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Biomedical subjects

G Di Giulio

Publications and source records attributed to G Di Giulio.

At least 19 recordsLinked to original sources
PubMed2006

Premenstrual dysphoric disorder: prevalence, diagnostic considerations, and controversies.

Premenstrual dysphoric disorder (PMDD) has been included as a formal diagnosis of a mood disorder in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition in 1994. The ensuing, critical attention has resulted in increased research productivity and clinical recognition of this neglected women's health problem. A decade later, this paper will review the current literature on PMDD focusing on prevalence, biopsychosocial etiological correlates, history of the development of a formal DSM diagnosis, and the controversies surrounding the current classification of PMDD. The authors conclude that PMDD presents a distinct diagnostic entity and that recognition through formal diagnostic criteria serves the important minority of women who suffer from this cyclical mood disorder distinct from premenstrual symptoms and major depression.

Adult↗
PubMed2004

Cross-sectional survey of ticks (Acari: Ixodidae) in sheep from an area of the southern Italian Apennines.

A cross-sectional survey of ticks was conducted on 197 ovine farms with animals pasturing in an area (3971 km2) of the southern Italian Apennines. The farms were selected to be uniformly distributed throughout the study area using Geographical Information System (GIS). Ticks were collected from 309 (31.4%) out of the 985 sheep sampled, belonging to 92 (46.7%) out of the 197 farms included in the study. The following tick species were found (farm prevalence): Dermacentor marginatus (37.6%), Haemaphysalis punctata (29.4%), H. sulcata (2.5%), H. parva (2.0%). H. inermis (0.5%), Ixodes gibbosus (2.0%), I. ricinus (0.5%), Rhipicephalus sanguineus group (1.0%), and R. bursa (0.5%). A point distribution map (PDM) was drawn by GIS in order to display the distribution of each tick genus in the study area. The general trends of the PDM show that Dermacentor marginatus and Haemaphysalis spp. were widely and homogeneously spread throughout the study area, whereas Rhipicephalus spp. and Ixodes spp. were present only in a few concentrated zones of the study area in accordance to their biological and ecological characteristics.

Animals↗
PubMed2001

Image-aided estimate of tumor burden in Hodgkin's disease: evidence of its primary prognostic importance.

PURPOSE: To explore a more direct method for evaluating tumor burden (TB) in Hodgkin's disease (HD) and to verify its prognostic importance. PATIENTS AND METHODS: The volume of TB at diagnosis was directly and retrospectively measured in 121 HD patients through images of the lesions recorded by computed tomographic (CT) scan of the thorax, abdomen, and pelvis for all deep sites of involvement and many superficial ones, and by ultrasonography (US) for the remaining superficial lesions. RESULTS: The TB, which was obtained from the sum of the volumes of all the lesions measured on CT scans and US and normalized to body-surface area (relative TB [rTB]), showed a median value of 102.6 cm(3)/m(2) (range, 2.2 to 582.8). At multivariate analysis for prognostic value, rTB was the parameter that statistically correlated best with time to treatment failure (P = 2.2 x 10(-6)), followed by erythrocyte sedimentation rate (ESR) (P =.0003), and serum fibrinogen (P =.0112). The prognostic discrimination allowed by rTB alone proved to be clearly superior to that obtained with the score of the International Prognostic Factor Project. The rTB was found to be correlated with many clinical staging parameters (bulky disease, number of involved lymph node regions, serum lactate dehydrogenase, ESR, hemoglobin, Karnofsky index), but its predictability from these variables was low (R(2) =.668). CONCLUSION: Relative TB is emerging as a strong prognostic factor in HD, more powerful than and largely independent of those hitherto known and used. Further studies are needed to confirm these results and exploit their clinical value, particularly the relationship among rTB, drug doses, and response.

Adolescent↗
PubMed2001

Renal vein thrombosis in a newborn with prothrombotic genetic risk factors.

