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L Viola

Publications and source records attributed to L Viola.

69 records · Page 4Linked to original sources
PubMedDate not supplied

[Diffuse axonal lesions in childhood].

OBJECTIVE: About 48% of all primary traumatic intracranial lesions are represented by so-called Diffuse Axonal Injury (DAI): a pathologic condition characterized by multiple microscopic lesions and hemorrhage at the level of midline cerebral structures, in the subcortical grey matter, and/or within the brainstem. The natural history of DAI is depressing: 100% of the patients deteriorate rapidly to coma and approximately 50% die, while 50% remain in a vegetative state or with severe neurological deficits. In the present report, we describe the results of a study aimed to evaluating the cerebral hemodynamics and the neuroradiological findings observed in four children (6, 8, 10 and 12 years old) affected by DAI. METHODS: All the patients had been admitted to the Pediatric Intensive Care Unit with Glasgow Coma Score (GCS) of 5. On admission, all patients underwent mechanical ventilation, antiedemigen and barbiturates therapy. Serial CT scan and Transcranial Doppler Sonography (TCD) examinations were carried out in all children. TCD of the middle cerebral arteries was performed through the temporal window. The children underwent insertion of a ventricular catheter for intracranial pressure monitoring. Follow-up time has been, respectively, 4 years, 3 years, 7 and 1 months. RESULTS: The Glasgow Outcome Score (GOS) of three children is 2 (persistent vegetative state), while the GOS of the one child is 3 (severe neurological deficits). CONCLUSION: DAI results in unfortunate prognosis and large health care costs. The proper medical management of this condition should be based on TCD and SjO2 and CEO2 evaluations, in order to monitor efficaciously the cerebral blood flow.

Adolescent↗
PubMedDate not supplied

[Nutritional status and dietary habits of children in the Province of Modena].

Under the auspices of the "Food and health" project, research was undertaken (Nutritional Diagnosis) to evaluate the state of nutrition and health of a sample of the population of the Province of Modena. 155 children of an average age of 10 +/- 2 years were studied. These children, resident in the Local Health Areas 15 (Mirandola), 16 (Modena) and 18 (Pavullo), took part in a questionnaire comprising specific items. A general examination was carried out checking BMI, arterial pressure and pubertal development. Biohumoral examinations were also carried out which, as far as the average haematic lipids were concerned, showed no significant difference between the various Health Areas for CHT, LDL, and TGT, while for HDL there were significant difference (p < 0.01) for Area 16 with respect to Areas 15 and 18. Extremely high values of CHT and LDL were noted in the three areas and low values of HDL, particularly in Area 16. Case histories obtained while completing the questionnaire showed that the children's knowledge of the normality or not of bodily development was fair, since their replies to the question "how is your weight?" had a correlation of r = 0.6 with respective BMI. The prevalence of allergic illness in the three areas is 34.8% with significant differences for some zones and no significant difference for sex. With regard to physical activity, the evidence is disturbing: 31% of the children did not engage in any form of physical recreation whatsoever, which, given the average age of the target group (10 years), is serious. The findings for fatty acids and haematic lipids reflects the findings of an unbalanced diet. It is clear from the findings and observations reported that a study such as this should give rise to primary preventive strategies aimed particularly at young children, to prevent incorrect lifestyles as far as feeding and motor activity are concerned. Bad habits, once established, are difficult to eradicate and lead to obesity and hypercholesterolaemia, sure risk factors for ATS.

Child↗
PubMedDate not supplied

[Helicobacter pylori. Part II. Epidemiology, diagnosis, and treatment].

In recent years, the diagnosis of Helicobacter Pylori (HP)-mediated infection has become increasingly important not only in adults but also in children. Factors such as residence in a country with low social and economic standards and the presence of HP-positive family members underscore the widely-acknowledged fact that the incidence of HP infection tends to increase with age both in children (where the increase is roughly 1% per year) and in adults, where it reaches values of 50% in the industrialized nations and 80% in developing countries. This has led to research aimed at developing more accurate and less invasive diagnostic techniques that can be used in children as well. Also, the development of simple, cost-effective diagnosis is all the more important given the widespread occurrence of HP infection, particularly in the developing countries. The techniques employed range from the classical histological and culture examination, which involves esophagogastroduodenoscopy (a rather invasive technique), to serology and the Urea Breath Test with 13C. Also, the feasibility of tracing HP antigens in the faeces, a non-invasive and simple technique, is under investigation. As for therapy, there is as yet no unanimous agreement about when to start treatment, about which antibiotics (beta-lactams, macrolides and nitro-imidazoles) to use in association, about their effect on the gastric mucosa, nor, indeed, about the treatment routines to be followed in adults and children.

Child↗
PubMedDate not supplied

[Sedation in pediatric digestive endoscopy].

