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Biomedical subjects

G Franco

Publications and source records attributed to G Franco.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Coronary artery anomalies and coronary disease: is there a relationship?].

BACKGROUND: It has been suggested that in coronary anomalies the turbulence of the flow might develop atherosclerosis, but this theory remains controversial. The relationship between coronary anomalies and coronary artery disease have been studied. METHODS: Twenty-five patients [15 males, 10 females (mean age 75+/-1.4 years)] with coronary anomalies at coronary angiography were enrolled in a prospective study. Thirteen patients out of 25 (group 1) had critical coronary artery disease (>50% of reduction in luminal diameter). The anomalous vessels passing intramyocardial or between aorta and pulmonary veins were excluded. Twelve patients out of 25 had no sign of atherosclerosis (group 2). At clinical and instrumental follow-up (54+/-8.4 months) the number of cardiovascular events (acute myocardial infarct, unstable angina, silent ischemia, bypass or PTCA interventions, cardiovascular death) was evaluated in the two groups. RESULTS: Age and ejection fraction value were no statistically different in the two groups. Risk factors were significantly (p<0.04) higher in group 1 (smoke, hypertension, hypercholesterolemia, diabetes). The patients number with cardiovascular events was significantly higher in group 1(11 patients vs 2) confirming the independence of the two phenomena. No correlation was found between presence of risk factors and presence of events. A correlation (r=0.70) was found only between previous coronary artery disease and number of events. CONCLUSIONS: No relationship between coronary anomalies and coronary artery disease seems to be confirmed. The real relevance of flow turbulence in the development of atherosclerosis in coronary anomalies needs to be still confirmed.

Aged↗
PubMed2000

Ozone formation in California's San Joaquin Valley: a critical assessment of modeling and data needs.

Data from the 1990 San Joaquin Valley Air Quality Study/Atmospheric Utility Signatures, Predictions, and Experiments (SJVAQS/AUSPEX) field program in California's San Joaquin Valley (SJV) suggest that both urban and rural areas would have difficulty meeting an 8-hr average O3 standard of 80 ppb. A conceptual model of O3 formation and accumulation in the SJV is formulated based on the chemical, meteorological, and tracer data from SJVAQS/AUSPEX. Two major phenomena appear to lead to high O3 concentrations in the SJV: (1) transport of O3 and precursors from upwind areas (primarily the San Francisco Bay Area, but also the Sacramento Valley) into the SJV, affecting the northern part of the valley, and (2) emissions of precursors, mixing, transport (including long-range transport), and atmospheric reactions within the SJV responsible for regional and urban-scale (e.g., down-wind of Fresno and Bakersfield) distributions of O3. Using this conceptual model, we then conduct a critical evaluation of the meteorological model and air quality model. Areas of model improvements and data needed to understand and properly simulate O3 formation in the SJV are highlighted.

Air Movements↗
PubMed2000

Evaluation of a western blot test as a potential screening tool for occupational exposure to Mycobacterium tuberculosis in health care workers.

Health care workers (HCWs) have a higher than average risk for contracting Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB). No markers of MTB-exposure are available, and TB risk assessment is performed by tuberculin screening, identifying individuals with acquired MTB infection. This study evaluated a western blot (WB) anti-M. bovis A60 complex antibody as a MTB-exposure marker. WB reactivity was evaluated on 127 exposed and 28 non-exposed HCWs from four divisions of the Policlinico Hospital of Modena, and 140 non-exposed bacille Calmette-Guérin-vaccinated controls. Excess of occupational TB risk according to the Occupational Safety and Health Administration (OSHA) was calculated in each division. WB-positivity (%) was: (1) significantly higher in exposed HCWs compared with non-exposed (72% vs 25%, P < 0.00001), (2) highly related (r = 0.99) to OSHA risk excess in all divisions, (3) higher than non-exposed in HCWs with short (< 5 years) MTB-exposure (purified protein derivative [PPD], P > 0.18; WB, P < 0.04). PPD-positivity (%) was higher than controls only in HCWs with longer (> 5 years) MTB-exposure. The study suggests that the WB antibody might represent a more sensitive biological marker of MTB contact among exposed HCWs, related to the level of TB risk and detectable earlier than the PPD skin test, thus providing new tools for TB risk assessment in health care facilities.

