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Biomedical subjects

M Leonardi

Publications and source records attributed to M Leonardi.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Diagnosis and general assessment of acute subarachnoid hemorrhage].

CT is still considered the first and most important examination in the case of subarachnoid hemorrhage. Frequently the CT findings are normal and no blood is detected in the CSF spaces. If that is the case, it will be useful to reevaluate the clinical presentation and it might be indicated to enhance the diagnostic evaluation with the use of lumbar puncture and CSF exam, or recurring to the study of the spine. In other cases, CT may detect slight modifications, with small blood collection in the CSF spaces, or more important bleeding in the CSF, intracerebral or intraventricular. Angiography represents the following diagnostic step.

Acute Disease↗
PubMed1997

[Hormonal contraception and benign breast disease. Evaluation of a treatment protocol for chronic mastopathy with mastalgia].

INTRODUCTION AND AIMS: The aim of this study was to study patients suffering from mammary nodules, fibrocystic disease and mastodynia. Having established the absence of malignant disease, the effect of EP (oestroprogestin) was evaluated in the treatment of fibrocystic disease with mastalgia. METHODS: From January 1990 to December 1995 a total of 1921 women underwent breast examination at the "Centro di Fisiopatologia della Mammella" in the Division of Gynecology and Obstetrics of Iseo Municipal Hospital. Subjects were aged between 9 and 84 years old. The experimental protocol included a retrospective study of a group of 89 patients suffering from chronic fibrocystic disease with mastalgia with a 3-month follow-up. The clinical examination was commenced by recording the patient's history and the measurement of the thickness of the gland and the evaluation of mastalgia represented important stages of the eco-clinical assessment. The setting for the study was the breast pathology out-patient clinic of the Division of Gynecology and Obstetrics. These women regularly attended our outpatient clinics for the following reasons: depistage, mastodynia, mammary secretion, self-diagnosis of mammary nodules, checkups in patients during follow-up after surgery for genital neoplasia. All patients underwent clinical, echographic and often mammography/X-ray. Patients were selected on the basis of the following criteria: absence of malignant pathology and presence of chronic fibrocystic disease with mastalgia. Of those admitted to the study (no. = 89), only 59 completed the course. In addition to the absence of malignant pathology and the presence of chronic fibrocystic disease with mastalgia, the following parameters were assessed: measurement of the thickness of the mammary gland involving QSE before and after 3-month treatment with EP. The EP used were: gestodene 0.075 mg and etynylestradiol 0.03 mg-Minulet, or etynylestradiol 0.02 mg and dexogestrel 0.150 mg-Securgin and Mercilon. RESULTS: The response to treatment was classified according to the 4 levels of the Cardiff Breast Score (CBS). The results were relatively good: 35.59% of patients showed a reduction in symptoms; 25.42% showed a marked improvement, and 18.64% a remission of symptoms. No effect was reported in 20.33% of patients. CONCLUSIONS: In conclusion, it may be said that EP treatment for 3 months can at least be proposed in patients with chronic fibrocystic disease and mastalgia given that a reduction and improvement in symptoms was seen in 60% of patients.

Adult↗
PubMed1996

The economic cost of the medical-legal tort system.

OBJECTIVE: Our goal was to evaluate the financial expenditures of the medical-legal tort system on the single largest medical campus in the United States. STUDY DESIGN: The true financial expenditures directed to the medical-legal system were determined and related to the total revenue and expenses of the Detroit Medical Center. All costs were determined, including malpractice premiums, paid claims information, accrual expense information, and risk management administrative expenses for the fiscal years 1992, 1993, and 1994. RESULTS: The total medical-legal expenses for the years 1992, 1993, and 1994 were $73,732,000, $70,490,000, and $79,043,000, respectively. The claims paid to plaintiffs were 35.9%, 28.1%, and 28.1% for the same years. CONCLUSION: The medical-legal system process in the United States is very long and fraught with many inequities and inefficiencies. It was found that approximately 12% of the medical-legal expenditures of the Detroit Medical Center go to the individual alleged victim after defense and plaintiff attorney fees and costs and administrative costs. The failure of the American health care system could be in jeopardy if the nation's leaders do not reform the process to provide a more cost-effective system.

