The last images. Pneumoretroperitoneum, pneumomediastinum and subcutaneous emphysema of the neck after stapled hemorrhoidopexy.
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Adult↗
Biomedical subjects
G Gravante
Publications and source records attributed to G Gravante.
Familiar history and predictive risk factors to type 2 diabetes: a cross sectional study in young Sicilian subjects of both sexes.
AIM: For many industrialised populations, family history to type 2 diabetes mellitus (DM) is a risk factor to the development of illness, inducing early anthropometric and metabolic modifications. Aim of this study was to confirm in Sicilian population the influence of family history to type 2 DM on anthropometric data and basal blood pressure, considering the different degrees of familiar history to illness. METHODS: In a cohort of 680 young healthy Sicilian subjects (278 men and 402 women) we analysed the relations of family history degree of DM on anthropometric data, such as body mass index (BMI), waist/hip ratio (WHR) and triceps skinfold. Degree of family history of DM was defined as presence in the family of at least one sibling of first degree or a parent with documented DM (FHDM++), of at least one family member of second degree with documented DM (FHDM+). RESULTS: In both sexes the FHDM++ groups showed the highest values of body weight (P<0.001 for men, P<0.0001 for women), BMI (P<0.0005 for both sexes), WHR (P<0.0001 for men, P<0.01 for women), triceps skinfold (P<0.0001 for men, P<0.001 for women), with consequently higher proportion of obesity and overweight in the group with FHDM++. Subjects with FHDM+ were closer to control subject without family history of DM. FHDM++ was also associated with tendency to higher diastolic and systolic blood pressure values in both sexes. CONCLUSIONS: The study shows that young subjects with familiar history of type 2 diabetes have a higher prevalence of overweight and central obesity compared to other groups, suggesting that obesity in adolescents and young adults may be a strong pathophysiologic mechanism predictive of higher degree of future development of type 2 diabetes and hypertension.
Adolescent↗
Prospective randomized trial of submucosal hemorrhoidectomy with radiofrequency bistoury vs. conventional Parks' operation.
BACKGROUND: Postoperative pain has always been the main adverse effect of the surgical treatment for hemorrhoids. Surgical techniques evolved mainly to solve this problem as well as postoperative bleeding, stenosis and recurrence. This randomized study compared the results obtained using submucosal hemorrhoidectomy with radiofrequency bistoury with those of the conventional Parks' operation. METHODS: A total of 102 patients were randomized to undergo submucosal hemorrhoidectomy with radiofrequency bistoury (51 patients) or conventional Parks' haemorrhoidectomy (51 patients); loss of some patients at follow-up resulted in 49 and 45 patients available for analysis, respectively. The operating time, amount of pain (VAS scale, 1-10), postoperative analgesic requirement, intra- and postoperative complications, length of hospital stay and patient satisfaction were documented. RESULTS: In comparison to Parks' technique, use of radiofrequency bistoury reduced mean operating time (61.2 min vs. 37.4 min; p<0.05), first postoperative day pain score (5.9 vs. 4.0; p<0.05), pain score at first evacuation (5.7 vs. 4.2; p>0.05), postoperative stay (2.2 days vs. 1.3 days; p<0.05), and pain score on postoperative day 7 (3.6 vs. 2.8; p>0.05). Fecal incontinence was never observed. Incontinence to flatus with spontaneous resolution within 2-3 weeks was reported by 4 subjects in each surgical group. Urinary retention requiring catheterization occurred in 21 subjects in the radiofrequency bistoury group and in 18 patients in the control group. No complications nor recurrences were reported at the 6-month follow-up in either group. CONCLUSIONS: Performing submucosal hemorrhoidectomy with radiofrequency bistoury improves the results obtained with Parks' technique, allowing us to simplify the surgical procedure, reduce operating time, postoperative pain and bleeding, and shorten the hospital stay.
Adult↗
Comparison of ground reaction forces between obese and control young adults during quiet standing on a baropodometric platform.
