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Biomedical subjects

G Cioni

Publications and source records attributed to G Cioni.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Roxatidine in the treatment of gastroduodenal mucosal lesions in hepatic cirrhosis].

In about 50% of patients with liver cirrhosis, upper digestive bleeding is not due to oesaphageal varices rupture, but to a group of peculiar mucosal lesions usually referred as "congestive gastropathy" and "hepatogenic ulcer". The pathogenesis of such mucosal damage is still unclear: an important causative role is commonly thought to be played by portal hypertension, but the role of peptical pathway and of the mucosal barrier impairment must not be underscored as well. Aim of this study was to evaluate the effect of roxatidine in the long-term treatment of mucosal damage in 19 patients with liver cirrhosis. Patients showed a good tolerance and no side effects. The improvement of endoscopic pattern after a three months period of roxatidine therapy was statistically significant; moreover there was no occurrence of digestive bleeding. In conclusion, H2 antagonist may be considered as the drug of choice for the treatment of mucosal damage in patients with liver cirrhosis, for both its safety and effectiveness.

Adult↗
PubMed1994

High D-dimer levels: a possible index of risk of overt disseminated intravascular coagulation and/or digestive bleeding in advanced liver cirrhosis?

The coagulation parameters of fourteen patients with advanced liver cirrhosis (3 in Child class B and 11 in class C) were prospectively determined quarterly for one year in order to evaluate the possible relationship between high D-dimer levels and incidence of disseminated intravascular coagulation (DIC) and of gastrointestinal bleeding. The values of D-dimer, fibrin(ogen) degradation products, platelets, fibrinogen, prothrombin activity and antithrombin III were fairly stable in almost all patients and no patient developed an overt DIC; one patient had a significant increase in D-dimer three months after the first control. During the one year follow-up, four patients died, one by the occurrence of hepatocellular carcinoma and three by digestive bleeding. Overall, four patients had upper digestive tract bleeding, three from esophageal varices and one from hemorrhagic gastritis. Hemorrhage was more frequent in patients with high D-dimer levels (3/7, 43%) than in patients with normal D-dimer levels (1/7, 14%). In conclusion, the detection of high D-dimer levels in patients with advanced cirrhosis is not predictive for the occurrence of a overt DIC but seems to be related with an increased risk of gastrointestinal bleeding.

Aged↗
PubMed1993

Differences and variations in the patterns of early independent walking.

The early development of walking was investigated in 25 normal fullterm and in 25 low-risk preterm infants. All subjects were videorecorded within 3-4 weeks of the beginning of independent walking and again 4 months later. Analysis of the videos was carried out according to a predetermined list of items, with a semiquantitative score for each. The results indicate wide interindividual differences in normal infants in the form of independent walking. Several items seemed to be associated in different ways in different individuals. Age of onset, as long as the corrected age was considered, did not differ between preterm and fullterm infants, neither did their walking patterns. Gait asymmetries were often observed in both groups and they were related with asymmetries observable in prewalking locomotor behaviour. Toe-strike often occurred at the beginning of walking, but not after 4 months; in preterm infants the toe strike pattern correlated significantly with certain motor characteristics observed during the first weeks of life.

Aging↗
PubMed1993

Predictive value of general movements in asphyxiated fullterm infants.

The developmental course of spontaneous motility was investigated in a group of 26 fullterm infants, affected by mild to severe hypoxic-ischaemic encephalopathy. Serial 1-h videorecordings were carried out from birth to 15-22 weeks and a quality assessment of general movements (GMs) was made from a replay of the videos. Neurological follow-up of the infants were continued until at least 18 months of age; neonatal EEG and neuro-imaging techniques (US-scan, CT or MRI) were also carried out in all cases. The results indicate that perinatal asphyxia has important effects on the spontaneous motility of fullterm infants. Hypokinesis occurred very frequently during the first days of life, followed by a transient or prolonged (lasting longer than 15-22 weeks) abnormal quality of GMs. In the first 2 weeks the results of GM assessment did not correlate with the simultaneous findings of neurological examination, neuro-imaging and EEG, whereas they did when the results at 15-22 weeks were considered. The changes in spontaneous motility and especially GM developmental trajectories were good predictors of the neurological outcome. The predictive value of GM assessment was found to be similar to that of EEG and neuro-imaging, and better than neurological examination.

