Biomedical subjects
Publications and source records attributed to P Fiore.
Twenty children with a variety of metabolic liver diseases were given two doses of hepatitis A vaccine. Adverse reactions were mild. All subjects responded to vaccine with seroconversion to hepatitis A virus antibodies after the first dose, regardless of transaminase values, and had a booster effect from the second doses.
Maintaining linear growth and weight gain in HIV-infected children is often difficult. Nutritional evaluation and support are recognised as important factors to improve their quality of life. Combination antiretroviral therapy including protease inhibitors (HAART) reduces HIV-viral load and improves survival, quality of life and nutritional status. Our study aimed to determine changes in nutrional status based on body weight, height and nutritional habits, of HIV-infected children receiving HAART. Possible side effects of lipid metabolism were also studied. Twenty five children, 13 treated with HAART (group B) were followed up for 12 months. We did not observe statistically significant differences in nutritional status over that time or between groups A and B. Inadequate energy intake was more common in patients with advanced HIV-disease. Hyperlipidemia was found in 70% of children receiving ritonavir and in approximately 50% of children receiving nelfinavir. We observed an important although not statistically significative modification in the height of those in group B.
OBJECTIVES: Abnormalities in cardiac function have been reported in liver cirrhosis, suggesting a latent cardiomyopathy in these patients. In this study we investigated cardiac function in cirrhotic patients and in controls. METHODS: A total of 20 cirrhotic patients without previous or ongoing ascites, 20 cirrhotic patients with moderate-to-severe ascites, and 10 healthy controls were studied by two-dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular function were evaluated. The left ventricular geometric pattern was calculated according to Ganau's criteria. Diastolic function was evaluated by the peak filling velocity of E wave and A wave, E/A ratio, and deceleration time of E wave. The pulmonary systolic arterial pressure was also estimated in patients with tricuspid insufficiency. RESULTS: Right and left atrium and right ventricle diameters were significantly enlarged in cirrhotic patients versus controls. E/A ratio was decreased (p < 0.05) in patients with ascites (0.9 +/- 0.2) versus those without ascites (1.3 +/- 0.4) and controls (1.3 +/- 1). The estimated pulmonary systolic arterial pressure was slightly elevated in patients with ascites (35 +/- 5 mm Hg, six patients) versus those with no ascites (28 +/- 5, 10 patients) and controls (27 +/- 8, 6 controls, analysis of variance, p < 0.05). The pattern of left ventricular geometry was normal in the majority of patients. Nitrite and nitrate levels were increased in cirrhotics irrespective of the presence of ascites. CONCLUSIONS: Liver cirrhosis is associated with enlarged right cardiac chambers. Diastolic dysfunction and mild pulmonary hypertension are evident in cirrhotic patients with ascites. These changes do not depend on variations in the left ventricular geometry.
BACKGROUND AND AIMS: Skinfold anthropometry has been used to evaluate the nutritional status in cirrhosis. Such estimates are based on the calculations which derive from healthy subjects and may not apply to cirrhotic patients. We aimed to calculate the limits of agreement between Skinfold anthropometry (SA) and dual-energy X-ray absorptiometry (DXA) in estimating body fat in cirrhotics. METHODS: Forty cirrhotic patients were studied by both methods. The limits of agreement were estimated by the Bland and Altman method. RESULTS: Percentage body fat was similar when measured by DXA and SA (29.6 +/- 9.2 vs 28.9 +/- 7.5 %). Body fat mass was also similar (20.3 +/- 8.4 vs 20.3 +/- 7.7 kg). The limits of agreement between DXA and SA measurements were -7.04 (95%CI: -9.55 to -5.2) +8.56 (95%CI: +10.7 to +6.4.) in the assessment of percentage body fat and -5.32 (95%CI: -6.77 to -3.87) +5.24 (95%CI: +3.79 to +6.69) in the assessment of fat mass. CONCLUSION: Percentage body fat can be evaluated by SA or DXA with a difference of less then 5% in the majority of cirrhotic patients without overt fluid retention. This result is important when considering the large applicability of SA.
Bifrontal craniotomy and interhemispherical approach, usually used to remove olfactory groove meningioma, does not allow a view of posterior pole, which is very important in the surgical management of this neoplasm, and, provides for an anatomical sacrifice of frontal bridging veins, not without complications as a result of venous infarction. From 1975 the pterional approach was performed on 20 patients with olfactory meningioma, with good results in 90% of cases. This approach presents several advantages over bifrontal craniotomy and, in order to minimise surgical damage, it avoids planned sacrifice of venous vessels.
