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G Cioni

Publications and source records attributed to G Cioni.

At least 73 records · Page 4Linked to original sources
PubMed1997

Comparison between observation of spontaneous movements and neurologic examination in preterm infants.

OBJECTIVE: The Prechtl method of qualitative assessment of general movements (GMs) has been shown to be a good predictor of neurologic outcome in fetuses, preterm infants, and term infants. The aim of this study was to compare the results of this new technique with those of traditional neurologic examination and of cranial ultrasonography in preterm infants. METHODS: Serial videotape recordings (with off-line assessment of GMs), ultrasound examination of the brain, and neurologic examinations were performed from birth until about 6 months of corrected age, on a group of 66 preterm infants whose gestational age ranged from 26 to 36 weeks (mean 30.7 weeks). The agreement between the two techniques and their predictive power, with respect to the neurologic outcome at 2 years of corrected age, were evaluated for five different age groups from preterm age to 65 weeks of postmenstrual age. RESULTS: Overall agreement of the neurologic and GM findings was 80.3% and strongly age related (lower during the preterm and term periods and higher thereafter). At all ages the results of GM observation correlated highly with neurologic outcome; they showed higher sensitivity and specificity than the neurologic examination. This held true in particular before term age, when poor neurologic responses might be related to transient complications, and at term age, mainly because of infants with normal neurologic examination results but unfavorable outcome. During the preterm period the ultrasound results showed a better specificity and a lower sensitivity to outcome than GM findings. CONCLUSIONS: The results of this study indicate that quality assessment of GMs should be added to traditional neurologic assessment, neuroimaging, and other tests of preterm infants for diagnostic and prognostic purposes.

Child Development↗
PubMed1997

MRI findings and sensorimotor development in infants with bilateral spastic cerebral palsy.

The correlation between MRI findings and sensorimotor development was investigated in a group of 48 infants with bilateral spastic cerebral palsy (CP). The ages at MRI examination and cognitive assessment were fairly homogeneous (mean 15 months and 17 months, respectively). The following MRI parameters were scored: size of lateral ventricles, extension of white matter lesions and of white matter reduction, thinning of corpus callosum, presence and size of cystic areas, dimension of subarachnoid spaces and presence of cortical abnormalities. Cognitive assessment included Griffiths Developmental Scales and Uzgiris-Hunt Scales. The patients were subdivided into six classes according to intellectual level (DSM-III-R). For the whole group a highly significant correlation was found between all MRI parameters and the level of cognitive development. This result was probably due to the inclusion of 14 untestable, severely mentally retarded infants, who showed very severe MRI abnormalities. However, when the untestable infants were excluded from the analysis, it was the presence of cysts and the entity of white matter reduction that correlated with both Griffiths Scales and Uzgiris-Hunt Scales. These results indicate the clinical value of MRI findings and particularly of white matter abnormalities for early identification of sensorimotor impairment in infants with bilateral spastic CP.

Cerebral Palsy↗
PubMed1997

Cerebral visual impairment in preterm infants with periventricular leukomalacia.

Neonatal brain lesions are the main cause of cerebral visual impairment in infancy, i.e., of a visual deficit caused by damage to posterior visual pathways. Visual outcome of preterm infants with periventricular leukomalacia (PVL) was investigated in 14 subjects affected by severe cystic PVL, another 34 with moderate PVL (prolonged periventricular echodensities), and 18 control preterm infants. All cases with significant ocular abnormalities (such as retinopathy of prematurity state III or upwards, optic nerve atrophy, or major refraction problems) were excluded. Visual acuity, visual field, eye alignment, fixation and following, optokinetic nystagmus, and visual threat were tested at 1 year of corrected age. A high incidence of cerebral visual impairment, consisting mainly of low visual acuity, severe oculomotor disorders, and reduced visual field, was found in infants with severe PVL. Visual defects were less frequent and less severe in the moderate PVL group, and very rare in the control group. The results of neuroimaging, and especially of magnetic resonance imaging, correlated with the visual outcome and indicate lesions at the level of optic radiations as the main anatomic substrate of the visual impairment. All infants with PVL need a visual follow-up, from the first months of life, the results of which are important both for visual and motor rehabilitation of these cases and for their daily care.

