Advanced imaging of the diabetic foot and its complications
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Journal Article↗
Biomedical subjects
A Gentili
Publications and source records attributed to A Gentili.
Determination of herbicides in water using HPLC-MS techniques.
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Chromatography, High Pressure Liquid↗
MR imaging findings in spring ligament insufficiency.
OBJECTIVE: Spring ligament insufficiency is associated with chronic posterior tibial tendon dysfunction, and may constitute an indication for surgical repair or reconstruction. This study examines the accuracy of MRI for the diagnosis of insufficiency of the spring ligament. DESIGN AND PATIENTS: Two experienced musculoskeletal radiologists independently scored the MRI findings in 13 cases of surgically proven spring ligament insufficiency and in 18 control subjects, using a standardized scoring system. RESULTS: Insufficiency of the spring ligament was associated with increased signal heterogeneity on short TE spin echo images, and an increase in the thickness of the medial portion of the ligament. The sensitivity of MRI for the diagnosis of spring ligament insufficiency was 54-77%, while the specificity was 100%. MRI assessment of the plantar portion of the spring ligament was unreliable (kappa=0.33), but the assessment of global ligament integrity was substantially reproducible (kappa=0.76). CONCLUSION: The medial portion of the spring ligament can be reliably assessed on routine MRI. The findings of spring ligament insufficiency on MRI are only moderately sensitive but highly specific.
Case-Control Studies↗
Increasing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program.
OBJECTIVE: To determine the magnitude of changes in muscle mass and lower extremity body composition that could be induced with a regular regimen of functional electrical stimulation (FES)-induced lower-extremity cycling, as well as the distribution of changes in muscle mass among the thigh muscles in persons with spinal cord injury (SCI). STUDY DESIGN: Thirteen men with neurologically complete motor sensory SCI underwent a 3-phase, FES-induced, ergometry exercise program: phase 1, quadriceps strengthening: phase 2, progressive sequential stimulation to achieve a rhythmic pedaling motion (surface electrodes placed over the quadriceps, hamstrings, and gluteal muscles); phase 3, FES-induced cycling for 30 minutes. Participants moved from one phase to the next when they met the objectives for the current phase. MEASURES: Computed tomography of legs to assess muscle cross-sectional area and proportion of muscle and adipose tissue. Scans were done at baseline (before subjects started the program), at first follow-up, typically after 65.4+/-5.6 (SD) weekly sessions, and at second follow-up, typically after 98.1+/-9.1 sessions. RESULTS: Increases in cross-sectional areas were found in the following muscles: rectus femoris (31%, p<.001). sartorius (22%, p<.025), adductor magnus-hamstrings (26%, p<.001), vastus lateralis (39%, p = .001), vastus medialis-intermedius (31%, p = .025). Cross-sectional area of adductor longus and gracilis muscles did not change. The ratio of muscle to adipose tissue increased significantly in thighs and calves. There was no correlation among the total number of exercise sessions and the magnitude of muscle hypertrophy. CONCLUSIONS: Muscle cross-sectional area and the muscle to adipose tissue ratio of the lower extremities increased during a regular regimen of 2.3 FES-induced lower extremity cycling sessions weekly. The distribution of changes was related to the proximity of muscles to the stimulating electrodes.
Adipose Tissue↗
Latex allergy in subjects who had undergone multiple surgical procedures for bladder exstrophy: relationship with clinical intervention and atopic diseases.
OBJECTIVE: To evaluate the prevalence of latex sensitization in a group of patients with bladder exstrophy, and to determine the role of associated risk factors, e.g. atopy, and the number and duration of surgical and anaesthetic procedures. PATIENTS AND METHODS: The study comprised 17 patients (15 children and two young adults) affected by bladder exstrophy who had undergone multiple surgical procedures. Skin-prick tests and specific immunoglobulin-E (IgE) assays against latex, food allergens cross-reacting with latex and inhalant allergens were carried out. RESULTS: Twelve patients showed latex sensitization and five showed symptoms related to latex exposure, the most common of which was contact urticaria (four of the symptomatic patients). Intraoperative anaphylactic reaction had led to life-threatening events in only one child. Latex-specific IgE determined both by the prick test and assay was positive in all those with symptoms. Specific IgEs against inhalant allergens and foods were present in four of five symptomatic patients. In the seven sensitized patients with no clinical symptoms, the assay was positive in all, while the skin-prick test was positive only in four; specific IgEs against inhalant allergens were present in three of the seven. In the five patients not allergic and not latex-sensitized, only one showed allergic sensitization against grass pollen and mite allergen. None of the children without latex antibodies had symptoms of latex allergy. Symptomatic patients had a undergone significantly more hours of surgery, more cystography and had used intermittent catheterization for longer than those with no symptoms. CONCLUSION: A third of patients with bladder exstrophy showed latex symptoms and another third had latex sensitization. Multiple surgical procedures and atopy play a major role in the development of latex hypersensitivity
Adolescent↗
[Problems in anesthesia in pulmonary cystic adenomatosis].
Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare disease. It is about an abnormal proliferation of mesenchymal elements and failure of maturation of bronchiolar structures, characterized by the replacement of normal pulmonary tissue with "cysts" in variable size and number. These lesions communicate with the tracheobronchial tree. During fetal period hydrops and polyhydramnios can be associated with CCAM. A cystic adenomatoid malformation can be detected by antenatal ultrasound, and, at the birth, it is confirmed by chest radiography. From January 1990 to December 1998, 24 cases with CCAM came to our observation; 16 of these patients underwent surgery and 14 have come to a complete recovery. The newborns, with CCAM, can show early acute respiratory distress for rapid expansion of the cysts leading to compression of normal lung and mediastinal shift. Conventional mechanical ventilation may cause further expansion of the involved lobe with a ball-valve effect: this take a clinical deterioration. Perioperative ventilatory management with high frequency oscillation (HFO) is useful to stabilize and to improve arterial blood gases of this patients. At the moment, thanks to the early prenatal sonographic diagnosis, it is possible, and strongly advisable, after adequate serial checkings during the pregnancy, to refer CCAM cases to a tertiary centre that is properly equipped, where a poly-specialist team consisting of obstetrician, neonatologist, pediatric anesthetist and pediatric surgeon, will be able to plan and arrange in the best treatment necessary for the newborn.
Anesthesia↗
[Inhalation of foreign bodies].
Accidental aspiration of a foreign body (FB) is an event which is reasonably frequent and dramatic in children and is still today one of the main causes of death due to accidents at home in children up to three-four years of age. The severity of the clinical picture varies according to the size, shape, type and site of arrest of the material aspirated and can be associated with both severe asphyxial forms and forms with insidious and vague symptoms which are difficult to diagnose correctly. A late diagnosis is however a fairly common event in literature. An anamnesis suggesting probable aspiration in a child under the age of 3 should direct doctors towards diagnostic and operative endoscope examinations of the patient, even where there is a negative clinical and radiological picture. Organic material, mainly peanuts, represented 60-75% of the findings, particularly in the 0-3 year age-band. In the other of cases inorganic material was extracted from school-age children. Aspiration of a FB exposes the patient to risk of serious complications and sequelae. Antibiotic, dexamethasone therapy and the ventilation support in the CPAP helped to avoid post-extractive sequelae. Prevention should in any case be the primary aim as regards to aspiration of foreign bodies in children. This should be stimulated by appropriate educational campaigns to raise awareness. The study included 62 child patients observed in the Department of Anesthesia and Intensive Care of the S.Orsola-Malpighi Hospital of Bologna over the last 11 years who were admitted for suspected FB aspiration.
Asphyxia↗
Sleep disorders in older people.
Sleep complaints are common among older people. As there are often multiple contributing factors, insomnia should be considered a symptom, and not a diagnosis. There is a high prevalence of sleep apnea and nocturnal myoclonus. When these primary sleep disorders are suspected, the patient should be referred for polysomnography. Use of hypnotics should be discouraged for chronic insomnia. More research is needed to clarify the role of light therapy and melatonin in the treatment of sleep disorders in older people.
Aged↗
Evaluation of the efficiency of heat and moisture exchangers during paediatric anaesthesia.
This study evaluates the efficiency of heat and moisture exchangers (HMEs) in allowing adequate humidification and warming during anaesthesia in children. Eighteen paediatric patients undergoing anaesthesia were divided into two groups: group A ten patients: infants up to 10 kg-->Hygrobaby HME; group B 8 patients: children above 10 kg-->Hygroboy HME. The following parameters were evaluated: body temperature (bT), room temperature (rT), fresh gas temperature, HME warm-up time, inspired and expired gases temperature and humidity, conserving efficiency, and duration of anaesthesia. Gas temperatures were recorded by means of a recorder fitted with four thermal probes. Humidity values were mathematically derived. The correlation between efficiency and rT, bT, and fresh gas temperature was computed. In both groups the inspired gases temperatures were below 30 degrees C. Inspired absolute humidity was never more than 28 mgH2O.l(-1). The conserving efficiency was good (0.93 in both groups). A positive correlation was found between efficiency and fresh gas temperature. HMEs did not meet the minimum standards for humidity and heating during anaesthesia in children, although their conserving efficiency was found to be satisfactory.
Analysis of Variance↗
Determination of arylphenoxypropionic herbicides in water by liquid chromatography-electrospray mass spectrometry.
