Biomedical subjects

R Totaro

Publications and source records attributed to R Totaro.

At least 19 recordsLinked to original sources

PubMed2006

A population-based study of the incidence and prognosis of lacunar stroke.

OBJECTIVE: To evaluate incidence and prognosis of lacunar stroke in a prospective, population-based patient registry. METHODS: The authors included first-ever strokes occurring between 1994 and 1998. They assessed incidence, risk factors, mortality, and recurrence in patients with lacunar stroke. RESULTS: The authors identified 491 patients (15.3%) with lacunar stroke (252 men and 239 women) and 2,153 patients (67.3%) with nonlacunar stroke (998 men and 1,155 women). Crude annual incidence rate for a first-ever lacunar stroke was 33.0/100,000 (95% CI 30.2 to 36.0). At the univariate logistic regression analysis among patients with lacunar stroke there was a higher proportion of cigarette smoking and hypercholesterolemia and a lower proportion of chronic atrial fibrillation than in patients with nonlacunar stroke. For lacunar stroke, the 30-day case-fatality rate was 4.3% (95% CI 2.5 to 6.1) and the 1-year case-fatality rate was 13.0% (95% CI 10.0 to 16.0). During the first year of follow-up the average annual stroke recurrence rate was lower in patients with lacunar (2.83%; 95% CI 1.36 to 4.30) than in those with nonlacunar stroke (5.10%; 95% CI 4.17 to 6.03) while from the second year onward, rates were similar in both groups. CONCLUSION: In the short term, patients with nonlacunar stroke had more vascular events, but in the long term, the risk of death and of stroke recurrence was similar.

Adult↗

PubMed2005

Prevalence of Parkinson's disease in the L'Aquila district, central Italy.

OBJECTIVE: We estimated the prevalence of Parkinson's disease (PD) in the L'Aquila district. METHODS: Cases of PD were identified screening all available case sources including general practitioners and antiparkinsonian drug-users by means of pharmacy records. Prevalence of PD was computed considering the prevalence day of December 31, 2001. RESULTS: On the prevalence day, 682 patients with PD were alive and residing in the L'Aquila district. A total of 354 patients were women and 328 men. The overall crude prevalence rate was 229.3/100,000 (95% CI 212.7-247.1), without any difference between men (227.4/100,000; 95% CI 200.0-257.5) and women (231.1/100,000; 95% CI 202.2-263.1). Prevalence rates increased with age in both sexes and were higher in urban (244.5/100,000; 95% CI 213.7-278.5) than in rural residents (214.7/100,000; 95% CI 189.0-242.9) (SRR = 1.7; 95% CI 1.3-2.1). CONCLUSIONS: The prevalence of PD in the L'Aquila district was within the range of prevalence rates found in our country and steeply increased with advancing age in both sexes.

Age of Onset↗

PubMed2001

Stroke in young adults in the community-based L'Aquila registry: incidence and prognosis.

