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Biomedical subjects

R Manfredi

Publications and source records attributed to R Manfredi.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

[Medicolegal aspects of chronic alcoholism. Considerations on the behavior of 285 chronic alcoholics].

The Authors examined 285 male sex chronic alcoholics hopitalised in the Psychiatric Clinic of Parma University from 1969 to 1974. Clinical diagnosis, family anamnesis, degree of learning, civil status, beginning of abuse of alcoholics were considered. The Authors then, made a research at the Criminal Court records-office to verify how many of these alcoholic patients had committed crimes, what kinds, how many, related particularly to single subject's personality.

Adolescent↗
PubMedDate not supplied

Diagnostic imaging in lower limb atherosclerosis.

At present, there are a number of diagnostic imaging procedures for the evaluation of lower limb atherosclerosis. In particular, MR-angiography with contrast medium and multislice CT are rapidly developing. However, their role in clinical practice is still to be defined. In this article, first, the functional anatomy of peripheral arterial system divided into inflow arteries (aortoiliac trunk), outflow arteries (femoropoplietal trunk) and runoff arteries (leg and foot vessels), is examined. Then, image extraction with color-Doppler US, inflow MR-angiography with contrast material, multislice CT and angiography is briefly illustrated. The corresponding advantages and disadvantages, are indicated. The findings of combined imaging in relation to the various stages of atherosclerosis are analyzed. In particular, intimal thickening leading to occlusion is considered with respect to both morphology and flow alterations. Based on these considerations, the use of the different procedures is discussed in relation to the clinical presentation (no symptoms, claudication or pain, trophic lesions, during postoperative follow-up). For each stage, questions the radiologist should address for a correct approach and the best cost/benefit ratio, are described.

Arteriosclerosis↗
PubMedDate not supplied

[Long-term asymptomatic incubation in vertical HIV infection. Description of a case and review of the literature].

The natural history of HIV infection in perinatally-infected children is still poorly defined; more information about disease progression is needed for the design of clinical and therapeutic trials. According to the most recent reports, vertically-acquired infection seems to follow two different modes of progression, with the majority of patients expressing early signs of severe disease, whereas a subgroup of mildly affected infants has a longer survival, comparable to that previously reported for adults: the long term prognosis of this last patient group remains unknown. Current estimates of incubation periods in children are based on limited data, largely drawn from ill patients: hence subjects with a short incubation time are more likely to be observed. A case is described of a child born in 1982 to an asymptomatic intravenous drug abuser mother. HIV infection was detected in both mother and son only in 1984, but other risk factors for HIV infection of the infant (i.e. blood transfusions, sexual abuse) were excluded. The child had an uneventful neonatal period and childhood, with normal growth and development; up to now, at the age of 9 years 6 months, no clinical signs and symptoms possibly related to HIV infection became evident. Laboratory examinations showed only slight immunologic abnormalities (class P-1 B, CDC), such as increased serum immunoglobulin levels, reduction of CD4+/CD8+ ratio with no relevant decrease of absolute CD4+ lymphocyte count (1100/mm3); HIV-p24Ag and virus isolation were always negative.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

[Clinical and diagnostic approach to children of low stature. Evaluation of a 24-month hGH treatment of patients with growth impairment of diverse etiopathogenesis].

Growth retardation represents a frequent reason of consultation of Clinical Centers interested in Pediatric Endocrinology. Short stature is a problem especially considered by patients and their families, either because of fear of organic pathologies possibly underlying growth retardation, or because of psychological implications, frequently related to growth retardation and short stature. The Authors describe their clinical and diagnostic approach to short stature; general data from 302 patients followed and treated for growth delay are presented. Clinical experience with recombinant growth hormone (hGH) is discussed in detail: a total of 61 prepuberal children (9 with classic GH deficiency, 26 with partial GH deficiency, 18 with neurosecretory deficit, 6 "short normals", one patient with Turner's syndrome and one case of skeletal dysplasia) have been treated with hGH for a period ranging from 12 to 24 months. Height velocity (expressed as cm/year) increased significantly in all considered groups during the first and the second year of treatment, while considering standard deviation values for chronological age, all treated subjects increased significantly their stature after one year of therapy, but only patients with total GH deficiency appeared to obtain a significant gain after a 2-year course with hGH. No significant adverse effects attributable to hGH administration were observed.

Child↗
PubMedDate not supplied

A new syndrome of long-term idiopathic, severe CD4+ lymphocytopenia: isolated paraparesis and conjunctival ischemic microangiopathy.

