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1.
Pediatr Surg Int ; 40(1): 65, 2024 Mar 04.
Article in English | MEDLINE | ID: mdl-38436753

ABSTRACT

INTRODUCTION: Diagnostic delay in Hirschsprung disease is uncommon. Different definitions have been proposed but that of a diagnosis achieved after 12 months of age seems to be the most reliable and resorted to. Some authors reported a worse outcome in case of delay. Our study aims at providing the most relevant features of a series of patients who received a delayed diagnosis of Hirschsprung disease. MATERIALS AND METHODS: All consecutive patients admitted to our Center with a delayed diagnosis of Hirschsprung diseases between January 2017 and July 2023 have been retrospectively enrolled. Demographic data, phenotype, genotype, surgical complications, and outcome were assessed and compared to those of literature. A number of variables were also compared to those of a series of patients admitted during the same study period without a delayed diagnosis. RESULTS: A total of 45 patients were included (16.4% out of a series of 346 patients with data regarding age at diagnosis). Male to female ratio was 3.1:1. Median age at diagnosis was 41 months with a wide variation (range between 17 months and 58 years). All patients but 2 suffered from classic rectosigmoid aganglionosis. Normal meconium passage (58%) was reported in a significantly higher number of patients compared to what observed in a series without diagnostic delay (p = 0.0140). All other variables (associated anomalies, preoperative enterocolitis, complications, and functional outcome) proved not to have statistically significant differences compared to a series of patients without a diagnostic delay. CONCLUSIONS: The results of our study underline that a significant percentage of patients are basically missed in the neonatal period mostly due to mild symptoms. Overall outcome does not differ from that of patients without diagnostic delay. Nonetheless, we underline the importance of a throughout investigation of all patients with meconium delay/failure and that of adopting a low threshold for performing rectal suction biopsies in constipated children to avoid misdiagnosis to serve the best for our patients.


Subject(s)
Hirschsprung Disease , Child , Infant, Newborn , Humans , Female , Male , Infant , Hirschsprung Disease/diagnosis , Hirschsprung Disease/surgery , Delayed Diagnosis , Retrospective Studies , Biopsy , Constipation
2.
Musculoskelet Surg ; 104(1): 43-48, 2020 Apr.
Article in English | MEDLINE | ID: mdl-30758765

ABSTRACT

PURPOSE: Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. MATERIALS AND METHODS: The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016. RESULTS: Out of a total of 4770 THA, 40 claims were received. Peripheral nerve injuries represent the first cause of litigation (37%), followed by infectious complications, leg length discrepancy, metallosis, dislocations of the implant and a case of deep vein thrombosis. From the analysis of the past trial judgment, complications such as nerve lesions and infections are almost always recognized, as a medical error, with a high percentage of claims settled. CONCLUSION: This study shows the necessity of preventive strategies to reduce the higher number of claims for malpractice in total hip arthroplasty. Some complications such as nerve injuries and infection are frequently considered directly dependent on physician's errors. Litigations can be reduced providing evidence of a diligent execution of the surgical procedure and of a proper postoperative management: the correct compilation of a specific informed consent and adequate doctor-patient communication.


Subject(s)
Arthroplasty, Replacement, Hip , Costs and Cost Analysis , Malpractice/economics , Malpractice/statistics & numerical data , Humans , Postoperative Complications/etiology , Retrospective Studies
3.
J Orthop Traumatol ; 20(1): 27, 2019 Jul 17.
Article in English | MEDLINE | ID: mdl-31317280

ABSTRACT

The advancement of technologies in orthopaedic surgery should provide the surgeon with precise and trustworthy support for pre-operative planning, intra-operative guidance and post-operative follow-up. The request for greater accuracy, predictable results and fewer complications, is the engine of digital evolution in pre-operative planning and computer-assisted surgery (CAS). It is an evolution rather than a revolution, and in the last few years these developments have begun to involve shoulder replacement surgery, too.


