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Biomedical subjects

R Bergamaschi

Publications and source records attributed to R Bergamaschi.

At least 73 records · Page 4Linked to original sources
PubMed2000

Circadian and hypothermia-induced effects on visual and auditory evoked potentials in multiple sclerosis.

OBJECTIVES: Body cooling has been proposed as a symptomatic treatment for multiple sclerosis. This study aimed to assess the effects of body cooling and of circadian variations on clinical parameters and on visual and auditory evoked potential measures in multiple sclerosis patients. METHODS: Clinical status was assessed and VEPs, BAEPs and MLAEPs (all with two stimulus frequencies) were recorded a total of 4 times on two separate days (two times per day at 08:30 and 15:00 h each day) in 10 multiple sclerosis patients and 10 controls. On one of these days, the subjects were submitted to body cooling before the afternoon session. RESULTS: Tympanic temperature was significantly higher in the afternoon. Cooling lowered the temperature by 1.4 degrees C. No clinical effects were observed. Circadian effects were detected on VEP amplitude, which increased both in controls and in patients at low stimulus frequency (P<0.01), and increased in controls and decreased in patients at high stimulus frequency (interaction: P<0.01). Cooling determined an increase in BAEP I-V peak-to-peak time in controls, and a reduction in patients at high stimulus frequency (interaction: P<0.01). In patients, cooling also determined a great increase in MLAEP amplitude (interaction: P<0.001). We did not find cooling effects on VEP measures. CONCLUSIONS: Visual and auditory evoked potentials showed differences in circadian and cooling effects between controls and multiple sclerosis patients. These differences are consistent with the hypothesis of temperature-dependent conduction blocks in demyelinated fibers. Cooling may have a clinical effect in selected patients only.

Acoustic Stimulation↗
PubMed2000

Instruction versus passive observation: a randomized educational research study on laparoscopic suture skills.

Implementing laparoscopic surgery is a challenge that should prompt educational research in an attempt to establish a link between instruction and the quality of patient care. This randomized study was undertaken to compare the impact of instruction versus passive observation on laparoscopic skills. The task was stitching and tying a surgeon's knot on a perforated ulcer in a foam stomach placed in a simulator. Outcome measures were accuracy error, goal-directed and non-goal-directed actions, operating time, and tissue damage. Time/motion analysis was carried out by an masked assessor. Twelve participants were well matched for hand-eye coordination at pretesting. Regardless of whether instruction was given or not, a positive correlation was found between overall actions and operating time, non-goal-directed actions and operating time, and overall actions and non-goal directed actions. Intraoperative instruction decreased errors, but this study did not have sufficient power to detect small differences in other outcome measures. The teaching of minimal-access surgery should increasingly be based on educational research data rather than on unstructured rating by attending surgeons.

Clinical Competence↗
PubMed2000

Interferon-gamma and interleukin-4-producing T cells in peripheral blood of multiple sclerosis patients.

Pro- and anti-inflammatory cytokines are thought to participate in the development and regulation of autoimmunity in multiple sclerosis (MS), a demyelinating disease of the central nervous system (CNS). We analysed the percentage of interferon (IFN)-gamma and interleukin (IL)-4-producing cells in the peripheral blood of both active and stable MS patients, and of healthy controls. After short-term stimulation, cytokine-producing cells were intracellularly stained and sorted. Significantly lower percentages of IFN-gamma and IL-4-producing T cells were found in stable MS patients than in controls, and in active than in stable patients. The diminution affected CD4(+) (Th1, Th2) and CD8(+) (Tc1) phenotypes. Tc2 cells were not detected. The Th1/Th2 ratio did not differ in active and stable MS, nor in controls. The fact that Th2 and Tc1 cell percentages were higher in stable than in active MS possibly indicates that these cells play a downmodulating role in the immune response. In contrast, a role in exacerbating the immune response is not attributable to Th1 cells, given their reduction in acute MS. Our data do not support the hypothesis that MS is a Th1/Th2 paradigmatic disease; rather, they suggest that sequestration in the CNS, or activation-induced apoptosis (whether in vivo or in vitro) may explain reduced levels of IFN-gamma and IL-4-producing subsets in the peripheral blood of clinically acute patients.

Adolescent↗
PubMed1999

Magnetization transfer imaging of patients with definite MS and negative conventional MRI.

