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Franceschini G, Talevi G, Maso S, Comparcini D, Porfiri M, Cicolini G, Simonetti V. Home-care educational interventions to prevent complications in patients with Ventricular Assist Devices: a systematic review. Ann Ig 2024; 36:41-59. [PMID: 37885355 DOI: 10.7416/ai.2023.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background The implantation of ventricular assist devices is the only effective alternative to cardiac transplantation in patients with chronic heart failure, in terms of survival and quality of life. However, their implantation can lead to physical and psychological complications, potentially preventable, especially in the long term, through patients' education. This research aimed to summarize the current best evidence on educational strategies towards patients after implantation of ventricular assist devices, in home-care setting, to reduce the major related complications, namely driveline infections, gastrointestinal bleeding and psychological complications. Study Design Systematic review. Methods Title and abstract selection, full-text screening, study quality assessment, and data extraction followed the PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions. The search was conducted through consultation of databases such as Medline, Scopus, EMBASE, and Web of Science, during the period from March 2022 to December 2022, in relation to English-language articles, from search strings processing and inclusion and exclusion criteria. Results Of the 1,231 items identified, 9 were selected because consistent with the inclusion criteria. The most effective educational interventions toward patients with ventricular assist devices were identified, delivered by multidisciplinary teams coordinated by a professional expert in management of ventricular assist devices, and regularly conducted. In particular, gastrointestinal bleeding and driveline infections could be prevented and reduced by complex, multimodal educational interventions, including telephone and app interventions. Educational strategies based on verbal instructions, hands-on demonstrations, innovative technologies, and active involvement of families/caregivers were particularly effective in preventing psychological complications. Conclusions Investing time and resources in educating patients with ventricular assist devices is mandatory, given the significant impact of educational outcomes on complications' reduction. Moreover, educational interventions geared towards patient's psychological well-being, brings positive outcomes on patient's compliance too, resulting in promising clinical outcomes. However, more in-depth research is needed, to support professionals in developing effective educational plans for such fragile and complex patients.
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Affiliation(s)
- G Franceschini
- Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - G Talevi
- Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - S Maso
- Azienda ULSS3 Serenissima, Venezia, Italy
| | - D Comparcini
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - M Porfiri
- Department of Management, Università Politecnica delle Marche, Ancona, Italy
| | - G Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - V Simonetti
- LUM University "Giuseppe Degennaro", Casamassima, Bari, Italy
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Tomietto M, Comparcini D, Simonetti V, Papappicco CAM, Stefanizzi P, Mercuri M, Cicolini G. Attitudes toward COVID-19 vaccination in the nursing profession: validation of the Italian version of the VAX scale and descriptive study. Ann Ig 2022; 34:572-584. [PMID: 35142334 DOI: 10.7416/ai.2022.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
FOREWARD Nurses' attitudes towards COVID-19 vaccination is a relevant issue, for the protection of the vulnerable people they care for, and the key role they play in promoting health behaviors that encourage trust and adherence to vaccination among population. This study aimed to validate the Italian version of the Vaccination Attitudes Examination (VAX) scale and to describe nurses' attitudes towards COVID-19 vaccination. DESIGN A cross-sectional study was carried out from May to June 2021. Descriptive statistics, Explorative and Confirmatory Factor Analyses have been performed. METHODS An online survey was carried out in Italy. The VAX scale referring to the COVID-19 vaccine was used. FINDINGS 430 nurses participated in the study, mainly female (73.2%). Mean age was 40.2 years. VAX scale revealed an optimal reliability; Exploratory Factor Analysis and Confirmatory Analysis supported a 4-factors model. VAX scale mean scores showed low mistrust about vaccine's benefit (2.03±1.07), concerns about commercial profiteering (2.33±1.39) and preference for natural immunity (2.90±1.37). More worries concerning unexpected future effects were found (4.46±1.36). Gender, taking care of a frail person in family, having children or working in a COVID-19 setting are no significantly related to vaccination attitude. Participants from northern Italy expressed greater confidence in vaccine's benefits, the younger had significant lower scores about commercial profiteering. CONCLUSIONS The Italian version of the VAX scale resulted a reliable tool to assess the nurses' attitudes towards COVID-19 vaccination. An overall positive nurses' attitude towards the COVID-19 vaccination was highlighted. The concern about unforeseen future effects suggested the need to increase the information on this issue. CLINICAL RELEVANCE The results provided a valid and reliable tool to measure vaccination attitudes in the Italian context. This study could strengthen the health policies with educational interventions of healthcare workers through specific vaccination pathways. The healthcare professionals' vaccination attitudes play the key role also in promoting vaccination uptake in the population.