A very sensitive and specific analytical procedure for determining arylphenoxypropionic herbicides in aqueous environmental samples, using pneumatically assisted electrospray (ESI) liquid chromatography-mass spectrometry (LC-MS) is presented. Arylphenoxypropionic acids are a new class of herbicides used for the selective removal of most grass species from any nongrass crop. These herbicides are commercialized as herbicide esters. It has been shown that the ester derivatives undergo fast hydrolysis in the presence of vegetable tissues and soil bacteria, yielding the corresponding free acid. The analytical procedure involves passing 1l of surface or ground water and 2l of drinking-water samples, through a 0.5-g graphitized carbon black (GCB) extraction cartridge. A conventional 4.6-mm I.D. reversed-phase LC C18, operating with a 1 ml/min mobile phase flow-rate, was used for chromatographing the analytes. A flow of 200 microliters/min of the column effluent was diverted to the ESI source. The ESI source was operated in positive-ion mode for neutral pesticides and in negative-ion mode for acid pesticides. For ion-signal optimization, the effect of the concentration of the acid in the mobile phase on the response of the ESI-MS detector was investigated. By evaluating the specificity and sensitivity of the method, the effects of varying the orifice plate voltage on the production of the diagnostic fragment and the response of the MS detector were also investigated. For the analyte considered, the response of the mass detector was linearly related to the amount of the analyte injected between 1 and 200 ng. In all cases, recoveries of the analytes were better than 91%. The limit of detection (signal-to-noise ratio = 3) of the method for the pesticides considered in drinking water samples was estimated to be about 3-10 ng/l.
Chromatography, High Pressure Liquid↗
Development of a method based on liquid chromatography-electrospray mass spectrometry for analyzing imidazolinone herbicides in environmental water at part-per-trillion levels.
An evaluation was made of the feasibility of using reversed-phase liquid chromatography-mass spectrometry with an electrospray interface (LC-ESI-MS) to measure traces of imidazolinone herbicides in different natural water samples. The imidazolinones are a significant new class of low-use-rate, reduced-environmental-risk herbicides for the protection of a wide variety of agricultural commodities. The procedure used involved passing 0.5, 1, 2 1 of river, ground and drinking water samples, respectively, through a 0.5 g graphitized carbon black (GCB) extraction cartridge. Analytes were eluted from the GCB surface by 8 ml of a methylene chloride-methanol (80:20, v/v) solution acidified with formic acid, 25 mM. Recovery was higher than 89% irrespective of the aqueous matrix in which the analytes were dissolved. A conventional 4.6 mm I.D. reversed-phase LC C18 column operating with a mobile phase flow-rate of 1 ml/min was used to chromatograph the analytes. A flow of 50 microliters/min of the column effluent was diverted to the ESI source. The effects of acid concentration on ESI-MS detector response in the mobile phase were investigated. The effects on the production of diagnostic fragments produced by varying the orifice plate voltage and the response of the MS detector were also evaluated. For the analyte considered, the response of the mass detector was linearly related to the amount of analyte injected between 1 and 50 ng. The limit of detection (signal-to-noise ratio = 3) of the method for the pesticides considered in drinking water samples was estimated to be about 2-5 ng/l.
Chromatography, Liquid↗
Stress injuries of bone: analysis of MR imaging staging criteria.
RATIONALE AND OBJECTIVES: The authors examined the prognostic value of magnetic resonance (MR) imaging in stress injuries of bone. MATERIALS AND METHODS: Clinical follow-up data were collected in 35 patients who underwent MR imaging because of suspected stress fractures. MR findings were correlated with total duration of symptoms, the time to return to sports activity, and findings at follow-up radiography. RESULTS: The MR imaging finding of a "fracture" or "fatigue" line or a cortical signal intensity abnormality was predictive of a longer symptomatic period, whereas muscle edema was predictive of a shorter symptomatic period. A published grading system could be used in only 24 patients; the MR imaging grade of injury did not show correlation with clinical outcome. CONCLUSION: The MR imaging finding of either a medullary line or a cortical abnormality appears to indicate a more severe stress injury of bone. A previously published MR imaging grading system for stress injuries of the tibia was not prognostic in this more heterogeneous patient group.
Adolescent↗
[Multiple granular cell tumor: case report and review of the literature].
We describe a case of multiple granular cell tumour (GCT) in 41 years old man. It manifested as subcutaneous synchronous multiple lesions. GCT is, usually, a benign lesion that is histologically diagnosed after biopsy or surgical excision. It raises doubts about his benignity in relation to multiple and distant localizations as in the present case.
Adult↗
Sexual dysfunction in older adults.
Not only is sexual function an obvious requirement for the survival of the human race, but sex also is a major contributor to quality of life. During the recent past, there has been a dramatic increase in our understanding of sexual function and dysfunction in older men. There is, however, limited scientific information on the sexuality of older women. It is important that clinicians understand what is known about ways we can assist our older patients when they suffer from sexual dysfunction.