BACKGROUND AND PURPOSE: Stroke type in the young may influence the outcome and may have a dramatic impact on the quality of life in survivors. This study aimed to evaluate the incidence and prognosis of first-ever stroke in the young and to make comparisons with older patients within a well-defined population. METHODS: All first-ever strokes occurring in the L'Aquila district, central Italy, were traced by active monitoring of inpatient and outpatient health services. Incidence rates were standardized to the 1996 European population according to the direct method. Long-term survival was estimated by the Kaplan-Meier method; outcome in survivors was evaluated by the modified Rankin scale. RESULTS: Of 4353 patients who had a first-ever stroke, 89 patients <45 years of age (55 men and 34 women) (2%) were identified in a 5-year period. Mean age+/-SD was 36.1+/-8.1 years. Twenty patients (22.5%) had a subarachnoid hemorrhage, 18 (20.2%) an intracerebral hemorrhage, and 51 (57.3%) a cerebral infarction. The corresponding proportions in patients >45 years of age were 2.4%, 13.3%, and 83.1%. Neuroimaging studies of the brain detected 14 intracranial aneurysms and 6 arteriovenous malformations in 20 of 38 patients (52.6%) with either subarachnoid (n=17) or intracerebral (n=3) hemorrhage. The crude annual incidence rate was 10.18/100,000 (95% CI, 8.14 to 12.57) and 10.23/100,000 when standardized to the 1996 European population. The 30-day case-fatality rate was 11.2% (95% CI, 6.2 to 19.4). Patients with subarachnoid hemorrhage had the highest proportion of good recovery (60%), patients with intracerebral hemorrhage had the highest mortality (44%), and patients with cerebral infarction had the highest proportion of severe disability (47%). CONCLUSIONS: Stroke patients <45 years of age showed a disproportionate cumulative high prevalence (42.7%) of subarachnoid and intracerebral hemorrhage with respect to older patients (15.7%), mainly (52.6%) due to aneurysms and arteriovenous malformations. Therefore, screening procedures and preventive strategies in the young should also be addressed to subjects at risk of subarachnoid and intracerebral hemorrhage.

Adult↗

PubMed2000

Noninvasive measurement of cerebral hemoglobin oxygen saturation using two near infrared spectroscopy approaches.

Spatially resolved spectroscopy (SRS) is a new near infrared spectroscopy (NIRS) method that, using the multi-distance approach, measures local cerebral cortex hemoglobin oxygen saturation [J. Matcher, P. Kirkpatrick, K. Nahid, M. Cope, and D. T. Delpy, Proc. SPIE 2389, 486-495 (1995)]. Using a conventional continuous wave NIRS photometer, cerebral venous oxygen saturation (SvO2) can be calculated from oxyhemoglobin and total hemoglobin rise induced by partial occlusion of jugular vein [C. E. Elwell, S. J. Matcher, L. Tyszczuk, J. H. Meek, and D. T. Delpy, Adv. Exp. Med. Biol. 411, 453-460 (1997)]. The aim of this study was to compare direct measurements of forehead tissue oxygenation index (TOI) with the calculated SvO2 during venous occlusion in 16 adult volunteers using a clinical two-channel SRS oximeter (NIRO-300). Measured TOI and calculated SvO2 values of either right or left forehead did not significantly differ. A good agreement between the two NIRS methods was also demonstrated. On 16 other subjects, no significant differences were found between the right and left forehead TOI values measured simultaneously, and between the TOI values measured by channel 1 or 2 on the same side. The results confirm that cerebral cortex hemoglobin oxygen saturation, measured directly by the SRS method, reflects predominantly the saturation of the intracranial venous compartment of circulation.

Adult↗

PubMed2000

Prevalence of multiple sclerosis in the L'Aquila district, central Italy.

OBJECTIVE: To estimate the prevalence of multiple sclerosis in the L'Aquila district, central Italy. METHODS: All available case sources were screened. Definite and probable cases of multiple sclerosis, classified according to the Poser criteria, were considered as prevalent cases. RESULTS: On the prevalence day, 31 December 1996, 158 patients (105 women and 53 men; ratio 2:1) affected by definite (n=131) or probable (n=27) multiple sclerosis were alive and resident in the L'Aquila district. Mean (SD) age was 38.4 (11.9) years (38.9 (11.7) years for women and 38.5 (12.3) years for men, p=0.9). The overall crude prevalence was 53.0/100 000 (95% confidence interval (95% CI)=45.4-62.0); 68.4/100 000 (95% CI=56. 5-82.8) in women, and 36.7/100 000 (95% CI=28.1-48.0) in men. The prevalence was similar (55.9/100 000) when standardised to the 1996 European population. Mean (SD) age at onset of multiple sclerosis was 29.4 (9.6) years and mean (SD) duration of the disease was 9.4 (7.4) years, without any significant difference between sexes. Mean age at onset was significantly higher in patients with the primary progressive than in those with the relapsing-remitting course (p=0. 0002, Scheffé's test). CONCLUSIONS: The prevalence found in the L'Aquila district gives support to the consideration of Italy as an area in which multiple sclerosis has been shown to have high prevalence at least in the populations that were surveyed recently.

