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Biomedical subjects

G Tomei

Publications and source records attributed to G Tomei.

At least 73 records · Page 4Linked to original sources
PubMed1975

Follow-up study of brain stem tumors in children.

In a series of 180 patients affected by brain stem tumors, 70 cases of children up to 16 years are analyzed. Diagnosis was made with clinical examinations, neuroradiological tests and, in 20 cases, with surgical explorations. A description is made concerning the clinical status with regard to site, extension and features of the tumor. Then the authors analyze statistically the survival of such patients in connection with clinical symptomatology, the radiological picture, medical treatment, radiation and/or surgical therapy either in the few cases of subtotal removal of the tumors, or in the more numerous cases of palliative procedures such as intra- and extra-thecal CSF shunting.

Adolescent↗
PubMedDate not supplied

Functional MRI: primary motor cortex localization in patients with brain tumors.

PURPOSE: Our goal was (a) to test the ability of functional MRI (fMRI) to localize the hand primary motor cortex in patients with brain neoplasms using a conventional scanner and (b) to compare within the same subject the location and morphology of the activated motor areas in the affected hemisphere with the contralateral ones. METHOD: Seventeen right-handed patients with frontoparietal intra- and extraaxial tumors were studied. Hand motor performance ranged from normal to slight impairment of finger dexterity. The fMRI study was based on a series of FLASH images. Two or three contiguous slices parallel to the bicommissural plane were acquired through the level of frontoparietal cortex. Each patient was requested to perform with each hand a finger-tapping task or a simpler repetitive flexion-extension of the last four fingers. Pseudo-color activation maps were then calculated by a Z-score method and superimposed on high resolution images. RESULTS: Five patients were excluded because of gross motion artifacts. In all other patients, areas of significant signal increase were detected on the precentral gyrus. They had a spot-like appearance, and no substantial side-to-side differences in shape or extension could be observed. In the presence of severe compression of the gyri, a displacement of the activated areas in the affected hemisphere with respect to the contralateral ones was noticeable. CONCLUSION: fMRI localization of the primary motor area using a conventional scanner can be obtained also in patients with brain tumors, although with a lower success rate than in normal volunteer studies, mainly because of subject compliance problems. Areas of significantly increased signal are detectable even in cortex where normal anatomical patterns are lost.

Adolescent↗
PubMedDate not supplied

Severe traumatic coma in infancy and childhood: results after surgery and resuscitation.

This study deals with 390 cases of severe traumatic coma in infancy, childhood and youth, aged between 4 months and 19 years. Cases in which unconsciousness lasted less than 24-48 hours have not been considered here. 161 patients were operated upon for intracranial space-occupying lesions or for open head injury: extradural haematomas 60; extradural haematomas + brain lacerations and/or subdural haematomas 16; acute subdural haematomas 18; brain laceration 36; open head injuries 17; decompressive operations, hydromas and contusions 14. 102 patients recovered and 59 died. 229 subjects were given only to resuscitation treatment. 164 recovered and 65 died. Recovery and mortality rate are discussed in relation to the pathologicial lesions and to the clinical picture (severity, evolution and duration of coma). Overall mortality rate was 31%. Mortality was higher in operated patients (36.6%) and lower in patients in whom space-occupying lesions were not demonstrated by angiography and who underwent only resuscitation treatment (28%). The lowest rate was observed in cases of extradural haematoma (25.4%) and open head injury (23%). Highest mortality rate have been observed in cases of decerebrated coma (with or without signs of low brain stem impairment). Complete recovery can be achieved even after prolonged decerebration. 31 patients showed the typical picture of the "apallic syndrome": in 28 cases after prolonged decerebrated coma, in 3 cases after coma without decerebration. Of our 31 cases, 4 died, 4 are still in a chronic apallic state and 23 recovered. Of these, 10 patients had a remarkable recovery and 13 remained severely disabled.

Adolescent↗
PubMedDate not supplied

[Use of TLV-ACGIH (HAL) and Strain Index for the evaluation of the upper extremity biomechanical overload].

Pathologies due to repetitive activity of the upper limb, well known in scientific literature as WMSDs (Work Related Musculoskeletal Disorders), are considerably increased in the last years. At the moment, there are no validated methods for the assessment of the work-related risk. This study compares two different methods proposed in literature for the assessment of the work-related risk, combining objective and subjective measures.

Arm↗
PubMedDate not supplied

[Scientific evidence in occupational medicine: meta-analysis of the data regarding the effects of working with video terminals on the psycho-physical well-being].

