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Biomedical subjects

P Torelli

Publications and source records attributed to P Torelli.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic splenectomy for hematologic diseases: a preliminary analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS).

BACKGROUND: The Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) was developed to provide at the national level an informative tool useful for performing multicenter studies in the field of spleen laparoscopic surgery. In this first study analyzing the IRLSS data, a cohort of patients with hematologic diseases was retrospectively investigated for potential predictive parameters that could affect the outcome of laparoscopic splenectomy. METHODS: A total of 309 patients who underwent laparoscopic splenectomy for hematologic diseases in 17 Italian centers (between February 1, 1993, and September 30, 2004) were entered in the IRLSS. Their records were analyzed retrospectively by the Student's t-test, chi-square, and logistic regression. RESULTS: The mean operative time was 141 min (range, 30-420 min). Conversion was necessary in 21 cases (7%), and approximately 1 accessory spleen in 25 patients (9%) was found. The mean spleen weight was 1191 g (range, 85-4,500 g). Perioperative death occurred in two cases (0.6%). No complications were experienced by 253 patients (81.9%), who had a mean hospital stay of 5.4 days (range, 2-30 days). Overall morbidity occurred in 56 patients (18.1%), mainly associated with transient fever (n = 22), pleural effusion (n = 13), and actual or suspected hemorrhage (n = 12), requiring a reintervention for 7 patients. Multivariate analysis found that body mass index (p = 0.024) and clinical indication (p = 0.004) were independent predictors for surgical conversion. The clinical indication was almost significant as an independent predictor for the occurrence of postoperative complication (p = 0.05). CONCLUSIONS: This first study analyzing the IRLSS data shows that laparoscopic splenectomy may represent the gold standard treatment for hematologic diseases with normal-size spleen. The low morbidity and mortality rate suggests that laparoscopic splenectomy can be successfully proposed also for splenomegaly in hematologic malignancies.

Adolescent↗
PubMed2006

Gender ratio of migraine without aura: observations over time.

Migraine without aura is typically considered a female condition. The purpose of this study was to determine if there have been any changes in the female-to-male ratio of the disease over time. We included in the study all patients with migraine without aura (n = 3457) referred to the Parma University Headache Centre between 1976 and 1995. They were divided into subgroups with respect to gender and year-range of onset of migraine (before 1960, in the 1960s, in the 1970s, in the 1980s, and between 1990 and 1995). Gender ratio ranged from 3.6:1 (in patients with onset before 1960) to 2.8:1 (in patients with onset in the 1980s), with no statistically significant changes during the observation period.

Adolescent↗
PubMed2006

Psychiatric comorbidity and headache: clinical and therapeutical aspects.

General population studies suggest a non-casual association (comorbidity) between migraine, major depression and anxiety disorders (panic attack disorder, obsessive-compulsive disorder, generalised anxiety disorder). The risk of developing affective and anxiety disorders is not increased uniformly in the different migraine subtypes, but it is more elevated in migraine with aura patients. The relationship between migraine and depression is "bi-directional" (i. e., migraineurs have a more than three-fold risk of developing depression compared with non-migraine patients, while depression patients that have never suffered from migraine before have a more than three-fold risk of developing migraine compared with nondepressed patients) and specific (i. e., the presence of migraine or severe non-migraine headache increases a patient's risk of developing depression or panic attack disorder, whereas the presence of depression or panic attack disorder is associated with a greater risk of developing migraine, but not severe non-migraine headache). Comorbidity with psychiatric disorders has also been described for chronic tension-type headache and for chronic daily headache, although these findings are based only on clinical population data.

Comorbidity↗
PubMed2006

Chronically evolving headaches: classification and terminology.

Chronic migraine appeared for the first time in the second edition of the International Classification of Headache Disorders (ICHD-II) in 2004, listed among the complications of migraine. Unfortunately, the diagnostic criteria of ICHD-II for this headache form tend to equate it with a migraine with a high frequency of attacks, rather than with an unfavourable evolution of migraine with loss of symptom-free intervals between attacks. On the other hand, the latter occurrence has increasingly been described in the last few years with the term "transformed migraine". Therefore, it seems advisable to carry out a revision of the ICHD-II in order to: (a) subdivide migraine at the three-digit level into infrequent episodic, frequent episodic and chronic migraine; and (b) introduce transformed migraine among the complications of migraine.

Chronic Disease↗
PubMed2006

Diaries and calendars for migraine. A review.