Subject(s)
Arthroplasty, Replacement, Shoulder/methods , Joint Diseases/surgery , Shoulder Joint/surgery , Surgery, Computer-Assisted/methods , Humans , Shoulder Joint/diagnostic imaging
4.
Eur J Orthop Surg Traumatol ; 28(5): 877-883, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29218649

ABSTRACT

INTRODUCTION: Secondary repair of flexor tendon injuries remain a challenging procedure for hand surgeons. Usually, secondary reconstruction should be performed by staged approach. When the tendon and pulley integrity are intact, tenolysis may be the first surgical option. One-/two-stage tendon grafts are suggested when the integrity of flexor tendon is compromised. Active tendon implants (Brunelli prostheses) may represent an efficient option in patients with a poor prognosis, as well as whenever classical techniques fail. Due to lack of literature about this second-line treatment, the authors present the experience of two different orthopedic departments with the permanent active tendon implant. MATERIALS AND METHOD: Nineteen consecutive patients with failed previous flexor tendons repairs were treated with active tendon implants between 2000 and 2011. The functional outcome of the patients was examined with a mean follow-up of 5.6 years, using Strickland assessment and QuickDASH. RESULTS: In 16 cases, the tendon implants were well tolerated and patients resulted satisfied with a QuickDASH score less than 33. Strickland score was fair to excellent in 10 patients. We registered adhesion complications in 3 cases. CONCLUSION: We can conclude that these prostheses represent an alternative to biological reconstructions and a potentially permanent procedure in complicated flexor tendon injuries. LEVEL OF EVIDENCE: Multicentric case series, Level IV.


Subject(s)
Hand Injuries/surgery , Prosthesis Implantation , Tendon Injuries/surgery , Tendons/surgery , Adolescent , Adult , Aged , Biocompatible Materials , Female , Humans , Male , Middle Aged , Nylons , Orthopedic Procedures/adverse effects , Orthopedic Procedures/methods , Prostheses and Implants , Prosthesis Design , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Reoperation , Silicon , Tissue Adhesions/etiology , Treatment Failure , Young Adult
5.
G Ital Med Lav Ergon ; 31(2): 149-53, 2009.
Article in Italian | MEDLINE | ID: mdl-19827274

ABSTRACT

INTRODUCTION: An integrated mental health surveillance program was developed by the department of occupational medicine at S. Chiara University Hospital in Pisa, Italy, in order to better assist and treat hospital staff suffering from psychiatric disorders in a preventive medical setting. MATERIAL AND METHODS: During the occupational medical surveillance of 4000 employees of S. Chiara Hospital in Pisa (Italy), 30 health care workers with psychiatric disorders were included in our program, which provided psycho-educational support and pharmacological treatment. Measures of effectiveness were: Clinical Global Impression (CGI scale) and a comparison between the average number of lost workdays due to mental illness before and after treatment. RESULTS: At the end of the observation period there was a decrease in the CGI severity score with a improved CGI score ranging from 1 to 2 and a reduction in absenteeism, from an annual average of 36.70 to 25.10 lost workdays. CONCLUSION: Our outcome measures data seem to indicate that a preventive medicine setting can offer effective psychiatric support that is better accepted and tolerated by health care workers and that this approach may reduce absenteeism.


Subject(s)
Health Personnel/statistics & numerical data , Mental Disorders/therapy , Population Surveillance , Psychotherapy/methods , Quality of Life , Surveys and Questionnaires , Absenteeism , Adult , Female , Follow-Up Studies , Humans , Italy/epidemiology , Male , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Middle Aged , Occupational Health Services , Outcome Assessment, Health Care , Psychiatric Status Rating Scales , Psychotropic Drugs/therapeutic use , Severity of Illness Index , Treatment Outcome
6.
Eur Rev Med Pharmacol Sci ; 13 Suppl 1: 55-62, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19530513

ABSTRACT

BACKGROUND: "Cancer stem cells" (CSC) have been identified as a minority of cancer cells responsible for tumor initiation, maintenance and spreading. Although a universal marker for CSC has not yet been identified, CD133 has been proposed as the hallmark of CSC in colon cancer. The aim of our study was to assess the presence of a CD133+ cell fraction in samples of colon cancer and liver metastasis from colon cancer and evaluate their potential as tumor-initiating cells. METHODS: Tissue samples from 17 colon cancers and 8 liver metastasis were fragmented and digested using collagenase. Cell suspensions were characterized by flow cytometry using anti-CD133, CD45 and CD31 antibodies. CD133+ cells were also isolated by magnetic cell sorting and their tumor-initiating potential was assessed versus the remaining CD133- fraction by soft-agar assay. RESULTS: Our results confirmed the existence of a subset of CD133+ tumor cells within human colon cancers. Interestingly, CD133+ cells were detectable in liver metastasis at a higher percentage when compared to primary tumors. Soft-agar assay showed that CD133+ cell fraction was able to induce larger and more numerous colonies than CD133-cells. CONCLUSION: Our findings data that the CD133+ colon cancer cells might play an important role in both primary tumors as well as in metastatic lesions thus warranting further studies on the role(s) of this subset of cells in the metastatic process.