OBJECTIVE: To assess, in a group of patients with clinically or laboratory-supported definite MS and negative conventional MRI scans of the brain, whether magnetization transfer imaging (MTI) is able to detect subtle white matter changes. BACKGROUND: MTI of the brain in patients with MS frequently demonstrates the presence of microscopic damage to white matter, which appears normal on conventional MRI. METHODS: Brain MRI and MTI scans were obtained from 11 patients with negative conventional MRIs of the brain, selected from 618 clinically or laboratory-supported definite MS cases scanned in the last 2 years in three Italian MS centers. RESULTS: Compared with control subjects, patients had significantly lower mean MT ratios (MTR) in the pons, cerebellum, and periventricular regions. The percentages of pixels with MTR values below 1, 2, and 3 SD of the mean MTR value of the control subjects were 7.6% (range, 3.2% to 11.8%), 5.2% (range, 2.0% to 8.5%), and 3.6% (range, 1.2% to 6.1%), respectively. They were mainly located in the white matter of the centra semiovalia, and usually were isolated. CONCLUSIONS: MTI can detect white matter abnormalities in patients with MS and negative conventional brain MRI scans. The detection of such abnormalities may increase diagnostic confidence in those cases where MS is clinically suspected, but conventional MRI does not suggest the diagnosis.

Adolescent↗
PubMed1999

Open vs laparoscopic repair of perforated peptic ulcer.

BACKGROUND: Most studies have found that the only advantage to the laparoscopic treatment of perforated peptic ulcer is a reduced need for postoperative analgesia. Therefore, we set out to assess the short-term outcome of open (OR) versus laparoscopic (LR) repair of perforated peptic ulcer. METHODS: A total of 62 consecutive OR patients were compared with a concurrent cohort of 17 diagnosis-matched LR controls treated at the same hospital between 1991 and 1996. RESULTS: The OR and LR patients were comparable for age, weight, American Society of Anesthesiologists (ASA) grade, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Boey score, ulcer site, Mannheim Peritonitis Index (MPI), delay of surgery, Helicobacter pylori infection, nonsteroidal antiinflammatory drug (NSAID) intake, and previous abdominal surgery. More LR than OR patients were operated on by staff surgeons (chi2 = 46.9, 1 d.f., p << 0.01). Mortality (OR: 12, LR: two), morbidity (OR: eight, LR: two), estimated blood loss (OR: 120 ml, LR: 95 ml), solid food intake resumption (OR: 5 days, LR 4 days), NSAID consumption (OR: 2,225 mg, LR: 1,815 mg), delayed gastric emptying (OR: two, OR: one), and hospital stay (OR: 9 days, LR: 7 days) were not significantly different for the two groups. Four LR patients (23. 5%) were converted to OR due to failure to progress (n = 3) or posterior perforation (n = 1). Operating time was shorter in OR patients (65 min versus 92 min, p << 0.01). LR patients had reduced opioid consumption (256 mg versus 134 mg, p << 0.01). One LR and 16 OR patients were lost to follow-up. Median follow-up was 14 months (range, 2-55) and 18 months (range, 1-62) in OR and LR patients, respectively. There were more LR than OR patients with Visick score I (p = 0.002) and more OR than LR patients with Visick score II (p = 0.0001). Scores III and IV did not differ significantly. CONCLUSION: The laparoscopic repair of perforated peptic ulcer does not yield any additional benefits over the open repair.

Adult↗
PubMed1999

Results of duodenopancreatectomy for solitary pancreatic metastasis from renal cell carcinoma.

The pancreas is an uncommon site of metastasis from renal cell carcinoma. We present five patients with solitary pancreatic metastasis from renal cell carcinoma located in the head of the pancreas, treated by duodenopancreatectomy. There were no perioperative deaths. Mean survival was 48 months; three patients were alive at the end of the study (at 27, 46, and 88 months, respectively) and two patients died, at 13 and 70 months. The 3- and 5-year survival rates of our patients together with 22 previously reported patients were 86% and 68%, respectively. We advocate aggressive surgical treatment when the metastatic disease is limited to the pancreas.

Carcinoma, Renal Cell↗
PubMed1999

Selective endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy for gallstones.

