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Biomedical subjects

A Barbato

Publications and source records attributed to A Barbato.

At least 37 records · Page 2Linked to original sources
PubMed2001

Altered renal sodium handling in men with abdominal adiposity: a link to hypertension.

OBJECTIVES: Central adiposity, insulin resistance and hypertension are clearly interrelated but the mechanisms underlying this association have not been thoroughly elucidated. As renal sodium handling plays a central role in salt-sensitive forms of hypertension, we investigated the relation of renal tubular sodium handling to abdominal adiposity, blood pressure and insulin sensitivity. DESIGN: Population-based study. PARTICIPANTS: Five hundred and fifty-five untreated Olivetti male workers, aged 25-75 years. SETTING: Olivetti factory medical centers in Pozzuoli and Marcianise (Naples, Italy) MAIN OUTCOME MEASURES: Anthropometric indices, serum insulin, homeostatic model assessment index of insulin sensitivity, blood pressure, fractional excretions of uric acid and exogenous lithium (as markers of renal tubular sodium handling). RESULTS: In univariate analysis, measures of central adiposity (i.e. sagittal abdominal diameter and umbilical circumference) were directly correlated with serum insulin (P < 0.001) and blood pressure levels (P < 0.001) and inversely associated with the fractional excretions of uric acid and lithium (P = 0.01-0.001). In multiple linear regression analysis, the same anthropometric indices but not the measures of peripheral adiposity (arm circumference and tricipital skinfold thickness), were significant predictors of the fractional excretion of uric acid and lithium, independently of age, blood pressure and serum insulin levels (P = 0.01-0.001). CONCLUSIONS: Abdominal adiposity was associated with altered renal tubular sodium handling apart from insulin resistance and high blood pressure. The data indicate that men with prevalent abdominal adiposity have an enhanced rate of tubular sodium reabsorption, mainly at proximal sites. These findings provide a possible mechanistic link between central adiposity and salt-dependent hypertension.

Abdomen↗
PubMed2001

Contribution of Doppler echocardiography to the evaluation of systolic and diastolic function of obese women versus a control group.

OBJECTIVE: To study by doppler echocardiography the cardiac systolic and diastolic functions of health, uncomplicated obese subjects. METHODS: Fifty-nine obese women with an average body mass index (BMI) of 35 kg/m2 were evaluated and compared with 19 subjects with an average BMI of 23 kg/m2 (control group). RESULTS: In the obese group, a clear tendency was observed toward higher systolic pressure, increased wall thickness and, consequently, myocardial mass, elevation on the circumference stress of the left ventricular wall, and an indisputable presence of diastolic abnormalities. Filling abnormalities were observed with impaired relaxation, with prolonged isovolumic relaxation time (IVRT) and augmented atrium contribution representing early indexes of cardiac dysfunction when systolic performance is still normal. CONCLUSION: Obesity is generally a chronic condition, and doppler echocardiography can be used as a noninvasive instrument for early evaluation of left ventricular diastolic indexes.

Adult↗
PubMed2000

Interstitial lung disease in children: a multicentre survey on diagnostic approach.

Chronic interstitial lung disease (ILD) is a rare disorder in the paediatric age group, with a poor prognosis. The diagnostic approach to ILD is based on more or less invasive methods. This study was implemented to verify which methods are the most often used in children. Questionnaires (333) were sent to members of the European Respiratory Society Paediatric Assembly belonging to 187 European and non-European centres. Questions concerned the use of noninvasive diagnostic methods, e.g. history taking, physical examination, routine laboratory tests, respiratory function tests and radiology (chest radiography, high-resolution computed tomography (HRCT)), and the use of invasive techniques such as bronchoalveolar lavage (BAL), transbronchial biopsy (TBB), open lung biopsy (OLB), video-assisted thoracoscopic biopsy (VAT) and HRCT with fine-needle aspiration biopsy (FNAB). Thirty eight centres returned the questionnaires and 131 children with ILD were studied. A diagnosis of ILD was achieved in five (3.8%) patients using noninvasive techniques alone. Using the various biopsy methods, histological assessment was performed on a total of 98 (74.8%) children. The most frequently used invasive technique both alone and in combination was BAL (83, 63.3%), followed by OLB (64, 48.8%), TBB (26, 19.8%) and VAT (11, 8.4%); FNAB was used in one patient. In conclusion a diagnosis of interstitial lung disease was reached on the basis of aetiological and/or histological findings in 117 (89%) of the 131 patients studied.

