Search PubMed⌕ Search

Biomedical subjects

Roberto Bergamaschi

Publications and source records attributed to Roberto Bergamaschi.

At least 19 recordsLinked to original sources
PubMed2004

Detection of occult liver metastases in colorectal cancer by measurement of biliary carcinoembryonic antigen concentration: a prospective study.

BACKGROUND: It has been suggested that bile CEA levels could be a sensitive index for the detection of occult liver metastases (LM) in colorectal cancer (CRC) patients. The aim of this study was to determine the potential value of biliary CEA assay in the early detection of occult LM from CRC. METHODS: From 1995 to 1999 biliary and blood CEA levels were determined in three groups of patients undergoing surgery; Group 1 (n = 35) patients with LM from CRC; Group 2 (n = 154) patients with CRC without LM; Group 3 (n = 23) was the control group. RESULTS: Biliary and serum CEA levels were significantly lower in group 3 than in group 2 (P = 0.008 and P = 0.002) and in group 2 than in group 1 (P = 0.001 and P = 0.005). With a follow-up of 36 months (group 2), 22 patients (14%) developed LM. For 59 patients, the bile CEA level during laparotomy was less than 5 ng/ml and for 95 patients this level was more than 5 ng/ml, 4 and 18 patients respectively developed metachronous LM; we found a difference (P = 0.03) between these two subgroups. When this analysis was performed with regard to the stage of the tumor, we found no difference for the node negative cancer (n = 79) subgroup (P = 0.6), but we found a significant difference for the node positive cancer (n = 75) subgroup (P = 0.01). CONCLUSIONS: Our data suggest that biliary CEA concentrations at the time of resection of the primary tumor cannot be used to identify patients with occult LM in the node-negative CCR subgroup. However, patients with node-positive CCR and bile CEA level under 5 ng/ml developed LM in only 3% of cases; it might be therefore, possible to use that as a discriminant in situations where the risk of LM is small.

Adenocarcinoma↗
PubMed2004

Clinical characteristics, course and prognosis of relapsing Devic's Neuromyelitis Optica.

OBJECTIVES: To evaluate the clinical characteristics, course and prognosis of Devic's neuromyelitis optica (DNO), to evaluate the prognostic role of demographic and clinical features, to evaluate the current DNO diagnostic criteria. METHODS: Demographic, clinical, CSF and MRI data of patients affected by DNO were collected from fifteen Italian MS centres. Inclusion criteria were: 1) two or more acute episodes of neurological dysfunction indicating involvement of the optic nerve and spinal cord, in a simultaneous or subsequent temporal relationship; 2) no evidence of lesions beyond the optic nerve or the spinal cord; 3) brain MRI at onset negative or non-specific for multiple sclerosis (MS) (white matter lesions < or = 2). Disability was scored by means of Kurtzke's Expanded Disability Status Scale (EDSS). RESULTS: 46 patients with relapsing DNO were included, 37 females and 9 males, with mean age at onset of 40.1 +/- 16.3 years (range 12-77 years). The follow up duration was 8.8 +/- 3.5 years, the mean annualised relapse rate was 1.3 +/- 1.2. After 5, 10 and 15 years EDSS 3.0 was reached respectively by 65%, 82 % and 86% of cases, EDSS 6.0 respectively by 42%, 53 % and 69% of cases, EDSS 10 respectively by 8%, 12% and 23% of cases. The probability of reaching EDSS 3 was statistically correlated with age at onset, interval between the first and 2(nd) attack, and relapse rate. The probability of reaching EDSS 6.0 was correlated with the residual EDSS at onset and to relapse rate. During the follow up, brain white matter lesions appeared in 8 subjects. Spinal cord MRI showed lesions extending across 3 or more segments in 39 subjects, only 1 lesion involving 1 segment in 4 subjects, and was normal in 3 subjects. One or more CSF abnormalities were found at least once in 29/44 patients (65.9 %), the most frequent findings being pleocytosis (38.6 %), oligoclonal bands (34.1 %), high protein level (25 %), and high albumin ratio (20.5 %). CONCLUSIONS: DNO has a poor prognosis in most cases. Compared with MS, DNO patients have a higher age at onset, females are more frequently affected, the course is more severe. Brain and spinal cord MRI permit the differentiation of DNO from MS. CSF supports the probability of DNO if it shows increased cells and proteins.

