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Biomedical subjects

D Cipriani

Publications and source records attributed to D Cipriani.

At least 19 recordsLinked to original sources

Three-point gait crutch walking: variability in ground reaction force during weight bearing.

OBJECTIVE: To investigate variability in ground reaction force (GRF) and kinematics on both sides during 3-point partial weight-bearing (PWB) crutch walking. DESIGN: Within-subject comparisons of kinematic and kinetic data collected at different levels of 3-point crutch walking: 10%, 50%, and 90% PWB at comfortable speeds. SETTING: An applied biomechanics lab in a university setting. An applied biomechanics lab in a university setting. PARTICIPANTS: Twelve healthy college students (9 women, 3 men). MAIN OUTCOME MEASURES: Spatial and temporal variables, major peak kinematic data, and peak GRFs from force platforms during the gait cycle. RESULTS: Large variations were found in replicating the target levels of PWB, particularly at 10% and 90% PWB. Subjects had a shorter stance phase and longer swing phase during the crutch walking gait cycle. Velocity significantly decreased (p =.006) because of decreased cadence (p =.002). Slightly greater hip abduction and external rotation on the noninvolved side and slightly less hip adduction and internal rotation on the involved side indicated that the center of gravity shifted slightly from the involved side toward the noninvolved side. There was no increase in vertical GRF, and there was a relatively constant loading pattern on the noninvolved side. CONCLUSIONS: Subjects have difficulty replicating a prescribed weight-bearing restriction. A shift of the center of gravity toward the noninvolved side may reduce the weight distribution on the involved side.

Adult↗

The test-retest reliability of an inclined squat strength test protocol.

Functional testing of the lower extremity is supported as a good predictor for successful return to premorbid activity. However, current reliable functional tests may be too strenuous for a patient in the acute stage of recovery. A functional testing protocol utilizing an inclined sliding board apparatus was evaluated for test-retest reliability. Thirty-five subjects (ages = 18-25, mean = 20.49 +/- 1.71) with no known knee pathologies were tested. Subjects performed a 20-second test for squat repetitions and a 50-squat repetition test for time, executing a single leg squat in an inclined position on the sliding board apparatus. The test was repeated 1 week later. The intraclass correlation coefficient equaled 0.80 for the 50-repetition timed test and 0.89 for the 20-second repetition test. The results indicate an acceptable test-retest reliability for the inclined sliding board apparatus protocol. We advocate the use of this testing protocol for the purpose of evaluating functional ability during the early stages of rehabilitation of lower extremity conditions.

Adolescent↗

Pseudohyperkalemia in extreme leukocytosis.

Spurious elevation of blood K levels is a well known occurrence in patients with extreme leukocytosis. A common explanation is the in vitro release of K from leukocytes undergoing lysis during the clotting process. Since in clinical practice blood electrolytes are now being evaluated in plasma or whole heparinized blood rather than in serum, this source of error should almost have disappeared. Another mechanism may be prolonged storage of blood at room temperature or in the cold before performing the test, most likely since unphysiological conditions and/or shortage of metabolic fuels may impair Na/K-ATPase activity in leukocytes, ensuing in K release from these cells. For these reasons, it is commonly advised that patients with extreme leukocytosis should have K levels determined on plasma samples that are separated promptly from the cellular elements. We have recently observed a case of pseudohyperkalemia in a patient with chronic lymphocytic leukemia which was unrelated to both of these mechanisms, and was instead related to a common mode of drawing blood, i.e. with vacuum tubes.

Blood Preservation↗

Community-acquired bacteremias from tunneled central intravenous lines: results from studies of a single vendor.

Tunneled central intravenous catheters are a common method for rendering prolonged outpatient intravenous therapy. Their safety, however, has not been well studied. We conducted a retrospective evaluation of bacteremias associated with tunneled central intravenous catheters managed by a single home health care vendor during a 1-year period. All catheters were inserted in the operating room under sterile conditions. To calculate total line days, the dates of catheter insertion and removal were obtained from either the hospital operating room or the home health care agency. Catheter care was conducted according to written protocols. Total line days were calculated. Community-acquired bacteremia (defined as bacteremia occurring more than 6 days after the patients' discharge from the hospital) was determined from records available in the infection control department. Sixty-eight patients received intravenous therapy from the vendor during the 1-year study period. Total line days were 5548 (median 52 days/patient). Eleven episodes of bacteremia occurred in five patients, providing an incidence density rate of 2.0 infections/1000 catheter days. The most frequent bacteria encountered were Staphylococcus epidermidis (five), Klebsiella pneumoniae (two), and Acinetobacter calcoaceticus var anitratus (two). Median time to bacteremia was 103 days. Two patients, both younger than 4 years, accounted for seven of the infections; both had short-bowel syndrome. On the basis of historical comparisons, outpatient intravenous therapy appears to be associated with a lower risk of bacteremia than in-hospital therapy. These data can provide quality improvement information and may be a means for comparing home infusion therapy vendors.