Environmental and genetic risk factors interact to cause venous thromboembolism. Renal vein thrombosis in the newborn has been frequently associated with "risk factors" as catheters, surgery or trauma, but it has also been demonstrated a pathogenetic role of genetic prothrombotic risk factors, i.e. activated protein C resistance and FV Leiden. The treatment of neonatal venous thrombosis varies worldwide and different approaches have been proposed. We present a case of renal vein thrombosis in a female newborn with normal plasma levels of protein C, protein S and antithrombin III, but with her genotype characterized by the presence of three prothrombotic risk factors: factor V Leiden, methylentetrahydrofolate reductase and platelet glycoprotein IIIa polymorphisms. The treatment with recombinant tissue plasminogen determined complete thrombus dissolution.

Factor V↗
PubMed2000

[Paranasal sinus mycoses].

In recent years there has been a marked increase in mycosis infections of the paranasal sinuses, attributed both to an increase in the survival of subjects at risk and improved diagnostic techniques (endoscopy, CT, MR) able to identify cases which had previously gone unrecognized and treated as aspecific chronic sinusitis. The present study involves 45 cases (4.3%) out of a total of 1050 patients who had undergone endoscopic surgery for sinusopathy between April 1994 and December 1998. Following the Katzenstein classification, the cases were broken down into non-invasive chronic mycoses or fungus ball (34 cases), allergic mycoses (7), chronic indolent invasive mycoses (3) and fulminating invasive mycosis (1 case). The mycetes most often involved was Aspergillus Fumigatus (76.9%). The recurrent symptom was facial algia, followed by nasal obstruction. Paranasal sinuses endoscopy did not modify the specific picture. CT presented such indicative signs as focal areas with non-homogeneous intensity, images of metal-like foreign bodies and endosinus calcifications in 84.4% of the cases. MR--performed in only 6 cases--always presented T2 images showing the typical signal void area corresponding to pathological lesions. All patients underwent endoscopic surgery of the paranasal sinus. The effectiveness of this treatment differed according to the clinical form. In the fungus balls surgery always resolved the pathology without requiring subsequent pharmacological treatment. In allergic mycosis, surgery improved the symptom of nasal respiratory obstruction but local drug treatment was required. With the aid of drug treatment, surgery resolved chronic indolent invasive mycoses and prevented the endocranial progression of complications. In the cases of fulminating invasive mycosis, timely surgery prevented the onset of endocranial complications and made it possible to perform antimycotic polychemotherapy to control the disease. This experience shows how important a protocol involving several different tests is in diagnosing the many clinical forms of paranasal sinus mycoses and distinguishing them from sinusopathies. Endoscopic surgery is indicated for all forms of paranasal sinus mycoses although the realistic objectives differ according to type.

Adolescent↗
PubMed2000

[Renal arteriovenous fistulas after renal biopsy. Percutaneous embolization].

PURPOSE: We report our experience relative to transcatheter percutaneous embolization of post-biopsy renal intraparenchymal arteriovenous fistulas in patients with chronic renal insufficiency. MATERIAL AND METHODS: We observed 5 patients affected with post-bioptic fistulas for possible embolization. In three cases the symptoms were represented by intermittent macro-microhematuria; one patient had hypertension of nephrovascular origin and one patient was asymptomatic. In all cases we performed angiography and it was possible to catheterize the peripheral afferent branch of the fistula with a superselective technique using a hydrophilic guide of 0.035 F and a hydrophilic Cobra catheter of 4-5 F. The occlusion was obtained by the positioning of Granturco metal coils: in 1 case we adapted a coil of 3 mm diameter and 1 cm length; in 3 cases 2 coils of 3 mm and in 1 case 2 coils of 3 mm and 1 coil of 5 mm diameter and 1 cm length were necessary. The success of the procedure was always checked with an immediate angiogram and color Doppler US after 48 hrs. RESULTS: The diagnosis of arteriovenous fistulas was always confirmed by a preliminary angiography that demonstrated the normal anatomic disposition of the renal arteries except in one case in which the fistula was fed by a peripheral branch originating from an inferior polar artery. All the lesions were localized in the inferior pole, the site of biopsy, and ranged from 3 mm to 2.5 cm in diameter. We never had any difficulties in the positioning and placement of the coils. The arterial occlusion and exclusion of the fistula was accomplished in all cases. The induced parenchymal loss ranged from 10 to 30% of the renal volume. There was a complete disappearance of symptoms in 3 of the patients, with hematuria without any modification of the blood pressure values in the patient with hypertension. Considering the patient status renal function did not worsen after the embolization. Each patient was followed-up with color Doppler US every two months. CONCLUSIONS: The intrarenal arteriovenous fistula represents a relative frequent complication of renal needle biopsy in patients with arterial hypertension and nephroangiosclerosis as risk factors. Embolization is a valid alternative therapeutic option to surgical treatments. The use of small size catheters permits the successful embolization also of peripheral lesions, reducing the induced parenchymal ischemia. We believe that among the embolization material available metal coils represent a valid solution as they are easily positioned and permit definitive occlusion without any risks of systemic venous microembolization.

