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  • 1
    Electronic Resource
    Electronic Resource
    The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children (1998)
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 8 (1998), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Since 1984, laboratory tests have not been routinely required for healthy paediatric patients scheduled for one-day surgery in our Paediatric Surgery Department. We reviewed the medical charts of all children ASA physical status 1 and 2 who underwent a minor surgical procedure in the last 15 years. We excluded all former preterm infants of less than 60 weeks postconceptual age. The series under examination includes two groups of patients: group A includes 1884 children who underwent routine preoperative laboratory tests; group B includes 8772 children who had preoperative, selected laboratory tests performed only when the child's history and/or clinical examination revealed some abnormalities. The following data were collected: demographic data, ASA physical status classification, surgical procedure, anaesthetic technique, major and minor complications, length of hospital stay, the difference between the expected length of hospitalization and the actual length, number and reasons for cancellations of surgery. On the basis of our experience we believe that a thorough clinical assessment of the patient is more important than routine preoperative laboratory screening, which should be required only when justified by real clinical indications. Moreover, this practice eliminates unnecessary costs without compromising the safety and the quality of care.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.1998.00703.x
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  • 2
    Electronic Resource
    Electronic Resource
    Respiratory depression following administration of low dose buprenorphine as postoperative analgesic after fentanyl balanced anaesthesia (1996)
    Oxford BSL : Blackwell Science Ltd
    Pediatric anesthesia 6 (1996), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Opioids are among the most ancient and widely used drugs in anaesthesiology. The pharmacology of opioid analgesics and their receptors is a complex and not fully understood matter; even more complex are the interactions between different classes of opioids at both molecular and clinical levels. We want to report here a clinical observation to emphasize the importance of the theoretical basis of anaesthesiology. This paper contains a clinical observation of respiratory depression following the administration of buprenorphine as postoperative analgesic after balanced anaesthesia with fentanyl. The observed case is interpreted in the light of the pharmacokinetics and pharmacodynamics of the different classes of opioid drugs (agonists, agonists–antagonists, antagonists) and of the interactions with their respective receptors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.1996.d01-1.x
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  • 3
    Electronic Resource
    Electronic Resource
    Evidence of higher insulin resistance in NIDDM patients with ischaemic heart disease (1994)
    Springer
    Diabetologia 37 (1994), S. 597-603 
    Details
    ISSN: 1432-0428
    Keywords: Key words Hyperinsulinaemia, insulin resistance, insulin tolerance test, ischaemic heart disease, NIDDM.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Prospective studies have shown a relationship between hyperinsulinaemia, an indirect index of insulin resistance, and IHD in men with normal glucose tolerance. In NIDDM this association is less clear possibly due to the poor significance of insulin and C-peptide concentrations as an index of insulin resistance. Therefore, only a direct measurement of insulin sensitivity could clarify the possible relationship between insulin resistance and IHD in NIDDM. We have evaluated insulin sensitivity, by means of an ITT, and some risk factors for IHD in 72 men with NIDDM, 36 with and 36 without IHD, attending our out-patient Diabetic Clinic. The two groups were of similar age, duration of diabetes, glycaemic control and body composition. Subjects with IHD were more insulin resistant (KITT index 2.45±0.18 vs 3.12±0.13 % per min, in patients with and without IHD, respectively, p 〈0.004), had higher total (p =0.011) and LDL serum cholesterol levels (p =0.010) and greater prevalence of hypertension (p =0.001) compared to subjects without IHD. Using step-wise logistic regression analysis, insulin resistance (odds ratio 2.57, 95 % CI 1.87–3.28, p =0.008), hypertension (odds ratio 8.17, 95 % CI 6.86–9.48, p =0.002), total serum cholesterol levels (odds ratio 1.02, 95 % CI 1.005–1.035, p =0.015) and BMI (0.79, 95 % CI 0.67–0.97, p =0.049) were independently associated with IHD. After adjustment for age and duration of diabetes, only insulin sensitivity was directly related to the age of onset of IHD, independently from other clinical and metabolic parameters (p 〈0.015). In conclusion: in NIDDM, patients with IHD are more insulin resistant compared to subjects without IHD. Insulin resistance is associated with IHD, independently from other cardiovascular risk factors. A higher insulin resistance seems to be related to an earlier clinical onset of IHD. [Diabetologia (1994) 37: 597–603]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00403379
