Rehabilitation in Italy.
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Education, Professional↗
Biomedical subjects
S Giaquinto
Publications and source records attributed to S Giaquinto.
Depression after stroke: an investigation through catamnesis.
BACKGROUND: In the early stage of stroke, depression appears to be linked to certain brain areas. The study evaluated the importance of the side of the lesion in depressed patients 3 years after their first stroke. METHOD: Patients who had suffered a stroke and been discharged after rehabilitation were identified by hospital records. We interviewed 180 patients at home. Demographic as well as socioeconomic data were collected. The North-western University Disability Scale, the Beck Depression Inventory (BDI), the Relatives' Stress Scale, and the Social Dysfunction Rating Scale were applied. The diagnosis was confirmed for each patient by a clinical assessment according to the ICD-10 criteria. Patients with previous psychiatric treatment, comprehension problems, or severe hemi-inattention were excluded. RESULTS: By using a score of 14 on the BDI as a cutoff, 62 patients (34%) proved to be affected by depressive disorders. Clinical records showed that the location of the lesion was in the right hemisphere for 37 patients and in the left hemisphere for 25 patients. Statistical analysis of the mean scores obtained in this subgroup of depressed patients showed (1) no significant relation between depression and the hemispheric location of the lesion or between depression and level of education; (2) relation between BDI score and social activities; and (3) stress on the relatives that was mainly dependent on both the disability of the patients and their loss of social activities, whereas depression played a minor role. CONCLUSION: A high percentage of patients have depressive disorders 3 years or more after the stroke, independent of the side. Such mood disorders worsen the relationship between the disabled patients and their relatives and worsen leisure independent of the affected hemisphere.
Activities of Daily Living↗
EEG recordings in the course of recovery from stroke.
BACKGROUND AND PURPOSE: This study was designed to assess the value of quantified electroencephalography (EEG) in the follow-up of stroke and its possible correlation with other measures of recovery. METHODS: EEGs were recorded over a period of 6 months in 34 patients with ischemic stroke in the middle cerebral artery territory who underwent spectral analysis. Two groups were formed: (1) 28 patients with a Barthel Index score of less than 60 at admission and (2) 6 patients with a Barthel score of over 60 and therefore with a much better prognosis. Ten recordings were made in each patient in the first group and at least three in the second group. Motor functions and activities of daily living (ADL) were assessed three times, on admission to the study and after 3 and 6 months. RESULTS: Quantified EEG was significantly abnormal in the affected hemisphere of the first group. Side and site were not relevant. Longitudinal recordings showed a significant improvement of the power spectrum in the first 3 months. Alpha mean weighted frequency of the injured hemisphere was always slower than that of the contralateral side. All patients improved in motor performance and ADL, with the greatest gain in the first 3 months. However, no correlation between quantified EEG and clinical testing was found. By looking at individual profiles, a frequent and unpredictable instability was seen in the "unaffected" hemisphere. In those who made the best recovery, the EEG spectrum became more symmetrical over the left and right hemispheres, an aspect that continued beyond the point of a good motor and ADL recovery. CONCLUSIONS: Quantified EEG undergoes early and subtle changes in the follow-up of stroke that can outlast clinical recovery. Routine evaluation for prognosis is not recommended because motor and ADL scales provide earlier and more accurate indicators. In contrast, quantified EEG can be useful for individual patients undergoing rehabilitation to monitor mechanisms of local repair and also to detect changes in the so-called normal hemisphere. It may reveal focal abnormalities that are undetected by coarse clinical evaluation and that call for appropriate neuropsychological testing.
Activities of Daily Living↗
The influence of depression, social activity, and family stress on functional outcome after stroke.
