Tuberculosis of the prostate.
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Diagnosis, Differential↗
Biomedical subjects
S Natale
Publications and source records attributed to S Natale.
Review article: the treatment of fatty liver disease associated with the metabolic syndrome.
The treatment of non-alcoholic fatty liver disease may be worthwhile to prevent progression to advanced liver failure, but no therapy is definitely evidence-based. Weight loss or lifestyle modifications remain the primary line of intervention, particularly in overweight or obese subjects. In adult non-alcoholic fatty liver disease, they are effective in the short-term, but require a multidisciplinary team approach that is rarely available in liver units. Insulin-sensitizing agents are probably the treatment of choice. They definitely reduce the insulin resistance that promotes steatosis. Several uncontrolled and controlled studies have documented an improvement in liver biochemistry and in histology, but the long-term results remain unsettled. This is an area where significant advances are expected in the next few years.
Adult↗
Ten years' experience of retrograde balloon dilatation of pelvi-ureteric junction obstruction.
OBJECTIVE: To analyse the long-term success of retrograde balloon dilatation (RBD) of pelvi-ureteric junction obstruction (PUJO). PATIENTS AND METHODS: The records of 58 adult patients (mean age 48 years, range 18-94) who had RBD between 1990 and 2001 were reviewed retrospectively. All symptomatic patients were included and assessed by dynamic renography. Success was judged as a symptomatic and/or functional improvement. Recurrence of symptoms was recorded and any evidence of deterioration of function despite improved symptoms. Complications were also recorded. RESULTS: In all, 44 (76%) patients were asymptomatic after RBD. There was no relationship between symptomatic change and renographic improvement; some patients who were rendered pain-free had either no improvement or even deterioration in their split renal function. Conversely, some patients who had a demonstrable improvement in their renal function continued to be symptomatic. However, a long-term follow-up (mean 6.1 years) of nine patients who were symptomatically improved showed good maintenance of split renal function. CONCLUSION: RBD is an effective treatment for PUJO and its success is maintained in the long term.
Adolescent↗
WHO and ATPIII proposals for the definition of the metabolic syndrome in patients with Type 2 diabetes.
AIMS: Different criteria have been proposed by the World Health Organization (WHO) and by the Third Report of the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) for the diagnosis of the metabolic syndrome. Its identification is of particular importance for coronary risk assessment. METHODS: The prevalence of the metabolic syndrome was determined according to the two different proposals in 1569 consecutive subjects with Type 2 diabetes. RESULTS: By the WHO proposal, 81% of cases (95% confidence interval, 79-83) were labelled as metabolic syndrome. Microalbuminuria had the highest specificity (99%) and visceral obesity the highest sensitivity (93%). Seventy-eight per cent of patients (95% CI, 76-80) fulfilled the ATPIII criteria for metabolic syndrome, low HDL-cholesterol having the highest specificity (95%), elevated blood pressure having the highest sensitivity. According to both proposals, 1113 patients were positive; 183 were concordantly negative, indicative of a fairly good agreement (k statistics, 0.464). Subjects only positive for the WHO proposal were more frequently males, had a lower BMI and a higher arterial pressure. Only subjects identified by the ATPIII proposal had a significantly higher prevalence of previously detected coronary heart disease. CONCLUSIONS: Minimum criteria for the metabolic syndrome are met in most patients with Type 2 diabetes. Correct identification of the syndrome is important for an integrated approach to reduce the high costs and the associated disabilities. The ATPIII proposal more clearly identifies the burden of coronary heart disease associated with the metabolic syndrome.
Aged↗
Cognitive behavioural therapy for obesity: one-year follow-up in a clinical setting.
Cognitive behavioural therapy (CBT) is the most comprehensive means of medically treating obesity, but only few data have so far been published concerning its long-term effectiveness. We here report our experience of 1068 consecutive patients (868 females) treated with CBT at a university-based obesity centre. The patients were enrolled into three different programmes: a 14-week LEARN programme (672 patients), a 16-week MOB programme for the morbidly obese (259 patients), or a 20-week BINGE programme for subjects affected by binge eating (137 patients). Eighty-five percent of the subjects completed the weekly programmes. The percentage of patients attending the scheduled control visits during the 1-year follow-up gradually decreased, being very low in the BINGE group (10%). The percentage weight loss was an average of 6% during the weekly courses, being higher in the MOB programme; by the end of the weekly sessions, it exceeded 10% of initial body weight in 22% of cases and increased to 36% during the follow-up. The cumulative probability of follow-up was higher among the patients undergoing the MOB and LEARN programmes than among the BINGE patients (p < 0.0001), and decreased with the increasing severity of obesity. Female gender and a weight loss of > 10% i.b.w. increased compliance to follow-up. The study further demonstrates the difficulty of achieving compliance to chronic management of obesity and the critical role of binge eating disorder in the medium-term treatment of obesity. Strategies are needed to improve adherence to a follow-up protocol.