Adult↗
PubMed2000

[Extensive cardiac angiosarcoma in the course of immunosuppressive therapy after kidney transplant].

We present a case of a 49-year-old man who underwent a kidney transplant. Treatment with azathioprine and steroid was increased due to an initial rejection of the allograft. Six months later, the patient experienced palpitations and precordial pain: the electrocardiogram recorded atrial fibrillation and the echocardiogram showed moderate pericardial effusion and the presence of a right atrial mass with infiltration into the interatrial septum and right ventricle. Computed tomography imaging confirmed the tumoral mass and magnetic resonance imaging revealed the extensive involvement of the right atrium, right ventricle and superior vena cava, suggesting the presence of an angiosarcoma of the heart. Despite chemotherapy the patient died within 1 month. The diagnosis was confirmed by autopsy, histological section, and electron microscopy examination.

Azathioprine↗
PubMed1999

Occupational physicians' education and training across European Union countries.

The framework directive on improvements in the safety and health of workers is being implemented into the national legislation of European Union countries, and occupational physicians are requested to play a key role in undertaking preventive measures. Since there is no common specific requirement for the training and education of these health professionals, this report aims to provide a comparative picture of the educational process across European Union training bodies. Each curriculum provides theoretical knowledge and practical experience, but deep differences exist among different countries. Core knowledge is mainly based on the traditional disciplines (such as occupational hygiene, occupational toxicology, ergonomics, epidemiology and biostatistics, relevant legislation, and preventive medicine). General learning objectives should include assessment of the workplace environment, communication and education, legislation, occupational diseases, and relationships between health and work. Core experience, often based on task-based learning, emphasizes the need for assessment of a range of working environments; for surveillance, including the biological monitoring, of workers at risk; for assessment of disability, impairment, and fitness for work; for the clinical ability to recognize occupational diseases; for the formulation of differential diagnosis; and for management of workers developing disease in the course of their employment. New curricular elements (such as management, economics, quality assurance, and marketing) are being introduced in some institutions with the aim of stressing the renewed role of the occupational physician in meeting society and employers' needs. The need to educate and train a professional figure whose competence should allow the delivery of high-quality occupational health services across European Union countries compels the harmonization of the formative process of occupational physicians.

Curriculum↗
PubMed1999

Reproductive capacity of spermatozoa from men with testicular failure.

Controversial reports have been published about the influence of sperm source and of the underlying testicular pathology on success rates of intracytoplasmic sperm injection (ICSI). In this controlled study, ICSI treatment cycles with testicular spermatozoa from men with obstructive and non-obstructive azoospermia were compared with ICSI ejaculated sperm cycles with semen parameters < or = 5 x 10(6)/ml and < or = 10% progressive motility. The control cases were matched for female age, rank of trial, female basal follicle-stimulating hormone serum concentrations and close proximity to the study group's procedure. The fertilization, cleavage, pregnancy and abortion rates were similar in matched groups irrespective of the type of azoospermia. However, the implantation rate in the non-obstructive azoospermic patient group was significantly lower than that in the matched ejaculated sperm group (13.4% versus 26%, P = 0.05). On the other hand, no impairment of the implantation rate was observed in the obstructive azoospermic patient group. These data show that testicular pathology has a negative impact on reproductive performance of testicular spermatozoa, resulting in a decreased implantation potential without any apparent effect on fertilization and early preimplantation development.

Abortion, Spontaneous↗
PubMed1999

Challenging the role of cremasteric reflux in the pathogenesis of varicocele using a new venographic approach.

