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21.
Doppler ultrasound and contrast-enhanced magnetic resonance angiography in assessing carotid artery stenosis 总被引:3,自引:0,他引:3
D'Onofrio M Mansueto G Faccioli N Guarise A Tamellini P Bogina G Pozzi Mucelli R 《La Radiologia medica》2006,111(1):93-103
PURPOSE: This study prospectively compares Doppler ultrasound (Doppler US) and contrast-enhanced magnetic resonance angiography (CE-MRA) with digital subtraction angiography (DSA) and endarterectomy findings to determine the accuracy in assessing carotid artery stenosis. MATERIALS AND METHODS: Thirty-two patients underwent carotid endarterectomy, 21 studied with Doppler US, CE-MRA and DSA and 11 with Doppler US and CE-MRA. In 41 carotid arteries, the degree of stenosis was analysed with Doppler US and CE-MRA and compared with DSA by using the Spearman rank correlation coefficient. Nine out of 32 endarterectomies were done using the eversion technique, and it was possible to compare Doppler US, CE-MRA and DSA with the specimen measurement. Twenty-three out of 32 endarterectomies were done using the standard technique, and the presence of ulcers was documented. RESULTS: There was a significant Doppler US/DSA (Rs=0.86; p<0.001) and CE-MRA/DSA (Rs=0.81; p<0.001) correlation for the degree of stenosis. The diagnostic accuracy of the three methods was the same (89%). Ulcers were most frequently seen at CE-MRA, with a diagnostic accuracy of 85%. CONCLUSIONS: These data suggest that endarterectomy on the basis of Doppler US and CE-MRA can be considered appropriate. CEMRA was the best noninvasive imaging modality to detect plaque ulceration. 相似文献
22.
The Authors describe a case of Freeman-Sheldon Syndrome, a rare congenital autosomal dominant disorder (gene mapped on chromosome 11p15.5) characterized by microstomia with crinkled lips, camptodactyly with ulnar deviation of the fingers and equinus-varus-supine clubfoot. The autosomal recessive form, even rarer and difficult to recognize, has a more severe clinical manifestation. The symptomatology is worsened by breathing and swallowing disorders due to the small orifices of the mouth and nose, which sometimes require tracheotomy to avoid obstruction of the airways. 相似文献
23.
Daniela Cologno Florindo d’Onofrio Teresa Esposito Fernando Gianfrancesco Vittorio Petretta Gerardo Casucci Fabio Frediani Maria Gabriella Buzzi Gennaro Bussone 《Neurological sciences》2008,29(2):113-115
Basilar-type migraine (BM) and hemiplegic migraine are clinically distinct subtypes of migraine with aura, however they do share clinical features and it is possible they may share genetic bases. In recent years, ATP1A2 and other gene mutations have been discovered in familial and sporadic hemiplegic migraine. More recently, an ATP1A2 mutation has been identified in an Italian family with BM. In this study we document the absence of ATP1A2 mutations in two Italian sisters with menstrual BM, suggesting that other genes are involved in the condition. 相似文献
24.
The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis. 相似文献
25.
Piero A. Pellegrino Ornella Milanesi Onofrio S. Saia Carla Carollo 《Child's nervous system》1987,3(3):141-144
Arteriovenous fistula is a relatively rare cause of severe congestive heart failure in the newborn. An intracranial arteriovenous malformation associated with an aneurysm of the great vein of Galen is the most frequent of such malformations and, although well known, it remains a difficult diagnosis in the neonate because the clinical picture first presents with findings suggesting cardiac disease. The newborn with a vein of Galen aneurysm has volume and pressure overload on his myocardium; cyanosis is often present due to persistent fetal circulation; peripheral pulses are generally decreased in amplitude except in those arteries near the fistula where they are bounding, as an expression of a hyperdynamic status. A continuous murmur may be heard over the scalp, but this highly suggestive sign is often not present. The majority of newborns with intracranial arteriovenous fistula die very soon. Unfortunately, most of these infants are at first considered to have congenital heart disease and are, therefore, subjected to cardiac catheterization and angiography, with their well-known risks, before a correct diagnosis is made. Cross-sectional echocardiography, by demonstrating normal intracardiac anatomy, eliminates the need for an invasive investigation in a very sick neonate. Ultrasonography of the head will then provide a rapid and accurate demonstration of the aneurysm of vein of Galen. Cerebral angiography will complete the diagnosis in those cases in which a neurosurgical intervention is contemplated. 相似文献
26.