Adolescent↗
PubMed2004

Fatigue in multiple sclerosis: multidimensional assessment and response to symptomatic treatment.

Sixty relapsing remitting multiple sclerosis (MS) patients were selected on the basis of their score on the Fatigue Severity Scale (FSS) and formed two groups: 40 patients (fatigued MS; MSf) scored above the 75th percentile of a previously assessed representative MS sample (100 patients), and 20 age- and sex-matched patients (nonfatigued MS patients; MSnf) scored below the 25th percentile. The patients underwent clinical evaluation (Expanded Disability Status Scale (EDSS)), further assessment of fatigue (Fatigue Impact Scale), scales evaluating depression (Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI)) and neuropsychological tests. All patients were evaluated for muscle fatigability and central activation by means of a biomechanical test of sustained contraction; they also underwent somatosensory evoked potentials (SSEPs) and transcranial magnetic stimulation (TMS). The patients of the MSf subgroup were then randomized to one of the following two treatments: 4-aminopyridine (4-AP) 24 mg/day and fluoxetine (FLX) 20 mg/day. After a one-week titration this treatment proceeded for 8 weeks. At the end of the treatment, EDSS, fatigue and depression scores were further evaluated. At baseline, fatigue test scores consistently correlated with depression and cognitive test scores, but not with the fatigability test. Fatigue scores decreased in both treatment groups in a similar way. Due to the design of the study, this cannot be disjoined from a placebo effect. The changes of fatigue scores could not be predicted in the FLX group, whereas in the 4-AP group higher basal fatigability test scores were associated with greater reduction in fatigue scores.

4-Aminopyridine↗
PubMed2003

[Do short-term duration drugs for anaesthesia give postoperative advantages compared to traditional drugs?].

BACKGROUND: We wanted to compare totally intravenous anaesthesia with propofol and remifentanil to mixed anaesthesia with isoflurane and fentanyl in terms of postoperative pain, nausea, length of stay and costs. MATERIAL AND METHODS: We present a prospective, non-randomised, anaesthetist-based double-blind study with a cost-utility analysis on consecutive patients undergoing laparoscopic gynaecologic day-care surgery. Premedication consisted of paracetamol and diclofenac. The mixed anaesthesia group received propofol, isoflurane, fentanyl, vecuronium, N2O and O2,the total intravenous group propofol, remifentanil, vecuronium, N2O and O2. Paracetamol and ketobemidon, metoklopramid and ondansetron were given to relieve pain and nausea, respectively. Patients were asked to report pain and nausea on a visual analogue scale after 4 and 24 hours. RESULTS: 26 mixed and 27 totally intravenous patients were comparable by age, body mass index and ASA (American Society of Anesthesiologists) scores. There was a protocol violation, as fewer totally intravenous patients received pre-medication (16/26 vs. 8/27 p < 0.001). Totally intravenous patients had significantly higher consumption of ketobemidon (mean 2.35 vs. 5.43 mg/24 h p < 0.004). Within the totally intravenous group, scores for pain at 24 hours were significantly higher as compared with 4-hour scores (p = 0.012). At 24 hours, scores for nausea were significantly higher for the totally intravenous group (1.87 vs. 3.21 p = 0.014). Length of stay did not differ significantly (mean 649 vs. 729 min p > 0.2). Costs of medication were significantly higher for the totally intravenous group (mean 211 vs 285 NOK p <0.001). INTERPRETATION: The use of totally intravenous anaesthesia led to more nausea and more expenses than mixed anaesthesia in laparoscopic gynaecologic day-care surgery. No recommendations for either method can be made because of the non-randomized design.

