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Biomedical subjects

G Bono

Publications and source records attributed to G Bono.

At least 127 records · Page 7Linked to original sources
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The Italian Multicenter Study of reversible cerebral ischemic attacks: IV--Blood pressure components and atherosclerotic lesions.

Utilizing the initial BP assessment in the 462 patients who entered the Italian Multicenter Study of reversible cerebral ischemia, an analysis of the effect of each BP component in respect of presence, extent and severity of atherosclerotic lesions, as displayed by angiography, was carried out separately for lesions located at either intra- or extracranial level. In a multivariate statistical model, among the following variables: sex, age, systolic BP, diastolic BP, cholesterol and smoking, systolic BP was found the best predictor of extent and severity of atherosclerotic lesions at extracranial level. None of the same variables was predictive of the severity of intracranial atherosclerosis. The results of this clinical study may confirm the indication, coming from physiopathologic observations, of a predominant role of systolic hypertension in the process of maintenance and acceleration of atherosclerosis in the large pre-cerebral arteries.

Age Factors↗
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Italian multicenter study on reversible cerebral ischemic attacks: VI--Prognostic factors and follow-up results.

A total of 462 patients (mean age 52 years) affected by reversible focal ischemic attacks (RIAs) were followed prospectively in 8 neurologic institutions in Italy for 4 years. All cases were evaluated with a cerebral angiography and 21% of angiograms were normal. At the end of the follow-up period the cumulated probability for death, stroke, cardiac event and new RIA was respectively 7%, 8%, 3% and 36%. The predictive value of the baseline characteristics of this series was evaluated by a multifactorial analysis which showed that RIA and stroke (specific cerebrovascular risk) were more likely to develop in patients with a history of more than one RIA and in those in whom multiple vascular territories were involved. Moreover, previous myocardial infarction, intermittent claudication, angina pectoris, time elapsed since the first attack, and duration and severity of the attack itself were independently associated with general cardiovascular risk (death, stroke and myocardial infarction). We conclude that predictive factors, and thus also pathogenetic mechanisms, may be different for general cardiovascular risk and specific cerebrovascular risk in RIA patients.

Adult↗
PubMedDate not supplied

[Pourfour du Petit syndrome and intracranial aneurysms (author's transl)].

A 52 year old female suffered for more than 20 years from a recurrent pulsating headache on the left side. Clinical examination showed the retraction of the superior eyelid and mydriasis on the left. Exophthalmometry revealed 17 mm of protrusion for each eyeball. Angiographic investigations showed two little aneurysms: one of the anterior comunicating artery, the second of the left middle cerebral artery. In view of the clinical and angiographic findings the authors discuss the pathogenetic mechanisms of such oculo-sympthetic syndrome.

Electrocardiography↗
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Unilateral headaches and their relationship with cervicogenic headache.

The concept of headache originating/starting in the neck is revised and considered in the light of previous descriptions of syndromes and entities and with reference to the current diagnostic systems for the classification of headache and other head pain. Cervicogenic headache (CEH), a clinical picture recently described by Sjaastad and coworkers and listed in the International Association for the Study of Pain (IASP) Classification, is analyzed, also taking into consideration its diagnostic criteria in terms of sensitivity and specificity. The problem of a differential diagnosis with migraine, tension headache and other well defined forms of unilateral headaches is discussed with reference to a case series of 114 patients who were selected based on their adherence to two fundamental criteria: (i) side-locked unilaterality of pain; and (ii) pain starting in the neck and spreading to the fronto-orbital area. Based on the results, these simple criteria can contribute to a preliminary identification of possible CEH cases that may then undergo a sequence of clinical and instrumental procedures in order to confirm the diagnosis and, possibly, to localize the level(s) of dysfunction in the cervical spine which may be the target for therapeutic investigations, whether invasive or non-invasive.

Diagnosis, Differential↗
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Whiplash injuries: clinical picture and diagnostic work-up.

