Unità Sanitarie Locali) become owners of almost all the structures in their territories and directly responsible for the satisfaction of all residents health needs. The former hospitals' network, based on independent first, second and third level public hospitals, in potential competition, was dismantled. Hospitals' financing, the main economic role of the S.S.N., was based on the documented running expenses: therefore the hospital interest to attract patients diminished and expenses increased in a uncontrolled way. In 1992, the Italian Government, (re)introduced (Law n 502) the quasi-market administered competition between Italian hospitals, making the major ones independent (Aziende Ospedaliere--A.O.) from the L.H.A. Hospital income from then is based on DRGs; the L.H.A. (and hospitals) leadership is now entrusted to managers and not politicians. We describe now how these changes were experienced by our hospital (A.O. Senese), placed in Southern Tuscany, Italy. We elaborated hospitalisation data regarding residents in the province of Siena (252,000 inhabitants) and activity data regarding its main hospital (A.O. Senese, 1200 beds, 47,000 admissions/year). Using the Gandy's Nomogram, we show the variation of patients mobility from 1988 to 1999. Our survey demonstrates that the Italian hospital system answers well enough to the legislative regulations: following the Law 833/1978 our hospital diminished its ability to attract patients from other areas; at the same time migrations of hospitals patients from Siena increased. Following the Law 502/1992, the power of attraction of our hospital is increased. Nevertheless the flow of escape continued to increase. It appears that to discourage the attraction power means to promote the loss of perceived quality and that it is difficult to correct such effects.

Data Collection↗
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[Mortality from malignant tumors in the industrial region of the province of Milan, 1980-1987].

For the period 1980-87 mortality data relating to residents of a densely populated area in the province of Milan was collected and elaborated. The area is heavily industrialised and had a particularly high immigration level in the 1960's and 70's. Malignant neoplasms represented the cause of death in 35.59% of male cases and 26.59% of female, with greater incidence in the former of tumours in respiratory organs and in the latter in the digestive tract. High mortality rates were noted for cancer of the lung in males over 35 years and for neoplasms of the digestive tract in those over 75 years but in females high mortality from breast cancer prevailed between 25-74 years and cancer of the stomach and intestine in those over 75 years. S.P.M.R. were elaborated with proportional mortality analysis showing an overall tendency to an increased death rate from malignant tumours that was statically significant in females, particularly at an advanced age. Increasing trends in tumours of the stomach and of the lympho-hematopoietic tissues were evident in females, in urinary organs in males, notably in elderly men, and in intestinal cancer in both sexes. The trend in mortality from breast cancer was however on the decline. As a whole, mortality was stationary in cases of cancer of the lung (although it was on the increase in females over 65 years), in cancer of the prostate (showing a decrease however in older subjects) and in cancer of the uterus and ovaries (but increasing in the latter case in elderly women). By means of S.M.R. elaboration the data was compared with that in Lombardy. In the area being taken into consideration a picture emerged of cancer mortality in general which was virtually the same as that found in Lombardy. However, the result of the comparison differs when considering sex and age groups. In fact in the 35-64 age group an inferior mortality rate to the Lombardian one was noted in the total population and in women, whilst for the age group 65 and over, a higher mortality rate emerged in men and in the total population. In males mortality was lower stomach tumours and higher for lung cancer, especially in more elderly subjects. Cancer of the colon-rectum, uterus and breast did not show statistically significant differences. The comparison with Italian data effected with direct age-standardisation has shown higher mortality from stomach, intestinal and lung cancer in the area being studied.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

[Mortality from malignant tumors of the digestive system in an area of the province of Milan from 1980 to 1987].

