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Biomedical subjects

R Manfredi

Publications and source records attributed to R Manfredi.

At least 127 records · Page 7Linked to original sources
PubMed1998

[Dynamic pancreatography with magnetic resonance after functional stimulus with secretin in chronic pancreatitis].

AIM OF THE STUDY: Magnetic Resonance pancreatography (MRP) was performed before and after the intravenous injection of secretin to assess the improvement in pancreatic duct visualization and to perform a dynamic study of the pancreatic exocrine function. MATERIAL AND METHODS: 20 MRP examinations were performed in 18 patients with suspected or known chronic pancreatitis. Coronal T2-weighted half-Fourier SSFSE images were obtained with a phased array surface coil. Images were obtained before and up to 10 minutes after the injection of 1 cu/kg b.w. secretin. Quantitative image analysis included main pancreatic duct enlargement over time after secretin injection and the amount of duodenal filling. Qualitative image analysis included: overall image quality improvement, number of pancreatic duct segments visualized, secondary ducts dilation, intraductal filling defects, the presence of pancreas divisum. RESULTS: After secretin injection the overall image quality was judged sufficient in 2 patients and satisfactory in 18 patients. The number of pancreatic duct segments visualized increased from 40/57 (79%) to 57/57 (100%); secondary ducts were visualized in 4 patients before secretin compared to 18 after secretin. The number of stenosis visualized increased from 6 to 9, while intraluminal filling defects increased from 2 to 6. Pancreas divisum was detected in 2 patients after secretin versus 0 before secretin. The main pancreatic duct enlargement was statistically significant in the head of the pancreas (p < .05). Duodenal filling was normal in 13 patients and decreased in 7. DISCUSSION AND CONCLUSIONS: Secretin injection extends the capabilities of MRP in visualizing the morphologic features of pancreatic ducts. The depiction of pancreatic ducts, stenosis, filling defects and pancreas divisum was improved after secretin injection. The exocrine function of the pancreas can be evaluated analyzing the entity and the timing of the duodenal filling.

Acute Disease↗
PubMed1998

[AIDS and opportunistic visceral mycoses. A diagnostic and therapeutic update].

Candidiasis, cryptococcosis, aspergillosis, histoplasmosis, and coccidioidomycosis are the most commonly recognized visceral mycoses complicating the course of HIV infection and AIDS. Their current management issues are discussed on the ground of the personal experience, and the most recent literature evidences.

AIDS-Related Opportunistic Infections↗
PubMed1997

Fluconazole as prophylaxis against fungal infection in patients with advanced HIV infection.

BACKGROUND: There is limited information regarding the usefulness of primary antifungal prophylaxis in patients with advanced human immunodeficiency virus (HIV) disease. OBJECTIVE: To evaluate the efficacy and safety of oral fluconazole treatment for the prevention of systemic fungal diseases related to the acquired immunodeficiency syndrome. METHODS: We evaluated the clinical records of more than 1300 HIV-infected patients followed up for 6 years to identify subjects with a CD4+ lymphocyte count less than 0.20 x 10(9)/L (200/microL) and no prior systemic fungal disease. We compared 128 patients who received oral fluconazole (100 mg/d every third week) with 121 subjects who received no antifungal treatment. MAIN OUTCOME MEASURES: The occurrence of visceral mycoses or death was considered an end point. The frequency of esophageal candidiasis and extrapulmonary cryptococcosis and their related clinical and laboratory features, as well as overall patient survival, were assessed and compared between the 2 study groups. RESULTS: Subjects not treated with fluconazole experienced a significantly higher incidence of systemic mycoses than patients who received fluconazole: 28.4 vs 8.8 cases per 100 patient-years (P < .001). Fluconazole treatment was more effective in preventing esophageal candidiasis than cryptococcosis and was more effective in subjects with a CD4+ cell count less than 0.10 x 10(9)/L. Moreover, fungal complications occurred later and were associated with a significantly lower CD4+ cell count among treated vs untreated patients, while the duration of antiretroviral therapy did not play a significant role. Although mortality rates were similar in the 2 study groups, the fatal outcome of disease was less frequently caused by a fungal disease in subjects who underwent fluconazole prophylaxis. Fluconazole had a favorable tolerability profile. CONCLUSIONS: In our experience, primary fluconazole prophylaxis proved safe and effective in the prevention of systemic candidiasis and cryptococcosis in patients with advanced HIV disease but it did not improve overall survival. Prospective controlled trials are advisable to confirm efficacy, to find the drug of choice and its best dosage and schedule of administration, to identify patient subgroups showing the most favorable cost-benefit ratios, and to evaluate the effects on overall life expectancy and the risk of emergence and spread of antifungal drug resistance.