OBJECTIVE: To determine whether centre of pressure location, plantar surface areas, or plantar pressures differ between obese and control young adults during quiet standing.Design. Cross-sectional study in university setting. BACKGROUND: Given the characteristic distribution of body fat in obesity, it is possible that obesity may systematically alter centre of pressure location, plantar ground contact areas and pressure distributions in males and females. METHODS: Thirty-eight obese subjects (23 women and 15 men) and 34 healthy controls (18 women and 16 men) with a mean age of 23 years were studied. Subjects were asked to stand bipedally on a baropodometric platform while centre of pressure location, plantar ground contact surface areas and pressures were measured over a 5 s interval. Group differences were examined by analyses of variance and Fisher's PLSD test. RESULTS: No significant group differences were found in centre of pressure location by weight or gender. Obesity was associated in both sexes with significantly larger plantar contact areas (+12.2%, P<0.0001 for women and +9.9%, P<0.005 for men) and pressures (mean load: +52.6% for women and +44.7% for men, P<0.0001 in both of sexes; peak pressure: +45.5% for women and +40.5% for men, P<0.0001 in both of sexes). There were significant gender differences in plantar contact areas (P<0.0001), while were no significant differences in mean and peak pressures. CONCLUSIONS: Although centre of pressure location was unaffected by obesity, these young obese individuals showed significantly increased plantar contact areas and pressures. RELEVANCE: The higher plantar pressures associated with obesity may have negative ramifications for foot function over the longer term.
Adult↗
Fatal thrombocytopenia and thrombocytopathia: an unusual onset of non-small cell lung cancer.
BACKGROUND: Although bone marrow is a common site of micrometastases for non-small cell lung cancer (NSCLC), thrombocytopathia and hemorrhagic diathesis are rare causes of death. CASE REPORT: A 57-year-old patient was admitted to the emergency room because of massive nosebleeding and hemoptysis. Routine blood analysis showed thrombocytopenia and prolonged bleeding time; results of functional platelet tests suggested concomitant thrombocytopathia. Routine chest X-ray revealed an 18 mm large spot in the right superior lobe. During the first hour of recovery the patient had another episode of nosebleeding. A bone marrow biopsy showed a wide infiltration with neoplastic cells. Histology was compatible with NSCLC. The clinical conditions and hematological parameters progressively deteriorated, and on the third day the patient died because of hypovolemic shock. CONCLUSION: This is a very rare clinical presentation of NSCLC characterized by massive bleeding due to thrombocytopenia and thrombocytopathia secondary to wide bone marrow infiltration.
Biopsy↗
[Milligan-Morgan hemorrhoidectomy with a radiofrequency scalpel].
BACKGROUND: Postoperative pain has always been the main adverse effect of surgical treatment for hemorrhoids. Therefore, surgical techniques evolved mainly to solve this problem and, secondly, postoperative bleeding, recurrences and stenosis. METHODS: Two homogeneous groups of 20 patients each were investigated. Both of them were affected by fourth grade hemorrhoidal prolapse and were homogeneous for age, sex and presentation symptoms. Patients previously treated for other proctologic diseases were excluded. A group was treated with standard Milligan-Morgan hemorrhoidectomy and the other with radiofrequency scissors. Every patient underwent a follow-up protocol based on outpatient visits at 15, 30, 45 postoperative days and 3, 6 and 12 months. RESULTS: The results show a substantial similarity between these techniques. However, radiofrequency scissors further improved the simplicity of the technique and the postoperative adverse effects. In particular, the procedure lasted 7 minutes less with radiofrequency scissors. Patients treated with the radiofrequency technique had their first postoperative evacuation 24 hours before the standard technique and reduced the mean postoperative hospital stay at 2.5 days (4.5 days in the standard group). The incidence of postoperative pain was reduced in patients treated with radiofrequency scalpel and the follow-up controls in both groups didn't show any complication as stenosis or incontinence. CONCLUSIONS: The radiofrequency-performed Milligan-Morgan hemorrhoidectomy is a valuable technique that improves the classical difficulties in execution, reducing the length of hospital stay and the incidence of postoperative pain or other complications.
Adult↗
[Description of a case of giant adrenal myelolipoma and survey of the literature].
Adrenal myelolipoma is a benign tumor affecting the adrenal gland. It is composed by adipose cells and myelopoietic cells present in each normal differentiating stage of the bone marrow. The neoplasia is often asymptomatic, sometimes leading to very large adrenal masses (more than 10 cm in diameter). These are often called "giant myelolipoma". A case is reported and a survey of the literature on this topic is made; the present knowledge of this disease as well as its diagnosis and treatment are discussed also.
