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Biomedical subjects

G Natali

Publications and source records attributed to G Natali.

At least 19 recordsLinked to original sources
PubMed2000

Acoustic intrameatal meningiomas.

BACKGROUND: The sporadic finding of an acoustic intrameatal meningioma stimulated the authors to the present study. An analysis of the cases previously reported in the literature aimed to outline a preliminary account about biological, radiological and surgical specific hallmarks of these tumours. METHODS: Eight previous cases of meningiomas, meeting the prerequisite of origin and situation within the internal acoustic canal, have been discovered in the known literature since 1975. A further case was recently observed in our experience. The cases in the series showed no sex prevalence and in most of them the age of incidence was comprised between the fifth and sixth decade of life. Hearing loss was the prevalent symptom, lasting 1 month to 7 years before presentation. Myelocisternography, myelo-CT or high resolution CT/MR revealed no specific radiological features to distinguish small intrameatal meningiomas from the more frequently occurring vestibular schwannomas, while CT scan with bone algorithm could point out valuable indirect details for differential diagnosis. Various surgical approaches, i.e. middle fossa, translabyrinthine and retromastoid, were utilized by the different authors. RESULTS: Basing on apparent individual surgical preference, one of three different surgical routes (translabyrinthine, middle fossa, retromastoid) was chosen for 10 procedures in 9 patients. In all, except two cases the impression at surgery was of complete tumour removal. CONCLUSIONS: The possibility for meningiomas to recur and invade the surrounding bone requires a differential diagnosis from vestibular schwannomas. In the absence of intrinsic distinctive signs, radiological evaluation of peritumoral bone alterations could help diagnosis. Although the various surgical routes have often proved effective, temporal bone invasion justifies more extensive approach even in small tumours.

Adolescent↗
PubMed1996

Functional therapy in hemifacial microsomia: therapeutic protocol for growing children.

PURPOSE: This study evaluates the skeletal response to functional orthodontic therapy in growing children with hemifacial microsomia (HM). A method of classification for mandibular growth subsequent to treatment is also suggested. MATERIALS AND METHODS: Sixteen growing children with unilateral HM were treated. Each patient was graded according to the skeletal, auricular, tissue (SAT) classification. Patients graded S4-S5 were excluded because the severity of the malformation made them unsuitable for functional orthodontic treatment. All patients initially underwent a period of treatment with an asymmetrical functional activator (AFA). RESULTS: In 7 of 16 cases (43.7%) classified as S1-S2/T1, regardless of the value of A, functional therapy brought about mandibular growth greater on the side of the malformation (G3-G4), re-establishing structural and functional harmony of the entire stomatognathic apparatus. Of the five cases (31.2%) classified as S2/T2, four required surgical intervention at about 10 years of age after an initial period of functional therapy that produced mandibular growth classified G1-G2. In the other case, functional treatment was sufficient to correct the malformation. In four patients (25%) classified as S3/T3 or S3/T2, it was necessary to combine surgical treatment with functional therapy. CONCLUSION: Use of the AFA in growing children with HM makes it possible to induce harmonious maxillomandibular growth. Statistically, in S1-S2/T2 cases, functional therapy brings about an overall resolution of the malformation whereas in more severe cases (S2/T2), it needs to be combined with orthodontics using fixed appliances and surgical intervention.

Activator Appliances↗
PubMed1995

Severe ulcerative colitis, dural sinus thrombosis, and the lupus anticoagulant.

Thromboembolic disease is a well-recognized but very uncommon complication of inflammatory bowel disease. The mechanisms of the increased risk of thrombosis are not well understood: although several coagulation abnormalities have been described in inflammatory bowel disease patients, it is not clear whether they actually contribute to hypercoagulation or whether they are nonspecific markers of inflammation. Antiphospholipid antibodies (anticardiolipin antibodies and/or lupus anticoagulant) have recently been associated with an increased risk of thrombosis, particularly cerebrovascular disease in young patients. We report the case of a 33-yr-old female with severe ulcerative colitis at first attack who developed thrombosis of the superior and inferior longitudinal dural sinuses. No risk factors for thrombosis or coagulation abnormalities were observed; however, lupus anticoagulant was detected in the serum. The patient was successfully treated with osmotic agents, prophylactic anticonvulsant, and antiplatelet therapy, combined with i.v. steroids. After 6 months, the colitis is in remission, and the neurological recovery is good even if not yet complete.

Adult↗
PubMed1994

Comparative stability study of wire osteosynthesis versus rigid fixation in the treatment of Class III dentoskeletal deformities.