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Affiliation(s)
- M Tomietto
- Full Professor, Department of Nursing, Midwifery and Health, Faculty of Health Sciences, Northumbria University, New-castle Upon Tyne, UK
| | - D Comparcini
- Ward Manager, Azienda Ospedaliera Universitaria "Ospedali Riuniti", Ancona, Italy
| | - V Simonetti
- Research Fellow, Department of Biomedical Science and Human Oncology, University "Aldo Moro" of Bari, Italy
| | - C A M Papappicco
- Department of Intensive Respiratory Care Unit, San Paolo Hospital of Bari, Italy
| | - P Stefanizzi
- Researcher, Department of Biomedical Science and Human Oncology, University "Aldo Moro" of Bari, Italy
| | - M Mercuri
- Nurse Director, Degree Course in Nursing of Ancona, Politecnica delle Marche University, Ancona, Italy
| | - G Cicolini
- Researcher, Department of Biomedical Science and Human Oncology, University "Aldo Moro" of Bari, Italy
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Valdenassi L, Rossi E, Corsetti MT, Sarli R, Bellardi D, Chirumbolo S, Simonetti V, Pandolfi S, Franzini M. Sjögren syndrome successfully treated with oxygen-ozone auto-hemotherapy (O2-O3-AHT). a case report. Eur Rev Med Pharmacol Sci 2022; 26:5911-5917. [PMID: 36066166 DOI: 10.26355/eurrev_202208_29530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Sjögren syndrome (SS) is an autoimmune disorder, affecting about 16,000 individuals in Italy, yet lacking a standardized therapy protocol and a plain inclusion in the reimbursed healthcare services. This raises many controversial issues about how managing the SS patient, to relief pain and discomfort and improve patients' health and social life. The ozone therapy resulted successful in previous reports, and therefore, it was used in this case report. CASE PRESENTATION A 69-years old female outpatient, showing positivity to Schirmer's test, was previously diagnosed as a primary Sjögren syndrome, who later developed an autoimmune thyroiditis and showed the presence of rheumatoid factors. The patient suffered from a marked ocular dryness, subsequently to a purported endothelitis, alongside with fatigue and pain. Laboratory tests showed a positive ANA 1:320 in a speckled pattern with negative anti-SSA and anti-SSB tests. From December 2020 to January 2021 she underwent 2 routes of three sessions of oxygen-ozone autohemotherapy (O2-O3 AHT), as described below and improved, with only 2 sessions, her symptomatology and clinical outcome, as ocular dryness, fatigue and pain, rapidly disappeared. CONCLUSIONS The use of ozone in the therapy of SS is a straightforward, affordable and feasible approach to treat primary Sjögren syndrome without significant side effects.
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Affiliation(s)
- L Valdenassi
- Italian Society of Oxygen-Ozone Therapy (SIOOT), Gorle (BG), Italy.
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Chirumbolo S, Simonetti V, Valdenassi L, Pandolfi S, Vaiano F, Franzini M. Editorial - A practical assessment to prevent serious complications in the use of a gaseous mixture of oxygen-ozone injected by needle-mediated infiltration. Eur Rev Med Pharmacol Sci 2022; 26:2224-2226. [PMID: 35442506 DOI: 10.26355/eurrev_202204_28452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- S Chirumbolo
- Oxygen-Ozone Therapy Scientific Society (SIOOT), Gorle, Italy; SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Italy; SIOOT INTERNATIONAL, Communian Clinic, Gorle Bergamo, Italy.
