A meeting of vascular neurosurgeons and therapeutic neuroradiologists. "Who treats what?" June 1995--"Fondation les Treilles" (France).
Explore the source record for details and available documents.
Embolization, Therapeutic↗
Biomedical subjects
A Andreoli
Publications and source records attributed to A Andreoli.
Whole body and regional body composition analysis by dual-energy X-ray absorptiometry in cirrhotic patients.
OBJECTIVES: To compare whole body and regional (arms, legs and trunk) fat mass, fat-free mineral-free mass bone mineral content and bone mineral density, measured by DXA, in cirrhotic patients and age, sex and BMI matched healthy volunteers. DESIGN: Cross-sectional study. SETTING: Two medical research institutions. SUBJECTS: Twenty-two non ascitic cirrhotic patients and 16 age, sex and BMI matched healthy volunteers. INTERVENTIONS: The Lunar DPX whole-body X-ray densitometer with Lunar software version 3.6z (Lunar Radiation Corp., Madison WI, USA) was used. Regional analysis was performed on the arms, legs, trunk and head. RESULTS: Compared to controls, cirrhotic patients showed a significant reduction in percentage body fat. When differentiated by gender, however, the reduction in percentage body fat was evident in female cirrhotics only, particularly in the trunk. In male cirrhotic patients fat-free mineral-free mass was reduced in absolute terms in the whole body and the limbs. For both genders and in each body segment bone mineral content and density were reduced in cirrhotics compared to controls. In cirrhotic patients bone mineral density was significantly correlated to both fat-free, mineral-free mass (r = 0.85; P < 0.001) and to the Physical Activity Index (r = 0.52; P < 0.01). CONCLUSIONS: Two different patterns of soft tissue loss may be found in cirrhotic patients: in women lean tissue is maintained while fat stores are reduced, as in early starvation; in men lean tissue is reduced, as seen under conditions of stress. Moreover, factors influencing lean body mass, such as nutritional depletion and physical inactivity, may contribute to the reduction of bone density frequently observed in cirrhotic patients.
Absorptiometry, Photon↗
Predicting body cell mass with bioimpedance by using theoretical methods: a technological review.
The body cell mass (BCM), defined as intracellular water (ICW), was estimated in 73 healthy men and women by total body potassium (TBK) and by bioimpedance spectroscopy (BIS). In 14 other subjects, extracellular water (ECW) and total body water (TBW) were measured by bromide dilution and deuterium oxide dilution, respectively. For all subjects, impedance spectral data were fit to the Cole model, and ECW and ICW volumes were predicted by using model electrical resistance terms RE and Rt in an equation derived from Hanai mixture theory, respectively. The BIS ECW prediction bromide dilution was r = 0.91, standard error of the estimate (SEE) 0.90 liter. The BIS TBW prediction of deuterium space was r = 0.95, SEE 1.33 liters. The BIS ICW prediction of the dilution-determined ICW was r = 0.87, SEE 1.69 liters. The BIS ICW prediction of the TBK-determined ICW for the 73 subjects was r = 0.85, SEE = 2.22 liters. These results add further support to the validity of the Hanai theory, the equation used, and the conclusion that ECW and ICW volume can be predicted by an approach based solely on fundamental principles.
Adult↗
Impedance ratio as a measure of water shifts.
Total and segmental body compositions (left arm and left leg) were measured by bioelectrical impedance analysis at 5 and 100 kHz and by dual-energy X-ray absorptiometry (DXA) in 14 healthy young males (body mass index, mean +/- SD, 23.5 +/- 2.7 kg/m2) every 20 min for a period of 100 min. During the measurements the subjects remained in the supine position on the examination table, except for the time between the last two measurements, where they got up to walk around. This study focuses on the impact of orthostatic fluid shifts on impedance ratios in body segments and the total body. After 20 min of lying supine lean tissue (DXA) was slightly but significantly lower for the total body and the left leg, but all other consecutive DXA measurements at different times did not differ. Total body impedance and leg impedance increased during the time the subjects were in the recumbent position. Impedance changes in the leg were more pronounced than in the total body, and at 5 kHz the changes were more pronounced compared to 100 kHz. After the subjects got up the impedance values again decreased. Impedance ratios (Z5/Z100) increased for both the leg and to a lesser extent for the total body during the time lying supine, but again decreased after getting up. The results of this study indicate a fluid shift from the legs to the trunk after lying supine and show that this fluid shift is mainly extracellular water. DXA measurements were not able to detect these changes, probably because the magnitude of these changes is below the detection level for lean tissue with DXA methodology. The observations have important implications in the interpretation of impedance measurements in the clinical situation when measurements are made in patients who have been reclining for some time.
