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Biomedical subjects

R Galletti

Publications and source records attributed to R Galletti.

At least 19 recordsLinked to original sources

Two different techniques in the rehabilitation treatment of low back pain: a randomized controlled trial.

AIM: The Back School is a widely accepted and effective method for treating low back pain, whereas no scientific evidence exists about the effects of the Pilates CovaTech method. With this study we wanted to evaluate the efficacy of this new method in patients with low back pain. METHODS: Fifty-three patients with at least 3 months of nonspecific low back pain were entered into a Pilates therapy or a Back School treatment group, 43 of which completed the study. Small exercise groups of 7 patients each followed a daily kinesitherapy protocol for 10 days. Evaluations were performed at the start of the study and then at 1, 3 and 6 months after the beginning of treatment. We used the Oswestry Low Back Pain Disability Scale (OLBPDQ) to assess disability and the visual analog scale (VAS) to evaluate pain. RESULTS: Demographic and baseline clinical characteristics were similar for both groups. A significant reduction in pain intensity and disability was observed across the entire sample. The Pilates method group showed better compliance and subjective response to treatment. CONCLUSIONS: The results obtained with the Pilates method were comparable to those achieved with the Back School method, suggesting its use as an alternative approach to the treatment of non specific low back pain.

Adult↗

Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS.

BACKGROUND: Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion. OBJECTIVE: To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure. METHODS: 25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) <50% underwent PRG after October 2000. They were compared with 25 consecutive ALS patients with FVC <50% who underwent PEG before October 2000. Respiratory function was evaluated before and after the procedure. RESULTS: The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (p<0.004). Respiratory function decreased more in the PEG group than in the PRG group (p<0.02). CONCLUSIONS: PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.

Aged↗

Percutaneous endoscopic gastrostomy: a long-term follow-up.

Percutaneous endoscopic gastrostomy (PEG) is the preferred method of long-term tube feeding, but only a few studies describe a long-term follow-up. The purpose of this study is to analyze the follow-up of PEG enteral feeding patients in the long term, and to report on the complication and survival rates. Between January 1991 and June 1995, we studied 136 patients (49% cancer and 51% non-cancer patients; male = 68%, female = 32%) after PEG insertion. One hundred twenty-eight patients had a long-term follow-up of over 31 d. The mean duration of PEG feeding was 277 +/- 358 d (range 31-1590): 17% of patients returned to oral feeding, 34% continued enteral nutrition, and 49% died. Major complications occurred in 3% of the patients: 1 aspiration pneumonia, 1 subcutaneous abscess. 2 buried bumper syndrome. Minor complications arose in 14% of our cases: 8 tube blockages, 4 tube dislodgements, 6 site infections. For the whole group of 136 patients, survival probabilities after PEG insertion at 1, 6, 12, and 24 mo were 90.5%, 52%, 42%, and 35%, respectively. After 180 d, the difference in survival probabilities between cancer and non-cancer patients became significant (P < 0.02). Median survival probability was 64% for non-cancer and 39% for cancer patients, and this trend did not change over 2 y.

Abscess↗

Passively administered antibody suppresses the induction of measles virus antibodies by vaccinia-measles recombinant viruses.

We have used vaccinia-measles recombinant viruses to study vaccination in the presence of pre-existing antibody. When mice were vaccinated with recombinants expressing either the haemagglutinin (H) or fusion (F) measles virus (MV) proteins, the humoral response to the MV protein was suppressed by passively administered polyclonal antibody. However, individual monoclonal antibodies (H or F) did not affect the response. Mice whose anti-MV antibody response to H or F was initially suppressed by passive administration of anti-MV antibody were revaccinated 120 days later and gave a normal humoral response to the MV proteins. The VV-H recombinant induces a strong class I CTL response in Balb/c mice. This was not affected by the presence of levels of anti-MV antibody which inhibited the humoral response.

Animals↗

[Trace nutrients in total enteral nutrition: the basal status and longitudinal course].