Adult↗
PubMed1997

Infusion of donor-derived peripheral blood leukocytes after transplantation of cord blood progenitor cells can increase the graft-versus-leukaemia effect.

We describe the case of a child affected by acute lymphoblastic leukaemia who received adoptive immunotherapy after cord blood transplantation (CBT). The patient, transplanted in second relapse resistant to chemotherapy, still showed lung and costal leukaemic nodular lesions 2 months after CBT. For this reason, three infusions of donor peripheral blood leukocytes 1 x 10(7)/kg each were administered on days +60, +80 and +100. The procedure was well tolerated by both patient and donor, and a complete disappearance of the lung lesions was documented 2 months after the last infusion. The patient remains in continuous complete haematological remission 13 months after CBT. This experience suggests that adoptive immunotherapy may be safely employed after CBT in order to increase the contribution of immune-mediated anti-leukaemia effect.

Adoptive Transfer↗
PubMed1997

Meningeal carcinomatosis in patient with esophagus adenocarcinoma.

Meningeal carcinomatosis (MC) is an uncommon from of metastasis of solid tumors. We reported a clinical case of a woman with esophagus adenocarcinoma that a few months after surgical operation, presented episodes of vomiting, nausea, hypertension, mental change, unconsiousness; A contrast-enhanced CT of the brain revealed an "area of enhancement in the caudate nucleus" and cerebrospinal fluid cytologic studies evidenced the presence of carcinomatous cells. The clinical state of the patient deteriorated and she died a few days later. Autopsy confirmed meningeal carcinomatosis without parenchymal involvement.

Adenocarcinoma↗
PubMed1997

[Blood flow assessment with Doppler color ultrasonography in primary and secondary tumors of the liver].

Our study was aimed at measuring hemodynamic changes in liver perfusion in patients with HCC and hepatic metastases using color Doppler US, a noninvasive investigation technique. Eighty-seven patients were examined: 14 of them had HCC and 34 had metastases; the control group consisted of 39 people. Blood flow was measured in the common hepatic artery and portal vein and the ratio of hepatic arterial to total liver blood flow (HPI = hepatic perfusion index) and the ratio of hepatic arterial to portal venous blood flow (A/V ratio) were calculated. HPI and A/V values were changed in HCC patients (HPI = 0.23, range: 0.16-0.35; A/V = 0.32, range: 0.19-0.55) as a consequence of reduced portal venous blood flow (9.76 +/- 2.51 cm3/s) and of increased hepatic arterial flow (2.78 +/- 0.46 cm3/s). HPI and A/V values were significantly changed also in the patients with hepatic metastases (HPI = 0.24, range: 0.11-0.38; A/V = 0.34, range: 0.12-0.61) compared with the control group. These changes were correlated with increased hepatic arterial blood flow (3.16 +/- 1.35 cm3/s) and decreased portal venous blood flow (10.39 +/- 3.81 cm3/s). These results prove the role of color Doppler US in the study of primary liver cancer and metastases. Additional examinations are nevertheless necessary to assess the diagnostic value of color Doppler US in the early detection of and discrimination between benign and malignant tumors.

Adolescent↗
PubMed1996

Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review.