Absorptiometry, Photon↗
Recent benzodiazepine use in depressed patients: a confound of psychoimmunologic studies?
UNLABELLED: Several studies have indicated that benzodiazepines influence immunity in both animals and humans. As these medications are commonly utilized by and for psychiatric patients, investigation of psycho-immunologic relationships in human psychiatric disorders may be confounded by use of these medications. METHOD: We undertook an investigation for possible effects of recent benzodiazepine use on depression-immune relationships by comparing 43 patients with current major depressive disorder (MDD) who used benzodiazepines in the week prior to study to 27 patients with current MDD but no use of benzodiazepines in the past month. Both functional and ennumerative measures were investigated. RESULTS: We found no differences in absolute numbers of lymphocytes or the lymphocyte and NK functional measures. We did find differences between these two groups in the percentage of lymphocytes and of NK cells. Upon further analysis, controlling for symptom severity, these differences were shown to not be independently predicted by benzodiazepine use. CONCLUSION: Immune measures in subjects with current MDD and recent benzodiazepine use did not differ from those without such recent use. Therefore, such recent use is unlikely to confound PNI results.
Adult↗
Comparison of the body composition of age-matched Italian, Ukrainian, and Dutch children.
In the present study, the body composition was measured in 35 Ukrainian children, 14 boys and 21 girls, aged 8-12 years, by dual-energy X-ray absorptiometry (DEXA), anthropometry, and bioelectrical impedance. The results were compared with those obtained from a sample of the same number of Italian and Dutch children of the same sex and range of age. The Ukrainian children were slightly smaller, had a lower body weight, and had a lower body fat percentage, as measured by skinfolds, as compared with the Italian and Dutch children, as well as a lower calculated fat-free mass (FFM) by impedance. Comparison between FFM as determined by different methods in the Ukrainian children showed that all assessed values differed significantly. In particular, all methods overestimated the FFM as compared with DEXA, but the differences between DEXA and the other methods were not dependent on the level of FFM as determined by DEXA. Furthermore, the difference between predicted FFM and FFM values obtained by DEXA was correlated for skinfolds and body mass index (r = 0.77, p < 0.01), but not for body mass index and impedance, or skinfolds and impedance. The mean differences were 1.8 +/- 1.5 for body mass index, 1.0 +/- 1.4 for impedance, and 3.6 +/- 1.6 for skinfolds. Some differences in the body composition have also been found between boys and girls. The boys had higher values of lean tissue (23.3 +/- 3.1 vs. 20.7 +/- 3.3; p < 0.01) and FFM (24.5 +/- 3.3 vs. 21.8 +/- 3.5; p < 0.01) as compared with the girls and slightly higher values of bone mineral content. It should be noted, however, that the differences between different groups and different methods are always small, even when they are statistically significant.
Absorptiometry, Photon↗
An antibiotic regimen for the treatment of active Crohn's disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin.
OBJECTIVES: Bacteria in the gut lumen may play a role in the etiology and/or the symptoms of Crohn's disease (CD). Although various antibacterial drugs have been employed in clinical practice, few controlled trials have been conducted, and those had conflicting results. The aim of this study was to investigate the efficacy and the safety of a combination of metronidazole and ciprofloxacin, compared with methylprednisolone, in treating 41 consecutive patients with active CD. METHODS: Eligible patients, 13 men and 28 women, mean age 38 yr, were randomly allocated to receive, for 12 wk, ciprofloxacin 500 mg twice daily plus metronidazole 250 mg four times daily or methylprednisolone 0.7-l mg/kg/day, with variable tapering to 40 mg, followed by tapering of 4 mg weekly. RESULTS: Ten of the 22 antibiotic patients (45.5%) and 12 of the 19 steroid patients (63%) obtained clinical remission (Crohn's Disease Activity Index < or = 150) at the end of the 12-wk study (p = NS). Five patients on antibiotics (22.7%) and five patients on steroids (26.3%) were considered treatment failures because of deterioration or persistent symptoms. Six patients receiving antibiotics (27.3%) and two on steroids (10.6%) were withdrawn from the trial because of side effects. One patient on antibiotics was not compliant. CONCLUSIONS: metronidazole and ciprofloxacin could be an alternative to steroids in treating the acute phase of CD.