Headache is one of the most common types of pain and, in the absence of biological markers, headache diagnosis depends only on information obtained from clinical interviews and physical and neurological examinations. Headache diaries make it possible to record prospectively the characteristics of every attack and the use of headache calendars is indicated for evaluating the time pattern of headache, identifying aggravating factors and evaluating the efficacy of preventive treatment. This may reduce the recall bias and increase accuracy in the description. The use of diagnostic headache diaries does have some limitations because the patient's general acceptance is still limited and some subjects are not able to fill in a diary. In this review, we considered diaries and calendars especially designed for migraine and, in particular, we aimed at: (i) determining what instruments are available in clinical practice for diagnosis and follow-up of treatments; and (ii) describing the tools that have been developed for research and their main applications in the headache field. In addition to the literature review, we added two paragraphs concerning the authors' experience of the use of diaries and calendars in headache centres and their proposals for future areas of research.

Humans↗
PubMed2005

How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study.

BACKGROUND: This study aims to evaluate the completeness of full thickness disc resection in the treatment of deep endometriotic bowel lesions. METHODS: This study comprised 16 women with bowel endometriotic lesions requiring segmental resection. For the purpose of the study, before intestinal resection, nodulectomy was performed. The presence of endometriotic infiltration in direct continuity with the removed nodule and the presence of fibrosis in the area surrounding the nodule were histologically evaluated. RESULTS: In seven out of 16 cases (43.8%; 95% CI, 19.8-70.1), endometriosis was found in the bowel wall adjacent to the site of nodulectomy; the infiltration was visible in the muscular layer in all cases. In cases of incomplete nodulectomy, the muscular layer of the bowel segment surrounding the endometriotic nodule contained limited or no fibrosis. CONCLUSIONS: Full thickness disc resection is not complete in > or =40% of women with bowel endometriosis. Our finding that fibrosis in the muscular layer, the main landmark during surgical resection, does not always surround bowel endometriotic lesions might explain why incomplete resection may occur.

Adult↗
PubMed2005

Epidemiology of typical and atypical craniofacial neuralgias.

Trigeminal neuralgia (TN) has a prevalence of 0.1-0.2 per thousand and an incidence ranging from about 4-5/100,000/year up to 20/100,000/year after age 60. The female-to-male ratio is about 3:2. A review of several case series shows that pain is more predominant on the right side, but the difference is not statistically significant. TN is significantly associated with arterial hypertension, Charcot-Marie-Tooth neuropathy, glossopharyngeal neuralgia (GN) and multiple sclerosis. GN has an incidence of 0.7/100,000/year and epidemiological studies have shown it to be less severe than previously thought. Post-herpetic neuralgia has a comparable incidence to idiopathic TN. The epidemiology of the central causes of facial pain is still unclear, but it is known that persistent idiopathic facial pain is a widespread, not easily manageable problem.

Age Factors↗
PubMed2005

Validation of a questionnaire for the detection of cluster headache.

BACKGROUND: In the absence of biological markers, the diagnosis of cluster headache (CH) rests on clinical evidence as reported through ad-hoc interviews. OBJECTIVE: The aim of this study was to validate a 16-item self-administered questionnaire designed to screen CH cases. METHODS: The questions were based on the second edition of the International Headache Society classification (ICHD-II) criteria for CH (n = 12) and on specific disease features (n = 3). Answers to each question were either "Yes,""No," or "Don't know." The validity of this screening tool was assessed using a two-step procedure. In Step 1, the 16 questions were submitted to 30 healthy subjects with different cultural backgrounds to verify content clarity. In Step 2, the questionnaire was given to 71 patients (32 women and 39 men) aged 15 to 78 years (mean 37.5 years), who were seen at the University of Parma Headache Center with a diagnosis of CH (episodic, 17; chronic, 13), migraine (without aura, 18; with aura, 3), and tension-type headache (episodic, 16; chronic, 4) according to the ICHD-II criteria. Sensitivity, specificity, and the positive and negative predictive values were calculated for each question as measures of validity. RESULTS: Severity, unilaterality, and location of pain had the highest sensitivity (100%), but low (34.1%) or fairly low specificity (61.0% and 58.5%, respectively). In contrast, a positive response to lithium or verapamil had a 66.7% sensitivity and a 97.6% specificity. Sensitivity and specificity were 100% and 90.2% for duration of attacks (<180 to 240 minutes), and 90.0% and 92.7% for compulsory movements, respectively. The best discriminatory pattern for symptom detection was unilaterality of pain and the presence of at least five of the following seven features: pain severity and location, duration, frequency and daily recurrence of attacks, rhinorrhea and restlessness as accompanying symptoms. CONCLUSIONS: Our findings confirm that this questionnaire is a useful method for CH screening in epidemiological studies.

Adolescent↗
PubMed2004

The involvement of the interstitial Cajal cells and the enteric nervous system in bowel endometriosis.