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Viapiana P, Simonetti V, Costa W, de Castro Ribeiro Heber S, Diniz Alessandro L, Antonio Cury F, Farias I, Godoy A, Fernandez Coimbra Felipe J. P-262 Multivisceral resections for gastric cancer - Should all patients with locally-disease receive them? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Viapiana P, Costa W, de Castro Ribeiro Heber S, Jesus Victor H, Mello Celso L, Freitas H, Simonetti V, Antonio Cury F, Godoy A, Farias I, Diniz Alessandro L, Fernandez Coimbra Felipe J. P-094 Early and long-term outcomes of gastric cancer patients treated with perioperative chemotherapy and radical surgery in a single cancer center. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moscarella E, Ricci C, Borgognoni L, Bottoni U, Catricalà C, Dika E, Fanti PA, Landi C, Manganoni AM, Pellacani G, Peris K, Pimpinelli N, Quaglino P, Richetta A, Simonetti V, Stanganelli I, Testori A, Zalaudek I, Argenziano G. Follow-up of cutaneous melanoma patients: a proposal for standardization. GIORN ITAL DERMAT V 2014; 149:633-638. [PMID: 24938723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- E Moscarella
- Dermatology and Skin Cancer Unit Arcispedale S. Maria Nuova, IRCCS Reggio Emilia, Italy -
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Molinari F, Simonetti V, Franzini M, Pandolfi S, Vaiano F, Valdenassi L, Liboni W. Ozone autohemotherapy induces long-term cerebral metabolic changes in multiple sclerosis patients. Int J Immunopathol Pharmacol 2014; 27:379-89. [PMID: 25280029 DOI: 10.1177/039463201402700308] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ozone autohemotherapy is an emerging therapeutic technique that is gaining increasing importance in treating neurological disorders. A validated and standard methodology to assess the effect of such therapy on brain metabolism and circulation is however still lacking. We used a near-infrared spectroscopy (NIRS) system to monitor the cerebral metabolism and a transcranial Doppler (TCD) to monitor the blood flow velocity in the middle cerebral arteries. Fifty-four subjects (32 neurological patients and 22 controls) were tested before, during, and after ozone autohemotherapy. We monitored the concentration changes in the level of oxygenated and deoxygenated haemoglobin, and in the level of the Cytochrome-c-oxidase (CYT-c). As a primary endpoint of the work, we showed the changes in the brain metabolism and circulation of the entire population. The concentration of oxygenated haemoglobin increased after the reinjection of the ozoned blood and remained higher than the beginning for another 1.5 hours. The concentration of the deoxygenated haemoglobin decreased during the therapy and the CYT-c concentration markedly increased about 1 hour after the reinjection. No significant changes were observed on the blood flow velocity. As secondary endpoint, we compared the NIRS metabolic pattern of 20 remitting-relapsing multiple sclerosis (MS) patients against 20 controls. We showed that by using only 7 NIRS variables it was possible to characterize the metabolic brain pattern of the two groups of subjects. The MS subjects showed a marked increase of the CYT-c activity and concentration about 40 minutes after the end of the autohemotherapy, possibly revealing a reduction of the chronic oxidative stress level typical of MS sufferers. From a technical point of view, this preliminary study showed that NIRS could be useful to show the effects of ozone autohemotherapy at cerebral level, in a long-term monitoring. The clinical result of this study is the quantitative measurement of the CYT-c level changes in MS induced by ozone autohemotherapy.