BACKGROUND AND PURPOSE: This study was designed to assess the quality of life after an active poststroke period of rehabilitation and to investigate the possibility of a return to a working environment for those still of working age. METHODS: The study was conducted on 180 consecutive patients affected by stroke who were hospitalized for the first time and discharged at least 1 year before the study. The group consisted of 65% men and 35% women with a mean age 65.29 years (SD, 11.22). The period between the stroke and the interview ranged from 12 to 196 months, with a mean of 37.5 months. The average Rankin score on discharge from the rehabilitation center was 2.718 (moderate handicap). The interview took place at home after consent obtained by telephone. The questionnaire included general and personal information regarding the individuals, their socioeconomic position, and scales for daily activity, depression, social activity, and stress produced in the family. The control group consisted of 167 age-matched subjects. RESULTS: A close correlation was observed in all patients between depression, social activity, and stress caused to relatives. The scores on the individual scales were clearly worse than those for control subjects. The patients received approximately 5 months of rehabilitation after the stroke. Differences emerged between men and women for depression and social activities, with the women scoring worse. In reference to daily life, 70% of prestroke ability was required on average after rehabilitation. The daily activity score at the time of the interview was also strongly influenced by the discharge score. The majority of patients were retired. Of the total, 20.64% returned to work, but not always to the same job and often after readapting to new conditions. Of this population, only 31.5% were women. With regard to the population aged younger than 65 years, 21.42% returned to work. Lesions in the dominant hemisphere do not necessarily seem to rule out return to work, even if associated with aphasia. The main discriminating element was the ability to understand language. The patients were often criticized by their cohabitants; the criticisms most often raised concerned apathy, irritability, and self-centeredness. Sexual activity was depressed in almost all cases. CONCLUSIONS: Despite the progress made in studying cerebral vasculopathies, patients in the aftermath of a stroke still seem to live unsatisfactorily, as they did many years ago. Useful measures include valid treatment against spasticity, psychological assistance, and greater social support.
Activities of Daily Living↗
[Subtotal colectomy in splenic flexure carcinoma in a patient with transverse colostomy who had undergone gastric resection (Billroth II)].
The Authors report a case of subtotal colectomy for splenic flexure adenocarcinoma in a gastro-resected patient bearing a transverse colostomy. They underline the considerable technical difficulties encountered during dissection because of multiple adhesions related to the previous operations (gastrojejunostomy and transverse colostomy). In fact, a gastric resection according to Billroth II and an emergency colostomy for bowel obstruction had been performed 20 years and 30 days respectively prior to the present operation. Nevertheless, reconstructive steps resulted easier and faster with the use of staplers.
Adenocarcinoma↗
Neurobiological mechanisms of adaptative plasticity. A possible contribution to cybernetic studies.
Cybernetics can take advantages of future development in the field of Plasticity. The adaptative abilities of the nervous tissue, which is capable to modify its own functional organization and cope with pathological events, are triggered by communication within a network carrying memorized variations in the functional activity of the system induced by external inputs. Plasticity is served by anatomical modifications, as well as by neurophysiological processes. Regeneration, reactive synaptogenesis, functional reorganization, redundancy, equipotentiality are discussed. Some of these mechanisms are still unclear in the human and probably far-fetched. Personal EEG contribution argues against redundancy and equipotentiality.
Animals↗
The resting EEG: an useful monitor of brain function in experimental aging research.
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Aged↗
[Intestinal occlusions due to neoplasms of the small intestine].
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Carcinoembryonic Antigen↗
The EEG in the normal elderly: a contribution to the interpretation of aging and dementia.
Forty-seven normal elderly, 16 normal subjects ranging from 40 to 60 years of age and 14 patients affected by primary dementia are studied. The EEG is recorded from different brain areas and analysed by FFT algorithm. Main results are: There is persistence of the regional distribution of the alpha frequency which is higher in occipital than in frontal leads in the normal elderly. Spectral composition in the same group keeps its typical profile with age. Alpha-dominant tracings form 68%. Values collected from the two hemispheres are similar. Therefore, no evidence is detected for a selective age effect on one side, either right or left. In the elderly group, a sex-linked difference is found. Women have less delta and more beta frequency. The opposite holds true in men. EEG slowing is typical of old age. However, in occipital leads the alpha frequency has an average of 9.46 Hz. Statistical comparison between the normal groups (middle aged vs. elderly) gives no significant results. Significant differences are seen when the normal elderly are compared with demented subjects. The data do not support the hypothesis of a continuum from aging to mental deterioration.
Aged↗
EEG changes induced by oxiracetam on diazepam-medicated volunteers.