Subject(s)
Antigens, CD/metabolism , Biomarkers, Tumor/analysis , Colonic Neoplasms/pathology , Glycoproteins/metabolism , Liver Neoplasms/pathology , Neoplastic Stem Cells/metabolism , Peptides/metabolism , AC133 Antigen , Aged , Female , Flow Cytometry , Humans , Liver Neoplasms/secondary , Male , Middle Aged , Tumor Stem Cell Assay
7.
G Ital Med Lav Ergon ; 29(3 Suppl): 765-7, 2007.
Article in Italian | MEDLINE | ID: mdl-18409949

ABSTRACT

Recently, Tuscany regional government has promulgated (Regional law n. 464/07) guidelines for setting up suitable sanitary rooms for patients allergic to latex. These guidelines enforced the managers of the Tuscany Local Health Units to promote educational activities and a correct methodology for the safe management of both health workers and patients who need latex-free diagnostical and/or therapeutical procedures. An other Regional law (n.345/05) had previously enforced all the Tuscany Local Health Units managers to implement and update a Registry of every latex-allergic patients ever hospitalized in their own local facilities. Since 2002 a multi-disciplinary task force of health operators, lead by the Preventive Medicine Section, has been elaborating and implementing a plan for the safety of latex-allergic patients of the Pisa University Hospital, along with a Registry where each of these patients were recorded. Moreover, since 2005 under the responsabilities of the staff of the Preventive Medicine Section, another Registry has been implemented and updated. In this Registry all the Hospital employees who have been diagnosed a latex allergy, through the medical exams performed within the occupational medical surveillance activity, have been filed. In this study we report the results of this preventive activity both aimed at patients and heatlh operators safety.


Subject(s)
Health Personnel , Latex Hypersensitivity/prevention & control , Occupational Diseases/prevention & control , Hospitals, University , Humans , Italy , Preventive Medicine/standards , Registries
8.
Dig Liver Dis ; 38(8): 563-77, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16807150

ABSTRACT

BACKGROUND AND AIM: Kupffer cells are intrasinusoidal space located macrophages with phagocytic capacity. Interferons are cytokines with antiviral, antiproliferative and immunomodulatory activities which may influence the activity of Kupffer cells. Aim of this study was to evaluate Kupffer cell gene expression after interferon-alpha or interferon-gamma stimulation in order to investigate a link between these cytokines and macrophage activation. METHODS: Rat Kupffer cells were cultured for 24 h and divided into three groups: unstimulated; stimulated with interferon-alpha and stimulated with interferon-gamma. After 8 h stimulation total RNA was extracted and processed according to Affymetrix protocols and hybridised on R34A microarray gene set. Data analyses was performed using Microarray Analysis Suite 5.0 software. Genes showing remarkably different expression in microarray analysis were confirmed by real-time PCR. RESULTS: Nearly 4000 out of the 8800 genes represented in the array were expressed by Kupffer cells. Among these, interferon-alpha up-regulates 91 genes by over two-fold (antiviral, antigen processing and presentation, and tumour suppressor/proapoptotic genes) and down-regulates 72 genes by 50% or more. Interferon-gamma up-regulates 70 genes by over two-fold and down-regulates 78 genes by 50% or more. Most of the genes induced by interferon-alpha are also induced by interferon-gamma. Down-regulated genes include growth factors and genes involved in cell cycle/proliferation. Real-time PCR confirms the results of the array. CONCLUSION: Interferons directly target rat Kupffer cells and are involved in the regulation of a wide variety of genes. Their expression profile shed light onto molecular mechanism of Kupffer cells activation in specific pathways such as antiviral and antitumour processes.