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Affiliation(s)
- F Molinari
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | | | - M Franzini
- Italian Society for Oxygen and Ozone Therapy, Bergamo, Italy
| | - S Pandolfi
- Italian Society for Oxygen and Ozone Therapy, Bergamo, Italy
| | - F Vaiano
- Italian Society for Oxygen and Ozone Therapy, Bergamo, Italy
| | - L Valdenassi
- Italian Society for Oxygen and Ozone Therapy, Bergamo, Italy
| | - W Liboni
- "Un passo insieme" ONLUS Foundation, Torino, Italy
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Sgouros D, Lallas A, Julian Y, Rigopoulos D, Zalaudek I, Longo C, Moscarella E, Simonetti V, Argenziano G. Assessment of SIAscopy in the triage of suspicious skin tumours. Skin Res Technol 2014; 20:440-4. [PMID: 24517201 DOI: 10.1111/srt.12138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Spectrophotometric Intracutaneous Analysis (SIAscopy) is a non-invasive, computerized technique for the diagnosis of pigmented skin tumours. The analysis is based on the evaluation of skin chromophores, i.e. melanin, haemoglobin and collagen within the epidermis and papillary dermis. Our aim was to assess the diagnostic validity of SIAscopy in the detection of melanoma and non-melanoma skin cancers compared to the clinical-dermoscopic diagnosis and the histopathologic results of the excised lesions. METHODS In total, 188 lesions of 180 patients were examined by dermoscopy and SIAscopy. A SIAscopy scoring system was first compared with the clinical-dermoscopic diagnosis and then with the histopathologic diagnosis of the excised lesions. RESULTS With respect to the clinical-dermoscopic evaluation, SIAscopy had sensitivity and specificity values of 85.7% and 65.4% respectively. Of the 188 evaluated lesions, 44 were excised with histopathologic examination revealing 31 malignant tumours, including 18 melanomas. With respect to histopathology SIAscopy had a sensitivity of 83.9%. Seven of the 13 benign excised lesions were scored as malignant by SIAscopy resulting in a specificity of 46.1%. CONCLUSION SIAscopy cannot replace the standard of care in skin cancer diagnosis, which includes clinical and dermoscopic examination. However, considering that the technique does not require specific training and expertise, it might represent an additional, relatively cost-effective tool to select lesions for referral.
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Affiliation(s)
- D Sgouros
- Second Department of Dermatology, Athens University School of Medicine, Attikon General University Hospital, Chaidari, Athens, Greece
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Lintas G, Molinari F, Simonetti V, Franzini M, Liboni W. Time and time-frequency analysis of near-infrared signals for the assessment of ozone autohemotherapy long-term effects in multiple sclerosis. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:6171-6174. [PMID: 24111149 DOI: 10.1109/embc.2013.6610962] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ozone autohemotherapy is an emerging therapeutic technique that is gaining increasing importance in treating neurological disorders. A validated and standard methodology to assess the effect of such therapy on brain metabolism and circulation is however still lacking. We used a near-infrared spectroscopy system (NIRS) to monitor the cerebral oxygenation of 9 subjects: 4 remitting-relapsing multiple sclerosis (MS) sufferers and 5 controls. Subjects were tested before, during, and after ozone autohemotherapy. We monitored the concentration changes in the level of oxygenated and deoxygenated haemoglobin, and in the level of the Cytochrome-c-oxidase (CYT-c). From the time and time-frequency analysis of the NIRS signals we extracted 128 variables, which were used to characterize the metabolic brain pattern during the therapy. We showed that by using only 7 NIRS variables out of 128 it is possible to characterize the metabolic brain pattern of the two groups of subjects. The MS subjects showed a marked increase of the CYT-c activity and concentration about 40 minutes after the end of the autohemotherapy, possibly revealing a reduction of the chronic oxidative stress level typical of MS sufferers. From a technical point of view, this preliminary study showed that NIRS could be useful to show the effects of ozone autohemotherapy at cerebral level, in a long term monitoring. The clinical result of this study is the quantitative measurement of the CYT-c level changes in MS induced by ozone autohemotherapy.
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Strippoli D, Russo G, Simonetti V, Motolese A. Lyell syndrome due to ticlopidine. GIORN ITAL DERMAT V 2011; 146:497-500. [PMID: 22095182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The antiplatelets drug ticlopidine is widely used in patients suffering from cardiomyopathies, coronary cardiopathies and thromboembolic pathologies. The potential and frequently seen side effects are diarrhoea, hematological dyscrasias and rashes. We describe a case in which the use of ticlopidine in the treatment and prophylaxis of transit ischemic attacks triggered the unusual and rare complication of toxic epidermal necrolysis (TEN). We will then go on to analyse the clinical-pathological aspects and therapies through the use of i.v. immunoglobulins at high dosages that led to a full recovery of the patient.