The present study was carried out in order to verify whether, in benzodiazepine-medicated healthy volunteers, oxiracetam retained the properties already observed after administration in normal volunteers. In a cross-over study, 12 volunteers, medicated the night before with 5 mg diazepam, were i.v. treated with 1 g oxiracetam or saline. An electroencephalogram (EEG) was performed before, and 15 and 120 min after, nootropic or saline injection. Computerized examination of the EEG traces showed an increase of the alpha- and a decrease of the delta-relative activities, particularly in the fronto-temporal regions. These preliminary results suggest that oxiracetam might be useful in benzodiazepine-treated patients by improving their cognitive activities without nullifying the sedation of anxiety and neurotic behavior.
Adult↗
Cluster analysis of cognitive performance in elderly and demented subjects.
48 elderly normals, 14 demented subjects and 76 young controls were tested for basic cognitive functions. All the tests were quantified and could therefore be subjected to statistical analysis. The results show a difference in the speed of information processing and in memory load between the young controls and elderly normals but the age groups differed in quantitative terms only. Cluster analysis showed that the elderly and the demented formed two distinctly separate groups at the qualitative level, the basic cognitive processes being damaged in the demented group. Age thus appears to be only a risk factor for dementia and not its cause. It is concluded that batteries based on precise and measurable tasks are the most appropriate not only for the study of dementia but for rehabilitation purposes too.
Age Factors↗
Quantitative study of action tremor in various patient categories.
An electronic method is proposed for quantifying the action tremor revealed by a threefold test of skill, which distinguishes young adult controls from elderly normals and patients with tremor. Parkinsonian patients can be differentiated from patients with essential tremor. The value of drugs against tremor is discussed.
Adult↗
On six cases of radiation meningiomas from the same community.
The article deals with 6 patients operated on for meningioma many years after they had undergone X-ray therapy because of an epidemic of tinea capitis in their community. One of the patients developed another meningioma 13 years after the operation. A causal connexion between radiation and tumors is supported by the patient linkage and by the similarity of tumor type, site and latency (36.14 +/- 7.51 years).
Adult↗
[A catamnestic study of recovered alcoholics].
Fifty-one alcoholics, previously admitted to the hospital for medical care and treated with disulfiram, were re-examinated after 1-3 years. In thirty of them (58%) total abstinence was found; eighteen patients (35%) behaved so in spite of disulfiram withhold during the first year of self-administration. No side-effects were reported. General behaviour, mood, work, interest and familiar relationships improved. The treatment generally failed in the cases of secondary alcoholism as in marked neurosis or psychosis. The research proved the main role of family and environment in the successful cases. The treatment with disulfiram is useful but incomplete.
Alcoholism↗
Alpha increase in puerperium.
Significant increases of both alpha peak amplitude and power were found in the EEG after delivery as compared to those observed at the 32nd week of pregnancy. Controls failed to display the same gain in the alpha rhythm. The frequency was unaffected. Beside these quantitative changes no particular EEG pattern occurred. Neither the methodology nor habituation were considered responsible for these increases, which are also independent of the prolactin levels, because they were observable after blockage by bromocryptine, a drug which also fails to modify the EEG. Significant reduction of anxiety, tension and irritability was scored in the Hamiltonian test for depression. It is likely that both aspects depend on a common humoral process. The role of the progesterone drop is discussed.
Adult↗
[The puerperium: a condition of special neurophysiological interest].
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Adult↗
Applications of statistical equivalence to newborn EEG recordings.
Epochs were selected from sleep EEGs of newborns during both quiet and REM phases. A first order parameter analysis was done in order to test the homogeneity (run test and one way variance analysis) of the data within the epochs, follwed by a study of spectral equivalence between epochs. Comparisons were made between average spectra in the frequency range 0.5--4 c/sec; and between their band-by-band components, to test the feasibility of automatic classification of sleep stages by means of frequency analysis. On the basis of the statistical parameters we used, spectral analysis appears to be of limited value for the purpose of automatic classification of newborn EEG records; due to a lack of complete homogeneity of the spectra within each sleep state, it is not possible to identify a characteristic spectrum for active sleep and quiet sleep.
Electroencephalography↗