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Biomedical subjects

A Grieco

Publications and source records attributed to A Grieco.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Epidural spinal stimulation in the treatment of refractory angina pectoris. Its clinical efficacy, complications and long-term mortality. An Italian multicenter retrospective study].

BACKGROUND: Spinal cord stimulation has been used for many years in the treatment of refractory angina pectoris. Its anti-anginal and anti-ischemic effect has been well documented in several studies, but the long-term efficacy, safety and survival rate are not well known. The aim of this study was to carry out a retrospective analysis of a series of patients from the Italian Multicenter Registry, the data of which were collected in five centers, by means of a questionnaire. METHODS: One hundred and thirty patients (83 males, 47 females, mean age 74.8 +/- 9.8 years) were submitted to spinal cord stimulator implantation for refractory angina pectoris in the period 1988-1995 and controlled during a mean follow-up of 31.4 +/- 25.9 months. A previous myocardial infarction had already occurred in 69.3% of patients, whereas in 67.6% multivessel coronary artery disease was documented. A left ventricular dysfunction (ejection fraction < 0.40) was present in 34% of patients; bypass surgery and coronary angioplasty were performed in 49.6% and in 27% of patients respectively. In 96.3% of cases revascularization procedures were not advisable. RESULTS: A complete follow-up of 116 patients (89.2%) was available. The spinal cord stimulator induced a significant reduction in NYHA functional class from 2.5 +/- 1.2 to 1.5 +/- 0.9 (p < 0.01). During the follow-up 41 patients (35.3%) died, and in 14.2% a new acute myocardial infarction developed. The total percentage of minor spinal cord stimulation-related complications was 6.8%. No major complications occurred. The annual total mortality rate was 6.5%, whereas the cardiac mortality rate was 5%. Compared to the survivors, patients who died showed a higher incidence of left ventricular dysfunction, previous myocardial infarction and bypass surgery at implantation. CONCLUSIONS: In our experience, spinal cord stimulation is an effective therapy in patients affected by refractory angina pectoris and who cannot undergo revascularization procedure. The complication rate is low, with the total and cardiac mortality showing a trend as that reported for patients with similar coronary disease.

Aged↗
PubMed2000

[The assessment of the coronary risk in a work setting. The results of the SEMM study and the outlook for prevention in Italy. Surveillance of Employees Municipality of Milan].

BACKGROUND: The goals of the present report are to assess the differences in distribution of traditional coronary risk factors in a work setting, aimed at identifying specific groups at risk and to compare mean values of such risk factors and of an overall risk score of the entire working sample with the results observed in the third WHO-MONICA population survey carried out in northern Italy (Area Brianza). METHODS: In the SEMM study 7872 employees (2601 men and 5271 women) were enrolled between 1992 and 1996. The third MONICA survey in Brianza was carried out on an age- and gender-stratified random sample of 831 men and 884 women in 1993-1994, selected from the 25-64-year-old residents of five municipalities, representative of the study population. In both studies coronary risk factors were measured according to the MONICA protocol, adopting standardized methods. RESULTS: In comparison with the MONICA population sample, the entire working group showed lower mean levels of blood pressure and total cholesterol, higher prevalence of current cigarette smokers and lower mean levels of HDL cholesterol, in both gender groups. Prevalence of overweight subjects was higher among men in the working group, but the opposite pattern was detected in women. The overall risk score, calculated using the coefficients of a proportional hazard survival equation estimated in a large collaborative Italian follow-up study, resulted lower in the working sample, in both gender groups. This result may be attributed to a selection bias known in occupational epidemiology as "healthy worker effect". In contrast to this finding, the prevalence of smokers, in particular among women, was higher in the employed sample, indicating that working stress conditions may play some role. CONCLUSIONS: In order to extend the assessment of cardiovascular risk factors as well as prevention activities in work settings, some advantages are highlighted: the high participation rates, the feasibility to adopt standardized protocols, and easier and cheap procedures for censoring in follow-up studies. Moreover, due to the recently adopted legislation in Italy which increases the number of working categories to be included in periodic clinical examinations, prevention activities in work settings to contrast the epidemic of widespread chronic diseases, like cardiovascular diseases, are encouraged. This will also allow for the investigation of individual variations over time of coronary risk factors.