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Affiliation(s)
- D Strippoli
- Department of Dermatology, Lecco Hospital, Lecco, Italy
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Simonetti V, Strippoli D, Pinciara B, Spreafico A, Motolese A. Ekbom syndrome: a disease between dermatology and psychiatry. GIORN ITAL DERMAT V 2008; 143:415-419. [PMID: 19169214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The Ekbom syndrome or parasitosis delirium represents a rare mono-symptomatic psychosis characterized by the delirious firm belief of the patient, against all evidence, of being infested by cutaneous parasites. The syndrome affects in particular middle-aged women, and can be the single manifestation of psychological uneasiness or represent one of the aspects of a more complex psychiatric case, compromising almost totally any normal daily work and/or social activity. The authors present a recently observed clinical case and discuss the clinical-diagnostic and therapeutic aspects.
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Affiliation(s)
- V Simonetti
- Operative Unit of Dermatology, 'A. Manzoni Hospital, Lecco, Italy
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Simonetti V, Manzini BM, Seidenari S. Patch testing with nickel sulfate: comparison between 2 nickel sulfate preparations and 2 different test sites on the back. Contact Dermatitis 1998; 39:187-91. [PMID: 9817224 DOI: 10.1111/j.1600-0536.1998.tb05891.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Among patients routinely undergoing patch testing for suspected allergic contact dermatitis (ACD), nickel is the most frequently sensitizing hapten, with a clear predominance in the female population. However, some patients who report the appearance of dermatitis upon exposure to metal objects show negative patch test results to a nickel sulfate 5% pet. application. In some cases, a positive response to nickel can be observed simply by repeating the patch test. The objective of our study was to assess if, during routine patch testing, positive responses to nickel sulfate are missed owing to contingent problems, referring to application site, patch test execution or variations in skin reactivity. To this end, we applied 2 different patch test materials containing nickel sulfate 5% pet. to 3040 consecutive patients, undergoing patch testing for suspected allergic contact dermatitis, during the same session. The rôle of the test site was also investigated by applying the preparation on 2 different sites of the back in 30 patients. Of the whole, 612 patients (20%) showed positive patch test responses. The 2 nickel materials were almost equivalent: 78% of nickel-sensitive patients had positive reactions to both, whereas 11% showed a positive response to 1 preparation alone. No variations in patch test responses in relation to application site were observed. Our data show that false-negative patch test responses to nickel are frequent. The use of 2 different preparations during the same patch test session increases the response rate by 10%.
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Affiliation(s)
- V Simonetti
- Department of Dermatology, University of Modena, Italy
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Abstract
Our study concerns contact sensitization in children, the frequency of which is still debated in the literature, even though specific reports are increasing. During a 7 year period (1988-1994) 670 patients, 6 months to 12 years of age, were patch tested with the European standard series, integrated with 24 haptens, at the same concentrations as for adults. We observed positive results in 42% of our patients. Thimerosal, nickel sulfate, Kathon CG, fragrance mix, neomycin, wool alcohols, and ammoniated mercury induced most of the positive responses. The highest sensitization rate was found in children from 0 to 3 years of age. Comments on main positive haptens are reported. Seventy-seven percent of our sensitized patients were atopics, suggesting that atopy represents a predisposing factor for contact hypersensitivity. Patch testing represents a useful diagnostic procedure for the definition of childhood eczematous dermatitis and for the identification of agents inducing contact sensitization which is frequently associated with atopic dermatitis.