Subject(s)
Antiviral Agents/pharmacology , Gene Expression Profiling , Immunologic Factors/pharmacology , Interferon-alpha/pharmacology , Interferon-gamma/pharmacology , Kupffer Cells/drug effects , Animals , Apoptosis/drug effects , Apoptosis/genetics , Cell Cycle/drug effects , Cell Cycle/genetics , Cell Proliferation/drug effects , Cells, Cultured , Cytokines/drug effects , Cytokines/genetics , Down-Regulation/drug effects , Female , Genes, Tumor Suppressor/drug effects , Immunity, Cellular/drug effects , Immunity, Cellular/genetics , Immunologic Factors/genetics , Macrophage Activation/drug effects , Macrophage Activation/genetics , Oligonucleotide Array Sequence Analysis , Phagocytosis/drug effects , Phagocytosis/genetics , RNA, Messenger/drug effects , RNA, Messenger/genetics , Rats , Rats, Wistar , Reverse Transcriptase Polymerase Chain Reaction , Signal Transduction/drug effects , Signal Transduction/genetics , Transcription Factors/drug effects , Transcription Factors/genetics , Up-Regulation/drug effects
9.
Aliment Pharmacol Ther ; 23(11): 1567-74, 2006 Jun 01.
Article in English | MEDLINE | ID: mdl-16696804

ABSTRACT

BACKGROUND: Aminosalicylates are the mainstay of therapy to prevent relapse of quiescent ulcerative colitis. The rationale for using probiotics is based on the evidence implicating intestinal bacteria in the pathogenesis of this disorder. AIM: To evaluate the efficacy of Lactobacillus GG alone or in combination with mesalazine vs. mesalazine as maintenance treatment in ulcerative colitis. PATIENTS AND METHODS: 187 ulcerative colitis patients with quiescent disease were randomized to receive Lactobacillus GG 18 x 10(9) viable bacteria/day (65 patients), mesalazine 2400 mg/day (60 patients) or Lactobacillus GG + mesalazine (62 patients). Disease activity index, endoscopic and histological scores were determined at 0, 6 and 12 months and in case of relapse. The primary end point was to evaluate sustained remission. RESULTS: Overall analysis showed no difference in relapse rate at 6 (P = 0.44) and 12 months (P = 0.77) among the three treatment groups. However, the treatment with Lactobacillus GG seems to be more effective than standard treatment with mesalazine in prolonging the relapse-free time (P < 0.05). CONCLUSIONS: Lactobacillus GG seems to be effective and safe for maintaining remission in patients with ulcerative colitis, and it could represent a good therapeutic option for preventing relapse in this group of patients.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Colitis, Ulcerative/therapy , Lactobacillus , Mesalamine/therapeutic use , Probiotics/therapeutic use , Adult , Drug Therapy, Combination , Female , Humans , Male , Prospective Studies , Secondary Prevention , Treatment Outcome
10.
Transplant Proc ; 37(6): 2711-4, 2005.
Article in English | MEDLINE | ID: mdl-16182791

ABSTRACT

BACKGROUND AND AIM: Tissue homeostasis and turnover require reserve stem proliferating cells. Several studies performed on immunodeficient animals have suggested a degree of plasticity by the hematopoietic stem cell compartment that may represent source for liver regeneration. We sought to explore the hepatic differentiation potential of hematopoietic stem cells from human cord blood, after toxic liver damage induced by allyl-alcohol in immunocompetent rats. MATERIALS AND METHODS: Wistar rats were divided into groups (A) allyl-alcohol intraperitoneal injection with hematopoietic stem cell intraperitoneal infusion at 1 day and sacrifice 3 days later; (B) stem cell injection and sacrifice 3 days later; (C) allyl-alcohol infusion and sacrifice 4 days later; and (D) sacrifice without any treatment. Livers, spleens, and bone marrows were analysed for human stem cells using flow-cytometry; livers were also tested by histology and immunohistochemistry to study the pattern of hepatic regeneration after damage and human stem cell conversion into hepatocyte-like cells, respectively. RESULTS: Flow-cytometry revealed selective recruitment of human hematopoietic stem cells by damaged livers (group A) compared with control group B. In addition, liver damage was reduced in animals treated with stem cells. Immunohistochemistry demonstrated that human stem cells could convert hepatic cells. CONCLUSIONS: Our study demonstrated that hematopoietic stem cells selectively recruited by injured livers can contribute to hepatic regeneration after acute toxic damage in immunocompetent recipients.