Female↗
PubMed1997

Hepatic tocopherol content in primary hepatocellular carcinoma and liver metastases.

The high incidence of hepatocellular carcinoma (HCC) in cirrhosis, where previous studies have indicated a severe reduction in several antioxidant vitamin factors, prompted us to compare plasma liposoluble vitamins with tocopherol content in healthy and neoplastic liver tissue in humans. This, with a view to a more positive preventive dietary approach, given the conflicting results obtained by liposoluble vitamin dietary supplementation in different malignancies. Eleven patients with cirrhosis, 18 patients affected by cirrhosis with HCC, and 10 patients with liver metastases (LM) from digestive tract adenocarcinomas were compared with controls who had undergone perlaparoscopic cholecistectomy. Plasma alpha- and beta-carotene, retinol and tocopherol, together with liver tocopherol, from both nonmalignant portions and malignant nodules of the same organ, were determined by high-performance liquid chromatography following a well-assessed technique. The results confirm a trend towards a reduction in circulating carotenoids and tocopherol in cirrhosis and in patients affected by cirrhosis with HCC. Tocopherol content in liver tissue is significantly decreased in cirrhosis (0.26 + 0.03 micromol/g prot., mean + SEM, P < .001) and in cirrhotic areas of the HCC group (0.31 + 0.02, P < .002), with respect to its content in liver specimens of healthy controls (0.46 + 0.03) and in healthy areas of the same organ in patients with LM (0.41 + 0.03). Tocopherol concentration is further reduced by 50% in malignant liver nodules of HCC, with respect to surrounding cirrhotic tissue, whereas in metastatic liver nodules from digestive neoplasms the tocopherol content is almost twice that of healthy surrounding areas. This unpredictable tocopherol behavior in liver specimens, of secondary as opposed to primary malignancies of the liver, affords further insight into the conflicting effects of liposoluble vitamins employed in the chemopreventive treatment of different malignant diseases, where hepatic tocopherol concentration show opposite trends: halved in primary HCC and doubled in LM of digestive adenocarcinomas, with respect to healthy controls.

Aged↗
PubMed1996

Rhythmical leg movements in low-risk and brain-damaged preterm infants.

The characteristics of rhythmical kicking movements of preterm infants with documented brain damage (BD), who later showed a severe motor impairment, are described and compared with those of low-risk (LR) preterm infants. Spontaneous movements were videotaped for 60 min in the incubator or in a warmer. A first group of 6 BD and 6 LR infants was observed at 31-35 weeks of postmenstrual age (PMA) and a second group (6 BD, 6 LR) at 37-39 weeks. Bouts of rhythmical kicks, defined as leg movements repeated in the same form at least three times at regular short intervals, were analysed during periods of activity. The results indicated non-significant differences between BD and LR infants at 31-35 weeks of PMA. In contrast, some differences were observed at 37-39 weeks. These differences were not due to leg movement frequency, but to inter-leg coordination and to temporal organisation of the kicking cycles. LR infants exhibited more alternate-leg movements and fewer semi-both-leg movements (simultaneous flexion and non-simultaneous extension) than BD infants. In LR cases the duration of the pause between flexion and extension was shorter, whereas flexion and extension periods were similar for all infants. Although there were significant differences, quantitative analysis of kicking characteristics was not clinically useful because of the large overlap in findings between the two groups. On the other hand Gestalt evaluation of general movements of the same videorecordings showed a closer correlation with the presence of brain lesions and with neurological outcome.

Brain Diseases↗
PubMed1996

Prognostic value of abnormal EEG transients in preterm and full-term neonates.

