Search PubMed⌕ Search

Biomedical subjects

M Vassallo

Publications and source records attributed to M Vassallo.

54 records · Page 3Linked to original sources
PubMed1995

An unusual cause of dementia.

Gliomatosis cerebri is a rare cerebral tumour that presents with personality and mental state changes. Diagnosis can be very difficult and many times is made at post mortem. We describe a 63-year-old man who presented initially with depression that merged into a schizophrenia-like illness, and who developed progressive dementia prior to his death. Two computed tomography (CT) scans of the brain were normal and the diagnosis of gliomatosis cerebri was made at post mortem. The progressively changing mental state was suggestive of an organic cause of his illness. Since this tumour may not be detected by a CT scan, a magnetic resonance imaging scan with T2-weighted images with spin echo sequences of the brain should be performed. Prognosis is very poor but diagnosis is important to plan terminal care. The patient described was unusual because he was older than most people with this tumour, and he presented with psychiatric symptoms which were thought to be non-organic for almost two years.

Brain Neoplasms↗
PubMed1994

Pituitary apoplexy after stimulation tests.

Pituitary apoplexy occurs after infarction of a non-neoplastic pituitary or sudden expansion of an adenoma following haemorrhage or infarction. It usually occurs spontaneously but can follow a number of causes including pituitary stimulation tests. Since this complication is potentially life-threatening, the benefits of subjecting patients who might have pituitary tumours to such tests should be considered.

Aged↗
PubMed1992

Transit through the proximal colon influences stool weight in the irritable bowel syndrome.

The inherent variability of symptoms and motor abnormalities in patients with the irritable bowel syndrome has hampered the demonstration of motor abnormalities that could underlie symptoms. The aim in the current study was to evaluate whether altered regional capacitance or transit of solid residue through the unprepared human gut were factors in the diarrhea of patients with the irritable bowel syndrome. In 10 such patients and in 5 healthy controls, gastric and small bowel transits were evaluated scintigraphically by means of a mixed meal containing 99mTc-labeled resin pellets. Regional colonic transit was quantitated by 111In-labeled pellets delivered to the ileocecal region by a pH-sensitive, methacrylate-coated capsule. Symptomatic patients did not have significantly altered gastric or small bowel transits, but colonic transit was accelerated in 7 of 10 persons with the irritable bowel syndrome (P less than 0.02), in the proximal colon of five patients and in the left colon of two patients. The 24-hour stool weight was positively correlated with the rate at which solid residue emptied from the ascending and transverse colons (r = 0.78; P less than 0.01). There was also an inverse relationship between emptying rates and maximal volumes accommodated by the proximal colon (r = -0.58; P less than 0.05), although the maximum volume of the proximal colon was not significantly different in patients and healthy subjects. Thus, accelerated transit through the proximal colon is a factor in the pathophysiology of the irritable bowel syndrome and influences the stool weight of such patients. The capacitance of the proximal colon presumably influences its storage capacity and, hence, the rate at which it empties.

Adult↗
PubMed1991

Scintigraphic measurement of regional gut transit in idiopathic constipation.

In this study, total gut transit and regional colonic transit in patients with idiopathic constipation were measured scintigraphically. Eight patients with severe constipation were studied, none of whom had evidence of abnormal function of the pelvic floor. 99mTc-radiolabeled Amberlite resin particles (average diameter, 1 mm; Sigma Chemical Co., St. Louis, MO) with a mixed meal were used to assess gastric emptying and small bowel transit; similar particles labeled with 111In were ingested in a coated capsule that dispersed in the ileocecal region. These were used to quantify colonic transit. Five healthy volunteers were also studied. Two patients showed delayed gastric emptying and two had slow small bowel transit. Seven of the eight patients had slow colonic transit. In five, delay affected the whole colon ("pancolonic inertia"); in two, transit in the ascending and transverse colon was normal, but solids moved through the left colon slowly. Mean colonic transit was also measured using radiopaque markers; this technique identified the patients with slow transit, as shown by measurements of overall colonic transit by simultaneous scintigraphy. However, estimated transit through the ascending and transverse colons was considerably shorter by the radiopaque marker technique. In conclusion, idiopathic constipation is characterized by either exaggerated reservoir functions of the ascending and transverse colons and/or impairment of propulsive function in the descending colon. Particle size may influence the result of regional colonic transit tests. Transit delays in other parts of the gut suggest that, in some patients, the condition may be a more generalized motor dysfunction.