Anesthetics, Intravenous↗
PubMed2003

Determinants of recurrence after sigmoid resection for uncomplicated diverticulitis.

PURPOSE: This study aimed to evaluate the impact of surgery-associated variables on recurrence rates after sigmoid resection for diverticulitis. METHODS: Patients who underwent elective sigmoid resection for uncomplicated diverticulitis between 1992 and 2000 at two tertiary referral centers were followed up for recurrent disease as the primary end point. Recurrence after surgery was defined as left lower quadrant pain, fever, and leukocytosis, with consistent CT and/or contrast enema findings on admission and after six weeks. A logistic regression of the following variables was undertaken: patient demographics, duration of preoperative symptoms, previous admissions and abdominal surgery, surgical access (laparoscopic or open), postoperative complications, splenic flexure mobilization, anastomotic technique (handsewn or stapled), specimen length, inflammation at proximal resection margin, and anastomotic level (colosigmoid or colorectal). The last three variables were defined by the pathologist. Anastomosis level was based on muscle layer configuration (taeniae coli) at the distal resection margin. RESULTS: Two hundred thirty-six patients (105 females) with a mean age of 60.4 (standard deviation, +/- 10) years were available for follow-up at 67 +/- 30 (range, 11-130) months. The median duration of preoperative symptoms was 18 (range, 12-120) months. All but one (99 percent) patient had at least one admission before surgery. One hundred forty (59 percent) and 96 (41 percent) patients underwent laparoscopic or open resection, respectively. The conversion rate was 13 percent (18 patients) in the former group and the 30-day complication rate was 23 percent, with 0.4 percent 30-day mortality and a 2.1 percent reoperation rate. The splenic flexure was mobilized in 109 patients (47 percent). Anastomoses were fashioned by stapler in 171 patients (73 percent) and were to the rectum in 143 patients (72 percent). Specimen length was 17.9 +/- 5.9 (range, 9-47) cm with inflammation at the proximal margin in 30 patients (14 percent). Twelve (5 percent) patients developed a recurrence at a mean of 78 +/- 25 (range, 34-109) months with reoperation in one (0.4 percent). The level of anastomosis was the only predictor of recurrence in regression analysis (P = 0.033). Patients with colosigmoid anastomosis had a four times higher risk of having a recurrence compared with patients with colorectal anastomosis (odds ratio, 95 percent confidence interval = 1.12, 14.96). CONCLUSION: Colorectal (rather than colosigmoid) anastomosis was the single predictor of lower recurrence rates after elective sigmoid resection for uncomplicated diverticulitis.

Aged↗
PubMed2003

Comparison of conventional and laparoscopic ileocolic resection for Crohn's disease.