Adult↗
PubMed2000

[The reform of the Italian Health Service: some concerns].

The new Italian health care reform (law 229/99) introduces relevant structural changes promoting a central role of the state government. We describe the reasons for concern caused by this administration strategy, owing also to the recent need for reforming the old state-centered health care service with new management models introduced by law 502/92. We emphasize the importance of a distinction between the role of physicians and their professional organizations on one side and the role of the administrative institutions on the other, in order to develop a health care system which operates correctly. We discuss the role of guidelines and scientific societies.

Guidelines as Topic↗
PubMed2000

[Single-lead DDD cardiac pacing: state of the art and future perspectives].

The electrical treatment of advanced atrioventricular block, with normal sinus node function, can be successfully and safely performed with single-lead atrial floating electrode VDD pacing. In comparison with two-lead DDD pacing, it offers some important advantages: easier and less time-consuming implantation procedures, simpler follow-up controls, and lower medium and long-term complication rates. However, should sinus node dysfunction develop, the atrium cannot be paced with this special kind of cardiac stimulation. For this reason, in the last few years, a particular research field has developed to overcome this problem. In this paper, the literature is reviewed, with special attention to the studies analyzing the commercially available leads and some prototypes implanted, outlining the pros and cons. The high stimulation energy, the inconstant atrial capture, and phrenic nerve stimulation are still unresolved problems. The reliability and efficacy of single-lead DDD pacing will presumably depend, in the future, on the development of preshaped, new-designed electrodes, with stable contact with the atrial wall, and on new stimulation waveforms. In this context, however, particular attention should be devoted to the correct atrial signal detection.

Cardiac Pacing, Artificial↗
PubMed1999

Hermeneutics and the philosophy of medicine: Hans-Georg Gadamer's platonic metaphor.

Taking as our starting point Plato's metaphor of the doctor as philosopher we reflect on some aspects of the epistemological status of medicine. The framework to this paper is the hermeneutics of Hans-Georg Gadamer which shows the paradoxical nature of Western medicine in choosing the body-object as its investigative starting point, while in actual fact dealing with subjects. Gadamer proposes a model of medicine as the art of understanding and dialogue, which is capable of bringing together its various constituent parts, i.e. knowledge, knowing how to do and knowing how to be, in medical practice and in the physician's training. The paper concludes with a brief discussion of the dyadic figure of the physician as Platonic "master of the living totality" and wounded healer, capable of activating the patient's self-healing capacity.

Art↗
PubMed1998

Epidemiology of musculoskeletal disorders due to biomechanical overload.

The link between occupation and musculoskeletal disorders has been focused on in numerous research projects, ranging from those simply observing the different pathological findings reported among workers performing particular tasks, down to the latest studies actually quantifying the 'exposure' of workers to physical and psychosocial stimuli. For some disorders and certain tissues, it has been reported that specific types of work-related exposure are associated with the development of musculoskeletal pathologies, and that the relative risks for certain types of occupational exposure can be extremely high. This has been proven in relation to tendinitis of the shoulder and hand-wrist, carpal tunnel syndrome, as well as several localized aspecific musculoskeletal symptoms, such as pain. For other pathologies, the studies reported contradictory results. This is the case for lateral epicondylitis and cervical radiculopathy.

Biomechanical Phenomena↗
PubMed1998

Application of the concise exposure index (OCRA) to tasks involving repetitive movements of the upper limbs in a variety of manufacturing industries: preliminary validations.