Adolescent↗
Crisis intervention and affective disorders: a comparative cost-effectiveness study.
In recent years, psychiatric institutions have been increasingly urged to justify their clinical policies in order to ensure both effective treatment and efficient management. Assessment instruments for effectiveness and costs are essential to respond to these needs. The aim of this study was to determine the cost-effectiveness of treatments for major depressive disorders. We conducted a comparative pilot investigation of treatment costs in patients with a major depressive episode assigned to specialised out-patient crisis intervention, to specialised in-patient treatment and to standard mental hospital care. The study included 122 subjects. The inclusion criteron was a diagnosis of DSM-III-R major depressive episode. Costs were assessed by determining the average cost for each treatment and the modalities of payment systems. Treatment duration and costs were high, but specialised crisis intervention may considerably reduce the duration of hospitalisation and its associated costs. The average costs of treating major depression were about 4 times greater in the specialised hospital unit than in the standard hospital unit and the crisis intervention centre. The burden of payment was comparatively higher for the state and reduced for insurance companies when the treatment of major depressive disorders involved less in-patient care.
Adolescent↗
Determination of intracellular water by multifrequency bioelectrical impedance.
Body composition was measured in 57 healthy males by 40K measurements and by multifrequency bioelectrical impedance. Intracellular resistance (Ricf) was calculated from the impedance values using the Cole-Cole model. From total body potassium, intracellular water (ICW) was calculated. In addition, in 14 subjects, total body water (TBW) and extracellular water (ECW) was measured using deuterium oxide dilution and bromide dilution, respectively. Prediction formulas from the literature from impedance at different frequencies were used to predict TBW and ECW, and ICW was calculated as the difference of predicted TBW and ECW. Predicted and measured values of TBW, ECW and ICW did not always show the same values as measured. Generally the ICW from potassium was well correlated with calculated ICW from impedance values, correlation coefficients varying from 0.68 to 0.79, depending on the used prediction formula. From the impedance index H2/Ricf, body weight and age, ICW from potassium was predicted with stepwise multiple regression. The prediction formula was ICW = 0.37065.H2/Ricf - 0.132.age + 0.105.weight + 12.2. The prediction error was 1.9 kg and the explained variance 0.69. The residuals of this prediction formula were dependent on the level of ICW as measured by potassium. The same phenomenon was observed when ICW was calculated as the difference of predicted TBW and ECW. The results show that multifrequency impedance is able to predict ICW, however, the prediction is influenced by body water distribution.
Adult↗
Dissecting aneurysms of the basilar artery.
Ten patients (six men and four women; mean age, 40 yr) with spontaneous dissection of the basilar artery are reported. Clinically, six were admitted with subarachnoid hemorrhage (SAH) and four were admitted with brain stem ischemia. Angiography demonstrated string sign in four patients, pearl reaction in four, double lumen in one, and arterial ectasia with mural retention of contrast medium in one. Magnetic resonance imaging was performed in two patients. Follow-up angiograms or magnetic resonance angiography in six patients showed spontaneous healing in two patients, improvement in two, progression in one, and no change in one. Nine patients were treated medically, and one underwent selective intravascular occlusion of the dissecting aneurysm. One patient died after further SAH, two remain severely disabled, three have residual neurological deficit, and four are in good clinical condition. The most interesting observations in this series include a relatively good course in a substantial number of patients and low further bleeding potential after SAH, the late "globular" evolution, which may be favorable for reconstructive treatment, and the diagnostic value of associated computed tomographic/angiographic findings. Surgical options in basilar dissection are very poor; in some reported cases, wrapping has been tried with disappointing results. In light of the possibility of spontaneous healing or improvement, wrapping should be reserved for only those patients with recurrent SAH or angiographic progression of the dissection.
Adult↗
Improved prediction formula for total body water assessment in obese women.
