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Biomedical subjects

S Musumeci

Publications and source records attributed to S Musumeci.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Accuracy of exercise testing in the assessment of the severity of myocardial ischemia as determined by means of technetium-99m tetrofosmin SPECT scintigraphy.

BACKGROUND: The separation of patients with suspected or known coronary artery disease into low- and high-risk subgroups by means of noninvasive testing is highly relevant in the selection of patients who require further diagnostic or therapeutic investigation. We evaluated whether exercise electrocardiographic variables during exercise testing might be a means of predicting the severity of myocardial ischemia as assessed with myocardial scintigraphy. METHODS AND RESULTS: We retrospectively reviewed 816 consecutive patients (mean age, 57+/-10 years) who underwent exercise technetium-99m tetrofosmin single photon emission computed tomography (SPECT) for the assessment of suspected or known coronary artery disease. Eight independent significant predictors of the extent and severity of reversible perfusion defects (ischemic perfusion score), which when integrated in a diagnostic algorithm satisfactorily discriminated patients with no reversible perfusion defects (sensitivity, 75%; specificity, 80%) and patients with severe impaired myocardial perfusion (> or =11 ischemic perfusion score; sensitivity, 77%; specificity, 82%), were identified by means of stepwise discriminant analysis. However, patients with mildly to moderately impaired myocardial perfusion (> or =21 but <11 ischemic perfusion score) were poorly discriminated (sensitivity, 50%; specificity, 78%). The set of variables that were significant (P<.0001) for prediction included sex, myocardial infarction, exercise angina, the maximal amount of ST segment depression, rate-pressure product threshold criteria, slope of ST segment depression, ST/heart rate index, and peak exercise heart rate. CONCLUSIONS: The results of the use of clinical and electrocardiographic exercise variables satisfactorily agrees with the results from scintigraphy only for patients with no reversible perfusion defects and with severely impaired myocardial perfusion. However, it fails as an approach with universal applicability.

Algorithms↗
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[Early relapse of herpes simplex encephalitis. Clinical and therapeutic implications].

A case of Herpes simplex virus encephalitis (HSVE) is reported in a 5 year old boy, who relapsed twice during the acute phase of the disease. The second relapse was completely cured by increasing the daily treatment with acyclovir to a dosage of 60 mg/kg intravenously for two weeks and 30 mg/kg by mouth for a further week. The full disappearance of the symptoms and the regression of cerebral lesions could be correlated to a prompt diagnosis and to the dosage of acyclovir employed, higher than that suggested for diseases caused that was by other members of the Herpes virus family.

Brain↗
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Bone marrow hypoplasia associated with acute viral hepatitis in four children.

Four cases of children, aged 2 to 11 years, with acute viral hepatitis and bone marrow hypoplasia are reported. Three patients presented only jaundice and hepatomegaly; one also had liver failure. All the four patients underwent bone marrow aspiration which showed bone marrow aplasia. In two of the four patients a liver biopsy revealed patchy necrosis with inflammatory mononuclear cell infiltrate. Half of the patients received a bone marrow transplantation; the remaining patients were treated by intravenous infusion of immunoglobulins, growth factors and steroids. The main epidemiological and etiological features of such association are also reported.

Biopsy↗
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Effectiveness of forced rehydration and early re-feeding in the treatment of acute diarrhoea in a tropical area.