A summary of eight investigations is presented, which were carried out using standardized methods, for the purpose of quantifying exposure to tasks involving repetitive movements of the upper limbs, as well as quantifying the prevalence of work-related musculoskeletal disorders (WMSDs) of the upper limbs in groups of exposed workers. A total of 462 exposed workers were examined, and the study also took into account the data pertaining to a matched reference group comprising 749 workers not exposed to any specific occupational risk. Regarding the quantification of exposure to increased risk, use was made of a concise index (OCRA index), proposed by Occhipinti, in this issue. The data resulting from the eight investigations were used for the study of measurements and models of association among the exposure variables (mainly represented by the OCRA index), as well as the effect variables represented by the prevalence of the various WMSDs of the upper limbs taken both individually and jointly. Significant associations were reported between the OCRA index and an effect indicator represented by the prevalence of all the WSMDs of the upper limbs, calculated on the number of upper limbs at risk. When a logarithmic conversion of the relative exposure (OCRA) and injury indices was carried out, a simple linear regression model resulted that seems to provide a satisfactory predictive performance of the risk of WMSDs of the upper limbs, based on the exposure index. The study confirmed the efficacy of various other models designed to predict effects based on multiple linear regression functions, in which the independent variables are represented by both the OCRA exposure index and by parameters relative to the breakdown by gender and age of the groups of exposed workers.

Arm↗
PubMed1998

Application of the Method of Organizational Congruencies in Substituting Organic Solvents With Vegetable Agents for the Cleaning of an Offset Printing Machine.

The aim of this research is the application of the Method of Organizational Congruencies before and after the substitution of organic solvents with vegetable agents for the cleaning of an offset printing machine in order to assess the organizational changes. A solvent-free process is the goal of the Subsprint Project (Technology Transfer Program of the European Community). This study shows how human and environmental health is improved by using vegetable agents, though this change may lead to some other organizational constraints such as an increase of the time needed, monotony, and repetitiveness of the technical actions involved. The authors underline that the knowledge of the impact of the new technology on health helps a better understanding of the resistance to the change and its further amelioration.

Journal Article↗
PubMed1998

Antipyrine clearance in chronic and neoplastic liver diseases: a study of 518 patients.

Antipyrine metabolism is widely used as an index of the drug-metabolizing reserve of the liver. It is well known that metabolism of this drug is impaired in subjects with acute hepatitis or cirrhosis, but conflicting data have been reported regarding patients with chronic postinfectious hepatitis or liver cancer. We studied conventional liver-function parameters and antipyrine metabolism (antipyrine per o.s. 18 mg/kg) in 518 subjects. One hundred and one patients had liver metastases (various primaries). Based on the number and size of lesions, the hepatic involvement was considered minimal in 47 and massive in 54 (groups B1 and B2, respectively). One hundred and two had chronic active hepatitis (CAH); 51 patients with histological evidence of fibrosis/early cirrhosis and 51 patients were without histological evidence of fibrosis/early cirrhosis. Ninety-two had histologically confirmed cirrhosis (group D), and the remaining 120 had cirrhosis and hepatocellular carcinoma (group E). The control group was composed of 103 subjects with healthy livers (group A). Antipyrine clearance (AP Cl) in CAH patients with fibrosis (0.246 +/- 0.98 mL/min per kg) was similar to that observed in patients with cirrhosis (0.223 +/- 0.148 mL/min per kg), and both values were significantly lower than that found in CAH patients without fibrosis (0.406 +/- 0.159 mL/min per kg, P < 0.01). Antipyrine clearance in patients with liver metastases (0.426 +/- 0.174 mL/min per kg) was similar to that of the healthy group (0.489 +/- 0.210 mL/min per kg). Cirrhotics and cirrhotics with hepatocellular carcinoma (HCC) presented similar degrees of impairment. Antipyrine clearance was positively correlated with serum albumin (r2 = 0.10, P = 0.01) and prothrombin time (r2 = 0.129, P < 0.01) in all groups, except those with liver metastases. In patients with CAH, the presence of fibrosis/cirrhosis is associated with impaired antipyrine metabolism. The lack of impairment in groups with liver metastases suggests that the functional hepatic reserve is maintained even in the presence of massive neoplastic invasion.

