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P Villari

Publications and source records attributed to P Villari.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Anatomo-functional study of 37 patients with monolateral chord paralysis].

The authors present a study of 37 patients affected by monolateral vocal cord paralysis in order to analyze etiology, degree of dysphonia and possible recovery of vocal function. The patients underwent the following tests: case history to determine the vocal characteristics prior to the lesion; video-laryngoscopy to define the position of the paralytic cord on the horizontal glottic plane and any compensation mechanisms; determination of the degree of dysphonia (light, moderate, severe, aphonia) on the basis of psycho-perceptive parameters; spectrography evaluated in classes (I, II, III and IV) according to Yanagihara. Analysis of the data obtained makes it possible to draw the following conclusions: the most frequent etiology encountered by the otorhinolaryngologist is surgical (particularly subsequent to thyroidectomy); the position taken by the paralytic vocal cord does not appear to determine the degree of dysphonia; during the period immediately after occurrence of the lesion (0-4 months) the vocal disorder is more intense and tends to be reduced thereafter, attenuated by a spontaneous compensation mechanism. In this regard, it must be pointed out, however, that such compensation can prove bad or even dangerous for good vocal function (falsetto voice); speech therapy makes it possible to nearly totally normalize vocal function in all patients presenting moderate dysphonia and in 60% of those with severe dysphonia. In the remaining 40% of those patients with severe dysphonia a partial improvement of vocal function was seen (from severe dysphonia to moderate dysphonia). This was determined by the fact that several negative prognostic factors came into play simultaneously in these patients (i.e. advanced age, longer time gap since the lesion occurred, position assumed by the paralytic cord) which prevented them from achieving better phonatory results.

Adolescent↗
PubMed2000

[CO2 laser cordectomy: analysis of morpho-functional results].

The authors have conducted a study of a large sampling of subjects who had undergone different types of cordectomy. The purpose of this study has been to analyze the anatomo-functional variables encountered with such procedures. In particular, the following were studied: post-surgical vocal recovery; type of glottic sphincter scarring, particularly as related to the extent of surgical excision; effect commissure synecchia has on the post-operative voice, again related to type of exeresis; different types of functional compensation related to the various surgical excisions and means by which the new scarring cord is built; severity of dysphonia resulting after each type of surgery. The study involved 69 patients who had undergone different types of cordectomy: from limited procedures--the so-called submucosal cordectomies for circumscribed, superficial neoplasms--to more radical ones, performed on tumours extending to the laryngeal ventricle of one or both sides. A history was taken of all the cases and they underwent videolaryngoscopy, psychoacoustic evaluation and voice spectrography. This study revealed the following: vocal recovery is achieved within 1-3 months after surgery, particularly when the exeresis was limited; longer recovery times were required for more radical surgery; with horizontal exeresis the prognosis for sphincteric recovery--characterized by a good neocord--is better than with procedures removing structures on the vertical plane (true vocal cord + ventricle + false cord) where scarring generally proves inadequate to re-establish a satisfactory sphincter; commissure synecchia is unusual in all types of surgery and is more frequent in bilateral forms. This is not specifically responsible for aggravating the dysphonia although, except in a few cases, it can make an important contribution in limiting the glottic opening and facilitating vocal sounds; as regards functional compensation, the observations show that the larynx is able to adapt to anatomic damage, the entire organ playing a part in reducing the air space to create a more or less valid phonatory sphincter, each part in its own way. Among the most noteworthy mechanisms for functional compensation we find the cord-neocord, the glottic mechanism at the false cords and ary-arythenoid compensation. There is no direct relationship between phonatory mode and neocord conformation since not all cases achieving a satisfactory neocord actually use glottic phonation. Although the Yanagihara spectrographic classification of dysphonia cannot distinguish between severe dysphonia and aphonia, it can be applied in the objective classification of limited post-cordectomy vocal compromise. In fact, spectrography is able to document that: Type II dysphonia--light--is unusual and was only found in 2 cases with a excellent neocord and a perfect pneumo-phonic picture; Type II dysphonia--moderate--is most often found in submucosal cordectomies and in other cases of monolateral exeresis with adequate scarring; Type IV dysphonia actually corresponds to the most important forms. It is present in all types of cordectomy and is most prevalent in those with a severe adductor deficit associated with inadequate or poorly balanced supraglottic functional compensation.