The study analyzed two samples of 10 patients with Class III dentoskeletal deformities and maxillary and mandibular involvement. Surgery was performed on both jaws at the same time, using different techniques for the stabilization of bone. In one group, osteosynthesis by wire fixation was performed (WF); and in the other group, bicortical screws were used for the mandible (RIF) and plates for the maxilla. At 20 and 40 days after the operation, radiocephalometric examinations were performed, and the differences in structural stability verified, by comparing the efficiency of the two methods of bone stabilization. Results indicate that in the postoperative period analyzed, dentoskeletal movements in the RIF group were inferior compared with the WF group. On the basis of these results, the advantages and the disadvantages offered by these two techniques of bone stabilization are analyzed.

Adult↗
PubMed1994

Long-term control of the stability of skeletal structures in Class II dentoskeletal deformities after surgical-orthodontic therapy.

This study analyzes long-term findings in a group of 10 patients with Class II dentoskeletal malrelationship and who have undergone orthognathic surgical procedures. Changes in cephalometric values relative to the bony structures of the upper jaw and of the mandible are discussed in detail. Patients were reexamined on average, 5.8 years after surgery to show possible modification of the skeletal regions in patients who underwent surgical-orthodontic treatment for malformation of the facial continuum. For each case we made a cephalometric analysis of the lateral cephalograms, as well as the superimposition of tracings relative to the various stages of treatment: at the end of preoperative orthodontic treatment, after surgery, and at the long-term control. Cephalometric values for all patients who took part in this long-term control were recorded and a structural assessment was made.

Adolescent↗
PubMed1994

[Transjugular intrahepatic porto-systemic shunt (TIPS): indications and results].

This study was aimed at describing some technical features of the transjugular portosystemic shunt (TIPS). December 1991 to November 1993, fifty-five TIPS were performed in our department. The right internal jugular vein, which is the most direct path to the inferior vena cava, was punctured in 48 cases, the left one in seven cases. The right suprahepatic vein was catheterized in 43 cases, and the median suprahepatic vein in 12 cases. The puncture of the portal vein was performed in 21 cases in the right portal branch, in the left one in 23 cases, and in the portal bifurcation in 11 cases. In all cases in which the puncture site was questionable, an X-ray exam with lateral or oblique projection was performed, to be sure that the needle had entered the intrahepatic portion of the portal vein. A landmark to locate the portal system, such as a catheter in the hepatic artery, a skin landmark or a metallic coil near the porta, were positioned in 30 patients. Particularly, in 20 patients, a 0.018-inch guidewire with platinum tip was placed at the bifurcation; in seven cases a 3F catheter was advanced over the guidewire, to visualize the portal bifurcation directly with contrast medium injection. In our experience, a total number of 83 stents were positioned in 55 patients: 53 Wallstents, 13 Palmaz stents, and 17 Strecker-Nitinol stents. One single stent was placed in 31 patients, two stents in 21 patients, three stents in two patients, and, finally, four stents were positioned in one patient. In our series the technical success rate was 100%. The use of a metallic landmark significantly decreased procedures duration, ranging 40 minutes to 2 hours, and, above all, it allowed for significantly fewer puncture attempts, which varied from a minimum of 1-2 in 80% of cases, to a maximum of 20 especially in these patients with ascitis and with small and hard liver.

Procedural Sedation↗
PubMed1992

Circadian rhythm of peak expiratory flow in children passively exposed and not exposed to cigarette smoke.

BACKGROUND: Because airway calibre shows a circadian rhythm and since exposure to passive smoking reduced lung function this study was undertaken to investigate whether passive smoking affects the circadian rhythm of peak expiratory flow (PEF) in schoolchildren. METHODS: Twenty schoolchildren (12 boys and 8 girls, aged 10-11 years) exposed to passive smoking were matched for sex, age, and height with 20 children who had not been exposed to cigarette smoke. Exposure to passive smoking was assessed by questionnaire and by urinary cotinine concentrations. A portable spirometer was used to measure PEF at 16:00, 20:00, 22:00, 06:00, 08:00, and 12:00 hours on a consecutive Saturday and Sunday. The circadian changes in PEF were measured by the cosinor method. RESULTS: Both groups showed diurnal fluctuation in PEF values with a noticeable circadian rhythm. PEF peaks were the same in the two groups and occurred around 15:00 hours. The cosinor mean was approximately 10% lower in children exposed to passive smoking and the amplitude was approximately 60% higher than in the unexposed children. CONCLUSION: Passive smoking in children is associated with a reduction in the cosinor mean and an increase in the amplitude of the normal circadian rhythm of airway calibre. This increased PEF rhythm amplitude may be considered as an early indication of airway obstruction.