Adolescent↗
PubMed1998

Efficacy and safety of permanent cardiac DDD pacing with contemporaneous double spinal cord stimulation.

Spinal cord stimulation (SCS) is currently used to treat peripheral vascular disease (PVD) and refractory angina pectoris not amenable to revascularization. In a case of contemporaneous SCS implant and permanent cardiac pacemaker (PPM), if multipolar electrodes are used it is possible to avoid any interference between the systems. We describe the case of a patient with a DDD pacemaker, in whom two bipolar SCSs were implanted at different times: one to control refractory angina pectoris and the other for PVD. No interference between the three systems has been observed.

Aged↗
PubMed1998

[Epidural spinal cord stimulation in the treatment of refractory angina pectoris. Mechanisms of action, clinical results and current indications].

The spinal cord stimulation (SCS) is an antalgic technique which has been used since 1967 for the treatment of several painful syndromes. More recently it was employed in cardiology to treat refractory angina, not suitable for revascularization. Despite the fact that published results on this subject have reported small, non-homogeneous series, and that the mechanisms of action are not completely understood, we can affirm according to the analysis of the literature and our own experience that SCS causes improvement in quality of life, reduction in frequency of angina attacks and reduced consumption of rapid-action nitrates. There is also evidence that electrical stimulation has a definite anti-ischemic effect, as revealed by increased work capacity, improved lactate metabolism and reduced downward slope of ST segment at comparable maximum work load. In expert hands SCS implantation is associated with relatively low frequency of complications, whose incidence is greatly reduced if the main contraindications are respected, particularly in patients receiving anticoagulants or with an infection.

Aged↗
PubMed1998

Cholestatic hepatitis due to ticlopidine: clinical and histological recovery after drug withdrawal. Case report and review of the literature.

A 72-year-old housewife presented with clinical and laboratory signs of acute cholestatic hepatitis. Symptoms had appeared 6 months after she was started on ticlopidine 250 mg/day. Infectious aetiologies were excluded by serology and there was no history of alcohol abuse or use of other drugs. Clinical findings were confirmed by liver biopsy. The drug was discontinued and symptoms gradually subsided. A second biopsy obtained during this phase documented complete resolution of the hepatic damage. A review of the literature shows that the late onset of hepatic toxicity in this case is unique and this is the first report to include histological documentation during the acute phase and after recovery.

Aged↗
PubMed1997

Manual handling of loads: the point of view of experts involved in the application of EC Directive 90/269.

This paper illustrates the viewpoint of a group of Italian research workers who have been directly involved in providing criteria and guidelines for application of EC Directive 90/269, Manual handling of loads. The problems posed by application of the Directive in Italy and which are mainly related to exposure assessment, health surveillance and risk management (work and workplace redesign) are thoroughly examined. Major questions still to be solved include defining methods for assessment of multiple and complex load handling tasks, identifying data sources on 'health effect' trends as investigated in a working population with low exposure or in the general population in order to fix action levels, and setting up a data bank of technical and organizational solutions and products accessible to experts and users.

Accidents, Occupational↗
PubMed1997

[Transurethral incision of the prostate].