Psycho-physical well-being of video display terminal (VDT) workers is often neglected. The aim of this study is to evaluate, through the comparison of controlled studies published in scientific literature, the psycho-physical well-being of VDT workers and, in particular way, the phenomena of strain and mental fatigue with their neuro-physiological, behavioural and subjective components. Seven-hundreds articles have been found from which we have selected twenty-one articles on the basis of the following inclusion criteria: controlled studies and evaluation of variables about mental fatigue; finally, only fifteen articles were utilized in the analysis due to the variability of data needed in the computation of effect size. For continuous variables we have performed two different types of elaboration methods; in case of variables showing no significant heterogeneity among studies, we have used the Weighted Mean Difference method, according to the Fixed Effect Model, while for variables showing significant heterogeneity among studies, we have used the Standardized Mean Difference method according to the Random Effects Model. Categorical variables have been analyzed trough the calculation of Odds Ratio according to the Fixed Effect Model or to the Random Effects Model respectively in case of heterogeneity's absence or presence among studies. Variables obtained by the studies were classified in four groups: biological assessment, strain assessment, subjective well-being assessment, and psycho-somatic symptoms. Statistically significant outcomes have been found for urinary adrenalin, sleep disturbances and for all the evaluated categorical parameters except headache. These outcomes allow for the following observations: 1) psycho-physical well-being of VDT workers, and especially mental fatigue, remain an object of uncertain identification and they are often neglected by Occupational Health doctors even though their evaluation is required by the Italian legislation (D.Lgs 626/94); 2) even though there is a huge interest on the argument, the amount of controlled studies on VDT workers is still insufficient. Furthermore, studies are often weak in power heterogeneous and discordant on potential problematic issues and consequently there is a difficulty in both the reproduction and overlapping of the studies; 3) Occupational Health doctor should be more careful toward this specific argument and, in his clinical practice, he should use only evidence-based parameters with high level of reproduction suggested by studied which can be considered homogeneous and overlapping for case studies and control groups. This meta-analysis suggests which evaluations to use as statistically significant parameters for the health protection of VDT workers.

Anxiety↗
PubMedDate not supplied

[Attention, repetitive works, fatigue and stress].

Repetitive work in occupational settings often requires a combination of mental and physical demands, but few studies were conducted concerning the relationship between attention and repetitive work. In attentive and cognitive tasks, it is common to observe effort and fatigue without the presence of those neuromuscular modifications that would justify the use of these terms. Therefore, we can talk about mental fatigue in those cases in which it is observed the exhaustion of the necessary resources for the execution of a job that doesn't demand the employment of neuromuscular apparatus. Scientific literature about this argument consists of experimental studies which aim to estimate at what extent attentive demands exspecially cognitive demands can interact with physical ones which are peculiarities of repetitive tasks. Work characterized by the maintenance of high levels of performance for a long time, produce cognitive effort with high level of vigilance, selective attention, decisional ability, automated control mechanisms, such as "eye-hand", and may contribute to the fatigue. Indeed, fatigue plays a important role in a working context since, it may interfere with the work itself by reducing the worker's efficiency and performance and if excessive and extended, it may alter the subject's psycho-physical condition and induce different pathologies. Repetitive work can contribute to the increasing of muscular fatigue by inducing mental fatigue: for example tasks which require high vigilance but low neuromuscular work, may induce a sense of effort and fatigue and cognitive factors and mental stress may cause muscular fatigue. Several intrinsic job factors, including repetitive works, may act as stressors and they can cause mental and physical symptoms such as anxiety, depression and somatic diseases. The European Community has often emphasized the pathogenic value of stress and fatigue with their high social and individual costs. For this purpose, it is opportune to consider the norm UNI EN ISO 10075, which points out the necessity to consider the human component, in term of mental load which implies not only the cognitive component but also the whole psychical sphere of the subject. Training intended like a sort of learning of specific modalities, supplies workers with the necessary instruments for a correct and more aware management of the peculiarities of working activity, contributing to the reduction of fatigue and stress deriving from the job.

Attention↗
PubMedDate not supplied

[Exposure to traffic noise and effects on attention].

This study was aimed to evaluate if workers exposed to environmental stressors, including the urban traffic noise, might show significant differences compared to a control group in neuro-psychological and emotional profile as well as neurophysiological functions. In particular if these differences could be evidenced by the application of the "oddball paradigm" for event related potential P300 component. The study consisted of the following examinations: (1) exposed workers vs. controls under the odd-ball paradigm and the Stroop test in baseline condition; (2) amplitude and latency ofP300 (in baseline condition and after administration of acute urban traffic noise and Stroop test). The research was carried on a sample of 81 volunteers: 39 workers exposed to environmental stressors and 42 controls. The phonometric measurements showed mean levels of noise due urban traffic like 74 dBAeq. In baseline condition significative differences in exposed workers vs. control were found in Raven's Matrices PM 38 (p = 0.002) and Arithmetic reasoning from WAIS-R (p = 0.0024). Attention capacities as measured by Digit Span Forward and Visual Search, emotional functioning as measured by state- and trait-anxiety test and mood profile were not different in the two groups. Either in baseline condition or after acute stimuli no significant changes were found in two groups concerning the odd-ball paradigm. Exposed workers showed a higher execution time at Stroop test compared to controls (p = 0.047). No differences were found in the number of errors at the Stroop test. Before the acute stimulus, P300 amplitude was significant higher in the exposed workers than in controls (p = 0.002) while the latency was not different between two groups. Both noise (p = 0.001) and Stroop test (p = 0.002) stimulation increased the P300 latency of the whole sample, without significant differences between exposed workers and controls. A significative decrease of P300 amplitude due noise both in the exposed workers (p = 0.001) and in controls (p = 0.012) was found, without significant difference between the two groups. These results are interpreted as follows: (1) there are chronic effects on cognitive functioning in the exposed group vs. controls in baseline condition, like showed by significant differences in Raven PM38 and WAIS-R; (2) the exposed workers have a smaller cognitive flexibility, as shown by the Stroop test results; (3) in baseline condition the greater P300 amplitude in exposed workers reflect a greater division of attentive resources vs. controls, probably linked to the chronic stimulation by environmental stressors, especially noise, to which these workers are exposed; (4) the effects on P300 latency and amplitude can document the physiological response both in the exposed and not exposed to the acute stimulus and that the lack of significative differences in P300 latency and amplitude may be due to adaptative response to acute stimuli in exposed too. Our results allow us to consider that in workers exposed to urban stressor, such as noise, there are effects on cognitive functioning, especially on attention, without auditory damages. The valuation of P300 might represent a valid diagnostic instrument to evaluate the effects on cognitive functions especially on attention, in workers chronically and acutely exposed to urban stressors.

