PubMed Health⌕ Search

Biomedical subjects

R Pascarella

Publications and source records attributed to R Pascarella.

At least 19 recordsLinked to original sources
PubMed2000

Effects of antiepileptic drugs on evoked potentials in epileptic children.

To evaluate the visual and auditory function in children and adolescents who are undergoing monotherapy with sodium valproate, carbamazepine, and phenobarbital visual-evoked potentials and brainstem auditory-evoked potentials were measured in 58 epileptic patients (30 males and 28 females), ages 13.7 +/- 6.9 years. Fifty healthy sex- and age-matched children served as controls. The measurements were performed before the beginning of therapy and after 12 months. Before the beginning of therapy, there were no significant differences in visual- and auditory-evoked potentials between the control group and the three groups of epileptic children. After 12 months of therapy, patients treated with carbamazepine demonstrated a significant (P < 0.001) increase of P100 latencies when compared with baseline data and control values; moreover, these patients exhibited a significant increase of peak latencies of waves I-III-V and interpeak interval I-V at auditory second evaluation. The patients treated with sodium valproate manifested a significant (P < 0.05) increase in VEP P100 latencies. On the contrary, children receiving phenobarbital did not manifest any significant abnormality at visual- and auditory-evoked potentials measurements. Our study demonstrates that for patients treated with carbamazepine and sodium valproate, an electrophysiologic dysfunction of visual and auditory sensory pathways can be present after 12 months of treatment.

Adolescent↗
PubMed2000

Hyperhomocysteinemia in children treated with sodium valproate and carbamazepine.

OBJECTIVE: To evaluate plasma homocysteine (Hcy) concentrations in children receiving sodium valproate (VPA) and carbamazepine (CBZ), monotherapy, in comparison with healthy control subjects and to determine the possible relationship between Hcy levels and dosage and plasma concentrations of the antiepileptic drugs. METHODS: We measured levels of fasting and post-methionine Hcy, plasma pyridoxal 5'-phosphate (PLP, active vitamin B6), serum folate, erythrocyte folate and serum vitamin B12 in 60 epileptic patients (29 females, 31 males), aged from 14.2 to 17.9 years, subdivided into two groups according to their therapy. Sixty-three healthy sex- and age-matched children served as controls. These measurements have been performed before the beginning of therapy and after 1 year of therapy with VPA or CBZ. RESULTS: Before the beginning of therapy, there were no significant differences in fasting and post-methionine Hcy, plasma PLP, serum folate, erythrocyte folate and serum vitamin B12 values between the control group and the two groups of epileptic children. After 1 year of therapy, patients treated with VPA and CBZ showed a significant increase of the plasma concentrations of Hcy when compared to baseline data and controls values. Moreover, was observed a significant decrease of serum folate and plasma PLP. On the contrary, serum vitamin B12 and erythrocyte folate levels remained in the normal range. CONCLUSIONS: Our study demonstrates that prolonged treatment with VPA and CBZ increases plasma concentrations of Hcy.

Adolescent↗
PubMed2000

Renal tubular function in patients receiving anticonvulsant therapy: a long-term study.

PURPOSE: The goal of the study was to evaluate the tubular renal function in children and adolescents who are undergoing monotherapy with sodium valproate (VPA), carbamazepine (CBZ), and phenobarbital (PB). METHODS: The urinary excretion of N-acetyl-beta-glucosaminidase (NAG), beta-galactosidase (beta-Gal), alanine-amino-peptidase (AAP), and alpha1-microglobulin (alpha1M) was measured in 58 epileptic patients (29 girls and 29 boys), aged 12.6 +/- 3.9 years, who were subdivided into three groups according to their therapy. Fifty healthy sex-and age-matched children served as controls. The measurements were taken before the beginning of therapy and after 6 months, 1 year, and 2 years of therapy. RESULTS: Before the beginning of therapy, there were no significant differences in NAG, beta-Gal, AAP, and alpha1M values between the control group and the three groups of epileptic children. After 6 months of therapy, patients treated with VPA and CBZ showed a significant increase in the urinary excretion of NAG and beta-Gal compared with baseline data and control values. After 1 and 2 years, these patients showed a persistence of the changes found after 6 months of therapy. In patients treated with PB, we did not find any significant variation in NAG, beta-Gal, AAP, and alpha1M urinary excretion. CONCLUSIONS: Our study demonstrates that in patients treated with VPA and CBZ, an impairment of tubular function can be present, whereas PB does not cause any significant change.