Adolescent↗
PubMed2000

Family interventions in schizophrenia and related disorders: a critical review of clinical trials.

OBJECTIVE: To update evidence from studies on family intervention in schizophrenia looking carefully at methodological issues. METHOD: Twenty-five studies were reviewed, using specific outcome criteria, and computing effect sizes whenever possible. RESULTS: Effect on relapse is relatively well assessed, although differences emerged particularly in comparison with poor control treatments and disappeared in recent studies. Findings on patient's symptoms, social functioning or family variables are limited and affected by methodological pitfalls. No difference between intervention models emerged, although behavioural/psycho-educational approaches were better investigated. Patients' inclusion, greater frequency and length of treatment led to better results. The main flaws were: poor control of standard treatment, small sample sizes, failure in evaluating clinical significance in continuous outcome variables. CONCLUSION: It remains unclear whether the effect depends on family treatment or on more intensive care. The failure to relate outcome to family-mediating variables is a challenge to the rationale underlying family interventions.

Behavior Therapy↗
PubMed2000

Chronic interstitial lung disease in children.

Chronic interstitial lung disease (ILD) is rare in children, but is clinically relevant because of its high morbidity and mortality rates. Several aetiological agents may have a role in this disease and various aetiopathogenic forms have been described, although they share a characteristic evolution towards pulmonary fibrosis. The aetiology sometimes remains unknown, in which case we speak of idiopathic interstitial pneumonia (IIP). Diagnosis relies on non-invasive methods (clinical history, respiratory function tests, chest X-ray and high-resolution CT scan) and invasive techniques (bronchoalveolar lavage, transbronchial biopsy, video-assisted thoracoscopic biopsy and open lung biopsy); the latter are used when the former fail to identify an aetiological agent. The gold standard for the diagnosis is lung biopsy, however, which also enables the classification of the idiopathic forms, in particular (usual interstitial pneumonia, desquamative interstitial pneumonia, non-specific interstitial pneumonia, and so on). In ILD, the most common therapeutic approaches involve the use of oral steroids and hydroxychloroquine sulphate for its anti-inflammatory and antifibrotic effect. The prognosis is often poor.

Child↗
PubMed1999

Cosmetic results in 242 patients treated by conservative surgery for breast cancer.

The surgery of breast cancer has changed lately in favour of breast conserving treatment, the main purpose of which is to provide good cosmetic results together with radical resection of the tumour. In this paper we describe the cosmetic results obtained in 242 patients treated by conservative surgery (226 quadrantectomies, 93%, and 16 lumpectomies, 7%) for low risk breast cancer. Several of these resections were combined with plastic surgical techniques for residual breast reshaping. The technique chosen depended on the site of tumour, width of resection, and breast volume. The cosmetic assessment was made by the patient and the physician. Our data suggest that better cosmetic results may be obtained when plastic surgical procedures are combined with conservative surgery for breast cancer.

Adult↗
PubMed1998

Psychiatry in transition: outcomes of mental health policy shift in Italy.

OBJECTIVE: To assess the outcomes of changes in mental health policy introduced in Italy in 1978. METHODS: Data on psychiatric services, before and after the policy change, are presented. Effects of change are evaluated through indicators related to four issues: transfer of care, criminalisation of the mentally ill, suicides, and homelessness. RESULTS: Admissions of new patients to mental hospitals have been stopped and the size of the mental hospital population is now very low (26 per 100,000 population). Psychiatric care has been shifted to community services including general hospital psychiatric units. There has been an overall reduction of psychiatric hospitalisation. However, the provision of residential facilities is inadequate and community services are unevenly distributed across the country. Few negative effects of changing patterns of care have been reported, although the low quality of data limits the validity of such a conclusion. Outcome of care in areas where the full range of community services is available has been rated as satisfactory. CONCLUSIONS: Although care of the mentally ill has been shifted to community services, we lack hard data on the social and clinical outcome of community care at the nation-wide level. Long-term monitoring and evaluation of community services is a high priority in Italy.