Child↗
PubMed1991

Diurnal variations of serum beta 2-microglobulin in multiple myeloma.

The chronobiological circadian behaviour in serum levels of beta 2-microglobulin has been investigated in three groups of subjects: (A) 6 healthy controls; (B) 6 patients with untreated multiple myeloma; (C) 6 patients with multiple myeloma in complete remission after polychemotherapy. From all subjects, under the same standard life conditions, venous blood samples were drawn at 4-hour intervals starting from midnight during the span of a whole day. Circulating serum beta 2-microglobulin levels were determined by RIA method. The time-related data were analyzed by chronograms and the "mean-group cosinor" method. A significant circadian rhythm for serum beta 2-microglobulin was detected in the control group, with a peak in the morning hours, and in untreated patients, with a peak in the afternoon hours. No significant rhythm was found in treated patients with multiple myeloma. A significant mesor reduction was noted in patients with complete remission, correlated with the absence of circadian rhythm, in respect to untreated patients. These data suggest that serum levels of beta 2-microglobulin could be related to the neoplastic plasma cell proliferation and to the effect of therapy, and that the circadian evaluation could be used as a guide in monitoring myeloma patients.

Circadian Rhythm↗
PubMed1991

[Epidemiologic chronorisk of acute cardio-cerebrovascular diseases].

This review summarizes the accumulated data demonstrating that several cardio-cerebrovascular diseases do not occur with casual periodicity, but present a predictable critical time of ultradian, circadian, or infradian recurrence in their onset. In fact, during the last years, it has been clearly established that there is a prominent increase in a definite period of the day, of the week, and of the year in the frequency of onset of acute myocardial infarction, sudden cardiac death, stroke, and fatal pulmonary thromboembolism. Morning hours, week-end, and winter seem to be the periods at higher risk, since a number of physiological processes that could contribute to the onset of the disease are intensified. Also environmental and behavioural conditions could contribute to these peaks. Consequently, the periodicity in the occurrence of these diseases may be due to the relationships between the exogenous factor rhythms, the endogenous biological rhythms, and the disease. These epidemiological and chronopathological observations suggest the introduction of time as a measurable structure for the clinical risk, and the term "chronorisk" as a predictable condition of temporally periodic or permanent risk for human health, which is generated by a temporal-quantitative disorder in the physiological course of the biological oscillating functions. The temporal recurrences in the onset of the acute diseases are not only epidemiological data, but, since the reasons for these rhythm changes in pathology are likely multifactorial, the study of such rhythms will probably help in the understanding of the pathogenesis and the triggering mechanisms. Moreover, further investigations of these rhythmicities may help the planning of more effective preventive therapy.

Adult↗
PubMed1990

Epidemiological chronorisk of stroke.

A retrospective study was undertaken on onset of symptoms in 667 cases of stroke. All strokes occurred out of hospital. There were 382 males and 285 females, observed from 1971-1988. The 667 cases of stroke consisted of 508 cases of cerebral infarction and 159 cases of cerebral hemorrhage. The data, analyzed by the single cosinor method, demonstrate a significant circadian, circaseptan, and circannual rhythmicity in the occurrence of stroke. The peaks occur in the morning hours, in the weekend, and in winter. Cerebral hemorrhages do not have a circadian rhythmicity in their occurrence, while they do present circaseptan and circannual rhythmicity. Cerebral infarctions present circadian, circaseptan, and circannual rhythms. No difference was found between males and females. The possible factors involved in temporal distribution of stroke are discussed. These observations could be useful for a better understanding of the pathogenesis and treatment of stroke.

Adult↗
PubMed1990

Circadian pattern of circulating plasma ACTH, cortisol, and aldosterone in patients with beta-thalassemia.

Plasma levels of ACTH, cortisol, and aldosterone were measured for an entire day every 2 h, starting from midnight, in 4 healthy subjects, and in 4 patients with beta-thalassemia, without evidence for any endocrine disease. The subjects, after synchronized standard life conditions for 10 days, were held in constant supine position during the study. The data were analysed by the "cosinor" method. The results show significant circadian rhythms for the three biological variables in healthy subjects. In the thalassemic patients a significant circadian rhythm was detected only for cortisol and aldosterone. No rhythm was demonstrated for ACTH in the patient group. While no differences were found in mesors and acrophases for the three hormones between the two groups, a significant difference was observed regarding amplitudes. These data suggest that in beta-thalassemia, the secretion rhythmicity of ACTH is modified, whereas the adrenal cortex maintains its own physiologic rhythmicity in hormone secretion.