Sedation for children doing diagnostic or operative pediatric gastrointestinal endoscopy (PE) procedures is performed differently over the world and no consensus is yet agreed on the best paediatric endoscopy sedation (PES). Some centres do not use any sedation, especially in infants, most centre use some form of sedation: conscious sedation, deep sedation and general anaesthesia. We review sedation drugs and describe our centre protocol on 188 consecutive PE: oral premedication with flunitrazepam (0.05 mg/kg/dose) at least 30 min before procedure, petidine (1 mg/kg) followed by increasing boluses of midazolam (0.05 mg/kg up to a maximal 0.2 mg/kg or 5 mg) were given i.v. to obtain a conscious sedation. All PE could be performed and ended safely, PES resulted satisfactory in approximately 65% of patient having conscious sedation. SaO2 < 90% was observed in 2% of cases, one child had a respiratory depression after PE that resolved with flumanezil. Endoscopy and sedation was always performed by the PE team in the immediate vicinity of anaesthesiologists at work. PE can be safely performed with conscious sedation. Basic and advanced resuscitation skills are needed for the PE team who wish to perform both endoscopic and sedation procedures.

Child↗
PubMedDate not supplied

[Neuropsychological course of patients with craniocerebral injuries in rehabilitation].

The aim of the present paper is to describe a neuropsychological assessment and intervention model in Traumatic Brain Injury (TBI) patients. The theoretical and methodological frameworks are described and the following diagnostic and rehabilitative flowchart is fully explained: 1. first visit with patient and his relatives; 2. clinical and testing assessment; 3. diagnostic balance and its communication to patient and his relatives; 4. neuropsychological rehabilitation and psychological counseling. Whenever necessary, patient's relatives are involved. Furthermore, TBI patients' health related quality of life is outlined as an important clinical and scientific issue deserving more attention, in spite of the objective methodological difficulties which its evaluation implies.

Brain Injuries↗
PubMedDate not supplied

[The management of the child with head injury: initial assessment].

In western countries, head injury is very important in public health; infact it is the main cause of mortality after infancy and a significant cause of long term disability. The patients with severe head injury needs an intensive care unit management, but the initial approach is a critical phase, too. In fact, it is demonstrated that trauma mortality and morbility are significantly reduced by a quick and well conducted approach. This article focuses the initial management of the injured child.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Antitransglutaminase enzyme-linked immune-adsorbed assay in coeliac disease diagnosis: evaluation of a diagnostic algorithm.

BACKGROUND: Tissue transglutaminase is the major autoantigen recognized in the sera of coeliac patients. An enzyme-linked immune-adsorbed assay based on tissue transglutaminase was recently used to measure serum tissue transglutaminase immunoglobulins A for coeliac disease diagnosis. OBJECTIVES: To determine the sensitivity, the specificity, the positive and negative predictive values of an immunoenzymatic assay based on guinea pig tissue transglutaminase, to compare antititransglutaminase immunoenzymatic assay to the antiendomysium immunofluorescent assay, and to define a cost-effective sequence to execute serum antibody determination in coeliac patients. METHODS: We assessed for coeliac disease antibodies 91 pediatric patients with symptoms suggestive of coeliac disease, and 23 patients with coeliac disease on a gluten-free diet as controls. RESULTS: Antitransglutaminase immunoglobulins A showed 93.1% sensitivity, 93.6% specificity, 87.1% positive and 96.7% negative predictive values. Antitransglutaminase immunoglobulins A were significantly higher in antiendomysium positive subjects. Correlation between antitransglutaminase immunoglobulins A and antigliadin immunoglobulins A was not significant. DISCUSSION: Our results show that antitransglutaminase immunoenzymatic assay represents a cost-effective strategy for patients' serological evaluation and it could substitute EMA determination, which could be considered a second level evaluation.

Adolescent↗
PubMedDate not supplied

Multiple learning tasks in patients with ideomotor apraxia.

The Authors studied a group of patients with ideomotor apraxia (LBD+) to verify if these patients had some difficulties in multiple learning tasks in respect to non-apraxic patients and normal control subjects. All five groups were submitted to gesture learning task, motor skill learning task, supra-span (Corsi) learning task. The results indicate that learning difficulties were present in LBD+ patients, as demonstrated by their low performance in gesture sequence, motor skill and score of block-tapping supra-span task. This fact may be seen as a basic learning deficit and therefore linked to memory impairment. On the other hand, this could be tied to an aspecific more diffuse deterioration of attention if we consider that our apraxic patients had a greater cerebral lesion than non-apraxic patients.

Aged↗
PubMedDate not supplied

Space occupying contusions of cerebral lobes after closed brain injury: considerations about 51 cases.