OBJECTIVES: To assess whether adding codeine to paracetamol has an additive analgesic effect; to assess the safety of paracetamol-codeine combinations versus paracetamol alone. DESIGN: Systematic literature review with meta-analysis, methodological quality of published trials being scored by means of 13 predefined criteria. TRIALS: 24 of 29 trials that met the inclusion criteria. Models studied in the trials were postsurgical pain (21), postpartum pain (one), osteoarthritic pain (one), and experimentally induced pain (one). INTERVENTIONS: Dosages ranged from 400 to 1000 mg paracetamol and 10 to 60 mg codeine. MAIN OUTCOME MEASURES: The sum pain intensity difference (efficacy analysis) and the proportion of patients reporting a side effect (safety analysis). RESULTS: Most trials were considered of good to very good quality. Only the single dose studies could be combined for analysis of analgesic efficacy. Pooled efficacy results indicated that codeine added to paracetamol provided a 5% increase in analgesia on the sum pain intensity difference. This effect was comparable to the difference in analgesic effect between codeine and placebo. The cumulative incidence of side effects with each treatment was comparable in the single dose trials. In the multidose studies a significantly higher proportion of side effects occurred with paracetamol-codeine preparations. CONCLUSION: The difference is analgesic effect between paracetamol-codeine combinations and paracetamol alone was small but statistically significant. In the multidose studies the proportion of patients reporting a side effect was significantly higher with paracetamol-codeine combinations. For occasional pain relief a paracetamol-codeine combination might be appropriate but repeated use increases the occurrence of side effects.

Acetaminophen↗
PubMed1996

Lung-angiodysplasia and von Willebrand's disease in a family with Rendu-Osler disease. A case report.

A young woman suffering from sideropenic anemia, bleeding disorders related to von Willebrand's disease and pulmonary vascular telangiectasias presented at our observation. Laboratory findings, genetic and hemostatic studies revealed platelet aggregation defect while in her father and grandfather lung angiodysplastic lesions without platelet aggregation defect. The association between bleeding disorders and pulmonary angiodysplasia has rarely presented in literature and deficiency of von Willebrand factor might increase the risk of bleeding in patients with coexisting angiodysplastic disease.

Anemia, Iron-Deficiency↗
PubMed1994

[Interventional modalities in immunosuppressed patients].

In immunocompromised patients interventional modalities have diagnostic and/or therapeutic purposes--in both cases they are justified on the basis of the frequently aspecific clinical and instrumental findings and because of the clinical need to carry out the most specific treatment as soon as possible. The authors stress the particular weakness of immunocompromised patients to invasive approaches and discuss the indications, contraindications and precautions which must be taken when performing interventional radiologic modalities. Diagnostic imaging uses radioscopy, US and CT for guidance, each of them allowing a rapid percutaneous confirmation of lesion nature, the assessment of infection in a collection, of a neoplastic lesion type, or of the microbiology of an infectious lesion. Interventional modalities are frequently indicated in chest diseases--e.g., for punctures and percutaneous drainage of empyematous pleural collections or of pulmonary abscesses, percutaneous needle biopsies of lung lesions, or endoscopic dilatation of tracheobronchial stenoses. The percutaneous drainage of lung abscesses in immunocompromised patients makes recovery easier. The diagnostic accuracy of the results of needle biopsy is lower in lung infections than in neoplastic lesions. Indications to abdominal interventional procedures are less frequent--i.e., percutaneous drainage of rare abscesses, percutaneous needle biopsy of nodal mesenteric or lumboaortic masses. Some clinical conditions are diagnosed only with invasive radiologic procedures--e.g., ERCP diagnoses sclerosing cholangitis in AIDS. CT is the basic and the best modality to guide percutaneous drainage in both the abdomen and the chest, to assess contraindications or to indicate some specific modes; in some cases even plurifocal abscesses can be treated with a percutaneous imaging approach.

Abdomen↗
PubMed1991

[The role of computerized tomography in the study of duodenal carcinoma].