Adaptation, Psychological↗
Psychiatric distress and health-related quality of life in obesity.
UNLABELLED: Health-related quality of life (HRQL) is poor in obese patients and not necessarily related to the severity of disease. In a large proportion of patients psychopathological distress is also present and its role on poor HRQL has never been quantified. METHODS: In 207 patients entering a University-based weight-reducing programme (38 males, 169 females), a package of self-administered questionnaires was submitted to measure HRQL (Short-Form 36) and psychopathological distress [general: Symptom Check-List 90 (SCL-90); depression: Beck Depression Inventory (BDI); binge eating: Binge Eating Scale (BES)]. Several clinical and anthropometric data were also recorded. RESULTS: HRQL, both in its physical and mental component, was significantly reduced in obesity when related to Italian population norms. SCL-90 identified psychopathological distress in 53 patients (26%), the BDI was indicative of depression in 89 cases (43%), whereas high scores of the BES were measured in 88 cases. Logistic regression analysis identified psichopathological distress as the major factor associated with poor HRQL. CONCLUSIONS: Psychiatric disturbances significantly contribute to poorly perceived health status. Only a comprehensive treatment including a specific approach to psychiatric symptoms may be effective in improving the perceived health status of obese patients seeking treatment.
Adult↗
WHO and ADA criteria for the diagnosis of diabetes mellitus in relation to body mass index. Insulin sensitivity and secretion in resulting subcategories of glucose tolerance.
OBJECTIVE: To determine the influence of body mass index (BMI) on agreement between the American Diabetes Association (ADA) and the new World Health Organization diagnostic criteria for the diagnosis of diabetes mellitus and to investigate the metabolic profile of the resulting subcategories. DESIGN: Cross-sectional study SUBJECTS: A total of 3018 subjects with no previous history of diabetes and fasting glucose <7.8 mmol/l, with a wide range of BMIs. MEASUREMENTS: (1) Prevalence of impaired glucose regulation (IGR) and diabetes (DM) according to ADA and WHO diagnostic criteria; (2) basal and post-load insulin sensitivity and secretion, calculated on the basis of data derived from an oral glucose tolerance test (OGTT). RESULTS: The diagnosis according to the two classifications was concordant in 2490 subjects, discordant in 528 (452 were identified as impaired glucose tolerance (IGT) and 76 as DM only by means of OGTT). The disagreement increased with increasing BMI, being as high as 25.3% in subjects with BMI > or = 35 kg/m(2). Subjects with isolated fasting hyperglycaemia were mainly characterised by reduced insulin sensitivity and secretion in the basal state, but normal first-phase insulin secretion and moderately reduced insulin sensitivity after glucose challenge. Subjects with isolated 2 h hyperglycaemia were mainly characterised by normal basal insulin secretion and by a marked insulin resistance associated with a blunted first-phase insulin secretion after the glucose load. CONCLUSIONS: The disagreement between ADA and WHO classifications is particularly relevant in obesity, making OGTT mandatory in these subjects. Different pathogenic mechanisms are involved in isolated fasting or post-load hyperglycaemia, possibly related to a different site of insulin resistance (hepatic vs peripheral), and/or to a different disregulation of insulin secretion (basal vs post-load). A correct identification of the underlying mechanism(s) is the rationale for future studies to detect the effectiveness of different pharmacological or behavioural approaches.
Adolescent↗
Effects of cognitive-behavioural therapy on health-related quality of life in obese subjects with and without binge eating disorder.
OBJECTIVE: To measure the effects of cognitive-behavioural therapy on health-related quality of life (HRQL) in obese patients, in relation to binge eating disorder. DESIGN: Longitudinal, clinical intervention study consisting of structured sessions of cognitive-behavioural therapy, preceded by sessions chaired by a psychologist in subjects with binge eating. SUBJECTS: Two groups of obese patients (92 treated by cognitive-behavioural therapy (77 females); 76 untreated controls (67 female), selected from the waiting list (control group)). Of 92 treated patients, 46 had a binge eating disorder at psychometric testing and structured clinical interview. MEASUREMENTS: Health-related quality of life by means of Short-Form 36 questionnaire at baseline and after 3-5 months. RESULTS: Cognitive-behavioural treatment produced an average weight loss of 9.4+/-7.5 kg, corresponding to a BMI reduction of 3.48+/-2.70 kg/m(2). No changes were observed in the control group. All scales of HRQL improved in treated subjects (by 5-19%). In obese subjects with binge eating weight loss was lower in comparison to non-bingers (7.7+/-8.1 vs 11.1+/-6.6; P=0.034). However, the improvement in HRQL was on average larger, and significantly so for Role Limitation-Physical (P=0.006), Role Limitation-Emotional (P=0.002), Vitality (P=0.003), Mental Health (P=0.032) and Social Functioning (P=0.034). Bodily Pain was the sole scale whose changes paralleled changes in body weight. CONCLUSIONS: The positive effects of cognitive-behavioural therapy, mainly in subjects with binge eating, largely outweigh the effects on body weight, resulting in a significant change in self-perceived health status.