Asphyxia Neonatorum↗
PubMed1993

Hyperekplexia and stiff-baby syndrome: an identical neurological disorder?

Hyperekplexia (startle disease) is an unusual, familial, neurological disorder characterized by abnormally enhanced startle response, followed in most cases by momentary generalized muscular stiffness. These attacks may cause the patients to fall rigidly, while remaining fully conscious. Startle symptomatology has generally an onset in infancy and is often accompanied, during the first years of life, by rigidity, sleep myoclonus, motor delay, regurgitation and apneic spells, which may cause sudden death. Stiff-baby syndrome is a familial disorder characterized by marked rigidity, with neonatal onset and gradual reduction during infancy, regurgitations, motor delay and attacks of stiffness. We report 4 new cases of hyperekplexia from two different families and another infant with stiff-baby syndrome discussing clinical, electrophysiological and genetic aspects of both neurological disorders in relation to other reported cases. We suggest a continuum between these familial syndromes, which are often misinterpreted as epilepsy or other disorders.

Diagnosis, Differential↗
PubMed1993

Duplex-Doppler ultrasonography in the assessment of portal hypertension. Utility of the measurement of maximum portal flow velocity.

To assess the utility of Duplex-Doppler ultrasonography (DDUS) in the evaluation of portal haemodynamics we studied 52 patients with compensated liver cirrhosis (mean age 53.9 +/- 9.2 years, males 32, females 20) diagnosed by laparoscopy and biopsy. All patients underwent laparoscopy and oesophageal-gastro-duodenoscopy (OGDS): we postulated that haemodynamically significant portal hypertension (PH) was present if varices were detected at OGDS and/or if collateral veins were revealed at laparoscopy. DDUS was performed with a strictly standardized method and maximum portal flow velocity (PFV) was measured in all patients. Max-PFV ranged between 3.5 and 33.4 cm/s. Overall, 36 patients (69%) had a max-PFV lower than 20.3 cm/s (normal max-PFV range in our laboratory is 20.3-33.3 cm/s), while 16 patients (31%) had normal max-PFV values. Five patients (9.6%) had no signs of PH at laparoscopy and/or OGDS and all five had normal max-PFV values. The other 47 patients (90.4%) had collateral circuli at laparoscopy and 29/47 (61.7%) exhibited also varices at OGDS: max-PFV was lower than 20.3 cm/s in 36/47 patients (76.6%). The measurement of max-PFV demonstrated a 76.6% sensitivity and a 100% specificity in detecting PH, with 100% positive predictive value and 31% negative predictive value. Three patients with PH and apparently normal max-PFV values exhibited a recanalization of the umbilical vein.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1993

Sensorimotor development in cerebral-palsied infants assessed with the Uzgiris-Hunt scales.

The cognitive development of a group of 89 cerebral-palsied infants, aged six to 24 months, was investigated using the Uzgiris-Hunt scales. The results were compared with normative data for the Italian population and with data obtained in a group of low-risk term and preterm infants, 11 to 13 months old. The test was easy to carry out, even on infants with a severe motor impairment. The majority of the infants showed cognitive delay on most of the scales. Tetraplegic patients performed significantly worse than those with diplegia or hemiplegia. There were no differences between preterm and term infants, for either normal or cerebral palsy groups, if age was corrected for preterm birth. Sensorimotor development appeared to be organized similarly for cerebral-palsied infants and normal controls; however, these data raise the question of the role of action in early cognitive development.