Seven patients suffering from carcinoma of the lower portion of duodenum were examined by means of CT. Water was used as oral contrast medium. In all patients CT showed parietal thickening in the lesion site, with hyperdense (4 cases) or isodense (3 cases) patterns with respect to adjacent normal walls; irregularities on the inner surface were also demonstrated. CT correctly staged the tumor in 5/7 patients (70%), showing pancreatic infiltration in 5 cases--in 1 case associated with hepatic metastases--, vena caval infiltration in 1 patient, and right anterior pararenal fascia involvement in 1 case. In 2 patients the relationship between duodenal carcinoma and pancreas could not be evaluated. CT is suggested for the patients with suspected neoplastic pathologic conditions of the duodenum thanks to its capabilities of showing extraparietal lesion spread, as well as adjacent organs infiltration, adjacent vessels involvement, and distant metastases.

Adenocarcinoma↗
PubMed1991

[The potentials of computed tomography in the study of mechanical ileus of the small intestine].

Eighteen patients were examined; they were suffering from small bowel obstruction due to adhesions (7 cases), hernia (3 cases), carcinoma (2 cases), metastasis from melanoma (1 case), radiation enteritis (2 cases), intramural hematoma (2 cases), and peritoneal carcinosis (1 case). CT capabilities in showing the site and the cause of obstruction were evaluated. CT was performed after conventional radiology in 13 cases, while in 5 cases it was the first exam and demonstrated the condition as an occasional finding. In all cases i.v. contrast agents were administered. Filling of the intestinal loop by oral contrast agent was never performed since the hypodense fluid present in the distended intestinal loops allowed good evaluation of intestinal walls. CT always showed the level of the obstruction thanks to the presence of the distended loops (phi: 4-8 cm) above the condition and of collapsed loops below. In 8/18 cases (44%) it was possible to show the cause of the obstruction. Those due to neoplasms, herniae and intramural hematomas were correctly diagnosed. On the contrary, it was not possible to identify the cause of the obstructions due to adhesions, radiation enteritis and peritoneal metastases because of the absence, in such cases, of specific parietal alterations. According to our results, CT is suitable in patients suffering from small bowel obstruction because it allows: to always show the site of the obstruction and, in some cases, its cause; to diagnose closed loop obstructions; to obtain a simultaneous staging in neoplastic patients.

Contrast Media↗
PubMed1990

[Staging of acute pancreatitis: use of computed tomography].

Since CT permits non-invasive imaging of the peripancreatic anatomy, the relationship between early CT findings and objective prognostic signs was evaluated in fifty-five patients with acute pancreatitis. The tomographic severity of pancreatitis was graded in 5 degrees in accordance with classification reported by Hill. An association of CT findings with objective clinical prognostic signs results in more accurate early identification of patients with a high risk of complications. Therefore early CT evaluation of the pancreas is recommended in patients who, upon clinical evaluation, appear to have pancreatitis of moderate or severe degree.

Acute Disease↗
PubMed1990

[Lymph node metastasis of carcinoma of the cervix uteri. Role of lymphography and computerized tomography].

The presence of lymph nodal metastases in the patients affected with carcinoma of the uterine cervix is of the utmost clinical relevance. In the Radiology, Obstetrics and Gynecology Departments of Pavia University we have evaluated the accuracy of lymphangiography and CT in recognizing lymph nodal metastases in 95 patients, 58 of them evaluated preoperatively (49 subsequently submitted to radical hysterectomy). CT accuracy was also evaluated in 37 patients with a clinically suspected relapse of cervical cancer. In the first group the overall results were: 91% accuracy, 88% sensitivity, 92.5% specificity for lymphangiography and 87.9% accuracy, 72.2% sensitivity, and 95% specificity for CT (in 49 patients, stage I-II, submitted to lymphadenectomy, lymphangiographic accuracy was 91%, sensitivity was 88%, specificity 92% versus CT accuracy 85.7%, 44.4% sensitivity, and 95% specificity). In the second group (relapse) CT accuracy, sensitivity and specificity were 94%, 100%, and 91%, respectively. In conclusion, lymphangiography gives better results than CT in the patients with early stages (I-II) of the disease. In advanced stages and relapses CT was found to have high accuracy in demonstrating lymph node status. This information is useful for treatment planning and for avoiding unnecessary surgical exploration.

Adult↗