Aged↗
Factors that disturb sleep in nursing home residents.
The purpose of this cross-sectional survey was to examine subjective sleep quality, and identify factors that disturb sleep in cognitively intact nursing home (NH) residents. We interviewed 51 cognitively intact NH residents using a validated instrument, the Pittsburgh Sleep Quality Index (PSQI). Questions regarding the environment, symptoms suggestive of restless leg syndrome, and periodic leg movements were also asked. Three individuals were unable to answer all the questions and, therefore, analyses were performed on 48 subjects. Seventy-three percent of the subjects were identified as "poor" sleepers based upon a total PSQI score > 5. Factors that disturbed the residents' sleep three or more times a week were: nocturia (71%), environment-related noise or light (38%), pain (33%), feeling too hot (6%) and leg cramps (6%). On multiple regression analysis, poor sleep correlated with depressive symptoms and comorbidity, not with age or gender. Poor sleep quality is common among cognitively intact NH residents. In our study, nocturia, environmental factors and pain were the most commonly perceived causes of sleep disturbance. Poor sleep independently correlated with depressive symptoms and comorbidity. These findings should be kept in mind when evaluating sleep complaints in the nursing home.
Aged↗
Saline versus gadolinium-enhanced magnetic resonance arthrography of porcine cartilage.
RATIONALE AND OBJECTIVES: The authors compared saline and dilute gadopentetate dimeglumine as injectants for magnetic resonance (MR) arthrography. METHODS: Sixty-three lesions were created on the joint surfaces of six pig patellas. MR arthrography (1.5 T) was performed with the specimens in saline and then in 2 mmol gadopentetate dimeglumine by using fat-saturated two-dimensional (2D) and three-dimensional (3D) sequences. Two musculoskeletal radiologists independently interpreted the images. RESULTS: At 2D MR arthrography, reader 1 performed equally well with saline and gadolinium solutes, whereas reader 2 had better sensitivity with the saline solute (P < .05); interobserver agreement was equivalent for saline and gadolinium solutes. With 3D MR arthrography, reader 2 performed equally well with saline and gadolinium solutes, whereas reader 1 had better sensitivity (P < .0001) but poorer specificity (P < .001) with the gadolinium solute; interobserver agreement was significantly better for saline than for gadopentetate dimeglumine (P < .05). CONCLUSION: In this initial evaluation, there was no clear advantage to using gadolinium-enhanced MR arthrography over saline MR arthrography for detecting lesions in porcine hyaline cartilage.
Animals↗
A series of 17 cases of congenital cystic adenomatoid malformation of the lung: management and outcome.
During a 5-year-period, 17 cases of congenital adenomatoid malformation of the lung were observed in the Department of Pediatric Surgery of Bologna University-S. Orsola-Malpighi Hospital; 16 cases were diagnosed in utero by ultra-sound. 13 patients had prenatal diagnosis between 21 and 23 weeks of gestation; 2 cases were diagnosed at 25 weeks and another one at 26 weeks. The other case came from another hospital, and the diagnosis was accidentally detected postnatally. In 3 cases the parents decided to terminate the pregnancy 3 cases had spontaneous improvement during the last weeks of gestation, and were perfectly normal at birth. One case was lost to follow-up; all remaining patients underwent resection. Among these patients only one was a nonsurvivor, while 9 have completely recovered. However, one patient developed persistent pulmonary hypertension, which could successfully be treated with drugs, another underwent laser treatment for laryngeal stenosis due to intubation. A special epidemiological information: 13 out 17 cases (76.5%) were female.
Cystic Adenomatoid Malformation of Lung, Congenita↗
Effect of clonidine and yohimbine on sleep in healthy men: a double-blind, randomized, controlled trial.
OBJECTIVE: To study the acute effect of clonidine, an alpha 2-adrenoceptor agonist, and yohimbine, an alpha 2-adrenoceptor antagonist, on nocturnal sleep in healthy men. SETTING: McGuire Veteran Affairs Medical Center, Richmond, Virginia, USA. SUBJECTS: Eight healthy male volunteers. METHODS: Each subject slept in the sleep laboratory for 2 consecutive nights on three separate sessions, at 3-week intervals. On the 2nd night of each session, the subjects received yohimbine (5.4 mg), clonidine (0.1 mg), or placebo in a double-blind, randomized, placebo-controlled, crossover design. RESULTS: There were no apparent effects of yohimbine. In contrast, clonidine completely suppressed rapid eye movement (REM) sleep in one subject and reduced REM sleep in the remaining seven subjects. CONCLUSION: Our study confirms that clonidine markedly decreases REM, even at a low single dose, and supports the hypothesis of the important role of alpha 2-receptors in controlling REM sleep.
Adrenergic alpha-Agonists↗