Adult↗
PubMed1999

When all else fails: stepwise multiple solutions for a complex cancer pain syndrome.

In the presence of insufficient pain relief and substantial adverse effects, application of alternative routes of administration and a change of opioid are the main methods used to improve the analgesic response. When all else fails, the result may further be optimized using adjuvant drugs by an alternative route, namely the intrathecal route. A stepwise approach with multiple drugs and routes of administration is described. This was implemented to resolve a complex pain syndrome otherwise considered uncontrollable. We found it possible to manage a very difficult pain situation by intrathecal home infusion through the efforts of a well-trained family and GP and a continuous exchange of information and advice with the pain relief team about changes in therapy to adapt to the clinical situation. A stepwise and a meaningful approach to clinical problems with use of advanced techniques and alternative drugs in the patient's home may be helpful in the treatment of conditions otherwise considered intractable.

Aged↗
PubMed1999

A comparison of different culture media for the membrane filter quantification of Aeromonas in water.

A comparative assessment of culture media for the membrane filter enumeration of Aeromonas spp. in water was performed, testing the effects of different incubation conditions (aerobic and anaerobic), temperatures (30 and 37 degrees C) and times (24 and 48 h). Different water samples seeded with test suspensions of Aeromonas spp., fecal material or raw sewage were examined. Results indicate clearly that plates should be incubated aerobically at 30 degrees C for 24 h. If the bacterial contamination is likely to be low, the use of most sensitive culture media, such as SAA, mA, ADA or PADE Agar, is recommended. By contrast, samples with an expected high level of background microbial flora should be analysed through more selective media, such as MIX Agar. However, the low selectivity of all media tested and the high likelihood of false negatives based upon the macroscopic examination of colonies means that further research directed to the development of more efficient media is needed.

Aerobiosis↗
PubMed1999

Unusual genetic heterogeneity of Acinetobacter baumannii isolates in a university hospital in Italy.

BACKGROUND: Acinetobacter baumannii has become an increasingly important nosocomial pathogen, particularly in intensive care units (ICUs). The aim of this investigation was to study the molecular epidemiology of A baumanii in a university hospital in Italy. METHODS: All A baumanii isolates were collected and typed with phenotypic and genotypic methods during a 7-month period. A 1-year prospective surveillance of ICU-acquired infections was performed by using the National Nosocomial Infections Surveillance methodology. RESULTS: A baumanni accounted for 28.4% of all infections and 46.7% of all pneumonia acquired in the ICU, with a nosocomial infection rate of 12.4% or 8 infections per 1000 patient-days. Risk factors for A baumannii acquisition in the ICU were mechanical ventilation and previous use of broad-spectrum antibiotics, whereas administration of carbapenems showed a significant protective effect. Pulsed-field gel electrophoresis of genomic Apa I digests identified at least 5 outbreaks in the ICU caused by 5 different clones, one replacing the other in a well-defined temporal order. CONCLUSIONS: Whereas the sequential temporal cluster of epidemic clones in the ICU is intriguing and requires further research, the clear evidence of cross-contamination of A baumannii isolates involved with infections in the ICU demands extensive preventive efforts.

Acinetobacter↗
PubMed1999

Caries and fluorosis prevalence in communities with different concentrations of fluoride in the water.