PURPOSE: The purpose of this study was to compare open with laparoscopic ileocolic resection in selected patients with refractory Crohn's disease confined to terminal ileum and cecum in terms of small-bowel obstruction and recurrence rates at a follow-up of five years. METHODS: Thirty-nine patients who underwent laparoscopic ileocolic resection during a four-year period were compared with 53 patients who had previously undergone open ileocolic resection by the same surgeons at the same institution. Small-bowel obstruction was any clinical evidence of obstruction requiring hospital admission, regardless of recurrent disease or the need for surgery. Recurrence was defined as histologically proven Crohn's disease requiring reoperation and assessed by the actuarial method. Data were presented as medians and ranges and analyzed with Fisher's exact test, Student's t-test, Wilcoxon's rank-sum test, and log-rank test. RESULTS: Open ileocolic resection and laparoscopic ileocolic resection patients were well matched for age, gender, body mass index, American Society of Anesthesiologists grade, smoking, length of time from diagnosis to index operation, site of disease, preoperative medical treatment, previous abdominal surgery, indications for surgery, anastomosis configuration, microscopical involvement of resection margins, and postoperative complications (9.4 vs. 10.2 percent). Operating time was longer for laparoscopic ileocolic resection patients (105 (60-120) vs. 185 (130-210) min, P < 0.001). Hospital stay was shorter for laparoscopic ileocolic resection patients (11.2 (5-20) vs. 5.6 (3-11) days, P < 0.001). At five-year follow-up, 90.5 percent of open ileocolic resection patients and 92.3 percent of laparoscopic ileocolic resection patients were available. Five-year small-bowel obstruction rates were 35.4 and 11.1 percent, respectively, in open ileocolic resection and laparoscopic ileocolic resection patients (17 vs. 4 patients, P = 0.02). Five-year-recurrence rates were 29.1 (14/48) and 27.7 percent (10/36). Median time to recurrence was 48 and 56 months, respectively, following open ileocolic resection and laparoscopic ileocolic resection (P = 0.9104). CONCLUSION: When compared with open ileocolic resection, laparoscopic ileocolic resection led to lower five-year small-bowel obstruction rates in selected patients with ileocecal Crohn's disease. Five-year recurrence rates did not differ.

Adult↗
PubMed2003

Recurrence rates at minimum 5-year follow-up: laparoscopic versus open sigmoid resection for uncomplicated diverticulitis.

The aim of the study was to compare the impact of surgical access to sigmoid resection on recurrence rates in patients with uncomplicated diverticulitis of the sigmoid (UDS) at a minimum follow-up of 5 years. Recurrence after surgery was defined as left lower quadrant pain, fever, and leucocytosis with consistent CT and enema findings on admission and at 6 weeks, respectively. Outcome measures included splenic flexure mobilization, specimen length, inflammation at proximal resection margin, and presence of teniae coli at distal resection margin. Seventy-nine patients undergoing laparoscopic sigmoid resection (LSR) were compared with 79 matched controls with open sigmoid resection (OSR) operated on at 2 institutions during the same period. Patients were well matched for age, gender, body mass index, ASA grading, and symptoms duration, but not for follow-up length (81.9 versus 86.9 months, P = 0.046). Differences in rates of splenic flexure mobilization (19 versus 41, P < 0.001), specimen length (16.1 versus 18.3 cm, P = 0.048), inflammation at proximal resection margin (21 versus 4, P < 0.001), and teniae coli at distal resection margin (4 versus 53, P < 0.001) did not show an impact on recurrence rates when comparison was made between LSR and OSR. Three LSR patients and 7 OSR patients had 1 recurrence (P = 0.19). There were no significant differences in rates of flexure mobilization, specimen length, and rates of inflammation present at proximal resection margin in 10 recurring and 145 non-recurring patients. The rate of teniae coli present at distal resection margin was significantly increased in recurring patients (7 versus 43, P = 0.03). Median time of recurrence after surgery was 29 (range 18-74) months. Two of 11 recurrences occurred after 5 years. Surgical access to sigmoid resection for UDS is unlikely to have an impact on recurrence rates provided that the oral bowel end is anastomosed to the proximal rectum rather than to the distal sigmoid.

Aged↗
PubMed2003

Preserving the superior rectal artery in laparoscopic sigmoid resection for complete rectal prolapse.

Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use, however, has been limited because of fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP. During a 30-month period, data on 33 selected patients with CRP were prospectively collected. Three patients were withdrawn from the analysis, as they had neither resection nor anastomosis. Twenty-nine women and 1 man (median age 55 range 21-83 years) underwent LSR with preservation of SRA for a median CRP of 8 (3-15) cm. There were 20 ASA I and 10 ASA II patients. Ten patients had undergone previous surgery. Four patients complained of dyschezia, whereas incontinence was present in 26 patients. Anal ultrasound showed isolated internal sphincter defects in 2 patients. Four young adults (21-32 years) had normal CTT, whereas 26 older patients had a median CTT of 5(4-6) days. Defecography demonstrated 10 enteroceles, two sigmoidoceles, and one rectal hernia through the levator ani muscle. Mortality was nil. Median operating room time was 180 (120-330) min, suprapubic incision length 5(3-7) cm, estimated blood loss 150 (50-500) mL, specimen length 20 (12-45) cm, solid food resumption 3(1-6) days, and length of stay 4.5(2-7) days. Thirty-day complications were not related to anastomosing and occurred in 20% of the patients. Median follow-up was 34.1 (18-48) months. One patient had a recurrence. Although the evidence provided by the present study suggests that sparing SRA has a favorable impact on anastomotic leak rates, these nonrandomized results need further evaluation. The division of the mesorectum at the rectosigmoid junction seems not necessary, and its sparing should therefore be considered as it may contain anastomotic leak rates.

Adult↗
PubMed2003

Laparoscopy for diverticulitis.

Although the literature on laparoscopic surgery for diverticulitis includes data on more than 1800 patients, the quality of the studies is insufficient to draw definitive evidence-based conclusions. Nonrandomized evidence suggests that laparoscopic resection for uncomplicated diverticulitis of the sigmoid may fare better than its conventional counterpart not only in short-term outcome (preservation of the abdominal wall, shorter disability), but also in the long term (decreased rates of late symptomatic small bowel obstruction). Five-year recurrence rates show that a laparoscopic or conventional access is unlikely to have an impact, provided that the oral bowel end is anastomosed to the proximal rectum rather than to the distal sigmoid. The superiority of laparoscopy should be proven by measuring health-related and patient-centered outcome rather than surrogate endpoints. Areas of concern include replacing a conventional resection with laparoscopic suture, drainage, and colostomy in patients with free perforation and peritonitis. The role of laparoscopic surgery should be limited to resection for uncomplicated diverticulitis of the sigmoid performed by adequately trained surgeons. Benefits can be expected with this procedure, provided that indications for surgery are not influenced by the mode of access and that postoperative complication rates remain within the range of that for traditional colorectal surgery.

Diverticulitis↗
PubMed2002

Assessment of normal-appearing white and gray matter in patients with primary progressive multiple sclerosis: a diffusion-tensor magnetic resonance imaging study.

BACKGROUND: Diffusion-tensor magnetic resonance imaging is sensitive to the more destructive aspects of multiple sclerosis (MS) evolution occurring outside and within T2-visible lesions and, as a consequence, holds promise for providing a more complete picture of primary progressive (PP) MS-related tissue damage than conventional magnetic resonance imaging. OBJECTIVE: To improve our understanding of PPMS by assessing the extent of occult pathological features in the normal-appearing white and gray matter of the brain using diffusion-tensor magnetic resonance imaging. METHODS: Ninety-six patients with PPMS, 47 patients with secondary progressive (SP) MS, and 44 healthy control subjects were studied. T2-hyperintense and T1-hypointense lesion volumes were calculated, and the volume of the whole brain tissue was measured. Diffusion-tensor magnetic resonance imaging scans were postprocessed and analyzed to obtain the mean diffusivity and fractional anisotropy histograms from the brain and from the normal-appearing white and gray matter in isolation. RESULTS: The mean T2-hyperintense and T1-hypointense lesion volumes were lower in patients with PPMS than in patients with SPMS, while the mean absolute brain volumes were similar in the 2 groups. The average lesion diffusivity was significantly higher in patients with SPMS than in patients with PPMS (P<.001). Histogram-derived metrics of the brain tissue and normal-appearing white and gray matter were significantly different between patients with PPMS and healthy subjects (range, P =.004 to <.001). Average diffusivity values were significantly higher in patients with SPMS than in patients with PPMS for all the tissues studied (range, P =.001 to <.001). Fractional anisotropy histogram-derived quantities did not significantly differ between the 2 patient groups (range, P =.94 to.03). CONCLUSION: This study confirms that, in patients with PPMS, normal-appearing white and gray matter are not spared by disease-related pathological processes, although they are affected to a lesser degree than in patients with SPMS.

