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Biomedical subjects

M Molinari

Publications and source records attributed to M Molinari.

140 records · Page 8Linked to original sources
PubMedDate not supplied

Bromocriptine acute effect on insulin, glucagon and growth hormone levels in acromegalic patients.

It has been shown that L-dopa or dopamine administration influences glucose metabolism, as well as insulin and glucagon release in man. In the present study, the effect of bromocriptine (CB-154), a long-acting dopamine agonist, on insulin, glucagon and growth hormone secretion in 32 acromegalic patients was investigated. Glucose, insulin and plasma glucagon levels were not modified following administration of bromocriptine or placebo. Moreover, plasma GH levels were decreased by more than 50% in 18 of the 32 acromegalics. Mean GH levels were significantly lower with respect to levels observed following placebo at 60 min to the end of the test (p less than 0.001). Administration of a double dose of CB-154 (5 mg po) one hour before arginine test did not affect insulin or glucagon secretion with respect to levels observed during arginine alone. In addition, there was a fall in GH levels similar to that observed following administration of bromocriptine alone. These findings suggest that bromocriptine in itself does not exert a direct action on insulin and glucagon release. Improvement in glucose tolerance and reduction in insulin secretion observed following prolonged CB-154 treatment in acromegalic patients are probably due to a simultaneous inhibition of GH secretion or to other peripheral effects of bromocriptine.

Acromegaly↗
PubMedDate not supplied

[The decision to hospitalize. Apropos of a survey of 539 hospitalizations requested by general practitioners].

Reasons for hospitalization. A study about 539 hospitalizations decided by general practitioners. In this paper hospitalization is studied from the point of view of the general practitioner (GP) who is the most frequent supplier of in-patients. Five GP's practising in the southern suburbs of Paris have analysed their decision to hospitalize a total of 539 patients over one year. Owing to the number of hospital units available in that area and to the variety of diseases treated, it is understandable that these patients were referred to not less than 62 different units. Nevertheless, two-thirds of the patients were referred to 3 units: the Regional Hospital Centre (CHR) and 2 private hospitals. The majority of surgical patients were referred to the private sector, the choice of the unit in such cases being determined by the surgeon's skills as experienced or heard of by the GP. The CHR attracts GP's by its departments of internal medicine and specialties. The notoriety of a department as a whole or that of particular physicians working in the department explains the GP's choice. The degree of uncertainty surrounding the diagnosis, which varies with the nature of the disease requiring hospitalization, divides the departments into two categories: over one-half of the patients with a known diagnosis were referred to surgical departments, whereas 41 percent of those with unknown or uncertain diagnoses were sent to the internal medicine department.

Aged↗
PubMedDate not supplied

Localization of ataxin-2 within the cerebellar cortex of the rat.

Spinocerebellar ataxia type 2 is caused by a polyglutamine stretch in the protein ataxin-2 that is due to an expansion of a CAG repeat in the spinocerebellar ataxia-2 gene. The function of wild-type ataxin-2 has not been clarified. A widespread distribution of this protein throughout the brain has been reported. We examined the expression of ataxin-2 in cortical cerebellar cells of the adult rat. We performed a single label immunohistochemical study of ataxin-2 and a single label immunofluorescence study of ataxin-2 and zebrin on adjacent sections, to compare the distribution of the observed parasagittal band pattern. We also performed a double label immunofluorescence study of ataxin-2 and one of each parvalbumin, calbindin, and calretinin. Single label studies revealed that between 50% and 70% of the Purkinje cells express ataxin-2. The abundance of ataxin-2 was different between hemisphere and vermis, with a clear prevalence for the former. Furthermore, the distribution of ataxin-2-positive Purkinje cells showed a peculiar alternating parasagittal band pattern. Among the other cortical cerebellar cells only basket and granule cells showed ataxin-2 staining. Our dual label studies showed that about 50% of calbindin and more than 70% of parvalbumin-immunoreactive Purkinje cells were also labeled for ataxin-2. The uneven distribution of ataxin-2 expression in the Purkinje cell layer does not support the hypothesized link between ataxin-2 content and cell vulnerability. The differences in ataxin-2 expression among the cell types of cerebellar cortex, on the other hand, suggest a possible correlation between ataxin-2 content and cell function.

