Conization of the uterine cervix: two different surgical techniques.
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Adult↗
Biomedical subjects
G Casella
Publications and source records attributed to G Casella.
An open multicentric study evaluating 4-hydroxybutyric acid sodium salt in the medium-term treatment of 179 alcohol dependent subjects. GHB Study Group.
We report the results of an "open' multicentre study evaluating the use, tolerability and therapeutic efficacy of the sodium salt of 4-hydroxybutyric acid (GHB) for the medium-term treatment of withdrawal symptoms in 179 patients with alcohol dependence followed up as outpatients. The follow-up of patients was 6 and 12 months after drug discontinuation. Following a daily oral administration of 50 mg/kg for approximately 6 months, no serious systemic or single-organ consequences leading to drug discontinuation were reported, and tolerability was fair in all patients. Eleven subjects (10.1%) showed craving for the drug and voluntarily increased their doses (6-7 times the recommended levels). GHB led to complete abstinence during drug administration in 78.0% of the patients. A significant reduction of compulsive desire ("craving') was observed in parallel, as deduced from evaluation of a specific questionnaire, the Alcohol Craving Scale. At follow-up examination, 43 of the treated subjects remained abstinent at 6 months, and 30 subjects were abstinent for 1 year after drug discontinuation.
Adolescent↗
Event-time analysis of the effect of 60-day milk production on the parturition-to-conception interval in dairy cows.
OBJECTIVE: To quantify the effect of early-lactation milk and milk fat production on time to conception. DESIGN: Event-time analysis (survival analysis). SAMPLE POPULATION: 44,450 cows delivering calves between September 1985 and September 1986, from 6,227 Ayrshire dairy herds in 80 Finnish communities. PROCEDURE: Primiparous and multiparous cows were analyzed in separate Cox proportional hazards models. 60-day milk and milk fat production were categorized and regressed against days from parturition to conception for the period 56 to 120 postpartum days, controlling for season of parturition, parity, herd production, occurrence of 43 diseases, and community. RESULTS: Multiparous cows producing above the 80th percentile for 60-day milk, but with milk fat production below the 75th percentile, were significantly more likely to conceive, compared with cows with lower production and compared with cows with similar milk production but with milk fat between the 75th and 97th percentiles. They were slightly more likely to conceive than cows with highest milk fat production, although not significantly so. Primiparous cows producing above the 80th percentile for 60-day milk with milk fat below the 75th percentile also had the highest conception probability. The highest producing primiparae had significantly lower conception probability than all others. CONCLUSIONS: Controlling for disease occurrence, calving season, parity, herd production level, and community, there appeared to be an inverted U-shaped relation between 60-day production and conception probability. CLINICAL RELEVANCE: Primiparous cows that are high producers may not be receiving the same careful management that high-producing multiparous cows receive.
Aging↗
Event-time analysis of the effect of season of parturition, parity, and concurrent disease on parturition-to-conception interval in dairy cows.
OBJECTIVE: To quantify the effect of season of parturition, parity, and various diseases on time to conception. DESIGN: Event-time analysis (survival analysis). SAMPLE POPULATION: 44,450 cows delivering calves between September 1985 and September 1986, from 6,227 Ayrshire dairy herds in 80 Finnish communities. PROCEDURES: Primiparous and multiparous cows were analyzed in separate Cox proportional hazards models for postpartum days 56 to 120. Occurrence of 43 diseases or disorders was recorded; codes were condensed into 25 variables offered to each model. Season of parturition was categorized into spring, summer, and fall-winter; for multiparous cows, 3 categorical variables represented parity. Models controlled for 60-day milk and milk fat production, herd milk production, and community. For all observations, parturition-to-conception interval was plotted against calendar day of parturition. RESULTS: For multiparous cows, parturition in the spring or summer and being of parity 2 or 3-4 (vs older) increased the chance of conceiving; 10 diseases or disorders decreased this probability. Similarly, in the model for primiparae, parturition in spring or summer increased the probability of conception, and 6 disorders decreased it. Disorders that were detrimental in both models were anestrus, ovulatory dysfunction, other infertility, late metritis, and clinical ketosis. CONCLUSIONS: The effect of season on the parturition-to-conception interval was marked at this latitude. Parturition during late April, causing confluence of postpartum day 55 with the summer solstice, was associated with the shortest parturition-to-conception intervals. Ketosis was found to be an important factor in lengthening the parturition-to-conception interval, highlighting the effect of negative energy balance on postpartum restoration of reproductive function.