In a highly populated and industrialised zone of the province of Milan (Health Area 68, Rho) a study was made of mortality due to malignant neoplasms of the digestive organs in the years 1980-1987. The highest mortality percentage in both sexes is caused by stomach cancer, followed by neoplasms of the large bowel, particularly of the colon, malignant neoplasms of the pancreas, primary liver cancer and, in males, of the oesophagus. On the whole mortality from malignant neoplasms of the digestive organs is high in subjects over 75 years and in males a little earlier. Age standardised mortality rates of malignant neoplasms of the stomach and intestine are higher in the area being studied than in Italy. However in males mortality from cancer of the large bowel is lower than in Lombardy, especially in middle-aged subjects. The years 1980-87 have shown a statistically significant increasing trend in males of death from cancer of the colon, rectum and liver. There is an identical trend in females as regards cancer of the colon and liver with the addition of stomach cancer but mortality from cancer of the rectum is stationary. In both sexes mortality from malignant neoplasms of the digestive organs is on the increase but in females this coincides with a general increase in cancer mortality as a whole. Differences have emerged, however, between the sexes depending on age: in males the increasing trend refers mainly to the 35-64 year age group and in females to the over 65 age group. This is particularly true in the case of tumours of the large bowel. In the area being examined the middle-aged population was particularly affected by immigration caused by the rapid industrial development of the area in the 1960's and 70's. It is reasonable to assume that the increasing trend in tumours of the digestive organs, and in particular of the large bowel can also be explained by the fact that people coming on the whole from regions with a lower specific risk factor have had to adapt to different life styles and dietary habits that are typical of a highly industrialised metropolitan area. This assumption can be verified with case-control studies or with statistical techniques (e.g. the logistic regression model for the analysis of proportionate mortality data) that are more typical of occupational epidemiology. In this way it would be possible to understand better the effects of living in the area being studied, as well as of more specific risk factors.

Digestive System Neoplasms↗
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[Pollution with sulfur dioxide in an inhabited industrial area. Methodologic problems in monitoring].

The area around Rho and Pero in the north west of the province of Milan is densely populated and highly industrialised. It is also characterised by high levels of sulphur dioxide pollution. During the 1980s it was decided to check the sources of production of the pollutant and its distribution in the area. The main area for improvement was the refinery at Rho where it was aimed to disperse gases at a higher level by raising the chimneys and to use fuel gas in those burners which were connected to lower chimneys. For domestic systems it was decided to diffuse the use of methane as much as possible and limit oil-fired central heating, by statute from the Mayor. In order to rationalise the programme of action the pollution was to be determined for each single area by subdivision of the territory into a grid. By means of a census of all the production sources of sulphur dioxide appropriate data were collected to estimate each area's contribution to pollution. The theoretical hourly quantity of sulphur dioxide was calculated on the basis of the combustion equation. The data were then analysed, in total and divided into component parts, i.e. the type of fuel used, the season of the year and industrial or domestic usage. With Gifford and Hanna's ATDL mathematical model the data thus obtained, together with meteorological variables, were used to simulate the expected effect on the distribution of pollution after carrying out the programmed actions. The simulations foresee a reduction of up to 80% of sulphur dioxide concentrations in the areas of greatest use of liquid fuels. In the territory in question the monitoring of the pollutant was assured by the presence of five fixed positions of continuous survey. These turned out to be useful above all for analysis of the phenomenon over a period of time. In order to study spatial distribution better 374 findings were gathered in the winter of 1985-6 from various points of the territory by means of a mobile instantaneous detector. From these data the average aerial concentration was calculated on a grid, with sides of 500 metres, first for all the observations and then separately for the direction of the wind. Taking into account meteorological factors and the actual hour (during daytime) when the concentration of the pollutant was recorded, it was possible to estimate concentrations by means of linear models in which meteorological parameters were taken as independent variables.(ABSTRACT TRUNCATED AT 400 WORDS)

Air Pollutants↗
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[Mapping of radiologic risks: community and hospital aspects. Experience of a local socio-health unit].

A census was made of radiation-generating equipment and radioactive sources used for various purposes in the Local Health Unit of Rho, a small town in the Province of Milan, Northern Italy. Medical and industrial use of radiation equipment was found to be widespread, with a greater number of health care workers exposed occupationally but higher average levels of exposure in industry. In hospitals, independently of the formal classification, relatively higher exposure occurs among personnel operating in departments where radiological techniques have been recently introduced, due to a greater need for the personnel to operate close to the X-ray generator tube or presumably to an underestimation of a risk which is historically well known to radiologists.

