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Biomedical subjects

G Filippini

Publications and source records attributed to G Filippini.

At least 55 records · Page 3Linked to original sources
PubMed1994

Assessment of International Headache Society diagnostic criteria: a reliability study.

In 1988 the International Headache Society (IHS) introduced new diagnostic criteria for headaches and craniofacial pain. Since headaches can be diagnosed solely on the basis of information provided by the patient, it is essential that the criteria are reproducible and consistent. Two neurologists evaluated the clinical records of 100 consecutive outpatients and transferred the data on headache and associated phenomena to a form designed to reflect the IHS criteria. Interobserver concordance (kappa statistics) in the application of the diagnostic criteria of primary headaches was: (i) "perfect" to "substantial" for the first IHS digit, being kappa = 1.0 for cluster headache and paroxysmal hemicrania; kappa = 0.88 for migraine; kappa = 0.75 for tension-type headache; (ii) "almost perfect" to "substantial" for the second digit (kappa = 0.94 for cluster headache; kappa = 0.90 for migraine with aura; kappa = 0.81 for episodic tension-type headache; kappa = 0.78 for migraine without aura; kappa = 0.71 for chronic tension-type headache; kappa = 0.66 for cluster headache-like disorder not fulfilling the criteria; (iii) "moderate" for migrainous disorder (kappa = 0.48) and headache of the tension-type (kappa = 0.43) not fulfilling the criteria. These results show that the IHS diagnostic criteria are satisfactorily applicable to high quality medical records abstracted by experienced neurologists.

Adolescent↗
PubMed1994

Agreement in the clinical diagnosis of dementia: evaluation of a case series with mild cognitive impairment.

Interobserver agreement in the clinical diagnosis of dementia among four neurologists was evaluated. The physicians, masked to the original diagnoses, independently reviewed the clinical records of 50 outpatients consulting either the 1st University Neurology Department of Milan or the Neuropsychology Unit of the Medical Center of Veruno (Novara) for suspected cognitive impairment, during a 6-month period. The records contained patients' medical and neurological history, results of neuropsychological testing, laboratory tests, cerebral computed tomography and other investigations. For each patient, the raters had to provide both a diagnosis concerning the presence or absence of dementia and to assign an analytical diagnosis to all the dementia cases. The kappa statistic was used as a measure of interrater reliability. The level of agreement on the primary diagnosis of dementia was moderate (kappa = 0.49); with respect to the nosological diagnoses, the kappa values ranged from 0.16 for depression to 0.80 for multi-infarct dementia.

Aged↗
PubMed1993

Synthesis and CLOGP correlation of imidooxy anticonvulsants.

Continuing structure-activity studies on the anticonvulsant activity of analogs of N-(benzyloxy)-2-azaspiro[4.4]nonane-1,3-dione (2a), which displayed anti-electroshock seizure (MES) activity and a protective index (TD50/ED50) of > 4.5 are reported. An in-depth analysis of this moiety was studied employing the Topliss structure activity and the Craig plot analytical approaches as well as a semiempirical method. CLOG P analysis was also applied to this series after experimentally determining the NOR fragment. All compounds were minimized and these physicochemical parameters correlated to anticonvulsant activity. Several interesting substituted benzyloxy compounds emerged from this study: the 2',4'-dichloro (2b), 4'-(trifluoromethyl) (2c), 2'-bromo (2d), 3'-chloro (2o), 2'-chloro (2r), 2'-fluoro (2p), and 3'-fluoro (2w) analogs, all of which had comparable, or better activity than the parent unsubstituted analog (2a). X-ray crystal analysis of the active 2a versus inactive N-benzyl-2-azaspiro[4.4]nonane-1,3-dione (10) is discussed.

Animals↗
PubMed1993

Clinical and magnetic resonance features of the classic and akinetic-rigid variants of Huntington's disease.

We studied 32 patients with confirmed Huntington's disease (HD); six (mean age, 31.7 years) had the akinetic-rigid form and 26 (mean age, 46.1 years) had the classic hyperkinetic form. Clinical examination included a count of abnormal involuntary movements, motor self-sufficiency evaluation by the Physical Disability Rating Scale, cognitive function assessment by the Mini-Mental State examination, and a verbal fluency test. Magnetic resonance imaging permitted measurement of bicaudate diameter, a sensitive indicator of caudate atrophy in HD. Patients with the akinetic-rigid form of HD were younger and had earlier disease onset than those with the classic form of HD. All patients with akinetic-rigid HD (group 1) had striatal hyperintensity on T2-weighted magnetic resonance images; seven patients with classic HD (group 2) had a similar abnormality. Groups 1 and 2 were in fact similar in all other respects, except that the number of abnormal involuntary movements was greater in group 2. Groups 1 and 2 together had significantly younger age at onset, lower Mini-Mental State Examination score, more severe motor disability, worse verbal fluency test result, and greater bicaudate diameter than the 19 patients with classic HD without magnetic resonance signal abnormality (group 3) and appear to be a uniform population, distinct from group 3. The abnormalities on magnetic resonance images indicated greater striatal damage in groups 1 and 2, which could be the neuroanatomic substrate of their greater motor and cognitive compromise.