Animals↗
PubMedDate not supplied

Chronobiological pattern of growth hormone secretion in normal subjects and in retinopathic diabetics. Lack of suppression by a plurichronocorticoid drug.

Nyctohemeral variations in plasma concentrations of HGH, glucose, and FFA were studied in 22 normal subjects and 48 diabetic patients affected with retinopathy. In the normal subjects, (fourteen males and eight females, mean age 40+/-3 years; body weight less than 110% of I.B.W.) the determinations were made on blood samples drawn every hour. Seven of these normal subjects were examined before and after 10 days of administration of a new plurichronocorticoid drug (administered at 08(00) and 15(00), with a total amount of 14 mg of prednisolone and 15 mg of cortisone). In patients with diabetic retinopathy (32 male and sixteen female patients, mean age 46+/-2 years, body weight less than 110% of I.B.W.) the determinations were made on blood samples drawn every 3 hrs. All the diabetic patients were insulin treated and were under good or discrete metabolic control, and presented advanced retinopathy. Both in the normal subjects and in retinopathic diabetics, the mean HGH curve showed a characteristic elevation during the early nighttime hours (between 21(00) and 02(00). Despite higher values in plasma glucose and FFA, in diabetics the nocturnal elevation of HGH was only slightly lower than in the normals. The comparison between daytime and nighttime determinations, both in the normal subjects and in the diabetics, reveals statistically significant differences. These results suggest that in subjects with diabetic retinopathy, in the phase of good or discrete metabolic control, spontaneous HGH secretion is not increased, and that nocturnal elevation of HGH is not substantially influenced by higher plasma levels of glucose and FFA. Ten days of plurichronocorticoid treatment with a new drug which exhausts its activity before the evening, did not modify the circadian rhythm of HGH.

Adolescent↗
PubMedDate not supplied

[The prevention of risk due to the manual lifting of patients: the psychosocial component].

A high percentage of musculoskeletal disorders in nursing staff with the task of patient lifting is reported in the literature. These disorders are considered to be of multiple etiology and attempts have been made not only to assess the physical load but also to identify the direct or indirect influence of organisational and psychosocial factors so that preventive measures be more appropriate and effective (Law 626/94). In this context, in a recent publication NIOSH recalled that psychosocial factors can alter the relationship between exposure to physical loads and the development or the prognosis of these disorders, and stresses that understanding these relationships is the crucial factor in assessment of exposure that can be addressed with preventive and therapeutic measures. A study was carried out on the staff (113 subjects) of a large hospital in northern Italy with departments recognised by certified occupational physicians as at risk for the musculoskeletal apparatus. In order to quantify the working conditions and the disorders of the spine, a protocol proposed by the Ergonomics of Posture and Movement Research Unit of Milan University was further developed and validated. For assessment of psychosocial factors an Italian version of R. A. Karasek's "Job Content Questionnaire" was drawn up and validated by the Centre for Study and Research of Chronic Degenerative Diseases in Working Environments of Milan University. In addition, Borg's Scale was used for perception of physical load, Kurimori and Kakizaki's Scale for mental fatigue, Kjellberg and Iwanowski's Scale for states of stress, plus the Maslach burnout inventory. Nonparametric statistical analysis was applied to determine the influence of physical and organisational and psychosocial factors on disorders of the musculoskeletal apparatus. The results confirm a good agreement between the objective and subjective assessments of "manual patient handling" risk (Kendall p from 0.26 to 0.37, p > 0.001) and the significant relationships between psychosocial factors and disorders of the lumbar region of the spine: past history of episodes of acute low back pain is associated with limited possibility of making independent decisions (U-Mann Whitney z = 2.81, p 0.004) and job insecurity (U-Mann Whitney z = -2.36, p 0.01); episodes of acute low back pain above the threshold in the previous year were associated with low discretionary powers at work. The results will be discussed on the basis of the possible prevention measures.