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  • 4
    Electronic Resource
    Electronic Resource
    Evidence of higher insulin resistance in NIDDM patients with ischaemic heart disease (1994)
    Springer
    Diabetologia 37 (1994), S. 597-603 
    Details
    ISSN: 1432-0428
    Keywords: Hyperinsulinaemia ; insulin resistance ; insulin tolerance test ; ischaemic heart disease ; NIDDM
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Prospective studies have shown a relationship between hyperinsulinaemia, an indirect index of insulin resistance, and IHD in men with normal glucose tolerance. In NIDDM this association is less clear possibly due to the poor significance of insulin and C-peptide concentrations as an index of insulin resistance. Therefore, only a direct measurement of insulin sensitivity could clarify the possible relationship between insulin resistance and IHD in NIDDM. We have evaluated insulin sensitivity, by means of an ITT, and some risk factors for IHD in 72 men with NIDDM, 36 with and 36 without IHD, attending our out-patient Diabetic Clinic. The two groups were of similar age, duration of diabetes, glycaemic control and body composition. Subjects with IHD were more insulin resistant (KITT index 2.45±0.18 vs 3.12±0.13% per min, in patients with and without IHD, respectively, p〈0.004), had higher total (p=0.011) and LDL serum cholesterol levels (p=0.010) and greater prevalence of hypertension (p=0.001) compared to subjects without IHD. Using step-wise logistic regression analysis, insulin resistance (odds ratio 2.57, 95% CI 1.87–3.28, p=0.008), hypertension (odds ratio 8.17, 95% CI 6.86–9.48, p=0.002), total serum cholesterol levels (odds ratio 1.02, 95% CI 1.005–1.035, p=0.015) and BMI (0.79, 95% CI 0.67–0.97, p=0.049) were independently associated with IHD. After adjustment for age and duration of diabetes, only insulin sensitivity was directly related to the age of onset of IHD, independently from other clinical and metabolic parameters (p〈0.015). In conclusion: in NIDDM, patients with IHD are more insulin resistant compared to subjects without IHD. Insulin resistance is associated with IHD, independently from other cardiovascular risk factors. A higher insulin resistance seems to be related to an earlier clinical onset of IHD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00403379
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  • 5
    Electronic Resource
    Electronic Resource
    Transcranial magnetic stimulation selectively impairs interhemispheric transfer of visuo-motor information in humans (1998)
    Springer
    Experimental brain research 118 (1998), S. 435-438 
    Details
    ISSN: 1432-1106
    Keywords: Key words Transcranial magnetic stimulation ; Interhemispheric transfer ; Simple reaction time ; Manual response ; Poffenberger paradigm ; Human
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We investigated the cerebral cortical route by which visual information reaches motor cortex when visual signals are used for manual responses. Subjects responded unimanually to photic stimuli delivered to the hemifield ipsilateral or contralateral to the moving hand. On some trials, trans-cranial magnetic stimulation (TMS) was applied unilaterally over the occiput, with the aim of stimulating extrastriate visual areas and thereby modifying transmission of visual input. In association with the side of a visual stimulus and a motor response, TMS could change inter- or intra-hemispheric transmission needed to convey visual information to motor areas. Reaction time differences following TMS suggested that TMS exerted an inhibitory effect only when visuo-motor information had to be transferred interhemispherically. This result reinforces evidence for an extrastriate pathway of interhemispheric transfer of visuomotor information.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002210050299
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  • 6
    Electronic Resource
    Electronic Resource
    Cardiovascular mortality in non-insulin-dependent diabetes mellitus. A controlled study among 683 diabetics and 683 age- and sex-matched normal subjects (2000)