Adrenal Cortex Neoplasms↗
Diet associated with regular physical activity or drugs. A longitudinal study on obesity management.
AIM: To assess the influence of 2 methods for obesity management (drugs + diet or physical activity + diet) on body composition in premenopausal women. METHODS: We recorded longitudinally the body weight and composition of 9 obese premenopausal women divided into 2 groups: 4 women (group A; mean age+/-SD: 42.50+/-11.90 years; range 25-50) performed a hypocaloric diet associated with orlistat (120 mg/day), 5 women (group B; mean age+/-SD: 44.00+/-10.20 years; range 26-51) performed a hypocaloric diet increasing the physical activity levels (PAL). RESULTS: After 5 months therapy, the 2 groups significantly reduced the body weight, whereas B group improved the body composition limiting the fat free mass loss, increasing consequently the FFM/FM ratio from the beginning to the end of the study, even if marginally statistically significant (p=0.0787); group A reduced the body weight by the fat free mass and fat mass losses and presented the collateral effects of pharmacological therapy at the end of the study. CONCLUSIONS: The data confirm that in obese premenopausal women a regular physical activity improves the body composition, preventing the reduction of fat free mass hypocaloric diet-induced.
Journal Article↗
The basal energy expenditure of female athletes vs. sedentary women as related to their family history of type 2 diabetes.
The purpose of this study was to investigate the basal metabolic rate (BMR) in 16 professional sportswomen (soccer players) versus 15 sedentary women, as related to the presence (FH+) or absence (FH-) of a family history of type 2 diabetes. The sportswomen, in toto, had a significantly higher BMR than expected from predictive equations (+14.92%). However, the difference was limited only to FH- sportswomen (+18.66%, p<0.0005). FH- sportswomen showed a significantly higher measured BMR than FH+ sportswomen (p<0.005), and FH+ (p=0.058) and than FH- (p<0.05) sedentary women. There were no other significant differences relative to physical, metabolic and plasmatic data between the groups. The sportswomen with familiarity to type 2 diabetes had a BMR lower than that of FH- sportswomen, and similar to that of sedentary sedentary women. It appears that FH+ sportswomen have a "sub-clinical metabolic inertia", representing a precocious signal in young diabetes-prone subjects, despite the modifications induced from activity on their body composition (increased FFM, even though marginally significant).
Adolescent↗
Gemcitabine-induced atrial fibrillation: a hitherto unreported manifestation of drug toxicity.
BACKGROUND: Gemcitabine is an antimetabolic drug for solid tumors. Although its pharmacokinetics as well as its side-effects are well known, paroxysmal atrial fibrillation associated to the administration of this drug has not yet been described. PATIENTS AND METHODS: We describe the case of a 78-year-old man with pancreatic adenocarcinoma who presented repeated paroxysmal atrial fibrillation episodes 18-24 hours after every gemcitabine infusion which resolved with antiarrhythmic drugs. This clinical history was positive for a remote brief episode of atrial fibrillation, which resolved spontaneously, and the patient had no predisposing factors for supraventricular arrhythmias (systemic hypertension, diabetes or coronary artery disease). RESULTS: Cardiac work-up revealed only a mild mitral-valve prolapse and complete right bundle branch block. During the arrhythmia episodes no other precipitating factors were reported. The close temporal relationship of the arrhythmia to drug administration and the recurrence of arrhythmia upon rechallenge allowed to hypothesize an intrinsic pro-arrhythmic effect of gemcitabine or its metabolite 2',2'-difluorodeoxyuridine. CONCLUSIONS: The occurrence of atrial fibrillation during the administration of gemcitabine may be considered as a cardiac arrhythmia drug-related toxicity. This side-effect of gemcitabine infusion is a previously unreported sign of drug toxicity; therefore, a high level of awareness to this problem is warranted when this drug is administered.
Adenocarcinoma↗
Striatonigral suppression of focal hippocampal epilepsy.
