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Biomedical subjects

L Fuso

Publications and source records attributed to L Fuso.

At least 19 recordsLinked to original sources
PubMed2005

Autofluorescence bronchoscopy to identify pre-cancerous bronchial lesions.

BACKGROUND: This study aimed to assess the diagnostic yield of autofluorescence bronchoscopy (AFB) in the detection of pre-cancerous bronchial lesions in a non-selected sample of patients. METHODS: Both fiberoptic white-light bronchoscopy (WLB) and AFB using the Storz D-light system were performed on 166 consecutive patients. Biopsy specimens were taken in areas of the tracheobronchial tree judged as abnormal or suspicious at WLB and/or AFB. The bronchoscopic procedures were randomly performed by two operators. RESULTS: A total of 93 patients had a positive biopsy specimen: 80 for cancer and 13 for dysplasia. AFB was abnormal or suspicious in 85 of the 93 patients with a sensitivity of 91.4%. Specificity was 50.7%. In 16 patients with normal WLB examination, AFB identified abnormal or suspicious areas which had a positive biopsy. Thus AFB significantly improved sensitivity of WLB (100% vs 82.8%, respectively, p<0.001) in the entire sample of patients studied. Data was further analysed separately for patients with dysplasia and those with cancer. Indeed, 13 of 16 patients recognized only by AFB had a histological diagnosis of dysplasia. The remaining three patients had a diagnosis of cancer (small intraepithelial neoplastic lesions). Since no other patient with dysplasia was found, AFB had a sensitivity of 100% in diagnosing dysplasia. On the other hand, excluding the 13 patients with dysplasia, WLB had a high sensitivity in diagnosing cancer (93.7%). CONCLUSIONS: The AFB Storz system showed a high sensitivity. The increase in diagnostic yield of AFB in comparison with WLB was related to the power of AFB to identify pre-cancerous bronchial lesions so showing its usefulness in the early diagnosis of lung cancer.

Aged↗
PubMed2004

Prevalence of asthma and atopy in Italian Olympic athletes.

This study aimed to assess the prevalence of asthma and atopy in the Italian athletes who were trying for a position on the Italian Olympic team for the 2000 Sydney Olympic Games. Overall, 1060 athletes (mean age 24 years, range 15 - 69 years, 729 males) were recruited and divided into three groups of sport activities: 1) anaerobic, 2) aerobic-anaerobic, 3) aerobic. Asthmatic and atopic athletes were identified by a self-administered, standardized questionnaire modified from the ISAAC questionnaire. Spirometry was performed in the athletes who reported wheezing or asthma and in an equal number of randomly selected controls. Athletes reporting wheezing or asthma were 15 %. However, only a minority of asthmatics had moderate or severe disease: indeed, 2.5 % reported more than 4 attacks in the last year. The prevalence of atopy was 18 %. Asthma was more common in athletes engaged in aerobic sport activities than in the other groups. Asthmatic athletes had a significantly lower value of some spirometric parameters in comparison with the control group. In conclusion, the prevalence of wheezing or asthma in a large sample of Italian competitive athletes was found higher than in general population; respiratory symptoms were more prevalent in athletes engaged in aerobic sport activities; a significant impairment of lung function was found in athletes suffering from mild and rarely symptomatic asthma.

Adolescent↗
PubMed2003

The role of the French-Italian glossary of complications in the outcome evaluation of cervical cancer treatment: an Italian multicentric study.

UNLABELLED: The optimal treatment for cervical cancer is still a controversial matter: in the last two decades a lot of different modalities combining surgery, radiotherapy (RT) and chemotherapy (CHT) have been suggested and analysed in clinical trials. Nevertheless, analysis of treatment in cancer patients should be directed not only to survival, but also to the cost of complications and quality of life. In June 1988, a French-Italian co-operative group set up a glossary in which the complications of the treatment of cervical cancer are described and ranked. Nowadays, this is the only international system based upon an accurate description of symptoms and signs of complications following multidisciplinary treatment. The glossary was based on our previous experience in treating patients by surgery alone, RT or their combinations. Recently multimodality treatment includes also CHT. The aim of the present study was to verify whether the glossary is still a useful clinical instrument in outcome evaluation of cervical cancer treatment. MATERIALS AND METHODS: The analysis has been done on a retrospective consecutive series of 579 patients affected by cervical cancer, treated in five Italian institutions. A minimum of 12 months follow up was required. All medical records of the patients enrolled, were examined by two independent reviewers in order to classify the complications according to the glossary. RESULTS: Out of 579 patients 319 (55.1%) were free of complications and 260 (44.9%) experienced at least one complication. We found 436 complications. The distribution by Grade was: G1 58.9%, G2 27.5%, G3 13.5%. We had no fatal complication (G4). The glossary included all observed complications, except for pulmonary fibrosis. CONCLUSION: The glossary is still a useful instrument in evaluating the outcome of cervical cancer treatment, whatever the therapy, and should be considered in quality of life assessment.