BACKGROUND: To assess the outcome of endoscopic retrograde cholangiography (ERC) before laparoscopic cholecystectomy (LC) for symptomatic gallbladder and suspected duct stones. METHODS: During 3 years, one or more of four criteria led to ERC: jaundice, choledocus >8 mm, cholestasis, and severe biliary pancreatitis. Endoscopic extraction (ESE) of ductal stones was attempted before LC. RESULTS: In all, 990 patients were prospectively included. There were no exclusions. There were no deaths. A multivariate logistic regression analysis identified jaundice (P = 0.001), pancreatitis (P = 0.001), and cholestasis (P = 0.001) as statistically significant predictors of ductal stones. Choledocus >8 mm was not a significant predictor (P = 0.12). A total of 155 (16%) patients underwent ERC for suspected stones: 21 of 155 (13%) patients had no stones; and 6 of 134 (4%) patients had stone impaction cleared at open surgery. ERC clearance rate was 95% (128 of 134). LC was performed in 149 of 155 patients after a median interval of 3 days (range 1 to 7). Morbidity rates were 3% (4 of 134), 2% (3 of 149), and nil (0 of 6) after ESE, LC, or open surgery, respectively. Median hospital stay was 11 days. A total of 835 patients underwent LC with a 1.5% complication rate. Laparoscopic fluoro-cholangiography showed < or =3 mm-sized stones in 10 of 835 (1.2%) patients. No stones were reported at a median follow-up of 4 months including 990 patients. CONCLUSIONS: Ninety-five percent of patients with ductal stones can be successfully and safely managed by ERC prior to LC.

Adolescent↗
PubMed1999

Reduced spontaneous growth hormone secretion in patients with Turner's syndrome.

We evaluated growth hormone (GH) secretion in 81 patients with Turner's syndrome (TS) (mean age 10.7+/-3.6 y) with respect to karyotype, auxological characteristics and growth response to GH treatment (1 IU/kg/wk). None of the patients had spontaneous puberty or had started replacement therapy with estrogens. Thirty-nine patients (48%) had monosomia 45X, 29 (36%) structural abnormalities of the X chromosome and 13 (16%) X mosaicism. Before the start of GH therapy, each patient underwent an evaluation of mean nocturnal GH concentration (MGHC) and 75 patients also underwent 2 pharmacological tests. MGHC of the TS patients did not differ from that of 29 prepubertal GH-deficient girls (GH peaks < 8 microg/l after pharmacological tests) and both groups were lower (p < 0.0001 and p < 0.0005, respectively) than MGHCs of 27 short normal girls (GH peak > 8 microg/l). MGHC of the patients with TS was negatively correlated (p < 0.001) with bodyweight excess (BWE) at multiple regression analysis. MGHC of the TS patients with BWE < 20% was significantly higher (p < 0.02) than that of the TS patients with BWE > 20%, but again did not differ from that of the GH-deficient patients and was lower (p < 0.001) than that of the short normal girls. MGHC did not significantly differ between the 3 groups subdivided according to karyotype. Forty-four percent of the TS patients showed GH responses to pharmacological tests < 8 microg/l. Height velocity SDS at first and second year of therapy was not influenced by MGHC levels, chronological or bone age, target height or BWE. In conclusion, spontaneous secretion in our patients with TS was lower than that of the short normal prepubertal girls and did not differ from that of GH-deficient subjects, even if we excluded overweight patients. The level of GH secretion was unable to predict GH response to treatment.

Adolescent↗
PubMed1999

Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy.

OBJECTIVE: To assess the safety of the pancreatic anastomosis after pancreatico-duodenectomy (PD). DESIGN: Non-randomized prospective trial in consecutive patients. SETTING: University hospital. SUBJECTS: 171 consecutive patients with resectable periampullary cancer (80%) or intractable pain due to chronic pancreatitis (20%) undergoing PD. INTERVENTIONS: Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). MAIN OUTCOME MEASURES: Mortality and morbidity rates due to anastomotic leak following PJ and PG. RESULTS: 91 PJ and 80 PG patients were comparable for age, gender, total bilirubin, ASA grading, indication for PD, operating time, pancreas texture, blood loss and replacement. The rate of pancreatic fistula was significantly higher in PJ patients (13%) than in PG patients (3.7%) (12 vs. 3, p = 0.029). Overall death rate was significantly higher after PJ (12%) than after PG (3.7%) (11 vs. 3, p = 0.047). Fatal outcome due to pancreatic leak (3 vs. 1, p = 0.83) and other death rates (8 vs. 2, p = 0.14) were not significantly different in PJ and PG groups, respectively. CONCLUSION: PJ was associated with significantly higher pancreatic leak rate than PG. However, there was no statistically significant difference in mortality rates directly related to pancreatic leak.

Anastomosis, Surgical↗
PubMed1999

Pulmonary function abnormalities in children with Henoch-Schönlein purpura.