PURPOSE: Cremasteric or extrafunicular reflux is considered by many a major cause of primary and recurrent varicocele. Therefore, surgical techniques that allow ligation of the intrafunicular and extrafunicular veins are often performed. We evaluated the incidence of cremasteric reflux in patients with primary or recurrent varicocele with a new and simple venographic technique. MATERIALS AND METHODS: A series of 73 patients with primary (54) or recurrent (19) varicocele underwent venography of the left iliac vein while standing and performing Valsalva's maneuver to reveal the possible presence of reflux in cremasteric or other extrafunicular veins. In patients with recurrent varicocele antegrade transcrotal spermatic venography was also performed immediately before surgery. RESULTS: None of the patients presented with reflux of contrast material from the left iliac vein to the left pampiniform plexus via the extrafunicular veins. Cremasteric veins, in particular, were always continent at the confluence with the epigastric vein even when grossly dilated at spermatic antegrade venography in recurrent cases. CONCLUSIONS: Cremasteric reflux seems to have a limited role if any in the pathogenesis of primary and even recurrent varicocele. Dilatation of the extrafunicular veins is not necessarily a sign of reflux but may represent only a consequence of venous overflow due to insufficiency of the internal spermatic vein and possibly partial obstruction of the left iliac vein. The rationale of surgical treatments aimed at ligation of the extrafunicular veins should be questioned.

Adolescent↗
PubMed1999

[Primary absolute anorgasmy in the male. Report of three clinical cases].

Primary absolute anorgasmia is the impossibility to have orgasm and ejaculation during wake or every kind of sexual activity, in men with normal erectile function and nocturnal emission. In this syndrome the nervous system is unimpaired; the frequency is very low, with a very small number of reported cases in literature. Andrologists are generally requested by the patients for the first clinical approach. They should collaborate with sexologists for the diagnosis and treatment. Personal experience in 3 cases of anejaculatory men aged between 28 and 34, observed in the years 1995-1996, is presented and the clinical features of the patients and therapeutic strategy described. In two cases a sexual behavioral therapy was performed with success; in the third an electrovibration was employed to obtain the first orgasmic sensation.

Adult↗
PubMed1999

Total quality strategy in the formative process of the occupational physician.

Interest in applying the concepts of total quality management to the fields of health care and medical education is growing. This paper analyzes the field of education in occupational medicine to explore the relationships between teaching and the deliverance of a product or a service. Issues such as defining teaching customers, addressing customer needs, teaching processes, and assessing and improving quality teaching are described. The occupational physician is requested to act according to particular competencies. This demand implies the need to meet specific requirements. To assure the achievement of these goals, the implementation of a teaching process must include (i) targeting the learning objectives (the knowledge, skills, and attitudes the specialist should have), (ii) planning the evaluation system (ability of the course to assure the achievement of the objective), (iii) evaluating the curriculum (compliance of the acquired competencies to the needs).

Clinical Competence↗
PubMed1998

[Recurrence of varicosities in the femoral canal following surgery of the internal saphenous vein].

Perforating veins in the femoral canal, which establish a communication, on the medial aspect of the thigh, between the deep venous system and: either the trunk of the long saphenous vein, single or double, or one or several separate trunks, follow three anatomical patterns which clinical examination, phlebography and, now, echo-doppler, can identify clearly. When they are incompetent, they increase the natural progress of the varicose disease, after surgery of the long saphenous vein. Often, they are associated with a redux at the level of the saphenofemoral junction and also, sometimes, with an incompetence, primary or recurrent, at the short sapheno-popliteal junction, or, furthermore, with an incompetence of the medial gastrocnemial veins and their accompanying perforators, within the popliteal venous complex. Anastomotic networks between the different superficial venous territories in the inguino-genital region, the femoral canal and the supero-medial aspect of the leg, explain the cross-evolution between different systems. Sclerotherapy is effective when the perforators are not too large and their reflux not too important. If it fails, it is necessary to operate after precise localization of the sites of reflux through good imaging. A good picture is obtained with B mode ultrasound examination and hemodynamic studies with pulsed doppler and, even more reliably, with color Doppler. Thus, in recurrences in the femoral region, color Doppler will show up certain perforators which, despite being dilated, are nevertheless competent and do not need to be dealt with.