The prognostic value of abnormal EEG transients was investigated in 362 subjects submitted to EEG recording during the neonatal age and followed-up at least until the 12th month of corrected age. The incidence of negative and positive spikes and sharp waves, of rhythmic sharp theta and delta activities and of alpha discharges were evaluated by means of a quantitative score. These abnormal EEG transients appeared to be generally rare and even absent in a large number of subjects. In infants with normal outcome their incidence tends to increase from low postmenstrual ages towards term period. Full-term newborns with abnormal neurological outcome presented a significantly higher incidence of these transients. Preterm infants with unfavourable evolution showed a higher incidence only when submitted to EEG recording at around term age. However, no difference between subjects with normal and abnormal outcome was detected in preterm infants when evaluated at low postmenstrual ages. The hypothesis that at low postmenstrual ages brain damage might, on the one hand, give rise to abnormal transients and, on the other, alter the "capability' of manifesting them (together with other EEG maturational aspects), might explain these results.

Brain↗
PubMed1996

Electroencephalographic dysmaturity in preterm infants: a prognostic tool in the early postnatal period.

The aim of the study was to assess the prognostic value of maturational abnormalities in the electroencephalogram (EEG) of preterm infants. 63 subjects (mean gestational age: 32.7 weeks; range 28-34) were submitted to EEG recording within the first two weeks of life and subsequently followed up until at least 12 months of corrected age. Maturational features of background EEG were analysed and the occurrence of different degrees of maturational anomalies ("dysmaturity") was scored, according to standardised criteria. The results were compared to neurological outcome and to cranial ultrasound (US) findings. EEG maturational features significantly related to the outcome. When the EEG background activity was normal all but one patient showed a favourable outcome; the incidence of neurological sequelae became higher according to the degree of dysmaturity detected. However, some infants had a normal evolution, despite severe EEG dysmaturity in the early postnatal period. The correlation between EEG and US findings was low, although US also significantly related to the outcome. Background EEG maturational features seem to be a reliable prognostic tool in the early postnatal period of preterm infants, complementary to serial US scans.

Brain Diseases↗
PubMed1996

Correlation between cerebral visual impairment and magnetic resonance imaging in children with neonatal encephalopathy.

To identify brain lesions most often associated with cerebral visual i mpairment (CVI) after neonatal encephalopathy and to evaluate the prognostic value of MRI for visual outcome, the authors reviewed visual assessments and brain MRI of 80 infants and young children with documented perinatal hypoxic-ischaemic and/or haemorrhagic insults. MRIs were classified according to the severity of lesions at the optic radiations and at the visual cortex; visual acuity was tested with the acuity card procedure. Among the 48 children found to have a CVI, 42 had moderate to severe lesions of the optic radiations and 19 had lesions of the visual cortex. In both cases visual acuity was statically correlated with MRI grading, but the damage at the optic radiations was the better predictor. Early detection of abnormal MR findings in the visual cortex and especially, at the optic radiations may indicate which infants with neonatal encephalopthy should receive longitudinal visual assessment and specific rehabilitation and educational management.

Birth Injuries↗
PubMed1996

Does the measurement of portal flow velocity have any value in the identification of patients with cirrhosis at risk of digestive bleeding?

Upper gastrointestinal bleeding is a leading cause of death in patients with liver cirrhosis. In most cases haemorrhage originates from oesophageal varices or from congestive gastropathy, and the evaluation of the bleeding risk is based on oesophagogastroduodenoscopic data. The aim of this prospective study was to determine whether the measurement of portal flow velocity by Duplex-Doppler, compared with endoscopic data, can help in detecting patients with cirrhosis at risk of bleeding. One hundred and seventy-three patients underwent endoscopy to ascertain the size of the varices and the severity of congestive gastropathy. For each patient maximal portal flow velocity measurements were obtained. No difference in portal flow velocity was observed between patients with or without oesophageal varices or congestive gastropathy. During a 2-year observation period, 27 patients (15.6%) had at least one episode of acute digestive bleeding. Stepwise multiple logistic regression analysis demonstrated a correlation between oesophageal varices and congestive gastropathy endoscopic grading and the incidence of bleeding; only the former was entered into the final regression equation (p < 0.001). No relationship between the max portal flow velocity value and incidence of bleeding was found. This study shows that portal flow velocity is unrelated to the degree of the endoscopic abnormalities in patients with liver cirrhosis and that it has no value in the identification of patients with cirrhosis at risk of upper gastrointestinal bleeding.