Henoch-Schönlein purpura (HSP) is a widespread necrotizing vasculitis affecting small vessels characterized by nonthrombocytopenic purpura. Pulmonary involvement is a rare fatal complication with diffuse alveolar haemorrhage. The objective of this study was to evaluate possible early lung function abnormalities and to establish any relationship with the clinical activity of the disease. Fifteen children with HSP and without clinical or radiological evidence of lung involvement underwent pulmonary function study at the onset of the disease. A sample of 28 subjects matched by age, height, and weight was chosen as a control group. After a mean of 21 months (range 12-43) lung function tests were repeated in 10 of the previously studied children. During the acute phase of the disease the transfer factor for carbon monoxide, measured by steady-state (TL,COss) and single-breath (TL,COsb) methods, was found to be significantly lower in children with HSP than control subjects. There was no significant relationship between pulmonary function tests with symptoms and signs at onset, nor was there any correlation between variables and serum immunoglobulin A (IgA) concentration. In all but two patients, clinical recovery was observed within 6 weeks from the onset of the disease. In one case relapses of purpuric skin lesions were observed during the first 3 months of follow-up. The second case had relapses of purpuric skin lesions and microscopical haematuria during the 12 months following the onset of the disease with characteristic IgA mesangial deposition on renal biopsy. Although the overall mean value of TL,COsb improved from baseline to the second investigation, in both patients the recurrences of clinical signs were associated with a slight impairment of TL,COsb at the second evaluation. These data suggest an early subclinical lung impairment in children with Henoch-Schönlein purpura during the active phase of the disease. The presence of isolated pulmonary function abnormalities was not associated with the subsequent development of lung disease.

Adolescent↗
PubMed1999

Tumor necrosis factor-alpha and its soluble receptors in plasma and cerebrospinal fluid of multiple sclerosis patients treated with methylprednisolone.

Demyelination is the main pathological feature of multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system. Tumor necrosis factor-alpha (TNF-alpha) can cause myelin damage and contribute to MS pathogenesis. We measured plasma and cerebrospinal fluid (CSF) levels of TNF-alpha and its soluble receptors, TNF-sRp55 and TNF-sRp75, in 18 patients with active MS, and in neurological and healthy controls. The same determinations were repeated on plasma and on CSF samples that were collected after the MS patients had ended a six-day treatment with high-dose methylprednisolone (MP). Pre- and post-treatment plasma and CSF TNF-alpha levels, when detectable, and those of TNF-sRp75, did not vary, and were similar to those of controls. CSF TNF-sRp55 levels were higher in acute MS patients than in controls. Post-treatment CSF TNF-sRp55 levels were higher than in the active phase of the disease. The MS patients, who clinically improved, tended to have the highest CSF TNF-sRp55 levels. The increase was due to intrathecal TNF-sRp55 synthesis. Although it is involved in MS pathogenesis, TNF-alpha is not detectable in plasma or in CSF samples from MS patients in various phases of the disease. A better marker of disease activity seems to be CSF TNF-sRp55 levels. The increased CSF levels of TNF-sRp55 in response to MP circumstantially suggest that this receptor could partially account for the beneficial effects of MP in acute MS.

Adult↗
PubMed1999

Anatomic rationale for arterial bleeding from the liver bed during and/or after laparoscopic cholecystectomy: a postmortem study.

The aim of this study was to establish an anatomic rationale for liver bed arterial bleeding during laparoscopic cholecystectomy. Fifty consecutive human cadavers were dissected. A corrosion cast method was used. Six anastomotic branches (12%) of the cystic artery to the right or left hepatic artery ran underneath the gallbladder serosa surface and entered liver parenchyma after crossing the medial or lateral edge of the liver fossa without passing through the areolar tissue of the liver bed. Their mean length was 18.3 mm (range 4-60), and the mean diameter was 0.38 mm (range 0.2-0.8). Two cystic arteries that ascended in the midline between the gallbladder and liver bed were identified in 50 (4%) casts. Their lengths were 16 and 18 mm, and their diameters were 1.9 and 2.2 mm. Five and seven branches encircling the gallbladder arose radially. These two arterial branching patterns can cause arterial bleeding from the liver bed during and/or after laparoscopic cholecystectomy.

Adult↗
PubMed1998

Barber-Say Syndrome: report of a new case.

We present a girl with lax, redundant skin, ectropion, bulbous nose, macrostomia, and absence of mammary glands. To our knowledge, she represents the fourth described case of Barber-Say Syndrome (BSS). BSS and ablepharon macrostomia syndrome (AMS) share common and distinctive clinical manifestations that involve the same structure of the skin and adnexa. We hypothesize that they may derive from a defective regulation of the same gene.

Abnormalities, Multiple↗
PubMed1998

Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid.