Cerebral Palsy↗
PubMed1993

Duplex Doppler ultrasonographic comparison of the effects of propranolol and isosorbide-5-mononitrate on portal hemodynamics.

Eighteen cirrhotic patients with esophageal varices at risk for bleeding took part in a double-blind study. The variations in PFV induced by either 40 mg of propranolol or 60 mg of sustained-release isosorbide-5-mononitrate on two consecutive days were evaluated with a duplex Doppler device. Both drugs caused a significant decrease in maximum (propranolol, P = 0.002; isosorbide-5-mononitrate, P = 0.021). Four patients responded to propranolol, three to isosorbide-5-mononitrate, and eight to both drugs; three did not show any change. Duplex Doppler sonography may be of use in the selection of the right pharmacologic treatment for the individual patient for the prevention of a bleeding esophageal varix.

Delayed-Action Preparations↗
PubMed1993

[The activity of misoprostol on the gastric and duodenal mucosal damage in patients with liver cirrhosis].

Twenty-five liver cirrhosis patients with endoscopically demonstrated gastro-duodenal mucosal damage (microhemorrhages, erosions, ulcers) were treated with misoprostol (prostaglandin E1) 400 mg/die. Eleven patients (44%) had abdominal pain and diarrhea and stopped treatment. Three months later, a new endoscopy was performed in the 11 patients that completed the study (3 patients were lost at follow up). Mucosal damage was stable in 5 patients (45%) and improved in 6 patients (55%), with complete absence of mucosal lesions in 2 patients (P = 0.027, Wilcoxon Ranks test). No case of worsening was observed and no patient had digestive bleeding during treatment. Digestive bleeding is a common complication of liver cirrhosis, originating in about 50% of cases from gastro-duodenal mucosal damage. Misoprostol suggests itself as a possible alternative therapy to the drugs usually utilized in these lesions (beta-blockers, H2-inhibitors), but individual intolerance is frequent and must be preliminary excluded.

Aged↗
PubMed1993

[Posture in preterm infants is not a good indicator of brain damage].

The development of posture during the prenatal period was studied longitudinally in 12 matched pairs of low-risk and high-risk preterm infants. The gestational age of the infants in both groups ranged from 28 to 36 weeks. The two members of each pair had the same gestational age at birth and the video recordings were performed at the same postmenstrual age. They were filmed more than three times during the prenatal period, each video recording lasting 1 h. Time of occurrence and duration of each posture were analyzed from replay of the video recordings. No age-specific preference posture described in the literature was found from birth until the term age between two groups. There was no age-related tendency in duration and frequency of postures between two groups. There was a clear-cut dominant head position to the right side from 31 weeks onward. Asymmetrical tonic neck postures (ATN) were very inconsistently present before the term age. And there was no significant difference in the occurrence of ATN postures between two groups. We could not find any specific abnormal postures in the high-risk group. Our study suggested that posture in preterm infants is not a good indicator of brain damage in the prenatal period.

Brain Injuries↗
PubMed1992

Neuroimaging and functional outcome of neonatal leukomalacia.

Leukomalacia is a major cause of neurological impairment in the high-risk newborn. It can be identified during the early postnatal period by means of ultrasound (US) imaging of the brain, through the anterior fontanel. Magnetic resonance imaging (MRI) permits an optimal differentiation of brain tissue and of its abnormalities, without resorting to ionizing radiation or intravenous contrast. It is particularly appropriate for following the evolution of leukomalacia, after fontanel closure. Ninety-five fullterm and preterm infants with cystic and non-cystic leukomalacia, documented by US, were clinically followed-up until at least 12 months of corrected age. Thirty-two had a severe neurological outcome (mainly cerebral palsy, sometimes associated with mental retardation and/or cerebral visual impairment). The prognosis was worse in cystic leukomalacia than in prolonged flare. Electroencephalogram (EEG) carried out in the first 2 weeks of life provided valuable indexes of further outcome, especially for US findings of more uncertain prognosis. MRI was carried out at around 12 months of corrected age, by means of an apparatus operating at 0.5 Tesla. The main categories of abnormalities observed were the following: cystic lesions, enlarged ventricles with irregular outlines, delayed myelination, high intensity areas in the long TR (repetition time) images within the white matter, cortical atrophy. MRI findings correlated well with the results of US imaging and often with motor, cognitive and visual impairments. Nevertheless, clinical features cannot be predicted by neuroimaging alone and a comprehensive approach, including longitudinal functional and electrophysiological testing, is highly recommended.