Adult↗
PubMed1991

Gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis.

This report documents the disturbance in gastrointestinal motor function in a patient with selective cholinergic dysautonomia that occurred following acute infectious mononucleosis. Apart from the gut, other organs affected included the pupils, sweat glands, lacrimal and salivary glands, and urinary bladder. Autonomic function tests showed the preservation of sympathetic adrenergic functions in contrast to the generalized involvement of postganglionic parasympathetic and sympathetic cholinergic nerves, including denervation hypersensitivity of the pupil and urinary bladder to exogenous cholinergic agonists. Cardiac and abdominal vagal responses were abnormal. Colon myenteric plexus ganglion cells were normal by morphological and immunohistochemical studies, suggesting that the selective cholinergic dysautonomia was the most likely pathophysiologic process responsible for the observed motility disorder. This study documents the occurrence of selective cholinergic dysautonomia following a viral illness, the importance of the extrinsic neural control on the motor function of the gastrointestinal tract, and the usefulness of combined motility and autonomic function testing in the evaluation of patients with symptoms suggestive of gut dysmotility.

Adult↗
PubMed1991

Small intestinal motility and transit in disease.

Disorders of small intestinal motility and transit are becoming increasingly recognized partly as a result of a greater awareness of their existence and partly because suitable diagnostic methods are more widely available. Usually, the neuropathic and myopathic forms can be separated, and gut disease secondary to a generalized neuromuscular disorder can be identified by the clinician. The availability of better non-invasive methods for the diagnosis of disorders of motility and transit would greatly facilitate their management. Treatment must include the restoration and maintenance of nutrition, attempts to improve intestinal motor function and resection of any segments of localized disease. Regrettably, all such measures are ineffective in the severest cases. In the future, a greater understanding of the enteric neural control of the smooth muscle and an ability to manipulate it with novel, specific drugs or peptidergic receptor agonists and antagonists, or electrical pacing, may lead to more effective therapies.

Gastrointestinal Motility↗
PubMed1991

Neurohormonal factors in functional dyspepsia: insights on pathophysiological mechanisms.

Neurohormonal factors were investigated in 10 patients with functional dyspepsia who had normal or slow upper gut transit and 10 age- and sex-matched healthy controls. Gastric and small bowel motility and transit, jejunal responses to luminal distention and IM neostigmine, gut hormones, and vagal and sympathetic functions were studied. Slow upper gut transit was defined by a gastric emptying slope less than 0.3%/min or 10% small bowel transit time greater than 300 minutes. Four patients with slow transit had reduced postprandial antral motility and gut hormone responses. Two of the four patients had vagal and sympathetic dysfunction. In 6 patients with normal transit, balloon distention in the jejunum was perceived at a lower volume (32.7 +/- 5.9 mL) than in controls (46.6 +/- 3.0 mL). Pressure responses to balloon distention were reduced in 5 and exaggerated in 1 patient; abnormal efferent vagal (2 patients) and sympathetic (1 patient) function were also documented. In view of the normal transit, motility, and jejunal pressure responses to neostigmine in all 6 patients, the abnormal response to distention suggests afferent dysfunction. Functional dyspepsia is a heterogenous disorder. Abnormal transit is sometimes associated with disorders of extrinsic neural control, but the latter are also found in patients with normal transit. Increased perception of intraluminal stimuli in those with normal transit suggests a disturbance in afferent function.

Adult↗
PubMedDate not supplied

Strokes in the elderly - higher acute and 3-month mortality - an explanation.