Adult↗
PubMedDate not supplied

[Working reinstatement and mental health].

Mental illness, as anxiety, schizophrenia, obsessive-compulsive disorders, anorexia, have a huge impact on any working population. These disorders are a medical and social reality in strong increasing and they represent a great public interest. People suffering from a mental illness experience many inconveniences: a reduced possibility in choosing of the type of job, the necessity of a support, the difficulty in changing job, a reduction of the working hours, discriminations and abuse. This study explored the role of work in enhancing the economic and social integration of people with mental disorders. The importance of addressing specific issues (supported employment, vocational rehabilitation) related to the employment of persons with mental health problems has also been recognized.

Employment↗
PubMedDate not supplied

Posttraumatic diffuse cerebral lesions. Relationship between clinical course, CT findings and ICP.

One hundred and fifty patients with posttraumatic diffuse cerebral lesions were reviewed. Criteria of inclusion were immediate coma and CT appearance of diffuse lesions, that were classified as follows: (a) Diffuse axonal injury (70 cases): patients with normal CT scan (50 cases) and patients with shearing injury (focal hemorrhages in corpus callosum, basal ganglia and brain stem; gliding contusions) (20 cases); (b) Diffuse brain swelling (80 cases): reduced or absent lateral ventricles, absence of 3rd ventricle and basal cisterns. Many of these patients had either subarachnoid haemorrhage or subdural blood effusion. Clinical course and mortality rate were in a ranking order in the considered groups. Patients with normal CT had a less severe coma and a better outcome than patients with shearing injury and diffuse brain swelling. There was evidence of high intracranial pressure in 75% of the patients with brain swelling, whereas no patient with normal CT had ICP elevation. Diffuse axonal injury represents a primary posttraumatic diffuse lesion. Secondary vascular involvement, due to hypoxia, shock and other unknown causes, is responsible for the appearance of vasoparesis, hyperemia and diffuse brain swelling.

Adult↗
PubMedDate not supplied

Treatment of non-neoplastic stenosis of the aqueduct of Sylvius with extrathecal CSF shunts.

A series of 185 patients operated on with extrathecal shunts for non-neoplastic aqueductal stenosis has been reviewed. The longterm results of 84 of them, followed-up for 2 to 20 years after primary surgery, are illustrated and critically analyzed. This study indicates that a normal mental development or normalization of mental and neurological conditions can be expected in a high percentage of patients after the CSF diversional procedure which nonetheless is still associated with a high percentage of even serious complications.

Adolescent↗
PubMedDate not supplied

Intraventricular hemorrhage: role of early ventricular drainage.

Intraventricular hemorrhage (IVH) is usually the result of life-threatening intracranial bleedings eventually leading to death. Early ventricular drainage is suggested as a possible means of reducing fatalities. The retrospective analysis of 80 patients with CT diagnosed IVHs has indeed shown that early drainage prolongs significantly survival before death but does not influence mortality. Clinical and CT grading still remain fundamental prognostic indexes accounting for the irreversible hemorrhagic lesion. Thus ICP monitoring and ventricular drainage may be useful only in selected patients with alterations of consciousness of intermediate severity and sluggish evolution.

Adolescent↗
PubMedDate not supplied

Optic nerve and chiasm gliomas in children.

In a 30 years period, 42 children were admitted for optic nerve and chiasm gliomas; 20 patients aged less than 5 years and 22 between 6 and 16 years. Duration of symptoms ranged from 13.15 months in children aged less than 5 years, to 10.18 months in patients aged more than 6. Onset of symptoms were characterized by visual impairment and/or proptosis in 73.8%, diencephalic disorders in 16.6% and intracranial hypertension in 9.5%. All patients underwent skull X-rays; 31 had a PEG taken and 12 a CT scan. Surgery was prompted in 27 patients, 2 of which died in postoperative course. Radiotherapy was the treatment of choice in the other 15 patients, 40 patients were followed up: the best results were obtained in the group of patients operated on and irradiated.

Adolescent↗