An extraordinary case report of an adult patient followed-up for a decade with an extremely severe idiopathic CD4+ T-lymphocytopenia (as expressed by an absolute CD4+ count of 8-25 cells/microL), associated with an isolated paraparesis and a conjunctival ischemic microangiopathy is described, and discussed on the grounds of the available literature. Despite such a severe and prolonged immunodeficiency, no opportunistic disease occurred, in a observation period longer than ever reported to date. The neurological disorder was diagnosed concurrently with idiopathic CD4+ lymphocyte depletion, while the ocular complication occurred two years later, but remained stable thereafter. Both disorders remained stable during the subsequent eight years. Despite extensive and repeated instrumental and laboratory workout, only very limited immunological abnormalities were detected (besides the extremely low CD4+ lymphocyte count), and no apparent explaination was found for the disabling paraparesis syndrome. Idiopathic CD4+ lymphocytopenia, whose pathogenesis deserves careful investigation, has been associated with a very broad spectrum of signs and symptoms, ranging from negligible or no disturbances, to severe lymphoproliferative disorders, different opportunistic infections, and other focal diseases, including neurological pathologies. However, the association of a long-lasting profound peripheral CD4+ lymphocyte depletion in absence of any opportunistic infection or neoplasm, and isolated paraparesis and conjunctival microangiopathy, represents an absolutely unique finding, especially due to the apparently stable course of the above-mentioned syndrome.

Adult↗
PubMedDate not supplied

[Chronotherapy of tenoxicam].

A study was carried out in order to investigate the chronotherapy (dosing time dependency) of an NSAID, the tenoxicam administered in ankylosing spondylitis, rheumatoid arthritis and osteoarthritis of the hip. These variations in efficacy exist as much for pain as for stiffness and maximum efficacy is obtained with administration at 8 am or 12 pm. Since the tolerance was good, we recommend midday as an optimal once-a-day dosing time.

Adult↗
PubMedDate not supplied

Combined modality staging of high risk rectal cancer.

The personal experience with the radiologic staging of high risk rectal cancer undergoing preoperative treatment is reported. 61 patients shown to be affected by locally advanced (T3-T4, N+with any T) rectal tumors on combined modality staging, underwent restaging 4-5 weeks after treatment. In all patients liver US, pelvic CT and colorectal enema were performed before and after treatment. In 22 patients with low rectal cancer transrectal sonography was performed. In 19 patients pelvic MRI was performed. The 61 patients were considered operable on second staging and thus referred to surgery. Subsequent control on histology has confirmed the diagnostic accuracy of the single procedures and of their combination. US was shown to be of high accuracy in the evaluation of T (90.8%) and of high predictive value for N. CT accuracy (84%) and MRI accuracy (78.9%) was lower because both tend to overstaging in the evaluation of T of rectal tumors undergoing preoperative treatment. Low CT accuracy (64%) and MRI accuracy (58%) was observed for N. There was optimum agreement between histology and imaging in the assessment of tumor shrinkage, well visualized by rectal enema which supported combined restaging with 88% accuracy for T.

Combined Modality Therapy↗
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Staging rectal cancer with magnetic resonance imaging: methodology, signs and parameters.

Magnetic Resonance Imaging is a rapidly developing procedure suitable for rectal cancer staging. Initial results are extremely encouraging in T staging while at present this is not so in N staging. MRI is useful in the differentiation between stage T2 and T3 because images can be obtained in multiple planes, tissue contrast is high and thus scans are always perpendicular to the tumor base. However there is a trend to overstaging of rectal cancer frequently due to the concomitant perirectal inflammatory reaction. In a near future, the extensive use of surface coils will certainly increase spatial resolution with consequently improved accuracy.

Humans↗
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[The incidence, etiology and clinical significance of visceral mycoses in patients with AIDS].