BACKGROUND: Our aim was to investigate the relationships between gastrointestinal symptoms and histological findings in women with bowel endometriosis. METHODS: The gastrointestinal symptoms of 362 women with endometriosis were classified according to the subgroups of the Rome II criteria. All visible endometriotic lesions of the bowel were removed; the patients were prospectively followed up for 2 years. The interstitial Cajal cells (ICC) and the enteric nervous system were immunohistochemically evaluated. RESULTS: Sixty-eight (18.8%, 95% CI 14.9-23.2) women had bowel lesions. The endometriotic lesions infiltrated the serosal layer and surrounding connective tissue in 45 cases; the subserous plexus in 11 cases; the Auerbach plexus in eight cases; the Meissner plexus in four cases. Whenever the subserous plexus was interrupted by the endometriotic lesions, the ICC were damaged. All women with endometriotic lesions reaching at least the subserous plexus reported bowel complaints. The level of infiltration into the bowel wall was correlated with severity of symptoms. Removal of lesions resulted in improvement of symptoms. CONCLUSIONS: Endometriosis-induced damage of ICC, even before muscular infiltration, may cause bowel symptoms.

Adult↗
PubMed2004

Headache classification: criticism and suggestions.

The International Classification of Headache Disorders 2nd Edition (ICHD-II), published in 2004, marks an unquestionable progress from the preceding 1988 edition, but the in-depth analysis it offers is not immune from drawbacks and shortcomings. First of all, it is still basically a classification of attacks and not of syndromes. For the migraine group, while the revised classification more accurately characterises migraine with aura, it fails to provide a sufficiently structured description of those forms of migraine without aura that over the years evolve to so-called daily chronic forms. These forms are not adequately recognised as chronic migraine, which ICHD-II includes among the complications of migraine. The inclusion of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) in the cluster headache group is bound to generate some perplexity, while the recognition of new daily persistent headache (NDPH) included in the group of other primary headaches as a separate clinical entity appears somewhat premature. Doubts are also raised by the actual existence of triptan-overuse headache, which ICHD-II includes in Group 8 among medication-overuse headaches. Finally, the addition of headache attributed to psychiatric disorder, which is certainly a good option in perspective, is not yet supported by an adequate systematisation.

Cluster Headache↗
PubMed2004

Rare primary headaches: clinical insights.

So-called "rare" headaches, whose prevalence rate is lower than 1% or is not known at all and have been reported in only a few dozen cases to date, constitute a very heterogeneous group. Those that are best characterised from the clinical point of view can be classified into forms with prominent autonomic features and forms with sparse or no autonomic features. Among the former are trigeminal autonomic cephalalgias (TACs) and hemicrania continua, while the latter comprise classical trigeminal neuralgia, hypnic headache, primary thunderclap headache, and exploding head syndrome. The major clinical discriminating factor for the differential diagnosis of TACs is the relationship between duration and frequency of attacks: the forms in which pain is shorter lived are those with the higher frequency of daily attacks. Other aspects to be considered are the time pattern of symptoms, intensity and timing of attacks, the patient's behaviour during the attacks, the presence of any triggering factors and of the refractory period after an induced attack, and response to therapy, especially with indomethacin. Often these are little known clinical entities, which are not easily detected in clinical practice. For some of them, e. g., thunderclap headache, it is always necessary to perform instrumental tests to exclude the presence of underlying organic diseases.

Diagnosis, Differential↗
PubMed2004

Cluster headache: symptomatic treatment.

The clinical management of cluster headache (CH) attacks requires a symptomatic treatment that is rapidly effective in resolving or significantly reducing symptoms. First-choice drugs for the symptomatic treatment of CH are subcutaneous sumatriptan at a dose of 6 mg and 100% oxygen inhalation at a rate of 7 l/min for no more than 15 min. Sumatriptan acts by suppressing pain and the accompanying autonomic phenomena, with no substantial differences in its mechanism of action between episodic and chronic CH. The drug can be used for prolonged periods without loss of efficacy or safety and its side-effects are generally mild or moderate. Oxygen inhalation has a number of advantages over drug therapy: it is free from side-effects, has no contraindications--unlike sumatriptan, it can be used in patients with cardiac, cerebral or peripheral vascular disease and with kidney, liver or lung disease--acts rapidly and can be administered several times a day. Its disadvantages are that it is scarcely practical and may induce a "rebound effect". Sumatriptan nasal spray, zolmitriptan and dihydroergotamine nasal spray are scarcely effective. After the introduction of sumatriptan, ergotamine tartrate has been relegated to a secondary role in the symptomatic treatment of CH. Among other non-drug and topical drug treatment options, hyperbaric oxygen therapy and the intranasal application of 10% cocaine hydrochloride and 10% lidocaine in the sphenopalatine fossa have also proved effective.

Clinical Trials as Topic↗
PubMed2004

An updated review of migraine and co-morbid psychiatric disorders.