The term "whiplash" commonly refers to symptoms and signs associated with a mechanical event such as a sudden acceleration and deceleration of the neck (due, in the majority of cases, to a road accident), instead of to the mechanism itself. The recent Quebec Classification of Whiplash Associated Disorders (WAD) contributed to define nosographically all the clinical manifestations usually grouped under the terms acute/post-traumatic and late "syndrome". In the late phase of WAD, neck pain and neck muscle contraction have been reported in all cases, together with headache in over 50%. "Headache stemming from the neck", despite numerous attempts to classify this entity (i.e. cervicogenic headache) according to the IASP classification (headache associated with neck disorders), is still a subject of debate. An adequate multiparametric procedure is required to study WAD, which takes into account: the patient's principal details; an exact reconstruction of the event; description and analysis of the signs and symptoms, with various complications and correlated dysfunctions; an objective neurological and neck-shoulder examination; and a battery of complementary instrumental tests which are described in this study. These investigations include evaluation of muscle tension (manual palpation, algometry, EMG recording), kinematic analysis of the cervical spine, neuropsychological and psychological evaluation, and evaluation of disability. In order to assess cervical spine mobility in WAD patients, a 3D kinematic analysis by means of the ELITE system and clinical evaluation were performed in our setting. Seventy patients with whiplash injury and 46 healthy volunteers were enrolled in the study. Patients were tested at the time of first consultation and again 6 months and 12 months later. Clinical evaluation of the range of motion was performed both in patients and in 41 healthy volunteers. Furthermore, patients diagnosed according to the WAD Classification as grade 2 (n = 68) or grade 3 (16) underwent a Quality of life (QoL) evaluation, measured using the short form (36-item) Health Survey (SF36) and the migraine-specific questionnaire (MSQ). According to our data, whiplash patients showed an impairment of cervical spine mobility, as well as a poor QoL, compared to a control group population, even though we observed a trend towards improvement over time in cervical ROM.

Biomechanical Phenomena↗
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Current methods for cervical spine movement evaluation: a review.

Cervical spine mobility is difficult to investigate accurately because of its anatomic structure and the compensatory movements. Different methods have been conceived in order to obtain a reliable measurement of cervical range of movement (ROM). We reviewed different instruments described in the literature: x-rays, CT and MRI, goniometer, inclinometer, cybex and related devices, and opto-electronic scanners. Cybex and 3D kinematic analysis by means of opto-electronic scanners (Elite system) seemed to be the most reliable and reproducible methods. Cybex equipment is relatively inexpensive and easy to use in a clinical setting, while the Elite system is expensive and requires special training of the personnel. However, the choice of method depends primarily on whether the physician's goal is a clinical screening or a thorough investigation of neck function (e.g., post-traumatic cervical spine disorders). For the first purpose, certain types of goniometers (gravity goniometer, ad modum Myrin), as well as the cybex, show good reproducibility and reliability in evaluating maximal cervical ROM (flexion-extension, rotation, lateral bending), while x-rays and, above all, 3D kinematic analysis (using opto-electronic scanners) are more suitable for diagnostic and follow-up evaluation of neck disorders.

Biomechanical Phenomena↗
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Functional improvement in patients with severe spinal spasticity treated with chronic intrathecal baclofen infusion.

In this retrospective study we evaluated the efficacy and functional benefits of chronic intrathecal baclofen infusion in severe spinal spasticity. Twenty patients with a diagnosis of severe intractable spinal spasticity were evaluated prior to implantation of a programmable pump for chronic intrathecal baclofen therapy and at follow up, which ranged from 12 to 36 months (mean 22.4 months). The mean age of the patients was 39.1 years. The prevailing pathology was multiple sclerosis. All were unable to walk. Patient assessment was based on the Ashworth Scale, the Spasms Frequency Scale, self-reported pain and Functional Independence Measure (FIM) scores. The Wilcoxon test was used for statistical analysis. A statistically significant decrease in muscle tone, spasms and pain was observed in all the patients. The Ashworth score decreased from 4.4 to 1.8, the spasms frequency score from 2.5 to 0.5 and the self-reported pain score from 5.5 to 2.3. The FIM score also showed a statistically significant change (increasing from a mean of 33.8 to 58.7). Two patients in employment were able to return to work. No severe side effects were observed. Chronic intrathecal baclofen infusion was seen to produce a functional improvement in patients with severe spinal spasticity, particularly as regards bathing, comfortable wheelchair sitting and mobility.

Adult↗
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Neuropsychological changes after carotid endarterectomy.

Carotid endarterectomy (CEA), performed to prevent stroke, could lead to changes in cognitive functions. Sixty-four patients with severe carotid stenosis undergoing CEA treatment were evaluated by means of a detailed neuropsychological assessment before (baseline), from one to two weeks (1st follow up) after and 3 months (2nd follow up) after surgical operation. A significant post-CEA improvement was found in verbal memory and attention (p<0.05), while other cognitive functions showed no significant changes.

Aged↗
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Antiplatelet treatment after carotid endarterectomy: a pilot study.