Basmah Safdar Gail D’Onofrio James Dziura Raymond R. Russell Caitlin Johnson Albert J. Sinusas 《Clinical therapeutics》2017,39(1):55-63
Purpose
Coronary microvascular dysfunction (CMD) is a common but underdiagnosed cause of chest pain. Literature is scant regarding effective treatments. We explored the effect of ranolazine on coronary flow reserve (CFR) among symptomatic patients with CMD.Methods
This pilot double-blinded randomized controlled trial included emergency department patients with chest pain and CMD admitted to an observation unit between June 2014 and November 2015. Participants were assessed by cardiac Rb-82 positron emission tomography and computed tomography imaging at baseline and 30 days. CMD was defined as CFR <2 corrected for rate pressure product or <2.5 uncorrected, with no evidence of obstructive or nonobstructive coronary artery disease or calcification. Patients with infarction, hypertensive urgency, heart failure, or prescribed QTc-prolonging drugs were excluded. Participants were assigned to ranolazine or placebo in a 2:1 ratio. Primary outcome was change in CFR at 30 days.Findings
We enrolled 31 patients (71% female, mean [SD] age 50 [6] years) with CMD (mean [SD] corrected CFR 1.6 [0.3]). Ranolazine improved CFR at 30 days by 17% (P = 0.005) compared with 0% with placebo (P = 0.67). However, there was no significant difference in the primary outcome as measured by mean change in CFR (0.27 ranolazine compared with 0.06 placebo; 95% CI, ?0.08 to 0.62).Implications
The emergency department offers a unique venue to diagnose CMD with acute symptoms. In an exploratory randomized controlled trial of symptomatic patients with CMD and no coronary artery disease, promising results were seem with ranolazine and CFR improving at 30 days. Large robust clinical trials are needed to verify improvement of CMD in a sex-specific model. ClinicalTrials.gov identifier NCT02052011. 相似文献27.
Edward H. Cooper Onofrio Campobasso 《International Journal of Clinical & Laboratory Research》1976,6(1):1-12
Summary This article reviews the high incidence of colon cancer in Western countries; the contribution of cell biology and biochemistry
to our knowledge of the behaviour of the disease is discussed. The use of a series of markers to obtain early evidence of
metastasis and to make the prognosis is described. Some suggestions are made how to obtain improvements in the survival percentages. 相似文献
28.
DAndrea Giovanni Ostuzzi Roberto Francesconi Federica Musco Francesca Bolner Andrea dOnofrio Florindo Colavito Davide 《Neurological sciences》2009,30(1):55-57
Acute hemorrhagic leukoencephalitis (AHL) is a rare demyelinating disease mainly affecting children, characterized by acute
onset, progressive course and high mortality. A 62-year-old man was admitted to our Unit for diplopia and ataxia ensuing 2 weeks
after the onset of pneumonia. MRI T2-weighted images showed signal hyperintensities in the brainstem. Antibodies against Mycoplasma
Pneumoniae and cold agglutinins were found. Two weeks later the patient had a worsening of his conditions: he developed left
hemiplegia with motor focal seizures and the day after he was deeply comatose (GCS = 4). A second MRI scan showed extensive
hyperintensities involving the whole right hemisphere white matter with a small parietal hemorrhagic area. The clinical and
neuroimaging features suggested the diagnosis of AHL, Aciclovir in association with steroid therapy were administered and
then plasmapheresis was started. After 30 days of coma, the patient gradually reacquired consciousness and motor functions;
anyway a left hemiplegia persisted. 相似文献
29.
Piero Manfredi Pompeo Della Posta Alberto d’Onofrio Ernesto Salinelli Francesca Centrone Claudia Meo Piero Poletti 《Vaccine》2009
A threat for vaccination policies might be the onset of “rational” exemption, i.e. the family's decision not to vaccinate children after a seemingly rational comparison between the perceived risk of infection and the perceived risk of vaccine side effects. We study the implications of rational exemption by models of vaccination choice. By a simple model of individual choice we first prove the “elimination impossible” result in presence of informed families, i.e. aware of herd immunity, and suggest that limited information might explain patterns of universal vaccination. Next, we investigate vaccination choice in a game-theoretic framework for communities stratified into two groups, “pro” and “anti” vaccinators, having widely different perceived costs of infection and of vaccine side effects. We show that under informed families neither a Nash nor a Stackelberg behaviour (characterized, respectively, by players acting simultaneously and by an asymmetric situation with a “leader” and a “follower) allow elimination, unless “pro-vaccinators” assign no costs to vaccine side effects. Elimination turns out to be possible when cooperation is encouraged by a social planner, provided, however, he incorporates in the “social loss function” the preferences of anti-vaccinators only. This allows an interpretation of the current Italian vaccination policy. 相似文献
30.
Cologno Daniela Cicarelli Giulio Petretta Vittorio dOnofrio Florindo Bussone Gennaro 《Neurological sciences》2008,29(1):166-168
In order to assess the prevalence of Dopaminergic Premonitory Symptoms (DPS) in migraine patients with Restless Legs Syndrome (RLS), we chose migraine patients from a large Italian clinical headache population previously investigated for an association between primary headaches and RLS. We evaluated a total sample of 164 patients with migraine, in particular 114 with migraine without aura (MO), 10 with migraine with aura (MA) and 40 with MO and MA in various combinations between them or with episodic tension-type headache (ETTH), defined as a “mixed group”. About 20% of all migraine patients referred at least one of the following DPS: yawning, nausea, somnolence or food craving, confirming data already indicated in the literature. Among migraine patients with RLS (25.6%), DPS were referred from about half of the patients (47.6%) compared to those without RLS (47.6% vs. 13.1%; p<0.001). Based on migraine subtype, patients with MO referred DPS (26.3%) more frequently compared to the MA group and “mixed group” (12.0%, p<0.05), particularly in the presence of RLS (63.0% vs. 20.0%, p<0.01). No statistical differences were found between clinical and demographic data of the subgroups or related to medical conditions investigated (anxiety, depression, sleep disorders, body mass index). It is interesting that the chances of having RLS in migraine patients were more than 5 times higher in the presence of DPS. These results could support a hypothetical dopaminergic imbalance in RLS and migraine, as the dopamine is involved in the pathogenesis of both disorders and it is responsible for the migraine DPS reported above. 相似文献