General population studies suggest a non-casual association (co-morbidity) between migraine, major depression and anxiety disorders (panic attack disorder, obsessive-compulsive disorder, generalised anxiety disorder). The risk of developing affective and anxiety disorders has not increased uniformly in the different migraine subtypes, but it is more elevated in migraine with aura patients. The relationship between migraine and depression is "bi-directional" (i. e., migraineurs have a more than three-fold risk of developing depression compared with non-migraine patients, while depression patients that have never suffered from migraine before have a more than three-fold risk of developing migraine compared with non-depressed patients) and specific (i. e., the presence of migraine or severe non-migraine headache increases a patient's risk of developing depression or panic attack disorder, whereas the presence of depression or panic attack disorder is associated with a greater risk of developing migraine, but not severe non-migraine headache). The association described in this review has significant pathogenetic, clinical and therapeutical implications.

Adult↗
PubMed2004

Headache screening and diagnosis.

In most cases, diagnosis of the various headache subtypes is possible through the accurate collection of medical history data. However, sometimes serious problems of differential diagnosis may be encountered. Therefore, the distinction between migraine without aura and tension-type headache is not always easy, the relationship between chronic migraine and medication overuse headache is a complex one, and differentiation of chronic tension-type headache vs. new daily-persistent headache is often problematic. A clear knowledge of the distinctive clinical features of the various headache subtypes is necessary to establish a correct diagnosis in the group of unilateral headaches with short-lived attacks and in the group of headaches with nocturnal onset.

Analgesics↗
PubMed2004

Physiotherapy for tension-type headache: a controlled study.

The role of non-pharmacological therapies in the preventive treatment of tension-type headache (TTH) is still an object of debate. The primary aim of this study was therefore to investigate the therapeutic effect of physiotherapy in properly classified patients with TTH in a controlled trial. Fifty patients with TTH, 26 with episodic, frequent (ETTH) and 24 with chronic TTH (CTTH) fulfilling the International Headache Society classification criteria were included in the study. After a 4-week run-in period, they were randomized to either an 8-week period of standardized physiotherapy (group 1) or to an 8-week observation period followed by an identical course of physiotherapy (group 2); after the physiotherapy all patients were followed for a 12-week follow-up period. We then evaluated the number of days with headache, severity and duration of the headache attacks, and drug consumption for symptomatic treatment before and after the course of physiotherapy. Forty-eight patients completed the study. The average number of days with headache per 4-week period was reduced from 16.3 days at baseline to 12.3 days in the last 4 weeks of treatment [from 14.5 days to 10.5 days (P < 0.001) in group 1 and from 18.1 days to 14.1 days (P < 0.001) in group 2]. Severity and duration of headache as well as drug consumption were unchanged throughout the study. Analysing the response to treatment separately in the various subgroups, we found that the number of responders was significantly higher among patients with CTTH vs. patients with ETTH (P < 0.002) and in females vs. males (P < 0.02). No differences were found between patients with and without disorder of pericranial muscles. We conclude that a standardized physiotherapy programme has a good therapeutic effect, albeit on a restricted group of patients.

Adult↗
PubMed2003

International Headache Society classification: new proposals about chronic headache.

In the International Headache Society (IHS) classification of 1988, chronic daily headache (CDH) forms are not exhaustively categorized. The forthcoming revision of the classification will include a number of CDH forms that had been reported prior to 1988 or have been identified after that date. In particular, chronic migraine will be added to the classification as a complication of migraine, provided that use of symptomatic drugs does not exceed 10 days per month. In addition to chronic cluster headache and chronic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and hemicrania continua will be comprised among CDH forms with short-lived attacks. Hypnic headache will be included in Group 4 ("Other primary headaches"). No additions will be made to the new IHS classification for forms such as new daily persistent headache (NDPH) and cervicogenic headache as proposed by Sjaastad.

Chronic Disease↗
PubMed2003

Clinical observations on familial cluster headache.

Cluster headache (CH) has traditionally been considered a sporadic disease. Recently, an Italian study pointed out a risk of developing CH in the affected patients' firstdegree relatives that was increased 39-fold compared with the general population. The aims of this study were to investigate any possible differences in mean age at onset, clinical features and lifestyle between familial and non-familial CH cases. Among all CH patients referred to the Parma Headache Centre (n=691), we considered those who reported at least a first-degree relative with a probable diagnosis of CH in their family histories (n=30). CH diagnosis in the relatives was confirmed for 19 of the 30 patients. Each one of the 19 "familial cases" was matched by sex and age at the first visit (within 2 years) to two CH patients who did not report any family history for CH. The male:female ratio was 1.4:1 in the familial cases. Mean age at onset was significantly lower in women with familial CH than in those with non-familial CH. The study did not show any significant differences in symptoms between the two CH groups, such as pain location, accompanying symptoms, duration and frequency of attacks, and active periods. Our study seems to suggest that genetic factors play a role in the female gender, affecting age at onset of headache without modifying the clinical features.

Age of Onset↗