Adult↗
PubMed1996

[Spontaneous bacterial peritonitis in liver cirrhosis. What tests to perform on the ascitic fluid?].

Spontaneous bacterial perionitis (SBP) is a relatively frequent complication of liver cirrhosis and is associated with a high mortality if not early recognized and immediately treated. The text-books of Medicine available in Italy suggest the use of traditional laboratory tests (gravity, total protein concentration, Rivalta's test) to whom add white blood cell count for the assessment of the nature transudative (not infected) or exudative (infected) of ascitic fluid; nevertheless, in every day clinical practice, the association between total protein concentration and type of ascitic fluid may be misleading with respect to the diagnosis of SPB. The aim of this retrospective study, undertaken on 86 patients with liver cirrhosis consecutively admitted and separated in two groups, one without and the other with PSB (white blood cell count > 500/mm3), was to identify criteria for diagnosis of PSB. The traditional laboratory tests were significantly different in the two groups but Rivalta's test. Yet, none of them showed a diagnostic measurement sufficient for the use in the diagnosis of PSB (positive predittive value: gravity 41%, Rivalta's test 36%, total protein concentration 40%). The results of this work show the traditional laboratory tests unable to define the nature of the ascitic fluid. For the diagnosis of PSB the only reliable parameter is the white blood cell count.

Aged↗
PubMed1996

[The use of echo-guided fine-needle biopsy in the diagnosis of nodular hepatic lesions].

211 patients were submitted to percutaneous ultrasound-guided liver biopsy: 184 patients (87.2%) had only one focal lesion, the other 27 had two or more lesions. In 9 patients (4.27%) the material drawn out from the liver was not adequate for microscopic examination (Retrieval Rate 95.7%). Histological evaluation revealed: absence of neoplasm in 67 patients (31.75%), benign lesion in 29 patients (13.74%), primitive malignant lesion in 70 patients (33.18%) and metastatic malignant lesion in 36 patients (17.06%). Combining the histological data with disease manifestation, biopsy showed a sensitivity of 95.1%, specificity of 100%, positive predictive value of 100%, negative predictive value of 89.4% and a diagnostic accuracy of 92.4%. None of the most important complications described in literature was observed. Our study confirms that ultrasound guided biopsy is a procedure of high diagnostic value in patients with nodular liver lesions, advantageous for its simplicity, low cost and safety.

Biopsy, Needle↗
PubMed1995

Evidence for hepatitis B virus infection in patients with chronic hepatitis C with and without serological markers of hepatitis B.

To assess the influence of HBV infection on anti-HCV-positive chronic liver disease, we performed a prospective case-control study comparing 19 HBsAg-positive, anti-HCV-positive patients with 38 HBsAg-negative, anti-HCV-positive patients, pair-matched for age, sex, and ALT levels. HBV and HCV infections were investigated by standard serology and polymerase chain reaction. HCV RNA was found in all patients with CAH and in 90.0% with cirrhosis (33% HBsAg-positive). HBV DNA sequences were found, in the HBsAg-positive subjects, in 71.4% of CAH and in 83.3% of cirrhotics; in the HBsAg-negative ones, only 10% of CAH but 77.7% of cirrhotics had demonstrable HBV DNA sequences. Consequently, 80.0% of cirrhotics had evidence of both HBV and HCV infection. Conventional serology gives partial information on the true occurrence of HBV infection in HBsAg-negative patients, while PCR defines more accurately the HBV status. When the rate of double infection is defined in this way, it correlates with the presence of cirrhosis.

Case-Control Studies↗
PubMed1995

Effects of propranolol compared with clonidine on portal haemodynamics: a double-blind cross-over study using duplex-Doppler ultrasonography.