Female↗
PubMed2002

Exacerbated chronic obstructive pulmonary disease: a frequently unrecognized condition.

OBJECTIVES: To assess to which extent exacerbated chronic obstructive pulmonary disease (COPD) remains unrecognized in the emergency department, which factors account for misdiagnosis and which are the effects of misdiagnosis on patient's management. DESIGN: Retrospective study and stratified random sampling method as selection criterion. SETTING: University Hospital. SUBJECTS: Eighty patients representative of those discharged from the wards of medicine with a diagnosis of exacerbated COPD and 72 having a discharge diagnosis of coronary artery disease (CAD) were studied. MAIN OUTCOME MEASURES: Degree of concordance between admission and discharge diagnosis; presenting symptoms and signs of patients correctly or incorrectly classified on admission; impact of diagnostic procedures carried out by the physician on call on patient's management. RESULTS: The correct diagnosis was missed on admission in 13/80 COPD and 3/72 CAD patients (chi(2): 5.87, P=0.015). The prevalence of the following presenting features distinguished the 67 COPD patients who were correctly classified on admission from the remaining 13: severe weakness (21 vs. 10, chi(2): 9.53, P=0.002), dyspnea (60 vs. 3, chi(2): 28.75, P < 0.001), and limb oedema (14 vs. 6, chi(2): 3.70, P=0.054). Critical hypoxemia was diagnosed and treated only after admission in 19 COPD patients. CONCLUSIONS: Exacerbated COPD frequently escapes recognition in the emergency room, mainly if severe weakness and limb oedema are its presenting features. Arterial blood gas analysis is not systematically performed in the emergency room and, consequently, oxygen therapy is either not administered or given to selected COPD patients on an empirical basis.

Coronary Disease↗
PubMed2002

123I-MIBG radioaerosol lung clearance in COPD patients with fixed and partially reversible obstruction to evaluate the functional status of pulmonary adrenergic innervation.

In order to test the hypothesis that a greater sympathetic activity underlies partial reversibility of the bronchial obstruction in selected patients with chronic obstructive pulmonary disease (COPD), we assessed the pulmonary clearance of inhaled I-meta-iodobenzylguanidine ( I-MIBG) radioaerosol in 10 patients with fixed and nine with reversible obstruction. The clearance of inhaled I-MIBG is known to be inversely related to I-MIBG uptake by adrenergic terminals. Groups were matched for age and judged free from confounding comorbidity. The penetration index did not distinguish between the groups (fixed obstruction, 97.39+/-14.59%; reversible obstruction, 89.09+/-19.95%; P=0.659); this excludes the possibility that the inequality of tracer penetration could affect I-MIBG clearance. The I-MIBG clearance was 140.92+/-7.67 min in patients with fixed obstruction and 151.08+/-31.54 min in patients with reversible obstruction ( P=0.604). In conclusion, COPD patients with fixed and reversible obstruction show comparable binding of the tracer to adrenergic pulmonary receptors. Thus, a greater receptor responsiveness or post-receptor mechanism probably underlies the partial reversibility of bronchial obstruction.

3-Iodobenzylguanidine↗
PubMed2002

Different types of hysterectomy in the radio-surgical treatment of early cervical cancer (FIGO Ib-IIa).