Adult↗
PubMedDate not supplied

[Aging and work: health aspects in cleaners].

Over the last few years, studies on the relationship between ageing and work have attracted growing interest due to the increased probability among workers of developing major health problems as a consequence of ageing workers. Negative outcomes for health are possible when an age-related imbalance appears between physical workload and physical work capacity. Cleaning could be considered as a paradigm for studying the relationship between ageing and physically demanding jobs. Cleaning workers show a high proportion of ageing women who are at the bottom level of the social-status class and are generally poorly educated with low income and social support level. This study, particularly aimed at highlighting the presence of musculo-skeletal disorders, was conducted by means of standardized questionnaires and protocols for collecting anamnestic and clinical data. The results show an increased prevalence of disorders of elbow, wrist/hand and cervical spine which could be caused by work organization and non-ergonomic tools. On the basis of the experience gained it was possible to propose solutions for the ageing working population concerning the workload, health surveillance methods and the ergonomic measures as regards organization, work place and tools.

Adolescent↗
PubMedDate not supplied

[Computerized tomography guided biopsy in the diagnosis of neoplastic and inflammatory lesions of the pelvis].

PURPOSE: To assess the efficacy of percutaneous CT-guided biopsy in the diagnosis and therapeutic planning of neoplastic and flogistic diseases of the pelvis. MATERIAL AND METHODS: From July 1990 to December 1999 193 patients (113 males, 80 females: mean age 49, standard deviation 16) were submitted to CT-guided percutaneous biopsy of the pelvic region; 117 biopsies (61%) were performed at iliac, pubic and ischial segments and 76 (39%) at sacral region; 107 patients were admitted to the hospital and 86 were in clinic. Needles were 8 G (4 mm), 10 to 15 cm long. Approach to pelvic lesions was performed according to the specific site. Lesions of the lateral pelvic region have always been approached through the lateral surgical incision according to Enneking. Lesions of the posterior pelvic region have always been approached by the introduction of the needle along the posterior surgical incision according to Enneking. Lesions of the anterior region have always been approached through the anterior surgical incision according to Enneking. From July 1990 to May 1997 pelvic percutaneous biopsies have been carried out with a CT Sytec 3000. From May 1997 to December 1999 the device was replaced by a High Speed CTi. The introduction of spiral CT allowed reduction of performance mean time from 45 minutes (standard deviation 15) to 30 minutes (standard deviation 10). RESULTS: In 154 patients (80%) we observed a neoplastic, inflammatory or not classified degeneration. In 8 patients (4%) the retrieved material ended to be inadequate for a diagnosis. In 31 patients (16%) no disease was revealed at the histological examination. Such patients with negative histological examination have been kept under clinical and radiological control in the following period in order to verify the manifestation or the presence of an alteration previously not observed. On 31-3-2000 none of them had been submitted to a new percutaneous biopsy of the pelvic region. The overall mean accuracy has been 96% considering the negative patients as really negative. In 5 cases (2.6%) we have had complications represented by pain at the introduction and penetration site of the needle. DISCUSSION AND CONCLUSIONS: The choice of the needle, the approach to the lesion and the position of the patient are conditioned by the site of the tumor, its extension, the distance skin-neoplastic disease and by the respect of the incision lines of Enneking, in order not to complicate the job of the orthopaedic surgeon spreading tumoral cells outside the chosen surgical approach. The mean time of the procedure is 30 minutes (standard deviation 10). There are no absolute contraindications to percutaneous biopsy except the suspect or the presence of an hydatideal cyst. The risks have to be compared with those correlated with alternative methods or with the more concerning risk of a missed diagnosis. Complications in the literature range from 0% to 10%, the incidence varying according to the location; pain is the most frequent complication. Altogether the most negative event, although not a true complication, is the retrieval of an inadequate sample: the only drawback of percutaneous biopsy in comparison with incisional biopsy. The accuracy rate of percutaneous biopsy varies in relation to the involved anatomical region, to the pathological process, to the experience of the user, to the amount of the retrieved tissue and to the cooperation of the patient. Our experience shows that, in selected patients, percutaneous biopsy is a virtually safe and almost painless procedure which saves the patient from a surgical procedure in regional or general anestesia as for an incisional biopsy, and allows immediate planning and scheduling of a correct therapy for primitive or secondary neoplastic lesions.