In this paper the Authors present the preliminary results of an investigation of a series of a patients with BPH who have undergone TUIP by modified monolateral incision. Post-operative complications, hospital stay and short-term urine flow values have been assessed. From June '94 to April '96 at the Department of Urology of the Hospital of Matera, 56 patients with BPH-induced cervico-urethral obstruction undergone TUIP. Their average age was 66; the average follow up was 9.5 months. Thirty-one of them ha bladder catheters. The patients were selected by ultrasonographically measured prostatic volume (< or = 30 gr). The operation was almost in all cases conducted under spinal anaesthesia. A 5-10 mm-long monolateral incision was made medial to the right urinary meatus, starting just behind the trigonal bar and going up to the pre-spyncteric region, laterally to the veru montanum. The incision was made up to the section of the muscle fibres of the trigone and those of the prostate capsule, exposing the fat. Post-operative assessment included a urine culture after 15 days as well as a urine flow measurement every three months. The operative took an average of 10.3 minutes. The catheter was removed on average after 2 days. Post-operative hospitalization lasted on average 3.9 days. No post-operative complications were encountered. Only in 3 cases in which a catheter with no Coudè tip was used, was it difficult to insert. In no case was a blood transfusion necessary. Six patients with normal pre-operative sexual activity maintained their normal ejaculation. Of the 29 patients that had got through the 3-months' follow-up, seven who had been catheterized before the operation, showed, along with an average volume of urine of 236.7 cc, a maximum flow value of 10.8 ml/sec., an average flow of 6.8 ml/sec. and a bladder emptying time of 36.8 sec. The other 22 patients had an average maximum flow speed of 20.5 ml/sec. (+121.5%), an average flow of 10.3 (123.9%), an emptying time of 33 sec. (-8.8%) with an average volume of urine of approximately 300 cc (+58.9%). Thus, in view of the noteworthy post-operative improvement in the symptomatology, both in subjective and objective terms, as well as the low rate of complications and the considerably reduced costs, TUIP may be considered a valid surgical alternative for treatment of BPH with adenomas weighing < or = 30 gramis in selected patients.

Aged↗
PubMed1996

Massive haemobilia after percutaneous liver biopsy in a patient with POEMS syndrome successfully treated by arterial embolization.

A 65-year-old woman with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) developed severe upper right quadrant colic with jaundice, massive haematemesis and melaena following an apparently uncomplicated percutaneous liver biopsy performed for suspected liver involvement. Symptom onset occurred about 18 hours after the procedure. Haemobilia was diagnosed on endoscopic retrograde cholangiopancreatography. An arteriovenous fistula in the third hepatic segment was demonstrated by transfemoral arteriography and successfully embolized using Gelfoam pledgets mixed with Ivalon fragments. A review of percutaneous liver biopsy related haemobilia is presented.

Aged↗
PubMed1994

[Primary carcinoid of the umbilicus. Description of the 1st case].

A 78-year old male came to our observation presenting and enlargement of bilateral inguinal lymph nodes and a tumor of the mesogastric abdominal wall. Three years before the patient had been operated on for a primary tumor of the umbilicus with concomitant longstanding diarrhea. No histological examination was performed at that time. We performed a lymph node biopsy which demonstrated carcinoid metastasis. We went on to perform radical resection of the abdominal wall, regional lymphadenectomy and right hemicolectomy for malignant villous adenoma of the right colon. The abdominal defect was repaired by using Goretex mesh. Cyclic adjuvant alpha-interferon therapy was continued for more than 1 year, followed by long term therapy with longastatin. Twenty months after the operation the patient is in good clinical conditions and disease-free. On the basis of literature review our case appears to be the first primary carcinoid of the umbilicus.

Abdominal Muscles↗
PubMed1993

Study of distribution and characteristics of spinal disorders using a validated questionnaire in a group of male subjects not exposed to occupational spinal risk factors.

This article presents the content and the application criteria of a questionnaire intended for the study of spinal disorders in workers and the results of an investigation, carried out via this questionnaire, in a group of 1205 male workers not exposed to occupational risks for the spine either currently or in the past. The data, stratified into three age classes (26-35, 36-45, and 46-55 years) concern: cases of disc herniation, cases of acute lumbago, subjects with spinal disorders in the period before the last 12 months. In addition, for each spinal segment (cervical, thoracic, and lumbar) data are reported on cases classified as positive according to predefined criteria, cases with disorders of any degree, disability caused by disorders, absence from work, and recourse to treatment for disorders. These data constitute a reference for cross-sectional epidemiologic studies on the diffusion and features of spinal disorders in workers exposed to occupational risks for the spine, performed using the same questionnaire. The authors discuss selection criteria and criteria for use of the data in inferential analysis for the purposes of producing correct assumptions on the causal relationships between occupational risk and spinal disorders.

Adult↗