    Springer
    European journal of epidemiology 16 (2000), S. 677-684 
    Details
    ISSN: 1573-7284
    Keywords: Cardiovascular mortality ; Diabetes ; Epidemiology ; Macroalbuminuria ; Microalbuminuria ; Relative risk
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although non-insulin-dependent diabetes mellitus (NIDDM) is considered a major cause of death, the role of some independent risk factors in diabetic patients is under debate. In fact the prognosis of NIDDM diabetes varies considerably in relation to the individual risk pattern, and the different studies are not directly comparable because of differences in size, age and geography of the samples, and type of statistical analysis. The aim of the study is to identify the independent predictors of mortality in a cohort of subjects with NIDDM, and to verify whether the relative risk (RR) of cardiovascular mortality is different in comparison to that of coeval non-diabetic subjects from a general population. The study includes 683 patients with NIDDM from the Northern Italian town of Pordenone, followed up for 6 years and age- and sex-matched to 683 non-diabetic subjects from a Northern Italian general population. When the two cohorts were compared, NIDDM turned out to be a strong risk factor for cardiovascular mortality (RR: 2.67). Age, coronary artery disease (RR: 1.78), arterial hypertension (RR: 1.39), macro- (RR: 2.97) and microalbuminuria (RR: 2.01) were independent predictors of cardiovascular mortality in the diabetics. In conclusion, survival of diabetic patients is worse than that of non-diabetic coeval subjects. Only few items are able to predict cardiovascular mortality in the diabetics, namely age, hypertension, CAD, macro- and microalbuminuria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007673123716
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  • 7
    Electronic Resource
    Electronic Resource
    Retinal oscillatory potential abnormalities in patients with chronic renal failure, before and after dialytic treatment (1992)
    Springer
    Documenta ophthalmologica 82 (1992), S. 257-265 
    Details
    ISSN: 1573-2622
    Keywords: Chronic renal failure ; Dialysis ; Oscillatory potentials ; Retinopathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Nineteen patients with chronic renal failure were studied, oscillatory potentials (OPs) being recorded shortly before and after dialytic treatment. Mean values of either onset latency (O1 latency) and duration of the complex (O1-N4 inter-peak latency) were found to be significantly longer in patients than in controls (p 〈 0.001). Most of the patients (12) showed a pathological prolongation of latency (〉2.5 SD). Amplitude changes also affected OPs, but earlier components were reduced to a lesser degree than the later ones, as shown by statistical analysis. Moreover, seven patients showed an almost complete loss of O3 and O4 peaks. Latency changes may be transiently reversed by dialysis, suggesting a functional impairment of the retinal response; the loss of later components is a more persistent abnormality probably related with a structural damage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00160773
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  • 8
    Electronic Resource
    Electronic Resource
    Dermatomal somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies (1996)
    Springer
    Neurological sciences 17 (1996), S. 193-199 
    Details
    ISSN: 1590-3478
    Keywords: Low back pain ; Dermatomal somatosensory evoked potentials ; Lumbosacral radiculopathy ; Disc herniation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario La sensibilità diagnostica dei Potenziali Evocati Sensitivi Dermatomerici (DSEP) è stata valutata in una casistica omogenea di 15 pazienti con lombosciatalgia da monoradicolopatia lombo-sacrale. Sono stati definiti i valori normativi da L3 a S1 e i parametri di anormalità. In 7 pazienti con pseudoradicular or referred leg pain, obiettività neurologica negativa e imaging indicativa di protrusione o ernia discale paramediana, i DSEP sono risultati normaliin 6 casi e modestamente alterati in 1 caso. In 8 pazienti con de-afferentation leg pain, segni clinici di danno radicolare e imaging indicativa di ernia intraforaminale i DSEP presentavano vari gradi di alterazione, in genere correlabili alla severità del quadro clinico. Il metodopuò pertanto essere utile nel differenziare il dolore dovuto alla stimolazione dei recettori delle strutture osteo-articolari o delle guaine radicolari in cui i DSEP risultano normali, dal dolore dovuto a danno radicolare diretto in cui i DSEP risultano alterati. Questa valutazione del danno anatomico fornisce ulteriori informazioni che possono meglio indirizzare il comportamento terapeutico.
