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1.
Int J Legal Med ; 130(1): 13-22, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26342284

ABSTRACT

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.


Subject(s)
Whiplash Injuries/diagnosis , Humans , Medical History Taking/standards , Physical Examination/standards , Visual Analog Scale
3.
Forensic Sci Int Genet ; 7(1): e15-8, 2013 Jan.
Article in English | MEDLINE | ID: mdl-22917816

ABSTRACT

The 2011 collaborative exercise of the ISFG Italian Working Group GeFI was aimed at validating the five ENFSI/EDNAP miniSTR loci D1S1656, D2S441, D10S1248, D12S391 and D22S1045. The protocol required to type at least 50 multilocus profiles from locally resident individuals and two blind bloodstains in duplicate (i.e., using at least two different commercial kits), and to send the electropherograms to the Organizing Committee. Nineteen laboratories distributed across Italy participated, collecting a total of 960 samples. Full concordance was found for the five new miniSTRs as observed from the comparison of 13,150 alleles. The inspection of the electropherograms allowed the identification of a very limited number of mistypings in the miniSTR genotypes thus contributing to the establishment of an high quality Italian database of frequencies.


Subject(s)
Chromosome Mapping , Genetics, Population , Forensic Genetics , Humans , Italy , Laboratories , Microsatellite Repeats
4.
Monaldi Arch Chest Dis ; 71(3): 132-4, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19999960

ABSTRACT

The aim of this case report was to demonstrate the importance of detailed clinical assessment in victims of attempted manual strangulation, to prevent the occurrence of delayed death due to an airway collapse; and to provide an update on clinical management of these patients. An elderly male patient presented with a sore throat and speech impairment after attempting manual strangulation. Physical examination showed reddish skin of the neck, an extensive haematoma of the hard palate and anterior tongue. Flexible laryngoscopy failed to show any swelling of the hypopharynx or larynx. A few hours after presentation, the patient developed acute dyspnoea and died. Autopsy and post-mortem CT scan showed a haematoma in the thyro-epiglottal space. In conclusion, victims of manual strangulation can survive despite internal neck injury which can lead to delayed fatal airway collapse. This is because often there are few or no signs of assault, therefore medical evaluation should be thorough and timely. Sometimes immediate tracheotomy can be life saving.


Subject(s)
Asphyxia , Autopsy , Homicide , Aged, 80 and over , Asphyxia/diagnosis , Emergency Medical Services , Hematoma/diagnostic imaging , Humans , Male , Neck/diagnostic imaging , Tomography, Spiral Computed
5.
Int J Clin Pharmacol Ther ; 45(1): 16-22, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17256446

ABSTRACT

Erdosteine has positive effects on mucus rheology and transport due to the active metabolite (Metabolite I) which contains a free thiol group. Erdosteine inhibits bacterial adhesiveness and has antioxidant properties. A synergistic effect of erdosteine with various antibiotics has been demonstrated in pharmacological and clinical studies. The present study was multicenter, randomized, double-blind and placebo-controlled. The aims of the study were to compare a combination of erdosteine with amoxicillin against an amoxicillin-placebo combination in pediatric patients with acute lower respiratory tract disease. A total of 158 patients (78 in the erdosteine group and 80 in the placebo group) were treated for 7 +/- 2 days. The efficacy parameters were cough (primary), polypnea, rhonchi, rales and body temperature (all measured at baseline, on Day 3 and at the end of treatment). Safety was assessed by strictly monitoring the occurrence of adverse events and using standard laboratory parameters. The results of the intention-to-treat analysis showed that the severity of cough was decreased by 47% at Day 3 in the erdosteine group with a statistically significant difference compared to placebo, the difference was still significant at the final visit. The decrease in the severity of rales was significantly greater at Day 3 in the erdosteine group than in the placebo group. The incidence of polypnea and rhonchi in the two groups showed similar decreases, an improvement mainly due to the antibiotic. No adverse events occurred and no adverse changes in laboratory parameters were observed. It is concluded that the combination of erdosteine and amoxicillin is a safe medication which is clinically superior to that of the antibiotic combined with placebo, especially in regard to the effects on cough.