Cognition↗
PubMed1992

Visual acuity of low- and high-risk neonates and acuity development during the first year.

Binocular grating acuity of 65 neonates was measured using Teller acuity cards. At the time of testing, age corrected for prematurity ranged from -3 weeks to 2 weeks. On the basis of clinical data, serial ultrasound scans and EEG recording newborns were divided into 4 subgroups: fullterm low-risk (FLR, n = 22); preterm low-risk (PLR, n = 20); preterm medium-risk (PMR, n = 9) and preterm high-risk (PHR, n = 14). Mean visual acuity of PLR infants (0.86 cy/deg; S.D. 0.34 oct) was not significantly different from that of FLR newborns (0.80 cy/deg; S.D. 0.71 oct); the lower variability of the PLR infants might possibly be caused by their longer postnatal experience. Within the preterm groups, mean visual acuity of PLR newborns was found to be significantly higher than that of PMR (0.73 cy/deg; S.D. 0.26 oct) and PHR infants (0.73 cy/deg; S.D. 0.35 oct). This difference can not be explained by dissimilarities in postnatal or corrected age. Brain impairment, as documented by US scans and EEG recording could account for these findings. Longitudinal data are needed in order to substantiate these findings and correlate them with later neurological and neuro-imaging outcome. Preliminary results of an ongoing longitudinal study suggest acuity development of most, but not all, PHR infants, in whom a cystic-periventricular leukomalacia had been diagnosed, to be worse than that of low- and medium-risk infants.

Electroencephalography↗
PubMed1992

[Two patients with liver cirrhosis who presented with alpha-fetoprotein values diagnostic of hepatocarcinoma but without evidence of neoplasms].

Two liver cirrhosis (LC) patients with all major risk factors for hepatocellular carcinoma (HCC) had, at presentation, serum alfa-fetoprotein levels (AFP) higher than 500 ng/ml, usually considered diagnostic for HCC. They had elevated serum ALT levels too. No neoplastic liver lesions were detected by imaging techniques in both cases. During the following three months we noted a progressive improvement of clinical conditions with contextual normalization of AFP and ALT values. Therefore we suggest, when AFP is strongly elevated in LC patients but no hepatic lesion is detectable, a check for AFP and ALT time-course, before diagnosis HCC.

Biomarkers, Tumor↗
PubMed1992

[The magnetic resonance of small hepatocarcinoma. A comparison with echography, computed tomography, digital angiography and computed tomography with lipiodol].