Adult↗
PubMed2002

Vestibular evoked myogenic potentials in multiple sclerosis patients.

OBJECTIVES: Vestibular evoked myogenic potentials (VEMPs) are saccular responses to loud acoustic stimuli and are recordable from the sterno-cleido-mastoid muscle ipsilaterally to the stimulated ear. This study aimed to investigate VEMPs in patients suffering from multiple sclerosis (MS), and to compare these findings with both clinical and instrumental data. METHODS: We recorded VEMPs from 70 MS patients, whose clinical data were retrospectively evaluated for the possible occurrence of: past and current (with respect to VEMP recording) brainstem and/or cerebellar symptoms; current brainstem and/or cerebellar signs. Sixty-five patients underwent brainstem auditory evoked potentials (BAEPs) recording; 63 of the same patients underwent saccadic eye movement recording and subjective visual vertical (SVV) evaluation. RESULTS: VEMPs were abnormal in 31%, BAEPs in 38% and SVV in 21% of the patients. Saccadic eye movements showed a possible brainstem dysfunction in 44.4% of the patients. There was no correlation between the occurrence of abnormalities and the technical means of detection. The same held true for correlations with clinical data, with the exception of the BAEPs; these proved to be more frequently abnormal in patients presenting at neurological examination with brainstem and/or cerebellar signs that were possibly related to the complaint of dizziness. CONCLUSIONS: VEMPs should be considered a useful complementary neurophysiological tool for the evaluation of brainstem dysfunction.

Acoustic Stimulation↗
PubMed2002

Laparoscopic suture closure of perforated duodenal peptic ulcer.

The aim of this study was to assess the outcome of a continuous series of 30 patients with perforated duodenal peptic ulcers treated by a laparoscopic approach. Between January 1996 and December 1998, 30 patients (24 males, 6 females) with a mean age of 69.2 years were operated on with a laparoscopic approach. Laparoscopic treatment included peritoneal lavage, suture of the perforation, and omental patching in 24 cases. A conversion to laparotomy was necessary in five patients (16.6%). Mean operative time was 92 minutes (range: 58-114) and mean hospital stay was 6 days (range: 4-16). Mortality and morbidity rates were 6.6% (n = 2) and 16.6% (n = 5). With a median follow-up of 12 months, 96% of the patients were in good condition; one patient had recurrent duodenal ulceration. The results of our study show the feasibility of the laparoscopic approach for perforated peptic ulcer repair, with acceptable mortality and morbidity rates.

Aged↗
PubMed2002

Laparoscopic cholecystectomy in cirrhotic patients.

Since 1992, laparoscopic cholecystectomy has been the treatment of choice for symptomatic gallstones. The advantages of laparoscopic cholecystectomy for most patients have been extensively published. However, its benefits and successful use in patients with cirrhosis are less well documented. The aim of this study was to determine the efficacy and safety of laparoscopic cholecystectomy in cirrhotic patients. We did a retrospective review of the records of 26 consecutive laparoscopic cholecystectomy procedures performed on cirrhotic patients between January 1992 and September 2000. Twenty-two patients were classified as having Child's class A cirrhosis, and 4 patients were classified as having Child's class B. No patients were classified as having Child's class C cirrhosis. There were 20 men and 6 women, with a mean age of 57 years (range, 37-76). All procedures were completed laparoscopically. There was histologic confirmation of cirrhosis in all patients. The mean operative time was 126 minutes (range, 60-184). The mean estimated blood loss was 110 mL (range, 40-380). Complications occurred in 7 patients (27%). No operative mortality occurred in this study. The mean length of hospital stay was 5 days (range, 3-14). Our results and the results of others show that laparoscopic cholecystectomy in cirrhotic patients seems to be safe in selected Child-Pugh class A and B patients with compensated cirrhosis. Cholecystectomy remains a high-risk procedure in cirrhotic patients, and indications for cholecystectomy should be evaluated carefully. Controlled trials are required to confirm the safety of this procedure, and further studies are also required to evaluate the management of gallbladder disease in patients with Child-Pugh class C cirrhosis.