The need to defluoridate and fluoridate the water supplies in areas with drinking water naturally containing above-optimal (>/=2.5 mg/l) and suboptimal (</=0.3 mg/l) fluoride concentration and caries and fluorosis prevalence of 12-year-old schoolchildren were assessed in Italy. In the low-fluoride area, 48.4% children were caries-free (DMFT = 0) and the DMFT and DMFS were 1.5 and 2.6; in the high-fluoride area, 46.8% had a DMFT = 0 and the values of the indices were 1.4 and 1.6, respectively. Multiple logistic regression analysis showed a significant association in the caries-free status according to parents' employment status (OR = 1.2, 95% CI = 1.1-1.3) and children's sweets consumption, since children who consumed sweets at least once a day had an adjusted odds ratio of 1.8 (95% CI = 1.4-2.3) compared to those with a lower consumption. Multiple linear regression analysis showed that DMFT and DMFS were significantly higher in children with a lower socioeconomic status and in those who consumed sweets at least once a day, with the DMFS significantly associated also with the area of residence. DT and FT scores were higher in the high- and low-fluoride areas, respectively. No evidence of fluorosis was reported in 94.5 and 55.3% of children in the low- and high-fluoride areas, respectively. The Community Fluorosis Index (CFI) for all permanent teeth was significantly higher in the high-fluoride area, 0.8, than the value, 0.1, found in the low-fluoride community. Our results substantiate the difficulties in defining universal guidelines for the fluoridation or defluoridation of drinking water and the need for an epidemiological approach to the decision as to fluoridate and defluoridate the water supply.

Analysis of Variance↗
PubMed1999

Residential exposure to electromagnetic fields and childhood leukaemia: a meta-analysis.

Although individual epidemiological investigations have suggested associations between residential exposure to electromagnetic fields (EMFs) and childhood leukaemia, overall the findings have been inconclusive. Several of these studies do, however, lend themselves to application of the meta-analysis technique. For this purpose we carried out searches using MEDLINE and other sources, and 14 case-control studies and one cohort study were identified and evaluated for epidemiological quality and included in the meta-analysis. Relative risk estimates were extracted from each of the studies and pooled. Separate meta-analyses were performed on the basis of the assessed EMF exposure (wiring configuration codes, distance to power distribution equipment, spot and 24-h measures of magnetic field strength (magnetic flux density) and calculated magnetic field). The meta-analysis based on wiring configuration codes yielded a pooled relative risk estimate of 1.46 (95% confidence interval (CI) = 1.05-2.04, P = 0.024) and for that for exposure to 24-h measurements of magnetic fields, 1.59 (95% CI = 1.14-2.22, P = 0.006), indicating a potential effect of residential EMF exposure on childhood leukaemia. In most cases, lower risk estimates were obtained by pooling high-quality studies than pooling low-quality studies. There appears to be a clear trend for more recent studies to be of higher quality. Enough evidence exists to conclude that dismissing concerns about residential EMFs and childhood leukaemia is unwarranted. Additional high-quality epidemiological studies incorporating comparable measures for both exposure and outcomes are, however, needed to confirm these findings and, should they prove to be true, the case options for minimizing exposure should be thoroughly investigated to provide definitive answers for policy-makers.

Child↗
PubMed1998

Molecular epidemiology as an effective tool in the surveillance of infections in the neonatal intensive care unit.

OBJECTIVES: nosocomial infections result in considerable morbidity and mortality in Neonatal Intensive Care Units (NICUs). The aim of this study was to investigate the usefulness of the molecular epidemiology approach in the surveillance and control of infections in the NICU. METHODS: a 1-year prospective surveillance of nosocomial infections in a NICU was performed using traditional epidemiological methods as well as molecular typing of micro-organisms. RESULTS: the nosocomial infection rate among the 343 newborns was 24.8%. The risk of infection was associated with low birth weight, prolonged length of stay, empiric antibiotic treatment and nasopharyngeal colonization. Four pathogens (Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE) and methicillin-sensitive Staphylococcus aureus (MSSA) were responsible for more than 80% of the infections. Extended-spectrum beta-lactamase-producing (ESBL) K. pneumoniae and MRSA infections constituted outbreaks caused by a single clone, whereas MRSE and MSSA infections did not represent outbreaks but rather a series of sporadic infections caused by different strains. CONCLUSIONS: molecular epidemiology techniques are powerful tools that can elucidate modes of spread and reservoirs of infection in the NICU and identify effective measures to control epidemic or endemic situations.