Animals↗
[ST segment depression during recovery after treadmill exercise test in stable patients with previous myocardial infarction].
BACKGROUND: The significance of exercise-induced ST segment depression is well known while limited data are available on the clinical/prognostic power of ST depression occurring only during recovery. Aim of the study was to clarify the clinical/prognostic value of "recovery only" ST depression in stable patients late from myocardial infarction (AMI) and to determine whether the addition of recovery data to exercise parameters improves the interpretation of exercise test. METHODS: From a population of 766 consecutive patients (mean age: 57.2 +/- 8.6 yrs.; male: 89%) who underwent a Bruce Treadmill test at least 1 year after a Q wave AMI and whose exercise data were prospectively entered in the database of our Institution, 4 different Groups were identified: 1) 99 patients with a negative exercise test; 2) 53 patients with "exercise only" ST depression; 3) 140 patients with "exercise and recovery" ST depression; 4) 31 patients with "recovery only" ST depression. The main clinical and exercise data and a cardiac follow-up (average mean length: 1530 +/- 600 day) were evaluated by one-way analysis of variance, Bonferroni T-test, chi-square, relative risk (RR) with 95% confidence intervals (CI), Kaplan-Meler method and log-rank. RESULTS: Baseline clinical parameters were similar in the 4 Groups except for older age in Group 3 compared to Group 2 (< 0.05) and higher prevalence of anterior AMI in Group 4 compared to others (= 0.004). Patients with exercise and recovery ST depression or with "recovery only" ST depression had significantly less exercise tolerance than patients with negative exercise test or "exercise only" ST depression [exercise duration (< 0.05, Group 1 vs. 3, vs. 4; Group 2 vs. 3), peak rate pressure product (< 0.05), maximal heart rate (< 0.05; Group 1 vs. 2; vs. 3; vs. 4)]. Exercise-induced ST depression was higher and angina was significantly more frequent in patients with exercise and recovery ST depression as well as an high Mark's risk score (< 0.001). Only patients with exercise and recovery ST depression demonstrated significantly higher risk of overall mortality (RR: 1.35, CI: 1.04-1.74), unstable angina (RR: 1.34, CI: 1.09-1.65) or revascularisation procedures (RR: 1.51, CI: 1.25-1.83). Relative risk of patients with "recovery only" ST depression was similar to that of subjects with "exercise only" ST depression. CONCLUSIONS: In stable patients with old Q wave AMI, "recovery only" ST depression is rate, but does represent a true sign of ischemia. It could be associated with indirect indexes of worse ventricular function. The prognostical power of "recovery only" ST depression is mild, although similar to that of "exercise only" ST depression. Moreover the presence of ST depression not only during exercise but also during the recovery phase identifies patients with more severe prognosis. Therefore the inclusion of findings from the recovery phase in the analysis of the exercise test could increase the predictive power of the test itself.
Aged↗
CEDIA for screening drugs of abuse in urine and the effect of adulterants.