AIM: Stroke is common in older people. The objective of the study was to determine if older stroke patients have a higher mortality and disability compared with younger patients for comparable stroke severity and pathology and whether there is an explanation for the difference. METHODS: A prospective study was undertaken in 296 consecutive patients admitted with acute stroke. Patients were studied for neurological features, pre-stroke functional disability, severity of stroke defined by stroke syndromes and pathology of stroke on CT scans (202 patients). Post-stroke disability was defined according to the functional status within 72 h of admission. A record was made of the intercurrent illness while the patients were in acute wards and of the risk factors. Patients were dichotomized into two age groups: younger group - up to 75 years (163 patients) and older group - over 75 years (133 patients). Outcome was measured according to (1) discharge status from acute wards, i.e., dead or alive, and (2) mortality at 3 months. RESULTS: Although there was no significant difference in severe clinical stroke syndromes (p = 0.72), CT scan features (p = 0.68) and pyrexia (0.38) between the two age groups, the older patients had significantly more disabling strokes as defined on Barthel Index (p = 0.015) and a higher mortality in the acute phase (p < 0.01) and at 3 months (p = 0.001). The older stroke patients had more severe pre-stroke disability (p < 0.001) and more severe neurological impairment for similar stroke severity and pathology. Early mortality was more influenced by pre-stroke global health than age whereas 3-month mortality was influenced by age to the exclusion of all other known prognostic factors. CONCLUSION: The older stroke patients have more disabling stroke and an increased mortality for a similar spectrum of stroke severity and pathology. The explanation for higher mortality of the older patients is the poor pre-stroke health and higher immediate post-stroke disability.

Acute Disease↗
PubMedDate not supplied

Falls on integrated medical wards.

BACKGROUND: An effective approach to fall prevention should involve an assessment of environmental as well as patient-related characteristics. OBJECTIVE: To study the effect of age and ward design on fall characteristics among medical inpatients. METHODS: In a prospective open observational study over 1 year, we studied falls on three medical wards. Wards A and B are nuclear designed, and C is longitudinal. RESULTS: We recorded 199 falls involving 167 fallers. Fifty-four (27.1%) involved patients under 65 years. Most falls were intrinsic (60.8%) and involved elderly male patients (male/female ratio 97/48 vs. 24/30; p = 0.009). We identified no age differences in relation to location, activity, preceding fall, classification, time, consequences, and intervention required. On ward C, most falls occurred in the bed areas (bays and cubicles), but on wards A and B a higher proportion occurred in bathroom, corridor, and dayroom (C vs. A/B 87.9 vs. 73.7/62.0%; p = 0.04/p = 0.004). On ward C, activities of daily living around the bed significantly preceded falls (C vs. A/B 44.6 vs. 25.9/24.1%; p = 0.03/p = 0.01). Most falls were unwitnessed (C vs. A/B 10 vs. 21/20; p = 0.002/p = 0.0009). CONCLUSIONS: Intrinsic falls are the commonest; however, differences exist in fall demographics between wards, and this must be recognized to enhance the effectiveness of fall prevention programmes.

Accidental Falls↗
PubMedDate not supplied

Identifying priority patients for coronary angiography.

We conducted an open observational study with blinded endpoint evaluation to validate the use of the Duke treadmill score in identifying patients likely to require coronary intervention. We studied 101 consecutive patients referred for coronary angiography from a cardiology clinic. All patients had a Bruce protocol exercise test. A 70% stenosis was regarded as significant. Patients were referred for percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) surgery, if indicated. The Duke score was calculated as follows: exercise time (min) - (5 x ST segment deviation [mm]) - (4 x angina index [text]). Patients were classified into low, medium and high risk. The patients at high risk are more likely to have a significant stenosis (53/58 vs 30/43: p = 0.01 [OR 4.59 95% CI 1.34-16.6]) and require CABG or PTCA (47/58 vs 16/43: p < 0.001 [OR 7.21 95% CI 2.69-19.8]) than those at medium/low risk. Multiple logistic regression analysis, including ST segment depression, exercise time and symptoms shows that the score independently predicts a significant stenosis (p = 0.002) and the need for coronary intervention (p = 0.001). Introducing the score can help to identify those patients who need priority investigation.

Aged↗
PubMedDate not supplied

What influences outcome of stroke--pyrexia or dysphagia?