Adolescent↗
PubMed1990

[Simultaneous presentation of multiple myeloma and acute myelomonocytic leukemia in the absence of previous chemotherapy. Description of a case and review of the literature].

A case of simultaneous occurrence of multiple myeloma and acute myelomonocytic leukaemia without previous chemotherapy is reported. A careful search of the literature disclosed 16 other cases of the same association. The possible relationships between these two haematopoietic neoplasms are discussed. On the literature and personal data, it is concluded that in course of multiple myeloma the association with an acute myeloblastic leukaemia is due to two possibilities: the first, more frequent, is the long-term effect of chemotherapy, while the second, rare, is that, by still unknown causes, a simultaneous neoplastic development of a plasma cell and myeloblastic clone occurs.

Aged↗
PubMed1990

[Differentiated circadian chrono-risk of acute myocardial infarct].

In order to determine whether acute myocardial infarction (AMI) presents a circadian periodicity in its occurrence, the onset of AMI, evaluated by onset of clinical symptoms and pain, has been analysed in 520 patients with AMI. The definitive criteria of AMI were: typical chest pain, electrocardiographic findings, and plasma CPK-MB elevation. All cases of AMI were divided into subgroups according to sex (males = 369, females = 151), age (less than 60 years old = 254, more than 60 years old = 266), type of AMI (Q wave AMI = 407, non Q wave AMI = 113), previous pharmacological treatment (no treated = 373, treated = 147), history of arterial blood hypertension (normotensive = 403, hypertensive = 117). Cases of Q and non Q wave AMI were also subdivided according to treatment and hypertensive conditions. All AMI occurred outside hospital; silent AMI and reinfarctions were excluded by analyses. The data have been analysed by chronograms and by means of "single cosinor" method, both for total cases, and for each subgroup of AMI. The results show a diurnal variation in AMI occurrence regarding the whole group, with a peak from 4:00 am to noon and with a secondary small no-significant peak in the late evening, and the minimum in the afternoon. Rhythmometric analysis demonstrates a significant circadian rhythm (p less than 0.001) with acrophase at 7:52 am (from 6:08 am to 9:36 am). A statistically-significant circadian rhythm is demonstrated in each subgroup, except in hypertensive patients. Acrophases of males and females, and of patients aged over or under 60 years do not differ from that of the whole group, and between them (p greater than 0.05). The peak of non Q wave AMI occurs at 4:44 am, while the peak of Q wave AMI at 10:08 am: this difference is significant (p less than 0.001). There is also a significant difference between the acrophases of AMI in the treated and untreated groups (p less than 0.01), as well as between normotensive and hypertensive subjects (p less than 0.001). The previous treatment seems able to anticipate the maximum occurrence of AMI in the whole group and in the group of Q wave AMI. These results are very similar to previous observations and confirm the greater morning occurrence of AMI. The present data are discussed in respect with the literature observations, and the possible pathophysiological mechanisms that contribute and conditionate the morning increase and the different peaks in subgroups of AMI patients are discussed.(ABSTRACT TRUNCATED AT 400 WORDS)

Circadian Rhythm↗
PubMed1990

[The chronobiology of sudden cardiac death. The evidence for a circadian, circaseptimanal and circannual periodicity in its incidence].

The aim of the study was to verify if sudden cardiac death presents a circadian, circaseptan, and circannual periodicity in its incidence. For the study of distribution of sudden cardiac death by hour of the day, the day of the week, and month of the year, 269 cases (161 males and 108 females), that occurred during the years 1970 through 1987 were considered. Sudden cardiac death, that is, death within 1 hour of onset of symptoms, occurs with greater frequency in the morning hours, on the days from Saturday to Monday, and in the months from October to January. The rhythmometric analysis by "single cosinor" demonstrates significant (p less than 0.05) rhythms, with acrophases at 5:00 a.m., on Monday, and in November. No significant differences (p more than 0.05) were found between male and female groups. These data suggest that sudden cardiac death is an event with high "chronorisk" that is a phenomenon with a greater probability of occurring in a definite period of time. The periodicity in the incidence of sudden cardiac death may be due to relationships between exogenous factors and endogenous biological rhythms.

Chronobiology Phenomena↗