Bacterial Infections↗
PubMed1998

Molecular characterization of methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital in Italy.

The molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital in Italy was studied in a five-month period in 1996, during which all S. aureus isolated were collected. All MRSA isolates (95) and a sample of methicillin-susceptible S. aureus (20) were typed with a variety of phenotypic and genotypic methods. Clonal identities were determined by pulsed-field gel electrophoresis (PFGE) of chromosomal SmaI digests and, for MRSA isolates, by probing ClaI digests with a mecA probe and a Tn554 probe. Overall, MRSA represented 32.3% of all isolates, with very high percentages from the intensive care units (adult and neonatal). PFGE after restriction with SmaI resolved genomic DNA of 95 MRSA strains into 26 major PFGE patterns. The use of southern blot hybridization of ClaI genomic digests with mecA and Tn554 allowed us a significant increase in discrimination, differentiating at least 32 different clones. Two major clones, however, each sharing common ClaI-mecA and Tn554 type and PFGE pattern as well as a common resistance phenotype, represented more than 50% of all MRSA isolates. The recovery of these two clones in the majority of the isolates of adult and neonatal intensive care units, respectively, is indicative of typical nosocomial outbreaks and clonal spread. It is concluded that intensive care units are major areas requiring preventative interventions.

Adult↗
PubMed1998

Comparison of conventional culture and PCR methods for the detection of Legionella pneumophila in water.

A comparative assessment of conventional culture and nucleic acid techniques in the detection of Legionella pneumophila in seeded tap water samples was performed, using bacterial concentrations ranging from 994 to 0.015 cfu ml-1. Different filtration and centrifugation protocols were evaluated. The results permitted the development of a tentative algorithm for the detection of legionellae in tap water. Samples should first be analysed using PCR methods. In the event of quantitative data and bacterial strains for epidemiologic typing being required, the same sample, or a greater volume of the sample, if positive with PCR, can be re-tested by filtration through polycarbonate membranes followed by plating a homogenate of the filter. If samples are found to be negative with PCR, they can be re-analysed in greater volumes by filtration through polycarbonate membranes followed by direct placing of the filter on culture media, to allow detection of very low numbers of bacteria. This protocol should be validated in the field before it can be routinely implemented.

Culture Media↗
PubMed1998

Decreased susceptibilities to teicoplanin and vancomycin among coagulase-negative methicillin-resistant clinical isolates of staphylococci.

Of 41 methicillin-resistant coagulase-negative staphylococcal clinical isolates collected during a 5-month period between late 1995 and early 1996, 28 showed tube dilution teicoplanin MICs of 4 to 8 microg/ml which increased to 16 to 32 microg/ml upon prolonged incubation. Cultures of such bacteria were heterogeneous; they contained subpopulations with frequencies of 10(-5) to 10(-4) that could grow on up to 50 microg of teicoplanin per ml. The same cultures were also heterogeneous with respect to susceptibility to vancomycin; while the MICs for the majority of cells were 2 to 4 microg/ml, subpopulations that could grow on 6 to 12 microg of vancomycin per ml were also present at frequencies of 10(-5) to 10(-7). Selective enrichment of such cultures for the resistant subpopulation occurred with relative ease under laboratory conditions. Heterogeneous phenotypes for teicoplanin (but not for vancomycin) susceptibility were also identified in several Staphylococcus epidermidis isolates collected during the preantibiotic era. The addition of half the MIC of teicoplanin inhibited autolysis and caused formation of cellular aggregates which disintegrated to individual bacteria in the stationary phase when the titer of teicoplanin in the medium fell to undetectable levels, indicating removal of the antibiotic from the culture medium by the bacteria.