Deinstitutionalization↗
PubMed1997

Epidemiology of psychiatric care of patients with severe mental disorders in Italy. Rationale and design of a prospective study, and characteristics of the cohort. Italian Collaborative Study Group.

The rationale and design of a large, multicentre, prospective follow-up study on the outcome of severe mental disorders is presented. The study is currently under way in Italy, where psychiatric care has been uniquely characterised since 1978 by the statutory prohibition of admitting patients to psychiatric hospitals. The main purpose of the study is to describe the 5-year outcome of patients with a diagnosis of schizophrenia, paranoid disorder, affective psychosis, reactive psychosis or personality disorder with respect to five areas (clinical condition, personal autonomy, work, and family and social relationships); a secondary objective is to describe the heterogeneity of practices and resources of psychiatric services. The study is being carried out by 76 outpatient psychiatric services throughout the country, covering approximately one-tenth of the Italian population.

Adult↗
PubMed1997

Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres.

We have undertaken a survey to establish current practices and differences in the use of bronchoscopes in children in European centres. A questionnaire was sent to all 220 members of the Paediatric Assembly of the European Respiratory Society (ERS). The questions concerned the following points: indications for bronchoscopy; site of bronchoscopy; type of sedation; any oxygen supplementation during the procedure; number of procedures performed in the previous 12 months; number of procedures performed in the neonatal intensive care unit; number of bronchoalveolar lavages (BALs); side-effects during and after the procedures; and diagnostic yield. Fifty one European centres (40.8% of the European centres contacted) took part in the study. A total of 7,446 bronchoscopies had been performed in the last 12 months: 4,587 using the flexible bronchoscope and 2,859 using the rigid bronchoscope. At centres using only the fibreoptic bronchoscope, the most frequent indication was "recurrent/persistent pneumonia" (17%); at centres using only the rigid bronchoscope, it was "foreign body inhalation" (36.7%); at centres using both methods, the most frequent indication was "other indications" (23.9%). In 12 months, 2,231 BALs were performed: 1,419 in immunocompetent children and 812 in immunocompromised patients. In centres using only the fibreoptic bronchoscope, the highest yield was for "stridor" (81%); in centres using only the rigid bronchoscope, the highest yield was for "persistent atelectasis" (68%); and in centres using both instruments, it was for "foreign body inhalation" (93%). The results of the study suggest that bronchoscopy in children is now a well-established procedure at several European centres, while others are just beginning to use this technique.

Bronchoalveolar Lavage Fluid↗
PubMed1997

Ten-year incidence and natural history of gallstone disease in a rural population of women in central Italy. The Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO).

AIMS: To investigate the incidence, risk factors and natural history of gallstone disease, a random sample of females belonging to a rural population was enrolled in a ten-year longitudinal study. METHODS: The study has been performed in a small town on the hills south of Rome. In 1985, a random sample of 426 females, aged 20-69 years, was screened by real-time ultrasonography for gallstones and previous cholecystectomy. Screening methods included anthropometry, collection of a blood sample and a questionnaire on the occurrence of abdominal symptoms. During 1995, all these subjects were invited for a 10-year follow-up examination. RESULTS: The overall 10-year incidence of gallstone disease was 6.3% (5.5% of new gallstones and 0.8% of cholecystectomies). Only 23.1% of the women with gallstones were aware of their condition. More than three quarters (76.9%) had not suffered biliary pain. Univariate and multivariate analyses demonstrated a positive independent association of new gallstone disease with body mass index and parity. Out of the initially asymptomatic gallstone women, 15.4% experienced at least one episode of biliary pain, 23.1% were submitted to elective cholecystectomy and 61.5% remained asymptomatic. CONCLUSIONS: The study demonstrates a high incidence of gallstone disease in women belonging to a rural free-living population in Italy and suggests body mass index and parity as possible true risk factors. Moreover, it confirms that a remarkable proportion of asymptomatic patients become symptomatic and eventually undergo cholecystectomy.

