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D Melchiorre

Publications and source records attributed to D Melchiorre.

13 recordsLinked to original sources
PubMed2005

Comparison of ultrasonography and magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement.

The aim of this work was to evaluate the accuracy and reliability of ultrasonography in the diagnosis of temporomandibular joint (TMJ) disc position abnormalities compared with magnetic resonance imaging (MRI). Participants in this study were 41 consecutive patients with signs and symptoms of temporomandibular disorders. All 82 TMJs were evaluated to detect disc position abnormalities by means of ultrasonography and MRI, performed by blinded operators. The accuracy of ultrasonography was evaluated with respect to MRI. Ultrasonography demonstrated good accuracy in the evaluation of disc position, showing a sensitivity of 65.8% and a specificity of 80.4%, resulting in a positive likelihood ratio of 3.35, a negative likelihood ratio of 0.42, and a diagnostic odds ratio of 7.97. The predictive positive and negatives values were respectively 77.1% and 70.2% and the overall agreement between the two radiological techniques was 73.1%. Ultrasonography proved to be accurate in detecting normal disc position and the presence of abnormalities in disc-condyle relationship but not so useful for the distinction between disc displacement with and without reduction.

Humans↗
PubMed2003

A comparison of ultrasonography and magnetic resonance imaging in the evaluation of temporomandibular joint involvement in rheumatoid arthritis and psoriatic arthritis.

OBJECTIVE: To define the diagnostic value of ultrasonographic (US) examination in comparison with magnetic resonance imaging (MRI) for the assessment of temporomandibular joint (TMJ) involvement in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). METHODS: MRI and US examinations were performed in 33 patients (22 with RA and 11 with PsA). Alterations of the disc, alterations of the condyle and joint effusion were evaluated. RESULTS: Pathological changes of the TMJ were observed by MRI in 24 patients and by US in 31 patients. The sensitivity and specificity of US were calculated in comparison with MRI. The sensitivity was 72.2% and the specificity was 60% in the assessment of pathological changes of the TMJ. The sensitivity was 69.6% with specificity of 30.0% in the assessment of alterations of the disc; the sensitivity was 70.6% with specificity of 75.0% in the assessment of joint effusion. Significant concordance was not observed in the assessment of condylar alterations. CONCLUSIONS: US imaging appears able to detect different pathological changes of the TMJ and may be considered an important diagnostic tool for clinical evaluation of the TMJ in RA and PsA.

Adult↗
PubMed2003

Ultrasound assessment of increased capsular width as a predictor of temporomandibular joint effusion.

OBJECTIVES: The aim of this study was to evaluate whether an increased capsular width evidenced by ultrasound (US) could be an indirect marker of temporomandibular joint (TMJ) effusion. METHODS: 138 TMJs were evaluated by US and magnetic resonance imaging (MRI) by two blinded calibrated investigators. US measures of capsular width (in mm) and MRI diagnosis of TMJ effusion (presence/absence) were used to perform a receiver operating characteristic (ROC) curve analysis in order to assess the most accurate cut-off value of capsular width that was able to discriminate between joints with and without MRI effusion. RESULTS: Diagnostic accuracy of US to detect MRI-depicted TMJ effusion was good (area under the ROC curve=0.817). US sensitivity was high for values below the cut-off value of 1.950 mm (true positive rate (TPR)=83.9%; false positive rate (FPR)=26.3%), while specificity was high for values above the cut-off value of 2.150 mm (TPR=71.0%; FPR=11.8%). CONCLUSIONS: Analysis of ROC curve appears to reveal that the critical area is around the 2 mm value for TMJ capsular width. These findings need to be refined by further studies assessing the smallest detectable difference in capsular width, with attention to reliability of interobserver observations.

Area Under Curve↗
PubMed2003

The role of ultrasonography in the diagnosis of temporomandibular joint disc displacement and intra-articular effusion.

AIM: The aim of this work is to conduct a preliminary study to investigate the usefulness of ultrasonography (US) in the study of temporomandibular joint (TMJ), comparing ultrasonographic diagnosis of joint effusion and disc displacement with those based on an accurate clinical examination. METHODS: Participants in this study were 47 consecutive patients complaining for TMJ problems. All 94 TMJs were evaluated to detect the presence of intra-articular effusion and disc displacement by means of 2 diagnostic instruments: a standardized clinical assessment based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) at the Section of Prosthetic Dentistry, and an ultrasonographic investigation conducted by a blinded operator at the Operative Unit of the Department of Rheumatology, Univesity of Pisa, Italy. Agreement between the two diagnostic techniques has been evaluated by means of Cohen's K test. RESULTS: Ultrasonography showed a good agreement with clinical assessment for the diagnosis of both intra-articular effusion (percentage of agreement 80%; K=0.611) and disc displacement (agreement 81.9%; K=0.572). CONCLUSION: When compared to a standardized clinical assessment, ultrasonographic technique showed a good diagnostic capability to detect TMJ intra-articular effusion and disc displacement. Within all the limitations of this study, it can be suggested that ultrasonography could represent a promising imaging technique in the study of temporomandibular joint.

