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Biomedical subjects

L Fiori

Publications and source records attributed to L Fiori.

At least 37 records · Page 2Linked to original sources
PubMed1996

Early breastfeeding is linked to higher intelligence quotient scores in dietary treated phenylketonuric children.

Strict control of phenylalanine intake is the main dietary intervention for phenylketonuric children. Whether other dietary-related factors improve the clinical outcome for treated phenylketonuric children in neurodevelopmental terms, however, remains unexplored. We retrospectively compared the intelligence quotient (IQ) score of 26 school-age phenylketonuric children who were either breastfed or formula fed for 20-40 days prior to dietary intervention. Children who had been breastfed as infants scored significantly better (IQ advantage of 14.0 points, p = 0.01) than children who had been formula fed. A 12.9 point advantage persisted also after adjusting for social and maternal education status (p = 0.02). In this sample of early treated term infants with phenylketonuria there was no associated between IQ scores and the age at treatment onset and plasma phenylalanine levels during treatment. We conclude that breastfeeding in the prediagnostic stage may help treated infants and children with phenylketonuria to improve neurodevelopmental performance.

Breast Feeding↗
PubMed1995

Anterior fossa dural arteriovenous malformation discovered by means of PW-Doppler examination.

One case of dural arteriovenous malformation in the base of the anterior cranial fossa is reported. It was discovered by means of a PW-Doppler examination of angular branch of the ophthalmic artery in a patient under observation for hypertrophy of a superficial temporal artery. The nidus was located in the region of the cribriform plate and fed by the anterior ethmoidal arteries of both sides, draining into the superior sagittal sinus, via pial enlarged veins. The patient successfully underwent surgical treatment and a post-operative PW-Doppler confirmed normalization of the flow pattern in the angular branches of both ophthalmic arteries.

Cerebral Angiography↗
PubMed1995

Electrophysiological monitoring for selective shunting during carotid endarterectomy.

Selective shunt during carotid endarterectomy is more and more widespread, but it requires a monitoring system able to identify severe brain ischemia correctly. In 255 endarterectomies for severe carotid stenosis, we evaluated cerebral activity by means of sequential use of computerized two-channel electroencephalogram (EEG) and somatosensory evoked potentials (SSEPs). In 1.96% of cases, we observed changes referable to severe cerebral ischemia: in one case, in spite of shunting, EEG asymmetry persisted till the end of the operation, and the patient awoke with irreversible aphasia. In two other cases, a progressive disappearance of the cortical wave (N20) occurred in spite of a normal EEG pattern. None of the unshunted patients had postoperative deficit. Computerized EEG is an easily interpretable method of monitoring and reveals rapidly developing cerebral ischemia, but severe SSEP changes can occur in spite of a normal EEG pattern when cerebral ischemia has a slow onset. Although SSEP monitoring is a slower method of recording, it can give a finer distinction of less severe cerebral ischemia.

Adult↗
PubMed1995

The role of pulse-wave Doppler sonography in quantifying internal carotid stenosis.

To determine the accuracy of pulse-wave Doppler (PWD) sonography in quantifying cervical internal carotid artery (ICA) stenosis, we compared results of PWD with conventional digital subtraction angiography (DSA). A total of 202 carotid arteries were evaluated by means of these two techniques. The patients were divided into four groups according to the percentage of angiographic carotid stenosis as suggested by NASCET. A mathematic model of quadratic relationship between DSA stenosis and blood flow velocity, recorded by PWD, was worked out; peak systolic velocity and mean velocity values, corresponding to 70% DSA stenosis, were employed as key values to check PWD ability to detect high-grade stenosis. Finally, for each case, the correlation between the two techniques was evaluated. PWD well correlates with DSA, making it possible to detect and correctly quantify high-grade ( > 70%) ICA stenosis. In 4 cases with moderate ICA stenoses, blood flow velocity values were over the key values: in cases of moderate angiographic ICA stenosis, PWD identifies those patients in whom the haemodynamic pattern is comparable to the higher group, providing further matter for discussion in order to define surgical selection criteria.

Adult↗
PubMed1995

Ruptured cerebral aneurysms operated on with only MRA. Reports of two cases.

Two cases of ruptured aneurysms of anterior communicating artery were reported. The aneuryms were showed only by means of MR angiography and operated on without conventional angiography, since patients' allergy to drugs and medium contrast. The MRA showed precisely the sites of the aneurysm and the directions of the sac, but underestimated the size of the sac. In spite of the lack of angiograms induced a great caution during the dissection of the aneurysm and made necessary a larger operative field, anyway clipping of the aneurysm's neck was performed without great difficulties.

Adult↗
PubMed1995

Nutrition in children affected by inherited metabolic diseases.