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BACKGROUND: Basal meningiomas represent a significant group of intracranial tumours. Their surgical treatment presents still today several difficulties since these tumours, as it is well known, may involve critical neurovascular structures. METHODS: This is a retrospective study of 139 consecutive cases of basal meningioma operated on in our institution during the last two decades. Meningiomas location: olfactory groove 20 cases; suprasellar region 22; anterior cranial fossa 6; sphenoid wing 37; cerebellopontine angle/clivus 21; tentorium 26. In most cases the meningioma was larger than 5 cm. The tumour was completely removed (grade I-II of Simpson classification) in 111 cases (79.9%). The authors dwell upon some clinical and surgical aspects of prevailing groups (olfactory, suprasellar, sphenoidal, petroclival and tentorial meningiomas); regarding to operative procedures, the authors in particular emphasise the usefulness of the pterional approach to remove olfactory groove meningiomas and of the combined supra- and infratentorial approach, with preservation of transverse and sigmoid sinuses, to remove petroclival meningiomas. RESULTS: The surgery was followed by excellent or good results in 115 cases (82.7%): patients having a normal life with a score 80-100 of Karnofsky scale; poor outcome occurred in 5.8% of cases, postoperatively died 16 patients (mortality rate 11.5%). Tumour recurrence occurred in 7 cases. CONCLUSIONS: Based on their experience and on analysis of the reviewed literature, the authors conclude that advances in microsurgical techniques and in neuroradiological imaging have radically improved the outcome so that today basal meningiomas can be successfully treated in most cases.
Recently we treated 54 patients with acute epidural haematoma, diagnosed by early CT scan and operated on quickly, within 6 hours after trauma. In 18 cases the volume of the haematoma, calculated by three different methods, was more than 150 cc, and GCS score was equal to or less than 8. In all 18 patients, as well as in another 36, we obtained good results: all patients survived and 17 fully recovered (only one was left with moderate neurological disability). Our experience leads us to the conclusion that even volumes of over 150 cc can be compatible not only with survival but also with very low morbidity, if rapid surgical treatment is performed.
UNLABELLED: In patients affected by MMC both neurological and systemic dysfunctions may cause obesity and malnutrition. The aim of this study is a nutritional survey, with anthropometric assessment and dietary evaluation, of patients affected by MMC. CLINICAL MATERIALS AND METHODS: Anthropometric assessment, dietary evaluation, and a comprehensive assessment of motor impairment degree (MID) were performed in 100 patients (54 males, 46 females) affected by MMC aged from 6 to 228 months (median 91 months). RESULTS: Fifty-five/100 children and adolescents with MMC were classified as normal or wellnourished and 5 at risk of malnutrition or malnourished, while another 40/100 patients were classified as marked overweight (weight-for-height or BMI above the 95th percentile). Deficit in height-for-age was observed in 34/100 patients; 12 of these patients presented with obesity. Dietary assessment evidenced that the majority of wellnourished patients (48/55) were consuming less than 80% or between 80% to 100% of recommended daily allowances (RDA) of energy. Overweight patients had an energy intake lower than their own RDA: 5 below 80%, 25 between 80% to 100%, and only 10 over 100% of RDA of energy for age and sex. No statistical correlation was found between nutritional status and MID, while there was a statistically significant difference between nutritional status and dietary intake (p = 0.005). DISCUSSION: Overweight is the most frequent nutritional disease in patients affected by MMC. Since in our experience on correlation with MID was found, we can speculate that childhood and adolescent obesity in patients with MMC occurs as a result of complex interactive factors, not strictly related to energy intake and MID. Nutritional surveillance and specific treatment programs for overweight MMC patients are essential to enhance their quality of life.
The aim of the study was to evaluate vitamin A (Vit A) plasma levels in children with newly diagnosed neoplasia (NDN) admitted to the Department of Hematology-Oncology of G. Gaslini Institute. Vit A levels, retinol-binding protein (RBP), and nutritional status were evaluated in 54 children with NDN (22 solid tumors other than neuroblastoma, 16 neuroblastomas, 9 lymphomas, 7 acute lymphoblastic leukemia). Biochemical test results were also compared with those of 47 healthy controls (HC) comparable for sex and age. In children with NDN, mean Vit A plasma level results were 350 micrograms/L (95% CI 288-412); in HC they were 517 micrograms/L (95% CI 471-563), P < 0.001. Mean RBP value results were 3.2 mg/dL (95% CI 2.6-3.9) in NDN and 4.9 mg/dL in HC (95% CI 4.5-5.3), P < 0.001. Fifteen (28%) out of 54 children with NDN were classified as well-nourished, 27/54 (50%) were considered at risk of malnutrition, and 12 (22%) were malnourished. Children with NDN presented reduced Vit A and RBP mean values compared with those of HC. Further studies are needed to better evaluate Vit A metabolism in children with cancer at onset.