Adult↗
PubMed1996

Cryoglobulinemic peripheral neuropathy: neurophysiologic evaluation in twenty-two patients.

The aim of this study was to evaluate the frequency and degree of peripheral neuropathy in 22 consecutive patients with mixed cryoglobulinemia, whether symptom-free or with subjective neurological symptoms. Electrophysiological investigations were carried out and a biopsy of the sural nerve was performed in six patients. Peripheral neuropathy of the lower limbs was demonstrated, which was mostly sensory and light or moderate in 86% of cases (19 patients). F-Wave and H-reflex recordings were found to be the most reliable methods; in 77% of cases, they were abnormal (17 patients). Using somatosensory evoked potentials, we were able to exclude simultaneous central nervous system involvement in 10 patients.

Adult↗
PubMed1996

A placebo-controlled study on urokinase therapy in systemic sclerosis.

A 4-month randomized placebo controlled trial on urokinase therapy in 36 consecutive systemic sclerosis patients randomly treated with urokinase or placebo was conducted. While patients on placebo did not show any significant improvement, in those following urokinase therapy there was a noticeable improvement in skin sclerosis observed via hand-print and ultrasonography of the skin. Vascular involvement improved: this was demonstrated by capillaroscopy results, showing an improvement in pattern and signs of revascularization and the resolution of skin ulcers. Vascular damage is a typical occurrence in systemic sclerosis cases and various vasoactive drugs are used symptoms for some such as Raynaud's syndrome or skin ulcers. At the moment these drugs seem to constitute the most effective therapy, and have few side effects. We have found only one previous study utilizing urokinase therapy for acute digital ischemia in systemic sclerosis. Our study is the first in which urokinase therapy has been used for the treatment of systemic sclerosis in a large number of patients.

Adult↗
PubMedDate not supplied

Behavior of prealbumin in the acute phase of polymyalgia rheumatica treated with 6-methylprednisolone.

Serum levels of prealbumin, fibronectin, fibrinogen, alpha 1-acid glycoprotein, C-reactive protein, immunoglobulins, and white blood cell count were prospectively studied in 33 patients affected by polymyalgia rheumatica during the first 45 days of treatment with 6-methylprednisolone. Almost all parameters considered, except for fibronectin and IgM, settled within the normal range fairly quickly, while prealbumin showed a specular course compared with the other reactants. This behavior reflected the improvement of clinical symptoms registered in all patients after steroid treatment. Finally, the genesis of the low baseline prealbumin levels found in polymyalgia rheumatica/giant cell arteritis and their behavior during treatment are discussed.

Aged↗
PubMedDate not supplied

[Peripheral nervous system in limited systemic sclerosis].

OBJECTIVES: PNS is involved in Systemic Sclerosis (SSc) since the earliest phases. Our aim is to perform an ultrastructural study on skin PNS fibers in SSc. METHODS: Skin biopsies were taken from forearms of 8 patients affected by limited SSc (lSSc) and 3 controls and processed for transmission electron microscopy (TEM). The semithin sections (2 mm) were observed at light microscope and optical fields were chosen for ultrathin sections (1 mm) preparation and TEM examination. RESULTS: In lSSc skin, in the semithin sections, damaged areas are close to apparently spared areas. At TEM, in early lSSc patients, signs of inflammation and damaged microvessels are visible in derma. PNS fibers are no damaged. In advanced lSSc, fibrosis prevails on inflammation, and slight ultrastructural alterations of PNS fibers are evident in papillar derma. CONCLUSIONS: PNS lesions are different in severity in lSSc according to the disease duration, resulting more severe in advanced than in early phase.

Biopsy↗
PubMedDate not supplied

Impaired glutathione reductase activity and levels of collagenase and elastase in synovial fluid in rheumatoid arthritis.