The performance of the Microgenics CEDIA DAU assays for screening amphetamines, barbiturates, benzodiazepines, cocaine, opiates, phencylidine (PCP), and tetrahydrocannabinol (THC) was evaluated on the Boehringer Mannheim/Hitachi 717 in urine. Limits of detection ranged from 0.6 ng/mL for PCP, to 34.1 ng/mL for benzodiazepines. The average within run and total precision for these assays ranged from 1.3 to 7.3% for controls at cutoff concentrations, and control values at -25% and +25% of cutoffs. The rate separations by CEDIA between the negative and cutoff calibrators for all drugs were greater than corresponding EMIT II (Syva Co.) assays. The relative sensitivity and specificity of CEDIA as compared to EMIT II were 95.6 and 98.8%, respectively, on 13,535 urine samples. All positive samples, and those samples producing discordant results between the assays were confirmed by quantitative gas chromatography/mass spectrometry (GC/MS). Using SAMHSA cutoff limits (and including barbiturates and benzodiazepines at 300 ng/mL), the relative sensitivity and specificity of CEDIA vs. EMIT II were 96.7 and 98.8%, respectively. The overall sensitivity of CEDIA vs. GC/MS was 98.9% with 179 false positives, as compared to 96.2% with 189 false positives for EMIT II vs. GC/MS. The effect of adulterants added to urine to potentially invalidate screening results was also tested. CEDIA produced strong interferences for most drug assays in the presence of glutaraldehyde, detergent, and high concentrations of bleach and Drano. Minimal or selective interferences were seen with golden seal tea lemon juice, Visine, and low concentrations of bleach and Drano. Essentially no interference was observed with bicarbonate, sodium chloride, and vinegar.
Gas Chromatography-Mass Spectrometry↗
Prevention and treatment of complications after endoscopic prostheses placement in tumors of the upper gastrointestinal tract.
Endoscopic intubation is a popular palliative method to resolve immediately malignant dysphagia. However, the complication rate is still high. Between 1978 and 1993, at the Division of Diagnostic and Surgical Endoscopy of Istituto Nazionale Tumori in Milan, 305 patients suffering from malignant dysphagia, were endoscopically treated by insertion of an endoprosthesis. We report the analysis of data regarding our complication rate, compared with the literature, and our experience in preventing managing complications related to this endoscopic procedure.
Adult↗
Efficacy of long-term administration of transdermal nitroglycerin in asymptomatic patients with effort-induced silent myocardial ischemia.
The aim of our study was to investigate the effect of transdermal nitroglycerin (NTG) on effort-induced silent myocardial ischemia in asymptomatic patients treated with beta-blockers or calcium antagonists. The acute effect was compared to two different schedules, continuous (24 h/day) or intermittent (16 h/day), of long-term administration. Ten asymptomatic patients with coronary artery disease and a treadmill test positive for ischemia without angina were enrolled. Both acute (2 days) and long-term (24 days) evaluations were conducted in a randomized, double-blind, crossover fashion. The ergometric parameters were collected on the 1st and the 2nd day of the acute phase (placebo and transdermal NTG, respectively) and at the end of each 12-day period of long-term administration (continuous and intermittent, respectively). Transdermal NTG administration acutely increased (p < 0.05) both time to 1-mm ST segment depression (451 +/- 43.2 vs. 374 +/- 24.1 s) and total exercise time (561.3 +/- 43.2 vs. 419.5 +/- 24.5 s). The acute efficacy was maintained over long-term treatment, regardless of the modality of administration. During continuous and intermittent patch application, time to 1-mm ST segment depression was 437.9 +/- 30.4 and 422 +/- 33.4 s (p = NS vs. acute) and total exercise time was 498.8 +/- 30.4 and 495.1 +/- 33 s (p = NS vs. acute), respectively. Transdermal NTG increases, both acutely and chronically, exercise tolerance in asymptomatic patients with effort-induced silent myocardial ischemia. With the NTG dose we used, tolerance does not seem to be a problem over long-term administration.
Administration, Cutaneous↗
Comparative hemodynamic effects of intravenous digoxin and enoximone in severe chronic heart failure.
In order to compare the acute hemodynamic effects of digoxin (0.01 mg/kg) and enoximone (1 mg/kg), a phosphodiesterase inhibitor inotropic agent, in severe chronic congestive heart failure, 8 patients (male, mean age 56.7 years, sinus rhythm) were investigated with a randomized cross-over study. Peak effect of enoximone (30 min) in comparison to that of digoxin (90 min) resulted in a similar reduction of left-ventricular filling pressure (-27 vs. -28%) and mean pulmonary artery pressure (-23 vs. -24%). Pulmonary (-39 vs. -16%; p < 0.01) and systemic vascular resistance (-27 vs. -4%; p < 0.001) were significantly lowered by enoximone. Cardiac index (+30 vs. +6%; p < 0.001) and heart rate (+11 vs. -3%; p < 0.05) were increased significantly more by enoximone than by digoxin. Since enoximone resulted in an enhancement of cardiac performance greater than that produced by digoxin, enoximone could be a useful and powerful substitute for digoxin in the acute therapy of severe chronic congestive heart failure with sinus rhythm.