Subject(s)
Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Expectorants/therapeutic use , Respiratory Tract Infections/drug therapy , Thioglycolates/therapeutic use , Thiophenes/therapeutic use , Acute Disease , Adolescent , Body Temperature/drug effects , Child , Child, Preschool , Cough/drug therapy , Cough/etiology , Double-Blind Method , Drug Combinations , Drug Therapy, Combination , Female , Humans , Italy , Male , Respiratory Sounds/drug effects , Respiratory Tract Infections/complications , Respiratory Tract Infections/physiopathology , Romania , Severity of Illness Index , Time Factors , Treatment Outcome
7.
Forensic Sci Int ; 122(2-3): 184-8, 2001 Nov 01.
Article in English | MEDLINE | ID: mdl-11672978

ABSTRACT

A sample of 1176 males from 10 Italian regions have been typed for DYS19, DYS389-I, DYS389-II, DYS390, DYS391, DYS392, DYS393, and DYS385. Individual haplotype data are available on line. A low degree of variation is present among regions. Use of this database is specifically recommended for forensic applications in Italy.


Subject(s)
Genetics, Population , Haplotypes/genetics , Y Chromosome/genetics , Databases, Factual , Humans , Italy , Male
8.
Neuropediatrics ; 32(2): 90-2, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11414649

ABSTRACT

A child presented with recurrent episodes of lethargia for which he underwent several hospital admissions and investigations. A further episode culminated in respiratory arrest and hypoxic ischemic encephalopathy with permanent mental regression. Eighteen months later the mother was discovered while providing clonidine pills to the child; the mother appears to feature a Munchausen syndrome by proxy.


Subject(s)
Brain Damage, Chronic/chemically induced , Clonidine/poisoning , Magnetic Resonance Imaging , Munchausen Syndrome by Proxy/diagnosis , Poisoning/diagnosis , Acute Disease , Brain Damage, Chronic/diagnosis , Child, Preschool , Diagnosis, Differential , Heart Arrest/chemically induced , Heart Arrest/diagnosis , Humans , Hypoxia, Brain/chemically induced , Hypoxia, Brain/diagnosis , Male , Sleep Stages
9.
Pediatr Med Chir ; 19(3): 165-73, 1997.
Article in Italian | MEDLINE | ID: mdl-9340606

ABSTRACT

Syncope is a common phenomenon, well-known to all pediatricians: it is defined as a sudden transient loss of consciousness associated with inability to maintain postural tone that is incompatible with a seizure disorder, vertigo, dizziness, coma, shock or other states of altered consciousness. The purpose of this study are to analyse the multiple causes of syncope, to determine the characteristics of pediatric patients with syncope, to define the pathophysiologic mechanisms that result in neurally mediated syncope.


Subject(s)
Syncope/diagnosis , Adolescent , Child , Disease Susceptibility , Humans , Syncope/classification , Syncope/etiology , Syncope/physiopathology
11.
Minerva Pediatr ; 48(11): 475-83, 1996 Nov.
Article in Italian | MEDLINE | ID: mdl-9064494

ABSTRACT

UNLABELLED: A growing number of clinical and epidemiological data point to the fact that coeliac disease (CD) is a pauci- or asymptomatic occurrence, relatively more frequent than it was supposed in the past, manifested in atypical, silent and latent forms which are often undiagnosed or diagnosed only at a later age. The fact that resolutive treatment is now available means that CD is an ideal field for the application of a screening method. In this context the study by Catassi et al. (1994) is particularly important since it reported a prevalence of 0.38% of CD in healthy children in the Pesaro-Urbino area. AIM: The aim of this study was to verify the incidence of CD in a nonselected pediatric population in the province of Lucca, using the aforesaid screening method. METHOD: The eligible population consisted of 1585 students from 5 secondary schools around Lucca, aged between 10 and 15 years old, none of whom were known to be affected by CD. In the first phase of the study anti-gliadin-IgA (AGA-IgA) and IgG antibodies were assayed in capillary blood (collected at school) using Alfa-Gliatest (Eurospital); children with AGA-IgA, AGA-IgG over 7 and 15 U/ml respectively were considered positive. In the second phase children with positive results underwent a further assay of AGA-IgA, AGA-IgG, anti-endomysium antibodies (EMA) and total IgA in venous blood. Lastly, children positive for AGA-IgA and/or EMA, or those positive for AGA-IgG with IgA deficit underwent duodenal jejunal biopsy. RESULTS: 41 children were positive on screening (2.6% of the eligible population, 3.8% of subjects effectively tested). Of these, 39 were assayed for AGA (IgA and IgG), EMA and total IgA in peripheral blood, identifying 4 subjects positive for AGA-IgA and EMA. Of the 4 children selected in this way, only 2 underwent jejunal biopsy and both presented "duodenal mucosa with chronic phlogosis and subtotal villous atrophy". Two cases of CD were formally ascertained with a prevalence of 1 out of 793 (0.13%) of the eligible population and an estimated prevalence of 1 out of 546.5 (0.18%) of the subjects undergoing screening. The cost was approximately Lit. 23,000 per child screened and approximately Lit. 6,100,000 for each coeliac child diagnosed. COMMENTS AND CONCLUSIONS: The diagnostic iter proved efficacious and enabled 4 "high-risk" children to be selected. If the two subjects who did not undergo biopsy are also formally considered as coeliacs, the prevalence would be 1 out of 396 (0.25%) of the eligible subjects, namely 1 out of 273 (0.37%) of effectively tested subjects. This is a figure which is very similar to that reported by other studies. The 4 children identified here as strongly suspected of CD did not possess any anamnestic and/or objective elements which might have suggested "ex ante" a diagnosis of CD. If confirmed, these data provide concrete evidence of the need to perform mass screenings to identify CD. The economic convenience of this procedure depends on a careful analysis of the costs of the failure to diagnose CD.