Environmental Exposure↗
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[Standard radiography of the chest in heart transplantation. Our experience].

In the cardiovascular Surgery Department of the University of Padua, where the first heart transplant operation in Italy took place in November, 14, 1985, in a period of six months, nine heart transplants have been performed. The post-operative follow-up of these patients included, among other tests, a chest X-ray, which has given us many morphological and functional data concerning both the circulatory and the pulmonary systems.

Adult↗
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[Pulmonary throboembolism: radiological examination without contrast media. (Findings in 70 cases)].

The results are reported of radiologic investigations carried out without contrast medium in 70 selected patients with pulmonary thromboembolisms. The frequency of different signs is reported. Attention is stressed of the following data: 1) value of some semeiologic findings both hilar (hilar amputation, arterial dilation) and parenchimal (increased translucency, hypoperfusion), mainly compared with previous radiographic examinations; 2) frequency of atelectasis with its various findings; 3) significance of the evolution referred both to the infarction and the thromboembolic pattern.

Adult↗
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The original calibre of the lower limbs arteries as a possible risk factor for complications of atherosclerosis: a statistical investigation in 90 subjects by echocolor-doppler.

Ninety subjects with emodynamically significant atherosclerotic disease of the lower limbs were examined. They had no history of diabetes mellitus or hypertension. Each subject underwent a color Doppler ultrasonographic study of the common iliac, superficial femoral, and popliteal arteries. In each arterial segment, diameter and blood flow velocity were measured. In evaluating the hemodynamic significance of the stenoses, we used the Windsor method. In a comparison of the calibers of the arteries significant relationship emerged in each given subject in two sexes. Males: a statistically significant difference was found only in the iliac artery, in which the calibre and Windsor indices were greater in the right as compared to the left; right: 1) There was a statistically significant relationship between mean caliber and Windsor indices, (p < 0.01); 2) there was a statistically significant correlation between mean calibre and age (p < 0.05); Left: 1) There was a statistically significant correlation between mean calibre and Windsor indices calculated at the levels of both the posterior tibialis (p < 0.05) and dorsalis pedis arteries (p < 0.01); 2) there was a statistically significant correlation between mean calibre and age (p < 0.05). Females: Student's t test for paired samples of the three arteries did not reveal a statistically significant predominance of one side over the other. With respect to the coefficients of correlation between mean calibre and Windsor indices, the results were as follows. Right: 1) There was a statistically significant correlation between mean calibre and Windsor indices calculated at the levels of both the posterior tibialis and dorsalis pedis arteries (p < 0.01); 2) there was a statistically significant correlation between age and mean calibre (p < 0.05); Left: 1) There was a statistically significant correlation between mean calibre and Windsor indices calculated at the levels of both the posterior tibialis (p < 0.05) and dorsalis pedis arteries (p < 0.01); 2) there was a statistically significant correlation between mean calibre and age (p < 0.05).

Aged↗
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Internal carotid artery: relationship among arterial caliber, haematocrit and cerebral vascular resistance, investigation in eighty healthy men by echodoppler.

Eighty healthy male subjects (age range: 47 to 87) with hematocrits of 48% or greater and no vascular or hematologic pathology were studied. In each subject, the following values were determined: hematocrit, blood pressure (measured in both arms by sphygmomanometry), and the calibers and blood flow velocities of both internal carotid arteries. For the last 2 measurements, doppler ultrasound was used to examine the extracranial portion of the arteries before, 20 minutes after, and 7 days after euvolemic hemodilution. Following hemodilution, all the subjects demonstrated a statistically significant increase of the diastolic blood flow velocity of the two carotid arteries (p < 0.01). This corresponded to a statistically significant reduction of the hematocrit (p < 0.01). When the data were compared, no statistically significant relationships were observed among arterial caliber, side (left or right), blood pressure, and age. After 7 days, the results were practically unchanged. The precise correlation between the decrease of the hematocrit and the increase of the diastolic blood flow velocity of the internal carotid artery indicates that the latter is a valid index of cerebral vascular resistance. Thus, measurement of the diastolic blood flow velocity is a valid method for the assessment of cerebral blood flow, since the hematocrit is the single most important factor in the determination of blood viscosity.