PURPOSE OF INVESTIGATION: Surgery and radiotherapy achieved equivalent results for FIGO stages Ib-IIa invasive cervical carcinoma. The integration of radiotherapy and surgery provided the same results for a selected series of patients without increasing the rate of complications. The aim of the study was to verify if, applying a radio-surgical protocol, the reduction of the surgery extension on the parametrium in one of two consecutive series might achieve the same results in terms of survival and recurrence rates with fewer complications. MATERIAL AND METHODS: We analysed actuarial survival (with >10-year follow-up), local control rates and morbidity of 390 patients who had different the kinds of surgery applied in the radio-surgical treatment protocol: Protocol A: brachytherapy plus type III radical hysterectomy vs Protocol B: brachytherapy plus type II radical hysterectomy. Patients were all included in an analysis of complications according to the French-Italian glossary. RESULTS: Analyses showed no differences in terms of survival, patterns of recurrences and onset time within the two protocols. Urinary complications were more frequent and severe in protocol A vs protocol B (G2: 26.5% vs. 6.1%; G3: 5.3% vs. 3.6%). CONCLUSION: Our study pointed out that the reduction of the surgery extension allowed the same overall survival and relapses with fewer complications particularly in terms of grade of severity.

Adenocarcinoma↗
PubMed2001

Orolaryngeal sarcoidosis presenting as obstructive sleep apnoea.

A 53-year-old man was evaluated for snoring, dysphagia for solid foods and difficulty of breathing and a polysomnographic recording was consistent with a diagnosis of obstructive sleep apnoea syndrome (OSAS). A flexible fiberoptic bronchoscopy (FFB) showed the presence of a nodular lesion of the posterior ventral surface of the tongue strictly connected to the left lateral border of the epiglottis. The biopsy specimen taken from the lesion was consistent with sarcoidosis. No involvement of pulmonary parenchyma, lymph nodes or other organs was recognized. After two months of steroid treatment, symptoms disappeared and resolution of the nodular lesion at the FFB and normalization of the polysomnographic recording were observed. This is the first report of orolaryngeal sarcoidosis associated with OSAS as the only clinical presentation of the disease.

Bronchoscopy↗
PubMed2000

Repeatability of the ISAAC video questionnaire and its accuracy against a clinical diagnosis of asthma.

The objective of the study was to evaluate the performance of the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire in terms of repeatability and accuracy against a clinical diagnosis of asthma achieved according to the National Heart, Lung and Blood Institute (NHLBI) algorithm. Two hundred and forty-one subjects, aged 13-14 years from two secondary schools in Rome, Italy, were enrolled. Video and written ISAAC questionnaires were completed twice, 3 months apart, by 194 and 190 adolescents, respectively. Two months later, 106 subjects were visited by two physicians blinded to the results of questionnaires. Sixteen subjects were classified as having clinical asthma (CA) at the clinical visit, and eight of them as having clinical active asthma (CAA) on the basis of at least one positive outcome of the NHLBI algorithm. The repeatability of video questionnaire was similar to that of the written questionnaire for items on exercise wheeze and nocturnal cough and, to a lesser degree, for items concerning any wheeze in the past. The video questionnaire showed a worse performance than the written questionnaire for items on asthma attack: K-value (95% CL) = 0.59 (0.37-0.80) for video scene no. 5 and K-value (95% CL) = 0.86 (0.74-0.98) for written question no. 6. The overall accuracy of the video questionnaire, estimated as a positive answer to any video scene, was lower in terms of sensitivity than that of any written question when CA was used as a gold standard (0.50 vs. 0.81, P=0.025) and increased with respect to CAA (0.75 vs. 0.87, P = 0.317). The specificity of any video scene was better than that of any written question, independently from the gold standard used. In conclusion, the video questionnaire showed a fairly good accuracy, although slightly lower than that of the written questionnaire and provided sufficiently reliable results. However, samples of subjects from different geographic areas and cultures should be studied in order to conclusively define the performance of the ISAAC video questionnaire.

Adolescent↗
PubMed2000

Correlates of osteoporosis in chronic obstructive pulmonary disease.