Adolescent↗
Peyronie's disease-the Plymouth experience of extracorporeal shockwave treatment.
OBJECTIVE: To describe our experience of the use of extracorporeal shockwave treatment (EST) for Peyronie's disease. Patients and methods The study included 28 patients (mean age 57 years, range 34-72) with stable Peyronie's disease who were treated with 3.9 (3-5) sessions of EST to the Peyronie's plaque. The patients' erectile function, pain and penile angle were assessed before and after treatment with EST. RESULTS: Of the 28 patients, 20 felt that their erection improved after the procedure; 11 patients were able to recommence sexual intercourse and the index of erectile function increased in all but one patient. Conclusion EST produces a significant improvement in pain and penile angle, with no serious complications.
Adult↗
Systemic prostaglandin E1 infusion and hepatic aminonitrogen to urea nitrogen conversion in patients with type 2 diabetes in poor metabolic control.
Amino acid catabolism and urea synthesis are increased in type 2 diabetes mellitus in poor metabolic control. In different catabolic conditions, prostaglandins (PGs) of the E series produced metabolic effects on nitrogen metabolism, decreasing urea formation. In 10 patients with type 2 diabetes in poor metabolic control, urea synthesis and amino acid to urea nitrogen exchange were measured in the basal state and during an alanine load (6 hours) with 2-hour superinfusion of a PGE1 analog (30 microg/h) or saline in random order. The urea synthesis rate was calculated as the sum of urinary urea excretion and urea accumulation in total body water (TBW); total nitrogen exchange was calculated as the difference between infused amino acid-nitrogen and urea appearance. Plasma alpha-aminonitrogen (alpha-amino-N) increased 100% in response to alanine, to a steady-state without differences in relation to PG superinfusion. The urea synthesis rate (mean +/- SD) was 34.0 +/- 11.4 mmol/h in the basal period and increased to 161.2 +/- 37.0 during alanine + saline and to 113.5 +/- 34.6 during alanine + PG (P < .001). Nitrogen exchange was negative at baseline (-25.0 +/- 9.0 mmol/h). It became moderately positive during alanine + saline (14.6 +/- 25.1) and far more positive during alanine + PG (53.5 +/- 21.4), with the difference due to reduced urea formation. The metabolic effects of PG were not related to differences in insulin and glucagon. We conclude that PGE1 slows the high rate of hepatic urea-N synthesis in poorly controlled type 2 diabetes. Such metabolic effects have therapeutic implications.
Aged↗
Nonalcoholic fatty liver disease: a feature of the metabolic syndrome.
Insulin sensitivity (euglycemic clamp, insulin infusion rate: 40 mU. m(-2). min(-1)) was studied in 30 subjects with biopsy-proven nonalcoholic fatty liver disease (NAFLD), normal glucose tolerance, and a BMI <30 kg/m(2). Of those 30 subjects, 9 had pure fatty liver and 21 had evidence of steatohepatitis. In addition, 10 patients with type 2 diabetes under good metabolic control and 10 healthy subjects were studied. Most NAFLD patients had central fat accumulation, increased triglycerides and uric acid, and low HDL cholesterol, irrespective of BMI. Glucose disposal during the clamp was reduced by nearly 50% in NAFLD patients, as well as in patients with normal body weight, to an extent similar to that of the type 2 diabetic patients. Basal free fatty acids were increased, whereas insulin-mediated suppression of lipolysis was less effective (-69% in NAFLD vs. -84% in control subjects; P = 0.003). Postabsorptive hepatic glucose production (HGP), measured by [6,6-(2)H(2)]glucose, was normal. In response to insulin infusion, HGP decreased by only 63% of basal in NAFLD vs. 84% in control subjects (P = 0.002). Compared with type 2 diabetic patients, NAFLD patients were characterized by lower basal HGP, but with similarly reduced insulin-mediated suppression of HGP. There was laboratory evidence of iron overload in many NAFLD patients, but clinical, histological, and biochemical data (including insulin sensitivity) were not correlated with iron status. Four subjects were heterozygous for mutation His63Asp of the HFE gene of familiar hemochromatosis. We concluded that NAFLD, in the presence of normoglycemia and normal or moderately increased body weight, is characterized by clinical and laboratory data similar to those found in diabetes and obesity. NAFLD may be considered an additional feature of the metabolic syndrome, with specific hepatic insulin resistance.
