Search PubMed⌕ Search

Biomedical subjects

L Gagliardi

Publications and source records attributed to L Gagliardi.

At least 37 records · Page 2Linked to original sources
PubMed1995

Respiratory inductive plethysmography in the evaluation of lower airway obstruction during methacholine challenge in infants.

Respiratory inductive plethysmography (RIP) is a simple technique for an objective, noninvasive assessment of thoracoabdominal asynchrony, which in turn is an indirect measure of airway obstruction. We evaluated different indices of asynchrony obtained by RIP before and after methacholine-induced airway obstruction. Bronchial obstruction was elicited by progressive doubling concentrations of methacholine until a > 15% fall in the transcutaneous oxygen tension (PtcO2) had developed. Maximal expiratory flow rates at functional residual capacity (FRC) (VmaxFRC) was obtained by the squeeze technique before and after the challenge. Fifteen infants with a history of wheezing were studied after sedation. Thoracoabdominal movements were recorded with RIP bands placed around either the upper or the lower ribcage (RC) and around the abdomen (AB). An inspiratory asynchrony index (IAI) and an expiratory asynchrony index (EAI) were calculated as determined by the lag of RC relative to AB at start of inspiration and of expiration, respectively. The total time in asynchrony (TTA: the percentage of time in which the RC and the AB signals were in opposite direction) and phi (an angle derived from a Lissajous loop) were also calculated. All subjects responded to the challenge. The median fall in PtcO2 following methacholine challenge was 23.6% and in VmaxFRC was 43%. A large scatter of baseline values was found for all indices with the exception of TTA. There was no correlation between TTA and age, length, or VmaxFRC. The IAI and EAI with the RC band in the upper position were the most sensitive indices, both within subjects (65% of the subjects had a significant change in IAI and 80% in EAI) and for the group as a whole (median values increased for IAI, P = 0.007, and for EAI, P = 0.017). TTA and phi were less sensitive, and a great discrepancy was observed between the two measurements. Poor results were obtained with the RC band in the lower position. No correlations were found between the changes in IAI and EAI, with the RC band around the lower chest and VmaxFRC. We conclude that IAI and EAI, measured with the RC band in the upper position and another band around the abdomen, can detect changes in thoracoabdominal asynchrony in most infants. The usefulness of assessing IAI and EAI in infants with acute lower airway obstruction needs to be determined.

Abdomen↗
PubMed1995

Airway reactivity in parents of infants and young children with recurrent wheeze: a case-control study.

Increased airway reactivity has been found in family members of school age children and adults with asthma. As the relation between recurrent wheeze in infancy and bronchial reactivity is not yet clear, it was decided to test bronchial reactivity to methacholine in both parents of 50 preschool age children with recurrent wheeze and in 200 population based controls matched for sex, age, smoking habits, and atopy. Wheezy children fulfilled the following criteria: first attack of wheezing before the age of 2 years, at least four wheezing episodes triggered by a respiratory infection, negative skin prick tests, and no symptoms related to allergy. Four parents and five controls did not undergo the methacholine challenge because their forced expiratory volume in one second was < 80% of the predicted value. Methacholine reactivity was not significantly different in parents and controls. In summary, an increased bronchial responsiveness was not found in parents of infants and young children with recurrent wheeze triggered by infection.

Adult↗
PubMed1995

Hering-Breuer reflex and respiratory rate: a biased association.

The Hering-Breuer reflex (HBR) plays an important role in the regulation of respiratory timing in infancy. Some investigators have noted that HBR is stronger when the respiratory rate (RR) is faster. However, this finding may be due to a spurious correlation, since one of the variables (expiratory time) used to calculate both HBR and RR is the same. We investigated this hypothesis with Monte Carlo (simulation) studies by using uncorrelated random numbers to calculate RR and HBR and found a strong spurious correlation (r = 0.7) between HBR and RR, i.e., subjects with higher RR had a stronger HBR. These results were confirmed algebraically, and the formula for the expected value of the correlation coefficient [E(r)] was derived. E(r) was always >0; it was 0.707 when no prolongation of inspiration occurred and was larger in the presence of a prolongation; when HBR strength was 100%, E(r) = 0.89, and when it was 200%, E(r) = 0.94. The expected value of the slope of the regression line of HBR on RR was found to be directly proportional to expiratory time during occlusion. As faster RRs produce stronger HBRs, any variable associated with RR, i.e., age, length, and weight, may influence HBR. This can lead to inconclusive or biased results in studies of the maturation of HBR with age and can confound comparisons across groups that do not have the same RR.

Age Factors↗
PubMed1994

Reference values for respiratory rate in the first 3 years of life.