Femoral Vein↗
PubMed1997

Minimal immunological effects on workers with prolonged low exposure to inorganic mercury.

OBJECTIVES: This study was carried out to investigate possible immunological changes in workers with prolonged low exposure to inorganic mercury in a fluorescent light bulb factory. METHODS: 29 immunological variables were examined in 34 workers with prolonged low level exposure to inorganic mercury (exposed workers) and 35 unexposed workers as the controls. The selected indicator of mercury exposure was concentration of mercury in the urine (U-Hg), which declined progressively from 36.0 micrograms/l in 1978 to 6.0 micrograms/l in the study year 1994. RESULTS: None of the exposed workers had ever shown signs of either acute or chronic inorganic mercury toxicity or had shown any form of hypersensitivity. The only changes found in the exposed workers, compared with the controls, were a reduction of the cells that express cluster differentiation (CD25,(T activation antigen (Tac antigen))) and concentrations of tumour necrosis factor-alpha (TNF-alpha) in serum. However, the decrease of cells that express CD25 was unrelated to occupational exposure and was, in all likelihood a chance finding. Conversely, the decline in serum TNF-alpha was closely associated with occupational exposure. However, no dose-response relation was found between U-Hg and TNF-alpha concentrations; nor were TNF-alpha concentrations affected by cumulative occupational exposure to inorganic mercury in over 20 years. CONCLUSIONS: Tentatively, we suggest that reduced serum TNF-alpha concentrations might be indicative of an in vivo functional defect of the monocyte macrophage system in this particular group of workers even though they were clinically asymptomatic.

Biomarkers↗
PubMed1997

Allergic and Irritant Glove-related Diseases in Health Care Workers and Their Prevention.

Because the widespread use of gloves by health care workers has induced an increase of both irritant and type I or type IV allergic glove-related diseases, the Italian Society of Preventive Medicine for Health Care Workers set up a working group to collect information about glove composition and to standardize procedures for the diagnosis and prevention of glove-related disease and job-fitness evaluation of employees who will be wearing gloves. In addition, the group made recommendations for educational programs focusing not only on users but also on purchasers, who presently favor glove selection for economic reasons. The group's recommendations are summarized in a consensus document, but cannot be considered definitive. More research is needed to achieve answers to questions raised by the working group, indicated in the consensus document. In particular, diagnostic criteria must be standardized to plan multicenter studies to verify the real extent of the problem, and further studies are needed to verify whether limit values for substances contained in the gloves (e.g., latex proteins, residual chemicals) can be established.

Journal Article↗
PubMed1997

Manual versus computer methods for diagnosing obstruction from pressure-flow tracings in patients with benign prostatic hyperplasia.

PURPOSE: We compared manual versus computer analysis of pressure-flow tracings for diagnosing bladder outlet obstruction in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 105 patients with a clinical diagnosis of prostate enlargement and lower urinary tract symptoms was included in the study irrespective of free flow rates. Pressure-flow studies were performed in duplicate and tracings were evaluated by 2 independent investigators blinded to patients status. Manual reading of urodynamic printouts and fully computerized analysis using CLIM software were done. All urodynamic parameters relevant to the diagnosis of outlet obstruction were compared using the Abrams-Griffiths and Schäfer nomograms. Group specific urethral resistance factors were also compared. RESULTS: There was good correlation between manual and computer derived values of maximum flow (r = 0.9874, p < or = 0.0001), detrusor pressure at maximum flow (r = 0.9943, p < or = 0.0001), minimum detrusor pressure during voiding (r = 0.8816, p < or = 0.0001) and group specific urethral resistance factor (r = 0.9917, p < or = 0.0001). The diagnosis of outlet obstruction according to the group specific urethral resistance factor, and the Abrams-Griffiths and Schäfer nomograms was highly consistent using the manual and computerized approaches. CONCLUSIONS: Manual analysis of pressure-flow tracings generated by urodynamic equipment and digital data obtained by CLIM software appeared to be highly consistent and equally reliable for diagnosing and grading outlet obstruction.

Aged↗