The present study was undertaken in patients subjected to endarterectomy for extracranial carotid stenosis in order to verify the efficacy and the safety of medical treatment with indobufen (2-[4-(1-oxo-2-isoindolinyl)-phenyl] butyric acid), a drug which has been successfully used in the long-term treatment of cardiovascular ischemic diseases, and which showed a significant antiplatelet effect. One hundred thirty-eight patients entered into the study with previous diagnosis of cerebrovascular ischemic event within 3 months before surgery. Patients were treated after surgery with indobufen 400 mg/die/orally in the first 2 months after discharge and than 200 mg/die/orally. The planned duration of medical treatment was 24 months. Any patient interrupting the medical treatment for a cumulative period greater than 30 days/year was excluded from the analysis; the end points of the study were considered death and the occurrence of disabling stroke. Eleven patients were considered as dropped out because of treatment interruption. The operative (at 1 month after surgery) mortality rate was 0.79%. The cumulative operative mortality and morbidity rate was estimated in 2.37%. The mean follow-up period was 6 months and the cumulative mortality rate at 36 months was estimated in 7.14%. The cumulative risk/year of TIA or ischemic stroke is higher than the risk for myocardial infarction, but the long-term mortality rate mainly depends on the latter complication which occurred later. Treatment with indobufen after carotid surgery seems to be effective as far it was restricted to an homogeneous group of patients presenting symptomatic extracranial carotid disease.

Aged↗
PubMedDate not supplied

Tumor necrosis factor alpha levels in serum and cerebrospinal fluid of patients with AIDS.

We used a sensitive enzyme-linked immunosorbent assay technique to measure tumor necrosis factor alpha (TNF alpha) levels in serum and cerebrospinal fluid (CSF) samples from 30 patients infected with human immunodeficiency virus type 1 and from 10 normal controls. We found detectable levels of TNF alpha in 19 of 30 CSF and in 17 of 30 serum samples. The values of TNF alpha ranged between 20-90 pg/ml. All the patients had overt AIDS. More elevated TNF alpha levels in CSF correlate with focal damage within the central nervous system (p less than 0.01). Our results suggest that an intrathecal production of TNF alpha may occur during active inflammation in course of AIDS.

AIDS Dementia Complex↗
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Cognitive and neuroradiological findings in myotonic dystrophy.

Cognitive functions were investigated in 37 patients with myotonic dystrophy (MD) and correlated with clinical and neuroradiological variables. The whole cognitive performance was at a low-average level; in about 1/3 of the subjects, in fact, the scores at the neuropsychological tests were below the normal range. There was a consistent trend for patients with inheritance on maternal side to perform worse on Wechsler verbal score and to present cerebral atrophy. In 7 out of 12 subjects focal white matter lesions were found at nuclear magnetic resonance. The significance of these findings and its relation to cognitive performance are discussed.

Adult↗
PubMedDate not supplied

Analysis of higher nervous functions in migraine and cluster headache.

Three groups of patients, long-time sufferers from classic migraine, common migraine, and cluster headache respectively, and three control groups, age- education- and sex-matched, underwent a set of neuropsychological tests and tachistoscope tasks in order to evaluate cognitive functions and interhemispheric balance. Migraineurs and cluster headache patients were selected on the basis of the constant (90%) unilaterality of both pain and focal neurological deficits. No significant differences emerged between patients and controls in any of the neuropsychological and tachistoscopic tasks administered, thus indicating that between attacks of migraine as well as of cluster headache no evidence of cortical dysfunction is detectable.

Adult↗
PubMedDate not supplied

[Lithium salts in the treatment of cluster headache].

After analysing personal results and the data in the literature concerning the therapeutic effects of Lithium salts in cluster headache, the Authors discuss some of the pathogenetic problems related to this particular form of idiopathic headache. The results obtained seem very favourable however the therapeutic efficiency of Lithium salts, also observed in neuralgic-vasomotor syndromes (Charlin, Sluder) and in some forms of chronic headache, seems to indicate a relatively unspecific mechanism of action. The Authors suggest therefore an intervention in the stabilization of the membrane at the CNS level, with increasing efficiency of "antinociceptive" system.

Adult↗
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Functional opioid activity variates according to the different fashion of alcohol abuse.

Two groups of alcohol addicts (total of 14 subjects), were submitted to Traditional Manual Acupuncture and pituitary hormone plasma levels, including B-Endorphin (B-EP), were measured in basal condition and after 1, 5, 20 and 60 minutes from needle withdrawal. Group A patients had a polarity towards negative affective tone presenting signs of dysphoria while group B was composed of the so-called "social drinkers". No difference existed in basal hormonal values, except slightly elevated plasma B-EP levels in group A. No significant responses to TMA were recorded in plasma ACTH, Cortisol, Prolactin or GH levels in groups A and B. Social drinkers showed an increase of B-EP plasma levels in response to TMA (128 +/- 62.1%, mean +/- SD) which on the contrary was absent in dysphoric alcoholics (2.8 +/- 38.6%, p less than 0.01). The same was true for B-Lipotropin plasma levels. These preliminary results suggest that different fashions of alcohol abuse may be associated with different reactivity of the endogenous opioid system.

Acupuncture Therapy↗