Subject(s)
Celiac Disease/diagnosis , Celiac Disease/epidemiology , Adolescent , Biopsy , Child , Female , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Incidence , Italy/epidemiology , Jejunum/surgery , Male
12.
Acta Paediatr Suppl ; 412: 29-35, 1996 May.
Article in English | MEDLINE | ID: mdl-8783752

ABSTRACT

BACKGROUND: Recent studies suggest that coeliac disease (CD) is one of the commonest, life-long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy. PATIENTS AND METHODS: Fifteen centres screened 17,201 students aged 6-15 years (68.6% of the eligible population) by the combined determination of serum IgG- and IgA-antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA-AGA positive and were recalled for the second-level investigation; 111 of them met the criteria for the intestinal biopsy: IgA-AGA positivity and/or AEA positivity or IgG-AGA positivity plus serum IgA deficiency. RESULTS: Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening-detected coeliac patients showed low-grade intensity illness often associated with decreased psychophysical well-being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 x 1000 (95% CI 3.79-5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 x 1000 (95% CI 4.57-6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7. CONCLUSIONS: These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.


Subject(s)
Celiac Disease/diagnosis , Mass Screening/methods , Adolescent , Antibodies/blood , Antibodies/immunology , Autoimmunity , Biomarkers/blood , Celiac Disease/complications , Celiac Disease/epidemiology , Celiac Disease/immunology , Child , Female , Follow-Up Studies , Gliadin/immunology , HLA-D Antigens/genetics , Humans , Immunoglobulin A/blood , Immunoglobulin A/immunology , Immunoglobulin G/blood , Immunoglobulin G/immunology , Italy , Male , Prevalence , Sensitivity and Specificity , Serologic Tests/methods
13.
Pediatr Med Chir ; 18(3): 311-3, 1996.
Article in Italian | MEDLINE | ID: mdl-8966134

ABSTRACT

It is a common fallacy that the prominent ear correction is easy; on the contrary it is difficult to obtain a perfect result, as indicated by the continuous growth of new methods. For a long time we have used Mustardè's mattress suture technique (Francesconi) but quite often the result was incomplete and not infrequently there was recurrence. In recent years, in order to obtain a more complete and permanent correction, we have added to the mattress sutures the superficial scratching of the anterior aspect of the cartilage as suggested by Stenstrom. A well formed contour of the antihelix and of the crura is so reproduced and maintained by the spontaneous bending tendency of the auricular cartilage following abrasion. The surgeon is dealing with an intact cartilage so that many common inconveniences met with in other techniques are eliminated. No irregularities and no sharp ridges, which may project beneath the skin on the anterior surface, are formed and there is no persistent protrusion on the upper or lower portion of the ear. The technique is equally well suited when insufficient folding of the antihelix or when excessive cupping of the concha are pronounced features.


Subject(s)
Ear, External/abnormalities , Ear, External/surgery , Child , Ear, External/pathology , Humans , Male , Postoperative Complications/epidemiology , Surgery, Plastic/methods , Suture Techniques
14.
Minerva Anestesiol ; 62(5): 183-6, 1996 May.
Article in Italian | MEDLINE | ID: mdl-9045096

ABSTRACT

In order to investigate whether continuous lumbar epidural analgesia is associated with alterations of plasma levels of beta-endorphins and ACTH, we have studied a group (A) of patients under epidural analgesia and a matched group of control (B) at different stages of labour. Plasma levels of beta-endorphins and ACTH in group A did not significantly change during the labour, while in group B beta-endorphins and ACTH increased in the second stage of labour and decreased thereafter one hour after delivery. The levels of beta-endorphins and ACTH in umbilical cord mix blood were elevated in both groups.