Anti-Bacterial Agents↗
PubMed1997

An evaluation of the use of 4-methylumbelliferyl-beta-D-glucuronide (MUG) in different solid media for the detection and enumeration of Escherichia coli in foods.

The use of 4-methylumbelliferyl-beta-D-glucuronide (MUG) in different solid media for the detection and enumeration of Escherichia coli in foods was evaluated by testing the effects of different substrate concentrations (50 or 100 micrograms ml-1), incubation temperatures (37 or 41.5 degrees C) and incubation times (8, 12, 24 and 48 h). Different kinds of foods, both naturally and artificially contaminated, were analysed. The use of selective media without differential substances and an incubation time of 24 h seem to be worthy of recommendation. In this case an incubation temperature of 37 degrees C would be preferred and the MUG concentration could be reduced to 50 micrograms ml-1. Incubation times shorter than 24 h, which may cause a loss of sensitivity, require higher incubation temperatures (41.5 degrees C) and MUG concentration (100 micrograms ml-1).

Colony Count, Microbial↗
PubMed1996

Economic evaluation of HIV testing among intravenous drug users. An analytic framework and its application to Italy.

We performed an economic evaluation of HIV testing among intravenous drug users (IVDUs) in Italy using the analytical framework of cost-effectiveness analysis. A semi-Markov model was developed to calculate costs and life expectancy of a cohort of IVDUs with and without an annual HIV testing program. We also investigated the incremental cost-effectiveness of a hypothetical early treatment to prolong the life expectancy of HIV-infected asymptomatic subjects by 1 year. The testing program is cost saving in the low prevalence scenario (0.05), and costs L 14,000,000 (US $8,400) and L 55,800,000 (US $33,500) per year of life saved in areas of medium (0.3) and high (0.6) prevalence, respectively. The incremental cost-effectiveness of the hypothetical early treatment may compare favorably with other health care interventions. The program may be considered a cost-effective procedure in low and medium prevalence areas. Where prevalence is high, more evidence about the magnitude of the behavior change is needed. In these areas, the availability of an effective early treatment may become the economic rationale for implementing such a program.

Adult↗
PubMed1995

The economic burden imposed by a residual case of eastern encephalitis.

To estimate the economic burden imposed by eastern encephalitis (EE), we identified a series of residents of eastern Massachusetts who had survived EE infection and enumerated any costs that could be attributed to their experience. The records of three people who suffered only a transient episode of disease were analyzed as well as those of three who suffered severe residual sequelae. Transiently affected subjects mainly required assistance for direct medical services; the average total cost per case was $21,000. Those who suffered persistent sequelae remained at home and seemed likely to live a normal span of years, but without gainful employment. Early in the course of their chronic illness, costs ranged as high as $0.4 million per year, but plateaued at about $0.1 million after three years. Hospital costs, which dominated early in the disease experience, approached $0.3 million per patient. Educational costs tended to replace hospital costs after two years as the dominant economic burden and totaled about $0.3 million per patient during the first six years. Total costs then averaged almost $0.8 million. By the time that these subjects will have reached 22 years of age, disease-related costs will have totaled about $1.5 million. Institutionalization will impose an additional lifetime cost of $1.0 million. Insecticidal interventions designed to avert outbreaks of human EE infection cost between $0.7 million and $1.4 million, depending on the extent of the treated region. The direct costs of an intervention are less than the $3 million imposed on one person suffering residual sequelae of EE.

Adolescent↗
PubMed1994

Effect of clonidine on postpartum shivering after epidural analgesia: a randomized, controlled, double-blind study.