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Affiliation(s)
- B M Manzini
- Department of Dermatology, University of Modena, Italy
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Kralovich KA, Morris DC, Dereczyk BE, Simonetti V, Williams M, Rivers EP, Karmy-Jones R. Hemodynamic effects of aortic occlusion during hemorrhagic shock and cardiac arrest. J Trauma 1997; 42:1023-8. [PMID: 9210535 DOI: 10.1097/00005373-199706000-00006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the hemodynamic consequences of aortic occlusion during controlled hemorrhagic arrest. METHODS Ten anesthetized, hemodynamically monitored swine were subjected to a 40 mL/kg hemorrhage over 10 minutes, followed by a 5-minute period of apnea. At this time (T15), they were randomized into an UP group (n = 5) in which the thoracic aorta was occluded or a DOWN group (n = 5) in which the aorta was not occluded. Simultaneously, volume resuscitation with shed blood plus 20 mL/kg of normal saline was performed over a 10-minute period. Cardiac massage was performed until return of spontaneous circulation (ROSC), which was defined as a sustained systolic blood pressure > 60 mm Hg. After 30 minutes of occlusion (T45), the aortic occlusion was released. Parameters measured include mixed venous and arterial blood gases, serum lactic acid levels, cardiac index, mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), coronary perfusion pressure (CoPP), and left ventricular stroke work index (LVSWI). Oxygen delivery index (DO2I) was measured using a pulmonary artery catheter, and oxygen consumption index (VO2I) was measured by direct calorimetry (Delta Trac metabolic monitor). RESULTS Four animals in each group achieved ROSC after 3.0 +/- 1.8 and 2.2 +/- 1.8 minutes in the occluded and nonoccluded groups, respectively. During cardiac compressions and volume resuscitation, the CoPP, MAP, and MPAP were greater in the UP group, although the differences did not achieve statistical significance. After volume resuscitation was complete and during the period of aortic occlusion (T25-T45), the UP group had significantly greater MAP (mm Hg), with a difference of 42.5 +/- 20.75 mm Hg at T25 and 44.7 +/- 19 mm Hg at T35 (p < 0.03). Despite no difference in DO2I, VO2I (mL/min/kg) was significantly lower in the UP group than in the DOWN group, 4.28 +/- 0.48 versus 8.33 +/- 0.85 at T25 (p = 0.0002) and 4.62 +/- 0.9 versus 7.09 +/- 0.72 at T35 (p = 0.0005). After release of aortic occlusion at T45, the UP group had significantly lower CoPP (mm Hg) than the DOWN group (20.5 +/- 17.3 versus 66.5 +/- 28.2 at T45, p = 0.03). LVSWI (g/kg) was also lower in the UP than in the DOWN group (18.6 +/- 8.28 versus 36.5 +/- 10.2 at T60 [p = 0.031 and 23.6 +/- 6.48 versus 48.8 +/- 15.3 at T240 [p = 0.021). After release of the occlusion, there were trends toward increased acidosis and lactic acid levels in the UP group. CONCLUSIONS Aortic occlusion in this controlled hemorrhagic arrest model does not result in improved salvage but is associated with impaired left ventricular function, systemic oxygen utilization, and coronary perfusion pressure in the postresuscitation period.
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Affiliation(s)
- K A Kralovich
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA
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Abstract
A 10 year review of all blunt cardiac injuries (N = 70) at a single trauma institution was conducted. The majority of patients were diagnosed on the basis of elevated myocardial band fraction of creatine kinase (CK-MB), ST/T wave changes or arrhythmias. The presence of CK-MB elevation was not predictive of arrhythmias, cardiac complications, inotrope requirement, or mortality. The presence of ECG abnormalities or arrhythmias was also not predictive of inotrope requirement or mortality. Cardia complications requiring treatment occurred in 26 per cent (N = 18) of patients. Patients requiring inotropes (N = 12, 17 per cent) had higher Injury Severity Scores (ISS), longer times from injury to emergency, and higher mortality rates, than those not requiring them. Patients who died (N = 10) had a higher ISS, lower Revised Trauma Score, and a more frequent need for inotropes. Only three deaths were directly attributable to the cardiac injury. Myocardial contusion is an injury often of little clinical importance. Patients present with injuries of little or no consequence, severe injuries where the diagnosis is readily apparent, or as a confounding variable in a multiply injured patient. Early use of transthoracic echocardiography is advocated.
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Abstract
One hundred sixteen patients with granuloma annulare and necrobiosis lipoidica were studied. The relationship of these two disorders with diabetes mellitus suggests that atypical granuloma annulare could be linked to necrobiosis lipoidica, toward which it progresses.
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Affiliation(s)
- M Binazzi
- Department of Dermatology and Venereology, University of Perugia School of Medicine, Italy
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Vasario U, Giordanengo F, Oliaro A, Simonetti V. [Primary malignant tumors of the small intestine. Statistical review]. MINERVA CHIR 1971; 26:653-66. [PMID: 4935867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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