Adolescent↗

PubMed1999

Long-term prognosis of cerebral ischemia in young adults. National Research Council Study Group on Stroke in the Young.

BACKGROUND AND PURPOSE: Prognosis of ischemic stroke in young adults is reported as favorable, and transient ischemic attack (TIA) is commonly considered a benign event. We investigated long-term outcome and prognostic predictors of cerebral ischemia in patients under 45 years of age. METHODS: Three hundred thirty-three patients aged 15 to 44 years who suffered from a first-ever TIA or ischemic stroke were prospectively followed up with annual clinical evaluation or complete phone interview. End points were the composite outcome event of stroke, myocardial infarction, and vascular or nonvascular death and death from all causes. The probability of event-free survival was estimated by the Kaplan-Meier method. Univariate and multivariate estimates of hazard ratios were calculated according to the Cox proportional hazards analysis. RESULTS: An average follow-up of 96 months was available in 330 patients (99.1%). Survival was worse in patients with stroke at entry (86.5%) than in those with TIA (97.1%). Mortality in both groups was significantly higher than in the general population (standardized mortality ratio [SMR] 14.5, P<0.0001, Poisson distribution test, and SMR 7.9, P=0.002). The average annual mortality rate was higher during the first (3.94%, 95% CI 1.84 to 6. 04) than in the subsequent years. The average annual incidence rate of new stroke was higher in patients with stroke than in those with TIA at entry, and it declined from 1.56% (95% CI 0.21 to 2.91) during the first year to 0.06% (95% CI 0.04 to 0.08) at the end of the follow-up. Myocardial infarction occurred later, after the first year, with similar rates in patients with stroke and TIA at entry. The average annual rates of new stroke (2.36%), myocardial infarction (1.68%), and death (3.05%) were higher in patients with the mixed atherothrombotic and cardioembolic etiology than in the remaining patients. Male gender, age >35 years, stroke at entry, and cardiac diseases were independent predictors of the composite outcome event at the Cox regression analysis, whereas only stroke at entry and cardiac diseases predicted death from all causes. CONCLUSIONS: Stroke and TIA in young adults have severe prognostic implications, because the mortality risk was highly increased with respect to the general population. Preventive measures are strongly recommended in the presence of any unfavorable prognostic profile.

Adolescent↗

PubMed1998

Evaluation of potential factors affecting the measurement of cerebrovascular reactivity by near-infrared spectroscopy.

1.Near-infrared (IR) spectroscopy is based on the relative transparency of skin, skull and brain to the light in the near-IR region (700-1100 nm) and on the oxygen-dependent tissue absorption changes of haemoglobin.2. We evaluated the most relevant factors (reproducibility, venous return, age and sex) that might affect reliability of near-IR spectroscopy to test CO2 cerebrovascular reactivity.3.Thirty-four healthy volunteers were enrolled in the study. The protocol consisted of a 3-min baseline, a 3-min hypercapnia (5% CO2 in air) and a 2-min recovery. Transcranial Doppler sonography measurements were simultaneously performed. The CO2 reactivity test was repeated on 27 subjects after 1 h to assess reproducibility. CO2 reactivity was also evaluated at different body positions (supine, 35 degrees Trendelenburg and 35 degrees reverse Trendelenburg), and over a gradual increase of the inspired CO2.4. Changes in near-IR spectroscopy and transcranial Doppler sonography parameters were significantly correlated with variations of end-tidal CO2 (P<0.005). A significant correlation between the reactivity indexes of near-IR spectroscopy parameters and flow velocity was also found (P<0.01). A high reproducibility was also found for deoxyhaemoglobin (rI=0.76), oxyhaemoglobin (rI=0.68) and flow velocity (rI=0.60) reactivity indexes. No significant differences between the reactivity indexes of different body positions were found (P>0.05). The reactivity index of oxyhaemoglobin and deoxyhaemoglobin decreased (P<0.05) and increased (P<0.01) with age respectively.5. We found that near-IR spectroscopy is a reliable and reproducible method for the evaluation of cerebrovascular reactivity and might be considered, after appropriate validation, for the assessment of patients with cerebrovascular disease.