Adult↗
Health-related quality of life in obesity: the role of eating behaviour.
A poor health-related quality of life (HRQL) has been repeatedly documented in obesity. Overweight per se and associated diseases affect physical fitness, whereas mental well-being depends on social, cultural and behavioural components. Very few studies are available on HRQL in obese persons in relation to eating behaviour. We measured HRQL by means of Short-Form-36 questionnaire in 183 obese subjects, seeking specific treatment at a University-based weight management center. Only half had a Body Mass Index exceeding 35 kg/m2. Data were compared to age- and gender-adjusted normative values of the Italian population (2031 subjects). The Binge Eating Scale (BES) and the Three-Factor Eating Questionnaire (TFEQ) were used to assess eating behaviour. Most domains of HRQL were impaired in obese subjects, more severely in younger subjects and in females. The severity of overweight progressively affected physical fitness, but had a minor effect on mental status. In over 50% of subjects, BES and TFEQ identified a binge eating pattern, more frequently in females. A positive BES, as well as lower restriction, higher disinhibition and hunger values at TFEQ, identified subjects with poorer HRQL. Logistic regression analysis identified in a positive BES the variable more closely associated with low scores in mental domains of perceived HRQL. Waist-to-hip ratio, degree of obesity, osteoarticular and respiratory diseases, but also positive BES, were selected as variables more closely associated with poor physical fitness. HRQL is variably impaired in obese persons seeking treatment for their disease, mainly in patients with binge eating. Treatment of binge eating may be as important as any weight-reducing intervention for the overall well-being of the majority of obese persons.
Adult↗
Use of ultrasound in occupational risk assessment of low-back pain.
The aim of the study was to evaluate ultrasound technique in preemployment medical assessment of the risk for low-back pain. Volunteers for the study were recruited among agricultural workers employed in the "Agraria Department" of the University of Bologna, Italy. The group consisted of 90 subjects, 52 male and 38 female, aged 25 to 58 years. The subjects filled in a questionnaire on medical history of low-back pain and were examined using an ultrasonograph equipped with a high linear frequency probe (3.5 MHz). The oblique parasagittal diameter of the lumbar spinal canal was measured by transabdominal ultrasonic imaging in the lumbar (L4-L5) and lumbosacral (L5-S1) region. Individuals with significantly narrower canals (< 14 mm) had an increased risk of low-back pain. The paper concludes that ultrasound imaging could become a valuable screening tool in industry, permitting selective job placement for workers at high risk for disorders of the back.
Adult↗
Prostate specific antigen in urinary tract infection.
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Aged↗
Techniques of endopyelotomy.
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Catheterization↗
[Stereotaxic breast microhistology].
Mammography is currently the most reliable imaging technique to detect clinically occult breast cancer. Stereotaxic-guided aspiration biopsy during mammography allows lesion nature to be diagnosed in many cases. Our experience with 72 microhistologic breast samplings with fine-needle aspiration cytology is reported; 50% of inadequate cytologic samplings were avoided. Adequate cytologic samples were obtained in 88.9% of cases, while microhistologic samples were adequate in 94.4% of cases. Inadequate samples were 11.1% and 5.6%, respectively. Microhistologic biopsies yielded fewer questionable results than fine-needle aspiration cytology, which helped reduce the number of unnecessary biopsies. This method, which is reliable and well tolerated by the patients, can be considered as a valuable alternative procedure to fine-needle aspiration cytology.
Adult↗
EEG and spectral analysis in HIV immunocompetent patients free from clinical CNS impairment. A follow-up study in 20 cases.
Twenty HIV immunocompetent subjects without neurological symptoms were studied by EEG and spectral EEG analysis over a period of 6-16 months. 40% of them showed mild diffuse changes in background activity on basal evaluation, but the appearance of neurological symptoms and the evolution of clinical picture seemed unrelated to the presence of aspecific EEG and spectral analysis changes. As most of them were oppiate abusers, these findings could be ascribed to the long-term drug use.
AIDS Dementia Complex↗
Benign partial epilepsy with multiple foci. Its characterization among primary partial epilepsies.
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Adolescent↗