AIDS-Related Opportunistic Infections↗
PubMed1997

Bacteremia and respiratory involvement by Alcaligenes xylosoxidans in patients infected with the human immunodeficiency virus.

Seven cases of Alcaligenes xylosoxidans bacteremia and/or respiratory disease in patients infected with the human immunodeficiency virus (HIV) are described. Reported only thrice previously in this setting, these bacterial complications occurred during different phases of HIV infection and were associated with leukopenia-neutropenia in four patients and a central vascular catheter in two. Although the majority of cases were diagnosed after day 3 of hospitalization, a distinct source of infection was never identified. In four patients with advanced underlying disease, a polymicrobial infection was present. In vitro resistance to aminoglycosides, first-generation cephalosporins, and aztreonam was identified, but treatment with fluoroquinolones, piperacillin, or an aminoglycoside in combination with either ceftazidime or pefloxacin was successful in all cases. The relevance of Alcaligenes xylosoxidans and related species of gram-negative non-glucose fermenting bacilli as opportunistic pathogens in the immunocompromised host and in the setting of HIV infection is briefly reviewed.

AIDS-Related Opportunistic Infections↗
PubMed1997

Contrast enhancement issues in the MR evaluation of the central nervous system.

Because of its high intrinsic contrast resolution, magnetic resonance imaging (MRI) has largely replaced computed tomography (CT) in the diagnosis of central nervous system (CNS) diseases, and the use of contrast media in MRI of the CNS has increased progressively, gadolinium chelates being, by far, the most used ones. Our paper will focus on the current indications for contrast-enhanced MR imaging of the CNS and will outline the current role and the future trends in contrast medium (CM) administration in the diagnosis of CNS disease. Gadolinium chelates are now routinely employed in MRI of the brain and spine and have been shown to be relatively safe and well tolerated at standard doses of 0.1 mmol/kg b. w. Although there is general consensus on the usefulness of CM administration in MRI of the CNS, some controversy still persists on the type of CM to be used, on the administration scheme, and on the imaging protocol. The current trend is toward selective employment of CM, the effect of which can be enhanced by Magnetization Transfer (MT) techniques, to increase the sensitivity of the procedure. Double or triple doses of CM can be useful in the detection of small parenchymal lesions with faint enhancement, in functional/dynamic studies of the brain parenchyma and in MR angiography. Gadoteridol (ProHance(R)) closely resembles the features of an optimal CM, because it is non-ionic, has a low osmolality and a low viscosity, and may be particularly efficacious when high doses are required.

Central Nervous System↗
PubMed1997

Self-reported health and behavioral problems among adolescent victims of rape in France: results of a cross-sectional survey.