Diagnostic techniques as a whole and periodic ultrasonography (US) in particular frequently allows tumors < 3 cm (small hepatocellular carcinomas) to be detected in patients suffering from liver cirrhosis. Multifocal diseases are a major limitation to surgery. Recently, MR imaging has shown its capabilities in the diagnosis of small hepatocellular carcinomas. In our study the diagnostic value of MR imaging was compared with that of US, of pre- and post-contrast CT, of digital angiography and of CT after lipiodol injection (Lipiodol CT). The morphologic and signal intensity MR features of small hepatocellular carcinomas were investigated. Fifteen cirrhotic patients with 31 nodules of hepatocellular carcinoma < 3 cm were examined. All patients were studied with US, MR imaging, angiography and Lipiodol CT; 12/15 patients underwent CT. Histologic confirmation was obtained in 12 nodules (2 at surgery and 10 by means of percutaneous biopsy); in the extant 19 cases the diagnosis was made by combining US, CT, MR, angiographic and lipiodol-CT findings; in 9 tumors < 1 cm Lipiodol retention one month after angiography was considered as diagnostic. MR imaging detected 21/31 nodules (63%), US 22/31 (66.6%), CT 12/24 (50%), angiography 24/31 (74%), lipiodol CT 29/31 (92.5%). Mc Nemar test showed no difference in sensitivity between MR imaging and CT, MR and angiography, MR and US, lipiodol CT and angiography; however, the differences between the detection rates of MR imaging and Lipiodol CT and CT and lipiodol CT and US were statistically significant (p < 0.05). The difference in sensitivity between the detection rates of lipiodol CT and US was just above the threshold value which is usually considered significant (p = 0.065). One false positive was observed on US and none with MR, CT, angiography and lipiodol CT. On Se T1-weighted images 18 nodules were hyperintense, 2 isointense and 2 hypointense; on proton-density images 14 nodules were hyperintense, 7 isointense and none hypointense. On SE T2-weighted images 18 nodules were hyperintense, 3 isointense and none hypointense. A pseudocapsule was seen in 10/17 nodules (58%), especially on T1-weighted images. Accuracy and limitations of each technique and morphologic and signal intensity MR findings of small hepatocellular carcinoma are discussed. We believe that US is still the best diagnostic technique for the screening of hepatocellular carcinomas in cirrhotic livers.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1991

Globus pallidus alterations and brain atrophy in liver cirrhosis patients with encephalopathy: an MR imaging study.

Brain magnetic resonance (MR) was performed in 29 liver cirrhosis patients without (N = 10) and with hepatic encephalopathy (HE) of chronic recurrent (N = 10) and of chronic persistent (N = 9) type. Sixty percent of the patients with chronic recurrent HE and 100% of the patients with chronic persistent HE showed a bilateral and symmetrical hyperintensity of the globus pallidus in the T1-weighted images while the T2-weighted images were normal, suggesting the possibility of the accumulation of a paramagnetic compound in this brain area during HE. Other findings of the study were evidence of brain atrophy of mild or moderate degree in 70% of patients with chronic recurrent HE and in 77% with chronic persistent HE and patients with liver cirrhosis without HE appeared normal on MR examination.

Adult↗
PubMed1991

[Normal gamma globulin levels in liver cirrhosis: a prognostic indicator and improved survival].

UNLABELLED: Serum levels of gammaglobulins were evaluated in a population of 1334 patients with liver cirrhosis (mean age +/- SD 54.8 +/- 10.9; 898 males). Hypergammaglobulinemia was not as frequently observed as described in the literature 278 patients (20.8%) had gammaglobulin levels lower than 1.5 g/dl (first group) and the other 1056 had more than 1.5 g/dl of gammaglobulins (second group). At analysis of survival curves the first group had a median survival time of over 60 months, significantly higher than the 37.6 months of the other patients, when compared with the Lee-Desu statistic (p less than 0.01). Moreover, the patients of the first group had a lower incidence of ascites as compared to the second group (28% versus 45%; p less than 0.001), hepatic encephalopathy (7% versus 14%; p less than 0.01) and hepatocellular carcinoma (5.7% versus 8.4%; n.s.). The presence and the degree of oesophageal varices were significantly lower in the patients of the first group than in the others (p less than 0.001); a number of laboratory tests for the evaluation of liver cell function and the Child class distribution were more favourable in the first group than in that of hypergammaglobulinemic patients. IN CONCLUSION: normal blood gamma globulin level is not uncommon in liver cirrhosis and it may be considered a positive prognostic factor, which identifies a group of patients with a better quality of life, a lower incidence of decompensation symptoms and a longer survival time.

Adult↗