Adolescent↗

PubMed1997

Cerebrovascular reactivity in migraine during headache-free intervals.

Alterations of intracranial vessel tone have been implicated in the pathophysiology of migraine. The cerebrovascular reactivity was measured by means of transcranial Doppler in 60 migraine patients with (n = 30) or without aura (n = 30) during the headache-free interval and in 30 healthy controls. The vasomotor response was evaluated during hypercapnia induced by inhalation of a mixture of CO2 5% and O2 95% and during hypocapnia obtained after voluntary hyperventilation. To improve the power of the study in detecting possible abnormalities of cerebrovascular reactivity, two different measures were performed at 1 week intervals in migraine patients and controls. Reactivity index values during CO2 inhalation were significantly different (p = 0.01) among the three groups during the first and second measurements; in particular, lower values were found in patients suffering from migraine without aura with respect to controls (p < 0.05, Scheffé's test). Values of reactivity index obtained following induction of hypocapnia did not differ between migraine patients and controls (all p values > 0.05). Our data suggest a reduced vasodilatory response to hypercapnia of cerebral arterioles in patients suffering from migraine without aura with respect to controls that might be related to baseline arteriolar vasodilation.

Adult↗

PubMed1993

Platelet changes in classic migraine.

We investigated some ultrastructural aspects of platelet activity in patients with classic migraine during an attack-free period. We focused on the production of malondialdehyde (MDA), the intracellular concentration of Ca++ and the membrane phospholipid structure using a DPH (1,6 diphenyl-1,3,5 hexatriene) fluorescent probe. Our study comprised 20 patients with classic migraine and 5 healthy controls, from whom 10 cc samples of blood were collected in test tubes containing sodium citrate (1/9 cc). We found no significant differences in MDA production between migraineurs and controls either before or after stimulation with thrombin. The same applies to the concentration of intracellular Ca++ (Ca++i). The membrane lipid composition assessed by DPH fluorescent probe was normal both in migraineurs and in controls. Our findings suggest no intrinsic activation of platelet aggregation.

Adolescent↗

PubMed1993

Transcranial Doppler evaluation of cerebral blood flow in patients with paroxysmal atrial fibrillation.

Cerebral blood flow was measured by transcranial Doppler sonography (TCD) in 15 patients during and after an attack of paroxysmal atrial fibrillation. During the attack the mean flow velocity (MFV) was reduced significantly in the middle cerebral artery (p < 0.05) and nonsignificantly in the other arteries. The pulsatility index (PI) was reduced in all the arteries but not significantly. During the fibrillation phase the MFV and PI tended to decrease as the heart rate increased. None of the patients showed clinical signs of cerebral ischemia during the attacks. The absence of such signs despite the reduced cerebral blood flow in atrial fibrillation is probably due to the activation of mechanisms of autoregulation.

Atrial Fibrillation↗

PubMed1992

Reproducibility of transcranial Dopplersonography: a validation study.

Transcranial Doppler-sonography (TCD) is a useful noninvasive technique for the measurement of intracranial arterial blood flow velocity. The present study evaluated the reproducibility of this method for repeated measurements of flow velocity in the anterior, middle and posterior cerebral, and basilar arteries. Thirty-six patients (23 males and 13 females) were studied. Three measurements were made by the same examiner on each patient with a time interval of 1 h between the first and the second examination, and about 24 h between the first and the third examination. The statistical evaluation for the reproducibility was performed by calculating the correlation coefficient (r). The results showed good reproducibility of TCD for all arteries both between the first and second and between the first and third measurements (r = 0.78-0.97; p less than 0.001), but when the middle cerebral artery mean velocity is low the posterior cerebral artery reproducibility is poorest (r = 0.42-0.54).