In obstetric patients treated with epidural analgesia during labor and delivery, shivering is quite frequent due to stress, vasodilatation, infusion of fluids, low ambient temperature, and the direct effect of solution injected into the epidural space. Sixty obstetric patients who developed shivering after receiving epidural analgesia for delivery were randomly assigned to treatment with clonidine 0.150 mg i.v. (N = 20), meperidine 50 mg i.v. (N = 20), or saline solution (N = 20). Drug administration was double blind. The effect on shivering (graded as all or none), drowsiness, heart rate, and systolic arterial pressure was evaluated 5 min after the study drug was administered. Clonidine was as effective as meperidine in controlling shivering and caused a greater reduction in heart rate. Drowsiness occurred after clonidine as well as meperidine. Thus, clonidine proved to be effective in controlling shivering and adrenergic response after delivery using epidural analgesia and produced an acceptable level of drowsiness.

Adult↗
PubMed1994

Dentists and AIDS: a survey of knowledge, attitudes, and behavior in Italy.

OBJECTIVES: Italy, together with Spain, is second only to France in the total number of AIDS cases in Europe, with over 16,800 as of March 1993. The purpose of this study was to evaluate knowledge, attitudes, and behavior concerning AIDS and infection control among Italian dentists. METHODS: A questionnaire was mailed to 1,000 dentists randomly selected from the Italian Dental and Maxillo-Facial Association's register of dentists. RESULTS: Of the 715 dentists responding, 70.7 percent of dentists knew all the main risk groups able to transmit the infection and that semen is a biologic fluid potentially contaminated by HIV virus. This knowledge was greater if the number of patients per week was not higher than 55 and if the dentist had had a previous contact with an HIV-seropositive patient. Only a few (21.1%) knew all the oral manifestations of AIDS. Over 65 percent of the dentists indicated that they would treat HIV-seropositive patients (71.9%) or those with AIDS (66.8%). Dentists were more willing to care for an HIV-seropositive patient if they were involved in specialties with high blood contact, if they had a previous contact with an HIV patient, as the average number of patients per week increased, and if they did not consider saliva as a possible route of transmission of HIV. A small percentage of dentists who had the opportunity to treat patients at risk for AIDS (12.1%) or HIV seropositive (9.4%) refused to treat them. Willingness to treat was the most significant predictor of actual treatment of an infected patient. Only 24.4 percent routinely used all barrier techniques (gloves, masks, and protective eyewear). Predictors of routine use of all barrier techniques were specialties with high blood contact, considering saliva a possible route of transmission of HIV infection, average number of patients per week fewer than 40, and number of years of practice. CONCLUSIONS: Educational efforts for improving knowledge and finding and implementing ways to motivate dentists to the correct and routine use of infection control procedures are needed.

AIDS-Related Opportunistic Infections↗
PubMed1993

Cesarean section to reduce perinatal transmission of human immunodeficiency virus. A metaanalysis.

OBJECTIVE: Individual epidemiologic investigations into the association between type of delivery and perinatal HIV transmission have been suggestive but inconclusive. Metaanalysis was used in an attempt to establish if there is, at present, adequate evidence concerning the effectiveness of cesarean section in reducing vertical HIV transmission rates. METHODS: The MEDLINE data retrieval system and other sources were used to identify studies containing data on the relationship between type of delivery and vertical HIV transmission. No randomized control trials were located. Six cohort studies identified were included in the metaanalysis. Crude and, in the only study in which these were available, adjusted data were extracted and pooled. RESULTS: The overall weighted risk of perinatal HIV infection was 20.2% and 14.0% after vaginal and cesarean delivery, respectively. Pooling data of all studies showed a statistically significant difference of HIV perinatal transmission rates between cesarean and vaginal delivery (odds ratio 0.65; 95% CI, 0.43 to 0.99; P = 0.044) (Random effects model: DerSimonian and Laird method). Approximately 16 (95% CI, 76 to 9) HIV-infected women must deliver by cesarean in order to prevent 1 case of HIV perinatal infection. CONCLUSIONS: Results of this study show that performing elective cesarean section in HIV-infected women is potentially an effective procedure. However, the nonexperimental nature of the available studies leads us to conclude that randomized control trials are indicated before setting specific guidelines for mode of delivery in HIV-infected women.

Bias↗