OBJECTIVES: To measure the prevalence rate of rape among French adolescents; to analyze the associated health and behavioral problems; to analyze the use of the health care system by rape victims. METHOD: A national representative sample of 8,140 students attending public secondary schools in France (grades 8 to 12) filled in a self-administered questionnaire (274 questions) on health and behavior problems (acceptance rate = 87%). Each rape victim in the sample (n = 61) was matched to two nonvictims (n = 122). RESULTS: The reported prevalence rate of rape was .8% (.9% among girls, .6% among boys). For both boys and girls, there was a relationship between rape and current sleep difficulties, depressive symptoms, somatic complaints, tobacco consumption, and behavior problems (running away, violent behavior, stealing, and school absenteeism). Additional problems were associated for boy rape victims: attempted suicide, regular use of alcohol and of illicit drugs. Rape victims did consult health professionals, but the majority saw neither a mental health specialist nor a social worker. CONCLUSION: The findings indicate that rape victims, especially boys, have more behavior problems and health problems than nonrape victims. Authors suggest that adolescents who have ran away from home, attempted suicide, or manifested violent behavior should be systematically asked about rape.

Adolescent↗
PubMed1997

Sexual behavior among adolescents reporting chronic conditions: a French national survey.

PURPOSE: To compare sexual behavior in adolescents with a physical handicap or a chronic illness (HCI, n = 604) to a healthy group (HG, n = 7,332). METHODS: Data drawn from a French national health survey carried out among 7,936 adolescents (mean age = 16.2 years) were used. A self-report questionnaire concerning health behavior, sexual behavior, and chronic illness was used in 136 public secondary schools. HCI and HG groups were compared on reported sexual behavior as well as on information (on sexuality, AIDS, and pregnancy) given by the parents. Logistic regression was performed for boys and girls to explore the relationship of health status (HCI or HG) to sexual intercourse, adjusted for sociodemographic variables. RESULTS: Fifty-two percent of HCI boys and 38% of HCI girls reported sexual intercourse (vs. 42% of HG boys and 28% of HG girls). The HCI girls reported more often than HG girls changing partners, pregnancy, and use of oral contraceptives. The HCI boys reported more often than HG boys receiving information on sexuality from their parents. CONCLUSIONS: French HCI adolescents were found to be at high risk for pregnancy and sexually transmitted diseases (STD).

Adolescent↗
PubMed1997

Quantitative cytomegalovirus (CMV) antigenaemia during antiviral treatment of AIDS-related CMV disease.

In order to assess the value of quantitative measurement of cytomegalovirus (CMV) antigenaemia as a marker for the guidance of antiviral chemotherapy in the AIDS setting, 33 patients with CMV complications and showing at least 20 pp65-positive polymorphonuclear leucocytes per 2 x 10(5) cells, received either ganciclovir or foscarnet as induction and maintenance therapy. Antigenaemia was assessed every 1-4 weeks. During acute-phase antiviral therapy, a significant decrease of CMV antigenaemia (>50% of pretreatment levels) paralleled clinical improvement in 2-7 weeks in 32 of 33 subjects. In ten of 24 evaluable patients followed up during a further 4-12 months, disease relapses occurred concurrently with an increase of CMV antigenaemia in seven cases, while three cases of relapsing retinitis did not show a significant increase in antigenaemia. All patients with recurrent disease had a favourable response to further treatment, including halted clinical progression and significant decrease in antigenaemia. In HIV-related CMV disease, periodic monitoring of quantitative CMV antigenaemia proves useful in evaluating response to antivirals, in guiding therapeutic management and in predicting disease relapses.

AIDS-Related Opportunistic Infections↗
PubMed1997

Effects of diagnosis on treatment recommendations in chronic insomnia--a report from the APA/NIMH DSM-IV field trial.