Biopsy↗
PubMedDate not supplied

[Evaluation of the neurotoxic and nephrotoxic effects following long-term exposure to metallic mercury in employed at a chlorine/sodium-hydroxide plant].

OBJECTIVES: Within the frame work of a wide multicentre study, a sub-study was developed in order to explore the occurrence of early effects on the central nervous system, on the kidney and on the neuro-immune system in the workers of a chloro-alkali production plant exposed to metallic mercury at airborne concentration levels lower than 0.025 mg/m3 (TLV-TWA). They were compared to a control population of employees of the same huge petrochemical plant with different job that did not implicate exposure to mercury vapors. Specifically, the study aimed at revealing the occurrence of early effects on the central nervous system related with mercury exposure, as can be assessed through neurophysiological and neurobehavioral tests. METHODS: The excretion of urinary mercury was measured by atomic absorption spectrometry. The study of renal function was assessed by measurement of the urinary excretion of some high and low molecular weight protein markers (albumin, beta 2-microglobulin, retinol-binding protein, fibronectin, specific proximal tubule brush border antigens, N-acetyl-beta-D-glucosaminidase). The neurobehavioral status of the study subjects was assessed by means of several test parameters (Simple Reaction Time, Color Word Vigilance Test, Symbol Digit, Finger Tapping, Mood Scale of Kjellberg and Iwanowski, Subjective symptoms questionnaire (QSS), Luria Nebraska Motor Scale, Branches Alternate Movement Task and Tremometry). RESULTS: The values of urinary excretion averaged 12 +/- 8 micrograms Hg/g of creatinine for the exposed workers group (n = 38), while for the reference group (n = 34 cases) urinary excretion was statistically lower, averaging 4 +/- 6 micrograms Hg/g of creatinine. Neither the parameters selected for the assessment of renal functions, nor those chosen to probe the neurobehavioral status of the probands revealed statistically reliable differences between the group of exposed workers (length of exposure: range 1-34 years) and the control group. Nevertheless, some minor but still statistically reliable correlations were found between some neurobehavioral parameters and some demographic variables describing the whole group of tested workers, but not to the level of occupational exposure to mercury. CONCLUSIONS: The results of the study confirm the lack of toxic effects of clinical importance on the central nervous system and on the kidney for values of mercury urinary excretion lower than the suggested index of biological exposure (IBE) of 35 micrograms Hg/gram of creatinine.

Adult↗
PubMedDate not supplied

Hyperdense mucoid impaction in allergic bronchopulmonary aspergillosis: CT appearance.

Allergic bronchopulmonary aspergillosis is an immunologic pulmonary disease characterised by proximal bronchiectasis with normal peripheral branchings and mucoid impactions in patients with asthma. The pathologic damage consists of mucoid impaction containing macrophages, several eosinophils, fungal hyphae, scaled-off epithelium (Curshman spirals) and calcium oxalate crystals. On CT, the mucoid impaction of the bronchial tree generally shows slightly hyperhydric density. The originality and peculiarity of our case is the presence of high-density mucoid impaction inside an atelectatic area.

Adult↗
PubMedDate not supplied

[Strangulated obturator hernia as a rare cause of intestinal obstruction (report of 2 cases)].

