A method is described for simultaneous measurement of total body water, extracellular body water, plasma volume, exchangeable potassium pool employing radioactive tracers (3H2O, Na235SO4, 42KCl and 125I human serum albumin). Some suggestions are made that are particularly applicable to routine use in anuric and/or dialyzed patients. The observed values fit well with the values predicted for a reference subject.

Anuria↗

PubMedDate not supplied

Vascular tissue banking: state of the art.

INTRODUCTION: The cardiovascular homograft banks in Italy were set up in 1994 in Milan (Lombardia) and Treviso (Veneto) and in 2001 in Bologna, Emilia Romagna. In this study we briefly summarize the data from Emilia Romagna Cardiovascular Tissue Bank. MATERIAL AND METHODS: In Emilia Romagna, vascular homografts were harvested from brain-dead multiorgan donors (aged 15-55 years) by a dedicated vascular surgery team. All donors were virologically screened for human immunodeficiency virus (HIV), hepatitis B and C, Treponema pallidum, cytomegalovirus (CMV), and Toxoplasma. After transferring the vascular homografts to Emilia Romagna Cardiovascular Tissue Bank facilities, the arteries were prepared, classified (class III to I), and transferred to an antibiotic-containing solution under a laminar flow cabinet. After the decontamination, all homografts were cryopreserved and stored in the vapour phase of liquid nitrogen. Microbiological tests were performed in all phases of preparation. Samples were routinely taken from 1 vessel and formalin fixed for the histology. Bags with cryopreserved homografts were sent in dry ice to the hospitals when required and thawing protocol of the Bank was included. RESULTS AND CONCLUSIONS: From January 2002 to October 2004, 543 homografts from 125 heart-beating donors were harvested and transferred to Emilia Romagna Cardiovascular Tissue Bank. After preparation, 459 of 543 (85%) were cryopreserved and stored. Vascular homografts classified class I were discarded. Other criteria of rejection were: (1) positive serology, and (2) persistent positive microbiology after decontamination. From March 2002, 333 cryopreserved homografts were assigned to several vascular surgery departments in Italy. The assessment of 3-year activity of Emilia Romagna Cardiovascular Tissue Bank might be used as an indicator of the efficiency of selecting, cryopreserving, and allocating quality-controlled vascular homografts.

Adolescent↗

PubMedDate not supplied

A cost-effective sestamibi protocol in the managed health care era.

BACKGROUND: In the managed health care era a need exists to lower the cost of diagnostic tests for coronary artery disease. One possible approach is to eliminate the rest study in the conventional stress-rest perfusion imaging protocol with single photon emission computed tomography. OBJECTIVE: The aim of the study was to determine the frequency with which single stress single photon emission computed tomography acquisition can be used to diagnose disease in normal patients compared with dual stress-rest protocol. STUDY GROUP: Two hundred patients without history of myocardial infarction, coronary revascularization, valvular disease, dilated cardiomyopathy, or left bundle branch block undergoing 1-day (n = 86) or 2-day (n = 114) stress-rest sestamibi imaging were studied. The stress was exercise in 147 patients and pharmacologic in 53 patients. RESULTS: On the basis of the stress study, 112 patients had normal images, and 88 patients had abnormal images. On the basis of the combined stress-rest images, 131 patients had normal images, and 69 patients had abnormal images (agreement 85%, kappa 0.68 +/- 0.05). Only 6 (5%) of the 112 patients with normal images based on the stress images were considered to have abnormal images by the combined stress and rest images. CONCLUSIONS: In patients with normal stress images elimination of the rest study rarely alters interpretation. Rest studies are most useful in patients with abnormal or equivocal stress images. Such selective elimination of the rest studies may decrease the cost of nuclear procedures and should be considered in the current managed care health system.

Adult↗

PubMedDate not supplied

[Patterns of care in community mental health services in Lombardy].