Acinetobacter Infections↗

Creative psychotherapy and the facilitation of insight.

The following case studies provide insight into the effectiveness and methodology of the facilitation of insight technique in psychotherapy. This technique has been successful in reducing the incubation process, which is the second of four stages in Wallas's Stage Model of Creativity, i.e., Preparation, Incubation, Illumination and Verification. The application of this technique in other areas of human endeavor are discussed.

Adult↗

HIV-related severe thrombocytopenia in intravenous drug users: prevalence, response to therapy in a medium-term follow-up, and pathogenetic evaluation.

Severe thrombocytopenia (TP) accounted for 5.3% of cases in a consecutive series of 380 HIV-infected intravenous drug users (IVDUs) at presentation. Forty-one of 53 subjects with severe TP showed haemorrhages and were treated as follows: ten were splenectomized, 17 were given high-dose intravenous immunoglobulins (HDIg), and 10 received anti-Rh(D) immunoglobulins (anti-Rh Ig). Splenectomy induced a complete clinical response in all cases: four out of 10 patients maintained platelet counts greater than 100 x 10(9)/l. HDlg gave a good clinical response in all patients, but eight out of 17 suffered haemorrhages during the follow-up and recall treatments were necessary. Six out of 10 patients treated with anti-Rh lg maintained platelet counts greater than 30 x 10(9)/l, but in two cases the treatment was interrupted because of severe haemolysis. No patient progressed to overt AIDS during the follow-up. Splenectomized patients in particular did not show adjunctive risks of worsening of the HIV-related clinical picture. A platelet kinetic study performed in 20 patients with severe HIV-related TP suggests a possible role for platelet sequestration in TP of HIV-infected IVDUs, in which a liver involvement is very frequent.

Adult↗

A case of Vogt-Koyanagi-Harada syndrome in a patient affected by Hodgkin's disease.

The Vogt-Koyanagi-Harada (VKH) syndrome, a disease of unknown origin, characterized by inflammation of the uveal tract, retina and meninges, was observed in a patient with Hodgkin's disease (HD) who had been treated with chemotherapy and radiotherapy. Ten years later the patient developed a cluster of neurological symptoms and signs (fever, pain, bilateral hypoacousia, dizziness, uveitis and psychiatric disorder) which were initially interpreted as a relapse of HD. The diagnosis of VKH syndrome was thereafter suspected from the clinical findings, response to therapy and further evolution. During the follow-up (14 months) the patient showed a varying course; hypoacousia remained unaltered while uveitis recurred and only a partial improvement was obtained by immunosuppressive therapy.

Female↗

Surgical wound infections documented after hospital discharge.

Shorter lengths of hospitalization may result in more surgical wound infections being documented after hospital discharge. The current investigation analyzed 1644 surgical procedures performed over a 3-month period, and documented surgical wound infections both before and for 1 month after hospital discharge. Physician and patient questionnaires were used. One hundred eight infections were noted, of which 50 (46%) were seen after hospital discharge by either the patient or the surgeon. Rates of infection were 5.2%, 7.5%, and 7.5% for clean, clean-contaminated, and contaminated-dirty categories, respectively. Had postdischarge surveillance not been used, rates would have appeared to be 2.5%, 6.5%, and 6.8% for the same surgical classes. Infections following clean and clean-contaminated procedures were more likely to be noticed after hospital discharge. Excluding those that were patient-documented, wound infection rates would have been 4.2% (clean), 6.3% (clean-contaminated) and 6.8% (contaminated-dirty). Postdischarge surveillance is imperative to meaningfully document true rates of surgical wound infection, inasmuch as increasing numbers are likely to occur only after patients leave the hospital.

Follow-Up Studies↗

[Cortical responses evoked by vibrotactile sensations in deaf children].

Vibrotactile evoked responses (VER) to 250 and 500 Hz presented respectively at 50 and 70 dB HL by BC vibrator placed on right thumb, were recorded in 20 children (10 with pathological EEG) with severe sensorineural hearing loss, or deaf since birth, both to control accuracy of cortical responses to high intensity auditory stimuli and to diagnose central non auditory pathways lesions. The results have shown that: VER are present in subjects with severe sensorineural hearing loss or deaf; in children with auditory lesions VER have parameters different from auditory evoked response (AER); VER recording is not related both to the presence of auditory lesions and to neurological pathology.

Cerebral Cortex↗