The incidence, aetiology and clinical significance of visceral mycoses in HIV-infected subjects were evaluated by a retrospective survey of the clinical and microbiological records of 237 consecutive AIDS patients followed-up since 1984. Seventy-four patients out of 237 (31.2%) (56 males, 18 females; 55 IV drug abusers, 7 heterosexuals, 6 homobisexuals, 3 blood recipients and 3 children with congenitally-acquired HIV infection) presented 77 different episodes of visceral fungal infection as a whole, represented by candidiasis in 56 cases (oesophageal 45, pulmonary 5, sepsis 2, eye involvement 2, endocarditis and invasive oropharyngeal infection in the remaining 2 patients), cryptococcosis in 17 cases (meningoencephalitis in all subjects, with disseminated infection in 11 of them), and aspergillosis in 4 cases (pulmonary 2, cerebral and cranio-facial in the remaining 2 patients). In 57 out of 74 patients (77%), visceral mycoses were diagnostic or concurrent with the diagnosis of AIDS. Fungal diseases, as a whole, showed a significantly higher incidence (p < 0.03) among drug abusers, whereas homobisexual men presented a significantly lower frequency (p < 0.001, chi-square test) than AIDS patients with other risk factors for HIV infection. The onset of cryptococcosis was significantly associated with the male sex (p < 0.005, Fisher exact test). All subjects suffering from a visceral mycosis were severely immunosuppressed, with a higher rate of neutropenia in patients developing Candida and Aspergillus spp. infection (23 out of 56 patients with visceral candidiasis and 3 out of 4 cases of aspergillosis had an absolute neutrophil count lower than 1500 cells/mm3), while a severe reduction in CD4+ lymphocyte count was more evident among patients with cryptococcosis (13 out of 17 patients had a CD4+ cell count lower than 50/mm3). After remission of the primary episode of fungal infection (obtained in 80.5% of cases), the incidence of relapse observed in a long follow-up period (mean time 57.6 +/- 39.2 weeks) was elevated both for patients with cryptococcosis (7 cases out of 17) and subjects with candidiasis (19 cases out of 53), with no significant difference among patients receiving a secondary prophylaxis or not (22 relapses observed in 53 patients treated with maintenance antifungals versus 4 episodes in 8 patients followed for a comparable mean time with no antimycotic treatment). Fifty-two out of 74 patients (70.3%) have died up to now; in 21 of them death was due to or associated with the visceral mycosis (cryptococcosis in 11 cases, candidiasis in 8, aspergillosis in 2).(ABSTRACT TRUNCATED AT 400 WORDS)

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Liver toxoplasmosis and acquired immunodeficiency syndrome.

We report two rare cases of acute toxoplasmic hepatitis in patients that were serum positive for Human Immunodeficiency Virus (HIV) infection. Although Toxoplasma gondii is the main causative agent in infections of the central nervous system (CNS) in patients with AIDS and is known to cause widely disseminated infection in this clinical setting, few reports exist documenting involvement of the liver in these patients.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Chickenpox complications among immunocompetent hospitalized children in Italy. Acyclovir-Chickenpox Italian Study Group.

OBJECTIVE: To evaluate the frequency and clinical spectrum of chickenpox complications among immunocompetent hospitalized children. PATIENTS AND METHODS: Multicentre retrospective study of clinical records of all patients consecutively hospitalized for varicella during the last decade, in ten tertiary care clinical centres of Pediatrics and Infectious Diseases, throughout Italy. RESULTS: Two hundred and nineteen out of 991 patients (22.1%) hospitalized for varicella suffered from a complicated disease (247 complicating events on the whole). Central nervous system (CNS) involvement was prevalent (104 episodes), followed by skin/soft tissue infections, lower respiratory tract involvement, and thrombocytopenia. A complicated disease was significantly associated with the male gender and an elevated incidence of varicella-zoster (VZ) virus infection acquired by household contacts. The involvement of lower respiratory airways and skin/soft tissues seemed to occur at an earlier age, compared with CNS and thrombocytopenia. Moreover, lower respiratory tract and skin/soft tissue infections occurred earlier during disease course than complications interesting the CNS and coagulation system. All subjects with complicated chickenpox showed a favourable outcome within 5-40 days, except two patients developing a lethal cardiomyopathy and Reye syndrome, respectively. Anyway, chickenpox complications led to a prolonged hospitalization, and needed further pharmacologic treatment in all evaluated cases. The administration of anti-VZ virus treatments (i.v. acyclovir or VZ immunoglobulins) did not modify significantly the course of disease in treated patients, when compared with untreated ones. CONCLUSIONS: Although chickenpox is considered a self-limiting, uncomplicated disease in immunocompetent children, when assessing hospitalized patients a considerable incidence and a broad spectrum of complications are observed, requiring prolonged admission and pharmacologic and supportive care. Even though a lethal outcome remains a rare occurrence, it may be of relevant concern when considering the overall incidence of chickenpox in the general population. The role of an early antiviral treatment in reducing the incidence and severity of varicella complications deserves further evaluation.

Acyclovir↗
PubMedDate not supplied

Color Doppler US of intrahepatic vascular system.

Aim of this article is an up-dating of the state of the art of color Doppler US in the assessment of intrahepatic vascularization. Recent reports are reviewed, based on already acquired certainties to better the knowledge of the physiology and pathophysiology of hepatic circulation to investigate new clinical applications of color Doppler US.