BACKGROUND: Patients with liver cirrhosis and large oesophageal varices run a high risk of digestive haemorrhage due to the rupture of oesophageal varices, an event associated with a high mortality. At present, the only treatment for the prevention of first bleeding from oesophageal varices on which there is general agreement is drug-based. In order to tailor drug treatment to the requirements of individual patients more precisely, an ever-increasing number of drugs is being investigated. DESIGN: Double-blind cross-over study. METHODS: Sixteen cirrhotic patients with large oesophageal varices were studied by means of duplex-Doppler ultrasonography to determine variations in portal haemodynamics after oral administration of 0.150 mg clonidine and to compare these with the variations observed after oral administration of 40 mg propranolol. RESULTS: Propranolol caused a significant reduction in maximum portal flow velocity (P < 0.001), whereas clonidine failed to cause any such variation (P = 0.194). Considering as responders those patients who exhibited at least a 10% decrease in maximum portal flow velocity, 11 patients responded to propranolol; of these, three also responded to clonidine. No patient responded only to clonidine. CONCLUSION: The absence of any effects on the parameters of portal haemodynamics would appear to deny clonidine any significant role in preventing first bleeding resulting from the rupture of oesophageal varices.

Administration, Oral↗
PubMed1994

Background EEG activity in preterm infants: correlation of outcome with selected maturational features.

The aim of this study is to identify normal EEG patterns of preterm infants, characteristic of early postmenstrual ages (PMAs). Quantitative features of EEG background activity have been examined in records from 83 preterm infants within the first 2 weeks of life at a PMA of 27-34 weeks. These subjects presented different cranial ultrasound findings and different outcomes. EEG quantitative data have been compared to the subsequent neurological evolution. We supposed that the features of EEG background activity which were associated with a favourable outcome should be considered as indexes of "normality" of the tracing for that specific PMA. At 27-30 weeks of PMA a high incidence of "temporal sawtooth," a particular rhythmic theta activity detectable in temporal regions, relates to a favourable evolution, therefore it can be assumed that this activity is a normal feature of EEG tracings at this age. On the contrary, a significant correlation between a high incidence of "temporal sawtooth" and an abnormal outcome is observable at 33-34 weeks and leads us to deduce that this pattern should disappear at this time. After 31 weeks other parameters (such as the incidence of 8-20 Hz activities, the length of the intervals and burst duration) show a significant correlation with the outcome.

Brain↗
PubMed1994

[Hemoperitoneum supporting difficult diagnosis of diffuse hepatocarcinoma in liver cirrhosis].

The cases of two patients with liver cirrhosis HCV-related, admitted in our Department in consequence of the development of ascites, anemia and clinical deterioration, are reported. Both patients had all major risk factors for hepatocellular carcinoma and anamnestic and physical findings suggesting this diagnosis; nevertheless, the alpha-1-fetoprotein serum levels and the ultrasonographic findings were not diagnostic for primary hepatic neoplasm. Explorative paracentesis was diagnostic, demonstrating the presence of hemoperitoneum (the hematocrit ratio in the ascitic fluid was 12 and 10, respectively). Magnetic resonance revealed extensive diffuse hepatocellular carcinoma on both cases. Hemoperitoneum, in patients with liver cirrhosis, in face of non diagnostic levels of alpha-1-fetoprotein and ultrasonographic findings, can be indicative of the spontaneous rupture of a diffuse type of hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed1994

Increase in serum alpha-fetoprotein without recurrent disease after hepatectomy for hepatocellular carcinoma.

The case of a 58-year-old man with clinically-stable and compensated HBsAg-positive liver cirrhosis is reported. In April 1991, the patient underwent partial hepatectomy to treat a solitary 3.5 cm hepatocellular carcinoma (HCC), (Edmonson scale I), in the 5th liver segment. His serum alpha-fetoprotein (AFP) level was 24 ng/ml. After hepatectomy, the AFP level dropped to 8 ng/ml, but between the 4th and 12th month it rose gradually from 72 ng/ml to 4,520 ng/ml. Hepatic recurrence of HCC was excluded, but a 6 cm solitary metastasis (Edmonson scale III-IV) was detected on the right adrenal. Adrenalectomy was performed and two months later the patient is doing well and his AFP level is 51 ng/ml. The methodological approach to diagnosis, treatment and follow-up of HCC, and the relationship between AFP and liver and metastatic HCC, are discussed.

Adrenal Gland Neoplasms↗