Both caudate nucleus (CN) and substantia nigra (SN) appear to be involved in the control of epileptogenic events. Previous investigations had demonstrated that both CN and SN stimulations are able to induce hippocampal theta (theta) rhythm and an inhibition of epileptiform spikes. Since the two structures are reciprocally linked by fibre pathways, experiments were carried out to test the possibility that CN influences the hippocampus via SN or vice versa. To this end, changes in penicillin-induced hippocampal spikes by CN or SN stimulation were studied before and after destruction of SN and CN respectively. Steady interictal activity was induced in the hippocampus of encéphale isolé cats by local injection of penicillin. Stimulations of both CN and SN induced statistically significant reduction of hippocampal spike frequency, and in some cases a clear and regular theta-rhythm. These effects were unchanged by the destruction of either CN or SN. The results add further information to the role played by the basal ganglia and SN in the control of epilepsy, and underline the possibility that caudate and nigral influences on the hippocampus are mediated by different pathways.
Action Potentials↗
A study of caudate inhibition on an epileptic focus in the cat hippocampus.
The mechanisms whereby the caudate nucleus modifies hippocampal spiking activity have been studied. Epileptiform activity was induced in the cat hippocampus by topical application of sodium penicillin in different concentrations. The frequency of induced spikes appeared to be directly correlated to the two doses of epileptogenic agent. The inhibitory effect of 10 Hz caudate stimulation on spike frequency was present even when stimulation lasted for 180 s. Likewise 25 Hz caudate stimulation brought about an inhibition which was maintained by stimulus trains lasting up to 90 s, while the degree of inhibition was reduced by trains of longer duration (120, 150 and 180 s); similar results were also noted in some atropine-treated cats. The time course of spikes in cats with electrolytic lesions of the caudate exhibited an increase in both frequency and duration. The results indicate that there is an optimal parameter for caudate stimulation causing inhibition of penicillin-induced hippocampal spiking activity, and suggest the possibility of tonic control of hippocampal excitability exerted by the caudate nucleus.
Animals↗
[Regulating action of the substantia nigra on intestinal function].
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Animals↗
[Effect of penicillin on hippocampal theta rhythm in the cat].
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Animals↗
Negative occurrence between hippocampal rhythmic slow activity and epileptiform spikes: influence of the striatum.
The effects of caudate and septal stimulation on hippocampal activity were studied. Sodium penicillin was intravenously injected in order to induce a steady rate of interictal epileptic activity. Penicillin injection caused significant reduction of the rate of occurrence and duration of hippocampal rhythmic slow activity (RSA). Spontaneous RSA as well as RSA-eliciting caudate and septal stimulation induced a marked inhibition on frequency of epileptiform complexes. Lesions of the medial septal nucleus made it impossible to record RSA or to observe any sort of influence on hippocampal epileptiform activity by caudate stimulation. This result suggests that the septum is important for RSA genesis in the striato-hippocampal pathway or in the reciprocal septo-hippocampal connections.
Animals↗
[Feeding behavior of the cat in response to stimulation of the caudate nucleus].
In chronic free-moving cats unilateral, low frequency, long duration stimulation of the caudate nucleus causes a significant reduction of food intake. The effects are greatest at the beginning of the stimulation. On cessation of stimulation the animals take enough food to compensate for that lost during the time of stimulation. Results are discussed either considering interrelationships between striatum and lateral hypothalamus, either regarding recent viewpoints distinguishing two striatal compartments: dorsal or "non limbic" striatal region and ventral or "limbic" striatal region.
Animals↗
[Effect of the globus pallidus on hippocampal epilepsy in the cat].
The action of the pallidum on electrically induced afterdischarge of the hippocampus (HAD) was studied. Significant facilitatory influences on HAD duration were observed when pallidal conditional stimulation immediately preceded hippocampal test stimulation. The phenomenon appeared to be into correlation with the interval between conditioning and test stimulation. Experimental data are discussed as strongly presumptive of a functional interrelationship between the inhibitory role played by the caudate on both pallidum and hippocampus; facilitatory influence of the pallidum on HAD duration is discussed too.
Action Potentials↗
[Contrasting effects of stimulation of the caudate nucleus and globus pallidus on paroxysmal hippocampal activity in the cat].
The different actions exerted by pallidum and caudate nucleus on electrically induced epileptic activity of hippocampus were analyzed. Caudate appeared to inhibit hippocampal after discharges duration (HAD) while the globus pallidus exerted a facilitatory effect on HAD duration. Both effects were maximal when conditioning stimulation immediately preceded hippocampal test stimulation. The results are discussed considering reciprocal functional connections of the two striatal structures.
Animals↗