Biomedical subjects
Publications and source records attributed to R D'Alessandro.
Eighteen myasthenic patients have been operated on under general anaesthesia; 14 subjected to thymectomy and 2 to emergency procedures (caesarean section and laparotomy because of intestinal obstruction). Atracurium (0.3 mg/kg) and vecuronium (0.06 mg/kg) exhibited a long duration of action only in the two cases affected by the more severe signs and symptoms of the disease.
Twenty six asymptomatic patients with internal carotid artery occlusion had ultrasound follow-up for a mean period of 34.3 months. During follow-up 3 patients (11.5%) reported transitory ischemic attacks (TIAs), one of these (3.8%) occurred in the vascular territory ipsilateral to the occlusion. There were not strokes. Annual TIA rate was 4% for all vascular territories, and 1.3% for the territory ipsilateral to the occlusion. Annual mortality was 9.4%. Our data on stroke risk in patients with asymptomatic carotid artery occlusion show a good prognosis in the long-term.
Nitrite reductase from Pseudomonas aeruginosa has been successfully expressed in Pseudomonas putida. The purified recombinant enzyme contains haem c but no haem d1. Nonetheless, like the holoenzyme from Ps. aeruginosa, it is a stable dimer (molecular mass 120 kDa), and electron transfer to oxidized azurin is biphasic and follows bimolecular kinetics (k1 = 1.5 x 10(5) and k2 = 2.2 x 10(4) M-1.s-1). Unlike the chemically produced apoenzyme, recombinant nitrite reductase containing only haem c is water-soluble, stable at neutral pH and can be quantitatively reconstituted with haem d1, yielding a holoenzyme with the same properties as that expressed by Ps. aeruginosa (namely optical and c.d. spectra, molecular mass, cytochrome c551 oxidase activity and CO-binding kinetics).
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We performed a study on mortality from motor neuron disease in the province of Bologna, Italy, during the years 1986 through 1988. The study was based on death certificates from the Cancer Registry of the Province of Bologna. We verified death certificates for both false-positive and false-negative cases. The crude mortality rate was 1.93/100,000 population per year. The age and sex mortality rate, standardized on the Italian population, was 1.40/100,000 (95% confidence interval, 1.05 to 1.83). Our figures are higher than those previously reported both as the incidence and as mortality in Italy, but these data are similar to values that have been found in northern Europe and in North America.
We present the clinical and neuroimaging data of 4 patients (mean age: 62 years, range 54-67; mean follow-up: 19.5 years, range: 26 months-29 years) with chronic spastic atrophic hemiparesis (CSAH). Neuroimaging findings were non specific, CT scan and MRI showing white matter lesions located within the centrum semiovale in two cases, parieto-occipital lobe and pons in one case each. This study underlines that patients with CSAH may have a good long-term prognosis. MRI studies may demonstrate associated lesions within the white matter or brainstem and are advisable in all subjects with CSAH, but further studies are necessary to clarify the nature of the observed lesions.
The reaction of the oxidized derivatives of the dimeric (HbI) and tetrameric (HbII) Scapharca inaequivalvis hemoglobins with azide and fluoride has been studied. The two oxidized hemoglobins have specific characteristics. Oxidized HbI consists of a dimeric high-spin aquomet form which is in a pH-dependent association-dissociation equilibrium with a monomeric low-spin hemichrome. In contrast, in HbII the high-spin aquomet derivative is only a transient species that converts itself into a tetrameric hemichrome which in turn dissociates into lower molecular weight forms. The reaction of oxidized HbI with azide and fluoride can be described in terms of a simple reaction scheme which assumes that external ligands bind only to the aquomet derivative. In the case of HbII, the reaction route is the same; however, the situation is complicated by the fact that in the dissociated hemichromes the internal protein ligand can no longer be displaced. Therefore, irreversible processes take place whose relevance depends primarily on the affinity of the external ligand for the ferric heme iron.
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Recently many cases of Lyme disease have been described in Italy. The patients come prevalently from Friuli Venezia Giulia and the eastern Ligurian Coast. Isolated cases have been diagnosed in other parts of northern Italy and in the central regions. We describe the first Sicilian case, concluding that Lyme borreliosis may well be widely distributed in our country.