The aim of this study was to analyse the correlates of reduced bone mineral density in patients with chronic obstructive pulmonary disease (COPD), with special regard to a possible protective role of hypercapnia. One hundred and four consecutive COPD inpatients in stabilized respiratory conditions underwent a comprehensive assessment of their health status. Bone mineral density was measured by X-ray absorptiometry at the lumbar site and at the femoral neck site. Differences in health-related variables between patients with (group O, n=62) and without (group N, n=42) lumbar and/or femoral neck osteoporosis were assessed first by univariate analysis and then by logistic regression analysis aimed to identify independent correlates of osteoporosis. Group O was characterized by worse nutritional status, as reflected by indices exploring either lean or fat mass, and by a trend towards lower forced expiratory volume in 1 sec/forced vital capacity ratio. Arterial tension of carbon dioxide lacked any correlation with bone mineral density. According to the logistic regression analysis, body mass index < or = 22 kg m(-2) qualified as the only and positive independent correlate of osteoporosis (odds ratio=4.18; 95% confidence intervals=1.19-14.71). In conclusion, malnutrition characterizes COPD patients with osteoporosis, while mild to moderate hypercapnia lacks either a positive or negative effect on bone mineral density. Longitudinal studies are needed to identify predictors rather than correlates of bone mineral density.

Absorptiometry, Photon↗
PubMed2000

Role of spirometric and arterial gas data in predicting pulmonary complications after abdominal surgery.

The aim of this study was to evaluate the predictive value of preoperative spirometric and arterial gas data on severe pulmonary complications (PC) after elective abdominal surgery. We retrospectively studied 480 patients, 254 males and 226 females, mean (SD) age 63 (11) years, at risk for PC according to standardized criteria, who underwent laparotomy for resection of gallbladder for gallstones (44% of patients), resection of colon, rectum or stomach for malignant tumours (37%), and other abdominal surgery (19%). The overall incidence of postoperative PC was 18%. In a logistic regression analysis adjusted for smoking habit and clinical history of chronic bronchitis, FEV1<61% of predicted [odds ratio (OR)=16.86, 95% confidence interval (95%CI)=5.62-50.58] and PaO2<9.33 kPa (OR=6.42, 95%CI=2.48-16.61) were the main determinants of PC. Ischaemic heart disease (OR=3.44, 95%CI=1.08-10.93), operation for malignant tumours (OR=3.24, 95%CI=1.75-6.00) and age (OR=1.04, 95%CI=1.00-1.08) were also independent predictors of PC. Patients with moderate-to-severe airway obstruction combined with hypoxaemia had a significant higher risk of PC in comparison with patients with a normal respiratory pattern. Taking into account age, type of operation, and comorbidity, a preoperative respiratory functional assessment could be useful in identifying an increased risk of major PC in selected patients.

Abdomen↗
PubMed2000

Current practice in assessment and treatment of bronchial asthma in young males in Italy.

The aim of the study was to evaluate, in a sample of young asthmatics in Italy, the current practice in assessment and treatment of asthma after the publication of guidelines. Young soldiers who declared bronchial asthma at the beginning of the compulsory military service were evaluated. One-hundred and thirty-eight subjects with confirmed asthma were selected. Sixty-seven subjects (48.5%) had had at last one spirometry, and only one subject had underwent peak flow monitoring at home; most of the subjects (96.8%) had had prick tests. More of the 50% of the subjects with bronchial obstruction or with severe bronchial hyperresponsiveness, with clinical moderate or severe asthma, had used only bronchodilators or no therapy at all in the preceding year. In this sample of young asthmatics, the lung function tests were still underutilized for the diagnosis and follow-up of bronchial asthma; moreover, the inhaled anti-inflammatory drugs were still underutilized.

Adult↗
PubMed2000

Accuracy of indirect estimation of oxyhaemoglobin saturation in patients with respiratory failure.

The indirect estimate of oxyhaemoglobin saturation (Sa,O2) is largely used in the management of patients with respiratory failure. The aim of this study was to evaluate the accuracy of the Sa,O2 values calculated by using both the Siggaard-Andersen (SA) and the Severinghaus (SE) equation, in comparison with the real Sa,O2 values measured by a co-oximeter. A total of 558 arterial blood samples were analysed. On average, only a slight overestimation was found for Sa,O2 estimated by the SA (2.35 +/- 5.75%) and the SE (2.37 +/- 5.65%) equations in comparison with the real values. However, a difference higher than 5% between estimated and real Sa,O2 values was demonstrated in more than 20% of the blood samples evaluated. This difference was higher than 10% in 9% of the samples, with similar results obtained with the two equations. The discrepancy between real and estimated values, probably due, at least in part, to errors in measurement of arterial oxygen tension (Pa,O2) and pH, was maximally evident for Sa,O2 values lower than 70%. An indirect estimate of Sa,O2 is not homogeneously accurate, and the clinical consequence of this finding might be especially dangerous in monitoring patients with severe respiratory failure.