Diet-therapy represents an elective approach to the treatment of several inborn errors of metabolism. According to the type of disease, dietary intervention can be addressed to three different goals: a) dietary restriction (global or partial) of one or more nutritional components become "toxic" because of the occurring enzymatic defect; b) supplementation with a given defective nutritional component; c) elimination through the use of diet and drugs of the accumulated "toxic" compounds. These interventions are aimed at overtaking the metabolic block and to avoid the accumulation of intermediate "toxic" substrates. The efficacy of the therapy should then be evaluated by means of a thorough biochemical and clinical follow-up (including anthropometric and psychomotor development parameters). In particular, nutritional indexes should be constantly monitored in order to support the dietary therapy, discover and correct any possible nutritional deficiency secondary to the "by exclusion dietary regimen". To elucidate these general principles, we discuss in detail some hereditary diseases of amino acid (phenylketonuria) and carbohydrate (glycogen storage disease and galactosemia) metabolism that, being responsive to the nutritional intervention, can be considered reliable examples of all the problems linked to diagnosis, acute and long-term therapy and follow-up of these diseases.

Amino Acids↗
PubMed1993

The role of medical counseling in secondary prevention of cancer in the elderly.

In western countries the elderly are those who experience the major impact of cancer, as epidemiologic data clearly show. Thus, secondary prevention of cancer (SPC) in older persons deserves more attention than it has received until now. Target subjects, however, are often reluctant to enter SPC plans. The reasons range from the lack of knowledge about the importance of SPC to the underevaluation of the risk of cancer, or, even more often, to the anxiety and fear that may stem from such a clinical investigation. In this context, the intervention known as counseling finds its natural and essential role. In the paper some general considerations on the significance of medical counseling is given, with particular emphasis on its role in SPC in the elderly. The analysis herein reported points out the specific skills and methods that physicians can adopt to cope with the eventually adverse influences that may affect the participation of the elderly in SPC initiatives. However, such action should avoid any paternalistic approach and respect the patient's will and autonomy.

Age Factors↗
PubMed1993

In vivo radiofrequency-based ultrasonic tissue characterization of the atherosclerotic plaque.

BACKGROUND AND PURPOSE: The ultrasonic image can offer unique information on the composition of atherosclerotic plaque, ie, the relative content of lipids, fibrous tissue, and calcific deposits. To date, however, the echographic assessment of plaque structure is based on a subjective, qualitative evaluation of the bidimensional images. We evaluated the feasibility and accuracy of assessing, in vivo, the acoustic properties of arterial carotid plaques by means of a suitably modified echographic apparatus allowing direct access to the radiofrequency signal. METHODS: In 15 patients undergoing carotid thromboendarterectomy, the ultrasonic findings in 70 discrete sites (within the plaque, n = 54; normal sites, n = 11; or intraluminal thrombi, n = 5) were correlated with the histological analysis (hematoxylin-eosin and Mallory trichrome stains) independently performed on the arterial samples. The pathological examination was carried out at a similar level of the insonation; the sites analyzed within the plaque were chosen because of their uniform echoic characteristics. In each ultrasonic region of interest selected from the echographic image, the integrated amplitude of the rectified radiofrequency signal was measured as the integrated backscatter index. RESULTS: The intimal-medial layer of normal carotid wall (n = 11) exhibited values of -32.5 +/- 9.4 dB. The integrated backscatter index in fatty sites (n = 11, -40.3 +/- 5.4 dB) differed from that of fibrous (n = 12, -23.8 +/- 5.0 dB) and calcified (n = 26, -11.5 +/- 5.2 dB, P < .01 for all intergroup differences) sites. Intraluminal thrombotic sites (n = 5, -42 +/- 5.1 dB, P < .01) differed from fibrous and calcified subsets (P < .01) but overlapped (P = NS) with fatty sites. Histological sampling also showed two sites of intraplaque hemorrhage that exhibited very low backscatter values (-53 and -58 dB) and three fibrofatty sites showing backscatter values (-28, -28, and -32 dB) intermediate between the fibrous and the fatty subsets. CONCLUSIONS: Quantitative analysis of integrated backscatter of the arterial wall is feasible in humans and provides an operator-independent assessment of plaque echoic structure. In particular, integrated backscatter is effective in distinguishing lipidic, fibrotic, and calcific components in human atherosclerotic plaques.

Arteriosclerosis↗
PubMed1993

Primary cauda equina tumors.

During the last seven years (1985-91) 28 primary tumours in the cauda among 104 intraspinal tumors were observed. The largest group (71%) comprised ependymomas and neurinomas. The rest included 5 lipomas, 2 astrocytomas and 1 epidermoid. Low-back pain without or with sciatic or crural irradiation was the most common initial symptom. The length of symptomatology is generally measured in months, because pain is erroneously referred to discal pathology for long time. The X-ray standard test and the CT scan have been of modest utility in the diagnosis of these lesions, but however they have been necessary for diagnostic screening. The MNR, a bloodness test, showed an important diagnostic value for the identification of these tumors; it is also useful in follow-up to exclude recurrence. The lipoma's and ependymoma's surgery, although performed by microsurgical techniques, showed great problems. Total removal of the ependymomas assured no recurrence at the follow-up. Sphincter disturbances were frequent after the operation, but they disappeared after some months. In most patients with lipomas the resection was partial, but at follow-up they were symptomless. Neurinomas' surgery presented less technical difficulties and the postoperative course was more favorable. Astrocytomas underwent to radiotherapy but their prognosis is not favorable.