Fifty one cases of space occupying contusions of the brain have been treated between 1967 and 1974. These represented 2.4% of all head injuries. Forty four were surgically treated and only clinically. The total mortality was 50.9% being 91.4% in patients above 50 years of age and 41% in patients below 50. In 66.6% of patients the lesions were localized in the temporal lobes, and two patients had localized cerebellar contusions. Surgery was performed in 44 patients. There were 13 craniectomies and 31 craniotomies. The operative mortality was 54.5%. Mortality was 65.2% in patients operated on within 24 hours of injury, and 12.5% in those operated on more than 72 hours after trauma. Twenty five patients (20 treated surgically and 5 managed clinically) were examined one year after injury. Eighty four percent were in either good or excellent condition.

Adolescent↗
PubMedDate not supplied

[Continuous intraesophageal pH monitoring in the study of gastroesophageal reflux (GER) in children. Influence of age on the considered parameters].

Gastroesophageal reflux is a very common event in children; it is studied using 24-hour intraesophageal pH-monitoring, which has a large sensitivity and specificity, but in the literature is not clear if the age of the children could have influence on the parameters considered in the pH-monitoring. The aim of our study is to assess if the age of our small patients could modify the results of pH-monitoring. During 3-year period from 1991-1993 continuous intraesophageal pH-monitoring of 45 children (29 males and 16 females), divided in three groups on the bases of age, homogeneous for number, sex and clinical symptoms, with pathologic reflux time (> 4% of 24 hours) has been evaluated. In our cases the pathologic total reflux time in 24 hours doesn't seem change with age. It has been noted that under two years of age the pH-monitoring measures are homogeneous with a tendency of reflux longer than children over two years. This older group has more after lunch refluxes; that is the number of total refluxes is larger in older children but the number of refluxes with length higher than five minutes is more in younger. These data are discussed in relation to the anatomical and functional gastroesophageal characteristics of the different age of the child.

Adolescent↗
PubMedDate not supplied

[Autoimmune hepatitis: pediatric aspects].

Autoimmune hepatitis (AIH), a liver inflammatory condition, is characterized by hypergammaglobulinemia, hypertransaminasemia, presence of autoantibody and periportal hepatitis revealed by histology. Usually it comes with acute onset and with bad prognosis. We describe recent updated literature for clinical manifestation and pathogenesis, principally referring to adult disease. We described the data obtained from a multicenter investigation (10 Italian center) included in the Gastroenterology and Hepatology Italian Society. The investigation collected 42 AIH cases in 18 years, this confirms that the disease is rare for pediatric age. There is a prevalence of females on males but not as important as in adults (F/M:3/1). The average age at diagnosis was 7 + 4 years old. The diagnosis was always made based on observed symptoms excluding 2 cases with silent hypertransaminasemia. The most frequently observed autoantibody was SMA. In two cases, diagnosis was done without finding commonly investigated autoantibody. Prognosis is severe, in one case the hepatic transplantation was successful.

Adolescent↗
PubMedDate not supplied

[Vaccination against hepatitis A].

The epidemiology of hepatitis A, a disease endemic in various countries, is in a state of continuous change. Adults are more exposed to infection and considering the frequent absence of immunity, in contrast to children in whom the disease is almost always asymptomatic, the disease is often serious and prolonged with a mortality of up to 2.5%. The mode of transmission of HAV is predominantly the fecal-oral route; the virus is isolated during the prodromic period of the disease from the feces, blood, bile and seminal fluid. The virus can also be found in saliva (OMS '95); in addition it may also be transmitted by the maternal-fetal route. The HAV infects cells in vitro but does not cause a direct cytopathic effect. At the beginning of the acute phase of the disease the production of anti-HAV antibodies is of the IgM type followed later by IgG. Some studies have shown a potential role of cellular immunity in clearance of the virus from the hepatocytes and in the pathogenesis of the infection of HAV. The efficacy of immunoglobulin serum in the prevention of hepatitis A has been demonstrated since 1944. As regards active immunity two types of vaccinations have been prepared. One with live attenuated HAV carried by either bacteria or virus. The other, killed inactivated HAV, HAV capsule, antigenic subunit, synthetic peptides, anti-idiotypes or virosomes. The recent literature describe the vaccine produced by Merck Sharp & Dohme and by Smith Kline Beecham (SKB); both vaccines are made from HAV, grown in vitro, inactivated with formalin and adsorbed to aluminum hydroxide. The protection of the vaccine begins 14 days after administration and lasts from one month to one year. Numerous studies have been conducted which have shown that the vaccine is effective when given in 2 doses and confers protection against HAV for at least one year. The results have shown that the vaccination causes seroconversion in approximately 100% of subjects, and does not cause serious side effects and the acceptance of the vaccination worldwide has been good.

Global Health↗