Blood Flow Velocity↗

PubMed1992

Cerebral blood flow in migraine with aura: a transcranial Doppler sonography study.

Transcranial Doppler sonography examination was performed on 44 patients with migraine with aura and 88 controls. All patients were investigated in headache-free periods and 10 of them also during a migraine attack. During the headache-free period a not significant increase of mean flow velocity in patients compared to controls was obtained. The pulsatility index (PI) mean values were also higher in patients than in controls and the differences were significant in the MCA (p < 0.05). No difference between right and left side was observed. During the attack the mean flow velocity (MFV) decreased in all arteries but the decrease was significant only in MCA and ACA (p < 0.05). The mean PI increased in all arteries but not significantly. These variations were observed both on the headache and contralateral side. Nevertheless, the MFV decrease in all arteries was observed in four patients only. In four patients the MFV decrease was found in the anterior arteries and the MFV increase in the posterior arteries, while in two patients the MFV increase was observed both in the anterior and posterior arteries. The correlation between the variations of MFV values during the attacks and the time interval from the onset of attacks showed that the PCA and BA flow velocities were increased in patients examined between 0.5 and 3 hours, while an increase in MCA and ACA flow velocities were observed only in patients examined after 1.5 hours.

Adult↗

PubMed1990

[Changes in headache with age: symptomology and clinical features].

The clinical features of 76 patients 5 to 14 years old suffering from primary headaches has been compared with those of 495 adults in the same diagnostic group. An association between migraine without aura and female sex was evident in both age groups, while an inversion of the usual M/F ratio was found in the younger group with other types of headache. Childhood headache attacks resulted to be less frequent, less severe and with a shorter duration than in adult patients. Also accompanying symptoms were less common in children than in adults. Furthermore pain was more often unilateral but less frequently pulsating in the younger group. These results point out the need for a different approach to childhood headaches.

Adolescent↗

PubMedDate not supplied

Determination of superoxide dismutase-like activity in some divalent metal saccharinates.

The superoxide-dismutase-like activity of a series of divalent metal saccharinates of general stoichiometry [MII(Sac)2(H2O)4].2H2O (with MII = Mn,Fe,Co,Ni,Cu,Zn) has been investigated using the nitroblue tetrazolium O2- reduction assay. The results show that all these complexes possess the capability to dismutate the superoxide anion generated in the xanthine/xanthine oxidase system. Interestingly, the greatest activity is shown by the corresponding copper complex. The results are discussed and compared with those obtained for native superoxide dismutase, which was tested under the same experimental conditions.

Cations, Divalent↗

PubMedDate not supplied

Sumatriptan and cerebral blood flow velocity changes during migraine attacks.

Transcranial Doppler studies on the effects of sumatriptan on cerebral hemodynamics have shown conflicting results. We evaluated blood flow velocity changes in 21 patients suffering from migraine with (n = 4) or without aura (n = 17) during a spontaneous attack, before and after treatment with sumatriptan. Flow velocity in the internal and external carotid, middle cerebral, and basilar arteries was measured by means of transcranial Doppler. During the attack, measurements were taken before subcutaneous sumatriptan injection, then after 30 minutes, 2 hours, and 24 hours. An additional measurement was taken 1 week later, in a headache-free state. We found a significant reduction of flow velocity during the attack in the middle cerebral artery on both sides (P < 0.05). After sumatriptan administration, flow velocity increased in the internal carotid artery on both sides (P < 0.05) and in the middle cerebral artery on the headache side (P = 0.0001), but not in the external carotid and basilar arteries (P > 0.05). Flow velocity changes may reflect the vasodilation present at the onset of the migraine attack followed by vasoconstriction in the internal carotid and middle cerebral arteries after sumatriptan treatment. Since vasoconstriction occurs in responders and nonresponders to treatment, it is unlikely to be the primary mechanism by which sumatriptan relieves headache.