Legislation, Medical↗
PubMed1994

Interobserver variability in CT assessment of brain atrophy.

To assess interobserver variability in estimation of brain atrophy based on CT, four neuroradiologists examined CT brain images of 150 consecutive patients without focal lesions. An independent neuroradiologist made the following quantitative measurements: frontal horn index, subarachnoid space area and the ratio between subarachnoid space area and inner skull space area. Level of agreement was fair for the presence (k = 0.24), slight for the degree (mild, moderate, severe) (k = 0.24) and moderate for the type (cortical, subcortical, mixed) of atrophy (k = 0.59). There was a highly significant correlation between the number of observers agreeing and quantitative measurements. We concluded that neuroradiologists' subjective estimation of brain atrophy alone is not reliable. Quantitative measurements would be needed in cases where the presence of brain atrophy might determine clinical decisions.

Adult↗
PubMed1993

The freezing and thawing of water in poultry meat and vegetables irradiated by electrons at doses of 0.1-4 kGy.

Poultry meat and some vegetables, irradiated by 5 MeV electrons (0.1-4 kGy), were analysed by differential scanning calorimetry, from 24 h after irradiation. The temperature and enthalpy transitions of the water contained in the irradiated samples were measured and compared with those of unirradiated samples. We analysed 18 meat and 10 vegetable samples for each irradiation dose together with a similar number of unirradiated controls. The mean supercooling temperatures of water in the irradiated poultry meat samples and in some vegetables are significantly lower than those of controls. Moreover, the freezing enthalpies of the irradiated poultry breast are significantly lower than those of controls, while they are unchanged in the other cases. The mean ice melting temperatures and enthalpies are similar for all samples. The amount of the lowering of the water-ice transition depends on the nature of the sample and is highest in poultry breast and lowest in vegetables.

Electrons↗
PubMed1993

[Treatment of fibrocystic disease of the breast with myrtillus anthocyanins. Our experience].

The aim of this study was to further research into the therapeutic treatment of fibrocystic mastopathy. The study hypothesis included the clinical and instrumental control (echography) of patients with FCD before and after at least three months treatment with anthocyanosides. The protocol used was of the prospective and comparative type, whereas follow-up lasted three months. The study was performed in the outpatients' clinic of Breast Physiopathology and Echography organised within the ambit of the services of the Gynecology and Obstetrics Division. In this particular instance both echography and clinical examinations were performed at the same clinic. A total of 257 patients took part in the programme of which 35 were excluded since they failed to attend subsequent controls. Women were selected on the basis of absence of malignant disease and presence of clinical, echographic or mammographic symptoms of fibroso-cystic mastopathy. In addition, all women presented mastodynia which made therapy indispensable. The socio-demographic: characteristics of the population were polymorphous since women were resident not only in the area of USSL 36 but also other Italian provinces. The diameter of any lesions found was measured together with the thickness of the mammary gland. The thickness was always measured of QSE level both before and after treatment. The results were encouraging. There was a marked improvement in 75 patients, equivalent to 33.78%, symptoms were reduced in 61 women (27.47%) and disappeared in 14 (6.30%), whereas treatment had no effect in 72 cases (32.43%). In conclusion, echopalpation (clinical examination + echography) was extremely valuable in the study of these patients, especially if aged under 40. Moreover, therapy for three months in patients with mastodynia, consequent to fibrous mastopathy, was efficacious in reducing symptoms and mammary tension. At the same time, it is important to emphasise the absence of virtual absence of collateral effects to treatment.

Adult↗
PubMed1993

[The role of the Vabra aspirator in the screening of endometrial carcinoma. Our experience].