Adult↗
[Preanesthesia in elderly patients undergoing subarachnoid anesthesia: chlordesmethyldiazepam versus diazepam].
Forty patients over 65 undergoing subarachnoid anesthesia with bupivacaine 0.50% (5 mg) and fentanyl (0.1 mg) were subdivided into two equal groups: one was premedicated with atropine and chlordesmethyldiazepam (0.03 mg/kg-1) and the other with atropine and diazepam (0.015 mg/Kg-1). A statistically significant difference was found in the group treated with diazepam which required an increase for anesthetic drugs during surgery. The authors suggest a probable synergic or an enhanced effect between intramuscular chlordesmethyldiazepam and opiates in spinal anesthesia.
Aged↗
Endoscopic treatment of polyps in the resected stomach.
Between 1974 and 1992, at the Department of Diagnostic and Surgical Endoscopy of Istituto Nazionale Tumori, in Milan, 27 patients with resected stomach and suffering from epithelial polyps of the gastric stump (10 lesions) and/or anastomosis (25 lesions), were endoscopically treated using electroresection (13 cases), electrocoagulation (2 cases), combined methods (electroresection plus Nd:YAG photocoagulation) (1 case) and biopsy forceps (19 cases). Complications occurred in 4 cases and consisted of hemorrhage. Seven patients developed 15 recurrences. Endoscopic treatment of polyps in patients with resected stomach is a safe and effective treatment, considering the low rate of complication.
Adult↗
Endoscopic treatment of gastric carcinoids.
Carcinoids are the most common endocrine tumours, and arise from a multipotential primitive stem cell; the gastric location represents 2% of all carcinoids. From 1979 to 1992 at the Endoscopy Division of Istituto Nazionale Tumori, Milan, 2 patients suffering from single gastric carcinoid were endoscopically treated by electro-resection. No complication occurred during the treatment; 2 year- and 5-year-follow-up was performed in these patients, and no recurrence are observed. Surgical treatment represents the therapy of choice for gastric carcinoids, but endoscopic resection can represent an alternative in selected cases (lesions less than 1 cm or carcinoids with multicentric growth). Endoscopy can be used also in patients at high surgical risk.
Carcinoid Tumor↗
Exercise-induced ventricular arrhythmias in patients with healed myocardial infarction.
BACKGROUND: Controversy exists about the clinical and prognostic significance of exercise-induced ventricular arrhythmias late after myocardial infarction. The aim of the study was to identify the main clinical and prognostic features of exercise-induced ventricular arrhythmias in out-patients with healed Q-wave myocardial infarction. METHODS: The study population was 777 consecutive patients who underwent a symptom-limited (Bruce protocol) treadmill test from May 1988 to January 1991 after myocardial infarction (at least 1 year). Clinical and exercise data were prospectively entered in a computerized database and retrospectively two different groups were selected: (1) 228 patients with exercise-induced ventricular arrhythmias; (2) 549 patients without. Incidence and morphology of exercise-induced ventricular arrhythmias, various exercise parameters and a follow-up were evaluated. RESULTS: Patients with exercise-induced ventricular arrhythmias were older (P < 0.001), had higher blood pressure (P < 0.03) and peak exercise rate pressure product (P < 0.00) than the others. No difference was found in the incidence of exercise-ischaemia: either symptomatic or not. When simple (< or = 2 Lown) versus complex (> or = 3 Lown) exercise-induced ventricular arrhythmias were considered, the latter were more frequent in patients with anterior myocardial infarction, shorter exercise duration (P < 0.001) and lower exercise rate pressure product, lower ejection fraction and lower incidence of exercise-induced ischaemia. In the follow-up (mean 24 +/- 13 month) there were 24 deaths: five (2.2%) in patients with exercise-induced ventricular arrhythmias and 19 (3.4%) in patients without. Cardiac event rate was similar in both groups. CONCLUSIONS: We conclude that in out-patients with healed myocardial infarction exercise-induced ventricular arrhythmias are quite frequent, but they are not associated with exercise-induced ischaemia, either symptomatic or not. Exercise-induced ventricular arrhythmias seem to be related to age or peak workload. Moreover patients with these arrhythmias have no adjunctive negative risk on prognosis.