Adult↗
PubMed1996

[A case of pancreatic somatostatinoma].

The authors describe a case of somatostatinoma localized in the body and tail of the pancreas. They emphasize the rarity of this finding (only 33 cases with certain pancreatic localization are reported in literature) and the absence of a distinctive syndrome, which could direct to an early diagnosis, the authors are in doubt about the real incidence of this disease. The absence, generally, of a distinctive syndrome, the poor condition of these patient and then the lack of surgical treatment and histological examination, could lead to a lower valuation. Delayed diagnosis and then the local extension of this neoplasm often make surgical treatment vain. Nevertheless since somatostatinoma has more possibilities of radical resection than pancreatic cancer, it's required to know its features and course so to increase possibilities of an early diagnosis. In fact disregarding surgical treatment, the survival of these patients, one year after diagnosis, is about 48%. This result is better than the survival of patients with pancreatic or biliary duct cancers. Current diagnostic procedures are reported.

Adult↗
PubMed1996

Problems with the retrieval of long-standing inhaled foreign bodies in children.

In the last 7 yrs, we have removed 51 foreign bodies inhaled by children. In five cases involving long-standing foreign bodies, retrieval of the inhaled objects was complicated by their peripheral location in the bronchial tree and by the presence of abundant granulation tissue. In two of these children, the inhaled foreign bodies had been pushed further down the bronchial tree during a previous unsuccessful bronchoscopy. The use of a rigid bronchoscope with optical peanut forceps and 2-4 doses of an aqueous solution of epinephrine 1:100,000, at the dosage of 0.1 mL.kg-1.body weight (during removal of granulation tissue and after removal of the foreign bodies) permitted the complete removal of the foreign bodies in one session and a good control of bleeding.

Bronchi↗
PubMed1995

The first 20 minutes after a single dose of inhaled salmeterol in asthmatic children.

Very little is known as yet about the effect of salmeterol in pediatric asthma, so a trial was performed on children with mild asthma to compare salmeterol with salbutamol in terms of how quickly they took effect. The double-blind study involved 11 children (mean age 13.4 years) randomly assigned to inhale salmeterol 50 micrograms, salbutamol 200 micrograms, or a placebo three times on alternate days. Peak expiratory flow (PEF), heart rate, and blood pressure were measured before and 5, 10, 15, and 20 min after administering the medication. With salbutamol, PEF was higher at 5 and 10 min, subsequently dropping off at 15 and 20 min; with salmeterol, PEF was better at 10 and 20 min. Forced expiratory volume at 1 s (FEV1) measurements taken at the baseline and after 10 and 20 min revealed an important and consistent rise in values after salmeterol, whereas salbutamol was more effective after 10 min than after 20 min. No significant changes were recorded in heart rate or blood pressure after salbutamol; after salmeterol, there was a significant increase in heart rate after 5 min, but not at subsequent measurements. In conclusion, salmeterol begins to take effect already within 10 min of a single administration in asthmatic children, although the onset of its effect is slower than with salbutamol.

Administration, Inhalation↗
PubMed1994

[Working with families in the long-term treatment of schizophrenic disorders].

The authors present and discuss, within a systems frame of reference, the main aspects of family interventions with adults affected by long-term schizophrenic disorders involved in psychosocial rehabilitation. Special attention is paid to mutual influence between the interventions aimed at individual disability and those centered on family attitudes, beliefs and interactional patterns.

Activities of Daily Living↗
PubMed1994

[Misdiagnosis of asthma. Two paradigmatic case reports].

We present two children, respectively five and six years old, misdiagnosed and treated as asthmatics in allergological centers. After admission to our department, endobronchial inflammatory pseudotumor and lung tuberculosis were diagnosed respectively. While endobronchial pseudotumor is rather rare, lung tuberculosis is a less rare diagnosis that must be considered in patients with a history of persistent and recurrent coughing with or without wheezing, especially when there is no family history of atopical diseases and skin allergic tests are negative, and the social and economic conditions at risk.

Asthma↗