    Notes: Abstract The diagnostic sensitivity of dermatomal somatosensory evoked potentials (DSEPs) was evaluated in a homogeneous group of fifteen patients with low back pain due to isolated lumbosacral radiculopathy. The normative values from L3 to S1 were defined, as were the parameters of abnormality. In seven patients with pseudoradicular or referred leg pain, a negative neurological examination and images indicative of protrusion or paramedian disc hernia, the DSEPs were normal in six cases and slightly altered in one. In eight patients with deafferentiation leg pain, clinical signs of root damage and images indicative of an intraforaminal hernia, the DSEPs showed varying degrees of alteration which could generally be correlated to the severity of the clinical picture. This method can therefore be useful in differentiating pain due to stimulation of the receptors of the osteoarticular structures or the root sheath, in which the DSEPs are normal, from pain due to direct root damage, in which the DSEPs are altered. This functional evaluation of anatomical damage provides further information which may help to achieve a better therapeutic approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01995683
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  • 9
    Electronic Resource
    Electronic Resource
    Binocular interaction in normal vision studied by pattern-reversal visual evoked potentials (PR-VEPS) (1997)
    Springer
    Neurological sciences 18 (1997), S. 81-86 
    Details
    ISSN: 1590-3478
    Keywords: VEPs ; Binocular vision ; Monocular vision ; Visual acuity ; Stereopsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario Abbiamo studiato i PEV-pattern da stimolo monoculare e binoculare in 14 soggetti con normale acuità visiva e stereopsi, utilizzando quadrati con diverse grandezze angolari di stimolo (15, 21, 38, 84 minuti d'arco). L'ampiezza ottenuta da stimolo binoculare à leggermente maggiore di quella ottenuta dall' “occhio migliore”; questo effetto è osservato usando quadrati piccoli e quasi esclusivamente per la N75-P100. Le latenze della N75 e della P100 sono più precoci in seguito a stimolo binoculare rispetto allo stimolo monoculare. L'anticipo della latenza media della N75 è significativamente maggiore di quello della P100 utilizzando quadrati di stimolo più grandi. La latenza media della N145 non si modifica in modo significativo da stimolo binoculare rispetto al monoculare. L'effetto di lieve sommazione e l'anticipo della latenza nel PEV binoculare non sono in accordo con l'ipotesi che segnali monoculari separati si sommino nella corteccia visiva per dare origine alla risposta. Le componenti precoci del PEV monoculare e binoculare si pensa siano di origine post-sinaptica, fuori dallo strato 4c dell'area 17, dove la maggior parte delle cellule riceve informazioni da entrambi gli occhi. L'incremento in ampiezza del PEV binoculare, che si evidenzia soprattutto utilizzando i quadrati più piccoli, si può correlare all'area retinica selezionata, alla sua rappresentazione corticale e all'orientamento del campo elettrico di superficie. L'anticipo della latenza da stimolo binoculare, più evidente utilizzando grandezze angolari elevate, può essere spiegato considerando le correlazioni esistenti tra frequenza spaziale fondamentale del pattern ed eccentricità retinica. L'allargamento del campo visivo nella visione binoculare può inoltre ridurre la latenza della risposta quando si usano quadrati più grandi adatti alla stimolazione periferica.