BACKGROUND: The administration of oral re-hydration solution (ORS) via continuous infusion through a nasogastric (NG) tube and early refeeding facilitates delivery in hospitalised children and the return back home. METHODS DESIGN: the observation was made during a one-year stage in the Camillian Medical Centre (CMC) of Ouagadougou in Burkina Faso. 4,131 infants and children under 5 years old, affected by acute diarrhoea and severe dehydration (loss of weight > 10%) were studied. Those children having difficulties for oral re-hydration were hydrated by continuous infusion through naso-gastric (NG) tube; the NG tube was put in by the nurses and connected to a 500 ml bottle, in which a mixture of glucose and electrolytes was dissolved according to the formula (glucose 20 g + NaCl 3.5 g + NaHCO3 2.5 g KCl 1.5 g in 1 litre of water). The infusion rate was 20-30 drops/minute. No sedative or anti-emetic drug was given, unless in the presence of uncontrolled vomiting. At the end of infusion, flour of millet (60%), soy bean (20%), peanut butter (10%), sugar (10%) and salt (1%) was administered and continued at home or in the nearby areas available for the night. RESULTS: After 4-5 hrs of infusion 3,717 children (90%) showed a significant gain of weight, although the weight prior to the acute event preceding hospitalisation was never reached during their stay at the CMC. Only 413 children (10%) required a longer period of forced infusion: at the end of the day, however, they were fed with this flour. CONCLUSIONS: A simple strategy, based on a NG infusion plus an oral administration of flour has proven safe and effective in encompassing those difficulties encountered in the treatment and prevention of dehydration in developing countries where the therapy, in children affected by diarrhoea, still represents a major daily occupation.

Acute Disease↗
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[Chickenpox and Schönlein-Henoch purpura: a report of a case with nephropathy].

Authors describe a child affected by chickenpox, Schönlein-Henoch purpura and nephropathy. The ecchymotic lesions were diffused in buttocks and legs and they were associated with vesicular haemorrhagic injury in the back of hands and in pavilions of the ears. They suggest that varicella-zoster virus can play a "trigger" role in etiopathogenesis of Schönlein-Henoch purpura and that this syndrome worsens the renal failure. Steroids don't improve the renal disease in the acute phase but they seem to reduce the relapses.

Chickenpox↗
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[Proline hydroxylase (hPH) as marker of hepatic fibrosis in beta thalassemia].

Forty-four polytransfused thalassemic patients were considered to evaluate hPH enzyme, involved in collagen synthesis. The aim of this investigation was to verify the usefulness of such assay in the follow-up of liver damage in thalassaemic patients. The patients were separated into two groups: one group with normal transaminase activity and another one with pathological values from more than two years. A group of 20 healty children was chosen for the control values of enzymatic activity. In all patients HCV-Ab was determined. Results obtained confirm the role of viral liver infection in inducing fibrosis in polytransfused thalassaemic patients and suggest the possibility to use hPH assay in their follow-up.

Adolescent↗
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[Syndromal paucity of the interlobular bile ducts (Alagille's syndrome). A report of 2 Sicilian siblings].

The authors describe a sister and brother [correction of two brothers] affected by syndromic paucity of interlobular bile ducts in which a marked heterogeneity in the beginning of symptoms puts serious difficulties in differential diagnosis. The evident similarity to the mother and the presence of hypertelorism support the hypothesis of a genetic inherited autosomal dominant disorder at variable penetration and expressivity.

Alagille Syndrome↗
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[Operator exposure levels in nuclear medicine studies].

In diagnostic examinations performed in nuclear medicine, radio-isotopes with a relatively short half-life are used, the quantity varying according to the type of examination. After administration of the labelled substance, the patient becomes a large source of ionizing radiations. During the course of a scintigraphic examination, the operator is obliged to go near the couch to assist the patient in the positions and will therefore inevitably be in this radiation field. The paper reports the radio-activity levels recorded at gonad and eye levels of the operator in positions most frequently held during the course of the most commonly performed scintigraphic examinations using a G.E. STARCAM 500 A gamma-camera.

Gamma Cameras↗
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[Guillain-Barré syndrome in childhood: epidemiology and clinical aspects].

From 1980 to 1988, 25 cases of S.G.B. were diagnosed in children of ages between 2 and 12 years old at the Pediatric Clinic of Catania University. No seasonal or sexual prevalence was observed and only 5 children were less than 5 years old at the beginning of the disease. The diagnosis was based on 2 principal points: 1) pain at the inferior limbs with motor, sensitive and autonomous disturbances; 2) an increase of the globulins in the cerebrospinal liquid without a quantitative variation of the cells. The disease had a medium length of duration of 20 to 30 days; only in 2 children respiratory assistance was necessary, because of an ascending paresis, which included the respiratory muscles, while in 2 other aged 11 and 12 years old the disease presented itself as being diphasic with a short intermittent intervals, which made us think of a complete remission. In one of these 2 patients, the disease manifested itself in an unusual manner, hitting initially the muscles of the upper limbs, the III cranial nerve and with marked cephalgia. The E.M.G. taken on 7 children presented itself as being frankly neuropathic.