BACKGROUND: Raised respiratory rate is a useful sign to diagnose lower respiratory infections in childhood. However, the normal range for respiratory rate has not been defined in a proper, large sample. OBJECTIVE: To assess the respiratory rate in a large number of infants and young children in order to construct percentile curves by age; to determine the repeatability to the assessment using a stethoscope and compare it with observation. METHODS: Respiratory rate was recorded for 1 minute with a stethoscope in 618 infants and children, aged 15 days to 3 years old, without respiratory infections or any other severe disease when awake and calm and when asleep. In 50 subjects we compared respiratory rate taken 30 to 60 minutes apart to assess repeatability, and in 50 others we compared simultaneous counts obtained by stethoscope versus observation. RESULTS: Repeatability was good as the standard deviation of differences was 2.5 breaths/minute in awake and 1.7 breaths/minute in asleep children. Respiratory rate obtained with a stethoscope was systematically higher than that obtained by observation (mean difference 2.6 breaths/minute in awake and 1.8 breaths/minute in asleep children; P = .015 and P < .001, respectively). A decrease in respiratory rate with age was seen for both states, and it was faster in the first few months of life when also a greater dispersion of values was observed. A second degree polynomial curve accurately fitted the data. Reference percentile values were developed from these data. CONCLUSIONS: The repeatability of respiratory rate measured with a stethoscope was good. Percentile curves would be particularly helpful in the first months of life when the decline in respiratory rate is very rapid and prevents to use cut off values for defining "normality."

Aging↗
PubMed1993

Biased assessment of gestational age at birth when obstetric gestation is known.

The gestational age of 302 neonates whose obstetric gestational age was known was assessed at birth using the Dubowitz method; it was obtained from Dubowitz score both graphically from a nomogram and by calculation from the corresponding equation. The values obtained graphically differed to a lesser extent from the obstetric gestational age than did the gestation derived algebraically. With infants small for gestational age (SGA) the difference between the methods was smaller and not significant. It is concluded that the concurrent knowledge of obstetric gestational age introduced a bias in the graphic step; this did not happen in SGA infants probably because in these cases the available information is sometimes less certain. These data demonstrate that even simple procedures are influenced by concurrent information; as a philosophical point about the interpretation of data in general, this study provides an empirical example of the 'theory-ladenness of facts' in medicine.

Bias↗
PubMed1992

Precision of gestational age assessment in the neonate.

The precision of the Ballard scale for assessing gestational age (GA) was evaluated in a consecutive sample of 227 preterm and/or low-birth-weight neonates. Each newborn was rated independently by two neonatologists and the difference in GA estimation between them was computed. The estimated precision was not high, the 95% tolerance interval estimate being as large as 7.4 weeks. The precision of the neurologic and physical parts of the scale was poorer than that of the complete scale (95% of differences less than 10.5 and 9.2 weeks respectively), and more influenced by the type of delivery. These findings are not unexpected from statistical theory, and cast doubts on the use of only the physical part of the Ballard scale in assessing GA, since greater accuracy could be accompanied by reduced precision.

Anthropometry↗
PubMed1991

The length of pregnancy: an echographic reappraisal.

A study of 998 pregnant women was conducted to estimate the random errors in dating pregnancy by menstrual history and by ultrasound measurements of the fetus (crown-rump length or biparietal diameter before 20 weeks, menstrual age) as well as the biological variability of pregnancy length. The latter was found to be 7.74 days. The random errors made when dating pregnancy by menstrual history and by ultrasound measurements were 7.16 days and 4.26 days, respectively. (All variabilities are expressed as standard deviations). The differences between the two methods were mainly attributable to some large errors occurring when dating pregnancy on the basis of menstrual history. Differences between methods of more than 10 days were observed in about 10% of our population. When the two methods were used on the same patients to define a pregnancy as preterm, at term, or postterm, discrepancies were found in about 7% of cases.

Female↗
PubMed1991

In-vitro susceptibility of Haemophilus influenzae to loracarbef (LY 163892) and other oral antibiotics. Collaborative Study Group on Pediatric Infectious Disease in Lombardy.

Data on susceptibility of Haemophilus influenzae are scanty in Italy. We compared the activity of loracarbef (Ly 163892), a new carbacephem, with that of 4 other agents against 265 strains of H. influenzae (46 type b, 219 nontypable) isolated from adults and children at Istituti Clinici di Perfezionamento of Milano, between 1/1/84 and 1/1/89, and also from 7 children at pediatric departments in Lombardy during 1988. In adults 72 strains were all isolated from sputum of patients with pneumonia or chronic bronchitis; in children 199 strains were isolated from conjunctiva (53% of the patients had also a concomitant respiratory infection), 24 from middle ear, 18 from sputum and 32 from blood or cerebrospinal fluid. Minimal inhibiting concentrations (MIC) were determined by the broth microdilution technique. The incidence of resistance of H. influenzae to ampicillin was 3.8%; the lowest percentage of resistance was found for loracarbef (0%) and the highest for erythromycin (94% for strains isolated from children and 97% for strains isolated from adults).