Aged↗
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The valves of the internal jugular veins: a statistical investigation in 120 living subjects using ultrasonic tomography.

We examined both jugular veins of 120 healthy subjects (60 men, 60 women; age range: 18 to 90 years); thus, a total of 240 jugular veins were examined. The vessel diameter was measured by color Doppler ultrasonography, and when valves were present at the ostial level, their morphology and competence were assessed. A single valvular apparatus was detected in 206 cases (86%). It consisted of 2 cusps in 75% of these 206 cases, of one in 15%, and of three in 10%. No correlations with side or the subjects' sex, age, height, or body weight were observed. In the 34 cases in which a valvular apparatus was not visualized, we found a male predominance (22 men as compared to 12 women). The mean diameter of the jugular vein at the ostial level was 13.8 mm, with that of the men being significantly larger than that of the women (p < 0.01), and it showed a tendency to increase with age. The valves were observed to be incompetent in 95% of the cases.

Adolescent↗
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The measurement of the dimension of the human aortic ring using echocardiography: anatomical correlations and statistical investigation of 219 living subjects.

Using echocardiography, the dimensions of the aortic ring were measured in 219 healthy adults (103 men and 116 women; age range: 22 to 56 years). The mean diameter was determined to be 25 +/- 1.9 mm (26 +/- 2 in the men and 24 +/- 1.8 mm in the women). It was directly proportional to both body surface area (p < 0.01) and height (p < 0.01). The mean aortic ring diameter and the body surface area (BSA) could be related mathematically by the relationship: aortic ring diameter = 15 mm x BSA (m2); similarly, the relationship between the mean diameter of the aortic ring to height (h) could be expressed as: aortic ring diameter = 15 mm x h (m). Statistically significant correlations were not observed between the aortic ring dimensions and age, although the dimensions tended to increase with age. The mean values in men were found to be higher than those in women by a statistically significant margin. These results were compared with clinical and anatomical findings and with the classical anatomy textbook. This comparison revealed that our values were distinctly higher than those published in the textbooks. However, when compared with more recent clinical, surgical, and anatomical data, our results agreed fairly well. The discordance with classical measurements may have been due to differences in methodology or, more likely, to differences of weight and height in the populations studied.

Adult↗
PubMedDate not supplied

The measurement of the calibers and blood-flow velocities of the arteries of the circle of Willis: a statistical investigation of 120 living subjects using transcranial color-Doppler ultrasonography.

We have examined 120 subjects (52 men, 68 women; age range: 19 to 89) with no vascular pathology. In each subject, we used transcranial color-doppler ultrasonography to measure the calibers and blood-flow velocities of the anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA, respectively). Generally, the mean measured calibers were lower than those that have been described in cadaveric studies by other investigators. The mean caliber of the MCA was found to be higher than those of the ACA or PCA; this difference was statistically significant (p < 0.05). With age, the calibers of the ACA, PCA and PCA tended to increase, but this trend was not statistically significant. We have noted a statistically significant difference between the left and right sides, the arteries of the left being larger than those of the right. However, there was no statistically significant relationship between vessel caliber and age, sex, or body weight, though the women's arteries tended to be narrower than those of the men. With respect to the maximal and mean blood-flow velocities, no statistically significant relationships with regard to side (left or right), sex, age, or body weight were demonstrable. However, the mean and maximal blood-flow velocities of the MCA were found to be statistically higher than those of the ACA or PCA (p < 0.02). This was especially true under the age of 60 (p < 0.01).

Adult↗