The Authors report on tpo cases of strangulated obturator hernia observed in their department during the period 1977-1987 and successfully operated on by mid-line laparotomy, both pith a diagnosis of occlusion of the small bowel. The Authors review the clinical signs and instrumental investigations which may be of use in reaching an early pre-operative diagnosis, which constitutes the only possibility of reducing the mortality associated with this condition. Particular attention is devoted to the somatic characteristics of the patients: elderly, thin, chronic bronchitic, hypertensive cardiopathic. In one of the two cases, there was a concomitant crural hernia. In both cases, which presented a picture of acute intestinal occlusion, the type of surgery opted for was a mid-line laparotomy. In one case, an ileal resection was performed. To close the orifice of the obturator canal, plain suture of the peritoneum was used in one case and a mersilene patch in the other.

Aged↗
PubMedDate not supplied

Indications and limits of CT scan in prosthetic loosening.

The authors attempt to define the role of computed tomography (CT) in the study of loosened hip prosthesis. To this purpose they have studied 30 patients with clinical and/or radiographic findings of loosening, carrying out a conventional radiographic assessment and a CT scan of the hip in question, and then comparing them. They conclude that CT scan when carried out according to the correct procedures described is very useful. Despite the presence of technical artefacts due to the presence of the metal prosthesis, the test makes a considerable contribution, not so much to the diagnosis of loosening in itself, which continues to be a clinical-radiologic diagnosis, rather to the evaluation of the morphostructural states of the acetabular bone for correct planning of surgery.

Hip Prosthesis↗
PubMedDate not supplied

[Study of torsion defects of the lower limbs using computerized tomography].

January, 1990, to July, 1993, the torsional defects of the lower limbs were studied at the Department of Radiology of the Istituto Ortopedico Rizzoli, Bologna. Ninety-three patients were examined, all of them affected with congenital or acquired (posttraumatic and/or iatrogenic) torsional defects. The torsional angles, i.e., the anteversion acetabulum angle, the anteversion femoral neck angle and the tibial torsion angle, were measured as follows: the patients were laid supine with their limbs either in intrarotation with the patella perpendicular to the table (62 patients) or in neutral rotation with the feet in the pace position (31 patients). The images were always analyzed at the console by two different radiologists in the following days. The electronic lines for measuring torsional angles were drawn by the two radiologists ex novo on the previously acquired CT images. No statistically significant differences were observed between the two groups of patients. The measures were independent of limbs position and the interobserver differences were bigger in children and in the measurement of femoral neck anteversion angle; however, these differences decreased by about 50% with better console use. CT, thanks to its feasibility, has replaced conventional (direct or indirect) radiology to study the torsional defects of the lower limbs. Moreover, CT is extremely useful not only for early disease diagnosis (location, rotation degree and associated joint deformities), but also for treatment planning, be it surgical or conservative.

Adolescent↗
PubMedDate not supplied

Surgical treatment of gastric adenocarcinoma: impact on survival and quality of life. A prospective ten year study.

BACKGROUND/AIMS: The objective of this prospective study was to compare the results of total (TG) versus subtotal (SG) gastrectomy in patients with adenocarcinoma of the lower two-thirds of the stomach. PATIENTS AND METHODS: Two hundred and twenty-seven patients underwent curative operation. Preoperative nutritional assessment, postoperative tumor stage, postoperative morbidity/mortality, five-year survival, postgastrectomy dietary intake and nutritional sequelae were recorded in all patients. RESULTS: Postoperative mortality rate was 2.8% in the TG group and 1.1% in the SG group. The number of reoperations, anastomotic dehiscence rate and the length of postoperative stay were higher in the TG group. Five-year survival was closely related to lymph node involvement and gastric wall invasion. The extent of gastric resection did not influence survival when patients were matched for cancer stage. In the SG group, no recurrence in the gastric stump was observed. SG group showed a higher dietary energy intake than the TG group (p < 0.01). This might explain the ability of the SG group to increase body weight more than the TG group (p < 0.01). Only the TG group needed a monthly parenteral vitamin B12 supplements starting 36 months after surgery. CONCLUSION: The results suggest that SG should be considered the treatment of choice of the gastric adenocarcinoma when a cancer-free proximal resection margin can be guaranteed.

Adenocarcinoma↗