INTRODUCTION: Previous studies demonstrated deficiencies of selenium and other micronutrients in patients receiving total enteral nutrition (TEN). The content and bioavailability of trace elements in enteral formulas can be suboptimal. MATERIAL AND METHODS: Basal blood levels of some trace elements (copper, iron, selenium, zinc) and vitamins (B12, folic acid) were determined in twenty patients at the beginning of TEN. Vitamin E was measured in 7 patients. Primary diagnosis was cancer (no. = 13) and organic brain syndromes (no. = 7). Commercially available polymeric and oligomeric enteral formulas were used, containing respectively, as a percent of RDA in 1500 kcal, 65-39% of copper, 180-135% of iron, 80-100% of zinc. Selenium was not indicated; determinations in our laboratory gave a content of 78-63% of the minimum recommended intake. Blood levels of copper and zinc (no. = 6), selenium (no. = 5), iron, transferrin and ferritin (no. = 13) were measured after two months of TEN (mean intake of 30 +/- 3 kcal/kg/day). Copper, selenium and zinc were measured with atomic absorption; iron with the complessometric method: vitamin B12 and folic acid with RIA; vitamin E with HPLC. RESULTS: Mean values, expressed as mean +/- SD (range) were: copper: 129 +/- 23 (82-300) micrograms/dl; iron: 37 +/- 18 (16-89) mg/dl; selenium: 53 +/- 20 (22-93) micrograms/dl; zinc: 85 +/- 34 (44-185) micrograms/dl; vitamin B12: 632 +/- 450 (140-1575) pg/ml); vitamin E: 5.4 +/- 1.5 (3.3-7.8) mg/dl; folic acid: 11 +/- 8 (2-20) ng/ml. Values below the lower normal limit were found in 100% (vitamin E), 89% (selenium), 60% (iron), 35% (zinc), 24% (vitamin B12) and 14% (folic acid) of the patients studied. Copper was higher than the upper normal limit in 31% of cases; no data below normal range was found. Mean blood levels of depleted subjects were at the 28%, 43%, 54% and 63% of the mean normal value respectively for iron, selenium, vitamin E and zinc. Blood iron (p < 0.05) and selenium (p < 0.001) were significantly lower in more malnourished patients (weight loss > 20% vs < 20% on usual body weight). After two months of TEN, a reduction of 33% of mean blood selenium was observed in 4 of 5 patients studied. Blood copper and zinc remained stable in 6 subjects with initial normal or higher than normal values. Blood iron increased nonsignificantly, ferritin remained stable, transferrin increased significantly (p < 0.05). No clinical deficiency syndromes were observed. CONCLUSIONS: A careful monitoring of micronutrients during TEN is recommended. Selenium content of enteral formulas, unless supplemented by the producers, seems to be insufficient to maintain the initial blood level in two months of TEN.

Aged↗

[Percutaneous endoscopic gastrostomy].

Surgical gastrostomies were first performed in the middle of the 19th century and modified during the following years, but the most important technical improvement was percutaneous endoscopic placement (PEG), in 1980 by Ponsky and Gauderer. This technique doesn't require anesthesia and it in possible also in patients with contraindications to surgical gastrostomy. The simple procedure involves a shorter hospitalization, lower risks and reduced costs. Many authors already reported the good results of this new technique, that can be performed on a day-hospital regimen as well. The main indications are head and neck cancers, neurologic diseases involving food intake capacity, cancer cachexia, obstruction of the GI tract when there is enough space for an endoscopic procedure. Every disease that can compromise food intake for a period longer than 60 days can find an indication in placing a percutaneous gastrostomy. The advantage for the patient is a much better psychological tolerance compared with a naso-gastric tube. Also the incidence of mechanical complications of a PEG is much lower. In our experience from October '90 to July '92 we followed 34 patients with PEG, 22 males and 12 females, with mean age of 69 years (range 41-88). We used 9-French tube placed using the pull-method technique. All patients received antibiotic therapy for 5 days. About 12 hours after PEG placement all patients began using the gastrostomy, initially with the administration of electrolyte solutions and later with enteral polymeric formulas. The constant increase led all patients to a 1500 non protein calories daily intake in 3-4 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Benfluorex and blood glucose control in non insulin-dependent diabetic patients.