OBJECTIVES: To compare whole body and regional (arms, legs and trunk) fat mass, fat-free mineral-free mass bone mineral content and bone mineral density, measured by DXA, in cirrhotic patients and age, sex and BMI matched healthy volunteers. DESIGN: Cross-sectional study. SETTING: Two medical research institutions. SUBJECTS: Twenty-two non ascitic cirrhotic patients and 16 age, sex and BMI matched healthy volunteers. INTERVENTIONS: The Lunar DPX whole-body X-ray densitometer with Lunar software version 3.6z (Lunar Radiation Corp., Madison WI, USA) was used. Regional analysis was performed on the arms, legs, trunk and head. RESULTS: Compared to controls, cirrhotic patients showed a significant reduction in percentage body fat. When differentiated by gender, however, the reduction in percentage body fat was evident in female cirrhotics only, particularly in the trunk. In male cirrhotic patients fat-free mineral-free mass was reduced in absolute terms in the whole body and the limbs. For both genders and in each body segment bone mineral content and density were reduced in cirrhotics compared to controls. In cirrhotic patients bone mineral density was significantly correlated to both fat-free, mineral-free mass (r = 0.85; P < 0.001) and to the Physical Activity Index (r = 0.52; P < 0.01). CONCLUSIONS: Two different patterns of soft tissue loss may be found in cirrhotic patients: in women lean tissue is maintained while fat stores are reduced, as in early starvation; in men lean tissue is reduced, as seen under conditions of stress. Moreover, factors influencing lean body mass, such as nutritional depletion and physical inactivity, may contribute to the reduction of bone density frequently observed in cirrhotic patients.
OBJECTIVES: To establish the prevalence of increased hepatic iron content in patients with hepatitis C virus-related chronic hepatitis and to assess the accuracy of serum iron and ferritin in detecting tissue iron overload. METHODS: Serum iron, serum ferritin, and hepatic iron content were determined in 81 consecutive patients undergoing liver biopsy for chronic ALT elevation and hepatitis C virus infection. Moreover, in a subgroup of 28 patients, outcome of a 6-month course of interferon (IFN) treatment (6 million U of recombinant IFN, three times weekly) was determined after a mean follow-up of 24 +/- 6 months and the outcome was compared with the pretreatment values of hepatic iron content. RESULTS: Elevated serum iron or ferritin levels were detected in approximately 40% of patients, but elevated hepatic iron content was observed in only eight patients (10%). One of these patients had a hepatic iron index > 1.9, indicating hemochromatosis. Liver iron content and serum iron levels were not correlated. No differences in hepatic iron content were observed among patients with a sustained response to IFN (seven patients), short-term responders (seven patients), or nonresponders (14 patients). CONCLUSIONS: Ten percent of patients with chronic hepatitis C have elevated hepatic iron content. These patients cannot be identified using serum markers of iron status. The relationship between liver iron and response to IFN treatment requires further prospective investigations.
The availability of CT scanning has considerably improved the results in patients with extradural haematoma (EDH). However, only few reports referred the "zero-mortality" which today could be considered as possible. This goal was achieved by us recently even in those patients suffering from rapidly developing EDH. A series of 37 consecutive patients with EDH operated on during the last years is presented. 27 patients were comatose GCS 3-8 on admission (within 6 hours after the injury) and underwent surgery immediately; in 7 cases the operation was performed 6 to 25 hours after the injury, soon after the worsening of the level of consciousness; 3 patients were awake at time of surgery and were operated on later than 24 hours after the injury when signs of neurological deterioration appeared. All of our patients survived and 35 of them (95%) fully recovered. We believe that the duration of brain compression is the main factor strongly correlated with outcome. Therefore, in our opinion the primary prerequisite in order to obtain a good result is the prompt evacuation of EDH; furthermore, in this was it is possible to try to prevent brain ischaemia due to clot pressure, mostly the infarction on deeply situated territories.
We investigated 20 right brain-damaged (RBD) patients and 10 controls with chronic motor deficits for differences in anxiety and depression, measured by psychometric tests, and in aspects of emotional behavior, gauged from videorecordings. We found no group differences in the psychometric scores but, when we correlated these with the behavior scores, we found significant differences in the expression of depression (absent only in RBD patients) and in attitude to illness, ie joking and unconcern (present only in RBD patients). In both groups emotional gesture, facial expression and prosody proved on qualitative analysis to be interrelated, thus demonstrating that emotional behavior has a single cortical-subcortical substrate.
We studied the effects of a new topical angiotensin converting enzyme inhibitor, SCH 33861, in lowering intraocular pressure in 20 patients with ocular hypertension or primary open-angle glaucoma. In a double-masked, four-way crossover study with placebo and timolol, SCH 33861 was well tolerated and effective in lowering intraocular pressure. The magnitude of the drug's effect in lowering intraocular pressure was less than that of timolol 0.5%.
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After having reviewed the properties of calcitonin (Ct), a hormone involved in calcium-phosphate metabolism and bone turnover, mention is made of the effects of Ct at the level of the CNS and its role as a neuromediator interfering with endorphins, prolactin, dopamine and the Ca concentration of the CSF. Overall's rating scale was used to evaluate the effects of synthetic salmon Ct in nine subjects with severe depression syndromes refractory to normal therapy. The study demonstrated statistically significant improvements of the major symptoms (behavioural excitation, depression, agitation, anxiety and affectivity). The favourable results justify broader and more detailed studies involving the relationship between Ct and psychopathology.
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