Age Factors↗
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[Ogilvie's syndrome].

Ogilvie's Syndrome is defined as acute distension of the colon without any mechanical obstruction. We reported two new cases who underwent surgical treatment and the revision of the literature. Four hundred eight-six cases are described until now. The physiopathology is unknown. The diagnosis is done with abdominal x-ray, barium enema must be used with attention. The more frequent symptoms are nausea, vomiting, diarrhea, and abdominal pain. The perforation of the colon is possible with a diameter of 9-12 cm. The mortality was 11.3% in two hundred ninety patients (59.6%) who underwent conservative treatment. In one hundred ninety-six patients who underwent surgical treatment the mortality was 28.5%. The treatment is conservative, medical or endoscopic. The best surgical treatment is the tube cecostomy.

Aged↗
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[Reye's syndrome: reports of 7 cases in the period 1982-1987].

Reye's syndrome is an acute non-inflammatory encephalopathy with fatty degeneration of inner organs. The disease seems to be the metabolic response to a generalized mitochondrial insult. From 1982 to 1987, we studied 7 patients, age range being 2 months to 12 years, affected by R.S. None of them had taken salicylic acid before; three of them had been treated with acetaminophen. Two out of the seven patients examined had serious neurologic problems; other two recovered completely both under clinical and histological aspects, as it is shown by the hepatic biopsy done before and after the disease, and the remaining three died. We have tried to demonstrate the importance of hepatic biopsy in the diagnosis of R.S. and in the verification of the reversibility of the histological phenomenon. Hepatic biopsy demonstrated that the disease stopped at the initial stage, limited itself and evolved towards a complete recovery.

Biopsy↗
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[Hepatic pathology in beta-thalassemia major].

Liver function has been evaluated in 74 patients (aged 9 months to 19 years) with beta-thalassemia major. They were selected from 212 patients because their transaminase levels were three times higher than normal for over three months. In 36 of these subjects BSF clearance test was performed. In the majority of patients (70%) average GPT serum values were increased (66.33 +/- 35.41 U/L) while only a few of the youngest age group exhibited normal values. The transaminase level showed a direct relationship with age, ferritin level and transfusional iron. Furthermore a direct correlation was found between iron and gamma globulin levels both being related to age. Test for viral hepatitis markers showed that 60% of all the subjects studied had had HBV infection. Twenty-six of the 36 patients who underwent BSF test had normal values in the first part of the clearance curve, 8 others showed moderate changes while only the 2 remaining revealed severe alterations. The second part of the curve was abnormal in 34 and markedly altered in 2 subjects. Mean GPT serum values correlated with the first part of BSF clearance curve and BSF 45' values correlated with transfused iron. Siderosis, fibrosis, chronic inflammatory infiltration and vacuolar degeneration were seen at liver biopsy. Histological findings of chronic aggressive hepatitis were shown in two patients with high transaminase and gammaglobulin levels who had markedly abnormal BSF curve.

Adolescent↗
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[Neonatal cholestasis : clinical and diagnostic setting].

A retrospective study of 112 infants admitted at Pediatric Clinic of Catania from 1970 to 1985 with diagnosis of "Cholestatic jaundice" shows two prevalent pathologies: neonatal hepatitis and biliary atresia. Some other disease like cystic fibrosis. Hereditary fructose intolerance, Galactosaemia, Paucity of bile duct were found rarely. Some laboratory parameters (Serum direct bilirubin, Alkaline Phosphatase, Alkaline Phosphatase/Transaminase (GOT) show a characteristic pattern. Therefore the analysis of these data could help us to make a probability diagnosis and anticipate the liver biopsy that remain the most sensitive diagnostic instrument. In fact it is known that the earlier diagnosis is very important for the prognosis of these infants.

Biliary Atresia↗