Subject(s)
Chemical and Drug Induced Liver Injury , Cord Blood Stem Cell Transplantation/methods , Liver Diseases/therapy , Propanols/toxicity , Transplantation, Heterologous/methods , Animals , Disease Models, Animal , Flow Cytometry , Humans , Immunohistochemistry , Kupffer Cells/drug effects , Kupffer Cells/pathology , Liver Diseases/pathology , Rats , Rats, Wistar
11.
Transplant Proc ; 37(6): 2547-50, 2005.
Article in English | MEDLINE | ID: mdl-16182739

ABSTRACT

BACKGROUND AND AIM: Molecular adsorbent recycling system (MARS) treatment is able to remove both hydrosoluble and small- and medium-sized lipophilic toxins. MARS plays an important role in modifying liver failure complications, such as hepatorenal syndrome and hepatic encephalopathy. We sought to evaluate the clinical efficacy and safety of a MARS device in a consecutive series of hepatic failure patients. MATERIALS: Twenty patients with acute liver failure, transplantation failure, or acute on chronic liver failure fulfilled the inclusion criteria of total bilirubin > or =10 mg/dL and at least one of the following: hepatic encephalopathy (HE) > or =II grade, hepatorenal syndrome (HRS) for chronic patients or total bilirubin > or =5 mg/dL and HE > or =I grade for acute patients. RESULTS: MARS was able to reduce cholestatic parameters and improve neurologic status and renal function parameters in all treated patients. We also observed an improvement in the 3-month survival rate compared to the expected outcome in patients with MELD scores between 20 and 29, as well as 30 and 39. CONCLUSIONS: Based on these results, we confirm the safety and clinical efficacy of MARS treatment, with the best results in patients with MELD score of 20 to 29. Further studies are necessary to confirm whether this treatment is able to modify patient outcomes and prognosis.


Subject(s)
Hemodiafiltration/methods , Liver Failure/therapy , Liver, Artificial , Bilirubin/blood , Chronic Disease , Female , Hepatic Encephalopathy/therapy , Hepatorenal Syndrome/therapy , Humans , Liver Failure/etiology , Liver Failure/mortality , Liver Failure, Acute/etiology , Liver Failure, Acute/mortality , Liver Failure, Acute/therapy , Male , Middle Aged , Retrospective Studies , Sorption Detoxification/methods , Survival Analysis
12.
Transplant Proc ; 37(6): 2551-3, 2005.
Article in English | MEDLINE | ID: mdl-16182740

ABSTRACT

BACKGROUND AND AIM: The clearance of plasma cytokines by means of albumin dialysis (MARS) has been demonstrated in various studies involving patients affected by either acute liver failure (ALF) or acute on chronic liver failure. The aim of the study was to measure the plasma levels of TNF-alpha, IL-6, and IL-1beta in patients with ALF after each MARS treatment to evaluate the relationship between variations in cytokines levels and patient prognosis. MATERIALS AND METHODS: Ten patients with ALF undergoing several MARS treatments were enrolled (group 1). Blood samples were collected before and after each MARS treatment to measure TNF-alpha, IL-6, and IL-1beta, and other hematochemical parameters. We also enrolled 10 patients with ALF who underwent standard therapy (group 2) as well as a control group of 10 healthy subjects matched for sex and age (group 3). RESULTS: MARS reduced total bilirubin levels, biliary acids, BUN, ammonia, TNF-alpha, IL-6, and IL-1beta (P < .05). Moreover, the reduction in inflammatory cytokines levels and improved prognosis were related. CONCLUSIONS: We confirmed the therapeutic efficacy of MARS treatment for ALF, which appeared to be related to removal of toxins and inflammatory cytokines determine that which patients prognosis.