Benfluorex has been reported to decrease blood glucose in different dismetabolic conditions, particularly in noninsulin-dependent diabetic (NIDD) patients, but the mechanism of this effect is poorly known. We evaluate fasting glucose production (3H-glucose infusion) and B-cell secretion (phi 1, phi 2 and glucose utilization SI) (minimal model technique) in 7 mild, diet treated, NIDDM patients after 6-week administration of benfluorex (450 mg/day) and placebo, in random sequence and double blind design. Body weight, HbA1c, plasma glucose profile, fasting plasma insulin, lactate, pyruvate, beta-OH-butyrate, total cholesterol, HDL-cholesterol and triglycerides were also measured at the end of each treatment. Mean values of body weight (71 +/- 4 vs 69 +/- 4 kg, p less than 0.01), HbA1c (8.3 +/- 0.2 vs 7.7 +/- 0.2%, p less than 0.01), fasting plasma glucose (137.0 +/- 6.5 vs 121.4 +/- 5.6 mg/dl, p less than 0.01), lactate (1.82 +/- 0.13 vs 1.22 +/- 0.11 mmol/l, p less than 0.0025) pyruvate (0.164 +/- 0.011 vs 0.095 +/- 0.010 mmol/l, p less than 0.0005), and beta-OH-butyrate (0.91 +/- 0.06 vs 0.66 +/- 0.04 mmol/l, p less than 0.005) were significantly lower after benfluorex than after placebo. phi 1, phi 2 and SI values were not significantly different in the two treatments. Fasting glucose production was significantly lower after benfluorex than after placebo: 2.46 +/- 1.57 vs 1.84 +/- 0.85 mg/kg.min, p less than 0.02. These results demonstrate that 6-week treatment with benfluorex produces a significant blood glucose lowering effect in mild NIDDM patients, mainly by decreasing glucose production.

Blood Glucose↗

Electromyographic observations in patients with foot pain syndromes.

Abductor hallucis muscle EMGs were performed in control subjects and in patients with chronic foot pain (9 affected by the disease of the metatarsophalangeal joint of the big toe, 6 affected by chronic foot strain) to investigate pathophysiological mechanisms of muscle pain syndromes. Unlike control subjects, patients showed an abnormal involuntary activity when standing. All patients presented a decrease of abnormal EMG activity when postural changes were induced either by variations in body weight distribution on the feet, or by changes of position in the weight-bearing foot achieved by arch supports or by boards of variable thickness applied under the forefeet or the heels. Anaesthesia of the metatarsophalangeal joint of the hallux (injection into the joint cavity of 2-3 ml 0.50% bupivacaine) reduced the abnormal EMG activity only in patients with hallux valgus, whereas it did not affect muscular activity in the other patients. Present results support the idea of the role of abnormal muscular activity in causing and maintaining chronic pain and suggest that alterations of postural mechanisms and of afferent input, in particular that arising from joint receptors, are involved in the genesis of this abnormal muscular activity.

Adult↗

[Reactivation of the allogenous component of experimental skin inflammation after exposure to ultraviolet rays].

The effects of U.V. radiation induced cutaneous erythema on an experimental inflammation focus in another part of the body have been studied. The skin inflammation caused by carbon dioxide snow was used as a model. The onset of erythema is followed by reactivation of the diminishing inflammation process. It is therefore deduced that such effects are transmitted humorally and that reactivation is caused by histamine circulation. Histamine is released locally from the U.V. induced erythema and, entering into the circulation, increased the permeability of the microvessels in the inflamed area. This sends inactive chemical mediators to the interstitial sector where the appropriate conditions for their activation exist.

Adult↗

[Reactivation of the algogenic component in experimental inflammation induced by histamine administration].

The action of i.v. histamine on human skin inflammation experimentally induced with carbon dioxide snow in man is described. Histamine was injected when the skin reaction was on the wane to determine its possible reactivation of inflammation. Complete recrudescence of erythralgia was noted (reappearance of pain and of erythralgic halo, with a fresh spread of secondary hyperalgesia). It is felt that histamine was responsible. Its arrival to the reaction site through microvessels in a state of increased permeability during the remission of inflammation may be assumed to promote the passage of chemical mediators in the preactive stage from the vascular to the interstitial sector, and thus to pave the way for their activation.

Dermatitis, Contact↗

Relationships between characteristics of electrical stimulation, muscle pain and blink responses in man.

The present research was undertaken in 11 healthy volunteers with the aim of investigating the relationship between blink response, a feature of the startle reaction, and muscular pain evoked by muscle electrical stimulation (train of stimuli). At a repetition rate of 0.1 Hz, a close relationship was found between the threshold for muscle pain and that for the blink response, without apparent habituation. At the same rate and with stimulation intensity maintained at pain threshold, the subject could voluntarily inhibit the blink response, but not pain. Under the same conditions both pain and blink response were inhibited during a mental task. By increasing the current intensity pain became more intense and the blink response tended to increase in amplitude and to decrease in latency. Similar effects were achieved by increasing the repetition rate with the current intensity maintained at pain threshold. Habituation of the blink response, but not of pain, was found at repetition rates of 1 Hz or more. Present results indicate that nociceptive inputs from muscle have a facilitatory effect on central mechanisms subserving the blink response. It is suggested that the comparative analysis of pain sensation and the blink response may be a useful tool for pain research in man.

Adult↗