Adolescent↗
PubMed1999

Involvement of the skull base and vault in chronic idiopathic hyperphosphatasia.

Chronic idiopathic hyperphosphatasia (CIH) is a rare generalised skeletal dysplasia in childhood. The clinical, radiographic and cerebral MR findings in a 5-year-old girl with the severe infantile form of CIH are reported. In spite of cranial enlargement, the intracranial space and the skull base were markedly reduced, the whole brain was compressed and a Chiari I malformation was present. Normal flow in the dural venous sinuses was documented. The patient showed no detectable cranial nerve involvement or hydrocephalus. Cranial MR in this patient enabled us to confirm that CIH involves the skull base and vault.

Abnormalities, Multiple↗
PubMed1994

Immunogenetic heterogeneity and associated autoimmune disorders in myasthenia gravis: a population-based survey in the province of Ferrara, northern Italy.

INTRODUCTION: The well-established relationship between myasthenia gravis (MG) and HLA antigens varies among different ethnic groups. In Caucasians B8 and/or DR3 alleles have been found associated with young MG women without thymoma and with high titres of acetylcholine-receptor antibody (AChR Ab). An increased frequency of haplotype HLA-A3, B7 and/or DR2 has been observed in older MG patients with low AChR Ab levels. So far, there is no convincing evidence for an association between a specific haplotype HLA and ocular MG or MG with thymoma. MG subjects often show other concurrent autoimmune disorders suggesting a more general inherited predisposition to autoimmunity. We performed a community-based study to verify the HLA-A, B, C, DR and DQ profile on ethnically homogeneous MG patients and with the aim to estimate the frequency of concurrent autoimmune diseases and to compare HLA phenotypes to autoimmune status in different MG patients groups. METHODS: Forty-seven patients, living in the province of Ferrara, were followed-up in our neurologic department and typed for HLA Antigens. In addition a set of immunological laboratory tests was performed. RESULTS: We found a trend towards an increased B8 and DR3 frequencies in total affected population; an association between B8 allele and early onset of generalized MG sustained by thymic hyperplasia. The DR3 allele is statistically associated with the presence of additional autoimmune disorders. CONCLUSIONS: Our data support the hypothesis of a genetically-based heterogeneity of the disease and show an increased prevalence of associate autoimmune conditions in MG patients.

Adult↗
PubMedDate not supplied

Inveterate fractures of the acetabulum.

The authors reviewed 44 inveterate fractures of the acetabulum treated surgically by internal osteosynthesis. The definition of inveterate fracture concerns lesions that are treated from 21 to 90 days after trauma. Based on an analysis of this series several features of a prognostic and therapeutic nature may be determined. In particular, it may be observed just how difficult it is to standardize therapeutic strategies in relation to polymorphism and anatomopathologic progression of the lesions.

Acetabulum↗
PubMedDate not supplied

The opportunity of rehabilitation treatment in acetabular fractures treated by osteosynthesis.

Two groups of 24 patients each who had been submitted to osteosynthesis for the treatment of fracture of the acetabulum were evaluated. The first group was submitted to rehabilitation treatment according to the protocol used in the Division of Physiotherapy at the Rizzoli Institute; the second group did not use this protocol. Clinical-radiographic follow-ups were obtained after 1 month, 3 months, 6 months, and 1 year postsurgery. The results of the evaluations carried out showed the usefulness of specific physiokinesitherapy in obtaining more rapid and best possible functional recovery.

Acetabulum↗
PubMedDate not supplied

Osteosynthesis with percutaneous wiring in fractures of the proximal humerus.

The authors report the preliminary results of osteosynthesis with percutaneous wiring in the treatment of fractures of the proximal humerus. This method which is still described in very few cases, is characterized by several advantages such as its minor invasiveness, and respect for vascularization of the fragments that guarantee good functional results. The application of threaded pins or pins of large diameter guarantees excellent hold with a low incidence of loosening secondary to loss of reduction. The use of a traction device applied to the surgical table simplifies reduction maneuvers and osteosynthesis.

Adolescent↗
PubMedDate not supplied

Intra- and extra-pelvic lesions associated with unstable fractures of the pelvic ring.

Fracture of the pelvis is often caused by high-energy trauma, and for this reason it is frequently associated with fractures in other regions, hemorrhages, or severe lesions of the organs. Based on an analysis of the results, obtained by a review of 68 cases of unstable fracture of the pelvis treated at the IIIrd Division of the Rizzoli Orthopaedic Institute between 1980 and 1995, the authors make several suggestions concerning diagnosis and therapy for the evaluation and treatment of these patients.