Subject(s)
Bilirubin/blood , Cytokines/blood , Liver Failure, Acute/therapy , Liver Failure/therapy , Renal Dialysis/methods , Sorption Detoxification/methods , Adult , Ammonia/blood , Child, Preschool , Chronic Disease , Female , Humans , Interleukins/blood , Male , Middle Aged , Tumor Necrosis Factor-alpha/analysis
13.
Transplant Proc ; 37(6): 2662-3, 2005.
Article in English | MEDLINE | ID: mdl-16182777

ABSTRACT

Among the different approaches for diabetes mellitus-pancreas and pancreatic islet transplantation-the use of stem cells represent a renewable alternative source of insulin-producing cells. Stem cells capable of differentiating into beta-like cells can be isolated namely from embryonic cells, bone marrow, and umbilical cord blood, but also from adult organs such as pancreas, liver, and spleen. Several studies have demonstrated that by manipulating culture conditions and using growth and transcription factors of beta-cell lineage (in particular pdx-1 and pax4), embryonic stem cells can differentiate in vitro after formation of embryoid bodies. Bone marrow stem cells can give rise to mesenchymal; endodermal-, and ectodermal-derived cells. In vivo it has been shown that after bone marrow transplantation, using a murine sex-mismatched model, insulin-producing cells expressing the Y chromosome can be detected in the donor pancreas, although not in a significantly number. Cells characterized by a group of markers (Nestin, CK-8, CK-18) and transcription factors (Isl-1, Pdx-1, Pax-4, Ngn-3) important for beta-cell differentiation have been detected in umbilical cord blood. The recent evidence of the possibility to transdifferentiate stem cells to beta cells encourages further studies in animal models to exhaustively determine the differentiation pathways of stem cells to insulin producing cells. These findings might open the way to a successful human investigation.


Subject(s)
Pancreas/cytology , Stem Cells/cytology , Adult , Cell Differentiation , Diabetes Mellitus, Type 1/surgery , Humans , Islets of Langerhans Transplantation , Safety , Stem Cell Transplantation
14.
Eur Rev Med Pharmacol Sci ; 9(6): 315-24, 2005.
Article in English | MEDLINE | ID: mdl-16479735

ABSTRACT

Adult stem cells (ASC) have becoming a great domain of research by their promising interest for the regenerative medicine. For some years, the number of publications has been increasing, displaying the potential of ASC to differentiate in all tissue-lineages, challenging the previous dogma that ASC were restricted to give rise only to specific cells from their tissue of origin. Among the diversity of ASC, hematopoietic stem cells (HSC) have been the most studied and their use in the clinical setting is largely documented. Commonly, HSC have been harvested from the bone marrow, but for some years, two others sources, the peripheral blood and the umbilical cord blood have been introduced. All these HSC posses their own molecular characteristics and degree of maturity and represent a more or less good candidate to participate in the cellular-based tissue regeneration. We have reviewed the different parameters allowing to define which subset could be the more favorable such as the accessibility to the pool of HSC; the quantity of available cells; the tolerability of host-engraftment and the capacity of the cells to home correctly to the required site of damaged. Besides, recently, the molecular profiling of HSC has allowed identifying which subset posses the more promising characteristics.


Subject(s)
Stem Cell Transplantation/methods , Stem Cells/cytology , Animals , Bone Marrow Cells/cytology , Fetal Blood/cytology , Hematopoietic Stem Cells/cytology , Humans , Regenerative Medicine/methods , Stem Cell Transplantation/classification , Stem Cell Transplantation/standards
15.
J Hum Hypertens ; 16(6): 439-44, 2002 Jun.
Article in English | MEDLINE | ID: mdl-12037702

ABSTRACT

The objective of this study was to investigate stay-on-therapy patterns over 3 years among patients prescribed different classes of antihypertensive drugs for the first time. A retrospective analysis of information recorded in the drugs database of the Local Health Unit of Ravenna (Italy) was carried out on 7312 subjects receiving a first prescription for diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II antagonists between 1 January and 31 December 1997. Patients were followed up for 3 years. All prescriptions of antihypertensive drugs filled during the follow-up periods were considered. The patients continuing or discontinuing the initial treatment, the duration of treatment, and the doses taken were all calculated, as well as main factors influencing the persistence rate. The drugs prescribed were predominantly ACE-inhibitors, followed by calcium channel blockers, diuretics, beta-blockers and angiotensin II antagonists. A total of 57.9% of patients continued their initial treatment during the 3-year follow-up period, 34.5% discontinued the treatment, whilst 7.6% were restarted on a treatment in the third year. Persistence with treatment was influenced by: age of patient (persistence rate increasing proportionately with advancing years), type of drug first prescribed (persistence rate higher with angiotensin II antagonists, progressively lower with ACE-inhibitors, beta-blockers, calcium channel blockers and diuretics), gender of patient (persistence was better in males), age of general practitioner (GP) (the younger the GP, the better the persistence rate) and gender of GP (better stay-on-therapy rate with male GP prescribing). In the case of patients treated continuously, mean daily dose increased progressively over the 3 years. With adequate markers, helpful data can be collected from prescription claims databases for the purpose of monitoring the persistence of patients in continuing their medication, and the quality of antihypertensive treatment in a general practice setting.


Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Patient Compliance/psychology , Female , Humans , Italy , Male , Middle Aged , Proportional Hazards Models , Retrospective Studies , Time Factors
16.
Int J Clin Pharmacol Res ; 15(1): 27-32, 1995.
Article in English | MEDLINE | ID: mdl-7490172

ABSTRACT

Sixteen patients with RA (3 males, 13 females), diagnosed according to RA revised criteria, were selected and entered the study. They underwent six intra-articular injections of 750 mcg of SST14 at 15-day intervals. The thickness of the synovial membrane (SM) was measured with a 5-MHz linear sound with longitudinal and transversal scanning carried out on the upper patellar cavity. The contralateral knee was also assessed together with the injected knee in order to ascertain any systemic effect of the drug. A significant reduction of SM thickness was observed already at the first control (T3) in 14 out of 16 patients. At the 5th and 6th injections (T5 and T6) the reduction was still significant but to a lower extent. In 8 out of 16 cases a reduction of SM thickness was observed in the contralateral knee. Analysis of these data clearly shows that the intra-articular injection of SST14 is able to reduce the thickness of SM in patients with RA, and indicates that SST14 may directly reduce synovitis. This particularity has been detected in our work with a non-invasive technique such as the joint ultra-sound (US). In conclusion, our work confirms the efficacy of SST14 in the control of RA synovial hypertrophy and the reliability of US technique in the measurement of SM thickness.


Subject(s)
Arthritis, Rheumatoid/diagnostic imaging , Arthritis, Rheumatoid/drug therapy , Hormone Antagonists/therapeutic use , Somatostatin/therapeutic use , Synovial Membrane/diagnostic imaging , Female , Hormone Antagonists/administration & dosage , Humans , Injections, Intra-Articular , Knee Joint/diagnostic imaging , Male , Middle Aged , Somatostatin/administration & dosage , Ultrasonography
17.
Clin Ter ; 145(12): 463-7, 1994 Dec.
Article in Italian | MEDLINE | ID: mdl-7720354

ABSTRACT

19 patients with RA underwent six intraarticular injections of 750 micrograms of Somatostatin 14 in one knee at 15-day intervals. In all patients some clinical parameters were evaluated: articular function, pain on pressure, spontaneous pain, pain on movement, duration of morning stiffness. Also some laboratory parameters were examined: complete blood cell count, ESR and CRP. An overall and significant improvement of the symptomatology of the treated knee was seen in all patients especially after the 3rd infiltration and still more after the 5th. At follow up 3 months after the end of treatment 12 patients were controlled, 11 of these showed a persistence of the improvement. No side-effects were seen.


Subject(s)
Arthritis, Rheumatoid/drug therapy , Somatostatin/administration & dosage , Female , Humans , Injections, Intra-Articular , Male , Middle Aged
18.
Pediatr Med Chir ; 6(1): 161-3, 1984.
Article in Italian | MEDLINE | ID: mdl-6531238

ABSTRACT

It is described a case of a Aicardi's syndrome: it is a question of a child observed for the first time when she was 3 months old in these was gived: alterations of the callosum corpus, and of the cerebellar vermis, ocular desed, epileptics convulsions and electroencephalographics alterations of ipsaritmic type.


Subject(s)
Agenesis of Corpus Callosum , Eye Diseases/diagnosis , Spasms, Infantile/diagnosis , Electroencephalography , Female , Humans , Infant , Syndrome , Tomography, X-Ray Computed
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