Humans↗
PubMed1999

Electrocardiographic signs of chronic cor pulmonale: A negative prognostic finding in chronic obstructive pulmonary disease.

BACKGROUND: Chronic cor pulmonale (CCP) is a strong predictor of death in chronic obstructive pulmonary disease (COPD). The aims of this study were to assess the prognostic role of individual ECG signs of CCP and of the interaction between these signs and abnormal arterial blood gases. METHODS AND RESULTS: Two hundred sixty-three patients (217 men) with COPD, mean age 67+/-9 years, were grouped according to whether they had no ECG signs (group 1, n=100) or >/=1 ECG signs (group 2, n=163) of CCP and were followed up for 13 years after an exacerbation of respiratory failure. The median survival was significantly shorter in group 2 than in group 1 (2.58 versus 3. 45 years, respectively; Mantel-Cox test, 9.58; P=0.002). The Cox regression analysis identified S1S2S3 pattern, right atrial overload (RAO), and alveolar-arterial oxygen gradient (PAO2-PaO2) >48 mm Hg during oxygen therapy as the strongest predictors of death, with hazard rate (HR)=1.81 (95% CI, 1.22 to 2.69), HR=1.58 (95% CI, 1.15 to 2.18), and HR=1.96 (95% CI, 1.19 to 3.25), respectively. The median survivals of patients having both S1S2S3 pattern and RAO (n=14) and of patients having either S1S2S3 pattern or RAO (n=77) were 1.33 and 2.70 years, respectively (P=0.022). Group 2 patients had a 3-year survival of 18% or 53%, depending on whether their PAO2-PaO2 during oxygen therapy was or was not >48 mm Hg. CONCLUSIONS: Some ECG signs of CCP and PAO2-PaO2 >48 mm Hg during oxygen therapy qualified as a simple and inexpensive tool for targeting subsets of COPD patients with severe or very severe short-term prognosis.

Aged↗
PubMed1999

Hydrolysis of peripheral leucine enkephalin in allergic asthma.

Plasma hydrolysis of leucine enkephalin was studied in a group of patients affected by seasonal allergic asthma in acute and quiescent stage; data were compared with those obtained from a control group of healthy volunteers. Results obtained indicate a statistically significant reduction of leu-enkephalin hydrolysis in allergic subjects. In the quiescent stage, substrate degradation is reduced, and the pattern of the hydrolysis by-products is modified with respect to normal controls. In the acute stage, hydrolysis is further reduced, and the pattern of the hydrolysis by-products is further modified with respect to the quiescent stage. The variations of leu-enkephalin hydrolysis appear to be controlled by decreased activity of proteolytic enzymes and by increased activity of the low-molecular-weight plasma inhibitors active on these enzymes. The sum of these processes is conducive to a distribution of enkephalin-hydrolyzing enzymes, as well as a hydrolysis pattern, that appears to be specific for the allergic subjects and distinct from that seen in the controls.

Acute Disease↗
PubMed1999

Hypoxemia in young asthmatics with mild airway obstruction by methacholine challenge.

We studied 12 asymptomatic conscripts affected by bronchial asthma to evaluate the level of hypoxemia and its relationship with bronchial obstruction induced by methacholine (Mch) challenge. Arterial blood samples were obtained before and immediately after bronchial challenge. The range of decrease of forced expiratory volume/forced vital capacity x 100 in 1 second of expiration (FEV1), the absolute value reported as a percentage of the baseline value, after Mch challenge was from 21% to 36%. The mean decrease of arterial oxygen tension was 27 mm Hg (from 11.4 to 39.8 mm Hg), the mean decrease of hemoglobin saturation was 3.53% (from 0.4 to 7.2), and the mean increase of alveolar-arterial gradient for oxygen was 28.2 mm Hg. We found a significant correlation between the prechallenge and postchallenge differences of arterial oxygen tension and FEV1 (DFEV1P), which was expressed as a percentage of the predicted value. In conclusion, the Mch challenge seems to be a safe test, and the decrease of arterial oxygen tension can be sufficiently predicted by DFEV1P.

Adult↗