The aim of study was to estimate the utility of Vabra aspirator in the screening of endometrial carcinoma. For this and 656 patients aged over 40 were subjected to cytologic examination and we compared the date obtained with the histologic examination, when the woman was subjected to surgical operation. The research which we carried out was of the retrospective type and it lasted two years. The patients were recruited at the division out-clinic and locally. All the examinations were carried out at the division, using the method of Vabra aspirator with the Kit of Sterilab. The patients admitted to examination showed some menstrual anomalies, (spotting, abnormal uterine bleeding, metrorrhagias and after postmenopausal uterine bleeding), and stayed at our USSL or at neighbouring ones. The cytologic examination have been read beside a single centre and the cytologic diagnosis has been compared with the histology one on the operating organ. The result obtained agrees with the literature. In fact, out of 888 screened women, 656 were aged over 40 and 232 aged less than 40. In the group of 656 patients 3 adenocarcinoma have been diagnosed and 4 atypical hyperplasia, equivalent to 0.33% and to 0.45% respectively. In conclusion, we can say that the method has shown a good diagnostic reliability into the diagnosis of malignant neoplasia. According to other authors, its limit is, instead, the high number of inadequate, besides the impossibility to diagnose other uterine pathologies, such as the endometrial polyps and the uterine myoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

[Postmenopausal gynecologic pathology: 5-years activity at an ambulatory ultrasonography clinic].

The authors examine the role of ultrasonography in the diagnosis of gynecological post-menopausal pathologies and report the activities of the ultrasound out-patient clinic over the past 5 years. Due to the prolonged life expectation of women and consequently the growing request for gynecological examinations, increased importance has been given to the pathologies typical of this age bracket Gynecological exploration if often difficult in elderly patients leading to an increased request for ultrasonography in addition to clinical examination. Transvaginal ultrasonography allows the pelvic structures and endometrial echo-pattern to be examined with greater accuracy. During the period from 1986 to 1991 a total of 405 postmenopausal women were examined using ultrasonography out of a total of 3505 gynecological scans. Scans were performed using a 3.5 MHz suprapubic or endovaginal probe. The most frequent pathology was malignant endometrial carcinoma and the most frequent clinical symptoms was metrorrhagia. In line with findings reported in the literature, the authors underline the vital importance of carefully controlling all perimenopausal women attending an ultrasound out-patient clinic who present risk factors or metrorrhagia using integrated transabdominal and endovaginal diagnosis. The use of the endovaginal probe allows images to be obtained which are otherwise not visible using the transabdominal approach, thus permitting suspect echographic patterns to be identified. Moreover, endometrial evaluation represents an important stage of the examination. It is obvious that the endovaginal approach represents a useful diagnostic technique for screening purposes, especially in high-risk groups for endometrial pathology and ovarian cancer.

Adult↗
PubMed1993

[The value of ultrasonography in benign breast diseases].

In recent years breast scans have been widely used for the precise diagnosis of breast cancer. However, the value of this diagnostic tool is debatable in comparison to mammography in women of a childbearing age who often present a dense youthful breast. The role of clinical examination as a screening process is also examined. In the light of these findings the Authors evaluated the role played by ultrasonography in breast cancer, and in particular benign breast tumours, in a group of outpatients attending the clinic. The technique used was relatively simple: the scan in the department used for gynecological and obstetrical ultrasonography was fitted with a 5 MHz probe and was used to perform all the scans. In addition, a Kiteco space maintainer was used for ultrasonography of soft tissue. Scans were performed at a distance of 0.5 cm. The Authors examined 107 patients with benign breast tumours using ultrasonography. They evaluated the morphology, dimensions, edges and internal echo-structure of pathological formations and adjacent areas. The value of breast ultrasonography emerges from an analysis of the results both in the study of the glandular structure and in the differentiation between cystic and solid type lesions which are not always diagnosed during clinical examination. A total of 59 fibroadenoma, 44 cysts, 2 lipoma and 2 phylloids were diagnosed. Fibroadenomas had smooth edges in 98.4% of cases and were lobulate in 1.6%. In 100% of cases the fibroadenomas diagnosed presented fine internal homogeneous echoes with a lower echogenicity than that of surrounding glandular tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenofibroma↗
PubMed1993

Percutaneous treatment of lumbar disc herniation.