Adult↗
PubMed1993

Presence of T-cell subset abnormalities in newly diagnosed cases of multiple sclerosis and relationship with short-term clinical activity.

Abnormalities of T-cell subsets in patients with multiple sclerosis are well known; in order to assess whether immunological abnormalities are relevant in the pathogenesis of the disease after its clinical onset, peripheral blood lymphocyte subsets (CD3+, CD4+, CD4(+)-CD45RA+, CD4+CD45RA-, CD8+, CD8+CD57+, CD57+, CD25+) were analysed serially in 25 patients at the first clinical episode suggestive of inflammatory demyelinating disease and in an equal number of age- and sex-matched controls. During the follow-up period (12-18 months, mean 14) 6 of 25 patients presented new relapses: in this subgroup of patients, significant changes in CD4+ ratio (% CD4+CD45RA-/%CD4+CD45RA+) were detected in comparison both with healthy controls and with clinically stable patients. Patients clinically stable at follow-up did not display immunological abnormalities, regardless of the presence or absence of cerebrospinal fluid and/or magnetic resonance imaging alterations consistent with multiple sclerosis. These findings suggest a possible prognostic role of early T-cell subset imbalance in multiple sclerosis.

Adolescent↗
PubMed1993

Accuracy of self-assessment of the minimal record of disability in patients with multiple sclerosis.

We tested the validity of a self-administered version of the minimal record of disability (MRD) for multiple sclerosis (MS) by measuring the agreement level between patients' self-assessment and neurologists' independent ratings. 96 MS patients and 4 neurologists took part in the experiment; the agreement level was measured in terms of the intraclass correlation coefficient (ICC). On the Kurtzke functional system (FS) the ICC ranged from 0.26 in the sensory to 0.69 in the pyramidal function; a high concordance (ICC = 0.84) was found on the expanded disability status scale (EDSS). The ICC values were above 0.70 for most of the incapacity status scale (ISS) and environmental status scale (ESS) items. A modified, self-administered version of the MRD may represent a reliable instrument for obtaining a comprehensive profile of patients' abilities.

Adolescent↗
PubMed1993

Clinical trials in multiple sclerosis: a critical review (1970-1990).

The present study is a critical review of 100 papers concerning clinical trials in Multiple Sclerosis (MS), published between 1970-1990. We analyzed 20 validity criteria (internal 12, and external 8) and codified each item as "adequate" or "not adequate", so that the validity of each report was quantified. In addition, we used a statistical method of automatic classification (cluster analysis) to subdivide all the papers in 4 groups with growing validity. Only 52 reports had a fairly good or good validity, therefore more efforts are suggested to correctly plan clinical trials in MS and lead to reliable results.

Evaluation Studies as Topic↗
PubMed1992

International incidence of central nervous system tumors in children.

A study of the descriptive epidemiology of central nervous system tumors in children aged 0-14 was undertaken using international incidence data referred to the period 1970-1984. The median incidence rates were found to be 23 per million for males and 19 per million for females. The median cumulative incidence rates were found to be 341 per million for males and 296 per million for females. Males had incidence rates that were about 20 per cent higher than those for females. Variation in incidence rates by age, sex, race, and geographic area are discussed. Data on possible genetic and environmental risk factors for these tumors are reviewed.

Adolescent↗
PubMed1992

[Echocardiographic changes in patients with polycystic nephropathy].

We have studied with the echocardiography M-Mode, 2-D, Doppler three groups of 15 subjects for testing the presence of cardiac abnormalities probably related to primary collagen defect in patients with autosomal dominant polycystic kidney disease (ADPKD) The first group was made up of patients with ADPKD and normal renal function, the second of patients with ADPKD in hemodialysis (HD), the last one of patients in HD for other renal disease. In the first group we found no cardiovascular abnormalities while we found an increased incidence of valvular disease (p = 0.016) in patients with ADPKD in HD and an increased incidence in valvular disease (p = 0.016) and left atrial dilatation (p = 0.006) in patients in HD for different renal disease. When we estimated the cases on the ground of dialytic age uncorrelated with the initial renal disease, only the incidence of valvular calcifications was increased in patients on HD more than 3 years (p = 0.034). In our group of patients the echocardiographic abnormalities seem to be related more to uremic cardiomyopathy even if we cannot deny the existence of primary cardiac disease in patients with ADPKD.

Adult↗
PubMed1990

[A case of rupture of the tendinous cord caused by infective endocarditis].

The paper reports a case of infective endocarditis of the valve, with an insidious and slow onset accompanied by low fever, debility, loss of weight, anemia, and the concomitant echocardiographic observation of pericardial effusion. Subsequent echocardiographic tests produced images which probably referred to valvular vegetation. As a matter of fact these findings proved to be result of the rupture of the latero-posterior tendinous cord of the mitral flap and other similar cords whose stumps, covered in fibrin, had adhered to the edge of the anterior cups. This finding was discovered during surgery, which was performed early and successfully, and was followed by excellent long-term results.