Adolescent↗

PubMedDate not supplied

Cerebrovascular reactivity evaluated by transcranial Doppler: reproducibility of different methods.

Transcranial Doppler is routinely used to assess the cerebrovascular reactivity, despite scarce information on its reproducibility. We evaluated the reproducibility of cerebrovascular reactivity measurements by this method utilizing different vasodilatory and vasoconstrictor stimuli. The cerebrovascular reactivity was measured in 45 healthy volunteers during hypercapnia induced by inhalation of a mixture of 5% CO2 and 95% O2, breath holding and rebreathing, and during hypocapnia induced by voluntary hyperventilation. Three sets of measurements were performed at times 0, 1, and 24 h to assess the within-observer short- and long-term reproducibility. The reproducibility was analyzed using the intraclass correlation coefficient. For the CO2 inhalation method, a good short-term (rI = 0.55; 95% CI = 0.39-0.68) and a good long-term (rI = 0.43; 95% CI = 0.25-0.59) reproducibility was found. For the breath-holding method a good short-term agreement was found (rI = 0.41; 95% CI = 0.22-0. 57), while the long-term reproducibility was poor (rI = 0.17; 95% CI = -0.03-0.36). Rebreathing showed a fair (rI = 0.31; 95% CI = 0.11-0. 48) short-term and a poor (rI = 0.17; 95% CI = -0.03-0.36) long-term reproducibility. For voluntary hyperventilation, the short-term reproducibility was good (rI = 0.53; 95% CI = 0.36-0.66), and the long- term reproducibility was fair (rI = 0.31; 95% CI = 0.11-0.48). In our study, CO2 inhalation and voluntary hyperventilation had the highest reproducibility and should be preferred when assessing cerebral vasoreactivity, especially in follow-up studies.

Adult↗

PubMedDate not supplied

Effects of interferon beta, cyclophosphamide and azathioprine on cytokine profile in patients with multiple sclerosis.

We assessed the in vitro effects of interferon beta-1b (IFNbeta-1b), cyclophosphamide (CY), and azathioprine (AZA) alone and of the combination of IFNbeta-1b with CY or AZA on the production of Th1 and Th2 cytokines in 10 patients with multiple sclerosis. Cytokine levels were determined at baseline and after stimulation with IFNbeta-1b, CY, and AZA alone or with the combination of IFNbeta-1b with CY or AZA. The combination of IFNbeta-1b with CY resulted in a statistically significant decrease in the production of interleukin-2 (IL-2) (P=0.003) and tumor necrosis factor alpha (TNF-alpha) (P=0.03). An additive effect on the production of interferon gamma (IFN-gamma) (P=0.2) and interleukin-10 (IL-10) (P=0.6), and a positive interaction on the production of interleukin-4 (IL-4) (P=0.08) were observed although the findings were not statistically significant. The combination of IFNbeta-1b with AZA resulted in a significant negative effect on the production of IL-2 (P=0.006), whereas TNF-alpha (P=0.02), IFN-gamma (P=0.03), IL-4 (P=0.2), and IL-10 (P=0.3) were not statistically impacted. Our data show that CY was able to improve the effects of IFNbeta-1b on the ratio of Th1/Th2 cytokines.

Adult↗

PubMedDate not supplied

Echocontrast agents in neurosonology.

Temporal hyperostosis is the major limitation of transtemporal insonation of the basal cerebral arteries in transcranial Doppler sonography. New contrast agents capable of traversing the pulmonary bed offer new prospects for overcoming this limitation. Echocontrast agents improve the diagnostic potentiality of ultrasound techniques, increasing the diagnostic accuracy of these methods in cerebrovascular diseases, vascular malformations, venous pathologies and tumors, and may contribute to reducing the need for more invasive and expensive examinations.

Cerebral Arteries↗