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Biomedical subjects

R Iorio

Publications and source records attributed to R Iorio.

81 records · Page 5Linked to original sources
PubMed1988

Chronic hepatitis in childhood: the spectrum of the disease.

During a multicentre study of chronic hepatitis in childhood diagnosed by biopsy, the spectrum of the disease has been evaluated in 196 consecutive patients, including 157 from Northern Italy and 39 from Southern Italy. Only 31% of patients in the former group and 27% in the latter were symptomatic when first seen: the majority of cases being seen after familial screenings for hepatitis B virus (HBV) markers or during intercurrent infections, thus suggesting that the frequency of chronic hepatitis in childhood might be largely underestimated in our area. In Southern and Northern Italy 83% of symptomatic and 95% of asymptomatic patients were hepatitis B surface antigen (HBsAg) positive in serum; only 15 (8.3%) of these children were born to mothers known to be HBsAg positive at delivery, but a high circulation of HBV was found in their families: in fact more than 65% of household contacts in Northern Italy and more than 90% in Southern Italy had serological evidence of past or ongoing HBV infection. These data indicate that, although familial screenings for HBV could have enhanced the percentage of HBsAg positive asymptomatic cases, chronic hepatitis in Italian children is mainly caused by HBV infection acquired in the familial setting through horizontal transmission. Such findings also emphasise the importance of mass vaccination of infants as the most effective means to prevent chronic type B hepatitis in childhood in our area. Among HBsAg positive children 55% had histological features of chronic active hepatitis and 85% were hepatitis Be antigen (HBeAg) positive in serum. Anti-HBe positive hepatitis was significantly more frequent in Southern than in Northern Italy in parallel with the significantly higher prevalence (17%) of hepatitis delta virus infection in that area. Of the 16 HBsAg negative cases included in the study three had autoimmune hepatitis, three Wilson's disease, one alpha1 antitrypsin deficiency, and nine had cryptogenic hepatitis, often associated to mild liver lesions resembling those seen in our adult patients with chronic non-A, non-B hepatitis unrelated to percutaneous exposure.

Adolescent↗
PubMed1983

Positive airway pressure in patients receiving intermittent mandatory ventilation at zero rate. The role in weaning in chronic obstructive pulmonary disease.

Over a 20-month period, we treated 180 mechanically ventilated patients in our respiratory intensive care unit. Among these patients, we observed an interesting previously unreported phenomenon in 20 patients with severe chronic obstructive disease. During the weaning from mechanical ventilators of these 20 patients, there was a marked clinical deterioration when the mode of ventilation was changed from intermittent mandatory ventilation (IMV) at zero rate to that of a T-tube setup. To explain this previously unreported observation, we studied and compared nine different intubated patients for possible differences in airway pressure between IMV set up at zero rate and a T tube. We observed that peak airway pressures were greater on IMV at zero rate compared to the peak airway pressures on the T piece in all nine patients. At the end of expiration, seven out of the nine patients had higher airway pressures on IMV at zero rate compared to the T tube. These differences in the peak airway pressures and end-expiratory pressures were statistically significant in both groups. In spite of the obvious limitation of extrapolating the experimental results obtained in one group of patients to explain the clinical observations made in another group of patients, we believe that the higher airway pressures on the IMV system (even without any mechanical ventilation) prevent early collapse of the airways, and this may be of significant importance in successfully weaning patients with COPD.

Humans↗
PubMedDate not supplied

Athletic activity after joint replacement.

The first decade of the 21st century has been declared the "Bone and Joint Decade" by 35 nations and 44 states in the United States as of March 2001. It is not surprising that Americans are interested in musculoskeletal disease and the treatment of bone and joint disorders because our population is aging, the prevalence of arthritic joints is increasing, and senior Americans are demonstrating a strong desire to stay active in activities of daily living and athletics. One of the most successful treatments for painful arthritic joints, which limit activity, is total joint replacement, which predictably relieves pain and improves function. Much has been written about the technical aspects of total joint arthroplasty. Less has been written about safe and appropriate activities for patients who have had joint replacement operations. This article evaluates athletic activity after joint replacement by reviewing the orthopaedic literature and surveying members of The Hip Society, The Knee Society, and The American Shoulder and Elbow Surgeons Society. The authors have developed consensus recommendations for appropriate athletic activity for patients who have had joint replacement operations. This article is intended to serve as a guide for orthopaedic surgeons and primary care physicians who give patients recommendations for athletic activity after joint replacement. This article is also intended to stimulate further research in the area of athletic activity after total joint arthroplasty.