Hepatic Artery↗
PubMedDate not supplied

Functional radiology of the liver: magnetic resonance imaging.

Magnetic Resonance (MR) images sensitive to the flowing blood are defined as images of MR angiography. Proton movement within a magnetic field modifies both the intensity and the phase of Nuclear Magnetic Resonance (NMR) signal; two techniques of MR angiography are thus distinguished: (TOF) the "time of flight" (intensity) and the "phase-contrast" (phase) technique. In the time of flight MR angiography the blood may appear as hypointense or hyperintense compared to stationary tissues. Blood hypointensity in vessels is due to the flow void phenomenon while hyperintensity is due to the phenomenon of flow-related enhancement. In phase contrast MR angiography, protons moving within a magnetic field modify their phase directly proportional to the displacement velocity and gradient intensity. Moreover, MRI allows noninvasive measurement of blood flow. Flow velocity is measured with TOF sequences or phase-contrast sequences. In TOF sequences quantitative measurement is performed with the bolus tracking procedure. In contrast-phase sequences the velocity is measured based on the extent of signal phase modification induced by the proton displacement velocity. The recent use of liver-specific contrast media supplies information on parenchymal liver function.

Blood Flow Velocity↗
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New perspectives on the clinical applications of functional radiology of the liver.

Preliminary results of "new clinical applications" of functional imaging of the liver are reported. In 20 healthy volunteers portal flow measurement with Doppler US at the level of right, left portal branch and main portal trunk, showed the preferential distribution in baseline conditions of portal flow to the right liver (about 68%) as compared to the left portal branch. This influenced MRI volumetry of right liver as compared to left liver. After meal intake, flow increase was significantly higher at the level of left portal branch suggestive for a "functional reserve" in left liver. Portal flow physiology was examined in preparation of portal imaging before and after portal vein embolization, a procedure performed preoperatively before enlarged hepatectomies.

Diagnostic Imaging↗
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[Integrated diagnosis of liver angioma: comparison of Doppler color ultrasonography, computerized tomography, and magnetic resonance].

Hemangiomas are the most frequent benign tumors of the liver which are diagnosed at clinics only when they are very big. Their differentiation from primary or secondary liver tumors is a very difficult step. To investigate the capabilities of color Doppler US, CT and MRI in characterizing liver hemangiomas, we retrospectively examined 27 patients with 35 hemangiomas of the liver, all identified with US from January, 1995, to March, 1996, plus 26 patients with color Doppler US, 23 with dynamic CT and 19 with MR findings; 16 patients had been examined with all imaging techniques. Our gold standard was red blood cell SPECT in 16 patients, clinical-diagnostic follow-up in 8 and surgical specimens in 3 patients. Morphological data, the number, size and segmental site were investigated for all lesions. Doppler US was used to study the qualitative and quantitative data of intralesional color patterns, according to a modified Tanaka's classification, and of intralesional max, systolic velocity and pulsatility index (PI). Dynamic CT was performed with the polyphasic technique, that is unenhanced scans followed by selective, dynamic sequential and delayed scans. Morphological data and dynamic time/density curves of lesion/parenchyma were studied. MRI was performed at 0.5 T with T1-weighted SE (TR/TE 280/18), T2-weighted SE (TR/TE 2000/45-90-120) and T2-weighted fast SE (TR/TE 5000/160) sequences. Dynamic T1-weighted GE sequences were performed after Gd-DTPA bolus injection, using the same times as those of dynamic CT. US showed 1.3 lesion/patient, while CT and MRI showed 1.5 and 1.7 lesion/patient, respectively. No differences were observed in lesion size with the three imaging techniques and there was 78% agreement on segmental site. As for morphological patterns, US had 46% sensitivity, considering medium-small lesions only. Intralesional color signals, with spot and branch patterns, were seen in 6/20 lesions (mean phi; 8.4 cm), with a mean intralesional systolic velocity of 0.30 m/s (1.46 KHz); mean intralesional PI value was 0.83. Color Doppler sensitivity was 23%. Combined B-mode and color Doppler US had 69% sensitivity. The typical CT pattern (ring or globular enhancement with centripetal progression and late hyperdensity) had 66% sensitivity. Hyperintensity on T2-weighted images had 96% sensitivity; Gd-DTPA MRI combined with dynamic CT had 100% sensitivity. In conclusion, the US findings of a suspected hemangioma should be diagnostically integrated with MR studies to make the correct diagnosis.

Adult↗