OBJECTIVE: To test the activity of elastase, collagenase and glutathione reductase in the synovial fluid (SF) of patients with rheumatoid arthritis (RA) and in patients with osteoarthritis (OA); to correlate the elastase and collagenase activity with the glutathione reductase activity, which is important for the inactivation of oxygen free radicals. METHODS: 24 patients affected by osteoarthrosis and 24 patients affected by rheumatoid arthritis took part in the study. We measured elastase activity towards the substrate metoxysuccinyl-alanyl-alanyl-prolyl-valyl-p-nitroanilide (MeOSuc-ala-ala-proval-p-NA) which is highly specific for elastase, and insensitive to the other serine proteases, such as cathepsin G; collagenase activity was measured using [14C]-acetylated collagen as the substrate. Glutathione reductase activity was measured following the oxidation of nicotinamide adenine dinucleotide phosphate reduced (NADPH) in the presence of oxidized glutathione (GSSG). RESULTS: The concentrations of elastase, collagenase and glutathione reductase were statistically higher in patients with RA than in patients with OA. Moreover, in the SF of patients with RA we found positive correlation between enzyme activity levels. CONCLUSION: These results confirm a high activity of collagenase and elastase in the SF of patients with RA, which is about 30 times higher than that found in the SF of patients with OA. These data underline the synergic action of these enzymes in the pathogenesis of joint damage. RA patients also exhibit higher levels of glutathione reductase, which is important for the detoxification pathway of oxygen free radicals. However, compared with findings for collagenase and elastase, the increase in glutathione reductase is only three times higher than level found in the SF of OA patients. The limited increase in glutathione reductase activity during the inflammatory process might lead to an insufficient protective effect at the joint level in rheumatoid arthritis.

Adult↗
PubMedDate not supplied

Ultrasonographic vs magnetic resonance imaging findings of temporomandibular joint effusion.

AIM: The aim of this study was to assess the accuracy of ultrasonography (US) in the evaluation of temporomandibular joint (TMJ) effusion compared with magnetic resonance imaging (MRI) findings, assumed as the gold standard. METHODS: The study group consisted of 44 patients with signs and symptoms of temporomandibular disorders (TMD). Each joint (N=88) was evaluated using US and magnetic resonance (MR) to detect the presence of effusion. The 2 examinations were carried out by 2 blinded operators within no more than 2 weeks from each other. During that period the patients did not receive any kind of treatment. Sensitivity, specificity, positive predictive values (PPV) and negative predective values (NPV) of US were calculated. The agreement between the 2 diagnostic techniques was then evaluated by Cohen's K test. RESULTS: MRI depicted intra-articular effusion in 41 of the 88 TMJs (46.5%) while no effusion was detected in the remaining 47 joints (53.5%). Ultrasonographic imaging revealed effusion in 42/88 joints (47.8%), while the remaining 46 joints (52.2%) showed no effusion. US showed a sensitivity of 75.6% and a specificity of 76.5%. The PPV and NPV were 73.8% and 78.2% respectively. US vs MRI agreement for the diagnosis of TMJ effusion was fairly good (pct. agreement 76.1%; K=0.521). CONCLUSION: US is a low-cost, easy-performing, non-invasive, rapidly-executing imaging technique whose possible employ in the study of the TMJ is very promising.

Exudates and Transudates↗
PubMedDate not supplied

Etrurians vs Greeks: May ACE I/D polymorphism still be considered as a marker of susceptibility to SSc?

OBJECTIVE: SSc is characterized by immune dysfunction and microvascular involvement. A different genetic background may determine a different polymorphic allele frequency between different populations, and data from literature reported conflicting results about the role of genetic components in predisposing to the disease. We carried out this study in order to compare the ACE I/D polymorphism genotype distribution and alleles frequency in two different populations from the Mediterranean area. METHODS: Forty-eight Italian and 41 Greek SSc patients compared with 112 Italian and 93 Greek controls, have been studied. The ACE I/D polymorphism has been analysed. RESULTS: The genotype distribution and allele frequency were in Hardy-Weinberg equilibrium for Italian and Greek SSc patients and controls. Among the Italian patients a significantly higher ACE D allele frequency than in the controls was found, whereas among the Greeks a higher prevalence was observed in the healthy subjects. A significant difference in ACE D allele frequency between Italian and Greek controls was observed (p = 0.04). ACE D allele was associated to the predisposition to SSc in Italians, but not in Greeks. CONCLUSION: We confirm that Italian SSc patients have a higher ACE D allele frequency that is not present in the Greek patients. Thus, the two populations living in different Mediterranean areas and resulting from the Mediterranean civilization, do not show the same ACE-gene related allele frequencies. Other populations of the Mediterranean area must be investigated by using unlinked genetic markers to verify the homogeneity of the genetic background, and to test for a "true" difference in their ethnic origin.

Amino Acid Substitution↗