Adolescent↗
PubMedDate not supplied

The surgical treatment of inveterate hip dislocation in children affected with cerebral palsy: a preliminary report.

The incidence of hip dislocation in patients affected with cerebral palsy is directly correlated with the degree of neurologic deficit. Surgical treatment aimed at stabilization of the coxofemoral joint relieves pain and avoids the occurrence of changes in the static of the pelvis and vertebral column. The authors report their experience with procedures for the recovery of joint congruency (release of the adductors and psoas, surgical reduction of the dislocated epiphysis, femoral shortening associated with varus-derotation at the osteotomy level, acetabuloplasty) performed in one or more surgical stages, and operations with a purely anthalgic purpose (innominate osteotomy according to Chiari), specifying relative indications in relation to age.

Adolescent↗
PubMedDate not supplied

The surgical treatment of nonunion of the proximal metaphysis of the femur.

Nonunion of the proximal femur is a severe pathology, often provoked by the inopportune or improper use of a therapeutic aid: nonsurgical (primary nonunion), surgical (secondary nonunion). Surgical treatment of this nonunion may thus be characterized by different degrees of difficulty, depending on whether or not it is the sequela of surgery or of nonsurgical treatment. In lax nonunion, with atrophy of the segments and regions of necrotic bone interposed, modeling resection is required to correct the functional axes. The condylar blade-plate may be opposed by a cortical graft--to improve stability of the assembly--protecting the medial wall and providing the screws with excellent hold.

Adult↗
PubMedDate not supplied

Aseptic nonunion of the humeral shaft.

A total of 78 cases of aseptic nonunion of the humeral shaft treated at the third division of the Rizzoli Orthopaedic Institute between 1980 and 1997 were evaluated. There was a mean time of 19 months between trauma and definitive treatment. Surgical treatment consisted in osteosynthesis with a plate and bone grafting in 75 cases, and synthesis with screwed bone grafting alone in 3 cases. Consolidation was obtained in 96% of cases. The bone graft used (homo- or autoplastic) encountered complete osteointegration in a maximum time of 8 months. Postoperative motility of the shoulder and elbow were comparable to the preoperative findings.

Adolescent↗
PubMedDate not supplied

Valgus-lateralization osteotomy: notes on surgery.

There are specific forms of nonunion secondary to per-inter-subtrochanteric fractures that make surgical planning a critical phase. In cases such as these, it may be useful to transform the center of the nonunion into an osteotomy plane. Because of the anatomotopographical features, course and progression of the lesion, cases such as these constitute a pathology that is difficult to define in terms of a therapeutic protocol. The authors report the surgical technique used in 4 cases of nonunion of the proximal metaphysis of the femur.

Adult↗
PubMedDate not supplied

Rigid fixation with plate and bone graft in failures of intramedullary osteosynthesis for the treatment of diaphyseal nonunion of the femur.

Fractures and diaphyseal nonunion of the femur are normally treated by intramedullary nailing. In cases in which nailing fails, nonunion is treated by reaming of the canal and substitution of the nail with one of a more adequate caliber. Rarely, however, due to unfavorable mechanical conditions or in cases of atrophic nonunion or with scarce vascularization the biological conditions for healing are absent. In cases such as these, nonunion must be treated by rigid internal fixation with a plate, aided by the use of cortical graft on the opposite side. The authors present 7 cases of diaphyseal nonunion of the femur treated between 1994 and 1996 using rigid fixation (plate and graft) as a salvage method, as a result of numerous previous failures in surgery. The results were favorable in all of the cases without complications.

Adult↗
PubMedDate not supplied

Infected nonunion of the humerus.

Eight patients with infected nonunion of the humerus were treated surgically by removal of the instrumentation, surgical debridement or wide resection of the fracture site and stabilization in compression with an external fixator. A monoaxial external fixator was used in 5 patients, a circular external one in 3. The amount of time between trauma and treatment described was a mean of 13 months. Consolidation occurred in all of the patients after an average of 5.5 months. Long-term follow-up was obtained after a mean of 18 months (minimum 14, maximum 35). There was postoperative paralysis of the radial nerve in 2 of the cases, with complete recovery after 3 months. One case consolidated despite the persistence of a fistula.

Adult↗