This cooperative study was performed in the provinces of Bologna and Ferrara to estimate the prevalence rate of Myasthenia Gravis (MG). Two independent groups used the same case collection method and diagnostic criteria. The study was performed from January 1, 1987 to March 1, 1988. Cases were collected through: 1) review of clinical files from neurology clinics in Bologna and Ferrara, and from the main North-Italian centers for MG (neurology clinics of Milan and Turin; thoracic surgery unit, Turin); 2) thoracic surgery and intensive care units in Bologna and Ferrara; 3) physicians prescribing anticholinesterase drugs. Prevalence rates of generalized MG per million population were 60.9 in the city and 41.0 in the remaining province for Bologna and 118.9 in the city and 87.9 in the remaining province for Ferrara. The difference in prevalence rates between the two areas was statistically significant. Our survey shows that prevalence studies on MG may be biased by factors that cannot be controlled and that most previous studies have probably underestimated the prevalence of MG.
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The prevalence, causal origin of and impairments associated with severe mental retardation (SMR) were investigated among all school-age children (six to 13 years) living in the city of Bologna, Italy. 90 children (57 boys, 33 girls) with IQs less than or equal to 50 were identified. The prevalence of SMR was 4.2 per 1000 for males, 2.5 per 1000 for females and 3.4 per 1000 for both sexes. Causal origin was prenatal for 33.3 per cent, perinatal for 14.4 per cent, combined pre- and perinatal for 5.6 per cent and postnatal for 13.3 per cent. Another 12.3 per cent of the children with IQs less than or equal to 50 had autism or childhood psychosis, while there was no evident cause of mental retardation for the remaining 21.1 per cent. 50 per cent had at least one associated physical or neurological impairment other than mental retardation, with epilepsy and cerebral palsy predominating.
The frequency of abnormal findings at neurological examination was analyzed in an unselected sample of elderly people aged 67-87 years. Absent deep tendon reflexes and impairment of proprioceptive sensation rarely occurred in the elderly. Limitation of upward gaze and convergence appear a common finding, especially in the very old. Overall, the presence of cortical disinhibition signs (primitive reflexes and paratonia) did not discriminate well between subjects without CNS disease and demented patients. Only the presence of a prominent and persistent response to the stimulus and the number of cortical disinhibition signs found in the same subject appear useful criteria to distinguish between normality and dementia.
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The only prevalence rate of myasthenia gravis (MG) so far estimated in Italy by an epidemiological study carried out in Pavia, North Italy, indicates a prevalence quite similar to that observed in other countries. The purpose of the survey was to verify the frequency of the disease in a geographically well-defined and previously surveyed community. On the basis of 39 cases, on 31 December 1987 the prevalence per million was 105.3 (102.3 if standardized for the Italian population). This is the highest prevalence figure yet found, indicating a value similar to that established in Northern Europe. According to Kurtzke this high prevalence rate reflects the high standard of the local public health service, which permitted a more intensive search for affected subjects.
An epidemiological survey of the prevalence of snoring and sleep apnoeas was performed on 3479 30-69-year-old men living in Bologna, north-east Italy. First a postal questionnaire was sent. It was returned with appropriate answers by 1170. A 20% random sample of those who did not answer were invited by telephone to return the questionnaire. Among these groups 119 (10%) and 19 (5.6%) respectively answered that they always snored. A random sample of 40 every-night snorers were studied by polysomnography. Based on the frequency of every-night snoring and the results of polysomnography we estimated that the minimal prevalence of sleep apnoea among 30-69-year-old men was 2.7% considering an apnoea + hypopnoea index of 10 or more pathological. According to the Lugaresi classification we had a 2.5% prevalence of heavy snorers' disease (HSD) Stage 1 or higher. These figures indicate that obstructive sleep apnoea during sleep is a major public health problem.
A case-control study was performed to verify the association between the risk factors for cerebrovascular disease and the syndrome of ventricular enlargement with gait apraxia (VEGAS). This syndrome was defined on the basis of clinical and CT criteria alone; however, it may be representative of patients with idiopathic normal pressure hydrocephalus in whom gait disturbance is the initial symptom. Seventeen patients were matched for age and sex with one hospitalised and two general population controls. Among the risk factors considered we found a significant statistical association between VEGAS and hypertension (odds ratio = 3.14; p = 0.032), ischaemic heart disease (odds ratio = 4.20; p = 0.013), ECG ischaemic changes (odds ratio = 3.67; p = 0.029), low HDL-cholesterol levels (odds ratio = 3.75; p = 0.028) and diabetes (odds ratio = 6.00; p = 0.018). Our findings indicate that risk factors for cerebrovascular disease may play a role in the development of VEGAS.