Aged↗
Endoscopic resection of two cases of gastric carcinoids.
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Carcinoid Tumor↗
Duration of intracranial pressure monitoring does not predict daily risk of infectious complications.
A group of 205 patients (115 children and 90 adults) with a total of 212 intracranial pressure (ICP) monitors were retrospectively studied with attention to daily cerebrospinal fluid cultures, duration of monitoring, associated cranial injuries, and hospital site of the ICP monitor (intensive care unit or operating room). Only closed ICP monitoring systems without irrigation or compliance testing were used, and all patients received antibiotics as prophylaxis throughout the monitoring period. There were no complications associated with monitor placement. Incidence histograms and regression analysis were used to determine the daily risk of subsequent infections, in addition to evaluating the cumulative risk of infection, as has been previously described in the literature. No relation between the duration of ICP monitoring and the rate of daily infection through the period of maximal monitoring (1-2 weeks) was found in this series. The overall incidence of infection was 7.1% with a median duration of monitoring of 7.2 days. The age of the patient (adult vs. child), site of ICP monitor placement, and nature of the underlying disease (trauma vs. nontrauma) had no significant effect on the development of monitor-related infections in our study. These data indicate that the decision to continue ICP monitoring can be based solely on the clinical necessity for further monitoring rather than on concerns for monitor removal to prevent infection.
Adult↗
Comparison of nimesulide and diclofenac in the prevention and treatment of painful inflammatory postoperative complications of general surgery.
In a double-blind study, 40 patients scheduled for saphenectomy or inguinal hernioplasty were randomly assigned to treatment with nimesulide (200mg 3 times daily) or diclofenac (100mg 3 times daily) administered rectally. Therapy with either drug resulted in significantly less pain, oedema and hyperaemia, and resolution of mild fever. No adverse reactions attributable to treatment were observed.
Adult↗
The complementary effect of latrines and increased water usage on the growth of infants in rural Lesotho.
The effects of water quantity and sanitation, alone and in combination with each other, on infant weight gain and length gain were examined. Data on 119 infants were collected from 20 villages in rural Lesotho between July 1984 and January 1985. The interactions between sanitation and increased water usage for weight gain (p = 0.007) and length gain (p = 0.006) were significant after potential confounding was controlled. The biggest growth effects were dependent on families possessing a latrine and increasing their use of water during the warm, wet season. Infants gained 1.031 kg (95% confidence interval (CI) 0.420 to 1.642) and 2.028 cm (95% CI 0.523 to 3.533) more when both positive factors were present, as compared with only having a latrine. Increasing water usage compared with not increasing water usage resulted in only 0.105 kg (95% CI -0.175 to 0.385) more weight gain and -0.309 cm (95% CI -1.005 to 0.387) more length in the absence of a latrine. Similarly, infants gained 1.106 kg (95% CI 0.484 to 1.728) and 2.076 cm (95% CI 0.559 to 3.593) more if both factors were operating than did infants whose families only increased their water usage. In the nonincreased water group, the difference in growth between having and not having a latrine was 0.180 kg (95% CI -0.093 to 0.453) and -0.261 cm (95% CI -0.951 to 0.429). Water supply programs should emphasize use of more water for personal hygiene, and sanitation programs should install toilet facilities where water usage is high or has been increased because of an educational program.
Bias↗
Empirical methods for the estimation of the mixing probabilities for socially structured populations from a single survey sample.
"The role of variability of sexual behavior in the transmission dynamics of HIV and AIDS has been illustrated, through the use of mathematical models, by several investigators.... In this paper we describe some practical methods for estimating the deviations from random mixing from a single survey sample.... We include a description of the role of the estimated mixing probabilities in models for the spread of HIV, a discussion of alternatives and possible extensions of the methods described in this article, and an outline of future directions of research." (SUMMARY IN FRE)
Acquired Immunodeficiency Syndrome↗