Arthroplasty, Replacement↗
PubMedDate not supplied

Reconstruction of the anterior cruciate ligament with the tendons of the semitendinosus and gracilis doubled: a comparison with reconstruction using the patellar tendon.

A total of sixty consecutive cases of anterior chronic laxity of the knee the pre- and intraoperative features of which corresponded to the criteria of inclusion considered, hospitalized in our institute between September and December 1998 and submitted to reconstruction of the ACL were reviewed at a follow-up of 74 months. The series was made up of two groups that were homogeneous in terms of sex, age, degree of preoperative laxity and number and type of associated meniscal lesions; in the first group (20 cases) reconstruction was carried out using the patellar tendon (BPTB) and in the other (40 cases) the doubled semitendinosus and gracilis tendons (DGST) were used with the association in cases with greater rotatory laxity (20 cases) of peripheral reinforcement reconstruction. An accelerated rehabilitation protocol was used in the first group, a more prudent one with immobilization in extension for two weeks was used in the second group. The results, evaluated based on the IKDC form, appeared to be better in the DGST group, with a statistically significant difference; joint stability, evaluated at follow-up with a KT1000 arthrometer also proved to be better in the DGST group, with a difference that was not statistically significant. The present study seems to show that reconstruction of the ACL with DGST, a prudent rehabilitation protocol and peripheral reinforcement reconstruction in selected cases is capable of providing better long-term results as compared to standard reconstruction with the patellar tendon and accelerated rehabilitation protocol. Among methods used to reconstruct the anterior cruciate ligament (ACL), those that utilize the central third of the patellar tendon (BPTB) or the semitendinosus and gracilis tendons (DGST) continue to be those used most frequently. Although the debate between orthopedics is still going on as to which of the two methods is to be preferred, studies that compare the two methods do not seem to report essential differences in medium-term results. In a recent meta-analysis of the most important international literature, to this regard Freedman et al. concluded that despite a significant major presence of anterior pain reconstruction with BPTB is capable of guaranteeing better joint stability and patient satisfaction, with a minor incidence of transplant failure. Nonetheless, if methods of reconstruction with BPTB seem to be rather standardized in terms of the method used to obtain the specimen and that used for stabilization (with very few differences between interference screws and transverse stabilization), and in postoperative rehabilitation (so-called accelerated), when DGST is used there are many technical variables capable of influencing the final results (choice of methods of stabilization, postoperative rehabilitation in particular). For this reason we still cannot obtain an absolute comparison of the two methods, but can only compare reconstruction with BPTB and a particular method used with DGST. It is the purpose of this study to present the medium-term results not so much of ACL reconstruction with the semitendinosus and gracilis doubled, but as a more articulate approach to the pathology of the ACL, so that DGST is only one phase, even if it is the most important one. Because we wished to verify whether it is possible, even in terms of joint stability and patient satisfaction, to improve the results of the so-called gold standard for reconstruction of the ACL, reconstruction by BPTB with transverse femoral reconstruction and accelerated postoperative rehabilitation protocol was chosen as a term of paragon.

Adult↗
PubMedDate not supplied

[Neonatal cholestasis: the viewpoint of the pediatrician].

The heterogeneous nature of the diseases causing neonatal cholestasis, and the wide range of overlap among the specific entity frequently create serious challenges in their diagnosis. Moreover, the spectrum of correlated nutritional abnormalities in children with chronic cholestasis dictates a complex approach to their management. Nevertheless, pediatricians should be aware of the importance to recognize rapidly a specific treatable metabolic, infectious or malformative disease, in order to institute an early, specific, and effective treatment. However, despite all the still unanswered questions, in the last few years a tremendous progress has been achieved in the development of instruments and clinical procedures for diagnosis and therapy. Moreover, since orthotopic liver transplantation has been accepted as the treatment of choice of end-stage disease, a great deal of interest has been focused on the modalities of intervention applicable during progression of the disease. In this regard, nutritional support plays an increasing important role, since improved growth of these infants has a direct impact on their survival and suitability as candidates for liver transplant surgery. In the present article, Authors make an up-to-date of the main problems correlated with the diagnosis and management of chronic cholestasis.

Cholestasis↗