OBJECTIVE: To validate an improved formula for the calculation of total body water (TBW) from impedance values in obese women. SUBJECTS: A sample of 37 overweight females BMI ranging from 29.5 to 44.1 kg/m2. MEASUREMENTS: The reference measurements for TBW were obtained by deuterium oxide dilution. Body height (h), hip circumference (C) as well as body impedance at 100 kHz (Z100) were also measured. RESULTS: The values obtained for h, C and Z100 were introduced in the calculations and the following developed formula for total body water was determined: TBW = 0.069 [hC2/(4 pi .Z100)]+19.671. The validity of this formula was assessed through the statistical test of Bland and Altman which we also performed for other formulas containing the weight and/or the height. CONCLUSION: We found that the accuracy of the prediction of TBW by our formula, although lower than those formulas using body weight, is higher than that which takes into account only body height. We conclude that body volume, expressed through body height and hip circumference, is a good choice of parameter in bioelectrical impedance measurements. The new approach can be useful in clinical settings for repeated monitoring of obese women, during diet-restricted treatment.
Adult↗
Comparison of body weight, body height and body fatness of Italian children aged 6-12 years with American standards.
World Health Organization has suggested that American standards may be adopted for use in countries where no local reference data are available. Since no locally accepted growth standard is available in Italy, this study investigated if American growth curves for weight, height and triceps skinfold (TSF) provide reliable values for Italian children. Weight, height and TSF were measured in 1273 Italian children (boys: 656, girls: 617) ranging in age from 6 to 12 years and their percentiles were compared with that provided by NCHS for American children. Despite some minor differences, it is shown that American standards can be used safely in Italian children aged from 6 to 12 years.
Anthropometry↗
[Levels of the training of psychotherapists and results of analytic psychotherapy].
The purpose of this study was to investigate therapists experience as predictor of psychotherapy outcome. We studied consecutive patients (n = 76) assigned to psychoanalytic psychotherapy after being referred to the Geneva University Psychiatric Center for psychiatric treatment. Fifty-seven subjects were treated by trainees and nineteen had certified psychotherapists. Each treatment was carefully evaluated at intake, at the sixth session and at 1-year follow-up. Those patients treated by trainees appeared to be clearly improved (p < 0.01), but 49.1% of them did not completed the psychotherapy. In addition, increased therapist's training and experience (certified psychotherapist vs trainee) was associated with better global outcome, reduced early termination and more improvement after six psychotherapy sessions (p < 0.01). The present data indicate that increased therapist's experience is associated with more compliance and more improvement after the initial phase of the treatment in psychiatric subjects assigned to psychoanalytical psychotherapy.
Adolescent↗
The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders.
BACKGROUND: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision, and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. METHODS: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. RESULTS: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. CONCLUSION: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.
Adult↗
Dissecting aneurysms of the vertebrobasilar system: study of 16 cases.
In the last 14 years we have encountered 16 patients with spontaneous intracranial dissections of the vertebrobasilar (VB) system (mean age was 46 years and male/female ratio was 10/6). VB dissections presented in eight cases with subarachnoid bleeding and in eight with brainstem, cerebellar, or cerebral ischemia. Three patients had multiple dissections. Ten dissections occurred in the vertebral artery (two extended to the basilar artery), three in the posterior cerebral artery (one bilateral), two in the basilar artery, and one in the posterior inferior cerebellar artery. The angiographic configuration included "string" sign, "pearl and string" sign, fusiform dilation, and double lumen. The following angiographic evolution (available in 11 cases) was that of complete healing (three cases), partial resolution (five cases), progression (one case), and unimproving (two cases). Three patients died (two due to recurrent subarachnoid hemorrhage): two patients were explored surgically (one had further intravascular therapeutic embolization), and the rest were treated conservatively. Not all dissecting aneurysms fared in the same manner, depending either on the location in the VB circulation or on the variable vascular configuration: treatment should be fitted to the timing of diagnosis.
Adult↗
Oral mesalazine (5-aminosalicylic acid; Asacol) for the prevention of post-operative recurrence of Crohn's disease. Gruppo Italiano per lo Studio del Colon e del Retto (GISC).