BACKGROUND: Extent of bowel resection and level of anastomosis are unsettled issues of surgery for diverticulitis of the sigmoid. The aim of this study was to compare the adequacy of open colon resection (OCR) with that of laparoscopic colon resection (LCR) for uncomplicated diverticulitis of the sigmoid (UDS), specifically addressing level of anastomosis and length of specimen. METHODS: Comparisons were made between 40 selected patients undergoing LCR for UDS between 1992 and 1994 and 35 diagnosis-matched controls who previously underwent OCR by the same surgeons at the same institution. RESULTS: The OCR and LCR patients were well-matched for age, gender, weight, ASA grade, duration of symptoms, and number of previous admissions. There were no significant differences, respectively, between OCR and LCR patients in morbidity rates (2 vs. 5, p = 0.33) and rates of mobilization of the splenic flexure (17:18 vs. 29:11, p < 0.1). Specimen length (18 cm vs. 11 cm, p << 0.01), colosigmoid vs. colorectal anastomosis (24:11 vs. 1:39, p << 0.01), and presence of inflammatory cells at the proximal resection margin (2 vs. 11, p = 0.02) were significantly different. The OCR patients had statistically longer follow-up than LCR patients (63 months vs. 46 months, p << 0.01). Recurrent diverticulitis rates were 9.6% and 2.7% after OCR and LCR, respectively (3 vs. 1, p = 0.73). CONCLUSIONS: Inadequate sigmoid resection should prompt diligence to take down the splenic flexure placing the distal anastomotic margin on the rectum to ensure adequate surgery.

Anastomosis, Surgical↗
PubMed1998

Morbidity of thyroid surgery.

BACKGROUND: Morbidity is today's concern in thyroid surgery. The purpose of this paper was to quantify risk factors' contribution to morbidity rates. METHODS: During 50 months, 1,163 patients undergoing 1,192 thyroidectomies at one hospital were reviewed at follow-up of 8 to 58 months. RESULTS: There was 1 death (0.08%). Wound morbidity included 19 hematomas (1.6%), 3 chyle leaks (0.2%), and 6 abscesses (0.5%). Mean hospital stay was 4.3 days after surgery without drain and 5.3 days with drain (P < 0.01). Temporary and permanent hypoparathyroidism (TH; PH) rates were 20% and 4%. Parathyroid autografting and excision rates were 19% and 9%. TH rates were higher after parathyroid autografting or accidental excision (P < 0.01). There was no correlation between the severity of TH and the number of lymph nodes at neck dissection nor between postoperative serum calcium levels and the number of parathyroids identified at bilateral surgery. Temporary and permanent recurrent laryngeal nerve (RLN) palsy (TRLNP; PRLNP) rates were 2.9% and 0.5% (0.3% of 2,010 RLNs at risk). PH and TRLNP (not PRLNP) rates were higher after completion or total thyroidectomy with node dissection (P < 0.01). TRLNP and PRLNP rates after RLN exposure and after nonexposure were not statistically different. Surgical volume had no bearing on hematoma, abscess, TH, PH, TRLNP, and PRLNP rates. CONCLUSIONS: High surgical volume, identifying parathyroids and RLNs, failed to reduce morbidity. Completion and total thyroidectomy with node dissection increased PH and TRLNP (not PRLNP) rates.

Adolescent↗
PubMed1998

Eye movement abnormalities in myotonic dystrophy.

We studied saccade and smooth pursuit eye movements in 31 patients suffering from myotonic dystrophy (MD). On the basis of mean value comparisons, saccades were slower and hypometric and smooth pursuit eye movements performed worse in MD patients than in controls. On an individual basis, saccade duration was prolonged in 67.7%, saccades were hypometric in 19.4%, saccade latency was delayed in 9.7%, and the smooth pursuit performance index was decreased in 9.7% of patients. Eye movement abnormalities did not correlate with those detectable by visual, brain-stem auditory and somatosensory evoked potentials. We attempted to classify eye movement abnormalities as myogenic or neurogenic on the basis of differences in combination of eye movement abnormalities and the occurrence of D5/D35 dissociation; the latter consists of a prolonged duration for large (35 degrees) but not for small (5 degrees) saccades. Since D5/D35 dissociation occurred in 26/33 multiple sclerosis patients with increased saccade duration, we considered it to be a neurogenic pattern attributable to a central nervous system (CNS) dysfunction. A prolonged duration without dissociation especially in combination with saccade hypometria, is interpreted as a myogenic pattern, although the lack of dissociation may also occur with CNS impairment in case of a marked increase in saccade duration. Accordingly we classified the oculomotor abnormalities detected as neurogenic in 11 MD patients and as myogenic in another 10, but in some subjects belonging to the second group concomitant CNS impairment is not to be excluded.

Adolescent↗