Subject(s)
Adrenocorticotropic Hormone/blood , Analgesia, Epidural , Analgesia, Obstetrical , Labor, Obstetric/blood , beta-Endorphin/blood , Female , Humans , Pregnancy
15.
Pediatr Med Chir ; 17(6): 577-81, 1995.
Article in Italian | MEDLINE | ID: mdl-8668597

ABSTRACT

The cysticercosis is an infestation caused from the larva of Taenia solium, which is demoniated Cysticercus cellulosae. Infestation by the encysted forms occur within brain, muscle, cutis, eye and more rarely within kidney, liver, thyroid. The cysties cause inflammation, oedema and residual calcification. In the SNC they are responsible for seizures, usually of focal type, hydrocephalus, meningitis, endocranic hypertension, stroke. One case of neurocysticercosis in a 15 years old boy is described: the clinical pictures, the neuroradiologic images and the treatment are discussed.


Subject(s)
Brain Diseases/complications , Cysticercosis/complications , Seizures/etiology , Adolescent , Adrenal Cortex Hormones/therapeutic use , Anticestodal Agents/therapeutic use , Anticonvulsants/therapeutic use , Brain Diseases/diagnosis , Brain Diseases/drug therapy , Cysticercosis/diagnosis , Cysticercosis/drug therapy , Humans , Magnetic Resonance Imaging , Male , Neuroradiography , Praziquantel/therapeutic use , Tomography, X-Ray Computed
16.
Pediatr Med Chir ; 15(5): 481-8, 1993.
Article in Italian | MEDLINE | ID: mdl-8159582

ABSTRACT

Migraine has been recently defined a "central neuronal hyperexcitability state", maybe magnesium-dependent, and magnesium has been occasionally employed in the therapy of adult migraine. The Authors, on the basis of their personal experience (previous electromyographic studies), consider childhood migraine and periodic syndrome as a clinical equivalent of spasmophilia, in which an intracellular deficit of magnesium has been demonstrated, and have employed a magnesium salt in the prophylaxis of childhood migraine and migraine equivalents. 40 children with periodic syndrome (17 M and 23 F, aged 10.4 +/- 2.9 years) have been treated with magnesium pidolate, with doses ranging from 1.5 g/die to 4.5 g/die (corresponding to 122-366 mg Mg++):25 of them presented migraine as the main symptom, 12 recurrent abdominal pain, 3 fever of unknown origin, along with many other periodic symptoms. The first control visits have been done at 1 month, clinical follow-up lasted a mean period of 6.1 months. Therapy was stopped at 1 month visit if ineffective (of some other drug was added); otherwise, magnesium therapy was continued with the same dosage for another month, then gradually reduced. Clinical response was considered good if crises ceased completely or their frequency was reduced to less than 33%; partial if reduced to less than 67% of previous incidence; absent if only slightly or not at all reduced. Clinical response was good in 72.5% of cases at 1 month, in 77.5% later; partial in 12.5% and 10%; absent in 15% and 12.5% respectively. No side effects were observed. The compliance of children and their families was complete.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Headache/prevention & control , Magnesium/therapeutic use , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Pain/prevention & control , Periodicity
17.
Minerva Ginecol ; 45(9): 403-8, 1993 Sep.
Article in Italian | MEDLINE | ID: mdl-8255500

ABSTRACT

A retrospective review of multiple birth of higher order delivered at the Obstetric Clinic of University of Rome "La Sapienza" from 1982-1991 was performed. Comparison was made between this group (study group) and other published data. Since 1982 there has been more liberal use of abdominal delivery. Of the 25 multiple pregnancies, 17 were delivered by cesarean section (CS) and 8 by vaginal delivery. The corrected mortality rate in the study group was 19.2% (5/26) for vaginal delivery and 17.5% (10/57) for CS. Indication for CS was: elective (35%), fetal (18%) and maternal (47%). The main neonatal complications resulted from prematurity, and maternal noted complication were post-partum hemorrhage necessitating hysterectomy in one patient. The preferable mode of delivery cannot be stated dogmatically.