METHODS: A multicentre randomized controlled trial was conducted to evaluate the efficacy of oral mesalazine (5-aminosalicylic acid) for the prevention of post-operative recurrence in 110 patients operated on for Crohn's disease by first intestinal resection. Patients were randomly allocated to receive 2.4 g/day of mesalazine, or no treatment at all. The protocol included colonoscopy with ileoscopy at 6 months and yearly thereafter. Recurrence was defined on the basis of endoscopic criteria and classified as mild or severe. RESULTS: The demographic and pre-trial characteristics were very similar in the two groups of patients. The cumulative proportion of recurrence at 6, 12 and 24 months was significantly lower in the mesalazine group than in untreated group (P = 0.002). At 24 months the cumulative proportions of endoscopic recurrence were 0.52 +/- 0.12 (+/- S.E.M.) and 0.85 (+/- 0.07), respectively. At the same time the cumulative proportions of symptomatic recurrence were 0.18 +/- 0.09 and 0.41 +/- 0.09 (P = 0.006). The cumulative proportions of the severe recurrence was also significantly lower in the mesalazine group (0.17 +/- 0.09 vs. 0.38 +/- 0.09; P = 0.021). CONCLUSIONS: The preliminary results of this study show that administration of oral mesalazine soon after surgery is effective in preventing post-operative endoscopic recurrence in Crohn's disease over a 2-year period. It is estimated that this treatment prevents 39% of all recurrences and 55% of the severe recurrences.
Administration, Oral↗
Preoperative noninvasive coronary risk stratification in candidates for carotid endarterectomy.
BACKGROUND AND PURPOSE: Patients with symptomatic carotid stenosis who are candidates for carotid endarterectomy are at high short- and long-term risk of coronary events. To stratify patients at different risk of coronary events we investigated the usefulness of a noninvasive preoperative cardiological workup. METHODS: We studied 172 consecutive patients admitted to the Neurosurgical Department for symptomatic high-grade (70% to 99%) carotid stenosis (age, 42 to 74 years; mean, 57.8 years). Patients without history of coronary artery disease (CAD) and able to exercise were submitted to exercise electrocardiographic testing (EET) and, if abnormal, to exercise thallium myocardial imaging (TMI). Patients were classified into four groups: group 1, patients without CAD: no history of CAD, normal EET, or normal TMI in the presence of indeterminant EET (n = 93, 54%); group 2, patients with silent CAD: no history of CAD and concordant abnormal EET and TMI (n = 28, 16%); group 3, patients unable to exercise: no history of CAD and inability to perform adequate EET because of previous stroke or claudication (n = 29, 17%); and group 4, patients with known CAD: history of angina or myocardial infarction (MI) (n = 22; 13%). RESULTS: The four groups were comparable in regard to age, sex, and computed tomographic scan of the brain. The prevalence of stroke was higher in patients unable to exercise; hypercholesterolemia was more frequent in patients with known CAD. During the perioperative period (< or = 30 days after carotid endarterectomy), coronary events occurred in 3 patients (2%): fatal MI in 2 patients in group 4 and 1 patient in group 3. One hundred percent of patients were followed up for 6.2 years. Coronary events occurred in 23 of the 168 patients discharged from the hospital (13.7%); these were fatal in 11 (6.5%): 3 patients of group 1 (3%; sudden death in 2, fatal MI in 1), 8 patients of group 2 (29%; fatal MI in 5, unstable angina in 3), 8 patients of group 3 (28%; fatal MI in 4, nonfatal MI in 4), and 4 patients of group 4 (18%; fatal MI in 2, sudden death in 1, unstable angina in 1). Kaplan-Meier estimated curves of survival free from fatal and nonfatal coronary events were 97%, 51%, 49%, and 59%, respectively (P < .001, group 1 versus groups 2 and 3; P < .01, group 1 versus group 4). CONCLUSIONS: Among patients undergoing carotid endarterectomy, coronary events occurred twice as often as cerebral recurrences. A preoperative noninvasive cardiac investigation, including EET, can adequately identify groups of patients with diverse short- and long-term prognoses. In addition to patients with known CAD, those with silent CAD or who are unable to exercise represent, without the need of further investigation, groups at high risk of coronary events in long-term follow-up.
Adult↗
[Premenstrual syndrome: review of literature].
This is a comprehensive review of recent studies on premenstrual syndrome. The specific purpose of the present paper was to update major premenstrual syndrome related research/clinical issues in the following areas: nosographic validity, diagnostic reliability, clinical assessment, psychobiology, treatment progress. Increasing consensus has addressed the development of both performant assessment instruments and prospective clinical studies as well as careful psychobiologic investigation of the affective disorders/premenstrual syndrome crossroad as valuable directions for future studies. Such a research perspective is discussed in the light of the author's previous work in the field.
Female↗