Nine hundred and eighteen patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels (150 of whom were treated at two levels): 185 patients were treated with Onik's automate discectomy. Chemonucleolysis was carried out on 733 patients (79.8%) and automated discectomy in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy was an effective method of management in 74.6% of the cases. The availability of several therapeutic methods has allowed us to respond in a more appropriate way to the patient's requirements and, in the case of failure, offer a more flexible therapeutic spectrum, and to consider surgery as the last resort. As regards the relation between enzymatic nucleolysis with chymopapain and disc nucleoaspiration, we feel that the two should not be in competition, for the indications are precise for both methods: in the enzymatic treatment, the hernia can be medium-large sized, in a sub- or extra-ligamentous position. The treatment of patients with moderately severe symptoms is preferable. In disc nucleoaspiration, the hernia must be small-sized.

Chymopapain↗
PubMed1992

Chronic spastic atrophic hemiparesis with benign course.

We present the clinical and neuroimaging data of 4 patients (mean age: 62 years, range 54-67; mean follow-up: 19.5 years, range: 26 months-29 years) with chronic spastic atrophic hemiparesis (CSAH). Neuroimaging findings were non specific, CT scan and MRI showing white matter lesions located within the centrum semiovale in two cases, parieto-occipital lobe and pons in one case each. This study underlines that patients with CSAH may have a good long-term prognosis. MRI studies may demonstrate associated lesions within the white matter or brainstem and are advisable in all subjects with CSAH, but further studies are necessary to clarify the nature of the observed lesions.

Aged↗
PubMed1992

Neurological impairment in congenital bilateral ptosis with ophthalmoplegia.

A case is described of congenital bilateral ptosis and ophthalmoplegia due to incomplete bilateral paralysis of the third cranial nerve associated with dysmorphisms, brain malformations and epileptiform EEG abnormalities. We hypothesize that in our case the ophthalmological disturbance is due to mesencephalic impairment. In literature there are few reports of congenital bilateral paralysis of the third cranial nerve and they lack detailed MRI findings. We stress in patients with congenital third cranial nerve palsy the importance of thorough neurological investigations including prolonged wake-sleep EEG monitoring as well as CT scan and MRI to establish the origin of the disorder.

Blepharoptosis↗
PubMed1992

[Research on the understanding of the relation between patient, gynecologist and breast disease].

The aim of our work was to identify the most important aspects of the relationship between gynecologist and patient who presents himself during our observation because of breast pathology. In order to evaluate all that said above we asked patients to compile a questionnaire characterized by different questions. The results obtained were very satisfactory and at the same time they lead us to a greater engagement towards the prevention of breast neoplasia, especially for those women predisposed to such disease.

Breast Diseases↗
PubMed1991

Serum creatine kinase activity and its changes after a muscle biopsy.

The significance of the absolute elevations of serum creatine kinase (CK) levels after intense exercise and injuries was studied by measuring CK activities from seven healthy active males during a 2-week period, with a muscle biopsy taken between the first and second week. Most of the subjects (three lifters and two runners) carried on their normal exercise activities, while two lifters stopped training during the 2 weeks. The weight of the biopsy, number of fibres, percentage of fibre types, and cross-sectional areas of the muscle fibres were measured. The CK levels of the non-active subjects and runners remained consistently low during the control week, whereas those of the lifters were usually 500% greater than those of the other two groups, and fluctuated with the intensity of their workouts. A muscle biopsy, having a mean weight of 71.3 mg and containing 1800 fibres, increased the CK values by approximately 100 units litre-1 (U l-1) in most of the subjects. One runner injured his right hamstring muscles 2 days prior to the biopsy, and his CK values rose from 50 to 4400 U l-1. The increases in CK after the biopsy were not related to fibre type, activity, weight of the biopsy, or number or size of fibres removed. These results indicate that: (1) CK values are consistently lower in normal subjects and runners than in lifters. (2) Weight training results in chronic elevations of CK. (3) Compared to a muscle biopsy, muscular injury dramatically increases CK levels. (4) Elevation of serum CK is observed as early as 1 h after an intense weight-lifting session.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