Subject(s)
Delivery, Obstetric/methods , Pregnancy, Multiple , Adult , Delivery, Obstetric/statistics & numerical data , Female , Humans , Infant Mortality , Infant, Newborn , Italy/epidemiology , Male , Obstetric Labor Complications/epidemiology , Obstetric Labor Complications/therapy , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/therapy , Pregnancy Trimester, Third , Puerperal Disorders/epidemiology , Retrospective Studies
18.
Pediatr Med Chir ; 15(4): 353-9, 1993.
Article in Italian | MEDLINE | ID: mdl-8265454

ABSTRACT

The study of cardiovascular autonomic reflexes is the most physiological and reliable test for the assessment of autonomic function: they consist of the analysis of variation of heart rate and arterial pressure provoked by many physiological stimuli. Up to now normal pediatric reference data were not available: we have standardized these tests in 198 normal children (94 M, 104 F), aged 8.3-15.7 years, without any symptom of possible autonomic dysfunction pathology. A complete auxological evaluation has been performed. Autonomic tests were performed by ECG recording and arterial pressure monitoring during normal and deep breathing, Valsalva manoeuvre, lying to standing postural change, isometric muscular contraction (sustained hand-grip and leg rising). Eleven autonomic parameters were obtained. Many statistical correlation between autonomic parameters and auxological features have been explored, without remarkable results. A significative difference emerged only between sexes. Normal reference values has been calculated. Their utility for the study of autonomic dysfunction is discussed.


Subject(s)
Autonomic Nervous System/physiology , Adolescent , Child , Electrocardiography , Female , Hemodynamics , Humans , Isometric Contraction/physiology , Male , Neurologic Examination/methods , Reference Values , Respiration/physiology , Sex Characteristics
19.
Pediatr Med Chir ; 15(4): 361-5, 1993.
Article in Italian | MEDLINE | ID: mdl-8265455

ABSTRACT

The pathogenesis of periodic syndrome (recurrent abdominal pain, cyclic vomiting, headache and other equivalents of childhood migraine) is often related in the literature to a "neuro-vegetative dysfunction", by which occasional stimuli (environmental, metabolic, emotional) should find a particular somatic expression. The homeostatic role of the autonomic nervous system could be deficient in these cases, but systematic research has never been done to explore this hypothesis. We have evaluated the autonomic nervous function in 38 children (12 M, 26 F) with periodic syndrome, by cardiovascular autonomic function tests. They consist of ortho- and parasympathetic parameters obtained by ECG registration and pressure monitoring during deep breathing, Valsalva manoeuvre, lying to standing postural change, sustained handgrip. In the absence of adequate pediatric references values, we have previously standardized these tests in a population of 198 healthy children (94 M, 104 F), aged 8.3-15.7 years. Results have been compared with our standard reference values, matching them by t-test for independent data: in both sexes, significant differences have been found out in only one of 11 parameters (p < 0.05) of the autonomic tests performed. Children affected by periodic syndrome reveal a reduced heart rate variation in transition from the early orthosympathetic phase to the late parasympathetic one after lying to standing passage, showing a smaller fluctuation of autonomic feedback systems. The physiological meaning of this result is unclear. However, in children with periodic syndrome no prevalence of ortho- or parasympathetic systems is evident.


Subject(s)
Autonomic Nervous System/physiopathology , Familial Mediterranean Fever/physiopathology , Adolescent , Autonomic Nervous System Diseases/complications , Autonomic Nervous System Diseases/diagnosis , Autonomic Nervous System Diseases/physiopathology , Child , Familial Mediterranean Fever/diagnosis , Familial Mediterranean Fever/etiology , Female , Hemodynamics , Humans , Male , Neurologic Examination/methods , Respiration/physiology
20.
Minerva Ginecol ; 45(1-2): 27-30, 1993.
Article in Italian | MEDLINE | ID: mdl-8469361

ABSTRACT

1800 intrauterine contraceptive device users, during a period of more than thirteen years, and 1800 control non-users were examined clinically, cytologically and histopathologically for cervical pathological lesions. There was an increase, but not statistically significant, in the incidence of metaplasia, dyskariosis or mild dysplasia. There was no difference in neoplastic lesions.


Subject(s)
Intrauterine Devices/adverse effects , Uterine Cervical Diseases/etiology , Uterine Cervical Neoplasms/etiology , Vaginal Diseases/etiology , Adult , Cervix Uteri/pathology , Female , Humans , Prognosis , Uterine Cervical Diseases/diagnosis , Uterine Cervical Diseases/pathology , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/etiology , Uterine Cervical Dysplasia/pathology , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/pathology , Vaginal Diseases/diagnosis , Vaginal Diseases/pathology
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