Adult↗
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↗
PubMed1989

Growth of fetuses of diabetic mothers.

Longitudinal ultrasonographic examinations, with measurements of fetal biparietal diameter and abdominal circumference, were performed in 85 diabetic pregnant women submitted to different treatment protocols. Curves of fetal growth parameters were obtained for each group of patients and for a control group of normal fetuses, applying the function y = k(MA)2.e-a(MA) to the ultrasonographic data. With the use of this function it was possible to demonstrate that there are no significant differences in the pattern of fetal growth when a strict metabolic control is obtained in diabetic pregnant women.

Adult↗
PubMed1989

Ratio between aldosterone and atrial natriuretic peptide in pregnancy.

The possibility of evaluating the ratio between aldosterone and atrial natriuretic peptide (ANP) instead of the two hormones by themselves in studying sodium handling in normal pregnancy and in preeclampsia in the steady state and following albumin infusion was examined in this study. In 32 normal pregnancies monitored monthly, the highest aldosterone/ANP ratio was observed in the last weeks (28.7 +/- 12), and dropped in the first postpartum week (3.6 +/- 2.8), without changes in fractional excretion of sodium. In 18 preeclamptic patients, the ratio was significantly lower than in normal pregnancy at the same gestational ages, and it was coupled with absolute reduction in the sodium excretion. Among preeclamptic patients, a significant inverse correlation (P less than 0.025) was revealed between the ratio and sodium excretion. Natriuresis in response to acute volume expansion with albumin infusion occurred only in 50% of preeclamptic patients, and was associated with an ANP increase, an aldosterone decrease, and a further decrease in the ratio. A blunted natriuresis was observed in cases with a particularly low prealbumin value of this ratio. Furthermore, in preeclampsia, a particularly low ratio seemed to be typical of the patients who showed poorer placental flows and fetal outcomes. These results suggest that the balance between aldosterone and ANP may be a useful index in understanding sodium homeostasis in these settings.

Adult↗
PubMed1989

DNA flow cytometric studies of 66 human lung tumors analyzed before treatment. Prognostic implications.

To investigate the prognostic implications of DNA flow cytometry in human lung tumors, we analyzed specimens from patients with neoplastic and non-neoplastic lung disease. Most non-neoplastic and normal (taken at the resection border) lung samples yielded a single cell population with diploid DNA content (only two normal lung specimens from two cancer patients had aneuploid DNA content). At least one aneuploid cell subpopulation was seen in 91 percent of NSCLC and 50 percent on SCLC. To show intratumor heterogeneity, multiple-site sampling was done whenever possible in both primary tumor and metastatic sites, revealing a high incidence of multiclonality (50 percent). Although diploid tumors were rare, they associated with a higher survival rate than aneuploid monoclonal and multiclonal tumors with hypoploid and/or hypertetraploid clones, which had the lowest survival. Cellular DNA content analysis in patients with lung tumors may be useful in prognostic evaluation.

Aneuploidy↗
PubMed1989

Pregnancy-related acute renal failure.

From 1958 to 1987, 81 cases of pregnancy-related acute renal failure (PR-ARF) were observed (9% of the total number of acute renal failure [ARF] needing dialysis). In the three successive ten-year periods (1958-67, 1968-77, 1978-87) the incidence of PR-ARF fell from 43% to 2.8% with respect to the total number of ARF, and from 1/3,000 to 1/15,000 with respect to the total number of pregnancies. Maternal mortality was high (32%), with 5 cases of death in the last ten years. Irreversible renal damage was recorded in 11.6% of PR-ARF, and, in particular, in 26.3% of cases in preeclampsia-eclampsia (PE-E). Worse maternal and renal prognosis occurred in PE-E complicated by abruptio placentae. Neither disseminated intravascular coagulation (DIC), microangiopathic hemolytic anemia nor prostacyclin imbalance were significantly related to the severity of renal damage. Heparin therapy did not modify DIC evolution and renal outcome and was aggravated by severe hemorrhagic complications. In conclusion, PR-ARF has become a rare, but still critical occurrence, and the most effective measures would be a program of careful prevention.

Acute Kidney Injury↗