Aged↗
PubMed1990

[A study of the distribution of some risk factors in patients with myocardial infarct. Different cardiovascular prevention methods in relation to age].

In order to evaluate whether a different method of preventive approach to ischemic cardiopathy is appropriate in relation to age, the distribution of some classic cardiovascular risk factors (cigarette smoke, cholesterol) and a stress-related risk factor (type of work) was studied in two groups of patients, aged respectively over and under 60, admitted to hospital for acute myocardial infarction. The most significant data were: blood cholesterol values less than 220 mg/ml, found mainly in older patients; a larger number of heavy smokers in the group of patients aged under 60; the majority of patients were employees. In the light of these results, the paper discussed the need for different forms of preventive intervention, both clinical and epidemiological, for Ischemic cardiopathy in relation to age.

Aged↗
PubMed1989

Interobserver agreement in the diagnosis of multiple sclerosis.

Interobserver agreement in the clinical diagnosis of multiple sclerosis (MS) among six neurologists was evaluated. Three of them participated in a study of the clinical diagnosis of MS, the Italian Multicenter Study (IMS). The raters examined the clinical forms of MS of 50 patients randomly selected from among 430 patients recruited from the IMS. For each patient, neurologists were asked to make a diagnosis according to the McDonald-Halliday classification system of MS. The overall agreement on the diagnosis (MS present or absent) was fair, with no difference noted between the two groups of raters. Considering the six diagnostic levels instead, the reliability was higher for the neurologists participating in the IMS program. These neurologists agreed particularly on the Clinically Definite and Progressive Possible classifications. Complete disagreement was observed for the Early Probable or Latent and Progressive Probable classifications. Because of the different level of agreement on diagnosis, we suggest separate consideration of Clinically Definite and Progressive Probable MS cases in clinical trials and epidemiologic studies of this disease.

Adult↗
PubMed1988

A case-control study of brain gliomas and occupational exposure to chemical carcinogens: the risk to farmers.

During 1983 and 1984, 240 newly diagnosed cases of brain glioma and 742 controls (465 non-glioma nervous system tumors and 277 patients with other neurologic diseases) were recruited and interviewed in the neurologic and neurosurgical departments of two hospitals in Milan, Italy. The occupational histories of cases and controls were compared, and relative risk estimates, adjusted for sex, age, residence, and socioeconomic status, were computed using the Mantel-Haenszel method. A statistically significant risk increase was found for farmers (relative risk (RR) = 1.6, p = 0.0025). This risk increase was attributable to those farmers who reported the use of chemicals (insecticides or fungicides, herbicides, and fertilizers). Among the three groups of investigated agrochemicals, only the use of insecticides or fungicides was associated with a significant increase in relative risk (RR = 2.0, p = 0.006). Many farmers exposed to fungicides reported the use of commercial compounds of copper sulfate. Some of these compounds contain methyl urea, which has a specific carcinogenic effect on the nervous system in animals. These data suggest that the occupational exposure of farmers to agrochemicals might be responsible for the observed excess risk of brain glioma in farmers.

Adult↗
PubMed1982

Electrophysiologic changes in workers with "low" blood lead levels.

In spite of numerous studies, the minimum level of lead exposure at which "sub-clinical" electrophysiologic abnormalities appear is still under discussion. Furthermore, it has not been clarified whether the electrophysiologic changes are directly related to PbB levels or to duration of exposure. This study was conducted on a group of 62 subjects occupationally exposed to lead with average blood lead levels below 50 microgram/100 ml and durations of exposure of less than 10 years. A reduction of motor and sensory nerve conduction velocities and sensory action potential amplitude of the median nerve was found in the subjects exposed to lead, as compared with a control group. Such abnormalities were already present in workers with the lowest blood lead levels, but were more severe in workers whose blood lead levels had exceeded 70 microgram/100 ml, even if this occurred only once in the last two years. The electrophysiologic changes did not correlate with duration of exposure but occurred very soon after initial exposure to lead.

Adolescent↗
PubMed1982

Gliomas and occupational exposure to carcinogens: case-control study.

Patients with gliomas of the central nervous system hospitalized during the period January 1979--March 1980 at the Neurological Institute C. Besta of Milan were compared with controls admitted to the Institute in the same period for nonneoplastic neurologic diseases or benign tumors. The comparison was based on occupational history, smoking habits, and alcohol consumption. Two analyses were carried out: the first by case-control pairs matched for age, sex, and residence; the second by age, sex, and residence stratification. Patients with glioma were more likely than controls to have worked in agricultural activities and showed a relative risk of 5.0 (p = 0.043) in the matched analysis and 1.9 (p = 0.113) in the analysis by stratification. This high risk was confined to those who performed agricultural work after 1960, suggesting a possible etiologic role of exposure to organic pesticides, fertilizers, and herbicides, which have only recently been commonly used in Italy. No significant difference was observed between cases and controls in regard to other analyzed occupations and habits.

Adult↗