Adolescent↗
PubMed1993

Endovaginal ultrasound in patients at risk for repeated abortion.

Transvaginal echography was used to examine 78 asymptomatic patients at their first ultrasound examination, at risk for repeated abortion in the first trimester of pregnancy. The purpose of this study was to evidentiate, in the initial stages of pregnancy, reliable echographical evidence that can be used as a prognostic value on the future course of pregnancy. The normal sequential appearance of the yolk sac of the embryo and of the fetal heart activity have proved to be reassuring criteria on the course of pregnancy in 87% of the cases. Non-echographic visualization of the yolk sac has been associated in 48% of the cases to short-term abortion, whereas an abnormally low embryonic growth rate represents a risk-factor for medium-term abortion in this group of patients.

Abortion, Habitual↗
PubMed1993

[Rubidium chloride in the treatment of major depression].

The present study evaluated 20 patients (18 females and 2 males: mean age 55 +/- 8.8 years) suffering from major depression who had been treated with 360/720 mg/die rubidium chloride for 60 days. A gradual and significant improvement in depressive symptoms (HDRS and Zung Scale) and anxiety (Stai X1 and HamARS) was reported. Serum levels were not correlated to clinical improvement. Slight adverse effects were also observed (diarrhea and skin rashes). Rubidium chloride showed a marked and rapid anti-depressive action which was particularly evident in relation to mood, anti-conservative ideas, work, occupational interests and psychomotory slowing-down. It is clear that these symptoms represent the most important aspects of the polymorphous depressive syndrome and, in some ways, this improvement should be interpreted as the effective influence of the drug on the biological contest of mood changes.

Chlorides↗
PubMed1992

Assessment of intracranial circle after carotid endarterectomy.

To evaluate haemodynamic effects of carotid endarterectomy on cerebral circulation, transcranial Doppler sonography was performed on 69 patients operated for unilateral carotid stenosis greater than 70%. Pre- and post-operative Vm and PI on bilateral middle-cerebral arteries, Vm PI and flow direction on ipsilateral anterior cerebral artery and Vm on basilar artery were evaluated. All patients presented more or less evident preoperative haemodynamic alterations of cerebral circulation and after surgery showed a normal distribution of cerebral blood supply.

Brain Ischemia↗
PubMed1992

Intracranical aneurysm and cerebral embolism.

Embolism from the aneurysmal sac is a rare but possible manifestation of intracranial aneurysm; thrombus formation is probably related to the combined action of turbulent flow and a 'stagnant zone'. Three cases are presented: 2 with giant aneurysms (1 internal carotid and 1 sylvian) and 1 with a large aneurysm of the middle cerebral artery. In the latter, surgical treatment was performed, while in the others a conservative therapy was preferred. No ischemic manifestations were observed in the follow-up.

Aged↗
PubMed1989

Oxiracetam in the treatment of primary degenerative and multi-infarct dementia: a double-blind, placebo-controlled study.

A multicentre, double-blind, between-patient study was carried out to evaluate the efficacy and tolerability of oxiracetam (800-mg tablets), in comparison with placebo, each given twice daily for 12 weeks to patients suffering from primary degenerative, multi-infarct or mixed forms of dementia. Efficacy was assessed by the Inventory of Psychic and Somatic Complaints in the Elderly (IPSC-E), administered at entry and after 4, 8 and 12 weeks of treatment, and by the Blessed Dementia Scale and the Newcastle Memory, Information and Concentration Scale (NMICS), administered at the beginning and at the end of the study. Three hundred and seven patients were enrolled, 18 of whom were excluded from the analysis because of violation of the protocol. Two hundred and eighty-nine patients were analyzed (145 m, 144 f, mean age 73 years) and 272 completed the study; 3 patients in each treatment group were withdrawn because of poor tolerability, 10 because of poor compliance and 1 patient because of the occurrence of a cerebral stroke. A significantly (p less than 0.01) different effect, in favor of oxiracetam, was observed in the three main efficacy criteria (i.e. IPSC-E, Blessed Dementia Scale and NMIC total scores), and confirmed by descriptive analyses carried out on some subitems of the scales used. Thirty-one patients on oxiracetam and 27 on placebo complained of a total of 35 and 32 minor unwanted effects, respectively. No clinically or statistically significant changes were observed on routine laboratory examinations.

Aged↗
PubMed1982

Deoxycytidine and deoxythymidine kinase activities in plasma of mice and patients with neoplastic disease.

In C57BL x DBA/2 F1 (hereafter called BD2F1) mice inoculated with P815 neoplasms and in AKR mice with spontaneously developing leukemia, significant amounts of plasma deoxycytidine and thymidine kinase activities were detected in advanced disease. Undetectable or low levels of such kinase activities were observed in normal BD2F1 and in control AKR mice. Initial studies with leukemia patients revealed increased amounts of plasma deoxycytidine and thymidine kinase activities correlating favorably with the peripheral white blood cell counts. Initial studies with small numbers of patients with solid tumors revealed significant activities of both kinases in plasma of patients with four different cancers. Healthy volunteers revealed enzyme activities only insignificantly above background.

Adolescent↗