OBJECTIVE: The analysis aims to study patterns of care of patients in contact with 5 Psychiatric Services in Lombardy. Four patterns have been identified long term-high users, non long term-high users, long term-non high users, non long term-non high users. DESIGN: Data were provided by the regional Psychiatric Information System. The cohort of patients have been composed by 5,670 patients included in 1994 one year prevalence. SETTING: Five Psychiatric Services (Merate, Treviglio, Crema, Desio, Castano Primo) with a total population of 610,184 inhabitants aged over 14. MAIN UTILISED MEASURES: Some sociodemographic and clinical variables have been taken into consideration for a descriptive analysis; a multinomial logistic regression model was used to identify the characteristics of patients associated with different patterns. RESULTS: Long term-high users were 5.3%, i.e. a mean rate of 4.9/10,000 residents over 14, and absorbed 60% of resources, the absence of a partner was associated in regression analysis with this pattern. Non long term-high users were 1.2%, i.e. a mean rate of 1.1/10,000 residents over 14, and absorbed 7.8% of resources; age below 45, unemployment, absence of a partner, severe mental illness and first contact with Psychiatric Services in the period 1985-1989 were predictive variables. Long term-non high users were 23.4%, i.e. a mean rate of 21.6/10,000 residents over 14, and absorbed 18.1% of resources; age below 45, unemployment, living alone, absence of a partner, severe mental illness and first contact with Psychiatric Services before 1990 were predictive variables. Non long term-non high users were 70.1%, i.e. a mean rate of 64.8/10,000 residents over 14 and, absorbed 18.1% of resources. CONCLUSIONS: Data show that on the whole the activity of Psychiatric Services is addressed to most serious patients, though considerable differences between Psychiatric Services utilisation may be found. This study highlights the importance of a regional Psychiatric Information System, that allows the monitoring in time and in the regional territory of patterns of care.

Adolescent↗

PubMedDate not supplied

Sentinel node biopsy in breast cancer: the experience of Brescia Civic Hospital.

The accuracy of the sentinel node technique in the evaluation of axillary node involvement in breast cancer was evaluated in 83 consecutive patients with monofocal T1-2 carcinoma, who were clinically N0 and who underwent lymphoscintigraphy with 99mTc-colloid integrated with intraoperative sentinel node detection by a portable probe. Lymphoscintigraphy revealed at least one sentinel node in 75 patients (90.4%), always identified by the probe. In eight patients (9.6%) the sentinel node was detected neither by lymphoscintigraphy nor by the probe. All removed lymph nodes were analyzed by hematoxylin-eosin histology and the sentinel node by immunostaining. In 28/75 patients (37.3%) at least one metastatic axillary lymph node was detected; in 16 of the 28 N+ subjects (57%) only the sentinel node was positive. The false negative rate (sentinel node negative/other axillary lymph nodes positive) was 17.85% (5/28 patients). In 9/23 patients (39%) micrometastases were found in the sentinel node only. In conclusion, specific sentinel node positivity in 57% of cases supports the validity of the sentinel node concept. Moreover, nine patients would have been considered N0 by standard hematoxylin-eosin histology without sentinel node-aided immunostaining. A 17.8% false negative rate calls for caution in patients with negative sentinel nodes.

Adult↗

PubMedDate not supplied

[Alpha 1-antitrypsin deficiency: the Brescia clinical study].

In a longitudinal clinical study, two hundred subjects have been evaluated in order to identify alpha 1-antitrypsin deficiency patients. According to their serum alpha 1-antitrypsin levels, they have been divided into three groups: 25 patients with severe deficiency (with both pathological alleles--ZZ, SZ or Z and rare deficiency allele--and, if clinically suggested, to be treated with augmentation therapy), 92 patients with intermediate deficiency (with one pathological allele, to be followed up in order to evaluate the risk to develop deficiency related disease) and 63 healthy subjects (normal alleles MM). They performed lung function test (including cardiopulmonary exercise test and methacholine bronchial challenge) chest X-ray and high resolution computed tomography, blood tests. Severe deficiency patients also performed perfusional lung scan to detect early disorders of blood flow, evaluation of arterial blood gases and liver echotomography. Expiratory flow limitation, the prevalence of vascular disease, the amount of urine elastin products and correlations between the amount of nitric oxide exhaled and bronchial hyperresponsiveness have been also investigated. The study showed that in Brescia county the deficiency is more common than expected and that evaluation of liver and vessels might be as useful as lung function tests. In addition, beneficial effect on local system has been observed. The longitudinal study might permit to detect early organ damage and to eliminate additive risk factors.

Adolescent↗

PubMedDate not supplied

Results of [131I]metaiodobenzylguanidine treatment in metastatic malignant phaeochromocytoma.

The results obtained with [131I]metaiodobenzylguanidine (131I-MIBG) treatment in 6 patients affected by metastatic phaeochromocytoma are reported. Single doses of 3.7-7.4 GBq were given, in 1-6 courses, up to cumulative doses of 5.4-37.8 GBq. Objective responses were observed in 5 patients (2 tumour shrinkages, even if small; 5 lowering of blood pressure), which were only temporary in 3 patients and stable in 2. Complete disappearance of pain was obtained in 2/2 patients. No adverse side-effects were observed. The problem of treatment strategy in situations of stable disease deserves further study.

3-Iodobenzylguanidine↗

PubMedDate not supplied

The use of 99mTc(V)DMSA as imaging for the medullary thyroid carcinoma (MTC).

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Adolescent↗