The objective of this study was to determine whether sleep specialists and nonspecialists recommend different treatments for different insomnia diagnoses according to two different diagnostic classifications. Two hundred sixteen patients with chronic insomnia at five sites were each interviewed by two clinicians: one sleep specialist and one nonsleep specialist. All interviewers indicated diagnoses using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV); sleep specialists also indicated diagnoses according to the International Classification for Sleep Disorders (ICSD). Interviewers then indicated how strongly they would recommend each item in a standard list of treatment and diagnostic interventions for each patient. We examined differences in treatment recommendations among the six most common DSM-IV diagnoses assigned by sleep specialists at different sites (n = 192), among the six most common ICSD diagnoses assigned by sleep specialists at different sites (n = 153), and among the six most common DSM-IV diagnoses assigned by nonspecialists at different sites (n = 186). In each analysis, specific treatment and polysomnography recommendations differed significantly for different diagnoses, using either DSM-IV or ICSD criteria. Conversely, different diagnoses were associated with different rank orderings of specific treatment and diagnostic recommendations. Sleep specialist and nonspecialist interviewers each distinguished treatment recommendations among different diagnoses, but in general, nonspecialists more strongly recommended medications and relaxation treatments. Significant site-related differences in treatment recommendations also emerged. Differences in treatment recommendations support the distinction between different DSM-IV and ICSD diagnoses, although they do not provide formal validation. Site-related differences suggest a lack of consensus in how these disorders are conceptualized and treated.

Adolescent↗
PubMed1997

Potential benefit of acyclovir for chickenpox acquired from household contacts. The Italian Acyclovir-Chickenpox Study Group.

As a part of a trial of acyclovir treatment of chickenpox in otherwise healthy children, the assessment of disease features and evolution showed a significantly more severe clinical picture at onset in the 215 patients with intrafamiliar exposure to varicella, compared with the remaining 486 with community-acquired infection, although the disease course proved similar by the third day of antiviral therapy. Children with household exposure to varicella are likely to suffer from a more severe disease, and might especially benefit from acyclovir treatment.

Acyclovir↗
PubMed1997

[Bacteraemia in patients with HIV disease: aetiological spectrum and profile of antimicrobial susceptibility].

A retrospective survey of non-opportunistic bacterial pathogens isolated from blood cultures of patients with HIV disease has been carried out for a 6-year period, and the antibiotic susceptibility of the 748 microorganisms cultured from 682 consecutive patients, has been evaluated. Gram-positive organisms significantly prevailed over gram-negative ones, with Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus faecalis, Xantomonas maltophilia, Salmonella and Pseudomonas sp. as the most common isolates, and Rhodococcus equi, Serratia, Acinetobacter and Alcaligenes sp. as emerging pathogens. Useful suggestions may be obtained for empiric antimicrobial treatment of suspected sepsis in HIV-infected patients, from the evaluation of the antibiotic susceptibility profile of these non-opportunistic bacterial pathogens.

English Abstract↗
PubMed1997

[Septic arthritis in the setting of HIV disease. A case report and literature review].

A case of septic arthritis due to Haemophilus influenzae is described in a HIV-infected patient. Even though complicated by large effusion and extensive subcutaneous involvement, the clinical picture showed a favourable outcome after prolonged ceftriaxone treatment, leading to complete cure. The case report is discussed with respect to both other bacterial complications caused by H. influenzae in the setting of HIV disease, and the broad aetiological spectrum of HIV-associated acute arthritis. In particular, no other cases of H. influenzae purulent arthritis have been described until now in patients with HIV disease, at our best knowledge.

English Abstract↗
PubMed1997

[A case report of Listeria monocytogenes infection in a patient with AIDS. Efficacy of treatment with cotrimoxazole associated with rHuG-CSF (filgrastim)].

Listeriosis is an emerging opportunistic infection in the immunocompromised host. A case of sepsis due to Listeria monocytogenes in a patient with advanced HIV infection and severe neutropenia, treated for an underlying non-Hodgkin's lymphoma, is described. Therapy with cotrimoxazole associated with rHuG-CSF (filgrastim) led to a rapidly favourable clinical and microbiological outcome, and to the correction of concurrent neutropenia. The case report is discussed according to a literature review of all cases of listeriosis reported until now in the setting of HIV infection and AIDS. In particular, the role of both cotrimoxazole and rHuG-CSF adjunct in the treatment of listeriosis in the immunocompromised patient is focused.

English Abstract↗