    Notes: Abstract Monocular and binocular visual evoked potentials (VEPs) in response to different check sizes (15-21-38-84 minutes of arc) were studied in 14 subjects with normal visual acuity and stereopsis. The binocular VEP amplitude is slightly higher than the VEP amplitude on stimulation of the “better eye” and significantly higher than the VEP amplitude on stimulation of the “worse eye”; this effect is observed using small checks and almost exclusively involves N75-P100. Both the N75 and P100 peaks occur earlier after binocular than monocular stimulation. The shortening of the N75 mean latency is significantly greater than that of the P100 mean latency when larger check sizes are used. The mean latency of the N145 potential is not significantly different in monocular and binocular stimulus conditions. The slight summation effect and latency shortening in the binocular VEPs are not consistent with the hypothesis that it is the sum of separate monocular signals originating from the visual cortex that gives rise to the response. The early components of both monocular and binocular VEPs are thought to be of post-synaptic origin (outside layer 4c of area 17), where the imputs become mixed so that most cells receive information from both eyes. The amplitude enhancement of binocular VEPs, which mainly occurs when using small checks, may be related to the increase in the total amount of cortical activity representing the macular region; this may account for binocular superiority in fine spatial resolution. The latency shortening in binocular conditions can be explained by considering that the critical determinant of the latency is the fundamental spatial frequency of the pattern. When coarse patterns are used, their effectiveness in parafoveal stimulation may affect the VEPs, with a significant contribution coming from the more peripheral retina. The enlargement of the visual field when the eyes see simultaneously may therefore further reduce the latency of the response when using the larger checks suitable for eccentric stimulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01999567
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  • 10
    Electronic Resource
    Electronic Resource
    Cortical output modulation after rapid repetitive movements (1994)
    Springer
    Neurological sciences 15 (1994), S. 489-494 
    Details
    ISSN: 1590-3478
    Keywords: transcranial magnetic stimulation ; motor cortex ; plasticity ; exercise ; human
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario Abbiamo valutato mediante Stimolazione Magnetica Transcranica eventuali modificazioni dell'eccitabilità della corteccia motoria dopo movimenti rapidi ripetitivi. Sono stati studiati 5 soggetti sani di età compresa tra i 23 e 30 anni valutando l'ampiezza del potenziale evocato motorio (PEM) a riposo e dopo movimento ripetitivo di abduzione-adduzione del pollice sostenuto per 1 minuto a frequenza massimale. Sono stati inoltre valutati l'onda M e l'onda F da stimolazione del nervo mediano al polso. In tutti i soggetti esaminati è stata riscontrata una chiara modificazione dell' ampiezza del PEM dopo esercizio con una riduzione media massimale del 50–60% rispetto le condizioni basali e recupero completo entro 35 minuti circa. La sequenza temporale di questo fenomeno aveva un andamento trifasico: (1) rapido decremento entro il 5° minuto, (II) depressione massimale della durata di 10 min circa, (III) lento ritorno ai valori basali. Non sono state invece riscontrate modificazioni dell'onda M e dell'onda F. I dati ottenuti dimostrano l'esistenza di una modulazione reversibile dell'eccitabilità del I neurone di moto dopo movimenti rapidi ripetitivi. È verosimile che tale modulazione si realizzi a livello della corteccia motoria e che abbia come substrato anatomo-funzionale l'attivazione di circuiti intracorticali inibitori.
    Notes: Abstract Transcranial magnetic stimulation was used to evaluate changes in motor cortex excitability after rapid repetitive movements in five healthy subjects aged 23–30 years, by considering the amplitude of motor evoked potentials (MEPs) at rest and after one minute of maximal frequency repetitive abduction-adduction movements of the thumb. In addition, M and F waves were evaluated by stimulating the median nerve at the wrist. All of the examined subjects showed a clear modification in post-exercise MEP amplitudes, with a mean maximal reduction of 50–60% in comparison with basal values and complete recovery after a period of about 35 minutes. The time course of this phenomenon showed a triphasic pattern: (I) a rapid decrease phase up to the fifth minute; (II) a maximal depression phase for a period of about ten minutes; (III) a slow return to basal values. No significant changes were observed in post-exercise M and F waves. These results show the existence of a reversible modulation of the excitability of the upper motor neuron after rapid repetitive movements. It is likely that this modulation takes place at the level of the motor cortex and that its anatomofunctional substrate is represented by the activation of inhibitory intracortical circuits.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02334610
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