Adult↗
PubMed2001

Emergency Pancreaticoduodenectomy with Delayed Reconstruction for Bleeding: A Life Saving Procedure.

Emergency pancreaticoduodenectomy with delayed reconstruction can be performed as a life saving procedurein case of massive bleeding uncontrolled with conventional hemostatic techniques. The authors reportherein the case of a 39-yr-old patient with an acute episode of chronic pancreatitis-induced massive bleedingsuccessfully treated by this unorthodox technique.The concept of damage control surgery with abbreviated laparotomy and planned reconstruction couldbe useful in selected cases outside the trauma setting.

Journal Article↗
PubMedDate not supplied

Caspase-1 levels in biological fluids from patients with multiple sclerosis and from patients with other neurological and non-neurological diseases.

In multiple sclerosis (MS), pathological white matter damage in the central nervous system is sustained by immune-inflammatory response. Caspase-1 plays a pivotal role in immune-mediated inflammation, as it regulates the cellular export of IL-1beta and IL-18. We carried out a preliminary in vitro study of the kinetics of extracellular caspase-1 release. We then measured caspase-1 levels in paired serum and cerebrospinal fluid (CSF) samples of 75 MS patients, 15 healthy subjects, and patients with other neurological diseases. Paired synovial fluid and serum samples of patients with juvenile idiopathic arthritis, and paired sputum and serum samples of asthma patients were also studied. Mean serum caspase-1 concentrations did not differ between groups. Caspase-1 was detected in the CSF of patients with acute, but not stable, MS [7.5 +/- (SEM) 0.9 pg/ml; test's sensitivity, 56% and specificity, 100%]. Its levels correlated with pleocytosis. The highest mean caspase-1 levels were found in the arthritic synovial fluids (945.5 +/- 126.6 pg/ml, which correlated with erythrocyte sedimentation rate), and in the sputum samples (370.1 +/- 71.0 pg/ml, which correlated with the number of macrophages in the sputum). On condition that caspase-1 is determined in the fluids pertaining to the disease-specific inflammatory sites, its level is a reliable marker of ongoing immune-inflammatory response. The enzyme measurement in CSF can also help define state-trait in MS.

Arthritis, Juvenile↗
PubMedDate not supplied

A reliability study of impairment and disability scales for myasthenia gravis patients.

The authors developed two scales to be adopted for the evaluation of myasthenia gravis (MG) patients. The first scale (MG impairment scale) is based on objective patient evaluation and on patients' responses to standardized questions relating to the functioning of specific muscle groups. It consists of 13 items exploring strength and 10 items exploring fatigability. The second scale (MG disability scale) evaluates disability in those everyday activities that are often impaired in MG patients. Test-retest reliability of each item and of the global score (sum of single item scores) was assessed by the weighted K statistic and by the intraclass correlation coefficient. Reliability was invariably 'substantial', and for single items 'almost perfect' for the MG impairment scale, and invariably 'almost perfect' for the MG disability scale. The internal structure of the MG impairment scale was explored by means of the principal component analysis. This analysis resulted in three main (rotated) factors, which loaded respectively onto 'ocular', 'spinal' and 'bulbar' functions. For these factors, we report factor score coefficients that can be used to compute single patients' scores, which in turn may be used in further analyses, particularly for follow-up studies. We also report the results of an analysis of the correlations between the two scales. The MG impairment and the MG disability scales are proposed for application in both clinical and research settings.

Activities of Daily Living↗