To investigate the significance of pyrexia and dysphagia as risk factors for mortality at 90 days in patients admitted with an acute stroke when controlled with other confounding factors, 202 stroke patients admitted to acute medical wards were prospectively studied for demographic and neurological details, stroke syndromes and pathology. A number of other factors were recorded within three days of admission, including pyrexia and dysphagia. Cox's proportional hazards model was used to identify the effect of 10 factors on mortality at 90 days; 59 (29%) patients had died by 90 days. Univariate analysis revealed pyrexia and dysphagia to be independently and significantly associated with indices of stroke severity and 90 day mortality (p < 0.001 for both). Cox's proportional hazards model, however, revealed that stroke mortality was associated with dysphagia (relative risk 2.6, 95% CI 1.2-5.4; p = 0.009), pre-existing diabetes mellitus (2.4, CI 1.2-4.5; p = 0.006), higher age > 75 years (1.8, CI 1.0-3.1), ischaemic heart disease (2.1, CI 1.1-4.2, p = 0.025), total anterior circulation syndromes (2.8, CI 1.5-5.2) and previous stroke (1.8, CI 1.0-3.2, p = 0.028). Pyrexia was not a significant factor (p = 0.50). Although both pyrexia and dysphagia are associated with higher mortality in acute stroke patients, dysphagia was a significant variable predicting death at 90 days when controlled for other factors known to influence stroke mortality. Pyrexia is not significant when other variables are considered.

Adult↗
PubMedDate not supplied

Upper airway obstruction in a young adult.

Acute epiglottitis is a potentially rapidly fatal illness. Although commonly thought of as a disease affecting children, it is increasingly being diagnosed in adults. We report a case of upper airway obstruction due to epiglottitis in a 37-year-old female. The need for early diagnosis because of the risk of a fatal outcome is highlighted.

Adult↗
PubMedDate not supplied

A large transmural thoracic lipoma easily mistaken for pulmonary malignancy.

Lipomas in the thorax are very rare. Most such lesions are asymptomatic and discovered by accident on a chest radiograph. However, radiographic features are non-specific and can mimic malignancy. We describe the case of an 82-year-old woman whose history and chest radiograph suggest a malignant lung tumour. A computed tomography scan of the chest eventually determined the fatty nature of her chest lesion.

Aged↗
PubMedDate not supplied

Age-related variations in presentation and outcome in Wegener's granulomatosis.

Wegener's granulomatosis (WG) is increasingly being diagnosed in older people. The object of this study was to see whether age influences the clinical presentation and prognosis. In a retrospective open case-note review of 51 patients with a diagnosis of WG based on internationally accepted criteria, 29 patients (56.9%) below 60 years and 22 (43.1%) aged 60 or above were compared. The incidence of limited (10% vs 9.1%) and classical (89.6% vs 90.9%) disease was similar in the two groups, but some clinical features were commoner in the younger cohort at presentation: ear, nose and throat (100% vs 68.1%; p < 0.01), ophthalmic (48.3% vs 18.2%; p = 0.05) and dermatological (51.7% vs 18.2%; p = 0.05). There were no significant differences in the incidence of renal, pulmonary, rheumatological or neurological involvement or in the presence of antineutrophil cytoplasmic antibody. Outcome was significantly worse for the over 60 group despite a similar treatment regimen (prednisolone, cyclophosphamide, and dialysis if required) (six months' survival: 96.5% vs 59.1%; p < 0.01). Renal function at presentation was a significant determinant of prognosis: mean serum creatinine at presentation was 525 mumol/l vs 291 mumol/l respectively in those who died within six months and in those who survived (p = 0.03). Uncontrolled pulmonary vasculitis was the commonest cause of death. In conclusion, the classical presentations of WG are similar in older patients. Disease in the latter is more often restricted to the lungs and the kidneys, and this may cause diagnostic uncertainty. The outcome is worse in older patients, with uncontrolled pulmonary vasculitis the commonest cause of death despite immuno-suppressive treatment. Early diagnosis and treatment may improve outcome.

Adult↗